The URL can be used to link to this page

1031 GRANDVIEW ST.PDF11111111111111 14011 1031 G RAN DVI EW ST CITY 00 PUBLIC WORKS DEPARTMENT a SUSPENSE DATE: w F- � H f- H w F- TO' - 8 z Q DIRECTOR Investigate and Report ADMINISTRATIVE SECRETARY Take Appropriate BUILDING MAINT. FOREMAN Action Prepare letter/memo EQUIPMENT RENTAL FOREMAN PARK DEPARTMENT SUPT. for my sign. For Information Previously.Ref'd STREET DEPARTMENT SUPT. TREATMENT PLANT SUPT. Status of Action? WATE /SEWER SUPT. Return to: COMMENTS: ado. AL - •z ce .; FROM: DATE: S S17S % TER -OFFICE COMMUNITIONS S TO Jack Mitchell �g �I FORM 41 - LITTLE'S SUBJECT: Claim for Damages - Robert Clare DATEMay 280 19 75 FROM Archie Brena On the date these damages occurred, City crews were not working on the water system in the immediate area. However, DiOrio Construction was in the process of making a main line tie-in at this time. Therefore, they could have either opened the main line valve too fast or opened the wrong valve. After we received calls regarding pressure problems and dispatched our Special Assistant to the area, the pressure was normal. Consequently, DiOrio's work might have been the cause of the damages, although we cannot be sure. ADDRESS: M 1 (�yl LAW d1�i TAX ACCOUNT/PARCEL NUMBER: BUILDING PERMIT (NEW STRUCTURE):C17 COVENANTS (RECORDED) FOR: CRITICAL AREAS:— 'i DETERMINATION: ❑ Conditional Waiver Study Required ❑ Waiver DISCRETIONARY PERMIT #'S: ,�C5 DRAINAGE PLAN DATED: 10 * 7i ' PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS PLANNING DATA CHECKLIST DATED: 5 - 24 -04 i / / - l 'U1F j / 1' S' 04 SCALED PLOT PLAN DATED: /D •r Q4 SEWER LID FEE $: LID #: SHORT PLAT FILE: SIDE SEWER AS BUILT DA SIDE SEWER PERMIT(S) #: qq� GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: WATER METER TAP CARD DATED: OTHER: LOT: BLOCK: -40 L:\TEMP\DSTs\Forms\Street File Checklist.doc ' C. tam Address of City of Edmonds PENT NO: 9963 ;��A6�� SIDE SEWER PERMIT PERMIT EXPIRES Itruction: Coy ` LID # Property Tax Account Parcel No. 0 0 SqS7/CkM O d r7A d -- Attach copies of all access and utility easements __-_ Verified and Approved by Owner and/or Contractor: / Contractor License #: /j 69 f A-C A Building Permit #: 200 q 42/single Family ❑ Multi -Family (No. of Units ❑ Commercial (No. of Units ) ❑ Public Invasion into City *Right -of Way: ❑ Yes DINo *RW Construction Permit # Cross other **Private Property: ❑ Yes **Attach legal description and copy of recorded easement. Ownerr contractor signa�UW_4 acknowledgement statement: By signing for this permit I certify that I have read the City's public handout entitled &ide Sewer Specifications, and shall comply with all City requirements outlined therein. An Date W CALL DIAL -A -DIG (1-800-414L5555) BEFORE ANY EXCAVATION W W FOR INSPECTION CALL 425-771-0220 extensionW324W 24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS .. , : - FOR OFFICE USE ONLY Permit Fee $ Repair Fee Issued By: Trunk Charge $ �,��' Date Issued: r Assessment Fee $ Receipt City Permit Surcharge Fee Total Fees Paid $ z� NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED. Job Site Ready YES NO . Date: Initial: Partial Inspection: Wd kffiOe (I & 4 it othd Date: �nitial: �. Partial Inspection: Date: Initial: FINAL INSPECTION APPROVED:. Date: ,/f 0 �" Initial:�,�As-built to Street File: 0 t� PERMIT MUST BE POSTED ON JOB SITE' t� White Copy: File • Green Copy: Inspector Buff Copy: Applicant L;temp;bl dg;forms-,sspermitj Ig4/00 18" to center of column sewer 2.5' deep ED 0 CITY OF EDMONDS SIDE SEWER AS- BUILT ADDRESS SCALE 1031 GRANDVIEW ST NTS H❑ME❑WNER CONTRACTOR THOMAS NICHOLSON DATE DRAWN PERMIT 2/22/05 BY I. ABILA N❑. 9963 City of Edmonds Critical Areas Determination Applicant: Thomas B. Nicholson Determination #: CA-04-49 Project Name: Nicholson NSFR Permit Number: PC-04-475 Site Location: 1031 Grandview Property Tax Acct #: To Be Determined Project Description: Construct one new single-family residence. A small section in northwest corner of the site is within the building setback area from a Class 2 B (non-salmonid) stream. This area is within the rear setback of the site anyway and is not developable even without the stream setback area. Waiver Criteria (all criteria must be found to apply): X There will be no alteration of the Critical Area or its required buffers; X The development proposal will not impact the Critical Area in a manner contrary to the goals, purposes, objectives and requirements of the Critical Areas ordinance; X The development proposal meets the minimum standards of the Critical Areas ordinance; X The above findings are based on the following conditions of approval: 1. This conditional waiver is only for the NSFR shown in the attached site plan. 2. A building permit is required for all work. Based on the above findings and conditions, the requirement for a Critical Areas Study associated with this development permit is hereby Waived, as authorized by Chapter 20.15B.040 (A)(1) of the Edmonds Community Development Code. Ross C. Beckley 0404= 6W L November 8, 2004 Name Signature Date • S17-C PLlqA1 RECEIVED r L / racr4 ., Th.e c (oS � o� LoT T y OCT - 8 2004 L� ` j O � c ��M o�•c�s %ar-ce(00S-qrt 00000� a 2 o'� STREET FILE - \ (o C' Fe.o. z: G 10 0 to s (o fat = (S c +v .,., S i S o L, -r 7 SCALE /- 20 x a i C8 vf /11>0 / IVY Cn' & /r r � \ °o O� p 4- 3(. I 11 /► / cs C = / o 3.7 kCqP , Corner /v Ia N Re v?c1� 'rV�tn(S �;u.r�nce_ ti4�� ` ! o�iz,� �s� f Front Sred Actual Sides tel olLAa,'( Sel- 1\ froroSeSCur y #eaOther ay Wf .Zo cal o S � �e �►aI� Nei t— S � 100 ROVE Y PLANNING s T nn S (ke C/ao Fri S i 0 City of Edmonds Critical Areas Determination Applicant: Tom Nicholson Determination #: CA-2004-49 Project Name: Single -Family Residence Permit Number: PC-04-475 Site Location: 1031 Grandview Property Tax Acct #: 005951 000 00302 Project Description: Construct new single-family house. The first floor is 1303 square feet, second floor is 1318 square feet, and the garage is 460 square feet. The house maintains a 49 foot setback to the rear property line. The stream is on the adjacent property at the rear, and the required 25-foot buffer is perhaps entirely on the adjacent property at this point, and the building setback is definitely within the rear yard setback. Waiver Criteria (all criteria must be found to apply): X There will be no alteration of the Critical Area or its required buffers; X The development proposal will not impact the Critical Area in a manner contrary to the goals, purposes, objectives and requirements of the Critical Areas ordinance; X The development proposal meets the minimum standards of the Critical Areas ordinance; X The above findings are based on the following conditions of approval: 1. This conditional waiver is only for work proposed on the attached site plan. 2. Owner/contractor is responsible for erosion control and damage. 3. A building permit is required for all work. Based on the above findings and conditions, the requirement for a Critical Areas Study associated with this development permit is hereby Waived, as authorized by Chapter 20.15B.040 (A)(1) of the Edmonds Community Development Code. Meg Gruwell Name 11 / 5 /2004 Sign ture Date V r SITE- PLA RECEIVED ` LICANT e C CoS� of LofA T�y�a� OCT - 82004 .,,l PE MIT COUNTER l aoS4.s7 a0000� o Z v ,o�• mil i Zn w f Way S �orLc =,,t7 SCALE b � ' v { o `J40 / IN Aft ol ON*01 CDs (o X 5 4- pS e ! ki it v,e0►.- �o \ / z7, g' Set i ►� `rT ' ?rani o SJ C �A b t l rn / - r-o p e 4 y C. 0 t-L=loo y 2 o Fr .tL S • • PLANNING DATA NAME: / ' i, C o 10te DATE: 1Ay— SITE ADDRESS: .103I ?Aay'N ew PLAN CHK#: 0 - 7, PROJECT DESCRIPTION: /VSFR REDUCED SITE PLAN PROVIDED? es No MAP PAGE: 30 ( CORNER LOT: es No FLAG LOT: Yes No ZONING: V. CRITICAL AREAS DETERMINATION #: Li K`I Study Required: ❑ Waiver - ( _ Conditional Waiver '' uQ/ V1' 1 fo �(ea--� doGt r'rf f,Y,,4 1 �� 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 Street: k S Left Side: (° Right Side:y Rear: as Actual Setbacks: i y i Street: 50. Left Side: 1t Right Side: 1 t1 Rear: �� Street map checked for additional setback required? es No /DNA Q. DETACHED STRUCTURES: ❑ ROCKERIES: (� ❑ FENCEsrrRELLISES: D ' ❑ BAY WINDOWS / PROJECTING MODULATION: ❑ STAIRS / DECKS: - PARKING: Required: Actual: LOT AREA: R l o U LOT COVE RAGE i 7� ql ao 0/0 - Calculations: Svk;TaJwJ (7-- sZe OK pti a, lay lerry - lee vv el below BUILDING HEIGHT: Datum Point: �^ A�iT� �t7 W d PC Datum Elevation: 100 Maximum Allowed: Actual Height: (�S A.D.U. CREATED?: N Yes SUBDIVISION: Sec. y4 i o $ �✓ LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: es / No .-1 / ,, t%, mil - I - - - .L - -- -- - P Plan Review M�v tllI R4 C4q NewBPPlanningDataFonn.DOC PLANNING DATA NAME: t ( ion DATE: 114t7 SITE ADDRESS: 0?l PLAN CHK#: 0 — PROJECT DESCRIPTION: /V REDUCED SITE PLAN PROVIDED?: es No MAP PAGE:( 30 CORNER LOT: a No FLAG LOT: es No ZONING: „ — l CRITICAL AREAS DETERMINATION ❑ Study Required- A❑ Waiver L t ela Y Co,;,�tionalWaiver 1 f 1 v ` 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 Street:Left Side: 10 Right Side: CO. Rear: Actual Setbacks: i / i Street: 50' Left Side: 16 Right Side: 10 Rear: Y9 Street map checked for additional setback required? es / NoCIDNAD ❑ DETACHED STRUCTURES: ❑ ROCKERIES: ❑ FENCES/TRELLISES: ❑ BAY WINDOWS / PROJECTING MODULATION: ❑ STAIRS / DECKS: PARKING: Required: �- Actual: dZ LOT AREA: R l0 0 LOT COVE Calculations: BUILDING HEIGHT: Datum Point:__ Datum Elevation: Maximum Allowed: 5 Actual Height: A.D.U. CREATED No / Yes SUBDIVISION:),'( i X_ j1rC7_-r' 9'--\ 17)o0 Y {ra N. LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: es / No /- / OTHER•ThaT fJ2iR/.r.�r{I S✓ij[cT t'ui TS S��rajZ /o-'d--� �`( Plan Review 7�71 ct.,v�e SITE- PL/qAI RECEIVED OCT - 8 2004 S.w �d•.:, r(` C\o uM A- C—y�k MIT_COpYTSR �brce( dC7S4.�(oDoOo� O 2 o�v �+ = /Lv STREET FILE ., °� a G�� = G 0 L o s (o SCALE a ol i � v to �a X Uv & \o APPROVED AS NOTED BY ENGINEERING Date: .101 LI o %b *02 wlDe �xTiZJALT �r.nUcwby + 1 S" E.n 2.�3 eJ PEa ci r� S1.p �� .2.7, 8' ---�.. Corner A/ IV , S'1cks Fte uir a`? l� r , vu s s U. 0-e_ z,� �s�f Front _ S ed Actual ,nnSides �- nie /�aSep ProtoS��Cur� (0 G y k.lf .20 cJ op � s � �e,�al� Other y� Hett Pro pq,-4,( c.o r►ti2.r x aS w.aX c.- i 1 e-- r oo ROVE Y P NNING s 7-6 4A Stke ,C�ols� y z 0 k s S Lc-+nUr,cps u1l}- y �2 STANDARD OWNER: pi . i DETENTION SYSTEM- WORKSHEET (5000 SF OR LESS CALC. BY: � � ADDRESS: PHONE: ?_ 2 DATE: � 14 5 ►ZED FO r2 �� +C � ? �, IMPERVIOUS SUFACEAREA 301120 PIPE DIA. 09 PIPE LENGTH ORIFICE FOOTING DRAINS SHALL NOT BE RIM ELEV. I------ DETENTION PIPE LENGTH FINISHED GRADE TIGHTLIN -- 0.5`Yo TO 1.0% SLOPE UPPER CATCH BASIN NV. ELEV. CONTROLCB CONNECTED TO --LOCKING LID (TYP) IM ELEV. F 6" Min. clearance Measured from top of Conc. box or riser. 9" MIN. ELEV. _ OUTLET CONTROL DETENTION SYSTEM RIM ELEV. INV. ELEV. 2'X2'X12" DEEP CONTROL CATCH BASIN (4"-6" QUARRY SPALLS OR EQUAL) C IN. 6" COVER FROM CONTROL CONTROLCB RIPRAP OUTLET SHALL BE PERPENDICULAR TO SPREADER TRENCH PERF. PIPE SHALL BE LEVEL & CAPPED AT ENDS NOTES 1 {---1.5'--i SPREADER TRENCH TRENCH SHALL BE LINED WITH MIRAFI & ON TOP WASHED DRAIN ROCK 1. CALL ENGINEERING DIVISION (771-0220 EXT. 1326) 24 HOURS IN ADVANCE FOR A TIGHTLINE AND DETENTION SYSTEM INSPECTION BEFORE BACKFILLING AND FOR FINAL INSPECTIONS. 2. Responsibility for operation and maintenance of drainage systems on private property is the responsibility of the property owner. Material accumulated in the storage pipe must be flushed out and removed from catch basins to allow proper operation. The outlet control orifice must be kept open at all times. CITY STORM CONVEYANCE SYSTEM SPREADER TRENCH SHALL BE A MIN. OF 10' LONG AND PERPENDICULAR TO CONTROL CB. m y rid J memo �v/ac �o�ed RECEIVED MAY 112604 ' PERMIT COUNTER APPROVED BY PLANNING DLO T PI.a /v 'Tbl' TicFNr r_o_ 3-9—e 4k.r`c— ��.. yq' �o• � � it z aoX to ifcAA sic F •• 34 oP- -.� 71a. SF yoo.sF . 01 ;1 RACE . IV _.� }/.o.J b.G �iANO ViG�✓ $Rive 1031 lea/ 1L6L8 ON XH/%Zl 09:INHA tO/90/80 �b r05/01/2004 15.37 425157121121418 hgettt,;y t.ase tvo. 200401784 li-iii ... 4; `1; 1 ' Mi. Agency use Orly BILL AND JONI I PUGET SOUND CLEAN 110 Union Street, Suite 500 Seattle, WA 98101-2039 www.pseicanair.org NOTICE OF INTENT PAGE 02 Date Recaivec PSA1f3 M AY 3nn M04 Agency Use Only A. Proimt Tvoe• 1 ❑ Frjable Asbestos 3emovitl Z ❑ Pri9ble Asbsatosltetrloval & DemQjdt ob 3 Dennolltion Only 8. I r Property Owner: -MOhQTh• 6, N c.�Ol$0•' Phone: �J 7 7 1— -7?-Z.? Mailing Address: l 8 M /Ire ,SO, Ci : �=C ��ptJ State Zip: C. Asbestos PLrZu POINT_CMM7 MAUmt M AsAruNr Contractor: .,..___......._ S1 D. Site Address: 1031 6_i•rAfle4 SJ rgeT Site Manager: E. bestos Survey or I No. of ❑ Ma ' eStructures:' ARERA Building Inspector: I y� J Iiaspector: �t�. �� t�A An ARM Surrey Is required before rill demolition ptroj, etc F. Demolition $tart �q., a�A` C,r „l Information: I Date: Demolition Insert Aemolition contractor J me fling mm" Contractor: ©why' 7r- Date of AS esto,5 Was Friable Asbestos Identified? Yes o S e • rTl 70 0 Was Nor iable Asbestos Identified? Ryes ❑No Certification #: O!I 6 Attach a copy of the survey when frietble asbestos Bx . Daze: has not been identified, bf I No, of 1. Training ,Fire (List Fire Dept.) Structures: 2. ❑ Ordered Dcmolition attach co of Order) Its on back Will non$lable asbestos be left in place during demo? LJ Yes No If yes, list type and qty. G. Friable Asbestos Work Days: M T W Th F Sa Su Project Information: Stan Datc: Completion Date: Hours: Will all friable asbestos ❑ Yes Total Qry. to.be Removed: Linear Ft. Svwe Ft. materials he removed? ❑ No Ll Boiler\Fumace Insulation U Duct ]nsulaoo. i Pipe Insulation LJ Fireproofing U Paints LJ Plaster LJ Textured Coatings Cnmvm Board 11 Cement Pipe 13 Fria le Flooring LJ Friable Rooting Material Other: H. Asbestos/Demolitioa Project Categoriet : Notificaden rgiriod Project Demolition 1. Single -Family Residence (owner-occupi :dy A. ❑ Asbestos Removal Project Only Fee Surcharge 13.;: Demolition, Project (with or without as )estos retrwval project) A. Prior Notice H. 1.0 Days* A S25 Asbestos removal can be iu upon notific itioa• demolition must wait 10 days)-� Niue: if the single family residence is owned b i one family who has been or will be using the residence as their domicile, the above_ boxes lA or /B may be checked. ifthif is not ase or ter-oeek�►ied reSAdekCer one oftbe categories listed below tnrst be used. A single family residence does not Include rental property. M !d- amil emits, or amy mixed -use buildinr. 2. All Ocher Demolitions with no Asbestc s removal or Nonfriable Asbestos only 10 Da s $200 Friable A,sbegtos Projects other tha t Sin le Family Residence): Asbestos Demo 3• >- 10 - 259 linear feet and/or >_ 48 - 155 square feet of asbestos Prior Notice 10 Ds $100 $100 4. LJ 260 - 999 linear feet anal/or 160 - 4.99 square feet of asbestos 10 Da $200 $ I00 5. >1.000 linear feet and/or >5,000 s uar ; feer of asbestos 10 Da S750 $250 6. Emergency Asbestos Project or L3 )ri iergency Demolition Project Prior Notice Twice Project Fce (Single -Family Residences ere exempt from otnerRcn fee however, property owners must tov* a written ernergeney rnut4t) it. 1 cetlify of the information containpd In this noti(iei ;on dk suppleymntal date is, to the best of my knowledge:, accurate & complete, Age Xis ni VFA IR M In f signature Reprventin Date ' Revie>, ed B Puget Sound Clean Air Agency Fortn No.: 66-160 (Revise i 1104)'1'S zoo ljt AflflOUFdT/�06 y I{�0T. aiv Nvsno 5d CLOb 689 90Z %Vd CC:VT POOZ/50/50 PLANNING DATA NAME: 'Tno--i 6. N:M,61s .-. DATE: 5 /a4-/Z-o- SITE ADDRESS: 1y3! Gra,,,A '&„ SF . PLAN CHK#:y4 - (&Z PROJECT DESCRIPTION: km. ibb w (k t-tid* .ca Guv IZ l(0 J(= � wru a.K am -a Ya"..' a�= — will' .it— q40 ' i,, .. /9R71 REDUCED SITE PLAN PROVIDED?: e / No MAP PAGE: CORNER LOT: Yes / o FLAG LOT: ZONING: XS -1Z CRITICAL AREAS DETERMINATION #: 04 aStudv Reauired: 4�' sa"� 7-5 • 5"b'.. ❑ Waiver 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: Street: Z5• Left Side: I.o " Right Side: Rear: ZS" Actual Setbacks: a.-b (,� A,4- NA. $ 7- g Street: Left Side: Right Side: S Rear: Street map checked for additional setback required? es / o / N 0 DETACHED STRUCTURES: 1> 1—&-4f- ❑ ROCKERIES: ❑ FENCES/TRELLISES: ❑ BAY WINDOWS / PROJECTING MODULATION: nee s ❑ STAIRS [DECKS: PARKING: Required: 2- Actual: LOT AREA: �9 Z 400 " 9 Z LOT COVE Calculations: ib.7°�� BUILDING HEIGHT: Datum Point: Datum Elevation: Maximum Allowed: Actual Height: A.D.U. CREATED?: o Yes SUBDIVISION: LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: es / o OTHER: A,,,.,-cgc#:a .< A�r.+,� 1 t:;4 A e/a l.. Plan Review By. NewBPPlanningDataForm.DOC #P20 Critical Areas Checklist cA Fire x°: OAR Site Information (soils/topography/hydrolo vegetation) vi 1. Site Address Location ( (�d e 2 Property Tax Account Number. Oo 5 9 51 000 �sp3a2 5`t 5 I b-DD 063 oZo 3 bt-b 3. Approximate Site Size (acres or square feet): Ala act 4. Is this site currently developed? Zyes, no. If yes; how is site developed? Strjl e: 5. Describe the general site topography. Check all that apply. 1:7aa 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. Site contains areas of year-round standing water: �� Approx. Depth: 7. Site contains areas of seasonal standing water: YV ; Approx: Depth: What season(s) of the year? 8. Site is in the floodway _f� floodplain of a water course. 9. Site contains a creek or an area where wafter flows across the grounds surface? Flows are year-round? Flows are seasonal? (What time of year? ). 10. Site is primarily: forested ; meadow shrubs ; mixed urban landscaped (lawns, shrubs etc) 11. Obvious wetland is present on site: �a For City Staff Use Only 1. Plan Check Number, if applicable? Z Site is Zoned? fZ 5 - 1 Z 3. SCS mapped soil.type(s)? 5 - Al A ram,-,k, V, b— l" L,= ., 4. Critical Areas inventory or C.A. map indicates Critical Area on site? '1(c,; - Nan, s 4•,e,,.r, - C 1 ws s Z A( sue, 5. Site within designated earth -subsidence landslide hazard area? No DETERMINATION STUDY REQUIRED WAIVER Reviewed by: Date: 4/2Z%c4 City. *Edmonds Development Services Department Planning Division Phone: 425.771.0120 Fax: 425.771.0221 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 the application 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). Date Rece'ved• 4- IZ - ZoOA City Receipt #: P-391-1 Critical Areas File #: Critical Areas Checklist Fee: $135.00 Date Mailed to Applicant: A property owner, or his/her authorized 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. Please submit a vicinity map, along with the signed copy of this form to assist City staff in finding and locating the specific piece of property described on this form. In addition, the applicant shall include other pertinent information .