22043 99TH PL W.PDF9776
22043- 99TH PL W
a
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STREET FILE
Critical Areas Checklist"
Site Information
Pro . ect Name: &Ar Permit Number
U
Site Location:,;�AOI�3 Property Tax Account Number.
Approximate Site Size (acres or square feet): F3 0-r-
Have you filled out a Critical Areas Checklist for a project on this site before? — No
General. Site Conditions
1. Has the site been cleared or logged? L4r,7 Date of most recent action:
Soils / Topography �/_ 4- k W -, W� (�
2. In the Snohomish County Soil Survey, what is the mapped soil qpe(s)? 2 e_'c"w,,,5�4`5A
9-94dt . -
3. Describe the general site topography. Check all that apply.
Flat: less than 5 feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10 feet over a
horizontal distance of 66 feet.)
11illy: slopes present on site of more than 15% and less dm 300/,o a vertical rise
of 10 feet of horizontal distance-)
Steep: grades of greater than 30% present on site.
Comments &_;5-
Hydrology/Vegetation.
4. Site contains areas of year-round standing water: do
5. Site contains areas of seasonal standing water IV6 —Approx. Depth:
6. Site is in the floodway Toodplain of a water course.
*4
City of Edmonds
Critical Areas Checklist
'ac Critical Amu Checklist contained on
this form is to be filled out b any person
y
preparing a Development permit
Application for the City Of Edmonds prior
to his&cr submittal of 'a development permit
to the City.
'Me Purpose'of the Checklist is to enable
City staff to determine whether any potential
Critical Areas are or may be present on the
subject PrOPCItY. IhO information needed to
complete the Checklist should be easily
a 'lable fi-om observitions of the site or
vw
data available at City Hall (Critical Areas
inventories, maps, or soil surveys).
T3
V
MAY 1 1 1993
PERMIT COUNTER
An applicant� or his/her representative, must
fill out the chccldis;, sign and &to it, and
submit it to the City.'Me, City will review
the checklist, make a precursory site visit.
and make,a determination of the subsequent
steps necessary to complete a development
Permit application.
With a signed copy of this form, the
VPlicant Should also submit a vicinity map
of the parcel with enou.
,gh detail that City
staff can find and identify the subject
Parcel(s). ]In addition, the applicant is
encouraged to include any other pertinent
information or sttidies in conjunction -with
this Checklist to assist staff in completing
their preliminary assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers providedare
factual,. to the best o my knowledge (fill out the appropriate column below).
Owner / Applicant -
Applicant Representative:
Narn
2 M_ e_e 0
Title -
Street Address
. le-1
City. State, Zip.
1�7 Phone
ture Date
X'/xr 1AIL
Name S7�e-41 fl /Oly 'E'
7 /
Title
Street Address
29-74-Alz �-fz S 75— 4474
City, State, ZIP Phone
Si ture
Date
STREET FILE
CRY of Edmonds
Critical Areas Checklist
'ne Critical '4zeas Checklist co, ntained on
this form is to be filled out by any p=on
preparing a Development permit
Application for the City of Edmonds prior
to hisfticr submittal of 'a development permit
to the City�
Ile purpose'of the Checklist is to enable
City staff to determine whether any potential
Critical Areas arc or may be present on the
subject property. The information needed to
COMPICte the Cheddist should be easily
available from observations of the site or
data available at City Hall (Critical Areas
inventories, maps, or soil surveys) -
MAY 1 1 1993
PERMIT COUNTER
An applicant, or his/her representative, must
fill Out the C11061dist, sign and date it, and
submit it to the City- The City will review
the checidist, make a Precursory site visk
and make -a detennination. of the subsequent
steps necessary to complete a development
Permit application.
With a signed copy of this form� the
applicant Should also submit a vicinity map
of the parccl with enough detail. dw City
staff can find and identify the sabiect
Parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information or sttidics in conjunction with
this Checklist to assist staff in completing
their preliminary assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers providedare
factual, . /I to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant -
Applicant Representative:
Nam
Title
Street Address
z��dQW4 A!�� le�5�-Z-zv
4Cifttate,
y, S'S� ZIP Phone
Si
St ture
Date
�I
// �V/zz
Name 5�,44-41
'�
Title
Street Address
29—ly271-11Z 4 1 �-'fl 5 �5 3 7
City, State, ZIP
Phone
Sim ture
Date
hecklist
Critical Areas C
Site Information
Project Name: AW1,r Permit Number
Site Location:,;�;� 0,/-3 gq) ftoj U) Property Tax Account Number
Approximate Site Size (acresor square feet):
Have you filled out a Critical Areas Checklist for a project on this site before? Alo
General Site Conditions
1. Has the site been cleare d or logged? 64�17 Date of most recent action:
Soils / Topography
2- In the Snohomish County Soil Survey. what is the mapped soil type(s)? �rd
3. Describe the general site t0P0gr3PhY- Check all that apply -
Flat: less than 5 feet elevation change over entire site.
>< Rolling: slopes on site generally less than 15% (a vertical rise of 10 feet over a
horizontal distance of .66 feet.)
JEfilly.- slopes present on site of more than 15% and less than 30'0/p ( a vertical rise
of 10 feet of horizontal distance.)
Steev: g . rades of greaW than 30% present on site.
Comments
Hydrology/Vegetation.
4. Site contains area's of year-round standing water: 1\16
5. Site contains areas of seasonal standing water. 1�16 _Approx. Depth:
6. Site is in the floodway floodplain,__,d�of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? flows -
are year-round? Flows are seasonal?
8. Site is primarily: forested go - meadow 6L shrubs mixed
9. Obvious wetland is present on site: No
10. Wetland inventory or map indicates wetland present on site:
11. Critical Areas inventory or map indicates any Critical Area on site: 14410
T-6e--Gty-.Use Only
6? 9 0 . 1 9 9 -
City of Edmonds
RIGHT-OF-WAY CONSTRUCTJO V a go
FILE PERMIT Uyufllliaerizi 079,
lssueDate: L') 7-
. 1 41
A. Address or Vicinity of Construction: .22043 99 Pl. W.
Type of Work (be specitic): Repair Gas Leak (1,9300679 003)
00
C..Contractor: Washington Natural Gas Co.
MailingAddress: 815 Mercer St.Seattle, Wn.
98TIT-
State License #:
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224�2278
Liability Insurance: _ Bond:$
Side Sewer Permit # (if applicable):
F� Commercial El Subdivision 01
E. [] City Pr'ect X50[jJtility (PUD, GTE, WNG, CABLE, WATER)
F] Multi -Family E] Single Family F� Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut Yes Mqio G. Size of Cut: x H. Charge$
APPLICANT TO READ A,ND,SIGN
,I:Z;l
INDEMNITY: Applicant understands and by his signature to this application, agre s ho the City of Edmonds hat -nil S Lof 4jude� )mages or
17 .
&I the City of Edmonds, or any o its depanmen or enip,
claims of any kind or description whatsoever, foreseen or unforeen, that may be in ( yo u Iloy-
ees, including or not limited to the defense of any legal proceedings including defense costs, and attomeyfees by reason of granting this perinit.
7HE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP A ArD MA TERIALS FOR A PERIOD �F ONE YEAR FOLLOWING THE FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MA TED RESTORA 77ON FEES WILL BE 119LDUN7k THE FINAL STREET PA TCU IS COMPLETED BY
CITY FORCES, AT WHICH 77ME A DEBITOR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Departm
Work is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes. 771-0220
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signature:
Date: April 13, 1993
(Contractor or Agent)
CALL DIAIA-DIG PRIOR TO BEGINNING WORK
.COMMENTS, RECE1PT..NO.;.,.:
......... . . .......
... ... ......... ......... - ....... I ..... . ... ...
...DATE: � ISSUED BY:,_4
BEGIN PRIOR TO PERMIT
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
APPLICATION
FIV for
The City of Edmonds SIDE SEWER PERN[IT
iso EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS
400-05800
owNm............ J..o.c-k ... Keith ... P-ractor ..................................................
22043 99th Place W.
ADDRESS..................................... - ............................. .....................................
E
CONTRACTOR.................................................................................................. PERMIT No . ......................
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAMEOF ADDITION .........................................................................................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................
4951
04 04 04 ,4 �f -4 A
Peck
133
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AWE
WOr-Fle A44FIr.-I,
ie)7 ldy
RECEIVED
J U N 1 7 1993
PERMIT COUNTER
C - ityo'f Edmonds
CONSTRUCTION
PERMI'T PermitNumber:
y
Issue Date:
A. Address or Vicinity of Construction: 41-
B. Type of Work (be specific): ��-Vc.
890 -19"
C. -Contractor: (a -!:I," a+(.,, y (I C-)n 5 Cc,. Contact: &A
Mailing Address:. ESIE�, -nqv v cc, r- ZSco— Phone: 7- 2- 4- - -Z--2- -7 9�
State License #: Lo ek -S V� 'R k t Liabili ty Insurance: Bond- $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. 'n Commercial El Subdivision F1 City Project [g Utility (PUD, GTE, WNG, CABLE, WATER)
Multi-Farnily El Single Family Other
INSPECTOR: INSPECTOR: W41
F. Pavement or Concrete Cut : &Y� 0No G. Size of Cut:. ;?- x 44 H. Charge$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the CYiy of Edmonds harmlessftom injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the City of Edmonds, or any of its departments or employ-
ees; including or not limited to the defense of any legal proceedings including defense costs, and anorneyfees by reason of granting &his permit.
THE CON7RACTOR IS RESPONSIBLE FOR WORKMANSHIPAND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWNG THE FINAL INSPECHON
AND ACCEPTANCE OF THE WORK ES77MAZED RESTOR,47TONFEES WILL BE HEED UA71L THE FINAL S7REETPATCH IS COMPLETED BY
CITYFORCES, AT WHICH 77ME A DEBIT OR CREDIT WLL BE PROCESSED FOR ISSUANCE TO 7HE APPLJCANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Departmeii
Work is to be inspected during progress and at completion.
-0220
Restoration is to be in accordance with City Codes. 771
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signature: Date:
(Contractor or Agent)
CALL DIAL -A -DIG. PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVEDBY:, Wk4c.A RIGHT OF WAY DEPOSIT:
TIME AUTHORIZED: VOLD AFrER QiaT DAYS DISRUPTION FEEIFUND I 11:
SPECIAL CONDITIONS: AL 86041rl VY-12PYL- ......RESTORATION.FEE...
3
� TOTAL FEE:.
DATE- — ISSUED BY:
WORK SHALL BEGIN
V____ M 1601
NEW SERVICE PRE -INSPECTION REPORT
VVN r WAR I; R 34
SERVICE-ADDAESS
DATE GAS REQUIRED
9)�Ji f L
�J
EX STUB
LOC.
NO. EX. STUB
FOOTAGE REQUIRED
CONDITIONS
METHOD
STUB
CONC
PS
PUNCH
INSERT W/CU OR ST
SOD'
DIRT
OPEN TRENCH
EX. SERV
INSERT W/CLJ
W/ST
s' -,
NO. EX, SERV
FOOTAGE REQUIRED
If
TWIN
_j
SERVICE
CONDITIONS
METHOD
CONC
SOD
DIRT
PUNCH
INSERT
ROCKERY
GARDEN
PLOW
OPEN TRENCH
0-4 CALLED FOR LOC. OK D
EXCESS OF TRULE (RES)
METER
CHANGE MSA LOC.
CUST. VERIFIED MSA CHANGE
& ETC.
NOTIFIED OF MSA CHANGE
EXCESS WAIVED
BACKHOE
BOARO&IRONS
EXTRA CONES
EQUIP.
NO PARK BARRICADES
METER HOODS
BORE MACHINE
PLOW
SOD CUTTER
COPPER PULLING EQUIPMENT
REMARKS & SKETCH:
i wl
Ll
PRE-iNSPECTION BY
DATE
L
W,
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number-
45TREET FILE
Issue Date:
A. Address or Vicuillity of Construction: 22043 99 Pl W
B. Type of Work (be specific): Servi - ce Renewal — CONFIRMING PERMIT
JWork was done last summer)
C. Contractor: —Washington Natural Gas Company Contact: Frank Swan
OF- Z
1 9()
Mailing Address: 815 Mercer St, Seattle, WA Phone:
224-2278
State License #: Liability Insurance: - Bond:$
_13. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. E] Commercial 0 Subdivision El City Project [id Utility (PUD, GTE, WNG, CABLE, WATER)
n Multi -Family [J Single Family Other
i
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut RgYes []No G. Size -of Cut: 1 (2 x 44) H. ChargE�_$
In AsFhalt
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to ho ldi64� City ofEdmonds bar
fr-07eip =ges, or
?m. or
claims ofahy kind or description whatsoever, foreseen or unforeseen, that may N 1dagai;ii the City ofEdmondg, or any of its nts
n.
employees, including or not limited to the defense ofany legal proceedings including d�,f, n8e costs, und attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMA TED RESTORA 710,)�AEWIkL BE HELD UNTIL THE FINAL j5, EETPATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CRE DIT WILL BE PROCESSED FOR ISSuA NCF TeTd"PACIANT,
-c- 44
-Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the.end of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand the permit requirements and thepinkeopyof thepermit willbe
m. -or inspection purposes.
available on site at all t�m'�'
Z Signature: Date: March 14, 1994
(Contractor or Age"nt) - '"_
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME AUTHORIZED VOID AFTER DAYS
SPECIAL CONDITIONS:
COMMENTS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND Ill:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
RECEIPT FEE:
#I
W.-
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION D YES E] NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
AWbo-go &VWCaTV*N
WNG to window
Water main depth
unknown
11 gas main
Addendum to : City of Edmonds
Right of Way
Permit Application
--- Submitted by: Guyla Connors
Engineering Aide
Washington Natural Gas
521-5248
.00A#F'1&1V,I1V4 Peinl-r
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water
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gas -
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sewer
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water hydrant
0
water valve
815 M=cr St. (P.O. Box 1869), Scank, WA 99111 (206) 622-6767
PLAT MAP
!4TREET Fll E
Borrower Client
Property Add. 22043 99th Pl W
City WrMr-Ads County Srxiigmish state Va Zip Code 98020
Lender Urdve=i-tv 5gyinM Bank
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PERMIT COUNTER
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STREU FILE
10,
CITY OF EDMONDS
USE
ZONE
PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESSZ
/APT #
OWNER NAME/NAME OF BUSINESS
LEGAL DESCRIPTION CHECK SUBDIVISION NO.
LID NO.
cc
Lu
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MAILING IxDDRESS
0
3
PUBLIC RIGHT OF WAY PER
OFFICIAL STREET MAP.
TESCIP Approved 0
CITY ZIP
TELEPHONE NUMBER
271,
EXISTING — REQUIRED DEDICATION
RW Permit Required 0
Street Use Permit Req'd 0
PROPOSED
Inspection Required 0
NAME
Sidewalk Required 0
REMARKS
W
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ADDRESS
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CITY ZIP
TELEPHONE NUMBER
NAME
ENGINEERING MEMO DATED
VIEW BY
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ADDRESS
14C
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2
METER SIZE
BUILDING SUPPLY SIZE NO,
OF FIXTURES
cr
CITY ZIP
CITf1)1111C
TELEPHON E NUMBER
M
uj
Z
0
4�4 /S.�- I
;7,9
Wei, 0 3 7Y
REMARKS
STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA
SEPA REVIEW
ADB NO,
Legal Description of Property - include all easements
ALLOWED
PROPOSED
COMPLETE
EXEMPT
;;x
00
Z
rtaly �n Do L-1 I
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SHORELINE#
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IEXP
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51 < go - 0 a
VARIANCE OR CU
PON91J—AIEW BY
-/NOA T E
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SETBACKS — FEET
FRONT IDE
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HEIGHT
LOT COV
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Property
Tax Account 0 .2 Doi- 0 6 5% 40 .00-3
S
REAA/5
REMARKS
Parcel No.
NEW
RESIDENTIAL
PLUMBING
ADDITION
COMMERCIAL
MECHANICAL
APT.BLDG.
LnLREMODEL
SIGN
GRADING FENCE
CHECKED BY
PIE OF CONSTRUCTI
TY)=N ;CODE
1
HEIGHT
REPAIR CYDS I x _ FT)
4?1
DEMOLISH WOODSTOVE SWIM POOL
INSERT HOT TUB/SPA
AREA
OCCUPANCY
OCCUPANT
SPECIAL INSPECTOR
REQUIRED
0 YES
GROUP
LOAD
FGARAGE RETAINING WALL/
IC RENEWAL
'NEMARKS
0
ROCKERY
(TYPE OF USE. BLISINESS OR A EXPLAIN:
PROGRESS INSPECTIONS
PER UBC 305
Z
_fTIVITY)
NUMBER
NUMBER OF
CRITICAL
-57,*-t r Aa/"
A y --VrwW In JuPA 140&
0
OF
DWELLING
1 01ye-_
AREAS -127
I
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STORIES
UNITS
NUMBER?5
0
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION
REQUIRED
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE: GLAZING
BUILDING
2_02
3,50
PLUMBING
14—
Plan Check No. 71
MECHANICAL
This Permit covers work t bedone on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curt:
,s, sidewpiks,
J
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 an7d
ENG. INSPECTION FEE
u)
successors in interest, agrees to Indemnify, defend n.
harmless the City of Edmonds, Washington, its officials,
i
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
0
modify, waive or reduce any requirement of any city ordinance
in City's
nor.limit any way the ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or th.e duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authoriz-
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.
INSPECTION
acknowledged In space provided.
SIGNATURE 10, NER OR AGENT) DATE SIGNED
DEPARTMENT
Z
CITY OF
OFF[ 'S IGN TURE tATE
EDMONDS
A/-FtENTION
CALL FOR
DATE
INSPECTION
I,"r IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-0220
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL — File YELLOW — Inspector
Li
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
-1.1
PINK — Owner GOLD — Assessor