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1011 2ND AVE S.PDFIIIIIIIIIIII 4827 1011 2ND AVE S 'SEWER " PERMIT MONDS �-:SIDE, CITY OF ED ... .. WATER -SEWER. DEPARTMENT PE.RMIT Call 775-2525 for side sewer inspections BEFORE coveringany portion of the construction.) Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday Inspections. ADDRESS LOCATION OF CONSTRUCTION.........,;:,.. ..... . . ................................ ............ PROPERTY LEGAL DESCRIPTION ........... ..... . a f,-Z . ..... ..... . . ....... "'e; .. 7e. ,.v ............................................................................. ................................................................................................................................................................................. ............................. OWNER AND/OR BUILDER.......... ..................................... p. . . ............................... LDER .......... I, ew: ...... A—"?4 �NTRA- OR'S NAME & ADDRESS...... ;Z 0 = M.5 ............ '­e ....................... ...... .......... for repair and/or connection of a side sewer to the city sanitary sewer hiss!on 1� granted ... 19 ;s'y9tem in accordance with City of Edmonds ordinances. ATTENTION IS'CALLED-TO­THE FOLLOWING `6 S C_ -to consfruci. of -the property "may obtain,a-permit-.to c6iist-iticit. sewer `inside vr4erty line: 'A: IIcens:eiFj3`ld iv7er� ontr�dt-r wei I' not cover any, jigiti6fi-6f se .-.' yi sid�,se in area: --Do:n sewer -before it has-been Inspected NOTE No. 2—AII.W6rk• performed in city rlght-of-way requires an Invastori of. Right -of -Way Permit, obtaiirable:frorn the City Engineer's office. NomNo.r 3—_Obtain-full informaEion regarding Ordinance 11.16.630 and.Regul6tions 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 InWde 'property line;. mlnimum.grade'. of �2 in grade sharper than 'A will be permitted. NOTE No. 5--Trench . es In street must be water settled and surface of street restored to original condition. Contractors shall be responsi6le''foi-Iiifiire* due to Improper work which may develop within one year of completion. "s NOTE.No. 6—It is unlawful to alter or downy other work than is provided for in the permit, or to do any work on the main sewer or, � 'itappurtenances except to in- sert the pipe into the wye. DISAPPROVED* f--i Date..._ ................................... By.----........... Date...................................... By................ Date.................................... By............_... 'APPROVED Da te ......... ... 7 ................... By........... . .......... .. . ................................................................ 7 . . . . . . . . . . . . . . : . . . . . . . ............ I ........................................................ .............................................. I ........ Remarks . ................................................................................................. ........................................................................................................... ....................................... . ................... ...................... ............ In . ..... .......... -d- e 'v OW' P6� t Copies' T B Si dd� y Ow r of Firm Performing Construction PRIOR To Request For Inspection BOTB;/ g allation er o eco . . ... ............... ................. ... hereby certify that'the side sewe ins allation constructed under this permit. . ...... ............. cr of Contracti Firm Performing Construction) . .7 i Performing ordi nances oi� I was. instaJled accordance all governing ordinances of the City of Edmo s. . . .......... Dated this................................ ........ .............. ............. day of. N/ Check BEFORE you dig for Water: Gas E], Telephone, E], Power doSewer Other, Cl.. V V e. APPLICATION The City of Edmonds for SIDE SEWER PERMIT EASEMENT NO . .............................. : ............. NEW CONSTRUCTION E REPAIRS ❑ LID NO . .................. ASMT. NO. .......... ....... OWNER ..... ------------ ------ CONTRACTOR ----- .......... PERMIT NO. JOB ADDRESS ---...... �ffZ�- LEGAL DESCRIPTION: LOT NO - -------- 2-ES ... — ------ ------- BLOCK NO. ------------------------------------ ......-- --- ----- ------------------------------------------------------------------------------------------------------------------------------------------------------------ NAME OF ADDITION --------- ------- - YES 41-2 C-Fl-) r rg N I 7 Iv I ��2:7 Approved: DATE........................... .B ............ 11/75 - • MEMO TO: Art Housler, Director Finance Department' FROM: Leif R. Larson Director of Public Works SUBJECT: REIMBURSEMENT OF STREET CUT SECURITY DEPOSIT - ORDINANCE #1935 R/W CONSTR. PERMIT NO.: 78-157 DATE ISSUED: June 26, 1978 LOCATION OF WORK: 1011 Second Avenue SECURITY DEPOSIT AMOUNT: $220.00 RECEIPT NO. & DATE: #34 2 June 28, 1978 COMPLETION DT. OF REPAIR: September, 197 Please prepare a Treasurer's Check in the amount of $ 116.35 made payable to the following: Harve H. Harrison Civic Center Fifth and Bell Edmnds, Washington 98020 The balance of the deposit in the amount of $ ' 103.65 is to remain in Street Division Revenue Fund 111- -0 - . AB; Jak h 3 0 4r:i�ie� Dt. (Ij E. t. 7/31/78 PUBLIC W06P DEPARTMENT, ENGINEERING 'VISION APPI It-ATION PnR RIf;uT-nP-uAv (n!JCTRIl(T nr,l PPPM THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES �plicant to Complete Parts A and 13 Permit to be issued to: ,a,ek,iF. tt�4221S01J _ _ Fo r Wo r k a t : (address or vicinity)— L `t1 AvL;—So.M1�'6'1) t Type of Work to be done: SC:w�c LArcr-AL (attach drawing when applicable) Time Required -- Start: /7 Finish: Owner: r1Al,L,&� Name r A ve Mailing Address C—om6&l0J Cc%,�� I(, o -6) 77� li l�lf City I State Zip Telephone Number I Contractor: /L(J; j t otiAJ;Otil Name Mailing Address State License Number City State Zip Telephone Number `* NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE X* INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from any injuries, damages, or claims of any bind or description whatsoever, foreseen or unforeseen, that may be made against the applicant or the City of Edmonds, or any of its departments or employees, including or not limited to the defense of any legal proceedings including defense costs, court costs, and attorney fees by reason of granting this permit. Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year following the final inspection and acceptance of the restoration by the Engineering Division. Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at which time a debit or credit will be processed for issuance to the applicant. Work is subject to inspection and restoration in accordance with City Code. A 24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220. I understand that this permit must be available at the job site for inspection purposes at all times. Signature: 7 « Ll,—�.? 1,�2r,� Date: & /, 6 17 Owner or Agent ' TO BE COMPLETED BY ISSUING AGENCY: Date Issued:?� Permit No. Fee: f5:5----__ Security Bond: cia9,'-- 0 .221,20_�r6r«•��T�y` Time Authorized: 426��-eg 1 )- APPROVED BY Date ��8 • Date • One 26, 1978 MEMO TO: John B. Mitchell,_,/ Water/Sewer Superintendent G~yb FRO14: Richard H. Allen Assistant City Engineer` SUBJECT: SEVIER CONNECTION CILARGES Legal Description: Lot 2, Block 3, South Park Addition to Edmonds. Commonly known as: loll 2nd Avenue South Z.F.F. Calculation: ( 61.50) Z.F.F. x ( 5.50 ( 0 ) Lateral x ( 0 ( 1 ) Unit(s) x ( $25 APPROVED BA f Lei R. Directo cc: Owner �b Owner: H. Har on _ $ 338.25 Connection Fee _ $ Lateral Charge _ $ 25.00 Trunk Charge $ 10.00 Permit $ 373.25 TOTAL P-n, arson,' P.E. of Public Works 5/1n/77 I I I I C_o MP_ur"q-o �SCA-LrY2?p� I j I I117 � ! aVF S, t _ a I I � _� �_ _ -1 I � ► I I l - +-4 I I} 1 I I I i -t - }--- --t4 I � I 1-4 _t_ I I i I I� j i j I l i I I I i ' I 1 ! I �--� I I a---l--+--+---I --- -1--- I-�-- - ---t------1---I-r--�-_--, I �_ I I �T INSPECT[011 REC,01'D CITY OF I:D'•I0i''M , PUBLI-C �-!ORKS DE'l"ARTI-II:N17 =.c> ��3�?£�3 '� � ��,c���.-r�c�►�a .sue sP�c�r �_ ��� 78 f 0 � S� Gp"v4 ii: VA ,. �`t3Coo _ ! TANT! Press `nay — f e rf fng A�plieafion!Aplicant Building Relocation Permit FM Inside Heavy Lines I PERMIT NUMBER ` �j OWNER'S NAME NEW SIITE ADDRESS AILING ADDRESS lam, ��� I f/ 7/ m PRE -MOVE E INSPECTION PERMIT NO. a CITY & ZONE TEL. NO. pa ZONE BLDG. PERMIT NO. _ 4� FIRE 1 2 3 FOR WORK MOVING CONTRACTOR AT NEW SITE MOVE CONTRACTOR'S INSURANCE COVERAGE STREET ADDRESS NAME OF SURETY PROVIDING P.L. & P.D. COVERAGE n/ STREET ADDRESS C�IT�Y& ZONE 1,TEL.,NO. ? �ITYZO[r: STATE CONTRACTOR'S LICENSE NO. �n STATE CITY BUSINESS C q l � 1 I LICENSE NO.' VG.. ���VVG� . `Ci VALID INSURANCE PO ICY CHECKED BY;: DATE SITE DESCRIPTION ADDRESS OF PRESENT BUILDING SITE C? 7"��J BUILDING DESCRIPTION Legal Description of Present Bldg. Site (Show below or attach four copies) DESCRI$$ �B,A�SIC C�ON"STRUCTION & PRESENT USE OF BUILDING: OVERALL LENGTH OF BUILDING: O FT. ADDRESS OF NEW BUILDING SITE HEIGHT AS LOADED WIDTH AS LOADED BLDG. AREA I jl 11i / FT. FT. SQ. FT. ■.egni mescription Or 2Vew nleg. mie — tbnow oeiow or aa.a.on lour wplea) Power Company ❑ ..... .. Telephone Company ❑ .. .. dE OF OWNER OF PRESENT BUILDING SITE I hereby acknowledge that I have read this application; that the information given is correct; and that I aril the owner, a duly licensed moving contractor, or the authorized agent of one of these. I agree to comply with city and state laws regulating building relocation; and in doing this work, no person will be employed in violation of the Labor Code, State of Washington relating to Workmen's Compensation Insurance. Signature of Owner, / Contractor, or Authorized Agent ..... Z........................... ..................... Signer's /�77 1v�C?r�... None..:��:.'.. Address .(..lcz....... ............ City ...... .......... C... Date .... ca.