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20925 76TH AVE W
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
5-2
CRITICAL AREAS: -/., 6--� DETERMINATION: E] Conditional Waiver [] Study Required [��aiver
DISCRETIONARY PERMT #'S:
DRAINAGE PLAN DA
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID
SHORT PLAT FILE: LOT: . BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERM[IT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER MEETER TAP CARD DA:
OTHER:
LATEMPTST'sTomiAStreet File Checklist.doc
JDATIE REC:g FPERM'IT EXPIRES
USE PERMIT
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NAME
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METER SIZE
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NO. OF FIXTURES
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REMARKS
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GARAGE RETAINING WALL , [3 F:RE SPRINKLER
CARPORT 13, ROCKtRY F RE ALARM
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(TYPE OF USE. BUSINESS OR ACTIVrM EXPLAIN:.
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TYPE�OF CONSTRUCTI COD
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NUMBER
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Description
A,.�,FEE
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FEE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. 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.
PERMIT APPUCATION: 180DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Grading
Engr. Review
Engr. Inspectior2po
s q Z6 8.
9 U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCE§ORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF (440
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ZW—
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL -NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due -4
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' , !% 7F
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Recording Fee Receipt # 9&lez L
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 AGENT OF 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
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN!S COMPENSATION INSURANCE A��.27. OFFICIALM SIG T �E DATE
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(425)
SIGNATU 09 DATE,61GN7.
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A IFIA
771-0220 R ED BY DATE
A#LeNTION M 13133
IT IS UNLAWFUL TO USE "OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE 11EI I Omf 11106SPEAR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR
09/03 PRERR HARD Vntl ARE MAKING& MPIES
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Critical Areas* Checklist CA File NO: (t06
Site -Information (soils/ topography/ hydrology/ vegetation)
1. Site,, Address/ Location: a2�_,5 7eg, kt_ W. deeHr-w- Z�4440!:-,W- Etv-10"51,
1, - I 'q -
2. Property: Tax Account Number: q �9
P
3. Approximate Site Size (acres or s�quare feet) SE, 2 50�
4. Is this site currently developed? _Y-yes; — no. '6'�: FZ xu-k-t U, P2 n e-. -t
If yes;:how is site devel6ped?
5. Describelhe general -site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slop�s 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 horizontall 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: �19 Approx. Depth:
7. Site contains areas of seasonal standing water: Jk.J() ;Approx.Depth:
What season(s) of the year?
8. Site is in the floodway floodplain Ahv 'of a water course.
9. Site contains a creek or an area where waterflbWs acro�s' the grounds surface? Flows are year-round?
Flows are seasdnal? (What time of year?
10. Site is primarily: forested ; meadow ;shrubs mixed
urban landscaped (lawn,�shrubs etc)
11. Obviou.s w. etland is present on site:
qan',t�, necK,'N um ber;- ivapp "It _,7 -.V;
Y,
3: biM:soil'"'(
1�1-'
;,4..:: Critiqfl� itbry: offt indicates Ciifj�al-Ai6- on
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Critical Areas Check] i st.doc/3.19.2001
-ED
M,
City of Odmonds
Development Services Department
Planning Division
Phone: 425.771.0220
"J C. I C) (J
-Fax: 425.77 L0221
The Critical Areas Checklist contained on. this forin 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 Receiv�s
City Receipt III, ;;I, fC4 (K
Critical Areas File M
Critical Areas Checklist F66: A�
Date.Maile,d 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.
I
The undersigned applicant, and his/her/its heirs, and assi gns, 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/h6.r/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 tlRaPpli at* n on the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT DATE �A — �7
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 pennission for the public officials and the staff of the City of Edmonds to enter the subject propefty for the
purposes of inspection and poqting attend;nt to this application.
SIGNATURE OF OWNER
Owner/Applicant:
Name
40
Street Address
City State Zip
DATE _03
Applicant Representative:
%JA oc__
Name -
4&-S- 3
Street Address
I Ea"Wilh VJ� I 9-YO
city State Zip
Telephone: 1-145 :2-7& ),-2q Telephone: -9�& IV�'
Email address (optional): Jov� ( 14 - (et�F6 �, Email Address (optional):
I V44
Critical Areas Check] ist.doc/3-19.2001
.0
CITY OF EDMONDS ASSET INFORMATION SHEET'
El N EW'* STREET FiLE ASSET NO.
ADDITION ADDITION TO ASSET NO.
M RETIREMENT
DESCRIPTION
LA-J A rag ty t2 L rI
SERIAL NO.
LOCATION DEPT. NO.
Ps"o
"PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
'1:1
*PROJECT NUMBER to gh �7X oq6 ff--
PROJECT COMPLETION DATE 3o - e 0
COST -3,5- �
B.A.R.S. ACCOUNT NO. gi, - 0 - - 3
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY-
Wl DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
VERIFIED BY
PROCESSED
BATCH NO.
DATE
itnp
INITIAL
it copy
CITY OF EDMONDS BARBARA FAHEY
MAYOR
7110-210TH ST.S.W. - EDMONDS, WA 98026 (206) 771-0235 - FAX (206) 744-6057
COMMUNITY SERVICES DEPARTMENT - PUBLIC WORKS DIVISION
-(,,St. 189V
October 14,1996
Doug Misner
20925 - 76th Ave. W.
Edmonds, WA 98026-7103
Dear Mr. Misner:
STREET ADDRESS FILE
I understand per your conversation with Ilene that you may be interested in
red ucing your existing water meter size to either a 3/4" or 1 " meter.
There is no charge for this size change. Please call if'you want this done and if so
what size meter you would like.
Sincerely,
Scott Highland
Acting Water/Sewer Supervisor
wordatakwateftisner
Incorporated August 11, 1890
A=SS W, I 5M,005
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