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13 C— APPRO D PLANNING
MEMO TO: Building Division
FROM: Engineering Division
SUBJECT: 1930 LIP- W
After review of the subject building permit application, we have.the
following comments:
1)
Connection
to City
water system required.
2)
Connect ion
to City
sanitary sewer system required.
3) Right-of-way permit required for any work on City property.
4) Driveway slope not to exceed 14%.
5) Back water valve required if downstairs plumbing is below
elevation of upstream manhole.
6) Water and sewer lines to be separated by 10 foot minimum.
7) Builder/owner responsible for.containina all temporary runoff and
erosion on site and may not impact neig�boring properties in any
way.
8) Construction hours from 7:00 a.m. to 10:00 P.m. on weekdays and
10:00 a.m. to 6:00 p.m. on weekends and holidays.
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Tr= E W/ 4Low-, LEGS
SYSTEM CROSS-SECTION
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71-0
TRENCH CROSS-SECTION
In
STANDARD DRAINAGE PLAN
INFILTRATION SYSTEM
PAGE I OF 2
for ae
location- L'U
plan by e, rA Vl�
phone
date
DESIGN DATA
Trench Perc LF per Imperm Trench
Number Rate 1000 sq.ft. Area Req.
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the responsibility
of the property owner(s). Preventive
maintenance consists of preventing
soil and other materials from entering
trench during construction as well as
after construction. Catch basins should
be cleaned of floating material and
sediment at regular intervals (at least
twice per ye r).
, 9 /a
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CITY OF EOIVIONOS
1.5cpi P-o C) str-
101,
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NOTICE:
No warranty of accuracy.
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(�-). Any person or entity-reque sting a
copy should conduct an independent
inquiry regarding the information shown on
tf�e -map(s), including, but not limited to,
the 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
empto-yee-s o-r offiCer-s-3 Shall be Hab-Ife forthe
information given on this map(s), nor for
any one representation provided based
upon said map(s)..
*w
The City of Edmonds
Side Sewer Drawing
NEW CONSTRUCTION &N
OWNER-----------------------------------------
JOB ADDRESS A ------- ............
'Popp C-09mraft
F�� —
W"
SADDLE
8117 CANN.
17
PWW-0001-11/75 (REV. 11/78)
EASEMENT NO - --------------
REPAIRS E] LID NO.. 1-->7 ASMT.
es a 9 A 6
CONTRACTOR ------ Vks-T7 . . ............................. PERMIT No. 7(000
00
LEGAL DESCRIPTION: LOT NO - ------------------- ------------------ BLOCK NO. .-A ------ t---b
------------------------------------------- ........................................................................................... % --------- --------
NAMEOF ADDITION ---------------------------- .............. ........................................... ------- .......... ...
0
x
H
Approved:
DATE 4xorli,&22, jy-%--- By . ... . ..........................
*4
C I T Y of EDMON D
For Inspection Call 771-32
1`1140
Address of Construction: WC.
SIDE SEWER PERMIT
PERMIT NO. '07600
V%.VVV LtNE
Property Legal Description (include all easements): 0A) 4ze-1
Owner and/or Builder:
Contractor & License No:
Singl:e Family Residence
Multi-Fami.ly
Commercial
(No. of Units
(No. of fixture Units
Invasion into City Right -of -Way: No -
,>I,- Yes. (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement requi-red,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
I certffy that/I lia-ve read and shall comply Date
with Ae items listed on the back.
Permit Fee: sr Issued By: MA)
Trunk Charge: Date Issued:
Assessment Fee: Receipt No.:
Partial Inspection:
Comments Date Initial
Final Inspection Approved:
Date Initial
00
Rejected:
CD Reason- Date 7-nitial
(A
PERMIT MUST BE POSTED ON JOB SITE
Whjte Copy File Green Copy Inspector 'Buff Copy -.Applicant A
CITY OF EDMONDS
2/NEW
ADDITION
RETIREMENT
STREET FILE
ASSET INFORMATION SHEET
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION
/13to,-5 'r-111
DE�
7.1
* * PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
PROJECT NUMBER 4 � 'lj� /I -- �
PROJECT COMPLETION DATE
COST -; �. , 5-1-, 5 7
B.A. R. S. ACCOUNT NO.
41 ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
2� /DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE DATE
NP) INITIAL
DEPARTMENT FILE
VERIFIED BY
PROCESSED
BATCH NO.
CA FILE NO. 64-6V7
seTiRF.ET %&tical Areas. Checklist
Site Information (soils/topography/hydrology/vegetation) RECEIVED
1. Site Address/Locatioin: 18-3o13 A A -4 f,- W 0"
2. Property Tax Account Number: c)l 2- - cj I PlAY 1 104-M
3. Approximate Site Size (acres or square feet): 60, 000 001--iNTEF.
4. Is this site currently developed? 14 yes; no.
If yes; how is site developed? -St yi4 i,. -fanixlk-,
'I i
5. Describe the general site topography. Check all that apply.
X 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 tha n 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: /Y9 ; Approx. Depth:
7. Site contains areas of seasonal standing water: /YO ;Approx. Depth:
What season(s) of the year?
8. Site is in the floodway /rg floodplain AD of a water course.
9. Site contains -a creek or an area where water flows across the grounds surface? Flows are year-
round? /V'P Flows are seasonal? Ale (What time of year? ,ro
10. Site is primarily: forested
urban landscaped (lawn,shrubs etc)
RN
11. Obvious wedand is present on site: A
- meadow ; shrubs ; mixed
-M
V 9 0 - 19 1
City of E&mon&
Critical 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 Edmondsprior
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. Ile
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.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (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 Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the *appropriate column below).
Owner / Applicant:
V ie- noe, IP-obew-� MIeys
Name
10,-30-3 'IW!519t , AV'MU6 wlee'k-
Street Addrew
Applicant Representative:
Name
StreeA Addrew
e.Amov%k, V\J- 90020 -7-15-9974
City, State, ZIP Phone City, State, ZIP Phone
Signature Date Signature
Date
NORTH PACIFIC INSURANCE COMPANY Home Office
OREGON AUTOMOBILE INSURANCE COMPANY P.O. Box 74
Portland, OR 97207
�Insurance is Provided by North Pacific Insurance Company
Memorandum of Insurance - Continuation Certificate LIENHOLDER'S COPY
Additional Insured's YOURAGENT
Name and Address ROURKE & BELL INSURANCE AGENCY
CITY OF EDMONDS RECEIVED 425 PONTIUS AVE N STE 41
BUILDING DEPARTMENT SEATTLE WA 98109
121 5TH AVE NORTH
EDMONDS WA 98020 JAN 2 4 2001 TELEPHONE AGENTCODE
BUILDING DEPT. (206)622-1731 5151-40
THE RESIDENCE PREMISESCOVERED BYTHIS POLICY IS LOCATEDATTHE BELOWADDRESS UNLESS OTHERWISE STATED.
INSURANCE IS PROVIDED FOR ONLYTHOSE COVERAGES FORWHICH A PREMIUM ANDASPECIFIC LIMIT OF LIABILITY IS SHOWN.
NAMED INSUREDAND MAILINGADDRESS
ROBERT W MYERS
VIVIENNE MYERS
18303 81ST STREET
EDMONDS WA 98020
LOAN NUMBER
POLICYNUMBER
NPH 604353
I POLICY PERIOD]
12:01 A.M.
Standard Time At The
Residence Premises From
02/19/01 To 02/19/02
RESIDENCE PREMISES BEING INSURED IF DIFFERENT FROMABOVE
FIRE DISTRICT: EDMONDS (INC.)
FT.TO MI.TO FAMILIES/ YEAR
PC PG CONST. TERR. HYDT. STN. UNITS BUILT RT
04 08 F 036 1000 2.0 001 1987 18
-- PRIMARY
RESIDENCE
SECTION I COVERAGES:
LIMITOF LIABILITY
PREMIUM
A.
DWELLING
276,000
819
B.
OTHER STRUCTURES
27,600
Included
C.
PERSONAL PROPERTY
193 200
Included
D.
LOSS OF USE
55:200
Included
DEDUCTIBLE - SECTION 1 $1,000
In case of loss under Section 1,
we cover only that part of the
loss over the Deductible stated.
SECTION 11 COVERAGES:
E. Personal Liability (Including Per-
sonal In ury) - Each Occurrence 500,000 14
F. Medicali Payments To Others
Each Person 1,000
Under Section 11, the Described Premises
is the only Premises where the Named In-
sured or spouse maintains a residence.
Exceptions, if any:NONE
9.0% Loss Free Credit
25.0% Deductible Credit
7.0% Dwelling Age Credit
5.0% Account Credit
92CR
219CR
57CR
46CR
SUBJECITO ENDORSEMENT ADDITIONAL
COVERAGES LIMIT
PREMIUM
INFLATION GUARD COVERAGE -
1.25% INCREASE EACH 3 MONTHS
Included
PH-617
7:94
FULL VALUE REPLACEMENT COST
- COVERAGE A ONLY
4
PH-602�7
94�
REPLACEMENT COST - CONTENTS
55
PH-54W
7-96
EARTHQUAKE
403
ADDITIONAL ENDORSEMENTS AND FORMSATTACHED
Total Polic Premium ------------- >
$881
PH-3-W(;7-94)
PH-615-W(9-98)_137 4-45)
Premium to L Paid by Insured
PH-110(7-94)
PH-41(7-94) PL 321M-97)
THESE DECLARATIONS AND ANYADDITIONAL ENDORSEMENTS, ANQ/OR FORMS LISTED SUPER-
SEDE THOSE PREVIOUSLY ISSUED. WHEN COMBINED WITH THE PERSONAL HOMEOWNER'S �� 16 e44'�Z� 01/15/01
POLICY, THEY COMPLETE YOUR POLICY, NUMB EREDABOVE. PH 10 0 0-88) 6;��ArPRESIDENT
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USE 'q=v PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
NA;k(OR NAME OF BVINESS) AUL)HtSS
b
NAME
ADDRESS
CITY
BER
r-1
STATE LICENSE NUMBER
CA
,&D(j?�) MO
TELEPHONE NUM
on of Property - Include all easements
attach four copies)
5 12, 1_� 4 ILV
*-I
fs7 I�MlPdAl efl7Y e,
NEW
119 RESIDENTIAL
El PLUMBING
ADD/ALTER
COMMERCIAL
MECHANICAL
REPAIR
El RETAINING WALL
SIGN
DEMOLISH
EXCAVATE
1:1 OR FILL
FENCE
( x _FT)
PRE -MOVE INSPJ
El
swim
E]
REMODEL
COMPLIANCE INSP.
POOL
WOOD STOVE/ [:]
INSERT APT.BLDG
RENEWAL
05 NUMBER OF STORIES NUMBER OF
W
DWELLING
-2— [UNITS
0
NATURE OF 0 �K TO BE DONE 4ATTACH PLOT PLAN)
Sj C
J(?�n C(�!,
LEGAL DE 'CHECKI
SUBDIVISION NO.
.5- -7-,Z
LID NO. --a
1 /37
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING I-Plo RFQUIRED DEDICATION
__ZN
PROPOSED
fln=xt�� K.
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
STREET USE PERMIT REQUIRED 0
SEE ENGINEERING MEMO DATED
REMARKS
4"Mr0onzl U11 rl &,adl
METER SIZE
BUILDING SUPPLY SIZE
FIXTURE UNITS
REMARKS
SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADS NO.
SHORELINE#
VAR IANCE OR CU
PLANNING REVItW By
DATE/'
ka
YARDS'
FRONT'�'_,�, SIDE REAR
HEIGHT LOT
COVERAGE
REMARKS
CHECKED BY
JWA
TYPE OF CONSTRUCTION
j-- �j
CODE
)
HEIGHT
-,as-
SPECIAL INSPECTOR
REQUIRED
0 YES 0 NO
AREA
OCCUPANCY-
GROUP &I -
A—
OCCUPANT
LOAD
R ARKS
rnoJ eMJP— enfgj 4 cocle-
T-inaA (nspection r�6qd
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180-Days
ENERGY CODE
"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
PLAN CHECK DEPOSIT
modify,. waive or reduce any requirement of any city ordinance
nor limit In any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this appllcation�, that the
Information given Is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz-
ed thereby, no person will be employed In violation of the Labor
THIS PERMIT
AUTHORIZES
ONLY THE
Code.of the State of Washington relating to Workmen's Compensa-
WORK NOTED
t Ion, I r1sq)ance.. I
INSPECTION
SIGNVU E (OWNER GE DATE SI NED DEPARTMENT
ZA 4, CITY OF
I EDMONDS
ATTOqTION 771-3202
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102-78
VALUATION . I FhL
--/00.00
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL'S SIGNATURE DATE
RELEASED BY:
DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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