414 MAIN ST.PDFiiiiiiiiiiii
41469
414 MAIN ST
ADDRESS:
TAX ACCOUNTIPARCEL NUMBER:—A0 4�1 �� �,/ 4�� zW 1&29
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: � 2 tt - DETERMINATION: 0 Conditional Waiver E] 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:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
LID #:
LOT: BLOCK:
STREET USE / ENCROACHMENT PERMIT #: q�-10
WATER METER TAP CARD DATED:
LATEM P\DST's\Forms\Strect File Checklist.doc
0
ul-W11
Critical Areas Checklist
Site Information (soils/topogr . a h /h
of y ydrology/vegetation)
1.. Site Address/ Location:
2. Property TaxAccount Number: L4 `3 4 4 0 f - �3- 0 C) (0 C)
3. Approximate Site Size (acres or square feet): L4 6)< 9 0.
4. Is this site currently developed? Yyes; no.
J,
If yes; how is site developed? CO ni but I !�j
5. Describe the general site topography. Check all that apply.
CA File No:
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).
Q (a' Pris
-�Aitical; e'of,1040�t
My: slopes present on site of more id
over a horizontal distance of 33 to 66-feqt)
Steep: grades of greater than 30% p eA
j
r e4JA
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway tJ 0 floodplain (\J of a water course.
9. Site contains a creek or an area where water flows across the grounds surface?. Flows are year-round?
t13 0 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: 1-j
For City Staff Use Only
1. Plan Check Number, if ap licable?
2. Site is Zoned? (� F
3. SCS mapped soil "(s)?_ h0t 5- -Alderwaod -urba.-\ J'jkd comalu I To 9-
ef
4. Critical Areas inventory or C.A. map indicates Critical Area. on site? A16,
S. Site within designated earth. subsidence landslide hazard area? /V()
DETERMINATION
STUDY REQUIRED WAIVER
Reviewed br. '-25%rje� I- Date: 51-1 k Z"61-
#P20
City. VEdmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Ile 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 the application to the City.
The purpose of the Checklist is to enable City sta'ff 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
M.XUMENraBMDMf1na
u 'mr ERM9
Date ReceWed:
City Receipt#:. .42
Critical Areas File #:
Critical Areas Checklist Fee:-- C$135 * 00
Date Mailed to Applicant:
A property owner, or his/her authorized representative,
must'filVout the checklist -'sign and date it and submit it
to the City. The City will review the checklis� 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 !forrn. In
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant� and his/her/its heirs, and assigns, 'in consideration on the processing of the application agrees
to release, inderrinify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false,' misleading, inaccurate or
incomplete information ftmiished by the applicant, his/her/its agents or employees.
By my signature, I cer* that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANTVAGENT�0--�X� ��l W4Lat--�— DATE-4- o 4
W
Property Owner's Authorization
By my signature, I cer* that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
,SIGNATURE OF OWNER A4--.,O J) DATE a?- -0
PLEASE PRINT CLEARLY
Owner/Appficant.-
'Z> A N DQA 9 F—LL I AJ C— 14 A -
Name
I �5 (�s �
Street Address
6� r�,-cr�s,
city State zip
Telephone: DR--kp - � I � -'z� -7-
Email address (optional):
Applicant Representative:
Name - - -
Street Address
city State zip
Telephone:
Email Address (optional):
0
0
STRE FILE
OU 7— Ojc::� 4 C�S�,�JS 1WkV
STREET USE PERMIT APPLICATION A14Y 6
NAME OF APPLICANT: m/ 1/1/44
leek) 111AIG A
NANM OF B`USINESS:—z:d-,/wa7dLs O-Asl
MAILINGADDRESS:
CONTACT PERSON AND PHONE NUMBER: I —
— 10 � kd-l& (17 1 k
ADDRESS OF PUBLIC USE:
Describe the public pla�ce of portion of public space to be utilized:
I- ,, 11 4
Specify the type of use desired Is I 5,A) — e Y- �,s kDq,
Specify the length of time for use: 4 12L
NOTE.- The issuance of this permit is understood by the applicant to be of a temporary n(ature and that no vested right is
granted 3-e 's;
1NDFJ1YJYT.- The applicant understands and by hislher signature to this application, agrees to hold the City of Edmonds
harmlessfrom any injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may
be made against the applicant or the City ojEdmonds, or any of its departments or employees, including but not limited
to the defense or any legal proceedings including defense costs, court costs, and attorneyfees by reason ofgranting this
permit. In addition, the application understands that the City shall be provided a Certificate ofInsurance to indemnity
and hold harmless the City of Edmondsfrom all claims andlor property damage, and naming the City of Edmonds as an
additional insured
CODEAPPLIC4 TION.- By signing the application below the applicant warrants that s1he has read or had the
opportunity to read Chapter 18 of the Edmonds Community Development Code and s1he understands that all terms of the
adopted ordinance are J . ncorporated herein as ifsetforth in full and this application andpermits therefore are subject to
the terms of that Chapter.
A I - & _Oe-llet 61-w� Y--A(-�
a1x-4W;1'1t& "0'64'e-
STRUSEHO.DOCJLG/2-95
SIGNATURE OF APPROVAL ]PROM ABUTTING PROPERTY OV,7NERS
When applic^able, if the street use proposal directly impacts any adjacent business or private property
own6i t6'applicant must obtain written approval from the affected parties. This requirement is
evaivated, by City Staff after the initial submittal of the application.
Signature Address
Signature Address
Signature Address
Signature
Address
DO NOT WRITE BELOW TFUS LINE --FOR CITY USE ONLY
Planning Division Review:
ADB#
Approved By Date
Public Works Review:
Approved By LIX-, Date 5 - 4—!is
Fire Department Review:
Approved By —Date
Police Department Review:
Approved By Date
Permit Coordinator Review:
Certificate of Insurance Verified
Engineerin Division Review: Bond Required Amount $
9
Approved By Dated
Remarks or Comments:
19 1 MMJ!
RELEASED BY
DATE OF ISSUANCE
RECEIPT
&9-'00:
STRUSEHODOOLG/2-95
MAY.,.,11-98 MON 04:12 PM HALL-CONWAY-JACKSON INC, FAX NO, 2066WI6 P.01/02
Date:
Recipie
compa
Fax nu
From:
0
HALL-CONWAY-JACKSON, Inc.
INSURANCE BROKERS
9709 3rd AVE. N. E. * SUITE 502
SEATTLE, WASHINGTON 98115
P.O. Box 76978 Saatft, WA 98125
Fax (200) 625-1316
Fax Transmittal
-4
P.O. BOX '(5978 SEATTLE. WASKNGTON 98125--0978
(ZM) 527-Z444 - (aM) 8r7-8024 - FAX (200) -520-1�10
MAY'r-11-98 MON 04:13 FM HALL-CONWAY-JACKSON ING, FAX NO, 2065*16 F.02/02
I
HALL-CONWAY-JACKSON, Inc.
9709 3rd AVe N, e. SUITO 6CY.2
SEA7LE. WA8HI NO, TON 96115
may 11, 1998
TO: Janine Graf
I City of Edmonds
RE: Edmonds West Tavern
William & Kathleen Aldrich DBA_
This letter is to advise you that once the captioned establishment requires insurance, we wiff include
the City of Edmonds as Additional Insured Aith respect to the outdoor sign. A Certificate of
InsLo-ance will be faxed to you at that time reflecting this interest and will reflect a General. Liability
litnit of sj,000,noo,
Should you need anything further in order to expedite the issuance of the Aldrich Business License,
please contact ouroffice.
Thank you for this opportunity to be of service.
Sincerely,
s !,Ee B
he Br=ewnith
wV d
Commercial Accounts
for Steve Conway
Vice President
lb
P o eOx 7.5Va SEATT! F, WASHuGTON 9�i?�-Oqm
877-W24 - FAX �2,-A)523-131-53
,20C) 527-2444 - (800�
8 9 0 - 19 q
0tv of Edmond*
RIGHT-OF-WAY CONSTRUCTION
PERMIT 96- 2-23
Permit Number.
L%ue Date:
r'JG 13 1996 lik
ENOJNWeM�,JVicinity of Construction: 411el &AIA J ?T, a
B. Type of Work (be specific): &9W_.1E ur-p-
C. Contractor: 4A.,ug JW1_<4A1 .10'A�K
-&-a
Mailing Address: (9
State License#: 11'F_ -AIr- -klp( LwEg
D. Building Permit # (if applicable):
Contact: e&&ne (,'AN9
Phone: 7W- Z2�-3
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable): OM
E. Pi'Commercial E3 Subdivision El City Project E:] Utility (PUD, GTE, WNG, CABLE, WATER)
F1 Multi -Family [:] Single Family I n Other
INSPECTOR: J INSPECTOR:
F.' Pavement or Concrete Cut: , Bles 0No G. Size of Cut: x 2W H. Chargq�,$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmondg harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the defense ofany legalproceeding8 including defense Costs, and attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETEO B Y CITY FORCES, A T WHICH TIMEA DEBIT OR 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 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 thepermit requirements and thepink copyof thepermit will be
available on si at all ti for 7tpection purposes.
I h
Signature: Date: 05-/_
ntracto-r or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
r VIM 1,L I I
APPROVED, BY:'
TIME AUTHORIZED: VOID AFTER AVA 9- J�DAYS
�J
SPECIAL CONDITIONS:
?I
COMMENTS: OL(A
DATE: 94
f
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND III:
I
'r .
RESTORATION FEE:
I I.b
3
PERmITFEE
TOTAL FEE:
RECEIPT FEE-
-70
I SSUED BY:
AAA 12/t
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Eng. Div. 1994
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Date/Time M! j.q / i !?';A (17:51
jnh
�1-.e: 086/1-/376 08:00 R-arl.cle; 8-51
Name, ERGA3 CAROL
Address; 418 hAIN STREET
r.
Seelr-p-ll First%
AdditionalWork:
CalieF; CAROL ERGA
Bi Ilinn: PAY at time o� Service
Taken By: TERESA
ProLlpffl!
I Ul- . SiEWERLINE REPLACED
Driver! GARY2
Time oi Comp,.
Home Ph- 360-562-120-3
2 06 - 2. 7 8 - 7 5'0-'4
6112/�64H.E- ALLEY BEHIND T?,P BAKERY IS WHERE IT IS, THE �ITY HAS
r L-
ALREADY BEEN OUT Tfl ERE AND DID TH
. I L ..E- VIDEO CAM AND SAW THAT THE TILE
1 N 7 HE I I N E WAS BROKE, THIS LiN" IS CONNECT-T) TO TWO RUSINE5�IBAKrRY
L
AND TAVERN' AND IS ALSO UNDER THE ERLACKTOP3EPLACEMENT OR REPqIR
rl ATI:VP;, I' Ni:EDED. TP vi
DAUGHTER IS BAIR'BARA- 35.4-0556
CELL PHGNE FOR. CAROL -
APPLICATION
for
The City of Edmonds SUDE SEWER PERNaT EASEMENT No . ..........................................
NEW CONSTRUCTION C] REPAIRS E]
Mr. Kelly's West CONTRACTOR --- ---------------------------------------------------------------------------------------------- PERMIT No . ......................
OVIrNER ------------------ - ----------------------------------------------------- I ---------- -------- * --- *
AD -DRESS ............... 4.1.4 ... M.ai.n .... S.t-....- .................................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAMEOF ADDITION .........................................................................................................................................
0
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Dye Tested On Sewer
June, 1972
Approved:
DATE.. ............................................. By � .....................................................................
March 1, 1995
Mr. Richard Orrison
Edmonds West Tavern
414 Main St.
Edmonds, WA 98020
Dear Mr. Orrison:
The Fire Department has recently inspected your establishment and surveyed the
anticipated use of the Clark Radiant Electfic Broiler appliance. The Fire Department does
not require the use of a ventilation draft hood for this appliance. It is felt the "comparable
amounts of steam, smoke, grease or heat' (Uniform Mechanical Code Sec. 2003) will be
negligible due to the size and capacity of the appliance.
The following are the Fire Department requirements regarding your broiling operations:
1 Direct plug-in to a permanently installed receptacle.
2 Maintain a clear and unobstructed means of access to the electrical
panelboard.
3 Maintain access to a conspicuously mounted 2A:10B:C dry chemical fire
extinguisher mounted within 30' of the appliance.
4 Operations, maintenance, clearances and use of appliance are to be in
accordance with manufacturer's instructions.
5 A minimum daily cleanout is required. More frequent usage requires more
frequent cleanout.
Thank you for your assistance and feel free to call me at 771-0215 (ext. 301) if you have
questions or concerns.
Sincerely,
John J Westfall
Senior Inspector
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DEVELOPMENT SERVICES CTR.
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PERMIT EXPIRES
CITY OF EDMONDS
USE
ZONE
PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESs414 M. S f
OWNER NAM
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PIAT NAME/SUBDIVIS1
OT NO.
LID NO.
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MAILING AOVRESS I-J
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PUBLIC RIGHT OF WAY PER
OFFICIAL STREET MAP
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RW Pernalt Required
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CITY ZIP
TELEPHONE LjD6.'7j5.,,3t9g
EXISTING — PROPOSED
Street Use Pemit ReWd.
Inspection Required
Sidawak Required
InnG.
A%a olpq-,
REQUIRED DEDICATION—
FT
Underground
wiring required
NAME
METER SIZE
LINE SIZE
NO. OF Fl �RES
P,,ARF EQUIRED
I no S IQ V1
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YE NO 13
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE
FOR EROSION CONTROL/DRAINAGE
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CITY
LEPHONE
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ENGINEERING REVIEWED BY
DATE
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ADDRESS
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FIRE REVIEWED BY
DATE
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PITY ZIP TELEPHONE
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STATE LICEN3E NUMBER EXPIRATION DATE
CHIECKED.118Y..";,!
VARIANCE OR Cull
INS ECTION
REPS
BOND
POSTED
YES
$
$EPA REVIEW
SIGN AREA
HEIGHT
PROPERTY T X ACCO A R EL NO.
SL+ NT. o -I---
COMPLETE
EXEMPT
ALLOWED
PROPOSED
ALLOWED
PROPOSED
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ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (F6
FRONT URSIDE REAR
A6DM6N
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
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REMOCEL
MULTIFAMILY
SIGN
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�OT AREA
I PLANNING REVIEWED BY D t3f- I I
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-!L] GARAGE o RETAINING WALL F RE SPRINKLER
CARPOO.. ROCKERY F:RE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
[P
4NUMBER
CHECKED BY
TYPE OF =14iT-RUCTION
9ccu
GROUP
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NUMBER OF
CRITICAL
OF
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DWELLING
AREAS
SPECIAL INSPECTION
JAREA
OCCUPANT
to
STORIES I
UNITS
NUMBER
REQUIRED
QUI rl YES
LOAD
DESCRIBE WORK TO BE DONE
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REMARKS
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PROGRESS INSPECTIONS,PER UBC 108/FINAL INSPECTION REGI D
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Description
FEE
Description
FEE
Plan Check
—710--State
Surcharge
HEAT SOURCE
r—.-x 5
GLAZING %
1
LOT SLOPE %
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Building Permit
67cA
City Surcharge
PLAN CHECK NO, 0 3 _
VESTED DATE
Plumbing
Mechanical
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THIS PERMcr AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
0 E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
70 %,1"
9
DOMAIM (CUIRRS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: 180 DAYS
PERurr Limm i YEAR - PROVIDED WORK IS STARTED WITHIN, 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAW ON -BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
Z
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
0
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 MODIF� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
� 2
0
X1
NOR LIMIT IA ANY WAY THE cilys ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt III
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORAECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION
APPROVAL
THE OWNER. III AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permil until signed by thie,
TION; AND IN OING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her oeputy: and Fees are paid, and
.IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
'WORKMEN'S
FOR INSPECTION
receipt Is acknowledged In space provided.
P)MPENSATION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
R R AGENT) I
DATE SIGNED
(425)
LSIGNPTURE�(O%V
771-0220
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ATTENTION U
IT IS UNLAWFUL TO USE OR OCCUPY.A BUILDING OR STRUCTURE UNTIL
M 133
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A FINAL INSIPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL -FILE YELLOW. INIPECTO.'R
04/02
PINK -OWNER GOLD -ASSESSOR
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