706 FIR ST.PDF11111111111111
11273
706 FIR ST
0
ADDRESS:
TAX ACCOUNTIPARCEL NUMBER: MD
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
DETERMINATION: E] Conditional Waiver E] Study Required E] Waiver
PLANNING DATA CHECKLIST DATED: ezo
SCALED PLOT PLAN DA
SEVVFER LID FEE
LID #:
SHORT PLAT FILE: LOT.- BLOCK:
SIDE SEWER AS BUILT IDA
_V_
SIDE SEWER PERMIT(S),#:-
6 EOTECH REPORT DATED: �
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED: I's
OTHER:
LATEMP\DSrs\Forms\Street File Checklist-doc
P611T APPLICATION REQUEREMENTSSO? tk
o: Applicant "ft==T FILE
rom: Jamal Mahmoud, Engineering Inspector
,wner. Ltf A Co, A'd - Plan Check No:
Adress: 1�-, Date:
014 - f
-fter review of the subject permit application, the following requirements must be met
Construction hours are: WEEKDAYS — 7:00 A.IVL-10:00 P.r*L;WEEKENDS/HOLIDAYS 10:00 A.M.-6:00 P.1VL
A separate RIGI-IT-OF-WAY CONSTRUCTION PERMIT is required for all work on public property. (ECDC 1&60)
Truck haul route plan must be submitted and approved prior topermit issuance.
Builder/owner is responsible for containing all temporary runoff and erosion control on site (ECDC 1830.030d).
NO WORK SHALL BE DONE WITHIN 15 FEET OF STREAM OR 10 FEET FROM ANY CLOSED DkAWAGE
FACILITY. BUILDER/OWNER IS RESPONSIBLE FOR II)ENTIFYING CONDITIONS ON THE DRAMih4G.
(ECDC 18.30.50G)
FILTER FABRIC FENCE SHALL BE INSTALLED AND I NSPECTED PRIOR TO CLEARING AND CONSTRUCHON.
(ECDC 18-30)
INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEMS, TIGHTLINES AND CATCH BASIN
INSTALLATION. INSPECTIONS ARE REQUIRED PRIOR TO BACKFILLING. (ECDC 18.30)
Repair or replace all defective existing curb, gutter and sidewalk adjacent to the property. If an intersection is involved, a handicap ramp
may be required. Contractor shall meet with the City Engineering staff to determine the extent of repair prior to issuance of the permit.
(ECDC 1&90)
Driveway slope shall not exceed 14% without a waiver. Every attempt should be made to keep the slope below 14%. Waiver granted to
I _ %. (ECDC 18.80.060D)
Driveways must be paved from' property line to City RIGHT-OF-WAY. A separate permit is required. (ECDC 18.80.060C)
INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIOR TO AND AFTER POURING. (ECDC 18.30)
No burning of construction refuse without a permit from the Fire Department.
Connection to City water system is required. There is a separate charge.for the water meter. (ECDC 7.20)..
A back water valve is required if downstaii-s plumbing is below the elevation of upstream manhole. (ECDC 7.20)
Water and sewer main lines should be separated by 10 feet minimum. (ECDC 18.10)
Connection to the City sanitary system is required. A separate permit is required.
LID# Fees paid: Yes— No. Charge f5*5 (ECDC 18.10)
Underground wiring is required on all new construction, and for additions, alterations, and repairs that exceed 50% of the total assessed
value of the structure. (ECDC 18.90)
A FINAL ENGINEERING INSPECMON IS REQUIRED PRIOR TO THE BUILDING DIVISION GRANTING OCCUPANCY
OF THE BUILDING OR STRUCTURE. (ECDC 1&90)
MrA"DOC
I . 90JECT REVIEW CHECKLISTOL
PROJECT NAME: Prfifi Cpx-r�� PLAN CHECK#: q7 -3
PROJECTADDRESS: —ro(-o F—L-lt sb-,�_j RECEIPT DATE:-L<:�,
f
REVIEWED
BY: (IhitiAl/Date)
PLAN.
WATER
COMMENTS
FIRE
BLDG.
SEWER
STREET � ENG.
Setbacks/Variance/Setback Adjustment
- ----------
Conditional Use Permit
....2
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......
ADB Requirements
............
. . . . . . . . . . . . . . . . . . . .
------------
3.
Other Zoning Re uirements
UndergroundWiring Required
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................ . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . .
Lot Slope 15%
-6
SEPA Environmental Checklist/Hydraulics Permit
Tree Cutting Plan
........ . . . . . . . . . . . . ..... . . . . . . .
8
Plat/Subdivision Requirements ;ee -2 3 19
. . . . . . . . . . . . .
9
Legal Description Verification 5:0
................................ ............
-10--
Quit Claim/Street Dedications
x ... ..... . . . . . . . . . . . . . . . .
Easements - Public/Private
NO
-12-
Engineering Storm Drain Review Fee
'M "ll"M '1111-11111111
loom
T.Hpl PH
13
Engineering 2.2 Inspection Fee
14,
Drainage Plan (On -Site)
15
Setback - Top of Bank, Stream, Water Courses
"l-6
Setback - Storm Drain Line
17_
Open Ditch - Existing
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... ;m
18
Culvert Required
.............
.9
Culvert Size
. . . . . . . . . . . . . . . ....... .......... . . . . . . . . . .....
Shoulder Drainage/Shale Open Runoff
. . . . . . . . . . . . .
ZK
21
Catch Basin Required 19
-22-
Driveway Slope & Vehicle Access
........ . . . . .
-23
Sidewalk Required
. . . . . . . . . . . . .
24
Curb & Gutter Required
I . . . . . . .
j(4
25
Curb Cut For Driveway Required
1A
... - ......
Street Paving Required
2T
Right -Of -Way Construction Permit Required
28
Street Name Sign Required
Other Signing Required
30
Bond Required For Public Improvements
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I I I I I I I I I I I I I I I I I I I I I I I I . . . . . . . . . . . . . . . . . . . . . . . . 1—
31
FEMA Map Check/Water Table
.............
.. . . . . . . . . . . . . . .
32:....
Side Sewer Availability 44
- H I
.33
Calculate Sewer Connection Fee If No LID #
..................
34
Create Street File
.01
35
Existing Water Main Size
Water Meter Size
31�'
3.7...
Service Line Size
y*
38
Water Meter Charge Required
/A
Hydrant Required
. . . . . .
. . . . . . . . . . . . . . .
40
Hydrant Size Existing
5N
41
Fire Line Charge Required - Sprinkler
...............
::.42
Street Cut
VJR /Ju
... 4,3,:,.,
Miscellaneous
44
Reviewed By:
FIRE
PLANNING
:5-m
ENGINEERING
PU6LIC WORKS
RECEIVEU
JAN 2
-%1101 Irl %Aif)DVQ nrri,
R E C 0 R D OF C 0 N T A C T S
1
21
2
22
3
23
4
24
5
25
6
26
7
27
818
28
RW PERMIT # DATE ISSUED RECEIPT #
9
29
10
30
11
31
32
13
PAID $ RECEIPT # DATE
33
SS PERMIT # DATE ISSUE D RECEIPT #
14-
PAID $ RECEIPT # DATE
34
A,,2 LZ�
35
36
17
37
METER SIZE PAID $ DATE RECEIPT #
18
38
19
39
20
40
ENGINEERING
ROUTE �(ZMA__On F& 211f Add?__J-e 5 Total Day, a d /"g
REV
RESUB #I ON_�Zj_ToM_) Back Add? —Total Days Mailed
RESUB #2 ON TO Back Add? —Total Days ailed
REET FILE
1. Site/Drainage Plan & Calcs Corrections Required keceived
2. Grading Plan/Calcs/CYG—L(20 SEPA? — OK 1.
3. Driveway Slope % I �0 Profile OK 2.
4. Truck Route Plan
QK
5. Street Dedication? FEET
6. Easement _Type OK
OTHER COMMENTS:
3.
4.
5.
