21712 84TH AVE W.PDF111111111111
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21712 84TH AVE W
PROJECT REVIEW CHECKLIST
PROJECT NAME: �5 ff-1 - c t�ss
PROJECT ADDRESS:-- r� I + (Z 'N If I Air-, LAJ-
1,60
PLAN CHECK #:
RECEIPT D ATE:
REVIEWFD
BY: (I
at
hifi /Da
PLAN.
WATER
COMMENTS
FIRE -
BLDG.
ISEWER,
STREE
EN]Q
Setbacks/Variance/Setback Adjustment
*.1 ....................
Conditional Use Permit
ADB Requirements
Other Zoning Requirements
:-3
4,
Underground Wiring Required
5
Lot Slope 15%
.6
SEPA Environmental Checklist/Hydraulics Permit
t
Tree Cutting Plan
. . . . . . . . . . . . . . . . .
Plat/Subdivision Requirements
—8
Legal Description Verification
9
10
Quit Claim/Street Dedications
...... --
Easements - Public/Private
............ ....
En
Aineering Storm Drain Review Fee
.12
- 13
Engineering 2.2 Inspection Fee
14--
.. ....... 60
Drainage Plan (On -Site)
Setback - Top of Bank, Stream, Water Courses
Setback Storm Drain
- Line
7
18
Open Ditch - Existhi ig
Culvert Required
Culvert Size
Shoulder Drainage/Shale Open Runoff
.-20
Catch Basin Required
------ . . . . . . . . ..... - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ......... ....... ....
21
29
Driveway Slope & Vehicle Access
Zi
23
Sidewalk Required
_0
Curb & Gutter Required
.
2 4...
. ....
Curb Cut For Driveway Required
Street Paving Required
Right -Of -Way Construction Permit Required
. . . . . . . . . . . . . . . . .
7
..........................
Street Name Sign Required
...........
/V
Other Signing Required
�I.Xzgl
W*W*
30
Bond Required For Public Improvements
FEMA Map Check/Water Table.
31.
Side Sewer Availability'
'Sp;
Calculate Sewer Connection Fee If No LID #
Create Street File
Existing Water Main Size
.............. 41411
Water Meter Size
Service Line Size
..... . . . . . . . . ....
I W-111
. . . . . . . . . .
Iva
Water Meter Charge Required N
H.
ydrant Required
:-:40..,
Hydrant Size Existing 1113-lq
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
41�
Fire Line Charge Required - Sprinkler
- - - - - - - - - - - - - - - - - -
Street Cut
. . . . . . . . . . . . . . . .
-
:,42
43
IMiscellaneous
44
Reviewed By:
FIRE
PLANNING
Pz:-,e,�i /7—
EN61NEIE'AT46 —Pu 8 bic -ALR=K=S=;--,1�
R E C 0 R D OF C 0 N T A C T S
1
21
2
22
3
23
4
24
5
25
6
26
7
27
8
28
RW PERMIT # DATE ISSUED RECEIPT #
9
29
10
30
11
31
12
32
PAID $ RECEIPT # DATE
33
SS PERMIT ISSUED��ff RECEIPT 11/2,29
14-
PAID $ RECEIPT DATE
34
..DATE
15
35
16
36
17
37
METER SIZE PAID`�* DATE RECEIPT #
18
38
19
39
20
40
;06-487-6585 ARCHITECTS NW INC. 323 PO4 SEP 17 198 09:40
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206-467-6585 RRCHITECTS NW INC. 323 P03 SEP 17 '98 09:40
I Eq -.020 14:0 4257717105 NATHAI 4WHSTRUCT 110h PAGE .34
491 P93
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05/12/2020 14:18 4?.577 7105 NATHANCONSTRUCTION PAGE 01
ARCH I TECTS NW INC. 446 P02 MAY ii 'Sa 09:41
P,
CITYCOPY
777-Li 4E MATERIAL
,0VJAlCV-- /,S ROSdo"J.SlAce ACCEPTAB E TIGHWI 1(:
N-12 PIDO
SCh 40'PV
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SD� 35 (ASIM 3034)
Q.-us, NOV
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4K 699
CAL4.,
A
.75
-MM 2 9 1998
PERMIT COUNTFO
A\t*' 4;L*.CW
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AL
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glAt aj,
A Ap NOTED
PROVED
(obA;
ZW'71 Z
R1111111" %w mop M61F *mw
TRIP CHARGE
JOB NO.
GEOSCIENCES INC.
1. C, 14".4
TIME ON SITE
JOB TITLE
Post Office Box 2385
Kirkland, WA 98083
TIME OFF SITE
PAGE
Telephone (425) 827-1084
10: 1-5
OF
#3-L �7 ol - z- a 0007
o
WEATHER
-,—
PERMIT NUMBER
DAILY FIELD REPORT
C))��(_A 5
JOB LOCATION e&-. Aj A
�:) )-7 Y),( 4" 4 vv, Lxs
CLIENT / OWNER
A)AT)IA J
DATE
n yv/q 'a
DAY OF WEE
b'ENERAL CONTRACTOR
GENERAL CONTRACTOR'S SUPT
9N-S�TE?
A
C 9A RL
LX.-f N
GRADING CONTRACTOR
GRADING FOREMAN
ON -SITE?
Y/N
77D
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NEXT SITE VISIT:
COPY TO:
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SIGNAT
A� uj
Ation
juN i V-!9.98
OA
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-A PR yj -BYIKANNING
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41
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7
:T
CITY OF EDMONDS SIDE SEWER PERMIT
�18 9 -1 got 1, PERMIT N2 '8966
Address of Construction: 171A z�� 0
Property Legal Description (Include all easements):
Owner'and/or Contractor:
State License No
Single Family
0 Multi -Family (No..,bf Units—)
El Commercial
11 Public
RE(CEOVED
VIA EDA,40 lDS W-Ay SEP 2 4 E98
"UINK LINE
PUBLIC WORKS DEPI
Building Permit No.
Invasion into City Right -of -Way: fliny No 0 Yes
LK -
RW Construction Permit No..
/r
Cross other Private Property: No El Yes.
Attach legal description and copy of recorcle� easement
I certify that have —read and shall comply with all city requirements Date
as indicated on the back of the Permit Card.
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION.
OFFICE U SE-� ONLT,
FOR INSPECTION CALL "t-r52.N, PUBLIC WORKS DEPT.
PermitFee:_ Issued By
0 Trunk Charge: Datelssued:
Assessment Fee: 4AQ 17
Receipt,No.:
Lid No.:
.Partial Inspection:
Comments
Date —Initial
Reason Rejected: Date —Initial
Final Inspection Approved: "Date ?-1P) I n it i a I
PERMIT MUST BE POSTED ON JOB SITE
White Copy: File Green Copy: Inspector Buff Copy: Applicant Revised'3190
NOTICE:
-No warranty OT -a. u (..-, u i - d t�,:Y.
The information . shown on the attached
map(s) was compiled for use by the City Of
Edmonds, its Employees and Consultants.
Th,e City of �Edm.onds does not ' warrant the
accuracy of anything set for.th on these
rnap(�_). Any person or entity -requesting a
copy should conduct an independent
-ation shown on
inquiry regarding the Inform
I ted to
_ffi-e -m a p (s) , including, but not I'mi
b shown. Such
the lociation of any sewe r stu
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the �ity of Edmonds nor its
h, a I. I b e !--,I a. b-Ife f o r -,I h e
emp-to-yee-s o-r office-rs,s
information given on this map(s), nor for
tation provided based
any one represen
upon . said map(s).
Side Sewer Drawing I
The City of Edmonds EASEMENT NO - -------------------------------------------
REPAIRS F� LID NO - ------------------ - ASMT. NO . .................
NEW CONSTRUCTION Nr
CONTRACTOR.................................................................................... PERMIT NO.
