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20904 80TH PL W
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Edmonds
Critical Areas— 'Che'tkiist
The Critical Areas Checklist c6ntaine I d on
this form is to -be. filled out by any person
preparing a Development Permit
Application for the City of Edmondsprior,_
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. lbe.."
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
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent infonnation (e.g. site
plan, topography map, etc.) or studies in
cordunction 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 I Applicant:
z:>
Name
.,;? (9 <:� 0Y
Street Address
City, State, ZIP Phone
/10 —i Y Eate
J//
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
I
Signature
CA FILE NO -
Critical Areas Checklist
Site* Information (soils/topography/hydr-ology/vegetation)
1. Site Address/Location: loe-'e
2. Property Tax Account Number:- .56'�6�K 000 QQC1 COUD
it ,
3. Approximate Site Size (acres or square feet): JUL 2 0
4. Is this site currently developed? Y yes; no. 1 CWWEIR
If yes; how is site developed? �-Iaze e-e Koff
5. Describe the general site topography. Check all that apply.
Flat: - less than 5-feet elevation change over entire site.
Rollin.g:.',.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 standing water: A)O Approx. Depth:
What season(s) of die year?
8. Site is in the floodway Z) 0 floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flow�- . are year-
round? jU 0 Flows are seasonal? jJ0 (What time of year? A)lif
10. Site is primarily: forested meadow _; shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: 120
A
RevO110094
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 �Eclmonds does not warrant the
accuracy of anything set forth on these
map(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
tHe -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-1-o-yee-s o-r officers Shall be Hab-le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS
Call PRospect 6-1107 when work
CIVIC CENTER — WATER -SEWER DEPARTMENT is reaft for inspection. (No inspec- '%To
tions Saturday, Sunday or holidays.) 2075
SIDE SEWER PERMIT
ADDRESS _----_-------- Bernard Lee
------------------------------------------------------- ----- --------- I ............... .........................................................................................
OWNER -_----------------- ?_ Q a. 14 ---- — ---- AVC-TIRe ... �3.Q�9_th CONTRACTOR ---- Allied__Se-Dtic Service
--------- ...... — ------------------------------------------------
Permission is granted ...... Ap-ri-I .... 2-1, --- --------- jq__�7, 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:
NOTrE 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 not cover any portion of sewer before it has been Inspected.
NOTE No. 2—Obtain full information regarding Ordinance 11.16.036 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 shajWr 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.
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.
APPLICATION
Ob"IFREE7 FILE for � LYNN DPLAANr
The-Citiof Edmonds SEDE SEWER PERMIT
EASEM................ I ........................
NEW CONSTRUCTION REPAIRS rl
/3 F
OWNER ��TRACTOR .... f�.Tb. N_ 0.c/ ...... 5. ...... Sr-All.AX-.- PERMIT N,.
ADDRES 9 . ............ ........ j ..... .................. LEGAL DESCRIPTION: LOT I
.jo . ................ ? ......................... BLOCK No . ...........................................
RID b 'e-_
Al.. 7 NAME OF ADDITION ..... A J( .......... jg
............ ww
..............
APPROVED-.,
APR 2,0 1867
- - tvctt./*4
o
'7
DATE .................... By .....................
Side Sewer Drawing
The City of Edmonds EASEMENT NO - ---------------------------------------
NEW CONSTRUCTION REPAIRS [7] LID NO . .................. ASMT. NO . ..................
OWNER -------- ------ ...................................... CONTRACTOR ...... V.<AAOY� ........ PERMIT NO.
,2-090 4- 8o-rH PL, ' 1
JOB ADDRESS ...... ................................................................... 1Y.N. ---------- LEGAL DESCRIPTION: LOT NO . .........
............................ BLOCK NO . ....................................
-Tri-Plex
....................................................... I ..........................................................................................................
NAMEOF ADDITION ............ �-.U-M-4r ...................................................................................
