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1151 A AVE S.PDF11111111111111 10007 1151 A AVE S 3�$' • S F P EMT'[.: . -- - _...._.._... istnct City, of .. Edmonds ---Water Department �l TAP CARD 71962 I DAID.SEP.1.......:..._.......... No..................I—— ..... Meter Tap No......... ...... Size------- ........... Size ........... I ...... ..... .............._. Mfgrs. No .................... --......... ...... ....... Style ........................... For................11Q? 1.............Y.... �.. ............ ....... _........ Add- --------------------------- Service Location MeterLocation ............................................ ........ _...................... ------------. MakeTap.................................................................... ........ _...................... ......... ...................................................................................... _........ ....... _....... _........ .......... ... Pressure ........................... .... lbs. Test ...................... ............. -------------------------_.. Send Bills to ----- .................... :.....:................._............:..._.:... Dateof Work -- -�...................._.........._................. ................................................. --------_------- .------------- ----...... -.................... Foreman Guar. Voucher No ............................. .............. $................. _..... ..........._... Remarks: --- .................................. _............. ....... .................................................................................... .................................... ............... OUTGOING Index .......... Reg ......Route Bk.......... Stencil. ..... Card.-..._ INCOMING Index ......... Reg ....... Route Bk.... ..... Stencil ...... Card ........ MdVial Chargeable to Installation 1V W NO. SIZE DESCRIPTION RATE AMOUNT .......... :_._ .......... MeterO ------..............-� =l .............• ----•----- Meter Box .............................• -•--.......... .. ......---- .. .............. ... •....... Meter Plate ............................ .............. --......... ......... .............. .......... Check Valve ..... _.......... ......... •------------- __........ ......... Pipe, Galv. Screw •---••-•-- ....• Nipples-------------- ---------- - -------- ------•--- ------- -------- •-•--•-------- -----•---- Bushings .................................. .............. __.......... .......... --------------- .......... Plain Ells ............................................... ............ - ------•--- St. Ells ..................................... .......... .... -•---•-----•-• ............... .......... ---•-••--• I .......... Tees --------------------------------------•-• ..................................................... ..................................................................... -------•---- -------------- .... ........ ............. ..... ...... .......... .......... .......... Material Chargeable to Taps Connected NO. SIZE DESCRIPTION KATE AMOUNT .... Pipe, Black Screw -----••----•-- ----•-•-- Pipe, Galv. Screw ----•-••--•------- ................ ............. ..... ........... Lead Connections .................. . -------------- ---•---•-- Curb Cocks ---------•-----....----•-•.. .............. .... - .... - ......... ---•-•------•• ........... Corp. Cocks .......................... •-•--------- ............. ......... .............. ••----•--- Unions .................. ................. .............. .............. .....---- Saddles ----...-•---........-•----•--•.. ... .............. ..... _...... _..._ .............. ....... Nivples ............................... ............... ......... .--- ..-•--•- Bushings ....--------• .: ....... ....:......... .......:.. ..----•---•---. ......... Plain Ells ................................ ............ ............• •---•----- ....._..._ Street Ells .......................... Tees -------------- ...... -... Curb Boxes ..................... •...... .............. .............. ---------•-- •......... S. O. Extensions ...................• -•--••-....... --•-------- ...... ..••-• Gates ....................................• ............. ------ ........... ------------- .......... Plugs........................................ -•-•......... ..... ....... ....... • ....... •-•----•-- Couplings ............................... .-=....... ... ............. .............. -------------- ............ 0........ .............. .......... .......... -- .......... Gate Boxes ............................ .......................... •................... ....... ...................... -............................ ------•................•--•---•...................--•-•-... ....... 0...... ............. --•----------- ......... _............... ..... ........ --•---•----- ............ .... --=-- ........... .......... ••---•---- .............. --•----• ........••---- ............... ---------•-•-- -••-----•- .......... ---------- ... _........ - ........ ........................................................... ...................................................... ••-•..................................................... ........................................................... •--•..........................................................•••-............_.._... Hours Time —Day Men -------- ............... ............... ............ -• ---••-------- ------------ -- ............ ............. -----•---•-- -..... .. ------- ......... _.. _.... .... ........... ...•••......:............ Hours Time —Monthly Men-- ••--....--•- - -- Hours Time —Auto -_ ---- ---- -------7- -------------- .......... Superintendence ...................... ............. ___...__._ ._.....:_ Total Sheet INSPECTION REPORT STREET FILE BUILDING DEPARTMENT PERMIT NUMBER PROJECT INSPECTOR >_EvES ADDRESS .DATE INSPECTION DESCRIPTION' 7/13 /78 CITY OF EDMONDS )� �7P Cj"10} 1 COG 37 -7G fi�LLUV•11Z.3(� ^ � [�Oof.� r..1 P��1'C� �a � F1�!.�S �: �• ' nt._a 7 '' t Al2t -T LIN (Rt.�rz) �� LOTS AcO(LpING -TCj H a►nnt AS ARP. 7 "' AvE d yl Arz v--P FL MAI,JilZ)LE 2c.a?, ADDRESS: TAX ACCOUNT/PARCEL P BUILDING PERMIT (NEW COVENANTS(RECORDED)FOR: CRITICAL AREAS: _ / DETERMINATION: ❑ Conditional Waiver ❑ Study Required [Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DA' PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED PERMITS PLANNING DATA CHECKLIST DA' SCALED PLOT PLAN DATED: ,I I I I m SEWER LID FEE LID #: SHORT PLAT FILE: LOT: LOCK: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: 196 6 GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD DATED: 017�(Ii� L:\TEMP\DST's\Forms\Street File Checklist.doc J-A �i APPLICATION C., MUNI ON ON- P EMR M I T L Appl. No. ....... ....... CCTV OF -EIDMONDS Building Depadment Permit Limit, one year APPMATION . is hereby made for a permit to construct the following work, in accor,. - ce- with the accom- panying plans and specifications. Two nets are submitted herewith for approval. n alter -;'f-st Work62n repair ..... ....... 1� ....... 7 ............................................................. I ............... -eking ........ .............. Occupancy ................................ Coynst.t� c ......... ................ Use zore__)........--..I Fir� -one ' C ( //Y- - �V Address ........ ..... /�� * d................................... ....... I ......................... Lot ....... . .... ....... Blk ........... •......... ! 1n .. . Lot frontage ....... ................................ ... rea ...... Z 1 J ........... Septic tank ..... . ............................. Bldg. set -backs front_.......... r. side ......... ............. 1. side ........... ............... rear. ............... Owne ............. Address ....... IW3_ Tel.7. Builder.................................................................... Address .................................................... Tel. No ............ .................. Plansby .................................................................. Address .................................................... Tel. No ....................... .............. . ...... .... RcmarL --------------------------------------------------- ............................................. C ------------------------ I ----------------------- ................... V­6�b .................................................................................... The above is a correct statement, and I agree to comply with all applicable Codes and State laws regulating . this work. Signed Owner/Agcnte ...... .. ............ ....... Address ............................................ *Date ......................... R_Mff for the above work is hereby approved, subject to the above o-)nditions, and to compliance with the ap- proved plans and specifications, znd Building Department notations thereon. :,; ....... Permit fm ..... ................. Recd. by Valuation ... . ....... .. ........ ....... ...... .... ..... .... Building Department, By ........................................-0.Date ...... ... NOTE —This permit does not cover plumbing, sewer, or electrical installations, nor does -it penilit'anv done in the Right -of Way areas, Driveways and walkways must, be planned to meet thei-official i2aes'6, streets and aileys, and plans for future sidewalk development. Cit oPEdrrionds _,.. Y Development Services'Depai-tmierit' ,....h . Planning Division ..- Phone: 425.771.0220 Fax: 425.771.0221 Date Received: ,:;5 City Receipt #: ,,Critical.Areas File #:_ Critical%Areas-Check[ The Critical Areas Checklist contained on this form is to A property owner; ; or his/her authorized : representative,, : be filled out by any person preparing a -Development.', must fill out,the checklist, sign and date it, and submit it Permit Application for the City of Edmonds . prior to.. >' "to `the City: `Tl e -City' will review' the checklist, "make a his/her submittal of the application to the City. precursory- site+.visit, .and make a determination.,of the ii 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). su sequent 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 (erg: site " plan, topography map, etc.) or studies in conjunction, withthis Checklist to assistant staff in completing their preliminary assessment of the site: The undersigned applicant, and his/her/its heirs, and assigns,:iri.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. attomey'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/AGEN .. DATE Property Owner's Authorization t 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 S cJz (vim ✓► DATE (Z -i b a `i ��— v Owner/Applicant: Name iis-� 4 Street Address. ems" �.4 1,L7eL City State Zip Applicant Representative: Name 4 G) Street Address City State Zip Telephone: /, vo — q ca_s� Telephone:. y z.5'_ 4F Z.'z —/ 7 Email address (optional): Email Address (optional): Critical Areas Checklist.doc/4.22.2003 riti � I Areas Ch kllst CA File No: � �' 'l °1 C ca Site Information(soils%topography/hydrology/veg etation) 1. SiteAddress/Loation://S/ i/u e cSa 2. PropertyTax,Account Number:: UlJ�D, 3. Approximate Site`Size (acres or. 'square feet): 4. Is this site currently developed? :yes; If yes; how is site developed? NO - no. 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 horizontalldistance 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):-�5,.-F ° crz-d `'ori� 6. Site contains areas of year-round standing water: /i/G ; Approx. Depth: 7. Site contains areas of seasonal standing water: ' `_ ra ; Approx. Depth: What season(s) of the year? 8. Site is in the floodway. A ilo floodplain 66 of a water course.. 9. Site contains a creek or an area where water flows 'across the grounds surface? Flows are year-round? i1-6 Flows are seasonal? /V 6— (What time of year? ). 10. Site is�primarily: forested ; meadow ;shrubs ;mixed ; urban l'andscaped (lawn, shrubs etc) 11. Obvious wetland is present on site: �la Y -For.City Staff Use'Oiily 1. Plan Check Number, if applicable? 2. Site is Zoned? RS - to 3. ,SCS'mapped'soil type(s)? _ y.. _.�,..::>�. ..5�... •%; `�vtnsit�.'�a�iG><' Sri,: aan,•.. p'.. 4. Critical Areas inventory or C.A. map'indicabei C ritical Area on site? AIo 5. Site withimdesignated earth subsidence landslide hazard area? No DETERMINATION STUDY REQUIRED, V WAIVER Reviewed bv: Date: Z/ 1 9 Critical Areas Checklist.doc/4.22.2003 Z . Critical Areas Checklist cAFile N°. ite Information (soils/topography/hydrology/vegetation) Site Address/ Location: //S / A� AdU e cs® 2. Property Tax Account Number:DIOI 3. Approximate Site Size (acres or square feet):.5-oc Is this site currently developed? � yes; no. If yes; how is site developed? 4:LLeCDZa&�- 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):t S cf ;F0 J'In) ` ,0r*A-P eP2r p !'X C C� A.4k,, 6. Site contains areas of year-round standing water: Approx. Depth: 40 Site contains areas of seasonal standing water: _ to ; Approx. Depth: What season() Ys of the ear? 8. Site is in the floodway 11% floodplain of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round? / e Flows are seasonal? IV 6 (What time of year? ). 10. Site is primarily: forested ; meadow ; shrubs ; mixed urban landscaped (lawn, shrubs etc) & r 11. Obvious wetland is present on site: Ala For City Staff Use Only 1. Plan Check Number, if applicable? 2. Site is Zoned? Rai - lv 3. SCS mapped soil type(s)? 1 7 - �vur,t " Sr, 1, a 4. Critical Areas, inventory or C.A. map indicates Critical Area on site? S. Site within designated earth subsidence landslide hazard area? I�lo DETERMINATION STUDY REQUIRED Reviewed ✓ WAIVER Z/ I Critical Areas Checklist.doc/4.22.2003 City o�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: d City Receipt#• eZ/� Critical Areas File #: 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 mID knowledge and that I am authorized to file this application on the behalf of the owner as listed below. SIGNATURE OF APPLICANT/AGE DATE Z O 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 c �+ ��l�i DATE PLEASE PRINT CLEARLY Owner/Applicant: Street Address a Dom D City State Zip Telephone: V 0 - cl Cea s� Email address (optional): Applicant Representative: Street Address City State Zip Telephone: q_7 5'- F Z z —! 7 Email Address (optional): Critical Areas Checklist.doc/4.22.2003 The City of Edmonds IAI—A APPLICATION for SME SEWER PERMIT OUTSIDE INSIDE 0 REPAIRS 0 CARDNo. ............................... .. ...... EASEMENTNo. ....................................... . - OWNER ........... ............................................ ....... CONTRACTOR ... ......... .. ..... ................................................... PERMIT No. ./.// .. .......... STREET HOUSENo. .... . ... 9 ...... 4--if .......................................................... AVENUE LOT No . ........ ..... #7 .......... ... BLOCK No . .............................. ............................. 17 40- NAME ADD .................. . .... wloutu ..... !� ........ ........................... ........................ —.- X — ;# -or 16 75-14"4A'4�' APPROVED EP 6- Date Approved: ,.RACKFILL WORK ORDER ISSUED ... ........................................ DEPOSIT, .................................. ................. SEWER WORK ORDER ISSUED ................................................ DATE ..... ............... By —.k# O*S'TAEETFILE, RFCEIVED JUL 311978 Dir. Of Public Wu'" July 28, 1978 MEMO TO: Leif Larson VIA: John LaTourelle , FROM: Harold Reeves SUBJECT: DRAINAGE COMPLAINT AT 1151'"A STREET Request assistance from the Engineering Division to resolve a drainage problem at the above address. Copies attached. We propose a joint site inspection. HR/ae attachments LIP "?, &0 Ae r CITY OF EnMONDS PUBLIC WOF �"PARTMENT SUSPENSE CONTROL RECORD SUBJECT NAME SUSPENSE DATE NUMBER Drainage Complaint @ 8/8 1151 "A" St. FW-198 ` FROM FILE DESIGNATION Harold Reeves, CDD SUMMARY Drainage problem --request solution and joint site inspection. STREET FILE TO TO TO TO TO Fred DATE DATE DATE DATE DATE 0 • DATE �o CITY OF EDMONDS COMPLAINT RECORD STREET FILE Complaint voiced by: Name: e I" �o Address: l / �\ v 776 l0 (� S v AVI Property owner: Yes No Where Address of property to be investigated' Name of owner: Address: Phone: Res It of in,<estigation: LL 7j13178 5x—E A-TtAcH-D ' V2T--Po(ZT OT5 mPervIino N RECEIVED FEB 17 2004 Z-7 PERMIT COUNTER + M FOO 70// AM TI 1. -F-17 "ts Go, v e- in-r j . c, ', p 4.,,( JJ I t/ Q i R e T T") Lkjqd! 02, z co 8,;t)t cc QN CL 1151 /A- -Av'G+ 5,- 4 - O,3L I D f0) I)c I 4\01-\ /k R f 7 99. Ce I_ �XN fA- II � Y G pri Ell a m it ek co ;N 12 tj) tit%, IS w-1 kj(-.1 ... ..... ... K- It. 4A kJ r. dL ........... " VICO 416 C5 A4�, WeL L Cu,tf 4 b 51- 'e, I,v I, , W, 1440 Is Ae I I' V— ', zl� Y1 IT (16 n c re T�'... 7T 1,,-C s W— f I RECEIVED FEB 171004 PERMIT COUNTER � � "�T FILE