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1531 10TH PL N.PDF1111111111 559 1531 10TH PL N ADDRESS: TAX ACCOUNT/PARCEL NUMBER:/ 32-,,,70 / _. vy �D — a7 BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) FOR: CRITICAL AREAS: q "J— 1 W DETERMINATION: [I Conditional Waiver E] Study Required kJ Waiver DISCRETIONARY PERMIT #' DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED PERMITS (OTHER): PLANNING DATA CHECKLIST DA' SCALED PLOT PLAN DATED: 19 SEWER LID FEE $: SHORT PLAT SIDE SEWER AS BUILT DA' SIDE SEWER PERMIT(S) #:�,Q SOILS REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: FOR: WATER METER TAP, CARD. DATED: / OTHER: ZO \`� n`� �a cy LID3 LOT: BLOCK: LATEMPOsrsTormAStreet File Checklist.doc • PLANNING DATA NAME:�cx SITE ADDRESS: REDUCED SITE PLAN PROVIDED? Ye / No) MAP PAGE: CORNER LOT: Yes / No FLAG LOT: Yes / No) ZONING: IZ — I o`� CRITICAL AREAS DETERMINATION #: c) aQ ❑ Study Required: ® Waiver ❑ Conditional Waiver SEPA DETERMINATION: ❑ Fee ❑ Checklist . ❑ APO list w/ notarized form ❑ (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger) Exempt SETBACKS: Required Setbacks: Stree :@ Left Side: I c f Right Side: 101 Rear: QLC:""1 Actual Se b'a ks. f j f Ste .LeftSide: 1 C� .S Right Side: Rear: Street map checked for additional setback required? (Yes No NA ❑ DETACHED STRUCTURES: ❑ ROCKERIES: ❑ FENCES/TRELLISES: ❑ BAY WINDOWS / PROJECTING MODULATION: ❑ STAIRS / DECKS: PARKING: Required: ©Actual: LOT AREA: j L4 . o9?` o 1( LOT COVE _ BUILDING HEIGHT: Datum Point: Datum Elevation: 1 op Maximum Allowed: 1 ��Actual Height: 1 , s S7 A.D.U. CREATED No / Yes) SUBDIVISION LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: Yes / No) OTHER:�a Plan Review By: 0 /a . Q 7.S r3.fG1'�.o C Q 7.S • 100 .O NewBPPlanningDataForm. DOC OWNER / PROJECT ADDRESS:. EMOKE ROCK 1531 10M PLACE NORTH EDMONDS 98026 425- 776-2798 home 206 — 794 — 2920 cell TAX No: 132703 4 0840 002 LEGAL: NE CORNER OF SW V4 OF SE % THEN 89 47 OOW 59558 THEN S 38 34 00 W 66.7' TO TPB THEN S38 34 00 W 75' THEN 5102 OOE 18936' TO CENTERLINE OF 2ND STREET THEN 38 34 00 E 75' THEN N 5102 OOW 18936' TO TPB. 1 �av,0jL of yIUE 56 SCOPE OF PROJECT: NEW 450 SQ. Yr. UPPER STORY ADDITION. NO MAIN FLOOR ADDITIONAL SPACE.. RE ROOF ENTIRE RESIDENCE. ZONE: RS-12 LOT SIZE: 75' a 1901 =14,250 SQ. FT. LOT COVERAGE: - EXISTING HOUSE,GARAGE, DECK 2492 SQ. FT. 17.4% NO CHANGE. ' IMPERVIOUS: PRE-1970 HOUSE ( BUILT 1951) 1,974. SQ FT GARAGE 664.5 POST 1957 DECK. 705. oil 23 P0WlJ 5PoU-r5 To. l I5 FL. A. 544 E5 l_ O C KS _N � 01 z NI L� lo' SIDE 5� N RECEIVED DEC 0 t 2003 PERMIT COUNTER = 1 %e, fl-- 2'a- 1 "a SETBACKS: FRONT SIDE Iy ` REAR OTHER HEIGHT 2a SITE PLAN 1" = 20' 0" I oil GRADING: NONE CONTACT DURING PERMIT PHASE: KRISTIN HANSON HANSON DESIGN 652 ALDER STREET EDMONDS 98020 425 77.4-7129 425 771-3152 FAX h_ansondesignQhotmaiLcom W �xIS'Cl �1G 2�s.�4arz�E. V2 1 RooF I � at u � t .o wAl.l� 0' MWM 3 15'-0, PLANNING DATA NAME: SITE ADDRESS: I5�3� �V' p�. DATE: ZONING: (1,S --'I Z PLAN CHK#: PROJECT DESCRIPTION: CORNER LOT (Yes/No) FLAG LOT A) (Yes/No) SETBACKS: r + Required Setbacks: (� Front: 2S 1 Left Side: l� Right Side: % Z 1._ g Rear: O Actual Setbacks: n Front: 1'4 1y Left Side:_Right Side:_Rear: Street map checked for additional setback required? (Yes/No) LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N) LOT COVERAGE: _o Maximum Allowed: o Actual: BUILDING HEIGHT: i (I _ Maximum Allowed: Actual Height: (� 6 Datum .Point: I WA Datum Elevation: m A.D.U. CREATED?: SUBDIVISION: CRITICAL AREAS #: (-,7V`� SEPA DETERMINATION: k1A LOT A 1 Plan Review By: m\81UkP=1iA^p1endN.d0o TREET Critical Are-pLs Checklist' S.., Site information Project Name: Permit Number. Site Location: UProperty Tax Account Number -. Approximate Site Size (acres or square feet): 1yea 5, r, / 3? /I' - Have you filled out a Critical Areas Checklist for a project on this site before? General Site Conditions 1. Has the site been cleared or logged?y Date of most recent action:.�c� Soils / Topography 2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? 3. 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 prescnt on site of more than 15% and less than 305* (a vertical rise of 10 feet of horizontal distance.) Steep: grades of greAter than 301/6 present on site. Comments Hydrology/Vegetation. 4. Site contains areas of year-round standing water_ 5. Site contains areas of seasonal standing water. ./% 0 Approx. Depth: 6. Site is in the floodway floodplain of a water course. 7. Site contains a creek or an area where water flows across the grounds surface? flows N/Iq are year-round? Flows are seasonal? 8. Site is primarily: forested ; meadow _;shrubs ; mixed _: T 'S� IZPs, 11 9. Obvious wetland is present on site: I/'O 10. Wetland inventory or map indicates wetland present on site: 'J WAIVER: CriticaLareas studyis'not required Determination:Number. C S -la / Reviewer # Planner Date Rev 3127/92 v • Ki:c1'�J^1 r o e99-iq9 City of Edmonds Critical Are as Checklist The Critical Areas Checklist contained on this fora is to be filled out by any person . preparing a Development permit Application for the (Sty of Edmonds prior to his/her submittal of a development permit to the City. The purpose of the Checklist is to enable City staff to determine whether any potential Critical Areas art or may be present on the subject Prtaperiy. The information needed to complete the C heeldist should be easily available from observations .of the site or data available at City Hall (Critical Areas inventories, maps, or soil surveys). RECEIVED MAY 13 1993 PERMIT COUNTER An applicant, or his/her represeatative, must fill out the checklist, sign and date it, and submit it to the City_ The City will review the cheddist, make a precursory site visit, and make a determination of the subsequent steps necessary to complete a development Permit application. With a signed copy of this form, the applicant should also submit a vicinity map of the parcel with enough del°ar'1 that City staff can find and identify the subject panxl(s). In addition, the applicant is encouraged to include any other pertinent information or swdics in conjunction with this Checklist to assist staff in completing their preliminary assessment of the site. I have completed the attached Critical Area Checklist and attest that: the answers provided ire factual, to the best of my knowledge (fill out the appropriate column below)_ wne / Applicant: Applicant.Re resentativ P e. Name Name Title 1 5 -27 / Street Address LFC&0,Ke45 �a2G City, State, ZIP. Phone Title _/ y 2/5 v2v2�1fG� Street Address City, State_l' Z)P _ Phone Signature Date ignature y �� late %TREFT EI 1 0 _ usE PERMIT3C 5 CITY OF.EDMONDS 2ONE NUMBER 6 CONSTRUCTION PERMIT .. APPLICATION JOB 1 / SUITErAPTe OWNER NAMEINAME OF BUSINESS ADDRESS ,�1 yr .l .. 1I 11 I `r 'r•`.(1 r.. '` 1 ' a wrl P_ LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO. MAILING ADDRESS O S `5/ IO f )- /-, PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved ❑ CITY ZIP TELEPHONE NUMBER RW Permit Required ❑ /. 1 �7 ) EXISTING REQUIRE° DEDICATION Street Use Permit Redd ❑ 0 , (%%(> s Inspection Required ❑ NAME / PROPOSED Sidewalk Required ❑ CZ' REMARKS A � u LL F ADDRESS < CITY / // ZIP TELEPHONE NUMBER NAME / aL . �/, �• �U l7`� Q-(i I / ! 7 ,' pJ,'� ENGINEERING MEMO DATED REVIEW SY ti ADDRESS (� O 1� r/r/ it �� `, 11 METER SIZE BUILDING SUPPLY SIZE NO, OF FIXTURES CITY ( ZIP TELEPHONE N�jU%MBE-RrJI up �P (� /� (C/A l�. jl: % 6Tl REMARKS 3 STATE LICENSE `NUMBER n 1 EXPIRATION DATE in C/fIC. •J,C - �'! C "" 7 ✓ IV I SIGN AREA $EPA REVIEW ADS NO. Legal Description ° Propert - include all easements ALLOWED PROPOSED COMPUTE E%ryT SHORELmEe F a VARIANCE OR CU P N REVIEW BY / ATE SETBACKS —F T HEIGHT LOT COVERAO& w FRONTK 7 SIDE ✓ REAR 7 �j S � Property �/2 Tax Account ,% 2 ?6 J` L/� �J - q-cIUo7, Parcel Na NEW RESIDENTIAL PLUMBING _ ® ADDITION O COMMERCIAL ® MECHANICAL , REMODEL APT. BLDG. SIGN REPAIR a GRADING CYpg FENCE x—rn CHECKED BY TYPE OF CONSTRUCTION CODE / HEIGHT MOLSH OTOVE INSPECTAANCY OUOCCUPANT DEINSERTHOTIMTUB/SPA RECD LOADR❑ P GARAGE r CARPORT ROCKER RETAINING a RENEWAL MARKS" ` c PROGRESS INSPECTIONS PER UBC 305 (TYPE OF USE: BUSINESS OR ACTIVITY) EXP}AIN: i Pepe 99 wsEc. a NUMBER NUMBER OF CRITICAL O OF / DWELLING AREAS C.W,3'/al� m STORIES UNITS NUMBER DESCRIBE WORN TO BE OONEjATTACH PLOT PLANT dr y e* j[` FINAL INSPECTION REQUIRED CT � • �C rs-u.• 1l� VALUATION - FEE PLAN CHECK FEE ' HEAT SOURCE: (iLAZIN6 BUILDING �- 4 z! �f ! /' C- I % PLUMBING r 35' Plan Check No. C — MECHANICAL This Permit covers work to bedonedone on private property ONLY. GRADINGIFILL j Any construction on the public domain (eurhs, 81dewPlke, driveways, marquees, etc.) will require separate permission. STATE SURCHARGE Permit Application:180 Days Permit Limit:1 Year • Provided Work Is Started Within 180 Days STORM DRAINAGE FEE "Applicant, on behalf of his or her spouse, heirs, assigns and ENO. INSPECTION FEE successors in interest, agrees to indemnify, defend and hold w harmless the City of Edmonds, Washington, 118 officials, a employees, and agents from any and all claims for damages of < whatever nature, arising directly or indirectly from the Issuance Z of this permit. Issuance of -this permit shall not be deemed to PUN CHECK DEPOSIT ° modify, waive or reduce any requirement of any city ordinance i 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 ATTENTION APPLICATION APPROVAL Information given Is correct; and that I am the owner, or the duly authorized agent of the owner. I agree to comply with city and THIS PERMIT This application Is not a permit until state laws regulating construction: and in doing the work authoriz- AUTHORIZES ad thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her Code of the tate.of Washington relating to Workmen's Compensa- WORK NOTED Deputy: and fees are paid, and receipt is I n In n' ' acknowledged in space provided. INSPECTION IGNATU 1 E 09'AGEN,1,_/ jDAT9;lQN90 DEPARTMENT V CITY OF OF I A '6 SI ATURE 0yE EDMONDS CALL FOR aEIE DATE - TTENTION INSPECTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL — File YELLOW — Inspector A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC /oZit ftu" 1` + 100 ��t--101 rp- sa N s STREET FILE APPROVED BY PLANNING v 6 G�zsA5 ,ft 3 C. � 1'R — x W1 The City of Edmonds WATFR SERV IGE Drawing EASEMENT NO- -------------------------------------------- NEW CONSTRUCTION ❑ REPAIRS g LID NO- ------------------ -ASMT. NO. ------------------ - v • mmam i riLt OWNER--------•.................•------------...-----.......------...-----........---.........---..... CONTRACTOR..--......-.-..-•-----------•--••---•----------------------------------------------. PERMIT NO. 93037$-- TH JOB ADDRESS-----I.S.1...--.......1-0............P-....... -0 .--- •-- -. . .. LEGAL DESCRIPTION: LOT NO - ---------------------- --------------- BLOCK NO.------------------------------------ 10 T" P L . Approved: PWW-0001-11175 (REV.11178) DATE ...5?.-13.- 9 3............... By ..----_---11 W- ----------------------------- - OWNER / PROJECT ADDRESS:. EMOKE ROCK 1531 10M PLACE NORTH EDMONDS 98026 425- 776-2798 home 206 — 794 — 2920 cell TAX No: 132703 4 0840 002 LEGAL: NE CORNER OF SW V4 OF SE li4 THEN 89 47 OOW 59558 THEN S 38 34 00 W 66.7' TO TPB THEN S38 34 00 W 75' THEN 5102 OOE 18936' TO CENTERLINE OF 2ND STREET THEN 38 34 00 E 75' THEN N 5102 OOW 18936' TO TPIL 11016 I 1 bE 5& N) Dowd SPoU"T5 To... of 5 ?L- A 544 B�.ocKS LD C\I lo' SIDE S ' RECEIVED DEC 0 t 2003 PERMIT COUNTER, �PShf e-vy' SCOPE OF PROJECT: NEW 450 SQ. FT. UPPER STORY ADDITION. NO MAIN FLOOR ADDITIONAL SPACE. . RE ROOF ENTIRE RESIDENCE. ZONE: RS-12 LOT SIZE: 75' a 1901 =14,250 SQ. FT. LOT COVERAGE: EXISTING HOUSE,GARAGE, DECK 2492 SQ. FT. 17.4% NO CHANGE. IMPERVIOUS: PRE-1970 HOUSE ( BUILT 1951) 1,974. SQ FT GARAGE 6645 POST 1957 DECK, I 0 N 1t r l� L---T -d- i z �- � I Ai N l ao2�N ' SETBACKS: FRONT.' SIDE 1 0 ` REAR aS ' OTHER HEIGHT 2 SITE PLAN 1" = 20' 0" 705. GRADING: NONE CONTACT DURING PERMIT PHASE: KRISTIN HANSON HANSON DESIGN 652 ALDER STREET EDMONDS 98020 425 774-7129 425 771-3152 FAX hansondesign a,hotmaiLcom �,-✓ ►ram ep POJ i 1 i �tArZAE l I _ p - APPROM BY PLAN G �1C RooF I r—� O � C1 � m wAU� O� CIVIC CEWER • EDMONDS, WAStIINGTON 980" • (206) 775-252 DEPARTMENT OF PUBLIC 'WORKS STREET FILE May 4, 1978 Bruce A. Spence Underwriters Adjusting Co. 6256 N.E. 154th Bothell, Washington 98011 Dear Mr. Spence: HARVE H. HrR�I50N MA"04 Enclosed please find,drawings an-d information relating to the sewer stoppage at'1531„10th Place -North, Edmonds, which you requested in your conversation with Larry Ogle, Sewer Leadman. We hope this information is of benefit to you and should you have any further questions, please feel free to contact this office. Yours very truly, LEIF R. LARSON, P.E. Director of Public Works jac Enclosures -�� ; S.Leadman Dt. VP Si6pt. Dt. mi Se .Dt. CITY OF EDMtF3rNJD5 CIVIC CENTER • EDMONDS, WASHINGTON 98020 • (206) 775-2525 DEPARTMENT OF PUBLIC WORKS STREET c FILE May 4, 1978 Bruce A. Spence Underwriters Adjusting Co. 6256 N.E. 154th Bothell, Washington 98011 Dear Mr. Spence: HARVE H. HARRISON MAYOR Enclosed please find drawings --.and information relating to the sewer stoppage at `1531 loth Place North, Edmonds, which you requested in your conversation with Larry Ogle, Sewer Leadman. We hope this information is of benefit to you and should you have any further questions, please feel free to contact this office. Yours very truly, LEIF R. LARSON, P.E. Director of.Public Works jac Enclosures S.Leadman t. W S pt. t. mi Se Dt. e *SSTREEt FILE ft May 2, 1978 MEMO FOR RECORD SUBJECT: PLUGGED SE14ER AT 1531 LOTH PLACE NORTH On April 20, 1978, at approximately 2:00 p.m. I was dispatched to 1531 loth Place North to check out a plugged sewer call. Upon my arrival, I noticed that a contractor had dug in the right- of-way to locate the sewer lateral serving 1531 loth Place North. I asked them if they had the necessary permit to excavate in the right-of-way and they said that Engineering gave them permission to dig in that area. I then inspected the section left open by the contractor and found no stoppage at that point. I then took out another section of tile and found the root growth. It com- pletely cut off the service to the property. After removing the roots, we replaced the tile sections and the contractor backfilled the area. It should be noted that since the contractor felt it necessary to locate the stoppage on the Mencher property, that he be held responsible for his actions. Furthermore, any damages or costs sustained other than a normal backup situation should for the most part be the responsibility of the home owner. We did not remove the tree, fence section, or dig up the yard. LDO : j ac oA-, , 3 S-/, S Su t. Dt. A in Sec. Dt. P.W. Dir Dt. ,I e� . - = �i rA -- - - - - rt - - I I I j 1 1 r- - rt T- I APPLICATION. "he City of Edmonds for � CARD No. ........: ............................... :.: SIDE SEWER PERMIT - OUTSIDE .❑ - -- INSIDE ❑ , REPAIRS ❑ EASEMENT No. CONTRACTOR ... .:...... .............. PERMIT �.�� ..... P STREET +)USE No. `�..�..(...:��...........� !.l _ .- . ,-_;N _ ...... .. , N . .....,................................................. AVENUE LOT No............................. ................................ ............ .... BLOCK o................... ............. ................. NAME ADD .:........................ .�-. �. v. .. . ....... .......... e .•••�= ��;•-r+r5. // ,, �; � , -. may. P �.'t. S. y%p•f7 -:.�• 550..��'� T _3e Zi 1 APPROVED p 2 1962 Approved o Y _ 42k �� :I •r�"� s� � y..-t '� ar7sanrx „' DATE.. = r CITY. OF E D M 0 N D S - SEWER DEPARTMENT - STOPPAGE OF SANITARY SEWER MAIN REPORT DATE: TIME CALL RECEIVED: 7 LOCATION OF STOPPAGE: OAJ a/TY .SIDE , ,c�T 7E6 TIME OF ARRIVAL ON THE JOB SITE: 5 AA . TIME NORMAL FLOW OF SANITARY SEWER REESTABLISHED: C:P.1 30 a.11V , CAUSE OF STOPPAGE:X ACTION REQUIRED TO CLEAR MAIN AND/OR LATERAL: .4?/7-x3.c ��Mb CITY CREW ON STOPPAGE CALL OUT (Personnel Involved) : JM %Jc,iU'SdE7 ,v LOCATION OF RESIDENCE AFFECTED: ;De gip. NAME, ADDRESS, AND PHONE NUMBER OF PROPERTY OWNER: joaA i V M45_AlC.s-JE/cam ,aMG7�I X� S, kVA:) - ?SO24 DESCR I BE DAMAGE TO PRIVATE PROPERTY: REMARKS: C_— tiC �tiC O C EG /� CLAIM FOR DAMAGES ° NOTICE 00 .a Claim MUST be presented to the City Council and filed with the City Clerk within 120 from the date of Accident or Accrual of Damages. � ��7�y AP R a . (88 TO THE CITY COUNCIL OF THE CITY OF EDMONDS: �dmnn =City Clerk PLEASE TAKE NOTICE, THAT _ �_ �` I, V, M k r. (if married, give husband's name) WHO NOVI RESIDES AT ' �r� 3 % % 0 �t � � C. � ;,', N C C d r,-I f n d :a W at.. P• �v [ c�,-1 (State present actual address by street, number and city AND WHO FOR SIX MONTHS PRIOR TO DATE OF ACCID%NT HAS RESIDED AT Give residence by street, number and city CLAIMS DAttAGES OF AND FROM THE CITY OF M40NDS IN THE SUM OF 3 7 6 9 . y_?_ arising out of the following circumstances: Describe Claim, giving tr. ewe. Sties+ens @ren �l DATE and .TIME injury or damage occurred, PLACE ��.c e t� �r:��,rr r r, �c�-�I i�r� t �►exst �ro^ and full particulars. Accurately locate and 11 IQ 0`i t i G by 4-6 i.;.. .5: i-y P Achs describe defects caus- ing injury or damage L�xr4.d��g 1'emcvt d i rr•. �eni E C 4,4 4eta 4_ and all acts of negli- gence claimed. ��-nn le- ll�zd� bC<<oir to Accurately describe injuries or damage j_La41 ,L e he_t pro:m1 a_c;j; �,� "rc*.I+ 9li► ?a 4 G 1� �' � Lt �: 4 i` � L�• C ' � F1A ! 11 ^ �i l Il 1 � �t J W l� l' v y j � C M Q i1. C t )� +rGG ci�ri,cygt '7ro,4 i State items of damage claimed. Itemize all _El b L23 C. e � to l.n.-., Ee rs expenses and losses. 1 Tz�,f� jereC. (Claim must be sworn to by claimant) � S Gnat re of Claimant Su&50ZIBED AND SWORN TO 7 before _me this �� •��day of ,19 7d� Notary Public !- and for ,he State of 1laehington, residing STREET FILE Api,47 ---5, 197,, MIE[-ti) TO: HAr-%'VE H. HARRISON !1VIYOR FROM,: 1 'k E N' E VAR,D', MORAN CITY CLERK `%CKNOh!!-EDGE RECEIPT ';F CLAIM FOR DAMACTS At'.'-ac.'ied. is Z CO"), of a Claim for Dai;,,,-9eS "t! the amount o-,-' f ro::i john V. itlenuher, 1531 - 1 Oth 'Place N. v,,as received April 2' , 197L"lj ar,14- copies forwardc,,, to ins—:nce agency and to the Public lalorks Departi:;P-rtt. Y*-"l-."f-l.,,'l,,%!l;d treat Ciourcil ack'no�..'I'Age recci;)t of titi-Is clai.., --jr 2 City i ouncil ;-,ce'Zing. Att"-,-,-',roenz NOTICE Claim MUST be presented to the City Council and filed with the City Clerk within 120 days from the date of Accident or Accrual of Damages. TO THE CITY COUNCIL OF THE CITY OF EDdONDS: PLEASE TAKE 140TICE; THAT (if married, give husband's name) WHO NOVI RESIDES AT �:`l : 3 j % C -t.� � I ,' _ � �\1 � j- {' •, , � --' � � 1 State present actual address by street, number and city) AND WHO FOR SIX MOLiHS PRIOR TO DATE OF ACCIDZNT HAS RESIDED AT r. .._ "..I t, � , t_j,, Give residence by street, number and city CLA!f[S DA,`1AG ES OF AND FROM THE CITY OF M-IONDS IN THE SUM OF ,ri % %, ') . arising out of the following circumstances: Describe Claim, giving DATE and TIF!E injury or damage occurred, PLACE and full particulars. Accurately locate and describe defects caus- ing injury or damage and all acts of negli- sen:e claimed. Accurately describe injuries or damage OL� (:., fit, Seh,�r .��,�:en-t Cre:,••�� C:C••'11irei r`•t '(Lt.C,lie t.'"s 1%i%% L�A r%A ei, fe,,,ev,t a fir., F f enLr 3, �• ire t { I (, Y'Y'c't'� Ie.w w WhtL)' �k. e _ii,r :n, cl trc•„ 9/,dig 4 911e 7 on, jr +rtt� ci�t„n�! a Jr,,4 State items of damar_e claimed. ItEriliZC all expenses and losses. � � j10 f-. C•pern fir• v i Tz io� .rL 1V rr (Claim must be. sworn to by claimant) of Claimant /�gnatGre SwuC:r2IDED AND SWORN TO � befure me �,' ,19 i''• {,-' 7 Notary Public it and for State of Attie flAshington,residing at�"� CITY OF EDMONDS SIDE SEWER PERMIT WATER —SEWER, DEPARTMENT STREET FILE o PERMIT 47 Call 775-2525 for side sewer inspections BEFORE covering any Portion Of the construction. Inspection will be Provided within 24 hours after requst. NO Sat-, Sun., or holiday inspections.) ADDRESS LOCATION OF CONSTRUCTI[ON ...... PROPERTY LEGAL DESCRIPTION.. .... ....... ............ ! ...... e_­­4�K ..................... . ................................... ............ ) .................. ........................................................ ...................... . .......................... . ......... ....................................... I ............................ ............................................................................................................................................................. .. .......... . ......................... olr*rlkjM AND/OR BUILDER —CONTRACTOR'S NAME & ADDRESS ....... .... ....................................................... Permissi On Is granted ........... . .......... . .......... system in accordance with City of E""ds ordinances. ...... 19-2j�i� repair and/or connection r--) Of a side sewer to the city A___;NTrON is CALLED TO THE FOLLOWING: sanitary sewer side sewer in street area. Do not cover any Portion NOTE No. —The Owners of the Property May obtain a Permit to construct sewer Inside Property line. A licensed Side sewer contractor must Of sewer before it has been inspected. NOTE NO. 2—All work Performed In city right-of-way requires an Invasion Of Right -of -Way permit be employed to construct NOTE No. 4—Top, Of side sewer must have at least 3G inches coverage at Property Obtainable from the City Engineer's office NOTE NO. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when You get permit. "harper than % will be Permitted. line and 12 inches inside Property line; minimum grade of 2%. No bends In grade NOTE No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to ,improper NOTE No. work which may develop within one Year Of Completion. 6—It Is unlawful to alter or do any other work than is provided for In the Permit, or to do a-1Y work on the main sewer or its appurtenances except to in- DISAPPROVEDwoe, [] Date..._...._. ..........................•-• BY..-.------ X ---9-q,_1V4KBDay,t-­e ......APPROVED Z-- _B—y ------------- ................................. ........D...a..t..e........................................BY---------------- Penarks_ ...... L.". - �__ I ......................... . ................................... ........................................... BOTH Pe it Copies ST Signed 13 owner of Firm Perform- ......... lo� in construction PRIOR To Request For Inspection I.. .. ... . . ........ ..................... ......... a (Owner of Contractinghereby certify that the side Perf in Const .... .... .... rue ion) sewer installation constructed under this permit %,,Installed in accordance with la�llrlmj PV ing ordinances of the City of Edmonds. .0 you g for: Water �, Gas �, Telephone m AppmVed: ..................................... o, Ix APPROVED m 10 JP—"- APPLICATION The City of Edmonds for SIDE SEWER PERMIT NEW CONSTRUCTION ❑ REPAIRS EASEMENT NO - -------------------------------------------- LID NO- ------------------ ASMT. Nam_ A t.....................•---------..-------------------- CONTRACTOR d7CTJli�i�.... �„P!/ � ........-_.................... PERMIT NO. OWNER ../ -�-•` =-r--'=---r�-�--- - JOB ADDRESS -- .- ---- ------------------------- LEGAL DESCRIPTION: LOT NO....................................... BLOCK NO. .................................... W -----------------------------------------------------------...------....--------------------------------------------------------------------....... NAME OF ADDITION ..... .. G-•---......--•--------••----•-•---.....-•------------------•------ ........ 0 Approved: DATE-------------------------------------------- BY -------•-•--•------••------------------------....... iiis i` r,: �. n-er-"'4,) .;.! �.M,1.+ i' ".F.� �.,-n(', rp Pi''Ttr,. - .f,:: t:'"`44'tr'nrx-..r r ..i'Tw... rs. .. ....:Vl.-_t�>._�1"J�ti•,v v1C 1''3•;r!"w�;,-Fi 'v�.,.4•ir `?�ts.�.*i..:q {� Ex w2,�.jp*•i�u�,;,�.%t'u.::.' CITY OF EDMONDSPerm it No. 88 " 44 COMMUNITY SERVICES DEPARTMENT Issue Date __9__0_'?_to_O RIGHT-OF-WAY CONSTRUCTION PE' IREET F" A. • Owner: Washington Natural Gas B. • Contractor: Same Nq&S 156 Av NE Name Mailing Address Mailing Address Bellevue, WA 98007 City State Zip City State Zip 447-0700 State License Number Telephone Number • Address or Vicinity of C(`p Type of Work to be Done: in 10 Pl N fraan 2291 tl to install an 141 plastic gas main Work in Connection With: ❑ Sub or Plat ❑ Single Family ❑ City Projects F., ❑ Commercial ❑ Multifamily IN Utility Q Pavement Cut: ❑ Y ❑ N U a APPLICANT TO READ AND SIGN a Q INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds � harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or unforseen, that may Abe made against the City of Edmonds, or any of its departments or employees, including or not limited to the defense W of any legal proceedings including defense costs, court costs, and attorney fees by reason of granting this permit. a THE CONTRACTOR IS RESPONSIBLE FORWORKMANSHIP WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE p" '''YEAR FOLLOWING _THE -FINAL INSPECTION ANDTACCEPTANCE OF THE WORK.t U Funds held from the Security Deposit (estimated restoratiori' fee) will -be held until the final street patch is completed by City forces, at which time a debit or creditwill be processed for issuance to the applicant. s A 24 hour notice is required for inspection; Please call Public Works: 771-3202 • Work is to be inspected during progress and at completion. • Restoration to be in accordance with City Code. • Street to be kept clean at all times. • Traffic Control to be in accordance with .City regulations. 9 All street -cut ditches must be patched with asphalt or City approved material prior to end of working day; no exceptions. W O W Cn F-� U Ix 0 w I understand the above and that this permit must be available at the job site for inspection purposes at all times. Signature:i�'" �-� Date: 9-16-88 Owner or Contractor This Permit Must Be Posted at the Job Site For Inspection Purposes Call DIAL -DIG Prior To Beginning Work ISSUED BY: Qii� Time Authorized: Void after';j '30 .:. days. Special Conditions: Amendments: PERMIT FEE: Security Deposit: 6 Receipt .N o..� Fund III Fee: Street Cut Dimensions: NO WORK TO BEGIN PRIOR- TO PERMIT ISSUANCE Eng. Div. July 1963 FIELD INSPECTION NOTES (Fund II I - Route copy to Street Dept.) Comments: Diagram: CONTRACTOR CALLED FOR INSPECTION Partial Work Inspection by P. W.: Work Disapproved By: FINAL APPROVAL BY. ❑ YES ❑ NO Date: Date: Eng. Div. July 1985 S OENm 3' PAST OT►Vy PE 1P MAIr4 PiQCH F EDM V. Y - NOTr • %i t BEFORE 10U. D1G; _ 1-800=424=5:555. 10 'r4 r CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER - NAME/NAME OF BUSINESS -pit } V/ ,r'", i w MAIL NG ADDRESS CITY ZIP TELEPHONE NAME CITY ZIP ITELEPHONE NAME cc ADDRESS ems_ Q CITY °J f ZIP1 TELEPHONE z f U i � •`�i i;" R �6�'_�td�i rt� •� "" i.'� „fit . STATE LICENSE NUMBER EXPIRATION DATE I i•-eIgfftKED'Bl( `LEGAL DESCRIPTION OF PROPERTY - INCLUDE ALL EASEMENTS a W PROPERTY TAX ACCOUNT PARCEL NO.uu ❑ NEW ©PRESIDENTIAL ❑ PLUMBING / MECH ❑ ADDITION ❑ COMMERCIAL O ❑ CHANGE OF USE ©fl$EMODEL APARTMENT ❑ SIGN ❑ REPAIR ❑ GRADING CYDS ❑ FENCE x ( ❑ DEMOLISH ❑ TANK ❑ OTHER L�GARAGE ❑ RETAINING WALL CARPORT ❑ RENEWAL z ROCKERY O f (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: cc cc ti. w NUMBER Nl MBER OF m OF DWELLING 7NUMBERff1 CRITICA � , AREAS __ ee O STORIES UNITS .x DESCRIBE WORK TO BE DONE 6 'G''r-- t,-,*r,r t_- 3r f.e^ -,r s—A.r> I FT) PERMIT EXPIRES r� USE PERMIT ZONE NUMBER 14 JOB SUITE/APT# ADDRESS LEGAL DESCRIPTION CHECK SUBDIVISION NO. I LID NO. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ' ❑ RW Permit Required ❑ EXISTING REQUIRED DEDICATION Street Use Permit Req'd ❑ Inspection Required ❑ PROPOSED Sidewalk Required ❑ METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED O YES ❑ NO ❑ z REMARKS w z z z it w ENGINEERING MEMO DATED ,1% / REVIEWED BY FIRE MEMO DATED l REVIEWED BY W IL VARIANCE OR CU ADB SHORELINE # SEPA REVIEW SIGNAREA* 41E&T COMPLETE EXEMP PROPOSED ALLOWED PROPOSED d AlALLOWED P' EXP i .� LOT COVERAGE REQUIRED IETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR c7 LOT AAR•�E'AA PLA NIING REVIEW BYE ,. D}ATE a AB _ O.C.�`9 r ) z$ .i' a II V Ci e A Z'"'i irP . - y L•,,,, v .Art .,.... a ,J� 0 i HECKED BY I TYPE OF CONSTRUCTION I CODE OCCUPANT Y C. GROUP p SPECIAL INSPECTOR ATREX OCCUPANT REQUIRED ❑ YES LOAD REMARKS PROGRESS INSPECTIONS PER UBC 108 FINAL INSPECTION. REQUIRED VALUATION FEE PLAN CHECK FEE a HEA1`SOURCEFiIAZING /, LOT SLOPE % Aa.�. BUILDING [ i� 5 %'aw. t°w.d ...� y� PLAN CHECK NO: VESTED DATE PLUMBING - MECHANICAL F THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL zi DOMAIN (CURBS,SIDEWALKS, DRIVEWAYS, MARQUEES,ETC.) WILL REQUIRE SEPARATE PERMISSION. X.cc STATE SURCHARGE j a PERMIT APPLICATION: 180 DAYS PERMIT LIMIT: 1 YEAR -PROVIDED WORK IS STARTED WITHIN 180 DAYS STORM DRAINAGE FEES N w "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE J IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND i a x ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY 0 FROM THE ISSUANCE. OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE p DEEMED TO MODIFY,.WAIVEORREDUCEANyREQUIREMENTOFANYCITYORDINANCE PLAN CHECK DEPOSIT a �... / f� /;{; faSz� •� = NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO.ENFORCE ANYORDINANCE PROVISION.- / 7 r TOTAL AMOUNT DUE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED application is not a permit until signed by the IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Building Official or his/her Deputy: and Fees are paid, and WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. receipt is acknowledged in space provided. SIGNATURE (OWNER OR AGENT DATE SIGNED (425) OFFIC LS SIGNAT RE I DATE , l 771-0220 (4o_ , �..... .,f ~`� `' W DATE L 'BY ATTENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- CATE OF OCCUPANCY -HAS BEEN GRANTED. UBC SECTION 109 /{ PINK - OWNER G01.D • ASSESSQR / • OWNER / PROJECT ACE;RESS: EMOKE ROCK 1531 10"" PLACE NORTH EDMONDS 98026 206 - 972 - 3470 CELL TAX No: 132703 - 4 - 0840 - 002 LEGAL: NE corner of SW 4 of SE 4 then 89 47' 00" W 595.58' then 5 38 34' 00" W 66.7' to TPB then 5 38 34' 00" W 75' then 51 02' 00"' E 189.36' to centerline of 2"d Street then 38 34' 00" E 75' then N 51 02' 00" W 189. 36' to TPB. I VARIANT: E: APPROVED V - 911 - 188 , AN- 7, 1999 CRITICAL AREA APPROVAL: 5 - 18 - 93 GRADING: NONE I ZONE: RS -12 SCOPE OF PROJECT: RE ROOF EXISTING GARAGE AND CARPORT. ENCLOSE CARPORT. NO NEW LOT COVERAGE. CONTACT: HANSON DESIGN KRISTIN HANSON 652 ALDER ST EDMONDS 98020 I i 425 - 774 - 7129 LOT SIZE: 14, 250 SQ FT ca0'/o COVERAGE 2873.5 SQ FT 425 - 771 -3152 FAX '1 NO CHANGE. IMPREVIOUS SURFACES: EXISTING BUILDINGS ( BUILT 1951) HOUSE: 974 SQ FT GARGAGE, ETC. 664.5 SQ FT NEW SINCE 1957 DECK j 235 SQ FT p R0 Z F,G-r Z21-,oil EA A I? - As 10' 5I1�1E 1511-5 E x. !Z S I C> E I -lc, E I �14 5Q- FT Ex- Zoo F dEG% l.li.lE EX -CA Poer z 0 47. t°S �Y �i..- E 0 , DATUM Imo I ki-r: *-FIIZI` 4YDRA4T TD F az I oo.o' q ai1 L • C% 0 N N III ED By PLANNING HEIGHI CALLS- PATUM F01"T. too'-o' A• t3 • 9 g'- o �, � • 98' �" Iz i QCi E To R>E : 109'- G" ALLo WAP> L.l:: 1Z3'-0" RECEIVED FEB 2 21999 PERMIT COUNTER