20051028.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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NAME
ADDRESS
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CITY
STATE LICENSE NUMBER
L12,5- 15 3- 65 31
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PERMIT EXPIRES
PERMIT
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NUMBER
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SUITEIAPT11
ADDRESS Cl -7 1 50 0111
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApProved
RW Permit Required
E3
Street Use Permit Required
Inspection Required
EXISTING PROPOSED
Sidewalk Required
E3
REQUIRED DEDICATION FT
Undrifgrmind
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METER SIZE
LINE SIZE
IES
PRV REQUIRED
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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VARIANCE OR CU SHORELINE OR ADB# INSPECC ON SEPA
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EXPIRATIO14 DATE CHECKED BY D COMPLETED E PT
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PROPERTY TAX ACCOUNT PARCEL NO.
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M NEW RESIDENTIAL
ADDITION COMMERCIAL
MIXED USE
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4-50—
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REMARKS
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FIRE SPRINKLER
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NUMBER
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NUMBER OF
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STORIES
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REMARKS
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GEOTEPH REPORT
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Descriptiort
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Plan Check
HEAT SOURCE LOTSLOPE% VESTED DATE
Building Permit
67A 5
PLAN CHECK NO:
C41 0�,
Plumbing
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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
Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
Fire Review
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, AR ISING DIRECTLY OR INDIRECTLY
Fire Inspection
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
LandscapoInsp.
NOR LIMiT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording 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
CONSULTANT
FEE
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
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 FOR INSPECTION
WORKMEN'S5P ".SATION INSURANCE AND RCW 18:27.
SIGNATURE 13WNER
,bR AGENT):.- DATE SIGNED (425)
�ez, -� I? - 5 _&__0 55 771-0220(
OCCUPANT
GROUP
OCCUPANT
LOAD
Description
State Surcharge
City Surcharge
Base Fee
FEE
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Plan Chk. Deposill K111U.7-
Receipt # I ;! -711
Total Amt. Due
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Receipt # 42 7- P)i
APPLICATION AP0`IkOVAL
This appiwation is, (tot a pormit ontil signed by Ibu
Building otfit:iai or tuytior Deimly and Fees aru prisiti, and
rtiC.oirit Is acknow1odgfid in %paro ;40videl
—VFFI MLS SIGNAT(illt- OATI.
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL LL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1109 / IBC110 I IRC110.
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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Scale: i" - 20'
Owners: Treece, Torre& Kendra
AS CIT ED
Address: 1970180 PI West Edmonds, WA 98026 APPROVE III
Tax Parcel #: 00606400001000 N I N, -1EBING,
M-ELRVIOUS SURFACE CA
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Existini curldilng Roof Outline: 1377sf (const. 1959)
Existing Garage: 517sf. (const. 1959)
Existing Driveway: 782sf. (const. 1959)
Proposed West Addltlon��.� 498sf" 3 7, 2- ;6
Proposed East Addition: 205sf.
Proposed Covered Patio: 380sf
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AVG GRADE 107-25'
GUTTERS/DOWNSPOUTS
ACTUAL = 123.75'
MAXIMUM = 132.25' Existing \V T6 CONNECT TO EXIST S.YST. CO)
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Driveway
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Height Cale Worksheet
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Date
P rMit Number
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Max Height'05'4 -Ave )-S
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING. DIVISION
�FROM: FIRE DEPARTMENT DATE
PUASF SIGN
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ENGINEERING DIVISION DATE 116
P LEASE Sid-H
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PLANNING DIVISION DATE
PIXASESIGN
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DE OF WORK TO BE INSPECTED 106, e�
-field i 6 :,
imspec ion was conducted to.Aetermine compliance with -a proved plans. Final approval
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_d ere are no objection's from the above signed Department to, the release 'of:''
ehotes ''liat th,
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PERFORMANCE BONDS and the granting of
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'GRANT. FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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;.'El: Copy ot CONDITIONS iven to owner/contract'or by inspqctor
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
:0. Copy of COPJ�ECTION NOTICE given to ownier/contractor by inpector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT, APPROVAL
DAte Signature�
1:temp:b1dg:fonns:ocaprv1 3/25/04