221 4TH AVE S.PDF111111111111
5059
221 4TH AVE S
ED
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Critical Areas File #: — 0 106'
Critical Areas Checklist Fee: $45.00
Date Received by Dev. Sery. Dept:- G -2-9--.2,coo
City Receipt No: 1 -74-1,
Date Mailed to Applicant:
CRITICAL AIR vr_ JAS CHECKLIST
The 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. 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, and submit it to the
City. 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.
Please submit a vicinity map, along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e.g., site plan, 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 Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
PLEASE PRINT CLEARLY
Owner/Applicant:
Name
Lf —6 cy
Street Address
6kmp P" v - w (+ -1 -7
City State Zip
C,g�c- (0 ) 5%. -
T�iephon�
SiOture
6 /,--; z SA
Date t I
Applicant Representative:
Name
Lao
Street Address
to 77
City State Zip
("�2Z4 5-tk'
Telephone
SigrStdre
Date
d:reception/jana/CACLHandoul.doc Revised 4/10/2000
CA FILE NO.
Critical Areas Checklist
--------------------------------------------------------------
41 Site Information (soil s/top o graphy/hydrol ogy/ve getation)
I. Site Address/Location: �42-2� Z4f'4 A,--,.g- ��-Q -
2
2. Property Tax Account Number: __7
3. Approximate Site Size (acres or square feet): Ir-3-5 _3 1_5 5 F
4. Is this site currently developed? _��_Yes; — no.
If yes; how is site developed? `G� F I.
5. Describe he general site topography. Check all that apply.
7FIat: less than 5-feet elevation change over entire'site.
Rolling: slopes on site generally less than 15% (a vertical rise of I 0-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
I 0-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical -rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: C) ; Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
40 What season(s) of the year?
8. Site is in the floodway floodplain_ of a water cou . rse.
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: forested ; meadow shrubs mixed
urban landscaped (lawn,shrubs etc) ' L�--
11. Obvious wetland is present on site: /,JO
.:m 1. e ca,::.::e
:ft 1:'
:4
S;
s.
.5.Ubs'jd' s i e. azar,.
na n. No
1'c&_chk.d=; Rey 10/01/97
Cf*ffACT YEMPORARY POSTRUCT
47** Ave. 'Co.
SPA10AAv0J "14 110W
ZONING
SITE AREA SF
ALLOWABLE SITE COVERAGE
PROPOSED SITE COVERAGE 270 9 Of - -YI. Z 0/5
REQUIRED SETBACKS F /5*' S /0' S /47" B /57/
PROPOSED SETBACKS F IF'
BU%LDWG HEIGHT, GRADE TO RIDGE S-" WC& _X
'FIRSTFUDOR AREA Mlp 6-C
SECOND FLOOR AREA 17 -m �F
TCrIIAL GROSS AREA
TOFIIAL GLAZING AREA
TOTAL HEATED AREA va
GLAZING TO FLOCIll AREA RA710 %
ELECTRIIC SERVICE BY
WATER SERVICE BY
SANITARY SEWER DISTRICT
TELEPHONE SERVICE BY
Kri- C44 4 51w a Tw
171�4 OF (ATq IAISS
j nr-mm As vmv a
L
ENTRAME FM DUAIL)
I BUILDING MIGHT CALCULATION I
CORNM A EL 10/ �c
WRNM 5 EL /OX�-Q
e0RNM C EL /,W-o
CORNER D EL -c2/-' 10
TIOMAL ItO eo - e , 4
M /0J �b
ALLOWAKE SUIILDIINQ H EKIINT
+ w —
MAXIIIIIIIAIII ALLOWABLE maHT.
EL/Zdl!r,"
PROPOSED MAXAMI! BU11ILDIING ELEVATIOtt EL
0
IAj*A9ll P" a .5, M 5bLw^
mp5-r v (.*Teujv- -p es fLvXql'-D
104 ki&r, "01= SD%Jep- m-er.
%, 24p3arro3i A4404 use f it or Awr Ir
,Owe* 44 Lxpo ('4
PAU3T
CRAWLSPACE EXCAVATION
NPERVIOUS AREA CALCULATION
PIR EXISTING
WIIIUDINGS SF BULDINGS 1106 SIF
DECKS SF DECKS 1010 SF
PATIIOS SP PATIOS SIF
WALKS
31 SF WALKS 104 SIF
DRIVEWAY 10W sF DRIVEWAY -5&8_ SF
SF SF
TOTAL e: �_
1WERVIDIJIS
AREA
13 WLTRATION TRENCH REQUIRED — LF
erIDETIENTION PIPE REGMED -'!F& UP 0,(S'Jp(
13 NO ON49TE DRANAGE DETENTON SYSTE&I REQUFlW
Ems
".Lm OF pow
T
ir
A�
—4
FLOOR..
01IFftHAMG
A%LWE OF IEXMTWG
TO "
COMO
'ro=
L
El E
2 -1—
Lu
PROPOSM: REMOVED
DUPLEX
RESIDENCE1
I Ir
mi
ay-
COVERED PARKM
?E
AMPHAlf
'u% tA
TWO4TORY STRLJCTLM
TIGHTLIkE FROM ELI=,
I
DOWNSPOUTS
R .0,1TRY
OVERHAM
ANNE
rFF7rNr
--------
rr—
(2 FTJ EXtSTING CONCRETE WARNEAD
X _�Lo T. I lip'l
STORM — TO
NOTE
FUMP AS REOLNIED Om""' A""
_T
TO 9"T al IKV.L CONFORM
EL. 100'-W NOTE* MNER/COFRACTOR IS RESPONSIBLE W=--
TOP Of CA. ORATE 45 CY FOR CRAWLSPACE EXCWTION CONTROL AND DRAINAGE
SITE PLWS
SCALE. r
comTRACTom $HALL VOWY SCOWED
'!swz244v-. VNEC'EVIOLE COR14ERS RELATIVE TO
MMWpOSff) NOW TO t=AMUW
6"'Le.' "wpwT
ANY DESCAVANCES Sl"LL SE W"MW TO
fnc RECEIVED THE ATTENTION OF THE'AE$QfA.AW'
CLEVAnOW %W NEED ft-CALCL&Amm-
JOWBOM ON "0 AffUU GRAM SCUM "VINE
SE ANY.OqqqWFV�.
ILI m r", 0 C T 18 2000
'�A
I -Toll ICTION ENTRANCE (PER DETP
RNTY RVICES CTR.
qM'OPM E
CITY OF EDMONDS
89
Lu
(L)
z
uj 0
cy
0
LU . co
mom
x . -4
ui Lu
_j >
Z
cc le.0
x 1-2
LLI cy o
2. cy III
R FET RIM
.5-ria. �_ �,Lrl_
co
CONTACT PHONE
PROJECT ADDRESS
11 Z/ 0* Ave . �co.
"MOAAW.r, Aw Ildac
ZONING
SITE AREA .4-57157
ALLOWABLE SITE COVERAGE lyroA c tyfoo
PROPOSED SITE COVERAGE 27080#� IP
REQUIRED SETBACKS F /5*' S le S,(7' 6 le
PROPOSED SETBACKS F /3" S 10'6"S
BUILDING HEIGHT, GRADE TO RIDGE l-" 7AWC9 -M
*FIRST FLOOR AREA 193C C,.-
SECOND FLOOR AREA 17g?, OL9
TOTAL GROSS AREA
5132 5F
TOTAL GLAZING AMA
Z/S/, 5. fr
TOTAL HEATED AWA
vzz for,
GLAZING TO ROM AMA RAT10
%
EUECTRIIC SERVICE BY
WATER SERVICE BY
SANITARY SEWER DISTRICT
TELEPHONE SERVICE BY
I rp 1xv
BUILDING HEIGHT CALCULATION
CORNER A EL 1,0/ �0
CORNER 8 EL /07,�—Q
CORNER C EL /OZ�—o
CORNER D EL- t-c7,*
TOTAL 3CO 6'0' 14 EL, /0"
ALLOWABLE BLSJXW HEKIlff + w
MAXIMIJM ALLOWABLE HIE11011111T. 16/"'rl"
PROPOSED MAXNAN BIJILDIW ELEVXrXft
1 '67 11
1
.4a An
IMPERVIOUS AREA CALCULATION
FIR EXISTING
BUILDINGS SIP BUILDINGS "PIP SF
DECKS SF DECKS SF
PATIOS SF PATIOS SF
WALKS SIF WALKS 106 SF
DRIVEWAY 10LO SF DRIVEWAY IF2.8 SF
lgqo SF
704IJ SIF
TOTAL
IMPERVIOLIS W(as
AREA
Ej INIFILTRATIGAI TRENCH RlEQIJllRED - LF
VfDETENTION PIPE REQtIIRED -'!F4 LF 4V /8 "Or
El NO ON-SITIE DRAINAGE DIETENTM SYSTEM REQUIRED
ZAV
(V
Exrsl. 4-FT.-F-&—cE
REMMOVE
EXIST. DRIVE
.
7-WAV-/ 11
ARM
A
FLOOR .
OVERHANG
4- -
L
ABOVE
'W-LIKE OF EXISTING
BE
PROPOSED',
�CONC
ir
IN
y
hc'i,
DUPLEX I
RESIDENCEI
BY'
, � -
AIMA
TWO-STORV STRUCJURE
COVERED PARKING
It
plr
TKINTLIKE FROM awy.
DOWNSPOUTS
ir
7\1
10
FLOOR
IT
#j*11
INA+AY
ADS
I
OVERHANG
ASOVE
y
4- ToAfTLNE TO
STORM WINER III STRUT
CATCH BASIN
mom
TO EXOT C@
EL. 1001-11. DATUM
TOP OF CZ. GRATE
13 ITJ EXISTING CONUM19
TM IL CBIG CAT04 BASN
0 EA. END
NOTE,
45 CY FOR CRAWLSFACE EWMATION N
SITE PLAN
SCAM, 1* - . 2-Q ' 0
RECEIVED
OCT 18 2000
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
DFVVg*W APRON!
ON" CONFORIN
TO CITY STANDARD
DIHIKIN MOUNIMMENT11.
CONTRACYOR SHALL VERIFY INDICATED
STE ELEVATKM (FOOTPRINT
tRECTANGLI CORNERS RMATIVE TO
-QomJm POKII PRIOR TO 9XCUAT)ON.
ANY DESCREPA"OES SHALL BE BROCIGHT
THE ATTENVONOF TWJASIGFO�AIJI'
ELEVATIONS I&IN NEED RE-CALCULATM
iDEPMOM ON THE AMAL GRAM SHOULD THIM
jlF ANY.DESCF"APF�-.
A
I
10,
CITY OF EDMONDS WATERLINE AS -BUILT
ADDRESS HOMEOWNER
221 - 4th Avenue South � xxxxxx
CONTRACTOR
xxxxxxxx
DATE DRAWN
6-23-2001 13Y K, Haney
SCALE
NTS
WATERLINE
NO, 20010989
117C. 18913
N 0 T I C E
TO PERMITTEE AND/OR OWNER
F-1 PARTIAL APPROVAL
VIOLATION
CORRECTIONS REQUIRED
Permit Number Owner
Job Address Ac�, I *Vlk (&e, , (&XtW
No PERMIT -STOP WORK -REMOVE CONSTRUCTION OR OBTAIN PERMIT AND MAKE WORK COMPLY
0 WITH ALL APPLICABLE CITY CODES.
F-1 CONSTRUCTION Is NOT IN ACCORDANCE WITH APPROVED PLANS AND PERMIT - STOP WORK.
MAKE WORK COMPLY WITH APPROVED PLANS AND PERMIT OR REMOVE.
F-1 STOP WORK - UNTIL AUTHORIZED To CONTINUE By CITY INSPECTOR.
fx ^
CORRECTIONS LISTED BELOW MUST BE MADE: BEFORE WORK CAN BE APPROVED AND/OR THE
NExT PHASE IS STARTED; To AV OID POSTING OF A STOP WORK ORDER, ORDER To
CORRECT, OR ABATEMENT PROCESS.
LjJOB CARD MUST BE POSTED ON SITE AND BE VISIBLE FROM STREET.
LjAPPROVED PLANS MUST BE AVAILABLE To INSPECTOR ON SITE.
F-1 WORK DESCRIBED BELOW HAS BEEN INSPECTED AND Is APPROVED.
L] CONTACT INSPECTOR AND ARRANGE FOR APPOINTMENT.
LJRECALL FOR INSPECTION.
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED WITHIN
4/ZYoLDAYS OR PENALTIES MAY BE APPLYED. FOR INSPECTIONS CALL 771-0220.
Building Division La Planning Department Engineering Department F—IFire Department
CITY OF ED ONDS
Inspector Date
STANDARD DRAINAGE DETENTION SYSTEM
WORKSHEET
OWNER BY: tTQ�'14
Z CALC
7
ADDRESS S2-/ f"e* 4v-e- TE: -1'2-5'- 77 F0*-Z-
PHON
,V,01 4.
DATE:
*****DESIGN DATA*****
IMPERVIOUS AREA PIPE DIA PIPE LG ORIFICE
DE-TENTION PIPE LENGTH v. LOCKING LID
(TY ICAL)
FINISHED G
MINIMUM
TIGHTLI E 6 NR& RDAMI
kE AT U PR Cf13P OF
.5X TO IV SLOPE CONC BOX OR RISER
Q OUTLET
UTLET CONTROL
IIN.
UPPER CATCH BASIN .ORIFICE
CONTROL CATCH BASIN
RECEIVED
SYSTEM CROSS SECTION
OCT. 1 8 2000
2'XZ'X6, DEEP, 4-6' SPALLS OR EQUAL DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
FROM CONTROL CB 2'X 2'X 3- DEEP, 3/4' CRUSHED ROCK IST!NG GRADE
H
7ROCK
JTLE 14ASHED
FROM CONTROL OUTLET WAS
ZENC
Bj MIN 10' LdNG.
PIPE To LEVEL
;,,,,<PERF
P
PERF PIPE W/ END CAPS
TRENCH SMALL BE LINED WITH MIRAFI
,RIPRAP OUTLET PRIOR TO PLACEMEN OF WASHED DRAIN ROCK
RUNOFF SPREADER. TRENCH
FOOTING DRMNS SHALL NOT BE CONNECTED TO DETENTION SYSTEM
NOTES.-
1. Call Engineering Division (771-0220) for a tightline and detention system inspection
APPROVED BY
before backfilling and for final inspections.
2, Responsibility for operation and maintenance of drainage systems on private property is the
responsibility of the property owner. Material accumulated in the storage pipe must be flushed
DATE
out and removed from the catch basins to allow proper operation. The outlet control orifice
must be kept open at all times.
