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Burg Height Handout-fags 3 of 4 <br /> City of Everett,WA <br /> Base Elevation Survey <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 framing inspection. Contact the Planning <br /> Department at 425.257.8731 if the structure does not meet the height limit.) <br /> Date of Survey: tl PERMIT# ZOJ3 7� <br /> Property Location Surveyed: �� `r 00S5310 LZOoCa <br /> (address and/or parcel#) <br /> Description of Bench Mark: S8 0,4jjUjr <br /> Bench Mark Elevation: (6 S"o/-�71,3 <br /> BOX 1 BOX 2 <br /> A= �r <br /> B= Highest point of the <br /> C= sidewalk EL <br /> D= <br /> A+B+C+D= /4= Average Base Elevation *Submit a map showing <br /> the location of the highest <br /> +Maximum Height of (feet) point of the sidewalk <br /> Maximum Elevation Allowed abutting the property. <br /> Check: --�' <br /> BOX 1J4 I, IA [ C (, , certify that I measured the grade at the <br /> midpoints of the proposed structure at the ❑undisturbed ground elevations/Rapproved <br /> topography elevations for the property above. <br /> BOX 2 ❑ I, , certify that I measured the highest point <br /> of the sidewalic for the property above. <br /> __ ignature of Surveyor Date <br /> Company tt L.L L=Atitl> <br /> Address 3 (7 (-(r4PLl� e`tVE y <br /> Phone/Email �Q��1/ �i � pSryeUC—W seat N ANpS <br /> EXPIRES <W <br /> i lil <br />