HomeMy WebLinkAbout9003 169th Street NE_BLD1658_2026 Y °� RESIDENTIAL PERMIT APPLICATION
Department of Community& Economic Development
l`N City of Arlington • 18204 59th Ave NE •Arlington,WA 98223 • Phone (360)403-3551 G`t
THIS APPLICATION IS TO BE USED WHEN APPLYING FOR A NEW SINGLE-FAMILY, DUPLEX, TOWNHOUSE,
ADDITION, DECK,OR ACCESSORY STRUCTURES. THIS APPLICATION MUST BE ACCOMPANIED BY TWO(2)SETS
OF CONSTRUCTION DRAWINGS AND TWO(2)SETS OF STRUCTURAL CALCULATIONS. THE APPLICATION MUST
ALSO INCLUDE THE PLUMBING SUBMITTAL AND THE MECHANICAL SUBMITTAL FORMS. THE ZONING
VERIFICATION MAY BE SUBMITTED PRIOR.
Project Address: MIE Plat: 2 66-7011-1 Lr�
Single-family ❑ Duplex ❑ Townhouse ❑ Addition ❑ Accessory structure
�CI►�C
Proposed Area: 1st Floor: f01,�o 2"d Floor: I _ Garage: Total SF:
Describe Proposal (include cross street): 1
Valuation: �)O►q5 / .7-10
Owner: L& t' skr s WLIk,4-ro A
Address [LR() MCI tq�9—ye ity: W State: Zip Code:
Phone: 47 '7K• C7-m Email:
Applicant: 0-->AM[%z k, ' (71,J► pi
Address: City: State: Zip Code:
Phone: Email:
Contractor: � P"
Address: ,I City: ttint AA State: Zip Code:
/y(
Phone: �7�.1Q . ��� Email: 14v�,1ti9 �i! 5. Csru1
Contact Person: License Number:L414g t 11M Expiration: Z
,qOCeived
FAn lvl�b
6/16LP Page 1 of 3
RESIDENTIAL PERMIT APPLICATION
'y �
Department of Community&Economic Development
�ljNG�O City of Arlington • 18204 59th Ave NE•Arlington, WA 98223 • Phone(360)403-3551
Plumbing Section (continue filling out if plumbing is involved)
(Check all that apply and indicate the number of fixtures proposed)
i Bath/Shower Combo (4.0) x 2 Sink(1.5) x
Shower(2.0) x Lavatory(1.0) x
C� Clothes Washer(4.0) x - Water Closet(2.5) x
Dishwasher(1.5) x f ( Water Heater x j
Hose Bibb (2.5) x ,� Water Heater Model#
Other(list) x
5N-�T-L�
Plumbing Section Continued
J` k�S
Proposed Water Piping Size: Proposed DWV Material:
Proposed Piping Material: Proposed DWV Size:
• All hose bibs required to be equipped with Atmospheric Vacuum Breakers per ASSE 1019
• All water supplies at 80psi or greater shall have Pressure Reducing Valves (PRV)
6/16LP Page 2 of 3
' °r RESIDENTIAL PERMIT APPLICATION
Department of Community&Economic Development
'AlINc�SO City of Arlington • 18204 59th Ave NE•Arlington,WA 98223• Phone(360)403-3551
Mechanical Section (continue filling out if mechanical equipment is involved)
Select proposed appliances:
W Furnace(80+) Model# I?YC fU SG 3 5 3 likk AFUE v
❑ Heat Pump Model# SEER HSPE
d1 AC Unit Model# SEER
Type ll Hood ❑ Commercial Cooking Appliance Ql Hydronic Piping
Ol Boiler ❑ Solid-Fuel Appliance PV System
Fireplace Insert ❑ Outdoor BBQ Storage Tank
Freestanding Stove S Gas Piping Other
Gas Piping Information
Not Applicable: C�li
Pipe Material: l��C(_ Pipe Size:_Total BTU's of all Appliances:
Distance from Meter to Furthest Appliance: 4()`
• New gas piping requires a pressure test to hooking to any appliance
• Sediment traps (drips) are required on all gas lines
Gas lines are required to be supported/secured every 6 to 8 feet
Proper combustion air and venting required for all appliances
• A shut-off is required within 6 feet of all appliances
Applicant Signature: PY, Date: Z
Print Applicants Name:
6/16LP Page 3 of 3
A i TERRA ASSOCIATES, Inc.
