20030596.pdfI
,'DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
'MAILING ADDRESS
L V_,,IJ
CITY rELEPHONE
�Iymo — �Q 12 49
NAME
ADDRESS
C
3
1 /?-0 1 U2Li
CITY ZIP ITELEPHONE
ADDRESS
( 46 4 r) IE,
CITY ZIP TELEPHONE
0WOWIVICIL-1 I U � a! 29_,C_>_2A t0S_ -
STATE LICENSE NUMBER' EXPIRATIO
NEW
ADDITION
REMODEL
REPAIR
ii�_MOLISH
oGARAGE
CARPORT
COMMERCIAL
MULTIFAMILY
GRADING CYDS
TANK
RETAININGWALL
ROCKERY
SS OR EX
I �STI�Wml_,"
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
PWRW WORK TO BE D0NE'j
r
CBL
40
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
JOB
ITE/APT#
ADDRESS
Ll
.3
AIZI-
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IESCP Ap=.
W ".",
Sum Ute Pemift R80
EXISTING — PROPOSED
InspoWm Flaquired
Sidewalk Requirod
REQUIRED DEDICATION— FT
tim1mgmund
tj�2g raqul,.d 13
METER SIZE
LINE SIZ
OF FIXTURES
PRV REQUIRED
1
YES13 NO C1 z
I
REMARKS
I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 11
REVIEWED BY DATE
FIRE REVIEWED BY DATE uj
01
If
VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
REO'D POSTED
113YEs 13NO 1$
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE . EXEMPT ALLOWED . PROPOSED I ALLOWED . PROPOSED
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
COMPLIANCE OR
CHANGE OF USE I —
PARKING LOT AREA I PLANNING REVIEWED BY DATE
SIGN REO'D I PROVIDED 916
oFENCE
( _ _ FT) REMARKS
o OTHER
oFIRE SPRINKLER
FIRE ALARM
CHECKED BY ITY OF N I
f)
OCCUPAZ�
GROUP
CRITICAM
SPECIAL INSPECTIONTREA
OCCUPANT
REQUIRED [I YES
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC
10-8/F--INAL INSPECTION REaD
$
Description
FEE Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
F
Building Permit
City Surcharge
C—
Z2
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AIJTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERUITAPPLICATION: 180DAYS
PERMIT UMrP I YEAR - PROVIDED WORK IS STARTED WTTHIN 180 DAYS
Engr. Inspection /_nn
BEE 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 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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
Landscapeinsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CrFYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
PLICATION APPROVA
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 a plicallon Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
ficial or his/her Deputy: and Fees are paid. &nd
IN VIOLATION OF THE 1284S STATE OF WASHINGTON RELATING TO
THE
FOR INSPECTION
W�t Is acknowledged In space p!*Ided�
WLA
N IN%OF
WORKMENS COMPEN NINS CE AND RCW 18.27.
F N
E
SlaKiTURE (OWNER Ok�A!GENIT) NED,�
(425)
aA
771-0220
U_/
TE
R BY
ATTEN ION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
AUG-i5-2003 15:56
WL LABS
2066341936 P.02/03
f%U I
Sample Log / Chain
�%A jV non-7 nn
jam__9MWC99;&_P_-C
P0 so elm "MM. Ma"
Seaft WA WIM10" FM
MC*W*Mc#MMMECMM
.Client Company: inmental
Client Address: P.O. Box 81005
SeatUe, WA 98108-1005
Phone Number: (206) 523 4 4 41
Fax Number: (.206) 522-4099
LAB:
LAB Job Numb8c
Number of Samples:
AEC Job Number:
Job Location: Le"Olids
-7#,Wt-v4 734 Se-Irmooids &J&e
26
W A .2!LO
(Ch2M -Goal
RqwrtResubTo: BRA of AD
nEi
U31
ANISM
At MIN Number C] Paint
C2<m (air)
F-1 Soil
AtgMNumber [Z] Dust/Wipe (Wea?)
=1 PCM (bulk) Air (volume?)
M Results MR Hard Copy MTCLP
r76-ch lio MURM
X
q25- 49j- o/75 6
4111
Severe Damage (Spillage)
Condition of Pm*'age*. �G F-1 Damaged (No Spillage) El
Lab ID! Sample iD AfR
Lab ID Sample ID AIR
E A
A
E
Lab ID Sample-11) A/R 4,
17
10 18
2 02
19
3 -5/91- 03
20
C t" 12
4
21
13 �zl
5
22 , R
14
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23
15
7
24
16
X.
