267 4TH AVE S.PDFlill 11111111
5070
267 4TH AVE S
41) C. I S9�
City of Edmonds PERMIT NO: 9245
SIDE SEWER PERMIT PERMIT EXPIRES
Address of Construction: 2 (- -I '-i JV/ f,* 04�
Property Tax Account Parcel No. za -2 0 `3
Attach copies of all access and utility easements Verified and Approved by
Owner and/or Contractor: rz
Contractor License U� k, 1�� cx� !A Building Permit e",)o�p 2,k ir,
F� Single Family
Multi -Family (No. of Units
F] Commercial (No. of Units
Public
Invasion into City *Right -of Way: JM Yes Ej No
*RW Construction Permit # '760 j�ej-,
Cross other "Private Property: Ej Yes E] No
"Attach legal description and copy of recorded easement.
Owner or contractor signature and acknowledgement statement:
By signing for this permit I certify that I have read the City's public handout entitled
Side Sewer Specifications, and shall comply with all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION 9
- rft "
W FOR INSPECTION CALL 425-771-0220 extension, -�- IF 1,6��
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS L
Permit Fee $ a* 0 _Repair Fee $
Trunk Charge $ P q*'
Assessment Fee $
City Permit Surcharge Fee $5.00
Issued By: NLg .a , ---
Date Issued: k k �-4
Receipt No: co
Total Fees Paid $
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO —Date: Initial:
Partial Inspection: 1-jeed T &E,21,6 Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: 112-;1,oj Initial:-6'-C-- As-builtto Street File:
t- PERMIT MUST BE POSTED ON JOB SITE t�
White Copy: File Green Copy: Inspector Buff Copy: Applicant
L-,temp;bidg,forms,sspermitjlg4/00
TL r: 9 VAm^mAe Side Sewer Drawing
EASEMENTNO . .......................... ............... -
NEW CONSTRUCTION REPAIRS 0 LID NO . .................. ASMT. NO . . ..............
OWNER .................................... ......................... ................... .......... CONTRACTOR ...... ..................... PERMIT NO.
JOB ADDRESS Z�71 ..... 4& .... 04V4 ..... . S .... ... ................... LEGAL DESCRIPTION: LOT NO. .— .................................. BLOCK NO . .................... ..............
......................... ................................................... ....................................................................................
NAMEOF ADDITION ---------------------------------- ------------------------------------------------- ----------------------------------
Z- (0 -+
lEt
� a* R'. I)c
01.1f. * 39 A - -f
PWW-0001 - 11175 (A EV. 11178)
rip
Approved:
DATE .............. By -19.44444 . ......... ......
WAT
Im';;Z -2
MET
LID
V
CONCRETE
SIDEWALK
CONCRETE
DRIVEWAY
122'-81/2"
e2'-8 1/2"
COAJI-. $r-CA b,�IPFWA-L-�
d,,J MA4, RE rIA) fj-,V(, WA-UL Ar PecPEP-Fl( i-i lv&-
122.11,
po (W7- 4 102,33
i a-? -.33
,D
60" WIDE LEVEL AREA NO
MORE THAN 60" EBELOW LEVEL
ONE FIN15HED FLOOR (50% MIN. PERIMETER)
2:1 5LOPE
0-3
-Z C- -7
A C)E- /02 - 7� RF.CEIVED
/-?-2 -7� SEP 2 7 2000
;, 14 �;,�
,q C-r t-32. laUILDING DEPT.
/- o T- Co V r
Cocer7o 30-56"?e
6eaf 3e-3,oc *
Alle�
161-01, R.O.W.
