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24214 89TH PL W
ADDRESS:i�?It/o?/ Ll ex)
TAX ACCOUNT/PARCEL NUMBER: Cosli -7o0cwca00
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: F] Conditional Waiver F] Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:.
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: �z z
SEWER LID FEE LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERM[IT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERM[IT #:
WATER METER TAP CARD DATED:
LATEMP\DSrs\Fomis\Street File Checklist.doc
0 9
PLANNING DATA
C 9 . / '
NAME: An#fll . DATE: 617107
SITE ADDRESS: ),q4jq Vqg plit(f twt�—j PLANCHKO: 01
PROJECT DESCRIPTION: o+- fa,.q, 1�4
L
RE DUCED SITE PLAN PROVIDED?:
MAPPAGE CORNER I LOT: FLAG LOT: OLea&No
ZONING: CRI71CAL AREAS DETERMINATIONM
Studv Reaulred:
Waiver
Conditional We
SEPA DETERMINATION:
El Fee
El Checklist
QAP0 list w/ notarized form
0','Needpetd for 500. cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Sallingeo
em
SETBACKS:
Required Setbacks- jff
Street. 8�'5 Left Side: 7 Right Side: 7 Rear
Actual Setbacks, , it A
-�Lf I Right Side:
Street: Left Side: I Rear 7
a ck
Street map checked for addition required? (Yes I No / DNA)
aDETACHED STRUCTURES: I "V �t-j r
�"v
1 ROCKERIES: (ej4-t,�)VL(_d
3 1-39 -rac
El FENCES/TRELLISES:
El BAY WINDOWS / PROJECTING MODULATION:
13 STAIRS / DECKS:
PARKING:
Required: a Actual:
-7 8- qO
700 =- JL 7� � c'.
M,
BUILDING HEIGHT:
Datum Point: Datum Elevation:
Maximum Aljo_wed: ___Actual Height,_
A.D.U.
SUBDIVISION: /V
LEGAL NON CONFORMING LAND USE DETERMINATION ISSUED:
OTHER: Le V1
Plan Review B
C U/I(-. V/
NewBPPIamingDataFonn.D0C
PROJECT ADDRESS I OWNERS: TAX No: 00511700000200
JERALD & CAROL SANDERS STREET FILE
24214 89T" PLACEWEST LEGAL: H e,(�K CAL&I
EDMONDS 98020 MATHAY'S ADD 3, BLK 000, D-00 LOT 2
T27 R04 S31SW I
2062764922
BUIOLT: 1965
LOTSIZE: 7,840 SQ.FT. .18ACRE IL�- loo.
CO
t3 LOT COVERAGE: Zone Carnerffl?laa A/ C. [00.,
0 co) 6
CL Ndl FMSTING RESIDENCE -GARAGE: 1515.2 SQ. FT. Setback Actual.,/ C). too-
Cn 8 Front -5q " 7 ----
ADDMON 621.25 SO, Fr
3: m 2136-5 SQ. Fr. 27.5%
Sides 71 7 0
Cn IMPERVIOUS SINCE 1 Tn: - "70(a Z# NtW I MPOW045 ATgj+ Rear 17
CIO NEW LONNER: 621.25 SQ FIr Othe
Uj r
PqfW--U-P-P—ER-j-. 116. SO FT. ONSIBLE Heiaft Ak4)(
or- 737.25 SQ. FT.
"Isrr. .... OWNER/CWTRACT OR IS RF-Sp
Ck %mw9*WAW5 Y14 p- t t
m AK')
I kk
wm
rr\F!.Z-1
RECEIVED
1> t�, 1z r1l/ F- w
?-4 Z 14- JUN 17 2004
I L PERMIT COUNTER
t
0
Wy
I -7Y-":51
LU Z
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All. I A. 17^^
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NOTICE:
c
-ranty ... --a -
N-O"*W,a
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 'Edrn.onds does. not. wa rra nt the
accuracy of anything set for ' th on t. * hese
m a p A n . y person or entity,requesting a
copy should conduct an independent
inquiry regarding th*e infcbrmation shown or
-rnap(s),, including, but not limited to, I
the location of any sewer stub shown. Suc
sewer stubs may or may- not e.x1st and may
or may not exist at the location shown.
