19106 88TH AVE W.PDF111111111111
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19106 88TH AVE W
_ATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWRER NAMEINAME 01 BUSINESS
At
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1106 6`9 IV 4t,-e 41,,�Iy
CITY ZIP TELEPHONE
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NAME . . If
CITY ZIP TELEPHONE
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ADDRESS
CITY
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STATE LICENSE NUMBER
EXPIRATION IATE
911 .1 ECKED BY
IROPERTY TAX ACCOUNT PARCEL NO.
q ) z — 0, —,901-0006
HEW
TIAL
0 PLUMBING I MECH
AUDITION
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0 COMPLIANCE OR
CHANGE OF USE
REMODEL
C3 SIGN
REPAIR
0 GRADING FENCE
CYDS
( X FT)
DEMOLISH
0 TANK
OTHER 2w-rL
CAFRIPW'IT
0 GA AG
11TANIN1 ILL
R.0 E, Y C] RENEWAL
(TYPE OF USE BUSINE�S OR ACTIVITY) EXPLAIN
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N MBER
OF
NUMBE F OF
DWELLING
CRITICAL
A 'EAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE ke PA 1*1- 4- It,, ellb �r c
h e.41 2eek (2-
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,:FPERMIT EXPIRES �42*,Ql
USE
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0
PERMIT
NUMBER
JOB
t SUITE/APT.
ADDRESS
P P LAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
Te.1 Ap 0
" P R".v" 0
EXISTING --7— PROPOSED—
S"'t Us- 0 0
1 0
Sol-alk Rls— 0
REQUIRED DEDICATION—
FT
U..,...
Wifinse—d E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
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YES C3 NO 0
REMARKS
5
OWNERACONTRACTOR RESPONSIBLE FOR EROSION CONTROL/ORAINAGE
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ENGINEERING REVIEWEDIDATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADBO INSPECTION a NO
_REO 'D POSTED
SERA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
_X 4- 1 / i7xi
P
t
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE FEAR FRONT IJRSI�E REAR
PARKING LOT AREA
D I PROVIDED _,��D BY /,�ATE
F CON CODE OCCUPANT
.rl -7 GRO P
,ARIA OCCUPANT
REQUIRED LOAD
YES
3EMARKS
-ROGRESS INSPECTIONS PER _UBC 108(FINAL INSPECTION
VALUATION FEE
PLAN CHECK FEE
HEAT SOURCE
_rj
LOT Sq.P7j�y
BUILDING
PLAN CHECK NO:
IVESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
GRADING/FILL
t B
DEDONEONPRIVAT PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATI N: 180 DAYS
PERMIT LIMIT, 1 YEAR - PROVIDED WORK IS STARTED WITHIN 1$0 DAYS
ENO. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APP ICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2� E MONDS. WASHINGTON ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
==e_L;1,W_(r1&,f774i,11e
;Z77) -
I ALDL CLAIMS FOR DAi OF WHATEVER NATURE, ARISING DIFIECTLYOR INDIRECTLY.
IRECEMT,
PLAN CHECK DEPOSIT
.,
I FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMEOTO MODIFY. WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION.'
IRECEIP
TOTAL AMOUNT DUE
Ll,�l
-,17575��
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4
1 HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT 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 13 not a Permit until signed by the
TION: AND,IN D ING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Oficial or hiVhe, Deputy: and Fees ,a paid, and
IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
receipt is ackhmiedged in space pro,idad.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OF SIMNATURE, DATE
1
DATE SGNEO (425)
tIALS
�=NT)
2- "-D
771-0220
RELEASED BY DATE
ATTENTION EXT 333
U
IT IS UNLAWF L TO USE OR OCCUPY A BUILDING OR STRUCTURE
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UNTIL
771-0221
8RI�INAL - FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 F:Ay
PINK -OWNER GOLD - ASSESSOR
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7 ONGWEST P
A S S 0 T E S. I N.C. Date
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CA FILE NO.
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrology/vege.talion)
I Site Address/Location:
11/0�
2. Property Tax Account Number,
3
4.
5.
R
7.
Approximate Site Size (acres or square feet):
Is this site currently developed? yes;
If yes; how is site developed? fi ftde- A
no.
Describe the general site topography. Check all thKt apply.
.9
Flat: .- less than �-feet elevation change over entire site.
