23429 75TH AVE W.PDFlill 11111111
6023
23429 75TH AVE W
City of Edmonds
STRE
A I
VA4F-WAY CONSTRUCTION
PERMIT
-20
Permit Number. 23
cr Lssue Date:
A. Address or Vicinity of Construction: - 23429 75 Av. W. (9320904)
--mmor— C� B. Type of Work (be specific): Install New Service
9 0 - 1 9
C. Contractor: Wqqh i n g t nn NA t I - Qq R ffn
Mailing Address: 815 Mercer St.Seattle,Wn
State License #: 981 . 11
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278/
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. Commercial E] Subdivision F1 City Project XZ* Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family E] Single Family Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut [N Yes ONo G. Sizeof Cut: (A)2 1 4
I/x H. Cbargq�,$
C u t @Wt7e'-r
APPLICANT TO READ A, SIGN
91 he City ofEdmond8 harmles)/;� / i�i�ries
INDEMNITY. Applicant understands and by his signature to this application, agrees tool, In Idamages, 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 or not limited to the defense ofany legal proceedings including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATIONFE�S WILL BE HELD VNTIL�TUE-FINAL TREETPATCH
;E� FOR ISSUANCEPO-
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL �EWR%� A
bICANT.
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.
T'raffic Control and Public Safety shall be in accordance with Q i,%regulations asrequire4y t eCity-Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the erla ohhj'"king day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at all times for inspectio urposes.
Date:
Signature: July 16, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy. to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION 1:1 YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
E] NO
I ddendil" to e t-; +- .0
.Y V Edmonus
Right of Way
Permit Application
Submitted b Guyla Connors
Engineering Ai de
Washington Natural Gas
521-5248
-75 &\,j \,.4,/
� J,
WNG to window
Water main depth
2-4 1101
gas mai
Key:
-w-
water
-g-
gas
-ss-
sewer
-e-
water hydrant
0
water valve
8:5 M=cr St. (P.O. B, x 1869), Seattle, WA 98111 (206) 622-6767
CRY Of Edmon&
Critical Areas theckfiest
'Mr. Critical,&= Clia&jist contained on
this fOm is W U-, filled -out by any person
prcpanng a Development Permit
APPlication for the City ofEdmonds prior
to his&cr =bmittal of a development permit
to the city.
nO Purpose Of the Checklist is to criabie
City staff to determine whether any potential
Critical Areas are or may bc present on the
subject property. no information needed to
cOmPlete ffic Choddlist should be easily
'lablc fiam observations of the site or
avai
data available at City Hall (Critical Areas
inventories. maps, or soil surveys).
An applicartt�, or his/her represwtative, must
fill out the chedidist. sign and date it, and
submit it to the City. The city will revic"
the cheddist, make a precursory site visit,
and mWw a determination ()f&e mbsequcnt
stcPs necessary to complcte a development
Permit application.
With a signed copyof this forn3, the
aPPlicant Should also submit a vicinity map
of the parcclwith enough detail that city
staff can find and identify the subject
Pawl(s)- In addition, the applicant is
encouraged to inCIU& anyothcr pertinent
information or sttidics 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 aftest that the answers provided -are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
(9
Title
77
Street Ad
Ity. State,IZIP --T-
Phone
Signat
Date
Applicant Representative:
Name
Title
Street Address
City, State, Zip
Signature
Phone
Date
STREET LE RECEIVED
Critical Areas Checklist'
APR 0 1993
Site Information PERMIT COUNTER
PrcjectName: Permit Number.
Site Location: .--7QJAkk�)ryf__ Property Tax Account Number- Af-08 - (20 5 -001�-0�195
Approximate Site Size (iLcres or square feet):
Have you filled out a Critical Areas Cheddist for a project on this site before? J�A IA —
General Site Conditions
1. Has the site been cleared or logged? p),p Date of most recent action:
Soils / Topography um,.V-�Wm [,vs
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)?