Neither the city of Edmonds nor its
tf=mp*1*o*yee*s o*r offi-ce-rs -sh- a-1.1 be 1-1a-b-'Fe for the
n on this map(5), nor for
information g'Ve-*
any one representation provided based
upon said map(s).
�#�P20
city.. of Edmonds
PeyelopmentServices Department
Plarming,Division
Phone: 425.771.0220
Fax: 425.771.0221
-%;. to,
Date Received:
City Rec6ipt M
Critical Areas File M
Critical Areas' Checklist Fee:. $135.60
Date MailedtolApplidant:
The Critical -Areas Checklist contained on this form is -to, A property owner, 'or his/her authorized representative,
be filled out by any person. preparing a Development. must'fill out the checklist, sign and',date it and submit' it
Permit Application. for the City of Edmonds prior to to the City. The City will review the checklis� make A
his/her submittal.of the application to the City. precursory site visit, and make'a determination ofthe
subs6quent steps necessary -to complete a deveopment
The purpose of the Checklist is to enable City,staff to
determine whether any potential Critical Areas are, or pe I mut applicat , ion.
may be, present on the subject property. The information Please submit a vicinity map, along with the si ed copy
need' d to com ete the Checklist should. be easily of this form to assist City staff in finding and loc"a'ting the
e pl.
avail'ablefrorn obs ons of specific piece of property Oescfibed on this form.. In
ar it addition, the applicant shall *include other pertinent
ervat
formation (e.g. site plani' topography map, etc.) or
C studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
nnt o h S i
The undersigned applicant, and his/her/its heirs, and assigns, 'in consideration on the probessing.lof the application agrees
to release, inderrinify, defend and hold the City of Ed�nonds. harmless froinlany and. all damages,, nclu'dingij,reasonable�
attorney's fees, arising from,any action or infraction based in,whole or part upon false, n'psl6adiii
g, ma curate or
mcomplete information furnished by the applicant, his/h&/its agents or employees.
T
By my signature, I cer*, that the inforinAtiorr -and exhibiis�16i6with submitted. ate iriie and correct to llb�st of 'my
knowledge and that I am authorized to file this application on the behalf of the, owner as listed below,.-
P
SiGN'ATURE oF APPLicANTIAGENT DATE I
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent tolapply for the subject land use:E�ij"opliqatio�i,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject 0 , rt
prop y. forlhe
purposes of inspection a g a
ttendant t. /Wapplication.
SIGNATURE OF OWNER DATE
Owner/AppHcqnt:
Name
9-Q:244
Street Address
city
State Zip
Telephone:A.�
Email address (optional):
Applicant Representative:
Name
Street Address
City State
, . .. !zip
Telephone:
Email Address (optional):
#P20
Critical Areas Checklist
71" 1'
CA File No:
site infOrmation (soilsl topography/ hydrology/vegetation)
1 1 site lAddress/ Location: 2 4 2- F.L_ A Cf�, f!-s T
'700000
2. Property Tax Account Number: 00 c7 U
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed?
—yes; no.
If yes; how is site developed?.
5. bescrib� the general site topography. Check all that apply.
J�, Flat less than 5-feet elevation'c'fiange over entire site.
-fe6t over a horizontal
Ro
Uing: slopes on site.generally less than 15 (a,yertical rise of 10
e- of 66-fe�t).
1441
e
n site of 'more than 15 % -le ve -6f 104d.0e
distafic
i Hilly':' s opesf present o an�
over A'horizontai distance of 33 to 664eet�).
1 Steep. 'grades of greater than 30% prese a rise h4urvetp�,e rW
Pi Njjg�nsdt_ yid horiio'
distance of less than 33-f6et).
Oth& (please describe):
6.: -,Site contains areaspf year-round standing water- Q 0 Approx. Depth:
';'Ap rox.Depth:
areas
'Site contains 9w te p
7. 6f seas6nal'standin a r.
ar?
What season(s)
flC
8. site isIn the'flo'od 'ay tQ 0
9. Site contains a cr k cir�,.an -area. wl
t FIows`&e:s
10. Site. isipriman
1.
2.
3.
4.'
landscdped.(�awn; shrubs etc
a , s wedand.isipresen' tlon'site';,
dpiain' UO'- 'of a"Water course.
re wiiter� flows across.the grounds surface? Flows are year-round?
Lsofiilf (What time of year?
shrubs. mixed.
For, Cit� Staff Use.Only
�lan Check Niim app ca e
Site is Zoned?
I — To 'Ki =e
SCS mapped soil t�",(S)? ikk er—a 0- (bal\ 14tAd- cda 6A
ry di
Critical AreasInvento' or '�A map T icates Critical. Area on site? MPAe,
Site withmi de�ignated earth, subsidence- landslide hazard area7 /VO
DETERMINATION
STUDY R QUIRED X WAWER
_T Revieiw6d b -Date: L17 6q
Y1-
JUL-06-2004 09:55
P. 02/04
CITY OF. EDMONIDS�
SPECIAL INSFEMON AND TESTING AGREEMENT
ns 2sd under building
Theprojectat -s
, Wmco �
�Af
c
peririit numbei q�ms special insp�ctiori an /or testing per UBC Chapter 17
�md WAC Amen eats 1702, The complete list of special inspections is attached to this document.
BEFORE A PERMIT CAN BE ISSUED: The owner and contractor and special inspector sliall
complete this a&r�ement and the attached structural test(s) and inspections schedule including the
required acknowledgments.
APPROVAL OF SPECXAL INSPECTORS: Each special inspector shall be approved by the
Building Official prior to perforanian duties or inspections. Each special inspector shall submit
e
0 U,?
Staternprit.of Qualifications to dng Official for review. Special inspectors shall display
identification when 6 1 ipecial inspections on site. Special inspection and testing shall meet
pe onning
the minimum requirements of UBC Chapter 17 and the following-
1. Observe Work
The special inspector shall observe the site work for confbrinarice with the approved
rstain&d) plans and specifications and applicable worlananship provisions of thi UBC.
=tpq or Engineer reviewed sh dra i s may be used only as an aid to inspection.
"Of wIng
be Per orm on b ai:,,m 'a, h
ti ' e "od
ml ge� Ion- P ic
pec al in Mb uo
in 0
n ecto, =e �a` ft�es 0 s� 8 " requiring sp -tt plan
b a �01
0
n rect an to v bw Cl d se e
i *7 0
1 sp r 1 on It t
i s ons, if y or ap n a i parat wri
view an a M 0 ve n cam 0 th e mv�ewec oroarch ct orrecor
t ha i g YA r
re d pp v byte B ild d
2. Report Non -conforming Items
The -special inspector shall. bring,no nf items to the immediate attention of the
n
contractor and note all such- itet& in the daily7f ii ort.
pll rep - Any itern not resolved- in a timely
manner shall be immediate cause of the special inspector to notify the Building Official of the
plan deviation, emr, change or omission. It shall also be the duty of the special inspector to
promptly notify the engineer or architect.
3. Complete Daily Reports
Each special inspector shall complete and both the special inspection record and the daily
report form for each day's gispection, Aese records shall remain at the jobsite with the
c*ntractor for review by the City Building Inspector.
4. Furnish Weekly Reports
The special inspector or inspection agency shall ftirnish the City with weekly reports of tests
and inspections. The p�qject engineer or architect and others as designated shall also be
copied on reports. Weeldy reports must include the fbllowing:
Description of daily ins tions and tests made with applicable locations
.pe�
List of all nonconforming items
Report on status of nonconforming items (resolved or unresolved)
Iteinized changes authorized by the Architect Engineer and City if not included in
nonconformance items
5.' Furnish Final Constmetion Report
Ilie ecial inspector or inspection agency shall submit a final signed report to the City stating
that NJ items requiring ecial inspection and testing were fulfilled and reported. And, to the
best of his/h �Xlc the project is in con-fonnance with the ;%pproved plans and
specifications, approved change orders, and the applicable workmanship provisions of the
UBC. Items not in conformance or unresolved items or any discrepancies in inspection
cov"o, (i,e, missed inspections, periodic inspection when continuous inspections were
requirid, etc.) -;�all be specifically iteinized in this report.
'iLZ -ULJ--LL:UJ
FR,3N1 LOCLE-N AND SCNS CONST Fr)X �,O. 9 257714531 ':)(� 07:40PM P3 P.
