21004 82ND PL W.PDF11111111 lill
7660
21004 82ND PL W
City of Edmonds
RECEIVE
R E EIBIZOF-WAY. CONSTRUCT104
PERMIT
Perwitt'"Ity
Issue Date:
A. Address or Vicinity of Construction: 2-1004 e 2- Ai o 1'0
9 9 C) (3 B. Tyl3e of Work (be specific): Of_Fer_-r7yr�E r—F_r-_Dr,1z_ cA--
-rG w 3 3 ' uW P uj 4
C. Contractor: _CHAtANeA5- . -CA Aj PrEA f OR- Q-A
MailingAddress: 5-37 MAIrJ5r e-_:DK(jiJ0S_
State License #: Iry.4 04 eC, 10 1 Q, A'.
D. Building Permit # (if applicable): V
Contact: \IAC-1-f 61AD VOHL-
Phone: 7 7 4- -514 (6
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. F� Commercial Subdivision Qi City , P \ 'ect M"Uitility (PUD, GTE, WNG,C6A'B_L_b WATER)
F-1 Multi -Family r0i --------
Single Family Other
i
INSPECTOR: \INSPECTOR:,' W\_4%1Tr_%rM
F. Pavement or Concrete Cut [I Yes ONo G.: Si�ze of Cut: x H. Charge$
APPLICANT TO READ A
INDEMNITY. Applicant understands and by his signature to this application, agrees r.'1d_,heCiy of Edmonds harmlessftom injuries, d mages, or
claims of any kind or description whatsoever, foreseen or unforeen that may be made against the City of Edmonds, or any of its departments or employ
I
ees, including or not limited to the defense of any legal proceedings including defense costs, and atiorneyfees by reason of granting this permit.
THE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP A ArD MA TERIALS FOR A PERIOD OF ONE YEAR FOLLOWNG THE FINAL INSPEC71ON
AND ACCEPTANCE OF THE WORK ES77MA TED RESTORA 7709-FEESWILL BE HELD UN77L THE FINAL STREET PATCH IS COMPLETED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR,5�?ED�TW,LL BE PR06ESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work requir'9d with pe'rinit application.
4 24 hour notice is required for inspection; -Pl'ease call 'the Engineering Department- 771-3202,
Work is to be inspected during prokres� and at completion.
Restoration 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 City regulations as required by the City Engineer.
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 ie �ermit requirements and the pink copy of the permit will be available
on site at Iqll timesf6iinspection purposes.
\,x
Signature: /V\_A�,� Date:
� _�'Co, tractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGMNING WORK
TE:. ISS.UED.A.Y.;
NO WORK 9HAT,T, RRGIN PRIOR TO PFRMIT USSIJAN
Engrg. Div. 1991
FIELD'IN SPECTION NOTES (Fund I I I Route copy to Street DepQ)
Comments:
Diagram:
CONTRACTOR CALLED FOR, INSPECTION C1 YES 0 No
Partial Work Inspection by W.:
Work Disapproved By: Date.
FINAL APPROVAL BY: Date:
Eng. Div. July 11
PL
7
--1004 82 MC V\,/
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PUBLI T L.4:�T
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4,1 (address) ORO
Street Right -of -Way Existin�.���(:5��]REQD
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Access Easements Existing--m C) K) K
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Utility Easement Exist'
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W
Lot Per Subdivision Plat
lat
As�sessor
it
S e Plan Checked for AccuracyL_L
all
Z
Underground Wiring Reqd. Y
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H
I
Check Accuracy of Legal Description
Review by_
Date
Existing Water Main Size- to" P7-
Water Main Required Ot-O_
Service Line Required
Hydrant Size Exist
Hydrant Reqd Per Fire Code
--Size
Detector Check Yeter Reqd. A--'O
Cross Connection Inspection A-�P
Fire Department Conments
:3:
Water �16ter Charge Ri�(q
Review by JZO
Date X/A 7
0
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Avail ty
a�:, i i - �)
Proi. Pe--,.+7-
Drawing No.
