20814 88TH PL W.PDFIIIIIIIIIIII
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20814 88TH PL W
Critical Areas Checklist CA File No: 0 1 — �&
Site Information (soils/ topography/ hydr� , 1(�gy/
1. Site Address/ Location: 2CG)4
�etation)
In o2_� L'O I
2. Property Tax Account Number: — -7 2-51 00 0 00 2- 0
3. Approximate Site Size (acres or square feet): f�q,
4. Is this site currently developed? \� yes; — no. ---,--
If yes; how is site developed?
5. 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).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of 10-feet
over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standingwater: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway — floodplain — of a water course.
9. Site contains -round?
a creek or an area where water flows across the grounds surface? Flows are year
(n-- Flows are seasonal? (What time of year?
10. Site is primarily: forested ; meadow shrubs mixed
urban landscaped (lawnshrubs etc) X
11. Obvious wetland is present on site: nr)
Critical Areas Chccklist.doc/3.19.2001
'. L 0 1
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
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 the application 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).
Date Received: -Z /, A!:
City Receipt#: /Y 2��
Critical Areas File M V — (0 t1-3
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant:
A property owner, or his/her authorized 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.
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
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT
DATE
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and poling at�endant t application.
SIGNATURE OF OWNER t��Uy,— i! 's DATE
Owner/Applicant:
Name
iooc,(4 (,� Phu,
Street Address
E� vy)(In
City State zip
Telephone: V7 2- - 2�S9 0
Email address (optional):
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
Critical Areas Checklist.doc/3.19.2001
PLANNING DATA
NAME: Deib-bir..
SITE ADDRESS:_�acqiLi R91V ?�_. Nd. DATE:
ZONING: PLAN CHK#: Qt -F?
PROJECT DESCRIPTION:- a:m ,,q-nc3,,j QE Cp' Woc,�D T::",c -tic-re Lq k-�e;T-H
CORNER LOT Yesjg�) FLAG LOT (Yesigip
SETBACKS:
Required S tbacks:
Front: -Left Side: Right Side:_____:_Rear:
Actual Setbacks:
Front: Left Side: Right Side:_Rear:
Street map checked for additional setback required? (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED
LOT COVERAGE:
Maximum Allowed: -Actual:
N)ABUILDING HEIGHT:
Maximum Allowed: -_Actual Height:
Datum Point: Datum Elevation:
A.D.U. CREATED?: Kt/A.
SUBDIVISION
CRITICAL AREAS #: C-A, - 0, - CoF; 'VJAwq_v__
SEPA DETERMINATION:
LOT AREA: rao
OTHER:
Plan Review By:
STATEMENT OF PLAN REVIEW SERVICES AGREEMENT
ACKNOWLEDGEMENT OF REQUIRED
DISCRETIONARY APPROVALS
I, �� �tw a 24 am the owner/agent for the owner, for a
building permit to construction improvements upon real property located at:
wtoy\o ks
in Edmonds, Washington. I acknowledge that, pursuant to terms of this agreement, the Building Permit
Application I have submitted will be accepted for review by the City concurrently with the review of any
necessary discretionary project permits or approvals required by the provisions of the Edmonds
Community Development Code. I also acknowledge that the City shall not accept an application for
building permit that is not complete as determined by the minimum submittal requirements published by
the City which I have read and understand. In signing this form, I acknowledge that I have submitted all
necessary documentation in order to make a complete application for a building permit. The City
determined that the discretionary application(s) for this project were deemed complete on (date).
I acknowledge that any plan review fees paid in connection with this application are solely for the
expenses and costs associated with review the plans as I have submitted them, and do not entitle me to
any right. or claim to the issuance of a building permit. In consideration for the consolidated review of the
building permit application concurrently with any required discretionary project permits or approvals, I
hereby acknowledge and agree to be bound by terms and conditions of this agreement as, set for herein.
1. The required discretionary project permits or approvals for this project currently include, but are not
limited to the following:
E] Architectural design review ........................................... Hearing date:
Subdivision or short subdivision ................................... Hearing date:
Planned residential development ................................... Hearing date:
Conditional use permit ................................................... Hearing date:
Variance......................................................................... - Hearing date:
-�!�Critical areas determination or variance request ............. Hearing date:
F� Other (specify Hearing date:
I further understand that additional discretionary project permits or approvals may be determined
during the course of discretionary project review which may affect plan review timelines and plan
review fees paid for this building permit application.
2. Any building permit issued and approved for this project will be subject to any conditions or
restrictions imposed pursuant to the review and approval of any required discretionary project permits
or approvals. Such conditions or restrictions may require that the building plans I have submitted be
modified or amended to be consistent with such conditions or restrictions. I understand that additional
plan review fees will be required in the event that modifications or amendments to the plans
submitted are required by conditions or restrictions imposed pursuant to a final decision to issue or
grant any required discretionary project permits or approvals. In the event that modifications or
amendments are required, the owner shall be solely responsible for any and all costs which result
therefrom, including, but not limited to, additional full plan review fees. When additional plan review
fees are required, the fees shall be paid in full prior to the commencement of additional plan review
by the City.
3. No building permit will be approved or issued until such time as a final decision for all required
discretionary project permits or approvals have been. issued or granted, including the expiration of all
appeal periods. A decision to issue or approve any required discretionary project pen -nit or approval
shall not be considered final until the limitations period for any appeal has expired or until all
administrative and Superior Court appeals have been resolved. In the event that an appeal of a
discretionary project permit or approval results in new or additional conditions or restrictions which
require modifications or amendments to the building plans, such conditions and restrictions shall be
treated as if originally imposed in the issuance or granting of the discretionary permit or approval.
However, new full -plan review fees shall be required.
4. The building permit application shall expire 180 days after the building permit submittal regardless of
whether a final decision, including'expiration of appeal periods, for all discretionary project pen -nits
or approvals have been issued or granted. I understand that I may request a building permit
application extension for an additional 180 days, in writing, if filed before the expiration of the
original application. The City may grant only one extension. In the event that the building permit
application expires prior to a final decision on the issuance or approval of all required discretionary
permits or approvals; or if not request for an extension is submitted in writing prior the expiration of
the original application, then the application shall expire and a new application and new full -plan
review fees will be required.
5. In the event that any application for a required discretionary project permit or approval is withdrawn,
or if such permit or approval is denied either by the City or upon appeal, no portion of any plan
review fee shall be refunded by the City.
6. In the event that the building permit applicant initiates or requests amendments or modifications to
the building plans after plan review by an applicable City Department is complete, new full -plan
review fees will be required and shall be required to be paid in full prior to the commencement of
additional plan review by the City.
I certify that I have read and understand the terms and provisions of this agreement for plan review
services and agree to be bound by suc
Owner/Agent of Owner Date: kD
Development Services Permit Coordinator Date:
statement of plan review sery agree.doc 2
01.17.2001
r
Critical Areas Checklist CA File No:- 0
Site Information (soils/ topography/ hydrology/ ve etation)
I& Site Address/ Location:_ZOS)L� 7Ac_C'_ L'/0'
2.
3.
4.
Property Tax Account Number: -72-31 0- 02 nO 2- 0
Approximate Site Size (acres or square feet):
Is this site currently developed? \� yes; — no.
ce e7� At i -A C_�_)
If yes; how is site developed?
5. 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).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of 10-feet
over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: 01- -, Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway _ floodplain of a wa r course. A
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
N ( (43— Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawnshrubs etc) _ Y
11. Obvious wetlarid is present on site: - nr)
4.
5.
Critical Areas Chccklist.doc/3.19.2001
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
1.7c. J%grj Fax: 425.771.0221
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 the application 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).
Date Received:
City Receipt#:
Critical Areas File M 0I —(OF3
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant:
A property owner, or his/her authorized 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.
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
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of MY
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT
DATE
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and p9qing attendant to4is application.
