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1259 BIRCH ST.PDF11111111111111 10315 1259 BIRCH ST ADDRESS: TAX ACCOUNT/PARCEL NUMBER: 0 brp [ 0 �- dbbb L kQ OO BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) CRITICAL AREAS :'dZ--21 DETERMINATION: ❑ Conditional Waiver ❑ Study Required SeWaiver DISCRETIONARY PERMIT DRAINAGE PLAN DATED: PARKING AGREEMENTS DA' EASEMENT(S) RECORDED FOR: PERMITS (OTHER): Oby� 9 3J (T�f'l ICcS) PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED k54 lq 7 Z c SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: WATER METER TAP CARD DATED: L:\TEMP\DSrs\Forms\Street File Checklist.doc j. ,`cA File No: � M. 2 �� - 4--c itical Areas Checkl°rs Site Inf6 o; n' (soils/:topography/hdol yrogy/vegetation)„ 1. "Site;Address/Location: S.�j ; r c 2. Property Tax Account Number: 1 2 Q O 1 G a 31. Approkimate•Site Size (acres.or square feet) ,:.. - 4. Is this site currently developed?�es;• no. If yes; how is site, developed?. R i. a ., l 5. Descri/be.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 3U°r6„present on site (a vertical rise of 10-feet over a horizontal distance of less than 33-feet).- Other (please describe): f 6. Site contains areas of year-round standing water: Alk Approx. Depth: 7. Site contains areas of seasonal standing water: r1 ; Approx. Depth: _ What season(s) of the year? Site is in the floodway /14 floodplain of a water course. 9. Site contains a creek or an area where water flows Across the gr,''ounds surface? . Flows are year-round? /IlJ Flows are seasonal? (What time of year? ). 10. Site is primarily: forested ; meadow, ;shrubs ; mixed urban landscaped (lawnshrubs etc) 11. Obvious wetland is present on site: ,/V0 ` 7. •'S.`.•Ph [R �! k• t�'i„ n .�yal �-~--^'I..:�fif�"y ��'nr��"MA�4'. f - •Aj �i.:]I'.J��{i�nip? V•t{Yy.' � <f' / S 1 �:.(w"`".'s t-?, (•t'11. t( } t1 �.� `liiii6.�?a(�1 � '. 1?SJ at^y -.. .'C. {� nY� i�71-,iiiA.4 Y;}..: Y. �` ! l� '} .'�� 3( u`%'y't >. 1 .i J 1 t'N •�Zh •S M � r 47."'.y. '� is ri" f 3'�y 1 L � S 4t. L n: Y .x. al r.�'!et.' s+.r� e.:.f, ur,. lJ. 'fir n,� t... t. �: '�: re�..0 3r .r '•'#'� % pS S � a �, ?� i.�''r..U.°la xs+ i . � i T"�.ie� t'i'y C4`' r t �' � For �� StaffFUSe Dillyv w. 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A a✓'rk f '� s �.. 4 t } ,{- y Kr b: '". s• i `pi'a !r F `i /! -� ; a, j i ti,x, it• -'^ice i'?i.5 •.'9 �r F.l sd. +ivE t'C't 1r t-i?�L".2, Ham' �?�:2.' i ti°r h 1'.n..r %' ''��'? �'g �:.t -ri k -n� '°:-. o 3s,i�Y,•F�-+ yS�y; y t } f' t Phr's.� dy�j ; {t`^,"tg•P;y� 4 C:nhcalTArea§an`ventoryoor CAA map inchcates;d- 1 1 ?,l.? rr r t i Y. �. s_ r.�', i:+t8' l =a�+d+ -r.;, ss *. r y 4 ti'+'��•S\ 'il�iti �T?,1,� '. f�2^ �J �;a•T�� y - }• �,rl: f'i[.' i_ r 'a } �LL�,�`q�'(a !!`r� F 'RA ,'0� - a z b �?.. 5`I'tr. !� r.+'fi,�J' f• ...rti ,�•a.• f ' p+ € s•qt ' - b. �. T- -;' 3 - ..,� t4� ,i�,-,i A . r: 'p yriu' ' }t; .�-•• tR r,,,, _ w �. s,� r.:;.ai t o ' t •' -l' a it i!sZ'. 5 ; t r Site within delibed earth` subs�d ean`slitle¢ -`s, 6 cat Ste",t. ( *c'Yy'•. k'�y, l* �� - *�1:c }3.r�✓ 3 - f�v.rl r`S.` 9-R'. '�� �`'s1- fs A� } t. q}r g., Mr r a i r�� ;�� r � �� •�.s4�3fini r f - .3."S .. a n.�s°`r rig .t tt a •� J � ��q N� c - - �.:r`�%-� "t••t� ri.� *'�R ki � .. t � r_,'41 x �1 �"s •}, � -� S OlY at g h f. 2 "•cks7�s� 2�I�S.- .� rAd rN �- •�' ...#rs 9 "�}}it, f i 7" Jf •� r..r 5'' r �r� a-i� �i.,'w � •,� 'J t.4 11.iy - r'S t �,xk. - '+�..•r is . z to rt-:c,.7ttiJ .7:,�' f W � �tr;ivx�".'�',; a �2T },{�? �r7 y���R ." �c�' :F, ,//�fi��. /�l�I ai•%�-��;�> ��''�hq.�t� �,�; . =e.. jj 7F../1eWed} i.?,Mil�S.. `•e> ® :/_=-4/�►.�'f/: i�•f.3R.-5.,.. >'°:. ie;ltr-i Critical 'Areas Checklist.dod3.19.2001 City W-Ei.dm, .. iads �? wA 'Development Services Department A. Planning Division' Phone: 425.771.0220 'Fax: 425.771:0221 .- 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 ' • M,_*st, fillbut the clieckhst sign) and date 'it, and, submit it Permit Application for the City of Edmonds priori to to the City. ; The Cityi will. review the checklist, make a his/her submittal of the application to the City. precursory site' visit, l and "make "a ' determtnation of the f subsequent steps- necessary,;to complete a development The purpose of the Checklist is to enable City staff"to ' "permit application. determine whether any potential Critical; Areas;, are,,, or. ; may be, present on the subject property. The information Please submit a vicinity. mapj;along with the signed copy needed to complete the Checklist should be easily of this form to assist City staff in finding and locating the available from -observations of the site or -data availabl'e=at 'specific piece of property'.described,•'on this, form. In City Hall (Critical areas inventories, maps, or 'soiladdition, the 'applicant shall' include other pertinent surveys). 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 thi p lication.on. the behalf of the owner as listed,below. SIGNATURE OF APPLICANT/AGENT Z t DATE /�= /3"6Z 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 posri^g attegant to/ i application. SIGNATURE OF OWNER: IZ-p DATE Owner/Applicant: APt J. C(A ro►in IL ?1e MS Name 2 j7 rj� �JirLh s+ Street Address 10Ldm0nds City State Zip, Telephone: tia 5 1 S Email address (optional): ,esentative: - ...=TN K Name j P0: j�x ?755Z Street Address City State Zip Telephone: .ab6 - 30 b - i061 Email Address (optional): Critical Areas Check] ist.doc/3.19.2001 APPLICATION for The City of Edmonds SIDE SEWER PERMIT EASEMENT No . .......................................... NEW CONSTRUCTION ❑ REPAIRS 400-09400 OWNER........... Mrs ...... Ni•Ch0ld5••PEtOS........ ...................................... CONTRACTOR............................_..-----...._..._...............-----....---.......................... PERMIT No....................... ADDRESS ........ 1.2.59._ 1.rch...St............................................................... LEGAL DESCRIPTION: LOT No............................................... BLOCK No. ............................................ A U. • NAMEOF ADDITION ....................................... ---•-------............_....._....................................................._............. Dye Tested On Sewer 1972 Approved: DATE................................................ By--......---................................._._........._............. W N /973 3 t$gIN g N Sw-3eh1 ' T9i ` I tgw e�- Ina —i75N �9�J r951 6.��0 ' a m llbr .r : v a rrerN ,�KPs .3 M tone Yt �S4' � RCH'� R®� $t4a Ito -lob .3 S7 t!N SIN. - I sty d"AE lP /t�G • P' !%4"P API 'L � pL� ,� � _ Ell u4 aL rta aye zvv Off e� \m PskGasXftt\TlFkQI65066.TIFI 65066.f ,q��sgem ........................... ........ .... . .... ... . ........... ......................... ... . .... .. .................................. ........ ........ ............................... .......... ........... ...... ................................. CX_ r,/B;.361 SEE 4W-425*s 9 A 5a. 302'N - 5 jWN i3j, an '-'p 1p BS-- -7m o J IL > IW asrH DUAL *9 fk f PEI 1-973 910 CL ri cu- •a 0 34OW low" PAM gpe ,ate *79 410 43n.(BIRC RO -toll) RAPED 223 ST sw. tq 2' PE TP mR 9=722_j5'W Qmw sw doop 04.rp 006 14 set MIT ic n ►.3; (LARCH to W+) 14 ____ a _IST 4sw � , „ .. � } .. , •. � • ' .�.r. i.. Wry::..,'...: „ , i � .y' Z,: .. ' c � it �w RIGHT - AY CONSTRUCTION PERMIT Permit No:2062 —O S3C7 Issue Date: �' 7 A. - Address. or:Vicinity of d' np�st' gttiio"n: c)..`� `'j j �\ YC✓� �' " B. Type of Work (be.specific): C. Contractor: I � 't` Cont C�L,I.Jact: Mailing Address: 13 �� v c•OU Phone: 141 R— `�2' Vc 1 State License # el L e Ne 1©1 M Liability Insurance: Bond:. $ D: Building`Permit # (if applicable), ':` e Sid"e'-SewerEermit # (�f applicable): ' Jr E. ❑ Commercial ❑ Subdivision ❑ City Project ❑ `EUC (PUD, VERIZON, PSE, AT& T,' OVWD) ❑ Multi -Family [ Single Family ❑ Other INSPECTOR: F. PAVEMENT•CUT: 0 YES•; ,f; u NO G. SIZE OF CUT .. X' ' CONCRETE CUT: YES `• NO' }' ,t INDEMNITY: 'Applicant, understands by his/her signature to -this application he/she holds the City. of Edmonds harmless from ,.j3. - - injuries, damages or claims. of any kind or description whatsoever,. foreseen :or. unforeseen, that maybe, made against the City of " Edmonds or.any.of its departments or employees,, including but not limited to the defense., of any legal"proceedings including defense costs and attornev fees by reason of granting..th permit.. r' `D THE CONTRACTOR IS RESPONSIBLE FOR. WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR. FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF -THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD, UNTIL THE, FINAL WREET PATCH IS COMPLETED BY CITYbFOR -ES,T WHICH TIME A DEBIT OR CREDIT W/LL BE PROCESSED FOR ISSUANCE TO THE APPLICANT '" ♦ Traffic•control and -public safety shall be in accordance with City regulations as required by the City' Engineer. Every flagger must bel.trained as. required by (WAC) 296-155-365 and must have certification verifying completion of the required training -in their possession. t ,:= ; y. i Restoration rs=`to�be in ccordance!,with° Ci>y co{&: All°street-eut'trench work.hall: be. patched,* witlf� asphalt. or City- 4 , l - -approved. material prior"to the end of the workday�- NO EXCEPTIONS. . Three sets of construction drawings of.proposed work Eire, required with the permit application.. ,. C C L DIAL -A -DIG (1=800-424-5555) PRIOR TO BEGINNING WORK I HAVE READ THE ABOVES'TATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE THAT I MUST MAKE THE PINK COPY OF THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS Signature: ,Contractor or Agent) Date: FOR CITY USE ONLY - Approved by: tt F Right-of-way Fee a Time Authorized: Void After / to / a3 DisruptionFee/Fund: 11: ` Special Conditions: IES-TORE tZoo 'M eAl STAB . RestorationFee: VEC�,-MR6 Dtc--fUggEb LAND_,�t'14?E UITOt_ TotalFee: a : JSF— 'TM 0MOJ-n0N< , f�JF:;V Aff - i�61Fa �, 'Receipt No: ' PR:ta12"T1� WdRlc- STA NAi 10 SETMC LS. � -Issued by: 1> � "JI `�1tG �0NT1Z�L. Wf ucs ,►J: a UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL INSPECTION 1S REQUIRED PER CHAPTER 18.00 OF THE EDMONDS: COMMUNITY DEVELOPMENT,CODE (Phone '425-771-0220, Ext. 4326) . FINAL APPROVAL'OFPERMITTED WORK: CiQsii< .014 DATE: lU/Zto%T 1 spector's Signature -For inspection requirements see Engineering Inspection Information handout. L DAMyDocumentsiFoimsiEngnrngiROWpermit .doc