415 9TH AVE S (2).PDFIIIIIIIIIIII
9941
415 9TH AVE S
0 &
ADDRESS: 1#5--q,", lyyl, _S
TAX ACCOUNT/PARCEL NUMBER: 71-
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
P4�*Iwlkg
CRITICAL AREAS: L4.1 DETERMINATION: E] Conditional Waiver E] Study Required KIWaiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
5
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
/I /, /Yjw)
SHORT PLAT FILE: LOTA? 31, q0 BLOCK: -71
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
m
LATEMP\DSrs\Fonns\Street File Checklist.doc
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Critical Areas File #: -,;ZOW- /.?- Lo
Critical Areas Checklist Fee: $45.00
Date Received by Dev. Serv. Dept: �,/ i
City Receipt No: /5-9s-/
Date Mailed to Applicant:
CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to —be filled put 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. RECEwED
eA;
CTS.
The purpose of the Checiffiff-It ty staff to
'miwiWki
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:
Name
9 1 � U-)0J V\\,+
Street Address
EJWC'�6 Kcgo
City State Zip
S- ?-71
Telephone
Signature
Date 71A I I � QF-2-
Name
(f I )— 17
Street Address
F&"n Y1 r(.5" x A 0 -2- 0
City State Zip
Telephone
Signature
Date
d:receptiortqana/CACLHandout.doc
Revised 4/10/2000
FILE NO.
&tical Areas Checkliso
----------------------------------------- ---------------
Site Information (soils/topography/hydrology/vegetation)
I. Site Address/Location: 4 IS I J u e— -S, Lok 93Kon
2. Property Tax Account Number: 44 3 '�:L_ Q -7 Q 0 0
3. Approximate Site Size (acres or square feet): go 0
4. Is this site currently developed? yes; no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire 'site.
v,"* Rolling: slopes on site generally less than 15 % (a vertical rise of I 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
I 0-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: d Approx. Depth:
_41,
What season(s) of the year?
8. Site is in the floodway CV floodplain Ato of a water course.
9. Site contains a creek 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) )je _S L A LV12 5�h Y
11. Obvious wetland is present on site:
77 17
CS
N. .0
ps
.-C
.Y
Mo*"
.... au
-DETEAM. M. A4-,T-.10$*-,:, Y:!
C.
ewed.
Jr, 7,':::
M;.2-03—
ACVhLdK PAV JQM/97
0
PLANNING DATA
NAME: I -A"
SITEADDRESS: L4i,__,-
PROJECT DESCRIPTION:
REDUCED SITE PLAN PROVIDED?: (Yes / No)
MAP PAGE:.,;1_2ta CORNER 1_01��/ No)
TE
0
ao 15
PLAN CHK#nQ -
FLAG LOT: l(Yes A�gp
ZONING: '046—to — CRITICAL AREAS DETERMINATION #: I -m- Cg'
Ll Study Required:
7EXWalver
LlConditional Waiver
SEPA DETERMINATION:
Ll Fee
Ll Checklist
APO list w/ notarized form
Ll (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Bailinger)
Exempt
SETBACKS:
Required Setbacks: f
Street. q n Left Side: 15 Right Side: aO Rear:
Actual Setbacks: 15(
StreetQCL Left Side: Right Side: :;2- 0 Rear: 10
Street map checked for additional setback required? (Yes / No / DN )
J DETACHED STRUCTURES:
ROCKERIES:
F ENCESITRELLISES:
BAY WINDOWS / PROJECTING MODULATION:
STAIRS / DECKS:
PARKING: Required: 2— Actual:
So -7-7 .' (R -,,P --.-)
BUILDING HEIGHT: W
Datum Poin v41 q Qj Datum Elevation: -79
Maximum Allowed: _-3 C-9 C5 I Actual Height:!a I
A.D.U. CREATEWy"(N_;)/ Yes)
Q
SUBDIVISION: LL- - 2_002 — -7 9
LEGAL NONCONFORMINQ LAND USE DETERMINATION ISSUED: (Yes / No)
49
PER"A b t,,+s -b& Vl-jL %,e,6-± e � sz �,j� -P -A- +-0
. -L
dc= -N--%f A j � e e') � t . -i A . r-I tW a � i�
Plan Review By:
41- �_�
NewBPP1anningDataForm.D0C
0
I-
jn;7-71�� ��
S.=-;z G �lq , - �
PL X� 5 'm
�S4 L
9th & alnut
415 9th Ave. S. Edmonds, WA 98020
Abbreviations Project Team
Pr icct Scope
Project Location/Adxlress
Project Tax No.
ZMW= Legal Description
MoMg & Building Codes
VICINM MAP
Drawing Symbols
A
L
0
Building Height Calc.
Contractor Coordination
Notes
IMF=
ST8EET FEB I
FILE
PERMIT Cou,-�
ALDER STREET N 89'55'40" W
- — - — - — - - — - — --
'r3 " BRASS DISK,"X",
FND. (7-22-92) ZONIING : RS-6
i 1 1 1 1
Sheet Index
Insulation Data
IT—
,'ZrA le
Deferred Submittals
& Separate Permits
ONINNVld AG (13AOUddy
i -
PUBUC
----------- L ----------- L -�j
ALLEY
CL
7Ej
W
I
C)
p
z
A
1Q.- 4
Q-Crt-1 G,'UL-k--e
WALNUT STREET
SrM PLAN 101,
0 A1.1
APPLICATION
The City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS LID NO - ------------------- ASMT. NO - ------------------
OWNER ------ ---------- knk��- E=-�� ---------------- CONTRACTOR E? .. f:.� ------------------------------ PERMIT NO.
JOB ADDRESS ............................... LEGAL DESCRIPTION: LOT NO. -9�Ne .... BLOCK NO . ............. 71- ................
T%TAMlP nP AnT')TrTn
---('c-,)
(avcROGIM-)
........................................................................ -------------------------------------------------
---------------------------------
....... I By ...... .
.............
APPLICATION
lor
EASEMENT -NO - -------------------------------------
SIDE SEWER -PERMIT
NEW CONSTRUCT -ION - Qj: REPAIRS E] LID NO.-.-., ------------------ ASMT. NO.
-OWNER A.A Y!i- ..... - ----------------------------------
JOB ADD SS .......
%E ......................................
CONTRACTOR 6_-A ...... -------------
............ — ----------- ..................... PERMIT NO . ..... ..........
LEGAL DESCRIPTION: LOT NO.Jtf;�l.t-YL -------------- BLOCK NO - --------------------------------- --
---------------------------------------------------------------------------------------------------------- ...............................
NAME OF ADDITION --------------------------- ------------------------------------------------------- -------------
------------ --------
Approved:
DATE....................
...... By ....................... . ...
......................................
11/75
J
C EDMONDS SIDE SEWER PERMIT
ITY OF
WATER -SEWER DEPARTMENT
PERMIT
tion.
covering any portion of the construe,
-2525 for side sew BEFORE
y inspections.
er inspections
Call 775 t. NO Sat., Sun., or holida
vided within 24 hours after requs
Inspection will be pro
..........
j . . ......... ...................................
A ........................... . ................... ..
.....................
gS LOCATION OF CONSTRUCTION ----- ; ..... - "': . % . . - I I -
ADDRE .................
-----------------------
............ .... ....
TION ....... ............
PROPE4TY LEGAL DESCRIP ..................................................
............ . ...........................
........ .... .................
. ..................
......................
3�? --------- C:n ...............................
........ . ....... -- - ---------- - -----------------------------------------
ER---
... OWNER AND/OR BUILD-
............................. ................... .......
..............
............ ................................
.................. .............................. . ... ..
-------------------------------------------
_r—'RA'MWS NAME & ADDRESS ---------------------------
(Y-
----------- 119_7!/3�, for repair and/or conneCtiOn of a side sewer to the city dtary sewer
p ,liassion Is grg .... ... . ...........
tntned ---
"tem in acACordance wfth City of Edmonds ordinances.
a
construct
employed to
D TO THE FOLLOWING: A licensed Side sewer contractor must be
NTION IS CAM sewer inside property line.
rty may obtain a permit to i . , _
NOTE No. I —The owners of the prope before it has been inspected.
Do not cover any portion of sewer from the City Engineer's office.
side sewer in street area. ion of Ught_of_Way permit obtainable
-of-way requires an Invas
NOTE No. 2—All work performed in city right and Regulations governing side sewers when you get Permit No bends in grade
hes inside property line; minimum grade of 2%.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inc responsible for failure due to improper
sharper than % will be permitted.
restored to original condition. Contractors shall be
st be water settled and surface of street
NOTE No. 5—Trenches in street mu lop within one year of completion.
work which may deve permit, or to do any work on the main sewer or its appurtenances except to in
ork than is provided for in the
NOTE No. &—It is unlawful to alter or do any otber,w
sert the pipe into the wye.
------ By ---------------- Date ---------------- ------------------- By -----------
.................. By ---------------- D& --- ---- -- -- - -----------
DILSArPROVED El Date... -- ----- .........
B .....................................................
y ............
. . ........... . ..... . .............
...............
APPROVED
..........................
------------------------------------------- - --------------------------------------- -------------- - ----------------
Remarks: ....... - ------- -------------------------- - -------------------
.... .......................................................
z" ........................................ . .. ....... ....................
.................
............... . ........................ ......
. .................................................... Inspection
o Request For
rm Performing Construction PRIOR T
BOTH Permit Copies MUST Si d By Owner of Fi
.... .... hereby certify that the side sewer installation constructed under this permit
------------
ct n rm. F r ing Construction)
e City of Edmonds.
ger of Con't all governing ordinances of th
wp.-Installed in accordance
of..... I .1--n - - --------------------------------------
Dated this ........... ..... day
For Inspection
-ted under this permit
of "Cont.tinjj!;�— e
wi h
..........................
Power 0 Sewer 0, Other
hone E],
Gas Telep
Check BEFORE you dig for: Water n,
7— - — - — - - =_
-�r .77
7-- 7.t
mi6l
�v-Q' D E' STREET
9*55'40" W
BRASS DISK9" xII,
FND. (7-22-92) ZONIING RS-6
2
------------ ----------- --
PUB�IC ALLEY
u;
89*55'29" W F;7
54.70'(P.)
N 8r5VI8W
Nom.
MTC14 DENOrM TWE HM4 ADDITION r2M)
WALNUT STREET T�R W.OT OF TM 1310 , to m ow.HA
5. PK NAIL wom OULT IN wr7 LDW
BRASS DISK. " )r.
FND. (7-22-92)
1,V rIM PIAN
4
101
9
z
Ejmclw�
Dm
-A pey*m
02A&M 04
SHIM Tnm
am"
9 SCAM
DRAWN By.
All maw
aw
DA-M
aMa= By'
12/wam
to
�IRCr NO�
FRE NAME
DEC 2 9 2003 L'i 97Zcv--)fj
PERMIT CoUNTER 4% 9 OL.N,-e-- S',
C-C &A-v%'m C� > N LO ft q,9 o -Z o
ft
To: City of Edmonds il
Re: Letter sent about a citizen's complaint regarding remodeling of my residence j U L i "-' 2005
without a building permit PERMIT COUNTER
My name is Miomir Tomici and I am the new property owner of the home located at:
415 9h Avenue South, Edmonds, WA. 98020. The home use to be an Adult Family
Home. The home had a very bad odor and the walls were scratched and dirty. The home
was remodeled, as I understood from the previous owners, in 2003.The only work I have
been doing is repainting the house inside, repainting the moldings, changing from carpet
to laminate floors. I was told that for this type of finish work I do not need a building
permit from the city. I have been reading the handout on exempt work and I assure you
that I am in compliance with the City of Edmonds building permit rules and regulations.
Feel free ad contact me at: 206-240-3036 if you have any questions.
07/11/05
STREET FIL�E
RECEIVED
........ ..
JUL 3 0 2004
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
119 IN I lilt N oil 11
200406160162 2 PGS
crry, tLr—RK 06-16-2004 09:35am $20.00
. .......... CffY OF-EDMONDS SNOHOMISH COUNTY. WASHINGTON
-.01 r
�OVE NO.
E.QM W 8020
COVENANT
..f.ojc,Adult Family Home's Second Kitchen
Whereas, the Grafktor(s�.
.,refe.rred to as "Grantor(s)", have received a Building
Permit# 02004nnots f 1PAODerty.which is zoned A Ile family residential, and is
0 ro,
d
located at -41 q S Utr
tax account parcel number, -7/*Q -1 i?Q 6 and legally
descnbed as follows:
t74
Lo 7- .3 q $:4.,0 de- -71
3 47 e.44, Ak�.. tC4_)
y—
.... ... ...
