23753 76TH AVE W.PDF111111111111
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23753 76TH AVE W
0 0
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ADDRESS: �5 7o"' �
TAX ACCOUNT/PARCEL NUMBER: /-) S 2� - 66 ()- -00.2-00
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED
PERMITS (OTHER): Y-00 Z
I
PLANNING DATA CHECKLIST DATED: &
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
DETERMINATION: 0 Conditional Waiver 0 Study Required E] Waiver
LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:- )IOZ4 SIDE SEWER PERMIT(S) #: Za25:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
w - M-91
LATEMPOST'sTorms\Street File Checklist.doc
0
PLANNING DATA
NAME: /<� !;
SITEADDRESS: 2-3-1-5-7 - -7&r- Avx
PROJECT DESCRIPTION: 13,-IA /I., >'
REDUCED SITE PLAN PROVIDED?:
MAP PAGE: CORNER LOT: (Yes
TE: (0/21,03
PLAN CHK#: 03 -Z- 14
6 be e--4 -/ S40- --4 3 "d�V-f AAA
FLAG LOT: (Yes
ZONING: P--S - V CRITICAL AREAS DETERMINATION MIMI -- 76 -p&-oA�r
Ll Studv Reauired:
Uywaiver
L3Conditional Waiver
SEPA DETERMINATION:
U Fee
Ll Checklist
(J APO list w/ notarized form
VLi eeded for 500 cubic yards of grading, Shorel . ine Area. site within 200 ft. of Puget Sound or Lake Ballinger)
E,empt
SETBACKS:
Required Setbacks:
Street: ?-S' Left Side: ?,5 Right Side: Rear:-L9-*-A-41j"'-A mc4lae-'
ActualSetbacks: footw-- - 8
Street: 7 2-' Left Side: .36' Right Side: sw",j- z-7* Rea 97
-- r: 5 63'
Street map checked for additional setback required? (Yes / No / 150
U DETACHED STRUCTURES:
Ll ROCKERIES:
Ll FENCES/TRELLISES:
0 BAY WINDOWS/ PROJECTING MODULATION:
UrSTAIRS / DECKS: � i,,. i-.
PARKING: Required: 2- Actual: AL Z- ov,,rA
_7
LOT AREA: Y4 1--at ? Z to �q
LOTCO RAGE:
Calculati ns:
BUILDING HEIGHT: N.
Datum Point: Datum Elevation:
Maximum Allowed: Actual Height:
A.D.U. CREATED?AN-o
Yes)
SUBDIVISION:
LEGAL NONCONFORMING- LAND USE DETERMINATION ISSUED: (Yes
OTHER:
Plan Review
NewBPP1anningDataForm.D0C
APPLICATION
for
The City of Edmonds SME SENVER PERMIT
OUTSIDE INSIDE REPAIRS
EEO FILE
OVVNE- ------ ........ ....................................... CONTRACTOR ------
STREET
,4 /'v AVENUE LOT No
HOUSENo . .. . ........... ............... ........................ . ................. � ....... ............... .........
NAME ADD.
CARDNo . ...................... L ................
EASEMENT No. ............. ...........
444-fM ................. PERMIT No.
............ BLOCK No . ...... ................... ....................
. ..................... ........ - .............. .................
Y
IN IN
�lk I
-7
A P P R-C) V
AR 6 1964
33' 1 r . ... ....................
74 /�-p
Date Approyed:
BACKFILL WORK ORDER ISSUED ........... -- .................... DEPOSIT, $ ............... ...................... I ..... - / / " .' 4 .1 1
.................... ...... 64 1'
SEWER WORK ORDER ISSUED ............. DATE .................. By
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 liable for the
information given on this map(s), nor for
any one repre I sentation provided based
upon said map(s).
�;�tCITY -00 :EbMGNDS-.-_. -
.:wh
Call ]?Rospect� -1107 en_wor
_k
MATER-SEWER-DEPART
CENTEIV� MENT-.* : Is. readj for Iii.
pection. (No' lftsp�c,_
t1ofis So* , N�0!-, 10'05
wrd�y, Stu ,oi�ho Iday..)- -
_04
SIDE SEWER PERMIT,,.-
K 2;._7
ue .. ........... ............................................. ....... ............ ...........................................
DRE .375.3...-.!: .... 7.6.th-.�Ayehi --Yeat_
R ...... .............. .......
fOWNE& .......... Uestern�.*-Z-racti6n ........ .... XONTRACTO ... $ewei�
............ ..........
SQg .... ... M R -a Side, Wer
;V. 'h 26 I'l- '6 4' for ji_
'erlylissilon ran ed [?K:rjQ .............. ........ 19.-_ - 7 .... .. ..... d YS, to� REPM or CONNECZ, Se
I Olt - S6W,�rs.Wa&6rdanb6 with- pp 'm -d nin
rSq -,Ii lfci4loil:�oll;fil�i gover r,ordiniifi�es.'
�y
TVT NTION: 18, CALLED TO THE FOLLOWING:
I -to4 e6nstruct�'se%���,'Inita6'�pr6pdrty, line. 7A Side, Sewer Contra tor intuitz
OT No; I —The owners of the� ;Pro 3tairf,44errifft
be ampioyed to const . ca .
rticti!eiiitde7'�ysn6E�Lv���-�oin -stree re. -Do.noccove d
-any, portion:.of��se�� r- before,, it.,.haa.-.been InsRecte
-140TE.No. 2—Obtain, full-Infor . matIon 4regarding' OrdinanceJI.M030, and'Regulation's' , 'governtnk, side -sewers wh . err You;
�get perzr!it..
p.of.-Islde�sewer, must �have. at least 30. lnches�,c6ve'rage at'propert��ilne� and,,12 *Inches -inside property line; minimum grade of 2
--N0TF,No.'- 3—To
r�o. -bends. in,,grade. sharper than �A.mlll be* perfilitted-'
�4iqd.-:�4—,Trench s-�
e �Jjn�stre-et7xnust- be.-watir settIe'd-and:-s&f&ce-bf streeL_FestoredA6, origin�l-Je6ndition" Contraetons: shaW-be-responsiblb: f6r',
failure- due to? Improper wor�--wnlo-,may-.',�ey�lqp :;Yi�4in'one y,ear of -bompletton...,,-
unlaw or do afij,otfiir,,work.�than Is,p I rov d
f�l 'fo:�altei the permit, 4r--t& do- anyz,.wdrk on the malnsewer.
piatenahces -ex6ept to Insert the-plip-e7into'the wye.
NOTE :No.-577-- tAs Ide :for in- or., It
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CITY OF EDMONDS I mr
PUBLIC WORKS DEPARTMENTSTE)
RIGHT - OF - WAY CONSTRUC FEET FILE
A. eAddress or vicinity of Construction
23753 7�5- AV L11--St Plat
Owner: rn
Name
Af),;
Mailing Address
�,,Tac-hirxfccn qBO07
City, State, Zip Code
0' Contractor: SWEP An AbOVe
Name
Mailing Address
City! State, Zip Code
10it No.
Issue Date
0 Permit Issued To:
9 Type of Work to be Done: 11---i -r -) T�11c
• Work in Connection With:
El Sub or Plat 0
0 Comml. / Ind. El
• Pavement Cut: El
State License Number
Telephone Number
C
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
Single Family
Apt. Condo.
Yes El No
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220—
I - P,
I understand that t i Vp,er �it rri�ust availagle job site for inspection purposes at all times.
0
D
Signatu�re� ate 5
OwneLl/07r Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Void after Vq?) —days
Special Conditions:
Ammendments:
Permit Fee:
Security Deposit:
Receipt No.:
Fund I I I Fee:
Street Cut Dimensions
X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
FIELD INSPECTION * TES
I IF
(Fund 111 - wite cony to Street Dent.
Diagram:
Y,6
Contractor called for inspection-
Kork Disapproved By:
j: 100r) Bv: Date:
Work Approved By: -Date:
Inspector: Dir. Of Pu, Ir ftrk.,;,
Encr. Div. December 1978
DATE RECEIVED
PERMITEXPIRES 1 :24- 14
U6E PERMIT
ZONE C 6
1pf� n;7
CITY OF EDMONDS NUMBER '2 4;�
JOB UITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
';� lb 7 5 S
OWNER NAMEMAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT No. LID NO.
MAILING ADDRESS LID FEE $
t"-, TESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Req'd
CITY ZIP TELEPHONE. EXISTING _____7 PROPOSED Inspection Required 13
Sidewalk Required E3
REQUIRED DEDICATION— FT Underground
74e, Wiring required 13
K,
NAME ME I ER SIZE LINE SIZE I NO. OF FIXTURES RV REQUIRED
I I YEPs 13 NO 13
Ei
W
CITY
NAME
ADDRESS
CITY
STATE LICENSE NUMBER
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ZIP I TELEPHONE
JCBL #
I I ENGINEERING REVIEWED BY DATE
ZIP I TELEPHONE
EXPIRATION DATE I CHECKED BY
)ROPERTY TAX ACCO
PARCEL NO.
A/
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF BUSINESS OR ACTIVITY) EXPLAINt
e 0
NUMBER
NUMBER OF
0
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
5 () , I d. 10 ", ), 6"r
+0 ta_ eVe tA,_ Wk
T_ I t_j
10 5 hzi, r. _-
HEAT SOURCE GLAnZG,
0'\, -z'
PLAN CHECK NO:
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
oFENCE
( X FT)
OTT a c K
F RE SPRINKLER
FIRE ALARM
1!5 — / _N
CRITICAL ( tu I
AREAS ()3`7 -'
NUMBER ,
it L_
FIRE REVIEWED BY DATE
0
3
Ix
ul
z
Lu
95
U.
VARIANCE OR CU SHORELINE OR ADB11 I INSPECTION I BOND
REO'D POSTED
YES 3110 $
SEPA REVIEW SIGN AREA HEIG
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
I r. / 31.
z -7 z/g. >('Cl z
5 7.5 . 7zrl z z
PARKING .L.OT AREA PLANNING REVIEWED BY DATE
RECI'D PROVIDED I
Z I ;�a2i 10 910"1
REMARKS
CHECKED BY I TYPE OF
GROUP
SPECIAL INSPECTION
REQUIRED
JAREA ,
j"A
QZve%Kj?
OCCUPANT
LOAD
YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ-0
VAILUATION
$ /Z- )61
Description FEE Description FEE
Plan Check -710 State Surcharge
Building Permit S City Surcharge 1,4;).
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PEdmrr'CO�ERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
2 Engr. Review
PERMIT APPLICATION: 180 DAYS
W
SLOPE %
9L ..
PERMIT ILIMM I YEAR - PROVIDED WORK IS STA ED WITHIN 180 DAYS-
- . .
Engr. Inspection
7
. .....
..
_ _' I
I
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
7/0.
W
_j IN 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 #
_Z� zo
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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
I
Landscapelnsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
x
_fReceipt
Recording Fee
#
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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 C3WPEkSATION INSURANCE AND RCW 18.27.
OFFIVIALS S19NATURE 'AT
SIGNATURE'JOWNER 'R AGEN-0
DATE SIGNED
(4 25
aw)
771-0220
'REL &T�
ATTENTION
EXT 1333
E
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
4
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
081 YE INS�ECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK-IOWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING