20903 72ND AVE W.PDFlill 11111111
5700
20903 72ND AVE W
. . . . . . .............................. r
o"r
-DL
Drive\—�qy
®r.
17,
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AZI
F
IOLA)
-.)L4 017
APPROVED APPROVED BY PUMNW-1641 --Sai5u' L.J_
3
clj'y COP
y
j u tj - i9q,
22� Iq x
PERMIT COUNTER
s
t -. -
77
The City of Edmonds Water Service Drawing EASEMENT I NO . ............................................
NEW CONSTRUCTION J_4 1,EPAIRS El LID NO . .................. . ASMT. NO . ..................
PERMIT NO. 170.71k.
OWNER......................................... ........ ......................................... ... CONTRACTOR .......... .... . ................................................................
2oqo3 7240AJF- LEGAL DESCRIPTION:- LOT. NO . ...................................... BLOCK NO. _ .................................
JOBADDRESS ----- . . .. ..........................................................
V_
..j
0
N
91
Z <
PwW-00Ul- 11175 JREV.11 1178)
NAMEOF ADDITION .............................................................. ........................................... .. I
C:
I
z iwt
20903 - 7?-"" AVE. W.
IN
7z
Approved:
DATE ..�/ By .........................
3 ............
�10 2ky's
Q
82
TY OF EDMON]Rk 199? S 10 E SEWER PERMIT
C1
110%
'9 go. 19-1 D16A I PERMIT NO- 8841
Address of Construction: 2'02�ojf
Property Legal Description (include all easements).: Sor-. /7- 0-0/
N. 4, ZO -7 a 4-
9 Co,- -z-o r 7 0 /4
Owner and/or Contractor: C>
State License No. Building Permit No.
[�fSingle Family
El Multi -Family (No. of Units-)
0 Commercial
0 Public
VIA BALLINGER
Invasion into City Right -of -Way: 9,No C1 Yes
RW Construction Permit No.
Cross other Private Property: 0-,No 0 Yes
Attach legal description and copy of recorded easement
211411 /9 ?
I certify that I have read and shall comply with all city requirements Date
as indicated on the back of the Permit Card.
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION *
OFFICE USE ONLY
FOR INSPECTION CALL W44=, PUBLIC WORKS DEPT.
-771-0,-,R 357
Permit Fee:'04 0. 00 Issued By
Trunk Charge: Date Issued:
Assessment Fee: Receipt No.: *2-4407
Lid No.: -
Partial Inspection: Date -initial.
Comments
Reason Rejected: Date -Initial
Final Inspection Approved:, Datw?__*__Vinitiali:�F__�
11
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Green Copy: Inspector . Buff Copy: Applicant
Revised 3/90
i
The City of Edmonds Side Sewer Drawing EASEMENT NO . ............................................
NEW CONSTRUCTION REPAIRS LID NO . .................. . ASMT. NO . ..................
OWNER...................................... ............................. ...... * ......... CONTRACTOR .................................................................................... PERMIT NO.96-61/
72 JOB ADDRESS ... R.= ..... j ....... 3 ....... .......................... ...... LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
-t N( 0-t r__ .
StF, �---fiwrLVA-5
4
1
PWW-0001-11175 (REV.11/78)
PW6 L: -I
NAMEOF ADDITION .......................................................................................................................
VIA SALLNGER
O� e- —I LIFT STATION
1-7 ;z wo 466-- Approved:
DATER-.2 1�1 7 ........
... . ..... . ... By
0
Wcly.,.e- P*AcL. �?qO7
P I ..scQke
APPROVED BY PIM&-o'
APPROVED
%mane
i u 'N
-A 22� 14X
mw�ne, SVP Ant 4A.Vrl-
S,
PLANNING DATA
NAME: ("j/ //I ---
SITE ADDRESS:-Z 3 - 74?jV'v,1 DATE: —
ZONING: 5- PLAN CHK#:
PROJECT DESCRIPTION: 7- ees- ga%te C$' 4ejrba.".
CORNERLOT 1 4/0 � —(Yes/No)
SETBACKS:
Required Setbacks:
Front: I $- Left Side: I Right Side: Rear: 1 5-
Actual Setbacks:
Front: 51"' Left Side: Right Side: Rear: Is -
Street map checked for additional setback required? - —(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE:
72.1 Maximum Allowed: Actual:
#j 2,
6 Z
BUILDING HEIGHT:
Maximum Allowed: Actual Height:_ Z -5'
Datum Point: 144.lXote Datum Elevation: i o 7. 85-
SUBDIVISION:
CRITICAL AREAS #: 7 C(o
SEPA DETERMINATION: )YL. e!1,4
LOT AREA:
OTHER:
'S 1C!P-q//V AJ.C-%l Cd'WO V- J" I
Plan Review By:- 4ZI-4 VL L�1�
A.!
1�4 o(o
cjo*
10 Lip
E Y.
V-0,
sve,
s
J\
Or. APPRONEW-5
[6 e6
7
SMEET FILE
..,Q6�. (_�vxlqoe- '3 6, A 27),4X
f1cf.st —I-
..Sc Qke
-$Q:x 104, --- S"Q 15
AVED
RECE
JUN 5
PERMIT COUNTER
S,
s
CA FILE NO.
Critical Areas Checklist
Site Information (soffs/topography/hydrplogy/vegetation)
1. Site Address/Location: Q 0 q 0 3 -2 Q vi cl () L-14-1 L#1j Eck V" 0 \AJ -S
2. Property Tax Account Number: oc),8 -C-) t C30
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? no.
If yes; how is site developed? Sir% le --Pc.�\X
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
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):
.4
6. Site contains areas of year-round standing water: 0 _;Approx. Depth:
7. Site contains areas of seasonal standing water: 0 Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. 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 Qawn,shrubs etc)
11. Obvious wedand is present on site: 6
or 90-194-
City of E&non&
Critical Areas Checklist
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 Edmondsprior
to histher submittal of a development
permit to the City.
17he 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. Ilie
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).
An applicant, or his/her 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 maim a determination of the
subsequent steps necessary to complete a
development permit application.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent infonnation (eg. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing thew preliminary
assessment of the'site.
I have completed the attached Critical Area Ch�cklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Appkant:-
Name
-2 2-
2_--CD `� 0 /' L
Street Address
City, State, ZIP Phone
Signature Date
Applicant Representative:
Name
Street Address
City, State, ZIP
Signature
Phone,
Date
:W1 fl�
City * of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT. PermitNumber:
Issue Date: 1 /51- 9eik
77 F�11111_117
A. Address§ 4'iiin'li tC3ro'fC6nstruct ion 20903 72 Avenue West
B. Tvne of Work (be specific): Initall New Service
9 94
C. Contractor: Washington Natural Gas Company Contact: Frank Swan
Mailing Address: 815 Mercer S tree t* Phone: 224-2278
State License #*: Seattle, WA 98111 Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. 'R Commercial Subdivision [I City Project XX Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family E] SingleFarnily Other
INSPECTOR: INSPECTOR: R % -T "IT
F. Pavement or Concrete Cut D Yes PNo G. Size of Cut: x H. Charge$
APPLICANT TO READ A
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harrnlessftom injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the City of Edmonds, or d)iy of its departments or employ-
ees, 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 FOLLOWNG THE FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MA TED RESTORA 77ON FEES WILL Bk HELD TIN77L THE FINAL STREET PA TgHJS CPJ.4PLETED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT. WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Departf 0. e,.-.23
Work is to be inspected during progress and at completion.
771002410
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
_E
Traffic Control and Public Safety shall be in accordance with City regulaitions as required by the Ci y ngineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the. end of the working day;
NO EXCEPTIONS.
I have read the above statements -and understand the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspfetion purl psey_
Signature: 75�5m Date: September 9, 1992
(Contractor or Agent)
CALL DIAIA-DIG PRIOR TO BEGENNING WORK
KIENTS:
RECEIVUNO:
ISSPED. BY:
kul
Engrg. Div. 1991
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
0 YES 0 NO
Date:
Date:
Eng. Div. July 198'.
um to :
Submitted by:
WNG to window
Water main depth
unknown
gas main
City of Edmonds
Right of Way
Permit Application
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager 9(_-g - 1(,05G
�,Ar-> C-Ak-vs
-w-
water
-g-
gas
-ss-
sewer
-e-
water hydrant
0
water valve
815 Ma= St. (P.O. Box 1969). Scan , WA 98111 (206) 622-6767
U L.t'
CITY OF EDMONDS
LAURA M. HALL
250 - 5TH AVE. N. EDMONDS, WA 98020 (206) 771-0220 FAX (206) 771-0221 MAYOR
COMMUNITY SERVICES DEPARTMENT PETER E. HAHN
89 0 C� Q� Public Works 9 Planning 9 Parks and Recreation Engineering DIRECTOR
LETTER OF TRANSMITTAL
Date: May 28, 1992
To: Dave Stitt
15909 53rd Pl
-Edmonds,-Wa. 98020
Subj ect: Critical Areas Checklist
Transmitting:
For your information: xx
As you requested:
For your file:
Comment and return:
Note attachments:
Comments:
Planning Division
Diane Cunningham
e Incorporated AUgLJSt 11, 1890
Sister Cities International — Hekinan, Japan
d .
890-194—
City of Edmonds
Critical Areas Checklist
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 a development -permit
to the City.
Ile purpose of the Checklist is to enable
City staff to determinewhether any potential
Critical Areas are or may be present on the
subject property. Ile 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).
An applicant, or his/her representative, must
fill out the checklist, sign and date it, and ,
submit it to the City. The City will review4"
the chccldk,,% make a precursory site visit,
and make a determination of the subsequent
steps necessary to complete a.development
permit application. I
Mrith a signed copy of this form, the
applicant* should also submit a vicinitymap
of the parcel with enough detail that City
staff can find and identify the -subject
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information or studies in conjunction with
this Checklist to assist staff in completing
their preliminary assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
dCrne
Title
,�ree�Addr
City State ZIP
Applicant Representative:
Narne
Title
Street Aftess
Phone ity, State, ZIP Phone
Date Signature Date
Critical Areas Checklist
Site Information
Project Name: Permit Number.
SiteLocation: ZOW__� '72- Alf W Property Tax Account Number.
Approximate Site Size (acres or square feet):
Have you filled out a Critical Areas Checklist for a project on this site before?
MAY 1 3
PERMIT COUNTER
NO
General Site Conditions
1. Has the site been cleared or logged? Date of most recent action:
Soils / Topography .09 .
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? 400-40QVP U-W-8*W
3. Describe the general site topography. Check all that apply.
X—Flat less than 5 feet elevation change over entire site.
Rolling- sl' es on site generally less than 15% (a vertical rise of 10 feet over a
OP
horizontal distance of 66 feet.)
Hilly: slopes present on site of more than 15% and less than 30% a vertical rise
of 10 feet of horizontal distance)
Steep: grades of greater than 30% present on site.
Comments
Hydrology/Vegetation
4. Site contains areas of year-round standing water: zll��
5. Site contains areas of season standing water: Z)/)
--Approx. Depth:
6. Site is in the floodway floodplain 40 of a water course.
7. Site contains a cr%kJor an area where water flows # . cross the grounds surface? xzzaflows
are year-round? d1,41—Flowsare seasonal?
8. Site is primarily: forested 2 in ow Ishrubs mixed eAj.
9. Obvious wetland is present on site:
10. Wetland inventory or map indicates wetland present on site:
11. Critical Areas inventory or map indicates any Critical Area on site:
For City We Only
CITY OF EDMONDS
cc
�pj U ASSET INFORMATION SHEET
10/NEW
ADDITION
RETIREMENT
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION Z 4
SERIAL NO.
LOCATION DEPT. NO.
I (J. 60k:=5-174
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
B.A. R.S. ACCOUNT NO.
ESTIMATED LIFE
INITIATED BY
DATE
*PROJECT NUMBER
PROJECT COMPLETION DAT&��
COST
APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
,,.,XDEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE DATE
itnp INITIAL
DEPARTMENT FILE
ZtJ2�
VERIFIED BY
PROCESSED
BATCH NO.
419
"bEEZT FLE
CITY OF -EDMONDS HARVE H. HARRISON
MAYOR
200 DAYTON ST. - EDMONDS, WASHINGTON 98020 - (206) 771-3202
OFFICE OF THE CITY ENGINEER
December 21, 1981
Mr. Burch Cambers
16527 60th Ave. W.
Lynnwood, Wa. 98036
Dear Mr. Cambers:
SUBJECT: L.I.D. 206 SANITARY SEWER CONNECTION
RE: PROPERTY LOCATED AT 20903 72ND AVE. W.
City of Edmonds records indicate that you are the owner
of property located in the College Place Area, and that the
,�sanitary sewer service is now available to your property.
Residents abutting this sewer main are required to be connected
per Edmonds.City Code (18.10.010).
In consideration of the completion of the sewer system and
the aforementioned code, you are hereby advised that you should
make arrangements to make the necessary sewer connection within
sixty (60) days.
If you have any questions, please contact Jerry Saterlie
at 775-2525, extension 259. Permit and connection information
may be obtained at the Building Department, at 505 Bell Street.
Sincerely,
JAMES E. ADAMS, P.E.
City Engineer
JR: jky
87REET RE
CITY OF EDMONDS SIDE SEWER PERMIT
8 9 0 19", _J PERMIT NO 8430
Add,essolConslruction:
Property Legal Description (Include all easements): 608 -0/
RF_CF-IVF_D
VIA i3ALL11'4J 1 6 1993
T S__
LlIV '�� JAN
PUBLIC WORKS DEPT.
Owner and/or Contractor:
oil
"-f-M A /I 5-�9,y 1-i Ax (��0&57
1Z
State License No. A A
—2— k'kt-Building Permit No.
'�&/Single Family Invasion into City Right-of-Way:'K No 0 Yes
0 Multi -Family (No. of Units-) RW Construction Permit No.
1.3 Commercial Cross othe r Private Property: E4<No 0 Yes
El Public Attach legal description and copy of recorded easement
k, z44,,i�
I certify that I have rea(fand shall comply w'�ith all city requirements
as indicated on the back of the Permit Card.
/- �-
Date
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION *
OFFICE USE ONLY
FOR INSPECTION CALL OUBLU; WORKS V EPT.
-30,00 10�
Permit Fee: 7_ 1.02" By
71-CM (::t-. =
6`0 / -
Trunk Charge: C�115_1 Date Issued:
Assessment Fee: Receipt No.:
Lid No.:_C�v
Partial Inspection: Date -Initial
Comments
Reason Rejected:
Final I nspection Approved: Date Z-61 -L-' I nitigf::7!;�
Date -Initial
** PERMIT MUST BE POSTED ON JOB SITE **
While Copy; File Green Copy: Inspector Buff Copy: Applicant
Revised 3/90
The City of Edmonds Side Sewer Drawing . EASEMENT NO - ------------------------------------ W
NEW CONSTRUCTION REPAIRS Fj LID NO - ------------------ - ASMT. NO - ---------
OWNER------------------------------------------------------------------------------------------------ CONTRACTOR ------------------------------------------------------------------------------------ PERMIT NO.
JOB ADDRESS ... �.ITO
............................ LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
c—
NAMEOF ADDITION -----------------------------------------------------------------------------------------------------------------------
VIA
C. 0
e.
-7 � WD Noe W.
Approved:
PWW-0001-11/75(REV.11/78) DAT I, ./� ... �,3 .......
I .. ...........
By ��Kll-
---- --------
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
141tq Y.-Vr:
MAILING ADDRESS
CITY ZIP
I TELEPHONE NUMBER
- -�) / - ).
4X W/4 '" Z -
Cf- r- 1;,v5 o (,os �c_
.1ADDRESS
XZ_ 442,_,v
cc CITY ZIP ITELEPHONE NUMBER
C77 o6i
NAME
WAY,4�r, m", Poo &
ADDRESS
'22
clix TELEPHONE NUMBER
ZIP 2.
01-
STATE L)CENSE NUMBER EXPIRATION DATE
Legal Descriptiop of Property- includ alleasementst.
, 2�0 oo I
Z &-k1re, "44 rs V X "I
0 -7—
E W
, $a ',Of' 11, F�'rAl 4ar a 34 Af. /, .4y z 47 x i:
X
ja j! Ae. 1 0 4j.C.'
4al- 72 t3lAe
7 Of
VFUPU"y
Tax AccounI5766 1-00 1 -04>8 -0/ 0o
Parcel No.
F;a
NEW
Le-J% RESIDENTIAL
PLUMBING
ADDITION
El COMMERCIAL
MECHANICAL
REMODEL
APT. BLDG.
El SIGN
GRADING
FENCE
REPAIR
— CYDS.
( x—F T)
DEMOLISH
WOODSTOVE
INSERT
SWIM POOL
HOT TUB/SPA
r; Q-1 GARAGE
tC�CAR
RETAINING WALL1
RENEWAL
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
2, C�, 0.0
NUMBER
OF
NUMBER OF
DWELLING 2� JAREAS
CRITICAL
TORIES,
UNITS
NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
0+ *7&4,#o
Y. 2.4
c- eJ
74.,,J 6
Aor dp_
—1 0/0
USE
ZONE PERMIT
NUMBER
JOB SUITE/APT #
ADDRESS "V
_;P III�Vyre_4(*
%
;�
.EGAL DESCRIPTI
DIVISION NO.
LID NO,
�2 06
PUBLIC RIGHT OF WAY PER OFFICIAL STREET
MAP.
TESCP Approved
0
_LJC�kw
RW Permit Required
0
EXISTING 160 REQUIRED DEDICATION
ba
Street Use Permit Req*d
Inspection Required
11
E)w
PROPOSED
Sidewalk Required
0
MET SIZE
LINE SIZE
NO. OF FIXTUR-77
PRV RE UIRED
NO 0'
3EMARKS
Z
uj
tit
Ila 41
IEERING MEMO DAT� REVIEWED BY
tj
k /-A Ae
SIGN AREA SEPA REVIEW ADS NO,
ALLOWED I PROPOSED I COMPLETE IEXEMPT I
EXP 1 1, 1
VARIANCE OR C LANNING REVIEW By DATE
SETBACKS - FEET
HEIGHTJLOT COVERAGE Z
Z
FRONT SIDE /0._ REAR 15* 7
REMARKS
rHECKEO BY TYPE OF CONSTRUCTION CODE
A)
9 1 OCCANT
SPEC I ALINSPECTOR I
REQUIRED I LOAD ANT
YES
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
PLAN CHECK FEE
BUILDING
d7' 0/0
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on p6ate property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
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
u)
successors in Interest, agrees to indemnify, defend and hold
uW'
i
harmless the City of Edmonds, Washington, its officials,
x
employees, and agents from any and all claims for damages of
Ix
<
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
modily, waive or reduce any requirement of any city ordinance
X
1
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
information given Is correct; and that I am; the owner, or the duly
ATTENTION
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
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tion Insurance and RCW 18.27.
SIGNATURE (OWNER OR AGENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
ATTENTION
CALL FOR
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
CHAPTER'3.
10247
�Zc- & 61z?
.C:711��
7
APPLICATION APPROVAL
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.
OFFICIAL
V/
ORIGINAL — File YELLOW — inspector
PINK — Owner GOLD — Assessor
RECORD OF INSPECTIONS
INSPECTOR
SETBACKS ...................
FOUNDATION:
Footing .....................
Wall .......................
Pier/Porch ................
Retaining Wall ............
Slab Insulation ............
PLUMBING:
Underground .............
Rough -in ..................
Commercial Final ........
HEATING:
Gas Test .................
GasPiping ................
Equipment ................
Commercial Final .........
EXTERIOR SHEATHING
NAILING ....................
FRAMING ....................
INSULATION:
Floorinsulation ............
Wall Insulation ...........
Ceiling Insulation .........
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
RADON MONITOR AT SITE
FINAL APPROVAL
FOR OCCUPANCY .........
DATE APPROVED