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CITY OFEDMONDS
SIDE
SEWER
PERMIT
�890 19Q°
PERMIT N2
8377
Address of Construction: Maple- Edv"Oy-rls.' ' t1ja
Property Legal Description'(Include all -easements):
Owner and/or Contractor: Q)'D%GtGC i'�1Q50
State License No. t ) 9 A Q rnT IIy� Building Permit No.
Single Family
❑ Multi -Family (No. of Units )
❑ Commercial
❑ Public
1
Invasion into City Right -of -Way: No ❑ Yes
RW Construction Permit No.
Cross other Private Property: No ❑ Yes
Attach legal description and copy of recorded easement
I certify that I have read and shall corrfply all city requirements
as indicated on the back of the Permit'Ca
Date
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION,*
OFFICE USE ONLY
* FOR INSPECTION CALL 771-3202, PUBLIC WORKS DEPT.
®o
Permit Fee: 30� Issued By
Trunk Charge: ���'41�' Date Issued
Assessment Fee: Receipt No.: I-S'66
Lid No.: 160
.. Partial Inspection.:
Comments
Reason Rejected:
Final Inspection Approved
Date Initial
Date Initial
Date 't� 7921nitia
w'�'R..i N SP. o. ►c. 4 -I'7-9 2 X
** PERMIT MUST BE POSTED ON JOB. SITE **
WhFew ite Copy: File Green Copy: Inspector Bull Copy: Applicant .
' ed 3:90
ti The City of Edmonds Side Sewer Drawing EASEMENT NO- -------------------------------
i
NEW CONSTRUCTION REPAIRS ❑ LID NO ................... .ASMT. NO............... �..
t
OWNER -------------------------------------- --- CONTRACTOR ........ BR.- ---- MASOtA.......................................... PERMIT NO..$.3'7`T
JOB ADDRESS .�Q ---------tAk LC------------•------------------•------ LEGAL DESCRIPTION: LOT NO. ?� j9� Y�- ----------- BLOCK NO.-----------------
rz-CI ST.
4,'�coNc.
e wuLDE R
5 DEEP
RV.c. wyE
PWW-0001-11/75 (REV.11/78)
-ta
MTR -
-----------•--------•-------
EDMONDS
�AIPdEt1�r__P4-AN -------------
I
Approved:
DATE �.7-1.7.- J- -------------- BYlip
---------•----•---......-----------
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ELF. FILE
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AP
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PERMIT APPLICATION REQUIREMENTS
TO: Permit Coordinator, Building Division
FROM: Lyle Chrisman, Engineering Inspector S
T�
OWNER: I�s't'� I. EET Fj PLAN CK #36,
�
(oV
ADDRESS. �4 t�,tiF� )ATE: 7tq1
After review of the subject permit application, the following requirements mustbe met.
1. Construction hours are: WEEKDAYS .......... 7:00 A.M.-10:00 P.M. WEEKENDS/HOLIDAYS ..... 10:00 A.M.-6:00 P.M.
2. A separate RIGHT-OF-WAY- Construction Permit is required for all work on Publicproperty. (ECDC 18.60)
3. Truck haul route plan must be submitted and approved prior to permit issuance.
4. Builder/Owner is responsible for containing all temporary runoff and erosion control on site. (ECDC 18.30.030d)
5. NO WORK SHALL BE DONE WITHIN IS FEET OF STREAMS OR 10 FEET FROM ANY CLOSED DRAINAGE FACIL-
ITY. BUILDERIOWNER IS REPSONSIBLE FOR IDENTIFYING CONDITIONS ON THE DRAWING. (ECDC.18.30.50G)
6. FILTER FABRIC FENCE SHALL BE INSTALLED AND INSPECTED PRIOR TO CLEARING AND CONSTRUCTION. .
(ECDC 18.30)
7. INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEMS, TIGHTLINFS, FOUNDATION DRAINS, AND
CATCH BASIN INSTALLATION. INSPECTIONS ARE REQUIRED PRIOR TO BACKFILLING. (ECDC 18.30)
8. Repair or replace all defective existing curb, gutter,.and sidewalk adjacent to the property. If an intersection is involved.a
handicap ramp may be required. Contractor shall meet with the City Engineering Staff to determine the extent of repair prior to
issuance of the permit. (ECDC 18.90)
9. Driveway slope shall not exceed 14 % without a waiver. Every attempt should be made to keep the slope below 14%.
Waiver granted to %. (ECDC 18.80.060D)
10. Driveways must be paved from property line to City RIGHT-OF-WAY. A separate perimit is required. (ECDC
18.80.060C)
11. INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIOR TO AND AFTER POURING.
(ECDC 18.30)
12. No burning of construction refuse without a permit from the Fire Department.
13. Connection to City water system is inquired. There is a separate charge for the water meter: (ECDC 7.30)
14. A back water valve is required if downstairs plumbing is below the elevation of upstream manhole. (ECDC 7.20)
15. Water and sewer mainlines should be separated by 10 feet minimum. (ECDC 18.10)
16. Connection to the City sanitary system is required. A separate permit is required.
LID# Fees paid: Yes No Charge (ECDC 18.10)
17. Underground wiring is required on all new construction; and for additions, alterations, and repairs that exceed 50% of the total
assessed value of the structure. (ECDC 18.05.010)
18. A FINAL ENGINEERING INSPEC77ON IS REQUIRED PRIOR TO THE BUILDING DIVISION GRANTING OCCU-
PANCY OF THE BUILDING OR STRUCTURE. (ECDC 18.90)
19. �/0 i�w"Ae }� qp 6 �� 2a, T- om CAc�e d 2d .
20.
PUBLIC WORKS DEPAP0 CHECKLIST
WILDING PERMIT REVLEFT �; , :. �
a ess to
0
Street Right-of-Way.Existing
z
Access Easements Existing,'-, At
Fes.
REQD
H
Utility Easement Existing N
REQD
w
Lot Per Subdivision Plat
Assessor Map
w
Site Plan Checked for Accuracy:
S
z
Underground Wiring Reqd.
H
Check Accuracy of Legal Description
NO
z
Review by '� ,OAK
Date —5111
w
'sting Water Main Size
Water Required
Service Line Re d
Hydrant Size Existing
�
Hydrant Reqd Per Fire Code
Size
w
Detector Check Meter Reqd.
Cross Connection Inspe
H
Fire Departmen mnents
er Meter Charge Regd.
Review by , ,
Date
tic Tank Design Approved
Date
Septa Tank Permit Reqd.
Permit No
Sanitary wer Availability
Pro/j.
Drawing No.
File No. /
Side Sewer Avai ility
'
w
Sanitary Sewer Conne 'on Fee Reqd,
r
3.
Review by
Date
w
Open Ditch Existing
Regd.
Culvert Reqd.
Size
w
Catch Re
dicate on Site Plan
;Basin
Shoulainage maintain collection on swale open off
H
Mm ole regd.
Indicate on Site an
Soil Conditions and Ground Water Field
Checked
Review by
Date
Revised: 1vl0-1977
Page 2 •
et Paving Regd.
Curb and Reqd.
W Sidewalk Reqd.
W Curb Cut for Driv
w Righ - ay Constriction Permit Reqd.
H Bond Reqd. for Public Improvements
Street Name Sign Reqd.
Other Signing Reqd.
A Pre e 'to Inspection made on
z
a BY : SEGJER
H
W w WATER
a
M
H STREET
w ENGINEERING
Special Requirements listed in memo to Community.Development Department,
Building Division
BY Date
o All items filled in on Building Permit Application
9 BY a? �- `' Date
a' Drawings Stamped and Notations Made
BY Date
Approved by Public Works Department
Revised- lv 10-1977
INSPECTION RECORD
CITY OF EDMONDS., PUBLIC WORKS DEPARTMENT
DATE : S� 8 PROJECT: ��HGI�C A. STUNS FI F_L--D
/024 /' Apt e
7S[TE
140
N D I-JtqLFyvy iD 1-#5 E 1)
A- 5, -M 2 AO 41AA )4 P-
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REGARDING:
1024 Ma le Street
/b3-b.3900
(address)
R E C O R
D O F C O N T A
C T S
DATE
NAME, PHONE NO., &
ADDRESS of CALLER
COMD4ENTS - ACTION TAKEN
INITIALS
5/l/74
Charles Grove
Certified
Letter No. 406428 sent Letter received.