CONCRETE
PAVING
STANDARD DRAINAGEDETENTION SYSTEM
WORKSHEET
OWNER CALC ]BY:
ADDRESS PHONE: Lt
,s Y" Ave- S DATE: Cy -
"'DESIGN DATA*****
IMPERVIOUS AREA PIPE DIA PIPE LG ORIFICE
DETENTION PIPE LENGTH LOCKING LID
XTYPICAL)
(TYPICAL)
FINISHED
MINIMUM
3G
n _E:_ 6 8EP&Nffop
Mio
TIGHTLI E *Al'U"R or
CONC BOX OR RISER
.5% TO IrY SLOP
7
0 OUTLET
OUTLET CONTROL
,Btj1L[)mG oEF. 12MIN. RE.CEIVED
UPPER CATCH BASIN .13RIFICE
SEP 2 7 2000
CONTROL CATCH BASIN
BUILDING DEPT,
SYSTEM CROSS SECTION
2'X2'X6'.DEEP, 4-6' SPALLS OR EOUAL
FROM CONTROL CB 2'X 2'X 31 DEEP, 3/4' CRUSHED ROCK EXI ING GR DE
FROM CONTROL OUTLET ASHCD ROCK
N
UTFL13V TRENC
B� MIN 10' LdNG.
1.5' ERF PIPE TO LEVEL
IERF
PIPE W/ END CAPS
TR NCH SHALL BE LINED WITH MIRAFI
,RIPRAP OUTLET PR5OR TO PLACEMENT OF WASHED DRAIN ROCK
RUNOFF SPREADER. TRENCH
. ... .......
FOOTING DRAINS SHALL NOT BE CONNECTED 70 DETENTION SYMM
NOTES.-
1. Call Engineering Division (771-0220) for a tightline and detention system inspection
APPROVED BY
before backfilling and for final inspections.
2, Responsibility for operation and maintenance of drainage systems on private property is the
oz
responsibility of the property owner. Material accumulated in the storage pipe must be flushed
DATE
out and removed from the catch basins to allow proper operation. Ile outlet control orifice
must be kept open at all times.
r-,V.-,E RED
*-zol 00 _[PERMITEXPIRES
us
CITY OF EDMONDS
ZONE
W,
tf,�7564,
i
NUMBER
�7
CONSTRUCTION PERMIT APPLICATION
JOB
S7T*
OWNER NAME/NAME OF BUSINESS
(,_7
11�6 L4 rvl/) V1 r=-
P- NA..lSUS.IVIEI.N NO.
I LOT NO.
L D NO.
MAILING ADDRESS
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP AMd 0
Alq.kld 0
ZIP
TELEPHONE
EXISTING — PROPOSED—
t"P.-I
S .1 - P.- `,.1 d 0
n.— '_ 0
S..� 0
112 '57- IS7)
REQUIRED DEDICATION— FT —
_`9—
W." ....d
NAME
METER SIZE
lINE;7...FFI.T.RES
PRV REOUtREO
I
YES 0 NO 0 3
ADDRESS
REMARKS
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROL/ORAINAGE
717
I 11r, A
NAME
0 Lf A_1_0 V1,W )o-,-
_S
ENGINEERING REVIEWEDIDATE
cu-�C�.
ADDRESS
jv"
DATE
FIRE REVIEWED BY
CITY ZIP
TELEPHONE
VARIANCE OR CU
SHORELINE OR ADS.
i INSPECTION
RE 0.1
IPBO D
OSTED
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED Y
&)
5&_f,to tma-�)k 5121
0 YES ONO
HEIGHT
SEPA REVIEW
SIGN AREA
7ROPERTY TAX ACCOUNT PARCEL NO,
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
-2_?)1_;? -12-2 r)0
I
,
I
, -, /
EXP
0 NEW
[q:-VfSlOENTlAL
F] PLUMBING MECH
LOT COVER GE
REQUIRED SETBACKS (PT.)
