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644 HEMLOCK WAY
APPLICATION
for
The City of Edmonds SWE SEWIM PFxmrr
NEW CONSTRUC77ON 0 REPAIRS EASEMENT No . ............................... I ...........
AN,.
*,V"d i --- % ...... -CONTRACTOR . ....................... ....................... -Pz
0 Ba ................................ t ................. ............. . T ....... --- .... .. ......................... ........... FRam No . .....................
. ......... ........... ......................... ................................... DESCRIPTION-. LOT No . .............................................
4(<eNAME OF ADDITION .........................................................................................................................................
0
Ap
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The City of Edmonds
APPLICATION
for
SIBIE SEVVIM PERN"
NEW CONSTRUCTION M,--' REPAIRS 0
.......... - ----------------------------------
q;;� ..... w .. 4.
ADDRESS ..... . ............ i - I ----------
1*
EASEMENT No.
4-1
........... CONTRACTOR .... ...... ......... PERMIT NO . ......................
----------- LEGAL DESCRIPTION: LOT No . .......... 8 ............................... BLaOCK No . ............................................
J.1 c d L.t. 9-4,
NAME OF ADDITION --4�eS 1�e,$ ....... 104t:9 ......... ).9. ! . . . . ...............................................
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APPLICATION
for
The City of Edmonds SEDE SEWER PERMIT
NEW CONSTRUCTION E) REPAIRS EASEMENT No . ..........................................
OWNER .......... LO.M. . ............ W.-I .. ------------------------------- CONTRACTOR .............. ...... ................................................ PERMIT No . ......................
ADDRESS ............. ........ .. w-cd- LEGAL DESCRIPTION: LOT No . ......... --------------------------------- BLOCK No . ............................................
NAME OF ADDITION ......... W. j
.... ............. ....... ............
0
DATE................................................ By ......................................................................
CA FILE NO.
Critical Areas Checklist
Site Information (soils/top.ography/hydrology/�egetation)
I - Site Address/Location:
2. Property Tax Account Number: �Ie4�
3. Approximate Site Size (acres or square feet):
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
10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% 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: A40 Approx. Depth:
7. Site contains areas of seasonal standing water: lye —; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway �VIO floodplain_ of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? AA) ' Flows are seasonal? (What time of year? J
10. Site is primarily: forested . meadow mixed
urban landscaped (lawn,shrubs etc) -)<' shrubs
11. Obvious wetland is present on site: 1111d
-On]
forcitystaff.u.s -------
e -- — ------------ - - -----
L Site -is Zoned? 7
SCS mapped-soi.-tyy -45 7 T- - C- 7112 -k\j r_- Lk Lut) Lo^ M
Wetland inventofy-or C.,'.'.A,,: miapi di
in - icatds wdliand pr�sentwofisitt?: -
4. Critical Areas inventibry or CA-.: in
f,jtical,Afda on site?q.
5. Site within desigiiaied::'q'i h * . .. .... .
..sub.si.&nce: andslide hazzr&area?��::-
M�
6.' Site:desigiiaied on th-e':-tnviro i ive eas ap?
menta.1.1V S6fit"t-
DETERMINAT-46N
STUDY R�UJKED.' CONDITIONAL WAIVER
WAIVEI�'
R e—wed.by� 'ZI
evi
P-jahner.-..:..:
Date,
^0-ft.dm Rw 10/03,V7
*1JC. 1 %9'
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax:, 425.771.0221
DATED RECEIVED:
CITYRECEIPT#: J/,,�,'
Critical Areas File #:
Critical Areas Checklist Fee: $45.00
DATE MAILED TO APPLICANT:
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 pot6ntial 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/or 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
assistant 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).
Applicant:
6 ��' i ZkE
Street Address
12, ZA �; �4: � a, � �
City State Zip
Telephone: 70-1- t — 71.::2- —0
Signature Date:
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Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Signature
Date:
City of Edmonds
Critical Areas Determination
Applicant: Margaret Brannon Determination #: CA-01-004
Project Name: Permit Number:
Site Location: 1 6960 160'h St. SW Property Tax Acct #: 6109 000 008 00
Project Description
Install Propane Tank for SFR
Waiver Criteria (all criteria must be found to apply):
x There will be no alteration of the Critical Area or its required buffers.;
x The development proposal will not impact the Critical Area in a manner contrary to
the goals, purposes, objectives and requirements of the Critical Areas ordinance;
x The development proposal meets the minimum standards of the Critical Areas
ordinance;
x The above findings are based on the following conditions of approval:
1. This conditional waiver is only for the propane tank shown in the attached
site plan.
2. A building permit is required for all work.
Based on the above findings and conditions, the requirement for a Critical Areas Study
associated with this development permit is hereby Waived, as authorized by Chapter 20.15B.040
(A)(1) of the Edmonds Community Development Code.
Chanda Earhart
Name
1/12/2001
Date
APPLICATION.�
for
The City of Eamonds SIDE SEVVER X-Flawil EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS 0
LD -r74
........................... ......................................... PER
MIT No . .......... I
M --.__%*NA 4�,,,.------CONT-RAC- TOR
...........
..... . ............................................
----LEGA-L-- DESCRIPTION: LOT Wo.- ............. .............
ADDRES3 . ... ........ ......... ....... .. .................. .. .......................... .......................
�e
...........................................................................
NAME OF ADDITION ................................................
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RECEIVED
Zp",
%sz JAN 17 2001
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CITY OF EDMONDS
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Approved:
Y,
DATE............ . .. ............... .. .......
NUM Ht=HK I Mb I Ut= HNLJ LLUDt= I Vt�D I UN t-HUNt NU. � :�Ub (44 0 (Z�Z Jan. 1( euui lob.-IjOrlill rle
51be following shall apply to aboveground containers installed alongside buildings:
I. Containers of less than a 125-gallon (473.2 L) water capacity are allowed next to the building they serve when in com-
pliance with Items 2, 3 and 4.
2. Department of Transportation specification containers shall be located and installed so that the discharge from the
container pressure -relief device is at least 3 feet (914 mm) horizontally from building openings below the level of such
discharge and shall not be beneath buildings unless the space is well ventilated to the outside and is not enclosed for
more than 50 percent of its perimeter. The discharge from container pressure -relief devices shall be located not less than
5 feet (1524 mm) from exterior sources of ignition, openings into direct -vent (sealed combustion system) appliances or
mechanical ventilation air intakes.
ASME containers of less than a 125-gallon (473.2 L) water capacity shall be located and installed such that the
discharge from pressure -relief devices shall not terminate in or beneath buildings and shall be located at least 5 feet
(1524 mm) horizontally from building openings below the level of such discharge and not less than 5 feet (1524 mm)
from exterior sources of ignition, openings into direct -vent (sealed combustion system) appliances, or mechanical
ventilation Air intakes.
4. The filling connection and the vent from liquid level gauges on either DOT or ASME containers filled at the point of
installation shall not be less than 10-feet (3048 mm) from exterior sdurces of ignition., openings into direct -vent (sealed
combustion system) appliances, or mechanical ventilation air intakes.
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JAN 17 2001
_EVELOPMEN`l SERVICES CTP..
CITY OF EDMON[).'z
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PERMIT EXPIRES Z?1dl
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
PERMI.T.40/
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PROGRESS INSPECTIONS PER U8C IOSIFINAL INSPECTION REO'D
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FEE
PlIN CIEC. FEE
NEAT SOURC. LOT ILIPE I
PLAN CHECK NO: 11-11DATE -AGINI
T-er-WHORIZESO HE WORKMTEII TALS PER PIT COWIRS WORK TO
GONG 0, 'ARNITE PAT;ET
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REIGHT =WITNI. -Al. END AINIEWFEES
PEFART LORT. I YEAR; PROID D WORK IS
See eACK 0 PINK PERART FOR 0..
APILCINTOAMNALF0 MSOR.ERSMU3E,lEll3,ASVGISAID�E�S END NIOE-N IEE
E=S� AGREES TO IDE1111 . DEFEND AND HOLD HARIALESS THE CITV OF
DEWA5HINGTON.ITSOFFO E-E&A....1.11RONANYAN. -DSCAP AD
ALL-1-DAILANG.101WHAT E.-SAII-R-O.-FEC" IN11-10. FEE
=ETD.,E.ISS- OF THIS PERNIT. ISSLANCIE OF THIS IEAAAI SHALL NOT IT RE-11
.,o PI.&H CHECK DEPOSIT
NORLINAT ARODI PANEOAAEOLIC-RE-MENITOFANY -.:
ANN - THE 1. ENFORCE ANY GMNAvmCE PPGvSR,N -
T- - DLE
INERE YACKNOW.EDOETHAT-E.-TH11-:7HATTHERIF.-
ORVEN 13 CORRECT, AND THAI. AN THE OWNER OR THE MILKY AUTHO-D AGE" OF PPFL CATION APPROVAL
THEOWNE , 1AGREITOCOARLTIRTICI"ANDITATE-1--CONS Ti! A -A-.
FOR; AND IN - THE WORK AUTIACIALEED "El- NO 1- .1111 =TIX� CALL
IN Y-TION OF THE ASOA CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WOMMEN 5 COMPEI u IS27.
(RE -HER DATE IGNEI (425) �A "S3GI IRE DATE
771 114 In, 71el
j 0220
11 U Z�� - - - —
ATTENTION EXTt333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 77i nnqi
ORIGINAL -FILE 'i 1ELLOW INSPECT A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX FINK-1 GOLO-ASSESSDRA
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City of Edmonds
Critical Areas Determination
Applicant: I Margaret Brannon Determination #: CA-01-004
Project Name: I Permit Number:
Site Location: 6960 160t' St. SW Property Tax Acct #: 6109 000 008 00
Project Description
Install Propane Tank for SIR
Waiver Criteni a (all criteria must be found to apply):
X There will be no alteration of the Critical Area or its required buffers;
X The development proposal will not impact the Critical Area in a manner contrary to
the goals, purposes, objectives and requirements of the Critical Areas ordinance;
X The development proposal meets the minimum standards of the Critical Areas
ordinance;
X The above findings are based on the following conditions of approval:
1. This conditional waiver is only for the propane tank shown in the attached
site plan.
2. A building permit is required for all work.
Based on the above findings and conditions, the requirement for a Critical Areas Study
associated with this development permit is hereby Waived, as authorized by Chapter 20.15B.040
(A)(1) of the Edmonds Community Development Code
Chanda Earhart 1/12/2001
Name Signature Date
City of Edmolids
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. _�&r
Wue Date:
Aql)
A. Addfess or Vicinity of Construction: 4*4141 1-1g��Iyl L.00/< UJA y
89 B. Type of Work (be specific): fjFMOV6 C-OA)CPE7-F Ak1V_r-CJAV U)f-f#
0
4SON441- 4- T61V C2Z AS &4L-r, ��JsrALL 0151.
C. Contractor: &W J5AhMP4ZJSr,5 lNt�- Contact: A)&
Mailing Address: '10 ?,-7-' 145*- OL 5A) Phone: q41 4P 717
State License #: Aty SF Liability Insurance: Bond: $
x Af 1 *'10 -7 D 4
D. Building Permit # (if applicable): hJ1
Side Sewer Permit # (if al5'plicable): A11A W
E. E] Commercial [:] Subdivision [:1 City Project EJ Utility (PUD, GTE, WNG, CABLE, WATER)
1:1 Multi -Family �j�Single Family F] Other
INSPECTOR: AL4—" INSPECTOR:
F. Pavement or Concrete Cut 0 Yes []No G. Size of Cut: x H. Chargq�_$
APPLICANT TO READ)
A P (d(14 G N
INDEMNITY. Applicant understands and by his signature to this application, agr�6"to hold tlWCity of Edmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the defense ofany legalproceetliqgstincludiQ defj6nse costs, and attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR P�-RIOD OF ONE YEAR FOLOWIN -THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD VNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing 4jproposed work required with permit application.