Rolling: slope s on site generally less than 15% (a vertical rise of I 0-feet over a
horizontal distance of 66-feet). -12� '- rL elleV, C4,a4)t ot"ie-of" C*7�9-1f,
2 —1T
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 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
Site contains areas of year -round standing water: 460A C Approx. Depth:
Site contains areas of seasonal standing water: )V� /? e— ;Approx. Depth:
What season(s) of the year?
8. Site is in the floodway Yo 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? —A4 (What time of year.?
10. Site is primarily: forested meadow ;shrubs :mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: ED
For CityStaff Use Only -------- — --- — ------------- -- -- — - — ----------------
i. Site is Zo'
I ned! CS- lez-
2. SCS rn a . ppe . dsoiltype(s)? 7,
3.. Weiland inventory . or C.A. mAo indicates. wetland present on site?
:4. Critical Areas inventory or C.A. map indicates Critical Area on site?
:5. within designated earth subsidence landslide ha- d area'?
V,
Site -,desiRnaied,:o.n.-the: Environmentally Sensitive Areas Map?�..
b9TEIRMINATION
Ao_chk.doc; Rev 10103/97
City of Edmonds
'TW 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
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 ihe
City. The City will review the checklist, make a
.precursory site visit, and make a detem-iinition 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 m-ation (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:
P a- eh -
Name
)1al 14M-4
Street Address
r4#, 0 h I/ IV A qrda
city State Zip
f) J6/
T
Signature
712 7/4Z d-11
Date
Applicant Representative:
;`7 C1
Name
Street Address
city State - Zip
Telephone
Signature
Date
(over)
creceptionVana\cad.doc
-A,
City of Edmonds
�,00� RIGHT-OF-WAY CONSTRUCTION
/17 C.
,S9C
PERMIT Permit Numbe,.Ct
31z
L-sue Date:
Z
A. Address or Vicinity of Construction: MP4 99-S164 ve, 1J.
B. Type of Work (be specific): Zg!� j.1 e e-i Aj vl
/K krjyc
C. Contractor: I& P. dd*f 06t 4a JAt4 Ail h e
Contact: Id Z/
Mailing Address/p ,P_ ffoy Y?9 Phone: _?/z e
State License#: P Liability Insurance: Bond: $Z
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): &/2
E. El Commercial E] Subdivision El City Project E] Utility (PUD, GTE, WNG, CABLE, WATER)
0 Multi -Family )1�1 Single Family Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut 0 Yes tro'No G. Size of Cu�A, x H. Chargq�,$
APPLICANT TO REAf)NAND SIGN_-,�' U
N111., * .1
INDEMNITY: Applicant understands and by his signature to this application to hold the City ofEdmonds harmlessfrom injuries, damages, or claims �fany
kind or description whatsoever, foreseen or_unforeseen, that may be made against the.Cily of Edmonds, or tiny of its depar(ments.-or
employees, includingornot limitedlo the defense ofany legal proceedings including defense costs and attorney fees hyreason of granting. this permit.
THE CONTRACTOR IS RESPON�JBLE FOR WORKMANSHIP AND MATERIALS FOR APERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TIONAND ACCEPTANCE OF THE WORK ESTIMA TED RESTORATION FEES WILL BE HELD UNM�� THE FINAL STREET PATCH IS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings of proposed work required with permit application.
24 hour notice is required for inspection.- Ple'ase call the Engineering Division, 771-0220.
...,York and material is to be inspected during progress and at completion.
Restoration is�to* be in accordance with City C.6des.
Street shall be kept clean at all times.
TrAffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut trench work shall be patched with asphalt or City approved material prior to the 'end of the working day;
NO EXCEPTIONS.
I have read the above statements an'd understand the permit requirements and the pink copy of the permit will be
available on site at all times . . . purposes.
for inspAction
Signature: Date.,
(Contrtrcto 6r Agen
CAI tAl-DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: 614-
TIME AUTHORIZED: VOID AFTER 30 DAYS
I
SPECIAL CONDITIONS: f,64
r
RIGHT OF WAY FEE: 3D
DISRUPTION FEENUND 1], 1:
RESTORATION FEE:
T OTAL FEE: -
RECEIPT NO.: 10617
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Di� 1997
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CITY OF EDMONDS W W Permit No. 7—&& a
PUBLIC WORKS DEPARTMENT F�LE Issue Date
MET
C
RIGHT - OF - WAY CONSTRUCTION PERMIT STF
A. *Address or vicinity of Construction
19106,191Y4 & 19128 88 Av West.
0 Owner: Washington Natural Gas Co
Name
805 156 AV NE
Mailing Address
Bellevue, Washington 98007
city, S ta te, Zip Code
0 Contractor: Same As Above
Name
Mailing Address
City, State, Zip Code
0 Permit Issued To:
Type of Work to be Done: Install a Main (2")
On Job # 793 266
0 Work in Connection With:
0 Sub or Plat 1?F Single Family
El Comml. / Ind. 0 Apt. Condo.
0 Pavement Cut: El Yes 0 No
State License Number
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any 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 it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this Perm t be available at the job ite for inspection purposes at all times.
I a
Signature:—Vapz�fna V. 4"'J" Date Aug 28, 1979
Owner 0 `r9F
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time AuthdpKed:
Special Conditions:
Ammendments:
id after
Permit Fee:
Security Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimensions
X —
Fa-
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. Dccember 1978
APPLICATION
for
The City of Edmonds a wV, SME SEWER PERNaT
FILMNEW CONSTRUCTION [_1 REPAIRS E]
OWNER ............ ........... �7:-.
---------------------- - ...... ...................
7—
ADDRESS............ ...................... .... ar .. ............. I ........................
BASEMENT No . ....................... ...... ..........
A,
CONTRACTOR .................. ... 4i -e..
. ................................................................ PERMIT No.
...........
LEGAL DESCRIPTION: LOT No . .............. .............................. BLOCK No . ...................... ......
... ............
NAMEOF ADDITION ....... '-'./ ..............................................................................................
� I
APPROVED']
JUL 2 2 1969
Approved:
DATE ....... ................. By ........ .............
......................... ..........
-SEWER Dk pARTMENT
CIV,�C CENTER —WATER
SM RMI
SEWER' PER
T_ Y�
6-1167 V�ben work 3324
for inspection- (NO insPec-
N2
tions Saturday, Sunday or holidays.)
UnviuET FILE
nue West ----------------------------
----------------- ........ - --------------------------- - . ...............
19106'm- 88th Ave ..... ...............................
-------------------------------
ADDRES& --------------- ------------
OR----------------
OWNER------------- ------ Kenne --------------------------- ............
�ii4y �4 19_.§9�' for . ------_------------ days to REPAIR or CONNECT a side sewer
perli-jission is granted ---- ile and governing ordinances-
witil city Sewers in accordance witIl ?,pplication On f
AT . TENTION IS CALLED TO THE FOLJOWING: line. A licensed Side Sewer Contractor must
btain a permit to --truct sewer inside property
NOTE No. I—Tbe.owners of the property may 0 in street area. Do not cover any portion of sewer before it has been inspected.
be employed to construct side sewer 0 and Regulations g6verning side sewers when You get permit.
NOTE No. 2—Obtain full information regarding Ordinance 11.16.03 minimum grade of 2v/0.
NOTE No. 3—Top of side sefwer must have at least 30 inches coverage at property line and 12 inches inside property line;
No bends in grade sharper than 1/s will be permitted. d to original condition. Contractors shall be responsible for
NOTE No. 4--irenebes in street must be water settled and surface of street restore t
failure due to improper work which may develop within one year of comple ion.
e permit, or to do any work on the main sewer or its appur-
NOT'k No. 5—It is unlawful to alter or do any other work than is provided for in th
tenances except to,insert the Pipe into the wye.
NOTICE:
warra - Ty ... o.- -am
N*o---
hown on the attached
The information S he UtY Of
map(s) was compiled fc)r use by t
Edmonds� its Employees and Consultants.
Th.e QtY of 'Ecim.onds does not. wa rra nt the
accuracy of anything set for.th on t, ' hese
Map(�-). Any person or entity,requesting a
copy should conduct an independent
inquiry regarding the infOrm'ation shown on
tF�e -map(s)i including, but not Hmit(-2d to, -h
th . e location of any sew-er stub shown. Suc
sewer stubs may or may, not exist. and may
or may not exist at the location shown.
,--;ty of Edmo-nd-s/ nor its
Neitheir the 11.1 r the
emp*l-o*yee*s o'r offi-ce-rs -sh-a-11.1 be 1-Ja-b-Ife fo
information gjVF-n on this map(s), nor for
any one repr . esentation provided based
upon . said map(s),