LOT 10 HILLVIEWADD - STREET FILE17818 73RD PL W
CITY OF EDMONDSI
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❑ ADDITIOU. -
❑ RETIREMENT
ASSET INFORMATION SHEET
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ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION DEPT. N0.
**PURCHASE ORDER NO. *PROJECT NUMBER
PURCHASE ORDER DATE PROJECT COMPLETION DATE
COST COSTS
B.A.R.S. ACCOUNT NO.-5���'DOD- O/C-3, UO• lo�
ESTIMATED LIFE
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 _
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REFERENCE
DATE
VERIFIED BY
PROCESSED
BATCH NO.
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USE �w%'PERMIT
CITY OF EDMONDS ZONE NUMBER
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CONSTRUCTION PERMIT APPLICATION
JOB
NAME (OR NAME OF BUSINESS) ADDRESS
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�\ ` I\ I� i� (j LEGAL DES RIPTION CHECK SUBDIVISION NO. LID NO.
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MAILING ADDRESS
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TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
CITY //
60
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C/ 1/-)7c, IL,C1 S LJ-A, �� EXISTING REQUIRED DEDICATION
PROPOSED
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T , ' � iA ` RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED W
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STREET USE PERMIT REQUIRED ❑
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v(� . 's . SEE ENGINEERING MEMO DATED _ w
CITY TELEPHONE
NUMBER SEE PIW DEPT. REVIEW CHECK LIST DATED
Sea�� �LG - �� �' REMARKS
NAMEL
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CITY TELEPHONE NUMBER cc
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STATE LICENSE NUMBER CITY LICENSE NUMBER
/ C,2 ` ,y SIGN AREA ENV. REVIEW ADB NO.
Legal Description of Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT
(show below or attach four copies) SHORELINE q
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LEI NEW RESIDENTIAL PLUMBING
❑ ❑ ®"
ADDIALTER NON-RESIDENTIAL MECHANICAL
❑ ❑ ❑
REPAIR RETAINING WALL SIGN
EXCAVATE FENCE CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
❑ ❑ ❑
DEMOLISH OR FILL ( xFT)
❑PRE -MOVE INSP./ ❑ SWIM SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
COMPLIANCE INSP. POOL REQUIRED GROUP
LOAD
❑0 YES I7 NO
SIDE SEWER ❑ WATER ❑ REMARKS
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LINE
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OF STORIES NUMBEROF m
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UNI I,
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
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VALUATION FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY. GRADING/FILL _. 1
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
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successors in interest, agrees to indemnify, defend and hold
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harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
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whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of. this permit shall not be deemed to /�}n HI/92—
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modify,.waive or reduce any requirement of any city ordinance
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nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
Information given is correct; and that 1 am the owner, or the duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and in doing the work authoriz- 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 are paid, and receipt is
tion Insurance. INSPECTION acknowledged in space provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
r CITY OF OFFICIAL'S SIGNATURE
C7 V O EDMONDS
ATTENTION AUG'1-919185 DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
A. CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Owner GOLD — Assessor
102-78
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