20050286.pdfCITY OF* EDMONDS
CONSTRUCTION PERMIT APPLICATION
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[PERMIT EXPIRES - 01
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PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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RW Permit Rxred
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Street Use Permit Required
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EXISTING PROPOSED
inspection Required
Sidewalk Required
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REQUIRED DEDICATION --0'000� FT
underground
Wiring require
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION
CONTROLJDRAINAGE
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ENICINEERING REVIEWED BY DATE
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FIRE REVIEWED BY
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STATE LICENSE NUMBER I EXPIRATION PATE L; KED BY REO'D COMPLETED I E ZET
13YES 9W
71,
6L CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. WAIVEI`j;� ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
El NEW RESIDENTIAL PLUMBING ir MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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ADDITION COMMERCIAL COMPLIANCE OR 256- 10 71"r z
MIXED USE CHANGE OF USE 5
PARKING LOTAREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D PROVIDED
GB,�2DING FENCE -1, 1. 1�_ 119,00 Litill gLe-
REPAIR k_� 941 CYDS I X FT.) REMARKS
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DEMOLISH TANK E]
GARAGE RETAINING WALL FIRE SPRINKLER
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t- (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
TRUCTION CODE OCCUPANT
TYPE OF GROUP V
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OCCUPANT
NUMBER OF -TIL
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0 OF DWELLING SPECIAL INSPECTION
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0 SIORIES UNITS
REQUIREI
DESCRIBE WORK TO BE DONE REMARKS
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gem 6) r);F--� Description FEE Description FEE
Plan Check State Surcharge
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HEAT SOURCE LOT SLOP ESTED DATE
Building Permit a City Surcharge
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PLAN CHECK NO: Plumbing Base Fee
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ORK TO Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS :
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE,, Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS 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 # -2 f5"6
0: INDIRECTLY
4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR
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 Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* --T—Receipt
X1 — Recording Fee a(o�
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 This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy; and Fees are paid, and
TION; AND IN DOING THEWORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
OFF SIALS SIG14AT RE VATE -
SIGNAT E(OWNqR0 AGEV)/ DATE NED (425)
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1:21 10, zvor7 771-0220 ASED BY AT
ATTENTiON EXT 1.333 <� Liz
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL W
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ��_)OR�INAL -FILE \�ELLOW -INSPECfOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. PINK -OWNER - GOLD - ASSESSOR
110104 PRESS HARD - YOU ARE MAKING 4 COPIES
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NOTICE: I F THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT,
RECEIVED
ZONE: RS-12
LOT SIZE: 19,517 SQ FT (290 x 67.W) LEGAL FEB 1 2005
GRADING: LESS THAN 50 CU YDS. USED ON SrrE. SE 13 T 27 R 03 RT 81. BEG INT C/L 2ND AVE
PERMIT COUNTER
IMPERVIOUS: SINCE 1977 :432 SQ FT DECK & CP NEWPORT AVE AS PLATTED IN ORG. PAUL & CAROLE SHAW
312 $0 FT LIVING. PLAT OF N. EDMONDS TN S 38'34"OOW ALG C/L 1515 10THPLACE NORTH
744 SQ FT NEW. 2"DAVE 134 FT TO TPB. TN N 38'3,COOE EDMONDS WA 98020
8.17FT TN N 51'02"00W 29OFT THE S 38'34"00W
7756533
HEIGHT CALCULATIONS: 10-19FT TN SWLY ON A LN PL TO C./L OF 2ND AVE
DATUM: WATER METER 100.W 57 FT TO ESTS. FENCE LN AGREED BTWN PARTIES TAX No: 27031300 409600
A. 93.0' C. 98.0' TN SE LY ALG SD FENCE LN 290 FT TO C/L
8 98.6' D. 93.0' 21m AVE TN NELY 57 M/L TPB.
TOTAL 382.5'—.4 =95.61 + 251 =120.161 MAX
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PROPOSED RIDGE: 117.9' IV
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ADD GUTTERS /DOWNSPOUTS
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APPRUVED A
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Date:
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FINAL PROJECT APPROVALi FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: -FIRE DEPARTMENT DATE
PLEASE SIGN
DIVISION DATE,
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PLANNING DIVISION DATE
PLEASFSIGN
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PROJECT
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DESCRIPTION OF WORK TO BE INSPECTED In -ad
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A field inspection was conducted to determine compliance with approved plans. Final approval
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-above signed Dep art * ent to the release of
denotes that there are . no objections from the in
PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of !CONDITIONS given to owner/contra6ior.by.inspector.
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
Copy of CORREi CTION NOTICE given to owner/contractor byinipector
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RE4N`SPECTED ourSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
I:Ieiiii):.bidg:foriiis:ocal)rvI 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
Mona Po,)r-
SETBACKS .....................
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FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. f" 7-
Retaining Wall ...........
Slab insulation .......... 0-T
PLUMBING:
Underground .............
Rough -in ......... .........
Commercial Final ......
HEATING:
Gas Test .................... (YIT
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ...........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ........... MIT -
Ceiling Insulation .......
SHEETRO
CK NAILING ...
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR 71
OCCUPANCY ..................
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The Initials MT are Milton
Thompson, a temporary contract
Inspector for the City.
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