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7011 180TH ST SW.PDFiiiiiiii lill 1260 7011 180TH ST SW '0 4 TAX ACCOUNT/PARCEL NUMBER: (�o 0 w 0 BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) CRITICAL AREAS: OV2 -111 DETERMINATION: E] Conditional Waiver F] Study Required Waiver DISCRETIONARY PERMIT DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED PERMITS PLANNING DATA CHECKLIST DA SCALED PLOT PLAN DATED: SEWER LID FEE SHORTPLAT SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: SOILS REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD DA fty) U c ( -� LID LOT: - BLOCK: LATEMP\Dsrs\Fon-ns\Street File Checklist.doc #P20 Critical Areas Checklist Site Information (soils/ topography/ hydrology/yegetation) 1.. Site Address/ Location: 2. Property TaxAccount: Number: 0 tto K eo 15 3. Approxninate Site Size (acres or square feet)- X 6-1 4. Is fl-ds site currently developed? Zyes; no. If yes; how is site developed?. A'a� 66co, �Q—� 5. Describe the general site topography. Check all that apply. CA File No: Flat. less than 5-feet elevaticinchange over entire site. :Rolfing: slopes on site generally less than 15% (a vertical rise: of 10-feet over a horizontal' distance of 66�feet). Hilly: slopes present* on site of more than 15 % and. less than 30% (a vertical rise of 10-feet over..a horizontal distance of,33 to 66-feet). Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal distance of less than. 33-feet). Other, (please describe): 6. Site contains areas of year-r . ound, standing water: Approx. 6 ep th: 7. Site contains areas of seasonal standin waten- ;Approx. Depth: 9 What season(s) 'of 'the year� 8. Site is. in the floodway floodplain Of a watercourse. 9. Site conUtiz)s a creek or an ar , ea where water flows across the grounds surface?, Flows are year-round? Plows are seasonal? (What time of year? 10. Site is primarily: forested meadow --shrubs mixed urban.landscaped.0awn, shrubs etc) Z7, 11. Obvious wedarid-is present on.site: 1Q) For City Staff Use Only 1. Plan Check Number, if applicable? 2. Site is Zoned? 3. SCS mapped soil "(s)? A 4. Critical Areas inventory or C.A. map indicates Cxitical Area on site? kk 5. Site within designated earth. subsidence landslide hazard area? ml�l DETERMINATION* STUDY REQUIRED Reviewed by, Date: 0 .WAJIVE R #.P20 .0 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 Development Permit Application.for the City of Edmonds prior to his/her 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 subject property. The information needed -to complete, the, Checklist should, be I easily: available from observations of the site or data available at City Hall (Critical areas inventories, maps, or soil surveys). 0 Date Received: City Receipt#: oq74e-7fS- Critical Areas File #: Critical Areas Checklist Fee: $135.00 Date Mailed to Applicant: A property owner, or his/her authorized representative, must fill out the- checklist,. sign and date it, and submit it to the City. The City will review the checklist� make a precursory . site visit, and make a determination of the subsequent steps necessary *to complete a development permit application. Please submit a vicinity map, along with the signed copy .of this form to. assist City, staff in, finding,,and. locating the specific'piece of. property, de�wilQ on this form. In Addition, the applicant. shall include other pertinent iriformat ion-.(e.g. site plan, topography map, etc.) or studies in conjunction with this Checklist to assistant staff in completin of the site. gtheir preliminary Assessment 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 Ci ..of Edmonds harmless ftorn any and all damages, including reason able ty iriftA fion, based whole or part upon false,' misleading, inaccurate or attorney's fees, arising from any action or C I. P, mconiplete information:ftimished'-by the Applicant, his/hef/its agdnts�.or employees.-, By my signature, I cer*. that. the 44drinaidn' 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 aslisted below. SiGNATuRE oF APPLicANT/AGENT DAM� Property, Owner's Authorization By my signature, I certify that I have authorizedthe above ApplicantfAgent toApply for the subject land us'e,'application, and grant my permission forthe public officials and the staff of the City of Edmonds to enter the subject property forthe ' ' M Mtioli S attendant to tion. S OF OWNE� DATE Owner/Appticant! Name Street Address city State zip Telephone: Appikant Representative: Name Street Address city State zip Telephone: Email address (optional): Email Address (optional): TIMEQUO -1 DST SINGLE FAMILY ROUTING FORM ***FOR INTEROFFICE USE ONLY*** Applicant eFo I fto�— Date, H Joe-5—,,an Check # do"M Address C-7011 - my�� f:T� Type AD6 PLANNING Tarizet To On Back ADD? Days Mail/Fax RESUB #1 Tamet To On Back ADD? Days Mail/Fax RESUB #2 Tarj�zet To On Back ADD? Days Mail/Fax RESUB #3 Tar2et To On Back ADD? Days Mail/Fax 1. Zone 104��e —Comer /Flag t'� fk— _ 2. Street Map Width Dedication? 3. VAR Cu SM LLA 4. SEPA Expires 5. Building Pad: Existing Proposed 6. Lot Area Lot Coverage 7. Height Calcs: Datum Ave Grade Max Actual 8. Req'd Parking ----!_Provided 9. C.A.# CA's CONSULTANT Target Mailed To Back ADD? Days Mail/Fax RESUB #1 Target Mailed To Back ADD? Days Mail/Fax PLANNfNG COMMENTS & NOTES BUILDING FEMA Map Soils Report Lot Slope VIAQ Worksheets Retaining Wall / Rockeries? Shown on site / civil plans? Top & Bottom wall elev? IN-HO USE Tamet To On Back ADD? Days Mail/Fax RESUB #I Taryet To On Back ADD? Days Mail/Fax RESUB #2 Target To On Back ADD? Days Mail/Fax RESUB 43 Tamet To Oil Back ADD? Days Mail/Fax RESUB #4 Taraet To On Back ADD? Days Mail/Fax CONSULTANT Target 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's\Fon-ns\Routing Sheet SFR 3-4-04 ENGINEERING Taraet To On Back ADD? Days Mail/Fax RESUB #1 Target To On Back ADD? Days Mail/Fax RESUB #2 Target To On Back ADD? Days Mail/Fax 1. Drainage Plan & Calcs 0 2. Grading Plan/CYD's SEPA? 3. Step Footings? WN? 4. Driveway Slope %—OK—Waiver Apprv'd? Street Dedication Req'd? FT 6. Easement Type Proposed Impervious 8. Existing Impervious (Pre 1977)_(Post 1977) 9. State Hydraulics Pen -nit I O.Check Plat Requirements I I.Sidewalk Required 12.EUC Forrn COMMENTS/NOTES N a 0 N N 2 a E 0 8 0 0 a 0 M 0 0 a N a a a a N 0 a 0 E 0 a 0 s 0 a N a 0 a 0 a a N N 0 N 0 E 0 0 0 0 0 0 0 a E 0 a N 0 0 a 0 a a ff E a M N a N a a 8 a a a 0 0 0 a 0 E v a a 0 a 0 1 *REVIEWERS: PLEASE CALCULATE BUSINESS DAYS* PLANNfNG REVIEW TIME TOTAL DAYS **** ENG REVIEW TIME TOTAL DAYS PW REVIEW DAYS""BUILDING: 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 ( - - 9,Z 4 .��\\C� 01, Phone �4a) Contact Person (PrintClearO CORRECTIONS: Fax to: E-mail Items required prior to permit issuance: 1 . - 2. 3. Mail to: -�iQ% �S\- Su,� EdncwA. 4. 5. L:\TEMP\DST's\Fonns\Routing Sheet SFR 3-4-04 EXEMPTION FROM CONTRACTOR REGISTRATION VERIFICATION FORM The undersigned property owner or contractor has applied for a building permit from the City of Edmonds and claims that he/she/it are exempt from providing contractor registration in accordance with the provisions of RCW` 18.27. The property owner, by their signature below hereby verifies to the City of Edmonds that: 0 Value of work under $500.00. The aggregate contract price of labor and materials and all other items required for the project is less than $500.00 and is not part of a larger opertation to be undertaken on the property. The person employed to do this work has not advertised nor otherwise put himself forward to the permittee to be a contractor or qualified to engage in the business of a contract. RCW 18.27.090(9). ---0 Work performed personally on own property. The undersigned verifies that all work done. under this permit will be done by the permittee personally on his/her own property and that the improvements constructed on the property are not being undertaken with the intention and purpose of selling the improved property. 0 Commercial property exemption. The permittee is the owner of commercial property and the owner's own employees will perform all maintenance, repair and alteration work on the property. No work will be done by contract under the permit. RC!W 18.27.090(13). 11 Licensed architect, engineer, electrician or plumher. All work performed under this permit will be performed by an architect, civil or professional engineer, licensed electrician or licensed plumber operating within the scope of his or her license. RCW 18.27.090(14). General Contractor. The owner is the General Contractor for the project and is required to hire a minimum of two licensed subcontractors (unrelated building trades or crafts). The general contractor is responsible to verify all State licenses of subcontractor. RCW` 18.27.010 THE UNDERSIGNED PROPE RTY OWNER HEREBY VERIFIES THAT ALL INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE BEST OF HIS OR HER KNOWLEDGE AND ACKNOWLEDGES THAT IF ANY OF THE INFORMATION PROVIDED ON THIS FORM IS FALSE, HE OR SHE UNDERSTANDS THAT THE BUILDING PERMIT WILL BE IMMEDIATELY REVOKED AND ALL FEES PAID FORFEITED. Dated this day of 2 OQ PROPERTY OWNER/PERMITTEE WITNESS: .......... LATENIMBUILDINGTORMS\exernp contractor regis verif form.doc03/28/01 �.1 I Owner Plan Check # Project Address Buildinz Valuation & Fees Date USE AREA VALUE PER SQ. V1r VALUATION SFR COM Basement Semi -Finished 69.30 Basement Unfinished 25.00 Garage/Carport 32.90/22.00 $ First Floor 92.40 $ Second Floor 92.40 $ Unheated/Storage 25.00 $ Deck 17.00 $ Unheated Sunroom 25.00 $ TOTAL VALUATION $ PlumLbing FEES Base Fee -$30 Permit Fee $ Fixtures x $10 Plan Check Fee $ Base Fee $85 State Surcharge $4.50 City Surcharge $15 Total. Plumbing Investigation Fee ($205 min or double) $ Plumbing $ Mechanical Mechanical $ Base Fee $30 Grading Nardage $ Total Mechanical==$ Total $ Fees Calculated b Checked by: Planning Fees 1% Inspection Fee $65 minimum Bond Amount $ $ SEPA $420 up to 5 hours More than 5 hour Charge $ $ Recording fee Base $ + #Pages $ ADB Administrative Approval $100 Critical Areas $135 $ Other Total $ Fees Calculated by: L:\TEMP\BU1LD1NG\HAND0UT\fee sheet itemized form.doc06/30/05 Microfilmed En2ineerin2 Fees COST X # OF INSPECTIONS Storm Drainage Review SFR >5000 sq.ft. $50 $ SFR Inspections $50x $ Commercial/MF Inspections 2.2% (Bond Amount $ $ Right of Way Base $160 + $15 Surcharge $ Right of Way Inspections $50x Street Cut Fee $ Water Meter Fee Size $ Water Connection Fee $ Side Sewer Connection Fee $ Side Sewer Permit Fee ($30 SFR, $100 Com/MF) $ Alley Disruption Fee 111.000.000.344.110.000.000.00 Base $140 Parking Disruption Fee 111.000.000.344.120.000.000.00 Base $140 Sidewalk Disruption Fee 111.000.000.344.130.000.000.00 Base $140 Storm System Dvpt. Charge New SFR 412.200.000.379.000.000.000.00 $428 Traffic Mitigation Fee ($840.72 SFR) $ Development Project Peer Review Fee $50 Plus Actual Cost In Lieu Sidewalk Fee LF $ Fee $ $ Other Total $ Fees Calculated by: Fire Fees Plan Review Fee ($50 per hour) Number of Hours $ Inspection Fee $50 x Number of Inspections $ Fire Connection $345 $ Total - Fees Calculated by: Miscellaneous Description Department Total ,-,Total Fees Bu ilding- $ Planning $ Engineering $ Fire $ Investigation Fee $ Miscellaneous $ _TF—Review $170 5 Ih Review $170 6th Review $170 Grand Total $ LATEMPTUILDING\HANDOUT�fee sheet itemized form. doc06/3 0/05 Microfilmed STATEMENT OF PLAN REVIEW SERVICES AGREEMENT ACKNOWLEDGEMENT OF REQUIRED DISCRETIONARY APPROVALS 6Z am the owner/agent for the owner, for a building permit to construction improvements upon real property located at: -9 o) i i 2,z 4-41 � -% 'S �kj lc� m o),�s in Edmonds, Washington. I acknowledge that, pursuant to terms of this agreement, the Building Permit Application I have submitted will be accepted for review by the City concurrently with the review of any necessary discretionary project permits or approvals required by the provisions of the Edmonds Community 'Development Code. I also acknowledge that the City shall not accept an application for building permit that is not complete as determined by the minimum submittal requirements published by the City which I have read and understand. In signing this form, I acknowledge that I have submitted all necessary documentation in order to make a complete application for a building