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18111 76TH AVE W.PDF111111111111 6233 18111 76TH AVE W E%U %TRE.ETFILE HONG WEST &ASSOCIATES Geotechnical Engineering * Hydrogeology - Materials Testing * Construction Inspection December 3, 1990 Mrs. Doris Belt 917 9th Avenue South Edmonds, Washington 98020 Subject: Foundation Soils Investigation 18 111 76th Avenue West Edmonds, Washington Our Project Number 90130 Dear Mrs. Belt: h-- 14 iEE D DEC 6 - 1990 PERMIT COUNTER Per your request, personnel from Hong West & Associates (HWA) visited the above referenced site on November 30, 1990. Location of the project site is marked on Figure 1, the Project Location Map. Four test pits were conducted at the corners of the proposed residence at the time of our visit, the ap- proximate test pit locations are shown in Figure 2. The detailed test pit logs are included in Appendix I . This letter report summarizes the subsurface conditions encountered in the test pits, and expresses con- clusions regarding our evaluation of the footing design. Subsurface Conditions The project site is underlain with approximately 3 feet of fill material. The fill consists of loose, silty sand with gravel and beds of dark brown organic soil. Wood, asphalt concrete, and a rusty fork were also encountered in the fill material. Below the the fill material is a unit of medium dense, brown and gray sand with variable amount of silt.. Small pockets of brown silt and clean coarse sand were found within the unit. This is the lower- most soil unit encountered in the test pits; its base was not observed. Ground water seepage was encountered in all test pits except TP-4. The ground water table (in test pits TP-I through TP-3) was measured at approximately 7 feet below the existing ground surface during the test pit excavation. Footing Foundations Based on the design drawing provided by Mrs. Doris Belt, HWA understands that an allowable bear- ing pressure of 2000 pounds per square foot (psf) was assumed in the footing design. HWA agrees with the assumption, provided that the following criteria are met: P.O. Box 596, Lynnwood, Washington 98046 * (206) 774-0106 I I I I I I I I I I I I j I a) All footings should be founded on the native, medium dense sand. No footing should be founded on the existing fill material. b) All footings should have a minimum footing embeddment of 18 inches. c) A minimum footing width of 18 inches and 24 inches for strip and square footings, respectively. The allowable bearing'pressure of 2000 psf may be increased by one-third- (1/3) when designing for transient loads such as earthquakes and winds. All footings trenches should be finished in a neat condition. Disturbed or loosened material should be removed from the trenches prior to placing rebar. It is recommended that all footing bearing surfaces be inspected by a geotechnical engineer of HWA to ensure that the soil conditions within the footprint of the building are consistent with those encountered in the test pits. Ground Water As designed, we believe that the spread footings will be founded above the water table. In this case, we do not expect the ground water to interfere with the construction of the footing foundation, al- though ground water may be higher later in the rainy season. We believe that this letter should serve your immediate needs. Should any questions arise, please con- tact this office at your convenience. Sincerely, HONG WEST & ASSOCIATES 6?a H��ng, P.E. 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I '�T' PL Sw cr IT7TH IT 176tH PL SW x 3. > (A 3: N < 0 17a rH I I ST SW_ 4;> 179TH ST 177TH sw T i: — - ': - - - > 4- - - t 179TH 1 4 p7LSW S r-01 ZT w ;T Sw ;w, 0 Z� 3: �LWTH PL S w 181ST PL Sw w 32ND L,- 3: SIV > LYNWOOD� 82NO ST w Islay, PL Sw b N PL JW < HSj 82ND ;w -la-1183f p � 56TH .182ND T SW PL S.Via.33: Z3: n > IMRD -19-Ro _P'L_ —Sw 184TH ST I 1� > 184TH-ST ISAMTE IT IW; Sw W% H c 1, > I95TH_ ST tW 186TH ST I m A! iiih WOOD MAL 115TH� IL W z �Z S. RD ig C14 S, !P�w X W c') _4 it > FS lb INTH PL < PROJECT it PENNY eN 1821H PL SW 3: S > 188TH ST SW _�T I T ,I PS S, I r P_ WL Sw ALDI -I,--PL Sw 09TH - PL Sw V_ IT jjTH > T w A MA Off > P4 Sw S 191ST ST sw IS DIS T'S SW z 192ND �TUWL *F SW IMS sw 192NO T SW 9iNDI" CH lW.D ST I I P _Sw 92NO ST PL X 4D IT 92 P Z" 1, t40 L 5W PARK 'RISER 92ND PL I _Sw Sv 793RD PL F 93RD K I a N2 PL SW '18 S rV H PL 1. 'P9L3?IV- 194T > < STt' L x 154T f S H :r SW .T4 T 3: SW IT Sv, g > (FILBERY PROJECT SITE LOCATION .181.11 76TH AVE. WEST EDMONDS, WASHINGTON Figure I HONG WEST & ASSOCIATES 190130 SITE PLAN & EXPLORATION PLAN Lines 18111 76TH AVE. W. EDMONDS, WA. T)oeo Slope T P '-2 TP-1 v — �ti FProposed R�esidence A-- Af TP-3 TP-4 HONd WEST & ASSOCIA*TES Scale: 1 30' Legend: ib-Test Pit Location-& TP-2'r Designation . �:__ - ... Figure 2 LEGEND OF TERMS USED ON EXPLORATION SOIL LOGS The classification of soils in these logs is based on visual field and laboratory observations, based on ASTM D 2488. Soil descriptions con- sist of the following: Density/consistency, color, modifier, MAJOR CONSTITUENT, minor constituents, wetness, soil structures, additional remarks. Density/Consistency Soil density/consistency in test borings is usually based on the SPT, the standard penetration test or resistance, ASTM D1586. Ile test result is the sum of the of the blow counts for the last 12, inches of sampler drive. Non -Cohesive Soil Standard Cohesive Soil Standard Approximate Shear Density Penetration Consistancy Penetration Strength in TSF Resistance Resistance (Blows/foot) (Blows/foot) Very Loose 0-4 Very Soft 0-2 < 0. 125 Loose 4-10 Soft 2-4 0.125-0.25 Medium Dense 10-30 Medium Stiff 4-8 0.25-0.5 Dense 30-50 Stiff 8-15 0.5-1.0 Very Dense >50 Very Stiff 15-30 1.0-2.0 Hard >30 >2.0 Wetness Dry Little perceptible moisture Damp Some perceptible moisture probably below optimum Moist probably near optimum moisture content Wet Much perceptible moisture probably above optimum Minor Constituents Estimated Percentage Trace 0-5 Some 5-12 Modifier (sandy, silty, etc.) 12-30 very plus modifier (sandy, etc.) 30-50 Terms Describing Soil Structures laminated composed of thin (less than 1 cm.) layers of varying color and texture. bedded composed of laminations greater than I cm in thickness of varying color and texture. interbedde d composed of alternating beds of different soil types. well graded having a wide range of grain sizes, with substantial amounts of all intermediate particle sizes. poorly graded predominantly one grain size, or having a range of sizes with some intermediate sizes missing. fissured containing shrinkage cracks, frequently filled with fine sand or silt, usually more or less vertical. slickensided having inclined planes of weakness that are slick and glossy in appearance. calcareous containing appreciable quantities of calcium carbonate. HONG WEST & ASSOCIATES LEGEND OF SYMBOLS APPEARING ON THE SOIL LOGS GRAPHICAL SYMBOLS FOR SOIL TYPES NON -COHESIVE SOILS (<50% passing the 200 sieve) GW well graded gravel and gravel/sand mix GP poorly graded gravel, gravel/sand mix GM silty gravels, gravel/sand/silt mix GC clayey gravels, gravel/sand/clay mix SW well graded sands, gravelly sands SP poorly graded sands. few fines SM silty sands, sand/silt mix SC clayey sands, sand/clay mix COHESIVE SOILS (>50% passing 200 sieve) ML inorganic silts and very fine sands CL inorganic, low plastic clay mixes OL organic, low plastic clays, silt/clay mix tM H inorganic, micaceous silts. silt/sand mix 0 CH inorganic, high plastic clays OH organic, medium to high plastic clays Pt peat and other highly organic sail Note: The graphical symbols used for the vz based on the symbols recommendated ir Classification system. Graphical logE jective field indentification of soil data where available. Letter designat the basis of laboratory data and calc GROUNDWATER INSTALLATIONS AND OBSERVAI 1T_k7q_____Bentonite Seal out Backfill ."Iuttings Backfill or Caved Hole iezometer Casing SAMPLE TYPE SYMBOLS BOREHOLE SAMPLES 2.0* 00 Split Spoon (SPT) Shelby Tube 3.0" 00 Split Spoon with Brass Rings Grab Samples (cuttings) Core Run TEST PIT SAMPLES Bag (bulk sample) 0 Grab (small volumn) Shelby Tube HANO BORING SAMPLES Non-standard penetration (40 lb. hammer with 12 inch drop) Grab Sample (post hole) Shelby Tube ROTARY B OREHOLE SAMPLES Continuous Core Samples rious soil types are the Unified Soil are based on sub- s, and laboratory ions are assigned on u 1 a t i ons . JONS ATTERBERG LIMITS Groundwater Level (noted during drilling) Groundwater Level (measured in piezometer after water level stabilized) lotted Piezometer Tip nd Backfill PL ILL HONG WEST 9 ASSOCIATES 0 Natural Moisture PL Plastic Limit LL Liquid Limit LLJ Uj I I z n LLI 0 =I HONG WEST & ASSOCIATES TEST PIT LOG NATURAL MOISTURE % o MOISTURE % Cn U-j __j 0- M: 10 20 30 40 50 60 70 80 c%SYMBOLS IM D L'I", Uj -i co --X cc LU DESCRIPTION Loose, bro wn and grey SAND. Some silt to silty. Beds of dark brown, organic topsoil. Trace gravel and roots. A piece of rusted fork. (FILL) Medium dense, some silt to silty, grey brown, fine to medium SAND. Trace rounded, fine to medium gravel. Trace tiny pockets of brown silt. Trace pockets of clean, coarse sand. Moist to wet. A lens of very dense, grey till, probably less 12", at a depth of 4 feet. (OUTWASH) End of hole PROJECT NAME: Single Family Residential LOCATION: 18111 76th Ave. W., EdMDnds PROJECT NUMBER: 90130 TEST PIT TP-1 DATE EXCAVATED: 11/30/90 SURFACE ELEVATION: ft. TOTAL DEPTH: 8 ft. T I Uj Uj U- z n- Uj 0 n U HONG WEST 9 ASSOCIATES TEST PIT LOG NATURAL MOISTURE % Cn o MOISTURE % LU —i 0- X: 0 10 20 30 40 50 60 70 BO C`n�c SYMBOLS DESCRIPTION Loose, brown and grey SAND. Some silt to silty. Trace asphalt concrete, trace roots, and gravel� A couple pieces of woods. (FILL) Medium dense, some silt to silty, grey brown, fine to medium SAND. Trace rounded, fine to medium gravel. (OUTWASH) End of hole PROJECT NAME: Single Family Residential LOCATION: 18111 76th Ave. W., Edmonds PROJECT NUMBER: 90130 a TEST PIT TP-2 DATE EXCAVATED: 11/30/90 SURFACE ELEVATION: ft. TOTAL DEPTH: 7.5 ft. W -j M Uj Uj n LLJ 0 ri HONG WEST & ASSOCIATES TEST PIT LOG NATURAL MOISTURE % U') o MOISTURE % LU -i 0- ME 10 20 30 40 50 60 70 80 ZnSYMBOLS 2— ......... ......... ........ 4— ........ ........ 11 P'. DESCRIPTION Loose, brown and grey SAND. Some silt to silty. Trace gravel. Some organic matter and roots. A few pieces of woods. (FILL) Medium dense, some silt to silty, grey brown, fine to medium SAND. Trace rounded, fine to medium gravel. Trace tiny pocket of brown silt. Test pit wall sloughed. (OUTWASH) End of hole PROJECT NAME: Single Family Residential LOCATION: 18111 76th Ave. W., Edmonds PROJECT NUMBER: 90130 TEST PIT TP-3 DATE EXCAVATED: 11/30/90 SURFACE ELEVATION: ft. TOTAL DEPTH: 7.5 ft. LU -i M T I HONG WEST 9 ASSOCIATES TEST PIT LOG NATURAL MOISTURE % o MOISTURE % LU 0 10 20 30 40 50 60 70 80 SYMBOLS 2 . ........ ........ 4— ........ LU LU z Uj 6— B— ........ ......... DESCRIPTION Loose, brown and grey SAND. Some silt to silty. Beds of dark brown, organic topsail. Trace gravel and roots. (FILL) Medium dense, some silt to silty, grey brown, fine to medium SAND. Trace rounded, fine to medium gravel. Trace tiny pockets of brown silt. Moist to wet. Test pit wall sloughed. (OUTWASH) End of hole PROJECT NAME: Single Family Residential LOCATION: 2111 76th Ave. W., Edmonds PROJECT NUMBER: 90130 TEST PIT TP-4 DATE EXCAVATED: 11/30/90 SURFACE ELEVATION: ft. TOTAL DEPTH: 7.5 ft. Uj -i co cc 0 ASSET CITY OF EDMONDS INFORMATION FINANCE DEPARTMENT * EDMONDS, WASHINGTON -2525 ItO o (206) 775 SHEET 890 ig) ASSET NO. BATCH DATE f "I ACTION: L /_6NEW -J ADD TRANSFER RETIRE CATEGORY CODE: SERIAL NO. A S DESCRIPTION: S E- --- ---- ... ... T I LOCATION: r IN F "L" LOCATION CODE: 0 R ACCOUNT aQ. �k.'a CJ N LIFE OF ASSET: YEARS A DEPRECIATION CODE: L /y T I 0 WAR RANT(!:�PR OJ E �CT: NO. G DATE: COST INITIATED BY_q__,_,� APPROVED BY----,--. I TRANSFER DATE I TRANSFER'FROW,' I" TRANSFER TO 1*"L" CODEJ T R A IN S F 3 E R R ACCOUNTING USE ONLY E T RETIREMENT DATE I R RETIREMENT METHOD E M RECEIPT NO. TOTAL DEPRECIATION E N GAIN (LOSS) T DEPARTMENT FILE Z 0 W Cn U C4 0 4. CITY (9V EDMONDS COMMUNITY SERVICES40L MAR-21 RIGHT-OF'WAY CONST' IT A. Owner: Washington Natural Gas Company B. e Contractor: Name 815 Mercer Street �aiiin No C() ea t1A11,e,, WA 9811, e City State Zip Permit, No'. c?