20050319.pdfDATE RECEIVED -7
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER Nr
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MAILING ADDRESS
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NAMEg
ADDRESS
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ADDRESS
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ST E LICENSE NUMBER
414f
TAX ACCOUNT PARCEL NO.
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13 REPAIR
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PERMIT EXPIRES
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PERMIT
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NUMBER
JOB
ADDRESS 'A'
-7
SUITEIAPTH
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UBDIVISION NO,
LOT NO,
LID NO,
S
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Potoid Required
EXISTING PROPOSED--
street use Pernrit Required
inspection Requited
REQUIRED DEDICATION
FT
Sidowalk Required
undeirgiround
Wainq requited
M.QER SIZE
LIN5 SIZE
N�F FIXTURES
PRV REQUIRED
_.$
1 / k
YES13 NO[3
REMARKS
OWNER]CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINA
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CYOS
TANK
RETAINING WALL
ROCKERY
OR ACTIVITY) EXPLAIN
D 9Y
REVIEWED BY
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DATE
DATE
VARIANCE OR CU OR AD13# INSPECTION I . SEPA
REQZ/ I COMPLETED T
YES ^W1 I x
CAU ZONE SIGN AREA HEIGHT
Al LOWED PROPOSED
WAIVER;I
V VA v l-
Y 13
31
STUDY
S T U
RPLUMBING MECH
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
L/R SIDE REAR
ALLOWE PROPOSED
FRONT
SIDE REAR
FRONT
COMPLIANCE OR
tRE
7
—7 -5 .1� lit
CHANGE OF USE
AR KING
P A
REa'D PROVIDED
LOTAREA
PLANNING REVIEWED BY DATE t
SIGN
110,
cc
FENCE
-4
X FT.)
ARK
m S
NUMBER OF
DWELLING
UNITS
F__
ef t-� 0
OTHER
FIRE SPRINKLER
FIREALARM
SPECIA L INSPECTION
REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY:
sTRUCTURAI DESIGN
BY
VALUATION
Description
Plan Check
LOT S�21�
VESTED DATE
Building Permit
PbAWCHECK 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
'A'PPLICANT, 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
4
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
rI 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC :) CALL
T I ANI E
ION; AND IN DOING THE WORK AUTHORIZED THEREBY� NO PERSON WILL BE EMPLOY 0
INVIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S QtMENSATION INSURANCE AND RCW 18:27.
S Ej -iGiNTT DATE SIGNED
SIGONIR (425)
GROUP
TANT
OCCUPANT
LOAD
FEE
Description
FEE
State Surcharge
City Surcharge
Base Fee
F-1
Plan Chk. Deposit
Receipt #
Total Amt. Due --e 5Y
It Receipt #
APPLICATION AP 311bVAL
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.
LS SIGNIRE , PATE
P a 11 10%111C;Qelle�
f -1 -Uzzu
f RI(INSED BY
ATTENTION EXT. 1333 �eo
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
___UOF
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 if IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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FILI YELLOW - INSPECTOR
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FMA DEVELOPMENT SERVICES, L.L.C.
DRIVEHAY IcI400 35RD AVE. K SUITE 200
P LrNNNOaD, NA q5056 U Lu
--7 (423)"775-1511 FAX(425)&-72--7cIq5
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LOT r,0VERArE
LOT AREA:
STRUCTURE:
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5,012 S.F.
NALKS 6 DRIVE: 1,055 5 * F. 10. q %0
N M275OE35F-.2(o TOTAL IMPERVIOUS: 4,04-7 S.F. 42.b%
F.F. ELEV.: IM
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Height Calculation Worksheet
Address:
Date: co"v3--c's-
hispector(s):
oint:
1. Datum P UL"d4o"�
2. Datum Point Elevation:
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3. Averige Grade: U -
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.4. Maximum Elevation AlloweJQL,, I (iverii -ade):+ 25
5. Reference Point Elevation Shot to House:
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(datum elevatio )+f4
LLI-4grade to transit level Hue
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.6. Measurements from.line shot onto house to k6of ridge:
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7. Actual Elevation: (reference point elevation) + (measurements,
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from #6)
Conclusion:
-7 Le Wtu 21) is greater L�'(allowed); therefore the house b/
ffess than)
is not over the height requirew"entprr-faic 1610.30 requirements
Inspection Fees TO BE PAID
Contact notified.of fees due: El by phon F—I correction notice given
.Date Paid:
Receip
Collected By:
Engineering Notiri
���Payment Received
00
'REFUND Due:
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Reconciled By: Date
Original to: Permit File Copy to: Engineering Admin (refunds only)
Revised 3/2/06
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FINAL PROJECT'APPROVAL FORM
TO:
DATE.
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
P AS I
ENGINEERING DIVISION DATE
PLEASESIGN
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PLANNING DIVISION DATE
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PLEASESIGN
PROJECT
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PERMIT # C� S-) ADB# DATE INSPECTED
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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 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 PROHCT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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0 Copy of CORRECTION NOTICE given to owner/contractor by inpector
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2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fornis:obaprv1 3/25/04,
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .... I .................
Wall .....
.....................
Pier/Porch ................. z
0
Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
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Underground ............. M
C
MO
0
Rough -In ...................
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Commercial Final ......
M
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HEATING:
Gas Test ... .................
19 — el —
Gas Piping ................. �4v
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Equipment .................
Commercial Final .......
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0
EXTERIOR SHEATHING 0 (n
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NAILING ............ I ............. 0
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C 0)
FRAMING ......................... C CO)
Q 0
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FIRST FLOOR FRAMING...
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INSULATION ...................
\�Roor!
Insulation ......... z
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Wal&sulation ...........
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Ceiling Insulation ....... z
10 0
SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...................
SideSewer#,
Amout Paid $ rccc.pt
WaterMetersi-,%- 14
AmountPaId
'ins
DatePurdhas
holl
ROW# Tile lilitiais MT are Mi
P. C - 1 - t f." Tilollipsoil, a temporary contract
Amount Pc!d illspector for the CitY.
Date I="
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