16921 76TH AVE W.PDFIIIIII IIIII IIIII IIIII IIII IIII6179
16921 76TH AVE W
CITY of EDMONDS SIDE SEWER PERMIT
For Inspection Call .771-3202 fro?%/ PERMIT NO. 07658
Address of Construction:
Property Legal Description (Include all easements):
LYNNWOOD LINE
Owner and/or Builder: �1��\-AL �-� �� S V,, `
Contractor & License No: T)A HL 1--A-1- , /YR
-Single Family
Residence
PIv
Multi -Family
(No. of Units
Commercial (No. of fixture Units )
Invasion into City Right=of=Wa_y: No 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 LISTEVON THE BACK
- /A�Aw //� K:;,� . 3 -10 -W7
I ce/'tify that I have ead and shall comply Date,
with the items listed on the back. "
Permit Fee: Issued By:pt�tGi<-�/(%
Trunk Charge: ��,5-d� Date Issued:
Assessment.Fee: Receipt No.:
Partial Inspection: 3--I�
Comments Date Initial
Final Inspection Approved:
Date Initial
00
Rejected:
C) Reason Date Initial
a
**,,PERMIT MUST BE POSTED ON JOB SITE **
a
White Copy - File Green Copy - Inspector Buff Copy - Applicant
..Side Sewer Drawing
The City of Edmonds
NEW CONSTRUCTION
OWNER -I)PVA.......... ---------------------- ......
JOB ADDRESS --- [.(O-')-Z-1 ----------- 7G---r-H --- Avr— ----- W ........
.00,
ext%T. 6'C-0. catp
%.slop.
Is's
2..5bp. o-
ra"Tf ST TXC
W
W0,902-5
7(61r"
PWW-0001 f 1/75 (REV. 11/78)
CONTRACTOR
EASEMENT NO- -------------------------------------------- 'vk
REPAIRS ❑
%a -4--t -co - I
------ PERMIT NO. .740.58
LID NO- ------------------ AsmT. NO. .........
LEGAL DESCRIPTION: LOT NO_ -------------------------------------- BLOCK NO. ------------------------------------
NAM
------------------------------------------------------------------------------------------------------------------------------- --71
............................................................ E OF ADDITION ----------------------------------------------------------- F
I-Sbp 2O.5.
SDp
I roc) 2 % 76'r 0
Approved:
PA'p,TjAL 3-11-187
DATE........... By ---------------------------------
71X,
r
I890-19�
STREET FILE
CITY OF EDMONDS
250-5th AVE N. • EDMONDS. WA 98020 • (206) 771-3202
COMMUNITY SERVICES:
Public Works • Planning • Parks and Recreation • Engineering
July 13, 1988
Mr. and Mrs. John Horn
16921 - 76th Ave. W.
Edmonds, WA. 98020
Re: Detention System
Dear Mr. and Mrs. Horn:
LARRY S.NALIGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
It has been called to my attention that the detention system installed
with your new house is not functioning. As it is your responsibility
to have an operational detention system, I have enclosed, for your
information, a copy of the Community Development Code defining the
possible consequences for failure to comply with this code.
Please contact me at your first opportunity with a schedule for the
necessary repairs. Thank you for your prompt attention.
Very truly yours,
JERRY W. HAUTH, P.E.
Hydraulics Engineer
JWH/sdt
Enclosure
JOHNHORN/TXTST530
• Incorporated August 11, 1890 •
Sister Cities International — Hekinan, Japan
18.30.070
performance bond or other suitable security, in accordance with Chapter
17.10. A maintenance bond may be required before final approval of the
drainage system.
18.30.070 MAINTENANCE
A. Owner's Responsibility. The owner of the site shall maintain the
on site drainage system unless the City chooses to, according to
specifications set by the Public Works Director before the final
inspection is approved. The owner shall keep records of the cost
of maintenance.
B. Failure to Maintain.
1. Failure to maintain the on -site drainage system in accordance
with this chapter and the approved specifications shall be
punishable as a misdemeanor. In addition, the Public Works
Director may notify the owner of the violation in writing,
which notice may set a reasonable time for compliance. The
Public Works Director may extend the time limit for reasonable
cause. The notice shall also contain an explanation of sub-
section 2 below.
