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110 8TH AVE N.PDFIIIIIIIIIIIIII 14788 110 8TH AVE N .,Qc. 199, City of Edmonds Development Services Department Planning Division Phone: 425.771.0220 Fax: 425.771.0221 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 the application 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). Date Received: 9 - —7 - O i City Receipt #: TS (::�, ( Critical Areas File #: CiPt -O[ - Critical Areas Checklist Fee: $45.00 Date Mailed to ADDlicant: A property owner, or his/her authorized 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 assistant staff in completing their preliminary assessment of the site. The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or it -nplete information furnished by the applicant, his/her/its agents or employees. By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my knowledge and that I am authorized to file this application on the behalf of the owner as listed below. SIGNATURE OF APPLICANT/ ENT DATE Property Owner's Author' By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application, and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the purposes of inspection and posting attendant to this application. SIGNATURE OF Owner/Applicant: Name Street Address City State Zip Email address (optional): DATE !S'—:Z ,-- U Applicant Representative: Name Street Address City State Zip Telephone: Email Address (optional): Critical Areas Checklist.doc/3.19.2001 Critical Areas Checklist CA File No: -� �Z(P Site Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: 2. Property Tax Account Number:_-5/2y2 3. Approximate Site Size.(acres or square feet).: 4. Is this site currently developed?;Z es; no. If yes; how is site developed? 5. Describe the general site topography. Check 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 than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water: 1; Approx. Depth: 7. Site contains areas of seasonal- standing water:: a.e ; Approx. Depth: What season(s) of the year? 8. Site is in the floodway !&,o floodplain -%n_ of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round? �o Flows are seasonal? %&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: In 5. Critical Areas Check] ist.doc/3.19.2001 --sue J„ CITY OF EDMONDS GARY HAAKENSO MAYOR 121 5TH AVENUE NORTH • EDMONDS, WA 98020 • (425) 771-0220 • FAX (425) 771-0221 -<.. Website: www.ci.edmondsma.us DEVELOPMENT SERVICES DEPARTMENT jnc. 1.So�p Planning • Building • Engineering October 1, 2002 John Plancich 3830 NE 195th Street Seattle, WA 98155 RE: Sight Distance Obstruction / Alley Intersection at 110 Eighth Avenue North Dear Mr. Plancich: Our records indicate that you are the owner of the subject property at 110 Eighth Avenue North. We have received a complaint that a portion of your hedge located next to the alley at the NW corner of your property is making it difficult for drivers exiting the alley onto Eighth Avenue North to see. City of Edmonds staff has investigated the matter and determined the hedge in question does, in fact, create a sight distance hazard per Edmonds Community Development Code (ECDC), Street Obstructions, Chapter 9.25 (copy enclosed. In order to reduce this hazard and enhance public safety, the City of Edmonds is requesting that you remove vegetation, which is impeding sight distance, 15 feet back from the traveled roadway. This will likely require the removal of one to two of your evergreen trees. When a driver is exiting the alley onto Eighth Avenue North, he or she should