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PERMIT COUNTER
USE
CITY OF EDMONDS
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CONSTRUCTION
PERMIT APPLICATION
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OWNER NAMEINAME OF BUSIN ss
JOB
ADDRESS .7 d1l e eS
CLEGAL
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DESCRIPTION CIEC11
SUBDI NO
LID NO.
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TESCP
CITY:
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TELEPHONE NUMBER
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
APPROVED BY
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EXISTING REQUIRED DEDICATION
P R 0 PO S E D
NAME
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED. .
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ADDRESS
STREET USE PERMIT REQUIRED.
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SEE ENGINEERING MEMO DATED
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BY
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CITY
PHONE NUMBER
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REMARKS
NAME
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ADDRESS
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METER SIZE
BUILDING SUPPLY SIZE
E UNITS
CITY
TELEPHONE NUMBER
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REWRKS
31
STAT E LICENSE N UMBER
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'j�>GA coc- r!>'A
SIGN ARW
ENV. REVIEW
Legal Description of Property - include all easements
ALLOWE
PROPOSED
COMPLETE
, EXEMPT
(sh6w below o 'r attach two, copies)
SHORELINE N
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2
CA
I e5 P M—r
VARIANCE OR CU
PLAN REVIEW BY
DATE
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SETBACKS - FEET
HEIGHT
LOT COVER AGE
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FRONT--J!:�7 SIDE -1��RE R-1(-47--'C1
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1�2 ACCT--
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REMARKS
NEW I
RESIDENTIAL
PLUMBING
ElADD/ALTERI
El
MECHANICAL
COMMERCIAL
F-1
1:1 APT.IBLOG.
El
REPAIR
SIGN
E] EXC�VATIE FENCE
DEMOLISH OR �ILL I- x -FT)
CHECKED BY
TYPE OF CONSTRUCT19N CODE
HEIGHT
00
I
CARPORT SWIM
REMODEL G ARAGE----- POOL
SPECIAL INSPECTOR
REQUIRED
OCCUPANCY
GROUP LOAD
93
UPANTI
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WOOD STOVE I RETAINING WALL/
INSERTI RENEWAL
C-1 YES E NO
EMARKS
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of
RockERY
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PROGRESS INSPECTIONS PER UBC 305
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NUMBER OF STORIES
NUMBER OF
YA- 1%1e-1 A/1 ArIll- A%V116 I/ 6OA!5
DWELLING
00
0
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOTPLAN)
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P-4-� LLk Vla-1
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VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
1`9D VY0 2-0 10 ans
Thi's Permit covers work to be done on private property ONLY.
GRADING/FILL
Xny 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 Worh is Started Within 180 Days
ENERGY CODE
I "�pplicant on behalf of his or her spouse, heirs, assig4s and
successors ik interest, agrees to indemnify, defend and hold
harmless the, City of Edmonds, Washington, its officials,
2'
em�loyees, and agents from any and all claims for damages of
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wh�tever nature, arising directly or indirectly from the issuance
DEPOSIT
if
of his p rmit. Issuance of this permit shall not be deemed to
PLAN CHECK
mod ify, waive or reduce any requirement of any city ordinance
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noril�imit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
1
i
provision." I
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I hereby acknowledge that I have read this application; that the
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information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVA L
autho.hzed 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 not a permit until
I
ed thereby, no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or hi"
S
'C6de 'of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt
�ti6n In I suraace. A i
INSPECTION
acknowledged ip space provided.
�Ihm
PIGXA R NNE OR�AG
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DATE SIGNED
DEPARTMENT
,
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WYTJ
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CITY OF
OFFICIAL'S SIGNATURE DATE
i
EDMONDS
ATITENTION
771-3202
RELEASED BY: DATE
IT
IS UNLAWFUL TO USE OR' OCCUPY A BUILDING OR STRUCTURE
UNTIL
A FINAL INSPECTIONIHAS BEEN MADE AND'APPROVAL OR ORIGINAL — File YELLOW — Inspe''
M
'A
CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
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CHAPTER
3.
PINK — Owner GOLD - Assessor
102-871'
DATE: ,z /Z. 4
EMO TO:,..,Permit Coordinator ,Bu,ilding Division
FROM: Dan Smith, Engineering Inspector
ADDRESS:
OW
NER:
After review of. Ithe subject building permit application, we have the
9
following comments:
Construction hours ar.e:.'-,.WEEKDAYS-�.- 7:00am to 10:00pm
WEEKENDS/HOLIDAYS 10:00am to 6:00pm
A Right—of�-,Way construction permit is required for any work on
city p roperty.
3) Connection to City wate� system required.
4) Connection to City sanitary sewer system required; obtain separate
permitJ
5) Water and sewer lines to be separated by 10 foot minimum.
6) Driveway must be paved'a Minimum of 20 feet back from City
right-of-way; separate.permit required'.
7) Drivewa slope not to,.�eiceed.14%..
y
8) Back water,valve.require if downstairs plumbingis below
elevation of upstream man hole.
9) Builder/Owner resoo6§ible for containing all temporary runoff and..
erosion' control on site:'.'.' Construction may not impact neighboring
properties in any wiy.-',
10) No burnihg'of constructi6n refuse without approval from Fire Dept.
11) StreetJo be kept clean""of debris, dirt, mud, and construction
materials. Contracio'�'Jr'es'ponsible for dust control.
12) Inspectlion requ . ired on'drainage system, catch basin installation,
driveways, and sidewalks.'. A final engineering inspection is
required prior to*the''buildin'g division granting occupancy.
1.2 1 /Z 1/0. zi ...-/ 111441.,11 A'AA 11AAJ
ON D SE:ff REET FLE
CITY of EDIVI SIDE SEWER P L R M-I T
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For Inspection Wl 771-32 PERMIT NO. ON35
'BVII-OP46- r&�"Xwrr a 5 000szz'
Address of Construction: I � I a Y — -7-,;L- PL. W4=--,T7—
Property Legal Description (Include all easements): LaT 9��t6 4-6E5
Owner and/or Builder:*�OA (!!VAJS7YZUe-)17o,4 " Z Ce-AZA--
C o n t r a c t o r & L i c e n s e N o : PUS 5 J.- J Pl— el,*l 61 AJ C, r1-kJ 49
/?- U s's 3-f S
Singl:e Family Residence
Mul ti-Family (No. of Units
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description and county easement number.)
PCEASE
D THE
ITEMS
LISTED ON THE'BACK
I
ave
read and shall comply
with the
items
listed
on the back.
Ir
� 11� I I � I �� I ��� I � i �� I � � 1� � I � � I � 11�� rd
;I.;, ;I ;I � �i � 110 W� 2 .1 .-1 �J Al 5150 A A' W F, 0505,104, 'FA - - - - I OAF 105' 515 05 515 FAI 5115 11 - - - - - -
Issued By:
Permit Fee: I
Trunk Charge: Date Issued:
Assessment Fee: xap Receipt No.:
Partial Inspection:
EHEE
3 -26
Date
Comments Date Initial
Final Inspection Approved: 13 -1 D
Date Initial
Rejected:
Reason -Ta—te. 7—nitial
** PERMIT MUST BE POSTED ON JOB SITE **
Wh.ite Copy - File Green Copy - Inspector Buff Copy - Applicant
The City of Edmonds Side Sewer Drawing
EASEMENT NO . ................................. ..........
NEW CONSTRUCTION REPAIRS Fj LID NO . ............. .-....ASMT. NO - ------------------
OWNER — --------------------------------------------------------------------------------------------- CONTRACTOR -.7R%AS5 ------- V�)
---------------------------------- PERMIT NO.
JOB ADDRESS --- — ------ --------------------------------------- LEGAL DESCRIPTION: LOT NO - --------- Q ---------------- --------- BLOCK NO - --------------- ---------------
--7 1�a 09 -?(- .
77
2 t> 0
4
PWW-0001-1 1/75 (REV.1 1/78)
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NAME OF ADDITION ----------------- ------ ---------------------------------
------------ ---- ------
all C,,�� 0,!M3
EE�E
Approved:
DATE .......... —J:� -------- ID ------------ By(--3�/ -------------------------------- -
CITY OF EDMONDS
STREET rlLE ASSET INFORMATION SHEET
NEW
ADDITION
RETIREMENT
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION %
��v(, ce, LAA-�c
SERIAL NO.
LOCATION 14 rh I PLa c,e W, DEPT. N06 .17y
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
*PROJECTNUMBER Wdj-,; ()Sq-
PROJECT COMPLETION DATE
COST-131-60
B.A.R.S. ACCOUNT NO. 4 (1 - MO -61 L4 --SL4,57- o(-) - 6 3
ESTIMATED LIFE 2-s-
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
KDEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
is G.L. ENTRY
REFERENCE
ttnp INITIAL
VERIFIED BY
PROCESSED
BATCH NO.
DATE
DEPARTMENT FILE
CITY OF EDMONDS
USE
ZONE PERMIT
NUMBER 9 60;�Z
CONSTRUCTION PERMIT APPLICATROOM
.
i B St IITF/APT #
ADDRESS A/', / 1Z
OWNER NAME/NAME OF BUSINESS
M
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7oi,,,,
LEGAL DESCRIPTION CHECKI
SUBDIVISION NO.
LID NO.
MAILING AD
PL LAJ
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — REQUIRED DEDICATION
PROPOSED
TESCP Approyed 0
RW Permit Required 0
Street Use Permit Req*d C3
Inspection Required 0
Sidewalk Required
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CITY zip
F_N� I w-i I-) 96 2-ite 1744Z
TELEPHONE NUMBER
- 15 15 1
L)
Cc
NAME
METER SIZET
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 0
ADDR S
REMARKS
w
FT—y ZIP
TELEPHONE NUMBER
NAME
,A0Ur,-reSy &LA,5.S, I k-1 IC -
ADDRESS
I I s pa. pa:j.�� �, ST. PO 0 1 ( Z 50
gIg
I
ENGIN . EERING MEMO DATED REVIEWED BY
CITY ZIP
TELEPHONE NUMBER
FIRE MEMO DATED REVIEWED BY
Lu
Lr
Z
jtdp7Z 1185-
q6qq
STATE LICENSE NUMBER EXPIRATION DATE
LL
JKr6j I Z0C9 3-31-7,17,
L,ty
SIGN AREA
SEPA REVIEW
ADS NO.
ALLOWED PROPOSED
COMPLETE
Legal Description of Property - include all easements
Z
9
(L
I
1EXEMPT
EXP
SHORELINE I
VARIANCE OR CU
PLANNING REVIEW BY
DATE
W
_j
SETBACKS - FEET
FRONT SIDE REAR
HEIGHT
LOT COVERAGE
Z
Z
Property
Ts Account 7�(l _60 t,?
P.xrcel NIx 9
REMARKS
1:1 NEW RRESIDENTIAL PLUMBING
E] ADDITION E] COMMERCIAL MECHANICAL
0RD F-1 APT. BLDG. El
EMO'EL SIGN
CHECKED BY
TYPE OF CONSTRUC [ON
CODE
OCCUPANT
GRO
P og
GRADING FENCE
REPAIR CYOS. x _FT)
DEMOLISH WOODSTOVE SWiMPOOL
INSERT HOT TUB/SPA
G . ARAGE RETAINING WALL/
C ROCKERY RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
PECIAL INSPECTOR
REQUIRED
C3 YES
EA
OCCUPANT
LOAD
MARKS
PROGRESS INSPECTIONS PER.UBC 305
Z
NUMBER
OF
NUMBER OF:
DWELLING
CRITICAL
AREAS
W
0
0)
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REQUIRED
-z_ r�p kj,
LU h H t,.�e V_)
VALUATION
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING
I %
PLUMBING
Plan,CheckNo.
Z go 5 9
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
47,
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
ENG. INSPECTION FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
2
successors in interest, agrees to Indemnify, defend and hold
harmless the City of Edmonds, Washington, Its officials.
m
0
employees, and agents from any and all claims for damages of
whatever nature, arising directly or Indirectly' from the issuance
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
nor limit In any way the City's ability to enforc.0
provision." �ny ordinance
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the
Information given Is correct; and that I am the owner, or th.e 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 of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid. and receipt Is
tion Insurance and RCW 18.27. INSPECTION acknowledged In space provided.
SIGNATURE (OWNER OR AGENT) DEPARTMENT
OFFICIALA,-SIGN RE DAT
,,�SIGNED CITY OF fp
EDMONDS WIZ�
CALL FOR RELEASED BY: 4 JDAtE
-ATTENTION INSPECTION.
ITAS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0 20 ORIGINAL - File YELLOW - Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
CHAPTER 3. Z�, PINK - Owner GOLD - Assessor
A
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JOB NO.84-036 SHEET 2 OF'2 SHEETS
145 - 17'
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