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1010 PUGET DR
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IMPERVIOU5 SURFACE CALCULATIONS
BUILDING HEIGHT CALCULATIONS .
J9 4
Sq' A�Dat%o V►
<-EXISTING RESIDENCE: 2008 S.F. (CONSTRUCTED IN Ig58/lggl)
19 9.0
EXI5TIN6 DETACHED GARAGE: q72 S.F. (GON5TRUGTE0 IN Iqql)
AVERAGE REFERENCE GRADE =
MIA' + qq,0' + 015.4' + qb.l')/4 = ql.l'
361
Sol ADoe-> PA-"'�"�TOTA0BUIROP5EDLA DI ION: 5(OSS
MA
l�7
AREA: 3036 S.F.
EXI5TING DRIVEWAY: 3625 S.F.
BUILDING HEIGHT = ql.l + 25 = 122.1
DATUM POINT =
PROPOSED WALK: b2 S.F.
PROP05ED ENTRY DECK: 232 S.F.
EXI5TIN(5/PROPO5E0 BUILDING HEIGHT = 110.2'
+100.0' (TOP OF
WATER METER
TOTAL IMPERVIOUS AREA: bg55 S.F.
�'�.�
IU�I lMlQ�1Wk3U5 �uv�,cc Aae/E )977
COVER)
I80.00'
a`nG6 =
e45 o
OL inn
.q ol
/aid!
0
J
ll_
PPP
EXISTING
GARACGE
q12 S.F.
EXISTING
RESIDENCE
EXISTING GARAGE .TO BE 1125 S.F.
CONVERTED TO LIVING
SPACE (260 S.F) O
----�q5.4'
NEW BRICK PLANTER
V �EXI5TING ASPHALT NEW 45"—
DRIVEWAY
GONG.
(3b25 5.F) 51DEWALK
(62 5.F)
PLOT PLAN �Ior
AREA OF NEW ADDITIQN
TO EXISTING RE51DENOE
(56 5.F)
NEW ENTRY DECK TO
IPIRW .
GIN EERING
BY EN ol��"
Date:
LOT AREA: 18,000 S.F.
TOTAL LOT COVERAGE = bg55 5.F./18,000 S.F. = 3810%
PLANNING DATA
NAME: L_6L4,-wxr-A DATE: 'A/solo ,
SITE ADDRESS: ioio P, YeO Da., PLAN CHK#:
PROJECT DESCRIPTION:f per.
REDUCED SITE PLAN PROVIDED?�.� / No
MAP PAGE: 25 Q CORNER LOT: Yes / FLAG LOT: Yes /
ZONING: Q-S- 1 2-- CRITICAL AREAS DETERMINATION #: LoU
❑ Study Required:
® Waiver
❑ Conditional Waiver
SEPA DETERMINATION:
❑ Fee
❑ Checklist
❑ APO list w/ notarized form
❑ (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
® Exempt
SETBACKS:
_./ Required Setbacks:
Street:'2-E) Left Side- 1 C Right Side: 10 Rear: S
Actual Setbacks: q_w--r,,
Street* - 7 Left Side: 11 • Right Side: 9>` Rear: 1
Street map checked for additional setback required? Yes / No
❑ DETACHED STRUCTURES:
❑ ROCKERIES:
❑ FENCES/TRELLISES:
❑ BAY WINDOWS / PROJECTING MODULATION:
❑ STAIRS / DECKS:
PARKING: Required: Z Actual:.
LOT AREA: )6, 000
LOT COVE
Calculations: 1-? a 4 - 4 w�►„ , Nci �l� - S 1 o G� �- - �C x+s r� ,ace n� T,o v c yray� _
�-1 5co
BUILDING HEIGHT:
Datum Poine" , 0 ,. Q r4j2 or,l w2 Datum Elevation: 1 CEO
8� 0 _
Maximum Allowed: arr-'), Actual Height: 161
A.D.U. CREATED? / Yes
SUBDIVISION: \
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: Yes N
OTHER:
Plan Review By: A_X
NewBPP1anningDataForm.D0C
.................. ......
