20041035.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
WNER NAMEINAME OF BUSINESS
komzj zni,
CL
MAILING ADDRESS
C�,
CITY ZIP TELrHONE
_�IiA I eje7j4a
1,� nnurrd 6. _0
NAME
ADDRESS
CITY ZIP
TELEPHONE
NAME
LA Pe\ az vem-v,
±�
4KteJICBL#
ADDRESS
1,61
CITY ZIP
TELEPHONE
cig
;l — ) --) y) —) *7 V�2,
4 60 /4-1
STATE LICENSE NUMBER EXPIRATION DATE
CmEeKED By
L.. 69 /Vz* Q N /I
_
PROPERTY TAX ACCOUNT PARCEL NO.
0 0 5'�7 (jo `7 0 0 a OR (o
Oa
ID NEW
PLUMBING / MECH
.712CRESIDENTIAL
ADDITION COMMERCIAL
El
COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY
SIGN
GRADING
REPAIR CYDS
FENCE
( X�m
OOTEMOLISH TANK
OTHER
oGARAGE Ei RETAINING WALL
CARPORT ROCKERY
FIRE SPRINKLER
El FIRE ALARM
CT
UYPE OF USE, BUSINESS OR A V EX
I
NUMBER NUMBER OF
CRITICAL
OF DWELLING
AREAS
STORIES UNITS
NUMBER
D,RIBE WORK Tl� BE DONE 6 R
/0 L-V\ *n\ 1171, r tClr 7::� F: lw� <,, kA 0 el
Lk 'Se lots 9 +-.+— —
5
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
W
IL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
W
�j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHAT EVER NArURE, ARISING DIRECTLY OR INDIREC RY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
2 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
1N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN-S,SP)ARkNSATION INSURANCE AND RCW 18,27.
DATE
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS Q Jj
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
I FSCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Requited
Street Use Permit Req'd
EXISTING — PROPOSED— inspection Required
Sidewalk Requited
REQUIRED DEDICATION— FT — underground
wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YES 0 NO 11
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLYDRAINAGE
0
Z
W.
W
z
z
5
z
ul
-�NGINEERING REVIK�IJNSpEL-MON REQUIRED DATE
0 OF DE13RIS
6q;p&jy;; -rr% nR r-I-EANED
FIRE REVIEWED BY uj
13 SEWER MUST BU CAPPd6EAT
0 S1
. DROPPwrY UNB
VARIANCE OR CU HORELINE OR ADBN I INSPECTIO FM QKNDD
MIMR"M 1B111R8W3ii1I` TE
0 W siraTA16LED
r ln!WITH AXW
SEPA REVIEW "llif n-- SIGN AREA HEIG
&*Lkf E pWME, 6"SED
COMPLETE EKb Qn] 1C UMI"
EXP
LOT COVERAGE bEl' S (FT.)
ALLOWED PWOCH 7CKLIM 40� OMREP�PWDEFIEAR
REQU IR9 z
Fof� INSPECTION z
I I z
PARKING LOTAREA I PLANNING REVIEWED BY DATE 5
a.
REO'D I PROVIDED
REMARKS
CHECKED BY
TYPE WMON
I
ICn7
OCCUPANT fit-7
GROUP
r=�z
I
I
SPECIAL INSPECTION
ul��UVMI r
REQUIRED [3 YES
rRN
LOAD
0
z
5
REMARKS
INSPEC71ONS PER UBC 108 IBC1 09 IRC1 09 FINAL INSPECTION REO'D
PROGRESS
VALUATION
$
Description
FEE
Description
FEE
Plan Check
. . .
.........
State Surcharge
Building Permit
2
City Surcharge_
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
3 VAL
APPLICATION APPROVAL
�n
�F-aes
CALL
db h
This application is not a permit until signed by the
Building Official or his/her Deputy: and are paid, and
FOR INSPECTION
recciol is acknowledged in space provided.
OFFICIAI[ SI,)AT RE
(425)
771-022 0
P
1, 1EASED AY
-Al"TENTION tyk I 1;jjj
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCLI-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
z
0
1
0
M
-1 -n
0 M
C 0
M 0
--1 0
0
M
M z
—z
W
0 71
n
M M
06
0 r-
0 rn
C cir)
9 Cn
M 0
Z
z
0)
z
0
1
0
ITI
,0"D U,C CONC W/
1 34:' BRASS CAP.
GG, ) 2* LS ISO? 7
Ilis% io CE W
P FOUND 1/2.* IRON
CITY OF EDMONDS SP NO. S-2004-64
C PE. 0 IS C SET REDAR & CAP
1 \7 O.iq- to ---/LS 305MI ITYR)
R.
OFF PROPERTY EASEMENT
FOUND UIC CONC
W1 1 3/4- BRASS
CAP. DOWN O's.
82nd KACE V
APPUCANT If OWNER
LEGEND
GARY HARMS
HARMS LAND DEVELOPEUENT
PROPOSED LOT LINES
3711 CALLOW Rol
— - - - - —
PROPOSED ACCESS AND
LAKC STEVENS. *A 90250
UTKJIY EASEMENT LINE
(206) 229-2593
------------
PROPOSED SETBACK LINE
OFISTE LOT LINES
OFTSITE ACCESS AND
UTUTY EASEMENT ME
ROAD CENTER LINE
4eZeZ4W-14'-
ROAD EDGE
ZONING
EXISTING ZONING
ns-a
0057SI-OcK, LOCATEDON SP NO. S-2004-63. SURVEY NOTES
am FAIMLY LMTD
INSTRUMENT USED: SOKKIA SET 5 EDU
mCM00 USCO; FIELD TRAVERSE
LIA It APPROXIMATE PONT ACCURACr.k Q05'
G it
CKRSI vANGUICAL SURVEY MEETS OR EXCEEDS STATE STANDARDS PER WAG
N 2*42'48* W q.41. LUINCRUI C"URCH 332-130-OM
-----------
r 7.5' 1, MONUMENTS SHOWN HEREON WERE VISITED ON �Y 31.
ACCESS & EIS L BSBLI AUGUST I & 2. 2000�.
VTLIMS
T r - - - I I ME INFORMATION SHOWN ON THIS MAP REPRESENTS THE
7.5 1 B5BL EASEMENT I I . RESULTS Or A SURVEY MADE ON NC INDICATED DATE
050L I — — — — i t = AND CAN ONLY TIC CONSIDERED AS ME GENERAL
I 1 6 CVSMG CGI,UITION AT THAT ME.
16 M r"
I LOT I NO CASEMENTS. RESTIMCTICNS OR RESCOVATION Or
To. 7 SF
.1 1.0 �t RECORD �CH WOULD BE DISCLOSED BY A TITLE REPORT
N 0 z 1 .703 CROSS ARC SHOWN.
19 4, 1 0513L
s
VERTICAL DATUM - HAVI) i9da PER USCGS BENCH MARX 0-407
BRASS DISC MOUNTED ON NORM FACIE Or BUDG,
oos� rNO. 3 '/2;423 HW. 99 ELEV. 107.95 FEET.
X, WALL AT 2
75- 1
I -
7.S
-----
I -----------------
7---
10.1c
----- ---
-
H02-39 20 " 2-4054
W DEED
ut 03
--------------
10' X WIDTH or LO I
URr
— JNW
DEDICATED TO THE 114W
-.1
NOTE: SETBACKS SHOWN ARE FOR
REFERENCE ONLY AND VEST
NO RIGHT.
SET I
CAP
S Or"'42' C (BASS (IF BEARING)
VA *��Ga a,
FOUND MIC CORC W/ F D Vic =cOHc W
1 3/4 . URASS CAP. 2 3/4- BRASS DIS9.
00" 0.5' DOWN OW
,PWOLI It 0`53?
1, 616 �
GRAPHIC SCALE
0 15 30 60
SCALE: I" - 30'
LOT AREAS
LOT I
TOTAL LOT AREA
IL067 sr (GROSS)
LESS EASEMENT
7.5411 Sr (NET)
AREA Of EASEMENT
505 So,
LOT 2
TOTAL LOT AREA
m000s SF (GROSS)
LESS EASEMENT
7,495 SF (NET)
AREA Of EASEMENT
1,371 SF
LOT 3
TOTAL Lot AREA
7.203 Sr (CROSS)
LESS EASEMENT
7.203 SF (NET)
,,VERTICAL DATUM: RAVI) 1958
wTBM VERTICAL DATUM - PER USCGS BENCH MARK 0-407. FND. 3 1/2' BRASS DISC
MOUNTED ON NORTH FACE OF OLDC, WALL AT 23423 HWY, 99
CLEV. 407.98 FEET.
(7 AN
�j
OtIL LIO a
kz:W
CONTOUR MrERVALS - 2 FEET I w
TAX ACCOUNT NO. I r
005767-000-026-02
LEGAL DESCRIPTION
A PORTION OF TRACT(S) 25. SKELTON'S LAKE MCALEER 5 ACRE TRACM
ACCORDING TO THC PLAT MEPEOF RECORDED IN VOLLNE 5 OF PLATS. PAGE(S) 21.
RECORDS Or SHCHEMISH COUNTY. WASHINGTON. DESEARIED AS FOLLOWS:
BECRORING AT THE NORTHEAST COMER OF SAID TRACT 26;
THENCE SOUTH 57155'57' WEST ALONG THE NORM LINE INERECIf FOR 79.9 FEET TO
ME NORTHWEST CORNER OF A TRACT or LAND CONVEYED TO LYLE C. EDWARDS AND
LUCLC EDWARM HIS WIFE. 13Y DEED RECORDED UNDER RECORDING NO(S). 1057354.
ME TRUE POINT OF DEGINNING OF THIS TRACT TO BE DESCRIBED'.
THENCE SOUTH 2*42'4a' EAST ALONG THE WEST BOUNDARY LINE Or SAID TRACT FOR
311.41 FEET TO ME SOUTHWEST CORNER Or THC EDWARDS PROPERTY.
THENCE SOUTH 87'55'21' WEST FOR MIT FEET TO THE SOUTHEAST CORNER OF A
TRACT Or LAND CONVEYED TO ANION T. PETERSON AND ELSIE 1. PETERSON. HIS WIM BY
DEED RECORDED UNDER RECORDING NO(S). 1014562;
THENCE NORM 2'40*54' WEST ALONG THE EAST BOUNDARY LINE OF THC PETERSON
PROPERTY FOR 3fl.44 FEET TO MC NORM LINE Or TRACT 24;
MENCE NORTH BM5'57' EAST ALONG THE NORTH LINE THEREOF rEIR 79.9 FEET TO
ME POWT OF BEGINNING; EXCEPT ROADS.
TOCEMER WIN EASEMENT LOCATED ON SP NO. S-2004-63.
SITUATE IN THE COLINTY OF SNOHOMISH. STATE OF WASHINCTOM
SURVEY IN THE:
SW 1/4 OF THE HE 1/4 OF SECTION 31. TOWNSRVP 27 NORTH. RANGE 4 EAST. W.M.
AORT SUBDIVISION
GARRET SHORT PLAT
FOR
GARY HARRIS
TIMERALD LAND IUIRVIIIYINIL INIL
"X 13864 M" CRIEM WA $41,414111 M (4114111 IMMI
CRAWN Dr.
BLE
CIIIICM IVI
BLE
or
DAIRIII
2
9/9/04
HAPRUJEW CIW9, WIT
a
[a
FINAL PROJECT Al . TROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: PI.FASr SIGN FIRE DEPARTMENT DATE
ENGINEERING DIVISION DATE
PLfASESIGN-
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT das veyx
SITE ADDRESS— 62-16 12,34
PERMIT# ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final approval.
denotes that there are no objections from the above signed Department to tile release of
PERFORMANCE BONDS and the granting of:
G NT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
1:1 Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenip:b1dg:fom1s:ocaprv1 3/25/04
z
0
i
0
M
--i -n
r
M
0
0
0
0 C
--i K
X M
M Z
0 ---1
C
o -n
n ;d
-4 >
:C 9
M M
0
0
0 M
C cf)
K.
M
Z
X
__4
r
z
C/)
z
0
i
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall .......
Slab Insulation ..........
!_ 14
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
I- . a_C�10
The Initials MT are Miltol,
Thol"Pson, a te'llporary colitract
illSI)Cctol- fol. tlC City.
z
0
4
0
M
-4 -n
M
C
M0
0
-10
0 C:
M
M z
_Z
Cn
o -n
n
:lf
M M
0 —0)
0 r-
0 M
C 0)
9 C/)
M 0
Z
z
z
0
i
0
11