631 GILTNER LN.PDF11111111111111
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631 GILTNER LN
CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SE WER DEPARTMENT
-A
PERMIT
Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.)
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.
ADDRESS LOCATION OF CONSTRUCTION ......... . ..... _M-� . ........ [-\10-& ......... W . .................... ........................................................
PROPERTY LEGAL DESCRIPTION .................... --------- ...........................................................................................................
.................................................. . ..................................................................................................................................................... ..................................................
................................................................ OWNERANDIOR, BUILDER ................................................................................................................................... :.
CACTOR'S NAME & ADDRESS ........ ..................................... ............................................................................................
Permission is granteA -,? . .......... . .
. ........ . .................. 7 ........... 19.. <!:7,P for repair and/or connection of a side sewer to the city sanitary sewer
Wtem. in accordance with City of Edmonds ordinances.
ENTION IS CALT D TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must be employed to construct
'ide sewer in street area. Do not cover any portion of sewer before it has been inspected.
r
NOTE No. 2—All work performed In city right-of-way requires an Invasion of Rlght-of-Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 Inches coverage at property line and-12 Inches inside property I ine; minimum grade of 2%. No bends In grade
sharper than 'A will be permitted.
NOTE No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion. . I
NOTE No. 6—It is unlawful to alter or do any other work than is provided for in the permit, or to.do any work on the main sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED E] Date ... . ................................... By ................ Date..... By ................ Date ............... . ................... By -----_-_----
APPROVEDDate .......... . ... 12 . ................. By ........ ........ . .......................................................................................
Remaxks: ............ /10111 .. 1�46_A� ...... .......... / ....................................................................... ....................................................
..................................................................... . .................................................................................................... ................................................................................
WBOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
I ...... 4.1� ------- ............... . ............................................. ... I hereby certify that the side sewer installation constructed tinder this permit
...........
(Owner of Contracting Firm Performing Construction)
IRS installed in a6cordance with all governing ordinances of the City of Edmonds.
'7
Dated this ........... . . 7 ........... day of ...............
...................... ............ 19.,
V N/ Check BEFORE you dig for: Water [], Gas E], Telephone E], Power E], Sewer E], Other [:) V V
TAX ACCOUNT/PARCEL NLJMBER:—/a
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver E] Study Re uired/rtWaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DA
SEWER LID FEE
LID #:
SHORT PLAT FILE:!��) LOT: BLOCK:
SIDE SEWER AS BUILT DA
SIDE SEWER PERMIT(S).#:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER
LATEMP0.SrsTorrns\Street File Checklist-doc
APPLICATION
for
The City of Umonds SIDE SEWER PERMIT EASEMENT NO. - --------------------- --------------------
NEW CONSTRUCTION REPAIRS D LID NO ASMT. NO - ------------------
TACOL I
=-. F= p 4
OWNER ---------- KA . F�eEl=�r�- CONTRACTOR --- EN=*--- PERMIT NO. -A-f- -------
----------------------------------------------------------- --------- -------------- ------ ------------------ - - ... ------- -
JOB ADDRESS ---- - ------ --- LEGAL DESCRIPTION: LOT NO. -- --------- BLOCK NO - -----------------------------------
----------- ----------------
APPLICATION
a
The City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMff
NEW CONSTRUCTION 0 REPAIRS F-1 LID NO - ------------------ ASMT. NO - -----------
OWNER ---- �/-hzo'r ------ /,f/ W ----------------------------------- CONTRACTOR --- --------------- ---------- --------------- PERMIT NO.
JOB ADDRESS /v
------------- ---------------------------------------------- LEGAL DESCRIPTION: LOT NO - ------- -------------------------- BLOCK NO - --------------------------------
................................................. 5e- e ..... 477.4c4eg/ ................ ..............................................................
--------------
NAMEOF ADDITION ---------------------------------------------------------- ----------------------- ------------------------------------
;7/l/
Approved -
DATE-------------------------------------------- By ------------------------------------------------------------
0
FIRST HALF MUST BE PAID BY APRIL 30
1915 OR ENTIRE TAX PLUS INTEREST MUST BE
PAID. SECOND HALF DELINQUENT AFTER
i—�E:AL ESTATE TAX STATEMENT OCT. 31ST. TAX UNDER $10.00 TO BE
SNOHOMISH COUNTY, STATE OF VJASHINGTON PAID IN F U,L L.
