7040 164TH ST SW.PDFIII lill
907
7040 164TH ST SW
cA FiLE No. Ch -ft - (
Critical Areas Checklist
---------------- ----------------------------------------------
Site Information (soil s/topography/hydrology/ve getation)
1. Site Address/Location: -704-0 1 &�frl* Sr Gkd Trwakln!& litceja_
2. Property Tax Account Number: 1,3 / — M - o W 0 41
3. Approximate Site Size (acres or square feet): 13, 719SO
4. Is this site currently developed? yes; — no.
If yes; how is site developed? ggSiOV
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of I 0-feet over a
horizontal distance of 66-feet).
H i I I y: slopes present on site of more than 15% and less than 30% ( a vertical rise of
10-feet over aborizontal distance of 33 to 66-feet).
Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: MO. Approx. Depth:
7. Site contains areas of seasonal standing water: k� 0 Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? - kW — Flows are seasonal? - (What time of year?
10. Site is primarily: forested ; meadow shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: 00
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E D
City of Edmonds
. . . . . . . . . . . . . . . . . . . .
Development Services Department
xx
Planning Division
Phone: 425.771.0220
A0 C. Fax: 425.771.0221
Critical Areas File #:
Critical Areas Checklist Fee: $45.00
Date Received by Dev. Serv. Dept:
City Receipt No:— J -':;-7 9 -)
Date Mailed to Appiicant:
CRITICAL ARUEAS CHECKUST-F"'
M7 I
7
The Critical Areas Checklist contained on this form is An applicant, or his/her representative, muqflot,-put
��'O i S�.R , the
to be filled out by any person preparing a the checklist, sign and date if,"W"pst; nu-towto
Development Permit Application for the City of City. The City will review the checklist, make a
Edmonds Prior to his/her submittal of a development precursory site visit, and make a determination of the
permit to the City. subsequent steps necessary to complete a development
permit application.
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 easily available from observations of the site or
data available at City Hall (Critical areas inventories,
maps, or soil surveys).
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 assist staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
PLEASE PRINT CLEARLY
Owner/Applicant:
Name
,7Q40 1
Street Address
Trwo'ups
City State Zip
47--:� -74S 4q S I
Telephone
L. Z4
Signalure
-1 17 /2�
Date
d:reception/jana/CACLHandout.doc
Applicant Representative:
S-�botc 'X-S.
Name
Street Address
City State Zip
Telephone
Signature
Date
Revised 4/10/2000
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).
Rd,
co
C)
CA
CITY of EDMONDS 91VED SIDE SEWER PERM'JIT"
For Inspection Cal%%ET F1 RERMIT NO. 07W
tr d 800
Address of Construction: VA
Property Legal Description (Include all easements):
Own
Contractor & License No: I G \) F_ H L _Z_0q VN-A NJ
Single Family Residence
Multi -Family
vl�
(No. of Units
LYNNWOOD LINE
Commercial (No. of fixture Units
Invas ' ion into City Right -of -Way: No 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.)
PLEASE READ THE ITEMS LISTED ON THE BACK
�p �y
I cert fy that I have read �and shall com I Date
with the items listed on the back.
Permit Fee:
Issued By:
Trunk Charge: tate Issued: SR Sr'
Assessment Fee: Receipt No.:
Partial Inspection:
Comments
Final Inspection Approved:
Date rn—itial
Rejected:
eason
** PERMIT MUST BE POSTED ON JOB SITE **
Date —5—itial
Daf—e— --1nit-5aT
White Copy - File Green Copy - Inspector
Buff Copy - Applicant
A Side Sewer Drawing
The City of Edmonds EASEMENT NO. - --------------------------- I --------------
NEW CONSTRUCTION REPAIRS Fj LID NO . .................. ASMT. NO - -----------
OWNER- --------------------------------------------------------------------------------------------- CONTRACTOR -- ------ ------ (�� PERMIT NO. C�j V0
JOB ADDRESS ------- L-64" ------ S LEGAL DESCRIPTION: LOT NO - ------------------ ------------------- BLOCK NO. ..- ...............................
------------------ am ------- v:7um — ---------------------------------------------------------------------------------------------------------------
0,11 !1A "s To 0, i�-
'A -T t-k 's. �� -
PWW-0001 -11/75 (REV. 11/78)
, 0- V -e-
NAMEOF ADDITION ------------------------------ ----------------------------------------------------------------------------------------
72,
i
9
el
(e I
CAD
CID140- �&Wt -(L M14,�J� Approved:
DATE ... -.,3. -. -! r. � � ................. -.� ..... !��7
U P P P- P,
CATCH
B45kN DETEWTION PIPE LENGTH COV4rP41- CATCH
(Yrzwr)
I' MIW 2' mt'x COVFP,
OLrrLCT
co irrRoi-�
SLOPE-
70 0 U'T LIE 7
(rki P P,,t,.p o R
KU NO F F
SPPEADEZ)
SYSTEM CROSS SECTION
SEE PAGE 3 FOR OUTLET CONTROL DETAIL
- Z' . (.'I De---P, 4t-6" SPALLS
1'- 2' 3" 0G';Z'P' %'-UUS�412D ROCY,
r Pc�vl
0 Lr- L E
CC",,—ROL.
RIPRAP OUTLET
WAZWED O�T--FLOW 'TRENC4, MIN 10' LONG,
-rCP 4 A- PFR�F PIPE -M 15E' —vE:L_
CZN
AV ?ZRF PIP7= WITH CARS
RUNOFF SPREADER OUTLET
jQtftR DRAINAGE PLAN
DETENTION SYSTEM
PAGE I OF 3
for
location
plan by
phone
date
DESIGN DATA
System Imperm pe
Number Area Diam
Pipe Orifice
Length iametec.,
NOTES
1. Call Engineering
Division (771-3202)
for prebackfill
and final inspections.
2. Responsibility
for operation and
maintenance of
drainage systems on
private pro ' perty
is the resconsibility
of the property
owner(s). Material
accumulated in
the storage pipe must
be flushed out
and removed from catch
basins to allow
proper operation. The
outlet control
orifice must be kept
open at all t�
es
A
CITY OF EIDIVIONIDS
A,04tl'
7CWT4 Ave.
FLi MIN(E�WA',(
Ar tt a�
PROPOSED r_M5lvENcx-- t. 1-1
/'?2'9 6Q. F-T fAAIN
460 .ora- FT LOVIEP-
f-559 5,gg- IF7. -rOTAL
-rL-� 19'2 9 TT-1
LA 10 7�
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Or -1
Lor 4
�4
Alq_--U k--,ee-0 Q-Cy,�5-r
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LE6,N- I>F—SCr-11-TION,
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Lo-r 4 THAT I-AlZ-T it TI-AcT
05, T-I-AT- OF MEArYIWD��,LE�
BEACH , AS r-r-e-. INI VOL, --,
0 F Pl- P,-,TS F 45NOPOMISH
Is"'q
I
COVN-rr, VJA,
c-
CITY OF EDMONDS ASSET INFORMATION SHEET
T F-f!
1j;/NEW ASSET NO.
1:1 ADDITION ADDITION TO ASSET NO.
1:1 RETIREMENT
DESCRIPTION
SERIAL NO.
LOCATION 41
DEPT/ Nq_
Cefl=) "74�
* * PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
PROJECT NUMBER
PROJECT COMPLETION DATE
COST
B.A.R.S. ACCOUNT NO. -6
�3- 06 -3-
ESTIMATED LIFE 15-
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE DATE
(tnp INITIAL
4,Q-
VERIFIED BY
PROCESSED
BATCH NO.
PLANNING DATA
NAME: PAIKA-da�
st�K/
SITE ADDRESS: 10'10 1641-H1 DATE:
11-7100
ZONING:- PLAN CHK#:
PROJECT DESCRIPTION:
CORNER LOT_-A(a_(Yes/No) FLAG LOT IVO —(Yes/No)
SETBACKS:
Required SgItgg—�s-,
Front: '25 Left Side: Right Side: Rear:
Actual Setba�ks: I/
Front: — '2-�l Left Side: _Right Side: Rear:
Street map checked for additional setback required? (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED Y/N)
LOT COVERAGE: IVO C-,Ab4AI&lr��
Maximum Allowed: 55;1" Actual:
BUILDING HEIGHT:
Maximum Allowed:::?� A Actual Height:
Datum Point: i!5�t4�� Datum Elevation:
A.D.U. CREATED?: /Vo
SUBDIVISION:
CRITICAL AREAS
SEPA DETERMINATION:
LOT AREA: 113 0 2--9(5> -S�=
OTHER:
Plan Review By:
cAfdes\permiAAp1andat.doc
ENGINEERS- NORTHWEST INC. PS.
6869 WOODLAWN AVE. N. E. - SUITE 205 - SEATTLE, WA 98115 - (206) 525-7560 - FAX # (206) 522-6698
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JOB No. JOB NAME DATE
SUBJECT* SHEET OF
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July 24, 2000
Jose L. Parada
7040 160 St. SW
Edmonds, WA 98026
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
Subject: Determination regarding Critical Areas Checklist# CA-00-1 08
GARY HAAKENSON
MAYOR
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
................. ...... .........
.................................... . .........
............ . . . ..... A.-. ..
........................................................... ......
.....................
........................ .......................................................................
. .......... ...... ...........................
. ............ .............. o ......... ..................................... ............................ ..................... : ...... ...... ......................................... ........................... ..............
