21605 76TH AVE W.PDF11111111111111
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21605 76TH AVE W
ADDRESS: c7g/615:
TAX ACCOUNT/PARCEL NUM13ER: X69E9
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: [] Conditional Waiver F1 Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER): OV6�1 —VfflX�9
PLANNING DATA CHECKLIST DA
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #: ZdO
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATE 3 -7
D: 19—A?
/ `� 5 //A7 R1
OTHER:
LATEMP\DSrs\Fomis\Street File Checklist.doc
PLANNING DATA
Ne'w bom lv�C.2-c iA, L_
NAME: Pur�,
0
SITE ADDRESS: -761 -DATE: lqr
ZONING: IIIAU_Uke'bOU�Q, PLAN CHK#: 27—Y1
PROJECT DESCRIPTION:
USE(S) PROPOSED: %ew -- �& - ALLOWED?:
LEGAL NONCON MING LAND USE DETERMINATION ISSUED VIA' (Y/N)
CUP File: N 7 . I
ADB FILE #: N ' 1A OR D#TE WAIVED:
PLANS MATCH APPROVED PLAN: AIM
PARKING-
L l;s e: rA i1AA 0)
L,131 M
X
(floor
Use:
X (floor
# nf:L�- 1, F
No. Spaces RequiredILE
�4
area, # employees, etc.) =
No. Spaces Required:
area, # employees, etc.) =
Total Required: Actual
Provided: tTt
SETBACKS:
Required Setbacks:
Front: K / Left Side: Right Side: A;_' Rear:
Actual Set c s'
'�'c s
Front. Left Side: VZ Right Side: Rear: A2
1 t
Street map checked for additionfil setback required? VP,� — g —(Yes/,No)
I W AM0_4
MAXIMUM FLOOR AREA:
Maximum Allowed: Actual:
BUILDING HEIGHT:
Maximum Allowed:—k /-4 —Actual Height:
Modulation Allo, Modulation Height:
Datum Point: 9 L-A. Datum Elevation:
LANDSCAPING:
Matches ADB pXoved: ' AVA
Bond: win
I
SUBDIVISION: /V
CRITICAL AREAS #:
4Af11cs%pe=WPLANDAc.D0C
SEPA DETERMINATION:
SHORELINE REQUIRED?:
Plan Review By:
c:%fl1=kperTnAt^?LANDAc,D0C
b 1C.
t
DATE
'It1hor,
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMME OF BUSINESS
MAILING ADDRESS
21101 lip-M AV5. Id � SUM 205
CITY ZIP 'l TELEPHONE
et*400m lilem I A2!5)1,o46 -
NAME
ADDRESS
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CITY ZIP TELEPHONE
W-5
NAME
"I ADDRESS
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PERMIT EXPIRES
USE
ZONE
NONE
PERMIT
NUMBEROW,.41
J013
ADDRESS 21 bO5
I a 1'""
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Pamill Required
Street Use Permit RaqV
EXISTING - PROPOSED
impaction Required
Sidewalk RaquW
REQUIRED DEDICATION- FT
Undergrounid
Whing required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
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YES13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
By DATE
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CITY TEL.901HO E
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FIRE,,_FWi1lEPED B Y DATE
to
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STATE LICENSE NUMBER EXPIRATION DATE Y
16 5 a 5 C $r 13,11112- W 0 0610, 1 /03
VARIANCEORCU
HqRELINE ORADB#x
ANW, IdplJOYi
INSPECTION
REO'D
i )gL
BON D
POSTED
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5
SEPA REVIEW
'.-COMPLETE EXEMPT
EXP,
:'.�SIGN AREA,,-
a-ALLOWEIY,
HEIGHT
A�LOWED PROPOSED
PROPERTY TAX ACCO NT PARCEL NO.
13 NEW RESIDENTIAL PLUMBING MECH
COMPLIANCE OR
ADDITION .0 COMMERCIAL CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRA DING FENCE,
REPAIR CYDS X Fr)
LOT- COVERAGE".,'
'ALLOWED PROPOSED.'
REQUIRED SETBACKS (FT),
FRONT SIDE, 1- REAR
�PROPOSED SETBACKS (FT.)
FRONT L/R SIDE REAR
V
PARKING'
REO'D PROVIDED
LOT -AREA
PLANNINd-REMEWOD.,BY; DATE
REMARKS
OTHER..,
DEMOLISH E] TANK
Ei GARAGE RETAJkING WALL, F,
ROCKERY: RE SPRINKLER
CARPORT FIRE ALARM.
CrYPE OF USE, BUSINESS OR ACTIVITY) EXPLNN",
CHECKED BY,
17YIPE OFPON STRUCT116N DE
OCCUPANT
GROUP
NUMBER' NUMBER OF,-'; CRITICAL
OF DWFLL114G AREAS
TO UNITS: R,
S RIES NUMBE
SPE CLAL INSPECTION
REOUIR
AREA',',`�
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE'
REMARKS
PROGRESS INSPECTIONS PER-,UBC196/FINAL INSPECTION RE01D
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121 P_ or= t4e EVEIR Er :6,01m)
�VALUATION.,'
Descriptil n .,.,FEE Description FEE
tv
Plan Check-
State Surcharge
HEAT SOURCE
GLAZING %
I
, �LOT PE %
�Bu ild ingFFFFp,,,,,�r
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City Surcharge
PLAN CHECK NCU% VESTED DATE
I
�'Plurnb6g�Y /W)
_I
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONILX ANY CONSTRUCTION ON THE PUBLIC
a
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, E TC.) WILL REQUIRE
SEPARATE PERMISSION.
.4E"VW. eview
PERUffAPPUCATION: 160 DAYS
06 PERMIT UMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SV. Wsection e4
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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE
Landscapel4sp.
ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR umrr IN ANY WAY THE crrrs ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
x
Total Arnt Due
Recording Fee
Receipt # A,
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 APPROVA158
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE -LAWS REGULATING CONSTRUC.
CALL
This application Is not a permill until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE!.VkR!�ODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space pro vided
WORKMEN'S COMPEN ���RANCE AND RCW 18.27.
SIGNATIJYE�NER dkMj!EP/, DATE JIGNED/
OFF C G
L) I DAT§ I
1A9 I Mi 11 U I
%425)
771-0220
A
LL4461 11-`1 1 L
E BED BY DAYt
A-ftENTION
Off 1333 e
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
lNePECT04
04/02 PRESS HARD -YOU ARE
MAKING 5 COPIES
PINK - OWNER - GOLD - ASSESSOR
GREEN -ACCOUNTING
:A:
A . TE RECEIVED 12
PER MIT EXPIRES
r4n�uA
USE PERMIT eL&Z 15
ZONE
CITY OF EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB #
ADDRESS
2-16o 6z 77
OWNER NAME/NAME OF BUSINESS
V 0� �,u
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
W
MAILINGADDRESS
01 f-h ve kA/e�.�
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
ItSCP Approved
RW Permit Required
Street Use Permit Rsqd
EXISTING _ PROPOSED
Inspection Required. 13
Sidewalk Required 13
CITY ZIP TELEPHONE
0
REG UIRED DEDICATION- FT
_FNO.
UnotuiPoUnu
g required 13
NAME
_. METER SIZE
LINE SIZE
OF FIXTURE$
'PRV REQUIRED
YES13 NO 13
x
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTRoL/DRAINAGE
z
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C . ITY ZIP ITELEPHONE
NAME
OCk
4-11 6 /11`1�
CBL#
the V
ENGINEERING REVIEWED BY DATE
Oi
ADDRESS
2_2 ol oLbt
FIRE REVIEWED BY DATE
ul
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CITY ZIP
TELEPHONE
I-L
00
� F_ QZ 6 H Ol- 11A
Ro - -7-Ig 10
VARIANCE OR CU
SHORELINE OR
INSPECTION
BOND
STATE LICENSE NUMBER EXPIRATION DATE
CtWCKED BY
REO'D
POSTED
BXT H-1 X135L.
L
11-el . to - C) 2-
YES ONO $
SEPA REVIEW .
SIGN AREA
:
HEIGHT
ALLOWED PROPOSED.
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE
EXEMPT
ALLOWED.
PROPOSED
t5sol 000 0),&
,
T:bc)-r
EXP
5�fNEW
RESIDENTIAL
Aft -UMBING / MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS IFT)
FRONT L/R SIDE' REAR
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
z
PARKING LOT
AREA
P�ANNING REVIEWED BY DA4E
REMODEL
MULnFAMILY
SIGN
REOD
PROVIDED
I ]���10
GRADING FENCE
REPAIR 0 CYDS x -FT)
0
,�, %Zr-
DEMOLISH 0 TANK OTHER'
Viat )k W k L-k- tic)-T %
11064 1 %
Qjr, I— gQL-
GARAGE RETAINING WALL F RE SPRINKLER
CARPORT ROCKERY ME ALARM
v4s%6 -r or _at
0
(TYPE OF USE. BUSINEss_0aAcTiv" EXPLAIN'
I (ft
.
tv .
CHECKED BY .
TYPE OF
I .
STRU%1ON
IC?8."
OCCUPANT,,r
GROUP
It/M
,2k� .
%-I _
NUMBER
OF
:?_�
NUMBER OF
DWELLING
CRITICAL
-AREAS
SPECIALINSPE ON JAREA
OCCUPANT
LOAD
OM
STO RIES
UNITS
NUMBER
RE UIRED []CTl
YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ10
W R.00FTOF
A"I R to&& Ta oY� R
M,fv%/G . AT PQ 6 F-r 'WuNb
vALLIATm
U PA 0 R. 0-1 Tu T
$
.1 Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHEck NO:
9- 0-T
VESTED DATE . .
Pluirribing
Mechanical
THIS PERMIT AUTHORLTES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I=
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
23
DOMAIN (CURBS, SIDEWALKS, DRIVEWAY% MARQUEES. ETC.) WILL REQUIRE
I=
SEPARATE PERMISSION.
a
Engr. Review
Lu
PERMIT APPLICATION: 180 DAYS
PERMIT ILIUM I YEAR - PROVIDED WORK IS STARTED WITHIN I SO 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
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY. OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERM17. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
E OVISION."
NOR LIMIT IN ANY WAY TH CITYS ABILITY TO ENFORCE ANY ORDINANCE PR
Recording Fee
Receipt #
I HEREBY. ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATIONAPPROVAL
GIVEN IS CORRECT; ANDTHAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. - I AGREE TO COMPIY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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
fecelpt Is acknowledged In space provided.
WORKMEN'S COMPE.NSATWNJURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
SIGNAftIRE (OWNER MIT/
DATE SIGNED
LA-02
I 125
—
771-0220
RELEASED BY 00E
ATTINTION
M 1333
V_t�_ '�/-3 /0 2--
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
. ORIGINAL - FILE YELLO4 - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 106'�_
PINK -OWNER GOLD -ASSESSOR_
04/02 PRESS HARD -VOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
WIA
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