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FEB 0 2614
Site Classification W.orksheetgrDr y111,,3,.FO gltl OR TNmDENt
Page 1 of 2
ED
The project's Site Classification will dictate t];ie specific stormwater management
requirements applicable to your site. Completing this worksheet win help determine the amount of
regulated impervious surface and whether your project falls into the classification of a Small Site
(Category 1 or Category 2), or a Minor Site. Please reference the GlossM (pp. 10- 11), Figures D and
E, (pp. 8-9), and Examples (pp. 11-12), to assist with completion of this worksheet.
1) Is Permeable Pavement' Proposed For Use on this Site?
Refer to Stonnwater Supplement Chapter 5.1 El Yes 01 No
If YES, the subject area is to be considered impervious for initial site classification purposes. Include total
permeable pavement area in the calculation of Non -Regulated, Replaced and/or New impervious surface
areas in the table below.
2) Determine the Amount and Type of Existing & Proposed Impervious Surface for the Site
Refer to Stormwater Supplement Chapter 2 and Fig. C
Line 1: Identify the Non -Regulated Impervious Surface Area.
Line 2: Identify the Replaced Impervious Surface Area, dividing the total between Exempt and Regulated; either or both
may be zero. Note: For project classification purposes, Replaced Im
pervious may only be considered exempt
under certain c onditions. Refer to the Glossary and Figure D.
Line 3: Identify the New Impervious Surface Area for your project. All impervious areas created post -July 7, 1977 or
after the date of annexation into the City are regulated & should be included in this total unless they can be
categorized separately as a Replaced -Regulated area.
Line 4: Enter the sum of the total Rdplaced-Regulated plus the total New impervious areas.
Line 5: Identify the total area currently mitigated by an existing city -approved stormwater managenient system.
Line 6: Enter the sum of the value in Line 4 less the value in Line 5 to identify the total Regulated area in which
stormwater controls have not yet been applied.
Line 7: Identify the total area proposed'to be mitigated through the use of Low Impact Development Techniques.
Line 8: Identify the totalarea proposed to be mitigated through conventional Stormwater Managegient Techniques.
Provide a copy of the following table on the drainage plan sheet for the proposed project
ALine
Type
Are a (squa r e feet)
1.
Non -Regulated
t I .
Exempt
Regulated
-2.
Replaced
3.
4.
New (Post 1977) 4 4 4 4 4 4 4
Total Regulated Impervious Area
Mitigation required if in excess of 2000sf
+
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29 r
2a�
5.
6.
Total Area Mitigated by Existing Stormwater Management System(s)
Regulated Area Not Yet Mitigated
=
7.
Area ProposeA to be Mitigated by. Low Impact Development Techniques
I
=
8.
Area Proposed to be Mitigated through Conventional SWM Techniques
=
I
(e.g. porous asphalt, porous concrete, paver blocks, concrete open ceHed paving grids, or plastic lattices filled with turf or stone)
Revised on 310512012
M
E72-SWA41_Erosion—Control-03.05.12.doc
Page 5 of 12
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CITY of EDIVIO , NO . S C? DVJ SIDE SEWER P 4 E'R.'M I T
For Inspection Call 771-3202 PERMIT NO. 00�
87ROL�J'RL& ruction: '51 1��
Property Legal Description (Include all easements):
Owner and/or Builder:
Contractor & License No:
Single Family Residence
— I -.-" . /� 'r , I Z 7 1 P
Multi -Family (No. of Units
EDMONDS
TREATMIENT PLANT
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No w-'� Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No t,� Yes (If Yes, easement required,
attach legal description and county easement number.)
P EASE EAID THE ITEMS LISTED ON THE BACK
I certify that I have re'rd-and shall comply Ate
with the items listed on the back.
-?6, CC
Permit Fee: iissued By:
Trunk Charge: Pate Issued:
Assessment Fee: C"�:'fi Receipt No.:
Partial Inspection:
Comments Date Initial
Final Inspection Approved: 6-4-96 Jfd Z/�
Date Initial I--' ,
Rejected:
Reason —Ma—te —I—nitial
** PERMIT MUST BE POSTED ON JOB SITE **
Wh.ite Copy - File Green Copy - Inspector Buff Copy - Applicant
The City of Edmonds Side Sewer Drawing EASEMENT NO - ---------- ---------------------------------
NEW CONSTRUCTION REPAIRS Ej LID NO. � .......... ...... . ASMT. NO - ------------------
,OWNER ----- R- A T ---------------------------- ---------------- CONTRACTOR --- A-k�A�-t-F-o ----- -B.A.,c--KiA09 .................... PERMIT NO.
JOB ADDRESS PL.\\J ,
4 LEGAL DESCRIPTION: LOT NO - ------ 1-0 ------------------------ BLOCK NO - ------------------------------------
------------
- ----------------------------------
HOR-r" —4w
/-*'c 0
. . Z:
----------------- -------------------------------------------------------- ------------------------------------ --------- E-DIMIONDS ----------- ........
TREA14JENT PLANT
NAME OF ADDITION .... OV�M-PA-C — ----- P. LA!;;; �f C ---------------- I rl
co W��
Approved:
RD
93
PWW-0001-1 1/75 (REV.1 1/78) DATE --- 5umc .... 4.,.050---- By
---------------------
NOTICE:*
...w-ar-ranty...0_a c
N'0
The -information shown on the attached
Hed for use by the OtY Of
map(s) was com ' p
Edmonds, its Empl.oyees and Consultants.
Th,.e City of 'Edm.onds does ' n ot. warrant the
these
accuracy of anything set for.th on
'ty-requesting a
Map(s,_). Any person or enti
copy should conduct an independent
i the infbrm'ation shown, o
inquiry regard'ng
_tFe -map(s)/ including, but not Hrn'ted to
c ion of any sewer stub shown, Suc
the lo' at'
-not exist and may
sewer stubs may or may
or may not exist at the location shown,
Neitheir the �jty of Edmo-nal-sl nor its
t h
empl.ovee*s Of office-rs be 1`1 a- b-1--e f o r
I n on this map(5), nor for
infor . r-nation g'Ve' Ided based
any one representation prov
upon'sald map(S).
CITY OF EDMONDS ASSET INFORMATION SHEET
F E
is �,Z/N E W ASSET NO.
ADDITION ADDITION TO ASSET NO.
RETIREMENT
DESCRIPTION
X, Sle If, VC�r
W Lim
SERIAL NO.
LOCATION 2,13 0 q - q -3 rd
PL,
DEPT. NO.
*PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
PROJECT NUMBER Vi () Ys 0,5�9
PROJECT COMPLETION DATE(n 13 0 1 1 -7 0
COST --t(4, El'
B.A.R.S. ACCOUNT NO. 000 1- q�S, Q0, (10 3
ESTIMATED LIFE Yrs
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
V/DEPRECIATE VERIFIED BY
MONTHLY DEPRECIATION AMOUNT PROCESSED
ANNUAL DEPRECIATION AMOUNT BATCH NO.
G.L. ENTRY
REFERENCE DATE
INITIAL
DEPARTMENT FILE
TO: Permit Coordinator, Building Division
FROM: Dan Smith, Engineering Inspector
ADDRESS �/,;5/Z� 9�� ,.- -( �
OWNER �Z' /�� /,_7 � �-b' rlFaer "ezv/ PLAN CHECK #
After review of the subject building permit application, we have the
following comments:
1. Construction hours are: WEEKDAYS ........... 7:00 a.m. to 10:00 p.m.
WEEKENDS/HOLIDAYS..10:00 a.m. to 6:00 p.m..
2. A Right -of -Way Construction Permit is required for any work on
City property.
3. Connection to City water system required. Fees paid.
4. Connection to City sanitary sewer system required; obtain separate
permit. Fees paid.
5. Water and sewer lines to be separated by 10 foot minimum.
6. Driveway must be paved a minimum of 20 feet back from City
right-of-way; separate permit required.
7. Driveway slope not to exceed 14%.
8. Back water valve required if downstairs plumbing is below
elevation of upstream manhole.
9. Builder/Owner responsible for containing all temporary runoff and
erosion control on site. Construction may not impact neighboring
properties in any way.
10. No burning of construction refuse without approval from Fire Dept.
11. Street to be kept clean of debris, dirt, mud, and construction
materials. Contractor responsible for dust control.
12. Inspection required on drainage system, catch basin installation,
driveways, and sidewalks. A final engineering inspection is
required prior to the building -division granting occupancy.
13. Repair or replace all defective existing curb, gutter, and
sidewalk. If intersection is involved, installation of wheelchair
access may be required.
BLGPER/TXTFORMS
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CITY OF EDMONDS ZONE U�1# R
CONSTRUCTION PERMIT APPLICATION Gs ITE/AP
OWNE_"AME,/NAM OF B INESS ADDRESS
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LEGAL DESCRIPTION CHECK SUBDIVISION NO LIU NO.
MAILING ADDRESS I ��t // ij
gZ //V- I PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
Y ZIP I UVPHONE NUMB EXISTING REQUIRED DEDICATION APPROVED BY
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NAME PROPOSED !!�O
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0 Uj
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STREET USE PERMIT REQUIRED 0 Z
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�ZIEW BY Z
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TELE :2
CITY ZIP PHONE NUMBER REMARK� -74ii
NAME
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ADDRESS
c7y" METER SIZE DING SUPPLY SIZE FIXTURE UNITS
CITY ZIP TELEPHONE NUMBER X
REMARKS
STATE LICENSE NUMBER
SIGN AREA ENV. REVIEW ADS NO.