TE
requiring
hook-up within 60 days.
5/2/74
Scheduled
dye test for 5/3/74.
TE
5/3/74
Will they
do dye test today?
TE
5/6/74
D•T-O-S•
TE
• 6/5/74
Certified
Letter No. 406457 sent Letter received.
TE
-
rescinding letter.
? ;SENDER: `8e, sure fo follow insfrucflons on other -aide
PLEASE ''FURNISH' kRVICE(S).-INDICATED BY ;CHECKED bLQCK(S)t
(A`dditiottal chargci requtrcd for, these services) ;
aShow address Deliver `ONLY
where delivered 'to, addressee •'
RECEIPT+:
i Rec.eivied the nuni6gr'ed•drticie`d4;!nbed below,
;REGISTERED NO.. .SIGNATURE:O _ ME OF•ADDRESSEE,(Must always be fulad 1N
�.-CERTIFIED,NO 1 Y�l�"i��,, RECEIPT FOR CERTIFIED MAIL-30 (plus, postage)
S16NAiURE OF ADDRESSEES AGENT, IF ANY `'
j y - : SENT, TO .
rL p TMARK
INSURED NO f ti'ht 74� a Y , " 00 _ Mr. Charles R. Groveb',OIRRATE
_ c y x s STREET. AND NO.. fti� 4P,
� Ir�
_ CV
z{jE5 DELIVERED ,S W WHERE DELIVERED (Only<s equestedand zrurude ZIP eode)�i I _ Post Office Box 1483 _ P�%
P.0 STATE AND ZIP CODE
Alf
.nnwood Washi n ton• 9.8036
`OPTIONAL SERVICES FOR-,
CD
ADDITIONAL FEES
L' 4 RETURN 1. Shows to whom and date delivered .
With deliver to,addiessee only...•, ..... 1
RECEIPT 2 Sh ............ 350 ,
i _ s y
t om to where delivered .. 35�
• 'SERVICES •. oris o who da and
With delivery to addressee only ....,...... 85�
9' DELIVER. TO 'ADDRESSEE ONLY ... C: 50cr
SPECIAL DELIVERY (extra fee required)................... ...............
PS Form
3800 NO INSURANCE COVERAGE PROVIDED— (See other side)
Apr. 1971
NOT FOR INTERNATIONAL MAIL 4GPO; 19700-397-436
'•r, c i f��r'•• f : e• ,-h;xr;a.`:. _ } it—r3'.. •.•..••r,^.,a,r - . . - .. --__ - _ _ _..... .....
iSENDER 8e5sure�fo follow_rnsfrucirons on other side A !'