PROPOSED SETBACKS (FT I
I
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
0 ADDITION
COMMERCIAL
o COMPLIANCE OR
C RANGE OF USE
PARKING LOT ARJ���ED BY DATE
REMODEL
0 APARTMENT
0 SIGN
REDD I PROVIDED
REPAIR
M GRADING
m FENCE
REMARKS
CYDS
( X
FT)
0 TANK
o OTHER
0 GARAGE
0 RETAININGWALL
0 RENEWAL
CARPORT
,.CKE�,
(TYPE OF USE. BUSINESS
OR ACTIVITY) EXPLAIN:
CHECKED By TF CONSTRUC�l. �Nj
r-
C�� 0 C NT
OCR P
NUMBER
OF
MBEROF
D LLIN.
AR AS
C ITICALOC)_
U8
. PECIALEINSPECTOR
-_
JAREA
OCCUPANT' -
STORIES
UNITS
NUMBER
REOU R 0 YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPE_�JIONS PER UBC 108/FINAL INSPECTION REO'D 0
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE _T
GLAZING I
%
BUILDING
PLAN CHECK NO:
IVESTED DATE
PLUMBING
MECHANICAL
THISPERMIT AUTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
D E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
OMAN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.� WILL REOUdIRE
GRADINGIFILL
SEPARATE PERMISSION.
STATE rURC.AR.E
PERMIT APPLICATION: 180 DAYS
ENG. REVIEW FEES
PERMIT LIMIT.- I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-A PUCANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
cl
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITSOFFICIALS, EMPLOYEES. AND AGENTS FROM ANYAND
A CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
LL
I FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
'I DEEMED TO MODIFY WAVE 01 REDUCE ANY RE011111ENT11 ANY CITY ORDINANCE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
RECEIPT
0 NOR LIMIT IN ANYWAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
x
TOTAL AMOUNT DUE
R I �PTI.
0
iHEFIEB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IY CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION
APPROVAL
THEOWNER IAGIETETOCO PLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
H W TOC
TI.NCAN I DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
T " , i3 not
0
hi
d.9 O".1a, 0' S/har
, p—it until s,g,ed by InS
DoPuly: and F oa,0. and
IN VIOLATAIN OF TI-Ig-TAPOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
...,Pl is acknolledged
in space plov,ded.
WORKMEN'S �OMPENSATIqN INSYRANCE AND RCW 10.27, - OFFICIALS S"N" E DATE
SIGNAT N (425) 4
GNED
771-0220 LAIL
Ti �i� R�LEASED BY
ATTENTION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 1
w A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW INSPECTOR
I CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
CA FILE NO CA -OD - �g
Critical Areas Checklist
------- ------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 2 4 7 — 1-1�4 sxp
2. Property Tax Account Number: 2- '3 2 7 -2 - Io-
3. Approximate Site Size (acres or square feet): 12 0- 7/
4. Is this site currently developed? >,'� yes; — no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
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
I 0-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 areas of year-round standing water: AIIA- 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;� creek or an area where water flows across the grounds surface? Flows are year-
round? 111P - 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: 11 /JP
ftR-ChLd09 Rev 1WMW
City of Edmonds
C.; XX
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Critical Areas File #:
Critical Areas Checklist Fee: $45.00
Date Received by Dev. Serv. -Dept:
City Receipt No: t 5Z F1:J
Date Mailed to Applicant:
CRITICAL AIRTEAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City of
Edmonds Prior to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The
information needed to complete the Chebklist should
be easily available from observations of the site or
data available at City Hall (Critical areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
PLEASE PRINT CLEARLY
Owner/Applicant:
Name
_ZaZ 57Y.,,�
Street Address
t'� 0,17
City State Zip
211-:11.4 - 5-31d - /�' 9-c—
Telephone
Signature
Date
Applicant Representative:
Name
Street Address
city State zip
Telephone
Signature
Date
d:receptiortianalCACLHandout.doe Revised 411 QWW
DAT E.10 I 6L C I T Y 0 F E D M 0 N D S NO.
