21224 95TH AVE W (2).PDFiiiiiiii ' lill
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21224 95TH AVE W
USE PERMIT
CITY OF EDMONDS 111E NUMBER 9,10
CONSTRUCTION PERMIT APPLICATION JOB
OWNER NAME /NAME OF BUSINEP,, . "9 "/..0 ADDRESS .21,72-V, d�!S� 1W
LEGAL DESCRIPTION CHECK SUBDIVISION NO, LID NO
lt�4AODFIE.
,nL I -) (-'� A 1A J
P PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
U BL
TESCP Approved 0
CITY
ZIP TELE PHONENUMBER
RW Permit Required 0
-7
EXISTING — REOUIRED .�.ICATION
Street Use Permit Req'd 0
NAME
PROPOSED
Inspection Required 0
Sidewalk Required 0
J�ZICITY
R EMARKS
u,
ADDRESS
0
ZIP ITELEPHONE NUJ..EFI
XP &,//0
(c
0
NAP
,q (Z
ENGINEERING MEMY�EP I JW BY
A ESS
P,
I - -7
10-60k )-t
METER SIZE
BUILDING SUPPLY SIZE
NO. OF FIXTURES
0
Z
Z
C Y ZIP
J-6
TELEPHONE NUMBER
0
REMARKS
SnTE LICENSE NUMBER k"11 t---
4 - 91- 6: c- -e ?
SIGN AREA
ALLOWED PROPOSE
SEPA REVIEW
COMPLETE XEMPT
EXP
�O,
SHORELINE#
Q
<1
Legal Description of Property - include all easements
N0(,-+t, r
VARIANCE OR CU
PLANNING REVIEW BY
p-- rj
K 7 19ZC1e1LL-,0'qa
Tax Account Parcel No.
SETBACKS - FEET
c--� +/-I- R E A R
EIGTT LOT
COVEOGE/
:6
REMAHKb
�( 7-0
NEW RESIDENTIAL PLUMBING
ADDIALTER 11 COMMERCIAL MECHANICAL
a-,- 0 71:1 6,
0 REPAIR E] APT. BLDG. El SIGN
11 DEM LISH D GRADING CYOS ( FENCE x —FT)
f—i CARPORT swim
El REMODEL GARAGE
E000 STOVEI F7 RETAINING WALL/ POOL
] INSERT 11 ROCKERY RENEWAL.
CHECKED BY
TYPE OF CONSTRUCTION
I -'=
CODE
019
HEIGHT
SPECIAL INSPECTOR
REOUIRED C3 YES I
OCCUPANCY
AREA GROUP
.
R3
OCCUPANT
LOAD
REMARKS
Z
0
PROGRESS INSPECTIONS PER UBC 305
(TYPE OF.WSE, JIUSINES S OR ACTIVITY) EXPLAIN:
044 IM6 WIf 44W,4y eW
NUMBER OF STORIES NUMBER OF
DWELL NG
UNITS
DESCRIBE WORK TO BE DONE (ATTAC PLOT PLAN)
"3
- /
FINAL INSPECTION REQUIRED
;�yp 2 2-
VALUATION
FEE
PLAN CHECK FEE
2-53
BUILDING
36?
16b �ICt47-
PLUMBING
3)
Plan Check No.
MECHANICAL .
This Perm it covers work to be done on private property ONLY.
Any construction on the public domain (curL,8, sidewpiks,
driveways, marquees, etc.) will require separate permission.
GRADINGIFILL
STATE SURCHARGE
so
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within . 180 Days
STORM DRAINAGE FEE
X6
"Applicant, on behalf of his or her spouse heirs, assigns and
successors in interest, agrees to inclemnif�, defend and hold
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damage of
whatever nature, arising directly Or indirectly from the issu'.Snce
Of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
ENG. INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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 APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT
:tate laws regulating construction; and In doing the Work authoriz- AUTHORIZES This application is not a permit until
d 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
fiojn nsurance. INSPECTION acknowledged in space provided.
SIGN Up - E AG T) DATE SIGNED 0 EPARTMENT
CITY OF :��WTUAE DATE
EDMONDS �-C?& -9/
ATTENTIO CALL FOR RELEAS# DATE
N INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUIL61NG OR STRUCTURE
UNTIL A F:NAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-3202 (5RIGINAL - File YELLOW - Inspector
A CERTIF CATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
10247 PINK - Owner GOLD - Assessor 'r
I
FILE
APPLICATION
for
The City of Edmonds SIDE SEWER PER3HT
NEW CONSTRUCTION E] REPAIRS 0 EASEMENT No . ..........................................
111-07200
OWNER.......... Pater ... C.-Ilatl.iPaw ...................................................... CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ...... 2.1224.-!n ... 9.5t[i ... A.m.-!] . ............................................... LEGAL DESCRIPTION: LOT No . .............................................. BIJOCK No . ............................................
40
NAME OF ADDITION..
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................
ri A y — 7 — S. I
-r Ll E: I :F; = Z —. D'PeRIaS Co"s-r-
I " Cl
R - 0 1
STREET
FILE
CITY
COPY
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APPROVED BY PLANNING
i
NOTIC�.
d.. (-A., U1O�__-Y----
N--.��w`a -r.r a n Ocy...
The Inform ation'shown on the attached
piled for use by the City 01
map(s) was com '
Edmonds/ its Empl-oyees and Consultants.
The City ofEdrn.onds does. not . warrant the
on these
accu acy of anything set for.th
Map(s). An . y person or entity -requesting a
copy should conduct an independent
inquiry regarding th*e 1nfO*rm_at1 - onshown,c
-t Fi-�� -m a p (s), including, but not Jimited to/
n of any sewer stub shown. SU(
the lociatio
sewer stubs may or may' not exist and rna�,
t the location shown.
or may not exist a
Neitheir the r"ity of Edmoncj S1 nor its
e M pj O*y O,r o ff i -c e -r s -s h- a I I b e a. balf-e f o r
information given on this map(5), nor for
d
entation provided base
anyone repres
Upon'said map(s).