6601 172ND PL SW.PDF980
6601 172ND PL SW
STREET FILE
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PLANNING DATA
NAME:
SITEADDRESS: &&01-17kJ /DATE: -71z / /f r/
ZONING. PLAN CHK#: 3/
PROJECT DESCRIPTION:
I CORNER LOT4L—(Yes/No) FLAG LOT 14-�o (Yes/No)
SETBACKS:
Required Setbacks: 0 �Z_ 5 e-1, // a
Front: '2,5' Left Side: Right Side:—L�A�Rear:
Actual Setbacks: /1"
Front: I.S "' Left Side: Right Side: 31 Rear: 32
Street map checked for additional setback required? �— (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE: /7
Maximum Allowed: Actual: 3'�
B UILDING HEIGHT: I ---
Maximum Allowed: Actual Height:
Datum Point: Datum Elevation:
A.D.U. CREATED?:
SUBDIVISION:
CRITICAL AREAS #:
SEPA DETERMINATION: i—�- i�,�
LOTAREA:
OTHER:
Plan Review By: Ascl /6,9-7'eze
c:Tt1eskpennit\-p1andaLdoc
City of Edmonds
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).
J U L 1 1 199.7
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 detennination 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:
Z 7,2 A'd 1�2
Street Address
6QA46 A/0- W
city State Zip
� �� �) -2 �13 -
Telephone tO - -2 7/ -0d,3)
Signature
Date
cneentionvianakad doc
ulltl4'1�
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signatuie
Date
(over)
ck-,6 CM /
CA FILE NO. 91
Critical Areas Checklist
---------------------------------------------------------------
Site Intormation (soils/topograp y/hy rology/ vegetation)
1. Site Address/ Location: (a�01 11.2qd 10Z_ 3Lx—, rl
,)AA
2. Property Tax Account Number:
3�2-000 —001—no
3. Approximate Site Size (acres or square feet): n 0 0 EZ
4. Is this site currently developed? AL/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 lessthan 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 10-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 horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: __AZ�2_; Approx. Depth:
7. Site contains areas of seasonal standing water: IV 0 Approx. Depth:
What season(s) of the year?
8. Site is in the floodway- floodplain of a water course.
9. Site contains a cree or an area where water flows across the grounds surface? Flows are
year-round? /t/ � Flows are seasonal? - (What time of year?
10. Site is primarily: forested ; meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) I V_
11. Obvious wetland is present on site: A16
For City Staff Use Only—
.I. Site is Zoned?'
.2. SCS mapped soil type(s)?
:3,::*. Wetland inventory or C.A.. map indicates wetlandpresenf on site?
,4 Critic . a . I . Areas inve . ntory or C.A. map indicates Critical Area on site?
Site with in desi & na ted ear th subs . idencelandsl . ide haz ard area? h10
6. Site designated o n the Environrn . en . taUy . Sensitiv . e Ar . eas . M . ap
$TUDY REQUIREb
WAIVER
.Revi.ewedby:
PlaAner
ACA—chkAoc, Rev 02/11/97
CA FILE NO..
Critical Areas Checklist
------------------------------------------------------------- -
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Ad dress/Location: �,�rjl_ / )- !,- d /�,"Z__ �- r- /--) AA
2. Property Tax Account Number: !L:3�2-000 -001-no'
3. Approximate Site Size (acres or square feet): noo S � ET
4. Is this site currently developed? Zyes; _ 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 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 10-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 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: IV 0 Approx. Depth:
.What season(s) of the year?
8. Site is in the floodway— floodplain— of a water course.
9. Site contains a cree or an area where water flows across the grounds surface? Flows are
year-round? A/ � Flows are seasonal? (What time of year?
10. Site is primarily: forested ; meadow ;shrubs
urban landscaped (lawn,shrubs etc) mixed
11. Obvious wetland is present on site: A,10
-7 --------------------- — ------ For City. Staff Use. Only—
ite is Zoned?
