1110 5TH AVE S.PDFIIIIIIIIIIII
5140
1110 5TH AVE S
The City of Edmonds
APPLICATION
for
SEDE SEWIER PERMW
CARDNo . ......................................
OUTSIDE E] INSIDE E] REPAIRS EASEMENT No . ......................................
. ............................................ PERMIT No
OV17NER ....... ��.Aj ------------ ------------------------------------- CONTRACTOR ......... IP&..y ...... R1 --- C-n
STREET
. . ................... ....... TE LOT 'No - ----------------------- 41 ----------------------------------------- CK No . ....... / ........... ........................
HOUSE No. ..... A).a ..... AVENL BLO
NAME ADD. ...... A .............................................
311:1 13381S th Or rr
w-
1.20,
/Y
APPROVED
D E C 2 1-1 1965
0 -
Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .............................................
SEWER WORK ORDER ISSUED .......................................... DATE .......... ....... By ........
.................................. ...
X1_
,-:-.-'CITY" -:11)MONDS
Call ]?Rosp�et. 6-1107 when work
..CIIV�][C'-;CF,NT-ER�'�.WATER-SEWER -DEPARTMENT
*_ 0
lsra4 for insoection; (No inspec-
tions Saturd6j, Sunddy or holidays.)
IDE SEWER; PER. -MIT
ADDRESS.................. 111.0L.Tifth ... Axiinue ... Snuth ....... .................................................................................................................
OWNkR ............. Donald A.
...... .................... ................................... CONTRACTOR ............ �qY ... AUPD ...........................................
Permission U granted ...... Dq.Qe.Mb.e'r ... 22 ............ 19.,Q5... for ............ ... . ..... days -to REPAIR or CONNECT a side sewer
%,�ith.City Sewers In accordance with application on Me and governing ordinances.
-A:TTENTION IS CALLED TO THE FOLLOWING:
NOTE -No. 1—The- owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer -Contractor. must
be employed to construct side sewer in'street ari& Do not cover any portion of sewer before it has been inspected.
-NOTE No. �2�Obtaln full Information regarding Ordinance 11.16.030 and Regulations governing. side sewers when you get permit.
NOTE No. 3--�Top of side sewer must have at least 30 inches coverage at property -line and 12:inches inside property line; minimum grade of 2%.
.'No bends in grade sharper than %. will be permitted.
�NOTE No. 4=Tren*ches In street�,must be water.settled and surface of street. restored to original condl.tion. Contractors shall be responsible -,for
failure due to Improper -work which may develop within one year of completion
IqOTR:No. 51LIt, is -unlawful to alter or do any other Work than Is provided for in the -permit, or to do any. work on the main sawer or. its ap-_
purtenances except to Insert the pipe Into the wye.
September 4, 2015.
City of Edmonds Development Services
Application for fence replacement permit
ALL WORK,SUBJECT
TO FIELD
INSPECTION FOR
CODE COMPLIANCE
I -
Fence is S ft tall and approximately 142 ft long.
City Wide Fence Company has been hired for the project.
Fence will sit on property line. r--
Attached is:
Critical Area Checklist
Site drawing
Scope of work from City Wide Fence Co
Photo of finished product
RECEIVED
SEP 0 4 2015
OEVELOPMEN I SERVICES CTR.
CITY OF EDMONDS
Cit)'Of Edmonds Building Division
Arl. vE,D nAN
I am the contact person for this project. If you have any questions please don't hesitate to call.
Varney Blake
11105 th Avenue South Unit 104 rR
?VED ILANNING
Edmonds WA 98020
206 930-9658
Nothing in this permit approval
process shall be interpreted as
allowing or permitting the
maintenance of any currently existing
illegal, nonconforming, or
unpermitted building, structure, or
site condition which is outside the
scope of the permit application,
regardless of whether such building,
structure, or condition is shown on the
site plan or drawing. Such building,
structure, or condition may be the
subject of a separate enforcement
action.
