18705 85TH PL W.PDF111111111111
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18705 85TH PL W
1-'7 C. 1 B913
CITY OF EDMONDS BARBARA FAHEY
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 FAX (425) 771-0221 MAYOR.
COMMUNITY SERVICES DEPARTMENT
Public Works - Planning/ Building - Parks and Recreation Engineering * Wastewater Treatment Plant
September 14, 1998
Janris Construction
18705 85" PI W
Edmonds, WA 98026
Re: Address Correction
Mr. Thompson,
".,-FT R.F'
This letter is to inform you that when we assigned addresses for your two lots off
840'Ave West, we did so incorrectly. We assigned 18310 & 18320 84 1h Ave West
when in fact these numbers need to be odd. The corrected address house numbers
are 18311 (#980516) & 18321 (#980517) 84"Ave W. I will inform all interested
City Divisions and write a letter to the Postmaster. I am very sorry for this
inconvenience. If you have any questions, please call me at 771-0220.
Thank you,
Lara Knaak
Permit Coordinator
cc: Building Official
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
AM)
LOT 4 HELLEREN LANE
TAX # 8389-000-004-0000
97-/-
25
F-
10,
395'
L-Li
�,D
LIJ
05 RECEIVE[)
U? c:) MAY i I iggs
Qj 5, Lr)
MMff COMIR
Qj 0i
A io3ar
L) 24'
/oe-
DCCK
10,
16'
SEWER
s7uB WALKWAY z 390' o 0 5-,
lo/ ;z s-
DRIVEWAY
�CITY
25
385' PArft-?bitx-= too
u-_a
85th PL W SC . ALE 20
APPROVED BY PLANNING
LOT 4 HELLEREN LANE
TAX # 8389-000-004-0000
97/
25/
10,
395'
c
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26,51
6 4
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5' :z
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16
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14 .
1
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b
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16,
c- 190", 101.<
SEWER
---
STUB
WALKWAY
390'
10.
rK
DRIVEWAY
RECEIVED
13D,<
157 Z
25
MAY I I 19's
fir.
. /
PEW COUNTER
APPROUE AS NOTED Ati'�-b 46
—/1 IJ -w- & - - a--- 6 r&& fr
ACCEPTABLE TIGHTLINE MATERIAL
"X% P L W
so
WATER SERVICE INSPECTIONS
REOUIRED. CALL 771-0235
385'
17-('
AWX dPL7A 4WO IDArof- PT-z
ZX- C3
CA-M" Z05 %NJ
SCALE 20
CITY .- COPY
-z�
PROJECT REVIEW CHECKLIST -7
PROJECT NAME:... 7
PLAN CHECK #:-9,
PROJECT ADDRESS: Ae -70S- RECEIPT DATE:
PLAN. TER
COMMENTS
SetbacksNariance/Setback Adjustment
Conditional Use Permit
.. . ........
. . . . . . . . . . . . . . . . . . . . . . . . . . ------------
AD13 Requirements
Other Zoning Requirements
4
Underground Wiring Required
.... .
----- - - --------
M. -M
...................
Lot Slope 15%
X: . .. .. ........
SEPA Environmental Checklist/Hydraulics Permit
7 1
Tree Cutting Plan
..... .....
Plat/Subdivision Requirements
Legal Description Verification
A
Quit Claim/Street Dedications
Easements - Public/Private
---------
. . ....
Engineering Storm Drain Review Fee
Engineering 2.2 Inspection Fee
Drainage Plan (On -Site)
IS, -
Setback - Top of Bank, Stream, Water Courses
.................. .......
.......
Setback - Storm Drain Line
..... ...
....
Op6h Ditch - Existing
.....
.... . .....
.. . .
F18.1
Culvert Required
Culvert Size
X-M
Shoulder Drainage/Shale Open Runoff
Catch Basin Required
.... ..........
Driveway Slope & Vehicle Access
X:
23.
Sidewalk Required A.Jb
Curb & Gutter Required
.....
Curb Cut For Driveway Required A.W
Street Paving Required "o
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ki
Right-Of-Way Construction Permit Required
-28-
Street Name Sign Required AV
Other Signing Required A-114
Bond Required For Public Improvements
FEMA Map Check/Water Table
. ..... ..... .
Side Sewer Availability
.......
. . . . . . . . . .
:", .......... ........... .
Calculate Sewer Connection Fee If No LID #7,r7
:,��i:3 , 4 .
Create Street File
A 5
Existing Water Main Size
36.:
Water Meter Size
......................................................... ....... ..
. ...
3
Service Line Size
.................................
:3&-
Water Meter Charge Required
..
.... . . ..
-75
. . .
39
Hydrant Required
. . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . .
Hydrant Size Existing
sit
V-1v
t
Fire Line Charge Required - Sprinkler
..... ....
Street Cut
Miscellaneous
p IUB 0
Reviewed By:
FIRE PLANNING ENGINEERING PUBLIC WORKS
R E C 0 R D OF C 0 N T A C T S
1
21
2
22
3
23
4
24
5
25
6
26
7
27
8
28
RW PERMIT # DATE ISSUED RECEIPT #
29
10
30
11
31
12
32
13
PAID $ RECEIPT # DATE
33
SS PERMIT # ?7CZ) DATE ISSUED(6-/S-9�' RECEIPT #/5Pf06
14
PAID $ RECEIPT # DATE
34
15
35
16
36
r
37
METER SIZE�� PAID $ 37s' DATE C,/,�-J�5RECEIPT # 1,9�;?(-
18
38
19
39
20
40
" zm�
LOT 4 HELLEREN LANE
TAX # 8389-000-004-0000
9 7
25
�,D 26,
0i CD
co
ru
11.5'
"u
4'
DCc —
10,
-p 16'
SEWER
STUB
10 WALKWAY z
DRIVEWAY
25
385'
10 /
/ 1 395'
RECEIvED
MAY I 1 1995
Lo
PERMIT COUMER'
l6w
le�v
A
P)
el 10 -7, 5'
V 5-
3 --;7
90' A2,
zs—
CITY
44A.
85th PL W SCALE
tot,
20
APPROVED BY P!-.AN,'.N;A3
The City of Edmonds
Water Service Drawing
EASEMENT NO . ............................................
NEW CONSTRUCTION REPAIRS F1 LID NO . .................. . ASMT. NO . ..................
OWNER ....PAu.L - ----- TjA.ot- C
..lpsa.N ....................................... CONTRACTOR .................................................................................... PERMIT NO.9542AR7
JOB ADDRESS --- ....... 8-5-" .... PL.
. .., ... ........ ... $tw ......... LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
NAME OF ADDITION ....... 14Exj-eqfi,!4 ..... ln!!k ..........................................................................
-.09
8 5 '" PL. W.
PWW-0001-11/ 5 .11/78)
5 PS.I. P.E.
'MAC." %ol"
V6 r I "Coope*
Approved:
DATE By,.4&...[ . . ... ...........................
.... #1
NOTICE:
—0—___h_ty_0
wa rr a
The information 'shown on the attached
map(s) was compiled for use by the City Of
Edmonds) its Employees and Consultants.
Th,.e City of �Edm.qnds does not . warrant the
accuracy of anything set for.th on these
rnap(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform'ation shown on
.___tRe -map(s), including, but not limited to,
th*e lociation of any sewer stub shown. Such
sewer stubs may or may'not exist and may
or may not exist at the location shown.
Neither the city of Edmo*nds nor its
emp'fo-yee-s o-r offi-ce-rs shall be Via-b-Ife for the
information given on this map(s), nor for
any one representation provided based
upon . said map(s).
CITY
1 q
Address of Construction:
OF EDMONDS
1,9 n 0 z�- Ili
SIGE SEWER, PERMIT
PERMIT fl\jO - 87CO
Property Legal Description (Include all easements):
'g�'4 F2 LI *i� XEz, I (Ant I F�_' RFCF.IVF-D
i U N 1 5 1995
PUBLIC WORKS IJEP7
Owner and/or Contractor: 'li J Ar, 9�"3
State License No. 4\1 en C 111K I 1 .0 \25 Building Permit No. Co 7
-ff-Single Family
0 Multi -Family (No. of Units—)
El Commercial
El Public
Invasion into City Right -of -Way: 6-No 13 Yes I
RW Construction Permit No.
Cross other Private Property:A. No El Yes
Attach legal description and copy of recorded easement
I certify that I 40re-fe—ad and shaOrcomply with all city requirements
as indicated on the back of the Permit Card.
(61qc
Date
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION
:OFFICE. LISE,� ONLY
FOR INSPECTION CALL 771-OW PUBLIC WORKS DEPT.
