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USE PERMIT
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CONSTRUCTION PERMIT APPLICATION
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' This, Permit covers work to be done On private property ONLY.
GRADINGIFILL
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Any construction on the public domain (curEs, sidew,,Iks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
- Permit Application: 180 Days
Perm
Permit Limit: 1 Year •Provided Work is Started Within 180 Days
ENERGY CODE
I "Applicant. On behalf of his or her spouse, heirs, assigns and
N successors in interest, agrees to indemnify, defend and hold
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W harmless the City of Edmonds, Washington, its o'flcials.
cemplOyee3, and agents from any and all Claims for damages of
whatever nature, wising directly Or indirectly from the issuance
T Of this permit. Issuance Of this not be deemed
PLAN CHECK DEPOSIT
permit Shall t0
modify, waive or reduce any requirement of any city ordinance
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nor any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
Drovision."
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I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the oY;ner, or the duly
ATTEN lOr4 APPLICATION APPROVAL
authorized agent Of the owner. I agree to comply With city and
state laws regulating construction: and in doing the work au!horiz•
rHIS PERMIT This application is not a permit until
AurHORI. F.$
ed thereby, no person will be employed in violation of the Labor
ONLY THE signed by file B.Jilding Official or his
Code of the State Of Washington relating to Workmen's Compensa•
WOPA NOTED Deputy; and fees are paid, and receipt Is
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INSPF.GTIOA
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ATTENTION
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771-13^^C1l RELEASED By. �DATE
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IT IS UNLAWFUL TO USE OR OCCL OY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLCW —Inspector
A CERTIFICATE OF OCCUPANCY HAS PEEN GRANTED. UBC
CHAPTER 3.
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PINK — Owner GOLD — Assessor
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ATY OF EDMONDS
- ST-rl AVE. N. • EDMONDS, WA 90(720 • (206) 771-3202
-IMMUNITY SERVICES:
blic Works • Planning o Parks and Recreation • Engineering
1991
:r.
TARRY S. NAUGHTEN
MAYOR
PETER E. HAHN
aREcroR
:onstruction
6028
IA 98155
t #900116 Single Family Residence
to Building Division records, the subject permit has expired
ie required final inspection. The initial permit is valid for
'rom the date of hermit issuance, and a final inspection is
•o grant occupancy.
•ify the building division within 10 days date of -this latter
e for the required final inspection. If .your work is not
the permit must be renewed immediately; the renewal fee cost
e, occupying the area without a final inspection is a
of Section 307 of the I:tniform Building Cade and subject to
civil penalties ordinance.
e any questions contact the building division at 771-3202.
c;� 1
Sharon F. Nolan
Permit Coordinator
• Incorporated August )1, 1890 •
Sister Cliiies International — Hekiran, Japan
IN
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Date Sent To Engineering_ "ac — f/
ENGINEERING APPROVAL FOR OCCUPANCY
5
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MEMO TO: Perm't Coordinator " {
Building Division
FROM: Lyle Chrisman
Engineering Inspector �+
DATE INSPECTED:
SUBJECT ADDRESS:—J_��
PERMIT HOLDER: PERMIT #
PERMIT APPROVED FOR FINAL
X PERMIT NOT APPROVED FOR FINAL, SEE REQUIREMENTS
Requirements:
1. tii�w�35pou^r 6�1 5 • S l�� cF Vkf' NOT'60IlN�a 71444r(A&* C,4
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Additional Comments:
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21
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Critical Areas Checklist
CA File No: (�,q - 2DO 2 7 V
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: l -7 D
r Z, r I Lj
2. Property Tax Account Number: DO 7q l'7 0,60 QOU Oo,
3. Approximate Site Size (acres or square feet): oo I ok
4. Is this site currently developed? ✓yes; no.
If yes; how is site developed? � o use.
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: ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
Flows are seasonal? (What time of year? ).
10. Site is primarily: forested ; meadow -shrubs ; mixed
urban landscaped (lawn,shrubs etc) 1��
11. Obvious wetland is present on site: N n
Critical Areas Checklist.doc/3.19.2001
Of EDMD�O City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
l g90 _ '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: Z Z_
City Receipt #: S-74
Critical Areas File #: ' b°
Critical Areas Checklist Fee: S45.0
Date Mailed to Applicant:
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
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/AGENT /� `� ,7 `' `' DATE /Z� / 0 (,
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 attendant to this application.
SIGNATURE OF OWNER
PLEASE PRINT CLEARLY
Owner/Applicant:
Name
l�oow -1zd pL w
Street Address
City State Zip
Telephone: 4l�S —I'H — +3 i
Email address (optional):
DATE
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
Critical Areas Checklist.doc/3.19.2001
City of Edmonds
Critical Areas Determination
Applicant: William McNeil Determination #: CA-02-74
Project Name: Permit Number:
Site Location: 17005 72°d Pl. W Property Tax Acct #: 00 7417 000 004 00
Project Description:
Non -Project Specific
Determination: Study Required:
During review and inspection of the subject site, it was found that the site has some potential for steep
slopes on portions of the property and/or adjacent to the property pursuant to Chapter 20.15B of the
Edmonds Community Development Code (ECDC). Based on these findings, prior to submission of any
building permit, you will be required satisfy the requirements of ECDC 20.15B by completing the
following:
THE "STUDY REQUIRED" PROCESS:
1. First Step: In order to determine whether or not a steep slope does in fact exist on your property
and/or is adjacent to your property, you are required to submit a topographic survey. This survey
must be completed by a Licensed Land Surveyor (with a professional stamp on the drawing). The
survey must include the following information:
A. Top of the slope
B. Toe of the slope
Note: If there is not an obvious break in the topography to indicate the
top and toe of the slope, then a Geotechnical Engineer may be required
to locate the top and the toe of the slope. Refer to the City Code section
ECDC Chapter 20.15B.
2. Second Step, if deemed necessary: If you feel that you need to have the proposal located in the
buffer area or in the critical area, then you may apply for a Steep Slope Exemption, Critical Areas
Exemption, or Conditional Waiver. It is important to understand that not every applicant will qualify
for the exemptions and waivers listed above. Only a few applications are issued exemptions and
waivers on a project by project basis.
Please do not submit any new materials, such as Geotech Reports, elevations, soil reports,
unless you have received an official memo from the City requesting additional information and
you have contacted a Plannef,#t the City togtey iine�ow to proceed with your proposal.
Name Signature \'_J Date
PLANNING DATA
NAME: ,1 t MCIVAti DATE:
SITE ADDRESS: 17,0ag _ 72^" rt, cJ PLAN CHK#:
PROJECT DESCRIPTION: Y Zo ty f.' akc ctaei; rhr - cat
(.4 rh S�N-( d*%, 2 jL4GK c'k of AAA C+nrH !^o
REDUCED SITE PLAN PROVIDED?: es No
MAP PAGE: CORNER LOT: Yes / o FLAG LOT: Yes 1 0
ZONING: W - 81- L CRITICAL AREAS DETERMINATION #: L^oz - 74 (,.",\WA gizz p ay ti 4130�
7 ❑ Study Required: r ccJl
❑ Waiver
❑ Conditional Waiver
SEPA DETERMINATION: Erg
❑ Fee
❑ Checklist
❑ APO list w/ notarized form
❑ (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
0 Exempt
SETBACKS: bu ba rk< /. 1,r� �• �tcrru �" `� `ti " / H' • ' err Arsd <. lllo>N''�'�
Required Setbacks: � �� � ��
Street: -- Left Side: — Right Side: - Rear: - P`'4p' 99" 9S,
Actual Setbacks: H36
Street: Left Side: — Right Side: Rear:
Street map checked for additional setback required? (Yes / No / DNA)'
❑ DETACHED STRUCTURES: AA-,
❑ ROCKERIES: IWI_
❑ FENCES/TRELLISES: Ana-t
❑ BAY WINDOWS / PROJECTING MODULATION: N.+K
CU STAIRS / DECKS: —s Qom r"Pn i n, 4u,c . iw gyp/" - 41r, pub- 99- 9s
PARKING: Required: Z Actual: ca t4. e
LOT AREA: STREETLOT COVE
Calculations: G ha vac
BUILDING HEIGHT: nJa
Datum Point:4 Datum Elevation:
Maximum Allowed: Actual Height:
A.D.U. CREATED?: No / Yes Na
SUBDIVISION: L+r % , "L,r Cre�r i PU -&I - 7 . P44." -Fj- . T P°�'"°"' o< artiv. Opt
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: Yes / No
OTHER: Su fFs-`7`)-ys — tU` ek_.i, 4�r sy"C AM-4
Sn i•r l�y+.mw. Art,
Plan Review By:�
NewBPPlanningDataForm.DOC
CITY of EDMONDS. SIDE SEWER PER,MI-T
p STREET HLE 9 ��
For Inspection Call 771- PERMIT NO. 0 ° j�
Address of Construction: 72 /-4 W
Property Legal Description (Include all easements): 9 0 0 /
Owner and/or
Builder:
%1211)a 6- CrW57-
, I(YC.
