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551 ELM WAY.PDF11197 551 ELM WAY Critical Areas Checklist qq ---------------------------------------------- Site Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: 6�57 A--Z— H 0 Nxl. (F,,o ?,go 2 C) 2. Property Tax Account Number: C,,4 5� f-�C_ - I - ?- Z coo mpoo 0 3. Approximate Site Size (acres or square feet): -& At Q 7- 2�0 6'0 4. Is this site currently developed? yes; no. if yes; how is site developed? to 'R 0 &A / A)6 0 k) IW-Z�-7 4�14 /JO 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 3 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: & 0 —; Approx. Depth: 7. Site contains areas of seasonal standing water: & 0 Approx. Depth: What season(s) of the year? A) 0 ALF, 8. Site is in the floodway _ �&LQ floodplain__,A/O of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? A/ D -- Flows are seasonal? a 0 (What time of year? 4� D A) e 10. Site is primarily: forested meadow shrubs mixed urban landscaped (lawn,shrubs etc) 11. Obvious wetland is present. on site: A) D Aq_ChLdm- Rev 10103M City of Edmonds RECEIIVE�L r"* 1 0%, DEr 0 9 PERMIT COUNTFk 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 thi! checklist, sip 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 devel'opment 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 infor m-ation (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 fac tual, to the best of my knowledge (fill out the appropriate column below). Owner/Applicant: — Z WES AILT6 / of) o F-o o)o-lv o Name Street Address H P Aag zyk 0 city State Zip 2z- 7-2- Telephone ?U41% ell Id2fli-) Signature c.7mptionVanakul.doc Applicant Representative: Name Street Address city State Zip Telephone Signature Date (over) �P, ;;vi CA FILE NO. C?6? —3 Z Critical Areas Checklist I ----------------- -------------------------------------------- Site Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: 2 3 4 Property Tax Account Number: Approximate Site Size (acres or square feet): J)0 NOT LA� i4J Is this site currently developed? _�?� yes; no. If yes; how is site developed? 4 "R 0 &A / Y02 0 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 10-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: Approx. Depth: 7. Site contains areas of seasonal standing water: Approx. Depth: What season(s) of the year? A) 0 A) lt;�_ 8. Site is in the floodway &LD floodplain of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? A/ 0 — Flows are seasonal? AZ 0 (What time of year? 4) Dx) 6: 10. Site is primarily: forested meadow ;shrubs mixed urban landscaped (lawn,shrubs etc) 11. Obvious wetland is present on site: ---------------------------- — ------------------------ For City Staff Use Only ----- — ------ — - — ----------- — ------------------ ... ..... . .. . ...... . . .... 1. Site is Zoned? 1. SCS mapped soil type(s)?., I Wetland inventory or C.A. map indicates wetla n . d present on site! Critical Areas inventory Or C.A. map indicates Critical Area on site? 5. Site within designated earth subsidence landslide hazard area? 6. Site designated on the Environmentally Sensitive Areas Map? MMMINATION LIC A K M dw 1*_chk.doc; Rev 10103/97 City of Edmonds 01 - '�> 2- 1 RECISIVF�7-- 0 E C, 0 9 " -1W CRITICAL AREAS CHECKLIST PERMIT COUNTFk 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 sub ect 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, andmake a determination of the subsequent steps necessary to complete a devel*opment 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 infor m-ation (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: -, - Z 4 1 C--S k16 lev o F-0 0"ex o Name 6's-1 Street Address E6 H P IfJa zyk ?go 2- 0 city State Zip 2z- 2L-Z?- L Telephone JJ -43 b2c, t7 7 Date creception\janakaddoc Applicant Representative: Name Street Address city State Zip Telephone Signature Date (over) - d�., . r. "t �t 12 C . 1 S9 \3 Ines A. Fourno 551 Elm Way Edmonds, WA 98020 Subject: Dear Applicant: CITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 DEVELOPMENT SERVICES DEPARTMENT Planning - Building - Engineering December 20, 1999 Determination regarding Critical Areas Checklist # 99-321 4 3Z2- BARBARA FAHEY MAYOR 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 (bottom of page). It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records. ........... . - -1-1. ........... ............... . ......... ............ ............... .......... ............................................... .. . ....... - .......... .................... ........... ............. INFORMA TI.ON.To.':BE:N.0,TED,�'..'::'::::::::. .......... ........... ............. ..... ... ........................................... ........... ...... ................. .......................... PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIS OR CRITICAL AREAS STUDY, The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a project -specific determination. mo. You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL 4111111 PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED. Permit applications include the following: Eric: Determination * Architectural Design Board C:Reception\Jana\CRLTR.doc Building Permits Conditional Use Permits Subdivisions Variances Applications to the ADB* Land Use Applications Any other development permit applications. Thank you. Planning Secretary Incorporated August 11, 1890 0 Sister City - Hekinan, Japan ----------- EXIST. LANDSCAPE V:EX. A-5SPHAALLT 2 GARAGE F=X- RESIDENCE EXIST. -4- LANDSCAPE 4 NORTH FAFKIN G FL AN APPROVED BY PLANNING %15 I N E 5 f= 0 Ll f;RN 0 -1�11111p� 551 ELt,�l I City of Edmonds STREET FILE RIGHT-OF-WAY CONSTRUCTION PERMIT Permit Number:; 7 Issue Date: A. Address or Vicinity of Construction: - 551 Elm Way B. Type of Work (be specific): Install New Servico/ C. Contractor: —Washington Natural Gas Company Contact: Mailing Address: 815 Mercer Street, Phone: State License #: Seattle, WA 98111 Liability D. Building Permit # (if applicable): F. Pavement or Concrete Cut : INDEMNITY. Applicant understands and by his signature claims of any kind or description whatsoever, foreseen or ur ees, including or not limited to the defense of any legal proc THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND ACCEPTANCE OF THE WORK ES77MATEDRES�ORA C17Y FORCES, AT WHICH 77MEA DEBIT OR CREDIT ALL J �cation, agree\j_�hold the City of Edmonds harmlessfiomi injurfe) damages, or may be made agaidt the City of Edmonds, or any of its departments or employ - riding defense costs, and attorney fees by reason of granting this permit. 't �j TERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC77ON ES WILL BE HVL:D, UkFLI THE FINAL STREET PA T_CHJ[S�CO��LETED BY kSSED FOR ISSUANCE TO THE APPLICANT Construction drawingf proposed work r d with"permit application. r jrf e�d A 24 hour notice its for inspecl Ple�,, e call the Engineering DepartmN7,11711111 Work is to be insp� duringKogress and at co\npletion. to 0 b ac4 c Restoration is I Ord ce with City Codel-I or Street shall be ke clean/catIl times. Traffic Control a Public afety shall be in accordance with City regulkions as required by the' City Enginee'r. All street cut ditch hall e patched with asphalt or City approved material prior to the end of the working day; 4S. NO EXCEPTIONS. I have read the above on site at all timesfor Signature: (Contractor or requirements and the pink copy of the permit will be available Date: September 2, 1992 -:,DATE::.:.:� .... .. ISSUED BY: ( 4 - I 1 4 - �3 4 4%� � /. I WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991 Eng. Div. July 1985 E a tuf W CW A%%W blMOVI Addendum to : . 0 Right Of Way Permit Application Submitted by: I;ele-KA-eD Hl"Apzj."�� LM Wy kii. gi:.n e arl ng Aide Washington Natural Gas 622-6767 X2761 Pager WNG to Window Water Main depth unknown . �Z-" gas Ma -in xey: -w- water 9- gas -ss- sever watOr hYft-ant 815 him= SL (PC)' B�= 'SO)- SCICUC. WA 99111 (206) 6=-67r, The City of Edmonds Side Sewer Drawing EASEMENT NO - -------------------------------------- 107-02800 NEW CONSTRUCTION M REPAIRS E] LID NO - -------------- .--. -ASMT. NO - ---------------- OWNER------ DAVID ... L.� .... TWEST ------- ------------- ------ ------------------- CONTRACTOR ------------------------------------------------------------------ ----------- ----- PERMIT NO. ----------------- JOB ADDRESS ---- 551 --- EI.M.-WAY -------------------------------------------------- LEGAL DESCRIPTION: LOT NO . ......... ............................ BLOCK NO - ------------------------------- ...................................................... ---------------------------------------- ------------ -------------------- I --------------------------- NAMEOF ADDITION ------------------------------- ........................................................ LIJ —i Nova LJL uj ui DYE TESTED ON SE14ER Approved: PWW-0001-11/75 (REV.11/78) DATE -------------------------------------------- By ------ CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS MAILING ADDRESS CITY ZIP �TTE�LE7PHONE NAME ADDRESS ,,�--t7lZ !"2 -CITY TELEPHONE NAME L ADDRESS CITY ZIP TELEPHdNE STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY , I I _j W P ROPERT ACCOUNT PARCEL NO. _j 0�,NEW RESIDENTIAL PLUM13ING / MECH ADDITION COMMERCIAL COMPLIANCE OR IQ CHANGE OF USE REMODEL APARTMENT SIGN REPAIR GRADING; FENCE CYDS X FT) DEMOLISH C] TANK OTHER GARAGE Q RETAINING WALL RENEWAL CARPORT.� ROCKIRY 0 2 _7 (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: NUM13ER NUMBER OF CRITICW�;�/, OF, DWELLING '3 A ­S*RIES �?, UNITS N DESCRIBE WORK TO BE DONE 0 f - I I V -,-'/ , L , j i ; ; ". SOUPICE GLAZING % LOTSLOPE % PLAN CHECK NO: i r IVESTED DATE '6 (r EXPIRES FPERMIT USE ZqNE PERMIT UMBER JOB ADDRESS SUITFJAPT#. PLAT NAM E/SU BDIVI SION NO. LOT NO. LID FEE $ PUBL(� RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 0 RW Permit Required Q street UBe Permit Req'd [3 EXISTING PROPOSED I Inspection Required 0 Sidewalk Required 0 REQUIRED DEOiCATiON FT Underground WhIng required 0 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 0 NO A tu REMARKS z z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE a z uj ENGINEERING REVIEWED./DATE F1((,)jEVIEW DATE (7 LL /ARIANCE SHORELINE OR ADB# INSPECTION BOND O�CU REO 'D POSTED YES &<O SEPA RE\hEW SIGN AREA HEIGHT COMPLETE EXEMPT,* ALLOWED PROPOSED ALLOWED PROPOSED Y, _ I 0 LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 45-1. M/C. is, /-51 z /Vo �±� PARKING LOT AREA z PLANNING REVIEWED BY DATE REQ'D PROVIDED 1 � 1,,IZ 1/4t I I T :M�l REMARKS 40' 64M 4,^&t4- rtbVie't IV t W I't-1 A e%#% >C#I:) A LAe-t tb I 1%.%e ".N ff-j I 1 .1 elv^* WU CHECKED BY T . :WNSTRUCTION . OCCUPAg _VROU P SPECIAL INSPECTOR REQUIRED E] YES 4pfft OCCUPANT LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 7 . , -.I_ I. 1A 17 o A--"O' J I A i L_ VALUATION FEE PLAN CHECK FEE BUILDING PLUMBING k__4 J IL MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 2 GRADING/FILL DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. V STATE SURCHARG PERMIT APPLICATION: 180 DAYS CIL PERMIT LIMIT* 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS REVIEW FE SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUpCESORS INSPECTION FEE W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS. THE CITY OF _j 2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS� FROM ANY AND L-AftBe"101ING h ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY INeP&&TtC"FEE RECEN/ x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALLNOT BE PLAN CHECK DEPOSIT 0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE _j 0 NOR LIMIT IN ANYWAYTHE CITY'S ABILITY TO ENFORCE ANY ORDI�ANCE PROVISION." x RECEIP1 TOTAL AMOUNT DUE f�� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPL16ATION 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 ()DING 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 reSeipt is ackno ledged in space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. 