C'e--- $
PW REVIEW Date SentI2'� Back FIRE REVIEW Date Sent Back
PLANNING REVIEW TIME TOTAL DAYS *** ENG REVIEW TIME TOTAL DAYS
FIRE DEPT REVIEW TIME TOTAL DAYS PW REVIEW
BUILDING DEPT REVIEW TIME: In -House Outside
TOTAL DAYS
TOTAL DAYS
ORDINANCE COMPLETION DATE COMPLETION DATE TOTAL REVIEW TIME DAYS
PERMIT # ISSUE DATE
*CONTACT PERSON STATEMENT*
BY SIGNING TMS FORM I UNDERSTAND THAT I AM TIIE ACKNOWLEDGED CONTACT PERSON FOR
THIS PROJECT. IT IS MY RESPONSIBILITY TO COORDINATE ALL SUBMITTALS WITII THE CITY
AND ONLY I CAN -MAKE INQUIRIES ON THE STATUS OF THE PERMIT. I UNDER . STAND THAT IT IS
MY RESPONSIBILITY TO DETERMINE IN ADVANCE OF PERMIT SUBMITTAL ANY DISCRETIONARY
PERMITS THAT MAY BE APPLICABLE TO TEIIS PROJECT. I ACKNOWLEDGE THAT TO TFLE BEST OF
My ABRM I IIAVE SUBMITTED ALL NECESSARY DOCUMENTATION IN ORDER TO MAKE A
7COMPLTE'APPLICATION.
Signed Date Mailing Address
A - Ri , r:: Ap, A / 247
Contact Person (Print Clearly)
';;� 6 1 / -Z 7
Phone Number FAX Number
-7 7
R0UTE.D(XAJ7c'mepA3 IdgfForms-5/96
0 0
PLANNING DATA
NAME:.
SITE ADDRESS:-70& 4;v- 5�-, DATE: 2-11el 9 7
-7-3
ZONING: P-S-6a PLAN CHK#. p6 - 9 -�t
PROJECT DESCRIPTION:
CORNERLOT 2- �rYes/No)
SETBACKS:
Reauired Setbacks:
Front: 70' Left Side: !P Riaht Side: Rear:
Actual Setbacks:
Front: 2-o' Left Side: Right Side: Rear: 2-Z-'
Street map checked for additional setback required? (,�',+�:t-V/Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (U (Y/N)
LOT COVERAGE: 6
3 39c,
Maximum Allowed: Actual: bev- -0 -
BUILDING HEIGHT -
Maximum Allowed: 2-5' Actual Height: 2-4'
Datum Point: -ta4 Datum Elevation:-
- ��f I � f-41k �4ZLI-
A.D.U. CREATED?: _ Pc�sinxr 'I t- �,-, b�-� si,�w ( A
I &,It 0-n X^A &� &:C, f122!t lmk�j /, VX 4 bdAa" of--
W-�A a k W, 91n --" I- MILe 1- 10 41 -A- Wk d/ IA( A�� , �,,
r—% -ef 3 W"� n-a "k fp-t -
SUBDIVISION: Z, -3 -
CRITICAL AREAS #: &.,,, S - 23 - ?9
L
SEPA DETERMINATION: �k� "v'14 s*,,� w,,,
e_j
LOT AREA: 600' 0
OTHER: r-#� K6 m-c p., 3o-' v— 1=2=S W-C4 6-1
65u,
Plan Review By:
STANDAJV DRAINAGE DETENTZ SYSTEM
WORKSHEET
OWNER CALC ]BY: -V E oe
ADDRESS PHoNE.- 77, R-. Z �)-o 7
-Z 4
DATE: Z / Z ct, t 4
'"DESIGN DATA
IMPERVIOUS AREA PIPE DIA PIPE LG ORIFICE
DETENTION PIPE LENGTH LOCKING LID
I , XTYPICAL)
FINISHED G X
MINIK04
IN E RA"CfP
TIGHTL %EASURa NOM OF
CONC BOX OR RISER
TL .5Z =TOIZ SLOPE 0 OUTLET
r ET CONTROL
I F41 TNL
UPPER CATCH BASIN PIFICE
CONTROL CATCH BASIN
01TY COPY
SYSTEM CROSS SECTION
JAN 2 9 1997
2'X2'X6'.DEEP, 4-6- SPALLS OR EOUAL PERMIT COUNTER
FROM CONTROL CB
2*X 2'X 3' DEEP�, 3/4' CRUSHED ROCK ISTING GRADE
�.ASHKD ROCK
FROM CONTROL OUSTLET
PIP -13NG.
PERr P PE TO BE LEVEL
PERF E W/ END CAPS
L%NCH SMALL BE LINED WITH MIRArI
RIPRAP OUTLEr OR TO PLACEMENT or WASHED DRAIN ROCK
RUNOFF SPREADER. TRENCH
FOOTING DRAINS SHALL NOT BE CONNECTED TO DETENTION SYSTEM
NOTES:
1. Call Engineering Division (771-0220) for a tightline and detention system inspection
before backfilting and for final inspections. APPROVED BY
2. Responsibility for operation and maintenance of drainage systems on private property is the
responsibility of the property owner. Material accumulated in the -storage pipe must be flushed
out and removed ftom the catch basins to allow proper operation. The outlet control orifice DATE
must be kent open at all times.
6 , .
STANDAW DRAINAGE DETENTIW SYSTE'M
WORKSHEET
QWNM �Xw,
ADDP,ESSk 7&1)6
mom.- 7 7.
DATE: la!:�L / 4 -/ 14
""DESIGN DATA*****
IMPERVIOUS AREA PIPE DIA PIPE LG ORIFICE
FINISHED G!�� ' J_ OCTENTION PIPE LENGTH
I t_r_ MINIMUM
UPPER CATCH BASIN
= TO Iz SLIM
4
MG LID
ICAL)
i MIN C
RgCfop 00�2
tM
ASURa F\;�
CONC BOX OR RISER
------ TO OUTLET
OUTLET CONTROL
THIN.
.PRIFICE
CONTROL CATCH BASIN
SYSTEM CROSS SECTION
JAN 2 9 1997
2'X2'X6' DEEP, 4-6- SPALLS OR EGUAL
PERMIT COUNTER
FROM CONTROL CB 2'X 2'X 3- DEEP. 3/4- CRUSHED ROCK ISTING GRADE
FROM CONTROL OUTLET WASHED ROCK
OUTFLOW TRENCH, MIN 10- L6NG.
L5' PERF PIPE TO BE LEVEL
PERF PIPE W/ END CAPS
"TRENCH SMALL BE LINED WITH MIRAFI
,RIPRAP MlEr PRIOR TO PLACEMENT OF WASHED DRAIN ROCK
RUNOFF SPREADER. TRENCH
FOOTING DRAINS SLULL NOT BE CONNECTED TO DETENTION SYSTEM
NOTES:
L Call Engineering Division (771-0220) for a tightline and detention system inspection
before backfilling and for final inspections. APPROVED BY
2, Responsibility for operation and maintenance of dn&age systems on private property is the
ibility of the, property owner. Material accumulated in the -storage pipe must be Bushed
responsi
- out and removed fiom the catch basins to allow proper operation. 11W outlet control orifice DA7E
must be t oVeO at all times. I
6,.
F_
L-1
CITY OF EDMONDS
9 0
Address of Construction:
Property Legal Description (Include all.easements):
R F.
SIDE SEWER PERMIT
PERMIT N.0- 8860
c,� 7,e� '17a'.
[an
U`81
pUBLIC VVOKKS V71
4
f AV) I, AA A .4 1 1 � It 70
Owner and/or Contractor: F=
State License No. ilo r Building Permit No.
Single Family
0 Multi -Family (No. of Units—)
El Commercial
El Public
Invas ion into City Right-of-Wa No El Yes
y X.
RW Construction Permit No.
Cross other Private Property: No 11 Yes
Attach legal description and copy of recorded easement
I certify that I have read and shall comply with all city requirements
as indicated on the back of the Permit Card.
Date
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION
U§E,:6NLY
FOR INSPECTION CALL 771-92ez, PUBLIC WORKS DEPT.
Permit Fee: _�4 Issued By
Trunk'Charge: Date Issued: L!� V
Assessment Fee: Receipt No.:
Lid No
Partial Inspection: Date —Initial,
Comments
Reason Rejected: Date —initial
Final Inspection Approved: Datk-11-611nitialef:!�
9
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3190
The City of Edmonds
Side Sewer Drawing
NEW
OWN8R---- ............................. ................. ............ ------------------ ----------- CONTRACTOR .......... ---------------------- ----------------------------------- .............. PERMIT NO. .%K�.. .-
—_.......... ...................................................... ................... .................................................... ..................
NAME OF ADDITION ......... -------------------------- .................
EVVI------' —'
TREATMENT PLANT
��������, �
�
��
Pvvvx*001-1/175(nsxA 1ne
�i7
---------------
el
City of Edmo,n.*
RIGHT-OF-WAY CONSTRUCTION
PERMFF Permit Number,
Lssue Dat-*
A. Address or Vicinity of Constniction: - 706 F I R STREET'
- GTE to place. operate, and maintain a buried service
B. Type of Work (be specific): wi re f rom exi stj ng f I ower pot I ocated at 706 Fi r Street
then west to a residence at-7U6-FT_r Street. UIL to plow b* feet, push oiFe
driveway and push no road. R.O.W. Footage 90 feet.
MarilynHolmgren, Permit Coordinator
C. Contractor: GTE 142if �pp&
sVgphg:5,d Contact: Chuck Roberts 771-9036 mobile 388-1358
0
Mailing Address: Nerett. WA 98204-1440 Phone: Marilyn Holmqren 425/710-0786 or 488-1628
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. F1 Commercial [:J Subdivision CityProject 0 Utility (PUD, GTE ATER)
...a WNG, CABLE, W
rJ Multi-Farnily Single Family Other 2100-9POOlDB 242310
INSPECTOR: INSPECTOR: LJ
F. Pavement or Concrete Cut: 0 Yes E]No G. Size of Cut: x H. Charg4�_$
Please see attached ske�ch.'$,
APPLICANT TO READ AND SIGN
INDEMNITY.- Applicant understands and by his signature to this application to hold the Ch�v of Edmonds harmlessftom injuries, damages, or claims ofany
kind or description whatsoever, foreseen or unforeseen, 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 and attorneyfees by reason of granting this permit.
THE COMW CTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA TERIA LS FOR A PERIOD OF ONE YEAR FOLIO WING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings of proposed work required with permit application.
A 24 hour notice is required for inspection. Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut trench work shall be patched with asphalt or City approved material prior to the end of tile working day;
NO EXCEPTIONS.
I have read the(Oe st *n and un nd the permit requirements and the pink copy of the permit will be
f 11 5",
ava ilahle onsit I 1 111 * es o i sp n ur oses.
Signature.. M1/2Vz David Squires- Date:
o;nrtactor or Agent) Sec Mgr -Access Design
CALL IAL-A-DIG PRIOR TO BEGINNING WORK
NO WO RK SHALL BEGIN PRIOR TO -PERMIT ISSUANCE Eng. Di, 1997
LEGEND
CD
z PERMIT SUBMITTED BY
CTE
-/o y
,,ie
------------------------ -------
PEDS a I
POLES 0
ROAD BORES
OVERHEAD LINES-
J.D. UTILITY POTHOLE =
UC TRENCHING ---UCT-
0
R. 0. w.
------------ EOP
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STREE'T FILE
Al 'c 77
JAN 2 9 1997
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FEB - 7 1997
PERMIT COUNTER
CITY OF EDMONDS
USE PERMIT
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT #
ADDRESS
0WNERNj%ME/ E OF BUSINESS
X (ft fi*A"
DESCRIPTION CHE
/ e- 7—
U"f)IV . ('�21 T
KE
LEGAL CKI
/Or Z
SUBDIVISION NO.
23-9
LiD NO
W
MAILING ADDRESS
Z
—Wel kX1,
_4c,—
PUBLIC RIGHJ OE WAY PER OFFICIAL STREET MAP.
TESC P Approved 13
RW Permit Required 0
0
R/ � ioerr '40
CITY 41p,
TELEPHONE NUMBER
�e'QG
`K,
EXISTING REOUIRED DEDICATION
Street Use Permit Req'd 13
Inspection tl�
'ED
Required
Sidewalk Required W
c,
E
_XMZ;jM — 4e�7
METER SIZET
LINE SIZE
NO. OF FIXTURES
PRV REOUIRED
W
AWRESSUI
YES 0 NO 0
L)
0 , !_�)e / � 104 .
REMARKS
(1) iw; 4D
b,. C
IZ-1
W
cc
ZIP
ELEPHONE NUMBER
QTy.. .
x, LA 1�1
L
Z
V_
lic- btl,
NAME
ADOR
Mw
Q
It 14
ENGINI�ERING MEMO DATED
REVIEWED BY
cc
C!TY
HONE NUMBER
I`_
Z
FIRE MEMO DATED
REVIEWED BY
W
8
STATE LICE SE NUMBER EXPIR TI 0 DATE
Cr
F#j A r e5ec 5"8-7b ;;i I/I �0191
SIGN AREA
SEPA REVIEW
—orvbf!Pr6perty 1- inclyclei 11
LleplDeSdrii-pti a easementd
ALLOWED
PROPOSED
COMPLETE
I
1EXEMPT
SHORELINE#
EXP
r,
L)
n 0 q-2
)e
VARIANCE OR CU
PLANNING REVIEW BY
DATE
0.
A-17U'77
SETBACKS — FEET
V
HEIGHT
LOT COVERAGE
FRONT;W' SIDE
REAR
12.5'
3 0,7,
Z
Z
_w.
Property
Tax Account
4/17,q.
REMARKS
P.rcel No. t5oq_
12NEW
0 P LUM61NGIMECH
ESIDENTIAL
COMPLIANCE OR
ADDITION
COMMERCIAL
CHANGE OF USE
Ej.R*E-..DEL
El APT. BLDG.
SIGN
FENCE
REPAIR YDS. x _FT)
CHECKED BY
TYPE OF CONSTRUCTION
CODE
OCCUPANT
GROZ
E] WOODSTOVE SWIM POOL
M DEMOLISH INSERT HOT TUB/SPA
SPECIAL INSPECTOR
REOUIRED
OCCUPANT
13 YES
LOAD
GARAGE RETAINING WALL/ RENEWAL
CARPORT -El.
—REMARKS
L_j ROCKERY
Z
0
*1
(TYPE OF USE. BLISINESSPR ACTIVITY) EXPLAIN:
PROGRESS INSPECTIONS PER.UBC 108
Z
51A.
r V140.
NUMBER
NUMBER OF
CRITICAL El
W
0
DWELLING
AREAS
Go
0
STORIES
U
NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT P�AN)
J7 2ase&
64�n2
L-2j::4VT--_
FINAL INSPECTIO14
PEQUIRED
61 17&
VALUATION
FEE
PLAN CHECK FEE
HEAT GLAZING'
BUJLDING
SOURCE:
%
A7r7 4<'
PLUMBING
Plan Check No. 9
MECHANICAL
GRADING/FILL
This Permit cov ' e * rs work to be done on private property ONLT._
Any construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
4,
Permit Application: 180 Days
Permit Limit: 1 Year'- Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
(WA
harmless ' the City of Edmonds, Washington, Its officials,
m
employees, and agents.from any and all claims for damages of
cr
<
whatever nature, arising directly or Indirectly from the Issuance
X
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
a
modify, waive or reduce any requirement of any city ordinance
0
x
.
nor limit In any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
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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
APPLICATION APPROVAL
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
T his application is not a permit until
ed .thereby, no person will be employed, In violation of the Labor
ONLY THE
.
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Iniprance and RCW 18.27.
INSPECTION
acknowledged in space provided.
SIGN JOWN.E OR A I ATE SIGNED
DEPARTMENT
12
I
CITY OF
OFFICI SIG A e DATE
'C", Sit
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EDMONDS
ATTENTION'
CALL FOR F(EL
INSPECTION
A E By DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
OR�IN;L File YELLOVV.
— Illey
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
PINK — Owner GOLD :d Assessor
10247
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RECCORDED
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Return Address:
City of Edmonds City Clerk
505 Bell Street
Edmonds, WA 98020
97 MAR -3 AM 11: 21
580HOt`,1S�i COLIHTY, WASH
.DEPIJTY----
STATEMENT ON ACCESSORY DWELLING UNITS
Property Address:
Edmonds, Washington
Legal Description: _ VC,0,64
--4 4? / / "'\ -A
Assessor's Parcel Number: 6 / C? 11—e 411 —e /6 — eel 0 Z—
I have read the requirements for accessory dwelling units contained in Chapter 20.21 of
the Edmonds Community Development Code and understand that an accessory dwelling
unit, including a second kitchen, is prohibited for two years after occupancy by the
current owner (unless a waiver is granted by the Community Services Department) and
until after a conditional use permit has been approved by the City of Edmonds Hearing
Examiner.
I also understand that approval of a conditional use permit is subject to a public
hearing, and neither this statement nor the issuance of a building permit shall act to
limit the discretion of the City in the r view of any application for a conditional use
permit.
Property Own S' nature:
7
Date:
STATE OF WASHINGTON
COUNTY OF SNOHOMISH
( - — , 1E , (Z f Ile
C. Michael Arnim
I certify that I know or have satisfactory evidence that C -
signed this instrument and acknowledge it to be h isA;oF free and* voluntary act for the uses and purposes
mentioned in this instrument.
Nolary's pressure seais must be smud-ed
01
0.�
%
Dated: A��-A -
Signature of
Notary Public:\�,�
Residing at:.
My Appointment
Expires:
THIS DOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY AUDITOR.
voL. 3275PAGE1696