19107 94TH AVE W.PDFiiiiiiiiiiii
9192
19107 94TH AVE W
0 , 6,-
TAX ACCOUNT/PARCEL NUM BER:
BUILDING PERMIT (NEW STRUCTURE):,s%on-13�
COVENANTS (RECORDED)
CRITICAL AREAS:A�(,/64 DETERMINATION: E] Conditional Waiver XYS-'tudy Required 0 Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (
PLANNING DATA CHECKLIST DATED:. 1712T*05
SCALED PLOT PLAN DATED: m&6&,f Z,/57
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED -
SIDE SEWER PERMIT(S) #: f-5(1�3
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
LATEMP\DS'l7s\Fonns\Street File Checklist.doc
BUILDIN'G DEPARTM ENT
Applicaot Fill
U
Zsr NUMBER
ONE
0`1 4:3
PERMIT APPLICATION
Imide Haa,y Lines
JOB
ADDRESS
NAME: OF BUSINESS)
0— �Lf,
LEGAL LOT
E NO
EOT A R EfA
SUUDIVIjION NO.
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III I
0
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CTk /aVR-
VARIANCE OR
CONO. USE NO.
ADD NO.
C_
IT
NUM DER
Z
ITELEPHONC
PROPOSED YARDS
SIDE
HEIGHT
EAR
ALLOWABLE
SIGN AREA
1PROPOSED
SIGN AREA
ADDRESS
OTHER
REQUIRE
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CITY
NE NUMBER
PLRE L DATE
0
NAME
'7�
A..A.
ST�CCT
EXISTING STREET RIW60X? FT. -.F.C1 .... .. 1. P
COMP. PLAN ST. R/W T. 0 FT.
U
M
REMARK rJot fo exL
s Drive -gay siopes eed those
K
CITY ELEPHON
A. -7. .
W
rc
" D,,M
indicated on Standa- NO. 103
.Vi 1, .
Z
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-
E NUMBER CITY LICENSE NUMBER
W
ICHECKED By
Legal Description Tf T'r—operty(Show Below or Attach Four C') pies)
STREET ANDjOR UTILI TY CD YES
'14
WORK REO'D �r- 0
UNDERGROUND C3 YES
WIRING REQ'U 0.
Vr*fLC-&L C- T (L--- C 7 b
TYPE CONNZCTION VERIFIED Y
SA4 SEW M-
Ally.
Id
rL 0 M or/ o
Y NUIABE r:
y ,ES PER W
PTic SYSTEM
APPVD BY CITY ENG.
NO
REMARKS
W
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MET �t SERVICE SIZE CLEARANCE Y
W
sf
Real ENTIAL LA.
INEE
FIRE ZONZ TYPE OF CON/r� io /j
TIAL
NON-R.Il.rN SI-11
7 -7
ADO
F� RE
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SPECIAL IDNSPE;CT OCC LOOCAC P A N
OC
REOUIRC G R
W ALL
C YES No
ALTER
E] EXCAVATE FENCE
R FILL X—FT)
H:Z D Y THI _-tITE IS LOCATED, IN THE CITY W
PRE- OVE
F
OFEDMONDS. LOCAL SALES TAX
PWIM
REPAIR
INSPM 0 OL
"LOD z
NUMBER IUIA13ER OF
W ELLING
)NITS
NATURE OF WORK TO BE DONE
VALUATION FEE
z
PROPO D �JSE
PLAN CHECK
2
NO.
PLOT PLAN (INDI C ATE BUILDING SE BACKS,
ABUTTING STREETS)
x
BUILDING
U
Id
PLUMBING 4-0—
00
al
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
I hereby acknowledge that I have read th is application: that the In-
TOTAL AMOUNT DUE
formation given Is correct; and that I am the owner, or the duly a thOr-
lZed agent of the owner. I agree to comply with city and state it'. t'j;u-
on
ATTENTION
APPLICATION APPROVAL
V
lating COOSt—tic, and In doing the work authorited there'll. no ,r
Was itst-
will oe employed in vtointl,.l of th, Labor Code of the State Of III
THIS PCRMIT This application Is not a permit until
relat;ng to Workmen'. Comi,-eation Insuran".
