202 9TH AVE S.PDFIIIIIIIIIIII
9929
202 9TH AVE S
for
SIDE SEWER PERMIT
4 e C 1 0 f Y; d ut On 4d,
t NEW CONSTRUCTION REPAIRS
102
-00700
OWNER ........... Dor ..............
.... .. ......... .......... ......... ........
A-73DRESS ............ P-0-a ... 9th ... Ame.-S . . .................................. ...............
EASEMENT No . ..................... - ..............
CONTRACTOR......................... ........................................................................ PERMIT No . ......................
LEGAL DESCRIPTION: LOT No. . ............ - ....................... ....... BL0CK No . ............................................
NAMEOF ADDITION ................................... .....................................................................................................
Dye Tested On Sewer
June, 10.72
Approved:
DATE.................... ........................ By ................................ ................................
INTER -OFFICE COMA\ .'CATIONS
"z7"
FZ I I � 71r
TO
FORM 41 — LITTLE'S
FROM
' '_ 7'
DATE 19
SUBY�ECT: A",
J�l
OCALLME 0 NOTE & FILE F%tv
0 SEE ME 0 FOR YOUR SIGNATURE
COMMENTS:
2-
Form OA.4 17
1 Offic, Aid,, ISO , c"'.ck sfel.,. YomkIl. N.Y. 10710
'T .. .....
city of. Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number-
r Issue Date: /0
A. Address or Vicinity of Construction: 202 - 9th Avenue S.
I -1A=!W7 3 . I B. Type of Work (be specific): GTE to place, operate & maintain a boried service wire -
ISOrom existing pole #4516, tocated at 202 9th Av. S.,.then wast to a residence at the same address.
GTE to plow 40 feet, push no driveways, and oo reads. 4.041 featage 4r. 10 feet.
C..Contract6r: GTE NORTHWEST INCORPORATED Contact:Linda Price, Permit Coordinabor 425/710-4133
Mailing Address: 2312C W. Casino Rd. EXRrStt,,,,WA Phone:* ENGR: Terry Anderson 425/771-8683
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. El Commercial F City Project N. Utility (PUI)4��g WNG, CABLE, WATER)
Subdivision
n Multi -Family SingleFamily. E] Other GT�,�.# 2100-9POOlDB /2
0
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: 0 Yes NNo G. Size of Cut: X H. Chargq�,$-
Please see attached sketch/drawing.
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany
kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds" or any o f its departments or
employees, including or not limited to the defense of any legal proceedings including defense costs and attorneyfees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings of proposed work required with permit application.
A 24 hour notice is required for inspection. Please call the Engineering Division, 771-0220.
WoAk and material is to be inspected during progress and at completion.
Re"sioration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with-,,�ity regulations as required by the City Engineer.
All street cut trench Work shall be patched with asphalt or City ap "roved iriaterial prior to the end of the working day;
p
NO EXCEPTIONS.
I haveread the above statements and understand the permit requirementsand the pink copy of the permit will be
available on site at all timesfor inspf
�tion purQOAS�.
Signature:
Date: 10-06-98
(CQntrwor or A z--en
Dave Hawkins, Section anager --Ac1CQss Design
. CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY. 2 "1
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS:
RIGHT OF WAY FEE: 00
DISRUPTION FEE/FUND I 11:
RESTORATION FEE:
T OTAL FEE: o , 0 (-3
RECEIPT NO.:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE , Eng. Di� 1997
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.�
I Comments:
I Diagram
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by'P.W.:
Work Disapproved, By: Date:
FINAL APPROVAL BY: Date:
N
'sin)
0
3
I
------------------------- .7 dft — ------------------------------
v�h
'd03 ------------------
VM 110 98
4��- IV
I or�— 3
m
31C
a4lingfori State
AIrrDEPARTMENT OF
SOCI
SOCIAL&HEALTH
S S
ERVICES
.Adult famil HomU LiccnQse
Y
In compliance with and pursuant to the laws of the State of Washington and the Minimum Licensing Requirements
of the Department of Social and Health Services a license is hereby granted
to EDGARDO & JFJW BULACLAC License Number 407100
to conduct and maintain at 202 SOUTH 9TH AVEME
city of EDMONDS zip code 98020 county of SNOHC)MTqH
State of Washington, an Adult Family Home for the care and supervision of adults as follows:
24-hour family care for no more than six w— adults
This license shall be in force from the 3,2TH day of AUGUITT .) 19 97 , to and including
the 12TH day of A-UGUST —) 19 9 a , subject to revocation for due cause.
Special Terms:
ucenviigmmonxi7 %�,j
JoAnne Pullen Mary DeLange
NOTE: This license is not transferable, and is valid only for use by the individual (s) to whom it is issued and at the location above
described. Issued by Authority of Chapter 172, Laws of 1967, and RCW 70.128.
am 1&173 (Rv. WI)
E
CITY OF EDMONDS' IGNE
dONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS LADDRESS
4kLEGAL DE
_ k &, i,,t, ZE
MAILING ADDRESS
IN (j 4
Not"
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. T S P
cpry IF �z I�P -PYHONLE iMABER AEPCOVEO BY
L— 0/77 Q 0 -S EXISTING — REOUIRED DEDICATION —
NAME PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
.0 ADDRESS STREET USE PERMIT REOUIRIED 0
SEE ENGINEERING MEMO DATED MEVIEW —BY
I% fz rL E: Pj w E-n—
)DRESS
--JI6o5 &I C - 5(, 7t -716
TY ZIP TELEPHONE NUMBER
in,tkLono o
'ATE LICENSE NUMBER
ag, =ion Of Property - include all easements
r attach two copies)
a
SIZE . IBUILDING SUPPLY SIZE IFIXTURE U717
7'. � -- I ADS
ALLOWED COMPLETE 1"V'EtXEMPT
L 0 T-5 17., Lq� c 47 X�
Oot-*, 2—
VARIANCE OR CU
Z! � � 0,., 177,
PLANNING REV., wy
DATE
z
z
0
z
4-a 39
SETBACKS — FEET
FRONT Zk-� SIDE_ REAR
3E
Tax Account Parcel No.
REMARKS
E] NEW -a-RESIDENTIAL PLUMBING
ADDIALTER COMMERCIAL MECHANICAL
REPAIR APT. BLDG.
SIGN'
EXCAVATE, FILL FENCE
DEMOLISH OR GRADE X —Fn
CARPORT
a A swim
REMODEL E G RAGE
POOL
CHECKED BY
TY 7,
;E F Co;�RUCTION
100DE
HEIGHT
2-5
!PE INSPECTOR
0 - YE . a -- 0 NO
AREA
IOCCUPANCY
GROUP
OCCUPANT
LOAD
ElWOOD STOVE I RETAINING WALIJ
INSERT ROCKERY RENEWAL
REMARP-
PROGRESS INSPECTIONS PER LIBC 305
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
��e5, L)e-n I Irk L
NUMBER OF STORIES
'21
fNUMBER OF
.WELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH
PLOT PLAN)
NUU z,,econU 5,rox 4
FINAI! INSPECTION REOUIRED
VALUATION
FEE
ftD
PLAN CHECK FEE
501
BUILDING
PLUMBING
Plan Check No:�w
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewpiks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
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
h armless the City of Edmonds, Washington, its officials,
z
54
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
PLAN CHECK DEPOSIT
0
modify,, waive or reduce any requirement o any city ordinance
1
1
nor limit In any way the City's ability to enforce any ordinan ce
TOTA L AMOUNT DUE
provision."
Q10, 60
,tj,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
authorized agent of the owner. I agree to comply with city and
:tate laws regulating construction; and In doing the work authoriz-
THIS PERMIT
AUTHORIZES
This application is not a permit until
d thereby, no person will be employed In violation,of the Labor
Code of the State of Washington relating to Workmen a Compensa-
ONLY THE
WORK NOTED
signed by the Building Official or his
Deputy* a d I
I nd rece)4t is
IGNED J�A�d��
S INSPECTION ided./
rTURE (OWN ENT) OAT, S DEPARTMENT F1 /bAI
CITY OF
07 Rllollo
EDMONDS
ATTENTION CALL FOR VELEASED BY G(ATE/
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTUR �71
E
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL.OR 771-3202 ORIGINAL — File YELLOW — Inspector`
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC,.-
CHAPTER 3.