/-o ?3 issue Date Name Mailing Address City State Zip State License Number Telephone Number C. 0 Address or Vicinity of Construction: 18111 76 Avenue West Type of Work to be Done: Install New Service D. 0 Work in Connection With: El Sub or Plat Single Family 0 City Projects 0 Commercial 0 Multifamily, 0 Utility E. 0 Pavement Cut: &I Y El N F. 0 Size of cut: 2 X 4 (1) @ R 2 0 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 deparfiiients or employees, including or not limited to the defense* of any legal proceedings including defense* costs, court cd�is, and attor-ney,-fees by reason of granting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPECTION AND -ACCEPTANCE, OF THE WORK. Estimated restoration fees will be held until the final street patch is completed byCity 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. • Restoration to. be in accordance with City Code. e Street to be kept clean at all times. - , * Traffic Control to be in accordance with City regulations. .9 All street -cut ditches must 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. Signature: MCMA"c� �- Date: Mardh 11, 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: :B\A/ Time Authorized: Void after MAY 7-7 days. Special Conditions: 2-)A e--u T -= /1,0, 0 0 X RAP /—Q 8 x _Z RELEASED BY: PERMIT FEE: 10'36- A-1-a-, ZL&o& D1159U?n0N FCE r Restoration Fee: ;� / e�7 00 Receipt No.: — Fund 1,11 Fee: — Street Cut Dimensions: Date9 —d / —?./. INSPECTED BY NO WORK TO BEGIN . PRIOR TO PERMIT ISSUANCE X-=$ Date tng. uiv. marcn no?5y FIELD INSPECTION NOTES Route copy to StreerDept.'> (Fund I I I Comments: Diagram: CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO Partial Work Inspection by P. W.: Work Disapproved By: Date: FINAL APPROVALPY: Date: Eng. Div. July 1985 IV . I's wwa -rc) - \N IWCOA/ Addendum to: City of Edmonds Permit Application Engineering Aide Kerry Walsh Washington Natural Gas 622-6767,x 2588 00 \/-Awes. I Lkl'-P�L PA Uj V,JAI-I:-:P- MAIN tx=-Pr4 UNA willow NJ �e,� I srr I t-4c=t A I/ C--j AS AAAIKI PFbPC6E0 KEY: :s sanitary sewer storms -w- water 0 water valve CITY OF 8 9 0 1 4 C' W1 a SIDE SEWER PERMIT PERMIT N2,.. 8297 Address of Construction:I&V - '74 7h Property Legal Description (Include all easeme'nts): 40 7- -5X" 7- Alo r A-',51/ - 0- Owner and/or Co ntractor: State License N o. Building Permit No. Single Family Multi -Family (No. of Units-) Commercial El Public Invasion into City Right -of -Way: 1� No Yes RW Construction Permit No. Cross other Private, Property: $ No Yes Attach legal description and copy of recorded easement RE 7-1- � .1l If f - r1181 1(; wa I certify that I have read and shall comply with all city requirements Date as indicated on the back of the Permit Card.... * CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION * OFFICE USE ONLY FOR INSPECTION CALL 771-3202, PUBLICWORKS DEPT. Permit Fee: Issued By Trunk Charge: 60 Date Issued: Assessment Fee: AY 2 ' ez Receipt No.: Lid No.: Partial Inspection: Date -Initial - Comments Reason Rejected: Final Inspection Approved DateS�I_q ( lnitiaI2�9 Date -Initial ** PERMIT MUST BE POSTED ON JOB SITE ** White Copy. File Green Copy. Inspector Buff Copy. Applicant Revised 3/90 The City of Edmonds Side Sewer Drawing EASEMENT NO - -------------------------------------------- NEW CONSTRUCTION 2" REPAIRS F-1 LID NO - ------------------ IASMT. NO. -------------- OWNER--------------------------------------------- - ------------------------------------------------- CONTRACTOR ------------------------------------------------------------------------------------ PERMIT NO. JOB ADDRESS --- ( 1� i t ------ Iku --- -\j\t. .. ......... -------- ------------ LEGAL DESCRIPTION: LOT NO - ------------------------------- ...... BLOCK NO - ------------------------------------ cz L4 ---------------------------- ----------------------------------------------------------------------------------------------- JOOD Lf NAME OF ADDITIO ------------ LEYN:N �V 0 D L INE _ =0 V. e- e-16 Dz eq, Approved: PWW-0001-11/75(REV.11/78) DATE.................. B, ------- ---------------- 9V 776-2829 BUILT ujw 13ELT 917 - 9th Ave. So. Edmonds, WA 98020 .11 A, R, <--,s Z"O rl wff i � *PROVED BY PLAN 1`�'I'Nl u I lq"00 "cxoop- 6Ae, / *� . 01101 po / er ' 778-0247 ST REET RLE MITIGATED FILE# N/A DETERMINATION OF NONSIGNIFICANCE SlPscript7ion of proposal Single Family Dwelling Proponent -Thomas Belt- 917 9th Ave. S., Edmonds, WA 98020 Location of proposal, including street address, if any 18111 76th Ave. W. Edmonds, WA 98026 Lead Agency Edmonds Planning Divisi.on The lead agency for this proposal -has determined that it does not have a probable significant adverse impact on the environment. An environmental impact statement (EIS) is not required under RCW 43.21C.030(2)(c). This decision was made after review of a completed environmental checklist an&other information on file with the lead agency. This information is available to the public on request. There is no comment period for this DNS. x This DNS is issued under 197-11-340(2); the lead agency will not act on this proposal for 15 days f * rom the date below. Comments —must be submitted by December 29, 1990 Responsible Official John Bissell Position/Title Code.Enforcement Tech. Phone 771-3202 Address 250 5th Ave. N., Edmonds WA 98020 Date December 19, 1990 S i g n a t u r e X_ You may appeal this determination of nonsignificance to Hearing Examiner at 250 5th Ave. North, Edmonds, WA 98020 no later than 5:00 p.m., January 14, 1991 by filing a written appeal citing reasons. You should be prepared to make specific factual objections. Contact John Bissell to read or ask about the procedures for �EPA appeals.. There is no agency appeal. CONDITIONS OF MITIGATION THOMAS BELT BUILDING PERMIT, PLAN CHECK # 233 This determination of nonsignificance is subject to' the following conditions: 1. All excavation and grading shall comply with Chapter 70 of the Uniform Building Code, 1989 edition. 2. The Applicant shall obtain a building permit from the Building Department and shall.comply with all conditions of permit approval. 3. TheAppli6ant shall -submit -a drainage' plan'to the'City' Engineering Division and follow the required guidelines. 4. The applicant shall follow all recommendations of Hong West & Associates project number 90130, report dated December 3, 1990. 5. All footings shall be founded on native, medium dense sand. No footings shall be founded in fill. 11. The Applicant shall make every reasonable.effort to -keep exposed soil covered during construction. 