AUTHORIZES signed by the Building Offlc�al or his Dep-
NOTE: Permit Limit One Year (E.C.Pt DE.MOLITIONS which
ONLY THC
uty; and fees are paid, fund receipt is ac
shell be completed In =ty days; MOVED -IN BUILDINGS shall be ,-M-
W ORK NOTED
knowledged in space provided.
pleted In six mcnini.)
INSPECTION
SIGNATURE JOWNER OR AGENT) DATE SIGNED
CEPARTMCNT 0 SIGN T E
C!
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Cleck P`CC
775-25t5 7,6
Th;! Permit COv8r2 work to be don? on private property ONLY.
t Any construction on the public do main (curbs, sidewalks, driveways,
ORIGINAL - File YECLOW -
marquees, etc.) ill recUiVO separate pOrM,SSIOB.
rINK-0-w, GOLD-Avv�so,
STREET Fl
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/N jLtLA
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r A WLY
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of
6 A P A r. P_
I(ORSTAD INVESTMENTS, INC.
WGER D. KORSTAD. PRES.
erRft10107 94th AVE W.
. EDmONDS. WAN= USA
ROM (2DO) 77""
FAX (206) 774-4427 61
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# PLANNING DATAO
REDUCED SITE PLAN PROVIDED?: &No) (_,C4 rff � 7- CM
nj
MAP PAGE:
"_'70t CORNERLOT: FLAG LOT: ()Les
ZONING: 1�5 6 CRITICAL AREAS DETERMINATION #: q p
-*N Study RequiredL�
LlWaiver
L] Conditional Waiver
0-
SEPA DETERMINATION: ewn
Ll Fee
LJ Checklist
L3 APO list w/ notarized form
L] (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft- of Puget Sound or Lake Ballinger)
NJExempt
SETBACKS:
e uire e acks: 0 0: 1 C) street..
W Ll Street:__2m5�,t-eft Side: Rigm S- Rear-j. -Z,571
Actual Setbacks- le S.MP-+ Z 101.24161 Q�)
�Y461�41" S�treet:^O Left Ll
t Vej 4 *3�'Riglvt pa —jan,
Street map checked for additional setback required? (Yes / No NA)
Ll DETACHED STRUCTURES: Warw 6mwyl Dyl bi P I aw\,.
ROCKERIES: tXj&hY)3 f&a1V1*WC3 WMlt) >
L] FENCEsrrRELLISES:
Ll BAY WINDOWS / PROJECTING MODULATION: V1 0"t
STAIRS/ DECKS: I AN\, 4 A
� &X+. Mb 9 2,9; Z 140 2-q
PARKING: Required: 20 Actual:-Nv(, "+ e #40 Box 2'(0 ;S 1-80
a a0 t - ar
LOT AREA: 41 SZ %; 0 1 o - 3 a cre ep p 6 se 5-soy, P to? up 6 ed 2-4o )c I At 2-3
LOT COVERAUL: - Vt -'�o )
Calculations: ~2.0./. 80 + I tP6 a's 0 1 of-
>k BUILDING HEIGHT: I-' cov-e'rgnt tu
Datum Point: Datum Elevation:
Maximum Allowed:
'j5) Actual Height:
A.D.U. CREATED?: &Yes)
SUBDIVISIOWAAMAX)� 5<44
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: (Yes /(No))K x\-e, +oun cl.
Plan Review By: a LdnAz
New13PP1an_ningDataForrn.D0C
STREETOILE, QRLE NO.
Critical Areas Checklist
Site 1nformation (sb-Ils/topograp rology/ etation)
1. Site Addr=/Locatio �6
2. Property Tax Account Number.-
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? es; no.
