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1121 EDMONDS ST.PDF1121 EDMONDS ST 0 ADDRESS: �(2! �C,G �/LlD/`(GL) TAX ACCOUNT/PARCEL NUMBER: BUILDING PERMIT(NEW STRUCTURE): COVENANTS (RECORDED) CRITICAL AREAS: 2'Wb DETERMINATION: ❑ Conditional Waiver ❑ Study Required Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DA' PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR - PERMITS PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: Z SEWER LID FEE $: LID #: / SHORT PLAT FILE: LOT: BLOCK:�j _ ✓/L�.e �� SIDE SEWER AS BUILT DATED: 2 `2 1/4 SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: FOR WATER METER TAP CARD DATED: OTHER: L:\TEMP\DSTs\Fonns\Street File Checklist.doc MEN CITY, OF EDMONDS. & WORK PERM Application No. -::�.I`.''� Z_3 Building Department Permit Limit, One Year k, , T.I0.W'is*-hereh,'; made for a t to construct the following work, in accordance with the accompanying plans a tOries ...... 4"/Ad dn . .................................. .............. .................................................. Ground Area ................................... No. S 7' ................. Const. Type ....... ................ Height ............... ........................................................................... ............ re Zone ................ Andress' ............................. i / ............................................ L ....... .... .... J.... Use Zone.. ............ 7 ....... e . . ... ............................ .............. ... Sewerage. ........Block-. .. ........ d'n ...... .. / ..... ............... ........... UL Setbacks ............ r .......... Bldg. ........ f ...,frY .......... Min. Rear........ 17-1 ....... ....... Sides... ........... Width...... Bldg. Setbacks, Front and ...... ............ . ....... Phone..,..��... .. Address... 36 ...... ........ .......... ......... Phone ........................ ....... .............. ......................................... )y ................................ Addrpss ....... .................... . ....... ........................ Address ...................... ..................................................... Phone ............. Phone....................... ........ by.. . ................... Address ................................................ ... ................... Phone....................... liig.by ........................................................ ............................... . kddregs ............................................... ..................... . ....... I t..by ........................................................................................... Address ........................................................................ Phone......................._..:.... Arks................................................. ,The above Is a correct " Signed: Owner/Assent PERMIT . :for the above work is hereby approved, subject to the above conditions, and to compliance with the. approyed 'plans and"spedifications and Building Department notations thereon. VALUATION PERMIT FEES Bldg. $ ..... ......... Plbg . .... ............. APPROVED: Heat .... $ .......... .. . ............. Zi c Co Elect. ........................................ Date ................. .................... BUILDING DEPARTMENT Others ... $ .............................. By.................................... ........................ TOTAL FEE $ NOTES: No work requiring Building Department or City Engineer' ' s Inspection shall be covered before Inspection and approval. Twenty-four (24) hour notice requested. Contact the City Engineer prior to construction of all site utilities, such as curbs, paving, driveways, sewer, water and street connections. .............................................................................................................................7... .. ........................................................... .............................................................................................................................................................................................. -------- ......... .......... ............................................................................................. 7 .............................................................. comply. with all applicable Codes an s t ment and I afire d State Laws regulating the ,work.- .... Date.. .. ........................ Address ............ ....................................................... .... • N w Cl) Z: c � _ N� O N ti *Critical Areas CheckliM CAFile No: Site Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: k- 2. Property Tax Account Number: Cc4 ( O 3. Approximate Site Size (acres or square feet): 4. Is this site currently developed? 21yes; no. If yes; how is site developed? 57.1 "a C_ ( Q- FWt, =:: ,,� 121 -1 �Z 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: Approx. Depth: 7. Site contains areas of seasonal standing water: ; Approx. Depth: What season(s) of the year? 8. Site is in the floodway J�f floodplain 4_ of a water course. 9. Site con creek or an area where water flo s oss the grounds surface? ws are year-round? Flows are seasonal? (What time of year? ). 10. Site is primarily: forested : meadow ; shrubs ;mixed urban landscaped (lawn,shrubs etc) 11. Obvious wetland is present on site: Critical Areas Checklist.doe/3.19.2001 City oAdmonds Development Services Department Planning Division Phone: 425.771.0220 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 Receives!==-'o� City Receipt #: Critical Areas File #: Critical Areas Checklist Fee:_ $45.00 Date Mailed to AoDlicant: 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 histher/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 wflle this application on the behalf of the owner as listed below. SIGNATURE OF APPLICANT/AGEI 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 andpostingattendant to this application. SIGNATURE OF OWNERS, \ :,�I� \ �. _�l \ \ DATE / Z —7C S —67 PLEASE PRINT CLEARLY Owner/Applicant: 1,11 /) Name Street Address c' City State Zip Telephone: --? Email address (optional): Applicant Representative: Name Street Address city/ // State / Zip Telephone: Email Address (optional): Critical Areas Checklist.doc/3.19.2001 C WORKS DEPARIME U CHECKLO16 �� �g Date STREET FILE BUnDING PERMIT REVIEW - 1 IZ.1 ��Mor[DS ���ess Street Right -of -Way Existing p REQD Access Easements Existing REQD Utility Easement Existing REQD.` Lot per Subdivision `}- Plat UU�jl % \)ILUU ssessor Map Site Plan Checked for Accuracy Underground Wiring Reqd. Check Accuracy of Legal Description Environmentally Sensitive Area Environmental Checklist Reqd. Flood Hazard Zone Shoreline Management Area Slope, Soil, Vegetation Stream, Creek, Drainage Basin. Existing Zoning Per Codes LZ Amenities Design Board Approval Reqd. ADB # Approval Board of Adjustment Approval Reqd. Review By- Date: b Existing Water Main Size Water Main Regd. Service Line Reqd. Hydrant Size Existing Hydrant Reqd. Per Fire Code Size Detector Check Meter Reqd. Cross Connection Inspection Fire Department Comments Water Meter Charge Regd. Review by: Septic Tank Permit Reqd. Sanitary Sewer Availability Drawing No. Side Sewer Availability Sanitary Sewer Connection Fee Reqd. Review By: Date: Date: Permit No. Proj . _ File No. 00. of Open Ditch Existing Reqd. Culvert Reqd. Size P4 Catch Basin Reqd. Indicate on Site Plan o Stioulder drainage maintain collection oiz swale open runoff H 1,1-u-tiole rcgd. Indicate on Site Plan_ Soil Conditions and Ground Water Field Checked Review by Mite Street Paving Reqd. H Curb and Gutter Reqd. W Sidewalk Reqd. W Curb Cut for Drive�say Reqd. P� Right -of -Way Construction Permit Reqd. H Bond Reqd. for Public Improvements Street Name Sign Reqd.,. Other Signing Reqd. Pre Permit Site Inspection made on z BY: SEj:'ER H U W W WATER a '-' STREET ENGINEERING .� \\ rol Special Requirements listed in mem to Comrunity Development Department, Building Division 13Y Date o All items filled in on Building Permit Application � BY Date PA Drawings Stamped and Notations Ikide w BY Date d Approved by Public %�7oi:lcs Depar. tint Revised: lv 10-1977 PUBLIC WORKS DEPAR T IST L+ 0M Dm • M6_ 1)11- SMNT FILEz ' BUILDING PERMIT address to 0 Street Right -of -Way Exist' � 0 REQD z Access Easements Existing REQD H a4 Utility Easement Existing REQD w Lot Per Subdivision '-"- Plat Assessor w Site Plan Checked for Accuracy. 'a- z Underground Wiring Reqd. At H Check Accuracy of Legal scription �• z Review by Date. �•. 2 w Existing Water Main Size Wa Main Required Service ' e Required Hydrant Size P4 �Fire Hydrant Reqd Pere Size w Detector Check Meter Reqd. Cross Connection In ction H Fire Depar mnents Wat Meter Charge Reqd. Review by Date Septic Tank Design Approved Date is Tank Permit Reqd. Permit No. Sanit Sewer Availability Proj. Drawing File No a Side Sewer Ava' ability w Sanitary Sewer Conn Lion Fee Reqd. 3 . Review by Date w Open Ditch Exist' Regd. Culvert Reqd. Size c4 Catch B n Reqd. Indicate on Site Plan O der drainage maintain collection on swal>ebpen runoff H Manhole reqd. Indicate an 'te Plan Soil Conditions and Ground Water Field Checked Review by Date Revised: 1v10-1977 N Page 2 ­ .• . et Paving Reqd. Curb an ter Reqd. W Sidewalk Regd. W Curb Cut for Driveway Reqd. x Right -of -Way Construction t Regd. H Bond Reqd. for 'c Improvements Str�Signing gn Reqd. Reqd. Pre Permit Site Inspection made on z a BY: S H W W WATER a FAH STREET ENGINEERING Special Requirements listed in meim to ConTmmity Development Department, Building Division BY Date o All items filled in on Building Permit Application a: BY Date a' Drawings Stamped and Notations Made a' BY Date Approved by Public Works Department Revised: lv 10-1977 The City of Edmonds OWNER................ . ...... HOUSE No. -11104-1 ...... Lu U. APPLICATION CARD No. ------ I . . ............................... for SIDE SEWER PERMIT OUTSIDE [-] INSIDE (-] REPAIRS ❑ EASEMENT No. ...................................... ........................... PERMIT No. ...... CONTRACTOR y------ � STREET ----------- - ........ .... AVENUE LOT No. ...................................................................... BLOCK No- ............................................... NAMEADD . ..... ....................................................................................................................................................... APPROVED 9 /77 Date Approved: BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .............. ........................ 7 cl SEWER WORK ORDER ISSUED ..................... ......... .......... DATE ... ...... ......... BY .... CITY OR EDMONDS Call PRospect 6-1107 24 hours (plus CITY HALL —WATER-SEWER DEPARTMENT Saturday, Sunday and Holidays) be- NO ® 924 fore work' is ready for inspection. 1J1 1 SIDE SEWER PERMIT 1 + ; ADDRESS OWNERNTRACTOR ✓7-p—� i Permission is granted ..._ ....(... ..... , 19 ......,for a ..... days, to REPAIR or CONNECT a side sewer IIII t with City Sewers in accordance with application on file and governing ordinances. 1 i ATTENTION IS CALLED TO THE FOLLOWING: 1 NOTE No. 1—The owners of the property may obtain a permit to conatruct sewer inside property line. A licensed Side Sewer Contraotor 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—Obtain 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 '/s will be permitted. 1 NOTE No. 4—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. 1 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 ap- 01 except to insert the pipe into the wye. I 1 ti Cam - ---'"' '008,00 T25�: V�V�wt 42 - CV4"(- d , I ( � 5 /-1 j f e� 60-70? 1 000 cq oo ZONE _ 12 S 1-2- SETBACKS: = FRONT SIDE ID REAR OTHER HEIGHT 25� Any request for modification, variance or other administrative deviation (hereinafter "variance") must be specifically called out and identified. 'ning provisions wh' do not comply with city code and for whi a variance has not been specifically ide tified, requested and consi ered by the approp 'ate city official in accor nce with the appropriate provision of city coca or state law does in of approve any items not to code specification. RECEIVE® FEB - 5 2002 DEVELOPMENT CITY OF EDMONDS CTR. RO ED PANNING %• L '1�► v ,7 ct I, 5'12 f � 3 -------- 73 7\ y • _.. _. _ .._ _ _ ____ -� q1 �b r� I r', 5 TVI Li`JT WORK Ai' OPESS 01, 3Y V,/0 V 6,�4Dr •�y sl*5 FILE STREET FILE � I d I �F d m,,els S� 1p