Permit'Fee: I ss u ed B y
Trunk Cha rge: Date Issued:
Assessment Fee: Receipt No.:
Lid No.: —
Partial Inspection: Date -Initial.
Comments
Reason Rejected: Date I nitial
Final Inspection Approved: DateLLO__&_Initial�
PERMITMUST BE POSTED:ON JOB SITE,
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3190
1*
The City of Edmonds
Side Sewer Drawing
EASEMENTNO . ...................... ...... ------------- j
NEW CONSTRUCTION REPAIRS F� LID NO . .................. IASMT. NO . ................
OWNER................................................................................................ CONTRACTOR .................................................................................... PERMIT NO. �Mt
JOB ADDRESS --- I 9.1� S.— 3 5� -.. -V-4 .................... LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
NAMEOF ADDITION ............................ - ............................................................ ............................
-0-
PWW-0001-1 1/75 (REV.1 1178)
'k-K 11, -rb ?--r-c-
7
i
13
Approved:
DATE3K70 46 ............ B .. ........................
CITY OF EDMONDS
USE PERMIT
ZONE < NUMBER
CONSTRUCTION PERMIT APPLICATION
ADDRESS z�4 OTE AIT.
Z
0
0 ER IF BUSINESS
!fAME NAME C
L 7
LEGAL DESCRIPTION CHECK
o r
",),VISION NO
LIONO
MAILING ADDRESS
2 - Pic
PUBLIC Riff J�r`WAY PER 001CIAL STREEVAp
EXISTING !:!:�UMED DEDICATION
PROPOSE D
TESCP Appro,ed 0
RW Permt Required 0
Street U-0 P01-1 Roo it 0
nio.Clor Required IIN
Sidewalk Required 0
CITY 411
`T7- QM 0-1, 9 S.
EL. —NE NUL48ER
NAME
I.)
LINE SIZE
NO IF FIXTURES
Zo
PRV E RED
YES NO 0
S
ADDRESS
REMARKS
U
lox Let //,7/?,�-
Z
CITY ZF7TELEP-ONE
NUMBER
Z5
Z
NAME
L
1\1� a % S /Z j -r% U
ADDRESS
2 - �6 C), 0
0
2
8
ENGINEERING MEMO DATED 11ZE EDBY
&,:�-
IIP
( -4 I
TELEPHONE NUMBER
—n � - -7 (AR
FIRE MEMO DATED REVIEWED BY
STATE LICENSE NUMBER EXP R T ON DATE
C 10 P IS 1)
=
SIGN AREA
ALLOWED PROPOSED
SEP REVIEW
COMPLETE EXEMPT
E.P
AD
7" 1
.-OTINE*
Z
LegarDeSCription of Property - include all easements
A- 0?LLIF(Z&,, LA,AF
X
VARIANCE ?R Cu
P�AN
BY
L)
�j
ZIREVIEW
SETBACKS - FEET HEIGHT
FRONT SIDE REApf)5
JLC��FACdL
Z
wZ
Property
REM -Ks
tl
T x Account
P:rcel No. 000-00/4-
XNEW EZ RESIDENTIAL IM PLUMBING
[I ADDITION [] COMMERCIAL [91 MECHANICAL
ElREMODEL F] APT. BLDG. 11 SIGN
CHECKED By
TYPE OF CONSTRUCTION CODEe
;T
OCCU PANT
GROUF�
EP'F GRTOIN6 C'cs FENCE
x _ Fn
WOODSTOVE OL
r7 DEMOLISH swim PO
INSERT HOT TUBISPA
GARAGE RETAINING WALL/ -1
CkhuaQa& ROCKERY RENEWAL
SPECIAL INSPECTOR
REOUIRED E3 YES [5,73
A
&A 1,A
'OCCUPANT
E—MARKS-
PROGRESS INSPECTIONS PER UBC 305
Z
0
(TYP 0 �E, BUAINESS OR ACTIVITY) EXPLAIN:
-r/y3ia AC -At- 1-7,71
0
M
0
Me
NO ER Z NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS Offt. NUMBER
OAlf,4 KVAwR,4f-#
DESCRIBE WORK TO BE DONE IATTACH PLO
r o�wa-
FINAL INSPECTION REQUIRED
lorLIW, g/6%
--=
VALUATION
FEE
6,moinj 3toorMs
1
PLAN CHECK FEE
BUILDING
21330733
RrA-T SOURCE:
GIAS
GLAZING
1(0 %
PLUMBING
Plan Check No. 9,'� - ZZ
MECHANICAL
:76,
This Permit Covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidenvolks,
driveways, marquees, etc.) will require separate permission.
