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CliV OF EDMONbS
BUILDING DEPARTMENT
WORK PJA
ADDRESS
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OWNER
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RECEIVED
JAN 16 2001
PER IT COUNTER
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30- 12-�x
CA FILE NO. -7 -7
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
I Site Address/Location: IP9 -76
2. Property Tax Account Number:
C1,00 1.07 C)"
3. Approximate Site Size (acres or square feet): F6 2-
4. Is this site currently developed? -N</ yes; _ no.
If yes; how is site developed? L_-�10 L,
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 I 0-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
I 04eet over a horizontal distance of 3 3 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round 'standing water: /L-) ;Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway � -) 6 floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? J, Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) �)/Y,/
11. Obvious wetland is present on site: A)b
A�� v iewed by: - ..... ... t . 2i . 71el 9, 9
(,Planner Date
hca—chkAoc; Rev 10103/97
1�
City of Edmonds
CRITICAL AREAS CHECKLIST
v'�
?VOO�
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City of
Edmonds prior to his/her submittal of 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.
Please submit a vicinity map along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
r -Caz�'/ /-)kl� I, I I----
n
Name
37
Street Address
Xv-
city
State
Zip
Telephone---�,
Date
Applicant Representative:
Name
Street Address
city State Zip
Telephone
Signature
Date
c:rcception\jana\cac1.doc
(over)
e�
City of Edmonds
Critical Areas Determination
Applicant: R. Gregory Payne Determination CA-99-177
Project Name: Permit
Number:
Site Location: 18510-76 Ih Avenue W. Property Tax Acct 4346 000 107 0106
Project
Description:
Non -Project Specific
Determination: Study Required for Steep Slope and Conditional Waiver for Stream:
During review and inspection of the subject site, it was found that the site contains
and/or is adjacent to a Steep Slope Hazard Area and a Class 2B stream pursuant to
Chapter 20.15B of the Edmonds Community Development Code (ECDC).
Based on these findings, prior to submission of any development permit, you will be
required satisfy the requirements of ECDC 20.15B by completing the following:
Steep Slope Hazard Area Delineation Requirements:
To determine the extent of the Steep Slope Hazard Area, a topographic survey prepared
by a Licensed Land Surveyor delineating Steep Slope Hazard Areas must be completed.
Any slope of 40% or more with at least 20 feet of rise will be classified as a Steep Slope
Hazard Area. A 50-foot buffer is required from both the top and toe of a Steep Slope
Hazard Area. A 15-foot building setback is required from the 50-foot buffer.
For development of any kind which is proposed within the critical area, 50-foot buffer
or 15-foot buffer setback, it must be shown that the development will not adversely
impact the Critical Area or its buffer, by doing one or possibly both of the following
depending on the outcome of the study:
1. For development proposals which will occur within the 50-foot buffer, but no
closer than 25 feet from the top or toe or the slope, the 50-foot buffer requirement
may be reduced to 10 feet if a study is completed by a licensed geologist or
geotechnical engineer which clearly demonstrates that the proposed buffer
alteration will have no adverse impact upon the site, the public or any private
party. All Critical Area Studies must be completed by a licensed Geotechnical
X
Engineer (as defined in ECDC 20.15B.020.Y) or under a three p . arty contract
where the City hires the professional required, and the applicant pays for the
study (pursuant to ECDC Section 20.1513.140).
2. If development must occur within the critical area, buffer, and/or buffer setback,
and is not identified as an exception per ECDC Chapter 20.15B, a Reasonable Use
Exception and Variance must be obtained pursuant to ECDC 20.1513.170A and
20.1513.040C.
If the property owner wishes to apply for a specific development permit which they feel
would not impact the Critical Areas located on the site, they may submit their proposal to
the Planning Department for review. If the Planning Department findsthat the proposed
development permit will not adversely impact a Critical Areas or its buffers, a conditional
waiver may be issued on a project by project basis.
Conditional Waiver for Stream:
During review and inspection of the subject site, it was found that the site contains a Class 213
stream, Perrinville Creek, pursuant to Chapter 20.15B of the Edmonds Community Development
Code (ECDC). However this stream is wholly contained within culverts across this site. This
Conditional Waiver is in regards to the stream only and shall be good for all projects on the site,
until such time as the property is redeveloped or portions of the stream's culverts are proposed to
be dug up, moved, or otherwise disturbed.
