20050162.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
01 ER NAMEINAME OF BU"SS
PE MIT
NUMBER
JOB
ADDRESS C
PERMIT EXPIRES
I PLAT NAM EISUB DIVISION NO, LOT NO. LID NO
C�\ 1;2
MAILING ADDRESS
Uj LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7ESCPAPProvea IN
30: P() RW Priand Required C3
CITY zip TELEPHONE street use Permit Required
EXISTING PROPOSED inspection Required
Sidewalk Required
0-2,C)l Lk:�_Is L�O 05L� REQUIRED DEDICATION FT underground
wama required
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NAME METER SIZE� LINE SIZE NO. OF FIXTUIRET PRV REQUIRED
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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I-IJI PROPERTY TAX ACCOUNT PARCEL NO.
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EXPIRATI(
7Z2
NEW RESIDENTIAL
ADDITION COMMERCIAL
MIXED USE
REMODEL MULTIFAMILY
1;=l
REPAIR CYDS
DEMOLISH TANK
GARAGE RETAINING WALL
CARPORT ROCKERY
019
JYM OF USE, BUSINESS OR AUWLT*KMIN:
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11R.-OP'LUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
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OTHER
FIRE SPRINKLER
FIRE ALARM
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FIRE REVIEWED BY DATE
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SIGN AREA
HEIGHT
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ALLOWED PROPOSED
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STUDY E3
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LOT COVERAGE
REQUIRED SET13ACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
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PLANNING REVIEWED BY DATE
REO'D PROVIDED
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FT.) § REMARKS
TYPE OF MUCTION
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NUM13ER
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STORIES
NUMBER OF
DWELLING
UNITS
SPECIAL INSPECTION
REQUIRED 13YES
____
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DESCRIBE WORK TO BE DONE IV&)
REMARKS
GEOTECH REPORT
BY:
STRUCJL��Ne
BY:
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VALUATION
$
Descriptio'n
Plan Check
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VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT., SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
2
0:
4
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
HE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
EEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT T14E 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-
TION; AND IN 0 THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATI ' OW90MF'THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
C SATION INSURANCE AND RCW 16:27.
WORK C S
CALL
FOR INSPECTION
/MEN'S
(425)
771-0220
SIG WN R 0 AGE
DATE SIZINED
14,
ATTENTION 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 if IBC110 / IRC110-
OCCUPANT
GROUP
OCCUPANT
LOAD
? C_
FEE Description FEE
State Surcharge 64:
City Surcharge
Z i, Base Fee
) j A
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
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APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
CIAXS SIGNATUR DATE
I t:Aqr;f) Y
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINC-*FILE - YELLOW - INSPECTOR
PINK -OWNER - GOLD - ASSESSOR
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Height Cal culation Worksheet
Address: SY V I- !S 2. Lj
Date: 44 105
Inspector(s): m 77=,.
1. Datum Point:
2. Datum Point Elevation: S 9
Z�
0
3. Average Grade: �3 9�-
Elevation AAowed::9j + 25
.4.. Max.h.num gi�ade):—
co
5. Reference Point Elevation Shot to Hous e:
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M q
*shot
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3 9,1,2 Z5 (datum elevation) + 1.9,5 (grade to transit level line to house) sj7 q15
M M
z
-6. Measurements from line shot onto house to i6of ridge:'
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F
CO
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rb 04
M 0::
Z r
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Total:
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7. Actual Elevation: 3YI-.f45 (reference point e vatiori) +20.4'1 ts
le measuremen
from #6) 11 9q4
Conclusion:
1-11164�i (actual) is grea ter /AesDth an 4j(r z (allowed); therefore the house b/
is not over the height requirement per ECDC 16.20.30 requirements
A
FINAL PROJECT APPROVAL FORM
I
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...................... TL
Wall ..........................
Pier/Porch .................
z
Retaining Wall ........... 01
Slab Insulation ..........
M
PLUMBING:
Underground ............. Cl)
CS
0 M
Rough -In ................... a O'�
M
0
Commercial Final ......
0 C
HEATING:. M
M z
Gas Test .................... jo
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Gas Piping .................
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Equipment .................
-n
6
Commercial Final .......
M M
EXTERIOR SHEATHING
NAILING ..........................
00)
0 M
C C/)
FRAMING ........................
C C/)
FIRST FLOOR FRAMING ... 1711 0
z
INSULATION ...................
L Floor Insulation .........
"s - 9L n z
Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ... S -cis z
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SPECIAL INSPECTION ... 0
M
C)!�
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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swese
wer#,.
-Receipt#.
Amout 1wd $
Amcuntpc!z�l
Dateftm
are Milton Row
The initials MT
Thollipson, a temporary contract AmountPa1d$.._ Receipt
inspector for the city.
D."tebsued