20050361.pdfDATE
r
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS }
MAILING ADDRESS n /
2 "ZCJ �� yrli GLS
CITY ZIP TELEPHONE
N1�U�lil.c��l�'►�,tcL C.?f(�j�
NAME
XOIS
rte,.
.PERMIT EXPIRES ,1 0�
PERMIT i
NUMBER�� �� f
JOB jj SUIT - APT#
ADDRESS
PLAT NAME/SUBDIVISION NO, LOT N LID NO
LID FEE 5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP rESCPApprovod O
RW Permit Required - 0
Street Use Permit Required I,
EXISTING PROPOSED _ inspection Required 17
Sidewalk Required O
REQUIRED DEDICATION FT Underground O
Wovin required E3
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES O N013 z
w
REMARKS w
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE Z
C7
REVIEWED BY DATE
/ J FIRE REVIEWED BY DATE it I
CITY ZIP TELEPHONE
LL
VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
STATE LICENSE NUMBER EXPIRATION DATE"T CHECKED BY
REQ'D COMPLETED EXEMPT
.�.__. OYES �NO I
PROP R TAX ACC UNT PARCEL O. CA# 0 � � 4'1 ZONE SIGN AREA HEIGHT
eo.)�.�; /'] .WAIVER O ALLOWED. PROPOSED ALLOWED PROPOSED
U V
fj s�% %/f /� �j
LT L' V L•�L� taC STUDY Gr -X 1'C2 /VA NA
❑ NEW RESIDENTIAL ❑ PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR O
❑ COMMERCIAL COMPLIANCE OR NA . NA z
❑ ADDITION ❑ CHANGE OF USE Z
❑ MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATEIL
g
❑ REMODEL ❑ MULTIFAMILY ❑. SIGN REQ'D PROVIDED
REPAIR GRADING FENCE / �57/57/aI
NL
❑ ❑ CYOS ❑ ( X FT.) REMARKS
OTHER �� (•` l/1+L�3.� /CI'__�iL Z 3 �• Z� C.. Z.
DEMOLISH ❑ TANK ❑ .Tr
air I i C rou6A I S Zo Wa'w
❑GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ❑ ROCKERY ❑ FIREALARM
(TYPE OF USE, BUSINESS CTIVITY) EXPLAIN:. YH' S ! {l L3, �'� ��p.
TYPE OFI STRUCTION CE OCCUPANT
L� GROUP
NUMBER NUMBER OF t
OF DWELLING I SPECIAL INSPE TION CONSULTANT OCCUPANT
STORIES UNITS LOAD
DESCRIBE WORK TO BE DONE /� REQUIREb YES
L n , MARKS Q
' 4q La I* d w e f oxI"O A J GEOTjECHREPORT. ,,c �I m
BY: l�t��C{1� 1J
STRUC RAL DESIGN { otgs
1 BY: V�c `
r
. "u,.. _ VALUATION
7 Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit J� City Surcharge
PLAN CHECK NO: Plumbing Base Fee
.THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO Mechanical .
- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
� SEPARATE PERMISSION.
� Engr. Review
De w PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
a 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 Fire Review Plan Chk. Deposit
w IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
Q 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 Landscape Insp. Total Amt. Due
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT 1 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 apermit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Doputy: and Fees are paid, and
TION; AND IN DOING THE WORK 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, OFFICIALS SIGNATURE DATE
SIGNATUREWNER O AGENT): DATE SIGNED (425)
I / /Z ��2
e =_7 � /0 C 77 A 1 '0220 RELEASED BY {, TE
TENTIO EXT. 1333 / '
f.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE YELLOW - INS CT R
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC110• PINK -OWNER GOLD - ASSESSOR
10/04 PRESS HARD YOU ARE MAKING 4 COPIES
i
0
'_'I.
m
cM
M
�0
00
C
mM
Z
D Z.
r=
0mn�
Z
mm
0r
r Z rn-
0 m
16
D
Z
I
i Z
0
0
M
4
Dec 06 05 11:26p Brian Patneaudo 4257440973 p•2
FIELD REPORT
Field Report 1 Page. 1 of 1
Dale Prapect Name
Project No.
Associated Earth Sciences, Inc. 41NOV05 OlvieraPoolFill KE05887
® ® ® ® WeaM
location Clou r
i ® 16430 Olympic View Or Cloud 50's .
Municipality Bldg. Permit No.
911 Fifth Avenue, Suite 100 City of Edmonds
- Kirkland, Washington 98033 Engineer/Arc Meet
425-827-7701 FAX 827-5424
ClienVOwner
70: Pablo Olviera lira
`
23205 60 Ave W General Contractor/superintendent
Moneake Terrace
ATTN: Grading Contractor/Superintendent
- AS REQUESTED BY: z
O
THE FOLLOWING WAS NOTED: n
I on monitoring of backfill compaction. Upon my arrival, I observed
was on site for part time constructi!?�
the site had already been backfilled_
Pool Fill
aM
Upon my arrival, there were no contractors on site: I was informed that the west side of the house was m v
the fill area. I observed the fill area had a thin layer of sand; over a thin layer of 5/8 inch crushed rock, over the 0O n
sand backfill material. I did not observed the compaction processe
e
y ed an in lace density reading on the fill material with a result of 95% of the maximum dry Z
I perform p hr
density, according to ASTM D-1557% I was able to penetrate from ? to 3 inches on the fill area with a 1/2 inch c z t.
diameter probe rod. rD
O M
mn
mm:
O
n
m
��
mjj
t
Ii