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18813 81 ST AVE W
ADDRESS: MIA-, - /Z
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTt
COVENANTS (RECORDED) FOR: —
CRITICAL AREAS:- DETERMINATION: Conditional Waiver E] Study Required Xwaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED: —
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
LID #:
LOT: BLOCK:
LATEMP\DS'Ps\Forms\Strcet File Checklist.doc
0 PLANNING DATA
SINGLE FAMILY RESIDENTIAL
0 11 STREET FILE 11
Name:
Date:
Site Address: L3
Plan Check # q
6;>-
Project Description: mc/(-((�n S-4.9ry
Reduced Site Plan Provided: E NO)
Zoning: (0
Map Page: --- —1
Corner Lot: (YES 'FFlaq Lot: (YES
Critical Areas Determination ff a A---;? oe�r,_006 2
11 Study Required
P!rWaiver
— -----
SEPA Determination:
Pf-Exempt
Needed (for over 500 cubic yards of grading)
El Fee 0 Checklist 0 APO List with notarized form
Requhr-ed lbacks
Sbet: ide: Side: Rear:
J�S,d
__1 - 5 /0 ------ -
Actual Setbacks___
Street: Side: Side 2- Rear.
El Detached Structures:
El Rockeries:
Fences[Trellises:
Bay Windows/Projecting Modulation. -
El Stairs/Deck:
8011dif I
Datum Point: im 4-
Daturn Elevation:
Maximum Height Allowed: Z_ S-
Actual Height. -z
Other
Parking Required:
Parking Provided:
Lot Area: 3 Maximum Lot Coverage: 35% Proposed:
Lot Coverage Calculations: 4_�
ADU Created: (YES / 46
Subdivision:
Legal Nonconforming Land Use Determination Issued: (YES / 0
C0177fliefILS
J/ L 1) A-V 5
A- /00
tOA0
00
Plan Review By: to P�P� I/ Id �
Ptdmli(M Oata Foum 04 -11 06-doC
0
#P20
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/ vegetation)
L Site Address/ Location: I XIKH K('11- k) CL
2. Property Tax Account Number: Q q $7 f 0 (J 0-6
3. Approximate Site Size (acres or square feet): , '3'� cx -s- P- S
4. Is this site currently developed? _4_ yes;_ no.
If yes; how is site developed? S
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
6.
7.
8.
9.
CA File No:C-,aAU1Cj1a�-/,1
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal
distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% (a vertical rise of 10-feet
over. a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal
distance of less than 33-feet).
Other (please describe):
Site contains areas of year-round standing water: Oo ; Approx. Depth:
Site contains areas of seasonal standing water: YJ o ; Approx. Depth:
What season(s) of the year?
Site is in the floodway ij o floodplain 0,9 of a water course.
Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site:
1. Plan Check N
2. Site is Zoned?
0.
4.
5.
SCS mapped s
For City Staff Use Only
if applicable?
Critical Areas inventory or C.A. map indicates Critical Area on site? A/4
Site within designated earth subsidence landslide hazard area?
DETERMINATION
WIRED
WAIVER
Reviewed bv:
Date: yj ) 10q
#P20
V ED
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
The Critical Areas Checklist contained on this form is to
be filled out by any person preparing a Development
Permit Application for the City of Edmonds prior to
his/her submittal of the application to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The information
needed to complete the Checklist should be easily
available from observations of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
Date Received -
City Receipt#:
Critical Areas File
Critical Areas Checklist Fee -
Date Mailed to Applicant: ,3-0
A property owner, or his/her authorized representative,
must fill out the checklist, sign and date it, and submit it
to the City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed copy
of this form to assist City staff in finding and locating the
specific piece of property described on this form. In
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in con unction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or mifi-action based in whole or part upon false, misleading, inaccurate or
incomplete information fumished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT
DATE
Property Owner's Authorization
By my signature, I certify that I have authorized, the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this applic* aii6n.
SIGNATURE OF OWNER
Owner/Appficant:
Name 11
( V1 1 2) Aile LJ
Street Address
EJ oJA go/-p
city State Zip
Telephone: 7 '? L-1 - 4 q 3
Email address (optional):
DATE
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
USE i� M IJQT
BUILDING DEPARTOW Applicant Fill ZONE NUMB
PERMIT APPLICATION Inside Heavy Lines JOB RE 7-F.L
NAME (OR NAME OF BU . SINESS) ADDRESS Me
LEGAL LOT P A E
0;_W VISION NO.
zvea DYES 1:11NO SUBDI
W MAILING ADDRESS
z rlc&fj::s I -
/5 PUBLIC RIGHT OF WAY PER ORDINANCE NO.
0 rll_�11
UTY ELEPHONE NUMBER
, r"i /-?-� 0 h (ys IT 776 3�76_.), EXISTING RIGHT OF WAY___ ke
PROPOSED RIGHT OF WAV
DEFICIENCY OF RIGHT OF WAY
W ADDRESS
t
STREET/UTILITY WORK REQUIRED
[]YES
ONO
x
U
PERMIT FOR WORK IN PUBLIC R/W
YES
ONO
It CITY
TELEPHONE NUMBER
UNDERGROUND WIRING REQUIRED
OYES
le. 0
CONNECTION TO SANITARY SEWER
XYES
0 NO
NAME
Z_ 71
SEPTIC TANK PERMIT REQUIRED
OYES
0 No
SEPTIC TANK PERMIT NO.
0 ADDRESS
U
tl C, x 3
61--7-1 W3
SEE MEMO DATED g _81
4
it CITY
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TELEPHONE NUMBE5
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0
77�-,- -3,76 1
LREMARKS
U STATE LICENSE NUMBER
CITY LICENSE NUMBER
CHECKED BY
Legal Description of Property (Show Below or Attach Four Copies)
. T ER SIZE
BUILDING SUPPLY SIZE
0
SIGN AREA ENV. REVIEW AE
ALLOWED PROPOSED COMPLETE EXEMPT
U
0 SHO5
W
0
.J
REMARKS
W
.J
VARIANCE OR CU PLANN ING REVIEW 13Y
YARDS LOT COVERAGE
FRONT SIDE REARI
NEW RESIDENTIAL I
L4j —1 AS FIRE ZONE TYPE OF CONSTRUCTION CODE
LAJ r -LINE 11
kON-RESIDENTIAL
SIGN
ADD
DEMOLISH
RETAINING
WALL
SPECIAL INSPECTOR
REQUIRED
ALTER
EXCAVATE
FENCE
0 YES NO
OR FILL
'— X—Fr)
PLAN CHECKED BY
REPAIR
PRE -MOVE
INSP.
swim
POOL
Z NUM13ER OF,STORIES
,IUMBER OF
REMARKS
2 Z_
3WELLING
�,,J
MATURE OF WORK TO BE DONE
ci)
IUA
W
0
_.MPLAN
CHECK FEE
'[PROPOSED USE
M
PLOT PLAN IINDICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
i
U
(A
PLUMBING
0
MECHANICAL
FENCE
SIGN
IA "Applicant, on behalf of his or her spouse, heirs, assigns and
III
W
j successors in interest, agrees to indemnify, defend and hold harmless
I the City of Edmonds, Washington, its officials, employees, and
RETAINING WALL
agents from any and all claims for damages of whatever nature,
x arising directly or indirectly from the issuance of this permit. Issu-
SWIMMING POOL
01 ap!��,,q(jhis permit shall not be deemed to modify, waive or reduce
HEI,UH
Ci
:AR E :A OCCUPANCY OCCU—PA
GRD1UP r LOAD
up (z 3
::[ IS
THIS SITE IS LOCATED IN THE CITY
0 EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
DATE:
70: Building Division
Community Development Department
k KUM:
SUBJECT:
Engineering Division
Public Works Department
IM13 Vir -.4ye- W
After revi'ew of the subject Building Permit application, we have
the following comments:
1. Connection to City water system required.
2. - Connection to Citv sanitary sewer system required.
3.
Right-of-way Permit required for any work on City property.
4,
Driveway
slope notto
exceed 14%.
5.
Backwater
valve required if downsLairs p1timbing is below
elevation
of-uDstream
manhole.
6.
Water and
sewer lines
to be separated by 10 foot
-7
t)--
_J__ J, " -
-minimum.
41P
0
. 9
Signature
PUBLIC TAORKS DEPAR71-M CHECKLIST
BUIIDING PERUT REVIEW
(address) (date)
Street Right -of -Way Exist
Z
Access Easements Exist
Od
Utility Easement Exist
REQI�_
Lot Per Subdivision Plat :rAAMO'*LWf%sessor
Site Plan Checked for Accura
Z
Underground Wiring Reqd. Ar
H
0
Check Accuracy of Legal i��sption
Z
Review by
Existing Water Main Size— s7-
Water Main Required AVA
Service Line Required
Hydrant Size Existing,
c4
Hydrant Reqd Per Fire Code &JA
Size
Detector Check Meter Reqd.
Cross Comection Inspection
Fire Department Comments
Water Meter Reqd. SO.
S�t, &ej��
Review by 22������te
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
Proj
Dra:wing No. 3
File No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
Review b AC-e�
Date
- 1 .2 -&&
fn
Open Ditch Existing___,/4-/'� �-.._Reqd.
Z
Culvert Reqd. -_ ' Aga&-
Size.
04
Catch Basin Reqd.
Indicate on Site Plan
0
Shoulder drainage maintain collection on
swale open runoff
Ow
Manhole -Indicate
Z
t P
Soil Conditions and Ground Water Field Checke
Review by_
Date
I
on
Revised: lvlO-1977
Page 2
Street Paving Reqd.
Curb and Cutter Reqd.
Sidewalk Reqd.
Curb Cut'for Driveway Reqd.
04 Right -of -Way Constructi ; on I Permit "-, R6qd. r
E-4 Bond Reqd. for Public Improvements —
Street Name Sign Reqd.
Other Signing Reqd.
Pre Permit Site Inspection made on
z
0
BY: S94ER
WATER
STREET
ENGINEERING
Special Requirements listed in mew to'Canuunity Development Department,
Building Division
BY Date
o All items fillec*in-on Building Permit Application
P� BY Date
Drawiiigs'Starrped and Notations Made
BY Date
Approved by Public Works Department
Fzvised: 1v 10-1977
APPLICATION I yru m
for F Lt'"I 11
Th(i C"ll.
SIDE SEWER PERMIT
EASEMENT No . .........................................
NEW CONSTRUCTION REPAIRS E)
4
0 N . ............. ..... PERMIT N .............. . "I
Nv ............. CONTRACTOR ......... 7 ... .. .................. .... .....
........... ----------------- ......
ADI)'ftJt8$ . ...............
P.— ................. RIPTION: LOT No . ............. .........................
...... ... . . .. ............. LEGAL DESC
BLOCK No . ..... ..................................
NAME OF ADDITION ........ .................... ......
Ak
<2�
'00 i�
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Y
miE. ... .. ...... .... ............ -By ... x - ------------- ................
----------
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37/
CITY OF EDMONDS
PUBLIC WORKS DEPART 0 T
SIDE SEWER PERMIT
FOR INSPECTION CALL Permit kfoo _00,0-0,�
775-2525 Ext. 220 Issue Date 5p,/s
PERMIT MUST BE POSTED ON JOB SITE
3WrWr30r"
1. Address of Construction
2. Property Legal Description (include all, easements)
1<' _,1
3. Single Family R=idence. Multi- Fa mily No. of Units'
Commercial
4. Owner and/or Builder
5. Contractor & License No.
6. Invasion into City Right -of Way: Nov,--*" Yes (If Yes Right-of-
way Construction Permit Required Call Dial Dig (342-5344) before
excavation) .
E-1 7. Cross other private property: Yes No/"-- Easement required -
U attach legal description and county easement number.
H
�4 READ THE FOLLOWING AND SIGN:
P4
P4
4 a. Property owners must obtain a permit to install side sewers on
>4 their property. A licensed side sewer contractor must be employed to
9Q construct side sewers in the public' right-of-way.
0
The side sewer contractor assumes full reponsiQL60 �Unj HICh
W
installation for -one-year.
OSL Y;
4 c. '-Comm&'rcial establishment requires a minimum fflk 'PUh 016)
P4 %
side sewer line. 000 - 562�§ 7
0 d. Sid'e-sewers may not be installed closer than thirty inc H �30")
to any structure.,
0
e. Side sewe.r lines must be laid at a minimum grade. of 2% (1.15
0 and maximum grade ' of 100% (450). 0
E-4 f. No turn in side s8wer greater than 45 (1/8 bend) is 0 allowed
between cleanout.,. All 90 turns must be constructed of a 45 (.1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be c,,onnected
to side sewer system. j
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil. I
i. Cleanouts are required at 30"-60" from each plumbing exit ' line
and at minimum..intervals of 100' along sewer 'line run__._er- ,
j. Trenches wi I thin City right-of-way must be restored to o�iginal
conditions. Contra:,ctors shall be responsible for right-of-way failure
due to poor'compact�ion of fill.
k. Side sewer must be left uncovered until inspected and approved...,
by the City..
1. Inspection during normal working hours only. Two (2) working
days notice required.
DATE:
I certify that I have read
and shall comply with the above
_14Z
PERMIT FEE:'
CONNECTION FEE:
0
rX4 * PERMIT MI
DISAPPROVED BY: Date:
B Date:
APPROVEd By.
Date: 4
T BE POSTED ON JOB SITE
The City of Edmonds Side Sewer Drawing EASEMENT NO . .........................
NEW CONSTRUCTION REPAIRS LID NO. /n5-9 ...... ASMT. NO. ...........
6.6 1' /
OWNER ... S.K . . ..... ................................... CONTRACTOR ................... PERMIT NO. -
JOB ADDRESS tv.,
.............................. LEGAL DESCRIPTION: LOT NO. - ............... .................... BLOCK NO . ....................................
NAMEOF ADDITION .......................................................................................................................
Approved:
PWW.0001 -11/75 (REVA 1/78) DATIE z r/ ---------------
0 -- --------
CITY OF EDMONDS -POET INFORMATION SHEET
F)(INEW ASSET NO.
ADDITION fILF"ITION TO ASSET NO.
REST
FIRETIREMENT
DESCRIPTION
W4 1-9 5 fft2 11 4-
SERIAL NO.
LOCATION DEPT. NO.
-2
a 1 -17
*PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
*PROJECT NUMBER cu s
PROJECT COMPLETION DATE L_ 3 S-
COST 1-/ _t, ^. e5 �pl
3 q
B.A.R.S. ACCOUNT NO. L
L
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
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
INITIAL
DATE
VERIFIED BY
PROCESSED
BATCH NO.
I
PUBLIC WORKS REVIEW ROUTING
SITE ADDRESS:
TYPE: BUILDING PERMIT (CHECK ONE)
SINGLE FAMILY
MULTIPLE
E=J COMMERCIAL
FENCE
GRADING
r I DEMOLITION
RELOCATION
r= SIDE SEWER PERMIT
E-1. RIGHT-OF-WAY PERMIT
STREET USE PERMIT
STREET TREE PERMIT
SEPTIC TANK DESIGN PERMIT
NEW METER/WATER SERVICE
E.I.S.
OTHER:
SUBDIVISION REVIEW
PLAT/PRD REVIEW
DRAINAGE PLAN
IN
-OUT
Reviewed By: Date Reviewed:
(See Comments)=El
CITY ENGINEER
DRAINAGE ENGINEER
�FATER/SEWER DIVISION
STREET DIVISION
E2� P.W. RECEPTIONIST
WORK ORDER COORDINATOR
UTILITY BILLING
DIRECTOR/ADMINISTRATOR
El
RECORDS (FILE)
OTHER:Attl
COMMENTS:
2/3/81
qP 40
DATE:
fN
MEMO TO: Building Division
Community DevelopmenL Dep;-irtment:
FROM: Engineering Division
Public Works Department
SUBJECT: -IM13 RIP- 4W W
After revi ew of the subject Building Permit application, we have
the following comments:
Connection to City water system required.
2. . - Connection to City sanitary sei-ier system required.
3. Right-of-way Permit -required for any work on C.ity property.
4, Driveway slope not to exceed 116'..
5. Backwater valve required if plkimbing is beloi-i
elevation of upstream manhole.
6. Water and sewer lines to be seoarated by 1-0 foot minimum.
CO -t!
0
Signature
C-l'. -d! 1704
-,V7
BUII.DING PERMIT REVIEV lyfI3 &L 445-,
(address) (date)
0
Street Rig�ht-of-Way Existing.....REQI�_
Z
Access Easen-xmts Existing A4,&A--
REQD
H
Utility Easement Exist
Lot Per Subdivision Plat
Assessor
94
Site Plan Checked for Accuracy
Z
Underground Wir ing Reqd. 44
�-4
0
Check Accuracy of Legal ion
Z
Review by A COU&
Date
Existing Water Main Size_
Water Main Required 0A
Service Line Required
Hydrant Size Existing
r4
Hydrant Reqd Per Fire Code
Size
Detector Check Yleter Reqd.
Cross Connection Inspection 6;Z4
E-
Fire Departnmt Comnents
Water 14eter Chfarge Reqd. J/,3-19-00
Review b
Date
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
Proj.
Drawing No.
File No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
:3:
Review by
Date
W-
---- -
Open Ditch Existing___,4A�-ez
_____�eqd._
Culvert Reqd.
Size—
Catch Basin Reqd.
Indicate an Site Plan
C4
0
Shoulder drainage maintain collection an swale open runoff
�tm-Lole r/eqd. 114;�Z
Indicate Si te Plan
Soil Conditions and Ground Water Field
Checked 434
Review by
Date
M
Revised: lvlO-1977
1.
M
W
Z
0
USE '-MW FrM I I
BUILDING DEPARTMEO Applicant Fill ZONE P,� j1L_NUMBER
PERMIT APPLICATION Inside Heavy Lines J013
ADDRESS
NAME (OR NAME OF BU SINESS) (a8l f) P-) I �i` M
LEGAL LOT PLAT NAME SUBDIVISION NO.
MAILING ADDRESS DYES 0 NO
.3 /7 VS
TELEPHONE NUMBER
776 3
U
W ADDRESS
t
U
M CITY TELEPHONE NUMBER
-C I I
NAM�S
Z_ (f
0 ADDRESS
o W3
< 3
M CITY TELEPHONE NUMBEi�
Z
0
U STATE LICENSE NUMBER ICITY LICENSE NUMBER
iption of Property (Show Below or Attach Four
Z
0
I- AITAC4EV:)
IL
M
U
In
W
Q
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W
Ili I I
PUBLIC RIGHT OF WAY PER ORDINANCE NO
EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY_
DEFICIENCY OF RIGHT OF WAY
STREET/UTILITY WORK REQUIRED
DYES
PERMIT FOR WORK IN PUBLIC RjW
0 YES
UNDERGROUND WIRING REQUIRED
0 YES
CONNECTION TO SANITARY SEWER
1:1 YES
SEPT�C TANK PERMIT,REQUiRED
OYES
SEPT C TANK PERMIT NO.
SEE MEMO DATED
REMARKS
CHECKED 13Y
METER SIZE I BUILDING SUPPLY SIZE
SIGN AREA ENV. REVIEW
ALLOWED I PROPOSED 1COMPLETE1 EXEM PT
REMARKS
VARIANCE OR CU
Q
YARDS
M
NEW
RESIDENTIAL
YA
M
GAS N
Is)
LINE IN
FRONT
FIRE ZONE
TYPE
ADD El
ALTER
F
NON-RESIDENTIALI
DEMOLISH
EXCAVATE
OR FILL
SIGN
RETAINING
WALL
FENCE
I- --* -
I
SPECIAL INSPECTOR
REQUIRED
0 YES 0 NO
PLAN CHECKED BY
REPAIR
PRE -MOVE
INSP.
swim
POOL
REMARKS
Z NUMBER
OF STORIES
-z_
NUMBER OF
DWELLING
UNITS
I
NATURE OF WORK TO BE DONE
M
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In
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0
M
0
PLAN CHECK FEE
' PROPOSED USE
PLOT PLAN IINDICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
i
U
in
ILI
PLUMBING
Q
IFENCE
MECHANICAL
M
0
VI "Applicant, on behalf of his or her spouse, heirs, assigns and SIGN
V1
ILI
j successors in interest, agrees to indemnify, defend and hold harmless
2 the City of Edmonds, Washington, its officials, employees, and RETAINING WALL
agents from any and all claims for damages of whatever nature,
X arising directly or indirectly from the issuance of this permit. Issu- SWIMMING POOL
o ance of this permit shall not be deemed to modify, waive or reduce
j
01 any requirement of any city ordinance nor limit in any way the
I City's ability to enforce any ordinance provision."
I hereby acknowledge that I have read this application; that the in- TOTAL AMOUNT DUE
formation given is correct; and that I am the owner, or the duly author-
END
ONO
1:1 NO
ONO
ONO
A
SHORELI
PLANNING REVIEW BY I DATE
ILOT COVERAGE
SIDE REARI
F C NSTRUCTION 1CODE 19 HEIGHT
q
AREA OCCUPANCY OCCUPA
I GROUP R -3 LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
ized agent of the owner. I agree to comply with city and state laws regu- ATTENTION APPLICATION APPROVAL
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington THIS PERMIT This application is not a permit
relating to Workmen's Compensation Insurance.
a AUTHORIZES until signed by the Building Official or
NOTE: Permit Limit One Year(Except DEMOLITIONS and FILL ONLY THE his Deputy; and fees are paid, and
PERMITS without conditional use permit, which shall be completed in 90 WORK NOTED receipt is acknowledged in space pro-
ldays;t MO ED-IN BUILDINGS shall be completed in six months.) vided.
SIG �TURE (OWNE 0 AGENT), DATE SIGNED INSPECTION
4 D EPARTMENT DIRECTOR'S SIGNATURE
e I CITY OF
EDMONDS DATE
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, 775-2525
marquees, etc.) will require separate permission.
.ATTENTION JAN 2 8 REC P 0 ORIGINAL — File
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE PINK — Owner
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304,306.
102-78
YELLOW — Inspector
GOLD — Assessor
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