SCS mapped soil type(s)? "p - Al 42:�
W-tl di
e an inventory or C.A. map indicates wetland vresent on site?.
4. Critical Areas inventory or C.A. map indicates Critical Area on'site?
1.�Site within d F
e.s.ignated: earth. s.�bsldence landslid ha Ard AtW:::
te designated on the Environmenta.Uy Sensitive Areas Map?
0ETbW1N*AtI *' *
ON
^ca_chkdoc; Rev 02/11/97
City of Edmonds
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).
�JUL 1 It 10497
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 inforination (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:
ft
Name
&6?0� I
Street Address
61D Alt 0 A10, W
city State Zip
-2 -It 3 -
Telephone �U-
e�-
Signature
Date
ccg-�' 6), 6-14�
c:recentionvianMead
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date
(over)
oo6- d-3 /
REET ADDRESS FILE
CITY OF EDMONDS ST LAURA M. HALL
MAYOR
7110 - 210TH ST. SW - EDMONDS, WA 98026 - (206) 771-0235 - FAX (206) 744-6047
COMMUNITY SERVICES DEPARTMENT - PUBLIC WORKS DIVISION
8 go . 1 99
October 5,1995
Sue Johnson
6601 - 172nd Pl. SW
Edmonds, WA 98026
Dear Sue:
I have reviewed your account and will allow a credit of 45 units for the billing period of
"June 21, 1995 through August 24, 1995 in accordance with our City policy. The policy
states that the customer will be billed at the retail rate based upon the average water
consumption for the same period during the previous year. In addition, the excess water
lost from the leak will be billed to customer at the City's wholesale rate with a 15%
surcharge added for administrative cost. Only one leak credit will be granted in any three
year period.
Should you have any additional questions after you receive your new billing, please
contact Ilene Larson, Utility Billing Clerk, at 771-0241.
Sincerely,
Z4��
Ron Holland
Water/Sewer Supervisor
RH/lk
cc: Ilene Larson
Utility Billing Clerk
wordata\water\#301025
* Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
October 3, 1995
RON HOLLAND
WATER/SEWER SUPERVISOR
CITY OF EDMONDS
Re: Johnson residence - 6601 172nd PI SW - Edmonds
REcEIVED
0 C T 0 3 1995
PUBLIC WORKS DEpI
Ron; as I mentioned to you awhile back, our personal residence had a water leak which seems to have
significantly raised our water bill (although not as bad as we had feared). We noticed the water coming up
through our driveway on August 29th, which was a Sunday. We turned off the water at the meter at that
point, and began digging. It did take a couple of days to complete, as we had to rent a cement cutting tool
to complete the job. The leak was found and the water pipe was completely replaced.
if you think this problem might constitute any kind of credit from the City, we would appreciate your
consideration.
Thanks!
Sue (and A?ew)l Johnson
(if you would Re to contact me any ftirther, you can reach me at extension 230)
'9TREET FILE
M E M 0 R A N D U M
December 3, 1987
TO: Ilene Larson
Utility Billing Clerk
FROM: Bobby Mills, Superintendent
Public Works Division
SUBJECT: ACCOUNT #301025 &
I have reviewed the attached letter with Archie Brena and agree this
is -subject to our leak credit policy. The letter explains very well
the.event. The response by our Water Division saved many gallons of
'V
water.
Mrs. Johnson called me December 1 and said you would be sending an
adjusted bill.
Should you have any questions, please call.
BM/lk
Attachment
0
#301025/TXTWATER
0 0
- - .! �.' J
November 20, 1987
Mr. Bobby Mills
City of Edmonds Water Department
501 Bell Street
P.O. Box C-2008
Edmonds WA 98010
Nov 21 Asa'
PUBLIC VqORKS
Re: #301025 - Possible Adjustment to Bill Due to Leaky Underground Pipe
Dear Mr. Mills:
After talking with you yesterday by telephone, we are now submitting for
your consideration the circumstances which caused the water bill we received
yesterday to be in the amount of $453.94.
