20209 83RD AVE W.PDFiiiiiiiiiiii
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20209 83RD AVE W
APPLICATION
STREET FILE for
T�e City of Edmonds SME SEWM PEBBUT
NEW CONSTRUCTION REPAIRS MASEAlpNT No.
��W, IL �
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OW74ER ...... ........................ CONTRACTOR ......
PERlArr No .... ..
ADDR=S ... . ..... 'BLOCK No. — ........ ................................
.t ... A.AlE, ....... 1o.0J.i.... IYGAL DESCRIPTION: LOT No . .....
NAMEOF ADDITION ............. ........... ........................ ..................................................... . ...........................
APPROVED
APR 21 1970
Approved:
DATE ... y -.." .................
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CITY OF EDMONDS Call PRospect 6-1107 when work
CIVIC CENTER — WATER -SEWER DEPARTMENT is ready for Inspection. (No InsPee,
SIDESEWER PERMIT tions Saturday, Sunday or holidays.) N2 3674
--- d Avenue. We-51 ----------------------------------------------------------------------------------------------------------------------
ADDRESS ---------------- ---Ur
OWNER. J. R.. Hol m --------- ------------_------- CONTRACTOR ............. Ly-n.r%wQ.Q.d ... $.Pmer ..............................
----------- le .... an -----
Permission is granted ....... April-.21 --------------- 19 ---- 7.0, for ------------------------ days to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners 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—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%.
No bends In grade sharper than % will be permitted.
NOTE No. 4—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. 5--it is unlawful to alter or do any other work than is provided for In the permit, or to do any work on the main sewer or Its appur-
tenances except to insert the pipe Into the wye.
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13"I"REET FILE
Critical Areas Checklist'
Site Information
Project Name: Permit Number.
Site Location: Property Tax Account Number:
IaO EA-TtZATAt-ee". bill. 2
Approximate Site Size (acres or square feet): �,-t
Have you filled out a Critical Areas Checklist for a project on this site before?
General Site Conditions
1. Has the site been cleared or logged? N 0 Date of most recent action.
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)?
3. Describe the general site topography. Check all that apply.
--2�--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.)
Mr. slopes present on site of more than 15% and less t1m 30Yp ( a vertical rise
of 10 feet of horizontal distance.)
Steep: grades of greater than 30% present on site.
Comments 0 rJ j F G, -f Lpca4�on
Hydrology/Vegetation -
4. Site contains areas of year-round standing water.
5. Site contains areas of seasonal standing water. — NO Approx. Depth:
6. Site is in the floodway floodplain of a water course.
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City of Edmonds
critical Areas Checklist
Thr- Qitical 4ZeaS Ch . eckliSt 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.
Ile Purpose of the Checklist is to enable,
City staff to determine 'whether any potential
Critical Areas =-or may be present on the
subject PrOPCrW- The information needed to
con"Plete the Checklist should be easily
available fi-OM observations of the site or
data available at City IUI (Critical Areas
inventories, maps, or soil surveys).
An applicant. or his/her representative
,. must
fillout the chocIdist, 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:
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Narne
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Street Address
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City, State, ZIP Phone
/10� - 1'�) " _� �_ -L- C,, - 9 -3
S ii�t, !_ Date
Applicant Representative:
Name
Title
Street Address
City, State, Zip
Signatui-e
Phone
Date
0
NOTICE:
N�owarranty of
The -information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of �Edm.qnds does not . warrant the
�accuracy of anything set forth on these
a
rnap(�_)- Any person or enti
copy should conduct an independent
inquiry regarding the information. shown on
tF�e -m a p (s) , including, but not limited to,
th-e 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
ernpto-yee-s o-r office-rs be lla-b-'Fe for the
information given' on this map(s), nor for
ion provided based
any one representat'
upon . said map(s).
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RF-CF-IVED
MAR 1 5 1993
PERMIT COUNTER
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STREET FILE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE5PAMEINAYE OF BUSINESS
MAILING ADDRESA -,4
,� C) '? o �P.
CITY ZIP TELEPHONE NUMBER
17 2,0(-,9,Z 5
NAME
NUMBER
PERMIT
NUMBER
ADDRESS 20 Z09 /j ,YITEIAPT.1
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCIP Approved
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EXISTING REQUIRED DEDICATION
RW Permit Required 'd
Street Use Permit Req
0
0
inspection Required
0
Sidewalk Required
0
NAME
S:W- i�,, zA
ENGINEERING MEMO DATED REVIEW BY
ADDRESS
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11-2.2
METER SIZE
BUILDING SUPPLY SIZE
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0. OF FIXTURES
CITY ZIP
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TELEPHONE NUMBER
REMAIY§,d
STATE LICENSE NUM61ER EXPIRATION DATE
C,4
SIGN AREA
ALLOWED PROPOSED
SEPA REVIEW
COMPLETE EXEMPT
EXP
ADS NO.
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Legal Description of Property - include all easements
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VARIANCE OR CU
PLA NING REVIEW BY
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SETBACKS — FEET
FRONT ;�REAR
HEIGItil,
CO
LOT ' ;�rG E
Property
Tax Account
Parcel No. !P312-
EMARKS
ElNEW RESIDENTIAL El PLUMBING
RADDITION COMMERCIAL 1:1 MECHANICAL
ElREMODEL APT.BLDG. SIGN
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GRADING FENCE
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ElDEMOLISH WOODSTOVE . SWIM POOL
INSERT El HOT TLIB/SPA
EGARAGE RETAINING WALL/
l CA ROCKERY RENEWAL,
CHECKED BY
TYPE OF CONSTRUCTION
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CODE
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HEIGHT
2S4
SPECIAL INSPECTOR
REQUIRED
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AREA
OCCUPANCY
GROUP
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OCCUPANT
LOAD
EMARKS
PROGRESS INSPECTIONS PER UdC 305
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN
NUMBER OF STORIES NUMBER OF
DWELLING
1 UNITS
_556 ot VjAQ,1M1e_
RISE I WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REQUIRED
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Inteisret— 6-d'
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PLAN CHECK FEE
227
BUILDING
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HEAT SOURCE:
GLAZING
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PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewelks,
STATE SURCHARGE
SD
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
.1 Applicant, on behalf of his or her spouse, heirs, assigns and
ENO. INSPECTION FEE
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successors in interest, agrees to indemnity, defend and hold
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harmless the City of Edmonds, Washington, its officials,
2
employees, and agents from any and all claims for damages of
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whatever nature, arising directly or indirectly from the issuance
11
of this permit.'Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
TOTAL AMOUNT DUE
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nor I.imit in any way the City's ability to enforce any ordinance
provision."
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I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz-
THIS PERMIT
AUTHORIZES
This application is not a permit until
ed thereby, no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Insurance.
INSPECTION
acknowledged in space provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED
DEPARTMENT
CITY OF
0 DATE
;�M
EDMONDS
5-23-�Sp
ATTENfION
CALL FOR
AELEASED'S DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
INSPECTION
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL — File YELLOW —.Inspector
A !�,CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
Im-si7
PINK — Owner GOLD — Assessor
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