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1141 2ND AVE S.PDF111111111111 4845 1141 2ND AVE S 0 ADDRESS: 114 / T,214 Owe— S TAX ACCOUNT/PARCEL NUMBER: BUILDING PERMIT (NEW STRUCTURE): COVENANTS(RECORDED)FOR: CRITICAL AREAS : W— 79 DETERMINATION: ❑ Conditional Waiver ❑ Study Required �Ziver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DA' PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER): PLANNING DATA CHECKLIST DAT D: 5{ SCALED PLOT PLAN DATED: I I SEWER LID FEE $: SHORT PLAT FILE: LOT: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMITS) SOILS REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD DATED: OTHER: LID #: BLOCK: LATEMPTST'sTormAStreet File Checklist.doc #P20 Critical Areas Checklist cA File No: Site Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: 1 W 2 k., A v�G S V,4r t O h A j, UJ A Qg a2-o 2. Property Tax Account Number: P P, F-C F L tzo 00 5, Tao - ao 3. Approximate Site Size (acres or square feet): (Q' CIO i�S 4. Is this site currently developed? X yes; no. If yes; how issite developed? V-X IST1.3(1 H0V- 5. Describe the general site topography. Check all that apply. Flat: less than 5-feet elevation changeover entire site. _ Rolling: Hilly: Steep: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal distance of 66-feet). ; ' `` F'f F t i V P * R,� t n �s; ,' ; i 0� � �' k slopes present on site of more 615'06 adEi le3a, rt�liWW .veica `r} o�f�,10�feet s over a horizontal distance of 33 to 66-feet) �q, grades of greater than 30% press n sits,(" cal risf � set ver a H than orizontal distance of less an 33-feet). °�"""` - Other (please describe): 6. Site contains areas of year-round standing water: ;.Approx. Depth: 7: Site contains areas of seasonal standing water: ICI C ; Approx. Depth: What season(s) of the year? 8. Site is in the floodway f-3 10— floodphdn of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round? NO Flows are seasonal? (What time of year? ). 10. Site is primarily: forested ; meadow ; shrubs ; mixed urban landscaped (lawn, shrubs etc) 11. Obvious wetland is present on site: No For City Staff Use Only 1. Plan Check Number, if applicable? 2. Site is Zoned? Q a - Co 3. SCS mapped soil type(s)? 4. Critical Areas inventory. or C.A. maAdicates Critical Area on site? t-io . Site within designated earth. subsidence landslide hazard area?VJ,*,+ DETERMINATION STUDY REQUIRED. Reviewed WAIVER City. o0dmonds 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 in ma 9 BU G MMU RRE FNI I a w1w1 IAATIA►i nN% it l 4-116I'l,Y"' - Date ReceiJV I( ()Z; City,Receipt .Critical Areas File #: 200 0072— Critical Areas Checklist Fee: 1 5.00 Date Mailed to Applicant: Oo 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 foim- In addition, the applicant shall include other (pertinent information .(e.g. site plan, topography map,! etc.) or n cdies in conjunction with this Checklist to assistant staff ompleting their preliminary assessment of the site. ncT undersigned applicant, and h-W-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 applica 'on on the behalf of the owner as listed below. SIGNATURE OF APPLICANT/AGENT -� DATE D Property Owner's Authorization 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 attenuant to this application. SIGNATURE OF OWNER __4!7DATE Owner/Applicant: X 1::�01 Name. I (4 l z"� AAJ 5 Street Address f�-c1 wt0V c s w l� R 8 020 City State Zip Telephone: 4 2S 7 Y `(- 60 3�3 W, Email address (phos ):7 ?S - I �8.4 — {-c aM E Applicant Representative: Name Street Address City State Zip Telephone: Email Address (optional): Q Ke mna..ex, fkeet;t� C" PLANNING DATA NAME: OAJTa/1i n DATE: SITE ADDRESS: I VVr 11 PLAN CHK#: -1 ?O Pa20JECT DE$.CR PTION: urn id,, a �%,�— c, ms �Tfr roowIL4P,"P/ REDUCED SITE PLAN PROVIDED? a No MAP PAGE: (S� CORNER LOT: ffes N FLAG LOT: es o ZONING: U 6 CRITICAL AREAS DETERMINATION 0.6 1-1 —? pZ ❑ Study Required: giver Conditional Waiver SEPA DETERMINATION: ❑ Fee ❑ Checklist ❑ APO list w/ notarized form ❑ (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or take Ballinger) Exempt SETBACKS: Required Setbacks: Street: Left Side: Right Side: Rear: Actual Setbacks: 11 aZ U Street: 3 S Left Side: t; Right Side: Rear: 7 Street map checked for additional setback required? Ye No / DNA DETACHED STRUCTURES:�f ROCKERIES: FENCES/TRELLISES: A a; i BAY WINDOWS / PROJECTING MODULATION: STAIRS / DECKS: PARKING: Required: d` Actual: o< LOT AREA: 71 1.51) I q _p �} 7lSd. � ,fig' LOT COVE % ` U Calculations: BUILDING HEIGHT: C ` L.lad Datum Point: J / �a^ 'T�'{ Datum Elevation: Maximum Allowed: S Actual Height: LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: es No OTHER: Plan Review Spy i fo NewBPPlanningDataFormDOG CITY OF EDMONDS 'Wermit No. If C&NUNITY SERVICES DEPARTMENT RIGHT- OF- WAY CONSTRUCTION PERMIT RECEIVED Issue Date (0 ' � S f JVW ►iiiiiiiiiiiii►iiiiiiiiiiiiiiiiiiiiiiii��iiiiiiiii A. • Owner: Washington Natural Gas Company Contractor _Ir N%TS Mercer Street GINEWN(3 Name M ress WA 98111 d��� ` Mailing Address Ste' f City State v dip �/� �� City, State Zip State License Number Telephone Number C. •Address or Vicinity of Construction: 1141 2 Avenue Type of Work to be Done: Install New Service D. • Work in Connection With: ❑ Sub or Plat ❑ Single Family ❑ City Projects ❑ Commercial ❑ Multifamily xxUtility E. • Pavement Cut: Y El N F. •Size of Cut: 2 X 4 (1) @Water APPLICANT TO READ AND SIGN —1 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, forseen or unforseen, that may . be made against the City of Edmonds, or any of its depkt`tnents oar employ s, including or not limited to the defense of any legal proceedings including defense costs, court costs. andiattorrnoy � sCpy+reason of granting this permit: �, � 1 1t 11 THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPECTION AND"ACCEP�TANCEkOF 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. • A 24 hour notice is required for inspection; Please call Engineering: 771-3202 • Work is to be inspected during progress and at completion. • Restora�o .bein accordance with CityCode.aa • Street �tept clean of all Yimes. • Traffic, Control#to, be iniAdcordance with City regulations. • All street` cut ditches rdtfst"be patched with asphalt or City approved material prior to end of working day; NO EXCEPTIONS. I understand the above and that this permit must be available at the job site for inspection purposes at all times. ►��V�f Signature: /V May y 28 , 1991 Owner or Contractor This Permit Must be Posted at the Job Site For Inspection Purposes Call DIAL -A -DIG Prior to Beginning Work . APPROVED BY: Bw OTime Authorized: Void after A4Q) 4 -5 4 days. w Special Conditions: �%�►- Pc)T1.40L.E tt_5J/t1_L 'fr1U51., U RELEASED BY: Date ~' a O NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE PERMIT FEE: ­F —'XJ Restoration Fee: Receipt No.: Fund III Fee: Street Cut Dimensions: x = $ INSPECTED BY Date Eng. Div. March 1989 FIELD INSPECTION ��: �i•. . Comments: I I I - Route copy to Street Dept:) twwt. ). Diagram: CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO Partial Work Inspection by P. W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: Eng. Div. July 1985 City of Edmonds Permit Application Engineering Aide Kerry Walsh Washington Natural Gas 622-6767 x 2588 Willa T'� \ � WATER MAIN tX-=--Fr4 W It CCVV I uN K�lo�NrJ I S r,- /i eAS Mai KEY: -ss- sanitary sewer -s- storms -w- water Owater valve FA 6 21s00 11535 11505 11401 11333 ^1 21616 MNCAH RO 21700 21 21701 115w 11400 11320 21720 21700 217 21801 21800 Q 6 21 21000 21 11816 219M 21901 11405 21900 21 Rai 21 11820 11800 11414 ]--7 21 lm 1. LDA 2,0ne F/H 701 801 B27 BO1 BIs g29 304 o� 318 917 402 .,. w 3za 325 260 263 410 Wildlife 3za > axo 40S n Refuge 33B s 941 272 r7 Q 271 M saw .. c 32B 497 EZ 40s . 403 318 s2o 414 412 410 408 408 404505 400Sound E512 View all 618 424 Edmonds Park an 409 407 mo 405 540 420 403 546 504 430 303 401 560 525 4� Olympic View 434 833 • _ ]5�.7 m 60B o 511 610 537 . ... n 10dl.NM .. 515 m a 814 511 • h .600� - B2, 1O 14 B20 517 sts HIM 510 • a 627 mo w 631 m Q hoe • eau Fie1a t$� am 534 v 813 a - me 844 mB EdeIJ •relax 817 . ,. 641 684 -I mo g 543 BBB 647 621 a 848 04 ssg 664 d 031 B 3 O 7B3 702 - M 651 j city 70D 710 p 2 - 711 sw D r RGErk•% 715 716 Adm�y H01sa �L 72, 717 960 505 • 305 319 726 727 41r 40 u � 110 1T8 y� S N & QQ ra s, gg id gg bf 4190 1U 1025 1010 1019 1018 401 1001 1020 d a 102e 1022 1ox4 1oa ta2o E,t 1030 1030 4Wn 1043 1ooB 1031 > ,c 102s 1024 , tms p 6M 1045 Bowdwalk 1045 1042 t047 Ims S 1051 1048 1049 307 �0a too E 17 1074 1051 306 MapwA- t007 11/e IBev 1034 - 1071 1W0 Ilia 1109 IIw C.BIBIB �� 1103 1124 1110 1116 p00d 1120 ,I28 1121 1190 1113 1120 1119 1129 1127 1138 Stela do Ore 1123 1122 1130 W�W S1130 LA1� 1132 4 1138 1140 M ELM UN ��O Zp A A'- 41. Y � 1139 1190 S �' y1152 1149 1142 C 1140 1148 1142 el 500 11 1184 213 1156 1165 660 Highland 22021 The City ®f Edmonds Side Sewer Drawing EASEMENT NO--------------------------------------------- 100-01600 NEW CONSTRUCTION ❑ REPAIRS 0 LID NO . .................. ASM71'. NO. .................. OWNER----- T,-----Q--...BRl.WS ............................................................... CONTRACTOR .................................................................................... PERMIT NO. ............. JOB ADDRESS ....1141 ..2NTD ..AVE. I --S- ..... LEGAL DESCRIPTION: LOT NO- -------------------- ................. BLOCK NO. .................................... ........................................... ...................................................................................................................... NAME OF ADDITION ....................................................................................................................... • T)YE TESTED ON SET�FR Approved: PWW-0001-1 1/75 (REV. 11/78) DATE ......................................... — 3y ------------------------------------------------- APPROVED AS NOTED BY ENGINEERING ALUF RESIDENCE ADDITION/REMODEL 1141 2ND AVE SOUTH EDMONDSCONTACT, WA 98020 OWNER/CONTRACTOR IS RESPONSIBLE FOR CONTACT KONSTANTIN ALUF WORK PHONE -�4255� 744-6033HOME PHONE - N:UTH P 84MMION CON'MOA,D DRAINAGELEGAL DESCRIPTIN: OUTH PARK ADD TO EDMONDS LOT 9 BLOCK 3- v7� Si 1� 1 f1vL 1714 fiMAl119 N 65FT OF W 11OFT OF LOT 9 VOL. 8 PAGE 13, SNOHOMISH COUNTY PARCEL NO: 5820-003-009-0309 ZONING: R84 SINGLE FAMILY, LOT: 7,150 SF, BUILDING PAD: 1,200 SF, 0.17% LOT COVERAGE GAS HEAT, 128.5 SF GLAZING AT 1100 SF OF NEW ADDITION: 11.7% O HEIGHT CALCS IMPERVIOUS SURFACE CALCS AA +104� EXIST. BUILDING ROOF OU INE: 1025 SF. (CONS IN 1961) N Q B = +104: EXIST. DRIVEWAY: 420 SF(CONSTRUCTEDIN 1961) C = +103' EXISTING PORCH: 30 SF CONSTRUCTED IN 1961 D = +103' EXISTING DECK: 180 SF (CONSTRUCTED IN 1996� (W� 4V AVE GRADE = 103.5' PROPOSED ADDITION: 9255 SF ACTUAL = 123' L = +103 MAXIMUM = 128.5' +103 fr 0 MATERIAL 0 M N W 'cc H 0 I z 24'-0' Z m m u5 p> I F81 0 RANCOR I s Lu I + 04' �� pp (`� `p'� +104' I O OC m- - - - - - - RELOCATED EXISTING DECK G , I A' Z PROPOSED ADDITION 160 �� ® -0 / I PROPOSED5SADDITION ABOVE I -� I PROPOSED ADDITION N q- 9 '°° SF Im 7-4 I�©,C, tio� oI a I 0 1h Ih E ISTINGRESIDENCE Z1920 V g (960 SF EACH FLOOR) 7 -D. --- PORCH ---� D �I +1--------- +103' EDPoVEWAY HALT 35X.. W �` r%� io S�¢i 00 11% SLOPE W a:0 ' Z LL N WATER METER TELEPHONE I I - POLE ^� --- �LLLLL - - 0490 PROPERTY LINE 65' +99 DATUM PT. +100' 10'-0• 2ND AVE SOUTH TOP OF SS MANHOLE COVER O - - - - -C---- -G--OF----------------- PLOT PLAN SCALE: 1" = 20' RECEIVED MAY 1 12004 PERMIT COUNTER Swr , GAsr '"r-) r tP'^' ,. Y' uw.—vY•�^'vYT Y r .... ` aT.l lit• u �_. �1•lI�' •Ii��"'1..,�A'Y+F.n...v.i<•:'t«•�y.__•F�:`r•.r�—..•.•....•.w v �It.'Y• .� '''��l'.l PERMIT NO: 8 5 'Cityof Edmonds PERMIT; EXPIRES0— hoc, l 89� SIDE SEWER PERMLT . ,. _ ._ .�... Address of Construction: 11 q-1 7&d W J' Property Tax Account Parcel No. 15920 003— 030 Attach copies of all access and utility easements Verified �-and. Approved b � �S y Owner and/or Contractor: �1 I r T0 �� W 1j 17f t- Contractor License #: "Single Family' i ❑ Multi -Family (No. of Units _ ❑ Commercial (No: of Units ) ❑ Public Invasion into City *RW Construction P .ig h t=of Way: ❑ Yes IgNo mlt # 3perty: ❑ Yes No and copy of recorded easement., tractor, O� �6 Owner or contractor sign re and acknowledgement statement: �a"�-"� Date • By signing for this permit I certify that I have read the-City's public handout entitled �ide Sewer Specifications, and shall comply with all City requirements outlined therein. 9 CALL DIAL -A -DIG (1-800-425555) BEFORE ANY EXCAVATION 19 FOR INSPECTION CALL 425-771-0220 extension �3ab1 24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS Cross other "Private **Attach legal descripti l NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN. INSPECTOR ARRIVES•A $45 RE -INSPECTION FEE WILL, BE CHARGED. Job Site Ready YES NO Date: Initial. Partial Inspection: Date: Initial: Partial Inspection: Date: Initial: FINAL INSPECTION APPROVED: Date: y 10*4 Initial: (-TM As -built to Street File: ❑ t� PERMIT MUST BE POSTED ON JOB SITE 1�, White Copy: File Green Copy: Inspector BuN.Copy: Applicant L;temp;bl dg;forms;sspermitj lg4/00 E.D* ADDRESS HOMEOWNER )ATE'- " - ' - IDRAWN 008 �vw I" - CONTRACTOR PERMIT NO. SCALE 11.5' GARAGE DOOR DWY 9.5' 7' W Q N EXISTING REPAIRED LATERAL LINE FERNCO CONNECT TO EXISTING ABS REPAIR of ED�*o� CITE' OF EDMONDS SIDE SEWER AS —BUILT ADDRESS HOMEOWNER v u' 1141 - 2 AVE S __CONSTANTIN CONTRACTOR SCALE NTS DATE DRAVM PERMJT 1890 09/21/2004 BY SIBREL 03/22/2005 NO. 9855 APPROVED AS NOTED BY, ENGINEERING ALUF RESIDENCE ADDITION/REMODEL Date. -- 1141 2ND AVE SOUTH CONTACT KONSTANTIN ALUF OWNER/CONTRACTOR IS RESPONSIBLE FOR WORK PHONE - 425) 744-6033 HOME PHONE - 425) 775-1384 EROSION COUTROL AND DRAINAGE LEGAL DESCRIPTI N: OUTH PARK ADD TO EDMONDS LOT 9 BLOCK 3- N 65FT OF W 11OFT OF LOT 9 VOL. 8 PAGE 13, SNOHOMISH COUNTY PARCEL NO: 5820-003-009-0309 ZONING: R84 SINGLE FAMILY, LOT: 7,150 SF, BUILDING PAD: 1,200 SF, 0.17% LOT COVERAGE GAS HEAT, 128.5 SF GLAZING AT 1100 SF OF NEW ADDITION: 11.7%. HEIGHT CALCS IMPERVIOUS SURFACE CALCS AA +10— EXIST. BUILDING ROOF OU INE: 1025 SF. (CONS IN 1961) B = +104' EXIST. DRIVEWAY: 420 SFCONSTRUCTEDIN 1961) C = +103 EXISTING PORCH: 30 SF CONSTRUCTED IN 1961) D = +103' EXISTING DECK: 180 SF ONSTRUCTED IN 1996) AVE GRADE = 103.5' PROPOSED ADDITION: 92 SF ACTUAL = 123' +103 MAXIMUM 128.5' +103 O —ACCEPU-131- E. I rUrl ILWtj 0 0 MATERIAL O $DR 35 z m I 24'-0' SON 40 ' (m'� m a Fi31A NANCOR I �, �L o 0 A B +104' � �V +104' I p m Z --------cQ --------- X REL180 EXISTING DECK '� SF PR156 SF ADDITION 0�--� I PROPOSED116SF ADDITION ABOVE I CD m (j) PROPOSED ADDITION 300 SF gg $I S EXISTING ASPHALT DRIVEWAY I 11% SLOPE TELEPHONE POLE - 0+99 METER PROPERTY LINE 65' 0 Z Q W yO EXISTING RESIDENCE 1920 SF S (960 SF EACH FLOOR) I N r-o• M I r0 lQIN �I ieIIRE ------ I --- ♦+103'c'—jw D sicrT Flu c6 i To Fay sT 411 I K41- I - - +99 - - DATUM PT. +100'MANHOLE - 10'=0' 2ND AVE SOUTH TOP OF SS MANHOLE COVER O CENTER OF RIGHT-OF-WAY ------------------------- CJ PLOT PLAN SCALE: 1" = 20' lot I V O w � _ z LL-v)cr-0� O w r�4 CA = RECEIVED MAY 112004 STREET FILE PERMIT COUNTER 'DATE RECEIVED j 1— am PERMIT EXPIRES42 CITY OF EDMONDS 20NE NUMBERUSE PERMIT U - CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT# ADDRESS OWNER NAME/NAME OF BUSINESS O Lu r� PLAT NAME/SUBDMSION NO. LOT NO. !] LID NO. SDuTIi PARK AAD J ._.. MAILING A� RESS � tAd � C 1 � � LID FEE f V PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approves c I RW hermit