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APPROVED BY PLANNIING
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CA FILE NO.,
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Nkl�in`fo 0 Soi
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1. site
"'WDp6io Tax Account Number. L&IO-7-000-- 0 1 fo —010fo
3. A prg)Cunate Site Si
p me (aaes or square feet):
4. Is this site currently developed.? _*—Yes; — no_
If yes; h6w is site developed?_I:L2����e_-�.
5. Desc'be the general site topography. Check all that apply.
Flat:' less dm 5-feet elevation change over entire site.
9 oiling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
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).
.0 grades of.greater dm 30% present on site (a vertical rise of 10-feet over a
distance of less dun 33-teet).
er4lend desen
She contitins %reas� of 6d stud* water. E�pth:'�*
year-ood U19 Vona-
.90 . 1. .,toi 16b,,
7.* Sitt contain" bf i6iti6nal
a^4 Approx
e
42 p*
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W.-,.,Whatseas6n eao_ 1%'�*,-,,--:--tt -I r. *
., , . : - - - o"
_,Qs)of�the
0*�;,:*;Q;fl'
6odplain Alb: of a 'w" ier imurse.'
- #..rM*$d9M'
contalava aiRktrappea. vAtem water flows across die grounds surface? Flows are year -
am ("a time of year?. �411;,
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City of Edmon'ds,,-...... . JAN 18 1994
Critical Areas Checklist COMMUNITY SONIMS
The Critical Areas Checidist contained on and submit it to the City. Ile City will
this form is to be filled out by any person review the checidist, make a precursory site
preparing a Development Permit visit, and make a determination of the
Application for the Cityof Edmonds prior subsequent steps- necessary to complete a
to his/her submittal of a development development permit application -
permit to the City.
With 'a signed 'Copy of this'formi. the.'-
'�POH 'A8uld �also, submit a Vicinity
7he purpose of the Checidist is to 6i�61W
City staff to determine whether any lanfor lots -of.
... .... ptotp indivi ual the parcel
er�may.bq.--- 'th.enough detail that City staff can find.'',
potential Critic�l --W1
present on the ;ubject,p!pperty. .7ne . 1�je
parcel
ect
to cioiimpli��thd
information- n�
-7
u
W-libidly avai M W&�don siti, P,,.
cg.
413
observatiorii'of the site or data avail�bi�:!Vb D 0�
'49pogrio iy1na
City �Hall,(Cfifical Arms. 1"ies j1h Ch
or Sod
Su
s)- 7
P
A'
MUM
fak gaMMOS
Name
,n
Street -Addrem,
Cify�_ State"
_ZIP'
N
-jaty. Sta,te .
N\
Signature
Datel' Si
AA -44 2-
1- V.
V
4,
;,�;4 �t4 %Y
A FIL
.1 r Checkii
as'. st,
Site Iddr on- sk I th hy/hydrbloff/vegetafi6n)
PoVap,
A-
A dre's's'/Lkm
1. Site' d
�-,2. Proktj Tax Account Number: 10 -7 —.0 0 e?- — 0 1 0 NO
-,3,. Appr9iiinate Site S' (acres or square feet):
ize
4. Is this site currently developed? _J�:_yes; no.
If �es; how is site developed?_ LA—) 00-6, Ift, Oa,!&i
5. Descipibe the general site topography. Check all that apply.
Flat:* less than 5-feet elevation change over entire site.
golling: 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:-4.
, grpilesg.greater than 30% present on site (a vertical rise of 10-feet over a
horizoi�`Jmtance of less than 33-feet).
-n
J,� fr ne -t r
.; 7�-,O t e. ry 1 I.J
el k
T-7 %
6. Ske contains Wei3W--YeW-idfihd'stafidhig water. Alo*^4— Depth.-`
Site Wse�soiWsbridi -water
7.'
_qg
C? m
Wolf
.4,What sea�dn(o) o �die YW.
7
M,7-, 7 �7,
9. d6ritifins A,iibiWbpanp. where "er flows across the grounds surface? - Flows are year-
7.,- ows am seasorta . -
19 VO
V a AU
2.;' —,r;l
is qm�aW,4k
shruUs .,*44* iv
:Siials
`.-Iscs-imapped =a-type(sp
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lig4cates *tdand pFes6m! an
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Q4 or-C-A-*xna ite?
.1 p-indi Critical Area,,on-s .7
kid.
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too AreasMaO-
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RECEIVED
City of Edmon'&,._____
Critical Areas, Checklist
JAN 18 -1994
COMMUNITY SERVICES
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
prepanng a Development Permit visit, and make a determination of the
Application for the Cityof Edmonds prior -subsequent-steps-necessarl -to complete a
to his/her submittal of adevclopment- deveJopment Ij),el-111fit appiic�tion.--_
jW,L111 L LW die City.
t.
IMe purpose of the Checklist is to
City staff to determine whether
potentiil"Z26 Azeasareor�j ayj;�47...
prese��,qn thq sg4ject,plqperty. 1 U-,
VIUlLi,.'� , Q!S�
infbnnafion-� W compleWthe-71,
Checklistshould',
I libi e-V611 47"
of thi�sit�Or4�jftavailabk
rve
orsoilsu e.;
City, Staie;zl
Sit
JI
W�ith-Wsign -cppy Of
.�Oli �Abffld Wso submiti vicinity
or zplanf6tsiWdi—vfd-u—al.jdt�-�of�th�
PLANNING DATA
SITE ADDRESS:;�3J(26 02M�' -PLODATE:
ZONING: 1�6 -a PLAN CHK#: 46 -, 3 --/
PROJECT DESCRIPTION: AT-7p rn rQ
SETBACKS:
Required Setba�ks:
Front: 01�2' Left Side: -7 IZ- Right Side:--7y2- R e a r: 15
Actual Setbacks:
Front:....�� Left Side:—/;,7 Right Side: Rear: 15
CORNERLOT �c)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED
LOT COVERAGE:
Maximum Allowed:- (Of 0*0a6Actual:
BUILDING HEIGHT: I
Maximum Allowecl:-�U, 15� (14") Actual Height:
SUBDIVISION:
CRITICAL AREAS#: CA - q6 -e)
SEPA DETERMINATION: A6---26--00i0AE:��t
LOT AREA:
OTHER:
Plan Review By:
ft&
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number.
L-4ue Date: -7 Q
A. Address or Vicinity of Construction:
890 _10 B. Type of Work (be specific): _T 1.1
uwva Qk^6 ko�
C. Contractor: 4s� xA6MkC_, �A (01A,kA \t P Q. r) . Contact:
Mailing Address:- JJ()J6 "L_J�f Phone: C_ga:�! 0 - D_ 0
State License #: Liability Insurance: Bond: $
qcS02_k-o -
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. E] Commercial E] Subdivision El City Project rxutility (PUD, GTE, WNG, CABLE, WATER)
F1 Multi -Family 9 Single Family F] Other
INSPECTOR:! INSPECTOR:
F. Pavement or Concrete Cut: [__1 Yes El No G. Size of Cut: x H. Chargq�_$
APPLICANT TO READ AND
INDEMNITY: Applicant understands and by his signature to this application, agrees to e Ci ty of Edm o nds h a rrn4k�. fr:—in2rilf., damages, o r
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made agal t the City of Edmonds, or any of its departments or
employees, including or not limited to the defense of any legalproceedings including defense co� I and attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATIONFEES WILL BE HELD UNTIL Tl�rE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL Bk`Pl��K;;ED FOR ISSUANCE fO(TfIL9>PNCANT.
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'lE Agineer.
All street cut ditches shall be patched with asphalt or City approved material pri6r'to, the end of the working day;
NO EXCEPTIONS. X_ %2
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit willbe
available o(nsite at all timedsor inspe�tion purposes.
