1124 2ND AVE S.PDFIIIIIIIIIIII
4838
1124 2N D AVE S
CITY OF EDMONDS
ASSET INFORMATION SHEET
NEW
❑ ADDITION
❑ RETIREMENT
ASSET NO. S�3 6
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION ''�
DE . NO.
* * PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
* PROJECT NUMBER
PROJECT COMPLETION DATE
COST
B.A.R.S. ACCOUNT N0.
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
O DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
b P INITIAL
DATE
VERIFIED BY
PROCESSED
BATCH NO.
DEPARTMENT FILE
112ZI2W,
STANDARD OR:= PLAN
CATU{ O.L51H:
X-Do IT30(ok
rouAt�
TA,CNCW tea.-j
2 �(
>
rnSr+Cu covrn
............................
_......
_.......... a
�}-nGueru>,c J
4 rERF r17-. �,
7EE w/ 4"LOKG CGS
L17VK-L TXCNCN
cXP
SYSTEM CROSS-SECTION
MIRAFI 50OX �
OK U I V c I��IT ,
TC B LA'; E D oN >
1U
:)A 11/2� WA5uE0
.L 01AM F=RF PIPE2.
1.0�
TRENCH CROSS-SECTION
INFILTRAT101-: S'' S EM
PAGE 1 r 2
Sea�oO�
for
�e
location
plan by
phone
date T O /Q7
I DESIGN DATA
Trench
Pert
LF per
Number
Rate
1000 sq.f�
Icpern Trench
Area Re
wX61
NOTES
1. Call Engineering Oivisi:^ (771-3202)
.for prebackfill and final inspections.
2. Res)cnsibility for oper2:ion and
maintenance of drair.ag! systens en
private property is tha responsibility
0,, the property cwnar(s)Prevent'--le
maintenance consists cf priVenting
Soil and other materials frcn entering
trench during construct'•ar as well as
after construction. Catca Sasins should
be cleaned of floa:inq ,:,a:eriat and
sedi-ment at regular ir,:ervlls (at least
twice per — r).
2 (o a7
CITY OF EOMONOS
timpE2✓lo�S S�eFiac.�s
HouSE. + Gr- -
f kkvE Lo 5� ,
ZONE 2Cm—(0
SETBACKS:
FRONT �'
SIDE -'
REAR ► 2'
OTHER
HEIGHT q - '
/ ^!i- ~r\ 117 L�
STREET FILE
ZU-55E14- -, P-E ECGA LJOLFE 112ti 7-AO AVE 5. Ef)y P/vp5, t.�A �vzo I PAeCEL 0075g400000500
�y�� I �o7"GVVE�I+C�E 339/a
1. Site Address/Location: // 2 y- 0)
Critical Areas Checklist
Site Information (soils/topography
Q,,... S'
CA File No: 0 J "—io
/ vegetation)
9
2. Property Tax Account Number:, o o -7 a- `h N - 0 o a _ o a
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes; 99 no. n
If yes; how is site developed? _I tr rn e b u ` /c n► a P_ s t1s e re h
5. Describe the general site topography. Check -all that apply.
Flat: less than 5-feet elevation change over entire site.
6.
7.
8.
1_�.
10.
11.
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):
Site contains areas of year-round standing water: ; Approx. Depth:
Site contains areas of seasonal standing water: ; Approx. Depth:
What season(s) of the year?
Site is in the floodway _ _ floodplain of a watercourse,
Site contain`tree an area where water . -flows across the grounds surface? Flows are year-round?
e n Flows are seasonal? (What time of year? ),
Site is primarily: forested r e e �, h e meadow ;shrubs ; mixed
urban landscaped (lawn, shrubs etc)
Obvious wetland is present on site:
For City Staff .Use Only St
1. Plan Check Number, if applicable?
2. Site is Zoned?
3. SCS mapped soil type(s)? o - 8
4. Critical Areas inventory or, C.A. map indicates Critical Area on site? ; _ tb - wrr•t;, ri w.itQ , C.u*_ �4 Tza 2.g •
5 maM
5. Site within designated earth subsidence landslide hazard area? No
/ DETERMINATION
STUDY REQUIRED WAIVER
Reviewed by. Date: 51l. s/ CQ .
Critical Areas Checklist.doc/4.22.2003 k-i "W#-A ^.U, 4It P- 3 •8L (fly PNV. ?I,+)
Gr+tr faµ wt ioF of � c.Mr. �%- lr t�F. �:�AcJ lv,�t µw,fca �+... IS � A. 25 ,(w �. � l.t+rl :l3• S..v �i Pew , IS %..t� t; Su•►.;tt . e...,..� .._ ..
City of Edmonds
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 Received: O
City Receipt #: 6-3
Critical Areas File #:_ c.4 - o; - -7-
Critical Areas Checklist Fee:_ $1-35.00
Date Mailed to Applicant:
A property owner, or his/her authorized representative,
must fill out the checklist, sign and date it, and submit it
to the City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary 'to complete a development
permit application.
Please submit a vicinity map, along with the signed copy
of this form to assist City staff in fording 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 famished 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 "sication 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 pos ' g a ndant to this application.
SIGNATURE OF OWNER DATE
Ownee licant:
�iy.
Name
S'
Str%tt Address
C A- 1' jr- U z 0
City State Zip
Telephone:_ 41 2 S 7 -7 2` e 2-4
Email address (optional):
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
Critical Areas Checklist.doc/4.22.2003
r-
City of Edmonds
Critical Areas Determination
Applicant: liisseii-
Wolfe Determination #: AA-03-70
Project Name: Deck Replacement and Permit Number:
Extension
Site Location: 1124 — 2"d Avenue S. Property Tax Acct #: 007544-000-005-00
Project Description:
To rebuild an existing deck on the stream -side of an existing house,
and to extend the deck to the end of the house, parallel to the
stream, but no closer to the stream.
Waiver Criteria (all criteria must be found to apply):
X There will be no alteration of the Critical Area or its required buffers;
X The development proposal will not impact the Critical Area in a manner contrary to
the goals, purposes, objectives and requirements of the Critical Areas ordinance;
X The development proposal meets the minimum standards of the Critical Areas
ordinance;
X The above findings are based on the following conditions of approval:
1. This conditional waiver is only for the rebuilding of the existing deck and
extending that deck to the edge of the house, without any further extension
towards the creek.
2. No heavy equipment shall be used in the back yard for demolition or
construction.
3. A building permit is required for all work.
Based on the above findings and conditions, the requirement fora Critical Areas Study
associated with this development permit is hereby Waived, as authorized by Chapter 20.15B.040
(A)(1) of the Edmonds Community Development Code.
Meg Gruwell 5/29/2003
Name Signa a Date
City of Edmonds
Critical Areas Determination
Applicant: Russell B. Wolfe Determination #: CA-03-70
Project Name: Permit Number:
Site Location: 1124 — 2"d Avenue S. (Lot 5, Property Tax Acct #: 007544-000-005-00
Deer Park, Division 2
Subdivision)
Project Description:
Non -Project Specific
Determination: Study Required, Map Completed:
During review and inspection of the subject site, it was found that the site appears to contain
and/or is adjacent to a Class 2 (no salmonids) Stream pursuant to Chapter 20.15B of the
Edmonds Community Development Code (ECDC).
Based on these findings, prior to submission of any development pen -nit, you are required to
submit a survey prepared by a Licensed Land Surveyor delineating the top of the stream bank,
required 25-foot buffer, and 15-foot setback to any proposed new building. This stream was
surveyed as part of the subdivision, file P-3-86, when the setbacks to the stream were only 15
feet from the top of the bank. The survey shows the approximate centerline of the creek, and the
top of the approximately 16-foot high bank that slopes down to the stream. The current 25-foot
buffer is to be taken from the top of bank, meaning the top of the channel or bed which
demonstrates clear evidence of the passage of water. If the owners wish to have the top of bank
shown at the stream bank edge, they will be required to obtain a new survey. However, the
existing survey map has been determined to be adequate to locate the stream and a very
conservative top of bank.. With any development permit, you are required to submit a copy of
this map or any new survey.
