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114 SKYLINE DR.PDF114 SKYLINE DR 610 ADDRESS: TAX ACCOUNT/PARCEL BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) FOR: CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: SIDE SEWER AS BUILT DATED:_—/ SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: WATER METER TAP CARD DATED: OTHER: L:\TEMP\DST's\Forms\Street File Checklist.doc l-g _. BUILDING ARTM�ENaTs. USE � ,{ I t ZONE PERMIT t In$I PERMIT APPLICATIOW vY i � _ NUMBERLbn Li Lines � ��.• ' / NAME IOR NAME OF JOB 1J r n BU.a1N E.SSI r ^ AOORCSS // r V ` VANIANCe ON GO W AILING .1DD O, U .aE Np AD.) NO, HEIG i,� / 1- / 0 C)-v�..t o7ry �G % t Yy PROPOSED YARDS / RAC CLEPHONE NUMBER LOT-7-4- FRONT' SIDE S AR /- r `� {' pL M��AREA / V^IRON - C\ F ALLO',nD PROPOSED MENTAL REVICW V l U �I W ADDRESS- / -331,3 REMARKS��-COMPLETE ' XF.M- Pr Z O V Z U cc CITY J �y a ANNINb EPT, AP ROV AL 6 •1{ < TELEPHONE NUMBER DATE U - 1 6 - ' LEGAL LOT NAME ��- 1LOOTT ,A/�R, CA,r. SUBDIVISION NO.� S ON. - E 0 STR.ECI' R/W tf ((J EXISTING STREET R/W FT, DEFICIENCY THIS PROPERTY COMP, PLAN ST. R/W 6, FT, 'S C< CITV F 0 i'7. TELEPHONE NUMBER 0 p REMARKS Ilrivelaay slope not to excc-cit�,�,�e U STATE LICENSE NUMBER indicated on Standard TJrawir.`n Legal Description of Pro a (Show Below or Attach F p Y CUr Copies) L STREE- ANO OR = t / VTILITCY�WORK R/W PERMIT REDIJIRED REO•D. ❑ YESNO W ��.. Z LJ YES 6 Lo 36 VNDERGROUNO V 1 WIRING REO'D. &yes UNO W . I,• / H I �i /7� TYPE CC'NNEC TION -�-� YES VERIFIF,D BV ' SANITARY gEWt: {? ❑ NO D -1APPVD - SEPTIC SYSTEM PERMIT NUMBER BY CITV Er: G, � YES ' D AND ' W REMARKS] METE SIZE SERVICE SIZE CLEARANCE •/LJ I/ ) . CHECKED B I i IYi NEW T�i KS W I 1 ♦ < / REgIDENTIAL CAS LL_1i ❑ LINE 13 NON-RESIDENTIAL SIGN ADD ❑ FIRE ZONECONSTRUCTI � CO ❑ DEMOLISH DWELL NING 'n ALTER EXCAVATE FENCE SPECIAL IREQV RED SPECTOR REA S7^- OCCUPANCY OCCUPANT •I GRGVP OR FILL ❑ (-_ X �) G YEg O j' _ 'LOAD `I PLAN CHECKFD B REPq IR ❑PRE -MOVE INSP. ❑WIM - THIS SITE S LVCAT a, IEC•-IN THE CITY OF EDMONDS- P POOL pF STORIES NUMBER LOCAL SALES TAX 'cc R A H L." C' OF ----I DWELLING / UNITS KS ' - V Z. NATURE OFWORA TO BC DONE J PROPOSED USE 0 T PLAN CHECK VALUATION FEE C P 07 PLAN IINOSC. TE BUILDING SETBACKS, C ABUiTI NG STREETS) U NO. - d D BUILDING QQ 1 7 o� _ PLUMDING HEAT B, GAS LINE _-'- ai = PENCE --�----� SIGN RETAINING V. "-L � SWIMMING POOL -� 1 i:erehy acknuwledge tha! I have read this applicati- on; (hat the in- TOTAL AMOUNT DUE formation given is correc!; and that I am the owner, or the duly author- izea .gent Of the awner- I agree to comply with city and state laws regu- hating constructic:l; and in doing the work authorized th reby, no person will be emplovec) it, violation of the Labor Code of the State Of Washingtun relating t,) Wi ,knlen's Compensation 1 ATTENTION APPLICATION THIS PERMIT APPROVAL nsulance• NOSE: Permit Limit One Y00f(Exccpt DL'SIOL1TfONS AUTHOONLYRIZESTh•s application is not a perrnit u^UI and FILL days; PERMITS EE-IN mnditi--! use permit, which shall be completed in 90 days; \fOVg�'.lN BUILDINGS ai fitted by the Building Official or his 1.ep• WORK Norco uty; and tees shall be completed in six months./ I gIGNATURE tOWNE R AG�_NT are paid, and receipt L xc- knowledged to space provided. IEPAR ATESIGNED TION DEPARTMENT -IRE O 'SSIG ypE 7-r / CITY Of: I%10 IApplicar:t Su,5icct to Plan Check Fee EDMONDS DATE Th!s nrmit coven work b the pub i domaino(curb,, sidewalks, Eirerty riivinlY. Any connruarqu %%$'2$25 J - 2 7 s, vvoys, marquees, etc.) will require separate permission. r --Fes YELLOW. ORICI NAL- COLD - Assesxr PINK • OKner 7 . nl �( 7701-0 :2 ' o Neo 3.0 I N IS CITY OF EDNONDS = ENA(RING DEPT. LeT 5C.. ! -l- 8 , Examined by— _�_ �f/��.t"S,E.t.►7 �11�1 5 -lo''b ? F�Y� 3a ,Y/ Date_ �� • '%��-.-_— 5t,.ra�= cs;ti►5i-� c,c,uhrr: - ---- \` kAz (4 i ► cr-Toj.j, {� ` h° / ... Remarks 01 - ! I G.4 .. c 1. _ _ i RECEIVED FEB - 3 1977, N 127.400 _ CITY OF EDWROS , 9uRv�� _:STAKE' C`:'`�P) �!'•"' !'Y•~. W.' NO WAFTI`,",17 OACCURACY The InfOiTma-U`m C', 'to; ase by bit City of EdrjlC,-L c of Ednioiids dcic:, nut wzai(.,,.: ul. aWY`l:,zW S, ti7 z L; i,;jap Any pl-.isuil or entity req:1 S!; ct ca k` inqpy ie, wd;,i-. thy' h,". b:hrnl.;e,! to the locdoo:, of an' S'.e. 1, sluk. ic o: noexist wd niu, or m--y ncl c:e': si,:-- N,,14— thk City 0 Edn:03'nc; Its iii, -,, wZJw this map, ac,,- tu, zji, Jt piuvijiw uiuouv upuii salu neap 0 0 E 0 V PI �z M r • APPLICATION 10 The City of Edmonds for EASEMENT NO- -------------------------------------------- SIDE SEWER PERMIT NEW CONSTRUCTION REPAIRS 0 LID NO- ------------------ -ASMT. NO. .................. OWNER .-Lr 0"44.....-:24O .IE' �f PERMIT NO. •------•---- CONTRACTOR ..----- !. ,f LD U _ SE.v------------------•- e JOB ADDRESS ------- //�----- �Ky ✓Ali-RLY.G-....................... LEGAL DESCRIPTION: LOT NO. --4F ?------------------------- BLOCK NO. ------------------------------------ -.- 00'Lz 1 �N i 250 5th AVE. N. • EDMONDS. WASHINGTON 98020 • (206) 771-3202 COMMUNITY SERVICES June 26, 1987 H. Pedersen .114, S'ky:l' i_ne .:Qri ve Edmonds, WA 98020 SUBJECT: BACKFLOW PREVENTION DEVICE TESTING Dear Mrs. Pedersen: . LARRY S. NAUGHTEN MAYOR PETER E. HAHN DIRECTOR The backflow prevention device in your water supply system is due for annual testing as required by State�Code WAS 248-54-500. Our records show a total of one device in your system. Please have the testing performed by a person holding a certificate of competency as a cross connection specialist, issued by the State Department of Social and Health Services (telephone 464-7674). If a device fails its test, please have the necessary repairs made. Upon completion of a satisfactory test, have the certified tester fill o.ut the enclosed Test and Maintenance Report and return it to this office within thirty days. Additional information relative to this matter may be obtained by con tacting our Cross Connection Control Specialist at 771-3202, extension 294. Sincerely, Archie Brena Water/Sewer Division Supervisor lk Enclosure PUBLIC WORKS 0 PLANNING 0 STq fz r FILE LW dt. PARKS AND RECREATION ENGINEERING CITY OF E D M O N D S LARRY S. NAUGHTEN DEPARTMENT OF PUBLIC WORKS (206) 771.3202 MAYOR Edmonds, Washington 98020 Administration — 250 - 5th Avenue North Maintenance & Operations — 200 Dayton Street M Mrs. Harold Pedersen 114 Skyline Drive Edmonds, WA 98020 Dear Mrs. Pedersen: May 1, 1984 SUBJECT: BACKFLOW PREVENTION DEVICE TESTING The backflow prevention device in your water supply system is due for annual testing as required by State Code WAC 248-54-500. Our records show a total of one device in your system. Please have the testing performed by a person holding a certificate of competency as a cross connection specialist, issued by the State Department of Social and Health Services (telephone 464-7674). If a device fails its test, please have*the necessary repairs made. Upon completion of a satisfactory test, have the certified tester fill out the enclosed Test and Main- tenance Report and return it to this office within thirty days. Additional information relative to this matter may be obtained by contacting our Cross Connection Control Specialist at 771-3202, extension 294. Sincerely, STREET FILE CHIE BRENA Water/Sewer Division Supervisor ml Enclosure isc� �--�=-2 tJ ��o 5-- ?-�% WILLEIKSEN DT CMAiH DT MILLS DT 4- • HARVE H. HARRISON MAYOR 200 DAYTON ST. • EDMONDS, WASHINGTON 98020 • (206) 771-3202 DEPARTMENT OF PUBLIC WORKS November 19, 1982 Mr. Harold Pedersen 114 Skyline Drive Edmonds, WA 98036 SUBJECT: BACKFLOW PREVENTION DEVICE TESTING Dear Mr. Pedersen: The backflow prevention device in your water supply system is due for annual testing as required by State Code WAC 248-54-500. Our records show a total of one device in your system. Please have the testing performed by a person holding a certificate of competency as a cross connection specialist, issued by the State Department of Social and Health Services (telephone, 464-7674). If a device fails its test, please have the necessary repairs made. Upon completion of a satisfactory test, have the certified tester fill out the enclosed Test and Maintenance Report and return it to this office within thirty days. Additional information relative to this matter may be obtained by contacting our Cross Connection Control Specialist at 771-3202, ext. 294. ml Enclosure t BRENA DT Sincerely, STREET qLE JOHN B. MITCHELL Superintendent of Public Works f/-ZZ -sZ ILLEIKSEN DT MOCH D n. MEMO FOR RECORD MEMO TO: File FROM: Lee Willeiksen Water/Sewer Divison SUBJECT: CROSS CONNECTION/IRRIGATION SYSTEM AT 114.Skyline`Street'- Harold Pedersen The irrigation system at the above address is in compliance with the State of Washington and City of Edmonds ordinances per Lee Willeiksen. LEW/amm TP 77,