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23709 78TH AVE W.PDFlill 11111111 6703 23709 78TH AVE W CITY OF EDMONDS. SINGLE FAMILY/DUPLEX COVER SHEET Directions: Applicants at* to complete the Information In the WHITE BOXES ONLY (Shaded boxes are lot City us* only). This cover shoot must accompany each building permit application for A new single-family residence. r% PROJECT. ADDRESS Qa-72�� 63 Al I r- I - x PROPERTY TAX ACCOUNT PARCEL # DESCRIPTION OF WORK OWNER rt)VA *EL:T� WOWIC-S PHONE A4X- CONTACT PERSON PHONE E-MAIL FAX MAILING ADDRESS '50 FAX CORRECTIONS MAIL CORRECTIONS E-MAIL CORRECTIONS BY SIGNING THIS STATEMENT I UNDERSTAND THAT I AM THE CONTACT PERSON FOR THIS PROJECT. 17 is MY R ESPONSIBILITY TO COORDINATE ALL SUBMITTALS WITH THE CITY AND ONLY I CAN MAKE INQUIRIES ON THE STATUS OF THE APPLICATION. I UNDERSTAND IT IS MY RESPONSIBILITY TO DETERMINE IN ADVANCE OF PERMIT S UBMITTAL ANY 0 1 SCRETIONAR Y PERMITS THAT MAY BE APPLICABLE TO THIS PROJECT. I ACKNOWLEDGE THAT TO T it E B EST OF MY ABILIT I : HAVE SUBMITTED ALL NECESSARY DOCUMENTATION IN ORDER TO MAKE A C OMPLETE APPLICATION AND NO D SCRETIONARY APPROVALS ARE REQUIRED, SIGNATURE DATE ZONING INFORMATION ZONE g:5 LOT AREA to:;, a) NUMBER OF DWELLING UNITS'EXISTING of. DEMOLISHED --PROPOSED DISCRETIONARY APPROVALS CA Determination SUBDIVISION CU_ VARIANCE SHORELINE_ SEPA Expires_ OTHER City Use Only LOT COVERAGE INFORMATION EXISTING SF PROPOSED SF. TOTAL SIC HEIGHT CALCULATION INFORMATION DATUM A. 0 C 0 AVE MAX 77. ACTUAL SETBACK INFORMATION REQUIRED FRONT SIDE_ SIDE' REAR PROPOSED FRONT SIDE SIDE- REAR Y -]NO. 0 YESi 13.NO ST.:� DEDIC. YES []N'O, �L' I, T. CNR- LOT 0 Ii.s FLAG LOT, ADU STATEMENT REQUIRED YES No 1 RECORDING # STAFF COMMENTS: ENGINEERING INFORMATION DRIVEWAY SLOPE % GRADING CYDS EASEMENTS EXISTING IMPERVIOUS AREA CONSTRUCTED BEFORE 1977 SO.FT EXISTINGAMPERVIOUS AREA INSTALLED 1977 OR LATER _SG.FT. PROPOSED NEW NET IMPERVIOUS SURFACE City Use Only SIDEWALK REQUIRED [-]YES [-]NO DRAINAGE PLAN REQUIRED []YES [:]NO UNDERGROUND WIRING REQUIRED [3 YESE]NO STREET DEDICATION FT. LID# STAFF COMMENTS: SPECIAL INSPECTIONS REQUIRED FOR THIS PROJECT,(City Use Only) SOILS* STRUCTURAL6 E]START OF WORK OPLACEMENT OF REINFORCEMENT DEXCAVATION & GRADING OPLACEMENT OF CONCRETE EISHORING INSTALLATION & MONITORING []BOLTS INSTALLED IN CONCRETE OPROOF ROLLING []STRUCTURAL MASONRY EIPLACEMEN . T OF FILL A CO . MPACTION EISTRUCTURAL STEEL ERECTION 13SUBSURFACE DRAIN . AGE []HIGH STRENGTH BOLTING VERIFY SOIL BEARING ED ONLY) 0 WELDING (WABO CERTIFI E]PILE * PLACEMENT' []OTHER— EI EROSION CONTROL 1 GENERAL SITE MONITORING BY THE 3GEOTECHNICAL ENGINEER OF RECORD E] GENERAL*SITE MONITORING BY THE GEOTECHNICAL ENGINEER OF RECORD DURING WET W EATHER CONSTRUCTION EIFINALGRADING A FIELD REPORT OOTHER PLAN CHECK 0 "PLICANT DATE RECEIVED BUILDING CONSTRUCTION INFORMATION CODE EDITIONS 1997 UBC, UMC, UPC, WSEC, VIAa WITH AMENDMENTS DESIGN CRITERIA WIND EXPOSURE 0 WIND SPEED 80 MPH SEISMIC ZONE 3 Floor Live Load 4-0 Root Snow/Live Load__2S :::::ny Live dT— Floor Dead Load__M Roof Dead Load /0 ny=d Los NUMBER OF STORIES BASEMENTS FLOOD ZONE LOT SLOPE % 2? 