Whereas, the City of Edmonds has receivea . A-b-*U�'ldin&_p.er_i4it application for an Adult
Family Home with a second kitchen to be located iq,in ikisfing single family residence
in a single family residential zone.
..............
Whereas, pursuant to WAC 388-76-190 an adult famiji . hom-'e"Is considered a residential
use of property for zoning purposes, and are permitteil *' % :
in, artai'x6ned for single family
dwellings.
Whereas, the City desires to approve utilization of a second'�kitchtif in th-e Adult Family
Home as a reasonable accommodation to the facility as care �r_*�-_vi(tef *** - "' *1
.. P thedisabled for
so long as the second kitchen is utilized, and only utilized, in con'j�jr6io.irwith the Adult
Family Home use.
Therefore, in consideration of the City of Edmonds, Washington app
rb*ipg the,s*61coad.
kitchen as a reasonable accommodation by issuance of a building permi toe-6ra`
n.tars
agree as follows:
>
This covenant and all terms hereof shall be binding on Grantor, heirs, assigns
2ind successors in interest, and shall be deemed to run with the land and bind all
Ature owners to the real properties described above.
4.
..Tfriv cavenant shall be recorded with the Snohomish' County Auditor and
ra .011'l-ray for all recording fees.
3.
Oratitor %
r,,h0%,ebY6-venant that the kitchen on the lower, basement floor of the
ijubjedi residence-caA. be used only in conjunction with the Adult Family Home
shall be removed immediately upon termination of the
Adul�t'Fath�iply.-Il-.om'e'.gtate License # -5-0 6-0 0 for the subject facility
or cessatid� of -U'S'"C-af the property as an Adult Family Home, unless, or until,
"
zoning f ' 16'*' 9 *
:kws w #�eMtse.
4.
The provisi6ps of parkir.aPhNIgbove shall be specifically enforceable in the
Superior Cotirt-afSqofiomigh County. The prevailing part shall be entitled to its
attorneys' fees in:s�ch.a"*
procee, ng.
5.
Grantors acknowledge qiIi-d-agree'that-ipproval of the second kitchen for the
Adult Family Home tht'"' d* of this Covenant are a reasonable
accommodation of Gran't.p6'.righp-is a care provider to the disabled and of its
clients' foreseeable needs. -.The.Crantors, theeif4pre, on behalf of themselves, their
successors and assigns do h6eby waive *4 a it! claims of the Americans With
.�d
Disabilities Act or the Washington V`
La v Agivin�t Mcrimination which they may
have as of the date of the executiqln' of th6 Coi6aftt and promise to hold
harmless and indemnify the City,%I'q oi'ficir's', a **
and employees from any
...Onts
cost, claim or liability which may beingwrrvc
.1-hy-dUense of such a claim.
By signing and execution of this Covenant, the pgrtiiOciet4 agree that Grantors are in
compliance with existing zoning regulations.
Sig]
Subscribed
4 before me this day of IA
ap
%C, Nota lie illd for the Statof
fill wo,
#
'11110P MON Residi g at &5�aakk, we-
SIKEET
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 FAX (425) 771-0221
Website: wwwxi.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
C. Planning - Building - Engineering
January 20,.2004
Mr. Ward Brown
415 9th Avenue South
Edmonds, Washington 98020
RE: Building Permit #2004-0015
Dear Mr. Brown,
FILE
GARY HAAKENSON
MAYOR
The purpose of this letter is to confirm the use of that portion of existing north basement
(previously used as a two car garage) area in your home where you obtained remodeling
building permit #2004-0015.
Prior to issuance of this permit you and I had several conversations regarding your
preliminary proposal and specifically on code issues related to sleeping rooms. I recall
you inquired about creating a new sleeping room in the north part of the basement area
space, but as we later discovered there were several major code issues (specifically
egress, natural light and access directly into a garage) that would need to be resolved in
order for this area to be converted into a sleeping room.
On January 5, 2004 you obtained a remodeling permit for this area of the house and on
the approved plans described the use as 'recreation room'. Be advised, this room use is
for recreation purposes only and shall not be used as a sleeping room. If you have any
questions please contact me immediately at 425-771-0220 extension 1226.
Sincerely,
6 � � 4—* --� T—-
Jeannine L. Graf
Building Official
Incorporated August 11, 1890
Sister Citv - Hekinan. Jamn
'y 9 0 - 1 9 9 -
r 1 :9 %, Ly U JL2,U111U11UW
-OF-WAY CONSTRUCTION
PERMIT Permit Number:?
Issue Date: /c� 2_3
A. Address or Vicinity of Construction: 415 9 Av. S. (9310130)
B Type of Work (be snecific): Install New Service
C. Contractor: Washington Nat 11. Gas Co. Contact: Frank Swan
MailingAddress: 815 Mercer St.'Seattle.Wn Phone: 224-2278
98111
State License #: Liability Insurance: Bond:$
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. -'M Commercial E] Subdivision El City Project Pq Utility (PUD, GTE, WNG, CABLE, WATER)
Fl. Multi -Family E] Single Family Other
INSPECTOR: INSPECTOR: t _,)k,�"i4
F. Pavement or Concrete Cut Mes E]No G. Size of Cutt3)2 x4 H. Charge$
@ water & 1) In pavement
APPLICANT TO READ A
INDEMNITY. Applicant understands and by his signature to this application, agrees to the City of Edmonds hat I
to ?n ess W fa� damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that maybe made a he City of Edmonds, or any ofiO34, ;-2;x5or employ-
ees, including or not limited to the defense of any legal proceedings including defense costus, Zaattornneyfees by reason of granting this permit.
THE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP A ND MA TERIALS FOR A PERIOD OF ONE YEA R FOLLO WNG"FHE FINAL INSPEC77ON
A AD A CCEPTA NCE OF THE WORK. ES77MA TED RESTORA 7TON FEES WILL BE HE U WL THE FINAL S7REET PA T!Iff C
YMPLETED BY
C17Y FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR lAibAWirE't0 THE APPLICANT. -
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Departin
Work 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"w6rking'. day;
NO EXCEPTIONS.
I have read the above statements and understand the permit re�qu'irements and the pink copy of the permit will be available
on site at all timeSfor inspection purposes.
Signature: March 8 1993
(Contractor or Agent)
UAL-L, I)IAL-A-DI
R'1'0 BEGINNING WORK
I"
PERMIT
Engrg. Div. 1991
1' i'
FIELD INSPECTION N S (FIR I I I - Route copy* to Street -q.ept.).
Comments:
I Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by W.:
Work. Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng., Div. Ju
0. , -
0
Addendum to City of Edmonds
Right of Way
n
=.LAUJ.T- Application
Submitted by:
Engineering Aide
Washington Natural Gas
4115 1�3 L,\-j
0 r
N DS
1"'�"-VV CON&T,
S T I N' G
OE��A
'WNG to window
Water main de�
unknown
gas main
(ZK4� ?4�JQ: C-U--�-S
&-:T- C-4r-=,
Key:
-w-
water
-9-
gas ,
-ss-
sewer
-e-
water hydrant
0
water valve
815 Mercer St. (p.O. Box 1869). Seattle. WA 98111 (206) 622-6767
W#K CITY OFEDMONDS I$
PUBLIC S DEPARTMENTj ENGINEERINO) I -VI SION
'4 FnR RTCHT-nF-14AY r(NqTP11rTTf)N"PPPMTT
THIS PERMIT MUST BE AVAILABLE AT THE JOB SJTE FOR INSPECT -ION PUk'POSES
Applicant to Complete Parts A and B
A. Permit to be issued t o
For Work at :(address or vicinity)
Type of Work to be done:
(attach drawing when applicable) <'
Time Required Start: Finish:
Owner:
Name
Mailin
Address
C"Ity State Zip Telephone Number
Contractor:
Name State License Number
Mailing Address
City State Zip Telephone Number"
B, INVEMNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including or not limited to the defense of any legal proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and restoration in accordance with City Code. A
24-1�our notice is required.for inspection by Engineering. Call 775-2525, ext. 220.
I understand that this permit must be available at the job site for inspection
purposes at all times.
-4:
Signature:
Date.
Owner or Agent
I TO BE.COMPLETED*BY ISSUING AGENCY:
Date Issued:l'-/ . 1� - ,
Security Bond: 2/7/
Time Authorized: ';�/,
0
Permit No.: Fee: Z�
10-771v (Reviqed)
APPROVED B
Date.