24318 100TH AVE W.PDFiiiiiiiiiiiiii
15580
24318 1 OOTH AVE W
PLANNING DATA
NAME:-6��,,c eLr. tk-1 q e-IAo,
d
SITE ADDRESS: ?-4 31 Ove V. DATE:
ZONING: P-S4 --PLAN CHK#:
PROJECT DESCRIPTION: AA LyLg
C/
CORNER LOTJ�L--(Yes/No) FLAG LOT ft (Yes/No)
SETBACKS:
Required Setbacks: z A 3-Pi. .
Front: 2,!5' Left Side: 75' Right'Side: 29' Rear: ?. 5,
Actual Setbacks: -f. Z oty
Front:- 7-9' Left Side: 11' Right Side: 24 G' Rear: 6 3
Street map checked for additional setback required? iv. - n��Aw>.,A (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE: 4-71"
Maximum Allowed: _.Actual: It 040 Z117.
BUILDING HEIGHT:
Maximum Allowed: as) Actual Height: 14 '3
Datum Point: r* qwpo - -!W doa Datum Elevation: IVA
A.D.U. CREATED?:
SUBDIVISION:
CRITICAL AREAS#:, Z6611- -74 - W&.W-
SEPA DETERMINATION: "r-
LOT AREA: 1(04,00
I
OTHER:
Plan Review By:
c.TileAperiniftAptandatdoc
_V
I V
RECE
AY
DEVELOPMENT SERVIt i,�
ES
C
ififf& DS :7,
City of Ed
,,C
RITICAL AREAS. CHECKLIST,,,
%
44
J - -4��
The Critical Areas Checklist contained on this for m- is An yplicant, or. his/her representative, must fill ou-,
fille y any person prepa-ri"n-g" he'*ckhst',`-IsIg_n'M d'aale"'I't
to be d _011 i�t Md.- s bmit 'it to the
Development Permit Application for the City of City. The City will review- thi�-'-_checklist, make
hi �h
Edmonds prior to s er -submittal of a developm eifit precursory site A�i 'nation of the
and make'adete'imi
-.,§u Sequent steps necessary to copapiete a developmen-.
permit to the City.— b
pe
t application
0- Please su mit a vicinity map along with the signed,
The purpose of the Checklist is to enable City staff t b
determine whe _itaf!
Ther any potential Critical Areas are', or copy of'ihis form'to4'assist City' f in finding and
may be, present on. the subject property. The locating the specific piece of property described or
information needed to complete the Checklist should _ihis.form. In. addition, the- app
ji�ant -',phall include
be easily available from observations of the site or other pertinent information (e.j., iit�'jian*`, topography
data available at Ci Hall (Critical Areas inventories,. mia, n con . nctid�-'��t�- this Checklist
p, etc.) or studie.si Ju
maps, or soil surveys),. to assist staff in completini.. thdir preliminary
. IMAM&!,
sesgrn6ntb the sif6'
I have. completed L the attached Critical Areas Checklist and attest that the answers d ctual,' to the
best of my kno�y��6d p e co umn
_4(�(flll out the appro riat
Owner/Applicant: 'A plicant Represehtative:'
40
Name
6
Street Address
JEW)I 040J.
city S tate Zip
Telephone ��___7
-.:— C=A.-I
Signature
Address
ity State
Zip
2 0
Telephone..
j A
Signature
Date
. creception\janakaddoc
Date
(over)
a
OFILENO.
Critical Areas Checklist
-s-i Wfn_fo_r m__a_fi_o_n_(_s_o _i1_s/_to_p_o_g_raphy/hydro I ogy/ye get at ion) -------------------
I Site Address/Location: 2 4�3 / 9 — / "�� 4 - a)
4 �
2. Property Tax Account Number: Q 3 3 — 1365, —040
/40 /_/0 '�g '&;r
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? X yes; 00.