On October 16th I noticed a small amount of water running along the sidewalk
curb and into the drain in the front of our house at 6601 172nd Place S.W.,
Edmonds. As there had been men working across the street putting in cable just
prior to that, I thought that perhaps they had damaged an underground pipe and
at that time I called the Water Department. Shortly after that, at about 4:00
pm of that same day, a man from the Water Department came up to investigate the
situation.
He said our water meter was spinning like crazy. He came into the house and
turned off the water going into the house (in the garage), but the meter was
still running very fast. He determined that the water pipe must have broken
between the meter and the house and located a spot where he felt the leak must
be, as the ground was quite wet and seemed to be running down toward the
street.
We recently had
our property surveyed, and we
do have property that is now on
the other side of
the fence between us and our
neighbors.
That is where the
pipe had broken,
and any kind of wet ground was
not even
visible to us because
of this. He then
asked me if I would like the
water shut
off completely, from
the meter, and I
told him to do -so immediately
as we had
already been going
through so much
water without our knowledge.
When my husband
got
home
from work at 5:30 pm that
same evening, he started
digging, and with
the
help
of one of our neighbors and
some floodlights, , they
found the leak in
the
pipe
and repaired it by 10:30 pm
that evening.
We would really appreciate any help you could give us on this bill. I talked
with a man in, your off ' ice by the name of Scott on the day this happened. He
advised me to contact you when the next bill arrived and let you know what had
happened.
I would be. ' happy to talk with you anytime if you need to come and check out
this situation any further. Thank you very much.
Sincerely,
Susan Johnson 743-9321
Andrew Johnson
STREET FILE
DAM-MMrA &9� 1 1 f3—�l
IMP,10 TO: Harry YhitCUtt
Buildinq Official
F R 0 Richard H. Allen
Assistant Citv Ennineer
SUBJECT:
After review of the subject building permit application, we have the following
c e n t s ;
EM- P M-l"r LL I\J(D-r
�Q (IgA
p�g�UC g�q
, ffi I IQ D1
a
_T
P153LIC ".'()PJ,S DEPT. OMCK LIST
2f) n,
J�JUILDENG PI'MI-IT MAIM! _7L
Street Pdph t-of-VI'ay Existing
Access Easemcnts Existing,
REOT)
Utility Easement Existing�_ ITDD
Lot Per Subdivision Plat Assessor Ilan
Site Plm (lieched for Accuracy r2_2_1 --7::]
Ibidorground lvdrinv 1) nO..
C -
(heck Pkcar,14 of Lequi Oticr.ipl'ibm k,/
Revicv., by—_ 1 Datem-3i
Existingy f"Itcy SizC
Vf�ater �!nin I'm uired
Se r � IC�C_ I , A e- REqtl " P (A ,
llydra_nt Size Yxisting
Hydrant Rcquired per.Fire COCIO, --Size.
Detector Check I'!CtCr Renuired
Fire llcmarti-,icnt Corvents
?Ir,DIeT6-C
Rate :;) —
.1 Scptic Tanl. Desj.�M Approved —
Septic Tank Permit Renuired Pemit
Sanitan 1) ewer Availability roj._
V4 T
,)r,,�jqijjg �T File '�!O.