This stream flows into Puget Sound, therefore, prior to submission of any development permit
the applicant must contact the Department of Fish & Wildlife, have them review the site and
submit a letter to the Planning Department determining the impacts of development on this site
and, if necessary, recommend mitigation measures to ensure protection of the habitat/stream. If
culverting or redirecting the stream is proposed for development of the site, please have
Department of Fish & Wildlife address this matter as well.
If the property owner wishes to apply for a specific development permit which they feel
would not impact the Critical Areas located on 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
Date
City of Edmonds
Critical Areas Determination
Applicant: Russell B. Wolfe Determination M CA-03-70
Project Name: Deck Replacement and Permit Number:
Extension
Site Location: 112t— 2"d Avenue S. Property Tax Acct #: 007544-000-005-00
Project Description:
To rebuild an existing deck on the stream -side of an existing house,
and to extend the deck to the end of the house, parallel to the
stream, but no closer to the stream.
Waiver Criteria (all criteria must be found to apply):
X
F.�
M
M
There will be no alteration of the Critical Area or its required buffers;
The development proposal will not impact the Critical Area in a manner contrary to
the goals, purposes, objectives and requirements of the Critical Areas ordinance;
The development proposal meets the minimum standards of the Critical Areas
ordinance;
. The above findings are based on the following conditions of approval:
1. This conditional waiver is only for the rebuilding of the existing deck and
extending that deck to the edge of the house, without any further extension
towards the creek.
2. No heavy equipment shall be used in the back yard for demolition or
construction.
3. A building permit is required for all work.
Based on the above findings and conditions, the requirement for a Critical Areas Study
associated'with this development permit is hereby Waived, as authorized by Chapter 20.15B.040
(A)(1) of the Edmonds Community Development Code.
Meg Gruwell 5/29/2003
Name SignafWe Date
Critical Areas Checklist CA File No:
Site Information (soils/topography/hydrolo /vegetationR
ry
1. Site Address/Location: �� 2 `�- �^� S S� Q e�-- 9
2. Property Tax Account Number: o a-7 y- a s- o a - C,0
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes; no.
If yes; how is site developed? y/L1iP rn e A u ; -�, / 91S- Lp-(-A /- ► e IJ re '+I
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).
V--" 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 floodplain of a water course.
tA9. Site contain an area where water flows across the grounds surface? Flows are year-round?
e &- Flows are seasonal? (What time of year? ).
10. Site is primarily: forested re e n h 4 me da ow ; shrubs ; mixed
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site:
For City Staff Use Only i 5Z
1. Plan Check Number, if applicable?
2. Site is Zoned?
3. SCS mapped soil type(s)? J% - F6=Swt� O - 8 S of
4. Critical Areas inventory or C.A. map indicates Critical Area on site? (4o - ;, ware, Gwx. , k i m ZB
s fw�
5. Site within designated earth subsidence landslide hazard area? Ne
+ / DETERMINATION
V STUDY REQUIRED WAIVER
Reviewed by: Date: 51l sl 03
Critical Areas Checklist.doc/4.22.2003 "r ice. per-* w.u, 4 iv 9-3 -81, (D�r P�•�.Q��,+) h A�.� u h.c
c �, w,► �Q of 6 &- p c.� . u,,.;,%, I S �, ,� 25 �- A U..,1 2 6 S",jr.., P � IS' /.� � +w�
AlanitoA+ A-� �-41. {. H. I -, c-.J.
City of Edmonds
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 Received .�U �
City Receipt #: 521 96 �i
Critical Areas File M c4 - o3 - -7-
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant:
A property owner., or his/her authorized representative,
must fill out the checklist, sign and date it, and submit it
to the City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed copy
of this form to assist City staff in finding and locating the
specific piece of property described on this form. In
addition, the applicant shall. include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, 'including reasonable
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 ication on the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT DATE a ��
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 pos ' g a dant to this appl ation.
SIGNATURE OF OWNER DATE
Own" licant: / / /�
c{�se.l� �. LCJ v 1 t 14-�,
Name
Street Address
CJ ��r �'�U z C
City State Zip
Telephone: Lf Z S 7 7,9— 2 `V 2-40
Email address (optional):
Applicant Representative:
�a
Street Address
City State Zip
Telephone:
Email Address (optional):
Critical Areas Checklist.doe/4.22.2003
City of Edmonds
Critical Areas Determination
Applicant: Russell B. Wolfe Determination #: CA-03-70
Project Name: Permit Number:
Site Location: 1124 — 2nd Avenue S. (Lot 5, Property Tax Acct #: 007544-000-005-00
Deer Park, Division 2
Subdivision)
Project Description:
Non -Project Specific
Determination: Study Required, Map Completed:
During review and inspection of the subject site, it was found that the site appears to contain
and/or is adjacent to a Class 2 (no salmonids) 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 are required to
submit a survey prepared by a Licensed Land Surveyor delineating the top of the stream bank,
required 25-foot buffer, and 15-foot setback to any proposed new building. This stream was
surveyed as part of the subdivision, file P-3-86, when the setbacks to the stream were only 15
feet from the top of the bank. The .survey shows the approximate centerline of the creek, and the
top of the approximately 16-foot high bank that slopes down to the stream. The current 25-foot
buffer is to be taken from the top of bank, meaning the top of the channel or bed which
demonstrates clear evidence of the passage of water. If the owners wish to have the top of bank
shown at the stream bank edge, they will be required to obtain a new survey. However, the
existing survey map has been determined to be adequate to locate the stream and a very
conservative top of bank. With any development permit, you are required to submit a copy of
this map or any new survey.
This stream flows into Puget Sound, therefore, prior to submission of any development permit
the applicant must contact the Department of Fish & Wildlife, have them review the site and
submit a letter to the Planning Department determining the impacts of development on this site
and, if necessary, recommend mitigation measures to ensure protection of the habitat/stream. If
culverting or redirecting the stream is proposed for development of the site, please have
Department of Fish & Wildlife address this matter as well.
If the property owner wishes to apply for a specific development permit which they feel
would not impact the Critical Areas located on 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
Date
DEER PARK-
A REPLAT OF LOTS 5.6.7 do 8. BLOCK 4. SOUTH PARK ADDITION TO EDMONDS '
IN THE SE 1 /4, NE 1 /4. OF SEC. 26. T.27 N., R.3 E.. W.M.
EDMONDS., WASHINGTON
15
b
wH
= l o 9
w
IWed
tarot
2nd
IeeT Vem Noww r On)
LEGAL DESCRIPTION
IWOODWAY I PARK ESTATES I I
I 16 I 17 I 18 I 19. I.
let AVENUE S. •�
ra•o'ee•t see.et •���
SOUTH PARK ADDITION I /
ISLOCK 4 I y'
ev+ea. lrem I�
I I Ij�2 �I (17 ��1 I b
I sll 3 4 1 5 6 a
: " I i i i c •O Leo
I
I I � t-!�j
LDse.et �- " L_.
eee.e4 r— --
AVENUE S 590,00P
LOU 4 S. 7 aW & Block 4. Scrth Park AddiUm To Ed 'v Acg to
the Pllo�ot thereof recorded In Volwne 6 of Plato. Pogo 13. Race of SssohOM%h .
EXCiPwooftingtom
T tAot Portion of LOU S. 6 and 7 eanveyed to tat State of waalsington
for State Rood 104 by dead needed February 22. 1671 under Recording .
No. 2165=
atueto b the County of 9whomw State of 1far ingtan. .
SURVEYOR'S CERTIFICATE
SHEET 1 OF 2 SHEETS
YI Z
SCALE: I as 5 0'
L LeRoy r. 1011"aton. Regbtend Lad Surviyw. do hereby ortlfy get
this plat Is bawd upon as actual ao my and asbdldelan of Section ML
Township 27 NaU. Raga 3 East. M.Y. and that the nww n ents all
be eat and lot aamva slat od as the wow W as dwm brsa►
aRegistered
oy F. Land ors. Cart Ito. 4601
Reld b1ld"an ,AA�' ea bra
RYA 02-66-051
CITY
of EDIMONDS
SIDE SEWER PERMIT
For Inspection Call 771-3202
Address of Construction: 14:22
�D
l
PERMIT NO. 07778
Property Legal Description (Include all easements):
� (a D� Dfek pAk k
Owner and/or Builder: \ ,pl IJ A veil /47"74 , .e 5- ___4-!_2C,
Contractor & License No: 4wi a l5y
Sin9 l:e FamilyResidence
c/
EDMONDS
Multi -Family (No. of Units ) TREATMENT PLANT
Commercial (No. of fixture Units )
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description and county easement number.)<
PLEASE READ THE ITEMS LISTED ON THE BACK
I rti y that I ha� ead and shall comply Date
with the items l Jed on the back.
Permit Fee: 39 (�(�
Trunk Charge: 25.co
Assessment Fee:
Issued By:
Date Issued:
Receipt No.:
—7G
a'-Z g 9 Z
7�8
Partial Inspection:
Comments Date Initial
Final Inspection Approved:
/ Date Initial
00
Rejected:
CD
Reason Date Initial
-n
a�
** PERMIT MUST BE POSTED ON JOB SITE **
m
White Copy - File Green Copy -'Inspector Buff Copy - Applicant
The City of Edmonds Side Sewer Drawing EASEMENT NO_ ------------------------------- 4 , . I
-------------
A .
NEW CONSTRUCTION REPAIRS F1 LID NO_ -------------- --- ASMT. NO. ---------------- N
OWNER ------ HOM.ES ------- VNjC,.i -------------------- CONTRACTOR - ------- COt4CPE-T�. PERMIT NO. -777.8
JOB ADDRESS ... 112A ") "c' . \ -5 ------------------------- 4 -- — ---------- ^--j ---------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO. ------------------------------------
NAME OF ADDITION ..... or ----- - D .. r,-- ------------------------------
I IZ4 LND So.
X4- i
4'P.V.c
G-P.V.c, -
FENCIS POSTS
PWW-0001-11/75 (REV.11/78)
5' OR
—4-"T.T,
14'
tVA
L--� z ===
EDMONDS
TREA
TMENT PLANT
Approved:
By- --- -- ---- --- ...............
SIR
STREET: FILE
... ... . .................... .... .
77
l
-�
OR
CP
�,etAAUc.
elz
157 Af
1 I I i
obq , to ' kw,
87
q S
LN
. - /2
CATC-M C p".SIN: xmC oUIT�O(o1
A.
UK 9
IMMUM
?268=�
4 A.
Bw
,aD
TACNCW L.W " r-'rH
i r
3>
TnCNcH covCR
Q
4 -nr-,-�uwx
4 FrK7F y,.-:
TEE W/ 4"L0tt L=GS
L17VXL 7-&CNCH
GAP
SYSTEM CROSS-SECTION
M1R4.F1 SOOX 0�
OR U I V E LE-i-IT w
TO B Lam,`; ED ON >
TFF-tCH COVER---�
GR>VEL—�� •y� ��
I •' I
t: OIAM F=RF PIPE
TRENCH CROSS-SECTION
STANDARD DP\"- PLAN
INFILTRAT101'.'S�' S H K''
PAGE I �2�/��
for
location ,; /C
plan by �jh Cr 7��A��.[� 0�/
phone
date�0
DESIGN DATA
Trench Pert LF per Ir..pern Trench
Number Rate 1000 sq.ft. Area Req p
I I. I �-I'a�� �
NOTES
1. Call Engineering Oivisio', (771-3202)
.,or preback.'ill and final inspections.
2. Respcnsibility for oper-tiOr, and
maintenance of drair.ag= systens en
privateoproperty is the-!sPor.sibility
Of the property cwner(s} preventive
maintenance consists c. , °Venting
soil and other materialsfrcn entering
trench during constrLct'.or as well as
after construction. Catc� basins should
be cleaned of floatinq .-aterial and
sedi,ent at regular intervals (at least
twice per , ar}.
CITY OF EOMONOS
-CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUS' S)
w MAILING ADDRESS _
CIT� n�� r, TELEPHONE NUMBER
UX 1 7
NAM fG
Ill ADDRESS `
U
Q G O
G CITY �I TE UMBE 4��
TV�Q(Jf
NAME
s ADDRESS
U
CITY TELEPHONE NUMBER
O STATE LICENSE NUMBER
-se&Q-D kS E, C_%�s
Legal Description of Property - include all easements
(show below or attach four copies)
NEW
RESIDENTIAL
PLUMBING
ADDIALTER
COMMERCIAL
MECHANICAL
REPAIR
RETAINING WALL
SIGN
EXCAVATE
FENCE
DEMOLISH
ORFILL
II x-FT)
❑
PRE -MOVE INSPJ
❑ SWIM
REMODEL
COMPLIANCE INSP.
POOL
WOO
SERTVEI
APT. BLDG
RENEWAL
S NUMBER OF STORIES NUMBER OF
DWELLING /
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
SIn/,4_' Gl , l/
USE 'WAW PERMIT
ZONE 0� �(J
— NUMBER
JOB
ADDRESS
EGAL DESCRIPTION CHECK SUBDIVISION NO.
�11 S ). 3 96
NO.
L
T OF WAY PER OFFICIAL STREET MAP.
GREQUIRED DEDICATION
DAY CONSTRUCTION PERMIT REQUIRED 0
PERMIT REQUIRED ❑ERING MEM DATEDZ f
METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS cc
W
REMARKS
3
SIGN AREA I ENV. REVIEW ADB NO.
ALLOWED I PROPOSED COMPLETE I EXEMPT
a
VARIANCE OR CU IPLANNING REVIEW BY I DATE
IYARDS FRONT (i"y SIDE J/ REAR I ✓r ZJ IT ILOT COVERAGE Ig
REMARKS ICL
CHECKED BY I TYPE OF CONSTRUCTION
-Ji{j , N
SPECIAL INSPECTOR
REQUIRED
❑ YES ❑ NO
REMA S
j 6,e,t, ►+100 :fir,
PLAN CHECK FEE 7(
BUILDING ({
PLUMBING U
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application:180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
ENERGY CODE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
PLAN CHECK DEPOSIT
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of. this permit shall not be deemed to
modify,.walve or reduce any requirement of any city ordinance
nor limit In any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
Information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and in doing the work authoriz-
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Wo men's Compensa-
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
tion uranc" .
INSPECTION
DEPARTMENT
OF
EDMONDS
it ATURE ( E�p R A N ) DATE SI NED
f.CITY
/
CODE HEIGHT
1q%
OCCUPANC OCCUPANT
GROUP �l"i' LOAD
lcl �c�i' ccSTu
L � .
I
VALUATION FEE
--Icuv I be(el5
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL'S SIGNATURE DATE
ATTENTI n132o2
IT IS UNLAWFLOC TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
RELEASED BY:
DATE
ORIGINAL — File YELLOW — Inspector U
PINK — Owner GOLD — Assessor
MEMO TO: Building Division
FROM: Engineering Division (�
SUBJECT:
After review of the subject building permit application, we have the
following comments: .
1) Connection to City water system required.
2) Connection to City sanitary sewer system required.
3) Right-of-way permit required for any work on City property.
4) Driveway slope not to exceed 14%.
5) Back water valve required if downstairs plumbing is below
elevation of upstream manhole.
6). Water and sewer lines to be separated by 10 foot minimum.
7) Builder/owner responsible for containing all temporary runoff and
erosion on site and may not impact neighboring properties in any
,way.
8)
I
/0
Construction hours from 7:00 a.m. to 10:00 p.m. on weekdays and
10:00 a.m. to 6:00 p.m. on weekends and holidays.
PI2ATECT REVIEW CHELMUST
PROJECT NAME s l` O i� PROJECT
APPT.TrATTI*N RFrp..TAT `nATP.: 'shalqza-
Reviewed
by: (initial/date)
x; COMMENTS
FIRE,
SD=2 F1F¢LY/MJL.TMX/0(ff4MCIAL - (Circle One)
PLANNING
BUILDING
WTR/SWR
STREET ENGNFdNG,
111171
/-7T71111111
SE MC'KS CHECKED - Planning
VARIANCE/SEMACK ADJ.-111111171
/ //
/
CONDITIONAL USE. PERMIT
//////
/////////
////////
////////
2
ADB RE=REME TPS CHECKED
177777
//////
/////////
////////
//////
3
/
/
arH R ZONING REQUIRDOM
//////
/////////
////////
//////////
4
ENVIRONMENTAL FEATURES
777777777
ACCESS SIDPE 6 VEHICLE ACCESS ��`
/////////
/////////
//////
6
DRAINAGE PLAN (On Site)
//////
/////////
/////////
////////
7
STREET FILE
//////
/////////
/////////
////////
8
/
LEGAL DESCRIPTION VERIFICATION L
9
QUIT CLAIM/DFDICATICXNS
//////
/////////
/////////
10
EASEMENT - PUBLIC/PRIVATE '
111111711
/////////
/////////
////////
11
CALCULATE SIWER CUOWTI(�1 F Mn T,ID GS/�` ��3
//////
/////////
/////////
////////
12
PLAT/SUBDIVISTON REQUIREMEN`T5 --
//////
///////
777
//////
.
13
RIGHT-OF-WAY CONSTRUCTION PERMIT READ
BOND REOD FOR PUBLIC IMPROVEMENTS
//////
/////////
/////////
j
14
15
SOILS C C NDITIMIS 6 GMUND
WATER FIETD CHECKED
//////
/
/
16
STREET PAVING REQUIRED
//////
/////
17
CURB AND GAITER REQUIRED
//////
/////////
/
18
SIDEaLK REQUIRID I
//////
/////////
/////////
19
CURB Ct" FOR DRIVEWAY REQO
//////
/////////
/////////
jdj//////////
20
STREET NAME SIGN READ
////
/////////
//////////
21
MUM SIGNING REDQD
//////
/
/////////
1////// //
22
SIDE SEWER AVAIIAAII,TTY
//////
23
EXISTING WATER MAIN SIZE
WATER METER SIZE
//////
.�
29
25
SERVICE LINE SIZE
/////////
?
J //
////////
//////1///
26
HYDRANT REQUIRED a
HYDRANT SIZE EXISTING
/////////
/////////
/////////
,�
////////
////////
//////////
//////////
27
28
CROSS CONNECTION INSPECTION READ
WATER METER CHARGE READ
///////////
t777TR7
5 Po
////////
//////////
29
30
FIRE LINE CHARGE READ - SPRINKLER
STREET CUT
31
32
OPEN DITCH EXISTING
//
33
REQD
CULVERT ROM
SIZE
//////
//////
/
/////////
/////////
..
34
35
36
CATCH BASIN
//////
111114111
/////////
37
INDICATED ON SITE PLAN
//////
////
38
SHOULDER DRAINAGE MAINTAIN
SHALE OPM RUNOFF
MISC.
7 7 7 7 7 7TITITT1739
//////
/////////
1777/77777
/////////
/////////
111171111
/////////
'.
REVIEWED BYs
PLANNING MQt.
ENGINEERING MGR. PUBT-TC WORKS MGR.
40
r,.
;Y