Waiver Criteria (all criteria must be found to apply):
X There will be no alteration of the Critical Area or its required buffers pursuant to the
requirements of Chapter 20.15B;
X The development proposal will not impact the Critical Area in a manner contrary to
the goals, purposes, objectives and requirements of the Critical Areas ordinance;
X The development proposal meets the minimum standards of the Critical Areas
ordinance;
X The above findings are based on the following conditions of approval:
1. The stream (Perrinville Creek) and its culverts shall not be disturbed.
2. No discharge is allowed to Perrinville Creek.
3. Any redevelopment of the site in excess of 50 percent of its replacement cost
at the time of destruction/demolition shall require a new Conditional Waiver
or Critical Areas Study.
4. Any project shall be constructed in compliance with the City of Edmonds
approved plans and code requirements.
Based on the above findings and conditions, the requirement for a Critical Areas Study of the
stream is hereby Waived, as authorized by Chapter 20.15B. 150 (B) of the Edmonds Community
Development Code.
Meg Gruwell
Date
Name S —ig n�a 7/8/1999
PLANNING DATA
NAME: &LC21 (��j
SITE ADDRESS: qsz(2, J(P M - DATE:
-0 O-Z 21
ZONING: OR- N&,L(,K�WTU�f� PLAN CHK#:
PROJECT DESCRIAON: 6,tuaiq-(�
CORNER LOT —(Yes/No) FLAG LOT Q —(Yes/No)
SETBACKS:
Required Setbacks: M
Front: LeftSide: NIA RightSide Rear:
ro"
—u;,, LS �eb
Front: Left Side: Right Side:- Rear:
Street map checked for additional setback required? (Yes/No)
2LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED VM -(Y/N)
I f
LOT COVERAGE: .2
Maximum Allowed: VY,4e - �)4a�Actual
BUILDING HEIGHT:
Maximum Allowed:-Z-E; ______.Actual Height: .940&1�
Datum Point: Datum Elevation:
SUBDIVISION:
CRITICAL AREAS
WILT -A 11 us] I a, w1f, 11 F, - - - I ---
LOT AREA:
CA FILE NO L'1 L4 7
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
I Site Address/Location:
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet): .4�
4. Is this site currently developed? ��" yes; _ no.
If yes; how is site developed? LY 1C,
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 I 0-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
I 0-feet over a horizontal distance of. 3 3 to 66-feet).
Steep: grades of greater than 30% *present on site (a vertical rise of I 0-feet over a
horizontal distance of less.than 33-feet).
Other (please describe):
k�
City of Edmonds
Critical Areas Determination
Applicant: R. Gregory Payne Determination CA-99-177
Project Name: Permit
Number:
Site Location: 185 10 — 76'h Avenue W. Property Tax Acct [4346 000 107 0106
Project
Description:
Non -Project Specific
Determination: Study Required for Steep Slope and Conditional Waiver for Stream:
Engineer (as defined in ECDC 20.15B.020.Y) or u
nder a three party contract
where the City hires the professional required, and the applicant pays for the
study (pursuant to ECDC Section.20.1513.140).
2. If devel'opment must occur within the critical area, buffer, and/or buffer setback,
and is not identified as an exception per ECDC Chapter 20.1513 ' a Reasonable Use
Exception and Variance must be obtained pursuant to ECDC 20.15B.170A and
20.1513.040C.
If the property owner wishes to apply for a specific development permit which they feel
would not impact the Critical Areas located on the site, they may submit their proposal to
the Planning Department for review. If the Planning Department finds that the proposed
development permit will not adversely impact a Critical Areas or its buffers, a conditional
waiver may be issued on a project by project basis.
Conditional Waiver for Stream:
During review and inspection of the subject site, it was found that the site contains a Class 2B
stream, Perrinville Creek, pursuant to Chapter 20.1513 of the Edmonds Community Development
Code (ECDC). However this stream is wholly contained within culverts across this site. This
Conditional Waiver is in regards to the stream only and shall be. good for all projects on the site,
until such time as the property is redeveloped or portions of the stream's �culverts are , proposed to
be dug up, moved, or otherwise disturbed.
I IV. :;�C_
UETROSC,11V PROPERTY PROFILE
ShohomIsIs
Lownpow mFoRmAnON
Parcel Number :4346 000 102 01 06-
B14gIdNumber I of RTSQ; 04E
Record 7�pe Phad Developmenfrypc Comm
0wj1ery7;MqXr perrin Skip
CbOwner
SyteAddress
19510 76th Avc W Edmonds 98026
MOIIAddrcss
:4517 Alta Dr JAS Vega, Nv S910,7
Phone O.w ner
.
Ten4w:
EALES AND LOAN MogMATION -1
s;�;S AN
Recording Date :
Auditors Fee #
LoanAmount
:
&1e Price
Lender
Deed
Loan Type
x OWZ
N: Inkrestpak
Vesting Type
LASSESSMENT AND TAX INFORMAnON
Land
Structure
$63,300
:S9,300 Levy Code :00217
Total
:S72,600 1.9.96 T=ef S825.52.
Senior Tax
Vo -Improved
&cite Number
:13
SchoolDisr
EMMption T
EPROPERTY IDESCRnMON
Easement
Census : Tract: 503.00 Block: 2
Neighborhood Code : 520
MqpGrld
: 455 A3
Zoning
Zoning Rest
Actual Ute
: Retan store
BuildingN4me
: FMUUNVJLLE GLASS SHOP (VACAN7)
Land Use
SubdivisionlPlat
: 59951 COr3.OtherP,-t4rjifts,Souvcnirs
: Edmonds Sea view Tram
legal
: BLK 000 Dol . BEG NE COR TR 107 TH
Vol
3 Page : 75
:Froflk-Page I of 3
rhg,r'PrmgiyOnPmWdtdlsZ)Cem*dJWob4& awlyot Cw..,,tsgd
tr 411
APPLICATION LYNN PLANT
for
The City of EdmondsSIREET FILE SIDE SEWER PERMIT EASEMENT No.
NEW CONSTRUCTION UZ REPAIRS "L, I Yly,,zete,0 sc-t—r,�,
(t,,4T E u w e- I 15--/ 0 M E,4 0 C 44 D,41-1-: V6 el
/' A�i� ----- .......... 16WIER-S -
OWNER .......... Cr�nlj.441 .... ..... ........................ I .......................... CONTRACTOR %-�llj .— x S .................. ................................... PERMIT No.
ADDRESS ........ 11520 ........
JUN 23
ApplROVED
JUN
7A
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAME OF ADDITION ................... ........
.................
N /V ��Cy 6 J) �,W E�7 /V
(j
CIO
j
A.,pproved:
DATE ..... c� ......... B
... .... ... .... .... Y�..
APPLICATION
for
The City of Edmonds SIDE SEWER PERYaT EASEMENT No . ..........................................
NEW CONSTRUCTION 19 REPAIRS
.... .................................................... CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS .... L 5� .... .......
.. ... ............... ............... LEGAL DESCRIPTION: LO 1�3 . .............................................. BLOCK No. ...........................
ON ...
NAME OF ADDITI ................................................... .......... ...........................
....................
f I
ON
A-pproved:
DATE................................................ By ......................................................................
Date: April 22, 1969
to: John 1:. Pior�.i-n
Director of Public llorks
From: Leif R. Larson
City Engineer
Subject: Sewer Connection Charges
Legal Description: D-I Edmonds Seaview Tracts
Beg NE cor TR 107 th S alg E In sd TR 80 ft. TPB)
th W 125 ft.9 th S 77.411ft., th E 125,ft., th
N 77.41 ft. to TPB.
Commonly Known as: 18510 Meadowdale Road Owner: Jennie G. Perrin
(residenre only)-----
Z.F.F. Calculation:
77.47 Z. F. F. x $5.50 $ 426.09 Connection Fee
1 Unit x '$25.00 25.00 Trunk Charge
10.00 Permit
461.,09 TOTAL
lc btty Engineer
71
Date: April 22, 1969
ilemo to: John TI. Noran
Dire ctor of Public Works
From: Leif R. Larson
City Engineer
Subject: Sewer Connection Charges
Legal Description: D-1 Edmonds Seaview Tracts
Beg NE cor TR 107 th S a1g E 1n sd TR 80 ft. TPB,
th W 125 ft.9 th S 77.41 ft.9 th E 125 ft., th
N 77.41 ft. to TPB.
Commonly Known as: 18510 Meadowdale Road Owner: Jennie G. Perrin
(residence only)
Z.F.F. Calculation:
( 77.47 ) Z.F.F. x $5.50 $ 426.09 Connection Fee
Unit x $25.00 $ 25.00 Trunk Charge
$ 10.00 Permit
$ 461-09 TOTAL
Ic
1-7
. rI
Apri -1969
1 25,
Memo to. Donald C. Lawson
Edmonds City Supervisor
? j
".4
John U. Moran
From:
of Public Works
Director
Y
18510 Meadowd'
ale Road.,,
Re: Gertie Perrin,
nk which has," -
The above captioned address has a broken septic ta
-iusing
become inoperative and is c, a definite health.hazard.