I
Table 1 - Detention Pipe Sizes
,[mpe�rrpeable
Required
AreaSq.-rt.'
Vol Cu Ft
2000
50
2500
62
3000
75
3500
87
C 4000
100
4500 - — — — —
— — — 7, =
5oo6
1'25
Note: Allowable Pipe Materials:
Impermeable
Area Sq. Ft.
2000.
2500
3000
4500
5000
Pjp-d\Diame,ter,
1511 1811 24 11
3011
40 28' 16
11'0
50 35 20
13
60 42 24
15 Required pipe
70 AQ 28
18 length in feet
80 56 32
21
90 -36
23
100 ''70* 40
25
Reinforced Concrete
Aluminized Steel
Aluminum
CMP Asphalt Coated
N - 12 ADS (Not permitted on roads)
Table 2 - Outlet Orifice Sizes
Outlet Orifice Diameter (inches)
5/8
5/8
3/4
7/8
7/8
Table 3 - Rectangular Catch Basin Requirements
Detention Max. size Catch Basin
pipe diameter knockout Type
< 1811 2011 T ype 1, CB 15
18H to 24" 2611 Type I L, 55B �1�
24" to 36" 3611 -----,.:v-p
y e 11, L;b 19 19 (48' Basin)
36" to 42" 4211 Type 11, CB 19 19 (54"Basin)
*Source: Assoc, Sand & Gravel Co. Standards
Revised 3/16/95
101
City- of Edmonds, Permit No:
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date:
A. Address or Vicinity of Construction: 4v=� A-vr,-
B. Type of Work (be specific):
0wo *AL Ak VAL
C. Contractor: onr_e tk Contact:
44-
Mailing Address:9 zo Lt YUCIAA'� W 11ahone: -7 _74— T)
State License cr
A Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. Commercial Subdivision City Project E] EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
Multi -Family Single Family Other
INSPECTOR-
F. PAVEMENT: YES n NO G. SIZE OF CUT x H. Charge: $
CONCRETE CUT: YES NO
APPLICANT TO READ AND SIGN
IDEMNITY. .4pplicant understands by his/her signature to this application helshe holds the City of Edmonds harmlessfrom inj . url . es,
damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and
attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERJALS 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 BYCITYFORCES, AT WHICH TIMEA DEBITOR CREDIT WILL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT,
* Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must , be trained as required.'by (WAC) 296-155-305 and.must have certification verifying completion of the
required training in their possession.
+ Restoration is to be in: accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the endof the workday — NO EXCEPTIONS.
* Three sets of construction drawings of proposed work are required with the permit application.
IHAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THATIMUSTMAKE THEP17VKCOPYOF THE PERMIT AVAILABLE ONSITEATALL TIMES FOR INSPECTIONS
Signature:
(Contractor ol Agent)
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
Approved by: A,6,- Right-of-way Fee:'-70 ��_w cl'w C'
Time Authorized: Void A—fte- Disruption Fee/Fund 111:
S lal Conditions: Restoratiqp Fee:
P��'P 102�h'T1JtJ_, Total Fee-._!Jf�-
Receipt No: I C,, -7 L4
-7-
^4� ILL :�-4QM'a7 Issued by:
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMITTED WORK.
- I SPECTOR'S SIGNATURE ATE: M112-101
N D
',For'hnspection requirements see Engineering Information Handout.
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
DATE RECEIVED
WI I PERMIT EXPIRES I Z_ I L01
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
d1aw'Oes 1111k#e_
MAILING ADDRESS
NIV /c�*-'
CITY ZIP TELEPHONE ;Ld&
IS1 q2
Sm ard-i 32—
NAME
da-,4
TDDRESS
I'(10
CITY ZIP TELEPHONE
50"n,,� '1,60 -x4 -7 -7
USE PERMIT Wouum
ZONE PM-1,T NUMBER
JOB 114 V� K Q SUITE/APT#
ADDRESS 1-7 1
PLAT NAME/8UBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC R16HT OF WAY PER OFFICIAL ST, EET MAP
TESCP Approved 13
RW R:jukod —
&0
R"d
S,.=: P 13
EXISTING PROPfD
Inspection Required
Sidewalk Req Ired
u
REQUIRED DEDICATION-4 FT
Undergrourd
wiring required
METER SIZE
LINE SIZ
OF FIXTURES
PRV REQUIRED
YES 13 NO C3
3
REMARKS
z
OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
0
4*
AME
70
&AZ q �7-
Sjf-�,1CAr_f
ENGINEERING
REVIEWED/DATE
X6 rel&o
ADDRESS
7� 72- 2E�Md".f
(11-/70
FIRE REVIEWED BY
DATE
uj
cc
CITY ZIP "
7_10)"OK)Oj t)� �rd 24
I TELV?
ill P!140
STATE LICENSE NUMBER/ EXPIRATION D AT. E,
'16 776t(- 0 Z, *7 K-4-
CHECKED BY
VARIANCE OR CU
SHORELINE'OR ADB#,,'
INSPECTION
RE 0
0 YES VNO
BOND
POSTED
z
.:SE,0A WEVIEW
Y�Ltlt] EX I EMPT
EXP�%,-
AREA
A.LLOWED PROPOSED
116GHT
ALLOWED PROPOSED
)RQWRTY TAX ACCO PARCEL NO
)7:2
00
2/�W
N 2r'*`RESIDE.1NT1 . AL 2'**'PLUMBINr. MECH
OMMER .1 Cl . o COMPLI ANCE OR.
0 ADDITION 0 C 4L.
CHANGE Of1USE
0 REMODEL 0 APARTMENT 0 SIGN
o FENCE
0 REPAIR CYDS
x
0?'*'DEMOLISH 0 0 OTHER
EARAGE 0 WALL
11r2ARPORT 0 RENEWAL
LOT COVERAGE
ALLOWED I : ..
RQPOSED
+0 4t,5Z
REQUIREDSETBACKS (FT.)
FRONT SIDE REAR
iti,
PROPOSED SETBACKS (FT.)
FRONT UR S IDE REAR
4;
j1de,146
PARKI
REO'D j:F
'PLA N E EWE B DATE
N� �G
LOf�PIEA " R
MARKS-
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:,
NUMBER
NUMBER OF
CRTCAq/VfT14
OF
DWELLING
AREAS(RWA/)-
STORIES
UNITS
DESCRIBE WORK TO BE DONE
CN
0- B
e`,3,4.s-A,L.,4 Z S)V.,Z - I (A qA
J-P A &Y—Cl.:
OZ *O-�W-, - 04*-_r
Soo- //C!X (.5
f �Lfo
IDOCE� DECLen, (
HEAT SOURCE GLAZING % ) LOT SLOPE %
A 6cA a- /a/0
PLAN CHEC5"- VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2
M DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
w PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT, I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
1A
IN INTEREST. AGREES TO INDEMNIFY� DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0
i DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
x
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
:�N
SIG, AATIOWNIE�R WORT
DATE SIGN
( y,
.Y21
�/a 71 AeW
A17ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
5/98
CHECKEDBY 'ITYPEOFC
17TO
N'
CODE
OCCUPANT
GROUP Pe,
SPECIAL INSPECTOR
REQUIRE60 YES
AREA
ftir,
179W
'ucm)
REMARKS
PROGRESSI , ISISPECTIONS PER,.'
UBC IMFINAL INSPECTION REQ'D
0
3
be"
__A�,em j7-
AW8
VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
Pf)
MECHANICAL
GRADING/FILL
STATE SURCHARGE
VREVIEW FEES
ENG. INSPECTION FEE
.E.E
9_1
F
PLAN CHECK DEPOSIT
RECIYT, z --:!z
"ODA
TOTAL AMOUNT DUE
I"
� 1.6 _hl 2—
rc-lz 1 91H. S-0 I
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APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
FOR INSPECTION receipt is acknowledged in space provided.
(425)
0 ICIALS SIGNATUR AT�
kol
."141C
771-0220
. a
9
RELEASED BY DATE
EXT1333
771-0221
ORIGINAL - FILE - YELLOW INSPECTOd
FAX
PINK - OWNER - GOLD - ASSESSOR
lie
OF EDMONDS
CITY
SINGLE FAMILY/DUPLEX COVER SHEET
Dirac on$: Applicants are to complete the Information In the WHITE BOXES ONLY (Shaded boxes as for CRY
use nly). This cover Ghost Must accompany each building permit application for a now single-family
rasidence.
PROJECT ' 'ADDRESS e4Z e51L t -4
PROPERTY TAX ACCOUNT PARCEL 0,
DESCRIPTION OF WORK &4W
OWNER_
CONTACT
E-MAIL
PHONE
PHONE i�� 619 Z- 12'73
FAX �x5- 0 2- 2-? 3 * -*,
MAILING ADDRESS
5FAX CORRECTIONS MAIL CORRECTIONS E-MAIL CORRECTIONS
By SIGNING THIS STATEMENT I UNDERSTAND THAT I AM THE CONTACT PERSON FOR THIS PROJECT. IT 15 MY
RESPONSIBILITY TO COORDINATE ALL SUBMITTALS W17H THE CITY AND ONLY I CAN MAKE INQUIRIES ON THE
STATUS OF THE APPLICATIOIL I UNDERSTAND IT 15 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 APPLICA70AND NO DISC�RETN Y APP OVALS ARE REQUIRED'
1 6 4 1,ta::�
SIGNATURE&j:'�' DATE
ZONING INFORMATION
ZONE Em t 16 LOT AREA
NUMBER. OF DWELLING UNITS: EXISTING__L_ DEMOLISHED PROPOSED 2-
S CA 00 -1 ID rO Distermination WALVEP,,
DISCRETIONARY APPROVAL
SUBDIVISION rJA CU PJA VARIANCE_..,_ SHORELINE A44
SEPA__&�= ExpIr*S_ OTHER
City Use Only
LOT COVERAGE INFORMATION 'OcL
EXISTING'SF . -flo(a.. PROPOSED SF
_Z��ZVMAL SIC
HEIGHT CALCULATION INFORMATION
DATUM -,A 0 C. kki-
AC U
AVE MAX- 1242 44 T AL'
SETBACK INFORMATION
REQUIRED FRONT /5 SIDE /0 Slut. REAR
4-
eaaEaMFRONT SIDE /0.4 SIDE- - /0'& REAR
CN;t,-LOi0*Y:Ei[3 0 FLAQ,-LOT[]!9'�fRAb. ST:.DF0IG,[]yiq]i6
IENT REOUIR . ED n510,40"... RE'6006ING
.STAFF COMMENTS:
ENGINEERING INFORMATION
DRIVEWAY SLOPE % GRADING CYDS 130 t- yds
EASEMENTS' A1114
EXISTING IMPERVIOUS AREA CONSTRUCTED BEFORE 1977 re) At &ggeff,�,_SO.FT
EXISTING'IM PERVIOUS AREA INSTALLED 1977 OR LATER SO.F .
