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7115 180TH ST SW
k� KING DATA
SINGLE FAMILY RESIDENTIAL
STREET FILE
Name: ,- .�
I.� (.�� O 0.51 g d 0 000 20'0
Date: i
Site Address: two v
Plan Check #�G Z(c-( 0 S
Project Description:
Reduced Site Plan Provided: / NO)
Zoning: S --
Map Page: ��
Corner Lot: (YES / P45P
Flag Lot: (YES
Critical Areas Determination #: //�
❑ Study Required
Waiver
SEPA Determination:
O-LExempt
❑ Needed (for over 500 cubic yards of grading)
❑ Fee ❑ Checklist ❑ APO List with notarized form
Required Setbacks
Street: Z �—
Sidg: �—
Side*
Rehr: f�
... Actua/ Setbacks
Street:
Zz eA s� h & se
Side:
S e,c f �� J ��
Side:
3
Rear:
f 6
Detached tructures:
❑ Rockeries:
❑ Fences/Trellises:
❑ Bay Windows/Projecting Modulation:
❑ Stairs/Deck:
Buildin Height
Datum Point: �-
Datum Elevation: -----
Maximum Height Allowed:
eight:
Other
Parking Required:
Parking Provided: Z 'e'C (o fzen�
Lot Area: 1 Z j Z 5 5
4/
Maximum Lot Coverage: 35% Proposed: l0.
Lot Coverage Calculations: h d / Se (/6 S0) -r rc. 4-. ke f -76t- a dG/,
ADU Created: (YES / O
Subdivision: rs d 4i. f 6" Z
v?
Legal Nonconforming Land Use Determination Issued: (YES /EO
Comments
!1 �t
/q- nN �-L
� siL
Plan Review By:
Planning Data Form 0411-06.doc
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�` ,� PERMIT NO: 9321
Vlk'l
Ci of Edmonds �� , g90 SIDE SEWER PERMIT PERMIT EXPIRES co 0
Address of Construction: -7 ®S' LID #
Property Tax Account Parcel No. S7 / i'F3y UU 0 2 D 0 0 Y,
Attach copies of all access and utility easements /Verified and Approved by
Owner and/or Contractor: ,t��w4w.•0j tZ ot- S
Contractor License #:
6 z lk
Single Family
❑ Multi -Family (No. of Units
❑ Commercial (No. of Units )
❑ Public
7
ilding Permit #: `�—*--
Invasion into City *Right -of Way: ❑ Yes
*RW Construction Permit #
O No
Cross other **Private Property: ❑ Yes 9f:No
"Attach legal description and copy of recorded easement.'-
I f i Owner/Contractor a o e
Own or re contractor signature and acknowledgement statement: Date
'By signing for this.permit I certify that I have read the City's public handout entitled
ide Sewer Specifications, and shall comply with all City requirements outlined therein. „
9 CALL DIAL-A-DIG.(1-800-425-5555) BEFORE ANY EXCAVATION 2
9 FOR INSPECTION CALL 425-771-0220 extension/Y?_ ff1_ff—
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
...... FOR OFFICE USE ONLY
y�
Permit Fee $ 30 Repair Fee $ Issued By: ,
Trunk Charge $ Date Issued: 't' Z 1! O
Assessment Fee $ Receipt No: 2.
City Permit Surcharge Fee $5.00 Total Fees Paid $ ._..
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:
L Partial Inspection: Date: Initial:
r_^ � I 1
FINAL INSPECTION APPROVED: Date: Aakq Initial: As -built to Street File:,
1,� PERMIT MUST BE POSTED ON JOB SITE Vz-
White Copy: File Green Copy: Inspector Buff Copy:_ Applicant
L;temp;bl dg;forms;ssperrn itj lg4/00
N
180TH ST. SW
CITY OF EDMONDS SIDE SEWER AS -BUILT
PERMIT
ADDRESS 7115 180TH ST, SW I NUMBER 9321
H❑ME❑WNERXXXXXXXXXX
DATE 04/06/01
CONTRACTOR
BRAWN ISMAEL ABILA
I
I , I
I I i I
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).