22034 99TH PL W.PDF1111.11111111
9773
22034 99TH PL W
2-0
F
lk
w f-
E,x 15 r/lvl
bAiv*e &a47 9? 2- S
14,E161.f--r e4l-es
4 = + q3.zr
13 4- J-(
4
4-
ex 1.5TI,AJ '
Rs,si ci
-L-vT RIL&,+
'7, qc,,O SF.
�6 1
t'l 4
'D
+q5 I
9
+
twt
CVR%s
D,+-rv,, +I o 0
/ 0 p v F k/4 J-f,,P, Mt/Al
e-oKx4,% 7-e- v*v6-1
NING
Ec U V
SEP 2 G Z-7,51
DEVELOPMENT SERVICES C*j*P
CITY OF EI)tPOiyl)s * -'
4,0 2-1 - opt - po 'Poo
2-o 3 q 'T5 r" P t- - K/ -
ko.d kiAlso,,v
STREET FILE
ST APPLICATION
I L E for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No . ..........................................
NEW CONSTRUCTION 0 REPAIRS 0
400-06500
OWNER........... Rt ... RJ-14rren ................................................................... CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ....... ?2034 99th Place W. LEGAL DESCRIPTION: LOT No . .............. ............................... BLOCK No . ............................................
................................................................................................
0
0
NAMEOF ADDITION.. .......................................................................................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................
NOTICE,
'0 w,a r-r a my ... o
N'
shown on the attached
The -information
-led for use by the City 01
map(s) was c0M ' pi
Edmonds/ its Empl-oyees and ConsLiltants.
Th,..e City of-Ecim.onds does, not. warrant the
accuracy of anything set for,th on t. ' hese
m a p ('s"). A n . y person or e.ntlty -requesting a
copy should conduct an.independent
inquiry regarding the info'rm . ation shown* c
t-F� -map(s), including, but not limited to,
-er stub shown, Su(
the location of any sew
sewer stubs may or may- not e.xist and ma�,
t the location shown.
or may not exist a
,�'ty of Edmoin'r-41 S1 nor its
Neitheir the "'I
emp`o-yee-s 0-r off i-ce-rs -sha-H be 1--ja-b-1--e for +h
n' On this map(s), nor for
infor . mation g ve . t' ' Ided based
any one represe.nta ion prov
upon said map(s).
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OV47E3 NAME/NAME OF BUSINE
MfqNG ADDRUS I
�5/0 CEW.14— 5r
-zip I TFVEPHPNE
rellt-W44-11S q902,0 rt;,3 7/2- t 2,7-r
NAME
0/
PERMIT EXPIRES __r_ I �() '
USE
ZONE
PERMIT
ZZ/ 715'
NUMBER
JOB
ADDRESS 2
SUITE/APT#
T" PL W
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Pennit Required 0
Street Use Permit Req'd 0
EXISTING — PROPOSED
Inspection Required 0
SPJe.alk Required C3
REQUIRED DEDICATION—
FT
Underground
wiring required
METER Sl ZE
LINE SIZE
I
NO. OF FIXTURES
I
PRV REQUI:,
.
VD
YES CI NO
ADDRESS REMARKS
I OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP I TELEPHONE
CITY
I I,—,
ZIP I TELEPHONE
ENGINEERING REVIEWED/DATE
FIRE REVIEWED BY DATE
M
W
z
z
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
REO'D
0 YES 0 NO
BOND
POSTED
3
z
z
SEPA REVIEW
XEM
COMPLETE I EYPT
.
EXP
SIGN AREA
0 ED
ALL 7� PROPqSED
IVA
HEIGHT
ALLOWE PROPOSED
1&lcp 120 ,z
ERTY TAX ACCOUNT PARCEL NO.
P .
Xel'x_ 1 00 1 00 4 OP006
C] NEW RESIDENTIAL _PL U �11 MECH
N.---
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
C3 REMODEL APARTMENT SIGN
REPAIR 0 GRADING CyDr FENCE
C:] X FT)
DEMOLISH 0 TANK OTHER
GARAGE C] RETAIENRING WALL
CARPORT ROCK Y RENEWAL
LOT COVE'A E
ALLOWED P )SE,
-%_ e
�6171�, .
REQUIRED SETBACKS (FT.)
FRONI SIDE REAR
I
PROPOSED SETBACKS (FT)
FRONT L/FkSIDE REAR
sy,
PARANG
RE,%D PRhIDED
LOT AREA
9,
PAQIEWE ATE
/0
REMARKS
(TYPE OF USE, BUSINESS OR IN:
3;_1Z
I
CHECKEDBY
ITYPEOFCMON
I
OCCUPAI��T
GROUP
z
5
NUMBER
OF
ST RIES
NUMBER OF
DWELLING
UNITS I
CRITICAL
AREAS
I NUMBER
SPECIAL INSPECTOR 1;�EA�J$r(
REQUIRED C] YES
7—
t%ACDUPANT
DESCRI . SE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG D
. IL1,53111
7644-40AA
:70,0 _norf) -tmAy :�o
'Mir
VALUATION I FEE
PLAN CHECK FEE
ZATSOURCE GLAZING % LOT,SLOPE % BUILDING Ps
. 11 AW A / 1710 P", a 4�� — e!Rn —_
PLAN CHECK NO. . OVESETED DATE � PLUMBING C-.f—/
921Z — 221L U
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
M SEPARATE PERMISSION.
t
/
STATE SURCHARGE
AJRV.�
W PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
.j
LANDSCAP NG
p
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
MC ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
RECEIPY,?,�
Af�A
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
a DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
_j
x 0 NOR LIMIT IN ANYWAYTHE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION.'
RECEIP
411W
F017. 6.0
1
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid. and
IN VIO)O%TION OF THE LABOD. CODE QF THE S.TATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
WORr1P'Sj4PkENSATI#,fSURAy7FE AND RCW 18.27.
-
QF#1ALS
SIGNATURE DATE
SIG# , T E R(
DATE GNED
C7 J'a
(425)
771-0220
Of
1
RELEAS DAtE
ED BY
ATTENTION
EXT 13�33
/)�J<
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
'771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL-��- YELLOW
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
5198 *