A 24 hour notice'is required for inspection; Please call the Engineering Division, 77-l-'220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic'Control. and Public Safety shall be in accordance with City regulations as require4 by the City Engineer.
All str6et cut dit�hes shall be patched with asphalt or City appro"Ved material prior to th6.e'n'd of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
avail4ble on sitg-aZ all times for ' spe ion purposes.
Z::�� � Z�. Date: 7
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
4 1 1
FOR CITY USE ONLY
AYPROVED BY:
(00
TIME AUTHORIZED: VOID AFTER DAYS
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SPECIAL CPNDITIONS: F—Ml/ krl'�-ht� r0ek— et (J kP
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RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND 111-
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Nv. 199 1
at Av.
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
El NO
EDMONDS CITY COUNCIL
AGENDA MEMO
Item number:
Originator: Bob Alberts For Action: X For Information:
SUBJECT: V/;
ACCEPTANCE'.OF UTILITY EASEMENT FROM JAMES AND
GERTRUDE TASCHE
AGENDA TIME: Consent
AGENDA DATE: 4/6/86
EXHIBITS ATTACHED:
LETTER FROM JAMES &
GERTRUDE TASCHE
DATED 3/20/86
EXECUTED UTILITY
EASEMENT CONTRACT
Clearances: Dept./Indiv./Initial^-
ADMIN SVCS/FINANCE
CITY ATTORNEY
CITY CLERK
COMMUNITY SERVICES
ENGINEERING &e,'-
PARKS & RECREATION
PLANNING
PUBLIC WORKS
FIRE
PERSONNEL
�POLICE
COMMITTEE
MAYOR
COMMENTS:
EXPENDITURE AMOUNT APPROPRIATION
REQUIRED: $ 0 BUDGETED: $ 0 REQUIRED: $ 0
HISTORY AND SUMMARY STATEMENT:
The attached utility easement is for a buried storm drain pipeline
on the Tasche property which is part of the City's storm system.
The pipeline was installed many years ago to replace an open ditch
without the City's knowledge. The pipeline has been inspected and
determined to be of adequate size. The easement will allow the City
to perform maintenance.
RECOMMENDED ACTION:
Staff recommends the City Council accept the utility easement from
James and Gertrude Tasche.
W Q�e 0- / - k�,
Rhonda VDate fJackie Date
644 Hemlock Way
Edmonds, WA 98020
March 20, 1986
City of Edmonds
Civic Center
Edmonds, T,,Yt 93020
Re: Utility Easement Lot 8, Westin's Park Addition
Gentlemen:
We hand you herewith the executed "Utility Easement" which you are
authorized to record orovided the City of Edmonds assumes all costs
of installation including access covers for said storm sewer; and
provided said easement is accepted no later then June 1, 1986 and
construction'corrmenced as soon as possible after acceptance.
Very truly yours,
jamies E. Tasche
Gertrude J. Tasche
gt
VIXIALWA2��
P,ECEIVED
1AAR 2 0 '1986
ENGINEERING THESE MINUTES SUBJECT TO
APRIL 1, 1986 APPROVAL
EDMONDS CITY COUNCIL MINUTES
MARCH 18, 1986
Ail
The regular meeting of the Edmonds City Council was called to order at 7:00 P.M. b a Larry
Naughten in the Plaza Meeting Room of the Edmonds Library. All present n ag sa-
lute. joined i 014 6K,
PRESENT
Larry Naughten, Mayor
John Nordquist
Steve Dwyer
Laura Hall
Jo -Anne Jaech
Bill Kasper
Lloyd Ostrom
Jack Wilson
Cindy Browne, Student Rep.
STAFF PRESENT
Mary Lou Block, Planning Div. Mgr.
Peter Hahn, Comm. Svcs. Director
Steve Simpson, Parks & Rec. Mgr.
