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TAX ACCOUNT/PARCEL NUMBER:&4�
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BUILDING PERMIT (NEW STRUCTURE):
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COVENANTS (RECORDED) FOR:
CRITICAL AREAS:��j go--k/)Z DETERMINATION: E] Conditional Waiver E] Study RequireKWaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DA
SEWER LID FEE $: LID
SHORT PLAT FILE: LOT:— BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DST,s\Fomis\Street File Checklist.doc
OWNIRICONIRACTOR ISSRESPONSIBLE
FOR EROSION CONTROL AND DAMAGE LANDSC.
MAINTAIN PLAT INSTALLED EROSION CONI'ROL 15' BUILDING UTILITY/
SET CK LINE
7A
ALL EXPOSED SURFACES TO 46.51'
11 TR)N(�T`998
BE COVERED WITHIN 2 DAYS
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MATERIAL C71
SDR 35 1 .
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SCH 40 V-Jw JL M.
N - 12 1 -62004
F810 HANCOR STREET ILE SCALE 1"=20, P R T CO
OWNER /CONTRACTOR
\11KING PROPERTIES, INC. W E
P.O. BOX 1034 0' 10' 20'
LYNNWOOD, WASHINGTON 98046 4TER & SEWER
c4w,j�-,b
PHONE : 425-670-2711 NSPECTIONS REQ-D. PLOT PLAN ocr 20
BENCH MARK CALL 425-771-0220 EXT. 1326 FOR 2004
THE PROJECT BENCH MARK IS THE CONCRETE
MONUMENT IN CASE LOCATED AT 11-iE LOT 7, VIKING HEIG� Nf-y/ F§AR' .vNl Ss,s c rR
CENTERLINE OF 238TH STREET S.W. AT
APPROXIMATELY THE MIDPOINT OF 11-iE 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 EN EERING
Date:
Lovell — Sauerland & Associates, Inc.
En&een/Su"eyors/Planners/Development CousWtants
e-mail: lnfo@lsaengineering.com - web: Isaeu0neering.com
'"M 33rd Avenue T-, Suk 200 - LYDRY00d, 111A 98036 - (425)775-1591 - (425)672-7M fax
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l(SIEVIGA'BURKHOLDER
TTRM- ASSOC I ATES, LLC
DPW4 LAND Usfi PLANNING I CIVIL ENSI146BRING
172.1 " It Avlfu& Milto 401 0 Everett. WA 95201
'... (Z).. . f.. (425)252-9551
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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:,51 f V 1072
City Receipt#:_ I '�H (� "--7> 0
Critical Areas File #: 003AW20
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant:-4—//-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 con unction 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, indernnify, 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 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-,�is)pplicationSiiffie behalf e owner as listed below.
SiGNATuREoFAPPMANVAGENT DATE AZ le)
Property Owner's Authi:or�'atfli-oo/
ha�
By my signature, I cer* I c authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for =epublic 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:
"O�kZ 'J ) /
Name
Street Address
city State zip
Telephone: 6/' C"7 !!944�;5
Email address (optional):
DATE
AppHcant Representative:
m7 A
1�)C'�IAJ C>F
Name
-77, / HL;4dt Tr— 4c/-;r
Street Address
. 46;4&r
City State zip
Telephone: q Z5 - 7-5�0 - 2,E3Z
Email Address (optional): ohe-v � ok#-bt
Critical Areas ChecklisLdoet3.19.2001
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
Termit 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
deternime 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: I 0.�2
City Receipt#: 110 .,-,5 C)
Critical Areas File #: -2003 -002-i
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant.-_ ��13 —
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 shaJI include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in con unction 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 anyaction 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 o e behal e owner as listed below.
SjGNATuREoFAPPuCANT/ATG DATE Z,
r
Property Owner's Autho * atio
e aut
By my signature, I cer* I X horized the above Applicant/Agent to apply for the subject land use application,
C
and grant my permission fcorr 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/Applicant:
I —
" 0
14ame
2:5 C3 Z ye- 4& F - 5c-x�
X
Street Address I
16;6w&)V95 V(14
city State zip
Telephone: (-/' 4f
Email address (optional):
Applicant Representative:
") �,,,,,J
Name
-77,
Street Address
6�7 crr-
city State zip
Telephone: 7-572-
Email Address (optional): johr-v o4p-bi -5saflcom-
V
Critical Arms Chocklist.doct3.192001
0
0
-V. 107
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 inforination
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 .1 (D�;7
City Receipt#:. 7-1
Critical Areas File#:
Critical Areas Checklist Fee: $45.00
Date M.ailed 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 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 fiom any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information ftimished 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 authorize di to file h be
e owner as listed below.