If yes; how is site developed?7i6z:
5- Describe the general site topogr.Vhy. Check all dw apply.
Flat:* less than 5-feet elevation change over entire site.
Rolling: slopes on AW generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66ted).
I-rdlY-' Slopes Present On site Of more " -15% and less than 30 % ( a vertical rise
of 10-feet over a horizontal diLstanceof 33 to 66-fed).
Steep: grades of gripter 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. Approx- Depth:
7. Site contains areas of seasonal standing water:
Approx. Depth:
VVhat season(s) of the year?
8. Site is in the floodway 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? Y
10. Site is primarily-- forested mead6w shrubs mixed
urban landscaped (lawn,shrubs etc)
11- Obvious wedand is present on site:
Fof>citystaff
tbe,
j*,"_.'�._-:,__::S;i� 'XonSV-, IS
_-A
.=apo- d.s6if-V
po(�)? YIL __Oe SaAA U
V _j
W01401��-ar C-A. thapoindicates wedand-premt an siteT., A/Owdk.
Critical Area on site?
-or-CA��znap indicates 41si
'earth subsid6dce'landslide.hazard-area?
Ve__S*..
6"Q5r_KM
0
City of Edmon&
Critical Areas
Che*cklist
The Critiml JIV= Checklist contained an
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.
T'he purpose of the Checklist is to enable
City staff to determine v4m�her any
potential Critical Areas am or may be
present on the subject -property. Ibe
information needed to complete the
Checklist should be easily available from
observations of the site or data available at
City 11all (Critical Areas inventories. maps,
or soil surveys).
An applicant� or histher representative,
must fill out the checklist, sign and date it,
and submit it to the City. ne 4MW Will
review the cheeldist, mabe a precursory site
visit, �nd make a deternfimfion of the
subsequent steps necessary to complete a
development pennit application -
With a signed copy of this form the
applicant should also submit a';� Map.*
or plot plan for individual lots of the parcel
withenough detail that City staff can find
and identify the subject parcel(s). In
addration, the applicant shall indude
other pertinent information (eg. site
plan. topography pmp,. etc.) or studies in
co!ijunction with tlets Checklist to assist
staff in completing their preliminary
as�sessment of the site.
I have completed the attached Critical Area Checklist and attest tW -the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner I Applicant -
Nam
Applicant Representative:
Name
Strad Addrem
Sigmtuve
Date
DD.
-U24
�.l
2
/90th
Of
Al
0
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r
— — —
". --5
03
5
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PL.
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10
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NOTIC�:
U - I
Theinfor I mation*shown an the attached
piled for use by the City 01
map(s) was com *
Edmonds/ its Empl.oyees and Consultants.
Th,.e City of *Edm.onds does - n ot. warrant the
accuracy of anything set for.th on t. ' hese
M a P (s). A n . V person or entIty -requesting a
copy should onductanindependent
orm-ation shown, c
inquiry regarding the inf'
tHe -rn a P (S) / including, but not J'rn'ted to
t e lotation of any sewer stub shown. SU(
h.
-sewer stubs may or may- not exist and ma�,
or may not exist at the location shown,
,ity of E,.J mon'r.,14s, nor its
Nei-Itheir the %__I i -c e *r s 's h- a i- I b e I.-i a- b-4-e f 0 r -11"rhi
emp.4.0.yee-s O.r off.
infc)rmation given on this map(s), nor for
any O.ne representation provided based
upon*said map(s).
APPLICATION
I A
The.City of Edmonds for EASEMENT NO . ............................................
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS 0 LID NO - ------------------ ASMT. NO ............
OWNER c ---.4 4;; 9 5 - 4 ----------------------------------- CONTRACTOR Wt,-4t-r'F—:Q ------------- �WF---FM21
----------------------------------- PERMIT NO.
