21102 SUMMIT LN.PDF13331
21102 SUMMIT LN
#P20
Critical Areas Checklist
CAFileNo:
Site Information (soils/ topography/ hydrology/vegetation)
9 -Iry
1. Site Address/ Location: 7- L 1 0 2- -5 LA f-^ t-^ vr- Lr-J e_-Pr-Ac" 602
2. Property TaxAccount-Number:
3. Approximate Site Size (acres or square feet): -1,r7 12 P
4. Is this site currently developed? X yes; _ no.
If yes; how is site developed? e';� "Or?--TH FLAL-F C�F Oz4f6rL-Y
5. Describe the general site topography. Check an 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: �4 /A ; Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway t4 IA,- floodplain of a watercourse.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
t4 IAII - Flows are seasonal? (What time of year?
10. Site is primarily: forested — ; meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc) �<
11. Obvious wetland is present on site: Z^
1. Plan Check Number, if a
9
2. Site is Zoned? -PS— �
3. SCS mapped sod type(s)?
—For City Staff Use Only ffiw 19Q
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4. Critical Areas inventory or C.A. map indicates Critical Area on site?
5. Site within designated earth subsidence landslide hazard area?
DETERMINATION
STUDY REQUIRED WAIVER
Reviewed bv.
#P20
IV
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.02�O
Fax: 425.771.0221
— L;. I a,,
The Critical Areas Checklist contained on this form is to
be filled out by any person preparing a Development
Permit Applicationfor 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: W KA 10-4
City Receipt #: 04.1 1CV5
Critical Areas File #:r,-pA - r- -00L11
Critical Areas Checklist Fee: $135.00
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 firiding and locating the
specific piece of property described on this form. In
addition, the applicant shall include other pertinent
infon-nation (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, inderin ify, 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, histher/its agents or employees..
By my signature, I cer* that the information and exhibits herewith subiruitted are true and correct to the best of my
knowledge and that I am authorized to file this a lication on the behalf of the owner as listed below.
SIGNATURE oF APPLicANT/AGENT DATE !�107
Property Owner's Authorization
By my signature, I cer* 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 posting attendant to this application.
SIGNATURE OF OWNER DATE � 1 17JO-7
Owner/AppUcant: Applicant Representative:
I L-- L-, too-'t �- � 'P,6, "i L-1,
Name Name
ILA L V 7--
Street Address
V�- �,t-*J P T 4 * L'--J N 5�80Z-s&
city State Zip
Telephone: 4-S-17' -111-99-19
Email address (optional):
I L? (o!;,s
Street Address
City State Zip
Telephone:
Email Address (optional):
CITY OF EDMONDS
CRITICAL AREAS RECONNAISSANCE REPORT
Site Location:
21102 Summit Lane
Tax Acct. Number:
00373600501703
Determination:
Study Required
Determination #:
CRA-2007-0041
Owner:
William Davis
Applicant:
Same as Owner
CRITICAL AREAS RECONNAISSANCE REPORT: STUDY REQUIRED
During review and inspection of the subject site, it was found that the site may either contain or be
adjacent to critical areas, including Landslide Hazard and Erosion Hazard Areas, pursuant to Chapters
23.40 and 23.80 of the Edmonds Community Development Code (ECDC).
GENERAL CRITICAL AREAS REPORT REQUIREMENTS
Critical Areas Reports identify, classify, and delineate any areas on or adjacent to the subject property
that may qualify as critical areas. They also assess these areas and identify any potential impacts
resulting from your specific development proposal. If a specific development proposal results in an
alteration to a critical area, the critical areas report will also contain a mitigation plan. You have the
option of completing the portion of the study that classifies and delineates the critical areas and waiting
until you have a specific development proposal to complete the study. You may also choose to submit
the entire study with your specific development application.
Please review the minimum report requirements for all types of Critical Areas that are listed in
ECDC 23.40.090.D. There are additional report requirements for different types of critical areas
(see below).
Note that it is important for the report to be prepared by a qualified professional as defined in the
ordinance. There are options on how to complete a critical areas study, and there is an approved
list of consultants that you may choose from. You may contact the Planning Division for more
information.
