20050049.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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3ROPERTY TAX ACCOUNT PARCEL NO.
PERMIT EXPIRES
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PERMIT
NUMBER
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ADDRESS b'7a5
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SUITE/API #
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
tOWNER/CONTRACTOR
TESCP Approved
RW Permit Required
Street Use Permit Roq'd
inspection Required
Sidewalk Required
Underground
Wiring required
METER SIZE
LINE SIZE
NO. OF fIXTURES
P RV QUIRED
YEW NO 13
REMARKS
RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
15�NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
El REMODEL
1:1 MULTIFAMILY
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=NGINEERING REVIEWED BY ATE
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VARIANCE OR CU SHORELINE ORAD1111 I INSPECTION 1. BOND
REqD. POSTED
E]YES PqNO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWE�D I PROPOSED
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LOT COVERAGE VQIJIRED.SETBAPKS (Fr.) PRO OSWSETBA (FT.)
ALLOWED IV ?Re -')
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REMARKS
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GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED (3 YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108 IBC1 09 / IRC1 09 FINAL INSPECTION REO'D I �
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TU Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
N ( �t I / Building Permit City Surcharge
PLAN CHEC VESTED DATE Plumbing Base Fee
Mechanical 41//�
THIS PERMIT AUTHORIAS ONLfTHE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION: i80DAYS
W
916 PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection /71
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Fire Review Plan Chk. Deposit
'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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE Landscapelnsp. Total Amt. Due
,
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
x Recording Fee Receipt
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WIT11 CITY AND STATE LAWS REGULATING CONSTRUC_ CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED TIIEREBY. NO PERSON WILL BE EMPLOYED 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 in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW W.27. FI LS SIGN TURE DATE
ED
SIGN UR NER AGEN DATE (425)
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-0220 A D BY
4 771 R 'Y
ATTENTION Off 1333 q
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL —p.Xk , / / /,//
I NSPECTION HAS BEEN MADE AN D APPROVAL OR A CERTI FI CATE OF OCCU - ORIGINAL -FILE YELLOW - I(ISPECAR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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Other
Height Calculation Worksheet
Address: 1, L) 7 C)
Date: LA - 2.,x - O's
Inspector(s):
Datum Point:
2. Datum Point Elevati on:
3 Average Grade:
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.4. Maximum Elevation Allowed: Lt-s-A-6veragb giade) IS 9L.,4
5. Reference Point Elevation Shot to House:
CA
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o transit level line shot u
b (datum elevation) + (grade t to-ho, se)= i 7. Ur
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0
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.6. Measurements fiom line shot onto house to k6of ridge:'
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7. Actual Elevation: 5 11.1 (reference point el + I IAJ -(measurements
evation)
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Conclusion:
15,97,75A (actuaOisgireater/40han (allowed); therefor the house is/
e
is not over the height requirement per ECDC 16.20.30 requirements
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM. FIRE- DEPARTMENT DATE
PLEASE SIGN
/,,LW —ENGINEERING DIVISION D ATE CeZz
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PLANNING DIVISION DATE
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PLEASE SIGN
PROJECT
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SITE ADDRESS /Qz Q .22 (o
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PERMIT #,Z 0 (0 ADB# DATEINSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED—
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A field inspection was conducted to determine compliance with -approved plans., Final appieval
denotes that there are no ob . j ections from the abo ve 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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FAILED FINAL INSPECTION - OUTSTANDINP. ISSUES
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El Copy'of CORRECTION NOTICE given t6 owncr/contractor by inpector
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3.
RE -INSPECTED OUTSTANDING ISSUES - GRANTFINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fonns:ocaprv1 3/25/04
>03
R IONS
ECORD OF INSPECT
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ... ...................
Wall..........................
16 — 6-6
Pier/Porch .................
Retaining Wall ...........
Z
0
Slab Insulation ..........
PLUMBING:
Underground ..........
-n
Rough -In ...................
M
C
Commercial Final ......
M
0
0 0
C
HEATING:
M
Gas Tbst ....................
ITIZ
C
Gas Pip ing .................
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Equipment .................
MT
L1 _12_
Commercial Final
0 -n
-n
EXTERIOR SHEATHING
-MIS
1711 M
NAILING ..........................
M *r
6:5
CO)
FRAMING .... ....................
0 r-
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FIRST FLOOR FRAMING ...
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INSULATION ...................
M 0
Z
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Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING ...
MT
CD
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SPECIAL IN SPECTION ...
0
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0.
RE
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
SideSewer#
A ut Paid $ Receipts-
mo
D elssued 4 Ole 61�
ati
WaterMeterSize
AmmintPaid
DatePurchaSed
The Initials MT are Milton.
ROW#
ThorliPson, a tenvorary contract
Amount Paid
inspector for the City.
Datelssued —Expires