20050780.pdfDATE RECEIVED ll�
CITY OF EDMONDS
.CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
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NAME
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ZIP I TELEPHONE
PERMIT EXPIRES
PERMIT
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SUITE/APTN
ADDRESS
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7LAT NAME /SUBDIVI SION NO.
LOT NO
LID NO
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required 13
Street Use Permit Requited
EXISTING PROPOSED
Inspmlion Required
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Striewalk Requited
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REQUIRED DEDICATION
FT
Underground
Wit no ifquirric
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESO NO 1:1
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINE OR All Ell I INSPECTION I , SEPA
REO'D COMPLETED I EXEMPT
13YES A NO x .
ZONE SIGN AREA EIGHT
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AIVER [3 ALLOWED I PROPOSED I ALLOWED PROPOSED
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NEW M-I§ESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT) I PROPOSED SETBACKS (FT)
% ALLOWED PROPOSED FRONT SIDE REAR ONT URSIDE REAR CD
COMMERCIAL COMPLIANCE OR IfT e_ W .5 z
02"'ADDITION 511�i '. I so 2
MIXED USE CHANGE OF USE 2.97 z
PARKING LOT AR�EM PLANNING R VIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED I
GRADING . FENCE 12.- 11015 t) g;
REPAIR CYOS X FT.) REMARKS
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El DEMOLISH TANK %�j
o GARAGE RETAINING WALL FIRE SPRINKLER
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p (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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rx I- TYPE OF TRUCTION OCCUPANT
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NUMBER NUMBER OF '70CCUPANT
r) OF DWELLING SPECIAL INSPECTION CONSULTANT
M UNITS LOAD
0 STORIES QUIRED DYES
71 RE
DESCRIBE WORK TO BE DONJ;%
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It Al GEOTECH REPORT
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Descriptiob FEE Description FEE
I W"I Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTE6 DATWp�h Building Permit City Surcharge
A, 60
PLAN CHECK NO: Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERYY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT 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 100
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
01 1 1 -
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROV S ON.
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 hisihor 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'Sjl��ATION INSURANCE AND RCW 18:27. 0 1 S SIGNAT E D
C
LSIGN RE C N G DATE SIGNED (425) 1( 5
771-0220 RRELSE I ATE
ATTENTION EXT. 13.33 N C�
IT IS UNLAWFUL TO -USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- OIR NJA -FILE - Y OW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 / IRC1110. �11 OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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Zone P-6 -K Comer NO Flag
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Setbacks Required Actual (to
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AUG 1- 2005
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J102 -NO i ED BUILDING DEPARTMENT
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CITY OF EDMONDS
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Date: AUG 2 i.;
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OF I-J'AGNID--
APPROVED BY PLANNING
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PFROVED BY.: LRE
DRAWN BY
SCALE: .4 to
VA REVISED
DATE:
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DRAWING NUMBER
Height Calculation Worksheet
ate 3 1- cc,
Permit Number�-:)Mc->- 0,
Address S�j
Inspector
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Max Hei ht (25'+Ave.) I 75
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1/teiiip/buildiiig/foniis/liciglit worksheet
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Sound/noise originating from temporary construction sites us a res6h of
construction activity are exempt trom th,,� limits ef LCC Chaptc�!.
5.30 only during the hours *u0pin on weekdays and
10:00om and 6:00pin on Saturdays, -excluding Sundays and Federal PERMIT#: 0?(Y)5_-0 70
"of, -c originating from construction
Holidays. At till other times the nois
EXPIRES:.,�
sites/activities must comply with the noise limits of Chapter 5.30, unless
a variance has been granted. pursuant to ECC5,30,120..._.... ISSUED:
City of Edmonds'_
TH.IS CARD MUST BE POSTED ON SITE AND AVAILABLE TO THE INSPECTOR
Owner: KE:H N lo-&- LQT
Site Address: 101�26 2-21a_lh PL
Project I
Sbtbacksfor Zone
Frono 74;'
Rear:
Side: 7�6'
J.'Height:
Variance #:
Inspections
ppro�.e
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'#I ENGINEERING
MOBIL17ATION AND ERO-SION'CONTROL INSTALLATION MUST BE APPROVED PRIOR TO COMMENCEMENT OF ADDITIONAL WORK.
(415) 771-0220 x1326, Mobilization / Erosion Control
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Tiebtline
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Detention
Forms (sidewall� driveway)
- --- - - - - - - - - - - - - - - - - - - - - -
- -
Service:,
�,.Water
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Permit # Side Sewer
Permit # Right -of -Way -Z�'-
(s/wc/g.pavingie.':
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#2 SrI'E/DEKOLITION Pre-Demol*1*0'
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Sewer Cap
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Cleaned Sitdffinal,�,'�.
#3 FOYNDATION -'Setba'eks:4
'Footingd!
Foundation"N.. jl`*�
99 _;N44
�7�- Pierg
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�Slab Insulation,
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#4 PLUMBING Grbu`nd.Work.-
P =it # Rough In
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Grease Fixture
- - --- - - - - - - - - - - - - -
�5 PUBLIC, WORKS Cross t'6nnictidn Co'httoll
(425)77i-0235- 0' Tr7asy-NEC-0--sm-r-el
#6 MECH/HVAC- Gas Test/Pipe-'�.
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#7.FRAMING,,,t;,:.�.N,� !-E'X'i-Vrf6r�heathin'Jz;'�!
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Floor
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#10 FIRE 'Rydrant
(425) 771-0215 FQC
- - - - - - - - - --- -
Firti Protection System
Extinguishers
Addressing Visibility
I
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ALS
FINAL PROJECT APPROV
Engfilleering
Sewer"Division
Water Division
Nanning
Fire
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****FINAL OCCUPANCY
APPROVAL
BUILDING INSPECTOR
FINAL PROJECT APPROVAL FORM
TO:
DATE:-.7131160
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
P -ASRSIGN
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V-11-10 jttiAINEERING DIVISION DATE_Z//V
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PLANNING DIVISION DATE
PLEASI! SIGN
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PROJECT
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SITE ADDRESS
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PERMIT # ADB# DATE INSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED 14
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A field inspection was conducted to determine compliance with -approved plans
Final approval
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denotes. that there are no objections from the above signed Department t)
the release of
PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION OUTSTANDING ISSUES
El Copy of CORRECTION NOTICE. given to owner/contractor by inpector
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
Henip:b1dg:fbrnis:ocaprv1 3/25/04