20051068.pdf1 DATE RECEIVED
C ITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMEINAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP YELEPHQ�E
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NAME
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NAME
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CITY ZIP
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PERMIT EXPIRES
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NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
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PLUMBING / MECH
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COMPLIANCE OR
MIXED USE
CHANGE OF USE
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REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYOS
FENCE
( X FT.)
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
FIRE SPRINKLER
ROCKERY
FIREALARM
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(TYPE OF USE, BUSINg-%�,OR ACTIVITY) EXPJ-AIN:
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SUITEIAPT#
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PLAT NAME/SUBDIVISION NO, LOT70 LID NO
I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESrPAppfowed
RW Permit Required
Street use Ponnit Required
EXISTING PROPOSED inspection Require()
Sidewalk Required
REQUIRED DEDICATION FT Unde(gratind
Wienq requited
METER SIZE LINE SIZE XTURES PRV REQUIRED
YES 13 NOE3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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NEERING REVIEWED BY
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FIRE REVIEWED BY
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DATE
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VARIANCE OR CU SHORELINE OR ADBI I INSPECTION I SEPA
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13YES ONOI Y,
CA# ZONE SIGN AREA HEIGHT
WAIVER ALLOWED , PROPOSED ALLOWED PROP05EII
STUDY 9-5-9 1 — 95 1 -z,.5,1 2,2? 1
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
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PARKING LOTAREA ANNING REVIEWED BY DATE
REQ'D I PROVIDED 1 0 1PL fN
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REMARKS * ei. " ryi r-, W e. I I ( D151 I -:H
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TYPE OF flp�RUCTION
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OCCUPANTj,)
GROUP
NUMBER
NUMBER OF
OF
DWELLING
I
SPECIAL INSPECTION
CONSULTANT
OCCUPANT
STORIES
UNITS . -
REQUIRED
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
9106-OLM5
GEOTECHREPORT
BY:
STRUCT
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BY: N n-,Tyo�(
VALUATION
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Description
FEE
Description
FEE
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Plan Check
-7 Slate
Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building
City Surcharge
Permit
If
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
J
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
Fire Review
Plan Chk. Deposit
J IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
I 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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
1 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 00
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
�\Tlolil; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
Building Official or lus1hor Deputy: and Fees are paid, and
VIOLA 0 E LABPR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acKnowledged in space provided.
�ORKM S MP ATIOtINSHRAN,CE
AND RCW 18:27.
FI(^S SIG14ATLJ DATE
(OWNER AG
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DATE IGNED
(425)
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771-0220
—TA—SED BY DATE
ATTENTION
EXT. 1333
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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
IG9AI. - F YELLOW
KE-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110
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NOTICE: IF THE DOCUMENT IN TH - IS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
NSIDLE FCXR
ER
122.641 OWNERS:
N 55' 20' W
GENTLE SLOPE
SCOTT AND GON5T,4NGE ST,41RBARD
EXISTW, �7* TALL ROCrZRY
n, A REVISION
FIRZOPERTY
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GENTLE SLOPE
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pUILDING DEPARWENT
TAX FARC-EL EDK40NDS
NEU) ROOF AREA 4000-5
OOECJ300000 I
FXISTI!,* C-ARPORT HEir_-PT CALCULATIC)N5
FxISTIW-. 5WE LOT AREA:
35 EF.
10,012.
AE)EXTION 105. 15,
OVER EXIST.
U) U) A 4 LOT SLOPE: c -100.00'
u- c! RE
-100.00,
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EXl5TIW_, DRIVEWAY
EX15TING SIDENCE LOT COVERAGE: AvG. GRADE:
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X15TINI-2:
FROFIC ED DDITION- 1-15 5;f� 2411 S.F. (24.roB%) RI DGE: 12 3. r. 9'
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EXI51T. CARPORT ROOF LINE:
163 6F. (GON5T. lc355)
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EXISITNG DRIVEWAY 4 WALKWAYS: .2305 5.F. (GON5T. I'- o2 IcJ55)
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255 SF. (GONST. n55)
SPED.
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110 5F. (CON5T. 1960)
ASSUME 100 "A pliov,�_cj AS N I EX15TING DECK:
MTOF OFF F.H.
W 1045 ERING 145 5F.
BY ENGINEE REMOVING DECK:
Zo c6 Corner "Ing ROOF LINE: 213 5F.
FROi=05ED 5UILDING
Setb cks i�ed Actual
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Front
Sides co
'Rear I P3 V11cw 5G,4LE 1 20'-0" 0 10 20
Other
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CAS ADE . TESTING LABORATORY, INC.
TESTING & INSPECTION
12919 N.E. 126TH PLACE
KIRKLAND. WASHINGTON 98034 (425) 823-9800
EVERETT (425) 259-0817
FIELD REPORT
TO:
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RECEIVF
2M
ATTN:
PREVIOUS
REPORT No. No. 121446
DATE N-Q.
1. 11 - 11 -
PROJECT J04 ?66,44
LOCATION
BLDG. PERMIT NO. OWNER
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WEATHER TEMP. AT AM
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ENGINEER
DEVELCOIPMEN I
Ty OF
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(2)
(3)
ITEMS INSPECTED
INSPECTION PERFORMED
FOUNDATIONS
RESTEELlCONCRETE
— RESTEEL ONLY
— FOOTINGS.
SLAB
RESTEEUMASONRY
— STR.STfWELDING
— AUGER CAST PILES
COLUMNS
OT HER
— STR.STIBOLTING
— DRILLED PIERS
WALLS
BEAMS
(4)
7o 74 L
c)&frs)ot
LOCATION (AREAS)
MIX NO.
C NCRETEIMASONRY DESIGN STRENGTH (fd)
SUPPLIER TOTAL CU. YD. PLACED
SLUMP (INCHES) SPECIMENS CAST.
AIR CONTENT (%) SEE CYLINDER REPORT NO.
XYES NO ITEMS INSPECTED WERE IN CONFORMANCE WITH BLDG. DEPT. APPROVED PLANS
REMARKS: A11112:_ 10 .70
7,212�V W(5
40 �74_
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TEST RESULTS APPLY ONLY TO THE ITEMS
HEREIN TESTED. THIS REPORT SHALL NOT INSPECTOR(S), NAME(S) PRINT
BE REPRODUCED EXCEPT IN FULL, WITH-
OUT THE WRITTEN APPROVAL OF CASCADE
TESTING LABORATORY. INC. INSPECTOR SIGNATURE
REVISED 7/05 SIGNED BY 'A
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COPIEST filk/jIL111,A) All 'ill-7
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FINAL PROM . PROVAI FORM
TO:
DATE.
--mt:-Imo,ro: PEIZMITCOOIZDINATo1�, BU1'I-DING DIVISION
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PLANNING DIVISION DATE
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PERMI 0 c-;, z5 DATE INSPECTED
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DESCIU-PTION 01- "IORKTO BE INSPECTED
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A field inspection was conducted to determine compliance with ipproved plans. Fin. pproval
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-om the above signed Depallment to tl I of
denotes that there are no objections ft ic re case
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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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FAILED FINAL INSPECTION - OUTSTANDING ISSUES.
n Copy orCORRECTtON Nurt,CE given to owner/contractor by itipcctor
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tcn1p:b1dg:fomis:ocaj)rv1 3/2.5/ 04