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�84 g, PERMIT
CITY OF EDMONDS 12. NUMBER
CONSTRUCTION PERMIT APPLICATION joe
T'ON
OWNER NAME/NAME OF BUSINESS ADDRESS /95 9/5
QO�',AC`4 LEGAL DESCRIPTION eI4ECK SUBDIVISION NO.
MAILING'ADDRESS
y "k a) - PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
CITY ZIP TELEPHONE NUMBER]
'I t, EXISTING — REQUIRED DEDICATION
9-0 L 6 -7 6— Oq �4 t
ADDRESS
CITY ZIP TELEPHONE NUMBER
NAME
Le- Q\ C (JA C e-T U .0 k,
ADDRESS.
I 1�� " ,, (-- '1 -4-1 r VN r
CITY ZIP TELEPHONE NUMBER
U iij
2-Z, - G C-
VAA
STATE LICENSE NUMBER EXPIRATION DATE
L 9 o
Legal Description of Property - include all easements a
S� CO"N �,J I
W
T 16-, L
LD
L�u Property
Tax Account
Parcel No.
DNEW
RESIDENTIAL
PLUMBING
ADDITION
COMMERCIAL
MECHANICAL
APT. BLDG.
REMODEL
SIGN
F2
GRADING
El
FENCE
Uni REPAIR
- CYOS.
( x _FT)
DEMOLISH
r _1 WOODSTOVE
SWIM POOL
INSERT
HOT TUB/SPA
FGARAGE
]
RETAINING WALL/
F-1
El
C
ROCKERY
RENEWAL
Z
21 (TYPE OF USE.AUSINESS CIR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF CRITICA4*j'j I I(?,0.
OF DWELLING OWe AREAS
11 STORIES UNITS NUMBER ss
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
C I ^A e- r i`� qr,]_),�A elAa � � "'t A. i V*1
.960.3-7.3
SUITE/APT #
ILID NO.
METER SIZE LINE SIZE I NO. OF FIXTURES
ENGINEERING MEMO DATED
TESCP Approved
0
RW Permit Required
0
Street Use Permit Req-d
El
Inspection Required
0
Sidewalk Required
0
Cr
PRV REQUIRED
W
YES 0 NO 0
Z
Ir
W
W
Z
0
Z
W
REVIEWED BY
SIGN AREA SEPA REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
EXP &/# I SHORELINEJI
VARIANCE OR CU PLANNING REVIEW EIT DATE
SETBACKS — FEE T HEIGHT I LOT COVERAGE
FRONT SIDE REAR I
By ITYPE OF
/V
4t?e&F
GROn):2
SPECIAL INSPECTOR
AREA
OCCUPANT
REQUIRED YES
111P`ROGRESS
LOAD
EMARKS
INSPECTIONS PER UBC 305
FINAL INSPECTION REOUIRED
Tillilillililillis
VALUATION
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING
I IN)
PLUMBING
Plan Check No. 6?/-- Adt
f W /2,7-
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
STATESURCHARGE
driveways, marquees, etc.) will require separate permission.
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
successors in interest, agrees to indemnify, defend and hold
20 harmless the City of Edmonds, Washington, its officials,
m 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
to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
0
:r nor limit in any way the City's ability to enforce any ordinance
I
TOTAL AMOUNT DUE
provision."
I herebv acknowledne that I have read this application! that the
_zv kjqle.
I n 1 0 ri� 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
u ' 0 ri
THIS PERMIT
state laws regulating construction; and In doing the work authoriz-
S' a a I a
AUTHORIZES
T his application is not a permit until
ed he r
ed thereby, no person will be employed in violation of the Labor
t
ONLY THE
.
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
Lahinformation
t I
ion Insurance and RCW 18.27.
INSPECTION
acknowledged in space provided.
Tu I
IG RE (OWNER OR/GENT) DATE SIGNED
S s, NATUI .7 "1 / ,:I
DEPARTMENT
CITY OF
OFFIAC!AG& DATE/
EDMONDS
CALL FOR
RELEASED BY: DAj`E
ATTENTION
71 4 �91/�
INSPECTION
1411 r
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL File YELLOW Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
— —
CHAPTER 3.
102-e?
PINK — Owner GOLD — Assessor
5,52 ^VL Ili,
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41'
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WL
L 1,:'.'T 10
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1.44
IL
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0
NOTICE:
N'o ... wa rra nty0TaC(,U1--dk�Y-
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
Th,e c'ty of �Edm.onds does not ' warrant the
accuracy of anything set forth on these
rnap(�_)- Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform-ation shown on
_tFe -map(s), including, but not I*m*ted to,
th-e loc'ation 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 Edmonds nor its
ernp-to-yee-s o-r officers -sh-a-1.1 be Via-b-'Fe for the
information given on this map(s), nor for
ation provided based
any one represent
upon . said map(s).
3
APPLICATION fL-y--N-N—WOOD Ll-- kA(&)P k/AJS7-
The City of Edmonds F" for fq E,
SIDE SEWMa PEP*lkHT
6 0 EW CONSTRUCTION 0 REPAIRS EASEMENT No - ------------------------------------------
LIP
OVVNER ....
— — -------------------------- CONTRAC'TOR PERMIT No
...... ... ........
ADDRESS ... ....... ZX4431K ....... 0V
...... ... ..... LEGAL DESCRIPTION: LOT N ------- Z ---------------- PLOCK No . ............................................
16SC4 S. ArAl "S
NAME OF ADDITION X 40
. ......... ........ ;.PP .............
14
I
41
Approved:
DATE ..... 7.� ............. I
RECE,",i-D
LZ
APR 4 1972
#07
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34
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1 10
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r::AVjA
�; WICK HOMES, INC.
VAV
DATE REVISION
::---tfGAL- LOT ---
__Coo
ADDRESS
PLOT PLAN DATE B N
SCALE it- 2d'
I
ITY'F�*�:E,D.,M�,�,O'NID.,S,,,.—.'-S,klp,�El-,.-'Stt,"�ER PER!Mnlr
.0,
W/AT.�ER-.SEW,,ER;,DEPA�AT-MENT.,,
for aide, sev�.Crl trispections BEmnlin.,cove"iftig;f-any portlbn� 'of: the,'ebriscruction'.
/Call iio,
3�Rhin, 24 'hours, after requdst. ��TWS&V., Sum,, o'r holiday, !qspedtl n
A -I ec on w lV,,be,,pro.vlde
'CONSTRU, CTIONI.� ..................... ................................................................................. . ..............
W'T
DAE S�:Lbc .1mioir
,2v'6i,
x 'h ........
'AD
PROPERTY 'LEGAL ''DES".6Ri'16P 6N-.'..,;X 'XA R
............. ............. ............ . .............. ......................................
................... ................................ ............ ...................... .................... .........................................
. ..... ........................ -BUIL ................................. ..................... ................. ................. I
OWNER-ANWOR DER ............................ .......
.......... ........ ..... *** ...... .
...............
s 2
.�Ext-vat6r
SS C a
CONTIVAC TOR',& NA—MK &.ADDRE .... ...... . .................................. ................ ....................................................
Auburn'
tn.,
JA .. ... .............. r 0air, -sewer to-'.th*�ii�§,-sanitary sewer
Pennigsioiri* te A-,b ..4 for e
6!sigyan, d.:. T ..Xor conn64t1.on,*of,a.,,side
o dan withiCity of* . Edlmonds� ordinances:
systemIniace
1% -
..&TTENTION: IS: CkLLED-T0`THE�:F0fL0WIN
ropeity: line: -A,:li� emp%�eali' 6Ct
'TE'No. !�L-The,owners.,of.'the opertk. -may obtain, W pumitAo'iconstruct, sewer lnslde'�.p ensed� Sid eL Sewer ;Contraetor-�must- �bell to):constr
side,' sewer. �in street are&.. .-DoJiot:cover any portl6hl of,sewer*.before' it has ibeenAnspeated'.
I�XoTF,� pio; � -Am -work -,perforinddi in: ci�C�,�'rig�t-of-wa�y,,r�quire4�ari���Inv"]6n,of' RJght-of-W&Y-'Peiffilt-;obfr�inabl6 from. the�:Clty Enklheer's ioffice:
N0tE1�No;,3'—'0btalrV,fullt informati6nt,regdxdine,;brdin&�ce 147A.,66--and� iieg'ulatlons! gbv6riiing�sid'e*,',-s'q'wers-whbn youl� ef p�armit.
g
0 ra opeit
NOTR,No.�14LLTor�,,of -slde,sewer,muA-%have-at least 3OAnches�'c ve ge at., property Alne:,and� .12� inchesinsidO pr y;,,Iine;, minimum grade,lof*� : 2 :,Not bend a'i ri�.igrad
.:�,�slfiarper than 'A wlll� beJerrnitted.-
K0TE`No.,.,&--!-�Tren�hesAn street mu9t bewaier settledt and'�surfae6 Wstreet restored 0: okiina]�,'6on ltlon.', Contra�tors shall, be, responsible fort liu du6 to, improper
- - * f t
work 'wfil'ch may deNielop: within one'year of, completion:
NOT-EI.No., 6--If' is, -unlawful' to alter,or do -.any other'workjhan .4s..proyided for in the perrnit,-,6`r. fo;'do, an�y work on,. -the mairv,sewer. ori, lts!.�appurtenanees. ex6elit to- in-,
�sertIhe pipe into the�`Wye_
0 Dat ......... : .........
Ay.
DISAPPR VED' FjiPate� .............. ....................... Date ........... ....... .......
B.
D, - ....... Y_ % ........
APPROVE Date:...:7 ... ..... ..................
R..................... ....................................... .......
Winarks: ........................... ............................. ........... ...................................................
.............................................. ..................................
.......... . .......... ............ ............
---------------- ----
'P �r -m' ng, ponstrudtion' PRIOR To Req est or-Inspec iol-�
'?Bp,signe I '� ", 1. � t�., ., I I
"I P 'e*miit Cople& 14U,§T, di By, �,er -o -Firm, e —for"" 1 .1! t
tn),
Xe es 6
, C_ e4si e�;se werAfistalla'
'hereby -certify h td6h�(constrii�ted,- iid
I ............ 4hatA
1-heCity;
n
.yFas,,1
nst: '6djln:accordan�&W ith,.,a.11: g6verhirig, Q i -a-ii6. of'tdi�onidls,.
Date& �thisi_ .. ........ day ............ ... ......... ....
ORE*yqU,:�'g';f6t', Pow- iotfteniEl. V"-
Check BEF
J;!4
oil, MOVIVA:
�QA
-- - ------- --- T
1! 7
STREET FILE
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