23706 80TH CT W.PDF111111111111
7233
23706 80TH CT W
060
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
Lfl- 7 Un-
CRITICAL AREAS ) 2� - Z�j j DETERMINATION: Conditional Waiver E] Study R
equired)<Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: L T: BLOCK:
SIDE SEWER AS BUILT DATED:— Ag— X. S--'
SIDE SEWER PERNUT
(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERM[IT
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DST's\Fonrts\Street File Checklist.doc
� it.
PERMIT NO: 9925
City o.f Ec Lon s PERMIT EXPIRES
1") C. I SIDE SEWER PERMIT.
Address of
1_51r
Property Tax Account Parcel No. 14ev-16-A? 491 e�=47 ev
Attach copies of all access and utility easements Verified and Approved b
Owner . a \ n'd/orContract'or: 'V11_k1--17z1F Z, 4f
ContractorlLicense #: 1// 1:4zAze .1 ? 73 6: 1�uilding Permit#:
Peosooingle Family
Fj'Multi-Family (No. of Units,,
F� Commercial (No. of Units
F_j Public
invasion into City *Right -of Way: El. Yes -E3-1qo
*RW Construction Perrnit�'#
Cross other "PrivaO Property: Yes ;21�<
"Attach legal description and copy of recorded easement.
Owner or co�tractor signature 'ah/acknowiedgement statement:
y signing for this permit I cerffy that I have read the City's public handout -entitled
ide Sewer Specifications, and shall comply with all City requirements outlined therein.
Date
9 CALL DIAL -A -DIG (1-800 42,-5555) BEFORE ANY EXCAVATION 9
.9 FOR INSPECTION CALL 425-771-0220 exten'sion,
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
NOTE: IF JOB SITE ISNOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES, A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO' —Date: Initial:
Partial.Inspection-
Partial Inspection:
Date Initial?--Z-
Date Initial:
FINAL INSPECTIONAPPROVED: Date Ini As -built to Street File: E]
. t4��
PERMIT MYST BE POSTED. 014 JOB SITE t,
White Copy: File Green Copy: Inspector Buff Copy: Applicant
L;temp;bldg;forms;ssperTnitjlg4/00
k 1 0 0
1
7.4'
9.4' 45* Bend
Conn from
ABS to SDR-35
. 3'deep
45* Bend - 3" ABS - 1'deep
45* Bend - 3" ABS - 2'
Under construction patio
4" C/O U/G @ 3'deep
6" C/O @ grade / 5'deep
To Main
6' Stub w/ 6" - 4" Reducer
E.D.4 F EDMONDS SIDE SEWER AS- BUILT
CITY 0
01-
All, <::> ADDRESS HOMEOWNER
23706 80th Court SW Viking Properties Inc.
ICONTRACTOR SCALE
- Cajun NTS
M
DATE DRAWN PERMIT
6/3/2005 BY Nima M.Moghaddam NO. 9925
a
.4 C. 1 819�
0
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: 0 ---12
CityReceipt#:_
Critical Areas File#: ----100'-3,-JW2-0
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant:
A property owner, or Ins/her authorized representative,
must fill out the checklist, sign and date it, and submit it
to the City. The City will review the checklist� make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed copy
of this form to assist City staff in fiiiding and locating the
specific piece of property described on this form. in
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, inderrmify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I cer* that the information and exhibits herewith subn-dtted are true and correct to the best of my
knowledge and that I am authorized to file t is plicat3o owner as listed below.
to 4filet -:s
SiGNATuRE oF APPLicANT/AG DATE
tio;Property Owner's Author* ad I
By my signature, I cer* I C authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for e public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATME OF OWNER DATE
Owner/AppHeant:
I —
"OL�J 'J _) / rH)CPA�$
14ame
2:5 C3 Z F -!5c�
Street Address
4;�DvOA1495 V14
city State zip
C,
� 17 44;5
Telephone:
Email address (optional):
AppHcant Representative:
Name
1-77, 1 Hc;-,-2-rr— Acl-;-
Street Address
qT—
city State zip
Telephone: qz5- zi5-0 -22�0,c
Email Address (optional): )ohry okp-bs
V
Critical Areas Checklist.doc/3.19.2001
City of Edmonds Date Received: 2119
Development Services Department City Receipt#:
Planning Division Critical Areas File #: -7003 -602-1
Phone: Critical Areas Checklist Fee: 45.00
Fax: 425.771.0221 Date Mailed to Applicant 3
Ile Critical Areas Checklist contained on this form is to
be filled out by any person preparing a Development
Perrnit 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).
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 conjimction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
Ile 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 file plication gu#e behajf"e owner as listed below.
SIGNATURE oF AppucANT/AG
Property Owner's Autho * ati
By my signature, I cer* I authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permmission 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:
A,V OW 'J rAP-040 ZJ
14ame I .
-Z 1; C3 Z Y-4!
Street Address
16;6"A/95 V-4
city state zip
Telephone:
Email address (optional):
AppHcant Representative:
Name
-77, Aa;r
Street Address
qT—
city State zip
Telephone: q�Z!T - 7-5-2- -2S:52 IC
Email Address (optional): )ohry,� o4p-bt
U W
Critical Areas Checklist.docJ3.192001
0
is
City of Edmonds
Development Services Department
Planning Division
Phone:
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 pwpose of the Checklist is to enable City staff to
deterniine 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: 311 V I 0-�;,
1 7-7
City Receipt#: I
Critical Areas File #: ;—;, cr-)�3 - 00Z -2-
Critical Areas Checklist Fee: $45.00
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 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 hisAher/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, misleadmig,' miaccurate or
incomplete information fumished 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) finle s pli ti 4e behal e owner as listed below.
ZZ
SIGNATURE oF AppucANT17/AG 7
hor_
Property Owner's Author' ation/
By my signature, I certify I authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for =epublic officials and the staff of the City of Edmonds to enter the subject property for the
purposeg of inspection and posting attendant to this application.
SIGNATURE OF OWNER DATE
PLEASE PRINT CLEARLY
Owner/AppHcant:
"O�q 'J ) /
Name
2 �
Street Address
t;�PvOA/95
city State zip
'c
Telephone: "" 11
Email address (optional):
Applicant Representadve:
Name
-77, / Hc;c-)i -rr— Avar
Sftwt Address
e1r- 621T
city State zip
Telephone: 1Y 7-570
Email Address (optional): ohl-P okp-bt -550,a>x,
Critical Areas Chocklist.doc/3.19.2001
No.
Critical Areas Checklist
--------------------------------------------------------------
Sit� Information (soils/topography/hydrology/veg��ation)
N-7
1.
Site Address/Location: POO-,L 234,744 S2 sw.
2.
c a /9,7
Property Tax A count Number:
3.
Approximate Site Size (acres or square feet): 3S.
4.
Is this site currently developed? —,��Yes; no.
If yes; how is site developed? /JaMca— fj77s gPN -S,6- AX7�-
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 30% ( a vertical rise of
I 0-feet over a horizontal distance of 33 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: AlMgsr Approx. Depth.
7.
Site contains areas of seasonal standing water: A&A11'-- Approx. Depth:
What season(s) of the year? A144
8.
floodplain
Site is in the floodway of a water course.
9.
Site contains a creek or. an area where water flows across the grounds surface? Flows are -year. -
round? AVIV255— — Flows are seasonal? (What time of year?
10.
Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc)' &11 7--A� 7V
7
11. Obvious wetland is present on site:
------ — --------------------- --- — ---------- --- — ---- For City Staff Use Only ----------- .... . .
Siteis-Zoned?
A
V
9C8 Tnapped soil type(s' , IL A
UWIL, 24
Weiland inventory or C.A. map indicates wetlan* d present on site)
j e inv ntory
4. Critica Ar*as'- 'e* or iC.A. mdl5'Mi*dicaies Critical Area on site�-*Nb
:Site within designated earth subsidence landslide hazard area? lip
6. Site designated on the Environmentally Sensitive Areas Map?
DETERMINATION
)D.Y REQUI.RED
ke v*iew*ed by:
^u-chk.doc: Rev 10/03
0
E
City of Edmonds
RECSIVED
JAN 0 6 19909
COMMUNITY OWES
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 oobservations 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 complewa,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 ans:wers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
I
Toycd A
Name / .
Applicant Representative:
Name
-Y
Street Address
Street Address
city State Zip city State Zip
q
y-Z
Telephone Telephone
Si' n
9 Signature
--4Dafe Date
(over)
City of Edmonds
'07 1 SIDE SEWER PERMIT
Address of Construction
Property Tax Account R
Attach copies of all access and utility easements Verified and Approved by
Owner and/or Contractor: e, P?,A 4g��- bg tA
Contractor License V1 Al P J/ k'jeil Building Permit
�/Single. Family Invasion into City *Right -of Way: El Yes E o
F� Multi -Family (Nd.. of Units *RW Construction Permit #
Commetcial(No. of Units Cross other "Private Property: El Yes E50NO
Public ."Attach legal description' and copy of recorded easement.
Owner/Contractor
w er oi`co�trktor sign e and acknowledgement statement: Date
y signing -for this per J. certify that I have read the City's public handout entitled
Side Sewer Specifications, and shall comply with all Cityrequirements outlined therein.
9 CALL -DIAL -A -DIG (1-800-41.4-5555) BEFORE ANY EXCAVATION 9
9 FOR INSPECTION CALL 425-771-0220 extensioril-3a6miX
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REOUESTS
... ... FOR OFFICE USE ONLY'
..........................
. . . .........
Permit Fee $ Repair Fee$ Issued By:
Date Issued: lea
Assessment Fee $ ....... Receipt No:
City Permit Surcharge Fee 0.00 Total Fees . Paid $ -7
z
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: Initial:
iFPartial Inspection: k1ja C-:T jjjtMk&jje eL Date: Ohio /6�-Initial:
Partial Inspection: Date: Initial:
IF1 I NAL INSPECTION APPROVED: Date: I Lgjo!� Initial,: As-bui It to Street File: E]
-t� PERMIT MUST BE POSTED ON JOB SITE 1.
White Copy: File Green Copy: Inspector Buff Copy: Applicant
L;teinp;bldg,forms;sspennitjlg4/00
PERMIT NO: SM
.PERMIT EXPIRE
E
-1 () F ED,,,�,_
4
- .11,
4" C/o
@ 4'deep
4" PVC
Connect to main
installed with development
Private Drive
CITY OF EDMONDS SIDE SEWER AS- BUILT
A
C:5 ADDRESS HOMEOWNER
23707 80th Court SW
Viking Properties Inc.
CONTRACTOR SCALE
Viking Properties Inc. NTS
DATE DRAWN PERMIT
6/16/2005 BY Nima M.Moghaddam NO. 9918
,a ��'D 6 57(ot-n- a SLA-)
ALL EXPOSED SURFACES TO
BE COVERED WITHIN 2 DAYS
FAMILY b-1
CNI
-110)60-
0i
I
DQNCE
)th COURT W
-
l/CONTllACl-0R
IS".
ESPO
Sk
FOR EROSION CONP" ND DA
AIG
1'21'37" W
16.'50'
6-50*
MAINTAIN PLg INSKIE ER --/-I)
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0100-1111
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1.50' _ 1000
19'41'37" w I
-46.50'
L50- m
� 8
SING�E FAMILY
RESIDEUCE
237 =. W
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N �A'2173 7" —W
17
SINGLE F
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;NN CITY PERU., COUA
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MATER 41 xcotjlv
SDR 35 TER
OWNER/CON TRACTOR SCH 40 SCALE 1"=20'
VIKING PROPERTIES, INC. N-12 w E
P.O. BOX 1034 F810 HANCOR 0. m D
LYNNWOOD, WASHINGTON 98046 10, 20' R4V SIVS
WATER s� SEWER
PHONE : 425-670-2711 INSPECT" 1. hjS REQ'D. PLOT PLAN
ICES CTR-
BENCH MARK CALL 425 77,1-0220 EXT. 1326 FOR SERV DS
I)EVELOPMEON1 EDVAON
THE PROJECT BENCH MARK IS THE CONCRETE
MONUMENT IN CASE LOCATED AT THE LOT 17, VIKING HD6479
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
�ffim% Lovell— Sauerland & Associates, Inc.
APPROVED AS NOTED &Wn--/S—eyo-/Pl-n=/Developmeut Consuitants
41�11111 E e-mud- infog'saengineering.com - web: L-Aeugineering.com
BY EERING 19M 33rd Avenue T, Suite 200 Lynnwood. WA 980M - (425)775-1591 - (425)6n-7998 tax
242=9 -- —
DRAWN EMMD I DATE FJL WALK FU No.
Date: r JTT JTT 3.6.03 in = 20- 4656-0-04
LIU ASSOCIPTES 4862746 P.01
DAILY FIELD REPORT
JC0 NO
ID r�l
ASSOCIATES, INC. 4AO85 J. LiLl 1
(koh:01lic,9! Engineering. Fr�ginceiivv (Jcllog.� & l:ni*jh.� I
VITGs y 0i
26 11 JOA 2!18/2005
19213 Kenlake Place NE J ravel Tirra �Wrs) __ W76�Tur
Kenmore, Waqh;ngton 98028 11 2:30P St.in2L
77i,�
Phone: (425) 483-9134 Fax: (4-151486-2746 Vehicle Hrs on SUF-rs' haig
-rroject i — 1 1.5
Tot) Location
Lots 14 thro lient
19 - Sunrise Ridqe 80xx - 238th Strer,�', Sv`�, C-drnonds I kinq Properties
V!
�,i—Iv—ed Unchockc,.i 13y
GcFneral —Contractor — C;eneril Contractor SuPetintendent— R
-Miking Properties Ted Coleman
6hhwoik Uontraeor Earthwo rk- Con tra-W Tu—pt-- 7kecolved Z%7e7k3 -d-__
C y
Cajun Expavatinq
At the reoliest by Ted Coleman with Viking Properties, I come on Site to verify the footing bearing soils for the
h0dses to be built on the subject lots. At the time of my site visit the footing trenches on these lots !Iave all be -on
excavated out down to the footing level.
'T'ne footing trenches over about the eastern halves of the building footprints aT. Cut il)tC light -gray, gravelly, silty fine
s s
ind, while the footing$ over about the eastern halves of the buildirg footprints are cut into brown s0ty fine sand',
A stcel T-bar manually pushed into the footing bearing soils can penetrate no more then a couple U incriecQ into the
grAy Qrave!ly silty sand, but --an penetrate up to about 8 to 10 inches into the brown silty sand
I ir-form Bob, the foreman with Viking Properties. that the loose disturbed soils pushed into the footing trenches
S1101,11d be removed. and tne surficial brown silty fine sand in 'he footing tren&ies over abo�ft the eastern na;ves ol thL,
building footprints should be compacted to a non -yielding state with a vibratory rnechanical compactor. if the abovc
are dome. it is my opinion that the footing bearling soils will be able to render an allowable bearing capacity of at le�jst
3.0,00 psf
RECEWED
FEB 21- 8 2005
DEVELOPMENT SERVICES CTR
CITY OF EDMONDS
1) Ted CclernaniViking Properties 2) on Next
4) parle
0
ALL EXPOSED SURFACES TO
BE COVERED WITHIN 2 DAYS
Z-
8
FAMILY N -01 SINGLE
co 0: 1 SING�E FAMILY
DF�NCE dj: I 9N RESIC
RESIDEUCE -9 0 >- -q-
'11I - < 23705 80t
L - W. 0
aVVNER/C00w& 8A R -�POR 237
A
qp DA IE"'a ve�'
FOR EROSION 00`1� A
6.50'/, - 0.
'21'37" _A
T05-0 7 Q- N 8
6.50- Rp
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MAINTAIN PLAT, &STALiED'QIOSIp/N L
B
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0 .17
7
- FAMILY FN 0 SINGLE FAUILY 8D SINGLE
00 C?. 8
DENCE c8 F3.Egil
-/ W. C3 RESIDEN�i 771')
h COUR -23-707 809
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ACCEPTABLE 1IGHTLINE
ID t —MATERIAL N
SDR 35 S7RE COUNT'CR
SCH 40 SCALE 1"=20'
OWNER/CONTRACTORN - 12
VIKING PROPERTIES, INC. F81 0 HANCOR w E
P.O. BOX 1034 0' Eli D
LYNNWOOD, WASHINGTON 98046 10' 20' 4R C AM V
S
PHONE : 425-670-2711 WATER & SEWER PLOT PLAN OCT 2 0 2004
BENCH MA I RK INSPECTIONS REQ'D. FOR DEVELOPMENT SERVICES CTR.
THE PROJECT BENCH MARK IS THE cog&425-771-OV-0 EXT. 1326 CITY OF EDMONDS
MONUMENT IN CASE LOCATED AT THE LOT 17, VIKING HEIGHTS
CENTERLINE OF 238TH STREET S.W. AT
APPR - OXIMATELY 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 �INEERIN42
Date:.----.- I Wj44
I
Lovell — Sauerland & Associates, Inc.
&wneers/Surverrs/Planners/Development Consultants
L�E 0 =a- inholsa-gineering.com - web: Lsaengineering.com
19" 33rd Avenue T, Suite 200 Lyn"00d, WA MW - (425)775-1591 (425)M-'M8 fax
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NWLAND USE pLANNING I CIVIL ENGINFERING
1721 HavAtt AVWMG Wts 401 111 Everett. WA 9521M
phone (425)252-2=6 fox (425)252-9551
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
PR.fff/N�ME OF BUSI*%S
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side..", Required
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METERfIZE
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,;REE Description FEE
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Plan 9heck
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State Surcharge
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PLAN CHECK NO: ST7 D
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15,
,,Plumbing"
Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
a
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: ISO DAYS
PERMIT LIMrP 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
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
.2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt # Z*171
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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
Landscapelnsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fe
Receipt #
I 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-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Oificial or his/her Deputy: and Fees are paid. and
IN VIOLATION Q�E LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTIO receipt Is acknowledged in space provided.
WORKMEN'S 91%11PEN�NTION INSURANCE AND RCW 18.27.
_gTDATE
LS SIG LIFE DATE
SrIA RI WN GENTI // SIGNED
(425)
771-0220
L ED DATEF
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ATTENTION
M 1333
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IT IS UNLAWFULTO USE OR O411UPYA BU I WING OR STRUCTUR E UNTILA FINAL
jr A J A
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I NS PECTI ON HAS BE EN MADE AN D AP PROVAL OR A CERTI FI CATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
ORIGINAL -FILE YELLON- I�SPE(CTOR
PINK -OWNER GOLD -ASSESSOR
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