SIGNATURE OF OWNER DATE
PLEASE PRINT CLEARLY
Owner/Applicant:
Name
/2oig(4 S�,-4� Plctu--
Street Address
-EJv,n(1n�c-Z:) L/00
City State Zip
Telephone:(47-C;) (g�-7 2- -299 C/,/'
Email address (optional):
Applicant Representative:
Name
Street Address
City State zip
Telephone:
Email Address (optional):
Critical Areas Checklist.doc/3.19.2001
-qj-
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CC
REC.E11YED
CITY of E*DMON DS SIDE SEWER PERMIT
For'Inspection Call 1 MAR 6 19A
-3202 MIT NO. 07449
TREET PUBLIC WORKS 400010 EDMONDS
Address of Construction: '5�g /�� = 6,0 TREATMENT PLANT
Property Legal Description (Include all easements):
X
7--
Owner and/or Builder:
AContractor & License No:
Single Family Residence
Multi -Family
(No.
of
Units
Commercial
I
(No.
of
fixture Units
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No 'e—�Yes (If Yes, easement required,
attach legal- de I scription and county easement number.)
PLEASE,RtA'DTHE ITEMS LISTED ON.THE BACK
c6r*ffy that I'have read and shall comply Date.
with the items listed -on the back.
Permit Fee:
Trunk Charge:
Assessment Fee;
Partial Inspection:
Issued By:
Date Issued:
Receipt No.:
Comments �� W.
Final Inspection Approved: 3-G-86 'J.1-
Date Initial
Rejected:
Reason
PERMIT MUST BE POSTED ON JOB SITE
Wh.ite Copy - File Green Copy - Inspector
5ate Initial
—Ta—te 7—nitial
Buff Copy - Applicant
Ale_'?n
Side Sewer Drawing
The City of Edmonds EASEMENT NO . ..... -------------------------------------- -
NEW CONSTRUCTION REPAIRS E LID NO. �1-(OA -------- ASMT. NO . .. ............... .
OWNER .... B(O-la ..... �A-ONDF — --------------------------------------------- CONTRACTOR ...... ---------------------- PERMIT No. 74.4-9 ------
JOB ADDRESS 2.0-8-14 .......... ..... W- � ------- LEGAL DESCRIPTION: LOT NO. 00= ----------------------------- BLOCK NO - --------- EDM-CrNf)S --------
TREATMENT PLANT
............................................................................................................................ I ......... ------------
NAME OF ADDITION ---------------------------------------------------------
2,0814- 8 E3 PL.W.
NeslpzT- H-
S
(0.5-0. 1
st 6's,
lljDP
31
(0, D P.
Approved:
....... .... .... .
PWW 9994 14 4;169 (RF!5V 14 48) DATE%.W.11 ... By ...............
-71
NOTICE:
r-r a n
-N'o
The -information"shown on the attached
map(s) was compiled for use by the CitY Of
Edmonds/ its Employees and Consultants.
Th,,e City of 'Edmonds does. not. warrant the,
accuracy of anything set for.th on these
Map(s�. An . y person or entity
copy should conduct an independent
information shown on
inquiry regarding the
---tF� -map(S)i including, but not limited to,
-er stub shown. Suc
the lociation of any sew
sewer stubs may or may not e.xist. and may
or may not exist at the location shown
Neither the City of Edmonds nor its
tompl-o-yee-s o'r office-rs -s-hal-1 be 1--ja-b-1--e for the
information given' on this map(s), nor for
any one representation provided based
upon'said map(s),
FOR
ol A
DATE —TIME
M
0 F Fil F
PHONE
AREA CDOE NUMBER EXTENSION
TELEPHONED Z I PLEASE CALL
CAME TO SEE YOU
WILL CALL AGAIN
WANTS TO SEE YOU
RUSH
RETURNED YOUR CALL
SPECIAL ATTENTION
MESSAGE
J`70
SIGNED iolo
UTWO I ...
-TOPS if Fow 30—E-)-21?
T
CITY OF EDMOND
f
Preoerty o
e it 0 N DS�--
Ew
I N2 05047
E] ADDITI0(_-_-_
FIRETIREMENT
ASSET INFORMATION SHEET
ASSET NO. 217
ADDITION TO ASSET NO.
STREET FILE
DESCRIPTION
SERIAL NO.
LOCATION
DEPT. NO
"PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
*PROJECT NUMBER -7
PROJECT COMPLETION DATE
COST
INITIATED BY DATE . APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
ODEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
INITIAL
itnp
REFERENCE
DATE
C:!�Zc
VERIFIED BY
PROCESSED
BATCH NO. -
DEPARTMENT FILE
""TREramp FILE
PRO,= REVIEW CHEM
NAME PM= ADD S:
Pizojk-T
APPT.Tr-ATTnm R=TpT nATE!
Reviewed by: (initial/date)
CQ%HwrS
PiANNiNG.
wrRIswR STREET RX;MG
FIRE
BUILDING
SINGLE FAMILY/MtTME/Mk�ERCIAL- (Circle One)
SETBACKS CHECM Planning
111777777T7TTI
-F7
VARLANCE/SETM�K ADJ.
Y/77777777
777W77777777F
7T
CONDITIONAL USE PERMIT
2
1111111117
ADB REQUIREMM ; CHECKED
3
77 77T
/1///////
77T/7777/7777/77
arHER ZONING P=nUMWM
4
ENVIR0109MAL
5
7 7 T7=
77/77=
ACCESS SLOPE & VEHICLE ACCESS
6
1 .. � . .� t,�. , ..
DRAINAGE PLAN (On Site) -25�
177777771
7777
7777
7
STREET FILE,
8
11111777T77777Tif
LEGAL DESCRIPMON VFRIFICATION
.9
QUIT CIAIM/DEDICATIONS -7
10
EASEMENT PUBLIC/PRIVATE . d,;�- r.
777777777
/////////
IIIIT177T
/////////
. . . I . I , -77777T
CAILULATE SEWER MINECTION IF NO LID#
77777777T
12
777777
PJAT/SUBDIVISIGN REQUIREMENrS
13
RIGHr-OF-WAY CONSTRUMON PERMIT REQD
777TI-1777TIUITff
14
///7/7
T11111111
BOND REQD FOR PUBLIC IMPROVDIENTS
//////
/////////
15
SOILS CONDITIONS & GROUND
17777T
R111111
T
WATER FIETD CHECKED
WX
16
7T11 777
7 -7-
STICIT RAVING REQUIRED
17
CURB AND GU`= REQUIRED
7 7 777
-1W
77TI 7 IT17
SIDEUAIX REQUIRED
19
7T7777F77
CURB CUr FOR DPdVEWAY REQD
20
77777777T7
STREET NAME SIGN REQD
21
777T/7
7T7777TI7
IT711TIT
1177111111'
01HER SIGNING REQD
22
SIDE SEWER AVAILABMITY
23
EXISTING WATER MAIN SIZE
77777777777777
1111711111
24
7777777777
WATER �=-SIZE
25
7777T/7T
SERVICE LINE SIZE
26
HYDRAMr REQUIRED
77777777
////////
777777777
--F-
27
-
-777T
T/ 7 7 7 7 7 7
1111117T
7 11TIT177
HYDRAMr SIZE EXISTING-
28
1111IT777711111
CROSS COMECTION INSPECTION REQD
//////
/////////
29
777777
T7777777
7777777777
MTER MEMR CHARGE REM
30
FIRE LINE CHARGE REQD -,SPRINKLER
TRI11111
31
CUr .
,-x-A
32
.STREET-
OPEN DITOi EXISTING
33
11-IT111
77
7777-77777-
1 LVII/
1 REQD-
//////
/////////
/////////
34
77 7 -77 7
-7 F1 7 7 -77 7 7
77-7 -77 7 7 7 7
A
CULVERr REQD
35
.SIZE
36
7T7777
77 7.7777
T77777777
CATCH BASIN REQD
37
'TITITI-711111111
INDICATED ON SITE PLAN
-17Tf7TFF1
38
siiW- -M& DRAINAGE numfAIN
SHALE OPEN RUNOFF
39
-7
7-77777777
777777777
MISC:
40
REVIEWED BY:
PLANNING MG.R.
ENGINEERING MGR.
6
PUBLIC WORKS MGR.
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
f%k1Q%'rI5Hf%*r1r% DCORAIT ADDII I ATInK1
113� OB
NAY;ICFP) NAM �,OF S) ADDRESS Zi921ZI
NAME
ADDRESS
CITY,��
STATE LICENSE NUMBER
9 U no_- I . / �--
)ascription of Property - Inc
below or attach four copies)
LEGAL DESCRIP ION CHECKI SUBDIVISION NO. LID NO.
6�� I e,- 7V/_1?_ 1 L I _��
TELEPHONENUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — ��O REQUIRED DEDICATION
PROPOSED��
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
STREET USE PERMIT REQUIRED 0
TELEPHONE NUM . BER SEE ENGINEERING MEMO DATED
R RK
W
I TELEPHONE NUMBER
I basements
s'-e
NEW
RESIDENTIAL
PLUMBING
ADDIALTER
COMMERCIAL
MECHANICAL
REPAIR
RETAINING WALL
SIGN
EXCAVATE
FENCE
DEMOLISH
OR FILL
( x _FT)
E]
PRE- OVE INSPJ
MC
swim
REMODEL
COMPLIANCE INSP.
_P0QL
STOVE/
EWOOD
I INSERT
E:1 APT.BLDG
RENEWAL
MBER OF
NUMBER OF STORIES NU
DWELLING
[UNITS
NATURE dF WORK TO BE DONE (ATTACH PLOT PLAN)
METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
REMARKS
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE I EXEMPT SHORELINE
VARIANCE OR CU PLANNING REVIEW BY DA E
HEIGH� LOT COVERAGE/
YARD REAR
FRONT
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
Al' 1,7Z
1 47j
SPECIAL INSPECTOR OCCUPANCY OCCUPANT
REQUIRED GROUP k-1:Z LOAD
0 YES 0 NO
REMARKS
-Tfy5UL PEtt
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGIFILL
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 permission.
STATESURCHARGE
Permit Application: 180 Days
ENERGY CODE
Permit Limit: I Year - Provided Work is Started Within 180 Days
w
u0i
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
x
cc
<
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
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."
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
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; andln doing the work authoriz-
THIS PERMIT
AUTHORIZES
ed thereby, no person will be employed In violation of the Labor
ONLY THE
Cod,gi." State of Washington relating to Workmen's Compensa-
WORK NOTED
tiorflnsura*e..
I NSPECTION
GNATURE TE SIGNED
DEPARTMENT
MWIE�N7
CITY OF
EDMONDS
AtTENTION
771-3202
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL
OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102-78
VALUATION
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 provided.
OFFICIAL'S SIGNATURE DATE
RELEASED BY:
DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
lu
Uj
Z
0
Z
M
W
Z
Z
5
�DATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
7CONSTRUCTION
USE PERMIT
ZONE
NUMBER Z. W�ll
PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
oie'i ZI)
Ty�� ER NAME/NAME OF §WSINESS
-e E+
PLAT NAM E/SU BDIVI �O.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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RW Perrnit Required 0
Street Use Permit Req'd C3
Inspection Required 0
Sidewalk Required
Underground
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REQUIRED DEDICATION FT
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NAME
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OSED SETBACKS (FT.)
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED., THIS PERMIT COVER
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES�,,ETC.) WILL REQUIRE
GRADING/FILL
SEPARATE PERMISSION.
_S= S FICHARGE
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
I SPECTION FEE
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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 REQUIREMENT OF ANY CITY ORDINANCE
RECEIPT
PLAN CHECK DEPOSIT
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NOR LIMIT IN ANY WAY TH E CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
TOTAL AMOUNT DUE R EC E I pf
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 AGEN . TOF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
This application is not a permit until signed 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.
KM 'S COMPENSATION INSURANCE AND RCW 18.27.
[SIGNAT�R'E "NE OR AGENT) rD�ATE.S,jGNEDj
(425)
OF�FIIAL SIGNATURE D
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771-0220 IL')
-
DATE
A17ENTION EXT 13 3
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
5/98 ?-�A k V 1 5p, 7 f
PINK -OWNER - GOLD -ASSESSOR