Consultants in Geotechnical Engineering,Geology
and
Environmental Earth Sciences
FOOTING EXCAVATION OBSERVATION REPORT
DATE FOOTINGS OBSERVED: 11-15-17 PROJECT NO.: T-5753-5
PROJECT NAME: Stonebrook PROJECT LOCATION: Arlington, WA
CONTRACTOR: LGI Homes REPRESENTATIVE: Les
DESCRIPTION COVERED BY THIS REPORT: Foundation for lot 70
FOOTING EXCAVATION FIELD CONDITIONS NOTED
Approximately 6"— 12" deep Exposed at the bottom of the excavation we observed
dense brown silty sand with gravel.
Soils appear firm and compact.
NOTES: Soil conditions observed are consistent with those expected and are suitable for support of
foundations designed for an allowable bearing capacity of 2,500 pounds per square foot(psf).
Our representative has observed only the footing excavations listed above.The results of this observation are only
valid for a period of 48 hours. If any change in the subgrade occurs,we should be promptly notified.Any loosened
soils observed in foundation areas due to construction activity or rainfall should be removed prior to concrete
placement.
KaCe� SI VWtm' COPY TO:
SIGNATURE
Kacey Simon
TERRA ASSOCIATES REPRESENTATIVE
12220 - 113th Avenue NE, Suite 130, Kirkland, Washington, 98034 ♦ Telephone No. (425) 821-7777
' CITY OF ARLINGTON
238 N. OLYMPIC AVE -ARLINGTON, WA. 98223
PHONE; (360)403-3551
BUILDING PERMIT
Address:9003 169th Street NE Permit#•1658
Parcel#:01166900007000 Valuation:309450.70
OWNER APPLICANT CONTRACTOR
Name:LGI HOMES-WASHINGTON LLC Name:LGI Homes-Washington,LLC Name:LGI Homes-Washington,LLC
Address: 1450 LAKE ROBBINS DR STE 430 Address:11410 NE 124th Street,Ste#103 Address: 11410 NE 124th Street,Ste#103
City,State Zip:THE WOODLANDS,TX 77380 City,State Zip:Kirkland,WA 98034 City,State Zip:Kirkland,WA 98034
Phone: Phone:425-785-0797 Phone:360-353-0588
MECHANICAL CONTRACTOR PLUMBING CONTRACTOR
Name: Name:
Address: Address:
City,State,Zip: City,State,Zip:
Phone: Phone:
LIC#: EXP: LIC#: EXP:
JOB DESCRIPTION
PERMIT TYPE: Single Family Residence CODE YEAR: 2015
STORIES: 2 CONST.TYPE: V-13
DWELLING UNITS: I OCC GROUP: R-3
BUILDINGS: I OCC LOAD:
PERMIT APPROVAL
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION 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
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC IOARCI10.
SUES TAX N0TLCJ,.Sales tax relating to construction and construction materials in the City of Arlin ton must be eportcd on your sales tax return form
a d d Ci fA mgton# 0l. �
;2�1�/ ;i�� V 2 i } I all
S* nature Print Name Date Released 13 Date
I
CONDITIONS
Adhere to approved plans.
THIS PERMIT AUTHORIZS ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY
CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION.
PERMIT FEES
Date Description Fee Amount
9/28/2017 Building Permit Fee $3,076.58
9/28/2017 Building Plan Review Fee $1,999,78
9/28/2017 Furnace $25.00
9/28/2017 Gas Outlets Base Fee 1 to 5 $10.00
9/28/2017 Mechanical Fee(Enter Fixture Fee) $25.00
9/28/2017 Mechanical Permit Base Fee $25.00
9/28/2017 Park-Community SF $1,662.00
9/28/2017 Plumbing Permit Base Fee $25.00
9/28/2017 Plumbing Permit Fee(Enter Fixture Fee) $192.00
9/28/2017 Process ingfrechnology Fee $25.00
9/28/2017 State Building Code Surcharge Fee $4.50
9/28/2017 Traffic Mitigation-City $3,355.00
9/28/2017 Water Heater $25.00
Total Due: $10,449.86
Total Payment: $0.00
Balance Due: $10,449.86
CALL FOR INSPECTIONS
BALDING(360)403-3417
When calling for an inspection please leave the following information:
Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon
I SETBACKS NOTES:
f �T 20' •BUILDING D/AAWONS ARE 70
FAar 6F fWNDAnCW
fTAV9i 0 CONT UR I REAR 5' •pPALYNG VOW AS DES)'GW
(nP) ACTUAL LOCAhav A/AY VARY
II I •,%T ffEW TOW/NSW LED P&
arr CF ARL/NGT6W� STANDARD
- - - - - --� - L — — — — — — — — J L - - _ - - - -Z T fENLY 70BE/NSTALLE96W
N8970'49"W WA0/EHT SIDE 6►`WILLVNG
PARQ2
4500 �� •C6ws7PUc776w ENTRANCIF 70 BE
— — — — — — — - �- - - - - - - /NSTALLMPERaTr6F
TOP 457.8 I 5'B519L i i p/lpoEgTy ARL/NGTTW S STANDARDS
TOE 454.0
3.B EX/51/NC L1OPiVER STORM NOTES.
I I COW WR (TYP.) I I (TYP.) •TESL^INSTALLED PR/614 TO
/0 WALL/ NN 61GWS1RUCn6w
EASEA/ENT 5'80L I I •BARE SOILS COWRED W7H A/ULQY
I` PA AO 12 SF 5 BSB[rl I 4?AN07NM APPROVED aW
I I I I •7WSOIL PER M500E aW 75I3
5' 5 I ((EFT 12'DEPTH)
P ROOD OtFRHANG Imoo •ALL LWSYIE RUNOiF CDWNECTED TO
LOT 70 I -MEys AU BE SW PKIP
8 ITOP 45 Z B � - PRCPOSEO Rf3flO LE I TO BU/LUNG PE M#r BEING
TOE 454.0 PALIX--2514 Gvwr Rlovr aW I RNAU20
/'6mgr $ o ^ I SITE NOTES:
$ c I •77OWL/NE fW77NG DRAINS AND
aW GARAGE' �a O 1 RCS DRAINS 7D PERA/ANENT
\ ST61PA/DRA/NAX Sn7M P&
o = APPROVED PLAT DRAINAGE f'LAIV
cW ALE WH THE COUNTY.
p0 OUTLINE I •AREA 6F D/STURBAN6T INCLUDES
= E]VnRE LOT.
TOP 457.8 I 24.00
5 I f0'PUB
3.8 VC
TOE 454.0 I $ UTILITY LEGEND.
LEASEAa r BLOW Off
5'PRIVATE 471.S —- ® WATER A/ETEJP
STtA41/ AQ11I41Y1 r � « RRE HYDRANT
EAS9611T BMa AIR VAC
® CATal BASIN
- A 897GE'49V ' O afANOUT
• 4500 a i O MallOCE
4
- ® scoff WALL
169TH ST. NE �' TRLL REMOVAL
.` � CT ROW AND
0071, c MAINS WN6� j 4f0 SEP 1. 4 2017
wcyo
8'SENER Sr,ALE 1'=20' � I
Zmu
&WA0� LOT 70
E..