JOB ADDRESS - ------ bZ4 rr—= ---- ---- W --- ------------- LEGAL DESCRIPTION: LOT NO - ---------------- --- = ------------------- BLOCK NO . ............ --------------
--------- --------------------------------------------------------------------------------------------------------------------------------------------------------
NAME OF ADDITION -------------------------------------------------
ed:
.... ...... ... .......
APPUCATION
The City of Edmonds for
SIDE SMR PERM EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION Ur' REPAIRS LID NO - ------------------ - ASMT. NO - ------------------
OWNEp
. .............. //,?./ - --------
........ .. - ---- --------------- ---- --- -------------------- CONTRACTOR -------
JOB ADDRESS Zfl-q--2 ------------ .......... '0 ---------------------- ----------- ... PERMIT
W -- ;, 4v
--- ---------- -------- LEGAL DESCRIPTION: LOT NO - --------- ---------------------- BLOCK No.
----------------------------------------- ------------------------------------------------------------------------------------------------------------------------
NAME OF ADDITION
Appro-ed:
DATE-------------------------------------------- BY ----------------------------------------------- Yi7ylK
, i�C
'EDM0ND&'- -SIDE SEWER. PERMIT,''
'WA TER -SEWER DEPARTMENT
STREET FILE.
PERMIT
pal
`ii:.�g Any portion', 84 the constfu"ctfon,�
ii��25245: for side sewer in�cfio.
t
:W Gumspe&ioh� W_Jl 15e 15f6vided-within U houFs- af er requst. �NO SaI., 'Sun.,, or ho-lida.? im�eftidns.)
ADbAkSl�'§ L&A!fto�4 6v c()N!§ty1fjct1ON .......
---------- - -- - ----------- -- --------- ----------------- ---------- .... . . ......... .....................
PROPERTY LEGAL DESCRIPTION.-:__
v ? e
- ------------- -7 ------- - ------ z --------- �A� ............ ...................... - ---------------------- ................ . ..........................................................
---- ------- ; ....... ......
---------- ---------- - -777 - -7--- ----------- _ -- ------- ....................
'NER AND/0R. BUILDiM --------------- . ....................... ........ .......... .
...... ......... .... .. ....... .......... 0T ........ ------------- I --------------------- I
'A:fiAME &A*D1f)R1_�SS ....... --------- ------------------------ - ---------------------- ------------
--A -- - -- ------------ 7 -------- ----------- % --------- ------------------ -
Pern-Assi 6-r� __ -------------- ---------------- ------ ------ j io:16�rfor- rel" aild/or c6nni��tldn bf ra Side
sewer th the city sanitary'gewer
iA _*ith Oi� 4-rdinances.
0�
Al IS QAIL� FOLLOW]Nq�;
p,Tq TMf
NbTt -�6 ip�sjdi p�f�ry iii,6. A lideftsd'side s,.Wir bditra- ct6r ihu I s I t be ernpioy6d,to c - on s ruc
e� otrRyg, q t4i,�jtpe . y-, pj�q opt�i!i e*er�
, I � - ': ' s� .- - , 7
idi �ewer in street -area. Do ff6t d6ver any po;IiRn,of se*er,be,fore it -has Ncidi-inspected' *
"i-way
Nott N6. �.Wii imik 1,&fi6i-rned I �i 9 hjht�o - requires,an nvasion of Right---16f-W&k ticfmit bbtaina.1>16' vifi. the City Engiixe6r's offi6e.
NOTEV& inj side sewers when --you get -petihit.
Nbft No. 4—Toi5 of gideo se�wer must hai�e atleast �o inches �ovemge at proyierty line a6d 12 inclies,ihside property"iine; iminimum g�ade of 2 No bends in',grade
��iirj5jr thLd'%,wi - ll be*pZr�at6d.
Contractdrs shall be rieipohsible for failure due t
NOTE No. 5=-Venchegiffi. street niust be Water iettledL and surface bi itrbet resto ed !to original condition. .0 irriproper
*6rk Wfiich �aajr 4ev6lop within one yeii of c&hpletion.
NOTE No. 6�_-It 'vi6h1awfdl to alte� or d6 any other,w6rk thin. 19 -provided ibr in the p6rhInit, or to do any *ork on the'inain semO:r or its ap rtenances except to in-*
into thi Wye�.
ert iP4
......... ------
bigAPPIk6VED, - E) Mf6 ....... B
:7 7- - r -------------------- 7 --------- ------
y
... . ...... .......... . ... .. . ............................... . ...... ----- -------------- ---- ... ......
APPROVED jUt�6, .....
Rbffi�rk-s 2A . A ... .....
- -- I -- - ---------------- ------ ; ------- .............. . ................... ..... .......... --------------- ......... z --- ...
------------- ....... ..........
........................... ............. ........ ---------- -- - -- ............. ---- - ------------ ------- ------------- - -- -- - ---------------------------------- ........... .
-7-.j,, `C, n
.67 i&ed, By Ow-h6r Ot kiim Perio'inling Constructibri,ftIOA to Re ue9t For I spi�dtion
�7 77i
pies.MUST 13
.,q
lation c n. cted under this perinit
-eby ar instal. 6 stru
....... ----- --- hei qertify that ih6 side sewe
i�60& q ��._4:fn� t �iin`,'! or
pner_ Son A
�n -ti - - In ming Construction)
9
was ifistaUdd-ifi-Adddrdah t al) govelininj�, Ordinances of the City 'of Edmohds.
ILDated this___� - - --- ------- ... (1ay Of -------- ------------------ ........................... m ........
v v Check BEF(M.Eybd dig f6r: Water F
Gas �Telephone E], Po-wer In, Sewer ther
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
Website: www.d.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
tpc. 18(),13
November 3 0, 2004
Barbara Steward
19107 94h Avenue West
Edmonds, Washington 98020
RE: Demolition Perrm't to Remove Un-Permitted Structure
Dear Ms. Steward:
GARY HAAKENSON
MAYOR
The City is prepared to issue your demolition permit to remove the east and west doors and walls and
roof structure of the shop area. This pennit-is requested by you in order to bring the structure 'into
compliance with setbacks. A condition of the issued permit shall be that any 'shop area' remaining
must be permitted with a building permit, within 60 days of demolition (reference item three below
from City letter dated November 2, 2004).
0 Submit a complete application for removing that portion of the structure that encroaches into
the required setback and submit a complete building permit application for that portion of the
structure that will remain with required fees.
In order to obtain a permit for any portion of the remaining structure follow the minimum permit
submittal requirements outlined in our Addittion/Remodel handout already provided to you, If you
have any questions please feel free to contact me during City business hours of 9:00am to noon and
1:00pm to 4:00pm, Monday through Friday, excluding Holidays.
Lastly, demolition permits are only valid for a period of 180 days and cannot be renewed so all
demolition work associated with the shop area must be completed within 180 days of permit issuance.
Sincerely,
Jeannine L. Graf
Building Official
Incorporated August 11, 1890
Sister City - Hekinan, Japan
000.0e.-
I.- I " —.18()13
June 1, 2005
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONbs, WA 98020 - (425) 771-0220 - FAX (425j 771-0221
Website: www.d.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
Barbara Steward
1910794 1h Avenue West
Edmonds, Washington 98020
RE: Demolition Permit #2004-0989
Dear Ms. Steward:
GARY HAAKENSON
MAYOR
Please refer to the enclosed City letter dated November 20, 2004. As you recall, a condition of the
subject permit was that any 'shop area' remaining must be permitted with a building pen -nit within 60
days of demolition. The City Building Inspector confirmed yesterday that portions of the shop area
that encroached into the required setbacks have been removed and are now in compliance with
minimum setback requirements of an RS-12 zone (including a maximum eave encroachment; of 30
inches). You are now required to submit a complete building permit application for all remaim . ng
portions of the shop area by July 15, 2005 (anticipated City review time of 10 business days such that
the permit may be issued by August 1, 2005).
Please be advised, during the inspection yesterday the City Inspector noted that an additional roofed
structure (defined as a carport) was located in the northern comer of your property --in violation of rear
and side yard setbacks. Upon receipt of this information I have researched City records to attempt to
find building permits and setback variance approval but my research has found no City approvals for
this structure. if you have permit records please provide copies to the City as soon as possible. If you
agree that no permits have been issued the following options are available to you:
Make complete application for a variance and building permit. Enclosed are applicable City
handouts that explain what constitutes complete applications. Since it is our understanding that
the work was performed by a previous owner, violation fees 'Will not be assessed but all other
normal pen -nit application fees are required. OR,
Make complete application for a carport building permit showing existing and proposed
setback compliance to property lines (issuance of this type of permit would approve the carport
with complying setback and portions if the structure would have to be removed in order to meet
minimum setback requirements). OR,
e Make complete application for a demolition permit to remove all portions of the illegal carport
work.
Incorporated August 11, 1890
Sister City - Hekinan, Japan
Ms. Steward
June 1, 2005
Page Two
Regarding questions yesterday posed to the Inspector in the field on retaining walls, please find
enclosed the City handout for retaining wall pen -nits. If after reading the handout you have any
questions about retaining wall construction contact a City Engineering Technician. If after readi ng the
handout you have any questions regarding height of retaining walls within setback areas contact a City
Planner. Please be advised even if a building'permit is not required (see permit exempt section within
handout) all retaining walls must be constructed to the adopted City standards.
If you have any questions about yo ' ur permitting requirements for the shop or carport, please feel free
to contact me during City business hours of 9:00arn to noon and 1:00prn to 4:00pm, Monday through
Friday at 425-771-0220 extension 1226.
Sincerely,
Jeannine L. Graf
Building Official
Cc: Mike Thies, Code Enforcement Officer
ON L.
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Cfff"'of Edmonds
De Men, I *Ce, Department
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121 S& A n e Z"Ed ads, WA 98020
Phone: 425-771-0220 Fax: 42S-771-0221
Oft Use Only . 03-06.
FMMO:
.2.
LAND USE COMPLAINT FORM
If you have distinctive handwriting jou may choost-tolybe this fo
Alleged Violator's Name/Phone:_ Y-3 2 Z
Violation Address or Site Location:
DEWLS, OF COMPLAINT:- (Be s
Decific) 7�
7be City of Edmonds'lnvestigates Possible violations on' a comiplal . nt'bas" Is dnly� Ther;eftre, the
name of the person filing ;he complaint must be pro* vided In order fbr the City to Investigatp.
Name okase pft): 1`71ie 66 U 1_// ,Phone:
Address: lqo 57-sw
Pursuant to State Public D closure La
. I$ w RCW 42.17.31.0(lXe), the complaluant may Indicate i request
for nondisclosure of their name and Identity. . If non -disclosure .1s'desired thie.bottom portion of this
form, which indicates your Identity as a complaban14 will. be -.:red --do
acted(blaickeil ..00florto a
disclosu're.' Please be advised6the majority of violations are. resolved. without the release of c 0*11PPlaint
information. - HOWEVEX WTHE CIWJS REOUMD'TO 'USE -LEGAL.- INGS-TO
�W.Nm�
ff rRg dh wt want m Ate
nft dNdgsed.&ec* the bk7
,DO NOT DISCLOSg natu
W -1
CITY OF EDMONDS EET FILE Termit No. C1 0— 4 33
J. � wK
OMMUNITY SERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date 0
Z
U
W
0
�J.
A. Owner: Washington Natural Gas Comp ny B. e Contractor:
Nam
N8W Mercer Street
%aj*�ldre,s WA 98111 Mailing Address
City State Zip City State Zip
State License Number Telephone Number'
C. 9 Address or Vicinity of Construction: 19107 94 Avenue 4ssp2:r i ;Z
Install NEw Service
Type of Work to be Done:
1;�w
D. 0 Work in Connection With: El Sub or Plat 0 Single Family 0 City Projects
0 Commercial 0 N"i amily xx utility
E. 0 Pavement Cut: KI Y El N F. 0 Size of Cut: 2 x 4 2) @ Gas and H 0
2
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to thi6af_PffbTti.obZagi,ees to hold.the City of Edmond's
harmless from any injuries, damages, or claims of any kind d h
rt;rr f,
,, de ion w atSoeve�� oryen or unforseen, that may
be made against the City of Edmonds, or any of its depar en s, (sycP(K1ployees�Gchidi6g-'or unot limited to the defense
re
of any legal proceedings including defense costs, court costs, and ttorney fees by reason of granting thi's permit.
THE CONTRA�TOR IS RESPONSIBLE FOR WORKN��'N§HIP 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 pa`�cfi'is- completed by City forces, at which time a debit or credit will be
processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Enginedr&g:- !"?L-�3202
• Work is to be inspected during progress and at completion.
* Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
I understand the above and t hat this permit must be available at the job site for inspection purposes at all times
Signature: Date: September .7, 1990
Owner or Contractor
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: - ROY W PERMIT FEE:
Time Authorized: Void after days. Restorati4onF
Special Conditions: N All Receipt
Fund I I I
Street Cut Dime
RELEASED BY:\" kUM. Date INSPECTED BY
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Date
Lng. Div. MarCh 1989
FIELD INSPECTION
I I I - Route copy to Street Deptj
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection"' by P. W.:
Work Disapproved By: —
FINAL APPROVAL BY:
Date:
Date:
Eng. Div. July 1985
0.
Vb.d*K ton
j-
WNG to window
Addendum to-:
City of Edmonds
Permit Application
Engineering Aide: Kerry Walsh
Washington Natural Gas
622-6767 x2761
C� (CQ IY_4') G:?' 9_610
lepth unknown
"I
existing
gas main
proposed
Key:
:s- sa�itary sewer
w- wa er
-g- gas
water valve
hydrant
815 Mercer St. (PO. Box 1869). Seattle, WA 98111 (206) 622-6767
00
STREET CITY OF EDMONDS
ENGINEERING DEPARTMENT
505 BELL STREET
EDMONDS, WASHINGTON 98020
APPLICATION FOR INVASION OF RIGHT-OF-WAY
(Submit In Duplicate)
Permit to be issued to: a L C-- A r.-L. Ls�
For work at-* (address or vicinity) ci
T
Type of work to be- done: I, u r—, LK/ Y4 L I 1 6
(Attach Drawing when Applicable) 1 1,4 S -Te) L:t- v rD o-1 t) 7y -1—
Owner:.. Q- L rL L-o- o yt)
Name
a J 1
0
Mailing Address
a
City State
,ontractor: o m
Na.me
Mailing Address
City State
Owner or Agent
bO NOT WRITE BELOW THIS LINE (To be completed, GU'in—g
Permit. Issued (date)
Remarks: -��e '�� -2 7 4
E . NOINEER'S AFFROVA�L I I - DATE
Upon issuance of this permit, the contractor is responsible
for workmanship and materials for a period of one year
following inspection of the restoration by the Engineering
Dept.
Signed
Permit Number- (191
NOTICE:
Work subject to inspection and restoration in accordence
with city code. A 24 hour notice is required for inspection.
C-ill .7.7.5 252.5
90
0
CITY OF EDmoNDS
ENGINEERING DEPARTMENT
ff N ... CAO
Insp Date .................. By ....................... �Rem .... a Ae7
Remarks.1.1s,
InspDate ........... ..... By ........................ ...... I . ....
Insp Date ................. By .............. .......... R . emarks7.—:). f T <A .. ... .... ..... . ......... ........ PN.Y/.W
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'InEsT D t .... 'By ........................ RemarkCiP. ------
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wo, 10702 187TH ST SW
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1324
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Edmonds
P GET WAY L 1303 Z 1306 1305
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. Address or Vicinity of
B. Type of Work (be specific):
C. Contractor:
Mailing Address:
State License #:
D. Building Permit # (if applicable):
vr\
Permit No:
Issue Date: 114) 1?,40 -3
Phone:
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable
E. F-1 Commercial El Subdivision City Project Fj EUC (PUD, VERIZON, PSE, AT& T, OVWD)
Multi -Family Ej Single Family Other
INSPECTOR:
F. PAVEMENT CUT: El YES El NO G. SIZE OF CUT X
CONCRETE CUT: El YES [] NO
INDEMNITY: Applicant understands by.hislher 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 attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOJWNG THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES KILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BYCITYFORCES, AT WHICH TIMEA DEBITOR CREDIT F"LL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT.
* 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
IRAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THAT I MUST MAKE THE PINK COPY OF THE-ZERMITA VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Signature,
t-ontractor or
Date: /— �oo —:�
Z 516M) -PP-7N / T
FOR CITY USE ONLY
tv , "-g-
Approved by: Right-of-way Fee: 10.5nle-
Time Authorized: Vo-id After Of -411 1403 Disruption Fee/Fund 111:
Special Conditions: DF_M215' -M
&estoration Fee:
TotalFee:
L;>-�JO 0;iL ellP 72461-&-t5F ReceiptNo: V'543
Issued by:dAinonned
41grrga' RL'
UPON COMPLETION OF PERMITTED WORK9 AN ENGINEERINGYMAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE ED
,WNDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-022
'"xt. 1326)
FINAL APPROVAL OF PERMITTED WORK.
.20� I I - DATE:Agak
Inspector's Signature
For inspection requirements see Engineering Inspection Information handout.
I NO WOIZK SHALI. l3l'J;1N 11U01Z TO ll',1ZM1'F ISSUANCE
DAMy Documents\Forms\Engnmg\ROWpermit doc
O�,
0Wff(?,', 67A-46/tA4
A-PN1'
LEGAL DESCRIPTION:
That portion Of Tract So., EDMO*NDS SEA VIEW TRAC'TS� according to the Plat
t , hereof recorded in Volume 3 of Plats, Page 76f records of Snohomish
county, Washington, described as'follows:
Beginning at the Northeast corner of said Tract 5'
0, which lies 20 feet
Southe , rly of the'c'enterline of 190th Street Southwest;
TliENCE Southerly along the Easterly line of said Tract for 1.10.00 feet-;
THENCE North 890151231 West 73.40 feet to the t
rue point of beginning;
THENCE continue Westerly along said line' for 189.36 feet to a point on
Westetly of said Tract;
THENCE Southerly*along said Westerly line of said Tract for 96.28 feet;
THENCE Southeasterly along the So'-uthwesterly line of said Tract for
50-28 feet.'
THENCE Nor�h 4303012711 East for 276.52 feet to,the true voint of
beginning.
situate in the County of Snohomish, State of Washington.
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140 5t1t;->VF-Y A-VA-tL-k1?L-F
APPROWED AS NOTED
BY ENGINE IING E.R,-,,c3!0NN
EEF
Date:
.5
GUTTERS/DOWNspoUTS
TO CONNECT To ExIST. SyST.
- - - - - - - - - -
9
. qk(NW-�
RESUB
AUG 08 2005
BUILDING DEPARTMENT
CITY OF EDMONDS
C=)";
FLE
IKI
tL L
38541
C)
----------------
7-/q,0,5
F[ 0—
RECEIVED
JUL 15 2005
PERMIT COUNTER