File No.
Side Sewer Availability
L -1
W
Sanitary Sewer Connection Fee Reqd.
:3:
Review by
Date—///02 -2
Open Ditch Existing_//,22,.g._
Reqd. —
Culvert Reqd,
Size —
r4
Catch Basin Reqd.
V4
Indicate on Site Plan 9:�__
0
CD
Shoulder drainage maintain collection on swale open runoff 94�
CV
�kmhole reqd. 4�11
Indicate on Site Plan 0%
Ln.
Soil Conditions and Ground Water Field Checked C�_15
Review by,
Date i��,
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Revised: lvlO-1977 Q;
GIN
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BUI INC DEPARTMENT
Applicant Fill
PERMIT
ZONE NUMPR
PERMIT APPLICATION
Inside Heavy Lines
I I )- 1 jaf3
JOB a --I - I
ADDRESS
NAME OR NAME OF BUSINESS)
MAILII
LEGAL LOT
4@ Yes C1 No
LOT AREA
SUBDIVISION No.
1P LAI
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3:
0.
CITY ELEPHONE NUMBER
�E7COMP,
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STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
PLAN ST. R/111 50 FT. FT.
D
NAME
REMARKS
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W
W
t
ADDRESS
CHECKED BY
W
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U
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CITY
TELEPHONE NUMBER
STREET AND/OR UTILITY WORK
REQ'D. 0 Yes AFNQ
R/W PERMIT REQUIRED
El YES *NO
Z
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NAME
IV4,A2 7TV 00,ey> zy
UNDERGROUND
WIRING REQ'D. Yes NO
0
I.-
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ADDRESS
Z 2-52 (0 Z -7
TYPE CONNECTION &YES. IVERIFIED
SANITARY SEWER
NO
Y
t ; iTtli
0:
z
0
CITY
k
TELEPHONE NUMBER
966
SEFTIC SYSTEM 1:1 YES
APPV'D BY CITY ENG.
No
PERMIT NUMBER
---------
1
U
.. A C NS IBV
V�M
CITY LICENSE NUMBE
. REMARKS
Legal Description of Property (Show Below or Attach Four Copies)
Jn) .
MET.RZ.Z., I BUILDING SUPPLY SIZE
I
REMARKS
W
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0-
A 6:5,
SIGN AREA
SNV. REVIEW
ADD NO.
cr
U
W
ALLOWED PROPOSED
COMPLETE EXEMPT
.J
REMARKS
W
VARIANCE OR CU
PLANNING REVIEW 13Y
DATE
YARDS
��1;1 FRONT SIDE REARI
LOT COVERAGE
R:SIDENTIAL GAS
Dl< EW LINE
FJADD N N-RESIDENTIAL SIGN
F-1 DEMOLISH RETAINING
WALL
EXCAVATE FENCE
ALTER OR FILL I— X—FT)
REPAIR PRE -MOVE swim
INSP. POOL
FIRE ZONE
I
TYPE OF CONSTRUCTION ICODE
HEIGHT
SPECIAL INSPECTOR AREA
REQUIRED
0 YES El r
OCCUPANCY
GROUP
I
OCCUPANT
LOAD
PLAN CHECKED BY THIS SIT E IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
I -
z
NUMBER OF STORIES
NUMBER OF
DWELLING
MARKS
UNITS
W
NATURE OF WORK TO BE DONE
Co k)5 �;-4_ U c r" 0 L. 0/1 411(_�s C
L
W
PLAN CHECK
NO.
VALUATION
FEE
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0
0:
U
0
W
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0
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PROPOSED USE
PLOT PLAN (INDIC,%ffE BUILDING SETBACKS/
ABUTTING STREETS)
BUILDING
PLUMBING
HEAT & GAS LINE
10
0
W
FENCE
Z
SIGN
3
RETAINING WALL
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SWIMMING POOL
I
APPLICATION
P% I t for
The City of Edmonde'*"T ,q aw.0-
SIDE SEWER PERMIT EASEMENT NO. — .........................................
NEW CONSTRUCTION REPAIRS LID NO . .................. ASMT. NO . ..................
I &
OWNER ... .... ........ ------------------------- CONTRACTOR - ----- =- -TF: .... �- -T4� ---- - f�-- PERMIT NO.
JOB ADDRESS Z�Q5;Z>--.4 ----- --- ��t ------------- LEGAL DESCRIPTION: LOT NO - ------------ -------------- 11--- BLOCK NO . .................. .................
-------------------------------------------------------------------------------- -----------------------------------------------------------------------------
NAME OF ADDITION ------- ex
--- ------------
x1pproveo:
DATE ..... ...... . ..
E�,p
T-Y" OF SIDE -Sf Ek,, ERM
-i�V;A�iEWSEWER,:. D EPWRTMENT.-,
ERMIT,
6022*.,,
-of'
pall 77572525 for side sewer inspections.AIEF0.111E covering� any �portlon the construction,
-re, ust. NO t Sun p.
Inspection -will be-, provided -within. 2.4 hours -after. q Sa or holiday S.
jInspqcti,6 . n
A
-CONSTRUCTIO ..........................................
'ADDRESS'.`LOCATION� OF
N
................................................................ ............
PROPERTY', LEGAL'Dlk91CRIPti1ON ...... f
........................................................ .................................................................. .........................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . 7 . . . . . . . . . . . . . . . ..... . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.............................. . ....................... .
-�B ...............................
� 1:�, -i Illq _., . .
.................................................... UILDER .. .........
......... . ............................................. ......
VC-T. OW& 'NAME, &ADDRESS ......... ...... ........... .................................................................
................................ : ............... ...... I .. . ...... ..
")Ps- .,�Dn I .................................................. 19-1�_ for repair and/or- connectiow�of a -side �sewer 4o,Ahe!�cl -sanitary,
syst(AAA cordance ifith -Rit' of -Edmonds -ordln*
�nees.-
y
'EN+10WIS�CA-LbEDIT :THE F LLOWING:
v—
.,0
.:.the. -property, may obtain a,permit to, construct -sewer - inside property line., A- licensed� Side Sewer Con tractor -.m-ust. De �emp�oy�de to, construe
e sp -,'street-area. Do*not cover any portion be ..been tnspectsd:� to construe
_fore It has
'�Jfo'r4nedl In.city, rlght�of
%er�in
--A' I IT.Mo r k. -way requi�es ah'Invasion 6f.RJght-of-Wiay.Pie'rmJ1t obtaJnabI6'from the City Englneer'�,'Off fee.*.
0 1 stion reiaidfng,-Ordinanc�_ 1 ' 3 jand� Regulations governing I slde,-sewerii I ypu get permit.
e�vnt:`&t
":1'. 6.0 0 ."When
0. -To _' 01 sine 9 �m at 1�"��130441nc,hes coverage at -property 12 ln&�s.'Instde propirty line;mInimum grade, of 12 '�,Nbl
B rpe I IIP be permitted.. n;,gr e
and surface of street -restored to orIgInaJ .,condition. Contractors shall be responsible r I '-t p
—1 f—H q j - I _;nt'V;. tle' 0 r6 er
-may d op wlthlri-one�year'of* completion:
evel
un
-1 , is r to-ilter or do anyother wo'rk:-than is proviaed for in the permlt,..'o� to do any -work on the'main sewer or�kf 5 U t t to,'*:In
a
ii�rtttieLpip�jnto, t e wye.
P �ZD� liate ... . ..............................
ft .. ............. . Date... -BY
.......... Date...'.* .......................
y .........................
........ My ........
. .... ..... ..........
ate.
------------------- ..............................
....................................
r 8 . ......... ...................................................
�MVA
..........
................................. .................................. .................................
r j ............................................... ...... . . .........................................
........... .......................................................... ..... ............ ................................... .........
