316 7TH AVE N.PDFIIIIIIIIIIII
6898
316 7TH AVE N
City of Edmonds
RECEIVED
APR 12 1999
TW CRITICAL AREAS CHECKLIST FEANkova 904.
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 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).
Owner/Applicant:
Name
a 16 74-4, P, Te- 1�,k-e- K'
Street Address
city State Zip
ill L C
/-Telephone
Signature
Date
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date -
c:recepfion\jana\cac1.doc
(over)
CA FILE NO.
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
I Site Address/Location: 3 i L A 9,&2<
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet): C-)
4. Is this site currently developed? _t!fyes: _ no.
If yes; how is site developed? R012se— Alljc� q V�"
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 30% present on site (a vertical rise of 10-feet over a
0
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: gA10 Approx. Depth:
What season(s) of the year?
8. Site is in the floodway &10 floodplain it,�4) of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? 0-f 0 Flows are seasonal? ao (What time of year?
10. Site is forested meadow shrubs ;mixed
ban ilandscaped wn,shrubs etc)
11. vious wetland is present on site:
-.�SC5.. appedsoil,type(s)?:
3'..''. W.etland: inventory -or CA:'ina indicateswetland, present on site? .
p
4.� ::'.'Critical Areasm—vintory or C.A. map indicates,Cntical*Area on.site?
5;. Site. su e hazard. area?
withimde§16aied eafth bsidenc.e:1.an*dslid
0-., Site deagnated onothe Envir6hinentally:Sensitive Areas Map�
DETERMINATION
^ca_chk.doc; R� 10/03/97
�(,.) C . 1 S 9 \)
April20,1999
Michael P. Lowell
3167 th Ave. North
Edmonds, WA 98020
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
Subject: Determination regarding Critical Areas Checklist # 99-101
BARBARA FAHEY
MAYOR
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (boftom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
..................... ........ .............. .......... . ................ ......
............
... ... ..................
. . ..... .....
.............. ........................ ............ I .... ....._... ..................
............. ......... I .................. 1q.:...:.._ .................... ........ ........ - ........... ....... ................ .............. . ......................
............. .... .... I ............... I ....
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENWRONMENTAL CHECKLIS OR CRITICAL AREAS STUDY,
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL 4*1
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Enc: Critical Areas Determination
* Architectural Design Board
Thank you.
Sharla Graham
Planning Secretary
C:Reception\Jana\CRLTR.doc
Incorporated August 11, 1890
Sister City - Hekinan, Japan
-�9'.1999
To: City of Edmonds
Development Services Department
Planning Development
Subject: Permit application for Fence at residence (316 7 th Avenue N. Edmonds).
I am in the process of purchasing a house at 316 7 1h Avenue N. Edmonds, WA (98020). 1
will be closing this transaction on April 30, 1999. Subject property currently has no
fence on site. Prior to closing the current owner has provided permission to install a
fence on the property. I am not sure if a permit is required but wanted to follow City of
Edmonds procedure to be sure.
Description: Install a four foot (4) high chain link fence (approx. 257 Lin.Ft) with 3
walk through gates. See attached fence plot plan.
I would like to install prior to moving in (4/30) as I have small children and do . gs and 7 th
avenue is somewhat of a busy street. Please contact me for any questions at my work or
home phone number.
Michael P. Lowell
Current Address
1037 Cedar Place
Edmonds, WA. 98020
/-Work # 206-662-7198
Home # 425-775-5603
CA %tu -0
PLANNING DATA
NAME: Z"o �Ve, I I
SITE ADDRESS: 14-k AW- /V DATE:
ZONING: —PLAN CHK#:.
PROJECT DESCRIPTION: — a
CORNER LOT_0_S_(Yes/No) FLAG LOT Yes/No)
SETBACKS:
Required Setbacks:
Front: - 20 �Left SIde:_5 Right Side:
Actual Setbacks:
Front: gnQ' Left Side: -7 _�Right Si. c
Street map checked for additional setb Ir
ear:
WRear:
J? (YestNo)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUEQ--=�-�(Y/N)
LOT COVERAGE: (00 evisfhs
Maximum Allowed: Actual:
Plew 40"�
BUILDING HEIGHT:
Maximum Allowed:_0�57 //Z t:Z—Actual Height:/ 2,2- - 2 -2 -
Datum Point: WA-kv- W MC-V— Datum Elevation:— 100
A.D.U. CREATED?:
SUBDIVISION:
CRITICAL AREAS
SEPA DETERMINATION:
LOT AREA:
OTHER:—.
