535 HOLLY DR.PDF11111111111111
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535 HOLLY DR
STREET FILE
, 4�1
6 6
PLANNING DATA
NAME:
SITE AFD_
PROJECT
?.-I -r-_5
REDUCED SITE PLAN PROVIDED?(V / No
jL_j
MAP PAGE: 0 :5 CORNER LOT: (Yes FLAG LOT: (Yes I
ZONING: Co — CRITICAL AREAS DETERMINATION #.QA- q.',) Ot E,
Study Reguired:
Waiver
UConditional Waiver
SEPA DETERMINATION:
L3 Fee
U Checklist
L3APO list w/ notarized form
L3 (Needed for r,00 cubic yards of grading, Shoreline Area- site within 200 ft. oi Puget Sound or Lake Ballinger)
Exempt
SETBACKS:
Required Setbacks:
Street: Left Side: Right Sidfr Rear:
Actual Setbacks:
Street: t1"LeftSIde:S1 Right Side: 1B Rear:
Street map chocked for additional setback,required? (Yes I No I
0 DETACHED STRUCTURES:
UROCKERIES:
U FENCEtrrRELLISES:
U BAYWINDOW PROJECTIN MODULATI
Ll STAIRS / DECKS:
PARKING: Required: —Actual:
LOT AREA: 14 1 q
LOT COVERAGE
BUILDING HEIGHT:
Datum Point: —Datum Elevation:
Maximum Allowed: Actual Height:
A.D.U. CREATED?fQ Yes)
SUBDIVISION:
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: (Yes / No
O,r A
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Plan Review By. �Ie- f I
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City of Edmonds
Plan Review Corrections
Plan, Check#: 02-479 Date: October 15, 2002
Project Name/Address: Giles / 535 Holly
Contact Person/Address: Pamela Giles / 535 Holly Dr., Edmonds, WA 98020
Reviewer: Star Campbell Department: Planning
I have revi * ewed your building permit application for the above permit. Before I can sign off on
it, I need the following:
You will need to submit height calculations with your application. I have included a
handout on height calculations to assist you. Please note that the "height calculation
rectangle" that is shown on'your site plan should include the attached carpart and any
projecting modulation.
The site plan indicates a I ' "deck overhang" that projects from the rear of the house.
Please clarify what this means. If this is indicating the second sbDry projection to the
rear, the elevations show this projection to be 3'.
Please provide the total area of the existing house footprint including the attached
carport. t-'(0
1-414-- �,� (�_
If you have any questions, pleagedo not sitate to give me a cai�at(425)771-0220.
-Star Campbell
Please make all submittals to the Development Services Coordinators, and provide three
copies of any revised plans or two copies of elevations. Your existing plans and elevations
may also be red -lined.
�VoV-0
A-�
DATE FAXED (Affach fax transmiftal���� PAGE 1 OV-1—
CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 - J206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT.
Public Works e Planning e Parks and Recreation * Ehoineering
8 9 0 . 1 9 9 - '
LAURA M. HALL
MAYOR
PETER E. HAHN
DIRECTOR
LETTER OF TRANSMITTAL
Date: June 4, 1992
To: Jeff Bendock
17109 Sealawn Dr. STREET FILE
Edmonds, Wa. 98026
Subject: Critical Areas Checklist
Transmitting:
For your information: xx
As you requested:
For your file:
Comment and return:
Note attachments:
Comments:
Planning Division
Di'ane Cunningham
Incorporated August 11, 1890
Sister Cities International — Hekinan, Japan
8 9 49'Ci
City of Edmonds
Critical Areas Checklist.
The Critical Meas Chedidist 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.
Ile 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,4
the chec4dist, make a precursory site visit,
and make a determination -of the subsequent
steps necessary to complete a development
permit application.
Mrith a signed copyof this form, the
applicant should also submit a vicinity map
of the parcel with enough 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 studies in conjunction With
this Checklist to assist staff in completing
their preliminary assessment of the site.
1 have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Narne
Title
Street Address
City, State, ZIP
Signature
. Applicant Representative:
Narne
Q� 0M �V r_YC_kt3Lr
Title
I -I I Ar vi v-)
Street Address
� C74-). 7 7-7 05
Phone City, State, ZIP Phone
re
Date \S Date
-�3
RECE:IVE:0,
Critical Areas Checklist JUNO 2 1992
Site lnforrriation'�,q/ PERMITCOUNTER
ProjectName: Permit Number:
Site Location: S-1�; ��oUl Property Tax Account Number: 1�45_L703-2_-a-?0-00'5
W -
Approximate Site Size (acres or square feet):
Have you filled out a Critical Areas Checklist for a project on this site before?
General Site Conditions
f�c)
1. Has the site been cleared or logged? 6- Date of most recent action:
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? S (-��5
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 IS% (a vertical rise of 10 feet over a
horizontal distance of 66 feet.)
slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10 feet of horizontal distance.)
—Steep: grades of greater than 30% present on site.
Comments
Hydrology[Vegetation
4. Site contains areas of year-round standing water:
5. Site contains areas of seasonal standing water: 1�1 0 --Approx. Depth:
7
6. Site is in the floodway �J 0 floodplain N 0 of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? N0 flows
are year-round? Flows are seasonal?
8. Site is primarily: forested shrutrs
9., Obvious wetland is resent on site:
p
10. Wetland inventory or map indicates wetland present on site:
11. Critical Areas inventory or map indicates any Critical Area on site: ND
For City Use Only
mixed
STUDY REQUIRED: Critical areas study is required.
CONDITIONAL WAIVER: Critical areas study not required if specified conditions satisfied.
WAIVER: Critical areas study is not required.
Determination Number-. Reviewer
Planner
Rev_31.21TOX_...
STRE
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The City of Edmonds Side Sewer Drawing EASEMENT NO - - ------------------------------- ---------
104-06600 NEW CONSTRUCTION [-] REPAIRS LID NO - ------------------ ASMT. NO - - ---- ----------
OWNER --- -H� --- B, .... VALENTINE ----------------- ------------ ................. CONTRACTOR --- -------------- --------------------------------------- ----- ------------------- PERMIT NO - --------------------
JOB ADDRESS ------ 535 ... ROLLY --- DRI-VZ ............. ---------------------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - -------- ----------------- --
NAMEOF ADDITION -------- — ................... --------------------------- -------------------------------------------------- ---------
DYE TESTED ON SEWER
Approved:
PWW-0001-11/75 (REV.11/78) DATE ------------------------------ — -------- — By ------- ------- - ----------------------------------------
�,�_-.�*ZITY OF EDMONDS
PUBLIC WORKS DEPARTMENT FOR INSPECTION CALL Permit tJ
9I,Dt SEWER PERMIT 775-2525 Ext. 220 Issue Date
WN
PERMIT MUST BE POSTED ON JOB SITE
1. Address of Construction e"
2. Property Legal Description (include all easements)
3. Single Family Residence Multi -Family No. of Units
Commercial
4.
Owner and/or Builder
5. Contractor & License No.
6. Invasion into City Right -of -Way No Yes (If Yes Right-of-
-7 —v�%
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
E-1 7. Cross other private property: Yes No Easement required -
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
04
a. Property owners must obtain a permit to install side sewers on
>4 their property. A licensed side sewer contractor must be employed to
construct side sewers in the public' right-of-way.
b. The side sewer contractor assumes full reponsibility for each
E-4 installation for one year.
W
4 c. Commercial establishment requires a minimum of a six inch (6")
P4
side sewer line.
0 d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
0
e. Side sewer lines must be laid at a minimum grade of 2% (1.15
0 and maximum grade of 100% (450). 0,
E-4 f. No turn in side s8wer greater than 45 (1/8�bend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side s'ewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 1001 along sewer 'line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
-due.,to poor compaction of fill.
..k.. Side sewer must be left uncovered until inspected and approved
by,the-.City.
.1. Inspection during normal working hours only. Two (2) working
days notice required.
Al
DATE:
STR`EET FILE I certify that I have read
and shall comply with the above
PERMIT FEE:
E DISAPPROVED BY: Date:
By: Date:
'A CONNECTION -FEE.:
P4:::) APPROVED By,:;���Date:,-?Z/".;
0
PERMIT MUST BE POSTED ON JOB SITE
Side Sewer Drawing
I'The City of Edmonds
EASEMENT NO . ............................................
NEW CONSTRUCTION REPAIRSX LID NO . .................. ASMT. NO . ..................
.OWNER .............................................................. CONTRACTOR ----- ------------------------------------------------- PERMIT NO.
jOB ADDRESS LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ................
............................
P�jw
-0601-11175(REV.1178)
................. ................................................................................................
NAME OF ADDITION
75
7,
4Z
Approved:
DATE.............. .................
r
E
ME, MO TO:
FROM
—August 31,*"* 1979
Art Housler, Director
Finance Department
Fred F. Herzber
Director of Public Works
STREET FILE
SUBJECT: REIMBURSEMENT OF STREET CUT SECURITY DEPOSIT -
ORDINANCE #1935
R/W CONSTR. PERMIT NO.: 79-126
DATE ISSUED:— 2 / 2 2 T7 —9
LOCATION OF WORK: .- 535 Holly Drive
SECURITY DEPOSIT AMOUNT: . �304.00
RECEIPT NO. & DATE: #1909 7-27/79—
COMPLETION DT. OF REPAIR: July 1979
Please prepare a Treasurer's Check in the amount of $ 226.75
made payable to the following:
B & M Contractors Inc.
21400 Hwy 99
Edmonds, Washington
The balance of the deposit in the amount of $ 77 .25 is to
remain in Street Division Revenue Fund 111-000-000-3897.10.
lv
Admin. dt-1
6PEDMONDS Wit No.
44ZJ�. —2- —z
PUBLIC WORKS DEPARTMENT Issue Date
RIGHT - OF - WAY CONSTRUCTION PERMIT
A.
oAddress or vicini of Construction
15-315- //.*- 'N" -
0 Owner: A122 :C:)
Name
-1-7 Lzl NA
Mailing Address
, lida q W/O 7
City, I State, Zip �ocle
Contractor:
Name
Mailing Address
City, State, Zip Code
0 Permit Issued To:7-J-7-0
• Type of Work to be Done:
• Work in Connection With:
0 Sub or Plat K��ingle Fam I ly
El Comml. / Ind. 0 Apt. Condo.
• Pavement Cut: Yes El No
12,3) -01-86 -CQ-1VC-,V 2-2-1 )�C
State License Number
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
>� . 1B. APPLICANT TO READ AND SIGN
INDEMITY: 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 City of Edmonds, or any of it's 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.
U
W Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
ca following the final inspection and acceptance of the restoration by the Engineering Division.
0
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 to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this permit m st �e available
Signature: —
Owner or Agent
sio for inspection purposes at all times.
'1/ 2, 72-
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Void after days
Special Conditions:
0 --,4- - - I
Ammendments:..
U
0,
2
Permit Fee: 1 1
Security Deposit:
Receipt No.:
Fund. 111 Fee:
Street Cut Dimensions
x I
0 WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
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77
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
—4a
F -yNeAc' 6;';
MAILING ADDRESS
0
CITY ZIP TELEPHONE
NAME
ADDRESS
CITY ZIP ITELEPHONE
IPERMITEXPIRES
USE
ZONE
PERMIT
NUMBER CQM9
JOB
ADDRESS.
q2,jg 0611-1 DIP,
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street use Permit RoWd
EXISTING
— PROPOSED
Inspection Required
Sidewalk Required [3
REQUIRED DEDICATION— FT
underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
1
1
YES 0 NO 13
3
M
W
REMARKS
z
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
(3
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NAME
ICBL#
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EN�tNEERINIII REVIEWED BY DATE
IX ADDRESS
FIRE REVIEWED BY
DATE
Lu
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CITY ZIP,
TEL9PHONE
0
VARIANCE OR
SHORELINE OR ADB�
INSPECTION
'REO'D
BOND
POSTED
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
OYES AO
$
SEPA : REVIEW_.,
COMPLETE , EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED
HEIGHT
�ALLOWED PROPOSED
z
z
64
_j P ACCOUNT PARCEL NO.
ROPERTY TAX
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45 64 00,�? 0 7P MR
NEW RESIDENTIAL.'.�_. PLUMBING [MECH. .
COMPLIANCE OR
ADDITION COMMERCIAL
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
X,
LOT COVERAGE
ALLOWED PROPOSED
1-40 QA4 q tx�q
REQUIRED SETBACKS (Fr.),
FRONT SIDE REAR
,PR6POSED SETBACKS (FT.)
FR N REAR
PARKING
REO'D I PROVIDED
t4c(50
LOT AREA
PLAVNING REVIE'A ED 6r DATE
REPAIR
DEMOLISH
GRADING..
CYDS
TANK
FENCE,:
X F .. T)
OTHER
0 0
AP
AS
Atd;�. "
_rl
GARAGE
CARPO
RETAINING WALL
ROCKERY
F RE SPRINKLER
FIRE ALARM
T7_
-�AL—
(rYPE OF USE, BUSINESS OR ACTIVITY) EXPLAJN:-TWV-e ey' Iz;.T ' &.�5w
- a ,
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CHECKED BY
TYPE q5-j?rION
OCCUPANTO,2�
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196DI-7
117
GROUP
NUMBER
NUMBER OF
CRITICAL y
U "W
0 F _2_
DWELLING
10
AREAS
SPECIAL INSPECTION
OCCUPANT
STORIES
UNITS
10
NUMBERdAI[?,Q-Q3
REQUIRED
YES
JAREA
LOAD
DESCRIBE WORK TO BE DONE
upp ee2.
REMARKS
PROGRESS INSPECTIONS PEWUBC 10q/FINAL INSPECTION REQ-0
WEST
54-94
DIX M
C 14' "t k
VALUATION
$
5LA'1 ��04
-T'C� ClUT-
Description
,.,FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
r
LOT41-OPE %
",' -
I BuiIdi%P.errnii*:''
City Surcharge
PLAN CHECK NO: 6 , I VESTED DATE _ Plumbitig-i
Ul; A. - — /4'&1
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
UA PERMIT APPLICATION: 180 DAYS
QL PERMIT UMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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 MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnspi.
TotalAmt.Due k�Ov
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
x
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION Recording Fee Receipt #
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S 5PNW�NSATION INSURANCE AND RCW 18.27. q
- -VffICIAL6QNATUAE(j DATE
DATE SIGNED
W. 1 11 (425)
SIG�A�QW ORAqN-0
y-K
771-0220
A'I'TENTION M 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. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ovz'�6 11446A
BY I _*TE
PINK - OWNER - GOLD - ASSESSOR
GREEN - ACCOUNTING
CITY -OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF USINESS
MAILING ADDRESS
U.
CITY zip TELEPHONE NUMBER
&
NAME
I ADDRESS STREET FILE
ICITY ZIP ITELEPHONE NUMBER
NAME
ADDRESS I : - .1
lo
CITY
C�— ��
STATE LICENSE NUMBER
1_346N )C) 45 -7 S.,
Legal Description of Property - incli0c
7 __ PERMIT
ONE
NUMBER
JOB
AUUI`Itbt�
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — REOUIRED DEDICATION
PROPOSED
ENGINEERING MEMO DATED
LAI �r
IE NUMBER
-7 EMARKS
I IR . " ,J: .
VA, /P
easements
Property
Tax Account s5;21 03 C)70 -oot.'
Parcel No.
0 NEW RESIDENTIAL
LUMBING
19ADDITION 11 COMMERCIAL
MECTNICAL
1:1 APT. BLOG.
El
REMODEL
SIGN
GR&PIUQ.
E] REPAIR 1:1 a -s- ADS.
FENCE
X _I[M
EIDEMOLISH WOODSTOVE
1:1 INSERT
SWIM POOL
E] HOT TUB/SPA
GARAGE RETAINING WALL/
C
RENEWAL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER OF STORIES
IUMBER OF
)WELLING
INITS
DESCRIBE WORK TO BE T C OT PLAN)
R6 S, APZ_.)� iUK1
ADn ewrazr 168 X JAW &5V'14tCk
a)
3.1
TESCP Approved
0
RW Permit Required
Street Use Permit Req'd
0
0
Inspection Required
Sidewalk Required
0
0 a
Z
a:
Id-f /14a�s
w
wo
Z
Z
REVIEW BY
NO. OF FIXTURES
I SIGN AREA
ALLOWED PROPOSED
SEPA REVIEW
COMPLETE' MPT
EXP
ADB NO.
SHORELINE#
VARIANCE OR CU
LANNING REVI
A.A.4 /S--7
DATE
61 �S' - V_
SETBACKS - FEET
FRONT Qo-,B,DE REAR/
HEIGHT
VS
LOT COVERZAE
&3, 0
REMARKS
CHECKED 9Y
TYPE PF CONSTRUCTION\ j
.0Z)
CODE
�,-, F
HEIGHT
os.'
SPECIAL INSPECTOR
REOUIRED
13
AREA
OCCUPAN_gY
GRO UP?L,7
OCCUPANT
LOAD
EMARKS
PROGRESS INSPECTIONS PER UBC 305
A
FINAL INSPECTION REOUIRED
EEEE�a VALUATION
7-fv /0 1
PLAN CHECK FEE
qrs-14M
MQ 7T$5 1r&t9/2P*t,. -IB/ A
BUILDING
HEAT SOURC�,,,
GLAZING %
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) will require separate permission.
STATq SURCHARGE
Pennit Application: 180 Days 'I
Permit Limit: I Year - Provided Work Ii Started WIIjhIn 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or hEik spouse, heirs, assigns and
ENG. INSPECTION FEE
w
successors in interest, agrees to indemnify, 'de end and hold
2
harmless the City of Edmonds, Washingtonl its officials,
m
employees, and agents from any and all claims for damages of
a:
<
whatever nature, arising directly or indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any re,uiremgnt of any city ordinance
0
nor limit In any way the City's ability to enforce any ordinance
*
TOTAL AMOONT DUE
provisiom" I
I hereby acknowledge that I have read I his application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
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
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tion Insurance.
INSPECTION
SigNATURE (0 OR AGE.NT) DAT
W E SIGNED
2—
DEPAR MENT
CITY OF
0.
EDMONDS
Aff ENTION
CALL FOR
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-0220
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
10247
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
ATURE A
AWN
WELEASE&iX T E
ORIGINAL File YELLOW - Inspector
PINK - Owner GOLD - Assessor
cc