22604 95TH PL W.PDF9360
22604 95TH PL'W
PLANNING DATA
NAME:
SITE ADDRESS:, DATE: qq
ZONING: -PLAN CHK#:
PROJECT DESCRIPTION:_
CORNER LOT— IVC2 (Yes/No) FLAG LOT 410 --_(Yes/No)
SETBACKS:
Required Setbacks: 7. Right Side,._7,'5"f Rear:
Front: 2<-' Left Side:
Actual Setbacks:
FrontTE�Left Side:
- A. --Right Side:% Rear:
Street map checked for addition aT—seiback required? A11&WJA0T_(Yes1No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED
VP (Y/N)
LOT COVERAGE:
Maximum Allowed% Actual: 1100/0
BUILDING HEIGHT:
Maximum Allowed: 'Z"0 —Actual Height:
Datum Point:- Al —Daturn Elevation:.
A.D.U. CREATED?: 11W) —
SUBDIVISION:
CRITICAL AREAS
SEPA DETERMINATION: AM
LOT AREA: ](19: �"� Z_
OTHER:
Plan Review By:
c\fi1cjkparWt\^p1andu&*
PL LAJ
-f,qc. igg"
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, mqso2o.- (425) 771-0220 - FAX (425) 771-0221
Website: wwwdedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineedng
February 6, 2006
MEMO TO:
Edmonds School District
Verizon Northwest
SNOCOM Police and Fire Dispatch
SNOPAC
Snohomish County E911
U.S. Post Office
Snohomish County Assessor's Office
Snohomish County Irtformation Services
Snohomish County P-U-D.
Puget Sound Energy
GARY HAAKENSON
MAYOR
IS rRee r
Edmonds Fire Department
Edmonds Police Department
Edmonds Utility Billing
Edmonds Public Works
Edmonds Building/Street File
Edmonds Address Files
Lynnwood Disposal
Comcast Cable
Waste Management Northwest
Please be advised that the attached addresses have been added to the Edmonds address
system: New: Lot 2 - 22520 and Lot 3 - 22522 950, PI W, existing addresses of Lot 1 - 22518
and Lot 4 - 22604 95thPI W to remain.
Occupancy: R3 Tax ID Number. 005443-000-087-00
Subdivision: S-2005-0140 Lot #s: Lot 1 & 4 (existing addresses), Lots 2 & 3 (new)
If you have any questions regarding this letter, please contact me at 425-771-0220 or
Umbaugh@ci.edmonds.wa.us. Please contact me if you wish to be removed from this list
Respectfully,
.':eeU
Permit Coordinator
Edmonds Building Department
L\T&mp\DST's\Master Letters\New Address2/6/2006
Incorporated August 11, 1890
Sister City - Hekinan, Japan
NI
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47*PA
227TH
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PL
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Zoning Vicinity Map N
RS-20 = RS-6 RM-3 SP CG2 Rezones
RS-12 RSW-12 RM-2.4 BN Cw Mu CD PRE) A
Rs-i o Rs-mP Rm-i.5 Bc F�I mpi P
CG EO MP2 OS 0 200 400
-6
Beet
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1690
File S-2005-140
Attachment 2
SE 1/4p SE 1/4, SEC. 25, TWP. 27 No RGE. 03 E.,
W.M.
ORIGINAL LEGAL DESCRIPTION TOTAL PARCIEW
Lois as AND 87 OF THE FLAT OF PINE GROG ACOMM TO THE PLAT
IIHERDOF RECORDED IN VOUACK t3 Or PLATS AT PAGE K R 3 or
INCHIA091 O"TY. WAMHOTOK
NEW LOT Is
OMWDM* AT M NORTHEAST DOW Of LOT Cr THE PLAT OF PINE
cow A NO TO THE PLAT TAOICOF 4a JN&X PONT 0
NOWPINKI FOR THN DESCRInUft
MIZE N" W2rW INST, ALONQ THE NORTH LK OF LOT 66, A
OMA*C9 CF 113AO FW 10 THE VEST LINE OF NEW LOT u
LOT
DICKS SCUTH 8222 Of A THE SMITH Uft OF AM 60% A
DISTANCE OF 10404W Z LAST UNE OF BAD L4071
THgxOt NORTH OW3r CAST, "NO THE EAST UNK OF "D LOT, A
102 LINE TABLE as
DISTANCE OF =42 FW TO
I LINE A
10m. M WITH AN AND
ACROU THE 9" to_v FEET or BAD M LOT 1.