be able to see 155 feet minimum and preferably 280 feet to the south when located 15 feet, from the traveled roadways. Please complete the trimming by Octoberl8, 2002. Your cooperation in bringing your vegetation into compliance is appreciated. Please feel free to call me with any questions at 425-771-0220, Ext. 1328. Sincerely, DARRELL C. SMITH, P.E. Traffic Engineer DCS/cmc Enclosure c: Jason Tourtellot, Code Enforcement Officer David K. Gebert, City Engineer Jim Kammerer, Street Division Manager S:\ENGR\DARRELL\Traffic Concern0th and Bell Stretx Sight DisCan L'etl dbcrated August 11, 1890 Sister City - Hekinan, Japan Itic. 189" CITY OF EDMONDS GARY HAAKENSO MAYOR 121 5TH AVENUE NORTH • EDMONDS, WA 98020 • (425) 771-0220 • FAX (425) 771-0221 Website: www.ci.edmondsma.us DEVELOPMENT SERVICES DEPARTMENT Planning • Building • Engineering September 23, 2002 John Plancich ;ri�"th ve we ` ort0 Edmonds, WA 98020 RE: Sight Distance Obstruction at the Alley Intersection with Eighth Avenue North Dear Mr. Plancich: Our records indicate that you are the owner of the subject property at 110 Eighth Avenue North. We have received a complaint that a portion of your hedge located next to the alley at the NW corner of your .property is making it difficult for drivers exiting the alley onto Eighth Avenue North to see. City of Edmonds staff has investigated the matter and determined the hedge in question does, in fact, create a sight distance hazard per Edmonds Community Development Code (ECDC), Street Obstructions, Chapter 9.25 (copy encloses!). In order to reduce this hazard and enhance public safety, the City of Edmonds is requesting that you remove vegetation, which is impeding sight distance, 15 feet back from the traveled roadway. This will likely require the removal of one to two of your evergreen trees. When a driver is exiting the alley onto Eighth Avenue North, he or she should be able to see 155 feet minimum and preferably 280 feet to the south when located 15 feet from the, traveled roadways. Please complete the trimming by October 4, 2002. Your cooperation in bringing your vegetation into compliance is appreciated. Please feel free to call me with any questions at 425-771-0220, Ext. 1328. Sincerely, DARRELL C. SMITH, P.E. Traffic Engineer DCS/cmc Enclosure c: Jason Tourtellot, Code Enforcement Officer. David K. Gebert, City Engineer Jim Kammerer, Street Division Manager • In S:\ENGR\DARRELL\Traffic Concernc\gth and Bell Street Sight Distanc&rp rated August 11, 1890ce Sister City - Hekinan, Japan Critical Areas Checklist CA File No: CT I Site Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: 2. Property Tax Account Number: 0Cp -CEO 3. Approximate Site Size (acres or square feet):. �5'd 4. Is this site currently developed?;j,!!� y es; no. If yes; how is site developed? �� %,44le 'Ft3� e A ee 5. Describe the general site topography. Check 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 than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water: Approx. Depth: 7. Site contains areas of seasonal standing water: .e ; Approx. Depth: What season(s) of the year? 8. Site is in the floodway floodplain , - %n— of a water course. 9. Site �contains a creek or an area where water flows across the grounds surface? Flows are year-round? w0 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 Critical Areas Checklist.dod3.19.2001 '. 