Contractor &
License No:
TZ/2CF C
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00
0
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N
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Single Family Residence
Multi -Family
(No. of Units )
LYrfOOD LINE
Commercial (No. of fixture Units )
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEAS READ THE ITEMS LISTED ON THE BACK
I certify that I have read and shall comply
with the items listed on the back.
Permit Fee:-yy
Trunk Charge:
Assessment Fee:
Partial Inspection:
� A
Date
'Issued By:
Date Issued:®%y
Receipt No..
Comments
Final Inspection Approved:.
Date Initial
k
Rejected:
Reason
** PERMIT MUST BE POSTED ON JOB SITE **
Date Initial
0
Date 7nitial
White Copy - File Green Copy -'Inspector Buff Copy - Applicant
Side Sewer Drawing
rTke City of Edmonds EASEMENT NO- ---------------- ---------------------------
NEW CONSTRUCTION REPAIRS ❑ LID NO . ............... ....ASMT. NO.._._.._.__-----.__
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OWNER------------------------------------------------------------------------------------------ CONTRACTOR.----------------------------------------------------------------------------------- PERMIT NO.
JOB ADDRESS l- TO-b-- ?--------- LEGAL DESCRIPTION: LOT NO- -------------------------------------- BLOCK NO.-----------------------------------
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PWW-0001-11/75 (REV.11178)
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NAME OF ADDITION--------------------------------------------------------------------------------------------------------------------
LYNNWOOD LfNE
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Approved: V ail A
DATE —� �— c!------------- By ------- e�Z=
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CONSTRU,PTION PERMIT APPLICATION JOB
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SIGN AREA ENV. RE EW ADB NO.
Legal Description Of Property-linclude all easements I I ALLOWED PROPOSED COMPLETE EXEMPT _
(show below.or ttach two copies)II„ I
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a APT. SLDGII i I' II
ill
I 'III; EXCAVATE I 'I!j I I F NCE I CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHS.
DEMOLISH,') OR FILL III ( X I FTC
i °
II
REMODEL I GARAGE (SWIM j i � CARPORT'' i I I � pOOL � I � � SPECIAL INSPECTOR AREA I OCCUPANCY OCCUPANT
REQUIRED GROUP 7 LOAD
WOOD STOVE) RETAINING WALL/ j'I I j I YES C NO R 3
zINSERT I I ROCKERY III III'' Ii R NEWAC REMARKS
'I PROGRESS OUZ
I l lj i II; PRORESINSPECTIONS PER SC 305 z
,� ! �I I I' � i
'I W NUMBER OF STORIES�
i NUMBER OF �.I I, %/(F I�L�%�l� ��� �6�/ �GD m
o „" II I I j, DWELLING
m _�- UNITS I'I.,I II
O
i NATURE OF WORK ,7 BE DONE (ATTACH PLOT PLAN)
VALUATION FEE
PLAN CHECK FEE
r
I BUILDING
I
I II III PLUMBING
II III I' I I
I MECHANICAL
This Permit coyeirs work to be done on private p'ro erty ONLY. GRADINGIFILL I I
y Any construction:on the public'domain (curbs, sidewalks)
driveways„,marquees, etc.) will,require separate permission. STATE SURCHARGE
Permit Application:j180 Days
'II I ENERGY CODEPermit Limit:61 Year• Provided Work is Started L�t'lliq180 Days
"Applicant; on ,behalf ,of his or, her spouse, heirs, assigns and !
i successors in ,interest, agrees to! Indemnify; defepd and hold
W harmless the I City of ,Edmonds; Washington, Its officials,
`'I ¢ employees, and"agenfs from anyland all claimsilforldamages of I
a whatever na!I arising directly or',indirectly from >he issuance
0 of this, permit. Isof. this (permit shall not bo deemed to PLAN CHECK DEPOSIT I —2.DD
o modify, waive orlreduce any requirement of an'Ici y ordinance
x nor limit in any ,way the City's ability to enforce a y ordmarice
'j provision." 4 ! I' II TOTAL AMOUNT DUE
'I I hereby acknowledge that I have read this appliicat on; that the
information given is correct; and that I am the owlner or the duly ATTENTION APPLICATION APPROVAL
l' authorized agent) of the owner. II agree to comply with city and '
I t, I THIS PERMIT This state laws regulating construction;'and in doing thew rk authoriz- AurrloRlzes application is not a permit until
ed thereby, no person; will be employed in violation �t the Labor ONLY THE signed: by the Building Official or his
I I Code of the State oflWashington relating to Work'men's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
lion suranc I I I I' ; I acknowledged in space provided.
INSPECTION
SIG A LIRE (O NE O / ) DATE 'SIG ED DEPARTMENT
CITY OF OFFICIAL'S SIGNATURE DATE
EDMONDS i
RELEASED BY: DATE
ATTENTION , Ii I! i 77�-3202
!'I IT IS, UNLAWFULITIO IUSE OR OCCUPY A BUILDING OR STRUCTURE
! UNTIL A FINAL 'INSPECTION HAS'' BEEN MA AIN .i DEI D APPROVAL OR ORIGINAL —File YELLOW — Insp
ector
A ;CERTIFICA;E OF OCCUPANCYi-]HAS BEEN); GRANTED) UBC !
' CHAPTER 3. PINK — Owner GOLD — Assessor
i 162•a7
71%, "I'mmm
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' � I� � � ��'7f��;,� ! I',l_I' „I��I1Iil I t I�IC f 'I I v'? �i�i � ,,
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MEMO TO.: Permit,Co'edina Building Division
I
II
'Inspector
''1
FROM:, Dan Smith, Engineering
ADDRESS,-. 746�_ i '/,0
"
OWNER:'I' 00, 4-S
After.revi,e of the:S'U' 6cti uildingi perlmlit application, 06 have the
I I'l I . I I " '�: !, 11; 1 ;1 , I
following �commen
I'llY Constfullftionl uls are: WEEKDAYS. 7:00,am to 110:00pm
lid,, I II r! U
WEEKEND S/HOLIDAYS 10:0 Oam to 6:00pm
uct'io�n' permit is required IA' Right-of-Way'�constr k on
City property tl
y
j
0
It i in" to 'C' tt` water
Conin'6c system required.
4" Connection to City -sanitary sewer system required; obtain separate
permits
Water bindi ver}lines ' to be separated by 10 foot minimum.
d' of 20 feet back froml City
Driveway 'must; 'paved a minimum
I
1 right 16 se r"a t e �,ermit!requi,red..
sep
Driveway s ope; not � to exceed 14%.
Back�wa equir6dlif downstairs plumbing is below
1, 11.1 ; I I I. A ea'Im lianhole.'
elevatiion,ofil ul
'Builder/Owner responsible foricontaining all temporary runoff and
-q-1 � I - - I
erosio''ni�'ont�o'l�ion-site.: Construction may not impact neighboring
5
t P
x
8
s
9
any.
properties in,,way.
19) No burning o f:c6hstruction refuse without approval from Fire Dept.
:11) Street1to bellke t;!cl6an,pf debris, dirt, mud, and construction
I :I 1 1materials. 1 1 P11 � I Il
dht responsible for dust control.
I o ractor
Pil'i
2 'required on crainage i installation,
1 Inspection d system, catch basin
inspection is
Ariv6kys a'hd I s ew 1 k' A final engineeringlinspi,
a
required pribr,,,t,o building division granting occupancy.
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CITY OF EDMONDS
S�c�� ; 9 FILE ASSET INFORMATION SHEET
.NEW
❑ ADDITION
❑ RETIREMENT
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION S e
C I '
DEPT. NO.
* * PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
* PROJECT NUMBER W Q(, l0
PROJECT COMPLETION DATE
COST I
B.A.R.S. ACCOUNT NO. `T 1 t r OOO . (o1 yE qJ , 7 3
ESTIMATED LIFE 2 V s
INITIATED BY
DATE
APPROVED BY
**SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
b P INITIAL
DATE
VERIFIED BY
PROCESSED
BATCH NO.
DEPARTMENT FILE