20050429.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LIdENSE NUMBER EXPIRATION DATE CHECKED BY
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'ROPERTY TAX ACCOUNT PARCEL NO.
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NEW
FM RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
CYDS
El DEMOLISH
El TANK
GARAGE
c-i4,FIETAINING WALL
CARPORT
YWROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCIJIBE WORK TO
BE.DONE,
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PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
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OTHER
FIRE SPRINKLER
FIRE ALARM
AREAS
NUMBE
PERMITEXPIRES
USr PERMIT
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JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO LOT NO. LID NO.
LID FEE S
TESGP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP my permit noquired
Street use Permit Roq'd
EXISTING PROPOSED inspection Required
Sidewalk Required E3
REQUIRED DEDICATION Fr I underground
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
_�/ 4 A YES 13 No 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
W-�INAL UT-1
ENGINEERING REVIEWED BY
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FIRE REVIEWED BY
A.1
DATE W
VARIANCE OR CU
SHORELINE OR ADBN
INSPECTION
BOND
REO'D
POSTED
KS ONO
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
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LOT COVERAGE
REQUIRED SETBACKS (FTj
PROPOSED SETBACKS (Fr.)
aLOWED , PROP
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REQUIRECV, YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/iRC109 FINAL INSPECTION REO'D z
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VALUATION
$
Descripilon FEE Description FEE
Plan Check— A� State Surcharge
HEAT SOURCE GLAZING% LOT E
%
Will Building Permit z City Surcharge
PLAN CHECK�n__., VESTED DATE Plumbing Base Fee
ID Mechanical
THIS PERMIT AUTHORIZES ONLY THI WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading.
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:I .
SEPARATE PERMISSION..
Engr. Review
Lu PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review PlanChk.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 #
M ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt� Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT TH I E INFORMATION Recording Fee LReceipt # 7;;5'
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
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COM PEN SATIONI�SURANCE AND RCW 18.27.
0 - C�ALS SIGNATU"If DATE
'C'ALS
E DATE SIGNED 1(425)
771 -0220 t-EAMSED By f DAIrE
Atr&a10 E)ff 1333
IN CTURE UNTILA FINAL
ITISUNLAWFULT E ROCCUPYABUILDINGORSTRU
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
ORIGINAL-FILE - YELLOW. INSPFdTOR
PANCY HAS BEEN GRANTED. UBC109!IBC110/IRC110. PINK -OWNER - GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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�01 I a Uri JR—i603
I:nrth Sokitions NWLLC'
151 st Pl. N.E. Redmond, WA 98052
(425) 284-330 FAX (425) 284-2855
DAILY FIELD REPORT
Field Rep.
Project No.
Page of
V/
Report No.
Time On Site
Time Off Site
Date
Day of Week
Travel Time
Hrs. Charged
Project Name
MA bj�QVAIA
CoWl-
Job Location
37 cc:.-7 ve/,? 75
Client / Owner
�IOV17,�55
General Contractor
General Contractor's Superintendent
Received Onsite By
Grading Untractor
Grading Foreman
Checked By
Are approved Plans/Permits onsite F� YES F-1 NO Project No.
Permit No.
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RECE-IVED
JUN 3 0--2005
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
COPYTO:
CONTINUED ON NEXT. PAGE
Height Calculation Worksheet
Address: L�ff�
Pate:
Inspector(s): -7
1. Datum Point:
2. Datum Point Elevation:
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3.: Average Grade:. 4 3
.4.. Maximum Elevation Allowed: 1�3, a �Cavera& gia&): 2 5
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.5. Reference Point Elevation Shot to House:
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6,734datum elevatio + (P, use) <4
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6. Measurements from line shot onto house to i -dof ridge.*
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Totga )3 - S-7
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7. Actual Elevationlcl�),02 (reference point elevation), measuremen ts.
from #6)
Conclusion:
(actual) is I preate</ �essth`a�42�' (allowed therefore the house ii/
is not over th.e.height requir.emeuper�EdDC 16.20.30 requirements
FINAL PROJE C11 APPROVAL FORM
TO:
-
DATE:
MEMO TO: PERMIT COORDINATOI 1
Z, BU LDING DIVISION
FROM: —FIRE DEPARTMENT DATE
P 'ASH
IX IGN
fln .i ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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P -ASESIGN
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PROJECT
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SITE ADDRESS 21(v* �Pz S
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PERMIT ft 04 2- 9 ADBft- DATE INSPECTED
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DESCRWTION OF WORK TOBE INSPECTED <
65
A field inspection was conducted to.determine compliance with - approved plans. Final app�oval
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denotes that there - are no objections from the -above signed, Department to the release of
PEPWORMANCE BONDS and the granting of:
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A/ -GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL. WFI714, CONDITIONS NOTED:
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Copy of' CONDITIONS given to owner/contractor by. inspector.
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TAILED FINAL INSPECTION OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE given to owner/contractor bytinpector
2.
3.
RE -INSPECTED -OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL,
Date Signattire
1:tetnp:b1dg:forni-;:ocaprv1 3/25/04
Alf
DEPARriWgNT 60'4UILQJNGS
PERINTERNI&TI NAL RESIDENTIAL CUDE SECTION R110
loll PI SW —Building O�c!nit M 2005-0429
AT: 8530 —2
Occupancy established by this certificate: R3 Dwelling UnitiO.II
1 71,
Type of Constry!
No. Stories: 2 Basement: N/A ction: VB
rM "51 4,_
qg'
Owner of building: B-4nd I'
�Y
PI S
The Sinale Family Residence at 8530-210" W-9has bebtf-',J�' d"' d
#pddte6',an -approve complying with the requirements of the
division of occupancy and the use for which
2003 edition of the International Residential Code as adoptediby,,to'M-Y
Vifool,the group and
the proposed occupancy is classified.
Issued this 30th day of January . 2006
Chief Building Official.
By:
Any change of occupancy or use requires a building permit and a now Certificate of Occupancy Issued by the City of Edmonds Building Official.
Wig"
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION.
Footing .... ...........
vv\
—05
Wall ..........................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ...........
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PLUMBING:
qvt
C
Underground .............
1711,C)
0,
—10
Rough -In .................. 1.
0 C
Commercial Final ......
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HEATING:
C Z
Gas Test .....................
Gas Piping .................
0 -n
Equipment
711
.............
—4
Commercial Final .......
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0 Cn.
EXTERIOR SHEATHING.
vy)
S
0
0 m
NAILING .........................
FRAMING
C C/)
..........................
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FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
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Wall Insulation ............
Ceiling Insul ation .......
SHEETROCK NAILING
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...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
VIn
oLo
OCCUPANCY ..................
ObSewer#
Amout Paid $
Date Issue.-l—__
A
Water
Amount Pz!..*_��_-.
DatePum ;7P
7
The Initials MT are Milton
ROW# -.7
Thompsori, a temporary contract
Am ount Pal d U.cz. V�
hispector for the City.