CITY OF EDMONDS
BUILDING DEPARTMENT
WORK
ADDRESS
OWNER
APPROVED DATE:
BLDG. OFFICIAL:
PERMIT NUMBER
i L4 5--
STIREE"I'FILE
CUSTOMER
JOB ADDRESS I/zo
CITY ZIP COQE!2 =Z-- . CCqrni Y AM D! Eo..
PHONE -ICE FAX kN
_4. FENC COMA I *fq. INC.
EMAIL VA 6 5l`0er,0 - 15.a rzZ& it
— 16923.48th Ave. K, Lynnwood, WA 98037
OWNER OR BILLING ADDRESS
www.citywidefenc.e.covh
Phone:. (425)745.8645
ATTN 111-44ju�� Fax: (425)361-4578
DATE i5- City Wide Will Call Dial -A -Dig YESK NO El EMAIL sales@citywid,efence.com
Specification Description
Chain Link
11 ga. 0 9 ga. 0 Slatted 0
Barb Wire
Ten. Wire
Top Rail
Line Posts
Term Posts
Ornamental 11ron Fence
Height
Gates
Set in Cement
Approx. Post Spacing
Cedar Fence —42L
S ty I e e-
Faces ;412' Space A.Ao
To Grade 0 Stepped 0 Level);r
Airline l3cst.CapsiR
ot,
Posts
Rails
boards
Le
i r!
15r 0(0, isl�
C;w
"Ile
&A
10
7
f
LZ.
Old Fence Removal 0 Leave 0 Haul Away D.
Special Eclu.ipment Needed on Job 2,AIZZ—
Add To Price YES 0 NOD.
mf�-UZ,0*3
�g
11
! I
t,:5 Cori do.,
Rzlz)L- Y)
16 Juni.p--rs
c k r
--------------
OWNER/CO CTOR IS RESPONSIBLE FOR
'ONTROLAND DRAINAGE .
EROSI
-VIA
CZ) �HUVED AS
NOTEU
N EERING
D te:
a
D lY PLAN.NINC
C
r—Flag
OWNEWCONTRACTOR RESPONSIBLE
tbacks NG ALL ON -SITE UTILITIES.
ISS a Actual FOR LOCATI
RELOCATIOWREVISION TO ANY UTILITIES RECEIVED
Front
MIT
MAY REQUIRE SEPARATE PE -
Sides,
SEP 0 4 2015
Rear,
DEALOPMENT SEHVIGES CTR.
CITY OF EDMONDS
FILE
Other'
'TREET
15-- 11 L4 E5
City of Edmonds
Critical Area Notice of Decision
Applicant:
Property Owner:
dj o d 14,),,,�-
Critical Area File #:
.5- 0 0 C? S_
Permit Number:
S—
.Site Location:
Parcel Number:
AlA
Project Descriptio n:
C4 CC et C'&M
Conditional Waiver. No critical area report is required for the project described above.
1. There will be. no alteration of a -Critical Area or its required buffer.
.2. The proposal is an �Ilowed activity pursuant to ECDC 23.40.220, 23.50.220, and/or
23.80.040.
3. The proposal is exempt pursuant to ECDC 23.40.230.
��Xrosion Hazard. Project is within erosion hazard area. Applicant must prepare an erosion and
sediment control plan in compliance with ECDC 18.30.
F-I Critical Area Report Required. The proposed project is within a critical area and/or a critical area
buffer and a critical area report is required. A critical area report has been submitted and evaluated
.for compliance with the following criteria pursuant to ECDC 23.40.160:
I The proposal minimizes the impact on critical areas in accordance with ECDC 23.40,120,
Mitigation sequencing;
2. The proposal does not pose an unreasonable threat to the public health, safety, or welfare
on or off the development proposal,site;
3. The proposal is consistent with the general purposes of this title and the public interest;
4. Any alterations permitted to the critical area are mitigated in accordance with ECDC
23.40.110, Mitigation requirements.
5. The proposal protects the critical area functions and values consistent with the best
available science and results in no net loss of critical functions and values; and
6. The proposal is consistent with other applicable regulations and standards.
F1 Unfavorable Critical Area Decision. The proposed project is not exempt or does not adequately
mitigate its impacts on critical areas and/or does not comply with the criteria in ECDC 23.40.160 and
the provisions of the City of Edmonds critical area regulations. See attached findings of
noncompliance.
0—Favorable Critical Area Decision. The proposed project as described above and as shown on the
attached site plan meets or is exempt from the criteria ih ECDC 23.40.160, Review Criteria, and
complies with the applicable provisions of the City of Edmonds critical area regulations. Any
subsequent changes to the proposal shall void this decision pending re -review of the proposal.
F-1 Conditions. Criti cal Area specific condition(s) have been applied to the permit number referenced
above. See referenced permit number for specific condition(s).
M JC I U5 4Z��
Reviewer
4. -
Signature
q
Date
Appeals: Any decision -to approve, condition, or deny a development proposal or other activity based on the
requirements of critical area regulations may be appealed according to, and as part of, the appeal procedure, if any,
for the permit or approval involved.
Revised 12/16/2010
1 z'
0 E L),V
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS,WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20080317
SIDE SEWER PERMIT (2-Multi-Family)
Permit Number: ENG20080317 Expiration Date: 11/14/2008
Job Address: 1110 5TE AVE S, EDMONDS
ROT 0 ROOTER ROTO ROOTER
8015 BROADWAY AVE SUITE E 8015 BROADWAY AVE SUITE E
EVERETT, WA 98203 EVERETT, WA 98203
LICENSE #: ROTORSC122BR EXP: 4/3/2010
•
•
JOB DESCRIPTION
IREPAIR P N 1PROPOS TOREUSELATERAL LID NUMBER--
CRINDER PUM N I PROPOSE TO REUSE SIDE SEWER
SIDESEWERREPAIR
N
EASEMENTINFOICNIATION
PROJECT CROSSES OTHER PRIVATE PROPERTY
I VERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMATTY- The Applicant has signed an application which states helshe holds the City ofEdmonds harmlessfrom injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City ofEdmonds or
any ofils departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorneyfees by reason ofgranting this permit.
CALL DL41,A-DIG (1 -800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
MS AP PLICATION IS NOT A PERNUT UNTIL SIGNED BYTHE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Thursday. Aueust 14. 20(
ON
0 FILECOPY F] INSPECTIORCOPY [] APPLI CANTCOPY
It,
STATUS: ISSUED
ENG20080317
• Refer to City of Edmonds Side Sewer Infonnation handout for approved pipe materials, inspections and other requirements.
• A 6" cleanout with 12" locking cast iron larnphole cover is required at.the property line.
• Maintain 10'separation between the sanitary s ide sewer and the water service line.
• Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the perrnitted project.
0 EEngineering Final
PARTIAL INSPECTION DATE: IMTIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
121 5TH AVENUE NORTH - EDMONDS,WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20080317
SIDE SEWER PERMIT (2-Multi-Family)
Permit Number: ENG20080317 Expiration Date: I I /14/2008
Job Address: I 110 5TH AVE S, EDMONDS
ROT 0 ROOTER ROTO ROOTER
8015 BROADWAY AVE SUITE E 8015 BROADWAY AVE SUITE E
EVERETT, WA 98203 EVERETT, WA 98203
LICENSE #: ROTORSC122BR EXP: 4/3/2010
•
•
JOB DESCRIPTION
IREPAIR P N PROPOSE TO REUSE LATERAL -LID NUMBER--
CRfNDER PUM N I PROPOSE TO REUSE SIDE SEWER
SIDESEWERREPAIR
•
•
LA,S ENIENT INFOICUATION
I PROIECT CROSSES OTHER PRIVATE PROPERTY
VERIFICATION OF RECORDED EASEMENTS COMPLETE
IADEMAVTY- The Applicant has signed an application which states helshe holds the City ofEdmonds harmless)rom injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City ofEdmonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
anorneyfees by reason ofgranting this permit,
CALL DLA1,A-DIG (1 -800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EKT. 1326
24 HO UR NO-nC E REQ UIRED FO R ALL INSPECTIO N REQ UESTS
THIS APPLICATION IS NOTA PERNUTUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Im
DATE
ursday. Au2ust I
EJ FILE COPY 1� INSPECTOR COPY E] APPLICANTCOPY
STATUS: ISSUED
ENG20080317
• Refer to City of Edmonds Side Sewer Information handout for approved pipe materials, inspections and other requirements.
• A 6" cleanout with 12" locking cast iron laniphole cover is required at the property fine.
• Maintain 10'separation between the sanitary side sewer and the water service line.
• Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the pertnitted project.
0 E-Engineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES;
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
OV E 0
City of Edmonds
Permit Application Form
Form A
Permit Application for: F-1-NeWS.ingip N,im.il�, Fj_New Com/Apt E] Addition -
F1 Interior Remodel E] Garag'd/carpoft DRepair D'Sign
F] Fence- [j Grading cyds El Sto'rage/Shed
Te I nant Im I proviementlChan'e of Use, E] Fire S�stdm, (Specify)
9
r I Rpck6ry1Retaining*WMl,.'_
n Other (Specify) 15eLL4�C: C_QA 1 DATE:
Brief Description:
Site Address: 1110 -S—" 62—e= Suite #
Sno County Tax Account Parcel #:
Business/Tenant Name (if applicable):
PROPERTYOWNER: G_4DCCU,,J&_,r0 CDroo
Mailing Address: IfI0 57�4V-e_
City:- —State: WA- Zip: �Ieo
Phone: (_)
CONTRACTOR:
Mailing Add
FAX: (_)
0 Same.. as Prop6ft OWne.r, _00ther(Name)
oll�- 6-ro
5-ul
E-Mail:
_Ij
City: Ei�uq_ State: zip.
Phone: (_) FAX: (_)
State License Number: VZ7Z(3(Z_ Exp
E-Mail:
Date: 1/h ho City Business License No:AA4—&ft-3Y/
ov /, "
APPLICANT/CONTACT: OSame,,as. , Property -Owner &ame as,Contractor 00ther
Fill out the following information if "Other'.. V., -%,o
Name & Mailing Address:
City: State: Zip:
Phone: (_)
FAX: (_) E-Mail:
L:\TEMP\BUILDING\WEBchecklists\SFR.COMM.APP.doc5/24/2007
PLUMBING FIXTURE COUNT
Number Fixture Type
Water Closet (Toilet)
Sink (kitchen, laundry, bar, etc.)
Lavatory
Tub/Shower
Dishwasher
Hose Bib
Water Heater
Expansion Tank For Water Heater
Floor Drain
Pressure Reduction Valve
Water Service Line
Drinking Fountain
Bidet/Urinal
Clothes Washer
Backflow Protection Device
Hydronic Heat In Floor Wall
Other
GAS OUTLETS
AC Unit BTUs Location
Furnace BTUs Location
Water Heater BTUs Location
Boiler BTUs Location
Dryer
Stove/Range/Oven
Fireplace/insert BTUs Location
Outdoor BBQ
L:\TEMP\DST's\FORMS\PLUMBFIX.xis. 8-31-06 update
DETAILED SCOPE OF WORK
Please provide a complete detailed written scope of work for the proposed
project.
Additions (additional square footage): Specify room use, floor level and square footage and
direction if applicable (i.e. 545 square foot master bed room/bath room addition on the second.floor
with 140 square foot deck and 245 square foot kitchen addition on the main floor at south side of
house).
Remodels (interior renovations): Specify room uses and floor levels (i.e. combine bedrooms 1 and
2 on the main floor to create new master bed room/bath room; replace dining room sliding glass door
with new French doors, reconfigure kitchen with new island prep counter and install new gas fireplace
in the living room).
L:\TEMP\BUILDING\WEBchecklists\SFR.COMM.APP.doc5/24/2007 3