I
Itz t-Nm I I V.11 wl.vk�--m W:
ubcc
2143
it suc nuuuway----_,.__ uooqpiun of a {Flab
Was a. cmk or an area whem water flows actoss the V
Flows are seasonal? (What tin
1. 1-1: h f,l 1, C'. —k, V.,; ...... ;;, 1,
a90.199-
City of Edmonds
Critical Areas Checklist
The Critical Antes (1=I t contained on
this form is to be filled out by any person
Pa+e xdng a Devdcpmed Permit
Application for the 01y of Edmonds prior
to his/her subs txal of a development
permit to the City.
The purpose of the C heddist is to enable
City staff to determine whether any .
Potential Cortical Areas 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 soya surveys). ,
An applic a04 or his&weve,
must fill out die dreM.% sign and date it,
RECEIVED
APR 18 1999
COMMUMTY "Mug
and submit it to the City. The City will
review the dwdlist, make a precursory site
VW and m lee a determination of the
subsequent steps ==ssary to complete a
deHelopment permit application
Witt a a;gned copy .of this form, the
vpr=m dMid also submit a vicinity map
o
wide atough detail that My staff can find
and idea6fy ft subject parnd(s). in
addition, Me applicant stall include
other pediment information (eg. site
Pbm, topograpby map, etc) or studies in
coq me imt with Ibis Checklist to assist
staff in cmpkag their pry
aftim sit
I have � dieattachod Critical Area C�ecldiataad attest dell t6eaosw� p
�vral, tD 8iebest'oft�►ianowledge (5ll ont tie typpc�Clateco� L�.�`;}� ��
$'R2k S.�s
winded arc
R.,
1
c ri',t i ca I A e,'b aS
1 47
ATA#:
5489-000-009-07
New.. Undo.. Find. " CC r�, Exit
Reviev' Number:
CA-1995-0064 "
Datb .Received:
4/18/1995
.Applicant:
Landreth
.
Bldg Number:
1010
Street Name:
Suffix:
DRDir:
Suite:
Int?:
El -streets:
..�
D.etermDate:
Determination:
Waiver ,
1
i
Staff Person:
Bissell _-
j
-,
�;, 'Notes:
l
A
p2-of. L(ne
690-194-
City of Edmonds
Critical Areas Checklist
The Critical Areas awdIdist contained on
this form is to be filled out IIV any person
LeInruw, a Development Permit
Appfication for the City of Edmonds prior
to bis&w submittal of a development
permit to the Oty-
RECEIvED
APR 19 1995
COMUMW am"#
and submit it to the city. The city will
review the Checklist, maim a precursory site
VW and make- a deierminadon of the
�sdmquatsteps ncccssuytocomplete a
4
V% ~ipmNA- permit application.
-3
IVA aslgnod Dopy of this'fotm, the
_applicant
IU purpose of the CUM& is to enable
dwdd also submit a vicinity nap
city staff to determine whed ter any -
pia pian ftr m&aa a no-t-sar mup —siza
PoteaW CrifiW Ann are or may be
1101"OtO (11CW that Cilyst2ffm find
present on the StddCCt PPDPMty. The
and idedfify the subject parcegs), "rn,-,,
needed tocamg4ftdie
addition, the applicant diaH Indudecho
---;-St-dwuldW'cnHya,i:;rt-ii1labi6froni
otim.pelginogd information(e.& site..
domvadons of the site or data available at
map, etc.)
etc.) or studies In
City Sall(Cdfical Ann in%=wdesj;-vq)s,..
this Chieldist'tai ajda
or wH SMVCIS)O,,-,
staff in cOmPlOft d1dr preliminary
lassessmat of the site..
AaMMUcant, 4w llisilw J!�.�eswtafive,
IMUSt fiR out the sqF and date it,
I bavecompiftd.dwauadied-CMW Area a
„k
Ito-. I 11 ;,2: .4tij qf:i I IF:
I
I
I I i T�: i � i
LIL RM
-I PERMIT APPLICATION REQUIREMENTS
To: Applicant
From: Lyle Chrisman, Engineering Inspector
Owner. UA-K OP,&'H Plan Check No:
Address:— 1,00ye-" : Date:
After review of the subject permit application, the following requirements must be met:
1. Construction hours are:
WEEKDAYS — 7:00 A.M.-10:00 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 FEET FROM ANY CLOSED DRAINAGE
FACILITY. BUILDER/OWNER IS RESPONSIBLE FOR IDENTIFYING CONDITIONS ON THE DRAWING. (ECDC
18.30.50G)
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 PRIOR TO BACKFILLING. (ECDC 1830)
8. 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 18.90)
9. Driveway slope shall not exceed 14% without a waiver. Every attempt should be made to keep the slope below 14%. Waiver granted to
%. (ECDC 18.80.060D)
10. Driveways must be paved from property line to City RIGHT-OF-WAY. A separate permit is required. (ECDC 18.80.060C)
11. INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIOR TO AND AFTER POURING. (ECDC 1830)
12. No burning of construction refuse without a permit from the Fire Department.
13. Connection to City water system is required. There is a separate charge for the water meter.
(ECDC 7.20)
14. A back water valve is required if downstairs plumbing is below the elevation of upstream manhole. (ECDC 7.20)
15. Water and sewer main lines should be separated by 10 feet minimum. (ECDC 18.10)
1
16. Connection to the City sanitary system is required. A separate permit is required.
LID!/ Fees paid: Yes No Charge (ECDC 18.10}.
17. 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)
18. A FINAL ENGINEERING INSPECTION IS REQUIRED PRIOR TO THE BUILDING DMSION GRANTING OCCUPANCY
OF THE BUILDING OR STRUCTURE. (ECDC 18.90)
PRMTREQR )OT
CITY OF EDMONDS
PUBLIC HCRES - ENGINE MING
ACTIOREPORT
STRLC:E T F'IL E N® 1373
SUSPENSE DATE:
Date: 5/7/82 Time: 3:55 p.m.
File H
---------------
Attachments: Yes
SUBJECT: Construction People covered her water (Z7No
meter with dirt. Now she doesn't know where it
is. Please find it and uncover it
i
REQUESTOR: NAME: - R. Wn Ap 1 an d
ADDRESS: R "Pu
get Dr
PHONE: na
REQUEST RECEIVED BY:
TELEPHGNE
CONTACT IN OFFICE Mx
OTHER: O
RECEIVED BY: _ Mary Le Van
ROUTE TO:
� # OPR
NAME INIT. DATE OPR
NAME IN
i A4--Gh-,�Rz�r�a.� ra
6 i
z wiu.a SPA. �0 7
3
8
4
9
5
� 10
ACTION,• T6}lKE n Nor 3>ONJ;,Y�1'�
f'
I
All Concerned Notified
Action Completed/File E2gI
w i
PLANNING DATA
SITE ADDRESS:ID/D -46C -Pof, DATE:_
ZONING: r��Z PLAN CHK#:
✓�A i� _L1.i
SETBACKS:
Required Setbacks: Front:�TT,/Left Side: ♦ V Right Side: /QRear: -2-!5_
Actual Setbacks:
Front:.Z45 Left Side:If) Right Side:A*Rear: 30
CORNERLOT��
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED 6jtA—Z5Qih
LOT COVERAGE:
Maximum Allowed: (36a ctual:
7-7
BUILDING HEIGHT: `C
Maximum Allowed: Actual Height:
SUBDIVISIO
CRITICAL AREAS #: `6�
SEPA DETERMINATION:
LOT AREA:
OTHER:
Plan Review By:
=XIS 'G ` 11
SIDE NALK ooll
lU
>.
i9i
4EN!
)RI f
1EW
�RI E
IDS
ME
F--
ILl
O
IAY
PHAL
AY
i
i
�16t`'y'�Dt NEW 4' GONG.
SIDEWALK
150.00,
ci --10' SIDE SETBACK
NEW GA
3a RAGE
FRONT
SETBACK
EXf T:G RESIDENCE
> I �
i I
E" I --
DECK
E IST'G ASPHALT DRI\/EWAY EXI T'G
CARPORT ..
(TO f3E
REMOVES
a
s
aT
R� ,.,, RECEIVE
?.r ,
APR 2 1 IT
APPROVED BY PLANNING
µ D
i I� ,
II
PLOTr
Z
LEGAL DESCRIPTION
;G,r t5;r JND MhGHIN!%�Y
p�pDT, PSG '(�!'GTJ, �� PE►z PI.t�T �2FG0(� E liF--Fkr
41 , s, D 05Ne:5)NdM115H GoUNT'f ;
NvI.� i� �7 , 7HE OF; ANDx GE i�T
-rHE *vUTH 1''P45:;' F-T.
To "rHr- �opD
pE�, I�G�En UN►�fz (Z�Co�pIN� No• � fi o2o�iG��t ,
PROPERTY ADDRESS
O r'U&r--r 17�1y�MoNbl V�1�.�NIN�ToN
rP,000
ZONING �!2
SEPA
SETBACKS
LOTCOVERAGE
BUILDING HEIGHT aD «
SIDEWALKS
STREETDEDICATION �Lo"
SUBDIVISION REO.-- —
WETBAR STATEMENT a
GUEST HOUSE STATEMENT
FLOOD AREA
OT EHA
- EX IoXING
j���IDENG�:
G
DECK
ZONE
8€i FROZS.
PLAN
�. REA ____ra
REAR 2s
II
OTHER
HEIGHT
C)
Wf a I
+ 100
BUILDING
iUL2I. 1995
4
8
19
971
4e.,o„
D QT.3 n
A-rrni: s�ONt� i f
MCI Sr6r €DES l pwN)c--
{ --1441 1 G 5;8' ?.5 -- `18.1 P Dice
8 7.4 g MAx Ah uW4*1,-C-, F+r.
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
EASEMENTNo ...........................................
NEW CONSTRUCTION ❑ REPAIRS ❑
119-02800
OWAER........... R.--K....Appl.in...................................................................
ADDRESS ....... IOIO...PUC)2t..Dl"J.Ve.... ....
Is
CONTRACTOR...............................................•---........----•-......_.......................... PERMIT No.......................
LEGAL DESCRIPTION: LOT No ............................................... BLOCK No. ............................................
NAME' OF ADDITION........................................•--••----....---.................---........--•--...__........_......._..._............_.........
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ....._.................._.............
q��
E PERMIT Ac-�
CITY OF EDMONDSZONE %c S
NUMBER
CONSTRUCTION PERMIT APPB '' SUITE APT.
OW NAME NAME OF BUSINESSDRESS G'i /
v �. i
_ C GAL DESCRIPTION CHECK 5U DIVISION NO LID NO
MAILING ADDRESS I
D BLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
CITY ZI TELEPHONRW Permit Requ,red ❑
ISTING REOUIRED DEDICATIONC;' ��' Street USe P—Qequ,Fe Rep'tl ❑
OPOSED I^SPecloR Rqu,red ❑
NAME S,dewalk Requ,retlMETER SIZE LINE SIZE NO. OF FIXTURE$ PRV REQUIREDADDRESS YES ❑ NO ❑MARKS 2
/ w
i CITY ZIP TELEPHONE NUMBER AI-src
>7/V'•Jr/.�/,�1/�,(.�..L S
NAME
S�
l .ice �.i�a c4
Fivac
ADDRESS
NEERING MEMO DATED
d
's /.I�
REVIEWED B
/A —C►^
CITY ZIP
TELEPHONE NUMBER
MEMODATED
tALLOWED
REVIEW 0
STATE LICENSE NUMBER EXPIRATION DA
SIGN AREA
PROPOSED
SEPA REVIEW
COMPLETE EXEMPT
EXP
$AO11PLegal
Description of Property - include all easements
a
ANCE R U.
P
IN IEW BY
A E
AC. S — FEET
HEIGHT LOT
VER E/
—
J
Property
ague
HeAH r/ - —
1, Accounl tif8j_ CIO ^0�
REMARK
Parcel No. 70-3
�J (J O
NEW
RESIDENTIAL
O PLUMBING
ADDITION
COMMERCIAL
MECHANICAL
APT. BLDG,
l 4F'r
D J/
REMODEL
SIGN
O FENCE NCE
ElREPAIR ❑ GRADING
CHECKED BY
TYPE OF CONSTRUCTION
CODE
OCCUPANT
CYOS. x—�
WOOOSTOVE SWIM POOL
DEMOLISH ❑ INSERT El HOT TUB/SPA
"
INSPECTOR
AREA
OCCUPANT
REQUIRED
YES
LOAD
GARAGE RETAINING WALL/
CARPORT ROCKERY RENEWAL
MARKS
S(TYP
F USE. BUSINESS OR ACTIVITY) ExPPLAIN:
PROGRESS INSPECTIONS PER UBC 305
LIS.
NUMBER
NUMBER OF
�
CRITICAL�/J' (w{
.--
7)56
W
STORIES
UNITSING
NUMBER /�r� /
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLANT
lA C K -Pe G
FINAL INSPECTION
REQUIRED
i (. '/
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE:
GLAZING
BUILDING�'-
I�
D/0
(\)i
PLUMBING
Plan Check No. Z —
MECHANICAL
This Permit covers work 10 be done on private property ONLY.
GRADINGIFILL
Any Construction on the public domain (Curbs, sidewPlks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
✓
Permit Applicatlon: 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
N
successors in interest, agrees to indemnify, defend and hold
w
harmless the City of Edmonds, Washington, its officials,
s
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
Gt
modify, waive or reduce any requirement of any city ordinance
°
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
5C7
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. 1 agree to comply with city and
stale laws regulating Construction; and In doing the work authoriz•
THIS PERMIT
AUTHORIZES
This application is not a permit until
s a pp
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 St 9 Washington relating to Workmen's Compensa•
WORK NOTED
Deputy: and fees are paid, and receipt is
do sure and RCW 18.27.
INSPECTION
acknowledged in space provided.
O AGENT) DATE SIGNED
DEPARTMENT
r,r-Z
CITY OF
OFFICIAL'$ SIGNATUREr DATE
,41r}
EDMONDS -
";,:-'` .50,
ATTENTION
CALL
REL�o D/ ` 'TE—T
ION
I SPECT
ry
k
IT IS UNLAWFUL, TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771 022o
ORIGINAL — F,le YELLOW — inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
Scte �S
S7�2t�-T-
I) F— CAZ QED- 2 ' �)- 5 SA-*- rVOM
0' .. IFAck-- 5 le'P, t n, Ce::a-,mca)
°'9a-199..
City of Edmonds
Critical Areas Checklist
The Critical Areas Chaddist contained on
this form is to be filled out by any person
preparing a Development Permit
Applicatioa for the Qly,of Edmonds :prior.
to histher submittal of a dMdopment
permit to the City.
Thej.:.:..: _" :,•. _ `
purpose of the Cheddist is to enable
City staff to determine whether any -• •
potential Critical Areas are or may be
present on the subject property. The
information needed to complete the
Cheddist should be easHy available from
observations of the site or data available at
caty Hall (Cd ical Areas inventories, maps,
'or son surve
An applicant, or his/her representative,
must fill out die cheMst, sggn and date it,
RECEIVED
APR 18 1995
MMMUN"
and submit it to the City. The City will
review thechoddist, malae a 1 ecausory site
visit, and malm a determination of the
sWbwquea steps necessary to complete a
developmait permit application.
:Vrmh a Agned copy of this form, the
OPPficant dwuld also submit a vicinity map
or plot pin for hdNRiffW-OTMFFgEg
with enough detail that City staff can find
and identify the subject paroei(s). ln'. . .
addition, the app shall include
othac pettinent in%rmathon (e g. site.'
per• tOPa, wi'OPi maps etc.) or studies in
c4macdon with this Checklist to assist
staff in compkft their prerminaty ,.
assessment 'Of the site..
I
I
UILAU bAdmulg-vigaw.-
Istanding water: = q
ROOOPWn .ofawat
ea where w,-dw floors mms the g=
ws,are seasonal? _ (what tin
meadow, . ;SW
ks etc)
RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
QWR NAME/NAME OF BUSIN SS
JcK - h dre7�Li
MAILING ADDRESS
i�jm
ZIP TELEPHONE -'
Igh d 5 %0w ws -77zf -372-
NAM
ADDRESS ,4}1 'j'�
U 3 1 1 Q� Mo S` e-L—
CI Y ZIP TELEPHONE
NAME
CITY ZIP I TELEPHONE
STATE LICENSE NUMBER
EXPIRATION DATE I CHECKED BY
>ROPERTY TAX ACCOUNT PARCEL NO.
(00
5"4/
9 0'
❑ NEW
ESIDENTIAL
j�
UMBING ECH
AUDITION
COMMERCIAL
❑
C IANCE OR
CHANGE OF USE
REMODEL
❑ APARTMENT
❑
SIGN
❑ REPAIR
GRADING
❑,.
❑
FENCE
CYDS
( X • FT)
❑ DEMOLISH
❑ TANK
❑
OTHER
❑GARAGE
CARPORT
❑ RETAINING WALL
onrvcov
RENEWAL
(TYPE OF USE, BUSINESS OR G^ITY) EXPLAIN
NUMBER NUMBER F CRITIC
OF STORIES I I ,.LINITSI NUMBE�
LING
DESCRIBE WORK TO BE DONE i
AD,pi�i�H
f' I
PERMIT EXPIRES ~_
USE
PERMIT
ZONE
G,
� � _
NUMBER
JOB
ADDRESS
1�! V
bp,
SUITE/APTp
PLAT NAME/SUBDIVISION NO.
LOT NO.
Lip NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Pe it Required
RW Permit Required
0
Street Use Permit Req'd
0
EXISTING
PROPOSED
Inspection Required
0
Sidewalk Required
0
RE UIRED DEDICATION
FT
1 Underground
wiring required
'�hj!E&IZE
LINE SIjE
NO. OF FIXTURES
PRV REQUIRED
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YES ❑ NO ❑
W
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING
FIRE REVIEWED BY DATE
LL
VARIANCE OR CU
SHORELINE OR ADBN
INSPECTION
BOND
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P TEC
❑ YES NO
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
Al_,O ED PR POSED
ALLOWED PROPOSED
EXP I >
♦
a 1 11t1
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
R"T IQE REAR
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YR
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PARKING
LOT -AREA
PLANNING REVIEWED BY DAT
RE2. I PROVIDED
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Cll�rn,. \ .. .., lh n 0 I �Ci
CHECKED BY TYPE OF CONSTRUCTION CODE OCCUPANT .
11
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SPECIAL NSPECTOR AREAr. OCCUPANT .
REQUIRED.LOAD �X� I��f� LOAD
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REMARKS C5
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D o
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VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE %
BUILDING
PLAN CHECK NO: VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t- BE DOME -ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
J SEPARATE PERMISSION.
•'
STATE SURCHARGE:
W PERMIT APPLICATION: 180 DAYS
a PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
BACK OF PINK PERMIT FOR MORE INFORMATION
IOU
N "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
¢
INSPECTION FEE
Q ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
c
J DEEMEDTOMODIFY,WAIVEORREDUCEANYREQUIREMENTOFANYCITYORDINANCE
RECEIPT
PLAN CHECK DEPOSIT
/^
/ VVV t1� 4�44.����00°
51( 0
s NOR LIMIT IN ANYWAY THE,CITY'SABILITY TO ENFORCE ANYORDINANCEPROVISION."
RECEIP
TOTAL AMOUNT DUE
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building
Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
WORKMEN3ffleOPSNSATION INSURANCE AND RCW 18.27.
Sill SI EL(4VLAGEL DATE SIGNED
(425)
LS SIGNATURE DATE
IA�-
771-0220R
B
ATIONT
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771 -0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
k
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
ORIGINAL -FILE YELLOW - INSPECTOR
PINK - OWNER • GOLD -ASSESSOR
5/98