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CITY OF EDMONDS
USE PERMIT
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
ADDRESS /S TE AP
e( _JE AP
OWNER NAME NAME OF BUSINESS
C14,QP_LES allkiQUIT-5
LEGAL DESCRIPTION CHECKI
SUBDIVISION NO
LIO NO
MAILING AD[ IRESS
2-04-14
TESCP A pproved 0
0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — REOUIRED DEDICATION
RW Permit Required 0
Street Use Permit Red d 0
CITY llp
qgoX
TELEPHONE NUMBER
C-'Dmohj'b5
PROPOSED
insoection Required 0
Sidewalk Required 0
NAME
METER S17E
LINE SIZE
NO. OF FIXTURES
PAV REOUIRED
YES 0 NO 0
ADDRESS
REMARKS
1Z
CITY ZIP
NUMBER
ITELEPHONE
NAME
0
ADDRESS f
ENGINEERING MEMO DATED REVIEWED BY
a:
CITY ZIP
NUMBER
FIRE MEMO DATED REVIEWED BY
Z
ITELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA
SEPAREVIEW
Z
Ck 4-
PROPOSED
COMPLETE
.
Legal Description of Property - include all easements
JE7
SHOOLINE I
Z
0
EXP
Vzd
VARIANCE OR cu
PL N ING IEW
By DAT
-7/1 q
U
5---
SETBACKef- FEET HEIGHT
LOT Cct�ER
Z
FRON SIDE REAR
Z
Property
Tax Accouril 0 0 ()o Z,:- 0 0
-j
EMA
Pa rcel No.
0 El
NEW RESIDENTIAL PLUMBING
P?rADDITION El
COMMERCIAL MECHANICAL
REMODEL E] APT- BLDG. El SIGN
CHECKED BY
ITYPE OF CONSTRUCTION PODE
OCCUPANT
G
P,
GRADING FENCE
CYOS
0 REPAIR 1 x —FTJ
T
DEMOLISH WOODS OVE Ej SWIM POOL
INSERT HOT TUB/SPA
SPECIAL INSPECTOR JAR
REOUIRED
EA
OCCUPANT
LOAD
0 YES
/30
GARAGE r7 RE NING WALL/
CARPORT L-J R OTCAKI E R Y RENEWAL
REMARKS
Z
PROGRESS INSPECTIONS PER UBC 305
z
0
QYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
to
S VlAk
0
NUMBER' INUM BER OF CRITICAL
OF I S UDWELLING 01V AREAS qs-114
STOR E NITS F— INUMBER
W
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLANI
'eL4RG6
FAMILY 1?06M QA/
FINAL INSPECTION REOUIRED
L-01kh,-9 FLOok P 130 SO -PT
VALUATION
FEE
2)/,R6-Cn--/ vAIZIER EF)QST1A/4G
PLAN CHECK FEE
BUILDING
61 / 7,
HEAT SOURCE:
GLAZING
o'd
1
614 -�
/11
PLUMBING
Plan Check No. 9-,s--//2
MECHANICAL
A I A I-e
GRADINGFILL
This Permit covers work to be done on private property ONLY.
Any Construction on the public domain (curbs, sidewelks,
d.riveways, marquees. etc.) will require separate permission.
STATESURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - PrOVIded Work Is Started Within 180 Days .
STORM DRAINAGE FEE
ENG. INSPECTION FEE
"Applicant, on behalf of his or her spouse. heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless t he 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
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
nor limit any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provlslon��
I hereby acknowledge that I have read this application; that the
ATTENTION 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 THIS PERMIT This application is not a permit until
8 late laws regulating construction; and in doing the work aulhoriz. AUTHORIZES signed by the Building Official or his/her
ad thereby, no person will be employed in violation of the Labor ONLY THE
WORK NOTED Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa.
acknowledged in space provided.
tion Insurance and RCW 18.27. INSPECTION
SIGNATURE tOWNEFt UH AUL-) DATE SIGNED DEPARTMENT 0 F1 iAL 5 S NATURE OA
CITY OF Ak7—�—
EDMONDS
CALL FOR L� D, DATE
ATTENTION INSPECTION Za2
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FiNAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL - File YELLOW - Inspector
A CERTIF CATE OF OCCUPANCY HAS BEEN GRANTED. . USC
CHAPTER 3. PINK - Owner GOLD - Assessor
102-67
1%
AT
The City o I&qff FILE
APPLICATION
for
SIDE SEWER PERrMT
NEW CONSTRUCTION Y�' REPAIRS
EASEMENT No . ......... -?.. ... / ....
................. .
OWNER ................... c ......... u
........................................
I /
CONTRACTOR ..................... ............... Sf?Je .............................. PERMIT No
ADDRESS ..................... "
...........................................................................
Pl4ec
LEGAL DESCRIPTION: LOT No . ......................
.1,
. . 2 ....................
BLOCK No . ............................................
NAME OF ADDITION ......................................... ....... t?..f ...
K�.x.j c
... ................................................
A
Approved:
DATE......... .. . ... 0 ............. . By.�.� ...........................
