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1011 WALNUT ST.PDFiiiiii iiiiiiii 13628 1011 WALNUT ST ADDRESS: 1011 6lI%1 Gl 0 TAX ACCOUNT/PARCEL #: o0q`3q�2_D34oD3766 BUILDING PERMIT (NEW STRUCTURE) #: COVENANTS (RECORDED) FOR: CRITICAL AREAS #: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver CRITICAL AREAS #: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORD FOR: PERMITS (OTHER —list permit #'s): / j,'�- C &00 (dddl;4�o4 PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE/ENCROACHMENT PERMIT #: FOR: WATER METER TAP CARD DATED: OTHER: L:\TEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc o .10 J 14 �- N �c L�©U��t��fIO ���7Dryry��S pp pCppV ��r��1f��ppOF ��ULDING EPAA'.I U�14LSN 1 CORK Fence __. DDR6_-: sfi� 81 .DO. OFFIMC, 60 W-A O T JAN � � 201t -y VELOPMEWT SERVICES CTR. ^1TY Or e. MOWDS APB OVA° D `6!fB�� U� l,:A 1=1L1i NU. Critical Areas Checkii:* IV Site Information (soils/topography/hydrology/vegetation) sitoa ocaa�`'oa g.E. l/>/i9 wa T , 2; Pro . Tax Acco �{t Z 096 -'037 —OODO #,�;,���^✓*`� 3. Approximate Site Size acres or a feet): r'v �A046 0111fe c urrentin /� If yes; how is site developed?_ .17E/✓T/,,QL:. LC9%s► 5. Describe the :t FOP general site topography_ Check all Zhat 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 -aver 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. N0 ; Approx. Depth: y. Site contains areas of seasonal sta ding water. AJO ; Approx. Depth: _ What season(s) of the yearT 8. Site is in the floodway AJO floodpWn of a water course. 9. Site contains�af peek or an area where water flows across the grounds surface? Flows are year- round? NCB Flows are seasonal? (What time of year? }. 10. Site is primarily: forested A meadow ;shrubs ;mixed urban landscaped (lawn,shrubs etc) _ 11. Obvious wetland is present on site: Ajo For City Staff Use On-Y. 1. Site is Zoned? 2. SCS mapped soil type(s)? C_`vou-r>' �Srgi5/ �it7utoy 6ekK 3. Wetland inventory or C.A. map indicates wetland present on site? ALL 4.j- -,Critical Areas inventory or C.A. map indicates Critical Area on site? - ./b 5.. Site within designated earth subsidence landslide hazard area? /V/Q 6. Site designated on the Environrieataliy Sensitive Areas Map? /tiQ .DETERMINATION ' : - " 'STUDY REQUIRED CONDITIONAL WAIVER WAIVER Reviewed by: % fi er ate FAVarM"4 AECag\YZL J U L 2 6 1996 • j_ 4 0 L� CE IVED , JUN-.2� E 1996 A reas IUI,000IYItR 1'C„mu owryicn CileCiClISt. 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 Mall (Critical Areas inventories, maps, or soil surveys). 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. With a signed copy of this form, the applicant should also submit a vicinity reap or plot plan for individual lots of the parcel with enough detail that City staff can find and identify the subject parcel(s). In addition, the applicant shall include other pertinent information (e.g. site &=4 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 Area Checklist and attest that the answers provided are factual, to the best of my knowledge (fill out the appropriate column below)_ Owner / Applicant: _Z�w� Nam /V // MV4,v4c J7T Street Address State, ZIP Phone XO Signature Date Applicant Representative: �KIAV t��47V,-W 4A&3 Name -115W S*VAr)� Street Address City, State, ZIP Phone Signature Date CA FILE NO. • Critical Areas CheckliIV Site Information (soils/topography/hydrology/vegetation) 40 i3 \� SStts/iocattot �iJ/4L/VllT t' 44 u'i Prppe �Tax Accou ►.11%Z. ._ p36 ''037 �C)OD� u_A; !/�/ a2 ti �3 Approximate Site Size (acres or s uare feet): do 600 C, tli&`lti a currently es; 6 ao T � . If yes; how is site developed? .CUES/.17E/✓T/.lL:. � LO%s _ - - y 5. Describe the general site topography- Check, all that apply. Fiat: 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 l0-feet over a horizontal distance of less than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water. ,, Approx. Depth: y. Site contains areas of seasonal standing water: /U/0 ; Approx. Depth: What season(s) of the year?. S. Site is in the floodway /Uo floodpWn of a water course. 9. Site contains meek or an area where water flow_ s across the grounds surface? Flows are year- round? -- Flows are seasonal? (What time of year? j. 10. Site is primarily: forested A meadow ;shrubs ; mixed ; urban landscaped (lawn,shrubs etc) _ 11. Obvious wetland is present on site: /-/0 For City StatiUse Only ; 1. Site is Zoned _ �$ 2. SCS mapped soil type(s)? 