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RE:C WED
0006.150.0 . 52 CITY COPY NOY 12 1996
08/25/89 PERMIT COUNTER
WSS/klt
COVENANT
ACCESSORY DWELLING UNIT
'WHEREAS,
the
undersigned
owner of
property has
been granted
a conditional
use
permit by
the City
of Edmonds to
maintain an
accessory dwelling unit on the hereinafter described residential
realty, and
WHEREAS, such approval is subject to certain conditions and
will automatically expire in the event that such conditions are
no longer met, and
WHEREAS, among those conditions is the provision that the
permit is personal to the applicant and will expire in the event
that the primary residence and accessory dwelling unit are
rented, leased, sold or otherwise conveyed to a person other than
the applicant.and undersigned owner,
NOW, THEREFORE, (hereinafter
"Owner(s)") does hereby covenant, stipulate and promise as herein
set forth:
1. Touch and Concern the Land. This covenant touches and
concerns a tract of residential real property (hereinafter
11site") with a street address of 4,01 Edmonds,
Washington, and legally described on the attached Exhibit A,
incorporated by this reference as fully as if herein set forth.
2. Existence and Expiration of Accessory Dwelling Unit
Approval. on the application of the Owner(s), the City of
Edmonds has approved a conditional use permit to install an
accessory dwelling unit at the subject tract described in
WSS51667A
-1-
paragraph 1 in the incorporated Exhibit A. The terms of such
approval and conditions are described in Chapter 20.21 of the
Edmonds Community Development Code as the same �exists or is
hereafter amended. Among the conditions are the requirements
that the approval is personal to the Owner and shall
automatically expire whenever:
2.1 The accessory dwelling unit has been substantially
altered and is no longer in conformance with the plans and
drawings reviewed and approved by the City of Edmonds.
2.2 The Owner(s) ceases to maintain three or more off-
street parking spaces on the site for the use of the primary
residence and the accessory dwelling unit.
1
2.3 The primary residence and accessory dwelling unit
are sold, rented, leased or otherwise conveyed to a person other
than the undersigned Owner(s) and applicant.
Therefore, in the event that the residence and
accessory dwelling unit shall be jointly sold, rented, leased or
otherwise conveyed to a' person other'than the Owner, the approval
for the residential real estate shall automatically expire.
3. Covenants to Notify and Restore Property. In
c onsideration of the approval of a conditional use permit to
maintain the accessory dwelling unit permit, the undersigned
I
Owner(s) hereby covenants to notify any prospective purchaser of
the automatic expiration of the accessory dwelling unit uponthe
sale, rental, lease or other conveyance of the herein described
residential parcel. The Owner(s) further covenant that, prior to
WSS51667A
-2-
& I &
closing such sale or conveyance, the premises shall be restored
to its original condition by removal of any kitchen facilities
other than the primary kitchen installed for the use of the
primary residence.
DONE this day of 19
OWNER (S)
STATE OF WASHINGTON
ss:
COUNTY OF
On this day of 7s� 2kQ-",VA4- 199�O before me, the
01 1
undersigned, a Nota Public 'duly commis oned and sworn,
personally appeared L(3aL�-qQV to me known to
Z� . ed in and who executed the foregoing
be the individual(s) desc il
Covenant, and he/she/they acknowledged to me on oath tat they
executed the same as their free and vo�pntary act and deed.
NOTARY PUBLIC LO" Z111) W1. MQt-,6.t1-)
My commission expires: I-C�-9=6
WSS51667A
-3-
CITY CLERK
CITY OF EDMONDS
505 BELL STREET
EDMONDS, WA 98020
0006.150.052
08/25/89
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96 NOV 25 P11 3: 01
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ACCES%q9T �LING UNIT
-REC I EVVED
N OV 4 � 1996
I
H-WITCOUNTER
WHEREAS, the undersigned owner of property has been granted
a conditional use ' ermit by the Cit of Edmonds to maintain
P y an
accessory dwelling unit on the hereinafter described residential
realty, and
WHEREAS, such, approval is subject to certain conditions and
will automatically expire in the event that such conditions are
no longer met, and,
WHEREAS, among those conditions is the provision that the
permit is personal to the applicant and will expire in the event
that the primary residence and accessory dwelling unit are
rented, leased, sold or otherwise conveyed to a person other than.
the applicant.and undersigned owner,
NOW, THEREFORE, TNJJI'4 J64ACI (hereinafter
"Owner(s)") does hereby covenant, stipulate and promise as herein
set forth:
1. Touch and Concern the Land. This covenant touches and
concerns a tract of residential real' property (hereinafter
11site") with a street address of Edmonds,
Washington, : and legally. described on the attached Exhibit A,
incorporated by this reference as fully as if herein set forth.
2. Existence and Expiration of Accessory Dwe lincr Unit
Approval. on the application of the Owner(s) the City of
Edmonds has approved a conditional use permit to install an
accessory dwelling unit at the subject tract described in
WgS51667A
VOL 3237 PAGE 1.365
;I
I
paragraph 1 in the incorporated Exhibit A. The terms Of such
approval and conditions are described in Chapter 20.21 of the
Edmonds community Development Code as the same exists or is
hereaf ter amended. Among the conditions are the requirements
that the approval is personal to the Owner and shall
automatically expire whenever:
2.1 The accessory dwelling unit has been substantially
altered and is no longer in conformance with the plans and
drawings reviewed and approved by the City of Edmonds.
2.2 The Owner(s) ceases to maintain three or more off-
street parking spaces on the site for the use of the primary
residence and the accessory dwelling unit.
1 2.3 The primary residence and accessory dwelling unit
are sold, rented, leased or otherwise co'nveyed to a person other
than the undersigned Owner(s) and applicant.
Therefore, in the event that the residence and
accessory dwelling unit shall be jointly sold, rented', leased -or
otherwise conveyed to a person other than the Owner, the approval
for the residential real estate shall automatically expire.
3. Covenants to Notify and Restore Property. In
consideration of the approval of a conditional use permit to
maintain the accessory dwelling unit permit, the undersigned
Owner(s) hereby covenants to notify any prospective purchaser of
the automatic expiration -of the accessory dwelling unit upon the
sale, rental, lease or other, conveyance of the herein described
residential parcel. The Owner(s) further covenant that, prior to
WSS51667A
-2-
HL. 3237PAGE1366
AM
VC)
closing such sale or conveyance, the. premises shall be restored
to its original condition by removal of any kitchen facilities
other than the primary kitchen installed for the use of the
primary,residence.
DONE this day of
19
OWNER (S)
..........
C)
STATE OF WASHINGTON
ss:
COUNTY OF
On this 11c)6 day of 199(V
I before me, the
undersigned, a Notary Public duly commi iofled and sworn,
personally appeared -F%zoa N-�A-n � LQ=StV-V- to me known to
be the individual(s) descAbed in and who executed the foregoing
Covenant, and he/she/they acknowledged to 'me on oath tat they
executed the same as their free and voauntary act and deed.
5
NOTARY PUBLIC w—T
My commission expi
M
WSS51667A -3-
9" 6 112 5 0 7 0 8
voL. 3237 1 PAGE 1367
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Critical Areas Checklist
Site Information (soils/topographylhydrology/vege . tion
1. Site Address/Locatiow. LO 1 14 V.
* ** ". 3 71 ?.— 0 tv Z d9 40
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):, 75-00
4.. Is this site currently -dev'elopO? X yes;_ no -
If yes; how is site developed? !!%zd61-6 I L 4- 1 AJ 46
.5. Describe the general site topography. Check all that apply.
Fiat: 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):
42 e-1 7- 22
6. Site contains areas of year-round standing water. ozyo
Approx. Depth:
7. Site contains areas of seasonal standing water: IV 49 Approx. Depth:
What season(s) of the year?�
S. Site is in the floodway floodplain 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)
11. Obvious wetland is present on site:
—For City Staff Use Only
1. Site is Zoned?
c L7>-t
0Z J,&,
2. SCS mapped soil type(s)? Uv,,&cja - 4(A<f,j.*A
3. Wedand inventory or C.A. map indicates wetland present on site? jVb
4.-.�. :-,Critical Areas inventory or C.A. map indicates Critical Area on site?
5.. within' designated earth -subs1&nce* landslide hazard area?
N,.
6. ''SItc aes*ignated on the Environmentally Sensitive Areas Map?
DETERMWATION
"STUDY REQUIRED CONDrrfONAL WAIVER
W, AIVER,
Revi6'wed by: 10&11511- -71_731Z
1(ajner Date
Pev 01/04/94
*go -191"
City of Edmonds
Critical Areas Che. s
cklist
The Critical Areas Checklistcontainedon
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. -
T'he purpose I of the Checklist is to enable.
City staff todetermine 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
observafions 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,
JJECE.JVE:D
JUL
FTMAIT r'01JNTEP
I
and submit it to the City. The City will
review the checklist, make a precursory site
visit, 2nd:. make a determina. '
tion of the
subsequent steps necessary to complete a
development permit application.
With a signedcopy of this form, the
applicant should also submit a vicinity map
or plot plan for indT7id—ual lots -of the parcel
withenough detail t ' hat City staff can find
and identify the subject parcel(s). In.
addition, the a ' pplicant shall include
other.ped7inent information (e.g. :site
plar4 topography map, etc.) or studies in
conjunctin with this Checklist to assist
st aff in completing their preliminary
assessmentof the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best -of my knowledge (fillout the appropriate column -
Owner I Applicant:
X/V1 Y- AA6-b
Name
Street Add?ess
City, State, ZIP Phohe
.
Signature Date
Applicant Representative:
Name
-Algol '4ax'0A'sq --?fv
Street Address , 'XV
W4. 9 S /0
City, State ZIP
" I --
Phone
7- ;? z -
Signature Date
PLANNING DATA
NAME: -
SITE ADDRESS: 0 DATE:
ZONING. —PLANCHK#:- 016'Z�36
PROJECT DESCRIPTION: UAI
CORNERLOT 00". )�5 (Yes/No)
SETBACKS:
Required Setbacks:
Front: 'Z V Left Side: Right Side: 57 Rear: 15-
Actual Setbacks- it
Front: Left Side:3- 5' Right Side-.-23tq"
___r Rear: -
Street map checked for additional setback required? C$ —(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED - , VQ (Y/N)
LOT COVERAGE:
Maximum Allowed: -.Actual: 3
BUILDING HEIGHT:
Maximum Allowed: L Jr —Actual Height:
Datum Point: Datum Elevation:
SUBDIVISION:
CRITICAL AREAS #: 140
SEPA DETERMINATION:
LOT AREA: 7 5—co
Plan Review By:
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegqation)
1. Site Address/-L,oc.ation:: 6,01 9W 4,1.
2. Property �Tax Acc'6 u int Number: .3 7 1 9 ep 45 1
3. Approximate Site Size (acres or square feet): 0
4. Is this site currently developed? X yes; _ no.
If yes; how is site developed? 5jjV6e_6 t4�jy I L Y 2>k,),6 4- 4- 1 AJ 46
5. Describe the general site topography- Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site genera4y 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 le ss than 3 0% ( a vertical rise
of I 0-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
47
5 -A_2e2&,-J0q 7-22 jg=,4 ja 'P-
-6. Site contains areas of year-round standing water:
Approx. Depth:
7. Site containsareas of seasonal standing water: _IV 0 Approx. Depth:
What season(s) of the year?,
8. Site is in the floodway floodplain of a water course.
9. Site contains a creek 'or an area where water flaws across the grounds sufface? Flows' are year- //D
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:
For City Staff Use Only
1. Site is Zoned? P6- (0
9 PA 1; L7;L-*
2. SCS mapped soil type(s)? Ajt�, I" _-4
W&M t04 7
3. Wetland inventory or C.A. map indicates wetland present on site? IVO
4.-�:-. :-,Critical Axeas inventory or C.A. map indicates Critical Area on site?