12. The Applicant is to make every--possible-effort to -keep dust controlled and to keep the streets clear of dirt and debris. CITY OF EDMONDS ENVIRONMENTAL CHECKLIST A. BACKGROUND 1. Name of proposed project, if applicable: New single f amily residence for Parcel 1 of Edmonds short subdivision No. S-1-90. (18111 - 76th Avenue W., Edmonds, WA.) 2. Name of applicant: Thomas.E. Belt 3. Address and phone number of applicant and contact person: Applicant: Thomas E. Belt Contact: Dale B. Watkins 21400 Highway 99 Lovell-Sauerland & Associates, Inc. Edmonds Wa. 99020 19400 33rd Avenue W., Suite 200 Telephone: 778-0247 Lynnwood, Washington 98036 Telephone: 775-1591 4. Date checklist prepared: December 7i 1990 5. Agency requesting checklist: City of Edmonds Building Department 6. Proposed timing or schedule (including phasing, if applicable): Construction of the new residence will commence upon issuance of the construction permit, with completion expected in 1991. 7. Do you have any plans for future additions, expansion, or further activity related to or connected with this proposal? If yes, explain. No. 8. List any environmental information you know about that has been prepared, or will be prepared, directly related to this proposal. Topographic survey map portraying pre -grading and post -grading conditions, a copy of which is submitted herewith. 1 9. Do you know whether applications are pending for governmental approvals of other proposals directly affecting the property covered by your proposal? If yes, explain. No. 10. List any government approvals or permits that will be needed for your proposal, if known. Construction Permit for one new single family residence. 11. Give brief, complete description of your proposal, including the proposed use and the size of the project and site. There are several questions later in this checklist that ask you to describe certain aspects of your proposal. You do not need to -repeat -.,.those answers �on -this page. - -(.Lead-: agencies m.ay.. modify" this form to include additional specific information on project description.) The proposal is an application for the issuance of a construction permit for a single family residence to be constructed on one of two lots in a recently approved and recorded short subdivision, i.e., Edmonds Short Subdivision No. S-1-90 as recorded on October 4, 1990, under Auditor's File No. 9010040286, records of Snohomish County, Washington. A new single family residence has already been constructed on the other lot (Parcel 2) of the short subdivision under Construction permit No. 900449 issued June 1, 1990, by the Edmonds Building Department. The site comprises 19,964 square feet and, while not indicated as environmentally sensitive on the Environmentally Sensitive Areas map published by the City of Edmonds, the site, subsequent to grading and excavation that has occurred in recent years, now contains ground slopes that are in excess of 60 percent. Relative to construction of a new single family residence on the site and with the exception of necessary foundation excavation, utility trenching, and final yard grading, it is not anticipated that further site grading or alteration will be necessary. 12. Location of the proposal. Give sufficient information for a person to understand the precise location of your proposed project, including a street address, if any, and section, township, and range, if known. If a proposal would occur over a range of area, provide the range or boundaries of the site(s) . Provide a legal description, site plan, vicinity map, and topographic -map, . if reasonably available. While you should submit any plans required by the agency, you are not required to 2 duplicate maps or detailed plans submitted with any permit applications related to this checklist. The site is located on the east side of 76th Avenue W approximately 0.2 miles north of the intersection of Olympic View Drive and 76th Avenue. The common street address of the site is 18111 - 76th Avenue W., Edmonds, WA., the legal description for the project site is as follows to wit: The north 83.37 feet, as measured along east line of Lot 3, Admiralty Acres, according to the plat thereof recorded in Volume 12, of Plats, page 48, in Snohomish County, Washington. SUBJECT TO AND - TOGETHER an easement fDr.,ingress, egress a a and' th6`� * -ifist llationt, .operation � nd, maintenance �.! -of utilities, over under, across, through and upon the south 20 feet of the north 93.37 feet, as measured along the east line, of Lot 3, Block 3, Admiralty Acres, according to the plat thereof recorded in Volume 12 of Plats, page 48, records of Snohomish County, Washington; EXCEPT the east 222.47 feet thereof. TO BE COMPLETED BY APPLICANT B. ENVIRONMENTAL ELEMENTS 1. EARTH (See accompanying site inspection report by Hong West and Associates dated April 26, 1990.) a. General description of the site (circle one): Flat, rolling, hilly, steep slopes, mountainous, other The site has, been subjected in recent years to significant grading and excavation, including the exportation of approximately 10 thousand yards of sand. The site now slopes upward from 76th Avenue W. at a slope of between 10- and 20 percent to a relatively large and generally level building site located in the central portion of the property. Steep slopes are located along the north property line and in the most easterly portion of the site with existing rockeries, having an average height of between 4 and 5 f eet, located at the toes of said slopes. b. What is the steepest slope on the site (approximate percent slope)? The steepest slope on site range from approximately 1.5 to 1 to 2 to 1. See attached Grading Exhibit. 3 c. What general types of soils are found on the site (for example, clay, sand, gravel, peat, muck)? If you know the classification of agricultural soils, specify them and note any prime farmland. Onsite soils consist of commercial grade compacted sand with traces of gravel. d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe. Despite recent periods of intense and prolonged rainfall, there are only minor signs of surface erosion on the steep slopes, with same being located in the lower portions of t.h.e..slopes above the S r6ckeries. .-:,Slopes :were '.1hydrose*eded,-in -199'6o,-- -A hydroseeding matures, surface erosion should decrease. e. Describe the purpose, type, and approximate quantities of any filling or grading proposed. Indicate source of fill. With the exception of foundation excavation, utility trenching, and final yard grading, it is not anticipated that construction of a new single family residence on the site will necessitate further significant grading or filling. Importation of fill materials will be limited to whatever surfacing materials, i.e., topsoil, crushed rock, etc., may be necessary to complete the driveway and landscaping. f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe. Increased potential for erosion is a normal consequence of any project involving clearing and grading, particularly in the short term construction period. In this instance, the lower portions of the existing slopes exhibit minor signs of surface erosion and scouring. The slopes have been seeded and resulting ground'cover has afforded reasonably good protection from erosion despite recent periods of intense and prolonged rainfall. It is essential that the existing ground cover be preserved, maintained, and perhaps augmented to provide long term protection. g. About what percent of the site will be covered with impervious surfaces after project construction (for example, asphalt or buildings)? Coverage of the site by building and pavement will be approximately 20 percent. 4 h. Proposed measures to reduce or control erosion, or other impacts to the earth, if.any: Preservation and maintenance of existing ground cover on existing slopes is essential to continuing long term protection from erosion and the effects thereof. (See inspection report by Hong West & Associates dated April 26, 1990.) 2. AIR a. What types of emissions to the air would result from the proposal (i.e., dust, automobile, odors, industrial wood smoke) during construction and when. the project is -completed? any,.,,, generally -�44§sckib6. znd' :give. approximate quantities if known. Minor amounts of dust could result from construction activities occurring during dry weather months. Automobile emissions will be generated by traffic to and from the site during construction and subsequent residential use. b. Are there any off -site sources of emissions or odor that may affect your proposal? If so, generally describe. Vehicle emissions from traffic using adjacent streets, with minor and insignificant effects. c. Proposed measures to reduce or control emissions or other impacts to air, if any: Construction will be limited to weekday daylight hours. Watering of dusty areas will be performed when necessary to suppress dust. 3. WATER a. Surface: 1) Is there any surface water body on or in the immediate vicinity of the site (including year-round and seasonal streams, saltwater, lakes, ponds, wetlands)? If yes, describe type and provide names. if appropriate, state what stream or river it flows into. No surface water body is located on -site. 9 2) Will. the project require any work over, in, or adjacent to (within 200 feet) the described waters? If yes, please describe and attach available plans. Not applicable. 3) Estimate the amount of fill and dredge material that would be placed in or removed from surface water or wetlands and indicate the area of the site that would be affected. Indicate the source of fill material. Not applicable. 4) Will the proposal require surface water withdrawals or diversions? Give general.description, purpose, and approx mate -quantities -if 'known. No. 5) Does the proposal lie within a 100-year f loodplain? If so, note location on the site plan. No. 6) Does the proposal involve any discharges of waste materials to surface waters? If so, describe the type of waste and anticipated volume of discharge. No. The new residence will be, connected to a public sanitary sewer. b. Ground: 1) Will ground water be withdrawn, or will water be discharged to ground water? Give general description, purpose, and approximate quantities if known. No ground water will be withdrawn as part of this proj ect. The new residence will be connected to a public sanitary sewer. 2) Describe waste material that will be discharged into the ground from septic tanks or other sources, if any (for example: Domestic sewage; industrial, containing the following chemicals ... ; agricultural; etc.). Describe the general size of the system, the number of such systems, the number of houses to be served (if applicable) , or the number of animals or humans the system(s) are expected to serve. Typically, stormwater from roofs and driveways contains minor amounts of petrochemicals. Stormwater .9 runof f f rom the proposal I s impervious surf aces will be collected and discharged into the existing stormwater control system. The use of a septic tank will be avoided by connection to the available Public sewer system, therefore no sanitary waste materials will be discharged into ground water. c. Water Runoff (including storm water): 1) Describe the source of runof f (including storm water) and method of collection and disposal, if any (include quantities, if known). Where will this water flow? Will this water flow into other waters?. If so, -describe. upon construction of the new residence, storm run- off from the building and new pavement surfaces will be collected and conveyed by a piped system into the existing drainage system located in 76th Avenue W. d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any: In connection with construction of the new residence, storm water and runoff from impervious surfaces will be collected and discharged into the existing drainage system. . Connection of the new residence to an existing sanitary sewerage system will be provided. 4. PLANTS a. Check or circle types of vegetation found on the site: deciduous tree: alder, maple, aspen, other: x evergreen tree: fir, cedar, pine, other: western hemlock x shrubs x grass pasture crop or grain wet soil plants: cattail., cabbage, other: water plants: water lily, other types of vegetatior 7 buttercup, bullrush, skunk eelgrass, milfoil, other b. What kind and amount of vegetation will be removed or altered? With the exception of grass on.the steep slopes and an existing cedar tree, having a caliper of 20 inches and being located in the west central portion of the site, there is no vegetation on the site, consequently, no further vegetation will be removed or altered. c. List threatened or endangered species known to be on or near the site. No threatened or endangered plant species are known or expected to exist on or near the site. d'. Proposed landscaping', 'us. -of -'-native,plants, .!.or: other e measures to preserve or enhance vegetation on the site,' if any: Pursuant to completion of the new single family residence to be constructed on the site, the grounds will be completely replanted with lawn, shrubs, and small trees by the builder and/or future home owner. 