I
Krlrf
NEW LOT 24
OINMOCINO AT THE NOW11HEAST OMER Of LOT Sk CF THE PLAT Or PINE
CRIS. ACCORD(NO TO THE PLAT MAM
To "-N
rmmm pom Wme Im MAW Im wom um; of LOT &A
DESTANCE OF II&OD FWTD THE ME PC" OF INGINKNO Or
a
a
to
7-5: OR
74
PENCE NORTH 5n2W Witt, ALCHO ?W N" UNg OF SAID LOT, A
DISTANCE OF 92M FUT TO THE NEXT L09 OF KW LOT t
TH13409 MOUTH QW31' WEST. ALDNO THE WEST LINE Or BOB LOT. A
I?
DISTANCE Or 87M FEET TO THE SCUTH LINE Or END LOT)
rANCE OWTH SS2rW EAST, A DISTANCE OF 01411. FW.T.O THE tAST
4 -
.
. .
. . .
Lfte Or SAID In
NOW WONIN Ow3r um. A DIETAKCE OF 87.03 FEET TO THE T"
POW OF awwwo or Do MORPRON.
NEW LAT I
NEW LOT 36
9,3108F
A'043 or
COWDIONO AT DEE SCUMAST OGDEN W LOT III. C11 THE PLAT OF PIKE
ACCONTINO TO THE PLAT TAIINEM
rKNM NORTH SnVQr W". ALONG PC WIN UNK OF SO LOT, A
DISTANCE OF 1O&Q0 FICIT TO R =A POW OF WONNIN OF rATS
DEWRIPTICH:
THICHOR N" SnSOr INST, A MITANCE OF "&40 M-r TO THE VEST
LINE Or NM UIT 3;
1WINCK NORTH 07911' ICAV. A DWANCIC OF 77.00 FW TO THE MOM
6f
ACCU
LIKE or
PENCE ='OvW CAM. A OIFTAHCZ Of 102.0 nW M iNt EMIT
ILA am ZWT Wr
In
it'll
F
THIDICIE SVM OW3r IM A OSTMOE OF ".0 TO THE IM POINT
or o0wom
- - - - - - - -
. ....
IS
NEW LOT 44
COARNONO AT THE 310IMCAST OMM OF LOT 47, Or ft PLAT OF PRE
MW AOCORDIN* TO THE PLAT THCRZ)Pl�
7.5'IISK
PENCE NORTH W7ZOr IrC ALCHO Tit S" UNK OF LOT 07, A
Qq
w w2rae
OWAWZ Or 103.00 FWr 0%
IWINCK NORTH OWW VAST, A DWANCE OF 77.62
IIHIDIM NORTH NUDS' XV. A DWANCK Of 10,00 FEM
SSOL
THOM NORTH OW3r EAn A DISTANCE OF 4.61 FMT 70 THE NORTH
01
UKE Or SAM wn
. Co-& '��u -
THIM BYJTH 8ftrw EAST, A DISIANW Of 113,00 FMI To 1)K EAST
Ulft Of SAID LOM
.
w 3op r4
TH10001 SOUTH OW3r VEST. A DISTANCE OF SLQ FEET TO THE TWE
POINT OF BEGGINNOt
WIN, LOT 2
8,02460' NEW LOT 4
TOGETHER NTM AN CASEMENT FOR NORCO AND OYER AND
AD= THE WORTH 4.81 I= OF SAID NEW LOT 0.
8.3am or
A
100 01 -v 1 .2 z r on"
TOTAL AREA OF BOTH PARCELSo
= as - 16.0211 9
WT "L . 19,9118 sr
'w*m Wu
TOTAL AREA 3&9126 IF
0
ACCESS EASEMENT.
LOT AREA - 1.023 OF
- - - - - - - - -
z
BU14BABLE ARM
'.b. esk YD G) h41111 i ';FA", -0-
00
LOT AREA - 33,012 Sr - 1,1105 Sr 32,217 V
OL.)