171Z) 2!� ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property - include all easements
(show below or attach two copies) SHORELINE N
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'PTe r///4�-
IL4 - VARIANCE OR CU PLANNING REVIEW BY DATE
HEIGHT LOT COVERAGE Z
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FRONT SIDE REAR Z
SETBACKS - FEET
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Tax Account Parcel No. REMARKS (L
U_-f NEW R*ESIDENTIAL D*'PLUMBING
1:1 ADDIALTER El COMMERCIAL MECHANICAL
APT. BLDG. "I'-1,<eelu
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EXCAVATE, FILL FENCE CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
DEMOLISH OR GRADE I- X _ FT)
CARPORT swim
SPECIAL INSPECTOR JAREA OCCUPANCY OCCUPANT
REMODEL GARAGE POOL REQUIRED GROUP,4(�_\_3 LOAD
WOOD STOVE/ RETAINING WALL/ I F.1 YES 1*; NO
INSERT ROCKERY RENEWAL REMARKS
(TYPE OF USkjUSINESS OR ACTIVITY) EXPLAIN: ROGRESS INSPECTIONS PER UBC 305. Z
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
I
Permit Limit: 1 Year - Provided Worl� is Started Within 180 Days
"Applicant, 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
a:
<
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
0
x
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowle;ge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz-
THIS PERMIT
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 his
Code of the
State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
tion lnsurpbce.
/7 A
INSPECTION
acknowledged in space provided.
SIGNA
OR GENT),�_
SI NE/D
DEPARTMENT
LEEQ
JDATE
CITY OF
OFFICIAL'S SIGNATURE DATE
EDMONDS
ATTENTION
CALL FOR
RELEASED BY: DATE
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-3202
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL
OR
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED.
UBC
CHAPTER 3.
PINK — Owner GOLD — Assessor
T
R 'RPEI Ell E
USE -IMIT— - - -_
CITY OF EDMONDS ZONE :.UMBER goo 2142-
CONSTRUCTION PERMIT APPLICATION
11
JOB IFE/AP
OWNEB-14AME/NAM OFB INESS ADDRESS 7
". 2.
LEGAL DESCRIPTION SUBDIVISION NO LIOr NO.
MAILING ADDRESS
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Y ZIP PHONENUMB EXISTING '&2 nEOUI RED DEDICATION APPROVED BY
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PROPOSED -j!tC-
NAME
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
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STREET USE PERMIT REQUIRED 0
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Z
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-7� / - RPYIEW BY
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SEE ENGINEERING MEMO DATED
CITY ZIP TtLEPHONE NUMBER
U1
e"rz a - 9�1 -77f - 2� -5 REMARKS
NAME
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ADDRESS
0
U
(Y,)� /E FIXTURE
METE��
CITY ZIP NUMBER IBUILDING SUPPLY SIZE
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ITELEPHONE
STATE LICENSE NUMBER
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SIGN AREA ENV. REVIEW ADS NO.
Legal Description of Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT
(show below or attach two copies) SHORELINE #
Z
0
7— VARIANCE OR CU PLAt.,INING
REVIEW BY TE
V
7 SETBACKS - FEET HEI�H/T LOT COVER,�GE
Z
FRONT SIDE IZ— REAR
Z
Tax Account Parcel No. REMARKS
CL
Alb Ziiz---s io
2'NEW ErPLUMBING
RESIDENTIAL
1:1 ADDIALTER COMMERCIAL 0 MECHANICAL
F-1 REPAIR ET APT. BLDG. El SIGN 1k1Xee-,S ar
F] EXCAVATE, FILL FENCE CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
El 45-
DEMOLISH OR GRADE 1— x _FT)
CARPORT swim
REMODEL GARAGE POOL SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
WOOD STOVE/ RETAINING WALL/ n.YES 1-7, N 0
INSERT RENEWAL REMARKS
Z
0
ROCKERY
US
(TYPE OF US" INESS OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBC 305
Z
(L
0_
NUMBER OF STORIES NUMBER OF (f0,0wf-
DWELLING
0
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
FINALINSPECTION REQUIRED
VALUATION FEE
PLAN CHECK FEE
Ld fl�,
84 o
BUILDING
A/� PLUMBING
/
Plan Check No. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Worl� is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
w
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 or indirectly from the issuance
0
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
j"
e
0
T
nor I.imit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
Z404
provision."
1 hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I 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 his
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurplice. /7 A INSPECTION acknowledged in space provided.
-7
SIGNA E EQ OR GENT) DA—TE SI ED DEPARTMENT
CITY OF OFFICIAL'S SIGNATUR DATE
�: ; 0%5=21
1 7?
EDMONDS
CALL Z� A E BY:
ATTENTION 0,�
INSPECTION ho
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-3202
UNTIL A FINAL fNSPECTIONL.HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Owner GOLD — Assessor
102-87