17927 TALBOT RD.PDFIiiiii lill lill
13467
17927 TALBOT RD
CITY OF EDMONDS
ASSET INFORMATION SHEET
ER/NEW
ADDITION
RETIREMENT
ASSET NO.
Al: I I LO AS
SET
r__N
L
DESCRIPTION
SERIAL NO.
LOCATION
-2
DE T NO
41 1
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
PROJECT NUMBER A4�Z6 14V -
PROJECT COMPLETION DATE Z
COST
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
X/DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
b1p) INITIAL
DATE
vi=pi;:i;=n Ry
PROCESSEE
BATCH NO.
DEPARTMENT FILE
CITY of EDMONDS B_F-C�-OtF
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lqr
co
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For Inspection Call 771-3202
Address of Construction:
21
SIDE SEWER P E R M I T
PERMIT NO.
Property Legal Description (Include all easements):
T- 0 iq6 r-S o 7-
Owner and/or Builder: 140 01L�l '+-A) 14-0 Vk7 8 021
Contractor & License No: 140
Singl:e Family Residence -
Multi -Family (No. of Units r"E T F L E
T E'
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 Pri vate Property: No Yes (If Yes, easement required,
attach legal description and county.easement number.)
YPL�E,�,/SE READ THE XIT.K- L -STED ON THE BACK
/to 4;
I certify that I have read and shall comply Date
with the items listed on the back.
Pe.rmit Fee:
T�unk Charge:
Assessment Fee:
5o C' 0
_Z5� 00
issue d By -
Date Issued:
Receipt'No.:
Parti,al Inspection:
Comments Date Initial
Final Inspection Approved:
Date Initial
Rejected:
White Copy - File
eason
** PERMIT MUST BE POSTED ON JOB SITE **
Green Copy'- Inspector
I
Date Initial
Buff Copy Applicant
The City of Edmonds Side Sewer Drawing EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION REPAIRS E] LID NO. 16.4 ..... ASMT. NO - --------------
OWNER --- A0lAF_LPkK0 140-rAec!> ------ ------------------ CONTRACTOR ........... ------------------------------------------------------------------------ PERMIT NO.
JOB ADDRESS A79.2,71 -------- Tpsx�_. 77 ---- R_ _D_ ...... LEGAL DESCRIPTION: LOT NO. _44 ........................... BLOCK NO. ----------
lpptRy - ---------------------------------------
NAME OF ADDITION --- RL_ X ---- a-F ----- TAi-Bom---
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Annroved:
PWW-0001-1 1/75 (REVA 1178) DATE,&"_.5_1Y84 ...... By - ----- -------- -------------------
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE NWPFRMIT
ZONE RS-20 NUMBER
jo
ADDRESS 17927 Talbot Road
UJM
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NAME (OR NAME OF BUSINESS)
Homeland Homes Inc..
LEGAL DESCRIPTION CHECK
ok
SUBDIVISION NO.
LID NO.
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MAILING ADDRESS
221 James St.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING -13� REQUIRED DEDICATION
PROPOSED 6 6)
FC-177- TELEPHONE NUMBER
Edmonds 775-2033
NAME
Design Consultants
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED Ir"'e'
STREET USE PERMIT REQUIRED 0
ADDRESS
903 10th. St.
SEE ENGINEERING MEMO DATED
2-efC
ICITY
Mukilteo
TELEPHONE NUMBER
745-6569
REM7/AR S
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NAME
Homeland Homes Inc.
ADDRESS
221 James St.
METER SIZE
BUILDING SUPPLY SIZE
FIXTURE UNITS
CITY
Edmonds
TELEPHONE NUMBER
775-2033
EMARKS
STATE LICENSE NUMBER
HO-ME-LHI-174*KE
SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADB NO.
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Legal Description of Property - Include all easements
(show below or attach four copies)
SHORELINE#
Lot 44 Plat of Talbot Park
VARIANCE OR CU
PLANNING REVIEW BY
.
DATE
YARDS
FRONT SIDE REAR
HEIGHT LOT
COVERAGE
REMARKS
2
acl
Uj
a
aNEW 5i RESIDENTIAL El PLUMBING
ADDIALTER COMMERCIAL MECHANICAL
REPAIR RETAINING WALL SIGN
EXCAVATE FENCE
DEMOLISH OR FILL ( x _FT)
PRE -MOVE INSPJ swim
REMODEL ET COMPLIANCE INSP. POOL
CHECKED BY
TYPE OF CONSTRUCTION
_Y_/V
CODE
/cU2
HEIGHT
. SPECIAL INSPECTOR
REQUIRED
0 YES — 0 NO
AREA
OCCUPANCY
GROUP
OCCUPANT
LOAD
WOOD STOVE/
INSERT 7 RENEWAL
AFT. BLDG
REMARKS
)&9-MAL zwsiu oe.-L /T co dc
SlAk
/�6/U5.S. 1;jsP&61-70YS &A 1,16 6
NUMBER OF STORIES
two
NUMBEROF
DWELLING one
[UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
/7,W91- 4tCU,0/jyt_y _VVJ5,,0
construct single family home
VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any construction an the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
GRADINGIFILL
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year --Provided Work is Started Within 180 Days
ENERGY CODE
DATE : Z/-Z - f6
ME I'A 0 TO Building Division
Planning Department
FROM: Engineering Division
Public Works Department
SUBJECT: z2q2
I , AZ-1307
After re,ii*e-..i of the subject Building Permit, application, vie have the -following
ccimmen ts :
1- Connection to Citv water system required.
2.
Connection to
City
sanitary
le-wer system
req0red.
3.
Right-of-way
permi I-
required
For any work
on City property.
4. Driveway slope not to exceed 111%
5. Back-.-iater valve r'--quired if dw-instairs plumbing is below elevation ol'
UOStream manhole.
6. Water and se-.-ier lines to be separated by 10 foot minimum.
V
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ry)
- /.2 0 - 0 ')
20
P/9 7.10
PL P AJ .2 5.5 7
GAP46E 11
-.7 D
q 5 F H 4'L 7-
C- T.
7W L F 0 7- 0,4-D
SITE PLAN, SCALE: 1"=30-
Note;
All roof —0=38mmleffe
drains will be independently
routed to catch basin then
released to detention
system.
NOTE: DO NOT USE RUNOFF SPREADER ON SLOPES
I
STANDARD DRAINAGE PLAN
DETENTION SYSTEM
up pp_ P,
C A7T-V4
CpETEwrj!!_!j LENGTH -rROL H
CON. CA
(Yrzt,I-r) BASim,
MIN , 2* MA)( COVEP,
5LOPF-.
SYSTEM CROSS SECTION
SEE PAGE 3 FOR OUTLET CONTROL DETAIL
------ a. j
FROM
0 Lrr L E-r
CON-- -ROL
OLrrLrT
COV4T;toC
4.
70 11�:r-r'
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2' 2' . G" DZe-F, A 16 1. (0- WV.�L)
CIZUSIAED ROCK
2' FP , ;;----Cs- =s I �
RIPRAP OUTLET
C- KAY 6 L OLr7FLOW 7RENC MIN 10' LONG,
PC P1
'TOP 4 A" PE -rD BE LF-VEL
SL -
FRCM
h'
E7
0 Lrr-L la
C0N-rROL
4" FERF PIPE W1 CAP'S
- 1= PIPS w. CAP-5
Piz
NOFF SPREADER OUTL
STANDARD DRAINAGE PLAN
DETENTION SYSTEM
PAGE I OF 3
for City of Edmonds
Eng.Dept.
location 17927 Talbot Road
plan by H.Lewis
phone 775-mii
date !iarch 2�,±986
DESIGN DATA
System Imperm Pipe Pipe Orifice
Number Area DiaT,,Length Diameter
Z---
8
1 4354 18" 1 60 7/
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and final.inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the resDonsibility
of the property owner(s). Material
accumulated in the storage pipe must
be flushed out and removed from,catch
basins to allow proper operation. The
outlet control orifice must be kept
open at all times.
e'3 /.S,/
1 m
CITY OF EDMONDS
V\
cli
2 0
.15 20
'PA77.10.
/Z
-PIL /9 Al 25 7
P46E
EX.
7-4 L �3 0 7- R 04-D
SITE PLAN, SCALE: 1"=301
Note;
All roof
drains will be independently
routed to -catch basin then
released to detention
system.
NOTE: DO NOT USE RUNOFF SPREADER ON SLOPES
OVER 15 PERCENT (WITHOUT SPECIAL DESIGN )
Table 2 - Detention Pipe Lengths
Pipe Diameter
Impermeable Required
Area Sq. Ft, Vol. Cu. Ft.
151''
1811
2411
3011
2000 50
40
28
16
10
2500 62
50
35
20
13
3000 75
60
42
24
15
3500 87
70
49
28
18
4000 100
80
56
32
21
4500 112
90
63
36
23
5000 125
100
70
40
25
L
Table 3 - Outlet Orifice Sizes
Impermeable Outlet
Area Orifice D ' iameter
Inches
Sq. Feet
2000
5/8
2500
5/8
3000
3/4
3500
3/4
4000
7/8
4500
7/8
5000
7/8
>-Required
pipe
length,
f eet
ro b.
rob
C-D
<Z-
58
61
All
Al
;Z;
(0
ta
re) co co
co 55
4
2
6
17 9 Lh PL. S. W'
AJI Ln
r\j
9 10 1.1 12
-W��15 5
180TH ST S. W LZI
NOT OPEN
6 K�TALBOT
SEAVIEW
A D D.- C30
0
60 60
T 0 R
5HT-OF-WAY MAPS
1. DWO, #40
PRFPARFn Ry' f7. N
I-) P P P- R
C A"rc H
B451 N DETENTION PIPE LENGTH COVCrROL r-A-rcH
(yr.N-r) bk3tk
M14 , 2' MIY. C.OVFP,
"176 5L0PF---*-
SYSTEM CROSS SECTION
IL SEE PAGE .3 FOR OUTLET CONTROL DETAIL
OLrrLr,T
cowrROC
70 OLrFL-E*T
(NIP RAP OR
P'UNOFF
SPREADER)
. Z' . C." DM�r, 4t f." SPALLS (.-. C*U^0
2:- 2' 3** DEEP, %*- r-RUSWED POCK
FP,0M
0 Lrr L E
CO N-I-ROL
RIPRAP OUTLET
WA-3HED rR-kyEL OUT -FLOW `TRENC9, MIN
10' LONG,
70P 4 A" PeFt.F PIPE -ra The "FvEL.
FRCM
0 Lrr, ET
CON—, ROL
'L
4" PERF P%PF- WITH CAPS
RUNOFF SPREADER OUTLET
I
STANDARD DRAINAGE PLAN
DETENTION SYSTEM
PAGE I OF 3
for -City of Edmonds
-Engineering Dept.
location-17927 Talbot Road
plan by U-�S�
phone //D-LUJJ
date 9-5-86
DESIGN DATA
System Imperm Pipe Pipe Orifice
Number Area Diam Length Diameter
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the resoonsibility
of the property owner(s). Material
accumulated in the storage pipe must
be flushed out and removed from catch
basins to allow proper operation. The
outlet control orifice must be kept
open at a I times.
ACZ-,
CITY OF EDMONDS
SITE PLAN, SCALE: 1"=301
NOTE:
All roof drains d fiUEW-ftUp
ft:* will be independently
routed to the.detention system
and then control released to
the existing storm drain
system in Talbot.Road.
STANDARD DRAINAGE PLAN
DETENTION SYSTEM
NOTE: DO NOT USE RUNOFF SPREADER ON SLOPES
OVER 15 PERCENT ( WITHOUT SPECIAL DESIGN
PAGE 2 OF 3
Table 2 - Detention Pipe Lenqths
Pipe Diameter
[Impermeable Required
Area Sq.' Ft. Vol. Cu. Ft.
1511
18
24"
3011
2000 50
40
2B
16
10.
2500 62
50
35
20
13
3000 75
60
42
�24
15
3500 87
70
49
28
18
40aO 100
80
.56
32
2 . 1
4500 112
90
63
36
23
5000 125
100
70
40
25
J
Table 3 - Outlet Orifice Sizes
Impermeable
Area
Sq. Feet
2000
2500
3000
3500
4000
4500
5000
Outlet
Orifice Diameter
Inches
5/8
5/8
3/4
3/4
7/8
7/8
7/8
'Required
pipe
length
f eet
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DEDVCP\T10N
KNOW ALL MEN EYY 7HESE PRESENI
laws of -the State o-F Calrfor-r
owner in.-.fQe sim,ple of. the trp
�dedl.C.O+e -to the "-5e of 'the �U
any - and oil public purpos2z�
.upqn +he lo+s and blocks shov-v
roads shovvn +hereon; and alEc
...marqins for the erec+ion.conistri(
'+ronismi,ss�or) -oi e�ec+v-%ci+L� for
in. connection fherewith. Said
IN . )NI-TNESS WHF_RE_oF, we hove
i4A.-50
4-8 tn
ST
tv
444 '74- 6.3-3 ACKNOWLEDGMENT
I*,.-: ID
0
t4 0 P\ L_ I F=O PR
(D - A-7
6
Un ... S
N" , I . 0 .. . .
I .. .- . V CI-TY PNID COUt,4TY Or— SPN FIRP04CIS
ff:bA w F-S, T S'T
This to cer-+%fL� t-ho-t :)i
P
ublic personalig appecjred6�-/
0 6 w
0� POpe Talbo-� I n c., to me k
W r. S_r
WES
Q.56
6. 4-�5 z 2 instrument ond ocknowled d
0 S r..,j S 0,0
40 t.-- 4.5 6 0 fo r +he uses c-knd purposes Yher(Ir
0 -x�tfion to execute lbaid inst-ru.-r
T
secil of �aid corpc)rafion.
S4-5-47 1 C.5 3 N
T- 0
R, 2,1,z _T N E hoye
I N V\/ I _SS WHEREOF
44 6
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to WEST w E ST
53,4; -5 8
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e__ "Ziever-s Trecksurev- oi
V"rn0c., 11,
10 CO n do hereb cer-+rf
fu IV
C 31 Lc r t be dl�
on e,-. above
)Q t to and tpctud r
4 n
Priam
PR3,TECT NAME, -51,r AovxtAn d
- I nLlv-.Oyy" nxn, P. �9- 3k/,
CCMMENTS
FIR�
PLANNING
OUTEDING
Reviewed. by.- -A- (initial/Aa"
wrR/swR. DXNRNG
1-Y,1.111111
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VARIANCE/SE,'rBACK ADJ.
CONDITIONAL USE PERI%1IT
777777/T/
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//W/0
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OTHER':ZONING�REQUIREMENTS
Eyrv-IRCMEMAT, MATURES
.6
ACCESS SMPFN'VEHICI ACCESS
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HYDRANT SIZE EXISTING
7
CROSS CONNECTION INSPECTION REM
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—SHOULDER DRAINAGE MAINTAIN
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A,
MGR
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
Homeland Homes Inc.
3fl 221 James St.
0 1
Edmonds 1 775-2033
Design Consultants
903 10th. St.
CITY TELEPHONE NUMBER
Mukilteo 745-6569
Homeland Homes Inc.
ADDRESS
221 James St.
CITY —7TELEPHONE NUMBER
Edmonds 775-2033
STATE LICENSE NUMBER
HO-ME-LHI-174*KE
Legal Description of Property - Include all easements
(show below or attach'four copies)
Lot 44 Plat of Talbot Park
ElNEW
1E RESIDENTIAL
PLUMBING
1:1 ADDIALTER
1:1 COMMERCIAL
MECHANICAL
ElREPAIR
1:1 RETAINING WALL
SIGN
DEMOLISH
EXCAVATE
OR FILL
FENCE
( x �IF7)
REMODEL
PRE -MOVE INSPJ
COMPLIANCE INSP.
swim
POOL
WOOD STOVEI
INSERT APT.BLDG
RENEWAL
USE NWPERMIT
ZONE RS-20 NUMBER
AUL)KIzZib 17927 Talbot Road
-EGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
Ok I - I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EMSTING -43 REQUIRED DEDICATION
PROPOSED 6 6)
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED Gr*�
STREET USE PERMIT REQUIRED 0
SEE ENGINEERING MEMO DATED
//- 2-,f6 I
METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
REMARKS
SIGN AREA ENV. REVIEW
ALLOWED I PROPOSED COMPLE TE i EXEMPT
IVARIANCE OR CU PLANNING REVIEW BY I DATE
YARDS HEIGHT I LOT COVERAGE
FRONT SIDE REAR I
NUMBER OF STORIES NUMBER OF
two DWELLING
I UNITS one
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) I
construct single family home
N
F CO
CHECKED BY TYPE O.NSTRUCTION CODE HEIGHT
_N
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP _3 LOAD
0 YES 0 NO
REMARKS
f&9MAL jwsta pe.,L nxo shb4-- Co a!,e-,-
)Rwae-ss, &A 0 13 6 —30-5—
AW-Y- R601L)
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Perm * It covers work to be done on private property ONLY.
GRADINGIFILL
Any construction an the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permlt,Llmlt: 1 Year - Provided Work Is Started Within 180 Days
ENERGY CODE
"Applicant, on behalf of his or her spouse, heirs, assigns andt
To
successors In Interest, agrees to Indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
x
X
<
0
I
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 enforce any ordinance
provision."
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 the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authorlz'
ad thereby, no person will be employed In violation of the Labor
THIS PERMIT
AUTHORIZES
ONLY THE
Code of the State of We ton relating to Workmen's Compensa-
WORK NOTED
tion Insw-fance
A
SIGN T E (0 R OR A DATE SIGNED
I NSPECTION
D EPARTMENT
Mar.26,1986
9;�v
CITY OF
EDMONDS
ATTENT1W 771-3202
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 27 - 2A?b
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102-78
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
RELEASED BY:
DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
M
W
Z
Z
1
MEMO TO:
FROM:
SUBJECT :
Building Division
Planning Department
Engineering Division
Public Works Department
DATE : Z/-Z - Y6
After revie-ei of the subject Building Permit application, vie have the. following
c or,-,rn e n t s
Con nect ion, to C i ty wa t e r 5 ys tem reau i red .