C-0. O'deep)
16"
C-0. (Scleep)
16--
2-1 c
V-4c,t4g�
==j j
.Vl
C-i
wAtc-Lfte
Z 80TIl
PL. W.
�WW-0001 -11/75 (REV. 11178) \,_ DATE
9 qI........ . ....
0
CITY OF EDMONDS
i*"PUBLIC WO
RKS DE**T FOR INSPECTION CAO Permit
SIDE SEWER PERMIT 775-2525 Ext. 220 Issue Date
PEP -MIT MUST BE POSTED ON JOB SITE
l.. Address of Construction
2. Property Legal Description (include a,ll, 6a,% ments) I_rr- W-7
le T
U Met
3. Single Family Residence Mult��,Family No'-I-of,,Units
Commercial
4. Owner and./.o-r_Bu_ilder -To k Ec_pe_�-
5. Contractor & License No. 13)00M Cft"gfVVa&-n
6. Invasion into City Right -of -Way: No V" Yes (If Y�,, Right -of-.
way Construction Permit Required - Call Dial Dig (342-5�44) before
excavation).
E-1 7. Cross other private property: Yes Nol Easement required -
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
P4
a. Property owners must obtain a permit to install side sewers on
>4 their property. A licensed side sewer contractor must be employed.to
M -
construct side sewers i-n the public' right-of-way.
b. The side sewer con�ractor assumes full reponsibility for each
E-4 installation for one yeard
W
0 C. Commercial establishment requires a minimum of a six inch (6")
P4
z side sewer -line.
0 d. Side sewers may not be installed closer than thirty inches ('30")
U to any structure.
W
M e. Side sewer lines must be laid at a minimum grade. of 2% (1.150)
0 and maximum grade of 100% (450). 0 1
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 tovpoor compaction of fill.
k. Side sewer must.be left uncovered untii inspected and approved
by the City.
'i. Inspection during normal working hours only. Two (2) working
days notice required.
DATE:
I cer:t;ify have read,
and shall comply With theabo've
PERMIT FEE: �bC`
DISAPPROVED BY: Date:
B Date:
CONNECTION', FEE: APPROVED By: Date:
1:4:D I-rq
0 _T_
44
PERMIT MUST BE POSTED ON JOB SITE�*
""eo
CITY OF EDMONDS
CONSTRUCTION P�RMIT AP LICA4TION
CO T
USE AK -7 PERMIT
ZON NUMBER 97057-7
-
.1
, 1
0 B 60 ITEIAPT N
su
ADDRESS FDT
W A E11M B ES,
0AWM ' h e E�101?%rl
A e� e f&� M rO
A6
LEGAL DESCRIPTION U111,C]
SU..I11FION NO,
LID NO,
W MAILING ADDRESS
30:
PUBLIC RIGHT OF WAY PEFCOFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
PROPOSED
TESCIP Appro�ed [3
Rw Permit Required [3
Street the Permit Rett'd 0
Impection Required 0
Sidewalk Required 13
ITY ZIP T H R
C y
NAME
METER SIZE
LINE SIZE
1 .0. rURES
FEW RE YJRED
k
0
YES 13 No: 0
S
ADDRESS
7F& I J A, >�
CITY ej
ZIP ;.7e
,,jTELEP"ONE NUMBER
r909 - 95 9
NAMP
14
ADDRESS.
CITY
ZIP
ITA� r
Legal.Description of Property - include all easerpeniLs
Hbvlt:WLU131
FIREMEMODATED REVIEWEDBI
SIGN AREA SEPA REY`itW� ADS NO.
ALLOWED OPOSED COMPLETE EXEMPT
PR EXP
F, : . , .
VARIANCE OR CU
PLANNING REVIEWe Y
DATE
0.
SETBACKS -FEET
EIGHT
LOT COVERAGE
Z
Properl y
Tax Account
aA
0c) co
S IDE '74
2AIRA'
1 REAR
AFto
Parcel No.
El..
RESIDENTIAL
R(Si>EH
0
El COMPLIANCE OR
ADDITION
COMMERCIAL.
CHANGE OF USE
$41111,1131DEL
APT. BLDG.'
SIGN
GRADING FENCE
CHECKED BY
TYI�A�RUCTION
DREPAIR CYDS.
SEDSTOVE . SWIMPOOL
DEMOLISH WINOORT El HOT TUB/SPA
AREA
OCCUPANT
SPECIAL INSPECTOR
REQUIRED
YES
L.A.
GARAGE RETAINING WALIJ
CARPORT ROCKERY RENEWAL
REMARKS
1E
0 (TYPE OF USE. B ITY),EXPLAIN:
PROGRESS INSPECTIONS PER.UBC 108 s'
NU
NUMBER OF
CA T.I.M
OFMBETI
DWELLING
ST RIES
UNITS
DESCRIBE IYORK T9 BE DONE (ATTACH PLOT PLAY)
Cot, r 40",Cl ,117 k,
FINAL, INSPECTION
REQUIRED.
Q
,66*0"veir+ T78A'xAPM'V. 40
VALUATION
—FEE
't I
PLAN CHECK FEE
ove relrW Aw
BUILDING
HEAT SOURCE: GLAZING
%
fLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING11FILL
Any construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) Will require separate permiss . ion..
'STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"AppliCant. on behalf of his or her spouse, heirs, assigns and
ENO. INSPECTION FEE
. successors in interest. agrees to indemnify, defend and hold
. harffiless the City of. Edmonds, Washlngtor�, its officials,
employees, and agents from any and all ClairWfor damages of
5 whatever nature, arising directly or indirec
wly from thii issuance-
xerned to
x of this permit. Issuance of this-permall ri�t�.,bee
modify, waive or reduce any require. I of any, ct rdinance
PLAN CHECK DEPOSIT
,
nor limit in any way the City's ability force ahj'girdinance
TOTAL AMOUNT DUE
2q I
provision."
I hereby acknowledge thA1,1 have readA�lg application;. that the
information given is correct; and that I iryi th6 owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. .1 agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authoriz.
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 histher
Code of the State of Washing prel Ing to Workmen's Compensa.
WORK NOTED
Deputy; and fees are paid. and recelpt is
tion Insurance-9d RCW 18.2v - I
INSPECTION
acknowledged In space provided.
SIGNAT YR JDATE S�NE�
L
DEPARTMENT
CITY OF
ONFISP �E DATE
U'7
91-2
A,
EDMONDS
I"
ATTENTION
CALL FOR
- KT—
RE77
*1 .
INSPECTION
��)
IT S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
7
UNT14 A FINAL INSPECTION. HAS BEEN MADE AND APPROVAL R
j
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. U o
BC
771-0220
ORIGINA it. YELLOW - Inspector
4..
SECTION 109
PINK - Owner GOLD - Assessor
102-87
I
-40
STREET FILE
—mg o qe i�v,�4
,/-o Ke.
r.,410 if,
RECEIVED
MAY - 5 1997
IERMIT COUNTER
a
APPROVED BY PLANNING
-7
PLANNING DATA
NAME: L�at.�A W)9,tU-- 4 /V1 i
V i
SITE ADDRESS:-2-0904 - P' P1 Q\ —DATE: 5-/ 9 2
ZONING: P-S -k -PLAN CHK#: 97-134-
PROJECT DESCRIPTION: 21 � 7 7e'o -,;4
CORNERLOT (Yes/No)
SETBACKS:
Required Setbacks:
Front: '7-5, Left Side: 71/'Z-' Right Side: Rear: /5-'
Actual Setbacks: �6 bAl (",t—a—, /
Front: Left Side: 1 2-' Right Side:- / I Rear: 13.75"
Street map checked for additional setback required? IV" (Yes/No)
V, r4v-
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED A) (Y/N)
LOT COVERAGE: 2_7�, 4--2o+) 1533'
60 — :: -_ - /,- I 1z
Maximum. Allowed: 3 5�2. —Actual: 1 -7 3�� 7,3,.,o
BUILDING HEIGHT:
Maximum Allowed: 2- —Actual Height:
Datum Point: 1 15�-�� - r,-�- LP4,PeA Datum Elevation:
A.D.U. CREATED?: �4, - 5nat /-� - Ae,-, spz,,�e k,,q , ,�f
SUBDIVISION:
CRITICAL AREAS #: 95- -15- -7
SEPA DETERMINATION:
LOT AREA: 730,oc
OTHER:
Plan Review By:
CA FILE NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
I Site Address/Location: C
2. Property Tax Account Number: 5�516ZL Coo a-)9 COC�0_ RaCSIV61D
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? A- yes;-. no. jut
. %*%I
If yes; how is site developed? e--e
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: /V 0 ;, Approx. Depth:
7. Site contains areas of seasonal standing water: �-)O _; Approx. Depth: _
What season(s) of the year?
8. Site is in the floodway 00 floodplain of.a water &6urse.
9. Site contains a creek or an area where water flows across the grounds surface? F17o� are year-
round.? Flows are seasonal? c) (What time of year? ��f
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) )(
11. Obvious wetland is present on site:
-----For City Staff Use Only
Site Is Zoned.
soil type(s)?
M6tlanid inventory or C. A. map indicates wetland present on site?_
4.' Critical Areas inventory or C.A. map indicates Critical Area on site?
:5. Site within designated earth subsidence landslide hazard area?
:6. Site designated on the Environmentally Sensitive Areas Map?
DETERNfINATION
STUDY REQUIRED CONDITIONAL WAIVER
WAIVER,,�, J
Reviewed by:
Planner Date'
R,cv01/04194
Ic
k � -,Y. 4 -
9
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
or plot plan for individual lots of the parcel
with enough detail that City staff can find '
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (e.g. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing their preliminary
assessment of the site.
j 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:
6ve
Name
Street Address
11-Kdy,7_1>5
City, State, ZIP Phone
712, /5;. 1
Signaiure Fate
7'
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
I
Signature
Date
CITY OF ED,'AONDS
BLDG. DEPT.
-CONDITIONAL PERMIT
WORK.
ADDRESS(;����
OWNER- Wellev-
APPROVED DATE -
BY
BLDG. OFFiolA;
KEEP THESE STAMPED
PLANS ON j0E-ISITE FOR
ALL INSPEC'HONS
PERMIT NO. SHEET
OF
AUG.2 GRECO
efly COPY
D--Ck-
N'. ZONE
SETBACKS:
FRONT 26-
SIDF
R LE A R
OTHER
HEIGHT — 25
0
W - f. 13
SoT,F: ')CC" it
_,c,La-V4Trz> �7-0
I
Ilk
STREET FILE
C A FILE NO.
Critical Areas Checklist
Site Informafion,(soils/topography/hydrology'/vegetation)
1. Site Address/Location:
2. Property Tax Account Number: 559�6,K 000 00,� coba
Rr
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? Y 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: /V 0 Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway 1-) 0 - floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flo year-
round? P 0 - Flows are seasonal? PC) (What time of year? M�7 —).
10. Site is primarily: forested meadow _; shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: too
Rev 01/0094
1, -Iq
9 9 C�J
Udmonds
,.Critical Ar'eas-'-,Ch-eCK11St''
The Critical Areas Checklist c'ioitaiiini:ea o'.n"'."
an d� submit i . t t 1 6 th e City. The'City will
this form is to be,fil1bd-out'by -any. persoiin"i
thechecklist, rnake a precursory site
preparing a Development Permit
Visit,' and make a determination of the
Application - for, the City of, Edmonds pnior,,�,!,..,
subsequent steps necessary to complete. a
to his/her submittal of a development
development permit application.
permit to the City.
-With a signed copy of this form, the'
The purpose of the Checklist is to enable
applicant should also submit a vicinity map
City staff to'determine- whether any
or plot plan for individual lots of the parcel
potential Critical Areas are or may be
with enough detail that City staff can find
present on -the, subject property., .1be- -�)and identify the subject parcel(s).; In"',
information needed-to-coMplete the -addition,
theapplicant shall include.
Checklist should be easily availablei 66 m-"
other pertinent infonrnation (e.g. site
observations of the site or data available at
plan, topographi map, etc.) or studies in
City Hall (Critical Areas inventonies,'maps,.
conjunction with this Checklist to assist
or soil, surveys).
staff in completing their preliminary
assessment of the site.
An applicant, or his/her representative,
must fill out the checklist, sign and date it,
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:
z:>
Name
<9
Street Address
ev /z>
City, State, ZIP Phone
ate
Sig4nare�
Name
Street Address
City, State, ZIP Phone
Signature
Date
A
IZC 1�6
CITY OF EDMONDS
250 51h AVE. N. - EDMONDS. WASHINGTON 98020 - (206) 771-3202
COMMUNITY SERVICES
August 15, 1986
BUILDING
LARRY S. NAUGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
Lloyd Weller AU G
W STREET FILE
Edmonds, Wa. 98020
Dear Mr. Weller,
We have received a complaint about a deck built on your west property line.
We have no building permit on file for the structure.
The Edmonds Municipal Code includes setback standards for structures
on residential lots. Your property is in the RS-8 zone. Any structure
in the RS-8 district over 30 inches which'is not attached to a house
must be at least 5 feet from the rear property line and 7 feet 6-inches
from the side property line.
Please respond to this matter by August 29, 1986. You should apply for
a building permit.for the structure, and move it to comply with code
standards.
If you have any questions, please call me at 771-3202.
Si nce rel y,
Leigh Francis
Code Enforcement Technician
PUBLIC WORKS 0 PLANNING 0 PARKS AND RECREATION 0 ENGINEERING
CITY OF EDMONDS Permit No. K
PUBLIC WORKS DEPARTMENT VOW Issue Date J/1
8 1 ?1 f /
RIGHT - OF - WAY CONSTRUCTION PERMIT 9"EET F-IR:
A. oAddress or vicinity of Construction
20904 80 pl t4 — Plat # 163--69,006
9 OwnerMas1iinciton Natural Gas Co
Name
805 156 AV NE
Mailing Address
Bellevue, Washington 98007
City, S ta te, Zip Code
e Contractor: Skme As Above
Name
Mailing Address
9 Permit Issued To:
• Type of Work to be Done:
Inst-i-,i1l, New Servi0e
• Work in Connection With:
D Sub or Plat 0 Single Family
El Comml. / Ind. El Apt. Condo.
• Pavement Cut: 0 Yes El No
State License Number
Z
< City, State, Zip Code Telephone Number
U
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
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
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
0
U
Upon issuance of this permit, the contractor is responsible for workininship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
0
Z
0
0
P
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 th I at this permit must. at t4gwtos, - Iftction purposes at all times.
Signature: ateOct 21, 19P1
Owner or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By: -/1-0.z4
Time Authorized: /Vold after days
Special Conditions:
Ammendments:
Permit Fee: --&—
Security Deposit:
Receipt No.:
Fund 4.11-1 Fee:
Street C ut Dimensions
X
1.
�aNq-��QRXM TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. December 1978
FIELD INSPECTION NOTES (Fund!lll - Route.conv to Street Dept.
0^MM__*w-
Diagram:
Contractor called for inspection Yes No
Work Disapproved By: Date: Date:
Work Approved By:_ —Date:
Inspector:
Ena. Div. December 1978
:A1 Y
CITY OF EDMONDS
USE PERMIT
ZONI� <7_ NUMBER 9504 -37
CONSTRUCTION PERMIT APPLICATION
.
i V % - A UITE APT a
ALJL?Ht�Zi 14 - �;n �1- 'I /_ , I
0 VV7 E NAME OF BUSINESS
U_j
z
'3
0
6lue
LEGAL DESCRIPTION CHECK
I
SUBDIVISION NO
LID NO
MAILING ADDRESS
c) oj.,o q 104,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING —REQUIRED DEDICATION —
PROPOSED
TESCP Approved 0
RW Permit Required 13
Street Use Permit Req'd 0
Inspection Required 0
Sidewalk Required CI
a:
U)
CITY zle _7TELEPHONE
NUMBER
NAME
w
L)
(r
ICITY
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 11 NO 0
ADDRESS
REMARKS
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a:
W
w
Z
ZIP
TELEPHONE NUMBE R
3
Z
NAME
Cc
0
1
ADDRESS
tiw �r,# 4-4,rf
ENGINEERING MEMO DATED REVIEWED BY
#L&
I
CITY z P
TEOEPKONE NUMBER
FIRE MEMO DATED REVIEWED BY
Lr
Z
0
U
STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA
SEPA REVIEW
ADS NO
ALLOWED PROPOSED
COMPLETE JEXEMPT
SHORELINE
Legal Description of Property - include all easements
Z
EXP
0.
Cc
U
VARIANCE OR CU
PLANNING REVIEW BY
DATE
SETBACKS — FEET
HEIGHT LOT
COVERAGE
Z
'"j
FRONT SIDE REAR
Z
Property
Tax Account
Parcel No. OU0 001 0000
REMARKS
NEW RESIDENTIAL PLUMBING
ADDITION COMMERCIAL MECHANICAL
0 REMODEL APT. BLDG. SIGN
GRADING FEbjCE X
EIREPAIR — CYDS. I to ?6 4FT)
CHECKED BY
TYPE�_qf CONSTRUCTION
CODE
14_1
OCCUPANT
RC;L49_
GX,__5
Z
0;
WOODSTOVE SWIM POOL
DEMOLISH El INSERT HOT TUB/SPA
GARAGE RETAINING WALL/
CARPORT ROCKERY RENEWAL
SPECIAL INSPECTOR
REQUIRED YES
AREA
OCCUPANT
LOAD
REMARKS
PR OGRESS INSPECTIONS PER UBC 305
Z
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
RITICAL
ICAREAS
UMBER
W
0
to
DESC;R?IE WORKJO BE DONE (ATTACH PLOT PLAN�,
1�eeee oye,7005-; ow
FINAL INSPECTION REOUIRED
4
t r
VALUATION
FEE
(A ),6"
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
of 5
GLAZING
1 %
PLUMBING
Plan Check No.,
MECHANICAL
GRADINGIFILL
This Permit.covers work to be done on private property ONLY. .
Any consiruction on the public domain (curts, sidewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 11 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
ENG. INSPECTION FEE
24
Cr
. "A'Oplicant, 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,
employees, and agents from any and all claims for damages of
whatever nature, arising directly cij 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
nor limit in any way the City's ability to enforce any ordinance.
provision."
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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
state laws regulating construction; and In doing the work authoriz- AUTHORIZES signed by the Building Official or his/her
ed thereby, no person will be employed In violation of the Labor ONLY THE
Code of the State of Washington relating to Workmen's Compensa. WORK NOTED Deputy; and fees are paid, and receipt is
surance and RCW 18-21. 7 INSPECTION acknowledged in space provided.
RE JOWNER OR AGENT DATESIGNED DEPARTMENT OFFICIA,�7 T RE DATE
CITY OF
EDMONDS
I�� W, 1�� 1�:, _ � wl�
CALL FOR R E n�EWY' /OAT
ATTENTION INSPECTION
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 Lj
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3. PINK — Owner GOLD — Assessor
102-87