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21020 PIONEER
WAY
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TAX ACCOUNTIPARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE): mb -6e5�
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: [] Conditional Waiver n Study Required 0 Waiver
DISCRETIONARY PERMIT #'.S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE LID #:
SHORT PLAT FILE: —S1 a WOO& F— /
0-65LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L\TEMP\DS'Ps\Fon-ns\Street File Checklist.doc
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CITY OF EDMONDS
GONStRUCTION' PERMIT APPLICATION
USE 'qWPERMIT
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ADDRESS
7- 0 PIONfi-9 WAY
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PUBLIC R�G�HTPEURJ OFFICIAL STREET MAP.
EXISTING REO RED DEDICATION
PROPOSED
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TELEPHONE NUMBER
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NAME
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
STREET USE PERMIT REQUIRED 0
ADDRESS
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TELEPHONE NUMBER
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NAME
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METER SIZE
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TELEPHO?NUMBER
REMARKS
STATE LICENSE NUMBER
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SIGN AREA
ENV. REVIEW
ADB NO.
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PROPOSED
COMPLETE EXEMPT
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Legal Description of Property - Include all easements
(show below or attach four copies)
SHORELINE
Plat of SezzL,)oof�
VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS
FRONT SIDE REAR
HEIGHT
LOT COVERAGE
REMARKS
NE RESIDENTIAL PLUMBING
W
ADDIALTER COMMERCIAL MECHANICAL
REPAIR RETAINING WALL SIGN
CHECKED BY
TYPE OF CONS RUCTION
CODE
HEIGHT
EXCAVATE FENCE
DEMOUSH OR FILL x —FT)
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0
PRE -MOVE INSPJ swim
REMQDEL COMPUANCE INSP. POOL
0
SPECIAL INSPECTOR
REQUIRED
0 YES 0 NO
AREA
OCCUPANCY
GROUP
OCCUPANT
LOAD
WOOD STOVE/ r-�
INSERT APT. BLDG RENEWAL
REMARKS
NUMBER OF STORIES
NUM B�ER OF
WL
[D E LING
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'UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
ZS/ n res;sent
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VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Perm * It 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
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
ENERGY CODE
'spouse,
Applicant, on behalf Of his or her heirs, assigns andt
02
15
successors In interest, agrees to Indemnify, defend and hold
harmless the City of Edmonds, Washington, Its officials,
em,ployees, and agents from any and all claims for dama
__ges of
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For Inspection Call 771-3202
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Address of Construction:
Property Legal Description (Include all.easements):
tAJ o a c�
Owner and/or Builder: '5e LO e-
t 6o
Contractor & License No: 5e_'ALJ6A; IT?' Co
Single Family Residence,
Multi -Family (No. of Units
Commercial (No. of fixture Units
SEWER PERMIT
PERMIT NO*. 07973
EDM NDS
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lu/ FRF-A E104T PLANT]
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required.- Call all -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 TH BACK
Lit, 1(ye' Z��z
I ceftify *that ve read andl shall comply Date
with the items listed on the back.
Permit Fee: &. 00
T runk Charge: _25-00
Assessment Fee:
Issued By -
Date Issued: 912,4196
Receipt No.:
Partial Inspection:
Comments.. Date Initial
Final Inspection Approved:
- Date Inilial
Rejected:
Reason 7Ta t _e —Tn i —ti a I
** PERMIT MUST -BE POSTED ON JOB SITE **
Wh.ite Copy - File Green Copy �- Inspector
Buff Copy - Applicant
The City of Edmonds Side Sewer Drawing
EASEMENT NO - ----------------------------
NEW CONSTRUCTION REPAIRS Ej LID NO. -1-60-1 --------- - ASMT. NO. - ----------------
OWNER
-------------- CONTRACTOR
0j .... . ......... ........ t4a�j ------------------- PERMIT NO. 7,573 -----
JOB ADDRESS -2.1-0-21-0 --------- -k-f ---- LEGAL DESCRIPTION: LOT NO - ----- 1 -------------------------- --- BLOCK NO.
- ---------- EDMCFt4DS---'
------------- ---------------------------- ---------------------------------- TREATMENT PLANT
------ --------
NAME OF ADDITION
--------------------------------------------
07,6P
Ob"WDE
PROPaul
C-00."CR
PWW4)Wl -11/75 (REV. 11/78)
06� CO-5 OP.
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Approved:
DAIIP.&.16 1186 -----------
.. � 1 041:1 6 --------- - ----- - ---
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CITY OF EDMONDS
E/NEW
ADDITION
RETIREMENT
ASSET INFORMATION SHEET
STREET FILE
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION
DE7,2V
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
INITIATED BY
DATE
9
*PROJECT NUMBER /,;?-/
3
PROJECT COMPLETION
COST -2, 0
APPROVED BY
**SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
2/'DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
ttnp INITIAL
VERIFIED BY
PROCESSED
BATCH NO.
DATE
DEPARTMENT FILE
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