20050372.pdfDATE RECEIVED [;7ERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTY
ADDRESS
OWNER NAMEINAME OF BUSINESS
PLAT NAM E/SUBDIVI SION NO. LOT NO. LID NO,
W 4.
> LID FEE S
LOT90
MAILING ADDRESS (0
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPAppioved
RW Permit Requited
0 Street use Permit Required E3
CITY Z10 TELEPHONE EXISTING 1--' PROPOSED Inspection Required
Slaowa* Required
ION Underground
REQUIRED DEDICAT d
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NAME METER SIZE NE SIZE NO. OF FIXTURES PRV REQUIRED
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YES [3 NO13
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I- ADDRESS REMARKS UJI
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VARIANCE OR CU SHORELINE ORADB11 INSPECTION SEPA
STATE LICENSE NUMBER EXPIRATION DATE BY REQ'D 01 COMPLETED I EXEMPT 0
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) M
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COMMERCIAL COMPLIANCE OR -z
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REMODEL MULTIFAMILY SIGN RE,5'�o PROVIDED -4
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REPAIR % 117% CYDS X FT.) REMARKS 10 -4
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(tYPE OF USE, BUSINES P�CTIVITY) EXPLAIN: CCUPANT o -n
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Lu NUMBER NUMBER OF CONSULTAN OCCUPANT
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0 STORIES UNITS I I
REQUIRED LJ YES
DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
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VALUATION
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Description
FEE
Description
Plan Check
State Surcharge
SOURCE I 171T Q1 1`71PIZ01- %/F:CZTF:n nATF
Building Permit
City Surcharge
Plumbing
Base Fee
PLAN CHECK NO:
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERM - IT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
FEE
Grading
9 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION. Engr. Review
P ERMIT 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
U *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSO
) RS 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
x FROMTHE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
a NCE LandscapetInsp. Total Amt. Due
_1 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINA
01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY.TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
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 hisfher Deputy: 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 RC**V 18:27. S SIGNATU DAT
GNATI.17�09WNER OR AGENT): DATESIG ED/ 425)
17 "S 771-0220
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T T TI
ENTI 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- ORIGINAL - FILE - YELLOW - I`NSP6CT
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC`109 / IBC110 / IRC110. PINK -OWNER GOLD - ASSESSORT,
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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Height Cailculation Worksheiet
Address. 4A
Date: (0-6S
:hispector(s
I Datum Point: C
2. Datum Point Elevation: Lo - 0,3
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3.' Average Grade:
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All
.4, Maximum Elevation owed:4�01� avera&. giade) 25
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5. Reference Point Elevation Shot to House:
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bU.03 (datum elevation) + (grade to transit level fine'shot to house) -741-7 S
C
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6. Measurements from line shot onto house to roof ridge:
C
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(93
4CO
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MM
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Total:
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7. Actual Elevation474 74reference point elevation) + (measurements
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from #6)
Conclusion:
(actual) is g1reater s n49o,K (allowed); therefore the house is/
is not over the height requiremen ECDC 16.20.30 requirements
RNAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT cooRDINKrOR, BUILDING DIVISION
FIRE DEPARTMENT DATE
LE&SE. SIrN
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z_r4_NGfNEER1NG DIVISION DATE__/�05
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PLANNING DIVISION DATE
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PERMIT 90 2 0--) 1— _f ZZ ADBf1 DATEINSPECTED
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DESCRIPTION OF WORK TO BE INSPEC
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A field -inspection was conducted to�detcrmine compliance. with *approved plans., Final a &oval
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denotes that there are no objections from the above signed Department to the release of
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PERr, ORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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.0 Copy of CONDITIONS given to owner/contractor by inspector.
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
D Copy of CORRECTION NOTICE given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES -'GRANT FINAL PROJECT APPROVAL
bate Signature
1:tenip:b1dg:fomis:oc.aprv1 3/25/04.