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17502 72ND AVE W
low
IL
STREET Rf 067.
May 19, 1930
MEMO TO: Building Division
FROM: Engineering Division
SUBJECT: FILL AT VACANT LOT, &-_4f
�C�JC7 57
(or �'-- -/ _X
We have observed a fill at the subject address
which has apparently been placed without a grading permit.
In our opinion, this fill could present safety hazards.
lie suggest that you inspect this site and, if
necessary, take appropriate correct"ve action. lie will be
willing to assist if required.
JAMES E. ADAMS
JEA/j f
PUBL I C WORKS REVIEW ROUTING
�3
SITE ADDRESS -
TYPE: BUILDING PERMIT (CHECK ONE)
SINGLE FAMILY
MULTIPLE
COMMERCIAL
FENCE
GRADING
r DEMOLITION
= RELOCATION
L�7-
] SIDE SEWER PERMIT
L:_j RIGHT-OF-WAY PERMIT
STREET USE PERMIT
STREET TREE PERMIT
SEPTIC TANK DESIGN PERMIT
NEW METERMATER SERVICE
E.I.S.
OTHER:
SUBDIVISION REVIEW
PLAT/PRD REVIEW
DRAINAGE PLAN
I N OUT
Reviewed By: Date Reviewed:
(See Comments)
A
CITY ENGINEER
4--�4 DRAINAGE ENGINEER
WATER/SEWER DIVISION
STREET DIVISION
P.W. RECEPTIONIST
WORK ORDER COORDINATOR
UTILITY BILLING
RECORDS (FILE,).
OTHER:
COMMENTS:
. L
V L
ez%
CITY OF EDMONDS
RECORD OF SHORT SUBDIVISION
This Is to cert.4.fy that the properties as shown on the attached map (Exhibit "A") and
described as follows:
See Exhibit "B"
have been divided under the provisions of the Edmonds Subdivision Ordinance (Sec.12.10)
File No. S-46- 76 subject to the following conditions and requirements:
I. Exhibit "C" Hold Harmless Agreement
2. Ten foot right-of-way dedication required on 72nd Avenue West.
3. Connection to City water system required.
4. Turn around required on Lot A.
ZOSewer requirements: The owner of Lot A will be allowed to use an on-si
septic system if the perc rates and design are acceptable to the City
Engineer. When an L.I.D. is prODOsed, the owner of Lot A agrees to
support the L'.I.D. & to hook-up �o the sewer line as soon as it is
available. A covenant reflecting these items is required
slt,)7c recording. prior to
C,0M(-tZ%6. Drainage plan per Ordinance #1924 is required prior to issuance of
building permits.
7. Underground wiring required per Ordinance #1387.
8. Excavation and grading per U.B,C requirements.
9. All conditions set forth in the attached restrictive covenant must be
complied with.
I/we certify that I/we are the legal owner(s) of the property described above. I/we
warrant that all representations are true and correct and understand that in the,event
of any misrepresentation or failure to comply with the conditions and regulations set
forth herein, the City of Edmonds shall have the right to declare the subdivision void
and record a statement to that effect in the GranLor-Grantee's Index in the office of
the Snohomish County Auditor..
(_L REQUIREMENTS MUST BE MET AND ALL
.4 1'71 c
SIGNED:
PROVEMENTS MUST BE INS
G
D ISSUANCE OF BUILDIN
FOR
RECOIZDING
(.FrY OF EDNIONDS Z.
N
9y
DATED this
Pday 19 2�
STATE OF WASHINGTON
COUNTY OF SNOHOMISH� ss:
On this day personally appeared before me
and.,/('/ i ell,
to me known to be als describe( -
in and who exe,6uted the withi and foregoing instrument, and acknowledged that
signed the same as77_7-/-,u_,_�� free and voluntary act and deed for 0— — A
therein mentioned.
Given under my hand and official seal this
�-e,'day of
-a an purposes
Notary Fublic in -and for the State of Washingt,
residin at
9
�IEMO TO- Building Division
. Community DevelopmemL Dep;n-LiiieiiL
FROt4:
Engineering Division
Public Works Departinei-iL
SUBJECT:
Z1,2A16
L
After review of the subject BuildinE..,, Permit application, we have
the following comments:
1.
Connection
to
City
water system required.
2.
-Connection
to
Citv
sanitary s(,%..,er
system required.
3. Right-of-way Permit required for n.ny work on City property. .
4 Driveway slope not to exceed 147..
5. Backwater valve required _if p1timbing ... is helow
elevation of unstream nianhole.
6. Water and sewer lines to he separ.i_t:e(_I by 1.0 foot miniinum.
Signature
RNW- --EEE�n
- -.t== '..
DEPARMOU VIST
FOLIC WORKS
BUILDING PM41T REVIEW
4 At -(aa-
(address)
0
Street Right-Of-WaY Exist
REQD
Access Easenr-nts Existin
REQD�_
rZ
Utility Easement t-XISL
on Plat----------�s sessor Yhp-,fe--c
Lot Per Subdivisi
Site Plan Checked for Accura
Z Underground Wiring Reqd.
�-4
U Check Accuracy of Legal Description --------- Date
Z Review b
Existing Water Main Siz
Water yjain Required V/
Service Line Required
Hydrant Size Exist*
Hydrant Reqd Per Fire Code
Size
Detector Check Meter Reqd.
Cross Connection Inspecti
E-4
Fire Depa-ttmnt COm-nents
:3
Water Meter Chg�e Reqd.
Review b
Date
Septic Tank Design Approved
Date 3 41
I
Pe rmit No.
Septic Tank Permit Reqd.
Sanitary Sewer Availabili
Drawing No. — L , / -
File No.
Side Sewer Availability
V4
Sanitary Sewer Connection Fee Reqd.
7
:3:
Review by
Reqd.
open Ditch Existing—e 7
Size
Culvert Reqd. �� I
Indicate an Site Plan
P�
Catch Basin Reqd.
0
Shoulder drainage maintain collection on swale open runof f /-�j
Indicate an Site Plan—'
�Im-ihole req
soil Conditions and Ground Water Fi eld
Check, ed
Date
Review by
Re�ed- IvIO-1977
1-777777..-TOTAL AMOUNT DUE
Page 2
Street Paving Reqd.—IZ-:22�
Curb and Cutter Reqd.-4Z�
Sidewalk Reqd.
Curb Cut for Driveway Reqd.-L—&Z:�Zy—
Right-of-Way Construction Permit Reqd.
Bond Reqd. for Public InpraveTr-nts
Street Narm Sign Reqd. P/
10ther Signing Reqd. if /
C�' Pre Permit Site Inspection made an
z
0-40 BY: S94ER
WATER
H z STREET
F-4
44 ENG=RING
0
V4
P4
41
Special Requirements listed in memo to Conumity Development Department,
Building Division
BY Date
1 items filled in an Building Permit Application
BY
Drawings Stamped and Notations �lade
BY
by Public Works Department
Date
Date
Revised: lv 10-1977
Ali)
LD1 N G DEPART MENT1W Applicant Fill
11 NMI N G
PERMIT APPLICATION I I micle Heavy Lines
A
NAME (OR NAME OF BUSINESS)
N A M E ' 0 R
Kirk E. Black
K ir k
W"
W
M ILING ADDRESS
L,
I�A G
Z
Z
13:
1411 - 7th Pl. So.
"cuT
40
Y
PHONE NUMBER
T LIE-,
j
Edmonds
76-8455
--NAME
F
Lloyd L. Black
u
W
F
ADDRESS
u
1411 - 7th Pl. So.
X
CITY _FLEPHONE
NUMBER
Edmonds
76-8455
NAME
Lloyd L. Black Constructors
0
ADDRESS
1411 7th Pl. So.
It
I-
CITY
TELEPHONE NUMBER
Z
Edmonds
776-8455
1
0
U
STATE LICENSE NUMBER
[CITY LICENSE NUMBER
Z
u
0
W
a
J
0
a
J
-01 LL-OY-DL-B300KD 1 80648
Description of Property (Show Below or Attach Four
See Attached Plot Plan
ADDRESS
/
LEGAL LOT LOT AREA SUBDIVISION NO.
'T
9- ES EIN 0 71
I STREET R/W
EXISTING STREET R/W &C, FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W FT. FT.
'117
I'REMARKS
CHECKED BY
STREET AND/OR UTILITY WORK
R/W PERMIT REQUIRED
REO'D. 0 YES
YES No
UNDERGROUND
WIRING REQ'D.
El YES ONO
TYPE CONNECTION
0 YES
VERIFIED BY
SANITARY SEWER
No
SEPTIC SYSTEM
F-1 YES
PERMIT NUMBER
APPV'D BY CITY ENG.
El NO
REMARKS
METER SIZE BUILDING SUPPLY SIZE
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED I PROPOSED I COMPLETE I EXEMPT I
REMARKS
VARIANCE OR CU
YARDS
r 7V
I Al
NEW X RESIDENTIAL
GAS
LINE
FRONT
FIRE ZONE
ADD MON-RESIDENTIAL
E] DEMOLISH
ALTER EXCAVATE
OR FILL
SIGN
RETAINING
I N.NG
WALL
FENCE
E
X X —FT)
7
SPECIAL INSPECTOR
REQUIRED
0 YES 0 No
PLAN CHECKED BY
REPAIR PRE -MOVE
INSP.
swim
POOL
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
2 W/Basement
UNITS
NATURE OF WORK TO BE DONE
Const.
Single Family Residence
PLANNING REVIEW BY I DATE
ILOT COVERAGE
SIDE REA
OF CONSTRUCTION I COD
AREA JOCCUPANCY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
PROPOSED USE
Residence
PLAN CHE�K
NO.
VALUATION
PLOT PLAN (INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
u
0
III
0
III See Attached Plot Plan
0
OW
Z2V
BUILDING
PLUMBING
HEAT IN GAS LINE
FENCE
SIGN
RETAINING WALL
7/Q5
SWIMMING POOL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
formation given is correct; and that I am the owner, or the duly author -
A * r 01 1 .. * � 1 +1' "t . A .# +. I- . ".
FEE
IZe agen o . ag, - —F., r' ATTENTION APPLICATION APPROVAL
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington THIS PERMIT This application is not a permit
relating to Wor ' kmen's Compensation Insurance. AUTHORIZES until signed by the Building Official or
NOTE- Permit Limit One Year(Except DEMOLITIONS and FILL ONLY THE his Deputy; and fees are paid, and
PERMITS without conditional use permit, which shall be completed M1 90 WORK NOTED receipt is acknowledged in space pro -
days; MOVED -IN 0ILDINq5_shal1-§e completed in six months.) vided.
7I—GNATURC �� I NSPECTION
'�,'O GE �!T) DATE SIGNED DEPARTMENT DIRECTOR'S SIGNATURE
CITY OF
EDMONDS DATE
NOTE: Applicant Subject to Plan Check Fee 775-2525,
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, ORIGINAL - File YELLOW - Inspector
marquees, etc.) will require separate permission.
GOLD - Assessor PINK Owner
MAR 1. 9
77777777�_._
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