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1001 MAPLE ST
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I I i j i1 CITY (?F,EDM0NDS
T F I I I ► ! I ! T t; ! G ,_ 1;- I EUILDING- DEPARTMENT
WORD Ii_
- fi ; _ ADDRESS,_..PLE"T; -
f I I I ii t r OWNERGK,;C,�,C/IL� 1
APPROVED DATE.
�L4�9S-;;;-r AP RO D D 7
1 I I t 1 A 2 I BLDG. OFFICIAL
PI-ER-M-I-T- NUMB -ER
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V,�''D i f t I I I I, i I I -- :MOYERC'105 N7r I! !r
I P. O. Box 502
a i JUL 9 1 1995 r - r . 'Indianola, WA' 98342' '
. 'CITY r , (206)-297-4520 ;
i�IT C00NT'R I a !- . P Y ! - 1 j
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JUL I i IS95
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711
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ZONE <.
SETBACKS:
FRONT
SIDE
REAR
OTHER 6XACOL Ll
HEIGHT--
01 E D lv�.4tJS
BUILDING DI.-D"'ARTMENT
WORIK
AIDDRESS"l-0-c- - 2v zy-
OWNER L
APPROVED DATE:
BLDG. OFFICIAL
PERMIT NUMBER.
0 1
MOYER CONSTRUCTION
MOYERC 105 N7
m
P. O. Box 502 49 p Indianola, WA 98342
CITY COPY (206) 297-4520
CITY OF EDMONDS
USE PERMIT
ZONE _ NUMBER 95639.
.CONSTRUCTION
PERMIT APPLICATION
JOB SUITE-APTn
ADDRESS
OWNER NAME NAME OF BUSINESS
0,0-vNAa rC c
LEGAL DESCRIPTION CHECK
SUBDIVISION NO
LID NO
MAILING ADDRESS
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1001 v>t -
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP,
EX ISTINO REQUIRED DEDICATION
PROPOSED
TESCP Approved ❑
RW Parmit Requred ❑
Slreal Use Permit Repo ❑
InfpecuPn Required ❑
Sidewalk Required ❑
'
CIT]; ZIP
TELEPHONE NUMBER
NAME
NU
METER SIZE
LINE SIZE
NO OF FIXTURES
PRY REOUIRED
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YES ❑ NO ❑
ADDRESS
REMARKS
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CITY ZIP
TELEPHONE NUMBER
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NAME
ADDRESS
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ENGINEERING MEMO DATED REVIEWED BY
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CITY ZIP
C \QNU�0._ ��)
gNUMBER
TELEPHONE
FIR MEMO DATED REVIEWED BY
SIGN AREA SEPA REVIEW AD NO.
W
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STATE LICENSE NUMBER EXPIRATION DATE
V' •1— SOS N l ,
Mp � L 1
ALLOWED PROPOSED COMPLETE EXEMPj
A ,1�// SH9RELINE0
EXP
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Legal Description. of Property - Include all easements
a
VARIANCE OR CU
PLA G R W.BY
DAT
SETBACK — FEET HEIGHT
LOT CO RAG
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a
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FRONT SIDE REAR—
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P Pen t
X Ac t (� �`I / - / O ��(� O /',\�
P eel —1 ✓ Y V(J
REMARKS
it
NEW RESIDENTIAL PLUMBING
ADDITION COMMERCIAL MECHANICAL
ORE ... EL APT. BLDG. SIGH
CHECKED BY
TYPE OF CONSTRUCTION COOS
q
OCCUPANT
O REPAIR O GRADING O FENCE
CYDS. L_ x —Fr)
IRE
El DEMOLISH O WO STOVE O SWIM POOL
INSERT HOT TUB/SPA
GARAGE M AETAINING WALL/
CARPORT ROCKERY RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) E%PLAIN: '
SPECIAL INSPECTORt
REQUIRED
VES
OCCUPANT
LOAD
MARKS
PROGRESS INSPECTIONS PER USC 305
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to
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NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS
I NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION
REQUIRED
«k 0, A LZ 15 6 1`1
VALUATION
FEE
PUN CHECK FEE
BUILDING
ra
HEAT SOURCE:
0. I L
GLAZING D
PLUMBING
Plan Check No. c--
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any Construction on the public domain (curbs, sldewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
S
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
�y�(
ENO. INSPECTION FEE
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"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
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
PLAN CHECK DEPOSIT
p
i
modify, waive or reduce any requirement of any city ordinance
nor limit In any way the City's ability to enforce any ordinance
[— � 7,
Gl'
TOTAL AMOUNT DUE
provision."
J
I hereby acknowledge that 1 have read this application; that the ATTENTION
information given is correct; and that I am the owner, or the duly
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
ed thereby, no person will be employed in violation of the Labor ONLY THE
Code of the State of Wast�ngton relating to Workmen's Compensa• WORK NOTED
tion Insurance and R W 1 27. - INSPECTION
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
SIGNATURE (OWNER O AGENT DATE SIGNED DEPARTMENT
Iiq�eCITY OF
O F IALS SI NATURE DAT
I I EDMONDS
CALL FOR
ATTENTION INSPECTION
ELEA 0 /n DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771 O��O
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
_
1
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Site Information
FILE NO.
rRCE1/�D
�.•f; ry a :_;
1. Site Address/Location:'
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this site•currently developed? des; no.
If yes; how is site developed? . ho tii..4 .l. riAAk• ', L. A -
De
scribe
S. I�e• t r. ,A . ,. o q � y. , . • .r.}.>'' K... � >v''' , ,_ � $rs%'xtz:' I` m`f! a Et `�i ,�•
the general site topography. -Check all that apply.
Critical Areas Checklist
,✓ti > Flat: less, than S feet elevation change over endre site. w -.; : ,sb =• a � ;s S`
F r.,Rolliug ;.slopes on site generally less than 159G:(a vertical rise of 10-Beet over i' �Z-v
»horizontddistance, of66-feet). i :'t r-':�`' :L!?: 3Zt •"`n' :. 1 `3fP�2::a'? ay6•,
801y' slopes present on sift bf mare than "L N `and leso di�='30%'(a vei:ical rise
y yP t ;j
j -....� _, t- w of. lo-eet over a horsiomal distanceof 33 to 66-feet). `g `` '�'
Steep: _ grades of greater than 30% present on ske (a vertical rise of 10-feet over a
_' : horiioatal d�tance-of less than 334eeo.,
6. Site contains areas ofyear-round ,� :. •'qpp�; ��;
water: ,
7. Site . �mx- �m-
contains arm ofseasotw s�taddiggwat�er.
What season(s)r _ .
,�.. oftheyearR ..:_= • ....'1•;:.,.xt�.:.;� =1,r,". .
8. ,Site is in the G/ way- ' .floodplain Vw of a water comae:
9. Site contains a creek or =-a=' whei+e water flows across the gramds smiaoe? Flows are year -
rand? /w Flows ara sea9oaal't t/W (What dmre of vent?
10. Slte � rtmatl�l ���:.;: - -,
•
ttcban P Y• ,meadow sbmbs
landscaped (lawn aht t etc)
11. Obvious wedand is present on site:
Y
''to
r. 4�.:Zt:r•. OYERCOIS -T) li xT4flN`b'ttcrr'�S4rf �.
t
N ..
;Y
�MAYE�,C;J105 ,p _ �r A,
P 0. Bohr 502
.'^.,.indiano�la
W<A-�.�9834 2.
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City of Edmonds
CriticalArea's Che'ckl".
sis
The Critical Ai+eas (�roddist oontainedon' �� `.:"''.
:;' '°"� . .;. ` •.,µ . .
Wand'submit rt to the City. The City wily
this form is to be mled ",by any.pe,son ., ...,..
, rcvi= the Chocldist ;,nift,a , site
preparing a Development Permit
: _ visit; and aialae'a de�ernnination of the
Application for the City of Edmonds brior. .
•develop -
snbsequed SWps. y.�' complete;a
to his/her submittal of a meat-=
development permit application.
permit to the City.
Wide a s�grted_copy Of tins form, the
The purpose of the ChwJ ist is to enable -
appicmd should 86- submit a vicinity map
City staff to determinem any ." ...._. _
or P o
potential Critical Arras are or may be
with =Ou& deW that (may staff can find
present on the anb}ectproperty. The
and idea6fy due sxgedparoel(s):=t'in r,
information needed to complete the
Ad&Ggm4 the applimmd shall Wade : `r
Cheoldist should be easily available from
ether.
ther pertinent ioformion (eg. site
observations of dw site or data available at
- plantopo0rapl,ylniap, etc.) orstndies in
aty HA (Critical Ann inventories, maps;
eoyjnnedon•v4th this Qieekfist to ass�i
or sort
� P
, assess<neat.of die. site.
An applicant, or bis&ji - Apr+— " -a' -_.
must .fill out the dleCldrst, sign and date it, "
w•... _ . _. , ..._ . , - ' ; ° '' '
Y'
.e
go 4
1 i
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as'�F St � tr 1t+� !` `t�jj rztX�� � [I t�'•ty-+7,t ,s t�\�4 t�h+F'rg y�'`��'� ^C �'�l Y �! i`}"'P'k .
/...r� r3'^ J'�t0�'Kw�Iyt '' �i 1��'�7�{" e'�w�sR ,�",!°! `2�1,•� `s,yt�tj'.m.'�s7'�"
t J �"fir 74• -�' - ,_
~i^Af , q. .i�A Y � -t � t � :.*.+ , I- tl >-t 1'�� f it2?i �•��y¢��Lt�rs �!� i`.i l`:
MOYER CO Iy �•
Via...; aTR�CTFON
MOYERC .1.05 N7.: 3
Bow 7�
Indianola, WA_98342
(206 ) 29774520. _.: R
City of Edmonds
Critical Areas.. Checklist"'
The Critical Areas Checklist coaWned'on and submii it to the City. The My will
this form is to be Shed oat by any person review the male- a precursory site
Prepazing a Development Permit visit, and make a determination of the
Application for the City of Edmonds prior - - subseaueat steps necessary. eomplde.a
to his/her submittal of a development devdbpmreat permit application.
pernut to the City.
The purpose of the Checklist is to enable
City staff to determine vAxther any
potential Critical Areas are or may be
present on the subject property. The
information needed to complete the
Checklist should be easily available from
observations of the she or data available at
City Hall (Critical Areas inventories, maps,
or soil surveys).
An applicamt, or his/her + tati le,
must fill out the dkddist, sign and date it,
With a signed copy of this form, the
applicant should also submit a vicinity map
or pkkplan for indiivid ots o
with Mough detail that City staff can find
and identify the subject parrel(s).-: Iln
addition, the applicant shall include
other peitineat information (eg. site
plan, topography snap, etc.) or studies in
cogjunction with this Checklist to sssist
staff in completing their preliimir aty
ass+essaneat of the site.
i have complftd the Mated Critical Area Chedkfi t and attest that the answers provided are :., '`.,
Owner / Appricaft,
KUM I.. ftL
stx+eAdd
et�Wa. w �• d. * J�� �7{lW� i > i� 9' ^..
S- "1�Aj+�`����>i �v�i' n4•;, r :�� l�: rr �"1 a �. �`•il •'f ��'�•
0% Stalk UP
t
Ub"
213
MIIMIIA1►�II1l1
in um luir yeart
sbraft
-4
?eel
City of Edmonds
Critical Areas-Ch6ckli't..
as a
The Critical Areas OwMist wbinifit 6'dii City. jjje a4�vij
this form is..to bqEfiPd.out byany peww.i-r,,..,- review dw-dwckILs�:'malm"ip"re=smy�sit�
preparing a Devdapment par*
it- ofthe
Application for the City of Edmonds
-;ubscqucd-stcPs:n==try.t.04bomplcte,a
to histhtir idbn&W aid
permit applicatiorL
permit to the City.,
WMa's-H-MOdewof this form, thi
The purpose of the Checidist is to
should also submit a vicinity ump
City staff to detennine.m6edier any..
--,or pka plan for kdiREirjjS—oTvzpIEg
potential Critical, Amu are or may -be.
---VAenough deW that City staff can find
present an the suldeq property. The .
:,.,A,and ideaffy the suVj'ectpnwks)"hj:�'
information needed to complete the
:„Odifloo, the applicant shall lndudel:'e�
Checklist should be 60y'a�vailable fiilm-'
jlW onnation (e.g. site!
obsavations of the site ardata available at..
I snap, ete4 or Au&e . s In
y Hall Areas uw�tories,maps;
C09JUnCfi=-Iwf&this 'ChMkft&`
or soil s;urveys)*
their.prefimhM
t.assessineut.efthe site. �j-, -
Anapplicant.orhisfhei
Must.filloutthedmMistsignind-1*6-te
Ihave completed the nua&WOWcalArea Cbwift=ifaaddW&ems%= :d,m-
n m6ymA
IV
Owner I APPHCUft,
P I
APPLICATION
The Cityof Edmonds for
SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS 0 EASEMENT No . ..........................................
10.3—C� �2�C1
OWNER}.6 --------------------------------------------------------------- CONTRACTOR....------------........................................................... PERMIT No. ..................
ADDRESS ...L.Q..0./.-... 11�..�Ac&S.iy LEGAL DESCRIPTION: LOT NO ............................................... BLOCK No.............................................
4
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NAMEOF ADDITION.........---••...........................................••--•-----......----.......................----.................................
4U
(Y7�-
Ap
ro
DATE................................................ By................---..............-----................................