18709 92ND AVE W.PDFiiiiiiiiiiii
8847
18709 92ND AVE W
ADDRESS:
TAX ACCOUNT/PARCEL NUMBEP�V
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver 0 Study Required Zpgaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:-C4/1�2-)Z44Z
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LATEMPOST'sTonnAStreet File Checklist.doc
E
0
PLANNING DATA
NAME: 5 DATE: 7_1-2-690q
SITE ADDRESS: 1 ?�-7001 - 12--k7ef AV W PLAN CHK#: 0L1-0q9
PROJECT DESCRIPTION:
REDUCED SITE PLAN PROVIDED?: (Yes / No
MAP PAGE: CORNER LOT: (Yes I No FLAG LOT: (Yes No
ZONING: P-S - 1.2�- CRITICAL AREAS DETERMINATION #: 1--'2
Study Required:
.�,alver
E3 Conditional Waiver
SEPA DETERMINATION:
Fee
Checklist
UAPO list w/ notarized form
Q(Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
P"'Exempt
SETBACKS:
Required Setbacks: e I
Street: :25' Left Side: 167 Right Side:- Rear:
Actual Setbacks: I
Street, ��5 LeftSide: N& RightSide: LIS Rear: 10"e)cls-h
Street map checked for additional setback required? (Yes No I DNA.)
DETACHED STRUCTURES:
U ZU ROCKER
FENS/TREELLISES:
0 Y I
U WINDOWS / PROJECTING MODULATION:
S T S
TAIRS DECKS:
PARKING: Required: 2- Actual:
LOT AREA: 1'3, ?Qi4-
LOT CO RAGEV. , ' 3SZ-,, 141
Calculations: IL/LgX
BUILDING HEIGHT:
Datum Poly
Maximum
Datum Elevation: -4- 1690
-ActualHeight: 23-F712-5.7S;"
A.D.U. CREATEQ?,-(No —/Yes)
SUBDIVISION:
LEGAL NONCONFORMING LAND'USE DETERMINATION ISSUED: measljoo
OTHER:
Plan Review By.
NewBPPIanningDataForm.D0C
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PL MUmd Harris
18709 92nd Ave. West
Edmonds. WA 98020
425-774-4178
.APN: 434SWO03707
hLLIF F I L
A
4 141�w T
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r-41
D 44 P.
.----,�PPROVED
AS
FOTED
BY ENGINEER11
jj,�D
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U-1
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a.
PrloAle-- Dt-,,),e— I C to 4.1— /00�
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WOMCalm: RECEIVED
+102
+102 FEB - 9 2004
:+102
+103
re. Grade = +1 022?ERMIT COUNTER
Aual = +125.75
Wmum = 027.25
roposed addition meets ex roof llne)
endow surface Caks*
Roof Outline: (constr. 1986) 1,820 st
Drivewdy- (constr. 1986) 1,890 sf
Patio: (constr. 1986) 154 ef
Dedc (constr. 1992) 350 sf
posed AdMw. 172 sf
il Lot Coverage: 4,386
Area: 13,881
Slope: 2%
31
0 0
ZONE Fa�
SETBACKS:
FRONT —
SIDE 1,01, of
REAR —
OTHER
HEIGHT
CA File No: i-
Critid.al Areas Checklist
/to
Site Information (soil� ppgra-ohy/hydrology/veget-a-tion),
1. Site Address/ Location: 4ur—, Wq__J_ - 662 0
2. -Prop . e 1570*7 L43W Obo 0_3_1 0-1 0
,4y!TaxAccount Number: �:,Vt)(1114tgc>000,
cres or square feet):
3.:., Ap'pr size (a''!
4. Is thi& site currently.developed? !!!�Yes; no.
wis
If y6slj�o ` gitedevdopoa� "-.,g U
.5. Describe -the, general sit�, tbpography�'Check, all that apply.
Flat-.' 'less than 5-feet,eleyation �hange over entire site.
Rolling: s�ppe rally e -feet over a horizontal
p..,on site gene less Ahan, 15 % (a v rtical rise of 10
distance.6f 66-feet)..
slopes- p , rpspr I kt Ion, -site of more than 15% and -less than 30% (a vertical rise of - 10-feet
riz
6v4r'*ho, onWdistanc66f'33to664eet).
Steep: grades � of, greatier.;than , 30% present on site (a vertical rise of 10-feet over a horizontal
:: �J distance of less Ithan,33-feet).
Other (please describe):
6. Site'cofiWns.,ireas of y6ar-roundsianding'w'at�i:�, Approx Depth:
Approx. Depth:
7. Site contains areas of seasonal star�d�ngwater:
What season(s) of, the year?,
8. Site is in the floodway dp"ia�m"' of a water courie.
9. Site;'co tains, acr6ek 60 an -area where*a—ter-.*flows I across- thd gTour�ds surface? Flows are year-round?
10 Flows are seasonal? (What time of year?
10. Site Is" primarily: forested'-'.* d shrubs mixed
mea ow�
urban lkndkaped'(lawn,, s'hiub6-�tc)
11. Obvious wetlaind is,16resent on -site:
�,A For;C ity-Staff-Use, Only
Plir�d�kk Nui�&r,' applicM0.
41
2. Site is Z6ne&
3. SCS mapped soil "(s)?
4. Critical Areas. inV;entory or C.A. map indicates Critical Area on'site?
5. Sitewithindesi ated earth subsidence landslide hazard 4-rea? �-!�o+
gn _,3 c4
4 7
DET ERMINATION
_STUDY,� UIRED WAIVER
C)
Critical Areas Checklist.doc/4.22.2003
City of Edmonds....,
Development Se m.-ces Department
sio
Planning Divi
Phone: 425%.7.71.0220
_4
�Fax`��"425�'771,012'1
0
.Q-1,tq,R.ecei1ved:
jb �;,, -
ity Rebeipt M 07 13 311- Y's
�c;r,iti'-bal,A,r,e*as't'h"O"c�k7l';Id"t�F6e:—": 'f$13 do'
,,006 -Mailied, to Appil''
T
The Critical Areas Checklist contained -on.,this form
-is-to A - property! owner,' or rhis/hei*-,* authorized � representative,
4
be filled out by any person preparing 4, -D . Fl�pment._ )-must 411,ou. . checkli.,
qv t. thq sign, ind�,daie it and submit it
f �t,
Il� C hec'idist, make a
Permit Application for the City 'Q,f Edmonds prior to to'di6'-City.' e ity will rivi6w'.th6'c
his/her submittal of the application to the Ci . ty. precursory site and.'mitke-.a'determinati
iination - of the
I
The purpose of the Checklist is to enable Qity...�staffto,, subsequent steps necessary to complete a deyel�pment
deterniine, whether any potential Critical Ar . eaq gTe,.. or f Ap,pli6ation'
ma� be','pr e*senf on -66 subject 'Orb0i�.- The ild6rniatioli,"W'l V16ase submit a- vicinit niAp, al
y ong with the signed- copy
needed to. complete the Checklist should be easily of this form to asMk City staff n' finding and locating the
c
available. from observations- of the site or data available at, t: specific piece of p rty., described. on this iorm. In
rope
City Hall (Critical areas inventories, maps, or soil addition, the applicant shall include other' Ip&tinent
surveys). information' (e.g. site 'pl�n, topography map,1 etc.) or
7: studies'in7 co fijunctionwith!this Checklist t6 assistant staff
in pompldting.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 E.d6o-nds harmless from, any, and all damages, including,, reasonable
attorney's fees, anising from any action or infraction 6as-ed m"wh'ole or part upon :ta'lse,"rrusl'eading',"il."n'accurate. or
incomplete information furnishedby the applicant, hi"idifs.ageritkir employ'ee&
By my signature, I certify that the information and Aexhibi herewith submitted are true and -correct -to the best of my
I
ic tio If
knowledge and that I am authorized to file this a icati
pplicati the behalf of the owner as listed -below.
0104 SIGNATURE OF APPLIcANT/AGENT 7A DATE L
Property Owner's Authorization
By my signature, I cer* that I have authorized the. above ApplicanVAgent to. apply for the subject land use application,
and grant my permission for the public officials arld.the I staff Of the City of Edin6nds to enter the subje'ct
purposes of ins X s,application. property for the
,pection and posting Attendant
SIGNATURE OF OWNER
DATE — /4 0 Lw
Name
/87C)i
Street. ddress WA q50AZ)
city State zip
Naine
Street.Address
city State zip
Telephone: 41,* 5"- '/ -7 4117 'S Telephone:
Email address (optional): ft4 ErnaffAddress (optional):
Critical Areas Checklist.doe/4.22.2003
mC Ity Of
IDevelOpment SeAri!-ces"D4xt'rtm_6iij
Planning Division:,11
Phone: 425,37 L0229
Y :�'�'��-425-37f,02!f
ak-
2 -V
�cit X1�3
x-Robeipt 0:
",as * -F116*1-1
7.
.qp A66816 'Ohod'
�,',1Jqt"Feie." $135,00-
The Critical Areas Checklist contained. on,this form,is,,to representative,
be filled out by any person preparing a,-Pqvplopmept, Jm1W fillout the-checklist,,sigix
in�idate it, and submit it
city th6-C'
Permit Application for the 0 ' f ]��moiids,pr-or t� to' *� "ity." � Tie- City will't6viiVthechecklist make 'a
his/her submittal of the application to the City. -visit �aAdt:mak6�� a:detaminati6n of- the
precursory site,
The purpose'of the Checklist is to enable:C to, s�bsecluent steps necessary,, to complete a . devel�
ity. Atat 'pment
application.
determine whether any..potential Critical Areas am or
may be, present on the subject property. The inf Pie- aiisie submit a vicinit
on , y mapq along with the signed copy
needed to: complete the Checklist should be easily of this form : assi'::.
to staty'i�.iwfinding and I the
ocating
available. from observations -of the.site or data -available at: sp ific piece of pro .,described. on this form ' in
qpi
i . . I. I . . _ pqrty
City Hall (Critical areas inventories, maps, or, so.il a4dition, the. #pplJqant, shall include other peitinent
surveys). inf6rmition (e� g. si plan, topography map, etc.) or
studie'sin, corijuriction withAhis Checklist t6 assistant staff
in compl6tingtheir preliminary assessment of the site.
The undersigned applicant, and his/her/ - its heirs, and wigns,.in.consideration on.the processing�of the application agrees
to release, indemnify, defend and hold the City of Ediponds harmless from� any, and a4 damages, ihc1udipg,,.reasonabl
e
attorney's fees, arising from any action or inftactiofi based in whole or part upon false, misleading, inaccurate. or
incomplete information furnished by the applicant his/her/its.agents & employee&
By my signature, I catify,that the information and AexMibi _h7ere�w�ithsubmitted are true and correct to the best. of my
�ati C
knowledge and that I am authorized to. file this applica.ti the behalf of the owner. as listed -below,
SiGNATuRE oF APPLicANT/AGENT 77T DATE //J. 0 /0
Property Owner's Authorization
By my signature, I cer* that I have authorized the. above Applicant(Agent to. apply for the subject land use;application,
and grant my permission for the public officials aqdJhe . staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant s application.
SIGNATURE OF OWNER. DATE
Owner/Appflcgt: j Applican; 4epresentadve:
'0
.o
K /A
Name Name
7 c) q1W1 kviL
Stred A
t ddress Street Address
WA
city State Zip City State zip
Telephone: 41.1 -4117 Telephone:
Email address (optiong): ft. k, Email Address (optional):
Critical Areas Checklistdoc/4.22.2003
n 16.6.1 Areas Checklist
Site Inforinatiow. (soils/ to'pq&;��F;q�:p�p4-y" hydrology/vegetation).
-4-1 A. OW.
1. Site Address/Location:
2. -Proppr
,tyTax,AccountNutnber-. -)-tob, I,
;q(010,b0n 701
3.:';: Appiid�eSi Size (acres: or-squamfe�t)-'
CA File No:
4.. Is this,site currently.developed? Zyes; no.
ope' ?
s',�.ho*iisli'Mt6devel d
If yie AJ: �Ia
t
5. Describethe.; general site tbpography..Check; all that apply.
F t: ess �-feet tion than over entire site.
M ge
Rolling* site,:
'40p oh '. generally less than: 15% (a vertical rise of 10-feet,over a horizontal
of
disZce ,66-feet).
I preseRt. site of
Hill s opep
.Y: on more than 15% and less than 30% (a vertical rise of 10-feet
over.'a hon-i6fifid, disiance biM to 661-feet).
Steep: grades 1!6f. greater -than 30% present on site (a vertical rise of 10-feet over a horizontal
distance of less� ihan,33-feet).
Other (please describe):
6. Site contains are" of year-round standing*i�iabey. Approx. Depth:
7. Site contains areas of seasonal ter: Approx. Depth..
What season(s) of Ahe year?
8. Site is in the floodway o a water course.
e grourids surface? Flows
th are year-round
9.* Site: taifis a.creek or' anarea where wifer:.flows qcrossl ?
ZT10 Flows are seasonal? (What time of year?
10. :Sitel s- primarily:: forested meado'w'., shrul-#6 n-dxed
!(laivriAiubs�, e*k)
ukbao
11 Oh-tAnive urptlaind iq trirpspnt nn -qitp-
or;C-it -StaffUse
y
iA
t
I Planitfikk N if affi ibld
2. Site i6 Zoned?
3. SCSmapped so�"�. -Lid .:C.
4. Critical Areas inventory or CA. map indicates Critical Area on site? er-� S2 -L
S. Site wifi-dn des4gnated earth subsidence. laridsfide hazard'area? 0,z�+
DETERMINATION
STUDY
UIRED WAIVER
7
ikevie-.-;e d Date. tk
Critical Areas Clieddist.doc/4.221003
U.
LLI
LLI
cl:
00
CD
CITY of E DIV16i DS S#E SEWER PERMIT
For Inspection Call 771-3202 9 PERMIT NO. 07592
UU
EDMONDS
TREATMENT PLANT
Address of Construction: A,( W F,
Property Legal Description (Include all easements):
,� �) —r / , f— —/ 3 — J�6 '
Owner and/or Builder:
Contractor & License No:
Single Family Residence
Multi -Family
Ll_�
(No-. of Units
4z), rh &--s / N Q_"
�, 14 T A�— / -7
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No 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 required,
attach legal description and county easement number.)
YPIE"�-�LSEREAD TH S STED ON THE BACK
�PM
I certify that I have read and shall comply
with the items listed on the back.
Pe�mit.Fee: -3060 Issued By:
_Z C)
Trunk Charge: —0- �0_ Date Issued:
Assessment Fee: Receipt No.:. (,c)54
16 _j -; 7_?�
.Date
Partial Inspection:
Comments Date Initial
Final Inspection Approved: IS-87
Date Initial
Rejected:
Reason Date InitiaT.
PERMIT MUST BE POSTED ON JOB SITE
White Copy File Green Copy Inspector Buff Copy Applicant
9
NOTICE:
-ra. nty ... 0 t a-'- c a-u- -r..*
N 0---W*a r
The -information on the attached
map(s) Was cOmpiled for use by the CitY Of
Edmonds� its Employees and Consultants.
Th,.e City of.Ecim.onds does. not . warrant the
n these
accuracy of anything set for ' th o
m a p (�-). A n . y person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform-ation shown- or
-rnap(s), including, but not limited to,
t
the lotation of any sewer stub shown. Suct
sewer stubs may or may not e.xist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
empjo-yee-s o-r officers -shal] be 1-Ja-b-11--e for the
this map(5), nor for
information g ven on
any one representation provided based
upon said Map(s).
Tho ifw #4 FAmnnAc
Side Sewer Drawing
EASEMENT NO. --- ------------- ----------- --------
NEW CONSTRUCTION REPAIRS LID NO. ]51 ------- - AS?,ff. NO - ----------------
OWNER 14OM—E..'e� ------- 1-Ism, ------------------------- CONTRACTOR --LU-77 - ----- -BF-,r,--KA0c ------------ ---------------- PERMIT NO.7-5-9,2..
