20050031.pdfCEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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/I V I I PERMIT EXPIRES
PERMIT
NUMBER
JOB SyITE/APTf1
ADDRESS
PLAT NAM EIS UB DIVISION NO.
LOT NO.
LID NO,
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved C3
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RW Permit Requited
Stroot Use Permit Required E3
EXISTING PROPOSED
inspection Requited
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SidoWalk Requited
Underground E3
REQUIRED DEDICATION FT
Mind required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE E5
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
STATE LICENSE NUMBER
EXPIRATION DATE-1
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SHORELINE OR ADB#
INSPECTION
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ALLOWED PROPOSED
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ADDITION
REMODEL
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RESIDENTIAL
COMMERCIAL
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MULTIFAMILY
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RETAINING WALL
ROCKERY
.PR ACTIVITY) EXPLAIN
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OF DWELLING
STORIES UNI
DESCRIBE WORK TO BE DONE
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PLUMBING / MECH
LOT COVERAGE
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REQUIRED SETBACKS (FT.)
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PROPQSP SETBACKS (FT.)
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COMPLIANCE OR
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( —.x FT.I)REMARKS
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FIRE ALARM
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SPECIAL INSPECTION
REQUIRED OYES
REMARKS
GEOTECH REPORT
BY:
STRUCTURALOI?N,
BY:
CONSULTANT
OCCUPANT
GROUP
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LOAD
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I Description FEE
Description
FEE
Plan Check State Surcharge
HEATSOURCE LOT SLOPEOO VESTED DATE City Surcharge 7
Building Permit
PLAN CHECK NO: t Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
i.- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
:_E DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Lu PERMIT APPLICATION: SEE ECDC 119.00.005(A)(5) Engr. Review
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATIO14 Endr. Inspection
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'APPLICANT, ON 13EHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR S
Fire Review
Plan Chk. Deposit
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 #
< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Landscapelnsp.
Total Amt. Due
x 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
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee
Receipt #
APPLICATION APPROVAL
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_
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Foes are paid, and
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION
receipt is acknowledged in space provided
IS SIGNATURE TC
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WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
(425)
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11 .17
SIGNArum�6`wlhl,�R R ' NIT 1
DATE SIGNED
771-0220
AT'fENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
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Legal Description:
PARCEL A:
ALL THAT PORTION OF TRACT 17, SKELTON'S LAKE McALLEER
5 ACRE TRACTS, ACCORDING TO THE PLAT THEREOF RECORDED
IN VOLUME 6 OF PLATS, PAGE 2 1, RECORDS OF SNOHOMISH
COUNTY, WAS HINGTON, DESCRIBED AS FOLLOWS:
BEGINNING AT A POINT 240.00 FEET SOUTH OF THE NORTHEAST
CORNER OF SAID TRACT 17; THENCE WESTERLY PARALLEL WITH
THE NORTH LINE OF SAID TRACT 17 TO THE WEST BOUNDARY.
THEREOF, THENCE SOUTH ALONG SAID BOUNDARY 103.28 FEET,
THENCE EAST* PARALLEL WITH SAID NORTH, LINE OF TRACT 17
TO A POINT ON THE EAST LINE OF SAID TRACT 17 WHICH IS
243.36 FEET SOUTH OF THE NORTHEAST CORNER THEREOF;
THENCE NORTHERLY 103.36 FEET TO THE POINT OF BEGINNING.
0.
PARCEL B:
ALL THAT PORTION OF TRACT 17, SKELTON'S LAKE McALLEER,
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5 ACRE TRACTS, ACCORDING TO THE PLAT THEREOF RECORDED
IN VOLUME 6 OF PLATS, PAGE 21, RECORDS OF SNOHOMISH;
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COUNTY, WASHINGTON, DESCRIBED AS FOLLOWS:
BEGINNING AT A POINT ON THE EAST LINE OF SAID TRACT 17
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WHICH IS 323.36 FEET SOUTH OF THE NORTHEAST CORNER. TH EREOF;
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THENCE SOUTH ALONG SAID LINE 20 FEET,
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THENCE WEST PARALLEL TO THE NORTH. LINE OF SAID TRACT TO*
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THE WEST LINE THEREOF;
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THENCE NORTH ALONG SAID WEST LINE 20 FEET,
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THENCE EAST TO. THE POINT OF BEGINNING.
BOTH SITUATE IN THE COUNTY OF SNOHOMISH, STATE OF WASHINGTON.
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HEIC71-IT CALCULATION
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AVERACvE 6RADE= 100-00'
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MAXIMUM 13UILDIN6 HEIrvHT= 125.00'
ACTUAL* E3UILDIN6'HEIC7HT= 113.33
LOT COVERAC515:
(PROP05ED)
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EX15TINC RE51DENCIE 2,20cl 5 GUARE FEET
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NEIN CAR PORT 462 5GUARE FEET
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TOTAL 2,6-71 5GUARE FEET (IcI.O%)
55% MAXIMUM
LOT GOVERA6E
-PERVIOUS AREA5.
(PROP05ED)
LOT 14,252 5GUAREFEET
EX15TINC7 RE51DENGE 2,20q 5GUARE FEET
NEV4 CAR PORT 552 56ZUARE FEET
(V41 OVERAHN&5)
-7 DRIVE 32-70 5GUARE FEET
EX15TINC
TOTAL (5,051 56?UARE FEET (43.0%)
VINAL PROJECT APPROVAL FORM.
To:_
DATE:
MEMO TO: PERMIT COORDINATOR) BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASESIGN
ENGINEERING, DIVISION DATE '311
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PLANNING DIVISION DATE
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PROJECT
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SITE ADDRESS— _2132- ? 7_124' C�& -
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PERMIT #2 ADB# DATE INSPECTED 7 405
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DESCRIPTION OF WORK TO BE INSP Cb
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A field. inspection was conducted to determine'compliance with -approved plans. Final approval
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denotes that there. are no obje tions from the above signed. Department to the
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PERFORMANCEBONDS and the granting of
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED.
Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRE.CTION NOTICE given to. owner/contractor by inpector.
2.
RE -INSPECTED OUTSTANDING ISSUES -GRANT FINAL.PROJECT APPROVAL
Date Signature
I temp:bldg: forms: ocaprvi. 3/.25/04