1004 OLYMPIC AVE.PDF1004 OLYMPIC AVE
CITY OF EDMONDS - SIDE SEWER PERMIT
�j. WATER -SEWER DEPARTMENT
PERMIT ''a
Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.1
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections./
ADDRESS LOCATION OF CONSTRUCTION.......... c�`�a .. �1..r. evl�, �79.1.............. 9. A. ............................. .........
PROPERTYLEGAL DESCRIPTION.................................................................................................................................................•-•-----..............................
...............................................................................................sc......---•G'?.Q....-.. cc. n.....
................................................................OWNER AND/OR BUILDER ......... tu.��...`.�
....... . !a!o.K�Ik�lc "-: ..............---•---•--•-......-----................--•-
CONTRACTOR'S NAME & ADDRESS ... .....-. ,-.. ?"-- ...... ?ft.S^ .4' �.-........
rQ� _-----------------------•---......._..•--•-----...............-----------------------------
Permission is granted ..... r.� ..9. ............................ 19� , for repair and/or connection of a side sewer to the city sanitary sewer
sM in accordance with City of Edmonds ordinances.
A NTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The. owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer hefbre it has been inspected.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%. No bends in grade
sharper than 1/s will be permitted.
NOTE No. 5—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6—It is unlawful to alter or do any other work than is provided for in the permit, or to do any w6rk on the main sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED0 Date ... _................................... By....------...... Date.-- . ..................... By ----------------- Date ............... -................... By ................
APPROVED0Date... .-F-. ..'... ...................... By... ........ ... ...... ....._...................................................................................
Remarks: .....
c� 1. s .... .. C 0
•.................••••..4�----------!.-........_--•---"----........--•--........--------------------•--••-•-••••••------•-•••-•.....---------......
— BOTF-I P Iit Codes *ST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection —
..-................... hereby certify that the side sewer installation constructed under this permit
Owner of Co ing Firm P crming Construction)
Sale in accord c with all erning ordinances of the City of Edmonds.
Dated this ...... I..Cl............. day of........
.................................... 19-
J J Check BEFORE you dig for: Water ❑, Gas p, Telephone Power Sewer Other ❑ J J
APPLICATION
The'lCity of Edmonds
for EASEMENT NO- ---------- ---------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION ❑ REPAIRS ■ LID NO- ------------------ ASMT. NO. -----------------.
R��►t� o�v LY
OWNER ...... ------------------------------------- CONTRACTOR ---------- PERMIT NO.
JOB ADDRESS IOL"��__-_C�YMF?IG_-I�V11 1'E=, LEGAL DESCRIPTION: LOT NO- -------------------------------------- BLOCK NO. ------------------ .--_.--_--_----.-.
OFADDITION -----------------------------------------------------------------------------------------------------------------------
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Approved: <�
DATE S- l0- LQ... By
11/T5
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTIONS REPAIRS
EASEMENTNO- ------ ------------------ ------------------
LID NO- ------------------ AsmT. NO. ------------------
0 . ................ -----------
OWNER --- -------- . ...... .... CONTRACTOR --- rj�/.575 PERMIT NO.
JOA ADDRESS .. --- 6�--/4 --------- 0 LEGAL DESCRIPTION: LOT NO. ------------------------ --------- BLOCK NO. ------------ -----------------------
lr'c" //c
DATE-------------------------------------------- By --------------------------------------------------- yjyjrg
PLANNING DATA
NAME: � C/
DaVl /✓'L
SITE ADDRESS: y u r t� DATE:
ZONING: �� _ lZ PLAN CHK#: �� 2
PROJECT DESC✓RIPTION:
CORNER LOT !^/b (Yes/No) FLAG LOT VO (Yes/No)
SETBACKS: zoo
Required Setbacks:
Front: 2-3 r Left Side: ° Right'Side: I o Rear:
Actual Setbacks: / �4✓e� / �` ;�' ,
Front:"�K _i_eft�i e!�,� _jd' Right Side: _Rear:_6U _
Street map checked for a6fo�' I setback required? — (Yes/No)
LEGAL NONCONFORMING LAND USE TION ISSUED Y/N
LOT COVERAGE:
Maximum Allowed: 3 ��� Actual: s s {, 3 5� J
BUILDING HEIGHT: � _ � / ` � LP
Maximum Allowed: Actual Height: 7' I
Datum Point: Datum Elevation:
A.D.0'CREATED?: /f/G
SUBDIVISION:
CRITICAL AREAS #: Ch _ f 7- /gz,- V A I ✓M .
SEPA DETERMINATION: � kr-
LOT AREA:
OTHER:
Plan Review By: �s� /Ov TO, 1.O7
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City, of Edmonds }}
_ I
RIGHT OF -WAY CONSTRUCTION
PERMIT peat Number:
Issue Date: ?- L2I/P
A. Address or Vicinity of Construction: 1()24Q I ,,t ln,gpi• r �t p
I 0 B. Type of work (be specific): }��, �"� � 1' 61 S'r u.x r M LUsc
Inc. . 1.8 9 �
C. Contractor: n A ., �/� r, /N� Contact: S M G
Mailing Address: � K LAAln� a e�Jtf �1Ph§ne: a 0 t/
State License #,S M A t ' C& I q l L Liability Insurance: Bond: $
D. Building Permit # (if applicable): q 1n(2!Q- "7 Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project [:I Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family] Single Fa •ly ❑ Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: ❑ Yes NFINo G. Size of Cut: x H. Charge $
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmless from injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the defense of any legal proceedings including defense costs and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Two sets of construction drawings of proposed work required with permit application.
A 24 hour notice is required for inspection. Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to. be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
1 have read the above statements and understand the permit requirements and the pink copy of the permit will be
available on site at all times for inspection purposes.
• i
Signature:
e,
Date: a /a S-/ y �
CALL DIAL-A=DIG PRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
OCT-08-97 WED 09:19 MALONEY ARCHITECTS 206 623 1105 P.O2
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OCT - 9 1997
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City of dr ondS
Critical -Areas Checklist
1u.
The Critical Areas Checklist contained
on this form is to be filled out by any
person preparing a Development Permit
Application for the City of Edmonds
prior to his/her submittal of a
development permit to the Gty_
The purpose of the Checklist is to enable
City staff to determine whether any
potential Critical Areas are or may be
present on the subject property. The
irdormation needed to complete the
Checklist should be easily available
from observations of the site or data
available at City Hall (Critical Areas
inventories, maps, or soil surveys).
An applicant, or his/her representative,
'rust pill out the checklist, sign and. date
it, and submit it to the City. The City
will review the checklist, snake a
precursory site visit, and make a
determination of the subsequent steps
necessary to complete a development
permit application,
With a signed copy of this form, the
applicant should also submit a vicinity
map or plot plan for individual lots of
the parcel with Enough detail that City
staff can find and identify the subject
parcel(s). In addition, the applicant
shall include other pertinent
information (e.g. site plan, topography
map, etc.) or studies in: conjunction
w1fh this Checklist to assist staff in
completing their prellininary
assessment of the site.
I have completed the attached Critical. Area Checklist and attest that the answers
provided are factual, to the best of my knowledge (fill out the appropriate column
below),
Owner/ Applicant:
VJA * 5—
City, Stace, ZIP phone
Applicant Representative:
�l4'ul. �d i mow, td we �/rt�, v'TCGT-tea
St xit Address
City, Statel, Zip Phone
4
9A&
SEP-16-97 TUE 09:58 MALONEY ARCHITECTS 206 623 110 P.04
CA FILE NO �J
Critical Areas Cheddist
---.---.-------------------.------•-------------- =---------------�-----
Site Information (soils/topography/hydrology/vegetation)
1. Site Addreao/Location: QOGA t't
2. Piopetty Tax Account Number; 5' 9 • bdb • Q;.D • o 164.
3. Approximate Site Size (acres or square feet):o ,'°j t �i-• s.�fr
4. Is this site currently developed? dyes, no.
If yes; haw is site developed? I 4D rv, . (z
5. Describe the general site topography. Cheek all that apply. (Os+�*r«�•e.�
Flat: less than 5-feet elevation change over entire site.
.` Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more Shan 15% and less than 30% (a vertical
rise of 10-,feet ova a horr1'�ontal distance of 33 to 66-feet).
._XAt W04+ prop. iiwe, • k�tts "T..4 ; IK ptw.cc. Ott •si-
Sheep: grades of greater titan 30% present on. site (a vertical rise of 10-feet over
a horizontal distance of less than 33-feet)_
Otlier (please describe): -
6. Site contains areas of year-round standing water: 0 ; Approx. Depth:
7. Site contains areas of seasonal sUuuling water. U a ; Approx. Depth:
What season(s) of the year? —
8. Site is in, the floodway t t8 floodplain_ of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are
year-round? - Flows are seasonal? (What time of year? ),
10. Site is primarily: forested _ ; meadow : shrubs : mixed
urban landscaped (lawn,shrubs etc) _
11, Obvious wetland is present on site: _ 40
—T--� ---For City Staff Use only---.
L Site i5 Zoned.? -- . IZ 4. _- .1,Z.: oco .
2. SCS mapped soft tvpe(s)? ,,-:,on �- (�.;�� . 4.. �c ►-� I - �� S
3. Wetland inventory cr C_A.. uiaOndkates wetland present on . `/fit
4. critical Areas inventoryor C.A;. map ihdicatzs Critical Area on site? Vn l�,
5- ' Si.te.within designated hazjrd, area?'
6- Site designated on the En..vironmezttatty Sem" tive Arum lviap?,
`Ujhk&a Axv 02111 f97
PLANNING DATA
NAME: LLlocl§ 4
SITE ADDRESS: /Oo DATE:
ZONING: �S^�L PLAN CHK#- 97- 3111
CORNER LOT %A (Yes/No) FLAG LOT lob (Yes/No)
SETBACKS:
Required Setbacks:
Front: 25 Left Side: i° Right Side: / o Rear: 2 S
Actual Setbacks:
Front: • 70 Left Side: �u Right Side: 145 Rear: 5�
Street map checked for additional setback required? -- (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
Zlv�9/c
LOT COVERAGE:
Maximum Allowed: S Actual: 3 �.
BUILDING HEIGHT:
Maximum Allowed: Z Actual Height:
Datum Point: CW vd- 1-4.4 tii✓Datum Elevation: 100
A.D.U. CREATED?: N
SUBDIVISION:
CRITICAL AREAS #: � 7— 4'z ' -Z✓fdi m -.
SEPA DETERMINATION: �rC,P7
LOT AREA: 'L � , `I1 `I i�'
�f
OTHER:
Plan Review By: —J A -so, 2r�LcrT
c:V ilas\permit\^plandat.doc
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:. City of. Edmonds
RIGHT-OF-WAY CONSTRUCTION
i i� �xfY , PERMIT
Inc. --1890
A. Address or Vicinii ;-of Construction:
Permit Number.
�;. Issue Date:
1004 Olympic Av
B. Type of work (be'specif►c): Install service (9805619 )
C. Contractor:. PUGET SOUND ENERGY Contact: Doug Usitalo
Mailing Address:1122 75th ST SW Everett Phone: £(425) 356-7520
State License #: 98203 Liability Insurance: Bond: $
4
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ~ ❑ Subdivision ❑ City Project ® UtilIty (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other f
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: Yes []No G. �SiI Cut: 3 x 54 H. Charge $
APPLICANT TO READ AND SIGe X
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmless from injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the defense of any legal proceedings including defense costs and allorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
p
Two sets of construction drawings of proposed work required with permit application.
A 24 hour notice is required for inspection. Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to, be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut trench work shall be patched with asphalt or City approved material prior to the end of the working day;.
NO EXCEPTIONS.
I have read the above statements and understand the permit,requirements and the pink copy of the permit will be.
available on site at all times for inspection purposes.
Signature: Pk a'0 Date: 2%26/98
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
FIELD INSPECTION NOTES (Fund 111.- Route copy to Street Dept.)
Comments• .
CONTRACTOR CALLED 'FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
------------------------------ NOTES ---------------------------- ----
1. CALL 2 DAYS BEFORE YOU DIG 1-800-424-5555
2. CITY OF EDMONDS:
• Maintain a minimum of 5' horizontal
and 3' vertical clearance from all
city utilities and appurtenances.
• Cuts in paving are shown as
1 cuts in paving anticipated (in R.O.W.)
♦ Notify Engineering Division 24 hrs
prior to construction - 425-771-0220
3. PAVING SHOWN IS APPROXIMATE
i
4. PROJECT MANAGER: DOUG USITALO - 425-356-7520
No.
DESCRIPTION
DATE
BY
APP'D
REVISIONS
AS BUILT, INFORMATION
FITTER OR CONTRACTOR:
COORDINATOR:
F
DATE COMPLETED:
PERCENT COMPLETED:
E
L
TEST
INSTALLATION/RETIREMENT
SUMMARY
TYPE OF TEST:
PRESSURE:
I/R
MAIN SIZE
MATERIAL
TOTAL FOOTAGE
DATE ON:
TIME ON:
D
DATE OFF:
TIME OFF:
TYPE OF PIPE:
PIPE MANUFACTURER:
TESTED BY:
1�4"
MPi✓
3ZS�
P U G E T
SOUND
ENERGY
OP MAP: I (v O . &Z
PLAT MAP: 161. ou -i
,� SEC: N e - Z4 - 2
WORK AREA: 1131
PROPOSED MAIN FOOTAGE
EMERGENCY SEC. #:
MAIN SIZE
MATERIAL
TOTAL FOOTAGE
DESIGN PRESSURE: _psig
D
SYSTEM MAOP psig
psig
E
PERMITS: E)>MOND.S
S
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MPS ��CTH
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DRAWN: T DD 2 0/95
JOB # 9906U19 DGR: 3 -16 -98
--
CHECKED: //
APPRO ED: CC'� I� S I�
DRAWING#
6056
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u PERMIT , .-r I" .... -7 �.
ZONE NUMBER
CONSTRUCTION :;.PERMIT APPLICATION IDB su1TE/APTp
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ADDRESS , it / /" I �,V g4 .
OWNER NAME/NAME'OF,BUSINESS u
1. ,fr.$� 0`'Gt;1,0LEGAL DESCRIPTION.CHECK iSUBDIVISION..NO LIQ NO
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CITY ZIP TELEPHONE NUMBER RW PermH Requved i O'
r r+� +�}' �g EXISTING. REOUIREb�DEDICATION rSlreet Use Permit PeQ,d O
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employees,,and agents from any and ;all olafms for damages.of l
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state laws regulating cfori truction 'arid do{ng,'the work+atithoriz AUTHORIZESsign the'Building ;OffiaaI orfiis/her
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SIGNAaTURE IOW,NER O :A EN - DATE SIGNED DEPARTMENT rgLS gIGNATU DA .�.
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A CERTIFICATE .. OF OCCUPANCY 'HAS BEEN' GRANTED:: UBC' PINK —Owner G LD —Assessor
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STATE SURCHARGE
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Permit Application:180 Days
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TOTAL AMOUNT DUE
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provision." - -
I hereby acknowledge that I have read this application; that the
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authorized agent of the owner. I agree to comply with city and THIS PERMIT This application is not a permit until
state laws regulating construction; and in doing the work authoriz• AUTHORIZES
ed thereby, no person will be employed In violation of the Labor ONLY THE signed by the. Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa• WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance aria RCW 18.27. INSPECTION acknowledged in space provided.
SIGNATURE ( ER OR AGENT) DATE SIGNED DEPARTMENT
6 CITY OF O"!SIGN i A TIE
EDMONDS [
ATTENTION CALL FOR ELEA T
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 0220
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771 ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109 PINK = Owner GOLD — Assessor
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CITY.OF EDMONDS
USE PERMIT
ZONE NUMBER 960441
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This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit:1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
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successors in interest, agrees to indemnify, defend and hold
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harmless the City of Edmonds, Washington, its officials,
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employees, and agents from any and all claims for damages of
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PLAN CHECK DE OSIT
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modify, waive or reduce any requirement of any city ordinance
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nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUErl
'
I hereby acknowledge that I have read this application; that the
Information . given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. 1 agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authoriz- AUTHORIZES This application is not a permit until
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
ion Insurance aria RCW 18.27.
l�I'cknowledged i space provided.
INSPECTION
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UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
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