20050048.pdfDATE RECEIVED
0 LPERMIT EXPIRES
USF'� PERMIT
09
CITY OF EDMONDS NUMBER Cy�
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
OWNER NAME/NAME OF BUSIN ADDRESS
C7 Ess 76 7 *27(o 1 5r(�vj
crl> I C�N I) PLAT NAM EISUBDIVI SION NO, LOT NO. LID NO.
%� Q� '7A
LM MAILING ADDRESS qL: TV LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Appr
oved
RW Permit Required C3
Street Use Permit Roq'd E3
CITY ZIP TELEPHONE EXISTING — PROPOSED inspection Required
REQUIRED DEDICATION� FT Sidewalk Required
1 Undo(gro(ind
I Wiring required
NAME NO. OF FIXTURES PRV REQUIRED
YES NO 13
METER SIZE LINE SIZE
AD —DRESS
REMARKS z
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE z
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CITY ZIP TELEPHONE
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IX ADDRESS jDATE
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STATE LICENSE NUMBER EXPIRATION DAT VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
P 13YES )KNO S
PL SEPA REVIEW SIGN AREA
PROPERTY TAX ACCOUNT PARCEL NO. PRO HEIGHT
COMPLETE EXEMPT ALLOWED POSED ALLOWED PROPOSE
75
4FtV EXP
[a NEW [Z RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBAPKS (Fr.) P OPOSUSETBAUS (Fr)
ALLOWED PROPOSE A �)Iwai�loor
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ADDITION COMMERCIAL COMPLIANCE OR 17, 1^10 r z
CHANGE OF USE 0 10
PARKING LOT AREA I P: NZNING REVIE D Y DATE
REMODEL MULTIFAMILY E] SIGN REO'D I PRYDED IL
R L EPAIR FENCE 040/0
_4&2 CYDS ( REMARKS
DEMOLISH TANK OTHER
ARAGE RETAINING WALL FIRE SPRINKLER
ARPORT ROCKERY FIRE ALARM
(TYPE OF USE, 13USINESS OR ACTIVIM EXPLAIN: monamovem� VIEW
NCKED BY TYPE -OF COECTION E OCCUPA
GROUP
NUMBER NUMBER OF CRITICAL L In I
OF DWELLING AREAS SPECIAL INSPECTION ARO-A
2— 1 OCCUPANT
0 STORIES I UNITS NUMBE REQUIRED [:] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D z
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VALUATION
Descr(ption FEE Description
Plan Check FEE
State Surcharge
HEAT SOURCE GLAZING % LOT4LPPE % Building Permit City S I urcharge
t1i - G_ - 1 -0 - - I o 1-3
PLAN CHECK NO: VESTED DATE Plumbing Base Fee 4:;�42::� —
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Mechanical
THIS PERMIT AUTHORIZES ONL4 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 Grading
SEPARATE PERMISSION.
Engr. Review k7
PERMIT APPUCATION: 180DAYS
IL PERMIT LIMIM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS On HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS 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 #
W ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
91 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 Landscapeinsp. Total Amt. Due
I
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROAS ON.
Recording Fee Receipt # 191�� -76
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 Foes are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COM50SA�ION INSURANCE AND RCW 18.27. V11
FI S SIJURE DATE
SIGNATURE 9121&E�� 'AGE DATE SIGNED I .
I __,0 / 1 (425) dl
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y1c.V7 � 'L� /2:? LA' 771-0220 ELDA Y DA
ATTE'NTION Off 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADEAND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED, UBC109/IBC110/IRC110. ORIGINAL - FILE YELLOW - INSP TOR
PINK - OWNER GOLD - ASSE SOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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Height Calculation Worksheet
Address: 16 -z-nl 1,9- 6 A
Date: 6 - 4, - a.5
IWector(s): Ovi AV,I
1. Datum Point: f5
2. Datum Point Elevation: I z4 a j
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3. Avera�ge Grade: -15�
rp
n Allowed:;5ij,2�(averagb.giade) 5'***
4. Maximum Elevatio 2
5. Reference Point Elevation Shot to House:
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5 L4,:5 (datum elevation) + L.,q S (grade to transit level Hue 'Shot to house) 616
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.6. Measurements from line shot onto house to roof ridge:
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.7. Actual Elevation: S W.'I q (reference point elevation) + 20.Aq (measurements
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conclusion:
53-7, LA (actual) is greater allowed); therefore the house b/
is. not over the height requirement per ECDC 16.20.30 requirements
RNAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
SIGN
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NGENEERING DIVISION DATE
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PLANNING DIVISION DATE
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PERMIT 200 _ADBff DATE INSPECTED , 3 Zta::::,�):
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A field inspection was conducted to -determine comp!iance.witli -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 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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El C opy of CONDITIONS given to. owner/contractor byinspector.
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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El Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE'4NSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
Lteinp.-b1dg:fonns:ocaprv1 3/25/04