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ce P-ERMITNO: 9212, -
of Edi�onds
ity. PERMIT EXPIRE
SIDE SEWER PERMIT
Address of Construction: 02_'_N'7 5� j 11 AUE LED #
Property Tax Account Parcel-No.31 2. ?64 '001
Attach copies of all access and utility easements 'Verified and Approved by
Owner and/or Contract6r-.'r(5 M JR ts
Contractor License 'MM Building Permit #:
Single Family
n Multi -Family (No. of Units
El Commercial (No. of Units
Invasion into.City *Right -of Way: El Yes No
*RW Construction Permit #
Cross other.* *Private Property: El Yes XNo
Tj Public **Attach legal description and copy of recorded easerent.
A C)n
N A�^ 'Owner/Contractor
nA nva Date
Ow er or contr tor sig ture and acknJwledgement. state'ment:
-By signing for this permit I certify that I have read the Cit"s public' handout entitled
y
Side Sewer Specifications, and shall comply with all City requirements outlined therein.
*2 CALL.DIAL-A-DIG (1-800-425-5555) BEFORE ANY EXCAI/ 10A
FOR INSPECTION CALL 425-771-UN extension 329 9
24 HOUR NOTICE REOUTRED FOR ALL INSPECTION REOUEST.S TREATMEN
T PIANT
......... .. . .... ... . ...............
'FOR OFFICE USE ONLY
. ........... .
Permit Fee$ Repair Fee" $ Issued By:
TrunkCharge.$ Datelssued: QQ
Assessment Fee $ Receipt No: (o2Q
City Permit Surcharge Fee $5.00 Total Fees Paid $ �00.
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 R.&INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO -Date: Initial:
Partial Inspection: y,,") Date: 1016 Initial: .5,41
Partial Inspection: Date: Initial:
FIN . A L INSPECTION APPROVED: Date: Initial: C-C As -built to Street File:
t� PERMIT MUST BE POSTE D ON JOB SITE T,�
White Copy: File Green Copy: lnspe�tor Buff Copy: Applicant
L;tcmp;bldg;forms;sspenniijig4/00
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the -map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
P
The City of Edmonds Side . Sewer Drawing EASEMENT NO . ................. ..........................
NEW CONSTRUCTION REPAIRS LID NO . .................. ASMT. NO . ..................
OWNER ........................... ............. ...................... ........... ........... ..................
CONTRACTOR ...... ........................................ PERMIT NO.
JOB ADDRESS ....... LEGAL DESCRIPTION: LOT NO . ........ — . ................ ........ BLOCK NO . ................ ...................
............................................................................................. .................... ...... ...... .
;,. jp&LIMER --- ---
. CV,' S VATiON I
. rV77'
NAMEOF ADDITION ............................... r ........................................... .... .................. ...
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Approved:
L AV -"Y . .............
PWW-000 I - 11175 (R EV. 11178) DATE ............... ........... . ...............................................
RECEIVED
APR 2 2 1999
City.of Edmonds PERMIT COUNTER
CRITICAL AREAS CHECKLIST
The Critical Areas Checklist coritained on this'f6rm 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 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 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 answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
cc
Name
Street Address
'�"s W 0-�- ,
City State Zip
DGG- r,50 - 7 a-o'�-O—L
T ele
:7 one
,&jWat e
L6 &
Date
Applicant Representative:
Name
Street Address
city State Zip
Telephone
Signature
bate
(over)
c:reception�anakacl.doc
CA FILE NO
Critical Areas Checklist
--------------------------------------------------------------
Site Info rtn.ation�.(§,oil s/topography/hydrology/ve getation)
1. Site Address/Location: -3 3
2. Property Tax Account Number: "7 001 ov
3. Approximate Site Size (acres or square feet): q 7, 000
4. Is this site currently developed? 4C yes; no.
If yes; how is site developed? 0 Y\SZ— 15
5. Describe the general site topography. Check all that
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 3 3 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:
7. Site contains areas of seasonal standing water:
What season(s) of the year?
; Approx. Depth:
; Approx. Depth:
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? Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs , etc)
11. Obvious wetland is present on site:
%a_chk.doc� Rev 10103/97
FPERMITEXPIRES -7/r�"/,)L
CITY OF EDMONDS
... PERMIT
Z ONE,
NUMBER
CONSTRUCTION PERMIT APPLICATION
J013 SUITE/APT
ADDRESS
Au D
OWNERNAME/NAME OF BUSINESS
LEGAL DESCRIPTION C54K
SUBDIVISION NO.
LID NO.
ul
MAILING ADDRESS
0
?2, J `�4
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — REQUIRED DEDICATION
TESCP Approved 0
RW Permit Required 0
Street Use Permit Req'd 0
CITY ZIP
TELEPHONE
7,90 Z_ 6
14L V262 3XV
Inspection Required 0
Sidewalk Required 0
PROPOSED
NAME
o vi r
METER . §IZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YE NO
ADDRESS
REMARKS
z
�z
2
y I 0
1;eg
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1., 1" Ifl, ms Prrzuk�
4
CITY ZIP
muY,ILT10 .
TELEPHONE
1
4-)
ul
hziknq Zia im r Pj AnIhOl Cl) 54-'SrhM
NAME
ENGINEERI� REVIEWED BY
c:
ADDRESS
FIRE MEMO DATED REVIEWED BY
w
0
cnt —3 LL4
tK
LL
z
CITY ZIP
TELEPHONE
VARIANCE OR CU
ADB
SHORELINE #
0
STATE LICENSE NUMBER EXPIRATION DATE
Lf
CIj1iGKE0W#iii
SEPA REVIEW
SIGN AREA
HEIGHT
(
AAJ
IT"t'
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED , PROPOSED
Z
LEGAL DESCRIPTION OF PROPERTY -INCLUDE ALL EASEMENIS
I'_
2:
_12
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
2'�, 622'
1,
2"/ 1 A -1,
z
PROPERTY TAX ACCOUNT PARCEL NO.
_j
<
z
/DATE
a
W
0 00
LOT AREA
PLANNING REVIEW BY
—4-001
t
RESIDENTIAL
NEW PLUM13ING MECH
REMARKS
Co MPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL APARTMENT SIGN
REPAIR GRADING , FENCE
CYDS X FTj
CHECKEDBY
fY-- OF CONSTRUCTION
Cogg OCCUPANT
DEMOLISH TANK Ej OTHER
GROUP
SPECIALINSPECTCR
OCCUPANT
ZARAG- RETAINING WALL C] RENEWAL
REQUIRED E] YES
JAREA
LOAD
z
ROCKERY
P:
TYPE OF: USE. BUSINESS OR ACTIVITY) EXPLAIN:
REMARKS
PROGRESS INSPECTIONS PER UBC 108
U)
W
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
_j
0
STORIES
UNIT
NUMBEa
DESCRIBE WORK TO BE DONE
q7
V* T�a
FINAL INSPECTION,REQUIRED
hir
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE
GLAZING %
LOT SLOPE %
BUILDING
15.
.20-1
22 , A
��AN CHECK I NO:
VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
:i
DOMAIN (CURBS.SIDEWALKS, DRIVEWAYS, MARGUEES,ETC.) WILL REQUIRE
STATE SURCHARGE
SEPARATE PERMISSION.
W
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
STORM DRAINAGE FEES
ILI 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EMPLOYEES, AND AGENTS FROM ANY AND '7t
cc EDMONDS, WASHINGTON, ITS OFFICIALS. -I-t4 flk y ro ke I
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
0 DE EMEDTOMODIFY, WAIVEOR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANYWAYTHE CITY'SABILITYTO ENFORCE ANYORDINANCE PROVISION.'
I TOTAL AMOUNT DUE
I HERESY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVE1, 14Z CORRECT., AND THAT: AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL'
0 R. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This ac-!,:a! :- z -:: _- ;,: -I'll SlgneZ Dy Me
CALL
INDOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building 0"': 1 : - - s -a: DeDu-y and Fees are paid. and
0'. 0 THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To FOR INSPECTION —iowledgec'm space provided.
Z :.3!.IPENSATION INSURANCE AND RCW 18.27.
OR AGENT) TE7,IGNED (425) Z SIGNATURE- DATE
7
771-0220 n &)
LEASED BY
ATTENTION
IT IS UNLAWFU_ TO UZ= 0; O-CCUPY .4 BUILDING OR STRUCTURE UNTIL
A FINAL INSPECT 10". H -.S E-EE"',?.I.ADE AND APPROVAL OR A CERTIFI- ORIGINAL-CILE
CATE OF OCCUPANC'�' ".-S E E E_,N' G RANTED. UEC SECTION 109 PINK
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'SIVED.
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IT W, PLANNING DATA
NAME:
Av 14/
SITE ADDRESS: DATE ---
ZONING: —PLANCHK#:-
PROJECT DESCRIPTION:
CORNERLOT es/No) FLAG LOT (Yes/No)
.SETBACKS:
Required Setbacks:"-.
Front: 2�4� Left Side:--7,y2,' Right Side: Rear:
Actual Setbacks:
Front:- !7-2 Left Side: Right Side. Rear:
Street map checked for additional setback required? (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED P"Alin-A- "091
(Y/N) -70
2-
LOT COVERAGE: t -i z--j
Maximum Allowed: �Z006�.Actual:
B UIL . DIN G HEIGHT: '2�0-0-Actual
Maximum Allowed:
Datum Polnt:��R �!E kyutri hd"atum
ewe P
A.D.U. CREATED?:
Height: "3,30, 0!�—
Elev ation: '3s-z�. t ��—
SUBDIVISION: L��"WAPO? F — c7:9'- / 0 ?2
CRITICAL AREAS#:
SEPA DETERMINATION:
LOT AREA: 631 <0
OTHER:
Plan Review By: