1102 12TH AVE N.PDF1102 12TH AVE N
CITY OF EDMONDS
STREETSFEIMORMATION SHEET
j2"NEW N2 0 5 0 Z 0 ASSET NO. SO.,?
❑ ADDITION - ADDITION TO ASSET NO.
❑ RETIREMENT
DESCRIPTION
SERIAL NO.
LOCATION
0 � �� [�� !' �G •
DEPT. NO.
CGS
"PURCHASE ORDER NO. _
PURCHASE ORDER DATE
COST
*PROJECT NUMBER
PROJECT COMPLETION DATE
COST
B.A.R.S. ACCOUNT NO.-Y��—d00— O/�—� . UO•6,5
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
"SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT _
iG.L. ENTRY
REFERENCE
I INITIAL
V1
c�
VERIFIED BY
PROCESSED
BATCH NO.
DATE
DEPARTMENT FILE
CITY of EDMONDS SIDE SEWER PERMIT
MAR 101986
For Inspection Call 771-3202 T N0. ®1 4 0 41
PUBLIC WOITREET NDS -
EDMO
Address of Construction: /02 /�1= �/� /�/ TREATMENT PLANT
Property Legal Description (Include all easements): �� , � �`,y1r V
�s,74
Owner and/or Builder: /Jr_v-r! , iA?�
Contractor & License No: tii'l „L�/�
Single Family Residence
Multi -Family .(No. of Units )
Commercial (No. of fixture Units )
Invasion into City Right -of -Way:" No Yes (If Yes,,Right-of-Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
I cer.tyfy th I have read and sh ll comply Date
with the items listed 'on the back.
Permit Fee: :50.0C) Issued By.
Trunk Charge: 26 D® Date Issued: 3•/D• �6
Assessment Fee: Receipt No.:'9/�
Partial Inspection:
Comments Date Initial
Final Inspection Approved:
Date. I niffl al iwsP.'e,j 3oa R6ra-«ER
Rejected:.
Reason Date Initial
** PERMIT MUST BE POSTED ON JOB SITE **
Wh-ite Copy - File Green Copy - Inspector Buff Copy - Applicant
�i�%in
Side Sewer Drawing
The City of Edmonds EASEMENT
r NO_ ____________________________________________
NEW CONSTRUCTION 64 REPAIRS ❑ LID NO..V(0_1_ ---_--. ASMT. NO_ __________________
OWNER ------ Q_MseS-------------------------- CONTRACTOR __�ALzr-------�, U_TZ
----- ----------------------_-----_ PERMIT NO. 7:
JOB ADDRESS ---- 1. Q .--.---1 ----------- LEGAL DESCRIPTION: LOT NO. _- 5------------------------------ BLOCK Ni. --- EDMM1)S----------
!� TREATMENT PLANT
12.T" No.
PWW-0001-11175 (REV.11/78)
NAME OF ADDITION --- NQ_RTIdN_l_Sw..... STAT S----------------------------------------------
13,
S'tOA DRIUM
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b"comc.
Approved: T H
/p 12 Poe- No.
DATE BYy--------------------
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1- EXISTING RESH3ENCE
O
AVERAGE REIGHTOFBLJXU.AREA'
�•
33M
f
C)
/ MAXD41MMHEIGHT ALLOWED.
BUILDING mairrMALNFL
3559W
I
ACTUAL
MIL
333M
V
N
��,ay.
GENERAL INFORMATION
PROPERTY TAX ACOUNT 0 705 BBO W5 BOOB
ZONE
RS•12
LOrAREA
13,197 SF
EXISTING LOT COVERAGE
2.371 SF; 18%
PROPOSED LOT COVERAGE
2.492 SF; 19%
MAXIMUM LOT COVERAGE
4,615 SF; 35%
EXISTING BUILDING AREA:
LOWER FLOOR
1,136-5 SF
MAIN FLOOR
TOTAL EXISTING:
7.5 SF
NEW BUILDING AREA:
LOWER FLOOR
1, 136.5 SF
MAIN FLOOR
2,492.0 SF
UPPER FLOOR
TOTAL NEW:.
4,038.0 SF
GLAZING:
NEW GLAZING
307.90 SF
EXISTING GLAZING
35115 SF
SKYLIGHTS$(:
TOTALULA23NO
675.05 SF
GLA23NO AS S OF FLOOR AREA:
16.7%
HFATING SYSTEM: GAS,
FORCED AIR
"VAC EQUIPMWT EFFICIENCY:
HIGH
WSEC APPROACH: OPTION III. PRESCRIPTIVE
6ifi:D'- I
12 th AVE. N
INDEX
SITE PLAN A GENERA INFORMATION i
LOWER FLOOR PLAN 2
MAIN FLOOR RAN A DR. SCHED. 3
MAIN FLOOR FRAMING RAN A NOTES 4
UPPER FLOOR PLAN A WIN. SCHED. 5
UPPER FLOOR FRAMING RAN 6
NORTH A WEST ELEVATIONS 7
SOUTH A FAST ELEVATIONS 8
BUILDING SECTIONS A GENERAL NOTPS 9
WAIL SECTION A DETAILS t0
LEGAL DESCRIPTION
LOT 5, NORT HVIEW ESTATES
EDMONDS. WASHINGTON
SITE PLAN
N
UB'-F-o
11
3I4.0•
PARTICIPANTS
JOHN A GLORIA BURGESS
1102 -12TH AVENUE NORTH
EOMONDS, WA 9B020
206bTt�9116
CONTACT. PfIL1IP L EIIN ARCHT EC7
EDMMAIN
ONDDS, WA 9STREET8@0
2066771-$W
BUILDER: BRUCE BUNCH A COMPANY
50 - 6TH AVENUE SOUTH
EDMO NDS, WA 98M
206.7714M
STRUCTURAL CHARLES GRIEVES
ENGINEER CT ENGINEERING
180 NTCKERSON, SUITE 302
SFAT11F, WA 99109
206-2834512
EXKT. G.b.
012..14 •
Addition A Alterations to
THE BURGESS RESIDENCE
1102 - 12111 Avenue Noah
Edmonds, WA 98020
uw rKCISTIRED
IIRp111ELT
ML, Low
PHILLIP LEHN ARCHITECT
524 Main Sow
Edmonds, WA 98020
4.4.94
1
STREET FILE
PLANNING DATA
SITE ADDRESS: %/D% l2t&j Auk DATE: /7//�;
ZONING: A - I Z� PERMIT#•
PROJECT DESCRIPTION:
SETBACKS:
Required Setbacks: t-1zo1ii' s�
Front: �-L- Right Side:41e4w. �
Actual Setbacks:
Front:e25— a991, �_Right Side: O i��_L0--
FLOOR AREA:
LOT COVERAGE:
Maximum Allowed: 5 a Actual: d O
BUILDING HEIGHT:
Maximum Allowed: )Actual Height:
CRITICAL AREAS #: 61f' 14 —7 7 - ic,Ahylty
SEPA DETERMINATION:
LOT AREA: 8 1
OTHER:
Plan Review By:
STREET FILE CA FILE NO. (?T'ftci-7
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site AddressAL ocation: 110Z — I Z T{� Ne/ - 0 -
2. Property Tax Account Number: -706-1 000 005 00,06
3. Approximate Site Size (acres or square feet): 1 W7 �;,F
4. Is this site currently developed? ✓ yes; no., 1
If yes; how is site developed?__ l2INN1 N/Y�i/
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: 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: 1.1D ; Approx. Depth:
7. Site contains areas of seasonal standing water: IJ D ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway �.i 0 floodplain 0 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? 00 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: m 0 _
xov mroa(na
B9a.199-
P 1zUG �3UtJG� 4 C�M�
SD S le AVtF- -
-7-7L —060Z
City of Edmonds
Critical -Areas .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 Edmonds 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 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 soil surveys).
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
addition, the applicant shall include
other pertinent information (e.g. site
plan, topography- map, etc.) or studies in
cogiunction with this Checklist to assist
staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name
Applicant Representative:
MIVI.if7 LOW A"rMitr
Name
I IOz — 12-V AVV - N • 6-24 - MAW 4-r•
Street Address Street Address
15PIAOMP5� , WA, Jb o &72- ql l b quoNDs, WX 4020 -711-8�6�
City, State, ZIP Phone City, State, ZIP Phone
3 zy 9�
Signature Date Signatu ate
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CA FILE NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
• 1.
Site Address/Location: IOZ 12-TI�
2.
Property Tax Account Number: -7D -/ 000 0015 O 00 8
3.
Approximate Site Size (acres or square feet): 1 % 1 0 7
4.
Is this site currently developed? ✓ yes; no.
_,
If yes; how is site developed? GJIMkV9 EM W I 4mice
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: 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: IUD ; Approx. Depth:
7.
Site contains areas of seasonal standing water: u D ; Approx. Depth:
•
What season(s) of the year?
8.
Site is in the floodway N 0 floodplain �J of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? 00 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: Is 0
Rc,oiroaga
790•199-
City of Edmonds
t7urt,��
�R(1G1; $Ulm 4.COM���
sos �-r MiF. s
15 to ; wA
R8o2o
776 --060Z
Critical Areas .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 Edmonds 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 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 soil surveys).
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;
visit, and make a determination of the
subsequent steps necessary
�Y to COmPlete a
development permit application.
With a signed copy of this form, the
aPPli cant should also submit a vicinity ma
or plot plan for individual lots of the pazc4
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant Shan include
other pertinent information (e.g. site
plan, topography map, etc.) or studies h
conjunction with this Checklist to assist
staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers factual, to the best of my knowledge (fill out the appropriate column below provided are
Owner / Applicant: ).
Name
I 1 OZ —12-7W aU-6 . N .
Street Address
MONr, WA y' 02-6 �72-RI ►6
city, state, ZIP
Phone
Applicant Representative:
Lx�w
Name
,> 2-4 MAW
Street Address
City, State, ZIP I
Phone
Signature
DateASignatu 3 L�te
UREET FILE
USE
CITY OF EDMONDS ZONE <
CONSTRUCTION PERMIT APPLICATION ,OB
OWNER ' INAME1NAM/E OF BUSINESS
ADDRESS
116PK1 .4 f7f u)eIi� 7�U f�•%7 LEGAL DESCRIVTK
IIDZ - ►ZTH AyE - N '
TY ZIP TELEPHONE NUMBER
IEPNON%, q&/ZO 672_ q I I b
Mj11LUP LNN AQLNIT�I,T
)9RES5
SZ.4 MAIN
TY ZIP TELEPHONE NUMBER
v10ti11 °I boW . 771- M-6`
02UVu_ oUNCH 4 eNENNY
)DRESS
50S 61-N AVM. 2
r-_ IM AVy q046 1 -1 1I "ybvz-
STATE LICENSE NUMBER EXPIRATION DATE
uc>✓>3c o_1 -v F' a -94-
Legal Description of Property - include all easements
LOTS � y I� �i?AT�Li
0
.0
PERMIT
NUMBER
UITE�APT e
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP,
TESCP Approved ❑
RW Permit Required ❑
EXISTING REQUIRED DEOtCAT10N
Slreel Use Permit Read D
Inspeclion Required ❑
PROPOSED
Sidewalk Required ❑
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRY REQUIRED
I
YES O NO ❑
SIGN AREA
SEPA REVIEW
ADB �IQ�
ALLOWED PROPOSED
COMPLETE
EXEMPT
,
SHORELINE
E%P
v
V
VARIANCE OR CU
LA NI VIEW BY
D TE
F'
s�
SETBACKS — FFEET
HEIGHT
LOT C ERAGE / Z
Z-r?
—
il�— _
FRONT ' SIDE
REAR
Tax Account
Parcel No.
, 05'I 000 0015 QD o 8
REMARKS9 /1
C A �i• ^�
Er
O
/
NEW
RESIDENTIAL
PLUMBING
COMMERCIAL
MECHANICAL
[�yr y1-ADDITION
APT. BLDG.
SIGN
r REMODEL
REPAIR
GRADING
, O CYOS.
FENCE
O 1—_>t _Pn
CHECKED BY
TYPE OF CO=TRUCTIO
COD/
DEMOLISH
TOVE
INSERT
HOTTUSPA
OB
INSPECTOR
AREA
QUEDO
OYES
GARAGE
CARPORT
M RETAINING WALL/
LJ ROCKERY
El RENEWAL
MARKS
PROGRESS INSPECTIONS PER UBC
305 -.
(TYPE OF USE. BUSINESS OR AC IVITY) EXPLAIN:
I G-1�1GE ��I N
AM I.
$,�lllT ,ASS/b✓�S y �
F�ES�F,
NUMBER
OF
NUMBER OF
DWELLING I
CRITICAL
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) • 1
FINAL INSPECTION REQUIRED
VALUATION
�7 `\ PLAN CHECK FEE
• {Z U��'�'TAI� R GAIIOIV BUILDING
HEAT SOURCE: OLAZIING
1 % PLUMBING 2
LOAD
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (Durts, sidewPlks,
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
ENO.INSPECTION FEE
rn successors in interest, agrees to indemnify, defend and hold
w harmless the City of Edmonds, Washington, Its officials,
employees, and agents from any and all claims for damages of
whatever nature, arising directly or Indirectly from the Issuance
^
3
i of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
a
c
modify, waive or reduce any requirement of any city ordinance
Q
i nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
iV
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. 1 agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and In doing the work authoriz.
AUTHORIZES
THE
signed by the Building Official or his/her
ed thereby, no person will be employed In violation of the Labor
ONLY
WORK NOTED
Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa•
acknowledged in space provided.
lion Insurance and RCW 18.27.
INSPECTION
SIG ATURE (OWNER OR AGENT) DATE SIG ED
DEPARTMENT
OF IA GNA RE TE
CITY OF
yp /
EDMONDS
CALL FOR
RELEASED Bv: DATE
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771 OwA
-I ORIGINAL — File YELLOW — inspector
LLO
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
_.....�_..
OINK — O-N,e, GOLD — Assessor
A
n
y
PRW= REVIEW CMX=ST
r!
`Ale
;, I
SbbT Tn1�TTPV.1 .1 111=611111 I
DVVIA6 T iIATG`• i. JAL Q
4e 141 .�
Al
--- ---�, --
Reviewed by: ( itial7date
OOMMFNIS
PLANNING
WI'R/SWR STREET ENGNRNG
BUILDING
11111TF11
FIRE
.5II4Q;EFAI�II'LY/MMTIPLE/aCI�M CIAL - (Circle One)
;'
.!• �•.:� ;,' III///
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3E BACKS , aMCE® - Plann q ,:
/
/
..
'A%RT E/SEMACK ADJ.
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1
30NDITIOMV USE PtWIT ,1
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-ITfFff/
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2'
/ /
/ /
/
ADB RDQUIREMEWS CHECiCFD
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3
MIM;lzoillNc RDQUIREMF3IPS
IJ711111
4
TIVIRaMTPAL FEATURES
?1CCE ,,SWPF. & %oiI= ACCESS
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6
�,
/
/ / /
DRAINAiGE,PLAN (On Site)
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7
,,''....
/ //
/
S'IRF.ET•FILE
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8
T..I)GAL`FDESCRIPTION VERIFICATION Gam/ (7
9
'WIT *CIAIM/DED:ECATIONS �
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10
cASDon - PUBL.IC/PRIVATE
r 4•.
'ALC=TE SEWER CONNECTION IF NO LID#
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12
11111177T77TI7777
'_'LAT/SUBDMSION REQUIRREEiEWS
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13
-x•;r : •
RIGHT-OF-WAY CONSTRUCTION PERMIT READ �1�
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14
77777777777777777
90NID"R666'FOR PUBLIC IMPROVEMENTS
15
SOILS -CONDITIONS & GROUND
4ATER=FIELD CHECKED
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16
3TREh'P..PttAVING REQUIRED _
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17
3M AND GUTTER REQUIRED
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18
,3rDEWALK PIMIRID
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19
AM CUT FOR DRIVEWAY READ
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20
—
iI'REEP'NAME-SIGN RDQD.
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21
y!'fiEli'.SIGNING READ.. 4 ;t.
22
3IDE'SEWER AVAILABILITY .
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23
CISTING'.WATER MAIN SIZE
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� YYit
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24
.1ATER MFTEIt SIZE •'
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•.3 y
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25
3ERVICE'LZNE SIZE
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'3��
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26
:1YDRANT:REQUIRID
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27
aYDRADTP;SIZE EXISTING ''a.
//////
/////////
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////////
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28
77777
.mOS.S';CONN CTION'INSPECTION~REQD
//////
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29
777T/7777
EATER METER .CHARGE REQD ''
//////
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30
kFIRE LINE CHARGE'READ SPRINKLE t
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1171
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31
ry �' r '!. 'err
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32
777777
OPEN DITCH EXISTING i;
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33
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34
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USE TWPERMIT
CITY OF EDNIMIDS ZONER`L/2- NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
NAIVE (OR NAME OF BUSINESS) ADDRESS V _ ff
2 I L, ! LEGAL DESCRIPTION CHECK SUBDIVISION 40. LID NO.
W MAILING ADDRESS �oT �_ ?-
CI TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
771 �g� EXISTING_ REQUIRED DEDICATION
NAME PROPOSED
Jo'C",,a �1 RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
w ADDRESS i STREET USE PERMIT REQUIRED ❑
U - SEE ENGINEERING MEMO DATED
CI TELEPHONE NUMBER
REMARKS /��
NAME %�. _Z. 11 __- _./B
. Iel ✓.Pi A
ADDRESS
v v
METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
CITY TELEPHONE NUMBER
1- ,F _J?
