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18622 78TH PL W
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ADDRESS: 19& ZZ,
TAX ACCOUNT/PARCEL NUMBER: -7 WO /,900
BUILDING PERM[IT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: w1=22 DETERMINATION: [] Conditional Waiver F] Study Required Q'(Vaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: —
SEWER LID FEE $: LID #:
SHORTPLAT
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERNUT #:—
FOR:
WATER METER TAP CARD DATED:
OTHER:
LOT: BLOCK:
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PROJECTADDRESS OWNERS: 78-6 pf-Ace Wt57-
KATHV'& MATT COO.K'-�i
18622 78�"; PLACKWEST
EDMONDS 98026 (TO-REMAM LPANG: 926 SQ F�-
1,931.5,- SQ.Flr.
NEW WANG
425 640 3373 HOME - 'I ��W GARAG�E 483 SQ. Flr.
2062392353 Ms. COOK.@.W-ORK'-'d"m
.-!!!l%;�jl0T_SlZE: 8413.5 SQ Flr-
TAX No: 0051700001800
LEGAL: MONTEBELLO PARK, LOT COVERAGE: 2,133.25 SQ. Flr. 25.3%
LOT 18
-T-27-R-04-S-I&NE IwERVIOUS SINCE 1977: 1207 SQ FT
BLKOOOD-00 RECEIVED
ZONE: RN -a GRADING: ABOUT 6oCUYDS. TRUCKAWAY
BUILT: 1%1 AUG — 9 2004
PERMIT COUNTER STREET FILE
Zone V � - 'K Comer /V Flag
Setbacks
Required
Actual
Front
;(5
Sides
-77(
7 "Pf
Rear
19"
1 -,
Other
3t:T—kaK- i-)
Heiaht
5 v-%,tx.
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 for ' th on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location 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
employees or officers shall be 1--ia-b-le for the
information given on this map(s), nor for
any one representatio ' n provided based
upon. said map(s).
0
APPLICATION
for
The City of Edmonds SME SEWER PERMIT
,STREET Fl
U;EW CONSTRUCTION 42�- REPAIRS
Lyn' FLUT
EASEMENT No . ......................................
.-- 4 A -P ort-
OWNER ... /rey ........ COA.-M/P.l " -6
............................................... CONTRACTOR .... V
. ................ - ................... PERMIT No - -----
ADDRESS ... /gj��.,Zz ..................
................. LEGAL DESCRIPTION: LOT No . .......... /.9 .......................... BLOCK No . ..........................
NAME OF ADDITION../V`0/ ....... 'c::: ,
...... . ..... ... ............
.....................................
APPROVED
MAY 1 3 Iftl
Approved:
DATE.5'�/-57:�/,/ ................... By &,I;a. ......................
.:CITY -OF EDMONDS
CIVIC CENTER — WATER -SEWER DEPARTMENT
IDE EWER PERMIT
Can FRospect 6-1107 whe n work,
is ready for Inspection. (No ln8PCC-
tions Saturday, Sunday or h . ol . idf�ys.) N 0-: 2247
ADDRESS.... Ak. ....... "I ..... � ......................................................................................................................................
..................
OWNER .... �1.lv ....... .................................................. CONTRACTOR ..... RV A..& C
Permission is granted ..... ................. 19k.1, for ........................ days to REPAIR or CONNECT a side sewer
-ion on file and koverning ordinances.
i-with City Sewers in accordance with applicat
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer inside property line. A licensed side Sewer Contractor must
. be employed to construct side sewer in street are.. Do not cover any portion of sewer before it has been Inspected.
NOTE No. 2—Obtain full Information regaxding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
N No. 3—Top of side sewer.must have at least 30 Inches coverage at:property line and 12 Inches inside property line; minimum grade of 2%.
No bends in grade shaxper than % will be permitted.
F, No. 4—Trenches in -street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
NOTE No. 5—It is unlawful to alter or do any other work than Is provided for In the permit, or to do any work on the main sewer or Its appur-
tenances except to insert the pipe into the wye.
0
PLANNING DATA
4
NAME: 'Cook DATE:— W V6q
Z
SITE ADDRESS: d,�, WIL P1, W PLAN CHK9: OY - 36 k
PROJECT DESCRIPTION: Ne t-, �t_ — 5-r.,4 Jh�,g,,
REDUCED SITE PLAN PROVIDEW:
MAP PAGE: CORNER LOT . : (Yes FLAG LOT: fyes (Nob
ZONING: CRITICAL AREAS DETERMINATIONM
QStudy Required:'
aWaiver,
Ll Conditional Waiver
SEPA*DETERMINATION:
L3 Fee
L3 Checklist
L3APo list w/ notarized form
(Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
PlExerno
SETBACKS:
Required Setbacks: -7
Stree Left Side: 7 Right Side: Rear:
Actual Setbacks:
31de:
Street: Left.' Right Side: Rear:
Street map checked for additional tback.required? Pe's-Y No DNA)
mo
0. DETACHED STRUCTURES: &C -IV'f
LJ ROCKERIES:
L3FEN'CES/TRELLISES:
BAY WINDOWS I PROJECTING MODULATION:
Q STAIRS/DECK*S: 5eU-J ITY1 dt(K N--- "OTP" td 0
Act
PARKING: Required: ual: 0
LOTAREA. 01�
LOT COVERAGE d51 %
Calculations:
BUILDING HEIGHT: 0-j
Datum Point:_WaTe'-- ��l av Datum Elevation:
Maximum Allowed: -Actual Height: �3"
&D.U. CREATED?: CNQ Yes)
SUBDIVISION:
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: (Ye�SNO
OTHER:—
Bir �eAy
Plan Review
NewBPP1anningDataForrn_D0C
0 0 CA File No:
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/vegetation)
1. Site Address/ Location: 79t' t>& (.1,4.
2. Property Tax Account Number: 00517
3. Approximate Site Size (acres or square feet):
4.. - Is this site currently.developed? %yes;_no.
.If yes; how is site developed? Ow.6 av _cr-rg
5. Describe the general site topography. Check all that apply.
v1 Flat: less than 5-feet elevation change over entire site.
I
A_F14-
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal
distance of 66-feet).
Hilly: slope' s 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 c6ntains areas of year-round standing,wat6r: J,/O Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year? &A
8. Site is in the floodway floodplain-� of a water course. -
9. Site contains a creek or an area where water flows across the'grounids surface? Flows are year-round?
NA Flows are seasonal? (What time of year?
10. Site is'
.primarily: forested meadow shrubs mixed
urban. landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site: _WV
ty
�or Ci Staff Use Only
1. Plan. C i heck Number,.ff app table?
2. Site is Zoned?
I SCS mapped soil type(s)? 4S,4 e-A� 51 t4 SIJ. �00_, La Qxz=.p,,R_ 2 ozo
4. Critical Areas inventory or C.A., map indicates Critical Area on site?
PCM-
5. Site within designated earth subsidence landslide hazard area?
C,
DETERMINATION
STUDY REQUIRED wArVER
Reviewedbr. Date: to 04
Critical Areas Checklist.doc/4.22.2003
rmwrm
City ottdMon,ds
Development Service's Department,
Planning. Division ., I
Phone: 425.771.0220
Fax:- ' 425.771.02211,'�
The Critical Areas Checklist contained on this form is to A property owner,, or his/her authorized representative,
be filled out by any person preparing a Development must fill, out the.. checklist, sign and date it, and submit it
Permit Application for the City of Edmonds 'prior" to " to -th6'City.' -The City 'will review the checklist, make a
his/her submittal of the application to the City. precursory site visit, and make a. determination of the
subsequent steps necessary to complete a development
p i it application.
emu
Date Recei;ewd:.
City Receipt#: c�4i_40�
Critical Areas File M
Critical Areas Checklist'Fee: $135.00
,:.,.Date Mailed.to Applicant:
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, Please 'submit a vicinity map, along with the sig�ied copy
needed to complete the Checklist should be easily of this form to assist City staff in finding and locating the
available from observations of the site or data available at specific piece of property described on this form. In
City' Hall (Critical areas inventories, maps, or soil addition, 'the applicant. shall include other -vertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to' assistant staff
in completing their preliminary assessment of the site.
surveys).
The undersigned applicant, and his/her/its heirs, and assigns, in consideration. on the processing of the application agrees
to release, inderrinify, defend and hold the City of Edmonds harmless from,any,and all damages, ihcluding.reasonable
attorney's fees, arising from any action or infraction'6ased in whole' or part upon false, misleading, �inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I cer* that the information- and exhibits herewith submi,tted are true and correct to the best of my
knowledge and that I am authorized to file this �pplotion on the behalf of the owner as listed below.
SIGNATURE OF APPLICANVAGENT DATE 3 - 13 - 0 lei"
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 officials and the staff of the City of Edmonds to enter*th.e subject property for,the
purposes of inspection and posting attend#nt to this application.
SIGNATURE OF OWNER DATE , 3-15-041
Owner/Applicant: Applicant Representative:
J coo
Name Narne
IMZZ '78�� 12L V
Street Address
V14 �80Z_6
City State Zip
Telephone: LlqZ,5 ) 6 e-10 - 33 73
. k IF
Email address (optional):
Street Address
City State Zip
Telephone:
C. W S - Mc- RnLrfic- 00mail Address (optional):
Critical Areas utiecklist.doc/4.22.2003
v2
PERMIT NO: 9
City of Edmqods 19'
PERMIT EXPIRES e7fl_71,�..s
SI]jE SEWER PERMIT,
Address of Con struction: ig(,q . z- -79 h UJ 7-
LID #
Property Tax Account Parcel No. 4Ngi�Z2
Attach copies of all access and utility easements Verified and Approved b
Owner; and/or Confractor: 6c�,�exc�� S>e_4
Contractor License UJ uilding Permit #: '720 1f - 0-742
1 -7 1(dw
ngle Family ..Invasion into City *Right -of Way: 0 Yes 0
M Multi -Family (No. of Units *RW Construction Permit
Commercial (No. of Units
EI/Public/"-/
Cross other **Private Property: El Yes
"Attach -legali description and copy of recorded ea'ae*m�e;nt.'
Owner/ieoon��tractor /,,2/5 /0�v
- / I r signature and acknowledgement sta,temerit: D�t/
Owner 4�ontracvl
By signinvg fqir tll�is permit I certify that I have read the City's public handout entitled
ide Sewer Spe'cifi cations, and shal I comp ly wi th all"City requirements outlined therein.
W'CALL DIAL -A -DIG (1-8004i4_5555). BEFOREANY EXCAVATION W
FOR,INSPECTION CALL 425-771-0220 1 extenslonys$- wr
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
. ... .. FOR OFFICE USE ONLY
. . . ........ .. .
Repair Fee Issued By:
Permit Fee $ 7: kAzio�_
T2 rg Date Issued:
Asse�sment Fee $ Receipt No:
rm it Surcharge Fee I—S51W Total Fees Paid.$..
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
IN SPECTOR- ARRIVES A $45.RE-I'NSPECTION. FEE. WILL BE CHARGED.
Job'Site Ready YES NO —Date: Initial:
Partial Inspection: —Date: Initial:
Partial Inspection: L Date: 14i ditial:
I eet ile::
FINAL INSPECTION.APPROVED:' Date: nitial: As -built to Str F
F
't- PERMIT MUST BE -POSTED ON JOB SITEt,
White Copy: File Green Copy: Inspector :Buff Copy: Applicant
L;temp;bldg,forms;sspermitjlg4/00
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ell
CITY OF EDMONDS SIDE SEWER AS- BUILT
ADDRESS
18622 — 78-PL W
HOMEOWNER CONTRACTOR SCALE
COOK NTS
DATE DRAWN PE MIT
12-27-2004 BY SIBREL NO, 9941
CM===:w
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K)A
15' RiSAX
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21 C-00
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PROJECT ADDRESS / OWNERS: it 76-6 pLACE WES7-
KATHY & MATTCOOK
*118622w-7�Lm--mPrAvC--E4W,E-SiT�,
EDMONDS 98026 VaSITNG (To REMAM LIVING: /-----926-SQ,
1,931.5 -V, SQ-FT-
425 640 3373 140ME NEWLIVING 483
NEw GARAGE
2062392353 Ms.COOK(§WORK
TAX No: 0051700001800 LOTSIZE-. 8413.5 SQFT-
LEGAL: MONTEBELLO PARK, LOTcovERAGE: 2,133-25 SQ.FT. 25.3%
LOT 18
-T-21-R- rMp VIOUS SINCE 1977: 1207 SQ FT
BLK 000 D-00 RECEIvED
ZONE: ' Its -a GRADING., ABOUT 60 CU YDS. TRUCK AWAY
BUILT: 1961 AUG - 9 2004
PERMIT COUNTER CITY COPY
Zone R� -F come*r IV Fla&�
Setback
Required
Actual
Front
T �5
Sides
7
"k
Rear
/9"
if
Other je-,&, K 0
Ir' To eh-3 —, ixo-e
Height
a9 '1-11:1
xq "r
DATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
ZONE NUMBER
MEN
CONSTRUCTION PERMIT APPLICATION
1
JOB SAT APT#
ADDRESS
0 & -7,
OWNER NAMEMAME-eF-81:1191W"S
KAV-f coot<-,
PLAT NAME/SUBDIVISION NO.
LOT No.
LID NO.
cc
Ul
MAILING ADDRESS
ML Jai
LID FEE $
ce
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
RW Permit Required C3
CITY zip
TELEPHONE
EXISTING PROPOSED-
Street Use Permit Req'd 13
Inspection Required 0
Side.alk Required 13
go e
�40
—
REQUIRED DEDICATION FT
1 Underground
119
ngrequirea E3
NAME
4A,0e7of-j
METER SIZE LINE
SIZE
NO. OF FIXTURES
0
PRV REQUIRED
YES 13 NO
cc
ADDRESS
REMARKS
Lu
z
&c77- AL-De-r— 5-r,
OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP
TELEPHONE
P'l) / WSPE C 7-1 ON /�Zcrz' f 0 N
Tt e,, 4 L 1 1,,4 eC a t-
NAME
677F5T
r
BL
EI'MINEERING REVIEWED BY DATE
cc
ADDRESS
0
P'i
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(ARE
- -- — - ----------
CITY
" REVIEWED BY DATE
LAI
0
ZIP
cz;l
TELEPHONE
U.
�VARIANCE OR CU
SHORELINE OR ADB#']�
INSPECTION
�REQ
80 ND
POSTED
STATE L11 ENSE NUMBER EXPIRATION'DATE
AECKED BY
CyEs )(INO
$
SEPA REVIEW
COMPLETE EIKET
SIGN AREA)'
ALLOWED PROPOSED-,
HEIGHT
�ALLOWE�, PROPOSED
PROPERTY TAX ACCOUNT PARCEb.NO
00-
W
V77
E , XP: ,
NEW
RESIDI� I'L
PLUMBING MECH
.1 - LOT-COVERAGE,�
4LOWED
.:.REQUIRED SETBACKS (Ffia
V'ROPOSED SETBACKS (FT.)
COMMERCIAL
COMPLIANCE OR
PROPOSED
3 5:'Yo 01b'I
FRON T. SIDE REAR ,
.01,
-7
FROV EAR
',� YR S'9'E Ap
z
ADDITION
0 CHANGE OF USE
01
ol%5'
va'gRk,7� 11
2
PARKING
LOT
ARE
DATE
z
REMODEL
MULTIFAMILY
SIGN
REO*D
I PROVIDED
;�'
IN
o-/—
CL
FENCE
, I..
ri REPAIR CyDS X FT)'
GRfZ
REMARKSj_p
_f
T,
DEMOLISH TANK 0 HER
—Irvcw(f,
GARAGE RETAINING WALL FIRE SPRINKLER
ARPORT
7
ROCKERY, L-J FIRE ALARM
-
0
I[TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
�5FK, % AL I
CHECKED BY
TYPE 0 -
n6RUCTION
OC UPANZ
GROCUP 3
NUMBER NUMBER OF CRITICAL
OF Z
I DWELLING
AREAS
Oq
SPECIAL INSPECTION
AREA U
OCCUPANT
ct
STORIES
NITS
NUMBER
REQUIRED
El
91 0
:Z
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
'K .1015fl,
PROGRESS INSPECTIONS, PER UBC 108/FINAL INSPECTION REO'D
Z3
4,01) 2.
Ae�DVa, Z- CAK. rak,�- EAAA- RFA
VALUATION
$
C1 A-fLi &fa E
Nescription,
FEE
DescriptIon
FEE
WEQ WVW4 Tz-r
'Plaff; lec
State Surcharge
HEAT POURCE
GLAZING %
YLOTNLOPE %
lBuildihl
r"
12.1
P nr�
AA InIr
lot-
12
City Surcharge
PLAN CHECK NO:
VESTED DATE
1�g!�.' -
iP-Iumb 1.10
C/ n
I 0 U
Base Fee
Mechanical
0
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I=
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
q(2
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
1!5c)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
2
IN INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
all,
x
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
V7
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
Landscapelnsp.
Total Amt. Due
150—
0
x
N OR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee
Receipt #
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
APPLICATION
APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged in space provided.
WORKM N' COMPENSATION INSURANCE AND RCW 18.27.
(425)
OFFICI I N R
;16W
SIGNATIR lll!�*
DATE GNE
A
a(O�INJOR
/ 0'6'D4--
I
-kELIE
771-0220
BY
ATTENTION I
FM 1333
Ae�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL -FILE - YELLOW 1/13-11/1W
PINK -OWNER - GOLD -ASSESSOR
09/03 PRFq-q i4ARn -Vn1I ARF-
MAKINI112A r.f)PIF.q