MUST -Be Signed' By 6,�i'n'� of lo�Fll Perf6�nI ing;.1tConstruc tion' PRIOR, To-Requies t . on,.
i'F,ov. nsnec I
fa I
r e
T ... A .......... nder. this, permit.
...... .. .... . ............ C�riif�'tfidt,�,ihe.*.side'sewer installation. constructed- 1i
?n g:
qng: Fir rfcrT, yopslr�5.1
`h4o din
italled4ft'4665rda al erning oirdiffai h I
ofit
144 t
�19;
a ed t s,:*
-T
Gas."-
v!r-.p,; ewer
"GhebWBEFO E
'R yo�"dlj,-,ior.`..W'_a'h-e r-D. 'ljone'
APPLICATION
/
`
`The City �f �d����= forSIDE SEWER PERMITEAyE»«EmTNK� ---'�--________..OWNER
--'------'-----''''—'------------''--'''----'-----'-'----
Al
NAME OF ADDITION
--......................................... -------- -----------------------------------------------
DATE------------------------ ------------------- By ------------------------------- -................ ---
NOTICE:
Nb-warranty.of a.ccuracy.
The -information'shown on the attached
map(s) was compiled for use by the City Of
Edmonds, its Employees and Consultants.
The city of �Edm.onds does not * warrant the
accuracy of anything set for.th on these
map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
tFe,map(s), including, but not limited to, ch
the location of any sewer stub shown. Su
sewer stubs may or may, not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
-1 h e
sh-a-1.1 be I'la.b.-IF-e for L
ernp-l-o-yee-s or officer---) ), .
information given on this map(s), nor for
- ne representation provided based
any 0
upon I said map(s).
,21do�l YZ /� 141
STREET
RETURN ADDRESS:
City of Edmonds, City Clerk CONFORMED COPY
121 5th Avenue North 200401050534 3 PGS
01-05-2004 04:16pm $21.00
Edmonds, WA 98020 SNOHOMISH COUNTY, WASHINGTON
NOTICE OYLEWITATION AND COVENANT
ADULT FAMILY HOME
Reference #:
1 Wj 'gel
Grantor(s): (1) a 75-Injo (2 ;Odin 14 Additional on pg.
Grantee(s): City of &dmonds
Legal Vescrip . tiou (abbreviated): Sec-4 -9 ffwu—!Z—_-Rug Qtr S&
OR Lot—jj6----BlockML&--Ld2la ke & k-
Assessor's Tax Parcel ID#(s): (1) 00 6 4 22- A900 MOO (2
------Assessor's Tax Parcel ID# not yet assigned
AUTHORIZED FOR RECORDING
dmonds
By: Date:/A611"/
6W
1 Page_/ of
WHEREAS, the undersigned owners of property located at24004 82nd..TLW
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,au 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 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
660wner") 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. Covenggit: LiMitatign on He�iden�m The owner hereby stipulates
and agrees that occupancy of the structure as an adult family home shall be limited
to 6' or f�wer 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 - C residents or attempts to rent, lease or
otherwise provide residence for additional residents above the
a 1 0 - 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 furt ' her stipulates that this
covenant touches and concerns theland 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 at24 004 82 ng. w
Edmonds, Washington and legally described as:
W001 L 4 kE ?A P k BLk 0oo - h -60 Z-OT fS
-<dw-� -7-.?) 'ES.'a, P/A -1 �7 9'sw rEl- .0 Z'h� Q� Edmun;k
3. NotificatioU to Future Purchasers and Assignees. This notification
and covenant has been recordedin 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 . C5 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
t of Edmonds
BY Date 1/07 ill /Alf?
Pa-ge /
Of
DATED this !�&,b day of
ACCEPTED BY:
OWNER:
APPLICANT/PROPERTY
20AAd W.41-60
Applicant
Jeannine L. Gra�.. Applicant.
Building Official
NOTIFICATION
Owner
Owner
COVENANT AND
i
ACKNOWLEDGED.
Mortgagor
NOTARY FOR OWNER SIGNATURES
State of Washington
)ss
County ofs-MLewo
I certify that I know or have satisfactory evidence that
signed this instrument, on oath stated that he/she was authorized to execute
ipstrument and acknowledged it as the b U) 911- (title) of d Z f/X
(name of party on behalf on whom instrument was executed) to be the
free and voluntary act of such party for the uses and purp9ses mentions in this
Subscribed and sworn to before me this day of
ILE �J�
Notary Public in and for the t te of Washington.
My commission expires
I certify that I know or have satisfactory evidence that di'm iami'n PdJdRQed9Q
signed this instrument, on oath stated that he/she
,,7aj authorized to execute th
I s r t 'Li
t and acknowledged it as the fi,6 91- (title) of
kL-p4ame of party on behalf on whom instrument was executed) to be the
free and voluntary act of such party for the uses and pur es mentions in,this
in trumen, Subscribed and sworn to before me this day of
Notary Public in and for
My commission
F-of
.) [yashington.
AUTHORIZED . FOR REIQORDING CONSTANCE M. GUK I
C*t f Edmonds NOTARY PUBLIC
By: Date: STATE OF WASHINGTON
4
COMMISSION EXPIRES
age of APRIL 9, 2007
L:NTEMP\BUILDING\FORMS�ADF—COV.DOC
RZCZjVEJ:)
2004
':NT
DEVELOPME CTR.
CITY op
RETURN ADDRESS:
City of Edmonds, City Clerk CONFORMED COPY
121 5th Avenue North 200401050534 3 PGS
. 01-05-2004 04:16pm $21.00
Edmonds, WA 98020 SNOHOMISH COUNTY, WASHINGTON
NOTICE OF LIMITATION AND COVENANT
ADULT FAMILY HOME
Reference #: I A�g —
Grantor(s): T-01MO (2) &A
Additional on pg.
Grantee(s): City of Edmonds
Legal Description (abbreviated): Sec 4-9 Twn 2- 7--Rng Qtr Sff
OR Lot— -& __, d dA-dd Plai*dfdke & k-
_jBlock L
Assessor's Tax Parcel ID#(s): (1) (90 6 S 2 2— 0,000 -&99 0 (2)
-----Assessor's Tax Parcel ID# not yet assigned
AUTHORIZED FOR RECORDING
dinonds
By: Date:zwm�/
Page _j of
WHEREAS, the undersigned own' -P
ers of property located at2/1004 82qd,� L W
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 or fewer residents and their
caretakers; and
WHEREAS, the City has issued a permit based upon such representations;
66 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 appli cant
seeks revision of the applicant's state license to operate an adult family home with
an occupancy of greater than - ic residents or attempts to rent, lease or
otherwise provide residence for additional residents above the
6 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 at24 OM g2,,4, PL - vi
Edmonds, Washington and legally described as:
L 0 kE Pig Q k BLk Ooo - �, -oo Z-OT f
SC18Y 'rz) C-S,6 ?1Jb I V 62,EAI -F-El- .45 -/* V 6dmmJ-<
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.eurrent level of improvement to single families and adult family
home residents fewer than 6 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
Cit of Edmonds
133407��J Date
i;ge -- of
-4:91 -9--
DATED this day of
ACCEPTED BY:
OWNER:
Jeannine L. Gr—af--"'.
Building Official
NOTIFICATION
NOTARY FOR OWNER SIGNATURES
State of Washington
County ofSAk1—*P—d--/)1)ss
APPLICANT/PROPERTY
Applicant
Applicant
Owner
Owner
COVENANT AND
ACKNOWLEDGED:
Mortgagor
I cert . ify that I know or have satisfactory evidence that—j-'a M k r t
signed this instrument, on oath stated that he/she was authorized to execute) 4 1
ipstrument and acknowledged it as the &A' i 11,L I' - (title) of d' , 1i
Vk4tL . (Dame of party on behalf on whom instrument was executed) to be the
free and voluntary act of such party for the uses and purpQses mentions in this
in,strument. Subscribed and sworn to before me this day of
Notary Public in and for theSt4te of
Washington..
My commission expires 16`7
1 certify that I know or have satisfactory evidence that . &,11'1 (IjUl yj-
signed this instrument, on oath stated that he/she was authorized to execute t
11, strp ent and acknowledged it as the. (title) of mu/'t;*
4W1 4
r, �Mt,'�.me of party on behalf o� whom instrument was executed) to be the
free and voluntary act of such party for the uses and pur o es mentions in this
instru!nen�. Subscribed and sworn to before me this day of
—7��7
Notary Public in'and for the S i f ashington.
, 00!
My commission expires 4'/4roP7
CONSTANCE M. CURTIS
AUTHORIZED FOR RECORDING
C"t f Edmonds NOTAR I Y PUBLIC
By: Date: 11K'14101 -q STATE OF WASHINGTON
Page of 2 COMMISSION EXPIRES
APRIIL 9.L,20,0,7.,—,
LATEMMUILDINGWORWADF COV.DOC
CITY OF EDMONDS
10 C== PERMIT APPLICATION
OWNER NAMVNAME OF BUSINESS
PjQZ flM9F_ 4NII ThA984 Irmm v
MAILING ADDRESS
2400 4 824 N - V1
CITY ZIP TELEPHONE
-0/
Edmond 51 VVY14 9&OU 1425' 42 4 83
NAME
ADDRESS
CITY ZIP TELEPHONE
NAME CBL#
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITE/API#
ADDRESS 210047 82.v4o &W
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TIESCP Approved [3
RW Permit Required 13
Street Use Permit Req'd 13
EXISTING - PROPOSED
Inspection Required El
Sidewalk Required
REQUIRED DEDICATION- FT
Undergrourul
Wiring required CI
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES E3 NO 13
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REMARKS
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OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE.
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ENGINEERING REVIEWED BY DATE
cc ADDRESS
FIRE REVIEWED BY DATE
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CITY ZIP
0
0
TELEPHONE
VARIKNCE OR C0
SHORELINE OR ADB#
113YES
IN8P ION
RE04
BOND
POSTED
1
STATE LICENSE NUMBER EXPIRATION DATET3��KED
BY
140
$
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2
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SEPA REVIEW
COMPLETE EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOW D OPOSED
PROPEFITY-�TAX-r.-�ACCOUNT,PARCE4'.NO.
co
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COMPLIANCE OR
ADDITION COMMERCIAL
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE X FT)
REPAIR CYDS
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
PARKING
REO ED
LOT AREA
P N ING REVIEWED BY ;4E
9, 717 L' V 06 VI/— I
REMARKS
OTHER
DEMOLISH TANK
GARAGE RETAINING WALL
. [:] F:RE SPRINKLER
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(rYPE OF-PSE, BUSINESS OR ACTIV" EXPLAIN:
CHECKED BY
ITYPE OF CONSTRUCTION
CO _DE_
OCCUPAqT,
�ROVIP
rc
uj NUMBER
a OF
,on STORIES
NUMBER OF
DWELLING
UNITS
CRITICAL
A EAS
NRUMBER
SPECIAL INSPECTIO717R�
]RED [:] YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGR%LS INSPECTIONS PER UBC 108/FINAL INSPECTION ncu-
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VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
coor —7
Plumbing
Mechanical
IZI
THIS PERMIT AUTHOR ZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
a DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
_j SEPARATE PERMISSION.
Erldr. Review,
PERMIT APPILICATION: 180DAYS
CL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr.1,,,,In'spection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR . HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES7, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
I= 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 MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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Recording Fee I Receipt # R
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
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 CONSTRUC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSONWILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
S IGNATUR &(OWNEW 0 Ik&EN"T)-)_ QATt-SIGNM
772-1
(425)
OFFICIALS SIGNATURE TE
—03
771-0220
ARE
Igo
. SE DATE
ATTENTION
EXT 1333
It IS UNLAWFULJO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL.
j
.A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL -FILE YELL04-INdECTOR
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
Ail