X S.
x
G�
�:D
000 6 446 1427')3-2—C�'9-0005
D: r i�.' 7s:
1975
7 6. 261,771
8o531021*
43.31
F R E S, rtR DIKE 15
2 '140. 581
LEGAL DE-SCRIPT10N
C 2 4 TWP 27 RGE A,
RT-IC &
3A-1) E -233FT OF FDT BEG AT NE
98020
CC!R GONT
LOT 2 TH 4 30FT TH S 30FT TO
THE COP
OF THF P4VE-P HWY 7TH ST TH S
4LG THE
lr4FST SMF -IF 7TH OF
157.67FT
TO TP5 TH W 568
- '�'4317-T T-'Ol E SIOE�
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TH S �-L Y A' LG ',THE- S I DE OF 3RO
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1 7 FT H E 61"I'007FT TO THE W
OF,
YTH ST TH AL3 THE W SIOE
7TH ST
76FT T�l Ti�j 145FT
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6 4 3 / 2 61 T ""i C F'TV OF
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nj
PY40POE: I MEUK11T
LA_ I-, der Sefr�rlb�f�j
140.00'
"Nothing in this permit approvial Proam W
intoMreted Rs allowing -or permitting the
maintenance of any currently existi
00e �g illegal,
oor
IS' REAR SB
noncontorming or unpermitted building, structure
m� �UiJB miv,� de th
rmt application, regardless of A such
uilding, structure or condition is shown on the I tn
fite plan or drawing. Such building, structure or
condition be the
may subject of a separate
enforcement action."
q1;
ME
i
_W,
LOT I
ACCESSTO
BASEMENT
20.001
rh6N�
— — — — — — — — — 20'FRONTSB ROPOSED-AD
PROPOSED7* SIDE SET
I ... .... ... -
C' tv
100.00
CILTNER LANE
_'_ _. - ----- --- --- ----- - ----------------- -----------_---_-----
----- - ----- --- --- ----- -- ----- - - --- - - -- %
OWNE LINDA SOLTMAN LEGAL DESCRIMON: LOT SIZE 8750 SQ rr
631 GILTNER LANE SEC 24 TWP 27 RGE 03 COVERAGE IOZ7 SQ rr 11.7 %
EDMONDS, WA LOT I SP NO S -13-72, RECORDED PROPOSED COVERAGE: UM SQ FT 1:24%
Ar No. 8401120223 KING A PORMON ZONE: RS - G 1419 13�
TAX NO 242703 - 2- -009 - 0005 OF SW 1/4 NW 1/4
BUIL11 1952
PLANNING4 2006'EDITION IRC*
ENDMEN IT 00
W/WAC AMM
o"
2006 EDITION IBC
W/WAC AA.4MFJq()MENTS
PLOT. PLAN.,,A
SCALE: I" = 10'- 0" F F 11
tk7 67- C)'L".
0 PU44'1
z
RECEIVED
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
STREET FILE
CITY OF EDMONDS -
BUILDING DEPARTMEN
WORK -T
ADDRES
OWNER S
4 APPROVED
BLDG. OFFICIA
PE®RM ENUMBER
0
APPROVIED
DE�A �TMENT
f.- -6:5
0
30'-6
. 0
1 S' REAR SB
ZD
140.00,
OWNER/CONTRACTOR IS RESPONSIBLE FOR
EROSION CONTROL AND DRAINAGE
- - - - - - - - - - - - - - - - - - - - - - - -
IM-SP,F-CTION REQUIRED
ik'!
fit
P
"tg ill
LOT I
ACCESSTO
a4SFMFNT
P
�g
20.00,
20, FRONT SB p POSED X 1 -2,
6k4d
0i,
PROPOSED 7* SIDE SET 13ACK -------- 14.
q
HAR 1 1998
KIPMIT WiNTP7!
I-> foe--- �—o M r4 r4 14 o U,6 I
GILTNER LANE jpm (-o%/t5('z-
----- — ----------- — ----- -- — — — — — — — — — — --- — — — — — — — — — — — — --- — — --- —
OWNE LINDA BOLTMAN LEGAL DESCRIPTION:
GSI GILTNER IANE SEC 24 TWP 27 RGE 03 LOT SIZE 8750 SQ ff
EDMONDS, WA LOT 1 SP NO S -13-72, RECORDED CQYKMG-j- 1027 SQ FT 11.7 %
AF NO. 9401120223 BEING A PORTION PROPOSED COVERAGE: AM SQ rr I:spg%
TAX NO 242705 - 2- -009 - 1 0005 OF SW 1/4 NW 1/4 ZONE: RS - G 1(-'3%
AMLI- 1952
ENGINEERING APPROVAL
NOTED
q(V 6j r!
IT FILE
APPROVED BY PLA NING
0
PLOT, PlAN:,-."-'-'L:
SCALE: 1" 14Y - 0"
FED
pIrptMiT L 'Dl�":a- -0-
RECEIVEL
MAY �' 0'
DEVELOPMENT SERVICE� OT'
CITY OF EDMONDS
w
—..-140.0 - 0,
OWNEWCONTRACTOR IS RESPONSIBLE FOIJ
EROSION CONTROL AND DRAINAGE
5' REAR SB tnswt4,
- - - - - - - - - - - - - - - -epmoh^-e- I Z i- � 4; k � X, - - 4
r *ter
G,
14i
0 VZY- 0 02
04 — — — — — —
20,
FRONT SB
20.60,
72,
PROPOSED 7' SIDE SET 13A(-X ------- 6htd
T-
7X �,y
3
loo.
