6920 172ND ST SW.PDF1111111111
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6920 172ND ST SW
ROPREET FILE
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
P� I tiC * "R Lit) 1 4( t+LE le- i�e�
MAILING ADDRESS
CITY
-7 78 -b30
NUMBER
NAME
�!� A/A P 6wo /v/ e, TA a e - /7 oIJ
ADDRESS V,
00 // 27 -7 M 7- A/e
CITY TELEPHONE NUMBER
Z /4,4 t hi,/ b
0 1 ki�-2 -1v 6
U STATE LICENSE NUMBER
. . A F-6- C 1-77- LO
Legal Description of Property - include all easements
(show below or attach two copies)
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eve ans-
N EW
RESIDENTIAL
PLUMBING
ADDIALTER
COMMERCIAL
MECHANICAL
REPAIR
APT. SLOG.
El SIGN
EXCAVATE
DEMOLISH OR FILL
FENCE
E]
CARPORT
REMODEL
I- x -FT)
swim
GARAGE
POOL
WOOD STOVE/ r7 RETAINING WALL/
INSERT ROCKERY
RENEWAL
NUMBER OF STORIES
NUMBER OF
DWELLING
lu
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
VF 5 1ptlije E
USE PERMIT
ZONE NUMBER
JOB
ADDRESS
69,20 17
57shl
_EGAL DESCRIPTION CHECK
-U
I WIVISI NO.
LID 110
Z07
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP
EXISTING f&77 -REQUIRED DEDICATION
PROPOSED,5;t--
APPROVED BY
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED
SEE ENGINEERING MEMO DATED
41
REVIEW BY
C,,� A
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REMARKS
NG SUPPL
SIGN AREA I ENV. REVIEW
ALLOWED I PROPOSED COMPLETE i EXEMPT
VARIANCE OR CU
SETBACKS — FEET
FRONT SIDE REAR
BY ITYPE OF
UNITS
ADB NO.
I SHORELINE 0
NING REVIEW BY I DATE
---T—HEIGHT I LOT COVERAGE -
HEIGHT
SPECIAL INSPECTOR AREA OCCUPANCY OCCU PANT
RE0141RED GROUP _JLOAD
r] YES [�NO
REMARKS
PROGRESS INSPECTIONS PER UBC 305
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided WorN is Started Within 180 Days
ENERGY CODE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
i whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be d eemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
TOTAL AMOUNT DUE
nor limit in any way the City's ability to enforce any ordinance
provision."
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and in doing the work authoriz-
THIS PERMIT
AUTHORIZES
ed thereby, no person will be employed in violation of the Labor
ONLY THE
C.ode.gf the State of Walhington relating to Workmen's Compensa-
WORK NOTED
#9n Laurance.
INSPECTION
DEPARTMENT
I TUREi (OWNER OR
f
DATE SI IN� 1
AAT)
_
1�; 5,/
7
CITY OF
EDMONDS
VALUATION
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL'S SIGNATURE DATE
0
a:
0
Z
Z
Z
0
Z
03
ATTENTION
771-3202
RELEASED BY:
DA rE
PROJECr NAME: PRWBCT
APPLICATION R IPT DATE: 1-1��4 q
CHI=ST , L;
ADDRESS: 172 -5;7- Shl
Reviewed by: (initial/date)
Commmm
PLANNING
WTR/SWR SMM ENGNRNG
FIRE
BUILDnr.
/77-777777777777
1111-71711
Sn4ME F=Y/MULTIME/CaMME11CIAI, - (Circle One)
SETBACKS CHECKED - Plarming
7 777-7 TI-17
—7 77 717
77TTIT17 7
VARIANCE/SETBACK ADJ.
/////////
////////
I
F/ 7 77 7 T
7 TR T1 7 7
7TF7-7 17TFI
-
CONDITIONAL USE PERMIT
/////////
////////
2
777T/7—T777--7777-7
77777777'7777777777
ADB, REQUIREMENIS CHECKED
/////////
////////
I
77T17T-777=7777177
O`IHER ZONING REQUIREMENTS
ENVIRCNKMAT, FEATURES
5
7 7 777T/7
77/77777
77777T7
RECY
ACCESS SLOPF & VEHICLE ACCESS
DRAINAGE- PLAN (On Site)
777717
777777777
777777777
77777TI7
STREgr FILE
//////
/////////
/////////
////////
/ PIRI. I,,
A
LEGAL DESCRIPTION VERIFICATION 06'
11171
/////////
/////////
/////////
/////////
////////
////////
'
9
77T77TRT
17777777
QUIT CIAIM/DFnICATIONS
10
EASEMENT - PUBLIC/PRIVATE
7777=7777777/
/////////
////////
11
CAJ,CMATE SEWER CMNaCTION IF NO LID#.
7777777777777"111111111
//////
/////////
/////////
12
/ / ff/7
7777=72//////
PLAT/SUBMISTON REQUIROwlENTS
13
R1GJJT-OF-WAY CONSTRUCTION PEPMTT RFj_M
TfTrl 7
//////
7777 7TI 77
/////////
7 7 7 7 7 " 7
/////////
*O�?
/
14
//////
7T/-/77777777777777
PIOND REQD FOR PUBLIC IMPROVEMENTS
15
SOILS CONDITIONS & GROUND
11111f
77777777T771111111
WATER FIET,D afECKED
//////
/////////
/////////
MM/k
16
77T/7
77777TI7
777-=
-
STREET PAVING REQUIRED
17
CURB AND GUTM REQUIRED
777TTTTR7
18
771111
111117171
7T/777777'
SIDEVOUX REQUIRED
//////
/////////
/////////
W
19
77-77-77
7TI77TR7
aM CUT FOR DRIVEWAY REQD
/////////
20
STREET NAME SIGN REQD
TIT11717T
T777TITIT
7TT777717
—
21
0711ER SIGNING REM
7,777T/T/7
/////////
T17TI77TI7
—
22
SIDE SEWER AVAIIABILITY
77771-f
//////
7777=77/-=
/////////
////////
23
EXISTING MER MATN SIZE
RT17
//////
JV, 1,
777M77
////////
24
�ATER MF.TER SIZE
7M11
7777777
1117711111
—
25
SERVICE LINE SIZE
777Tff
777777T/7
11IR71117
—
26
HYDRANT REQUIRED
7TI77777T-111111111
1111111117
—
27
-ITT-177
11117777
—
HYDRANT SIZE EXISTING
//////
/////////
28
CROSS C'C�TION INSPEC?ION REQD
1111177TITIT17T
//////
/////////
�m
29
WATER MTP C31ARGE REQD
7T/P7
30
FIRE LINE CIMRGE REQD - SPRINKLFR
150
////////
////////
31
STREET CUT
z/V
32
OPEN DIMi EXISTING
77777TTIT17[17T711111111
33
REOD
77777/7777777777
All
34
CULVERT REM
35
1771777T1"flTf-1-r1f11111
SIZE
//////
/////////
36
CAT01 RAS IN REQD
777777'777777777
//////
/////////
37
ITTRI
INDICATED ON SITE PLAN
//////
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38
SHOULDER DIUdiNG—E mmwmm
=7777'77777
7
s 112 OPEN RUNOFF
39
MISC:
40
V E 1)
i M
WKS
REVIEWED BY:
PLANNING MGR.
m-mmmmr mr.R-
DATE: 671
MEMO TO: Permit Coordinator, Building Division
FROM: Dan Smith, Engineering Inspector
ADDRESS: s�o
OWNER:
After review of the subject building permit application, we have the
following comments:
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 separated 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
el-evation of upstream manhole.
9) Builder/Owner responsible for,containing all temporary runoff and -
erosion control on site. Constructio.n may not impact neighboring
properties in any way.
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, catch basin -installation,
driveways, and sidewalks. A final engineering inspection is
required prior to the building division granting occupancy.,
Lo-T 8 Luv.�ow)5
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C I T . Y of EDIVI ON DS SIDE SEWER PERAII
For Inspection Call 771-3202 PERMIT NO. 07965
,STREET FILE
Address of Construction: 5-r
Property Legal Description (Include all easements): 46)7-,�3 r_,b�xl
Owner and/or Builder:
Contractor & License No: !�;� A R F _- / -72- L-0
Single Family Residence X, # gqo
FLYNNWOOD LINE I
Multi -Family (No. of Units L_
Commercial
(No. of fixture Units
Invasion into City Right -of -Way: No X 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 Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASEAEAD THE ITEMS&ISTED ON THE BACK
I A I % - - - ; -- Ld
I ��em_ W�� I
-I c rtify that I ve rea6—and shall comply FEB 2 2 1989 Patel
with the items 11'sted on the back.
PUBLIC WORKS
Permit Fee:
Trunk Charge:
Assessment Fee:
C>v 0 L)
Partial Inspection:
Issued By:
bate Issued:
Receipt No.:
Comments Date Initial
Final Inspection Approved:
Date 6 rnitfal
Rejected: Reason . —Ta—te —I—nitial
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy - File Green Copy - Inspector Buff Copy - Applicant
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).
Side Sewer Drawing
The City of Edmonds N
EASEMENT'NO - --------------------------------- -----------
NEW CONSTRUCTION REPAIRS F� LID NO . ................. ASMT. NO - ------------------
OWNER ------------------------------------------------------- ........
------------- -------------------- CONTRACTOR- ----------------------------- PERMIT NO.
JOB ADDRESS -------- VIA. W.
------- - ----- ---- S ------------------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
-------------------------------------------------- I ..........................
Vo ----------- ....... !A-g;_ -t
PWW-0001-11/75
NAMEOF ADDITION -----------------------------------------------------------------------------------------------------------------------
38
0
0&0
Approved:
11/78) DATE _ -2% .......... y ... q ...............
0 D � _�WE
- -----------
------- . ..........
IT 7,77
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0
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04
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CkTY OF EDMONDS STREET FILE Permit No.
COMMUNITY SERVU;ES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date
1FAFAFAFAFA_FAFAFAFAFAF5
C : r
B. o Contractor
A. o Owner: C �� A \-4\, _�� �)ALkC—
Name,,-,, Ia$e
i::� 7-5 _,� /N\\-" " 11 . :)N -c)
Mailing Address Address
1�:, , I - a =% Q10 % i
City State Zip City State Zip
i�lx_ C-e— %,S, 1(3;-- It '\ LA
,16 �Jxs(.,o
State License Number Telephone Number
C. 9 Address or Vicinity of ConsLruqiqx�, Uklat` 4'M 0 % Q k T1 t-1 z, i
Type of Work to be Done:' QL4"._ QQ c_ A
i . A�� -, a -V J -T
D. 0 Work in Connection With: 0 Sub or Plat ED Single Family El City Projects
�_w
0 Commercial 0 Multifamily Utility
E. 0 Pavement Cut: El Y i N F. 0 Size of Cut: — X
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or unforseen, that may
be made against the City of Edmonds, or any of its departments or employees, including or not limited to the defense
of any legal proceedings including defense costs, court costs, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
Estimated restoration fees will be held until the final street patch is completed by City forces, at which time a debit or credit will be
processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
I understand the above and that this permit st be avalfla le at the job site for inspection purposes at all times.
V I
Date:— Q
Signature:.
Owner or)Contractor
Thig-Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: PERMIT FEE: �, ju. C o t ktl "J�
Time Authorized: Void after-- days. Restoration Fee:
Special Conditions: Receipt No.:
Fund I I I Fee:
Street Cut Dimensions: x
RELEASED BY: Date INSPECTED BY Date
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. March 1989
FIELD INSPECTION NOTES
Comments:
Diagram:
(Fund I I I - Route copy to Street DeM.),
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
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CITY OF EDMONDS
STREff FILE ASSET INFORMATION SHEET
12//NEW
ADDITION
RETIREMENT
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION
D6PT. NO.,
*PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE -
INITIATED BY
M, 1:4
*PROJECTNUMBER
PROJECT COMPLETION DATE
COST
APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
DXD"EPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE DATE
(yp) INITIAL
DEPARTMENT FILE
VERIFIED BY
PROCESSED
BATCH NO.-