Plan Review By:
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CITY OF EDMONDS CP 71� pl� Permit No.
COMMUNITY SERVICES DEPARTMENT E T Issue Date
RIGHT-OF-WAY CONSTRUCTION PERMIT brh i: RE U I (J U
A. 9 Owner: B. e Contractor: OWW�qyTy_� Ni_ivormO
Name Name
5714 1 o Jn4 AM--, P-55t4-
Mlailing Add ess ailing Address
r:�WNM 01002D
WA ijt4ft,a �AJA
City State Zip City S'tate Zip
Ly M (:000 :30 4- WAO
State License Number Telephone Number
9 Address or Vicinity of Construction: 527-11P 'Ifli Ayr--- V�A q OdZD
Type of Work to be Done:
Work in Connection With: El Sub or Plat 11�(_ Single Family 11 City Projects
El Commercial El Multifamily 0 utility
Pavement Cut: El Y 0 N
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant 6nderstands 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 dedription whatsoever, forseen or unforseen, that may
be made against the City of Edmonds, or any of its departments,or employees, including or not limited to the defense
of any legal proceedings including defense costs, court costs, andattorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
-7
Funds held from the Security Deposit (estimated restoration fee) will be held Juntil 4he' , final"sii� ��'Ppatch is completed
by City forces, at which time a debit or credit will be processed for issuance to the applicant.
0 A 24 hour notice is'required for inspection; Please call Public Works: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphaft or City approved material prior to end of working day;
no exceptions.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signa u
t I re: Date: &(4
'Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
ISSUED BY:
Time Authorized: Void after days.
Special Conditions: I
PERMIT FEE:
Security Deposit:
Receipt No.:— �Zrl I
Fund 111 Fee:
Amendrne�nts: Street Cut Dimensions:
X
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTION NOTES
Comments:
Diagram:
(Fund I I I - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 191
CITY OF EDMONDS
COMMUNITY SERVICES DEPARTMENTS"�
RIGHT-OF-WAY COI�STRUCTION PERMIT
A. ip Owner: GTE NORTHWEST INCORPORATED
Name
5315 Evergreen Way
Mailing Address
Everett, Washington 98203
City State Zip
2100-4811488 2D=pb-�,
I
0 Address or Vicinity of
Type of Work to be E
Work in Connection With:
B. 9 Contractor:
`:'S
Permit No. o -393
Issue Date B - 1_� - S16
Name
Mailing Address
City State Zip
On File Paul Delong 488-1630
State License Number Telephone Number
16 — 7th Avenue N.
El City Projects
Commercial Multifamily Utility
z
.< Pavem�nt Cut� El Y EX N
U
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
>4 harmless from any injuries, damages, or clAi 's of any kind or description whatsoever, forseen or unforseen, that may
m
be. made" against the City of Edmonds, or any of its 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.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECT;�ON AND ACCEPTANCE OF THE WORK.
0
U Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed
by City forces, at which time, a debilt or, , credit will be processed for issuance to the applicant.
0
0 A 24 hour notice is required for inspection; Please call Public Works: 771-3202
0 Work is to be inspected during progress and at completion.
o Restoration to be in accordance with City Code'.
4 Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut Vches must be pat hed with asphalt or City approved material prior to end of working day;
a, Lhe
a wl'
no exceptions.
I understand the Eat e and that t s rmit must be available at the job site for inspection purposes at all times.
Signature: Engineering Supervisor Date: 8-9-88
TERRY 'M. HORKner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call.DIAL-DIG Prior To Beginning Work
,1_..G1TE.to,road push to place 2" PVC for a buried service wire.
�"'/Phes"�'�" see attachdd �Pints.
El Sub or Plat M Single Family
>� ISSUED BY: k��g PERMIT FEE:" -�)o be bii�ed
�4 V V 30
Z Time Authorized: Void after - —days. Security Deposit:
0
W Special Conditions: Receipt No.:
Fund I I I Fee:
Amendments: Street Cut Dimensions:
U
09 x
0
�4 NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
T* Oh --i �-' r_-� - z J _1/
CITY OF EDMONDS . , I , T. Permit No.
t'd
COMMUNITY SERVICES DEPARTMENT CET FILE Issue Date.
fRIGHT-OF-WAY CONSTRUCTION PERMIT
A. e Owner- Washinqton NatuuAl 4as.
Name.
205 — 356 Air NE
Mailing Ada7ress
Ballayne., WA 98007
City State Zip
B. 0 Contractor: S ame
Name,
Mailing Address
City State Zip
447 0700
State License Number Telephone Number
7 AV N
e Address or Vicinity of Construction: §�Z k
Type of Work to be Done: New gas service installation
DgSingle�Family r--E] CityoiProjects
Work- in --Connection, With: -ED-, Sub, -or --Plat
0 Commercial El Multifamily E�Utility
z
< Pavement Cut: El Y 0 N
U
APPLICANT TO READ AND SIGN
< INDEMNITY: 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, forseen or unforseen, that may
be made against the City of Edmonds, or any of its 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.
4
THE CONTRACTOR* 18 RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
0
U'��7#undp s
_�,h6ld from the Security Deposit (eitimated restoration fee) will be held until the final street patch is completed
by C ity forces, at which time a debit or credit will be processed for issuance to the applicant.
0 A 24 hour notice is required for inspection; Please call Public Works: 771-3202
9 Work is to be inspected during progress and at completion.
e Restoration to be in accordance with City Code.
9 Street to be -kept clean at all times.
9 Traffi� Control to be in accordance with City regulations.
e All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
no exceptions.
I understandithe above and that this permit m'ust be available at the job site for inspection purposes at all times.
Signature: Date: -
Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
MUMMA
>.� ISSUED BY: PERMIT FEE: 00
Z Time Authorized: Void after' k3 n —days. Security Deposit:
0
W Special Conditions: Receipt No.:
Fund I I I Fee:
Amendments: Street Cut Dimensions:
U
X
0
vo NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTION NOTES
(Fund I I I Route copy to Street Dept.)
Comments:
iDiagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL A PPROVAL BY: Date:
Eng. Div. July 1985
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APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No . ..........................................
NEW CONSTRUCTION C] REPAIRS
115-02900
Eleanore H. Dimond
OVITNER.............................................................................................................. CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS....... 3.1� .... Y.tb..."e ....... N ................. .....................................
0
0
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAMEOF ADDITION ................................................................................. .......................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................
AL
ED
FILE RECE
TMEE I
000
JUN 12
Hik a and LY 6da LOsall PBORR: 425-775-3603
OV.SSS,S
ITS ADDRZSSj 316 7th ave a., adond, We. DEVELOPMENT SEFVICES CTR.
i CITY OF EDMONDS
SITE UNIX, IS 6 A".. 4392-005-001-00 SUM USA: 90'x110'.9,q00.f
61" LEG&L. Lot. Is W, Slock 05, City 'of Zanoft, according to plat r
In VOI%*6 2 Of Plat-, Page 39, records of Snohomish County, Va.
'TTZ COVERs "lot. house/garage
x",
exist. Seek 1:10 :f
porch ff
—,at*
P.I.t. total
4�,
'I'd Itc' e, "h" , 311 *1
'PA. Ic
cas ttol . 2849 or 28.706
IOUs ARZ&St "let h—/g—.g. jg:f
dip- 0 :f
deck 491 f
t fr. porch 36 f
1447.4A" exist. drive 1447.5of
xI.t total 3942.5.f or 39.020
add stor./shop 354 If
DIV total 4296.5.f
43.404
THIS is TO My CORDITIONED SPACRASERST CODE DOW NOT APPLY.
8"Ic Ym SPSM: 8� -Ph SX7SX1C WHES 3
RUNTORCM 6?=: AM 615 graft 40. ap all bar. a of 24 diams
mmr(;n Lrvz zamss joa-2,000 psf, roof-25pf
t.r.
z (12"). reinforcing to be ogntin. &rOund all coxners ad at allintorsections.
Drill — -t—1 let. .I.ti.9 foundation and grout solid �Ith non—hrLk
POy grout.. Cosaj sth _at
0 3* bottom, 2' ides. I*' all other
ANCHOR P-10' -I-- anchor bolts to be at 4-0- D.C. is.: and ithi.11'0*
of alBOLT'
--I Intersectin— end --da of
I All ccmcriti t. be-
5, 28 day ultimata at .. gth .9 2,000 p...i. in.
Ck- tYP- I c—t Par yard. 6.6 9.1. of sater V. per Seek of cesent.
Arl
v VOOO rVARIMS —I— ecod or —d in contact ith —rate to be cedar
C. t!d, as callod.out.
ot P.O.— tlI
nail per MIC 23-1!-B-1, unless called out otherviss.
bases girder., and �pwt* to be 02 BTIL D.P.
rafters and joist. to be 02 &TR HIP
tp
t.d* be mo/Bn o/r.
J
13MM 7777—
taming listed a. above called Out th—i-.
r2TLYWOOD: roof Neale j- *w CDX plywood OSS kPA rated Par MRS. call with ed "It.
0 6" OC edge. Od;12! OC at Interior support..
GESSRAL. .11 work tb ccmPly with all cod"/ordinances I- affect at Lee —
of parait-�
Mt==t! verify all cOndltIOnS/dLS*Z&LOO� It site Prior to
40
Out scalo dreel",
Tor Awl* stitten dimatOIjous t.Va p".i6scou.
responsible for site conditions.
Arlloca HT.
........ .....
APPROV
ED BY PLANNING
7 4 j:
67-
7TO. /4N/r= 14.
. .. ........ ..
T 1"DATE RECEIVED
PERMrT-EMMI ES
CITY OF EDMONDS
USE PERMIT'
ZONE -NUMBER 2_:0zaS3ff
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
I � .
OWNERNAM E F BUSINESS
FCITY
PLAT NA ME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
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MAIL]Nd-AD6RESS
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10
"AA0 -7
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
RW Permit Required 0
EXISTING — PROPOSED
Street Use Permit IReq'd E]
. inspection Required
Sidewalk Required Aox
ZIP
TELEPHONE
2-15
REQUIRED DEDICATION— FT
Underground
Wiring required
NAME
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
YES 0 NO 0
11— 1 r-T
LU
3
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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TELEPHONE
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NAME
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REVIEW�D/DJTE
ENGINEERING
ADDRESS
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TELEPHONE
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VARIANCE OR CU
SHORELINE OR ADB#
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INSPECTION
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STATE LICENSE NUMBFH EXPIRA�IONDATE
142-
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CHECKEDBY
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SEPA REVIEW
COMPLETE EXEMPT.
SIGN AREA
ALLOWED PROPOSE
HEIGHT
ED PROPOSED
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P2rRTY
TAX ACCOUNT PARCEL NO.
uj
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EXP
NEW RESIDENTIAL PLUMBING / MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT UR W 4!IEAR
$AADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
7/0
0 51.2,0
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REMODEL F] APARTMENT C] SIGN
PARKING
REQ�D 1IDED
LOT AREA
PLANNING REVIEWED BY DATE
qei- 60
REPAIR C] GRADING 0 FENCE X
CYDS FT)
RE
64
OTHER
DEMOLISH TANK
71—
Z
o GARAGE E] ROETANNGWALL
C ARPORT R CKtRY C:] RENEWAL
ed X"
(TYPE OF USE, BYSINESS OR ACTIVITY) EXPLAIN:
CHkKED 9Y
TYPE OF CONSTRI ICT�<N
E OCCUPANJ�, v
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0
GROUP
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS -
/
OL
SPECIAL INSPECTO R
AREA OCCUPANT
0'
STORIES
UNITS
NUMBER /, 0 /
REQUIRED C] YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
0
_7
VALUATION
FEE
PLAN CHECK FEE
H SOU GLAZIN % LOT SLOE Y.
."T 19181-
-4 F-- Q
(�/, fz 1 1
BUILDING CIO 01
PLAN CHECK NO.: VESTED DATE
PLUMBING
ob - -2-5-b
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:
E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
M
DOMAIN (CURBS, SIDEWALKS, DRI VEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
cc
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES 0
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
to
"APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
U.,
_j
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2
M
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
RECEIPT
PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
RECEIPT
TOTAL AMOUNT DUE
1 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-
This application is not a permit until signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or histher 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.
W?RKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
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771 -0220
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A17ENTION
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IT
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK -OWNER - GOLD - ASSESSOR
5198
PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
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CONSTRUCTION PERMIT APPLICATION,,
JOB SUITF/APT11
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LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
LID NO.
MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING REQUIRED DEDICATION
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Street Use Permit Req d 0
CITY ZIP
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LEGAL DESCRIPTION OF PROPERTY -INCLUDE ALL EASEMENTS
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REMARKS
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DESCRIBE WORK TO BE DONE
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PLAN CHECK NO: VESTED DATE
PLUMBING
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THIS F;ERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
5
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
75
DOMAIN (CURBS,SIDEWALKS, DRIVEWAYS, MARQUEES,ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
STORM DRAINAGE FEES
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'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
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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
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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0 EEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
1:
NOR LIMIT IN ANY WAYTHE CITY'SABILITY TO ENFORCE ANYORDINANCE PROVISION."
TOTAL AMOUN T DUE
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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Building Official or his/her Deputy: and Fees are paid. and
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
receipt is acknowledged in space provided.
,��GNATURF_(OWNER,-OR AGEpf-), DATE SIGNED
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771-0220 -&'�
RELEASE145� DATE.,
ATTENTION
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A
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
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