HAR I
-7Z2
geWP AaQ7 -OY� W tNTI:71
GILTNCR LANE HOL5 I
QWNEV LINDA BOLTMAN LEGAL
631 GILTNER LANE SEC 24 TWP 27 RGE 03 Wl SIZE 97.50 SQ ff
EDMONDS, WA
LOT I SP NOS PLOT PLA
-13-72, t L- Ll ff- �N
RECORDED COVERAGE: 1027SQrr 11.7% Aa.
T" NO 242703 2- -00!) 000S AF NO- 8401120223 BEING A PORTION PROPOSED COVERAGE: -,Q rr SCALE: I" = 10- - 0-
OF SW 1/4 NW 1/4 ZONE: RS - G
BUIL71% 195? FED
0
PIRI'liff
RECEIvE:D
�D FEB 0,9 2001
PERMIT COUNTER
0
PLANNING DATA
NAME:
SITE ADDRESS:
ZONING: �2S—& —PLAN CHK#: 00—
PROJECT DESCRIPTION: Ad4-ha" -- &d:j bK71-14,�-aa777(>
CORNER LOT--M—(Yes/No) FLAG LOT_ /\A, (Yes/No)
SETBACKS:
Required Setbacks: . - /
Front: '2-0 Left Side: G Right Side: Rear:
Actual Setbacks: . per 0/10-
A
Front: `7 Left Side: Right Side:l�/& /fRear: Iq
Street map checked for additional setback required? -(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE: 4V1- 162,-7
Maximum Allowed: -Actual:
BUILDING HEIGHT:
Maximum Allowed: —Actual Height: —
Datum Point: "4- rawyed Datum Elevation:
A.D.U. CREATED?: A/0
SUBDIVISION: A/0
CRITICAL AREAS #: Of -7 - 7,��--7
SEPA DETERMINATION:- -S5FA d� -e
� tA//v toz�e -.1 Ke
LOTAREA: .9-�13i-o
OTHER:
Plan Review By:
C.AffleApeffniffp1andaLdoc
0
CITY OF EDMONDS
STAT ADDRF
AR
MAY
PUBLIC WORKS DEPARTMENT - 7110 — 210TH ST. S.W. - EDMONDS, WA
(425) 771-0235 - FAX (425) 744-6057 - E-MAIL: k1ein&i.edmondsma.us
C. 1 S 9 ") WEB SITE: www.d.edmondsma.us
June 14, 1999
Linda Boltmann
631 Glitner Lane
Edmonds, WA 98020
Re: Boiler Cross Connection
Dear Ms Boltmann,
The State Board of Health has established rules and regulations pertaining to cross -connection
control in public water systems. For the purpose of protecting the health of consumers receiving
water from the public water supply system, the City of Edmonds has adopted these rules and
regulations.
According to the Board of Health, a cross -connection means any physical arrangement whereby a
public water supply is connected, directly or indirectly, with any plumbing fixture. Any other device
which contains or may contain contaminated water or other liquids of known or unsafe quality;
which may be capable of imparting contamination to the public water supply as a result of backflow.
The term backflow means an unwanted flow of non -potable water, or other substances from
domestic, industrial or institutional piping system into a pure or potable water system.
After a call from you regarding bad tasting water at your home, a city water maintenance personnel
came to your resident located at 631 Giltner lane. During his visit he noticed a boiler in your
basement which was not properly protected against backflow contamination. It is necessary for you
to take certain steps to minimize the danger of contaminating the drinking water supply by installing
a proper backflow prevention assembly for the degree of hazard. Therefore, the proper type of
assembly for your situation would be a reduced pressure principal backflow assembly.
Please contact a Certified Plumber at your expense to make the proper corrections. Once you
have made an appointment with a plumbing contractor, please have the contractor make
arrangements with me to ensure proper installation and testing of the assembly. You will have 90
days from the above date on this letter to have job completed.
Any questions or need further information regarding this matter, please call me at 425-771-0235
extension 644.
Sincerely,
Linda McMurphy
Water Quality Control
WordatakWater\Boltmann
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
CA FILE NO. '7
Gritical Areas, Checkli*
--------------------------------------------------------------
Site Information (soils/ to ography/
hydrology/ vegetation)
I. Site Address/ Location: 11A C /- /_ 4�
2. Property Tax Account Number: 0� — ) . 00--i
2- Z
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? Zyes; no.