WORK ORDER
LOCATION DIRECTIONS
WW"m It IN
I
: ---------$—Connection Cha ge
$ Installation Deposit
MATERIALS
IN
IN
IN
IN
IN
ME
101
0
IN
IMIMMEME
mmm
Ml
IMIMEMME
IN
IMM
MMIMMM
MIMI
MIMMM
IN
MEMMI
IMMI
IMM
IMMIMM
Ml
INNIMM
Ile)
"It'll C11CM
LABOR:
!`,'�'J;!'lBenefits:
t !Subtotal:
TOTAL LABOR COST:
EQUIPMENT:
'TOTAL EQUIPMENT COST:
CAPITALIZATION ADDITION
C P17ALIZATION REDUCTIONi
DEPARTMENT
MAINTENANCE
ORDER NUMBER
AMOUNT DUE
INVOICE DATE
CREDIT AMOUNT
SIGNED:
STF"P)EET FILE
August 29, 1983
To
City of Edmonds
Mr. Bill Stroiid
Street Department Manager
Subject: Alley surfacing between 4th and 5th Avenue, from Walnut
. going north.
Dear Mr. Stroud,
The following properties are involved in the alley surfacing:
5th Avenue side:
Shoreline Savings, Building Maintenance, Mr. George Norman
Olympic Properties, Edmonds, Wa.
4th Avenue Side:
Mrs. Lee Hopper, 405 Walnut Avenue Apt.. #2, Edmonds, Wa.
Mr & Mrs. Roy Elf, C/o Reverend Hallovay
275 4th Avenue S. Apt. #2, Edmonds, Wa.
Mr & Mrs. Eugene Nagy, 271 4th Avenue S. Apt. #5 Edmonds, Wa.
Mr & Mrs. Cliff Cuff c/o Tom Petrowitz, 267 4th Avenue S.
Edmonds, Wa.
T-lease bill us according to our property size.
Thank you for your kind cooperation.
Property Owners:
Sincerely yours,
Mrs. Eugene (Irene M.) Nagy
271 4th Ave S. Apt. #5
Edmonds, Wa. 98020
Telephone No.: 778-9263
A
1-0
APPLICATION
for
The City of Edmonds SIDE SEWER PERAHT
EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS
101-05300
OWNER........... ............................................................ CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ....... 2,67..A.th..A.v.e ...... S ............................................................. LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
0
uj
.—j
NAMEOF ADDITION .................................... ....................................................................................................
DYE TESTED ON SEWER, 1972
Approved:
DATE........................... .............. By ......................................................................
DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
c
\) of S L) e,4iTU44PA
MAILING ADDRESS
q0z
CITY ZIP TELEPHONE
65DMOA)DS C?'�L201
NAME
R
ADDRESS
CITY ZIP TELEPHONE
.'S e A - -,)O(a Dq/ 7V_X)
NAME
X ADDRESS
0
q0 *-ue
U
P CITY ZIP TELEPHONE
z
0 u
obtook1c)-s q�P(201 qzS7
STATE LICENSE NUMBER EXPIRATION DATE DBY
HECKE
S00W)VII 006 A) 01
PROPERTY TAX ACCOUNT PARCEL NO.
(9 3 L/ 2 2— 0
Lu -7 7
01,NEW RESIDENTIAL CK PLUMBING I MECH
0 ADDITION E] COMMERCIAL C3 COMPLIANCE OR
CHANGE OF USE
REMODEL [3 APARTMENT E] SIGN
Fi FENCE
REPAIR CYDS X FT)
DEMOLISH [3 TANK
z WGARAGE 10ETAIERING WALL
ARPORT R CK Y 0 RENEWAL
0
r- (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
cc cav'c-r-
L) t6��ao"
U)
W NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
31 2__ NUMBERC;f 06
al STORIES UNITS 00
I DESCRIBE WORK TO BE DONE
V e It;
HEAT SOURCE GLAZING % LOTSj_OPE
' 'In .
1(06-1511 41. to 4D
PLAN CHEC&NO: fVESTED DATE
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
SEPARATE PERMISSION.
t
PERMIT APPLICATION: 180 DAYS
(L PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n -APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
0
uj
_j IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, 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. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
,I NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDI NANCE 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: AAD IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIC/LATION OF T*I� LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WOR41VIF�'S COYPEN!JAT19)N INSURANCE AND RCW 18.27.
od
A17ENTION
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
USE
ZONE
JOB
ADDRESS.
PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES
PERMIT
NUMBER co
oe SUITE/APT#
NO. LID NO.
ILID
FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Apprwed 'Id 0
RW Per": q
R:, U'
EXISTING PROPOSED
P
S11..1 U. .11 1lq'd
Insp8c1�,0nRR*qUl1d9d
�4
REQUIRED DEDICATION FT
underground
Wiring requLred 56
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIREd
37
I YE�v NO 0
z
M
Uj
REMARKS
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
z
z
LU
vkmtr(
22 41;r (
ENGINEERING REVIEW /D TE
P :P W('"
7A',7,
FIRE REVIEWED BY DATE
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
REO'D
I PBOND
OSTED
0 YES 2<0
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOW ROPOSED
ALLOWED PROPOSED
I
I ,
I
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
45 g '-30' 5A
15. 10, 15 -
11!5, , 0 /' -,
;10 is
C3
z
3
z
PARKING
LOT AREA
REVIEWED BY DATE
5
REO'D PROVIDED
FPLANNING
(L
4 I +
Z 03�
CHECKEDBY ITYPEOFCONSTR . LICTION CODE OCCUPANT
1, GROUP
SPECIAL INSPECTOR AREA-(&.5k f—f A-1 OCCUPANT
REQUIRED [:] YES r,(O' . 5, LOAD <10
IREMARKS
tFROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D1
VALUATION
FEE
PLAN CHECK FEE
BUILDING
q IBI)
7 qL4
PLUMBING
q
q0
MECHANICAL
90�
GRADING/FILL
STATE SURCHARGE
ENG. REVIEW FEES
ENG. INSPECTION FEE
PLAN CHECK DEPOSIT 1
1 16'32A 1
lqq'11�1. 00
TOTAL AMOUNT DUE IRICEIPT
�
(0 D
L4 I _-�S
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 space provided.
(425)
OFF IALS SIGNATURE DATE
ExhA106
771-0220
L ASED BY WE
EXT1333
771-0221
FAX
ORIGINAL - FILE -
PINK - OWNER - GOLD - ASSESSOR
),q�M
A'%
113, AQ5
L
I.V\
R04 (�Cko�-
—
3� 4�5 3M
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A
c
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0
'p
A*-LA&-e Ag
-D -ftf LOS
js
MOM- CALL 771-0235
JUGHT-OF-WAY CONSTRUCTIM PERMIT
AND INSPECTION HEOUIRED
v
RECEIVEP
WAMRARY
UCTION ENTRAN AM
CONSTR CE (PER DET
�EP 2 7 2000
BUILDING DEPT.
a"ffVCoNMCTOR IS RESPONSIBLE FOR
DRAINAGE
----EROSIONLCONTROL-AND
C��:ig:4 1993 C- - Wt�� S_,:�- Z��,
i
�o
RECEIVED
SEP 2 7 2000
BUILDING DEPT.
K
4?
CITY Of EDMONDS.
SINGLE FAMILY/DUPLEX COVER SHEET
Directions: Applicants are to complete the Information In the WHITE BOXES ONLY (Shaded boxes are for City
use only). This cover sheet must accompany each building permit application for a new single-family
residence.
F PROJECT AD FIESS rQL
PROPERTY TAX ACCOUNT PARCEL If
DESCRIPTION OF WORK N&3 -eJ-U
OWNER \_I 4? 51
CONTACT PERSON I�P
PHONE F') 0(,o —
- -1 -0 CLat, C -
E-MAIL dfV,-y-C6,\ 'A A F A X LP2,a MW 61 /Q
- T
MAILING ADDRESS C"L!�&
5 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
RESPONSIBILITY TO COORDINATE ALL SUBMITTALS WITH THE CITY AND ONLY I CAN MAKE INQUIRIES ON THE
STATUS OF THEAPPLI CATIO IUpqRSTAqD IT 15 MY RESPONSIBILITY TO DETERMINE IN ADVANCE OF PERMIT
E P
MITTAL AN DISI KTI01AR4RMIT THAT MAY BE APPLICABLE TO THIS PROJECT. I ACKNOWLEDGE
S11: ' Y ABILI 4AVEUBMITTED ALL NECESSARY DOCUMENTATION IN OR R TO MAKE A
TH 7 TO THE BESTPF V Nt I C
COMPLETE APPLIC 11 R 10 RY_A"ROVALS ARE REQUIRED. 70
SIGNATURE_ DATE L-71
ZONING INFORMATION
ZONE I - !�� LOT AREA 1 03
NUMBER OF DWELLING UNITS' EXISTING 0 DEMOLISHED PROPOSED 2-
DISCRETIONARY APPROVALS CA Determination WA�Vcr
SUBDIVISION CU VARIANCE SHORELINE
SEPA Expires OTHER
City Use Only
LOT COVERAGE INFORMATION
EXISTING SF PROPOSED SF 1,1,21TOTAL SF 3
.3c)-.6 14
HEIGHT CALCULATION INFORMATION
0c)
DATUM _1CL A C (0
ACTUAL
AVE 10-Z -72
tv
SETBACK INFORMATION
aEQU0= FRONT SIDE SIDE' 10. REAR
FRONTi*� SID SIDE i c, REAR
-IYE�0*0 St. . -bFOIC, Yes .
CNR.'LOT YES [3NO .,.FL-'jkG' LOT,
fiFNT REQUIRED 0 YES [D NO`� R E do' h IJI N G 11'
STAFF COMMENT$: 3 't,
3)'
ENGINEERING INFORMATION
DRIVEWAY SLOPE % GRADING CYDS
EASEMENTS --
EXISTING IMPERVIOUS AREA CONSTRUCTED BEFORE 1977 SO.FT
EXISTING IMPERVIOUS AREA INSTALLED 1977 OR LATER — SQ.FT.
PROPOSED NEW NET IMPERVIOUS SURFACE
Clty+Use Only
SIDEWALK REQUIREDOYES ON + 0 DRAINAGE PLAN REQUIREDIDYES [-]NO
UNDERGROUND WIRING REQUIRED YES [:]NO
STREET DEDICATION FJ 1) 41 -5 FT. LID#
STAFF COMMENTS: Aej j�Aee,
SPECIAL INSPECTIONS REQUIRED FOR THIS PROJECT (City Use Only)
SOILSO
13 START OF WORK
DEXCAVATION A GRADING
0 SHORING INSTALLATION &.MONITORING
PROOF ROLLING
OPLACEMEN ' f OF FILL A CO . MPAPTION
SUBSURFACE DRAINAGE.
VERIFY SOIL BEARING
PILE. PLACEMENT
EROSION CONTROL
DGENERAL SITE MONITORING BY THE
GEOTECHNICAL ENGINEER OF RECORD
EIGENERAL SITE MONI TORING BY THE
GEOTECHNICAL ENGINEER OF RECORD
'DURING WET WEATHER CONSTRUCTION
FINAL GRADING A Fl ELD REPORT
DOTHER
PLACEMENT OF REINFORCEMENT
OPLACEMENT OF CONCRETE
BOLTS INSTALLED IN CONCRETE
S TRUCTURAL MASONRY
0STRUiCTURAL STEEL ERECTION
HIGH STRENGTH BOLTING
WELDING (WASO CERTIFIED ONLY)
DOTHER
PLAN CHECK
DATE RECEIVED 9
BUILDING CONSTRUCTION INFORMATION
CODE EDITIONS 1997 UBC. UMC, UPC, WSEC, VIAG WITH AMENDMENTS
DESIGN CRITERIA WIND EXPOSURE 0 WIND SPEED 80 MPH SEISMIC ZONE 3
Floor Live Load J40 Rools7now/1.1.0 Load_2!L Balcony Live Load -^
Floor Dead Load -La Root Dead Load Balcony Dead Load_L?2_
NUM13ER OF STORIES7,.2:., BASEMENTS FLOOD ZONE
LOT SLOPE % SOILS REPORT PRO.VIYED
0 YES [0 NO
FLOOR AREA (MEASURED TO EXTERIOR FACE OF EXTERIOR WALL)
Existing P �as Tot&
Living SPACS oryl-1- g -
1;) -7
Garage r
Carport
DoCk/Covered Porch
Other
ENERGY CODE COMPLIANCE INFORMATION
FUFL TYPE 15GAS, OIL 0 ELECTRIC 0 OTHER., .
0 FORCEDAIR ONEATPUMP 0HYbRONIC OOTHER
y 11nnF FTHOD OF COUP LIANCE
PRESCRIPTIVE: List Option I V
TARGET UA APPROACH: Provide UA Calcustions
SYSTEMS ANALYSIS: Provide Computer Analysis
ENERGYIVENTILATION WORKSHEETS PROVIDED
WINDOW SCHEDULE PROVIDED
VENTILATION CODE COMPLIANCE INFORMATION
EQU
Coiling Insulation
Wall Insulation
Floor Insulation
Door U-Valu.
Window U-Valuo
Skylight U-Volue �-6
Glazing 1�
KITCHEN FAN CFM fC)C) BATHROOM FAN(S) CFM 100 LAUNDRY FAN
WHOLF HOU . SF VENTILATION SYSTEM 7 ILI
70
171EXHAUST OPTION
FRESH AIR TO BE PROVIDED TO
INDOW VENTS O(L WALL PORTS
qn-w F9
EACH HABITABLE ROOM WITH:
EXHAUST FAN TO BE CONTROLLED WITH 24 HOUR TIMER AND SIZED AS FOLLOWS:
T,31 - 2 BEDROOMS: 60 - 76 CFM
Iff"
13 4 BEDROOMS: 100 - 150 CFM
1:1 3 BEDROOMS: 80 - 120 CFM
5 BEDROOMS: 120-180 CFM
1:1 HVAC INTEGRATED OPTION
nDEDICATED HEAT RECOVERY VENTILATION OPTION
SEPARATE PERMITS (City Use Only)
�MFIIGHT OF WAY CONSTRUCTION PERMIT [3MECHANICAL PERM17
C]ENCROACHMENT PERMIT 0PLUMBING PERMIT
STATE ELECTRICAL PERMIT 0WATER METER
13FENCEPERMIT SIDE SEWER PERMIT
0RESIDENTIAL FIRE SPRINKLER PERMIT 0IFIRIGATION (SPRINKLER SYSTEM)
[3OTHER 0OTHER_
Any request for modification. variance or other administrative deviation (herinalter "variance")
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
identified, requested and considered by the appropriate city official In accordance with the
pploplisto provision of city code of state law does not approve any Items not to Code
:pocillcation.
PERMIT ISSUANCE APPROVALS
PLANNING REVIEW & APPROVAL
CONDITIONS OF APPROVAL:- C/
(City Use Only)
DATZ
EN GINCERING REVIEW & APPROVAL
CONDITIONS Of APPROVAL:
DAT
BUILDING REVIEW & APPROVALC��.,'t
CONDITIONS OF APPROVAL:
DATE
I
if
GoPyr&9,1 1,�q� joujrworM C;o WeSt S I or,rugfiela. Mass. 01089 - C)rCer No. 0473
do.mROCA
llp
\lr
t4q-,,_ -
RECEIVED
SEP 2 7 2000
BUILDING DEPT.