Date Time
Si
gnature
sampled By, 4,&.eA
63 -
Delivered By: �Z— Al
.............. .........
Received By: "/w,
[Analyzed By:
Reported By:
w
Mailed By:
Invoiced By:
Special: ter Than .01 f/cc;
Read Abatement Sample ONLY if Sample #_2@lr Is Grea
AUG-i5-2003 15:56
Job Location: 7M
Sampled !y-joildw-L
NVL LABS
2066341936 P.03/03
Air Sample Da BATCH ID
Y-�N d�s 1 �J4 � 23108,57-00
Date: IF- 15
Sample ID:
o)
Location: qV-
Sample Type:
g "ZjWork
Activity: jVgwwvja
Protection%
Observations'
Worker:
Decon:
Environment:
Time: Start
ump#:
Time: End
Minutes
Sample ID:
Location:
Sample Type:
rPrrotectiornr:
Work Activity:
t
Observations: Dkn�
Decon:
'Worker
Environment:
Time: Start /p
Pump #: —gn--
Time: End 1:0/
Minutes =
Sample ID: Location:
Work Activity:
sampl!Lype-.
Protection: Observations: ljd—�
Decon: Worker:
t. Time: Start 11--29
-7
Environment: -
Pump Time: End
Minutes
Sample ID: 31?1,oy Location:__=?j56-- 23Y
Sample Work Activity' AJoAjg-
T
' D
p
"o Loca
Work
t
e
Type: L
e'
0 Observations:
Protection: I
W k4
Decon: Worker
i m T
Time: Start /:P)
Environment:
jV Time: End 2: <0
Pump #: -
I e 'D
Sample ID:
m p
Location:
T
sample Type:
m P "D yp'
Work Activity:
-observations:
ctio
Protection:
Pro te
rDecon:
Worker
v 0
Environment:__:]
Time: Start
P Pump
Ump
Time: End
Minutes
Of
s3t?/
ie:
:-CAA SS#: 9 -7 2, Cert#:20011YA19A
Rate: Start Fibers Fibers
R ate: End Liters /field /cc
IS
Averag
SS#: --Cert#:
d dD Z-
Rate. Start
Fibers Fibers
Rate: End 12- Liters Ifigid /CC
/2,
Average
VI'Ajv I % 3 J*
�AAjrj
SS#:
Rate: Start 2_ Fibers Fibers
Rate: End 2 Liters Ifield /cc
Average
SS#:
Cert#:
Z�19--o ec;D2--
Rate: Start 7
Fibers Fibers
Rate: En d 7-,
Liters /fi /cc
Average I 2-t
ss#: Cert#:
Rate: Start Fibers Fibers
Rate: End Liters Ifield /cc
Average
;.4 4A
TOTAL P-03
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AtI IT1tII1 4 IIIed A0 4 ITI;k Lk IAfeek 1 4 k IIPrecon 1— .7 1I4 tIfI eJ left I I II F, AA I I .11. der I I I r 1 Clearing Limits and diversion trench upper Soil Nail Wall Iee0 1 11 d I I I L d I I k I tA4
2. How do we address questions to the regarding the soils Eng. TIIIIt'3,Temp sign/ Monument sign II1IT I 1 4
Ile4 ell4AT'Question on Fir tree to be saved
AItI1Developer extension agreement for the water service
IIII d, I I IfIifItIId
d, ITT I P& I I I IIee IAItd 'k Id t I IA1 d I II 4 10
4 IV1d ItAIt11 1
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ITIItII1AAIIItd IIIttItIId, 1ITIf I I 1ITI I I IIIAA . k 4 1
itAIAII1I I 1if I k II.10 1,14. I AkA ITII141 IIIIifI11AALd
IAA0 d 1IIt
td 4 0 r4 :0
IIIIAeId I
TIIIIItIIIeI I
IIIAI IIIIA6 A 1tIt IIItII1III1. k I k k ItIAITItIIIIAIIITd I letIIIA IdA II1 d 1; fiAVit irk IIIfftIt V er4 .1 1
ItIAT, IIAIII d ItAII tIIII. It I I ITIli P7 IAIt II . I . I I 1IAilt Id III144 eAtAeAIItA
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AUG-06-2003 11:44
HO GLOBAL
WORKPLACES.
Agency Coo
PUGET SOUND CIAW
AGENCY
20-0302383
110 Wm Stec; saim 500
Se&Wc.wA "101-2038
www.pwlcanak.org
WIN
NOME OF DiMN
P. 02/03
RROL"ED
JLI: 0 1 - 20
AM
owner. -
I Phone: G -56-19 1 a- VVACI
MaitiogAddna: I.Ciamov �-4-m Stdo Ams -- 3"1
Ifte "%LA F - - - 9-
4ddre.=.--
She
mm
IL 7m. or
Is
AHEItA DWIding
F. Deodmon shut *VMG14
Idarmuflon: Daft:
Demlidon ~[Ibm
conbactor: CW
Dm of Asbestos Wo Ffiable Asbestos identiftV mve, 0
�Z= 1011 Was Nonfibble- A6mstm MoWflod? MYe*JI@&0
C*ffir@CWm#: %C�ft-&305 Alrachocom Of Me "MV mIrmufrkble 4$6010
W Der. 2.
No. of 1. U T ng Fire (Li Fire VCPQ
Stmehnos. 2. CI Ordered Demolition Lamb SM of Order)
n m bacL will nonmabit asimms be left in piect during dmo? U Ym LJ No
Ifyce, list " and qty.
G. 76" AdMztn Dmw. M T W Th F SA SU
Embq mmmagm. NW. W30&3k 'Comoledowlar. %113193 Hours:
Will $11 fflable asbellos Yes
TOW 2gL. to be Remove& Lln=Ft !sum Ft. mman
-%Sir
List M*e) of matedil to be Fwmved:
Jor
Asbm10sffi4moWm PreJftt
P*Gjcd Demomum
SFp&I&F&,n*VAddvvwt:
Em
A. 13 Asbestos Ranaval, Pm*,Ct OdIY
A. Not Mateo
A. $25
B. a0b�on Project (with or wWwut as-besim MMVSI p(tWA)
D, 10 11."66
a. m
ICAsbatug BMW m bggW ME g2ufiamione-demplition mum wait 10
V&e S&Wkj2m* ramome & cmmw Ay awfolo WW An bem or WU bf mft
aw ra&Wm a dwk dop*ik AW a&M 6=0
]A dr 10 ag bs AmW A doftft midgee Awn" bl&dt MMWMFOM�
9 Wn,
All Odwr Dgmalitions With No 61�� Remmel PI*jM
ORD
-
Fri" A"Ns Mods Laft thA2 MM Rms&LK&
Asbestos Dem
3.LIZIO-2591jumfector2:49-159smfmofasbestm
R�r Notice 10 Dw
$150 SS0
473260 - 999 lipar fect or 160 - 4.999 vgM feet Of Wbestof
10 Day?
$300 POO
--a-1,900 - 9,999
S. hum fed or 5,000 - 49.999 Sam foot of mbeatos
10 DnLmL
37 3250
so
6713 > 10.000_linemr fL--t or > 50.000 Suare feet ofesbestos
-
10 Days
$2,
7.(3Emgmy AsbeM PMOCt CC U ErmSency Demlitiou Pfoject
Priar'Notice
TwicePtojoctFec;
L I m6fy dat the idwastia"coaWr4d in ftw6rcadw mffhmmW d0
Ve
V4.
acm. no.s
(�AJG-06-2003 11:45 HO GLOBRL WORKPLACES
P-03/03
,Th* PW Sound 0=0 Air Agftq ftqum Wnm nodficatim bdm Cantn== a Si" abcsidis pndect
involving matamb aw to of ptaw M an &M 10 Unear feet 6wt and for all dcmoUdon pn*m
(1vownsess of a*edw owbof) wolvinz xtrumu Vn& a pmeew'IME
am Feder *im 120 equare fm (Rcguiadm
UL Asticle 4). All asbcstog removal BW dmolitiou nodffcmfim must k AWWWRod to the AgaW an CUMM Agency
f0m. 1192 MM "v IGO ftoftfi2a vmkeh invoLin mided* and sftgggM INjow ftagificadon dumhold-am
still subLeft to R110 RE realikWW11% of Rgg&ft IM McIg 41.
Aftr acciving a =Wleft notificaden wid, the aftmprige p0ject fee� &e Agmy win wvkm the farm nd relum a
COPY tO the 08bestm and demolition conbactor by nail. The robvned copy wW be your Vgjd&ted nodncadom
J. Demandals
cdahmftar- &-. %�� -- — I — Aas C=Dl
MaifinsAddrm- 'W*0 cofttts�ws
Jpb 0:
Ca 4%.4-Ne samc. %QO not —L%*4 - ZOO 13PH"00%
GUIDELNE8 FOR OUSUMING M ABBESTOMDENOUTION NOTIFICAMm
SOVI. Cbeck6coM PMjQCt IM in Dow A, Frimble-MMton includes popcom cciling nUMIK shea vinyl flooring, canent
zsbcsft bond Wdip& and dud insuWan. hipaWft mftipi is nommily Smad in vinyl Iloor tiles, window play nd most roofing
Sap 2. Enta pruperty own" ingwmtku in X" p.
St@P 3. Em the asbeam conhadar at pwpM oww infmnsfion, if dw property owvw 1*5 condueft a si�fiwdly
Tmww.
proiect, in Box C. Print dearly WE is your alum Mal residcatial
Stop 4. Ent" the site addrms for all 09fificasm iri NU B. For towd'*Uctme pa4mb, aftch supplewenW dwa whis a site map
(include an address fbF "ch Bile) End A Un Ofthe WP od amount of firiable nbeafts to be nuoved ftgn efth Mcturc.
Sftp & Check cgbbfT &sbcAn nricy or natcrid prcwmvd m Box E. All detnalitious aquire that an Asbestos Pmmd Emmgmey
Rnpooze Act (AHMA) nbestas sumay be !!!!:!!����,buiwing inspector. AnwjLg_gRft of the jMrvMLW
Wfificationafadematirk - 1- -. . _*e
and .... ....
SkPG-
00" oWer =W be WA*cd)' All UbOws mum bc =mwvcd Prier to 00dwft c ftai*9 fir& Addificed asking fim
Bre ma'ned 'n ftubdolk L Section 8-41L If MY 000fliBbIc nbcdox ulwdlialo will be left in Place during d=dWm,
dwck Yes and list Ow ine and qwmty ofmaiew-
St4P I Enter albOUN 99*00 WGIMIUOU in Box G. List tHm Of A ONO Uh.2fitm umtcrinl to be removed.- sufforft fagwrW such as
POPCOrn cvdiuP Of Plut0f. shm VW-Vl flootiam duct and pipe im"ono cmagnt adwgft board gWing or pipe. eU.
Sup L FOr 96RO-Fau* RWdOBW Pmjvft. check BOX HIA for RuDY81im Pwjwtk BOX . ME far don"m projam with of
witim ubwoa nmv&L A*ntoa mcoval may be CmIneted afta a COMPIM 00tififtfim in aceived, bw demlition advides can
o* b*d an tk IOP day aller the notificifim in no"ved, Nd&.. If dw zjq*f"* mUmw Fa ONWO by 09W/Amo %*0 his
#em or Wo 't wbg Ike r=d*w6 93 dwk dm'sk& bmm JA Or 18 AGO he ahwAsA A j&Vkjbw& nwUmw do" HW Lvb*
JmffIdAU*. Raft or AV awke6dw #1090W.
Aw Cameoftdd PMJMS (Or P*ft tk" d9 M 4UM N Sh4ft Fan* RaldsWW, check the
6 dw maidms tile YM*" Cams" IH2 -
MOM of kkbk asbcdos d* *13 be mboved. If a ftnalition is jnvalv4 iacbj& dw opkft Udiarp.
AddidQUI fee) in your plyrocat. To file ibr an emaracy abcdos or dcomfitim 'ed, chwk tW 1-6001dje
Wlimble MUN90M7 box in 117. All —ememme hV MIM
X omeft mme be awwmgWed & finm ohs �Poa.
StrP 9- Piew ceWfY " GccurIcY 40A COUIVICM021 of the itdownuitim provided by Wvdng the nati&atkm in sox 1.
Ma'"My =w2d%Mts to dw 100040ift are reqWnd for chmOPS dwt 02mcm tb 9wint catcm. cAmp the 4pa of =bMw
mWals to be =wed SM c1bkongm to start dab-, complaWn deft and wodc scliedule for saboutus p*ft. No Ibe is required for
work Sch0d* daftes if the canhuctor is pu*oating ig Ibc Agency wodt zdhW* fix PrOgnan. A S2S.00 pwcamiag fee is
required for all num2duients.
Pdl% Sawd Clean Air AVU-7 IRIb"tQG OVANIhm and ftrw am downlwdW ftm dw Agency web pW at www4=Wa=ijrW&
For tecimW GGWBMWG 000tut (206) 6994059 Wd for administrative Wqohift contact (206) 6894M.
ftdS0UndCk=AirA&eiw7Fwt&tk; 66.160OWWW310)TS I
TOTAL P.03
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The initial
Roberts, a temporary contract
+,kp ritv
inspecLUL
I
DATE RECEI
PERMIT EXPIRES
USE PERMIT
ZONE
CITYOFEDMONDS B P NUMBER900)
)-()5q
JOB #
CONSTRUCTIbN PERMIT APPLICATION ADDRESS La Li
OWNER NAME/NAME OF BUSINE88
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE $
71ESCP Appmod
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pa" ReWhred
SUM Use P@fMN
EXISTING — PROPOSED k4pectlaft PAquired
PITY ZIP90.0 ELEPHONE r4dwah S4**Id
A P T
undwwmw
REQUIRED DEDICATION— FT
Widna requm 13
NAME METER SIZE LINE SIZE I NO. OF F07RES I PRV REQUIRED
ATA A 'r YES NO 13
J-1inc. A&,\rVNIAt--S L�Q,"qk�'
ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
Y-\
NAME COL I
ENGINEERING REVIEWED BY
DATE
ADDRESS
14cLo tiff. &*T
FIRE REVIEWED BY
DATE
CITY ZIP TELEPHONE
Ir
r 9Pn') �;_�7. 11 J? -
Wgg�.kA � 0: 1
-C q 1 —
— y
STATE RICENSE NUMBER' EXPI -QH15CKED BY
VARIANCE OR CU SHORELINE OR A050 INSPECTION BOND
REO'D POSTED
113YEs
[3NO1$
L��j6aajz I dal -x ya
14
SEPA REVIEW SIGN AREA HEIGHT
PROPEMY TAX AtPOUNT PARCEL NO.
COMPLETE EXEMPT ALLOWED
PROPOSED ALLOWED PROPOSED
, ,
EXP
[3 NEW PLUMBING I MECH
LOT COVERAGE REQUIRED SETBACKS (Fr) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT LIRSIDE REAR
><RESIDENTIAL
ALLOWED PROPOSED
0 ADDITION-'.-�. [3 COMMERCIAL COMPLIANCEOR
CHANGE OF USE
' I
REMODEL MULTIFAMILY SIGN
PARKING LOT AREA
REQ`13 PROVIDED:
PLANNING REVIEWED BY DATE
I . L
I
[3 GRADING CyDS 0 FENCE X
REPAIR FT)
REMARKS
f<DEMOUSH TANK OTHER
oGARAGE [3 RETAININGWALL 0 FIRE SPRINKLER
CARPORT ROCKERY FIREALARM
(TYPE OF, USE. BMNM OR ACTIVITY) EXPLAIN:
s; 7
CHECKED BY TYPkIOF C4NSTRUCTION OCCU
GROUP
NUM13ER 1
I NUMBER 0 RM A
OF )WELL)MY CREACS
SPECIAL INSPECTIONTREA
OCCUPANT
STORIES UNITS NUMBEW
REQUIRED [3 YES
LOAD
DESCRIBE WORK70 BE DONE
REMARKS
PROGRESS INSPECTIONS PER U13C I 08/FINAL INSPECTI EaD
A
All tftL-P9W1%--
J
fkAw- I
I
- Im"LP-1 ffi--
I r
I Loom
I
VALUATION
F-
$
Deacriptlon
FEE
Description
_—TEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit .00z
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT ivimRizEs ows THE WORK mnw. THIS PERMIT COVERS WORK TO
t: BE DOW bN PRIVATE PROPERTY OUM ANY CONSTRUCIrION ON THE PU13UC
Grading
DOMAIN JCURB% SIDEWALKS, DRIVIEWAYS, MARQUEES, ETC.) WILL REQUIRE
-6
r. Review
PE=rrAP P u a & 6 ft III
Mwd
PERMIT LIMM I YgAR - PRO%IDED WORK IS STA WITHIN INVAYS,
gngr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
PAP:MON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS' . AN D . SUCCESORS
Fire Review
Plan Chk. Deposit
IN RE . AGREES TO INDEMNIFY, DEFEND AND HOLD HAQMLESS THE CrTY OF
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES. ANV90 AND
R%&N&on
Pt #
STSi
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING190 MY
H AL
HA
FROM THE 18'SUANCE OF THIS PERMIT. ISSUANCE OF THISIt L61 T BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN AS FORCE OININMNSION..
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I HEREBY ACIMNLEDGE THAT I HAVE READ THIIi AP TION; THAT THE INFOR
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This kation Is not a penrdt until signed by the
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PE BE EMPLOYED
IN VIOLATION OF THE LA OF THE STATE OF WAHIO;TWTILL/f�"T�N(G
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8 IK03 (OMER 0 AGENT) DATE SIGNED
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ATTENfION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN ORAWED. UBC, SECTION 109
PINK -OWNER GOLD -ASSESSOR
GREEN - ACOOLINTING
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