S/TEPLAN
i� GREGOR Y PARK
L GI HOMES PLAN NO. 14(I -
LOT AREA = 4,320 SF DATE 812312017 PARCEL # LOT 70
HOUSE = 1,679 SF 14711 NE 29fh PI-1 a 1 o I
DRIVEWAY= 471 SrCaE 9euerue,woshingron 98007 DESIGNED CORE ADDRESS ',�1"S�S9TH ST. NE
425.HE5.7 777 Fax 425.BH5.7963
WALKWAY11PAA0= 12 SF ��DE,I ,N PROJECT NUMBER
TOTAL= 2,162 SF
ENGINEERING , PLANNING • SURVEYING DRAWN CAF 13O24L-GRGOO
CITY OF ARLINGTON
238 N. OLYMPIC AVE-ARLINGTON, WA. 98223
PHONE; (360)403-3551
BUILDING PERMIT
Address:9003169th Street NE Permit#:1658
Parcel#:01166900007000 Valuation:309450.70
OWNER APPLICANT CONTRACTOR
Name:LGI HOMES-WASHINGTON LLC Name:LGI Homes-Washington,LLC Name:LGI Homes-Washington,LLC
Address: 1450 LAKE ROBBINS DR STE 430 Address:11410 NE 124th Street,Ste#103 Address: 11410 NE 124th Street,Ste#103
City,State Zip:THE WOODLANDS,TX 77380 City,State Zip:Kirkland,WA 98034 City,State Zip:Kirkland,WA 98034
Phone: Phone:425-785-0797 Phone:360-353-0588
MECHANICAL CONTRACTOR PLUMBING CONTRACTOR
Name: Name:
Address: Address:
City,State,Zip: City,State,Zip:
Phone: Phone:
LIC#: EXP: LIC#: EXP:
JOB DESCRIPTION
PERMIT TYPE: Single Family Residence CODE YEAR: 2015
STORIES: 2 CONST.TYPE: `/-$
DWELLING UNITS: I OCC GROUP: R-3
BUILDINGS: 1 OCC LOAD:
PERMIT APPROVAL
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION 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
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC110/IRC110.
SA.LESTAXNOTICE:Sales tax relating to construction and construction materials in the City of Arlington must be ported on your sales tax return form
a�dCi A.ington#0 01.
I
S' nature Print Name Date Released B Date
CONDITIONS
Adhere to approved plans.
THIS PERMIT AUTHORIZS ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY
CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION.
PERMIT FEES
Date Description Fee Amount
9/28/2017 Building Permit Fee $3,076.58
9/28/2017 Building Plan Review Fee $1,999.78
9/28/2017 Furnace $25.00
9/28/2017 Gas Outlets Base Fee 1 to 5 $10.00
9/28/2017 Mechanical Fee(Enter Fixture Fee) $25.00
9/28/2017 Mechanical Permit Base Fee $25.00
9/28/2017 Park-Community SF $1,662.00
9/28/2017 Plumbing Permit Base Fee $25.00
9/28/2017 Plumbing Permit Fee(Enter Fixture Fee) $192.00
9/28/2017 Processing/Technology Fee $25.00
9/28/2017 State Building Code Surcharge Fee $4.50
9/28/2017 Traffic Mitigation-City $3,355.00
9/28/2017 Water Heater $25.00
Total Due: $10,449.86
Total Payment: $0.00
Balance Due: S10,449.%
CALL FOR INSPECTIONS
BUILDING(360)403-3417
When calling for an in peetion please leave the following information:
