18111 84TH AVE W.PDF111111111111
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18111 84TH AVE W
ADDRESS: I C M I I (Y] - c
TAX A&OUNT/PARCEL NUMBER: -91
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED: —
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED F1
PER.MfTS(OTHER):,'/-tQ1Q( a(zlumb)
. I
DETERMINATION: r] Conditional Waiver [] Study Required [] Waiver
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE LID #:
SHORT PLAT FILE: �2 �No?,'slcoa:ie-a) LOT: BLOCK:
SIDE SEWER AS BUILT DATED:— /o q 0 t
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STR-EET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
I-F)
I
Iva, 7/1
L\TEMP\DS'Ps\Fomis\Street File Checklist.doc
Critical Areas Checklist CA File No: -GM _C�_Lvv
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: 19111 K41-' A%-'e-,t,1,
2. Property Tax Account Number: 2_--�o I EDO 100 9c) 0
qy, cfq 6 -
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? _Zyes; _ no.
If yes; how is site developed? I kou5e_4,j_ �L11%ve-04!j 3, Petvc4e_ Acce,,s ra,,4,
-.1
5. 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 present on site of more than 15% and less than 30% (a vertical rise of 10-feet
over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: V 0 ; Approx. Depth:
7. Site contains areas of seasonal standing water: 0 Q ; Approx. Depth: -
What season(s) of the year?
8. Site is in the floodway PO floodplain . of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
N 0 Flows are seasonal? (What time of year?
10. Site is primarily: forested I meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc) Ve- s.
11. Obvious wetland is present on site: - �!o
------
- ---- - - - ----------------- - - - - - - - - - ---------- For City Staff Use Only-
1.
Plan Check Numi- if aglicable?
rV 1
1
2.
Site is Zoned
3.
SC� manned soil tyVei(s)?_k&J-iW0rRV('6CV1 IC04, erivo c
J( -/S 0/1 S e
oarc'0 '41duv 0o 1 010,41/14
4.
1
CriticalAe inventory or C.A. map incyicates CrItical Area on site? 100551
e__6�0SI'Q'
.61 A c-d
S aN Aor* 4, WA St
5.
Site within designated earth subsidence landslide hazard area? A/0
t r-ost an DETERMINATION
&,as REQUIRED
4 WAIVER
Reviewed by7 A — _V -?o LO
��11_ W5�1� Date:
Critical Areas Checklistdoc/2.17.2004
0 #P20 0
0 V ED -Af
C* of Edmonds Date Received: -Z A-)
ity City Receipt#:
J' Development Services Department Date Mailed to Applicant:
Planning Division Critical Areas File #: CM zwo p ooqg
Phone: 425.771.0220 Critical Areas Checklist Fee: $135.00
gqz Fax: 425.771.0221 1
The Critical Areas Checklist contained on this forrn is to
be filled out by any person preparing a Development
Permit Application for the City of Edmonds prior to
his/her submittal of the application to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The information
needed to complete the Checklist should be easily
available from observations of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
A property owner, or his/her authorized representative,
must fill out the checklist, sign and date it, and submit it
to the City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed copy
of this form to assist City staff in finding and locating the
specific piece of property described on this fon-n. In
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in con unction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, t certify that the information and e,;Khibits herewith submitted are true and correct to the best of my
�1.
knowledge and that I am authorized to fileqs app icat n on the behalf of the owner as listed below
ZSIGNATURE OF APPLICANVAGENT DATE /7 OC
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public offici �ls and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and postin tt endant is application.
SIGNATURE OF OWNER DATE d
Owner/Applicant:
0-*1
54eve- t 4 s e, Lie j-
Name
Applicant Representative:
Bc, 't 't 4 R � +
Name -J
P6, aox 3LI5 1�000 IA;�itll-r�m 919 5-0V+1n.
Street Address Street Address"
L "%A V1 kA/00 at vvA cfYo q 6 Evere-l+ WA
City State Zip city State Zip
Telephone: (Y 29-) 2-vl -� 15")
Email address (optional):
Telephone: N 1!9 56 - Z-7 0 0
Email Address (optional): 6,.rim C 6) we 54-e4A qfJJ-"e-eJ,5. 60
APR 2 8 20n
ENGNEERNG DIVISION
0
0
CITY OF EDMONDS
CRITICAL AREAS RECONNAISSANCE REPORT
Site Location: 18111 84 th Avenue West Tax Acct. Number: 27041800100900
Determination: Study Required Determination #: CRA-2008-0046
Applicant: Barry Constant Owner: Steve Krassner
CRITICAL AREAS RECONNAISSANCE REPORT: STUDY REQUIRED
During review and inspection of the subject site, it was found that the site contains and/or is
adjacent to critical areas, including Geologically Hazardous Areas, pursuant to Chapters 23.40 and
23.80 of the Edmonds Community Development Code (ECDC).
According to the City's LIDAR data, the subject parcel slopes downward to the north and west
from a plateau in the south-central portion of the parcel from approximately 35% to more than
60%. This qualifies the slope as an erosion hazard and possibly a landslide hazard. In addition,
there is a large retaining wall near the southwestern edge of the parcel along 84 th Avenue West.
GENERAL CRITICAL AREAS REPORT REQUIREMENTS
Critical Areas Reports identify, classify, and delineate any areas on or adjacent to the subject
property that may qualify as critical areas. They also assess these areas and identify any potential
impacts resulting from your specific development proposal. If a specific development proposal
results in an alteration to a critical area, the critical areas report will also contain a mitigation plan.
You have the option of completing the portion of the study that classifies and delineates the critical
areas and waiting until you have a specific development proposal to complete the study. You may
also choose to submit the entire study with your specific development application.
Please review the minimum report requirements for all types of Critical Areas that are listed
in ECDC 23.40.090.D. There are additional report requirements for different types of
critical areas (see below).
Note that it is important for the report to be prepared by a qualified professional as defined
in the ordinance. There are options on how to complete a critical areas study, and there is
an approved list of consultants that you may choose from. You may contact the Planning
Division for more information.
General Mitigation Requirements for all Critical Areas are discussed in ECDC 23.40.110
through 23.40.140.
STUDY REQUIREMENT — EROSION HAZARD AREA
It appears that this property contains or is adjacent to an Erosion Hazard Area. Erosion Hazard
Areas include:
* Those areas with Alderwood and Everett series soils on slopes of 15 percent or greater.
Any area with slopes of 15 percent or greater and impermeable soils interbedded with
granular soils and springs or ground water seepage.
Areas with significant visible evidence of ground water seepage, and which also include
existing landslide deposits regardless of slope.
0
0
DEVELOPMENT PROPOSALS ASSOCIATED WITH EROSION HAZARD AREAS
Development within an Erosion Hazard Area must meet additional criteria.
For erosion hazard areas with suitable slope stability, the only critical area study needed is
an erosion and sediment control plan prepared in compliance with the requirements set
forth in Chapter 18.30 ECDC as part of the construction documents. This option is at the
director's discretion, per Edmonds Community Development Code section 20.80.050.G.
In areas where the slope stability is not suitable, projects within Erosion Hazard Areas will
require a report by a licensed Geotechnical Engineer or other qualified professional. Note
that it is important for the report to be prepared by a qualified professional as defined in the
ordinance.
Report requirements are given in ECDC 23.80.050, and more generally in ECDC
23.40.090.D.
0 Development standards are given in ECDC 23.80.060 and 23.80.070.
STUDY REQUIREMENT — LANDSLIDE HAZARD AREA
It appears that this property contains or is adjacent to a Landslide Hazard Area.
A Landslide Hazard Area is any area with a slope of forty percent (40%) or steeper and
with a vertical relief of ten (10) or more feet (except areas composed of consolidated
bedrock).
0 Landslide Hazard Areas are further defined and illustrated in ECDC 23.80.020.13.
In addition to the general requirements for Critical Areas reports referenced above, specific
Critical Area report requirements for Landslide Hazard Areas are provided in ECDC
23.80.050.
DEVELOPMENT PROPOSALS ASSOCIATED WITH LANDSLIDE HAZARD AREAS
Development is restricted within a Landslide Hazard Area and its buffer.
Projects that will intrude into these areas will require a report by a licensed Geotechnical
Engineer.
0 The criteria that are applied depend on the amount that the buffer is reduced.
The buffer can be reduced to a minimum of ten (10) feet (with an additional 15' building
setback per ECDC 23.40.280) if a report is prepared that meets the standards listed in
ECDC 23.80.050. The alteration must also meet the requirements listed in ECDC
23.80.060.
In addition, proposals to reduce the buffer to less than ten (10) feet must comply with the
design standards listed in ECDC 23.80.070.A.3.
ALLOWED ACTIVITIES
Certain activities are allowed in or near critical area buffers as specified in ECDC 23.40.20. If you
have any questions about whether your proposed development qualifies as an allowed activity,
please contact a Planner for more information.
2
0
0
EXEMPT DEVELOPMENT PROPOSALS
Certain development proposals may be exempt from Critical Areas Requirements (ECDC
23.40.230). If you think that a specific development proposal may be exempt, contact a Planner
for more information.
Michael Clu April 30, 2008
-gston, Planner W4��
Name Signature Date
NOTE: Cited sections of the Edmonds Community Development Code (ECDC) can be found on
the City of Edmonds website at www.ci.edmonds.wa.us.
STANDARD
DETENTION SYSTEM- WORKSHEET
(5000 SF OR LESS)
ATRES�: CALC. BY:
PHONE:
DATE:
o.
IMPERVIOUS SUFACE AREA PIPE DIA. -TPIPE LENGTH 0 FORIFICE
RIM ELEV. 23
FIR*D
G
FOOTING DRAINS SHALL NOT
DETENTION PIPE LENGTH
/67/
BE CONNECTED TO
---LOCKING LID (7P.1
IM ELEV. 0
F6" Min. clearance
Measured from top of
Cone. box or riser.
DETENTION SYSTEM
RIM ELEV.—
TIGHTLINE— I. MITMUM
0-5% TO 1 .0% SLOPE t( STREET FILE
(2) P ("PC TO CITY CONVEYANCE
--- 4NV. INV. ELEV.
NV. ELEV, ELEV,
L "'�OUTLET
UPPER CATCH BASIN ; CONTROL
ROM CONTROL CB IN. '--ORIFICE
'X2'Xl 2" DEEP CONTROL CATCH BASIN
(4'-6- QUARRY SPALLS OR EQUAL) IN. 6" COVER
FROM CONTROL C
ROM CONTROLCB
2' ��,�j 2" DEEP
(4 QUARRY SPALLS'
2
C? —T
SHALL BE PERPENDICULAR 1.5' CONTROL CB
I
T Tj SPREADERTR 2 1�,,TRENCH SHALL BE LINED
0 ENCH
WITH MIRAF1 &ON TOP
PERF. PIPE SHALL BE
LEVEL & CAPPED AT ENDS 1,5'
RIPRAP OUTLET 71 6----(17/8" WASHED DRAIN ROCK
SPREADER TRENCH
NOTES
1. CALL ENGINEERING DIVISION (771-0220 EXT. 1326) 24 HOURS IN ADVANCE FOR A TIGHTLINE AND DETENTION
SYSTEM INSPECTION BEFORE BACKFILLING AND FOR FINAL INSPECTIONS.
2. Responsibility for operation and maintenance of drainage systems on private property is the responsibility of the property
owner. 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 STORM
CONVEYANCE
SYSTEM
-SPREADER TRENCH
SHALL BE AMIN.
OF I O'LONG AND
PERPENDICULAR
TO CONTROL CB.
�A�-� I I �t
FEB 14 2006
BUILDING DEPARTMENT
CITY OF EDMONDS
DATE
Table 1 --
Detention
Pipe
Sizes
Impervious
Surface
Required
Pipe
Diameter
Area Sq. Ft.
Vol Cu Ft
15-
1811
24"
30"
2000
50
40
28
16
10
2500
62
50,
35
20
13
3000
................. ..... Z'�
24
15
:T5-00
__�6042
70
49
2L
8,)
470-00
100
80
56
32
21
4500
112
90
63
36
28
5000
125
100
70
40
25
Required pip
ength in feet
*NOTE: Use the next highest surface area to determine detention size if calculated impervious surface area is
greater than 1/2 the value between numbers. (i.e., 2280 use 2500)
Table 2 -- Outlet Orifice Sizes
Impervious Surface
Area Sq. Ft. Outlet Orifice Diameter (Inches)
2000-2999 5/8
3000-3999 3/4
4000-5000 7/8
Table 3 -- Rectangular Catch Basin Requirements
Detention
Max. Size
Catch Basin.
pipe diameter
knockout
Type
< 18"
20"
Type 1, CB 15
18" to 24"
26"
Type IL, CB 16
24" to 36"
36"
Type 11, CB 19 19 (48" Basin)
36" to 42"
42"
Type 11, CB 19 19 (54" Basin)
*Source: Assoc. Sand & Gravel Co. Standards
ALLLOWABLE STORM DRAINAGE
DETENTION OR CONVEYANCE MATERIALS:
• Reinforced Concrete (right-of-way) I
• Non -reinforced Concrete (non -right-of-way)
• Aluminized Steel
• Aluminum 16 GA or better
• CMP Asphalt Coated
• N-1 2 ADS HDPE (Min. 2' cover required under paved areas) water tight
• PVC-SDR 35, ASTMD-3034 or better
• Ribbed PVC pipe, ASTM D-2444
• Ducticle iron pipe Class 50
- Tightlines system:
• N-12 ADS (Smooth Wall)
• PVC-SDR 35, ASTMD-3034, or better
• Hancor F-810
S:\ENGR\HANDOUTS\Drainagefes E21
9
0 F E.0,&,_
LlY4" 200 PSI POLY W/ TRACER
OP. CORNER
CITY OF EDMONDS WATERLINE AS -BUILT
A
:::� ADDRESS:
tf� 1 18111 84TH AVE W
PERMIT NO,
BLD20060180
CONTRACTOR: HOMEOWNERi SCALE:
xxxxxx I KRASSNER I NTS
DATE INSPECTED: INSPECTED BY: DATE DRAWN: DRAWN BY:
5/19/06 1 E. SIBREL I 8/22/C 1. ABILA
0 0
COVENANT
For Adult Family Home's Second Kitchen
Whereas, the Grantor(s) YJ-Z-ZIL-� k " J rvek—
hereafter referred to as "Grantor(s)", have received A Building
Permit# fE-
f br o )erty which is zoned single family residential, and is
pr
located at 9 � W q2ne,,,qr &fn
tax account parcel number P-70Y1001-0-6100 and legally
described as follows:
6F,C 19 -Fwf 27 F-6E 04 P-T- 3-,4A-5-A2-) T4f N Z02 r-T OF- FPT VAC 8,Lk' Ig
C o A/%
1 31 V W L ITTCf 00.04o."S T&W <11 De
F "L. LftoArT AVre- -rRC rJ1/I, VA L
r, 9. W
00V Avt� 6' -) 1/2' OF "AL F-x9-I)EJZ ST 67-,J (/L. " 9 SLwooO AVF-A F
VA-C' ADJ 5f) 8"- 15 f, �W AL-L-F-Y 74-P-L4 �D SLv- iq M-s
Whereas, the City of Edmonds has received a building permit application for an Adult
Family Home with a second kitchen to be located'in an existing single family residence
in a single family residential zone.
Whereas, pursuant to WAC 388-76-190 an adult family home is considered a residential
use of property for zoning purposes, and are permitted in areas zoned for single family
dwellings.
Whereas, the City desires to approve utilization of a second kitchen in the Adult Family
Home as a reasonable accommodation to the facility as care provider to the disabled for
so long as the second kitchen is utilized, and only utilized, in conjunction with the Adult
Family Home use.
Therefore, in consideration of the City of Edmonds, Washington approving the second
kitchen as a reasonable accommodation by issuance of a building permit, the Grantors
agree as follows:
1. This covenant and all terms hereof shall be binding on Grantor, heirs, assigns
and successors in interest, and shall be deemed to run with the land and bind all
future owners to the real properties described above.
2. This covenant shall be recorded with the Snohomish County Auditor and
Grantors shall pay for all recording fees.
I Grantors hereby covenant that the kitchen on the lower, basement floor of the
subject residence can be used only in conjunction with the Adult. Family Home
and that the said kitchen shall be removed immediately upon termination of the
Adult Family Home State License # — 71+70o for the subject facility
or cessation of use of the property as an Adult Family Home, unless, or until,
zoning laws allow otherwise.
4. The provisions of paragraph 3 above shall be specifically enforceable in the
Superior Court of Snohomish County. The prevailing part shall be entitled to its
attorneys' fees in such a proceeding.
5. Grantors acknowledge and agree that approval of the second kitchen for the
Adult Family Home use and the creation of this Covenant are a reasonable
accommodation of Grantors' rights as a care provider to the disabled and of its
clients' foreseeable needs. The Grantors, therefore, on behalf of themselves, their
successors and assigns do hereby waive any and all claims of the Americans With
Disabilities Act or the Washington Law Against Discrimination which they may
have as of the date of the execution of this Covenant and promise to h old
harmless and indemnify the City, its officers, agents and employees from any
cost, claim or liability which may be incurred in defense of such a claim.
By signing and execution of this Covenant, the parties heret a ree that Grantors are in
compliance with existing zoning regulations.
Signed T7
�!rir this
Subscribed and s Qa
N 6"'Itt
J
AF?)� 0,
01
0
o ry
ta P
FO Z7
PU-
"%t# 4-09 L
1//
Residing
OF �NN
day o
for the State Washington.
0
S?REET FILE
PLANNING DATA
NAME: DATE: 23, Zao 6-
SITE ADDRESS: igut 44"Ayt. LA� PLANCHK#: 09 5 1
PROJECT DESCRIPTION: -
7-
REDUCED SITE PLAN PROVIDED?: (Yes / No) 7 -
(Ao re- -VW111
Yes o
MAP PAGE: �5& CORNER LOT: (Yes FLAG �T:
ZONING:- P-S - 10 - CRITICAL AREAS DETERMINATIONM 1W, Z 51
LJStudV Required: tJ-I'tt S �-*c , j.K - AU km 1-k f. f*",V
Waiver
Conditional Waiver
SEPA DETERMINATION:
Ll Fee
LJ Checklist
LlAPO list w/ notarized form
Ll (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
0"Exempt
SETBACKS:
Required Setbacks:
Street: 2-5" Left Side: Right Side: 10. Rear:
Actual Setbacks: &3j 5b 13'
Street: go, Left Side: 40 * Right Side: Rear: -?-tl b - -Ic�41 --
Street map checked for additional setback required? (Yes D A)
F1 r%r-'rAtUCf% CYD"f—r"000 A0,4. f k�
Q ROCKERIES:
0 FENCES/TRELLISES:
IJ BAY WINDOWS / PROJECTING MODULATION:
El STAIRS / DECKS: iku'�-s &%t ir--i xq,,-
PARKING: Required: 2- Actual:- 4 h (4,.rp,-
LOT AREA: 4o 4 is P4-"-9'f-4j
LOT COVERA615: 51
Calculations:
BUILDING HEIGHT:
Datum Point: Ar.,bu. 1.,juj� by, Datum Elevation:
Maximum Allowed: 25, (193 1 Actual Height:
A.D.U. CREATED?: (No / Yes) 0 fcs� 4rt"
SUBDIVISION: '- S-Zr,-72,- aot. 1-1-- 99,67 -Si!z �kA kki 91-4o1zff,-x a, Sol-� A4-
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: (Yes
OTHER:— ADIAL,�-j F4,"j(,-Y t*j*
Plan Review By:_
1'4- fWft.&--A
OIL-
NewBPP1anningDataForm.D0C
tritical Areas Checklis OFILENO. qg -261
� 10
E
10
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Site Information (soils/topq
,Wqhy/hydrology/vegetation) \LP
I
Site Address/Location: 0
2. Property Tax Account Number: e_-t) CNF_
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? — yes; Y no.
If yes; how is site developed?
5. 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 I 0-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of
I 0-feet over a horizontal distance of 3 3 to 66-feet).
Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: XAO Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway Y�0 floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrAs'etc)
11. Obvious wetland is present on site: 'A i_>)
^cMhk.doc; Rev W03/97
0
0 �1 a C _E rvi'_r. [_-�
ICT 2 6
City of Edmonds
TRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City 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 are, or
may be, present on the subject property. The
information needed to complete the Checklist should
be easily available from observations of the site or
data available at City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent infor mation (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
Lk�\] Lc b Y\ ay -
Name TL
12(. —
Street Address
city State Zip
Telephone
�) W"'/ 0 -6y.\
Sign �ure V —
10 1 ccas-N
Date
Applicant Representative:
Name
Street Address
city State Zip
Telephone
Signature
Date
creception\jana\caddoc
(over)
0 0
PLANNING DATA
NAME: :5+4y< j/_rAS$A1r DATE: 91P_Z'."S-
SITE ADDRESS: 19/ 11 - 9�- A"'e, vj. PLAN CHK#: 0 q - 1130
PROJECT DESCRIPTION: P-&.-,p -A ADai�r A4,4Y t4bz
REDUCED SITE PLAN PROVIDED?: IPY_e'm�/ No) 11
,Z=7 �'� '.Z"11
MAP PAGE: 351, CORNER LOT: (Yes 3 ob
FLAG LOT: (Yes
ZONING:- CRITICAL AREAS DETERMINATION #: i"g - 2_S�-)
LJStudv Reauired:
2"Waiver
LJ Conditional Waiver
SEPA DETERMINATION: &w-
Ll Fee
Ll Checklist
L3APO list / notarized form
LJ (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
LXExempt
SETBACKS:
Required Setbacks:
Street: 2-51 Left Side: /0. Right Side: 0 Rear: Zo'
Actual Setbacks: t. ropr 45-,
Street: '04, Left Side: Veg*, Right Side: Rear: h"""j
Street map checked for additional setback requirec (Yes /(W/ DNA) p",
Q DETACHED STRUCTURES: t,— j __
Q ROCKERIES: hiz, 4 k"..' .
LJ FENCES/TRELLISES: t fk--,
U BAY WINDOWS I PROJECTING MODULATION:
El STAIRS / DECKS:
PARKING: Required: .2 Actual:- 4
LOT AREA: A3 ' 56o __4 '_/ I OL� A4t%"f�
LOT COVERAGt:
Calculations:
BUILDING HEIGHT:
Datum Point: baturn Elevation:
Maximum Allowed: Actual Height:
A.D.U. CREATED?: 4fFJ4
SUBDIVISION: ' 6 -U-77, A,,,A LI-' 0, W '. Sz� 5��i &9 pJA*-o 1/3d/Adax In Skw,� 4v.
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED:
OTHER: NO -It 41w* Alurr e'q4_—'7 /V 4
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P
PERMIT NO: 4,79
Citv. of Edmond§
SIDEREWER PERMIT PERMIT EXPIRES_jVjptzL��
V9,
Address of Construction: LID#
Property Tax Account Parcel No.
Attach copies of all access and utility easements Verified and Approved b
Owner and/or Contracto'r: 0 tA 4 O(L/1'40 Jj
Contractor License #:
Building Permit
ZT 11 1201 022 n
Wsingle Family
Multi -Family (No. of Units
Fj Commercial (No. of Units'
F� Public .. 1�%
Invasion into City *Right -of Way: E1 No
*RW Construction Permit # Z9
Cr6s other "Private Property: El Yes
"Attach legal description and copy of recorded easementr
ContractoDr 2 j 0
jr,4� gAt Ly�t Owner 16ontractor
Owner or contractor signature and acknowledgerent staternenC. Date
By signing for this permit I certify that I have read the City's public handout entitled
Side Sewer Specifications, and shall comply with all City requirements outlined therein.
W CALL DIAL -A -DIG (1-800-424--5555) B�F_'ORE ANY EXCAVATION W',''
9 FOR INSPECTION CALL 425-771-0220 extension (3�-246W'
24 HOUR. NOTICE REOUIRED FOR ALL INSPECTION REQUESTS
.......... . .................... ...
. . .. .. ......... FOR OFFICE USE ONLY
.... . . ......
Perm'itFee$ --l' —Repair Fee Issued By:
Trunk'Charge $ Date lssued:__A/�
Assessment Fee $ Receipt No: 0
--J&- ,
-Waco
City Permit Surcharge Fee $5.00 Total Fees Paid $
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45- RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO —Date: Initial:
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date:— I'01A10 Street File: E]
'C;� tKMI [ MU I bt FUb [tU UN JUt$ bi I I: 7;�,
White Copy: File Green Copy: -Inspector 130 Copy: Applicant
L;temp;bldg,forms,sspermitjlg4/90
's R�PAIR
3:
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=011111
45* loend
CITY OF EDMONDS SIDE SEWER AS- BUILT
A
z::� ADDRESS
tl�l 1 18111 84TH
HOMEOWNER
RONALD T. DEUADEL
DATE DRAWN
10/04/01 BY 1. ABILA
SCALE
AVE W NTS
CONTRACTOR
SOUNDVIEW HIVIBLDRS INC
PERMIT
NO, 9549
10/41ol
OA P
9i
84* Ati, Wu�ST
U) G' M
- C-D
0 rn
0
NOTICE:
-No warra-n*ty of -a -�czur�acy,
The information shown on the attached
map(s) w(3s compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of �Edm.onds does not warrant the
accuracy of anything set for.th on these
map(s). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
ff�e -map(s), including, but not limited to,
th-e loc'ation of any sewer stub shown. Such
sewer stubs may or may'not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
empl-oyee-s o-r officle,rs -S-halfl be 111ab.-II-e for the
i n
information give* on this map(s), nor for
any one representation provided based
upon said map(s).
j
110 C. 189,11
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS. WA 98020 - (425) 771-0220 - FAX (425) 771-0221
Website: www6edmonds.wa.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
March 12"', 2009
MEMO TO:
Edmonds School District
Ven'zon Northwest
SNOCOM Police and Fire Dispatch
SNOPAC
Snohomish County E911
U.S. Post Office
Snohomish County Assessor's Office
Snohomish County Information Services
Snohomish County P.U.D.
Puget Sound Energy
GARY HAAKENSON
MAYOR
SrRee�
Edmonds Fire Department
Edmonds Police Department
Edmonds Utility Billing
Edmonds Public Works
Edmonds Building/Street File
Edmonds Address Files
Lynnwood Disposal
Comcast Cable
Waste Management Northwest
Please be advised that the attached addresses have been added and/or changed to the
Edmonds address system:
1-811 t 84"' Ave W has become 3 parcels.
Lot I will be addressed 18109 84h Ave W
Lot 2 will be addressed 18111 84 th Ave W
Lot 3 will be addressed 18113 84th Ave W ( Has original house to remain)
Occupancy: R3 Tax ID Number: (for short plat): 2704t800100900
File number: S-2008-30 Lots #: 1, 2 & 3
If you have any questions regarding this letter, please contact a City of Edmonds Permit
Coordinator at 425-771-0220. Please contact our office if you wish to be removed from
future address change notifications.
�n
in
Permit Coordinator
L\Ternp\Ds,r,s,,master Letters\New Address 3/12/2009
Incorporated August 11, 1890
Sister City - Hekinan, Japan
0 0
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
Website: wwwuedmonds.wa.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
March 13, 2009
Steve Krassner
PO Box 345
Lynnwood, WA 98016
Re: Address Change Due to Recent Short Plat 18tit 84 1h Ave W
Dear Mr. Krassner,
GARY HAAKENSON
MAYOR
The purpose to this letter is to inform you that due to your recent short plat 'it is necessary
that your address be changed. All addresses are required to be in conformance with the
City addressing grid for emergency Fire and Police response.
Because address numbers are limited in your area Your address has been changed from:
18111 84t" Ave W to 18113 84 th Ave W (lot 3 w/ existing house)
1811184 th Ave W is addressed to lot 2
1810984 th Ave W is addressed to lot I
By way of a memo all City Divisions including Fire, Police, Utility Billing, Public Works
and Building will be informed of the address change.
it is your responsibility to inform the apphicable utility companics (phone, gas, electric,
cable, etc.), and all other 'interested parties of this address change. We apologize for the
inconvenience this may cause you and greatly appreciate your cooperation.
Sincerely,
�1� cm,�Wl Oalr�6
Linda Thomquist
Permit Specialist
Ctity of Edmonds
Encl: Memo
Incorporated August 11, 1890
Sister City - Hekinan, Japan
— — — — — — — — -- — — — — — — — — —
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CITY CLERK
CITY OF EDMONDS
121 STH AVENUE NO.
I;DMONDS- INIA 9802-0 b RRT FILE:'
COVENANT
For Adult Family Home's Second Kitchen
Whereas, the Grantor(s) -Rlzn/&-� /-< " J rw�,
Permit #_ a rll�/
located at
tax account parce-l—nur
described as follows:
6f-C 19 Twf 27
creafter-rIerred to as "Grantor(s)", have received a Building
f6r pr erty W_%—ichils�oned single family residential, and is
ro;;��-I- 0 0
and legally
F-6E 04 KT. 3-4,4, 5-A2-) TNf N ZOZ Fr or- FPT 11AC 81_k IF
t'IR�T' ADO
To C rr(4(_
roMowoS -r6w
SI/Z YAC BEI-ftaArT AvfrG
-roC OVZ, VA(_
�-'100P AvF,
& W)12.
OF V'At CXF-If-g
ST . 67-W C/4' or' SF-'�Mlfvf
& FLwaO AVEA&IFS
^6 ADJ 5D
8PV- 15 f,
VAC, At_.LCf TH-e-Li
5D 4v_ ig
Whereas, the City of Edmonds has received a building permit application for an Adult
Family Home wi th a second kitchen to be located in an existing single family residence
in a single family residential zone.
Whereas, pursuant to WAC 388-76-190 an adult family. home is considered a residential
use of property for zoning purposes, and. are 'permitted in areas zoned for single family
dwellings.
Whereas, the City desires to approve utilization of a second kitchen in the Adult Family
Home as a reasonable accommodation to the facility as care provider to the disabled for
so long as the second kitchen is utilized, and only utilized, in conjunction with the Adult
Family Home use.
Therefore, in considerati ' on of the City of Edmonds, Washington approving the second
kitchen as a reasonable accommodation by issuance of a building permit, the Grantors
agree as follows:'
0
1. This covenant and all terms hereof shall be binding on Grantor, heirs, assigns
and successors in interest, and shall be deemed to run with the land and bind all
future owners to the real properties described above.
2. This covenant shall be recorded with the Snohomish County Auditor and
Grantors shall pay for all recording fees.
3. Grantors hereby covenant that the kitchen on the lower, basement floor of the
subject residence can be used only in conjunction with the Adult, Family Home
and that the said kitchen shall be removed immediately upon termination of the
Adult Family Home State License # — 71470o for the subject facility
or cessation of use of the property as an Adult Family Home, unless, or until,
zoning laws allow otherwise.
4. The provisions of paragraph 3 above shall be specifically enforceable in the
Superior Court of Snohomish County. The prevailing part shall be entitled to its
attorneys' fees in such a proceeding.
5. Grantors acknowledge and agree that approval of the second kitchen for the
Adult Family Home use and the creation of this Covenant are a reasonable
accommodation of Grantors' rights as a care provider to the disabled and of its
clients' foreseeable needs. The Grantors, therefore, on behalf of themselves, their
successors and assigns do hereby waive any and all claims of the Americans With'
Disabilities Act or the Washington Law Against Discrimination which they may
have as of the date of the execution of this Covenant and promise to hold
harmless and indemnify the City, its officers, agents and employees from any
cost, claim or liability which may be incurred in defense of such a claim.
By signing and execution of this Covenant, the parties heret a ree that Grantors are in
compliance with existing zoning regulations.
Signed
Subscribed and
1 10
067
,ton.
CONFORMED COPY
20060315ilO2 2 PGS
03/1512006 4:33�m
, J33.00
SNOHOMISH COUNT ASHINGTON
CITY CLERK
CITY OF EDMONDS
121 5TH "ENUE NO.
19I)MONDS. VVA 9802-0
COVENANT
For Adult Family Home's Second Kitchen
Whereas, the Grantor(s) -RIZ-1/cf k
hereafter -referred to as "Grantor(s)", have received a Building
Permit #_ flolr prqperty which is zoned single family residential, and is
located at EV 0,04,0 f, 410 <91FOZ-C
tax account parcel number and legally
described as follows:
C 19 Twf 27 F-6E 04 AT- 3- -4 A- 57A 2-) T1+E fJ 7,o2 Fr oF FPT t/AC aLk'
FIRiT, ADO 1-0 G romoffos T6w
St/Z YAC OF_LAwvr AVE. -rKC V2, yA
e"'000 AVE 8. W'12- OF t'At rr-XF-1*-A ST 87-w c/t- ac i3"M,#Vr & FLwa-0 AVEAMES
VA'- 60J 5D BPV- .15 ?� VAC A"F-f 14eLi SD S"
Whereas, the City of Edmonds has received a building permit application for an Adult
Family Home with a second kitchen to be located in an existing single family residence
in a single family residential zone'.
Whereas, pursuant to WAC 388-76-190 an adult family home is considered a residential
use of property for zoning purposes, and are 'permitted in areas zoned for single family
dwellings.
Whereas,theCity desires to.a�pprove utilization of a seco . nd kitchen in the Adult Family
Home as a reasonable accommodation to the facility as care provider to the disabled for
so long as the second kitchen is utilized, and only utilized, in conjunction with the Adult
Family Home use.
Therefore, in consideration of the City of Edmonds, Washington approving the second
kitchen as a reasonable accommodation by issuance of it building permit, the Grantors
agree as follows:
1. This covenant and all terms hereof shall be binding on Grantor, heirs, assigns
and successors in interest, and shall be deemed to run with the land and bind all
future owners to the real properties described above.
2. This covenant shall be recorded with the Snohomish County Auditor and
Grantors shall pay for all recording fees.
I Grantors hereby covenant that the kitchen on the lower, basement floor of the
subject residence can be used only in conjunction with the Adult. Family Home
and that the said kitchen shall be removed immediately upon termination of the
Adult Family Home State License # — 71+-7oo for the subject facility
or cessation of use of the property as an Adult Family Home, unless, or until,
zoning laws allow otherwise.
4. The provisions of paragraph 3 above shall be specifically enforceable in the
Superior Court of Snohomish County. The prevailing part shall be entitled to its
attorneys' fees in such a proceeding.
5. Grantors acknowledge and agree that approval of the second kitchen for the
Adult Family Home use and the creation of this Covenant are a reasonable
accommodation of Grantors' rights as a care provider to the disabled and of its
clients' foreseeable needs. The Grantors, therefore, on behalf of themselves, their
successors and assigns do hereby waive any and all claims of the Americans With'
Disabilities Act or the Washington Law Against Discrimination which they may
have as of the date of the execution of this Covenant and promise to.hold
harmless and indemnify the City, its officers, agents and employees from any
cost, claim or liability which may b.e incurred in defense of such a claim.
By signing and execution of this Covenant, the parties heret a ree that Grantors are in
compliance with existing zoning regulations.
Signed
Subscribed and
I If
06,
P-ton.
V* I fm State
8
DEC 2 2 2005
EDMONDS CITy C, raw
Adult Family Home License
License Number: 714700
Pursuant to thelaws of the State of Washington and the Minimum Licensing Requirements
of the,.Department of Social and Health Servicesa license is hereby granted to
TENDER L
OVING CARE AFH INC
If P2irtnir'sh1p'/Cdr' dratt' --reprqented:by MARIA LETTY VILLANUEVA KRASSNER*
8
4o: ocift tia an main in -at
id f2i
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H`1*48titeo�*W hi
gt
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-DMONID
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it o fT,
As 4 on
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'ifie'.care -a
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64d i -
k-orn -th- h. at Iiii Mdafibn for,due 'cause.
This licens6-shill:be in*fbrce'0,. subjedi't
0 WVPhs oo.pr reiv
we as, a on to f
Thit"ho' h spec al'deslifiii prions with.
lwp
tal Illnes8
Conditions -'on Lieenke If
py:
Licensing Authority.
t �4;ac*tion under WAC 388-76-1-0�5-
NOTE:'The' departmen renewal. of a license doe`eii6tvreclude th diii��f I 1C. g
basedon ins�ection'.
This license.19 not transferable,, and Is valid only for use by i14 �cor'pqr'atlopf parmershiparlidividuAl(s) to Whom It Is issued and at tb
e location above described,
Issued by Authority of Chapter RCW 70.12
N
MEMORANDUM
Date: July 5, 2005
To: Street File for 18111 — 84th Avenue W.
From: Meg Gruwell, Senior Planner ?k,"
Subject: Tree Cutting
On July 1, 2005, Gina Coccia and I visited 18111 — 84 th Avenue W, following up on an e-
mail from Steve Bullock stating that a neighbor claimed there was tree clearing going on
at that address which would be a concern due to steep slopes and the fact that the lot is
large enough to be subdivided into more than two lots.
There was no active tree -cutting going on when we arrived. Tyler, who said he was
helping out the owner, Steve Krassner, explained that the tree -cutting had occurred earlier
in the week. This seemed to be true, since no branches or trunks were seen, though there
was some fresh sawdust near the stumps. The reason for the tree cutting was to clear out
the front so that the front of the house could be seen more easily as people drive up to the
house (see photographs). The house is to be converted into an adult family home. Only
the stumps were left to judge the size of the trees. Several were smaller than six inches
even at the stumps, and appeared to be as Tyler described, vine maples, rhododendrons,
or other shrubs or small trees. Two trees were larger but had obvious rot in them, and
could have been removed as hazardous trees, due to their proximity to the house. Some
others were less clear as to the actual size (caliper) of the tree, and whether the location of
the tree would have made it a hazard to the house or not. The ground in the area where
the trees were cut is quite level.
Tyler mentioned that the owner would like to subdivide the lot in the future. The new
lots would be to the west, away. from where the trees were cut at the front of the house.
The tree cutting at the front of the house seemed to be a landscaping choice, and not to
clear the land for subdividing or sale. Also the slope was quite level at that point. Most
of the cutting appeared to be allowed by Edmonds Community Development Code
Chapter 18.45, Land Clearing and Tree Cutting Code.
At the south side of the house two junipers had been removed, but they were shrubs and
not covered under ECDC 18.45.
To the southwest of the house, two trees had been cut down, and the entire tree remained
on the ground (see photographs). Tyler stated that the former owner had cut these down.
First he thought that he had cut them down last fall, but due to the green needles still on
one of the trees, that did not seem likely. Then Tyler pointed out that the house had only
closed last week, so the tree cutting could have been more recent. The trees appeared to
be in the viewshed of the house to the south, and it is possible that the neighbors had
requested the former owner to cut them. The base of the trees appeared to be on the steep
slope. One tree was obviously dead. Judging from where the trees fell, they did not seem
to be a great hazard to either house. The house at 18111 — 84th Ave. W. did not benefit
from their cutting, as their view was not improved. Since it appeared that a former owner
had cut the trees, there did not appear to be a lot of benefit to pursuing the current owner
for restitution.
I asked Tyler to tell the owner that he should consult with the City about a tree cutting
permit prior to cutting any more trees on this lot.
Page 2 of 2
MEMOFILE.DOC
7/5/20U
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MEMORANDUM
Date: Septempber 30, 2002
To: Subdivision File S-28-72
From: Star Campbell, Assistant Planner'�:�
Subject: Recognition as valid subdivision
A recent inquiry regarding the subdivision potential of 18111 84 th Ave. W. led to
research to determine how the existing lot was established. In inspection of the
subdivision file (S-28-72) showed that the lot was created along with two others 18311
84 1h Ave. W. and 18321 84 th Ave. W. as a 3 lot short plat (S-28-72). This lot was
approved by the City but there is no recorded document in the subdivision file. It is
therefore, not evident whether the subdivision that was approved by the City was
recorded within the allowed time period. A subdivision that is not recorded within the
allowed time period autornically expires and thus, is not a valid subdivision.
However, further research indicated that a lot line adjustment was approved by the City
in 1998 (LL-98-63). This Lot Line Adjustment moved the boundary line between the two
southern lots (18311 and 18321 84 th Ave. W.) and changed the location of the access
easement across 18111 84 th Ave. W. In addition, two building permits were issued by
the City for new single family residences at 18311 and 18321 84 th Ave. W. in 1998. By
the granting of these approvals, the City has recognized the original 3 lot subdivision (S-
28-72) as 1�g�, regardless of whether or not the subdivision had been recorded within
the allowed time limit. This was confirmed by Rob Chave, Planning Manager, and
Duane Bowman, Director of Development Services.
