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17522 71 ST AVE W
APPUCATION
for
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The City of gdmonds 1 M6=
ti. � FIWEW COWSTRUC"ON 76"%PAIRS
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ADDRESS........ ------ ........................ ........
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"71,
tsj�j
EASEMENT No . ..........................................
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CONTRACTOR ----------- 0 ---- W. ---------------------------------------------------- PERAMMT . . . .. ......
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I,WAJ, DESCRIPTION: LOT No . ............ --------------------------------- BLOCK No . ................. f --:EEii .... P ... 0-i;tion
The Easterly 120.86' of the South 120' 0
NAME OF ADDITION ... of ... Tract—L43 --- ApLd ... N.orth of
existine Countv Road, as measured along the South line.
RECEWED
im it 1571
w 1E
Approved:
DATE ..... ...........
4
:57—
D'S E�',� Sf)W#4ER. PtRWAUT,
1E A
00 IN
-IM,
-PER yT
3.9,74.
of
i;�mb7rfor side, inspections. BEFO]Ii,�Voverlrg. -an�' .1.1 o n.
iP 7-7 -
L�i. wllll;be� provided �W_t 'er nsp ct n
I lilm:214',thb6�s: aft -requestt NO 'SEW 1 un.4.or.-holl ay'
S t
..........
ZS&�LOCAMOM �OVICONSTRUC TION.-Z.%- . ...................................... ......
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ftk-, �_q .0 f Or— ch
pi6i�itt;k'.Y,,:�L-EGYAM--l�:,DFSC- RIF ........ ...... ....... ........ z ............ ............................................. ........... 7; .......... .....
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r
and
7) TI i%
............................. .......................................................................................................
............ ............................. ........ ...............
10", ER1'-A1Nff/,OR,-BU,1LDEW ...... ................................ ........... ..... ................ ................... ........ ............. ... ............
. ............... 71 ........ . ...................
. ..........
. . . . . ............................................................................................... .
.................
4C�DNTR�AC-T-OR',Sf'N'AM-E�,&�;VDDRESS� ......................................................................
t!f6pekty �4�jtary--.
............ 9.-.�.�..-.'-.,,.foi�,repair�anilY.or.;coniiectioifz,.o:f'a dde1�,,seW.6r,.,.'t0
-.9f"Edminds,-ordinances.
tem' Sr
'EIJ� TO"THE'FOLLOW1NG`
art Y, 'Sicic (Fon�tractor must..bejeffip1oyed:.to, construct
E' j*o�,consted&'��sewer. 4inslde,,propi
n.
-gldef,sewenln, street -area%. Do, not -,cove�.-.-aqY.tp9rt 1?n�,ofl sew�r,,befoi
Imetty;-right . -ol-wayre'qufrei�.an, Inv aglon
:� 'n Atghi_-_o*f-Way`P6�mli iob`tai�zWle- fr6m' '.the-Cit�
when . ypu,,:get� Parm
1' !2. 11 N%�qr perl'ormedi; j6�ojo'-�snd;� Re4uld6s',:ljoye
m "minirnur
6rdffia�n�`e- +1�. -
Obta"InCiulli'Infor atl6n% regaxp ng
M No�i, ... ;�grade,
'e4,tcovera'ge`at_-proPerty, -line, iLhdi*.j2'i'n�h6�':--Inside�.pro erLy
N& at;. lea:st '30k inch
WOTE a))se,wer1;inu'st'-have'.
con
sha,�,per t an,,��,'wiMibe" P��i.tte.� 1;n'�mpe,
d --d
'NOM No�. 15-�-:T?enches.dn! itreW,inu st' `,be, Miter, sett I ecti-and!,surface, of' st reet'l-rest'o red, U, originalv
mp etjon.7�
hin, one year 6f,6 I
work, which!arnay.developr wit
n-�
fo, r n, jh�c �rk on,-'the--__maln-_.9CN4er or,lts� appurtenatices,.:except �to
'fjfl�;t te �or-,i6i-,-6;
-NOTE'.No:. 16,1t7isjwnlaw . O..al r
jieit�,thet,61pe,.intolitbe,wye:�'.
Dt :_B ....... ......
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J 7 T
.j, r _ ., , . TO Request,
.Yni --MUST"b -'sig��-Wdi-4y,;;6.
BO ',Pe t.C6pi�s' e' rjer o m -Performing Onstruction'-PRIOIC'
ar,,thisr,permit
h by- certify--t�at- the
ere ;side�-sew6r,�iii�talla�ti6n�',6ohst�.uc.t�d'..Lin
........................................................... . ..... .
C
f.,Contracting -Firm,;Perfcrming �.qnitruCt!oln:),
-'(Owner* o
il`hgtdlled�'inl_accordance�
wa 4
0
-'Pated!Ahm'
E] -Te ep on6,Eji;
`�G heck: 'BEFORE !TOU
VA
t
. m-mi.-W
RECE F-
PER EXPIRES
0 (D 1711
USE PERMIT.
CITY OFEDIVIONDS";
-.14UMBER
B.,
CONSTRUCTION PERMIT APPLICATION 10 SUIT
ADDRESS
OWNER NAME/NAME OF BUSINESS 7. S7+
PLAT NAME/S BDIVISION NO. LOT NO.
do,
s
0 LID FEE $
CC. MAILING ADDRESS.' e )4
ILI
TIESCP Approved 0
P e PFW6FF1cl
A, RW Pamit Required 0
r UB�IC RIGH1 AISTAFET MAP
0 / 7C2 2- 7�,Ll A Street Use Permit Raq'd 0
X -PROPOSED Inspection Required
CITY il P. E 67ING
TELEPHONE 0
Sidewalk Required 0.
underground
mp ul"ru EDICATION— FT
Ad 5Y .7 -511 _7 9 Wiring required 0
ETER SIZE PRV REQUIRED
NAME' �INE'SIZE No OF FIXTURES
0
YE - NO
0
EMARKS uj
ADDRESS z
z
RESPONSIBLE FOR EROSION CONTROUDRAINAGE
L)
z
uj
�PITY ..Zip fE�EPHONE
NAME
ENGINEERING REVIEWED/DATE
ADDRES . ..... .
E� iVI ATE
ILI
N r
ITY I J]ZLEPH L
Zip 10,
0
TO u.
0
77 0 tRIANCE -6 CU, SHORELINE OR ADB# INSPECTION BOND
UP19ATION DATE �1!EeKED BY
STATE LICENSE NUMBER 'D
wssis RE)d POSTED
ES NO
0Y
'37 VN
�SEPA REVIEW HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE' EXEMPT ALLOWED PROPOSE I D ALLOWED PROPOSED
uj r,*,4`- a-ss osssw
EXP.
16T COVERAGE . REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
PLUMBING MECH ALLOWED' 'PROPOSED -FRONT SIDE REAR FRONT, LJRSIDE REAR
f NEW Cff RESIDENTIAL,
z
ADDITION M COMPLIANCE OR 0
qO M . ERLCIAL,.,: CHAN-GE,OF. USE 7,
�:PARKNG_ LOT AREA 3� 4REV EWED'B'Y DATE
SIGN. -_REQ'R,.� 1,.PROVIDED I
REMODEL
FENCE
-REPAIR X FT) REMARKS,
GRADING,
DEMOLISH
RAGE
c3 GA RETAINING LL WAL
CARPOAI� 'R Y. �A _],'REN6'
z OCKER
P (TYPE OF 1.19t BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYPE OF: OCCUPANT
6 '.4-,Ie -e GROUP
Lu
u) NUMBER N UMBEROF T—ARE�-:1',,
C F: AALINSPECTOR.r
DWELLING' ;AREAS SPEC OCCUPANT
o STORIE CRITICAL"
S UNITS NUMBER, REQUIFED:'n'E� LOAD"
iql
DESCRIBE WORK TO BE DONE
j
REMARKS
RID z
GRESSANSPECTIONS PER UBC 108iFINAL INSPECTIONIREO'D 6
L
.2; _c) \j
VALUATION
15 7-a,ur-': FEE
PLAN CHECK FEE.
HEATSQURCE.' LOT SLOPE %
BUILDING
PLAN C1iEbK7ffff-_7 VE$TED DATE
PLUMBING
3�i
MECHANICAL
�THIS Pik'RAIT�AUtHOF!i�!IiS �NLYJHE WORK NOTED.-,jHIS,PkRMIT COVERS WOPKTO
BE 66NS ON PRIVA*E PROPERTY, ONLY. ANY CONSTR UCTION ON THE PU I BLIC
DOMAIN (CURBS, S1 . DEWALKS, DRIVEWAYS,-jM�ROUEES,:E . TC.) WILL REQ . U I IRE GRADING/FILL
:SEPA P
R�TE. EP.MISSION.'
t
SURCHARGE
ILI PERMIT APPLICATION:'. 18,0,6AYS
PERMIT LIMIT. I YEAR � PROVIDED WORK IS,STARTED WITHIN 180 DAYS
-@NO FIEVIEW FEES
SEE BACK'OF PINK PERMIT FOWMORE INFORMATION 00
-APPLICANT:ON BEHALF OF HIS OR HER SP US I S.AS
W .0 E, HE R' S18NS AND SUCCESORS )41i� —INSPECTION FEE
w IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND -HOLD HARMLESS THE CITY OF� -
LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM . ANY AND
ALL CLAIMS FOR DAMAGES OF WH EVER. NATURE; ARISING DIRECTLY OR INDIRECTLY INSPECTION FEE
AT
x FR64THE ISSUANCE OF THIS PERMIT: ISSUANCE OF THIS PERMIT SHALL NOT BE �LAN CHECK DEPOSIT RICEIPT
0 MODIFYWAIVE OR REDUCE ANY REQUIREMENfOF ANY 61TY ORDINANCE cf�
_j1 DEEMEDTO led), fn
0 NOR LIMITIN ANYWAYTHE CITY'SABILITYTO ENFORCE ANYORDINANCE PROVISION.".,
RECEIPT
TOTALAMOUNTDUE 7,
. . . a, - ao
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN - IS CORRECT., AND THAT I AM THE OWNER,.OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILLBE EMPLOYED CALL Building Official or histher Deputy� and Fees are paid. and
IN VIOLATION OF THE LABOR CODE'.OF THE STATE OF - WASHINGTON,. RELATING To FOR INSPECTION receipt is acknowledged in space provid-edi._
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27�
IALS SIGNATURE DATE
SIGNATUR(_(OWN 0.
i0ORAGENT). DATE SIGNED 25),
hm nat
F—C
141A Col 10A /a
771-0220 ATE
ATTENTION EXT 333
BUI' 00
IT IS UNLAWFUL TO USE OR OCCUPY'A LDING OR STRUCTURE UNTIL /(
j
A FINAL INSPECTION 'HAS BEEN'MADE AND APPROVAL OR A CERTIFI' 77110221
ORIGINAL -FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
5/98