1022 C AVE.PDFIIIIIIIIIIIIII
10479
1022 C AVE
-'_ n , . CITY OF EDMONDS — SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT �l o �102
Call 776-1107 for side sewer inspections BEFORE covering any portion of the construction.\
Inspection will be provided within 24 hours after request. NO Sat., Sun., or holiday inspections./
ADDRESS LOCATION OF CONSTRUCTION...........:Q.�� .......••-•-------...........--•---.-•--......-........---.....---..-.......-..-.-.-..........----..........-.................----.........
/2 t)� Lot 2, r1:► o :;; 2 , . • ! , :ncs uldition ,1-0 l,diao:±ac�
PROPERTYLEGAL DESCRIPTION............•-------------------••--......--•---......---•---"--='•JV...•--......-----...........---............----..................................................----•-
..............I..........................._...............--------.....----------------........----....----..........---.......--•-------.....------.....----........................................................... •----....----•-• •...........
OWNER AND/OR BUILDERDc:n F .Lil i.1sn
......................... ............................................ _.......................................................
TRACTOR'S NAME & ADDRESS..,i.0b--ilk;(_,-D _.:.1CkhU^ Sc.TJ:�(1i�„ 24006 - �triCe �YT.1-.•--_'L.......E&-onei,7 ..9bU2C............
---------------------------------------------------------••------......---- •...
Permission is granted ------- _;.::?.:'`' ?....=>....................... 19.12.., for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
TE No. 1—The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer before it has been inspected.
00TE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%. No bends in grade
sharper than 1/8 will be permitted.
NOTE. No. 5—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVEDDate
... _.........n...............:........ By....--------....
Date .................................... By....---------_ Date .................................... By ................
APPROVEDDate.-._2..'.G.0
By...._..7 �.............................................................
Remarks:
.........--•
...............................................................•----.
----------------------------------------•
•--------------•-------•---•---........--.-...-----..-----------------------------_....................------.............................
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection —
..............- �.................................. hereby certify that the side sewer installation constructed under this permit
(Owner of Contracting Firm Perfcrming Construction)
was installed in accordance with all governing ordinances of the City of Edmonds.
• G�
' Dated this ........ a-Z........... day of...---- . .ric...:.--------••--•--•-------.-------------•--,Z'-
J J Check BEFORE you dig for: Water ❑, Gas p, Telephone E], Power E], Sewer E], Other p V d
ADDRESS: d27 �t7i�l LL L
TAX ACCOUNT/PARCEL NUMBER: D �j
BUILDING PERMIT (NEW STRUCTURE): l q 7 /(Y7 z
COVENANTS (RECORDED)
CRITICAL AREAS q 4...!Uw DETERMINATION: ❑ Conditional Waiver ❑ Study Required (Waiver
DISCRETIONARY PERMIT #'S: W.�O$' CUl (�IpbtG(pug i "�
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DA'
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #: ' /
SHORT PLAT FILE: LOT: BLOCK: 2
SIDE SEWER AS BUILT DATED: S 32—
SIDE SEWER PERMIT(S) #:Gar
GEOTECH REPORT DA
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
LATEMP\DSTs\Forms\Street File Checklist.doc
� 37125 Y, ck.,lt f :,- - ". , ,• .,_ �: •a [ (1• `�.hu t1- rr:!l:,�,%��'VtF�� q�;:'..1
t a`j<r,ti \.+=.. / J'f.r'F�jAf. ram-' rtl t' �;�� 'i'-serarYirrw�v.a+wuev.wr.o '� ....-+•4 �Y..�-'"•W're e��L• ��y! �(}'�
POSTED ON KROLL MAP NO.: PEitMIT
i • t�•_ ` • NUM3,ER 110591
•
t F11-h,
.L'D I N q.; D E P d RT M E H T,"I ppplleant Fill
RMe�T APPLICATION I=�IdeHeavy Uneu )oB ADDItE9sE (OR N/:ME Ok' B;7BLYE88)i _ I �7 2 YARD�T➢ACH{{d
1 - t;1DE YARD SETBACK I STREET B[.TBACK AEAF O U.I ! �i t -
po vl t aQ VI 2 fJ _ / S fh) q�l}u g r ff ,
j - Mw1i,ItiO ADDRESS I .
