20000108.pdf"•. ATE RECEIVED
PERM
R IT
CITY OF EDMONDS
= NUSEE L , <J,u NUMBER
v
CONSTRUCTION PERMIT APPLICATION
SUITE/APT•
ADDRESS L
k1
'OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO,
-
LID FEE 5
¢ MAILING ADDRESS
0 �� (I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
rmea O
m�RRepunea e
10
CITY ZIP TE
PHONE
EXISTINp PROPOSED
O
SIa� a O
PIT a
, $i -,+ttop
REOVIREDDEDICATION FT
a grad rvae
METER S12E LINE
SIZEFIXTURES
PRV REQUIRED
NA
-
E5 ❑ NO C] -
wL
r- ADDRESS
REMARKS s
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
t
CITY ZIP TELEPHONE
NAME
y1 (A
ENGI E RIN
//��,e REVIEWED/GATE
¢°
ADDRESS
^,L
�'I `/ (,N"'•/�-1 L✓��"
FIRE REVIEWED BY GATE
CITY ZIP
TELEPHONE
°
0
VARfflIANCE OR CU
SHORELINE OR ADW
INSPECTION
BOND
STATE —LICENSE NUMBER PIRATI N DATE
CHECKED BY
/,/
-
REQO
YES ❑ NO
OSTED
.r
1
i/l_
SEPIA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
.
PROPERTY TAX ACCOUNT PARCEL NO,
w
� I f —
r
EXP I
LOT COVERAGE
REQUIRED SETBACKS IFT,)
PROPOSED SETBACKS FT)
RESIDENTIAL-
❑ PLUMBING /MECH
ALLOWED PROPOSED
FRONT SIDE REAR
FIR*OND, UR TOE REAR O
❑ NEW
Z
❑ ADDITION
❑ COMMERCIAL
❑ CHANGE OF USE COMPLANCEOR
�Q a�
!V •�
PARKING LOT AREA P EWED BY DATE a
REMODEL
❑ APARTMENT
❑ SIGN
REO'D
PROVIDED
❑ REPAIR GRADING - FENCE
❑ CYOS ❑ ( X ,�. FT)
ARKS
❑ DEMOLISH ❑ TANK ❑ OTHER
11��11 GARAGE RETAINING WALL ❑ RENEWAL
❑
+ C.�si/T (�ON(/d�J MFlG
I
i
LJ CARPOflT
OR ACTIVITY) EXPLAIN:
A
O,CCUPANT
Inc
uly1`r
(TYPEOF USE. BUSINESS
CHECKED BY TYPE OF CON T UCTION CODE
✓7T I GROUP
w
NUMBER ,e
OF L
NUMBER OF (
DWELLING
CRITICAL
PEASNUMBER
SPECIAL INSP (OR AAEA
REQUIRED
OCCUPANT
LOAD
O
STORIES
UNITS
YES
DESCRIBE WORK TO BE DONE`� � h
REMARKS °
o
ll� A
NSPECTION^REO^'D
PROGRESS INSPECTIONS PER UBC 1081FINAL IJi
u r r
r
-�,I,,;..A rP - In,,II c,+p. r•e- w rf
ex5l�Dfin <
•� �{
VALUATION
FEE
N
PLAN CHECK FEE
HEAT SOURCE GLAZING% LOT SLOPE •:
BUILDING
r:+L
PLAN CHECK NO: YpSTED DATE
PLUMBING
MECHANICAL
THIS PERMITPERMIT COVERS TO
BEON PRIVATE PROPERTY ONLY. ANY CONST UCTIONON B THE P PUBLIC
GRAOINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
'
STATE SURCHARGE
41 S-0
PER MITAPPLICATION: DAYS
WORKISSTARTED WITHIN 180 DAYS
n PERMIT LIMIT. 1 YEAR S
- PINK
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOP MORE INFORMATION
O PER
^�
•APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. AS SIGNS AND SUCCESORS_���*�,
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
ANYAND
LANDSCAPING
i EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM
DIRECTLY OR INDIRECTLY
INSPEC' 1N FEE
••
a ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING
THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
RECEIPT
! L� 7�• O Qj�
¢ FROM THE ISSUANCE OF
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
i No t)IMITINANY WAY THECITY'SABILITYTOENFOPCE ANYORDINANCE PROVISION.'
TOTALAMOUNT DUE
RECEIPT �` ��•C '
ACNNOWLEDGDTHATI HAVE READ THISAPPLICATION: THAT EINF�RMATION
APPLICATION APPROVAL
HEREBY
GIVEN IS CORRECT: AND'THAT I AM THE OWNER. OR THE DULY AUTHORIZEOWGENT OF
LAWS REGULATING CONSTRUC
CALL
T^ia ePPlrcalion is not a permit u^Id ¢rgnetl by Ine
Fooz are partl anp
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE
NI REEMPLOYED
Burltling011rcial or KIs/^er Dapuly' and
1.II—ded.
ION: AND IN DOING THE WORK
INGTOON
STATE FWASNO
CODE THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION bmpllaacknpw gatl rn
ODEOFTHE
I IN VIOLATION OF THE LABOR OF
WORKMEN'S COMPENSATION INSURANCE AND RCW-10.27.
OFF CIALS SIGNATURE' S ! OAT) _
NA RE IOW ? QA` iIINEP'
(425)
- �. � ;..,•,
771-0220
RE SE DI ,TE
EAT JJJ
;_ �:
ATTENTION
UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
IT IS
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL- YELLOW -IN5P. ECTOR
GOLD -ASSET. :OR
A FINAL
HAS BEEN GRANTED. UBC SECTION 109
FAA
PINK. OWNER
LATE OF OCCUPANCY
5'9B
Z
Q
n
m
c:m
mo
80
m m
10
O
C Z
_ _
�cl)
� � Imm
0
C y
MO
Zrmm
D'
z :r
Tn
Z
O
0
m
I
9Y J' ...,..j V �.
city of edmonds
development information .,00
!:
e
a
0
0
m
C
�0
�m
m
3
yZ
§!
.E:J
i
mm i Es
rn is
0
cy' f.'.
Z �'.
Z
_
r:
(a
O i
n.
In
-.
r
L:\LIBRARY\PLANNMG\Fo'ms & Handoun\Public HandouBVand Use Applicationn.dot
❑ ARCHITECTURAL DESIGN REVIEW �
❑ COMPREHENSIVE PLAN AMENDMENT "
CONDITIONAL USE PERMIT FILE# ZONE
❑ HOME OCCUPATION DATE REC'DBY ��
❑ FORMAL SUBDIVISION
HEIGHT CHECK VERIFICATION FORM
MAXIMUM ELEVATION ALLOWED
ACTUAL RIDGE ELEVATION /S,`i
A
�A
SECOND FLOOR PLATE ELEVATION
1
I
PREPARED BY
Name Title Date
DATUM POINT ELEVATION ° VERIFIED BY CITY BUILDING INSPECTOR_
L:\temp\bullding\handout\sfMFIeldHtCk.vsd 8100 Name Date
(5l C,NT C. AL -CS.
Al
8 501 - 1
C = 507
Av G. GRADE = 503.5' PROVED Y PLAN I
tXcMuRn Der
To, Edmonds Building Dept. HPru /,ff, GV V'
Re: Garage Permit
Address: 15722 75 h Pl. West
I understand that I will be responsible for maintaining the length of
sewer line that is located on my neighbors' property, ( per the
easement he granted me), until such time as he amends that
easement to include the Ciy of Edmonds as an additional Grantee
for purposes of maintainance .
Burt 011estad 'R 1�
Property Adress
RECEIVED
APR 2 4 2001
ENGINEERING DIVISION
I
l
'1
i I
a
t
I
�
m.,
I
I
I
c m•
mo
i €
�o
o6 :
I
�• '
I k
>z,I'
� ca
Tom:
i
u
i
MM_
mm,
I
o
yi:
C
ka),
�
f
as
r
Z'
Z
1
2{
og
n,.
I
7
I
I
I
6
I
iY
P,
STATEMENT OF PLAN REVIEW SERVICES AGREEMR1f'G! I V E D
ACKNOWLEDGEMENT OF REQUIRED FEB 2 6 2001
} I DISCRETIONARY APPROVALS DEVELOPMENT
OF SERVIcS CTR.
CITYEDIVIO
am the owner/agent for the owner, for a
building permit to construction improvements upon real property located at:
in Edmonds, Washington. I acknowledge that, pursuant to terms of this agreement, the Building Permit
Application I have submitted will be accepted for review by the City concurrently with the review of any
necessary discretionary project permits or approvals required by the provisions of the Edmonds
Community Development Code. I also acknowledge that the City shall not accept an application for
building permit that is not complete as determined by the minimum submittal requirements published by
the City which I have read and understand. In signing this form, I acknowledge that I have submitted all
necessary documentation in order to make a complete application for a building permit. The City
determined that the discretionary application(s) for this project were deemed complete on (date).
I acknowledge that any plan review fees paid in connection with this application are solely for the
expenses and costs associated with review the plans as I have submitted them, and do not entitle me to
any right or claim to the issuance of a building permit. In consideration for the consolidated review of the
building permit application concurrently with any required discretionary project permits or approvals, I
hereby acknowledge and agree to be bound by terms and conditions of this agreement as set for herein.
1. The required discretionary project permits or approvals for this project currently include, but are not
limited to the following:
❑ Architectural design review ........................................... Hearing date:
❑ Subdivision or short subdivision ................................... Hearing date:
❑ Planned residential development ................................... Hearing date:
❑ Conditional use permit ................................................... Hearing date:
Xvariance.......................................................................... Hearing date:
❑ Critical areas determination or variance request ............. Hearing date:
❑ Other (specify) Hearing date:
I further understand that additional discretionary project permits or approvals may be determined
during the course of discretionary project review which may affect plan review timelines and plan
review fees paid for this building permit application.
2. Any building permit issued and approved for this project will be subject to any conditions or
restrictions imposed pursuant to the review and approval of any required discretionary project permits
or approvals. Such conditions or restrictions may require that the building plans I have submitted be
modified or amended to be consistent with such conditions or restrictions. I understand that additional
plan review fees will be required in the event that modifications or amendments to the plans
submitted are required by conditions or restrictions imposed pursuant to a final decision to issue or
N
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
iI,I
FOUNDATION:
Footing ......................
- Wall
Pier/Porch .................
Retainlri Wall ...........
j
{ S
� �`
Slab Insulation ..........
Z
Q, ,-I
I
.1
PLUMBING:
<%
R
Underground .............
Dd
I
Rough -In ..................���
Commercial Final
mQ'
HEATING:
-
'i0.
C
Gas Test ....................
m I
Gas Piping ..........
. ........
p
Z-z
Nx
Equipment :...:............
Final
Commercial
EXTERIOR SHEATHING-,�
8^'�
, T
NAILING ................:.........
ITIm
FRAMING ........................'
O ti,.
Q�
"1
FIRST FLOOR FRAMING... -- -
C N
�'
INSULATION ...................
$.
Insulation —
PI
Floor .........
-
Well Insulator ...........
..
Calling Insulation
7^
SHEETAQCK NAILING ...
_
-..SPECIAL INSPECTION ... -
Z;
;..
Q.
17"
MISCELLANEOUS ..........
i
FINAL APPROVAL FOR -S
OCCUPANCY ..................
I
l
S
[t