REMARKS
STATE LICENSE NUMBER
SIGN AREA ENV. REVIEW ADB NO.
Legal Description of Property. include all easements
ALLOWED PROPOSED COMPLETE' EXEMPT
(show below Or attach four Copies)
SHORELINE M
..�
VARIANCE OR CU PLANNING REVIEW BY DATE
YARDS ( / HEIGHT LOT COVERAGE
FRONT, SIDE /v R6pp•
REMARKS
NEW RESIDENTIAL
PLUMBING
ADDIALTER COMMERCIAL
MECHANICAL
REPAIR CI RETAINING WALL
SIGN
EXCAVATE
FENCE
CHECKED BY TYPE OF CONSTRUCTION ICODE HEIGHT
DEMOLISH OR FILL
(_-x FT)
PREPLIA EIN
REMODEL COMPLIANCE INSP.
SWIM
POOL
SPECIAL INSPECTOR a- AREA OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
a WOO VE
El
NO
SERTI APT.BLDG
RENEWAL!
REMARKS
��
i%ll,mv— .Z/ 5,/4 r /`l fo S24le C.d yc
NUMBER OF STORIES NUMBER OF
2 DWtLLINu
UNI12f
NATURE OF WORK TO BE DONE (ATTACH PLOPLAN)
1--Il, G 0YSPQ-T)a'✓
VALUATION FEE
PLAN CHECK FEE
BUILDING
PLUMBING
This Permit covers work to be done on private property ONLY.
MECHANICAL
GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application:180 Days
Permit Limit: 1 Year • Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
m
successors in interest, agrees to Indemnify, defend and hold
—
J
harmless the City of Edmonds, Washington, its officials,
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
omodify,.
waive or reduce any requirement of any city ordinance
z
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
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz-
THIS PERMIT
AUTHORIZES
ed thereby, no person will be employed In violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tl Insur ncg._
SI A RE (OWNER OR AG T) DATE SIGNED
INSPECTION
DEPARTMENT
�l0'J
CITY OF
EDMONDS
ATT E T t
7771-332�0�2/�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE Xe/1%% &J
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS .BEEN GRANTED. UBC
CHAPTER 3.
102-78
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL'S SIGNATURE DATE
RELEASED BY:
DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
L7
2
K
W
Z
0
z
W
W
a
3
7
1
t
UPPER STANDARD DRAINAGE PLAN
C ATC.H
B451N DETENTION SYSTEM
(VENT) DETENTION PIPf LENGTH CONTROL CATCH
PAGE I OF 3
I� MIN, 2' MAX COVER
%for - r�i.L�t �!lV�\ �C-.��C
OUTLCT location- li�Z. lz-L-Au� ^�
C O NT;to c
plan by
= 17 SLOP , M, phone 77 - , ---�
-i E~4, date_
s Lo d-s
TO oL1TLFT
(RIP RAP OR
RUNOFF DESIGN DATA
SYSTEM CROSS SECTION SPREADER ...
System Imperm Pipe Pipe Orifice
3EE PAGE 3 FOR OUTLET CONTROL DETAIL Number Area Diam Length Diam ter
2 a Q' • (D' DEEP, 411-" SPALLi
(OR fOU1L)
Z • 2' r 3" DEEP, V.'_ CRUSHED ROCK
FNOTESFROM ? ineering Division (771-3202)
OUTLET ackfill and final inspections. l CONTROL ��
2. Responsibility for operation and !
maintenance of drainage systems on I
"• private property is the responsibility
of the property owner(s). Material
RIPRAP OUTLET '
accumulated in the storage pipe must I
{ be flushed out and removed from catch
basins to allow proper operation. The
j outlet control orifice must be kept
fl open at 1 times.
`Y.'ASHED 6RAYEL
OUTFLOW TRENCN� I IN 10' LONGS
TOP
�t 4+ PERF PIPE TO BE LEVEL
FROM
OUTSET ( I t
CONTROLt
4" F-RF PIPE WITH CAP_
gd. h 1
RUNOFF SPREADER OUTLET
q � �
4 rIrAo
FCOTY inf= =r'SMONDS
�..,'
.tr '.+ 1yt/ " �•��, a .�'.�i
''�a�ll+��l"'i.,� � '• ���I ii•'Ck3�t �"; `fie � �4i'^ �,+ �. • • � ' '
Aw"" _� td del. '��,• _X'
67
44
I !
(—' DATE RECEIVED-71q14 I ^ )
PERMIT EXPIRES 144&
USE PERMIT
CITY OF EDMONDS ZONE ��l NUMBERJOB
CONSTRUCTION PERMIT APPLICATION ADDRESS o Z 12�' A�Its N��
6suITE/APTr
OWNER NAME/NAME OF BUSINESS .�01a1r� 61i.L�+21 f5UQ6tG5S
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
m MAILING ADDRESS I O 2 I -L v 1 ve � TESCP Approved
PUBLIC RIGHT OF WAY. PER OFFICIAL STREET MAP Rw Permit Required
O Street Use Permit RegV
EXISTING PROPOSED Inspection Required p
CrIT{Y� ZIP TELEPHONE LI'Zrj 6%Z °h I (p Sidewalk Required Q
REQUIRED DEDICATION FT
1 Underground
widnp requffm 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
t7
\ YES ❑ NO ❑ Z
t ADDRESS REMARKS Z
¢V
Z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP TELEPHONE
NAME _' CBL#
ENGINEERING REVIEWED BY DATE
a ADDRESS i' !•'
O
G 9 Z27 � W
FIRE REVIEWED BY a I 4\ DATE W
CITY ZIP TELEPHONE cc
STATE LICENSE NUMBER VARIANCE OR.CU SHORELINE'OR ADBj INSPECTION BOND
„ , EXPIRATIO DATE CHE ED BY i
-` � REQ'D POSTED
= T. ❑YES ONO $
f i
SEPA REVIEW i SIGN AREA y HEIGHT
Q P OPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT - < ALLOWED PROPOSED 'ALLOWED PROPOSED
T LJ O D EXP.
❑ NEW RESIDENTIAL.": ❑.PLUMBING/:MECH, -` LOTCOVERAPO REQUIRED; SETBACKS (FT.):, ,PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED` FRONT "SID REAR FRONT LIRSIPE REAR
a COMPLIANCE OR c
❑ADDITION COMMERCIAL 1I
{{ '.❑ ❑ CHANGE OF. USE '
PARKING L07 AREA' PaNNINGREVIEWED BY DATE
❑ REMODEL = ❑ MULTIFAMILY ❑ SIGN REOD PROVIDED IL
FENCE "
C�G 9:12 L/A FJ
91 REPAIR ❑' GRADING.:-" CYDS ❑
❑ DEMOLISH ❑ TANK ❑
OTHER
GARAGE RETAINING WALL——, FIRE SPRINKLER
Z ❑ CARPORT ROCKERY ❑.,FIRE ALARM i 1�" `,,.
O (TYPE OF USE,
,BBUSINESS OR ACTIVITY) EXPLAIN: t'�J
�S ✓�,' vGL CHECKED BY TYPE O CONSTRUC_TIQN CODE OCC ANT
��� �/ C/ / GROUP
u
G NUMBER NUMBER OF CRITICAL
O SOF D TORIES UNITS
' �., AREAS NUM ER 5 SPECIAL INSPECTION AREA OCCUPANT
111 REQUIRED YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS`INSPECTIONSPER UBC 108/FINAL INSPECTION fIEG'D 9
Rk;�MovAJ -Roma-'? Derx- Q-6a �a5
-C_..� / h,�? C!R� VALUATION
Description FEE Description FEE
X ^
.''✓ Y _._.. Plan Check ai '� 5r State Surcharge
HEAT SOURCE GLAZING % % '}LOT. -SLOPE %
tBuilding:Permit=' CitySurcharge
PLAN CHECK VESTED DATE Plumbing #
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
7 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
s Engr. Review
PERMIT APPLICATION: 180 DAYS
d PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN ISO DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
i Revew
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Plan Chk. D@pOSII
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # a�lo ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
ar
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape lnsp. Total Amt. Due
= NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
GIVEN BIS CORRECT; AND THAT I AM THE OWNER, OR ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION;
DULYTHAT
U HOR TINFORMATION ENTAPPLICATION 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.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OF I IALS SIGNATURE DATE
M
I ATU W ER O AG DATE SI NED (425)
---2' OZ 7 e%1 -0220 REL ED BY
E44TION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CFRTIFI ORIGINAL - FILE YELLOW-INSPE R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING