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RECF.IVED
FEB 2 4 1993
PERMIT COUNTER
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RF-CEIVED
FEB 2 4 1993
PERMIT COUNTER
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COPY
STREET EMal Areas Checklist
Sitc Information
P -ect Name: j�z- file -A &-a r,,O-&J Permit Number.
r0i I
Site Location: 7 0 2�1 1 9 Isr- A -tot-. W - Property Tax Account Number -3 10:2 - 000 - 001 - Oo
Approximate Site Size (acres or square feet):
Have you filled out a Critical Areas Checklist f(ir a project on this site before?
General Site Conditions �?
1. Has. the site been cleared or logged? )IS Date of most recent action: 11
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? At QF11WOO ) 4(elW IhMl)
3. 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.-)
Wly: slopes present on site of more than 15% and less than 300/,p ( a vertical rise
of 10 feet of horizontal distance.)
Steep: grades of greaAx than 30% present on site.
Comments
ReY3127/92
I At
9
QtY of Edmonds
Critical Areas C'hec'klist
'Me- Critical .4,reas 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&cr SUbmittalof a development permit
to the City.
Ile Purpose Of the Checklist is to enable
CitY staff to determine 'whether any potential
Critical Areas M or may be Present on the
-qlbjcct PrOPCItY- Ile information needed to
Complete the Checklist should be easily
available fi'Om Observations of the site or
data available at City IWI (Critical Areas
inventories, maps, or soil surveys).
An applicant, or his/her representative, must
fill out the ch0C'dis4 sign and date it, and
submit it to the City. Ike City will review
the chccldis4 =dbe a precursory site visit,
and make a determination of the subnunt
Steps necessary to complete a development
Permit application.
With a signed copy of this for.,,, the
applicant Should also submit a v*icinity map
of the parcclwith cnou
'gh 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 -
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:
Name
Tide
Sheet Address
City, State, Zip Phone
Signature Date
Applicant Representative:
9 K Y"A' A i F-I e t)
Name
Title
/ i� 7 -41� T-A-L--'.' /) /�'.
Street Address
1
City, State, ZIP , ;,VA �eNOJ
Phone
a Date
CITY OF EDMONDS
STRUCTION PERMIT APPLICATION
ZONE PERMIT
k., <_ (�, NUMBER
JOB SUITE/APT
ADDRESS, —7 If
OWNER NAME/NAME�OF BUSINESS
&,N F 4
LEGAL DESCRIPTION CHECKI
SUBDIVISION NO.
LID NO.
Z
MAILING ADDRESS
V L
PUBLIC RIGHT OF WAY PEA OFFICIAL STREET MAP.
EXISTING — REOUIREO DEDICATION
PROPOSED
TESCP Approved a
AW Perfrilt Required D
Street Use Pennit Roq*d 0
I-spectio. Required 0
Sidewalk Required 13
a
Z,
.Ty ZIP
14
TELEPHONE NUMBER
NAME
REMARKS
x
ADDRESS
Z
CITY ZIP
TELEPHONE NUMBER
NAME
ENGINEERING MEMO DATED 'REVIEWBY
m
ADORES 9
�,j
METER SIZE 1BUILDING
SUPPLY 51ZL
NO. OF FIXTURES
171TY
ZIP TELEPHONE NUMBER
4 15 � �� I
WA
STATE LICENSE NUMBER EXPIRATION DATE
<'
I L� C lIC — Oeltl D (a U Q i A
REMARKS
SIGN AREA
lita"ED SED
I T070
SEPA REVIEW
COMPLETE JEXE
17
Z
Legal Description of Property - include all easenteft
,, .
nt,f UTY
WA 5 , W T(
rV
EXP
VARIANCE OR CU
P VkA61
�r, L7
P_
T..I=.t
Parcel No,
A0QIT`1oK1 1,0-r
SETBACKS — fIETr I,
FRO T SIDE 'IMAR r-�?
t
I HEIGHT
LOT CO
on
REMARKS
EDNEW
ESI - DENTIAL
PLUMBING
E�ADDITION
FC6MMEACi`AL
D MECHANICAL
EDREMODEL
APT. SLOG.
SIGN
-M
GRADING
PENCE
CHECKED BY TYPE OF CONSTRUCTION
CODE H
REPAIR CYOS. I x ---- FTI
I __T
1
?/
1
0 DEMOLISH' ED WOOOStOVE 0 SWIM POOL
114SERT HOT TUBISPA
/0
2-s-'
SPECIAL INSPECTOR,
AEOUIRED
AREA ;k
I;AICY.
GROU
- PANT,
GARAGE M RETAINING WALtJ
CARPORT —1 RENEWAL
L_J
13 YES
MA KS
ZF/
LOTD
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
PROGRESS INSPECTIONS PER, UBC 305
Vj_-3 I Q[ AJT $A L_
NUMBER OF STORIES NUMBER OF
0
I
DWELLING
UNITS olve,
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLA
r>- cr -1 AQ0IT-ICI�)
FINAL INSPECTION
REQUIRED
VALUATION
FEE
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE: GLAZING
0�—O 0/0
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewpiks,
driveways, marquees. etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit; I year - Provided Work Is StartediVithin 180 Dayi
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigni dnd'
ENO. INSPECTION FEE
successors In Interest, agrees to Indemnity, 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
/IV 5 1,-
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
I e- 7-1 �115`lf3
Q
0
modify, waive or reduce any requirement of any city ordinance
nor limit In any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
ellaillille
I hereby gicknowledgethat I have read this application; that the
ATT=
APPLICATION APPROVAL
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 construction; and In doing the work authoriz-
THIS PERMIT
AUTHORIZE
This application Is not a permit until
ed thereby, no person will be employed In violation of the Labor
ONLY THEE
signed by the Building Official or his/her
Code of the State of Washington relating toWorkmen's Compensa.
WORK NOT ED
Deputy; and fees are paid, and receipt Is
'
INSPECTION
acknowledged Wepace provided;
A OR AGENT) DATE SIGNED
_2
DEPARTMENT
CITY OF
OFFI I 'S SIGNATURE DATE
EDMONDS
-3
CALL FOR
ELEA Irc 9 TE
N
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A 13UILDING OR STRUCTURE
771-0220
UNTIL A F:NAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL — File YELLOW — inspector
A CERTIF CATE OF. OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK — Owner GOLD — Assessor
102-97
NOTICE:
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
'._'_tFe -map(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
emp'fo-yee-s o-r office-rs -sh-a-11*1 be 1--ia-b-11--e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
APPLICATION
for
The -City of
EASEMENT NO - ---------------------- --------
SIDE SEWER PERMIT
NEW CONSTRUCTION F-1 REPAIRS [7] LID NO - - -------------- ASMT. NO.
c>
CONTRACTOR ---------------- ----------------------------------------- ----------- PERMIT NO.
OWNER --------------------------------- ::K=
----------------- ------------- -- ...... ........ -----
JOB ADDRESS ---- LEGAL DESCRIPTION: LOT NO.
--------- ----------------------------- _ ------------------ -----_---------- I -------------------------------------- BLOCK NO_ --------- ------- --------------
------------------------------------------------------------------------------------------------------ ---------------------------- -----------------------------
\—T\ (�__> V--N
-------------------------------- ---- - -----_--_------------ ----------- ------------ ---------
pproved:
ATE 17'1 B
— ....... - I— __/ ---------- .1 -1,,--, ...... ------
W, -)El!�
E E W, /i E R; P E R)MY 11 TY,
k
Y
-CIT ;',OF' E
SID''
NT
4,
ER
S]�W�
ruct on..),,.,:
alli T75 cons-t
T252q-' for �side,`sewer. Insplectionsk,'] 4ar
Insp
6 " ide; -or.)tfoliday' inspection 1,
C IiFJ�6�F: I
p ov diw n,!24 ho�r'
ectio willl.b7e r It s.466��'requst. 'NO SaU,.,.SUw,.
