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The City of Edmonds
Water Service Drawing
EASEMENTNO . .................................... .......
NEW CONSTRUCTION REPAIRS LID NO . .................. . ASmT. NO . ..........
OWNER Jj�nkl'C-A ;0-00A.b ......................... ....................... CONTRACTOR .................................................................................... PERMIT NO. 170?.V7
JOB ADDRESS -/To/ ................................ LEGAL DESCRIPTION: LOT, NO . ...................................... BLOCK NO . ....................................
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NAMEOF ADDITION ........................................................................................................................
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Approved:
PWW.0001.11/75(REV.11/78) DATE A.-7'�ll ........................ By . ............. ;jr .......
STREET ADDRESS FILE
FILE COPY
CITY OF EDMONDS BARBARA FAHEY
MAYOR
7110-210TH ST.S.W. - EDMONDS, WA 98026 - (206) 771-0235 FAX (206) 744-6057
COMMUNITY SERVICES DEPARTMENT.- PUBLIC WORKS DIVISION
March 4, 1996
Tom & Sherri Brothers
17611 Talbot Rd
Edmonds, WA 98026
RE: Leak at 17611 Talbot Rd (#310900)
Dear Mr. & Mrs. Brothers,
I have reviewed your account and will allow a credit from November 1995 through January
1996 in accordance with our City policy. The policy states that the customer will be billed
at the retail rate based upon the average water consumpti ' on for the same period during the
previous year. In addition, the excess water lost from the leak will be billed to customer at
the City's wholesale rate with a 15% surcharge added for administrative cost. Only one
leak credit will be granted in any three year period.
Should you have any additional questions after you receive your new billing, please
contact Ilene Larson, Utility Billing Clerk, at 771-0241.
Sincerely,
Ron Holland
Water/Sewer Supervisor
RH/lk
cc: Ilene Larson
Utility Billing Clerk
wordata\water\credit96\#310900
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890.199-
City of Edmon&
Critical Areas Checklist
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 Edmondsprior
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 am 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).
An applicant, or histher 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 necessaryto complete a
development permit application.
With a signed copy of this form, the
applicant should also 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 information (e.g. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing thew preliminary
assessment of the site.
I have completed the attached Critica ' I Area Checklist and adest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant-. A=resentafive:
Wf - T6M
Name Name
17 6 H
Street Address
City, State, ZIP Phone
Signature
Date
&V
Shed Addrm
W� 57% -122b�
ZIP Phone
r
A, Date
CA FILE NO
Critical Areas Checklist -
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 12(Wi Nat
2. - Property Tax Account Number: 51 .416060
A-
3. Approximate Site Size (acres or square feet): �51(0,3o
4. Is this site currently developed? �(- yes; _ no'.
If yes; how is site developed? go,( W-ga;
5. Describe the general site topography. Check all that apply.
— Flat: less than 5-feet elevation change over entire site.
q q --Zo, I
Rolling: slopes on site generally less than 15% (a verticallise of 10-feet over a
horizontal distance -of §&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: �o Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
.What season(s) of the year?
8. Site is in the floodway floodplam. 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 Qawn,shrubs etc) �,4-
It. Obvious wedand is present on site: Wo
RcV01104(94
CA FILE NO. 'q q -Z0j
Critical Areas Checklist
Site Information (soi.Is/topography/hydrology/vegetation)
1. Site Address/Location:
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? Y— yes; no.
If yes; how is site develoved?
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 tha n 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: 1j o Approx. Depth:
7. Site contains areas of seasonal standing water:' JJQ 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 Qawnshrubs etc)
11. Obvious wetland is present on site-
� MWOM91
Rcv01/0094
8-00 .1,99-
City of Edmon&
Critical Areas Checklist
The Critical Areas Checklist co ntained 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 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. 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).
An applicant, or his/her 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.
With a signed copy of this form, the
applicant should also 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 information (eg. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge'(fill out the appropriate column below).
Owner / Applicant: Ap
CRepresentative.
4wpi
Name Nam
'WbOT 0
'Street Addmw
eDW�03 - WA - `Jca'62-o 07SI
City, State, ZIP Phone
Signature
Date
&61
Street Addrew
b W� 5* -22b�
ZIP Phone
k1i.
Date
1,/`7
�_7
d 9 0 . I o 4 -
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT 01
Permit Number: Z3-t/&/
Issue Date: -2d-93'
A. Address or Vicinity of Construction: - 17611 Talbot Rd. (9318177)
B. Type of Work (be specific): Install New Service
C. Contractor: -Washington Nat'l. Gas Co.
Mailing Address: 815 Mercer St.Seattles Wn.
