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19523 86TH AVE W.PDF8138 19523 86TH AVE W 't . ' CA FILE NO. Qq-Z-71 Critical Areas Checklist -------------------------------------------------------------- Site Information (soil shop o graphy/hy drology/vegetation) I - Site Address/Location: 19 5 7- '-> 2. Property Tax Account Number: 6 9 0 1- 001 - -5 �2-3 0 00.3 e_ I be 3. Approximate Site Size (acres or square feet): 4 4. Is this site currently developed? >:-" yes; — no. If yes; how is site developed? /*-i> O�J,T C-Oodco Kttj 5. Describe the general site topography. Check all that apply. Flat: less than 5-feet elevation change over entire *site. a_C_\rDSS S; X Rolling: slopes on site generally less than' IS% (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 33 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: NO Approx. Depth: _V_2!N_ 7. Site contains areas of seasonal standing water: __N_ _o; Approx. Depth: What season(s) of the year? AS, 8. Site is in the floodway C) floodplain —N0 of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? Flows are seasonal? 0 (What time of year? 10. Site is primarily: forested meadow ;shrubs mixed urban landscaped (lawn,shrubs etc) Uk%A,,N 04J13 SCAPE- 11. Obvious wetland is present on site: M 6 1=_chk-dw. Rev 1W03/97 City of Edmonds NAW CRITICAL AREAS CHECKLIST The Critical Areas Checklist contained on this form is to be filled out by any person preparing a Development Pen -nit 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 th� 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 infor m-ation (e.g., site plan, topography map, etc.) or studies in conjunction with this Checklis't 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: Le—e- \eJ. C"le-l-real- Name 19S2-3 36 Ave . LJ Street Address LJA 2, city State Zip Jj .15 - -1 -1 q - (o L/ -1 q Telephone SignatLde (3� - 2- 1 Date Applicant Representative: ---F - A U , -r Name 194 Z Street Address 1� � F4 C-, A S q,5 0 2— (, City State Zip 2 5) V8 — 02 Telephone W 0 (0 0 C-). ..... .......................... Signature Date creceptionyanakcad.doc (over) V 4 1 1. I - �) PC. 189 October 18, 1999 Lee Clement 1952386 th Ave. West Edmonds, WA 98026 CITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 DEVELOPMENT SERVICES DEPARTMENT Planning - Building - Engineering Subject: Determination regarding Critical Areas Checklist # 99-271 BARBARA FAHEY MAYOR Dear Applicant: Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City is located on the reverse side of the form (bottom of page). It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records. .............. IMPORTANT INFORMATION TO BE NOTED: PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR CRITICALAREASsnipy. The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a project -specific determination. You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED. PerTnit applications include the following: Building Permits Conditional Use Permits Subdivisions Variances Applications to the ADB* Land Use Applications Any other development permit applications. c: Rick Utt Enc: Critical Areas Determination * Architectural Design Board C:ReceptionUanakCRLTR.doc Thank you. Shada Graham Planning Secretary Incorporated August 11, 1890 Sister City - Hekinan, Japan '52 "-5 6 Edmonds, WA. 98026 ?�-R I-T )S,?Pl C)S.Tl 0 t-j -ro IZF-J>PtK u C�T- T--- WA b�-4 0 5 -T6 ITZ -To L-YN�4WOOD . , rE, RECE. IVED , A11111j, CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNJR;�NAME/NAME OF BUSINESS I I , MAILING ADDREi ) 1 �,2 �,41% wt CITY zip FELEPHONE 1 NAME ADDRESS 1142-4 CITY — M PERMIT EXPIRES USE PERMIT ZONE NUMBER JOB 10 PTO ADDRESS 9Z 5 60 7 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Permit Required EXISTING PROPOSED Street Use Pennit Req'd Inspection Required Skimalk Required REQUIRED DEPICATIQN_ FT_ Underg und wiring required METER SIZE, LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 0 NO C3 REMARKS OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE ADDRESS CITY ZIP TELEPHONE 6j-e�j�' W �* . 9 S zo ( 4 as� ;;is V STATE LICENSE NUMBER EXPIRATION DATE CHECKED Bd C7 -r P-q o' A) 4 cl-9 III If q PROPERTY TAX ACCOUNT PARCEL NO. Lu 4�0'9 o J M NEW RESIDENTIAL 0 ADDITION C]: -COMMERCIAL REMODEL APARTMENT XREPAIR GRADING CYDS C3 DEMOLISH TANK o GARAGE 0 ROETAINING WALL z CARPORT R CK'Ry (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: IL & NUMBER OF go z NUMBER OF DWELLING I o STORIES UNITS DESCRIBE WORK TO BE DONE of a- 0 601-15 C:] PLUMBING / MECH COMPLIANCE OR CHANGE OF USE C3 SIGN 0 FENCE X FT] OTHE 0 RENEWAL ENGINEERING REVIEWED/DATE FIRE REVIEWED BY DATE VARIANCE OR CU SHORELINE OR ADB# INSPECTION I PBOND REO'D OSTED 0 YES 0 NO SEPA REVIEW SIGN AREA HEIGHT COMPLETE I EXEMPT ALLOWED I PROPOSED ALLOWED I PROPOSED EXP LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED sETBAdKsLFT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR PARKING LOT AREA PLANNING REVIEWED BY DATE REQ'D I PROVIDED I I IV99 el�e-on M 10-/Ir-* CHECKEDBY I TYPE OF CQNSTFIUCTIC CRITICAL—, I V AREAS SPECIAL INSPECTOR JAREA NUMBER qSq- 2—T LJ REQUIRED C3 YES I M RIM PLAN CHECK NO: IVESTED 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 PERA4q.SION. PERMIT APPLICATION: ISO DAYS Lu PERMIT LIMIT* 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION LU ;APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF _j 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY -AND M ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENTOF ANY CITY ORDINANCE x 0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE 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 JN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORIMEN'S COMPENSATION INSURANCE AND RCW 18.27. SIGNAfbRE (OWNER OR AGENT) DATE SIGNED ATTENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI_ CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 5/98 W4 & -/J�7- ? ? 0 4, L C OCCU PANT GROUP 0 0 U CCUPANT Lu S U. z z REMARKS 0 z PROGRESS INSPECTIONS PER UBC 1 O"INAL INSPECTION RE0'Dj PLAN CHECK FEE BUILDING PLUMBING MECHANICAL GRADING/FILL STATE SURCHARGE ENG. REVIEW FEES ENG. INSPECTION FEE LANDSCAPING INSPECTION FEE PLAN CHECK DEPOSIT T61* AMOUNT DUE CALL, FOR INSPECTION (425) 771 -02.0 20 1 EXT 333 771-0221 FAX VALUATION I FEE R APPLICATION APPROVAL This application is not a permit until signed by the Building Official or his/her Deputy: and Fees are paid. and receipt is acknowledged in space provided. 79SALS SIGNATURE DATE .LEWIN &Y I--, DATE vORIGINAL- FILE - YELLOW- INSPECTOR PINK - OWNER - GOLD - ASSESSOR TE RECEIVED K EXPI RES /D/� 0 CITY OF EDMONDS USE PERMIT ZONE 1)) '!4 NUMBER CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT# ADDIU OWNER NAMEINAME OF BUSINESS PLAT NAME/tUBDIVISION NO. LOT NO. LID NO. �jq_ A um z MAILING ADDRESS LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING — PROPOSED REQUIRED DEDICATION— FT TESCP Approved E3 RIN Permit Required Street Use Pemit Roq'd E3 Impaction Required 0 Sidewalk Required 0 Underground WhIng required CITY ZIP TELEPHONE NAME C METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED YES 13 NO 0 Lu 3 a ADDRESS 9 REMARKS OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z z a z W CITY ZIP TEL�PHONE 1r-4j)1('Pjd-S, lip NAME� ENGINEERING REVIEWED/DATE ADDRESS CC z FIRE REVIEWED BY DATE w LL CITY zip fiA . 1 3 TELEPHONE 1 0 VARIANCE OR CU SHORELINE OR ADB# INSPECTION 0YREQ'D ES 0 NO BOND POSTED STATE LICENSE NUMBER EXPIRATIONDATE IS C— M (j 5 elMoo f—E V CHEFKEnRy S-- SEPA REVIEW SIGN AREA . HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED 0 W EXP I I C] NEW RESIDENTIAL PLUMBING /'MECH 0 0 ADDITION 0 COMMERCIAL o COMPLIANCE OR CHANGE OF USE C] REMODEL 0 APARTMENT C1 SIGN LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (FT.) FRONT SIDE REAR PROPOSED SETBACKS (Fr.) FRONT URSIDE REAR z z n CL PARKING REO'D I PROVIDED I LOT AREA I PLANNING REVIEWED BY DATE REPAIR C] GRADING C] FENCE CYDS X FT) , A M KS :te y 0- 14 162 WL" n DEMOLISH C] TANK OTHER z o GARAGE [D ROETAINING WALL CARPORT R CKERY RENEWAL &41V Ajo 9— :21-P CA� 11 i M (W7- .41 7- a (TYPE OF I)SE. BU6INESS OR ACTIVITY) EXPLAIN: ti" CHECKEDBY TYPE OF C2STRUCTION CODE OCCUPANT GROUFV NUMBER OF STORIES2, NUMBER OF DWELLING UNITS 3, CRITICAL (.Al ) AREAS NUMBER 100 SPECIAL INSPECTOR REQUIRED(:] YES JAREA OCCUTIANT' LOAD DESCRjBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D go —1 A L J-- -j VALUATION FEE PLAN CHECK FEE HEAT SP9RCE G, ING % OT SLOPE % N1 6 A BUILDING CH9CK N VESTED DATE PLUMBING MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL :3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE t: SEPARATE PERMISSION. STATE SURCHARGE uj PERMIT APPLICATION: 180 DAYS 0. PERMIT UMIT* 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION 0 APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS to ENG. INSPECTION FEE ;N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT RECEIPT a DEEMED TO MODIFY� WAIVE OR REDUCEANY REQUIREMENT OF ANY CITY ORDINANCE -j 0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* A CEIPT TOTAL AMOUNT DUE D I KREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL 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- CALL This application is not a permit unill-signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: an6lFees are paid. and IN VIOLATION OF THELABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27, OFFICIALS SIGNATURE DATE SIGNATZLIRE (OWNER OR AGENT) DATE SIGNED. (425) 0 - oo 771-0220 (VRELEiSE DATE ATTENTION EXT 333 /U� IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX ORIGINAL - FILE - YELLOW - IIIISPECTOR PINK - OWNER - GOLD - ASSESSOR - I '..., , � .. .. 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L . . , :: 1. - 1 . 0. 11 � * PERMIT UMIT: I �YEAR ':PROVIDED WORK IS STARTED LWITHIN'180 DAYS' . ... 'L ENG.'RqVIEW, FEES "L . . , ,:i.� . L . . . - I 11 . " .. , .. , I * , , I ! , , . e . : : , . ,� I - . - I . . 3 '. '', - " , : *..�. . I L . P .. � I.. .. I ., . , '... ,.: I, .: �':. : L �:.. . " . . . . . - . ., ;1 . . .. : , I . L.. .1 . . *, . .- '. SEE'BACK OF PINK PERMIT FOR, MORE INFORMATION , ':�L �..: . ;L I . .. . I., . 11 . I .. . , ,. 1. . -----7--7- - � . , . . .. . � t.L' . �% . . ..." . _ , _,., .4 . ''.. I � - , , . , . . 'i I 11 -1 . . .L �, 1� �. I , - (a .: I I . .. . L., %. ,, �, L, �_ .1 � .11.1 .� ' ' . ::�, , �:, , �: L , L I L 'A L " -HEIRS,;A S' � ENGANSPECTIONFE� �'.,�� L �;L. ��.' I I - . L . . . - , APPLICANT, ON BEHALF OF HiS.OR HER SPOUSE. S. IPNS AN6§066E66kS�l 1,;:�l '.. 1. %; ,� .. I I I _1 1. ... � . I I . 1 . , L I . .1� I ' L . uj :..IN INTEREST, AGREES TO INDEMMF'�L�D&END'Akb`,HoLb HARM4'ESS%THE1tI.`fY'd0 � , � - . . 1. . .. . 1� . . . . I - . I _j , L . . L , , ,, , . It'. 11 � . CA * I . ,_ � � I . .. PING ' .11 � 2 EDMONDS, WASHINGTON,. FFIr 7 : 'LAN , L - ITS 0 , ,IALS,,EMPLOYEES,AND,�G NT.SFROM-ANYANO , , ..; - %�_ L �� I I . . L I ; I I . . . . , I INSP Ti N FEE 'L, ., I . . cc .. , . � . . I I �� . . . 4 L . .. I I . ALL CLAIMS FOR DAMAGES OF WHATEVER NAtURE,ARiS�INGDIR�CTL'�OR�'IN61'R�C*LYLI:! : � < L . . . , L' I I . I , -_.'._ . I . I ;L ; � �. . . . 'L . I I '. L. . � q . L _ EIPT . x - FROM THE'ISSUANdE OF'THIS PE RMITASSUANCE:OF THIS.' PERMIT SHALL.NOT BE - ,� :- I �. .� REC - "' 0 DEEMED TO MODIFY, WAIVE OR,REDUCE ANY REQUIREMENTOF ANYCITY 0 1 It,: "L I ': ; :, L . I L . � . "ft. , RDIN N E - , 'L� I -'� � :'7 I.. I. I 1. I � I lA., q , L L : I I I ' _: " �;:,:L : ' :� ,�. . d / V.3 / S , :. _j ' L . . . I 1. . . .1 . . I I �L . 1. , .. I . .� PLAN CHECK DEPOSIT. - , '14, -4 - 7 �;, . I: 0 NOR LIMIT INANY.WAYTHE CITY!S ABILITYTO ENFORCE ANY ORDINANCE PRO L � �, , L , �' * ` : , . ...- -.1,4._.: - L I. � � % ,:' . L .: � - ,� I 1. % RECEIPT - L . , ., L L � - �4- �' �' : x - ��. . -, . I , .r �, VISION.", ,, � :'L� .t � 1'� , '. ; ' . �: ! , I ,.., L .. ., I . I I I L . " . I ' ' . � L '::;�..,' .. - . . � ... , � . 1. ow iiiiisess '', :'�. I- .' � .- . . . '. �.% s , 1, - I :11 JOTAL AM,O LINT DUE .1 �;� -I' . . ' 'L I.. . 11 f � J0 ;1 Z., nil I ZL: . .. . I I � �, ... I . . I : : ," � " L . - "'' _4 ' . I HEREBY ACKNOWLEDGETHAT I HAVE READTHIS APPLICATION; THATTHE JNFORMATION �. ; - I : , ,r: .. �. - .�, L" .. L �� . I . . . _ . ". - . , I . , .. . I L,L . :AP0L1CATid14',APPR0VAL, '. �, , ' L ., . , I I PLY AUTHORIZED AGENT. OF %., I . I I I I ' GIVEN IS CORRECT; AND THAT] AMITHE OWNER, OR THE D . . L 'r. ' ' ' ' I .1 .1 , , .� � , : L.. . . L I , , . THE OWNER. I AGREE TO'COMPLY WITH CITY AND STATE LAWS R . . I L EGULATING CONSTRUCm , I I. ."L`- - . This applicatio� is not a�per�nit until signed by the . . r . � L L L:. QALL � - � ' I . TION; AND IN DOING THE WORK AUTHORIZED THEREBY, -NO.P ERSON WILL BE EMPLOYED-, '�. , . ;. - Building 011,61af or hiather Deputy: and Fees are paid. and � . .. .. . . .. .. I , ; " "` , ' I 4 ' � I IN VIOLATIONOF THE LABOR 60DE�br,THE: STATE OF WASHINGTON 'RELATING , .1 ) I I . TO. . 0( k ANSPECTION - ,' receipt is ac�nowle�aed in'space provide& . , WORAMEN'S COMPENSATION.INSURANCE AND RCW 18.27. � � : ' � L:. I .'' . I . I �� L;L :,r,:, . , 11 , , ', " � . .. � . - I . - I .. . I... I % .4. - . . _ ., - . , � , .� I I .. I 11 I. I., I � - � I �L L% : , :, 't., . . . .L . E I L I L. . OATFE , i . . � ALS S'IGNATUR ; �` OFFICI . I , � 1. � 1. . I 1�1 I .6 'L :':� - � L I,': . . � � . - . . - � i - � ' ' . . . SIGNATUR ) L� , . . ' " _ , r,� . . I . L, � � I i ' . * E . � . � ''. , .1� . �:�,� I.,. I I . . � . I . I . E(OWNERORAGENT D 1, � (425) isles, : . . L ' �', .. �, :" % � , I 11 I I I --- � * . . � , .. . 1. L. LLL / i:y//l � 'I � �41 . I . I . .. . L . � I � L ' . , i- . ,, 1, .1 . I.. � I I I : : �/� . : I .. I : � - I . I 1 4-001 L L �,:, - i I � it :L . , ;��L I * ( ,3qn 'L �, I � - - 4 1 ..: . , , I I 11, I 1; I. - . I )22_'O'�L 1. . L ,,7�7,1 , 1. .., ... .. LEA 1) . I . _ � mm I . .. I . L � I , . I . .. � .1., L . D E .11 ..- I ,,, :.. 0 �. I .. . .L I 11 .1 ,. _ ,� I . I L 1, . .,� I I I . . .1 . .1 .I ,: . . . I 1 . - .1 . .L. '�. ': ATT8N . . . I.. ., .L: I � * I L . L I . L :.... .. . ,,, % ., I L �,4 TIOW � . . ' .. - . � I . � L . I . . . - EXLT M3 �' : �L: . . , � . I .1 . . : ., / : .. - CR I .. I L . I . I.. � " , :.,.� � " , ;, I I ,� ., . � .1 L I . I I .1 I 1. . , � . IT IS UNLAWFUL76 USE. OCdUPy AL BUIPING.-OR STRUCTURE.UNTIL L .11:�. . . , .� �_ . L . i � .. Id Q)_'j . . I - ... L I . . . . 1. . '02r2l'L I *,, 771", I .1 . . A-FINAONSPECT101"l HAS EN MADE AND.APPROVAL OR -A CERTIFI -,' .� I. � I I L r ot : . - L ' , L . I . I I . I . I .... - . ., __..�. �L ,� ORIGINAL - FILE e . CATE OF OCCUPANCY. HAS BEENL GRANTED. UBC SECTION 109 L ; � . YELLO 4s . 1. , j L �. !� L FA.)(",, . - ' - -ASS' . . . . PINK OWNER GOLD ESSOR L I . . � L - " � . . .. . � L I . � . . ,, .. I . . . I . . . I I . . ,� . 'k, 07- E RECEI D PERMIT EXPIRES 101/ ozcx�j .;7 CITY OF EDMONDS USE PERMIT ZONE 7CONSTRUCTION NUMBER JOB SUITEIAPT# PERMIT APPLICATION ADDRESS / 1 OWNER NAME/NAME OF BUSINESS PLAT NAME/81JBDIVISION NO. LOT 140. L�D NO. L D FEE CC W z MAILING ADDRESS PUBLIC TESCIP Approved 0 0 RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING - PROPOSED RW Perrnh Required Street Use Pemb Rsq'd Inspection Required CITY ZIP ttv"%o T LEPHONE 06 tf REQUIRED DEDICATION- FT Sidewalk Required 0 Underground rN A A. :a7l Wiring required 0 NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 0 NO 0 Ck 1;pc A CC W ADDRESS REMARKS z z 14] A J WNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z W CITY ZIP TELEPHONE NAME -S-Mye ENGINEERING REVIEWED/DATE ADDRESSA - 0 cc R FIRE REVIEWED BY DATE W CITY ZIP TELEPHONq z Lr 0 Dizrgrl U)A- mp U. STATE LICENSE NUMBER EXPITTIJN DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION REO'D IPBOND OSTED 0 YES E3 NO SEPA REVIEW COMPLETE EXEMPT SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED PROPOSED _j PROPERTY TAX ACCOUNT PARCEL NO. w o)— on i GID -u3 I , EXP. NEW 1zRESIDENTIAL E] PLUMBING /. MECH LOT COVERAGE ALLOWED REQUIRED SETBACn PROPOSED SETBACKS (FT.) PROPOSED FRONT SIDE FRONT LIR.SIDE REAR 0 ADDITION o COMPLIANCE OR COMMERCIAL z CHANGE OF USE z PARKING REO'D I PROVIDED LOT AREA I PLANNING REVIEWED BY DATE REMODEL 0 APARTMEN T SIGN REPAIR 0 GRADING 0 FENCE X FT) CYDS REMARKS DEMOLISH TANK OTHER �a Msl' Lf /A z o GARAGE RETAINING WALL 0 RENEWAL CARPORT ROCKIERY .5-4 4, I( LOL Ah'Adf CQ1)1,*1CAJf 17 = (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: CHECKEDBY YPE OF RfiION 1T IT Ca OCCUP ANT GROUP k NUMBER NUMBER OF CRITICAL uu SPECIAL INSPECTOR OCCUPANT OF DWELLING AREAS 7 1 0 STORIES UNITS NUMBER JAREA REQUIRED YES LOAD DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D A-) M MA zm' V 0 VALUATION FEE PLAN CHECK FEE HEAT SJURCE GLAZING % I P, :5 f SLOPE% BUILDING ,\ d dHE!,dK NO: VESTED DATE PLUMBING MECHANICAL 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 GRADING/FILL SEPARATE PERMISSION. STATE SURCHARGE s-b cc PERMIT APPLICATION: 180 DAYS uj Q. PERMIT LIMIT' I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ;N ENG. INSPECTION FEE W INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF _j LANDSCAPING 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Ir INSPECTION FEE IW x ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE _j RECEIPT PLAN CHECK DEPOSIT 3. -1r 0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- M. RECEIPT TOTAL AMOUNT DUE ;Lj D r 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 APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until sig� nod by the CALL TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid. and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. WONIMEN'S COMPENSATION INSURANCE AND RCW 18.27. OFFICI.ALJS SIGNATURE DAT NER OR AGENT) D4 SIGNED (425) 4>0 771-0220 %ELEASE D TE ATTENTION EXT 333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771 -0221 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI_ CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL - FILE - YELLOW - INSPECTOR FAX PINK - OWNER - GOLD - ASSESSOR 5/98