6631 172ND ST SW.PDF994
6631 172ND ST SW
Q-
ADDRESS:
TAX ACCOUNT/PARCEL NUM13ER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: — DETERMINATION: E] Conditional Waiver Ej Study Required n Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED: v4-
SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DS7s\Fomis\Street File Checklist.doc
0 0
PLANNING DATA
NAME: mict7w DATE:- VIAYO-v
SITE ADbRESS: 1 66JI (1 577 �L,- � —PLANCHK#: 04-IS-7
PROJECT DESCRIPTION: Mdo(t 7"-,Y- 17173
REDUCED SITE PLAN PROVIDED?:& No)
MAP PAGE: q5'K. CORNER LOT: FLAG LOT:
ZONING: CRITICAL AREAS DETERMINATION ot(
El Stud Required:
)kWalver
Conditional Waiver
SEPA DETERMINATION:
13 Fee
LJ Checklist
0AP0 list w/ notarized form
Q (Needed for 500 cubic yards of grading, Shoreline Area. site within 200 ft. of Puget Sound or Lake Ballinger)
Oilempt
Jve rd
SETBACKS:
�R' ' e
eAulred Se K;ackr.
Str et: Left Side: Right Side: 7 Rear:
6ct A I S
ctual Setbac. 011
Street: Left Side: Right Side:_ Rear:
Street map checked for additional setback required? (Yes No I DNA)
DETACHED STRUCTURES:
ROCKERIES:
FENCES/TRELLISES:
9 BAY WINDOWS / PROJECTING MODULATION:
:TAIRS / DECKS: VC
PARKING: Required<—Z:--�
LOTAREA: 44&�l 10�d-"
LOT COVERAGE , �6 7 �-o
Calculations: 65, Die-, "0
BUILDING HEIGHT:
Datum Point:— Datum Elevation:
Maximum AJIQwed: Actual Height:
A.D.U. CREA
SUBDIVISION:
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: (Yes / No
OTHER:
NewBPPIanningDataForrrLD0C
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RECEIVED fAd
STREET FILE MAY 14 2004
BUILDING DEPT.
R5-4� 0
;61802'
6901
Playfil
6911
1622
16230 w
I 3RD PL SW.,,. �160RD RL SW
16310
63
1
ts
LU 1 6316 1 63,
16324
1 7
I F14TH ST SW
5 16403 1640
w 1640
1 408 1 16410
16QO 6506 3: 1640 16411 641 16409
16415 16415 16407
6415 16418 16419 16424 16420 .6418 16419 1642 3: 16421
1 1642 25 LIJ 16415 Uj 0
16423 16425 16426 16426 .64 16428 > 16418
16426 <
I . I I I I 1 1-9 1�" 16427
16430
16431
16602 1 29 16428
16505
6507 16 5 16503 1 !! --
6510 s I a 16508
16511 16511 6511 16515
164TH P W 16510
164TH PL SW 16521 16520
2 6531
16530 IP
16.60., 660 —05 16610 16606
6505 16611 1 6612 16611 16812
ale 16619 18616 16619 16622 16824
'16'60"
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16710 16710
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168TH S7r SW
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16822
16822 3: 16817
6500
16830 < 16825
1682
16905
16.10
16910 16911
16919
M31
in 0 16929 16925
IWIMIMINIMIM
17012 inol 17004 17005
17015
8 , 7019
1702D 6605 i66TH 0 w
17010 17015 19 170TH PL SW Mead wda
17017 17022 6416
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17026 V\ High cho
1702 Lu 7,0. 17024
1 7102 28 0 17025
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17122 17117 17120 171 .41 1712 17105 171ST PL �' W
17126 71
40 17125 6505 17125
17130
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17206 8 :� . — ST SW
tu 1722 172
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17208 172N
17215
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17210 17 17233
17324 17326 J.'310
6903
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#P20
CAFileNo:10 .—GI
.Critical Areas Checklist.
Site InformatioA'(soils/topography/hy ogy/vegetation)
.1 0)
Site Address/ Location:
2. Property TaxAccount Number:
3. Approximate Site Size (acres or square feet): noe�
4. Is this' site currently developed? yes; no,
do _S
ite oped
If yes; how is. s devel ?