✓✓I/ !ff. ... / 9%7 /............................... POLICE PT. PPROV OF MOVING ROUTE DATE . , o Time to Commence Moving: Aoloa ........Time to Finish: Moving: .... ....................... FIRE DEPARTMENT CLEARANCE OF ROUTING DATE W By: A111.1 E INEERIN CLEARANCE DATE RELOCATION 00 RECEIPT NO. ' FEE EE $ "IL ATTENTION: PERMIT APPROVAL THIS PERMIT THIS PERMIT DOES NOT BECOME AUTHORIZES VALID UNTIL SIGNED, BY THE ONLY THE BUILDING OFFICIAL OR HIS DEPU- TY, THE FEES ARE PAID, AND RE- CEIPT IS ACKNOWLEDGED IN THE OF THE SPACE PROVIDED BUILDING NOTED By Director's Signature ` BUILDING J�1/ INSPECTION M DEPARTMENT Date '• 1 CITY OF EDMONDS DISTRIBUTION OF COPIES PR 6-II07 WHITE — File (Bldg. Dept.) YELLOW — Move Inspector GREEN — Assessor GOLDENROD — Police Dept. PINK — Moving Contractor NIK ZO E U BIER 180249 ' BUILDING DEPAR:TMTWT Applicant Fill PERMIT APPLICATION inside Heavy Lines ' A "^ aAjq I DRESS _ . I N E )OR NAME OF BUSINESS) t SUBDIVISION NO. PLAT NAME ASSESSOR MAP NO. yl MAILING ADDRESS PUBLIC RIGHT OF WAY PER ORDINANCE NO. O CITY TELEPHONE NUMBER �4 69 EXISTING RIGHT OF WAYrw, '" _14 PROPOSED RIGHT OF WAY _ NAME 1 DEFICIENCY OF RIGHT OF WAY N F J.� O Y STREET/UTILITY WORK REQUIRED DYES i N� W ADDRESS: r I . II --11 PERMIT FOR WORK IN PUBLIC R/W OYES l.iNO ? ' U !Y CITY TELEPHONE NUMBER UNDERGROUND WIRING REQUIRED El YES ENO U a Q El� CONNECTION TO SANITARY SEWER YES NO G i SEPTIC TANK PERMIT REQUIRED ❑YES NO 0.. NAME � SEPTIC TANK PERMIT NO. •I 0 F ADDRESS , SEE MEMO DATED A ii jM.E.� 1 : - ':,i �I U Q REMARKS 0: ITV' TELEPHONE NUMBER F\ 2 4 CHECKBY W STATE LICENSE NUMBER CITY LICENSE NUMBER ID METER ., �UILDING SUPPLY SIZE �IL' n Legal Description of Property (Show Below or. 'Attach Four Copies) .,I LOT ,l REMA�2N$ ••I 0 /' -AOD SIGN AREA ENV. REVIEW ADS NO. ALLOWED PROPOSED COMPLETE EXEMPT U c a o riQu N W 0 I J REMARKS W J I VARIANCE OR C PLANNING R[P BY DATE 'f YARDS' ' LOT COVERAGE GAS FRONT 'SIDE Lj REAR �. NEW ���JJJJJJ RESIDENTIAL Ej LINE FIRE ZONE � TYPE OF CONSTRUCTION CODE HEIGHT ❑ NON-RESIDENTIAL ❑ SIGN ❑ ADD ❑ DEMOLISH RETAINING ElJJJ SPECIAL INSPECTOR REQUIRED AREA OCCUPANCY GROUP T� OCCUPANT LOAD 1 WALL �/' ❑ YES10 1 . ALTER � ORCFILLTE- ❑; ENCE X_FT) PLAN CHECKED By THIS SITE IS LOCATED IN THE CITY El PRE -MOVE. swim OF EDMONDS. LOCAL SALES TAX SHOULD BE CODED 31.04. REPAIR Pool INSP. � REMARKS .. F II NUMBER OF STORIES NUMBER OF DWELLING UNITS ` NATURE OF WORK TO BE DONE ' F I r AAFW FO UA0 4 T IO tiI I � PLAN CHECK FEE VALU ATION� FEE ` Z PROPOSED USE 0 P 6S IEAi C. ;� •� y PLOT PLAN JINDICATtE BUILDING SETBACKS, BUILDING t (y+ E ABUTTING STREETS) U PLUMBING Q a { W 0 m MECHANICAL �15T 0 FENCE SIGN t _ RETAINING WALL SWIMMING POOL -) ..1 City of Edmonds Development Services -Department Planning Division Phone: 425.771.0220 Fax: 425.771.0221 DATED RECEIVED: 13��1 CITY,,, RECEIPT Critical''Areas "File #: Critical Areas Checklist,Fee:$45.00 DATE MAILED TO APPLICANT: CRITICAL AREAS CHECKLIST The Critical Areas Checklist contained on this form is The City will review the checklist; make a precursory to be filled out by any person preparing a Development site visit, and make a determination of the subsequent .f./ , ., _,...,... f; fir. 7,. . 