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22625 105TH AVE W.PDF1111111111 313 22625 105TH AVE W CA FILE NO. Critical Areas. Checklist -------------------------------------------------------------- Site Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: 2. Property Tax Account Number: 00D - OZ 7- — 0006 3. Approximate Site Size (acres or square feet): /0 V71 0" 4. Is this site currently developed? �/_yes; _ no. If yes; how is site developed? 5. Describe the general site topography. Check all that apply. Flat: less than 5-feet elevation change over entire site. K"­ 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 3 ) 0% ( a vertical rise of I 0-feet over a horizontal distance of 3' ) 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: 9 r/ ; Approx. Depth: 7. Site contains areas of seasonal standing water: t�,l 0 Approx. Depth: What season(s) of the year? N A 8. Site is in the floodway t,1 0 floodplain �Ao of a water course. 9. Site contains a creek or an area where water flows across the grQuiuLs- surface? Flows are year- round? r1t 0 Flows are seasonal? t4 o (WITat-ti-me of year? No 10. Site is primarily: forested meadow shrubs mixed urban landscaped (lawn,shrubs etc) y 4-15 11. Obvious wetland is present on site: N D F -City -Staff Use Only or ------ ---------------- E -Site 'is Zdiiedl' r S ma p pe d so it typ�(Q?: V. CS, :3 Wedand inventory or C.A. map indicates wedand present on sitel A:):*-/ A., Critical Areas inVentory or C.A. niap indicates Critical Area o n* site? :5; Sitel�ithindesignated earth subsidence landslide hazard 9 T" ..,area.. A -TIT-1- Site- desig-iiaiedbin1he �nvironmenially Sensitive- Area's Ma**p'?. 'DETtRmiNAT.1w ;STUDY RE D WAIV�ER y Review.Mb,-. Planiiii .�chk:doc; Rm 10103/97 \_J C NDITIONAL WAIVER Ibate RECEIVED City of Edmonds MAR 0 1 1999 DEVELOPMENT SERVICES CRITICAL AREAS 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 infor m-ation (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). Owner/Applicant: Name Z '—'(a2-S I D i� T1^1 Aug_ �J Street Address t�-D VVI E) 1-4 r-> S � tj A 1?907-D city State Zip Ll 2-L 7 7(:v 14'1cl C-> Telephone Signature Date Applicant Representative: 9AOko / Pf4C-o=*1e_- 6-A/ZA&i0>- Name Z-7a-Lo izLJ4-A�-,5-Z A\J6— Street Address jl��a -r-- W pq q,8 City State Zip ItZ6 Telephone Signature Z Date c:recepdon\jana\cac1.doc (over) I � z PC. 1 S9 March 11, 1999 Larry Saltarelli 22625105 th Ave. West Edmonds, WA 98020 CITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 DEVELOPMENT SERVICES DEPARTMENT Planning - Building - Engineering Subject: Determination regarding Critical Areas Checklist # 99-44 BARBARA FAHEY MAYOR Dear Applicant: Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City is located on the reverse side of the form (bottom of page). It is very important f or you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records. ...................... ......... i, w., IMPORTAW. INFORMATION TO BE:NOTED- ............. ...... . ........... PLEASE EXAMINE THIS" DETERMINATION -"FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT ADDITIONAL INFORMATION SUCH AS AN ENVIROXMENTAL CHECKLIS OR CRITICAL AREAS STUDY, The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a project -specific determination. mo, You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED. Permit applications include.the following: Building Permits Conditional Use Permits Subdivisions Variances Applications to the ADB* Land Use Applications Any other development permit applications. Enc: Critical Areas Determination * Architectural Design Board Thank you. Sharla Graham Planning Secretary C:ReceptionQanakCRLTR.doc Incorporated August 11, 1890 Sister City - Hekinan, Japan N.W. #36 T271 R3 053 .............. fs Vr % T. 6,11 Z21006 04 ?260.7 IT" CU 10 22601 ;z 22610 T PL. ev 15*04 15,05, OU 23 M23 22624 d ZZ62.5 cv 08 16*06 1509 .22,631 =30 co 227010 Z2628 Ir /5708 )5,6 511 3 22704 22615 Z27'03 __4 ZZ 711 227/4 Z27(1 20712 Z2711 4�4 CEMETERY =7/9 ZZ720 1� I 1D 227250 227Zq 9 728 9vy 'o w W 722740 Zell 229" 2zsmu Ws .22,820 Z28W all 2ZO211 22030 W31 SmEltw000 2283 0 13 12W TO ELEM. SCH. 22830 P140TO :Q 229 2zqoI 90 41 2911 Z2915 9/2 S. W. ........ 915 229 22920 22930 qtj ? 00 2 2N , . -4 a , 20, 2300 2 23WO 23006 Po 1 F 23019 IT. ZIO04 2W.3 274m J 25 2300(p 3 �( �_ 2yoo.'r, 7026 029 IL 27026 23008 23)02 23103 1231*5 1- 2.3104 )049 Is 07 x ST; I 23joe 23 23113 2 31 m 0 its 231 10 co 23)22 tv In Z P, 2-3121 2 010' woopwRy 23208' in Iny 0, H-S- 0 qr tn rrhTE ZU00 r HOOD DRIVE M6 PARKINC- CHVRCN ?,53oz TL-Nwo coven 233/0 z 3301 Xy LOW Z3303 �o 33 1 30 r-00 T aA" GATG 13015 Z 1 23 Z33zo V - 23313 44 ; f 2 FF RIAR 330.f 1. 23130 3319 23321 c-i 23312 a 23313 3329 V Z3406 OFFKN LU 23329 3328 23 ae ?3403 23419 2X405 4 Z34 It to )Fomws"Am My 2 3 Z 414 Aq 35705 34 Z, ROBBERS ROOST N %A 23520 a T5,30 107. 'Ai Mil 256T" PI.. &V EVI�NC 34 #1* bly -21 IM 14 Comm 3� Z z 0 ""-'W Z,^� 76.6 COLLEGE.. 12359 _rj _fj �tll C. is 9\3 March 11, 1999 Larry Saltarelli 22625105 th Ave. West Edmonds, WA 98020 CITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 DEVELOPMENT SERVICES DEPARTMENT Planning - Building - Engineering N: Subject: Determination regarding Critical Areas Checklist # 99-44 Dear Applicant: BARBARA FAHEY MAYOR Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City is located on the reverse side of the form (bottom of page). It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records. ............. .. .. . IMPORTANT INFORMATION TO BE NOTED: PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT ADDITIONAL INFORMATION SUCH AS AN ENVIRONM#NTAL'CHECKLIS 'OR CRITICAL AREAS STUDY, The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a project -specific determination. mio, You mustsubmit a copy of the CRITICAL AREAS CHECKLISTand DETERMINATION WITH ALL 40 PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED. Permit applications include the following: Building Permits Conditional Use Permits Subdivisions Variances Applications to the ADB* Land Use Applications Any other development permit applications. Thank you. M. ,SfiaHa* Graha Planning Secretary',' Eric: Critical Areas Determination * Architectural Design Board C:ReceptionUana\CRLTR.doc Incorporated August 11, 1890 Sister City - Hekinan, Japan 4 RECEIVED MAR 0 t 1999" City of Edmonds <z DEVEI-OPMENT SERVICES CRITICAL AREAS CHECKL IST 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 -nay 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 thb, checklist, sign and � date it4 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. I Please submit a* vicim'ty� map . along with the signed copy of this form to assist City staff in finding and, locating the specific piece- of property, described on thi& 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 Ctitical Areas Checkfist and attest that.the answers provided are factual, to. the best of my knowledge (fill out the appropriate column below). Owner/Applicant: Name _21-(c,2_S I c> S T"I A,)p IJ Street Address vv),:) --I b S .- I) A 2% 0 2-0 city State Zip Ll IG; 7 7(-, q 19 Telephone Signature Date Applicant Representative: - PAOtc) Name . Z-72-Lo iZLJ4,K4_7, A�)d_ Street Address — 11�4)a_ R -r- w �q q&2-01 city State Zip — qZ-6 Telephone Signature Z - *7_57,9c', Date c:reception\jana\cac1.doc (over), CA FILE NO. Critical Areas Checklist -------------------------------------------------------------- Site Information (soil s/topo graphy/hydrol ogy/v e getati on) I . Site Address/Location: zz. i T- A cJ 2. Property Tax Account Number: to V 14 - C.,00 - 0 -Z 2- - COc,(" 3. Approximate Site Size (acres or square feet): 4. Is this site currently developed? V'--yes; no. If es; how is site developed? - y 1Zt151'Qt947i41- A10,4AA__ 5. 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 I 0-feet over a horizontal distance of 66-feet). Hilly: slopes present on site of more than 15% and less -than 3 )0% ( a vertical rise of I 0-feet over a horizontal- distance of 3 31 to 66-feet), Steep: grades of greater than 3 0% 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: 90 Approx. Depth: 7. Site contains areas of seasonal standing water: /,to Approx. Depth: What season(s) of the year? N A 8. Site is in the floodway t4o floodplain P40 o f a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? P�Q Flows are seasonal? No (What time of year? No 10. Site is primarily: forested meadow ;shrubs mixed urban landscaped (lawn,shrubs etc) ;_s 11. Obvious wetland is present on site: NO DEIIRMIN�TION N. W. #36 T277 R3 053 "r I 6LO14 04 504 Zz6oq Z2610 15704 5'05 I Z2� Z2624 08 Ln 16106 t509 22631 Z2630 2270/0 ZZ628 /5*08 )51,5 511 227o3 22704 22615 3 §. 5Dmopos mem. IK in 711 V712 N Z ZZ 711 0 ZZ7/4 CEMVERY cr. c, No 227/9 Z2720 77m 22725 0 z 7Z4 cb Z=9 4 IZ27ZBI %4, !� a, — — 7M GAS E=3 X Aw 2 z a 04/-&4 1� .-P -P 007 2Z740 c Zell 228" 2zuj 821 22620 vyJ2z9z9 0 r-3 22830 22831 SHERWOOO 2293 2W.T01 L, ELEM. SCH. .2 Ph 27-Clof 290 %a 22910 229/2 2915 S. W. ;A� -7 2ZGZ8 22920 2 2 229z.5- qzj �.ATE 22930 1 3001' c"If 230!�� 23000 3 W > 23 2ioig ZIO04 Pol ZWI� 23-022 25 1 2 3! 27026 ��024 3027 3Dn -4 029 CL 3105 — 23008 z 23J02 '23)06 2310; IZ-3iS 1: 2.75 If 04 Z3700 a on 07 Sz. 23113 2-31A Z7115 231 117— %n cq a 2311(o 231to ZM4 Z312ro vs12f --z A P, — �z 0 :e a Z310, own 23121 in — 1 11 -- %--f] I 232m' 10 K wool)WAY S. tn a CraTE 2 23zoo 7=6 ROW HOOD DRIVE 100 L PARKINC- cmvRcji Trwwa 4Z, cove" M/0 330/ 23303 130-5 a 33 MOTBALL GA76 -t� .1 . .I 23320 V 23 23113 2 fR1 As? Y30S t 23330 33/9 23321 3 3 23312 a 23 1 izi 43 3329 x OFFICE Z3406 Uf 23329 r 23328. a rL 230- cm U403 23411 214" 0 23411 WONAM LA 2 XIT 1 4 Zm 14 ,C1 'r E�j 7A,1r 2' 2350-4 3 Ift 4 Z4 V, 23515 ROBBERS ROOST ASIMA&A. f U TO 4 35 35,30 �'l `71NI z o 5T, k" %U z > AX 6111236'0 X6 /1 2.3 56T" PL. S EVhNC%E 11,18 0 2361 ou Zli 1A Comm 9A. ;awl 'na 2 4 7 ,PLANNING DATA NAME:, 1311qq SITE ADDRESS:_22,�2!5 /00 Ap � 'ATE:-3 ZONING: —PLAN CHK#:qq_,s37 PROJECT DESCRIPTION: CORNERLO (Yes/No) SETBACKS: FLAG LOT & (� (YesINo) Required Setbacks: Front: Z,;" Left Side: Right Side: Rear:7 Actual Setbacks;.,' /17 ' 11 01 1 0 Front: AM LekS!de: '7' Right Side: ar: 7 6 Street map checked for additional setback required? (Yes/No) LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED —NO _(Y/N) LOT COVERAGE: Maximum Allowed:. �_O_Actual: BUILDING HEIGHT: Maximum Allowed: ctual Height: Datum Point: kw" teir taturn Elevationd(T) A.D.U. CREATE D?: N SUBDIVISION: CRITICAL AREAS #: 'Tq�_qq SEPA DETERMINATION: LOT OTHER: Plan Review By: rif '7 Citv of Edmonds It.7 c RIGHT-OF-WAY CONSTRUCTION PERMIT Permit N umber. Issue Date: 01 "q�e3 A. Address or Vicinity of Construction: Z�S' —/0 B. Type of Work (be specific): ED F7W OA-,�rAC��e' C. Contractor: 1A cw RAfA_a,9 Contact: �'t LZ� A< Phone: Mailing Address: 491 State License #: FAC., I (-(A 11 0 �ci I N Liability Insurance: Bond: $ D. Building Permit # (if applicable):M Side Sewer Permit # (if applicable): E. Commercial Subdivision El City Project 0 '��4ity (PUD, qTE, WN'G, CABLE, WATER) Multi -Family %Single Family Other INSPECTOR: —,c L"7� INSPECTOR: F. Pavement or Concrete Cut: [I Yes []No G. Size of Cut: x H. Chargq�_$ APPLICANT TO READ AND SIGN INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany kind or description whatsoever, foreseen or unforeseen, tha t may be made against the City of Edmonds, or any of its departments or employees, including or not limited to the defense of any legal proceedings including defense costs and attorneyfees by reason of granting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC- TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT Two sets of construction drawings 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 NPblic Safety shall be in accordance with City regulations as required by the City Engineer. wo All street cut trench wo shall be patched with asphalt or City approved material prior to the end of the working 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 times for inspection purposes. Signature: Date: (Contractor or Agent) CA,LL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY APPROVED BY: TIME AUTHORIZED: VOID AFTER DAYS SPECIAL CONDITIONS: PEY4— '4r&z'V'jFP PLO-r'J RIGHT OF WAY FEE: _-70 � DISRUPTION FEE/FU­ND I 11: RESTORATION FEE: T OTAL FEE: - RECEIPT NO.: ISSUED BY: FIELD INSPECTION NOTES I 'Comments: I Diagram (Fund 111 - Route copy to Street Dept.) CONTRACTOR CALLED FOR INSPECTION El YES NO Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: z NAME PACIFG1088JN JOB SITE/ADDRESS Aot; 2726 Rucker Ave. (425) 259-1311 Everett, WA 98201-3404 1-800-801-1311 TAX NO. 000 ozz_ oot�)C" Lr-rr za LEGAL DESC VOL Z-0 1B.L. OFF:-* I �RtX) ?()I C' LL 2 0 _q T N LOT 'PQ , .\,JT- '1_7� T I P ID P, , ') -1�1 P, p A-, 0 i I ?_ AL�,S APPR VED BY P ING z A LA -YL- Z�a2SJOAI I_S ko� 'Jr -�o'�i 4 �s 7! F_ A C; ya of tij ^ y L %A �;7 li_x � 5-ri ""� I Hou5iE__ L 5 _7 910 Lar Co %1fA0Wa_, D,k- I Z Leo 7 Lk zo 6-f.�zr" , � YF- -yet go 45 Pq.4L-r 7_0 Do r14 0.4 _a7 4 X D 11 1 V) i5: 1. ;-L 81. . 1: 1 j go- /to A -0 " Se_� L F__ / " _- 2_� I I I N6 I ' (A) 4 176 7 17.6 Z.(; -01 M A' X MEtb-�HT_ mAr Y_' A A L- A,,,WV�5v A-S A�_b RUBIO MAR 17 IS99 PERMITEXPIRES CITY OF EDMONDS USE PERMIT ZONE 3 90159. NUMBER CONSTRUCTION PERMIT APPLICATION JOB /APT# ADDRESS 05-0" A�t OWNER NAME/NAME OF BUSINESS I- q (I r Ly 5A t--rA a Ij: L 37 1 1 LEGAL DESCRIPTION CHECK SUBDIVISION NO- LID NO. MAILING ADDRESS 0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP so EXISTING REQUIRED DEDICATION TESCPAPPIO�ed YF5 RW Permit Required *5 Street Use Permit Req'dfVto CITY ZIP TELEPHONE '/L47 7 7 1/3q IS Inspection Required )fe�,S Ea� PROPOSED Sidewalk AequiredjV�p 0 NAME METER SIZE LINE SIZE NO. OF FIXTURES REQUIRED VPRV YES 0 NO 0 cc W t- ADDRESS REMARKS L) cr &1jD"6-C'W1VL) if/14146 )CEO'o S aEz>',:2 CITY ZI7_7LEPHONE 0 W Q_>/,4 "VA-c- 1692�6,ve ul. NAME ENGINEERING MEMO DATED PIEVIEWEVBY A cc ADDRESS 0 FIRE MEMO DATED REVIEWED BY LLI -7 -z- A)X- < U. I- CITY P z Z P T, TELEPH ONE 0 L) r 1� Ja R Lj Z'S Z 51 VARIANCV OR CU API)# ANA SH?IIELINE 11 STATE L CE UMBER PIRATION DATE NSE N' EX It ECKED E1_?\ SEPA 4EVIEW SIGN'ARIEA HEIGHT COMPLETE 0-11" EXP 117 ALLOWE PROPOSED JV4 ALLOWED I., PROPOSED 1 z LEGAL DESCRIPTION OF PROPERTY - INCLUDE ALL EASEMENTS 0 P: a: LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSEV 2crIo FRONT SIDE REAR / 7.5 /57, 2,5 FRONT UPSIDE REAR z 0 ERTYTAX ACCO TPARCEL W PC; 'bzz (OT AREA I C),-A C� C17n yt ING112VI pz, BY DATE _.jN1qq CK NEW PESIDENTIAL PLUMBING MECH REMARKS ADDITION COMMERCIAL Ej COMPLIANCE OR CHANGE OF USE REMODEL E] APARTMENT SIGN FENCE REPAIR GRADING CYDS X FT) . DEMOLISH OTHER . TANK CHECKEDBY ITY"-OFCONSTF3UCTION CODE: OCCUPANT GROUP GARAGE RETAINING WALL CARPORT R6CKERY RENEWAL SPECIAL INSPECT(7R REQUIRED:E:] YES JAREA I A OCCUPANT LOAD (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: 6-,4 (z REMARKS PROGRESS INSPECTIONS PER UBC,108 U NUMBER OF NUMBER OF CRITICAL LAdCV4V*(A" DWELLING n 2 STORIES AREAS UNITS NUMBER 'r A I- L HEAT SOURCE GLAZING % LOT SLOPE % A PLAN CHECK NO: '53 VESTED DATE THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC :1 DOMAIN (CURBS,SIDEWALKS, DRIVEWAYS, MAROUEES,ETC.) WILL REQUIRE ..SEPARATE PERMISSION. W PERMIT APPLICATION: 180 DAYS PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS U) U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND.SUCCESORS IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF a: EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND x ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY a FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE _j 0 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY TH E CITY'S ABI LITY TO ENFORCE ANY ORDINANCE PROVISION. - I HEREBY ACKNOWLEDGE THAT I HA�'E-READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECT, AD THAT I AM,,THE.,OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER� I AGREE TO COMPLY WIT14 CITY,AND S�ATE LAWSREGULATING CONSTRUC- TION; AND IN DOING THE WORK AUTI­16RII�b THEAEBY, Nb,P�RSON WILL BE EMPLOYED f D IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMGN'S COMPENSATION INSURANCE AND RCW 18.27. SIGNATURE (OWNER OR AGENT) DATE SIGNED 13 FINAL INSP PLAN CHECK FEE BUILDING PLUMBING MECHANICAL GRADING/FILL STATE SURCHARGE STORM DRAINAGE FEES ENG. INSPECTION FEE PLAN CHECK DEPOSIT TOTAL AMOUNT DUE CALL FOR INSPECTION (425) ' 771-0220 N�REQUIRED VALUATION FEE P 70#7,41 M W r. APPLICATION APPROVAL This application is not a permit until signed by the Building Official or his/her Deputy: and Fees are paid, and receipt is acknowledged in space provided. D,�TE Adm. 7/ 311 nq F .69 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 BY ORIGINAL -FILE Yffl_LOW� INSPECTOR PINK - OWNER GOLD - ASSESSOR