16219 70TH PL W.PDF111111111111
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16219 70TH PL W
SPECIAL INSPECTIONS HAVE BEEN CALLED FOR ON THIS PROJECT AND
ARE NOTED ON THE APPROVED CONSTRUCTION PLANS AND BUILDING
PERMIT IT. IT IS THE OWNER AND/OR CONTRACTORS RESPONSIBILITY
TO ASSURE THAT REPORTS ARE PROVIDED TO THE CITY IN A TE%IELY
MANNER BE ADVISED --IF SPECIAL INSPECTION REPORTS ARE NOT
FORTHCOMING, THE BUILDING OFFICIAL MAY ISSUE A STOP WORK
AND NO CITY INSPECTIONS WILL BE PROVIDED UNTIL SUCH TIME AS
THE REPORTING - AGENT HAS- --COMPLIED-AND-.1&PORTS-._ARE
REVIEWED AND APPROVED BY THE CITY.
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FROM : J. Keith Cross, P,E. AUG.19.1998 10:04 AM P 2
J. KEITH CROSS, P.E,
Gooteohnical Engineering Consultant
(206) 820-0951
9210 ONE 130 atr* Igrl WW, Wamhgon 08034187E
August 18,1998
1Ron 6219 STREET FILE
6270th Piano W Edmonds, Washington 08028
Preliminary $Its Reconnaissance and deatechnical Engineering Assessments, Foundation
Support Considerations, Proposed Deck Replacement, 16219 70th Place W, Edmonds,
Washington Project No. 9332-001
This letter Is prepared to summarize the results of an Initial geotechnical assessment conducted
for Conceptual foundation support considerations for re -construction of the deck system off the
northeast comer of your residence at the above referenced site, The subject deck has
deteriorated and Is In need of repair to reduce the risk of injury, Based on our discussions during
MY Site visit of August 7, 1998, your contractor (Deck Crafters) has proposed to add a couple of
supports and replace questionably founded existing footings. During my site visit, I observed that
the house had been constructed on the upper portion of the north facing slope. No readily
observable significant cracks were noticed In the house foundation In the deck area or reported by
you In other areas. Timber landscaping walls showed signs of deterioration and there were
Indications of fill placed on the slope, probably during the house construction. Probing the ground
around the area of the deck suggested that there were areas underlain at shallow depth (less than
one foot) where glacially densifred soils are likely to be encountered, and other areas where looser
fill appeared to overly the glacially dsnsifred, soils.
The existing deck foundations have provided a nominal Level of support performance since they
were Installed (probably at the time of construction of the house). It would generally appear that
spread footings founded on the glacially densitied soils would provide performance somewhat
better than the performance experienced with the current footing system. Allowable bearing
pressures in the 1.000 to 2,000 psf range are expected to be applicable for a first pass design, to
be verified and adjusted when the excavations are made. Alternatively, 2-inch diameter pipe piles
are sometimes used In areas where the glacially deneified soils are encountered on slopes at
depths greater than a couple of feet. These pipe piles are generally considered capable of vertical
design loads of 2 tons each. Although the lateral capacity of these small diameter pipe piles is
limited, they have performed moderately well in situations where the lateral loadings have not been
particularly severe.
. FROM : J. Keith Cross, P, E. RUG. 19. 1998 10:05 AM P 3
�1 Letter to Ron Gailis
r " Project No. 9332-001
August 18, IM
Page 2
We discussed that you desire to retain my services to be on site to monitor either the spread
footing preparation or the installation of the small diameter pipe plies to determine that foundation
support has been attained for support performance better than the current deck support footings.
am willing to observe the ground conditions for footing preparation or pipe pile Installation on this
project at my customary billing rate. During my site visit observations, during the foundation
construction, I will make and document specific recommendations and Installation observations for
the various foundation support locations. It will be necessary for your designer to provide me with
the specific loads at each deck column location.
I have prepared this letter for use by Ron Gailis and his agents for use In planning and design of
the development at this lot. The data and report should be provided to prospective contractors for
their bidding and estimating purposes, but my report conclusions and Interpretations should not be
construed as a warranty of subgrade conditions. There are possible variations In subsurface
conditions.
The scope of my work does not Include services related to construction safety precautions, and my
recommendatlons are not Intended to direct the contractor's methods, techniques, sequences or
procedures, except as specifically described in our report for consideration In design.
Within the limitations of scope, schedule and budget for my work, I warrant that my work has been
done In accordance with generally accepted practices followed in this area at the time the report
was prepared. No other warranty, expressed or Implied, is made. If there are any questions
concerning this report or if I can provide additional services, please call.
Yours very truly,
Z.
J. Keith Cross, P.E.
1141Fa
J. KEITH CROSS, RE, 020 NE130 Street, Mland, Washington 090341s?s
\• €�„xT fin+ .p � • k: r ' • '� � � � ) _ s ..�,�, {�'�-M,�' r r }. �.
CITY, -'OAF "IE' �1'M;O�N1DSi - fS;I�D;E rS'E�WER� :1PERNI�ITw
Y !
✓A'TER-SEWER 'DEEARTMENTI � �
REE
�� ♦2t r"' - .F CatlI 77R 2825 for .side sewer 'inapectlimer BEFORE'
covering, any ;portion -of the- construction 11
�tInspectlon will be provided wlthlm.2t hourat after`requst:`.•NO Sat.,�3Sun ,for �holid ay,'llnspectlons / - _
ADDRESS LOCATION�tOF CONSTRUCTION..
i� �P, {s.' OP`4ER, •,T,,. law fi�.,..- s . ... - .' r. • L-.
,
MRmEA',DESCRIION............................................................YL?P-. ................ ..... .. ..- .... ...
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:. .:..O.WNER'.AN•D/ORi'BUILDER:.....-. (i1-}................................l�� (t1P-.-G�n. 11
Brlh Akl�n
CUNrTRt>;CTOR(S�N✓AMEi 8 ADDRESS:- ... ..-- ... ..... }
ti :,
V4ermission�s granted �5� u•a��:...:�......, ,...., 19 a.7for, repair',andyor iconnecttom of'la. side sewer ito afier,clty/ sanitary se
i 'Stem+inaaecordanceiwith City:of Edmondsi ordinances
A� r NTION IS' CALLED TOi THE FOLLOWING
NOTEINo 1'i�Thetto,wneras}ofrthe,,property,-may,-obtain,a•.permit :to„construct. sewer, iinside,property"aline.; Ailicensed' Side Sewer Cont1.ractor<muati_be+,employedl)fo?'conafr
side Tsewer;ln;streetarea:;-•Do;not;coyer,any••portlon,of,sewer before it •hasrbeen;inspected!, ]
t NOTElNo•:;2—AllAwork performed in,•city,�rlght-of-way,.7cqufres•'an;InbazionoC"RJght-of Way-�Pernilt.,obfalnable4from�.-the�City Engineerstoffice }
4�01TEFNo' ;3=0btalnl fuih:lnformation• -'egi rding; Ordinance 11t16:030: and- Regulations governing, side: sewerecwhen you get permltij. '.
f NOTEf No- (4,-Toploftislde iaewer musiv_have'at.least':30; inches --coverage: at -'property, line a.nds;12 inches.1 side'property, line minimum gradai,of '2:q •,No' ibenda>dm is
�harper`than Ffi.wlll beipermltted:' .". " t!
NOTE No-.'S--Trenches,Imstreet mustitbe water settled?,and4surface:,of street; restored to.loifglnal��condition. Contractors.,shall.,be�.'responsible,for',fallure�1due!'to),improl
-" work"�whlch'e may develop within, one,, year of, coinpletion' i - ^' - - ' -- .-• - -' -1
r NOTEF�No -6-It, isl+tinlawfull.fo alter•ocdo. any: other work- than is- provided', for in -the permit; or to do'. any. work on -the. maim •sewer or its' appurtenancesZ a ept to;
y y dsertnthe pipelnlo the wye, 1
`tDISiAFPPRO�'EDy.'�f Date By...... Date ��/f .-..-... By.:.. ..... .Date :.. By
r 'i E 7 Date 9 : G �i� By �y/
a
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".:Remarks a • ........... r� .