f , e1�PLEASE FURNISH SERVICES 1NDICATED�BY CHECKED BLOCKS * " ,
;• . (elddxironal ch`a�9es r"equue`d forzthese eery}ces) 2 (,
z Shovrraddress ' Deliver ONLY
where delivered ,, to addressee , RECEIPT FOR CERTIFIED MAIL-30� (plus postage)
{ RECEIPT "' ri`
F ;Received the num6eredprtrctedescnbed below' a SENT To POSTMARK
• _ - = ' I �, ^ OR DATE
'REGISTERED :NO -: ' SIGNATURE OR NAMEW ADDRESS EES(Must always b lillod.(n) , h'ir - p�//lYs • a� �S �j�Dl��
T % STREET AND NO. r^ '
CERTIFIED NOL'G %. U _ D O�Z_o
•P.O., STATE AND ZIP CODE
'SIGNATURE OF ADDRESSE,S AGtNT, IFCD
NSURED NO OPTIONAL SERVICES'FOR'ADDITIONAL FEES
RETURN1. Shows to whom and date delivered .............1W th delive to addressee nl ........ 6i r o'LATEDELIVERED SHOW •WHERE DELIVEREDV- (Only if rEqueated :aii8'iitcludc ZlP Codc) , SERVICES RECEIPT 2. Shows to whom, date and where delivered . 3With my . 8DELIVER TO ADDRESSEE ONLY ... ery to addresSPECIAL DELIVERY (extra fee required),n
1! - - -
n { - AprPS F1971 3800 orm
NO INSURANCE COVERAGE PROVIDED— (See other side)
`°' 3 r • _ NOT FOR INTERNATIONAL MAIL 4 GPO: 19700-097-6SB
Al� O V E 1),V
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS,WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
Inc. 1 R90
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20070374
SIDE SEWER PERMIT (I -Single Family)
Permit Number: ENG20070374 Expiration Date: 11/2/2007
Job Address: 1024 MAPLE ST, EDMONDS
GREG BREWER
PO BOX 1692
EDMONDS, WA 98020
OWNER EXEMPT
LICENSE #: EXP:
Y
N
JOB DESCRIPTION
REPAIR N PROPOSE TO REUSE LATERAL LID NUMBER:.
GRINDER PUMP N PROPOSE TO REUSE SIDE SEWER
SIDE SEWER REPAIR
N
N
I PROJECT CROSSES OTHER PRIVATE PROPERTY
VERIFICATION OF RECORDED EASEMENTS COMPLETE
IADEMATTY- The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees by reason ofgranting this permit.
CALL DIAL -A DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT.1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOT A PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
� /l Printed: Thursday. Ausust 02, 20(
FILE COPY U INSPECTOR COPY F APPLICANT COPY
STATUS: ISSUED
ENG20070374
• Alert affected residents and/or businesses prior to work start.
• Maintain erosion & sedimentation control. Keep street clean.
• Construction hours are Monday -Friday 7anr6pm and Saturdays 10arrr6pm. No work on Sundays or Federal Holidays.
• Refer to City of Edmonds Side Sewer Infomration handout for approved pipe materials, inspections and other requirements.
• A 6" cleanout with 12" locking cast iron lamphole cover is required at the property line.
• Maintain 10' separation between the sanitary side sewer and the water service line.
• &Sanitary Side Sewer Inspection
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: fMTIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
�A 0LLE D y�o
City of Edmonds
Plumbing/Mechanical/Tank/Demolish
Permit Application Form 47C. t89°
Site Address: / D7-q
Suite#: Parcel #:
Business/Tenant Name (if applicable):
PROPERTY. OWNER: (T✓
Mailing Address: v, V_—*_,-J0
City: 91 1Y & State: (mot/ Zip:
Phone: ( � ) �7--�OZPJ FAX: (G ) 6 70 � � E-Mail: i
.CONTRACTOR:
Mailing Address:
City: State: Zip:
Phone:. ( )
State License Number:
FAX: ( )
E-Mail:
Exp: Date: City of Edmonds' License No:
MECHANICAL
Fixtures
Total
PLUMBING
Fixture Type
Fixtures
Total
Fixture Type
Water closet
Gas Furnace/Fireplace:
Sink
BTUs Location
Lavatory
Gas logs/direct vent fireplace
Tub/Shower
BTUs Location
Dishwasher
Air Handler Location
_BTU
❑ Electric
Hose Bib
Gas water heater w/expansion tank
❑ Other
BTUs Location
Boilers BTUs Location
Hydronic Heating
Expansion Tank
Floor Drain
Vents, Single Duct #
Other:
Pressure reduction valve
Water Service Line ft
Gas Piping ft
# of Outlets
Other:
Tank aallons
❑ Fill Material
Gas Outlets
❑ AC Unit o Furnace
❑ Water Heater ❑ Boiler
❑ Pump. Rinse & Ca
❑ Removal
Critical Area Chklst
❑ Dryer ❑ Stove/Range
❑ Fireplace ❑ BBQ
Other Gas Outlet
❑ Studv Req. ❑ Waiver
❑
L:\TEMP\BUILDING\WEBchecklists\MECH.PLUMB.APP.doc 8/31/06 1
EXEMPTION FROM CONTRACTOR
REGISTRATION VERIFICATION
FORM D
The undersigned property owner or authorized person as described below, has applied for a
building permit from the City of Edmonds and claims that he/she/it is exempt from providing
contractor registration in accordance with the provisions of RCW 18.27. The property owner or
authorized person, by their signature below, hereby verifies to the City of Edmonds that:
O Value of work under $500.00. The aggregate contract price of labor and materials and all
other items required for the project is less than $500.00 and is not part of a larger operation
to be undertaken on the property. This exemption does not apply to a person who advertises
or puts out any sign or card or other device which might indicate to the public that he/she is
a contractor, or that he/she is qualified to engage in the business of contractor. RCW
18.27.090(9).
O Owner who contracts for a project. A property owner contracting with registered
contractors for the project, and who him/herself is not performing any activity of a
contractor for the purpose of leasing or selling improved property that he/she has owned for
less than twelve months. RCW 18.27.090(11).
NWork performed personally on own property. Anyone personally working on property
e/she owns, or at which he/she resides, as long as the property owner, or resident, does not
perform any activity of a contractor on his/her property for the purpose of selling,
demolishing, or leasing the property. RCW 18.27.090(12).
O Use of own employees. Property owner using him/herself or his/her own employees to
perform maintenance, repair, and alteration work in or upon his/her own property. RCW
18.27.090(13).
O Licensed Architect, engineer, electrician or plumber. All work performed under this
permit will be performed by an architect, civil or professional engineer, certified electrician
or certified plumber operating within the scope of his/her certification. RCW 18.72.090(14).
O Other. Specify which provision of RCW 18.27.090 applies:
THE UNDERSIGNED PROPERTY OWNER OR AUTHORIZED PERSON HEREBY VERIFIES
THAT ALL INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE
BEST OF HIS OR HER KNOWLEDGE AND ACKNOWLEDGES THAT IF ANY OF THE
INFORMATION PROVIDED ON THIS FORM IS FALSE HE OR SHE UNDERSTANDS THAT THE
BUILDING PERMIT WILL BE IMMEDIATELY REVOKED AND ALL FEES PAID FORFEITED.
DATED this 7/ day of , 20Q)
PROPERTY OWNER/AUTHORIZED
PERSON
Signature
Print Name
011U:&W
Sigr�atur — U \
Print Name
REVISED 7/07
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No ...............................
NEW CONSTRUCTION C] REPAIRS 0
OWNER------ ....... 0/zo. A L ............................................. CONTRACTOR .................................................................................................. PERMIT No .......................
ADDRESS ...... h%"I . ....... . & ........................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............. ..............................
NAMEOF ADDITION .........................................................................................................................................
0
Approved:
DATE................................................ By .......................................................
,I 7
�� of ED 0 CITY
2d ADDRESS,
BEND
BASEMENT
WINDOW
IMNEY
o FRONT DOOR
LL
w I ; 2�' STAIRS
L- - - - - --
CYCLONE FENCE
�6" C/O @ GRADE W/ C/I
\ LOCKING LID
MAPLE ST
OF EDMONDS SIDE SEWER AS— BUILT
PERMIT
C❑NTRACT❑Ri
XXXXX
1024 MAPLE ST NO. ENG20070374
HOMEOWNER, SCALEi
XXXXXXXX I NTS
i t 1NZWLL i tDI INSPECTED BYI DATE DRAWNI
08-13-2007 1 JH 08-13-07
DRAWN BYi
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CITY OF EDMONDS .
