1010 9TH AVE S.PDF111111111111
9905
1010 9TH AVE S
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR: —1\ M 1015
CRITICAL AREAS: �`7 lJ� DETERMINATION: ❑ Conditional Waiver ❑ Study Required kaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DA
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMITS) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DSTs\Forms\Street File Checklist.doc
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APPROVE® BY PLANNING FEB 18 2005
® �o �, J3r!3' F STREET FILE IT COUNTER
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• •
PLANNING DATA
NAME: Pan & 7ecAv- 0/4.y- DATE: 3/Dias
SITE ADDRESS: 10 /a - 9 stir . 5_ PLAN CHK#: OS - 0 71,
PROJECT DESCRIPTION: ,ram 4
REDUCED SITE PLAN PROVIDED?: QQ No)
MAP PAGE: 153 CORNER LOT: Wes )/ No FLAG LOT: Yes / N
ZONING: AS - 12- CRITICAL AREAS DETERMINATION #:_ .413
❑ Studv Reauired:
OWaiver
❑ 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:
i
9� Street: Z 5' Left Side: 101 Right Side: 25 ' Rear: (o '
Actual Setbacks:
Street: 3 2 • Left Side:5'Right Side: Za' * Rear: 641 a,,; fk, krbAe,q _ j1,
Street map checked for additional setback required? (Yes / No / 0 N,
❑ DETACHED STRUCTURES:
❑ ROCKERIES:
❑ FENCES/TRELLISES:
❑ BAY WINDOWS / PROJECTING MODULATION:
❑ STAIRS / DECKS: N— I ti--
PARKING: Required:_2_Actual: 1 % ,h J
LOT AREA: S 6,06 "
LOT COVE 3a q-d k 96Z
Calculations: 2 5.3 9,
BUILDING HEIGHT: /do
Datum Point: Datum Elevation:
Maximum Allowed: Actual Height:
A.D.U. CREATED?: No / Yes I,h�, ,tiw a, �^ e r Na IWL4 W K,;
f' . ryt"
SUBDIVISION:
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: Yes / No)
OTHER:' A- 19" - 4 - I c t.a Iv, sf^tu sc>�rc� - ���.,,,�,,
�� bw.t� -� 195a
Plan Review By:
NewBPPlanningDataForm. DOC
COLE NO.
STREET FILE OCritical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: i
2. Property Tax Account Number:'
3. Approximate Site Size (acres or square feet): K / 3'd
4. Is this site currently developed? '� yes; no.
If yes; how is site developed?
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. y Site contains areas of year-round standing water: ii4 ; Approx. Depth:
7. Site contains areas of seasonal standing water: h ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway W-�' floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? o jV 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: �}
Revolroaroa
890.199-
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 prectwsory site
visit, and make a determination of die
subsequent steps necessary to complete a
development permit application.
With a signed copy of this form, the;
applicant should also submit a viciniity 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
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 providled are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name �f
/ 0 1 0
Street Address
City, State, ZIP Phone
Signature Date
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
Signature Date
APPLICATION
for
The City of Edmonds FILE SIDE SEWER PERMIT
108-01700 NEW CONSTRUCTION E] REPAIRS 0
EASEMENT No . ..........................................
cc l
OWNER......... E..._..J-.-- - . . rt_......1./..% ............................ CONTRACTOR ............... .................................................................................. PERMIT No . ......................
ADDRESS------.0-1.0...-...9-th--AYEnue... S.................................................. LEGAL DESCRIPTION: LOT No............................................... BLOCK No.............................................
I'
NAME OF ADDITION
•
i
•
DYE TESTED ON SEWER
JULY, 1972
Approved:
DATE................................................ BY------.......---•-•----•-•---._........................._..........._.
Pilchuck Contractors, Inc. aycn•4
Job # 107022841
February 9, 2005 8�
Sheet 1 of 1 Rob Inglis '0n°'"
0"I"
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avow
NOT SMOaavN
avom
TO
SCALE
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PINE ST
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� s
03SO10 .
NlvmmiS •
-11s► N
18" x 24" BM •
KEEP •
RIGHT •
•
T
SIDEWALK
CLOSED
APPROVED AS NOTED
BY F EERIN
Date:
CHANNELIZATION DEVICE SPACING
MPH
TAPER
TANGENT
50/70
40
80
35/45
30
60
25/30
20
40
• Notes:
1. All signs and spacing to conform
to the MUTCD & City of Edmonds Traffic
Control specs.
2. Channelizing devices are 28"
traffic cones.
3. All signs are 48" x 48" 8/0 unless
otherwise specified.
u 4. Alert affected residents.
> 5. Work to take place between 9 a.m.
And 4 p.m.
6. Maintain two 11' lanes.
oe
go
• 2x24-
18" BM/
• WORK AREA X x 5'
IN SIDEWALK
•
•
•
O
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A
O
22 � ROAD
NARROWS
T
a) ROAD
WORK
T AHEAD
LEGEND
•
28' TRAFFIC CONE
®
WORK AREA
TRAFFIC FLOW
WORK VEHICLE
SIGN LOCATION
City of Edmonds Permit No:
RIGHT-O&WAV `CONSTRUCTION PERMIT Issue Date: =5 — l 'OS
...... w.T,..,_ ,.... w �Q I Q TN S ,
A°PAddress or Vicinity of Construction: r .,. A vir..,
B. T e of Work (be specific):
�� ' 1 U5 1 - O`� f 1 C�.S 4�1 At �j L'0 �3
4 Av S h
\ti•'A.' J' o CIL r �r ,-ai�
a� 13O' S '`: t [L.
.� P,vLe- �60 -ice G-70ZZ F-4( or'Q_ c� o
C. Contractor: `C'.\1AJ�.C��
i n Contact:.SL
Mailing Address:
GUk) Phone:
State License #:P1 LO—Hor-1di VY1 Liability Insurance: Bond: $ `
t
City Business License #:
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
4
E. ❑ Commercial ❑
Subdivision ❑ City Project EUC (PUD, VERIZON, PSE, COMCAST,-OVWSD)
0 Multi -Family UR
Single Family Other
�/
INSPECTOR: � (AA
/'❑I/�
I 4-Q W IN I + S
F. PAVEMENT CUT: ® S'^�,❑ NO G. SIZE OF�UT, � X �
CONCRETE CUT: S 1�'NO J
G. ❑Mail Approved t ❑ Call for Pickup n`{
. APPLICANT TO READ 1 SIGN
INDEMNITY: Applicant understands by his/her signature to this application he/she holds the City of Edmonds harmless from
injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of
Edmonds or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense
costs and attorney fees by reason of granting this permit.
vk
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION. AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. f
r ,
♦ Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
♦ Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asodit or.City=j
approved material prior to the end of the workday — NO EXCEPTIONS. r' -
♦ Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THAT I MUST MAKE THE PINK COPY OF THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS
Signature: " l �`` Date: c� -1 q `6
(Contractor or Agent) 1
• s.
Approved by:
Time Authorized: Void After
Special'Conditions:
0HU il'UIXTIVS . V 14rU
n
L
Right of-Way...Fee
Dis phon` Fee/Fund `1'11
Ins ction Fee
Total Fee:; o a
Receipt No" "�`�
REQUIRED INSPECTIONS:(1 imnc Karam, n SI,,ap-m K- rz2gm
�f 164
Call 425-771-0220, Ext. 1326 for a 24-hour voice-reco �in ection request line.
FINAL APPROVAL OF PERMITTED WORK: DATE: O
r
S
CADocuments and Settings\CunisNy Documents\Forms\Engnrng\ROWpermit_ doc Revised 10/01/03
CITY CLERK'CONFORMED COPY
CITY OF EDMONDS
121 STH AVENUE NO.' 200504270559 1 PG
EDMONDS, WA 98020 04 - 27 - 2005 12 : 52pm $19.00
SNOHOMISH COUNTY, WASHINGTON
STATEMENT ON ACCESSORY DWELLING UNITS
Property Address: Solo 1111� Ayr 1=t*40t-4ps W-N- `18e32c
Edmonds, Washington
Legal Description: `flbo i S I 1Lt A-yp -M pL--t- dF
Assessor's Parcel Number: Cho (a 19 4t>0
I have read the requirements for accessory dwelling units contained in Chapter 20.21 of the
Edmonds Community Development Code (ECDC) and understand that an accessory dwelling
unit as defined in ECDC Section 21.05.015 is prohibited until an AccessoryDwelling Unit
Permit is approved.
I also understand that an Accessory Dwelling Unit Permit cannot be approved unless all the
criteria in Chapter 20.21 are met, and all the necessary items are submitted, including an
affidavit of occupancy and a covenant to be filed with the Snohomish County regarding the
regulations imposed on AccessoryDwelling Units.
Property Owner Signature:
Property Owner Name (printed):
Date: 3 lzq �(0,!�-
STATE OF WASHINGTON )
COUNTY OF SNOHOMISH )
I certify that I know or have satisfactory evidence that��`�� (�
signed this instrument and acknowledge it to be his/her free and voluntary act for the uses and
purposes mentioned in this instrument..
Notap�,'\,mpsure seals must. be smudged. Dated:
FtA M. ✓,q' Signature of t
ip, Notary Public:
D51 �` Residing at:
m Z,
SLID My Appoint
',i
Expires:
� a �4-08 2 _ 1
i 0 �nu,���".i��` O(n 1
/SHING�
THIS DOCUMENT MUST BE RECORDED WITH THE'SNOHOMISH COUNTY AUDITOR.
s
ADUstatement
%..
STREET FILE
CITY CLERK CONFORMED COPY
CITY OF EDMONDS
121 STH AVENUE NO. 200504270559 1 PG
EDMONDS, WA 98020 04 - 27 - 2005 12 : 52pm $19.00
SNOHOMISH COUNTY, WASHINGTON
STATEMENT ON ACCESSORY DWELLING UNITS
Property Address: jo10 ,yyr,-� S t-t*40tJps Wk �18e32�
Edmonds, Washington
Legal Description: %,rvS i S I A -op � 1E--pk0 f-iPS pLA-1-- OF
�� - i �c� Af a.-7 , IQaeA-Al-IDk : �inV
Assessor's Parcel Number: 00 eo 19 +C>0 I vo 100 _
G7�v J 01C7 Comon�D
I have read the requirements for accessory dwelling units contained in Chapter 20.21 of the
Edmonds Community Development Code (ECDC) and understand that an accessory dwelling
unit as defined in ECDC Section 21.05.015 is prohibited until an Accessory Dwelling Unit
Permit is approved.
I also understand that an Accessory Dwelling Unit Permit cannot be approved unless all the
criteria in Chapter 20.21 are met, and all the necessary items are submitted, including an
affidavit of occupancy and a covenant to be filed with the Snohomish County regarding the
regulations imposed on Accessory Dwelling Units.
Property Owner Signature:
Property Owner Name (printed):
Date: (05—
STATE OF WASHINGTON )
COUNTY OF SNOHOMISH)
I certify that I know or have satisfactory evidence that
signed this instrument and acknowledge it to be his/her free. and voluntary act for the uses and
purposes mentioned in this instrument..
Notaia,',s,pwpsure seals must be smudged. Dated: :t�
FiA M.
Signature of t
jP �,�
W°#6rq `.o Ni
Notary Public:
,� ' • . '` = 2 %
Residing at: �LI%
may% GeLIG _
/�ziO.o'a��4���$.��;�0
MyAppointmen
_-
Expires:
lf)7
THIS DOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY AUDITOR.
ADUstatement
STANDARD GAS CONSTRUCTION NOTES:
PINE ST I y
03
moo:
03
y EOM
y 2" PE CAP
O 130'S CL & 28'W CL
(_')S CL & (_JW CL
® PROPOSED 85' LONG
2" PE IP MAIN
y 28'W CL (_7W CL
4N 4y
-� 64' I y TIE-IN
R/W FUSE
435'N CL & 28'W CL
�-- (_')N CL & (_JW CL
W
� I _
J
� y 5r8-429'N w
1991
5 8 4291N V
3 1993
iyy` y
c�
_ PAS IN 5/18"331'N
j 1993 L4
�JJ I
co 5/8"288'N IL
C7
�- 1999
I y
5/8.268'N
2003
o'
FIR ST
PLOT PLAN
SCALE: 1 50
J
NOTE: OVERHEAD POWER 9 AV S
PHONE, CABLE 0 28'W
ASPHALT
S—Bound Lane CL N—Bound Lane
W z �' z �' E .
7' SIDEWALK 7' SIDEWALK
• PROP. 2" GAS • ° ° •
28'W CL EX. SEWER EX. WATER
10'E CL 30'E CL
64' ROW
ROADWAY CROSS—SECTION
N.T.S.
FITTER (CHECK BOX IF COMPLETE)
Work area left in Clean & Safe condition
Complete all Pipe Tables and Gas Pressur Stamp
Field changes Red —Lined on as —built
Material verified and Changes noted on paperwork
All Valve & Tie—in Locations noted on a:' —built
Note beginning of Main, EOM & Line of '•Rain locations
Show Rope Locations & Cul—de—sac Radius_
Foreman's Signature
Company Date _.
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. EXCAVATOR TO CALL "ONE —CALL' TWO WORKING DAYS PRIOR TO
TO CONSTRUCTION, IN WESTERN WASHINGTON CALL 1-800-424-5555. IN KITTITAS COUNTY CALL: 1-800-553-4344
2. NOTIFY APPROPRIATE PERMITTING AGENCY PRIOR TO JOB START (SEE PERMIT REQURRMENTS).
3. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS AND GAS FIELD PROCEDURES.
4. EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE 0150.3200 TECHNIQUES FOR TEMPORARY
EROSION AND SEDIMENT CONTROL AND ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.
5. NOTIFY PROPERTY OWNERS ADJACENT TO PROPOSED CONSTRUCTION ACTIVITIES A MINIMUM OF TWO WORKING DAYS
PRIOR TO BEGINNING CONSTRUCTION. USE iSi TO DISTRIBUTE FLYERS IF JOB IS LARGE, OTHERWISE HAND
DELIVER FLYERS BE SURE TO INCLUDE THE LIST OF FREQUENTLY ASKED QUESTIONS AND INFORMATION ABOUT
THE OPPORTUNITY TO PURCHASE AN EXCESS FLOW VALVE WHEN THEIR SERVICE IS INSTALLED OR REPLACED
PER GAS OPERATING STANDARD 2550.1600. ALLOW ADEQUATE TIME FOR CUSTOMER DECISION AND RESPONSE.
6. ANY CHANGE IN ROUTE, PIPE SIZE/TYPE, TIE—IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE APPROVED BY
THE APPROPRIATE PSE ENGINEER OR PSE REPRESENTATIVE.
7. COMPLETE "PIPE CONDITION REPORT' ON ALL METALIC PSE FACILITIES. CHECK BOX. ON REPORT FOR WIRE
BOX (TEST LEAD) INSTALLATION.
8. PIPELINE MARKERS AND WARNING SIGNS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR. PER PSE GAS
OPERATING STANDARD 2525.2500.
9. INSTALL MAIN VALVES OUT OF TRAFFIC WHERE POSSIBLE. VALVE MARKERS SHALL BE INSTALLED AND RECORDED BY
THE CONTRACTOR PER PSE GAS OPERATING STANDARD 2525.2600 FOR ALL HP VALVES IF THE LOCATION IS
NOT READILY ACCESSIBLE, AND FOR ALL VALVES WHERE PERSISTANT SNOWFALL MAY OBSCURE THE VALVE BOX.
10. TO PREVENT ACCIDENTAL OVERPRESSURE OF ADJOINING SYSTEMS, NO TWO MAINS SHALL BE CONNECTED EXCEPT AS
SHOWN ON THIS DESIGN UNLESS APPROVED BY APPROPRIATE PSE ENGINEER OR PSE REPRESENTATIVE.
11. SYSTEM MAOP DENOTED BY: ISYSTEM MAOP = 45 PSIG
12. GAUGE AND MONITOR USE OF ALL STOPPERS TO ENSURE ADEQUATE FEED.
13. RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION.
14. PURGE POINTS AND PRESSURE TAPS TO BE INSTALLED PER PSE GAS OPERATING STANDARDS 2525.3300, AND 2525.1200.
15. MAINS AND SERVICES SHALL BE TESTED AND PURGED PER PSE GAS OPERATING STANDARDS 2525.3300 AND 2525.3400.
16. IF METALLIC PIPE IS INVOLVED, COORDINATE INSTALLATION WITH CP TECH.
--------- PHONE
17. NOTE ALL ACTUAL FOOTAGE, LOCATION AND MATERIAL CHANGES ON THE AS —BUILT IN RED. ( ') DENOTES
FOOTAGE BETWEEN FITTINGS.
GAS MAIN INSTALLATION/RETIREMENT
Type/Work
Pipe Size
Type
Estimated
Length
Actual
Length
Manufacturer
INSTALL
2"
PE
85,
GAS MAIN PRESSURE & TESTING
TYPE TEST_ __
DATE ON i
PRESSURE
TESTED B%.' _ -
TIME ON
DATE OFF
TIME OFF
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
DATE OFF
TIME OFF
Design Press 60
SYS MAOP 45
PROJECT PHASE
NOTIF#
ORDER#
O
SAP Superior
Service/Meter
Service/Meter
Service/Meter
Service/Meter
Ind. Service
Ind. MSA
Dis. Reg. / FT
HP Svc/MSA
Relocate
Retirement
X185032706
107022841
X185032549
106146981
Vicinity Map
WORK SITE
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Owner / Developer Contact Info
JEANNE BLAIR
8205 226th ST SW
EDMONDS, WA 98020
ATTN: JEANNE BLAIR 425-672-4796 office
Contractor. CONSTRUCTION COST CODES:
051-103.1
Project Manager Contact Information:
so2
CALL (800) 424-5555
BUSINESS DAYS BEFORE YOU DIG
KIM GRAY
CELL: 425-290-2678 THIS SKETCH NOT TU BE RELIED UPON FOR EXACT LOCATION OF FACILITIES
EMAIL: kIm.GRAYQpse.com REAL ESTATE/EASEMENT
PERMIT
N/A
EDMONDS
REV# DATE BY DESCRIPTION FUNCTION
CONTACT
PHONE DATE
3 PROJECT MGR
KIM GRAY
206-418-4233 2/8/05
2 ENGR - GAS
1 2/16/05 J.T.M. CORRECTED WORK SITE ADDRESS DRAWN BY
JOHN MOSS
206-418-4253 2/10/05
CHECKED BY
KIM GRAY
206-4111-4233
COUNTY EMER SECT GAS WK CTR APPROVED B
KIM GRAY
206-418-4233
SNOHOMISH 5 MCNSEG CP APPROVAL
❑
1/4 SEC OP MAP PLAT MAP
❑
NW-25-27-3 164.062 164.066 MAPPING
❑.
JOINT FACILITIES ARRANGEMENTS
❑
UTILITIES
❑
CONTACT
❑
PHONE#
µ PUGET
SAP Order:
.
JEANNE BLAIR
07022tio
SOUND
ENERGY 2" PE IP MAIN EXTENSION
DraMrl NIA mbar:
1010 9"S, EDMONDS, WA 98020
SCALE: PAGE:
DESIGNED BY PILCHUCK CONTRACTORS INC.
1" = 50' 1 1/1