21007 PIONEER WAY.PDF11111111111111
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21007 PIONEER
WAY
CITY OF EDMONDS
V"N E W
ADDITION
RETIREMENT
STREET FiLt SSET INFORMATION SHEET
ASSET NO
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION
D2�,�O
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
FA
PROJECT NUMBER
PROJECT COMPLETION DATE
COST �F2
B.A.R.S. ACCOUNT NO. 1:9e 4�1�3
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
M/DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE DATE
ktnp INITIAL
DEPARTMENT FILE
4
1:5-ea
VERIFIED BY
PROCESSED
BATCH NO
cj
CITY of EDMONDS
For Inspection Call'771-3202
15
Address of Construction:
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Pro I perty Legal Description (Include all
U6, Owner and/or Builder: f�e
Contractor & License No:
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LU Single Family Residence
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Multi -Family (No. of Units
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S I' DE SEWER PERMIT
PERMIT NO.
/7�
EDMONDS
I �
asements): �417
Commercial (No. of fixture Units
Invasion into City Right -of -Way:. No Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description 'and county easement number.)
PLEASE READ THE ITEMS LISTED, ON THE BACK
17 </- Jk6
I-E—e ri tify that' -I ave read and'shall comply Date
with the items Yisted on the back.
Pe.rmit.Fee: Issued By:. e5��Ilt4 J/t/L)
v I
Trunk Charge: Date Issued:
Assessment Fee: Receipt No.:
I
Partial Inspection:
Comments
Final Inspection Approved':
Date
Rejected:
eason
Date Initial
Initial
Date Initial
PERMIT MUST BE POSTED ON JOB SITE
WhAte Copy - File Green Copy - Inspector Buff Copy - Applicant
The City of Edmonds Side Sewer Drawing . EASEMENT NO - -------------------------------------------- i
NEW CONSTRUCTION REPAIRS Fj LID NO - ------------------ - ASMT. NO. I -----------------
OWNER -S-F—FtW-00 ------------------------------------
-0 ---- go-tAJES --- 114c-� ---------------- ---------- CONTRACTOR --- PERMIT NO. 7.57Z -----
JOB ADDRESS ---- 2,100.7 ------ ----- W"� ------------ LEGAL DESCRIPTION: LOT NO - -------- 7 -------------------------- BLOCX NO --------- E-DM0t4DS --------
I TREATMENT PLANT]
NAMEOF A ITION ----------------------------------------------------
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Approved:
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PWW-0001-1 1/75 (REV.1 1/78) DATE,,�i" B, -- - ---- -------- -------- --------------
PROJECT REVIEW CH]XXMST
PRQJECT NkC i I PrdXJECT ADDRESS: 2107
ji;�wwo A
APPLICKPION JUMIPT DATE:
Reviewed by: (initial7date
PLANNING
wrR/swR STREET ENGbMG
J, FIRE
'FAMILY/mmTi�
BUILDING
f"7[1111
1117777711
SINGLE /CMMCI�d' (Circle 'One),
SETBACKS CHECKED Planning
VARIAWE/SETBACX!ADJ'�,t
A
77777T/77
M/M
T17711
111111TR7
CQNDITIONAL USE PERMIT
2
712171-
1IT1171117
ADB FIQUIREMENTS CHECKED
3
OTHER ZCNING REQUIRMIM
7TF17TIT771717R7
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m''fum
Av�
ACCESS Siopp. & VEHICLE ACCESS
6
DM6�NAGE PLAN (On Site) fZ�t'AA"
7
V-7
11TIT1717
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STREET Flu
//////
/////////
8
LEGAL DESCRIPTICN VERIFICATION
1,1717717
9
-7TTT17
Qr= CLAIM/DEDICATICNS
. //////
-77TI7777
10
7T17T1777-
EASEMENT - PUBLIC/PRIVATE
CALCMATE SEWER CONNECTION IF ZID#
7TITff
777111711
TTIT171771111111
I
12
PLAT/SUBDIVISION REQUIRM-OM,
13
77
77TI7777
RIGHT-OF-WAY CONSTRUCTION PERMIT REM
/////////
14
777777
111117111
7777TIT77TRTIW-
/ /
B(M REOD FOR PIMLIC IMPRQVh7*2M
/////////
////////
15
SOILS CONDITIONS & GROUND
WATER FIELD 0MCKED
77777777
7/77777T
16
777777
111711111
STREET PAVING REQUIRED
//////
-
17
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CURB AND ITER REQUIRED
//////
/////////
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18
-777777
771171111
SIDEMM MQUIRED
- <�P
19
111111177
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CURB CUT FOR DRIVEWAY REM
20
1171111111
STREET NAME SIGN REQD
21
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-11-177TTIT711plIll
111117717
OTf1ER SIGNING REM
22
111117-717T77111
7R/7777
SIDE SEWER AVAILABILITY��
23
77TI-11711111111
MaSTING WATER MAIN SiZE
24
WATER METER SIZE
77777-7T/T
7777777777
25
SERVICE LINE srzE
7TIT17
7"777777
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777777TIW
26
///////77
71111117
HYDRAW !MUIRED
27
- . . :'."' N -
HyDRANT SIZE EXISTING
TITTIT
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1117
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7T97777/7
28
117177111
-15.
