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6912 161 ST PL SW
ADDRESS: L
TAX ACCOUNTIPARCEL NUMBER:Xr)-7
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR -
CRITICAL AREAS: xs =y
-aL DETERMINATION: E] Conditional Waiver P(Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKIING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DA
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID 4:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED: -5/"
SIDE SEWER PERMIT(S)
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR: —
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DS'Ps\Fonns\Street File Checklist.doc
CITY OF EDIVIOND6
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METER SIZE IBUILDING
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TELEPHONE NUMBER
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REM�RKS
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- STATE LICENSE NUMBER
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SIGN AREA
ALLOWED PROPOSED
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ENV. REVIEW
COMPLETE I EXEMPT
ADB NO.
Legal Description of Property - include all easements
(show below or attach two copies)
HORELINE #
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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
Permit Application: 180 Days
ENERGY CODE
Permit Limit: 1 Year - Provided WorR is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
w successors in interest, agrees to indemnify, defend and hold
0
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 PLAN CHECK DEPOSIT
dev 0
modify, waive or reduce any requirement of any city ordinance
0
I nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision." I
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- AUTHORIZE This application is not a permit until
S
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his
"'On 't
Or h
hat' he
e d u' y
W'th c ity a nd
0ork a ut h 0 riz_
of t he Labor
Code of the State of Washington relating to Workmen' 's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance. INSPECTION acknowledged in space. provided.
SIGNATURE (OWNER OR AGE DATE SIGNED DEPARTMENT
OFFICIAL'S SIGNATURE DATE
00OF CITY OF
EDMONDS
_�EIEASED BY: DATE
ATTENTION- -�--77,1732021=w
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL' A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
,Jtjl !-, - V)",') ORIGINAL — File YELLOW — In 1PICtor
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Owner GOLD — Assessor
42-87
..!v11IT C0UNT,r:*.R
DATE:
MEMO TO: Permit Coordinator, Building Division
FROM: Dan Smith, Engineering Inspector
ADDRESS: 4�t7l'llq AW
I
OWNER:
After review of the subject building permit application, we have the
following comments:
r
1) Construction hours are: WEEKDAYS 7:00am to 10:00pm
WEEKENDS:/HOLIDAYS 10:00am to 6:00pm
2) A Right -of -Way construction permit is required for any work on
City property.
3) Connection to City water system required.
4) Connection to City sanitary sewer system required; obtain separate
permit. -
5) Water and sewer lines to -be separoted by 10 foot minimum.
6) Driveway must be paved a minimum of 20 feet back from City
right-of-way; separate permit required.
7) Driveway slope not to exceed 14%.
8) Back water valve -required if downstairs plumbing is below
elevation of upstream manhole.
9) Builder/Owner responsible for,containing all temporary runoff and
erosion control on site. Construction may not impact neighboring
properties in any way. 7-4157411
Ce AS
10) No burning of construction refuse without approval from Fire Dept.
11) Street to be kept clean of debris, dirt, mud, and construction
materials.- Contractor responsible for dust control.
12) Inspection required on drainage system, c ' atch basin.installation,
driveways, and sidewalks. A fi'nal engineering inspection is
required prior to the b:uilding division granting occupancy.,
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CITY of EDIVI&IDS SVE SEVEP
STREET FILE PERMIT NO.'
For Inspection Call 771
Address of Construction:
Property Legal Description (Include all easements): /_ ::) 7 (,=� /Y1 F-A- () o — 0 A L. lf_
1 4-) c; I :r
Owner and/or Builde.r:
Contractor & License No: 6 A /f T
C_
Single Family Residence C 1 �/ ED
Multi -Family (No. of Units APR 2 6 10 Q
Commercial (No. of fixture Units PuBLIC WORKS
Invasion into City Right -of -Way: No k Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No X Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
I certify that I have read and shall comply
with the items listed on the back.