City of Edmonds cQ Planning Division
CITY OF EDMONDS DAVE EARLING
MAYOR
121 5th AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - fax (425) 771-0221
www.edmondswa.gov
DEVELOPMENT SERVICES DEPARTMENT
/r? C. 1 B913 -
DATE: June 22, 2015
-RE: Flood zone determination for the property located atr,_*,_'fi18-;;j1 _111 8-_4_'h_Ave`_W Edmonds
WA
To whom it may concern,
By review of City of Edmonds critical areas maps and FEMA FIRM #53061CI305 E, it appears that
the property at the above listed address is located in zone X, which is outside the 500 year flood
plain. Please consider this letter as an official statement, as there is not presently a formal certificate
designed for this purpose.
Thank you,
Leif 'Bjorb,�wk
Building Official
City of Edmonds
(425) 771-0220 x1380
Incorporated August 11, 1890
Sister City - Hekinan, Japan
"PpriOV'rn
N4Kr,-. A tA i
oatc,
CMP BAND (GALW
BOTTOM OF TRENCH
1 114'DIA x 3'-0* LONG
WITH WELDED CAP (3- DIA)
PROFILVELEVATION
112- BOLTS (GALW
CMP BAND (GAL%O
LOCATE BEHIND PIPE BELL
ONE ANCHOR PER PIPE
PLAN VIEW
PIPE ANCHOR DETAIL
FOR SLOPES
NOT TO SCALE
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REBAR OR EQUAL
1-1
NOTES:
1. PROVIDE PIPE ANCHORS WHEN
SLOPES EXCEED 3:1.
2. SPACE PIPE ANCHORS EVERY
15 FEET.
EPDXY COATED TIE WIRE WRAP
3 TIMES AROUND BOTH BARS
AND TIE OFF WITH A MINIMUM OF
4 FULL TwISTS OF THE WIRE
-o, MIN.
DPE PIPE
UNDISTURBED
GROUND SURFACE
;u
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0
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PIPE ANCHOR DETAIL
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RECEIVED
MAR 14 2000
BUILDING DEPT.
STREET FILE
fp, I B913
mw�
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS. WA 98020 - (425) 771-0220 - FAX (425) 771-0221
Website: wwwb.edmondsma-us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
March 12"', 2009
MEMO TO:
Edmonds School District
Verizon Northwest
SNOCOM Police and Fire Dispatch
SNOPAC
Snohomish County E911
U.S. Post Office
Snohomish County Assessor's Office
Snohomish County Information Services
Snohomish County P.U.D.
Puget Sound Energy
GARY HAAK ENSON
MAYOR
8r1?e46r )'/Zt
Edmonds Fire Department
Edmonds Police Department
Edmonds Utility Billing
Edmonds Public Works
Edmonds Building/Street File
Edmonds Address Files
Lynnwood Disposal
Comcast Cable
Waste Manajement Northwest
Please be advised that the attached addresses have been added and/or changed to the
Edmonds address systen-t:
18111- 84t" Ave W has become 3 parcels.
Lot I will be addressed 18109 84t" Ave W
Lot 2 will be addressed 1811 t 84"' Ave W
Lot 3 will be addressed 1.8113 84t" Ave W ( Has original house to remain)
Occupancy: R3 Tax 0 Number: (for short plat): 27041800100900
File number: S-2008-30 Lots#: 1, 2&3
If you have any questions regarding this letter, please contact a City of Edmonds Permit
Coordinator at 425-771-0220. Please contact our office if you wish to be removed from
future address change notifications.
n
in t
Permit Coordinator
L\Ternp\DST's�Master LettersNew Address 3/12/2009
Incorporated August 11, 1890
Sister City - Hekinan, Japan
fnc, . 1 g ()'�'
0 0
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
Website� wwwo.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
March 1-3), 2009
Steve Krassner
PO Box 345
Lynnwood, WA 98016
Re: Address Change Due to Recent Short Plat t8lit 84 th Ave W
Dear Mr. Krassner,
GARY HAAKENSON
MAYOR
The purpose to this letter is to inform you that due to your recent short plat it is necessary
that your address be changed. All addresses are required to be in confon-nance with the
City addressing grid for emergency Fire and Police response.
Because address numbers are limited in your area your address has been changed from:
18111 84th Ave W to 18113 84 th Ave W (lot 3 w/ existing house)
181tt 84 th Ave W is addressed to lot 2
l8t09 84 th Ave W is addressed to lot t
By way of a memo all City Divisions 'including Fire, Police, Utility Billing, Public Works
and Building will be informed of the address change.
ft is your responsibility to inform the applicable utility companies (phone, gas, el
_ectric,
cable, etc.), and all other interested parties of this address change. We apologize for the
inconvenience this may cause you and greatly appreciate your cooperation.
Sincerely,
�1�
Linda Thomquist
Permit Specialist
City of Edmonds
Enct: Memo
Incorporated August 11, 1890
Sister City - Hekinan, Japan
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City of Edmonds Permit No:
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date:
A. Address or Vicinity of Construction: nnl ve
B. Type of Work (be speci�ic): R9_16 024AL Lx_1t('4d ti-R-03
C. Contractor: Sat4.V106 , R(#j ti'04a6l-��
Mailing Address: �Oa (;Th Avz S
State Lic(Fhse V k 006 A.) L)3
D. Building Permit # (if applicable):-
E. Commercial Subdivision
Multi -Family Single Family
INSPECTOR:. "!;)%�
F. - PAVEMENT CUT: KYES NO
CONCRETE CUT: El YES El NO
Contact:
Ron
Dtvx
PrAl
Phone:
Liability Insurance: — Bond:.$
Side Sewer Permit # (if applicable):
E] City Project E] EUC (PUD,.VERIZON, PSE, AT& T, OVWD)
r_1 Other
G. SIZE OF CUT. X
INDEMNITY. Applicant understands by his/her signature to this application helshe holds the City of Edmonds harmless ftom
injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of
Edmonds or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense
costs and attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOW!NG THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES W!LL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT 97LL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
* Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305, and must have certification verifying completion of the
required training in their possession.
* Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt. or City -
approved material prior to the end of the workday - NO EXCEPTIONS.
Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
"�IND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
I HA VE READ THE ABO VE STA TEMENTS
THAT I MUST MAKE THE PINK COPY OF THE PERMITA VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Signature:
or Agent)
IDate:
FOR CITY USE ONLY
Approved by:. Right-of-way Fee:
Time Authorized: Void After /0 0 Disruption Fee/Fund 111:
Special Conditions: Rif.5TOkff 6EUROJ�J 7"0 UWqeRestorafion Fee-
fg-7TM 0201norJ6* W-PAI-L, 4-0400,1— Total Fee:
Ar pgmoc& 1_04A� kJ1Zq4t1^M_44A4ft1,E* Receipt No: 19
F � &
C611cx AWb A r A76V D_r, Reg Yin F iyA r-Fi G Issued by:
darmgov.
CA t 4- FOOZ INSPEMOLIS 19EFOR& SAC4_'F14-
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)
FINAL APPROVAL OF PERMITTED WORK. DATE:
AL22-
Inspector's Signature
For inspection requirements see Engineering Inspection Information handout.
DAMy Documents\Forms\Engnmg\ROWpemit-,doc
City OVEdmonds Permit'No:
RIGHT-OF-WAY CONSTRUCTION PERMIT" "Issue Date:
A. Address or Vicinity of
I
B. T I ype of Work (be s I ecific):
p
111 �1-, a,,-i ,, n,,., s . F
r e_...
SJ C_
A r-, --A K
-N- 4x.> r I t_--r in ICA 'r -0
J
-1
FS T 'S�-1 Ck il
,r CA 4'r e- I.S 1-112 -;1/0%
-,,� � k
� -, J
CA Q (A
A1_1> C a ^_ 00
� e 11 e— I
; 12 -
C. Contractor: Polo Contact: . C-A!F ACA 1^ Q L 17 fZ-_
Mailing Address: Po B o I i oJ ) Fug,*9.rT 9624-1 I*hone:—'(4 ? V- � �4 -1 A14 %4 1 —7
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit# (if applicable
E. F-1
Commercial
E] Subdivision
0
City Project EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
Multi -Family
n Single Family
Other
INSPECTOR.
F. PAVEMENT: [] YES C&NO G. SIZE 6FCUT'
CONCRETE CUT: E] YES "RZO
poss%0c PaA �,,Je �0ey%ls,�J
X - H. Charge: $
IDEMNITY. Applicant understands by his/her signature to this application helshe holds the City,ofEdmonds harmlessfrom inj*uries,
damages or claims of any kind or description i�hatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and
attorneyfees by reason ofgranting.this'p ermit..,,,.
THE CONTRACTOR IS RESPONSIBLE,;�FOR 'WORKMANSHIP AND. -MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
* Traffic control and public'safety, shall be in accordance with.City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
* Restoration is to be in accordance with �ity cddes. All street -cut trench work shall be p!tched with asphalt or City -
approved material prior to the edd,6f IN.
y EXCEPTIONS.
* Three sets of construction drawings of proposed work are required with the permit application.
I HA VE READ THE ABO VE STA TEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNO WLEDGE
THA T I MUST MAKE THE, PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
011A 10
or Agent)
CALL DIAL -A -DIG (1-806-.424-5555) PRIOR TO BEGINNING WORK
r FOR CITY USE ONLY
It . I Right-of-way Fee:
Approved by:.C�a 1'wnf
Time Authoriz'ed-V Vo'i'di After _111' 20 1 al Disruption Fee/Fund 111:
b'ditions:
Special Coll M. U)mf 1%A)rj2&To,-2 4V. Restoration Fee:
gYkT t6COT16fJS aF j_J T1 L I TIF I Fee:
)�, STeIOM -50. Tota
4A�/77 OW161AIAL)Pttl Receipt NO:
yr,�ko -�P,4:7_2 Issued-13y.
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMOND
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMITTED WORK. -
INSPECTOR'S SIGNATURE DATE:
For inspection requirements see Engineering Information Handout.
I NO WORK SHAI-1, BEGIN PRIORTO PERMIT ISSUANCE
I.-
9
0
SNOHOMISH COUN—T—T-1
P)Enmoir,
k PUBUC tffnffY DISTRICT tL IJ
Work Order # 323251 Task # 05
Requested by: Phone Date
Jurisdiction issuing permit: (specify)
CITY Edmonds
COUNTY
STATE AGENCY
OTHER
Type of Permit Requested: Underground E Overhead E]
Description of Project/Activity:
Road bore 84th Ave W
R.O.W. Frontage (linear feet)25
Customer: Orlo Fuller
Property Address: 18111th 84th Ave SW, Edmonds
Section 18 Township 27 Range 4
CONSTRUCTION: ESTIMATED START DATE: 10/29
DURATION: 1 Day
ESTIMATED COST:$2000
Additional information for incorporation in transmittalor permit application
FOR INTERNAL USE ONLY
PERMIT REQUESTED: PERMIT NEEDED BY:
PERMIT RECEIVED: REQUESTOR NOTIFIED:
EROSION AND SEDIMENTATION
CONTROL BEST MANAGEMENT PRACTICES
Local agencies and the State require prevention, control and/or treatment of
stormwater in order to prevent im to water bodies or adjoining properties.
Sediment is considered a pollutant= state and local low, and must be
prevented from entering water bodies. The following design teria are
intended to ensure that no sediment from a PUD project cacursies pollution in
localwaters and are drawn from State and localagency manuals and standard
documents. For further detailor questions, contact the project engineer
or Environmental Affairs Department at (425) 347-4441.
E
LLJ
z
LLJ
00
01-Z
4
Road'Bore
P
8403 4-�
EDGE OF
EXISTING
ASPHALT
LAYOUT
1 30
LAYOUT LEGEND:
PAD MOUNTED TRANSFORMER
SECONDARY PEDESTAL
PRIMARY UNDERGROUND CABLE
— - — - — - 350 SECONDARY UNDERGROUND CABLE
-------C--POLE AND OVERHEAD LINE
—PROPERTY LINE
— —RIGHT-OF-WAY LINE
—U— EXISTING UNDERGROUND CABLE
EXISTING DUCT
FUTURE DUCT
-,'�SANITARY SEWER/MANHOLE
,STORM DRAIN/CATCH BASIN
z�WATER MAIN/IMETER
FIRE HYDRANT
STREET LIGHT
SCHEMATIC:
REFER TO SHEET I
8412
6333 *X 6��,3 4 31
BE
T
RE-OV
TO
A 3
'U" POSTS
I
TRANSFORMERSO-120/240 V
BY PUD OR PUD'S CONTRACTOR
A-3430 9 37.5 KVA A-34310 37.5 KVA
UTC UTC
SER SER
MAKE MAKE
ASSYO 12U610 ASSY* 121J611
VAULTS
BY PUD OR PUD'S CONTRACTOR
A-34309 THRU A-34311
42" x 42" x 30" OPEN BOTTOM W/A 21" x 25" ACCESS HOLE
L-896i-X
8324
L-4436-X
T To E
V
0 BE
p REMOVED
X
155 . . .
Sol
L A-34302
-�i
OVHD,.
P20 L�E I AN D
7!FDETENT;ION PIPE
I.
IO'DRAINAGE
EASEMENT
�(�DTENT -ON -PE
'0� �DR.NAIEP7
4
-302
A-34311
P-4868-X
TO BE TO BE
_k1N
REMOVEDI REMOV
8403
I P
IRAN-0 M
TO BE REMOVED ON I
WO* 3 3359/03
w
2
.41
3
ED P I
LEDGE OF)
EXISTING
ASPHALT
. cl
LAYOUT
V - 30'
TO
A-30555
CABLE ALL FOOTAGES APPROXIMATE 9
BY PUD OR PUD'S CONTRACTOR
A-34311 37.5 KVA
FROM POLE TO A-34309
100' OF (1) 02 AL CNCTRC NEUT DG JCKTO PRI IN 2" PVC
UTC
MAKE —Po -- — REEL
SER
FROM, A-34309 TO A-34310
lB5' OF (1) 02 AL CNCTRC NEUT 09 JCKTO PRI IN 2" PVC
MAKE
MAKE Po _ REEL
ASSY- 12U610
FROM A-34310 TO A-34311
370' OF (1) 02 AL CNCTRC NEUT DB JCKTD PRI IN 2" PVC
MAKE Po REEL
445' OF 350 KCM AL TRX 08 SEC IN 3" PVC
SECONDARY PEDESTALS
BY PUD OR PUD'S CONTRACTOR
7 SEC PEDS/INSTALL PER DIST ASSYO 1U801
CONSTRUCTION NOTES:
AT A-34310
REMOVE RISER FROM POLE.TRENCH TO A-34310
AND TERMINATE EXISTING CABLE* 54600 AT NEW XFMR
AT A-34311
REMOVE RISER FROM POLE, TRENCH TO A-34311
AND TERMINATE EXISTING CABLE* 54718 AT NEW XFMR
IN ANY TRENCH WITH GAS. THE CONTRACTOR/PUD SHALL SUPPLY
AND INSTALL SCREENED/WASHED SAND FOR A BEDDING, WITH A
MINIMUM DEPTH OF 3", AND A COVER WITH A MINIMUM DEPTH
OF 6". FOR ALL CONDUITS IN SAID ThENCH.
2
.J
SECONDARY
TRIPLEX CABLES
0
SMALL/LARGE
SECONDARY
PEDESTAL
3" PVC DUCT
T FEED IN/OUT
09 CORNERS OF
P�DESTAL
3".PVC W/90*
24'R BEND AND
BELL END FROM
TRANSFORMER/
PEDESTAL
TYPICAL P EDESTAL
DETAIL
NTS
WIDTH VARIES
30" MINIMUM
NOTE
Ty 1. 12" MINIMUM GAS TO
POWER SEPARATION.
z 2. NUMBER OF UUNIJUIlb
< IN TRENCH VARIES.
i
0 0 3. ALL CONDUCTORS IN
Z 0"
:2
z
wo < — CONDUIT.
2
0 12"
MIN
En z
STREET
z <
LOHT
AN D
GAS V '—SECONDARY
3' MINIMIUM OF POWER AND GAS TO STAKE
SAND ON SIDE EVERY 10*AS NEEDED TO
RETAJN TRENCH POSITION.
SINGLE PHASE
TYPICAL JOINT TRENCH DETAIL
NTS
GAS IN PLAT
LOCATION 1811184 H AVE SW _LDMOS
98026
SO COUNTY
POLE NO
REASON FOR WORK PROVIDE 10 PRIMARY
UNDERGROUND E;IlInEER MILACEK
TAS;�_ 06
DISTRIBUTION SERVICE FOR DFAFTEP JCL
u.-!jD NO 9733-2
THE 4 LOT PLAT OF
VED DW
SCALE NOTED
SEAVIEW HIGHLA14D
DATE WCR? COMPLETED FORE—N—
ENVIRONMENTAL
SUBSTATION PERRINVILLE
FEES REQ'D
a yES [3,40
'ANALYSIR
ElE.Pi 0 OT EXEMPT
PARA. ITEM C
CIRCUIT NO PHASE 3
_18
-12--93
PRIMARY OVERHEAD
OVID COI,DUCIOR—K,
IROAD CROSSINGS ONLY
0 P-SIDENTiAL
ADD CK7 FT _Pll
I APPV DATE DESCRIPTION
0 COMMERCi4l
PE. F7 -- P,
L
LED-
NET T
S—
UGND CONDUCTOR_ 7.2 _ KV
REVISIONS
PRIMARY UNDERGROUND
ADD 660 CKI FT 1 P-
APPV
NO.1
DATE DESCRIPTION
E2 RESIDENTIAL
REM CKI FT
0 COMMERCIAL BASIC FEE i
NET _�60 CKT FT
LEU.
PERMITS (C.AIE GRANTIDI
5
0 TREE T� 1!
SECONDARY UNDERGROUND
0 STATE
BASIC FEES
_QLaUNT,
UNDERGROUND PLAT
EI
BASIC FE's
EASEMENTS 0 REOU:PEO
EN-1-Z"""
c- 44272 0 NOT REOUIRED
FT . .— .11
—1
PLAT CONSTRUCTION
RECUEST NO. 5260
F7 0 S_ t
DATE APPROVED 9/20/01
STREET LIGHTING
FOREIGN CONTACTS
4.11T 0 %_ S
0 VERIZON JPN-
CROSS, NGS
0 CATV
F T V 1
2 JOINT ENCH VERIZON & CATV
WORK IN RIGHT OF WAY
OJOINT BORE VERIZON & CATV
0 PRIMARY
a JOINT TRENCH W1 PSE
AS —BUILT
0 SECONDARY
POLE STENCILING
APPV
NO.
DATE
DESCRIPTION
_FT 0 1_ - I
FROM _ TO
MISCELLANEOUS FEES
TAKE OFF POLE
VAULT I
PRE-CONSTR REOUIREMENTS
PEPMIT S
EITREE IRIV OPUD LOCATOR
0 BAC�,HOE 0—
S
0 ONE CALL DATE_
TOTAL DUE I_
IND )
I POLES
I
JPL�T
DATE PAID) 9/20/01
�RECEIPT-
ILOGS
�OLE
U-.AP
I -LINE
C 54228
XF.R
IGIS
W SVCE APPLICATION-
N'W ;� L'C
LOCAT'ON MAP PAGE_,t �J2
[E.GINEER MARK MILACEK
CUS70LIER ORLO FULLER
XING PRINTED
(425)347-4489
PHONE (425) 171:10CLO
PRINTED-
m Ty
P,
PUGET
SOUND rr
L
T
L 1
D
MONDS
Ti
VICINITY MAP
WORK
SITE
TAGS
VAULT: A-34309 THRU A-34311
CABLE: 55910 THRU 55912
(c)
cli
0 0
ROAD DEADENDS
15 T
0, to
100,
ork Area
t
100' Max
50'Min. a
I
AL
AL
AL 4--
-§L 4
Permit No:
City of Edmonds
RIGHT-OF-WAYCONSTRUCTION PERMIT Issue Date:
ty
A. Address or -Vicini of Coristruc-tion:
B. Type of Work (be specific): I C) A
I . ..... w_
0, V-\ A-c)
LV c. nL(' VU
., /0 Ll
,o,e Y- A (�,\o 4— (C-pl-
\V
C. C o n tr a c t o r: 0 iN Cont�et: C(C- Z DG L, Us 6
d
Mailing Address: Phone: 0 3 �-t
State License #: I L-0 I k� I 10 Liability Insurance: Bond: $
D. Building Permit #`(if applicable): Side Sewer Permit # (if applicable):
E.
