23709 80TH CT W.PDF111111111111
7236
23709 80TH CT W
ADDRESS:-,�,�)3
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DA
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DA
SIDE SEWER PERMIT(S)
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
TION: E] Conditional Waiver 0 Study Required>�Waiver
LID
LOT: BLOCK:
LATEMP\DSTs\Fonns\Street File Checklist.doc
23709
Fgcrage
80TH COURT SW
LOT# 24
2004-1025
f ront
door
3/4'
copper
wm
E
L
1" POLY 20OPSI
—Pillars
WITH TRACER WIRE @ 2' DEEP
80TH COURT SW
0 F E.D*
CITY OF EDMONDS WATERLINE AS
BUILT
0
ADDRESS
HOMEOWNER
Q),
23713 80TH
COURT SW
VIKING PROP.
CONTRACTOR
SCALE
CAJUN EXC.
NTS
.at. 1890
DATE
7/26/05
DRAWN
BY 1. ABILA
WATERLINE
NO. 2004-1025
C . 199
PERMIT NO: 9920
City of Edm. Or ds
PERMIT EXPIRE
SIDE SEWER PERMIT
Address. of Construction: Z7 2!�)F
Property Tax Account Parcel No.
Attach copies of all access andutility easements Verified and Approved b
Owner and/or Contractor: V k (n,0
Contractor License #:
2-'$S <n jg I e F a m i ly'
D mu'lti-Family (No. of Units
[7� Commercial (No. of Units
Ej Public
uilding -Permit,
Invasion into City *Right -of Way: 0 Yes ETNo
*RW Construction Permit
Cruss-6ther "Private Property: [:1 Yes E510
"Attach legal description and copy of recorded easement.
Owner/Contractor
wner ot contractor signa e and acknowledgement statement: Date
y signing for this permi certify that I have read the City's public handout entitled
Side Sewer Speci ications, and shall comply with all City requirements outlined therein.
CALL D IAL-A-DIG (1-80
0-424-5555) BEFORE AN'17EXCAVATION 2
9 FOR INSPECTION CALL 425-771-0220 extens1onj,2Zk-9
HOUR NOTICE REOUIREDVOR ALL INSPECTION REOtftSTS
..............
........ . .....
."::':FOR OFFICE USE ONLY . .....
..... ... . . ........ ......
Permit Fee ��:Repair Fee $ Issued BY:
Date Issued:
Assessment Fee $ Receipt No: e46
City Permit Surcharge Fee 45.00 Total Fees Paid $
NOTE: IF JOB SITE IS NOT READY'FOR INSPECTION WHEN.,
INSPECTOR ARRIVES A $45"RE.-INSPECTION
WILL BE CHARGED
Job Site Ready YES NO Date.� — 'Initial:
5 nitial. Im
Partial Inspection: (i _Date:_Ub1Vb'
P p
artial Inspection: -Date: -Initial.:
F F
INAL INSPECTION APPROVED: Date:. "A/6/7 __�.�nitial: 'As -built to Street File:
t� PERMIT MUST BEPOSTED ONJOB SITE t�-
Copy: -File-Green Copy: Inspector BuffCopy: Applicant
L;temp;bldg;forms;ssperTnitjlg4/00
23709 80th Court
Garage
Covered
Parking
18,
ABS
Lot # 24
Permit # 9920
4" C/O
F . PVC 4.5'
19.5' 4"PVC
6" C/O. 18.5!
PVC
2'D
eep
4.5' Deep
Connect to main
detailed in plat dwgs.
23711 80th Court
Lot# 25
Permit # 9919
Porch
2' C/o
f 4'deep
6"PVC
ABS
to
WYE Connect to main
I detailed in plat dwgs.
Pdvate Ddvew(�_
of 0 CITY OF.EDMONDS SIDE SEWER AS— BUILT
ADDRESS 23709 80th Court SW HOMEOWNER
23711 80th Court SW* Viking Properties Inc.
CONTRACTOR Viking Properties Inc. SCALE NTS
DATE' DRAWN PERMIT 9919
-&t 1890 . 6/16/2005 By Nima M.Moghaddam NO. 9920
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 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: -7,9
City Receipt#:_ (o'�) 0
Critical Areas File #: --2 co'-:3.—W20
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 histher/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/ber/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
lmowledge and that I am authorized to file #0s 3pplication o Jjie behalfof-t4e owner as listed below.
,n
I/AG '!�>
SIGNATURE oF APPLicANT/AG DATE /1Z
Property Owner's Autho ' atio'
I
By my signature, I cer* 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:
14ame
,7 5 C 3 Z 4L- F
Street Address
4�bvaAlk�5
city State zip
Telephone: J(0!;7-
Email address (optional):
AppHcant Representative:
C>,Ipj
Name
/ -77, Ael-;;-
Street Address
e-7T—
city State zip
Telephone: 7-s-2-
Email Address (optional): )oht-z),� okp-bt
V
Critical Arvas Checklist.dorJ3.192001
0
-C. Jb7-
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: 3 1 f I/ I (D_�)
CityReceipt#:_ 1 2-1'(0-30
Critical.Areas File#: -700-3-(-0o2-1
Critical Areas Checklist Fee: $45. 0
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
pem-dt 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 ail 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 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 plicabo e owner as listed below.
SIGNATURE OF APPLICANVAGENT DATE
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 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
PLEASE PRINT CLEABLY
Owner/AppUcant:
" 0 �q
Name
-2 �
Street Address
4;bwOW5
city State zip
Telephone:
Email address (optional):
DATE
Appficant Representative:
.7
Name
Street Address
city State zip
Telephone: q Z 7-572-
Email Address (optional): joh4-,v oko-bi
Critical Areas Checklist.doc/3.19.2001
City of Edmonds Date Received:
City Receipt#. 1 7-1
Development Services Department
Planning Division Critical Areas File#: COZ-2-
Phone: Critical Areas Checklist Fee: $45.00
Fax: 425.771.0221 Date Mailed to Applicant.,_ J/-,eZ3
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 area 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
inforniation (e.g. site plan, topography map, etc.) or
studies in conjtinction 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, 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 conrct to the best of my
knowledge and that I am authorized to file plication "e belia4fAft#e owner as listed below.
'i
:,IA7G:
SiGNATuRE oF APPLicANT DATE 't:>
Property Owner's Author' atio
r 0
e
By my signature, I cer *i T authorized the above Applicant/Agent to apply for the subject land use application,
ou lic offi
and grant my perrnission for i 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:
"OL�/ IJ I rkprJ40 V 0
14ame I
2 5 /,' 'Z "2
qY
Shvet Address
4;6V0A4?5 VOL
city state zip
r7
Telephone: ' !;7- c/'
Email address (optional):
Applicant Representative:
get-
,,,) Cl/&) / 15>/T
Name
1 -77, / AIL;4v, Tr— 4,1-;7'
Street Address
qr-
city State zip
Telephone: 7-572- -2,e12- A --
Email Address (optional): johtvj 4pt-b,
U W
Critical Areas Checklist.doct3.192001
WILE NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site-Address/Location:
)AWO or
2. Property Tax Account Number: ad Z- 0;2,;� -
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? _k��Yes; no.
If yes; how is site developed? - ZINS,0- A,,71 eN -S,6- 42Mkd ep/= 140��
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
A1,1k_ Rolling: slopes on site generally less than 15% (a vertical rise of 110-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 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: A&?AZj5-� Approx. Depth:
What season(s) of the year? Al 1A
8. Site is in the floodway Ala floodplain jQ0 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are -year. -
round? NeIV,6r — Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (law.n,shrubs etc) W�74 2�9� -g4^
.7V
11. Obvious wetland is present on site: Aal�v
----------------
------------------- ----------- — ---- for -City Staff.Use -Only ------------- — - — --- --
4 F Site is Z
onedlem �s
.. . .......
4v_
.1' SCS mapped soil type(s)?
3 Wetlan d inventory'or C.A. map indicates wetland present on site'?
4.- CriticalAreas invento or C.A. map indicates Critical Area on site� AID'*
ry
Site witbin designated earth subsidence landslide bazard area? lip
:,6.. Site designated on the Fnvifonmenta.11y Sensitive Areas Map? M)
]DETERMINATION
Eff REQU1RED
Reviewed by.
�ca_chk.doc; Rev 10/01
CONDInONAL WAIVER.'.:'
6.401.
D te
0 .0
City of Edmonds
RECEIVED
JAN 06 19.009
COMMUNITY SERVICES
1tv. 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-z,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 mation (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:
i Jea I
1--Ovgd &
Name
Street Address
&ZZ
City State Zip
Applicant Representative:
Name
Street Address
city State
Telephone Telephone
Sign
Signature
Zip
Date
Inver)
0
ALL EXPOSED SURFACES, TO <
N V) 23
BE COVERED WITHIN 2
SINGLE FAMILY E3
ky
I L Y _8
E
C, :R :E 07 80th COU
IT W.
F-mve-5
OWNERiCONTRAC1*02 iS R—E:3)*P N IS L
x :7,
6'xl
FOR EROSION CON `lF80L A D�fl AG _0
r
(6 1.5-04'
8 9,2 �13 7 W
r<
0 >
.36.50"' 1�5. 0
04
C
MAINTAIN PLAT 1 24/
0
0 dE rAMILY 1_0
LY 8
8 Z N R�SIDENCE
V) z I C�
23700 80th COURT W.
W.
D 19 2
,/'n ro D 19
36.W,,
. � 4.�lrejn,
1:4.94 21� 11 , r: , ":
gy
R
-lb PLA
51.43'
1:4.92[
SINGLE FAMILY
L Y 0
PFqinFN(.F
q
A
7, -7 r
ac 7 - -
ACCEPTABLE TIGHTLINE
MATERIAL
SDR 35 N PERU/ C
"'�C
6
04
01
r) CO
SCH 40 0, 7
T& _
OWN ER/CON TRACTOR N - 12 SCALE : 1"=20'
\AKING PROPERTIES, INC. F81 0 HANCO% �_E
P.O. BOX 1034 0.
LYNNWOOD. W I ASHINGTON 98046 WIAT4E& SEWER 10' 20' 40 RPhIVED
PHONE 425-670-2711 INSPECTIO�,IS REQ'D. PLOT PLAN
BENCH MARK CALL 425-771-0220 EXT. 1326 FOR OCT 2 0 2004
DEVEL
THE PROJECT BENCH MARK IS THE CONCRETE 1DRIVIENTESE VNICES CTFI.
MONUMENT IN CASE LOCATED AT THE LOT 24., VIKING HEIGHFS OF DV�o DS
CENTERLINE OF 238TH STREET S.W. AT
APPROXIMATELY THE MIDPOINT OF TIAE 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 ERIN
Date:
Lovell—Sauerland & Associates, Inc.
kagineers/Surveyors/Planners/Development Coandtants
e-mail. infoftAeu&ea*.e= - web: Isaengineermig.com
19M 33rd Alrenue If, S—uIte 2oo Lymwood. VA 98036 - (425)775-1591 - (425)672-7998 fax
DRAWN CMXM DAM SCAI Fu NO.
JTT JTT 3.6.03
1!"= 20 0-04
L
LIU Q ASSOCIATES 4962746 10 I[N—sw
DAILY FIELD REPORT
'1TMT'
Field HeP.
?agr-
i 11ePQRT1'0—
LIU & ASSOCIATES, INC.
4AO86
J. Liu
1 of 1
7
26
2.35A
4/13/2005
'1 hUr.
19213 Kentake Plice NF.
Travel Time (Hr5)
Time Te
trier
Kentnore, Washington 98028
1
3:05P
ELnf)y to paruy
Phone: (423) 483-913.4 Fax: (425) -166-21746
Whicle Mrs on Site
Mrs
Vi—sitors
JCb Locatioll
Uien[
Lots 20 thwLi h 24 Sunrise Ridge 80xx - 238th Street SW, Edn,,ords Vilkinq Pro I
E)ert;es
��—eae �W 'con tractor General tracto., 5�jperinter)dent Received Uilchecked i3y
ViKing Prop�jles Ted Coleman
F;ri�lwork Goritractor EarthWork contractor Supt. Receved Checke _E)�_ ----- ---- - -
Cajun li�KSaVatinq
At the request by Ted Coleman with ViKing Properties, I corne on site to v& ify the footing bearing soils for the
�,,ouses to be built on the subJect lots. At the time of my site visit the footing trenches on these lots have, all been
exca,vated out down to the footing level, No grourdwater Seepage or standing water is observed within the subject
lots. Some loose disturbed soils have fallen into the footing trenches, and in places a thin layer of soils over the
t)ottcm of tile footing trenches is disturbed by the scraping of the backhoe bucket.
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 penet,ale no more
than 4 to 6 inches into the undisturbed footing beahng soils, indicating the soils are medlurn-dense to dense,
I inform Bob, the foreman with Viking Properties, that the loose thin layer of soils disturbed by backhoe oucket
should be compacted to a non -yielding state with a vibratory mechanical compactor, If the above recommendations
are followed, it is my opinion that the footing bearing soils will be able to , ender an allowable bearing capacity (.1' at
least 3,000 psf.
(1 -1 S,
WASQ
NA
axpous
q�
1) Ted Coleman/Viking Properties 2) on Noxt
3) 4) Pia. —I
0
ALL EXPOSED
BE COVERED
ILY c,-,
- C"�
'T W. 'r'
,.,.,.OR i�
A A h' L; N RA
FOR EROSION CONITARC1
MAINTAIN PLAT I
5
ACCEPTABLE TIGHTLINE
SDR 35 MATERIAL N
SCH 40
C ")0.
'-
X
6
04 ICY
.5.04'
0
.54 17
I z
APPFIOVEI)
6 , 2004
OWNER/CONTRACTORN - 12 SCALE : 1"=20' v
\MKING PROPERTIES, INC. F810 HANCOR w E ---
P.O. BOX 1034 01 10' 20' 40 A
LYNNWOOD. WASHINGTON 98046 1
PHONE 425-670-2711 WATER & SEWER OCT
INSPECT!f'0,'.3 REQ'D. PLOT PLAN 2004
DEVELOphfEVT
BENCH MARK CAU 425-771-0220 EXT. 1326 FOR CITY OF SERVICES
THE PROJECT BENCH MARK IS THE CONCRETE LOT 24 ED)WONDS CTR-
MONUMENT IN CASE LOCATED AT THE VIKING HEIGHTS
CENTERLINE OF 238TH STREET S.W. AT
APPROXIMATELY TI-IE MIDPOINT OF PiE 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 ENGINEERIN
Date:
L IIIIIIIIIIIIIIINEM Lovell—Sauerland & Associates, Inc.
Engineer.,/Surveyors/Planners/Development Consultants
e-mail: info@Lsaengineering.com - web: lsaengineering.com
1kW 33rd Avenue T., Suite 200 Lyunwooct TA 98036 - (425)775-1591 - (425)672-M8 fax
DRON CHZ= DATE F.B. -- Sol I Z NO. —
JTT JTT 3.6.03 1 "= 20' 4656-0-04
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F.
ANN
22WHIGA-BURKHOLDER
fWASSOCIATES, LLC
LAMD USE PLAt4Ml"Q f CIVIL EN(IINERRING
1721 Hewitt Avwms 0 vitte 401 0 Evwett. WA 95=1
phone (425)252-2M fox (425)252-0651
DATE RECEIVED
Ailik
'
-7 __j - ,
PERMIT EXPIRES A
- I /
CITY OF EDMONDS
USE PERMIT
ZONE
N U M B E ZJ46::
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRES;,,,�)q
OWN /ZME OF BUSINE
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LID FEE $
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PUBLIC RI&k OF WA�JER OFFICIA
TESCP Approved
RW Permit Required
CITY ZIP
TELEPHONE
EXISTING -If PROPOSED
Permit Req'd
Inspection Required
Sidewalk Required
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Lo f\ III, W
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REQUIRED DEDICATION FT
Undergromd
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-
wiring required
NAA
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METER SIZE LINE
11
SIZE
NO. OF FIXTURES
REQUIREd
YE NO 13
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IN
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ARRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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STAtt)ILICENSE NUMBER EXPIRATION DATE
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SEPA REVIEW�
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SIGN,AREA V
ALLOWED PROPOSED
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REQUIRED SET13ACKS (FT.)
"OkOPOSED SETBACKS (FF.)
COMPLIANCE OR
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TYPE, F TRUCTION
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PROGRESS INSPEC71ONS PER USC 108 1 IBC109 /,IRC1 09 FINAL INSPECTION REO'D
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Description
FEE__,A,
Plan CheR,
State Surcharge
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City Surcharge
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Base Fee
790
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
DOMAIN
Grading
3
(CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION: 180 DAYS
Q.
PERMIT LIMIr 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
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
1
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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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
Landscapeinsp.
Total Amt. Due
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0
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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
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 Official or his/her Deputy: and Fees 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 C? INSURANC� AND RCW 18.27.
,WZU,SATION
"OF) C S SIGNA#E DATE
S1GNWURE!2:NE�
(OW
TE SIGNED
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W113AFIAEW�4�1
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771-0220
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ATTENTION
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IT IS UNLAWFULTO USE OR OCLPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
ORIGINAL - F11 - YE OVV R
PINK - OWNER - GOLD - ASSESSOR
09/03
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