(e.g. site plan, topography map, etc.) or studies in conjunction with this Checklist to assistant staff in completing their preliminary assessment of the site. The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable attor ney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate . or incomplete information fir nished by the applicant, his/her/its agents or employees. By my signature, I certify that the information and exhibits herewith submitted are true and connect to the best of my knowledge and that I am authorized to file this applicationon the half of the owner as listed below. SIGNATURE OF APPLICANT/AGENT DATE 0/4/ Property Owner's Authorization By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application, and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the purposes of inspection and posting attendant to this application. SIGNATURE OF OWNER PLEASE PRINT CLEARLY Owner/Applicant: Name Street Address City State Zip Telephone: Email address (optional): DATE AppH Representative: Name Street Address Reo zz City State Zip Telephone: �Z 7 %f , . . Email Address (optional): City of Edmonds Critical Areas Determination Applicant: Bill Bickel Determination #: CA-04-49 Project Name: Permit Number: Site Location: 1031 Grandview Street Property Tax Acct M 5951 000 003 0203 Project Description: Non -Project Specific Determination: Study Required: During review and inspection of the subject site, it was found that the site appears to contain and/or is adjacent to a Category 2 (without salmonids) Stream pursuant to Chapter 20.15B of the Edmonds Community Development Code (ECDC). A study was done with critical areas determination CA-1998-0097 that classified the stream. Based on these findings, prior to submission of any development permit, you will be required to submit the following for review by the Planning Department: Submit a survey prepared by a Washington state Licensed Land Surveyor delineating the top of the stream bank, required 25-foot buffer, and 15-foot setback to any proposed new building. This stream flows into Puget Sound, therefore, the applicant must contact the Department of Fish & Wildlife, have them review the site and submit a letter determining the impacts of development on this site and, if necessary, recommend mitigation measures to ensure protection of the habitat/stream. If culverting or redirecting the stream is proposed for development of the site, please have Department of Fish & Wildlife address this matter as well. If the property owner wishes to apply for a specific development permit which they feel would not impact the Critical Areas located on or adjacent to the site, they may submit their proposal to the Planning Department for review. If the Planning Department finds that the proposed development permit will not adversely impact a Critical Areas or its buffers, a conditional waiver may be issued on a project by project basis. Certain development proposals may be exempt from Critical Areas Requirements. Refer to ECDC 20.1513.040. Name Date 0 0 City of Edmonds Critical Areas Determination Applicant: Thomas B. Nicholson Determination #: CA-04-49 Project Name: Demolition and Wall Permit Number: PC-04-182 Repair Site Location: 1031 Grandview Street Property Tax Acct M 00-5951-000-003-02 Project Description: Demolish a detached hobby shop with attached carport, demolish a 12 x 16 foot shed, demolish an 840 square foot addition to the existing house, and repair the wall where the addition was removed to include a kitchen in the old house. Waiver Criteria (all criteria must be found to apply): X There will be no alteration of the Critical Area or its required buffers; X The development proposal will not impact the Critical Area in a manner contrary to the goals, purposes, objectives and requirements of the Critical Areas ordinance; X The development proposal meets the minimum standards of the Critical Areas ordinance; X The above findings are based on the following conditions of approval: 1. This conditional waiver is only for work done as shown on the attached site plans which include the demolition of the two detached structures in the rear of the lot, with the face of the building permit stating that there will be no digging of the foundations. The site plan shows the applicant has measured the distance to the stream as 26 feet and more, and the aerial map confirms that it is about 30 feet away. The removal of structures near the stream may also prove to be beneficial to the stream. The work also included demolition of the 840 square foot addition on the residence and repair of the wall. This work is well outside the 25-foot buffer and 15-foot building setback. 2. Owner/contractor is responsible for erosion control and damage. 3. A building permit is required for all work. Based on the above findings and conditions, the requirement for a Critical Areas Study associated with this development permit is hereby Waived, as authorized by Chapter 20.15B.040 (A)(2) of the Edmonds Community Development Code. Meg Gruwell May 25, 2004 Name Sign a Date City of Edmonds CriticalAreas Determination Applicant: Bill Bickel —TO" �� 0 d'� Determination #: CA-04-49 Project Name: I Permit Number: Site Location: 1031 Grandview Street Property Tax Acct #: 5951 000 003 0203 Project Description: Non -Project Specific Determination: Study Required: During review and inspection of the subject site, it was found that the site appears to contain and/or is adjacent to a Category 2 (without salmonids) Stream pursuant to Chapter 20.15B of the Edmonds Community Development Code (ECDC). A study was done with critical areas determination CA-1998-0097 that classified the stream. Based on these. findings,, prior to submission of any development permit, you will be required to submit the following for review .by the Planning Department: Submit a survey prepared by a Washington state Licensed Land Surveyor delineating the top of the stream bank, required 25-foot buffer, and 15-foot setback to any proposed new building. This stream flows into Puget Sound, therefore, the applicant must contact the Department of Fish & Wildlife, have them review the site and submit a letter determining the impacts of development on this site and, if necessary, recommend mitigation measures to ensure protection of the habitat/stream. If culverting or redirecting the stream is proposed for development of the site, please have Department of Fish & Wildlife address this matter as well. If the property owner wishes to apply for a specific development permit which they feel would not impact the Critical Areas located on or adjacent to the site, they may submit their proposal to the Planning Department for review. If the Planning Department finds that the proposed development permit will not adversely impact a Critical Areas or its buffers, a conditional waiver may be issued on a project by project basis. Certain development proposals may be exempt from Critical Areas Requirements. Refer to ECDC 20.1513.040. Name ignature Date Side Sewer Drawing The Cftyr of Edmonds EASEMENT NO- -------------------------------------------- NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO. ------------------ ASMT. NO. ------------------ OWNER----. RQBERT--- J._... CIARE----------------------------------------------- CONTRACTOR-----------------..-------------------------------------------------------------- PERMIT NO. -------------------- JOB ADDRESS--.1031—GRANDVIEW ---- LEGAL DESCRIPTION: LOT NO.-------------------------------------- BLOCK NO. --------------------------------.-_. ---- -............................. ---------------------------------------------------------------------- ----------------------------------------------- uj „j NAME OF ADDITION ------ ---------------------------------------------------------------------------------------------------------- uj uj cc V� DYE TESTED ON SEWER Approved: PWW-OWI-11/75 (REV.11/78) DATE --------------------------- ----------- BY-------------------------------------------------- 1031 A-T ASBESTO-TEST, INC. "LIMITED" ASBESTOS SURVEY 1031 Grandview St., Edmonds, WA 98020 Page I of S IN#240447 May 1, 2004 Tom & Sue Nicholson 920 8" Ave. S Edmonds, WA 98020 Ph: 425-771-7873 fax:425-580-8324 On April 29, 2004, Asbesto-Test personnel conducted an Asbestos survey (per U.S.E.P.AJA.H.E.R.A. guidelines as designated and specified by Puget Sound Clean Air Agency and Washington State) of the north addition area only of the house & the "hobby shop" structure behind the house na,1031 Grandview St, Edmonds, Snohomish County, Washington 98020. This survey purpose is to identify any Asbestos Containing Materials that may be present and will require professional removal prior to demolition or renovation. NARRATIVE OF FINDINGS BASIC CONSTRUCTION: The north addition of the house is one story wood frame on a concrete basement. The exterior siding is wood. The wood siding vapor barrier was sampled. The composition roofing was also sampled. INTERIOR CONSTRUCTION, FINISHES, AND FLOORINGS: The interior is drywall and wood. The drywall/taping materials were sampled. Tile flooring materials with relating mastics and backings were sampled per each located homogenous area. The laminant mastic was sampled from the kitchen area. Most of the floors throughout are wood. INSULATION: The insulation was sampled. CONTINUE TO PAGE 2 1429 Ave. D. PMB #187, Snohomish, WA 98290 ph: 206-914-5500 fax: 360-563-2469 page: 206-540-2401 Page 2 of S May 1, 2004 IN#240447 Asbesto-Test, Inc (206) 914-5500 north addition area only of the house & the "hobby shop" structure behind the house 6a 1031 Grandview St., Edmonds, Snohomish County, Washington 98020 ELECTRICAL SYSTEM: The electrical wiring insulation is not of the kind to be ACM and was not sampled. Any suspect electrical wiring insulation or any suspect TSI (Thermal System Insulation) found in, around, or behind any located fuse or breaker boxes should be considered to be ACM (Asbestos Containing Material), unless determined otherwise by laboratory analysis. HEATING AND VENTILATION SYSTEM: Heating throughout is baseboard/wall electric. There was no visible suspect ACM located associated with the electric heating units. There was no visible suspect ACM located associated with any of the electric heating units. Note: It was not possible to dismantle the electric heating units to locate and/or evaluate any additional suspect ACM which may be concealed, inside the units, or associated in hidden areas. It is our opinion any further handling of the heating units should be coordinated by the project manager and/or abatement contractor. If any additional relating suspect materials are located prior to and/or during any demolition or renovation, any and all additional related suspect materials should be considered to be ACM (Asbestos Containing Material), unless determined to be otherwise by laboratory analysis. Misc.: None. ADDITIONAL STRUCTURES ON SITE INCLUDED IN SURVEY: There is a work shop behind the house. The shop is wood frame with a metal and composition roof. The structure is on a concrete slab. The only heating source located in the shop is a wood stove. The tile and mastic flooring materials were sampled from the entry way and restroom areas. # of structures included in survey: partial area of one house & shop structure in back Requested by: Tom Nicholson accred.#CLAY 5327 (Expires 8/ 12/04) A-T continue to page 3 Page 3 of 5 IN#240447 May 1, 2004 Asbesto-Test, Ina (206) 914-5500 north addition area only of the house & the "hobby shop" structure behind the house (k), 1031 Grandview St., Edmonds, Snohomish County, WashinWon 98020 Any and all materials identified as ACM or PACM in this report (and/or additional materials associated with the structure that may be discovered and later identified as ACM or PALM), must be professionally abated prior to demolition. ASSESSMENT AND QUANTIFICATION OF ACM FOR ABATEMENT PURPOSES AND/OR PRICING FOR. REMOVAL SHOULD BE DETERMINED BY ON SITE EVALUATION, AS LISTED QUANTITIES ARE NOT GUARANTEED AND ARE AN APPROXIMATION ONLY. SAMPLES 1-3 ARE ASBESTOS CONTAINING MATERIALS except the mastic as listed in sample L I ANALYSIS ID ASBESTOS//TYPE//OUANTITY OTHER MATERIAL 1.0) FLOOR TILE yes // chrysotile // 2-5% house kitchen & little pieces in laundry corner of the bathroom color: tan rock TILE IS NON -FRIABLE ACM APPROX. 35 SQ. FT. ON WOOD 1.1) MASTIC NAD 2.0) FLOOR TILE yes // chrysotile // 2-5% hobby shop restroom-color: tan ACM 2.1) BLACK MASTIC yes // chrysotile // 2-5% MASTIC AND TILE IS NON -FRIABLE ACM APPROX. 30 SQ. FT. ON CONCRETE 3.0) FLOOR TILE yes H chrysotile // 2-5% hobby shop entry hall in front of restroom ACM color: bluish green spec 3.1) BLACK MASTIC yes // chrysotile // 2-5% MASTIC AND TILE IS NON -FRIABLE ACM APPROX. 30 SQ. FT. ON CONCRETE non -fibrous materials adhesive, cellulose non -fibrous materials adhesive, cellulose non -fibrous materials adhesive, cellulose THERE WAS NO ASBESTOS DETECTED IN ANY OF THE REMAINING SAMPLES 4.0) drywall house 4.1) drywall taping compounds SAMPLED PER AHERA PROTOCOL 4.2) surface paint (homogenous throughout) NAD non -fibrous materials cellulose, fiberglass, paint, (gypsum) NAD non -fibrous materials, cellulose, fiberglass NAD paint, cellulose A-T continue to page 4 Page 4 of S IN#240447 May 1, 2004 Asbesto-Test, Inc. (206) 914-5500 north addition area only of the house & the "hobby shop" structure behind the house (&- 1031 Grandview St, Edmonds, Snohomish County, Washington 98020 ANALYSIS ID ASBESTOS//TYPE//QUANTITY OTHER MATERIAL 5.0) drywall NAD non -fibrous materials hobby shop cellulose, fiberglass, paint, (gypsum) 5.1) drywall taping compounds NAD non -fibrous materials, SAMPLED PER AHERA PROTOCOL cellulose, fiberglass 5.2) surface paint (homogenous throughout) NAD paint, cellulose 6.0) laminant mastic NAD adhesive, cellulose house latchen countertop 7.0) the flooring NAD non -fibrous materials house bathroom -color: brown & tan design 7.1) mastic NAD adhesive 8.0) insulation NAD fiberglass, cellulose house 9.0) composition roofing NAD cellulose, tar, fiberglass, & underlying materials -house non -fibrous materials 10.0) composition roofing NAD cellulose, tar, fiberglass, & underlying materials -hobby shop non -fibrous materials NOT TO SCALE N Hs H Grandview St. H=NORTH END OF HOUSE INCLUDED IN SURVEY, HS=HOBBY SHOP A-T continue to page 5 J Page 5 of 5 IN#240447 May 1, 2004 Asbesto-Test, Ina (206) 914-5500 north addition area only of the house & the "hobby shop" structure behind the house (k), 1031 Grandview St., Edmonds, Snohomish County, Washinz on 98020 Some sample analyses listed may be a representative analysis of individual and separate samplings and analysis of homogenous materials, as prescribed by A.H.E.RA. protocol. Samples taken are listed with their corresponding analyses. If asbestos is detected, those samples containing asbestos are listed first and noted with the initials "ACM". If, during demolition or renovation, any additional hidden or covered suspect materials similar to those identified in the survey are located [may include but not limited to: sheet vinyl flooring, file flooring, wall or ceiling texturings or paints, concrete siding or skirting, cement pipes, cement wallboard, electrical cloth, electrical wiring insulation, thermal paper, wallboard, joint compounds, vinyl wall coverings, spackling compounds, or any other suspect 7SI (Thermal System Insulation)], they should be treated as Asbestos Containing Materials unless determined to be non -asbestos by laboratory analysis. Note: Asbesto-Test, Inc, does not guarantee approximations of quantities of ACM, which may be listed with the analyses. It is therefore recommended professional abatement price and/or disposal quotes be obtained by inquiring as to fees per area of specific ACM material (i.e. square or linear foot, etc.), or by on site assessment Any and all materials ideidified as ACM in this report must be abatedprior to ACM disturbance, renovation, or demolition AU materials identified as ACM must be professionally abated by a licensed asbestos abatement contractor prior to any disturbance - Analytical test method: USEPA 600/R93/116** (PLM); WAC 296-62-07753 App_ J Bev: ACM signifies "Asbestos Containing Material" PACM signifies "Presumed Asbestos Containing Material' CAB signifies "Concrete Asbestos Board" < signifies "less than" TSI signifies "Thermal System Insulation" HVAC signifies "Heating Ventilating Air -Conditioning" NAD signifies "No Asbestos Detected" **One percent is the USEPA regulatory limit for asbestos in bulk samples. PLM has been known to miss asbestos in small percentages of some samples, which contain asbestos, thus negative PLM results cannot be guaranteed. Floor tiles and wipes should be tested with SEM or TEM, to insure analytical accuracy when reported in small percentages. Asbesto-Test, I ponsibility for sample content only. END OFREPORT Ana ' al Chemist, B.Se- proficient A-T 05/01 gC04y 5: too. 425670i 470 200401784 Agency Use Only BILL AND JONI BICKEL PUGET SOUND CLEAN AIR AGENCY 110 l.inion Street, Suite 500 Seattle, WA 98101-2038 www.pscicanair.org NOTICE OF INTENT PAGE 02 Date Received PAU MAY 3 2004 Agency Use Only A Proiect Tyne 1 ❑ Friable Asbestos Removal 2 Q Friable Asbestos Rome" Demolition 3 X Demolition Only B. Property Owner: Tlkoh't- D, N, lPhonc:q 6 `— / � Mailing Address: t c)/ g IIsle -I-City. e Sd_ . ta')u"`'I_j State wl' Zi : -(o "0V C. Asbestos 7PUYI-RARIArT UNRLY. MIS WILL UR R51" "AtitM: LAME Contractor: Owner/CEO: Contractor Mailinv, Address: Phone: Job No.: I i City:State. Zip: Fax: D. Site } ? 1 � J l � •� 1 + � F� �c!J tN Zi : ►b C7 D0 i Address: ( Ja Ci Site 7 Manager; � � Local Phone: �� 7 ��70�r _- - I&. XUsbestos Survey or No. of Date of As csto�5 Was Friable Asbestos Identified? WYes AONo ❑ Ma ' resume Structures: C Survey. rj j Was Nonfriable Asbcstos Identified? kYes ❑No AHERA Buildings _J a� Certification #: FHa-6 Attach a copy of the surrey when friable asbestos Inspector: !`K z-y� Exp. Date: has not been identified An AHERA Sumey is required bejore all demolition projects F. Demolition Start M4y ►).,ebb Gr^ °l err No. of 1. Training Fire (List Fire Dept.) Information Date: Structures: 2. ❑ Ordered Demolition attach co of Order) Demolition lnserr demolition contractor's mailing address on back Will nonfriable asbestos be left in place during demo? Yes No Contractor: ©wtvu' If yes, list type and qty. G. Friable Asbestos Prnieet Information: I Start Date: Work Days: M T W Th F Sa Su Hours: Will all friable asbestos ❑ Yes Total Qty, to.be Removed: Linear Ft. S uare Ft. materials be removed? L l No 11 BoilerTurnace Insulation Duct Insulation Ll Pipe Insulation U Fireproofing LJ Paints LJ Plaster U Textured Coatings Cement Board LJ Cement Pipe LJ Friable Flooring U Friable Roofing Material Other: H. Asbestos/Demolition Project Categories: Notification Period Project Demolition l . Single -Family Residence (owner -occupied): Fee Surcharge . A. ElAsbestos Removal Project Only A. Prior Notice , A $25 �: B.;i�Demolition Project (with or without asbestos removal project) B. 10 Days• t ._ • Asbestos removal can begin upon notification; demolition must wait 10 days) Note: If the single family residence is owned by one family who has been or will be using the residence as their domicile, the above boxes IA or 1 B may be checked. If this is not an owner -occupied residence, one of the categories listed below must be used. A single family residence does not include rental property, multi -family units, or any mixed -use buildin . 2. All Other Demolitions with no Asbestos removal or Nonfriable Asbestos 0n!j 10 Days $200 Friable Asbestos Projects other than Single Family Residence): Asbestos Demo 3. LJ >_ 10 - 259 linear feet and/or >_ 48 - 159 square feet of asbestos Prior Notice 10 Days $100 5100 4. U 260 - 999 linear feet and/or 160 - 4.999 square feet of asbestos 10 Days $200 $100 linear feet and/or >5.000 square feet of asbestos 10 Days $750 $250 6. C3 Emergency Asbestos Project or J Emergency Demolition Project Prior Notice Twice Project Fee rc:....i._F.m.1.. Roc,denroa Are exemnt from emeraency fee; however, orooem owners must provide a written emergency request) I. l certify pt the information contained in this notitication & supplomental data is, to the best of my knowledge, accurate & complete. fit, .� .—. � �" 3,�• .Qlvvature Reoresentin, Date Reviewed B11 Puget Sound Clean Air Agency Forts No.: 66-160 (Revised 1/04) TS AMOUNT-t 21; G CX. wo. j RCPT. FJ. L- 3 -1((4.--)- ■-��i-�-- �� T R Alt DE RIPTIQ A REP! /►- of SLOcK 4% 1N THE ORIdINA1- PLAT O! NO�ITN EO r• The annexedPlat of TA`f LOFT TRAG'TS embraces thf foilow►n9 deSCi-ib¢d \ / j SIEVERS tract of Iand; All of Block 42 in the Original Plot of North Edmonds and the .f CIVIL E.WGR. 5o►-Itherl1� one half of vacated Lake Avenue adtocent to and abu+inn43 upon 50id 61ock 42, and the Northerlyy one half of vacated Liberty Avenue adjacent' to and abutter upon Bold �►ocrc a2, and the Souihaasterl one half of That rt ion o qq �-ii $ . laorr •I�e +rw►wt•�w= .: portion f�acofed rid Street 1 in9 Nortt^erl of the ceiTterllne of vacated Liberty AJRIue and utherly of to Northwest&rly production of the Nor+herlyy3��e t p!gtt¢d All¢L) ►n said (block a2 and adjacent to / .'p A' �' •to*�cFieTE «RowuN►WT"^°' ,: and abu+Wic) J on Id eilock42. The above tract being mane particular der d as follows; Corrimenunq at an Intersection of the c terhn¢ vacated Lake Avenue and the Northerly / \ righ4 of L'99'a of Third Str1c•rt, the true point of beginning., r� ti jo re r •hence a 'S1 W al sold right of way rnarq in for alo.o it Man *o ? o \\ r,•/ \\ ►ntereect vfh centerline of vacated Liberty Avenue; therxe,,, o: w►SI'LG'in' .d onCcppsa centerline for 5400 ft' to on Intersection ti 'Ito :; `23 / \ ��{ with theMenifT Is of vacated Second Street thence NS6'a4'e r' o alongq s cc me a for Ieo o it to an iniemec+Ion with • �rcE;' / ^ �� i /yA 9��/r- the tlorthwesterly of of tt-.e Northerly line of the plotted Alley in Dloek42 in the original plot of Nor-+h / .'t.\ \ / 0 4/ ,4\/ �- edmond-; thence SSI.2e'fl alontj said Nertheriyy Alley �` \ ``p 1 hnt. product►on for 400 it to on in+ersectlon wl{h +he s �westerlL, corner o1: lot 20 in said block 421 +he p t',� ,:/ S \ \ eo e i ?� ' \� r�, ►(\ N. s4•E along the Nor%wes4eriq It ne of said block 42 ►;,, o :/ °\�� i / for 150.0 fi to an in}eraec+/on with the cengterllnc of o YT / \\ e 40 / \ t�k ti ?;• vacated lake Avenue; +hence ssi'ac'E olon said centerline t{ c; 4i LOT ► \ for Soo,a ft tc the true point of beq►nninc3 / / \ d� DEDICATION" KNOW ALL MEN 0Y T11Lbi MtESf.NT3 that William S.-Taylor, a single mon, owner, in fee simple of the above described tract of land as shown on the annexed PLO+ of TA'VL-0M-tRAGTB does t+¢.-¢by declare sold. Pint and dedicate to the public 'e \ 0 a / •o 'e \. �L�� ^ ' for the" use of the Public,'forever. all streets, drives, aril lor.-. ° _ \\ // `y shown thereon. IN . \1` .` / �•' \ o bated this-S"_doLj of-�acv...6ar 194 �,. ? 1�. I p /'\ ACKNOWLEDGMENT \� /2s '°o?c \ STATE OF WASHINGTON t SAL^,. ' •fin \. \ o�/ / \ C°VNTV OF S"0140MISH J t , \ F ,' !"y This ►s to certify that on this.!? of-AScg76ac-lS47_ persorlolly -'; ��e 2d '�F \ appe:ll��d before me wolsom S.Taylor• a single mon, to me known to be +he <.� O 1�^ IN 1 �• r , •/ Lt� o' in-vvriUQi who executed The within and foregoinq instrument and who �A /' •\�, _�. or.ler.•w:,ecv�ed to me that he signed and sealed the some as a free and �� • c"; \ pt 4 act and. deed for the uses and purposes therein mentioned. ��.:•,"^tESs wNERF-oF, i hove hereunto set my hand�und.affixed my official s e day and year first above written. -'`!,•.�, '�a \ wOTw�wY PY VC N AN FOt TNQ bT /.Tf ,•,�, �° / / \ /� � - ' Os 1 sS M.NpTON R!6 .MO �. <K R.TT NN ENGINEERS CERTIFICATE , i •ioword - Sievers, por ner o severs and UuecLj, Civil Engineer, do her¢bLj certify that t.:e onnf•.!d Plo+ of •TAYLOR TRACTS is based on an actual survey and +hat all " IO'.n huvc been staked and monuments set as' shown ' PRO��iMilMttY � O ♦ ^ 7 n � 'i T_ REASUR£RI5CERTIFICA .: me • 1;-very reasurer o no omish Courl+y Woshinq+on, do hereby Cert►fL� ttTa+ c1' the above described tract of land have been f ly p d up .to and / I•.•: ,.id1•I�7 1'•�e Lieor 194�-- ,�LM4_��-�� APPROVALS Exam,ne a approved on of- Vecember_ RFr IRI)INr-. 10 36., F. c v,4 Vic. Ear+,m l W4 9PLo (,70- 047o Warn �n_�a\ WCAJ 'k,, o�- mcrq,>-z-,4 -�� 2- lo-�s o,j Ec0. vy-•o v-jA s a Qr° `j e CIA C�v Y'c-e, OvJ WL��C S TO'(--" �G:t4 O vJ RECEIVEDn MAR - 51004 v / PERMIT COUNTER �2,''� — %—]tp � �� 2ie MICROFILM [L6LS ON YN/XZl OZ:ST (IRA VO/90/90 '65/01/2904 15:37 42557e64`t9 ngcucy case rto. 200401784 Agency Use Only PAGE 02 Date Received PSAiR MAY 3 2004 Agency Use Only i A. Prnimt Type: 1 ❑Friable Asbestos lemoval �, ❑ I'SrLble A,q e9tos rrlov�t & D M911tion 3 Dertioittion OalL1V B. II_ Property Owner: �0i' Gu- B, N 'k060-, Phone: 7d 7 7 (— - Mailing Address: l Do 'K k- / Ise city: F-"OV-0`di State Zip: (o U0 v BILL AND JONI BICKEL PUGET SOUND CLEAN AIR AGENCY 110 Union Street, Suite 500 Seattle, WA, 99101-2039 www,pscicanair,org NOTICE OF INTENT C. Asbestos MrS WILL R A!L/pG Contractor: O"CrICF-O: Contra.ci0r Mailing Address: Phone: Job No.: City: Sl ►tE• Zip: Fax: D. Site - Address: 10,3( U(q^A r(e4 -S1 TV eT Ci -} <i : Site Q Manager:. Local Phone: 7 71-70 7 E. JaAsbestos Survey or ❑ No. of Date of As esto�5 Was Friable Asbestos Identified? Yes o Mar r Rstx a Structures: S a rfl Was No,&iable Asbestos Identified? JaXes ONO Attach a copy o te survey when asbestos r ,% f PY h AHERA, Building y� �� J Inspector: KJI Certification ��I � 6 1rx . Dare: has not been identified. F. Demolition Start q L Information Date: Gt - tar No, of 1. Training Fire (List Fire Dept.) Structures: 2. ❑ Ordered Demolition attach co of Carder) Demolition lnserraelnotitian contractor's me uing ddArots oR back VMll nonfiiable asbestos be lei in place during derno? LJ Yes . No Contractor: If yeas, list type and qty. G. Friable Asbestos Work Days: M T W Th F Sa Su Project Inlfortrration: Start Date: Completion Date: Hours: Will all friable asbestos ❑ 'lyres materials a removed? ❑ 11jo 'total Qty, to.be Removed, Linear Ft. Square Pt. El BoilerTurnace Insulation Ll Duct 1nsulatio.11 Pipe Insulation Fireproofing U Paints LJ Plaster LJ Textured Coatings Ccmicnt Board L1 Cement Pipe U Fria,le flooring U Friable Roofing Material Other: H. Asbestos/Demolitiou Project Categories : N 'ficatio Mod Project Demolition � I. Single-Fam ly Residence (owner-occupi rd). Fee Surchauc A. © Asbestos Removal Project Only A. Prior Notice A $25 B. }: Demolition, Project (with or without as )estos removal project) B. 10 Days' 6, $36" .. Asbestos removal can begin upon notific ttion• demolition must -air 10 days)-� Nate: 1f the single family residence is owned b i one family who has been or will be using the residence as their domicile, the above boxes 1 A or 1 B may be checked, if this is not an OK ner-occupied reside*ee, one of rise categories listed below miust be used, A single family residence floes not include rental property. M14 !ti- anvil Nnits, or any mixed -use buildln Z. 2, g5 All Other Demolitions with no Asbestc s removal or N'onfriable Asbestos only 10 Days $200 Friable .Asbestos Projects other tha i Single Family Residence)! Asbestos Demo 3. LJ a 10 - 259 linear feet and/or a 49 - 155 square feet of asbestos Prior Notice 10 Days $100 $100 4. U 260 - 999 linear feet and/or 160 - 4,99 square feet of asbestos 10 Da $200 $100 5. U >1,000 linear feet and/or >5,000 s uar ; feet of asbestos 10 Days $750 $250 6. L3 Emergency Asbestos Project or L3 Er tergency Demolition ,project Prior Notice Twice Project Fce (Single -Family Residences ore exempt from *MtERen y fed; however, propcttr owners must pmvide a written emergency ro uayt) )C. I certify of the information contain in this nwitics ;on & supplemental data is, to the hest of my knowledge, accurate & complete. Age YJS tll� S \ Mu Si.grtature Re resenthi Date Reviem-ad B r..�r Pugat Sound Clean Air Agcncy Form No.: 66-160 (Revise t 1/0d) TS M►GIoN�T • o e L Q 1 l l CK. Itl®. t--IA� Z000 giv NVHIO 5d CLOP 699 9OZ Xtrd CC:bT r009/s0/s0 Arno 5�ie-F� /a�-� be (,QV-E)q J �dd�r� e�fo`� /ceMo me RECEIVED MAY 112004 PERMIT COUNTER APPROVED BY PLANNINU COPLor ALCM N THE E CO. 3-9-89 AJjaCeA-r f rVPO+j 7o' 1.e tax Ig6 i U. Sig. OY DK rl� NX 711. $F L. 5ARA6E 03 N Telephone / Counter �st 1g90 Conversation Record DATE: TIME: FILE: /V16-17o/loi✓ —' t-,4 Kew. (}� No1��'�cL%10�i0G Gd✓09��'a✓ G��/off l9GG � Div /r�� 6✓ll V;UfjR4OVaV 410 s�� dii,e v✓o�ld Gw�6� cv�� .4 .�f ►�rii ®�v,6�,4.t � 04ol✓A17a✓aw -AA4 . s v rz✓cu rat l,✓t uI o� u l�✓ �.C�V d:receptionlanaNdgtelephone-caunteroonvrec.doc 7/5MW1 STANDARD OWNER: 1 I DETENTION S YSTEY WORKSHEET (5000 SF OR LESS CALC. BY: 15- ADDRESS: �^ �. 1 PHONE: 2 DATE: SIZ640 soR IMPERVIOUS SUFACE AREA 0'00 PIPE DIA. �L� PIPE LENGTH ORIFICE i RIM ELEV FINISHED GRADE FOOTING DRAINS SHALL NOT DETENTION PIPE LENGTH 1' MINIMUM UPPER CATCH BASIN 0.5% TO 1.0% SLOPE ELEV CONTROLCB BE CONNECTED TO DETENTION SYSTEM OCKING LID (TYP) irIM ELEV. r6" Min. clearance Measured from top of RIM ELEV. II Conc. box or riser. 9" ELEV. OUTLET CONTROL INV, ELEV. 2'X2'X12" DEEP CONTROL CATCH BASIN (4"•6" QUARRY SPALLS OR EQUAL) FROM CONTROL CB IN, 6" COVER D- CONTROLCB RIPRAP OUTLET SHALL BE PERPENDICULAR TO SPREADER TRENCH PERF. PIPE SHALL BE LEVEL & CAPPED AT ENDS NOTES 1 i-- 9.5'----I SPREADER TRENCH TRENCH SHALL BE LINED WITH MIRAFI & ON TOP WASHED DRAIN ROCK 1. CALL ENGINEERING DIVISION (771-0220 EXT. 1326) 24 HOURS IN ADVANCE FOR A TIGHTLINE AND DETENTION SYSTEM INSPECTION BEFORE BACKFILLING AND FOR FINAL INSPECTIONS. 2. Responsibility for operation and maintenance of drainage systems on private property is the responsibility of the property owner. Material accumulated in the storage pipe must be flushed out and removed from catch basins to allow proper operation. The outlet control orifice must be kept open at all times. CITY STORM CONVEYANCE SYSTEM SPREADER TRENCH SHALL BE A MIN. OF 10' LONG AND PERPENDICULAR TO CONTROL CB., m ci O Z T .] 0 1 0 0 X M n M SATE PLA-,J E��/E® 7-heloS'o�Ccj T lac��ar 1rac� OCT —82004 CAT CO COPY cA A- t� C-- p IT COUNj-&g Norce(� adS ,Cert o6600� 0 2 / Zo L o s (o (Lt ol � � o C_•I I1 v�t w S �o � : p7 a; SCALE /= 00 i a ' 7-op C8 i c %- v,, 1 , �J & ko APPROVED AS NOTED BY ENGINEERING <4- u �w � J �a- \ ` � � ate•ON C —r• � r _ 41 .► o 1, I \ ,�. < \ C_ \ x �v _ o sr ? � 0 - ioZ- ev ell3 zS 7, r✓1 Q�( v,�t7 X e0\�.6,w,a.F (� `V � f �D6pGWU1120$6 ACI Nac.T itJaL Kw 4 PEe, G►7 Sn y NpA asP c Fok INS �APPLyl A-s C riom Pkioe To ►t4s u jOVE Y NNING P14ALT, TM 1 5 Cke 01Ll� /i �. o s C'�eg%2�,u0�sL 11/23/2004 08:20 4257478561 GEOTECH PAGE 02 DAILY FIELD REPORT GE O T E C H TRAVEL"EP TIME JOB NUMBE CONSULTANTS, INC. hooc ErA t� I D TIME ON SIT DATE 10 13256 NE 20(h Street. SWSC 16 TIME OFF SITE /6 OAVeF&ECK Bellevue, WA 98005 — 425-747-5618 FAX 425-747.8561 HOURS CHAR ED WEATHER JOB LOCATION /43/ GENERAL COW _.-Lll�f�bL GRADING CON' O.7i cLiENTiovAER - S GENERAL CONTRACTOR'S SUPERINTENDENT MILES PERMIT NUMBER GRADING SUPERINTENDENT VISITORS PAGE / OF 7all=.'� / � .._ L � .� .. is � ,� � .,. . t � ./, r.,.• .,.. PW i r > S �� ... ._ _ NEXT SITE VISIT: COPYTO SIGNATURE; 11/23/2004 08:20 4257478561 GEOTECH PAGE 03 GEOTECH CONSULTANTS, INC. 13256 NE 20th Street. Suite 16 Bellevue. WA 98005 425-747-5618 FAX 425-747.8561 DAILY FIELD REPORT TRAVEL"EP TIME J08 NUMBER TIME ON SITE DATE TIME DFF SIT DAY OF EK HOU96CHARGED I WEATN �• �' JOB LOCATION � ` ,� CUENTIOvuNER GENERAL CONTRACTOR GENE Al CONTR TOR'S SUPERINTENDENT MILESPERMIT NUMBER r GRADING CONTRACTOR GRADING SUPERINTIENDEKV VISITORS PAGE A OF n NEXT SITE VISIT. COPY TO. (_ I o l SIGNATURE: Men1U To: 'Lee- From: Date: Re: 71>m Slit /1P t Glop `S p,y, REED & ASSOCIATES CIVIL & STRUCTURAL ENGINEERING 8311 - 212T" STREET SW - EDMONDS, WA.98026 OFFICE (425) 778-2793 FAX (425) 775-2073 0 Fmmd ! Mailed ! Office ! Virg. N�� E7GlS rlO3�i� e �<i✓_S OL Y-t f`iaZ� K �-4J/ S iL! • L / �/ /'7 �1C i/�`�s e G O K J' 1�✓ ✓ c -- h H_. ----- � e ?�8/"�s-►� � G � ��i w / �% � i/ x Z� ii G i�',oX �i� J/ e of w, 4.Z /Cz � � �o � � o 7- � f' 7/.�J � v G f!/ ✓'a G ��r - �i I�GA C/ �3 fc� T D 001- RECEIVED PLAjPERMIT COUNTER QM a c 0 cc a E w 0 T U T N c i o c' Z w e tn Q� D ➢� ,�' !� p ! ` LD FAIS, T v�r- �S?-.D TiFIE- Or �a t,1YE7 WON 10 A to ?> K 2* 4 0 f 8 x�b rfv r- z 4 J-a 7!'VoIT� pp op --5,900 `1 RA1,44 FRS Z��i�I�IEli+�jJ/)�OoD_ 11/23/2004 08:14 4257478561 GEOTECH PAGE 02 R CEIve® ?OEOTEC CONSULTANTS, IN _ V 2. 4, 2004 13256 WE 20th Street, Suiw 16 PERMIT C®UNTER Bellevue, WA "005 425-747-5618 FAX 425-747-8561 JOB LOCATOU 14XI 4it !g gkolln s . GpgRAL CONtNASTOR GENERAL CONiHAcrOab SIPERINTENDENT DAILY FIELD REPORT TRAVEUPREP TIME JOB NUMBE . 75 wt 4" 4,4r,41• TIME ON SITE DATE TIME OFt' BITE /5 DAY F VoEEK HOUR$CHARGED _ WEAT4911 CITY COPY PERMIT NUMBER QL PAGE / OF NOV-23-2004 07!58 PM #L . REC�'IVEC A NOV Z 4 2c } �avoCH 1 CONSULTANTS, INC. :4�— - 13256 NE 20th Saes, Suite 16 Bellevue. WA 9M 425-747-5619 PAX 425-747-8561 JOB LOCATION _ - I I DAILY FIELD REPORT TRAVELVIMP TIME jw Nt^IM TIME ON SITE DATE tll/ TIME OFF OAY F I[. / OC�lERAL CONTRACTOR G (OR'S SUPERNRENDENT MILE � ' Pef"T M MOER r ~ItG CONTRACTOR GRADING SUPERINTIENDOW I VISITORS ^� PAGE g OF NEXT SRE VISfT: COPTTD 1 SIGNATURE: f� Ogki t lb "(W6 f Poasoc. -C'MD `7 — Zom. cilyof�dn��nds Cert' ' ate of Occupancy m PER INT AT: Occupancy established by this certificate: No. Stories: 2 Owner of building: The Single Family Residence at 1031 Grandvie 2003 edition of the International Residential Code as the proposed occupancy is classified. GS R110 �Bdilding P rmit M 2004-0940 q Dwelling 'Un Type°of Constriction: VB roved complying with the requirements of the and division of occupancy and the use for which Issued this 1st day of November . 2005 Chief Building Official By: Any change of occupancy or use requires a building permit and a new Certificate of Occupancy issued by the City of Edmonds Building Official. F *(w2o-') . SEE NOTE 1 ROAD NARROWS (w5_ ) 30 SEE NOTE I TAPER LENGTH (TABLE A) TABLE A SPEET (MPH) TAPER LENGTH (FT) CONE SPACING ALONG TAPER (FT) OFFSET WIDTH 10' 12' 25 1 100 120 1 25 30 150 180 30 35 200 240 1 35 40 270 320 40 45 450 1 540 45 NOTE 1, DISTANCE BETWEEN SIGNS SHALL BE` 100' FOR RESIDENTIAL STREETS (25 MPH), AND 200' FOR ARTERIAL ROADWAYS 2. FLASHING BEACON SHALL BE INSTALLED AT EACH SIGN FOR NIGHT-TIME USE. 3. DISTANCES MAY VARY AS APPROVED BY THE ENGINEER. 4. FLAGGERS REQUIRED TO CONTROL TRAFFIC WHENEVER THE CONTRACTOR MUST INTERRUPT TRAFFIC FLOW TO ACCESS THE WORK SITE WITH MATERIALS OR EQUIPMENT. LEGEND: ill MIN O CONE OR CHANNELIZING DEVICE 3 (SEE STD..7-14) a cu 1 TRAFFIC CONTROL PLAN Ell 2 LANE ROADWAY: PARTIAL LANE CLOSURE 0 (A APPROVED AS NOTED RV ENGINEERING v _ If WORK AREA y TRUCK WITH ~LASHING OR WITH BEACON 30" T TAPER LENGTH (TABLE A) SEE ,NOTE 1 SEE NOTE I ROAD ONSTRUCTION AHEAD (WYO-1) 30" 3-1-95 17-2 date number. Date: To: From: Subject: MEMORANDUM September 13, 2004 Street File: 1031 Grandview Meg Gruwell, Senior Planner Determination of Two Lots at 1031 Grandview Street This memo is in regards to 1031 Grandview Street, more formally described as Lot 3 of Taylor Tracts, which has been determined to be two lots. The real estate agent for 1031 Grandview submitted a letter on March 5, 2004, requesting a determination as to whether there were two lots at 1031 Grandview, Edmonds. His letter stated, and the documentation was attached, that the westerly 60 feet was transferred on February 9, 1954. The owners he represented purchased the westerly 60 feet in October 15, 1958 and the easterly part in March 1969. I had also gathered some information from our archives for a potential purchaser of the property, regarding a setback adjustment. The site plan with that file (#A-1987-8) shows that the addition is squarely over the middle of the lot, and shows what the applicants state is a "hobby shop" with carport (see attached site plans). I submitted this information to our City Attorney. He notes that the lots were created prior to the cut-off date for subdivisions of December 31, 1972, so two legal lots were created. These lots were at some point rendered nonconforming when zoned RS-12, which requires a 12,000 square foot minimum lot size. He also notes that the lots have been in common ownership and therefore would have been "combined" pursuant to ECDC 17.40.030(C). The lots have also been used in a manner consistent with combination — that is, used as a single lot since you cannot have a building which straddles the lot line. Our City Attorney further states that the property may qualify for the exception created by ECDC 17.40.030 (D)(1) if all of the criteria can be met. The only criterion that was in question was subparagraph "c" referring to the destruction of "housing stock." To meet the criteria allowing the property to be considered to be two lots, no "housing stock" can be torn down to create an opportunity to divide the lots. So long as it can clearly be shown that no portion of the structures crosses the intervening lot line or, alternatively, that no "housing stock" is being destroyed to allow the separation of the lots, the property can be considered to be two building lots. For example, if a part of the afore -mentioned addition (larger house) was encroaching on the lot line but was removed (leaving the existing "housing stock" intact), this would meet the requirements of the code. City of Edmonds (�R Community Services A • 0 Mr. Tom Nicholson, who has since purchased the lot, and Mr. Vince Norberg, his builder, have been in discussions with the city about the lot at 1031 Grandview Street. They provided a preliminary copy of a survey done by Jeffrey Treiber of Lovell-Sauerland & Associates, Inc., dated April 14, 2004, which showed that the addition did straddle the lot line. Further, with building permit number BP-2004-0409, they have demolished the addition that straddled the line and brought the older portion of the home back to its earlier footprint. They have also restored the kitchen in the house, so that it is a complete single-family residence. They also removed the accessory structures on the site under separate demolition permits. The owner now meets all of the criteria in Edmonds Community Development Code section 17.40.030.D.1, which are as follows: 1. In an RS zone, such nonconforming lot may be sold or otherwise developed as any other nonconforming lot pursuant to the following conditions and standards: a. The lot area of the nonconforming lot is not less than the minimum lot area specified in the table below [8,400 square feet for RS-12 zone) for the zoning district in which the subject property is located, and Comments: According to the preliminary copy of the survey done by Jeffrey Treiber of Lovell-Sauerland & Associates, Inc., dated April 14, 2004, the dimensions of the overall lot are 125 feet by 140 feet for a total of 17,500 square feet. The westernmost 60 feet provides a lot area of 8,400 square feet, with the easternmost lot being 9,100 square feet. b. Communityfacilities, public utilities and roads required to serve the