7007 LAKE BALLINGER WAY.PDF7007 LAKE
BALLINGER WAY
V
INTER -OFFICE COMMUNICAAONS
'k,
TO Leif
FORM 41 - LITTLE'S
SUBJECT: Permit Application to W.S.H.D.
DATE March 19 19 74
FROM Bill
raft __
ST/jt:E-r
Per conversation with Perry, the applicant has already constructed the
concrete retaining wall alo.ng.h.is property line. The permit is for fill
to be placed on State R/W so the individual will have an area for off
street parking.
Also, I talked to Mr. McKeithan and he said that the property owners on
244th were told that they could use State R/W for off street parking
as part of acquiring R/W for widening of 244th.
I suggest that the Building Department write a letter to W.S.H.D.
WJN:Rdr
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PLANNING DATA
SINGLE FAMILY RESIDENTIAL
==FLLE
.Name:-
Date: k/(-4/4.
Site Address: -10o-7 se_[ (At
Tax Parcel:
Project Description:
Plan Check #:
_7� -2-,> i C�, 0'2— o
Reduced Site Plan Provided; KES_� NO)
Zoning:
Map Page:
Corner Lot: (YES /M
FFlag Lot: (YES
Critical Areas Determination #:
El 'Study Required.
Waiver
SEPA Determination:
19 Exempt*
El Needed (for over 500 cubic yards of grading)
0 Fee 0 Checklist 0 APO Uist with notarized form
Rec7ulr6d Setbacks
Street:
Side: -
Side:
ActualSetbacks
Street:
Side:
El Detached Structures:
El Rockenes:
F1 F'ences/Trellises:
EJ Bay Windows/Projecting 'Modulation:
El Stairs/De
B Hi�ight
Datum Point:
Datum Elevation: k (L-) c)
Maximum Height Allowed:
Actual Height:
Other
Parking Required:
Parking Provided:
Lot, Area:
Maximum Lot Coverage: 35% Proposed:
Lot -Coverage Calculations:
ADU Created: (YES / NO)
Subdivision:
Legal Nonconforming Land Use Determination Issued: (YES NO)
'Comments
Plan Review By:
Plannihg Data Form G7-14-09
)iw%- V I Le I" Ab� -
arime Comotruction and Kcrair
10101 Mail, E3i;., E3ultd L3 + F0. box 2113
Bothell, WA 98041-2113
FAX.- 2065-481-66M-
800-352-766634-
RECEIVED
JUL - 9 1997
PERMIT COUNTER
cy-_ P'Aw K'bw- (�
CITY Copy 9-q-q�
To 0"'v
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WASHINGTON STATE
HIGHWAY COMMISSION
DEPARTMENT OF HIGHWAYS
Office of Oistrict Engineer
Oistrict 7
10506 N.E. 4th Street
Bellevue, Washington 96004
March 6, 1974.
The City of Edmonds
Civic Center
Edmonds, Washington 98020
CS 1748 SR IA
SR 99 to SR 5
Joseph Walsh
Permit - Gen. Corr.
Attention: Mr. Lief Larson
Gentlemen:
Drill-wrvans -Governor
nd rews - Director
Irsur-EI'D
low. .
-,
JA A'R I L
jjn,054� up. WIL
Transmitted herewith is a permit application this office has received from
Mr. Joseph P. Walsh, to construct a retaining wall and pave a parking area
within the State's right of way.
As this is within the city limits of Edmonds we are transferring to you for
further processing.
The State would prefer that no parking be allowed on the State,l�s right of
way and provisions are made so a person leaving this property can do so
without backing out onto SIR 104.
If you need any additional information, please contact this office at
455-7088.
LCR:mg
Attach.
cc: Mr. Joseph P. Walsh
Very truly yours,
E, 1. ROBERTS
District �ngineer
__ VJH SEMENOCK
istrict Utilities Engineer
lo637 N. E. 8th
Bellevue, Washington 98004
Z?,( d-'4-
Pfi'
1-14 CIC 5,�f /-7, C
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4r 17
0
John N. Rupp Chairman Harold Walsh Baker Ferguson Lorna Ream
Seattle Everett Walla Walla Spokane
A.H. Parker Harold L. Boulac
Bremerton secretary
s
APPLICATION FOR FRANCHISE OR P-ERM`--T
!,JUSHTN:'�T�"' STAV7, HTfI.TJAY COMMISSION
De-art-xent. )f Highways
Olympia Washington
. I ip
Gentlemen:
Application is hereby made for to
4's, PklA 4 T Tj
and maintain a.OA I ktype)
-42KI&& ARZA aR PRIVAl-&-
I I
upon a portion of State Highway No. 4- A K F I
inSAIZ))L
161\11.5/-/_County, Washingtons, described as fonows:
t? r-- 7-9 ip, t A -t *w 1? 1 -
Rcc'e,� 4, ii"C74
��'.UTU. Y"
Y
ff. U :L. ENV. I
AG(,�"(. 2
JGh 3
operate
3
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K
Fitt
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F?sf
9SPM+1r 96,9D WAY
The followin7 paragraph shall apply to utility Franchises and Permits only:
Fees in the amount of $ are Daid herewith to defray the basic admin-
,istrative expense incident to the nrocessing of this utility anplication according
to 11ashington State Highway Commission Resolution No,-2224 p
and the ap licant
further promises to pav such further amounts as shall be billed, if any, in
reimbursement of the actual costs of the Washington State Department of Highways
in engineering costs, travel, etc,, incident to investigation of the application.
I THE UNDERSIGNE4
submits said application and accepts the conditions as set forth above,
JQ
DATED THI�Ljd—t4zv of RC-14.9
Address: 21� �'-57C-> p U)A I-
D7F/227
tA/
D r 57,, 7
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780393
FILE #
FOTM FOR IMMM/1-INAL] DECUIZATION Or- fWWNW=U/1NONSIG1NIFICA.NCE]
Description of proposal docW�.
Proponent Joe Wa I sh
Location of- Proposal 7007 Ballinger Way
Lead Agency City of Edmonds
1his pTonposal has bccn dae-mined to �bwg/not havel a significant ad-
c'
'Verse imp=-t upon �Lhe envirom-icnt. �aj ETS fig/i
s not) required tun�er
10-1 4-3.21C.030(2)(t). 'Fnis dcc-i-sion ims madc after review by ulic -lead
aclenc! v r
O-t. a completed eirviromilental che-c1dist and other infomation. on
file with the lead agency
Re—sponsible Officia-1 Mary Lou Block
Positiorn/Title Associate City Planner
Date July 10, 1978 SignatUr-O/Y� L4J "44—
780393'
PROICIT NAME
DATE SUBMITTED
ENVI RONMENTAL ASSESS PIENT
In order to meet the requirements,of the State Environmental Policy Act of 1971,
the responsible official must make a declaration of environmental impact as early
as possible in the process of evaluating a project.
The information in this form will be used to det , ermine whether it will be necess-
ary to require an environi,.iental impact statement. If an impact statemient is
not required, a Statement of lNeoative Declaration will be placed in the file.
If an impact statement is required, a draft statement must be filed with this
office, public notice given and a revievi per . iod of 30 days allowed. The final
statement and comments must be filed with the Department of Ecology, Office of
the Governor and the Ecological Commission.
The Edmonds Planning Staff will assist you in any way vie can in accumulating
this information and .qe would appreciate your cooperation.
1. Land:
Z
Area in drres-
Soils type Limitations
Description of topography (% slope)
Grading: estimated cubic yds. NOTE: If grading or filling
wi 17 exceed 500 cubic ya-rd -
Filling: estimated cubic yds. a grading and filling plans
must be sub.mitted with the
2. Water: application.
Stream - estimated flow (cubic feet per second) lv"11-11�e
I-A-Kcz- " - MH-q-
Will -str-&a-R be altered? Ag� / &�IIAA &-f.
To what degree7
Impact on storm drainage (increase in run-off) o�lt�741
Estimated area.to be paved
Estimated area in open space
Shorelines: within 200 ft. of 1"lean Higher High Water
Adjacent to shorelines zone /ff-s— V'P5 ;B-t'j /Z
. il
Environmental Assessment, page 2
3. Vegetation:
Type of trees % to be removed
Minimum diameter of trees to remain
Ground cover % to be removed
Proposed landscaping if any
4. Existing Land -Use within 300 ft. radius of proposed development:
Vacant
Single
Family
Mu I ti -
Family
Comm.
Other
North
Sou-".-h
East
West
5. Ci rcul ati on:
Estimated increase in auto trips daily
Estimated demand for public transportation Ala /i/z,-0
Degree of change on adja.cent streets Cle
6. Area of imoact:
.5"Z / C7 IV-7--
neighborhood
city-wide 'Af Zc-
regional /Y /'/ '7--
7. Effect on air quality:
8. thanges in noise generation:
3
4
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
144
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
10. Do y u have any plans for future addOolls, expansion,
or further activity related to or connec ted with this
pr sal? If yes, explain:
OZ a
11. Do you know of any p _YY�Ottiers which may affect
the roperty covered by your proposal? If yes, explain:
12. Attach any other application �orm that -has been com-_-
pleted regarding the proposal; if none has been com-
pleted. but is expected to be filed at sonic future
date, describe the nature of such application form:
II. ENV IRO'NINMENTAL IMPACTS
(Explanations of all "yes" and "maybe" answers are
required)
Yes M
�_O
(1) Earth. Will the proposal result in:
(a) Unstable earth conditions or in
in
changes geologic substructures?
(b) Disruptions, displacements, com-
paction or overcovering of the soil?
(c) Change in topography or ground
surface relief features?
(d) The destruction, covering or
modification of'any unique geologic
or physical features?
(e) Any increase in wind or water
erosion of soils, cith&r on or off
the site?
(f) Changes in deposition or nro-
sion of beach sands, or changes
in siltation, deposition or*erosion
which may modify the channel of a
river or stream or the bed'o( the
ocean or any bay, inlet or lake?
Explanation: 6'741A,4� 7" izr-
(2) Air. Will the proposal result in:
(a) Air emissions or deterioration
of ambient air quality?
(b) The creation of objectionable
odors?
(c) Alteration of air movement,
moisture or temperature, or any
change in c'Lmatc, either locally
or regionally?
Explanation:
-32-
4
9
2 ;
3',
4
5
61
71
8
9
10'
1111
12 i
13 i
141
15
161
17
181
191
20
21
22
2311
24,
25
261
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
.55
56
57
58
(3) Kj�cE. Will the proposal result in:
(a) Changes in currents, or th e
course or direction of water move-
ments, in either marine or fresh
waters?
(b) Changes in absorption rates,
drainage . patterns, or the rate and
amount of surface water runoff?
(c) Alterations to the course or
flow of flood waters?
(d) Change in the amount of sur-
face water in any water body?
(e) Dischal7re into surface waters,
or in any alteration -of surface
water quality, including but not
limited to temperature, dissolved
oxygen or turbidity?
(f) Alteration of the direction
or rate of flow of ground waters?
(g) Change in the quantity of
ground waters, either through
direct additions or withdrawals,
or through interception of an
aquifer by cuts or excavations?
(h) Deterioration in ground water
quality, either through direct in-
jection, or through the seepaoe of
leachate, phosphates, detergents,
waterborne virus or bacteria, or
other substances inLo the ground
waters?
(i) Reduction in the amount of
water oLherwise available for
public water supplies?
Explanation:
(4) Flora. Will the proposal result in:
(a) Change in the diversity of
species, or numbers of any species
of flora (including trees, shrubs,
grass. crops, wicroflora and
aquatic plants)?
(b) Reduction of tile numbers of
any unique, rare or endangered
species of flora?
-33-
Yes Maybe No
— cl�
— L_� .
k_IZ
4 - -/
— 6;��
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
.19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
4 7
48
49
50
51
52
53
54
55
Yes Maybe No
(c) Introduction of new species
of flora into an area, or in a
barrier to the normal replenish-
ment of existilig species?
M Reduction in acreage of any
agricultural crop?
Explanation:
(5) Fauna. Will the proposal result in:
(a) Changes in the diversity of
species, or numbers of any species
of fauna (birds, land animals
including reptiles, fish and s1fell-
fist', benthic organisms, insects or
microfauna)?
(b) Reduction of the numbers of
any unique, rare or endangered
species of fauna? *
.(c) Introduction of new species
of fauna into.an area, or result
in a barrier to the migration or
movement of fauna?
