7124 165TH PL SW.PDF926
7124 165TH PL SW
PROJECT REVIEW CHECKLIST
PROJECT NAME: 4 �\
PLAN CHECK
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PROJECT ADDRESS: ��� �CpS JDL S� RECEIPT DATE;;//� -s—
EVIEW
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PLAN.
WATER11
COMMENTS
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SEWER STRE
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Setbacks/Variance/Setback Adjustment
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Conditional Use Permit:
ADB Requirements
Other Zoning Requirements
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Underground Wiring Required
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Lot Slope 1596
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SEPA Environmental Checklist/Hydraulics Permit
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Tree Cutting Plan
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Plat/Subdivision Requirements
Le ai Description Verification
Quit Claim/Street Dedications
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Easements - Public/Private
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Engineering Storm Drain Review Fee
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Engineering 2.2 Inspection Fee
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Drainage Plan (On -Site
Setback - Top of Bank, Stream, Water Courses
Setback - Storm Drain Line
Open bitch - Existing1g_
Culvert Required
Culvert Size
Shoulder Drainage/Shale Open Runoff
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Catch Basin Required
Driveway Slope & Vehicle Access ft-
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Sidewalk Required
Curb &Gutter Required
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Curb Cut For Driveway Required
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Street Paving Required
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Right -Of -Way Construction Permit Required
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Street Name Sign Required
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Other Signing Required
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Bond Required For Public Improvements
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FEMA Map Check/Water Table"'
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32
Side Sewer Availability�b
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Calculate Sewer Connection Fee If No LID # 7 3
Create Street File
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Existing Water Main Size
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Water Meter Size
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Service Line Size
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Water Meter Charge Re uired lY
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Hydrant Required
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Hydrant Size Existing
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Fire Line Charge Required - Sprinkler
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Street Cut
Miscellaneous
Reviewed By:
FIRE
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11
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PAID RECEIPT DATE
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SS PERMIT DATE ISSURECEIPT
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PAID $ RECEIPT # DATE
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METER SIZE ZV PAID $J25 DATE -Z- RECEIPT ,Zb7
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APPROVED DY I'! ANNiCu ' I
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F_Jrnwds, WA
RECEIVED
N O V 1 7 1995
PERMIT COUNTER
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LEGAL: PARCEL 1 - All of the Southerly 80.2 ft. as measured along the West line of the
Westerly 149.7 ft. as measured along the South line of Tract 85, plat of Meadowdale
Beach, records of Snohomish County, Washington, EXCEPT the West 10 ft. deeded to the
City of Edmonds for street purposes.
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RECEIVED
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c _. _7r2%wad PERMIT COUNTER
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APPROVED AS NOTED— E'd fnon�5 , WA 9802co e��D
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Dennis M. Bruce, P.E.
M.S.C.E., M.B.A. Geotechnical/Civil Engineer
November 8, 1995 RECEIVED
N 0 V 17 1995
Alconmar Co., Inc. PERMITCOUNTER
7016 165th PI. S.W,
Edmonds, WA 98026
Attn: Mr. Conrad Matlock - --
Subject: Geotechnical Assessment C ,
Proposed New Single Family Residence
.�- @ 7124 165th PI. S,W._)(
This engineering report presents the results of a visual geotechnical assessment with
hand dug soil test holes for the proposed new single family residence at 7124 '165th PI.
S.W_,'Edmonds, Washington. This assessment was necessitated by owner/developer
concerns, as well as City of Edmonds requirements.
References: e Proposed Residence Plans
Site Plan Sketch (attached)
• Site Photographs (available)
Background:
The lot is rectangular in shape approximately 80 ft. wide (along 72nd Ave W.) and
approximately 150 ft. deep. The property has never been developed and contains shrubs,
brush, and small trees.
The lot consists of a relatively flat or gently sloping eastern portion and a
moderately sloped western portion adjacent 72nd Ave, W.
Vehicle access to this lot is understood to be via easement from 165th,P1. S
along the east property line of this lot and adjacent (to the north) lot.
The neighborhood consists of existing single family residences on similarly sloping
or more severe slopes. The lots surrounding this lot all hr ve existing S.F.R.
Assessment:
Visual assessment of property reveal:; 110 evidence of any geotechnic.al distress.
No settlements, no creep, no sliding, nor any erosional distress was observed.
SOILS - FOUNDATIONS + SITE DEVELOPMENT • INSPECTION DRAINAGE • DESIGN & PERMIT - 'AL
I
17814 8th Ave, N.W. • Seattle, Washington 98177 (206) 546-9217 • FAX 546-8442 r=
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' Td Wdi T :90 ,r•GT TT '^^N 17M78 9t,S 9C�,_ 'OH 310Hd l��_it� u� � •� __m ig r� llacid
Hand dug soil test holes were dug to 30 inch depths. Analysis of the test Boles
verified sufficiently dense soil subgrade to enable standard reinforced concretecontinuous
footings be uti I i zed.
No drainage courses, or drainage problems were observed on this lot. It is
pt -sumed that the proposed S.F.R. will comply with City of Edmonds stormwater
management requirements.
The street right-of-way of 165th PI. S.W. does contain stormwater. control (curbs,
inlet catch basins, etc.).
The right-of-way along 72nd Ave. W. does not appear to have any stormwater
mitigation.
Conclusion/Recommendations:
This lot is viable for the proposed S.F.R. development subject to the following
constraints:
e Compliance with City of Edmonds permit requirements.
