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STREET FILt
CITY OF,EDMONDS
CONSTRUCTION PERMIT APPLICATION
US9 -
ZONE PERMIT
NUMBER 191060 L.
d.
ADDRESS 1,98- .7 — p- .2 102- 0 TE/APT a
OgINAME/rME
OF BUSINESS
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L,�\o
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LEGAL DESCRIPTION CtIA.13.1VISI.N
NO.
LID 110.
3:
0
MAILING ADDRESS
&9-4L F� �j
-
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
tXISTING — REOUIRED DEDICATION
PROPOSED
—
TESCP Approved 0
RW Permit Required 0
Street use Permit Req'cl 0
'MP.0ion Required 0
Sidewalk Required 0
C,
Z
CITY ZIP
FA , 'A 0) j S Cl
I TELEPHONE NUMBER
-
�AME
We kkc,
REMARKS
0
U
ADDRESS
0-30<_ ATL S
Z�
CITY. RdjP �
Se,+Ilu L1
ITELEPHONE NUMBER
NAME
(aO )A) e-
ENGINEERING MEMO DATED REVIEW BY
ADDRESS
0
METER SIZE
ING SUPPLY SIZE
7
NO. OF FIXTURES
-c-
CITY ZIP
PHONE NUMBER
Z
0
U
ITELE
REMARKS
STATE LICENSE NUMBER
I
SIGN AREA
ALLOWED PROPOSED
SEPA REVIEW
COMPL
ADS NO.
�T —
SHORELINE 0
Legal Description of Property - include all easements
5-o8:1 Maet, d
EXP
000 - V-_� C, 10
VARIANCE OR CU
L
BY DATE
7 / ZS7 C,
SETBACKS - FEET HEI
F;M. SIDE HEAR
4
COVERA�
3
Z
wo
Tax Accou nt Parcel No. 000 - 0 1 C) -W.91
ElNEW Y1 ESIDENTIAL PLUMBING
E'ADDIALTER COMMERCIAL E] MECHANICAL
DREPAIR APT.EILDG. SIGN
CHECKED BY
TYPE OF CONSTRUCTION [CODE
__,V7
_ _11)
jW
HEIGHT
25
GRADING FENCE
DEMOLISH — CYDS. I x _FT)
CARPORT
G swim
REMODEL ARAGE POOL
E] WOOD STOVE I r7 RETAINING WALL/
INSERT " ROCKERY RENEWAL
SPECIAL INSPECTOR JAREA
REOUIRED YES
JOCCUPANCY
GROUP
I OCCUPANT
IWAD
REMARKS
Z
0
PROGRESS INSPECTIONS PER UBC 305
Z
(TYPE OF USE, BUSINESS OR�fEITY) EXPLAIN:
AOX 1-ftl 100 4-4�0 ewz
�s
NUMBER OF STORIES INUMSEROF
DWELLING
UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN'
LA Lifs6i,
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
BUILDING
321,51"Zo
Z
PLUMBING
Plan Check No.
MECHANICAL
This.Permit-coverg wOrk to be done on private Property ONLY.
GFIADING/FILL
..-Any construction on the public domain (curts, sidewolks,
STATE SURCHARGE
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
0
Cu
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington. its officials,
employees, and agents from any and all cial ms for damages of
whatever nature, arising directly or Indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed t 0
modify, waive or reduce any requirement of any City ordinance
nor mil any ordinance
provii�ion�� any way the City's ability to enforce
PLAN CHECK DEPOSIT
6-0
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
APPLICATION APPROVAL
Lauthorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and In doing the work authoriz- AUTHO "" ES
ed thereby, no person will be employed in violation of the Labor ONLY THE
C C cle he S ate of Washington relating to Workmen's Compensa- WORK NOTED
I I r .
I �n I nor,u a n c e' INSPECTION
SIGNATURE JOWNER OR AGENT) DATE SIGNED 0 EPARTMENT
CITY OF
EDMONDS
This application is not a permit until
signed by the Building Official or his/her
Deputy: and fees are paid, and receipt is
acknowledged in space provided.
I
OFF1 I *S SIGN TURE DATE
CALLFOR
ATTENTION INSPECTION
ELEA Y DATE
IT IS UNLAWFUL TO USE OR 0 CCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-3202
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
Lj
ORIGINAL File YELLOW - Inspector
CHAPTER 3.
DINIV - n rnI
CITY OF EDMONDS
ACTION REPORT
STREET F11 E N9 4047
SUSPENSE DATE:
Date: 15— Time: File #
A:�54&
Attachments: =Yes
I
REQUESTOR: NME:
ADDRESS: =Zae.
PHONE:
_ 7 7 07
REQUEST RECEIVED BY:
TELEPHONE
CONTACT IN OFFICE r---j
OTHER:_ r---j
RECEIVED BY:(�=,
PnilTF Tn-
9 E""l I RAI
rZAR14
FA-
am
MIN
um
MMWM���==
ACTION:
All Concerned Notified =
Action Completed/File /F-r
13
NOTICE:
..Wa r-ra nt—yot
N'o
The -information on the attached
map(s) was cOmpiled for use by the City Of
Edmonds/ its Employees and Consultants.