(d) Decerioration to existing
fish or wildlife habitat?
Explanation:
(6) N o i s c . Will. the proposal increase
existing noise levels?
Explanation:
(7) Light and Glare. Will the pro-
-prjj-j-��,-new light or
glare?
Explanation:
(8) Land Use. U'ill the proposal
F�-.I—;Uf—LLII the alteration of the
present or planned land use of an
area?
Explanation:
-34-
- 4-/
Z�
- ZI-I"
U
2(
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
Yes *.Lbe No
(9) Natural Resources. Will the pro-
2 posal reiUl-C —in.
3
4 (a) Increase in the rate of use
5 of
any natural resources?
6
7 (b) Depletion of any nonrenewable
8 natural
resource?
Explanation:
L
(10) Risk Of Upset. Does tile proposal
rnvofv—L,i
risk of an explosion or
the release Of hazardous substances
(including, but not limited to,
oil,
pesticides, chemicals or
radiation) in tile CVenL of an acci-
dent
or upset conditions?
Explanation:
(11) PLc?pulaLion. Will tile proposal
---
alter t1le location, distribution,
density, or growth rate of the
human Population of
an area?
Explanation:
(12) Hous ing. Will tile propoq al affect
Cx]-sting housing availability, or
create a demand for additional
huusilig?
Explanation:
(13) Ti ansporta t ion/ci. ,-culq tion. .!i
tlie_PYOPOsal_r��uj_L_—,�:
(a) Generation of addition,-11
Vehicular movement?
(b) Effects on existing parking
facilities,
or demand for new
parking?
(c) ""Pact uP011 existing trans-
Portatioil systems?
M Alterations to present
.patterns of cil:culation or move-
nient of people, zind/Or goods?
(e) Alterations to waterborne,
rail or air traffic?
-35-
Yes Maybe No
2
3
4.
5
6
7
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
,34
35
36
37
38
39
40
41
42
43
44
45
46
4 7
48
49
50
51
52
53
54
55
56
57
58
59
60
61
(f) Increase in traffic hazards
to motor vehicles, bicyclists or
pedestrians?
Explanation:
(14) !LybILc Services. Will the pro-
posal_7�,�ve —an effect uPO", or
result in a need for new govern-
mental services in any of the
following areas:
(a) Fire protectioni
(b) Police protection.
(c) Schools?
(d) Parks or other recreational
facilities?
(e) Maintenance of'public facill.-
ties, including roads?
(f) other governmental services?
Explanation:
(15) Energy. Will the proposal resuIC in:
(a) Use of substantial amounts of.
fuel or energy?
(b) Demand upon existing sources
of energy, or require the develop-
ment of now sources of energy?
-Explanation:
(16) VLilitiCS. Will the proposal
resul-c in a need for sYstems,
or alterations to the following
utilities:
(a) Power or natural gas?
(b) Conmiunications systems?
(c) Water?
(d) Sewer or septic tanks?
e ).. Storin water drainage?
(f) *Solid waste and disposal?
E,xplanation:
-36-
— LI_*'
M
31
5
7
811
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
341
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Yes
No
MY . Ifu - m"I'll IN1001 Will tile proposal
Wic creation of ;Illy
health ha7ard or POtL
"Itial health
hazard (excluding,
mental health)?
Explanation:
(18) Aesthetics. Will the proposal
i:c_suYEi_nthe obstruction of any
scenic vista or view open to the
:Public, or will the -Proposal re-
sUlt in tile creation of all
aesthetically offensive site open
to public view?
Explanation:
(19) Recreation. Will tile proposal
Fe—S-L-11717i-n—an impact upon tile
quality Or (111;illtitY of existing
recreational opportunities?
Explanation:
(20) 11 i storica I. Will the-
prop6—s-a-1 __T_r_ ---tteraLion of
� 0 1 U t7f
a significant archeological or his-
torical site, structure# object
or buildilig?
Explanation:
III - SIGNATUM.
. I, the undersigned, state that to tile
the above informatio best of my 1,11owledge
that thc- lead agenc 11 's true and co1,,11.)Jcte. It is understood
ficance that iL-111i y may wiLhdraa any declaration of non-signi-
Olt issue in reliance upon this c1lecl-lis-t
should there be any IllisrepresentaLion or lack of full
on my part. disclosure
7
Proponent:.
lk'A(' 197-1.0-370 WITHDRAVIAL OF AFFIRMATIVE THRES11OLD
DETERFMN7,_�'f-1U,N-- IT_aL any time after tile entry of a declara-
t'011 Of SiPnificance, the Proponent i-,1Odifies tile Proposal
so Vllat' '11-tlle judV11"It Of the lead agcncy, '
adverse environmental ilMP,2ct:s resuitin' 111-1 sirilificant
ated, thc declziraLion of 9 therefrom ilre elimin-
and a declaration of sii"llificance ��hall be withdra,...rn
N, 1101-1-sil'Ilifica2ce entered instead. The
lead ' 'ellcy shall also revise tile registers
public information center -1ccord at its ST',PA
Polient of a prop lingl '
_s a private appl.icallt, tile 1)
J Y- If tile pro-
r0l)C)sal
.,hall not be considered 1110dific!d until .11.1 license aPplica_
ti011s for tile Proposal are revised to reflect the modification.
-37-
DATE: 6o - ;2_(q
A $25 fee will be collected by the City of Ed'monds.for analysis
of the Environmental Checklist and the preparation of a Threshold
Determination. No'fee will be charged for proposals which . would
be categorically exempt if they were not located in an environ-
mentally sensitive area.
ENVIRODIRENTAL CHECKLIST FOWI-I
I. BACKGROU14D
1. Name of Proponent 30 e- PCS�I
2. Address -and Phonje Nmm)er oi,Proponent:
3. Date C11CCE ist Subl'.1itted
4. Agency Requiring ChecklisL.Ed 4 'OV 6 4
5. Vame of Proposal, if applicable:
6. Fa_tdTc_and brief Descr I)Lioll of One Proposal (includ-
ing but not limited to its size, general desigm cle-
ments, and other factors that will j;ive an accurate
understanding of its scope and nature):
t/,-, 141 -, "C e�
7. Eo'cation of Proposal (6escriUe the p �7e L t: —in 8 o f
the proposal, as well as the extent o�- the land area
affected by -.iny environmental irilp.ICLS, including any
other inforviation n.eedcd to Five an accurar_- underSLand-
0 f the environmental setting 01: the proposal):
1�06e /AV 4 e *,'�/W
8. ET—tima_L_Z�_d Date ror Completion of the ProPosed Act on:
-r-elxo�o ;,/
9. UsL of a]-171'erm ts, Licenses or Government Approvals
Required for the Proposal (federal, state and local--
includi.11Z rezones)
-31-
DESCRIPTION OF PROPOSAL:
ENVIRONMENTAL. ASSESSMENT 0
Del-ck -M 7_1Z ;aol�4T
FILE #
04111111 4,fKF a-44441A,1K,6,Z
PROPONENT: _-�ro_AC)-N W,145,11
EXISTING USE:.-3�5AIc&
ENVIRONMENTAL IMPACTS FROM PROPOSAL:
S OILS /TOPOGRAPHY - 2'1'L-F XP41'elV6 -0Re4477;0,V, wwlrw uv&i -niA(E
P4 7V 5�e A,-*-;�
V"rogopi. PIr. 0 4 #19 E BeV,
y OA-- 4 lAo'll At &'Al
A/1,14 44cl-CC-
lAt P-4er.
WATER/DRAINAGE 4011.1.0-1, or Se
zyt S6*-eMCVr or/a t"o, P"41,vo ;P/Zc e4
AIR QUALITY - "y 41
CIRCULATION
VEGETATION
ECONOMIC - szsgr
CITY SERVICES - 4101we V/ rzeo
A4 I-/- IV,4 cpz
pto yqAo S&rar*fy- /A/
lw,* fVAJEC r /0-
ne."Pose/
We f,/4 $I * I
L74
j1AF M 44 UOqPlAef 7V . W*j1V_t
1'4414�A) A"O 7NNT 74F- "IfIr 'rW6'CeF&U AM-r
llfifftg 71�je, #4464 AS T*16y 1A0 P-AArIVOM
ENVIRONMENTAL FINDINGS:
wl/ There will be certain environmental impacts but they do not constitute a signif-
.i-cant adverse impact on the environment and no environmental impact statement
will be required.
There will be significant adverse impacts on the environment and an environmental
impact statement will be required.
There will be certain impacts on the environment however it is necessary to obtaii
more information before a declaration of significance or non -significance is made.
AM 54 17
CITY PLANNER / 'DATE
CITY ENGINEER DATE
APPLICATION
for
The City of Edmonds SWE SEWER PERrMT EASEMENT No . ..........................................
NEW CONSTRUCTION 0 REPAIRS 0
ZQ2 QQ2j=
OWNER.... %3.15K) ----- J-,-..P ................................................................. CONTRACTOR .................................................................................................. PERMIT No . ......................
A ------ wo.q. ............... LEGAL DESCRIPTION: LOT No. —... ........................................ BLOCK No . ............................................
DDRESS .3003 ... LCO(l(Le-AIC W.
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NAMEOF ADDITION ................................................................................... .....................................................
J,,a., IQU
D\iq- -Tts+ On 5Qwqr
Approved:
DATE................................................ By ......................................................................
0
Z
Z
F4
*MIC WORKS DEP=,OU CHECKLIO, Z2 Date
F I L -7
Street Right -of -Way Existing REQD
Access Easements Existing J--4 [-7- REQD
Utility Easement Existing REQD
Lot per Subdivision I?-- Plat 1,kN�,�,Ag,��sessor Map.
Site Plan Checked for Accuracy
Underground Wiring Reqd.
Check Accuracy of Legal Description.
Environmentally Sensitive Area
Environmental Checklist Reqd.
Flood Hazard Zone
r-1 Shoreline Management Area
Z Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Existing Zoning Per Code
Amenities Design Board Approval Reqd. ADB # Approval
Board of Adjustment Approval Reqd.
Review By: Date: -���/78
Existing Water Main Size
Water Main Reqd.
Service Line Reqd.
Hydrant Size Existing
Hydrant Reqd. Per Fire Code
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Comments
Water Meter Charge Reqd.
Review by:
Septic Tank Design Approved
Septic Tank Permit Reqd. _
Sanitary Sewer Availability
Drm,7ing No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
Review B)r:
Size
Date:
VVkYkVVkVW
Date:
Permit No.
Proi .
File No.
Date:
Open Ditch Existl*-ng____________________________�eqd-
Culvert Reqd. Size
P4 Catch Basin Reqd. Indicate on Site Plan
0 Shoulder drainage n-nintain collection (xi swale open runoff
U) -ln�hole reqd:
.11 Indicate on Site Plan
Soil Conditions and Ground Water Field Cliecked
Review by Rate
!gStreet Paving Reqd.
Curb and Cutter Reqd.
Sidewalk Reqd.
Curb Cut for Driveway Reqd.
P� Right -of -Way Construction Permit Reqd.
H , Bond Reqd. for Public Inprovements
Street Nam, Sign Reqd.
Other Signing Rcqd.
Pre Perniit Site Inspection'made on
0
BY: S SE, R
WATER
U)
STREET-
E2\7(-,TN17r:.PING
%11� I -,
\N. 1) P-T. ENG1
EXAMINED
— — — — — — — — — — — — — — — — — — -
-Special Require-ri-exits listed in mem to Conm_mit�y Developrwnt Departrre_nt,
Building Division
BY Date
o All items filled in on Building Permit Application
BY Date
P4 Drawings Stan-ned and Notation*s �kide
P4 BY Date
<� lApproved by Public '%%7orl-,s Departinm-L
Kevi.sed: 1v 10-1977
I i j - I /,l I I .
7 (0. c) 1 ->
6a-l(1-Yi1tr Wo"I
2-0
7007 La-Kc &J11'ylq-er
m 0 ri cj f Lu A 98 OeA
I-oi- 12 lgloc-K
La-,Kc &'k-l.h'Ylqcr
0 Is pi a,:�r
\3 b 011 \(14 I' 0A NO.
ria-ts, Fl.