------------ .................... ---------------------------------
OWNER ----------------------------
JOB I ADDRESS -v-c ------ W ------- LEGAL DESCRIPTION: LOT NO . ...................................... BLOC I K NO - ------------------------------------
----- 421-7-14a ------- .. I -------- #4
NAMEOF ADDITION ............ --------------------------------------------------
�l
ul
Iz.
L ELF
IU' ij,!,��,y
VIA.T. . f�FJAI—Hlljf� 7,j,,1,:,y
Approved:
1/78)
W&iu�
...... ............... By ..... ----------------------
DATE.
206-487-6585 HRCHITECTS NW INC.
- , W.001
rT /0 1 ACCEPTA
0 -70
st
4E
w*N,
'N�
y* F:
wn,
A Ni4'/+
01 0 U 4 4�4, +pb
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A
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- Xfew
-_ i(— = -wt'—TFu`c v
PPA.'TJ�j r1e:'jWj To Wr,
Mzwlmc;, m-f f3ult�pg
491 P02 MAY Is 198 11:07
E T14LINE MATERIAL
N-12 At D
Sch 401 p
35 (ASTM D3034)
Z_ul? me mr.
<0�
r"OFF
Pi R.S;C;f ft�
MAY 2 9 1998
PERMIT COUNTER
�lr- ll'4TO P-d"1044
; . r-j A!,IpWrte UWE
oil
APPROVED AS NOTED
206-487-6585 ARCHITECTS NW INC. 491 P03 MAY Is 198 11:08
S7A'1VDARD DRAINAGE DEZENTION SYS7'FIL4
woRKsHEEr--
OWNER
ADDRESS
IMPERVIOUS AAEA
zz
CALC Ay:
MONE:
DATR:
*DESIGIV DA rA
PIPE DIA PIPE LG
- 1k I
UPPER CATCM BASIN
ORIFICE
10
rt Nj,~6 or
L W�6 DR ASCII
mit, CURTWX
141N.
Airier
CONTROL CATCH BASIN
SYSTEM CROSS SBCrION
w
VWXW.MP. 4-6* PALLS = COUAL
Or" CMTMX co Ilk Elk 11 DEEP, 3/40 dikitNto Itack
rqa4 ammtm
"law UN LW a W�4
,RIPAAP . IV w"MAVAII, mccx
RUNOFF SPREADER. !rRENCH
FOOTING DRAINS SHAU NOT BE COMVECZZD TO DETEA71ON SYSTEM
NMS:
1. Call RuSinsednS DIYW= MI-0220) for a tightthms ud detmti= "aft= fn�dajt
bohn bsckSUWS md for fical Inq*cdow.
2. RampmAbift for opmdon md =daftats of dnaw xyxt= = pdvm property Is ft
faVORAMY at do property awner. MasrW accumlaW in die-sWrato pipd, nud be f1uhm
aut sud ranoved tMat tba =CA bad= to i0aw proper apemdan. IU outiat wntmi arifict
APPROVED 11Y
DATE
,A�
JUN i
r-Pm=-,P=P
-T�-W-r fmTlc*4 OF -rt-v 6ar"Wm
Y4, OF TrtF- NmTtiWe.:3
F
N E .4:.:;W 0F'-SF NW4
sn: 4 10 .00 LrE 424.44t +pb
f
P R E Y P N�� I NY
'01
��S .375
4! .1
CF -r+IFl- f� r.-.- ae*km 7-7
1�4 l4enl�
OP -r��fg�lp�y JH L4�gpo�j
40
PLANNING DATA
NAME:. 6L6,5
SITE ADDRESS: 95���—DATE:
ZONING: PLAN CHK#:
PROJECT DESCRIPTION: 4� Sjf�Z
CORNERLOT (Yes/No) FLAG LOT. A) (Yes/No)
SETBACKS:
,Required Setbacks:
Front: �� Left Side: Right Side: �'Rear: /cS
Actual Setbacks: /I A
Front: 6�� Left Side: �7 1Q, ' Right Side: Rear:
Street map checked for additional setback required? (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED /V/ (Y/N)
LOT COVERAGE: 249,5��
Maximum Allowed: ctual:
BUILDING HEIGHT:
Maximum Allowed: a:2�, Actual Height:
Datum Point:#&9 - WO Datum Elevation:
A.D.U. CREATED?: AD
SUBDIVISION:
CRITICAL AREAS #:
SEPA DETERMINATION:
LOT AR
OTHER:
Plan Review
i3/?,�/J@20 13:23
0 a - ,
4257717105 NATHANCONSTRUCTION
CITY OF EDMONDS-,
PAGE 01
4257717ID5:0 2
MY of Ed ds
CRITI
The 0itical Azm ChwMa ceftjoW a
to be Hed out by ony perwa
Developm4mt PaWl App2"doft fx
Edmonds prior to WwUr nbmhW of
?WMjj to tw chy.
The pu*m of the CheckM to to *=W,
dewmins whAfter may potatw cftog
BW b% Pmut on *0 9W�= Vrc
WW=adan Weded to complm em. CIM
b* 9UW &vWIWe tom obumtla= 4
dma aysUbla at City RW (CrWad Arta
MV1. or IOU VWVVyS).
I have Completed the WAched CvWW
bi* of my knowk4a Mu = dw amm
DWAWApOunuz
: 0 1 ma, to, r'_'
...... ....
.CHECIMIST
RECENED
MAR 6 1998
i
PLANNINij DEP"
i this fo=, lo his&W
WPA4 t6 Aiokl* SIP and d9le it, a
the City dfl....!�"'Clty* ''Tu ctty will -review t"
kvdqpmnt ili�'#itl Vilik W M** a d
Ifteslaq to COM
city ogi�" *iWt)r mup al()Z
uf IWI fbrm to LWa City r
aly.
lklW dloWd ftia. in a"g0L tW A;Vli
oil
Q0MPW*
Qf to ft
M Cbe&W *0 us
WM provided
.1** Add=
0
zip Chy
7"wl
V% am ful =
Submit il to the
104klilt mAke a
nuiudon of the
* a dM10praml
' V
, Ath ft siped
ff in faing and
ity desabed =
Mt AAB includo
plan, ""hy
ith this chowdist
M& r*'WWWy
hauW, to *0
ZIP
(DVW)
03/e5/2020 13:23 4257717le5 NATHANCONSTRUCTION PAGE 02
SENf BY: �' ; 3- 5-15 ; 3:02PN;; CITY OF EDMONDS-* 4257717105;8 1
CA PILE NO.
Cddcal Are' "a' Chockffst
-------------- -------
Site Information (soils/topo$raphyA"10&y/Vegetation)
1, Site Addm/ Lmdm ZA —1 1
2. Frop=V Twc A=== .
N=dxr.
3. Apprcxh=te She Shm (acm or sqnare foot)%'
4. U fte site currmtly developed? yap, MO.
If y0s; how is she deveWpedi A 'e:i, 4 .!g 5)4616 &Pqfti� 140&6 0A, 5!j�,g
Des=ibe the sanual site
WP in 4* apply,
mt., ku than &Ust ekvatio�. O=r om Utdry atte.
R01Hnr ftes on Oft samilly im 6M 15% (a Vadul rim! Qf iw,�Llvdr a
hciiz� dhftM of Weak).
HM)r.. gopaprqmtondimai.inmeth=18%AACIIme=30% (a Cal
dw of 10,� 0M Chotimntol diftme of 33 to West).
st"P. pad" of ima*er thart 30% P"s4nt an site (a vertical Ase of 10 fett over
hori=W dUftme 04iee dum 334ad).
