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1112 EXCELSIOR PL.PDF1112 EXCELSIOR PL CITY OF EDMONDS - SIDE SEWER PERMIT WATER -SEWER DEPARTMENT PERMIT 44. Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.1 Inspection will be provided within 24 hours after requst. NO sat., Sun., or holiday inspections) ADDRESS LOCATION OF CONSTRUCTION.--...' �;7 .:. ¢?,-....-.... r K PROPERTY LEGAL DESCRIPTION ............. r"?`"',���-'r-✓.......-......-.....-.-...............................-.......--......-........................------------------------------ .......................................... .......... _.......... _..................._-------------- ......... ......................................................... .................... • • ......................................................OWNER AND/OR BUILDER.........: r�........ !./,... _...................................... ............... CONTRACTOR'S NAME & ADDRESS ........ -- r,. +........................................................................•----........ .r.�-..... .... , . Permission is granted ........ 0.: ............... 19for repair and/or connection of a side sewer to the city sanitary sewer system in accordance with City of Edmonds ordinances. F*TION Is CALLED TO THE FOLLOWING: NO No. 1—The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct side sewer in street area. Do not cover any portion of sewer before it has been inspected. NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office. NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit. - NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%,. No bends in grade sharper than % will be permitted. NOTE No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper work which may develop within one year of completion. NOTE No. 6—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its appurtenances except to in- sert the pipe into the wye. DISAPPROVED ❑ Date .... ................................... By ................ Date.------- ..... ............... By................ Date.... .. By ................ Q ROVEDDate...�•../e...,�,%! .......................... By................................_........................------.......................................................... Remarks: ....... _...... _.......................................................................................................................................... . ............................................................ -............................................................................................................................ _............................................. .......... — BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection — . hereby certify that the side sewer installation constructed under this permit I,............. (Owner of Cont ding Firm Performing Construction) •installed in accordance with all governing ordinances of the City of Edmonds. Datedthis ............................ day of................................................................ , 19----•---- J 4 Check BEFORE you dig for: Water ❑, Gas ❑, Telephone ❑, Power ❑, Sewer ❑, Other 0 V V 4. T❑ UTILITY BILLING INTER -OFFICE COMMUNICATIONS , DATE January 9 FROM BUILDING DIVISION SUBJECT: CHANGE OF ADDRESS • Per our conversationjaddress for A/B Construction (Tom Holman) should be 1112 Excelsior Place. Thanks Ann STAEEr FicE 0 19 79 Kum TAX ACCOUNT/PARCEL NUMBER: BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) FOR: CRITICAL AREAS :n ` DETERMINATION: Conditional Waiver Study Required ❑ Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DA' PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED PERMITS (OTHER):_ ,�,604-6a9 PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: �3 I 1� SEWER LID FEE $: SHORT PLAT SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: SOILS REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: WATER METER TAP CARD DATED - LID #: LOT: BLOCK: L:\TEMP\DST's\Forms\Street File Checklist.doc TO:360 794 3326 a PAGE:01 05-24-04 08:52 FROM:JEN/hIAXMARKET 14257873286 0 :5fTj5ACJ< R'AN 6EORGE ml UER i I l 2 EXGBS/Oi 2 AVE MDmOtim WASHINC270" J-04-ol Z-004 RECEIVED MAY 2 7 2004 PERMIT COUNTER MUD 3w `�'w _ � �� ✓ �°%'S �� � '1'.� AT F Coe 3G�. 00VA M. aoo 70 W _ & N, 4 r a4m 0 0 do- FJ�-- SEl"l�i60 v �o � 115�0� o N MlEig YISr�G N M�� iF� RC:LDCATE �XtsTl� �A`.E I=1eDN'�I�G oN CXCELSiOR Ave µ/ W 704Pr of Z7- Re"ORLi5 5A)OHVM1l5H COLWry", VJ4;5Hl GTW NPR � rd at) I 4ve,Qy / rl6 ALE •. Rig L7CCK STREET FILE n N 9 v 7—ff �% A e oxvt� 1 T d 4/4C_ Can aI waivt, (r`- adc�iri�lJ��i D ` K 5 a 1���no OK - 01?7� l Q ya1-a y e r2/o��T►`v � rr�--Pl ad dd , n , FLi l/ cir ad'dTT-d�(,A.I cor�—(/VClNar\ . glad,- 7, 6r- Ip,,J U 5� aCr-�-(OA) wl d I ref UVf recd4i d erarlw, U-� Tl/geed 4 r C'd rli-^,vt cn rrc. I a/ec, S uet, Si .nj �j>_ AA �aTe�: 4/ IH/O V RECEIVE® MAR 1 8 2004 PERMIT COUNTER Pagel of 2 SnohomishOnllne Government information S Services County4* Washington Structure Information Close Window General Description Parcel Number 00434600009104 (R01) Structure Class Dwelling Structure Type 1 Story wBasement Year Built 1978 Exterior Features Foundation Conc or CB Exterior Siding -Lap ROOF Type: Gable Pitch Low Cover Built Up Interior Features Bedrooms 4 Full or 3/4 Baths 3 1/2 Baths 0 Heat Forced Hot Air - Gas Fireplace Masonry 2s stacked fireplace Floor Area Floor 1 Base SF 1616 Finished SF 1616 Floor B Base SF 1560 Finished SF 200 Garage(s) & Carport(s) None Other Features http : //web 5. co. snohomish.wa.us/prop sys/asr-tr-propinglPropInfoO5-StructData. asp?parcel... 9/ 15/2004 Page 2 of 2 Close Window http ://web5 . co. snohomi sh.wa.uslpropsys/asr-tr-propinglPropInfoO5-StructData. asp?parcel... 9/ 15 /2004 Consulting Robert M. Pride, Inc. Engineer February 19, 2004 Mr. and Mrs. George Miller 1112 Excelsior Place Edmonds, WA 98020 Re: Report on Geotechnical Evaluation Proposed Garage Structure 1112 Excelsior Place Edmonds, Washington RMP Project No. 04-147-01 Dear Mr. and Mrs. Miller, ir CITY Copy R�C�J�EC MAR 1 8 2004 PERMIT COUNTER This report summarizes the results of my site inspection and geotechnical evaluation of your property located on the south side of Excelsior Place in Edmonds. It is understood that you are planning an expansion and relocation of the existing garage that is situated at the front north side of the property. A "Site Plan" prepared by your designer Chuck Lee dated February 2, 2004 was used as a reference for this report. Geologically this area of Edmonds is underlain by glacial outwash deposits consisting of dense sands, silts and gravel soils (Qva). No prior soils information is available for this site, but previous investigations in the Edmonds area showed the presence of competent glacial deposits within 2 to 3 feet of the existing ground surface. The easterly side of the property was cut into the gentle hillside, and there was some minor filling along the westerly side of the garage. A 4 to 5 foot high fill -over -cut slope is located just west of the existing garage. An unpaved driveway access currently exists along the east side of the garage leading to the entry door on the south side. Crushed gravel covers most of this driveway and most of the surface water penetrates into the crushed gravel surfacing. Existing floor slab in the garage is at an elevation of about 111.5 feet, and the new garage slab will be raised about six inches. An existing 24 inch diameter evergreen tree is situated on line with the proposed relocated west garage wall. There is a two foot deep catch basin inlet structure (invert @ no feet) in the street swale immediately opposite the proposed garage location. On the basis of my site inspection and on prior experience on sites in this area of Edmonds, it is my opinion that the relocated garage and the new addition can be 13203 Holmes Pant Drive NE Kirkland, WA 98034 Phone: 425-814-3970 Fax: 425-814-5672 February 19, 2004 Mr. and Mrs. Miller Page 2 constructed as shown on the Lee "Site Plan." A majority of the footings will only need to extend a minimum depth of 18 inches below the existing ground surface. Footings along the west side of the relocated garage structure will be situated on the slope, and they will need to be deepened so that they bear on the dense glacial deposits. Estimated depths of these footings will be on the order of 3 to g feet below the slope surface. An allowable soil bearing value of 2000 psf may be used in the design of the bearing wall footings. Estimated settlement for footings founded on the dense outwash deposits will be less than 1/2 inch. The west retaining wall footing should be designed for an active pressure of 30 pcf, and lateral forces may be restrained by a passive pressure of 200 pcf. All backfill behind the retaining wall and under the floor slab should be compacted to a uniformly high density before pouring the garage floor slab. Drainage off of the roof of the new building should be captured by gutters and down drains, and then tightlined to the catch basin at the front of the garage. A strip drain is recommended along the front of the garage slab in the new paved driveway, and this water can also be directed to the catch basin. In my opinion there is not a need for new area drains since the garage expansion will cover most of the previous impervious area that consisted of the old driveway. Please call me if there are any questions regarding the findings and recommendations of this report. at JK ®� ��T Respectfully, A A o? WAsy���'�� Robert M. Pride, P. E.t,,'� Principal Geotechnical Engineer dist: (2) addressee rmp: MillerGaragei EXPIRES d� , 13203 Holmes Point Drive NE Kirkland, WA 98o34 Phone: 425-$14-3970 Fax: 425-814-5672 05-24-04 08:52 FROM:JEN/MRXMARKET 14257873286 TO:360 794 3926 PRGE:01 �11 IZ SITBAcj< RAN GE RGE M) UER L i 12. EgaZ5i4oQ AVE ?OWW 3w RECEIVED MAY 211004 PERMIT COUNTER M1911MOFILM _ xc ts� A. LE _ . _ • _ �� 89° AT F or v-T ifv waoe� 70 q - - ~ ~ MIL-LER ,~, 'aB o Sr! 19X "Aye 5- 0 i � 09' F��•- SST /�a0 J y- <E H • �115010 LAAl)a //r6 r.Pjc�s v EX AV V/5�L7 h/ ME120 � 1 f� RELOCATE MXts7'1 � G4R^6;E FROAM A6- oN ADCCELSJOR Ave JAI W 70"PJ' of E.437- A%QLF TleACr 91-9; MZX5 :5ZQViOW 77e4CTs! RECORaT VoU080,W15H COVAvTY, \0,-#41PGrCW (off 6e Ay 6l�lo I /Vel41, -m Wt, i - i N Qaf i - + a-g x/a, = -x I " 4ve,,4 r� • R6 LOY CAA / ova f, 'e) �?, S 13� Q v s 7-� �% �,f ,� �' o�v� T �qL ,4 7— - G� FXC'L p�o•�p: vv 4- RECEIVED MAR t 8 2004 PERMIT COUNTED 5-rvJ i e 5 Tk-i� L-,A'(VV0 e S On ly -m ��� � a llcocr►o /\ ,-*- oq - oo?7 � Q G R la G Q lel caP--U ^ " a r-ro n , dr adJTrYu,,a I Co�IVel�an \ 9 /ac�, "7 ar Ia^j USA acT-fbA)�eca�3�riP�a q/ l q/o y t City of Edmonds Critical Areas Determination Applicant: George Miller Determination #: CA-01-90 Project Name: N/A Permit Number: N/A Site Location: 1112 Excelsior Pl. Property Tax Acct #: 4346 000 09104 01 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 critical area, including a Erosion Hazard Area and a Wetland/Stream pursuant to Chapter 20.15B of the Edmonds Community Development Code (ECDC). Based on these findings, prior to submission of any development permit, you will be required satisfy the requirements of ECDC 20.15B by completing the following: Erosion Hazard Area The site is also in an ai Potential. All proposes Edmonds Engineering Based on the above fin area and to delineate th buffers. The required c specialist in botany, fis field experience with v shall be performed ass tl property owner or appl The qualified critical areas consultant=shall perform the following: 1. Classification of the stream and/or wetland pursuant to the criteria established in ECDC Section 20.15B.060(A)(4) and (5). 2. Delineate the edge of the stream and/or wetland on the site. 3. State any mitigating measures appropriate to preserving and protecting the stream and/or wetland. 1 LAP r ram.- PI.AM M ueTr ►�� rt City of Edmonds Critical Areas Determination Applicant: George Miller Determination #: CA-01-90 Project Name: N/A Permit Number: N/A Site Location: 1112 Excelsior Pl. Property Tax Acct #: 4346 000 091 04 Ol 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 critical area, including a Erosion Hazard Area and a Wetland/Stream pursuant to Chapter 20.15B of the Edmonds Community Development Code (ECDC). Based on these findings, prior to submission of any development permit, you will be required satisfy the requirements of ECDC 20.15B by completing the following: Erosion Hazard Area The site is also in an area designated on the Critical Areas inventory as Slopes with Erosion Potential. All proposed development must have an erosion controll plan approved by the City of Edmonds Engineering Department. Wetland/Stream Based on the above findings, a Critical Areas Study is required to determine the hydrology of the area and to delineate the approximate boundaries of any wetland or stream and identify its buffers. The required qualified critical areas consultant needed to perform the study shall be a specialist in botany, fisheries, wetland biology, and/or hydrology with a minimum of two years' field experience with wetlands and/or streams in the Pacific Northwest. All critical areas studies shall be performed as three party agreements with the city selecting the consultant and the property owner or applicant paying the fees. The qualified critical areas consultant shall perform the following: Classification of the stream and/or wetland pursuant to the criteria established in ECDC Section 20.15B.060(A)(4) and (5). 2. Delineate the edge of the stream and/or wetland on the site. 3. State any mitigating measures appropriate to preserving and protecting the stream and/or wetland. 1 After the qualified critical areas consultant has delineated the stream and/or wetland boundary, a surveyor licensed by the State of Washington must perform the following: 1. Physically mark the edge of the wetland. 2. Delineate the required buffer (see ECDC 20.15B.120.A and 20.15B.130.C). 3. Delineate the required building setback from the buffer (required setback is 15 feet). 4. Create a map showing the wetland, the buffer and the building setback. The water from this site 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. Both the qualified critical areas consultant and the Land Surveyor shall enter into a three party contract with the applicant and the City of Edmonds as required in ECDC 20.15B.140(D), where the applicant pays for the study. The applicant may suggest qualified professionals for the City's approval. If the results of the Critical Areas Study determine that the lot may not be developed, the applicant may apply for a Reasonable Use Exception and Variance pursuant to ECDC 20.15B.I70A and 20.15B.040C). If the property owner wishes to apply for a specific development permit which they feel would not impact the Critical Areas located on 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. Chanda Earhart V/V'f' ri" (AllfW4 July 9, 2001 Name Signature Date 2 'r Y Critical Areas Checklist 46 CA File No: CA -20C, (-L Site Information (soils/topography/hydrology/vegetation) 1. Site Address/ Location: ///.? A7X C E /- Sl e) R AL 2. Property Tax Account Number: q3 V 6 - D oa -- o Q/ - o 9,o / 3. Approximate Site Size (acres or square feet): /7, SD 0 'e-1, / 4. Is this site currently developed? -k yes; no. If yes; how is site developed? / 1S ,OII S>c A M a E 5. Describe the general site topography. Check all that apply. Flat: 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: /moo _; Approx. Depth: 7. Site contains areas of seasonal standing water: No ; Approx. Depth: What season(s) of the year? 8. Site is in the floodway floodplain of a water course. 9. Site contains a creek or an area where water 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 (lawn,shrubs etc) x 11. Obvious wetland is present on site: ,,. L L l�Ud V// /a eer6' � / - -T R RovNZ Critical Areas Checklist.doc/3.19.2001 -�.,.°F15 City ofEdmonds Development Services Department Planning Division Phone: 425.771.0220 ♦�� 1 g90 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 Received: -47—4 — 02 a) / City Receipt #: / '7 8 9 Critical Areas File #: CIA —DI - G 0 Critical Areas Checklist Fee: $45.00 Date Mailed to ADDlicant: 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 attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or incomplete information furnished by the applicant, his/her/its agents or employees. By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of -my knowledge and that I am authorized to file this application on the behalf of the owner as listed below. SIGNATURE OF APPLICANT/AGENT DATE 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 Owner/Applicant: GEo 8CE IN AW IL ER Name /.2 EXCF-1-s -O R OG Street Address E'O//04/9s ! /A oz o City State Zip Telephone:��2.5� 776 ZZZ D Email address (optional): DATE Applicant Representative: Name Street Address City State Zip Telephone: Email Address (optional): Critical Areas Check] ist.doc/3.19.2001 City of Edmonds Critical Areas Determination Applicant: George Miller Determination #: CA-01-90 Project Name: N/A Permit Number: N/A Site Location: 1112 Excelsior Pl. Property Tax Acct #: 4346 000 09104 01 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 critical area, including a Erosion Hazard Area and a Wetland/Stream pursuant to Chapter 20.15B of the Edmonds Community Development Code (ECDC). Based on these findings, prior to submission of any development permit, you will be required satisfy the requirements of ECDC 20.15B by completing the following: Erosion Hazard Area The site is also in an area designated on the Critical Areas inventory as Slopes with Erosion Potential. All proposed development must have an erosion control plan approved by the City of Edmonds Engineering Department. Wetland/Stream Based on the above findings, a Critical Areas Study is required to determine the hydrology of the area and to delineate the approximate boundaries of any wetland or stream and identify its buffers. The required qualified critical areas consultant needed to perform the study shall be a specialist in botany, fisheries, wetland biology, and/or hydrology with a minimum of two years' field experience with wetlands and/or streams in the Pacific Northwest. All critical areas studies shall be performed as three party agreements with the city selecting the consultant and the property owner or applicant paying the fees. The qualified critical areas consultant shall perform the following: 1. Classification of the stream and/or wetland pursuant to the criteria established in ECDC Section 20.15B.060(A)(4) and (5). 2. Delineate the edge of the stream and/or wetland on the site. 3. State any mitigating measures appropriate to preserving and protecting the stream and/or wetland. After the qualified critical areas consultant has delineated the stream and/or wetland boundary, a surveyor licensed by the State of Washington must perform the following: 1. Physically mark the edge of the wetland. 2. Delineate the required buffer (see ECDC 20.15B.120.A and 20.15B.130.C). 3. Delineate the required building setback from the buffer (required setback is 15 feet). 4. Create a map showing the wetland, the buffer and the building setback. The water from this site 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. Both the qualified critical areas consultant and the Land Surveyor shall enter into a three party contract with the applicant and the City of Edmonds as required in ECDC 20.15B.140(D), where the applicant pays for the study. The applicant may suggest qualified professionals for the City's approval.. If the results of the Critical Areas Study determine that the lot may not be developed, the applicant may apply for a Reasonable Use Exception and Variance pursuant to ECDC 20.15B.170A and 20.15B.040C). If the property owner wishes to apply for a specific development permit which they feel would not impact the Critical Areas located on 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. Name Signature Date 2 K Cityof E7 1r RIGHT-OF-WAY CONSTRUCTION. PERMIT, Permit Number. o,* Issue Date �w7 ► .. '1112 Excelsior PI (9614178 ) A. Address or Vicinity of Construction: Inc. p B. Type of Work (be specific): Install a 2" plastic gas main in Excelsior PL 1.$9 from 11' W to + 230' E c/1 of Olympic Av C. Contractor: PUGET SOUND ENERGY Mailing Address'1.122 75th ST SW State License #: D. Building Permit # (if applicable): Contact: DOUG USITAW Phone: _(425)'.356-7520 Liability Insurance: Bond: $ Side Sewer Permit # (if applicable): E. ❑ Commercial [JSubdivision ❑ City Project :K] Utility (PUD, GTE, WNG, CABLE, WATER) ❑ Multi -Family ❑ Single Family ❑ Other �j J INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut : 10 Yes ❑No G. Size of Cuts( 3' x 5' H. Charge $ APPLICANT TO READ AND SIGN INDEMNITY. Applicant understands and by his signature to this application to hold 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 of its departments or employees, including or not limited to the defense of any legal proceedings including defense 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 INSPEC- TION 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. Two sets of construction drawings of proposed work required with permit application. A 24 hour notice is required for inspection. Please call the Engineering Division, 771-0220. Work and material is to be inspected during progress and at completion. Restoration is to be in accordance with City Codes. Street shall be kept clean at all times. Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer. All street cut trench work shall be patched with asphalt or City approved material prior to the end of the working day; NO EXCEPTIONS. I have read the above statements and understand the permit requirements and the pink copy of the permit will be available on site at all times for inspection pur oses. Signature: FELMA H. LOM—FIK,UM /. Date: (Contractor or A ent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY APPROVED BY: RW RIGHT OF WAY FEE: TIME AUTHORIZED: VOID AFTER 3yAe- '30 R DAYS DISRUPTION FEFIFUND I 1 I: SPECIAL CONDITIONS: Nj 4= RESTORATION FEE: T OTAL FEE: d o RECEIPT NO.: ( ./ NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. 1997 FIELD INSPECTION NOTES - (Fund 111 = Route copy to Street Dept.) Comments CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: BUILDING DEPARTMENT Us. PER PERMIT APPLICATION Applicant Lines I Heavy Lines ZONE I � UMBER J _ NAME (OR NAME Ga pV3�rl ESij �/, ADDRESS rI L C G�VI ����Vi �]AJ , r� y ✓ �' s . 1 • W MAILING AODR LEGAL LOT T AREA SUBDIV�JKIO �AN NO. ❑ NO I S"-„j�J ^•`JYJ �.� 1.1 CITY �f O ♦ `y' jP { d. 0NONE NO ELE �` TRM BER STR<LT R'1 EXISTING ST TREET R/W 3V FT. DEFICIlNCY THIS PROPERTY COMP. PLAN t / 71 ST. R/W �A O� NAME `-+ll V 1 C Nil (z) F ADDR L'S5 AEMARKS n CNCL•HC B W C CITY I = ( TELC+HONE NU`.tBF,R STREET AryD/OR UTILITY WORT( PNO R/W PERM IT HE I EO I D r .7 V✓,i.�A/� "Al C� YI?p W it ram'//tJ•+ TR (JJ�JI 7/y/f) /�/� WNOERGROVND `-IY IRING REO'D. .�i 0 AD DRES: V J'� V L: ❑YES t�NO H U-�'//��Z TYPE CONNECTION ETC' VERIFIE Y 7}y1[�1VISANITO.RY C `' ""�-f��---fff Yi/��LiI /`+�• lA�" SEWER CITY P TELEPHONE NUN,BER ❑Np SEPTIC 57s, EM �{ { u Gmc/ APPV'D BY CITY ENG. CI YES PE MIT NUMBER 'Y srw LIc 'NS NUtlER CITY LICF,NSC NUM UEH al � REMARKS - '} 2s—*2� ,ram. e0sDescription Pro of rty (Show Below or Attach Four Copies) I MErCH 513E BUILp SUPnL V SRE L?%•Sr' C )� [— //z o— 3�r 10=L J L� It T [^ . n\v r�j�l + ,) O ( •�' V'�L SIGN AREA ALLOYJED SN V. REVIEW 1De NO. +'S O PR AED EXEMPe � {{ y^7 J R 5 i:1 O- eev-elo RK-A• Nc6- � cLnts;lorJ —�.. It VARINCE OR R CV J �n �� PLANNING REVIEW BY DATE 1 ' ly 1 N!W L/�.RP.SIDEN TIAL ❑ GASLINE Yf,1a' FRONT t LOT / O SIDE COVERAGE / NON•RESIDFe1TIAL ❑ SIGN • 1 1 qDD FIRE zo.e TYPE OF CONSTRUCTION CODE HEIGHT �� ` 1 .11. 4 ❑ DEMOLISH ❑ RETAINING ..JJJJ--���� v- IJ ►�1�3 ,O,Mrx yECIAL I SPECTOR ;I WALL Al... ❑ EXCAVATE ENCE wREA OCCUPANCY OCCUPANT 1 b PGA o�Z13- I •t O.R FILL i X �� YES IO LDAO 1 RIPwIR PRG NtovESWIM INSP, PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY OF EDMONDS. LOCAL ` POOL NuMBER of sror.le5 NUM BE SALES TAX SHOVLO RE CODED 31.00. REMAtr�t KS -- 2 D\YELLING j UNITS NATURE OF WOR' TO BE GONE 1J. TN4rL 1^nW 1. `' 1 p•'{ t- {� 1f�>,.,L\ t011 FERt 11F qQ H Z (/ IOOD �!'- ,f rk.t)C-VC.A.l iCA— 1 v LOT D�AI N'AL � PF t� ORD, � �ChlLl?7L� li 14 . M 1►s-c�c�0 Vi cIt _ • PROPOSED - 5 t `to (iN{ I 3 USE Z (�T 11.. �J ) W VALUATION FCC PLAN CHECK _= NO. ? 6 PLOT PLAN IN DILATE GUILOI NG SETBACKS, __ Z '! S ABUTTING STRl ETS) _N - ----- W f W/��t-• ,I /T'T a �J ' D SI..C. BUILDING JS -S84 0 �! . /t-({ rT�f' IL%• PLUMBrNG D lO W -- HE/.T tr > GAS LINE --- W InFENCE — -- -- H slory —_ i RETAINING WALL Z 0 SWIMMING POOL _ U - .1 t I ,:reby acknowledge that 1 ha- this applica?ir,:l; that the in- formation given is correct; and ?hat I am the / 00 TOTAL AMOUNT DUE I � c: onrr, or the duly author- ized agent or the owner. 