Commercial
Subdivision E] City Project E] EUC (PLTD, GTE, PSE, CHAMBERS, OVWD)
Multi -Family
Single Family F1 Other
INSPECTOR-
F.-
PAVEMENT:
F-1 YES
r-1 NO G. SIZE OF CUT x H. Charge:3
CONCRETE CUT:
YES
F� NO
IDEMNITY, Applicant understan6 b))`671-her signature to this application helsh,e holds the. City of Edmonds � harmle�s ftom. injuries,
dqni I dges or claims of any kind or description whatsoever, fqreseen'or �nfi6reseen'� 'thaimay bema de against the City of Edmonds or
any of its departme'n'ts. oremplo�ees, including but not�limi�t'ed to the defense of any legal proceedings including defense costs and
attorneyfees b� reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE .'FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BY CITYFORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO. THE APPLICANT.
* Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Eveiy
flagger'must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
* Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEPTIONS.
* Three sets of construction drawings of proposed work are required with the permit application.
I HA VE READ THE ABO VE STA 1EMENTS AND UNDERSTAND THE PERMIT REQ UIREMENTS AND A CKNO WLEDGE
I
THA T I MUS T MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FO�rINSPECTIONS
Signature:
MW
or Agent)
ir—NW-Aluir
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
Appro I vedby:o_ffiftno/� run %_11 I t.
TimeAuthoriz4 'VoidAfter 02-
Special- Conditions: MA I 9TAt 0 - 1�1
:Ek0?d,5f, ft I-L YVPrTr— R eg#!�IM5.
E ONLY - J,
0
Right of -way Fee: :aWt
Disruption Fee/Fund 111:
Restoration Fee:
Total Fee:
Receipt No:
Issued by: A
I A (A F_ 61;
U PON COMPLETION -AN ENGINEERING FINAL I
INSPECTION IS REQUIRED PER CHAPTEk'i 8' .00 `10WT AWEDMONDS'."O'
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMITTED WORK. -1
INSPECTOWS SIGNATURE DATEe
For inspection'requiremen.ts see Engineering Information Handout.
NO
WORK SI-IALJ,
BEGIN I`RIORTO
I"ERNII
11' ISSUANCE
STANDARD NCC GAS CONSTRUCTION NOTES:
IBe
SCALE : I" = 50'
2" MPE BRANCH SADDLE
----- 9 E - ------ N CIL
184 ST SW
Owner / Developer Contact Info
SEAVIEW HIGHLANDS
1811184 AVE W
EDMONDS, WA 98026
425-344-1371
ATTN: ORLLO FULLER
FITMR (Check Box if Complete)
• WORK AREA LEFT IN CLEANISAFE CONDITION. El
• COMPLETE ALL PIPE TABLES AND GAS PRESSURE STAMP. El
• FIELD CHANGES RED -LINED ON AS-BUILTS. F1
• MATERIAL VERIFIED AND CHANGES NOTED ON PAPERWORK. El
• ALL VALVE AND TIE-IN LOCA77ONS NOTED ON AS -BUILT. El
• NOTE BEGINNING OF MAIN, EOM,& LINE OF MAIN LOCATIONS. 1:1
• SHOW ROPE LOCA77ONS & CUL-DE-SAC RADIUS. ID
Fitter's Signature
Company
Employee ID#
E.O.M.
------ N - ------ E C/L
)ROPOSED 2" MPE-IP MAIN
16 WE CIL
"' X 90 MPE ELL
16 O'E, 5'N C/L
Project Manager Contact hiformation: DOUG USITALO
Office Phone 206-418-4236
Cell Phone 425-327-3451
GAS MAIN INSTALLATION RETIREMENT
I / R
SIZE
PROP -FT-
ACTUAL FT.
TYPE
MANUFACTURER
1
211
200
MPE
PROJECT PHASE
NDTIF #
ORDER #
GAS MAIN
X212194828
107012104
IND MTR
SERVICE
RETIRE
GAS MAIN PRESSURE & TESTING
TYPE TEST:
PRESSURE;
TESTED BY:
DATE ON:
TIM,-- ON:
DATE OFF:
TIME OFF:
DESIGN: 60 PSIG
SYS MAOP: 45 PSIG
CONSTRUCTION COST CODES:
0111-102-2
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. CALL "ONE- CALL" 48 HOURS
PRIOR TO CONSTRUCTION9 1-800-424-5555.
2. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS
AND GAS STANDARDS PROCEDURES MANUAL.
3. INSTALL MAIN VALVES OUT OF TRAFFIC WHERE POSSIBLE.
4. ANY CHANGE IN ROUTE, TIE-IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE
APPROVED BY PSE REPRESENTATIVE.
5. COMPLETE "PIPE CONDITION REPORT" ON ALL EXPOSED EXISTING PSE
FACILITIES. CHECK BOX ON REPORT FOR WIRE BOX (TEST LEAD)
INSTALLATION.
6. INSTALL ONE POUND ANODE FOR EVERY 1000' OF LOCATING WIRE. INSTALL
ANODE AND TEST LEAD WIRES PER PSE GAS OPERATING STANDARDS 14.2 AND
14-5.
7. MAINTAIN CATHODIC PROTECTION FOR STEEL MAINS BY THE USE OF
CONTINUITY BONDS OR OTHER MEANS DETERMINED BY THE PSE CORROSION
ENGINEER PER PSE GAS OPERATING STANDARDS 10.3
8. INSTALL ANODES AND TEST LEAD WIRES AS REQUIRED PER PSE GAS
STANDARDS PROCEDURES P0201 AND P0303 AND PSE GAS OPERATING STANDARD
10.2. TEST LEAD WIRES ARE REQUIRED ON ALL TRANSITION FITTINGS.
9. REFER TO PSE GAS OPERATING STANDARD 6.8 FOR MAIN AND SERVICE COVER
REQUIREMENTS.
10. MAINS AND SERVICES SHALL BE TESTED AND PURGED PER PSE GAS
OPERATING STANDARDS 6.14 AND 6.17.
11. EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE 0150.3200
TECHNIQUES FOR TEMPORARY EROSION AND SEDIMENT CONTROL AND ANY ADDITIONAL
LOCAL JURISDICTION REQUIREMENTS.
VICINITY MAP
NOT TO SCALE
PROJECT SITE
CALL 1-800-424-5555
2 BUSINESS DAYS BEFORE YOU DIG
THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATION OF FACILITIES
5
REAL ESTATE/EASEMENT
EASEMENT REQUIRED
PERMIT
EDMONDS
4
3
FUNCTION
CONTACT
PHONE NO
DATE
2
PROJECT MGR:
D. USITALO
(206 )418-4236
1
ENGR - POWER:
REV#1
DATE
BY
DESCRIPTION
ENGR - GAS:
COUNTY
SNOHOMISH
EMER SEC
4
Work Center
MCNSEG
DRAWN BY:
PHUONG DAD
(206) 418-4218
11/16/01
CHECKED BY:
C. WOOLERY
(253) 476-6300
1/4 SEC
NE-18-27-04
OP MAP
160-0658
PLAT MAP
160-069
APPROVED BY:
D. USITALO
(206) 418-4236
FOREMEN #1:
U-MAP# (POWER)
CIR MAP#
CIRCUIT#
FOREMAN #2.
MAPPING:
JOINT FACILITIES
ARRANGEMENTS
UTILITIES
CONTACT
PHONE#
PUGET MAIN & SERVICE EXTENSION SAP SUPERIOR ORDER# 107012104
SOUND 18111 8 4 A V E W RETIREMENT#
ENERGY (SEAVIEW HIGHLANDS)
DESIGNED BY PILCHUCK CONTRACTORS, INC., SCALE: 1 50
0
J
REQUEST FOR INSPECTION- Adult Family Home
APPLICATION NUMBER:
Applicant must complete sections 1, 2, 3, and 4. Application must be complete to be processed.
SECTION 1 - PROPERTY INFORMATION
SITE ADDRESS: ASSESSOR'S TAX/PARCEL #:
— — — — — — — — — — — -
PROPERTY OWNER NAME:
LICENSEE NAME (IF DfffERWO:
DAYTIME PHONE:
DAYTIME PHONE:
SECTION 3 — FLOOR PLAN
A complete floor plan must include all sleeping rooms, identified by number (#1, #2, #3 etc.) and all components for
exitin g, i.e. stairs, ramps� platform lifts and elevators. (Attach additional sheets if necessary)
SECTION 4 — DISCLAIM ER/SIG NATURE BLOCK
I certify under penalty of perjury that the information furnished by me i; true and correct to the best of my knowledge, and that I am authorized by
the owner of the above premises to request inspection for and operate an Adult Family Home at this location. I further certify that I have made
application to the Department of Social and Health Services and the jurisdiction for the appropriate license(s) to conduct such business at this
location. I further agree to hold harmless the jurisdiction conclucting such inspections at my request as to any claim (including costs, expenses, and
attorneys' fees incurred in the investigation offsuch claim), which may be made by any person, including the undersigned, and filed against the
jurisdiction, but only wl�lfre such claim out of the reliance of the jurisdiction, including its officers and employees, upon the accuracy of the
information supplie'oe jurisdiction s part of this application.
NAME/TITLE: I W� - I . I/-/- DATE: 0/aj
PROPERTY OWNER El APPLICANT [I LICENSEE
SECTION 5 - INSPECTION CHECKLIST
YES
NO
Home licensed (or applying for license) on or after July 1, 2001
F/
a
SLEEPING ROOMS
K
0
Sleeping Room #1 0 S NSI 0 NS2
Bedroom door is openable from the outside when locked
Closet doors are readily openable from the inside
V,
0
Smoke alarm is installed in the bedroom
F�K
0
Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24"high; 20"wide)
W
11
Sleeping room window has a maximum sill height of 44"
GK
0
. Sleeping Room #2 0 S 9/NS 1 0 NS2
Bedroom door is openable from the outside when locked
V
0
Closet doors are readily openable from the inside
IR"
0
Smoke alarm is installed in the bedroom
R,
0
Sleeping room window has a minimum net operiable area of 5.7 sf. (minimum dimensions- 24"high; 20"vvide)
El
Sleeping room window has a maximum sill height of 44"
C1
Sleeping Room #3 0 S V NS 1 0 NS2
Bedroom door is openable from the outside when locked
11
Closet doors are readily openable from the inside
11
Smoke alarm is installed in the bedroom
0
Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20"vvide)
0
Sleeping room window has a maximum sill height of 44"
El
Sleeping Room #4 0 S VNS I [I NS2
Bedroom door is openable from the outside when locked
(9"
El
Closet doors are readily openable from the inside
El
Smoke alarm is installed in the bedroom
0
Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24"high; 20"vvide)
El
Sleeping room window has a maximum sill height of 44"
9'
El
Sleeping Room #5 0 S 0 NSI VNS2
Bedroom door is openable from the outside when locked
&�
0
Closet doors are readily openable from the inside
ffr
El
Smoke alarm is installed in the bedroom
e
0
Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide)
17r
0
Sleeping room window has a maximum sill height of 44"
le
0
Sleepinj'Rooth #6 0 S 0 NS-1 0 NS2
Bedroom door -is openable from the outside when locked
0
0
Closet doors: are readilyopenable from the inside
0
0
Smoke alarm is installed in the bedroom
0
0
Sleeping room window has a minimum net. openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide)
0
0
Sleeping room window has a maximum sill height of 44"
0
0
GENERAL
Bathroom doors are openable from the outside when locked
ffr
El
Smoke alarms are installed on all levels of the dwelling
0
AJI smoke alarms are audible in all parts of the dwelling upon activation of a single device
0
Access road and water supply approved by Fire Department
El
WIPASSED CORREC77ONS REQUIRED
INSPECTOR: C—F;0 DATE:
C 0
0 PERMIT REQUIRED
_W5*10-.r-
C� _'Sb�-Gs
STREET FILE -,�,twiDATE —REcEvE.7,--T---7,,t
[PERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
rl-z!�Pt L<M ;mK_
MAILINGADDR5SS
PERMIT
NUMBER
JOB
ADDRESS -1
PLAT NAME/SUBDIVISION NO. I LOT NO
P 0 PDY—
3�_r
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
0
CITY
ZIP
TELEPHONE
EXISTING _ PROPOSED
Lyffl�
7?
REQUIRED DEDICATION FT
1?�
NAME
METER SIZE
LINE SIZ
NO. OF FIXTURES
.... ......... I
.1
..........
U
, .
Uj
t:1
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTRC
NAME
sr?-f C-L-./( f
STATE LICENSE NUMBER
PROPERTYTAX ACCO NTPARCELNO / t; ol"
—f 0/411 X00 -
0 NEW
RESIDENTIAL
COMMERCIAL
17 ADDITION
MIXED USE
13 REMODEL
MULTIFAMILY
0 REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY), E,;5PLAIN
ENGINEERING
FIRE REVIEWED BY
BY
SUITE/APT#
LID NO.
LID FEE $
TESCP Approved
RW r Required
permit
Street Use Permit Required
Inspection Required
Sidewalk Required
Underground
W,nn�",'U'r.d
PRV REQUIRED
YES 13 NO E3
C9
LLI
LU
z
a
z
.1�
DATE
11r)— I i
DATE
X6
CHECKED BY VARIANCE OR CU SHORELINE OR ADBO I INSPECTION I SEPA
REO'D COMPLETED I EXEMPT
13 YES 01�01
CA# ZONE10 SIGN AREA HEIGHT
WAIVER Er ALLOWED PROPOSED ALLOWED PROPOSED
STUDY 13 0 7- 5-
PLUMBING / MECH
LOT COVE GE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT
SIDE REAR
FRONT URSIDE REAR
,&;eCOMPLIANCE-QQ
57
tic.
7-5'
jo Zo
104 NAk 45-
12
SIGN
PARKING
REO'D PROVIDED I
LOTAREA
I
PLANNING REVIEWED BY DATE
— - —
5
1z
FENCE 2— 1
x FT.) REMARKS
*AMA' 0
FIRE SP14INhAER
FIREALARM
TYPE OFIIQ
549JRUC1
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
SPECIAL INSPECTION
REQUIRED 13YES
BESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
BY:
LanSTRUCTURAL
DESIGN
BY:
VALUATION
Description
Plan Check
HEAT SOURCE
LOT SLOPE7_____j_
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE,,DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
PgNiiiIAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT., SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr, Inspection
'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 MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Fire Review
I
Fire Inspection
Landscapeinsp.
—
Recording Fee
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL
IN VIOLATION'OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S 5W
'AUNSAfgICIN SU RANCE AND RCW 18:27.
SI P6 RE WNER GENT): DATE S�IGD (425)
LO. S 771-0220
OCCUPANT
GROUP
FEE Description
State Surcharge
Xa
City Surcharge
Base Fee
I -
Plan Chk. Deposit
Receipt #
Total Amt. Due L&IA
1 Receipt # I 5��5
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
VICM-5 SIGNATUREA DATE,
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL Z.iLE� YELLOW - INSVECTC
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 i IRC1101., PINK - 0 GOLD -ASSESSOR
0i
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Q'S
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
4VN��
C) -3c�-os
OCCUPANCY ..................
'200 5--, 0 05-3
RETURN ADDRESS:
City of Edmonds, City Clerk
121 5th Avenue North
Edmonds, WA 98020
NOTICE OF LIMITATION AND COVENANT
ADULT FANULY HOME
Reference#: PiPM172
Grantor(s): (1) -97r1of e1L4Sf#§_ (2) A,1,fWd 6C_�17Y 1"�'Jj-'Udditional on pg._
Grantee(s): City of Edmonds
Legal Description (abbreviated): Sec_1.8 _Twn N Rng M Qtr_Y�L�
OR Lot Block Plat
Assessor's Tax Parcel ID#(s): (1) :;_701t, /too /00 5W (2)
Assessor's Tax Parcel ED# not yet assigned
AUTHORIZED FOR RECORDING
City of Edmonds
By: WIC Date:-- �/29-71rf-
Page of 5
WHEREAS, the undersigned owners of property located at
I in Edmonds, Washington legally described
below or on the attached Exhibit A, have applied for a building permit for
compliance and/or to remodel a structure located on the site; and
WHEREAS, the applicant has notified the City of applicant's intention to utilize the
improvements and/or to convert an existing single family structure to an adult
family home; and
WHEREAS, under the Uniform Building Code the number of occupants of a
structure trigger certain requirements relating to the fire suppression and exiting
requirements; and
WHEREAS, the City has notified the applicant that the permit will ' be issued
conditioned on limitation of residents to (a or fewer residents and their
caretakers; and
WHEREAS, the City has issued a permit based upon such representations;
NOW, THEREFORE, the undersigned property owners (hereinafter
"Owner") in consideration of the issuance of a building permit and in order to
confirm the promises upon which such issuance is based while providing notice to
any future owners or mortgagors of the property does hereby stipulate, covenant
and agree as follows:
0
1. Covenant: Limitation on Residence. The owner hereby stipulates
and agrees that occupancy of the structure as an adult family home shall be limited
to —or fewer adults and their caretakers as allowed by applicable
provisions of state law. The owner acknowledges that in the event that the applicant
seeks revision of the applicant's state license to operate an -adult fandly home with
an occupancy of greater than �,o residents or attempts to rent, lease or
otherwise provide residence for additional residents above the
(a permitted in the current occupancy classification, the structure shall
be vacated and all residential use ceased until such time as the property is brought
into compliance with the provisions of the State Building Code, under the edition of
the Uniform Building Code then in effect. The owner further stipulates that this
covenant touches and concerns the land so long as the present structure and use
continues and shall run with the land to all future purchasers and assigns.
2. Sublect Tract. The above stipulation and promises shall apply to and
run with the land with respect to a residential structure located at /,91/ 1 .-,%s Ll 1-h
PVF, W - dmonds, Washington and legally described as:
3. Notification to Future Purchasers and Assignees. This notification
and covenant has been recorded in the records of Snohomish County, Washington
in. order to provide notice to any and all future owners of the property of the
limitation at the current level of improvement to single families and adult family
home residents fewer than in number.
4. Enforcement. In addition to any and other remedies civil or criminal
which the City may have, the property owner hereby agrees and stipulates that this
grant of covenant shall entitle the City to enforce by injunction the provisions of this
code and, in so doing, to recover its reasonable attorney's fees and costs.
AUTHORIZED FOR RECORDING
City of Edmonds
BY: W(�_ Date: �Wi5_
Page of
DATED this day of 20 05
ACCEPTED BY:.
OWNER:
Jeannine L. Graf"'r
Building Official
NOTIFICATION
NOTARY FOR OWNER SIGNATURES
State of Washington )
)ss
County of SnoApni/.g4)
APPLICANT/PROPERTY
7 e. - --t 2. L - -
Applicant
Applicant //1'
Owner
Owner
COVENANT AND
ACKNOWLEDGED:
Mortgagor
I certify that I know or have satisfactory evidence that 5-S/ -/--
signed this instrument, on oath stated that he/she was authorized to execute the
instrument and acknowledged it as the 1)"e- title) of
(name of party on behalf on whom inkrument was executed) to be
the free 4,qdyqluntary act of such party for the uses and purposes mentions in this
ins �lbed and sworn to before me this 13A dayof
07,�q
Puk3oG N#w'y OUblic in and46r the State of Washington.
CP
e�ommission expires
0,6
0
I or have satisfactory evidence that
signed this instrument, on oath stated that he/she was authorized to,execute the
instrument and acknowledged it as the (title) of
(name of party on behalf on whom instrument was executed) to be
the free and voluntary act of such party for the uses and purposes mentions in this
instrument. Subscribed and sworn to before me this day of
.19
No tary Public in and for the State of Washington.
My commission expires
AUTHORIZED FOR RECORDING
City of FAlmonds
By: V Dat
Page of
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BUILDING DEPARTMENT
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BUILDING DEPARTMENT
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BUILDINGFDEEOPARWENT
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NOV 2 3 2005
BUILDING DE A ENT
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BuILDlYNG DEPARTMENT
CIT OF EDMONDS
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