20118 80TH AVE W.PDF111111111111
7118
20118 80TH AVE W
NOTICE:
No warranty of accuracy.
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of 'Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
th-e -map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may'not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
emp-loyees or officers --,hall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
V
STREET FILE
9 0 9 01'�'
City of Edmonds
Critical Areas Checklist
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.
With a signed copy of this form, the
applicant should also submit a vicinity map
of the parcel with enough detail that City
staff can find and identify the subject
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information or studies in conjunction with
this Checklist to assist staff in completing
their preliminary assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Applicant Representative:
Narne Name
Title Title
Street Address Street Address
City, State, ZIP Phone —.,--City-�S,tate, ZIP Phone
Signature Date Signat�ra/ Date��/i
Critical Areas Checklist
Site Information
Project Name: Permit Number:
r
SiteLocation. operty Tax Account Number:
71 :15 -�02,fO -.�9622 - ,ezo.
Approximate Site Size (acres or square feet): Slo " >- --, " —7�� / -" 4-
Have you filled out a Critical Areas Checklist for a project on this site before?
General Site Conditions 0
1. Has the sl , te been cleared or logged? Date of most recent action: I
Soils / Topography /,&. "-'� C;:o I ;�"'?
2. In the Snohomish County Soil Surve*y, what is the mapped soil type(s)? 17./i. �IA J-) A to� 0/0
2 --7 cp
3. Describe the general site topography. Check all that apply.
Flat: less than 5 feet elevation change over entire site.
L-l"O'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 of horizontal distance.)
steep: grades of greater than 30% present on site.
Comments
Hydrology[Vegetation
4. Site contains areas 6f year-round standing water: e",
5. Site contains areas of seasonal standing water: prox. Depth:
6. Site is in the floodway A,4--/ floodplain f a water course.
7. Site contains a creek.or an area where water flows across the grounds surface? A- ��flows
are year-round? Flows are seasonal? Z-2
8. Site is primarily: forested meadow. shr . ubs _;mixed
9. Obvious wetland is present on site: :��
10. Wetland inventory or map indicates wetland present on site: �20 -
1. Critical Areas inventory or map indicates any Critical Area on site:
.......... .......
-For City Use Only - ------------------------------------ - -
------------ --- - --- - ------------------- - -
STUDY REQUIRED: Critical areas study is required.
qONOITIONAL WAIVER: Critical areas study not required if specified conditions satisfied.,
WAIVER: Critical areas study is not required.
Determination Number. Reviewerc
Planner D L
R e Y �3 17.71`9 21
�2011 3.
C, �) c e,-- 0/,: - - , 7 t- - - -
Al
CITY OF EDMONDS
....... - (206) 7 71-3202
200 DAYTON ST. - EDMONDS, WASHINGTON 98020
OFFICE OF THE CITY ENGINEER
May 26, 1983
Occupant
j%,
AV,'61 WT-z!)
Edmonds, WA 98020
Dear Occupant:
HARVE H. HARRISON
MAYOR
We are in the process of finalizing a design and speci-
fications for the storin sewer line between 80th,- Ave. W. and 81st
Ave. W. that will run under the northerly ten feet of your
property.
If you desire to review the plans and specifications before
we advertise for bids, please contact Gordon Hyde of our office
before June 7, 1983.
We expect to award the bid prior to June 30, 1983. If you
have further questions, please contact Gordon or me at 771-3202.
GH/ml
HYDE
IT,
Sincerely,
S E. ADAMS, P.E.
City Engineer
THIS LETTER WAS ALSO SENT TO THE RESIDENTS ON THE ATTACHED
LIST.
FILE
21TY OF EDMONDS
PUBLIC VKM — EMINEERING
ACTION REPORT
N? 1564
ki
SUSPENSE DATE:
Date: 10/22/82 Time: '9� 15 am File #
Attachments: =Yes
MNo
SUBJECT, Needs to talk to you about the storm drain
which is not draining properly at her residence.
REQUESTOR: NAME: Mary Jane Gossard
ADDRESS: (2—'C[,1j8:-80th
PHONE: 223-1200, e)ff-. 230 (wo—rk)
REQUEST RECEIVED BY:
TELEPHONE Nil
CONTACT IN OFFICE
OTHER: —
RECEIVED BY: M. LeVan
OEM
mom
MEMO
ACTION: hez- -/�, -2qvvZj:::,� 79L /25�"O
All Concerned Notified
Action Completed/File
CITY OF EDMONDS '00"REE"I" FILE
PUBLIC YVORKS DEPARTMENT
RIPHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Construction
Owner: to
Name
12,422
Mailing Address
City, S ta te, Zip Code
Permit No. i�
Issue Date
i I I I �
0 Permit Issued To:.,1]C-'
e Type of Work robe Done: L 1 t�
0 Work in Connection With:
0 Subor Plat 0 Single Family
El Comml. / Ind. El Apt. Condo.