21 SOILS RE PROVIDED [] YES g] NO FLOOR AREA (MEASURED TO EXTERIOR FACE OF EXTERIOR WALL) Existing Proposed Total Living Space Garage Carport Deck/Covered Porch I Other — ENERGY CODE COMPLIANCE INFORMATION FUrL TYPE GAS, OIL [] ELECTRIC 11 OTHER FORCED AIR []HEAT PUMP []HYOFIONIC []OTHER ENERGY CODE METHOj OF COMPLIANCE PRESCRIPTIVE: List Option 11 1 — TARGET UA APPROACH: Provide UA Calcuations SYSTEMS ANALYSIS: Provide Computer Analysis Is ENERGY/VENTILATION WORKSHEETS PROVIDED, E3 WINDOW SCHEDULE PROVIDED FOR CITY USE ONLY Calling Insul:tIon -AC: Wall Insulatl n Floor InsulatI099— Door U-Value @ Window U-Valus Skylight U-V.Iu; Glazing %-1i VENTILATION CODE COMPLIANCE INFORMATION KITCHEN FAN CFNI 100 BATHROOM FAN(S) CFM 5C) LAUNDRY FAN CFM jt>0 WHOLE HOUSE VENTILATION SYSTEM 0 EXHAUST OPTION FRESH AIR TO BE PROVIDED TO WINDOW VENTS WALL PORTS EACH HABITABLE R60M WITH: El 11 EXHAUST FAN TO BE CONTROLLED WITH 24 HOUR TIMER AND SIZED AS FOLLOWS: 1:1 1 - 2 BEDROOMS: 50 - 75 CFM $4 BEDROOMS: 100 - 150 CFIAI 13 3 BEDROOMS: 80 - 120 CFM 0 5 BEDROOMS: 120-180 CFM 1:1 HVAC INTEGRATED OPTION El DEDICATED HEAT RECOVERY VENTILATION OPTION SEPARATE PERMITS (City Use Only) 0 RIGHT OF WAY CONSTRUCTION PERMIT 0MECHANICAL PERMIT 0ENCROACHMENT PERMIT 0PLUMBING PERMIT LAM-TATE ELECTRICAL PERMIT 0WATER METER 0FENCE PERMIT 0SIDE SEWER PERMIT 13RESIDENTIAL FIRE SPRINKLER PERMIT 0IFIRIGATION (SPRINKLER SYSTEM) 0OTHER_ DOTHER Any request IOF Modification. VaFIaftCS or other administrative deviation (herinalter 'variance") must be Specifically called out and Identified. Approval of any plat or plan containing provisions e,hich do n of com ply with the City Code and for which a variance has not been specifically identified, requested and considered by the appropriate city ofliclal In accordance with the appropriate provision of city code or state low does not approve any Items not to code specification. PERMIT ISSUANCE APPROVALS PLANNING REVIEW & APPROVAL CONDITIONS OF APPROVAL: (City Use Only) DATE ENGINEERING REVIEW & A&PPROVAL CONDITIONS OF APPROVAL: DATE BUILDING REVIEW & APPROVAL CONDITIONS OF APPROVAL: DAT E City of Ednionds'_P "Rm".. PERMIT EXPIRES_�o)n ao SIDE SEWER PERMIT 'Address of Construction: LID # Property Tax Account Parcel No. Attach copies of all access and utility.easements I Verified and, Approved by Owner and/or Contractor: Contractor License -TOKR?-��4 4e Building Permit #QM773_-S� Single Family lknvasion into City, *Right -of Way: [3 Yes No Multi -Family (1�p. of Units RW Construction Permit. E] Commercial (No. of Units, Cross other "Private Property: E]Yes A'No Public, **Attach legal description and copy of recor easement' Owner/Contractor I A`VA Owner or contractor signature anjaMcnowledgement statement: ate By signing for this permit I certify that I have read the City's public handout entitle Side Sewer Specifications, and shall comily with all Cit ts outlined.therein. p y require.men CALL DIAL -A -DIG (1-800-425-5,555) BEFORE ANY EXCAVATION 2 0 A_i6 .19 FOR INSPECTION.CALL 425-771 4W extension M9 9 24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS FLAW I WdA MilL11111111M I . ... . .... .. FOR OFFICE USE ONLY . ........ .. Permit Fee Repair Fee $ issued By: Trunk Charge Date Issued: 0 Assessment Fee $ Receipt No: 446 (o City Permit Surcharge Fee iuo Total Fees Paid $ QO NOTE:. IF.JOB SITE IS NOT READY FOR INSPECTION WHEN INSPECTOR ARRIVES A $45 RE-I,NSPECTION FEE WILL PE, CHARGED.., Job Site Ready YES NO Date: —Initial. Partiallrispection: A)ez.�S C,-T Date: 1-010-00nitial: Partial Inspection: Date: Initial: FINAL INSPECTION'. 'APPROVED: Date: !Atl 1: .1nitia -As-built to Street File: A� PERMIT MUST BE POSTED.ON JOB SITE '6- White Copy: File Green Copy:. Inspector B.uff Copy: Applicant L;temp;bldg-,forms;ssperinitjlg4/00 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 lia-b-le for the information given on this map(s), nor for any one representation provided based upon said map(s). The City of Edmonds Side Sewer Drawing EASEMENT NO . .......................................... NEW CONSTRUCTION REPAIRS Ej LID NO . .............. .... ASmT. NO . .................. OWNER .................................................................. ...... ......... ACTOR ...... ......... CONTR ........... ....... ...................................... PERM]l NO. .91AC� JOB ADDRESS ... ...... ....... LEGAL DESCRIPTION: LOT NO . ........... .......................... BLOCK NO . ................ ............................................................................................. ....................................... .......... ........... - .4t NAMEOF ADDITION .................................................................. ......... .... ........... A-1 Iql ", Y LZI , -7 Approved: PWW-000 I - 11175 (R EV. 11178) 0 DATE .... !�� -. N!�.'.M ............. By ........ i&W ....................................... PLANNING DATA NAME:—BF-L--r HOMES SITE ADDRESS: 2--6-709 7W AVF-W, DATE: 548-0c;', ZONING: FS - �a PLAN CHK#:. 00 -bZ4 PROJECT DESCRIPTION: NF-W si=R& . CORNERLOT —Wi (Yes/No) FLAG LOT 140, .(Yes/No) SETBACKS: Required Setbacks: Front: 1-15' Left Side; -71/,2,1 Right Side: Rear: Actual Setbacks - Front: T-7 Left Side: Right Side: Rear: Street map checked for additional setback required? (Yes/No) LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N) LOT COVERAGE: %47 Maximum Allowed: �)'SAJ-3 MA Actual: B UILDING HEIGHT: Maximum Allowed: Actual Height: Datum Point.- Datum Elevation: A.D.U. CREATED?: N 0,* SUBDIVISION: .— ?,U-�-ro F-95-1�3/L-gr CRITICAL AREAS #: 9c) - I I G SEPA DETERMINATION: LOTAREA. 94(,02,z -ba,v:r, OTHER: Plan Review By: c:Tt1es\permiA^p1andaLdoc B I T g-71 a I -?- I o t+ I L OT 3 GFr LOT -rLOPG R E C: E I V E= D C.I.T-i OF E�'OMOMX)S AUG 0 SF 2:000 FILF DEVELOPMENT SERVICES CTR. TEMPORARY CONSTRUCTION ENTRANCE (PER DETA14 CITY OF EDMONDS \ A, )-49-IC,V4-r CA.LCA I 3t6. 2�' UTILir%f 7 .:L A,\j r0T kL 1-14 3AJ -2. 1 F + 2 — 347-11 14A.9 AC-TUNL- ONTRA�?TOR IS F' '"""",13LE FOR 1.1 AWAGE SION CONTROL At A:' AY W SERViCk MSPECTIONS lu C 0 I NED. CALL 771-0235 1,0 0. 1 XLE' 1'r 2 0.- 0 IV-2;1 V" 5'7* fT '150* IZ For= 34-1.5 I"Pm*,vl0v-% sv*rAC-E: Zen 4.) Ll -2. sp ---2 r- -91 F IN go-) SP w A= ING 1-07 AP OVED A W TED w L-OT AfkF-A c16-4 CITY OF EDMONDS. SINGLE FAMILY/DUPLEX COVER SHEET Dirge lions: Applicants are to complete the Information In the WHITE BOXES ONLY (Shaded bases are for City use only). This cover sheaf must accompany each building permit application for a now single-family residence. PROJECT. ADDRESS a3r7L1!!2 -ifTm -A-t-)-j:-- i-x PROPERTY TAX ACCOUNT PARCEL # DESCRIPTION OF WORK OWNER --rr)vA *R7� WnW,6'> PHONEA4 CONTACT PERSON PHONE -1-74- acct i E-MAIL FAX LL2,12-- MAILING ADDRESS 0 FAX CORRECTIONS MAIL CORRECTIONS E-MAIL CORRECTIONS :Y SIGNING THIS STATEMENT I UNDERSTAND THAT I AM THE CONTACT PERSON FOR THIS PROJECT. 17 18 MY ESPONSIBILI IF TO COORDINATE ALL SUBMITTALS W17H THE CITY AND ONLY I CAN MAKE INQUIRIES ON THE STATUS 0 F THE APPLICATION. I UNDERSTAND IT IS MY RESPONSIBILITY TO DETERMINE IN ADVANCE OF PERMIT a UBMI T TAL ANY DISCRETIONARY PERMITS THAT MAY 13E APPLICABLE TO THIS PROJECT. I ACKNOWLEDGE THAT TO THE BEST OF MY ABILITY I HAVE SUBMITTED ALL NECESSARY DOCUMENTATION IN ORDER 70 MAKE A C OMPLETE APPLICATION AND NO DISCRETIONARY APPROVALS ARE REQUIRED. SIGNATURE DATE - ZONING INFORMATION ZONE g -5 --b LOT AREA NUMBER -OF DWELLING UNITTEXISTING DEMOLISHED ---PROPOSED DISCRETIONARY APPROVALS CA Determination SUBDIVISION CU VARIANCE SHORELINE SEPA Expires OTHER City Usa Only LOT COVERAGE INFORMATION EXISTING Sle PROPOSED SF. TOTAL SF HEIGHT CALCULATION INFORMATION DATUM C.: A—. AVE MAX. ACTUAL'. SETBACK INFORMATION REQUIRED FRONT SIDE— sidi- REAR CROPOSEQ FRONT SIDE SIDE REAR DO [:]*Ei[:]Nd FLAG-LoT[]yES:[]N:iD -.ST',-OPDIC-[]Y6 T.: ADU STATEMENT '[]YES[]N 0. RECORDING If STAFF COMMENTS: ENGINEERING INFORMATION DRIVEWAY SLOPE % GRADING CYDS EASEMENTS EXISTING IMPERVIOUS AREA CONSTRUCTED BEFORE 1977 —SQ.FT EXISTING IMPERVIOUS AREA INSTALLED 1977 OR LATER SO.FT. PROPOSED NEW NET IMPERVIOUS SURFACE City Use Only SIDEWALK REQUIRED DYES ONO DRAINAGE PLAN REDUIRED []YES []NO UNDERGROUND WIRING REQUIRED DYES [:]NO STREET DEDICATION FT. LID# STAFF COMMENTS: SPECIAL INSPECTIONS REQUIRED FOR THIS PROJECT (City Use Only) SOILS- STRUCTURAL- E]START OF WORK OPLACEMENT OF REINFORCEMENT E]EXCAVATION & GRADING C]PLACEMENT OF CONCRETE 0SHORING INSTALLATION & MONITORING [—]BOLTS INSTALLED IN CONCRETE C]PROOF ROLLING EIS . TRUCTURAL MASONRY EIPLACEMEN . f OF FILL & COMPACTION []STRUCTURAL STEEL ERECTION 0SUBSURFACE DRAIN I AGE EDHIGH STRENGTH BOLTING 0 VERIFY SOIL BEARING WELDING (WABO CERTIFIED ONLY) E]PILE. PLACEMENT []OTHER DEROSION CONTROL E:]G:NERAL SITE MONI . TORING BY THE G OTECHNICAL ENGINEER OF RECORD ] GENERAL SITE MONITORING BY THE GEOT E CHNICAL ENGINEER OF RECORD 'DURING WET W EATHER CONSTRUCTION 131`14AL GRADING A FIELD REPORT EDOTHER PLAIN CHECK 0 APPILICAN DATE RECEIVED BUILDING CONSTRUCTION INFORMATION CODE EDITION$ 1997 UBC. UMC. UPC, WSEC. VIAG WITH AMENDMENTS DESIGN CRITERIA WIND EXPOSURE 0 WIND SPEED SO MPH SEISMIC ZONE 3 Floor Live Load Root Snow/Liv* Load y Live Load — Floor Dead Load_L2 Roof Dead Load ::11:::y.DsF1Md Load NUMBER OF STORIES BASEMENTS FLOOD ZONE LOT SLOPE S I -� � .?, — SOILS R5??4TPROVIDED 0 YES ID NO FLOOR AREA (MEASURED TO EXTERIOR FACE OF EXTERIOR WALL) Existing Proposed Total Living Spec* Garage Carport Oack/Covered Porch Other — ENERGY CODE COMPLIANCE INFORMATION FUFL TYPE GAS, OIL [] ELECTRIC [] OTHER FORCEDAIR [:]HEATPUMP ONYORONIC []OTHER ENERGY CODE METHOD OF COMPLIANCE- 10 PRESCRIPTIVE: List Option # 11 TARGET UA APPROACH: Provide UA Calcustions 1:1 SYSTEMS ANALYSIS: Provide Computer Analysis ENERGYIVENTILATION WORKSHEETS PROVIDED WINDOW SCHEDULE PROVIDED FOR CITY USE ONLY Callingsinsul::On Wall In J11111 �_ Floor Insulation4, Door U-Valus . Window U-Valus--j Skylight U-Value (a Glazing %—LIM VENTILATION CODE COMPLIANCE INFORMATION KITCHEN FAN CFM too, BATHROOM FAMjS) CFM--5-r—1 LAUNDRY FAN CFM_IQQ WHOLE HOUSE YENTILATION SYSTEM EXHAUST OPTION FRESH AIR TO BE PROVIDED TO WALL PORTS EACH HABITABLE ROOM WITH: WINDOW VENTS EXHAUST FAN TO BE CONTROLLED WITH 24 HOUR TIMER AND SIZED AS FOLLOWS: I - 2 BEDROOMS: 60 - 75 CFM P BEDROOMS: 100-150CFM ;bEDROOMS: 80 - 120 CFM 13 5 BEDROOMS: 120-180 CFM NVAC INTEGRATED OPTION DEDICATED NEAT RECOVERY VENTILATION OPTION SEPARATE PERMITS (City Use Only) EIRIGHT OF WAY CONSTRUCTION PERMIT 0MECHANICAL PERMIT 0ENCROACHMENT PERMIT 0PLUMBING PERMIT USTATE ELECTRICAL PER.IT El WATER METER 13FENCE PERMIT OSIDE SEWER PERMIT 0RESIDENTIAL FIRE SPRINKLER PERMIT OIRRIGATION (SPRINKLER SYSTEM) 0OTHER 110THEA Any request lot modification. variance of other administrative deviation (herinafter 'varianw) must be specifically Called Out and Identified. Approval of any plot or plan containing provisions which do not comply with the city code and for which a variance has not been specifically iden tilled, requested and considered by ills Appropriate city 0111CIal In accordance with the appropriate provision of city code or slots low do@$ not 2PPfOV4 Any Items not to Code specification. PERMIT ISSUANCE APPROVALS PLANNING REVIEW A. APPROVAL CONDITIONS OF APPROVAL: (City Use Only) DATE 914GJNEERING REVIEW & APPROVAL CONDITIONS OF APPROVAL: DATE BUILDING REVIEW A APPROVAL— CONDITIONS OF APPROVAL: GAT DATE RECEIVED 0 ERMIT EXPIRES 0 FP i 1, f USE PERMIT F!tONE K , NUMBER CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT# ADDRESS 1 .3 OWNER NAME/NAME OF BUSINESS (' , PLAT NAME/SUBDIVISION NO. LOT NO. L cc MAILING ADDRESS 1,3 z TESC:.Ap P "=ad 0 0 X PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW 0 0 Street Use Permit Req'd 0 CITY ZIP TELEPHOPE EXISTING OSED Inspection Required ' Sidewalk Required do X_ 0 F—I)m C)KJOS 9 0 Z_ 0 L�Z C; -7-) 1-f 2 Z) REQUIRED DEDICATION— FT Underground Pi 11 Wiring required NAME :,,WETER SIZE LINE SIZE t7�0, OF FIXTURES PRV REQUIRED YES 0 NO 0 LU UJ z REMARKS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z C) CITY ZIP TELEPHONE v-lu K 1,_'TE 13 5- k+z, �g 2 L�.5 C /5 NAME 1-0 ENGINEERING RFAIIEWEAAT cc ADDRESS 0 'e 0 fo FIRE REVIEWED BY DATE LU CITY �"�z TELEPHONE M LL 0 0 Kj C�,� VARIANCE OR CU SHORELINE OR ADB# INSIDE N BOND STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY C �ST REO P ED )K 0 YES i 0 [r6 r 4 4 L� I g/() I nzk SEPA REVIEW SIGN AREA HEIGHT PROPERTY TAX ACCOUNT PARCEL NO. \./I COMPLETE EXEMPT ALLOWED I PROPOSED ALLOWE PROPOSED ej -7 c) L+ 601 0 0- W 0 � I SZ,-7' EXP LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) NEW RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR ADDITION COMMERCIAL COMPLIANCE OR 215 1 77 1 1 1 z ,�S___A-tz-) Z-7 215/7� 10"' 2 CHANGE OF USE z PARKING L�:T AREA jP?NING REVIEWEV BY, DATE 0 REMODEL E] APARTMENT 11-:SIGN REO'D PROVIDED —0 REPAIR G jl�AqN�j FENCE CYDS C3 X FT) REMARKS DEMOLISH TANK o OTHER GARAGE C] RETAIN . ING WALL 0 RENEWAL z CARPORT ROCKaRY 0 P: (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: 0. CH�EXY TYPE OF CONSTFILLCTION ICODE OCCUPANT 2 U GROUP W ML, w NUMBER NUMBEROF CRITICAL W ) OF DWELLING AREAS L SPECIAL INSPECTOR AREA OCCUPANT 0 TORIES UNITS NUMBER 115, REQUIRED [:] YES LOAD DESCRIBE WORK TO BE DONE .5� I- 57� s REMARKS PROGRESS INSPECTIONS PER UBC lq8/FINAL:INSPECTION REP'D o iv \j cn- i n v jittt"k k- + x - tc(ll 05ULA�n'p,) OLE 14STIZ— V) 1X( V�_ ber- K_ 0-t�tl-_-kj I,r 0; L�JATION j,YA FEE PLAN CNE6K FEE A. 114 3 -7" HEAT SOURCE GLAZING % LOT SLOPE % BUILDING e /to q0 rN CHECK NO: VESTED DATE PLUMBING -79 m--, 4 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 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSIOV. cc PERMIT APPLICATION: 190 DAYS STATE SURCHARGE W PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION U) ENG. INSPECTION FEE 40 U) "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF j "C3a0;PMNG Cull- EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND < n c) ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF. THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE $iECEIPT DEEMEDTO MODIFYWAIVE OR REDUCEANY REQUIREMENT OF ANY CITY ORDINANCE PLAN CHECK DEPOSIT t 0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* x TOTAL AMOUNT DUE R pp 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- 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 Fegi 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 COMPENSATION INSURANCE AND RCW 18.27. OF ICIALS SIGNATURE DATE A (425) 'q SIGNATUR (OWNEF I T) DATE SI ED I '' �Z�Luu 7- Z— 771-0220 "RIELEASED BY DATE C, :�� ' " j I— , I A17ENTION EXT 333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771-0221 ORIGINAL - FILE YELLOW - INSFECTC CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX F�NK -OWNER GOLD - ASScE S-50M 5/98 -Alt ?I -- //.S:- 0 0 Critical Areas Checklist R 67�C' — ----------------------------------------------------- �ZIVZD S -information (soils/topography/hydrolo§)�/vegetation) i�e 1— 0 1 AUG n - 1 S he Address[Location: - -7 - JZUUU -.7"ft�T SERVICES CTR 00 0 V CITY OF En r�A Qp6r c - Ai Numbe -6 M 'IDS 2., Pr ty Tax A.c ou r: 3. Approximate Site. Size (acres or,square feet): 4. is this site currently developed? yes; — no. If yes; how is site developed? 5. Desc . ribe the general site topography. Check all that apyly. U. 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 -feet). I 0-feet over a horizontal distance of 33 to 66 Steep: . grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal distance of less than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water: Approx. Depth: 7. Site contains areas of seasonal standing water: Approx. Depth: What season(s) of the year? 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- round9 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:. Tvq __.. DETF,RMI AT 0Y. Q NDMPN�kL :,CO !keyiiewed'by- FA R E C&,,.- V L= 1) FILE REE A W j- 20,90 DEVELOPMENT SERVICES CTR. CITY OF,,':" tIDS Fof,.. S t Pet "<,Z(F A- '2-1 041 \A/ I �-.)w Ave tP� #�GL=' ev�t IN *J I- Q- \\J v C� L--'v E- t> AS <-lYc-VL-ATE-b: &wt> belm- 0"'-1�7pA.'Tanb ANt> o" Su6m)ll-eo K-OT VLIkIV, C0 SPhC-Ec' Gf�,,AtG- F-L-C-%/tMblV *W L 5.67 Lt.(>-7 G 7* 67 2- CZ t I - C Z S -2-7 CIL o.c) 3-17 ci, 0 17 0. L OT 3 C—IT'i OF EADMOV,4106 .5 tJ 0 1-4 0 " tS 1-4 C-0., WA. SCALEW=20--O Ri J-4 E71 Car V4 T C A. L A 1 6!:09!j, uTtL-tr4 A -,"Of T— 0 /To % 40 1 15, ft. FF:: 347.f A&M L lk NJ JAm t, sc- ik fL-z L-A IQ roll- T6 T" eL�T A -a" es 46 -7 Av%6 w: ,-2- ) vtvr= lvokfi.-C- G,-"(3) 1. K0004L-E ID RC-S I ib EEWC c- CAU clo Q NLPAV.,Ik (J) S'VCr A-zALii-A A--LM fAL M &Tvvq c .6 iv v IF- i4 i 4.. .0 REC81VED. 0 2000 0 0 DEVELOPMENT SERVICES CTR. CITY OF EDMONDS 0 o isLu Le\, (G):� 'PLAT.. V-6 Nt� w