1a• Date Received: - �7 - CO 1 City Receipt #: Po Critical Areas File #: G -o( - Cdtical Areas(Checklist Fee:. $45.00 Date Mailed to ADDlicant: City of Edmonds Development Services Department Planning Division Phone: 425.771.0220 Fax: 425.771.0221 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 the application 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). A propertyowner, or his/her authorized representative, must fill —Wilke 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 assistant staff in completing their preliminary assessment of the site. The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable attorney's fees, arising from any action or infraction based in., whole or part upon false, misleading, inaccurate or incomplete information furnished by the applicant, his/her/its agents or employees. By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my knowledge and that I am authorized to file this application on the behalf of the owner as listed below. SIGNATURE OF APPLICANT/ ENT DATE pu Property Owner's Author' By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application, and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the purposes of inspection and posting attendant to this application. SIGNATURE OF Owner/Applicant: Name Street Address 912 City State Zip Telephone: - 56, 2- -�'/ 26 5 Email address (optional): DATE !S!-;2 % 0 I Applicant Representative: Name Street Address City State Zip Telephone: Email Address (optional): Critical Areas Check] ist.doc/3.19.2001 00 ;.r {J . fjf I I N g. Pr PE t lg aEPTH /. tt 8�f��f A% r � i $�irLdt"d�s 6 4pd� • t , ill j , �� � ; � � v • � V ! 1 i i �, 1' � 1 ,� + i t M i i � i i 3 9. ro jf'b a R I i j k !O'1•doe i V N C'v V L2 EO 1 I - � i t 1 1 � • t l M. Hj i ,�� �� i � ) •..• .. „fir .,�.... •-� ;"' RECEIVE I t. r r r -a I i E . SgiT l... - Y/r;TeAl iyr T.,�.-. R � ,[j y.. � .Rtt _.. !';!�'.m.. . r r„/- l - r ! 4 . f y S _ t, .• (r. CITY of EDMONDS C WORKS DEPARTMENT JOB PUBLIC ORDER UESTOR' ''Leif.R. Larson WORK CENTER: Sewer Dept. DATEPREPARED: `6/.1R/74` RE JUB Onl11:R DEPARDIENT , HEAD' 5 -� NUMBER.: .,. IGNATURE:rr.- FACILITY: DESCRIPTION AND/OR SKETCH OF WORK TO BE -PERFORMED location of sewer main adjacent to 110 8th Avenue N. and 813.3 -Verify Majd'St. per' attached sketch. Recommend using sna a nser ed inTiouse c can out to sound out line. Make drawing of findings- for your file :t `send copy 'to Engineering. ' i( "t. ? � _ - ,. .. i ! '. `: i '1. a 1�.1, 1.• +�'r - f.Ii .. - 1 ,' .. y y! ♦tea �{{'' "4 !- ., MANHOUR5'r (mated est actual MATERIAL REQUIRED:'-. 4 AUTHORIZING SIGNATURE DATE ASSIGNED• PUBLIC WORKS DIRECTOR: DATE COMPLETED: CRAFTSMAN'S INITIALS: IOREMAN'5NITIALS; ,:. [i� ,�• Sy cp 4 ` It z Sus Aitii!o t�NN�tT�uJ ftO DYV 7 T •� GSP/viK't�t:itAl S W TN OWNS Ats MAN - - - . -ruES � P1�o rFs�1F� caNNFcrEo Ta r 3 s Side Sewer DrawingThe City of Edmonds EASEMENT NO. 215-00100 NEW CONSTRUCTION ❑ REPAIRS �_] 1,11) NO ................... ASMT. NO...-----------.--- OWNER---N-•- BALCH ------------------------------------------------------------- CONTRACTOR .--•----•---------••-•---•-------------•----------------•-•------------------------ PERMIT NO. _...-..----------•-- JOB ADDRESS ..... 11Q... BTH..AVE...... lu_--------------------------------------- LEGAL DESCRIPTION: LOT NO. -------------------------------------- BLOCK NO. ----------------_---..-----------__. ••----------•-------------•-----•----•---•---•-•--••-•---•--••-----•-------.-----------.---_-_---------•------•--•-•---•--•-----------------•-•----•----------- PWW-0001-11175 (REV.11178) NAMEOF ADDITION------------------------------------------------------------------------------------------------------- DYE TESTED ON SE�,!ER Approved: DATE-----•-----------------------••---•---•--.. . 3y, STREET FILE Goo g it - -- :zj /t--- - To 8�-/ L 33' 7 -C boa o 93 to 3c ,4 vc, ke RECEIVED is J U N L 3 1994 PERMIT COUNTER I �� • T .,;. ,E T s j TY OF ED _— h I PUBLIC-- _ ENG a� ACTION REPORT Nq 2736 SUSPENSE DATE: —4-1 — � (,�i File � Time: l ' , AttachmentS: ONo Date. h _ - t, SUBJECT: NAME: REQUESTOR: e/\''rS�r•rhll� aa%�. ADDRESS: -PHONE: .,•.. - � ' REQUEST RECEIVED BY: -TELEPHGNE CONTACT IN OFFICE O OTHER: �� Action cslz ON vc\ 12 qoac-, 5:2 6 GOSF -ro7n-L- NECO ., Itozzo 4Z" s a-12 sa 00 an ,c)3Go( _ ( r j f 'fy` BUILDING HEIGHT CHECK •` TRANSIT SHALL BE SET UP FOR YNSPECTOR AT FRAMING INSPECTION TO CHECK HEIGHT OF STRUCTURE, ;2.-'..r 1120, vc:IL1l;I1J. FRMT 2D 9 NEW, EXTENDED, RE -BUILT OR ;ATED ELECTRICAL UTILITY AND/OR ^F gMll-RF RI -ACE UNDERGROUND ml,- o 2 CITY OF EDMONDS`O ° ' ""- CONSTRUCTION PERMIT APPLICATION OWNER NAME NAME OF BUSINESS /1 MAILING ADDRESS GNU - CITY ZIP TELEPHONE NUMBER ri) /h u -j S rN k T r'Q NAME It" J I1 NUMBER LAA) u Z PERMIT d^ (�/( �940423 NUMBER JOB ADDRESS SUITE/APT a LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved ❑ RW Permit Required ❑ EXISTING REQUIRED DEDICATION Street Use Permit Req'd ❑ Inspection Required ❑ PROPOSED Sidewalk Required ❑ u¢i METER SIZE LINE SIZE NO. OF FIXTURES,,, _ PRV REQUIRED a I I YES ❑ NO ❑ 3 p ADDRESS D 1 O� ¢ ENGINEERING MEMO DATED REVIEWED BY CITY ZIP TELEPHONE NUMBER FIRE MEMO DATED REVIEWED BY Z O O STATE LICENSE NUMBER EXPIRATION DATE SIGN AREA SEPA REVIEW ADS NO. ALLOWED PROPOSED COMPLETE EXEMPT EXP SHORELINE M 0 Z Legal Descrip' n of Property - include all easements _ %, e5 �t w (/' Ci /' �C /% �� i A �I o In c Q rZ c.. / 5 , ^ �L�!` ` VARIANCE OR CU PLANNING REVIEW BY DATE Zi moo/ Z 17 SETBACKS — FEET 1 FRONT SIDE REAR 10fl HEIGHT 2.5 1 LOT COVERAr E 3-5- 7 Property Tar Account y3 V 2 Q) r- Q 3406a? Parcel No. REMARKS El NEW RESIDENTIAL PLUMBING ADDITION COMMERCIAL MECHANICAL o REMODEL El APT. BLDG. SIGN CHECKED BY TYPE OF _ A , 1.7 ,(/�,�� CODE � / OCCUPANT G P GRADING FENCE 1:1CONSTRUCTION REPAIR CYDS. .1�_x �,�FT) DEMOLISH El NSERTWOODSTOVE SWIM POOL❑ HOT TUB SPA 1`� EGARAGE RETAINING CARPORT ROCKERY WALL/ RENEWAL REQUIRED SPECIAL INSPECTOR AR OCCUFANT LOAD' R MARKS 0 iUL PROGRESS INSPECTIONS PER UBC 305 (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: GJ NUMBER STORIES STORIES NUMBER OF DWELLING /'1y�{D UNITS (/rrV CRITICAL AREAS �1 . NUMBER W O of O DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) FINAL INSPECTION REQUIRED O ^ C A VALUATION FEE /tt PLAN CHECK FEE BO BUILDING 41 HEAT SOURCE: GLAZING IN, PLUMBING Plan Check NO. MECHANICAL GRADING/FILL This Permit coo work to be done on private property ONLY. str Any conuoiion on'the public domain (curbs, sldewalks, driveways; 9fitrqueeg, etc.) will require separate permission. STATE SURCHARGE Permit AppllCation: 180 Days Permit LIml1: 1 Year - Provided Work Is Started Within 180 Days STORM DRAINAGE FEE ENG. INSPECTION FEE ti w ° "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 modify, waive or reduce any requirement of any city ordinance PLAN CHECK DEPOSIT 3 7 NX ° nor limit in any way the City's ability to enforce any ordinance provision." TOTAL AMOUNT DUE / 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 n authorized agent of the owner. I agree to comply with city and THIS PERMIT This application is nc` a permit until state laws regulating construction; and in doing the work authoriz- AUTHORIZES THE signed by the Building Official or his/her ed thereby, no person will be employed in violation of the. Labor Code of the State of Washington relating to Workmen's Compensa. ONLY WORK NOTED Deputy; and fees are paid, and receipt is tlon Insuran a andjRCW 1 Z7. INSPECTION acknowledged in space provided. SIGNATURE AGENT DATE SIGNED r DEPARTMENT OVICIA 'S IGNATURE DATE G CITY OF 6 3� 171A EDMONDS AT T/tt# ION CALL FOR INSPECTION OkLiAyf DATE 7-- IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771 Ow1LAo ORIGINAL — File YELLOW — Inspector A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC CHAPTER 3. PINK — Owner GOLD — Assessor arm r% u PERMIT A CITY OF EDMONDS NUMBER CONSTRUCTION PERMIT APPLICATION a aoB ADDRESS ^ SUITE,APT OWNER NAME NAME OF BUSINESS (✓ 4 LEGAL DESCRIPTION CHECK SUBDIVISION NO, LID NO w MAILING ADDRESS O .fan ' / (] Ale— ✓� r". TESCP Cl j PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP, Approved CITY, ZIP TELEPHONE NUMBER'. RW Permit Required : ❑ 1 EXISTING REQUIRED DEDICATION - Street Use Permit Req'd O -7 —S _ �0 D � I �' IM O e �O 7 r Inspection Required O PROPOSED NAME Sidewalk Required ❑ METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED w a w ADDRESS YES ❑ NO ❑ 3 r S REMARKS U Z U a CITY ZIP TELEPHONE NUMBER Z i NAM ' c� Z w QC_,: 4c, O V ADDRESS !/ ` "ham n , ENGINEERING MEMO DATED REVIEWED BY UI ? /VE Q CITY ZIP TELEPHONE NUMBER ¢_ / (� Se -(/ f f` �/ S J ( y� L/ FIRE MEMO GATED REVIEWED BY p/11 ( O U STATE LICENSE NUMBER EXPIRATION DATE PA C Z L SIGN AREA SEPA REVIEW ADS NO. s c L tC . Legal Description of Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT SHORELINE M Z EXP o. VARIANCE OR CU PLANNING REVIEW BY DATE U IA w SETBACKS — FEET HEIGHT LOT COVERAGE Z a w J FRONT SIDE REAR Property Z Z j Tax Account REMARKS a Parcel No. El PLUMBING 1 NEW RESIDENTIAL 0 ADDITION COMMERCIAL MECHANICAL APT. BLDG. REMODEL SIGN GRADING FENCE CHECKED BY TYPE OF CONSTRUCTION CODE OCCCUPPANT REPAIR CYOS. xFT) 51/ 3 DEMOLISH WOODSTOVE SWIM POOL SPECIAL INSPECTOR AREA OCCUPANT INSERT HOT TUB/SPA REQUIRED LOAD YES GARAGE RETAINING WALL/ RENEWAL REMARKS CARPORT ROCKERY (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER USC .305 Z 0 0 o. Ix Ix W / NUMBER NUMBER OF CRITICAL _ L m 0 OF DWELLING AREAS I 0 STORIES UNITS NUMBER DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) L C_ FINAL INSPECTION REQUIRED OO �� �(f.,� 1a,��' VALUATION FEE PLAN CHECK FEE vv.�.'SS'rJ�+'t.� BUILDING HEAT SOURCE: GLAZING 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, driveways, marquees, etc.) will require separate permission. STATE SURCHARGE Penult 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 N successors in interest, agrees to indemnify, defend and hold w harmless the City 'of Edmonds, Washington, its officials, s 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 0 J modify, waive or reduce any requirement of any city ordinance nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE �s provision." t thATTENTION APPLICATION APPROVAL I hereby acknowledge that I have read this application; thjtyh information given is correct; and that I am the owner, or _ authorized agent of the owner. I agree to comply with THIS PERMIT This application' : is not a permit until laws regulating construction; and in doing the work AUTHORIZES state ed thereby, no person will be employed in violation of tONLY THE signed by the Building Official or his/her Code of the State of Washington relating to Workmen's CoWORK NOTED Deputy; and fees are paid, and receipt is tion Insurance and RCW 18.27. INSPECTION acknowledged in space provided. SIGNATURE (OWNER OR A NTI DATE SIGNEDDEPARTMENT DATES/ CITY OF OFFICIAL'S UR EDMONDS •CALL FOR RELEA E`D Y: DATE ATTENTION -..:;, INSPECTION IT -IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR•, 77*1 _0220 ORIGINAL — File YELLOW — Inspector Ll A CERTIFICATE OF OCCUPANCY HAS BEEN .GRANTED. U.BC, 1 - CHAPTER 3. PINK — Owner GOLD — Assessor tk,\ :5F -TD7-fft_ IIozz 0 .2.331 VF �._._ .......... �--- opt a2 SO 3 F .._....._. c ., 00 ©-2F 03GOO � _ r BUILDING HEIGHT CHECK • TRANSIT SHALL BE SET UP FOR INSPECTOR AT FRAMING INSPECTION TO CHECK HEIGHT OF STRUCTURE, .._....._. �� �_ .... cam...: �.-.�.�.c. ZGa% E ScTBA, GI(S: � F0", Oi T 101, 10� - NEW, EXTENDED, RE -BUILT OR ,ATED ELECTRICAL UTILITY AND/OR e e►.i��� DATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS MAILING ADDRESS CITY ZIP TELEPHONE NAME CITY ZIP I TELEPHONE NAME /'1 . ' CITY ZIP I TELEPHONE STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY PROPERTY PARCEL NO. TTAX ACCOUNT RT� t)o-Y :2 Q ❑ NEW RESIDENTIAL g1'� ADDITION �❑ ❑ COMMERCIAL REMODEL ❑ APARTMENT ❑ REPAIR ❑ GRADING CYDS ❑ DEMOLISH ❑ TANK ❑GARAGE CARPORT 2ETAINING WALL ❑ rvcov (TYPE OF USE, BUSINESS OR ACTIVITV EXPLAIN 600 01"PLUMBING / MECH ❑COMPLIANCE OR CHANGE OF USE ❑ SIGN ❑ FENCE ( X FT) ❑ OTHER ❑ RENEWAL NUMBER,OqNUMBER OF CRITICAL OF DWELLING AREAS STORIES UNITS NUMBER DESCRIBE W RK TO BE DONE 15T HEAT SOURCE GLAZING % LOT SLOPE C I PLAN CHECK NO: VESTED DATE 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 SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS 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 •t,,.FROWTHE 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 ANYWAY 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 CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S C SATION INSURANCE AND RCW 18.27. SIGNATURE WNER AGENT) op DATE SIGNED , ATTENTION IT IS UNLAWFUL TO 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 5/98 4 PERMIT EXPIRES USE PERMIT ZONE NUMBER xe JOB SUITE/APT# ADDRESS O}�\��� PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ CIP PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pe Approved Q Permit Required O Street Use Permit Req'd o EXISTING PROPOSED Inspection Required Q Sidewalk Required Q REQUIRED DEDICATION FT Underground Wldng required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES ❑ NO ❑ Z ¢ w REMARKS Z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z W ENGINEERING REVIEWED/DATE FIRE REVIEWED BY DATE W LL VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND REO'D POSTED ❑ YES ONO,] SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLO ED PROP SED AL�L}OW�ED PROPOSED I ��� 4 -261 �'T EXP LOT COVERAGE REQUIRED SETBACKSS ((FFT.) PROPOSED SETBACKS (FT.) ALLOWED O� ED 12 FRONT r 1 R! I" '�T. U `SID �� ;EAR ` 7 2 " :? /'C fisEAR �1 I6 Z Z PAR14NG LOT AREA P Y % DATEREQ'D PROVIDED tNG�4REIEW VA i a CHECKED BY I TYPE OF CONST UCTION CO OCCUPANT�� GROUP SPECIAL INSPECTOR JAREA't r O OCCUPANT REQUIRED ❑ YES //j LOAD e i REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D W ( IA VALUATION FEE PLAN CHECK FEE BUILDING PLUMBING MECHANICAL, GRADING/FILL STATE SURCHARGE 70 ENG. REVIEW FEES ENG. INSPECTION FEE LANDSCAPING PLAN CHECK DEPOSIT 0 TOTAL AMOUNT DUE RECEI,r/,i 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) O ICIALS SIGNATURE DATE 771-0220 RELE SED BY DATE EXT 1333 ( 771-0221 FAX ORIGINAL -FILE • YELLOW- INSPE TOR PINK • -OWNER GOLD -ASSESSOR