WD EDMONDS
JOB ADDRESS 11870-9 ------------ u - ------ Avs---w --------- LEGAL DESCRIPTION: LOT NO. ---1 ------ --------- %-M-BG BLOCK NO. TREATMENT- PLANT]
------------------------------------------------------------------- ---------------------------------------------------------------------------- -----------------
PWW-0001 -11/75 (REV. 11/78)
NAME OF ADDITION ------------------------ ------
18709 15z"DA11E.W.
ss'ap.
C.O. IT.Pop
.,_rr-%LsrtmG G"A.C.— — —
53 0
. ............... ss,
— — --=C-- --0,
4b�op. -)
V,-44r%-j3E pu.
Approved:
DATE B,
1114-
3
a
10
Ul
OT PL/? A/
14.0 M E LP A/.D /-/0 AA E 5 AJ C.
221 LIPME6 5T. 6U17-E.100.
IL 0 -r
1AJ AJAI�lzl OF SECT10AI 16,77.10-7
AJ, ) ;�? - .4' E -) 1,V A4.
,EDII,40AIZ)j
�-B-7 0 1
s nr. T
6, -1: - L I- , -c7,; F
PURC "A? 15 E;F
-IBCXLIST
C= REVIEW.,Cl
RW AD"D f 770 Al2 Ax'141
PRaJECT NAME P, ECT RESS:
hoDT.Tt'hq'-Tr*j
Z11
Reviewed by: (inkt�date)
COMtvfEM
PLANNING
wrR/SWR STREET ENGNRNG
FIRE:
TUILDING.
11711111
SnCEZ FAMnY/MULTIPLE/COR-ff=TAL'- (Circle,One)
SETBACKS CHECKED - Planning
77-777777
77-77777777
VARIANCE/SETRACK ADJ. %ijauc-
CONDITIONAL USE PERMIT
-2
71-1111-111
.
ADB RBQUIREMEM CHECKED
/////////
3
177777777
TI-71-111111
OTHM ZONING REQUIREMENTS
4
ENVIRONMENTAL FEATURES
5
ACCESS SLOPF & VEHICLE ACCESS
111111777
////////
6
77777777
DRAINACE PLAN (On Site)
.7
777711
////////T7/777////
77TIFIll
STREET FILE
8
g/77777T7T77777
//T///7T
LEGAL DESCRIPTICN VFRIFICATION,
_727
9
VJ
I 11171711
T 777TIT
777_77
1
CXJIT CLAIM/DEDICATIONS � . -,e
J��l
//////
/////////
/////////
////////
10
_)�p
A4t41^0'1 . dot".
.
EASEMENT - PUBLIC/Pf(IVATE.A4)`/"
CALCULATE SEWER CaNNECTION IF NO LID#
777777T/7777/7777
/////////
////////
12
777777
111111117
T_
PLAT/SUBDIVISICN REQUIREMENTS
13
RIGHT OF -WAY CONSTRUCTION'PERMIT:_REQD
7=
7TITRT17
7T/T/77T
14
POND R�D FOR PUBLIC IMPRO'VEMENTS:;:�
15
SOILS. CONDITIONS & GROUND
77777777T
WATER,FIELD CUECKED
/W/U/
16
11111T
STREET PAyING REQuiRED
17
117771,111111111
V
CURB AND GtR`TER REQUIRED
18
777777777
V
SIDEWALK REXIRED
19
7 7 -/T/—/
_7 TF1 T/ T1 T
7717 7 T/7
T777/
CURB.* CUr FOR DRIVEWAY REQD
20
/F/T/T/7777/77F/7
SITtEET NAME SIGN REQD
21
fER'SIGNING RE(_)D
1 T/77
7771
22
—
SIDE -SEWER AVAILABILITY
77711111
23
EXISTING WATER MAIN SIZE'-
11171177777////
//////
/////////
# '5TI1111111
—
24
__...777,2�
77
— —
11711TIll
777777////
�ATER N2TER -SIZE . .
25
SERVICE LINE SIZE
7777777//
V
1117777T
26
HYDRANT'REOUIRED
111111117
T1777777T
27
fTTTIT
111TR
HYDRWP SIZE EXISTING -
28
—
ITFITITIT
TITITITI-77
CROSS )D
CONNECTION INSPECTION REC
29
///W
'o-o
VVffER METER Cf1hRGE REQD
30
/////T/T7T/77-///7/
FIRE LINE CHARGE REQD SPRINKLER'
31
STREET CUT
Imll
1
32
OPEN DITCH EXISTING
lu
33
7TT17
77T/777/7
V
REOD
_77777-7777
34
—��--T/7-7/7
CULVERT REr_]D
35
777T//77T7////////
SIZE
36
CATCH RAS IN RE)QD
7 TITI 7
7 Tf FfFR T
7 7 71 T/7 T
37
7 7 TFIT
7TTFITI IT
7 T1 1/ 7 ITI
INDICATED ON SITE PLAN
//////
/////////
/////////
38
SHOULDER DRAINAGE MAINTAIN
IITF17
IITF11117TIT11-1111
SHALE OPEN RUNOFF
39
117FIR7
MISC;
40
1�
m
IEWED BY:
PLANNING MGR. ENGINEERING MGP,.
7
CITY OF EDMONDS ZONE
io
CONSTRUCTION PERMIT APPLICATION joe
INAME (OR NAME OF BUSINESS) PADDRESS
NAME
DEST
ADDRESS
3:
0 903-
cr
CITY
k
TNAME
_IADDRESS
CITY
Edmonds
ETATE LICENSE NUMBER
HO ME LHI *174KE
Legal Description of Property -
(show below or attach four copi
PERMIT
NUMBER MW -
LLUAL UtbUNII-I ION CHECKI SUBDIVISION NO. LID NO.
lor e / 1 5- / 3 -,�& 1 15-1
TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING -6-0— REQUIRED DEDICATION D_
77 5-2033 PROPOSED e-'
-670—
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED [I
STREET USE PERMIT REQUIRED 01
SEE ENGINEERING MEMO DATED
FELEPHONE NUMBER
REMARKS
'7 /A 91 - A 9) A C) I f / /
METER SIZE IBUILDING SUPPLY SIZE
TELEPHONE NUMBER
775-2033
I SIGN AREA I ENV. REVIEW
ude all easements I ALLOWED i PROPOSED COMPLETE i EXEMPT
cr
u Lot 1, Short Plat S-13-86
Lo
W
< City of Edmonds
0
W
_1 I
FLI NEW
Ed RESIDENTIAL
1:1 PLUMBING
ADD/ALTER
1:1 COMMERCIAL
E] MECHANICAL
REPAIR
RETAINING WALL
SIGN
EXCAVATE
FENCE
DEMOLISH
OR FILL
I— X_ FT)
PRE -MOVE INSPJ
swim
REMODEL
COMPLIANCE INSP.
POOL
F WOOD STOVE/ [_1
INSERT
APT.BLDG
El RENEWAL
3) NUMBER OF STORIES NUMBEROF
W
0 DWELLING
ca Two [UNITS 0 n I-
9 NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) I
VARIANCE OR CU IPLANNING REVIEW BY
C)
Uj
Z
0
Z
LU
UNITS
a:
w
ADB NO.
SHORELINE#
I DATE. -
YARDS - I i I I HEIGHT LOT COVE
__7
FRON;��_ SIDE �(:�) I
CHECKED BY I TYPE OF CONSTRUCTION I CODE
HEIGHT
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
1:1 YES 0 NO I I I I
PLAN CHECK FEE
ri IA1 P 1 1 i In g
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
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
w successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
m employees, and agents from any and all claims for damages of
(r
< whatever nature, arising directly or indirectly from the issuance
Z of this permit. Issuance of this permit shall not be deemed to
a modify, waive or reduce any requirement of any city ordinance
0
:r nor limit in any way the City's ability to enforce any ordinance
provision."
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz-
ed thereby, no person will be employed In violation of the Labor
THIS PERMIT
AUTHORIZES
ONLY �HE
Code of the State of Wash' ton relating to Workmen's Compensa-
WORK NOTED
lion Insurance.
SIGNATURE 15 A OR AG T) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
ATTENTION
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
-1,z- 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 DArE
1�
RELEASED BY: D1
410,
ORIGINAL — File YELLOW
PINK — Owner GOLD — S0990t
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MEMO TO: Building Division
FROM: Engineering Division
SUBJECT: �z ��n e/ Ae 4h-sr
After review of the subject building permit application, we have the
following comments:
1) Connection to City water system required.
2) Connection to City sanitary sewer system required.
3) Right-of-way permit required for any work on City property.
4) Driveway slope not to 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 containing all temporary runoff and
erosion on site and may not impact neighboring 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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AUG 19 `92 17:08 7HE PAPER COMPANY 206 441 8468
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FILE
CITY OF EDMONDS
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250 - STH AVE. N, P EDMONDS, WA 98020 -1 (204) 771-0220 4 FAX (206) 771-0221
COMMUNITY GURVIC96 DEPARTMENT
Public Works 9 Plannina a Parks and Recreation * EngineerlAq
August 18, 1992.
Dear Resident, (
P. 1/1
LAURA M, HALL
MAYOR
The backfiow prevention device In yourwater supply system Is due for
annual testing as required'by State Code WAC 248-54-285. Please have
the testing perfomed by a person holding a certificate of competency
as cross connection specialist, issued by the State Department of
Social and Health 5ervices. Enclosed is a list of certified testers
which you may contact.
If a device fails it's test, please have the necessary repairs made.
Upon completion of a, satisfactory test, �ave the certified tester fill
out the enclosed Test and Maintenance Report and return it to this
office within thirty days.
Additional information relative to this matter may be obtained by
contacting our Cross Connection Control Specialist at 771-0235,
extension 349 or 347.
Wwely
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Water Leadparson
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Enclosures e'7 0 9 17-21 �j
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OKFL/LT1/TXTWATER
0 Incorporated August 11, 1890 0
Sister Cities International — Hakinan, Japan
CITY OF EDMONDS
ERe"NEW
ADDITION
RETIREMENT
ASSET INFORMATION SHEET
KhEff RLE ASSET NO. 51 -7z-,
ADDITION TO ASSET NO.
DESCRIPTION
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SERIAL NO.
LOCATION
DE2�. NO
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PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
B.A. R. S. ACCOUNT NO.
ESTIMATED LIFE
INITIATED BY
DATE
PROJECT NUMBER
PROJECT COMPLETION DATE
COST
APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
XIDEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
0 G.L. ENTR
REFERENCE DATE
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PROCESSE[
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2" MIN. COMPT Or-PTH CLASS'B'
ASPHALTIC COWCRGTJ� oVEF;Z
21, MIM. COMPT DEPTH CRUSHED
I . ALL CONSTRUCTION SHALL BE IN ACCORDANCE WITH CITY OF EDMONDS SPEC'IFICAT IONS.
2, ALL SEDIMENTATION/EROSION FACILITIES MUST BE IN OPERATION'41OR TO CLEARING
AND BUILDING CONSTRUCTION, AND THEY MUST BE SATISFACTORILY MAINTAINED UNTIL
CONSTRUCTION 15 COMPLETED AND THE POTENTIAL FOR ONSITE.'ROSION HAS PASSED.
3. ALL STORMSEWER PIPE SHALLBE CONCRETE, NONTREINFORCED ASTM C-14, OR
CORRUGATED METAL 16 GA. GALVANIZED AND ASPHALT COATED TeREATMENT I OR BETTER,
OR CORRUGATED ALUMINUM PIPE, 16 GA., ASPHALT COATED TREATMENT I OR BETTER.
(SEE RESTRICTORDETAIL FOR DETENTION PIPE),
4. GALVANIZED STEEL PIPE UTILIZED AS DETENTION FACILITIES SHALL HAVE ASPHALT
TREATMENT #1 OR BETTER INSIDE AND OUTSIDE.
5. GRASS SEEDING WILL BE DONE USING AN APPROVED TYPE HYDRO-S5EDER, OR AS OTHER-
WISE APPROVED BY CITY OF EDMONDS,
6. ALL PIPE SHALL BE LAID ON A PROPERLY PREPARED FOJft4bATION ACCORDING TO
WASHINGTON STATE SPEC. 7-02.3(l). THIS SHALL INCLU6E NECESSARY LEVELING
OF THE TRENCH BOTTOM OR THE TOP OF THE FOUNDATION 14ATERIAL AS WELL AS PLACE-
MENT AND COMPACTION Or REQUIRED BEDDING MATERIAL TO UNIFORMGRADE SO THAT
THE ENTIRE LENGTH OF THE PIPE WILL BE SUPPORTED'ON A UNIFORMLY DENSE UN-
YIELDING BASE. IF THE NATIVE MATERIAL IN THE BOTTOM,OF THE TRENCH MEETS
THE REQUIREMENTS FOR "GRAVEL BACKFILL FOR PIPE BEDDING", THE FIRST �IFT OF
PIPE BEDDING MAY BE OMITTED PROVIDED'THE MATERIAL IN THE BOTTOM OF THE
TRENCH IS LOOSENED, REGRADED AND COMPACTED TO FORM A DENSE UNYIELDING BASE.
7. ALL BUILDING DOWNSPOUTS It' I SHALL BE CONNECTED'TO THE STORM
DRAINAGE SYSTEM, UNLESS OIHERWI�E APPROVED BY THE CITY OF EDMONDS.
8. THE STORM DRAINAGESYSTEM SHALL BE CONSTRUCTED ACCORDING TO THE APPROVED
PLANS WHICH ARE ON FILE AT THE CITY OF EDMONDS. ANY DEVIATION FROM THE
APPROVED PLANS WILL REQUIRE WRITTEN APPROVAL'FROM THE PROPER AGENCY,' -CUR-
RENTLY THE CITY OF EDMONDS ENGINEERING DEPARTMENT.
9. A COPY OF THESE APPROVED PLANS MUST BE ON THE JOB SITE WHENEVER CONSTRUCTION
IS IN PROGRESS.
10. ROOF DRAIN STUBS ON EACH LOT SHALL BE MARKED WITH A 2",4" LOCATED AT TIiE
END WITH PORTION ABOVE GROUND PAINTED BLACK WITH WHITE LETTERS LABELED
"ROOF DRAIN" WI TH DEPTH .
11. LOCATIONS OF EXISTING UTILITIES AND IMPROVEMENTS SHOWN ARE APPROXIMATE
ONLY AND IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO DETERMINE
THE EXACT LOCATION(S) OF ALL UTILITIES AND IMPROVEMENTS TO AVOID DAMAGE
OR DISTURBANCE.
WATF-R UOTES
1. ALL CONNECTIONS TO EXISTING WATERMAINS TO BE ACCOMPLISHED BY THE CITY OF
EDMONDS WATER DEPARTMENT. ALL NECESSARY EXCAVATION, BACK -FILL AND MATERIALS
TO BE SUPPLIED BY THE CONTRACTOR AND BE ON SITE PRIOR TO NOTIFICATION TO
WATER DEPARTMENT TO SCHEDULE CONNECTIONS.
2, SERVICE REQUIREMENTS TO BE ARRANGED FOR PRIOR TO START OF CONSTRUCTION THROUGH
WATER DEPARTMENT CUSTOMER SERVICE SECTION (TEL.: 775-2525).
3, CONTRACTOR SHALL NOTIFY OWNERS OF ALL AFFECTED UNDERGROUND UTILITIES FOR FIELD
LOCATING THEIR FACILITIES, THE ONE CALL LOCATION NUMBER IS 1-800-424-5555.
4. POSSIBILITY OF EXCESSIVE PRESSURE DOES EXIST. PRESSURE REDUCER SHOULD BE
INSTALLED IN EACH HOUSE.
SAUTAIZY SEWER WOTES
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