1045 DALEY ST.PDFiiiiiiiiiiiiii
10724
1045 DALEY ST
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER: 00`f ':�$+Zf)-t V
BUILDING PERMIT (NEW STRUCTURE): jcy57 m C a FA
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: 9 r,—H I (p DETERMINATION: ❑ Conditional Waiver ❑ Study Required Eywaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA'
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER): ftq D ( `ice-Y-wT"� I CI , I` ta,.��S�
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATECbLO i-S r
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LOT: - 7ekBLOCK:
LATEMP\DST's\Forms\Street File Checklist.doc
• CAOE NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: (b L45
2. Property Tax Account Number:Z
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? Ryes; no. c.
•
If yes; how is site developed?`
5. Describe the general site topography. Check all that apply.
XFlat- 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: 46ZO ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway LO floodplain N O of a water course.
N
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? ,f/00 Flows are seasonal? IVO (What time of year? IV aME ).
0
10. Site is primarily: forested ; meadow .;shrubs ; mixed ;
urban landscaped (lawn,shrubs etc)_ .
11. Obvious wetland is present on site: /V 4
Rcvo1roasa
•
<a, S
�8 9 0 1914
City of Edmonds..,.
Criti...,.A.- reas...'... --hecklist
: ,,• ., _-
-
The Critical Areas Checklist contained on.',. and -submit it to -the City. The Citywill
this form is to be filled out by any person ,
review the checklist, ;make a precursory site .
preparing a Development'Permit ' .
:..visit, and malm a'det 'rmination of the
Application for the City of Edmonds prior
subsequent steps necessary to complete a
to his/her submittal of a development'• '
":`-development.permit application.
permit to the City.
With a signed copy of this form, the
The purpose of the Checklist is to enable; -
_ `applicant should also submit a vicinity map
City staff to determine whether any
or plot plan for individual lots of the parcel
potential Critical Areas are or may be _
with enough detail that City staff can find
present on the subject property. The-.
and identify the subject parcel(s). In
-" -' information -needed -to complete the __-"-
addition, the applicant shall include
Checklist should be, easily available fromJ_'&_.- .._.:
''other -pertinent information (e.g. site'
observations of the site or data available at
plan, topography map, etc.) or studies in
City Hall (Critical Areas inventories, maps, ,
conjunction with this Checklist to assist
or soil surveys):
staff in completing their preli ninary
assessment of the site
An applicant; or his/her representative,
must fill out the checklist, sign and date it,
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant: Applicant Representative: 1
Name Name
Street Address Street Address
UA- 77 4,
City, State, ZIP Phone City, State, ZIP Phone
Signature - ... - Date re--___ :..... Date
APPLICATION
for
The City of Edmonds SIDE SEWER PERMT EASEMENT No ..........................................
NEW CONSTRUCTION ❑ REPAIRS ❑
118-04450
OWNER01......................................................dtl......................................... CONTRACTOR.................._............-----.............._....-----...._................---.............. PERMIT No.......................
ADDRESS....... 10.4.5... Daley ...S.t................................................................
•
0
0
0
LEGAL DESCRIPTION: LOT No .............................................. BLOCK No. ----•---............_......._......-----....
NAMEOF ADDITION.......-•....................................................••--.._........._............................._..........._.............._..
Dye Tested On Sewer 1972
Approved:
DATE................................................ By .......
T1
e4 z ����' t ?pj•k�:.
•
J �i
•
sr+
CITY OF EDMONDS, WASH114GTOZI
BUILDING PERMIT
inf hireby=certifies. that a plot, plan, drawings, and sufficient details to indicate
mtion-to fulfill all requirements of this code are attached hereto.
Ition is hereby made for permit to do the following work: +�^ / _ _
= -- -............. ...... ................. . G
This Space Is. For
City inspector Only
i
�r _..._........... ................. ....... ............................. _.... _.... _.._.....
�.
c t .Lot ._ ..................•-•................_....._...... Block.. ..................
4
4.
..................:o> /t.x.............
..........I..
1: Building din._nsicns ...... _..._......_fa. 3 y.............
• � ' ' '2. Lot dimensions ...... ........./...0.�....x....... e�/ o..: .........
3. Building will be ...._--.--_?..........
4: Basement ------._yA'
t e. Occupancy of building will be ................ ......... ..----------- •------------- ••------•-----•--------------
G, ------------ ll..... f from the nearer lolnin me.
7. Owner:.- � ....-......_..------.... .....
�:
8. Owners Add?....... :......
�re.....................9. Builder.:............._.......... ..........---..._._....._............................_
.......................10. Builder's .:.. y/.. .... <........
..........................................................................__........_..,..........
a ^
Date,... 19...
A L�tn/
--•--(Owner or his agent)';
Permission is hereby granted to do the work described hereon, according to the approved plan and specifications pertafaing hereon
subject to compliance with the ordinances of the City of Edmonds.
Estimated cost $41D D iJ ``•'r
Life of permit...........-.
s.............................. -----
due R :clued
4 �T s� date ','(^/j�s,/i'/`//;�;
PEPERMIT 1�1 U sets .. r suit—OSca) . --• '� ,
Plans filed: Yes D No ❑ Department of uildings !
City of Edmonds
I. The building permit fee which applicant pays when permit is issued shall he based on estimated case of the proposed uructum,-u the rate of.S2.00 for each
$I000.00 of cost. 11' the actual cast of the smante, when finally determined, excerds the estimated cost by to than 3ia, applicant aszees to pay,an sdelitioaal Ea
of $7.00 for each $1000.00 of such excess cast. '
2, Whenever a contract for construction is executed for any structure costing more than $1000.00 for which a licensed architect or engineer is,noa requited
the Building Code of the City of Edmond,, the application for a building permit shall be accompanied by a copy of the contnn and .a copy of the- derail ed
specifications.
3. Prior to employing any labor or commencing work, purify the Industrial insurance Division of the Department of Labor and Induurirgiving an admste of
the payroll and make monthly reports of payrolls. Full instructions should be obtained from the nearest once of that Department of Labor and Iodustrlea. Before '
final payment. the owner should obtain a release from the general contractors who in turn should obtain release from all mb•contracton. The releases ahmfd Is.
aneued by the Department of Labor and industries. The above procedures us requirements of the State Industrial Insursnce A.t. i
Y it
' 1
n r7
................... . ....... Districi
City of Edmonds ---Water Department
TAP CARD
Datg.r-. Pt.. -. 1.. JqEI.11....
No..---.......................... TaNo .........................................
MeterSize .............................. p Size.........................................
Mfgr" ... Styl ............................................
For ..,Llt
. . .............. . ............ .... . . ...................................................
...........................................................................................................................................
.........................................................................................................................................
r
Lot No ........................................... Blk. No ............... .................... .........
Add. .................................................................... . . .. . ........ ........ .................
Service Location .... /a ... . ..... . ... .......................
....... ......................................................................................... ............................ .........
MeterLocation ................................................................................................
.......................................................................................................................... ...............
MakeTap ...............................................................................................................
................................................................... ..........................................................
Pressure.............................. lbs. Test .................................... %
SendBills to ......................................................................................................... .
..................................... ................I. .......... , ........... ..............................................
..........
Dateof k 7 .................................................
.................................. Foreman
Guar. Voucher No ........................................... $ ..........................................
Remarks: ..................................................................... ............................................
..........................................................................................................................................
......................................... ir .... 1"M ... . ..............
.................. .......
......................... .......................................................... ...
......................
. I .............................................................................................................................
......................................................................................................................... . ................
......................... .................................................................................................................
.................................................... ......................................................................................
........................................................................................................................... ..............
OUTGOING Index..... -....Reg....... Route Bk ......... Stencil ...... Card ........
INCOMING Index .......... Reg ....... Route Bk ......... Stencil ...... Card ........
r
Material Chargeable to InstaL.. -.on Meters
NO S ZE DESCRIPTION RATE AMOUNT
O
meter
•--_-- . Meter Box .._.._.
.._ Meter Pate ............................ .............
•-•-•-
Check Valve ... "'"'"""'
. Pipe, Galv. Screw •................. •-------
.....
Nipples---•------•----• ....................
.......----- Bushings ------------------------- •---•-•--
Plain Ells -••-"""•-'
St. Ells ------------------------------------
Tees
---•• ..- •-----
- _, :...
.....G...
Material Chargeable to Taps Connected
NO, SIZ.E DESCRIPTION
RATE AMOUNT
.........
..............� ......... Pipe, Black Screw ...................-•-•----
e Galv. Screw
Pipe, ....... ..............
Lead Connections
Curb Cocks ....--••-••-••............
`. .
Cocksf ... Corp. ...........................
..
...... Unions .....----• ........................ .... ....
Saddles ................................ . ..-.... ... --- ii
::.. Nipples -• ..................• ::... ......
_--•-.--------. •._... •.-------
--_•..-. Bushings •-•---•.--
Plain Ells ----"'"-•-•
Street Ells .......................... :::.
-- -
Tees
------- Curb Boxes ..................... .........
....... _
.............
S. O. Extensions .--.---• _
............. •---•- Gates ._._......._....................... -....... .--�'/ 1
j-••-••__.... Plugs ...................... .�,.,1. d.......
_..... Couplings
Gate Boxes ............... .. ....................
.............. -_-••••--•-_•-- ...........
- ...._.. .•............... .......
...... I
-• ..... .................................• ....::::::::::
...... ...
......• ....
.....................................••-... .......
... ....
•••-_........................ •.. ......... .......
.....
................................................
.. -
Hours Time —Day Men ---•--- . }
Time —Monthly Men..
•-----•--•---- ••/�• Hours Time—M Y •---•-........ ---
............... Auto
Hours Time— ""'
•-•--.••• • -- . Superintendence ---------------- �. ...%. .�•�-
Total
w • •
30'W � 19'N
O
2" PE SOR II I MAIN. ZVN —.—
(D
DAL.EY ST
R-
END 3' PAST SERVICE
. o
FIELD LOCATE
2' OFFSET
H.
31'W g 19'N
W
N
EX. z" STw IF, Ic)'N (CP) X
NOTES
Ex's. 2G -
STREET FILE
FI w - (0043=3
2 X 91C PE ELL. (04--4$5
5 I 2" PE CAP
4 1 2" SDR I1 TRANS. FIT 78-gOC
3 1 Z" EXT STOPPER HI7154 7(0--72Z
2 c)O' # BURIAL WIRE a5- )40
z 1 90' 2`PE SDR II PIPE 70-2�0
ITEM OUANT, DESCRIPTION STOCK NO.
W BILL OF MATERIAL
I Q WASHINGTON NATURAL GAS COMPANY
PERMIT EDMONDS D. G. R. I /O/-7c)
PERMIT 1/4 SEC. SE 24-2-?-3
PERMIT OP. MAP I�oU. (02
TAX CODE 480 PLAT NO. I�a3.lo-7
A AREA EDMONDS SEQ. NO. OO 1, OOZ
2" PE SDR i l I P MAN EXT'N
110415 .DcY .- S
DWN.M: HARRISON 12/15 /78 IRCoD43-� RR
JOB _793-050
NO. DESCRIPTION DATE BY APP D CNK D
����'� � �� DRAWING
REVISIONS SCALE 1"'20' APP'0
a