SiGNATuRE oF AppucAw/AG DATE t>
Property Owner's Author* atio
By my Signature, I certify I bwta/uthorized the above Applicant/Agent to apply for the subject land use application,
and gmnt my pennission for tke" 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/AppHcant.-
I —
"w
14ame 1
-2 : 5 C 3 Z Le-X F
Shvet Addrew
16;6"A/95 �<;A
city State zip
C
/ r7 44;5
Telephone: L'
Email address (optional):
DAIE
App�cant Representative:
,� Cupi 7�, 6—s: E;
Name
-70 / RL;ddl 7T- 461-;7-
Strwt Address
CIT- 6212
city State
Telephone: IYZ ! T - 7- ! 52- ZQ
Email Address (optional): johrxj
V W
Critical Areas ChecklisLdoc/3.192001
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soil s/topography/hydrol ogy/vegetation)
I Site Address/Location: ),VM -34V- 42
)W-,6V S 4a
-A�
Property Tax Account Number:
2. Od 011? ad
Approximate Site: Size (acres or square feet): 3S
3. 2/d
4. Is this site currently developed? _,:::f�-Yes; - no.
If yes; how is site developed? 1710as,-g- 6;,T� eN -S,.-f- /b�/M/
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Allk 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.rea.s of year-round standing water: Approx. Depth,:
7. Site contains areas of seasonal standing water: Al,�WPj5-- Approx. Depth:
What season(s) of the year?
8. Site is in the floodway A,0 floodplain NjQ of a water course,.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are,year-
round? NeX5'- - Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) 7V
II. Obvious wetland is present on site:
--------------------------- - - - ------------- For City Staff Use Only --- ------ - --------
1-. - Site is lo'n�V
.2'. SC8,mapped soil type(s)? '000r
r
Weiland inventory . or C.A. map indicates wetland present on site?
4. Critical Areas inven io*r y or C.A. in ap indicates Critical Area on site! /V 6
5. :site within designated eartb subsidence landslide hazard area?.. ND.
p
0. Site designatO on the Environmentally Sensitive Areas Ma'? .0
nrTPRMINATION'
CONDITIONAL WArVEk
Reviewed by.
^a-chk.doc; R" 1W.
0
City of Edmonds
R EC EMEW IV ED
JAN 0 6 ing
COMMUNITY -SERVICES
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 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 completi�,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 assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklis�t and attest that the ans:wers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
O,si,ner/Applicant:
�Jr—"u A
Name
Street Address
City State Zip
Applicant Representative:
Name
Street Address
city State
Telephone Telephone
' 1Cdn::1z
Sign,af&
---Dde
Signature
Date
Zip
(nver)
.47
PERMIT NO: 9945
C of Edmonds
ity PERMIT EXPIRES
SIDE SEWER PERMIT
Address of Construction: r5-1-22
Property Tax Account Parcel No.1le
Attach copies of all access and utility
Owne'r,and/or Contractor: )(I
Contractor License
21'ingleF'amily
Multi -Family (No. of Units
r_1 Commercial (No. of Units
F] Public
ents — "' Verified and Approved by
ilding Permit #C.4M1_1Ak,1
Invasion into City *Right -of Way: El Yes EIR-o
*RW ConstructionPermit
Cross other "Private Property: El Yes EJ-50
"Attach legal description and copy of recorded easement.
Owner/Contractor /01j;b/1)
Owner or contractor signature and acknowledgement statement: Date
---,-,By signing for this permit I certify that I have read the City's publicliandout entitled
ide SewerSpecificati.ons, and shall comply with all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-8004T4f_5555) BEFORE ANY EXCAVATION 2
2 FOR INSPECTION CALL 425-771-0220 extensionMWAr
.24 HOUR NOTICE REOUTRED FOR ALL INSPECTION REQUESTS
...... .......
FOR OFFICE USE ONLY
. .. . .. ....
. .......... .
Permit Fee $s,� Repair Fee $ Issued By:
Trunk Charge $_-29D Date Issued: lt,4 lr"Id4l
Assessment Fee $ Re ceipt No:
City Permit Surcharge Fee A.00 total Fees Paid $ 726:
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED,
)ob Site Ready YES NO Date: Initial:
Partial Inspection: Date:VZ/Ad5" Initial:
Partial Inspection: Date: Initial:
Date: 5 Initial: As -built to Street File: E]
t, PERMIT MUST BE POSTED ON JOB SITE 'n,
White Copy: File Green Copy: Inspector Buff Copy: Applicant
L;temp;bldg;forms;ssperTnitjlg4/00
0
---,Oqq ;e;--Ammw
80 COURT
4" WYE
4" C/O @ GRADE
SIDE SEWER @ 2.0- DEEP
10" C/O @ SEWER END
10" PVT SEWER LINE
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1 0 F E.D,�V_ CITY OF EDMONDS SIDE SEWER AS- BUILT
11
�� ADDRESS SCALE
U'l - 23720 - 80 CT I NTS
-at. 1890
HOMEOWNER CONTRACTOR
-VIKING PROPERTIES —VIKING
DATE DRAWN PERMIT
02/15/2005 BY SIBREL NO. 9945
f
r!
LIU & ASSOCIATES 4862'746 zo
DAILY FIELD REPORT
LIU, & ASSOCIATES9 INC, 4AO85 j. Liu
Q'Colq'� till) Miles Time 01
26 1:50P
'9213 Kenlake Place NE Tmvel Time (Hrs) Tirno 0
Keninorc. Wishingion 9802� 1 2�20P
Plionc�(425)483-9134 Fax:02-)486-2146 Vehicle Hrs on Site TTr—s TF
1 of 1 5
517, e—, -------
1/19/05 We'd.
�Neather
Cloudy
!m'1010CE qvlv WIVOMW I _. 11
Lots 6 & 7 - Sunrise Ridge 60xx - 238th Street SW, Edmonds Viking ProptL
qies
U; General Conttictor au�erirteindent Received ui��hecke,j By
Ted Coleman
Eaj-"j'Ar,r.14 Earlhv�ork Contractorsupt. Re,.eived Che,*ed By
C,ajun Excavating ........
At tile re%jest by Ted Coleman with Viking Properties, I come on site to veirify the footing r)earing sells for the
I"OLlses to be built on the subject lots. At the time of my site visit the footing trenches oil these lots have all been
cxcavated out down to the footing level, The footing trenches were inund.ated by stormwater due to the tain in
t lie last fow d8ys. Watr,,:, ill t)e trenches Were Pumped out and the trenches are now free of standing water. A kiyel
of muck covering the bottom of footing trenches S.being removed by a crew at the time of site visit, and most of
the much ha,3 already been removed.
The bofforn of the footing trenches on th lots is excavated! into light -gray fresh till soils. except near the northeast
corner of the building foolprint on Lot 7 where it is excavated into brown weathered till soils AsteeIT-bir
manually u5l�iecl into undisturbed footing_��5LiL�jpj�ils can penetrate no more than 0.5 to 3 in0es, indicating that
. . . P.. .. . .. ...... ...
the Ii
ght-gray fresh till is very dense and the brown weathered till is dense. It is my opinion that if 'he ref aining
muck is completely removed down to undisturbed till soils, the, footing bearing soils will be aOle to render in
allowable bearing capacity of at least 3,000 psf.
014
A
R E C E UV L..)
JAN--2 5 2005
DEVELOPMENT SERVICES CTR.
oriv to: Coil till tj
1) Ted Colema-li'Viking Properties 2) oil N(,)(t
3) 4.) Page-
,,* �( S -� 2-0 604� a3LA.)
OWNER/CONTRACTIOR IS RESPONSIBLE
FOR EROSION CONTROL AND DAMAGE
MAINTAIN PLAT INSTALLED EROSION Cd
ALL EXPOSED SURFACES TO
BE COVERED WITHIN 21PAX"G
C'i 'C
0
C14
-7,
)-0 9
0
15' BUILDING
S7ACK LINE
tl
46.51'
0 VA
20 0)
... . ...... ....... -7.
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SINGLE FAMILY
RESIDENCE
�3720 80th COURT W,
�, A D -,,,
/' �-36.50`/
47.
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ACCEPTABLE TIGHTLINE
WIERRED BY PLANNINGUTY COPY
SDR 35
SCH 40 �
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JU 6.2004
N - 12 0"--02"
'[1 INSPECTIONS REQ'D.
PER T Co
F81 0 HANCOR
C&L 42,r)-77j-o220sFM 13fg=20-
OWNER/CON TRACTOR
\(IKING PROPERTIES, INC. W
E
P.O. BOX 1034
LYNNWOOD, WASHINGTON 98046
0' 10' 20'
C
40
PHONE : 425-670-2711
S PLOT PLAN
OCT 2 0 2004
BENCH MARK
EVELOPMENT SEFIVI
FOR CITY OF EDQCES CTR.
DS
THE PROJECT BENCH MARK IS THE CONCRETE
MONUMENT IN CASE
LOT 7. VIKING HEIGH
TS
LOCATED AT THE
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 EXRGI EERIqG-
Date:
Lovell — Sauerland & Associates, Inc.
Engineers/Surveyors/Planners/Development Consultants
e-mail: liLfo@lsaen&eering.com - web: Isaengineering.com
19" 33rd Avenue V.. Suite 200 LYnnW00d, TA 98036 - (425)775-1591 - (425)672-79M fax
DRAWN CHMM Dm
J =TT - 3-16.03 F"' s1c"'! 2 0' 1 FT- - - D-04]
DATE RECEIVED
IIIIIII
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ME/�AME OF BUS*44S
, W Vrcj� H te _<Z�,
MMMG ADDRESS. X
vc) f3�1,
CITY ZIP TELEPHONE
— .. fl u md 2B,,,j,4 IgA 670j,
N -*N
4--< . 77�A,G[
ZIP TELEPHONE
.ITY f
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64
PERMIT EXPIRES
USE
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PERMIT
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N U M B E Pe4oll
JOB
ADDRESS
SUITE/APT#
T NAMEISUBRIJISION
NO.
LOT NO_7
L D NO,
11�T ly)n
Hpi(
L�D FEE $
PUBI_16'1`116�JTOF WAY dR OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Pamit Reqd
EXISTING 101
,e PROPOSED
Inspection Required
Sidewalk Required
Underground
REQUIRED DEDICATION FT
required dry
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED /
YEg� NO C3
a
Z
REMARKSi
z
3
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
I - — . - I - - __ - - , A
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.,COMPLETE EXEMP
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�SIGNAREAr"N
ALLOWED PROPOSED...W-'.
%
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX AQCOUNT-PARCEV'-NO
NEW 5rR, ESIDENTIAL PLUMBING MECH
COMPLIANCE OR
ADDITION COMMERCIAL
E]. El GE F
CHAN 0 USE�
REMODEL MULTIFAMILY SION
LOT COVENkGj;4---
ALLOWED PRUPOSED
45% 450
REQUIRED SETBACKS (FT.P,
�FRONT DE REAR
70i6OPOSED SET13ACKS (FT)
FR? EAR
of�� LIR SI E R
10,
PARKING
REQ*D PROVIDED
LOT AREA
PLANNING REVIEWEbrdN1 DATE
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REPAIR /&
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DEMOLISH TANK
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GARAGE RETAINING WALL FIRE,SPRNKLER
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(tYPE OF USE. BUSINESS OR
ED BY
TYPE 0
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NUMBER
OF
NU&ISER 01, CRITICAL 0,1
DWELLING AREAS
I
SPEr1AL INSP�CTION EA
OCCUPANT
STORIES
UNITS NUMBER
REQUIRE
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PBOGRIESSINSFECTIONS PER VBCIOB/IBC10911RC109 FINAL INSPECT10N REO'D
L)
�111"N X. a 7111
if r k
VALUATION
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Description
FEE
Description
FEE
Plan (�heck
State Surcharge
HE GLAZING % 'LO LOPE%
1,Buildinif-Permit' Y
Al-V
City Surcharge
PLAf4 CHECK NO:
lt� ;�7 v
4'0. 1 u rin b IA
Base Fee
THIS 99 9KTO
Mechanical
PERMIT AUTHORIZES ONLY THE WORK NC
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
23
Grading
DOMAJN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
11= SEPARATE PERMISSION.
PERMIT APPLICATION:
Engr. Review
ISO DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
0 ;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
9 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 #
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
0 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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
This application Is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN-S,q"P SATION INSURANCE AND RCW 18.27.
FOR INSPECTION
receipt Is acknowledged In space provided.
E
SyMtTURIE (�r��NER AGENT) SIGNED
F1
IQ
LS SIGNA RE DATE
"', ,
07
771-0220
ILE
R&
ED IiIATE
A17ENTION
DIM 1333 6, W�
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
/"q A&
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110.
ORIGINAL -FILE - YELLOW. INSPECTA
09/03
PINK -OWNER - GOLD -ASSESSOR
r%r%r'f%O% I@Ar%r% %1^111 Ar%V-
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