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21427 92ND AVE W
CITY OF EDMONDS
B/NEW
El ADDITION
1:1 RETIREMENT
ASSET INFORMATION SHEET
RE
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION I/ Z, 1
SERIAL NO.
LOCATION
DEPTAO.
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
PROJECT NUMBER
PROJECT COMPLETION DATE
COST /litV
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
19//D'EPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE DATE
ktnp INITIAL
DEPARTMENT FILE
VERIFIED BY
PROCESSED
BATCH NO.-
co
CD
-0
W
CITY of E DIVI ON DS
For Inspection Call 771-3202
Address of Construction:
S I D E S E W E R
PERMIT N
0? 1 Ll ') IUK1010-1* A u �,- W.
roperty Legal Description (Include all easements):
Ow ner an d/or Builder: OJ60coc 9, A f: I Ho WtE'57
Contractor & License No:
single Family Residence
Multi -Family (No. of Units
P E R M - I T
10 7 00 �08
EDMONDS
TREATMENT, PLANT
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
_N'
1�1?0
I cePtify th'at-I havq,'tead and shall comply Date
with the items listeVon the back.
2V 11
Permit Fee:
Trunk Charge:
Assessment Fee:
Partial Inspection:
Final Inspection Approved k! -
'4'
Date
Rejected:
I
s-On,
it 1"T",
Issued By: 2:6z -
Date Issued: 112-01;T -7-
Receipt No.; 3�
10,
Initial
** PERM'I',Te,-*MUST BE POSTED ON JOB SITE-**
Date Initial
Date —!—nitial
White Copy - File Copy - Inspector
Buff Copy - Applicant 4
NOTICE:
n t. y .-6r( .. .1.. ..
Nowa r.r a ... cyrra—c--c-crrl.
The -information shown on the attached
Hed for use by the City of
map(s) was com - p
Edmonds, its Employees and Consultants.
Th,,.e City ofEdm.onds does. not. warrant the
accuracy of anything set for.th on these
M a p ('s"). A n . y person or entity'requesting a
copy should conduct an independent
i orm'ation shown- or
Inquiry regarding the 'nf'
_tRe -m a p (s) . including, but not limited to,
c ion of any sewer stub shown. Sud
the lo' at'
sewer stubs may or may* not e.xist and may
or may not exist at the location shown.
Neltheir the C t y o f E cd, m o"n d.As nor its
Mpl-o-yee-s o-r off i*ce*rs -shal-1 be l--'-,a-b4-e for the
n on this map(5), nor for
information g ve
e representation provided based
any on
upon . said map(s),
The City of Edmonds . Side Sewer Drawing EASEMENT NO . ...... ------------------------------------- I.,
NEW CONSTRUCTION lK REPAIRS LID NO . .................. ASMT. NO - ------------------
OWNER ....... V-4.Qjne-tP ------ ------------------------------ CONTRACTOR ---- Lu7r:;:� ..... 16-Pvc,-KNAogt .............................. PERMIT NO-76.3-0---
JOB ADDRESS -ZAI-r7 ------ ------- N-0--AIIE-W—f ---- LEGAL DESCRIPTION: LOT NO - ------- 2 --------------------------- . BLOCK NO. EDMONDS
l'TRE-ATM'ENT-'PLANT
.................................................................... ................ ................ -----------------------------------------------------------
NAME OF ADDITION ........ ....... LA, (: - -------------------------------------------------
PWW-0001-1 1/75 (REVA 1178)
21 0 ty C4
"** Nacz-r I,-*- aum--
T>R
Approved:
"7
'4- -5� - - - ----------------------
DATE"..%.�.08.7.--- . By !;V:-.
PrIaMr REVIEW 09XMaST
TO`
vi" JAM PROJECT ADDRESS-
X, WZY, T rA'PTnN RFI!RTPql MTF L"T, ),T/
1<4
Reviewed by: (initial/date)
I sTRF.rT
ENGKMNG
COKqEN7`S
PLANNING
wmlsw
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BUILDING
7777777
IRII17T
FIRE
'114ME,)PAMILY/MMTIPLE/CDt�OCTAL - (Circle One)
Planfirng
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1111117
_MITIONAL USE PERMIT
2
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CHECKED
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717117111
71111111
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-TER ZONING REQUIREMM
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,4VIRONMENTAL FEMURES
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111717177
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rIEWED BY:
PLANNING MGR. ENGINMRING W.R.