Odw (YWU d4cipbs)II
6, Site cmfthu Xmas d ygwwra�md su�dt�g, "i ter, WJ2 Approx Depth- ea/
7. Site cmtahu aress d seasm� stnding wa.4r: kf 0 Appriay-
Wul ft"M96) of *A YW7 I
a. site is in t�,* goodway-10 fioodplsb%�� of a water coux"i
9, Sift conb&s a Creek or an � Where Watu Akwo A*=$ ft Pounds "Xiace?
U" Rpm U4
you-mund? was 4U,WWf W (�ftt tit" d YQ4 2r A
IM She ie prjzna�r famted zwadow 9=bs
urban landoc"d
21. Obviou wodwd b pre"Ut
sift'.
fta-chk.dK Rav W03/97
USE
CITY OF EDMONDS ZONE _. < PERMIT
CONSTRUCTION PERMIT APPLICATION NUMBER 98N36
jub
OWNER NAM.E/NAME OF BUSINESS ADDRESS tj UITE/APT #
SUB)IVISION NO
LEGAL DESCRIPTION UHt:(;K LID
Z MAILING A60RESS
? PUBI
LIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved
CITY' ZIP TELEP Ir
�HONt:NUM ER RW Permit Requiredyk-.3 43-
-2 - 7-7 EXISTING REOUIRED DEDICATION Street Use Permit Re�% 0
NAME ROPOSED Inspection Required _e_
Sidewalk Required 0 cc
\C\MF_TE SI W
3 _LlNf Slij NO. OF FI
ADDRESS
REMAAKS
< CIT�� cc
ZIP, ITELEPHONE NUMBER A/1. Al 11 VC-C 7-7�IVC ui
e) W
14 R9_ 1 j5W0.5 I V A..l C.;w �L_
V-\ C"Ll n'k'a 7,nc
a: ADDRESS
0
I`_ ENGINE RIN,9 MEMO DATED
TREV E�
BY
ZIP- -I TELEPHPAE NUMBER 7
0 P�-21J FIRE MEMO DATED 'REVIEWED BY
Z
0 MW L4 W
STATE LICENSE NUMBER EXPIRATION DATE cc
N\)PrV4� qpu)l VARIANCE OR CU ADB# SHORELINE a
Le§61 DdscHl5tion of Prop6rty - include all easements
SERA REVIEW
SIGN AREA "HEIGHT
o —n,,� COMPLETE I EXEMPT ALLOWED I PROPOSED ALLOWED PROPOSED
EXP
L4
Lu ...... LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
Z
u.' Property Z
Tax Accou It L0)rAFIEA NING REVIE
Parcel No.
EMARKS- EP1w
RESIDENTIAL PLUMBING(MECH
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL APT. BLDG. SIGN
GRADING FENCE HECKED BY TYPE OF CONSTFJIUCTION COD�j
OCCUPANT
REPAIR CYDS. X_ FT)
DEMOLISH WOODSTOVE SWIM POOL
INSERT PECIAL INSPECTOR
HOT TLIB/SPA EQUIRED
[;:51 GARAGE RETAINING WALL/ YES LOAD
J,
L_ ROCKERY RENEWAL
Z 'IN C
(TYPE OF USE, BUSINESS OR ACTLVIV) E�ft PROGRESS INSPECTIONS PER UBC 108
Zz�iIL
N NUMBER OF I CRITICAL
UMBER .
uj j
0 OF DWELLING AR ik_eak-j-, A&a.
00 STORIE UNITS EAS
0 1 1 1 NUMBER
DESCRIBE WORK TO BE DONE IATTACH PLOT PLAN)
FINAL 114SPECT104 REQUIRED
VALUATION
FEE
PLAN CHECK FEE
__Z1 L
HEAT SOURCE:
GLAZING
BUILDING
-7
%
19.1 �41
PLUMBING
Plan Check No. gg
0
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGWILL
Any construction on the public domain (curbs, sidewpiks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
_50
w
successors in interest, agrees to indemnity, defend and hold
'Wn
harmless the City of Edmonds, Washington, its officials,
X.
employees, and agents from any and all claims for damages of
a:
<
whatever nature,.arising directly or indirectly from the Issuance
;tz
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
01
nor limit in any way the City's ability to enforce any ordinance
provision."
TOTAL4MOUNT 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
state laws regulating construction; and in doing the work authoriz-
THIS PERMIT
AUTHORIZES
This application is not a permit until
ed 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
tion Insurance aria RCW 18.27.
INSPECTION
acknowledged in space provided.
SIGNATURE (OWNER OR AGENT) SIGNED
DEPARTMENT
JDATE
CITY OF
OFFI 1GNA JDATE I
EDMONDS
/
0/'Y 7?
ATTENTION
CALL FOR
RrLEA6E."B
-I
R1
INSPECTION
.114
4.2
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
OAIG`1NAL — File YELLOW
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
— inspector
SECTION 109
111112.A7
a < , n-
PINK — Owner GOLD — A%-;P_q-,nr
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
ADDRESS
CITY ZIP ITELEPHONE NUMBER
NAME
USE
ZONE
ADDRESS
PERMIT
NUMBER (50170
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — REOUIRED DEDICATION
PROPOSED —
METER SIZE I LINE SIZE I NO. OF FIX—TURES
TED
-I —x—x -% 47-- 1 —J-2 Is:&& VARIANCE OR CU
-'inbILTWall easerne-nTs'
SEPA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERAGE
ALLOWED I PROPOSED
W Property
Tax Account
Parcel No.
I[]
1:1
NEW
RE'SiDENTIAL
PLUMBINGMECH
COMPLIANCE OR
ADDITION
COMMERCIAL
CHANGE OF USE
APT. BLDG.
REMODEL
SIGN
GRADING
FENCE
REPAIR
- CYDS.
I x_ FT)
DEMOLISH
WOODSTOVE
INSERT
SWIM POOL
HOT TUB/SPA
GARAGE
RETAINING WALL/
j CARPORT
ROCKERY
RENEWAL
0 -
;-F(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
NUMBER NUMBtR OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PC67 PLAN)
ECKED BY
SUITE/APT #
TESCP Approved
0
RW Permit Required
0
Street Use Permit Req*d
11
Inspection Required
0
Sidewalk Required
0
PRV REOUIRED
YES 0 NO 11
BY
ADB # SHORELINE
SIGN AREA HEIGHT
ALLOWED IPROPOSED I ALLOWED IPROPOSED
1EQUIRED SETBACKS (FT.) 'PROPOSED SETBACKS (F1
FRONT SIDE REAR FRONT UR SIDE REAP
PLANNING
SPECIAL INSPECTOR AREC-
REQUIRED YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108
FINAL INSPECTION REQUIRED
DATE
OCCUPAK
GROUP J
Pf _1_1
OCCUPANT
LOAD
PLAN CHECK FEE
BUILDING
M
HEAT SOURCE:
1777
%
-622
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewolks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
1,
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officiail s''
employees, and agents from any and 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
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordInApce
nor limit in any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
I
1/111!�,
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or thje duly
' or I he d u 'y
ATTENTION
APPLICATION APPROVAL
it h
authorized agent of the owner. I agree to comply with city and
C I t' and
state laws regulating construction; and in doing the work authoriz-
r u
ka th 0 r.z.
THIS PERMIT
AUTHORIZES
This application is not a permit until
ed thereby, no person will be employed in violation of the Labor
)f I he Labo r
ONLY THE
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa-
]
WORK NOTED
D��uty'; and fees are paid, and receipt is
tion Insurance aria RCW 18.27.
INSPECTION
acknow,ledged in pace provided.
f
NATURE (OWNER OR AGENT) ATE SIGNE—D
DEPARTMENT
I I.
CITY OF
OFFIqAL-S, IGNATURE DATE
L
EDMONDS
ATTENTION
CALL FOR
RELE4 I S—E 0 B Y:
INSPECTION
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OF,
771-0220
ORIGINAL — File YELLOW — inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. U BC
SECTION 109
PINK — Owner GOLD — Assessor
10247