216 4TH AVE N.PDFlill iiiiiiii
5024
216 4TH AVE N
V
I I
ADDRESS: IWP-11\1
TAX ACCOUNT/PARCEL #: 00",440D �-O 1000
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION:
El Conditional Waiver El Study Required El Waiver
CRITICAL AREAS #: DETERMINATION:
Conditional Waiver El Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DST's\Forrns\Jana's Street File Checklist 5-14-08.doc
m
STREET FILE AWLI"U"
for
"M City Of 8xlW= rzltam EASEDCOM No . ..........................................
NEW CONSMUMON 0 REPAMS C-j
114-01550
0VVN= ........... J.a.ne .... S - k-ube ------------------------------------------------------------------- CONTRACTOR ............... ........................................................ ......................... PER-IWW No . ......................
ADDREm ....... 2.1� ... Alh ... AY9�, .... N, ................................................... LaGAL DESCRnMON: LOT No . .............................................. BLA)CK No . ...........
NA3WOF AMMON .......................................................................
Dye Tested On Sewer 1972
Approved:
DATE ----------
BY
Applicant: Darrell and Paula Marmion776-3135)
4th Ave N
---------------------------------------------------------------------------------------------------
Datum 0 +100
Water Meter Cover
--------------------------------------------------------------------------------------------------------
+1001-0"— —+100'-l"
Edge of Sidewalk -J
Edge of Right of Way
Existing Fence
C
Alley
a I/ ---- 4
D
Existing House
STREET FILE
APPROVED BY PLANNING
RECEIVED
APR 12 1996
5'-0" pERMIT COUNTER,
Street Address: 216 4th Ave. N HEIGHT CALCULATIONS:
Legal Descriation: The Southwesterly 45 feet of Lot 10, Block 2, Plat of Edmonds, A = +101'-l" B = +101'-4!'
according to the plat thereof recorded in Volume 1 of Plats, C = +101'-7" D = +102'-5"
page 26, records of Snohomish County, Washington.
Avg Grade = + 10 1'-7"
Tax Acct Parcel No: 4344-002-010-001 MaxHeight =+116'-7"
Actual Height = +115'-5"
N
Scale: 1 20'
March 1, 1996
20'-0"
A+ +�
House Moved From.
203 4th Ave N.
I I I 4c—*Ik 5-U'
flt"-)
W-0
AIALLMM'� Of -
Existing Fence-
L lQNS:
HEIGHT Q LQULAI
rB = +IOU
A +99,-e' B O�
+99' +99 r
C +991-7- D = +99'-r
7 "
F-17 N::
Avg Grade = +99' -9"
i h ?;-
LD
Max Height - = +124'9"
t +1
Actual Height +1 24�-T'
1A
WATER SERVICE HNSPECTIONS
P �POSED
ROPOSE
HOMED, CALL 771-0235
2
;1TE PLAN
'�1-`PRtnVrD AS NOTED
Scale: 1" = 20'
k7 T FILE
Edge of Sidewalk -1
Edge of Right of Way
Existing Fence
14'-0"
A+ &
r ----I +P
8'-6"
Existing House to be
Tom Down & Salvaged
Moved 203 House
.1
51-01,
C+
C)
CITY COPY
C*4
....... . ...............
Existing Par;dng
(2 Vaces) APPROVED BY PLANNING
2 - Y
45'
Alley
Street Address. 216 4th Ave. N
Lggal Descripfign: The Southwesterly 45 feet of Lot 10, Block.2, Plat of Edmonds,
according to the plat thereof recorded in Volume 1 of Plats,
page 26, records of Snohomish County, Washington.
Tax Acct Parcel No: 4344-002-010-001
HEIGHT CALCULATIONS:
A = + 100'-4" B = +99'-1 V
C = + 100'-5" D = + 100'4, N
AvgGrade =+100'-3" Scale: 1
Max Height = +125'-3" 1 20'-
Actual Height = + 125'-1 " I Jan 24, 19M
9 9
PLANNING DATA
SITE ADDRESS: (6 4'61461- (V -DATE: z
ZONING: PLAN CHK#- q,5-- 7,
PROJECT DESCRIPTION: 5 �r "p- -k4.1jed z7b .5"- 4-L-
SETBACKS:
Reauired Setbacks:
Front: Z 11 'Left Side: f Right Side: Rear: / 3--
Actual Setbacks: / t I
Front: 7-0 LeftSide: Right Side: F Rear: 5_,Y
CORNERLOT /4/ -(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED AltJ Y/N)
LOT COVERAGE:
Maximum Allowed: 70 Actual:
BUILDING HEIGHT: I
Maximum Allowed: Actual Height: /0
Datum Point: .-4-(,, Datum Elevation: 4- (00
SUBDIVISION:
CRITICAL AREAS #: . q5--,IZ
SEPA DETERMINATION:
LOT AREA:
OTHER: V 115' gt2L6�6 7-0
Plan Review By:— ,,e
PLANNING DATA
SITE ADDRESS: 22 1 & - fl, A,,e Al —DATE: -1,/1 & ,-, f,-
ZONING: PLAN CHK#: 96 - e, (
PROJECT DESCRIPTIOW-;-o-� 51A�b S
Anse ko&44A
SETBACKS: (6�_;s S_1-pM_,aA 6
,� to,, 66 &-P�r
Required Setbac�"?O. 5' 1 Atuss,*.- 9-6-&
— I , . p-S-6
Front: Q Left Side:- Right Side: Rear:
Actual Setbacks:
Front: /V,4- Left Side: Right Side: , gr Rear:
CORNERLOT -(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED �J JYIN)
9(
LOT COVERAGE: t4- A"e" ': I
.35,17. " 1A
Maximum Allowed: Actual:
BUILDING HEIGHT: 5" ktasl_� 6--In's
Maximum Allowed: Actual Height:
DatumPoint: Avc Datum Elevation:- 10o'
Aj
SUBDIVISION:
CRITICAL AREAS #: 95- - 9 2
SEPA DETERMINATION: "'j,
LOT AREA: 4000
OTHER: P-ft,, .6 avy,�a- `)bO117 - zi � ;A� ayk 4-14 5,'
aA,%.j t pr)—,K qjrK±�A 4:c: -ru. 5- je4,-&(Aj ,j ot pf=.-!zTt-c4 s" tseA
21-z. Lt-. 441 t,6b �v 5-1 3e+b z.4,ic, "144-4-k
Plan Review By:
CA IW NO. 6j6 —C1
Critical Areas Checklist
,�:8ite lfif6rinitW* ii -(so'ils'46 p'-o"gr'aphy/hydrology/vegetation)
.,L: :'SiteAddress/Location ii&:' 4f� Avg AJ,
450AIDAiLs 98OZO
__g,TaxA uinbei- 4A44 - OOZ - 010 - 00 1
3. Approximate Site Size (acres or square feet)- SI+00
4. Is this site currently developed? Y, yes; —no.
If yes; how is site developed? SJQe=LF- PAMILY IZESIMAC-C,
5. Describe thegeneral site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
21
7.
8.
Rolling- - slopes oh site generally less than 15% (a vertical rise of 1'0-feet over a'-"
horizontal distance of 66-feet).
Hilly: slopes present on site'of more than 15% and less than 30% a verti . c , al rise
of 10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greiter than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
Site contains areas of year-round standing water. NO ; Approx. Depth:
Site contains areas of seasonal standing water: N 0 _;Approx. Depth: _
What season(s) of the year?
Site is in the floodway tJo floodplain " C) of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? tolpk Flows are seasonal? M/A (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) v/
11. Obvious wetland is present on site: Ajo
�;�WAIVER
ewed
.,Revi
D%,(e
Plann-Ir"J
RcvOIIM4
RECEIVED
MAY 2 2 IM
41 go - 19cl—
City of Ednon&
Critical Areas Checklist
Tbe-Critical Areas Checklist contained on
this form is to be.fiRed 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.
Ile 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).
An applicant, or his/her representative,
must fill out the checklist, sign and date it,
MAY
and submit it to the City. -Me 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.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail dw City staff can find
and identify the subject parcel(s). In
addition, the applicant shaH include
other pertinent inforrnation. (e.g. site
plan, topography map, etc.) or studies in
cogiunction 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).
Owner / Applicant-
DAkEeLL MAtZMtorJ
Name
. —L I C, 4-�,
Street Address
F—MONDS WA 916OZO 776-335
City, State, ZIP Phone
Signature
sh z A -5
Date
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
Signature Date
LN-1J
V 9 0 - 19 1 -
City of Edmon&
Critical Areas . Checklist
The Critical Areas Checklist contained on
and submit it to -the City. The City will
this form is to be filled out by any person
review the checklist, make a precursory site
preparing a Development Permit
visit,'and make a determination'of the
Application for the City of Edmonds prior
subsequent. stqp� neoessary to complete a
to his/her submittal of a development
development permit application.
permit to the City.
ith a signed copy of this form, the
The purpose of the Checklist is to enable
applicant'sh6uld also submit a vicinity map
City staff to determine whether any
orp tp r UmW��� o5tso � FcQ
�par
potential Critical Areas are or may be
with enough detail that City staff can find
present on the subject property. The
and identify.the subject parcel(s).. In,
information needed to complete the-
addition, the applicant shall include
Checklist should be easily available from_
other pertinent infor2natioin! (eg. site
observations of the site or data available at
plaJ4 topography map, etc.) or studies in
City Hall (Critical Areas inventoriest Maps.
CO . ni . unction with this Checklist to assist
or soil surveys).
staff in completifig their preliminary
...
assessment of the sit"i."
An applicant, or his/her representitive,
must fill out the checklist, sign and date,it,.-,.�
I have completed the attached Critical Area Ch Jnd attest provided are,,
e
e owl q
Owner./Applicant.
.pnate
A B Rep
pp cant reseid
city, Sultol-
zlp_"-�
JL !1Z
X_
I
FILE NO. M6-64
Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
I. Site Address/Location:
2. Property Tax Account Number: 4JI11 -oos--gol-- 001) tEl AM#- 066--00A-00171
3. Approximate Site Size (acres or square feet): o .:4 4L
4. Is this site currently deveW ed?
OP
yes; _ no.
If yes; how is site developed?
S. 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 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:
Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain 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? _ (What time of year?
10. Site is primarily: fbrested meadow ;shrubs mixed
urban landscaped Qawnshrubs etc)
11. Obvious wedand is present on site:
MWOU04194
6 9 0 - 199 -
A
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
ffERMIT Permit Number: 9':;� -
STREET FIL 40.
Issue D�te: —/0 -,:;Zo
A. Address or Vicinity of Construction: 203 4 Avenue North
B. Type of Work (be specific): Install New Service
C. contractor: Washington Natural Gas Company
MailingAddress: 815 Mercer Street,
State License #: Seattle, WA 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. 'M Commercial El Subdivision El City Project, Rk Utility (PUD, GTE, WNG, CABLE, WATER.)
M Multi -Family E] Single Family Other
INSPECTOR: INSPECTOR: I
F. Pavement or Concrete Cut: 0 Yes EDNo G. Size of Cut: x H. Charge$
APPLICANT TO READ AT�VS116G"/N
0,
INDEMNITY. Applicant understands and by his signature to this application, agrees'r Ph om i unes, es, or
, _9 the City of Edmonds harmlesslo� 41h(-,@11r;)M—ag—
claims of any kind or description whatsoever, foreseen or unforeen, that may be made aj"a—init the City of Edmonds, or any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings including defense cons, and attorney fees by reason of granting this permit.
,THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND M47ERIALS FOR A PEFJ�JD`OijArE YEAR FOLLOWING THE FINAL IAPEC77ON
AAb ACCEPTANCE OF THE WORK. ES77MAYED RESTORA77ONFEES WILL BE HELD UN77L THE FINAL STREET PATCH IS COMPLETED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Departmentsom,
Work is to be inspected during progress and at completion. 771-0220
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 b7 thel Qity Engineer,,
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working t day;
NO EXCEPTIONS.
I have, read the above statements and understand the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspec3t*WtJurposes.1 I.
Signature: Date: October 14, 1992
(Conrra�cl�o- r- or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
.......................
RECEIPT NO ....... . . .. .................... .............. .....
........................
.......................................................... .. ........ . .......
... .. ....... ............. .. ................................. ... ............ .. .......... ...... ........ ......... ---- ......... ...
DATE: ISSUED BY:.:. k4ze
40
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION N TES (Fund I I I - Route copy to Street Dept.)
Comments:.
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
,Work Disapproved. By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. JuI3
202, A 4�,V NJ
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: MICAAR-C� �il" A.Qr>
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager )(
�09 - I(OBG
J
Ic
-z
I
WNG to window
Key:
Water main depth .-w- water
unknown -g- gas
-ss- sewer
gas main -e- water hydrant
0 water valve.
815 MaM SL (P.O. Box 1869), Scott WA 98111(206) 622-6767
LICENSE NO.
- 0
CITY of EDMONDS B LICENSE APPLICATION
DAO&_
4 Civic Center Edmonds, Washington 9 STREET FILE TYPE OF BUSINESS
City Cierk Phone 775-2525 US
qSTRUCTIONS:
All items must be completed
or application will not be ac-
cepted.
Sign and return application
with fee. Renewals received
after February 15 must . pay
penalty in addition to fee.
NEW B �_SES AFTER
JULY 31, 1/2 FEE.
NAME.QF FIRM
MAILING ADDRESS
6�10 . 3- - q- t_�
C3 (A) HOME OCCUPATION
ANNUALFEE AFTER FEB. 15
$15.00 $ 2250
(B) BUSINESS WITH $20.00 $ 30.00
1 TO 3 EMPLOYEES
(c) BUSINESSWITH $22.00 $ 33.00
4 TO 9 EMPLOYEES
Fj (D) BUSINESS WITH 10 $75.00 $112.50
OR MORE EMPLOYEES
P4, NEW APPLICATION (LA)
.0 RENEWAL (LB)
CHANGE (LC)
DELETE (LD)
PLEASE MAKE ANY NECESSARY CHANGES)
BUSINESS PHONF_�7 FNO OF EMPLOYEES
77t,7 _7 S
NATURE OF BUSINESS
P
CL,�J�IYEAR
LIC.EFFEC
DATE
LIC NOISPEC.1
JREASG
RECEIPT NOk:
DATE PAID
PRINT 'X'
IN SPEC. BOX
FOR ISSUE OF
CORRECTED
FEE PAID
PENALTY PAID
I
LICENSE WITH
/I Z��I)
i I I I
'LC' ACTION.
BUSINE SS ADDRESS* INDIVIDUAL
A e3 - Y-//) L;n �S)
'41d,
OWNERS NAME HOMEADDRESS
(T
HOMEPHONE DATE OF BIRTH PLACE OF BIRTH
�-7S 2
EMERGIiNCY NOTIFICATION- (1) NAME& TELEPHONE
(PLEASE LIST TWO) (2) NAME & TELEPHONE
PARTNERSHIP CORPORATION
(P) (C)
SOCIAL SECURITY NUMBER
'-22-
---41XA -Tt)Qf Y R16�-IWP -�
WASHINGTON STATE TAX NO. 0 APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, LIFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR DISAPPROVAL, DATE, AND
SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT" SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT 1�// I
DATE _x LAND USE CODE ZONING CODE
*-APPROVE 0 DISAPPROVE ;N/
SIGNATURE
CONDITIONAL USE PERMIT
COMMENTS
BUILIDING DEPARTMENT
DATE
Building
0
PPROVE 0 DISAPPROVE
SIGNATURE-, r, VC';
Permit
0
Hotel/Motel
Apt. Bldg.
(L).
(A)
El
Office Bldg.
(0)
COMMENTS:
Occupancy
El
Restaurant
(R)
Group
0
Hosp/Nurs Home
(H)
CAPACITY: (NO. UNITS, APTS. OFFICES, SEATS, BEDS, STUDENTS)
0
School
(S)
FIRE DEPARTMENT
DATE 11-17-W
U.F.I.R.
APPROVE 0 DISAPPROVE
S16NATURE
: =eM
[5 =' 137
COMMENTS:
—TO
POL DEPARTMENT
te- ePPROVE El DISAPPROVE DATE SIGNATURE
COMMENTS:
PUBLIC WORKS DEPARTMENT
0 APPROVE 0 DISAPPROVE DATE SIGNATURE
y t
COMMENTFw4
PLEASE RETURN TO CITY CLERK
STREET FILE --ft,
CHTY OF HARVE H. HARRISON
200 DAYTON ST. EDMONDS. WASHINGTON 98020 (1206) 175 252: M AY OR
DEPARTMENT OF PUBLIC WORKS
March 16, 1981
Dear Resident:
On February 17, 1981, the Edmonds City Council passed
Resolution 488 for construction, reconstruction and repair
of deteriorated sidewalks. A public h(-,�aring will be held
in the Council Chambers at the Civic Center on April 21,1981
at 7:30 P.M. -..,,You are invited-jo-,.-at.tend this he�iring r —
75 fo -
discussing repair,of' portions-of.� de*t,er-iorate�d�"�'-.�'i'dew'a'.Iik.�:,:,'-
abutting your -prope*r�y-.�'--�'T�6'''i'm�.'P'rove�i6r�t of si��lks in
,need of repair at the expense of the abutting property
owner is provided by City Ordinance, Chapter 7.20 and�
Revised Code of Washington, Chapter 35.68.
The areas needing repair have been marked in paint on
the sidewalk adjoining your property. Reconstruction and
repair of these sidewalks Must be completed on or before.
September 1, 1981. In the event improvements are not
completed within the ahove specified time, the City,will
perform and complete the improvements at'. the expense,of the
abutting property owner.
This aption is' in response to many citizen requests
and pedestrian falling accidents which have been increasing
in recent years as a result of sidewalk deterioration and
increased pedestrian traffic.
Sincevely,
FRED F. HERZBERG
Director of Puhlic Works
STREET FILE APPLICAT10"
for
The City of Edmonds SWE SEW= P=taur EAsroura-rr No - ------------------------------------------
NEW CONSTRUCTION 0 REPAIRS 0
114-oo800
OWNER........... Raym-o-nd --- S ....... Hi- s - e --------------------------------------------------- CONTRACTOR -------------------------------------------------------------------------------------------------- PER11IT No .................
203 4th Ave. N. IEGAL DESCRIPTION: LOT No. ----------------------------------------- 13I.4C)CM NO . ............................................
ADDRESS.... ....................................................................................................
NAMEOF ADDITION ..........................................................................
Dye Tested On Sewer 1972
Approved:
DATE------------------------------- I ---------------- BY .........
APPLICATION
for
The City of Edmonds SIDE SEWER PERBUT EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS C]
OWNER ... Hall.m.tar-K ........ Hous --------------- ------------------ CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESSaaa .... 4-th ..... Ave, ... !6� .......................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
0
0
NAMEOF ADDITION .........................................................................................................................................
JUnQ-, 197Q
�rroeved:Te6-'cd On Sa-wer
DATE................................................ By ......................................................................
Chach
1?.- 510 619 821 025 w 630 am 657
1P 11 � W4 5w 815 1 816 0 7
J11 fie % Soundview Apartments 611 ri 647
1110 426 801 614 809 C, 614
z —C,
VZO "is Lu p. Bible Holy Rosary ew am 610 645 1
657
"7
§ible ra SIMI School
GLEN ST Parlang 62075.24 528 529
--- JAj.
C d 1' J
428 Rectory z
410 603
6V
323 771
�T FE I � g i1i -
DALEY ST
471, 722 S
AMEN
304 Tennis 805
412
cou"s
Civic E ST all
01 oirfs`C&&Ub Center
V 2W 315 No 656
EFD pi
#17 300 EDMONDS
orww stww
. I I --
Public Sdety 210
IF '180 Complex 212 731 205
204 751
-it BELL S
wz
Z. z
40 > LU
4E z
633 ass
MAIN ST CD
Sno-Isle J 700
10 4 Ubrary 850
Frances
20 Play
22 Anderson
51 wo Fielid
24 ::� — I
F 1137
701 Center
117
DAY"r0N ST
Old MU 'T 203 1
201
02 211
Ei
10
Science 551
Ch-Irch
34* MAPLE ST
303 624 0 0
Richmar Condos I I ; a
4C
315 The Me ner 318
555
'0 ------ r ---------- ALL)hK 5 1
20
—
4
13 eck's
wo
commocione
410
7�
a
c?
4
Ink
2
—
102
1 hl
1
415
—4
-2
1,
502 14
660 "a-
�! R
W4 SIX 5
61,
.15
sm L;
519
521
604 623 525 CEDA ST
--T--F-T--F-1 F------7--i ;e= iEMN
525 L- 77J
EXEMPTION FROM CONTRACTOR REGISTRATION
VERIFICATION FORM
* The undersigned property owner or contractor has applied for a building permit from the City of
Edmonds and claims that he/she/it are exempt from providing contractor registration in accordance with
the provisions of RCW` 18.27. The property owner, by their signature below hereby verifies to the City of
Edmonds that:
0 Value of work under $500.00. The aggregate contract price of labor and materials
and all other items required for the project is less than $500.00 and is not part of a larger
opertation to be undertaken on the property. The person employed to do this work has not
advertised nor otherwise put himself forward to the permittee to be a contractor or
qualified to engage in the business of a contract. RCW 18.27.090(9).