PROPOSED NEW NET IMPERVIOUS SURFACE -3 & 0 z
CHX'Use Only
SIDEWALK REQUIRED OYES []NO DRAINAGE PLAN REQUIRED ES []NO
/UY
UNDERGROUND WIRING RED. UIRED MYES []NO
STREET DEDICATION T. LID#
STAFF COMMENTS:
SPECIAL INSPECTIONS REQUIRED FOR THIS PROJ ECT (City Use Only)
START OF WORK
EXCAVATION A GRADING
SHORING INSTALLATION A MONITORING
PROOF ROLLING
OPLACEMEN ' t OF FILL . A CO . MPACT16N
SUBSURFACE DRAINA GE.
VERIFY SOIL BEARING
PILe. PLACEMENT
EROSION CONTROL
DGENERAL SITE MONITORING BY THE
GEOTECHNICAL ENGINEER OF RECORD
GENERAL SITE MONITORING BY THE
GEOTECHNICAL ENGINEER OF. RECORD
'DURING WET WEATHER CONSTRUCTION
FINAL GRADING 4 FIELD REPORT
0OTHER
PLACEMENT OF REINFORCEMENT
PLACEMENT OF CONCRETE
13 BOLTS INSTALLED IN CONCRETE
[IS TRUCTURAL MASONRY
13STRU*CTURAL STEEL ERECTION
HIGH STRENGTH BOLTING
0 WELDING (WASO CERTIFIED -ONLY)
E]OTHER
PJAX CHECK #
DATZ RZCZEVZD
BUILDING CONSTRUCTION INFORMATION
CODE EDITIONS 1997 us C. UMC. UPC. WSEC. VlAa WITH AMENDMENTS
DE61ON CRITERIA WIND EXPOSURE B WIND SPEED 80 MPH SEISMIC ZONE 3
Floor Live Load Root Snow/Live Load .2 Balcony Live Losd_J4
Floor Dead Load, 17 Root Dead Los Balcony Dead Losd_La
AIR
NUMBER OF STORIES BASEMENTS FLOOD ZONE
ES
LOT SLOPE SOILS REPORT PROVIDS, 0 V GINO
FLOOR AREA (MEASURED TO EXTERIOR FACE OF EXT,�01�Fl WALL)
r
E Isting . ..4
Living Sps�ce
Garage
Carport
Oeck/Coy#rod MfIl Z Inn
Other2*iaaLl— 1 -7
ENERGY CODE COMPLIANCE INFORMATION
FlIF1 TYPE 10 GAS. OIL 11 ELECTRIC 0 OTHER
WFORCEDAIR [:)HEATPUMP []HYDRONIC []OTHER
ENERGY CODE 110 JANCE
M PRESCRIPTIVE: List Option 02z— FOR CITY USE ONLY
0 TARGET UA APPROACH: Provide UA Calcustions Coiling Insulation, 12—
SYSTEMS ANALYSIS: Provide . Computer Analysis Wall Insulation-
1-3 Floor Insulation o—
n: 0�— 1 -1
Door U-Value . . tic)
window UVslus . ti 5
ENERGYIVENTILATION WORKSHEETS PROVIDED Skylight U-VOIUOIIE I
WINDOW SCHEDULE PROVIDED Glazing
VENTILATION CODE COMPLIANCE INFORMATION
KITCHEN FAN CFIS IM . BATHROOM FAN(S) CFM 5b LAUNDRY FAN CFM
WHOLE HOUSE VFNTILATIQN SVSTfdi
EXHAUST OPTION
FRESH AIR TO BE PROVIDED To WINDOW VENTS [3WALL PORTS
EACH HABITABLE ROOM WITH:
E I 9SWUST FAN TO -BE CCUT-FICLLED-WITH-241 -HOUR- TIMER Jk No SIZE 0- AS FOI- LOWS?
r% I - 2 BEDROOMS: So - 75- CFM 0 4 BEDROOMS: 100 - 150 CFM
64pa
0 3 SEDR061AS: 60 - 120 CFM 0 5 BEDROOMS: 120-160 CFM
HVAC INTEGRATED OPTION
0 DEDICATED HEAT RECOVERY VENTILATION OPTION
SEPARATE PERMITS (City U0* Only)
RIGHT OF WAY CONSTRUCTION PERMIT
ENCROACHMENT PERMIT
STATE ELECTRICAL PERMIT
FENCE PERMIT
0 RESIDENTIAL FIRE SPRINKLER PERMIT
OOTHEIR ,
01MECHAMICAL PERMIT
OPLUMBING PERMIT
13 WATER METER
W SIDE SEWER PERMIT
0 IRRIGATION (SPRINKLER SYSTEM)
OOTHER
Any request lot modification. variance or other administrative deviation (herinalter vallance")
must be Specifically Called out and Identified. Approval Of Any Plat Of PI811 Containing Provisions
which do not comply with the city code and for which a Variance has not been specifically
identified. requested and considered by the appropriate City official In accordance with the
pploplisto provision of city Code Of state low does not approve any items not to Code
:Pacification.
PERMIT ISSUANCE: AP OV
PLANNING REVIEW & APPROVAL
CONDITIONS OF APPROVAL:
USe 0 n1y)
DATZ
9110111129RING R.EVIBW a APPROVAL DATF.ZX
CONDITIONS OF APPROVAL:
00
BUILDING REVIEW & APPROVAA'�-,�fv_��,
CONDITIONS OF APPROVAL:
DATS
of
K
CITY OF EDMONDS
SINGLE FAMILY/DUPLEX COVER SHEET
W
141: 1 sq�
Dirac ions: Applicants are to complete the Information In the WHITE BOXES ONLY (Shaded bases are fw City
use nly). This cover sheaf musl accompany each building permit application for a new single-family
.-.IA.—.
PROJECTADDRESS 41641 -FV d!!2= ----7
PROPERTY TAX ACCOUNT PARCEL I
DESCRIPTION OF WORK hmow: L6"Agg��e
OWNER -)A'm
CONTACT PERSO
E-MAII
MAILING ADDRESS
PHONE
PHONE.Ii�� & 9 Z- - 1-273
FAX (,7 2- / 7-? 3* -f
0"FAX CORRECTIONS 11 MAIL CORRECTIONS . E-MAIL CORRECTIONS
BY SIGNING THIS STATEMENT I UNDERSTAND THAT I AN THE CONTACT PERSON FOR THIS PROJECT. IT IS MY
RESPONSIBILITY To COORDINATE ALL SUBMITTALS W17H THE CITY AND ONLY I CAN MAKE INQUIRIES ON THE
STATUS OF THE APPLICATION. I UNDERSTAND IT 15 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 APPLICATOAND NO 0 OVALS ARE REQUIRED-
DATE_Z6
SIGNATURE,::�.,�
ZONING INFORMATION
ZONE____ LOT AREA
NUMBER. OF DWELLING VNITS. EXISTING__L_ DEMOLISHED I PROPOSED-7-
: - 11Dr
DISCRETIONARY APPROVALS CA DeteratinationWAIVEX,
SUBDIVISION J4 CU P%14 VARIANCE—,_ SHORELINE A44
SEPA_.&Zd= EXp1roS_ OTHER
City Use Onix
LOT COVERAGE INFORMATION
EXISTING SF . 1/0(01 PROPOSED SF_t?j?n OTAL SF 2.31*
HEIGHT CALCULATION INFORMATION
A 0 C.:
DATUM 17 106 �-Sp` " -
ACTUAL%
AVE - IQ% 16' 1249� A�
SFTBACK INFORMATION
BEQUIM FRONT /f SIDE /0 sidt. dv� REAR 45"
e&QEQ1= F R 0 N T SIDE lo.4 SIDE-.'- /01& REA1;i 27
- --------------
Y 0
CNR�'LOi[j:Ei[R ELA 9T:DFDIC.
a ?0 4906-- x'' 0 Y
nu STATEMPST REQUIRED '[]'YES04O" RE*661RIJING 11'
.STAFF COMMENTS:
ENGINEERING INFORMATION'
DRIVEWAY SLOPE %
EASEMENTS' A��
EXISTING IMPERVIOUS AREA CONSTRUCTED 13EFORE 1977 At AgwmsdP SQ.FT
E XISTING'IM PERVIOUS AREA INSTALLED 1977 OR LATER Q.FT.
PROPOSED NEW NET IMPERVIOUS SURFACE
0/0— GRADING CYDS 130"
rltx,usa Only
SIDEWALK REQUIRED E)YES []NO DRAINAGE PLAN REQUIRED Y
/E] ES ONO
UNDERGROUND WIRING REQUIRED MYES O'NO
STREET DEDICATION 00 FT. LIDO
STAFF COMMENTS:
SPECIAL INSPECTIONS REQUIRED FOR. THIS PROJECT (City Use Only)
SOILSO
START OF WORK
OEXCAVATION A GRADING
OSHORING INSTALLATION AMONITORING
PROOF ROLLING
OPLACEMEN I i OF FILL a CO . MPAPTION
0 SUBSURFACE DRAINAGE.
VERIFY SOIL BEARING
0 PILe. PLACEMENT
OEROSION CONTROL
[GENERAL SITE MONITORING BY THE
3GEOTECHNiCAL ENGINEER OF RECORD
EIGENERAL SITE M ONiTORING BY TH E
GEOTECHNICAL ENGINEER OF. RECORD
'DURING WET WEATHER CONSTRUCTION
FINAL GRAqING 0 FIELD REPORT
0 OTHER -
OPLACEMENT OF REINFORCEMENT
PLACEMENT OF CONCRETE
BOLTS INSTALLED IN CONCRETE
OS TRUCTURAL MASONRY
13 4TR.UCTURAL . &TEEL ERECTION
HIGH STRENGTH BOLTING
WELDING (WASO CERTIFIED' ONLY)
OOTHER
PLAN CffzCz #
APPLICANT-N- JDATS ILZCZIVZD
BUILDING CONSTRUCTION INFORMATION
CODE EDITIONS 1991 US C. UMC, UPC. WSEC. VIAG WITH AMENDMENTS
DESIGN CRITERIA WIND EXPOSURE 9 WIND SPEED 80 MPH SEISMIC ZONE 3
Floor Live LOIA Root Snow/Live Load .2 Balcony Live Lood-L4
Floor Dead Lai Root Dead Load 14 Balcony Dead Loadjjj
NUMBER OF STORIES BASEMENTS FLOOD ZONE NO
lbo Es
LOT SLOPE %_ _ �? SOILS REPORT PROVID& [3Y . (@'
FLOOR AREA (MEASURED TO EXTERIOR FACE OF EXTE"'I R WALL)
E Isfing !110 4
act q
Living SPII90
Garage
Carport
ackicovered Porfb
72,M
ENERGY CODE COMPLIANCE INFORMATION
FIIS:L TYPE 10 GAS. OIL ELECTRIC [:] OTHER
rMFORCED AIR HEAT PUMP C]HYDRONIC [:]OTHER
I"
ENERGY CODE METHOD OF COM
PRESCRIPTIVE: List option #—,7z;- FOR CITY USE ONLY
TARGET UA APPROACH: Provide UA Calcustions calling logo! . AtIon
SYSTEMS ANALYSIS: Provide Computer Analysis wall insulation— 941
Floor Insulation 0
Door U-Vsluo , .
window 11-Value
ENERGY1VENTILATION WORKSHEETS PROVIDED Skylight 11-Value, Im
WINDOW SCHEDULE PROVIDED 1 J
VENTILATION CODE COMPLIANCE INFORMATION
KITCHEN FAN CFM IM . BATHROOM FAN(S) CFM 5Z LAUNDRY FAN CFM
WHOLF HOURF VFNJILATIOM SYSTEM
0 EXHAUST OPTION
FRESH AIR TO BE PROVIDED TO WINDOW VENTS 13 WALL PORTS
EACH HABITABLE ROOM WITH:
IE I )jjfA'U5T FAN'TO-DE =47TICLLED-WITH 24 HOUR TIMER.&ND 917EP AS FOI. LOWS! -
IM I - 2 BEDROOMS: So - 76- CFM 4 BEDROOMS: 100 - 150 CF1M
LP
0 3 BEDR06MS: 80 - 120 CFM 5 BEDROOMS: 120-160 CFM
NVAC INTEGRATED OPTION
Of DICATED HEAT RECOVERY VENTILATI ON 0 PTION
SEPARATE PERMITS (City USO Only)
RIGHT OF WAY CONSTRUCTION PERMIT 0 MECHANICAL PERMIT
0 ENCROACHMENT PERMIT OPLUMBING PERMIT
JjOSTATE ELECTRICAL PERMIT WATER METER
11 FENCE PERMIT SIDE SEWER PERMIT
0 RESIDENTIAL FIRE SPRINKLER PERMIT 0 IRRIGATION (SPRINKLER SYSTEM)
OOTHER-' — 00THER
Any request for modification. variance or other administrative deviation (herinalter *vadantsl
mug, be specifically called out and Identified. Approval at any Plat Of Plan Containing Provisions
which do not Comply with the city code and for which a variance has not been specilicallY
Identified, requested and considered by he appropriate city official In accordance with the
pplopristo Provision of city code or state low does no, approve any II@mj not to code
:Pecillcollon.
PERMIT ISSUANCE AP OV Use Only)
PLANNING R9VI9W III APPROVAL DATZ
CONDITIONS OF APPROVAL:
fill . GIN99RING R5VI9`W III APPROVAL DATff0z10i/%0
CONDITIONS OF APPROVAL:
BUILDING R9VI9W & APPROVAl5Q�-.0?:>P-'Ak-JA2D40j DATS 14J4,
CONDITIONS OF APPROVAL:
if