20050371.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINE S
MAILING ADDRESS
CITY Zip TELEPHONE
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NAME
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ADDRESS
ArX 55513
CITY ZIP TELEPHONE
AME CBLH
PERMIT EXPIRES
USE PERMIT
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NUMBER
JOB
ADDRESS
SUITE/APT#
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LOT NO.
LID NO,
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I ESCP OiFp�,O�od�
HW Permit Ro1U:,'1d1q,n
EXISTING PROPOSED
street use Palm
inspection Roquirod
Sidewalk Raquired [3
REQUIRED DEDICATION FT —
Undergrowd
Wiring roquirod
METER SIZE
LINE SIZE
URES
PRV REQUIRED
1
4"
YES13 NO 13
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REMARKS
OWN ER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
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ENGINEERING REVIEWED BY DATE
1E ADDRESS
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DATE ul
FIRE REVIEWED BY cc
CITY ZIP TELEPHONE ic
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VARIANCE OR CU SHORELTNE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE JCHECKED BY REO'D POSTED
F I OYES 'EkNo IS
-7T14 1 ?2 A I/ r SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
Lu . - _3 �x
CIO r7,1 7 —L666 EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
NEW E?"RESIDENTIAL LUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT . I SIDE REAR i [o
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COM EOR
COMMERCIAL ?X. ' 4')
PLIANC
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PARKING LOT AREA PLANNING REVIEWED BY DATI!
REMODEL El MULTIFAMILY RO
SIGN REO'D I P VIDED
FENCE A>
REPAIR XGR
CYDS X F-T) REMARKS
OTHER
DEMOLISH TANK
RETAININGWALL FIRE SPRINKLER
-ARPORT ROCKERY FIRE ALARM
-(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: MIN
CHECKED BY ITYPE OFJ!�%WCTION JPE�5 OCCUPAT
P
rx GROU
NUM13ER
NUMBER OF CRITICAL JAREA OCCUPANT
R'T'C L
OF DWELLING TAREAS SPECIAL INSPECTION
UM S LOAD
NUMBER erwo2k
0 STORIES UNITS lt4) REQUIRED [] y
ES
DESCRIBE WORK TO BE DONE 0
REMARKS z
PROGRESS INSPECTIONS PER II joa IBC109 IRC109 FINAL INSPECTION REO'D -9
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VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
GLAZING % LOT SLOPE %
HEAT SOURCE go
Building Permit City Surchar
ILC-'Sc. 17114A. U.
PLAN CHECK VESTED DAT Plumbing Base Fee 21
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
21 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS,. MARQUEES, ETC.) WILL REQUIRE Grading
3 SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
UJI
PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
PERMIT LIMIr 1 YEAR
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS 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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
I FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
!3 DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4
x Recording Fee Receipt # 1 IN
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
F IALS SIG ATURE D TE
I AT IRE (OWNER OR Vfi- DATE Sl tED (1425)
AV-_� �)115 0?
C) 771-0220 R APED B 11 TE
ATTE
01tION INAL EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAF
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW �INSPII 0/
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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Height Calculation Worksheet
Address: a
Date:
hispector(s): CC)
I Datum Point:
2. -Datum Point Elevation: L -6
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I. Average Grade:
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.4. Maximum Elevation AllowedA O�,-03 average grade) 25
S. Reference Point Elevation Shot to House:
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(datum elevation) + (grade to transit level line shot to house)
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6. Measurements from line shot onto house to i e:
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7. Actual Elevation: (reference point elevation) k ts
(measuremen
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(actual) is gireate less.tha ko (allowed); therefore the house W
is not over the height requireme r CDC 16.20.30 requirements
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO -TO: PERMIT COORDINAToR, BUITDING DIVISION
'NT DATP_�
FROM: FIR-E DEPARTME
PLEASE SIGN
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ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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KrASESIGN
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PROJ_ECT
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SITE ADDRESS 7-
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PERMIT ADB/t DATEINSPECTED.
DESCRIPTION.OF WORK TO BE INSPECTED y2c-f P- '14 LM 49
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A Field inspection was conducted to determine co -approved. plans. Final app�oval
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denotes that there are no objections from the above signed Department to the release of
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PERF ORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
El Copy of CONDITIONS given to owner/contractor by.ins.pector.,
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FAILED FINAL INSPECTION - OUTSTANDNG ISSUE S
0 Copy of COPMECTION NOTICE given to.owner/contractor by inpector
.2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED.
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SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ...... ...................
Pier/Porch .................
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Retaining Wall ............
Slab Insulation ..........
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1711
PLUMBING:
Underground .............
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Rough -In .................
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commercial Final ...... .
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HEATING:
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Gas Test ....................
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Gas Piping ..................
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Equipment .................
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Commercial Final .......
EXTERIOR SHEATHING,
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION ...................
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Floor Insulation ......... .
Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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SideSewer#.
Receipt
Amoutrwd$
DaftlWued-
WaWN[eterfte
Amount Pild............Recelpt
DatePorchwed
ROW#�
Tile Initial's NIT ar*e Milton
Thompson, a temporary contract
Amount Paid $wmr�ReCefpt 6.
Inspector 0.1
r tile, City.
Date Issued__-__E xPim