Compliance with mandated 25 it. B.S.B.L. and further restriction of no
disturbances of westerly slope without additional geotechnical investigation.
The current house siting location is well setback from slope fa ._. and is
geotechnically approved.
Standard reinforced concrete footings designed for 2,000 p.s.f. are acceptable.
Drainage compliance with City of Edmonds standards. Do not discharged onto
westerly slope face.
Owner/developer should examine lot frontage along 72nd Ave. and clarify
any issues of concern with the City of Edmonds. (i.e, exact roadway limits,
quality of shoulder zone, lack of or future need for roadside drainage, etc.).
The westerly slope face is not Steep enough to require no vegetation removal.
Rather, select tree/shrub removal and thinning is geotechnically acceptable.
Erosional considerations, as well as aesthetic factors preclude total
vegetation removal on slope face. "Reasonable" landscaping efforts are
acceptable as well as leaving slope in its current
s This engineer should inspect excavation and footing formwork before any
concrete placement to verify the anticipated conditions. Advance notice is
appreciated and required.
Summary:
The proposed S.F,R, at 7124 1 GSth PI. S.W. is geotechnically approved, stroject to
the requirements herein and City of Edmonds permit standards.
fi� 's M'
Please call if there are questions. ► e�WAS,�,G
17405 1 ��
Dennis M. Bruce, P.E.
Geotechnical/Civil EngineerAL
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c.d bJJST:90 S66T TT '1I �t°t'1 Dt-S 90E� : 'Cif! 31,I0Hd as=ut5u3 •3'd `3-naH'19 : HOaJ
JRN-01-1996 04:13 FROM ALCON RR CO.iINC. TO
Deirnnis M. Bruce, P.E.
M.S.C.E., M.S.A.
January 8, 1996
F.01
14J.,iJsi� r'. tul
Enginoor
RIEVEIVED
JAN o, 9 1996
PERMIT COUNTER
V 114 FAV
Akonmarto., Inc.
7016 16511 PI. S,W.
Edmonds, WA 98o26
Attn: Mr. Conrad Matlack
Subject: Inspection of Foundation Subgrade
7124 165"' P1. S.W.
Reference: Geotechnical Asses;ment, November 8, 1995 by D. Bruce, P.E.
This engineer has observed and inspected the site grading and excavation for
the proposed SAR. it 1124 1659, PI. S.W.
Photographs available.
"O. clusion;
The (Oundation subgrade soils were as anticipated: Dense, relatively clean
gravelly sands, Thus, "O.K.- to proceed with foundation formwork, reinforc-Ing
steel, and concrete per City of Edmonds approved plans and inspection
requirements.
Call if qumlons.
Dennis M. 8ruce, P,E,
technical/Civil Engineer
DMB:njt�
Sol" • FOUNWIONS SITE DEVELOPM&NT WSPECTION .
IWCaE - oFalpN � PEftMrr • LEGAL
17814 8164ve, N.W. • Seattle. WAMI%ton 98177 (2g6) 546-9217 FAX 546.8442
TOTAL P.01
CA 1'ILL= NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location:
2. Property Tax Account Number: S 13 I — 0 o O — 0 $ S — 1007
3. Approximate Site Size (acres or square feet): ' °' ''/ Z . Oy,
4. Is this site currently developed? yes; A. no.
If yes; how is site developed?
R
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PEPMff c9q TER
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 10 feet over a
horizontal distance of 664eet)_
_ Hilly: slopes presept-on site of more than 15`:1; and less than 3096 (a vertical rise;:
R;. of 10-feet over a horizontal distance of 33 to 66-feet). N••;
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): y
6. Site contains areas of year-round standing water_ 0 ;Approx. Depth:..
7. Site contains areas of seasonal standing water_ No; Approx. Depth:
What season(s) of the year? `
8. Site. is, in the floodwayN ip floodplam _ of a crater course_
9. Site contains. a creek or an area where water flo cross the grounds surface? Flows are year-;.-, ,
round? 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: _
For City Staff use only -
1.:.:;:,': Site is Zoned? rz5- (Z-
7 ':.Sr4 ffnanned soil tvne(sl? A ncy_&a, ic717 jlift{
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City `�of$dmonds
Y
Critical Areas._ CheCk-list-
Ine Critical Areas Checklist contained on -
and submit it to the City. The City will -.
this form is to be`filled out by any person `''
review the checklist, make a precursory site '
preparing a Development Permit :•
visit, and make a determination of the
Application for --the City; of Edmond$ prior
subsequent steps, necessary to complete a
to his/her submittal of a developm"t,; , . ` .k ''
development permit application.
permit to.the City::, x.;,�
:'• 4- .
With a signed copy of this form, the
The purpose of the Checklist is to enable
applicant should also submit a vicinity map
City staff to determine whether any-'
or plot plan for individual lots of the parcel
potential Critical -Areas are or "may tie _ ; ,'
with enough detail that City staff can find
present on the subject property. The �-=1'; .
and identify the subject parcel(s)_ 'In` '
information needed to complete the ,aY, ; ; ; V
addition,' th e-applicant shall include .-.. _.
Checklist should be easily available from
other pertinent information (e.g. site ..
observations of the site or data available at
plan; topography map, etc.) or studies in
City Hall (Critical Areas inventories, maps, -
conjunction with this Checklist to assist"'
or soil surveys).,_ .\- :. . _
staff in completing their preliminat3► . ,.
assessment of the site.
An applicant, or his/her representative,
must fill out the checklist, sign and date it,
I have completed the •attached Critical Area Checklist and attestthatthe answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
AI m)o
Name
Street Address
Applicant Representative:
Name
1016 165 ' P/-, Syv
Street Address
d Mon ds I VYA
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ft�n,0,A V/ A fgoZ.�
:. �� y5 3514
City, State, ZIP
Phone
City, State, ZIP.
.
.Phone
Signature
Date
Signature
Date
PLANNING DATA
SITE ADDRESS: 7i Z4" '16sl� Si✓ DATE: 11- 3 0 - -7r
ZONING: es- 1 Z PLAN CHK#: 4 S- - zoo
PROJECT DESCRIPTION: S.F1-p- ,
SETBACKS:
Required Setbacks:
Front: 2 S Left Side: I ° Right Side: 10 Rear: Z �'
Actual Setbacks:
Front: Z f Left Side: 13 Right Side:I/ _Rear: 6 S
CORNER LOT i✓��
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED Ajo
LOT COVERAGE: 99
Maximum Allowed: 3 S� Actual: Z 5,!v
BUILDING HEIGHT:
Maximum Allowed: jf ?. Y Actual Height: Is 9
SUBDIVISION:
CRITICAL AREAS #: fl- -
SEPA DETERMINATION: M
LOT AREA: t 7-, o 0
191ta4 ;
Plan Review By: � 4 ^k
'1� �, "�. ,„ '_. _.--.-w..s.—.,r✓tti.-t�Wr+�-`�..�"f�•�!'1..y>—�,:i.,.�✓+�t,�.r-�.yr•..r •.-��..-.•�....^•'v.i�`F-,,,iv7r.°i+�+�:V`".,,•hY✓i.,.v�....,..n-l�+-•i""...•-c.��� l:-���i{•:,.nn.:�...2�1,.��t.�...•
City 0 Edmonds. �!
-OF-WAY CONSTRUCTION.
RIGHT
PERMIT
Permit Number.
Issue Date: C%3" 0.9
A. Address or Vicinity of Construction: 719A 165 P1 SW (9608456 )
18 o B. Type of Work (be specific): Install Service
90.19 4�
C. Contractor: Washington Natural Gas
Mailing Address: 1-1_9 9 75 St ew 'yixerre t t
State License #: 98903
D. Building Permit # (if applicable):
M
Contact: Mar_iamnp Kingsbury V,
Phone:' 356-7500 ext 7596
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project U Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR:
4
F. Pavement or Concrete Cut: ❑ Yes WNo G. Size of Cut:r x H. Char e $
APPLICANT TO REA' , ND SIGN 0
INDEMNITY: Applicant understands and by his signature to this application, agrees tol dId"Ithe City of Edmonds harmless from injuries, damages, or
claims of any 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- fens' costs, and attorney fees I n arson of �nting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing 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 bAept 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 ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be
available on site at 7allimes for inspecti n purposes.
Signature: Date: 3-6-96
ontrac or or en
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: �_A_)L,
TIME AUTHORIZED: VOID AFTER
RIGHT OF WAY DEPOSIT —
DISRUPTION FEE/FUND 111:
SPECIAL CONDITIONS: RESTORATION FEE:
PERMIT FEE:C"7
:drluli�i�4iiL��
TOTAL FEE: �4 l-)' C n
i•-
DATE: ISSUED BY:
NO WORK SHALL BEGIN- PRIOR. TO PERMIT ISSUANCE
Eng. Div. 1994
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Watermain depth N/A
Z- gas main
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Addendum to: City of Edmonds
Right of Way
Permit Application
.- - Kingsbury Submitted by: Mariamne ings ry
Engineering Aide
Washington Natural Gas
1356-7500 . X7596
-%,- %Mb
-SS- Sever
.& Water hydrant
Q Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331
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"Wm"Q1on[r* C-vewV Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 .X7596
Watermain depth N/A
gas main
7
-4 12 4 ! cow
Pt- SW
Key:
-W- Water
-C- Gas
-SS- Sever
-& Water hydrant,
0 Water valve
Washington Natural Gas Company
1122 75th Street S.. Everett, Washington 98203, (206) 355-3331
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a~*VIonEr*WCanvna Addendum .,to: City of Edmonds
Right of Way
Permit Application
Watermain depth N/A
Z- gas main
N
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 .X7596
�be� 9Gao�q-sue
-412 4
PL Sv,,1
Key:
-W- Water
-G- Gas
-SS- Sever
-. Water hydrant
p Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331
I
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number:
Issue Date: d
A. Address or Vicinity of Construction: 7124 165th Place SW
GTE to place operate and maintain a buried service
B. Type of Work (be specific): wi re from ex(sti no ei+�r pole #3093 1 ocated at
8 9 0 1 9 1 20 land Av W then east to a res ence at�'f 65th Place SW. TE to plow
50 feet and push one road 2? ;.re
A Bower, Permit Coord.
C. Contractor: GTE Northwest Incorporated Contact: Dennis Alexander 771-9036 or mobile 388-1358
22118 20th Av SE, Suite 130
Mailing Address: Bethnal l , WA 98021 Phone: Mary 906/4RR-1628
State License #: Liability Insurance: Bond: $
D. Building Permit 11(if applicable):
Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ® Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ® Single Family ❑ Other 2100 -9P001 DB 242310
INSPECTOR: INSPECTOR: I Nin l,04+
F. Pavement or Concrete Cut : ❑ Yes ®No G. Size of Cut: / x H. Charge $
Please see attached sketch.
APPLICANT TO READ ANfi�)N
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold�tke, ty of Edmonds harml a fro injuri'soamagea, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or anof its departments or
employees, including or not limited to the defense of any legal proceedings including defense costs, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing 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 ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be
available on site at all7'eslnsp ion purposes.
Signature:(IT441�John H. Stewart Date: January 29, 1996
(Contractor or Agent) Oprns Supv-OSP Engrg.
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: km t-i1 �I RIGHT OF WAY DEPOSIT _
TIME AUTHORIZED: VOID AFTER 1 'I EA ►``' DAYS DISRUPTION FEE/FUND 111:
SPECIAL CONDITIONS: iJ h RESTORATION FEE:
COMMENTS:
PERMIT FEE: <)
TOTAL FEE: �t! C>C7
RECEIPT. FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
sw�
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FIELD INSPECTION NOTES
I Comments
Diagram
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
D-
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PERMIT SUBMITTED BY
GTE
093�
3 ,`
THE FOLLOWING INFO TO BE PROVIDED
1
I
1
1
1
1
1
1
------------------------
t
1
1
1
1
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1
1
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1
LEGEND
PEDS
POLES 0
ROAD BORES
OVERHEAD LINES
I.O. UTILITY POTHOLE C�
UG TRENCHING ---UGT
R.Q.W.
EOP,
f
RIGHT OF WAY LINES.EOP OR FACE OF CURB, EXISTING SIDEWALK. POLES. ROAD CUTS AND THE UTILITY UNDER ROAD CUTS.
Ln
A80VE GROUND FACILITIES.0e:) PEDS.BOXES.CABINETS. ETC -.UNDERGROUND TRENCHING AND OVERHEAD LINES.
1-4
0
FOOTAGE OF WORK IN R.O.W.
tl
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M
Ca
cm
PERMIT SUBMITTED BY
GTE
1
1 -
3 '-
1
1
1
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=----- - - - - - -
LEGEND
PEDS
POLES 0
ROAD BORES
OVERHEAD LINES
1.0, UTILITY POTHOLE C]
UG TRENCHING ---UGT
5e PA 5 tl-j R.O.w.
----------------------- EOPy
� pow „
1
fej
1
712
1
1 -
THE FOLLOWING INFO TO BE PROVIDED
W _
RIGHT OF WAY LINES.EOP OR FACE OF CURB, EXISTING SIDEWALK. POLES, ROAD CUTS AND THE UTILITY UNDER ROAD CUTS.
Ln
ABOVE GROUND FACILITIES,(Ie:) PEDS.80XES.CABINETS. ETC..UNDERGROUND TRENCHING AND OVERHEAD LINES.
FOOTAGE OF WORK IN R.O.W.
0 i 40�
IEGAL ''P��;RC-21 1 - All of the Southerly 80.2 ft. as measured along the West line of the
Westerly 10.7 ft. as measured along the South line of Tract 85, plat of Meadowdale
Beach, records of Snohomish County, Washington, EXCEPT the West 10 ft. deeded to the 0
z
City of Edmonds for street purposes.
0 '� -1
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I 12,006 �� I
Na�t~� Cabs. I I
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A = IR8.3N I
a= 190•IG I I
C= 139.25 I
p = 139 . a3 I A + Iz8.3q
Avc. 6rodc. s 134A I
A��►41 = Asa .9' . I -
ftux — 159•y ml
r- ml
T QI 56
i
I
i Garaje.
—
+ 139.93
Dr&vcwct j
86.2,
APPROVED BY/ PLANNING
4-4 r, 4#1j - ,;;—/ 13—
IV
RECEIVED
NOV 1 7 1995
,\ PERMIT COUNTER
CA DILL NO. 10- -L-0
Critical Areas Checklist
Site Information (soils/topography%hydrology/vegetation)
1. -.-Site Address/Location:,. -7 � ), w - RECRIVEM
- - `4
2. Property Tax Account Number: 5 /.3l.- 000 0$5 /00-7 O C T= -0 �..,..✓ , ; fp �;
3. Approximate Site Size (acres or square feet):
4.
..1995.. .
4. Is this site currently developed? yes; no. , z PERMIT COUNTER
If yes; how is site developed?
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:10-feet over a
horizontal distance of 66-feet)_
Hilly: = slopest present on site of more than 15% and less than.30%. ( a;vertical rise
of .10-feet over a horizontal distance of 33 to Cj6-
v _
Steep: grades oFgreater than 3096 present on site (a vertical rise of 10-feet over
horizontal distance of less than 33-feet).
• - Other (please describe):
6. Site contains areas of year-round standing water. ;.,Approx. Depth:..- t
7. Site contains areas of_�seasonal standing,water. ; Approx:; Depth:
What seasons) of the year?
8. Site is in the floodway Nfl _ - floodplain p of a water course.q 4
9. Site contai s a creek or an area where water flo cross the grounds surface? Flows are.year- _n_;:;
round? ,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: _
For City Staff Use Only _
1. Site is Zoned?
O
'es mapped soil typels)?i(,�91,1�e0✓� (�(,P1 V�LE�I 6'�lll�►/ l - r-
3 <;< ' >Wetlaud inventory or C.A_ map indicates wetland present on site? _
4:> is<: Critical Areas inventory or C. A. map indicates Critical Area on site? jt3c7
5>;;><'Site within designated earth subsidence -landslide hazard area?%D
6 ite-designated on the Environmentally Sensitive Areas Map? �
:DETERMINATION - -
.'STUDY REQUIRED CONDITIONAL WAIVER
WAIVER
Reviewed by.
annex
Rtv01/OV94
�1
City ofEdmonds
Critical Areas
6 i
RC`��f?,.eF
_. ��.V i 'i-/,• �• •1. ..t' .r13:. fit' t ��'',
TER
Checklist
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 Edmond$ prior.,
to his/her submittal of a development" '
permit to the City..
The purpose of the Checklist is to enable
City staff to determine whether any"'
potential Critical Area 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). - I I ... .
An applicant, or his/her 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.
With a signed copy of this. form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In'r''•
addition, the applicant shall include -,-.
other pertinent information (eg. site .
Plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing their prelim nary
assessment of the site.
I have completed the attached Critical Area Checklist and attest thai the answers provided are_
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Al mAoc-k
Name
�o/(� Xys P4 sir
Street Address
iJm on d_s I YA gSoza 745 35yZ
City, State, ZIP Phone
Signature Date
Applicant Representative:
annzd Mock
Name _
1016 165")'. Pz, svv
Street Address
r �hmnd S In�A MZ.to' 2 q5 359Z .
City, State, ZIP -Phone
Signature Date
40
rl 12Z
165
01
pL
SLd
? Z-f
I65s�
STREET FILE
APPROVED
'6a - c B
E-Z.d
G6
"a; c g
rfne
ll�� 6-reok Yt
P; rup
1n " tS ►"eju'Pe J r��v'r 1-v r -(3. ttoS�a.G� ok•
61 4t,, Cb t k% n e-etoy--
�. -712,4 165
5 J
Ll
-� 2,1
166
VL
5a
STREET FILg
APPROVED
21
*-- ;: f 0 - 4 2-
I Lu yt,
5�'ater service drawing
Tne City ^f Edrinond:, EASEMENT NO . ............................................
NEW CONSTRUCTION ® REPAIRS ❑ LID NO ................... .ASMT. NO...................
07*4
OWNER/........................................................................ CONTRACTOR..AL.... MAT...1,.�?K.............................. .......... PERMIT NO....5 ...
JOB ADDRESS ... ..�..� 4......... .N.....I.. STH... PL. SWLEGAL Dl-SCRIPTION: LOT NO .............. `....................... BLOCK NO. ....................................
..................................................................................................................................................................
NAMEOF ADDITION ............. ......................................................... ..................................................
0---#_ —
r-1 ku
War 3�4~ CoPPER
PWW-0001-11175 (REV.11178)
AP Paox. 3 '*OEtP
Ex►sTI►40 l'/z" P.V.C_ ma P.S.I.
SuPEa ►.oN 'Re.
20'
1
4.LP
P.S' DUP
2'
.
'7114- 144 STw PL.
I
I
Approved: PAFCr%NL
DATE ... 9<Q............. B �/��!'" .. y.................................
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).
............... -�, v�..,i-tm..�., w •,.P.. --,. .,r�^^^w.,i,....rv. rr °a+.y ;`.y -,:a�� .,,, ....n '•....y _ __._ c�2 r.�. . v n: r -
srYlv�Jy.. ...... q4.x2 .... Y. ;�.�., i •..l ^c (+41e
City "of EdmondS ,
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number
r i Issue Date:
A. Address or Vicinity of Construction: 7i 2 4 1 &5 k FBI_ .s w
18 9 0 1 9 B. Type of Work (be specific): SU Qy JfAE1Igr _AJ _gZS t F LI A/L
SEE ATTAl. BEZ
C. Contractor: Laty1�S LFBL.� Contact: "Tb lY)IULRSQAJ
Mailing Address:3 N� Phone:
State License fi: REL eA 101 QA Liability Insurance: Bond: $
D. Building Permit tt (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project IQ Utility (PUD, GTE, WNG, rABLEJ WATER)
❑ Multi -Family ❑ Single Family ❑ Other 7�
INSPECTOR: I INSPECTOR:
F. Pavement or Concrete Cut : ,Yes ❑No G. Size of Cut: . x . H. Char e $
EwsrIAd,& X',AJ& - $E L15�D. i �`
APPLI ANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, -agrees to hold the City of Edmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of.Vj?umds, or any of its departments or
employees, including or not limited to the defense of any legal proceedings including defense cost- ,{ attorney fees:by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
1l
Construction drawing of proposed work required with permit application.
A 24 dour 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 ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and thepink copy of the permit will be
available on si at all ti a for inspection purposes. ,
Signature: Date:
(69h,�,
Ontrac or or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
`� j FOR;CITY4tJSE ONLY
APPROVED BY: 1T�'+' 1 RIGHT OF WAY DEPOSIT t
TIME AUTHORIZED: VOID AFTER (kl_6 DAYS ` "DISRUPTION FEE/FUND ..I11:
SPECIAL CONDITIONS: RESTORATION FEE:,
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
I Diagram;
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
-7124 /694 I-L Sw
w
Q
z
N
r
SS
I(o54 PL s, w.
'Burn NEW RG -1 i C IL
1NC_1_uDrni�,- zs' Rofa BO2E
-TRY TO USE EX I! ►KY— 61FIV
LPO.SS l W-T CONDuT
9Z' -TOMAI-
2' X4 ` VV/ND0W OVERL WATEK
IF LARi USE LckIstiuG k'/N(=.-
r ;•-n%-,--..r��,.rY'Elr'v�r.M1C?'°`r-%`� E. Wit':' `'RJ :. :<'4 C• ' Trn'u ra::x: v 3: •s�Si':. "r; �„g •F •�.{Fi'. �v�'., . �:a .-8- at-,M
I --now-
9 0 - 1 9
City of Edmonds .1
RIGHT-OF-WAY CONSTRUCTION
I
PERMIT
r 96 Permit Number, --
Issue Date: 6 /? / 9y
A. Address or Vicinity of Construction: / 6� � '04 ,
B. Type of Work (be specific): '70 ar
�!