CONSTRUCTION PERMIT APPLICATION
USEEE PERMIT [B' 6�p
— NUMBER J �e.�V
(42
JOB 1 SUITE/APT#
ADDRESS \
OWNERNAMEVNAME.OF BUSINESS
J�C < -�51A- kl_s ' f
LEGAL DESCRIPTION CHECK
SUBDIVISION NO,
LID NO.
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MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
PROPOSED
TESCP Approved ❑
RW Permit Required ❑
Street Use Permit Req'd ❑
Inspection Required ❑
Sidewalk Required ❑
CITY ZIP
(/ 1-774
TELEPHONE NUMBER
M
NAME
L Go it
REMARKS
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ADDRESS
�j 3o D� N ST "Co
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CITY ZIP
TELEPHONE NUMBER
6-DM DS v o
-276-7373
{�
rlr^•In�-^FitiCi2G . INSP• ���✓>-
NAME
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ENGINEERING MEMO DATED / (� I REVIEW BY
t0
ADDRESS
L :;IL, Z L SAC% S^/e O�j`
METER SIZE
BUILDING SUPPLY SIZE
NO. OF FIXTURES
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3
C TVY a A (� ZIP
Z `/ l n w oo dl / O 0� ('
TELEPHONE NUMBER
-77 6- / Z 2- Z
REMARKS
STATE LICENSE NUMBER
SIGN AREA
ALLOWED PROPOSED
('
N
SEPA REVIEW
COMPLETE EXEMPT
ExP
OB NO.
SHORELINE #
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Legal Description of Property - include all easements
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VARIANCE OR CU
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PLANNING REVIEW BY
DATA
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I ( G �� ON D S .
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SETBACKS -FEET
FRONT Za SIDE REAR
HEIGHT
(
LOT COVERAGE
J ��
Tax Account Parcel NO.
REMARKS
NEW RESIDENTIAL CJ PLUMBING
ADDIALTER COMMERCIAL MEGHANICAL`-
rJ
REPAIR 1:1APT. BLDG. LJ SIGN
CHECKED BY
TYPE OF CONSTRUCTION
AJ
CODE �
HEIGHT '
25
C7
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OF
DEMOLISH 1:1 GRADING � FENCE
CYOS. ( x _FT)
CARPORT SWIM'S (
REMODEL GARAGE POOL,
WOOD, STOVEI.. RETAINING WALL/
INSERT ROCKERY El RENEWAL
SPECIAL INSPECTOR
REOUIRED
YES
AREA
OCCUPANCY
GROUP
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 305
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
0.
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O
7
m
57X�CTI ` �✓Y(/✓y,/
NUMBER OF STORIES
MBER OF
[DWELLING
NITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REOUIRED
F%
VALUATION
FEE
PLAN.CHECK FEE
BBUILDING
PLUMBING
Plan Check No. Jaw �Z
0
MECHANICAL
GRADING/FILL
This Permit covers work to be done on privatd property ONLY.
Any construction on the public domain (curbs, sidewplks,
driveways, marquees, etc.) will require separate permission.
STATE 'SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
STORM DRAINAGE FE
q�
.30
ENG.INSPECTION
Q!
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
'LOU
harmless the City of Edmonds, Washidgton, its officials,'
s
a
=
°
:r
employees, and agents from any and 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
nor limit in any way the City's ability. to enforce any ordinance
provision."
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
(JIB J
I hereby'acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and THIS PERMIT This application is not a permit until
state laws regulating construction; and in doing the work authoriz• AUTHORIZES
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
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 (OW%/-NEERRR OR AGGEENTT)) DATE SIGNED DEPARTMENT
CITY OF OFFICIAL'S SIGNATURE — DATE
EDMONDS
- ELE B DATE
ATTENTION " CALL FOR
,, J.NSPECTION — IT IS L—
UNTIL AFINAL INSPECTION HAS BEEN MADE BUILDINGRE
APPROVAL 771=3202 ORIGINAL - File YELLOW - Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK - Owner GOLD - Assessor
10Y.67