23701 80TH CT W.PDF111111111111
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23701 80TH CT W
ADDRESS: -Ott
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TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
Ll
CRITICAL AREAS: C)=a,_ g6Q�,�DETERMINATION: El Conditional Waiver E] Study Required )<Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DA
SEWER LID FEE $: LED
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S)
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED: �
OTHER:
LATEMP\DS'rs\Fonns\Street File Checklist.doc
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PERMIT NO: 9923
'Cifty of Edmonds PERMIT EXPIRES
SIDE SEWER'PERMIT.
Address of Construction: 'r-asmu 0:� LID #
Property Tax Account Parcel No.
Attach copies of all access and utility easements Verified and Approved by
.0 - I / - A^ J -%( . -
Owner and/or Contractor: IZ ( r— / P7 Q rWPW,1'7 /-.A') C
J, j /
Contractor License #: up I J 7 X Building Permit
Single fa�ily
Multi -Family (No. of Units
Commercial (No. of Units
Public
Invasion into City *Right -of Way: [I Yes 21(01*'
*RW Construction Permit #
Cross other "Private Property: F� Yes
�� �No
"Attach legal description and copy of recorded easement.
Owner or contractor sig re and acknowledgement statement:
twl
y signing for this permit I certify that I have read the City's public handout entitled
Side Sewer Specifications, and shall comply with all City requirements outlined therein.
Date
9 CALL DIAL -A -DIG (I -800-0,�_ 5555)'BEFORE ANY EXCAVATION 2
9 FOR INSPECTION CALL 425-771-0220 extension7/320AW
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS
...... . .....
FOR OFFICE USE ONLY
Permit Fee S Repair Fee $ Issued Ely:
Date Issued:
Assessment Fee $ Receipt No:
City Permit Surcharge Fee F 045.00 Total Fees Paid $
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED..
Job Site Ready YES NO —Date: In'itial:
4FPartial Inspection: C --T Date:_4h��nitial: "124
P
Partial In.spection: Date: Initial:
F F
INAL INSPECTION APPROVED: Date: Initial:_,_�As-built to Street File: El
1,� PERMIT MUST BE POSTED ON.JOB SITEt,
White Copy: File Green Copy: Inspector Buff Copy:'Appi,icant
L;temp;bldgforms;sspermitjlg4/00
I �
W 0 ad _x
Covered
Porch
Garage
6'4" —
6" 2'
6"C/O �45 45' 4"'C/O
6" wye
connect to main
installed with
development
Private Drive
E,0* CITY OF EDMONDS SIDE SEWER AS- BUILT
0
Ki
ADDRESS HOMEOWNER
23701 80th Court SW Viking Properties In . c.
CONTRACTOR SCALE
Ming Properties Inc. NTS
DATE DRAWN PERMIT
6/16/2005 BY Nima M.Moghaddam NO. 9923
0
Covered
Porch
6"
6" C/O
Garage
6'4" —
K1
6" wye �,� V 4" C/O
6" X 4" Reducer
connect to main
installed with
development
Private Drive
Eo* CITY OF EDMONDS SIDE SEWER AS- BUILT
ADDRESS HOMEOWNER
23701 80th Court SW Viking Properties Inc.
CONTRACTOR SCALE
M
Viking Properties Inc. NTS
DATE DRAWN PERMIT
6/16/2005 BY Nima M.Moghaddam NO. 9923
0 0
Covered
Porch
Garage
6'4" —
6"
6" C/O t a
6" wye 4" C/O
6" X 4" Reducer
connect to main
installed with
development
Private Drive
ED* CITY OF EDMONDS SIDE SEWER AS- BUILT
0
23701 80th Court SW HOMEOWN
ADDRESS ER
Viking Properties Inc.
CONTRACTOR I SCALE
M
Viking Properties Inc.
DATE DRAWN
6/16/2005 By Nima M.Moghaddam
NTS
PERMIT
NO. 9923
0
.,Qc. 199V
City of Edmonds
Development Services Department
Planning Division
Phone: '425'771.0220
Fax: 425.771.0221
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 the application 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).
Date Received:.-',51 i I/ 0�2
CityReceipt#:_
Critical Areas File #: --2 OU-3-W20
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant: 4—//-03
A property owner, or his/her authorized 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 assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indernnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file )plicatio if e owner as listed below.
SIGNATURE OF APPLiCANVAGENT DATE
Property Owner's Author' ati
By my signatm, I cer* I authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for e public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATURE OF OWNER DATE
PLEASE PRINT CLEARLY
Owner/Applicant:
I —
"w 1J)/
14ame I
-2 5 4� 3 Z F
Street Address
1��w,1,4?5
city , State zip
Telephone: C11 !�g/
ze;3
Email address (optional):
Appficant Representative:
cq1&)
Name
1-701 Pc;cvi-rr—Av-;-
Street Address
city State zip
Telephone: 1Y Z!5' 7-570
Email Address (optional): johov,� oko-bi
V W
Critical Areas Chocklist.doci3.19.2001
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Ile 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 the application 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).
Date Received: 51 f V 1 0--�2
City Receipt#: - 1 2- I -to -:5 0
Critical Areas File #: -2-00-3 -002-1
Critical Areas Checklist Fe 0
Date Mailed to Applicant:
A property owner, or his/her authorized representative,
must fill out the checklist, sign and date it, and submit it
to the City. The City will review the checIdist, 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 forni. In
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, inderrinify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I cer* that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to 4filet *:splication qu*e behal
qfaf* owner as listed below.
SiGNATuRE oF AppucANVAG DATE 't>
jol
Property Owner's Autbo * ati
By my signature, I certt� I C authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for e public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATURE OF OWNER - DATE
PLEASE PRINT CLEARLY
Owner/AppUcant:
I —
"ea 'i rHCP4(4 V
14ame
F 5C
Street Address
4��vOW5
city state zip
Telephone: '�/' �"
Email address (optional):
AppHcant Representative:
Ile? A
Name
/ -77, / �/c;cy/ -rr— )4c/-;:-
Street Address
city State zip
Telephone: 7-572-
Email Address (optional): )oh4lv 1.) oko-bi
U W
Critical Areas Checklist.dor/3.192001
City of Edmonds
Development Services Department
Planning Division
Phone: '425'771.0220
Fax: 425.771.0221
The Critical Areas Checklist contained on this forin is to
be filled out by any person preparing a Development
Permit Application for the City of Edmonds prior to
his/her submittal of the application 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).
Date Received: '51 f V I "
City Receipt#: I 7-i
Critical Areas File #: Z—cr-)�3 — 00z -2-
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicaft. 0'-jV--eZ3
A property owner, or his/her authorized 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 detertnination 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 assistant staff
in completing their preliminary assessment of the site.
Ile undersigned applicant, and his/hff/its heirs, and assigns, in consideration on the processing of the application agrees
to release, inderrmify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or. part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I cer* that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file t is plicati b h e owner as listed below.
to 4filet -:s
SIGNATURE oF AppucA�w/AG DATE
or.
Property Owner's Author* ati
By my signature, I cer* I authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for e public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATURE OF OWNER DATE
Owner/AppHcant:
14ame
�� 5 C 3 Z
Street Address
4;6W,1A14?5 V-4
city State zip
Telephone:
Emafl address (optional):
Applicant Representadve:
17�,6
ZqSh
Name
/ -77, / Alc;evi Tr— .4a-;;'
Street Address
city State zip
Telephone: qZ 5' - 7-570 - 2-650
Email Address (optional): joht-yj p A-bi --Lw/1,CZ>JW_
V W
Critical Areas Checklist.dorJ3.19.2001
*ILE NO.
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soil s/topography/hydrol ogy/vegetation)
1. Site Address/Location:
2. Property Tax Account Number: /7
3. Approximate Site Size (acres or square feet): 3S. 2/�?
4. Is this site currently developed? _&-:'O' s; no.
ye
If yes; how is site developed? 5/77s eN _Q5- AMT10,41 d/_= J0Ai4VVX_
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 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
I 0-feet over a horizontal distance of 3 3 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: AQA1,c— Approx. Depth:
7. Site contains areas of seasonal standing water: Ajgg6jZE_
—;Approx. Depth:
What season(s) of the year?
8. Site is in the floodway Ajjq floodplain A16 of a water course..
9. Site contains a creek or an area where water flows across the grounds surface? Flows are.year-
round? AI&Vd��_ —, Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs :mixed
urban landscaped (lawn,shrubs etc) (;U7W t;6,5_c--
.7V
11. Obvious wetland is present on site: AdAlzc_�
------- 7 ------------------------ — -------------- — -- — or City Staff Use OnlY ------- — 7 -----------
1'. Site is Zo . n I edl.
A
P..... . .......
SCS mapped soil type(sr
Wetlan d in.yentory.oi C.A. map indicates w etland present on sited?
74. Critical Areas* inveriior'y or iC.A. map indicates Critical Area on sitle� /V
5. Site within desigpated earth subsidence landslide hazard area? No
6. . 8itt designated on the Environmentally Sensitive Areas Map?
CONDITIONAL WArvTR.:
11a_chk.doc; Rv 10/03
Ll
City of Edmonds
RECSIVED
jAN 0 6 1999
COMMUNITY SEWCES
CRITICAL AR* EAS.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 completd-.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).
O,wner/Applicant:
. —7—oovu A'
Name
Street Address
Applicant Representative:
Name
Street Address
hs A) 4;1
city State Zip city State Zip
q2
Telephone Telephone
S i g nt�,e Signature
Date
-..q ;F; __�
A or
E.Djo,_
Firm
WITH TRACER WIRE @ 2' DEEP
CITY OF EDMONDS WATERLINE AS -BUILT
ADDRESS HOMEOWNER
23701 80TH COURT SW I VIKING PROP.
CONTRACTOR
CAJUN EXC.
DATE
7/26/05
DRAWN
BY 1. ABILA
SCALE
NTS
WATERLINE
NO, 2004-1026
A
WNERICONTRACTOR IS RL90NSIBLE
FOR EROSION CON1,7101- AND DAMAGE
ALL EXPOSED SURFACES TO
BE COVERED WITHIN 2 DAYS
9.44' tRO-S) _j
............
MAINTAIN PLAT_ 77\
lg
rAMILY
DENCE
lthl COURT W."�rrr
iN
1 51. 914'
At
2 .00, C
... ..... ..... f?* ... .....
-A _-� veff
_r�lz dl.
4".
��s rx C,
CP
CO 0)
CD
36W
�22 0
SINGLt FAMILY
RESIDENC
23701 a0th COU T W.1
A Dlrlp,�
1z'
SINGLE FAMILY
RESI ENCIt
2�703 80th. COORT
d- 3 7
c 7�&<-ol )l 0 )L 5-
imiusi
Poll
-,�,E 1"=20'
0. 10' 20'
LYNNWOOD, WASHINGTON 98046 u-v
PHONE : 425-670-2711 vr�Fo
WATER & SEWER PLOT PLAN OCT
BENCH MARK INSPECTIONS REQ'D. * FOR PAl
AL 425-7 l' 1326 C17Y SAIr S�,qV,
THE PROJECT BENCH MARK IS THE CONIC L6 v
MONUMENT IN CASE LOCATED AT 'ME VIKING HEIGH7§61'2"ss c r8
CENTERLINE OF 238TH STREET S.W. AT
APPROXIMATELY THE MIDPOINT OF THE IN SEl/4, SECTION 31, T.27N., R.4E., W.M.
PROPERTY. CITY OF EDMONDS
ELEVATION : 200.00 SNOHOMISH COUNTY, WASHINGTON
��g_
C
6 ACUCEPTADLE T IGHTLINE
MATERIAL
SDR 35
OWNER/CONTRACTO CH 40
VIKING PROPERTIES, INC.1 - 12 w
P.O. BOX 1034 F-810 HANCOR
DATUM : ASSUMED
APPHOVED AS NOTED
BY ENGINEERIN
Date:
�111§11111111112 Lovell—Sauerland & Associates, Inc.
En&eers/Surveyors/Planners/Development consultants
L-IIIIIIIIIIIIIIIIIII N 0 if.01mgiamming.e. - web: Lengineering..,
IUM 33rd Avenue T, -Suite 200 Lynnwood. TA 98M - (425)775-15M - (44)TM-M fax
MUN pm ru NO.
