1130 A AVE S.PDFiiiiiiiiiiiiii
10002
1130 A AVE S
so. cra
Distrkt 13�
"Zit Vid`ii�onds —Water Depar ent
TAP CARD
Reading: � Date Z _,1'/
No. No.
Meter Tap 3 „
Size Size /�
Mfgrs. No. 3_® ?,�/004� Style 9WS D2
Purchaser:
Serv. Add. 1130 �4
Lot No.
Add.
Residential:
Other:
Blk-. No.
Meter Location 7/�#T- OF
�R ICE We -CT- D °,-rr c'v 4 0 .
Service Material: /-4/2
Pressure lbs. Test
Da e of Work - I
�1, ; ��. 2-wse, - Foreman
uar. Voucher No. $
Proj . No: Z64 SS (Z'I 64
Remarks:
OUTGOING Index Reg. Route Bk. Stencil Card
INCOMING Index Reg. Route Bk. Stencil Card
ROUTING SLIP
NEW SERVICR INSTALLATION
ADDRESS: // -3 o
DATE:. a-6'e5-
FOREMAN
DIAL A DIG #
P.U.D.
TELEPHONE
CABLE T.V. wv
Aft
voy
Z�(9
GAS -
a
STORM SEWER
OTHER
FUTURE SERVICE INSTL: YES
NO
BORE: CUT:l--
CREW
LOCK
DATE: INITIAL:
UNLOCK
DATE: Z-4As INITIAL:
-w7S,
METER SHOP
ACCOUNT NUMBER: 0 4 - 4 S"
SUPPLIER: SE 1q-
(.�,)
�7
FOREMAN
TREATMENT PLANT
DE B L T
FOREMAN
INITIAL: DATE:
UTILITY
BILLING
TAP CARD
METER SHEET
APPLICATION /
DISPATCH
7/76
ADDRESS: 1130 A 7 V&/ (g,
TAX ACCOUNT/PARCEL NUMBER: oo t p c q4mo no
BUILDING PERMIT (NEW STRUCTURE): I Ui 0 (09 C)
COVENANTS(RECORDED)FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT #'
DRAINAGE PLAN DATED: I 1�171 P
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS
6,
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DA
SEWER LID FEE $:
DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
LID #: " / !
SHORT PLAT FILE:y / o LOT: Z BLOCK:
SIDE SEWER AS BUILT DATED:
hI�r/ /fir v
SIDE SEWER PERMIT(S) #:V l o< &
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DST's\Forms\Street File Checklist.doc Q'
S#?
610
.+O - • v VJE Pf 11MII r
CON T `CTIO ,�.
d 'CITY OF EDMONDS or:E' ULn,E") . 940698
W .Cay
S R - YN PERMIT' APPLICATION„
N—C ,�)A N—E D•' UVS,r.ESSI - f.DOi,C SS �� J
1 I V / / /u � L e r .; FaAL Ol .i7 I J:•,G tkC` yU(1v1s1OI, 1,0. LID t, ._.-
Iv
C,I) 1E:E Vx Or: E, rvUMUF4 PVULIC RIGi•1 OF .•.., RF4 OFFICIAL S194EET IAAP "
31yc
..IMni OF,v:A1 tU1. $)RUCL,Or. I'E:,MIi•R000Iri!
SIACLI 1JAVERM11 RLOV,RL'J
r
e —_~ •� ''. 'SEC QQ OnIFV
i Ci'' - 1LLE:P„Or,S'Jes oLE t,[. ••L,.. LIS: DA,ED,
REMAI„J mil. i
. LC ,'..0' lro?Gr;y Ir,=."t!a:: lo. arncr.: a_
• .I IS: G,i. _eIJ-' a.,.,C� !CL" C'G: .?a' � "t} I ' a••, •.•L. I: •' t
,_- —
_
e • } J 5'.i Tit l 7t' 1. L
Imo. .. _ _ , , _._.-s • -
J SL. i
•ram ,�•na^ i.
1 j
• - =c c!TS IS CATED iN_'1.tiE r. ._ . �' _� '�-f__...�'-• 1 - - ,
110,
- f
is RECEIVED
CITY cf E D M DS S E SEWER PERMIT
`r For Inspection Call 771-3202 PERMIT
PUBLIC WORKS EDMONDS
Address of Construction: / / O —"�% �2 , TREATMENT PLANT
Property Legal Description (Include all easements):
Owner and/or Bui 1 der: �// �/ z L
Contractor & License No:
Single Family Residence. �� o
nLc,-n u Mt
Multi - Family (No. of Units )
Commercial (No. of fixture Units )
Invasion into City Right -of -Way: No Y 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 certify that I have read and shall comply i/Da�te/`
with the items listed on the back.
Permit Fee: zo Issued By:
,—' Date Issued:
Assessment Fee: Receipt •
Partial Inspection:
Comments Date Initial
Final Inspection Approved: 2.-785 won► Howa►AD
Date Initia w. 3v'�
Rejected:
White Copy - File
eason Date Initial
** PERMIT MUST BE POSTED ON JOB SITE **
Green Copy - Inspector Buff Copy - Applicant
Side Sewer Drawing r
The City of Edmonds EASEMENT NO. ----- .--.._-.---- ------- - ------
NEW CONSTRUCTION D J REPAIRS ❑ LID NO.---..1..4--.--- ASMT. NO. --- -.---- V_-_-
OWNER - ------ k—LLCE-W----------------------------------- -- CONTRACTOR --- -Very--- .RSA!? V-C A------------ ------------------ PERMIT NO. 077.2-409
JOB ADDRESS-----I�.3 ----------I
-----e------�Ve-------------------------------- LEGAL DESCRIPTION: LOT NO. -------------------------------- BLOCK NO. ------------- -------- ---------
----------------------------------------------------------------------------------------------
NAME OF ADDITION .._ _ __ ..---.-.-- ............-------- .... TREATMENT PANT
------------------------------------
A F%v�.
Cce 4"wine Pvc 5 C ePp 1
C-10 k;o PVc V Deep /
PWW-0001-11/75 (REV.11/78)
Dfw
41 -!�,o 'A' were
V a-4 1h ,
Q
Iv`
12 11
Approved: b i E--- 11 1 —)
DATE ...... j;Z - 7 . 5------•-•------- BY ----- -- "-
-7
�J
t 9 Co
O
4
r
r
I� PL4,e
ST w /P /7'3
j"scR
tt 3
i
0
D
RE:ET FILE
ST
167'W I 14'N Cc
72C-17-
s_ 10,
a , -�o
2•' INSUL SERV 'T'
9
Vi'fs 's
' 170
W4 ie 2'/v Z
1971 W
4♦
-
i966 N
I
•
lgvZ
Q
r
•I Q
+
LST-1
;Wpll Z* Sa-R
V
CITY OF EDMONDS
L' 1 NEW
❑ ADDITION
❑ RETIREMENT
J.
:.: AS`= INFORMATION SHEET
Q"ASSET N
.ADDITION TO ASSftiT.NO:; -'� ^ "'
r - -� sr .•_•, art sa-�'rk t 1 �. a
e , 3yJtw i ttj}7'.' ¢ 1 a ` A�y1�•,,'�+(t�'fT". '�- � ' �y .r
t-1Myr •�: r Af t,�a� s.l.''^�"I4r �''• `t i�'ri t
DESCRIPTION / -
C.�I�L
SERIAL NO.
LOCATION
DEP NO.
/gym V ,.1. '?.' Y-�!'. A.VJ�.1• �L4 :
Vim/
"PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
B.A.R.S. ACCOUNT NO.
,..:,:'PROJECT NUMBER • ��'•�
PROJECT COMPLETION DATE Biel
ST.-
EST
IMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT,REQUEST.:.t..;
'SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF: PROJECT,-. ;� 1
ACCOUNTING ONLY
f .t,VERiF1ED BY
U DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
PROCESSED
ANNUAL DEPRECIATION AMOUNT
,; , BATCH NO:=
CG.L.
ENTRY
REFERENCE
DATE. ; ,; •~ '
INITIAL
f V
DEPARTMENT
FILE
t
CATCH dA51X:
I►LlS �IS30�C� TRGfVCW LWNGTH
WGUAL)
_ it
s
-MUNCH COVIM
1 Q
4• T16 UNE L[VLL Tnr NCH
41,igoF PIPE. CAP
TEE w/ 4'LONG LEGS
SYSTEM CROSS-SECTION
AGI I RAF I E-O O X
OK RUIVEL ITTO LA ;'ED oN
T 0.E NC H
3/4 0 - I I/1 " WASHED a u
GRAVEL
4'DIAM PERF PIPE
0
o
TRENCH CROSS-SECTION
-w
0
�U
l ,
&AND'ARD DRAWAGE PLAN
INFILTRATION SYSTEM
PAGE I OF 2
for
location- 4M .4
plan by
phone
date
DESIGN DATA
Trench Perc LF per Imperm Trench
Number Rate 1000 sq.ft. Area Req.
NOTES
I. Call Engineering Division (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the responsibility
of the property owner(s). Preventive
maintenance consists of preventing '
soil and other materials from entering
trench during construction as well as
after construction. Catch basins should
be cleaned of floating material and
sediment at regular intervals (at least
twice per year).
i7
CITY OF EDMONDS
APPLICATION
The Cityof Edmonds for
EASEMENT NO- --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO- ------------------ ASMT. NO. ------------------
107-00600
OWNER------------- Harry ------------------------------------------- CONTRACTOR------------------------------------------------------------------------------------ PERMIT NO. -------------------
JOB ADDRESS ..... 1130 " N' Avenue. ------------------------------------ LEGAL DESCRIPTION: LOT NO. BLOCK NO.
Uj
W
G�
h-
CD
NAMEOF ADDITION-----------------------------------------------------------------------------------------------------------------------
DYE TESTED ON SEWER - March 9, 1976
By Marsh Menne
Approved:
DATE-------------------------------------------- By---------------------------------------------------iiiys
�o a� eve s
F'rmi r-1) AS NOTED
RIMS
clI
5Y✓, EL.
lo�,•�
_ I EXGofJGjo
f� w �-t
Iv4-•I�
I
Iq n �
vno%.s�- -5
I
0
lbw.
E EIvU6E
___ � I
K�F
r-r41
to$
I•
/ ¢I
hE
L'LIoS•S
-!4
.—
3 oN
10,75
-==---5---
WALK5 $�
1�6w Da�DA iv�l 21 EA-JE {`(F'I6AL
�7� tb
5a FT.
In R
—
—�
—
U
- E� nrzl�EwAr
STPA
PROJECT AREA 50 PT
LIVING SPACE NEW EXI5TING TOTAL
FIRST FL
1162
1162
SECOND FL
9
1189
1198
BASEMENT
LIV. 5P. TOTAL 9 2-61 2960
6ARA6E
504
504
DECK
984
4
COS/PORCH
41
t�4
STAIRS
52
MISG. TOTAL 95 930 1023
LOT COVERAGE 50 FT
LOT AREA 1,688
MAX PERCENT COVERAGE 95%
MAX COVERAGE AREA 2,691
PROP05ED COVERAGE 2.511
PROP05ED PERCENTAGE 50.14%
LOT GALL NEW EXISTING TOTAL
HOU5E
9
1189
I'M
6ARA15E
INCLUDED
DECK
364
984
COS/ PORCH
41
41
STAIRS
52
42
94
HEIGHT LIMIT CALCULATION
REF DATUM LOCATION -
WATER METER IN RI6HT OF WAY TO EAST
REF. DATUM BASE ELEVATION
100.00
AVERAGE 6RADE (SEE CALG)
104.55
MAXIMUM HEIGHT LIMIT IN FT
25.00
MAXIMUM HE16HT ELEVATION
129.55
EXI5TIN6 HI6HE5T ELEVATION
125.15
NO CHANGE TO EX75T1N6 NEI6NT
NE EL = 103.-1 5E EL - 105.5, NW EL - 104.12
SW EL - 104.15, TOTAL = 416.12 / 4 - 104.53
r�6Ig4��cb�o
II�10,A AVE, 60,
GITC OI ALI
RECEIVED
MAR 112011
BU�TMe OFUEPARTMEDMONDS T
I SCALE I" • A PT
IF*1` Del11r1, °ra
0L Ioo,o
U
NORTH I ({) 2
t..
A A\IF l Svj1f �OWNER/CONTRAOTOR IS RFSPONSISLN FOR
EROSION CONTROL AND DRAINAgE
OF
IMPERVIOUS SURPACE S0 FT IMPERV. XREX HEW EXISTING TOTAL
a
v
uJ
tt i rILL
C •C
64 IzeeWca.i tur`p `t`b s E MO. � � � � a � x
V4 Lw v►a 2 e
W tv►Js
CAMPAGNARO RESIDENCE fyOK-.
1190 A AVE. SOUTH EAMON05 WA 950201 J�
Dpg14EM DF 6EFnLE"W V!W(iD O4C7011"IM�N:IVdffpPEP�PILDW DP IEE 9 PNQIBIIFDMDPPD�FLIFOpY fEAANUW,
EXI5TIN6 RETENTION SYSTEM I9 TWO INFILTRATION
HOV9E/GARA6E
9
1189
1198
TRENGHE5: 20 FT IN FRONT YARD, 20 FT IN REAR
PORGH/EAVES
29
224
253
PROPOSED OOVERA6E AREA 5,941
PATIO/WA4-KC5
12
640
652
PROP TA6,E 43.54%
DRIVEYtAY
644
644
EARTH INGLUDED7 YES TOTAL:
50
3291
9341
.' �#P20
s
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
zoo tag°
Fax: 425.771.0.221.
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:
City Receipt #:
Critical Areas File #: 7_0 1 I- 00 114
Critical Areas Checklist Fee: $155.00
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 app lication op the behalf of the owner as listed below.
/ I I I
SIGNATURE OF At?LICANTAGENT 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 t his application.
SIGNATURE OF OWNER _ ' r 1 ' DATE
Owner/Applicant:
Name r�t
t✓ �a+� ti s t a er;
Street Address
City State Zip
Telephone: 70 0, O
Applicant Representative:
Name
3�3o J�Y`ra s T. MCP
Street Address
�M orJ DS WA 90
City State Zip
Telephone: ZS'- 7?( 3
Email address (optional): Email Address optional): CUM
141,
Revised on 9114110 P20 - Critical Areas Checklist Page I of 2
#P20
Critical Areas Checklist CA File No:
Site Information (soils/ topography/ hyc
. i A • n r
1. Site Address/Location:
gy/vegetation)
'E. 56 U71,4
2. Property Tax Account Number: 00 a, 1 14OO 7oo300
3. Approximate Site Size (acres or square feet): Mg' V .SOL f
4. Is this site currently developed? Zyes; no.o.,
If yes; how is site developed? �1✓ Ve7r
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: , I�0 ; Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year? �jm
8. Site is in the floodway NO floodplain _ .� f of a water course.
9. Site contains a creek or an area where water flo across the grounds surfac ? Flows are year-round?
/ya 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:
1.
2.
3.
-- — For City Staff Use Only
Plan Check Number, if applicable? NIA
Site is Zoned?
SCS mapped soil type(s)? �'� - Evere_ ac'byG`\ga..e� 61 ram O An 9 % S�cce�
4. Critical Areas inventory or C.A. map indicates Critical Area on site? NO,
5. Site within designated earth subsidence landslide hazard area? No -
SITE DETERMINATION
W�.lvtr• _! STUDY REQUIRED WAIVER
Reviewed bv: / Date: 3AV I I
Revised on 9114110 P20 - Critical Areas Checklist Page 2 of 2
� STREET FILE
i CITY OF EOMONOS
GY{ GM11A �OYOHUS. IvKtiw�.ION �pp?p
SINGLE FAMILY MULTIPLE COMIC RCIP.L
O
_z
w
w
z
0
z
W
s
w
r
PROJECT NAME SVFN
ADo s 6 A i
ACCESS SLOPE AND VEHICLE ACCESS
DRAINAGE PLAN
STREET FILE
LEGAL DESCRIPTION YERIF1CA110N
QUIT CLAIM/DEDICATIONS
CASEMENT - PUOLIC/PRIVATE
NEERINO A
.PROJECT
PUBLIC WORKS
REVIEW
CHECK LIST
S',• L• CONTACT NAME 6 TELEPHONE NUMBER
CALCULATE SEWER CONNECTION JF NO 110 f
STREET PAVING REQUIRED
CURB AND GUTTER REQUIRED
SIDEWALK REQUIRED
CURB CUT [OR ORIVEWAY. REQUIRED
RI011-OF-WAY CONSTRUCTION PERMIT EQUIREO
BOND REQUIRED FOR PUBLIC IMPROVEMENTS
STREET HAMS SIGN REQUIREDA
OTHER SIGNING REQUIRED �-
(ADDITIONAL COMMENTS ON BA(
CIISTIHF k.l1ER Mill SIZE
WATER MAIN REQUIRED .,/.
SERVICE LI%E REQUIP.[0 �✓��y�
HYDRANT SIZE EXISTING s % �
HYDRANT REqUIR[D PER FIRE EpOE If"Af
CROSS C(1HHECTION INSPECTION SIZE
WATER 11ETER CHAR,E E UIRED `f' mac,
REVIEW BY
c""�cccw -L LurmmII ON BA
It SANITARY SEWER OWING IIIA'BER
W SIDE SEWER AVAILABILITY FILE NIAIBER
SANITARY SEWER C0111ECTIO11 FEE REQUIRED
W
DITCH IXIS111tG
} REQUIRED
;wL�; ;_C CYlttAl ItQUlAIO -�
, rA
SIZE
I- ul(w WIN t(QUTAID
INDICATED Ott SITE PLAN
lqt W►INALI IVINIAIN COLLEC11011 ON SHALE OPEN RUr10FF
" WIN$ I
INDICATED OV SIT[ PLAN
k � 'w1I1 11ILD CHICK(D
PAIE1 I (ADDITIONAL COWXNTS CAN BAC
i
f
MEMO TO:
FROM:
SUBJECT:
Building Division
Planning Department
Engineering Division
Public Works Department
DATE : /Z- 14-97- -_
A _-AvE__ _
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. Backwater valve required if downstairs plumbing is below elevation of
upstream manhole.
6. Water and sewer lines to be separated by 10 foot minimum.
R,
SD 6/82