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIS OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL .40
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit �pplications.
Enc: Critical Areas Determination
* Architectural Design Board
Thank you.
Shada Graham
Planning Secretary
C:ReceptionUanakCRLTR.doc
Incorporated August 11, 1890
ED
City of Edmonds
Development Services Department
...........
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Critical Areas File #:
Critical Areas'Checklist Fee: $45.00
Date Received by Dev. Serv. Dept:
City Receipt No: I -S-7 9:�Z
Date Mailed to Apphcant:
CRITICAL AIRIE-JAS CHECKUff"" v F— D
The Critical Areas Checklist contained on this form is An applicant, or his/her representative must I -put
MR '-LF
KNiMp -,
to be filled out by any person preparing a the checklist, sign and date i�W"s�4t M"I't-cit"31,to the
Development Permit Application for the City of City. The City will review the checklist, make a
Edmonds Prior to his/her submittal of a development precursory site visit, and make a determination of the
permit to the City. subsequent steps necessary to complete a development
permit application.
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 easily available from observations of the site or
data available at City Hall (Critical areas inventories,
maps, or soil surveys).
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 assist staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
I PLEASE PRINT CLEARLY . .1 1
Owner/Applicant:
Name
-X40 1 (06CII+ -2;j— SCO
Street Address
Trwo IJ p-, uj/� 'I baz( '0
City State . Zip
4-L%:� -1-(+C-, 4q.6i
Telephone
— LZ4,4
Signature
-1 17 /2�
Date
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date
d:receptiorLianalCACLHandout.doe Revised 4110/2000
CA FILE JV0. CA- -ft - I (7j� -
Critical Areas Checklist
---------------- -------------- -----------------
Site Information (soil shopo graphy/hyarol ogy/ve getation)
I. Site Address/Location: -704-0 16�4-T*
2. Property Ta,-, Account Number: .9 1 a I - M - ci,
q
3. Approximate Site Size (acres or square feet): 7-9:)cD ve S:`91f1C ES CTR.
4. Is this site currently developed? yes; no.
If yes; how is site developed? R&C>
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire'site.
Rolling: slopes on site generally less than 15% (a vertical rise of I 0-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
I 0-feet over a horizontal distance of 33 to 6.6-feet).
Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe): '
6. Site contains areas of year-round standing water: PO .- ; Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain I of a water cou . rse.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? - �JO -_ Flows are seasonal? — _ (What time of year?
10. Site is primarily: forested ; meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: �j C>
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CITY OF EDMONDS
'MW PERMIT
SIE TP-01P-11) NUMBER
CONSTRUCTION PERMIT APPLICATION
BUSI ESS)
JOB
ADIJKLZQ
NAME (OR NAME OF
'e.5 I
L DESCRIPTION CHECKI SUBDIVI—ISIO—NNO.— LID NO.
cc
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MAILING ADDRESS
193
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19501 Nva
CITY TELEPHONE NUMBER
kA/A- 142,-1 Cg-z- -3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING 4et�Q REQUIRED DEDICATION
NAME
Lx
PROPOSED_j��
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
cc
Uj
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ADDRESS
STREET USE PERMIT REQUIRED 0
q0?
SEE ENGINEERING MEMO DATED
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cc
NUMBER
X
CITY
At"� L ITELEPHONE
REMARKS
NAME
cc
ADDRESS
0
15q 7_0 LPP9 Airy
METER SIZE BUILDING SUPPLY SIZE
<
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CITY
I
REMARKS
Uj
<
STATE LICENSE NUMBER
A \j F--ft C;-z_0 2>
Legal Description of Property - Include all easements
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
(show below or attach four copies)
SHORELINE 0
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2
ATT/:"-c I+C--�->
VARIANCE OR CU PLANNING REVIi;V By DATE
W
YARDS HEIGHT COVERAGE
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FRONT REAR
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NEW RESIDENTIAL PLUMBING
REMARKS
ADDIALTER COMMERCIAL MECHANICAL
WALL SIGN
REPAIR RETAINING
EXCAVATE FENCE
El
CHECKED BY TYPE CONSTRUCTION CODE HEIGHT
Ir
I I 190-' 2_-:�'
DEMOLISH OR FILL x _FT)
wj'_"�_ ,-,%
PRE -MOVE INSPJ swim
SPECIAL INSPECTOR AREA OCCUPANC)�, OCCUPANT
GRO LOAD
REMODEL COMPLIANCE INSP. POOL
REQUIRED
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INSERT APT.BLDG RENEWAL
0 YES 0 NO
REMARKS
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NUMBER OF STORIES
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DWELLING
50—
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
4)b
VALUATION FEE no=
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways. marquees, etc.) will require separate permission.
STATE SURCHARGE.
