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20904 83RD AVE W
DEPA =,Tr CHEMIST Date
ST R E E"T'LM G PEPM REVIEW
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Street Right -of -Way Existing
REQD to
Access Easements Existing
REQD
Utility Easement Existing NL)NF--
REQD IE� /u i ATr=YL U
Lot per Subdivision
Plat Assessor Map
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Site Plan Checked for Accuracy
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Underground Wiring Reqd.
01
Check Accuracy of Legal Description
Environmentally Sensitive Area
Environmental Checklist Reqd.
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Flood Hazard Zone
"D
Shoreline Management Area
7-1
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
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Existing Zoning Per Code
A men ities Design Board Approval
Reqd. e2t� ADB
Approval
Board of Adjustment Approval Reqd. �T-Ao
Review By:
Date:
Existing Water 'IMain Size — 611 /.1
Water Main Reqd.
Service Line Reqd.
Hydrant Size Existing
Hydrant Reqd. Per Fire Code
Detector Check Meter Reqd.
Cross Connection Inspection 414
Fire Department Comments
Water Metier Charge Reqd.
Review bv: Date:
Size ':5
Septic Tard,, Design Approved Da Le:
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability J/C-�t S; Proj.
Drawing No. File No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
Review By: Date:
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DEPARTMENT
Applicant Fill
USE PERM IT
I N U M B;E R
ZONE /0
PE I APPLICATION
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Inside Heavy Lines
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ADDRESS
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NAME ("�aR--E OF BUSINESS)
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SUBDIVISION NO..
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MAP NO.
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MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER ORDINANCE NO.
CITY
TELEPHONE NUMBER
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EXISTING RIGHT OF WAY :n� Q
PROPOSED RIGHT OF WAY Co C)
DEFICIENCY OF RIGHT OF WAY
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NAMIE
51 &")�l
ADDRESS
STREET/UTILITY WORK REQUIRED A Y L's ONO
PERMIT FOR WORK IN PU13LIC R/W 11YES El NO
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UNDERGROUND WIRING REQUIRED YES El NO
CONNECTION TO SANITARY SEWER 16 Y ES . El NO
0 YES
SEPTIC TANK PERMIT REQUIRED NO
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CITY
TELEPHONE NUMBER
NAME
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SEPTIC TANK PERMIT NO.
0
ADDRESS
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SEE MEMO DATED
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CITY
TELEPHONE NUMBER
REMARKS
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STATE LICENSE NUMBER
CITY LICENSE NUM13ER
CHECKED By
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Legal Description of Property (SI Below or Attach FOUr c0opies)
METER i ZE,,,, IBUILDING
SUPPLYSIZE
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REMARKS
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SIGN AREA
ENV. REVIEW
ADD NO.
ALLOWED PROPOSED
COMPLETE EXEMPT
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W
REMARKS
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VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS
IF R 0 N T SIDE J9 REARI
LOT COVERAGE
GAS
U�NEW RESIDENTIAL EJL:NE
FIRE ZONE
OF CONSTRUCTION
HEIGHT
NON-RESIDENTIAL E:] S GN
DADD El DEMOLISH RETAINING
0 WALL
E CAVATE FENCE
0 ALTER 0 OX FILL 1:1 (_ X_FT)
ITYPE
1CODr
SPECIAL INSPECTOR
REQUIRED
[3 YES NO
AREA
OCCUPANCY
GROUP
I
OCCUPANT
LOAD
PLAN CHECKED BY THIS SIT E IS LOCATED IN THE CITY
El REPAIR ORE -MOVE r-1 swim
1:1 INSP.
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
NUMBER OF STORIES
NUMBER OF
F
DWELLING
UNITS
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NATURE OF WORK TO BE DONE
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PLAN CH ECK FEE
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VALUATION
Fee
PROPOSED USE
PLOT PLAN (INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
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BUILDING
PLUMBING
MECHANICAL
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IFENCE
SIGN
RETAINING WALL
P
SWIMMING POOL