,V - -) -7 -
Date '
Permit Fee: so qssued By:
Trunk Charge: 215 IDate Issued: -1 - 2- 7 — 70
Assessment Fee: - 2,1 D 0 Receipt No.: /Z2 622
Partial Inspection:
Comments Date Initial
Final Inspection Approved: _5 - t'f�-Vj 4 X"
Date
Rejected: , Reason _ffate Initial
** PERMIT MUST BE POSTED ON JOB SITE **
Wh-ite Copy - File Green Copy -'Inspector Buff Copy - Applicant
The City of Edmonds Side Sewer Drawing EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION REPAIRS F� LID NO - ------------------ - ASMT. NO - ------------------
OWNER------------------------------------------------------------------------------------------------ CONTRACTOR ------------------------------------------------------------------------------------ PERMIT NO. Q817-D
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JOB ADDRESS (C"il --- pt
el - - ----- A-L�-, ...... �-Jj BLOCK NO - ------------------------------------
.4 ------ LEGAL DESCRIPTION: LOT NO - --------- ------------------------
0
0
PWW-0001 .11/75 (REV. 11/78)
------------------------------------------------------------------------------------------------------------------------------- - L-YIVNVi6 ---- -----
OD LIIV,,
NAME OF ADDITION ............................................................ ---------------- ------
----- ------------------ --
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Approved:
...............
DATE .............................
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).
#P20
City. of Edmond's
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
The Critical Areas Checklist contiined on this'form is to
be filled out by any person preparing a Development
Permit Application. for the City of Edmonds prior to
his&er submittal of the application 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 sul:ject property. * The information
needed to complete the Checklist should be easily
available from observittions of the site or data available at
City Hall (Critical areas inventories, maps, or soil
Surveys) -
Date Received: 0.3'10 11 3'QD S�
CityReceiptt -
Critical Areas File
CrMc'al ' Areas Checklist Fee:-. $135.00
Date Mailed to Applicant,.___,
A property owner, or hiAer authorized representative, -
in f st,
ust ill out the checkli sign and date it, and submit it -
to the City. The City will review the checklist,. make'ej
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.
The undersigned applicant, and his/ber/its heirs, a . nd 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 infiraction based in whole or part upon false,- misleading, inaccurate. or.
mcomplete information furnished by the applicant, his;/herhts; agents or employees,
BY my signature, I cer* that the inforriiation and exhibits herewith submitted am 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.
SIGNA"M OF APPLICANVAGENT
Property Owner's Authorization
DATE
By my signature, I certify that I have authorized the above Applicant(Agent to apply for the subject land use application,
and grant my permission for the pu�ic officials td staff of the City of Edmonds to enter the subject property for the
ari
purposes of inspection'and po!,)�eattendant to this .1ication.
SIGNATURE OF OWNER DATE
.OWB5�%Appffcant:
Name
1�o.
Street Address
— r---A1111(04t1A
city State zip
Telephone:
Email addrm (optional): 11011,
Ile,
Applicant Representative:
Name
Street Address .... ..
city stw zip
Telephone:
Email Address (optional):
�ie /-
1-1fro" h 2 0
CAFileNo:.CA-b
Critical Areas Checklist
Site InfonwHon (soffs/t'opog'raphy/hydrology/vegetation)
I Site Address/Location: -1, 1 2
C
2. Property Tax Account Number: 0 0. Z 6 6) 0 C) 0
3. Approximate Site Size (acres or square feet).-
4. Is this site currently developed? yes; V-"no.
If yes; how is. site developed?.—. PLg le 1-7 0 U
Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling- slopes on site generaUy less than 15% (a vertical rise of 10-feet over a horizontal...
distance of 66-feet).
MIT. slopes present on site of more ftm 15% and less than'30% (a vertical rise of 10-feet
over. a honzontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 1D-feet over a 'horizontal
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water 47d Approx. Depth.
7. Site contains areas of seasonal standing water: ;Approx. Depth:
What se'ason(s) of the year?
8. Site is in the floodway i7c,� floodplafn /1 J of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?..
Flows are seasonal? X-1 j (What time of year?
10. Site is primarily. foreste - d meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc)
11. Obvious wedand is present an site: j
—For City Staff Use (�rdy 1, P -?a -
1. Plan Check Number, Tapplicable?
2. Site is Zoned?
3. SCS mapped soil type(s)? q - nr
Ili,,*,-, A7n
4. Critical Areas inventory or CA. map indicates Critical Area on site?
5. Site within designated earth -subsidence landslide hazard area? UnI �QiV�r
DEI E MWATION
RE
--511JDY �9UIRED
Reviewed by-
WAIM
lc�,
ce.,t�—
CITY OF EDMONDS
CRITICAL AREAS RECONNAISSANCE REPORT
Sitel-ocation:
6912-161sPI.SW
Tax Acct. Number:
00769600000600
Determination:
Study Required
Determination #:
CRA-2008-0008
I
Applicant:
Raymond Olitt
Owner:
Raymond Olitt
CRITICAL AREAS RECONNAISSANCE REPORT: STUDY REQUIRED
During review and inspection of the subject site, it was found that the site contains and/or is
adjacent to critical areas, including Geologically Hazardous Areas and Fish and Wildlife Habitat
Conservation Areas, pursuant to Chapters 23.40, 23.80, and 23.90 of the Edmonds Community
Development Code (ECDC).
GENERAL CRITICAL AREAS REPORT REQUIREMENTS
Critical Areas Reports identify, classify, and delineate any areas on or adjacent to the subject
property that may qualify as critical areas. They also assess these areas and identify any potential
impacts resulting from your specific development proposal. If a specific development proposal
results in an alteration to a critical area, the critical areas report will also contain a mitigation plan.
You have the option of completing the portion of the study that classifies and delineates the critical
areas and waiting until you have a specific development proposal to complete the study. You may
also choose to submit the entire study with your specific development application.
Please review the minimum report requirements for all types of Critical Areas that are listed
in ECDC 23.40.090.D. There are additional report requirements for different types of
critical areas (see below).
Note that it is important for the report to be prepared by a qualified professional as defined
in the ordinance. There are options on how to complete a critical areas study, and there is
an approved list of consultants that you may choose from. You may contact the Planning
Division for more information.
General Mitigation Requirements for all Critical Areas are discussed in ECDC 23.40.110
through 23.40.140.
STUDY REQUIREMENT — EROSION HAZARD AREA
It appears that this property contains or is adjacent to an Erosion Hazard Area. Erosion Hazard
Areas include:
0 Those areas with Alderwood and Everett series soils on slopes of 15 percent or greater.
Any area with slopes of 15 percent or greater and impermeable soils interbedded with
granular soils and springs or ground water seepage.
Areas with significant visible evidence of ground water seepage, and which also include
existing landslide deposits regardless of slope.
DEVELOPMENT PROPOSALS ASSOCIATED WITH EROSION HAZARD AREAS
Development within an Erosion Hazard Area must meet additional criteria.
• For erosion hazard areas with suitable slope stability, the only critical area study needed is
an erosion and sediment control plan prepared in compliance with the requirements set
forth in Chapter 18.30 ECDC as part of the construction documents. This option is at the
director's discretion, per Edmonds Community Development Code section 20.80.050.G.
• In areas where the slope stability is not suitable, projects within Erosion Hazard Areas will
require a report by a licensed Geotechnical Engineer or other qualified professional. Note
that it is important for the report to be prepared by a qualified professional as defined in the
ordinance.
• Report requirements are given in ECDC 23.80.050, and more generally in ECDC
23.40.090.D.
• Development standards are given in ECDC 23.80.060 and 23.80.070.
STUDY REQUIREMENT — LANDSLIDE HAZARD AREA
It appears that this property contains or is adjacent to a Landslide Hazard Area.
• A Landslide Hazard Area is any area with a slope of forty percent (40%) or steeper and
with a vertical relief of ten (10) or more feet (except areas composed of consolidated
bedrock).
• Landslide Hazard Areas are further defined and illustrated in ECDC 23.80.020.B.
• In addition to the general requirements for Critical Areas reports referenced above, specific
Critical Area report requirements for Landslide Hazard Areas are provided in ECDC
23.80.050.
DEVELOPMENT PROPOSALS ASSOCIATED WITH LANDSLIDE HAZARD AREAS
Development is restricted within a Landslide Hazard Area and its buffer.
• Projects that will intrude into these areas will require a report by a licensed Geotechnical
Engineer.
• The criteria that are applied depend on the amount that the buffer is reduced.
• The buffer can be reduced to a minimum of ten (10) feet (with an additional 15' building
setback per ECDC 23.40.280) if a report is prepared that meets the standards listed in
ECDC 23.80.050. The alteration must also meet the requirements listed in ECDC
23.80.060.
• In addition, proposals to reduce the buffer to less than ten (10) feet must comply with the
design standards listed in ECDC 23.80.070.A.3.
STUDY REQUIREMENT — FISH AND WILDLIFE HABITAT CONSERVATION AREAS
Since the site is located within a mapped fish and wildlife habitat conservation area, the City would
like to preserve as much of the native vegetation as possible.
2
DEVELOPMENT PROPOSALS ON A SITE WITH FISH AND WILDLIFE HABITAT
CONSERVATION AREAS
The applicant must submit a clearing/tree cutting plan with any development permit. Tree cutting
and clearing of native vegetation shall be limited to the footprint of development.
ALLOWED ACTIVITIES
Certain activities are allowed in or near critical area buffers as specified in ECDC 23.40.20. If you
have any questions about whether your proposed development qualifies as an allowed activity,
please contact a Planner for more information.
EXEMPT DEVELOPMENT PROPOSALS
Certain development proposals may be exempt from Critical Areas Requirements (ECDC
23.40.230). If you think that a specific development proposal may be exempt, contact a Planner
for more information.
Jennifer Machuqa, Planner February 13, 2008
Name e000l- Signalw-e' Date
NOTE: Cited sections of the Edmonds Community Development Code (ECDC) can be found on
the City of Edmonds website at www.ci.edmonds.wa.us.
This map displays LIDAR data at approximate
2-foot contour intervals. This map is for
information purposes only and should not be
relied upon for any action. Actual topography
should be verified in the field by survey for
accuracy. This map is provided with all faults
on an "as is" and "as available" basis. No
warranty of any kind is given. Users of this
map agree to indemnify and save harmless the
City of Edmonds, its officials. officers, employees
and/or agents from and against any claim,
demand or action, irrespective of the nature of
the cause of the claim, demand or action, arising
out of any use or possession of this map.
N
W+E
S
I inch equals 60 feet
15 30 60 Feet
HWAGEOSCIENCES INC.
Geotechnical & Pavement Engineering - Hydrogeology - Geoenvironmental - Inspection & Testing
April 11, 2008
HWA Project No. 2008-000-21 T01 5
Ray and Harieft 01itt
6912 161" Place
Edmonds, Washington 98026
Subject: GEOTEcHNicAL DESIGN OF FOUNDATION TO STABILIZE DECK
6912161ST PLACE
EDMONDS, WASHINGTON 98026
Dear Mr. and Mrs. Olitt,
This letter is to confirm the remediation concept that we proposed as an alternative to the
deck stabilization recommended in the report dated April 11, 2008. This letter must be
read in conjunction with that report. The report notes that measured movement of the
deck foundations is on the order of 2 to 8 inches over the past five years. The report then
goes on to say that the movement is a result of settlement of soft fill and sliding of the
fill.
The movement is very slope and it is our understanding from you that it there have not
been any sudden movements caused by such things as wet weather or the earthquakes. It
appears the sliding and settlement is relatively slow and will continue at somewhat the
same rate in the future, maybe I to 2 inches per year.
Other alternatives may include redesigning the deck to be entirely supported on the
house, or be flexible and supported such that it can be re -leveled easily. We have not
done any of the structural engineering but conceptually the following would be
reasonable alternatives.
DECK SUPPORTED ON THE HOUSE
The deck would probably need to be smaller the stem wall appears to be about 4 feet tall.
One could dig down and attach a support to that stem wall that would hold the column at
some distance out from the building. The sketch below is one option.
J U M - 5 2R"0- 64th Avenue W.
Suite 200
BUILDING DEPT.
Lynnwood, WA 98036.5957
Tel: 425.774.0106
Fax: 425.774.2714
www.hwageo.com
April 11, 2008
HWA Project No. 2008-000-21 TO 15
RE-LEVELABLE FOUNDATION
This approach is used often in Alaska where frost heave and thaw settlement are a
constant problem. There are many levels of sophistication that could be used but
basically you pour a relatively large concrete slab (say 2 feet square) under each column
location and place a column foundation block on the slab. When the slab moves more
than a tolerable amount (say I inch) you move the foundation block over and jack it up.
The moving and jacking could be as simple as a sledge hammer to move it over and a car
jack and shims to raise it. You could get more sophisticated in a number of ways such as:
build a screw jack into the foundation block so to easier to lift and shim,
place a pre -poured concrete slab on a pea gravel surface and tie that to the house
so that it will move down but not out,
build in water levels and plumb bobs to assist in determining when a given point
needs to be re -leveled.
The connection between the concrete slab and the column support block needs to be such
that it can rotate as well as slide as the slab tilts. The following sketch would be one
concept. There could be bolts or clamps used to hold it all together more if desired.
Letter on Jacked Foundation 4-11-08 2 HWA GEOSCIENCES INC.
April 11, 2008
HWA Project No. �008-000-21 TO 15
If desired, we could work with you in developing a system that would be economical and
workable. Alternatively your contractor may have a preferred method to use.
0.0
We appreciate the opportunity to be of service. If you have any questions or concerns,
please do not hesitate to contact us.
Sincerely,
HWA GEOSCIENCES INC.
Tom Kinney, Ph.D., P.E.
Geotechnical Engineer, Vice President
Letter on Jacked Foundation 4-11-08 3 HWA GEOSCIENCES INC.
TIME QUOTE
1).ST ., �
SINGLE FAMILY ROUTING FORM
***FOR INTEROFFICE USE ONLY***
Applicant Date Plan Check #
Address Type
PLANNING
RESUB #1 Target To On Back ADD? - Days Mail/Fax
RESUB #2 Target - To On Back ADD? Days Mail/Fax
RESUB #3 Target To On Back ADD? Days Mail/Fax
1. Zone
Comer /Flag—�)A— 2.�treet Map Width Dedication?
,/VAR CU SM LLA 4. SEPA -Expires
+ 6�0
5. Building Pad: Existing 6 Proposed t Area Lot Coverage
7. Height Calcs: Datum T� (Moe Ave Grade Max Actual
8. Req'd Parking 2 Provided 9. C.A.# h%'(iXg—D eten-ni nation
CA's CONSULTANT Target Mailed - - To Back ADD? Days Mail/Fax
RESUB #1 Target Mailed To I Back ADD? Days Mail/Fax
PLANNING COMMENTS & NOTES
BUILDING
FEMA Map Soils Rep 9a16 VIAQ Worksheets
rt
47 Lot Slope QL-: I
Retaining Wall / Rockeries? Shown on site / civil plans? Top & Bottom wall elev?
IN-HO USE Taryet
To
On
Back
ADD?
Days
Mail/Fax
RESUB #I Tary-et
To
On
Back
ADD?
Days
Mail/Fax
RESUB #2 Tanzet
To
On
Back
ADD?
Days
Mail/Fax
RESUB #3 Target
To
On
Back
ADD?
Days
Mail/Fax
RESUB #4 Tanzet
To
On
Back
ADD?
Days
Mail/Fax
CONSULTANT Tarizet Mailed To Back ADD? Days Mail/Fax
RESUB #1 Target Mailed To Back . ADD? Days Mail/Fax
RESUB #2 Target Mailed To Back ADD? Days Mail/Fax
BUILDING COMMENTS & NOTES
L:\TEMP\DST'sTonns\Routing Sheet SFk 3-4-04
ENGINEERING
WE
RESUB #1 Target To On Back ADD? Days Mail/Fax
RESUB 42 Target To Oil Back ADD? Days Mail/Fax
1. Drainage Plan & Calcs 0
2. Grading Plan/CYD's
3. Step Footings? Y/N?
4. Driveway Slope %
SEPA?
OK —Waiver Apprv'd?
5. Street Dedication Req'd? FT
6. Easement Type
7. Proposed Impervious
8. Existing Impervious (Pre 1977)_(Post 1977)
9. State Hydraulics Permit
IO.Check Plat Requirements
I I.Sidewalk Required
12,EUC Form
COMMENTS/NOTES
v 0 v 5 a 6 6 a 0 0 a If a 6 0 5 0 0 a 6 § 6 8 0 d 8 0 8 8 N 8 v 8 8 a b 5 8 a a § 8 d 8 a 8 N N a E w E E N v a § § w 0 E E 0 0 0 0 N 0 5 a 0 8 a a a 6 N N 0 a a a N 0 5 2 2 0 a 5 1
*REVIEWERS: PLEASE CALCULATE BUSINESS DAYS*
PLANNfNG REVIEW TIME TOTAL DAYS **** ENG REVIEW TIME TOTAL DAYS
PW REVIEW DAYS*** *BUILDrNG: In -House Outside TOTAL DAYS
RTG DAYS PERMIT # ISSUE DATE
*CONTACT PERSON STATEMENT*
BY SIGNING THIS FORM I UNDERSTAND THAT I AM THE ACKNOWLEDGED CONTACT PERSON FOR
THIS PROJECT. IT IS MY RESPONSIBILITY TO COORDINATE ALL SUBMITTALS WITH THE CITY
AND ONLY I CAN MAKE INQUIRIES ON THE STATUS OF THE PERMIT. I UNDERSTAND THAT IT IS
MY RESPONSIBILITY TO DETERMINE IN ADVANCE OF PERMIT SUBMITTAL ANY DISCRETIONARY
PERMITS THAT MAY BE APPLICABLE TO THIS PROJECT. I ACKNOWLEDGE THAT TO THE BEST
OF MY ABILITY I HAVE SUBMITTED ALL NECESSARY DOCUMENTATION IN ORDER TO MAKE A
COMPLETE APPLICATION.
Signed
Date
Contact Person (Print Clearly)
CORRECTIONS: Fax to:
E-mail
Items required prior to permit issuance:
1 . I
2.
3.
4.
5.
Phone
Mail to:
L:\TEMP\DST's\Forms\Roufing Sheet SFR 3-4-04
CITY OF EDMONDS
STREET FILE ASSET INFORMATION SHEET
2/NEW
ADDITION
RETIREMENT
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION bcQ, "I � ui
DEPT. ?,0,,-
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
INITIATED BY
DATE
PROJECT NUMBER ulonsnqi?
PROJECT COMPLETION DATE
COST 9 s--, ? V
61 1
APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
M//DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
0 G.L. ENTR
REFERENCE DATE
UJ--/
VERIFIED BY
PROCESSED
BATCH NO. -
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DEPARTMENT FILE
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