NOTICE:
No--Warran-cy.-ut -d-A.A, U..1..0
The information . shown on the attached
map(s) W3S compiled for'use by the City Of
Edmonds its Employees and Consultants.
Th.e CIty of �Edm.onds does not warrant the
accuracy of anything set for.th on these
Map(�_). Any person or entity -requesting a
copy should conduct an independent
-ation shown on
inquiry regarding the inform
-map(s)l Including, but not limited to,
th'e location of any sew-er stub shown. Such
stubs may or may not exist and may
sewer
or may not exist at the location shown.
Neither the city of Edmo-nds nor its
empl-o-yee-s o-r offi-ce.rs -sh-a-1] be 11a.b-'Fe for the
n on this map(s), nor for
information give
P representation provided based
any on
upon said map(s).
CITY OF EDMONDS
Call PRospect 6-1107 when work
CIVIC CENTER — WATER —SEWER DEPARTMENT Is ready for Inspection. (No inspec-
SIDESEWER PERMIT tions Saturday, Sunday or haliftys.) N2 3340
ADDRESS ........................ 2.0.414 ... .... �8.6-tb --- Plage-We-s.t ................................... . ..................
.. .. ....... -- -- ----- -- --
OWNER ---------- C.—M.—HO-lMe-5 ----------------------------------------------------- CONTRACTOR ...... SARi —S-af @L ................................ .................
Peri-nisslon is granted ....... 4�41y --- 2z ................ — 19.0L, 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. 1—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 nut 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
fallure 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-
tenanees except to insert the pipe Into the wye.
11 -
APPLICATION
for
The City of Edmonds SEDE SEWER PERMIT EASEMENT No . ........................
NEW CONSTRUCTION ZL--- REPAIRS 0
CONTRACTOR v . . ............................................... PERMIT No... ....................
OWNER /Z 4 �— �.. .. ... .... k
:04�- ---- — ------------------------------
ADDRESS.......................................................................................................... LEGAL DESCRIPTION: LOT No. ...- . . ................................... BLOCK No . ............................................
NAME OF ADDITION .......................
...................................................................
0
.kpproved:
I
DATE................................................ By ......................................
CA FILE NO..
Critical Areas Checklist,,:'
A'
Site Information (soils/topogr�aphylhydrology/vegetatip
PL VU
1. si&;�ddress/Ucation:,.'2:,6�4"�'1'
P
rQperty 'Tax Account Kikmb,ee,
skpproxir�i&"Site Size (a&s or-sqdare7f6bt): 2- 81 0'0 0
s site currently es; —no.
4. deveibp —Y
U_ -5 6.:�, � G A CAKPOP—T
if yes; how is site developed? RfiG F_�-
5. Describe the general site topography. Check all that apply.
-less than 5-feet elevation change over entire.site.
Flat-
ng'-. f o'*ver,a
-Rolli__ �slooes Wl than 15% (a. -vertical nis'e' of, 10� eet
on'site geheM y, ess
izontal distance of 66-feet).
6j;
H-11 on site of more than 15%'ind less than 30%
I y. s opes present
of 10-feet' 'o*v'_er�i__ho'ii distance of 33 to Wfw).
St6ep:-.',`grades ofgr 30% present on site (a vertical rise of 10-feet over a,-,.
horizontal distance of less than 33-feet),,.) w6
4.
:Other (Pleaii describe):
6. Site contains areas of year-round stand' water. r4
ing _p Approx. D
U
..... ......
9 0 - 19
City of Edmonds
'06,
Critical Are'' s��Checklist.
17he Critical Areas Checklist contained on �and submit it to the City. 17he' Citywill
this form. is., to be filled. ut Py -persqn,.a,;,,,. �.,,,reviewthe,checklist.-makepLp;wursq
' 0 f. ,�any
Ty,.site
preparing a Develop ment Permit
:visit, andmake a4etermination o'ft'h"e
Application for the City of Edmonds'pn*or
subs equ!ent steps, ne ssar a
y to,complete
to hisih6r"'i
"�bmittafbf a-d' ment
,qe
d' it on'
AJ,
permit to the City.
A ith a si e
gn copy,of th sId
The purpose of the Checklist is to enabli- t should alialsubmii a' vicinit� map
City staff to determine whether any.
or plot plan for individual, lots -of theparcel
potential Critical Areas are or may be-..---.--
with enough detail that City staff can find
present on the subject proper The
tY7
and identify the.:�40j(?qt,p arcel
inf6rm ation needed to complete the
addiii�n,* the applicant shall include
Checklist should b&easily available from
'xPe
6 e rtinenirinfoiiiiiifion'(64. MR6
9
observations of the site or data available. at,_
pla�,-topography niaj*,Veic.):or studies in
City Hall (Critical Areas.inventories, maps,
coqjunction rJo this,,,Chpcklist to assist
or soil surveys).
staff in�
!,completing their prelimmar
of1hiesitei 7
An applicant, or:hi s/he"i rioi ve,
.,assessmeri
.4
must fill'out the checklist, sign; 'a nd. date
'7 5
A
4 -,xfwivo�0 .I!
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 Represefitative:
CHACLE3 IUKQQIT5
Name
Name
70414. P.G
StreetAddress StteetAdcln='� -
R,
WA 0J80:2_6
City, State, ZIP ;-iI*IP4 J A W. J, k;Y111. f f -'City, State, 7M --P�I :TI%krfe
7-
..Si
Date
.;;1,
4:
z�
woky,7��
41
'CA FILE N
0.-
Critical Areas Checklist..
Site Information (soils/topogqk,p.,hylh�drology/veget2ition)
oV
�7- PL VV�.'
j. .,Si&' R�dress/Locatio�:.,
PrQperty'Tax Account Numbeft
Z8. 000 S(a IFT
kpproxid�*Site S acr or-S ua're'ldd)
4 Is- ly d 7 _yes; no.
jhis site currently d
ff'. CA
If yes; how is site developed?. 140058`��- GARAG 0
5. Describe the general'site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
ir cal rise of 10-feet over a
Rolling-,` slopes on site geiidially� less than 15%
horizontal distance of 66-feet).
'ind less than 30% a ve-rtkal rise.'.
15%
Hi Mopes present on'sitd bf more than
0 10-feet0:'v'er a horizontal distance of 33 to 66-feet).
f "", . . 6 .4
�Steep:� trades of greater.than 30% present on site (a vertical rise of 10-feet over a
horiz"orital.distance,of less than 33-feet)..
N
'01
.Other (please describe):, Q
e
6. Site contain'sareas of year-round standi , ng water: Ift Approx. Depth:
7. Site contains-'airi-eas"of s - easonal stand'mg' 'water: IV 0 Approx. Depth:
What season(s) of the year?
8. Site is in & flo6dway Vo floo . dplain of a �vater course-
9. Sii�:bontii n`s��"a� 'creek or an area "e're, i6ter flows across the grounds surface? Flows are7�ear-
round? &6 Flows are �dasbrial? (What time of year?.
10. Site is primarily: forested meadow. shrubs ;,mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wedand is present on site:- Ajo .4'
use 0
For City Staff
$ite is' oded?
-SCS'niapoeds6il type(s)?. Iowa -
Wdlazid invento CA. W indicates wedand Oresent offskol-,
or
Areas invent,6ry r tiWAiea 'an site?
4" oi C.A. tnap'indicai6iCii
.5�*:-�:-.-.:.:.Sit6widiin.:desigimted earth s6sid6ace Ian"& hazaid area?'--,.
-.S.6nsifi%ieArmMajO.'*'..'-::'*.***.-.-'.' Alm?
S, esi
OF QW.:...
TER�MATi
... .... ... .... .
ALWAIVER
7
D NDMON
W
VtR
-�R eivie' Wed b
er Date.
Plann
.. 1A
T.
Al w.
ego - I9QI-
A6,
lCt Q,8
V42
t
�*40
City of Edmonds
a ki'st
Critical Are, s�--.,,.G hec. i.",
The Critical Areas Checklist contained on.: �and submir it to the City.
this form is to, be,filled out by. apy.person. .,,,5!reWewthecheckIist ma4i� ;L p;ecu
1.11�e W � �
rtqry,site�, 4�`
preparing a Development Permit -..:visit, and make a4etermination 6f
Application for the City of Edmonds prior subsequent steps neessary- to c6niple�e a'�L
, f - ?, I_:_ q,
17e
to hisihei'S"u6ffiittal'- 6-i'a` cile`v6lo Om"ent - ment pprin
permit to the City.
with-as 6d' 'Sfthigf6rm*,thi4,,
Ign copy,c
The purpose of the Checklist is to ena-ble"E'..
"40plicafit should al0subm'it ir din 'miapA�,"..",
City staff, to determine -whether any.. or plot plan fou individual,-IotsPofthe
parcel
potential Critical Areas are or may with enough detail that City staff can find
present on the subject property. The and idenOfy the s
.40jqr4pArcel
(s).
inf6rmation needed to completethe addition the applicant shall include
Checklist should be'�asily available from' other Oertinent* inforifiAtidn (46.g. Mki
topogra0hrinaWlete-Yer studies in
observations of the site or data available at _ - &�;�_
City Hall (Critical Areas inventories, maps, ti n n rd*h Mist to assist
or soil surveys), staff ibm!iii6pletin !�is,,Chec
_g their preliminar
'y
ment bf,
,,asseg
C74%
An applicant, or'hisiiWrepr'es'entkive*V
mustfift-out the''checklist,.sign' an&date it",
"0
I have completed the attached Critical Area Checklist and anest that the answers p I rovided
factual, to the best of my.knowledge (fill out the appropriate column below).-
Ic
epreseiritati
Owner Applicant: Applicant R ve:
CHACLE5 KQ U I T5
VV,
Name Name'..,
_J,
Z0414, SG
Street Address tred
A
7 5 - GC �I i S ddress'�
7
W A' �18
(52-6
City, State, ZIP A4Y,'t A)0- lf`gp-�411
Z
V
'1, 0 -)k-:
Y!
Uhone..,,_�� State, ZIP -
el .