17210 68TH AVE W.PDFIIIIIIIIIIII
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C* of Edmoiicb*
-ity
Critical Areas Che: c*klist.,
The Critical Areas ChecMist containedon
this form is to be filledout by my person
prcpanng a Development Permit
Application for the City of Edmonds prior
to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable
City staff to determine whether any
potential Critical Areas are or may be
present on the subject property. 7he
information needed to complete the
Checklist should be easily available from
observations of the site or data available at
City HA (Critical Areas inventories, maps
or soil surveys).
An applicant, or histher epresentative,
must fill out the checklist, sign and date it,
and submit ifto the City. - Ile 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. -
W`ith a signed copy of this form, the
applicant should a1w submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall Include
other pertinent infonnation (eg. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing their prelinfluary
assessment of thisifte.
I have completed the attadied Critical Area Checklist and aftst that the answers provided are
factual' to the best of my knowledge (fill out the appropriate column below)
Owner / Applicant -
Deborah McAdams
Nam
Applicant Representative:
Tim McAdams
N=w
17210 68t
Street Add—
Edmonds,�-WA-98020
City, State, ZIP Phone
6/28/94
S4natwe Date
814EEffILE. CA ME NO.
Critical. Areas Checklist
Site Information (soils/to raphy/hydrplogy/vegetation)
P09
1. Site AddressALocationw. 17210 68th Ave. W, Edmonds, WA -98020 ..
2. property Tax Account Number: 75150000020001
one half.acre.
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? __x_ye�; _ no.
If yes; how is site developed? House, driveway,�-deck.
5. Describe the general site topography. Check all that apply.
Flat- less than 5-fed elevation change over entire stM
Rolling: slopes on site generally less than 15% (a vertical rise of 10fi�et over a
horizontal distance of 66-feet).
X
Hil1r. slopes pre.sm 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 descriU):
6. Site contains a of year-round standing water. No. Approx.,Depth:
7. Site contains areas of seasonal standing water: No. Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course. No -
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- No.
round? Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped Qawn,shrubs etc) - x
11. Obvious wedand is present on site: No.
ReVOI/04(94
CITY OF EDMONDS
KENT FiLtSET INFORMATION SHEET
'NEW
ADDITION
El RETIREMENT
ASSET NO.
ADDITION TO ASSET NO. -
6:5-?f
DESCRIPTION
SERIAL NO.
LOCATION
4�/ IV u A;_
D E&. N _O
4/
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
PROJECT NUMBER 4C1Z,:;7- .5b7
oe
PROJECT COMPLETION DATE
COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
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 DATE
thnp INITIAL
DEPARTMENT FILE
VERIFIED BY
PROCESSED
BATCH NO.
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CITY OF EDMONDS a
Permit No.
COMMUNITY SERVICES DEPARTMENT
T E E T FILE
Is sue Date
RIGHT-OF-WAY CONSTRUCTION PERMITS N"
A� 0 Owner: Washington Natural Gas Co B. 9 Contractor:
same
Na
Ige 156 AV NE
Name
Mailin Address
1
Mailing Address
1
Bel evue, WA 98007-
City State Zip
City State Zip
447-0700
/I A--)& L 3- .9 State License Number Telephone Number
o Address or Vicinity of Constr tion 10 6 8 AV W
Type of Work to be Done: New gas service installation /1g
Work in Connection With: 0 Sub or Plat El Single Family
El City Projects
0 Commercial 0 Multifamily.
R Utility
Pavement Cut: 0 Y 0 N
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, forseen or unforseen, 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.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAk17OLL:_OWING-THE"FINAL INSPECTION. AN.D,ACCEPTANCE, OF, THE WORK.
Funds held from the Security (estimatedrestoration fee) will be held until the final street patch is completed
I I
by City forces, at which time =ito/r credit will b
_9 processed for issuance to the applicant.
• A 2.4. hour, notice is required for inspection; Please call Public Works: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffi� Control to be in accordance with City regulations.
All street -cut ditches must be patched with asphalt or. City approved material prior to end of working day;
no exceptions.
I understand the ar this perm nust be available at the job site for inspection purposes at all times.
Signature: Date: 8/1/88
Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
ISSUED BY: Qnvk PERMIT FEE:
9 V
Time Authorized: Void after days. Security Deposit:
Special Conditions: Receipt
Fund I I I Fee:
Amendments: Street Cut Dimensions:
X
NO WORK TOPEGIN PRIOR TO PERMIT ISSUANCE
Eng. mv. July IV8--i
FIELD INSPECTION. NOTES (Fund I I I - Route copy to Street Dept.)
Comments:
Di agram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
ROPES
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CITY of 'EDMON-D-S R EC E IVIED
SIDE SEWER PERMI
For Inspection Call 771-3202* JUN 27-198 ERMI I T No. 07864
0",Hf,�TAEET. FIL5.
Address of Construction: Auc
Property Legal Description (Include,all easements).:' /6 T
Owner and/or Builder:
Contractor & License.No: PrR e
Si nal:e Family Residence
Multi -Family
Commercial
(No. of Units
(No. of fikture* 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,.easeme'nt'requ*ired,,
attach legal description and county easement number.).�
PLEASE READ THE ITEMS—L�I-S-T- D ON THE BACK
I —certify that6l h��e read _sh�-�omply
with the items listed on.t6e back-.
Permit -Fee: �0-00
Trunk, Charge: c)
Assessment Fee:
�,Issued By:
fDate Issued:
Receift-.P. 7.e!2
Partial Inspection:
Comments
Final Inspection Approved:
Initial
Rejected:
son 7
** PERMIT MUST'BE POSTED ON JOB SITE **
-7-
Date
5a —te Initial -
_T_
Date .. nitial
White Copy - File
Green,Copy -'Inspector
Buff Copy - Applic
ine City of Edmonds Side Sewer Drawing EASEMENT NO. - ------------------------------ ..........
NEW CONSTRUCTION Eg--" REPAIRS F-1 LID NO . .................. . ASMT. NO - ----------
OWNER------------------------------------------------------------------------------------------------ CONTRACTOR - ---------- 0 --- PERMIT NO.
JOB ADDRESS ------ (--V ------ --------- \At - BLOCK NO - ------------------------------------
------------------- LEGAL DESCRIPTION: LOT NO - ------- ----------------------
----------------- SN- .......... - ---------------------------------------------------------------------------
... ... ....... .... ...
NAMEOF ADDITION -----------------------------------------------------------------------------------------------------------------------
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Approved:
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DATE.r- C 6,
.............. ................. By
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MEMO TO: 3uildinq Division
FROM: Engineering Division
SUBJECT:, ZZM lw �o
After review of the subject building permit ,.ppl ication, vie have the
following comments :
I ) Connection to City water system required.
2) Connection to City sanitary sewer system required.
3) Right-of-way permit required for any work on City property.
4) Driveway slope not to exceed 14'..
5) Back water valve required if downstairs plumbing is below
elevation of upstream manhole.
6) Water and sewer lines to be separated by,10 foot minimum.
7) Builder/owner responsible for containing all temporary runoff And
erosion on site and may not impact neighboring properties in any
way.
8)
9F
Construction hours from 7:00 a.m. to 10:00 p.m. on we�ekdays and
10:00 a.i.m. to 6:00 p.m. on weekends and holidays.
No burning of construction refuse withaut -a�)prnuai by Fire Dept.
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Projoct RMEW affm.IST
ri,&.uu:r NAME: ao�r PROJECT ADDR'ESS 2.V., 1'6- 1,
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APPiJCATION j;tF=. In mm
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—Reviewed -by: Uni ial date)
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Cu*1ENTS Pl * ' iN
zN= FAMILY/MULTIPLE/CalIlL - (Circle one)
SETBACKS CHECKED - Planning
V�IRIANCE/SFTRACK Abi.
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COMITIONAL USE PtRMIT
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ADB REQUIRUENTS CHECKED I
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAMI (01i NAML 01: IIUSINLSS�
Q
MAILING ADDRESS
0
CITY TELEPHONE NUMBER
'TNAIVIE 1079 �C-
ADDRESS
CITY I TELEPHONE NUMBER
NAME
-7
a: ADDRESS
0
cr CITY TELEPHONE NUMBER
STATE LICENSE NUMBER
Legal Description of Property - include all easements
(show below or attach four copies)
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cr VARIANCE OR CU
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NEW
RESIDENTIAL
PLUMBING
FADDIALTER
COMMERCIAL
MECHANICAL
FTREPAIR
RETAINING WALL
SIGN
DEMOLISH
EXCAVATE
OR FILL
FENCE
E] REMODEL
PRE -MOVE INSPJ
(_ x _FT)
swim
COMPLIANCE INSP.
POOL
WOOD STOVE I
INSERT
APT.BLDG
RENEWAL
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0
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V) NUMBER OF STORIES
NUMBEWOF
00
DWELLING
UNITS
0
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
YARDS
FRONT SIDE
REMARKS
USE PERMIT
ZONE NUMBER
J013
ADDRESS
EGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO.
40,
TESCP ,
PUBLIC RIGHT 0 A P:P R OV E �DB
.F,WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED.
STREET USE PERMIT REQUIRED"
SEE ENGINEERING MEMO DATED REVIEW BY N
REMARKS
METER SIZE IBUILDING SUPPLY SIZE IFIXTURE UNITS
REMARKS
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED I PROPOSED I COMPLETE I EXEMPT I
SHORE
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IPLANNING R . EVIEW BY DAT7
EIGHT LOT COVERAGE
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REAR Z
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CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
r.)YES
REMARKS
PROGRESS INSPECTIONS PER UBC 305
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY. GRADING/FILL
A n
Any construction on the public domain (cu'rbs, sidewpiks,
d r IV y co
eway'
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
e r m
Permit Application: 180 Days
t A p p I
Permit Limit: 1 Year - Provided WorR is Started Within 180 Days ENERGY CODE
e r m I t L ' m I
A 0 p I I c a
"Applicant, on behalf of his or her spouse, heirs, assigns and
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successors in interest, agrees to indemnify, defend and hold
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harmless the City of Edmonds, Washington, its officials,
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e m I y
mployees, and agents from any and all claims for damages of
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whatever nature, arising directly or indirectly from the issuance
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of thi s permit. Issuance of this permit shall PLAN CHECK DEPOSIT
not be deemed to
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mod f
ify, waive or reduce any requirement of any city ordinance
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nor limit in any way the City's ability to enforce any ordinance
p ro v I s io TOTAL AMOUNT DUE
provision."
I acknowledge that I have read this application; that the
'her:by
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info tion given is correct; and that I am the owner, or the duly ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and in doing the work authoriz- AUTHORIZES
ed thereby, no p�rson will be employed in violation of the Labor ONLY THE
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED
lion Insurance.
INSPECTION
SIGrTURE WNER OR AGENT) OATE SIGNED DEPARTMENT
CITY OF
tj
VALUATION
-IcotD P.3,arlj
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APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
i
OFFICIAL'S SIGNATURE DATE
0
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RELEASED BY:
DATE
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK Owner GOLD — Assessor
102-87