20050428.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWN
NAME/NAME QF B I
MAILING ADDRESS go
Q�
CITY ZIP TELEPHONE
7Z� L4 L< - -7 iiq,�
NAME
ADDRESS
CITY
NAME
ADDRESS
I
�C'
USE
ZONE
JOB
ADDRESS
S 7?1-,,,-""'71
PERMIT EXPIRE 14
PERMIT
NUMBER('
SUITEIAPT#
PLAT NAME/SU13DIVISION NO.
LOT NO
LID NO.
LID FEE S 10�
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I k:5CP Approved
RW Permil Required
Street Use Permit Roq'd E3
EXISTING PROPOSED
Inspection Required X_
Sidewalk Required C3
REQUIRED DEDICATION Fr
Underground
Winngfoquirod
METER
LINE SIZE
NO. OF FI URES
PRV REQUIRED
SZE
4'
YES NO 13 z
cc
ILL!
REMARKS
z
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE a
z
461.,l I r) %,r
Z`\ /1A
ZIP ITELEPHONE
CBL h
C
CITY ZIP TELEPH
"I M M �M —1 1 Lfj� — i q 2_4 �,L/
STATE LICtNSE NUMBER EXPIRATION DATE
CHECKED
W_m m6A :)� LA W_73Aq�
-4jx
PROPERTY TAX ACCOUNT PARCEL NO.
ul
co\oo olkn-c)(_
-A
NEW RESIDENTIAL PLUMBING / MECH
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL MULTIFAMILY SIGN
RE GR D 0 FENCE
PAIR CYDS E] ( X FT)
DEMOLISH Lj TANK OTHER
z
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
UYPE OF USE, BUSINESS OR ACTIVrM EXPLAIN:,
0
S IV 1�__
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
Cl
STORIES
UNITS
NUMBER
o
DESCRIBE WORK TO BE DONE
L1 tOA 1&6\60 -0
FIRE REVIEWED BY
DAT
DATE W
VARIANCE OR CU SHORELINE OR ADBI i INSPECTION I BOND
RE POSTED
OYES �81NIO is
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
EXP x L4 .2c-.'�f 2405(B
LOT COVERAGE JiEQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
,4LLJWED I- 'OPOSED . FRONT SIDE REAR FRONT LJR DE R _T
I I I I z
5 5' 2
7!
PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D PROVIDED ;�)l I Ci
LJOLI 5
(je,_
R��S _jq�_ I p� C
_7 1
V C4
CHECKED BY ITYPE OF FUCTION CO E�� UU1.01UVAPIL.
GROUP
17
SPECIALINSP CTION JAA�E� OCCUPANT
i kj���
REQUIRED R YES LOAD
REMARKS
[PROGRESS INSPECTIONS PER UBC 108/IBC109/ IRC109 FINAL INSPECTION REO'D
VALUATION
Description
FEE
Description
FEE
Plan Check
state Surcharge
dEAT 4QURC GLAZING % LOT SLOPE %
B uilding Permit
City Surcharge (
PLAN CHECK N VESTED DATE
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= ON PROPERTYONLY. ANY CONSTRUCTION ON THE PUBLIC
BE DONE PRIVATE
Grading
a DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
.j SEPARATE PERMISSION.
I=
Engr. Review
Lu PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUdCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EM PLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
Ic ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT
Landscapelnsp.
Total Amt. Due 5,5�v;
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.8
21
Recording Fee
Receipt N
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
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
Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
I S SIGNATU D,�TE
DATE SIGNED
(425)
"9/77 el
771-0220
R ED BY DATE/
ATTE aM�'
Off 13 33
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILARNAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
ORIGINAL - FILE YELLOW-INSPE40R
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
a
z
z
0
11
0
M
11 -n
M
C
rn
0
-10
0 C
M
M Z
10--I
C
4 3:
05
0 -n
3:9
M M
a 5
0 r
0 M
C Cn
9 Cn
M 0
Z
X
>
z
z
0
0
M
z
M
Ea 'h Solutions NWLLC
rt
2603 151 st Pl. N.E. Redmond, WA 98052
(425) 284-330 FAX(425) 284-2855
DAILY: FIELD REPORT
Field Rep.
Project No.
Page of
Report No.
V
Time On Site
ao,
Time Off Site
Date
Day of Week
Travel Time
Hrs. Charged
Project Name
IMADkW—A f0y—ZE
Job Location
Client Owner
General Contractor
R PA
General Contractoi's Superintendent
Received Onsite By
Grading Contractor
Grading Foreman
Checked By.
Are. approved Plans/Permits onsite [:]YES EJN0 Project No.
Permit.No.
AS 7,
e--,c Al>,- 64-42
c,,,25F/2Vr--/) Z& 81,E YZ-
Aep �Vcx/ eo."'V,5-
RECEIVED
JUN 3 0-�2ao
DEVELOPMENT
SERVICES CTR.
CITY OF EDMONDS
1COPYTO:
CONTINUED ON NEXT -PAGE E]
Height Caiculation Worksheet
Address:
Date:
lWector(s):___
-IP-e—HILEq At
1. Datum Point:
2. Datum Point Elevation:
Z'
0
3. Average Ch-Ae:4zz--7S
M
.4. Maxun= Elevation Allowed: qZZ-75�,-verage grade) + 25'�:�-75
C M
5. Reference Point Elevation Shot to House:
M
LHS, n)+4�1 10 (grade to transit level fine shot to house) =42-0
(datum elevatio
0.
C
M
M z:.
.6. Measurements from line shot onto house to k6of ridge:'
z
C5
UP
-n
+
M.M
6. SLI
0 M
C 0)
ic VY
M 0
Z
z
A
Total: 0 (C -Ci
CO
z
4zc),c,.q
M
7. Actual Elevation-O* (reference point elevation) + (measurements
from #6)=
Conclusion*
a 4R. 7 ya
ess tha therefor*e the house b/
441 �Mactual) is greater S n Ilowed)
�r� —16.2(-'
height requirement per 0.30 requirements
is not over - ,�C�D—C
D WT FWQRK'TO
ESC ibf4b ]�E�.
uided -det 1* lth:ap -d,plaus,' in fl:z:approval'-,�'-
was- prove
d ..ermine: comp tanceIw
-a C c:llo Itobjecfions�.� rom� te a*b6v'e': sigii'doDepar-t 't J6 I C,
I�6 ; , ,
u c luen i re ease, i
-B 'dth
-Rr an le, gra�n mg 0
.PE �ORMANCE� OND&� t'
t.4.
CT APPROVAL.
T, �A, ROJE'
"N 3Lj".P
GRA - INk
OTE
GkANTPROJECT.-APPROVA �VITR:,CONDHIONS-W 1)
- " f 'CONDITIO rafj or. yins
....... "NS. pectOu'.
F
FAILE b P 1 N' A'L-,: C T ION.'4-" 0 UT S T AN D ING j S UE S
ac orr:
C-60,�,bf CORRECTIOM.-NOTICE tv'hAd-bWher'Qohtr"'t i`b'
C4 IM
'Is J
yi
I
'AL
T.,
GISSUES"�- G9AN
.9,E14. $P 7,uTFD','
K EC
r J.
1)atc:
I Winn-
qMlS:Ocaf)fy
z
0
i
0
M
r
0
M
c
M
0
0
--l.g
M
M
M
Z
JC)
-i
cn
0
-n
n
x
>
M
M
0
C-1)
0
r_ .
0-M
cn
Cl)
M
C)
Z
r—
M
M
3:
z
_q
M
cn
z
0
M
0 0)
0
0 M
Total Inspections Perforni ed
M 0
Z
--i M
# of Inspections: X $50.00
e ct' 0 Fee's TO BE PAID
FInspection
ate Paid:
D ate. aid
. P . IOU
Receipt #:
Collected By:
Contact notified of fee's due F Rreorrection notice given
t by phone
c n'
VEngigj neering Notified of Payment Received