STATESURCHARGE
Permit Application: 180 Days
Permit Limit: I 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
w
successors in interest, agrees to indemnify. defend and hold
harmless the City of Edmonds, Washington, its officials.
x.
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
01
x
modify. waive or reduce any requirement of any city ordinance
nor limit
p rOvIsion!p any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; th:t the
information given 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
Sta I a laws regulating construction; and in doing the work authoriz. AUTHORIZES This application is not a permit until
ed 'hereby, no It on , 11 be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Codeaftha��f a ington relating toWorkmen'S COMpensa- WORK NOTED Deputy: and fees are paid. and receipt is
S W
tion Insura a a d RC 18.27. INSPECTION acknowledged in space provided.
SI p4EA OR OENTI DATE SIG ED DEPARTMENT
CITY OF 'CAL S 6' NAT DATE
EDMONDS
MOFTUR
CALL FOR ELEA DATE
TTENTION INSPECTION A-,
IT S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
If
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL - F.Ie YELLOW - Inspector
CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 771-0220
U
LOT 4 HELLEREN LANE
TAX # 8389-000-004-0000
10 /
25/
I�D RECEIVEZ
V)
MAY
POW COW ER
390'
3.5. STREET F"
0 f )A�
85th PL W SCALE 20
APPRO ED BY PLANNING T*rv,40- TPI ""T- ov
Y. CL
LOT 4 HELLEREN LANE
TAX # 8389-000-004-0000
1 97/
10. /
�,D
15 z
Li -i -
12,
oj
G/)
ry
24'
C:) I. , "o
e, Dccl< ---
10,
_0 16' �o
SEWER 1 0 ---
STUB
WALKWAY
DRIVEWAY
A
AA5S i�oi-ED
AM P Rd I Nu I_r
ACCEPTAki) **HTLIR� MA101AL
N-12 ADS
I
A
25
[ I %"., %, .- . . .. - - - - - ,
gjER SERVICE INSPECTIONS
REqUIRE9, CALL 7714235
25/
10 /
395'
CD
Ln
V-1
V3q
c-
19 o
390' "rA,4
RIECIEIVED
MAY 1 1 ipoi
PEPimrr coumR
385'
1 -Z(,
c:3
%AS
SCALE 20
r /4>q
- zr
PERMIT APPLICATION REQUIREMENTS
To: Applicant
From: Lyle Chrisman, Engineering Ifispector
Owner Plan Check No:
Address:--&743 0-524A k/ Date: AFA414-f JVr
After review of die subject permit application, the following requirements must be met:
1. Construction hours are:
WEEKDAYS — 7:00 A.IVL-10:00 P.M.WEEKENDS/HOLIDAYS — 10:00 A.M.-6:00 P.M.
2. A separate RIGHT-O&WAY CONSTRUCTION PERMIT is required for all work on public property. (ECDC 1&60)
3. Truck haul route plan must be submitted and approved prior to permit issuance.
4. Builder/owner is responsible for containing all temporary runoff and erosion control on site.
(ECDC 18.30.030d)
5. NO WORK SHALL BE DONE WITHIN 15 FEET OF STREAMS OR 10 FEET FROM ANY CLOSED DRAINAGE
FACILITY. BUILDER/OWNER IS RESPONSIBLE FOR IDENTIFYING CONDITIONS ON THE DRAWING. (ECDC
1&30.50G)
6. FILTER FABRIC FENCE SHALL BE INSTALLED AND. INSPECTED PRIOR TO CLEARING AND CONSTRUCTION.
(ECDC 18.30)
7. INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEMS, TIGHTLINES AND CATCH BASIN
INSTALLATION. INSPECTIONS ARE REQUIRED PRIOR TO BACKFILLING. (ECDC 1830)
8. Repair or replace all defmfive existing curb, gutter and sidewalk adjacent to the property. If an intersection is invoWed, a handicap ramp
may be required. Contractor shall meet with the City Engineering staff to determine the extent of repair prior to issuance of the permit
(ECDC 1&90)
9. Driveway slope shall not exceed 14% without a waiver. Every attempt should be made to keep the slope below 14%. Waiver granted to
%. (ECDC 18.80.060D)
10. Driveways must be paved fiom property line to City RIGHT-OF-WAY. A separate permit is require& (ECDC I&SO.060C)
11. INSP ONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIOR TO AND AFTER POURING. (ECDC 18.30)
12. No burning of construction refuse without a permit from the Fire Department.
13. Connection to City water system is required. There is a separate charge for the water meter.
(ECDC 7-20)
. 14. A back water valve is required if downstairs plumbing is below the elevation of upstream manhole. (ECDC 7.20)
15. Water and sewer main lines should be separated by 10 feet minimum. (JZCDC I&1o)
16. Connectioulp the City sanitary system is required. A separate peerrait
,ipjequire
LID# Fees paid: Yes— No— Charge (ECDC 18.10Y
17. Underground wiring is required on all new construction, and for additions, alterations, and repairs that exceed 500/6 of the total assessed
value of the structure. (ECDC 18.90)
18. A FINAL ENGINEERING INSPECTION IS REQUIRED PRIOR TO THE BUILDING DIVISION GRANTING OCCUPANCY
OF THE BUILDING OR STRUCTURE. (ECDC 1&90)
PRMTREQRDGT
QTREET FILE
Q1
PROJECT REVIEW CHECKLIST
PROJECT NAME: —
PROJECT ADDRESS:- . 1P 70,3 - a's-zVA- ",)4 �j
PLAN CHECK #:
-9,-,5 /
RECEIPT DATE:
IREVIEWFD
(nitial/Date)
PLAN..IWATER
FIR
BLDG.
SEWERISTREET
ENG]
Setbacks/Variance/Setback Adjustment
111M.11,
M I'll
Conditional Use Permit
.2.
AD13 Requirements
-3
Other Zoning Requirements
Underground Wiring Required
S,
A
Lot Slope IS%
. . . . . . . . . . . . . . . . . . .
SEPA EnVironmental*Checklist/Hydraulics Permit
-7
Tree Cutting Plan
X.
8
Plat/Subdivision Requirements
- ------ 1
.... .......
MIMI
9
Legal Description Verification
1-10::,
Quit Claim/Street Dedications
Easements - Public/Private
..A
Engineering Storm Drain Review Fee el
Engineering 2.2 Inspection Fee
14
Drainage Plan (On -Site) 5 7-
Setback - Top of Bank, Stream, Water Courses
I MI.
Setback - Storm Drain Line
Open Ditch - Existing
------ s Ir
. . . . . . . . . . . . . . . .............. - - - - - - - - X.,
Culvert Required
19:.
Culvert Size
Shoulder Drainage/Shale Open Runoff
Catch Basin Required
. . . . . . . . . . . . . . . . . . . . . . . .
22",".
Driveway Slope & Vehicle Access
23,
Sidewalk Required AJ23
Curb & Gutter Required AM
........... IZ
Curb Cut For Driveway Required AW
. . . . . . . .........
Street Paving Required
. . . . . . . . . . . . . . . . . . . . .
Right -Of -Way Construction Permit Required
Street Name Sign Required AJD
:45
Other Signing Required A-pe
----------
Bond Required For Public Improvements
FEMA Map Check/Water Table
M:
Side Sewer Availability LM
. . . . . . . . . ...... ...
Calculate Sewer Connection Fee If No LID #
0
Create Street File
Existing Water Main Size
..
Water Meter Size
3/g
3 T�..,
Service Line Size
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - -------
..R
------
-
Water Meter Charge Required
- - - - - - - - - - - - - - - - - - - 25-75"
39
Hydrant Required
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......
Hydrant Size Existing
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Inu
t
%ff..,
Fire Une Charge Required - Sprinkler
. . . . .
Street Cut
(�5
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................
-43:
Miscellaneous
..... .. ...
-44
Reviewed By:
FIRE .