General Mitigation Requirements for all Critical Areas are discussed in ECDC 23.40.110 through
23.40.140.
STUDY REQUIREMENT — LANDSLIDE HAZARD AREA
It appears that this property contains or is adjacent to a Landslide Hazard Area.
A Landslide Hazard Area is any area with a slope of forty percent (40%) or steeper and with a
vertical relief of ten (10) or more feet (except areas composed of consolidated bedrock).
0 Landslide Hazard Areas are further defined and illustrated in ECDC 23.80.020.B.
In addition to the general requirements for Critical Areas reports referenced above, specific
Critical Area report requirements for Landslide Hazard Areas are provided in ECDC 23.80.050.
DEVELOPMENT PROPOSALS ASSOCIATED WITH LANDSLIDE HAZARD AREAS
Development is restricted within a Landslide Hazard Area and its buffer.
Projects that will intrude into these areas will require a report by a licensed Geotechnical
Engineer.
0 The criteria that are applied depend on the amount that the buffer is reduced.
The buffer can be reduced to a minimum often (10) feet (with an additional 15' building setback
per ECDC 23.40.280) if a report is prepared that meets the standards listed in ECDC 23.80.050.
The alteration must also meet the requirements listed in ECDC 23.80.060.
In addition, proposals to reduce the buffer to less than ten (10) feet must comply with the design
standards listed in ECDC 23.80.070.A.3.
STUDY REQUIREMENT — EROSION HAZARD AREA
It appears that this property contains or is adjacent to an Erosion Hazard Area. Erosion Hazard Areas
include:
0 Those areas with Alderwood and Everett series soils on slopes of 15 percent or greater.
Any area with slopes of 15 percent or greater and impermeable soils interbedded with granular
soils and springs or ground water seepage.
Areas with significant visible evidence of ground water seepage, and which also include existing
landslide deposits regardless of slope.
DEVELOPMENT PROPOSALS ASSOCIATED WITH EROSION HAZARD AREAS
Development within an Erosion Hazard Area must meet additional criteria.
For erosion hazard areas with suitable slope stability, the only critical area study needed is an
erosion and sediment control plan prepared in compliance with the requirements set forth in
Chapter 18.30 ECDC as part of the construction documents. This option is at the director's
discretion, per Edmonds Community Development Code section 20.80.050.G.
• In areas where the slope stability is not suitable, projects within Erosion Hazard Areas will require
a report by a licensed Geotechnical Engineer or other qualified professional. Note that it is
important for the report to be prepared by a qualified professional as defined in the ordinance.
• Report requirements are given in ECDC 23.80.050, and more generally in ECDC 23.40.090.D.
0 Development standards are given in ECDC 23.80.060 and 23.80.070.
ALLOWED ACTIVITIES
Certain activities are allowed in or near critical area buffers as specified in ECDC 23.40.20. If you have
any questions about whether your proposed development qualifies as an allowed activity, please contact
a Planner for more information.
EXEMPT DEVELOPMENT PROPOSALS
Certain development proposals may be exempt from Critical Areas Requirements (ECDC 23.40.230). If
you think that a specific development proposal may be exempt, contact a Planner for more information.
NOTE: Cited sections of the Edmonds Community Development Code (ECDC) can be found on the City
of Edmonds website at www.ci.edmonds.wa.us.
2
STREET FILE
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CA FILE NO.
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 1Z_ I i o,z- 5 " v� i-,". r-r- �- 0
2. Property Tax Account Number: '3 -7 3 (0 — "5_� -3 V
3. Approximate Site Size (acres or square feet): - 7 1,
4. Is this site currently developed? X yes; _ no.
If yes; how is site developed? !�_;7 i t-j &, .,.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 I 0-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
I 0-feet over a horizontal distance of 3 3 to 66-feet).
Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-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: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway �J floodplain t'i of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? �J I -A-- (What time of year9
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs etc) X
11. Obvious wetland is present on site: fj
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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).
RECEIVED
FEB 2 4 1998
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
pen -nit 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 assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
Name
,-,7-Lioz. L-t-J
Street Address
a--.) C,>-F i Z-�Z.
City State Zip
(If 2-5) -7 -7 1 -7 8
Telephone
Signature
Date I
Applicant Representative:
Name
Street Address
city State
Telephone
Signature
Date
Zip
c:recepflon\jana\cac1.doc
(over)
UTILITY EASEMENT
IN CONSIDERATION of benefits to accrue to the grantors herein, the
undersigned, Clifford R. Dean, hereby grants to the CITY OF EDMONDS,
a Municipal Corporation, a permanent easement for the installation,
operation and maintenance of water and storm utilities over, across,
through and below the following described property; and the further
right to remove trees, bushes, undergrowth and other obstructions
interfering with the location, construction and maintenance of said
utilities, together with the right of access to the easement at any
time for the stated purposes.
The easement hereby granted is located in the County of Snohomish,
State of Washington, and is more particularly described as follows:
The East 15.00 feet of the South 150.00 feet of the North 375.00
feet of Tract 17, Block 5, Alderwood Manor No. 5 ! as recorded
in Volume 10 of Plats, Page 6, records of Snohomish County,
Washington.,
THE CITY agrees to restore to substantially the original condition
such improvements as are disturbed during the construction, maintenance
and repair of said utility or utilities; provided the grantors, their
heirs, or assigns shall not construct any permanent structure over,
upon, or within the permanent easement.
DATED this day of 1\141 (,/ e VVI 19
L11
STATE OF WASHIN.GTON)
COUNTY OF SUQ"))
0/
la� - -
C' " KI 4? 4
On this day personally appeared before me I Cj / I
and to me known to be the individual(s)
described in and who executed the within and foregoing instrument, and
acknowledged that Ae signed the same as CA'�
free and voluntary act and deed, for the uses and purposes therein
mentioned.
UNDER MY HAND AND OFFICIAL SEAL THIS DAY OF &U
1993.
Z- -?
NOTARY PALIC'in -and fon/the State of
Wash""gton, residing at
SUMMIT.4/TXTFORMS
CITY OF EDMONDS
Call PRospect 6-IL107 when work
CIVIC CENTER — WATER -SEWER DEPARTMENT Is ready for Inspection. (No Inspec-
tions Saturday, Sunday or holidays.) N2 3509
SIDE SEWER PERMIT STRE-L'::f FILE
ADDRESS--------- Z11Q2 SUMd-t-19=0 ----------------- :.816'-th-'PLAC9-'=T ---------- - -----------------------------------------------------------------------------
OWNER ............. Cliff .-Dean ---------- .......................................... . ................................
....................... ..................... CONTRACTOR.... North End SeDtic Tank
Permission is granted ............. QPtQJ-)fW .. ZZ ..... 19..U., 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 not cover any portion of sewer before it has been inspected.
,TE 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 3A will be permitted.
NOTE No. 4—Trenches in street must be water settled and surface of Areet restored to original condition. Contractors shall be responsible for
failure 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-
tenances except to Insert the pipe into the Wye.
k
0001,
890 - 19 C)
Citv of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number.
Issue Date:
—7—L �11/
A. Address or Vicinity Of Construction: - 21020 & 21102 Summit, Ln_C142AQ25&&
B. Type of Work (be specific): Install New Sorvice 9421814)
C. Contractor. -Washington Natural Gas Conipany
MailingAddress: 815 Mercer St. Seattle. WA
State License #: 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-997A
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. 0 Commercial []Subdivision 0 City Project [3 Utility (PUD, GTE, WNG, CABLE, WATER)
C3 Multi -Family [3 Single Family E] Other
INSPECTOR: INSPECTOR: LA_)k! +CA*A
F. Pavement or Concrete Cut U Yes E3No G. Size of Cut: x H. Charg4j,$
APPLICANT TO READ AND SIGN
_71.
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold thaCity ofEdmonda harmlesVdl�-�n'�, 4nages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against Ae City of Edmonds, or any of its departments or
employees, including or not limited to the defense of any legalproceedings including defgns costa, and attorney fees by reason of
gra t thispernut.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR �$,PERIOD OF ONE Y&J�'R FOLL.." W121 _�J HE FINAL
T, E,
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORAT�ON §F4'WILL BE HELD UNTIL THE IF] _ I 4� -VIPA TCH
IS COMPLETED B Y CITY FORCES, A T WHICH TIMEA DEBIT OR CREDIT WILL-43kPROCESSED FOR ISSUANCE To T55PJ5LiA4�'T—
Construction drawing of proposed work required with permit application.
A 24 hour notice is required"for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink 11?pyof thepermit will be
available on site at all ti�L� inspection purposes. if
Signature: -.4 Date: July 26, 1994
FCO n tra,� to r o r Age n t)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
CITY USE ONLY
APPROVED BY: LAJINJC_�
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS:
COMMENTS:
DATE:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/M41)--lil'i
RESTORATION FEE:
PERMIT FEE: -30, 0c)
TOTAL FEE:
RECEIPT FEE -
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
IK�
0
APPLICATION
for
The City of Edmonds SEDE SEWER PERMIT
EASEMENT No . ..........................................
NEW CONSTRUCTION n REPAIRS E)
... . PERMIT No.
OWNER .............. . . ... I .......... .... . ............................. CONTRACTOR�.7
ADDRESS . .... — 7--7 ...... 7-7.2.z�l ... . LEGAL DESCRIPTION: LOT No . ............................ ................. BLOCK No . ............................................
-J� Aira 4*10, V� A(, 277- ,,4 �;;,
NAMEOF ADDITION.. ....................... 4 .............. F .............................................................................................
Approved:
DATE................................................ By ......................................................................
The City of Edmonds
APPLICATION
for
SEDE SEWER PERBUT
NEW CONSTRUCTION [:] REPAIRS E]
EASEMENT No . ..........................................
OWNER .............. 64*� .............. !!!2�& .. ;7;7 .................................. CONTRACTOR 2114-;� ;X�? ..... J,- .. Alf/- PERMIT No.
(�J- �rq-9
ADDRESS LEGAL DESCRIPTION: LOT No . ........ ..................................... BLOCK No . ..... ......................................
a . ......... ... .. ... ... e ... /- )
J, 1-��2 Z54 4e-
NAME OF ADDITrN ..........................
................................................................................
0
d[l
I- Approved:
-.1 -? �o.2, /./ /,; " ll:�
DATE.09.-2.02 --- ......... 13Y
8 9 0 - I o':) -
CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning 9 Parks and Recreation e Engineering
November 2, 1993
Clifford R. Dean
21102 Summit Lane
Edmonds, WA 98026
SUBJECT: WATER MAIN INSTALLATION ON SUMMIT LANE
LAURA M. HALL
MAYOR
The City of Edmonds is planning to install a 6" water main on Summit
Lane in the early months of 1994. In order to do this, the City must
obtain a water utility easement to permit us the right to install such
facilities and then legally maintaining them.
Attached you will find an easement that is needed prior to the
construction of this new water main. Please review and when you agree
to this, sign the document in front of a notary public and in turn your
signature will be notarized and stamped. The City will record all of
the needed easements and then we may start on this water main upgrade.
Please note that all easements from property owners on Summit Lane must
be notarized before this project can commence.
If you need the services of a notary, you may take this document to the
Community Services Department at 250 - 5th Avenue North in downtown
Edmonds. I would request that once the documents have been signed and
notarized, you have two copies made for your records and mail one copy
to the following:
Attention: Ron Holland
City of Edmonds Water Section
200 Dayton Street
Edmonds, WA 98020-3147.
Thank you for your prompt attention in this matter. Should you have
any questions or concerns, please contact me at 771-0235, extension 349.
Sincerely,
(Z 46��
Ron Holland
Water/Sewer Supervisor
RH/lk
Attachment
SUMMITT/TXTWATER Incorporated August 11, 1890
t'. .0"
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
0 ( L_ L- L)A
cc
uj MAILING ADDRESS
Z
3:
in_ -7, 1 1 o-z, rr
E,V"a-41125' '560Z(61 -7-71-051`78
�AME
C,>LA.# W e4Z—
ADDRESS
NUMBER
NAME Hc>"e I Hwove
ADDRESS 7r5 Q "7 __1 1 4%% 41' ' _4-�
CITY ZIP I IELEPHONE NUMBER
z
0
STATE LICENSE NUMBER EXPIR�TION PATE�
Legal Description of Property - include all easements
Z -"4e_,5aA*,14 lr7o qvq-4" n.5
9-
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_j Property
Tax Account
Parcel No. -7 Oc>'5 -0 1 -1 C)_3 C> -L
1:1 NEW Er R,S,DEN,T,At EiDiE.CH
R COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
APT. BLDG. I
REMODEL SIGN, 'f
GRADING FENCE
REPAIR — CYDS. x _FT)
DEMOLISH WOODSTOVE SWIM POOL
INSERT HOT TLEI/SPA
FGARAGE RETAINING WALL/
]CARPORT ROCKERY RENEWAL
Z
0 (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF CRITICAL
LU
0 OF DWELLING AREAS
Cc STORIES UNITS INUMBER
0 DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
y_evwAAe_j fze._ret,4;,.. v, ) 5_-'i Ia. oe�
5jakk,O-cA 424A
USE
ZONE PERMIT
NUMBER Sol 8�t
JOB SUIT E/APT
ADDRESS 0
-
ILEGAL DESCRIPTION CHECKI SUBDIVISION NO. ILID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved
0
RW Permit Required
0
EXISTING —REQUIRED DEDICATION —
Street Use Permit Req-d
0
Inspection Required
0
OSED
I
Sidewalk Required
0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRE-D
1?
I __/_
YES 0 NO 3
A
ENGINEERINGMEMO DATED
VARIANCE OR CU ADS # SHORELINE
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE � EXEMPT ALLOWED I PROPOSED ALLOWED I PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fl
ALLOWED I PROPOSED FRONT SIDE REAR FRONT UR SIDE REAP
LOT AREA PLANNING REVIEW —BY DATE
REMARKS
ECKED BY
SPECIAL INSPECTOR I AREA OCCUPANT
REQUIRED 11 YES I LOAD I
PROGRESS INSPECTIONS PER USC 108
FINAL INSPECTION REQUIRED
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
(5j?� - r1Z4-e(? 1-%"11V-
GLAZING 0/0
I /V/6'_
PLUMBING
Plan Check No. q % — Le I
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any Construction on the public domain (curts, sidewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I �qhr, -iProvided Work jli�S�taded Within I ' 80,6ays
STORM DRAINAGE FEE
"Applicanf,'dn bl�hilf of his or he� s'�odse, heirs, assi6ns.aind
ENG. INSPECTION FEE
successors in 'interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
2 employees, and agents from any and all claims for damages of
M
5 whatever nature, arising directly or indirectly from the Issuance
3: of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
0 ve or reduce any requirement of any city ordinance
modify, wai
0
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'l am the owner, or th.e duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
; jlw�7'
THIS PERMIT
state laws regulating consirulction; and In doing the work authoriz-
AUTHORIZES.
ed thereby, no person wit I I be employed In violation of the Labor
ONt,,Y THE �',
NOTEE I
Code of the State of Washington relating to Workmen's Compensa.
WdRK
.
tion Insuranc a-RCW 18.27.
PECTION
IAT� NED
SI RE (OtNER OR AGe�Tj E IG
D PARTMENT
CITY OF
EDMONDS
CALL FOR-;
ATTENTION
INSPECfi0N'
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220
A CERTIFICATE OF OCCUPANCY HAS . BEEN GRANTED. UBC
SECTION 1109
I 7L--) I 11WILI
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her —.--
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
T
MINAL — File Y9LLOW — Inspector
PINK — Owner GOLD — Assessor