7019 177TH ST SW.PDF111.111111111
1178
7019 177TH ST SW
0 , W'.
ADDRESS: I q F-7 --1 5 �-AJ
TAX ACCOUNT/PARCEL NUMBER: Q 6-71 9 -,�) 000"C20-7 00
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: 2W?,a— 00 -7 5 DETERMINATION: n Conditional Waiver 0 Study Required OWaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: -71141
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:— '-2-2
SIDE SEWER PERMIT(S) #: [A
GEOTECH REPORT DA'
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED: " 3 -9— 8?�
OTHER:
LATEMP\DS'Ps\Forrrks\Street File Cbecklist.doc
-C. 116-7-
* #.P20
City. of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
The Critical Areas Checklist contained on this formis to
be filled out. by any person preparing a Development
Permit Applicationfor the City. of E(hnorids, phor to, -
his/her submittal of the applicdtioi�to the City. ' t
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 fi-om observations of the site, or data available at
an M
RHEV
1%H%A0& 1, AM
Date Received: (0111(20
7 (�'( )1X*.
City Receipt#: 1-C
Critical Areas File #: a.-eO46 ---�06'1,5'
Critical Areas Checklist Fee: , $135.00
Date Mailed to Applicant: -
A property owner, or his/her authorized representative,
must fill out tYe-cheeklist, 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 assistant staff
in completing their prelin-dnary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns,:in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City.of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction, based in whole or part upon false,*. misleading, inaccurate or
incomplete information furnished by the applicant, his�heihts agents or employees.
By. my signature, I cer* that the information and e)&bits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file lic on the half of the owner as listed below.
SIGNATURE oFAPPLiCANT1A&2b DATE ,
Property Ownerls Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspectionandtos�in&aftep4ant to this application.
SIGNATURE OF OWNER (Ir6=1 E.4� DATE 0
PLEASE PRINT CLEARLY
Owner/AppUcant:
VA _( csc
Name I I
_(0 (q 1774-1 S-t SuD
Street Address
:�—'o O'A 0 0 0
city State Zip
Telephone: 00& — q'3-7 3-7 ( 0
Email address (optional):
Alicant Representative:
-Acfc
Name
Streqt Address G c�
MUIM-Ceo' -IG-2-7�
city . State Zip
Telephone: L�K_ 2,90 1-6" \ .
Email Address (optional): _'�ILOPrIP9-CM e 60AI
0 0
#P20 CA File No:
.Critical Areas Checklist
Site Information (soils/ topog raphy/hydrology/vegetation)
1. Site Address/ Location: V--;q "it— ZZ -�&� . 10 101 1114 h St. S 0
2. Property Tax Account Number: 1 ga —
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? es; _ no.
If yes; how is site developed?.— g�, Qq. C:�_o 7PLP I IX4 kao 1se,
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-fe
et over a horizontal
distance of 66-feet).
tk
Hilly: slopes present on site Of more th" 5�-
over a horizontal distance of 33 to
Steep: grades of greater than 30 % present on. si fical iris$iof,�,1&feetioveT�a�horizontat
9 q11
-feet).
distance of less than 33
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing, water: Approx. Depth:
What season(s) of the year?
Site is in e fl way
8. 1h. I o6d floodplhi "of dw.a�teucourse.
9. Site c a creek or an area where water flows across the grounds surface? Flows are year-round?
.0v .,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. Plan Check Number, if applicable?
2. Site is Zoned?
3.-. SCS,mapped soil type(s)? A iAl,,,.,.A - Wrb,-A IA,,k 1--,f,7,
4. 'Critical Areas inventory or C.A. map indicates Critical Area o , n site? NO
5. Site within designated earth subsidence landslide hazard area? No
DETERMINATION
STUDY REQUIRED WAIVER
Reviewed bv: Ar��� Date. (4122, 1-., /_
1 MV
IWA
0-8
MrA.—
E
0 0
PLANNING DATA
Name: Pat pa,9,c-h4l
Date: ()(P. 116. 7,00(p
SiteAddress: -+C)lq I-J-+"H C7JyP,4e,+!5w
Plan Check#: BLD-2006- (p'+8
Project Description: E5 og 4' a d d o v iry e,)( .3 ov-4 9 it 2 3 (p q GV1 Dp StCWa ee
w I (A ecv- o v eir -
Reduced Site Plan Provided: & NO)
Zoning: FL!5 —43
Map Page: 404
Corner Lot: (YES
Flag Lot: (YES /0
Critical Areas Determination M G P- A - S-00 (P - 0 0-t 6
EI Study Required
M waiver �:�
SEPA Determination: 1&)(C4%0t
N Exempt 4 60 CLwj� yairAs;P of 8radf-no pvopcw7ecl.