Th,.,e City of *Edrn.onds does. not. warrant the
n these
accuracy of anything set for.th o . -
map('�). An'y person or -entity -requesting a
copy should conduct an independent
inquiry regarding th*e inform-ation shown* or
_tFe -map(s)/ including, but not limited to,
-er stub shown. Suc
the location of any sew
sewer stubs may or may not e.xist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
ernpl,o'yee's o*r offi-ce-rs -sh-al-1 be I-Jab-]--e for the
information given on this map(5)) nor for
'ded based
any one representation provi
upon said map(s).
APPLICATION EEED j\4 0 N D S
T
The City of Edmonds for I? z F- A T 14, "1-, PLANIT
SEDE SEWER PERMIT
FILENEW CONSTRUCTION REPAIRS E] EASEMENT No . ..........................................
OWNER .... PAY.1.0 ...... Z..�t .... ................ ......................... CONTRACTOR ... PERMIT No
ADDRESS ...... 11914? tx/�
................................................ LEGAL DESCRIPTION: LOT No . ......
.................... ................. BLOCK No . ............................................
NAME OF ADDITION ...... M.A.PLE.."Op
P
I I- , W.
Approved:
Z4,
'7 Z-
DATE....... 7 ......... 3 ........................ .........
................................................
APPLICATION
for
'The City of. Edmonds SIDE SEWER PERNaT
EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS E]
A�l
7-RA r
EROWN ....... L ...... .................................... ... CONTRACTOR ....... .... q ..... M� ......... 6 . ............................................... PERMIT No.
74 Lg -r /0
ADDRESS jl? .. ---- - ------- e..q ................... LEGAL DESCRIP`rION: LOT No . ...... ....................................... 13WCK No . ............................................
NAME OF ADDITION ...... . ..... W-0-a-6 . ....... . 7,+
..................................................................
i,,p
P E R MV I T
-C1TY.,.,0f�,EDM%07,'
-Al"10EAMEW:
FEWSEWEX. I :N
E, T*
PERMIT No
Call� 7,76-1,107 for, side �sewer inspections covering. any portion -of the, donstructionj.
Inspection will be provided, Nithin, �4� hoursf after -request. X0i'Sat_:Sun_,or *,holiday in*spectl, ons
'829
ADDRESS -LOCATION OF'�CONSTRUCTIION ... 0 L
............ W ................... .................................................................... ............................. ...................... ......
PROPERTY LEGAL DESCRIPT[ON .......
........................ ............................................................................................ ...... I ...... ...................................
........................................... .... ........................... .........
.. . . ... . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 ....................................................................................
DAV IQ L �� �,fl EY
.......................................... I ....... .............. �.OMWER%AND/OR- BUILDER ..... : ..................................................... %
.......................... .................................................
.0
CTOW& NAME & ADDRESS: Box
-CONTRA , & k.tontractbrso, PA. :11e�lGitt. a
......................... ............ 7 ......................... ....... � a ! -,.h
................................. ...... .........
_io�'Ah� anit'
0
Penni'sSio'n ls,,granted .............................................................. 1,9:.,.772 fbr -repair and�6r-,coriwkfion, .'Of a sidesewe'r -
S ary sewer
systemIn accordance with,City of Edmonds,ordinances.
ATTENTION IS CALLED 'TO THE FOLLOWIN
NOTE* No. I —The owners of -the property may obtain,a -permit to construct sewer inside property -line;, A licensed Side Sewer Contractor must- be �employed� 'to,ponstruct
rside . sewer. in stre6t.area. Do not *cover any portion of sewer,before it has,been'insp6eted.-
YE No. 2—All work performed In city right-of-way,requires an Invasi6n of Rjghtwof-Way Permit obtairrabld-from the'City E nil rfeer., sofiic�.
1___TE No. 3—Obtain full information -regarding Ordinance ll.'16.030 and..Regulations governing side,sewers when you get permit.
NOTE* No. 4—Top of side sewer must have at least 30 inches coverage, at property_ line �and 12 Inches Inside' property fine; mininiurni.,grade,9U.2 :No, bends . �Jrr grade .
sharper than 1/8 Will be permitted.
NOTE No. S�Trenches In street must *be water settled, and'surface of street restored to originai conditioni Contractors sfiall b6, reiponsible,'for- ftrifure-dhe, to improper
work which may develop within one year of completion.
NOTE). No. �4-L-It is unlawful, to,alter or �do any. other work. tharv.is provided -for in the permit, o I r to�.d . 9, an I y, work oh, the main sewer��or its app�rtei I nances except to, in-
sbrt the pipe Into the wye.
DISAPPROVED . -E], Date 'By ..... Mate,
'BY ................... Date: ... ..................... ... ......
............... ........................ .................................... ABY: ...........
y ...................
APPROVED -Da .. ... ... ...........................
Rel�iitrks: ............ s .................................
......................... ......... ................................................................ ...............................
.............. .......
.......... ................ I ....................... ........... .................... .................... : ...... ...................................... ........................................ .........
CO
B6TWP'P' M1 pies, MU ST �Be,'Signe y y wner,:�"of �'F-ir-m''Peftb'rr�iing,,,C6n�tr,��ctioii PR1bRt,,T,o".,
71pr: -Inspection,
certify.,that,th6,:s1de Sew Jnstallation� comitruct6d).!under ithis: permit
&-� ........... ...... �h er
(,Owner of contracting Firm �Perfcrm ng iCon'struftion-)
Cit 0
was. installed, in accordance w th allgoverning 6rdindnce&, y f -tdmonds,
Dated;,thm ................. ... A�y 6f ..............
................................ . . ....... .........