9811.1
State License #:
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-227�8
Liability Insurance:
Bond: $
Side Sewer Permit # (if applicable):
E. n Commercial El Subdivision 0 City Project )a Utility (PUD, GTE, YVNG,, CABLE, WATER)
n Multi -Family E] Single Family n Other
INSPECTOR: INSPECTOR: W�At-rcv77
F. Pavement or Concrete Cut nkes []No G. Size,of Cut:( 1) 2 x 4 Cut H. Charge$
ie—In
APPLICANT TO READ XND
�,SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees 'he City of Edmond� hannlc&, J h 6e`sja�ges, or
claims of any kind or description whatsoever, foreseen or unforeen that "maybe made Agiiithekily ofEdmonds, or any of its departments or empl y
ees, including or not limited to the defense of any legal proceedings including defense cos&,'�and7&torneyfees by reason of gran'.tihi-Ais perRit.
THE CONM CTOR IS RESPONSIBLE FOR WORWANSHIP A NO kA TERIALS FOR A gRI4?D OF ONE YEAR FOLLOWING THE FINAL INSPEGII 0,
AND ACCEPTANCE OF 7HE WORK ES77MA 7ED RESTORA77ON FEES WILL BE HELDI��LITHE FINAL S77ZEET PATqq IffOAfP17ED BY
C17Y FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BEPROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A* 24 hour notice is required for inspection; Please call the Eng ineering Departme
Work is to be inspected during progress and at completion. 71-0220
Restoration is to be in accordance with City Codes. 7
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior*to the end of the wori�mg day; M
NO EXCEPTIONS.
M
I have read the above statements and understand >the pernnjt requirements and the pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signature: ;�//i�ate: :6/11/93
(Contractor or Agent)
M
CALL DIAL -A -DIG PRIOR TO BEGPQ1flNG WORK
FOR CITY USE ONLY
.......... ......
VTT RIGHT OFWAY DEPOSIT:. ......
..::::APPROVED: BY:::� ... . ...
Av(4 30
...TIME,.AU.THORIZED:.YOID.AF.TER..� �.DAYS. DISRUPTION FEFJFUND..1.1.1.;;
........ ........ .. 11 ........ ...
RECEIPT NO:
DATE:.:�_:::! ISSUED
............... .
LL
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund I I I Route copy to Street Dept.)
Corriments:
Diagram:
0
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. Ju
Addendum to City of Edmonds
iaht of Wav
Permit Application
Submitted by: Guyla Connors
Engineering Aide
Washington Natural Gas
521-5248
17( , i j -Tzs�o-r eo
\,Q&j & 4v-q:!> 1 b 1"1 -7
T7
W44WNG to window
Water main depth
-tlil-A unknown
1 11 gas main
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gas -
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sewer
-e-
water hydrant
0
water valve
815 M=cr St. (P.O. box 1869), Scank, WA 98111 (206) 622-6767
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CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Construction
Owner: �F�,ej
� Name
Mailing Address
City, State, Zip Code
o Contractor:- S eizn L/ 72
Name
Mailing Address
C 1-7 Staie," Zip Code
Permit No.
Issue Date
I-- - I
Permit Issued To: I . el, - (-, . .1, 1.� - � D -,y /
• Type of Work to be Done: El-L li-�, 1-i
'v A:;� /,I�/
• Work in Connection With:
El Sub or Plat JX Single Family
0 Comml. / Ind. 0 Apt. Condo.
Pavement Cut: 0 Yes M No
State License Number
—7
Telepho�e I�ur�ber
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
INDEMITY: 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 it's 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
I
Signature:
available at the Job site for inspection purposes at all times.
- Z27 -
Owner or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Vold after days
Special Conditions:
Ammendments:
Permit Fee:— -.;;
Security Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimensions
X —
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1979
FIELD INSPECTION NOTES (Fund. 111 - Route cony to Street Dent.
Comments:
Diagram:
Contractor called for inspection_ Yes No
T
.&Jork Disapproved By: Date: Bv: Date:
Work Aporoved Bv: Date:
Inspector:-
Enq. Div. December 1978
441' Z. � 'g, :,. t;,� 1. �-f I 'I % ?, - � I
Rn
00,
00 I�t L,TI:LITY DISTRICT No I 'of Shohom SO (:Z12 LJ W 'T"Y' -Area
ll�/7 t0_ County
FT� V 9
-7 F
DATE Z
L OC'4 ION W 0. NO,
PQL��,NO- 'S W '14 5 -7 1 2-2 R REVISION U. G. F I L-E NO.'.