PLANNING
S
, TRE,--T
FILE
ENGINEERING
pliBLIC V4UN\0 -
PUBLIC WORKS
LOT 4 HELLEREN LANE
TAX # 8389-000-004-0000
1 97/
�,D
aj
t
(u
D� 5'
(-u
116
CD 24'
DCcj<
10,
b 16' �o
SEWER
W
STUB W- 4-
10.1 ALK A.,
—DRIV—EWA—Y—�
AWPP OVED AS NO D
oe
GAP
ACCEPTABLE TIGHTLINE MATERIAL
N-12 ADS -
W,Z h
(rp PVt
SD M 3�34) W
25
25/
10 /
395'
c:)
Ln
V----i
�4 EF I(, W-r CALC-' '�
Z ri -7
fz(
(42
390' MrA,4
I(* Sr
RECEIVED
MAY i I lqc..i
PERMIT couvrim
385'
lAvoa Aer- j�t,+ Aso-0 wrif- Pr= lob
C3 -
CA-TCIA 'RAS 11)
SCALE 20
STREET FILE
REQUIRED. CALL 771-0235
J . PLANNING DATA
SITE ADDRESS: le "0 9
DATE: A,;
ZONING: Zs —i?, PLAN CHK#: q5--7)
PROJECT DESCRIPTION: d
61A)
SETBACKS:
Required Setbacks: I
Front: ,/,6 Left Side: /0 Right Side: /<0 Rear:
Actual Setbacks:
Front: Left Side:— / 0 Right Side: Rear:
CORNERLOT
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED
LOT COVERAGE:
Maximum Allowed:41zC6 g��) Actual:—Z-72-/�O/ (I&Zo)
I If '.--
BUILDING HEIGHT:
Maximum Allowed: Actual Height:
CRITICAL AREAS #:
SEPA DETERMINATIO
LOT AREA:
OTHER:
Plan Review By:
WEMMM
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE AME NAME OF tsutoNESS
^J
I INU UL�...
L - q I II, Z - . (I, P
C, I
71_1�7 `1 —
Y ZIP TELEPPONE �NUMBER
ADDRESS
— -----------
L) ___TTELEPHONE NUMBER
a: CITY
NAME it a AL
ADDRESS
0
L) 1p' TEL NUMBER—
TATE LICENSE NUMBER EXPIRAT ON DATE
(Z li C 0 j Ck
Lega scription of P'M9es4s_,irt8uq aji sements
MCI --
USE PERMIT
BER
', -c-
ADDRESS Z& — ,
JOB /,,? , �r
TE APT 4
EE—GAL DESCRIPTION CHECK SUBDIV151UN NO
LID NO
g-
I-or
OFFICIAL STREE
�PAp
PUBLIC RI�G_ AY PER
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REMARKS
PROGRESS INSPECTIONS PER UBC 305
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FINAL INSPECTION REOUIRED "
EE
GROUF
PLAN CHECK FEE
BUILDING
53 733
%
HrA'T SOURCE: PLUMBING
&AS
MECHANICAL
Plan Check No. i� 1,11, ii��
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5-
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work to b a done on pi I Vale property ONLY. GRADINGIFILL
This Permit covers
Any construction on the public domain (curbs, sidewplks,
STATE SURCHARGE
-------
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work is Started Within 180 Days .
her heirs, assigns and ENG. INSPECTION FEE
�;` C)
.'Applicant, on behalf of his or spouse,
successors in interest, agrees to indemnify, defend and hold
Washington, its officials,
harmless the City of Edmonds,
employees, and agents from any and all claims for damages of
Sing directly or Indirectly from the issuance
whatever nature. ari! deemed to PLAN CHECK DEPOSIT
shall not be
of this permit. Issuance of this permit
modify, waive or reduce any requirement of any city ordinanc a
nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision.
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
I agree to comply with city and
THIS PERMIT
This application is not a permit until
authorized agent of the owner.
and In doing the work authoriz-
AUTHORIZES
signed by the Building Official or his/her
state laws regulating construction;
be employed in violation of the Labor
ONLY THE
WORK NOTED
Deputy; and fees are paid. and receipt is
ed thereby, no gA )reo`n��Jll
I �Va4hington relating to Workmen's Compensa-
acknowledged in s pace provided.
Code of t e S e
tion lnsur�a. -a d RC\Af 18.2
IGNATURE. t" V�
INSPECTION
DEPARTMENT
CITY OF
OF lCiAL S SI NATURE DATE
EDMONDS
617
CALL FOR
e DATI:
ELEA a'.
)_ �
_'�NTION
ATT
INSPECTION
OA\
-_ )R OCCUPY A BUILDING OR STRUCTURE
IT IS UNLAWFUL TO USE C
HAS BEEN MADE AND APPROVAL OR
771-022 0
6RIGINAL — File YELLOW — inspector
UNTIL A FINAL INSPECTION
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
PINK — Owr�er GOLD — Assessor
CHAPTER 3.