If yes; how is site developed? _5 /A q, le �-a
c�t ne
5. 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 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):
6. Site contains areas of year-round standing water: N P -; Approx. Depth:
7. Site contains areas of seasonal standing water: ;Approx. Depth:
What season(s) of the year?
8. Site is in the floodwav 1\M floodplain of a water course.
9. Site contains a cre* or an area where water flows across the grounds surface? Flows are
year-round? U Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawnshrubs etc) X,
11. Obvious wetland is present on site:
Aca_chk.doc; Rev 02/11/97
A0;1 .'.
City of Edmonds NOV 2 It 10497
N,LW CRITICAL AREAS CHECKLI!�VMIT COUINTRI
The 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 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, 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:
I INDI� M 9047�
Name
�3 )-A)
Street Address
�V- d A -
City State Zip
Telephone
Signature
N ao c2�
Date
Applicant Representative:
So, M e-
Name
Street Address
City State
Telephone
Signature
Date
Zip
c:recepfion\jana\cac1.doc
(over)
117 C—
. 1 sq,�
12-2-97
Linda M. Boltmann
631 Giltner Lane
Edmonds, WA 98020
0. 0
CITY OF EDMONDS BARBARA . FAHEY
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 MAYOR
COMMUNITY SERVICES DEPARTMENT
Public Works e Planning/Building o Parks and Recreation - Engineering - Wastewater Treatment Plant
Subject: Determination regarding Critical Areas Checklist #97-227
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DET ERMINATION" reached by the City is
located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
IMPORTANT INFORMA TION TO BE NOTED:
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
momp, You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL -400
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Note Attachments:
* Architectural Design Board -
C:Reception\Jana\CRLTR.doc
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Diane Cunningham
Planning Secretary
9 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
..DATE zKz&_q
PERMIT EXPIRES
CITY OF EDMONDS
7CONSTRUCTION
ZCINE PERMIT
INILIMBER� 0Q C 7;
PERMIT APPLICATION
JOB SUITFJAPT#
ADDR=
/4' Y_
OYVNER NAME/NAME OF BUSINESS
I IIVZW 3 0�_�
PLAT NAMEISUBDi VISION NO.
LOT NO.
LID NO.
fA,1
LID FEE $
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3z
0
MAILING ADDRESS
/LV
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCIP Apprmed cl
RW Permit Required/V v 0
Permit Req'diN4(:)
EXISTING PROPOSED
REQUIRED DEDICATION FT --
Street Use
Inspect:on Required 0-
Sidewa k Required Alw 0
Underground
CITY ZIP
0
VQVI
TELEPHONE
-711. a
led12101)(15.
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NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
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=SO NO 0
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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SEPA REVIEW
SIGN AREA
HEIGHT
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PROPERTY TAX ACCOUNT PARCEL NO.
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7-�
CO�PLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP
NEW RESIDENTIAL PLUMBING MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT)
FRONT UR Slq�,,REAR
COMPLIANCE OR
Z' ADDITION 0 COMMERCIAL
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CHANGE OF USE
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PLANNING REVIEWE
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REMODEL 0 APARTMENT SIGN
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FENCE
REPAIR GRADING CYDS 11 X FT)
REMARKS
DEMOLISH TANK 0 OTHER
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c3 GARAGE ROETAIENRING WALL. [3 RENEWAL
CARPORT 8 CK Y
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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CHECKED BY
TYPE OF CONSTRU�TION
CODE OCCUPANT
GROUP
(A
uj
NUMBER
OF
NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS t!5;f,7 7,
—i
NUMBER
SPECIAL INSPECTOR JAREA
REQUIRED YES
OCCUPANT
LOAD
A
o
—STOF
.11'
DESCRIBE WORK TO BE DONE
dd I
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
5
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(f9 tO� 114-&
C�,fx) t..1, rvi-� o, ck L-,I,
100 _9�) ('1111- ('401
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77
VALUATION
FEE
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PLAN CHECK FE E
P
HEAT SOURCE GLAZING T SLOPE % 0
BUILDING
0/0
VESTED DATE
PLAWCHECK PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE�WORK NOTED. THIS PERM IT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
cc PERMIT APPLICATION: 180 DAYS
Uj
91. PERMIT LIMIT:11 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
rz� 0
0 'APPLICANT ON BEHALF OF HIS 00 HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPINd_
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY. RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
I
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
_j
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION., PIECE
MI TOTAL AMOUNT DUE f;
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED 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.
VVUHKMtN Z:, LU PENSATION INSURANCE AND RCW 18.27.
OFF CIALS SIGNATURE DAT
SI�YATUREPWNER 08 AGEN DATE SIGNED (425)
S!r A gel)
"A� 1
7- .1 1 " RECEASED
771-0220
By DATE
ATTENTION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPEC�QR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
5/98