-Tu I - 13 -
I. Notify the Speci3l Insp—Mor
1 'he vPcciid iMPLICtor whan Work is reWy ror Sreeial
It is ft. duty of th Conttactor to L
P WU and spedficati0q; W Mquk
j Opwhm Not*' the itemt; h&ted dcm It khe a h U 'loud On tl�c OPProved
r
RV1* apeciw icapectiolm,
PrOvfd9d bY thO 004trwtor so that.! g' pe6&1 ij� has tme to 1Abe1Ct,4Uftft %huM be
project. 1hini1W with ft
2. Provide �U.:*m 10 Approved Plans
4u =tracw ia ltspozwble for P, 'Vi k4
thajobsite. the Worial Ingeetur wccn to approvw Pins at
3. Retain SPOCW Inspectlelm Itswnis
The Oorit=wr it rupowible, to mt t,
by the special inspector, 'rhese, rece is 'the hwite all 2PftW id!pection roqw subinivc4i
rtquaa. ire to C Provided tO the 0 ty bW Wing
-in*=tar *n
L Appr�vt 9pecial fimpecum oy 141PO dw I agencies
Thc. build4 dquytmeint ghall
requirtuenhL -N VC et all Vee'&' - inBPOCtors and special in�jao
munit" spftw 1"Pecdon and appy V4 weekly pop"
Wcwk r7b 1A the e.f
M", wim �WCT I;=.-, loll special OOOM be
I w In Pe tot. us? M,
0 d rio
di. aMoval ;n be 6 ttunt P 7 to
vitift iti 2�d%tion to
J- AAM16- -U.. UU—L- -V
TU OJ�L.. Offi-L]
CW1 kav%w =04LA WCWU.V wwiql irivemor
-Op"i
2w
A Or
,jaer 13
7110 Omgm&uwu
PY)w Owher Or the enginscr or ar, ut e, of
sp=al m9pamfiam Savices. . F,4*r4 actlug IL9 agent mall fund
JDA ilk Min
Specificatiow. all a. svbial Impmdon tcqwttm= ckn the p1hrl's arid
read and qXrw AC)QqOV
0 COM 1
V wu)
Owner_
-5
.5
Spe-4al ter
ThsPec
Gems: Contractor
't
City Building OffitiaL---w
A
U DGIZMZrM
th' 1"rj and cm"On" Of' AxT 48reemew.
J —06-2004 09:56
LIL P.04104
SPECIAL INSPECTION AND TESTING SCHEDULE
Man= T&SWROMPIEC710" AGDCY OF SPECIAL V4P2CfQo
REINFORCED CONCRETE, GUNITE, GROUT AND MORTAR.-
r'-"ftrNvd� C.aftb* r
Agg"m Tests
unhircieff ts
W Deske!
RainfOrciar Plocetsieng
Bakh Plant Itsonlion
hispect plitemil
-
Can Samples
Pick-upSamp4s
I
cow"MoTests
PRECASTIPRMTRESSED CONCRETL-
pliks 1101111-7ims 14*-111MM
Aftresw Tow-
Prinforcing Tests
Tandon Tests
Mix Desipw
Reinforcing placement
InNal P111CM901
c4unte BAICNBS
LIS
Pick. Samples
MASONRY:
SPceisl Inspection Stresses Used
Preliminary AccqXaKe Tew (MASMY Units. Will I23isms)
Su"uent Tests (Monw. Grutit. Field Will Prims)
PIM91TICIm 111SPOC6011 Of Units
ADDITIONAL INSTRUCTIONS OR OTHER TESTS
AND INSPECTION$-
STRUCTURALSTEEILWELDING:
— SOMPle Mind *rest (IiSt XPedflo sumberis brilow)
— skip mimmial Idwitificadoft
— ftdiog Inspection Z) SW9 0 FW
— Uwasoftic Inspection OSbop 0 Field
— Higb-sVenift Bolting
11111IO'clim OShop OField
L3 A325 0 N C3X Lj F
DA490
— Metal Dcok Welding Inspecthm
— ReWoMing Steel N*Idis# lnq=dm
— Metal Stud WtIdiatt Intpection
— COM916 IrAtrt %Idiot Inspection
FIREPROOFING;
— PIKCMM IngpdMiOn
— Density Tt5u
— ThJckne%A TestS
— Inspect Botching
INSULATING CONCRETE!
— Sample u4 Test
— Placement Inspection
— Uslit weights
F7LL MATERIAL:
Accept&= Tests
Mcement 1129pCclion
Field Dent -my
STRUCTURAL WOOD:
Sbw)%Il Nailin# lnqwdm
hupwrion of Clu4wn Nb.
1pspwkin ofTruzz Joist r-ab.
Sample NW Tell Components
Form compbud br rolla:
Telepliew No.: Date:
T07AL P.04
CASCADE TESTING LABORATORY, INC.
TESTING & INSPECTION / ENGINEERS
PREVIOUS
�619
12919 N.E. 126TH PLACE
REPORT No. No. 116
KIRKLAND. WASHINGTON 98034 (425) 823-9800
EVERETT (425) 259-0817
DATE CERT. NO.
I ccvo
FiaD REP ORT
PROJECTt
S aa Zes
TO:
LOCATION
iz!�Z_a
DILI /4.bil
BLDG. PERMIT NO. OWNER
20C4 -OS"27_2
WEATHER TEMP. AT AM
AT PM
ENGINEER
ARCHITECT
ATTN: m(., I-'
CONTRAC.Z &
(2)
(3)
INSPECTION PERFORMED
ITEMS INSPECTED FOUNDATIONS
— RESTEEL/CONCRETE — RESTEEL ONLY
— FOOTINGS SLAB
E
E EU
— R EEUMASONRY — STR.STfWELDING
0o'
— AUGER CAST PILES COLUMNS
OTHER
R STR.ST/BOLTING
DRILLED PIERS — WALLS
— BEAMS
(4)
LOCATION (AREAS)
C
(5)
CONCRETEJMASONRY MIX NO.
DESIGN STRENGTH (f'c)
SUPPLIER
TOTAL CU. YD. PLACED
SLUMP (INCHES)
SPECIMENS CAST
AIR CO��(%*)
SEE CYLINDER REPORT NO.
F YES — NO —ITEMS INSPECTEDWEREIN CONFORMANCEWITH BLDG. DEPT.APPROVED PLANS
TEST RESULTS APPLY ONLY TO THE ITEMS I
HEREIN TESTED. THIS REPORT SHALL NOT INSPECTOR(S), NAME(S) PRINTED
BE REPRODUCED EXCEPT IN FULL
OUT THE WRITTEN APPROVAL OF C�S=
TESTING LABORATORY, INC. I INSPECTOR SIGNATURE
REVISED 8/00 1 SIGNED BY
COPIES TO: I I E. d%7 0 f (-,— 7—( :�,
01
CZ6-
41
0
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LLJ
LLJ
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MCD
LL
Cc >
Cx- CE
I PROJECT ADDRESS / OWNERS:
TAX 00511700000200 "ITY COPY
JERALD & CAROL SANDERS
24214 807"' PLACEWEST -
EDMONDS 98020 LEGAL: MAnUy'S ADD -4, BLK 000, D-0 LOT 2
2062764922 T27 R04 S31SW
BUILT: 1965
LOTSIZE:, 7,940 SQ.FT. .18ACRE
LOT COVERAGE: Zone U-T Comer IV Flag Al
EXISTINGRESIDENCE-GARAGE: 1515.2 SQ.FT. Setback Reouired Actual
ADDITION 621.25 SO, FT Front X5 ' f4—(r-,-'7
2136.5 SQ. FT. 27.5% Sides 7 "�"" 7r.,-, 8�
EUPERVIOUS SINCE 1977: - -)6 6 It NVA*) I Wavo &AS AV" Rear 1;7
NEW LOWER: 621.25 SQ FT Other
VNE 116. SO Fr. 57
5
L,!O 737.2. S9Z)ONER/CONTRACTOR iS RESPONSIBL
lutsr- FOR EROSION CONT9 OLAND DAMAG&4,
tA
Ex - -7
1;> 1z ry F- Uj
?-4
F-Y,191. Kr=I5.
L
z
41 111-1*
-J�7 '17'- 1 "
W��
�A 1$' pj
He,(�K CALG�i
A.
too.,
C.
too.,
D.
too-
100'.
+
RECEIVED
JUN 17 2004
4- PERMIT COUNTER
0
CL
C/3
= 8 Ll
31: M
0
0 x
, co
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P— I A - -,7~,.,o
ATE RECEIVED
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER 4�.7e
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS o�4
PLAT NAME/SUBDIVISION N(
SUITE/APT#
LID NO.
OWNER NAME/NAME9f-6U6N4Ee&
CAFOL `5AKJt)ILL5
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
LID FEE$
TESCP Approved
RW Permit Required
street Use Permit Req'd
MAILING ADDRESS
42' 4 FL
2 t,51
EXISTING PROPOSED
REQUIRED DEDICATION FT
inspection Required - WE,
Sidewalk Required
Underground
wlringequ,,ed 0
CITY ZIP
1) (
TELEPHONE
o (jo 1-7 (P 4`12- 2-
r2�
METER SIZE LINE SIZE NO,OF FIXTURES
PRV REQUIRED
YES13 NO
NAME
-T I
z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
z
ADDRESS
A L
CITY ZIP
�j D 5
TELEPHONE
4zr-) 7-7 4 11-'
NAME
JCILI�_
7 _V�ttjf
C
HARK Lo P_ WF_Q ENGINEERING REVIEWI:U Oy
w ADDRESS
0
FIRE REVIEWED BY DATE
U.
C ITY ZIP TELEPHONE
li� D M 0 �J eZ (P 4 zt� r2 VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REG �D POSTED
ES No $ _
EXPIRATION DATE CHEC 0 BY REO'D POSTED
STATE LICENSE NUMBER OYES NO $
0
C, SIGN AREA HEIGHT
OP
SEPA REVIEW 'I j
COMPILt: I C E T ALLOWED PROPOSED ALLOWED PROP?.S7/
PROPERTY TAX
02-00
ACCOUNT PARCEL NO.
UJI 0o L9 EXP
.j
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
RESIDENTIAL PLUMBING MECH SIDE REAR FROYT URA%
NEW x ALLOWED PROPOSED FROI`jT f 1 11 , / PEP
M COMPLIANCE OR 3ry 3,. 17 z
ADDITION F1 COMMERCIAL CHANGE6F USE 7V - 1.'' z
PARKIN LOT AREA P REV ED BY DATE . 5
r7l REMODEL MULTIFAMILY 13 SIGN PF D /x,
C3 — . . FENCE g V6
0 GBADING 13 x FT) REMARKS
REPAIR CYDS ( — —
1 4" 077 HER
F1 DEMOLISH 0-ITANK 1:1
GARAGE RETAININGWALL FIRE SPRINKLER
z 0 CARPORT 13 ROCKERY 13 FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: JJDE OCCUPAN
'CHECKED BY TY :INSTRUCTION GROUP
OCCUPANT
U) CRITICAL
ul NUMBER NUMBER OF AREAS SPECIAL. INSPECTION FAREA LOAD
a DWELLING �) ,
0 OF NUMBER REQUIRED
0i STORIES UNITS KYES I
DESCRIBE WORK TO BE DONE REMARKS z
PROGRESS INSPECTIONS PER UBC i08/FiNAL INSPECTION REGID
6�- �AWU-( ZOOM 1910061
I
L o 0 P__
A 01) 0 r- r2l I! 16' 1 D r--D E L 0 H VALUATION
$ -1 -71
Description FEE Description FEE
4,
StateSurCharge
E ME
Plan:Chl�ck State Sur �harge
HE�T SOURCE GLAZING % LOT SLOPE% City Surcharge
,- q U
Building Permit
VESTED DA Base Fee
.PD_DATEi Plumbing
Pak _CHECK NO: Mechanical 47)
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS 44ORK To
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review fm n(A 1z g
W PERMIT APPLICATION: 180 DAYS
0. PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Plan
Fire Review Chk.Deposit VW(P
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
;N AGREES TO INDEMNIF'� DEFEND AND HOLD HARMLESS THE CITY OF
-
INTEREST,
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ec pt #
Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
�F.
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 1 Amt. Due
Total Amt. Du
Landscapelnsp. a
ceipt #
Receipt #
Recording Fee 74-377-L.
DEEMED
NOR LIMIT IN ANY WAY THE CITYS ABILITY. TO ENFORCE ANY ORDINANCE PROVISION.*
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,
This application is not a permit until signed by the
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Building Official or his/her.Deputy: and Fees are paid, and
TION; AND I . N DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
,—c nc WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF IHE
WORKMEN'S COMPENSATION INSURANCE AND.RCW 18.27. OFFICIALS
DATE SIGNED 1A9
S16 A�Wl`lg (OVVNER OR zo 'I . . . Il
04- 771.i422_0_ S
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBO SECTION 109
uftf- Is Is A 9,0'11111,110- A ^^0111=112
RE DATE
BY
ORIGINAL - FILE YELLOW - INSPECTU
PINK -OWNER GOLD -ASSESSOR