1 agree to cumply with city and state laws regu- !tong I " 1S, construction; and in doing the work authorized thereby, no person the La work employed in ''olaem Code or the State or R'ashingtun ATTENTION APPLICATION APPROVAL ' velawill in muting to Workmen's Compensation Inswance. n NOTE: Permit limit One Year(r:.csept THIS PERMIT This I s application is not rmit AUTHpRl2ES DEMOLITIONS and FILL PERMITS without conditional until signed by the Building Orafipecial or ONLY THE { use permit, which shall be completed in 90 days; \10'.,F -IN BUILDINGS shall be completed in sis months) SIGNATVHC hi D^putt': and fees are paid, and wnRK N'oTEr, receipt is acknowledged ' (OWNr,,tt pR AGENT) DATE SIGNEC r jj%, 0(/•�t Iy -r I� in space pro- INSPECTION vldcd. OEPA RTMEYT IOIRF-CTOR' rl I i 17171 CIT'f OF /VOTE:•: A !leant Subject t� plait I PP EDIAONOS TC SJ C7reck Fec This Permit c�ra- work to be done 775-2525 r3-7-1 oR prirsta pro e Any tonttructlo:t an the publiC domain (curbs, si Property ONLY. / mirguess, ate.) Will rogoira separate permission. ORIGINAL - File YELLOW - Inspector _ - - GOLD • Assessor PINK - Owner; s¢ • 4 r. 7 Ditt. E, FOUNDArn%( �Pim-d ATI W ArL CDC \l�'"ttAL(X HO7'%ZL-N'TAL- PDrch", pfrs W.�qs Po oT Pu".!rswo UL MCATNG, SYSTE FRAM!Nr, IZ-11 WALLKAM. FINAL V�Al rt e,� it r77wl �-f�* �s F .1r' - xy : r ✓. �.�.�'Y JjyL• vtT. e+r`�i��'}�-trQ ;:r_��;rnr:e-p:,t;:��.G�j�• {:ir � `,•-;'1��'���.��r.C.'?ry. .�7.':,�:y%{'��T1.`—__: �.� .: �� to 3 /-p; .l A4 i. ter' :+.. ay'�`}'L""•.o�.R¢_��L��.'I.t •.LiY T-.i���.:�J•j^' :r��.. ��{�_f•�♦':y�?^r.'•. w•. - �w t �:�r -� t., ; !.w.}r. t _��.J1 t : o-Sr.':1'. _-.•1=t1.�';,. . r - ',�r.l��vt��+v� i_=+����.;3fJ1� ��D•'r.a". i.�r �' . ! .?•- _ _ •.�•��••//.. �(1� /�.�� '''Y.��• �•t ,j A L - .� ♦ f r•\ � -•l: .w✓ .z•'/;�F..�<Mr'/��C•Y� •ian �•� <.}! _ : �T. •t' �p �1 �4*�/"�.. r+•`-�'•^`,1' ` Y !' ��fj.:},t�,, .r •�'. � :'-_y.a`v• s �'''„y,,;:�•'�y,l. ,e` +•tr+'•;1n.-.4`.h�1:.tjyy.�J.�,• '" t,i•,�!''y'�.yY' •z!'-.�/[ ,'f� '� L/J-' r _ S�7�rn .�;•.'�yyy �7� ;.�` a� yti•Fy I/�Y` I.V L% =s1,:•`,5.1t:W 'n '� r:.4 `.�Y�:=•'Y' M �^+ •. c., :2.'� I d.C�CiC'�.•-IX('i': •�j.'G S mi-4%,;.�5', rt,li'�^I r•�l�f ,',Ve•w.1c�A�n�n,?;L�..<",. �.�•�.�?..�e•:.:'w'L.. b'ti���Y_'-F�!�•t�l P ,� I '�. j:j.if�'Y�3�1b.�l ' 1•S.''�� ',� ,t �f"e'. I. �•-..��'�J, `t�,; '_�.�,'•�'Yi:.+C `.�<l, i"..jl.�,;��;�•IC+:��1�1.ti.�%��;�LT�. `.'�'•�'.,�:'•RILJ!'�h r ii-�y.J.<+� f r _...��c .;!'1'` Y� ^y..• X ��]7��'ll ��yy ��(7 . . rt�j•'. ~ ,L��YI'LLb��I'ijy� �LA1fS j§;•�'r �rS'a 6' .ilrl>�1af '�' ��t.���.j �s�vc`3yJa, co .�%',�� ^��-�'-y�i� III r �4 =- ._ � _. .. - .. � _ Q:'L _ ._ .. :. .. - •� ...._ -- , . 7-77 b ± ��� .. ,-� r "�.=--' ''� _ --.. ---•�. `ram____- �`ti.,`_ --_- - -- 91- I,. .M�om,.•�� / r • .. ... .. - .. a I� 1. 1 ' APPLICATION D The City of Edmonds for SIDE SEWER PERMIT EASEMENT NO_ ---------------------------------- NEW CONSTRUCTION REPAIRS r-1 LID NO_ --------------- No- _________-________ OWNER -------- -------------------------- CONTRACTOR ------ Fa.ie- _V-A_ --- C4::*-4----V5 --- PERMIT NO. JOB ADDRESS 2" LEGAL DESCRIPTION: LOT NO- ------- -------------------------- BLOCK NO.------------------------------------ ........................... ------- =- ........................................................... ------------------ ---------------------------- ................................. ....... oved: -- --- ..................... By z�g ------------ The City of Edmonds APPUCATION for SIDE SEWER PERhIff EASEMENT No - -------------------------------------------- NEW CONSTRUCTION K REPAIRS ❑ LID NO- ------------------ - ASMT. NO. ------------------ OWNER X1 A Al -------------------------------- ------- ---------------- CONTRACTOR ---- ------- -------------------•- ----------------------------- PERMIT NO. <-,*t-tA --- ---- ----- ----- ----- --- ------ --------- -N - ----------- VA JOB ADDRESS / LEGAL DESCRIPTION: IOT NQ - ------ -- ----- - --- LOCK 0. i A T/r/Z 'W.710 1' 14)c J574 A/h ?S- i�; iif14674- ...... ......... --------------------------- I ......................... ----------------------------------- ------------------------------------ ------------ -1— -- I------- ------------------- --------------------------- -- g, -,a- � Approved: DATE BY--------------------------------------------------- YU-Fir PLANNING DATA NAME: G r M-d / DATE: SITE ADDRESS: i rflaxp PLAN C K#: d -Och7 PROJECT DESCRIPTION: Reloco.TQ exisTinLI& Pf Cjkl"fCA�3 Inr ark . REDUCED SITE PLAN PROVIDED?: @s / No MAP PAGE: 3o _1 CORNER LOT: Yes No FLAG LOT: Yes / No ZONING: ��- 1 CRITICAL AREAS DETERMINATION #: 01 _ q0 ❑ . Study Required: ❑ Waiver ."GranTed ivr r1�.} Pei.►�Ti anwy 5tA(C (�oQo5ed Ca.&VCf1an ';5 Conditional Waiver (3-00' +(-) CAJ '^0 5 g���iCa,T iMg)" Are AnrieiPr?ej. S?e noT2 Tn" µdjlpw SEPA DETERMINATION: EXe� i ❑ 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) IR Exempt SETBACKS: Required Setbacks: , Street: �_Left Side: 14 Right Side: 10 Rear: as Actual Setbacks: Street: aVV�Left Side: (O Right Side: q Rear: 015 + Street map checked for additional setback required? Yes / No / DNA DETACHED STRUCTURES: 4�72t O•k• �� �ROCKERIES: %Jam Proe� "� �,5,��� (ocke!' o f d a FENCES/TRELLISES: /Von2 froed5J. CA). BAY WINDOWS / PROJECTING MpDULATION: IVJq. pr(rkd IIMF STAIRS / DECKS: Note f r9j a PARKING: Required: �, Actual: 3 +- LOT AREA: W Q 30 LOT COVE 6 �� �/ 1 30 _ 7, b ✓ `p o k j f S li• df,- ?S Calculations: BUILDING HEIGHT: S-r/r, (^ cn � f Datum Point:yA-caT�y�� Datum Elevation: Maximum Allowed: 3,51 Actual Height: S LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: Yes No OTHER: 0 u CLX. NewBPPlanningDataForm.DOC City of Edmonds Critical Areas Determination Applicant: George Miller Determination #: CA-01-90 Project Name: N/A Permit Number: N/A Site Location: 1112 Excelsior Pl. Property Tax Acct #: 4346 000 09104 01 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 critical area, including a Erosion Hazard Area and a Wetland/Stream pursuant to Chapter 20.15B of the Edmonds Community Development Code (ECDC). Based on these findings, prior to submission of any development permit, you will be required satisfy the requirements of ECDC 20.15B by completing the following: Erosion Hazard Area UJ s F_ U UJ cr The site is also in an area designated on the Critical Areas inventory as Slopes with Erosion Potential. All proposed development must have an erosion control plan approved by the City of Edmonds Engineering Department. �:1� -D MAR 1 B 2004 Wetland/Stream � COUNTER Based on the above findings, a Critical Areas Study is required to determine the hydros} the area and to delineate the approximate boundaries of any wetland or stream and identify its buffers. The required qualified critical areas consultant needed to perform the study shall be a specialist in botany, fisheries, wetland biology, and/or hydrology with a minimum of two years' field experience with wetlands and/or streams in the Pacific Northwest. All critical areas studies shall be performed as three party agreements with the city selecting the consultant and the property owner or applicant paying the fees. The qualified critical areas consultant shall perform the following: 1. Classification of the stream and/or wetland pursuant to the criteria established in ECDC Section 20.15B.060(A)(4) and (5). 2. Delineate the edge of the stream and/or wetland -on the site. 3. State any mitigating measures appropriate to preserving and protecting the stream and/or wetland. t After the qualified critical areas consultant has delineated the stream and/or wetland boundary, a surveyor licensed by the State of Washington must perform the following: 1. Physically mark the edge of the wetland. 2. Delineate the required buffer (see ECDC 20.15B.120.A and 20.15B.130.C) 3. Delineate the required building setback from the buffer (required setback is 15 feet). 4. Create a map showing the wetland, the buffer and the building setback. The water from this site 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: Both the qualified critical areas consultant and the Land Surveyor shall enter into a three party contract with the applicant and the City of Edmonds as required in ECDC 20.15B.140(D), where the applicant pays for the study. The applicant may suggest qualified professionals for the City's approval. If the results of the Critical Areas Study determine that the lot may not be developed, the applicant may apply for a Reasonable Use Exception and Variance pursuant to ECDC 20.15B.170A and 20.15B.040C). f iiie property owner wishes to apply for a specific development permit which they feel would not impact the Critical Areas located on the site, they may submit their proposal to the Planning Department for review. If the Planning Department fords 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. Name Signature Date 2 4 -^ City of Edmonds Critical Areas Determination Applicant: George Miller Determination #: CA-01-90 Project Name: N/A Permit Number: N/A Site Location: 1112 Excelsior Pl. Property Tax Acct #: 4346 000 091 04 01 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 critical area, including a Erosion Hazard Area and a Wetland/Stream pursuant to Chapter 20.15B of the Edmonds Community Development Code (ECDC). Based on these findings, prior to submission of any development_permit,_y_ou will be -required satisfy the requiremen Erosion Hazard Ares The site is also in an a Potential. All propose Edmonds Engineering i Wetland/Stream Based on the above fir area and to delineate tl buffers. The required specialist in botany, f ; field experience with�N shall be performed as 1 property owner or appl The qualified critical areas consultant shall -perform the following: 1. Classification of the stream and/or wetland pursuant to the criteria established in ECDC Section 20.15B.060(A)(4) and (5). 2. Delineate the edge of the stream and/or wetland on the site. 3. State any mitigating measures appropriate to preserving and protecting the stream and/or wetland. 1 ., 0 F ED.�tr_ ti OCKERY EXCELSIOR. PL CITY OF EDMONDS WATERLINE AS- BUILT r ADDRESS HOMEOWNER 1112 EXCELSIOR PL CONTRACTOR SCALE MILLER NTS DATE DRAWN PERMIT 12-17-04 IBY SIBREL NO- 2004-0298 0 Consulting Robert M. Pride, Inc. Engineer February 19, 2004 Mr. and Mrs. George Miller 1112 Excelsior Place Edmonds, WA 98o2o Re: Report on Geotechnical Evaluation Proposed Garage Structure 1112 Excelsior Place Edmonds, Washington RMP Project No. 04-147-01 Dear Mr. and Mrs. Miller, RECEI;VELD MAR 1, 8 2004' PERMIT COUNTER STREET 71LE This report summarizes the results of my site inspection and geotechnical evaluation of your property located on the south side of Excelsior Place in Edmonds. It is understood that you are planning an expansion and relocation of the existing garage that is situated at the front north side of the property. A "Site Plan" prepared by your designer Chuck Lee dated February 2, 2004 was used as a reference for this report. Geologically this area of Edmonds is underlain by glacial outwash deposits consisting of dense sands, silts and gravel soils (Qva). No prior soils information is available for this site, but previous investigations in the Edmonds area showed the presence of competent glacial deposits within 2 to 3 feet of the existing ground surface. The easterly side of the property was cut into the gentle hillside, and there was some minor filling along the westerly side of the garage. A 4 to 5 foot high fill -over -cut slope is located just west of the existing garage. An unpaved driveway access currently exists along the east side of the garage leading to the entry door on the south side. Crushed gravel covers most of this driveway and most of the surface water penetrates into the crushed gravel surfacing. Existing floor slab in the garage is at an elevation of about 111.5 feet, and the new garage slab will be raised about six inches. An existing 24 inch diameter evergreen tree is situated on line with the proposed relocated west garage wall. There is a two foot deep catch basin inlet structure (invert @ ilo feet) in the street swale immediately opposite the proposed garage location. On the basis of my site inspection and on prior experience on sites in this area of Edmonds, it is my opinion that the relocated garage and the new addition can be 13203 Holmes Point Drive NE Kirkland, WA 98034 Phnna- A75.A1d_4Q7n Far A'>8LA1d+iR77 February 19, 2004 Mr. and Mrs. Miller Page 2 constructed as shown on the Lee "Site Plan." A majority of the footings will only need to extend a minimum depth of 18 inches below the existing ground surface. Footings along the west side of the relocated garage structure will be situated on the slope, and they will need to be deepened so that they bear on the dense glacial deposits. Estimated depths of these footings will be on the order of 3 to 5 feet below the slope surface. An allowable soil bearing value of 2000 psf may be used in the design of the bearing wall footings. Estimated settlement for footings founded on the dense outwash deposits will be less than 1/2 inch. The west retaining wall footing should be designed for an active pressure of 30 pcf, and lateral forces may be restrained by a passive pressure of 200 pcf. All backfill behind the retaining wall and under the floor slab should be compacted to a uniformly high density before pouring the garage floor slab. Drainage off of the roof of the new building should be captured by gutters and down drains, and then tightlined to the catch basin at the front of the garage. A strip drain is recommended along the front of the garage slab in the new paved driveway, and this water can also be directed to the catch basin. In my opinion there is not a need for new area drains since the garage expansion will cover most of the previous impervious area that consisted of the old driveway. Please call me if there are any questions regarding the findings and recommendations of this report. Respectfully, Robert M. Pride, P. E. Principal Geotechnical Engi dist: (2) addressee rmp: MillerGaragei EXPtRQ� Z,� � 13203 Holmes Point Drive NE Kirkland, WA 98034 Phone: 42�-814-397o Fax: 425-814-5672 � 0, P/4�FILE # FOMI FOR [PR-WFIhAL] DL-CI. MTION OF [SIGNUTCA /NONSIGNIFICANICE] . Description of proposal Single family residence Proponent Ronald Johnson Location of Proposal 1110,Exce.isior Place Lead Agenc9ity of Edmonds This proposal has been determined to R/not have] a significant ad- verse irpact upon -die enviror�,'icnt. An EIS [is/is not] required wider 10-1 43.21C.030(2) (c) . This decision was made after review by the lead agency of a completed envirm-niental checIdist and other inforniation on file with the lead agency. Responsible Official Mary Lou Block Position/Title Associate City Planner Date March 20, 1978 Signature h L6 (.� ENVI RONIMENTAL ASSESSMENT FILE # 7 q0I A � .DESCRIPTION OF PRO PROPONENT: EXISTING USE: I�•GA1�'C l V� O l_D GCA .GG l ENVIRONMENTAL I"1PACTS FROM PROPOSAL: SOILS/TOPOGRAPHY WATER/DRAIPJAGE - �'�l/V„py� ��C,ejS l A svo &Y\-� AIR QUALITY - p/�,1,-������ C" ;6 C7f CIRCULATION A LGF.�SS 01",\ VEGETATION - ECONOMIC - CITY SERVICES - ENVIRONMENTAL FINDINGS: f,X.L c OYC— t UI.N l�YUa-S ►-� l �1 �IGc S►'C o ts,� _ There will be certain environmental impacts but they do not 'constitute a signif- icant adverse impact on the environment and no environmental impact statement will be required. There will be significant adverse impacts on the environment and an environmental impact statement will be required. There will be certain impacts on the environment however it is necessary to obtain more information before a declaration of significance or non -significance is made. CITY PLANNER DATE CITY ENGINE&R DATE E/A '76 N M PROJECT NAME ENVIRONMENTAL ASSESSMENT DATE SUBIMITTED S ' & . 797 In order to meet the requirements of the State Environmental Policy Act of 1971, the responsible official must make a declaration of environmental impact as early as possible in the process of evaluating a project. The information in this form will be used to determine whether it will be necess- ary to require an environmental impact statement. If an impact statement is not required, a Statement of i'legative Declaration will be placed in the file. If an impact statement is required, a draft statement must be filed with this office, public notice given and a revievi period of 30 days allowed. The final statement and comments must be filed with the Department of Ecology, Office of the Governor and the Ecological Commission. The Edmonds Planning Staff will assist you in any way vie can in accumulating this information and we Mould appreciate your cooperation. 1. Land: Area in acres 41� 4T I�$ 64z— NLOmwovo C<VKMF4. SAND �Yv� kr-5idamftA� �/1�$ Soils type q C�. Limitations -50J U,rn kA Description of topography (% slope) 30 % ujrtl - LUG. A;- itaa OF- u7i Awso oiu, out /,moo OACS, r Grading: estimated cubic yds. 50 "9VW. NOTE: If grading or filling will exceed 500 cubic yards Filling: estimated cubic yds. 5;0 a grading and filling plan must be submitted with the 2. Water: application. Stream - estimated flow (cubic feet per second) Will stream be altered? To what degree'?� Impact on storm drainage (increase in run-off) u1mv.) Estimated area . to be paved OUWIWW o t J 10/0 Estimated area in open space °/rs Shorelines: within 200 ft. of Mean Higher High Water ko Adjacent to shorelines zone Oil Environmental Assessment, page 2 3. Vegetation: Type of trees %U6 FWU AWB_LZfNtll�� to be removed Minimum diameter of trees to remain Ground coverg**(,� A- % to be removed ®/0 Proposed landscaping, if any aWO (AW A459s, � 4 4. Existing Land Use within 300 ft. radius of proposed development: Vacant Single Family Multi - Family Comm. Other North South East Vies t 5. Circulation: Estimated increase in auto trips daily Estimated demand for public transportation 1w Degree of change on adjacent streets � 6 6. Area of impact: neighborhood city-wide regional 7. Effect on air quality: 1' W(w 1 2 RAO 8. Changes in noise generation: 21 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 2.4 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 • ._a DATE: 78 A $25 fee will be collected by the City of Edmonds for analysis of the Environmental Checklist and the preparation of a Threshold Determination. No fee will be charged for proposals which would be categorically exempt if they were not located in an environ- mentally sensitive area. ENVIRONMENTAL CHECKLIST FORM I. BACKGROUND 1. Name of. Proponent _osgi 2. Address and Ptione Numoer of Proponent: 3. Date Checklist Submitted- 4. Agency Requiring Checklist 5. Name of Proposa.., if applicable: 6. Nature and Brief hescripcion of the Proposal (includ- ing but not limited to its size, general design ele- ments, and other factors that will five an accurate understanding of ,its scope and nature): 7. Location o Proposa (describe the pF sicaT setting of the proposal, as well as the extent: of the land area affected by any environmental impacts, including any other information needed to give an accurate understand- ing of ,the environmental setting_of the proposal): 8. Estimated Date for Completion of thc: Proposed Action: 9. List of all Permits, Licenses or Government Approvals Required for the Proposal (federal, state and local -- including rezones): -31- 1 2 10. Do you have any plans for future adG.LtiunIs, expansion, 3 or further activity related to or connected with this proposal? If yes, explain: 5 5 - 6 7 11. Do you nova of any p ans by others which may affect 8 the property covered by your proposal? If D yes, explain: 9 10 11 12. Attach any other app ication form t at has een com- 12 pleted regarding the proposal; if none has been com- pleted, but is expected to be filed at some future 13 date, describe the nature of such application form: 14 15 16 17 18 II. ENVIRONMENTAL IMPACTS 19 (Explanations of all "yes" and "maybe" answers are 20 required) 21 Yes rlaybe No 22 23 (1) Earth. Will the proposal result in: 24 25 (a) Unstable earth conditions or in 26 changes in geologic substructures? 27 — -- 28 (b) Disruptions, displacements, com- 29 paction or overcovering of the soil? 30 — 31 (c) Change in topography or ground 32 surface relief features? 33 — — 34 (d) The destruction, covering or 35 modification of'any unique geologic 36 or physical features? 37 --- — 38 (e) Any increase in wind or water 39 erosion of soils, either on or off 40 the site? 41 — 42 (f) Changes in deposition or ero- 43 sion of beach sands, or changes 44 in siltation, deposition or erosion 45 which may modify the channel of a 46 river or stream or the bed'of the 47 ocean or any bay, inlet or lake? 48 _ — Explanation: 6�IJ& OG 5'Otli �f41�/t/ 549 0 i 51-- 52 (2) Air. Will the proposal result in: — 53 54 (a) Air emissions or deterioration 55 of ambient air quality? 56 i — 57 (b) The creation of objectionable 58 odors? 59 —" 60 (c) Alteration of air movement, 61 moisture or temperature, or any 62 change in c'imate, either locally 63 or regionally? 64 --' - — 65 Explanation: 66 -32- I 1' 2 3 4; 561 7 8 9! 10i lli 12i 13j 141 161 17' 18 19 20 21 22 23 24 25, 26, 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 Yes Maybe No (3) Water. Will the proposal result in: (a) Changes in currents, or the course or direction of water move- ments, in either marine or fresh waters? (b) Changes in absorption rates, drainage patterns, or the rate and amount of surface water runoff? (c) Alterations to the course or flow of flood waters? �( (d) Change in the amount of sur- face water in any water body? (e) Discharge into surface waters, or in any alteration -of surface water quality, including but not limited to temperature, dissolved oxygen or turbidity? (f) Alteration of the direction or rate of flow of ground waters? (g) Change in the quantity of ground waters, either through direct additions or withdrawals, or through interception of an aquifer by cuts or excavations? (h) Deterioration in ground water quality, either through direct in- jection, or through the seepage of leachate, phosphates, detergents, waterborne virus or bacteria, or other substances into the ground waters? (i) Reduction in the amount of water otherwise available for public water supplies? _ Explanation: (4) Flora. Will the proposal result in: (a) Change in the diversity of species, or numbers of any species of flora (including trees, shrubs, grass, crops, microflora and aquatic plants)? (b) Reduction of the numbers of any unique, rare or endangered species of flora? -33- 11 21 41 6I 8 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 Yes Maybe No (c) Introduction of new species of flora into an area, or in a barrier to the normal replenish- ment of existing species? (d) Reduction in acreage of any agricultural crop? I - 'X E?planation: 'Hf(C-A&-- YJLRn I A— e.n_. _ _ _ (5) Fauna. Will the proposal result in: (a) Changes in the diversity of species, or numbers of any species of fauna (birds, land animals including reptiles, fish and shell- fish, benthic organisms, insects or microfauna)? (b) Reduction of the numbers of any unique, rare or endangered species of fauna? " (c) Introduction of new species of fauna i.nto.an area, or result in a barrier to the migration or movement of fauna? (d) Deterioration to existing fish or wildlife habitat? Explanation: (6) IJoise_. Will the proposal increase —,_ existing noise levels? Explanation: (7) Li Aht aiui Glare. Will the pro- poses prO uce new light or glare? Explanation: (8) Land Use. Will the proposal 1 7 tin the alteration of the present or planned land use of an area? Explanation: -34- Yes 'l4la -be No (9) Natural Resources. Will the pro- posa result inn. (a) Increase in the rate of use of any natural resources? (b) Depletion of any nonrenewable (� natural resource? Explanation: (10) Risk of Upset. Does the proposal invo.ve a risk of an explosion or the release of hazardous substances (including, but not limited to, Oil, pesticides, chemicals or radiation) in the evert of an acci- dent or upset conditions? Explanation: -�- (11) Po.ulanon. Will the proposal alter. t e location, distribution, density, or growth rate of the human population of an area? Explanation: (12). Housing, Will the proposal affect existing housing availability, or create a demand for additional housing? ._ Explanation: (13) Transpor.tation/Ci.r_culation. Will t-Fie pr.oposa result (a) Generation of additional vehicular movement? (b) Effects on existing parking, -F= facilities, or demand for new parking? (c) Impact upon existing trans- portation systems? (d) Alterations to present patterns of circulation or move- ment of people and/or goods? (e) Alterations to waterborne, rail or air traffic? ' 1 -35- I 2 3 4, 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 I 21 22 23 24 25 26 27 28 29 30 31 32 33 .34 35 36 37 38 39 i 40 41 i 42 I . 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 Yes Maybe No (f) Increase in traffic hazards to motor vehicles, bicyclists or pedestrians? — Explanation: (14) Public Services. Will the pro- posal —have an effect upon, or result in a need for new govern- mental services in any of the following areas: (a) Fire protection? (b) Police protection? !� (c) Schools? (d) Parks or other recreational facilities? (e) Maintenance of•public facili- ties, including roads?— (f) Other governmental services? Explanation: (15) Energy. Will the proposal result in: (a) Use of substantial amounts of fuel or energy? (b) Demand upon existing sources of energy, or require the develop- ment of new sources of energy? Explanation: (16) Utilities. Will the proposal resu t in a need for r.. q stems, or alterations to the following utilities: �( (a) Power or natural gas? (b) Corrimunica t ions systems? (c) Water? (d) Sewer or septic tanks? lv (� (e)_. Storm -water drainage? (f) Solid waste and disposal? Explanation: u -36- ' Yes . Maybe No 1 (17). Human Will the proposal l resu .te creat_on of any 3 health hazard or potential health 41 hazard (excluding mental.health)? 5 61 Explanation: 7------- 8 9 (18) Aesthetics. Will the proposal 10 resu t in —the obstruction of any 111 scenic vista or view open to the 12? public, or will the proposal re- 131 sult in the creation of an 14 aesthetically offensive site open 15 to public viero? i 16 17 Explanation: 18 19 20 (19) Recreation. Will the proposal 21 resi1.t in an impact upon the 22 quality or quantity of existing 23 recreational opportunities? 24 25 Explanation: 26 27 28 (20) ArcheolgLical./lli.stol-ical. Will the 29 proposal resuT in an a teration of 30 a significant archeological or his- 31 torical'site, structure, object 32 or building? 33 TN` 34 Explanation: 35 36 37 III. SIGNATURE 38 39 I, the undersigned, state that to the best of my knowledge 40 the above information is true and complete. It is understood 41 that the lead agency may withdraw any declaration of non-signi- 42 ficance that it might issue in reliance; upon this checklist 43 should there be any misrepresentation or lack of full disclosure 44 on my part. 45 46 Proponent:. 47 . 48 WAC 197-3.0-370 WITHDRAI•MI, OF AFFIRMATIV }{}>l S110LD 49 DL'TL'RP I��1i'ION. 1 at any time after the entry of a declara- 50 tion of significance, the proponent modifies the proposal 51 so that, in the judgment of the lead agency, al-1 significant 52 adverse environmental impacts resulting therefrom are eicant 53 aced, the declaration of significance shall be withdrawn 54 and a declaration Of nonlimin- -significance entered instead. The 55 lead agency shall also revise the registers at its SEPA 56 public information center accordingly, if the pro- 57 ponent of a proposal is a private applicant, the proposal 58 shall not be considered modified until all license appli.ca- 59 tions for the proposal are revised to reflect the modification. -37- F7 LIMITING SOIL FEATURES INDICATED BY TIMER ON SOIL INTERPRETATIONS SHEETS SNOHOMISH COUNTY S.W.C.D. 0 All features satisfactory 1 Texture too fine 2 Texture too coarse 3 Gravelly, very gravelly, or stony 4 Unified or AASHO soil class unfavorable; less than optimum bearing capacity; moderate to high shrink —swell 5 Drainage class unfavorable; depth to seasonal water table too shallow; drainage may be needed 6 Flooding or ponding hazard 7 Slope or topography unfavorable: imposes use or construction hazard; sprinklers required when irrigated 8 Slippage potential 9 Depth to bedrock or impervious material is limiting 10 Frost action potential is moderate or high 11 Shrink —'smell potential is moderate or high; high shrink, low swell for organic soils 12 Permeability (percolation rate) is restricted 13 Accessibility by equipment is restricted 14 Excavation difficult due to consolidated materials; or clay or silty clay soil texture 15 Slope stability is fair or poor 16 Piping hazard 17 Thickness of suitable material is limited 18 Erosion hazard is moderate, severe, or very severe 19 Shear strength is moderate or low 20 Compaction characteristics are fair or poor 21 Permeability rate is too rapid 22 Permeability rate when compacted is too rapid . 23 Low water holding capacity, - 24 Practice not applicable 25 Sandy substratum at depths of 18 to 40 inches; limited water holding capacity, rapidly permeable 26 Organic soil 27 Possible pollution of ground water even though site is at least well drained 28' Stones cover 0.1 to 15% of ground surface 29 Soil textures permit ready sloughing of sidewalls 30 Compressibility is medium, high, or very high 31 Wet areas may be lower than available outlets 32 Moist consistence is loose, firm, very firm, or extremely firm 33 Excessive fines or limited supply SOIL SURVEY INTERPRETATIONS FSTIMATFn PHYSICAI enln I-WP7nn1(-A1 nonnI— i+ i. tFxva�oad �i «r,�r�e.r.a �,py W01hI Hc�fOA VYa(xy UG `v MAJOR Pub')(', CLASSIFICATION COARSE PERCENTAGE BY WEIGHT LESS THAN 31NCHES PASSING SIEVE NO. AVAILABLE SOIL FRACTION --- PERMEABILITY WATER SOIL REACTION SHRINK -SWELL POTENTIAL HORIZONS > 31N. (In/hr,) CAPACITY (PH) POTENTIAL FROST " (INCHES) U SDA UNIFIED AASHO / % 4 10 40 200 (in/In) ACTION TEXTURE 0-30 gravelly sandy S?: -1 or .,- 3-5 6;-00 0-75 40-55 21-32 2.0-6.3 loan .09-•11 5.6�.0 Low Moderate 30 gravelly candy S;: A-1 or - .0-5 65-80 55-75 33-52 15-3C, < 0.G6 -- 4.5-5.0 loam Low DEPTH TO BEDROCK OR HARDPAN: FLOOD HAZARD: EROSION HAZARD: CORROSIVITY—UNCOATED STEEL: 24-5% inches to hardpan ::one I.loderate to severeModerate DEPTH TO SEASONAL WATER TABLE; HYDROLOGIC GROUP: SLIPPAGE HAZARD: CORROSIVITY-CONCRETE: 2= feet C i•:oderate Moderate SUITABILITY AND MAJOR FEATURES AFFECTING SOIL AS RESOURCE MATERIAL i/ TOPSOIL; SAND: GRAVEL. - 3 7cor - 33 "Poor - 33 [ROADdFILL;roor DEGREE OF LIMITATION AND MAJOR SOIL FEATURES AFFECTING SELECTED USE SEPTIC TANK FILTER FIELDS: SEWAGE LAGOONS: SHALLOW EXCAVATIONS: LLINGS: Severe - 5, 12, 7 Severe - 4, 7 Severe - 14 3 7 Sever O LOCAL ROADS AND STREETS: RESERVOIR EMBANKMENTS; DIKES; OR LEVEES RESERVOIR AREAS OLF FAIRWAYS: Severe - 7, 22, 16, 18, 14, 2 21 7, Severe - 7 CAMP AREAS: PICNIC AREAS: PLAYGROUNDS; PATHS AND TRAILS: Severe - 7 Severe - 7 Severe - 7, 3, 5 I•:oderate - 7 SANITARY LAND FILLS CAPABILITY AND POTENTIAL YIELDS WOODLAND TRENCH TYPE: � evere - S, 7, i4 AREA TYPE: Severe - 5, 7 COVER MATL_ Fair G-3, " -"3 F-oor - 3, 32 3, CAPABILITY SUBCLASS WOODLAND SUITABILITY GROUP SPECIES AND SITE INDEX MANAGEMENT HAZARDS AND LIMITATIONS SEEDLING MORTALITY WIND THROW HAZARD PLANT COMPETITION EQUIPMENT LIMITATIONS SPECIES SUITABILITY 2d1 DF - 15R4 P,0 Slight Slight Severe Moderate DF• GF, ''PC . 4y{ 11' S1opc -,.-as not used as a rating factor. j CL R L V X 9 5�,� oF'coa-s q��Q�C OF EoMANo6 SAM w77{AcYs l C I irY 4'F VOK& 09 SHOHON10 Cca,. WA. o j, > N-4 z .o G a�Sa01- • A17T* 1-1a.J 0z f A vEo 3 '" 15T'tNC R E SI DEA/Cr -7 T- — — — — — — — — — — — — — — — --- 107 oL Tan& U- /1 0 Al j U111M rlag- MA. t IARS G 6 oRGg ,titIL) ER Setbacks Reggired Actual 1112 EXC-EL 510A PA. EPA OW03" wq. feo;to Front a 5 i'- 1415- 7764,10.9 -' Sides Lo L-10 -ot-S Rear �S ' (a S �- PROD LAN' INGOther �^T se -ck avex d pe,, ECDC Haaht x. ;LOV,* ,LOT A AEA ffx I9-71G dAn •�®a &A R APPA/ APPROVED AS NOTED BY ENGINEERING, Date: 4 IS/a0414 Set sie f � u,5 ll/ jodan yzen{� d 4 C) 0 0 Pr Alp,:( �C:";"Et0 AS NOTED BY ENGINEERING Date:_ 411alub j e ACCEP-I AS�E T IGHTLINE SDR 35 MATERIAL RIGHT-OF-WAY CCtiSTRUC 3 ION PERMIT SCH 40 AND INSPECTION REQUIRED N -12 AM F810 HANCOR TIGHT L1 to = Lo c, O'WNER/CONTPAC;OH IS RESPONSIBLE FOR EROSION CON O, AND Dr;MAGE L A N THE W. 70' 0F THE E. 1/z OF LOTS'if � 42 OF )`t7MON-1)5 '5EAYILW TRACTS C.IT1a OF EAMahir-75 mlQot-4oMt,5N COveA. 2149.0 EXISTiP1G I^- PK1= 1977 IJAPCRVIDCIS PAOPOSED A1EINADDL. J �7F7- 81 to ty umjj 6MPFR%/Wlts f1F�K} N f W 6 FtRA'8tf� � V1Ikc-IILV1/{� ) T1 �ma EXIST/ti_ RcS�97j /60� IF EXC4V4T/per /,v TE s 6c S - — — - -- R _r s Es To PC A S4oc tzlg�ti -?4?_ m-lz�cwn tF fi�Ewcl�CtvrJ �N1�S NF-�c�SfiR�( 2 2 q. o D'R t N4G E PTL ,4� N SrRk7er FDA. M R. k MR5 G1r ORG-E MILLS-R GARAGE 1112 EXCELSIOR PL. E-0MOND5,w�. 98o20 REF SITE PLANNINC 'IZi-774�,-HI10 CuuCK LEE RECEIVED MART 8 2004 a . . ffm��"`,kj .,-1 :,:-k `��° °r CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEINAME OF BUSINESS MAILING ADDRESS C.S/D L CITY nZJQo'O TELEPHONE s I.. I III &L 2 Ci 77/_ V �, r ADDRESS ; + Q Q .i CITY ZIP f6EPHONE TS" NAME CBLN ADDRESS CITY ZIP I TELEPHONE STATE LICENSE NUMBER EXPIRATION 1 I PROPERTY TAX ACCOUNT PARCEL NO. ; " PERMIT EXPIRES "I'i 4- USE E Gr C�I o; ,Q NUMBER JOB ? ` E/APT# / Q' 1,/� ADDRESS /'0z l/ PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ' RW Permit Requked street use Per"Ift �a EXISTING PROPOSED nspecdo Required 'Required "/ Sidewalk REQUIRED DEDICATION FT OadergrD1tlul Widng required Q METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED /~ YES E3 NO E3 REMARKS = OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE riY./1 I 1 Oi'. r1 i a it n,-�.�r.,. I � . f.1► ,gin n� , � ..1 f�i -r � .1..,•� r... FIRE REVIEWED BY I DATE CHECKED BY VARIANCE OR CU IRADB# INSPECTION \- . BOND `-' RE 'D III P D DYES NO $ N, AREA HT' PROPOSED ALLOWED PROPOSED ❑ NEW RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE ALLOWED 'RE UIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ❑ ADDITION ❑ COMMERCIAL COMPLIANCE OR ❑ CHANGEOF USE PROPOSEED 35 OOO/. s • ONT /SIDE REAR- I D/ 3,5 ,/D,(� FRONT UR SIDE REAR _L /' �d� T ❑ REMODEL ❑ MULTIFAMILY ❑ SIGN S o PARKING REO'D P OV�DED LOT AREA ' / � P NING REVIEWED BY DATE u l/ �. � FENCE 'r b P 1 � 4 REPAIR ❑ GRADINGCYDS ❑ X Fn REMARKS /(D Cr1 �IC OTHER a G i vj { (( `p r► k r ❑ DEMOLISH ❑ TANK ❑ I;�t%IV �r TAB pet.,., v/k19 GARAGE CARPORT RETAINING WALL ❑ ROCKERY FIRE SPRINKLER ❑ FIRE ALARM l I -e 4r add. i (TYPE OF USE, BUST CHECKED BY TYPE O RUCTION DE OCCUPANT � OROUP NUMBER OF NUMBER OF DWELLING CRITICAL AREAS C4-tV/_70 SPECIAL INSPECTION OCCUPANT STORIES UNITS NUMBER REQUIRED ❑YES JAREA LOAD DESCRIBE WORK TO BE DONE PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D E C' 'm VALUATION I I $ f i 9s.c Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge s PLAN CHECK NO: / _ L VESTED DATE Plumbing Base Fee 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 j DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. � Engr. Review W PERMIT APPLICATION: 180 DAYS Engr. Inspection d PERMIT UMrP I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS SEE BACK OF PINK PERMIT FOR MORE INFORMATION GO NT, 'APPLICAON 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 aEDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY ANO 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 S DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due O NOR LIMIT IN ANY WAY THE CITVS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* z �r r Recording Fee Receipt # C I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION 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 CALL This application is not a permit until signed by the IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Building Official or his/her Deputy: and Fees are paid, and receipt Is acknowledged In space provided. WORKMEN'S CO SATION INSURANCE AND RCW 18.27. SI Tu)iY(OWNE R AGENT) DATE SIGNED (425) OFFICIALS SIGNATURE DATE x "Cy 771-0220( ATTLdNTION EI T 1333 RE EA ' BY qTE ITjS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL - L { C; .��(_ • A'FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR osioa PRESS HARD -YOU ARE MAKING 4 CO� ES ■ APPR- VED AS NOTED BY ENGINEERING Date: E w SCAt.E : 1"= 20=o RIGHT -OF -WAY CONSTRUCTION PERMIT AND INSPECTION REQUIRED n 1:. 411 'TI 11�, C: ,tl ciuitu) 0 = , l� -�_ L� I�tvftcKAI S I N THE W. 70' Off' THE E. VZ OF LOTS 1.1 � 42 or- EIDMOND5 sEAVJGW TRACTS c ITY OF SDmom PT 5 �t.lol+ol�tl-sN c0,, wn�. ACCEPTABLE TIGHTLINE MATERIAL SDR 35 SCH 40 N-12 F810 RANCOR G X;�'rtN4- 120vKE t2.Y �.� 1 li.rlt 4tlr•.1 i 6.A� I� . ^�7 �j i �.;Z Z Cs \fit r 11(a�,- ' iEE- �i — a C.EJc.ti fidA!�� EX1STINK1 RE5)rEi�C PRE Ia7l IMPEAVIDUS PR DPDSED NEW ADDL. ? Q FT 87fo i{ Nzw6MP VloUs fl�aE�'. CN 4� Gm rem u.k--VJa-L-i N� � o� � C��) 055-�-Yot6 "IAl ca. �C��� "IF Fa6'r1wC- 5-*,C,4VA4 TO A/ /N7'ERS'0c 77-r SE �. ��:� T 22?. o 6WNER/CONTRACIFOR IS RESPONSIBLE FOR EROSION CONI ROL AND DAMAGE D R A I N A C IZ PLAN r FOP\ Mid. k MR5 C-SORGE MIL.LIER GrARACE (n 1112 EXCI`L5)01-', PL. ETJMOND5,kl�. 98020 `12-57 77�,- IWO REP; SITE PLANNING CHUCK LEE a° �Y a STREET 51LE RECEIVED MAR 1 8 2004 PERMIT COUNTER e k s w SCA.L.E : !"= 20=0 RECE1.VED SITE FLAN MAR 1 8 2004 TH E W. 70' Or THE E. )/z OF t_OTS qi � 42 O V- E- OM OND5 SEA.Y)G W TRACTS CITY OF ET)MoNn5 PERMIT COUNTER !!SuONOM115N C.O,, WA,. 'a Go vsrzET7 WA.14 L+AY fry 1 Q 13 Q a O Vr•..ev I RED PVEy, � �—• V ?_ r ,. yPArt. .J F� 0�. / — g A4E- i _... r U-- V yG r ZONE SETBACKS: If FRONT 15 SIDE -- - 10 14 - REAR '+ OTHER HEIGHT S ..., _.....,..,...... 2K9.0 EX)STI►.1G T�ESIAENC� 224. o ROVED BY PLANNING W,41 �Mid. ; MR5 GFoRGE M1LL.ER J4 1 0�� 1112 EXCEt-5)OR At_. EM-10M J5, WA,. 98o20 i '12-S- 7 7G - lr 11 m 4E1Crwr CALC5 A 1d2.o >3 l08.0 � tle.0 "TOTAL: 1-134,y 4 = 108.4. MEAtJ t 250 133.E M/4X JZ�•S- LOT ATZ EA = )6,93.0¢6 E x 113TG RG-3, : ► (� 09 + G N R A, Vp TO T-A L c v", 5 % ST REET FILE L 0 O rq .-Pr-RC} '-D AS NOTED ONLY BY ENGINEERING ��� i�RE 147 7 I,fiipERV l0[JS Date: +v``208�{ ��/$�2Q THE W. 70` oF• THE E. /z of LoT3 'I P /10PO5 c D AVE W ADDL . L7 F7" OF ETJMOND5 5EAV) aW TRACTS �1 GI71' OF EDMomrn5 81(n tu krrpw impe4"W is S -� m o w o M t-5H C o, , ACCE► IAELt TIGHTLINE SCA-1,G : zo, 0 MATERIAL /r; ,��c/Svl60 SDR 35 RIGHT-OF-WAY CCNSTRUC i coVFce _c,a ION PERMIT SCH 40 AND INSPECTION REQUIRED N -12 /V E 1,i 6PA A 4 (5N F810 HANCOR t 6,:f47- qt q,?,49 yy�) 4 Locw Tee ea Lj:rZJ49.0 C-:x ric. Rv�xEr2.Y f t •mot. t 1` 4 S ^' pot' '. r 71 . GHT LI t>'��� F. i • _ n j - , i� .�4a �'F� i T 24CZ �,�; `''' �N TIO, �`, T Q aF4S IF FooT�wG EX�9�4T�a� 14e rER s Fc 7s AI S R -�' � �f�CGN1�5 IVEC�c�4SfiRt( 2 2 q. o OuiiNER/CONTP,AC 9 OR IS RESPONSIBLE FORE osloN 00o � 3► AND DAMAGE RECEIVED MR. MR-5 GSo1ZGE MILLIER GARAGE MAR t 82004 III? EXCFt_5)0� PL, EDMON05, wx. 98o2o RE F 5)TE PLA NN IAJC y25- 774-- ylly C6) COUNTEF CUUCK LEE T E vV S"LE:t stat0 RIGHT-OF-WAY CONSTRUCTION PERMIT AND INSPECTION REQUIRED f;oR $TOM Cof�M'd:TW�) io 11, 1�.. Ld V 7" 71 EH NAINAC76 PLAff APPROVED AS NOTED TNg W 70' *Frbfr 5' OF-c ors if t ff- BY ENGINEERING OF EoMoi/,F s6=A11itv-0.1 ACTS JM ,u M �L(. c t $Y of F00(41410s Date: ����� S/voAf OM13# co,. WA. ACCEPTABLE TIGHTLINE MATERIAL SDR 35 SCH 40 N-12 F810 HANCOR OWNER/CONTRACTOIrl iS RESPONSIBLE FOP, E90F.'O.N 00,N- !0LAlllD 04 MA E 11l2. Z9q.0 RECEIVED MAY 2 7 2004 PERMIT COUNTER IWEW GArAkCE�- vl/AcKWAY 976 � AELOCA7ED GAAAGE C)qW-) 460 r_— XIST/Ncl AE5. CW61 14,o9 DRAINAGE PLAN Mi-\• t IhAS G E oRG6 MI1 l E� E01EL.510A PL. EPA ON091 wq, 98o�to 425- 716- 41" REV/S 1 o N T o -A PPAOVED P44N /, AEDVCES STRESs on/ CEPAA Aoo7-s 2.INCAEASFS 9-AU 4• ToCA%'c'H BASIN 3. REtDVCF5 I6 0 0 OF )M?ClkVIOL)S AREA IN FR D/VT o� ,49A 9�R" 5'" VEs G Q 0P IV Al !M PE1%l o OS ARCA 5y CW0,4)? TREE_ X 1) V CL 44 LI 3I Ici1. s ti 0 tp lra It t lot z z +r W ?9' of t I l OF CoM owov sr &� 7 fAcT c 12ry OF vvA( ffl A�7'S SNohl oM1sy Co, WA. w Ito'0Az o �� �•� .o � Z �s4�SW o'T� 4i7771 TION � v Q 7, vN E 3 � ti x ar a l; — —�� -- 7- `- --- — /. J r Zone S_I CornerN Flag /_ etbacks Rec--died Front Actual Sides Rear �,cK uveE j Other �"Q^� s pe i lzc/) c 16.X0 . qo 4 Hei t ES ,-Xczx' (6.3.fr 0 p VA 150AA; 19 C 51 D E7A/c E 21Cq. o MP,. * MRS G E oRGg M«c lilt J a C-6 . S(OA AL EDA ON09, W4. 9g0;10 It IS- 776,- Iftfe PPRO E Y PLA NING a C i =1 str;3' 14AF44 Al f zs.o )-oT AREA irx Is7'c 01 gs ff x !s'7'G GAj j �► sA R A0VN 70r4l c% . s (6,93c�i I �®off K=15.es90 APPROVED AS NOTED BY ENGINEERING �? ►M f w" - Date: �lsl ZaID4. flan {� 67 r- ' 4, ka SEP - 7 "o k CITY COPY' PERMIT COJ� 0 ' � S1.:F: .•� r J� .A.P City of Edmond's'= `" k Permit No: RIGHT-OF-WAY CONST.RU 1° TION PERMIT Issue `Date: j Jam' ;I n A. Address or Vicinity of Construcriori:--._ B. Type of Work (be specific): ' 4�l T�j�Kf C. Contractor: &90 CO IV S % e, Contact: (110 . RO to *e Mailing Address; 2 Z )D Phone: y2 � 7C% ""J State License #: ab`, Q '', 99 30 4 Liability InsurancOOD —,Bond: $ vC / City Business License #: D. Building Permit # (if applicable): �b ! Side Sewer Permit # (if applicable): E. ❑ Commercial i `❑ Subdivision ❑ CityProject, ❑ EUC (PUD, VERIZON, PSE, COMCAST, OVWSD) ❑ Multi -Family Single Family "© "Other INSPECTOR: (I��Qyfj L4*hJQAIS F. PAVEMENT CUT: ❑ YES ❑ NO G. SIZE OF CUT X 4 CONCRETE CUT: ❑ YES ❑ NO �. G. ❑ Mail Approved Permit ❑ Call for Pickup APPLICANT TO READ AND INDEMNITY: Applicant understands by his/her signature to this application he%she holds the City of .Edmoonds harmless from injuries, damages or claims of„an_y kind or description` whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense 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 AKE THE PINK C Y F THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INO PECTIONS t Signature: 'W Date: l ZD .% ontracto or Agent) Approved'by: Time Authorized Void After, to 'fee) Speeial Conditions: the r-i REQUIRED INSPECTIONS: Call 425-771-0220, Ext. 1326 for a 24-hour voice -recorded inspection request line. FINAL APPROVAL OF PERMITTED WORK: DATE:. 1 spector's Signature NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE CADocuments and Settings\CurtisNy Documents\Forms\Engnrng\ROWpermit_ doc Revised 10/01/03 wa r Tt:-w 2"j SACDL-: 19to ------- ---="---1i---------NAS-------------------------------- 1. CALL 2 DAYS BEFORE YOU DIG 1-800-424-5555 2. CITY OF EDMONDS: Maintain a minimum of 5' horizontal and 3' vertical clearance from all city utilities and appurtenances. Cuts in paving are shown as 'I cuts in paving anticipated. Notify Engineering Division 24 hrs prior to construction - 425-771-0220 3. WATER MAIN LOC. SHOWN IS APPROXIMATE 4. PROJECT MANAGER: DOUG USITALO - 425-356-7520 I I - Z4O' 2-" MPE PIPE ITEm OUANT. DESCRIPTION STOCK NO. BILL OF MATERIAL PERMIT TAX CODE PERMIT D.G.R. 5-12-qB PERMIT 1i4 SEC. SE - 13-,2-) -3 PERMIT PLAT Its 1 Ola-] OP MAP 1Lo0. O(.02 WastblgWi1_ AREA I I Ntura Gin AvkrshngMEr"WCoffpary SEQ. NO. Z'' MPE IP MAIN EjCTN I1I2N EXCELSIOR PL DWN. TWOOD .4 /1?-) 16116 IR �RR JOB %14)-75 D. CHKb ;CMG /��'/`lam DRAWING I SCALE W �' APP. CjW 1 "-T I'76