Ri-A��WFO'R WORK" ENGINEER (4 "klr-ll�ir)l 'AS RUILT
DRAFTER S ALE
V 1.n, I 1"t, s, V_vV Hn-n LA rim, APPROVALS
IRED E.WMEN
P4eRMILj.REPU ENVIRONMENAL, ANAILYSIS
0TREE
45 1w UREOVIREP 14NOT REQUIRED,-" TRIMMING, IDWATE R &XjMPT NOT EXEMPT
DIAL bib QSii W'tR
PAR�. c:_
C3PU() LOCATOR -06AS
0. K'U G. COND., Ki/
_DA�E�RELW(D BACK 140t
AdD'_CKT.l P
H
FEtsNE0UIREb YESIS NOO, TS i,
FOREIGN I POLE STENCILING
E M16 t FT PH.
7YM, FROM N
!GTNW;fsIO-1 0 CKT. FT-.
Tfl� A 40: A dU N T 2,
TV N
JA K-E-0 F POLE, G. E. t. E.
LOGS POSTED,
;-5.6 ii O.A"'.T 10 N C I RC U.IJ _NP.. TIlA_N5F CARDS U-MAPS,
0AfEj,�..ORK,cbmPlLETf.'D t POLE DEPT CIRC.
BY FOkEMAN.
DATE, PRINTED
.16
14
A
1-7 ra
'E5S(Z) t4c_m U, rcj:; 'TRI 70 1:1 7=.T;)
DISPATCHER POSTED
G* �ON
C PR
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.iT
P
MAP PAGE'
WO. NO. -77.
PLANNING DATA
SITE ADDRESS:- J'a 4.-PATE:
ZONING:
PROJECT DESCRIPTION:
SETBACKS:
Required Setbacks: S roi�?p LOT— 6') C, --1-t,>
Front: �7-6 Left Side: Right Side: /�D Rear:
Actual Setbacks:
Front: �17,6 Left Side: Right Side: Rear:
FLOOR AREA:
LOT COVERAGE:
v - - 60%
Maximum Allowed: v 4vActual:
-221L
BUILDING HEIGHT:
Maximum Allowed: Actual Height:
SUBDIVISION:
CRITICAL AREAS#: '7'1-1-(-) 1 -
SEPA DETERMINATION:
LOT AR
OTHER: 10 E, 2- n CD - C-) 5:--
APPLICATION
for FILE
The City of Edmonds SIDE SEWER PERMIT EASEMENT No . ............... ..........................
-NEW CONSTRUCTION 0 REPAIRS E]
L19 16.ql-
CONTRACTOR ..... ..... YK ......... .7
OVVNER ........ I ------- iv
... ......................... ................................. PERMIT N�...
.ADDRESS .... ........... ........
-4 ....... ........ LEGAL DESCRIPTION:. LOT No . ......... .............. - BLOCK No . ..... ....................................
.. C.f
. . ........
......
NAME OF ADDITION .......... ..................................
APPROVED
MAY 18 1970
-I-f4 Pp,
Approved:
DATE ... J ...... ... ...... 2 ......... By .....
..... .. ........ .....
'"M Q'I'l V"!iWjU!,A(jri?,.
K T +T, Jj
mop 'aa
X toa (a aAbt
........... . .... ....... .
t
�WCIUA
....... -nollivau-&
.7
7 1
%
q A
F EDMONDS 6-1107 when -Ork
CITY 0 can rRospect
WATER -SEWER DEPARTMENT is ready for InsPectiOn- (NO ULSPer-
civic CENTER Saturday, Sunday or hoUdaYS-) N2 3726
tions
SEWER PERMIT
SIDE
17611 Talbot Road ....................... . ......... --------------------------------------------------------------------
ADDRESS-----------------------------------------------------------------------------------.....
B & M Contractors
CONTRACTOR --------------------------------------------------------------..................
OWNER� -------------- ......................................................
M J 19_70, for ------------------------ days to REPAIR or CONNECT a side sewer
Ay.
.7 d .... -------------------
Perinission is grant ...
Sewers in accordance -ith ap plication on file and governing ordinances.
With City
ATTENTION IS CALLED TO THE FOLLOWING: r Contractor must
construct sewer inside Property line. A licensed Side Sewe
NOTE. NO. 1—The owners of the property may obtain a permit to cover any portion of sewer before it has been inspected.
to construct side sewer in street area. Do not
be employed
OEN —Obtain full information regarding ordinance 11.16.030 and Regulations 90 verning side sewer s when you get permit.
2%.
�,-OTE have at least 30 inches coverage at property line and 12 inches inside property line; minimu m grade of
No. 3—TOP Of Bide sewer must
No bends in grade sharper than 'A will be permitted.
street restored to original condition. Contractors shall be responsible for
NOTE No. 4—Trenches in street must be water settled and surface of
failure' due to improper work which may develop within one year of Completion -
NOTE No. S—It is unl awful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer Or its aPPUr-
tenances except to insert the pipe Into the wye.
7
n -V
CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-0220 FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
C) Public Works e Planning a Parks and Recreation Engineering
November 29,1995
LAURA M. HALL
. MAYOR
Tom and Sherri Brothers
17611 Talbot Road
Edmonds, WA 98020
Re: Permit Application - Plan Check #94-216
According to Building Department records the application noted above
expired on 11/9/95. No more extensions are allowed. If you'intend to
continue with theproject you must subm it new plan's meeting current code
requirements, fill out a new application, and pay a new plan review fee.
If you have any questions you may contact me at 771-0220..
Thankyou.
f.-) 4
Sharon Nolan
Permit Coordinator
cc: Ron Johnson
19601 23rd,NW
Seattle, WA 98177
EXPAPPL.DOC
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
APPROVED BY PLANNING
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APPLICANT COPY
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Memorandum
TO: Jeannie Graf, Building Official
FROM: Kirk Vinish, Planning4.'-'�
DATE: March 8, 1995
SUBJECT: Brothers - Addition[Remodel
Jeannine, one of the applicants declarations states that they need a variance for safety purposes
with respect to entering and leaving the horne. Could you please provide me comments as to
whether or not an at grade access to the horne would be safe per building code.
Encl.
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Details of Project or Proposed Use
The proposed use which necessitates aVariance is the addition- of a covered front deck
which will run along the street side (west side) of the garage and house, from the drive-
way on the north side, to the entry doorway at approximately the front center of the house
proper. The house sits on a lot in the shape of a pie -slice. The house is tight into the
"wedge" of the slice. Since the existing structure is against the setback limits ' on the rear
line of the angle, and is virtually sited along the setback line in the front, any deck will
have to be within the setback area although by only a few feet. In fact an uncovered deck
already exists,on the south half of the front of the house, connecting to a deck across the
south side and extending to the rear of the house. This deck protrudes into the setback. It
will remain in place.
The reason for a second deck is to permit the safe passage of visitors from the driveway
to the entrance. At present, visitors to the house must park in our driveway since street
parking in front of the house on Talbot Road is not practicable (or legal?). The large size
of the driveway can easily accommodate the parking, but the trick is getting to the front
door. Although the driveway is at grade with the entrance door the only way to get from
one to the other is to go down a vertical drop of abo ut six feet on a winding path and then
back up again: the ground slopes quickly away from the house to the street. First-time
visitors often greet us by saying "I hope we've come the right way. We weren't sure how
to get in." They say this at both front and back doors since not everyone does figure out
the path! A level deck walkway starting at the driveway and proceeding directly to the
front door would eliminate both confusion and inconvenience. And it would certainly be
more accommodating to those who are physically challenged.
The need for a cover on the deck arises from consi ' derations of safety, convenience and
aesthetics. Guests have already had accidents going between the driveway and the front
door. Although much of the present risk of falling will be eliminated by a level deck
alone, a cover will enhance safety by keiping the deck drier, and it will lessen the need to
"dash" in the rain from car to door (or vice -versa). The cover for the deck is also impor-
tant to prevent the deck from being an'eyesore. Facing a public street in an attractive
neighborhood, we do not want to detract from the appearance of that neighborhood. A
roof for the deck is not structurally necessary to support the roof of the house itself, but
it will complement the house roof. The roof for the deck as well as its structural supports
is designed to match the house in style and appearance. It turns a ftinctional but ugly ne-
cessity into an attractive and seemingly integral part of the house.
The proposed construction involves a minimal intrusion into setbacks reserved for the
purpose of future street improvements. In the actual circumstances this appears to be a
mostly theoretical purpose. The street the house faces -- Talbot Road -- has a sidewalk
on the opposite side which is more than sufficient to handle any foot traffic. It seems.
highly unlikely that a second sidewalk would ever be put in. Nor does any significant
widening of the road seem likely since it, too, is quite adequate for the traffic level.
USE
ZONE
CITY OF EDMONDS
PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION joa
SUITE/APT #
1,4,e
ADDRESS
OWNER NAME/NAME OF BUSINESS
16m 1_�Meyyi*
LEGAL
DESCRIPTIqN
CHECK[�S;USDIVISION
NO.
LID NO
MAILING ADDRESS
11uh lrol�lpi
PUBLIC RIGHT OF
EXISTING —
WAY PER OFFICIAL STREET MAP.
REOUIRED DEDICATION .3-1
TESCP Approved
RW Permit Required
Street Use Permit Req*d
0,
r)
0
0
CITY tip
W_M()V105WC1 Q007-bi
TELEPHONE NUMBER
149
PROPOSED
—
Inspection Required
Sidewalk Required
0
w
NAMV,noo
METER SIZE
LINE SIZE
I NO. OF FIXTURES
7-1
PRV RkOUIRED
YE�� NO 0
j
CITY ZIP ITELEPHONE NUMBE-8. ,
SUa !N 0 7
NAME t
ADDRESS-
ZIP I TELEPHONE NUMBER
PTATE LICENSE NUMBER
on of Property -
Property
Tax Account
P8141 No. t
1:1 NEW
1171
14!�LkDDITION
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EXPIRATION DATE
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all easements - ALLOWE
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REVIEWED BY
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LOAD
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FINAL INSPECTION REOUIRED
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BUILDING
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PLUMBING
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Plan Check No. 0,L1,
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MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curL,.o, sidewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I 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
successors in Interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
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employees, 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 this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
677
0
modify, waive or reduce any requirement of any city ordinance
50
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nor limit in any -way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
I
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 thje duly
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
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
ion Insurance and RCW 18.27.
INSPECTION
acknowledged in space provided.
IGUWNEFRI, N
DEPARTMENT
O,F.FJCIAL*S SIGNATURE DATE
4ORAGENT) JDATE
CITY OF
llale)s
EDMONDS
CALL FOR
'�AELEASED ffY: DATE
ATTENTION
INSPECTION
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. USC
CHAPTER 3.
PINK — Owner GOLD — Assessor
CITY OF EDMONDS
USE PERMIT
ZONE c
NUMBER 970093
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT
ADDRESS Taj,66 f 96�
#
Ow NER NI iE NAME BUSINESS
C MIC R/,A r
LEGAL DESCRIPTION CHECK
[SION NO.
LID NO.
Z
3
0
I.SUBDIV
MAILING ADDRESS
17L I I TQ kd
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION ---- 7—
PROPOSED
TESCP Approved 0
RW Permit Required 13
Street Use Permit Req`d 13
Inspection Required 0
Sidewalk Required .0
CITY ZIP
nds XC) -Z 6,
TELEPHONENUMBER
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 No 0
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ADDRESS
REMARKS
CITY ZIP
TELEPHONE NUMBER
0
NAME
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ADDRESS/
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ENGINEERING MEMO DATED REVIEWED BY
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MEMO,'DATED'�.. REVIEWED BY
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SIGN AREN:
SERA REVIEW
AD8 NO
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LLOWED. PROPOSED
COMPLETE' EXEMPT
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Property
Tax Accounl1%
0 00.
REPAIRk3
Parcel No.
EINEW Fit . SIDENTIAL PLUMBING/MECW
tOMPLIANCE,.0W.
D ADDITION. El COMMERCIAL E1,40HANGE-OFUSE,
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CHECKED BY
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WOODSTOVE SWIM POOL
DEMOLISH INSERT -HO U I PA'.
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GARAGE F_-j RET�INING WALL/
CARPORT ROCKERY RENEWAL
(TYPE OF USE. BUSINESS -OR ACTIVITYY EXPLAIN.
e- ty rA
Z
SPECIAL INSPECTOR'�,- JAREA
:REQUIRED
I . _. 13
'REMAR'l-K.S..
UPANT
LOAD
PROORES&INSPECTIONS-PER. UBC 108
t,,? 2-
-
NUMBER
OF
STORIES
NUMBER OF
DWELLiNG
CRITICAL' *
AREAS
NUMBER' 7
-, vky
7- AIV
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
"FINAL. INSPE&ION
-!.',�'�VALUATION
FEE
CK,FEE
HEAT SOURCE
GLAZING
0/�
PLUMB IN 0
Plan Check No.
MECHANICAL
GRADINGIFILL
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.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
STORM DRAINAGE FEE
ENG. INSPECTION FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
'Wn
2
cc
0
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
nor limit in any way the City's ability to enforce any ordinance
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
mou
provision."-
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 th.e duly
authorized agent of the owner. I agree to comply with city and THIS PERM IT This application is hot 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 !glned by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED _ Uty; and fees are paid, and receipt is
tion Insurance and RCW 18.27. INSPECTION /a�owledg in space rovided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED DEPARTMENT
CITY OF 0 FI L'S SIGN URE DATE
EDMONDS
M_ CALL FOR FRE64SED BY:
ATTENTION INSPECTION
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 L
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
SECTION 109 PINK — Owner GOLD.— ASSOSSor