0 F -I G AT 101—DATE ,.�NGNATUR 0 7NE ORAGENT) DATE SIGNED (425) 4ATTENTI 771-0220 IRELE D BY DATE T EXT 1333 L I o o IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 �'�/ORI�GINAL- A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- %, -INSPECTOR 'CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAY ,,"PINK - OWNER GOLD - ASSESSOR 5/98 � t 11 Cl� 1,14 PERMIT EXPIRES USE I, PERMIT CITY OF EDMONDS Z9 NE NUMBER QUI CONSTRUCTION PERMIT APPLICATION JOB RIESS SUITE/APT# ADD 5__ Cw OWNER NAME/NAME OF BUSINESS Ole A) PLAT NAM E/SUBDIVI SION NO. LOT NO. L/ LJ :�Z/ MAILING ADDRESS PUBL(8 RIGHT OF WAY PER OFFICIAL STREET MAP CITY ZIP 1� TELEPHONE EXISTING PROPOSED REQUIRED DEDICATION FT NAME ADDRESS cc CITY —zip/ TELEPHONE N AME ADDRESS CITY ZIP TELEPHONE STATE LICENSE NUMBER EXPI�AtION'DATE VCH EDB ACCOUNT PARCEL NO. N E W RESIDENTIAL C] PLUMBING / MECH ADDITION COMMERCIAL Ki COMPLIANCE OR CHANGE OF USE REMODEL 0 APARTMENT SIGN REPAIR E] GRADING; CYDS 0 FENCE I X FT) E] DEMOLISH TANK OTHER GARAGE CARPORT, ROETAIENRING WALL R CK Y RENEWAL (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: NUMBER OF NUMBER OF DWELLING CRITICA/It? A I A -'SqORIES UNITS N DESCRIBE WORK TO BE DONE J ,HEAT SOLIFICE GLAZING % LOT SLOPE % e-tan4c., I PLAN CHECK NO: VESTED 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. PERMIT APPLICATION: 180 DAYS w PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION w ;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SU1Q.CESORS 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 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALLNOT BE _j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE 0 1 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDI�ANCE 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 vi6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. ,6jGNATUF1qf�6 ___QOR AGENT) , WNE . I DATE SIGNED 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 METER SIZE LINE SIZE NO. OF FIXTURES LID FEE $ TESCP Approved RW Permit Required Street Use Pormit Req'd impact on Required Sldewa: k Required Underground Wiring required PRV REQUIRED YES 0 NO 11 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE ENGINEERING REVIEWED/DATE w z z a z FI DATE w 5 'cl il"i 4 1 LL /ARIANCE OYCU SHORELINE OR ADB# INSPECTION BOND REQ'D POSTED 0 YES 2<0 SEPA RE%hoEW SIGN AREA HEIGHT COMPLETE EXEMPT, ALLOWED PROPOSED ALLOWED PROPOSED I 0 LOT OVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 0 45,-,7" I.S. A,16 6*,0,2�4 3 z PARKING LOT AREA PLANNING REVIEWED BY DATE 5 REO'D PROVIDED 1 Ia/ z 3/01 11 IL S' I T -7x*�- to/t/ 7V., P—All P.: dHECKEDBY TYPE" CONSTRUCTION COW — SPECIAL INSPECTOR A _5L .5— OCCUPANT I jjM I_r .1 _ISO LOAD REQUIRED E] YES REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D j A-t� I I A RM VALUATION FEE 2-q PLAN CHECK FEE BUILDING PLUMBING MECHANICAL GRADINGIFILL . STATE SURCHARGE/ 4�015 &NIM. REVIEW FEPS t"&. INSPECTION FEE I:"ANe9eA'PtNG IN9FEe440N`FEE i rive 5 PLAN CHECK DEPOSIT PIECE L TOTAL AMOUNT DUE RECEIP/,qj-., tji( 14 It 4;5V APPLICATION APPROVAL CALL This application is not a permit until signed by the FOR INSPECTION Building Official or his/her Deputy: and Fees are paid, and receipt is ackno lodged in space provided. (425) OFFIGI.A5C61( AT 0 TE 771-0220 by DATE 1333 .EXT 1 1z' 771-0221 _7 '17'�R-MNAI FAX —YELLOW -INSPECTOR PINK - OWNER -'4GOLP - ASSESSOR