211 4TH AVE N.PDFiiiiiiiiiiiiii
14628
211 4TH AVE N
"'REET FILE APPUCATION
for
The City of Edinonds SME SLOWER PERMrr
NEW CONSTRUCTION REPAIRS EASMACENT No . ..........................................
11 -00 0
OWNER ........... Emerson Thom son
...................................... P- ....... 7 ................................................ C01WRACTOR ............................. ................................... ......... ...................... PERIM No
ADDRESS ....... 21.1 .... 41h ... Ave ....... N - - ---------------------------------------------------- LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ..........
NAME OF ADDITION ----- -_ ........................
Dye Tested On Sewer 1972
Approved:
DATE............................................ ... By
'90
City of Edmon&
Critical Areas Checklist
The Critical Areas Checklist contained on
and submit it to -the City. 17he City win
this form is to be filled out by any person
review the checklist, make a precursory site
preparing a Development Permit
visk,'and make a determinatioh'of the
Application for the City of Edmondsprior
subsequent steps necessary to complete a
to his/her submittal of a development
*
development permit application.—
permit to the City.
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 it_#�& mi li�WM �li��e �11�1
potential Critical Areas are or may be'
with . e I nough detail that City staff can find
present on the subject property. The-
a*nd.identify the subject parcei(s). In,.
information needed to complete the -
RAdition, *the applicant shall include
Checklist should be easily available from
other &rtinent informit6n (eg.- site
observations of the site or data available at
plang topography map,'etc.) or studies in
City Hall (Critical Areas inventories.' maps,
conjunction with this Cheddist, to assist
or soil surveys).
staff in completing their prelimin - ary
ass�eiit of the ki
An applicant, or his/her representative,
must fill out the checklist, sign and date.it,
I have completed the attached critical Area Ch6c --and attest that. di e.'.'
MY. out,the
column belqw).--,-
rop
Representsitii4k
cant
Vvinir I Appli A
OPH
A,&
A
U
Z'.7,
��7. 77 -
V:1, "u,
iq. ��kl .
2
'20".
Shed Ad
zdc�_, gy/o/
ty" We, zip: AW
ity UiW, ZEP;.� s.�7.H.
C S
D
CA FILE NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 2 o -3 �i a 1:13E A og lUc, e-
.2. Property Tax Account Number: 4,3 o0o 0 667-
1z _5
3. Approximate Site Size (acres or square feet): L� 4 4-L
4. Is this site currently developed? __t'
yes; no.
If yes; how is site developed?--
5. Describe the general site topography. Check all that apply.
v/ 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: slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet). -
-Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the yeat?
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? it, Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs
mixed
urban landscaped Qawnshrubs etc)
11. Obvious wedand is present on site:
RevO110094
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLIdATION
USL PERMIT
ZONE NUMBER ?d.3
JOB
ADDRESS
SUITFIAPT
$1
OWNER NAME/NAME OF BUSINESS
t1t\ Q A tkac,�,
LEGAL DESCRIPTION CHECKI
SUBDIVISION NO.
LID NO.
W
MAILING ADDRESS
Z
0'
OS -S:) A
cc
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — REQUIRED DEDICATION
PROPOSED
TESCP Approved
AW Permit Required C3
Street Use Permit Raq'd 13
Inspection Required 13
Sidewalk Recibired E3
CITY ZIP
TELEPHONE NUMBER
(,r17-Lj]0,f-70A
NAME
u0j
L)
c('
W
3.
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO E3
ADDRESS
REMARKS
4
zi
CITY P
TELEPHONE NUMBER
I
uJA 7—L
NAME
04 10 LL.
cc
-0
0
Z
8
rh Ili=
ADDRESS
C) (0 VZ r -2-0 2-
ENGINEERING MEMO DATED REVIEWED BY
CITY ZIP
CV3 k,5��
TELEPHONE NUMBER
U 0 -Vnl \
FIRE MEMO DATED REVIEWED BY
uj
M
STATE LICENSE NUMBER EXPIRATION DATE
6 6 —5 (!3
SIGN AREA
ALLOWED I PROPOSED
SEPA REVIEW.
COMPLETE 1EXEMPT
ADS NO.
SHORELINE 0
Legal Description of Property include all Baseman b4j'2�
Z
6XP
cc
VARIANCE OR CU
PLANNING REVIEW BY
DATE
uj
.j
<
ui
Z
Z
5
a.
SETBACKS — FEET
FRONT SIDE REAR
HT
LOT COVERAGE
Property
Tax Account
Parcel No. -7 -r-
REMARKS
NEW RESIDENTIAL PLUMBING
l'ill /4-5-AW _el
ADDITION COMMERCIAL MECHANICAL
REMODEL APT.BLDG. SIGN
CHE_ KED BY
TYPE OF CONSTRUCTION
I -DE)iric)
CODE
I
OCCUPANT
GROUP
0
Z
5
W
a
GRADING FENCE
REPAIR — CYDS. (__ x _FT)
WOODSTOVE SWIM POOL
DEMOLISH INSERT HOT TUE/SPA
GARAGE E] RETAINING WALL/ RENEWAL
c ROCKERY
1
SPECIAL INSPECTOR JAREA
REQUIRED
0 YES
OCCUPANT
LOAD
MARKS
PROGRESS INSPECTIONS PER UEiC 305
or
eE�Uqp#�g I
.4 jOR ACTJYITY) EXPLAIN:
3
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES 7UNITS -olve INUMBER
DESCRI ORa$ To BE DONE (ATTACH PLOTPLAN)
(7 ic_ A
A16 04a4�
FINAL INSPECTION REQUIRED
-7
VALUATION
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING
%
PLUMBING
eck No.
MECHANICAL
GRADING/FILL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sldewplks,
driveways,, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
ENO. INSPECTION FEE
(n
2
"Appilcant, on behalf of his or her spouse, heirs, assigns and
successors In Interest, agrees to indemnify, defend and hold
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
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
0
x
modify, waive or reduce any requirement of any city ordinan IS
nor limit In any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
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 THIS PERMIT This application is not a permit until
aws
state laws pegulating construction', and In doing the work authoriz- AUTHORIZES
ed therel signed by the Building Official or his/her
b,4, no person will'be employed in violation of the Lador ONLY THE
Code of/he State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion 1pmfirance andROW,18.27. INSPECTION acknowledged In space provided.
SIG U 0 R NT) DATE SIGNED DEPARTMENT f
NATURE ATV
CITY OF
DM NO I rG7
E 0 )S
CALL FOR - DATE.
AFM�.tlbN INSPECTION
IT Is. UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL - File YELLOW - Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
CHAPTER 3. PINK - Owner GOLD - Assessor
. A