20041061.pdfDATE RECEIVED&,/
PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/TT#
ADDRESS
OWNER NAME/NAME OF BUSINESS oaf
71'- r NAME/SUBD VISION NO LOT NO LID NO
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MAI ING ADDRESS
C ITY ZIP TELEPHONE
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NAM CB #
LILI
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CITY LEPHONE
nw CUA 1 �70-J�7 1)
STATE UCEN E NUMBER EXPIRATION DATE CHE
PROPERTY TAX ACCOUNT PARCEL NO-
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NEW
0 RESIDENMAL
ADDITION
1:1 COMMERCIAL
REMODEL
11 MULTIFAMILY
REPAIR
I _1 CYDS
�'(GRADI?
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
OYPE OF USE. BUSINESS C"CTIVITY) 9XPLAIN:
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS I
DESCRIBE WORK TO BE DONE
PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
F-1
SIGN
-EjFENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICA1 I 01:5—CLIL
AREAS
NUMBER
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HEAT SOURCE
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01— L� 70 "16' 01—
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED * THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
LU PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECrIYORINDIRECIIY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1 HIS PERMIT SHALL Nor BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIHEMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CIrYS 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 TIIE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION AND IN DOING TfIE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN V61LATION OF THE LABOR CODE OF THE STATE OF WASIIINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIG KTUR<.0WN.EjPOR AGENT) DATE SIGNED
LID FEE
PUBLIC RIGHT)8F
WAY
i OFFICIAL STREET MAP
I ESCP Approved
RW Permit Required
Street Use Permit Req'd
EXISTING
PROPOSED
inspection Required
REQUIRED DEDICATION--��
Sidewalk Required
Underground
Fr
wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
Y E Sh NO
REMARKS
OWNER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
I �314-th ki;;, ( ) i AA,0T;,-2\fi ir�, I � 42j:�: n
ENGINEERING REVIEWED BY
DATE
--in I 11,
FIRE REVIEWED BY DATE
VARIANCE OR CU
SHORELINE OR ADB#
!NSPECTION
--boN6
EO'D
POSTED
L
YES ONO
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOS ED
ALLOWED PROPOSED
EXP ,
LOT COVERAGP�'�
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJR SIDE REAR
H b C,2L, Li 5
1 C) N/A
&0
PARKING
LOT AR IEWED BY
D
REQ'D PROVIDED
2- --> - 2
I
RKS
TYPE
SPECIAL
OCCUPANTP
GROUP
OCCUPANT
LOAD
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REMARKS ' a
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REQ'D
QYjj14ir,oP WomdI7 7 -7
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FEE Description FEE
State Surcharge
City Surcharge_
ZL
Base Fee qz�
Plan Chk. Deposit A"'� /Y ()
Receipt # �q 71
Total Amt. Due
Receipt #
LD01 2S. f
APPLICATION APPROVAL
I his application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
A S SIGNATU7) DATE
771-0220'—'. /"xo
LfASED BY
DATE
ATTENTION E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/]RC110.
VALUATION 1
$ / �7� 315
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(4251
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
4
PINK - OWNER - GOLD - ASSESSOR
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Height Calculation Worksheet
Address: 1 0 Qj c, c3
Date: U� -
hispector(s): Ar 0 'N
1. Datum Point:
2. Datum Point Elevation: 9�-bo
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3. Average Grade:
4. Maximum Elevation Allowed: 2_03,S-L (averagb &ade) '6- '7—
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5. Reference Point Elevation Shot to House:
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2.9 -t
(datum elevation)+ jo,s,15 (grade to transit level line shot to house) =ILD_, -S
mm
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7. Actual Elevation: 2-1 A J.S (reference point elevation) + 2 4, 3 7 (measurements
from#6)=
Conclusion:
;LSO -141S (actual) is greatermFg@than 9-:3q,9 (allowed); therefore the house is/
is not over the heigbt requirement per ECDC 16.20-30 requirements
OWNER/CONTRAC"OR iF� RESPONSIBLE
-1 23730 so OUR
D
A 237�E
ALL EXPOSEd SURFACE-19-6;'Te
ro N 89'21'37" Ay i
6*. 101 ... ......
BE COVERED'WITHIN ?0. yc iq 1 7 1-
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RESIDENCEIL-1,,
MA&AA V-LA�'INSTALLED EROSIONi W 23732 80th COURT V. F
10,
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INSPECTION
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CALL 425-771-0220 EXT/10-326 -0
MA I thIAL
SDR 35
SCH 40
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SS—Er.8"SS
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CITY COP N
OWNER/CON TRACTOR
VIKING PROPERTIES, INC. W --E
P.O. BOX 1034
LYNNWOOD, WASHINGTON 98046
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Toll., 0
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4—
.32.57
SS
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JUL %6 2004
C Ut
PER IT C UNTER
SCALE : 1 "=20'
01 10' 20'
S
PHONE -. 425-670-2711 PLOT PLAN 08VEL SEP 2 u 2004
BENCH MARK FOR 0"41ENT Sk-F?1-i, ,
crr�, OF PDA,6 k1t.", Gila.
THE PROJECT BENCH MARK IS THE CONCRETE IVD,�
MONUMENT IN CASE LOCATED AT THE LOT 1, VIKING HEIGHTS'
CENTERLINE OF 238TH STREET S.W. AT
APPROXIMATELY THE MIDPOINT OF THE IN SE1/4, SECTION 31, T.27N., R * 4E., W. M.
PROPERTY. CITY OF EDMONDS
ELEVATION : 200.00 SNOHOMISH COUNTY, WASHINGTON
DATUM : ASSUMED
OTEI;
11157
�Nm% Lovell -Sauerland & Associates, Inc.
En&eers/Surveyors/Planners/Development Consultants
L�1111 0 e-mail: info@lsaengineering.com - web: Isaengineering.com
1%W 33rd Avenue T., Suite 200 - Lynnwood. TA 98036 - (425)775-1591 - (4Z5)672-7998 lax
DRLVV I E-� I DAn B. FUZ NO.
JTT JTT 3.6.03 Sic" 20' 1 4656-0-04
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FINAL PROJECT APPROVAL FORM.
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLWE SIGN
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ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
75-
PIXASHSIGN
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PROJECT K' I LJ G; /Y T_
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SITE ADDRESS 2 3 7 2 C,(2j2zK� 7-
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PERMIT #2-GgO 4 - le) C 6//
2 / _ADB# DATEfNSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED-T-4
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A field inspection was conducted to determine compliance with -approved plans. Final appioval
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
D Copy of CORRECTION NOTICE given to owncr/contractor by inpector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signaftire
1:teinp:b1dg:f6nTis:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
0
SETBACKS .....................
FOUNDATION:
—0
Footing ......................
Wall ..........................
05
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
M7
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
L4 2-1 - 0
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
L4
P97—
5�
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Sidesewer#
Amout Paid $ ReCelPt
XPIM
tWatebsuW-4
WaterMeUrSize
R 0
Amountrald
DaftPurcb,
ROW#
The Illiti,,11s MT,,jrc Milton Amountpald$
Thompsovi, a Wil,I)O1111"Y c0l'tract
jljSj)CCt0I* FOI* thc city. Datelssped
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