9., .,�-, 1 Permit Application for the City of Edmonds prior to steps"' necessary to' complete a development permit his/her submittal of a development permit to the,City: � application: r, The purpose of the Checklist is to enable City staff to Please submit to vicinity map, along with the signed determine whether any potential Critical Areas are, or copy of this form to assist City staff in finding and may be, present on the subject property. The locating the specific piece of property described on this information needed to complete the Checklist should form.. In .addition, the applicant - shall include other be easily available from observations of the site or data pertinent. information (e.g. ,site plan, topography map, available at City Hall (Critical areas inventories, maps, etc.) or studies in conjunction with this Checklist to or soil, surveys). assistant staff 'in completing their preliminary assessment of the site. An applicant, or his/or representative, must fill out the, checklist, sign and date it, and submit it to the City. 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: Applicant Representative: DVI�IG� P-AL L6eA�) i' l ILI�Sf?/L Name Name Z oi/ gw-40c S� ,&- Street Address City State Zip Telephone: 6 2�- )eN �—, Signature / Date: d di —7- — 0 k Street Address City State . , Zip Telephone: I Signature Date: G:\Share\Library\Planning\Forms\Public Handouts\ Critical Areas Checklist.Doc/1-16-2001 Critical Areas Checklist CA File No: Site Information (soils/topography/hydrology/vegetation) 1. Site Address/ Location: /Ott X AV 5- 5'a3 ��utie S �JA�t`f 2. Property Tax Account Number: _S _� ;?_Q_42 o ID p .-A_ Q -7_© 7 3. Approximate Site Size (acres or square feet): /4 O r4 / 3 5- 4. Is this site currently developed? yes; no. If yes; how is site developed? f�s� 5. Describe the general site topography. Clieck' 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 thari'33=feet).' Other (please describe): 6. Site contains areas of year-round standing water: AO ; Approx. Depth: 7. Site contains areas of seasonal standing water: tic) ; Approx. Depth: What season(s) of the year? 8. Site is, in the floodway a— floodplain A O of a water course. 9. Site contains a creek or an area where water flows across. the grounds surface? Flows are year-round? -r - Flows are seasonal? (What time of year? ). j 10. Site is primarily: forested , meadow, _ 'shrubs ; mixed urban landscaped (law-h shrubs etc) �C 11. Obvious wetland is present on site: 11 r .F — — .... ----- --- or City, Staff Use, Only---a_lnL�- --- ------ ----- -- - -- ------------- 1.. Plhn-Check Number, if apphcablell sr `- , 2 Srte is Zoried� Q-�•=(�^J '� � _ _ ,. 3 SCS mapped sotl;type(s)7' �ta►'v� z } C'�=,9�� f c ,., �ra., _ —5�� c� Pic �F1 ' t- 4 �' : Cntual Areas inventory or C1 map miitcates�rihcalArea on site? ,.r� q 4 r. ,. t: r i-' x�. _:•. t �� .� - -'. 4 fr,.- ".d � r,. T v. !1� F#. .. S Site�withtn destgriated earthFsu"bsidence:lartdslide hazard':area?; ' tlt C�Fn'�nc,t,rr�n#nrl n,rt>>}�c Fiicnrn,nmoi,.f�I���FCen�. i.ern �., `' �.:`.•� rYt`, J. t EI z rD X a l STTDY REQUIF 99 1 r Reviewed by •-4 ., eas ap -� tD r4{ r WARIER Date I o G:\Sharc\Library\Planning\Forms\Public HandoutsN Critical Areas Checklist Doc/] - 16-2001 -.,, r DATE RECEIVED ��.�b.,•; .j/��. •• PERMIT EXPIRES�V % —�r,'.' CITY OF EDMONDS USE -� PERMIT ZONE NUMBER .�� _ JOB SUITE/APTN CONSTRUCTION PERMIT APPLICATION ADDRESS ll OWNER NAME/NAME OF BUSINESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. - l" L' C.� � .�. e t C. ';1 U a ..�_ LID FEE $ w MAILING ADDRESS Z v^ -/ c fit. a �:... PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑ RW Permit Required ❑ o . N¢ ^� EXISTING PROPOSED Street Use Permit Req'd ❑ Inspection Required CITY ZIP TELEPHONE •�-- j,) Y d - Y 1 t'\. ` / �� �l [.. L) ! C.) �.... ..-/ ( (� REQUIRED DEDICATION FT Sidewalk Required ❑ Underground Wiring required ❑ NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES ❑ NO ❑ t,7 Z r ¢ W uu t- ADDRESS REMARKS Z s OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE C7 z to %It%f ; !f ` �"'r'.ti r' f '/.•' / i'<% /` OfGfF,1/ CITY ZIP TELEPHONE s:%'�j.r: .+�/ j' r;�'G'j:, �%, �i%'C G.J,'�1�� .✓�/'r:/-�/ rri'%°•i �•f 1^._. <<'�Ll /'!` !',:/ ✓,�r :�:r �'r.;a'�1 .y _�)i�±/�-j'�tCJ(:;YC=S /<./°..� . _ t - ;� •-'-'' � � ENGINEERING REVIEW D/DATE ADDRESS ¢ U -( ¢ FIRE REVIEWED BY DATE W CITY ZIP TELEPHONE I- ¢_ O U LL VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY T_� REOP A POSTED YES KNO SEPA REVIEW COMPLETE EXEMPT SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED PROPOSED J PROPERTY TAB ACCOUNT PARCEL NO. uu I f ❑ NEW RESIDENTIAL ❑ PLUMBING / MECH '❑C LOT COVE�AGE ALLOWED OPOSED REQUIRED SETBACKS (FT.) FRONT SIDE REAR PROPOSED SETBACKS (FT.) L/R SIDE REAR fn ❑ AUDITION COMMERCIAL ❑ �� �� �I�pl pFFR�.O.�NT u' I y z CHANGE OF UOE ❑ REMODEL ❑ APARTMENT ❑ SIGN g PA F INC REQ'D PROVIDED LOT AREA p P G REVIEWED BY) DATE / 1 r f I ' b� FENCE fM �" t''+' i i,". �.�`' `t��cr~T ❑ REPAIR ❑ GRADING CYDS ❑ X FT) REMARKS,gwl pry✓ ❑ DEMOLISH ❑ TANK ❑ OTHER IV) ply �D 1 Z pGARAGE ❑ RETAINING WALL ❑ RENEWAL CARPORT y� ® �y�q �r 1 tl� { �•� I m L 1" t o4:7-: 5 f Fi tY/1 pr' fz' IlG7 �•C.:1,, `� r o (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: � CHECKEDBY F• ON TRUCTION C/OE OCCUPANT // ) , ccc - ITYPF. vJ GROUP NUMBER OF NUMBER OF DWELLING CRITICAL AREAS w D O !i! SPECIAL INSPECTOR AREA OCCUPANT STORIES UNITS NUMBER ...,,• REQUIRED ❑ YES LOAD DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D o J m .1 "I'7 �J VALUATION FEE PLAN CHECK FEE % ;J l HEAT SOURCE GLAZING % L SLOPE % xJ — � BUILDING (," / ,/ /0e% i PLAN CHE K NO: _ VESTED DATE — ) f PLUMBING MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE '7 ) r SEPARATE PERMISSION. STATE SURCHARGE ¢ PERMIT APPLICATION: 180 DAYS W a PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION*•� f� "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE 140 W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF WASHINGTON, ITS OFFICIALS, EMPLOYEES, L'AN[75Ciit31NG / �• ¢ EDMONDS, AND AGENTS FROM ANY AND IN9PEETION'FEE ( L a ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY JFROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMEDTOMODIFY,WAIVEORREDUCEANYREQUIREMENTOFANYCITYORDINANCE ECEIPJf / PLAN CHECK DEPOSIT / i NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION." RECEIPT TOTAL AMOUNT DUE 715- ) w I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL 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. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. SIGNATURE (OWNER R AGENT) ,,I DATE SIGNED OFFI LS SIGNATURE _ DATE (425) t�, " - � " 12 771-0220 '. �(:�••: � �a -� R��EASED BY DATE ATTENTION - EXT 1333 �71, 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 YELLtDJJ - IN PECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER • GOLD -ASSESSOR 5198