10
Side Scwer Availabilit,,,
V,
Swiitary Sewer Comection Fee Pcquircd
Open Ditch Existirg— Requi
0 Culvcrt Pemiircd Size
Catch Disin Renuired Indicate on '�ite Plan
S I r0% _-T[6n in suo
Lr, bouldQrd We
11-inholc required Indicate oil Site Mail
Soil Conditions, c] Gromid Water Field (Ioc'x-,cd_
Review by —Rite Iz
Street Paving Requi�cd
Curb an.d Gutter RICquircd—&-ld�-1-
Reo.i.-iired
Cur]-) Cut for Driveway Required
Rj,ryht-of-1,','a-,?- Construction Permit Rcouired
Bond Required for Public Improvements
Street Name Sign Required
Other Signing Rcouircd
P, 12
-n-nit Site Inspection made on
Pre Ile
r-, BY: Scv,:cr
Water
r-;4 �L:
�trcct
Enaineering
Special Requirements listed in memo to Building Popnrtment
Bv— Date
All items filled in on Building Permit Application
By Datc
e>
Drawings Stamped and Notations 11�-idc
By Date
Approved by Public Worhs Department
0
STREET FILE
December 13, 1976
MEMO TO FILE:
Permit #760213 (Steinmann)
Permit issued 5-6-76
Will expire 5-6-77
Progress inspection made 12-13-76
House framed up to first floor
No apparent work -has been done in R/W under street use.permit
#76-6
Requirementt.in R/W contained in Engineering memo dated 5-14-76
and attached to permit. Engineering Department holds bond for
work in R/W and completion will.be required prior to expiration
of permit.
HMW/ae.
cc: EngineeringL,-,*'
MAA
�U -7�0z�
NOTICE:
No warranty of accuracy.
The information shown on the attached map(s)
was compiled for use by the City of Edmonds,
its Employees and Consultants. The City of
Edmonds does not warrant the accuracy of
anything set forth on these map(s). Any person
or entity requesting a copy should conduct an
independent inquiry regarding the information
shown on the map(s), including, but not limited
to, the location of any sewer stub shown. Such
sewer stubs may or may not exist and may or
may not exist at the location shown. Neither
the City of Edmonds nor its employees or
officers shall be liable for the information given
on map(s), nor for any one representation
provided based upon said map(s).
APPLICATION
for
Tl.�' I City of Edmonds SIDE SEWER PERMIT EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION tj REPAIRS F� LID NO . ............. .... ASMT. NO - ------------------
OWNER -�� ...... --------------------------------------- CONTRACTOR ----- --------- --------- PERMIT NO.
ft -i
JOB ADDRESS ------- F----L- ------ LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
0
0
rEa��- t-4uMEi6SV=L, ?-
NAME OF ADDITION . .................................................................................................... -----------
Approved:
B�DATE ... . .. .&/ff ...... By . ... ..................
7-
S-% �Sl�DE�,,-,�.',,,5,,EWER:,PE,R,MIT..
ED, Mr,, D
L
WATER-SEW&R`DEPAIRTMENT
-64
PERIN
(,,Call' 715-2525 r ewer inspection FOR!� covering.,any� i;,n, of the construction.
fo side; s s
s !If , 130 or hol a
pection.will be provided; within.124 hoursoafter requst -NO).Skt., Sun.;, iday In pec�lonei.
72.2
.�IADDRESS�sL,*OCAT-TON�.OF'�CO�i$T-RUO�T]ION� ... ..................... ......................................... ...................................................
IPROPEkii��L I k=v4l 4--_,
F ......
�-GA�X"�PE CRIPTION ....................... � .............. Vi .... ............................ ....... ...................... ........................................
....................................... ............................................................................................................... .................................................... ..................................................
VA ".4 AA�v.�&,Cn_ 1��
....... ........ ....... 01,8WER AND/OR BU, IIDER'....: ................ Q
......................................................... ..................... ...... .
.............................. ....................... .......................... : .......... ............
CONTRACTOW&NMIE. &,"DRkSS ...........
Pennission is granted- ....... 48; Pa /or :c I onnection, oVa side sewer to the"city'-sanitary sewer
............. .................................. 19 -1ofYe Ir and
sy-4--e . m. in accordanMwith. Citi. Edmonds, ordinances..
A1-1-ENTION, IS CALLED TO -THE; -FOLLOWING:
NOTE No. 1—The owners of the property may obtain a. permit, to construct sewer insidi property fi6e. A licensed Side Sewer Contractor.. muse be employed to construct
side sewer in street area. :,Do 'not cover any portion of sewe before it,.:has',been lnspe�cted.
NOTE No.' 2—All work perform"e �d'i�i('city right-of-wxk, requires, an Invazlov-61! RJght-of-Way. PernalfJobtal6able fromthe'City Engincerlh, office.,
NOTE Noi 3—Obta.1n, full infornriatio6.regarding Ordinance. 1l.M030 and, Regulations,,' goveinink�al.de�,",S,ewersj%�hen yopget permit.
146TE! No. 4—Top, f,iide,sewer must have atleast 30, inches coverage at property�; llne,,and'.12 Inches ins . ide. property� Iine;..MInI mum 'grade,:of 2 No benda, tn;.gr�de
shaxpoer than �4-wlll be'permitted.
NOTE No. 5--Trenches in street; must be water settled' and surface of street- restored tR original condition. Contraetors shall be responsible for fallurei due to, improper
work which may develop within one year of completion.
NOTE No. 6—It is unlawful to� alter or do, any other work than is provided, f.or J6 peKmJt, or -to do any',work orr -the maln sewer- or Its app urterarom except.,to in-
sert the pipe into, the wye:
DISAPPROVED E]',�.Date ............ By ................ Datb..., Date ..... .................... B ...........
. ... ........ ......
....... BY!..
BY .........
APPAOVED al 4 .......... .
... ................... ............................................
Remarks: ......................................................... ................................. ....................... ................................................ ...........
.......... ................
171 .......... ...................................... ....................................................
............ .............................. .................. .................... ........................................................
BOTH 1?6rLt'��Co�ie��MUST'Be Signedl`]�y 40wner-,&f",F�irm�'Pe'rformin'g'...�Cbrlstr�uctio'rr!PlilOR To Request- PorInspectilo'n
-he, side sewer installation constru�tbdunder this, permit
................. *.... hereby ..'certify that t
(Owner Contracting Firm Performing Construction)
,�,.�,;',Installed in accordance with. all -governing ordinances, of, the City of,EdmondS,.
64 11
Date&ithN ............................. day.,of ................................................ ........ G ...... IR .........
Check, BEFORE. you, dig for: Wat6r' E]�,' Gas �El�i, Vele hone;,,0, Power-- E],,i Sewer,:E]y Other-'E]�-
P
APPLICAVON
for
The of E�monds SIDE SEWR PERAW EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION E] REPAIRS n LID NO - ------- ---------- - ASMT. NO - ------------------
CONTRACTOR V ....... --------- PERMIT NO.
- ---------------------
of E,
monds
0 R - - ------- -------- - ----------------------
top-
---------- -----------------------------------
17A -------- ... )f LEGAL DESCRIPTION: LOT NO. --- BLOCK NO.
7- ia--
-----------
/BADDRESS ... ............. ------------------------------------------------------------------------------------------- ----------------------------- ------ -------------------
tl;t *0,
NAME OF ADDITION D.P.10 - --------------------
--- I/ ----- F-3-T .................... ....... -
0
Approved:
DATE-------------------------------------------- By --------------------------------------------------- yi7.yg
Permit Address
Legal Descriptioter-
STREET FILE
BUILDING PERMIT RFVIEW - FNGINFFRTr1r3 DFPARTl,4FNT
CHECK LIST
Reviewer's
Intials
AeN 1. Septic Tank System nesign Approved K) 14
2. Sanitary Sevier Availahili"Y�_�Sht-. of Dwn. No.-&Q31
Project:FW DWRE64> Side Sewer Availa . bility:
3. Any Sanitary Sewer Connection Fees,
4. S i te Drai nage Checked (0
5. Storm Sewer Availability: Sht. f Dwq. No.
. )125
Project:RAT Roadside Ditchobi 112-NO T
6. Grading Final Contours WEr
7. Sidewalks (S,ite Tnspection shows condition of existi-nn vialks"as follows):
8. Curbs
9. Curb
10. Underground Wiring A Street Linlitino
11. Street Riqht-of-%,,ia.v MO. Sht.
of Dwq. No. of Officia,l Street Map.
12. Existing Utility Fasements-
13. Access Easements
14. Water Mains & Fire Hydrants (Indicate Size !-later Main)
15. Bonds for Site 14ork-
16. Special Requirements listed in memo to Bldg. Dept.
17. Commercial Apt Requirements form completed
18. Drawings stamped notations made
19. Site Inspection made on-
20. All items filled in,on Mdg. Permit Application
21. This Lot included in Subdivision (List any special requirements):
3/9/76
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
j0H1L)501%1
MAILING ADDRESS
4-111064 1-);�-,21
CITY ZIP .7TELEPHONE NUMBER
-7 z/5
7AME
ADDRESS
NAME
/1", 4547�
j01,t1-4,0&)
ADDRESS
V-n A Qel_�
r.1TV ZIP I TELEPHONE NUMBER
STATE LICENSE NUMBER . EXPIRATION DATE
tion of Property - include all easements
,��r,q-re.5 Alo. .2- - 114�1— 1
ubt PERMIT
ZONE 9 7r-y-,?- G
.NUMBER
JOB T 7147 SUITE/APT #
ADDRESS (a
LEGAL DESCRIPTION CHECKI SUBDIVISION NO. I LID 1,10� "Mr
I ,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCIP Approved 0
FEW Permit Required 0
EXISTING —
REQUIRED DEDICATION
Street Use Permit Req'd 11
Inspection Required 0
PROPOSED
Sidewalk Required 11
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 0
REMARKS
10LI-1-
NGINEERING MEMO DATED REVIEWED BYf
W111101rora
VARIANCE OR CU ADS # SHORELINE #
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLOWED PROPOSED ALLOWED I PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED j..PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
Property
Tax Account
^7_1
LOT AREA
PLANNING REVIEW BY
DATE
Parcel No.
i AJ
E] NEW 4E-J RESIDENTIAL PLUIMBINGI`MECH
REMARKS
COMPLIANCE OR
ADDITION COMMERCIAL El CHANGE OF USE
REMODEL APT. BLDG. E1.,SIGN
I.HECKED BY
Ty E- INISTRUCTION
JC�(/.
OCCNA11T
GjkQ P/_
GRADING FENCE
REPAIR CYDS. X 6 FI)
WOOD$TOVE SWIM POOL
DEMOLISH M INSERT: HOT TUB/SPA
GARAGE E] RETAINING WALL/
CARPORT ROCKERY t, RENEWAL
SPECIAL INSPECTOR
REQUIRED
AREA
OCCUPANT
LOAD
REMARKS
Z
Lo (TYPE OF USE; BUSINESS OR ACTIVITY) EXPLAIN:
PROGRESS INSPECTIONS PER UBC 108
NUMBER
0 OF
CO STORIES
NUMBER OF
DWELLING
I UNITS
CRITICA�__
AREASff4
INUMBE
0
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
7FEE.1
HEAT SOURCE:
GLAZING
PLUMBING
Plan Check No.
MECHANICA L
.This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any Construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Llm.1111:1 Year- Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
12 harmless the City of Edmonds, Washington, its officials,
m employees, and agents from any and all claims for damages of
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5 whatever nature, arising directly or indirectly from the Issuance
T of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT.-
0
modify, waive or reduce any requirement of any city ordinance
0 the City's to enforce any ordinance
nor limit in any way ability
TOTAL AMOUNT DU
provision."
il I A - Ih,t I have read this aninlicatione that the
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y
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n
.friformation -given is correct; and that I am the owner, or the duly
'n f` 0 r� a 0 n g '
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
h ad agent
aut' 0 r iZ
state laws regulating construction; and In doing the work authoriz.
st a a aw s regu'ati
THIS PERMIT,
AUTHORIZES
Thj'A application is not a permit until
by the Bu Ing Official or his/her
ed thereby, no person will be employed In violation of the Labor
Y' no Pei
to Workmen's Compensa
....ONLY THE
WORK NOTED
si§ned
eputy; and fees
re paid, and receipt is
ode of the State of Washington relating
C C 0 f t e State (
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ti I su r
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INSPECTION
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GNA URE (OWNER OR AG�N
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DEPARTMENT
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OFFIbj S
DA&
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CITY OF
EDMONDS
rATL
CALL FOR
RE BY:
DATY
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A -FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220,
ORIGINAL — File
YELLOW — Inspector
A'CERTIFICATE OF OCCUPANCY HAS 8.EEN GRANTED. UBC
SECTION 109
PINK -- Own6r
GOLD — Assessor
37
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE
ZONE PERMIT
R5 - Z__ NUMBE . R 3, 05�1 0
JOB ITE/APT #
'ADDRESS 66ol �.z P0,
OWNER NAME/NAME OF BUSINESS
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LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
LID NO. p.
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — REQUIRED DEDICATION
PROPOSED
TESCP Appr ad 11
RW Permit Required 11
Street use Permit Req'd 0
Inspection Required 11
Sidewalk Required 0
CITY ZIP
C-Vlmrav Pis
TELEPHONE NUMBER
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LOU
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NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 11
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ADDRESS
REMARKS
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CITY ZIP
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NAME
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ADDRESS
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STATE LICENSE N EXPIRATION DATE
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SEPA REVIEW
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EXI
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ALLOWED 1PROPOSED
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0
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LOT COVERAGE
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REQUIRED SETBACKS (Fr.)
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0
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Z
Property
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Tax Acco nl Z
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LOT AREA
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YNEW ORESIDENTIAL PLUMBINGWECH
REMAR
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.
REMODEL APi.-BLDG. SIGN
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"E/XNSTRYCTION
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OCCUP"T
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0
0
M
0
GRADING FENCE
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WOODSTOVE SWIM POOL
DEMOLISH El INSERT H_WTUB/SPA
GARAGE RETAINING WALL/ _Dfiz_19
CARPORT El ROCKERY J�eRENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
__ff
—IN
SPECIAI�s.INS%PTOR
REQUIRED
11 YES
- I
AREA
7 _77
OCCUPANT
LOAD
REMARKS
PROfqRILSS INSPECTIONS PER UBC 108
NUMBER
OF
STORIES -2-
NUMB�R 60
DWELLING
UNITS
CRITIC Ale-i
CR'T C
AREAS
UMB :R
7
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
12F,44 Palo P'lf-v oecx o- vlyksi
FINAL INSPECTION REQUIRED
3, J,
VALUATION
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING %
PLUMBING
Plan Check No. �3,F
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewplks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
11�7)
Permit Application: 1.80 Days
Permit Limit: 1 Yeair Provided Work Is Starte,&Wlthih 180 Days
STORM DRI�INAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnity, defend and hold
ENG. INSPECTION FEE
ow)
5
0
,
0
X
harmless the City of 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
nor limit in any way the City's ability to enforceany ordinance
provision."
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
q/, 60
I hereby acknowledge that I have read this application; that the
information -given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL'
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and in doing the work authoriz- AUTHORIZES This application is not a permit until
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance aria RCW 18.27. INSPECTION acknowledged in space provided.
W SIGN6TURE JOWNER OR AGENT DATE SIGNED DEPARTMENT
WOFFI,WS SIGN6TIRE, DATE
k CITY OF J$k
EDMONDS Z
y )
CALL FOR 'AELEASED BI--" DATE
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL — File YELL Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109 PINK — Owner GOLD — Assessor