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PUBLTC WORK MPGR.�
ERWAM"
USE PERMIT
CITY OF EDMONDS
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
AME (0 OF BUSINESS)
JOB
AVUHtZ1Z1
�2u-h -7
WOODCRAFT HOMES, INC
j
S
LEGAL DESCRIPTION CHECK UBDIVISION NO. LID NO,
Z
MAILING ADDRESS
(A7-
303 — 3RD AVENUE NORTH #1
CITY TELEPHONE NUMBER
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EDMONDS 775-4801
EXISTING R QUIRED DEDICATION
t_
NAME
PROPOSE�A_?515_
L_
- RON JOHNSON
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
ADDRESS
STREET USE PERMIT REQUIRED El
19601 23RD NW
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CITY TELEPHONE NUMBER
SEE ENGINEEFYNG MEMO DATED
SEATTLE 546-2288
NAME
REMARKS
WOODCRAFT HOMES, INC
cr
ADDRESS
303 — 3RD AVENUE NORTH #1
METER SIZE BUILDING SUPPLY SIZE URE UNITS
CITY TELEPHONE NUMBER
7
1Z
EDMONDS 775-4801
REMARKS
STATE LICENSE NUMBER
WOODCHI186QA
SIGN AREA ENV. REVIEW Ace NO.
Legal Description of Property - Include all easements
ALLOWED PROPOSED COMPLETE EXEMPT
(show below or attach four copies)
SHORELINE#
12
:'s
VARIANCE OR CU PLANNING REVIEW BY DATV
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YARO� HEIG�T ILOT COVEVGEV
/A
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FRON SZEI I I 2!� —qr 7.1
RE A R KS
REMARKS
MV
L�J F1
NEw RESIDENTIAL PLUMBING
1-4
__1 ED
ADD/ALTER COMMERCIAL
MECHANICAL
REPAIR Fil RETAINING WALL SIGN
EXCAVATE FENCE
CHECKED BY TYPE OF CON LICTION CODE HEIG T
DEMOUSH OR FILL FT)
X_
PRE -MOVE INSP./ swim
REMODEL COMPLIANCE
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
INSP. POOL
OUR C
REQUIRED GROUP f7 LOAD
I I
WOOOSST OVEI
0 YES 0 NO
IN ERT APT.BLDG F] RENEWAL
R S
REMARKS
JI
5 NUMBER OF STORIES NUMBER OF
DWELLING
2 [UNITS I
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
NEW CONSTRUCTION
PLAN CHECK FEE
BUILDING
PLUMBING
Permit covers work to be done on private property ONLY.
MECHANICAL
GRADINGIFILL
,HThIs
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Il
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENERGY CODE
successors in interest, agrees to indemnify, defend and hold
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harmless the City of Edmonds, Washington, its officials,
2
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
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
r 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
Code of the State of Washington relating to Workmen's Compensa-
ONLY THE
WORK NOTED
U12RInsui
SIGNATURE OWNER OR �PENT), DATE SIGNED
INSPECTION
DEPARTMENT
fly) I
T1_/_d_C1?_9_C
CITY OF
EDMONDS
771-3202
UNLAWFUL
TO USE OR OCCUPY A BUILDING OR STRUCTURE
INTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
:1APTER 3.
�2-78
I
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and recelpt is
acknowledged in space provided.
OFFICIAL's SIGNATURE DATE
RELEASED BY:
DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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MEMO,-TIO: Building Division
FROM: Engineering Division
SUBJEM - -aNL7 Mo _" 6<.)
After review of the subject building permit application, we have the
following camients:
1) Connection to City water system required.
2) Connection to City sanitary sewer system required.
3) Right-of-way permit required for any work on City property.
4) Driveway slope not to exceed 14%.
5) Back water valve required if downstairs plumbing is below
elevation of upstream manhole.
6) Water and sewer lines to be separated by 10 foot minimum.
7) Builder/owner responsible for containing all temporary runoff and
erosion on site and may not impact neighboring properties in any
way.
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