permit. The City determined that the discretionary application(s) for this project were deemed complete on (date). I acknowledge that any plan review fees paid in connection with this application are solely for the expenses and costs associated with review the plans as I have submitted them, and do not entitle me to any right or claim to the issuance of a building permit. In consideration for the consolidated review of the building pen -nit application concurrently with any required discretionary project permits or approvals, I hereby acknowledge and agree to be bound by terms and conditions of this agreement as. set for herein. 1. The required discretionary project permits or approvals for this project currently include, but are not limited to the following: [] Architectural design review ................... F-1 Subdivision or short subdivision ........... ................. Hearing date: ................ Hearing date: Planned residential development ........................ Conditional use permit ......................................... variance.............................................................. Xcritical areas determination or variance request.. E] Other (specify Hearing date: Hearing date: Hearing date: Hearing date: Hearing date: I further understand that additional discretionary project permits or approvals may be determined during the course of discretionary project review which may affect plan review timelines and plan review fees paid for this building permit application. 2. Any building permit issued and approved for this project will be subject to any conditions or restrictions imposed pursuant to the review and approval of any required discretionary project permits or approvals. Such conditions or restrictions may require that the building plans I have submitted be modified or amended to be consistent with such conditions or restrictions. I understand that additional plan review fees will be required in the event that modifications or amendments to the plans submitted are required by conditions or restrictions imposed pursuant to a final decision to issue or grant any required discretionary project pennits or approvals. In the event that modifications or amendments are required, the owner shall be solely responsible for any and all costs which result therefrom, including, but not limited to, additional full plan review fees. When additional plan review fees are required, the fees shall be paid in full prior to the commencement of additional plan review by the City. No building permit will be approved or issued until such time as a final decision for all required discretionary project permits or approvals have been, issued or granted, including the expiration of all appeal periods. A decision to issue or approve any required discretionaTy project permit or apprroval shall not be considered final until the limitations period for any appeal has expired or until all administrative and Superior Court appeals have been resolved. In the event that an appeal of a discretionary project permit or approval results in new or additional conditions or restrictions which require modifications or amendments to the building plans, such conditions and restrictions shall be treated as if originally imposed in the issuance or granting of the discretionary permit or approval. However, new full -plan review fees shall be required. 4. The building permit application shall expire 180 days after. the building permit submittal regardless of whether a final decision, including'expiration of appeal periods, for all discretionary project permits or approvals have been issued or granted. I understand that I may request a building permit application, extension for an additional 180 days, in writing, if filed before the expiration of the original application. The City may grant only one extension. In the event that the building permit application expires prior to a final decision on the issuance or approval of all required discretionary permits or approvals; or if not request for an extension is submitted in writing prior the expiration of the original application, then the application shall expire and a new application and new full -plan review fees will be required. 5. In the event that any application for a required discretionary. project permit or approval is withdrawn, or if such permit or approval is denied either by the City or, upon appeal, no portion of any plan review fee shall be refunded by the City. 6. In the event that the building permit applicant initiates or requests amendments or modifications to ull-plan the building plans after plan review by an applicable City Department is complete, new f review fees will be required and shall be required to be paid'in full prior to the commencement of additional plan review by the City. I certify that I have read and understand the terms and provisions of this agreement for plan review services and agree to be bound byauc�. k74 Owner/Agent of Owner Date: tl� t4 Development Se4ices Permit Coordinator :Date - statement of plan review sery agree.doc 2 01.17.2001 91 I !'.' do CA"Gvjl�' Rw L w 5 A el r� PC GWA4-1(qfl �40 C,6-4CAE, ftV4:7q< e)As� t'L AJ-L I otle-kLo?- tz"Oikl ED By ENGINEERNG doom jjwjc�� 0 tit, vt� 0 tell I I . I � N 4L-A Date: W2-�, -rm 80T� t- "Ji. RECE'IVE� APR 2 2 2PMI0. PERma ^ :.:., !. I -70- lec-TI4 �Llkf'�qa 0--s 8000 9-7 CITY COPY RECEIVED CITY OF EDMONDS 11 CONSTRUCTION PERMJTAPPLICATION OWNER NAME1NAME 0 NESS 5A M 01" A IoPoi;41A MAILING ADDRESS 9011 1% b CITY ZIP TELE7PHONE Li 2-'2-') L L rim- "NM ADDRESS CITY ZIP ITELEPHONE NAME ADDRESS CITY STATE LICENSE NUMBER ZIP I TELEPHONE CBL # 0 PERMIT EXPIRES 'J" EUSE PERMIT ZONE NUMBER �zv� J 8 JOB 0 EBB ADDRESS 5-t' CHECKED BY IROP ACC=O (ao NEW lqeRESIDENTIAL PLUMBING / MECH ADDITION COMMERCIAL COMPL ANCE OR CHANGE OF USE �(REMODEL 0 MULTIFAMILY SIGN REPAIR GRADING CYDS FENCE ( _X_ DEMOLISH TANK OTHER oGARAGE CARPORT RETAINING WALL ROCKERY F RE SPRINKLER F:RE ALARM (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: ia NUMBER NUMBER OF CRITICAL OF DWELLING AREAS STORIE UNITS I NUMBER k4r DESCRIBE wolik To BE DONE % LOT SLOPE % M . I — __ I VESTED DATE PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEES PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TES . '.zP ,- Street Use Permit Rocfd EXISTING — PROPOSED Inspection Required 13 Sidewalk Required 13 REQUIRED DEDICATION— FT UndsiWourld Wiring required 13 METER SIZE NO. OF FIXTURES PRV REQUIRED YES E3 NO El REMARKS z OWNER/CONTRACTO'R RESPONSIBLE FOR EROSION CONTROLJDRAINAGE ENGINEERING REVIEWED BY DATE FIRE REVIEWED BY DATE 11 IU_L' VARIANCE OR CU SHORELINEORADB# INSPECTION BOND REO'D I POSTED I [3YES 13NO $ SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP I , , LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR z z PARKING I LOT AREA PLANNING REVIEWED BY DATE I REO'D I PROVIDED FT) I REMARKS THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICAK ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS 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 WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMM ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION; THAT THE INFORMATION GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- 'n CK DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED IN ' 10 TION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO 0 IP4 W yv 6RfEN'S COMPENSATION INSURANCE AND RCW 18.27. F1 GENT)( 81 NA, WIOWR DATE SIGNED CHECKED BY TYPE OF CONSTRUCTION , OCCUPANT I _T&j 17-7 GROUP �'> -?> — SPECIAL INSPECTI3NTAREA OCCUPANT REQUIRED [I YES LOAD REMARKS PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REGID VALUATION Description FEE Descriptlon FEE Plan Check 15�5 State Surcharge Building Permit City Surcharge Plumbing Base Fee Mechanical Grading Engr. Review Engr. Inspection Fire Review Pla n Chk. Deposit Fire Inspection R eceipt # Landscapeinsp. Total Amt. Due 92 6 Recording Fee Receipt # CALL FOR INSPECTION (425) 771-0220 APPLICATION APPROVAL This application Is not a permit until signed by the Building Official or his/her Deputy: and Feas are paid, and rwe[;O Is a&novAedged in space proWded. FIC*VIGNATAE N DATE/ 9149ASII�q BY f - DOE ATTENTION EXT 1333�,_Wy 6 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A ClklAl lklO0Mf%'rlf%kl LIAO M 11 r-14 MALLth AND APPROVAL. On A CER 111-1- ORIGINAL - FILE YELI 01A PFCTC CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 09/03 , PRESS HARD -YOU ARE MAKING 4 COPIES Zone'B 7, 179D9 179M ps 7330 179W 1 70M 1 110 A 17916 1 15 17912 -CC 1 1 7107 70M 7007 17M 17907 17910 Ir 11" 1 14 17M I 711S 17�GM24 18MSTSW 17930 1807H ST Sw T T T 18W5 — 18007 7114 7104 7024 7m 70M 18015 19017 18015 18012 18013 18012 16024 18021 JSW017 Is= 19019 18101 4 0 laws 18027 ISM 18027 IBM N isisT PL - 4 16102 18103 1. lam Is= op 18102 04 ISM islos 18107 18106 6! 18107 As% 16116 lalle 10116 18114 15 7101 7023 18124 7211 ISISTPLSW 18121 812=9 182ND ST SW 81 ISM7 7324 am 72. S is is 9, R 11212 182D1 18211 3. 10 8216 > 182 18219 18214 W 111213 18212 t:WU,, 162N SW 70M 16212 ism -C 1 1821 182 ism ia22o 0 1822=6 8220 18229 z 11121 GV V#AY 8:M: 1=7 18228 laz 7418 lawl 18300 IBM Is= M303 7101 1 To. 1 ism M305 IMS 18308 418304 ism 76M 18311 1.12 18314 18316 ism 921 183' 7532 1! 1% 18317 ia320 18311 ism ism 1 1 , N Ima 7605 ism Mm 18327 ism 1V 1831 ism t84TH PL SW lS404 8401 IBM 1833D 18408 16327 1 ism )? I . ism 7807 18402 16401 10402 ia4O3 1840 10404 , 8410 184M — 18416 18408 18407 18412 — 18416 10415 18417 184M -4 s 18411 18416 ISM 16416 L" 18424 16412 164=2D 16404 I 1 ism 8419 16427 1 18417 18424 18423 18424 16500 18427 ia420 MTH STON 1111414 11*� 7425 18423 18430 18429 18502 1 18508 8433 ISM w 18505 1850, If 18504 IMO3 13 18503 16518 1 sm Ism 10501 1 2 )1. 1�. 18511 Iasi' I am I awo Ism IBM 18513 IeSI4 751,2 ISS21 Ism 16604 lowl 1 ISM PKL law — 16519 issm LU 1851 z T 1 law 18512 18629 1 ISM Ism I ism ism I ISM 19604 lesol ism 1 ism 30 18612 ism x 18810 Isell 1OW7 ism 18530 18616 w 18615 > c ISM lool? Isola leals Imle leel lem ism 18821 ism 191121 lam ISM lam 18014 IBS24 Ism 1 lam ism ism 18627 ism ism I is lam I 4 ISM low I is I is 187TH PL SW IM2 8 Lynnw ;z Fire SWi I 18m PL Sw 0 /7, PERMIT NO:, 9360 'City of Edmonds : ' PERMIT EXPIRE SIDE SEWER PERMIT Address of Construction: an I't . 1046 Ell- . 5-4.) LID # Property Tax Account Parcel No. .5 IS) ODD 16C) K' Attach copies of all access and.utility easements Verified and Approved by Owner and/or Contractor: C 'ntractor License#: Lj &L 3 Q Z. 0 BuilcHng Permit #: 6jLSingle Family invasion into, City *Right -of Way: El Yes ��No F-1 Multi -Family (No. of Units *RW Construction Permit E] Commercial (No. of Units Cross other "Private Property Yes �o FjPublic **Attach legal description and copy of recorded easement. Owne -V Owner or contractor signature and a�knowledgement statement: Date By signing for this permit I certify t9t I have read the City'spublic handout entitled ide Sewer Specifications, and shall comply with all City requirements outlined therein. 2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION 2- W FOR INSPECTION CALL 425-771-0220 extension 329 W HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS FOR OFFICE USE ONLY ....... .. . . ......... .. . . ..... .... .. ..... . a ... . ....... Permit Fee $ C-2,0, -Repair Fee $ Issued By: t3e��)c % , Trunk Charge$ Assessment Fee $ City Permit Surcharge Fee $5.00--__ - - Date Issued: L4 Receipt No: - I TS 301' Total Fees Paid $ -'A'S .120 NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED. Job Site Ready YES NO Date: Initial: Partial Inspection: Date: Initial: Partial Inspection: Date: .'Initial: FINAL INSPECTION APPROVED: Date:W-01 In1tiaI:_Pa_�__As-buiIt-to Street File: 1,� PERMIT MUST 9EPOSTED ON JOB SITE t� White Copy: File Gredri Copy:. 16spector 130 Cbpy: Applicant L;temp;bldg,forms;sspertnitjlg4/00 -10, 81 door C/o 33' LLJ > 16' 22* z 0-i - C/o 20' 180TH ST SW CITY OF EDMONDS SIDE :SEWER AS -BUILT ADDRESS 7011 180TH ST, S.W. PERMIT - NUM13ER 9360 HOMEOWNER xxxxxxxxxx CONTRACTOR AAA DATE 04/12/01 DRAWN ISMAEL ABILA BY I (29��6 ,�T -Y4. -08/ t OL 77 I- f �4c) CAAU� -01 10 lit t0b Ito AO nor"",- -11 TH49 w VeC, 45 oo6f, tA,4 a�> - s!z/ ,S/ coo PWFW7, ,Or' 47 '0�t ^air REcEjvED APR 2 2 2M4 PERM,lT COUNTER FILE