Bob Alberts, City Engineer
Bobby Mills, Pub. Wks. Supt.
Pat LeMay, Personnel Director
Art Housler, Admin. Svcs. Dir.
Jerry Hauth, Hydraulics Engineer
Jack Weinz, Fire Chief
Robin Hickok, Asst. Police Chief
Chris Beckman,.Engineering Coord.
Scott Snyder, City Attorney
Jackie Parrett, City Clerk
Margaret Richards, Recorder
PRESENTATION AND OFFICIAL WELCOME BY MAYOR TO FOREIGN EXCHANGE STUDENTS
Mayor Naughten requested the exchange students and their teacher, Gertrude Sauermost, to stand
for the reading of the proclamation. He read the proclamation into the record, and Police Offi-
cer Marty Speckmaier assisted with the reading of the students' names. Mayor Naughten presented
Ms. Sauermost with a replica of the first ferry that was in service in Edmonds, the official
proclamation, and copies of the proclamation for each of the students accompanied by a bumper
sticker that says, "It's an Edmonds kind of Day". Ms. Sauermost expressed her appreciation. She
said she was surprised that this week was proclaimed the welcome week for the German students
because everyone has already been so kind and friendly. She and her students are happy to be in
the United States and are having a wonderful time.
Ms. Sauermost presented Filmore Sankey, President of Woodway High School, with an album of a
popular German group called "Bap" and a book filled with photographs of Germany as a token of her
appreciation. Mr. Sankey expressed his appreciation to Ms. Sauermost and, in particular, to
Susanne Hall, who was tremendously instrumental in coordinating the sister school relationship.
He also thanked the volunteer parents and students for their hospitality in hosting their German
visitors, and Mayor Naughten and the City Council.
Mayor Naughten recognized Susan Hall for the tremendous amount of effort and coordination she put
forth in making the sister school relationship successful. He presented her with a replica of
the first ferry in Edmonds as a token of appreciation. Ms. Hall said the warm welcome the City
has extended to the students was very appreciated. She said some of the students patrolled with
Police Officer Marty Speckmaier last night and answered a call of a burglary in progress, which
was very exciting to them. She expressed her appreciation to the parents who extended their
homes and hospitality to the students. She asked the home stay parents to stand. Mayor Naughten
also expressed his appreciation.
The meeting recessed at 7:12 p.m. and reconvened at 7:15 p.m.
CONSFNT ACFNDA
Items (G), (H), (1), (K), (L), (N), (0), and (R) were removed from the Consent Agenda. COUNCIL -
MEMBER JAECH MOVED, SECONDED BY COUNCILMEMBER KASPER, TO APPROVE THE BALANCE OF THE CONSENT AGEN-
DA. MOTION CARRIED. The approved items on the Consent Agenda include the following:
(A) ROLL CALL
(B) APPROVAL OF MINUTES OF MARCH 10, 1986
(C) ACKNOWLEDGEMENT OF RECEIPT OF CLAIM FOR DAMAGES FROM JA14ES E. TASCHE ($6,350.90+)
UTILITY EASEMENT
IN CONSIDERATION of benefits to accrue to the grantors herein,
the undersigned, James E. Tasche and Gertrude J. Tasche
hereby grant to the CITY OF EDMONDS, a Municipal Corporation, a
permanent easement for the installation, operation and maintenance of
a storm sewer over, across, through, and below the following
described property; and the further right to remove trees, bushes,
undergrowth and other obstructions interfering with the location,
construction and maintenance of said utility or utilities, together
with the right of access to the easement at any time for the stated
purposes.
The easement and right-of-way hereby granted is located at the
County of Snohomish, State of Washington, and is more particularly
described as follows:
A ten foot st�ip of land that is 5.00 feet on each
side of the storm sewer as it now exists, within
.the following described property:
Lot 8, Westin's Park Addition to the City of Edmonds,
according to the plat thereof recorded in Volume 16 of plats,
page 21, records of Snohomish County, Washington.