Required q 1 S -1 75— ( et Use Pert dead CITY < ZIP TELEPHONE InsStrEXISTING '�" PROPOSED � InepectlonRequittred Sidewalk Required �t �►u oU n�5 9 ©zo Y 1 I `(i- 6 ® 33 wo REQUIRED DEDICATION FT =e� C NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV'REQUIRED O �u —•� —� YES i3 NO O E C ADDRESS REMARKS = x = V¢ OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE t7 t *CITY ZIP TELEPHONE NAME v - r r_ IrO D �—"y C H CBL Of ENGINEERIN REVIEWED BY DATE ADDRESS 6 8Z 3 mi'mc- PI NT Nhi) 014OPP s q ROZ6 CITY ZIP TELEPHONE C �L �I Z ri�1 FI DATE �DMo(,�� gB.Zb (425) 797-160Z STATE LICENSE NUMBER EXPIRATION DATE I CHECKED IANCE OR CU SHORELINE OR ADB# INSPECTION BOND . _ter ------ RE 'D POSTED IF � V 1 C -(o c• O 3 Z Di 63 ' ( �� EVL SEPA REVIEW SIGN AREA ❑YES O $ HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE ET T ALLOWED PROPOSED ALLOWED PROPOSED �SZO _ �0 00 O3 O EXP �U/ ❑ NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOCOMPLIANCE OR SE ,FFR/O�NT SIDE REAR FRONT LfR SIDE REA�, t7 l� ADDITION ❑ COMMERCIAL ❑ CHANGE F USE 35 ' " as, • �+ V"`+ / / , 35,617. d `( z_� ' REMODEL MULTIFAMILY PARKING LOT AREA Pl�[1NING R EW D DATE Q I ❑ ❑ SIGN REfYD PR VIDED () GRADING- FENCE 41� � Sa �p/{,/►Jq-- 511 � d 7 ❑ REPAIR :YDS ❑ ( X FT) REMARKS DEMOLISH TANK OTHER GARAGE RETAINING _ ❑ CARPORT ❑ ROCKERY WALL ❑ FIRE ALARMFIRE MR O (TYPE OF USE, BUSZ0,R ACTIVITY)LAIN:CHECKED BY TYPE OTRUCTION C E OCCUPANTGROUP C NUMBER NUMBER OF CRITICAL m OF DWELLING ` AREAS SPECIAL INSPECTION AREA OCCUPANT O STORIES UNITS I NUMBER REQUIRED ❑ YES LOAD DESCRIBE WORK TO BE DONE O IN REMARKSVat- PROGRESS INSPE ONS PER UBC 108/FINAL INSPECTION REQ'D 9 D vJ P 2 —C — VALUATION T&ajt)ym� Prw o -ri(. tT\i RIO //t/1 3VI Ula M 10. Description FEE Description FEE 1�22M K I 'T C H /QAvoLwk Plan Check State Surcharge HEAT SOURC GLAZING % LOT SLOPE % h 4 b I Ly Building Permit V City Surcharge S PLAN CHECK NO: VE ED DATE Plumbing 0 Base Fee 0q—170 Mechanical THIS PERMIT AUTHORZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO I_ BE DONE ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PUBLIC 7 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading SEPARATE PERMISSION. a Engr. Review W PERMITAPPLICATION: ISO DAYS d PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection 50 SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF 2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE / / 9 DEEMED TO MODIFY, WANE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due , = NOR LIMIT IN ANY WAY THE CnY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt # BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: IS CORRECT; AND THAT I AM THE wER, ORE DUAUUTHO�GENTAPPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application Is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OFFICIALS SIGNATURE j DAT SIGNATURE OWNER AGENT) . DATE SIG ED (425) ram" P 771-0220 D E ATTENTION EXT 1333 /� �� IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE •YELLOW • INSPECTOR/ CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD -ASSESSOR 09/03 PRESS HARD -YOU ARE MAKING 4 COES