nonconforming lot are available concurrently with the proposed development, and The area is adequately served by the above. C. Existing housing stock will not be destroyed in order to create a new buildable lot, and The owner has retained the old home on the easternmost lot and has removed the addition that straddled the lot line. d. The proposed development of the lot is generally consistent with the character of the surrounding neighborhood. The owner plans to build a new home on the westernmost lot that will be a two-story home with 2,621 square feet with a 460 square foot garage according to the building permit that has already been submitted (Plan Check number PC-2004-0346). This is much larger than most of the homes on this street, but similar in character to the new homes being constructed in the neighborhood. The older home, which is smaller and one-story, is similar in character to the older homes in the neighborhood. Therefore, the westernmost 60 feet of lot 3, Taylor Tracts, also known as 1031 Grandview Street is considered to be a legal nonconforming lot by meeting the criteria of ECDC 17.40.030.1) and the applicant may build one single-family dwelling unit on that lot. cc: Rob Chave, Planning Manager Ross Beckley Tom Nicholson, Owner 7 • CITY OF EDMONDS 121 5TH AVENUE NORTH • EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 Website: www.d.edmonds.wa.us DEVELOPMENT SERVICES DEPARTMENT Planning - Building - Engineering March 12, 2004 Mr. Bill Bickel 1036 Euclid Ave. Edmonds, WA 98020 Re: Lot Status 1031 Grandview, Edmonds Dear Mr. Bickel, GARY HAAKENSON MAYOR STREET FILE This letter is in response to yourequest which we received March 5, 2004, to obtain two lots at 1031 Grandview Edmonds. Your letter states, and the documentation was attached, that the westerly 60 feet was transferred on February 9, 1954. The current owners purchased the westerly 60 feet in October 15,.1958 and the easterly part in March 1969. I had also gathered some information from our archives for a potential purchaser of the property, regarding a setback adjustment. The site plan with that file (#A-1987-8) shows that the addition is squarely over the middle of the lot, and shows what the: applicants state is a "hobby shop" with carport (see attached site plans). I submitted this information to our City Attorney. He notes that the lots were created prior to the cut-off date for subdivisions of December 31, 1972, so two legal lots were created. These lots were at some point rendered nonconforming when zoned RS-12, which requires a 12,000 square foot minimum lot size. He also notes that the lots have been in common ownership and therefore would have been "Combined" pursuant to ECDC 17.40.030(C). The lots have also been used in a manner consistent with combination = that is, used as a single lot since you cannot have a building which straddles the lot line. Our City Attorney further states that the property may qualify for the exception created by ECDC 17.40.030 (D)(1) if all of the criteria can be met. The only criterion that seems in question is subparagraph "c" referring to the destruction of "housing stock." To meet the criteria allowing the property to be considered to be two lots, no "housing stock" can be torn down to create an opportunity to divide the lots. So long as it can clearly be shown that no portion of the structures crosses the intervening lot line or, alternatively, that no "housing stock" is being destroyed to allow the separation of the Incorporated August 11, 1890 Sister Citv - Hekinan. Japan Mr. Bill Bickel March 12, 2004 Page 2 lots, the property can be considered to be two building lots. For example, if a part of the afore -mentioned addition (larger house) or carport ("hobby shop") were encroaching on the lot line but were removed (leaving the existing "housing stock" intact), this would meet the requirements of the code. The property at 1031 Grandview is separable into two lots if the following issues can be resolved: • The current house at 1031 Grandview must be preserved. • The smaller house, referred to as a "hobby shop" as previously noted, must also be preserved, unless you can factually document (with photographs and other information) that the "hobby shop" is not "housing stock." (Note that if the "hobby shop" is shown to be only an accessory structure, then it would need to be demolished when the properties were separated -- i.e. you can't have an accessory structure without having a primary structure also on the property.) • From the information we currently have, it appears that the existing house has an addition which straddles the lot line separating the two potential lots. This addition would need to be removed or the encroachment otherwise resolved so that a structure was not on the lot line. The removal of the addition could not involve the destruction of the existing housing stock. • From the information we have, It is not clear whether a portion of the "hobby shop" (the older, smaller house) also crosses the separating lot line. We would need to have documentation, such as a survey, which clearly shows the location of the "hobby shop" and its carport. If the carport crosses the property line, it would also have to be removed or the encroachment otherwise resolved so that a structure was not on the lot line. If the above issues can be resolved, and the properties divided and under separate ownership, the new owners would be able to decide how they wish to develop their individual properties. In other words, an individual owner would be able to determine whether they wanted to remodel the larger house or demolish it and build a new house on the lot. If you have any further questions, please feel free to call me weekdays (except Wednesday) at (425) 771-0220, extension 1330. Sincerely, Meg ruwell Senior Planner Mr. Bill Bickel March 12, 2004 Page 3 cc: Rob Chave, Planning Manager Mayor Haakenson s 'THF TieErvr Co. • 10 3b w4 98aLfl i o r 4`� �®�� GW�rc�V�e�►J ��trv�OvJ�S a �'C'CT� EAMOTASCG c� —TLQI GvY'M CAA -7, F-v r-A'Y\k CJV RECEIVED MAR - 51004 PERMIT COUNTER �Z'� - %-] 2.., f AY L 4_R---J DESCRiPT10N �. RPt-AS Oi BLOCK 42 IN THE ORI he ann¢li¢ Plat of TAYLOR TRACTS embraces the fail owIndescrIbed tract of land; A11 of Block 42 In the Orlq,nal Plot of North Edmor..d3 and the Socifherlu one half Of vacated Lake Awnue ndiocent to and obu+hnc3 upon 501d B►ocic 42, and the Northerly one half of vacated Liberty Avenue adjacent'\ to and obuttlnq upon bold Q►ocl- 42 and the SouiheasierlyLt one half of that J portion of�acofed and Street. 1y1n9 Northerly of the centerline of vacated/. Liberty AMbue and uiherly of the Northwesterly production of the Norrherl4 ►e M t p!gtted AI►¢Li In said [31or-k 42 and adjacent to and obut$o q Id Block 42. The above tract being more particular d r d cis follows; COmmenclnc. at an intersection / of the c terilne vacated Lake Avenue and +he Nor-+herly �a righ4 of c. "a of Third Street, the true point of b¢ylnnlrT�;� r�.y •hence s 'w al said right of way rnarg+n for a+o.o ft to an v 4oa j Inter'sec I- centerline of vocotrtd Liberty Avenue; the NsI•tCw .al cnqq��s cen+erline for 5400 f+' to an Intersection v with the entE7-11 of vacated Second Street; +hence NW54E ° olonqq SC1313 ce ri f a for 16o o f+ t0 an Intersec+Ion with the Northwesterly duct -ion of t+-.e Northerly lire of +he plotted Alle in Olock 42 in the origlnol plat of NOT-rrh Edmond thence SSi'2G'e alonq Said Nor+heri Alley lme- �noduc+ion for 400 ft to on Intersection wifh +he 5. westerly corner of Lot 20 in bold Block 42; +he p r1. N, s4'E slang the Of Ilse of sold r3lock 42 for 150-o f+ to an intersection vvi+h the cen+erline of vacated Lake Avenue; +hence ssi•2c'E along said cen+erlin¢ •%�� ,"^/ L�,Y I for So0.0 ft tc the true point of becj%nnir`9 DEDICATION KNOW Au_ MEN OY TML66 PRESENTS that Williorn S.-Taylor, a single �� Y man, owner in fee simple of the above described tract of land as Shown On the annexed PLot of TAYLOR TRACTS cures hereby declare said Plat and dedicate +o +he public fort fhe use of +he public. forever, all streets,drives, and Iar.•S 'O f; Shown thereon. ' N, atcd this day of_Dece.•.6a,- 11/54� ACKNOWLEDGMENT ti Si ATE OF WASNII+ICsTON COVNTV OF S"a "%I," S.>5. ••.t This Is to certify that on +his day of- gZg,�n6e_-_IS47_ personally opP?cued before me Williom S.-TaLi\or, a single mon, to me known to be +he 1--j:al vvho executed The w++hin and foregolnq instrument and who oi..s•nv:iecr�ed to me that he signed and sealed +he some as a free and oct and deed for the uses and purposes therein mentioned. "•JGSS' WHE.iEOF, I hove hereunto set my hand and. affixed my official s lile day and year first above written. / ENGINEERS CERTIFICATE -toward - Sievers, i3ar ner O. ievers and Duecy, Civil Engineer, do hereby certift that Vie annc...-d Pla+ of iPVLOR TRACTS Is based on on actual survey and +Hat all lol. hux-c Deen stoked and monumen+s set as- shown ' PR0��6NCi THE ASUR£RIS,,.�CERTIFICATE . * rrie + . ers reasu rer o o�lornish Coun+y Washinq+on, do here Ci. •�JYQ'� r•-, the above described tract of land have beenP ILA p APPROVALS December Exam•ne on approved on +hi3 29_day' of_ _ _ _ certify that up +o and �' dLc•yCso RECORDING Z tl CIO 0 2 R cL rl�-A 10A ` A Lo , }.:,4 i Is :,.1T%'±)u.` -�.:t'ax'r xc.�l,�'M 2, 089 FORM L38 Statutory Warranty Deed VOL %A74'' THE GRANTORS ROBERT V. McCLENAHAN and AGNES F. Mcd' LENAHAN, hie wife for and in consideration of TEN DOLLARS ($10-00) and other valuable consideration in hand paid, conveys and warrants to FLOYD R. WURGAULT and DONNA J. BOURGAULT, his wife the following described real estate, situ;Ite(I in the ('()Ijntv of Snohomish Washington: State of The West Sixty (60) feet of Tract Three (3) of Plat of Taylor Tracts', as.. per�'Plat. recorded in Volume 12 of Plats, on page 91, records of Snohomish County, Washington 'I May 8, 1952. a. REAL ESTATE -SALEWA)(_- OUNT ftl),, RECEIPT,rm aaatusaee FE 719 By Do" Dated this 9th (ay' of 'Febru714Ca, ax L STATF OF WASHINGTON' County of Snohomish On this claN personally appeared before me Robert V. XcClenahan and Agnes -7., kfcClenahanAY , his wife to me known to be the individuals described in V a 1w fnregoii acknowle4ed'lhat, they C i;'.t, ___'i "I, w!hI.n, rti'i6st4ru - (I r Ir signed the same asftiuses a�di purjjo.�S/ thi; . Rnc voJun , Larylachind de6d"f.r!'the therein mentioned. ao, -ol t( nk)hand an fficial scal this 9th IVEN underd o day'jfF b e rU&ry;..'119�,4*� T �10 r., P J, r I n L; .,A'oS; Ir ., < , I V in, reM R, 5 2004 le Val COUNTER. vik • '' STATE OF WASHINGTON I Ss. COUNTY .OF SNOHOMISH Auditor, 1, . Bob Terwilliger, SnohomlSh countyiument is do hereby certify that the foregoing f the a true and correct cOpY odocurient now on file or recorded In my Office. hand La. hereof, I hereunto set m�� 20 ILLIGER, County uditor BOB Deputy MAR - PERMIT COUNTER t ' c -, ti Sr - s r 'r 4 z r `� 9 7A A�:C r dY '15 E i 7!v ••�• ' 4Q � � ! y�. F JCS � �yj�' ;Z 4 L r D _ t ` kk INGsiiC�\��' A ws r 1' s ' fir% 4 i :d• J�}• Yam, y,h h%' r . y I s -r4 D `rf 3n ' v �/:��q, ■ /.pq }Aj PA 0E170 THIS AGREEMENT; made, and entered into this 15tb day of October, 1958 between FL407D R. BOURtbAIJId',aad DONNA J. BOL>Ii4AU111', his `rife hereinafter called the "seller," and ROBERT JAMES GLARE and DRUSILLA I. CLARE, his wife hereinafter called the "purchaser;' WITN9SSETH : That the seller agrees to sell to the purchaser and the purchaser agrees to purchase of the seller the following described real estate, with the appurtenances, situate in the County of Snohomish , State of Wasjir", to -wit: That. part of'.Traot 3, Plat of Taylor Tracts, a Replat of Block 42 in The Original Plat of North Edmonds, according to the plat thereof recorded in volume 12 of Plats, page 91, records of Snohomish County, Washington, described as follows: Beginning at the most northerly corner of said Tract 3; thence south �1°26, east along the northerly line of said Tract, 60 feet; thence south 38 34, west 140 feet to the southerly line of said tract; themes north 51026, west to the most westerly corner of said tract; thence north 38 34' east along the westerly line of said tract to the point of beginning. SUBJECT TWO: Utility easement along the southwesterly 5 feet of said premises as shown on the face of the plat. In addition to the real estate, this contract covers all personal property on the premises as of this date including stove, refrigerator and drapes. The terms and': ' _ f th' —atract areas follows: The purchase price is $7,000.00 SEWN THOUSAND DOLLA':S AND NO 100 THS - - - - - ($ 7,000.00 ) Dollars, of which SEVEN HUNDRED DOLLA.iS AND NO 100 THS - - - - - ($700.00 ) Dollars hap been paid, the receipt whereof is hereby acknowledged, and the balance of said purchase price shall be paid as follows: SIXTY THREE DOLLARS AND NO 100 THS - - - - - - ($ 63.00 ) Dollars or more on or before the 15th day of November , 1958 , a.•d SIXTY THREE DOLLARS AND NO 100THS ($ 63.00 ) Dollars, or more, on or before the 15th day of each and every month thereafter until the entire purchase price, including interest on the unpaid portion thereof at the rate of 6 per cent per annum, has been fully paid. The monthly payment herein provided shall include both principal and interest, said monthly payment to be applied firs: to accrued interest and the balance applied to principal. Interest to begin on the 15th day of Oct-Dber , 19b f� . 1I%UkL ESTATE SALES iaX AMOUNT PAID...-' O. RECEIPT Wn............P..-20 OCT 15 IM YiBfJat �Ii:F6 c�^Lo,,,;;,lr-j -any,' �asc;:l Iw 0CPut/ When balance of purchase price equals balance of prior contracts, mortgages or other outstanding encumbrances on the property herein, said purchaser shall be entitled to a deed, subject to said encumbrances, provided purchaser has fulfilled all other commitments required of him by this contract. The purchaser is entitled to take possession of said premises on date of closing unless otherwise determined by the parties. The purchaser agrees to pay before delinquency all taxes and assessments that may as between grantor and grantee hereafter become a lien on said premises. The purchaser assumes all hazards of damage to or destruction of any improvements now on said land or hereafter to be placed thereon, and of the taking of said premises or any part thereof for public use. The purchaser agrees, until full payment of the said purchase price, to keep all buildings on said described premises insured to the full insurable value thereof against loss or damage by fire in some company acceptable to the seller and for the seller's benefit as interest may appear and to pay all premiums therefor and to deliver all policies and renewals thereof to the seller. In cane the purchaser shall fail to make any payment hereinbefore provided by the purchaser to be made, the seller may make such payment and any amount so paid by the seller, together with interest thereon from date of at the rate of ten (10) per cent per annum, shall be repayable by the purchaser on demand. RECEIto any other right the seller might have by reason of such default. MAR - 5 2004 PERMIT COUNT�A �; ; 171 VOL The purchaser agrees that full inspw•d on of said described premises has been made and that neither the seller nor assigns shall te held to any covenant respwting the condition of any improvements on said premises nor to any agreement for alteiritions, improvements or repairs, unless the covenant or agreement relied on be in writing and attached to and made a part of this contract. payments due by the seller or others on prior contracts, 0 The purchaser shall hive the right to make delinquent pa mortgages or encumbrances which are liens on this property, and by such payment have credit allowed purchaser on this contract as of date of payment. The seller has procured of Agrees, within sixty days from date hereof, to procure from Washington Title Insurance Company a purchaser's policy of title insurance, insuring the purchaser to the full amount of the said purchase price against loss or damage by reason of defect in the title of the seller to the said described premises or by reason of prior liens not assumed by the purchaser un der this agreement. The seller agrees, on full payment of said purchase price in manner hereinbefore specified, to make, execute, and deliver to the purchaser a good and sufficient warranty deed of said described premises, subject to the provisions herein provided for. Time is of the essence of this contract. In case the purchaser shall fail to make any paymc:" Of the said purchase price promptly at the time the same shall fall due as hereinZ>cfore specified, or promptly to perform any covenant or agreement aforesaid, the seller may elect to declare forfeiture and cancellation of this contract and upon such election being made all rights of the purchaser hereunder shall cease and determine and any payments theretofore made hereunder by the purchaser shall be retained by the seller in liquidation of all damages sustained by reason of such failure. Service of all demands, notices or other papers with respect to such declaration of forfeiture and cancellation may be made by registered mail at the following address, to -wit: — h or at such other address as the purchaser will indicate in writing to the seller. Or the seller may elect to b ' ring action, or actions, on any intermediate overdue installment, or on any payment, or payments, made by the seller and repayable by the purchaser, it being stipulated that the covenant to pay intermediate installments or to pay items repayable by the purchaser, are independent of the covenant to make a deed that every such action is an action arising on contract for the recovery of money only, as if the promise to pay had been expressed in a different instrument, and that no such action shall constitute an election not to proceed otherwise as to any subsequent default, and no waiver by the seller of any default on the part of the purchaser shall be construed as a waiver of any subsequent default. ct or to collect any installment payment or any charge In any suit or action to enforce any covenant of this contra � attorneys fees and all costs and expenses in connection arising therefrom, the put -chaser agrees to pay a reasonable sum a! judgment or decree with such suit, and also the reasonable cost of searching records" which sums shall be included in any entered in such suit. in du2licate the day and year . IN WITNESS WHEREOF, the parties hereto have executed this instrument . first herein written. .... (SrAL) . ....... / f A . .. .... (SILA2.) .7 STATE OF WASHINGTON, County of King On this day personally appeared before me Floyd R. Bourgault and Donna J. Bourgault executed the fwithin and foregoininstrument, and to me known to be the individual gdescribed.in and who nd voluntary actg and deed, for the acknowledged that theree a y signed the same as their uses and purposes therein mentioned. day of my hand and official seal this .............................. in and for the State of Washing10", per N♦ . . ....................... LCT 'Q rrsidiiig at ........... .... ..... v' 1ECEIVED MAR 5 2004 PERMIT COUNTER z V 01 pus 999 104 T 'IV roll....,... '•" l't •�G6 s'• o ?... G 3 p. REAL ESTATE CONTRACT TIIIS CONTRACT, awls and entered into this 14th day of March, 1969 (`%'—b=•w •.n �• t- Ac`., ' betwrea cc:, CHARLES K. GROSSE, also known as Charles Kenneth Grosse, who acquired title as Charles F. Grosse and MOREY GROSSE, his wife hereinafter called the "sr[ler," and ROBERT J. CLARE AND DRUSILLA CLAP.E, his wife CD hereinafter called the "purchaser," tdTr\ESSETH: That L'e seller agrees to sell to the purchaser and the purchaser agrees to purchase from the seller the following C-1 described real estate, with the appurtenances, in Snohomish County, Stale of t':—. :ngwn: Tract 3, Plat of Taylor Tracts, LESS the Ilorthwesterly 60 feet thereof; as per Ifs plat recorded in Volume 12 of plats on page 91t records of Snohomish County; L �7 situate in the County of Snohomish, State of Washington. ..� SLTWECT TO mortgage of record in favor of John Davis & Co., a Washington corporation which mortgage the purchasers herein will assume and pay according to its terms and conditions. 3!IBJW- TO: Easements, Restrictions and Reservations of record, if any, and subject to utility easement over the southwesterly 5 feet of subject property as disclosed by the plat. The terms and conditions of thii ,.:tntract are u follows: The purchase price is -Sixteen Thousand Six Hundred Fifty and no/100 - - - - - - - - - - - - - - - - - - - ($16,650.00 ) lJoilir,. at which Thirteen Thousand Eight unfired Forty Five and 86/loo - - ($13,845.86 i1:'I•r•• I,a.e been paid, the receipt whereof is hereby, acknuwte.iged, and the balance of said purchase price shall be paid as follows.—F' sty and no/100------------------- - -- - ---(s50.00 ,or more at purchaxrb optioe, on or before the Ii,rot day of May and Fi fty and no/100 - --- ----- --- --- -(s >U;tr.,,•. or more at purchaser's option, on or before the day of each succeeding calendar month until the balance of .aid 50.00 fire: purchase price shall have been fully paid. The purchaser agrees to pay interest on the dirainishing balance of said purchase price at the rate of eight per cent per annum from the f_'at day of April 19 69, which interest shall be deducted from each installment payment ir.d the balance of each pa.meat applied in reduction of principal. AU payments to be made hereunder shall be made at or at such other place as the seller may direct in writing. It is understood and agreed that the down paymer_t referred to herein consists of: $2,500.00 cash paid to the sellers at the time of closing; and , I111,345.86 in the form of the balance due on the existing mortgage referenced above as of ;:a-ch 1, 1969, which the plea'=hasers have agreed to assume and pay according to its terms and conditions. tj Permission is especially granted by Seller to Purchaser to make larger payments per month or pay the contract in full at any time, with interest.tc be charged only to the date of such payment. As referred to in this contract, "date of closing" shall be April 1. 1969 (1) The purchaser assumes and agrees to pay before delinquency all taxes and assessments tbat may is between grantor and hereafter become alien on said real estate; and if by the terms of this contract the grantee purchaser Au assumr:l payment a( any mortgage, ^ontrad or other encumbrance, or has assumed payment of or agreed to purchase subject to, any taxes or assessments now a lira on said rut {stile, the purchaser agrees to pay tic :same before delinquency. l l: The purchaser agrees, until the purrbasr. price is fully paid, to keep the buildings now and hereafter plac'c,l on :,aid real estate Insured to ;he actual cash value thereof against W,s or damage by both fire and wind>torm in a company acceptable b, lhr et:er and for I the sefler'i irnefit, as his interest may appear, and to pay all premiums therefor and to deliver all policies and rent—Aw tarrcoi to the seller. (.I) The purchaser agrees that full inspection of said rev oa ere has been made and that neither the seller nor his assigns shall be it'•I to any covenant respecting the condition of any improvements them rnor shall the purchaser or sellrr or the assigns of either be held t, - any covenant or agreement for alterations, improvements or repairs nrhets the covenant or agrKmrnt relied on is contained herein or is in writing and attached to and made a part of this contract. (4) The purchaser assumes all hazards of damage to or destruction of an, improvements now on said real estate or hereafter placed I thereon, and of the taking of said real estate or any part thereof for public use; and agrees that no such damage, destruction or taking shall constitute a failure of consideration. In case any part of said real estate is taken for public use, the potion of the condemnation award remaining after payment of reasonable expenses of procuring the same shall be paid to the seller and applied as payment on the purchase price herein unless the seller elects to allow the purchaser to apply all or a portion of such condemnation award to the rebuilding or restora- 600 of any improvements dimagrd by such taking. In ease of damage or destruction from a peril insured against, the Proceeds of such insurance remaining alter payment of the rcasonable expense of procuring the }ame shall be devoted to the restoration or rebuilding of such Improvements withina reasonable time, unless purchaser elects that said proceeds shall be paid to the seller for application on the purchase price herein. (S) The seller has delivered, or agrees to deliver within IS days of the date of cl sine, a purchaser's Policy of title insurance in standard form, or a commitment therefor, issued by Trww.wwwrlcw Till. Iwswronce Con g purchaser to the full amount of »Jd yony, iwurin the m purchase price against Ions or damage by reason of defect in sellers title to said real estate as of the date of closing and containing no exceptions other than the following: C7 a. Printed general exceptions appearing in said policy form; b. Liens at encumbrancer which by the terms of this contract the purchaser b to assume, or as to which the conveyance hereunder Is to be made a 'ect; and Q R� or contracts under which roller is purchasing said real estate, and any mortgage or other obligation, which ct agrees to pay, none of which lot the purpose of this paragraph (S) shall be deemed defects in seller's title. MAR - 5 2004 OFFICIAL RECORDS vas 302 PAu 671 PERMIT C�ONTER- -- — - z_ _,.r. �r _777. , -.; .r :.. , (6) If sdkr's title to said real estate is subject to an existing contract or contracts under which seller is purchasit.g said real estate, or any mortgage or other obligation, which .seller is to pay, seller agrees to make such payments in accordance with the terms thereof, and upon default, the purchaser shall have the right to male any payments necessary to remove the default, and any payments so made shall be applied to the payments next falling due the seller under tbi contract. (7) The seller agrees, upon recrivinte full payment of the purchase price and interest in the manner above specified, to execute and deliver to purchaser a statutory. warranty ...... _ _ _ deed to said real estate, excepting any part thereof bcmftcr taken for public use, free of encumbrances txapt any that mac attach after date of closing through any person other than the seller, and subject to the following: s.oraJaC-e of record in favor of TolLi Davis u '.'.Oa!panlr a ilashin� ort corporation, '.thigh _:orirage purchasers herein have assnmed and will pal accor6in, to i:-rs ter,::s and ccn;li `_ions. (8) Unless a different date is provided for bemin, the purchaser shall be entitled to possession of said real estate on date of closing and to retain possession vs long as purchaser is not in default hereunder. The purchaser covenants to keep the buildings and other improve• ornts on said real estate in good repair and not to permit waste and not to use, or permit the use of, the real estate for any illegal purpose. The purchaser covenants to pay all service, installation or conAruction.eharges for water, sewer, electricity, garbage or other utility services furnished to said real estate after the date purchaser is entitled to possession. (o) to case the purchaser fails to make any payment herein provided or to maintain insurance, as herein required, the seller map make sneh poymeot or effect such insurance, and any amounts so paid by the seller, together with interest at the rate of 10 o per annum then -on from date of payment until repaid, shall be repayable by purchaser on seller's demand, all without prejudice to any other right the w1ki might have by reason of such default. (10) Time is of the essence of this contract, and it is agreed that in case the purchaser shall fail to comply with or perform anp condition or agreement hereof or to make any payment required hereunder• promptly at the time prof inthe manner herein required. the seller may elect to declare an the purchaser's rights hereunder terminated, and upon his doing v. , all n.sl•ments made by the purchaser hereunder and an improvements placed upon the real estate shall be forfeited to the seller as liquida(nl damages. and the seller shall have right to re-enter and take possession of the real estate; and no a-aiver by the seller of any default on the part of the purchaser shall be construed as a waiver of any subsequent default. Service upon purchaser of all demands, notices or other papers with respect to forfeiture and termination of purchaser's rights may be made by United States Alan, postage pre -paid, return receipt requested, directed to the purchaser at his addres last knnw-n to the seller. (11) Upon selkr's election to bring suit to enforce any covenant of this contract, including suit to collect any payment required berrunder, the purchaser agrees to pay a reasonable sum as attorney's fees and all costs and expenses in connection with such suit, which s®s shag fie included in any judgment or decree entered in such wit. If the seller shag bring suit to procure an adjudication of the termination of the purchaser's rights hereunder, and judgment is so entered, the purchaser agrees to pay a reasonable sum as attorneys fees and all costs and expenses in'connection with such suit, and also the seasonable cost of searching records to determine the condition of title at the date such suit is commenced, which sums shall be ec idod in any judgment or decree entered in such suit. IN WITNESS WHEREOF, the parties hereto have executed this instrument as of the date first written above. (scar) _....._ _ . (sue) .... ..........(plat) _....(pLtt) STATE OF WASHINGTON, Cooary of Snohomish On this day personally appeared before me Charles K. :3rosse and Morey Grosse to not known to be the Individual 8 described in and who eaecuted the within and foregoing instrument, and acknowledged [bat they srigaed the same as their free and voluntary ad and deed, for tb��Qje�j'' sec tbcon anentioned. 9I�� I'?; GIVEN under my hand and official seal this %{ / day of MBreh 1 . So" Prbbe in aced for She State off l� , I k w. TRANSAMERICA TITLE INSURANCE CONIPANY ers Fled for Record of Requeit of — ^ r nW CORP ' ................_.. �_ED---- lfrr gyp:. •r'+al"4't,^,tC4 ynilib i 4 i i ._. i . -_.---PE#iMIT-CCiJIlTER ___.-.- . THIS SPACE RESERVED FOR RECORDER'S USE, OFFICIAL RECORDS mD O 4< ran Zvi $ cn C)0r rn =° .O o cc . c 11tf � >, � a9 n I c u0 —! O ix an S v rn OFFICIAL RECORDS ' ------------------ a02 VOL PAcE672 A�( COMMITMENT FOR TITLE INSURANCE CHICAGO TITLE INSURANCE COMPANY CHICAGO TITLE INSURANCE COMPANY, a Missouri corporation, herein called the Company, for a valuable consideration, hereby commits to issue its policy or policies of title insurance, as identified in Schedule A, in favor of the proposed Insured named in Schedule A, as owner or mortgagee of the estate or interest covered hereby in the land described or referred to in Schedule A, upon payment of the premiums and charges therefore; all subject to the provisions of Schedules A and B and to the Exclusions from Coverage (appearing herein) and to the Conditions and Stipulations hereof. This Commitment shall be effective only when the identity of the proposed Insured and the amount of the policy or policies committed for have been inserted in Schedule A hereof by the Company, either at the time of the issuance of this Commitment or by subsequent endorsement. This Commitment is preliminary to the issuance of such policy or policies of title insurance and all liability and obligations hereunder shall cease and terminate six months after the effective date hereof or when the policy or policies committed for shall issue, whichever first occurs, provided that the failure to issue such policy or policies is not the fault of the Company. In Witness Whereof, CHICAGO TITLE INSURANCE COMPANY has caused this commitment to be signed and sealed as of the date of policy shown in Schedule A, the policy to become valid when countersigned by an authorized signatory. " Issued by: CHICAGO TITLE INSURANCE COMPANY 3030 HOYT AVENUE EVERETT, WA 98201 (425) 258-3683 .'.cD.... ......... Authorized Signature MAR 5 2004 CHICAGO TITLE INSURANCE COMPANY ft. BY: ATTEST --Z se«w.y Form C 9800 (Reprinted 09M) CONDITIONS AND STIPULATIONS 1. The term "mortgage," when used herein, shall include deed of trust, trust deed or other security instrument. 2. If the proposed Insured has or acquires actual knowledge of any defect, lien, encumbrance, adverse claim or other matter affecting the estate or interest or mortgage thereon covered by this Commitment other than those shown in Schedule B hereof, and shall fail to disclose such knowledge to the Company in writing, the Company shall be relieved from liability for any loss or damage resulting from any act of reliance hereon to the extent the Company is prejudiced by failure to so disclose such knowledge. If the proposed Insured shall disclose such knowledge to the Company, or if the Company otherwise acquires actual knowledge of any such defect, lien, encumbrance, adverse claim or other matter, the Company at its option may amend Schedule B of this Commitment accordingly, but such amendment shall not relieve the Company from liability previously incurred pursuant to paragraph 3 of these Conditions and Stipulations. 3. Liability of the Company under this Commitment shall be only to the named proposed Insured and such parties included under the definition of Insured in the form of policy or policies committed for and only for actual loss incurred in reliance hereon in undertaking in good faith (a) to comply with the requirements hereof, or (b) to eliminate exceptions shown in Schedule B, or (c) to acquire or create the estate or interest or mortgage thereon covered by this Commitment. In no event shall such liability exceed the amount stated in Schedule A for the policy or policies committed for and such liability is subject to the insuring provisions, the Conditions and Stipulations, and Exclusions from Coverage of the form of policy or policies committed for in favor of the proposed Insured where are hereby incorporated by reference and are made a part of this Commitment except as expressly modified herein. 4. Any action or actions or rights of action that the proposed Insured may have or may bring against the Company arising out of the status of the title to the estate or interest or the status of the mortgage thereon covered by this Commitment must be based on and are subject to the provisions of this Commitment. EXCLUSIONS NOTE: THE FORM OF POLICY COMMITTED FOR MAY BE EXAMINED BY REFERENCE TO FORMS ON FILE IN THE OFFICE OF THE INSURANCE COMMISSIONER OR BY INOUIRY AT THE OFFICE WHICH ISSUED THIS COMMITMENT. The Exclusions from Coverage referred to in Paragraph 3 of the Conditions and Stipulations are as follows: ALTA OWNER'S POLICY FORM 10-17-92 The following matters are expressly excluded from the coverage of this policy and the Company will not pay loss or damage, costs, attorneys' fees or expenses which arise by reason of: 1. (a) Any law, ordinance or governmental regulation (including but not limited to building and zoning laws, ordinances, or regulations) restricting, regulating, prohibiting or relating to (i) the occupancy, use, or enjoyment of the land; (ii) the character, dimensions or location of any improvement now or hereafter erected on the land; (iii) a separation in ownership or a change in the dimensions or area of the land or any parcel of which the land is or was a part; of (iv) environmental protection, or the effect of any violation of these laws, ordinances or governmental regula- tions, except to the extent that a notice of the enforcement thereof or a notice of a defect, lien or encumbrance resulting from a violation or alleged violation affecting the land has been recorded in the public records at Date of Policy. (b) Any governmental police power not excluded by (a) above, except to the extent that a notice of the exercise thereof or a notice of a defect, lien or encumbrance resulting from a violation or alleged violation affecting the land has been recorded in the public records at Date of Policy. 2. ,Rights of eminent domain unless notice of the exercise thereof has been recorded in the public records at Date of 'Policy, but not excluding from coverage any taking which has occurred prior to Date of Policy which would be binding on the rights of a purchaser for value without knowledge. 3. Defects, liens, encumbrances, adverse claims or other matters: (a) created, suffered, assumed or agreed to by the insured claimant; (b) not known to the Company, not recorded in the public records at Date of Policy, but known to the insured claimant and not.disclosed in writing to the Companyby the insured claimant prior to the date the insured claimant became an insured under this policy; (c) resulting in no loss or damage to the insured claimant; (d) attaching or created subsequent to Date of Policy; or (e) resulting in loss or damagiftich would not have beep sustained if the i ed claimant had paid value for the estate or interest insured his policy. CHI*GO TITLE INSURANCE COAkPANY 0 HowAVENUE, EVERE'IT, WA 98201 A.L.TA. COMMITMENT SCHEDULE A Title Unit: E4683 Phone: (425)259-8214 Fax: (425)259-8243 Order No.: 5211369 Officer: FETZER UNIT Your No.: CLARE Commitment Effective Date: FEBRUARY 5, 2004 at 8:00 A.M. 1. Policy or Policies to be issued: ALTA Owner's Policy Amount: 1992 STANDARD Premium: Tax: Proposed Insured: TO BE DISCLOSED Policy or Policies to be issued: Amount: ALTA Loan Policy Premium: Tax: Proposed Insured: Policy or Policies to be issued: ALTA Loan Policy Proposed Insured: Assessment/Tax Search: $0.00 to follow $0.00 Amount: $ 0. 0 0 Premium: Tax: 2. The estate or interest in the land which is covered by this Commitment is: FEE SIMPLE $2.00 3 . Title to the estate or interest in the land is at the effective date hereof vested in: ROBERT JAMES CLARE AND DRUSILLA I. CLARE, HUSBAND AND WIFE AS TO THE NORTHWESTERLY 60 FEET; AND IN CHARLES F. GROSSE AND MOREY GROSSE, HUSBAND AND WIFE AS TO THE REMAINDER 4. The land referred to in this Commitment is described as follows: SEE ATTACHED LEGAL DESCRIPTION EXHIBIT WLTACOMA/RDA/0999 CHICAGO TITLE INSURANCE COMPANY A.L.TA. COMMITMENT SCHEDULE A (Continued) Order No.: 5211369 Your No.: CLARE LEGAL DESCRIPTION EXHIBIT (Paragraph 4 of Schedule A continuation) LOT 3 TAYLOR TRACTS, ACCORDING TO THE PLAT THEREOF, RECORDED IN VOLUME 12 OF PLATS, PAGE 91, RECORDS OF SNOHOMISH COUNTY, WASHINGTON. SITUATE IN THE COUNTY OF SNOHOMISH, STATE OF WASHINGTON. CLTACMA6/RDA/OM • 0 CHICAGO TITLE INSURANCE COMPANY A.L.TA. COMMITMENT SCHEDULE B Order No.: 5211369 Your No.: CLARE Schedule B of the policy or policies to be issued will contain exceptions to the following matters unless the same are disposed of to the satisfaction of the Company. GENERAL EXCEPTIONS A. Rights or claims of parties in possession not shown by the public records. B. Encroachments, overlaps, boundary line disputes, or other matters which would be disclosed by an accurate survey and inspection of the premises. C. Easements, or claims of easements, not shown by the public records. D. Any lien, or right to a lien, for contributions to employee benefit funds, or for state workers' compensation, or for services, labor, or material heretofore or hereafter furnished, all as imposed by law, and not shown by the public records. E. Taxes or special assessments which are not shown as existing liens by the public records. F. Any service, installation, connection, maintenance, tap, capacity or construction charges for sewer, water, electricity, other utilities, or garbage collection and disposal. G. Reservations or exceptions in patents or in Acts authorizing the issuance thereof; Indian tribal codes or regulations, Indian treaty or aboriginal rights, including easements or equitable servitudes. H. Water rights, claims, or title to water. I. Defects, liens, encumbrances, adverse claims or other matters, if any, created, first appearing in the public records, or attaching subsequent to the effective date hereof but prior to the date the proposed insured acquires of record for value the estate or interest or mortgage thereon covered by this Commitment. SPECIAL EXCEPTIONS FOLLOW WLTACOMB/RDA/OM • CHICAGO TITLE INSURANCE COMPANY A.L.TA. COMMITMENT SCHEDULE B (Continued) Order No.: 005211369 Your No.: CLARE SPECIAL EXCEPTIONS a 1. PAYMENT OF THE REAL ESTATE EXCISE TAX, IF REQUIRED. THE PROPERTY DESCRIBED HEREIN IS SITUATED WITHIN THE BOUNDARIES OF LOCAL TAXING AUTHORITY OF CITY OF EDMONDS. PRESENT RATE OF REAL ESTATE EXCISE TAX AS OF THE DATE HEREIN IS 1.78 PERCENT. ANY CONVEYANCE DOCUMENT MUST BE ACCOMPANIED BY THE OFFICIAL WASHINGTON STATE EXCISE TAX AFFIDAVIT. THE APPLICABLE EXCISE TAX MUST BE PAID AND THE AFFIDAVIT APPROVED AT THE TIME OF THE RECORDING OF THE CONVEYANCE DOCUMENTS. s 2. GENERAL TAXES, SPECIAL DISTRICT MANAGEMENT, AND SURFACE WATER MANAGEMENT FEES, IF ANY; PAYABLE ON FEBRUARY 15TH: YEAR: 2004 AMOUNT: NOT YET AVAILABLE TAX ACCOUNT NUMBER: 005951-000-003-02 LEVY CODE: 0210 ASSESSED VALUE -LAND: $ 145,000.00 ASSESSED VALUE -IMPROVEMENTS: $ 91,900.00 NOTE: GENERAL AND SPECIAL TAXES FOR 2003 IN THE SUM OF $ 519.79 HAVE BEEN PAID. c THE PROPERTY HEREIN DESCRIBED IS CARRIED ON THE TAX ROLLS AS PARTIALLY EXEMPT UNDER A SENIOR CITIZEN'S EXEMPTION AND THE ASSESSED VALUES MAY HAVE BEEN "FROZEN". IF SAID TAXES ARE NOT PAID PRIOR TO THE SALE BY OR DEATH OF THE QUALIFYING TAXPAYER, THE EXEMPTION WILL BE DISALLOWED, THE ASSESSED VALUES, IF FROZEN, WILL BE ADJUSTED, AND THE FULL TAX AMOUNT FOR CURRENT AND/OR PRIOR YEARS, IF ANY, WILL BE DUE. ASSESSED VALUATION CURRENTLY LISTED ON THE SNOHOMISH COUNTY TAX ROLLS IS 236,900.00. THE FULL AMOUNT OF THE TAX WITHOUT THE EXEMPTION AT THIS TIME IS $ 3,108.92. CLTACMBl/RDA/0999 • • D s CHICAGO TITLE INSURANCE COMPANY A.L.TA. COMMITMENT SCHEDULE B (Continued) Order No.: 5211369 Your No.: CLARE SPECIAL EXCEPTIONS 3. EASEMENT AS DELINEATED AND/OR DEDICATED ON THE FACE OF THE PLAT. PURPOSE: AREA AFFECTED: UTILITIES SOUTHWESTERLY 5 FEET 4. CONTRACT OF SALE AND THE TERMS AND CONDITIONS THEREOF: SELLER: CHARLES K. GROSSE ALSO KNOWN AS CHARLES KENNETH GROSSE, WHO ACQUIRED TITLE AS CHARLES F. GROSSE AND MOREY GROSSE, HIS WIFE PURCHASER: ROBERT J. CLARE AND DRUSILLA CLARE, HIS WIFE DATED: MARCH 14, 1969 RECORDED: APRIL 3, 1969 RECORDING NUMBER: 2085461 EXCISE TAX NUMBER: E03004 n 5. IN THE EVENT THAT THE PROPERTY DESCRIBED HEREIN IS OCCUPIED BY A MARRIED PERSON AND SPOUSE AS A HOMESTEAD, THE CONVEYANCE OR ENCUMBRANCE OF THE PROPERTY MUST BE EXECUTED AND ACKNOWLEDGED BY BOTH HUSBAND AND WIFE, PURSUANT TO RCW 6.13 WHICH NOW PROVIDES FOR AN AUTOMATIC HOMESTEAD ON SUCH PROPERTY. G THE MARITAL STATUS OF ALL INDIVIDUALS SHOULD BE DISCLOSED ON THE FORTHCOMING DOCUMENTS. a 6. TITLE IS TO BE VESTED IN PERSONS NOT YET REVEALED AND WHEN SO VESTED WILL BE SUBJECT TO MATTERS DISCLOSED BY A SEARCH OF THE RECORDS AGAINST THEIR NAMES. r 7. IF THE PROPOSED INSURED IS A MARRIED PERSON ACQUIRING TITLE AS HIS/HER SEPARATE ESTATE, WE WILL REQUIRE A DEED BE EXECUTED BY THE SPOUSE OF THE PROPOSED INSURED TO ESTABLISH SEPARATE PROPERTY. A DEED FROM THE SPOUSE WILL NOT ELIMINATE THE REQUIREMENT THAT BOTH SPOUSES EXECUTE ANY NEW MONETARY ENCUMBRANCES TO COMPLY WITH THE AUTOMATIC HOMESTEAD PROVISIONS OF RCW 6.13.060 IF BOTH SPOUSES INTEND TO RESIDE ON THE PROPERTY. nElavfE9 CLTACMB2/RDA/0999 MAR - 5 2004 PERMIT COUNTER • • CHICAGO TITLE INSURANCE COMPANY A.L.TA. COMMITMENT SCHEDULE B (Continued) Order No.: 5211369 Your No.: CLARE SPECIAL EXCEPTIONS END OF SCHEDULE B x NOTE A: MATTERS DEPENDENT UPON OUR INSPECTION HAVE BEEN CLEARED TO PROVIDE AN EXTENDED COVERAGE LENDER'S POLICY. GENERAL EXCEPTIONS A THROUGH H, INCLUSIVE, ARE HEREBY DELETED. L NOTE B: COUNTY RECORDS INDICATE THAT THE ADDRESS OF THE IMPROVEMENT LOCATED ON SAID LAND IS: 1031 GRANDVIEW STREET EDMONDS, WASHINGTON 98020 rr NOTE C : EFFECTIVE JANUARY 1, 1997, DOCUMENT FORMAT AND CONTENT REQUIREMENTS HAVE BEEN IMPOSED BY WASHINGTON LAW. FAILURE TO COMPLY WITH THE FOLLOWING REQUIREMENTS MAY RESULT IN REJECTION OF THE DOCUMENT BY THE COUNTY RECORDER OR IMPOSITION. OF A $50.00 SURCHARGE. FIRST PAGE OR COVER SHEET REQUIREMENTS: 3" TOP MARGIN CONTAINING NOTHING EXCEPT THE RETURN ADDRESS. 1" SIDE AND BOTTOM MARGINS CONTAINING NO MARKINGS OR SEALS. TITLES) OF DOCUMENTS. RECORDING NO. OF ANY ASSIGNED, RELEASED OR REFERENCED DOCUMENT(S). GRANTORS NAMES (AND PAGE NO. WHERE ADDITIONAL NAMES CAN BE FOUND). GRANTEES NAMES (AND PAGE NO. WHERE ADDITIONAL NAMES CAN BE FOUND). ABBREVIATED LEGAL DESCRIPTION (AND PAGE NO. FOR FULL DESCRIPTION). ASSESSOR'S TAX PARCEL NUMBER(S). RETURN ADDRESS (IN TOP 3" MARGIN). **A COVER SHEET CAN BE ATTACHED CONTAINING THE ABOVE FORMAT AND DATA IF THE FIRST PAGE DOES NOT CONTAIN ALL REQUIRED DATA. ADDITIONAL PAGES: 1" TOP, SIDE AND BOTTOM MARGINS CONTAINING NO MARKINGS OR SEALS. ALL PAGES: NO STAPLED OR TAPED ATTACHMENTS. EACH ATTACHMENT MUST BE A SEPARATE PAGE. ALL NOTARY AND OTHER PRESSURE SEALS MUST BE SMUDGED FOR VISIBILITY. CLTACMB2/RDA/09W i • CHICAGO TITLE INSURANCE COMPANY A.L.TA. COMMITMENT SCHEDULE B (Continued) Order No.: 5211369 Your No.: CLARE SPECIAL EXCEPTIONS FONT SIZE OF 8 POINTS OR LARGER. ALL INFORMATION MUST BE LEGIBLE AND CAPABLE OF BEING IMAGED. THE FOLLOWING MAY BE USED AS AN ABBREVIATED LEGAL DESCRIPTION ON THE DOCUMENTS TO BE RECORDED TO COMPLY WITH THE REQUIREMENTS OF RCW 65.04. SAID ABBREVIATED LEGAL DESCRIPTION IS NOT A SUBSTITUTE FOR A COMPLETE LEGAL DESCRIPTION WHICH MUST ALSO APPEAR IN THE BODY OF THE DOCUMENT: TRACT 3, TAYLOR TRACTS N HDO/JR CLTACMB2/RDA/0999 CHICAGO TITLE INSURANCE COMPANY A.L.TA. COMMITMENT SCHEDULE B (Continued) Order No.: 5211369 Your No.: CLARE SPECIAL EXCEPTIONS o THE FOLLOWING PARTIES HAVE BEEN SENT A COPY OF THIS COMMITMENT: RE/MAX CHAMPIONS BILL BICKLE RE/MAX CHAMPIONS BILL BICKLE CLTACMB2/RDA/0999 1- EXCLUSjV NS,,(ConYd.) 4. Any claim, which arises out of the transaction vesting in the Insured the estate or interest insured by this policy, by reason of the operation of federal bankruptcy, state insolvency, or similar creditors' rights laws, that is based on: (i) the transaction creating the estate or interest insured by this policy being deemed a fraudulent conveyance or fraudulent transfer; or (ii) the transaction creating the estate or interest insured by this policy being deemed a preferential transfer except where the preferential transfer results from the failure: (a). to timely record the instrument of transfer; or (b) of such recordation to impart notice to a purchaser for value or a judgment or lien creditor. ALTA LOAN POLICY FORM (10-17-92) The following matters are expressly excluded from the coverage of this policy and the Company will not pay loss or damage, costs, attorneys' fees or expenses which arise by reason of: 1. (a) Any law, ordinance or governmental regulation (including but not limited to building and zoning laws, ordinances, or regulations) restricting, regulating, prohibiting or relating to (i) the occupancy, use, or enjoyment of the land; (ii) the character, dimensions or location of any improvement now or hereafter erected on the land; (iii) a separa- tion in ownership or a change in the dimensions or area of the land or any parcel of which the land is or was a part; or (iv) environmental protection, or the effect of any violation of these laws, ordinances or governmental regulations, except to the extent that a notice of the enforcement thereof or a notice of a defect, lien or encum- brance resulting from a violation or alleged violation affecting the land has been recorded in the public records at Date of Policy. (b) Any governmental police power not excluded by (a) above, except to the extent that a notice of the exercise thereof or a notice of a defect, lien or encumbrance resulting from a violation or alleged violation affecting the land has been recorded in the public records at Date of Policy. 2. Rights of eminent domain unless notice of the exercise thereof has been recorded in the public records at Date of Policy, but not excluding from coverage any taking which has occurred prior to Date of Policy which would be binding on the rights of a purchaser for value without knowledge. 3. Defects, liens, encumbrances, adverse claims or other matters: (a) created, suffered, assumed or agreed to by the insured claimant; (b) not known to the Company, not recorded in the public records at Date of Policy, but known to the insured claimant and not disclosed in writing to the Company by the insured claimant prior to the date the insured claimant became an insured under this policy; (c) resulting in no loss or damage to the insured claimant; (d) attaching or created subsequent to Date of Policy (except to the extent that this policy insures the priority of the lien of the insured mortgage over any statutory lien for services, labor or material); or (e) resulting in loss or damage which would not have been sustained if the insured claimant had paid value for the insured mortgage. 4. Unenforceability of the lien of the insured mortgage because of the inability or failure of the insured at Date of Policy, or the inability or failure of any subsequent owner of the indebtedness, to comply with applicable doing business laws of the state in which the land is situated. 5. Invalidity or unenforceability of the lien of the insured mortgage, or claim thereof, which arises out of the transaction evidenced by the insured mortgage and is based upon usury or any consumer credit protection or truth in lending law. 6. Any statutory lien for services, labor or materials (or the claim or priority of any statutory lien for services, labor or materials over the lien of the insured mortgage) arising from an improvement or work related to the land which is con- tracted for and commenced subsequent to Date of Policy and is not financed in whole or in part by proceeds of the indebtedness secured by the insured mortgage which at Date of Policy the insured has advanced or is obligated to advance. 7. Any claim, which arises out of the transaction creating the interest of the mortgagee insured by this policy, by reason of the operation of federal bankruptcy, state insolvency, or similar creditors' rights laws, that is based on: (i) the transaction creating the interest,of the insured mortgagee being deemed a fraudulent conveyance or fraudulent transfer; or (ii) the subordination of the interest of the insured mortgagee as a result of the application of the doctrine of equitable subordination; or (iii) the transaction creating the interest of the insured mortgagee being deemed a preferential transfer except where the preferential transfer results from the failure: (a) to timely record the instrument of transfer; or (b) of such recordation to impart notice to a purchaser for value or a judgment or lien creditor. COMMITMENT FOR TITLE INSURANCE CHICAGO TTfLE INSURANCE COMPANY 171 North Clark Sftd Chicago, Illinois 60601-3294 P STREETFILE� CITY of EDMONDS 200 Dayton Street • Edmonds, Washington 98020 • Telephone (206) 775-2525 Department of Public Works December 11, 1975 Ms. Darla Carpenter Recovery Examiner United Pacific/Reliance Ins. 2200 Sixth Avenue Denny Bldg. - Room 300 Seattle, Washington 98121 Dear Ms. Carpenter: In answer to your letter, dated December 10, 1975, any and all correspondence re the claim submitted by Robert J. Clare should be directed to Irene Varney'Moran, City Clerk, Edmonds Civic Center, 250 Fifth Avenue North, Edmonds, Washington 98020. Sincerely, ';�OHN B. MITCHELL Water/Sewer Supt.. jt • RECEIVED DEC 111975 UNITED PACIFIC/RELIANCE INSURAME., COMPANIES C9� SEATTLE BRANCH: DENNY BLDG. • ROOM -300 •• 220076TH AVENUE SEATTLE, WASHINGTON 98121 AC 206-623-6080 December 10, 1975 City of Edmonds Department of Public Works 200 Dayton Street Edmonds, Washington Attention: John B. Mitchell, Water/Sewer Superintendent Re: Claim No. 94-11648 Insured Robert J. Clare Loss Date May 14, 1975 Dear Mr. Mitchell: Your letter of September 29, 1975, advised us that this loss was being forwarded to your insurance company for final disposition. You further advised that if we had further questions to contact the City Clerks office. Would you please advise us whanat the city clerk's office we should contact regarding thismatter? Thank you. Sincerely, UNITED PACIFIC INSURANCE COMPANY Darla M. Carpenter DMC/bj Recovery Examiner UNITED PACIFIC INSURANCE COMPANY UNITED PACIFIC LIFE INSURANCE COMPANY RELIANCE INSURANCE COMPANY J /b3 CITY of EDMONDS 200 Dayton Street • Edmonds, Washington 98020 • Telephone (206) 775-2525 Department of Public Works September 29, 1975 Ms. Darla M. Carpenter Recovery Examiner United Pacific/Reliance Insurance 2200 Sixth Avenue Denny Bldg. - Room 300 Seattle, Washington 98121 Dear Ms. Carpenter: In reference to your letter dated September 2, 1975, the claim submitted for Robert .T_ (Tare was filed with the City Clerk's office June 6, 1975, and has been forwarded to our insurance company for final disposition. If you have further questions, please contact the City Clerk's office. Sincerely, �JOHN B. MITCHELL Water/Sewer Supt. jt RE VED S E P 4 1975 UNITED PACIFIC/ RE L I ANC E INSURANCE COMPANIES SEATTLE BRANCH: DENNY BLDG. • ROOM 300 • 2200-6TH AVENUE • SEATTLE. WASHINGTON-98121 AC 206-623-6080 September 2, 1975 City Of Edmonds Department Of Public Works 200 Dayton Street Edmonds, Washington 98020 Attention; Mr. John B. Mitchell Water/Sewer Superintendent Re: Claim No.: 94 11648 Insured Robert J. Clare Loss Of May 14, 1975 Dear Mr. Mitchell: We enclose a copy of your letter and our Claim Form filed with you with regard to the above captioned claim. We also include at this time copies of our draft paid to our insured as a result of the above captioned loss. We would appreciate your forwarding your draft in the amount of $1,148.52, so that we may close our file. Thank you for your cooperation in this matter. Very truly yours, UNITED PACIFIC INSURANCE COMPANY .0. Arlene M. Washburn Recovery Department AXW:maP Encls. UNITED PACIFIC INSURANCE COMPANY UNITED PACIFIC LIFE INSURANCE COMPANY RELIANCE INSURANCE COMPANY CITY of EDMONDS !1' 260 Dayton Street • Edmonds. Washington 98020 - Telephone (206) 7 75-2525 Department or Public Works . IP 289 1975 Ms. Darla M. Carpenter Recovery Examiner United Pacific/Reliance Insurance 2200 Sixth Avenue Denny Bldg. - Room 300 Seattle, Washington 98121 Dear Ms. Carpenter: Per your letter dated May 21, 1975, please find enclosed the necessary form used to file a claim with the City of Edmonds City Clerk's Office. As you are probably aware, this claim must be signed before a Notary Public or it will not be honored. If our office can be of further assistance, please feel free to contact us. Sincerely, J�� `,JOHvi B. MITCHELL Water/Sewer Supt. jt Enclosure . i'Z. N.um; ir.;tlt.n; e. i�unnt RE-LIAW(;E Insured J. Clare INEa Ir1ANC:f_ COMPANIES City A Slate of Claim Office Preparing Fur-n-l- _Robert - P.P. --. - --.--' Chuck Sant to: U w — -' _ --- ---'—. Issue Date 213 Wit. Helens Ave. TuCJrT1 7, \Nash. 98402 4 T�.E bid x El Payee QCl Agent 0 22 -s y _ Claim Number ' Check Number Policy Number Date of Loss 1- reliance h:ti:::a"ceCompany it. Number If. Number )rj:i:nitcd f ac:':c insurance Company 1 2 - 3 4 5 6 7 1 ff 16-17 18 - 22 m. Number Mo. Day Y Planet Insurance Company ;`-: «., 94 27�7 P 00480 148 C' 6 4 8 Pay the sum of Two Hundred Seventy Seven and 62/100 � DOLLARS To the order of a Paul Jones Interiors 1063 Robin Hood Dr. Edmonds, Iota . 98020 1:�'•c., r ?[-:i 't:'% i_ i - r•�tit;=...�...i ;St•if- �. 1 - t. ti.; f:,tin Fc M ;.t is S F b.l e T a D Y I Kind Pint. D n s. e xr� Amount Reins. Co. Code Payment TTof of Loss t Bur cl Ct. Part 58 Sup. Fin. Fxp. 34 39 40 41-42-43 44 50 55 - 57 73-74 75 1 A -- —_ - 206 1 27762 x --r-- 12I �3 -- *— I 1 1 I 4 ' I I c, t I i I 7i l I E _ I ' i I I I I11� 12 - I WI.0 5b46 FD. 1/74 ii1:--, iitlV I, III, t ')IV Wack, W ly IIMk::. to Dt $ - -I - Iolal Amount to Dale Period Covered From: Through 16.20 1220 Agency Code Typist 33 Oft I Producer 25$ 5416 dm Claim 1. if Claim Number is from One Entry or Regular Face Sheet with edition date prior to Number 12/70, type Claim Office Code from Face Sheet in Cols. 2-3 and Claim Number in Cats. 4 thru 9. Be certain last digit is typed in Shaded Col. 9. If Claim Number is less than six digits precede with zeros to make six digits. 2. If Claim Number is from One Entry or Regular Face Sheet with edition date of 12/70 or after, type Claim Number in Cols. 2 thru 8 and a dash in Col. 9. (Notice first two digits of Claim Number are Claim Office Code.) • t To be completed when required in NO FAULT states. CLAIM FILE COPY ,rFIC/RELI COMPAN I E Report Insured: Is Coverage O.K.? Yes Facts/Liability: 1•0 DAY OR CLOS• ADJUSTER REPORT Closing Report CI _ No (Explain) Note: Make a specific comment for each caption. Claim No. Property Damaged/lnjuries: '0� d . -Q va 1o�,!fw o y cc 7,r"c, p cc C . �. / O 5esrl-_ Subrogation�SeWa": �� L= .C.f+�/��=/ 70. 470 Diagram on Back El OAdditional Comments on Back Claims Represen►ative/ LC-5675 ED. 7/72 Date of Report C-223 ED. 10/67 t i tr Order No. 8 5 8 0 Dept Dote 19 Nome �ZL Wr_� �,_ Address Ship To Address City WHEN SHIP f HOW SHIP TERMS BUYER SALESMAN i 'I IS- t Redifprm 5H,53 AST . CARPET. &LI LEU1 ry 7NORT �. VINYL - FORMICA -CERAMIC TILE, DRAPES 17534.--15TH AVE. N.E. Y SEATTLE, WASH. 98155 T ,* Sold to r ,2 Home Pone Date n 2 Street Address Work Phone Install 72 City State Zip Terms Mechanic i ^ Deliver To Salesmay�t�� P.O. No. Rec'd Loc. q.. Mfg. Quantity " Description @ Total Amount E - [ r A -G U !v f�• ,,14 rS • :: T k ..: •• .-. WORK DETAIL Total Sale �.� .. C .. 4 TAX < TOTAL DEPOSIT _ BAL.,DUE N c • SIGVATURE DATE f 4- CUSTOMER' L�0��{�� L L� A V{;E /wsun^wcscomp^w -- ` 728St.Helens Ave. T^co�n.wmux.8Ou( [`""^ ^....,`u"*`"w 8_O."."d�*.^'..�."^.c""=" [� p^"* /~"ia^"Co=*,* [ E. Robert J. Clare —Insured City & State of Claim Office Preparing Form P.P. Check Sent to: E] Issue Date Sys Claim Number Check Number Policy Number Date of Loss j Number 011. Number 1 _2 5 6 T, 7 f6- Pa, �� the =�m �DOLLARS B�z"�b�� a ��°«�" "e""=" Soc. Sec. or Employer's 1.0� To the 17534 I5tb Ave. 0O order of SeattIe* Wa 98115` Payment For 1� . 1r. . ~A..^. r°./ "1101` Al 206 Cr AnIOUnt X Code of Loss cl Part Sup. Fin. X0 .27090 XY 12 ..Fly Hot . Total Amount to Date Period Covered: Agency Code 33 Off Producer rxmvoh , 27O.9O � 7-1 1220 S. James -_- ~ Claim 1. it Claim Number is from One Entry or Regular Face Sheet with edition date prior to Number 12/70type Claim Office Code from Face Sheet inCols. 2'3and Claim Number in Cols. 4 thm 9 Be certain last digit is typed in Shaded Col. 9. U Clain Number is �ss than six digits precede with zeros to make mix digits. , 2. It Claim Number is from One Entry or Regular Face Sheet with edition claKe,o/ 12/70 o, after, type Claim Number in Cols. 2 thnu 8ung u Uaohjn Col. 9 (Notice first two digits of Claim Number are Claim Office Code.) | To be completed when required in NO FAULT states. wLc 3546so. vm RELIANCE \ INSURANCE COMPAN 728 St. Helens Ave. Tacoma, Wash. 984 ❑ F(clinnr.c Iniln.mt'c Ccntp.uly ;r��Uniead PaU11C Insu,ar.ce Company Planet Insurance Company CI (.Ici/t:a tll:; N:Ifne I Iil:i l:lUU :i t`1:11T)� 1 i In3ured Robert J . Clara ES — City & StateofClaim office Preparing Form P.P. Check Sent to: i_] Issue )2 SJ� '�i U �v LE A i _l P.-yce ?1 Agent _ ID,atte 0 8 L L 7�- ' 'ys C_I_airn Number �J Check Numlmr Policy Number Date of Loss Oft. Number Off. Number 1 2 - 3 4 5 6 8 <'i 1&-17 18 22 Sy m. Number Mo. Day Yr. U �' 1 1 6 J 8 IiP o04 G80 0� 14 75 i_;r..liin:y C.I,IInt Unty 1t�vvL.�-vT.1�`^ Total Amount to Date Period Covered: Anncy eCode from:_ (—.------ TYpist•1 —I—Off I Producer Through: 11I 5 N 5416 1 dm Pay the sum of Five _hundred Fifty and no/.100 DOLLARS $ 550.00 I— 1, ,fi10N ,C:GO IA E.F l is 20 Robert J . Clare Authorizod Signature 1220 To the 1031 Grandview Ave. Soc. Sec. or Employer's I.D.No. Agent order of EC'mondS , Ida 98020 James Payment For S. L 0'•4: 1r'.t t t.,; i r-aiifnrnia Rank rino S. Sorinn St.. Los Amtoles, Calif. 90051 C A D 2 < F u -- 34 1 n 39- -- 1) :1 Y --' 40 - - Kind D ut u Prid y -- - 41--4?•4;i -? 6- - -- Cr Amount I X� RReins. Co. Code Payment I TYPe of Loss 73-74 t Bur Cl. Cl. 15 Part — Sup.Lxp. - - 44 bo 55 - 57 5H - —5-5-010 0 3 I I 5 I I 6 ' 7 1 13 t I ' 9 ' I 10 ' t 11 I 12 Claim 1. If Claim Number is from One Entry or Regular Face Sheet with edition date prior to Number 12/70, type Claim Office Code from Face Sheet in Cols. 2-3 and Claire Number in Cols. 4 thru 9. Be certain last digit is typed in Shaded Col. 9. It Claim Number is less than six digits precede with zeros to make six digits. 2. If Claim Number is from One Entry or Regular Face Sheet with edition date f f • 12/70 or after, type Claim Number in Cols. 2 thru 8 and a dash in Col. 9. (Notice first two digits of Claim Number are Claim Office Code.) t To be completed when required in NO FAULT states. CLAIM FILE COPY WI-C 5546 ED. 1174 M. . z t;�t . i`t� _:-�- .}!'�` '�'i� �✓'' yt 4� � 11��. 51;•� 1 Y . _____ ��I � .. \. )l Ckm�'x��';5a .w,� „fir �� k ,C,•,.�y�,�a'�i ,,i �4 ��,�tl a C.1' yii' •1 _ - a R ��.�n ,L� � �"+�s rr �M�y� '-� ��1i � � /`�t 'Y: �� .�' ,�4t`p.�� .' / � _ tl•,al4n t. � f `$�' �; ,� � D�a++ �`� � �+ � tt, . MA i -4 % .� � - i.. /� � '.L, t�) �' � �'�^a►1� µtit �� _ b�?�'� sC. �fia,,y '��.,�Y � � �'�t /�j/ J 1^I !! 'Yq �i ��; L � ,��..41«.•,,. ak �C. s �i, ll;� 1'SY ,fir t •� �+• `C ,1 !`t` �iy� � 'I ... its tc . t' ,11 rA J Y�•�A ,�'t o 4i 1e1 I' 4 ti`1. ,�'i 'iiiip iy t `_ n i 1. 1 �S .I. .I ,I, •I CITY of EDMONDS 200 Dayton Street • Edmonds, Washington 98020 • Telephone (206) 775-2525 Department of Public Works . May 28, 1975 Ms. Darla M. Carpenter Recovery Examiner United Pacific/Reliance Insurance 2200 Sixth Avenue Denny Bldg. - Room 300 Seattle, Washington 98121 Dear Ms. Carpenter: Per your letter dated May 21, 1975, please find enclosed the necessary form used to file a claim with the City of Edmonds City Clerk's Office. As you are probably aware, this claim must be signed before a Notary Public or it will not be honored. If our office can be of further assistance, please feel free to contact us. Sincerely, JOHN B. MITCHELL Water/Sewer Supt. jt Enclosure st va o"'Yatvrn r%m vwt4tv4 va6d,.Aw I - :abessa� ar4EQ TcT1TL T :Cu • ! RECEIVED MAY 2 3 1975 UNITED PACIFIC/ REL I ANC E INSURANCE COMPANIES SEATTLE BRANCH: DENNY BLDG. • ROOM 300 • 2200-6TH AVENUE SEATTLE, WASHINGTON'98121 • AC 206-623-6080 May 21, 1975 City of Edmonds Department of Public Works Edmonds, Washington Re: Our Insured Robert Clare Date of Loss May 14, 1975 Gentlemen: This letter is to advise you we are the insurance carrier for the above named insured who sustained water damage to his dwelling and contents when a water pipe broke in the wall as the City of Edmonds was working on the water system. Under the provisions of our policy we are subrogated to the rights and interests of our insured and since our investigation discloses that liability rests with the City of Edmonds we are hereby making formal demand upon you for all monies we will be required to expend for the repair of our insured's damages. As of this date no payment has been made. Please send the necessary claim forms to our office in the stamped, self-addressed envelope provided, so we may file our claim. Thank you. DMC:jf Sincerely, UNITED PACIFIC INSURANCE COMPANY %o,q& rj� - Oate�r�tmj Darla M. Carpenter Recovery Examiner UNITED PACIFIC INSURANCE COMPANY UNITED PACIFIC LIFE INSURANCE COMPANY RELIANCE INSURANCE COMPANY from the date of Accident or Accrual. of Damages. TO Tim CITY COUNCIL OF THE CITY OF MMONDDARLA .SM CARPENTER, RECOVERY EXAMINER PLEASE TAKE NOTICE, THAT UNITED PACIFIC RELIANCE INSURANCE COMPANY - 1� (if married, give husband's name) _ WHO NOW RESIDES AT 2200 6TH AVENUE, SUITE #300, SEATTLE, WASHINGTON 98121_ (State present actual address by.street, number and city) AND WHO FOR SIX MONTHS PRIOR TO DATE OF ACCIDENT HAS RESIDED AT SAME AS ABOVE _ Give residence by street, number and city CLAIMS DAMAGES OF AND FROM THE CITY*OF EI)MONDS IN THE SUM OF UNDETERMINED AT. THIS TIME arising out of the following circumstances: Describe Claim, giving WATER DAMAGE TO INSURED'S RESIDENCE CAUSET3. DATE and TIME injury or damage occurred, PLACE; BY THE CITY OF EDMONDS WORKING ON SYSTEM IN and full particulars. Accurately locate and AREA.... SURGE IN PRESSURE BROKE PIPE IN HOUSLo. describe defects caus- = ing injury or damage INSURED: ROBERT CLARE - and all acts of negli- gence claimed. DATE: 5-14-75 TIME: APPROXIMATELY 9:00 A.M. Accurately describe injuries or damage UNABLE TO AT THIS TIME State items of damage claimed. Itemize all UNABLE TO AT THIS TIME expenses and losses. (Claim must be sworn to by claimant) k F'i Sig Q� eCl�m/n�t�F�zf1 C� v 'Z' :..: -RIBED AND SWOM T9_ before ate this day of tl Notary Public in and for t /State f ' /., t ► -' Washington, residing INFORMATION FOR FILING DAMAGE CLAIM No damages can be paid by the City of Edmonds unless a claim complying with the Laws of the State of Washington, and more particularly RCW 35.31.040 as amended, be pre- sented to the City Council and filed with the City Clerk within 120 days from the date such damages occur. This provision cannot be waived. (RCW 35•31.040) The pertinent sections of the applicable laws of the State of Washington are hereafter set forth relating to such filing. STATE LAVI RCW 35.31.040 - as amended "All claims for damages against noncharter cities and towns must be presented to the city or town council and filed with the city or town clerk within,one'hundred and twenty days from the date that the damage occurred or the injury was sustained: Provided, that if the claimant is incapacitated from verifying and filing his claim for damages within said time limitation,.or if the claimant is a minor, then the claim may be verified and presented on behalf of the claimant by any relative or*attorney or agent representing the injured person. No ordinance or resolution shall be passed allowing such claim or any part thereof, or appropriating any money or other property to pay or satisfy the same or any part thereof, until the claim has first been referred to the proper department or committee, nor until such department or committee has made its report to the council thereon pursuant to such* reference. All such claims for damages must accurately locate and describe the defect that caused the injury, reasonably describe the injury and state the time when it occurred, give the residence for'six months last past of claimant, contain the item of damages claimed and be sworn to by the claimant or a relative, attorney or. -agent of the claimant. No action shall be maintained against any such city or town for any claim for damages until the same has been presented to the council and sixty days have elapsed after such presentation." Outline of form for a claim is attached hereto for your convenience. CLAIM FOR DAMAG lury q RECEIVED rr 4 1975 . RECEIVEp NOTICE CI T Y OF hOMONDS JUN 5 1975 Claim MUST be presented to the City Council and filectvwith..tL ,ity...C' nxk,.w:ithin 120 days CITY CLERK from the date of Accident or Accrual of Damages. TO THE CITY COUNCIL OF THE CITY OF EDMONDS: DARLA M. CARPENTER, RECOVERY EXAMINER PLEASE TAKE NOTICE, THAT UNITED PACIFIC.R.ELIANCE INSURANCE COMPANY (if married, give husband's name) VIH0 NOIV RESIDES AT 2200 6TH AVENUE, SUITE #300, SEATTLE, WASHINGTON 98121 (State present actual addre4s by street, number and city AND WHO FOR SIX MONTHS PRIOR TO DATE OF ACCIDENT HAS RESIDED AT SAME AS ABOVE Give residence by street, number and city CLAIMS DAMAGES OF AND FROM THE CITY OF EDMONDS IN '1!HE SUM OF $ UNDETERMINED AT THIS TILE arising out of the following circumstances: Describe Claim, giving DATE and TIME injury or damage occurred, PLACE and full particulars. Accurately locate and describe defects caus- ing injury or damage and all acts of negli- gence claimed. Accurately describe injuries or damage State items of damage claimed. Itemize all expenses and losses. (Claim must be sworn to by claimant) WATER DAMAGE TO INSURED'S RESIDENCE CAUSED BY THE CITY OF EDMONDS WORKING ON SYSTEM IN AREA .... SURGE IN PRESSURE BROKE PIPE IN HOUSE. INSURED: ROBERT CLARE DATE: 5-14-75 TIME: APPROXIMATELY 9:00 A.M. UNABLE TO AT THIS TIME UNABLE, TO AT THIS TIME SSignatd. e/ f .Claim }t (,vet t � �Z;� , :L. RIBED AND SWI ORTO, 1 (J before me this day of ,19 S . '1 Notary Public in and for t ///State of llashington, residing at 0 Row City of Edmonds Permit No: D -DW�� RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: 101" aF C� A. Address or Vicinity of Construction: 10 3 1 T AVb V1 r VJ 6-7- B. Type of Work (be specific): RC P L A C%!�. M i; P R E C i A TE.. D aO L F S 4 T A/.s7-,Tl30"*6A/ P4r6E5*rA1. , ZoRX VD-1 D TRrMC/./ /N /?,/,/ A nl0 S E-r Pea E-r rA L A`d R 1401T T61 G 'J" 1 4 a Ts C. Contractor: �h/ O. C—O, roV O Contact: B 0,3 KA K A L E y Mailing Address: Z1618 Nt C q WA Y '7 /q Phone: 4Z 5 - (. ?d — 3 Z i¢ State License #: CD w d A/,D , tA/A 18C 24 Liability Insurance: ., Bond: $ City Business License #: D. Building Permit # (if applicable): Side Sewe'r`Permit # (if applicable): E. ❑ Commercial ❑ Subdivision ❑ City Project ❑ EUC (PUD, VERIZON, PSE, COMCAST, OVWSD) ❑ Multi -Family ❑ Single Family ❑ Other INSPECTOR: F. PAVEMENT CUT: ❑ YES ❑ No, ^ G. SIZE OF CUT X CONCRETE CUT: ❑ YES ❑ NO d G. ❑ Mail Approved Permit ❑ Call for Pickup p 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 ofits departments or employees, including but not limited to the defense of any legal proceedings including defense i costs and attorney fees by reason of granting this permit. 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. ♦ 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 asphalt or City - approved material prior to the end of the workday — NO EXCEPTIONS. ♦ 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 AVA�ILLABLE ON SITE AT ALL TIMES FOR INSPECTIONS Signature: /` �'` (60 Q *A L EY) Date: 1Z - 13 ' 04. (Contractor or Agent) -FOR:' ITY USE`ONLY i Approved by: _ Rlght of way Fee Time Authorized �'oid After % Disruption Fee/Fund 111 ' Special Conditions: 4,;In/ZF 40W- Tt' ), L/IkE A4nrn%2 :Inspection: Fee: � � S feJ. � = . j gz r res,Z Q-)nawmn" . AucA r 'AJr fiEr; ge n aCC Lt mTotal Fee i-00 C'At �t_/LnrUAIA,_I T/cTi6S,//AlNrAlpNoyT�/c? Nr♦rCrY— ,?dn ✓-1-f'3-%, . d I -111,T1. ^ -i&A AI^Al2%e : `- .. ,I!i _,f -A -4 REQUIRED INSPECTIONS: Call 425-771-0220, Ext. 13 FINAL APPROVAL•; OF;I RT ' A ry`I� !vim' :07' 7`tit.FKC QA ti i- Y� ' iF, N -r-kc L t- for a 24-hour voice-recor d i pection D WORK: c7K- InsD or's Signature �Wz request line. DATE: 611605 M, a,tA, C:\Documents and Settings\Curtis\My Documents\Fortns\Engnmg\ROWpe mit_ m Revised 10/01/03 0.1' (NW) OF PROP. LINE , CORNER POSITION � �A U \ J e �a $ y %9C'�� 000 r 4jJ r • ol RETAINING WALL FACE; i}o / 00'\` rA ` 0.6' (NW) OF PROP. LINE ` \ \�_s• 2 i 0 xon'�_ i EX CONC 00. F O�Fti (TYPICAL) I` m \ 9 IO2..B/ 'O Dig` F'Q p� \ s� o� OS/T SFT 9q p 0 yFp ?Js q96°9�' BUILDING CORNER; !FF L es?5 �- too 3� / ` OO 1.5' (NE) OF PROP" / v.`' o }�`°♦1 ♦02 FF ► ;/ F LINE �p0 °� o n�o ,Oy COe OFF . 0�5 04�� BGi 06'y�,F 0j) & + /AF ,50 99'+ / M1 �[y�c�J FO. ♦ 9 SllcFJ fyp �o O oyop �' *q0-• /� } }% FENCE END,(/�� 'OOSirFT o9 0 S/r0l 0, O� 2.3'(SE) OF / /+}, j �� y�� Ao o�`° ♦5 /O� a \ OSr �Q �C4 PROP. LINE / °, sg A' 7Y O �yi r♦os 9p/ / /Oti 4/ \ 0-1 v� tY e JJ / l • !p/ At c�5 0. \,n, 9�0.'` / �q qq/� \ q° .10 JJP?a't s?1 - 9 ��/ S/�O,yT ♦�GS 00 OJ PLO ♦G.t9 ♦♦�R b ;/ 00 t1 4 4 is.71v' <i EX. GRAVEL \ �aa rsaE� /(TYPICAL) ,`o FENCE LINE: 1. \ ` s� �0� /\ po pz,1 �•1 `F ` 1.3'(NW) OF C'% ! ♦� © q� t ti0' O 1 PROP. LINE o 9Sl "00 LS 0�Q f Y BENCHMARK SET P.K. NAIL o TOP 8/.14 EL.=100-00 O a Jzy o. ' o EX. WATERLINE (APPROX. LOCATION) t x,. i,�a� �/' EX. 1" IRON PIPE LOCATED / �\ '` "* 160 AT END FENCE LINE; OCT � Z �.�:;•: �; �!;:� �; �.`�;' A `O N 76'34'20" E, OJ9' FROM ('�4 U SET CORNER POSITION, � 0.38' (SE) OF PROP" LINE � EMIT m P R �\ ``� a'•-r�'"ud,.;: ;1 � COUNTER EX. SSMH / TOP 103.15 °o�s.00• \� INV 98-75 �� oJ / \` /sPELIy c IN S DATE RECEIVED j v ' f y, ,C PERMIT EXPIRES ZON , PERMIT _ 0 CITY OF EDMONDS ZONE NUMBER CONSTRUCTION PERMIT APPLICATION JOB sulTE/APT# ADDRESS D OWNER E/NAME j USINESS r L PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. MAILING ADDRESS LID FEE S 2 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved Rw Permit Required v Street Usa Permit Raq'd Sidewalk Required [3 CITY ZIP TELEPHONE EXISTING PROPOSED IoapecllonRequired 0 REQUIRED DEDICATION FT Underground ng O NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED l7 G/ YESX, NO ❑ z W ADDRESS REMARKS z z _ OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROODRAINAGE V CITY ZIP TELEPHONE r L� f _NAME a CBLk NGINEERING RtfMWED B DATE C ADDRESS �^' r 22 IRE REVIEWED BY DATE oIf . TELEPHON cnf� / M vJ:y/y !n A�(,J•(•� C VARIANCE OR CU SHORELINE OR ADBN INSPECTION . BOND STATE LICENSE NUMBER EXPIRATION DATE OFIEC` BY n RE 'D POSTED �� 'K�iPR�� OYES NO $ I D S"1 t I �� O SEPA REVIEW SIGN AREA HEIGHT a PROPERTY TAX ACCOUNT PARCEL NO. ry COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED J O S S` ® EXP / A5 / EW RESIDENTIAL LUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) kKNALLOWED jj PROPOSED FROIY SIDE/ REAR / FRONT / SID� REAR ❑ ADDITION COMMERCIAL COMPLIANCE OR❑ CHANGE OF USE 5 O" O`� �` `� O / �� `� �� z ❑ REMODEL ❑ MULTIFAMILY ❑ PARKING LOT AREA PG REVIEW D Y DATE / y a SIGN REO' PROVIDED O 0 izz f /�` / , ❑ REPAIR GR IN ❑ FENCE aj� CYDS ( X FT) fEMARKS DEMOLISH ❑ TANK OTHER ❑ py p e p A,�� C t GARAGE RETAINING WALL FIRE SPRINKLER ` r`�mf ~a� /` • ` ' LOT 1 "� `�/ 5rz ir, a� z ' ARPORT ❑ ROCKERY ❑ FIRE ALARM !� e l C (TYP OF USE.<U NESS OR CTVnY) PLAIN: 7 (T' �C C Ty CHECKED BY TYPE O STRUCTION' OCCUPA T 1 GROUP % GNUMBER NUMBER OF CRITICAL,:,/ OF DWELLING AREAS SPECIAIINSPECTION ARE OCCUPANT O STORIES' UNITS NUMBER �y REQUIRED Aq YES -� LOAD DESCRIBE WORK TO BE DONE �'' REMARKS _ Q PROGRESS INSPECTIONS PER UBC 108/ IBC109 / IRC109 FINAL INSPECTION REO'D 9 2_ a Z c f._ VALUATION l 0 Description FEE Description FEE ("1 Plan Check ��'r State Surcharge HEAT SOURCE GLAAZIINN +'�OT s Building Permit q G � City Surcharge -� J .�.± I- P N CHECK I�O', VESTED DATE_ :'. g j) v Base Fee O� Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 7 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading SEPARATE PERMISSION. Engr. Review a PERMIT LIMIT. 1 YEAR APPLICATION: 180 DAYS AR • PROVIDED WORK IS STARTED WITHIN 180 DAYS. Engr. Inspection DD . SEE BACK OF PINK PERMIT FOR MORE INFORMATION y 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE 9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due = NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Recording Fee Receipt # CIL. GIVEN ES CORRECT; AND THAT ACKNOWLEDGE THAT I AM THE OWNER, OR HAVE READ THIS APPLTHETDU Y AUTHOR Z DFAGENTICAION; TT THE IOF ON APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is nota permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION recelptisacknowledgedinspaceprovided. WORKMEN'S COMPENSATION NSURANCE AND RCW 18.27. O�Fflcl SIG NJ DATE VATURN A4 DATE SI D% 5Oa 71-0220ON EXT 1333LTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL INSPECTION HAS BEEN MADE AND PINK: APPROVAL ORACERTIFICATE OFOCCU- oRlcl 440, NL-ER YELLINS -ASSESSOR ECTOR PANCY HAS BEEN GRANTED. UBC109 / IBC110/ IRC110, G° 09/03 r%e+�e+r► a e w �� vi►a 1 w Me- u w vue� w �i►raa��► .S DATE RECEIVED PERMIT EXPIRES CITY OF EDMONDS USE PERMIT ZONE NUMBER- JOB 111TE111ADDRESS CONSTRUCTION PERMIT APPLICATION OWNER NAMEMAME OF BUSINESS _Momaj PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. 9, N, c LID FEE MAILING ADDRESS uW j z 3: �fe, K. "1 )- () PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved Rw Permit Required 13 0 Q E)ATINPR JNSP��OIP[OqVb RE UIRED Street Use Permit Req'd E3 inspection Required E3 CITY zip SO I TELEPHONE 7- -)-/- 7 S & REQUIR&MEMI (JF (IJIF CLFALNpn (-JE ED Sidewalk Required E3 ground ... - .J__ -DO g required 13 NAME MIWER SibE JEWIfl2ft ft cCAMW A r PRV REQUIRED — PROPE#tTY LINE YES 0 NO ❑ Ix i.. ADDRESS R 0 R%/fAFEflbRME0MIfflD FSEEMMORMCC&LAINAGE W z z 47 a Air E IN3TALLED HU311 1:511:11 WI-1-11111 J%VD z uA CITY ZIP TELEPHONE 7E DUMP AT APPROV111D.UUMP 3175 ONJUT NAME NOLA-W � CBL # bEE L)EMOLITION INSPELMOR 0 CHPrxi_isT om RArx op Ing CARn ENGINEE ft&Effi9Rft0N REQUIREMENTS DATE ADDRESS 4 CC 0 FIRE REVIEWED BY DATE CITY, ZIP �AWDWUI Uc- W7A TELEPHONE 4,25q� D-) 7 0 u. VARIANCE OR cu SHORELINE ORADB# REO'D INSPECTION 1$ BOND POSTED STATE LICENSE NUMBER EXPIRATION DATE /Dl_ k:�59 (�SEPA I OYES 13AONORYUC! REVIEW COMPLETE EXEMPT SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED PROPOSED Rj PROPERTY TAX ACCOUNT PARCEL NO. 005qS 1 -0 00- 0 03 —0;1. I EXP 0 ❑ NEW RESIDENTIAL ❑ PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR ❑COMPL ANCE OR COMMERCIAL ADDITION ❑OF USE CHANGE z z PARKING REQ'D PROVIDED I LOT AREA PLANNING REVIEWED BY DATE REMODEL MULTIFAMILY ❑ SIGN GRADING FENCE ❑ REPAIR 0 CYDS 1:1 ( X FT) I — W/O, 1b4 REMARKS OTHER ><DEMOLISH E] TANK 1:1 ftlAk 2- 676 Igh Z^A-1-1g,-P GARAGE RETAINING WALL Ei FIRE SPRINKLER ❑ Mr ti5 t2c• O CARPORT ROCKERY F RE ALARM (17YPE OF USE, -{BUSINESS OR ACTIVITY) EXPLAIN: komv tfw & CHECKED13Y CONSTRUCTION OCCUPA JTYPE� P GROUP NUMBER NUMBER OF CRITICAL uj SPECIAL INSPECTION �AREA. OCCUPANT '3 W OF OF DWELLING AREAS 0 STORIESUNITS --- NUMBER REQUIRED [:] YES LOAD DESCRIBE WORK TO BE DONE REMARKS PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REO'D (IL, V1 IPLV VALUATION . $ Description FEE Description FEE Plan Check State Surcharge SOURCEHEAT GLAZING % LOT SLOPE % Building Permit IH5 City Surcharge 15 PLAN CHECK NO: Olt ckrc) VESTED DATE Plumbing Base Fee I Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading 3 j DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE 1: SEPARATE PERMISSION. 2 Engr. Review PERMIT APPLICATION: ISO DAYS d-1 PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection f-5 SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF 2 EDMONDS, WASHINGTON ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT- ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due 0 NOR LIMIT IN ANY WAY THE CITY ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt # I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- I This application is not a permit until signed by the CALL TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. SIGNATUR(e_DATE SIG '%NE R AG ND NED /f OFFIcIALS SIGryATURE DATE (425) 771-0220 hELiA§tb fiY_ DATE ATTENTION ATTENTION M 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL -FILE - YELLOW - INSPECTOR PINK -OWNER - GOLD - ASSESSOR 09/03 PRESS HARD -YOU ARE MAKING 4 COPIES 0.1' (NW) OFnPROP.�LINE CORNEVPOSITION \ % F on i J a �9q' 4� qO . �c \ ° Q, �^ � o �' S� •9T '9� \ J 2s0 qj gq6 O+ J RETAINING WALL FACE; -_ 1- f °00• 0.6' (NW) OF PROP. LINE 0 . .hh / EX. CONC..qqs 9G�� q \ \N �2SoF,�,cF 'J (TYPICAL) p/�G� o \ % OS•'yc'F \ gg01. ' �G lob m + J oo'P,��:gF co,P / \ * 1 ^ I'd\ q96°q�'� �(f 6S / BUILDING CORNER; tide+qs�j / 1.5' (NE) OF PROP. LINE Sr,, Pp,e tic ,r .T9 �,o a / �� `� - o o- .yam C e 0� ��Fo°ptiFR. GAF �� r J� h o o a o °QYFkJ F1O. A SFT cOJ ti� Q S�sS 01 4Q0 'q�_ / / } �:- / / 9' qy� 6,TFT o°� c Qy O r A FENCE END; / / O 1jp O \ \� FQ o�SJ °� Po 2.3'(SE) OF / / ,' L / P� 7�a�i`.° 0 A" �� G�' PROP. LINE / eePPjj �'` `t•o `° �o�� 9 \ OTAI'L a 4 CO3 p/L0 \ / of5 'Ile OF�E.. QFJ C \ ./ A \\�/, 90�,`60 os/TSFT \'@ �;,,: � �!„ �iq0�. / s6 O Qo c' P O � q► he �q a +/ GRAVEL `cp (TYPICAL) "*� FENCE LINE; 1 F� ` 1.3'(NW) OF ` GJ PROP. LINE o �OO,Q LS�c. ap ` / ash §61 F `Q `V BENCHMARK SET P.K. NAIL o ' ,, a` 00• OOP 87.14 \ n EX. WATERLINE i$'�-' d!,., �r�•,'-TM..� \ O\i (APPROX. LOCATION) ea EX ENDRFON PIPE LOCATED OCT N 76'34'20" E, 0.79' FROM 94:RELT / IN,3 Wiz.. c SET CORNER POSITION, Q` P ^r x: � 038' (SE) OF PROP. LINE FILE ERMIT �:`';� `. COUNTS EX. SS TOP 103.15 Ap SO0 INV 98.75\\ (uJ IN, / \ I iCOPY IN S 0 RECEIVED / CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNEP NAME/NAME OF BUSINESS- J Gf�_.G{j Q . IVI' chGL ((\ MAILING ADDRESS_ q �% ":s CITY / ZI TELEPHONE NAME 1 J IJ14 ADDRESS CITY ZIP ITELEPHONE NAME El ADDRESS UbW 100 STATE LICENSE NUMBER n CBL # CHECKED BY )1101,1 _ sl{NT PROPERTY AX ,s 0 KO— r 3— Q� l v VV ❑ NEW RESIDENTIAL ❑ PLUMBING / MECH ❑ ADDITION ❑ COMMERCIAL ❑ COMPLIANCE OR CHANGE OF USE REMODEL ❑ MULTIFAMILY ❑ SIGN GRADING FENCE ❑ REPAIR ❑ CYDS ❑ ( X FT, ❑ DEMOLISH ❑ TANK ❑ OTHER _ GARAGE ❑ CAR ORT ❑ ROCKERYRETAININ; WALL ❑ FIRE ALARIRNKLER C (TYPE OF USE. ONINACTIVITY) ��' I NUMBER NUMBER OF' CRITICAL OF DWELLING AREAS STORIES UNITS NUMBER �- DESCRIBE WORK TO BE DONE j p (�� Uc I �r ; (na c? �c I 0 f� �7P_.' In p EkrsTj �#I-\ lrc,Ih �c c) - i 1-t PERMIT EXPIRES, U E PERMIT / ) ZONE NUMBERJOB ADDRESS i A sl I PLAT NAME/SUBDMSION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved RW Perma RaWked Street Use PermN Req'd EXISTING PROPOSED inspection Required g sidewalk Required REQUIRED DEDICATION FT Urrdergrowd Wlringrequired Q METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED (7 YESI3 NO E3 _ REMARKS Z OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE DATE FIRE REVIEWED BY DATE VARIANCE OR CU SHORELINE OR ADB# BOND EQ'D I.I.NSPECTION POSTED ❑NO $ SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED ✓ O • • G EXP LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REARAll 17 359, � Z 5 o N�. PARKING LOT AREA PLANNING REVIEWED BY DATE d REQ'D PROVIDED Z. too `5—/ 2 REMARKS `` X— * /.r SKr u A.- A_ 1a4-7-9 CHECKED BY TYPE OF CONSTRU ION CODE OCCUPANT- GROUP SPECIAL INSPECTION OCCUPANT REQUIRED ❑YES JAREA LOAD REMARKS _ PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 9 /� 1 s �,1 r c f N1v�l/ PG (;. ( I l Cry t I (!G Il ✓ C4 ( VALUATION � T44C/C LOA/ Description FEE Description FEE 1 .. Plan Check — State Surcharge Sd HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK N , / VESTED DATE Plumbing 0 Base Fee 7)0 Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CON$TRUCTIQN ON THE PUBLIC.. DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT APPLICATION: 180 DAYS PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION Grading g Engr. Review Engr. Inspection 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit " IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Fire Inspection Receipt # Jal�_ Landscape Insp. Total Amt. Due F C0 FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WANAN E OR REDUCE ANY REQUIREMENT OF Y CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITIPS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt # ,I �f 21 HEREBY ACKNOWLEDGE THAT I HAVE RD THIS ALICATION; THAT THE GIVEN IS CORRECT; AND THAT I AM THE OW ER, OR THE DULY AUTHORIZED AGENTTION OF APPLICATION APPROVAL THE OWNER. 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. CALL FOR INSPECTION This application is not a permit until signed by the Building Official or his/her Deputy: and Fees are paid, and receipt Is acknowledged in space provided. OFFICIALS SIGNATURE 7PE SIG RE E R . E 9 DATE SIGNED 1AID z(� - �i 1.��GG `�'�/ 771-0220 Y PATE ATTENTION EXT 1333 G j IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 6U j A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- SPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 oPINK -O OWNFILEER YELLOW ASSESSOR PINK -OWNER GOLD -ASSESSOR I 09/03 PRESS HARD -YOU ARE MAKING 4 COPIES RECEIVED !2� CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION R NAMEMAME OF By�I►� SS 6 M n C__1 IvI �1«ISM M 12() V, CW-C, Z)I CITY ZIP TELEPHONE l --A r,,, �,r, �l c 0 S I r7 A_n c� NAME ADDRESS CITY ZIP CBL L, lip o Uc h r1 c)i ��D TO L I TELEPHONE 8� • C NUMBER E7 'ROPERTY TAX ACCOUNT PAfICEL NO. ❑ NEW RESIDENTIAL ❑ ADDITION ❑ COMMERCIAL ❑ REMODEL ❑ MULTIFAMILY ❑ REPAIR ❑ GRADING CYDS DEMOLISH ❑ TANK ❑GARAGE RETAINING WALL ❑ CARPORT ROCKERY (TYPE OF USE, BUSI IESS OR ACTIVITY) EXPLAIN: NUMBER OF NUMBER OF DWELLING 7� ) STORIES UNITS (� DESCRIBE WORK TO BE DONE PERMIT D(PIRES USE PERMIT ZONE S I NUMBER JOB S U APTADDRESS 1031 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE S PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approvee RW pe,tr,d Requtred Street Use on fieq'A EXISTING PROPOSED Irmtllon Required G Sidewalk Rewired p REQUIRED DEDICATION FT UrKbramnd Wiring required 0 METER SIZE LINE SIZE NO. OF FIXTURES . PRV REQUIRED I I C7 YES 13 NO E3 z REMARKS z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE ENGINEERING REVIEWED FIRE REVIEWED BY DATE I W dt TION DATE CHECKED BY VARIANCE OR CU SHORELINE OR ADSN I INSPECTION REO'D,� I BOND POSTED -• "�� DYES LYNO $ - $EPA REVIEW COMPLETE EXEMPT EXP SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED I PROPOSED 2, ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FE) PROPOSED SETBACKS (Fr.) ❑COMPLIANCE OR CHANGE OF USE ALLOWED PROPOSED N� FRONT SIDE REAR FRONT UR SIDE REAR &A o 'z PARKING REQ'D PROVIDED LOT AREA PLANNING REVIEWED BY DATE ❑ SIGN rL FENCE ❑ ( X Fr) NA M I ,{�- F/ C4-1- ' REMARKS ❑ OTHER ❑FIRE SPRINKLER FIRE ALARM CHECKED BY TYPE QYSTRUCMDN COPE OCCUPANT 'I GROUP CRITICAL AREAS SPECIAL INSPECTION rEfA OCCUPANT NUMBER REQUIRED YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 9 m A'Irff A VALUATION Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Base Fee Mechanical THIS PERMIT AUTHORDMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Grading g BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 180 DAYS Engr. Inspection PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION 'APPLICANT; ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF Fire Inspection Receipt # EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY 1 FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landsca a Ins P P• Total Amt. Due -75 NOR LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt # `�. 2 351 1 HEREBY ACKNOWLEDGE THAT I HAVE ON GIVEN IS CORRECT., AND THAT I AM THE Ow ER, OR THE TDU Y AUTHORIZED AGENTION; THAT THE OFAPPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKIMENtS&MMILNISATION INSURANCE AND RCW 18.27. CALL FOR INSPECTION This application is not a permit until signed by the Building Official or his/her Deputy: and Fees are paid, and receipt is acknowledged in space provided. OFFICIALS SIG DA E NATURE �. / (425) 771-0220 _.... BIGNA OWN AGENT) j / DATE SIGNED` - '".: V = E BY A E ATTENTION EXT 1333 C % IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL" A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR 09/03 PRESS HARD -YOU ARE MAKING 4 COPIES RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNEERRrNAAME/NAME OF BUSINESS MAILING ADDRESS quo 8 i, A+*" SU CITY ZIP TELEPHONE t d vv,,c,rk Lvn Cf, cGdU L 2&1-7,(--7813 NAME NIA ADDRESS CITY ZIP ITELEPHONE NAME . 11A /) .. ` iv _ Ic%q ADDRESS t,/ 1 _ Plot TELEPHONE � U I Vo STATE LICENSE NUMBER �I \ \� EXPOD�/4'I ATE I CHECKED BY c-� l� III PROPEI IUNT P CEL NO. o as 0- U �3-0 ❑ NEW RESIDENTIAL ❑ PLUMBING /MECH ❑ ADDITION ❑ COMMERCIAL ❑ COMPLIANCE OR CHANGE OF USE ❑ REMODEL ❑ MULTIFAMILY ❑ SIGN ❑ REPAIR GRADING FENCE ❑ CYDS ❑ ( X FT) DEMOLISH ❑ TANK ❑ OTHER E RETAININGWALL ❑ ❑ ❑ CARPORT ROCKERY FIRE ALARMKLER (TYPE OF USE, BUSI�SS OR ACTIVITY) EXPLAIN: C •NUMBER NUMBER OF CRITICAL/l wG'W cq OF DWELLING /% AREAS O STORIES UNITS / ✓ NUMBER DESCRIBE WORK TO BE DONE Pao �� . 'I 03 - �{w s� v�E�� (}�Ma c-� ^{yob,s1, or\ STPe rsidvcF o ivI ,P*n-v Ct�- Sj'r LA C-(k Aff. ;7,�','LSo I h0 �19 1n IasiMtel� as �nartl�ot(llry c '1 . w PERMIT EXPIRES ZONE �C % PERMIT JOB ADDRESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ RIGHT OF WAY PER OFFICIAL STREET MAP • - TIEPUBLIC RW PeCIP Approved RW PermRequired , Street Use: Perm: Req'd EXISTING PROPOSED Iaepection Rq" ked g Sidewalk Required REQUIRED DEDICATION FT underground Wiring required 13 METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 17 NO E3 REMARKS / z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE FIRE REVIEWED BY DATE I Q VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND RE.' I POSTED I 13YES LIM $ — SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP I 0 i A LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR a NA NA z z PARKING LOT AREA PLANNING REVIEWED BY DATE REO'D n At I N� IL Qt� ° W 5/25A4 REMARKS CHECKED BY ITYPE SPECIAL INSPECTION jAR /SN REQUIRED ❑ I YES REMARKS PROGRESS INSPECTIONS PER 1_N1lrV_1r) 0 (on I I') Ucr r" wluld D Description Plan Check HEAT SOURC' GLAZING % LOT SLOPE % Building Permit PLAN CHECK NO: VESTED DATE Plumbing Mechanical, THIS PERMIT AUTHORS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE g SEPARATE PERMISSION. Engr. Review PERMIT APPLICATION: 180 DAYS PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION FEE 'ODE OCCUPANT GROUP OCCUPANT a LOAD INSPECTION REQ D I m' Description State Surcharge City Surcharge Base Fee FEE 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS -AND SUCCESORS Fire Review Plan Chk. Deposit +� IN INTEREST' AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF i EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt # ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY 9 FROM THE ISSUANCE OF THIS PERMIL ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Land a InS scaP P• Total Amt. Due = NOR LIMIT IN ANY WAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt # 2Lj 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECT, AND THAT 1 AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- TION;.AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEMS CO TION INSURANCE AND RCW 18.27. SIGN/A�TUR (OWNER 0 AIGra]AA 1D1AATE SIGNED `W APPLICATION APPROVAL CALL This application is not a permit until signed by the FOR INSPECTION Building Official or his/her Deputy: and Fees are paid, and receipt Is acknowledged in space provided. OFFICIALS SIGNATURE DAYE 1512flal (425) 771-0220 L D E ATTENTION EXT 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE Y OJV•IN PECTOR CATS OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 1119 PINK OWNER GOLD -ASSESSOR 09/03 PRESS HARD -YOU ARE MAKING 4 COPIES LE PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY LOCATION 1030 / 1031 Grandview St Edmonds. WA 98020 South County AREA POLE NO. SE 1/4S 13 T 27 R 03 DATE 11/23/04 W.Q. NO. 343821 REASON FOR WORK Replace depreciated pole ENGINEER Kakaley TASK 343929 and provide UG power DRAFTER U.G. NO. for- Norkri (2 lots - gas) scALE nts DATE WORK COMPLETED APPROVED & DATE PRINTED FOREMAN FEES REQ'D ■ YES ❑ NO PRIMARY OVERHEAD ❑ RESIDENTIAL ❑ COMMERCIAL LEO NO. SECONDARY OVERHEAD BASIC FEE f METER/CONV. POLE f PRIMARY UNDERGROUND ❑ RESIDENTIAL ❑ COMMERCIAL BASIC FEE f LEU NO. SECONDARY UNDERGROUND BASIC FEE f UNDERGROUND PLAT BASIC FEE S q- FT.0 ' '=$ STREET LIGHTING q- FT.0 '=$ WORK IN RIGHT OF WAY ❑ PRIMARY ❑ SECONDARY q FT.@$ MISCELLANEOUS FEES VAULT f PERMIT f f f f TOTAL DUE f DATE PAID RECEPT NO. NEW SVCE APPLICATION NO. LEGEND: o EXISTING POLE X EXISTING POLE -TO BE REMOVED • NEW POLE X NEW POLE TO REPLACE EXISTING ENVIRONMENTAL ANALYSIS ■ EXEMPT ❑ NOT EXEMPT PARA. 18 ITEM C O.H. U.G. COND. KV ADD CKT. FT. PH REM CKT. FT. PH NET CKT. FT. O.H. U.G. COND. KV ADD CKT. FT. PH REM CKT. FT. PH NET CKT. FT. PERMITS (DATE GRANTED) ❑ TREE TRIM ❑ STATE ❑ COUNTY ■ CITY EASEMENTS ❑ REQUIRED ■ NOT REQUIRED DATE RELEASED FOREIGN CONTRACTS ■ VERIZON JPN NO. ■ CATV JPN NO. ❑ JOINT TRENCH VERIZON & CATV ❑ JOINT BORE VERIZON & CATV POLE STENCILING FROM TO TAKE OFF POLE PRE-CONST. REQUIRMENTS ❑ TREE TRIM ❑ PUD LOCATOR ❑ BACKHOE ■ FLAGGING ■ ONE CALL DATE No. on form READY PHASING GIs WORKING POLE/ XFMR DMS FINISHED 1 LINE JOINT USE LOCATION MAP PAGE 454G-4 POLE DATE SUBSTATION -_ MopleWood CIRCUIT NO._12-345 PHASE 2.3 ENGR'S TEL. 425-670-3214 n� ENGR'S PAGER 425-787-7523 new schematic 75 15 2 3 blow-up of area P �S 9hL w.o. x 343821-03 A -A Set 45' pole 4' W of depreciated pole and frame per Const. Standards 12F201 and 12FG02 Hang new 3-phase 120/240V Dist # 75- Dist # 15- Voltage open delta xf.mr bank Ser. # Ser # per Const. Standard 4-13-7.0 w.o. # 343929-06 OInstall 4" sec riser on new pole and set large ped(VO104) near base of old pole Run - 45' of 350kcm Al quad-plex to feed new ped Intercept and re-route (2) sec risers into new ped From new ped, bore 20' road, trench 65' W to staked ped location, and install 85' of 3" PVC(total) from ped to ped (THIS WORK DONE BY PUD CONTRACTOR on task 05) .Run - 100' of 350kcm Al triplex from ped to ped W.O. # 343821-03 ORmv 120/240V open delta xfmr bank Dist # 75 - 2400 Ser # Dist # 10 - 1518 Ser # Transfer primary, neutral, (1) OH svc to new pole Strip -top -abandon dep. pole to Verizon/Comcast P \ B 1030 HANG RMV 4 P 75- 15- jl, e 1306 4-6 1300-M o+ v A3 SITE PLNN 'LOT 3, r,a, Y L-OR TRAICTs cirY c» 1^vmoNT7s S NO 14 O M 15 rt CO,, WA. 5 SCAX„E : 1"= 20 -O -� k Cm /t-Ad.�O/3//ze0, /1/�-�a✓��Ar�w� ,6�t�/oar .¢yd.��d \j L APPROVED BY PLANNING CITY COPY � z��✓ Si2SrUq- TOM SUE N.IC HOLSON AVE 5, ETJMON%)5,WfA., 78020 ,V25- 771-- 7873 RECEIVED MAY 17 2004 PERMIT COUNTER <5�cplaA4 RECEIVED MAY 17 2004 PERMIT COUNTER copy r �� SITE PLAN LOT 3, iAY.L-OR T► &CTS cl rY C>r FV M O NT7S Qs •o ��c s SCA, QE ; 1"= 20`-O �F i4e, Ctir �A 0�401 3/rZ�if t .q APPROVED BY PLANNING �T� EF--T BILE TOM � SUE NICHOLSON 920 - 8"-'AVE S, GDMONAS,WA., 98020 All S- 771- 7873 RECEIVED MAY 17 2004 PERMIT COUNTER 0 t 'S t Oz �-18 z �0316,'arti{Ul�c� S'' +C- Tfa4q, RECEIVED MAY 17 2004 PERMIT COUNTER Z ..jz fm� LEGAL DESCRIPTION LOT 3, TAYLOR TRACTS, ACCORDING TO THE PLAT THEREOF RECORDED IN VOLUME 120 OF PLATS, PAGE 91, RECORDS OF SNOHOMISH COUNTY, WASHINGTON. SUBJECT TO EASEMENTS, RESTRICTIONS AND RESERVATIONS OF RECORD. 61 ?�1S/s O Oq /` 6 qkd g6FENCE LINE; 00,• RETAINING WALL FACE; 1.0' (NE) OF SET 0.1' (NW) OF PROP. LINE + CORNER POSITION �60) rn / gg' `„A 5t3O 0L 7�i"� O°. 4� 60 4 RETAINING WALL FACE; � ,I•yo % 00,\ +/P% O � ?, 0.6' (NW) OF PROP. g \ 6 �` ? LINE � , \ r1 /y ??. '00, O O,� EX. CONC 00, J 10Z A 0x- \ F� OS/ 115 6s / BUILDING CORNER; 1003s / Op• 1.5' (NE) OF PROP. k �,o`' 30 LINE o o 00 `ory' / t�,�'c ��,a row F'f "�� ggat,* / ,`P GO / Cgh? °� ^ o / F.pAO,�,• o tiC '—FENCE END; / ��' �O 'd O, o ON + + 2.3'(SE) OF / QJ �O PROP. LINE / SON �� .`pry , �3g � °o 9�SG/C / �� ,0 33 c s piy 00 / / / S O fig'°� c�?�'O °��F,PF� 0c !4'�r JK 60, o O ry0 _�� + S/170 �jSF� O J/ ,00 h6 d g tK*OZg� a h+ / rnosrk.'. \ I`EX. GRAVEL _- �°° Q!, (TYPICAL) FENCE LINE; L 0O v p0 j �2 /4y F} L 1.3'(NW) OF Q ypr w 0I\ ' PROP. LINE o Zi / FCC r R S N000 l `C— \ �9 �. s o _BENCHMARK \ `�� " �a�4,,E� *, ?s 7 �o SET P.K. NAIL \ o�n,,; '" �,'00. TOP 87.14 EL.=100.00 `O^y?� % 4 V \ year �a t a7u J st ,Y �uT V o N. �/ --- EX. 1 IRON PIPE LOCATED r M X 6� AT END FENCE LINE; N 76'34'20" E, 0.79' FROM SET CORNER N POSITION, 0.38(SE) OF PROP. LINE / All EX. SSMH \ �� M., ��, •�' ,�� \ TOP 103.15 Ap `SO INV 98.75 O \ \DRF1 IMINAR) 'OF" PLANSTHESE NFINAL S 0 REIVI I S 10,11 T. EX. WATERL (APPROX. L BASIS OF BEARINGS N 51'26'00" W. AS MEASURED ALONG THE MONUMENTEDI; CENTERLINE OF EUCLID AVENUE ACCORDING TO PLAT OF' LUND'S ADDITION, FILED UNDER VOLUME 46 OF PLATS, PAGES 231 AND 232, RECORDS OF SNOHOMISH COUNTY, WASHINGTON. LEGEND 0 EX. 4"X4" CONCRETE MONUMENT IN CASING WITH 2" BRASS CAP MARKED WITH "X" 1® SET 1/2" X 24" REBAR & CAP STAMPED "LSA 22969" (LA) COURSE AND/OR DISTANCE PER LUND'S ADDITION (VOL. 46, PAGES 231-232) (P) COURSE AND/OR DISTANCE PER TALOR TRACTS (VOL. - 120, PAGE 91) " (M) COURSE AND/OR DISTANCE MEASURED PER THIS SURVEY BENCHMARK AND DATUM BENCHMARK: EL=100.00 SET P.K. NAIL APPROXIMATELY 31.4' (SE) OF MOST SOUTHWESTLY PROPERTY CORNER, 2.7' (SW) OF EDGE OF PAVEMENT. DATUM: ASSUMED NOTES 1. THE LOCATION OF UNDERGROUND UTILITIES SHOWN HEREON ARE APPROXIMATE ONLY AND DO NOT REFLECT ,THE LOCATION OF ALL UTILITIES ON OR IN THE VICINITY OF THE SUBJECT PROPERTY. THE OWNER SHOULD.CONTACT ALL . UTILITY PURVEYORS IN THE AREA TO ASCERTAIN THE LOCATION AND DEPTH OF ALL UTILITIES. 2. THIS MAP DOES NOT PURPORT ALL PROPERTY IMPROVEMENTS. BOUNDARY & TOPOGRAPHY: SURVEY _FOR TOM IN SW1 /49 SE1 /4, SECTION 13,, T.27 N., R.3 E., W.M. CITY OF EDMONDS SNOHOMISH COUNTY, WASHINGTON' Lovell—Sauerland & Associates, Inc. Engineers/Surveyors/Planners/Development Consultants 19400 33rd Avenue . W., Suite . 209 • Lynnwood, WA 98036 • (425)775-1591 • (425)672-7998 fax L I;A� s 10-15-o6 DRAWN, CHECKED DATE F.B. ` SCALE F'U NO. J.K.B. J.T,T. 4-14-04 - 478,.PG. 49 1" = 20' 4629-0--04`.