The Lynnwood 'trunk sewer runs by this property d,this is where,* V
an
rt.V should be connectede
the prope
6
to 4 1.09,
The connection charge in lieu of an L.I.D. amounts
e
and Mrs. Perrin has pleaded a hardship case as far as the charges ar,
concerned at this time.
re
This is to request a determination from you regarding procedu
`;4
to the
initely should be connected
in this matter as this property def
sanitary sewer system as soon as possible*
I A
4.
JEM:)*c.
I Y
r6
4
STREET FILE
Date: A=111 22- 1969
".1emo to: John E. Moran
Director of Public Works
From: Leif R. Larson
City Engineer
Subject: Sewer Connection Charges
Legal Description: D-1 Edmonds Seaview Tracts
Beg NE cor TR 107 th S a1g E 1n sd TR 80 ft. TPB,,
th W 125 ft.9 th S 77.41 ft.9 th E 125 ft.9 th
N 77.41 ft. to TPB,
745 416 4C-11
ommonly Known as: 1851() V(Wd6idale Road
Z.F.F. Calculation:
77.47
Z.F.F. x
$5.50
1
Unit x
$25.00
1C
Owner: Jennie G. Perrin
$ 426,09 Connection Fee
25.00 Trunk Charge
$ 10.00 Permit
461.U9 TOTAL
LEIF R. LARSON, P.E.
EDMONDS CITY ENGINEER
City Engineer
MAKE REMITTANCES PAYABLE TO-.*
z
VERNE SIEVERS
1969
Lu
SNOHOMISH COUNTY TREASURER
EVERETT, WASHINGTON 98201
P9421 OC&&i
c
2
SNOHOMISH COUNT).
JENNIE G PERRIN
STATE OF WASHI
a.
18510 HEADOWDALE ROAD
OF ALL STATE, COUNT'
(v
'D
co
OXONDS VAP 98020
SCHOOL AND RO�
0
b-
0
4-
-6
SEC- TWP BLK I RGE LEVY CODE SPECIAL
lio om
tA
(D
cc
c
D-1 ED9014DS SEAVIEW TRACTS
:2 0 3-s
BED NE CDR TR 107 TH S ALG E LN SD TR
80 FT TPB TH W 125 FT TH S-77.41 FT..TB
NAME OR
COMPANY--
E 12� FT It .77-411 -FT TO TP8
z
U
0
1.
ROLL PAGE
LEVY
LAND
BUILDINGS
TOY AL VALUE
CONSOLIDAI
M
c
CL
__
25
250
Z130
2.380
216.
w
m
Lu
E
Cie
B
THE FIGURES BELOW REPRESENT THE DISPOSITION OF'YOUR TAX MONIES.
fL
r
0
SiAii7- TAX 7 COUNTY TAX 1CITy,'ROAD/LIB SC1400L TAX FIRE DI STRICT PORT DI
E
0
c
w
76
.30 F
21.93t 21.87 135.
E
TAXES MUST BE PAID BEFORE APRIL 30th, OR ENTIRE TAX BECOMES D ELINQU
Lu
>.
0
LAST HALF BEI:OMES DELINQUENT ON NOVEMBER 1. INTEREST, 8% PER ANNUM.
0
z
0
RETURN B61ffl COPIF��', iNTERESY (O.AAPUTED TO
IT
2t-
74
71,
STREET FILE
May 7, 1969
Hoof Ing
185101-
Edmonds,
.Attenti(
Gentleme
Mrs. Perrin advises ihe,\that yplr�/fitm will install the sewer
connection at both the.building y. o Idully and also her residence, 18510
Meadowddle Road, Edmonds, due to t 1� t t4at in your operation you
broke the tile to her n is d' — ield.
Mrs. Per".ri tained t e neces-ary Papers fr.oin this office on
May 6, 1969, to fill ut 'and obt the side' sewer permit. It is our
desire to have this nection mad.11-as soon as possible, due to the health
hazard involved with JhoDerat4UG- seritic ta-nk.
s matter, please
call.
truly,
ON DS *
JOAN L. MORAN
Director of Public Works
JEM-eu
----------------------
STREET Flu:
RE G I S
Mrs.
