20050040.pdfDATE RECEIVED
PERMIT EXPIRES C
mom
SE PERMIT
CITY OF EDMONDS ZONE NUMBER nY�S � OWV40
JOB SUITE/ZT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BVSINESS
PLAT NAMEISUBDIVISION No. LOT NO. LID NO.
Jcolt� cr r, ocl 'I z , I LID FEE $
MA ILING ADDRESS �77 IESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
r (.,t) street use Permit Raq'd
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CITY ZIP TELEPHONE EXISTING _� PROPOSED Inspection Required
Sidewalk Required E3
REQUIRED DEDICATION '000� FT underground
91 V, 7 �1_1� 91 Waing required
NAME' METER SIZE LINE SIZE NO. OF FFURES PRV REQUIRED
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YES 13 NO 13 rc
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ADDAESIS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
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CITY. 11 ZIP TELEPHONE
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ADDRESS
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STATE
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NUMBER
ROP RTYTAX ACCOUNT PARCEL NO.
7701 OC600c0l M
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NEW
RESIDENTIAL
ES
El ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
CYDS
DEMOLISH
TANK
4
RETAININGWALL
PI�ARAGE
ARPORT
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ROCKERY —
(TYPE OF USE, BUSINESS OR AC 7�m_
NUMBER
NUMBER OF
OF
DWELLING
I
STORIES
UNITS
DESCRIBE WORK TO BE DONE
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71ON DATE VARIANCE OR CU 14 REZjD POSTED
OYES )QNO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED,
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EXP 4� 1- S -2.4 LM
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
1�r.PLUMBING CH ALLOWED PROPOSED FRONT SIDE REAR FRONT QRSIDE REAR
COMPLIANCE OR. a It 0 so 0 8 1
7012.15 12,S* 5 244 is:
CHANGE OF USE
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PARKING LOT AREA PLANNING REVIEWED BY DATE
El SIGN REQ'D I PROVIDED
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Ei OTHER
oFIRE SPRIINKLER
FIRE ALARM
FIRE REVIEWED BY
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AREAS SPECIAL INSPECTION JAREAL
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NUMBER REQUIRED t LOAD
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PROGRESS INSPECTIONS PER UBC 108/IBC109 IRC109 FINAL INSPECTION REO'D
All
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6�f $ 1 dp.
2=L Description FEE Description FEE
Plan Check State Surcharge
H T SOURCE
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GLAZING %
LOT SLOPE I (Y
to *
Building Permit
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City Surcharge
PLAN CHECK NO.0
VESTED rAtE
Plumbing
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Base Fee
Mechanical
C,410"72
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
rt DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
SEPARATE PERMISSION.
Engr. Review
ul PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT'l YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
00
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
Plan Chk. Deposit
gn 'APPLICANT. 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
Fire Inspection
Receipt #
Z52�-,
ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
SHALL NOT 13E
.
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT
Landsca peInsp.
Total Amt. Due
qipll.
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVIS ON
0 1
LReceipt
21
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Recording ee
#
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
AP
LI ION APPROVAL
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
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOaXLODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged in space provided.
WORKMEN'S COMPjg�)��SIAANCE AND RCW 18.27.
F I A E DATE
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SIGNATUR�
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.........
DATE SIG
ED
(425)
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X71_/771'1,
(1
771-0220
-RffASED B DAiE
ATtENTION
EXT 1333
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IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
, 'I
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
I
O4;G'/14A'L�FIL ELLOW - INS
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
. PINK - OWNE��` GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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Height Calculation Worksheet
Address': I'l, 5
Date:
iwector(s):
1. Datum Point: —L
2. Datum Point Elevation:
3. Average Grade:
Z.
.4. Maximum Elevation All owed: :5 �e, &,ade) 25`
(iveiitgb
M
5. Reference.Point Elevation Shot to House:
-n
3%&M(datum elevatio 3,45. (grade to* transit level line to house)
C M
M,
0
-40
0
.6. Measurements from line shot onto house to i-dof ridge:'
C:
M.
M Z..
-7
0
-n
ic:
MM
0).
01,
0 M:
C
mo�
Z
Total: .16
z
7 Actual Elevation: &f(5, 9 (reference point elevation) +14,7& ts
measuremen
z
-q
from #6)
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Conclusion:
(actual) is greater an (allowed); therefore the house b/
is not over the height requirement per ECDC 16.20.30 requirements
FINAL:PROJECT APPROVAL FORM