23708 80TH CT W.PDF111111111111
7235
23708 80TH CT W
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERM[IT #'
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORTPLAT
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER:
DETERMINATION: [] Conditional Waiver
LID
LOT: BLOCK:
St . udy RequiredXaiver
LATEMP\Dsrs\Fomis\Street File Checklist.doc
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I
City of Edmonds,
SIDE SEWER PERMIT
PERMIT NO': 9926
PERMIT EXPIRES
Address of Constructiom',A,_?/C/P 6141 C1f1_1 1!�I(la %��W LIE
Prope Tax Account Parcel No.
N. rty
Attach copies'of all access'and utility easements Verified and Approved by
Owner and/or Contractor: r2�14
Contractor License #: 3/7,767- Building Permit#: "ll—lemT
ZOOSOiongle Family
E] Multi-Famiily (No. of Units,
F� Commercial.(No. ofUnits
F� Public2
I . nvasion into City *Right- of Way: 0 Yes -ffrNo
.*RW Construction Permit
Cross other "Private Property: F1 Yes Ejo*No
"Attach legal description and copy of recorded easement.
fOwner or contractor signq6(re and acknowledgement statement: Date
signing for this permit I.certify that I have read the City's public handout entitled
i S w
yd e eo er Specifications, and shall comply with,all City requirements'outlined,,.thereiti.
2 CALL DIAL -A -DIG (1-800-4N45555) BEFOREANY EXCAVATION .9
9 FOR INSPECTION.'CALL 425-771-0220 extensio,43am-
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS
.. . .......
.... ... . ... .. FOR OFFICE USE ONLY . .....
Permit Fee S QW Repair Fee $ Issued By
Trm*-Ghafge $ Date Issued* A;A*
As . sessment Fee $ ------ A* Rece0t No.:
City Permit Surcharge Fee 45.00- Total Fees Paid 7/5
N OT E:.' IF.JOB SITE IS NOT. READY FOR INSPECTIONWHEN
INSPECTOR ARRIVES -A $45 RE -INSPECTION FEEWILL BE CHARGE
Job Site Read* YES -NO Date: Initial,
y
Partial I nspection: jleed= C-T '16",andk 1?t —Date: �11 I n. 1 ti a 1:
Partial Inspection: Date: Initial:
Al
I FINAL INSPECTION APPROVED: Date: (t-7 In itial: �As-builttqStr . eet File:
t�..PERMIT MUST- 8 ' EPOSTED ON JOB SITE 1,�.
File .: n OPY
White Copy: . Green Copy: I spector Buff 6 Applicant
IN
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I
Ep*
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At 1890
6 " C. 0.
5' DEEP
CITY OF EDMONDS SIDE SEWER AS -BUILT
ADDRESS: PERMIT
23708 80TH COURT SW
I NO. 9926
CONTRACTOR:
VIKING PROPERTIES
DATE
DRAWN: 6/7/05
HOMEOWNER:
CAJ U N
DRAWN SCALE:
BY: 1. ABILA I NTS
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).
1,,4 :3 — 1-:3
Date Received:--.,51 i V 1 0�2
City Receipt#: 1 .-)-4 (�, C)
Critical Areas File #: --2 CQ'-3,--W2-0
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant:—z/—V-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 bis/her/its; heirs, and assigns, in consideration on the processing of the application agrees
to release, indernnify, defend and bold the City of Edmonds barmless 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 ftirnished 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 t is plication_9jLfJie behal e owner as listed below.
SIGNATURE oF APPLicANT/AGE L/ S; e DATE
r
Property Owner's Author' ad
By my signature, I cert*i� 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 OVINER
DATE
I � --, ��- .1 .. - I . . PLEASE PRINT CLEARLY-.
Owner/AppUcant:
I —
"OW 'J ) /
14ame I
12- � C -3 Z
Street Address
4;6wOA/,05
city State zip
Telephone: 'V!� 4/-' '�67-!��
Email address (optional):
AppHcant Representative:
Name
-77,
Street Address
q7— ��P.
city State zip
Telephone: q 7-5-9
Email Address (optional): )ohcv,� okot-bt
V W
Critical Areas Checklist.doct3.19.2001
City of Edmonds Date Received:-431 LELO-I!
Development Services Department City Receipt#:_ I 2-No-5o
Planning Division Critical Areas File #: -7oO-3 -cx)2-1
Phone: 425.771.0220 Critical Areas Checklist Fee: $45. 0
Fax: 425.771.0221 Date Mailed to Applicant 11-41-6-3
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).
A property owner, or histber 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 consider-ation 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 fi-om 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 authorize to file t is 4pplication qjL�he behal
-t#e owner as listed below.
SIGNATURE OF APPLIC GENT DATE
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 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
Owner/AppUcant:
I —
"Otq 'J rHIICPA�0 V
14ame I
7�c3z Y-e!x F -: 5n, 1
Sure Address
16;6w0A195 V14
city State zip
Telephone:
Email address (optional):
DATE
Applicant Representative:
Name
Street Address
qT-
city State zip
Telephone: IY 7--572-
Email Address (optional): okp-bt
V
Critical Amas Checklist.doet3.192001
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.
Ile 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. Ile 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: 511- 7/1 o��7
City Receipt#: 1- 1 7-1 (,p*:�p
Critical Areas File#: Z—cr-1�3— 00z-2-
Critical Areas Checklist Fee: $45.00
Date Mailed to App licant—:!E�--Zz�l
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 detem-driation 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 harinless from any and all damages, including reasonable
attorney , s fees, arising from any action or infraction based in whole or part upon false, misleading, inaccumte 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 h )ie beha e owner as listed below.
SIGNATURE oF APPLicANT/AG DATE
r
or;Property Owner's Auth :o1r* atio'x/
By my Signature, I cer* I e authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for Ve *ppublic 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 - I
Owner/AppUcant:
I —
"ot,kZ 'J ) /
14ame I
C3 Z ye-
F -:5CX--
Street Address
4;6V0JV4?5
city State zip
Telephone:
Email address (optional):
Applicant Representative:
C-IN f T
Name
/ -77, 1
Street Address
q7—
city State zip
Telephone: 1Y Z 5' Z! 5 -Z - Z. e?-
Email Address (optional): joh4--a).j 4p-b,--�wfl,c-Dx�
V— W -
Critical Areas CheddisL&0.191001
*ILE NO.
Critical Areas Checklist
---------------- ---------------------------------------------
Site Information (soils/topography/hydrology/vegpta�ioij)
1. Site Address/Location: POOL 2,1421A S7 SW.,- --m72MAV
0S. 4d.
2. Property Tax Account Number:
6Z
3. Approximate Site Size (acres or square feet):
4. Is this site currently de V*eloped? _k��_Yes; no.
If yes; how is site developed? 1-1011Sg— 6/77� eN -S,=-- X T., 149*xv�
5. Describe the general site topography. Check all that apply.
F I at: less than 5-feet elevation change over entire site.
_�AAI 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
10-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 a.reas of year-round standing water: AYAI,.--- Approx. Depth:
7. Site contains areas of seasonal standing water: AjggdjZE_ Approx. Depth:
What season(s) of the year?
8. Site is in the floodway __Aje floodplain_ AJO of a water course..
9. Site contains a creek or an area where water flows across the grounds surface? Flows are.year.-
round? AVTJA,�5r — Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) 'W7W t;n�g� c4gr
.7V
11. Obvious wetland is present on site:
------- — --------- ---- — ------------------ — For. City Staff.Use Only ------------- — -- — -- --
Site 4 Z
I Is onedlem
CS
:2,.* S ma ped soil type(s)?
P
Wetlah d in . ventory or C A. map indicates wetland present on site7
4. 'Crfticaj Areas inventory or C.A. Map indicates Critical Area on site4
.5. .. Site within designated earth subsidence landslide hazard area? tic)
'6. Site designated on the Environmentally Sensitive Areas Map? M)
A IrTnrJ
CONDITIONAL. WAIVER-'-
I=_chk.dm; Rev 10103
0
City of Edmonds
R E C SE I V E D
JAN 0 6 1999
COMMUNITY SEWICES
CRITICAL AREASCHECKLIST
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 complete-a4evelopment
pFrmit application.
Please submit a vicinity map along with the signed
copy of this form to assist City st . aff-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 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 answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
-Z—ovq b Y'aw -,?;4/
i
Name -/ .
Street Address
City State Zip
Applicant Representative:
Name
Street Address
city State
q2 �5 — 9,�7)q
Telephone Telephone
Si n
9 �e
7 'A -M-444,4,�l
T ---- /
-'-Dge
Signature
Date
Zip
0 6
OWNER/CONTRACI-OFI IS RESPONSIBLE
FOR EROSION CONTROLA01DA& E
00 SINGLE FAUILY
FAMILY
0;6
DENCE c:
RESIDENtE —23707 80th
COUR 0 2370q. URT W.
w'
L12, 7 6 URE
ALL EXPOSED S4917X-CE TO Z
aV
A
6'x10' PDE
BE COVERED WI/THIN 2 AYS -0
D ?o 36.5(
D
N
0 0c 0.
36.
so
N 89'21'371' W
"36.5c
4A5. 5 0' 6.5
50' ;sv I ..>
36.5
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C �V, / . 1 4' 1 '
L SSE#2 C
44""' 00
�MAINTAIN PLAT IWTALLED LO' OSIQ�
0
16 0.
SINGL
FAMILY SI LE FAMILY b' 8 5
C� co 0- .1 8 z R�SIDJ
Ln
)ENCE tDENCE-!: V)
0
I COURT M. 23700 801(h
2370d 80th COURT.' W.
I Y4
D
50' r-kg" I 1 3650'
1'3 7 W I 10-019'r.. I . ", 36.50
P B921 '57
.50' 9'
30* 46.50' 8
5
9
C V. 24
13-
B
15 25
SINGLE
FAMILY C),
0 8 5INGLE FAMILY;
: C�' RESIDE
iENCE
RESIDENCE co
A QrN4." f1r\4 fr)T %A1
COURT W. 'I '! ; 1)-Z-A 1 23711 80th
c t ID q 7
f
/-7 0 7, 6�"
J
�ACCEPTABLE TIGHTLINE
14 .2004
MATERIAL SCA E
SD 05 PERA411
OWNER/CONTr\A r 00 r,
VIKING PROPERTIES,�� 40 W E FtR
P.O. BOX 1034 2 0' 10, 20' 40'
LYNNWOOD, WASHIN5869 WIMOR
WATER & SEWER
PHONE : 425-670-2711 INSPECTIONS REQ'D. PLOT PLAN
0 EXT. 1326
BENCH MARK CALL 425-771-022 FOR
010
THE PROJECT BENCH MARK IS THE CONCRETE IKING h`Elffl��-
MONUMENT IN CASE LOCATED AT THE L 0 T 16) V 2004
CENTERLINE OF 238TH STREET S.W. AT --/v --
APPROXIMATELY THE MIDPOINT OF THE IN SE1/4, SECTION 31, T.27N., R.4E., mvo cl)�
PROPERTY. CITY OF EDMONDS
ELEVATIION 200-00 SNOHOMISH COUNTY, WASHINGTON
DATUM : ASSUMED
APPRUVED AS NOTED
BY EN EERING
MM &= n �J5�t -
Date: 1j-u-1 zoe �
Lovell -Sauerland & Associates, Inc.
En&eers/Surveyors/Pla=ers/Develop meat Consultants
e-mal info@lsaengineer;ng.com - web: Isaengineehag.com
IMM 33rd Avmue I., Sdte 200 Lynnwood. TA 9W36 - (425)775-1591 - (425)672-7998 fax
DRAWN —FC—MX= I DATE F.B. swc"ux NO.
JTT JTT 3.6.03 20' 4656-0-04
gap
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R/H —��L PLANTING AREAS, —
ANTED
5 U18NED coV ER
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P LEGENID (TYP
----------- -- ----------------------
tl7g= HIGA-BURKHOLDER
IAPJI.lx
faASSOCIATES, LLC
LAND UOR PLANNING I CIVIL SISIGINFERING
1721 Hovdtt Avwwe 4m a Everett. WA 95201
phme (425)252-2a= fox (425)252-OSSI
LAU ASSOCIkTES 4862746 P.01
I;LVIV�
DAILY FIELD REPORT 0
LIU & A.SS0(AATES,,, INC. 4AO85 j. UU F. W. 1 of 1 6
Tirrl!97n itO U Re
QcALZ) & 1:srilh Scscllcq! VFQ S
26 11 -.50A 2!18/2005 f
192t3 Kerilake Placc NE I ravel Tirna (Hrs) Tirr-m-01FNt—o Vv�e7al.,cr
Kenmore, Wa.shington 98028 12�30P Sunny
phone: 025) 483-9134 Fax: (423*1496-2746
Vehicle mr—son-7side
roject 1 .1.
Job Location cherit
Lots 14 throuah 19 - Sunrise FZidqe 80xx - 238th Street SW, Edmonds V11ki
?1--inefal _C01111aCt6_r_ _�Pro�erties
Vikinp roperties Oen.151`21 COntreclor Superinteinde-rit-_ T�Wvcd
Ted Coleman
ifirthwork cont.raclor Earthwork Contractor S�p—t *_ived (C_heck,_%16y____
Caiun Excavating
At the reauest by Ted Coleman with Viking Properties, I come on site to verify the footing bearing soi15 for (he
hOLIses 10 be built on the subject lots. At the time of my site visit the footing trenches on these lots �)ave all be -on
excavated out down to the footing level.
Tilie footing trenches over about the eastern halves of the building footprints aT CUt intc light -gray, gravelly, silty fine
-lind, whiie the footings over about the eastern halves of the buildirg footprints are cut into biown si'ty fine sand.
i A steel I' -bar manually pushed into the footing 0earing sails can penetrate no more then a couple of inches into tile
gray grave:lv silty sand, but c-an penetrate up to about 8 to 10 inches into the brown silty sand.
I inform Bob. the foreman with Viking Properties. that the loose disturbed soils pushed into the footing trenches
should be removed. and trie suit6al brown silty fine sand in he footing trenches over aboLit the eastern naws G, ti1c,
building footprints shOU'd be C0Mp8Cted to a non -yielding state with a vibratory mechanical compactor. if tha above,
are done. it is my opinion that the footing bearing soils will be able to render an allowable bearing capadty of a, ie�jst
3.000 psf.
RECEIVED
FEB 212005
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
1) 1'ed Colemin/Viking Properties
2)
on Next
Paae
0WAIER/CONTRAc-rOR IS RESPONSIBLE
FOR EROSION CONITROL AND DAMAGE
C\j
FAMILY " -o I SINGLE FAK41LY oD
CO 0!
)ENCE / - 5E-SIC
n RESIDENt.E C' 7-fn-23707 80th
0 (23706 RT W.
S FAb
UR
-i COURX W. 0
ALL EXPOSED/ ES r E-
E-
6'. 10'
W PDE
BE COVERED/ -0
jTHlW' 2 DAYS I
36.5(
U
D (6 N 8
04
50' 36 50'.
9'2h '3 7 W t-'tt9'21'37f' wk
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MAINTAIN PLA C 00
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(A .6� R�SIDI
DENCE Gi S
�SIDENCE! V1
COURT M. 2370� 80th
23709 80th COU0 W.
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FAMILY �INGLE FAMILY; SINGLE
0- C 00 RESIDE
RESIDENCE C' 10
1ENCE
COURT W. ')-Z-7�r% QrN&L. rr%lir)T W 23711 80th
7,, 40-
4
9 t 7 7 4(4
7,
6-
ACCEPTABLE TIGHTLR4E 110*1
V JIJL
MATERIAL C9 2004
or '-4-tfol
OWn SCALE : 1 =20 PER44
OWNER/CONTR ACTOR SCH 40
VIKING PROPERTIES, INC. N - 12 W E
P.O. BOX 1034 pqjR HANCOR 0. 10, 20' 40'
LYNNWOOD, WASHINGTON 9 8b
PHONE : 425-670-2711 S WATER SEWER
INSPEC REQ'D.PLOT PLAN
BENCH MARK CALL 425-7-11;�-�"-20 O-ff. 1326 FOR oell
THE PROJECT BENCH MARK IS THE CONCRETE zll�
MONUMENT IN CASE LOCATED AT THE LOT 16J. VIKING HEIGH,
CENTERLINE OF 238TH STREET S.W. AT .0
APPROXIMATELY THE MIDPOINT OF THE IN SE1/4, SECTION 31, T.27N., R.4E.,
PROPERTY.
CITY OF EDMONDS
ELEVATION : 200.00 SNOHOMISH COUNTY, WASHINGTON
DATUM : ASSUMED
) ;... , 14
AR77"C"VED AS NOTED
!-'� EN'lNEERING
Oy U
Date:
41�
CZ
4
4P-
00
1�b
�jpmj Lovell—Sauerland & Associates, Inc.
En&eers/Surveyors/Pl&nners/Development Consult&nts
e-mal iafo@ls&engineering.eom - web: isaengineering.com
14W 33rd Avenue T.. Suite 2DO Lynnwood. WA 9W36 - (425)775-1591 - (425)672-7998 fax
DRAWN CEC= Um FjL 3= FM NO.
20'
JTT 1 3.6.03 4656-0-04
DATE RECEIVED
0 .11`` - I
&130104 1 PERMIT EXPIRES
CITY OF EDMONDS
USE , PERMIT
ZONE VM
NUMBE5,���—
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAPT#
ADDRESS 41-�
(:;3768.80 dsuj--
OF OU61NESS
)rE
tNA�F/NAME
. Ibc
P
NAME/SuMIVISIOEN.0
LOT NO.
LID NO,
5
AkILING ADnR%:.czsU
---41 1 .4 1 P--q-
LID FEE $
U81Ir R164 11 41 STREET MAP
TESCP Approved 131
RW I R= red
Penn"
0
'ul,
CITY
EXISTING
street us . P 11.1-d
Inspactle,
ZIP
TELF HONE
'US
PROPO D
Sidewalk
-6:7.0 1/
REQUIRED DEDICATION— FT
Underground
c3CI!
1 waing requirea fir
METERj,IZE LINE,SIZE
I
NO. IXTURES
PR
YES JrOUIRED�
C3
30
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN
Grading
(CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: 180DAYS
7
PERMIT LIMM. I YEAR . PROVIDED WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICAK ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan
Chk. Deposit
N 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
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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9
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
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Total
Amt. Due
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
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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 EMPU0YEjD
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING/0
FOR INSPECTION
is acknow edged in space provided.
WORKMEN'S C
,QkPENSATIO�JNSURANCE AND RCW 18.27.
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DATE SIGNED
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OF IGNAT E DATE
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ITISUNLAWFULTOUSEOROCq YA BUILDING OR STRUCTURE UNTILAFINAL
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INSPECTION HAS BEEN M) IOVALOR ACERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. USC109/IBC110/IRC110.
ORIGINAL -FILE YEIIC ?.INSPE-6R
PINK -OWNER GOLD -ASSESSOR
09/03
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