102-87 PINK — Owner GOLD — Assessor
FINAL PROJECT APPROVAL FORM
Is U I Lo IN r, TO:
AUCi 141998
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE S
PLEASE SIGN
ENGINEERING DIVISION DATE
PLEASESIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJECT 4�- AOc/r4-E
SITE ADDRESS 2� I
PERMIT # q�- 3 8- � A B# DATE INSPECTED / 'Y— 5�E
0
DESCRIPTION OF WORK TO BE INSPECTED Azzqvt ):s 1��,zr5rsl
tAs tlij
A field inspection was conducted to determine compliance with approved plans. Final approval denotes that
there are no objections from the above signed Department to the granting of:
Final approval of the described work
Performance Bonds associated with the project may be released
GRANT FINAL PROJECT APPROVAL
_X GRANT FINAL PROJECT APPROVAL WITH CONDITIONS NOTED
1 .
2.
0
rz
pr-oj(Z��S5
V6/9 C) L_ dlle__�
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
R -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
ocaprvi.doc.l:temp:bldg:fonns6/98
...... ..... .........
*-diinglon State
RDEPARTMENT OF
I
S SOCM
OCIAL&HEALTH
S
SERVICES
Adult family Home Licenose
In compliance with and pursuant to the laws of the State of Washington and the Minimum Licensing Requirements
of the Department of Social and Health Services a license is hereby granted
to EDGARDO & JEAN BULACLAC License Number 4o7i-oo
to conduct and maintain at 202 SOUTH 9TH AVENUE
city of EDMONDS , zip code 9 8 0 2 0 -- —, County of smommTsm
State of Washington, an Adult Family Home for the care and supervision of adults as follows:
24-hour family care for no more than six (f;A adults
numUr
This license shall be in force from the 3,2Tg day of KUGUST 19 97 , to and including
the 12 TH day of AUGUST —1 19 98 , subject to revocation for due cause.
Special Terms:
JoAnne Pullen Licomr Mary DeLange — — bweWlig AuuUmiV \'J
NOTE: This license is not transferable, and is valid only for use by the individual (s) to whom it is issued and at the location above
described. Issued by Authority, of Chapter 172, Laws of 1967, and RCW 70.128.
DSRS 1W73 (BET.. WI)
RETURN ADDRESS:
City of Edmonds, City Clerk
121 5th Avenue North
Edmonds, WA 98020
1807010018
07/01/98 10.19
P-0003 Rec -
Snohomish Orded
County
NOTICE OF LUMTATION AND COVENANT
ADULT FAMILY HOME
Reference M
Grantor(s): (1) fd?!!dv & 1-44144 (2) JkA�v AUIACIA 6 Additional on pg.--
Grantee(s): C 11y of Edmonds
Legal Description (abbreviated): Seiz-_Twn----_—Rng Qtr
OR Lot-IRFIC Block Plat ory ac 5dMC1,y(6
L- --Zk
Assessor's Tax Parcel HW(s): (I 042:j
�7*6-017-QQ — (2)
--Assessor's Tax Parcel 1D# not yet assigned
AUTHORIZED FOR RECORDING
City of Edmonds
Bv: Date: �011419,�
Page / of -3
WHEREAS, the undersigned owners of property located at -9P-Ae -�-OuA,
16i"Olvd.j. W4 , in Edmonds, Washington legally described
below or on the attached Exhibit A, have applied for a building permit for
compliance and/or to remodel a structure located on the site; and
WHEREAS, the applicant has notified the City of applicant's intention to utilize the
improvements and/or to convert an existing single family structure to an adult
family home; and
WHEREAS, under the Uniform Building Code the number of occupants of a
structure trigger certain requirements relating to the fire suppression and exiting
requirements; and
WHEREAS, the City has notified the applicant that the permit will be issued
conditioned on limitation of residents to 6 or fewer residents and their
caretakers; and
WHEREAS, the City has issued a permit based upon such representations;
NOW, THEREFORE, the undersigned property owners (hereinafter
"Owner") in consideration of the issuance of a building permit and in order to
confirm the promises upon which such issuance is based while providing notice to
any future owners or mortgagors of the property does hereby stipulate, covenant
and agree as follows:
1. Covenant: Limitation on Residence, The owner hereby. stipulates
and agrees that occupancy of the structure as an adult family home shall he limited
to 6 or fewer adults and their caretakers as allowed by applicable
provisions of state law. The owner acknowledges that in the event that the applicant
seeks revision of the applicant's state license to operate an adult family home with
an occupancy of greater than 6� � r I esidents or attempts to rent, lease or
otherwise provide residence for additional residents above the
61 permitted in the current occupancy classification, the structure shall
be vacated and all residential use ceased until such time as the property is brought
into compliance with the provisions of the State Building Code, under the edition. of
the Uniform Building Code then in effect. The owner further stipulates that this
covenant touches and,concerns the land so long as the present structure and use
continues and shall run with the land to all future purchasers and assigns.
2. Subject Tract, The above stipulation and promises shall apply to and
run with the land with respect to a residential structure located at 20Z-
!Z� -5j AF0449,n!�A Edmonds, Washington and legally described as:
Citv of Edmonds Blk 076 D-00 Lots 17-18-19
3. . Notification to Future Purchasers and Assignees. This notification
and covenant has been recorded in the records of Snohomish County, Washington
in order to provide notice to any and all future owners of the property of the
limitation at the current level of improvement to single families and adult family
home residents fewer than 7z in number.
4. Enforcement, In addition to any and other remedies civil or criminal
which the City may have, the property owner hereby agrees and stipulates that this
grant of covenant shall entitle the City to enforce by injunction the provisions of this
code and, in so doing, to recover its reasonable attorney's fees and costs.
AUTHORIZED FOR RECORDING
City of Edmonds
By: -1M D a t e: 16ZI21?9
Page 2- of _3
Ez,J007010U
,,,,a
DATED this —day of 19 q2(
ACCEPTED BY:
OWNER:
A! -
J annine L. Graf
Building Official
9
NOTIFICATION
NOTARY FOR OWNER.SIGNATURES
State of Washington )
Iss
County of 6/)D&ZLI
APPLICAN PERTY
OAer
COVENANT AND
ACKNOWLEDGED:
Mortgagor
I certify that I know or have satisfactory epidepp'q that �kAlAr6b 00LIOLL
signed this instrument, on oath stated that .1
PUe)was authorized to execute the
instrMent and acknowledged it as the- t2CJfV-J? _(title)of Mt2l2nin
L� q
d, E name of party on behalf on whom instrument was executed) to be the
free and voluntary act of such party for the uses and purpo mentions in this,
instrument. Subscribed and sworn to before me this — I DtT day of
19
%I on
Not6ry PubU in and for the State of Washington.
62,
My commission expires —
I
I certify that I know or have satisfactory evidene hat BdcleA
signed this instrumen4 on oath stated that h sh as authorized to execute the
(hiFtrument and acknowledged it as the _r) LOYL2141E (title) of M"
) 11V (name of party on behalf on whom instrument was executed) to be the
free and voluntary act of such party for the uses and pur os mentions,*Ahis
instrument. Subscribed and sworn to before me this day of
Notary Public in/and for theSta%of Washington.
My commission expires
'4,� Y1.0
AUTHORIZED FOR RECORDING J
City of Edmonds
By: Date: W2_
Page —?-Of
L:\TENIMUILDINGTORMS\ADF-COV.DOC
9807010ull
I'll
J0
RETURN ADDRESS:
City of Edmonds, City Clerk
121 5th Avenue North
Edmonds,, WA 98020
NOTICE OF LIMITATION AND COVENANT
ADULT FAMILY HOME
Reference #:
Grantor(s): (1) —Ed
2,qXdV&1AeJ,11 (2)JkA�v&IACIAC, Additional on pg,--
Grantee(s): City of Edmonds
Legal Description (abbreviated):
OR Lot_j Z:jj-19 Block__Zk Plat Ory oF Edwomd-y
'Assessor's Tax Parcel H)#(s): (1)04250-76-017-00 (2)
----Assessor's Tax Parcel 11D# not yet assigned
AUTHORIZED FOR RECORDING
City of Edmonds
By: X6 Date:
Page of -3
WH REAS the undersioned owners of rong-rtv Ineated nt -?'o Z '971, AW Sd'914A,
I r
1&6"Olvd-j in Edmonds, Washington legally
below or on the attached Exhibit A, have applied for a building
compliance and/or to remodel a sthicture located on the site; and
described
permit for
WHEREAS, the applicant has notified the City of applicant's intention to utilize the
improvements and/or to convert an existing single family structure to an adult
family home; and
WHEREAS, under the Uniform Building Code the number of occupants of a
structure trigger certain requirements relating to the fire suppression,and exiting
requirements; and
WHEREAS, the City has notified the applicant that the permit will be issued
conditioned on limitation of residents to (b or fewer residents and their
caretakers; and
WHEREAS, the City has issued a permit based upon such representations*;
NOW, THEREFORE, the undersigned property owners (hereinafter