5. ANIMALS a. Circle any birds and animals which have been observed on or near the site or are known to be on or near the site: birds: hawk, heron, eagle, songbirds, other: ravens mammals: deer, bear, elk, beaver, other: mice, and other small mammals. fish: bass, salmon, trout, herring, shellfish, other: b. List any threatened or endangered species known to be on or near the site. No threatened or endangered animal species are known to exist on or near the site. c. Is the site part of a migration route? If so, explain. The site is not a significant element of any migration route. d. Proposed measures to preserve or enhance wildlife, if any: No specific measures are proposed. F-11 6. ENERGY AND NATURAL RESOURCES a. What kinds of energy (electric, natural gas, oil, wood stove,.solar) will be used to meet the completed project's energy ' needs? Describe whether it will be used for heating, manufacturing, etc. Electrical energy will serve the illumination and domestic energy requirements of the new residence. Natural gas may be used f or space and hot water heating. b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally describe.. agr c. What kinds of energy conservation features are included in the plans of this proposal? List other proposed measures to reduce or control energy impacts, if any: The new residence will be constructed in compliance with applicable energy code requirements for energy demand and insulation. 7. ENVIRONMENTAL HEALTH a. Are there any environmental health hazards, including exposure to toxic chemicals, risk of fire and explosion, spill, or hazardous waste, that could occur as a result of this proposal? If so, describe. No unusual health hazards are predicted as a result of construction or inhabitation of the new residence. 1) Describe special emergency services that might be required. Standard police, fire, and emergency medical services could be required during construction, in the event of accident, fire, or other emergency event. 2) Proposed measures to reduce or control environmental health hazards, if any: All construction procedures, practices, and methods, will be performed in compliance with applicable safety rules and regulations. The new residence will be constructed in accordance with codes, rules and 9 regulations relating to fire protection and life safety. b. Noise 1) What types of noise exist in the area which may affect your project (for example: traffic, equipment, operation, aircraft, other)? Traffic on local streets. 2) What types and levels of noise would be created by or associated with the project on a short-term or a long-term basis (for example: traffic, construction, operation, other) ? Indicate what hours noise would come from.:.the site.. Construction equipment and traffic during site preparation and house construction, 7 AM to 7 PM, Monday through Friday, followed by residential traffic serving occupants of new residence. 3) Proposed measures to reduc6 or control noise impacts, if any: Short term construction activity will be limited to weekday daylight hours. Standard energy code construction requi . rements will provide substantial interior� noise attenuation for occupants of new residence. 8. LAND AND SHORELINE USE a. What is the current use of the site and adjacent properties? The site is currently vacant and undeveloped. Adjacent sites are occupied by single family homes. b. Has the site been used for agriculture? If so, describe. No. c. Describe any structures on the site. No structures exist on the site. d. Will any structures be demolished-, If so, what? No. 10 e. What is the current zoning classification of the site? RS-12 (Single Family Residential) f. What is the current comprehensive plan designation of the site? Low Density Residential. g. If applicable, what is the current shoreline master program designation of the site? Not applicable. a h Ras ny ..'part ..--Iof the site"� been --.classified -. as - an.:. "environmentally sensitive" area? If so, specify. No. i. Approximately how many people would reside or work in the completed project? One family (3-4 people). j. Approximately how many people would the completed project displace? None. k. Proposed measures to avoid or reduce displacement impacts, if any: Since there are no displacements, no mitigation is proposed. 1. Proposed measures to ensure the proposal is compatible with existing and projected land uses and plans, if any: Proposed development will be in accordance with the applicable comprehensive plan and zoning classification. The development characteristics and predicted density compare favorably with those of the surrounding neighborhood. 11 9. HOUSING a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low-income housing. One single f amily dwelling will be provided in the middle -income range. b. Approximately how many units, if any, would be eliminated? Indicate whether high, middle, or low- income housing. No housing units will be eliminated. m.easurqs_-.tqre.duc.e ..or ..cont . rol, ''housing impacts, if any: No housing impacts will occur; no mitigation is proposed. 10. AESTHETICS a. What is the tallest height of any proposed structure(s), not including antennas; what is the principal exterior building material(s) proposed? Building height will be limited to 25 feet. Principal exterior building material is expected to be cedar siding. b. What views in the immediate vicinity would be altered or obstructed? Change in character from undeveloped suburban, site to residential development. No scenic views from adjacent properties will be impacted. c. Proposed measures to reduce or control aesthetic impacts, if any: Future homeowners are expected to establish landscaping with consideration for site aesthetics. 12 11. LIGHT AND GLARE a. What type of light or glare will the proposal produce? What time of day would it mainly occur? Sources of light and glare will occur from grounds and future home illumination during non -daylight hours. b. Could light or glare from the finished project be a safety hazard or interfere with views? No. c. What existing off -site sources of light or glare may affect your proposal? Light from illumination of neighboring streets and residences. d. Proposed measures to reduce or control light and glare impacts, if any: Since no unusual sources of light and glare exist or will occur, no special measures are proposed. 12. RECREATION a. What designated and informal recreational opportunities are in the immediate vicinity? Several public parks and school playf ields are located within 1 mile of the site. b. Would the proposed project displace any existing recreational uses? If so, describe. No. c. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: None are proposed. 13 13. HISTORIC AND CULTURAL PRESERVATION a. Are there any places or objects listed on, or proposed f or, national state, or local preservation registers known to be* 6ii- or next to the site?. If so, generally describe. No. b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance known to be on or next to the site. No landmarks or evidence of historic, archeological, scientific or cultural importance exist. on or near the site. c. Proposed measures to reduce or control impacts, if any: None are proposed. 14. TRANSPORTATION a. Identify public streets and highways serving the site, and describe proposed access to the existing street system. Show on site plans, if any. Primary access to the site is provided by 76th Avenue W. upon which the site has frontage. b. Is site currently served by public transit? If not, what is the approximate distance to the nearest transit stop? A community transit system currently serves the general area within which the site is located with boarding points nearby. c. How many parking spaces would the completed project have? How many would the project eliminate?. The homesite will have off-street parking for a minimum of 4 cars. No off-street parking will be eliminated. 14 d. Will the proposal require any new roads or streets, or improvements to existing roads or streets, not including driveways? If so, generally describe (indicate whether public or private). No. e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so, generally describe. f. How many vehicular trips per day would be generated by the completed project? If known, indicate when peak volumes would...odcur. The completed residence is expected to generate approximately 10 vehicular trips per day with peaks occurring in the early morning and late afternoon. g. Proposed measures to reduce or control transportation impacts, if any: Measures are not considered necessary for this proposal. 15. PUBLIC SERVICES a. Would the project result in an increased need for public services (for example: fire protection, police protection, health care, schools, other)? If so, generally describe. The project will generate an insignificant increase in the need for such services. b. Proposed measures to reduce or control direct impacts on public services, if any. None beyond the incremental increase in the tax base contributing revenue toward support of such services. 16. UTILITIES a. Circle utilities currently available at the site: electricitV, natural gas, water, refuse service, telephone, sanitary sewer, septic system, other. 15 b. Describe the utilities that are proposed f or the project, the utility providing the service, and ' the general construction activities on the site or in the immediate vicinity which might be needed. Electricity: Snohomish County P.U.D. No. 1 Natural Gas: Washington Natural Gas Company Water Service: City of Edmonds Sanitary Sewer Service: City of Edmonds Telephone: General Telephone Company C. SIGNATURE The above answers are true and complete to the best o -my...know.l"edge'. I..understand:.--that f -the, lead agency.- is relying on them to make its*decision.*'.., Signature: - D/"/6_e - Dale B. Watkins Date Submitted: December 10, 1990 16 776-2829 BUILT. by 778-0247 BELT 917 - 9th Ave. So. Edmonds,* WA 98020 FA / - 5-/) 0 6r rl _2?,E-7 O/Y)�5, wff Jig / /�' 06) w, "-i� 1141. FIL, a " � - zc -/- e- A 0 / -s 7 - , -- -10 0, kj 0 x c e— t% gll u'uu- -P'9--rO')-? -PO , ly-r l6e-- / ,�rORKSHEET STANDARD DRAINAGETC= DETENTION SYSTE9 TC H COWl"ROL CA "'0" "MGT" 2, fx COvV-FKI. CO%JT%t0L6 % 5LOPE— A I I 'i t-M-t-4- TO OLrrWE*T (si P RAP OR PLUNOFF SYSTEM CROSS SECTION SPREAMEIL) 2' . 2' &"06ZXr, 4t-&.' sP^L.U; 2.7, 2' 3' VC'e 17a 2' 3" DeeP, C-RUSt�I�D vocK FROM OUTLET CON-rltOL RIPRAP OUTLET I %1*01,5"Ell &ILXYVL� fOLITFLOW -rRENC%, MIN 10' LONG, . . 'TOP *. 4' PERF PIPE 'in BE L-rvWL. FROM OLrrLET CONTROL' 'L 47 PERF P%PE WITH CAR.5 RUNOFF SPREADER OUTLET *--FOO-nNG DRAINS SHALL NOT BE age 9 of 9 CONNECTED TO THE DRAINAGE SYSTEM FAW" DESIGN DATA System Imperm Pipe Pipe Orifice Number Area Diam Length Diameter NOTES 1. Call Engineering Division (771-3202) for prebackfill and final inspections. 2. Responsibility for operation and maintenance of drainage systems on private property is the responsibility of the property owner(s). Material accumulated in the storage pipe must be flushed out and removed from catch basins to allow proper operation. The outlet control orifice must be kept open at all times. AMIN= j CITY OF EOMONOS TO: Permit Coordinator, Building Division. 8/90 FROM: Lyle Chrisman, Engineering Inspector ADDRESS: /em/ �6rw'0'6 DATE: IqI1717,0 OWNER: t6&;r 11w,0 PLAN After review of the subject permit application the following is required: 1. Construction hours are: WEEKDAYt .......... 7:00 a.m. - 10:00 p.m. (ECC 5.30.110) WEEKENDS/HOLIDAYS..10:00 a.m. - 6:00 p.m. 2. A separate Right -of -Way Construction Permit is required for all work on City property. (ECDC 18.60) 3. Connection to City water system required. Separate charge for water meter. (ECDC 7.30) 4. Connection to City sanitary sewer system required; obtain separate permit. LID # Fees paid: Yes No Charge $ (ECDC 18.10) 5. Water and sewer main lines should be separated by 10 feet minimum. (ECDC 18.10) 6. Driveways must be paved a minimum of 20 feet back from City right-of-way; separate permit required. (ECDC 18.80.060C) 7. Driveway slope not to exceed 14% without waiver. Waiver granted to- % (ECDC 18.80.060D) 8. Back water valve required if downstairs plumbing is below elevation of upstream manhole. (ECC 7.20) .9. Builder/Owner responsible for containing all temporary,runoff and erosion control on site. (ECDC 18.30.030D) 10. No burning of construction refuse without permit from Fire Department. "-11. Truck haul route plan must be submitted and approved prior to permit issuance. "412. Street shall be kept clean of debris, dirt, mud, and construction materials. Contractor responsible for dust control. (ECDC 18.30) 13. Inspection required.on drainage system, catch basin installation, driveways, and sidewalks. Contractor responsible to contact City for inspection. (ECDC.18.30) 14. Repair or replace all defective existing curb, gutter, and sidewalk adjacent to property. If intersection is involved, installation of wheelchair access may be required. Permittee to meet with Engineering staff to determine extent of repair prior to issuance of permit. (ECDC 18.90) '�1115. Underground wiring required on all new construction; and for additions, alterations, and repairs that exceed 50% of the total assessed value of the structure. (ECDC 18.05.010) 16. No work shall be done within 15 feet of streams or 10 feet from any closed drainage facility. 