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NOTICE:*
fity
0
'0w-a r-r al
N 'shown on the attached
The -information
map(s) was com ' piled for use by the OtY 01
Edmonds/ its Empl-oyees and Consultants.
Th,..e City ofEdm.onds does. not. wa rra nt the
accuracy of anything set forth on t - hese
M a P (s). A n . y person or e-ntity -requesting a
copy should conduct an independent
rm'ation shown* c
regarding the info' lmlted to,
tFe -rnap(s),r including, but not I
the location of any sewer stub shown. Su(
sewer stubs may or may- not e.xist and ma�,
t the location shown,
or may not exist a
r- i t y c) f E d m 0 n IdA (S. nor its
Neitheir the %1_1 icers'sha-[] be 1--jab].-e for th
emptoyee*s o*r off'
Iven on th�s map(5), nor for
information g d
e.ntation provided base
any one repres
Upon'said. map(S).
The City of Edmomb
STIJEE7* F7LIE Amt, mom
for I
SIDE SEWNR PZRWT
OUTSIDE 0 INSIDEJ*- REPAIRS 0
OWNER ....... G ... (j..
... ....... ........................ CONTRACTOR .....
STREET
HOUSE No . ...... ..... ................... ........... AVENUE LOT No . ............................ ............
/--e .2 2 rw Age. 4/. NAME ADD.... ................. .............. ..................
ow 0, 1
-&CIO
Z,
TN.
Date
BACKFILL WORK ORDER ISSUED.� .......................................... DEPOSIT, - ............................
SEWER WORK ORDER ISSUED .......................... . ..... .............
-M A
1 ol PERMIT NO
................................. BLOCK No . ........................................
........... ....................................... ......... ...........................
.v /,
Aw; �71'.
0011- w-...
....... .... .. . .....
I i
8"TREET FILE
6,90 - I qq-
CRY of Edmonds
Critical Areas Chec'kfis . t
The QiticalAxeas Checklist contained on
this form is to be filled out by any person
preparing a Development Permit
Application for the IMY of Edmonds prior
to his/her submittalof a development permit
to the City.
The purpose of the Chccldist is to enable
City slaff 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 histher 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 detcrmimfion 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.
of the parcel with enough dcfail that City
staff can find and identify the subject
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information or sttidies in conjunction 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). - . I
Owner / Applicant:
Name
&-AJ6z_
Title -
J 7 '
�ZJ:2�% T-1-- *� ('D
Street Address
I
�!Od' f - � > 72
City, State, ZIP— Phone
Si Date
—it�
Applicant Representative:
Name
ritle
Street Address
City, State, Zip Phone
Signature
Date
Critical Areas Checklist'
Site Information
Project Name: Permit Number.
SiteLocation: Z(ZV 6, e
property Tax Account Numb r.
Approximate Site Size (acres or square feet):
Have you filled out a Cfitical Areas Checklist for a ;roject on this site before? 14�
General Site Conditions
1. Has the site been cleared or logged?' Date of most recent action: -
Soils / Topography
2. In the Snohomish County Soil Survey� what is the mapped soil type(s)? &teigt
3. Descnibe the general site topography. Check all that apply.
>L--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.)
W1113r. slopes present on site of more tharl 15% and less than 300/,p ( a vertical rise
of 10 feet of horizontal distance.)
Steep: grades of greater than 30% present on site.
Comments
Hydrology/Vegetation -
4. Site contains areas of year-round standing water: ido
5- Site contains areas of seasonal standing water. -Approx. Depth:
6. Site is in the floodway /00 floodplain 2—of a water course.
-AL
7. Site contains a creek or an area where water flows across the grounds surface?x—u-flows.
are year-round? )JJ Flows are seasonal?
8. Site is primarily: forested meadow ;shrubs mixed
9. Obvious wetland is present on site:
10. Wetland inventory or map indicates wedand present on site:
11. Critical Areas inventory or map indicates any Critical Area on site:
Deferminatioli - N u m b e.r*..
Rey' 3127192
!:5� Re
ell/
.'..Planner
REET FILE
USE
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION joe
OWNER NAME /NAME OF BUSINESS 1 ADDRESS
MAILING ADDRESS .
:ZI-�_Z7— 9011- N-C UJtE_,;r
CITY Z` I TELEPHONE NUMFE—R
GAmo,)dc, 9SD2-C) OZ--;_�98!5
NAME >� 6 ;� _\"� �� 0 V I,/
ADDRESS
E NUMBER
NAME
ADDRESS
CITY ZIP I TELEPHONE NUMBER
STATE LICENSE NUMBER EXPIRATION DATE
Legal Description of Prc)?-eAy:7 inglude all easernents
I' �A VJ .1.7 . k— I
C,
S,
05�02." t4t�.-,T I 17.
Il�
'-5
% fo
Property
Tax Account
G t5�
Parcel No. Ifx)
ElNEW
RESIDENTIAL
11 PLUMBING
E]
F�
F-I
ADDITION
COMMERCIAL
MECHANICAL
APT. BLDG.
E]
1:1
REMODEL
SIGN
GRADING
REPAIR CYOS.
DEMOLISH WOODSTOVE
INSERT
SWIM POOL
F HOT TUB/SPA
FGARAGE RETXINING WALL/
IC ROCKERY
El RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
F1
PERMIT r, "
NUMBER
iUBDIVISION NO. ILID NO
PU B
S
P LC
UBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved 0
RW Permit Required 0
LEXISTING — REQUIRED DEDICATION Street Use Permit Req'd 0
X I T'
P P 0 S E Inspection Required 0
ROPOSED Sidewalk Required 0
REPOKS
R MAR S
�1 " f;,? ,� C -, —
ENGINEERING MEMO DATED If I' R�YIEW PY
--//, 7�Y
METER SIZE IBUILDING SUPPLY SIZE NO. OF FIXTURES
M
W
REMARKS
SIGN AREA
SEPA REVIEW
ADS NO.
ALLOWED PROPOSED
COMPLETE EXEMPT
SHORELINE#
I
I
EXP
VARIANCE OR CU
eLA N'RG REVIEW 13Y
SETBACKS —FEET
HEIGHT LOT
COVERAGE
Z
FRONT SIDE REAR
Z
REMARKS
HEIGHT
5FILCIAL IN5PECTUR I AHLA OCCUPANCY 0
REQUIRED 0 YES GROUP L
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewplks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
,n successors in interest, agrees to indemnify, defend and hold
'Uni harmless the City of Edmonds, Washington, its officials,
i employees, and agents from any and all claims for damages of
4 whatever nature, arising directly or Indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
TOTAL AMOUNT DUE
0
x nor limit In any way the City's ability to enforce any ordinance
provision."
I hereby acknowledge that I have read this application; that the
Information given is correct; and that I am the owner, or t" duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authorlz-
AUTHORIZES
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
tion Insurance. I
INSPECTION
DEPARTMENT
Sl NAT (OWNER OR AGE T) DATE SIGNED
CITY OF
EDMONDS
CALL FOR
TTENTI INSPECTION
IT IS UNLAWFUL 0 use OCCU�Y A BUILDING OR STRUCTURE
I _Ljj ' A 771-0220
VN-T4L_A_FJ_NAL1 SPECT (OJN'IHAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
CHAPTER 3.
10247
FEE
IZ
APPLICATION APPROVAL
This applicallon 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.
OFFICIA&Ts7i 65TAT DATE
,0RE
RELEASED BY: DATE
ORIGINAL — File YELLOW — inspector
PINK — Owner GOLD — Assessor