5. Des6lbe the general site topography. Checkill ��t apply.'
Flat less than 5-feet elevation change over e n-tire site.
site gener . y - ess rise of 10-feet a horizontal
Rolling- slopes on all 4. than:156/6 (a vertical over
distance of 664�et)-'
Hilly: slopes present on site of more. than 15% and less than' 30% (a'vertical rise of 10-feet
over a horizont�l distance of 33 to 66-feet).
Steep: grades of greater than 30% pr . esent on'site (a vertical rise- of 10-feet; over a horizontal
distance of less than 33-feet).
Other (please describe):
6. Site contains area . s of year-round standing water: _M6 Approx. Depth:
7. Site contains areas of seasonal standing water: Approx-Pepth:
What season(s) of the year?
8. Site is in the floo dway floodplain of a water course.
9. Site c"ontains a creek or an area where water flows across the grounds surface?. Flows are year-rodnd?
Xf 6 Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ---- ----shrubs mixed
urb4t landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site:,. xje)
-For City Staff Use Only
qq 3 1;
1. PlanCheck Number, if applicable?
2. Site is'Zoned?
3 .SCS !
ma
. pped soil type(s)? gf J_ U(bot, [C(Ad cd^w� -r,' perm—, s/,,) e f
4. Critical Areas inventory or C.A. map indicates Critical Area, on site? /\/O,-?
S. Site within designated earth-s�bsidence landslide hazard area? No.
D .1 WAIVER
ED
Y
llafp-
.hA, le //// '. . : 511
#P20
City, of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
The Critical Areas Checklist contained on this form is to
be filled, out by. any. person, preparing a Dev6loipment
Permit Application. for the Cit� of Edmonds prior to
his/her submittal of the application to the City.
The purpose of the Checklist is to enable City staff to
det&mine 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
Cit�, Hill (Critical areas inventories, maps, or soil
surveys).
Date. Receiveo:
City.Receipt#:
Critical Areai File
Critical Areai Checklist.ree: $135.00
7
Date Mailed t6 Applicani:
A property owner, or his/her authorized repre�entative,
must fill out the checklist sign and date it and:;submit it.
to the City. The City.w'111 review the checklis� make a
precursory site visit, a�d make a determination of the
subsequent steps necessary to complete a development
permit application.
Plea . se submit a vicinity map, along with the sig!ned copy
of this form to assist City staff in finding and lc�ating 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.
The!undersigned applicant� and his/her/its heirs, and assigns, 'in consideration. on the processing of the application agrees
to release, indemnify, defend and hold the City.of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction I based in whole or part upon false, . in . isleading, inaccurate or
incomplete information furnished by the applicant his/her/its agents or employees.
By my signature, I cer* that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE oF APPLicANT/AGENT
Property Owner's Authorization
By my signature, I cer* that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application. *
SIGNATURE O.F OWNER
Owner/Applicant:
Go_"(, N
Name. I
(tL S�
Street Address
E I -,-k o t-L As, I � , * q I 16 5
city State zip
Telephp.ne:(-a0Q 9
Email address (optional):
DATE �-(- A F'- 6 Y
Applicant Representative:
I
Name -
Street Address
city State zip
Telephone:
Email Address (optional):
in
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
The City of Edmonds SEDE SEWER PERMT EASEMENT No. TS1.4
NEW CONSTRUCTION REPAIRS 0
M(DW p'Y .................................... PERMIT No . ......................
OWNER --- WN .................. ................................................... CONTRACTORI . ................................................. ------- A4'?�)Cp
600:fa—ES% — 1-72 -m> -f—SM. =--,. Wo i
ADDRESS............................. ........................................................................ LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAME OF ADDITION S;�U.51—F= . ..... C::�.M ........... T2Zt:hbN-4-CH
9
a
0
t.-ITTY OF EDMwQ,,N1DS'_,'- SIIDE�.�SiEWE'R�l,PER�,M,'!IiTi'
WATER, -SEWER, DEPARTMENM
P E IRM I T
4 4 9,9:
-,/Call, 71OLMOT for side sewer' thsliecUoriv �BEIFORE; coVering:::any �portibn tof'Ahe% constru6tIon.,)r
kInspection%,will, �be�,proVidedl wI*6In1;2T �hours,�,after'xequest� NO, Zat,,; 'Sun.;, or holiday !nspectionsj
treo
'ADDRESS -L ATI 'RU Ox 6631* ..... 17.2nd . ... s ........... t ... S 7 ............................. .............
OC ADTI. ........... ...... ......................................... ................. I..
L0 t A,, 006ble, DO Ranch
PROPERTY LEGAL' DESCRIPTION'
.................................................................................. .................. ......................................... .......................
.................................................................................................................... ........................... ...... ............. .
.......................................................................................
'i Wayne. Mowry
....... ........................................ ............... OWNIER AND/OR, BUI �ILDER .. ........................ ................ ................. w ................ ...........
C( /� -1 . . . (,�ia,,,Tibers,/beHaven-constru�lti�on, -17 109- 67th.. Avenue. West Filmonds,
RACTOWS, NAME-4, ADDRESS ................................................................
............................................................................
VQ V4.V
PerinissiMls granted . .................... ..................................... 19 ......... f6r,repair and/br,connectlon�!of :a; side sewer to� the,'city sanitary sewer
system in, accordance withE ity of Edinonds ordinances., -
AT, �ION IS CALLED TO: THE FOLLOWING:
1—The owners ' of the property ma� obtain a permit to. construct sewer inside property'llne. -Ilcensed..Side Sewer Contractor mu I st I be, e I mployed!'to �c I onstruct
side sewer In street area. Do, not cover, any portion of sewer -before It, has �been Inspected.
NOTE No. 2—All work performed in,cify right-of-way requires, an Invasioni of-, RJght-of-Way Perrnie,oa.'Onable fromAhe City Engineer,.s �c;ffim
NOTE No. 3—Obtain full' information.regaxding Ordinance- 11,16.030,,and, Regulatibns. *governing, sidie sevversim'hen,you -get permiC
NOTE No. 4—Top of side sewer must have at least 30 Inches �coverage at..property Iine:an&'12� thchest insidel,property line; minimum. grade,'&' 2_%. No, bends, -in'- grade
sharper than 1/s will,,be permitted.
NOTE No. 5--Trenches In street must be� water settled and surface oV street restored, �to� original, condition. ;Contractors shall bew responsible for failure 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 providedi for* In, the permIt, or'to do any work on the main sewer or itg:,appurtenances except to, in-
sert the pipe.into the wye.
DISAPPROVED] Date.... V7 ........... By..i ..... ....... Date� ..... ... Date ................ .......... 'By ..........
.............
APPROVED Dat . ............... ,
....................................................
........... .
Remarks: ......................................................... ..................... ...... ...... .....................................
........................... ...... . .................................................................................................. ............. , ............................. ......................... ...............................
BOTH Pei ie MU T gned.By Ow,ner of'Firni, Performing Construction, PRIOR To ffequest. For Inspection. —
I ............
............................... hereby ce tify that the side s6wer.%instailation consiruciedi underthis� permit
ner of �Contracting 'Firm Performing Construction)
Wa -talled in accordance: with all.governing ordinances. of th.eCity 'of 'Edmonds_
Dated' thls'� ...... ......... day, of: ........ 10 ....... ..... ................................. . 19;1�_Ir'
Check BEFORE you dig for: Water �Gas :n, 'Telephone. �E],- PoW.er�;E]:,, Sewer .[3,.. Ofher`:C3
APPLICATION
for
The City of Edmonds SEDE SEWER PERMIT
EASEMENT No!..
NEW CONSTRUCTION-5;�-, REPAIRS 0
.. ... ... ..
OWNER ... ... d2 ............ ....... CONTRACTOR ..... . . .. .. PERMIT No . ................
PAY njRy -------
ADDRESS..... .......... z . .................................................. .......... LEGAL DESCRIPTION: LOT No . ............. .............................. BLOCK No . ............................................
NAME OF ADDITION ...... ....... ................................ . ..
3o Dff-Y,
i I I . I.-
6q A
,ell
177- -5,t 6i,,�
NOV 14 REn
q I
CITY 6i EDA"rfiCINDS
BLDG. DEPT.
CONDITIONAL PERMIT
WORK -
ADDRESS. 6191 721ro 615ff
OWNER -
APPROVED DAi i:--
B yr, o � *
BLDG. OFrFlr!AL
KEEP THESE STAMPED
PLANS ON jOBSITE.FOR
ALL INSPECTIONS.
PERMIT No. SHE
OF
ZONE
S E- T 8 A C K S:
f
T
2-1
�Zy
0 1 HER
H LE I "' 1-1 T
CRESTWOOD LAYOUT SHEET SCALE 114" = 6" INCHES.
1�11xzl,S!3-
,�06
COMPLAINTSLABE WPJ=: NO VERBAL Com��J*WILL BE ACCEPTED.
,T14IS FORKMUST'l BE COMPLETE.
STREET DATE
CITY OF EDMONDS
'AWOW", 04�1-20xwk
CWIAINT SUBMITTED BY:
Name: Z- Phone: 2 / 2—
Address: Z�2- -STREETHLE
ADDRESS OF PROP ERrY TO BE INVESTIGATED:
Nane of Owner:
Address: &,^31 -"57L Phone:
DESCRIPTION OF COMPLAINT:
Do NOT WRITE BELOW THIS LINE FOR. CITY USE ONLY
CODE SECTION VIOLATION: Al-9 1-5K "�q
TYPE OF ACTION EXPECTED:
TIME REQUIRED TO INVESTIGATE / ACT ON COMPLAINT:
RESULT OF INVESTIGATION: DATE: TIME REQUIRED:
I
/��A" 1110 AA A-De�rMp A IN OfS06AO
INVESTIGATED BY"
77��
N 0- T I C E
TO PERWrTEE AND/OR OWNER
El TIAL APPROVAL
t,�j-VIIOLATION
r-1 CORRECTIONS REQUIRED
PERMIT
NUMBER
JOB ADDRESS
r-,-,,.�O PERMIT --STOP WORK - REMOVE CONSTRUCTION OR OBTAIN
PERMIT AND MAKE WORK COMPLY WITH BUILDING LAWS.
CONSTRUCTION IS NOT IN ACCORDANCE WFM "PROVED PLANS
D AND PERMIT - STOP WORK. MAKE EXISTING WORK COMPLY WITH
APPROVED PLANS AND PERMIT OR REMOVE IT.
Fl STOP WORK - UNTIL AUTHORIZED TO CONTINUE BY INSPECTOR.
FCORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN
� BE APPROVED.
F� WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED.
FCONTACT ]INSPECTOR AND RECALL FOR INSPECTION.
� ARRANGE FOR APPOINTMENT. 1:1
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED
WITHIN -T . . ........ DAYS OR PENALTIES IMPOSED BY LAW MAY BE
APPLIED. FOR I XTIONS CALL: 775-2525.
0--BUILDING DIV.
CITY OF R PUBLIC WORKS
E] FIRE DErr.
EDMONDS Tid a
/Va r w�,
�� -q 1(
zo
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6 6
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RECEIVED
Ad
APPROV BY PLANNING C,rry copy MAY 14 2004
BUILDING DEPT.
4-4?
RECEIVED
PERMITEXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPUCATION
USE PERMIT
ZONE NUMBER
JOB SUITEJAPT#
ADDRES18
174
PLAT NAMFJSUBDIVISION NO. LOT NO. LID NO.
LID FEE S
OWNER NAMEINAME OF SINESS
MARM ADD
SIL
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXIffnNG — PROPOSED—
REQUIRED DEDICATION— FT
Apprmd
RW Perm ROQL*od
811" Um Pem* Ift"
R "
Sidewakft*dred
UndwWound
WiringreqWul
CITY ZIP
er�
TELEPHONE
NA E
ADDRESS
METER SUE I LINE NO. OF FIXTURES RV REQUIRED
SiZE T YES C3 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONMOLIDRAINAGE
z
CITY ZIP
TELEPHONE
NAME
ENGINEERING REVIEWED BY DATE
AbbRESS
FIRE REVIEWED BY DATE
Ir
CITY ZIP
TELEPHONE
VARIANCE OR CU
SHORELINE OR ADEkf
INSPECTION
REG§
13YES 'VO
BOND
POSTED
$
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED 13Y
SEPA REVIEW
COMPLETE EXr
EXP
SIGN AREA
ALLOWED PROPOSED
HEIG
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL. NO.
44 4//
0 NEW RESIDENTIAL PLUMBING / MECH
COMPLIANCE OR
13 ADDITION COMMERCIAL CHANGE OF USE
REMODEL MULTWANLY SIGN
RERIJR GRADING Cyos FENCE
( _X_Ff)
DEMOLISH 'M NK OTHER
[3 GARAGE [3 RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
LOT COVERAGE
ALLOWED PROPOSf
39 Yo C�o
REQUIRED SETRACKS (Fr.)
FRONT SIDE ', REAR
PROPOSED SETBACK13 (FT.)
FR )DE r
9PIT IA 0 "m
PARKING
Rl rPRXED I
LOT AREA
llo.Atlnl
I P DATE
=R 5111161
REMARKS
UWE OF USEPUSINE864R ACTIVTM EXPLAIN:
CL� 49zad e I I
CHECKED 13Y
TYP F CONSTRUCTION
.0
OCCUIPANTn
GROUP
NUMBER
OF
mmed&r
NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS
NUMBER
SPECIAL INSPECTION
REQUIRED [3 YES
AREA
OCCUPANT
LOAD
DESCRIBE WC41K TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC IOWFINAL INSPECTION RECrD
lz
10 a�c
VALUATION
Des�lritfflon
FEE
Duerlptlon
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO:
VESTED D ATE
Ptumbing
Bas 9 Fee.
&zz- 7.
Medmical
r
.
7
THIS PERMN AUTHORG= ONLY WdwORK NOTM THIS PERMIT COVERS WORK TO
r&IMT
It
2
BE DOKE ON PRIVATE PROPERTY ON111 ANY CONSTRUCTION ON THE PUBM
Grading
3
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC4 WILL REQUIRE
I=
SEPARATE PERMISSIONL
Engr. Review
PERMff APPLIrATION: IN DAYS
PERIM LIMM I YEAR - PROVIDED WORK 18 STARTED IMM IM DAYS
Eqr. Inspectim
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
`APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
VCESQRS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND. AND HOLD HARMLESS THE CITY OF
2
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt III
IALL
CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
9
FROM THE ISSUANCE. OF THIS PERMIT. ISSUANCE OF THIS PERMrr SHALL NOT BE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscape Insp.
Totall Arnt Due
0
XI
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE. PROVISION. -
Recording Fee
Receipt III
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 18 CORRECr AND THAT I AM THE OWNEFk OR THE DULY AUTHORIZED AGENT OF
APPLICATION
APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Tills Applicall n Is no a permit mill sigred by to
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
["ad' OftWOFhMWDOPLlty:andF:baarepaW,WW
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
moelpt Is aclawMedged In space provided
WORKMEWS COMPENSATIOWINSLIRANCE AND RCW 18.27.
SIGNATURE WNER OR AGENT)
DATE SIGNED
0�
. (425)
OFFICIALS SIGNATURE DATE
4NN
771-0220.
RELI?mml) BY 6ATE
E T
ATT NT N
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
011&Z
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL -FILE YELLOW-INSPEADR
OW03
PRESS HARD -YOU ARE
MAKING 4 COPIES
PINK . -OWNER GOLD.ASSESSOR
REOEIVED
Iqlb PERMIT EXPIRES
OW I W1
1;,`1TYDF'EDM0NDS
CONSTRUCTION PERMIT APPLICATION
UPE PERMIT
ZONE I V1
NUMBE6
JOB SUITWAPT#
ADDRESS, -72." -&* SO
0WNQR NAM EMAME OF BUSINE'SS
PLAT NAME/SUBDIVISION NO.
'go ?—C4
LOT NO.
LID NO.
LID FEE III
15
MAILING ADDRESS
-24
PUBLIC RIGHTOF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
RElo, UIRED DEDICATION— Fr
TESCV APWOV*d
RW Pwffdt RaWAred
Street Use Pam* Req'd
tretpecdon Reiltdred
Sidewalk ftcltdrecl
UnderWound
Whing required 13
CITY ZIP
TELEPHONE
60 0
NAME
, M�iERSIZE
LINE SIZE I
NO. OF FIXTURES
P"QUIRED
YES Z� NO 13
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
z
CITY ZIP
ITiLEPHONE
NAME
ENGINEERING REVIEWED/DATE
ADDRESS
FIRE REVIEWED BY DATE
CITY ZIP
NE
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
REO'D
[3 YES (3 NO
IPBOND
OSTED
STATE LICENS I 1� NUMBER EXPIRATION DATE
ECKED BY
SEPA REVIEW
COMPLETE EXEMPT
EXP
SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTYTAX-ACCOUNT PARCEL NO.
7
0 NEW RESIDENTIAL PLUM13ING MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT LIRSIDE REAR
z
PARKING
REOD PROVIDED
I
LOT AREA
PLAN NING REVIEWED BY .,DATE
REMODEL APARTMENT SIGN
IL
REPAIR GRADING CY06 0 FENCE X
FT)
REMARKS
0 TANK [3 OTHER
[3GARAGRET RETAINING WALL
CARPO 1:1 ROCKERY 0 RENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
'5f=R
CHECKED BY
TYPE OF CONSTMN
7
C
�017.
OCCUIV
G
NUMBER.
OF
STORIES
NUMBER OF
DWELLING
UNITS 7-
CRITICAL
AREAS
NUMBER
SPECIAL INSPECTOR
REQUIRED [3YES
JAREA
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION R EQ!D
Ghea�t -t�oc,14 'r a fA 0 0 O'� -- 'r 0- V-0 C-k
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NAWATION $
Description
FEE
Description
FEE
Plan Check
HEAT SOURCFj� GLA23 LOT SLOPE % Building &0 745
PLAN CHECK N,O:. VESTED DATE :Plumbing IfIVO
Mechanical
THIS PERMIT AUTHORGES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
ti ANY CONSTRUCTION ON THE PUBLIC
:E DOME ON PRIVATE PROPERTY ONUt Grading
OMAIN (CURBS, SIDEWALKSj DRIVEWAVS, MARQUEES, ETC.) WILL REQUIRE Recording Fee
SEPARATE PERMISSION.
Engr. Review City Surcharge
PERmrrAPPucATioN. lee DAYS
PERUIT UMn! I YEAR - PROVIDED WORK 18 STARTED WITHIN ISO DAYS Engr. Inspection State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLIC)ifff, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Traffic Mitigation Plan Chk Deposit,
IN INTERRST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS."IWASHINGTON, ITS OFFICIALS. EMPLOYEES, AND:�GENTS FROM ANY AND Fire Review Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVIEW NATURE, ARISINGMIRECTLY OR INDIRECTLY
FROM THE 18SUANCE OF THIS PERMrE ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Fire Inspection Total Amount Dub
NOR LIMIT IN ANY WAY THE crries ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapainsp. Receipt # - 77
I HEREBY ACKNOWLEDGE THAT I HAVE REA . D"THISAPPLIC A TION: THAT THE INFORMATION
GIVEN, IS CORRECT, AND THAT I AM THE OWNER. OWTHE 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
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Butding Official or his)ber Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR-CQDE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION mcelpt Is acknowledged In space provided.
WORKMENS COMPENRADPI11-1111BUF"CE AND RCW 18.27.
1.0 cmLs siGNAT",Y�TE
SIGNATURE (OWNER AGEPNT),� DATE SIGNED 142
1,125)
771-0220 'R BY 'DATt
ATTENTION,' Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL.OR A CERTIFI.; 771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL - FILE - YELLOW - INSPECTOR
FAX
IQ(01 PINK - OWNER - GOLD ASSESSOR
RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME/NAME Of BUSINESS
5
MAILING ADDRESS
01
1 1;', i "�-
CITY,
I" 'V-1 �'VY
NAME
ADDRESS
CITY
NAME
"DRESS
81.,",
STATE LICENSE N UMBER
i1±11
ZIP
10z1W
IWI
-4(-
PERMIT EXPIRES -LL
U6E PERMIT 47 --
ZONE
(61
NUMBER
JOB LjUITE/APT#
ADDRESS
( # ( a
PLAT NAMF/SUBDIVISION NO.
LOT NO.
LID NO.
po 419 4 C', 4,42 '��4tvrfl r"Mcf]
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TES6FA-PM"d
W Peradt ReWired
:treat
Use Permit ReqV
TELEPHONE EXISTING — PROPOSED inspection RNulrad
Sidewalk Required
underground
0 REQUIRED DEDICATION— Fr VRMg recitilred
METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRE
ZIP I TELEPHONE
ZIP I TELEPHONE
4 / / o -, .10 (,� / ty(�)
NEW RESIDENTIAL
0 ADDITION C OMMERCIAL
O(REMODEL 0 APARTM I ENT
YES
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION
ENGINEERING REVIEWED/DATE
FIRE REVIEWED BY DATE
'j
NO 13 z
z
EXPIRATION DATE — RLANCE OR CU SHORELINE OR ADB# INSPECTION I PBOND
CHECKED BY REQ'D OSTED
E3 YES (3 NO
REVIEW SIGN AREA HEIGHT
III COMPLETE . EXEMPT ALLOWED . PROPOSED ALLOWED . PROPOSED
GRADING
REPAIR
CYDS
DEMOLISH
[3
TANK
[30ARAGE.
CARPORT
[3
RETAINING WALL
ROCKERY
[TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF
OF DWELLING 2-
STORIES UNITS
DESCRIBE WORK TO BE DONE
EXP
I
I
I
I
f I
. LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT L/R SIDE REAR
PLUMBING / MECH
COMPLIANCE OR
r CHANGE OF USE
I
PARKING
REO`O PROVIDED
LOT AREA]
PLANNING REVIEWED BY DATE
0 SIGN
FENCE
I
Al" 0 1
.
0 I — x — Fr)
anc.) (c I-r,
Ot -i I -w 'j, C;: NL�X-)
RENEWAL
CHECKED BY I TYPE OF CONSTRUCTION OCCUPANTjr?—j
GROUP K7
CRIT19(Al.
A EAS OCCUPANT
R SPECIAL INSPECTOR AREA
NUMBER REQUIRED [] YES LOAD
e
:::4REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REO'D
U t-4. `iz —j 12
VALILIATION $
FEE I Description I FEE
Plan Check
HEAT SOURCE GLAZING % LOT SLOP!
I ,
Building
170
CACk.
I
PLAN CHECK NIX* VESTED DATE
C.)
Plumbing
:5
'RS
Mechanical
Ono
THIS PERMIT AUTHORGMS ONLY THE WORK NOTED. THIS PERMIT COVE WORKTO
t: BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
X DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
Recording Fee
3
SEPARATE PERMISSION.
Engr. Revie
City Surcharge
PERMIT APPUCATIOW ISO DAYS
ED
PERMIT LIMM I YEAR - PROVID D WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
State Surcharge
-APPLICAN'r, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Afriount Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Landscapelnsp.
Receipt #
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
D El
THE OWNER. I AGRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN OING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
This application Is not a permit until signed by the
Building Oftlal or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
FOR INSPECTION
receipt Is acknovAedged In space provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED
IA08
0 FIqIA;LS $IGNATU� �rfE
x �-I,, gE!"-4, 1
771-0220
11111
ATTENTION
Off 1333
R E SEt
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CF
.RTIFI-
771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ,
ORIGINAL - FILE - YELLOW - INSPECTOR
10/01
F"
PINK - OWNER - GOLD - ASSESSOR