23707 80TH CT W.PDF11111111 lill
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23707 80TH CT W
e25707 - 0
TAX ACCOUNT/PARCEL NUM13ER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
06UA"-Y-' 0
CRITICAL AREAS: DETERMINATION: Ej Conditional Waiver [:] Study Required [] Waiver
DISCRETIONARY PERMIT
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: LOT:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S)
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER:
BLOCK:
LATEMP\DST's\Fonrjs\Street File Checklist.doc
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:'.-Z I f V 10 �)
City Receipt#:_ I '-i4 (g'�) G
Critical Areas File #: :.z co3--JW2-0
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicaft 41—//-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, 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_ga4ie behal
9"e owner as listed below.
SiGNATuRE oF APPLicANT/AGENT DATE
r
Property Owner's Author' atio
By my signature, I certify I e 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/AppUcant:
I —
"O!�J J / rAPI(P40 --;J
Name
F
Street Address
lt�6w&)V95
city State zip
Telephone:
Email address (optional):
AppUcant Representative:
Name
-70 / AIL;cyl -rr— Acl-;-
Street Address
q7—
city State zip
Telephone: IYz5- 7-5�0 -0�30,6
Email Address (optional): ohry ok,-b, cnw-
Critical Areas Checklist.doc/3.19.2001
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: 1 0�2
City Receipt#:_ 1-�* '3 0
Critical Areas File M -700-3 -602-1
Critical Areas Checklist Fee: $4 .00
Date Mailed to App licant- 4C-44-6-3 —
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 forin. 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.
Tle undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the C ity 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 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 file is h
,Wp ication qa-�he behal. f e owner as listed below.
z /0
SIGNATURE oF APPLicAw/AG —/,z DATE
Property Owner's Autho 7'atio
I
By my signature, I certify I e authorized the above Applicant/Agent to apply for the subject land use application,
c
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 —
" 0 �!/
14ame I
�� � C 3 Z F
Street Address
4�6"A/e5 V-A
city state zip
Telephone:
Email address (optional):
Applicant Representadve:
,6
c:WT
Name
17Z 77- Aaar
Street Address
city State zip
Telephone: 1Y 7-572- -22�52-
Email Address (optional): )oh4--y,4 okp-bt
V - -
Critical Areas Checklist.doet3.192001
17J
E
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: V I 0�2
7-7 V�Sp
City Receipt#: I
Critical Areas File #: --cr-)�3 - 002:-21-
Critical Areas Checklist Fee: $45.00
Date Mailed to Applican * -�I-eZ3
A property owner, or his/her authorized representative,
must fill out the checklist, sip 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, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or in6action 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 plication gp#e behajfoft�e owner as listed below.
SIGNATURE oF APPLicANT/AG L/ DATE
r
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 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
PLEASE PRINT CLEARLY
Owner/Applicant:
I —
"OLq J),
14ame I
�� � C 3 Z F -:5o�
Stred Address
4;6w,1A14?5
city State zip
Telephone:
Email address (optional):
DATE
Applicant Representadve:
011AJ I
Name
1-701
Street Address
city State zip
Telephone:
Email Address (optional): johtP o4p-bt
V
Ciftical Anas Checldist.doc/3.19.2001
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrologylvegetatio4)
1.
Site Address/Location: sa/.
2.
Property Tax Account Number: Od 0- 112 a — ad 04
3.
Approximate Site Size (acres or square feet): 35, L/5?
4.
Is, this site currently developed? _k!-f s; no.
ye
If yes; how is site developed? Yed-ca- 5/77� eply -S,6- A*9�- AMPM7_X
5.
Describe the general site topography. Check all that apply.
J,,-' 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 IS% and less than 30% a vertical rise of
1 0-feet over a horizontal distance of 33 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: AIM 0— Approx. Depth:
7.
Site contains areas of seasonal standing water: AbMILE Approx. Depth:
'77
What season(s) of the year?
8.
Site is in the floodway 4ja floodplain All) of a water course..
9. Site contains a creek or an area where water flows across the grounds surface? Flows are.year-
round? N&OX' — Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs ;mixed
urban landscaped (lawn,shrubs etc) WjW
.7V 110WAF-,
11. Obvious wetland is present on site: /WA/Z��
— ------------------- ---- — ------------------ — For City Staff Use
1. Site is Zoned
SCS m.apped soil type(s)? &V
2
1. -W
etiland inventory ofC.A. map indicates wetland present on site?
4. Critical Areas inve filory 'or C.A.. map indicates Critical Area on sitel
5. Site with in design ated earth subsidence landslide hazard area?
Site designated on the'Environmentally Sensitive Areas Mapo
DY RE UIRED
Reviewed by'
fvA_chk.doc; Rev 10/03
CONDMONAL-WAMM"
DAte
0
0
City of Edmonds
R E C AEr I V E D
JAN 0 6 ing
COMMUN11Y SEMICES
'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 -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 coinpletd,�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 t . his 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/Applicaht:
. -7_OA1Q A'2��aIAVMZXO'
Name _/ . .
Street Address
City State Zip
Applicant Representative:
Name
Street Address
city State Zip
&Rza( gy
Telephone Telephone
Si na
9
Signature
Date
(nvor)
23707 80TH COURT SW
LOT #23
PERMIT # 2004-1016
post C�-
mv
SAME AS LOT #21
23703 80TH CT SW
PERMIT # 2004-1019
-1 () F E.Dt�,_
GARAGE
1 " POLY — 20OPSI
WITH TRACER WIRE @ 2.5' DEEP
CITY OF EDMONDS WATERLINE AS- BUILT
ADDRESS HOMEOWNER
23707 80TH COURT SW VIKING PROP.
CONTRACTOR SCALE
CAJUN EXC. N TS
DATE DRAWN WATERLINE
7/26/05 By 1. ABILA NO. 2004-1016
ALL EXPOSED SURFACES TO
BE COVERED WITHIN12 WN
OWNER/CONTF0
FOR EROSION C
Uj
MAINTAIN PLAT INSTAL-1
C,
Ci
C,:g
W.
19
C14 0 r-
04
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Cllf
00
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0
0
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SINGLE F4MIL'(
RE§pEggE_l
C
23
SINGLE EAMILY
. kEStDENCE
237b-7 80th COURT W/
'A 0' Pun
36.50' "
5).53'
F-- a V/ C4
SINdE FAMILY
R�SIDENCE
f 5.13'
i5-llV-
1-1\:i
LO
C3
w
OP
0 :�40
40-
1:5.0T
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A -- Iq (.19 A -1 116,13
4L. A ,e
6.20o4
ACCEPTABLE TIGHTLINE CO
MATE �RX
SDR 35
O�E i
OWNER /CON TR AcToRSCH 40 SCALE 1 1 "=20'
VIKING PROPERTIES, INC. N - 12 E
P.O. BOX 1034 F81 0 HANCOR 0' 10, 20'. 40-
LYNNWOOD, WASHINGTON 98046
PHONE : 425-670-2711 SWATER & SEWER OCT 2 a 2004
INSPECTIONS REQD. PLOT PLAN DEVELOPMENT SERVICES CTR.
BENCH MARK CALL 425-77"i-;.220 0\7-- 1326 FOR CITY OF EDNIONDS
THE PROJECT BENCH MARK IS THE CONCRETE
MONUMENT IN CASE LOCATED AT THE LOT 23, VIKING HEIGHTS
CENTERLINE OF 238TH STREET S.W. AT
APPROXIMATELY THE MIDPOINT OF 111E 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 E14 'INEERING
L
Date:
�VNM LoveU-Sauerland & Associates, Inc.
Enon-xs/Surv"or3/Planners/Development ConsultanU
L�E 0 e-mml- info#Is&en&aerizkg.com - web: Isaeu&eenng.com
INN 33rd Avenue T. Suite 200 - LYUMOd, TA 98036 -'(425)775-1591 -. (425)M-7998 fax
D"wN a(mm Dm
JTT I JTT I 3.6.03T 1 20- 1 ru4656-0-04
Tonl, MW R, �-` MM-r7r%:,,
pq
'T.
.4416AL FLA ED
I Mr. COVER
IEGEND (TYP)
- - - - - - - - - -
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RoBERr C.
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PIP
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At.
HIGA'BURKHOLDER
ASSOCIATES, LLC
LAND USE PLANNING I CIVIL EN43INEERIMO
1721 Hewitt Avenuf m quite 4C" 0 Evwett. WA 95201
phone (425)232-2826 fox (425)252-9551
ALL EXPOSED SURFACES TO
BE COVERED WITHIN 2� -S
'PAY
OWNER/CONTI
FOR EROSION
LJ
of
V)
V)
AINTAIN PLAT INSTALLED E00�1-
C4
W.
19 (6
L-12`:, C14
— A ,
00
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0
0
81 Z
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:SINGLE F MI Ll
RESID
FiBot CUR
89'21 W
B. 23
30L SINGLE EAMILY
�Q; R]ESfDENCE
"n -
-r 23707 80th COURT W/
A
0 PDE68 "j
-16.W
5).53'
rev
C 4
Cd
SING& FAMILY
R�SIDENCE
NORM'
OWN%
1:5.0j,
z
A- 116, 3
j J L 6,20%
F
L 6201
ABLE TIGHTLIN& p C
ACCEPTP ov ERM1 C TEa
MATERIAL C
SDR 35 SCALE : 1"=20'
OWNER/CONTRACTfH 40 W cl�Vl
VIKING PROPERTIES, INC. 12 E
P.O. BOX 1034 F81 0 HANCOR 0.
LYNNWOOD, WASHINGTON 98046 lMilnol' �201-z,
PHONE : 425'-670-2711 WATER & SEWER PLOT PLAN OCT 2 0 2004
'INSPECTIONS REQ'D.
BENCH MARK CALL 425-771-0220 EXT. 1326 FOR
C/Ty OLE ES CTR.
THE PROJECT BENCH MARK IS THE CONCRETE LOT 23 0 S
MONUMENT IN CASE LOCATED AT THE VIKING HEIGHI-Srj-", A10
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 ENGINEERING
Date:
�NWS Lovell—Sauerland & Associates, Inc.
Eminem/Surveyors/Pimners/Development consultants
0 .a wooi.�.. . web: Isaengimeering.com
ISM 33rd Avenue 1, Suite 200 LYMV00d. TA 98036 - (425)775-1591 -. (425)M-7998 fax
DUTN ---TFU So.
JTT l CRJKTMT I D =36 0 3 31 7 20' 1 4656-0-04
LIU & ASSOCIATES 4962746
C�- 5�'j
DAILY FIELD REPORT
J0b NO� -
Field Rep.
r'G2C1
I
LIU & ASSOCIATES, INC.
4AO86
J. Liu
1 of 1
7
Vrigineclilig. f:nginccrin, (;e-ology & Evil' Scicncc
7155
71 r7r F On- Ti re—
b 7ar - -
wi uNeo k
26
2 T1�3 5 A
4/13/2005
-Plur.
19213 Ketilake Plice NF.
Travel Time IRrs)
imIe ff,ite
f
"'97
Weatner
Kenmore, Wmhington 98028
o
1
3.05P
SLnny to paftiy Cloudy
Verficle R's on Site
t
-?—
�t6ioed
Phc,,nc:(423)483-9l34 Fax:(423).186-41746
--- �
1.5
J7 Locati5n
Uleni
L.0s 20 thrOLI1 h 24 - Sunrise Ridge__
80xx - 238th Sveet SW, Edrnords
i�iL Pro ertes
General Contractor
General ontracto. Siperintandoilt
Received Unchecked f3y
ViKilligl Prop�,qieG
-
Ted Coleman
--
iiTl�,,vork Contractor
Eerthwork Contractof Supt.
Peceved Checked By
Calun �Ysavafinq
At the request by Ted Coleman with ViKing Properties, I come on site to verify the footing bearing soils for the
t,.ouses to be built on the subJect lots. At the time of my site visit the footing trenches on these lots have all be -on
excavated out down to the footing level, No grourdwater seepage or, standing water is otserved within the subject
lots. Some loose disturbed soils have fallen into the footing trenches, and in places a thin layer of s , Dils over tile
bottcrn of tile footing trenches is disturbed by the scraping of the backhoe bu'^Ket.
The footing trenches are cut down about 2 feet below existing grade into brown to light -brown struCtLiral fill of silty
fine sand with a trace of gravel. A steel T-bar manually pushed into the footing bearing soils can penetrate no more
than 4 to 6 inches into the undisturbed footing bearing soils, indicating the soils are medlurn.-dense to dense.
I inform Bob, the foreman with Viking Properties, that the loose Win layer of so'lls disturbed by backhoe bucket
should be compacted to a non -yielding state with a vibratory mechanical compactor. If the above recomin'tenoations
are followed, it is rny opinion that the footing bearing soils will be able to I ender an allowable bearing capacity cf at
least 3,000 psf.
RECEIVED
AP R 2 12005
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
%JVWV —1 F) GOntil)LW0
1) Ted ColemanA/Iking Properties 2) on Noxi
3) 4) Peg", �
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
q!)liNAMEINAME OF BUSIrT
ZIP TELEPHONE
;cc I a<,. 6 t b -,�J I
I rwy I ZIP ITELEPHONE I
PERMIT EXPIRES
USE
ERMIT
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ZONE OA 11?A
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LOT NO.
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PUBLIC RIGHT Q8
WAY P OFFICIAL STREET MAP
TE
scepr:11 -R.'tedr.,
Aw
Street Use Pamit Req'd
EXISTING-
—'��PROPOSED—
Inspection Required
REQUIRED DEDICATION
FT
Sidewalk Required
Undergmund
wiring required
METER SIZE
LINE SIZE
RES
PRV REQUIRED
YE NO
REMARKS
z
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
0
z
ul
01, PER we,
L
1
ING REVIE 115�5Y DAT
AF&J�
FIRE", REVIEWED BY
W
CITY
ZIP,
TELEPHONE
-Ah
VARIANCE OR CU.
OR ADB#
INSPECTION
F REO'D
BOND
POSTED
k0E LICENSE NQIMBER
EXPIRATION'DATE
CH
C4? -
. 11.
ibs—
�= _s lfb
YE 0
s R
,�LKJ
SEPA REVIEW
SIGN AREA I-
A HEIGHT
)ROPERTY T#X ACCOUNT'PARCEC,NO.
COMPLETE
EXEMPT
ALLOWED
PROPOSED ;�XLLOWED
PROPOSED
EXP ,
Nk
30
I
P(NEW
RESIDENTIAL
PLUMBING MEC14'
LOT COVERAGeWf:
REQUIRED SETBACKS [FTY�
.
;1�90POSED SETBACKS (Fr.)
-V
ALLOWED PROPOSED
FRONT : STE" REAR
FRONT. L/R SIDE REAR
ADDITION
COMMERCIAL
COMPLIANCE OR
4sa;. L4 3
6A.. iq//
A 10
Iij ' j
z
2
CHANGE OF USE
2
REMODEL
muLnFAmiLy
SIGN
PARKING
REO'D PROVIDJED:
LOT AREA PLANNING REVIEWEb*611 DATE
'*014
5
REPAIR
GRADING— XFEr
0. 4,—% CYOS n.. I-- FT�
0
REMARKS
DEMOLISH
TANK
OTHER
RETAINING WALL ci., F RES RINKLER'.
MEAPLARM-1:
je(GARAGE
(CARPORT
ROCKERY,',:'
'(YYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY
TYPE OF
DE
OCCUPANT
19NITRUCTION
GROUP
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING .
AREAS -
SPECIAL INSP9TION
A
OCCUPANT
STORIES
UNITS
NUMBER
PIEOUIRE��YE
LOAD
DESCRIBE WORK TO BE DONE
R EMA'RKS
z
PROGRESS INSPECTIONS PERj�QC1_Qt/,,IPC,109/jRCj09 FINAL INSPECT10,14 REO'D
4,�Z,
yNck
t_1 U �jm
VALUATION
0
$
Cla-11, 0 a
esdriotion
-,FEE
Des ription
FEE
a
foy*)ll
no 1-11" ry�)
Plan Check k 1\
7
State Surnhame
PLAN CHECK NO:
ST D
i0lumbi4"
4_42Z)
Base Fee
Mechanical
A__x
THIS PERMIT AUTHORIZES ONLY THE .0. 'HIS Pilidinn' CAE;S WORK TO
t: BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION: ISO DAYS
IL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 100 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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
qq1t
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp,
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
x
Recording Fee
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
AP ROVAL
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 Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
I I
FOR INSPECTIO
KL receipt Is acknowledged in space provided.
WORKMEN.S.5�NSATION INSURANCE AND RCW 18.2-&
ALS SI DATE
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DATE S GNED
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771-0220
EL 15- BY—
ATTENTFION
EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HASBEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
ORIGINAL-FILE YELLOW- INSPEI�TOR
PINK -OWNER GOLD -ASSESSOR
09/03 r%r%r-'#%^ 111-111AMM %1^19 All 111RAW1111111,1110ft A