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N T I oL EDMON S I D E S,E W E R P E R M I T
For Inspection Call, 77,1-,3dTRF Dl�'RMIT NO.
Ad.dress.of Cons . truction: -�-,Ipnl wl� -ah 4 VE, w LINE]
01 d 12
Property Legal Description (Include all easements):* 4 7-
er: 1,14)16 W4e-7L 6 5 lFe
Owner,and/or Build
Contractor & License No: U S S 30 KI SO W
Single Family Residence
Multi -Family .(No. of Units
-Comme);,cial .(No: of fixture Units
Invasion into City Right -of -Way; N o Yes' .(If Yes, R,ight-of-Way
Construction Permit required. Call One-Ca.117Center 1 '(1-800-424-5555) before any
excavat.ion.)
Cross other.Private Property: No Yes.. (If Yes, easement required,
attach legal description and county easement number..)'
PLEASE READ THE ITEMS LISTED ON THE BACK
/3,
I certify thdt I h2ye�'r6ad and shall comply Da�e
with the'items listed on'the back.
Permit,Fee:.. 30100 'is sued,By:
Trunk Charge:, Date Issued: q-13
As'sessment Fee:. Rec6ipt..No.:
Partial Inspection:
Comments Date Initial
PMnAl_ 1#js#:�
Final Inspection Approved: A A Ad/ .'R - 440IL&A AJ
Date -I —ni - �1 ES -
Rejected:
eason
PERMIT MUST BE POSTED.ON JOB SITE
Wh-ite Copy File Green Copy - Inspector
-Na—te Ini-tial
Buff Copy. Ap�plicant
The City of Edmonds Side Sewer Drawing I , "
EASEMENTNO - ------------------------------- ---------
NEW CONSTRUCTION REPAIRS F� LID NO . .................. . ASMT. NO - ------------------
OWNER --- --------------------- CONTRACTOR ------- 30 -SO-N ---------------------- PERMIT NO. .7,37-7
JOB ADDRESS ..... I ISO 2-8 7G -rH ��P — - ------------ LEGAL DESCRIPTION: LOT NO.3 -- ------ ----------------------- CK NO. -------------------------
... . ... . .................. ---------------------------- ---------
-- ---------------- ---------
CK�N,
At)mipu� ... Ac-Res ------------ -------------------------------------------------- -----------
NAME OF ADDITION ------------------------ ---------- 6 -------------------- ��j
..... --------------
=Ann- 118028 7(c)
i� � ��
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Teru CW-R
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"cusa
EXISTING 6'PY.C.
FOR- i6104 76vu
4- OL" fteiDuceR
Semo
PWW-0001-11/75 (REV.11178)
3'
PRIVATE PUMP Sf-WGR
S 155 TF- M
FROFA 140USIE T a W L.&-Tcj%k^.L
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WATER
"EVERS
Approved:
DATE ..... ByJc.df ----------------
,/ .. . ... .....................
FART-IAL INSP Stl
006"M LLMD
,V7 AX~
CITY OF M40NDS STREET SECTION
STREET CUT REPAIR
R/W Const. Permit No - Notg- TNKE Date Received
SiMSEWF-FA 'PeRt-AYT 173r7r7 -SF-Pr. 13,4195.5
Project No. Date processed
Receipt No.
Date Assigned
Date Corrpleted.
r of reeir: A!Xhalt Roadway Conc. S/Walk
4 r X 10W Concrete Curb
CS, oe SEW R 114ST I-LN
PUMP 'PRESSUR.F- LIWE
Total area repaired 2
�2,-ft - x _5 ft., Total sq. yds/ln. ft
Sq.yds/Ln.ft Minimum Charges @$ =$
Sq.yds/Ln.ft Additional
Sq.yds Additional base lift
Yds. Additional base aggregate $
Total cost ................ $
72. 00
Fund #111 deposit fee .................................. =$ t4owe-
Totalreimbursement .................................... =$
Total additional expense to bill ....................... =$ 72-00
The Finance Division is authorized to:
Prepare a check in the armunt of $ made
payable to the following:
IV Bill the below mentioned company for $72,.'00 to cover
additional expenses incurred by the Street Division on'the
above subject work: RUSS %A0V4WS0K SF-WF-P. COMS'T.
sooe t4o-rK sw.
F—DmomM) WA,. i)1902,0
Requested by:/i 11-11-
�S�r�et Supervisor ,iqls LoDw,,kW Date
Approved by: A-2 ;0� �'-*S—.
Superintend&t of P.W. - Date
Verified 'by: 1--1 -4
'�w-b�rk:�Jei(/Coordinator Dat�e
RL&Poc'�19'
FILE #
DeRoster Building Permit
DETERMINATION OF NONSIGNIFICANCE
Description of proposal Single family residence on lot bordering creek in
-designated environmentally sensitive area.
Proponent Mike DeRosiers
Location of proposal, including street address, if any.
18028 - 76th Ave. W.
Lead agency City of Edmonds
The -lead agency for this proposal has determined,that it does not have a prob-
able signi'ficant adverse impact on the environment. An environmental impact
statement (EIS) is not required under RCW 43.21C.030(2)(c). This decisi'on was
made after review of a completed environmental -checklist and other information
on file with the lead agency. This information is available to the public on
request.
,P7 There is no comment period for thi,s DNS.
Th.is DNS is issued under 197-11-34OC2); the lead agency will not act on
this proposal for 15 days from the date below. Comments must be submitted
by___
Responsible official . Dan Smith
Position/title Planning/Engineering Inspector Phone
Address 505 Bell Street
Date Signature
,gy You may appeal this determination of nonsignificance
to James M. Driscoll, Hearing Examiner
at 250 Fifth Avenue N. Edmonds, WA 98020
no later than 5:00 p.m., September 9, 1985
by filing an appeal in writing
771-3202
You should be prepared to make specific factual objections. Conta - ct
Dan Smith to read or ask about the procedures for SEPA appeals.
0 There is no agency appeal.
CITY OF EDMO14DS
ENVIRONMENTAL ASSESSMENT
PROJECT NAME
DATE SUBMITTED
The information on this form will be used to determine the effect of your action upon the
environment of the City of Edmonds. Please answer each question as thoroughly as possible.
I . LAND
Area- /, -,� 11 C-9 AF-S Soils Type S19A-IA LA01 Limitations
Description of topography (%Q slope)
NOTE: If grading or filling will
GradiAg: Estimated cubic yards /Sc> �S. exceed 500 cubic yards a grAding
and filling plan must be sub -
Filling: Estimated cubic yards OOA),q mitted with the application.
Estimated area to be paved (including buildings)_
Estimated area in open space (pervious surface) C IQ 1�-
2 . WA T E
Stream. - Estimated flow (cubic feet per second) �Z. Y c&L'LT' II)e-Y S-OLOA.')&
Will stream be altered? A.10 If yes, to what degree?
Other water bodies?
Impact on storm drainage Method of handling runoff
Adjacent to shorelines zone?___A/4 Within 200 feet of MHHW?
3. VEGETATIO':
Type and approximate number of trees C) P1 I u's
Minimum diameter of trees to remain % of trees to be removed 0
Ground cover tj
'Al weo&� Aiqe,4 % to be removed
Proposed landscaping, if any
4. EXISTING LAND USE WITHIN 300 FEET RADIUS OF PROPOSED DEVELOPMENT:
Single Multi -
Vacant Family Family Commercial Other
North
-South
-East
West
5. CIRCULATION
Estimated increase in auto trips daily__ )q -T bo� I, I
Availability of public transportation �e�s
6. AREA OF IMPACT
Neighborhood City-wide Regional
7. EFFECT ON AIR QUALITY X) C9-AJ C_'
B. CHANGES IN NOISE GENERATION 'u- 0- "o-e
11/78)
ENVIRONMENTAL CHECKLIST
Purpose of Checklist:
The State Environmental Policy Act (SEPA), chapter 43.21C RCW, 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
id impacts from thC'PTOPOSal, if it can be done) and to help the agency decide whether an EIS is required.
or avol C�
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 an), additional information that %Yill help describe your proposal or its environmenjal
effects. The agency to which you submit this checklist may ask you to explain your answers or provide additional�4n-
formation reasonably related to determining if there may be significant adverse impact.
Use or checklist for nonproject proposals:'
Complete this checklist for nonproject proposals, even though questions may be answered "does not apply." IN AD-
DITION, complete the SUPPLEMENTAL SHEET FOR NONPROJECT 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. Name of proposed project, if applicable:
2. Name of applicant:
3. Address and phone number of applicant and contact person:
tA� C� QA NEZ Pq 40 % il 0- (Z A
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4. Date checklist prepared: Wite / rs-
5. Agency requesting checklist: C,11
Proposed timing or schedule (including phasing, if applicable):
7. Do you have any plans for future additions, expansion, or further activity related to -or connected with this proposal?
If yes, explain.
bo,as
8. List any environmental Information you know -about that ha.,� been prepared, or will be prepared, directly ielated to,
this proposal. 6 e� %
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.
10. List any government lapprovals or permits that will be needed for your proposal, if known.
(RAJ 0 i _V 0
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.)
� VC I k � % " '.5 (� le �-4 )41 8 11 �) ID " P_
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 range, 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 arc not
required to duplicate maps or detailed plans submitted with any permit applications related to this checklist.
0 '7 (J'_ 4 V,-
\,A) A ,
tit '� - 1� 10 C-k
TO BE COMPLETED BY APPLICANT
B. ENVIRONMENTAL ELEMENTS
1. Earth
a. General description of the site (circle one): Flat ®roliin hilly, steep slopes, mountainous,
other
b. What is the steepest slope on the site (approximate percent slope)? 0 1/4)
0
EVALUATION FOR
AGENCY USE ONLY
-2-
TO BE COMPLETED BY APPLICANT
EVALUATION FOR
AGENCY USE ONLY
c. What general types of soils are found on. the site (for example, clay, sa . nd, gravel, peat,
muck)? If you know the classification Of agricultural soils, specify them and note any prime
farmland.
CJ41 —
d. Are there surface indications or history of unstable soils in th e immediate vicinity? If so,
describe.
t' 0 WES AJ' OT 4
e. Describe the purpose, type, and approximate quantities of anv filling or.gradino pro-
posed. Indicate source of -Fill.
f. Could erosion occur as a result of clearing, construction, or use'? If so, generally describe.
g. About what percent of the site will be covered with impervious surfaces after project
construction (for example, asphalt or buildings)?
0 /X
0
h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:
C> e—S
2. Air
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, generally describe and gi
ive 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:
TO BE COMPLETED BY APPLICANT
3. Water
a. Surface:
1) Is there any surface water body on or in the immediate vicinity of the site. (including
year—round and seasonal stloeams, saltwater, lakes, ponds, wetlands)? If yes, describe type
and Provide names. If appropriate, state what stream or i . t flo s into.
11 nto, P", U"A C U-1
Will the project require any work over, in, or adjacent to (within 200 feet) the described
J
waters? Jf yes, please describe and attach available plans.
I
H0 tL& Pe
3) Estimate the amount of fill and dredge material that wou,ld be placed in or removed
from surface water or wetlands and'indicate the are� of the site that would be affected. In-
dicate tfii source -of fill material.
�s 0 e--% i-.5
4) Will the proposal require surface water withdrawals or diversions? Give general de-
scription, purpose, and approximate quantities if known.
V\ t) G�s N-J't- VN � P I \.(. -
C5D)Does the proposal lie within a I 00—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.
b. Ground:
1) Will ground water be withdrawn, or will water be discharged to ground water? Give
,' I
general description, purpose, and approximate quantities if known.
(2Describe waste material that will be discharged into the ground from septic tanks or
e r sources, if any (for example: Domestic sewage; industrial, containing the following
chemicals . . . ; agricultural; etc.). Describe the general size of the system, the ri�mbcr 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.
EVALUATION FOR
AGENCY USE ONLY
r
-4-
TO BE COMPLETED BY APPLICANT
EVALUATION FOR
AGENCY USE ONLY
(--E�Nater 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 wat'er
flow into other waters? If so, describe.
,prilew.
A� A e1r1qdk
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:
ON PI-k -','OA A.)
4. Plants
a. Check or circle of vegetation found on the site:
— deciduous treeV.�-Mde �aple, aspen, other
r
— evergreen tree. i edar R5 other
�74hrubs
-jz-grass
pasture
crop or grain
wet soil plants: cattail, buttercup, bullrush, kunk cabba other
water plants: water lily, eelgrass miffoil, oth
±--other typq4_of vegetation
b. What kind and amount of vegetation will be removed or altered?
c. List threatened or endangered species known to be on or near the site.
. --
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 hear the site:
birds: hawk, heron, eagle, Q�LQrd other: ... .....................
mammals: deer, bear, elk, beaver, other: ............ P . . ..........
fish: bass, salmon, trout, herring, shellfish, other: ..... ..................
b. List any threatened or endangered species known to be on or near the site.
A
TO BE COMPLETED BY APPLICANT
EVALUATION FOR
AGENCY USE ONLY
c. Is the site part of a migration route? If so, explain.
b 0 e�� A�_ � � �q
d. Proposed measures to preserve or enhance wildlife, if any:
ts 0 e�� A-� �\ P_� � __P � �
6. Energy and Natural Resources
a. What kinds of energy (electric, natural gas, oil, wood stove, solar) will be used to meet
the completed project's energy needs? Describe whether it will be u�sed for heatin-, manu-
faCtUTing; etc.
b. Would your project affect the potential use of solar energy by adjacent properties? If so,
generally describe.
. 6 Apr
c. What kinds of energy conservation features are included , in the.plans of this. proposal?
List other proposed measures to reduce or control energy impacfs-, if any- KO
A q T I PrALAL. C-
7. Environmental Health
a. Are there any environmental health hazards, including exposure to toxic chemicals, risk
of fire and explosion, spill., or hazardous waste, that could occur as -a result of this proposal?
If so, -descfibe. C_
1) Describe special emergency services that might be required.
t�sv Q--S (,\- f f t I
2) Proposed measures to reduce or control environmental health hazards, if any:
6 0 C--, Xro-l— Af F I -k
b. Noise
1) What types of noise exist in the area which may affect your project (for example:
traffic, equipment, operation, other)?
it�5
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-
catc what hours'noise would come from the site.
PQ 0 V_-�
U-11
TO BE COMPLETED BY APPLICANT
3) Proposed measures to reduce or control noise impacts, if any:
NO EjE!, -Fs, 0 10 1�
8. Land and Shoreline Use
a. What is the current use of khe site and adjacent properties?
IQ les I- �� 1�- I cx-�-
b. Has the site been used for agriculture? If so, describe.
�6 ct A-
c. Describe any structures on the site.
d. Will any structures be demolished? If so, what'?
t-J,0-
1�,W-(
4<:4, � f I \-�
EVALUATION FOR
AGENCY USE ONLY
e. What is the current zoning classification of the site?
f. What is the current comprehensive plan designation of the site?
,� � -) I �t-- �00,pt-�,
g. If applicable, what is the current shoreline master program designation of the site?
'��Has any part of the site been classified as an "environmentally sensitive" area? If so,
p)e c i fy. 0'2
4 L-7: PAWIAI& S,,K5 7T/1�
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:
0 1. Proposed measures to ensure the proposal is compatible *with existinj and pr9i e*ctcd land
uses and plans, if any:
Lo &\� -y, c�t% c9 A� S
Ck X We. C—t
.7—
I
TO BE COMPLETED BY APPLICANT
9. Housing
a. Approximately how many units would be provided, if any? Indicate whether high, mid-
dle, Or low-income housing.
b. Approximately how man), units, if any, would be eliminated? Indicate whether high,
middle, or low-income housing. -t' A
t) N-0 -? f�'
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 mate rial(s) proposed?
b. What views in the immediate vicinity would be altered or obstructed?
)'_�_A__ A-V k�
c. Proposed measures to reduce or control aesthetic impacts, if any:
S!V
Yy
11. Light and Glare
a. What type of light or glare will the proposal -produce? NA'hat time of : day wou)d.it mainly
occur? lzhl") I
b. Could light or glare from the finished project be a safety hazard or interfere with views?
ID a QNS A- V P I Y
c. What existing off -site sources of light or glare may affect lour Oroposal?
d. Proposed measures to reduce or control light and glare impacts, if any:
bo e.'�. Aji—k- kof I Y
12. Recreation
a. What designated and informal recreational oppor.tunitics are in the immediate vicinity?
b. Would the proposed project displace any existing recreational uses? If so, describe.
,,,,
EVALUATION KiR
AGENCY USE /JNLN'
TO BE COMPLETED BY APPLICANT
c. Proposed measures to reduce or control impacts on recreation, including recreation op-
portunities to be provided by the project or applicant, if any:.
. T-1
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 descri I be.
b. Generally describe any land'marks or evidence of historic, archaeolooical. scientific, or
cultural importance known to be. on or ncxt.to the site.
. If
c. Proposed measures to reduce or control if any:
EVALUATION FOR
AGENCY USE ONLY
( I �.
ransportation
a. Identify public streets and highways serving the site, and describe proposed access to the
existing street system. Show on site plans. if any.
V A V e�L 16 \r 'i %, vi cL AA
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b. Is site currently served by publickransit. If not. what is t e approximate distance to the
It stop
nearest trans '?
P
c., How many parking spaces would the completed project havj? How m ny would the
project eliminate'!
d. Will the proposal require any new roads or streets. or improvements to existing roads or
streets, not including drive,.vays*l 11' so. _,enerally describe (indicate whether public or
private). aA
e. Will the project use (or occur in the immediate vicinity of) water, rail. or air transporta-
tion? If so, gen erally describe.
f. How many vehicular trips per day would be generated by
the completed
project'! If
known, indicate when peak volumes would occur.
'A- -'r
1.') P� " � -I
C,
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TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE 6NLY.
g. Proposed measures to reduce Or control transportation impacts, if any:
15. Public Services
ire pro -
a. Would the project result in an increased need for public services (for examp e: r.
lection, police protection, health care, schools, other)? If so, generally describe.
C) 0 ., -^)-; —I— " kA
b. Proposed measures to reduce or control direct impacts on public services, if any.
'�So ta'�' t'a- - A, � f � V I '
16. Utilities
a. Circle utilities currently available at.the site: electricity, natural gas, water, refuse serv-
ice, telephone, sanitary sewer, septic system, other. t---.
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 tru and om te t the b of my knowledoe. I understand that
the lead agency is ern t m e ts ci on.
Signature: ... . ... . . . ..... . ..... . . ..... ....................
Date Submitted: ...... F . . 4./ ............................................
TO BE COMPLETED BY APPLICANT EVALUATION FOR
AGENCY USE ONLY
D. SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (Rezones, Code Changes , Annexations, etc.
(do not use 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 elements of the environment.
When answering these questions, be aware of the extent the proposal, or the.types of
activities 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.
1. How would the proposal be likely to increase discharge to water; emissions to ;air; pro-
duction, storage, or release of toxic or hazardous substances; or production of noise?
A)
Proposed -measures to a.void or reduce such increases are:
t
G�S
2. 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. How would the proposal be likely to deplete energy. or natural resources?
0 \--% 1^4 ? X -( '
Proposed measures to protect or conserve energy and natural resources are:
'�") 0 itq.& X-J'- cpv— - i�4_ � f k � -
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 sce.nic rivers, threatened or endangered species habitat, historic or cultural
sites, wetlands, 1`1664-2ibs, or prime farmlands?
Proposed measures to protect such resources or to avoid or reduce impacts are:
5. How 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?
ilo C:) '-� .6 et— P�1' F I t �-( . . . . '
_11—
TO BE COMPLETED BY APPLICANT EVALUAiiOl� FOF'r
AGENCY USE O?�LY
Proposed measures to avoid or reduce shoreline and land use impacts are:
6. 'How would the proposal be likely to increase demands on transportation or public ser-
vices and utilities? Alf
Proposed measures to reduce or respond to such demand(s) are:
')�40
7. Identify, if possible, whether the proposal may conflic ' t with local, state, or federal laws
or Tequirer�ents for the protecti the environment.
Side Sewer Drawing
The City of Edmonds
EASEMENT NO. ............................................
LID NO . ...... ...........
NEW CONSTRUCTION REPAIRS F _ASMT. NO . .......... ..........
737.7
OWNER ...
CONTRACTOR ....... 0 ... ....................... PERMIT NO.
... .....................
JOB ADDRESS ----- ........................ ..................... ................. CK -NO.
02, 8 7 G e LEGAL DESCRIPTION: LOT NO3 . .............................. z .........................
Ac............ ....................................... .......... ..........................................
-- -------------
C
K
............
NAMEOF ADDITION ............. ............. ................................................. ....................................
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PRDJECT NAME:
APEI�JCATION RECEIPr DATE:
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Reviem� 4y: (initial/date)
CMAENTS
PLANNING
WrRIswR I'm= l'IENaqmG
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FUILDING
117111111
//F//77//
3124= FAmny/MULTmz/cmmcIAL - (Circle One)
BACKS CHECKED - Planning
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VARIANCE/SETBACK AW.
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)ONDITIONAL USE PM*=
////////
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/////////
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YrHER ZONING MQUIREMENTS
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777777-777
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4
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TTMRONMENTAL FEATURES
.WCESS SLOPE & VEHICLE ACCESS
777777777T/777777
6
)RAINAGE PLAN (On Site)
7
MEET FILE
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)UIT CIAIM/DEDICATIONS :e�-
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[//////77777/7777
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/////////
/////////
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/////////
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BOND REQD FOR PUBLIC IMPROMOM
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SOILS CONDITIMS & GROUND
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4ATER FIETD MCKED
-16
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STREET PAVING M)UIRED
//////
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CURB AND GUTTER MQUIRED
3IDEWAIX RE*UIRED
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,aTER M'w= SIZE
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INDICATED CN SITE PLAN
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39
AISC:
7777777P
REVIEWED BY:
PLANNING MGR.
K17
ENGINEERING MGR. PUBLIC WORKSMGR.
CITY OF EDMbNDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
M / - I I /) -7- . - r,-- -, , - . �-/?
,c> n
CITY, ]TELEPHONE NUN
CITY ITELEPHONE NUMBER
M21=1
A DDR S
C TELEPHONE NUMBER
4 & _0 -7 -7-2
lee ql_6� "7'7-----)
STATE LICENSE NUMBER I CITY LICENSE NUMBER I
Legal Description of Property - include all easements
(show below or attach four copies)
USE %4�..-�ERMIT
ZONE NUMBER
JOB
ADDRESY�100 /I 11L�
4 4e, jV,
LEGAL DESCRIPTION Z��VISION
NO.
LID NO.
6)4-
-
1 14,9
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING 4� '7 REQUIRE[) DEDICATION
PROPOSED-.60
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
STREET USE PERMIT REQUIRED 0
SEE ENGINEERING MEMO DATED
SEE PIW DEPT. REVIEW CHECK LIST 4 D1
METER SIZE,// IBUILDING SUPPLY SIZE IFIXTURE UNITS
REMARKS
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELIN5
VARIANCE OR CU PLANNING REVIEW BY
_j YARDS
01 A_
WI
FRONT
V NEW RESIDENTIAL
191 PLUMBING
ANJ
ADDIALTER NON-RESIDENTIAL
MECHANICAL
REPAIR EI RETAINING WALL
SIGN
EXCAVATE
DEMOLISH El OR FILL
FENCE CHECKED BY T OF
L_x-FT) I
EPRE -MOVE INSPJ
T COMPLIANCI
SIDE SEWER WATER LINE
swim SPECIAL INSPECTOR
POOL REQUIRED
0 YES 0 NO
REMARKS
. NUMBER OF STORIE9 ----T-NUMRFR OF
DWhLLINU
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
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.
7ermit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
GRADINGIFILL
"Applicant, on behalf of his or her spouse, heirs, assigns and
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
VV
0
modify,,waive or reduce any requirement of any city ordinance
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
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-
THIS PERMIT
AUTHORIZES
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
i9riln-su.r?nce,
R A NT) DATE S GNE
I NSPECTION
DEPARTMENT
CITY OF
EDMONDS
ATT�:KITInKi
771-3202
SIDE REAR 1. LOT COVERAGE
ZI
LU
0
Z
Z
Z
n
CL
N Uuut HEIGHT
/1 02
OCCUPANCY OCCUPANT
GROUP LOAD
Z
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
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE L
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OA UG -6 1985 ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UB
CHAPTER 3. PINK — Owner GOLD — Assessor
102-78
E. A
DATE : - 5�— 36-
MEMO TO: Building Division
Planning Department
FROM: Engineering Division
Publ ic Works Department
SUBJECT:
After reviea of the subject Building Permit appl ication , vie have the fol lowing
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 exce-nd 1401
5. ac k,.-ia I-er val ve requ i red i f downs ta i rs pl umb i nq is below elevation oF
upstream manho e.
6. Water and' sewer lines to be separated by 10 foot minimum.
V
bppp-
C A-rcl
EAS I t'
(vr.t,4-r
M2
TT�MDN- Ps LENGTH
MIN-, '2' L4Ax CovrLp,
SYSTEm CROSS SECTION
CON-I"ROL CA-TC61
a" I t4 --�
EE PAGE 3 FOR OUTLET CONTROL DETAIL
OVrLST
C004TROL!,
rzwt�17_ 4"
le
TO 0UTk_ZT
(PJ PRAP OP
P,UNOFF
.S'P;ZEADEV,)
2' 2' 6" Dawr, At& - sp^LL& �% vou^L)
2' X' DErp, !V,'- CAUS"ED KOCV.
FROM
0U_rLET
CON_r1k0L
RIPRAP OUTLET
VVA3HED r&P-*,VIFL
—.6. IL
FRD%i
OLMLET
CONTROL
OL"FLO* TOWNCk, MIN 10' LONG,
'To' 4 A" 1"WRIF P'"r _rD IbIr 1=11KIL
4' FERF Pipt WrrH CAP—%
RUNOFF SPREADER OUTLET
STANDARD DRAINAGE PLAN
DETENTION SYSTEM
PAGE I OF 3
for 1) F-P Q
location=b
plan by
phone
date
DESIGN DATA
System Imperm Pipe Pipe Orifice
Number Area Diam Length Diameter
_�0'90 Yq
I I
NOTE S
I. Call Engineering Division (771-3202)
for prebackfi)l and final inspections.
2. Responsibility for operation and
maintenance of drainage systemson
private property is the resDonsibill'ty
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.
'47
CITY OF EDMONDS
_J]
A UG 6 1985
'-HAEL L EROSIER
ZO N E 2�
A 81 TY
LTY i ES, ACCORDING TO
:ORDED IN VOLUME 12 OF PLATS SETBACKS:
)F SNOHOMISH COUNTY, WASHINGTON. r- -.) r
r"-,,-)NT 2-5
R 1E A R - 2-
OTHER
HFICIHT e) S-/
0
�700TIN6) DeA'46 ZVLL No-rbc-
FOUND IRON PIN WITH PLASTIC CAP NO-D 4561
FOUND 2" x 2" WOODEN HUB WITH TACK
w
A[
01
A[
13'
/0
cv
-c
.a-
(0
Des.
A�ca' - Nawe"
ENGINEERS e SURVEYORS . PLANNERS T T
324 Main Streat Edmonds, Washington 98020 cm. R L S