Permit Number,Type of lnapection being requested.and whetheryou prefer morning or afternoon
Permit Information
Date 9/15/2017
Permit Number 1658
Project Name Gregory Park
Applicant Name LGI Homes-Washington,LLC
Applicant Address 11410 NE 124th Street,Ste#103
City,State,Zip Kirkland,WA 98034
Contact Matt Adams
Phone 425-785-0797
Email matt.adams@lgihomes.com
Permit Type Single Family Residence
Site Address 9003 169th Street NE
Valuation 309450.70
Status Applied
Permit Issued
Permit Expires
Square Feet 2894
Type of Construction/Occupancy Load V-B
Number of Stories 2
Proposed Use New SFR
Assigned To Kristin Foster
Property Information Owner Information
Parcel#:01166900007000 LGI HOMES-WASHINGTON LLC
LGI HOMES-WASHINGTON LLC 1450 LAKE ROBBINS DR STE 430
9003 169th Street NE THE WOODLANDS,TX 77380
Contractors
Contractor Name Primary Phone Email Contractor License License#
Contact Type
ILGI Homes-Washington,,Jake Jabusch .360-353- fake.jabusch@lgihomes.comCONTRACTOR i-abor and I-GIHOHL857M
LLC0588 Industries
Review
Date Type Description I Target Date Completed Date I Assigned To I Status
9/15/2017 Residential Dwelling 9/22/2017 fkmy Rusko 11n Review
9/15/2017 IlResidential Dwelling -9/22/2017 IRick Karns 11n Review
Fees
Fee Description Notes Amount
Building Permit Fee 322.10.00.00 $3,076.58
Building Plan Review Fee 345.83.00-00 $1,999.7
Furnace 322.10.00.00 $25.00
Gas Outlets Base Fee 1 to 5 322.10.00-00 $10.00
Mechanical Fee ffnter Fixture Fee) 322.10.00-00 $25.00
Mechanical Permit Base Fee 322.10.00.00 $25.00
Park-Community SF 345.85.00.0 $1,662.00
Plumbing Permit Base Fe 322.10.MOq $25.0
Plumbing Permit Fee(Enter Fixture Fee) 322.10.00.0 16 @$12 $192.0
Processing/Technology Fe 341.43.00.02 $25.0
State Building Code Surcharge Fee 386.00.01.0 $4.5
Traffic Mitigation-City 345-85-00,02 $3,355.0
Water Heater 322.10 00.00 $25.00
Totall $10,449.8
Notes
Date I Note
9/15/2017 Palix-Lot 70
Uploaded Files Upload File j
Date File Uploaded B
9/15/2017 4:21:16 PM 1658 Site Plan.pdf Foster,Kristin x
9/15/2017 4:21:16 PM 1658 Appiication.pdf Foster, Kristin x
6``Y RESIDENTIAL PERMIT APPLICATION
y
Department of Community&Economic Development
'AlING'`O City of Arlington • 18204 59th Ave NE •Arlington,WA 98223 • Phone (360)403-3551
THIS APPLICATION IS TO BE USED WHEN APPLYING FOR A NEW SINGLE-FAMILY, DUPLEX, TOWNHOUSE,
ADDITION, DECK,OR ACCESSORY STRUCTURES. THIS APPLICATION MUST BE ACCOMPANIED BY TWO(2)SETS
OF CONSTRUCTION DRAWINGS AND TWO(2)SETS OF STRUCTURAL CALCULATIONS. THE APPLICATION MUST
ALSO INCLUDE THE PLUMBING SUBMITTAL AND THE MECHANICAL SUBMITTAL FORMS. THE ZONING
VERIFICATION MAY
BE SUBMITTED PRIOR.
