20070083.pdfI
DATE RECEIVED
FP
ERMITEXPIRES
CITY OF
EDMONDS
USE
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PERMIT
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NUMBER
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SUITE/APT#
CONSTRUCTION PERMIT APPLICATION
ADDRESS
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OWNER NAME/NAME OF B SINESS
PLAT NAME,SUBDIVI SION NO
LOT NO.
LID NO,
LID FEE S
MAILING ADDRESS
PUBLIC RIGHT OF ',VAY PER OFFICIAL STREET MAP
7 ESCP Approved
RW Permit Required
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EXISTING — PROPOSED
Street Use Permit Reqd
Inspection Required
Sidewalk Required
CITY ZIP
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REQUIRED DEDICATION—
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Underground
Wiring required
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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ADDRESS REMARKS
I OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP I TELEPHONE
NAME
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17� ENGINEERING REVIEWED/DATE
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STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
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SHORELINE OR ADB#
INSPECTION
REO'D
BOND
POSTED
0 YES ONO
SEPA REVIEW
SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
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ALLOWED PROPOSED
ALLOWED PROPOSED
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NEW RESIDENTIAL PLUMBING / MECH
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REQUIRED SETBACKS (FT.)
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PROPOSED SETBACKS (FT.)
FRONT UR SIDE REAR
PROPOSED
Ej COMPLIANCE OR
E] ADDITION COMMERCIAL CHANGE OF USE
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
REMODEL APARTMENT SIGN
REO'D I PROVIDED
REPAIR GRADING FENCE
CYDS ( X FT)
REMARKS
DEMOLISH TANK OTHER
GARAGE RETAIN G WALL RENEWAL
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(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
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NUMBEROF
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SPECIAL INSPECTOR
REQUIRED
AREA OCCUPANT
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UNITS
NUMBER
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DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D
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VALUATION
FEE
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PLAN CHECK NO: VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING�FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
cc PERMIT APPLICATION: 180 DAYS
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Q. PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG REVIEW FEES
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in "APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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ENG INSPECTION FEE
Ud IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
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2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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RECEIPI
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T01AL AMOUNT DUE
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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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC '
CALL
Thisapplication is not a permit until signed by the
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
13tidding 011icial or his/her Det)uly: and Foes are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
FOR INSPECTION receipt is arknowledged in space provided.
FFICIALS SIGN Ui4ril DATE
SIGNATURE (OWNER Q,,R AGE T) DATDIGNED /1
(425)
9,12_9�
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771-0220 DAI i:
REVEASED By
A17ENTION
EXT1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD -ASSESSOR
5/98
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Modification granted per UBC 104.2.7 for exterior gUardrail at balcony or upper floor
loft area (Useable space of loft area less than 200 S(jUarc feet). GUardrail is 42" high (12"
More than reqUired by code). The c1carancc between intcrillediatc rails is 5", with 12"
clearance between the top rail and adjacent Intermediate rail. GUardrail is welded I Y2"
steel pipe.
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CITY OF EDMONDS GARY HAAKENSON
MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
May 25, 2000
Brian Moll
16119 N. Meadowdale Rd.
Edmonds, WA 98026
RE: Building Permit #: 990253
Dear Brian;
Your Renewal Permit has expired. Please come down to City Hall and fill out a new
renewal permit as soon as possible. Your fees are based on the number of inspections
you have remaining, which are four: Insulation, Sheet -rock, Final and Engineering.
Your total amount due is $180.00.
Thank you for your immediate attention to this matter.
Sincerely,
Jena Brooks
Development Services Coordinator
Cc: Building Official
Incorporated August 11, 1890
Sister Citu - Hp.kinAn Jannn
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
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MEMO TO: PEWIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PIXASE SIGN
ENGRNEER-ING DIVISION DATE
Pik
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT
SITE ADDRESS —
PERMIT ADB#_
DATEINSPECTED �Q-�qyol
DESCRLPTION OF WORK TO BE INSPECTED � K-s
A field inspection was conducted to determine compliance with -approved plans. Final approval'
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GKANT PROJECT APPROVAL WITH CONDITIONS NOTED
Copy of CONDITIONS given to owner/con tractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES Stjffl-�t� S'CYVff,
0 Copy of CORRECTION NOTICE (.;iven to owner/contractor by inpecto
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MICROFLIA
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tenij):b1dg:1'ornis:ocaprv1 3/25/04
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MEMO TO STREET FILE
16121 North Meadowdale Rd
October 31, 2007
SUBJECT: Moll Residence
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Engineering Final Inspection of Single Family Residence
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The City of Edmonds Engineering Division has inspected and approved the civil site
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improvements as required with the development of the single family residence at 16121 North
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Meadowdale Rd.
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The owner of the subject property is aware of the requirement for and is in the process of
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securing an easement from the adjacent property owner, 16123 North Meadowdale Rd, for that
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portion of the sanitary sewer line that crosses the adjacent property.
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J-eYn-q McConnell, Engineering Program Manager Date
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FINAL PROJECT APPROVAL FORM
RECEIVED
NOV I - 2007 TO:(
ENGINEERING DIVISION
DATE: -
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspection was conducted to determine compliance with -approved plans. Final approval nx
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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RE -INSPECTED OUTSTANDNG ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:tei11p:b1dg:rornis:ocapn,1 3/25/04
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INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING.
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
ell�
2000,�74F3P
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