K's vi -
A-z-- -4- -�s
Z 4- -7.
z
AV Grade:—
p�71 I c) 11 -7, C2-
ry-O r.0j cd, I
o v o
L o 4- AN -c cc Zc) j
01;z 19 If
z () V) I " I :: K,� vi - )'�-
20ne E-5'W—V2- eemer. Flag
Setback R 'rel
Front I
Sides
-Actual
Rear
Other
I -log
,ht
QJ,3 Y.-\ /-+
-100 +c-l-e �OAe
�"Ouylcc Irvel
APPROVED BY��,'NNING
:: I I �—�l " �,
APPROVEU AS NOTED
r—�W
,,IINEERI.N�
Date: STREET FILE
fif,Op,-<-
M7-ff ,UOF eVQZffi%6i
1111A mg rilla T RECEIVED
JAN 0 -7 416
OEVELOPMENT SERVICES
COUNTER
I
CITY OF EDMONDS
CGINISTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
USE . . . PERMIT
ZONE ;26WA, 7_ NUMBER !)7CGz
TJ0_8__1_1_ ,
ADDRESS �T J)-q� ".,
Fc—r_,&tnr:Qr.RIPTinN rwFrKI qllRnIVI' 10N NO�
El
I
6 1/
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
E 13
T SCP Approved
0
ZIP BER
EXISTING —7— REQUIRED DEDICATION
RW Permit Required
Street Use Permit Req'd 0
li5
Inspection Required 0
PROPOSED
Sidewalk Required 0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YES 0 NO 0
_�>. 0 -
LICENSE NUMBER
I I h; I I-] C I
DescriDtion 0
NUMBER
ZIP TELEP ONE NUMBER
EXPIRATION
perty - include all easeme �ts
I v, I j) P (I L17 T 1,
Property
Ta Account —o 1 Z —0��K
Pax�el No.
El NEW
N
. RESIDENTIAL
ED
PLUMBINGNAECH
EjADDITION
E] COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
APT. BLDG.
SIGN
GRADING
REPAIR CYDS.
FENCE
x _FT)
WOODSTOVE
DEMOLISH, El INSERT
SWIMPOOL
HOT TUB/SPA
FGARAGE RETAINING WALL/
]CARPORT ROCKERY
0. RENEWAL
(TYPE OF USE; BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
OF*
STORIES
NUM13ER OF
DWELLING
UNITS >�_INUMBER
CRITICAL
AREAS
DESCRIBE WORK TP BE DONE (ATTACH PLOT PLAN)
MEMO DATED
REVIEWED
VARIANCE OR CU
DB a
SHORELINE 0
V/
SEPA REVIEW
COMPLETE I EXEMPT
EXP
"JIGN AREA
ALL ED PROPOSED
I
HgIGHT
ALLOWED ' ROPO SED
LOT COVERAGE
ALLOWED I PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT UR SIDE REAR
LOT AREA P
%RKS
<A&y1mve &eA' 4
d/
REOUIRED YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108
FINAL INSPECTION REQUIRED
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING %
PLUMBING
Plan Check No.
MECHANICAL
GRADINGIFILL
This Permit covers work to be done on private property ONLY.
Any Construction on the public domain (curts, sidewolks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
ENG. INSPECTION FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
.
successors in interest, agrees to indemnify, defend and hold
,n
'Unj harmless the City of Edmonds, Washington , its officials,
and agents from any and all claims for. damages of
PLAN CHECK DEPOSIT
2 employees,
whatever nature, arising directly or Indirectly from the issuance
of this shall not be deemed to
-of this permit. Issuance permit
modify, waive or reduce any re iquirement of any city ordinance
0 nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application;.tha a
ATTENTION
information -given is correct; and that I am the owner,rior the duly
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
ed thereby, no person will be employed In violation of the Labor
e
ONLY THE
WORK NOTED
Code of the State of Washington relating to Workmen's Com0ensa-
tion Insurance aria RCW 18.27!__
INSPECTION
S, SIGNED
IGN,A1.URE (OWNER OR AGENT),.`//'
DEPARTMENT
OFF
CITY OF
EDMONDS
CALL FOR
ATTENTION
INSPECTION
Lt
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
BEEN MADE AND APPROVAL OR
771-0220
UNTIL'A FINAL INSPECTION HAS
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
ect-l"Ir011
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
Ip) �,NATUpq/7, DATE
IbINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor