20050256.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE NAMEINAME OF BUSINESS
MAILINGADDRESS
CITY ZIP I TELEPHONE
NAME
&YEE-
ADDRESS
CITY ZIP TELEPHONI
A
ADDRESS
I
.,,� /� d-
ZIP TELI:PHOVE
I'M in/ I Il-k( le,
STATE LICENSE NUMBER EXPIRATVION ME,
L
?H)LCKFU 5Y
PROPERTY TAX ACCOUNT PARCEL NO.
-DL
<740 C5 0
EReNEW
0"'ORESIDENTIAL
5,,PLUMBING I MECH
F ADDITION
11 COMMERCIAL,
COMPLIANCE OR
MMIXED USE
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
CYDS
FENCE
( — x —FT.)
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
PERMIT EXPIRES
PERMIT
NUMBER
JOB
ADDRESS
SUITE/APT#
NAMEISUBDIVISION NO,
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IESCP Approved
RW Permit Required
Street Use Permit Required
EXISTING PROPOSED
Inspection Required
Sidewalk RoquuN
REQUIRED DEDICATION FT
ound
"""g9fequired
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
it(
1?.7)
YESO N013
_214
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION
CONTROUDRAINAGE
M
V
REVIEWED BY
DATE
0
z
E
LU
LU
z
5
z
uj
Uj
x
U:
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
SEPA
>
I
REO'D ,
113YES
COMPLETED
I EXEMPT
I
I
MIN 01
V,
CAH
ZONE
SIGN AREA
HEIGHT
WAIVER 2f
I
ALLOWED PROPOSED
ALLOWED
PROPOSED
STUDY E3
IZS_
, WA
7-5- 1
2 5
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT
SIDE REAR
FRONT
URSIDE REAR
3 5_'%
`7.
7- 5-
-7.5 115
Z-9 I I-
4-?XL 15
PARKING
LOTAREA
PLANNING REVIEWED BY
DATE
z
15
REO'D PROVI DED
21
REMARKS
TYPE
NUMBER NUMBER OF W . I
OF _UDWELLING SPECIAL INSPECTION
UN REQUIRED 13 YES
F
STORIES
DESCRIBE WORK TO BE DONE
REMARKS
y t� LCI J /� f so
GEOTECH REPORT
BY:
STRUCTURAL DESIGN,.
BY: V,
7
VALUATION
14 q
Description
Plan Check
,��AT SOURCE
IL27 E%
/a are
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
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
'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
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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
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
FEE
2- t!
4001.�
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL
TION; AND IN DOING THE WORK AUTHORIZED IHEREBY, NO PERSON WILL BE EMPLOYE
IN VIOLA ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING T FOR INSPECTION
WORKME S COAEANSATION INS RA7 AND RCW 18:27.
SIG U1 Al 0 AGENTtx/ DATE SIANEd (425)
/ .. 1) 1_�' 1
711, � 7,27,
0�� - - /u , ./� zl� f [I _Uzzu
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 f IRC110.
OCCUPANT
GROUP
OCCUPANT
LOAD
Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Du e
1 Receipt # 1 /4 � �*52'7
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
VLS SIGNJAIE PATE
0 0jAK___., -J-11-11tr
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
I
ORIGINAL -FILE YELLOW .14PECT04
PINK -OWNER GOLD - ASSESSOR
0
z
z
0
A
0
M
--I -n
M
C
Mal
0
10
0 C:
X M
M Z
j) --i
C _z
3:
0)
0 _n
Till
M M
0
0
0 M
C (j)
90
M 0
Z
X
_11
3:
z
0)
z
0
1
0
M
Naf ED
W
ALL EXPOSED SURFACES To
517E F::'L- N 1. 1COVERED WITHIN 2 DAY '0
5CALE 1" 20'-0"
LAI Z,
M
Lu --A f�L Lu
F- 0 ACT 1 1 ATE R AD co
Zone (Zs-,? Comer Flag_
U-1 55'—o,, A
Cf.) Uf Setbacks 71: Actual
NX 0 "Ic
V Front U.
III= c At 64 CO3 (0 9 1
I n --3 A
n 11.1110 — .,
cwn R ; Sides —c( 7.5,
uj V ILITY EA5EMF—NT 2-
z 0 — — — — -- D
ILI, Rear
L—j-
w U)
ILTER F NCE Z co r,
4 Other
Lu
cc, � �;2
c\8
Rei0t
4 1
4 'N if �U, D
CL . 3 LE(57AL DESCRIFTION _r
is qt'';, �% - k
44, Z. r-, , , ., \ '0
1V u. LOT 1 I-P e
:P cith AVE 5. SHORT FLAT
Lu P
1— 4
4
Ju CITY OF EDMONI�)5 VqA JAN q 4
JTER
u
p PERMI f
I I 1 .1 -roe j I Z'.O
A/
<;
ONNER
0,
c%1 ea,;,;,� 0 A eciw PMA DEVELOPMENT SERVICES, L.L.C.
11400 55RD AVE. K SUITE 200
LrNNNOOD, NA qe)03(o
Lu tjA Q.G IQ C— Q
I P- -4,/ - (425)-7-75 FAX(425)( -72 U Lu
v —1511
'.&AZE50 Z
L-'j,
uj
—7
-50 . LOT GOVERA69E
z F- n F LOT AREA: F.
cor STRUCTURE:
2,015 S.F.
NAL<5 4 DRIVE: 1,455 S.F. 15.4%
R\/IoU5: 5,506 5.F. 5 (5.2 96'
5:20- P N M5220ABSU-0 TOTALIMPE
F.F. ELE\/..- 52 2 -5
Lu
0 RCH, (9, 017
0 1 -9 invoo
a
4
r
Fa,
4 Ir OPY
r" 71L ANW JOB NUMBER:
r AM,
ISE '��LEAFZING LIMIT5 (TYP.) 040'705j
Height Calculation Worksheet
Address: �Oc Q7
Date:
Inspector(s):
1. Datum Point:
2. Datum Point Elevation. (L
z
3. Averkge Grade: 0
M
4. -Maximum Elevation Allowed: iaverAgb giade):+'25
Reference Point Elevation Shot to House:
CO
a M
'5 G;t `i: 74datum elevation)+ 9. 1 (grade to transit level house)
line shot to
M
id
6. Measurements from, line shot onto house to kdofn ge:
M:
M z
Ot CI
z
CA
0 _n
i-7S
M M
0 M
C CO)
K V)
MO
z
z
Total
z
7; Actual Elevation: 3 ?1- "f"(Ireference point elevation) + (measurements
M
from #6)
Conclusion:
e 4
actual) is gre 0(allowed); th
ater kkis �tha erefore the house i.V
_16.20�0
is not over the height requiremen er 45-DC requirements
ENGINEERING INPSECTION
FEE RECONCILIATION
Z
Permit Fees Collected at Permit Issuance C
# of Inspections: x $50.00 $4,,�)o
Cn
0 -n
Receipt M Receipt Copy Attached: No
Only required if refund is due M
M M
0
0
0 M
C C/)
Total Inspections Performed 9 W
M 0
Z
# of Inspections:, X $50.00
X
M
Inspection Fees TO BE PAID
Contact notified of fees due: E] by phone El correction notice given
Date Paid:
R eceipt #:
:oticegiven]
Collected By:
F-1 Engineering Notified of Payment Received
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE___�
PLEASE SIGN
z
DIVISION DATE
—ENGINEERING
PLEASE SIGN
M
PLANNING DIVISION DATE
PLEASESIGN
PROJECT___fM_6_
M
C
MO
7t
0
0 C
SITE ADDRESS— 1
—1 r. I . .
PERMIT # ADB#* DATE INSPECTED
X M.
M Z
C Z
DESCRIPTION OF WORK TO BE INSPECTED-
4 vi
ed plans., Final approval
A field inspection was.conducted to determine compliance with approv ent to the release of
Departm
0."
denotes - that the re are no ob ections from the,. above signed
x 9
M M
PERFORMANCE BONDS and the granting of
0 Vi
0
0 M
C co
GRANT FINAL PROJECT APPROVAL
M 0
Z r-
;U
X
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given to owner/contractor by inspector
Cn
z
0
M
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:forms:ocaprv1 3/25/04
m