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CITY OF EDM_0F4b9__ w 0 vm
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49NE PERMIT
8 NUMBER 940448
CONSTRUCTION PERMIT APPLICATION
ijoB SUITE/APT #
ADDRESS
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OWNER NAME/NAME OF BUSINESS
LEGAL DESCRIPTION CHECK
SUBDIVISION NO. LID
NO
MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — REOUIRED DEDICATION
TESCIP Approved 0
RW Permit Required E3
Street Use Permit Req-d 0
CITY ZIP
TELEPHONE NUMBER
PROPOSED
Inspection Required C3
Sidewalk Required 11 cr
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NAME
METER SIZE
T
LINE SIZE
] NO. OF FIXTURES
W
PAV RECUIRED
YES 0 NO 0
ADDRESS
REMARKS
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CITY Z177
E NUMBER
NAME
ADDRESS
ENGINEERING MEMO DATED REVIEWED BY
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Z
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CITY ZIP
TELEPHONE NUMBER
FIRE MEMO DATED REVIEWED BY
U.
ICENSE NUMBER EXPIRATION DATE
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SIGN AREA
ALLOWED 4;OPOSED
SEPA REVIEW
COMPLETE JEXEMPT
EXP
ADEVqO.
IV/4
SHORVINEN
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0
0
Legal D s r . ption of P rt -i I d 11 m Ills
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VARIANCOOR Cu
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API&NIEW BY
DATE4__
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SETBACWS — FEET
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FRONT IZA5 SIDE? REAR/117
HEIGHT
LOT COkE`RAdF1__ T__ z
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Property
Td�Account
Parcel No.
REMARKS
NEW 7RESIDENTIAL OPLUMBING
ADDITI ON COMMERCIAL 1:1 MECHANICAL
APT.BLDG. Z!Weftk
E] REMODEL alum
CHECKED BY
TYPE OF CONSTRUCTION
I 5�111fr/l/pW*0 I
CODE
OCCUP!A##%.-
GROULel�2
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0
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0
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0
GRADING FENCE
REPAIR CYOS. L_ x _FT)
DEMOLISH WOODSTOVE SWIM POOL
M INSERT HOT TUB/SPA
GARAGE RETAINING WALL/
C ROCKERY RENEWAL
SPECIAL INSPECTOR
REQUIRED 13
AREA
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER USC 305 Z
(TYPEOF SE BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
OF
STORIES
NUM13ER OF
DWELLING
UNITS
CR T CA
r" L
AREAS
NUMBERf#/4��
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
Z�
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
%
PLUMBING
FPIan Check No.
MECHANICAL
This Permit covers viork to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit- Application: 180 Days %.
Permit Limit: I 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
26
successors in interest, agrees to indemnity, defend and hold
harmless the City of Edmonds, Washington, its officials,
x
x
01
employees, and agents from any and all claims for damages of
whatever nature, arising directly or Indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any City ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
I
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I
I 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 agLgalle-comply with city and THIS PERMIT
state laws regulating constr!�Oomrd_nd In doing the work authoriz- AUTHORIZES This application is not a permit until
ed thereby, no person_01,10156 employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the State 9104-ashington relating to Workmen's Compensa. WORK NOTED D6puty; and fees are paid, and receipt is
tion I nsuranceaKff RCW 18.27. - INSPECTION acknowledged in space provided.
TURE.( ER OR AGENT) IPATE SIGNED. DEPARTMENT
CITY OF PF TURE D/TE
07e:; EDMONDS
CALL FOR ELEASEVO DATE
ATTENTION INSPECTIO, ------------------
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Owner GOLD — Assessor
102-87
STOEET FILE.
ea..s
Ch.d. cAllst
.11 �
17he Critical Areas Chftl,dist contained'on
this form is to be filled out by any person
preparing a Development pwrnit
Application for the City of Edmonds'prior
to his/her submittal of a development
permit to the City.
The purpose of the CheckUst is to enable
City staff to detaimine whether any
potential Critical Areas am 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 his/her reprewntative,
must fill Out the checklist, sign and date itt
RF-CE:'V ED
Jul.
PERMIT roUt4TER
atnd subt t It to th`e city. ne city will
. I
ew�
h
cheeldist, make a precursory site
visit, and make a determimflon 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
or Plot pUn fbr individual lots of the parcel
with enoughdetail that Citi itiff can find
And identify the subject parcel(s). in
addiflont the applicant shall Indude
other pertinent Infonnation (e4. she
plang topography map, etc.) or studies in
c0djunction WM this Checklist to assist
ftff In coMpleting their preliminary
assftment of the site.
I haVecOmPleW the attached Q'itical Area Checklisi d
and attest that the answers provided are
factual, to the best of my 1(nowledge (fill Out the L'OMI
Wropna co umn below),
Owner /QQ� APP11",nt Repruentativel,
Name Nam' ......
Strut Addrew
StredAddnm,
City, State, ZIP. Phone Stm. ZIP Phone
ci�
Date SiJJ111AtM Date
.4
CA FILE NO. -1t4,S
Critical Areas Che'cklist -
Site Information (Solb/topography/hydirolo on)
I '?
L Site Address/Location:
2. Property Tax Account Number:
3. Approximate Sit$ Size (acres or square feet):
4. Is this site currently developed? es; , no.
If yes ' how is s Ito developed?— e�f to__5!0
S. Demibe the general site topography. Check all that apply.
'/X Flat: less than 5-feet elevation change over entire site.
slopes on site generally Ion than IS% (a vertical rise of 10-ft over a
horizontal disu= of 6&feet).
1. Rolling:
Hilly:
R E C E: I'v D
JUL 0 5 1994
PERMIT COUNTER
slopes Present on site of mote than 15% and lea than 30% (a vertical rise
Of 10-f0d Over a horizontal distance of 33 to 6&feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-ft).
Other
please describe):
6. Site contains area of year-round Ing water: er Approx. Dept4;
7. Site contains areas of seasonal WS Water: A_1014:e
Appmx. Depth
What season(s) of the year?
flood
B. Site is In the floodway plain eic.�'o f a water course.
9. Site contains a crock or an area �here' vMer flows Acton e grounds surfloPA? Flows are year-
round? Flows am misonal? _ XIA (What time of year?
10. Site is primarily: fbrested Meadow ;shrubs
mixed
urban lands ad Oawn,shrubs etc)
cap
11. Obvious wetiand is present on she: �V-o
Roy CIM4094
APPLICATION
for
Th SEDE SEWER PERMIT
EASEMENT No . ..........................................
NEW CONSTRUCTION 0 REPAIRS E]
324-04200
OWNER........... ..................................................................... CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ....... U.M34th-Avenue-14 ............................................... LEGAL DESCRIPTION: LOT No . .......................................... ... BL40CK No . .................................
0
0
NAMEOF ADDITION .........................................................................................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................