18925 88TH AVE W.PDF111111 lill 11
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18925 88TH AVE W
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DEVELOPMENT SERVICES CTR,l
CITY OF EDMONDS I
STREET FIL�
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
4C. Fax: 425.771.0221
The Critical Areas Checklist contained on thisfiorm is to
be filled out by any person. preparing a Development
Permit Application for the City 'of Edmonds prior to
his/her submittal of the application 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 Check -list should be easily
available from observations of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
Date Received: 14 �3 - 2-0012-
City Receipt#: ID q 11B 12—
Critical Areas File M
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant:
A property owner, or his/her authorized 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 statY in finding and locating the
specific piece of property described on this form. In
addition, the applicant shall include other pertinent
information (eg. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney.'s fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate. or
incomplete information furnished by the applicant, his/her/its; agents or employees. .
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT DATE
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agenito apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and postiii�atte da t cation.
SIGNATURE OF OWNER V- /,/A X DATE 4 1",
�JLEASE PRINT CLEAF
Owner/Applicant:
KENT- LIVLOITE-L
Name
P3 9 d 67 38 tk A V&
Street Address
Eb A4 ()/\I t)3 LA) A
City State Zip
Telephone: 7 PS - 3 B
Email address (optional): kENT.AJ5�HAeO&I19
CI leTI-1 L )A/ IC , N C r
Critical Areas Checklist.doc/3-19.2001
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
CA File No: lba -(Pq
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: 10ld-5 66��Are W &DA4()1VDS i LLA 96014
4,,-7/ 1-2
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet): 25 d 0 >! I I
4. Is this site currently developed? K yes; _ no.
If yes; how is site developed? _,S/ N& Le FAm tLy 140M ie
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 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: AJJ Approx. Depth:
7. Site contains areas of seasonal standing water: tA9 Approx . Depth:
What season(s) of the year? I -
8. Site Js 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?
AYA Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow -shrubs mixed
urban landscaped (lawnshrubs etc) A
11. Obvious wetland is present on site: A)o
Critical Areas Chccklist.doc/3.19.2001
Critical Areas Checklist CA File No:
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: 1.5lds 60t'111414� W &DM O/Vos UJA 60,�- 6
2. Property Tax Account Number: &f//V -_ d45� 4V�,
3. Approximate Site Size (acres or square feet): 6. ', 3dO �5(� F-T
4. Is this site currently developed? _K yes; _ no.
If yes; how is site developed? .,;IN&Le FA m i Lv t4om
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'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: &10 Approx. Depth:
7. Site contains areas of seasonal standing water: tj,? Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site contal'ns a creek or an area where water flows across the grounds surface? Flows are year-round?
Y—A . Flows are seasonal? — (What time of year?
10. Site is primarily: forested ; meadow ;shrubs mixed
urban landscaped (lawnshrubs etc)
11. Obvious wetland is present on site: A)0
Critical Areas Checklist.doc/3.19.2001
�_:Vw
Ile. I Y7 -
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax� 425.771.0221
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 the application 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 Check -list should be easily
available from observations of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
Date Received: . 14 `3 - �Z002-
City Receipt#: I 1:� 4 1-3 -2-
Critical Areas File M
Critical Areas Checklist Fee: $45.00_
Date Mailed to Applicant:
A property owner, or his/her authorized representative,
must fill out the checklist, sip 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 necess I ary 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 assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below. *
SIGNATURE OF APPLICANVAGENT DATE
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Ageni to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and postin 'attend
P4pt to cation.
SIGNATURE OF OWNER 7- /�'7� DATE--, ocy 7
PLEASE PRINT CLEARLY
Owner/Applicant:
KEW k1\1C-6HTE - L
Name
18 9 d 6- OR rk AVE (-J
Street Address
E13M0103 W 14
City State Zip
Telephone: qd-S - 715 - 35 61'
Email address (optional): keN iIJ5 �l A 9-0 �j
ei /eTo i ) iv K iv e r
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
Critical Areas Checklist.doc/3.10.2001
T
APPLICATION
The City of Edmonds for
SIDE SEWER PERMIT
EASEMENT No . ........... ..............................