5. S46. within' designated e� -subsidence* landslide hazard area?
N.
6. Site 8es;Ignated on the Environmentally Sensitive Areas Map?
aE__TE,RMTNATION
"STUDY REQUIRED CONDITIONAL WAIVER
W AIVER*
Reviewed by: 7IZ31 1�
1�jner Date
Rcv0l/OAt94
9 9
City of Edmonds
Critical Areas Checklis* t
The Critical Areas Checklistc.ontained an
this form is to be filled out by any person
Preparinga 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
prewnt 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,
d 'EceiveD
1
-J 'i L 6- �" -1996
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
develqxnent permit application. .
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). in
addition, theapplicant shall include
other pertinent information (e.g. site
plau, topography map, etc.) or studies in
C4014unction with this Checkl[ist to assist
staff in completing their preliminary
assessmentof the site.
I 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 I Applicant:
rt�
1-zxi.Awwr
Name r
Street A T&Ts�_
L91%11>
City, State, ZIP Phone
Signature
Date
Applicant Representative:
T3 L �J:> L/ MzC_d.5C+t>.6 (f0-A1S7-.
Nam
-Algol _"'?t1x0A'0q /?V, /V
Street Address
-544-rn.e 9 S /a -7
City, State ZIP Phone
7-
Signature Date
CITY OF EDMONDS 6o
Permit Nd.
COMMUNITY SERVICES DEPARTMENT
Issue Date
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. e Owner: Washington Natural Gas_Company B.. Contractor:
Name
Wff'mercer Street
�ai tin Mailing Address
ea tj Address
e WA 98111
City State zip City State Zip.
State License Number Telephone Number
C. *'Address or Vicinity of Construction: '9 Avenue South.
Type of Work to be Done: Install New Service
D. 0 Work in Connection With: El Sub or at 0 Single Family El City Projects
utility
0 Commercial 0 Multifamily
E. 0 Pavement Cut: 0 Y. 0 N F. 0 Size of Cut: X
APPLICANT TO READ AND SIGN
INDEMNITY: 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, forseen or unforseen, that may
be made against 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.
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 completed by City forces, at which time a debit or credit will be
processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call E ngineering: 771�3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with*City Code.
WStreet to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with,asphalt or City approved material prior to end of Working day;
NO EXCEPTIONS.
I understand the above and that this permit must be available at the job si�e for inspection Purposes at all times.
December.279 1990
Signature: Date:
Owner or,Contractor
This Permit Must be Posted at the Job Site.For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
�PPROVED BY: PERMIT FEE: -04-30
Z Time Authorized: Void after F-A- IS days: Resto . ration Fee:
0
Special Conditions: Is) Receipt No.:
Fund I 11, Fee:
Street cut Dim
U
RELEASED BY: —Date EJ. 21 INSPECTED Date
94
0 _"77
U. NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
IF�j. Div. March 1989
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P.
Work Disapproved By: —
FINAL APPROVAL BY:
Date:
Date:
tng. Uiv. July Iva)
Addendum to:
City of Edmonds
Permit Application
Engineering Aide : Kerry Walsh
Washington Natural Gas
622-6767 x 2588
E-'� I
V- MAIN VePr4
UP-4 W.MOWP4
If C-3 A S AAA40
KEY: -
-ss- sanitary sewer
-s- storms
-w- water
0 water valve
PUBLIC'WORKS DEPARMU*ECKLIST
BUIIDING PERNIT REVIEW.
(address) da ate
0
.
Street Right -of -Way Existin
- RE -A.
Z
Access Easements Existing-, tj
t4- A-
F-4
p4
Utility Easement Existi
NA,
W
Lot Per Subdivision Plat
Assessor Map
Site Plan.Checked for Accuracy___JZJ
213h --1
Z
Underground Wiring Reqd.
Check Accuracy of Legal Description
Review by_
Date,
lNi.�ting Water Main Size
Wate Required
Service Lirie_,�red
Hydrant Size Exi�ti-
c4
Hydrant Reqd Per Fire Co 0-
Size
Detector Check bleter Reqd.
Cross Connection Inspecti�_�
Fire Department,�Con�s
4
Wa er
t Charge Reqd.
Review by.
Date
Septic Tank Design Approved
Date
'S tic Tank Permit Reqd.
Permit No.
S,
S amzi t Sewer Availability.
Proj
Drawing
ma
File No.—
P4
Side Sewer Av;a±�ility
W
Sanitary Sewer Conn d.
:3:
Review
Open Ditch Exist'
Reqd.
Culvert Reqd._
e
c4
Catch Basin Reqd.
te ite Plar
Indicate ite Plan
0
Shoulder drainage main collection on swale open runoff
r
Yonhole reqd.
Indicate an Site Plan
Soil Conditi and Ground Water Field Checked
ReviL;ewby_
Date
. Revised: 'MO-1977
Page 2
-StzqLe ng Reqd.
PavJ
Curb an 'ter Reqd._
Sidewalk Reqd.—
Cuib Cut for DZr�iveway Req
Right- of"'Way cons tru,cti t Re.qd.
ic v��ts��'
Bond Reqd. for ic IWravements'-,'
Street V�-Sign Reqd.
Other Signing Reqd.'
Pre Permit Site Inspection made on
z
0
FA BY: SEWER
WATER
STREET
ENGINEERING
Special Requirements listed inImerm to Commmity Development Department,
Building Division
BY Date
c) All item filled in on Building Permit Application
BY Date -
Drawings. Stan-ped and Notations Made
BY Date
Approved by Public Works Department
Revised: 1v 10-1977
APPLICATION
for
The City of Edmonds SEDE SEWER PERNaT
NEW CONSTRUCTION REPAIRS C] EASEMENT No . ..........................................
108-03900
OWNER ............ Fette .. P.05.thumus ........................................................... CONTRACTOR .................................................................................................. PERMIT No . ......................
ADbRESS -------- 60-1—n—.9-th-Amenue ... S . ................................................ LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAME OF ADDITION ..............................................................
..................
DYE TESTED ON SEWER
JULY9 1972
Approved:
DATE................................................ By ......................................................................
CITY OF EDMONbs
USE
ZONE PERMIT
609-1
NUMBER .3
CONSTRUCTION PERMIT APPLICATION
OB SUITE/APT #
ADDRESS -V 4w,
601 (?/
OWNER NAME/NAME OF BUSINESS
F(ZfLEGAL
_b + 4#4 IT -A Lrjc, K_ 4 Ac e--T
DESC RIPTION CHECKI
SUBDIVISION NO. LID
NO.
Lu
Z
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved a
0
('e 0 Arv.
CITY ZIP
10 7-0
TELEPHONE NUMBER
_2 -7
7-7 '1
EXISTING — REQUIRED DEDICATION
RW Permit Required 0
Street Use Permit Req'd 13
0
Inspection
Required 11
Sidewalk Required 0
NAME
YAi 7-t4 I A Roo VE_e,
a:
MFEW�i7
LINE SIZE
NO
PRV REOUIRED
UJI
4FIXTURES
YES 0 NO 0
ADDRESS
-7
REMARKS
cc
W
CITY ZIP
TELEPHONE NUMBER
S 103
8) 3_ go3-2-
NAME
ADDRESS
0o, AV.
cc
0
1,_
ENGINEERING MEMO DATED REVIEWED BY
cr
CITY ZIP
TEUEPHONEeNUMBER
Z
156 A
A.? 3a
FIRE MEMO�DATED�-REVIEWED BY
UJI
0
STATE LICENSE NUMBER EXPIFV%TION PATE
C 4 -Sc-A e-b 0 (6 1
SIGN AREA":. J
ALLOWED PROPOSED,..:',�
SEPA REVIEW
co MPLETE- EXEMPT
ADS NO.
Legal Description of Property - inclut:16�611,easemdrfts
01 SHORELINE 0
2
EXP
To Eb gLock 061 'C> 0.4DA'ARiLoc' k, 2.40,
VARIANCE�OR;CU'
:PLANNING REVIEW"S_Y�
DATE
W,
U C;�;
—it TIC
:SETBACK S.FEET
:
I HEIGHT
LOT COVERAGE
2
Z
st Dh, REA R-1 5
Property
TAi,.AccouriP. 0:
3 -71
REMARKS
rcel No.
41
T
0 NEW KR15SIDENTIAL,
COMpL1ANCE',OR:
19 EI.COMMERCIAL
_*Vd!%OA
ADDITION ..CHAkGE'OF:U§E-'-
APT �BLQG.
SIGN
REMODEL --
CHECKED BY
'OF CONSTRUCTION
JJNPE'�.
Al
C 0 Qj,;
rilI
occ
GR
GRADING FENCE!
EIREPAIR EJ _CYDs E] .1 x �F-Tj,
EIDEMOLISH WOODSTOVE swi MP . 60L'
INSE13T HOT TUB/SPA:...:.
El. El
.
SPECIAL I NSPECTO
ED
AREA
OCCUPANT
LOAD
GARAGE 7 RETAI�ING WALLI
r
El. 'RENEWAL!
:A3YES-
REMARKS:
CARPORT L_J ROCKERY
Z
0
PROGFIESSMSPECTIONS�PERUBC 108
Z
SS,,oRiACT 'EXPUAIN- �,F
�WE. BUSI IVITY)
'h
I
W
0
&Z': I q 11�� Ah6f, Vj 1+ry
NUMBER r
OF
NUMBER OF .1c
RITICAL'�-_
AREAS, ,
NUMBA&—/60
W
STORIES
U�ITS�J�:. �Z_
DESCRIBE WORK TO BE DONt,(AT.TAC�.,PL9T FILA�N)
A- b b i
'FINAL' I NSPECTI ON REQUIRED
L)
NALUATION
FEE
arm
CHECK'FFE.
ING.
HEAT SOURCE:
GCAZING
�PLUMBINQ
j4EE2
Plan Check. No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewelks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Application: 180 Days
rPennit
F ermll 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
successors in interest, agrees to indemnify, defend and hold
02
harmless the City of Edmonds, Washington, its officials,
5
employees, and agents from any and all claims for damages of
PLAN CHECK DEPOSIT
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cc
whatever nature, arising directly or indirectly from the issuance
Issuance this not be deemed to
0
of this permit. of permit shall
modify, waive or reduce any requirement of any city ordinance
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Inor iimit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
ZAAID
provision."
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I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or tho duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT This application is not a permit until
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 signed by the Building Official or his/her
Code of the State of Washington relating to Workman's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance and RCW 18.27. INSPECTION acknowledged in space provided.
SIGNATURE jOnER OR AGENT) DATE SIGNED DEPARTMENT OFFICI IGON
CITY OF DATF.
lif.
EDMONDS
n
/l/o/W
CALL FOR RELEASED BY: Jf/ 16AYE
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL — File YELLOW inspector L
—
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
SECTION 109 PINK — Owner GOLD — Assessor
102.6?