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APPROVED <br />` PLANNING & COMMUNITY <br />DEVELOPMENT DEPT <br />DATE Lot Ll <br />(For surveyor Use Only IF a survey is required. Instructions: Complete this form to determine the average base <br />elevation of the proposed footprint or to locate the highest point of the sidewalk, whichever applies. This form is to <br />be submitted with the building permit application. Include these calculations on the site plan and building plans. <br />During framing, the Height Survey form will be required for the froming inspection. Contact the Planning <br />Department at 425.2:57.8731 if the structure does not meet the height limit.) <br />Date of Survey: _ PERMIT # <br />Property Location Surveyed: t 6 He s tJVl € 57 t` P f 71, `A <br />(address and/or parcel #) , <br />Description of Bench Mark: SET A N tl I L 1 iAS + C F FACI- 5VCE7 C 13 0 tj <br />)jam �'x t(�IO + oF 4b Sil . <br />Bench Mark Elevation: 0 F TRi 14-0Q' t @ ZZ((P <br />_ BOX 1 <br />A= �• <br />B= m, 43 <br />C = lots, Z3 <br />D= I0Q= 17 <br />A+B+C+D = 1. 18 / 4 = • Average Base Elevation <br />+ Maximum Height of 28 (feet) <br />= 0- Maximum Elevation Allowed <br />BOX 2 <br />Highest point of the <br />sidewalk EL <br />*Submit a map showing <br />the location of the highest <br />point of the sidewalk <br />abutting the property. <br />Check: <br />Box 1 I, ATT- ���f �t�l1�1 & certify that I measured the grade at the <br />�.X <br />midpoints of the proposed structure at the ndisturbed ground elevations / ❑approved <br />topography elevations for the property above. <br />BOX 2 ❑ <br />of the, sidewalk for the property above <br />ignature of Surveyor <br />Company - SPT 1 AN0 ,-591"ey <br />Address .> c,�; -. 26 f4yc ` u <br />Phone./Email M47TS C A1A'H,46i16, C:e)"r <br />certify that I measured the highest paint <br />7----/ <br />Date <br />