C. Contractor: & �� ' !.Contact
Mailing Address: 70 /�%7 TGv Phone:
State License #: 4 t- AIC! 7- / !o t& Iq Liability Insurance:
Bond: $
D. Building Permit # (if applicable): �L %T Side Sewer Permit /1(if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ❑ Utility (PUD; GTE, WNG, CABLE, WATER)
❑ Multi -Family [P] Single Family ❑ Other
INSPECTOR: ,A INSPECTOR:
F. Pavement or Concrete Cut: ❑ Yes JoNo G. Size of Cut: x H. Charge $
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless fro injuries, s, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any t epartm s or
employees, including or not limited to the defense of any legalproceedings including defense costs, and attorney fees by reasiQn o nting t permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE Y R LZOW/N THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTj� FINAL BEET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUA_N TO THE PLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Divisio , 7 1-022 .
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 ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be
available on site at all.time or inspection pur osaes.
a
Signature: = �- Date: ���
-(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BYr rn M
TIME AUTHORIZED: VOID AFTER (`I } DAYS'
SPECIAL CONDITIONS:
COMMENTS:
RRIGHT- OF WAY DEPOSIT -
DISRUPTION FEE/FUND
RESTORATION FEE:
PERMIT FEE: 30, C� `
TOTAL FEE: fi U
RECEIPT FEE: —j —
DATE: ISSUED .BY: —1
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments
Diagram
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
IVED
7z hc4 Ave. w.
so.z�
7.5' 658L.
Drivcwcty
OCT 0 4 1995
PERMIT COUNTER
-� 130
---�---
,,,.,,)) 11 � eitse-r�r� � I�S�'ti P1� Svc/
I
PROJECT REVIEW CHECKLIST
PROJECT NAME: /%/%frZ—oC,�-_ PLAN CHECK #:�
I
PROJECT ADDRESS:_'71/6� �5 RECEIPT DATE-
EVIEW D BY: (nitial/Da
e)
PLAN. WATER
COMMENTS
FIRE
BLDG. SEWER
STREET
ENG. ,.'
Setbacks/Variance/Setback Adjustment
:.
; .. ....
:> .
2
Conditional Use Permit
,,.
ADB Requirements
h..?.
,
Other Zoning Requirements
4::
Underground Wiring Required
—»a
Lot Slope 1596
SEPA Environmental Checklist/Hydraulics Permit
`
" ':.:
Tree Cutting Plan4:':'?fir
%v<:
8
Plat/Subdivision Requirements
Le ai Description Verification
Quit Claim/Street Dedications
;" :
: ° >
>•. K
Easements - Public/Private
`,:"mow:{:;r.•M
2 :
Engineering Storm Drain Review Fee
"' ` ' Y
�
> 1;3"
Engineering 2.2 Inspection Fee
x
I145
is>_1;4::.
Drainage Plan On -Site
�_
-.r{u. ..
: "';"y>f
•<�..:.••f�f•.
:
I�li� lit
::1'S.`.
Setback - Top of Bank, Stream. Water Courses
.:
-
Setback - Storm Drain Line
O en Ditch - Existing
Culvert Required
Culvert Size
>>
Shoulder Drainage/Shale Open Runoff:
21
Catch Basin Required
,r,:.>, <:»,'�> �.
.. .Y::ly+>Y�K>.:ti•� `? v
22
Driveway Slope A Vehicle Access t
f>"
23
Sidewalk Required ,Ja
-]C+M1 >:?•:?,v?:> -::,>:
Curb & Gutter Required
t-.'R: h f
"'~ "'' r•.. }
.;
�'-•-.h:: f}-;.:: r
Curb Cut For Driveway Required
Street Paving Required
_,�,',,,;;
.26
27
Right -Of -Way Construction Permit Required
-r' ='"A'
'w
Street Name Sign Required
29
Other Signing Required
30
Bond Required For Public Improvements
=.: ;'<:
Y`'mL..
.31
FEMA Map Check/Water Table
32
Side Sewer Availability
r : r _;:;{
33
34
Calculate Sewer Connection Fee If No LID #17
......:
Create Street File35
»
Existing Water Main Size..
':
;g%%f,"•,
?};'' .,w,;,,< •>
36
Water Meter Size
?} •;.;
:
>:,xh
," ',;
Service Line Size:38
Water Meter Charge Required
7(0 0
Hydrant Re uired
Hydrant Size Existing
.>;,
Fire Line Charge Required -
;'';
.42
—Sprinkler
Street Cut t`
-` ✓ 1
,.;:X};:x?::} • S
.Sf>'4'N?>�•:}!;Y!::.i{ •+} _?a .. v • .:
-}
Q J
-Y=
w
.:: Y3
—�
Miscellaneous
44
Reviewed Bj THE FILE
FIRE
FILE:DATA123/PROJCKLS.SFN
PLANNING
ENGINEERING PUBLIC WORKS
66 A� 1% 'E 0
NO
I/
�vt S h1,U q C• g � Luh h.eA �-l�c. d.,rou N9`Y
c-
(�
'?o+�T
RECEIVED
t3 KT CiRp
- �72 ► ,4 Ave, W. 95
prpA it,"
Ull (K 10. MSS �c $ Aw
F C q-5pk-Lt Coy Ga
I i M!
l.l{��:,. cjl\ }3n5�n
5i H I I t ..
I ILI M---. - _r -t +2.t�
_K Gyp c��n`c� tv
I X
liv
o
Jaag ,n Ico
W2;w _ ! _ ___z i _ �►,w = r33, 4 j 350 �a . cl s
J \ �\ NI
Q r. O
CL I i
i.
Q ,-'�+ (:ant<•� i ,
Tkouci 1A d "q
2-5' BSBL.- 135
No
NZ---
2 v
,
APPROVED AS NOTED �'� S v.i J
Y L W .-
� k ,5 , o ( 5
t1/4,6 /A(C.
-7-Wd
-7129 = 166- rL, S,cJ.
/tlf w /-!o u s E
-�xrSrrnrP� lJRtyE�
Z
PERMIT APPLICATION REQUIREMENTS
To: Applicant
From: Lyle C3uisman, Engineering Inspector
Owner !6rr,- Plan Check No: ZZ
Address• . 10140 l &Gk�' A- SW
After review of the subject permit application, the following requirements must be met:
1. Construction hours are:
WEEKDAYS — 7:00 A.M.40:00 P.M.WEEKENDS/HOLIDAYS —10:00 A.M.-6:00 P.M.
2. A separate RIGHT-OF-WAY CONSTRUCTION PERMIT is required for all work on public property. (ECDC 18.60)
3. Truck haul route plan must be submitted and approved prior to permit issuance.
4. Builder/owner is responsible for containing all temporary runoff and erosion control on site.
(ECDC 1830.030d)
5. NO WORK SHALL BE DONE WITHIN 15 FEET OF STREAMS OR 10 FBET FROM ANY CLOSED DRAINAGE
FACILITY. BUILDER/OWNER IS RESPONSIBLE FOR IDENTIFYING CONDITIONS ON THE DRAWING. (ECDC
1830SOG)
6. FILTER FABRIC FENCE SHALL BE INSTALLED AND INSPECTED PRIOR TO CLEARING AND CONSTRUCTION.
(ECDC 1830)
7. INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEMS, TIGHTLINES AND CATCH BASIN
INSTALLATION. INSPECTIONS ARE REQUIRED PRIORTO BACMUING. (ECDC 1830)
9. 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 staffto determine the acterrt of
(ECDC 1&90) repair prior to issuance of the permit..
�. Driveway slope shall not exceed 14% without a waiver. Every attempt should be made to keep the slope below 14%. Waiver granted to
% (ECDC ILS&060D) ,
10. Driveways must be paved from Pro" line to City RIGHT-OF-WAY. A separate permit is required. (ECDC IU0.060C)
11. INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIORTO AND AFTER POURING. (ECDC 1830)
12. No burning of construction refuse without a permit from the Fine Department.
13. Connection to City water system is required. There is a separate charge for the water meter.
(ECDC 7.20)
A. A back water valve is required if downstairs plumbing is below the elevation of upstream manhole.. (ECDC 7.20)
.5. Wager and sewer main lines should be separated by 10 feet minimum. (ECDC 18.10)
6. Connection to the City sanitary system isMuir+ed. A separate pernitjs required.
Lm# - / Fees paid: Yes No Charge 5S (ECDC 18.10}
7. Underground wiring is required on all new construction, and for additions, alftation4 and repairs that exceed 50% of the total assessed
value of the structure. (ECDC 18 90) ,
8. A FINAL ENGINEERING INSPECTION IS REQUIRED PRIOR TO THE BUUMING DIVISION GRANTING OCCUPANCY
OF THE BUILDING OR STRUCTURE. (ECDC 1&90)
STANDARD DRAINAGE DETENTION SYSTEM
WORKSHEET f.
OWNER A) 11) 4 kc -k CALC BY:
ADDRESS - •? D I C I �- c+� �� SW PHONE:
6 /Yl °Dn o WA I SOZ c, DATE: C
*****DESIGN DATA*****
IMPERVIOUS AREA PIPE DIA PIPE LG ORIFICE
DETENTION RPE LENGTH • WASHED GRAVEL
/� TOFLOW P ANIW LONG
DT4'KPCERF PIP O BE LEVEL
If+K�.
RIM ELEV PMIN COVER Z•MA% COVER 4rMpl SPACEON ELEV ` FRS
< & OUTLET CONTROL t+ .
i 1 4'PERFPtPE W/CAPS
4'0 MIN
t
z .
• ORIM RUNOFF SPREADER
� r
INV ELF •. j L" 5 ` OUTLET
LOPER CATCH
BASMO CORIROL CAM N '
BASfN
r, 6' DEEP, 4'-W QUARRY SPALLS
,2LS DEEP, 3/4- D ROCK
SYSTEM CROSS SECTION _
• FROM CONTROL
OUTLET
RIPRAP OUTLET
FOOTING DRAINS SHALL NOT BE CONNECTED TO DETENTION SYSTEM
NOTES:
1. Call Engineering Division (771-0220) for a tightline and detention system inspection
APPROVED BY
before backfilling and for final inspections.
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
DATE
out and removed from the catch basins to allow proper operation. TLe outlet control orifice
must be kept open at all times.
Page 6 of 6
}.JN"�"�r7+�1^'".r?'.gfy"�'4�,("�Jni.i•Y'Yi'nW�.r�•.w•..4r�t1r`f't•'f �; � �•r r-' �rr
2)AYS
CITY OF EDMONDS
B90 19
Address of Construction: / I,,(-'Y- —
SIDE SEWER PERMIT
PERMIT i" 8745
, 0-d A-ro/U.0 � , 9go
Property Legal Description (Include all easements): �� ' 4960 " O g-5 — >0®%
v. r �rupRKS DEP1
nil_
Owner-and/or Contractor:.
o e% / ff4 e o/L/ I-,f /i,< (o - /'� C ,
State License No. A,4e_OA,�lG jr-_ / / 0 Building Permit No. 900 7Ailil
Single Family
❑ Multi -Family (No. of Units )
❑ Commercial
❑ Public
Invasion into City Right -of -Way: LWNo ❑ Yes
RW Construction Permit No.
Cross other Private Property: 09NoNo ❑ 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 *
OFFICE USE ONLY
* FOR INSPECTION CALL 771- , PUBLIC WORKS DEPT.
Permit Fee: Issued By
Trunk Charge: 6 5Date Issued: I?_ 2 � f
Assessment Fee: A) Receipt No.: cV 0,19 26
Lid No.: 1 73
Partial Inspection:
Comments
Reason Rejected:
Final Inspection Approved: Date - 12 46 Initial
Date Initial.
Date Initial
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3/90
v
Side Sewer Drawing
The City of Edmonds EASEMENT NO . ..............
NEW CONSTRUCTION REPAIRS ❑ LID NO . .................. .ASMT. NO. ----------------- ,
OWNER................................................................................................ CONTRACTOR ....................................... .------------ -------------------------------- PERMIT NO.
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JOB ADDRESS .. �....%. ...".. �.�P. S- z w 7L.-.... ... w..... LEGAL DESCRIPTION: LOT NO . ................. BLOCK NO.
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�- NAME OF ADDITION ----------------------------------------------------------------------------------------------------------------------
PWW-0001.11175 (REV.11178)
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Approved:
DATE... 9-(.z....-......... By .... .........................................
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CITY OF EDMONDS ZONE `., �. �i„ NUMBER 50741
CONSTRUCTION PERMIT APPLICATION ,IOB SUITE APT.
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OWNER NAME NAME OF BUSINESS ADDRESS ( 47" ( L• :' r
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O LEGAL DESCRIPTION CHECK SUBDIVISION NO LID NO
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ADDITION D COMMERCIAL MECHANICAL
DREMODEL D APt• BLDG. D
SIGN
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D DEMOLISH D INSERTTOVE a HOT TUBSPA
GARAGE RETAINING WALL/
CARPORT D ROCKERY EI RENEWAL
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(TYP F USE. BUSINE S OR CTIVIT EXPLA
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NUMBER
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NUMBER � �--', .
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DESCRIBE_WORK TO BE DQNE (ATTACH PLOT PLAN)
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RW Permit Required
EXISTING
REQUIRED DEDICATION ^I,'
Street Use Permit Req'd ❑
Inspection Required Q
PROPOSED
Sidewalk Required ❑
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METER IZE j#
LINE SI7�
NO. OF FIXTURES
PRV REQUIRED Q
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YES NO ❑ 3
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ENGINEERING MEMO DATED � �' REVIEWED BY
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SIGN AREA
SEPA REVIEW
ADB NO
ALLOWED
PROPOSED
COMPLETE
EXEMPT
SHORELINE a
EXP
VARIANCE OR CU
PLANNING REVIEW BY
DATE
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SETBACKS — FEET
HEIGHT
LOT COVERAGE
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;HE D TYPE OF CONSTRUCTION CODE OCCUPANT
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iPECIAL INSPECTOR v" OCCUPANT
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g1OUIRED YES �� + j LOAD
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PRO RESS INSPE81OMtP>`IOBC 305 , .•_y
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1447&44. j"iba/Av- . goHok, t4c
FINAL INSPECTION REQUIRED
VALUATION FEE
PLAN CHECK FEE
795
BUILDING
HEAT SOURCE:
GLAZING
PLUMBING
Plan Check No. .7
MECHANICAL
This Permit covers work to be done on private properly ONLY.
GRADINGIFILL
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Any construction on the public domain (curbs, sidewalks,
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
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
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harmless the City of Edmonds, Washington, its officials,
5
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
PLAN CHECK DEPOSIT
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of this permit. issuance of this permit shall not be deemed to
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modify, waive or reduce any requirement of any city ordinanceinor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
14A
provision."
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
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
THIS PERMIT
This application is not a permit until
e laws regulating Construction; and in doing the work authoriz•
AUTHORIZES
signed by the Building Official or his/her
hereby, no person will be employed in violation of the Labor
WORK NOTED
Deputy; and fees are paid, and receipt is
e of the State of Washington relating to Workmen's Compensa
acknowledged in space provided.
Insurance and RCW 18.27.
INSPECTION
T RE (OWNER OR AGENT) DATE SIGNED
Led
DEPARTMENT
OFF( I 'S S ATURE DATE
ito/I
CITY OF
EDMONDS
I A%
CALL
?E 10 :' D TE
ATTENTION
INSPECTION
S?
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
LL
771 220
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ORIGINAL — F,;e YELLO — I pector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
CHAPTER 3.
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AI� /�
PINK — 0+%ner GOLD — Assessor
102-BT
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