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MASS CONNECTION INSPECTION REOD
29
7T717711
77 7
MTER METER CHARGE REQD
30
1171
FIRE LINE CHARGE REQJD` - SPRINKLER
31
177/7/7
STREET CUT
32
117111111
/11111111
OPEN DITCH EXISTING
33
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77TI11111
REQD
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34
717171
CULVERT REM,
35
SIZE
36
111711171,
CAICH WIN REM
37
INDICATED ON SITE PLAN
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SHOULDER DRAINAGE MAINTAIN
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SHALE OPEN RUNOFF
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REVIEWED BY:
PLANNING MGR., ENGINEERING MGR. PUBLIVMRKS MGR.
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (08 NAME OF BUSINESS)
��ectj_00&Q.
ILING ADDRESS
:P C)
CITY TELEPHONE NUMBER
-�Yoe 7 7 7 3 6.
NAME �R cy\ —3-C) V�
DRESS
CITY TELEPHONE NUMBER
;7AME
�s C)cQ
ADDRESS
p 6 --a
cITY,:S Yi a- TELEPHONE NUMBER
77Y _7-36el
FATE LICENSE NUMBER
'S e 0
Legal Description of Property - Include all easements
(show below or attach four copies)
I Z_ 6-1 # 7 P/_ a74 �f Sm J Z) oX I
:�t / ra 0
I'VI
n NEW
�KRESIDENTIAL
El PLUMBING
EJADDIALTER
. /E1 COMMERCIAL
MECHANICAL
REPAIR
RETAINING WALL
SIGN
DEMOLISH
REMODEL
EXCAVATE
OR FILL
PRE -MOVE INSPJ
COMPLIANCE INSP.
FENCE
E] I- x _FT)
swim
POOL
WOOD STOVEI [:]
INSERT APT.BLDG
RENEWAL
5 NUMBER OF STORIES NUMBER OF
DWELLING
[UNITS
NATURE OF WORK TO E DONE (ATTACH PLOT PL")
/* aM /_�
V is-(f Ale,,
ZONE
NUMBER
ADDRE:bb t.)
ZA9,072 170/yA_F40_7__14,1_,4
7CGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
1-0.1-7 1 1 A
PUBLIC RIGH�QF WAY PER OFFICIAL STREET MAP,
6,
EXISTING— REQUIRED DEDICATION
PROPOSED 115�
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
STREET USE PERMIT REQUIRED 0
SEE ENGINEERING MEMO DATEDAf
RE�Z_ 6�W 7
METER SIZE IBUILDING SUPPLY SIZE IFIXTURE UNITS
REMARKS
SIGN AREA , ENV. REVIEW
ALLOWED PROPOSED COMPLETE EXEMPT
VARIANCE OR CU PLANNING REVIEW
YARDS HEIGHT LOT
FROff.-O"
InF /4(A R
By
0
Z
cc
Uj
I -
Ace NO.
IORELINE 0
DATY
2
V E7T Z
, Z
Z
CL
SPECIAL INSPECTOR AREA OCCUPANCY JOCCUPANT
REQUIRED GROUP R3 ILOAD
0 YES 0 NO
REMARKS
Apmw rlwul, Re- IM SAk lla'we_
IPLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
ENERGY CODE
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
v) successors in interest, agrees to Indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
m employees, and agents from any and all claims for damages of
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< whatever nature, arising directly or Indirectly from the issuance
of this permit. Issuance of. this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify,.waive or reduce any requirement of any city ordinance
0
x 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
THIS PERMIT
state laws regulating construction; and In doing the work authoriz-
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
tIQ_n.Insur?tLci._
INSPECTION
DEPARTMENT
SIGN:A�TURE ATE SIGNED
W(OWN,�F%OR�AGEN
CITY OF
EDMONDS
VALUATION
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt Is
acknowledged In space provided.
OFFICIAL'S SIGNATURE DATE
a
Z
5
co
RELEASED BY DATE
771-3202
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspoctorl
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Owner GOLD — Assessor.,.,,
4,
102-78
ME140 TO:
FROM:
SUBJECT:
DATE
Building Division
Planning Department
Engineering Division
Publ ic Works Deparbiient
.- . .. . I
9- �c/)o
After revie,..i of thesubject Building Permit aPP1 ication, we have the Following
c omim e n t s
I Conn'ection -to Ci tv wa ter S vs �Pm rpnitirArl
Z. Connect -ion to' Ci ty san i tary. sewer sys tem req(iired.
3. Right-of-way permi t. required for '�'ny' %q'ork on City property.
4. Oriveway slope not to exceed 14
5 . 0 ac k,.,ia ter va lve re qu i red i f dot -ins ta i rs pl umb i n g is below elevation o1c
up�tream m__a_n_h-0T'e
6. -er and sewer lines to be separated by 10 foot minimum.
J
80 6/82
A
YEFAa-- HEJWT '6/�
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1140 + 4 - 9..W'
LAAV kEll-kr 1450S.1
I AaUMH4.4tT ;t;eo' I I P .
LOT
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Adr
Plo-�4 ELK WAY
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-FLCF fl-AQ 11 = 1 11
-1 20-0
ZEAWOOD Dl\/I-:�00
LOT -7 -