Project Address: !,07 101 t-Z,i,�x M� Plat: Z��(BIZ 1
Single-family ❑ Duplex ❑ Townhouse ❑ Addition ❑ Accessory structure
PMIyC
Proposed Area: 11 Floor: 101:�? - 2"d Floor: -1�� Garage: � � Total SF:
Describe Proposal (include cross street):
Valuation: ,�o? ,q5D . 70
Owner: L& L WL4,j -mj �
Address: lRD kVe,170U if�city: State: WTI Zip Code:
Phone: •7�• D-11-1 Email: Nt q
Applicant: W i'7A 1�
Address: City: State: Zip Code:
Phone: Email:
Contractor: VAZ--
Address: City: State: Zip Code:
Phone: �7�•'l�S • � � Email: MATT. kP U-21dum,5- . Ce
Contact Person: 't'1' L&u,5 License Number: Expiration: Z
Received
SEP 1. 4 2017
PAO III
6/16LP
Page 1 of 3
cs`" °�' RESIDENTIAL PERMIT APPLICATION
F
Department of Community&Economic Development
City of Arlington • 18204 59th Ave NE•Arlington, WA 98223 • Phone (360)403-3551
lr,'vell
Plumbing Section (continue filling out if plumbing is involved)
(Check all that apply and indicate the number of fixtures proposed)
Bath/Shower Combo (4.0) x Sink(1.5) x
Shower(2.0) x Lavatory(1.0) x
f) Clothes Washer(4.0) x [A- Water Closet(2.5) x
Dishwasher(1.5) x } Water Heater x j
Hose Bibb(2.5) x Water Heater Model#
Other(list) x
Plumbing Section Continued
Proposed Water Piping Size: Proposed DWV Material:
Proposed Piping Material: Proposed DWV Size:
• All hose bibs required to be equipped with Atmospheric Vacuum Breakers per ASSE 1019
• All water supplies at 80psi or greater shall have Pressure Reducing Valves (PRV)
6/16LP Page 2 of 3
0.6
YRESIDENTIAL PERMIT APPLICATION
Department of Community& Economic Development
City of Arlington • 18204 59th Ave NE •Arlington, WA 98223• Phone(360)403-3551
Mechanical Section (continue filling out if mechanical equipment is involved)
Select proposed appliances:
b1 Furnace(80+) Model# WYC_f tN;G 3 53 aK AFUE
❑ Heat Pump Model# SEER HSPE
❑ AC Unit Model# SEER
❑ Type II Hood ❑ Commercial Cooking Appliance Q Hydronic Piping
❑ Boiler Solid-Fuel Appliance LA PV System
❑ Fireplace Insert Outdoor BBQ Storage Tank
Freestanding Stove Gas Piping Other
Gas Piping Information
Not Applicable:
�q ZD Pipe Material: ��L Pipe Size: �Total BTU's of all Appliances: I I owb
Distance from Meter to Furthest Appliance: ID,
• New gas piping requires a pressure test to hooking to any appliance
• Sediment traps(drips) are required on all gas lines
• Gas lines are required to be supported/secured every 6 to 8 feet
• Proper combustion air and venting required for all appliances
A shut-off is required within 6 feet of all appliances
Applicant Signature: < Date: S �2-It
Print Applicants Name:
6/16LP Page 3 of 3
TERRA ASSOCIATES, Inc.
• Consultants in Geotechnical Engineering, Geology
and
Environmental Earth Sciences
FOOTING EXCAVATION OBSERVATION REPORT
DATE FOOTINGS OBSERVED: 11-15-17 PROJECT NO.: T-5753-5
PROJECT NAME: Stonebrook PROJECT LOCATION: Arlington,WA
CONTRACTOR: LGI Homes REPRESENTATIVE: Les
DESCRIPTION COVERED BY THIS REPORT: Foundation for lot 70
FOOTING EXCAVATION FIELD CONDITIONS NOTED
Approximately 6"— 12" deep Exposed at the bottom of the excavation we observed
dense brown silty sand with gravel.
Soils appear firm and compact.
NOTES: Soil conditions observed are consistent with those expected and are suitable for support of
foundations designed for an allowable bearing capacity of 2,500 pounds per square foot(psf).
Our representative has observed only the footing excavations listed above. The results of this observation are only
valid for a period of 48 hours. If any change in the subgrade occurs,we should be promptly notified.Any loosened
soils observed in foundation areas due to construction activity or rainfall should be removed prior to concrete
placement.
ICG1CeIJi BSI Vmv1. COPY TO:
SIGNATURE
Kacey Simon
TERRA ASSOCIATES REPRESENTATIVE
iqr7 wT4 C:T:;,
12220 - 113th Avenue NE, Suite 130, Kirkland, Washington, 98034 ♦ Telephone No. (425) 821-7777
Date: 04/10/2026
Permit#: 1658
Permit Date: 09/15/2017
Review Date: 09/15/2017
Perm it Type: RESIDENTIAL SINGLE FAMILY
Review Type: RESIDENTIAL SINGLE FAMILY
Target Date: 09/22/2017
Scheduled Time 00:00
Com pleted Date: 09/18/2017
Description: Site plan m xts all setback requirem acts.
Review Status:
Assigned To:
Tim eln: 00:00
Time O it: 00:00
H curs: 0.0
Property Information
Parcel#: 01166900007000 L GI HOMES -WASHINGTON LLC
LGI HOMES -WASHINGTON LLC 1 450 LAKE ROBBINS DR STE 430
9003 169th Street NE T HE WOODLANDS, TX 77380
Zoning: 111 Single Fam iy Residence -
DetachedLot: 70131ock:
Permit#: 1658
Permit Date: 09/15/17
Permit Type: RESIDENTIAL SINGLE FAMILY
Project Nam e Gregory Park
Applicant Nam a LGI Horn cs -Washington, LLC
Applicant Address: 11410 NE 124th Street, Ste #103
Applicant, City, State, Zip: Kirkland,WA98034
Contact: Matt Adam s
Phone: 425-785-0797
Em al: m at.adam s@lgihom cs.com
Scope of Work: New SFR
Valuation: 309450.70
Square Feet: 2894
Num ber of Stories: 2
Construction Type:
O xupancy G ioup:
ID Code:
Permit Issued: 10/11/2017
Permit Expires:
Form Permit Type:
Status: LASERFICHE
Assigned To: Kristin Foster
Property
Parcel# Address L egal Description O wrier Nam e Ovner Phone Zoning
LGI HOMES-
01166900007000 9 003 169th Street NE WASHINGTON Residence
Single Dam iy
-Detached
LLC
Contractors
Contractor P rim ay Contact P hone A ddress C ontractor Type L icense License#
LGI HOMES- 12951 BELRED CONSTRUCTION Labor and LGIHOHL857MB
WASHINGTON LLC RD#150 CONTRACTOR Industries
Inspections
Date I nspection Type D escription S cheduled Date C om Iieted Date I nspector S tatus
11/14/2017 R20.SFR/DUPLEX 02/21/2018 C omlieted
FINAL
Plan Reviews
Date R eview Type D escription A ssigned To R eview Status
09/15/2017 RESIDENTIAL SINGLE Site plan m e is all setback requirem acts.
FAMILY
09/15/2017 RESIDENTIAL SINGLE z.Rick Karns
FAMILY
Fees
Fee D escription N otes A m cunt
Building Perm i T able 4-1 $3,076.58
Building Plan Review T able 4-2 $1,999.78
Forced Air Heat f ee per Btu $25.00
Gas Piping/Units E nter#of units $10.00
Mechanical Fee(Enter Fixture Fee) $25.00
Mechanical Base P erm i Fee $25.00
Park-Com m nity SF S ingle Fam iy $1,662.00
Plum hng Base Perm i Fee $25.00
M echanical Com m mial Perm i T able 4-7;Per Unit 1 6 @$12 $192.00
Processing/Technology $25.00
State Surcharge- 1 st DU R esidential- 1 st Unit $4.50
Traffic Mitigation-SF S ingle Fam iy $3,355.00
Wier Heater(Tank) $25.00
Total $10,449.86
Attached Letters
Date Letter D escription
09/28/2017 Building Perm i
Paym arts
Date Paid By D escription P aym a►t Type A ccepted By A m aunt
10/02/2017 LGI Hom e; c heck#5557 L auna Black $1,999.78
10/02/2017 LGI Hom e; c heck#5558 L auna Black $8,450.08
O itstanding Balance $0.00
Notes
Date Note C reated By:
09/15/2017 Palix-Lot 70 Kristin Foster
Uploaded Files
Date File Nam e
11/20/2017 2788764-1658 Footing Excavation Report.pdf
10/11/2017 2692561-1658 Issued Perm i.pdf
09/15/2017 2608854-1658 Application.pdf
09/15/2017 2608855-1658 Site Plan.pdf
Permit#: 1658
Permit Date: 09/15/17
Permit Type: RESIDENTIAL SINGLE FAMILY
Project Nam e Gregory Park
Applicant Nam a LGI Horn cs -Washington, LLC
Applicant Address: 11410 NE 124th Street, Ste #103
Applicant, City, State, Zip: Kirkland,WA98034
Contact: Matt Adam s
Phone: 425-785-0797
Em al: m at.adam s@lgihom cs.com
Scope of Work: New SFR
Valuation: 309450.70
Square Feet: 2894
Num ber of Stories: 2
Construction Type:
O xupancy G ioup:
ID Code:
Permit Issued: 10/11/2017
Permit Expires:
Form Permit Type:
Status: LASERFICHE
Assigned To: Kristin Foster
Property
Parcel# Address L egal Description O wrier Nam e Ovner Phone Zoning
LGI HOMES-
01166900007000 9 003 169th Street NE WASHINGTON Residence
Single Dam iy
-Detached
LLC
Contractors
Contractor P rim ay Contact P hone A ddress C ontractor Type L icense License#
LGI HOMES- 12951 BELRED CONSTRUCTION Labor and LGIHOHL857MB
WASHINGTON LLC RD#150 CONTRACTOR Industries
Inspections
Date I nspection Type D escription S cheduled Date C om Iieted Date I nspector S tatus
11/14/2017 R20.SFR/DUPLEX 02/21/2018 C omlieted
FINAL
Plan Reviews
Date R eview Type D escription A ssigned To R eview Status
09/15/2017 RESIDENTIAL SINGLE Site plan m e is all setback requirem acts.
FAMILY
09/15/2017 RESIDENTIAL SINGLE z.Rick Karns
FAMILY
Fees
Fee D escription N otes A m cunt
Building Perm i T able 4-1 $3,076.58
Building Plan Review T able 4-2 $1,999.78
Forced Air Heat f ee per Btu $25.00
Gas Piping/Units E nter#of units $10.00
Mechanical Fee(Enter Fixture Fee) $25.00
Mechanical Base P erm i Fee $25.00
Park-Com m nity SF S ingle Fam iy $1,662.00
Plum hng Base Perm i Fee $25.00
M echanical Com m mial Perm i T able 4-7;Per Unit 1 6 @$12 $192.00
Processing/Technology $25.00
State Surcharge- 1 st DU R esidential- 1 st Unit $4.50
Traffic Mitigation-SF S ingle Fam iy $3,355.00
Wier Heater(Tank) $25.00
Total $10,449.86
Attached Letters
Date Letter D escription
09/28/2017 Building Perm i
Paym arts
Date Paid By D escription P aym a►t Type A ccepted By A m aunt
10/02/2017 LGI Hom e; c heck#5557 L auna Black $1,999.78
10/02/2017 LGI Hom e; c heck#5558 L auna Black $8,450.08
O itstanding Balance $0.00
Notes
Date Note C reated By:
09/15/2017 Palix-Lot 70 Kristin Foster
Uploaded Files
Date File Nam e
11/20/2017 2788764-1658 Footing Excavation Report.pdf
10/11/2017 2692561-1658 Issued Perm i.pdf
09/15/2017 2608854-1658 Application.pdf
09/15/2017 2608855-1658 Site Plan.pdf