0 Work performed personally on own property. The undersigned verifies that all work
done under this permit will be done by the permittee personally on his/her own property
and that the improvements constructed on the property are not being undertaken with the
intention and purpose of selling the improved property.
13 Commercial property exemption. The permittee is the owner of commercial property
and the owner's own employees will perform all maintenance, repair and alteration work
on the property. No work will be done by contract under the permit. RCW` 18.27.090(13).
0 Licensed architect, engineer, electrician or plumber. All work performed under this
permit will be performed by an architect, civil or professional engineer, licensed electrician
or licensed plumber operating within the scope of his or her license. RCW` 18.27.090(14).
General Contractor. The owner is the General Contractor for the project and is required
to hire a minimum of two licensed subcontractors (unrelated building trades or crafts). The
general contractor is responsible to verify all State licenses of subcontractor. RCW`
18.27.010
THE UNDERSIGNED PROPERTY OWNER HEREBY VERIFIES THAT ALL
INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE BEST OF HIS
OR HER KNOWLEDGE AND ACKNOWLEDGES THAT IF ANY OF THE INFORMATION
PROVIDED ON THIS FORM IS FALSE, HE OR SHE UNDERSTANDS THAT THE BUILDING
PERMIT WILL,� EDIATELY REVOKED AND ALL FEES PAID FORFEITED.
Dated this day of 20 15�*
PROPERTY OWNER/PERMITTEE
I / wrms/, I P - r a
WITNESS:
�U-4;0 V1
Print: S�L,0- t3ew et
LATEMABUILDINGTORMMexernp contractor regis verif form.doc03/28101
Ahk
Owner I 5z/ Plan Cheek#
Project Address Date
Ruildin-a Valuation & Fee,-v
USE
AREA
VALUE PER-SQ. Fr
VALUATION
SIR
COM
Basement Semi -Finished
69.30
$
Basement Unfinished
23.10
Garage/Carport
24.30/16.60
First Floo
92.40
$
Second Floor
92.40
$
Unheated/Storage
23.10
$
Deck
17.00
$
Unheated Sunroom
25.00
$
T&AL
VALUATION
$ //2Z
IFEES
S asi*�o
Permit Fee
tureslx�
Plan Cheek Fee
$
4W
Base Fee
$85
S tate Surcharge
$4.50
City Surcharge
$15
Investigation Fee ($205 min or double)
$
Plumbing
$
M echanical
$
'-Base�
$ i:,:.
Grading /Yardage
$
4
,Mee Z; j
T anlint
otif
Total
$
Fees Calculated by:
Checked by:
Planning Fees
1% Inspection Fee $65 minimum
Bond Amount $
$
SEPA $420 up to 5 hours
More than 5 hour Charge $
$
Recording fee
Base $ + #Pages
$
ADB Administrative Approval
$100
Critical Areas
$135
$
Other
Total
$
Fees Calculated b
LATENMBUILDING\RANDOU'Afee sheet itemized form.doc07/25/03 - . Microfilmed
En,aineenniz Fees
COST X # OF INSPECTIONS
Storm Drainage Review SFR >5000 sq.ft.
$50
$
SFR Inspections
$50x
$
Commercial/MF Inspections
2.2% (Bond Amount $
$
Right of Way
Base $160 + $15 Surcharge
$
Right of Way Inspections
$50x
Street Cut Fee
$
Water Meter Fee Size
$
Water Connection Fee
$
Side Sewer Connection Fee
$
Side Sewer Permit Fee
($30 SM $100 Coni/MF)
$
Alley Disruption Fee
111.000.000.344.110.000.000.00 Base $140
Parking Disruption Fee
111.000.000.344.120.000.000.00 Base $140
Sidewalk Disruption Fee
111.000.000.344.130.000.000.00 Base $140
Storm System Dvpt. Charge New SFR
412.200.000.379.000.000.000.00 $428
Traffic Mitigation Fee
$
Development Project Peer Review Fee
$50 Plus Actual Cost
In Lieu Sidewalk Fee
LF $ Fee $
$
Other
Total
Fees Calculated by:
Fire Fees
Plan Review Fee ($50 per hour)
Number of Hours
$
Inspection Fee
$50 x Number of Inspections
$
Fire Connection $345
$
Total
Fees Calculated by:
Miscellaneous
Description
Department
Total
$
Total Fees
Building
$
Planning
$
Engineering
$
Fire
$
Investigation Fee
$
Miscellaneous
$
4 th Review
$170
5 Ih Review
$170
6'R—eview
$170
Grand Total
$
L:\TENV\BLTILDING\HANDOUT\fee sheet itemized form.doc07/25/03 Microfilmed
ego -19,1-
City of Edmon&
Critical Areas
RECEIVED R-k(
MAY 2 2 1995 MAy
Paw =Na "
Checklist
The Critical Areas Checklist contained on and submit it to the City. The City will
this form is to be filled out by any, perso
review the checklist make a precursory site
preparinj a Development Permit visit, and make a -determination of th'
e
Application for the , City of Edmonds prip� subsequent steps necessary, to.complete a
to his/her submittal of a development development permit'aipplicaition.,
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. Ile
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 representative,
must fill out the checklist, sign and date it,
With a signed copy of thi's form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (e.g. site
Plans 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 Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:-
nkkeeLL MAR-MkOoQ
Name
2-16, 4+�, r-Nve M,
Street Addrew
EbmoNb5 jWA 900W 776-3-35
City, State, ZIP - Phone
/9 -5
Signature Date
Applicant Representative:
Name
Street Addrew
City, State, ZIP Phone
Signature
iiate
I
501
19
*CA FILE -NO.-----
Critical Areas Checklist
raphy/hydrology/vegetafion)
!ati6ti .(S6 lls/t6pog
�'SO d ion' hn� 4'h Avg tJ.
A dress/Locif .
enmomns '�Bozo
X'�pp
,qAX.Tax 4ccg putnbo.-" 4'114. - 00z - oi 0 - oo I
`Approximate Site Size (acres or square feet): 'SiOO -P42
4. Is this site currently developed? X yes; _ no.
.If yes; how is site developed? SJAJ4rDLF_ $rAMILY P—ES15WCC
4W
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rol I i ng-- slopes on eite y 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: NO Approx. Depth:
7. Site contains areas of seasoinal. standing water: No Approx. Depth:
What season(s) of the year?
8. Site is in the floodway No floodplain ou 0 of a water course.
9. Site contains a. creek or an area where water flows across the grounds surface? Flows are year- �jc)
round? M./A Flows are seasonal? ti./A (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: MO
For City Staff Use 0
J. Site is Zoned?
:2- SCS mapped soil type(s)? I-Pate-,ewp oz,!5 A-X)
-3. .-,Wedand inventory or C.A. map indicates wetland present on site? A10
.4., Critical Areas inventory or C.A. map indicates Critical Area on site?, A10
:5.:.- ::Site within designated earth subsidence landslide hazard area?
0
6. Site designated on the Environmentally Sensitive Areas Map? A10
DETERMWATION
RCYOIM04
Critical Areas Checklist Site Plan
Owner Applicant: Darrell and Paula Marmion (776-3135) CA File No.:
- - - - - - - - - - - - - - - - - -
4th Ave N
Alley
Street Address: 216 4th Ave. N
Legal Description: The Southwesterly 45 feet of Lot 10, Block 2, Plat of Edmonds, according to the plat thereof N
recorded in Volume 1 of Plats, page 26, records of Snohomish County, Washington.
Tax Acct Parcel No: 4344-002-010-001 Scale: 1 20'
PROJECT REVIEW CHECKLIST
PROJECTNAME: ILVkWeV�fl��11.1,�4a4l�(IPLANC.HECK#:
PROJECT ADDRESS: 216 A/ RECEIPT DATE:/
REVIEW
D BY. (nitial
Date
I
PLAN.
WATER
tt I
COMMENTS
FIRE -
BLDG.,
SEWER.
STREET'
...ENG]
Setbacks/Variance/Setback Adjustment
Conditional Use Permit
mom-
ADB Requirements
Other Zoning Requirements
.......
..... . .....
...
4
Underground Wiring Required
Lot Slope 15%
6
SEPA Environmental Checklist/Hydraulics Permit
Tree Cutting Plan
Plat/Subdivision Requirements
Lega Description Verification
Quit Claim/Street Dedications
Easements - Public/Private
Engineering storm Drain Review Fee
.....................
Engineering 2.2 Inspection Fee
7r
,Drainage Plan (On-Sit!-.l
ISetback - Top of Bank, Stream, Water Courses
-- ------ ------ --
Setback - Storm Drain Une
. . . . . .
Open Ditch - Existing
Cul'vert Required
Culvert Size
Shoulder Drainage/Shale Open Runoff
.2
..'21.
Catch Basin Re uireA4
::22
Driveway Slope & Ve c a fl-t-lpq-q
.......
. . . . . . . . . . . . ...
23
Sidewalk Required -
. . . . . . . . .
j.,-24
Curb & Gutter Required
:.::25-:
Curb Cut For Driveway Reguired mo
........ . . . . . . . . . . . . . . . .
26
Street Paving R ow Z, 67
27
Right -Of -Way Construction Permit Required Y45
28
Street Name Sign Required A*p
29
Other Signing Required
Bond Required For Public Improvements
FEMA Map Check/Water Table
32
Side Sewer Availability q,05
33
Calculate Sewer Connectibn Fee If No LID #
:'.34
Create Street File
Existing Water Main Size
.3 6
Water Meter Size
. . . . . . . . . . . . . .
Service Line Size
. . . . . . . . . .
--:38
Water Meter Charge Required
IN
Hydrant Required
40
Hydrant Size Existing
Fire Line Charge Required - Sprinkler
Street Cut
I In
.4 .
Wiscellaneous
Reviewed By:
FIRE
PLANNING
ENGINEERING
PUBLIC WORKS
FILE:DATAI 23/PROJCKLS.SFN
f
u tx u vf* u 11 1 h u I j
1
21
2
22
3
23
4
24
5
25
6
26
7
27
8
28
RW PERMIT DATE ISSUED RECEIPT-L
9
29
10
30
11
31
12
32
13
PAID $ RECEIPT # DATE
33
SS PERMIT DATE ISSUED3-ZC-l� RECEIPT I
14
PAID $ RECEIPT # DATE
34
15
35
16
36
17
37
METER SIZE PAID $ DATE RECEIPT #
18
38
19
39
20
40*
i,dant:
8PO' . Parrell'and Paula Marmion (776-3135)
4th Ave N
--------------- --------------------------------- ---------- ..........................
Datum 0 +100
Water Meter Cover
100'-0 -- ---------------------------------- —+100'-1
Edge of Sidewalk I
Edge of Right of Way
Existing Fence -\
A
C
45'
2 11F
Alley
Street Address: 216 4th Ave. N
D
Legal Description: The Southwesterly 45 feet of Lot 10, Block 2, Plat of Edmonds,
according to the plat thereof recorded in Volume 1 of Plats,
page 26, records of Snohomish County, Washington.
Tax Acct Parcel No: 4344-002-010-001
CITY COPY
Existing House
APPROVED BY PLANNING
- � �- - ±/ /:: i- -2z-f 11 t
RECF.IVEDi
APR 1 2 1996
51-01, PERMIT COUNTER
HEIGHT CALCULATIONS:
A +101'-l" B +101'-4!'
C + 10 1'-7" D + 102'-5" N
Avg Grade + 10 1'-7" Scale: 1 20'
Max Height +116'-7"
Actual Height +115'-5" March 1, 1996
Applicant: Permit No.:
Darrell and Paula Marmion (776-3135)
- - - - - - - - - - - - - - - - - - - - - - - - - -
4th Ave N
----------------------------------------------------------------------------------------------------------
Datum 0 +100
-------------------- f - ----- Water Meter -Cover --------------------------------------------------------------------
+100'-0"" '-'+100'-1"
Edge of Sidewalk -/ :41, 1 F lReduced Front Setbac
Edge of Right of Way 14!-0" per Variance V-96-1991
A+ +B
Existing Fence
8'-6"
C+ +D
Existing Parldng
(2 spaces)
+101'-,r 45'
Alley
Existing House to be
Torn Down & Salvaged
Moved 203 House
51-01,
CITY COPY
RF.CF.IVED
FIE a 9 1 1996
PERMIT COUNTER
APPROVED BY PLANNING
+ 102'-9" T
F 0
U
Street Address: 216 4th Ave. N HEIGHT CALCULATIONS:
Legal Description: The Southwesterly 45 feet of Lot 10, Block 2, Plat of Edmonds, A = +100'4' B = +99'-11"
according to the plat thereof recorded in Volume I of Plats, C = +100'-5" D = +100'-4!' N
page 26, records of Snohomish County, Washington.
Avg Grade = + 100'-3"
Tax Acct Parcel N : 4344-002-010-001 Max Height = +125'-3" Scale: 1 20'
Actual Height = + 125'-1 " Jan 24, 1996
S?REET FILE
CITY OF EDMONDS LAURA M. HALL
MAYOR
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-0220 FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT PETER E. HAHN
Public Works e Planning * Parks and Recreation * Engineering DIRECT09
9 0 1
LETTER OF TRANSMITTAL
Date: June 4, 1992
To: Darrell Marmion
216 4th Ave. N.
Edmonds, Wa. 98020
Subject: Critical Are'as Checklist
Transmitting:
For your information: xx
As you requested:
For your file:
Comment and retum:
Note attachments:
Comments:
Planning Division
Diane Cunningham
0 Incorporated August 11, 1890
Sister Cities International — Hekinan, Japan
I -
Critical Areas Checklist
Site Information
F—TI)CHE-f) 6-AQAc-,e COAJrPermit Number:
Project Name:
2,_16, 4"' Av& �J, Property Tax Account Number:
Site Location. — 2-0
Approximate Site Size (acres or square feet): 0
Have you filled o ut a Critical Areas Checklist for a project on this site before?
General Site Conditions
1. Has the site been cleared or logged? Y6 5 Date of most recent action: LM'Lio tj
Soils / Topography 5'q1VJX' Z-041117" 0 70
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)'? 7— _5 L 0 /14F 6
3. Describe the g'eneral.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 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 of horizontal distance.)
steep: grades of greater than 30% present on site.
Comments
Hydrology[Vegetation
4. Site contains areas of year-round standing water:
5. Site contains areas of seasonal standing water: K't/9 prox. Depth:
6. Site is in the floodway floodplain _"\J 0 of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? ;%J0 flows
are year-round? �'O Flows are seasonal?
8. Site is primarily: forested mixed
meadow ;shrubs
9. Obvious wetland is present on site:
10. Wetland inventory or map indicates wetland present. on site: A-)0
11. Critical Areas inventory or map indicates any Critical Area on site: A-) 0
For City Use Only
STUDY REQUIRED: Critical areas study is required.
CONDITIONAL WAIVER: Critical areas study not required if specified conditions satisfied.:
::Y�__WAIVER: Critical areas study is not required.
Determination Number. Reviewer
Planner
0 Z)
i
690 -199-
Ciq of Edmonds
Critical Areas Checklist
'17he 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. Ile 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).
RECEiva)
JUN - 3 1992
COMMUNITY SERVICES
An applicant, or his/ ' her representative, must
fill out the checklist, sign and date it, and
submit it to the C ity. 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:
With a signed copy of thi's form, the
applicant should. also submit a vicinity map
of the parcel with enough detail that City
staff can find and identify the subject
-parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information or studies 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).
Owner / Applicant:
Name -.7'7,6 --3,i3.s
Title
Street Address
City, State, ZIP Phone
_5ignatur� Date
Applicant Representative:
Narne
Title
Street Address
City, State, ZIP Phone
Signature
Date
PERMIT APPLICATION REQUIREMENTS
To: Applicant
From: Lyle Chrisman, Engineering Ifispector
Owner. --HAEM119k� Plan Check No:
Address.__Z//-,9 Date:
After review of the subject permit application, the following requirements must be met
1. Construction hours am:
WEEKDAYS — 7:00 A.M,40:00 PALWEEKENDSIHOLIDAYS — 10:00 AAL-6:00 P.M.
2. A separate RIGHT-OF-WAY CONSTRUCTION PERMIT is required for all work on p* ublic property. (ECDC 1&60)
3. Truck haul route plan must be submitted and approved prior to permit
4. Buildedowner h responsible for containing all temporary runoff and erosion control on site.
(ECDC 18.30.030d)
5. NO WORK SHALL BE DONE WITHIN 15 FEET OF LOW OR 10 FEET FROM ANY CLOSED DRAINAGE
FACMLX1rY. BUILDERJOWNER IS RESPONSIBLE FOR IDENTIFYING CONDITIONS ON THE DRAWING. (ECDC
18.30.50G)
FILTER FABRIC FENCE SHALL BE INSTALLED AND INSPECTED PRIOR TO CLEARING AND CONSTRUCTION.
(ECDC 18.30)
INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEMS, T1GHI7IH(ES AND CATCH BASIN
INSTALLATIOM INSPECTIONS ARE REQUIRED PRIOR TO BACKFILLING. MCDC 1830)
Repair or replace all defective existing curb, gutter and sidewalk adjacent to die property. If an Intersection h Involved, a handicap ramp
may be mquired. Contractor shall meet with the City Engineering staffto determine 69 e3dent ofrepali prior to issuatice of the permit.
(ECDC M90)
Driveway slope shall not exceed 14% without a waivu. Evay attempt should be made to keep the slope below 14% Waiver granted to
0/6. (ECDC IU0.060D)
.0- Driveways must be paved filom property line to City RIGHT-OF-WAY. A separate permit Is required. (ECDC IU0.060C)
I. INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIOR TO AND AFTER POURING. (ECDC 1830)
2. No burning of construction refuse without a permit fioni the Fue Department
.3. Connection to City water systern is required. There Is a separate charge for the WSW meter.
(ECDC 7.20)
4. A back water valve is required if downstairs plumbing is below the elevation of upstream manhoic. (ECDC 7.20)
5. Water and sewer main lines should:be separated by 10 fed minknum. (ECDC 1&10)
6. Connection to the City sai I
nitary system is revired. A separate permit is require&
LIDN Fees paid: Yet NO Cbtargt_ (ECM I&I0y.
7. Underground whing is required 00 all new construction, and for additions. alterations. and repairs that exceed 50% of the total assessed
value of the structure. (ECDC 1&90)
8. A FINAL ENGINEERING INSPECTION IS REQUIRED PRIOR TO THE BUILDING DIVISION GRANTING OCCUPANCY
OF THE BUILDING OR STRUCTURL (EMC 1&90)
WntEQP-D" ITT J- i L L
CITY OF EDMONDS PERMIT. SUBMITTAL RECEIPT
425-77170220 Fax: 425-771-0221
6L
DATE SUBMITTED: PLAN CHECK NO:
�PROJECT NAME/OWNER:(V),�4,4,
JOB ADDRESS: C�/s 4�4z 4-TYPE:
ADDITIONAL INFORMATION`�EQUIRED:
A
vit
PERMIT COORDINAT(-/ *CITY FIRST REVIEW DUE BY
PROJERREVIEW CHECKLIST
PROJECTNAME: CHECK#: ?Z5 -2.12
PROJECT ADDRESS: 216 �zP ty- /V RECEIPT DATE:_Z��-ZZ-71q-5--
OMMENT
-FIRE
EVIEW
-D d::
D-uy.�`(f
WA*
r
"EW IS
a
'ME
ENG.*
Setbacks/Variance/Sethack Adjustment
-----------------
Conditional Use Permit
2:;
ADB Requirements
Other Zoning Requirements
Underground Wiring Required
= WE
Lot Slope 1 5..
SEPA Environmental Checklist/Hydraulics Permit
........... ....
T�
Tree Cutting Plan
----- - - - - - - -
Plat/Subdivision Requirements
.9-�A
Legal Description Verification
Quit Claim/Street Dedications
Easements - Public/Private
. ..........
Engineering Storm Drain Review Fee
Ar&,,
Engineering 2.2 Inspection Fee
Drainage Plan (On-Sit!9
X1 S..
Setback - Top of Bank. Stream, Water Courses
Setback - Storm Drain Line
.
Open Ditch - Existing
. . . . . . --- ---
....A 6:"
Culvert Required
Culvert Size
Shoulder Drainage/Shale Open Runoff
Catch Basin Required
22'
23
Driveway Slope & Vehicle Access
Sidewalk Required ALO
r.24.
Curb & Gutter Required
. . . . . . ... ......
:25
Curb Cut For Driveway R ired 00
equ
.............
26
Street Paving Required AU.6y /_f "AA0 Z- *?-a
27
Right -Of -Way Construction Permit Required YZ5
28
Street Name Sign Required ^4p
........
29
Other Signing Required
30
Bond Required For Public Improvements
. . . . . . . . . . . . . . . . . . . . . .
-31
FEMA Map Check/Water Table
V, REMEM"
ME OMNI
'32
Side Sewer Availability
0. Ila
.33
Calculate Sewer Connectibn Fee It No LID #
34
Reate Street File
.35
Existing Water Main Size
36
Water Meter Size
-ffiwffi�
7
Service Line Size
..... .... ....
�38
Water Meter Charge Reiguired
.....................
....39
..40
Hydrant Required
Hydrant Size Existing
Fire Line Charge Required - Sprinkler
42
Street Cut
. . . . . . . . . . . . .
.. . ...
Miscellaneous
�44
Reviewed By:
IM11:1Z
PLANNING
ENGINEERING
PUBLIC WORKS
FILE:DATAI 23/PROJCKLS.SFN `1% - ":
!�M':10:0--T FILE
IApplicant: Darrell and Paula Marmion (776-3135) 1 Permit No.: I
------------------
4th Ave N FILE
STH Ll
------------ ----------------- ------------ ...... ---------------------------- ----------- ------------------------- -------
Datum 0+10o
Water Meter Cover
Edge of Sidewalk -1
Edge of Right of Way
Existing Fence
0
+01'.7,
A+
8!-&'
C+
Vr-al
Existing House to be
Tom Down & Salvaged
Moved 203 House
5'-0"
+P
&isfing Paddnq
(2 spaces) APPROVED BY PLANNING
2 - i - Y
4& 102*-9"
Alley
r
Street Address: 216 4th Ave. N HEIGHT CALCULATIONS:
Logal Description: The Southwesterly 45 feet of Lot 10, Block 2, Plat of Edmonds, A=+ 100'-4" B = +99'-11
according to the plat thereof recorded in Volume 1 of Plats, C = +100'-6' D = +100'4' N
page 26, records of Snohomish County, Washington.
AvgGrade =+100'-3"
Tax A Parcel No: 4344-002-010-001 MaxHeight =+125'-3" 1 ale: 1 20'-
Actual Height = + 125'-1 Ian 24, 1M
RP
C-itrof Edmonds
RIGHT -,OF -WAY CONSTRUCTION
PERMIT.
Permit Number.
Issue Date:
A. Address or Vicinity of Construction: 6 4th Av N
Is -
GTE to place, operate, and maintain a buried service
9 0 1 9� B. Type of Work (be specific): ,irp frnm AxiRlAng pnle #6S18 lorAt-j6d in alley —behind
residence at 216 4th Av N then north to the residence. GTE to plow 70 feet
and push one road 20 feet. 79 ft.
Mary A Bower , Permit Coord.
C. Contracton! CTF NnrthwAqt lncorp�oratpA — Contact: Dpnni-, AlAxAndpr 771-q036; nr mnhila 388-135
Mailing Address- 22118 20th Av SE, Suite 130 Phone:
I Bothell, WA 98921 Mary 296A88 1628
State License #: Liability Insurance: Bond:$
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. Commercial EJ Subdivision 0 City Project E Utility (PUD,(�J)rG, eABLE, WATER)-
F1 . Multi -Family E] Single Family EJ Other 2100-9POOlDB 242310
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: 0 Yes J]JNo G. Size of Cui� x H. Chargq
Possibility may need to do 2ft X 5ft window cuts to expos6,ex4'stJ/hg utilities. Please s6e attached sketch.
APPLICANT TO READ "SIGN
*h
INDEMNITY. Applicant understands and by his signature to this application, agrees t 61d-1hACi6ofEdmond8 harmle8sfrTm�n>j%iu,,,. damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that maybe madf� agat ilihe City of Edmonds, or4ciny �f,its departments or
employees, including or not limited to the defense of any legalproceedings including d6ren1se' co�ts, and attorney fees by reaso� ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS IF-,,� PERIOD OF ONE VEA*O WI*HE FINAL
EE( I
'J�
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION VE WILL BE HELD UNTIL ';VA S 'PA TCH
.LIC
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLIC NIT.
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-C ity 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 t& working day;
NO EXCEPTIONS.
Ihaue read the above statements and understand the permit requirements andthepink copyof thepermit willbe
available on site at a�eZf' '-Y ecti purposes.
Signature: Stewart Date: Apri 1 12, 1996
(Contractor or Agent) Oprns Supv-OSP Engrg.
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
DATE: ISSUED BY:,
� , � 0�1-14
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991
FIELD INSPECTION NOTES
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
YE , S El NO
D'ate'---i
Datd:
LEGEND
C3
z
PERMIT SUBMITTED BY
GTE
b
I
PEDS a
POLES 0
ROAD SORES
OVERHEAD LNES
W. UTILITY POTHOLE 1:3
UG TRENCHING ---UCT
R. o. w.
-------------------------------------- ------- ---;v ------------------ EOP
fl L L E "I
wet --&-
I--------------------------------
_5o
Ff-OIJOLII-n P6-r
CUTS.
LEGEND
co
I-
C3
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PERMIT SUBMITTED BY
GTE
PEDS a
POLES 0
ROAD SORES
OVERHEAD LNES
W. UTILITY POTHOLE 1:3
UG TRENCHING ---UGT
R. o. w.
------------------------------------- ---------- ------------------ EOP
n L L E
T-p ------- ---------------------
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Fl- 0 1-0 Llr n P6 -r
CUTS.
LEGEND
a)
co
I-
Z
PERMIT SUBMITTED BY
GTE
PEDS Is
POLES 0
ROAD BORES
OVERHEAD LNES
I.D. UTILITY POTHOLE I=
UG TRENCHM ----UGT
R. o. w.
-------------------------------------- ---------- ------------------ EOP
n L L E 'I tio
--------------------------------
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FL 0 1-0 ff, n P6 -r
CUTS.
"3
3)AY,5,
CITY OF EDMONDS
9 1 9 c�z
Address of Construction: 2, 160 A+ ve
SIDE SEWER PERMIT
Property Legal Description (include 611 easements):
6,�,i 4!S i—or /0 r L_C�oc_r_ 0`1
I
PERMIT N2 8758
MAR i -1 1-99q,
P, IRI 1C WOHKq DEPi
jpwne r DA a.# 15 LL— A le" I OA)
r-dnd/or Contracto':
State License No.
K Single Family
El Multi -Family (No. of Units-)
El Commercial
El Public
Bui . Iding Permit No. 960//7
Invasion into City Right-of-Wa No 11 Yes
y )X
RW Construction Permit No.
Cross other Private Property: )R"'No El Yes
Attach legal description and copy of recorded easement
I certify that I have read and shall comply with all city requirements
as indicated on the back of the Permit Card.
E3
Date
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION
Partial Inspection:
Comments
Reason Rejected:
Final Inspecti6n ApproVed
I E
Date Initiat
Date I nitial
Date -I nitial
PERMIT MUST BE POSTED ON JOB SITE
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3/90
The City of Edmonds
Side Sewer Drawing
............................................ "
I
NEW CONSTRUCTION .Nr REPAIRS E] LID NO . ................... ASMT. NO . ..................
OWNER................................................................................................ CONTRACTOR .................................................................................... PERMIT NO.
4 f�\j �L �
. .. .... LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ................ ...................
JOB ADDRESS ...... --------------- ----------------------- ---- -- - -------------------
t--� -r 1 -1 �Q e- - � ,
WW-0001 -11/75 (REV. 11/78)
EASEMENT NO.
NAMEOF ADDITION ......................................................... .........................
P-V.e- Q�o -
P.
-AC4
Approved:
DATE ... ...... 11.4 ............
By5-� ..... .................
11p,
V, iter Service Drawing
The C4y of Edt'nonds EASEMENT NO . ............................................
NEW CONSTRUCTION REPAIRS IR LID NO . .................. . ASMT. NO . ..................
OWNER .. tP
.........................
...... Mt -A CONTRACTOR ........................ ............................................................
PERMIT NO.%��1!5
JOB ADDRESS ... Zl�� ..........
4�1�4 ......
Aq-�� No ...................... LEGAL'bl-SCRIPTION: LOT NO . ............... ...................... BLOCK
NO . ....................................
PWW-0001-11/75 (REV. 11178)
NAMEOF ADDITION ..: ........................................... I ................................. I ......... I ............................
4 "rM kv. N 0,
- v4i.-Vc
I " P.F-. p1m
S*rsmc. pipe
Approved:
DATE. . ..... ......... 2 .................. .....................
2
CITY OF EDMONbs
USE
ZONE PERMIT
6' NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB 161 SUITE/APT #
ADDRESS
At_�
OWNER NAME/NAME OF BUSINESS
DA RRIELL -A A1819 10/t)
IV&2
LEGAL DESCRIPTION CHECKI
SUBDIVISION NO. LID
NO.
cc
W MAILING ADDRESS
Z
2. I�o 44A A)p
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved 0
RW Permit Required 0
0 Ave
CITY ZIP
TELEPHONE NUMBER —
66"
"7 - :3136
EXISTING — REQUIRED DEDICATION —
PROPOSED
Street Use Permit Req'd 0
inspection Required 0
Sidewalk Required 0
NAME
cr
METEF7
LINE SIZE
NO. OF FIXTURES
W
PRV REOUIRED
YES 13 NO 11
12 ADDRESS
REMARKS Z
L)
W
cc
< CITY ZIF_7FH_0NE
NUMBER
Z
W
NAME
ADDRESS.
ENGINEERING MEMO DATED REVIEWED BY
0 -
0
a: CITY ZIP
TELEPHONE NUMBER
Z
FIRE MEMO DATED REVIEWED BY
0
W
L)
STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA
ALLOWED PROPOSED
SEPA REVIEW
COMPLETE EXEMPT
ADB NO.
Legal Description of Property - include all easements
45 o=-r opr -.o-r / 0 6LOCX
EXP
SHORELINE#
2
E-C
PLAr E&""50 I
VARIANCE OR CU
PLANNING REVIEW BY
DATE
ch Or-; �16L
W
< PAC2C, Z& Oic PL47�5.
SETBACKS — FEET
HEIGHT
FRONT SIDE REAR
JLOT,COVERAGE
Z
Z
Property
REMARKS
Tax Account
4344 - 00`Z-Cj0- OC7
Parcel No.
NEW RESIDENTIAL PLUMBING
0 E] F]
ADDITION COMMERCIAL MECHANICAL
FIREMODEL 1:1 APT. BLDG. El
SIGN
CHECKED BY
TYPE OF CONSTRUCTION
CODE
OCCUPANT
GROUP
GRADING FENCE
1:1 E]
REPAIR CYOS. I x _FT)
E] DEMOLISH WOODSTOVE SWIM POOL
1:1 INSERT El HOT TUB/SPA
SPECIAL INSPECTOR
EAFAI E A
OCCUPANT
REQUIRED
0 YES
LOAD
GARAGE RETAINING WALL/
REMARKS
C ROCKERY RENEWAL
Z
PROGRESS INSPECTIONS PER UI§C 305 Z
0 (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
L es I oc IAL.
0
ch NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
C) 9
STORIES
UNITS
NUMBER
DES��WORK TO BE DONE (ATTACH PLOT PLAN)
F INAL INSPECTION REQUIRED
04 ra4 Sew V/,c 6-
—
========I
VALUATION
FEE
-A -- — — 14 —
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING
P J,4-n,1fiA L� 6PA5
It
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
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
w
successors in interest, agrees to indemnify, defend and hold
2
harmless the City of Edmonds, Washington, its officials,
5
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."
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/her
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Insurance and RCW 18.27.
-SIGNATURE
INSPECTION
acknowledged in space provided.
(OWNER OR AGENT) DATE SIGNED
I
DEPARTMENT
3/Z a
CITY OF
IAL� SIGN' TUR�,,/,` DATE
"F'c i
EDMONDS
71
ATTENTION
CALL FOR
RELEASED BY: DATE
INSPECTION
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
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
— — Inspector
CHAPTER 3�
PINK — Owner' GOLD — Assessor
%All 91
*NOW V1111 ami— -a
City.of Edmonds
RIGHT—OF—WAY CONSTRUCTION.,
—lox-
4& 7
Permit Number- �7
ok per Do4g U13italo
Received verbid
Issue Date:_J -
A. Address or Vicinity of Construction: 216 4 Ave 0 (9609883)
890 C) B. Type of . Work (be specific): Ins . tall Service
C. Contractor: _Vash;LUgton Natural Gas Contact: iamme KLMsbua
MailingAddress: 1122 75 St SW &er Phone: 745 7500 X7596
At
State,License #: 98206 Liability Insurance: Bond: $
D. Building Pernuit # (if applicable): Side Sewer Permit # (if applicable):
E. [3 Commercial El Subdivision El City Project I@ Utility (PUD, GTE, WNG, CABLE, WATER)
0 Multi -Family 0 Single Family 0 Other
INSPECTOR: INSPECTOR: �.AlAvre_U-11
F. Pavement or Concrete Cut D Yes 55No G. Sizeof.Cut: H. Chargi�_$
APPLICANT TO READ ANP-SIGN
INDEMNITY. Applicant understands and by his signature to this application, agreeso,hId the City ofEdmondg harmlessfrorrL:zhiuH�s, damages, or
v -
claims of any kind. or description whatsoever, foreseen or unforeseen, that ma3i be mad& against the City of Edmonds, r any ofit8 departments or
employees, including or not limited to the defense ofany legalproceeding8 including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FORWORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY F0)?CES,'A T WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
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 copy of thepermit will be
available on sit at all ft es for inspection pur,9ps s.
Signature.. Date: 3-11-96
(T��actor`or Oeiit) ' / .
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: \J%1
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS: . NA,
X#1Mi1tD1"_T
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND III:
RESTORATION FEE.-.
PERMIT FEE:
TOTAL FEE:
RECEIPT FEE:
,a,
DATE: ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ASUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
I Diagram.:
(Fund 1 11 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION E] YES NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
VINAL APPROVAL BY: Date:
Mama GaO—.�
AWeftV1cn[r*WCar"W AAAmisAim tne r-1 of Edmonds
Watermain 4epth N�o
gas main
Right of Way
Permit Application
Submitted by: Harlamne Kingsbury
Engineering Aide
Washington Natural Gas
#356-7500 X7596
(.o A- AV �,3
Kep,
-9- Water
--G- Gas
-SS- Sever
-& Water hydrant
0 Water valve
Washington Natural Gas Company
If 22 75th Strect S.W., Everett. Washington 98203, (206) 355-3331
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NANIE/NAME OF BUSINESS
DA&REI-L R. /nAlb"10M
cc -
tu MAILING ADDRESS
Z
31
lo ?Llto 4" AVIC AJ,
AM
NAME
ADDRESS
ZIP TELEPHONE NUMBER
CITY ZIpr TELEPHONE NUMBER
STATE LICENSE NUMBER EXPIRATION DATE
ption of Property - include all easements
CLJ A..S'f OP LCrr - 10 . I
?_j PLAr ato E,0&u:vv0S,_ V0
I doF
, PtAn PA(.F- _44o SOO. C-0.
�roperty
TaxAccount
oo 2-
Parcel No.
NEW
RESIDENTIAL
PLUMBING
RADDITION
COMMERCIAL
MECHANICAL
AREMODEL
0- APT. BLDG.
El SIGN
FIREPAIR
GRADING
FENCE
CYDS.
(—x—FT)
WOODSTOVE
DEMOLISH INSERT
SW M POOL
11017 TUBISPA
r;:;Fr GARAGE
RETAINING WALU
RENEWAL
Lj�N CA
ROCKERY
FTYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
1-11
NUMBER
OF
I
NUMBER OF
DWELLING
1
CRITICAL
AREAS 4 417-
9 5,_
STORIES UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FoUNtIlATIO."'J, SLA" ANN
CA12PO&T TO Be AuiLr A^ja
F-yu�Si-irJCm. 4=A4A6.,C 6ALVA(PeZ
HEAT SOURCE: I I GLAZING J,
USE
ZONE PERMIT
NUMBER
JOB SUITE/APT #
ADDRESS 4r,
`V ff-k 4)
LEGAL DESCRIPTION CHECKI SUBDIVISION NO. I LID NO,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TE5CP App'-ed 11
RW Par." Required 0
EXISTING — REQUIRED DEDICATION 'a " U30 Req'd 11
S1..p`.Ii.r, PRZu�',ed
PROPOSED Sidewalk Required
cc
W
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 0 NOO
1EMARKS
W
Lij
ENGINEERING MEMO DATED REVIEWED BY
261
SIGN AREA
SEPA REVIEW
ADB NO.
ALLOWED
PROPOSED
COMPLETE
__I
1EXEMPT
SHORELINIE#
EXP
VARIANCE OR CLI
PLANNING REVIEW BY
DATE
12 2
SETBACKS — FEET
v HEIGHT
.
LOT COVE RAGE Z
Z
. ..
4, SIDE 63
j Z
REAR ILI
Z
r"w Vr,c�r� !
I _L/_ I ^_j I L'A
SPECIAL INSPECTOR REA . . OCCUPANT
REQUIRED 13 YES Azil,"Wr LOAD
EMARKS
PROGRESS INSPECTIONS PER UBC 305 Z
D
FINAL INSPECTION REQUIRED
PLAN CHECK FEE
BUILDING
% PLUMBING
Plan Check No.
9& -- (�. �
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewpiks,
driveways, marquees, etc.) will require separate permission.
GRADINGIFILL
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
successors in interest, agrees to indemnify, defend and hold
harmless I e City of Edmonds, Washington, its officials,
h
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."
ENG. INSPECTION FEE
---
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I herebv acknowledne that I have read this application; that the
FEE
information given is correct; and that I am the owner, or tho duly
I n I e d U'y
ATTENTION
APPLICATION APPROVAL
and
authorized agent of the owner. I agree to comply with city and
u'
THIS PERMIT
This application is not a permit until
state laws regulating construction; and In doing the work authorlz-
st' 0 r z
Labor
in Labo
AUTHORIZES
ONLY THE
signed by the Building Official or his/her
ed thereby, no person will be employed violation of the r
ed
Co en Sa_
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
jYh
tion Insurance and RCW 18.27.
[a
INSPECTION
acknowledged in space provided.
SIGNED
SIG�A�ER OR AGENT) SIGNED
DEPARTMENT
CITY OF
0 F F I AC�A_l G URE DAT
..�DATE
EDMONDS
*ATEE
CALL FOR
RELEfSEA gl:_ f
-;ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
77- 220
ORIGINAL — File YELLOW — Inspector
A' CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPttR 3.
01&
PINK — Own'er GOLD — Assessor
10247
/*,C-� *
0W OF EDMONDS
USE PERMIT
ZONE&
UMBER 1
�1�
CONSTRUCTION PERMIT APPLICATION
I
.1.7
jos - PT
B
FAD R E S
AUUM�4 Z 142
OWNER NAME NAME OF BUSINESS
tlAIMELL'IPAULA ffiAAtA)O#*J
LEGAL DESCRIPTION CHECKI
SUBDIVISION NO. LID
NO
W
Z
3:
8
MAILING ADDRESS
2-1 to 4 41 A va
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
RW
IiXISTING — REQUIRED DEDICATION Street
inspection
PROPOSED Sidewalk
Approved
Permit Required *Q1
Use Permit Req'd 0
Required
Required
a:
W
CITY -ZIP
Ef1MQ1JM 96oZo
HONENUMBER
'77( o - -3).35
NAME
W
L)
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NOO
13
ADDRESS
REMARKS
LI, 4 - JAJ td I �1.
Z
Fr
W
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CITY ZIP ITELEPHONE
NUMBER
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NAME ,
ftj ATTSONJ
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PAw:2.
ADDRESS
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ENGINEERING MEMO DATED REVIEWED BY
A
CITY ZIP
TELEPHONE NUMBER
FIRE MEMO DATED REVIEWED BY
ui
E:
1`_
Z
0
Ebmombs 91307-01-178-0:1tq
STATE LICENSE NUMBER EXPIRATION DATE
&MMAIIiI
SIGN AREA
SEPA REVIEW
Ace NO.
ALLOWED PROPOSED
COMPLETE JEX I EM , PT
EXP
SHORELINE a
z
Legal Description of Property - include all easements
IRE AW 45 Er OF' LOr 10 6LOC-K
)
( in
W
FLAT
2_11 OF EbMOMAS VOLUME 1
VARIANCE OR cu
evo
V —95
PLANNING REVIEW BY
DATE
? - ; ... ..,
PA&oe U* o it PLA-rs.
SETBA
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FRdNT SIDE REARJ
'HEIgHT,IL
. i.1
0 T COVERAGE
I ,
Z
Z
Z
<�
Property
Tax Account
Parcel No. 00L 0 11)— W I
REMARKS
)J�12
a.
0 NEW RESIDENTIAL El PLUMBING
FTADDITION COMMERCIAL MECHANICAL
REMODEL APT. BLDG. SIGN
CHECKED BY
TYPE OF CONST IUCTION
77- /VP
CODE
OCCUPANT
GRQ"L-
GRA13a"' FENCE
REPAIR CYDS. F I x—FT)
W
0
at
0
DEMOLISH WOODSTOVE SWIM POOL
INSERT 0 HOT TUB/SPA.
GARAGE RETAINING WALL/
CARPORT ROCKERY El RENEWAL
SPECIAL INSPECTOR
REQUIRED E
AREA
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER.UBC 305
Z
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
w4ri AL
NUMB'ER` NUMBER
NGOF CRITICAL
OF DWELLI AREAS
STORIES UNITS NUMBER 96-9Z
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REQUIRED
tAovc 01: ROUSE OrM 61T W
.5mage Oerec7p4fi.,
f:OVAO 'nolltl) R.IEPLACZ -nA10 WINC111110WO
- - VALUATION
F
in 2- 1 Demo
PLAN CHECK FEE
fe"I
C-04MAIP—C—'r UTILITIE'51I, UAIDEASL& M"I
BUILDING
26*000
Z33
HEAT SOURCE:
ATUAAL GAS
GLAZING
0/
0
PLUMBING
Plan Check No. -Z
MECHANICAL
7-
GRADINGIFILL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curts, 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
SO
ENG. INSPECTION FEE
3
'Wn
2
<
0
I
. "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,
erhployees, 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
I provision."
PLAN CHECK DEPOSIT
_/S7
TOTAL AMOUNT DUE
S6
I hereby'acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
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 T.his 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/her
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance and RCW 18.27. INSPECTION acknowledged in space provided.
S�I;GN �NER OR AGE�NTJ e.40AITE SIGNED DEPARTMENT CFF_IcPVS S URE DATE
CITY OF S /1 4-6
1711Z S/ S S
EDMOND r__v
AFLg .'E�.O DATE
CALL FOR
ATTENTION INSPECTION
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. USC
CHAPTER-3. PINK — Owner GOLD — Assessor
Cr.
W
z
0
u
ZONE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
08
0
OWNER NAME NAME OF BUSINESS ADDRESS
L G4
49'A P. Hollcwsoi-J LEGAL DIESCRIPTIO
I �4_a_6�'_D_'Rj& YL 15 rt 1; ' .1
ADDRESS
ICITY ZIP iTELEPHONE NUMBER 0
CITY
ZIP TELEPHONE NUMBER
STATE LICENSE NUMBER EXPIRATION DATE
- include all easements
Lor I I 511-0c.K 005 PLAT Orr
EONUw4s. holi-tom(o A I 01JLy
(2.03
4�1% Ave, 00)
Property
Tax Account
4344-005-ooi-OX5
Parcel No.
FINEW
NA
L#CW RESIDENTIAL
PLUMBING
1:3
ADDITION
COMMERCIAL
MECHANICAL
DREMODEL
1:1 APT.'BLOG,
.0 SIGN
GRADING
CYDS.
FENCE
REPAIR
I— x _FT)
DEMOLISH
WOODSTOVE
INSERT
SWIM POOL
HOT TUB/SPA
GARAGE
C
RETAINING WALL/
E] RENEWAL
ROCKERY
�TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
.5 JWA"
FAMILY RCS 14,aAACAr
NUMBER
NUMBER.OF
CRITICAL
CR
OF
DWELLING
7NUMOER
AREAS
212MS
UNITS
U
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
W - MO VE I IAISPeCTIOA/f
Hoosier
-ro . de twvzo
rAaoh Z03
PERMIT
NUMBER 950196
SUITE APT a
4 k
SUBDIVISION NO I LID NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved�
0
RW Permit Requi�ed
0
EXISTING -REQUIRED DEDICATION
Street Use Permit �eq'd
0
InsPection Required
0
PR6POSED
Sidewalk Required
0
METER SIZE
LINE SIZE,
NO� OF FIXTURES
PRV REQUIRED
W
t
YESO NO 0
<
1EMARKS
cc
W
Z
0
z
.11
SIGN AREA SEPA REVIEW
ALLOWED I PROPOSED I COMPLETE 1EXEMPT
I I EXP I
MARIANCE OR CU PLANNING REVIEW BY,
EVIEWED BY
EVIEWEI BY
ADS NO.
ORELINE #
SETBACKS - FEET
HEIG
,a
OT COVERAGE
z
FRONT SIDE
REAR
z
REMARKS
CHECKED By
TYP OF CONSTRUCTION
CODE
I
OCCUPANT
GRr:
-mWe
00N " %-14—
SPECIAL INSPECTOR
AREA
OCCUPANT
REQUIRED 0 YES
LOAD
ARKS
PROGRESS INSPECTIONS PER
UBC 305
FINAL INSPECTION REQUIRED
— VALUATION "E E
AM mi-10' Vto' 0AVc 40. (JA).C, I r Y)
PLAN CHECK FEE
M
HEAT SOURCE:
-
GLAZING
BUILDING
11
IN)
PLUMBING
PlanCheckNo..
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
AnyconstructIon'on the public domain (curbs, sidewolks,
driveways. marquees, etc.) will require separate permission.
STATE SURCHARGE
.Permit Application.: 180 Da
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
.!'Ap.plic,an I t..,o,n..b.ehjIf..of his�ior.her.spciuse, heirsi assigns and
ENO. INSPECTION FEE
Jn. int t dbibels lo'Thd6iffl nklf- d d
successors ere$ , y, e en -arid hold
2
harmless the City of- Edmonds, Washington, its officials,
2
employees, and-agenits 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
PLAN CHECK DEPOSIT
0
modify, Waive or reduce.any requirement of any city ordinance
I
nor limit in any way the.,Clty's ability. tose,nforce.any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
Information giverils correct; and that-J aro the owner, or,th.e,duly
ATTENTION
APPLICATION APPROVAL
el
rze(' a
authoriz . d a ant of, the bwnerri'aglrde to`:coh)6Iy)wIth-cIty and:
' w S
state laws r g'ula'tln*g construction; and In doing the work authorlz-
THIS PERMIT
AUTHORIZES
This application is not a permit until
ed thyeareb, no person will be employed In violation'of the Labor
ONLY THE
signed by the Building Official or his/her
Code of a State of Wa*ng)on relating to Workmen's Compensa.
WORK NOTED
Deputy; and fees are paid,and receipt is
r I ce
,tion I ran6e an&RCV/1827.
INSPECTION
acknowledged in space provided.
CUJ Rj
SIGPIAJ �,[OWNE�. NT DATnSIGNED...
or, � V Z,
DEPARTMENT
C OF,FICiAL' SIGNATU DATE
OF
EDMONDS
ATYENI ION'.'
CALL FOR
RELEASIiO Byi:' 4. DATE
INSPECTION
IT IS UNI_ WFUL TO USE OR OCCUPY.A,1BUiLOING OR STRUCTURE
."UNTIL A FINAL' INSPECTION WAS BEEN MADE.-ANb APISROVAL OR(
771-022-0,,.--�
RIGINA'L File YELLOW - inspector
A CERTIkICATE OF OCCUPANCY HAS BEEN,.GRANTED. USC',.
CHAPTER 3*_
PINk 0,�r-br GOLD - Assessor
A
USE PERMIT 0 003
-CITY, OF EDMONDS ZONE NUMBER 96
CONSTRUCTION PERMIT. APPLICATION JOB UITE-APTs
OWNER NAME NAME OF BU§1NESS ADDRESS 4 V 0
DARREUL JAULA LEGAL DESCRIPTION CHECK SUBDIVISION NO LID NO
Lu MAILING ADDRESS
Z
8 Z I (a .4 A -Ag PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 0
CITY zip TELEPHONE NUMBER STING — REQUIRED DEDICATION — RW Permit Required 11
EXI Street Use Permi't Req'd 0
VoZO 7-74-:31 PROPOSED
EbrA0^)0, Inspection Required 13
NAME Sidewalk Required 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13
ADDRESS I
REMARKS Z
cc
Aff K,� )W-
PHONE NUMBER
Z
< CITY 777 1 ATEA_ fi/E-Rv�` -X..; AE- k(LLtE,0
NAME'
0 a) A) e
ADDRESS INEERING MEMO DATED REVIEWED BY
0 ENG
gig,
CITY ZIP ITELEPHONE NUMBER
cc
FIRE MEMO DATED REVIEWED BY W1
0
L) STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA SEPA REVIEW ADB NO,
ALLOWED PROPOSED COMPLETE EXEMPT
Legal Description of Property.- include all easements SHORELINE #
__:Sw 46 Pr &W L-07 10 1 46ii-OcK EXP I
VARIANCE OR CU PLANNING REVIEW BY DATE
5) 2.1 PLAT7' 0s: 00410405., VoLume
SETBACKS — FEET HEIGHT LOT COVERAGE Z
Z
IC Fill. A1.5 Z
0 PA66 FRONT SIDE REAR <
ul Property REMARKS FL
Tax Account
Parcel No 344 -aaZ 0 /0 001 8 jelly �r,57 LIZ::
0 NEW RESIDENTIAL E] PLUMBING
kql-�ooer) <,�-re
EIADDITION El COMMERCIAL MECHANICAL
APT. BLDG. 10 /.C- ZQ07_ <:LgF'X/�
11 REMODE'L El SIGN IC5,
CHECKED BY TYPE OF CONSTRUCTION ICOOE OCCUPANT
GX
C .9107
CYDS. FENCE
R EPAIR El GRADI NO 17 x—Fn
WOODSTOVE SWIMPOOL SPECIAL INSPECTOR AREA OCCUPANT
DEMOLISH El INSERT HOT TUB/SPA REOUIRED LOAD
OYE
GARAGE RETAINING WALL1
CARPORT ROCKERY RENEWAL
Z
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER. UBC 305 0
_j
R grit DIM 7"""'14L
NUMBER NUMBER OF CRITICAL
AREAS 95.72
0 OF DWELLING
CC STORIES [UNITS INUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) % C_ / V &_—,"
fi)(15n4& AOWAC 7*0 DEMOLIS FINAL INSPECTION REQUIRED
VALUATION
Ty AL&V AfFMOlaq rox A ivonce
PLAN CHECK FEE
HOLW- PO 66 BUILDING
HEAT SOURCE: GLAZING %
PLUMBING
MECHANICAL
Plainthilick-No..
This. Permit covers work to be done on privat.e.property ONLY. GRADINGIFILL
Any construction,'o . n the public domain (curbs, sidewpiks,
driveways, 0narqu . Sea, etc.) Will require separate permission. STATE SURCHARGE
Permit Applicatilloin'.180 D sylit-'.
STORM DRAINAGE FEE
Pe' ork Is.StArted Within 180 Days
miftLimIt: I Year.frovided W
G! INSPECTION FEE
Appllcant,� on behalf, of his -O��hitrsp6u`sie,, heirs, assigns and� El�
successors in interest, agreeli to,finderrinify, pefena and hold
(WA harmless . the . 'City, of —Edmonds, Washington, its officials,
Ind a0ents,from ortyprid all cldjms'for damages of
jempI6ye,es,:,E_ . � ,.. _. . t .: _ �
ratiIiiiiee n-at-�re',Ari:'Ino�Jli.e6ti�l'oriindirectly frorviAhe Issuance K DEPOSIT
f,. rmit shall not be deemed to
this permit. Issu nce�of thIS'pe
'modify, Waive or reduce. any requirement of any city widinan-
0 or limit. in any way. the City's ability to enforce ahy.qr.!�I�!nqis TOTAL AMOUNT DUE
X n
provision.."."
I hereby.a�knowledge.tliat I have read this applicatk9o; that the
information given is . co - rrect; and that I am Itfe owner,, or i , he duly ATTENTION APPLICATION APPROVAL
authorized agi�t of thelowner.:l agree Ap comply with city and - THIS PERMIT
I This application is not a permit until
state iaws reg6lating construction; and In doing the work authoriz- AUTHORIZES
ed thereby, no person will* be'employed In violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the State of Washington'relating to Workmen's Compensa- WORK NOTED Deputy: and fees are paid, and receipt is
acknowledged in space provided.
tion Insurance and RCW 18.27. INSPECTION
SIGNATURE IOWNER OR AGENT) JDAIE SIGNED DEPARTMENT DATE
CITY OF N7AURE
'4� — — 261e
2.5 EDMONDS
DATE
CALL FOR
ATTENTION- INSPECTION
IT IS UNLAWFUL'TQ USE OR OCCUPY A . BUILDING OR STRUCTURE File YELLOW — inspector
UNTIL A FINAL 'INSPECTION HAS SEEWMADE AND APPROVAL OR 771-0220 ORIGINAL L
A 'CERTIFIdATE.'OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Owner GOLD — Assessor
DATE I ED
AT EXPIRES
Usf PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRES&/
OWNER NAMEMAME OF BUSINESS 4�
jDaaafLL 14A Q M 1-04 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
'MAILING ADDRESS LID FEE $
TESCIR Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
2* 0A AVIF AJ Street Use Permit Recfd
CITY ZIP TELEPHONE EXISTING — PROPOSED hupection Required 13
Sidewalk Required 13
REQUIRED DEDICATION— Fr UnderWound
sow 14Z5-7743135 I wmg requaect 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PR� REQUIRED
CA(LL CQL&1q YES13 NO 13
ADDRESS REMARKS z
x OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
2-5407-`5 WK 44- 0,
CITY ZIP TELEPHONE
&r�WLL 99o2,1 416 -6C* 370-3
NAME ICBL#
0 wive-YL)
ENGINEERING REVIEWED BY E
ADDRESS Y
0
FIRE REVIEWED BY
CITY ZI TELEPHONE
,P
0
VARIAI�IqE OR QL.�-,.�-J^RELI li!l Nf ION BOND
CHECKED BY
STATE LICENSE NUMBER EXfIRATION,DATE E16 D POSTED
V7 $
S AREA'
Evi HEIGHT
P '-AL 'A
-j PROPERTY TAX ACCOUNT, PARCEL NO. OMPL M IWET'�, PROPOSED LLOWED PROPOSED
4344-0 Z-010,0611
low-
6 ;. 'HO111RED SETBAd -,PROPOSED SETBACKS (Fr.)
D_ FR r;�SIDE, EA FRONT L/R SIDE REAR
E] NEW XR SIDENTUkL,. [:].,PLUMBING/ PH.; LOWE 06st
COMP E
COMMERCIAL
ADDITION 13. C 0F1-U z
RKING LOT EA DATE
,0"* ,
if xj�
NNI G,R!��,PY
E] REMODEL MULTIFAMILY PROV D IL
GRAC FENCE
0 REPAIR YOS X FT RE MARKS
ri DEMOLISH TAN
R
GARAGE kETA ING111WA FIRE SPR&KLER
z CARPORT OCjY FIRE ALARM
(rYPE OF USE, BUSINESS OR AXW:
f CHECKED BY ITYPL" N OCCUPANT
RIIE5 1004 T I 4L GROUP
NUMBER 17 NUMBEILC# CRITICAL 7n ' —
A EAS E
UNITS NRUMBER REQUIRED [] YES
OF 1z D LIW SP CIAL INSPECTION', AREA, OCCUPANT
0 STORIES q5-9z LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS'INSPECTIONS PER U13C 1,08/FINAL INSPECTION REG
Aw rrioA) la WAk of= fjoustF,
JfJC-L�AX7 V_jTC,44& 6e0tw" 1 11- 6AT6
+ Ahinin 0fr 'GAS- Pja6PLAC05 VALUATION
P 4awk -ap
Description
Description �,_FEE FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % '�LOT-SLOBE %
Zuilding.Perrnit',,'., City Surcharge
PLAN CHECYNQ- VESTED DATE -
Plumbing.")
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
PERMITAPPILICATION: ISO DAYS
IL PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection,
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY; DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
I FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
!3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. 8
0 NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." %Oybu
zi Recording Fee Receipt #
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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknovAedged In space provided.
WORKMEN'S CO�MMTION INSURANCE AND RCYV 18.27.
OFFICIALS SIGNATURE DATE
S!I�G�OWNi�/WAG DATE SIGNED IQ )
1zlza a . %.-5
1 - A I . 771-0220 RELELASEDBY DATE
ATTENTION Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
IC
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- GI L 'S R
I " W
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 :N ER "04S
A'd VI
C
04/02 S REEN-ACCJU IbW
PRESS HARD -YOU ARWIN-G 5 CO;ES
7T
CODE TNE QUOTE
COMMERCIAL & MEADOWDALE ROUTING FORM
***FOR INTEROFFICE USE ONLY***
Applicant Plan Check #
Address Type
3r*
PLANNING Target To On Back ADD? Dgys Mail/Fax
RESUB #1 Target TO On Back ADD? DUs Mail/Fax
RESUB #2 Target To On Back ADD? Dgys Mail/Fax
RESUB #3 Target To On Back ADD? Dgys . Mail/Fax
I.C.A.# /?4W-4�P-,04!.>Determination),//,)"—/-.)
2. Zone /0 (�—' -Comer /Flag ��144
3. Street Map Width Dedication?.
4. VAR Cu SM ADB
5. SEPA Expires
6. Building Pad: Existing..JA/2 Prop . osed
t Coverage�
7. Lot Area �_Lo
8. Height Calcs: Datum
Ave Grade M
&L-L-Max Actual
9. Req'd Parking 2 Provided 4 4.
BUILDING
COMMENTS/NOTES .
Heat Source(;�Window Schedule Glazing % FEMA Map
Lighting Budget Grading, Yds Soils Repown� Lot Slope
VIAQ Worksheets
OVER 4000 Sq ft? (ALchit ct quiLredj Yes/ No,
IN-HO USE Target
To
On
Back
ADD?
Dgys
Mail/Fax
RESUB #1 Target
TO
On
Back
ADD?
Dgys
Mail/Fax
RESUB #2 Target
To
On
Back
ADD?
DMs
Mail/Fax
RESUB #3 Targei
TO
On
Back
ADD?
Days
Mail/Fax
RESUB #4 Target
To
On
Back
ADD?
Days
Mail/Fax
Consultants
Structural/Non-Struct Mailed
To
Back
ADD?
Dgys
Mail/Fax
RESUB #1 Mailed
TO
Back
ADD?
Dgys
Mail/Fax
GEOTECH,— Mailed
To
Back
ADD?
DUs
Mail/Fax
RESUB #1 Mailed
TO
Back
ADD?
DUs
Mail/Fax
RESUB #2 Mailed
To
Back
ADD?
Dgys
Mail/Fax
RESUB #3 Mailed
TO
Back
ADD?
Dgys
Mail/Fax
COMMENTS/NOTES
C:\Documents and Settings\Umbaugh\Desktop\Routing COMM-MEAD Form 2.docO3/01/04
ENGINEERING
RESUB #1 Target
To
On
Back
ADD?
Dgys
Mail/Fax
RESUB #2 Target
TO
On
Back
ADD?
Dgys
Mail/Fax
RESUB #3 Target
To
On
Back
ADD?
Dgys
Mail/Fax
RECYCLING Target
To
On
Back
ADD?
Dgys
Mail/Fax
1. Drainage Plan & Calcs (3 sets) OK COMMENTS/NOTES
2; Grading Plan/CYD's (3 sets)_SEPA?
3. Step Footings? Y/N?
4. Driveway Slope %—OK—Waiver Apprv'd?
5. Street Dedication Req'd? FT,
6. )Easement Type
7. Proposed Impervious
8. Existing Impervious (Pre 1977)_(Post 1977)
9. State Hydraulics Permit
I O.Check Plat Requirements
11. Sidewalk Required
12.EUC Form
13.Trash Enclosure?
FIRE Target To On Back ADD? Days Mail/Fax
RESUB #I Target TO On Back ADD? Days Mail/Fax
RESUB #2 Tareet To On Back ADD? Days Mail/Fax
CONSULTANT -Mailed To On Back ADD? Days Mail/Fax
RESUB #1 Mailed . To On Back ADD? Days Mail/Fax
RESUB #2 Mailed To On Back ADD? Dgys Mail/Fax
*REVIEWERS: PLEASE CALCULATE BUSINESS DAYS*
PLANNING REVIEW TIME ENG REVIEW TIME
FIRE REVIEW TIME
PW REVIEW TIME
BUILDING DEPT REVIEW TIME: In-house Consultant #1
#2
RTG , DAYS PERMIT # ISSUE DATE
*CONTACT PERSON STATEMENT*
BY SIGNING THIS FORM I UNDERSTAND THAT I AM THE ACKNOWLEDGED CONTACT PERSON FOR
THIS PROJECT. IT IS MY RESPONSIBILITY TO COORDINATE ALL SUBMITTALS WITH THE CITY
AND ONLY I CAN MAKE INQUIRIES ON THE STATUS OF THE PERMIT. I UNDERSTAND THAT IT IS
MY RESPONSIBILITY TO DETERMINE IN ADVANCE OF PERMIT suBmITTAL ANY DISCRETiONARY
PERMITS THAT MAY BE APPLICABLE TO THIS PROJECT. I ACKNOWLEDGE THAT TO THE BEST OF
MY ABILITY I HAVE SUBMITTED ALL NECESSARY DOCUMENTATION IN ORDER TO MAKE A
COMPLETE APPLICATION.
Signed Date
(�c V-Sayl P, BcLoe_,�, Phone 2-0 (o - 7--L+ 0 -G5L�G - (Ie�0
Contact Person (Print Clearly) L�2�� - (P-7 0 - q q-7 -3 - kaMC
CORRECTIONS: Fax to: Mail to:
E-mail cz��&tab 0 W'( YAJer met-:e - claniv
C:\Documents and Settings\Umbaugh\Desktop\Routing COMM-MEAD Form 2.docO3/01/04