20050586.pdfFOATE �RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT EXPIRES
PERMIT
NUMBER 4/�
JOB
ADDRESS SUITE/APTst
PLAT+i;�14; LOT NO. LID NO
gl I s— LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved
RW Permit Required
EXISTING ---f'PROPOSED Street Use Permit Required 13.
Inspection Required
Sidewalk Required
.REQUIRED DEDICATION FT undergiound
Mine required
METER f SIZEI LINE SIZE NO. DAFIXTURES PRV REQUIRED
C,) YES13 No CI 'z
REMARKS LU
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
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QV;6Iie&_4) 1A)"�V61--rIANIC 0 147N T117ACt.-IA I W
ENGINEERING REVIEWED BY DATE
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CITY ZIP TELEPHONE FIRE REVIEWED BY DATE
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STATEILICENSE NUMBER EXPIRATION DATE Y VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REQ'D COMPLETED I EXEMPT
kill .:a L_1A uk I C? W 113YES 0 NO1. 'K
PROPERTY TAX ACCOUNT PARCEL NO. 02,@19-41 Z2 PE SIGN AREA IGHT
WAIVER [3 HE
0� -00 -1 (30 0 0 , *1 P ALLOWED PROPOSED ALLOWED PROPOSED
STUDY
+1
NEW RESIDENTIAL LOT COVERAGE REQU
PLUMBING MECH ]RED SETBACKS (FT. PROPOSED SETBACKS (FT.)
ADDITION COMMERCIAL ALLOWED PROPOSED FRONT SIDE REAR. FRONT URSIDE REAR
COMPLIANCE OR to stycei- 15 91 C—AAjjqt I
CHANGE OF USE 102� n rIvi 5 so/
E] MIXED USE /- I W I I y' I Yla I -
REMODEL PARKING I LOTAREA,,l PLANNING REVIEWED BY DATE
1:1 MULTIFAMILY SIGN REQ'D PROVIDED
REPAIR Pq GELADING _f FENCE 1.- 1 -2�' '55L�r CX1UA,,PU D -1-/ (3 (o
02- LIT CYDS 0 ( — X — FT.) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL oiveoy-C4 5e, OmDW5 -6(a -z'z'
FIRE SPRINKLER
CARPe" ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: Pe"r -rVi Y17 LA 61 V1 a VtY� 9 Cv-1 0 K—)
TYPE \F 110
��TRUCTION JOCCUPANT
GROUP
NUMBER NUMBER OF
OF DWELLING SPECIAL INSP TION CONSU TANT OC6UPANT
STORIES LINITS 1 - f) LOAD
REQUIRED YES
DESCRIB5 WORK TO BE DONE . I I ' I `Iil�
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GEOTVPP
BY: ji PE� L toOl 9"
STRLM!�q� NW AS
BY
Q VALUATION
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Description FEE Description FEE
HEAT SOURCE LOTSLOPE I % VESTED DATE Plan Check State Surcharge Sri
Co A s I Building Permit City Surcharge
PLAN CHECK NO:
Plumbing ez �)"z Base Fee
THIS PERMIT IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
ui
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection n
in *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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_1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF M�7
a 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY 2.61:
< Receipt #
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
_1 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION Recording Fee Receipt #
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 urtil signed by the
TION;ANDINrD THE WOORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
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IN VIOLATIO! dF T CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided,
OMPE
WORKMEN'l I OMPE SATION INSURANCE AND RCW 18:27.
F C LS SIG TURE DA E
SIG 4OR AGENT): DATE SIGNED
1 (425)
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L 771-.0220 7E� E
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC110. ORIGINAL - FILE YELLOW INSPffCTOR
10104 PINK -OWNER GOLD - ASSESSOR
PRESS HARD - YOU ARE MAKING 4 COPIES
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WATER & SEWER
LEOAL LOT 15, MADRONA r-O\/E
INSPE",TIONS REQ'D. 00, MAINTAIN PLAT INSTALLED EROSION CONTROL
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CALL 425-711-0220 EXT. 15� r-A((jjAJv'C6
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10'UTILIT'r -0 UNIT OEVELOPMENT 'GE
ZONI N 67: FLANNE
EASEMENT
FOOTING DRAINS NOT
Li(b ULATION (E3A!5El::) FROM EX15TINO 0RAI:;)E)
OHT r-ALC
TO BE TIED INTO EI
DETENTION SYSTEM A�= 422�AX
= 42 IMUMI DRIVEWAY SLOPE
S 17E- r- = 426.5' a- -OWED 140/6
3 4. APPROVEr[f AS i,,l OT E U
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1-103.5/4= 425.5-75' Dv E, G
91. E TIGHTLINE IE33 E55 13 q2,0 A\/EF;ZAOE EX15TINC, (�RAOE= 425.95-15
R 11AL
Ar-TUAL BUILDIN6, HF=IOHT= 445.5-75'
425 T- — -,HT= 450.5-75'
SDR 35 MAXIIIIUM.BUILDINO HEIr Date: 21 LLI
SCH 40 15UR\/E-r'OR TO PROVIDE E3ENr-HMAf;-'< M05T
N-12 I - APROPRIATE FOR HEIOHT VERIFIC-ATION)
OAF-Ary IMf=1Ef:ZVIQU5 AREA�
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HANCOR
RE51DENGE 1,^V 2011 5OUARE FEET Zoneipp-p-p -i+k Come.rKL)oFIag__Qu
PORCHE5
Setbacks Required Actual
0 -10-7 50UARE FEET
or_ ORI\1EVqA"r5 Front 5
5
:T- 'N' 0 PATIO 112 SOUARE FEET
Nr-F- � � ) -5 -4
�j FI-Atll 2 1 'E FEET Sides(e:/V,/ -
rf- r-OTTA6,E L. V4ALr-NAys 5o 5OUAf.';-:.
Rear ( In,
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f '=F mA'N 0� --\. —2 TOTAL 2,8,50 50UARE FEET
422 / 00' 00,m(A fz vsepr- Ehhei
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Heigh 2`5
55E�L PA 10
LOT GOVERAOE
LOT r-C)VERAOE 15 E3A!5EO UPON 5596C)F EMTI 1;-:' E
FLANMEI:;) UNIT DEVELOFHEMT)
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63.66 2oll SOUAR-E FEET OF pROPOSE0 LOT r
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(INCLUI:;)E!5 5TRUr-TURE, C-OVEREE? FORr
E�A,5-rwci ofz495 EAST
5' CITY OF EDMONDS SANITARY
SEWER EASEMENT A.F. NO. 2070845
40 50 'PY
0 12 5 to 15 20 30 CIT" C"
AND 2070846
L-07 15
FEE RECEIVED
SEE 0ENERAL NOTE 5C-A
APPROVED BY PLANNING JUN 7 2005
AIR,' 09-1 t) (0-i v
PERMIT COUNTER
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Earth trth Solutions NWLLC
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2603 1 51st P1. N.E. Redmond, WA 98052
\W1 I 1 (425) 284-330 FAX (425) 284-2855
DAILY FIELD REPORT
Fiell Rep-
C.U(k,
Project No.
page of
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Report No.
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Time On Site
7:,00.
Time Off Site
C)
Date
-1`6�
Day of Week
M dy
Travel Time
11
rs. , hdrged
Project Name
MADACAIA C-OVZ
Job Location
01
Client / Owner
General Contractor
General Contractor's Superintendent
Received Onsfte By
Grading Contractor
Grading Foreman
Checked By
Are approved Plans/Permits onsite YES NO Project No.
Permit No.
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AUG 3 -2005
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DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
COPYTO:
CONTINUED ON NEXT PAGE
Height Calculation Worksheet
Date
Permit Nun-iber Z005— 053(0
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Address
Inspector
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Average Grade qZ5, 9
Max Height (25'.+Ave.) &-7_5-
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Actual Height (A+B+Q
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
ME MO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM. FIRE DEPARTMENT. DATE
PLEASESIGN
ENGINEERING DIVISION DATE'
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PLANNINGDIVISION DATE
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PERMW#2DQ.3 ADB# DATE,INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED '7
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mine compliance with -'approved plans. Final
;,,-A.,'fi.eld inspection, was. conducted to deter. approvat...
' 6t no objections om - the. a bove signed Department to the rel ease
den e 4hat there are.
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IiERFORMANCE BONDS and the rantingof:
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GRANT FINAL PROJECT APPROVAL,
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GRANT PROJECT A-PPROVAL 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
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El Copy of CORRECTION NOTICE given to owner/contractor by inpector�
2.
3.
RE-INSPECTE T TANDING ISSUES - GRANT FINAL PROJECTAPPROVAL.
'D OU S
Date Signature,
1-tc1np:b1dg:fortns:ocaprv1 3 /25/04
ENGINEERING INPSECTION
FEE RECONCILIATION
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Permit Fee's Collected at Permit Issuance
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# of Inspections: X $50.00. M
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Receipt #: Receipt Copy Attached: Yes No -n ;d
Only required if refund is due
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'Total Inspections Performed
9 Cn
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# of Inspections: x $50.00 —1
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Inspection Fee's TO BE PAID
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DatePaid:
Receipt#:
Collected, Py:
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Contact notified of fee's due: by ph keorrection notice given
Cont et one
Engineering Notified of Payment Received
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