El Needed (for sites with 500 cubic yards of grading or within 200 feet of Puget Sound or Lake
Ballinger. Requires: (1) Fee, (2) Environmental Checklist, and (3) APO List with notarized form).
(I'l 4-M ST Required Setbacks C "TH FL W)
Street-
Side:
S
Side: -4--S I
I VV
Fzr-
S.-Met -.7 S (a e.
2.15 N +-S
Actual.Setbacks
Street:
Side:
it -E;
Side:
VV 4- -2,
S,'Iyg'e+
N
El Detached Structures: 0 K 0 Wy� OV% r7 iir, L CL vA, -
IJ Rockeries:
El FencestTrellises:
11 Bay Windows/Projecting Modulation:
bi Stairs65e�ck-
Parking Required:
Parking Provided:
LotArea: q-+op3
Lot Coverage:
J(pJL4
Lot Coverage Calculations:
1541 > 2-145
Building h�t �
Datum Point:
Datum Elevation: qT
MaximumHeight:
Actual Height: kl,.
ADU Created: (YES /a C, V.,V W-VI
Subdivision: CVle" MLJ "V11t — L-O+ 4-+-
Legal Nonconforming Land Use Determination Issued: (YES /0
Other
A'- lot
101- A-VtN e. 6-4 v, a
c. i0D �Ae.Vaticyi
I D IV
Plan Review By: g,6w 6&e,� (Avi vitsed 00 / 0 1 / 14 (P 3P ) RVLA 6 10 LAXI t'
LA.;-- q 6 17 - 0 4
EET FILE
085)
NEIL ESHLEMAN Post Office Box 578 Edmonds, Washington 98020 Phone 776-3569
BUILDING CO., INC*
LEGAL: Lot 7, Plat of Cherry Hill Lane, Snohomish County
SCALE: 1", 20
4c" L"r-C.
i 14j,
�E
FBACKS:
--?ONT
'), I 0� CE
REAR
OTHER
7
I-t'
F1 E 1 G H T ,2,51'
/77t4
CITY OF EDMONDS FOR INSPECTION CALL %
PP.BLIC WORKS DEPAR&T Permit 01
SIDE SEWER PERMIT 775-.2525 Ext. (,27,2,-,o Issue Date
L PERMIT MUST BE POSTED'ON JOB SITE
,) [LYNNWOOD UNE
1 Address of Construction -7,0/cl 1 77
2. Property Legal Description linclude all easements) �7'
3.. Single FamilyGesidence Multi -Family No. of Units
4z_
ommercial
4. Owner dnd/or Builder
<Ze
'5. Contractor & License No. �69
- L/ V
6. Invasion into City Right of-�ay: N Yes . (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (30PS-TU14)) before
excavation).
F, 7. Cross other private property: Yes No V//Easement required
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
P4
F:4 a. Property owners must obtain a permit to install side sewers on
>-I 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-1 installation for one year.
W
4 C. Commercial establishment requires a minimum of a six inch (6")
P4
Z� 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
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 sewer 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 nly. Two (2) working
days notice required.
DATE: ( .- �; 7 4,9.1- �2_�
f.certify-tha:t I have read
and shall comply With the above
PERMIT FEE: Z0, on DISAPPROVED BY: Date:
By: Date:
CONNECTION FEE: -S
94 �:) - APPROVED By: Date: ve.83
0
44 PERMIT MUST BE POSTED ON JOB SITE
NOTICE:
No warranty of accuracy.
The information shown on the attached map(s)
was compiled for use by the City of Edmonds,
its Employees and Consultants. The City of
Edmonds does not warrant the accuracy of
anything set forth on these map(s). Any person
or entity requesting a copy should conduct an
independent inquiry regarding the information
shown on the map(s), including, but not limited
to, the location of any sewer stub shown. Such
sewer stubs may or may not exist and may or
may not exist at the location shown. Neither
the City of Edmonds nor its employees or
officers shall be liable for the information given
on map(s), nor for any one representation
provided based upon said map(s).
Side Sewer Drawing 0
The City of Edmonds EASEMENT NO . ............................... ............
