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18330 85TH PL W
40"TREET FILE
Critical Areas Checklist'
Site Information
Project Name. .- &7fZ*C-2- Permit Number.
Sift Location: no. wo.>Wroperty Tax Account Number:
Approximate Site Size (acres or square fed): / 5-co
Have you filled out a Critical Areas ChecIdist for a project on this site before?
General Site Conditions
-7-71
L Bas the site beeri cleared or logged? Date of most recent action: -
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)?
3- Describe the gcncrA site topography. Check all thatapply.
L,' 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-)
11illy.- slopes present on site of more flm 15% and less than 30'Yp ( a vertical rise
of 10 feet of horizontal d4tance-)
Steep: grades of greater than 30% present on site.
Co mmCnts
Hydrology/Vegetation.
4- Site contains areas of year-round standing water
' "' qr I 1 144 -,*"" -1 - . .."
SIC
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CitY Of Edmonds
Critical Areas Checklist
The CrificalAreas (MwMiq "*ntainodon
&is forra is to be Mcdout by my Person
P=Pafig a Uk-'VrI9PM=t Permit
Application for the City of M...& Prior
'W his4�cr milmoittal of a development permit
to the city
The Purpose of the Cheddist is to enable
City staff to detcrminewheethcr any potential
Critical Areas Me or may be present on the
subject pwperty The i0fOrMation needed to
compicto the Checklistshould be easily
available from observations of the site or
daft available at City Hall (Critical Areas
invcntOric:s� maps, or soil survcys).
An applicant. or his/her reprcsentafive. must
fill out the chocIdist, sign and dato k and
submit it to the city ihe city will =view
the �hcMistv 112ake a precursory site -Iisitv
and make a dctc�tion of he mbsXen,
steps necessaxy to complete a development
permit application -
With a signed copy Of this form. the
applicant should also submit a vicinity map
Of the Parcel'With enough detail dw City
staffcan find and identify the subject
Parccl(s). In addition. the applicant is
encouraged to include any other pertxucnt
information or sttidics in conjunction with
this Cheddlist to assist staff in completing
their preliminary assessment of the site -
have completed the attached Critical Area Ched . dist and attest that the answers provided -are
factuaL to the best of my knowledge (fill out the appropriate column below) -
Owner i Applicant:
Name
Title
—.IY3 3c, Dt
SIX,ect Addr=
Applicant Representative:
Name
Title
Street Address
0 <.
City. State. Zip
Phone City, State, ZIP
Phone
73
Signature Date Signature
Date
(D
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.70,
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77
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(VOLUME 3 PAGE 75)
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FL
la&. 1 -7 -
PLACE
V
CITY OF EDMONDS
/NEW
ADDITION
RETIREMENT
STREET FILE ASSET INFORMATION SHEET
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION t's P1
DEPT. NO.
* * PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
*PROJECTNUMBER \mol�L012
PROJECT COMPLETION DATE
COST I :;t-s I ) I
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
2 /DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
trp) INITIAL
DATE
PROCESSED
BATCH NO.
DEPARTMENT FILE
.::I-
00
a:
CITY of EDIVIO EET FILE
For Inspection Call 771- 2"
Address of Construction:
Property Legal Description (Include all easements)
SIDE SEWER P EA IkJ T
PERMIT NO. DOM
_T>L L U
Owner and/or Builder: 35.�Otfu
Contractor & License No: _�>ZGQ. /U
_T G- I Z 7Z
169t0-71,S__
Single Family Residence
Multi -Family (No. of Units
YNNW.00D UNE
Commercial (No. of fixture Units rL
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
flgC�IYED
FEB 0 6 1890 -2 - 5 7 -::1:6
/certify thatI'have read and shall comply Date
wit
with the items listed on the back. PUBUC WKS
Permit Fee: 30
Trunk Charge: Z5
Assessment Fee: 4/4 137
!Issued BY: _�Fh
Date Issued: 7,- S_- �PO
Receipt No.: //0//
Partial Inspection:
Comments Date Initial
Final Inspection Approved: 3_119b
Date Initial
Rejected:
Wh.ite Copy - File
son Date
** PERMIT MUST BE POSTED ON JOB SITE **
Green Copy -'Inspector Buff Copy - Applicant
The City of Edmonds Side Sewer Drawing EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION REPAIRS F� LID NO . ............ ----- - ASMT. NO. ---- -------------
OWNER --------------------------------------------------------- �4kA ---------------- ----------------------------------- --- PERMIT NO. UA-4a-
------------------ CTOR
------------------- CONTRA -------
JOB ADDRESS I --- S-33AD --- — --- QS --------- P-C ---------- W -------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
PWW-000 1 '11/75 (REV. 11/78)
NAMEOF ADDITION -------------------------------------- --------- ----------------------------------------------------------------------
P- V- c-
:Zl Deze
D,ee,
[L=YNN,VV00D =1LINE
Approved:
3--7-
DATE..................... ..... -------- B36 .......... ..
fl
NOTICE:
Nowar-rantyOT
The information'shown on the attached
map(s) was compiled for use by the City of
Edmondsl its Employees and Consultants.
The City of �Edm.onds does not. warrant ti IK-_
accuracy of anything set forth on these
Map(�_). Any person or en.tity'requesting a
copy should conduct an independent
orm, ation shown on
inquiry regarding the inf
including, but not limited to,
t :2 -rn a p (s),
er stub shown. Such
the lociation of any sew -not exist and may
sewer stubs may or may
or may not exist at the location shown.
Neit-her the city of Edmonds nor its
empto-yee-s o-r office-rs -sha-l] be 11a-b-'Fe for the
information given on this rnap(s), nor for
tation provided based
any one represen
upon said map(s).
00, S-3
S t7
-2 -Pv�7- F�2-- 1-.5 --2d 11
67
/Wx
, I �q
-5111f -f- GAR 341
.. ........
L
62' Ls�: _7�-:�47012t _x �YN
00, SlIz
S?" MW= v
1-.9 --Xrl
Kz_
,�.14 . . . . . . . . . . . .
i r
DATE:
MEMO TO: Permit Coordinator, Building Division
FROM: Dan Smith, Engineering Inspector
ADDRESS:
OWNER:
After review of the subject building permit application, we have the
following comments-.,
1) Construction hours are: '..WEEKDAYS 7:dOam to 10:00pm
,.IWEEKENDS/YQLIDAYS 10:00am to 6:00pm.
2) A Right -of -Way construction permit is required for any work on
City property.
3) Connection to City wa'ter,system required.
4) Connection to City sanitary sewer sys-tem required; obtain separate
permi t.
5) Water and -sewer lines. to' -be separated by 10 foot minimum.,
6) Driveway must be paved a minimum of 20-feet back from City
right-of-way; separate permit required.
7) Driveway slope not to exceed 14%.
8) Back water valve -required if downstairs,plumbi.ng i.s below
elevation of upstream manhole.
9) Builder/Owner responsible for containing all temporary runoff and
erosion control on site.* Construction may not impact neighboring
properties in any way.
10) -No burning of construction refuse without approval from Fire�Deot.
11) Street to be kept clean,of debris, dirt, mud, and constructi6n
materials.- Contractor responsible for dust control.
12) Inspection required on drainage system, catch basi,n-installation,-
driveways, and sidewalks:.,' A final engineering inspection is
required prior to the building division granting occupancy."
I
owls ro
4 CITY OF EDMONDS%# I I "'
CONSTRUCTION PERMIT APPLICATION
OVILNER NAME/NA E OF BUSIN
>/
W MAIL1f4j ADDRESS
Z
0
_j
CITY TELEPHONE NUMBER
-7 7
NAME
ADDRESS
-3) 2-
TELEPHONE NUMUR
NAME I r
ADDRESS
CITY NE NUMBER
STATE LICENSE NUMBER
LegaT Description of Property - include all easements
(show below or attach two copies)
_MvI UJ.A A MTA
7 NEW
�rRESIDENTIAL
PLUMBING
ADDIALTER
1:1 COMMERCIAL
MECHANICAL
REPAIR
El APT. BLDG.
SIGN
EXCAVATE
DEMOLISH OR FILL
FENCE
(
REMODEL CARPORT
x _FT)
SWIM
GARAGE
POOL
WOOD STOVE/ RETAINING WALL/
INSERT I I ROCKERY
RENEWAL
NUMBER OF STORIES
2-
NUMBER OF
DWELLING
UNITS___
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
I
Ub PERMIT
zo NUMBER
M7,
JOB
ADDRESS
.EGAL D SCRIPTION CHECK SUBDIVISION NO. LID NO.
45-
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
APPROVED BY
EXISTING REQUIRED DEDICATION
PROPOSED.,,� __
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED,
STREET USE PERMIT REQUIRED.
SEE ENGINEERING MEMO DATED EVr1Y
'I,
A_?
METER SIZE // IBUILDING SUPPLY SIZE IFIXTURE UNITS
REMARKS
VAQ
SIGN AREA- ENV. REVIEW ADS NO.
ALLOWED I PROPOSED COMPLETE i EXEMPT
NE#
VARIANCE OR CU PLANNING REVIEW BY T
SETBACKS - FqE;T HEIGHTZ I LOT COVERAGE
7 E� X_
FRONT-----. SIDE REAR D7X51 1
REMARKS
t�_ -
ED BY TYPE OF CONSTRUCTION CODE HEIqHT
0
Z
Z
0
Z
W
0
Z
i
Z
SPECIAL INSPECTOR AREA OCCUPANCY ___F_0CCUPANT
REQUIRED IL NO GROUPg _ _3
n YES ILOAD
REMARKS
0
PROGRESS INSPECTIONS PER UBC 305 Z
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewinlks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Wor� is Started Within 180 Days
ENERGY CODE
Applicant, on behalf of his or her spouse, heirs, assigns an
(n successors in interest, agrees to indemnify, defend and hold
harmiess the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
Cr
< whatever nature, arising directly or indirectly from the issuance
T of this permit, Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
0
modify, waive or reduce any requirement of any city ordinance
0
x nor limit 1 1 n any way the City's ability to enforce any ordinance
I
TOTAL AMOUNT DUE
provision.
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
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
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the §tate of Wash' `11)on relating to Workmen's Compensa-
WORK NOTED
tion loserarq�_,.% 75
INSPECTION
S ATUR A T
DATE SIGNED
DEPARTMENT
CITY OF
EDMONDS
VALUATION I FEE
—200 1///
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.
OFFICIAL's SIGNATURE DATE
ATT'�_ TION 771-3202
IT U NLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UZIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
RELEASED BY:
DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor