19400 82ND PL W.PDF111111111111
7619
, PI fell 00" ON
ADDRESS:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver F] Study Required [] Waiver
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 #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DSrs\Fbmis\Sftwt File Checklist.doc
Also see
19400
19401
19402
19403
NOTICE:
N�o-warranty ... of -a-ccuracy.
The -information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of �Edrn.qnds does not ' warrant the
accuracy of anything set for.th on these
map(�_)- Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
tF�e -m a p (s) , including, but not limited to,
th-e 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
em p]-o-yee-s o-r off i-Ce-rs sh-a 1.1 be 1--'-1a-b--lFe for 11-he
information given on this map(s), nor for
ion provided based
any one representat
upon . said map(s).
CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
I J
Call 7.76-1107 for side sewer inspections BEFORE covering any portion of the construction.N
Inspection will be provided within 24 hours after request. NO Sat., Sun., or holiday inspections.1
ADDRESS LOCATION OF CONSTRUCTION ........ 194 8 19400 - Ond Place West
..................................................................................................... . .......... ............................................
PROPERTY LEGAL DESCRIPTION .......... �0.t ... 8 ..... MaR ... ewo-o .....................................................................................................................................
. .. .. ....... ..
.................................................. . .........................................................................................................................................................................................................
Nord Homes
.................................................. ............. OWNER ANI)/OR BUILDER ............ ............................ .................................. . .......................................................
CONTRACTOWS NAME & ADDRESS ....... 1.us.s --- J.o-h.ns.o.n Sewer & PI umbi ng 16009 North Meadowdale Road
. .... .. .. .. .. .... .. ..................................................... .............................. . .. . .......................................................
Permission Is granted ........... Julv I 8 *, ....... . ............ 19.73., for repair and/or connection of a side sewer to the city sanitary sewer
----- ----------- '
system in accordance with City of Edmonds ordinances.
-. TION IS CALT D TO THE FOLLOWING:
1�1 —,Iqo. 1—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 area. Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of-Way_ Permit obtainable from the City Engineer's office.
NOTE No. 3--Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—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
sharper than 1/s will be permitted.
NOTE No. 5�---Trenches in street must be water settled and surface of street restored to or1ginaJ condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE] No. 6—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 appurtenances except to in-
sert the pipe into the wye.
DISAPPROVEDE] Date ... . ......... ........................ By ................ Date --------- Date ................ ................... . By ................
APPROVED E] Date ... —�-23 By --------
...... te000000
Remarks: ............ .............................. . ................................ ..................... . ........................ ............. . ...................................................................
------------------------------- ;�� --------------- ;2!f� . ............ .............................................................................................................. . ............................................. .........
— BOTH/f ermitAopies )6USI/pe ;%jgned By Owner of Firm Performing Construction PRIOR To Request For Inspection
..... ('c ......................... ... I hereby certify that the side sewer installation constructed under this permit
6 1;��'ner of, rm. Perfcrmi
1--� I ce�r
V stalVd in acco h al g or inances of the City of Edmonds.
z�� Dated this ............................ day of ................................................................. 19 .........
V V Check BEFORE you dig for: Water E), Gas [], Telephone E], Power F1, Sewer [:], Other 0 v v
11Y 0
7,
CITY of EDMONDS a b, NE,S-S,,-L-IC1:-k1S-E APPLICATION LICENSE No.
Civic Center - Edmonds, Washington
--) 9 L
U120 9—:z
City Clerk Phone 775-2525 ANNUAL FEES PENALTY AFTER FEB. 15
CLAS YEAR I LIC. EFFEC. DATE JREASG. LIC. NO. SPECI 0 HOME OCCUPATION
INSTRUCTIONS: '1 $10.00 (A) ADDITIONAL $5.00 0
• All items must be completed -e, *79 . . I I t I I I ;Rj_SMALL BUSINESS
or application will not be ac- RECEIPT . NO. DATE PAID � $15.00 (B) ADDITIONAL $7.50 0
01 4� PRINT'X'
cepted. qg� IN SPEC. BOX
FOR ISSUE OF 0 Business with 10 or
• Sign and return application FEE AID PENALTY PAID CORRECTE - D more employees ADDITIONAL $25.00 0
with fee. Renewals received I LICENSE WITH $50.00
. b t� � K,) LUACTION. (C)
after February - 15 must pay
penalty in addition to fee. NEW APPLICATION (LA)
NEW BUSINESSES AFTER 0 RENEWAL (LB)
0 CHANGE (I-C)
JULY 31, 112 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) D. DELETE N n)
N�14 F--R� BUSINESS PH -ONE
MAI,L1NG-iADDRES',1
I to 41114
L1, A/ Iq tv o o �),
P t- 0
IV ltq� 17
NATURE OF BUSINESS
0 ulz-e-x
NO. OF EMPLOYEES
BUSINESS ADDRESS
0 2-
INDIVIDUAL
PARTNERSHIP CORPORATION
IJ6
(S)
(P) P
'E)WNE-RS-NAME--
HOME ADDRESS
tDATE
L
HONIE PHONE
7 d'-02- ?7Z—
OF BIRTH
_ C, j_;?
_ ;?_
r
1 1) r: C, /01 ,-.6
PLACE OF BIRTH --7n^
Lnw � , , - , ,, - -
Y NUMBER
? j/, 'I r
EMERGENCY
NOTIFICATION: (1) NAME & TELEPHONE
(PLEASE
LIST TWO) (2) NAME & TELEPHONE
WASHINGTON STATETAX NO. APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, UFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE 9 LAND USE CODE ZONING CODE
e-'APPROVE 0 DISAPPROVE
SIGNATURE
I I I /J I
CONDITIONAL USE PERMIT
COMMENTS
B)ALDING DEPARTMENT DATE
t4l APPROVE 0 DISAPPROVE
Builcliqg
0 Hotel/Motel
(L)
SIGNATURE' M1,461-1 11
Permit
-
K-Apt. Bldg.
(A)
0 Office Bldg.
(0)
COMMENTS: 0
Occupancy
0 Restaurant
(R)
Group
0 Hosp/Nurs Home
(H)
F-7- I CAPACITY: (NO. UNITS, APTS., OFFICES, EATS, BEDS, STUDENTS)
0 School
(S)
FIRE DEPARTMENT DATE U. F. 1. R.
D'APPROVE 0 DISAPPROVE SIGNATURE
COMMEN
r-UDLIU VVUr1r%Z) Ut�Afl I IVItN I
B-APPROVE El DISAPPROVE
lip
.:0.,F-,,EQ,`M%%QNk IUS�,, -;SI:iDEjt.AE WNAER �PER A
IT' 7;
IWATEW.AWER-DE
:,P All
ER T
call; 7tu-1,101 'seWerins�ectlonw Bkr th- 8 'ti
for. Md:e 011it� c eflnv�ai.i ortio'n e� con triuc,�m%
tion will �be. provide 2 est. -NO S t�,,,Sum,,,or�
d! �Wlthln e.,�hou�rsilaiter.xequ Ov a hoiihay. inspections!],
06 Bx6d` P1,ac'*e,W: st
................ .............. ............. ................ .............
OCX-no ICTIOIS e
ADDRE�S;,L NOF CONSTRU 1.:..' ................. ...............
'Lot 8� - Ma -Fewooa
Y G ........ ! ....................... ........... .................... ...... ....... .......... . ...................
PROPERT. LE,�ILi,'DESCRIPTION.* ......... .....
.............................................................. ............. .......... ............ .............. . ...................................................
.................. ......... .....................
N
........ ............ ......... OWNER AND/OR,,BU -EDER ..............
....................... ...................... . . 7 .....
t.7 ............. 7. ........ .................................
'Meadow.dale- _a,d'.
Russ John�on'S.bwer-&,.Plumbln 160091orth.-
CONTIVACTOWSMAME: & ADDRESS ........................................ . .9 J
............................................ .......................................... I ........... ...................... .......
Ju1V 18.� 91a, . -of .,a side. sewer- to thw,clty ."n1faT'y,. se-wer,
f,e0)#ssi,!k-4,,g,raDjed . ........... ........................ .................. for.repaii and/or,66nnectfim
g�,ifem,, ifiii&ordiriceimith',City of Edmonds, ordinances.
.0"'giON IS,-CALLED,�TO THE, FOLLO WI NG:
V, 0-. 1-1 em construct, -:r
The owners, bf'Ahe-Property. may-obtain4a: perLnit' to- construct sewer Inside property 11ne� A',IIcensed,,SIde, Sewer11C6rit�icfor:,musV be., p lo�, e dl t'-
d"
lde::s�wei, In. stree t, area. 0dinot, cover any portion �of-seWer.,bef6r�,it,,.h'ag,beeii- inspects
kt,performed In, city rl W , ay, requires)' nl,o -of-Way abl�ifron��Ahe City ng ne
NO!J:)�,No.��2�'A,Wwor glit-of- an' lnvasi4' f Mght'� j?ermit �btaln _,:E' I ei,s oifice:
NOTKN6.'3L-Obt&I w4dIVAn formation, regardink:�Ordinarice,.1'1-.16!02�0'iindIR6gulattons� goyerningsidels�Wer,�i,.,��henf,y6'ti�;get permit-.
140-TE' No;` i—Top',Iof�l 30�*lnch6 coyerage,,&t,_pr6p inches, inslde,,pr6perty,,Ilne;� �minimud, ig 'e�, of '2,0
. sido'sewer,�Must have at least �rty lin . e and� 12 red /0' �No�.Ibendsi,ln,.,grade
'shmrper'than',i%_wIIV,be permitted.
NOTE; No...5�-�renches�i`n' �street`must the I water set I tledl,and� . surfmce of. stieet"restored to,original' conditiom, .�C . ont I ractors shaM be responsible. for failure, due:'�tb �im!
work Which, may develop within one year. of completiom. proper
NOTIDt No. 6�-It, Is* unlawfull to alter or do any �other work th�n Is provided' for In the permit; or toldo�'any work' on Ahe main:sewbr �or� its &ppurtena'n'ce's;-'excepf to, in-,
sert thepipe into, the wye.
BOT t-1 op�iesAUS, Be,, 'g-ned, By, Owiler,'of 'Firm, R6quest, Pon Inspectibn,
..... ......... ....... ................
her,eby, certify, that��t-he�sfdi!�s6w,6�,,installa'tion,.,construdtedtun(
6 V6' r of Contr' g-14Irm Perfrrmi
t
i Acedrd' 'th'al gor inances!,6f-fthe1Cityof Edmdndis.'.
................................. ........... ...... ......
BEFORK you,
Check dig for:, Water E:], �G,�l"j Telephona; Fl;,. �,Po_wei 4E],, Sewer:n;V 'Other, �0�
I
APPLICATION
7Z for
The City bf Edmoird' SIDE SEWER PERMIT
OsT. E E T H Ul "' NEW CON STRUCTION REPAIRS Q EASEMEN-T—No'
ON N
, _. : - - - CON -TRACTOR
..................................................................................... .................. ... ........ .............. ............... PERMIT -No.
ADDRESS ....................................................... ....... LEGAL DESCRIPTION: LOT No . ........ ......................
..............................
NAME OF ADDITION ... .... PF
.................. .........................................................
\NEST
I
an
Approved:
. ... ... By..
DATE ....
7
A
LO-T,
73
............. S.-
, _zy,
A -
y
-APPLICATION
CITY of EDMONDS
Civic Center - Edmonds, WashinA
City Clerk Phone 775-2525
INSTRUCTIONS: ICLASS I YEAR LIC. EFFEC. DATE JREASG. LIC. NO.JSPECI
LICENSE NO.
PENALTY AFTER FEB. 15
HOME OCCUPATION
$10.00 (A) ADDITIONAL $5.00 El
• All items* must be completed / � I I I I I I I ;Z_SMALL BUSINESS
or application will not be ac- RECEIPT , No- L DATE PAID PRINTW $15.00 (B) ADDITIONAL $7.50 El
q
IN SPEC. BOX
cepted. - FOR ISSUE OF 0 Business with 10 or
• Sign and return application FEE PAID PENALTY PAID CORRECTED more employees ADDITIONAL $25.00 0
D
LICENSE WITH
with fee. Renewals received I 'LC'ACTION. $50.00 (C)
after February 15 must pay 0�1 NEW APPLICATION (LA)
penalty in addition to fee. 0 RENEWAL (LB)
NEW BUSINESSES AFTER 0 CHANGE (I-C)
JULY 31, 1/2 FEE, _ (PLEASE IVIAKE.ANY NECESSARY CHANGES) 0. DELETE (LD)
M I.C5 41114
L— Lt*' IV-1q W 0 61),
pt 0 -
it) Av q so 3
BUSINESS PHONE
NATURE OF BUSINESS
NO. OF EMPLOYEES
,,,,BUSI'NESS ADDRESS
0 2- ' F2
INDIVIDUAL
PARTNERSHIP CORPORATION
-ov
) V4
HOME ADDRESS
;4t621
4 "44
!.(9 U.3
B My
HO EPHONE
-7 7 F 02.. 9-z�
DATE OF BIRTH
I V r: c
I
PLACE OF BIRTH SOCIAL SECURITY NUMBER
L1411111/14, 14,41f)d11 �776-
EMERGENCY
NOTIFICATION: (1)
NAME & TELEPHONE
(PLEASE
LIST TWO) (2)
NAME & TELEPHONE
WASHINGTON STATE TAX NO.
APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, UFIR NUMBERS, ZONING, ETC. CHECK APP I ROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE �L 2-Z 1 -2 9 LAND USE CODE ZONING CODE
APPROVE 0 DISAPPROVE
SIGNAT E -6t-kQZk-,,- Ire I d I
CONDITIONAL USE PERMIT
COMMENTS
BYILDING DEPARTMENT DATE C/),. Building
APPROVE 0 DISAPPROVE 0. Hotel/Motel
SIGNATURE nA�. Permit
A I )�T-Apt. Bldg. (A)
0 Office Bldg. (0)
COMMENTS: Occupancy 0 Restaurant (R)
Group 0 Hosp/Nurs Home (H)
-P"k APACITY: (NO. UNITS, APTS., OFFICES, �EATS, BEDS, STUDENTS) 0 School
==IO C (S)
FIRE DEPARTMENT DATE U. F. 1. R.
0 APPROVE 0 DISAPPROVE SIGNATURE
COMMENTS:
POJX"E: DEPARTMENT
-;L- -- SIGNATUR
VAPPROVE 0 DISAPPROVE DATE c— 22=��z
COMMENTS:
rUt5LIU VVUHK,'j ULPARTMENT
F'-APPROVE E) DISAPPROVE
CITY OF EDMONDS SIDE SEWER PERMIT.:.
WATER -SEWER PEPARTME?ff
4,41
PERMIT
iCall 7.70-1107 for side sewer Inspections BEFOXZ covert" 1 3 any portion of the construction.
h
Unspection will be provided within 24 hours after +*qUsA. Sat., Sun., or oliday Inspections)
A
941
19402 &AV j,
%. �, � 82n Place West
ADDRESSLOCATION OF CONSTRUCTION .............................. ......... -- — ----- ........................ ......................................
Lot 8 Ma
PROPERTY LEGAL DESCRIPTION ................... . ............. ........ . ...................... . ...... .............................................. I
t V.
..... . .............................................. ............... ...... . .......................... . ..................................................
.................................................. . .......... . .....
ord omes
........... s ................................................... OWNER AND/OR'BUILDEIR .......................... .............. .................... ......... . .........................................................
Russ Johnson Sewer tPl ing 16009 North:Meadowdale RoaC
CONTRACTOWSNAME "DRESS ........ . ............. ................................ ......... . . . ... ...... . ..... ............................... . .. . .. ..................................................... .
i P rmlssl Is granted ............ .... My ... 1& .. . .. . ........... �.V, 191.1, for re#alr &�W4 connaction of a side sewer to -the city sanitary sewer
e on
;77teitn In accordance with City of Edmonds ordinancelL
ATTENTION IS CALLED TO THE FOLLOWING:
�NOTE No. I —The owners of the property may obtain a permit,to construct sewer 4.1da proper y line. A licensed Side Sewer Contractor must be employed to construct
side sewer In street area. Do not cover any portion of sewer before IV has be=
NOJ�E No. 2—All . work performed In city right-of-way requIM an Invamlob of Right4�,af-WaWy obtainable from the City Engineer's office.
NOTE No.' lbtain full Information regarding Ordinance 11.18.030 and Regulations governifig sewers when you got permit.
78
NOTE 4—Top of side sewer must have at leafft'36 Inches coverage at Property as am 12 a Inside prolmaty line; minimum grade of 2%. No bends in grade
sharper than % will be permitted.
NOTE. No. 5--Tre.ch.. in street must be water settled and surface of street restored to original dition. Contractors shall beresponsilile t or failure due to Improper
work which may develop within one year of completion.
NOTE) No. 6---It is unlawful to alter or do any other work than Is provided for In permit,. r to do any work on the main sewer or Its appurtenances except to in-
sert"the pipe into the. wye.
APPROVED ................ �Date..
DateL .. . ......... ........................ BY .. ............. .... ......... Data. .............. .................... By ................ .
'"PROVED Date.. ....... ................. . .............. ................................. ........
... ......... ... ...... . ....... ........ ............ . ...... . .. . .. . ...................................................
Remarks: ...... . ... ................... .......... . .. . ..... ............................
.................. ........... ................................... . .. . ...................................................
. ................................ . . ............ ................................. ..........
er of FIrm s
ROT ermit, opies 8 Be gned By:Own Wo construction PJUOR To Reque tFor Inipection
ted under this permit
.... ........ .......... .............. ... hereby er the Side sewer installation constme
t
----------
.................
try t
r nt g Firm Perform
',,was Instal in accor th al or ances of. the Cit of.,
Dated. ........... day of ........ 0 . .................................. 19:
Che6k IMFORE dig for: Water 0, Gas Power Sewer 0,. Other 0 ...q -1
YOU
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FL --A-
LIMMASIVINT City of Edmonds PAGE 1
01/09/03 09:33 Print Master File Account Details
.;;p Account: 3-48825
Screen 1
*** Tenant Information *** *** Owner Information."*
01 Name MAYBERRY JAMES A 1OName MAYBERRYJAMESA
02 Care of 11 Care of
03 Addr 1 19400 82ND PL W 12 Addr 1 PO BOX 478
04 Addr 2 13 Addr 2
05 City EDMONDS 14 City LYNNWOOD
06 State WA 07 Zip 98026-6207 15 State WA 16 Zip 98046-0478
08 Phone (000) 000-0000 17 Phone (206) 745-0461
09 Status A 19 Water 0.00
===Meter Reading Information== 20 Surcharge 0.00
181-ocation 1940082NDPLW 21 Sewer 0.00
Current Previous 22 StrmDrain 0.00
27 Curr 6 28 Date 10/25/02 29 08/28/02 23 Swr Tax 0.00
30 YTD 0 31 Rdng 1162 32 1166 24 Previous Due 0.00
35 LTD 901 33 Rdng .0 34 0 25 Current Due 0.00
======Dates====== - 26 Balance 0.00
38 Extension Dt 00/00/00 39 Acct Setup 00/00/00
40 Last Pay 12/09/02 41 Last Bill 11/21/02
42 Due Date 12/21/02
36 Meter #:
Screen 2
2200 37 Location IN DR DUPLEX
** Misc Codes ** *** Rate Codes *** ** Units ** ***Meter Info*'*
01 Status A 14 Water 051 1 "APT 15 2.00 28 Meter BmdSR
02 Type 01
16 SurchargeOO1 TAX 17 1.00 29 Meter#: 2200
03 Cycle 02
18 Sewer 050 APTS 19 2.00 30 ID Meter
04 In/Out 1 20 StrmDrain005 STDRN 21 1.76 31 Type M B
05 Sort Cd 0000
22 Swr Tax 001 TAX 23 1.00 32 #Readings 1
06 Est Flag N
24 Misc 000 NOCHG 25 0.00 33 Meas Code HCF
07 #Tenant
26 Penalty 27 0.00 34 Install Dt 03/25/93
08 #Owner 1
35 Shutoff Dt 00/00/00
09 Respon? 0
36 Route 311
37 Sequ 1400
10 Penalty Y
11 Past Note B
12 Shut Note B
13 Account Info
41 Hist Memol
42 Hist Memo2
38 Codes AE1AL
39 ADDR CODE 1 00
40 ADDR CODE 2 00
UTILITY SERVICE ORDER
Today's Date Account Number Pulled -Meter Meter MOn. Py
LA
Service Address i n A -el rL UD Re —quested By
Water Service Date Turn -On— Turn -Off — C/B Read Reread Reread
Location of Meter Leave D/H Edit/Cust.
f Read Date urrent R rev o s Previous Read
Curren ead,. P i Read Date CohsUrriotion
Read By Date
Notes w3J�003
Date New Meters Installed
Size-3J q Lock plocked
Residential,
Apartment
Units
bfrice
Units
Commercial
Units
Sprinkler
Other:
Sewer Avail.,
Unavail.
Meter.Charge
$
FS Connection
$ . . .
H20 Connect
$
Stre6tout
$
Total (e 0.—
Receipt / J, ( L/
Permit .
Screen 1 ***Tenant lnfOrmation*** ***Owner Information"*
01 Name
09 Name
02 Care of
10 Care of
03 Addr 1
11 Addr 1
04 Addr 2
12 Addr 2
05 City
13 City
06 State 07 Zip
14 State 15 Zip
08 Phone
16 Phone
33 Meter #:
36 Acct Setup Date
34 Location
Screen 2
, Misc Codes"
***Rate Codes***
**Units**
01 status
14 Water
15 0.00
23 Meter #:
02 Type
16 Surcharge TAX
17 0.00
25 Type M A
03 Cycle
18 Sewer RSEWR
19 0.00
26 # Readings
04 In/Out
27 Meas. Code HCF
07 # Tenant
28 Install Dt.
08 # Owner
30 Route
09 Respon?
31 Sequ.
32 Codes
Mutlsvordtword