"Owner") in consideration of the issuance of a building permit and in order to
confirm the promises upon which such issuance is based while providing notice to
any future owners or mortgagors of the property does hereby stipulate, covenant
and agree as follows:
1. Covenant: Limitation on Residence, The owner hereby stipulates
and agrees that occupancy of the structure as an adult family home shall be limited
to — 6 —or fewer adults and their caretakers as allowed by applicable
provisions of state law. The owner acknowledges that in the event that the applicant
seeks revision of the applicant's state license to operate an adult family home with
an occupancy of greater than 6 * residents or attempts to ren4 lease or
otherwise provide residence for additional residents above the
62 — permitted in the current occupancy classification, the structure shall
be vacated and all residential use ceased until such time as the property is brought
into compliance with the provisions of the State Building Code, under the edition of
the Uniform Building Code then in effect. The owner further stipulates that this
covenant touches and concerns the land so long as the present structure and use
continues and shall run with the land to all future purchasers and assigns.
2. Sub-ject Tract, The above stipulation and promises shall apply to and
run with the land with respect to a residential structure located at 207—
T4_1%te. .5 51&9n�A Edmonds, Washington and legally described as:
�, A4
Citv of Edmonds Blk 076 D-00 Lots 17-18-19
3. Notification to Future Purchasers and Assignees. This notification
and covenant has been recorded in the records of Snohomish County, Washington
in order to provide notice to any and all future owners of the property of the
limitation at the current level of improvement to single families and adult family
home residents fewer than in number.
4. Enforcement. In addition to any and other remedies civil or criminal
which the City may have, the property owner hereby agrees and stipulates that this
grant of covenant shall entitle the City to enforce by injunction.the provisions of this
code and, in so doing, to recover its reasonable attorney's fees and costs.
AUTHORIZED FOR RECORDING
City of Edmonds
By: D a t e: 16ZId! ?J?
Page 2- of ___?_
DATED this day of -I-WL& 19
ACCEPTED BY: APPLICAN R PERTY
OWNER:
' 4Atj�"�
Jeannine L. Graf
Building Official
11�~r 7-# ��p
^47/7-1 1111a.-Vj-e lay 10,714(l)
NOTIFICATION
NOTARY FOR OWNER SIGNATURES
OAer
COVENANT AND
ACKNOWLEDGED:
'e Llts,, k ho4a,4 anau,,
Mortgagor
State of Washington )
county of fahm Us
I certify that I know or have satisfactory epidepr.4 that AlrdD 00�0,10e_
signed this instrument, on oath stated tha(V�lie/was auth , orized to execute the
mjtrqment and acknowledged it as the (title) of iam inq
AdIt- ��name of party on behalf on whom instrument was executed) to be the
free and voluntary act of such party for the uses and purpow mentions in this
instrument Subscribed and sworn to before me this day of
19
NoAry Publi4 in and for the State of W shington.
My commission expires- 62
I certify that I know or have satisfactory at ty/a e-L
signed this instrument, on oath stated th d to execute the
mftrurjipnt and acknowledged it as the (title) of
A -do h, (name of party on behalf on whom instrument was executed) to be the
free and voluntary act of such party for the uses and pur o entionsin-this
instrument. Subscribed and sworn to before me this �"day of
i 9AIK,
Notary Public in/and for the $tatc-of Washington.
My commission,expires �2
AUTHORIZED FOR RECORDING
City of Edimonds
By: - -- Date:-i//Z/,gjy
Page -3- Of
L:\TEMP\BUILDING'kFORMS\ADF-COV-DOC
'I k 17� r
USE
Z N PERMIT
a B
Jo
CITY OF EDMoNbs ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION jog
OWNER NAME/NAME OF BUSINESS ADDRESS
L L
EGAL DESCRIPTION CHECKI SUBDIVISION NO.