( 7 USE ZONE I.O•r A I VACANT BITE t
R r - �et
NO
° c11_fir IIov uxaex �//!�� G I U __I rxfd#I y&:u�
VAEUNCE NUMBER:•; "t-it•
jtr• I /'� '� (''{� I (� (� / J HEIGHT I BUILDING AREA
NAME
t PLOT PLAN APPROVED �f
w I nDDF•ES:I ®.. H/ W - - f.. 4'TJt"'`- r+a`C(_ rI i)'✓K"
STREET n/W 7
DEFICIENC T'fi38 PROPERTY 1°,y(r�p3r t,4,y;,
' E PHONE NUMBExBTINa STREET R/W `+ �•.F. to
< CITY COMP. PLAN ST. R/W _4.6 -FT.
' I I REMARK '^ /`' ."�•
sDrivcl-Iay elopes not to e�tcced those w � • : �r �''; a ��4x:a�` t .
r+AME indicated on SI jnda:':d Draerzng ( :
1
V W j1 °x } : ttfi�1y(yr
C ADDRESS
N iti {
O I CRL'CKED IY t .
\)."tom(/.
TELEPHONE NUMDF.It I}-• � i t �'^
/ C CITY 1 ✓ S.Y i!tt.,[f} 1 (� • }, ' F
i - ! MET B12iF.0 I BERVICN 81Z9: I CLhARANCF. I CHEC D BY
c},
� �
CITY LICENel: NL'MHER �14 t, �';d 1�
I � STATE LICENSE NUMBER ff
! - D ► - l 0 �f 3 i IUEMAIVCB - � ; �'"N � y;"`� �` �.``pF
LdfRnl DescrlDtlon of tzoperty (Show Ba1ow or Attach Four Cop1e.) 1 it
+LOT 2 _ ..fY l - ` n. x°rtrf r
1 - +he- Sow -tom •La O-F y� I•yY>y ovNECTIOV i •._"trIED..�➢.Y+�Q..� I ,r x�.: �...
9 p-ol-ca N Tb�yy�
• Q S�,S I PE}:C. TEST Iy[. �I�•(++t��fi ;�
//`y� t
[ + = n If �•✓a/1 L rQ'L.E U\ .REMARKS [ bl-�+P•�'^y M1;T '�E?�
< 1
l 0 _ FIRE ZO TYPE OF CTH:1�CTI)pN STREET IMPROVED
'��_ i1�(// /V I,� YES
O 1 ,n7 i7%. s4•,1^•�S`' 1
' - 'aP �CIAL L48PECT01: REQUIRED OCCUPANC tow "y
- GAS ❑ YES
�) Ell
ESIDELO LINE P./L•)ANCBE�C`.(E. /SY Tl-!iS SI?EIS LCc A t0, IN TH c tNEW SIGN`_or;RESIDENTIAL CITY OF ED C.•lam.AD7 ,`r1 RETAINING RItiMAtUCB WALL TAX S�C4LD.Lt'CO ED 3!. 4.. '
" I__1 D MOI1sA v /0 /1 yY(tJS e.. �_.
c ALTER ❑ FENCE
EXCAVATE ❑ ,
OR FILL (........,t..........Ft.) �d .1.�1 w
rRE-MOVE O evvin GAvK C�vctlttQ�.
REPAIR ❑ INeP. POOL �'L."!v`-'sly
NUMBER Of' " '.P.lEd NUMBS OF y`'•'r';°�'!t'�'."`;�';iit '
i I UNITS
Da 3� .'�y,,:.r".�1"'�!' !•y4�u:•'
NATURE OF WORIt'. TO BE DONE. Valun:l�n. Fee Receipt No.:FT m
_ Plna CaKk Yo._....._._Mrf'�At`�°t';+•�::1
BUILDING (' /1 ;�� T •:i7 �h�.'
�y� 4 Ae �'•aI ;
PROPOSED UeE PLUb(IIIN6
• V _ems
d PLOT PLAN (IdIcate Building netbnckn, nDut[lag etrcc[e) HEAT d:.CA9 LINE //7 (� + _ _ Z'y'��4•s ��'(((h��
FENCE
ilk
1 RETAINING WALL •T )-�. Sty'yi!�'+�'iR?%. ti,, •tII.
SWIMMING POOL _ — - W {•y54 .j`y•.
1 DEMOLrfION — _ I •`jt' _
PRE-MOVi I'i:CPECfION---=I,'.•'�-���.t��"}fc1'���.2s1�,
i EY.CAVATION OP. FILL
i ---- TOTAL AMOUNT DUE -•t ' %
1 hereby acknowledge that I have rted this application; that the in- 3 �O I Ef.li ,(y��,1•y315
tormnt:on given In correct; and that i api the ewnec, or the duly a;:thor- I• ;tftly �'u"k•
trod agent of ;a owner. I egad to comply w,'- city and dab law. rcry- ATTENTION APPLICATION
APPROVAL = ^� J."
1.ttog ccn l,,acUon; and m doing the work authorbied lbanby, no penoa - ,•f
will be employed In violation of the Labor Cote of the State of waanmRon TID8 PERMIT This application tG not a permit until
relating to workmen'. Compenaatlon In.uranoe. AU7'DORIZEB O1gIIed by the Building Official or his Dep-
onLY THE
NOTE: Permit Limit One Year (Esceyt DEMOLITIONS which WGRB NOTED uty; and fees are paid, and receipt is ae-,
.hall be completed I. ninety darn; MOVED -IN RUILDLYG9 shall be wm• . lmowledged In space provided- i (J �}++"vj
pleted In 41: months.) ..-
I^!GPEC'f10N %L4,?:r� :._. •,: 1�;�j.
SIGN TUBE (OWNEE7$.OA AGENT) DATE SIGNED D CTO '8 816 T
DEPARTMENT •46��: `j, G r ic1
CITY OF DATE '.t
EDMONDS
NOTE: AppffcaWSubjeCl fo Pldrr Check Fu PR 64101 ' „{
r m-at coven wori: b, be done on prl;ate
Any eea.lmctlen en the pnbllc dental. (-,be, ld.—B., dclvewV., FILE
m.muees. etc.) will rKmre .eP_Me pe-J-1 . - }
Critical Areas
ILE NO
Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 1 O22 C t�l V E�►t.t,E
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? X_yes; no. MAY � 9 1994
If yes; how is site developed? '11,41/r
5. Describe the general site topography. Check all that apply. C��NTER
Flat: less than 5-feet elevation change over entire site.
y 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: no ; Approx. Depth: N is
7. Site contains areas of seasonal standing water: "C> ; Approx. Depth: . W (A
What season(s) of the year?
8. Site is in the floodway N A floodplain N 1 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? h o Flows are seasonal? W (What time of year? N
10. Site is primarily: forested ; meadow ; shrubs ; mixed
urban landscaped (lawn,shrubs etc) _ , .
11. Obvious wetland is present on site: "n
. ,
Rcvoiromga
City ofEdmonds
pCfitlicc'al 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
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:
4AeWP_\'ecx.XS %C0F_tJP' J
Name
1 o2"Z C- 4\iek_�G
Street Address
EDc-t61,,joS,wf4 48p2o
City, State, ZIP Phone
S' Date
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
Signature
Date
The City of Edmonds
APPLICATION
for
SIDE WE P MIT
EASEMENT No ............. .........................
NEW CONSTRUCTION REPAIRS ❑
LID 7�Z
OWNER .....V.enr !'� "'wlff!ti....----••.................................••---.................. CONTRACTOR 3A4.....OX �,.. 13 r cRC�1e� ..?o r v
.-- ..... PERMIT No.... l
ADDRESS .... .a rZ.-..'.G..!......--.....•ve•............................................... LEGAL DESCRIPTION: LOT No............................................... BLOCK No.............................................
Saul i, ;� or ',, .2, 131oa1, a� yO57 $ firSj add.
NAME OF ADDITION ...7c.... �^t a.?��S......................................................................................................
-----1�7 0
0
-
0
a
FEB 22 1972
Approved:
DATE ....-./ ._ r _ .. By r ...................
it
G