........ ......... ... ..� ....... ••.. .......
- BOTH4'Permlt +Cow, iVl'UST9 Be Signed' By:Awnei of Fir-m Performing Constriction•, PRIUR'Ta'Request'rFor.Inspection
�r `"� ...... hereby:•,certify"that,,the sideaewer�installatlon!.constructed�,urider,thlsi-perm
k
`•: ` (Owner of_ Contracting Firm Performing• Construction)
nstalled�m{accordance with.•all governing^ordiliances of the City of Edmonds
:�Datedt this day, lof _..., 1i9
�.�
t� Checkf BEFORE you+•dig for:, Water'.0, - Gas ,Telephone+ Ej,; 'Power E]; ;Sewer iOther' J� Jr
APPLICATION
STREET FILE �r
The � City of Edmond SIDE SEYVER PERMIT EASEMENT NO- --------------------------------------------
NEW CONSTRUCTION REPAIRS ❑ LID NO- ------------------ ASMT. NO. ------------------
OWNER 12- �' 1 r /- r� 0-------------------------- CONTRACTOR 13Q�----- ------------------------- ---------------------- PERMIT NO. 7 0
JOB ADDRESS ..--Aty® �`' - LEGAL DESCRIPTION: LOT NO. - BLOCK NO-------------------------------------
Al
a
---------------------------------------------------------------------------------------------------------------------------------------------------------------------
NAME OF ADDITION 5.'Z',SI_�------� '..
Approved:
DATE ---------------- -------- -------------------- BY--------------------------------------------------ns i�
------•-
APPLICATION
.kT,-,,�,. for
The City of Edmonds � t, 4"(;�' ��� SIDE SEWER PERMIT EASEMENT NO_ ____________________________________________
e t- �
NEW CONSTRUCTION REPAIRS ❑ LID NO . .................. . ASMT. NO. __-_-_____-_-.____
OWNER ............¢-�-►LLD►.N�____ �1P 1�1Y.. CONTRACTOR __E30F�__.. �'-�?�N._.__OiCS 3 ------ PERMIT NO.
JOB ADDRESS-_!-<ZZg.-- T" .. F.L-61=._�... SST____ LEGAL DESCRIPTION: LOT NO. ____________8....__._....._.._... BLOCK NO. __-_-__-__________-__-___-_________.
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NAME OF ADDITION IT------ V_lE---\N.--- 4F.r2--------------•---------•---......_..-----..
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.
1v1H-
AMW ARA
CITY np EDMONDS
• ENGINEERING DEPARTMENT •
STREET FILE
APPLICATION FOR RIGHT-OF-14AY miSTRUCTION PERMIT
to Cc:7?vlete A & B rzxd Subt-tit in CUD`cate)
A. Permit to be Is s ted to
For work at: (address or vicl It Z
Type of work to bi! do-,1(j: le
Z__�v , ' - . / )' ' _ _ C�_
(Attach Dral-ing Anplicable).
Time Required Start: F 1 1-111 ENGIN
..x .1 il I 11 1 C d 1)"',
Name Z
Mai.ling Address j �; nl�rks___ _ _
City, State Telephone llttmb�
Contractor:
flame State License Numhe'r.
Mailing Address
City State Telephone Number
B., INDE''!`-'ITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including but not limited to the defense of any legal, proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon -issuance of -this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Department.
Work subject to Inectl'-and' restoration In accordance with City Code. A
24-hour notice �lPoll
e 't'-Kl-fo' inspection by the Engineering De rtment.
Call 775-2525./
Signat
7 Ite, S
I{ 11
DO NOT WRITE -BELOW THIS LINE (To be completed by lnaung Agency)
Permit Issued (Dat Permit NutllberiT_J=L_
Fee: no Bond:
IV
Time Authorized:
I � �rr
-1)
'ERING DEPT.
t
CITY of EDMONDS --- PUBLIC WORKS DEPARTMENT
Routing of Building Permit Applications
Proposed Property Address of Application:
i7
l6;?t� d
+H9+9 - 70th Place W.
DEPARTMENT
COMMENTS
DAB
WATER
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--
S T R E E T
SEWER
✓ �� t, .GCS. //J�_
` _" �-�`
—�
NOTES
BUILDING
DEPARTMENT COMMENTS
- - I
-BIYIL'DING DEPARTMENT Applicant Fill'
Inside Heavy Lines
PERMIT APPLICATION Y
USE PERMIT --- - - " - - w-�_ -
ZONE NUMBERAUG24 19
JOB
ADDRESS _ o----,. J
- ' r% •cam-a"u � u tuepr.
NAME (OR NAME OF BUSINESS)
rMr / �i
LEGAL LOT
YES ❑ NO
LOT AREA
SUBDIVISION NO.
W
Z
3
G
DD❑
MU NG ARESS
G IL, -_ / //
�y71 �LC •
VARIANCE OR
COND. USE NO. ,
ADB NO.
CITY
jrliY
TELEPHONE NUMBER
I / _
PROPOSED YARDS
FRONT. SIDE REAR
HEIGHT
Z
Z
Z
FC-�V
U
NAME
�-
ALLOWABLE SIGN AREASIGN
ROPOSED
AREA
a
F
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ADDRESS �� �OTHER
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REQUIREMENTS
E
CITY
NAME
TELEPHONE NUMBER
77
PLANNING DEPT. APPROVAL DATE
O
U
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oV2,7T
U
/
/�•(7 1.
STREET R/W '
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
COMP, PLAN ST. R/W FT, FT. .
ADDRESS _
'2/
(.,,(,�{.iL - �„i C-/
CITY
TELEPHONE NUMBER
REMARKS
U'
Z
W
CHECKED BY
W
U'
Z
STATE LICENSE NUMBER
o ��YFF !
CITY LICENSE NUMBIER
'
Z
a
U
W'
p
Legal Description of Property (Show Below or Attach Four Copies)
STREET AND/OR UTILITY ❑ YES
WORK REQ'D ❑ NO
UNDERGROUND ❑ YES
WIRING REQ'D ❑ NO
W
//// Q�
'Dl v i7iC� L/
TYPE CONNECTION
VERIFIED BY
r
SEPTIC SYSTEM ❑ YES PERMIT
APPVD BY. CITY ENG. ❑ NO
NUMBER
W
W
N
/ �, N
(.'! r
REMARKS
/ I
METER SIZE
SERVICE SIZE
CLEARANCE
CHECKED BY
K
W
%
REMARKS
Q
3
Z
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N
ly
0
m
Q
NEW RESIDENTIAL GAS
1 :1 LINE
NON-RESIDENTIAL SIGN
ADD
RETAINING
DEMOLISH ❑ WALL
❑ ALTER EXCAVATE FENCE
OR FILL ( X_FT)
PRE -MOVE swim
❑ REPAIR � INSP, POOL
FIRE ZONE
TYPE OF CONSTRUCTION CODE
SPECIAL INSPECTOR
REQUIRED
❑ YES ❑ NO
AREA
-
OCCUPANCY
GROUP
OCCUPANT
LOAD
F
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED t
W
0
Z
REMARKS
0
J
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
'
D
m
NATURE OF WORKTO BE DONE'
��tc ram,,
bra� r
PLAN CHECK
NO.
BUILDING
'VALUATION
FEE
PROPOSED USE
PLOT PLAN JINDICATE BUILDING SETBACKS,
ABUTTING STREETS)
'
-
PLUMBING
HEAT &•GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL' '
STREET FILE.f)ATF : September 20, 1976
HEPrn TO: 11arry ►'hitcutt
Puildino Official
FROM- Richard 1!. Me'n
Assistdnt (.itv Fnnineer
'11GJECT: 16219 - 70th Place West
Lot 8, Westmont View, Division #2
After review, of the suh,irct huildinn nermit anpli.cation, a-n have the fol-
1 ot-,i nq comments
1) Connection to sanitary sewer required.
2) Underground wiring required.
3) Driveway slope not to exceed 14%.
4). Lot drainage to be contained on site.
5) Right -of -Way Invasion Permit required for curb cut and
driveway,.
6) Legal description is for Lot 8 and plan as submitted shows
Lot 7 (which lot does developer intend tb build proposed house).
WJN:LRL:rf
10r)
Cart �lU�-��l( PERMIT ADDRFSe 1 W- ` 10 � If' l�-,
" • LEGAL DESCRI qWN 0_� e
BUILDING PERMIT REVIE14 - ENGINEERING DEPARTMENT CHECK LIST
Instruction:
Check Accuracy of Legal Description
Check Against Assessor's Map for Legal Subdivision
Does it conform to City Approved Subdivision?
Reviewer's
Initials
< i�j1. This lot included in Sub
2. Site Inspection made on:
3. What are around -rater and soil conditions? .L.?' e
4. Site Drainage Checked? Q—
.j I
5. Storm Sewer Availability: Sht ! Owq. No. (eC Project`
Roadside Ditch - "
6. Grading & Final Contours: _� Q
7. Septic Tank System Design Approved%
8. Sanitary Setter Availability Sht. of Nip. NoGOAEProject a
Side sewer availability:_
9. Sanitary Sewer Connection Fees? -
10. !dater Mains & Fire Hydrants (Indicate Size Main)) s '1 d�
Check Fire Dept.'s Comments '
11. Sidewalks: (Site inspection shows conditions of sidewalks as follows)
_Vfy m M.t\1A L hq"- '
12. Curbs: ' 'j►�; Curb Cuts/Driveways (Check driveways for safety, location,
grade and width) :( J1 Ole
13. Underground hiring: �.��� Street Lights:
14. Street Right-of-way & Bldg. setbacks: ��nl�(II� Sht. of official Street Map.
15. Existing Utility Easements. I`ll
16. Access Easements: —" 'A i en A 1 '
P� r
17. Site Plan checked for accuracy? "I(p T eg
18. Special Requirements listed in Memo to Bldg. Dept.M OM A
19. Commercial & Apt. Requirements for
20. Drawings stamped & notations made?
21. All Items filled in on Bldg. Permit Application?
22. Bonds posted for site work? ,
23. Right-of-way Invasion Permit required? �. �'.lil ii c'� ��il tkAA-1
[�I I�Iri�`►i��l�sitt��fl�i�� yf�!F,�l i��
Rev. 7/1/76
PEPMIT AD - SA
Date LEGAL DES( TInf
STEET FILE
MOM
� �. BUILDING PERMIT REVIEW - ENGIMEEP,IPIG DEPARTMENT CHECK LIST
1,
Check Accuracy of Lenal Description
Check Against Assessor's Man for Leal Subdivision
Does it conform to City Approved Subdivision?
Reviewer's
Initials
_ 1. This lot included .in Subdivision lat I1 .: visa
Z
2. Site Inspection made on:�� �j
3. Uhat are oround waterand soil conditions?m-ey—Liec, 5 LgopI is
4. Site nrainane Checked? _
5. Storm Seaver Availability: Sht. of Phrq. No Project
Ro6dside Ditch Al feWriz—
.6. Grading & Final Contours_ w�
7. Septic Tank System Desirn Approved: •
8. Sanitary Sevier Availability 5rK�ht. of Darq. PI05Pro,ject
Side sewer availability:
g. Sanitary Seaver Connection Fees
10. hater Mains A Fire hydrants (Indicate Size.flain)�
Check Fire Dept.'s Comments
11. Sidearalk�_ (Site_ inspection--,hoars-.LondiLLoils.Qf sidearaLks_as- follo:•rs)
12. Curbs:rh f..uts Drive•ra, s Check driveways for safety, location,
grade and wicth):
13. Undernround Uirinn:� 2 > _ Street Liqhts:
14. Street Right -of -•ray A Dldg. setbacks: Sht.
15. Existinq l)tility
16. Access Easements:
17. Site Plan checked
18.
19.
20.
21.
22.
Special Requirements listed in Memo to Bldg. Dept._
Commercial & Apt. Requirements form co leted? /�.
Drawings stamped F, notations made?
All Items filled in on Cldg. Permit Application?.
Bonds posted for site work?
23. Piaht-of-gray Invasion Permit reQuired?
COMMENTS:
of nfficial Street Map.
USE PERMIT
E AS -CITY OF EDMONDS zoN17 NUMBER q (9610
/
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
OWNER NAMErAME OF BUSINESS ADDRESS
t n
LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
w MAIL N A DRgSS
►/_-7 IC, '7n41, 91 r )
ADDRESS
ZIP . ITELEPHONE NUMBER
E
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
pprove
RW Permit Required [Y
EXISTING REQUIRED DEDICATION
Street Use Permit Req'd ❑
Inspection Required O
PROPOSED
Sidewalk Required ❑
cc
t-
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES ❑ NO ❑
3
(7
Z
3EMARKScc
w
w
Z
(7
Z
w
Ir
O ENGINEERING MEMO DATED REVIEWED
U
CITV ZIP- [ITLEPRONE NUMBER
FIRE MEMO DATED REVIEWED
O1— .11404M4
U
S ATE 6blINgE NUMBER p�, 40W6201,
RAT N ATE
Z r� VARIANCE OR CU ADB N SHORELINE t
Leg i Descr io o.f Pro rt- InCIGde all a ent
OZ ,� ° A Lj
SEPA REVIEW
COMPLETE I EXEMPT
SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED PROPOSED
a It
cc
N
LOT COVERAGE
RED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED P//RO--POSED
FRONT SIDE REAR
FRONT UR SIDE REAR
3
F7 )3s yfs �f o
Property
Tax Account
Parcel No. 41W AIM 60
LOT AREA
PLANNING REVIEW BY
DATE
NEW X RESIDENTIAL
ADDITION COMMERCIAL
REMODEL APT. BLDG.
REPAIR a GRADING
CYDS.
DEMOLISH ❑ INSERT WOODSTOVE
GARAGE a RETAINING WALU
CARPORT ROCKERY
PLUMBINGIMECH
COMPLIANCE OR
CHANGE OF USE
SIGN.
FENCE
( ` x_FT)
HOT TPOOL UB SPA
REM RKS
ffjt5a4r=LP4030 loc &)OW,4A,& ',-Wk 46
I
l �✓ -
nn
Y.
CHECKED BY
TYPE OF CONST • TION
CODE
Gocc
OCC
ROU N
SPECIAL INSPECTOR
REQUIRED
YES
AREA
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108
(TYPE OF USE, BUSIN S ACTIVITY) EXPLAIN:
NUMBER NUMBER OF
o OF �//� DWELLING
CO STORIES Z_ UNITS
CRITICAL ^
AREAS (,,+
INUMBE
...
I
O
DE CRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
Y
FINAL INSPECTION REQUIRED
0 'r" - _ " — I
PLAN CHECK FEE
3
BUILDING
H RCE:
GLAZING
PLUMBING
Plan Check No.
MECHANICAL
GRADINGIFILL
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.
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
N
successors in interest, agrees to indemnify, defend and hold
w
harmless the City of Edmonds, Washington, its. officials,
s
employees, and agents from any and all claims do'g., amages of
a
=
whatever nature, aris�i directly or indirectly fromp e.issuance
PLAN CHECK DEPOSIT
of this permit. Issu n1% of this permit shall not be deemetll to
omodify,
waive or re6ie6 a4y requirement of any cit; ordinance
x
nor limit in any way the City's ability to enforce ariy ordinance
TOTAL AMOUNT DUE
provision."
1 hereby acknowledge that I have read this application; that the
informationgiven is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I 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 o the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
ti n e Etna RCW 18.27.
INSPECTION
acknowledged in space provided.
kA) E NE OR AGENT) DATE SIGNED
��
DEPARTMENT
O
OFFICIA 'S IGN E
EDIMONTY
S
?DATE
J /9 .'.
CALL FOR
RELE SED BY: DATE
ATTENTION
INSPECTION
i
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
��� 0220ORIGINAL
— File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY. HAS BEEN GRANTED. UBC
SECTION 109
PINK — Owner GOLD — Assessor
tot-07