Signature: A Date: (I-
((�ontractor or �)ent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT
TIME AUTHORIZED': VOID AFTER DAYS DISRUPTION FEE/FUND 111:
SPECIAL CONDITIONS:
, +_ /1 / �A,.. K) 1',r JAk�,
COMMENTS:
RESTORATION FEE:
PERMIT FEE:
TOTAL FE
"RECEIPT FEE:
DATE:
ISSUED BY: __41
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991
'?, - -A-
FIELD INSPECTION NOTES
Comments:
Diagraw
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by
Work Disapproved By:
FINAL APPROVAL BY:
P.W.:
(Fund 111 - Route copy to Street Dept.)
11 YES
Date:
Date:
El NO
t 7
f 7,
J
T±F T,
44 R�o J
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-DISTRICT- N
PUBLIC-,UTI.LI,TY. 0.1 OF�SNOHOMISH COUNTY1
LOCATION
T 7 R DATE NO. 7 )2-,
EN C I!
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4EERtRi:l�:,TbU DWG_NO.�
t DRAFTER,
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Co 0 �U.G. NO.
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�=DAIE�:�WORK�_COMPLETED_71 -15ATE-IPRIN�I=
APPROVED
OREMAN, ENVIRONMENTAL, ANALYSIS:
0 EXEMPT -0. NOT EXEMPT SUBSTATION
Q_: -d.NO�
FEES -RE D--' YE
PARA. 18 ITEM C
PRIMARY OVERHEAD' O.H. U. G. C'ON D. KV CIRCUIT NO. PHASE
D-RESIDENTIAL
ADD CKT. FT. PH
0 COMMERCIAL REM CKT. FT. PH
LEO#" NET CKT. FT.
O.H. U.G. COND. KV
SECONDARY- OVERHEAD
BASIC FEE $
ADD CKT. FT. PH
REM CKT. FT. PH
-t.--CKT.
METER/C-ONVd-POLE-? t�
PERMITS (DATE GRANTED)
PRIMARY -UNDERGROUND
El TREE TRIM
0 RESIDENTIAL
0 STATE
0 COMMERCIAL
El COUNTY
BASIC FEE
.
LEU#
0 CITY
s
n
EASEMENTS
SECOND . ARY UNDERGROUND
El REQUIRED 0 NOT REQUIRED
BASIC FEE
UNDERGROUND PLAT
DATE . RELEASED
BASIC FEE
(LFT.O$ —=$--
FOREIGN CONTACTS
El GTNW JPN#
STREET LIGHTING
t FT, @S 2.
0 CATV JPN#
11 JOINT TRENCH GTNW & CATV
WORK IN RIGHT OF WAY
0 JOINT BORE CTNW & CATV
El PRIMARY
El
POLE STENCILING
FROM TO
0 SECONADARY
FT.,U $_.
KAI(-,rFl I Ar\jP0Hq. f7r7P(:Z
TAKE OFF POLE
VAULT S PRE—CONSTR. REOUIREIVIENTS
PERMIT S 0 TREE TRIM 0 PUD LOCATOR
[IBACKHOE El FLAGGING
11 ONE CALL DATE
TOTAL DUE S POLES I IPLAT
DATE PAID U-MAPI I
RECEIPT# ____ C-MAPI I
NEW SVCE APPLICATION# _QE)ct,�o7 LOCATION MAP PAGE H:7 q. ��
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--------------
2-29
3
4.,
CITY OF EDMONDS.:-*
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Wey ?44711Y ,W11.016,*V
W MAILING ADDRESS
Z
3165- /,o2
.CITY zip TELEPHONE NUMBER
WA M2 o 5512- 4 �(O
NAME
TAM e- -5 C 00 p6R 61, 3 / 641S
ADDRESS
uj
7o2- ti) . co4slxl o eD -4 o� 95
cc
ciry ZIP TELEPHONE NUMBER
i2o
&114
NAME
,fogy,orr 0
ADDRESS
C)�
062 q
CITY Z TELEPHONE NUMBER
Z
IF
gopea_ �,00/2 5; 7.0 d
U
STATE LICENSE NUMBER EXPIRATION DATE
"v'I rre C /0
,4! -7
,Legal Description of Property - include all ease(hents
Z
a:
w
Property
Tax Account
arcel No. 6-L 01,6 o 46
ru
NEW LIN RESIDENTIAL PLUMBING
IKI �DDITION F-1 COMMERCIAL 0 "MECHANICAL
0 REMODEL 0- APT. BLDG. El SIGN
GRADING FENCE
EIREPAIR El — CYDS. El I- x _FT)
DEMOLISH WOODSTOVE SWIMPOOL
0 INSERT 1:1 HOT TUB/SPA
1:1 GARAGE RETAINING WALL/
CA 1:1 ROCKERY E] RENEWAL
Z
; 0 (TYPE OF USE, BU SS OR ACTIVITY) EXPLAIN:
i
Cr
NUMBER NUMBER OF CRITICAL
W
0 OF DWELLING AREAS
CO STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE ATTACH PLOT PLAN)
USE
ZONE
ADDRESS
PERMIT'
-NUMBER 50 t S7
1010 SUITE/ T#
ON CHECKI SUBDIVISION NO, I LIU NO.
4�
PUBLIC RIGHT OF WAY PER OFFICIAL STRtiT'M_A_P*--
TeSCP Approved
0
RW Permit Required .
0
EXISTING —REQUIRED DEDICATION
Street Use Permit Req'd
13
I
Inspection Required
0
Sidewalk Required
0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 11
1
ENGINEERING MEMO DATED REVIEWED BY
SIGN AREA SEPA RE IEW
ALLOWED PROPOSED COMPLET�' EXEM
EXP
VARIANCEhR CU
A REVIEW BY
1, - - . - - -,-� �-1 -? � " MtIUHl_j
R E' R 15
FRONT I.--) SIDE A 7,0
CHECKED BY
TYPE OF CONSTRUCTION
CODE
OCCUPANT
SPECIAL INSPECTOR
JAREA
OCCUPANT
REQUIRED
13 YES
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIF
VALUA
PLAN CHECK FEE
HEAT SARCE: GLAZING
I %
BUILDING
P LUMBING 731
Plan Check No.
-
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewplks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
Lo
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
m
employees, and agents from any and all claims for damages of
Cc
4
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
nor limit in any way the Ci ty's ability to enforce any ordinance
TOTAL AMOUNT DUE
.
provision."
I hereby acknowledge that I have read this app�lication; that the
1 1.3
FEE
I
.1SV
- � - i. -, I% Vt^,-
Z
Z
5
IL
information given is correct; and that I am the owner, or the duly
ATTENTION
AFFI_IL;ATT0N_WPPRUVAL
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and in doing the work authoriz-
THIS PERMIT
AUTHORIZES
This application is not a permit until'
ed thereby, no person will be employed in violation of the Labor
ONLY THE
sign by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; ;nd fees are paid, and receiptAs
TM
tion Insjjrance and RCW 18.27.
ackn wleldged in space provided.
E S19NAJORI�.,(OWNER 08_12LDLJ�.
INSPECTION
DEPARTMENT
DATE .SIGNED
4
CITY OF
OFFICI 5IGNASURE DATE
EDMONDS��
C ..0
ATTENTION
CALL FOI
IN ECTION
RELEAS DATE
1111S UNLAWFUL TO USE OF; OCCUPY A BUILDING OR STRUCTURE
�T
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
7-1,
ORIGINAL File YELLOW — Inspector
-A,. CERTIFICATE OF OCCUPANCY, HAS BEEN GRANTED. UBC
7022
-CHAPTER'�.
PI r
N Owner' *GOLD Assesso