2.
Connection to
City
sanitary sewer
system
req(iired.
3.
Right-of-way
permit
required for
any work
on . City property.
4. Driveway slope not to exceed 11111,
5. Back-.-iater valve required if doeinstairs plumbing is below elevation oil
F
upstream manho e—.
6. Water and se-aer lines to be s'eparated by 10 foot' minimum.
BO 6/82
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OF ED-MOINDS
JBLDG. DEPT.
1 DITIONAL PERMIT
7-
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379Z
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3
DATE-
'ic'Fir'.IAL
H "E'S E S-1 ;l'A;P_ED
FOR
INSPE-
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A I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
HOMELAND HOMES, INC.
MAILING ADDRESS
221 James Street --TfE—LE—PHONE NUMBER
CITY
Edmonds 775-2033
NAME
DESSIGN CONSULTANTS
ADDRESS
903-10th St --FL—EPHONE NUMBER
CITY
Mukilteo 1745-6569
NAME
HOMELAND HOMES, INC.
ADDRESS
221 James Street
CITY TELEPHONE NUMBER
VA___A , I 771;_')0q^A
STATE LICENSE NUMBER
NO MP TPT*
all easements
Park
FL] NEW
a RESIDENTIAL
PLUMBING
ADWALTER
COMMERCIAL
MECHANICAL
REPAIR
RETAINING WALL
SIGN
1:1 DEMOLISH
REMODEL
EXCAVATE
E] OR FILL
PRE -MOVE INSPJ
COMPLIANCE INSP.
FENCE
( x _FT)
swim
POOL
WOOD STOVE/
INSERT APT.BLDG
F] RENEWAL
a NUMBER OF STORIES NUMBER OF
LU DWELLING
0 Two One
co UNITS
0
1 NATURE OF WORK TO BE DONE (ATrACH PLOT PLAN)
Construct a single family home
USE '41WPERMIT
ZONE jf�5_20 NUMBER
JOB
AUUKtSS 17927 Talbot Rd
LEG DEPCRIPTION CHECKI S so
27 4W
PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING -_ ��REOUIRED DEDICATIO —
PROPOSED Nr .
RIGHT OF WAY CONSTRUCTION PERMIT REOUIRED
STREET USE PERMIT REOUIRED 0
SEE ENGINEERING MEMO DATED
METER SIZE IBUILDING SUPPLY SIZE IFIXTURE UNITS
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE I EXEMPT SHORELINE
VARIA14CE OR CU PLANNING REVIEW BY DATE
YARDS HEIGHT LOT COVERAGE
FRONT SIDE REAR I
BY
REOUIRED
0 YES 0 NO
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
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
ENERGY CODE
Permit Limit: I Year - Provided Work Is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors In interest, agrees to Indemnify, defend and hold
21 harmless the City of Edmonds, Washington, Its officials,
I
x employees, and agents from any and all claims for damages of
a:
< whatever nature, arising directly or Indirectly from the issuance
of this permit. Issuance of. this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify,. waive or reduce any requirement of any city ordinance
TOTAL AMOUNT DUE
0 nor limit In any way the City's ability to enforce any ordinance
provision."
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
THIS PERMIT
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
Code of the State of Washington relating to Workmen's Compensa-
WORK -NOTED
tion InstwancAn A
INSPECTION
DEPARTMENT
SIGNED
�TE �10��
JDATE
CITY OF
CnkA^K1r'%0
CODE
HEIGHT
/qS,?,
25-
OCCUPANCY
OCCUPANT
GROUP C->57
�r__)
LOAD
VALUATION
0
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
a
LE
cc
W
W
Z
a
Z
Uj
cr
0
Z
Z
Z
(L
0
Z
ATTENTION 771-3202
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102-78
RELEASED BY:
DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
q1
MEMO TO:
FROM:
SUBJECT:
. I
DATE
Building Division
Planning Department
Engineering Division
Public Works Department
—4z�2-2 - 13c! 1
A- b-6w � ow-
15
/Neov,
Ai5 CA4 /VV
d
After review of the subject Building Permit application,'we have the -following
comments:
1. Connection to City water system required.
2. Connection to City sanitary sewer system req"ired.
3. Right-df-way permit required for any work on City propert
4. Driveway slope not to exceed 14",
5. Backwater valve required if downstairs plumbing is below elevation of
upstream mamhoTe - ------
6. Water and sewer lines to be separated by 10 Foot minimum.
6f
10;
0
BO 6/82