20051011.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ADDITION E] COMMERCIAL
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PERMIT EXPIRES___jkL__
PERMIT D.W15—
NUMBER
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ADDRESS
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PLAT NAMEISUBDIVISION NO. LOT NO. LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL. STREET MAP TF SCIP Approved
RVI Reirmi Required
EXISTING PROPOSED Street use Permit RPquue-
Inspection Required
Sidewalk Required
250 REQUIRED DEDICATION FT undorgiouna
Wuinq mquired
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YES 13 No 13
REMARKS V�
7 UONERICON I RACTOR RESPONSIBLE FOR EROSION CON F HUUDRAINAGE /1
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DATE I CHECKED BY
PLUM BING / MECH
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SIGN
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OTHER
FIRE SPRINKLER
FIREALARM
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS I
DESCRIBE WORK TO BE DONE FZr-_M1.r]97 -1 LOWLIZ—LaUj7OW4 j6iwl
NGIN ERING REV
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FIRE REVIEWED BY
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VARIANCE OR CU SHORELINEORADB4
INSPECTION SEPA
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CA# ZONE SIGN AREA HEIGHT
WAIVERflk ALLOWED PROPOSED ALLO1111D I PROPOSED
. STUDY P-6 5 1 2.,9 nAL
LOT COVERAGE REQUIRED SET BACKS (FT.) JIFROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOTAREA PLANNING REVIEWED 13Y DATE
REO'D PROVIDED
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TYPE OF PRSTRUCTION COD
OCCUPANT
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SPECIAL INSPECTION CONSULTANT OCCUPANT
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Description
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Plan Check
Building Pierrniit-�
HEAT SOURCE
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VE9'TED DATE
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES or 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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Fire Review
Fire Inspection
Landscapelnsp.
RL cording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
T14E OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THF,�ATE OF WASHINGTON RELATING TO
WORKMEN-slIll"143j5ACIN INSURANCE_�06RCW 18:27.
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CALL
FOR INSPECTION
(425)
SIGNATURE A.13A I T
DATES � ED
Description
State Surcharge
City Surcharge
Base Fee
FEE
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Plan Chk. Depositl / 1UP 06.9 �
Receipt #
Total Amt. Due
Receipt#
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his1hor Deputy, and Fees are paid, and
receipt is acknowledged in space provided
SIGNATUR DATE
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ATTENTION 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.
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC110.
10104. PRESS HARD - YOU ARE MAKING 4 COPIES
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DWN 6EIGLE DES16NS NO.
BY:
1410r. 555TH. AVE. W. OFFICE:(425) 787-251r.
L Sqtbacks �uirea Actual RRG EDMONDS, WA q8O26 FAX: (4Z5) 787-2516 050.5
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Sides W Ncn,__�_ I D' g 4-u2— APPROVED BY PLANNING
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PERMIT COUNTER
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PITZER & ASSOCIATES
S.TRUCTURAL ENGINEERS
If there are. any questions about this report or if I can be of any ffirther assistance, please
f6el free to call me at the above number between. 8 AM and5 PM Monday Friday. I
look forward to working with 'you in the ftiture.
Sincerely,
Thomas P er
T4homas ®r
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PITZER & ASSOCIATES
STRUCTURAL ENGINEERS
2722 Colby Avenue, Suite 722
Everett,.WA 98201
Office: (425)308-8070
Fax: (425)258-3292
tommyt42k@hotmaii.com
March 31, 2006
—ITY OF N
Mr. Pavel Rombakh
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3909205 Place SW
Lynnwood, WA 98056
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RF,: Pavel Rombalch Drill and Epoxy Special Inspection Report
P&A 05-196
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Dear Pavel:
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The purpos of this I
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p rocedure performed on March'30, 2006 at the above building.
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5/8" diameter holes were drilled a minimum of 6" into the footing. The debris was then
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blown out and the hole was filled approximately half, way up with Simpson Concrete
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Adhesive. Additional adhesive was applied to the 1/2" diameter rebar and the rebar was
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worked into the hole with a twisting motion to u niformly coat the bar and fill all voids
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and crevices. The rebar was worked into the epoxy until any trapped air underneathihe
epoxy was worked out and the rebar was seated into the bottom of the hole
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1" di ameter holes were drilled a minimum of 611 into the footing. The debris was then
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blown out and the hole was filled approximately half way up with Simpson Concrete
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Adhesive. Additional adhesive was applied to the 7/8" diameter anchor. and the anchor
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was worked into the hole with a twisting motion to uniformly coat the bar and fill all
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voids and crevices. The anchor was worked into the epoxy until any trapped air
underneath the epoxy was worked out and the anchor was seated into the bottom of the
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CITY CLERK CONFORMED COPY
CITY OF EDMONDS 200611 72 1 PG MICROFILM
121 STH AVENUE NO.
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EDMONDS.'WA 98020 J�1�71 S1 CH��, F2H
0 OM H OUN AS &TON
STATEMENT ON ACCESSORY DWELLTING UNITS
Property Address: 18121 88th Ave W
Edmonds, Washington, 98036
A�se.150r's PCtrr4t N tAVIA 10� I:t 0 C) q3 It 0 C) 0 00 Li OS
qln# escrib of
r 0r M eitq% "Wa 'fn)V it M S.gas��
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al;' I e? jecorded in Volume , Page 7.6', in Snohomis County,
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West line of said.Tract 4, 120 feet North of the Southwest come s d
COMM6& g. at a PoAn r thereto al
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portion boffis the Northwest comer of tract conveyed to WillWh F. Walker and wife by -Deed z=rdbd*.May
20, 19-54, under Audit&s File No. 1098406; thence North 0 degrees 25'30" West along said West Une -a
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dfstiance df 76 feet; thence South 98 degrees 2717" East 156.47 feet to the East line of West half of Tract 4-
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thence South 0 degrees 27'14" Sm along said Bast line. 70354 feet to a portion on the North line of sal�
Willimn. F. Walker tract; thence South 89 degrees 32143" West along said Walker tract to the point of
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�tck read V�u 'Gr kv%4�.s V%Ld t' el cv%Q'� a b-.11 a e +kA.
Edmonds Community Development Code (ECDC) that dwelling
3:
ancTunderstand an accessory
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unit as defined in ECDC Section 21,05.015 is prohibited until an Accessory Dwelling Unit
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Pt:rrnit is approved.
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I also understand that an Accessory Dwelling Unit Permit cannot be app;oved unless all the
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criteria- in Chapter 20,21 are met, and all the necessary items are s ;ubmitted, including an
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affidavit of,occupancy and a covenant to ed with the is C ounty regarding the
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regulations imposed on Accesso g U
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Property -owner Signature:
Property-Own�rName( Rombakh
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STATE.OF WASHIN GTON,
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dOUNTY OF SNOHOMISH)-
I cehify that I know or have satisfactory evidencethat -PLU e-- 60'4�1_
signed thii, insirurnent and acknowledge it to be hisihdrftee and voluntary act f6r the,uses. and
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purpoges mentioned in this instrument,
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N . eals must be smudged. Dated: 111(a Ze) 6
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Notary Public:
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Residinglat:
BLI 6 - My Appointment
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THIS 3C M.'Wf�T-MUST BE.RECORDED. WITH THE SNOHOMISH. COUNTY AUDITOR,
ADUstatement
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