79,
POCK
PA, FZ r- C-A IZ5 7tv
AIR 6 A
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-T�ICK wrjj� rn
ADD
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C-0 E4ZA-&F, b
pLANNING
AppRO\JED,BY
p
OT PLAO.
.sc. Or- ZO i��, P,!!� 4t 640
A
f�_
APPLICATION CARD No . ......................................
The City of Edm d6m for
T9m
I'll. EASEMENT No . ......................................
L'A't. - SEWER ;��REPAIRS
S]I)F
FILE OUTSIDE E] INSIDE
OWNEk _l.A1a.?l._z117.zz.11 . ..... ...................... ........................ CONTRACTOR .......................... .......... PERMIT No . .....
HOUSE ................... ... ............... STREET
................ A
VENUE LOT No . ...................................................................... BLOCK No - ------ --7.? .................................
Ave
NAME ADD . ...............
.. ............ ..............................................................................
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Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .............................................
SEWER WORK ORDER ISSUED ..................... .................... .. ..... .. . ....... By
AP'PRO-VED
20
I
- 00-:5 — 0015 —()-bc)5 -
A F09TIOrl '0 F w T
L�AK-�, DAWt�CoFP, L-t
PLOT. PL,.,.AO
m LIN
11 No --
SCALE
I it.= 2 CDP
OCT* 13
DLOCK, ��,Fj . . .
Cori Pa"oyl-�;, PLA-T., 4% M
: KmEET FILE
17� c" ,
F,�, -44��m� //op'-s—, .
P
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PLANNING DATA
NAME: �20 it 11V6 91 �G6--"
'j, ' / 1'�-7 /q -7
SITE ADDRESS:-73q2-1 q"- 6W� DATE: - A)
qrf
ZONING: PLAN CHK#:
PROJECT DESCRIPTION:
CORNERLOT /V,, (Yes/No)
6W G0946'r." 4./,
FLAG LOT /Jo (Yes/No)
SETBACKS:
Required Setbacks:
Front: 7 -5 Left Side: Z- Right Side: -7 L Rear: )5
Actual Setbacks: �-b
Front: b6 Left Side: t7 Right Side: Rear:
Street map checked for additional setback required? (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED -- (Y/N)
LOT COVERAGE: ).
Maximum Allowed: Actual:
B UILDING HEIGHT: 2�,�; 1/ 1-1
Maximum Allowed: - Actual Height: Z, /
Datum Point: bl&'(W41, IrkkW Jr"t 6110 Datum Elevation: /000
A.D.U.CREATED?: STREET-FILF
SUBDIVISION:
CRITICALAREAS#:
SEPA DETERMINATION:
LOT AREA: IS/ ()0 0'
�Gytzwt".,
Plan Review By:
cArileApem it\AplandaLdoc
RECEIVED
Critical Areas Checklist'
APR 0 5 1993.
Site Information Lr. PERMIT COUNTER
Project Name: Permit Number.
Site Location: Property Tax Account Number.
Approximate Site Si (,icres or square feet):
Have you filled out a Critical Areas Checkiist for a project on �is site before? T�A IA —
I I
General Site Conditions
1. Has the site been cleared or logged? r) Date of most recent action:
Soils I Topography AtVMw-"V-(k0AN k7w
2- in the Snobomish County Soil Survqy� what is the mappod soil type(s)?
3. Describe the general site topography. Check all that apply.
Ylat less than 5 feet elevation change over entire site.
Jkolling: slopes on site generally less d= 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 fl= 30% ( a vertical rise
of 10 feet of horizontal distance.)
Steep: grades of greAW than 30*/* present on site.
Comments
IL
LU
-W
Rev 3127/92
I
J\cc, -005 -0,605
888, 0030
A FogT100 'OF LOT
ROV
PLOT. PL40
I a Lo c- W- �? I
P Cor-1 Pa-,oy'-�7 PLAT,
�OVT-
CA L E
2
OCT 13
CITY COPY
?-y19AAwo 1-v/r.6
4;�s9ew`7
- (A r2
4
ZONE P RMIT
NUMBER
A'I MA- es- 8
CONSTRU C 2%FT ATION
oa ITE/APT W
OWNER NAME/NAME OF BUSINESS ADDRESS Z
"VY
LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO,
Lw (C
a:
uj
Z
MAILINIG-ACIDRESS If
SMIA Avt-:---
0
-:76 r2tr PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved 11
CITY Z III TELEPHQNENUMEIER . RW Permit Required 0
EXISTING — REOUI RED DEDICATION
5 n Street Use Permit Req'd 0
--7-7
T1S1o011L,-4—,(2 0'bz�7 y 1.r3 .1, 4 Inspection Required " 0
PROPOSED
NAME- .01 Sidewalk Required 0. 0
A" /A. REMARKS
L
t
L)
a:
Z
Lie e�;17 Lu
CITY P TELEPHONE 14UMBER
ZI �0-0/w ymj*v(*�,4
6WI,fta
NAME
ENGINEERING MEMO DATED REVIEW BY
a:
ADDRESS
0
�METER-SIZE, BUILDING SUPPLY SIZE - NO. OF FIXTURES
CITY z NE NUMBER
IP PTELEPHO Lu
0
low EMARKS
LZ)
STATE'l-rCtAgE NLAA BEA I
SIGN AREA SEPA REVIEW ADS N�.
L601 DWriplion of -Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT
Z
SH #
A,
0
A-3 -I
IF EXP
VARIANCE OR CU P G REVIEW BY DAT
9M
Ivc t)UJ2fA- 1'1( I
I T
UFI)
(
SETBACKS - FEET Hk:IUHT
jL6Tt?0ERA4
Z
F SIDE REAR Z
I
0 4
Ri�AIRK
Tax Account Parcel No.
Lil
NEW RESID;NTIAL PLUMBING
a
4z] ADDIALTER 11 'COMMERCIAL
MECHA NICAL
APT. BLDG.
REPAIR
SIGN
GRADING FENCE CHECKED BY TYPE OF CONSTRUCTION ICODE HEIGHT.
DEMOLISH CYOS. 10 L— x —FT) -7-7 -..Of)
CARPORT 011 1 --- i
REMODEL E] G ARAGE swim SPECIAL INSPECTOR 7-AREA OCCUPANCY OCCUPANT
POOL REQUIRED. GROUP LOAD
13 YE S
WOOD STOVE1. M RETAINING WALL/
.. INSERT L-J ROCKERYN RENEWAL EMARKS
Z
0
U 14 PROGRESS. INSPECTIONS.PER-UBC.305 Z
(TYPEOFUSE B S ESSOR ACTIVITY) EXPLAIN:
cr
0
e, y
:�e Cis)
U)
NUMBER OF STORIES NUMBER OF
1
DWELLING
2 NITS
TO BE DONE (ATTACH PLOT PLAN)
A-f 0-, PA41,- , P .. 1. � Joc DLwo� FINAL INSPECTION REQUIRED
d>1-16 N' -' I I I -
-- VALUATION FEE
'A f % Irr, h%A= -
PLAN CHECK FEE
-&b AAV ��JeQ!t4 R&29�:. km -VtCK BUILDING
PLUMBING
tft44 IT -
Plan Check No. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGWILL
Any construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Dayw-
STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
" Applicant, on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmondq�-/Washlngton, its officials,
2
employees, and agents from any 4'all 616ims for damages of
PP.
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 Feduce any requirement of any cityj ordinance
0
X
nor. limit in any way the City's ability to enforce 6ny:ordinianice OTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that f1he
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
state laws regulating construction; and In doing the work authoriz- THIS PERMIT This application is not a permit until
AUTHORIZES
ed thereby, no person will b6 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
tio-Wnsurance. INSPECTION acknowledged in space provided..
SA-.NA'TURE (OWNER OR AGEND E SIGNED DEPARTMENT
FT
OFFICIAL'S SIGNATURE DATE
CITY OF
47�
,4 A A" -4.,A� EDMOND!
5 �
CALL FOR RELE,�SFd Y: DATE
ATTENTION'.
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-3202
UNTIL A FINAL INSPECTION HAS BFFN MADE AND APPROVAL OR ORIGINAL - File YELLOW - Inspec*
A CERTIFICATE OF OCCUPANr- 'AS BEEN. GRANTED. UBC
dHA0fE!R 3.
PINK— Owner GOLD - Assessor
RECEIVED
APR 2 0 1998
PLANNow DEPT.
9712030610
12/03/97 16:57
Recorded
Snohomish County
Return Address:
City of Edmonds City Clerk
121 5th Avenue No.
Edmonds, WA 98020
STATEMENT ON ACCESSORY DWELLING UNITS
Property Address:
Edmonds, Washington
Legal Description: �12- Z 1'—� C,
6Z�Z� 4-6c, 0 0147"'
Assessor's Parcel Number:. �Ia 0))
I have read the requirements for accessory dwelling units contained in Chapter 20.21 of
the Edmonds Community Development Code and understand that an accessory dwelling
unit, including a second kitchen, is prohibited for two years after occupancy by the
current owner (u ' nless a waiver is granted by the Community Services Department) and
until after a conditional use permit has been approved by the City of Edmonds Hearing
Examiner.
I also understand that approval of a conditional use permit is subject to a public
hearing, and neither this statement nor the issuance of a building permit shall act to
limit the discretion of the City in the review of any application for a conditional use
permit.
Property Owner Signature: rdl�
Date: / ( — �� -�,
STATE OF WASHINGTON
COUNTY OF SNOHOMISH
I certify that I know or have satisfactory evidence that J�CL) I A)
signed this instrument and acknowledge it to be his/her free and voluntary act,for the uses Ind pu D6 ' pmme%
mentioned in this instrument. Q* !
J0010', A % 0 5. VAI
Notary's pressure seals must be smudged. Dated:
Signature of
90
Notary Public
Residing at:
My Appointment
Expires: _ 6� Lgte—r
THIS DOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY AUDITOR.
e95�y I
CITY Copy
Return Address:
City of Edmonds City Clerk
505 Bell Street
Edmonds, WA 98020
STATEMENT ON ACCESSORY DWELLING UNITS
Property Address:
Edmonds, Washington
1�e
Legal Description: /C7
Assessor's Parcel Number:
I have read the requirements for accessory dwelling units contained in Chapter 20.21 of
the Edmonds Community Development Code and understand that an a ccess6ry 'dwelling
unit, including a second kitchen,. is prohibited for two years after occupancy by the
current owner (unless a waiver is granted by the Community Services Department) and
until after a conditional use permit has been approved by the City of Edmonds Hearing
Examiner.
I also understand that approval of a conditional use permit is subject to a public
hearing, and neither this statement nor the issuance of a building permit shall act to
limit the discretion of the City in the review of any application for a conditional use
permit.
Property Owner Signature:
Date: I ( ±�2 - 1-1 1
STATE OF WASHINGTON
COUNTY OF SNOHOMISH
I certify that I know or have satisfactory evidence that A)
signed this instrument and acknowledge it to be his/her free and voluntary act for the uses' n'd
mentioned in this instrument. 1A S Vf4
C) ..... . y
%
Notary's pressure seals must be smudged. Dated: 3 4
:% qFV eggo?
Signature of
awl
Notary Public 2 W
C,41-'. W
Residing at:
My Appointment
Expires:
THIS DOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY AUDITOR.
USE'
'ZONE I...
N 05y"'
cl.Vy,
(t.�: 4�Pb NUMBER
icATION
011 QN STA VIPP9 JOB'
TE/APT
BLISILIN SS.-S;- Sul
E Z�r
)WNER /NAM5�01` ADDRESS,
SCRIPTI
SUBDIVISION NO
�EGAL , DE UN t;HLC.Kl LID NO
WAILING:ADDRESS
itk
TESCP App�oved
�PUBLld,!91914y,,OF�;WAY PER 6FFICIAL-STREEi MAP:
ZIP -1 TELEPHONE NUMBER 13.
I T r —da— RW Perniit'Required 13
ED DEDICATION L�- Street We Peiinii Req'd 13
:EX RE
sPectiori Requir4d_
1AME PROPOSED:
Sidewalk Required 0
ir
��I�E S ul
IZE NO OF FIXTURES PRV REQUIRE
iDORESS
ed, 3:
YES 0 NO 0
REMARZ z
ZIPI�,_.7;7 — �TELFPHONE NUMBER Q 1HPC-P-V'L)L"S__0E AJO 7�-
ITY' -,-.E76 T71 IV
W
z
DDRESS�
GINEERING MEMO DATED
REVIEWEPOY
W'3/
ITY_- ZIP LEPHONE NUMBER
IHF MEMO DATED ..REVI
EWEDBY
Ct
-tATit bbENSE N BEP, ,EXPIRATION DATE
VARIANCE OR CU
e. ADB 0 SHORELINE,#
94 erty"hiclu
P4,6p de" all- easerbent§!::,,
t 'L, .4 - SEPA REVIEW SIGN AREA HEIGHT
- 1. Co PII�ETE '
'Rlgock OPOSED
7 _T EXEMPT ALLOWED ALLOWED JPR
.-T
�EXO
PR2?
�LOT.COVERAGE - REQUIRED SETBACKS (FT.),' PROPOSED SETBACKS (FT.) -
ALLOWED PROPOSED FRONT SIDE REAR FRONT' URSIDE REAR
f �ql 9
.1� z
e z
DATE
rti. A -LOT;AREA
7
4
f,-7777 _REMARKS
.,j
IAJ - yh I Id. -
NEW' .
ESIDENTIAL 6H
fLyMa!NG"E
r7-, COMOILIAkIE OR.
"A
13-ITION! COMMERCIAL CHANGE OF USE:- -HUA115-
:APT' BLDG:
REMODEL.
1:h E�,. Ef.-SIGN bw Alz fKjr-1
OCCUPANT,
FENCE TYPE qF,�PONSTRUCTION,-!,,:�i CODE
El x —FT) GR
OU,
DEN ,WOODSTOVE,.. SWIM POOL- ECIAL.INSPECTOR
INSERT
OCCUPANT
HOT TUB/SPA
OU IRED LOAD
RETAINING :_-: . : -, YES .
C �RPA G E ROCKERY :WALL/,� . - .. ' I . . : '
R �RT"-. El RENEWAL
RE MARKS
PROGRES
�-Y,PEOF�CJSE�-BUSINESSPR'-ACTIVITY- EX S INSPECTIONS PER VBC 106
�LAIN:: ' . 11 1 — � 1 1. � - , - I _ _1
_j
3.
UMBiER. !NUMBER OF '
DWELLING AREAS'
CRITICAL'
TORIES: UNITS`
NUMeEk",
ItSdRIBEWORK,TO�BE DONE (ATTACH:PLOT PLAN)., i
:,FINAL�INSPECTION;.REOUII!Eb':-.
VALUATION.- FEE
K FEE
1 ig
pf
ze Av
GLAZING
IN);,
.. PLUMBING
EAfSOURC 4A
21 milli ECHANICAL
an ck,No.;.. �M
on,prlvata� property: ONLY'. GFIADINGIFILL
(curts, siddwelks,
F ue6s STATE SURCHARGE
�driveways;�,'marq .etc)�Will-..re�Uite';-�iBOar*ate.piarnii66166
ii. It.-Appi6tion:160�01ays
STORM DRAINAGE FEE
iftiULIMIe't Year -Provided Worivis Started Within 1
half of,his or her s 9
Ouse heirsi assi ns,and ENG.ANSPECTION FEE
pplicantnon,be p i
ucdess, nifiterest, agrees loAndemnify; defen& an&�hold.�
a 6s . the City: of, -Edmonds- wabihingtoni, its: officials..
J
Mployees,,and: aggritar rom any and:aIV'cIajms: for.:dc mages:of
ifiate.'V,�e'r':riature;.,arising!'directly or indirectly from the Issuarim'
I I h is . �permite-.�, ssu I an I ce . o':this-,pefrniLfSfiaII not be�d 6emed-,-to� PLAN CH.EC,K,DEPOSIT
I f 13
iod if y,,*waive:.:or.; re.duc.6�.�any: reci uireme.nt.�oU any.. city. Ordinance
or, Hirlit In any way the City's ability to enforce any ordinance 50
0i -TOTAL AMOUNT DUE
iro Sion
h6reby�ackriovirledge that 1-have readihis application; that -the
)�ii��ti;n,di"v6n,isic.orre6t�,a�d that-I.am,the owner,, or.,theAuty.., APPLICATION APPROVAL.-
ij1qr4z'6d-_,.agent,-of -the owner�i4 agreeAo7 comply with -,,city �an& '�HIS P . ERMIT
AijTH6Riz`Es
feAaw,i�rdgulating=nstruct Ion.; and t lnd61ng�t�e.workauith' This: application. is not a permit until.
of-the7 L-aii by the Building Official or his/her
thereby'; no."perfon��vili"bi�,ei�ployed In violation bdr, ONLY THE,
relating,'to�,W*orkmen's'Cor�pensa.� WORK- NOTED- �Deputy; and,fees are paid. and.receipt is: r
I e Bria RtW,18.27.
nsuranC acknowledged in space.provided.
-ANSPECTION,
P'(OW N E R,'OR;AG ENT).`-", DATE SIGNED DEPARTMENT�
A
SIGN E
OFFIC
CITY OF
EDMONDS
17.7
By, D Tt,
CALLIFOR 6TIC o
itNTION
INSPECTION
AL'AWFUL:.-T0,, USE. OWOCCUPY-,A,�BUILDING. OR,STRUCTURE-
Inspector
HA'Si -BEEN MADE�AND APPROVALAR V_
7-71 ORIGINAL — File YELLOW
GRANTE ; - - , .
ATIFICATE OCCUPANCY� HAS;, -BEEN, - 'D' ',UBC
:)NA09 'PINK Owner GOLD — Assessor
10, J-
Return Address:
City of Edmonds City Clerk
505 Bell Street
Edmonds, WA 98020
STATEMENT ON ACCESSORY DWELLING UNITS
Property Address: ;?-3 4�� �7 �9�
Edmonds, Washington
Legal Description:
If 1:=j
Assessor's Parcel Number: 1-167
I have read the requirements for accessory dwelling units contained in Chapter 20.21 of
the Edmonds Community Development Code and understand that an accessory dwelling
unit, including a second kitchen, is prohibited for two years after occupancy by the
current owner (unless a waiver is granted by the Community Services Department) and
until after a conditional use permit has been approved by the City of Edmonds Hearing
Examiner.
I also understand that approval of a conditional use permit is subject to a public
hearing, and neither this statement nor the issuance of a building permit shall act to
limit the discretion of the City in the review of any application for a conditional use
permit.
Property Owner Signature: ,/� (
Date:
STATE OF WASHINGTON
COUNTY OF SNOHOMISH
I certify that I know or have satisfactory evidence that et), A) C4
-J-4 ki I .:.� . .
signed this instrument and acknowledge it to be his/her —free and voluntary act for the uses rid pult".
mentioned in this instrument. 'A S VAI
01 ....... . V
Notary's pressure seals must be smudged. vo
Dated 31 VIt'vo."t-
54-4022.1; Z - - 1914, . ;; `
Signature of W.0 C/ ,
n
Notary Public C,
Residing at:
My Appointment
Expires: 61 LIT
THIS DOCUMENT MUST.BE RECORDED WITH THE SNOHOMISH COUNTY AUDITOR.