17. A final engineering inspection is required prior to the Building Division granting occupancy of the building or structure. (ECDC 18.80) 18. PROJECT REVIEW CHECKLIST PROJECT NAME: 13ell 11wuY PLAN CHECK #: 213-3 PROJECT ADDRESS: h/ RECEIPT DATE: 1011-S1-9D REVIEW D B I Itial/Date) PLAN. WATER COMMENTS FIRE BLDG. SEWER- STREET Setbacks/Variance/Setback Adjustment Conditional Use Permit AD13 Requirements d(62 m Other Zoning Requirements Underground Wiring Required Lfes. Lot Slope 15% SEPA Environmental Checklist/Hydraulics Permit Tree Cutting Plan Plat/Subdivision Requirements Legal Descripfion Verification *g- 10zho Quit Claim/Street Dedications A&MIC Easements 2f12!MPrivate ar"CITY, Engineering St&rm Drain Review FeWT:—�iex—z? jo:A.w Engineering 2.2 Inspection Fee dFac>. aO ...... AO tolliho ��'l Drainage Plan (On -Site) Setback - Top of Bank, Stream, Water Courses 0111140 Setback - Storm Drain Line AM Ank- -17A Open Ditch - Existing L4 A4 Culvert Required ... 19] Culven Size .. . .... .. .. :p 0 Shoulder Drainage/Shale Open Runoff 014- Catch Basin Required ot onz-m ma� Driveway Slope & Vehicle Access : Sidewalk Required ...... Curb & Gutter Required A-W -26 Curb Cut For DriveiWay Required A/0 Street Paving Required X0 015 27" Right -Of -Way Construction Permit Required 51! - --�Zop- Street Name Sign Required - ------------ '11 iirm 29. Other Signing Required X.. Bond Required For Public Improvements Ax,, FEMA Map Check/Water Table -32- Side Sewer Availability .......... Calculate.Sewer. Connection Feb.If No LID # Create Street File ..... ...... Existing Water Main Size Water Meter Size MG ........... -37, ........... Service Line Size g". Water Meter Charge Required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................. . . . . . . . . . . . . . . . . . . . . 1� 0 Hydrant Required .......... 4 Hydrant Size Existing Fire Line Charge Required - qprinkler ................ . . . . . . . ..................................... 2x. IStreet Cut 4CO: I Miscellaneous Reviewed By: RECEIVED FIRE OCT Wo PLANNING ENGINEERING PUYILIC WORKS PUBLIC. WNIA'S 4 CITY OF EDMONDS USE NUMBER 0 OG CONSTRUCTION PERMIT&JWN MEOW SUITE/APT *1 15 a4 # I OWNER NAME/NAME OF BUSINESS . `� N LEGAL DESCRIPTI.ON CHECKI SUBDIVISION NO.-37-/" LID NO. Z MAILING ADDRESS 0 7h TESCP CITY ZIP TELEPHONE PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. EXISTING REQUIRED DEDICATION APPROVED BY ffd-S 77,re �NUMBJ NAME , 1. - D S/64/ RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED)t W Uj ADDRESS STREET USE P ERMIT REQUIRED 0 W Z 0 L REVIEW BY SEE ENG ERING MEMO DATED Z 4 CITY . ZIP 7ELEPHONE 0- 1< L4 Ald NUMBER ew 4�e /0/1 No REMARKS 7?Pa NAME Cc ADDRESS )51AJ4L [-'AJCi((, 0 METEI;�If tr 17BUILDIN'G S,,�PPLY SIZE FIXTURE UNITS CITY Z177TELEPHONE NUMBER Z 0 REM , STATE LICENSE NUMBER ?& I& - — 4 19 /7 SIGN AREA ENV. REVIEW ADB NO. Legal Description of Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT Z (show below or attach two copies) SHORELINE N a. U j r VARIANCE OR Cu PL BY, to W LNNI�)REVIEW SET —F ET BACKS HE_ �jG V LOT COVER,,I%V Z FRONT Zq; SIDE REAT,::� Z Tax Account Parcel No. REMARKS J CL NEW F[EiIDEITIAL PLUMBING 0 ADDIALTER 0 COMMERCIAL MECHANICAL REPAIR APT. BLDG. El 'SI I GN EXCAVATE, FILL FENCE DEMOLISH OR GRADE I— x CHECKED BY ITYPE OF CONSTRUCTION CODE HEIGHT _FT) CARPORT swim REMODEL GARAGE POOL SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT REQUIRED 0 YES 0 NO I GROUP LOAD I WOOD STOVE/ E] RETAINING WALL/ INSERT RENEWAL REMARKS . Z 0 ROCKERY (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBC 305 Z 4 1A f! NUMBER OF STORIES NUMBER OF m myn z &A MaIde DWELLING 0 UNITS NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) :Rw1d hle- it,- Ird FINAL INSPECTION REQUIRED ,S�Avcf &fi 6y TeftvfleRfs, S44, r Fvo VALUATION FEE �=W,fr,ey sr PLAN CHECK FEE - 4 0 Wh . 2 -:: �v 0), S AMA,, 6 BUILDING 126.1A_W* r,6�,f,4 If Or PLUMBING Plan Check No. 233 MECHANICAL This Permit covers work to be done on private property ONI,Y. GRADINGIFILL Any construction on the public domain (curbs, sidewfilk6,, driveways, marquees, etc.) will require separate permission.' STATE SURCHARGE 4 Permit Application: 180 Days Permit Limit: 1 Year - Provided WorR is Started Within 180 Days Q71�� roefe-j "Applicant, on behalf of his or her spouse, heirs, assigns and lkwn6tj successors in interest, agrees to Indemnify, defend and hold U2 harmless the City of Edmonds, Washington, its officials, 2 employees, and agents from any and all claims for damages of cr < X whatever nature, arising directly or indirectly from the issuance 13W5' a of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT 0 modif,,, waive or reduce any requirement of any city ordinance 1 nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE L/ provision." L e, 67 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 state laws regulating construction; and In doing the work authoriz- THIS PERMIT AUTHORIZES This application is not a permit until ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is tion. Insurance. INSPECTION acknowledged in space provided. SIGNATU, E (OWNER OR AGENT) DATE SIGNED DEPARTMENT /4 6/� CITY OF OFFIC�IAUS [G�N��RE DATE EDMONDS ATTENTION CALL FO 1�� INSPECTION REMO B Y: O�TE 2 V/C?i IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771-3202 UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspecto A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC CHAPTER 3. PINK — Owner GOLD — Assessor