JTT JTT 3.6 3 20' 14656-0-04
a
Z9 20K
co r-,+E .1
W451900-jO1803
L;ND H'-LM\C CC-
Al2FA-% nETWEEN BUILDINGS--
Ebded Cwb
fill
C.
G
LAKD RM11ING CO-
qW19001001M,
INW51
TAMARA
ALL/ PLANTING AREA5;
S BE PLANTED
W 1RUND COVER
P L
LEGEND (TYP)
I HIGA-BURKHOLDER
ASSOCIATES, LLC
LAND USE PLANNING I CIVIL ENGINEERING
1721 Hewitt AvWmM a Suite 401 0 Everett, WA 95201
phone (425)252-2M fox (425)252-9551
IN 2.4 ME.,,
00452000--Mt
PA---q4;' sm
. as--e zom
OrAmoorm
It.Nn & DE
Km
td
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0046ZU003
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, -4520i
scoTr I
,238 TP-gq SW
- ------------------
LIU Q ASSOC14TES
4962746
REPORT
PAILY FIELD
J1)1J-lq0--
Field Hep,
r,agi:
LIU & ASSOCIATES, INC.
4AO814:
J. L;u
1 of
7
Priginec6q. Engineering Oeology & Eanh Scieric-
Miles
77re =nG—
na
26
2�35A
4/113/2005
T;-Air.
19213 Kentake Place NF.
Travel Time (Hrs)
7—me Off Site
Weatner
Kellillore, Washington 0028
1
3: 5 P
Sunn to portly
Cloudy
Plivile: (425) 483-9134 Fax: (425) 486-2746
Vehicle Krs o!i SiFe-
-R7,s-TU5—i—g-G0'
isitors
-
11.5
7E Locatiloll
Client
Lots 20 ti-1 h 24 - Sunrise Ridge_ 80xx - 238th Street SW, Edmords Vikin Properties
General Contractor General r6-niractoTTiperinferident Received Unchecked ry
ViKing Prop� �Ies 'red Coleman F*
-t'iWhwork Contractor Earthwork Contractof Supt.
Calun Exsavating
At the request by Ted Coleman with ViKing Properties, I corne on site to verify the footing bearing soi;s 'Or the
i)ouses to be built on the subJect lots. At the time of my site visit the footing trenches on these lots have. all bccn
excavated out down to the footing lavel, No groundwater seepage or standing water is observed within the sur.ject
lots. Some loose disturbed soils have fallen into the footing trenches, and it) pla(' eg 3 thin layer of soils over the
bottcm of the footing trencEes is disturbed by the scraping of the backhoe bucket.
The footing trenches are cut down about 2 feet below existing grade into brown to light -brown structural fill of silty
firic sand with a trace of gravel. A steel T-bar manually pushed iito the footing bearing soils can penet,ate tic more
than 4 to 6 inches into the undisturbed footing bearling soils, indicating the soils are mediLlm-dense to dense.
I inform Bob, the foreman with Viking Properties, that the loose tlil layer of soilis disturbed by 0ackhoe oucket
should be compacted to a non -yielding state with a vlbWory mechanical compactor. If the above recommeroations
are followed, it is my opinion that the footing bearing soils will be able to , ender an allowab'e bearing c.:3paclty cf at
least 3;000 psf.
RECEIVE:[)
APR 2 12005
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
q� 1.3 t 09
�Wwy
1) Ted Coleman/Viking Properties 2) on Il
3) 4) Page
O-\ASol
OWNER/CONTRACTORJS RESPOBLE
FOR EROSION CONTROL AND DAMAGE., Co 0/- 0,
ALL EXPOSED SURFACES TO
BE COVERED WITHIN 2 DAYS T
r
C
9. �4' rR OS) — i I I .
. . . . . . . . . . . .
51.9,
1 1 1
�2 '3
51.9�4'
CP
At 0
C%) (51
.0 8' (p I
0A It 2,3 , I 1�- �
0(
....... ..... ..... ? . ' .....
At 7L
CIO 0�.
C
rAMILY
DENCE
lth I COURT W.
14
mp
C
V5-�39'
.0
88� I -'�20
5. LO
SINGLL FAMILY
8
RESIDEN
`2 C�
CO
23701 80th ( �U'T W1
A D
ic
SIN LE FAMILY
RESIDENCIt I
2�703 80th COO I RT \V.
3 7
0 �- 5-
1-_,N
(Ovr�-JQ
q 6 ACCEPTABLE TIGHTLINEN j 67 tj
MATERIAL
SDR 35 f�.j CQEY: 1"=20' zCO3
OWNER/CONTRACTIBN 40
W
MKING PROPERTIES, IN(N. 12
P.O. BOX 1034 &�614COR 0' 101 20'
LYNNWOOD, WASHINGT4
PHONE : 425-670-2711
& SEWI:K ,,, ill 1. 4)
INSPECTIONS REQD. PLOT PLAN C�l I
I -At I A94.771-0220 EXT. 13126 . DELIZ, 6 29m,
BENCH MARK r m Op4fEAir Sp
THE PROJECT BENCH MARK IS THE CONCRETE C/ r �8VICSs CT'R
MONUMENT IN CASE LOCATED AT THE LOT 20, VIKING HEI
CENTERLINE OF 238TH STREET S.W. AT
APPROXIMATELY THE MIDPOINT OF THE IN SE1/4, SECTION 31, T.27N., R.4E., W.M.
PROPERTY. CITY OF EDMONDS
ELEVATION : 200.00 SNOHOMISH COUNTY, WASHINGTON
DATUM : ASSUMED
APPROVED AS NOTED
BY ENG�!NEERING
Do—
�VNM Lovell—Sauerland & Associates, Inc.
Eneneen��eyon/Pl�&nners/Development Consultants
L�Ill Ill e-mak info@lmen&eaiag.com - web: Ismengftmring.com
IRM 33rd Avenue T, Suite 200 LYnnvoodL TA 98M - (425)775-1591 - (425)672-7998 fax
DRUN I CM== I DAM �FJL W" No.
JTT JTT 3.6.03 1 1.= 20' 1 rU465.6-0-04
L
7DATE RECEIVED
PERMIT EXPIRES
OSE PERMIT
CITY OF EDMONDS ZONE NUMBER C��_IZW4�
JOB SUITE/APT
CONSTRUCTION PERMIT APPLICATION ADDRESS
'9 W h,*ME/NAME OF B &7IJ SU
711, N Nqus`rf r3 oaf ies, rE/ Dl�SIO LOT NO. LD NO.
NG AD L�D FEE $
TESCP Approved
PUB1UCFkQ RW Permit Requir d
c
Street Use PermiteReti'd
ITELEPHONE EXISTING PROPOSED Inspectio Required
ZIP SidowalknRequired
UnderWound
RE 41" FT I vvinng r uww
NAPq METERtIZE LINE SIZE NO OF IXTURES PRV 7QUIRED
z
41 72 YEbg NO 13 z
ADPSS REMAR 8 z
NER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLJORAINAGE
C)
TELEPHONE
444<� -7,484,aSW ./-eAK
'M
NA
I? mat,
q"41 N�lj BY DATE
AWESS
T1 -1 P. M&A
_.il. .4 ALr
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PLAN CHECK NO: VE ED felumbAg-1 C *29" Base Fee
Mechanical
THIS PERMIT AUTHORUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC Grading
a
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION. Engr. Review
2
.9 PERMIT APPLICATION: 180DAYS
AL PERMIT LIMM I YEAR _ PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Rre Review Plan Chk. Deposit ;2 5?
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
a EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY OtN 7
FROM THE ISSUANCE. OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. I IlTotal Amt. Due �A
0 V
,I NOR LIMIT IN ANY WAY THE criys ABILITY TO ENFORCE ANY ORDINANCE PRO ISION.' Recording Fee Receipt #
1 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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S
,rAV.,PENSATION INSURANCE AND RCW 18.27. S SIGN URE DAT
SrJUIR40�WN AGE�yl DATE SIGNED (425)
771-0220
6t)61BY
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE - YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER - GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES