1016 DALEY ST.PDF1016 DALEY ST
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER: O D' 4-5 4 2-0 4?2 0 O
BUILDING PERMIT (NEW STRUCTURE): 1 L 540-3 % Lp(bEg)
COVENANTS(RECORDED)FOR:
CRITICAL AREAS: vl ZJI Z1 22 2 DETERMINATION:❑ Conditional Waiver ❑ Study Required Waiver
/
DISCRETIONARY PERMIT #'S:V. �7' 3 V '
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER): _ !�y 1 l' Q.I 1 a 7 `'t' D z-q
7-06 6 (Ad A� A92-CRLH (WL� nus7ol'-s4imiur)
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #: f/
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED: bm Q �-ca of (Q l Z
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER: l.d W - I Z� l I irl 7►'ta 1 Y� P,UJ SQNV I �Q)
LATEMP\DSTs\Forms\.Street File Checklist.doc
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A
CITY OF EDMOh%,, WASH INGTQ N DEPARTMEW06F BUILDINGS
—
BUILDING PERMIT".
hereby� certifies :hat a plot, plan, drawings, and sufficient details to indicate
J- entention to fulfill all requirements of this code are attazhed hereto.
.2
.;;,"lication is here ':VZ�e for peipinit t, do the following work: b i
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at .........
(Street number
0 914 C611.
X. P. cn
1. Building dimensions are ........ :744 - ------------ ---- ------ —0 Z
2. Lot dimensions are.__. a ............. .......... ... . .......
3., Building will be ....... :_e .............. stories in height 0 - o 6 E 0
Z.
4. Number of basements -..-A ... ......
S. Occupancy of building vA4- be.. .. ..... ... .... V ---- ---- — --- -----------------------------
6. Building w feet fro rest dj!olot line-
.99
-7 .......... ......
7. Owner .................. .... ............ ........................... Enintated cost $
R. Own cad....... ....................................................
. .....................
9. Builder ........................ __2 .. ... .... . .................................... Group No. ..... ...... ................ ...... ...........
10. tuilder's Addr-ss .............................................. . .... . ..................................................... r.
7.
11. Architect or engineer .......................... ................. ................... ... Life of permit....
Date ....... ........
4 Plans filed:
Applicant's Signature ......................... ... ................ yes 0 13
..... . ..
li
PeL-mission is hereby granted to do the work described hereon, according to the approved plans and specifications pertainiii herit6,
97
s copy b your rcccipt for the following fees.
compliance with the ordinances of the City of Edmonds. This subject to com . .....
1. Building permit fee ........... ........... ........... ................... $ ........
.................
2. Sewer permit fee ....................... ............................ . ..... $ 3. Inspection and supervision fee_--_ -------------
..........
.................. ...... ......... S ----------- - " Z
4. Total .... . ................. ........................... ............ .............. ...... ..... ...... $ ..... N . ....
Received I
Dep.�ent of,-Buildiii
PERMIT N? 376 City of •-Edmonds
I. The building permit fee -hi,l, applicant par, when permit is issued shall be based on -tim, of the proposed structure. at the r2ft of St.00 for each •q
$1000.00 of coax. If the .—A re,st of the srtr,t_. when fut.11y.detertnined. eareeds the eteiumrted — by more than 5%. applicant agrees tc pay an -dd;:imal fea
of $2.00 for each $1000.00 of such "cen, roar. In such event no uae,pT!it !!.o!ll beAssucil until such **di%=p-=cy fre" is paid.
copy *Is am required. by
Whenever a comma for mnstrualon is exetuted for any strucrure crafting meremerethan 111000.01) for which a licensed archttect or engla —
'Nldios Code or the Ury of Edmonds, the applimim for a building permit shall be accompanied by . copy of the --a ,d If of the detailed
.p!.y. commencing wont, notify tbe; !ndtx%tri-!Llr!mrrance Di,rhioo of &.e P!p Labor and led 7" of 41-11•
-
ii��Ilty;.11 make � thly'repom f. p-ly lls. Full,injisructions %hould W obtildbd, fl�e. he nearat ii1ce SW an
%..y labor ,%c.no!,Z
t 1 :7 eparoutent, of =7;=uao"eJ. Before
• payment, the owner thould obtain a release from die -general IFbarrictora,u-bo'll tur.'ahould bW;,Txe1e.1i:fr&; JI sub—trata... Th. 'deatses Aoulrl'be
,uzeiird by the Zparurteot of Labor\=d Industries. 'Me above procedure 'arajeqiti—ta of the State Idu,721 Insurance Art,:
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City of Edmo
=1 _-
9t-
890 199v
RIGHT-OF-WAY CONSTRUCTION
f
PERMIT Permit Number:
Issue Date:
A. Address or Vicinity of Construction: 1016 Daley Street '
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Natural Gas Company
Mailing Address: 815 Mercer Street,
State License #: Seattle, WA '98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: -Bond: $
Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project Utility (PUD, GTE, MING, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR: iN �4l T LV1 "7
r. ravement or Concrete Cut.: LN x es vivo \L I ti..oize or g_ut: _ -$ x 4 ti. Lnarge Z
f R
APPLICANT TO READ
INDEMNITY. Applicant understands and by his signature to this application, agre ld the City of Edmonds hatmlE�s %r%h iuVe� damage's, or
claims of any kind or description whatsoever, foreseen or unforeen; that may betmade against the City of Edmonds, or any of its departments or en oy-
ees, including or not limited to the defense of any legal proceedings including defense costs, and_a(torney fees by reason of granting thtpptmit. .
'..: t ...,.w'sr � i' s ; 7 ��,,.... • :fir .
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INS ON
AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORA77ON FEES WILL BE HELD, 6fN,7 s,THE FINAL STREET PAfiH7S _6 ETE
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Department
Work is to be inspected during progress and at completion. +n
Restoration is to be in accordance with City Codes. 77l-0220 r
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above stateme nd understand
und ers and the permit requirements and the pink copy of the permit will be available
on site at all times for ection
Signature:' Date: October 20, 1992
(Contractor or Agent)
CALL DIA]
....................................................................
rA=DIG:PRIQQR.�TQ4BEGENNING WORK
............................................
�:. .........
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DATE::::- - : : ISSUED BY
NO WORK SHALL BEGIN.PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOT (FunMI - Route copy to Street D;it:)
Comments:
Diagram:
• 3
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CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection. by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. Jul)
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AVVb9vV n&MrgVCmpa rV
DI& pAICY s--
WNG to window --,-
Water main depth
unknown
2 " gas main
to City of Edmonds
Right of Way
Permit Application
Submitted by: RIc.N�
aP� Ftit.i,gQ)
Engineering Aide
Washington Natural Gas
622-6767 x2761
Pager 9(09
s� P .
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Key:
-w- water
-g- gas
-ss- sewer
$ water hydrant
O water valve
815 M=W St. (P.O, Box 1869), Seaak, WA 98111(206) 622-6767
.u. A,
Critical Areas Checklist
Site Information
Project Name: Aeo,,max,, /e,'c5& c,,/r. Permit Number:
Site Location: 1U/Co 4oeC- Y Property Tax Account Number.
Approximate Site Size (acres or square feet):
Have you filled out a Critical Areas Checklist for a project on this site before?
General Site Conditions
1. Has the site been cleared or logged?
V3</Z-- 0q3 -6o S -00
Date of most recent action:
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? . /JGG�2Guvo�� Ci,�iia�uy
3. Describe the general site topography. Check all that apply. S.oA-1-tly G" i°M r /S rb ZS
S40116
Flat: less than 5 feet elevation change over entire site.
jZ _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 of horizontal distance.)
Steep: grades of greater than 30% present on site.
Commentsex&na,,J QE SIZE
Hydrology/Vegetation
4. Site contains areas of year-round standing water: //i),
5. Site contains areas of seasonal standing water. r1110 Approx. Depth:
6. Site is in the floodway ) D floodplainA)of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? &_flows
are year-round? Flows are seasonal? N..—
8. Site is primarily: forested ; meadow ;shrubs ; mixed r' M
9. Obvious wetland is present on site: /U� M
��
10. Wetland inventory or map indicates wetland present on site: --�
°U
11. Critical Areas inventory or map indicates any Critical Area on site:
-- ----------�� _ For City Use Only
STUDY REQUIRED:.Critical areas study.is required.
CONDITIONAL WAIVER: Critical areas study not required if specified conditions satisfied.
WAIVER: Critical areas study is not required.
Determination. Number_. CA..-G,L-- 12,77.. Reviewer
Planner Date'
Rcv 3/27/92
ar9a _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 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
of the parcel with enough detail that City
staff can find and identify the subject
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information 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 provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name
Title .i.
—0/4;
Street Address
Applicant Representative:
Name
Title
Street Address
City, State, ZIP Phone City, State, ZIP Phone
Signature
Date Signature
%/1f7_
Date
3
3
APKICATION
The CRY of Edmonds fcw, EASEMENT NO. ------------- -- ---------------------------
SIDE SEWER PatMIT
NEW CONSTRUCTION REPAIRS n LID NO ................... . ASMT. NO.
OWNER- ....................................... ....................................................... CONTRACTOR .................. .................................. --------------- -- ..... PERMIT NO. --------------------
JOB ADDRESS ....I A. f- c...... bl.kj ------- 54X--eg-.-i ............. LEGAL DESCRIPTION: LOT NO. ---------- --------------------------- BLOCK NO- ------------------- ----------------
................................................................ ...................................................................................... ..........
NAMEOF ADDITION ............................................................... .......................................................
Approved:
DATE-------------------------------------------- By ------------------------ ------------------------
................---District ?o 196
4
City of Edmonds ---Water Departmenf4l&
TAP CARD
Date. ...... .........
MeterNo ............................... Tap No...........---------......................
Size.............................. -Size....................................._.
Mf9rs. N ..... .. ... . I�..... ........ ................ Style---........
. . .......................................................
. ..
For ... . ..... IZ.....
�. ......
.........................................................................................................
Lot No------------------------------------- ---- Blk.
.No ....................................................
Add. ..................................L2� ..... .......................................................
Service Location .4.. ......... .
.... ................................
.................................................................................... ....................................................
Meter- Location ................................................................................................
..................................................
Make Tap .......................
...................................................................................................................
Pressure.............................. lbs. Test........---....._................... %
SendBills to ..................................................................................
.................................................................... . ...............................
Dateof Work .................. 7 .. ..... .................................
...................................... 2) . .... a .... .................................................... Foreman
Guar. Voucher No ........................................... $ ..........................................
Remarks: ........................................................... ...............................................
................................................ ............. ....... ........ .............................................
........ ..... .... ........... .. VV . ... .. .....................................................................
............... .... . . ................. . ....................................................................................
................ .... ................ .......... . .......
STREET .... F
................................................ .............. I ...................................... IM"""' .................
OUTGOING Index .......... Reg ....... Route Bk ......... Stencil ...... Card ........
INCOMING Index .......... Reg ....... Route Bk ......... Stencil ...... Card ........
Material Chargeable to Installation M-effers
NO,
SIZE
.... .....
DESCRIPTION
RATE
AMOUNT
Meter
....... */ ...
..........
Meter io'x...
.
...............
..........
Meter Plate ............................
....
..............
..........
Check Valve ........................
..............
.........
Pipe, Galv. Screw ..................
..............
. . .........
..........
..............
..........
Nipples . ....................................
..............
.......................
..............
..........
Bushings ..................................
..............
.............
..........
.........................I
Pla"' Ells ................................
..............
...............
.........
St. Ells ....... ............................
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.......... I
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.........
...... ...
Tees .........................................
. ....................................................
...... ..............................................
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....................... I ...........................
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--- - -
............ I
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.........
.....
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-----------
..........
Material Chargeable to Taps Connected
NO.
SIZE
DESCRIPTION
RATE
AMOUNT
..............
.........
—
Pipe, Black Screw ..................
.............
.............
.........
..............
..........
Pipe, Galv. Screw .... __ ..........
...............
......................
--------------
Lead Connections ..................
CurbCocks
..............
............
.........
............................
Corp. Cocks ..... .....................
...............
..............
.......
........ ;�.
..............
..........
Unions ....................................
......... ....
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.........
........... —
..........
Saddles ................................ ...
..............
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. ........
..............
..........
Nipples ....................................
...............
...........
.........
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. .......
Bushings ..................................
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..........
...............
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Plain Ells ................................
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..........
........ .....
..........
Street Ells ---I........... ...
............ I
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..........
Tees ............ "'" -----------------
------ -------------
Curb Boxes '*
---_---------
......
...........
........... .
......
..........
........................
S. 0. Extens ions ....................
..............
............
..........
..............
..........
Gates ........................ ................
................
............
...........
.................
..........
�V
Plugs .......... ........................
Couplings ............
_ ..........
...............
..... .
......
.....
..............
..........
Gate Boxes ............................
...............
.............
..... ..
rW..A�
..
o-
........................ .... ........ ...
..... &A .. ...... .. .. .. —
..............
— ............
..........
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.........
........ I .................... � ............ 7 ............
........................................................
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....
..............
. ........
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. .......
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. ........
...
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...
.......... I—.
..........
.' - .
..
.............
........
..... ........
..
.......
...............
..........
..............
Hours Time—......................... * ....... * ......
Day Men ........
...............
...............
.....
.......
...................I.'--
Hours Time —Monthly Men...-------_.....
........ . 2g;
..............
..........
Hours Time —Auto .............................
................
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Superintendence ....................
..............
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Total ..................
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