Permit Application: 180 Days
ENERGY CODE
Und, I Year - Provided Work Is Started Within 180 Days
on behalf of his or her spouse, heirs, assigns andi
TApplicant,
successors In interest, agrees to Indemnify, defend and hold
4--n;'.t
#k� oiot, ^f Ct4mi� VJnehInnfnn Ifq nffirinin
mEMO TO: Building Division
FROM: Engineering Division
SUBJECT: IVI:;� 1'71 J7-
After review of the subject building permit application, we have the
following comments:
1) Connection to City water system required.
2) Connection to City sanitary sewer system required.
3) Right-of-way permit required for any work.on City property.
4) Driveway slope not to exceed 14%.
5) Back water valve required if downstairs plumbing is below
elevation of upstream manhole.
6) Water and sewer lines to be separated by 10 foot minimum.
7) Builder/owner responsibl'e for containing all temporary runoff and
erosion on site and may not impact' neighboring properties in any
way.
8) Construction hours from 7:00 a.m. to 10:00 p.m . on we�ekdays and
10:00 a im. to 6:00 p.m. on weekends and hol idays .
9) No burning of construction refuse vii-hn-u-t -�ppr6izal hy Pire Dept.
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O&TIE :Vr_(�grlrED -2- t/ P 10 1 PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS "" K_n� 2-- NUMBER ;007,
CONSTRUCTION PERMIT APPLICATION JOB Bull
1 ADDRESS t-Y,
OWNER NAMEMWE CF &S!%ESS
J05,L- L_ +_kR,*.DA,
MAILING ADCgeSS
-7 04-0 1 GAO)+ '�-;T S LL)
CfTy ZIP
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TELEPHONE
SS
CrTy ZIP
TELEPHONE
NAME
ADDRESS
CITY ZIP
TELEPHONE
_T_
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
C71(1-2-1,
RM
0 NEW
RESIDENTIAL
0
PLUMBING I MECH
0 ADDITION
0 C I OMMERCIAL
o
COMPLIANCE OR
CHANGE OF USE
REMODEL
0 APARTMENT
0
SIGN
0 REPAIR
0 GRADING
CYDS
0
FENCE
( X FT)
DEMOLISH
0 TANK
OTHj5R
oGARAGE
C] RETAINING WALL
0
RENEWAL
CA PORT
ROCKERY
(TYPE OF USE, BUSINESS_QSAICTIVITY) EXPLAIN:
_s7fle—
NUMBER
NUMBER OF
CRITICAL
OF
STORIES TRikvd
DWELLING
UNITS
AREAS
NUMBER
DESCRIBE WORK TO BE DONE
�) L_Jdt� t,070 7PM OZOM!S.
HEAT SOURCE GLAZING % LOT SLOPE %
C, /kS> /'A!11-4�' S to%
PLAN CHECK NO: VESTED DATE
G
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
N 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 NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANYCITY ORDINANCE
NOR LIMIT IN ANY WAYTHE CITY'S ABILITYTO 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 AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
DATE YIGN
,fD
'717/ZolatV
ATTENTION
%j
PLAT NAM EJSUBDIVI SION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TIESCP Approved
SW Permit Required
c
Street Use Permit Req'd
EXISTING — PROPOSED
Inspect on Required
Sldewa: Required
REQUIRED DEDICATION—
FT-
Underground
Wiring required
METER SIZE
LINE SIZE
I
ES
F
PRV REQUIRED
YES 0 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED/DATE
FIRE REVIEWED BY DATE
VARIANCE 08 CU
SHORELINE OR ADB#
INSPECTION
REQ'D
EBOND
------
0 YES,XNO
SEPA REVIEW
SIGN AREA
HE1bHT /23.4a
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PBO
EXP
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
,-7e--Vl
;7�_7L,7 ew5�4
f
�25 10 :75
f / IV
1.077 11'qz1a 4
. 'PARKING 1.
REO'D I PRO
1 6hT AREA
I
PLANNING REVIEWED BY DOE
I — 1P — /_
BY I TYPE OF
SPECIAL INSPECTOR JAREA
REQUIRED(DYES I Q
GROUP A
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBIC 108fFINAL INSPECTION REO'D
a
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADING/FILL
STATE SURCHARGE
ENG. REVIEW FEES
VALUATION
to
--AJA
`AJA
f_bp�: k-) I
PE'e-00 7s I
FEE
P5 __
ILANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT RECEIPT
I /-7--N ,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
5/98
TOTAL AMOUNT DUE
CALL
FOR INSPECTION
(425)
771-0220
EXT 333
771-0221
FAX
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.
IALS SIGNATURE Do/
4-612 6M4 L-h-9
5LEASED E;Y DATE
ORIGINAL - FILE YELLOW - INSPECT
PINK - OWNER GOLD - ASSESSOR
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