If yes; how is site developed? ��:km ita
1
5. Describe the general site topography. Check all that apply. R 27 C E I V E
X Flat: less than 5-feet elevation change over entire site. MAY 0 3 20rur
Rolling: slopes on site generally less than 15% (a vertical rise of I 0-feet over a PLA&--1NG DEP
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 3-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-
round? Flows are. seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs etc) '440jYj StIPM56-'-, - -
11. Obvious wetland is present on site: 4 �AJ'F__ .
A0_d&.ftr. R" 10MM
r jeprx
V4, w 4
10150
;646 3�o� 771J,442 7 -Ar.E o3
;rr
b(4-7hl
ox
vjA -
vi 4-Tra e A,4 A -
CIS.
44
Aj
M
Eylsr- exo4s, Salo -
root
c.2
-0 7 7 P.4
C.,
&7-44;& aA10 AMA'Op"-
RECEIVEP
RECEIVED
c4l &4WA rPr- .3660 PJ; AX 4%
MAY 10 2000
DEVELOPMENT S—
CITY OF DEVELOPUM7 SERMCES CTR.
CITY OF EDUCINDS
4W 16 11
44
Ac
-441
Z.,
NA \9
cs
-t3l
-- jl�
7K
lit
APPROVED BY PLANNING
'z 4110
A,
ri
24318 1 OOTH AVE W
Fld -
City of Edmonds
NTW CRITICAL AREAS CHECKLIST
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 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 shah 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 Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the. appropriate column below).
Owner/Applicant:
6 eM I J)
Name
ekll 7t
Street Address
city State Zip
Teleph:,,,,—
Signature L
Applicant Representative:
Name
L311 (C-51 10,
Street Address
C' (71
,A&
city State Zip
0z —
Telephone
Signature
Date
creception\janakad.doc
Date
(over)
CAF[LENO.
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soil shopo graphy/hydrol o gy/ye getation)
A,� �/
I . Site Address/Location: 2 4
2. Prop erty Tax Account Number: 0 3 3 0 -3 ( a 0
3. Approximate Site Size (acres or square feet): //,o /-/0 �g Z-&
V
4. Is this site currently developed? X yes; — no.
2
If yes; how is site developed? 6
5. Describe the general site topography. &ck all that apply.
R I V E D
X. 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 MAY 0 3 2000
horizontal distance of 66-feet). PL"i'i-A61 DEPT.
Hilly: slopes present on site of more than 15% and less than 3 )0% a vertical rise of
I 0-feet over a horizontal distance of 3' ) 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 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-
round? Flows are- seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs ;rnixed
urban landscaped (lawn,shrubs etc) 4�9k)41 Siqe-LI56S
11. Obvious wetland is present on site: li
taff-Use Only ------- ------ - ---- - - -- - ------ - ------------------
For, City S
.. .. ...... .
e
ZpDed.?.
X
i"I.-ty s gp, �:,. _ �.
2: mapped: so
1. Wetland inventory:or.CA.- map indicates wetiand present. on site?.:.
Criti.cal Areas inventory or C.A..map� indicates.Critical Area on. site?..
::.5.;. Site. within-Aesignated earth. subsidence landslide hazard.orea? 44
;:6,.' , SiteAcsigna.ted on ithe.Envirotimentally Sensitive A-reas Map?.
DETERMINATION
�a.�chk.doc; Rev 10/03197
T
!6v
(J�
(J-at
V� i
CEIVED
SEP Z 2 ""09
-L�u
bkD
od D!
oo
00
.OPMENT SERVICES CTR.
MY OF EIDIMOINMS
A
CITY OF ED- -,CNr-'
BUILDING DEPARTNALNIT
WORK
ADDRESS -'2d Q A VQ
OWNER
APPROVED DATE: A
BLDG. OF51CIA WA
PERMIT gUgWiSER
q�
Z.1 q - 0 #.
/43Z
oev
owl.
KA'
e5l
GN
I
LL.
,,-AP &jED BY P11
R E C EAVE D
A
T,
, I CTR.
DEVq T SEF
fTY OF EDMis
/0 10 .0(-
Z
4, 76 ;?
N
PERMIT EXPIRES 72�� Ti�V
CITY OF EDMONDS
USE
ZONE
PERMIT
NUMBER
ea 5�a
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
SVITE/APT#
OWNER.NAMEMAME OF BUSINESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
LW
0
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION— FT
TESCP Apj;med 0
RW Pennit Required E3
Street Use Penns Req'd 0
Inspection Required 0
Sidewalk Required 0
�Jnderground
Wiring required
CITY zip,
40 o
TELEPHONE
Ir
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 0
0
3
LU
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
z
z
.0
z
Ul
CITY ZIP
FTELEPHONE — I
I
NAME
ie rt'0_AC_J;I
ENGINEERING REVIEWED/DATE
ADDRESS
Li co A
Uj—
FIRE REVIEWED BY DATE
E
CITY ZIP
TELEPHONE
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
REO'D
0 YES (:] NO
BOND
POSTED
z
z
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
SEPA REVIEW
COMPLETE EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED?
PROPERTY TAX ACCOU14T PARCEL NO.
NEW RESIDENTIAL PLUMBING / MECH
AUDITION 0 COMMERCIAL C3 COMPLIANCE OR
CHANGE OF USE
R EMODEL 0 APARTMENT C] SIGN
C] REPAIR C] GRADING 0 FENCE X
CYDS FT)
DEMOLISH C] TANK OTHER
o GARAGE R NING WALL
- CARPORT 0 RMERY —_ 0 RENEWAL
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.�
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT URSIDE REAR
PARKING
REO'D I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
REMARKS
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: Ili%, -
e_— .4 ,6 1 C
'#-/"w/kr/ 44 4 / . "
CHECKEDBY
TYPE OF CONSTRUCTION
CODE
17
OCCUPANT
GROUP
z
0
NUMBER
OF
STORIES
NUMBER OF CRITICAL
DWELLING AR;�W
UNITS NU 7-/
SPECIAL INSPE OTRAREA
REQUIRED C] YES
S
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
I ol
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE %
BUILDING
PLAN CHECK NO- VESTED DATE
PLUMBING
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 (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
GRADING/FILL
:3 SEPARATE PERMISSION.
t
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WIT!j!N 180 DAYS
ENG. R W FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W *APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
E NG. INSPECTION FEE
W
i IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND,
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
RECEIPT
_j DEEMEDTO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANYWAYTHE CITY'SABILITYTO ENFORCE ANYORDINANCE PROVISION.'
x
R C�IP
TOTAL AMOUNT DUE
7
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APOLICATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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 orhis/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 COMPENSATION INSURANCE AND RCW 18.27.
OFFI ALS SIGNATURE.— DATE
UOWNE OR AGENT) DATE SIGNE
SIGNATUO D
(425)
771-0220
RFI EASED RY DATE
ATTENTION
EXTJ333
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
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
ORIGINAL -FILE YELLOW- INSPEdTOR
PINK - OWNER GOLD - ASSESSOR
5/98
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
' SUITE/APT*)
_417. CA
OWNER NAME/NA ME 01 BUSINESS
YX4
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
MAILING ADDRESS
1 w
0 2 go (06 4 vr= W.
PUBLIC RIGHT OF WAY PER OFFICIAL
EXISTING — PROPOSED
REQUIRED DEDICATION—
STREET MAP
FT
TESCP Approved
RW Permit Required 0
Street Use Pe-1 Req'd E3
inspection Required a
Sidewalk Required 0
Underground
Wirft required
CITY
E 044 e e 10, 5
TELEPHONE
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO
ADDRESS
REMARKS
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CO NTROUDRAINAGE
CITY jz P
TELEPHONE
NAME
CITY
STATE LICENSE NUMBER
ZIP I TELEPHONE
TAX ACCOUNT PARCEL NO.
L77)
DATE I CHECKED BY .
NEW
RESIDENTIAL
C]
PLUM`B'iNG / MECH
C-] ADDITION
0
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
0 'REMODEL
0
APARTMENT�"
0
SIGN
0 REPAIR
0
GRADING CY DS
o
FENCE X
FT)
0 DEMOLISH
0
TANK
oxbu
oGARAGE
CARPORT
o.
RETAINING WA4
ROCKERY
jo
RENEWAL
(TYPE OF USLMSINA
ACTIVITY)
EXPLAIN:.
80R
YJ NUMBER NUMBER OF CRITICAL QLtM-714
0 OF �DWELLING AREAS
' , STORIES U NUMBER
0 2e I
DESCRIBE WORK TO BE DONE
-�J- 12 0k.
. HEAT SOURCE GLAZING % LOT SLOPE %
444".
PLAN CHECK NO: VESTED DATE
`jHIS R`k TO
T441S PE MIT 4UtHbR'1:ZE_S ONLY THE WORK NO7.40-, ERMiT'C0VE6S WO
BE DONE ON PRIVATE PROKATY qNLY. ANN" d6h9TRtIbN ON -THE PUBUC
DOMAIN (CURBS, SIDEWALkS,)6fiiVEWAXS, MARQUEES, ETC.) WILL REQU
T
SEPARATE PERMISSION--,
Ito iopu��O
VgM�T N: 180 DAVS -
I .
PROVIDED WORK IS STARTED WITHIN 180 DAYS.
PINK PERMIT FOR MORE INFORMATION
APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDK4ONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. 19SUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUI REMENT OF ANY CITY-ORDI NANCE
NOR LIMIT IN ANY WAY THE CITY'S ABI LITY TO ENFORCE ANY ORDINANCE PROVISION. -
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
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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND PICW 18.27.
DATE SIGNED
ENGINEERING I REVIEWED/DATE
a
z
Lu
z
Lu
FIRE REVIEWED BY DATE Ul
M
rL
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
RE
060
I PSOND
IOSTED
0 YES
SEPA REVIEW
SIGN AREA
E. HT
COMPLETE EXEMPT
ALLOWED PRO�09ED
ALLOWED - PROPOSED
EXP'
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED -: PROPOSED
FROIJT SIDE REAR
FRONT UR SIDE REAR
vs, 1V
z
z
PARKING
LOT AREA
P IVW11Y
DATE
:.REQ'D PROVIDED
3.1 3
'Weri. -to 1119,
CHECKE E OF Cq�WION QOQE. OCCUPANT
7 GROUP�,
:7TYP
SPECIAL INSPECTOR AREA OCCUPANT
REQUIRED C] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
lkwilil Ille-111 'Pendo I , -)1C_CZ / I I f LA P-,
VALUATION I FEE
PLAN CHECK FEE
BUILDING
PLUMBING
r
�EdHANI
GRADING/FILL
3:kf&-bRCHARGE z)
L.W. "Fill RI. a 'n,
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
5/98.
ENG. INSPECTION
PLAN CHE(;K DEPOSIT
c)
TOTAL AMOUNT DUE
ECEIPT
.46 3 Yd
d
-APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in ips'oe p . rovided.
(425)
OF G E
fIALS SI DATE
771-0220
at
RELEASED By E
DAI E
EXT033
771-0221
iW 1_0 I( I r
FAX
ORIGINAL - FILE YELLOW - INSPICTOR
PINK -OWNER GOLD
- ASSESSOR
'WATE RECEIVED
CITY OF EDIVIO NDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
__-� !_�x "4 AT4
MAILING ADOOSS
CITY ZIP TELEPHONE
NAME
ADDRESS
j57-
CITY ZIP TELEPHONE
NAME
ADDRESS
CITY
ZIP TELEPHONE
X#
-STATE LICENSE NUMBER EXPIRATION DATIf KED BY
'of rs�-4 L2
PROPERTY TAX ACCOUNT PARCEL NO.
'(.'7 - 7 ..- (5�)
;-0;,*7
0 NEW RESIDENTIAL PLUMPING MECH
ADDITION. COMMERCIAL o COMPLIANCE OR
CHANGE OF USE
C3 REMbbEL C] APARTMENT SIGN
F1 REPAIR',. C:] GRADING FENCE
CYDS X FT)
r-1 DEMOLISH 0 TANK 0 OTHER
C GARAGE ROETAIMNG WALL
CARPORT R CKERY 0 RENEWAL
(TYPE OF USWUSINESSPR ACTIVITY) EXPLAIN:
5F xe.51dewce
PERMIX9 PIRES
USE PERMIT
ZONE NU M*BER
J013 SUITE/APT#
ADDRESS 44,
PLAT NAME/tUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required 0
Street Use Permit Req'd 0
EXISTING. PROPOSED
Inspection Required
Sidewalk Required 91
REQUIRED DEDICATION FT
Underground
Wiring required 0
M ETER SIZE,
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 0
w
REMARKS
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
S A?-4FO eneo 1=4H
61
5s4-zt.-jCW- 67v6,0AILI&O99�S)z I3551JfLu5fAJtk w77
ENGINEERI
REVIEWED/DATE
w, tr
-7/) U
FIRE REVIEWED BY
DATE
W
LL
.VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
REO'D
POSTED
0 YES QrkO
SEPA REVIEW
SIGN AREA
.. HEIGHT
COMPLET ! E EXEMPT
ALLOWED PROPOSED
ALLOWED -PROPOSED
I
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
3 5 -7. 7-1 %
L5 7%, -7;
2-q L13
21
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
:31
REQ'D PROVIDED
IL
I
04o
REMARKS
DhA,:-( fo,,(
-flm .30" tv-A� 4,, - i;
lvvej�
NUMBER NUMBER OF CRITICAL
OF S
DWELLING �71 AREA SPECIAL INS]E
OU
STORIES UNITS 111� NUMBER 7AI [REQUIRED
DESCRIBE WORK TO BE DONE
-re)
Lr- to 7,jq Aya 44 ro.,8, 0
TYPE 02F 9ONSTRUCTIIN CODE OCCUPANT
A/ GROUP R3
:TOR I AREA OCCUPANT
LOAD
kREMA(IRKS.
M
P P 0
ROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
6 WtL I Q5V LPM M5 k5rn 01�5 V1 A
GLAZING %
HEAT SOURCE 7 LOT SLOPE %
0-k
4- C e� 7.
PLAN CHECK`NO4f,':. VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WO�K Tp
B E DONE ON PRIVATE PROPERT. Y ONLY. ANY CdW9tF1UCTIQN'ON-THE`�M6L1C
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
ir PERMIT APPLICATION: 180 DAYS
Lu
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
(A
W ;N INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
cc
, ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOFANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITYTO ENFORCE ANY ORDINANCE PROVISION.-
x
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCm
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR,CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATU WNE R A 3ENT), DATE SIGNED
11D4z
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
5/98
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
f_1 k- �., f �,_ �0.
STATE SURCHARGE
ENG. REVIEW FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AM OUNT DUE
CALL
FOR INSPECTION
(4125)
771-0220
EXT 333
771-0221
FAX
VALUATION FEE
_,�D
o,tj
Sb
I so
C)(D
IPT
IPT
"/6- � �� , - 7 -7
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
OFFRIALS SIGNATURE DATE
RELEA� DA
2471j'�n
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
Fees Collected, Recei0t Number:,
-41
_i-Vr,9J1�"-nctersiaifcf tli—at—it i-s -my resp6ii�iilFfllity to notify all ftiture property owners or long-
term lessors of the existence of the ADU and that its existence is predicated upon the
occupancy of either the ADU or primary dwelling unit by the owner of the property.
Additionally, I will notify all prospective buyers of the limitations on use and maintenance of
the ADU as stipulated in Chapter 20.21 (Accessory Dwelling Units) of the Edmonds
Community Development Code. An example of the limitations of the ADU per Chapter
20.21 is the propert ' y owner is required to reside in the primary or accessory dwelling unit for
6 months out of every year. No changes to the Accessory Dwelling Unit can make it more
nonconforming than it was at the time of registration.
Finally, this covenant shall be recorded in order to notify all current and ftiture property
owners that if any conditions of the ADU approval are violated, the property owner will be
required to remove all improvements which were added to convert the primary dwelling unit
into an ADU and restore the site to a single-family dwelling unit.
Property Owner Signature:
Print Name:
Date: cqbco
STATE OF WASHINGTON
COUNTY OF SNOHOMISH)
I certify that I know or have satisfactory evidence that 's-r R Y K A H E L-6-v- L_ jA Vj ID
signed this instrument and acknowledge it to be his/her free and voluntary act for the uses and
purposes mentioned in this instrument.
Notary's pressure seals must be smudged. Da d: C)
Signature of
Notary Public:
T^
%t9TA /I �- I %.
Residing at: cis
Au a My Appointment
oc,
Expires: Ct - k C91 — 2-00 �6
op
THIS DOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY AUDITOR.