Aln C, T-1 ON ........................................ ........
AMDRIESS,-LOOC ON, --OF CONSTRU ........... ............................................. ................... .........................................
ti
P-ROPERTY LEGAIL,
�DESCRIPTION.: ........... ...................................
............................................................. .
................................................................
................ ............................................ ........... ................. ... z .................................................................... ................... ................
......................... ....................
"C.- A Aul
OWNER ANiDYQRz,�BU,I,LDER':.:.....M ........... �W ................................................. ...............................
.................... ........................................... ......................
%
X,T,XA' M, t" ......... ........ .............. ........................................ . ... ........... .................. ..........
1�, IRUR '. m � I - . I
div§MAME", ADDRESS ............................ ........
fq
r�,, won� I s) granti�&_.::..� pair 'aiidYoi- O"e�don,'Of-�a ',;$4fiitiLry*�sew'e-r
I "I"', .................... or re
....................
Sp,_1114n) acc6rdance wi*th,�'City,,:Of.Ediilo'nd�,,,o�r.dinaii�ces.-"
hT-ENTIONf ISt'GALLED).TO THE'F,01,LOWING',
;erty)inay-to�fa�in-a perniit'to,�c�iist�uct,.sewe��, e!�;A�Ilcensed �Side'liewer�:Conti.'d'ior, must:tbe�,erh�,1(5�,edl.fto,,�coristruct
P Noi. fm-�The,',owneis�-,of. thel,�roj inslde propeA�,.ilin
" �j ' - - o 8 '%tias
.�sidetisewe�llin4'streetarew..,boino�6ovei,�iiyzporitori�'flem�6r,,bef6�6'itI .,been Jnspect6d.',.�',�,
NOTE No� 2L-SAIll�,�.,)r�,�;e'rformedl�i*n',lcity�,fig4t-*of-:'%ya�,'req6'irdsi,�n,',Tn,�ail'onlc;f.tRlght-.Of-,Wak,
MOTE;. N ; 3—,6i;t&ln,-fulh4nf6r'
o n�ati6w iegELrding,10rdiniLnee,�l-It.-I*G'.630)'i�ndi Regulatio6& goverRlng,(side,-,hewers� when� you get.,permit
N6;rE" 6. 4—ToPs4of',s1de,;s*ew�r musVhsi�e'-at,leeLs�.36 lnches-�_ 6v�erag'ellat-property,'llne and 12'!lnchesAnsl'&:,propert lne;�,mjnimum;grad'e-.of'2 No� 1�dw1w_ grade'..,
shar . per,kthan "A- wilithe' permitted': - c' Y.
dce.(of,s reet:re'e
NOTE No., &�T�en6iis'� 6'street':must'bd'water t s ored' to originall c6xiditibriv 4Contraoctors �shaM,(�,b�,* r�espongfbie' "for, failurv, cl�le ',to, Improper
work�'whtcb� may -develop, within one,,year -of completion,
NOTE NorL—Ittis, nla-wful��t.o,al�er.�6r'.d6�iin�,..6t-her,,work,than,,is%�prc;.vided',for�.in the A,- k th t
Perm or fo,,do any,, wor lon, e..r�airr sewer, orIj s appurtenancesi,except to n.-
lOe' nto� the w�e.
sert"the p 3
MR" PROVER ...... L. ........ :_J� ............... .. Date... Dat ................................. *-..,.z::�,,By!:�.I.'...'.,.,....,-�
Y...
� MY.
R6,V)Eb1 ...........
Ai]�P' ...... ... :. . .:1. 4
................... ........ . .......... ...................................... ........
inar s: . ........................ . ..
k'' "' .. .. ............ ... ........... ................... ..... ................................ ....
................................ ................. 7 ---------------
........... . ..............
........... ........... ........ ............................................... ............................................... ................. ............. .............. .......... ......
�1111 W,�4v,�
'BOTH, "CbPiesMUST1'1 eesigmed-'By :0,w_,ner'�of,,.,Firm-, Performi4g,��C ns u 8hj!klO*�t�,,Request, r Jnspec idnl,�
7,
A
in�iall�tiorr..:congtructed!\urider,�this;ipermit
!,,':;fi'er6by certifythatAhe, i e'rs(
w n r, ...o tra -�,l forming�,C nstru t
6 C
0 the:iCity S- 'I
wa.i:t�/lnsta,ll'ed�'ii�:acc(5rdaiiee�w-1 r ifig ordinaii
qfEdm6ild"
1A
Y�, 0 ..........
_"','-DEU'e'di thl
er,
ih�ck;, U-, d i j-,
BEFOR&y� f�r:,,Wiiter;',E];,'
0
APPLICATION
for
Tho,City of Edmonds SWE SEVVIM PFP.MT
EASEMENTNo . ..........................................
NEW CONSTRUCTI[qNe REPAIRS 0
�06)
OWNER ax.)
. ......................................... CONTRACTOR --------------------------------------------------------------- PERMIT No. q7q� ......
31
ADDRESS ................. . . I ...................... ........................ .................. LEGAL DESCRIPTION: LOT No . ............ / ------------------------------ BLOCK No . ............................................
NAME OF ADDITION --- ...... A-,-.53 ........... q4 ....... e�� ...
uo 0 C,�, v- i cc,,c/ cif
Fri- i
RECFIVED
MAY 2 3 1974
Approved:
DATE................................................ By ......................................................................
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REGARDING: 20331 - 81st
Avenue West
(address)
R E C
0 R D 0 F C 0 N
T A C T S
DATE
NANE, PHONE NO., &
COMMEWS
ADDRESS of CALLER
5/l/74
Gene Albertson
Certified
Letter No. 406313 sent
requiring
hook-up within 60 days.
S/2/74
Please schedule dye test
5/2/74
Came into
office and obtained permit
#4794.
6/10/74
Connection completed.
ACTION TAKEN
Letter received.
D.T.N.O.S.
INITIALS
TE
TE
TE
TE
RECEIPT FOR CERTIFIED _MALL—_—MLI_�us postage)
418-06900 P'01TA1 - K
OR AT
�T E
cy) ALBERTSON, GENE
20331 81ST AVE. W �Q
M EDMONDS, WASHINGTON
C-0 980 c�
CD OPTIONAL SERVICES FOR ADDITIONAL FEES
RETURN � 1. Shows to whom and date delivered
RECEIPT With delivery to addressee only
S 1 S 2. Shows to whom, date and where delivered f350
ERV CE With delivery to addressee only ... .... 854
5:
0:
DELIVER TO ADDRESSEE ONLY ........................
SPEC 1�_L51EL I VERY (extra fee required)
PS Form NO INSURANCE COVERAGE PROVIDED —
Apr. 1971 3806 (See other side)
NOT FOR INTERNATIONAL MAIL 01-Oi 1070 0-397-408
iE N�OER: -B
PLEA
§E.'FURNISH;'SER .1ED - '.CHECKED,'BLbC'
:S) INDI'CA,T
(Additional'
ch' rj7
*4eiqldred,loi- tit, e 0-, -
ithow a dress,
11u,
"y
whem�dbliVe�' r.
1Vb
G§see.,
A r
REUIFT,.
ndMbiered.,il
-��WNATURE OR
Eu�OF AE).DRESSEE,,(Mu cdti�vhys e,
fi 105�j�)
ERTIFIED AO.
10-
31 3 :S[-GN 1rutie!
E Dr NO';; - 2 -A GEN -,,,IF ANY'
DATE DELIVERED"
SHO W
HUEZELIVERED
rifqWeitedi,i i itdliiibliide*'ZIF�tc�qeT,.",--�.
7. 2.