NEW CONSTRUCTION [W REPAIRS 7 LID NO - ------------------ ASMT. NO . ......... ..... t-
OWNER ZSHJUEMA�N ------- C-O-N.,�apm— ............................. CONTRACTOR --- L714NWOOD ..... 15EPTI-C - ----------------- PERMIT NO.G94S
JOB ADDRESS .770-19 ........... 1, r If 7-T.R ---- PL— .................. LEGAL DESCRIPTION: LOT NO . ..... 7 ............................ BLOCK NO. N W.00D.-LINE.]
.. ... ........ --------
iNORTWA
C.O. CAP
3;
REOX-
4'0P 4Agi
V
-T
INE
PWW-000 1 - 11 f75 (R EV. 11178) 177TH
NAME OF ADDITION ----- �;.RERR'J ...... LL I -A%
..................... N .............................................
Approved:
DATE E.71a.--83 --------- ----- By
0
0
STANDARD"DETENTION SYSTEM WORKSHEET
(5000 SF OR LESS)
CALC. BY:
OWNER: A 0,09E I E08 S. PHONE:
?A,5C-ANL1 M-1A-6TGQ
T—&�i DATE:' Uiilo-
FINIWIE,
GRADE
TIGHTLIN
.W.-M ----
FOOTING DRAINS SHALL NOT
DETENTION PIPE LENGTH
— 0-5%TOI.O%SLOPE
UPPER CATCH BASIN
NV. ELEV,
CONTROLCB
BE CONNECTED TO
OCKING LID (TYR)
IM ELEV.
F 6* Mln. clearance
Measured from top of
.rIF Cone. box or riser.
DETENTION SYSTEM
9W Now
STREt I
MIM CL
TO CITY CONVEyANCr
INV. INV. ELEV.
ELEV,
-F — ONTROL
YIN. RIFICE
'X2'XI 2" DEEP CONTROL CATCH BASIN
(4--6- QUARRY SPALLS OR EQUAL) IN. S" COVER
FROM CONTROL C
2" �,l 2 " DEEP,
(4�6' UARRY PALLS'
CONTROLCB
S S
HALL BE PERPENDICULAR 11,51
TO SPREADER TRENCH TRENCH SHALL BE LINED
PERF. PIPE SHALL BE WITH MIRAF1 &ON TOP
L L
EVEL & CAPPED AT ENDSI'-�!
RIPRAP OUTLET 7/8"WASHED DRAIN ROCK
SPREADER TRENCH
NOTES'
1. CALL ENGINEERING DIVISION (771-0220 EXT. 1326) 24 HOURS IN ADVANCE FOR A TIGHTLINE AND DETENTION
SYSTEM INSPECTION BEFORE BACKFILLING AND FOR FINAL INSPECTIONS.
2. Responsibility for operation and maintenance of drainage systems on private property is the responsibility of the property
owner. Material accumulated in the storage pipe must be flushed out and removed from catch basins to allow proper operation.
The outlet control orifice must be kept open at all times.
FILE
Ul IT 0 1 VKM
CONVEYANCE
SYSTEM
SPREADER TRENCH
SHALL BE AMIN.
OF I O'LONG AND
PERPENDICULAR
TO CONTROL CB,
:10 ALIO
I ONialine
gooz � Tinr
ans3u
CITY OF EDMONDS
EET FILE ASSET INFORMATION SHEET
y-
1� NEW
E] ADDITION
EIRETIREMENT
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
v tc d
SERIAL NO.
LOCATION
DEPT. NO.
o I ?= 57- -5 ,j
6, t(o
"PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
o
PROJECT N U M BE R LAJ 2
PROJECT COMPLETION DATE
COST
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT -
0 G.L. ENTRY
REFERENCE
DATE
VERIFIED BY
PROCESSED
BATCH NO.
INITIAL
DEPARTMENT FILE
BUILDING ADDRE
BLDG. DEPT. SUSPENSE
[I OFFICE ADMIN.
t5kITY ENGINEER
r__
_____bU1LUiNfj I'l-AUT1 I _K1',V11'-W
— PUBLIC 140
S -LOG IN
Multiple
Commercial.
DATE
A -A I e_1 /.I L
0 Access Slope and Vehicle Access
UA 0 Drainage Plan
Uj E]Street File
0 Legal Description
Quit Claim
Easement
1 "late" -Sewer., Connection
61
WATER/SEWER DIVISION
1V _'M
Detdrmine.t..Me ter;,, Size
0 et( Review
ilding�,,-Permit,,
B�i
T;DIVISION'.
4
C omplete':;Building Perm t,Review
-LOG OU TO BLDG -.-' DEPT.
_1OFFIC ADMIN.
-------------------------------------------------------------------------
(check)
D��BUILD;V.G PERMIT APPLICATION (COMPLETE).
42f__X� , . - � X3
19'2 COPIES OF SITE PLAN
2 COPIES OF FIRE PROTECTION PLAN
(PREVIOUSLY REVIEWED BY FIRE DEPT.)
3 COPIES OF DRAINAGE PLAN WITH CALCULATIONS Ely
REQUIRED BY SUBDIVISION
GREATER THAN 2,000 SQ. FT.
IMPERMEABLE SURFACE
LESS THAN 2,000 SQ. FT. Q
.E(PoECK ZONING'REqUIREMENTS (SE.T.'BACKS)
areCOPY OF ENG I INEERJNG CHECK. LIST
COPY OF PU"-'LIC'.WORKS MEMO
MULTIPLE OR CO14MERCIAL
YES ` �TIACH: COPY OFADB APPROVAL INCL. ALL DRAWINGS)
NO
14SUBDIVISION YES[] NAME.-
DATET Kt;L;UKWD
NUMBER
NO (ATTACH -COPY'O/F-RM-UIRE2
El YCK SEWER DRAWING AN D ATTACH COPY _--,AW
TI7SDEDICATION REQUIRED YES (0 QUIT CLA12
CITY CODE
NO r6A
jj�
n/DOES CITY RAVE EASEMENT ON PROPERTY
YES[] (ATTACH COPIPSOF DRAWINGS)
/ N .0I
0 E] "�
CHECK LEGAL ACCESS —"' #INGRES UTILITIP-Sa-11",
YES YES
NO NO
0 HAS SEWER ASSESSMENT BEEN PAID
YES L.I.D. NO.;
- PLAT NO.
SUBDIVISION No
-IF:, MULTIPLE: INCLUDE NUMBER OF UNITS
COMMERCIAL:
INCLUDE -NUMBER OF FIXTURE U14ITS
0 0
DATE : '2-3- 5
MEMO TO: Building Division
Planning Department
FROM: Engineering Divi-sion
Public Works Department
SUBJECT: /17 77'1, q J�v
After review of the subject Building Permit application, we have the following,
comments:
1. Connection to City water system required.
2. Connection to City sanitary sewer -system required.
-- - M-
3. Right-of-way permit required.for any work on City property.
4. Driveway slope not to exceed 14%
5. Backwater valve required if downstairs plumbing is below elevation of
upstream manToTe—.---'-
6. Water and sewer lines to be sAn;vr;ifarJ by 10 fo . ot minimum.
BD 6/82
0 0
PEMLIC UORKS DEPARINENT CHEacusT
MUDING PERMIT REVIEW Si�
(address) (date)
0
Street Rig�ht-of-`Way
Z
I
Access Easements Existing Al A7 RE_QD
H
04
Utility Easement Existing M-�& - REQD
94
lot Per Subdivision / Plat Assessor Yhp_,5���
W
Site Plan Checked for Accuracy,
Z
Underground Wiring Reqd.
W2
1.4
0
Check Accuracy of Legal Description 06:
Z
Review by Date X-3 _AF
Existing Water Main Size
Water Main Required
Service Line Required _VY
Hydrant Size Existing,
Hydrant Reqd Per Fire Code- 1411A Size
Detector Check lvlbter Reqd._
Cross Connection Inspection
Fire Department Comments
Water 1-16ter Charge Reqd. 13 7-
Review by_ Date
Septic Tank Design Approved NIA Date
Septic Tank Permit Reqd. AMA Permit No.
Sanitary Sewer Availability Z/O Proj.
DrxAng No. File No.
Side Sewer Availability /A�/A 6�z
Sanitary Sewer ection Fee Reqd.
:3:
Review by Date
Open Ditch Existing, Reqd.
Culvert Reqd. Size
i�d
Catch Basin Reqd. -Indicate an Site Plan
0
Shoulder drainage maintain collection on swale open runoff
Manhole reqd. —Indicate an Site Plan
Soil Conditions and Ground Water Field Checked 5� ,, ,,7, ---
Review by _7 - .57- �-
Revised: lvlO-1977
Page 2
Str-ee't Paving Reqd.
Curb and Cutter*Reqd.
Sidewalk Reqd.
