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20912 83RD AVE W
JQLIC 1,,TORKS DEPARI= CHECKLIST I ILI - In -'I. Date
'T.�BUILDING PERRT REVIEW
C A
ST R,,EE7 F kess
Street Right -of -Way Existing
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REQD I
Access Easements Existing
REQD
Utility Easement Existing
REQD "q=ZV T-LLW
Lot per Subdivision
Plat
Assessor Map
Site Plan Checked for Accuracy.
9
Z
Underground Wiring Reqd.
01
Check Accuracy of Legal Description I -I X-
Environmentally Sensitive Area
7-40
Environmental Checklist Reqd.
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Flood Hazard Zone
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Shoreline Management Area
Slope, Soil, Vegetation
SLre,,,n, Creek, Drainage Basin
OC Existing Zoning Per Code -T--> W L —
Amenities Design Board Approval Reqd. ADB Approval
Board of Adjust:men� pproval Reqd. T-�D
Revic-,y By: �Iv Date: IHI-�F
Existing Water Main Size
Water Main Rcqd. P,
0.
Service Line Reqd.
W
Hydrant Size Existing
Hydr,-mt Rcqd. Per Fire Code
Size
Detector Check Meter Reqd.
A/x
Cross Connection Inspection
Fire Departma-it ConTnents
Water Meter Cliarge Reqd.
-2
Review bv:
Date:
S -ptic' "i -1 1�
0
Septic Tw-ik Peri-Lit Reqd.
Permit No.
Sanitary Sewer Availability
Proj.
Drawing No.
File No.
Side Sm,7er Avail ability
Sanitary Sewer Connection Fee-/Reqd.
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Rcvim.; Bv: -7-
Date:
N
USE
BUIIflh_�Q DEPARTMENT Applicant Fill ZONE
PERR W-1. APPLICATION Tinside Heavy Lines
JOB
AME (OR N
AME OF BUSINESS) ADDRESS
LOT L All- 4")M E SUBDIVISION NO.
IN ilfmly) CD kA RA_ �j -1 LEGAL PL
MAILING ADDRESS 0 Y ES 1:1 NO
Ro PUBLIC RIGHT OF WAY PER ORDINANCE NO
0
CITY TELEPHONE NUMBER
I-L-i V%, V) wA, '11 EXISTING RIGHT OF WAY
NAME PROPOSED RIGHT OF WAY
DEFICIENCY OF RIGHT OF WAY
U R ,I e
W ADDRESS I
I- STREET/UTILITY WORK REQUIRED IM YES 0 NO
i PERMIT FOR WORK IN PUBLIC R/W 0
U ra YES El NO
(t CITY �:
HONE NUMBER UNDERGROUND WIRING REQUIRED IR YES NO U
U31 41-1 CONNECTION TO SANITARY SEWER UYES ONO
7_1P m
NAMd 0
Cr-, S EPTIC TANK PERMIT REQUIRED DYES 91101IN 0
SEPTIC TAN'K PERMIT NO.
0 ADDRESS
U SEE MEMO DATED
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CITY TELEPHONE NUMBER REMARKS
P. -1
0z N KI U-YD(-,D j
STATE LICENSE NUMBER Y LICENSE NUMBER CHECKED BY
Legal Description of Property (Show Below Or Attach Four Copies) 'AETER SITE BUILDING SUPPLY SIZE
_F?`EM A R K S
Z
0
P r-
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
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ILI SHORELINE
VJ-5c ELA:ri�, PL REMARKS
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CIL ,SK"C-1tttSi+ Coo,"J-VN VARIANCE OR CU _7NNING REVIEW BY DATE
YARDS FRONT SIDE REAR ILOT COVERAGE
NEW RESIDENTIAL GAS
F1 LINE 7 FIRE Z 0 JO�E T��YPE F NSTR ; CTION C?CE HEIGHT
NON-RESIDENTIAL SIGN
ADD El
EMOLISH RETAINING SPECIAL INSPE
CTOR JAREA OCCUPANCY OCCUPANT
DWALL REQUIRED GROUP LOAD
ALTER EXCAVATE E] FENCE YES. 0
OR FILL I >� - I
PLAN CHECKFD BY THIS SITE IS LOCATED IN THE CITY
El ,EpAlk PRE-1 OVE m OF EDMONDS. LOCAL SALES TAX
El SHOULD BE CODED 31.04.
z H U PA 0 E R rT_�T 0 1-11 F U-,#F%FF( r4F
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NATURE OF WORK TO BE DONE
F.
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0 CL
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2 LA -H�;CK FEE VALUATION FEE
4�A�T( P
PROPOSED USE
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PLOT PLAN (INDICATE BU LDING SETBACKS,
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ABUTTING STREETS)
BUILDING CL
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PLUMBING w
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o Re!-rz� v2— -vz�, Lj\ MECHANICAL
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FENCE >
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"Applicant, on behalf of his or her spouse, heirs, assigns and
In SIGN
ILI
-I successors in iutCreSt, agrees to indemnify, defend and hold harmless
2 the CitY Of Ed"'Onds, Washington, its officials, employees, and RETAINING WALL
aecnt� from :Tn\- and ;III ckiiin- 0
< S for dj;nii,,C1s of whatever natim-,