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17122 72ND AVE W
CITY OF EDMONDS
10 12-'NEW
El ADDITION
1-1 RETIREMENT
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ST"I""EFT rlE ASSET INFORMATION SHEET
ASSET NO. 1-5
ADDITION TO ASSET NO.
DESCRIPTION Z/,v
SERIAL NO.
LOCATION
_-2 --2
DT
* * PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
PROJECT NUMBER e�
PROJECT COMPLETION DATE
COST /0 --),
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT,ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
10- XDEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE DATE
(tnp INITIAL
DEPARTMENT FILE
VERIFIED BY
PROCESSED
BATCH NO.
DATE:
MEMO TO: Permit Coordinator, Building Division
FROM: Dan Smith, Engineering Inspector
ADDRESS: M/1 1z
OWNER: Z11
After review of the subject building permit application, we have the
following comments:
1) Construction hours are: WEEKDAYS 7:00am to 10:00pm
WEEKENDS/HOLIDAYS 10:00am to 6:00pm
2) A Right -of -Way construction permit is required for any work on
City property.
3) Connection to City water system required.
4) Connection to City sanitary sewer system required; obtain separate
permit.
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) Driveway slope not to exceed 14%.
8) Back water valve -required if downstairs -plumbing i.s below
elevation of upstream manhole.
9) Builder/Owner responsible for containing all temporary runoff and
erosion control on site. Construction may not impact neighboring
properties in any way.
10) No burning of construction refuse without approval from Fire -;Dept.
11) Street to be kept clean of debris, dirt, mud, and construction
materials.. Contractor responsible for dust control.
12) Inspection required on drainage system, catch basin -installation,
driveways, and sidewalks. A final engineering -inspection is
required prior to the building division granting occupancy:
' USC PEP1.10 In
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CITY OF EDMONDS :0", P9)) 11 laa ?.U%1BEP
C6-NSt-AUCTION PERMIT APPLICATION
OWNER NAME.'NAIVIE OF ROSINESS JADDR'ESS ' 2/y,10
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MAILING ADDRESS /1 4- 4es P��
CITY
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-.LEPHONL NUM8k:H
4:� 7 700
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ADDRESS
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CITY TELEPHONE NUMBER
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NAME
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ADDRESS
10.0. a
CITY TELEPHONE NUMBER
STATE LICENSE NUMBER
, -r III, (-T Iq 4--t c * �) 9 2 Q C
Legal Description of Property - include all easements
(show below or attach two copies)
+ 44 1
W� -rn"t
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING giVAeOUIRED DEDICATION
PROPOSEOP
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED
SEE ENGINEERING MEMO DATED
REMARKS
METq ?,ZE� BUILDING SUPPLY SIZE
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TESCP
APPROVED BY
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REVIEW BY Z
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USE UNITS
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SIGN SEA
ENV. REVIEW
ADS NO.
ALLOWED PROPOSED
COMPLETE EXEMPT
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SHORELINE If
VARIANCE OR CU
PLEANN G REVIEVY BY .
I DATE
SETBACKS - FEET
HEIGHt
LOT COVERAGE
REARZ57
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FRONT 10
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NEW 13,RESIDENTIAL PLUMBING
11
ADDIALTER
COMMERCIAL
MECHANICAL
REPAIR
APT. BLDG.
El SIGN
CHECKED BY
ADA
TYPE OF CONST RUCTIIN
I IV
CODE
/
HEIGHT
EXCAVATE FENCE
DEMOLISH OR FILL L_ x _FT)
REMODEL
CARPORT
GARAGE
SP WO 01M,
_
SPECIAL INSPECTOR
REQUIRED
EJYES NO
AREA
OCCUPA
APC�y
OCCUPANT
LOAD
WOOD STOVE/ F7 RETAINING WALL/
INSERT ROCKERY
RENEWAL
M R
REMARKS
S
ZI
PROGRESS INSPECTIONS PER UBC 305
P 0
01
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO -BE DONE (ATTACH PLOT PLAN)
`A4 -
.77
_ni;oec, M/
VALUATION I FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Worl� is Started Within 180 Days
ENERGY CODE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
PLAN CHECK DEPOSIT
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 I.imit in any way the City's ability to enforce any ordinance
provision."
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 the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and in doing the work authoriz-
ed thereby, no person will be employed in violation of the Labor
THIS PERMIT
AUTHOR IZ E S
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tion Insurance.
INSPECTI ON
DEPARTMENT
CITY OF
EDMONDS
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL'S SIGNATURE DATE
DATE
0
Z
A'T'TENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
1. CF111IFtCATE OF OCCUPANCY HAS BEEN GRANTED. UBC
C,PAAIIIJ�14 '%
tw
771-3202
RELEASED BY:
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
PIWEur mvim Chm:m'.Ler
tow PJXVECT ADDRESS:
.VPLICATION RECEIPT DATE: .
Reviewed by: (m itial7date�
COMMENTS
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