20041069.pdfDATE RECEIVED I I
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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,JER NAME/NAME BUS
oft olv. C., A V-1 (A Ile\
MAILING ADDRESS
2,336 75_11%,
ZIP TELEPHONE
o �,A5 412,S-- -79 1-10 7
NAME
ADDRESS
CITY
AD
CITY
ZIP
fk (A v\ t-� t/
STATE LICENSE NUMBER
TELEPHONE
PROPERTY TAX ACCOU�
PARCEL NO.
0
NEW
ZOOORESIDENTIAL
OrADDITION
COMMERCIAL
M REMODEL
MULTIFAMILY
El REPAIR
GRADING CYDS
E] DEMOLISH
TANK
'ARAGE
ZCCARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTAVITY) EXPLAIN
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
Vck5
5
101-4111121
CHECKED BY
wit:
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT,
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
CV
USE
ZONE
I
PERMIT EXPIRES
PERMIT
NUMBER
JOB
ADDRESS
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S�T T#
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
A �< E: 1, dro- (_ - t-� (; C- '�: �J,
LID FEE S
TESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
13
street use Permit Req*d
13
EXISTING PROPOSED
Inspection Required
E3
Sidewalk Required
E3
REQUIRED DEDICATION FT
Underground
Wiring required
MET.ER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
F
YES NO
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Fr
W
REMARKS
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OWNER/CONTRAC1OR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NEERING REVIEWED BY DATE
REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADBI I INSPECTION I BOND
AEqD POSTED
OYES f(NO s
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLO>D , PROP07 D
EXP I A- 15 ) I/
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FROW SP E REAR/ FRONT UR,,$IDE jlEAR
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C; UA 6'Vo a5 7 91 6o o 9 E
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PARKING LOT AREA PANNING, aEVIEWE BY DATE
REO'D I PROVIDZ
REMARKS..
7 TiAs 1/1
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CHECKED BY
ITYPE F COPIPTRUCTION
CODE
OCCUPANT
GROUP
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C.)
SPECIAL INSPECTION
JAREA
2
OCCUPANT
LOAD
REQUIRED [] YES
1
REMARKS a
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PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REQ'D I �
1 5M
-Ord 1011511n4 SbUl 4VJU1I?0f4 VALUATION
i - - - I — 7,6;q L
DeScAption FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % OT%OPE % Building Permit - City Surcharge
V� 0 vik I 7#41r , / "59 1
PLAN CHECK NO: ot� VESTED DATE Plumbing Base Fee -5,5
I Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr. Review
LU PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review PlanChk.Deposit
U)
!4 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
W ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY 67�
14
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF I HIS PERMIT SHALL NOT BE
9 DEEMED TO MODIF�� WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
x - Recording Fee Receipt #
1 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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged lit space provided.
WORKMEN'S C?,W�ENSATION INSURANCE AND RCW 18.27.
'A LS SIGN E ATE
SiHrG�' UR((,OWNE IOVN DATE SIGNE (425)
SED BY
771-0220 T
77
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
ORIGINAL - FILE - YELLOW - INSPEC16R
PANCY HAS BEEN GRANTED. UBC109/IBC110/lRC110. PINK - OWNER - GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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,PF -)'VI NOTEL,
LEON MARIA PALOMA Ei RAFFETY BRIAN
r-rU AVIC %A/ CrUAMWIC WA ORMA ALL UPUED SURFACES TO BY ENGINEERING
Tax Parcel No: 0048 880 040 0601
Height Calculations
[A 108'
B 108'
C 108'
D 108'
432' 4 108'
108'+ 15'
max. height 123'
Soil Classification
Sandy gravel (GW)
spi
5' min. rear
,sdtbkk for
-detached
outbuildings
Less than
600 sq. ft.
ING
WITHIN 2 DAYS
BE COVERED
T6 min. side 01�t
7 7(— �, zt:k-
BLE FOR
setback
EROSION
Ui AND DRAINALE
108,
-'Ap — — — — — , / — — — — — -PL- El. 100'.0"
17'-3" Datum point at
104'6" T base of
12'-7" 108, 0-- 9. 00
8.0. Q telephone pote.
Ail OF 0" 1 1 - - -T
7-- 7 r
G. Existing
I r o Existing driveway
s d Shed It
20'-0"
201-1331, L
108' 0** 1 0
lole(D
�oi
1 n
X108. 0-- - - - - - -
D 108' 0"
61-0
10
roof 20.1 12 cu
i overhang
Existing House
90'-0--
PL
PL
Ln
Existing I Existing porch
deck 48'-0"
20'-0"
8'-0"
13'-0"
Existing 105"-3"
I deck
b
E
901-0.1
—P,
108'
I e Corner- Af Flag_�L WSPECTIONS REQD Z
-XT. 11126
.7N C 1 pL;Hn C;Xs.
S!-Ibacks Reguired Actual
Front N
-7 Site Plan
Sides
157
SCALE 1" - 20,
Other JeT-cAd 4cceji. 4� &J .12Z
i FT 5 iq
L6l J( 1—t 4cce)3. 5-%,vcvc�
100*-0**
REcF-A'VED
P '!:" - - 4 2 0 0 4
PERMIT COUNTER
Height Calculation Worksheet
Address: 0, ' F. �5 Q
Date:
Inspector(s):
1. Datum Point:
2. Datum Point Elevation: 0
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3. Average Grade:
0
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4.. Max.imum Elevation Allowed: j&%,,_(averag6 giade):4:25,
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5. Reference Point Elevation Shot to House:
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0
0
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joc> (datum elevation)+ (grade to transit level fineshot to house)= 16f(.
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6. Measurements from line shot onto house to r6of ridge:
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0 -T1
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0
0
0 M
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Total:-- 4.
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0
0
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7. Actual Elevafion: to %,64 (reference point elevation) + (measurements
from #6)
Conclusion:
It,j, A I -- (actual) is greater/ less than r3 (allowed); therefore the house is/
is not over the height requireme—tift—per ECDC 16.20.30 requirements
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: —FIRE DEPARTMENT DATE
PL-WE SIGN
ENGINEERING DIVISION DATE9-/ 7 Iro-5
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LLASE S113P
P p .'.GN
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PLANNING DIVISION DATE
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rLmSE SIGN
PROJECT
SITE ADDRESS
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PERMIT #2 41-- Z Q 629) ADB# 'DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED A ck
A field inspection was conducted to determine final compliance with approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
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PERFORMANCE B_ONDS 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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u Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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a Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
ocaprv1.doc.1:tenip:b1dg:fonns 10/0 1
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
z
0
Slab Insulation ..........
0
PLUMBING:
M
Underground .............
Rough -in ...................
gQ
--ji
M
C:
Commercial Final ......
M 0
0
0
0
HEATING:
C
M
Gas Test ....................
M z
Gas Piping .................
C _Z
Equipment .................
Commercial Final .......
o -n
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EXTERIOR SHEATHING
M
NAILING ..........................
M
FRAMING ........................
0
0 M
C: (n
FIRST FLOOR FRAMING ...
9 Cn
M 0
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INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
-4
SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
0
4
0
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
The Initials MTare Milt011
Thompson, a temporary contract
illspector for the CitY.