Curb Cut for Dmveway Reqd.
ad Right -of -Way Construction Permit.Reqd. 7
Bond R.eqd. for Public Inpravenients*
Street Name Sign Reqd. "":5-
Other Signing Reqd. Z�e'-e
Pre Permit Site Inspection node on
z
0
BY: MER
WATER
HZ ST=
H
92.4 ENGINEERING
*4 Special Requirements listed in mew to Comnmity Development Department,
Building Division
BY Date
o All items filled in on. Building Pernit Application
04 BY Date
"4 Drmqirips Stanped and Notations Made
BY Date
Approved by Public Works Department
Fzvised: lv 10-1977
USE
CITY OF EDMWS ZONE
CONSTRUCTION PERMIT APPLICATION JOB
INAME (OR NAME OF BUSINESS) 1AUUHtZ10
I Neil Eshleman
Building
Co., Inc.
LEGAL UESUHIPTIUN GHECKJ
SUBDIVISION NO. I
A?'Z LX-'L7j
MAILING ADDRESS
P.O. Box
578
PUBLIC RIGHT OF WAY PER OFFICIAL STREET
EXISTING _60_ REOUI RED DEDICATION
PROPOSED
771 —TY
NAME Edmonds
Charles
Lee
TELEPHONE NUMBER
776-3569
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
STREET USE PERMIT REQUIRED n
ADDRESS
903 10th
Street
SEE ENGINEERING MEMO DATED.
SEE PIW DEPT. REVIEW CHECK LIST DATE6
F, —TY
ITELEPHONE NUMBER
NAME
Neil Eshleman Building Co., Inc.
ADDRESS
CITY TELEPHONE NUMBER
Fr1mc)nd 776-IS69
STATE LICENSE NUMBER CITY LICENSE NUMBER
F1;HT,RNQ2R1,TS
Legal Description of Property - include all easements
(show below or attach four copies)
I (-� 4 1-7
01 �, Ic V (
rx] NEW
1XI RESIDENTIAL
El PLUMBING
ADD/ALTER
NON-RESIDENTIAL
MECHANICAL
REPAIR
RETAINING WALL
SIGN
E] DEMOLISH
EXCAVATE
OR FILL
FENCE
(_ x _FT)
PRE -MOVE INSP.1
COMPLIANCE INSP.
swim
POOL
SIDE SEWER
WATER LINE
El
11
;UMBER OF STORIES
2
NUMBER OF
DWELLING
1 UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
REMARKS
SIGN AREA COMPENV. REVIEW ADS NO.
ALLOWED I PROPOSED LETE I EXEMPT I
VARIANCE OR CU JPLWING FtVIEW BY I DA
[ YARDS
FRONT SIDE X� REAIir;�� I
R 2EM A FRI K S
BY I TYPE OF CONSTRUCTION I CODE
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
FJ YES [!NO
RE MARKS
VALUATION I FEE
0
Z
cc
W
ul
Z
U
Z
cr ILU
Z
5
0
Z
a
_j
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
o
successors in interest, agrees to indemnify, defend and hold
W
w
harmless the City of Edmonds' Washington, its officials,
5
employees, and agents from any �nd 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
modify, waive or reduce any requirement of any city ordinance
0
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
T
provision."
I hereby acknowledge that I have read this application; that the
information given Is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz-
THIS PERMIT
AUTHORIZES
This application Is not a permit until
ed thereby, no person will be employed In violation of the Labor
ONLY THE
signed by the Building Official or his
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees arepaid, and receipt is
I tion Insurance.
INSPECTION
acknowledged In space provided.
SIGISIA��E (OWNER OR A�Gf� DATE SIGNED
-3
DEPARTMENT
CITY OF
OFFICIAL'S SIGNATURE
EDMONDS
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
ATTENTION SHOULD BE CODED 31.04.
775-2525
DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR — File YELLOW — Inspecto7j]
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED.
UBC JAN 14 ,89RIGINAL
CHAPTER 3.
PINK — Owner GOLD — Assessor
102-78
Pr!,g . E W ??S 9,
40
'<O
Vf MR. VIV Ko
FOR INSPECTION
APPROWED AS NOTED
BY ENGINEERING
AcHc-'-- T ........ ... .. .
g 0 L)F
L. 10 12re or
Apt 0 c7e srt� �t4c
TH t-A�Or I,C-P-
DL�C- �tjH c
Qj R>
7 rl I I
4-5
IL vA. �1140 t
I'l 7m TF
c::/>
se
V4
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