TOGETHER WITH A TEMPORARY CONSTRUCTION EASEMENT OVER THE
aforementioned property. Said construction easement will end upon
the completion of the construction of the storm sewer or Janury
1, 1987, whichever comes first.
THE CITY agrees to restore to substantially the original con-
dition such improvements as are disturbed during the construction,
maintenance and repair of said utility or utilities; provided the
grantors, their heirs, or assigns shall not construct any permanent
structure over, upon, or within the permanent easement.
DATED this 19th day of March 1 1986
I lusbao
Wife
STATE OF WASHINGTON)
COUNTY OF SNOHOMISH)
On this day personally appeared before me James E. Tasche
and Gertrude J. Tasche to me known to be the individual(sF
described in and who executed the within and foregoing instrument
and acknowledged that they signed the same as
their free and vZ;Tuntary act and deed, for the uses
and purposes therein mentioned.
UNDER MY HAND AND OFFICIAL SEAL THIS 19th DAY OF
Ma rch , 19 86
NOTARY PUBLIC il and to the Stfte.of
Washington, residing at Seattle
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PERMIT EXPIRES
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JOB. SUITE A-T-
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OWNER AME/NAME OF BUSINESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
Rw Permit Required
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EXISTING - PROPOSED
0
street use Permit Req d 0
Inspection Requited 0
Sidewalk Required 0
CITY ZIP
LEPHONE
17y1171'11V'(05 owL)
REQUIRED DEDICATION- FT
Underground
Wiring required
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 0
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ADDRESS
REMARKS
3
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP
TELEPHONE
NAME
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ENGINEERING REVIEWED/DATE
ADDRESS
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STATE LICENSE NUMBER EXPIRATION DATE
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INSPECTION
BOND
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REO'D
[3 YES ONO
POSTED
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COMPLETE E XEMPT
SIGN AREA
ALLIED PROPOSED
HEIGHT
LLOWED
A SED
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PROPERTY TAX ACCOUNT PARCEL NO. 00,
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[3_'PLUMBING / MECH
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT tJRSIDE REAR
ADDITION COMMERCIAL o COMPLIANCE OR
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CHANGE OF USE
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PARKING
REO'D PROVIDED
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LOT AREA
PLANNING REVIEWED BY DATE
REMODEL 0 APARTMENT El SIGN
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REPAIR CYDS
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REMARKS
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DEMOLISH 1!1 TANK 0 OTHER
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GARAGE - RETAINING WALL 0 RENEWAL
CARPORT ROCKIRY
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(TYPE OF USE, BUSINZESFil ACTIVITY) EXPLAIN:
CHECKEDBY
TYPE OF CONSTRUCTION
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NUMBER
NUMBER OF
CRITICAL
SPECIAL INSPECTOR
OCCUPANT
0
DWELLING
AR All
STORIE!
UNITS
NU
JAREA
REQUIRED 0 YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS,
PROGRESS INSPECTIONS PER UBC 108/FINAL INSP ECTION REO'D
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VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE %
BUILDING Z)A
PLAN CHECK NO: VESTED DATE PLUMBING
IMECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVER
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE GRADING/FILL
:3
t SEPARATE PERMISSION.
RCHARGE
W PERMIT APPLICATION: ISO DAYS
CIL PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYi ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) "APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
0
ui
j IN INTEREST, AGREES TO �NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
2 EDMONDS, WASHINGTON, TS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
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 RECEIPT
a PLAN CHECK DEPOSIT
D
i EEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
x NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
01
. I - TOTAL AMOUNT DUE RECE111
-7;7:;
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION L�4'9/4'-V
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- 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 his/her Deputy: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE A�PPCW 18.27.
OFEICIAL&SIGNA DATE
'�T YA (OWNER AGENT E SIGNED (425)
_V
SIGN T I
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121 v / j
771-0220 -
REL ASED By I Dpr
A17ENTION EXT1333
A/ A,
AZA;Zl�_Ff
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221 - I( - '
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- -
'
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL -FILE
5/98 FAX PINK - OWNER - GOLD - ASSESSOR