1003 SPRAGUE ST.PDFIiiiiiiiiiiii
13227
1003 S P RAG U E ST
0 --
ADDRESS:
TAX ACCOUNT/PARCEL
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:- ff3w DETERMINATION: ❑ Conditional Waiver ❑ Study Required Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PLANNING DATA CHECKLIST DATED:��
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE: LOT:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S)
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LID #:
BLOCK:
LATEMP\DSTs\Forms\.Street File Checklist.doc
• J lE
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: ('� 1j (L L)%J�5
2. Property Tax Account Number: Li 3'-t Z 0 �5 X v e t
3. Approximate Site Size (acres or square feet): Q �' ��� 0 s, 9
4. Is this site currently developed? I-- yes; no.
If yes; how is site developed? SUdK c.0 E!'1-M /� �
5. Describe the general site topography. Check all that apply.
i/ 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 than 33-feet).
Other (please describe):
6.. Site contains areas of year-round standing water: ;,4C) ; Approx. Depth:
7. Site contains areas of seasonal standing water: IJ !2 ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway N (} floodplain t.71i of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? ,'v O (What time of year? )•
10. Site is primarily: forested ; meadow ;shrubs ;mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: N 0
DETERMINATION
^ca chk.doc; Rev 10/03/97
• • • RECEIVED
MAR 121999
City of Edmonds
'kW CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City of
Edmonds prior to his/her submittal of a development
permit to the .City.
The purpose of the Checklist is to enable City staff to
determine whether 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 site or
data available at City Hall (Critical Areas inventories,
maps, or soil surveys).
PERMIT COUNTER
An applicant, -or his/her representative, must fill out
the checklist, sign and date it, and submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
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:
IP STD t-J, C
Name
Street Address
City State Zip
4'-77G--as�E'
Telepe
Signature
kl?r. . /Z
Date
Applicant Representative:
Name
Street Address
City State
Telephone
Signature
Date
Zip
c:reception\jana\cac I. doc
(over)
CITY OF EDMONDS BARBARA FAHEY
J , MAYOR
121 5TH AVENUE NORTH • EDMONDS, WA 98020 • (425) 771-0220 • FAX (425) 771.0221
DEVELOPMENT SERVICES DEPARTMENT
I,7 C. 189p Planning • Building • Engineering
March 24, 1999
Pamela/Philip Stone
1003 Sprague Street
Edmonds, WA 98020
Subject: Determination regarding Critical Areas Checklist # 99-61
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
IMPORTANT INFORMATION TO BE NOTED:
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL V/RREQUIREMENTS. YOU MAY NEED TO SUBMIT
CH
ADDITIONAL INFORMATION SUCH AS AN ENONMENTei
ECKLIST OR CRITICAL AREAS STUDY.
The `DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
y You must submit a co of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Enc: Determination
* Architectural Design Board
C: ReceptionUana\CR LTR.doc
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Planning Secretary
• Incorporated August 11, 1890 •
Sister City - Hekinan, Japan
• SrILE N
6_
Critical Areas Checklist
--=--------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
I. Site Address/Location: (1 LI 1G 't� 1 Lr %J0SR- EG E I V E D
2. Property Tax Account Number: 4 3 `t Z 0 `1" 3 0 5 Y 00 i 3
a � a o o- 7�, ter �� =��" 4 2000
3. Approximate Site Size (acres or square feet):
DEVELOPMENT SERVICES CTA.
4. Is this site currently developed? 1-'' yes; no. CITY OF EEYMONDS
If yes; how is site developed? S ( N4,L6 FA—M IL-\ 1 - ME
5. Describe the general site topography. Check all that apply.
y Flat: less than 5-feet elevation change over entire site.
i 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 than 33-feet).
Other (please describe):
6.. Site contains areas of year-round standing water: No ; Approx. Depth:
7. Site contains areas of seasonal standing water: /v' U ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway Ny floodplain IJ r) of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? IJ v Flows are seasonal? N LO (What time of year? ).
10. Site is primarily: forested ; meadow -shrubs ; mixed
urban landscaped (lawn,shrubs etc) L.--,
11. Obvious wetland is present on site: /N o
DETERMINATION
%a chk.doc; Rev 10/03/97
City of Edmonds
11�W CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City of
Edmonds prior to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable City staff to
determine whether 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 site or
data available at City Hall (Critical Areas inventories,
maps, or soil surveys).
RECEIVED
MAR 12 1999
PERMIT COUNTER
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
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:
I A mk�,L,q)PJ/4 i L- I V STz rJ .
Name
l vo =3P-A6Ei.
Street Address
City State Zip
S - 77 S
Telep e
Signature
Lr . lZ ,
Date
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date
c:reception\j ana\cac I. doc
(over)
0 .. 0
0 PLANNING DATA
•
SITE ADDRESS: DATE: 4 %/mod
ZONING: PLAN CHK#:_
CORNER LOT (Yes/No) FLAG LOT
(Yes/No)
SETBACKS:
Required Setbacks:
Front:�4ftr_� RightSide:_� �.
Actual Setbacks• �, ix fv to
Front:,�_LefL--� ide:
Street map checked for additional se ack required? ' (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED J (Y/N)
LOT COVERAGE: /00
Maximum Allowed: Actual: 6
BUILDING HEIGHT:
Maximum Allowed: Actual Height:
Datum Point: 6ft' 10" Daturn Elevation:_
A.D.U. CREATED?: tl�IO'
--------------------
SUBDIVISION:
CRITICAL AREAS #:_ fIrl .4
SEPA DETERMINATION:_
LOT AREA: 4 01,
N
890.19y-
CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works • Planning . Parks and Recreation . Engineering
T�EE1
CERTIFIED MAIL
September 17, 1992
Alice Thornton
1003 Sprague Street
Edmonds, WA 98020
RE: PROBLEMS WITH VENTING OF YOUR PLUMBING FIXTURES
Dear Alice Thornton:
LAURA M. HALL
MAYOR
PETER E. HAHN
DIRECTOR
FILE
The City's sewer cleaning records show that the home at this address is
experiencing problems with the venting of some of your plumbing fixtures
when the City crew is conducting cleaning operations of the City sewer line
in front of this address.
The City's cleaning operation is essential for both you and your
neighbors. It cleans debris in lines to prevent plugs, prevents corrosion
and potential future collapse, and achieves a better flow characteristic in
the public sewer lines. We need to do this.. often -- perhaps even 3 times a
year -- in some critical areas. The City's cleaning operation typically
involves the utilization of a high pressure water jet.
The problem which occurs at the home is the result of a high pressure surge
through your internal plumbing system. A properly constructed plumbing
system is designed to easily vent this additional pressure without any
visible impact at your residence. An undersized venting pipe (or not
having enough vents) cannot handle the pressure surge, and the only release
that's available is then through your toilet (or another fixture). The
Uniform Plumbing Code typically requires a 2" vent, and further requires a
separate vent for each plumbing fixture which is connected to the sewer (a
toilet, a sink, a shower). Your home may not have an adequate venting
system (you either have a 1-1/4" vent, or not enough of them), and you
therefore may continue to experience the pressure surges or you may be
experiencing a plugged vent.
The City does not have a choice as far as discharging its responsibility in
cleaning the public sewer line. It is therefore up to you to take
corrective measures as to how to improve your own venting system.
The City has come up with two options that will remedy your problem:
Option 1: Upgrade stack vents for toilets and other fixtures which
are experiencing problems to required sizes.
• Incorporated August 11, 1890 •
Page 2
Option 2: Install a clean -out outside of house per attached
specifications. Enclose box so it can vent properly when
excess pressure is put on house lines. This option would be
the cheapest and simplest way of correcting this problem.
At the same time, it would allow access to sanitary sewer
lines if stoppage should occur. This vent clean -out would
allow a place for backup in lines to go before entering your
house and causing costly damage.
The City would appreciate your expeditious cooperation in this matter. The
City must continue proper maintenance of its sewer lines, but we obviously
do not wish to see continued problems occurring on your property because of
poorly designed vents. A plugged vent will be your responsibility to
correct these deficiencies.
We cannot keep notifying you each time we come out to clean the line. It's
up to you to have a plumbing system that conforms to code. Option 2 is a
relatively simple one to construct.
Should you have any questions on these options, please call Everett Akau,
Scott Highland or myself at 771-3202, extension 317 or 318.
Sincerely,
GZYmj
Ron Holland
Water/Sewer Supervisor
Enclosure
SE/VENT/TXTSEWER
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CITY OF .ED"!ONDS
PUBLIC DEPARTMENT., ENGINEER" VISION
`il r L, A Uti I I U!Y I UR L, I UH I -VI -I � RU I IU11 ra=
EET FILE
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
A. Permit to be issued to:
For Work at:(address or vicinity) ze
Type of Work to be done:
(attach drawing when applicable)
Time Required. -- Start: d Finish:
Owner:
Name
Mailing Address
City State Zip
Contractor: i
Nam-e
(
Mailing Address
City State Zip
e/
Telephone Number
22elz If 70
State License Number
,,�f 7
Telephone Number
B, 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
kind 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 permitjust be available at the job site for inspection
purposes at all times.
Signature -.,Date:
Owner or Agent
L, TO BE COMPLETED BY ISSUING AGENCY:
Date Issued: --IPermit No.: /7g-07e) Fee:
Security Bond:
Time Authorized:
PPROVED BY(`.
10-771v (Revised)
Date::
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TEMPORARY REGISTRATION CARD
�a GOVERLEE NOR STATE OF WASHINGTON N2 8584
DEPARTMENT OF LABOR AND INDUSTRIES, CONTRACTOR'S SECTION
THIS CERTIFIES THAT THE PERSON NAMED HEREON IS LICENSED AS PROVIDED BY LAW AS.A
SPECIALTY CONTRACTOR
h�
,
FFI i' .,R+SEYDJR.
19 2 5 :;EAGEMONT
SEA=, WASH: 98199
ACCOUNT NUMBER EFFECTIVE DATE EXPIRATION DATE
02 1970 03 17 78 04 17
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' 2� (� EXISTING HOUSE
1007
v WODD DECK ..:x < > •, , j J �\� J J N — - -- 1 Zvi 7
rnir♦ i :cx =.. .. I I
�-7--� UPPER FLOOR i I II
I I11 ADDITI—
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cNo I A g6 EXISTING HOUSE\L 11 ? 5' SIDEYARD
P N I 1003 SETBACK
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o INSP _ .0 T 3 t
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_, � 14/o REQUIRED
�- BENCH M K z ORIVE1�l � �, � � �� 0 THAN
30' �J 30' ' METER- 4
75.00' a `�
RIGHT OF ONRVCTI�. MT,�,,?�T t I L
HEIGHT CALCS: � �. ` CT --NEW
A:. ; ryI� 9°
A = 215.5' 0 �6ONCRETE CURB NEW 20' WIDE
B = 217.65' CONCRETE DRIVEWAY o
C = 219.55' IMPERVIOUS SURFACE CACU ATION: rl) IMPERVIOUS SURFACE CALCULATION PRIOR TO 1977:
D = 219.7' EX. ASPHALT PAVEMENT TOTAL RDOF AREA - 2,59 SO. FT. TOTAL ROOF AREA - 1,695 SO. FT.
AVE GRADE = 218.1' TOTAL OF DECKS - 267SO. FT. TOTAL ROOF AREA CARPORT (REMOVED) - 350 SO- FT.
MAXIMUM = 243.1' DRIVE & WALKWAYS - 39 SO. FT. TOTAL EXISTING DECKS (REMOVED) = 515 SO. FT.
1 % TOTAL IMPERVIOUS SURFACS- 3057 SO. FT. TOTAL EXISTING CONIC. DRIVEWAY = 132 SO. FT.
_ CENTER OF R.O.W. 05.00� _ _ _ _ _ _ _ _ _ _ TOTAL EXISTING CONC. PATIO (REMOVED) - 280 SO. Fr.
EX. RAILROAD N 89 53'34" W ALLOWABLE LOT COVERAGE= 35% TOTAL IMPERVIOUS S - .
SPIKE TOTAL S P R A GI E STREET LOTSIZD8508 AREA i� 0"= 29 xS20 LOTSCONBWE O. OWNERS: N
PHILIP AND PAMELA STONE
I
PLOT PLAN ENGINEERING-ch r- -- • 4 ML AS (VOTED q�
%00
DATE RECEIVED
PERMIT EXPIRES 2c) /(2
CITY OF EDMONDS
USE
ZONE..
PERMIT >
�
NUMBER
CONSTRUCTION PERMIT APPLICATION
7JOB 1c
ADDRESS � U� �� � � %/ •-
SUITE/APT#
��:L(�G'�: ���^ /i��. '
OWNER NAME/NAME OF BUSINESS
`'
j.
'D}If-]:,,
PLAT NAME/SUBDIVISION NO.
LOf NO.
LID NO. r ""
`i 1 d 9f]: 1
�.
LID FEE $
it MALING ADDRESS .
�. �} -; 7
a o ") t-_,'�,a ;� ,GT
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required , 4
RW Pe Approvede � r
)) ✓ r �/ •✓ V
`
EXISTING ✓' PROPOSED
REQUIRED DEDICATION
FT "�
street Use Permit Req'd
Inspection Required-/I�
sidewalk Required .%Ju p
Underground ��
Wiring required ! O
CI Y, ZIP
i
TELEPHON4.
lm�Z2 . V ,
NAM
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED c7
-
YES ❑ NO ❑ Z
W
= ADDRESS r Y i _
y ►�
i1 pA�
REMARKS
OWNER/CONTRACTOR RESPONSIBLE
Z
75
FOR EROSION CONTROUDRAINAGE �r
z
E?V/i/"ts;_' /!✓(/ ii✓`_!�'rl7:U.1.lS ,4'NG� !� W
a 1 �C..r i SJ `"rr fw1"
CITY ZIP
JU' / is~. LJ r
TELEPHONE
"✓ �'C�} !/
r
-2ti �-A,j ","iL- L L"c)�,� �e�r I ell 12�./..l lUAL/sT, �� //
NAME
r?L
•-
ENGINEERING (
REVIEWED/DATE
r .%C�c.C/ ,� / r j .�
O¢ ADbffE§s
q)TY (I ZIP TELEPHO�E
De
STATE LICENSE NUMBER EXPIRATIOND TE CHECKED BY _Lot 2�-
�aPERTY TAX ACCOUNT PARCEL NO.
❑ NEW RESIDENTIAL PLUMBING / MECH
AUDITION ❑ COMMERCIAL COMPLIANCE OR ❑ CHANGE OF USE
0-REMODEL ❑ APARTMENT ❑ SIGN
❑ REPAIR ❑ GRADING CYDS ❑ F ENCE X FT)
❑ DEMOLISH ❑ TANK ❑ OTHER
�ARAGE RETAINING
CARPORT ❑ ROCKERY WALL ❑ RENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS 245)
STORIES UNITS NUMBER
DE RIBE WORK TO PE DONE
'Art
q&
F(E TCSOURCE GLAZING % -y ' LOT SLOPE
-) 1 P ,
PLAN CHECK NO: VESTED DATE
10
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT. COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
J SEPARATE PERMISSION.
f
¢ PERMIT APPLICATION: 180 DAYS
W
a PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
rn "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
rn
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
J
i EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
¢
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
= FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS' PERMIT -SHALL NOT BE
G DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
O NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
_
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR jC,6q OF THE STATE OF WASHINGTON, RELATING TO
WORKMEN'S CO PENSgT1O�INSU NCE AND RCW 18.27.
SIGNA;/� /( NER'OR ENT DATE SIGNE
FIRE REVIEWED BY DATE W
LL
VARIANCE OR CU
J
SHORELINE OR ADB#
INSPECTION
REO'D
BOND
POSTED
SEPA REVIEW
COMPLETE • EXEMPT
SIGN AREAHEIG
ALLOWED • PROPOSED
PROPOSED
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR O
PARKING LOT AREA PLApIN� R EWED BY /' DATE
REO'D I PROVIDED
1 OY-1 (AWN f, rl :Oa
IA UNLAWFUL` O USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
BY ITYPE OF CONSTRUCTION I CO(D,E r•l I OCCUPANT
SPECIAL INSPECTOR I AREA
,r1r) IL�Y'I, p � 'OOAD PANT
REQUIREDD, E]YES "'j< to
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
" v u art _ E tL 1 w _ j�(2
LArTPP_.m—'. 14r-I CIF P.4
VALUATION
PLAN CHECK FEE
fFEE
4-� •�
BUILDING
16
PLUMBING
MECHANICAL
(.•'"�
GRADING/FILL
ENG. REVIEW FEES
ENG. INSPECTION FEE o o
L.ANDSCARIN67. /' .. . r- 0 0
�.
PLAN CHECK DEPOSIT
(
ECEIPT �l
� U
TOTAL AMOUNT DUE
RECEIPT((f%''
i•'i Q9 ��
Y-�
/
r c) � `— t �+�—''
APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
(425)
OF WXIALS _ SIGNATURE_ DAT
I,
.
771-0220
�R£ �SEDBY ti..,- DATE r
EXT 333
771-0221
FAX
ORIGINAL- FILE YELLOW - INSPECTOR
PINK - OWNER GOLD -ASSESSOR