N i2;
Ay
DONSITY CALCULATION
I
zommo "-a) : 81000 sr
/ ar
TOTAL. NO. OF LOTS 3=7 &F. 4.041
NO. OF LOTS 4 LOIS
THS MAP CORRECTLY REPRESEM A SURVEY MADE BY ME
.4...
OR UNDER MY DIRECTION IN CONFORMANCE VATH THE
REWREMENTS OF THE SURVEY RECORDING ACT AT THE
A.-
REQUEST OF "S YOCKEY AND 13RYAN MIZE IN SEPTUBER
2005.
TRA L '"0'
CEROTIFICATIZ N 0037
MW ENGINEERINO PLLC
14218 SE 1011H SMUT
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BaLEVU6 98007
PROPOSED CONDITIONS
p !A
HONE:- .799-1078
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NORT14
05-05-07
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3141 9604 219211216M 219,
902 904 21920
21M 9630 21909
21912 219M 21 WO 219.4
9415 9413
21926 21014
21925 21915
9607 T, G417 9407
22004 22M 220" 22NS 22WO
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22011
22014 22015
3:. 22MS 22014 22014
222017
22011 22017
22024 22017 Li
22018 22018
22M 22024
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— ww 22029 22027 220M 22027 22020 22025
-'M
2203 " !� — —
1223 22032 22026
22104 22103
22042
22102
"a f'. 22043 22108 22100
4 22112 22109 22209
22047 22110 22124 22114
2U204"4 22 W
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22122
220M 22052 22053 22051 22124 22121 22117 221g2
I Westgate*
222013 22128 22129 130
22129 22
22006 Elementaty-",
22007 22210
IM7 14 Z =205 22M M,
22M MOS
220MO9 9601
22214
222
22218 22208 22209
1251 22221 2222 22224 22218 2MI 2222" 22219 22216
1259 22223 222
:r: 222 22M 2222 22229 22227
9
2222.
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�24 % 22M
0 1
2300 22303 22305 n302 0--
22301
6 2Z301
2314 =11 22307
22310 223061
22311 22309
22308 223D7 22314 2310 220 11
9919 2MI2 zi 22315 w
22316 22314 A
22317 22320 9C' 22337 22317
S9 22326 ' 'X I-- E2
9M 22324
9sig 44
9WI OS17 Xw
22327
=0
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22407 9916 0902 gwo no 22405
:::: 22407 224o6 �0-
9514 9512 9510 M2 22405 9310
22404
417 0218 V40� 40
2241S 22416 2204 22415 22414
22422 22408 b
22421 — 224DS ZZ410 2240e
423 22408
22421 224Z2 22421 22422
0
22424
— — 22412
433 22413 22416
22-M 22432 22431 22423 22428 22413 22416
22432 22477 22428
439 22421 2242
22420 22421 22420 22421
22413 22430 22503 22504 22420
992 22504
2260
445 5 9845 22507 22508
22429 22506
22502 22507
22506
Edmonds
QMS 22500
1449 V51
9924 21"" 22510 22511 M10
MIS Presbytefian 72511 [�22SVI..
Church
22US 225 2252
—1
51S 22514
i4; 22515
19 MIS MI
22600 7 Mill
N3
=7 22
2w
22604
22605 22.634
226
SOS, 7
22615
22608
9909 22WS 22608 22009
99 22618 1.,
22&
22612 22613 22612 22813
9M 2�26 12
is 22704 22M 22701 9715
22628 22629 22620
22619 22a2G 1* 22619 2,
:LU.
22710 713 22710 — --------- T
2ZYli 27708 22705 227aa 22708 I.-IJL
22705 22706
9709 22718
Qww I
2n2712 17 2"19
2272.
9513 z
22721
22714 2Z?2? y.
N 92M
9702
22aus 22M
22816
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ate
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22NS
CA FILE NO
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location:
2.
Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? -Kyes; no.
If yes. how is. site developed?
f 't� , , 6
5. Describe the general site topography. Check all that apply.
t: 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).
Hilly: slopes present on site of more than 15 % and less than 30 % (a vertical
rise of 10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over
a horizontal distance of less than 33-feet).
Other (please describe): -
6. Site contains areas of year-round standing water: /V0 ; Approx. Depth:
7. Site contains areas of s easonal standing water: ;Approx. Depth:
�Vlaat season(s) of the year?
8. Site is in the floodwaY4��floodplain_ of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are
year-round? WO Flows are seasonal? (What time of year?
10. Site is primarily: forested ; meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) r��
11. Obvious wetland is present on site: /,Y'O
t 1-,.,
Sitedesignaie d_,*_o.n,*.-_Ah* e.,.E,nvJro.Pm,e.n.taU,v Sen.s.i.ti.Y.e. Areas M�ap?
^ca_chk.doc; Rev 02/11/97
. XECEIVEr)
City of Edmonds
PERMIT COUNTF-P
CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City of
Edmonds prior to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential CriticalAreas are, or
may be, present on the subject property. The
information needed to complete the Checklist should
be easily available from observations of the site. or
data available at City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and submit it to the
City. The 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.
Please submit a vicinity map along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
Name
1^
Street Address
City §tate Zip
Telephone'
Signature
Date
AZ-77/�71-/ 111�
Applicant Representative:
Name
-K-910
Street Address
city State Zip
(�2S) 7�7 7-
Telephone',
Signature
2 2-
Date
c:reception\jana\cac1.doc
(over)
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
QJ Planning - Building - Engineering
C - Wis 19
March 18, 1999
Jeff Dodge
The Deck & Sunroom Co., Inc.
15919 Highway 99
Lynnwood, WA 98037
Subject: Determination regarding Critical Areas Checklist # 99-63
Dear Applicant:
BARBARA FAHEY
MAYOR
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
............ ..... .
IMPORTANT INFORMATION TO BE NOTED:
PLEASE EXAMINE THIS" DETERMINATI ON" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
so. You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL * Allow
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
cc: Brian Poor
22604 951h PL W
Edmonds, WA 98020
Enc: Determination
*Architectural Design Board
C:ReceptionUana\CRLTR.doc
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Planning Secretary
Incorporated August 11, 1890
Sister City - Hekinan, Japan
7
C,A FILE NO. qfl-- 4�-S
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: J,�_6 14"*4
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? X yes; — no.
If yes.- how is site developed? lg�n t-6!ZZ-
5. Describe the Reneral site topography. Check all that apply. BUIUDINQ
Flat: less than 5-feet elevation change over entire site.
MAR 2 2 1�99
Rolling: slopes on site generally less than 15 % (a vertical rise of 1 0-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15 % and less than 30 % (a vertical
rise of 10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over
a horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
A/ r
7. Site contains areas of seasonal stand' water: Approx. Depth:
What season(s) of the year? 1 1
8. Site is in the floodway_44:7:-�floodplain of a water course.
9. Site contains a cree� or an area where water flows across the grounds surface? Flows are
year-round? Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: ffO—
obitt iNATION::::
sTtiby REotjiR_tD C NDiTibNAL WAIVER
,Reviewed by:
^ca_chk.doc; Rev 02/1
. .......... ...... ..... ... ... ...... ....
�/�. kil
,6ate
City of Edmonds
V�h
rVECE:JVE:0
MAR 10 1999
PERMIT CouNTr-p
CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City of
Edmonds prior to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The
information needed to complete the Checklist should
be easily available from observations of the site or
data available at City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and submit it to the
City. The 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.
Please submit a vicinity map along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
R66A
Name
4— kv�
Street Address
2
city §tate Zip
(�60r) 7 -1 7 J>-5—
Telephone
Signature
Date
Applicant Representative:
Name
Yr.�10 ll-ewv
Street Address
' 4
city State Zip
4,5j- 7e5771-1111
Teiepho n-e'
OA*
Signature ////'
Date
cxecepti on\j ana\cacl. doc
(over)
CITY OF EDMONDS
USE
ZONE
PiRMIT
BER
NUM (3 C�
CONSTRUCTION PERMIT APPLICATION
Ir � ��' 9 4 A —
OWNER NAME/NAME OF ESS
joB
ADDRE s S, �wo
#�- % SUITE/APT 4
LEGAL DESCRIPTION CHECK
SUBDIVISION No
LIU NO,
W
Z
MAILING ADDRESS
0
CITY ZIP TELEPHONE NUMBER
UBLIC RIGHT OF WAY PER
OFFICIAL STREET MAP.
TESCP Approved 0
/VVY �,qt�,2 0
�
EXISTING . REQUIRED DEDICATION
. RW Permit Required 0
Street Use Permit Req'd 0
�> �',
PROPOSED
inspection Required 0
NAME
..,
Sidewalk Required 0
METER W
LINE SIZE
N F FIXTURES
�7RV TREQUIRED
W
I'-
<
L)
W
ADDRESS
YES 0 NOD
L)
REMARKS
0
Z
cc
CITY ZIP
TELEPHONE NUMBER
cc
W
W
Z
NAME
n
Z
LU
a:
ADDRESS
0
-
1/ ?1-1 ? �2 1
ENGINEERING MEMO DATED
REVIE WE11Y
L)
CITY ZIP
TELEPVONE NUMBER
7",-,(///
IRE MEMO DATED
REVIEWED BY
UJI
STAT� LICENSE NUMBER EXPIRATION DATE
cc
7 AW
VARIANQqOfj Cu
A
PIRgLINE 9
Legal Description of Property - include all easementsoq it.
A111i -
A,.
Z
SEPA F(EVIEW
COMPLETE EXEMP_T-
SIGN AREA
ALLOWE PROPOSED
- �EIGHT
WED
ALLO POSED
CL
(DOC) Z:)- 0 0
EXP
IPRO
Lu
LOT COVERAGE
VQUIRED SETBACKS (FT.)
PROPOSED SETBACKS
(FT.)
0
ALLOWED
PROPOSED
FRONT SIDE R(AI3
FRONt UR SIDE REAR
0
-j
0
Lu
Property
-7 e,
11
//07,)
-75' S7'.
164 qzjfll
Z
Z
Z
-i
V)
Tax Account 0 0
P I No.
arce 0%7 -00)0 0
T Aqt
&
I PLA%N� CREVIEW BY
T
[IN F—
EL
L
f-1
E]
REMARKS
NEW
WSJ RESIDENTIAL
PLUMBING(MECH
10
COMPLIANCE 6R
ADDITION
COMMERCIAL
CHANGE OF USE
1:1 'REMODEL
F-1 APT. BLDG.
SIGN
GRADING FENCE
REPAIR CYDS El
CHECKED BY
TYPE 07,�ONSTRU� ION 0
T I T!
OCCUPMT
GRO' - —1,
P-
X 7,—FT)
;
DEMOLISH WOODSTOVE swim Foo-6,
INSERT HOT TUB/SFA
SPECIAL INSPECTOR
REA
OCCUPANT
GARAGE RETAINING WALL/
C RENEWAL
REQUIRED 0 YES �r
LOAD
ROCKERY
EMARKS
Z
0—
(TYPE OF USE, BUSINESS OR ACTIVITY), EXPLAIN:
PROGRESS INSPECTIONS PER UBC f08
-j
to
u
0
NUMBER
OF
NUMBER OF
DWELLING
A A
CREITICAqq
ED
STORIES
UNITS
NUMBER
01
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL I NSPECTION REOUIRED
VALUATION
FEE
PLAN CHECK FEE
HEATSOURCE:
G
%
BUILDING
PLUMBING
rPlan Check No. 1 58
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any Construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
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
,n
successors in interest, agrees to indemnity, defend and hold
20
j
m
harmless the City of Edmonds, Washington, its officials,
employees,.and agents from any and all claims for damages of
I
M
-(
whatever nature, arising directly or indirectly from the issuance
M
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
:r
nor limit in any way the City's ability to enforce any ordinance
provision."
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
state laws regulating, construction; and in doing the work authoriz-
THIS PERMIT
AUTHORIZES
This application is not a permit until
ed th * ereby, 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 RCW118.27.
INSPECTION
acknowledged in space provided.
(OWNFR OR AGE
SIGNATURE RZT�
OATESIGNED
DEPARTMENT
1
L)
3-1e-ff
CITY OF
0 ICJAL1Sj'91GNATf§, WE
IVS/V/1�1 , ` I
EDMONDS
-V
ATTENT161I
CALL FOR
RFI EASE r BY: 1) r E
INSPECTION
I
A/
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771m0220
ORIGINAL File YELLOW — Inspector
.A CERTIFICATE OF. OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
102-87
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; . 1,-� & , �Ifzl-
PINK — Owner GOLD — Assessor