2. If the owner fails to correct the violation within the time
limit, the Public Works Director may cause the violation to be
corrected at City expense, and bill the owner for two times
the direct cost to the City. This bill shall be a lien on the
property.
C. City Inspection. The Public Works Director may inspect the main
tenance of the system from time to time, but shall have no duty to
inspect at regular intervals. The owner shall allow the Director
free access to all parts of the system for purposes of inspection
during normal working hours or in an emergency.
D. Owner's Covenant. The owner shall grant the City a covenant in-
corporating the provisions of subsection B and C above unless the
City assumes the maintenance. The covenant shall include a clause
releasing, and indemnifying and holding harmless the City from any
and all claims for damages or injunctive relief of whatever nature
resulting from the construction, operation or maintenance of the
drainage system. The City may record the covenant at the owner's
expense to give notice to later owners of the site.
E. City's Option. If the Public Works Director recommends that the
City assume the maintenance of a drainage system, because the
system provides a public benefit, the City Council may approve the
maintenance of the system at the end of the first two year maintenance
period. Before the Council accepts the system, the Public Works
Director shall:
136
STREET FILE
CITY OF E ®Yt0 O N® B LARRY S. NAUGHTEN
250 51h AVE. N. • EDMONDS, WASHINGTON 98020 • (206) 771.3202 MAYOR
COMMUNITY SERVICES PETER E. HAHN
DIRECTOR
January 20, 1988
Mr. & Mrs. Horn
16921 - 76th W.
Edmonds, WA. 98020
Re: Drainage
Dear Mr. & Mrs. Horn:
I believe that I spoke with you folks last month about drainage
problems in your area. I have since been unable to contact you by
telephone. Will you please contact me at your first opportunity.
Very truly you s,
JN Y W. HA H, P.E.
Hydraulics Engineer
JWH/sdt
HORN/TXTST530
PUBLIC WORKS • PLANNING • PARKS AND RECREATION • ENGINEERING
STREET FILE
CITY OF E ® ®'87d ® N ® S LARRY S. NAUGHTEN
250 5th AVE. N. • EDMONDS, WASHINGTON 98020 • (206) 771.3202 MAYOR
COMMUNITY SERVICES PETER E. HAHN
DIRECTOR
December 14, 1987
Resident
16921 - 76th Ave. W.
Edmonds, WA. 98020
Dear Edmonds Resident:
I have recently been contacted by some of your neighbors.They have
indicated that your contractor inadvertently damaged the drainage
system adjacent to your house. Upon inspection of your property and
adjoining properties last week, I saw what I believe to be the source
of the problem.
Since I believe the current drainage problems can be resolved with a
minimum amount of effort and little or no cost, I thought I would take
this opportunity to contact you and ask for your assistance in this
matter.
The freezing weather will bring sheets of ice that will make your
access road very hazardous for both you and your neighbors. If you
will contact me at your first opportunity, I would greatly appreciate
it. At that time, we can discuss what needs to be done to resolve the
drainage problem.
Thank you for your assistance in this matter.
Very t/r/ul�y, yours,
JERRY W. HAUTH, P.E.
Hydraulics Engineer
JWH/sdt
Alb r ch
DRN16921/TXTST530
PUBLIC WORKS • PLANNING • PARKS AND RECREATION 0 ENGINEERING
NEC,
CITY OF EDMONDS
U NEW
❑ ADDITION
❑ RETIREMENT
ASSET INFORMATION SHEET
ASSET NO.
ADDITION TO ASSET NO. _
DESCRIPTION SERIAL NO.
LOCATION 3/ � / � � ) DEPT. NO.
* * PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
* PROJECT NUMBER G!/'��� De�a
PROJECT COMPLETION DATE O �lz
COST r-
B.A.R.S. ACCOUNT NO. '7`�� �'�U��` ��7�• fin•
• ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
**SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
0 G.L. ENTR
REFERENCE
DATE
C
VERIFIED BY
PROCESSED
BATCH NO.-
b P INITIAL
DEPARTMENT FILE
STREET FILE��IqL 110M�S 119Qaz --1 C ,W
Z
# 87-00919' TR-�FE7 FBLE
ENVIRONMENTAL CHECKLIST
Purpose of Checklist:
The State Environmental Policy Act (SEPA), chapter 43.21C RCVS', requires all governmental agencies to consider
the environmental impacts of a proposal before making decisions. An environmental impact statement (EIS) must be
prepared for all proposals with probable significant adverse impacts on the quality of the environment. The purpose of
this checklist is to provide information to help you and the agency identify impacts from your proposal (and to reduce
or avoid impacts. from the'proposal, if it can be done) and to help the agency decide whether an EIS is required.
Instructions for Applicants:
This environmental checklist asks you to describe some basic information about your proposal. Governmental agen-
cies use .this checklist to determine whether the environmental impacts of your proposal are significant, requiring
preparation of an EIS. Answer the questions briefly, with the most precise information known, or give the best de-
scription you can.
You must answer each question accurately and carefully, to the best of your knowledge. In most cases, you should
be able to answer the questions from your own observations or project plans without the need to hire experts. If you
really do not know the answer, or if a question does not apply to your proposal, write "do not know" or "does not ap-
ply". Complete answers to the questions now may avoid unnecessary delays later.
Some questions ask about governmental regulations, such as zoning, shoreline, and landmark designations. Answer
these questions if you can. If you have problems, the governmental agencies can assist you.
The checklist questions apply to all parts of your proposal, even if you plan to do them over a period of time or on
different parcels of land. Attach any additional information that will help describe your proposal or its environmental
effects. The agency to which you submit this checklist may ask you to explain your answers or provide additional in-
formation reasonably related to determining if there may be significant adverse impact.
Use of checklist for nonproject proposals:
Complete this checklist for nonproject proposa!s, even though questions may be answered "does not apply." IN AD-
DITION, Complete the SUPPLEMENTAL SHEET FOR NON -PROJECT ACTIONS (part D).
For nonproject actions, the references in the checklist to the' words "project," "applicant," and "property or site"
should be read as "proposal," "proposer," and "affected geographic area," respectively.
A. BACKGROUND
1. Tame of proposed project, if applicable:
2. Dame of applicant: �� L_ �AO"`-t-S
3. Address and phone number of applicant and contact person:
L62z i.s4 41
L y,1,4 rwA ��17 7 31 ev-5
4. Date checklist prepared: I — ( 0. - V'j
5. Agency requesting checklist: 0,14-7
6. Proposed timing or schedule (including phasing, if applicable):
2 - 02-9 - -7 - ,�--_3 /- V 7
7. Do you have any plans for future additions, expansion, or further activity related to or connected with this proposal?
If yes, explain. 410
S. List anv environmental information you know about that has been prepared, or Hill be prepared, directly related to
this proposal. tv O r\- C-
9. Do you know whether applications are pending for governmental approvals of other proposals directly affecting the
property covered by your proposal",If yes, explain.
- � O
] 0. List any government approvals or permits that will be needed for your proposal, if known.
11. Give brief, complete description of your proposal, including the proposed uses and the size of the project and site.
There are several questions later in this checklist that ask you to describe certain aspects of your proposal. You do not
need to repeat those answers on this page. (Lead agencies may modify this form to include additional specific infor-
mation on project description.)
1. tr.!s A
12. Location of the proposal. Give sufficient information for a person to understand. the precise location of your pro-
posed project, including a street address, if any, and section., township, and ranee, if known. If a proposal would occur
over a range of area, provide the range or boundaries of the site(s). Provide a legal description, site plan, vicinity map,
and topographic map, if reasonably available. While you should submit any plans required by the agency, you are not
required to duplicate maps or detailed plans submitted with any permit applications related to this checklist.
14121 7 (.µ` 4 JGJ F J�,v wcl�
Lod
meaov
TO BE COMPLETED BY APPLICANT
c r e.--3
-SNO �o
B. ENVIRONMENTAL ELEMENTS
1. Earth
a. General description of the site (circle one): Flat, rolling, hilly, steep slopes, mountainous,
other.s / C, PIC
b. What is the steepest slope on the site (approximate percent slope)'?
1 2`- 9/ L
n
EVALUATION FOR
AGENCY USE ONLY
TO 13E COMPI_EM) BY APPLICANT
c. %Vhat general types of soils arc found on the site (for example,OlciDindnoic
gravel, peat,
muck)? If you know the classification of agricultural soils, specify t any prime
farmland.
d. Are there surface indications or history of unstable soils in the immediate vicinity? If so,
describe. IC) D JL2.e
EVALUATION FOR
AGENCY USE ONL1'
e. Describe the purpose, type, and approximate quantities of any filling or grading pro-
posed. Indicate source of fill.
Ot to t,� � `� d- I-oU✓lom
f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe.
k'6
g. About what percent of the site will be covered with impervious surfaces after project
construction (for example, asphalt or buildings)?
h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:
Z. ,fir
a. What types of emissions to the air would result from the proposal (i.e.. dust, automobile,
odors, industrial wood smoke) during construction and when the project is completed" If
any.-enerally describe and rive approximate quantities if known.
b. Are there any off —site sources of emissions or odor that may affect your proposal" If so,
generally describe.
c. Proposed measures to reduce or control emissions or other impacts to air, if any:
-3-
TO RIi COMPLETED BY APPLICANT
3. Water
a. Surface:
EVALUATION* FOR
AGENCY USE ONLY
1) is there anv surface water body on or in the immediate vicinity of the site (including
year—round and seasonal streams, saltwater, lakes, ponds, wetlands)? If yes, describe type
and provide names. if appropriate, state what stream or river it flows into.
00
2) \'Fill the project require any work over, in, or adjacent to (within 200 feet) the described
waters? if yes, please describe and attach available plans.
C
3) Estimate the amount of fill and dredge material that would be placed in or removed
from surface water or wetlands and indicate the area of the site that would be affected. In-
dicate the source of fill material.
4) Will the proposal require surface water withdrawals or diversions? Give general de-
scription, purpose, and approximate quantities if known.
pU �
5) Does the proposal lie within a 100—year floodplain? If so, note location on the site
plan.
6) Does the proposal involve any discharges of waste materials to surface waters? If so,
describe the type of waste and anticipated volume of discharge.
/V O
b. Ground:
1) Will ground water be withdrawn, or will water be discharged to ground water? Give
general description, purpose, and approximate quantities if known.
2) Describe waste material that will be discharged into the ground from septic tanks or
other sources, if any (for example: Domestic sewage; industrial, containing the following
chemicals . . .; agricultural; etc.). Describe the general size of the system, the number of
such systems, the number of houses to be served (if applicable), or the number of animals or
humans the system(s) are expected to serve.
—4—
TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
0
c. Water Runoff (including storm water):
1) Describe the source of runoff (including storm water) and method of collection and
disposal, if any (include quantities, if known). Where will this water flow? Will this watcr
flow into other waters? If so, describe.
w
aS
2) Could waste materials enter ground or surface waters? If so, generally describe.
d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if
any:
4. Plants
a. Check or circle types of vegetation found on the site:
_ deciduous tree: alder, maple, aspen, other
evergreen tree: fir, cedar, pine, other
J-'shrubs
_✓ grass
— pasture
_ crop or grain
_ wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other
_ water plants: water lily, eelgrass, milfoil, other
_ other types of vegetation
b. What kind and amount of vegetation will be removed or altered?
S a /ol-V2
c. List threatened or endangered species known to be on or near the site.
/I o ^-c._
d. Proposed landscaping. use of native plants, or other measures to preserve or enhance
vegetation on the site, if any:
5. Animals
a. Circle any birds and animals which have been observed on or near the site or are known
to be on or near the site:
birds: hawk, heron, eagle, son bir other: ..................................
mammals: deer, bear, elk, eaver, other: —4 i. .......:.................... .
fish: bass, salmon, trout, herring, shellfish, other: —7777�..
.....................
b. List any threatened or endangered species known to be on or near the site.
-5-
TO BE COMPLETED BY APPLICANT
c. Is the site part of a migration route? If so, explain.
N�
EVALUATION FOR
AGENCY USI ()NJ,)'
d. Proposed measures to preserve or enhance wildlife, if any:
6. Ener - and Natural Resources
a. What kinds of energy electri rural gasi oil, wood stove, solar) will be used to meet
the completed project's ene-r1T—heeds. rI e whether it will be used for heating, manu-
facturing, etc.
i-I k +S ,- f e 4 fir, t�
b. Would your project affect the potential use of solar energy by adjacent properties? If so,
generally describe.
c. What kinds of energy conservation features are included in the plans of this proposal?
List other proposed measures to reduce or control energy impacts, if any:
to a0 Cc IA-) (' ti CIO J 5 � / 41 c.J a- �
7. Environmental Health
a. .Are there any environmental health hazards, including exposure to toxic chemicals, risk
of fire and explosion, spilt, or hazardous waste, that could occur as a result of this proposal?
If so, describe.
I) Describe special emergency services that might be required.
2) Proposed measures to reduce or control environmental health hazards, if anv:
b. Noise
1) What types of noise exist in the area which may affect your project (for example:
traffic, equipment, operation, other)?
2) What types and levels of noise would be created by or associated with the project on a
short-term or a long-term basis (for example: traffic, construction, operation, other)? Indi-
cate what hours noise would come from the site.
-6-
TO BE COMPLETED BY APPLICANT
EVALUATION FOR
AGENCY USE ONLY
3) Proposed measures to reduce or control noise impacts, if any:
8. Land and Shoreline Use
a. What is the current use of the site and adjacent properties.
b. Has the site been used'for agriculture? if so, describe.
c. Describe any structures on the site.
d. Will any structures be demolished? If so, what'?
C)
e. What is the current zoning classification of the site?
S 12,660
f. What is the current comprehensive plan designation of the site?
g. if applicable, what is the current shoreline master program desi-nation of the site?
h. Has any part of the site been classified as an "environmentally sensitive" area? If so,
specify.
i. Approximately how many people would reside or work in the completed project?
j. Approximately how many people would the completed project displace'?
k. Proposed measures to avoid or reduce displacement impacts, if any:
I. Proposed measures to ensure the proposal is compatible with existing and projected land'
'uses and plans, if any:
1-0 BE. COMPLETED M APPLICANT
9. Housing
a. Approximately how many units would be rovided, if any? Indicate whether high, mid-
dle, or low—income housing. fit' pC , j�e
b. Approximately how many units, if any, would"b�e eliminated? Indicate whether high,
middle, or low—income housing. n On �
c. Proposed measures to reduce or control housing impacts, if any:
10. Aesthetics
a. What is the tallest height of any proposed structure(s), not including antennas; what is
the principal exterior building material(s) proposed?
2y�
b. What views in the immediate vicinity would be altered or obstructed?
c. Proposed measures to reduce or control aesthetic impacts, if any:
Al P
11. Light and Glare
a. What type of light or glare will the proposal produce? %Vhat time of day would it mainly
occur? YV
b. Could light or glare from the finished project be a safety hazard or interfere with views?
`_--- 11 0
c. What existing off —site sources of light or glare may affect your proposal?
d. Proposed measures to. reduce or control light and glare impacts, if any:
12. Recreation
a. What designated and informal recreational opportunities are in the immediate vicinity?
N A
b. Would the proposed project displace any existing recreational uses? If so, describe.
U
EVALUATION FOR
AGENCY USE ONLY
7
f
I
TO RE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
c. Proposed measures to reduce or control impacts on recreation, including recreation op-
portunities to be provided by the project or applicant, if any:
13. Historic and Cultural Preservation
a. Are there any places or objects listed on, or proposed for, national, state, or local preser-
vation registers known to be on or next to the site? If so, generally describe.
b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or
cultural importance known to be. on or next .to the site.
c. Proposed measures to reduce or control impacts, if any:
14. Transportation
a. Identify public streets and highways serving the site, and describe proposed access to the
existing street system. Show on site plans. if any. da n
/ AJLC
Yr 10 C." �
b. Is site currently served by public transit? If not. what is the approximate distance to the
nearest transit stop'?
c. How many parking spaces would the completed project have'? How many would the
project eliminate'?
d. Will the proposal require any new roads or streets. or improvements to existing roads or
streets, not includinL drivevays? If so. generally describe (indicate whether public or
private). � m
e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transporta-
tion? If so, generally describe. q -0
�v �1
f. How many vehicular trips per day would be generated by the completed pro'ec:t" If
known, indicate when peak volumes would occur. _ p,
—9—
TO BE COMPLETED BY APPLICANT
EVALUATION FOR
AGENCY USE ONLY
g. Proposed measures to reduce or control transportation impacts, if any:
15. Public Services
a. Would the project result in an increased need for public services (for example: fire pro-
tection, police protection, health care, schools, other)? If so, generally describe.
b. Proposed measures to reduce or control direct impacts on public services, if any.
1.6. Utilities
a. 'r-cl ities cure , available at the site: electricity, atural gas water efuse serv-
ice, elephone anitary se we , septic system, other.
b. Describe the utilities that are proposed for the project, the utility providing the service,
and the general construction activities on the site or in the immediate vicinity which might
be needed.
C. SIGNATURE
The above answers are try nd complete to the b of my knowledge. 1 understand that
the lead agency is relyi g o them to fits ec/i14
Signature: ...... .............. .......................
Date Submitted: .......... 1'-"/ef7f7..................................
-10-
TO III: ('Unfl'I_P_'fl:l; H1AI'I'I.ICi,iJ"I'
EVALUATION FOR
AGENCY USE ONLY
D. S111'tTHIILNIAt. SttliLT Ft.-M rJ()NI'R()JL•CT A( rl(.ms (Rezones, Code Changes, Annexations, etc.)
(do rot usm: this sheet for project actions)
Because these questions are very general, it may be helpful to read them in conjunction
with the list of the cicmcnts of the environment.
When answering these questions, be aware of the extent the proposal, or the.types of
aclivitics likely to result from the proposal, would affect the item at a greater intensity or
at a faster rate than if the proposal were not Implemented. Respond briefly and in general
terms.
I. How would the proposal tie likely to increase discharge to water, emissions to air; pro-
duction, stodge, or release of toxic or hazardous substances; or production of noise?
Proposed mea-stu-cs to avoid or reduce such increases are:
?. How would the proposal be likely to affect plants, animals, fish, or marine life?
Proposed measures to protect or conserve plants, animals, fish, or marine life are:
3. t'low woulil the proposal be likely to deplete energy or natural resources?
Proposed measures to protect or conserve energy and natural resources are:
4. How would the proposal be likely to use or affect environmentally sensitive areas or ar-
eas designated (or eligible or under study) for governmental protection; such as parks, wil-
derness, wild and scenic rivers, threatened or endangered species habitat, historic or cultural
sites, wetlands, floodplains, or prime farmlands')
Proposed measures to protect such resources or to avoid or reduce impacts are:
5. Flow would the proposal be likely to affect land and shoreline use, including whether it
would allow or encourage land or shoreline uses incompatible with existing plans'?
TO BE COMPLETED BY APPLICANT
EVALUATION FOR
AGENCY USE ONLY
Proposed measures to avoid or reduce shoreline and land use impacts arc:
6. How would the proposal be likely to increase demands on transportation or public ser-
vices and utilities?
Proposed measures to reduce or respond to such demand(s) arc:
7. Identify, if possible, whether the proposal may conflict with local, state, or federal laws
or requirements for the protection of the environment.
—12=
AiR RECEIVEB _
-� ENGINEERING j
..�.ILL
tbkjw_ .fit.- .
i• 7A ;
P,717
44 PROJECT REVIEW Cw--,a.IST
NAM; PrOJBCT ADDRES
' APPUCATICNJ RE10EIPT DATE':
fy
r�,n r Reviewed, . (inita.>a1'
c sl CCYyIIrIENTSI'$t �r, P%JANNING WTR/SWR^} STf2EEP
a ; r
SEN=AsFAMILY/MULTIPLE/COMMERCIAL - (Circle One)
'$.a� E� FTIECKAACK 1P+i1a77]11171CJ'�, "":;'
4k ast /// / //�/r
CONDITIONAL USE PERMIT/
// ////,��///.;'.
z ADBIR#EQUIRF NIS.
�r7A'�ii�'':)(YI7%EIt Z()1ING RFJQUIR04BM
i W t ,t /////
EWIRCMil'TAL' FT.ATRFS U* ////// r; ///////// ///////% ).5
ft
� AC(�SSriSLAPF & VFHICII'
--*-r--
DRAINA_GG PLAN On Site)111177-7777-11111
«
_LEGAL,DESCRIPTICN VERIFICATION L ==
�w lit// / //>'
Q(JIT<.('I�IM/DEDICATIONS '�' 10=
a
EASEMENT -`PUBLIC/PRIVATE "i
a-. _
I CAIrCtJLATE�SIWER CONNECTION IF NO LID#
PiAT/SUBDMSI(x7 REt�UIREhfEN`I'S 13 V"
7777771
p
GiIf=4F=WAY CONSTR(KTI(�1 PERMIT F.C)D ////// ///////// /////////
y
BOND REQD FOR``PUBLIC, IMPROWMEN`I'S rT///
// ///////// /// 15
SOUS C«UNDITIMS & : GROUND _ '
WATER FIETD CIIDCKF� x , �/ ////�//// ///// / 6
STREET. PAVING1177
REQUIRED ;
,,-
C(JRB.AND G[Ji•PER RDQUIR®
x '^ hk ga,
19
171117
3, r
CURB CUT FOR DRIMAY•RDQDs 7-/�/ 20
wt sr° m ��/7/ / /
STREET: NAME SI(�1 READ
ILV
j///////// ///////// //%///%/// 21
.OTf{ER SIC�I�aINGRDQD 22
/
SIDE SEWER 23
IS'PiNG NiA`PER'MAIN SI E. 24,'
WATERI�:PF1t SIZE
1 �r J I i
CE LINE SIZE
/%/ 26
RANPs hbouIRED c
f` #r; �P//// 27
HYDRI': SIZE EXISTING ,: •' ,, z ' `" ////// ///////// �rO�
CONNF�TION `INSPIDC!'ION`-RT'L�%// 29
/777711111
MEI'EIt'' CIIARGH READ " J.
lot {4T—,
3
o //
1,.OPENAITCH EXISTING34
Wf
Iva 33`
7/7
amEn
} RE M-
/ / R 36
rSIZE'"' N r � ,
r _
777777777
CAME ,MAS M REM 3
. NDICATED ON SITE PLAN ////// ///
Sf10tJiDER DRAINAGE MAINTAIN 9
,i"i'sSHALE OPEN RUNoFr
d/��/� f // 40
S h q
REVIEWED BY:
PLANNING MGR. ENGINEERING MGR. a r PUBLIC IRKS MGR :
#i''#
1.0
�t. .,k'.} � �_'.4sa�f4x'.°i�r.. ��, ,,i��a1�.,i:i�`i`i�� �deJ^�"� t�iz, .fin'4��'dit'>h`,�� '�-t Bi`?�•".�
• �rtsit'J,�i?Oa4►�+'i::'}ors'h.t��:t;:.ri1�P�L`�IfSi"%*RA;�h�.�'3k2�1'��'�"�i1.+f�•;. gyct�al,.�p,�y.rr�+law'.c..,s.,l ..•t i,.`A�y�.*•-. ,..,f': i,,-�x}, �r�.:.:
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
U' /, ^ sip
ADDRESS
IU(.ot 7 3
ADDRESS
TELEPHONE NUMBER
YJL =2Zfty
NUMBER
STATE LICENSE NUMBER
* 64114111 */yZes
Legal Description of Property - Include all easements
(show below or attach four copies)
G
NEW
RESIDENTIAL
I-1—L......�o
PLUMBING
^®
^-'AL.
�
-
-MECHANICAL
WALL
� SIGN
FENCE
x FT)
INSPJ
;E INSP.
EllSWIM
POOL
C�•�. '�
�
� RENEWAL
NUM
�—
IBER OF
_LLING
_
rs
NATI
CH PLOT PLAN)
USE
ZONE / Z
1fi16 9 Z
AGGRESS
PERMIT
NUMBER
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
STREET USE PERMIT REQUIRED 0
SEE ENGINEERING MEMO DATED
IW
.ID NO.
�; EV0i/
6/1 0��
METER SI E
y
BUILDING SUPPLY SIZE
I //
FIXTURE UNITS
I y
REMAEWS. v ^��I
/AREA
SIGN
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADB NO.
SHORELINE N
VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS
FRONT SIDE
REAR
HEIGHT
I -
I LOT COVERAGE
BY I TYPE OF CONST
REQUIRED
0 YES 0 NO
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
GRADING/FILL
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
ENERGY CODE
w
J
i
o
i
"Applicant, on behalf of his or her spouse, heirs, assigns ands
successors In Interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
whatever nature, arising directly or Indirectly from the issuance
of this permit. Issuance of, this permit shall not be deemed to
modify,.waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
PLAN CHECK DEPOSIT
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
ATTENTION
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and in doing the work authoriz-
ed thereby, no person will be employed In violation of the Labor
Code of the State of Washington relating to Workmen's Compensa-
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
ti n 18 nc(I._
SIGNATUR (OWNER OR� E T) DATE SIGNED
�— j / —
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
ATf E N T I O N
771.3202
IT IS UNLAWFUL TO USE OR OCCUPY -A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
g A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
i CHAPTER 3.
.102.78
WCTION CODEHEIGHT
a�% )
OCCUPANCY OCCUPANT
GROUP ) LOAD
/??4 w SAACiSy6c
P?e jq�� b1A L z05
VALUATION I FEE
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged In space provided.
OFFICIAL'S SIGNATURE DATE
RELEASED BY:
DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
a
z
2
w
z
MEMO TO: Building Division
FROM: Engineering Division
SUBJECT:
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) Back water valve required if downstairs plumbing is below
elevation of upstream manhole.
6) Water and sewer lines to be separated by 10 foot minimum.
7) Builder/owner responsible for containing all temporary'_runoff and
erosion on site and may not impact neighboring properties in'any
'..way.
8) Construction hours from 7:00 a.m. to 10:00 p.m. on weekdays and
10:00 a.m. to 6:00 p.m. on weekends and holidays.
� (/�✓12 Ley ���
n
CATCH
BASIN DETENTION PIPE LENGTH CONTROL CATCH
(VfiNT) BASIN
r r-- I' MIN, 2' MAX COVER —1 1.
i �r7 5LOPE�
I
SYSTEM CROSS SECTION
'SEE PAGE 3 FOR OUTLET CONTROL_ DETAIL_
OUTLCT
CONTROL
T.
MI
4"
s —
TO OUTL.FT
(NI PRAM OR
RUNOFF
SPREADER) ...
2' s Z' a w DESp, 4"- b" SPALLS (on rO u. L)
1'. 2' �c 3" DEEP, %*- CRUSHED ROCK
FROM iT
O Lrr L E-r
CONTROL
WASHED GRAVE
— L
FROM
OUT,.EC
CONTROL
RIPRAP OUTLET
OLITFLOW TRENCH, MIN 10' LONG,
TOP 4 4" PERF PIPE TD BE L-EVEL
4" PERF PIPE WITH CAPS
RUNOFF SPREADER OUTLET
STANDARD DRAINAGE PLAN
DETENTION SYSTEM
PAGE I OF 3
for
location
plan by
phone
date
DESIGN DATA
System Imperm Pipe Pipe
Number Area Diam Length
Orifice
Diameter
NOTES
1. 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). Material
accumulated in the storage pipe must
be flushed out and removed from catch
basins to allow proper operation. The
outlet control orifice must be kept
open at all times.
CITY OF EDMONDS
: RCCEIVED
to,
'Ac
N. 0! rz
0
H
JAN 2 8 "tOdf
MG I N-al N Q
e#"
zo
jo
I Aiv