MAILM1.3 AULJNrZ)
) o.� �-J/,
I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING —REQUIRED DEDICATION
CITY ZIP
TELEPH9NE NIJdMBER
?0
��L6 72- E)
NAME
PROPOSED
METER SIZ . E�
LINE SIZE
I NO. OF FIXTUi
ADDRESS
NUMBER
NAME
a:
0
ZIP TELEPHONE NUMBER
cr CITY
Z
0
0 STATE LICENSE NUMBER EXPIRATION DATE
Legal Description of Property - include all easements
Tax Account
Parcel No. _f5fZ_0
AWN &*-%
716-01 7�EA/
NEW
rul
AJ RESIDENTIAL
PLUMBINGIMECH
El
r -it -11 COMPLIANCE OR
ADDITION
COMMERCIAL
GMANe"F-USE
REMODEL
APT. BLDG.
SIGN
GRADING
FENCE
El
REPAIR
CYDS.
I X-F
DEMOLISH
WOODSTOVE
INSERT
SWIM POOL
HOT TUB/SPA
GARAGE
RETAINING WALL/
CARPORT
ROCKERY
RENEWAL,i.
:TYPE OrUSE, BUSINESS OR ACTAITY) EXPLAIN:,
&:. i. . I - , j 0— 1 ;
NUMBER OF CRITICAL
DWELLING
to I AREAS
UNITS _ NUMBER
TO B DONE (ATTACH PLOT PL I
".Ylr,�� '. , - - 4 r, .d-.,
ENGINEERING MEMO DATED
SUITE/APT It I
TESCP Approved 0
RW Permit Required
0
Street Use Permit Req . d
13
Inspection Required
0
Sidewalk Required
0
cr
PRV REQUIRED
W
YES 0 NO 0
(91
BY
VARIANCE OR CU ADB # SHORELINE #
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLIED I PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED I PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
LOT AREA
BY [TYPE OF
SPECIAL INSPECTOR
REQUIRED YES
REMARKS
PROGkt&INS
6% # 40
11INSPECTION
PLAN CHECK FEE
—
BUILDING
HEAT SOURCE:
GLAZING
0
/0
A/C
IYAC,
PLUMBING
Plan Check No. q
MECHANICAL
This Permit covers,work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewolks,
driveways, marquees, etc.) will req4ire separate pi�iimission.
STATE SURCHARGE
Permit Application: 180 Days
STORM DRAII41AGE FEE
Permit Limit: I Year - Provided Work Is Started Within 190 Days/
ENG. INSPECTION FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend Eind hold
harmless the City of Edmonds, Washington, its officials,
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
PLAN CHECK DEPOSIT
m-,Iif waive or reduce anv renuirement of anv citv ordinance
(0
110CCUPANT
LOAD r-
DNS PER UBC 108 Z -
5 2
2
M
Z_1741ay Apo
96 U", ht6-4 Y iic'14C MARSH p4j_
VALUATION FEE
0
3:
7,
nor limit in any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
I
go 00
1 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
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and in doing the work authoriz-
THIS PERMIT
AUTHORIZES
This application is not a permit until
ed thereby, no person will be employed in violation of the Labor
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
tion Insukaripp aria RCW 18.27.
INSPECTION
acknowledged in space provided.
S ENT) DATE SI NED
DEPARTMENT
CITY OF
EDMONDS
OFFICIAL'S SIGNATURE ATE
f
A;
L;ALL FOR 6
RELEA7SED 8V DATE
T ft N T 10 N
INSPECTION
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
SECTION 109
PINK — Owner GOLD — Assessor
0 P , ; 0
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing .....................
Wall .......................
Pier/Porch ................
Retaining Wall ............
Slab Insulation ............
PLUMBING:
Underground .............
Rough -in .................
Commercial Final ........
HEATING:
Gas Test .................
Gas Piping ................
Equipment ................
Commercial Final .........
EXTERIOR SHEATHING
NAILING ....................
FRAMING ....................
INSULATION:
Floor Insulation ...........
Wall Insulation ...........
Ceiling Insulation .........
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
MISCELLANEOUS
FINAL APPROVAL J2 r_=� e,
FOR OCCUPANCY ......