23504 96TH AVE W.PDFiiiiii lill 11
9506
23504 96TH AVE W
041
I cl� .30
chainlink fence !�12" cedar
)'50,00,, E 296.9u
R16" cedar 120" fir 14845,
-420,cedpr
10', $,P(Uceo
504,, 30" mufti-
1 po �,nw i;io trunked fir
8" tt, d
4M" multi-
trunked cedar
18" cedar 6" �eda 07"spruce
ar*
24" ced
486--
jo,- ced W. fir*
201, hemlock
23504
C8
Shed 18 k >
J hem
Ln CN W
garage 24" mult14
cidar 1amuftkk
trunked tru� e
LU V)
k d dar
oc
Y herbi
try -
(3)
12 f,r!k 9P
',.)24j
�4" ced Ir ik
ed,,k
C
�A
T
7,*
&
k� ev'ergree CIN
�d
C,4 A
cedJ_
20" cedar 11 U')
' It:
6" rn pie
Vt
epiduou
de duous
Japanese - I - // I .
split p 26" fir 30
0
f de _W 01001, W 148.3 nc
ower ozoo,
10.00, EXCEPTION nole 1 Ij
148 3a,
7-
296.76'
I
I
.ZN
RD
A V BY PLANNING
IP BY PLANNING
148,32'
S 69'50'00" W (P) (C) 296.68'(P) 296.63'(C)
236th Street SW (Forrest Street)
Found 4�' square concrete monument with tack in lead
at 96th Avenue W and 236th Street SW June 3, 1999,
Used top of monument as benchmark.
onunient with ELEVATION: 500.00'(assumed datum)
Mth 'Y'in case
reet SW —June 3 1999
LEGEND: 0 - set V2" diameter rebar with plastic cap "PAINTER 19640"
set nail with brass tag "PLS 19640"
(P) - plat
(C) - calculated
NOTE: All tree measurements refer to diameter
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
December 19, 2000
Kenneth Davis
23504 96h Avenue West
Edmonds, WA 98026
SUBJECT: Order to Correct — 23504 96 th Avenue West / Permit #990838
GARY HAAKENSON
MAYOR
Following discussions with Mike Todd and Jed of Todd Homes, and an additional site
visit, we reconfirmed that the patch work in the private drive on 96h Avenue West does
not meet City standards and is not considered to be a speed bump. Jed was informed on
November 27, 2000 that the following items need to be corrected before an engineering
final can be granted.
1. The trench patch is either to be removed and replaced, or both ends feathered out
to make a smooth transition into the existing asphalt.
2. Jute matting is required to be placed on the exposed slope along the private drive.
If the above listed items are not addressed and re -inspected within 21 days of receipt of
this letter, this file will become a Civil Violation and turned over to code enforcement,
per ECDC 20.110.
Once the requirements have been met, please call for an engineering inspection at
425-771-0220, Ext. 1326. If you have any questions regarding these requirements, please
contact me at 425-771-0220, Ext. 1338.
Sincerely,
JEANIE MCCONNELL
CIP Specialist
JM/cmc
c: Development Services Coordinators
Jason Tourtellot, Code Enforcement
DAMy Documcnts\Engsec\DEVELOP\96th.DavisOgl-fffbl')5orated August 11, 1890
q;�+— r;+,, - -T—nn
MAY-13-1999 16:37 CITY OF EDMONDS
4257710221 P.02/03
City of Edmonds
RECEIVED
JUN 0 8 igc,,g
10
CRITICAL AREAS CHECKIASLTMENT SERVICES
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 p:roperty. The
information needed to complete the Checklist sbould
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
tht 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
pern-dt 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).
Cn
Owner/Applicant:
11-6'K1A16:EH. 'Z?�15
Name
2.3 1� 6 -rq, V6;7
Street Address
IAI,4 �p6ozo
city S tate Zip
(2-06) 5-X.2 —
Telephone
Signature
Date
crcceptionyandkod.doc
Applicant Representative:
Name
Street Address
city State Zip
Telephone
Signature
Date
(over)
MAY-13-1999 16:37 CITY OF EDMONDS 4257710221 P.03/03
Critical Areas Checklist qq- / & -7
--------------------------------------------------------------
Site Information (soil s/topo graphy/hydrol o gy/ve getati on)
I . Site Addrcss/Location:
2. P roperty Tax Account Number: 6G-14��- 001- 0044- 090 L/
3. Approximate Site SiZe (acres or square feet): ;R q, co 0 1 q0 'Y' I(Do
4. Is this site currently developed? —no.
If yes; how is site developed? 45 i ur" i3 S'�
5. Describe the genural site topography. Check all that apply.
Flat: less than 5-fect 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 331 to 66-fect).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: K)O Approx. Depth:
0
7. Site contains areas of seasonal standing water: A-) 0 AJ 4L, ;Approx. Depth:
What scason(s) of the year?
8. Site is in the floodway floodplain_ of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? A-) Flows are, seasonal? — (What time of year?
I
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: �_)o r-4-1
---------------- ; ---------
12 -Use:: ------------------ ------ -------------------
Lrwy ---------
YP777 . ' ..' . .. .: !: .' .; ..'.: .. . � . . I I � �� ... :
- Fo S :ff
Y.
.1. .:::Sice is ZoncV
2. SCS mapped soil type(s)7'AD.'-tAM.;:-.:
3. Weiland inventor
y or C.A..rhap.ihdicates.+w�t andpresen.oh-sl e?.
4.- -Critical Areas'inveftto'ry or C�A. 4p;mdlicates:.dritical Aie'+a-bn"+si0
Slte.witbin�desiknated e�rth subs idebce: landslid' hazard.aren?
.6.:..., Site design*d on tht:Enviro'himen' M
tally., 56sifi�,e Areas a JJ
T
I)ETERMINATION
fts-clik.40%. R� 1000)197
TOTAL P.03
�tp C. is 9\3
June 10, 1999
Kenneth Davis
23504 96" 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 # 99-167
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 for you to retain. a copy of this Critical Areas Checklist "DETERMINATION" for your records.
.......... a .................
IMPORTANT INFORMATION TO BE NOTED:
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIS OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination. , .
M10, You must submit a cony of the CRITICAL AREAS CHECKLIST and DETERMINATION MTH 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:Reception\Jana\CRLTR.doc
Incorporated August 11, 1890
Sister City - Hekinan, Japan
�fp C. 1 S1911
CITY OF EDMONDS GARY HAAKENSON
MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221,
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
October 19, 2000
Kenneth Davis
23504-96'h Avenue West
Edmonds, WA 98020
SUBJECT: ORDER TO CORRECT —
New Single Family Residence a't 23504 96 1h Avenue Wes
Dear Mr. Davis,
A final Engineering inspection has been made at the site address listed above. There are
items that need to be corrected in order for the City to grant final engineering project
approval. A correction notice was posted at the site on August 29, 2000 and to this date
there has been no request for a re -inspection.
To prevent this file from becoming a Civil Violation and being turned over to code
enforcement per ECDC 20.110 (copy enclosed), the following items must be addressed
and re -inspected within 10 working days of receipt of this letter. If no attempt to correct
is made within this timeline a Notice of Civil Violation Will be Posted and monetary
penalties will be assessed.
1. Patchwork at base of hill is broken and does not match existing grade. Remove
and replace per City Standards.
2. All patchwork and/or areas of new asphalt must be sealed with AR4000.
3. A fire and aid address sign must be placed at the street.
Once the requirements have been met, please call for an engineering inspection at
771-0220, Ext. 1326. If you have any questions regarding these requirements, please
contact me at 771-0220, Ext. 1338.
Thank you.
JEat
CIP Specialist
JM/cmc
Enclosure
c: Development Services Coordinator, Permit #990838
C: \My DmuiiienL,\Engs�,\DEVELOP\235tli.96t[,Md4ftc"orated August 11, 1890
MAY-13-1999 16:37 CITY OF EDMONDS
4257710221 P.02/03
City of Edmonds
RECEIVED
JUN 0 8 igog
TW CRITICAL AREAS CHECKLIJS�TMENT SERVICE,
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, MLISt 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 nece55ary to complete a devel opment
perrrdt application.
Please submit a vicinity map along with the signed
copy of this fonn 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).
0
Own er/App lies nt:
/'46 0 5
Narne
-7
,— 3 7-1/ AV��
Street Address
141,4 �Zeozo
City S tate Zip
('Zen6 ) '5-x2 —
Telephone
Signature
Date
c:rccep tionV anskacl. doe
Applicant Representative:
Narne
Street Address
City State Zip
Telephone
Signature
Date
(over)
MAY-13-1999 16:3? CITY OF EDMONDS
4257710221 P.03/03
Critical Areas Checklist qcl- / �; -7
--------------------------------------------------------------
Site Information (soil s/topo graphy/hydrol ogy/vegetati on)
GIJ
I Site Address/Location:
2. Property Tax Account Number: o C, 0 1� 0 L/
3. Approximate Site Size (acres or square feet): ;P Lit 0 1 C. 'Y'
4. Is this site currently developed? _!�� -yes; —no.
If yes; how is site developed? V-,Cj L6_-, CIP� L�4
5. Describe the general site topography. Check all that apply. RECEIVED
L Fiat: less than 5-feet elevation change over entire site. OCT 2 7 1999
Rolling: slopes on site genet -ally less than 15% (a vertical rise of I 0-feet over a
horizontal distance of 66-feer). DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
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-fect). .
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feei).
Other (please describe):
6. Site contains areas of year-round standing water: k)o A-! C_ Approx. Depth:
7. Site contains areas of seasonal standing water: 0 Approx- Depth:
What season(s) of the year?
8. Site is in the floodway floodplain_ of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? A-) Flows are. seasonal? (What time of year?
I
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) ------------------
11. Obvious werland is present on site:
------------- ----- — --------------- ---------------
------------------- ; ......... -7.
Fi ty t I aff
I.. :Sire is Zoned'.1-..
.
2. SCS mapped s6iltype(s)?:Ap. AZ9X�,,1rkV:1_1
3:1 Wetiandihventor-y:orC.A..ri2ap.ihdi�ato4.w�t1 d h-slte?.
an..,! present..c
?
.5; Site. within: desiiin-ated euth subsidenice'lands:1 ide* h d' real
S.ite design*d on thie:Erivirdnmen tially 5efisfti-lk AM.'?P.. i. ;ip.*�`,
I)ETERMINATION
'ca—cl�LAO.. Ft— 10MV97
� a �0�
TOTAL P.03
PLANNINr-, DATA
NAME:—Inoll)
SITE ADDRESS: _�ATE: 10
_2_3'��Oq
ZONING: PLAN CHK#:
PROJECT DESCRIPTION: hk�"cw�Wp,_j�WJAi J101,41 A4 11 /7
CORNER LOT__jkD/,_(Yes/No) FLAG LOT
, I
6J64 2 4t�� I"
SETBACKS:
Required Setbacks-,
Front: Z< Left Side:71- Right Side:
Actual Setbacks:
Front:-.!40 LeftSide: 10 Right Side:
Street map checked for additional setb--'ack require�_?
(Yes/No)
L.Rear:
Re, I Arr:
IM
1 —(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED-60__(Y/N)
LOT COVERAGE:
Maximum . Allowed: 14—Actual:
BUILDING HEIGHT: 1
Maximum Allowed: AcIptill Heightjq., 5'
1- .0
Datum Point:' 1 um
a urn Elevatlonjgj�__
A.D.U. CREATED?:
SUBDIVISION: —AM
CRITICAL AREAS #:
SEPA DETERMINATION:
LOT AREA:
OTHER:
STANDARD DRAINAGE DETENTION SYSTEM
WORKSHEET
OWNM VW �Av k,
ADDPMS a,�Soq
V-7
,AMONAc-) j
k
CALC BY: ("AtV-C-, '(0 Db
PHONE: L(2�;-74�;-3033�Z
DATE: L /q 7,
"'DESIGN DATA*****
IMPERVIOUS AREA PIPE DIA PIPE LG ORIFICE
(OS C? 0 -71E
FROM CONTROL CB
-w
FINISHED
tDLTCNTION PIPE LENGTH �.00KING LID
TCNT'ON PIPE (T YPICAL)
MINIMUM
UPPER CATCH BASIN
6 IN
A UREhEPjtpCf0P or
M
3Z TO IX SLOPE CONC BOX OR RISER
1�4LQU-14 T
COUTLET CONTROL
)UTLI
MIN.
.ORIFICE
CONTROL CATCH BASIN
SYSTEM CROSS SECTION
RECF.IVED
-e-X2-A'.DE'EP, 4-61 SPALLS OR EGUAL OCT 2 7 1999
27 2'X 3' DEEP, 3/4' CRUSHED ROCK XISTING GRADE DEVELOPMENT SERVICES CTR.
cITY OF EDMONDS
FROM CONTROL
X - OUTFLOW TREn MIN 10- L&a
PPER
P r PIPE TO 3 LEVEL
PERF PIK V/ END CAPS
81PLLC&ELjNW 11�TN�l
NPAAP 017FLEr AUNT N V I&M ROCK
RUNOFF SPREADER -TRENCH
FOOTING- DRMNS SIMLL NOT BE CONNECTED -70 DEPENT[611� SYSTEM
NOTES.-
1. Call Engineering Division (771-0220) for a tightline and detention system inspection
before backfilling and for final inspections.
APPROVED BY
2, Responsibility for operation and maintenance of drainage systems on private property is the �3
responsibility of the property owner. Material accumulated in the -storage pipe must be flushed (//;?
out and removed from the catch basins to allow proper operation. 7"he outlet control orifice DATE
must be kept oven at all times. I
-------------
5 20 5 3�— 5 40 .5 -50 5
232nd Street SW (Fliqhland Drive)
C)
N89'42'00"E(P)N89"41'53"W(C) 297.07'JE)�9T.InC
148.55'
C14 W C�!
('0 An W1-
!C14 U)
VON"
C�
"*--chainlink fence----._
i� 12" cedar
N 89050'00" E 296.90' -------------------
ceda
14 874 5.%'� -T76or7't2-0" fir 149-45'
10" spruceo P20`,cedor
.504,1
8" Po w od
!00" multi-
trunked cedar ':�OA De 'Fw
_7
(31 6,
18" cedar
0 C)
IQ
24" cedar
'486
.,?0" ced r tp
36" firt
20" hemlock
ED
Zo 004'
Tl 1, A
Q)
C�
shed
18",hernl ckk Q
co LU
L0
in C-j C\i
(0 Lq L0 4�0 Ln
tQ
24" ul
fun) garage ti
%
18:'rnulti !�L
trunk d
t0iked dar
c�� d a r
6 her lock
C=)
L0 12" firk
4" fir
C:)
�X.
4" ced'r'�
CD
0
...... ..... ........
z
%6
51
—1 6'
C Pf I �" e gree'l
10
I split ju lit! d
�ple. 0 26" fir.
fen"cjj
1 ... ... -";:�Lls 69to'00 W
'10.00.
EXCEPTION
14S 38' :jEl 4 8.�3
S'69 50 00"VV 296.76'
RECEIVED
NOV 2 3 1999
DEVELOPMENT SERVICES CTFL
CITY OF EDMONDS
30
t, 51*(-
C e, A, 1
()P(
(U
A'r� A
60
>
-40
0
-20
M
U
ch
W
-0
-10
JC
20
+-.j
30
TL, &-PA,9-A�
U-3 /?-0 C, F=
14 148.32'
S 89-50-00"W (P) (C) 296.68'(P) 296.63'(C)
5 11
511
5 11
Ell
5 11
Oil
5 11
2361h Street SW (Forrest Street)
CIO Fourd 4" square concrete monument with tack in lead-\
at 9Eth Avenue W and 236th Street SW June 3, 1999. 70
found 4" square concrete nionuinent with Usec top of monument as benchmark.
1 1/2" diameter brass plate with "x"in case ELEYATION: 500.00'(assutned datum)
at 97th Ave W and 236th Street SW Julie 3, '199 V� 482.26' it
LEGEND: 0 - set 112" diameter rebar with plastic cap "PAINTER 19640"
/* - set nail with brass tag "PILS 19640"
NOTE: All tree neasureinents refer to diameter
(P) - plat
(C) - calculated
(PCopyright 1999 by Gerald L. Painter, PLSIADF 5urveyors. Design, map, text, and data may not be used, copied, or reproduced in any way without Vie express written peftillssion of (3erald L. Painter, PLSIADF Surveyors.
_10_ 5 40 5 50 5 60
Survey for
Legal Description:
The northeast quarter of the south 345 feet of Tract 4, Block 1,
Richmond Fruit Garden Tracts, according to the plat thereof recorded
in Volume 6 of Plats, page 44, records of Snohomish County,
Washington;
EXCEPT the south 10 feet thereof;
TOGETHER WITH an easement for ingress and egress over the east
10 feet of the north 264 feet of the north 264 feet of said Tract 4.
EQUIPMENT USED: Zeiss Elta 50 total station
PROCEDURE: Field Traverse
PRECISION: Exceeds statutory requirements
MERIDIAN: Plat of Richmond Fruit Garden Tracts
BENCHMARK: Top of monument at 96th Ave W and 236th Street SW
DATUM: Assumed
INDEXING DATA: Tract 4, Block 1, Richmond Fruit Garden Tracts, as
per plat reco in Volume 6 of Plats, page 44, records of Snohomish
County, Washington.
A portior, of 'the southwest quarter of the northeast quarter of Section
36, Township 27 North, Range 3 East, W. M.
RECORDING CERTIFICATE
Filed for the record this ............... day of ............................ 19 ........
at ............................ M., in book ........................ of Surveys at
page ............................. at the request of Kenneth G. and Angela
M. Davis.
... I .............................................. I ...............................................
County Auditor Deputy Auditor
AF#.
SURVEYOR'S CERTIFICATE
This map correctly represents a survey made by me or under my
direction in conformance with the requirements of the Survey
Recording Act at the request of Kenneth G. and Angela M. Davis
in May of 1,W9.
6' * ....... * ' ' 'i'nt'er',' 'P L'* S' ... ' . ....... ......... ** ............
Certificate number 19640 1
.P
ADF Surveyqrs
1521 Wetmore Avenue Tel: (425) 258-4522
Everett, Washington 98201-2057 Fax: (425) 303-9313
KP jP
......... I... I .......... ...... ................ . ..... ... of .;.i .........
drawn by checked by sheet
06/09/99 06/09/99 990520
date ate file number
pl��CJ�71 - 0
vl�
NOV 2 3 1999
DEVELOpA4ENr
CITY OF SERVICES C
ED Aloim;Ds TR.
sui"yV-1,u)
E RECEIVED
ICATT
tq9 , ,,
�,PtRMIT EXPIR E
CITY OF EDMONDS,
AE! .
ZONE
�, ��!:. 0'.
PERMIT
NUMBER 9 0 Safe
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESSa �5 15
SUITE/APT#
OtA� q6 U3
OkNER NAME/NAULOF
BUSINFSS
---"m
V_& 6.
PLAT NAME/SUB DIVISION
NO.
LOT NO
LID NO.
Cc
U)
MAILING ADDRESS
M
LID FEE $
z
0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Apprmed
RW Permit Required
CITY ZIP
TELEPHONE
EXISTING '_
PROPOSED
Street Use Permit Req d
Inapectioon Required
Gc(mot, I
A�, %Z&4
q25-745-303a
REQUIRED DEDICATION—
FT
Side.alk Required a 0
Underground
, �,.; I ., . , �. �.� I
Wiring required 1/6 C9.-
NAMJ�&
LINE�IZE
Al�ilk
NO. OF 9IXTURES
PRV
0
Si(EQUIRED
YE NO
z
Uj
m
cc
ADDRESS ..jj
5.�r_ .
.,REMARKS
6WNERICONTRAC
INJI? ROSION CONTROL/DRAINAGE
Uj
z
z
w
ZIP
TELEPHONE
&
NAME
0 C>4>
'ENGINEER
ADDRESS
eff
REVIEWED/DATE
-z 37
klbo I L4 I
z
CITY ZIP.
T 12L E 'PH O'N4 _E"4�
FIRE REVIEWED BY
DATE
LU
0
LL
"VAFIIA'NFE' OR CU
SHOREL NE OR ADB#
INSPECTION 4—BOND
STATE LICENSE NUMBER EXPIRATION DATE
EC
'T_000 HT* %;t ML:- �47/00
I
y
lit -
REQ'V
C] YES 0
I P
#jTED
15
SEPA REVIEW
COMPLETE EZXEMP
SIbN AREA
ALLOWED . PR - OSED
HEIGHT
�ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
WZ -ni,, CXA
5S r r)
EXP
1
NEW
RESIDENTIAL
PLUMBING MECH
LOT COVERAGE
ALLOWED PROP
:D
VEQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRON T U�RIDE REAR
ADDITION
COMMERCIAL,..,
COMPL ANCE OR
CHANGE
i OF USE
ft f.
K
0,
1�
z
2
z
REMODEL
APARTMENT
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OCCUPANT
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC'1'08/FINAL INSPECTION REQ'D
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VALUATION
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PLAN CHECK FEE
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BUILDING
PLAN CHECK NO:
VESTED DATE
PLUMBI I NG
M
"tCHANICAL
470
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
GRADING/FILL
t
SEPARATE PERMISSION.
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PERMIT APPLICATION: 180 DAYS
STATE SURCHARGE
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
50
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE; HEIRS, ASSIGN . S AND SUCCESORS
ENG. INSPECTION FEE
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IN INTEREST, AGREES TO INDEMNIFY. DEFEND AN6�HOLD HARMLESS T HE CITY OF
250
2
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FR OM ANYAND
LANDSCAPING
INSPECTION FEE'
x
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x
a
i
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL:NOT BE
DEEMED TO.MODIFY, WAIVE OR REDUCE 4
. NY REQUIREMENT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
RECEIPT/Vj
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
TOTAL AMOUNT DUE \
RECEIPT
/ � � ��"?
I HEREBY ACKNOWLEDGN �AVE READ,THIP APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT;AND T.1 AM THE oWNEkIOR THE DULY AUTHORIZED AGENT OF
-
APOLICATtON
APPROVAL
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
CALL
This application is not 4-permit untilTsigned by the
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her bbputy: and Fees are paid. and
receipt is acknowl6agqd in space
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
provided.
SIGNATURE (OWNE
DATE SIG D
(425)
OFFICIA 'RIGNATURE DATE
771-0220
11
AIJA_ V_2_1zky_
ATTENTibN
EXT 333
RELEAS D Y f DATE
A_h/
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION
771-0221
I
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
ORIGINAL -FILE - YELLOW- INSOE&OR
5198
PINK -OWNER - GOLD -ASSESSOR
City of Edmonds Permit No: V_�
QI OF -WAY CONSTRUCTION PERMIT Issue Date:
� _Alk
A. Address or Vicinity of Construction: - 2 3 -50 4 A ver
B. Type of Work (be specific): 6rlz- Z&7,4 7r�D U-171- / 7Y
C. Contractor: -770"�- Contact:
Mailing Address:
'Phone: 4-2 S% -7 4 5 - 10 3 -Z_
State License #: "L 00e Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. F� Commercial F] Subdivision. F] City Project F] EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
F-] M.ulti-Family �ingle Family Other
-re, c., 77-
INSPECTOk'
F. PAVEMENT: YES NO G. SIZE OF CUT x H. Charge: $
CONCRETE CUT: YES -NO P&-p— S P4_4w
APPLICANT TO READ AND SIGN
IDEMNITY.- Applicant understan& by hislher signature to this application helshe holds the City of Edmonds harmlessfirom injuries,
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 certificati�n 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 end of the workday - NO EXCEPTIONS.
* Three sets'of construction drawings of proposed work are required with the permit application.
I HA VE READ THE ABO VE STA TEMENTS AND UNDERSTAND THE PERMIT REQ UIREMENEV AND A CKNO WLEDGE
THA T I MUST MAKE THE PINK COPYAOF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Date: 12� �Z Iq
or Agent)
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
run %_1_t I U
A p
p, roved by.
Ti m�e,Autho , rized: Void -After
Special Conditions: P&-7Z e- 73/ 1 zAdl,:�34445
&ONLY
Rigkt- df-Way" Fee:_70
Disrupti6n'Fee/1Fuhd 111:
Restoration Fee:
Total fee: '70
Receipt No,:
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.
INSPECTOR'S SIGNATURE DATE:
"iion Handout.
For inspection requirements see Engineering Informa