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DEPARTMENT OF BUILDINGS
441
PER International Building Code Section 111
uilding Permit #: B
Occupancy established by this certificate: I Dwelling Units: N/A
B
pe Construction: VB
Maximum Occupant Load **21** (Per IBC 1004)
Room capacity signs, when required, must remain posted at all times.
No. Stories: 2
Basement: No
Building Owner: Bob Groeschell Owner Address: 1027 A Ave., Edmonds, WA 98020
THE Dr. Martha Groeschell Clinical Psycology, PLLC HAS BEEN INSPECTED AND APPROVED AS COMPLYING WITH THE
REQUIREMENTS OF THE 2009 EDITION OF THE INTERNATIONAL BUILDING CODE AS ADOPTED BY THE CITY FOR THE GROUP AND DIVISION
OF OCCUPANCY AND THE USE FOR WHICH THE PROPOSED OCCUPANCY IS CLASSIFIED.
Issued this 8th day of June, 2011
Ch F Bt1j I L
BY:
This certificate shall be posted in a conspicuous public area and shall not be removed, mutilated or obscured and shall be intained in legible condition 'mes. Any change of occupancy or use requires a building permit and a new
Certificate of Occupancy issued by the City of Edmonds Building Official.
``k of E Mo'1,
City of Edmonds °
Traffic Impact Analysis Worksheet
Inc goo
Name of Proposed Project: ��-�� �- `LJ`����t�, LLG
Owner/Applicant
Doi
Name
to1-7 A AvV_
Street/Mailing Address
ED N1MPe> 6NO2D
City rr,^, State Zip
Telephone: 2B W• �7 La q 1- l "�QT I A -
Applicant Contact Person:
KK15 t t w NON %
Name
UAL At,ye:. --7t
Street/Mailing Address
Ept W2D
City
State Zip
Telephone: 4 2q ` -7141 12' l
Traffic Engineer who prepared the Traffic Impact Analysis (if applicable):
Firm Name
Telephone:
THRESHOLD LEVELS OF ANALYSIS
Contact Name
E-mail:
Project Traffic Levels Sections to Complete
I. Less than 25 peak -hour trips generated 1 and 7 only (Worksheet/Checklist)
Il. More than 25 peak -hour trips generated All sections NEC c
PROJECT DESCRIPTION
9V/
OCT - 6 2010
DEVELOPMENT SERVICES CTR.
a. Location - Street address: � � ( 3 � � N CITY OF EDMONDS
Attach a vicinity map and site plan.)
b. Specify existing land use: Wn.
c. Specify proposed type and size of development: Y42` l _,
(# of residential units anUor square footage of building)
Revised on 6124110 E82 - Traffic Impact Analysis Workshee 9 � EE� FILE Page 1 of S
7. MITIGATION RECOMMENDATIONS
State recommended measures and fees required to mitigate project specific traffic impacts. Traffic
impact fee shall be calculated from the Edmonds Road Impact Fee Rate Study Table 4 (attached)
and as identified in ECDC 18.82.120, except as otherwise provided for independent fee calculations
in ECDC 18.82.130.
❑ 'CHANGE IN USE
Fee for prior use shall be based on fee established at the time the prior use was permitted. If the
previous use was permitted prior to the adoption of Ordinance 3516 (effective date: 09/12/04),
the 2004 ECDC 18.82.120 impact fee shall be used.
ITE Land Use Category
Per Unit
Fee Rate
New Use
Mom( CAL-
$ •
Prior Use
M �p G�► (�.
$ 44
New Use Fe $
❑ NEW DEVELOPMENT
ITE Land Use Category
New Use
Units in
square feet Fee
# of ing,
vfp, etc.
ZI15V2- = $'89-10.55
Zl 2-9 -I $ 8120.61
Prior Use Fee: $ g� ZO� I = $C'70�.`�(p�
Units in
Per Unit square feet,
Fee Rate # of dwelling,
vfp, etc.
$ X
Fee
❑ OTHER J Ml'ftr,-T ftWR 11SK M-C VgQ M160 915A
Ok,10, nAo Y'AfaPTo s - • • "0 ►-TIOM 61�-- t„ ,11�sS 'Rf*N Id 0 sue•
MITIGATION FEE RECOMMENDATION:
INDEPENDENT FEE CALCULATION: $200.00 + consultant fee $
TOTAL TRAFFIC IMPACT FEE $
City of Edmonds, Engineering Division Approval
10d04&
Date
' No impact fees will be due, nor will a credit be given, for an impact fee calculation resulting in a net negative.
Revised on 6124110 E82 - Traffic Impact Analysis Work -sheet Page 5 of 5
v A
PLANNING DATA street File
Multi -Family • Commercial
Name: 1� o to G ro e 5 GVi e l l
Review Date: 0• t 3. ;-0 10
Site Address: I ltp l 7j rA A-VLYi t4ti N () VV 1
Permit Number: BLD.20 1 D — 07 1 8
Project Description:
add i nttr f o r to atth , new 5 tZ f fej, r r t vlL od e l
Zoning: DPP-
Comp Plan: ,DT Mi Xfd Gommerci*a I
Corner Lot: ( ES / NO)
Flag Lot: (YES / V�O
Variance: '--'
Shoreline: _---
ADB:
CUP: •--•
Pre-App:
LLA:
Plans Match ADB Approved: (YES / NO)
Lot Aggregation Required: (YES /®O
Use Proposed: Off- Gle-
Use Permitted: ( ES / NO)
Subdivision/Legal/Recording Number: ld Mon dc, plat • Ib I o G K• 7 • l Ot & + N is' lot
s
Legal Nonconforming Land Use Determination Issued: (YES
Critical Areas File Number: /�
❑ Study Required P-A 1011 3 �f, • 0 I' 0
11I Waiver
SEPA Determination: Qix �m
❑ > 500 cubic yards of grading?
❑ 5 + new dwelling units?
❑ Parking for 20 + vehicles?
❑ > 4000 square feet of new commercial area?
Required Setbacks
Street: et
Side:
Side: �(
webt 1�
m �(
r iv
Actual Setbacks
Street: l y�
Side: 71
Side: L+ 5 i
Rear: 2�
❑ Structures: Rockeries/Retaining Walls • Fences/Trellises/Arbors 0 Trash Enclosure Signage
❑ Modulation: Boy Windows • Projecting Modulation • Chimney/Fireplace
❑ Encroachments: Covered Deck/Porch • Uncovered Unenclosed <30" Deck/Porch/Patio> 30"Stoirs • > 30" Eaves
Parking Required:
Parking Provided: 9
Coverage Required: ---
Coverage Provided: --
Lot Area: cl I T-7 9 i VP,,rI
Lot Coverage
Calculations: ~
Building Height.
Datum Point:
Datum Elevation:
Maximum Height: 2C> t
Actual Height: N{ L -t-o hel ht fe c-fang►
Signage
Existing/Proposed: n 0 V1.r., s h o w ru
S
Plan Review By: Gina Coccia, Associate Planner
0 0
PLANNING DATA street F►►e
Multi -Family • Commercial
Landscaping -Notes
Landscaping Matches ADBApproved: (YES / NO) Landscaping Bid Provided: (YES / NO)
1
Landscaping Bid Amount: $ Landscape Inspection Fee: $
Commercial -Parking Analysis
Business Name
Type/Use
Parking Ratio
Tenant Area
Required Parking
a
,
^ -Total Parking Required:
0p
Total Parking Provided:
Multi -Family Parking Analysis
# Bedrooms per Dwelling Unit
Parking Ratio • ; "
# Units
Required Parking
Studio
1.2/D.U.
1 Bedroom
1.5/D.U.
2 Bedrooms
3 + Bedrooms
2.0/D.U.
Total Parking Required:
Total Parking Provided:
Notes .
Plan Review By: Gina Coccia, Associate Planner
' CITY of EDMONDS BUSINESS LICENSE APP ICA
T .• Civic Center • Edmonds, Washingto 0 --
City Clerk Phone 775-2525
ON LICENSE NO. 757
TYPE OF BUSINESS ANNUAL FEE AFTER FEB. 15
CLASS
YEAR LIC.
EFFEC. DATE REASG.
LIC. NO.
SPEC.
❑ (A) HOME OCCUPATION
$ 15.00 $ 22.50
4STRUCTIONS:
L
�Q (B) BUSINESSWITH r--$20.OQ,.')
X
- —
$ 30.00
All items must be completed
RECEIPT NO.
DATE PAID
1 TO 3 EMPLOYEES
Or application t b
pp on Wnoe ac-
C s',�
PRINT W
IN SPEC. BOX
BUSINESS WITH
❑ IC) 4 TO 9 EMPLOYEES
$ 22.00 $ 33.00
cepted.
FOR ISSUE OF
Sign and return application
FEE PAID
0'0
PENALTY PAID
I
I
CORRECTED
LICENSE WITH
'LC'
❑ (o) BUSINESS WITH 10
OR MORE EMPLOYEES
$75.00 $112.50
with fee. Renewals received
10
ACTION.
after February 15 must pay
NEW APPLICATION
(LA)
penalty in addition to fee.
❑ RENEWAL
(LB)
NEW BUSINESSES AFTER
❑ CHANGE
(LC)
JULY 31, 1/2 FEE.
(PLEASE MAKE ANY NECESSARY CHANGES) ❑ DELETE
(LD)
OF FIRM
BUSINESS P ON
NO.
OF EMPLOYEES
T)40 .\.
I A)T-T o A E y_2,7
MAILING ADDRESS
NATURE OF BUSINESS
Tl,�t2V -Nv-c . jJ-
BUSINESS ADDRESS TfON
STREFI V(SjAL PARTNERSHIP (PjEDMONCOR�PO EPT.
OWNERS NA tw^ HOME ADDRESS
HOME PHONE DATE OF BIRTH PLACE OF BIRTH SOCIAL SECURITY NUMBER
`z - 4 - 51 I ()Ar hie g . -CL( 1 5)-3 - -7�/-/l s�-
EMERGENCY NOTIFICATION (1) NAME B TELEPHONE L << 7J J'4`- O Y L
(PLEASE LIST TWO) (2) NAME & TELEPHONE C �-k A , - e 2 7 — L-
WASHINGTON STATE TAX NO.ldl APPLICANT'S SIGNATURE -,
DO NOT WRIT BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, UFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR DISAPPROVAL, DATE, AND
SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT" SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE
;& APPROVE ❑ DISAPPROVE
SIGNATURE
COMMENTS
BUDDING DEPARTMENT 241
pPPROVE ❑ DISAPPROVE DATE 51, �3
/II
SIGNATURE 1A ,
COMMENTS:
CAPACITY: (NO. UNITS, APTS. OFFICES, SEATS, BEDS, STUDENTS)
LAND USE CODE ZONING CODE
CONDITIONAL USE PERMIT
0
Building
❑
Hotel/Motel
(L)
Permit
❑
❑
Apt. Bldg.
Office Bldg.
(A)
(0),
Occupancy
❑
Restaurant
(R)
Group
❑-
Hosp/Nuys Home
(H)
®
❑
School
(S)
FIRE DEPARTMENT DATE 18`30--8) U.F.I.R.
APPROVE ❑ DISAPPROVE SIGNATURE
COMMENTS:
POLI E DEPARTMENT '
PVPROVE ❑ DISAPPROVE DATE 3 SIGNATURE��
V
COMMENTS:
PU WIC
[!?'AP ROVEERKS ❑ D SAPPRO ENT DATE y �s� �3 SIGNATURE � �l X--7;1L49211
COMMENTS:
PLEASE RETURN TO CITY CLERK
:[�i�b-sLc'JYtiJ:Pre�•3'..... �......"�•t'.-"._�9w s���.d�'',..B�W���3 -:_�'....�... i.:ft--'.. `-...-......III'.,. {�,�{.n:..•.:�_-..'. 1, .___-. , ....., 9. ... .v. .l...-l.',��..�._.t f..�.._.., , _. ,__i�4 ::s.::_� -'aL _:.a.
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CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity o Coristruction /'
Permit No
ST"E-Issue Date
FILE
• Owner: &— V A0r, 6
Name
/3/ 3kO"" / wz
Mailing Address /
City, State, Zip. Code
• Contractor:,/Wff4eZV-* g6g? /V CAW
Name
_,4606
Maili Add /
,%4//?F�/
City, State, Zip Code
• Permit Issued To: /7%AA" GPirJ
• Type of Work to pe Done: 3122C/ , 169- l<-//*—F
• Work in Connection Within Connection With:
❑ Sub or Plat ❑ Single Family
[I�omml. / Ind. ❑ Apt. Condo.
• Pavement Cut: ❑ Yes ❑ No
Aysce,41 GA Z 2
State License Number
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
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 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 to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering.
Call 775-2525, extension 220.
I understand that this permit must be available at the j site for inspection purposes at all times.
Signature: Date
O net or Agent
* * THIS PERMIT MUST BE POSTED AT THE JOB SITE FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. issued By: Permit Fee:
Time Authorized: Void after �"" days
Special Conditions:
Ammendments:
Security Deposit: _
Receipt No.:
Fund III Fee:
Street Cut Dimensions
X=
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
FIELD INSPECTION NOTES
(Fund. 111 - Route cony to Street Dept.
Comments:
Diagram:
Contractor called for inspection
Nork Disapproved By:
Work .Approved By:
Inspector:
Yes No
Pate: Bv:
Date:
Date:
Ena. Div. December 1978
•
•
200 DAYTON ST. • EDMONDS, WASHINGTON 98020 • (206) 7713202
DEPARTMENT OF PUBLIC WORKS
CERTIFIED MAIL
June 15, 1982
Mr. Curtis Thomson
131-3rd Ave. No.
Edmonds, WA 98020
HARVE H. HARRISON
MAYOR
PROPERTY DESCRIPTION: Lots 5 & 6, Blk. 7
Plat of Edmonds.(4344)
Re: 1.3�A`ve . No .,, 200 Blk.
Edmonds, WA 98020
Dear Resident:
On February 17, 1981, the Edmonds City Council passed
Resolution 488 for construction, reconstruction, and repair of
deteriorated sidewalks. A letter dated March 16, 1981 was sent to
residents that were required to repair the sidewalk abutting their
property. The improvement of sidewalks in need of repair at the
expense of the abutting property owner is provided by City
Ordinance, Chapter 7.20 and Revised Code of Washington, Chapter
35.68.
DThe areas needing repair have been marked in paint on the
sidewalk adjoining your property. Reconstruction permits must be
obtained from the Building Department at 501 Bell Street within 30
days upon receipt of this certified letter. The fee for the
sidewalk repair has been waived by the City of Edmonds. In the
event these improvements are not completed within ninety (90) days
upon receipt of this certified letter, the City will employ a
private contractor to perform the designated repairs and the City
will bill the abutting property owner.
This action is in response to many citizen requests and
pedestrian falling accidents which have been increasing in recent
years as a result of sidewalk deterioration and increased
pedestrian traffic..
If you have any questions, please call Bobby Mills at 771-3202,
ext. 289.
Sincerely,
TFILE JOHN B. MITCHELL
Superintendent of Public Works
BM/ml
11
•
200 DAYTON ST. • EDMONDS, WASHINGTON 98020 • (206) 775 2525
DEPARTMENT OF PUBLIC WORKS
March .16, 1981
HARVE H. HARRISON
M. AYO?
STREET ,FILE;
Dear Resident:
On February 17, 1981, the Edmonds City Council passed
Resolution 488 for construction, reconstruction and repair
of deteriorated sidewalks. A public hearing will be held
in the Council Chambers at the Civic Center on April 21,1981
at 7:30 P.M You are invited to attend this hearing �fo,
discussingre air of '�'``.
p portions of deteric�r`ated�� sid'ewalk''j
abutting your' -property-:=- Thd"improveinent of sidewalks in
need of repair at the expense of the abutting property
owner is provided by.City Ordinance, Chapter 7.20 and'
Revised Code of Washington, Chapter 35.68.
The areas needing repair have been marked in paint on
the sidewalk adjoining your property. Reconstruction and
repair of these sidewalks must be com>leted on or before,,
September 1, 1981. In the event improvements are not
completed within the above specified time, the City will -
perform and complete the improvements at: the expense Hof the
abutting property owner.
This action is in response to many citizen requests
and pedestrian falling accidents which have been increasing
in recent years as a result of sidewalk deterioration and
increased pedestrian traffic.
Sincerely.,
F RED F. HCRZBERG i
Director. of Public works
' 1
I
ITY p
CITY Of EDMONDS BUSS
LICENSE APPLICATION D a/>3n LICENSE NO.
s,.
Civic Center • Edmonds, Washington 98020
City Clerk Phone 775-2525
ANNUAL FEES
PENALTY AFTER FEB. 15
vy
❑ HOME OCCUPATION
INSTRUCTION;:
CLLASSS
YEAR
LIC.
EFFEC. DATE JREASG..
LIC. NO.SPEC.
$10.00 (A)
ADDITIONAL $5.00 ❑
All items must be completed
"�
�j%E�
SMALL BUSINESS
or application will not be ac-
RECEIPT NO.
DATE PAID
PRINT'X'
$15.00 (B)
ADDITIONAL $7.50 ❑
cepted.
3
6
IN SPEC. BOX
FOR ISSUE OF
❑ Business with 10 or
�o Sign and return application
FEE PAID
PENALTY PAID
CORRECTED
more employees
ADDITIONAL $25.00 ❑
with fee. Renewals received
i t✓
LICENSE WITH
'LC' ACTION.
$50.00 (C)
after February 15 must pay
NEW APPLICATION (LA)
9
penalty in addition to fee.
RENEWAL
(LB)
NEW BUSINESSES AFTER
--CHANGE
(LC)
JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) ❑ DELETE
(LD)
NAME OF FIRM
I BUSINESS PHONE
I NO. OF EMPLOYEES
MAILING ADDRESS NATURE OF BUSIN !.`}�° �B[�
131 Third Avenue North Attorney -at Law MEET
dmonds, Wa. 98020
BUSINESS ADDRESS INDIVIDUAL PARTNERSHIP CORPORATION
3 — O (S) (P) (C)
OWNERS NAME HOME ADDRESS
Curtis P. Thomson 9220 CaS e a-cl-¢
HOME PHONE DATE OF BIRTH PLACE OF BIRTH SOCIAL SECURITY NUMBER
EMERGENCY NOTIFICATION: (1) NAME &TELEPHONE
(PLEASE LIST TWO) (2) NAME & TELEPHONE —Mr—Qz
r
WASHINGTON STATE TAX NO. gI L--$0 APPLICANT'S SIGNATURE �+ DO NOT NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, UFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE AVID kQ LAND USE CODE ZONING CODE
'\ APPROVE ❑ DISAPPROVE
SIGNATURE
CONDITIONAL USE PERMIT
COMMENTS m
BUILDING DEPARTMENT
DATE 10-10 -ejo
Building
❑
Hotel/Motel
)
EYAPPROVE ❑ DISAPPROVE
SIGNATURE
Permit
❑
Apt. Bldg.
(AA)
®❑
Office Bldg.
(0)
COMMENTS:
Occupancy
❑
Restaurant
(R)
Group
❑
Hosp/Nuys Home
(H)
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
®
❑
School
(S)
FIRE DEPARTMENT
DATE ®" 10
U.F.I.R.
X APPROVE ❑ DISAPPROVE
SIGNATURE
L.J_J_LJJI_M
L`s_1
COMMENTS:
POLICE DEPARTMENT
APPROVE ❑ DISAPPROVE
DATE SIGNATURE
COMMENTS:
PUBLIC WORKS DEPARTMENT
L�
❑ APPROVE ❑ .DISAPPROVE
DATE SIGNATURE
COMMENTS:
PLEASE RETURN TO CITY CLERK
DEPARTMENT CHEMIS
nUILDING PERMIT REVIEW
ad essREEI
to
Street Right -of -Way Existing
REQD
Access Easements Existing ,-j
ggQD
Utility Easement Exist'
Lot Per Subdivision _ Plat
Assessor Map
Site Plan Checked for Accuracy
Underground Wiring Reqd.
Check Accuracy of Legal Description ��,
Review by�_-���
- - .1 2
—Date—
Existing Water Main Size
Water Main Required
Service Line Required
Hydrant Size Existing
Hydrant Reqd Per Fire Code
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Conments
3 olater Meter C1�rge Reqd.
..; �
Review by
Size
to a - T ;
Septic Tank Design Approved Date
Septic Tank Pen -nit Reqd. Permit No. —
Sanitary Sewer Availability Prof, L-_
Dracaing No. File No. �� 1
Side Sewer Availability e�
Sanitary Sewer Connection Fee Reqd.
Revi a-7 by e` t 2�,�-@r Date
r
Open Ditch. Existing &119- Reqd.
Culver
Catch Basin Reqd, a J,i Indicate Site Plan 'r
Shoulder drainage maintain collection on swale open runoff
?,tii-ffiole regd.-12� ztv� Indicate on Site Plan D
0
Soil Conditions and Ground Water Field Checked �
Review bye, —Da te_
i'
;LDING DIVISION �R ZONE BIER
Applicant Fill �,�
// AIT APPLICATION Inside Heavy Lines t
,aG J O Fl -7
v r ME (OR NAME OFBUSINESS I. ADDRESS 1 ••S � �� ��+�'
LEGAL DESCRIPTION SUBDIVISION
{'V~ MAILING ADDRESS
SHORT SUB NO,
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'1 I-
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PUBLIC RIGHT"OF WAY PE ; R OFFICIAL STREET MAP
� ri
CITY TELEPHONE NUMBER
EXISTING
NAM�E PROPOSED �,•� .�
1\�I-Il l..�•,V���'�1-1, �1�1!�r�-L��NI�4 DEFICIENCY OF RIGHT OF WAY
ADDRESS PUBLIC IMPROVEMENTS REQUIRED
DRAINAGE IMPROVEMENTS REQUIRED ❑
CITY,` E NUMBER DRAINAGE PLAN REQUIRED ❑
141� 7TELEPHONUNDERGROUND. WIRING REQUIRED
NAME CONNECTION TO SANITARY SEWER
SEPTIC TANK PERMIT REQ:D ❑ NO.
ADDRESS ELEVATION OF PROPERTY CORNERS ❑
& FOOTINGS REQ'D
V r'_J✓/` 1 Z_
,j
CrCITY
TELEPHONE NUMBER
r
SEE ENGINEERING MEMO DATED
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STATE LICENSE NUMBER CITY LICENSE NUMBER CHECKED BY
Legal Description of Property (Show Below Or Attach Four Copies) METER SIZE BUILDING UPPLY SIZE
i
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REMARKS
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SIGN AREA ENV. REVIEW ADB NO.
y
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ALLOWED PROPOSED COMPLETE EXEMPT -7t.
10
_X/ SHORELINE
W
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REMARKS ,�'/� � •s �r`.�.v \l.:J tJ �%J U � J
W
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VARIANCE OR CU P NNING REVIa BY
`DATE
J
YARDS LOT COVERAGE
DDE
{'n
FRONT REAR
❑ ❑ GAS
fe
a NEW RESIDENTIAL
LINE FIRE ZONE TYPE OF CONSTRUCTION CODE HEI HT
1E]
NON-RESIDENTIAL ❑ SIGN ll' �-� ♦� 7 1 MAX✓
i
ti
❑ ADD r �j
❑ ANT
❑ RETAINING SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
DEMOLISH
WALL REQUIRED GROUP LOAD
+1
:.
_ _ �
❑ ALTER EXCAVATE FENCE ❑ YES ❑ NO •�`�"-1
❑ OR FILL ❑ ( X_FT1
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
0 REPAIR PRE -MOVE SWIM J itAIT-_ OF EDMONDS. LOCAL SALES TAX
❑ INSP. ❑ POOL ��1 SHOULD BE CODED 31.04
NUMBER OF STORIES NUMBER OF REMARKS
LING 1
�'F--Ulv
0
?J IJ�h. l/�(�IJN11II
UNITS
a
NATURE OF WORK TO BE DONE
:1
m
New
W
M
0
_
PLAN CHECK FEE VALUATION FEE ---
PLOT PLAN
f C
BUILDING
PLUMBING�(7-E
,gg1�
MECHANICAL ` 7_--
/
yr
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--
FENCE
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"Applicant, on behalf of his or her spouse, heirs; assigns and SIGN _
j
successors in interest, agrees to indemnify, defend and hold. harmless
E
the City of Edmonds, Washington, its officials, employees, and RETAINING WALL
aagents
from any and all claims for damages of whatever nature,
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:Iricing directly or indirectly from the issuance of this permit. Issu- SWIMMING POOL
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—
:•nee ol` Ihi.s permit sh,":I"I not he deemed to mr1r'it'v• caivc or redo.
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No ...........................................
NEW CONSTRUCTION ❑ REPAIRS ❑
113-04150
OWNER..........------------------------------------------------------------ CONTRACTOR---......------------------------------------...............------------------......------........ PERMIT No.......................
ADDRESS ...... 1.31.... 3r-d-.Aare.---.N............................................................... LEGAL DESCRIPTION: LOT No. .............................................. BLACK No.............................................
•
•
NAME OF ADDITION ...........
Dye Tested On Sewer 1972
Approved:
DATE................................................ By......................---.............................................
it/-N �T FILE-,%
USE PERMIT
CITY OF EDMONDS zoNE NUMBER 3�t8
CONSTRUCTION PERMIT APPLICATION JOB . v
OWNER NAME/NAME OFF BUSINESS ADDRESS rZ _ 11 /`� SUITE/APT a
J�l. / f I 't•' �' L'�I L�/V ���/� �U� �( «1 -I LEGAL DESCRIPTION CHECK SUBDIVISION NO. — C LID NO.
Z
0 MAILING ADDRESS (��{q
-. —
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved ❑
CITY ZIPjTf:77
NUMBER RW Permit Required ❑
^ `Z �" EXISTING REQUIRED DEDICATION Street Use Permit Req'd ❑
/��, PROPOSED Inspection Required ❑
NAME C�Nl%Y Sidewalk Required ❑
CoNN� REMARKS Z
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w AODDRRRES /' ��/j'^/ '/ '}/Q J / / Q/t� f �%5 S /V6'r
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a CITY, ZIP TELEPHONE NUMBER
/A r•p�!
NAME Jt
Ol (,3Lr ilA'cllrs �V. ��/ ENGINEERING MEMO DATE �f REVIEW
ADDRESS
U
Q / ��� C W / I� METER SIZE BUILDING SUPPLY SIZE NO.OF FIXTURES
F CITY % ZIP 7 / TELEPHONE NUMBER
G w
Ut W'6'0" / �U 3 l7 64 O - O g O D REMARKS ;
STA-tt LICENSE NUMBER EXPIRATION DATE
NC7- D SSo3 %� > SIGN AREA SEPARE, IEW ADB N0
Legal Description of Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT �/J
ON Z ,- / ^, 7 / „r--+ SHORELINE#
O LY"T CC: 7 EXP
a
cc VARIANCE OR CU PL9NNING REVIEW BY DATE
Uj )GO 4 - O- 3
a SETBACKS — F ET H IGLOOT COVERAGE i
w FRONT SIDE REARZ V
Property 0� �Fh
Tar elNo.Account REMARK a
Parcel No. /^
NEW RESIDENTIAL PLUMBING
ADDITION COMMERCIAL MECHANICAL '
MEMODEL APT. BLDG.El SIGN
GRADING FENCE CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
REPAIR CYOS. (_x_FT)
IV
DEMOLISH W'OODSTOVE SWIM POOL SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
INSERT HOT TUB/SPA REQUIRED 13 GROUP 'Q LOAD
GARAGE RETAINING WALL/ YES F)
CARPORT ROCKERY RENEWAL R MARKS
0 (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBCi 305 a
iE HM26 G,00; 7o2S . m
NUMBER NUMBER OF CRITICAL/' /%
O OF. DWELLING AREAS �I/ Jh
W STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FW6, Ve -rU 1,5 )d 'W %V00 FINAL INSPECTION REQUIRED
�/V NC ✓,(/j/ b��G VALUATION FEE
�v •� PLAN CHECK FEE
/ BUILDING ��
HEAT SOURCE: GLAZING
% PLUMBING
E
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Plan Check No. C, — MECHANICAL
1.0
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 NO. 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
i whatever nature, arising directly or indirectly from the issuance PLAN CHECK DEPOSIT
0 of this permit. Issuance of this permit shall not be deemed to Q
o modify, waive or reduce any requirement of any city ordinance
x nor limit in any way the City's ability to enforce any, ordinance TOTAL AMOUNT DUE
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 ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT This application is not a permit until
state laws regulating construction; and In doing the work authoriz- AUTHORIZES
ed thereby, no person will be employed in violation of the Labor ONLY'THE signed by the Building Official or his/her
Code of the State of Washin ton relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
ti n Insurance. INSPECTION acknowledged in space provided.
L
TURE tOWNER OR AGENT) i DATE SIGNED DEPARTMENT
CITY OF OFFI I L'S SIGN E DATE
7-1 EDMONDS 11 RELE TE
ATTENTION I CALL FOR ;'
INSPECTION —
3
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