0 Pavement Cut: 11 Yes El No
Contractor: OM's I'm -4cklr�
Name
2 2 0LB15,30 3171`0
3, — 0 1
Mailing Address State License Number
773 3124,
City, State,, Zip Code Telephone Number
U
,;:3
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
0 INDEMITY: 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, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of it's departments or employees, including or not limited to the defense of any legal
:2 proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
0
U
W Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of on, yea.
PQ following the final inspection and acceptance of the restoration by the Engineering Division.
0
E-
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this,'perm!' 'Must be available at theJob site for inspection purposes at all times.
Signaturq�;
Owr &i*Tien`r
THIS PERMIT MUST BE POSTED AT THE JOB SITTOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued BY: f2
Time Authorized: Void after
days
Special Conditions:
0
Ammendments:
Permit fee: Q
Security Deposit:
Receipt No.:
Fund I I I Fee:
Street Cut Dimensions
X
NO -WORK TO BEGIN. PRIOR PERMIT ISSUANCE
M79MMU-70-4,
4NA,
11'0
I Eng, Div. December 07ii
J
Encr. Div. December 1978
CITY OF EDMONDS
qq'-f PEET - FILE-, , ASSET INFORMATION SHEET
El ADDITION
0 RETIREMENT
ASSET NO.
ADDITION TO ASSET NO.
foperst at.
OCITY df -omdN
Fov or
DESCRIPTION
Ll / 0-k z / AJ
SERIAL NO.
1 LOCATION DEPT. 4rO.
2o14 cj
"PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
*PROJECT NUMBER 1"C)v ;na 00
PROJECT COMPLETION DATE - ��--_R_
COST Z,? /' '2 f
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
K'
VERIFIED BY
ECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
DATE
PROCESSED
BATCH NO.
INITIAL
bl-P)
DEPARTMENT FILE
Z
U
0
U
0
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LU
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CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
Rl�iHT - OF - WAY CONSTRUCTION
A. *Address or vicinity of Construction
20118 80th West.
Owner: Hofto Homes
Name
12422 Possession Lane
Ma'li Address
19onds, Wash 98036
City, State, Zip Code
-Wmit No. 8,R -83
Issue Date
FLE
0 Permit Issued To:
• Type of Work to be Done: AspLLI+ hEiy-quz�
• Work in Connection With:
11 Sub or Plat 0 Single Family
El Comml. / Ind. El Apt. Condo.
• Pavement Cut: 0 Yes El No
.a C—rr—rnro Olds Olympic Inc. dba Echs Paving
Name
P.O.Box 180
223-01 OLDSO 317BO
Mailing Address State License Number
Lynnwood, Wash 98036 778 3124
City, State, Zip Code Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMITY: Appi icant 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, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that thi 4perm must be available a�ttphe 'ob site for inspection purposes at all times.
Signatur Date
0 er or Agent
THIS PERMIT MUST BE POSTED AT THEJOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By: a. (
Time Authorized:
Special Conditions:
Ammendments:
Void after v&94�0
Permit Fee: 5c) , 0 0
Security Deposit: !?/±
Receipt No.: —,55�
Fund I I I Fee:
Street Cut Dimensions
X
L
FEB 4 1982
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
CITY OF EDMONDS
PUBLIC WORKS DEPARAT
SIDE SEWER PERMIT
FOR INSPECTION CALL Permit 140,
775-2525 Ext. 220 Issue Date//
PEP -MIT MUST BE POSTED ON JOB SITE *. q
1.
Address 0 nstruction
2.
Property Legal Description (include all. easements)
a-Mm=
U.
�- 0 -F &) -�- P- -3 — (5 / -to *-3 WI;X11 .
I
3.
Single Family Residence vl�"Multi-Family No. of Units
Commercial
4.
Owner and/or Builder 4e73�-�7�
5.
Contractor & License No.
6.
Invasion into City Right -of -Way: No V.,�Yes (If Yes Right-of-
way Construction Permit Required Call Dial Dig (342-5344) before
excavation) .
E-1
7.
Cross other private property: Yes NoV,,�Easement required -
attach legal description and county easement number.
Q4
READ THE POLLOWT,.NG AND SIGN:
a. Property owners must obtain a permit to install side sewers on
their property. A licensed side sewer contractor must be employed to
construct side sewers in the public' right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
c. Commercial establishment requires a minimum of a six inch (6")
side sewer line.
d. Side sewers may not be installed closer than thirty inches (30")
to any structure. 0
e. Side sewer lines must be laid at a minimum grade. of 2% (1.15
and maximum grade of 100% (450). 0
f. No turn in side s8wer greater than 45 (1/8,bend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is require d for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k.. Side sewer must be left uncovered until inspected and approved
by the City.
1. In ction during normal working hod only. Two (2) working
C
N :pe
days noti required.
DATE,: A
14
c�t.,.,y that I have read
and shall comply with the above
PERMIT FEE: DISAPPROVED BY: Date..
Ar By: P Date:
CONNECTION FEE: APPROVED By���� Date:,/rqe. FA-
0
r%4 * PERMIT MUST BE POSTED ON JOB SITE
The City of Edmonds
Side Sewer Drawing
EASEMENT NO . ............................................
NEW CONSTRUCTION REPAIRS LID NO. NO . ..................
7f 16-
OWNER ......... ....... CONTRACTOR ..... . ...............................
........................... �,.00 e--5;- -'o /
... ............................... PERMIT NO. A..g ..........
JOB ADDRESS ..... ........................ LEGAL DESCRIPTION: LOT NO . ............ 2
......................... BLOCK NO . ....................................
-3
..................................................................................................................................................................
NAME OF ADDITION - - /7/� 7ZA4
0
0
41
..........
""p vc
I
PWW-0001-11/75(REV.11/78) DATE ............ I ........................................
STREET FILE
CITY OF- EDMONDS
CIVIC CENTER EDMONDS, WASHINGTON 98020 (206) 775-2525
COMMUNITY DEVELOPMENT DEPARTMENT
January 15, 1982
HOFTO HOMES, INC.
12422 Possession Lane
Edmonds, WA 98020
RE: CHANGE'OF ADDRESS
Due to an error in as . s . Agning the.address for.the new
.residence.being built on Lot 2'of Hofto Addi , tion,
we will need to change. -the address from 20114' -
80th Avenue W. to 20118 - 80th.Avenue W.
We wfll notify the city's Utility Billing Department
but it will be your responsibility to notify other
concerned parties of this change.
C�M4-
Harol'd Reeves
Building Official
cn
cc: Utility Billing
Street File
HARVE H. HARRISON
MAYOR
46
r CATC-H SASIX:
&M5 4b1S-30(01L rR9r,4cw LwNr.-rH
WQUAL)
19
J01530(01L
UAL)
N
-Cavrn-b
. . ............................
................................ . ..........
A
-nc. UW1Kr LCVWI-
PFIRLF 1PIV./ CAP
ra"TEE W/ (-"LONG LEGS
SYSTEM CROSS—SECTION
IT lkssc" covr=pl -
3/4 VYASW E D
GRAVEL
do" DIAM MRF P1
TRENCH CROSS—SECTION
STANDARD DRAINAGE PLAN
INFILTRATION SYSTEM
PAGE I OF 2
for
PA-0 P
location :4—'0 -MV
z0o"k 9=>V%-0,W10e;P
plan by ftoy—VID
phone 7A: 5 -700-7
date--11- 4- - "91
DESIGN DATA
Trench Perc LF per Imperm Trench
Number Rate 1000 sq.ft. Area Req.
I P
1. 1 1 �� 13
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). Preventive
maintenance consists of preventing
soil and other materials from entering
trench during construction as well as
after construction. Catch basins should
be cleaned of floating material and
sediment at regular intervals (at least
twice per year).
I;t . �4t,-
CITY OF EDMONDS
05/
70 /
L-O+ 4- 2-
��'b 4�(jc_
OCT 2&RECb
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F
-CITYC oil
IL ROD :..-AM HiN, T021
7:
ing
YRE%P�Y I'lEll'] DATE.
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SIGNED -
'PLEASE
REPLY:�
I �tl
I -I le —
A.,
F ORM NO. ME�� i�T
EPLY.
-R
-ART-1-IS'RETURNED WITH'
SEN D 'PARTS 1 AND 3 WITH CARBON�.INTIKT,_
(address)
Street Ri&ht-of-Way Existin&_
REQD
Z
Access Easements Existin
REQD
Utility Easement Existing _
94
Lot Per'Subdivision Plat
Assessor Map jlef
Site Plan Checked for Accura
Z
Underground Wiring Reqd.
0
Check Accuracy of Legal Desc ption 4aAl
_7
4-�,
'Date
Z
Review by
4141
JV
Existing Water Main Size ,4ey
Water Main Required
Service Line Required
Hydrant Size Existing
P�
Hydrant Reqd Per Fire Cod
Size
Detector Check Vileter Reqd.-
Cross Connection Inspection
Fire Departmant Conuients-
4at ��ter Charge Reqd. 4 4�3-6.0
'er
41
Review by
D a t e 11Z 17 9'/
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit Ne.
Sanitary Sewer Availability
Proj
Drawing No. AaQ
Side Sewer Availability N(& or4�
3S;'-7i
Sanitary Sewer CoWection Fee Reqd.
Review by_ 46MA
Date &i*_
Open Ditch Existing xp
Reqd.
Culvert Reqd. Size
c4
Catch Basin ReqdJ
Indicate on Site Plan
0
Shoulder drainage maintain. collection on
swale open,runoff
1�- A n
olelf Jr?e_q__dr'c'
�Im-ih e Y
Indicate on Site Plan . ... ..............
Soil Conditions and Ground �ater Field Checked �'/,z
Review by_Z,2iA6 1IL:2
Date
Revised: lvlO-1977
t4-
All"
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MEMO TO: Building Division
Community Development Department
FROM: Engineering Division
Public Works Deparmenc
SUBJECT:
-201-L41- 80
After review of the subject Building Permit ApplicatidnV Whave
the following comments:
1, Connection to City water system_required.
2. 'Annection to Citv sanitary sewer system requVed.
1, akht-of-wav Permit rqquired for any work on City property. -
4, arivlway slope not to exceed 14%.
5. Backwater vnlve required if downnairs plumbing is below
elevacion of upstream manhole.
6. Water and sewer lines to be separated by 10 foot minimum.
7L" —/O�,
;,,/ el
/0,
0
(j Signawre
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3; 4�,
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PUBLIC WORKS DEPARTMENT
BUILDING PERMIT REVIEW
FILE
1---Single Family
ST R, E ET
Multiple
Commerci al
BUILDING ADDRESS ��O//9z)/ CIO
BLDG. DEPT. SUSPENSE,DATE
INITIAL
DATE
JTE: OFFICE ADMIN. —' PUBLIC WORKS LOG IN
CITY ENGINEER (check)
0 Access Slo�e and Vehicle Access
Dr'ainage Plan
Street File
Legal Description
OQuit Claim
ElEasement
IJCalculate Sewer Connection
WATER/SEI�TER DIVISION
tB-Determine Meter Size q5- e-�
Z-/
10 Complete Buildina Permit Review
STREET DIVISION
�'-XComplete Building Permit Review
I
C]OFFICE ADM IN. LOG OUT TO BLDG. DEPT.
a
zo a M 0 am am En —mmum
= a = a = : : : wo = 00 = um om an MM om MW am 0 M am M CM M SM 0= a MW MM M
a-�`UILDING PERMIT APPLICATION (COMPLETE) cl 11)12 L�/-4-/
OPIES OF SITE PLAN
13 2 COPIES OF FIRE PROTECTION PLAN
"' krrLV1UUbLx KhVitwto by tiKt I)Lel.)
0/'3 COPIES OF DRAINAGE PLAN WITH CALCULATIONS
REQUIRED BY SUBDIVISION 0
GREATER THAN 2,000 SO. FT.
IMPERMEABLE SURFACE
LESS THAN 2,000 SO. F-1.
F0�oCK ZONING REQUIREMENTS (SETBACKS)
COPY OF ENGINEERING CHECK LIST
I/COPY OF PUBLIC 14ORKS MEMO
MULTIPLE OR COM1MERCIAL
YES E] ATTACH COPY OF ADB APPROVAL INCL. ALL DTW,TI
NO�
13 SUBDIVISION — YES[j NAME
DATED RECORDED
NUMBER
NO (ATTAq�i COPY OF REQUIREMENTS)
0-�HE CK SEWER DRA14ING AND ATTACH COPY -Ae411V1
El IS DEDICATION REQUIRED YES[] (OBTAIN QUIT CLADI)
CITY CODE
NOIZI
'Q/D
OES CITY HAVE EASEMENT ON PROPERTY
YES: .(AT;-TACHICOPIES OF DRAWINGS)
0
:�Cf *Cy, GAL"'ACCESS I N Gq� �S UTILITIE�ff
YE YEsz
NO NQ
BEEN PAID
JzfHAS,�',-'SEWER "'AS SE S SMENT
L.,I. NO
�';�'-PLAT:. 140
NO�
7R.J., L
IF,?',,,M LTI� ',.;IINCLUDE�NUMBER 6F�UNITS�
E
I C OMME RC I AL I
NCtUDE NUMBER OF FIXTURE UNITS
-C411-
41
.1 CITY OF EDMOIWS
BUILDING PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
HOFTO HOMES, INC.
Cj MAILING ADDRESS
z
12422 Possession Lane
0 7EI -Ty ITELEPHONE NUMBER
Edmonds, Wa. 98020 743-7507
U
W ADDRESS
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0: CITY
<
USE PE T=V
ZONIS.- (3 N -0 R
ADDRESS Ile ,
_�gom
LEGAL OESCR'IPrION I SUBDIVISION ORT SUB NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING 40
PROPOSED 11�0
DEFICIENCY OF RIGHT OF WAY 0
CHECKED BY I SEE ENGINEERING MEMO DATED
REMAR�S
ELEPHONE NUMBER rA I
NAME
HOFTO HOMES, INC.
ADDRESS
u 12422 Possession Lane
M CITY TELEPHONE NUMBER
z Edmonds, Wa. 98020 743-7507
0 STATE LICENSE NUMBER [ITY LICENSE NUMBER
U
Er
R SIZE I BUILDING SUPPLY SIZE I FIXTURE UNITS
REMARKS
SIGN AREA ENV. REVIEW I ADEI NO
ALLOWED PROPOSED OMPLETEI EXEMPT
I IC I .
SHORELINE
Legal DescriRtion of Prope ty
L
B ovv or Attach Four Copies)
el
fioj
I
I i
VARIANCE OR CU
PLANN EVIEW B_
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0
YARDS
RONT
2-5
IIL
SIDE REAR
LOT
07T
cr
I
REMARKS
u
In
W
Ili
W
I
RX NEW
RESIDENTIAL
PLUMBING
CHECKED BY
OF CONSTRUCTION
CODE
NON-RESIOENTIALI
MECHANICAL
ITYPE
I
F1ADD
DEMOLISH
SIGN
SPECIAL INSPECTOR
REQUI RED JAREA
OCCUPANCY
GROUP
ALTER
EXCAVATE
OR FILL
FE14CE
x F-T)
El YES NO
REMARKS
REPAIR
CRE-MOVECINSP./P.
0 MPLIAN E'INS
SWIM
POOL
1-�
z NUMBER OF STORIES
0
NUMBER OF
EL LING
U U ,
NITS
NATU RE OF WOR K TO BE DON E tATTACH PLOT PLAN)
Ir
U
In Single family dwelling
W
0
ID
0
I
PLAN CHECK FEE
I
VALUATIO
MBUILDING
__jPLU.1a.NG
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FENCE
marquees, etc.) will require separate permission.
SIGN
Permit Application: 180 Days
;.Permit Limit: 1 Year - Provided Work Is Started Within 120 Days
RETAINING WALL
0
0
"Applicant, on behalf of his or her spouse, heirs, assigns and
SWIMMING POOL
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successors in interest, agrees to indemnify, defend and hold harmless
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the City of Edmonds, Washington, its officials, employees, and
agents from any and a 11 cla 'Lrns for damages of whatever nature,
I
arising directly or indirectly Troin the issuance of this permit. Issu-
permit shall not be deemed to modify, waive or reduce
TOTAL AMOUNT DUE
ment of any city ordinance nor limit in any way the
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City's abi ity to enforce any ordinance provision."
ATTENTION
I hereby acknowledge that I have read this application; that the in-
formation given is correct; and that I am the owner, or the duly author-
THIS PERMIT
ized agent of the owner. I agree to comply with city and state laws regu-
AUTHORIZES
tating construction; and in doing the work authorized thereby, no person
ONLY THE
willbe employed in violation of the Labor Code of the State ofWashingto
WORK NOTED
relating tgWorkmen's C9.a)pejsation Insurance.
sIGNAT ��(pWNELR A�EVJL)
JDATE SIGfED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
THISgITE IS LOCATED IN THE CITY
775-2525
OF MONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
.�kTT,ENTI ON
I T� . IS,�UNL . AWFUL TO USE OR OCCUPY A! BUILDING OR S7RUCTURE
'UNTIC; A FINAL, INSPECTION HAS BEEN'MADE AND APPROVAL ORn
A�CER*TIFICATEOF_OCCUPANCX HAS BEEN GRANTED. UBC 304, 306.VC
T 2 8 RECD,-
jt
HEIGHT
OCCUPANT
LOAD
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 pro-
vided.
DIRECTOR'S SIGNATURE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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