CONSTRUCTION REPAIRS 0
OWNER ..... LAk ........... CONTRACTOR ..K.U.SS.p ....... ................ PERMITNA:!Z__ft>.l
...... ..................................... A. ................. ........... ...... . ..... CRI No
ADDRESS lei!2>2�5'_eI66 ............. LEGAL DES PTION: LOT ---
............... BLOCK No.._. .......................................
NAME OF ADDITION
.171 ------
14"504 A
V'C LAY-%_
ye�, p
7
FR=KllC*4 CiF S=w SwwwR.
Approved
DATE.. By ..... .........
. . ... .... . . . .. ................
NOTICE:
N:o---W-a r-r a nty ... OT -d-�utura:c
The information shown on the attached
Y of
Map(s) was compiled for use by the Cit
Edmonds/ its Employees and Consultants.
Th,e City of 'Ecim.onds does not . warrant the
these
accuracy of anything set for.th on . -
Map(�_). Any person or entity -requesting a
copy should conduct an Independent
-ation shown on
inquiry regarding the inform
-map(s), including, but not limited to, -h
th . e location of any sewer stub shown. Suc
sewer stubs may or may, not exist. and may
or may not exist at the location shown.
r�;ty of Edmonds nor its
Neither the
emp]-o-yee's o'r offi-ce-rs -shall'l be !Jab -'Fe for the
information given on this map(s), nor for
any one representation provided based
upon said. map(s).
SIDE SEWER PERMIT
CITY OF EDMONDSC.,
WATER�SEWER DEPARTMENT
PERMIT
Call 7,76-1107 for side sewer inspections BEFORE covering any Portion of the construction.)
(Inspection will be provided within 24 hours after request. No Sat., Sun., or holiday inspections.1
I , Vi.
ADDRESSLOCATION OF CONSTRUCTION .................................................................................... ......................... . .......................................................
..........................
PROPERTYLEGAL DESCRIPTION ............. ..........................................................................................................................................
................................................... . ................................................................................................ ................ ......................................................................................
....... ---- OWNER AND/OR BUILDER ....... LaTry ............................... . .......................................................
......................................
................................................... ...
CONTRACMOR'S NAME & ADDRESS ------------------------------------- .............. :f ............................. . ... .......... ....... . .. . ......... ......................................
Y n
d 0
Permission is granted ........... ......... ................... ---------------- 1 19 ........ I for repair and/or connection of a side sewer to the city sa itary sewer
system in accordance with City of Edmonds ordinances.
All \ rION IS CALT D TO THE FOLLOWING:
NO, ,No. 1—The o ners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer before it has been Inspected.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way PermJt obtainable from the City Engineer's office.
NOTE No. 3--Obtain full information regarding Ordinance 11. . 16.030 and Regulations governing side sewers when you get permit. No bends in grade
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line, and 12 inches inside property line; minimum grade of 2
sharper than % will be permitted.
NOTE No. 5—Trenches in street must be water settled and surface of street restored to' original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6—It is unlawful to alter or do any other work than is provided for in the permit,or to do an work on the main sewer or its appurtenances except to in-
sert the pipe into the wye.
..... . ..... --- ................
DISAPPROVED 0 Date --- - --------- -------- ------------ By ----------------- Date -------- BY....
By
z ------------------
......... ..............
0 . ..... ........... .......
APPROVED . .. .. ....
----------------------------------------------------------------------------------------------------------
Remarks: .................... ....... P .... ...... ------------------ ...
--------------- -------------
......... . ....................... ....................................................................... .... ...................................................................... .........
..................... ;�� ............ ;,!� -------
B TH rmit opi ST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
- -- ----------- ........................ .... hereby certify that the side sewer installation constructed under this permit
Owner o c ng Firm Grming Construction) C
d in c r nee wit governing ordinances of the City of Edmonds. Y
Dated this ---- 0/ ................. (lay of--e;6,!-:& -------------------------------------------
Check BEFORE you dig for: Water F], Gas 0, Telephone 0, Power E], Sewer E], Other E] V j
The City of Edmonds
APPLICATION
for
SIDE SEW= PFUMT
NEW CONSTRUCTION REPAIRS 0
OWNER4------- ------ ------------------------
ADDRESS
..........
11
No �
]EASEMENT No . ...............................
CONTRACTOR -- -----------
. 1-61/
................... PERMIT
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAME OF ADDITION
Approved:
RECEIVED
APR 6 1973
DATE--------------------------------------------- — By ...
The City of Edmonds
APPLICATION
for
SIME SEVIFM PFJ&AW
NEW CONSTRUCTION REPArRs 0
EASEMENT No . .............................
- -------------
OWNER ....... --------------- ...... . ... S7- -9
.......... ------------------------ CONTRACTOR- ---- �P�ERNaT �No
ADDRESS ........ DESCRIPTION: LOT No . ............................. ---------------- BLOCK No . ............................................
'r ---------------
NAME OF ADDITION . ----------------------------- ....................
Approved:
DATE------------------------------------------- ---- By --------- .................................. ...... --- ............
RECEIVED
JAN 10 1973
Ill ttint flol.tinn it' Tr., -i F,W:1n0,;
T'(*j r ly t. 0
'hereof' rer:c rdad rj /o 1
i-t, ni !)�-j o'' !;m,horul.'�h C0111 t'.
jashingt.oii, dt,�,,i -r I jQf'.1 1�n 1 1 ()WS
corner of'
Tract. 17; 0'. 'JI011(l -.11;i WHW
I.
lj,: I ; 11 r.1c:f. I.Al/i.ii CelA, I.0 ill
true poini, �r.P 'ir,in(j: f hwi (� i wif itl,�il
fj, j (tij., tj1p blus ldn(i 12f.j.?
reet, mor,3 i r I e s.,'s c, tt.o '�o : #1 iwe a I
Lj i- i
f i,.! j I d T rac F;Jst
316.59 fpjt. more' or .1 jss Lo thL,
.1
o 9:i ! A of,;; fhanue ;:orf-1) along
-said linE t-) -3 p oin t. E is' of 1-he pol,
n f
r ir:i f;cj t.henee WF3,gt 71ti.ql
eet, moi j :ir less fo tl�e True �`oi(.L :)t
:'L'
i r w i! rj
A�
xr.apt"th;J purfiori I y�,-j I .- o'
'f.e w 'kw W��Sf, 167 fe�-3f.
ie r o V, f,,j f )e t l' I P 'L,! R 9 -2rI
o *�hla !-:L,! o! Edinoiid
,or stiiept,� y z:r,-
0
0
NOTICE:
-a r -Y
N- w a n 0 a.c. -cu. ualw�
The information shown on the attached
map (s) was cOmPiled for use I by the City of
Edmonds/ its Employees and Consultants.
The C1tY of 'Edrn.onds does not. wa rra nt the
et forth on these
accuracy of anything s-
Map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform-ation shown on
tfi-:� -map(s), including, but not limited to, -h
th . e lociation of any sewer stub shown. Suc
sewer stubs may or may- not exist. and may
t at the location shown.
or may not exis
of Edmonds nor its
Neithel the City the
I -a-' I be 11a-b-1--e for
emp'l-o*yee's o-r office-rs -sh
information given on this map(s), nor for
any one representation provided based
upon said map(s),
PUBLJC WORKS - EMINEMING
ACTION REPORT
F I L E N9
SUSPENSE DATE:
Date: Time: File #
Attach
SUBJECT:
REQUESTOR: AOO
ADDRESS:
PHONE:
REQUEST RECEIVED BY:
TELEPHONE
CONTACT IN OFFICE
OTHER: r---1
RECEIVED BY: um
Pn[ITF Tn-
1578 �
=Yes
cNaflo
#
OPR
NAME
INIT.
DATE
#
OPR
NAME
INIT.
DATE
7X
2
7
3
8
1
4
9
5
1
-1
1
0
1
i
1
1
1
ACTION:
777-
7
/7
All Concerned Notified
Action Completed/File
F`7TER-OFFICE COMML-41C, IONS
'STREET FILE DATE January 11, 19 72
TO Harry Whitcutt FROM
I bill Mills
Building Official Assistant Engineer
FD- 41 - LITTLE-B
SUBJECT:
Building Permit Application for Larry Rogerson, AITBT9-2,53WNAN�(�.- W.
Permit No.
The Perm -it cannot be issued until the proper legal has been
obtained. S-9-70 indicates a 26-foot access easement along the
south line of Lot B for direct access to Lot C. The legal that.
this department is in receipt of does not reflect such easement;
Please advise.
WJN:mjf
LJPPE�R
C A.-rC H
BASIN DETENTION PIPE L1E11QTI1 cowrROL CArCH
(yr.NT) ) - 1� BAZtN
r— I' MIN , 2' MAY. COVFP, ---I �7
OLrrLr,T
CONTROC
5LOPE�
4'
70 0LrrL-FT
Lr
X (NI P RA-P OR
RUNOFF
SPREADER)
SYSTEM CROSS SECTION
SEE PAGE 3 FOR OUTLET CONTROL DETAIL
2' - 2' - (0" DOMP, A!- 6 " SPALLS 6L CCU -A-)
1'. 2' 3�' DEEP, VA'- LRUS�4ED ROCK
FROM
OLrrLE-r
CON-r1k0L
RIPRAP OUTLET
YVAZWED r-P-NVEL OU7FLOW TRENCR, MIN 10' LONG,
-rOP 4 -4* PE-PF= PiPE -M 15E Lp-v,L
-
FRCM
0 Lrr-, E7
CC)N-rRDL
-rH CA.P.5
4:* PF-RF Pips vvi
RUNOFF SPREADER OUTLET
STANDARD DRAINAGE PLAN
DETENTION SYSTEM
PAGE I OF 3
for -City of Edmonds
FnQinPPr-j-D.g Dept -
location '19925 8 th.Avp-kl-
plan by H-1 PIAIJS
phone-27R-7551
date- 9— 1 9—R7
DESIGN DATA
System Imperm Pipe Pipe Orifice
Number Area Diam Length Diargeter
I Sr /Ye
1-34-&� 18 -5-2-
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 resoonsibility
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.
P7
CITY OF EDMONDS
N '5n-V jL -3,9
SITE PLAN, SCALE: 1 20'
:z
I
:z
,All downspouts
.-and driveway runoff
shall be routed to
the detention system
and control released
into the open ditch
along 200th.S.W.
TO�C�pEt4 1�17L4
STANDARD DRAINAGE PLAN
DETENTION SYSTEM '
NOTE: DO NOT USE RUNOFF SPREADER ON SLOPIES;
OVER 15 PERCENT ( WITHOUT SPECIAL DESIGN )
PAGE 2 OF 3
53
q001)
ov
V�l
HILL PARK
i q a T H
r
, It
It
I co
60
�o
S T. -�,
166 80' F.
2 3 C ' S- 4
S- 40 - 68
7T I
. MAPLEWOOD HILL
ELEMENTARY SCHOOL
MEMO TO: Building Division
FROM:* Engineering Division
SUBJECT: 5
__0 6� 7;zl-
After review of the subject building permit application, we have the
following comments:
1) Connection to City water system required.
2) Connection to City sanitary sewer system required.
3) Right-of-way permit required for any work.on City property..
4) Driveway slope not to exceed 14%.
5) Back water valve required if downstairs plumbing is below
elevation of upstream manhole.
6) Water and sewer lines to be separated by 10 foot minimum.
7) Builder/owner responsible for containing all temporary runoff and
erosion on site and may not impact neighboring properties in any
way.
8) Construction hours from 7:00 a.m. to 10:00 p.m. on weekdays and
%^-^^ - — 4— C.nn � — t%n woiz�and-z and Widays.
I
16
00
ay. 200TH
0
:14
;DE ORO
In
e-VeNu--PL.
- : -li-ll-lt S. W. -0,
10
00
60
00
60 so 202 ND ST S.W.
F I
198 TH
/Alld PROJECT ADDRESS:
I PT
-AppLicATioN REMPT DATE: -Igv ewed
itial
Im, ti
y * 0
date)
I date)
Apr",
PLANNING WrR/SWR 11
ET
STREET
GMG
ENGNRNG
FIRE FUILDING
IAL
pAba�y/KMTnW/CM%o'C (Circle One)
S324=
-77
7--
PI 9 7T[/ 1777
VARIANCE/SEMCK_bLXJ�.����
717 ITII-11-IV
7r//F//
F1
7
CONDITIONAL USE PERMIT T/ T 77 -77T7-7 7 PIT
7 T/7 TFff 77
2
3
ADB 4um CHECM
117
77TIV
01-
4 :Qr
fit
OTHER ZONING REMENTS..
5
6
VEHICIZ ACCESS 77T/7T 7T7TRT17 TIT77777
/7TR7/
7
jGE p __(9!1 Site)
DRAINAGE PLV4 (On site) T[TFff Trl7Tl7U TITF179
8
PX: -
ILE
-K: T7TTff TITITITU Tff J-/
9
1
,IN
LEGAL r%VqMYT"TrN VFATPTC!AT.TCO)N
D 1 C 7T/77
TITI
7TFIT177
7
10
WIT CL=1M/DEDICAT1CNS
C
UBT P TE
P IC/P
C=MTE SUM MqNWTION IF NO LID#
12
/T
13
PLIkT/SUBDIVISICN REQUIREMENTS
2, 17
14
RIGjn,k_op_WAy CONSML)CTION pERMIT REM- P&I -I T/ 77 7r/ 1-77TR 7R777W
W/
pzND REOD FOR PUB1,1C IMPROVD-OM :X&O ..— ////// ///////// /////////
77TF7 77TTf7777 7777177
////////
77TfR77
j�;jj� �-00141;TTTr*1.9 & GROUND
16
WATER FIEU) OfEICKED
/ 77771-ff 77TTIT177
4-RTI-
STREET pAVINC, REQUTRED h 1771
7 T1 TF1 TTF1
17
A8
Cum Aw Gurm REw-TRED --------------
Lks A
wpm MMN
TER SIZE
LIM SIZE
CROSS CoNNECTICN INSPBCTICN REDD
W L ATER METER CHARGE REM
FIRE LINE CHARGE. REM S,P-RINKLER
OpM ITCH EaSTING
REM
SIZE
CATCH BASIN REM..
CN SITE PLAN
f,� SH10,10.10t 11Yuatu!1j7i!,: i R.
SFAU OPEN RUWFF
Lo
7T/7
7Tfl7TR7 7M= 7/7,
7TI77 77TTfTR7 77
77T/7 77T/7777 77
7T/U 7TU/
T17TI1111
r/T/7
TI-1 4w
///// I ///
rA
21
22
23
7=
'////// 24
7=
25
,//////1-26
//////////128
29
30
77W-1717 -
31
3 2
33
34
. —135
37
38.
40
CEIVED V
q IL -,PERMIT EXPIRES
�5 2-0 02
CITY OF EDMONDS
USE PERMIT
ZONE
12. NUMBER20N
'CONSTRUCTION PE RMIT APPLICATION,
_RF=�
j . 08 SUITFJAPTF
ADDRESS / q&?
10 1 ar5
.
OWNER NAME/NWE OF BUSINESS
PLAT NAME/SUBD[VISION1 NO.
LOT No.
LID NO.
kf--VT 4- 5HARW) 10,d EC H T k 4-
LID FEE S
MAILING ADDRESS
TIESCP Approved
1612 5 A Lj F
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Porffdt Required
Street Use permit Wd
EXISTING — PROPOSED--
inspection Required
Sidewalk ReWired
CITY ZIP
IF—
ITELEPHONE
qgo Do
qps - T's 3861
REQUIRED DE . 61CATION FT
UnderWound
Wiring required 13
M&ER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
NAME
YES C3 NO 13
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
z
z
CITY ZIP
TELEPHONE
NAME
ENGINEERING REVIEWED/DATE
ADDR99S-
Fl L R E REVIEWED BY DATE
CITY ZIP
TELEPHONE
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
REG D(
1PBOND
4TED
.8
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
C ES
]YE NO
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
AL�O%YED PROPOJED
HEIGHT
ALLOWE PROPISEI
1
PROPERTYTAX ACC�UM 0.
0/7 ob
1',811
9
EXP
NEW RESIDENTIAL PLUMBING MECH
LOT C V RAGE
ALLOWE
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED.SETBACKS (FF.)
FRONT. 11RISID . EAR
COMPLIANCE OR
ED
40= 26
iao_ I
ADDITION COMMERCIAL
CHANGE OF USE
PAIfKING
LOT -AREA
P G REVI E Y DATE
Ral W;,114
REMODEL 0 APARTME . NT 0 SIGN
REGOD PROVIDED
MG
15-22,02
[:] FENCE
REPAIR GRADING
CYDS X Fri'
P
REMARKS
[3-DEMOUSH TANK OTHER
0 GARAGE RETAININP.WALL
CARPORT 0 R6CKERY RENEWAL.
(ME OF USE. BUSINESS OR ACTIVITY) -
4. jryz-.
CHECKED By,
TYPE OF CON T
OCCUPANT
- .
.
)qION
GROUP
NUMBER 7
OF
NUMBU 00 -
DWELLING
CRITICAL
AREAS
0
M
�SPECIAL INSPECTOR
AREA'
OCCUPANT
LOAD
0
STORIES
UNITS
NUMBER'
REQUIRED YES
DESCRIBE WORK TO BE DONE
REMARKS"
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REG'D
WEPIACE �-XIST11j6- IQ F*C-* 1C.- W?IH
a
�yf= We AieGke, otiF,
VALLIATION
:08i6dotion'
FEE
Description
FEE
Plan C hot
HEAT SOURCE. F GLAZING % LOT
PLAN CHECK NO. VESTED DATE Plumbing
asse. Mechanical
THIS ilrk W:ORK NOTE' D.'TTHIS, PERMIT COVERS WOR kTO
t BE DOME ON PRIVATE PROPERTY ONLX ANY coms:TRuicnolill ON THE PUBLIC Grading Redording.Fee
ROMAIN [CURBS, SIDEWALKS, DRIVMAYS MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
t: Engr. Raview q! Surcharge
ty 6-
PERMIT APPUCA TION: 180 DAYS
PERMIT umrp i YEAR - PROVIDED WORK 18, STARTED WITHIN 180 DAYS En rAnipection
9 State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
traff,
'APPLICANT, ON BEHALF OF, HIS OR HER SPOIJISE,. HEIRS, ASSIGNS AND SUCCESORS c Mitigation Plan Chk Deposit
!j IN INTEREST. AGREES TO INDEMNIFY, DEFENQ AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM. ANY AND Fire Review Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF. THIS PERmrr. ISSUANCE,OF THIS PERMIT SHAIJI. Not BE
Fire Inspection Total Amount Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CnY8 ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Landscapelnsp. Receipt #
7/ow
I HEREBY ACKNOWLEDGE T14AT I HAVE READ THIS APPLICATION:: THAT THE INFORMAT16N
.
APPLICATIONA0PROVAL
GIVEN 16 CORREC`f� 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- CALL This application is not a permit until Signed by the
.
TION;. AND IN D61NG THE WORK AUTHORIZED THEREBY. No PERSON WILL BE EMPLOYED Building Official or his/her Deputy: an d Fees are paid. and
.
Ili VIOLATION-IDE THE LABOR CO DE. -OF THE STATE OF WASHINGTON RELATING'TO FOR.INSPECTION A recelpt,is ackritiMedged In space provided.
WORKMEITSf"RATIONI INSURANCE ANDRCW 18.27,''
OFjIbIALS 8 G DATE
DATE 1 (42
SIGNATUAEf("�#NiE�RbR AGENT) IGNE16 5)
�0/ 20
-771-02
RELEASE DATd_
ATTENTION 0292
IT 19 UNLAWFUL TO USE, OR OCCUPY A BUILDING OR STRUCTURE UNTIL V
771-0221
A FINAL INSPECTION HAS BEEN, MADE AND APPROVAL OR A.PERTIFI- I-n-A F1,F; INSPECTOR.
CATE OF OCCUPANCY HAS,BEEN GRANTED. UBC SECTION 109,.., FAX PINK - OWNER - GOLD - ASSESSOR
10101
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
CITY
Edmonds
t HO M
Legal Desci
(show belo%
Z
0
�-j
CL
775—
LHI*174KE
)tiofi of Property -'include all easements
or attach four copies)
Parcel A. Tract 42, Maolewoo
Gardens
U NEW
RESIDENTIAL
PLUMBING
E] ADDIALTER
COMMERCIAL
MECHANICAL
REPAIR
RETAINING WALL
E] SIGN
DEMOLISH
EIREMODEL
EXCAVATE
1:1 OR FILL
PRE -MOVE INSP.1
El COMPLIANCE INSP.
FENCE
0 1 X_"
swim
-POOL
WOOD STOVE/
INSERT APT.BLDG
El RENEWAL
NUMBER OF STORIES NUMBER OF
DWELLING
Two 1UNITS
;ATURE OF WORK TO BE DONE (ATTACH PLOTPLAN)
home
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.
Permit Application: 186 bays
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
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,.walve or reduce any requirement of any city ordinance
nor limit In any way the City's ability to enforce any ordinance
provision."
I hereby acknowledge that I have read this application; that the
USE
ZONE
PERMIT
NUMBER
JOB
ADDRESS 19925-88th Ave. W., Edmonds
LEGAL DESL�� CHECK
SUBDIVISION NO. 7LID
1
NO.
16
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
PROPOSE gn
U ±WA
SZ40 � dls�Q n Z
RIGHT OF WA CONSTRUCTION PERMIT REQUIRiDk----'
STREET USE PERMIT REQUIRED 0
SEE ENGI�EERING MEMO DATED
REMARKS
METER SIZE
BUILDING SUPPLY SIZE
FIXTURE UNITS
REMARKS
SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADB NO.
SHORE07E _0
VARIANCE OR'CU
PLANNING REVIEW BY
DATE
YARDS
FRONT SIDE REAR
HEIGHT
LOT COVERA E
REMARKS'
irew-e
CHECKED BY
JM
TYPE OF CONSTRUCTION
-7 Al
CODE
/ W-5
HEIGHT
2-5-1
SPECIAL INSPECTOR
REQUIRED
0 YES 0 NO
AREA
OCCUPANCY
GROUP
OCCUPANT
LOAD
REMARKS
r1)5,V2_ Ae_ /-m 64-)e
_Z� - 77PIll loez_ 3D_5
Z4
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADING/FILL
STATE SURCHARGE
ENERGY CODE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
VALIJAHUN I t-ht-
0 0 1 &V3
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 ana THIS PERMIT
state laws regulating construction; and In doing the work authoriz- AUTHORIZES This application is not a permit until
I n fo rm
au t hor
state I a
La n e jd
t'O g u'�
zed age ty and
ws reg U It ho rz.
ed thereby, no person will b , L r ONLY THE signed by the Building Official or his
,p employed In violation of the Labor
Code of the State of Washi -ton relating to Workmen's Com pensa- WORK NOTED Deputy; and fees are paid, and receipt is
t tj s r acknowledged In space provided.
I n Ins ranrd INSPECTION
SIGNAT E'( ER OU�AGOT) DATE SIGNED DEPARTMENT
OFFICIAL'S SIGNATURE DATE
CITY OF
—61
EDMONDS
7 "t 771-3202 -RELEASED BY: DATE
1',A'T-
� kA'
IT" �ARNTION
IS'URLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIII�
LtAMNAL INSPECTION HAS BEEN MADE AND APPROVAL OR 0 ORIGINAL — File YELLOW — Inspector
A CERTIFIC&-rE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102-78 PINK — Owner GOLD — Assessor
0
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