1-8510
Edmor
Dear
conne
conne
at th
ation
tion,
If yo
into
JEM: eu
cc: Donald C. Lawson, City Supervisor
James A. Murphy, City Attorney
April 28, 1969
Edmonds sewer
ty will have
st your property
cost of install -
Dr the installa-
Drk is completed.
all me or come
truly,
4ON DS
JOHN E. MORAN
Director of Public Works
e
CIVIC CENTER
250 FIFTm AvE. N
ilk*
City Supervisor C11Y 01 IDMONDS
D. C. Lawson STREET FILE Snohomish County, Washington
M E M 0 R A N D U M
TO: John E. Moran
Director of Public Works
FROM: D. C. Lawson
City Supervisor
DATE: . April.25, 1969
RE: Gertie Perrin, 18510 Meadowdale Road
(2nd building from southwest corner, Perrinville Intersection)
Notify Mrs. Perrin by registered letter that because of her expressed
inability to pay the Edmonds sewer charge in lieu of an L.I.D. ($461.09)
that the City will allow connection to the sewer and will have to place
a lien against Mrs. Perrin's property at this location. Because of your
report and other verbal reports indicating there is a possible danger to
the public health, I request you to not only notify Mrs.* Perrin, but see
to it that this private sanitary sewer is connected to our sewer system.
By copy of this letter, I am notifying the City Attorney of our action
and alerting him to the need of having a lien recorded as soon as he
gets notification from you as to the fee and the fact that the work has
been completed.
DCL: db
cc: City Attorney
Mayor
PROSPECT 6-1107
I
RECEIVED
CITY OF.EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER 14AMEINAME OF BU--JNESS
ADDRESS
CITY ZIP
_46AM-35-
NAME
ADDRESS
CITY ZIP TELEPHONE
NAME
ADDRESS
CITY ZIP I TELEPHONE
A
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS /0/0 Weir
376, Atee-
PLAT NAME/SUBDIVISION NO.
OT NO.
LID NO.
T
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Apprwed
RW Permit Requir &dL�;41
13
EXISTING e__
PROPOSED
Street Use Pennft Req'd
Inspection Required
REQUIRED DEDICATION "fe' FT
Sidewalk Required
Underground jf
WIrIng, requ ad M7
A3
METER SIZE
LINE SIZE
NO. OF FIXTURE
T ,
RV REQUIRED
YES C3 No El
3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/ RAINAGE JC, -0
1z
I&I
STATE LICENSE NUMBER EXPIRATIPN DATE
CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
-zz -7 z/ 000 le::� -7e--
7--
0 NEW
RESIDENTIAL
C] PLUMBING / MECH
ADDITION
COMMERCIAL
0 COMPLIANCE OR
REMODEL
APARTMENT
CHANGE OF USE
REPAIR
0 SIGN
FENCE
C3 GRADING CYDS El X FT)
DEMOLISH
E:] TANK OTHER
GARAGE
CARPORT
RETAINING WALL
0�rvcm� R RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
/,Q 6�,e law lvoxfA 4!±vdot-vL.Z,6 6�� �,qvt
J/41" %K- &w1dk* eeiress -
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. 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.
W PERMIT APPLICATION: 180'DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED.WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
U)
uj IN INTEREST, AGREES TO NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
_j I
2 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
DEEMEDTOMODIFY. WAIVE OR REDUCEANY REQUIREMENT OF ANY CITY ORDINANCE
0
NOR LIMIT IN ANYWAYTHE CITY'SABILITYTO E NFORCE ANYORDINANCE 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 AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OR AGT2KT) j - I DATE
ATTENTION'_--i1----
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI_
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
5/98
ENGI RING REVIEWED/DATE
/, !L—. �;/ I 9P L)
FIRE REVIEWED BY DATE Lu
5
LL
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
I PBOND
OSTED
OYREO'D
ES 0 NO
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
,
:Xp f/t 4�
ff�_
I IV C_
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
IV6_
0
3
z
z
PARKING
LOT AREA
PL�NNING REVIEWED BY DATE
n
REO'D PROVIDED
I a
1
Cl.
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I
I I 1;3c�'_'
-4111 71A,
CHECKEDBY I TYPE OF CONSTRUCTION CODE OCCUPAN
V _IV
1 7_ GROUP
SPECIAL INSPECTOR JARE�Z3, OCCUPANT _j
REQUIRED 0 YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
VALUATION I . FEE
PLAN CHECK FEE
BUILDING
PLUMBING
7' t ^A L)
STATE SURCHARGE
ENG. REVIEW FEES
0 0
K
INSEEC1*W4E
FIECEIPT
PLAN CHECK DEPOSIT /
TOTAL AMOUNT DUE
RECEIPT
-W-7. 's-D
APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
FOR INSPECTION receipt is acknowledged in space provided.
(425)
OFFICIALS SIGNATURE DATE
771-0220
dw - sji'l
'RiLEASMBY
DAYE
EXT 333
771-0221
ORIGINAL - FILE YELLOW - IN
FAX
PINK - OWNER GOLD - ASSESSOR