6�v44c77- 3. Wetland inventory or C.A. map indicates wetland present on site? A/o,' // 4:,. :-,Critical Areas inventory or C.A. map indicates Critical Area on site? Kb 5.. Site within designated earth subsidence landslide hazard area? l�p 6. Site designated on the Environmentally Sensitive Areas Map? �Q .DETERMINATION 'STUDY REQUIRED CONDITIONAL WAIVER AIVER Reviewed by: 1� 7 Z nner46ate RM OIM404 — of Edm pis ritical - REGEIVE0 PEWI COURIM ,. ,Areas.. Chi^eckIi'st 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). An applicant, or his/her representative, must fill out the checklist, sign and date it, RECEIVED PERMIT COUNTER and submit it to the City. The City will review the checklist, make a precursory site visit, and snake a determination of the subsequent steps necessary to' complete a development permit application. With a signed copy of this form, the applicant should also submit a vicinity map or plot plan for individual lots of the parcel with enough detail that City staff can find and identify the subject parcel(s). 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 Area Checklist and attest that the answers provided are factual, to the best of my knowledge (fill out the appropriate column below). Owner 1 Applicant: e , .47 Name /a// J7- Street Address y, state, ZIP Phone Silmature Date Applicant Representative: VI Mla VA4' 4A&3Z -10AI Name y5-W SIWVAIy� BLYi� Street Address _��yst���, City, State, ZIP Phone signature Date 8go.199 City of Edm.O& a RIGHT-OF-WAY CONSTRUCTION PERMIT Permit Number: Issue Date: F A. Address or Vicinity of Construction: loll Walaut St B. Type of Work (be specific): Install Service (9604160) C. Contractor: Washington Natural, Gas Mailing Address: 1199 75 cr >JIa fterett— State License #: 98203 D. Building Permit # (if applicable): Contact: Mariamne Kingsbury Phone: _356-7500 K7596 Liability Insurance: Bond: $ Side Sewer Permit # (if applicable): E. ❑ Commercial ❑ Subdivision ❑ City Project [J Utility (PUD, GTE, WNG, CABLE, WATER) ❑ Multi -Family ❑ Single Family ❑ Other INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut : Yes []No G. Size of Cut: x H. Charge $ (( ) APPLICANT TO READ AN17 SIGN3cuts = INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or employees, including or not limited to the defense of any legal proceedings including defense costa, and attorney fees by reason of granting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A `PERIOD OF ONE YEAR FOLLOW41' G THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. Construction drawing of proposed work required with permit application. A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220. Work and material is to be inspected during progress and at completion. Restoration is to be in accordance with City Codes. Street shall be kept clean at all times. Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer. All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day; NO EXCEPTIONS. I have read the above statements and understand the permit requirements and the pink copy of the permit will be available on site at sm�es. oronspection purposes. Signature: �� Date: 19—�_Q (Contractor or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY APPROVED BY: �%�'� RIGHT OF WAY DEPOSIT TIME AUTHORIZED: VOID AFTER F DAYS SPECIAL CONDITIONS: }� DISRUPTION FEE/FUND Ill: RESTORATION FEE: PERMIT FEE: TOTAL FEE: �.illll COMMENTS: / �"'/1'7f RECEIPT FEE: -r' DATE: ISSUED BY: -G NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994 t .A Natu%�1 A VArJ-gtc n Energy Canper,y Q Addendum to: City of Edmonds Bight of Way Permit Application Submitted by: Mariamne Kingsbury Engineering Aide Washington Natural Gas 1356-7500 X7596 lot I WA uJUT- T— o(3 C?('LrL� (LvC) Key: -W- Water Watermain depth c,-�%-Dt,t� -G- Gas -SS- Sever " gas main $ Water hydrant p Water valve Washington Natural Gas Company 1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331 M .( • VWS NatxW M� 6 A Wtfstringtan EnerWComp" �1 Watermain depth c�Dt�l`r " gas main Addendum to: City of Edmonds Right of Way Permit Application Submitted by: Mariamne Kingsbury Engineering Aide Washington Natural Gas 1356-7500 X7596 Gf (A o Rey: -W- Water -G- Gas -SS- Sever -. Water hydrant Q Water valve Washington Natural Gas Company 1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331 • J • ■�Y�M��A Wei AvVb1* jtcnEnergyGomparty Watermain depth " gas main Addendum to: City of Edmonds Right of Way Permit Application Submitted by: Mariamne Kingsbury Engineering Aide Washington Natural Gas 1356-7500 X7596 n i i wA L QU,-�— c, c,�� Key: -W- Water -G- Gas -SS- Sever .& Water hydrant Q Water valve Washington Natural Gas Company 1122 75th Street S.W., Everett. Washington 98203, (206) 355-3331 24 Side Sewer Drawing The City of Edmonds EASEMENT NO- -------------------------------------------- 10 8— 0 7 b 0 0 NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO- ------------- ----- ASMT. NO. ------------------ OWNER ------ LENURA-- F .--. CULUElls------------------------------------- CONTRACTOR ---------------------------------------- ------------------------------------------- PERMIT NO. ------------------ -. JOB ADDRESS 1 II.L.1 — 1a1 1 T ST .ET ---------------- LEGAL DESCRIPTION: LOT NO. BLOCK NO. ---------------------------------------------------- NAME OF ADDITION--------- DYE TESTED ON SEWER Approved: PWW-0001-11/75 (REV.11/78) DATE ............................................ By 1011 u.4.1 nd f Sf When recorded mail to: STREET FILE City Clerk City of Edmonds 121 Fifth Avenue North Edmonds, WA 98020 CONFORMED COPY 201103160430 6 PGS 0311612011 4:16 m 17.00 SNOHOMISH COUNT�f , SHINGTON SPACE ABOVE THE LINE FOR RE !ORDERS USE Assessor's Parcel No.: 0O 49 ' ZQ --? 7d Applicant: 14f— � ENCROACHMENT AGREEMENT This ENCROACE[MENT AQkEEMENT "Agree ent") is entered into between the CITY OF EDMONDS ("City") and , A/ ("Owner[s]"), in accordance with Chapter 18.70 of the Edmon s Community Development Code. 1. 'The Property. Owner is the owner of that certain real property located at /O a a,ct -97 — , within the City of Edmonds, Washington, Assessor's Parcel Number O f 760 D and more particularly described as follows z=— ,.� 3,/- 70 or as described in Exhibit "A" attached hereto and incorporated herein by reference. 2. The Easement. The City right-of-way adjacent to rd(-na- Y) er' property or an existin easement used for (strike those that don't appl[s t, r lley, sidlk, bike th, pedestria sement, sanitagkkewer, wa r, st , of r 1—ArP iiA R o !�L 7 ,/ems /J C—c . i� n 1n /t,nn 0✓)ilt/L /1 ftLEy TO lR G KY) 3. The Encroachment. .T44 . The Owner desires to encroach upon the public easement and the City hereby covenants and allow (-4' d 19, fTA211 C.77 P .J O -ees and grants its permission to Owner to ,1 /=2�7i1JC-cam to remain in a portion of the City right-of-way/easement. A partial site plan, scaled 1"=20', showing the location of the encroachment is attached as Exhibit `B" and incorporated by reference. This Agreement is subject to the following terms and conditions: -1of4- a. On behalf of themselves, their successors and assigns, the Owner promises to maintain, repair, remove and/or replace the encroachment located 'in the easement at their sole expense to the standards established by the City. All maintenance, repair, removal and/or replacement shall be conducted solely at the Owners' expense. b. The Owner, on behalf of themselves and their successors and assigns, acknowledge that the City had no obligation to approve the encroachment within the easement for the sole benefit of the Owner, and the agreements contained herein, provide sufficient consideration for the Owner and their successors and assigns to maintain, repair, remove and/or replace said encroachment located in the easement at their sole expense in perpetuity. c. The Owner promises to indemnify and hold harmless the City, its officers, agents and employees from any loss, claim or liability of any kind or nature arising from or out of its promises contained within this agreement, including any damage that may be caused to the encroachment by the City's operation, maintenance, repair, replacement or other work related to construction activity within the easement This promise to hold harmless and indemnify includes defense by counsel of the City's choosing, the payment of reasonable attorney's fees and court costs. Nothing herein, however, shall be interpreted to require the Owner to indemnify the City from the negligence or intentional tortuous act of its employees, officers, or agents. d. The Owner shall at the request of the City, promptly remove, repair, reconstruct, and/or replace the encroachment at the Owners' sole expense. Upon receipt of notification from the City that the City requires removal of all or portions of the encroachment from within the easement, the Owner will promptly remove those portions of the encroachment from within the easement area as required by the City at their sole expense. If the portions of the encroachment required by the City to be removed are not timely removed by the Owner, they shall be removed by the City at the expense of the Owner, and the Owner shall reimburse the City for the costs of removal of the encroachment and disposal of materials as well as for any increased construction costs or consequential damages incurred by the City, due to the Owners' delay. In the event that portions of the encroachment must be removed to facilitate utility and/or construction activity by the City within the easement or other requirements of the City, the Owner shall be solely responsible for replacement of the encroachment at their expense upon completion of the utility and/or construction or other activity by the City. e. Whatever rights and obligations were acquired by the City with respect to the easement shall remain and continue in full force and effect and shall in no way be affected by City's grant of permission to construct and maintain the encroachment structure. -2of4- f. The property owner is required to provide and continually maintain during the term of the permit a certificate of insurance naming the City as an additional insured, with respect to liability, and providing that it shall be primary as to any other policy of insurance. A copy of the insurance certificate shall be provided to the City at the beginning of each calendar year, no later than the 21St day of January. 4. Entire Agreement. This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes and replaces all other agreements, oral or written, between the parties with respect to the subject matter. This agreement may not be amended except in writing in a document filed of record with the auditor of Snohomish County, Washington. 5. Notices. Any notice which is required or may be given pursuant to this Agreement shall be sent in writing by United States mail, first class, postage pre -paid, registered or certified with. return receipt requested, or by other comparable commercial means and addressed as follows: I to the City: City Engineer City of Edmonds 121 Fifth Avenue North Edmonds, WA 98020 Yto the Owner: which addresses may be changed from time to time by providing notice to the other parry in the manner described above. 6. Waiver. City's consent to or approval of any act or omission by Owner shall not constitute a waiver of any other default by Owner and shall not be deemed a waiver or render unnecessary City's consent for approval to any subsequent act by Owner. Any waiver by City of any default must be in writing and shall not be a waiver of any other default concerning the same or any other provision of the Agreement. 7. Termination of Agreement. In addition to any other remedy provided for by law, the City reserves the right to terminate this agreement in the event the encroachment negatively impacts or damages the City's easement and/or underlying utility systems or violates any condition of service adopted by the City, at its sole discretion, as may be necessary to prevent damage to the City's utility system, or any other public facility which may be impacted by the Owners' failure to properly use the easement. 8. Successors and Assigns. This Agreement shall be binding and inure to the benefit of the parties hereto and their respective legal representatives, successors, and assigns. Owner agrees to incorporate this agreement by reference in any subsequent deeds to the property, but any failure to do so does not invalidate this provision. -3of4- 9. Capacity. Each party represents that the person(s) executing this Agreement on behalf of such party has the authority to execute this Agreement and by such signature(s) thereby bind such party. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on this % day of , 20 % / OWNS (S By By: STATE OF WASHINGTON COUNTY OF SNOHOMISH This day, personally appeared before me, Dr B0 R, ,+4 K • L—OP12ES; t , to me known to be the person(s) who executed the within and foregoing document and that (he/she/they) tiS signed the same as (his/her/their) I' free and voluntary act and deed for the uses and purposes therein mentioned. •.�\SglO� F •� - "N• AL6Lf�+~ ` wash ,, CITY OF EDMONDS By: _ V1 N � ('i X 4--\ ENGINIrd SION Nchary Public Typed or Printed Name My Commission expires: &Y— ,/ 9' // -4of4- Y {-i1-bi'T 17ci3� �i-1 t.vr��5► i Ifj i is -A NL4r 6T' c 0 CITY OF EDMONDS 250 - 5TH AVE. N. • EDMONDS, WA 98020 • (206) 771-3202 COMMUNITY SERVICES: Public Works • Planning • Parks and Recreation • Engineering 890 19� CERTIFIED MAIL April 4, 1991 Deborah Kay 1011 Walnut St. Edmonds, WA 98020 RE: Problems with venting of your plumbing fixtures Dear Resident: LARRY S. NAUGHTEN MAYOR PETER E. HAHN DIRECTOR 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 clearly does 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. 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 properly vent your own plumbing 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. e In: o,porored August 11. 189' s Sister Cities International — Hekinan, Japan 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. It is 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 Hiahland or mvself at 771-3202. extension 317 or 318. Sincerely, Ron Holland Water/Sewer Supervisor Enclosure SEWERVEN/TXTSEWER 0 .,,b SSaX3 Ll /b/8:/q 1 nC�j b ,� � b t• �1 G -c.! �sL. 1.' 3 r 1. � -� � / � � , � �' `�s'' 3 ._ pr -) -►- v 04ij -ra+ -a MA �i/;- X (1 1 r6 'd aG Aa h/% T 3+� Q-N r -t.`v„- ch"",j1,ti 10 Ord Jts'D 9QId ,.6 X (1) �o6�ds x ►I ur'v4s ,Sh -)nc .,h X(t) a "^sV Oj5-V-1!d -.7A,-4 , h D< ( I ) s Illk'---I}bW C-a., SDs gnS -- USE PERMIT CITY OF EDMONDS Z°"E��-0 NUMBER �� �� r CONSTRUCTION PERMIT APPLICATION JOB / r / SUITE/APT # WNER NAME NAME OF BUSINESS ADDRESS 41 .f7j%Q�� %"j, LEGAL DESCRIPTION CHECKI SUBDIVISION NO. I LID NO PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. CITY ZIP TELEPHONE NUMBER S� �� w M� - �^-� EXISTING REQUIRED DEDICATION •I'/ j _ J PROPOSED _... w ADDRESS a CITY ZIP IJELEPHONE NUMBER i�7A \.4/0 ---s3 NAME ADDRESS O �o e3 C/ Ae F, ti ZIP Z �}IC< <-- �c d /216 TELEPHONE NUMBER — STATE LICENSE NUMBER - EXPIRATION 0��,/�on I Legal Description of Property : include all easements Z V, Property Tax Account Parcel No. �.J V-0 r� -o346 -o,9?- Q Q O NEW RESIDENTIAL PLUMBINGIMECH COMPLIANCE OR ADDITION COMMERCIAL CHANGE OF USE .REMODEL APT. BLDG. SIGN ❑ GRADING El FENCE REPAIR CYDS. L_x_FT) DEMOLISH WOODSTOVE INSERT El SWIM POOL HOT TUB/SPA I� GARAGE ❑ WALL/ 11 1 I CARPORT RnrKIFRYG RENEWAL TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN w NUMBER NUMBER OF CRITICAL /Q' o OF �% DWELLING AREAS I I O STORIES UNITS NUMBER70 ' , DESCEUBE WORK TO BE DONE (ATTACH PLOT PLAN) METER SIZE LINE SIZE I NO. OF FIXTURES DATED TESCP Approved ❑ RW Permit Required ❑ Street Use Permit Req'd ❑ Inspection Required ❑ Sidewalk Required ❑ tL w PRV REQUIRED YES ❑ NO ❑ C9 Z r w z Z SIGN AREA SEPAREVIEW ADB NO. ALLOWED PROPOSED COMPLETE EXEMPT .w.r SHORELINE EXP �^ VARIANCE OR CU PLANNING REVIEW BY DATE _....m. 9 SETBACKS — FEET V HEIGHT LOT COVERAGE FRONT Ur SIDE 51 REAR )5-r J 3S�_ BY CHECKED BY TYPE OF CO TRUCTION COD OCCUP Vj, A / GRO SPECIAL INSPECTOR AREA t� OCCUPANT REQUIRED LOAD ❑ VES REMARKS PROGRESS INSPECTIONS PER UBC 108 &r-.tys-w.s15;-_ 441- uI FINAL INSPECTION R PLAN CHECK FEE BUILDING HEAT URCE: S GLAZIN % 1 PLUMBING Plan Check No. . /& MECHANICAL This Permit covers work to be done on private property ONLY. GRADINGIFILL Any construction on the public domain (curbs, sidewalks, STATE SURCHARGE driveways, marquees, etc.) will require separate permission. Permit Application: 180 Days Permit Limit: 1 Year - Provided Work is Started Within 180 Days STORM DRAINAGE FEE "Applicant, on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE 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 modify, waive or reduce any requirement of any city ordinance nor limit in any Way the City's ability to enforce any ordinance provision._;_., TOTAL AMOUNT DUE I hereby acknowledge that I have read t •.5, application' that the i nformation given is correct; and that I ant/the'owner, or the duly ATTENTION APPLICATION APPROVAL uthorized agent of the owner. I agree to comply with city and THIS PERMIT, tate laws regulating construction; and in doing the work authoriz AUTHORIZES This application is not a permit until d thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her ode of the State of Washington relating to Workmen's Compensa• [IG WORK NOTED Deputy; and fees are paid, and receipt is ion I surance and RCW 18.27. INSPECTION acknowl ged in space provided. RE (OWNER OR AGENT) DATE SIGNED DEPARTMENT CITY OF EDMONDS OFFI�'ATU DATE ATTENTION CALL FOR RELEAS DATE INSPECTION �� ' IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771 0220 ORIGINAL — File YELLOW Inspector A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 A Mzz — PINK — Owner GOLD — Assessor