20020663.pdfDATE RECEIVED
CITY OF EDMONDS
USE PERMIT
ZONE
2002 _000 60-
NUMBER
CONSTRUCTION PERMIT APPLICATION
0' IIITEIAITI
'ADDRESS
OWN OF BUSIN SS
,;N,AMEINAME
FOR 6C CLIMT
FLAT NAME/SUBDIVISION NO. 1.11 NO.
MAILING ADDRESS
LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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CITY IIELEPH05
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EXISTING — PROPOSED— `s`V.1nn1
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REQUIRED DEDICATION— FT
NAME
METER SIZE LINE SIZE 1EV REQUIRED
YES E3 No 13
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ADDRESS
REMARKS
WNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP ]TELEPHONE
NAM.
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ENGINEERING REVIE1115. By DATE
ADDRESS
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I ,573 [),,A) It, vAhl
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FIRE REVIEWED By DATE
CITY 4
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—VARIANCE
STATE LICENSE NUMBER EXPIRATION E
OR CU SHORELINE OR ADB# INIPEOTION BOND
DIEGO STED
MIES ONO
SEPA REVIEW SIGN APRREoAPOSED
PROPERTY TAX ACCOt
C WED ALUO.EDHEIGHT
PLETE EXEMPT ALLo POSED
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Or
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EXP I
rl NEW
I IAECH
C OVERAGE REQ IRED SETBACKS (FT.) PROPOS D SET S IT
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ALLOWTE D FRONT
PROPOSED FRONT SIDE BEAR JR SIDE"KRIEAF�
ADDITIQN COMMERCIAL
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SIGN
PARKING LOUT DATE
REDD PROVIDED 11, ItgEA asy.2
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REPAIR GRADING G.
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REMARKS SIIAU BE INSTALLED ON
rl DEMOLISH 0 TANK
OTHER
LINE AN I A WN I L, K' .5 Tilt btiff
GARAGE RFTAININGWALL
FIRE SPRINKLER
L1 CARPORT ROOKERY
(TYPE OF USE, BUSINESS OR AI75rr,
LJ FIRE ALARM
CHECKED BY TYPE 1 1,27), ....UPAn
UP
7 NUMBER OF
WELL No
'Nff$
CRITICAL
AREAS
SPECIAL INSPECTIO AREA OCCUPANT
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NUMBER
So IRED 0 YES LOAD
REQU
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DESCRIBE WORK TO BE DONE
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VALUATION
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING
LOP,
T IL
IOTA.
Building Permit
City Surcharge
PLAN CHECK NO: STED DATE
Plumbing
THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
t: HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2
Grading
M DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS QUEEI, ETC.) WILL REQUIRE
t: 6 E PA RATE P E R M; SMS MID N.
PIERMITAPPLICATI N: 180IDAYS
Engr. Review
PenMITLIMMIYEAI PROW ED WORK IS STARTED WITHIN 80DAYS
Engr. Inspection
SEEDACKO; INK PERMIT FOR MORE INFORMATION'
'APPLIC ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN I.TEAR-Eil AGREES To INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMON11, WAIHIMIITON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
f9re inspection
Receipt #
I MIT
FROM THE ISSUANCE OF THIS PERMIT. JSSUANCj OF THIS PER T SHALL NOT BE
M' SH B
NY W 0
13EEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapainsp.
IT0taIAmLDUe I
0 NOR LIMIT IN ANY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE R IS 0,
V PROVISIO
'0 P DV I
Recording Fee
Receipt #
BY
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS GO RECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WIT14 CITY AND STATE LAWS REGULATING CONSTRUG.
D SLTORUC'
Z TH RE
TION� AND IN DING THE WORK AUTHORIZED THEREBy NO PERSON WILL BE EM
EGY6 as N WILL G _ EMPLOYED
P Y'D
CALL
B,I This spin s.tiod 1. Pat . pardift -III sign.d by M.
lal,�g OM21 , h1olhor Dop,ty: and Foos one paid, and
IN V, OLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
f ... Ipti—knoadodg,dinspacop—IdlVd.
WORKMIN'l COMPINEAR��U.NCE AND FCW 1. 111.
(425)
ZT�RE
U/I
771-0220
ATTENTION
E)ff 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEPITIFI-
ORIGINAL - FILE YELLOW, INSIECTO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER 00 -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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City of Edmonds PIRM"T 10:
SIDE SEWER PERMIT PERMIT EXPIREs**2---
Address of Constructi.,:—Or�zz vV70 5�—/ So LID #
Property Tax Account Parcel No. 2�04SOOO'ZO)200
Attach copies ofall access and utility easements v� Verified and Approved by afIA:)-
Owner and/or Contractor: Ciroacir C(j,orL / (;Qzyr/z
Contractor License#: Crwrr 1�*/Gsj?r- — Building Permit
&W, Iffe-3 1& 0&1 (1�9
ja"Single Family Invasion into City "Right-ofWay: Yes No
Multi -Family (No. of Units____) *RW Construction Permit # /1) 2-- o —
Commercial (No. of Units—) Cross other "Private Property: )��Yes No
0 Public "Attach legal description and copy ofirecorded easement.
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Owner or contractor signature and acknowledgement statement: Date
By signing for this permit I certify that I have read the City's public handout entitled
Side Sewer Specifications, and shall comply with all City requirements outlined therein.
9 CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION 2
W FOR INSPECTION CALL 425-771-0220 extensior 13�(b 2
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION RFQEESTS
Permit Fee $---L'YjAb09FV0tr ----- Issued BY- 11.
Trunk Charge $ -7 Date Issued:
Assessment Fee $ Receipt No:—
C4 Permit Surcharge Fee $5.0� Total Fees Paid $— 19 P�-
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES —NO —Date: —Initial:
Partial Inspection: Date: nittal:
Partial Inspection: —Date: nitlal:
FINAL INSPECTION APPROVED: Date: Initial: As -built to Street File:
i% PFRMIT Mt]qT RF POSTED ON JOR SITF- f�
White Copy: File Green Copy: Inspector Buff Copy. Applicant
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W. VACI 019tritc M' "Com""
First American Title
INSURANCE COMPANY'
OFFICIAL
Nj
Had far Record at Request of
1�1
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4:
Ch,
quit Claim Deaj
GROMOR Richard Lananc& par . triftg and Ana*%te H. P&rtw West his wigs
for an, in congImads, a Assumption of mortgage Balantm, only
sta"ys and qtdt dwItts to George B- Clian (a Single man)
%a Cesety of Sachomis Sr '"M ths
the fincz datorthed "A now. situakd in L 0 ft of
titk.1 0. t*t(-) thottIM2 Its S-lg5
aU dw "Vhd V
of Government Lot 2t Soc.30 TWP27N* Range 4Ek%#TCGMM uith an easeas for iw*os,
*&"as and utilities over under and actross that portion of said Gcv�gaach Lot 2 described 4%
folla,,al Beginning at the point of iterastition, of the N line at the 3 185.Oft of said wiof
W* of 84 of G*v.L*t 2 with the S line Of said R Jvthanoo from said pob run wee &long the
line of said 3185ft & distance a 56.Oft to the. TFofSv thence N pu%11*1 %* the Slimb Of
N
W.* f Gov lot 2, a distance of 127 rt more or least *0 ths S line Of the County
RO&dj long said S line of County Road 20.0 ft; thence S 127 ft more or less to a
th Wof% thence E along the N line of the S 185.0 ft a distance of
Point 20.0 ft —at of
2 0.0 f t to the of B.
More Commonly knoW set 882u-2k8th St SW. Lerrawood. W&9b=gtm
DW clins, takes dead subject +a a Real Ratate Contract (as attached) and sub4oat w an
underlying y" molqaag. in the approximate haiaac* of 412,500.00
NO SALSS TAX
REOUMI
DEC 9 1974
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OR day pow"Ilt fro",
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .................
FOUNDATION:
Fooling ......................
wait
Pier/Porch .................
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Retaining Wall
0
0
Stab Insulation ..........
PLUMBING:
Underground .............
171
Rough -in
0
Commercial Final
0
C
HEATING:,
M
ITI
Gas Test ...........
Gas Piping
Equipment .................
0 n
Commercial Final
M
EXTERIOR SHEATHING
055
NAILING ..................
0
0 Fn
_FRAMING ................
C: Cn
C In
FIRST FLOOR FRAMING
ITI C)
INSULATION ................
Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
0
171
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................