19515 86TH AVE W.PDF111111111111
8134
19515 86TH AVE W
w':-.S S 19515-19519�19523-86th.A.venue West
CITY OF EDMONDS CHECK LIST
j
'Ormiation and material required to be submitted for Commercial *and Apartment
Aits, w'here indicated.
ENVIRONMENTAL ASSESSMENT
SHORELINE MANAGEMENT PERMIT
CONDITIONAL USE PERMIT
VARIANCE
AHiENITIES DESIGN BOARD
APARTMENT RESTRICTIVE COVENANT
3 b�
SITE IMPROVEMENT BOND (Ordinance 1620,
017f
PLAN CHECK FEE R6 1-70 IRV
STRUCTURAL DATA, CALCULATIONS
ZOINI ING DATA
7-S7
BUILDING CODE DATA
CITY ENGINEER DAT
44/7
FIRE DEPARTMENT DATA
4A �'j
PUBLIC WORKS DEPART C-141T DATA
OTHER---� F1j
5e
N,�
CITY OF' EDMOND'S
DEPARTMENT OF BUILDINGS
CERTIFICATE OF OCCUPANCY
UNIFORM BUILDING CODE, Sec. 306
At— 19507-19515 86TH AVENUE WEST 780377
Building Permit Number
Occupancy established by this certificate:
Fire Zone 2 No. Stories
.2
H Type Const. V Hour Basement
il Floor Load signs in place (per Sec. 23o8 U.B.C.) Capacity signs posted (per Sec. 33or (i) U.B.C.)
Floor load and room capacity signs, when required, must remain posted at all timrs.
414
THE 4 unit building HAS BEEN INSPECTED AND APPROVED AS COMPLYING WITH
PROVISIONS OF THE EDMONDS BUILDING CODE AND WITH UNIFORM BUILDING CODES.
— 'A'
10th September 79'
Issued this -day of 19
CHIEF BUILDING OFFICIAL By rA PAc,�
Of—K
This certificate shall be posted in a conspicuous public area and shall not be removed, mutilated or obscured and shall be main-
tained in legible condition at all times. Any change of occupancy requires a new certificate.
a
7", 51
'V,
Tomo N�, V 1 IL�v 1,x_t,1k2%,V,1q U�_, i �oc 1
CITY OF EDM-ONDS
DEPARTMENT OF BUILDINGS
CERTIFICATE OF OCCUPANCY
UNIFORM BUILDING CODE, Sec. 306'
19511 - 19523 86TH AVENUE WEST
Building Permit Number
Lncy established by this certificate:
780378
Fire Zone 2 No. Stories
2
H Type Const. V Hour Basement
Load signs in place (per Sec. -3o8 U.B.C.) — Capacity signs — posted (per Sec. 3301 (i) U.B.C.)
Floor load and room. capacity signs, when, required, must reinain posted at all times.
.4 unit building HAS BEEN INSPECTED AND APPROVED AS COMPLYING WITH
PROVISIONS *OF THE EDMONDS BUILDING CODE AND WITH UNIFORM BUILDING CODES.
Issued this 10th day of September 1979
CHIEF BUILDING OFFICIAL By
rtificate shall be posted in a conspicuous public area and shall not be removed, mutilated or obscured and shall be main-
tained in legible condition at all times. Any change of occupancy requires a new certificate.
CITY OF EDMOND.S
DEPARTMENT OF BUILDINGS
CERTIFICATE OF OCCUPANCY
UNIFORM BUILDING CODE, Sec. 306
At 19423 - 19431
Occupancy established by this certificate:
Building Permit Number
Floor Load signs — in place (per Sec. 23o8 U.B.C.) — Capacity signs posted (per Sec- . 3301 (i) U.B.C.)
Floor load and room capacity signs, when required, must remain posted at all times.
THE 5 unit building HAS BEEN INSPECTED AND.APPROVED AS COMPLYING WITH
PROVISIONS OF THE EDMONDS BUILDING CODE AND WITH UNIFORM BUILDING CODES.
Issued this 10th day of Septemb(�r 19 79
CHIEF BUILDING OFFICIAL By
This certificate shall be posted in a conspicuous public area and shall not be removed, mutilated or obscured and shall be rijain-
tained in legible condition at all times. Any change of occupancy requires a new certificate.
-F" Mk
, v7JI11,
6
CITY OF EDMONDS
CIVIC CENTER - EDMONDS. WASHINGTON 98020 (206) 775-2525
COMMUNITY DEVELOPMENT DEPARTMENT
June 3, 1980
4�v 1
HARVE H. HARRISON
MAYOR
BUILDING PERMIT NUMBERS::7&0377,780378, 780379
19423, 19431, 195'07,' 1.9511, 19515,' 19523 86th Ave.' West
As a result of a site inspection on June 14, 1979, it
was evident that the structures at the above addresses
were, at that time, in substantual-compliance with the
1976 Uniform Building Code, Mechanical code, and Plumb-
ing Code, with*the exception of the items noted on a
correction notice dated 6-14-79.
,-A , V-D C
Harold Reeves
Building official
Dated this day
of
i�l
j ��,
On this day personally appeared before me A�-,,d) , ?
to me known to be the individual described in and who
executed the within and foregoing instrument, and
acknowledged that 7,& signed the same as
free voluntary act and de for the uses and purposes
therein mentioned.
iven under my hand and official seal thi's,
day of 19
Notary Public in and for the State -of
Washingf`8n residing at
AUG_1 01979
04 10017cfq
ZEz
cr(Ar-
TO
SUBJECT:
TUWAY MESSAGE
7)
�-.Aa FROM
nAT;:
a
E
s
A 9 ll&AAA�
s
A
G
E
SIS e, A5
1-2 —U
,cj c W5 A A,�S
(;'r, N F 17)
cgu
R
r
E
p
L
y
DATE:
SIGNED
SCADEG Ll-C2375
d
W
PRINTED IN U.S.A.
COMMUNITY DEVELOPMENT DEPARTMENT
Building Division
DATE: 6— 1.41-71
TO: FIRE DEPARTMENT
PUBLIC WORKS DEPT.t"'�
PLANNING DIVISION
SUBJECT:
Please review and advise any outstanding requirements on
above, in order that they may be given final approval and
a Certificate of Occupancy issued.
Harry M. Whitcutt
Building Official
HMW/ae
COMMUNITY DEVELOPMENT DEPARTME-NT
.Building Division
DATE:
TO: FIRE DEPARTMENT
PUBLIC WORKS DEPT.V"
PLANNING DIVISION
.RECFI"-
i U [1 15 1
Please review and advise any- . outstanding requirements on
above, in order Lhat they may be given final approval and
a C�ertificate of'Occupancy issued.
Harry M.
Building Official
HMW/ae
August 17, 1978
Jack Cooper, Fire Chief
City of Edmonds
250 - 5th N.
Edmonds, Washingtoln 98020
Dear.Chief,
d L. Kinderfather AIA
Architect
UG 2 3 1978
citV _.
Edrnond,
DOW. 400t
Thank you for taking.the time to -meet with me last month regarding
t h e-qMkivlffl:te4r-*gcio;nTdr(D)6*idn*i,*u�,mm�%p�r-(D-j-exe-t 1 o c a t e d a t 19 4 t h a. n d 8 6 t h W e s t .
Confirming our conversation, the following decisions were made
concerning the location of the fire extinguishers and fire hydrant,
and the entrance gate.
1. It was decided that the fire extinguisher could be located in
the garage next to the door that enters.into the living space
(you noted this on the back of the -plans).
2. It was also decided th-aton-ly� dne-f-ir-e -hydra:n,t.__lo-c.ated --in the,
pl, anti n�g_--are-a i-n- frb-nt- of the- depter-lbuilding- would be requirued.
You also requested that we determine the location of the fire
hydrants on the street relative to the property. Finally, in
regards to the entrance gate, we agree that a phone of your
choosing would be s et up to control the gate.
Please callme if this is contrary to your understanding.
Sincerely,
GARY STADLMAN
CC.: Sterling Miller
GS/wg
20,1 5th Ave. South Edii ionds, Washington 98020/USA (206) 775 9396
780377
780378-
780379
FILE. #1
FOM FOR R9WMM/F1N-Uj DECUTATION OF fSTG?MPM*MV1NONSIGNIFIQ1QNCE1
Description of proposal 13 unit condominium
Proponent Sterling -Miller
LocatiOTI of Proposal 19423 86th Avenue West
Lead Agency City of Edmonds
1his pToposal has bccn cictemined to RwWrot haxe] a sianificant ad-
C)
TS
Verse upon Iiie eiwirorincnt. fui E.L fd<%/is not] required u.nder
101 43. 21C. 030 (2) (6) . This dccision, was madc af ter review. by 't-he lead
.r
acyclil-Y 0i a comiDleted cirviromici-ital chec1dist, and other information on
C, -
file with the lead agency.
Responsible Official Mary Lou Bl-.6ck
Position/Title Associate City Planner
Date July 7,1978 Signa ture�A
FILE #
AlkENVI RONMENTAL ASS ESSMENT.
DESCRIPTION OF PROPOSAL:
PROPONENT: 57Z,-?41,,V,!.�7 *1ZZ,._-e
EXISTING USE: r-4e*Vr oloobeo
ENVIRONMENTAL IMPACTS FROM PROPOSAL:
SOILS/TOPOGRAPHY
WATER/DRAINAGE 41eA
AIR QUALITY A-4 4-��
CIRCULATION
VEGETATION "I AA4_64-
d
ECONOMI C.
CITY SERVICES
ENVIRONMENTAL FINDINGS:
There will be certain environmental im ' pacts but they do not constitute a signif-
fcant adverse impact on the environment and no environmental impact statement
will be required.
There will be significant adverse impacts on the environment and an environmental
impact statement will be required.
There will be certain impacts on the environment however it is necessary to obtain
more information before a declaration of significance or non -significance is made.
71717f
CITY PLANNER 1 OATZ
CITY ENGINEER DATE
E/A '76
2
'3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
15
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
.41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
DATE: CALY S 1 19 -7 8
A*$25 fee will be col)ected by the City of Edmonds for analysis
of the Environmental Checklist and the preparation of a Threshold
Determination. No -fee will be charged for proposals which would
be categorically exempt if they were not located in an environ-
mentally sensitive area. I
ENVIROMIENTAL CHECKLIST FOP-1-1
1. BACKGROUND
1. Name of Proponent g:5,-rF'j?Lj Nj!�, H I L(..F-tz
2. Address and Phone 11 "Iber C)i Proponent:
r>1 z -.1. 8 Gr ,&,v F_ , - W .
F_I>I-AOKM& 6,3 A 0% F3 OM 0
3. Date Checklist' Submitte-d -JUL',-(-- S, ) 19 -7 9
4. Agency Requiring Checklis�
5. Name of Proposal, if applicab-re--
_-=-mm L_ I kA 6-A CMOS7-
6. Nature and Bri�L �I)escrij-)C—Jonot the Proposal (incluU_-
ing but not limited to its s . ize, general ciesi,-,,n cle-
ments, and other factors that will f;
,ive an accuraLe
understanding of its scope and nature);
W-JI-r e_-OPj-_oHjAJICAM F;CO,)EC-r
7. Location of Proposal (6oscribe the *pS�ysi_c_TiT T_eLuing of
the proposal, as well as the exLent of the land area
affected by -.iny cnvirohmenLal impacts, including any
other informati.on needed to give an accura�_, understand-
ing of the environmental setting of the proposal):
W00t::)F_I> SLOFIO& -rO -rKF-
8. Estimated Date for Completion of _CnU Prollo—sed-Action:
PF-C- , I ':� -7 6
9. List of al rMItS, LICCIISCS (I!: GOVOI:11',I!OIIL i%ppro ;77
'ITS —
Required for the Proposal (federal, state and local --
including re on S) :
13UILDI�_)4 -PIECHrT,
?P_MMt-r , FLA-"PIAJ�-A'
A, - t> Vt '69MO&L /EbMaMnt%.
-31-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
10. Do you Ore any plans for future . additiolp, expansion,
or further activity related to or connecced with this
proposal? 11 yes. explain:
00
11. Do you know of any plan y oLhers which may affect
the prop ty covered by your proposal? If yes, explain:
-12. Attach any other application forin that has been com-
pleted. -regarding the proposal; if none has been coin-
pleted, but is expected to be filed at sonic future
date. describe the nature of such application form:
0.441,- -
II. EIWIR01,111,11ENTAL IMPACTS
(Explanations of all "yes" and "maybe" answers are
required)
Yes
Maybe No
(1) Earth. Will the proposal result in:
(a) Unstable earth conditions or in
changes in geologic substructures?
(b) Disruptions, displacements, com-
paction or overcovering of the soil? y,
(c) Change in topography or ground
surface relief features?
(d) The destruction, covering or
modification of'any unique geologic
or physical features?
(e) Any increase in wind or water
erosion of soils, either on or off
the Site?
(f) Changes in deposition or ero-
sion of beach sands, or changes
in siltation, depositio 11 or erosion
which may modify the channel of a
river or stream or the bed'oC the
ocean or any bay, inlet or lake?
E�ination:. e=0 H E (5% M AJ> I ki eA 4 r-ILLIAJ/. X
(2) Air. Will the proposal result in:
(a) Air emissions or deterioration
of ambient air quality?
(b) The creation of objectionable
odors?
(0 Alteration of air move I ment,
moisture or temperature, or any
change in c' LiTtate, either locally
ARMAK - 4 So CY
ASO 'C--Y e_vr)
or regionally? X,
Explanation: MAX 131L some 10 C_TZ CA-S-E P V_
to I f-; C V_ C AC. E r=? -rmP,,-fRc_ -
-32-
J:ILL 4
0
2
3';
4
5
61
71
8
9
10'
1111
12 i
13 i
141
15
161
17
181
11 1
20
21
22
2311
24
25
261
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
.55
56
57
58
Yes Maybe No
(3) Water. Will the proposal result.in:
(a) Changes in currents, or the
course or direction of.water move-
ments, in either marine or fresh
waters?
(b) Changes in -absorption rates,
drainage patterns. or the rate and
amount of surface water runoff?
.(c) Alterations to the course or
flow of flood waters?
(d) Change in the amount of sur-
face water in any water body?
(e) Discharge into surface waters,
or in any alteration -of surface
water quality, including but not
limited to temperature, dissolved
oxygen or turbidity?
(f) Alteration of the direction
or rate of flow of ground waters?
(g) Change in the quantity of
ground waters, either through
direct additions or withdrawals.'
or through interception of an
aquifer �y cuts or excavations?
(h) Deterioration in ground water
quality, either through direct in-
jection, or through the seepage of
leachate, phosphates, detergents,
waterborne virus or bacteria, or
other substances into the ground
waters?
(i) Reduction in the amount of
water otherwise available for
public water supplies?
Explanation: --rHERE WIU-
VA
76 DV_VF_rL_t a2btA/UE�o kv ATC ft A&v4Y
Ptum W-06 Z x -ts- r I P CA 5 RE A #.-T A.AJ rL\JEAj r-L.0", tzA,-rF-,
(4) Flora. Will tLe proposal result in: T>ESI&N -rO PL%( j,, rrJ4
(a) Change in the diversity of
species, or numbers of ally species C.,
Of flora (including trees, shrubs,
grass, crops, microflora and
aquatic plants)?
(b) Reduction of the numbers of
any unique, rare or eudangered
species of flora? JL
-33-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
.19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
It 7
48
49
50
51
52
53
54
55
yes
Maybe No
(c) Introduction of new species
Of flora into an area, or in a
barrier to the normal replenish-
ment of existing species?
(d) Reduction in acreage of any
agricultural crop?
Explanation: V- PIM 7MEF-S
I--, I LL
IA, R Lo A
rET 4, 1 W7.
(5) Fauna. Will tile proposal result in:
(a) Changes in the diversity of
species, or numbers of any species
of fauna (birds, land animals
including reptiles., fish and shell-
fish, benthic organisms, insects or
microfauna)?
(b) Reduction of the numbers of
any unique, rare or endangered
species of fauna?
(c) Introduction of new . species
of fauna into.an area, or result
in a barrier to the.migration or
movement of fauna?
(d) Deterioration to existing
fish or wildlife habitat?
ExplanaLion:
(6) Moi se - Will the proposal increase
existing noise levels?
Explanation: T WE Z F- A-,Y M F— so ^4 r
r-A,M I L I Cc, ,
(7) LiLht and Glare. Will the pro -
light or
glare?
Explanation:
(8) Land Uso. U'ill the proposal
Fi-s—LiF�LLn the alteration of tile
present or planned 1z"Id use of an
area?
Explanation: -ri4F_ PUMAL kALA- wo-r c�j4te
L Llk— Q #J r7-'ZL--1A—S. rK MG--M' k—IL—L oe— A r--
P rL V.E W -I- CA S 7- Mo &A A, V Ac.A,1'J-r
-34-
Yes No
V
15
1E
15
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
-50
51
52
53
54
55
56
57
58
I
(9) Natural Resources Will the pro-
P 0 s IT —rc E�T_C i —n-
(a) Increase in the. rate of use
of any natural resources?
(b) Depletion of any nonrenewable
natural resource?
Explanat�ion* k E rl FE
P At CL EL L rt
11 Ir L tj ro _r A-
(10) lZisk 0 .11pset. Does the proposal
ln�vo ve a risk of an exPlosion or
the release of hazardOLIS substances
(including, but 'not limited to,
oil, pesticides, chemicals or
radiation) in the event of an acci-
dent Or Upset conditions?
Explanation:
(11) P i -
L9P11 at'011, Will the Proposal
at—L—CF—t1le 10cation, distribution,
dcnsj-ty, or growth rate of the
huma n population of an area?
Explanation:
— I X
X
r A. o -r i ou
L L
(12) llousinL. Will the proposal affect
F),7Tj_,-;_t71.11F, flousing availabilic Y, or
create a demand for additional
housing?
X
Explanation: L Orzaij i mL- . Mo 0 (.4 C,
___n -tZF-_ _H.. 4J
(13) Tri-11-1sporra t,.Lojj/Cj rculat ion. Will
__ __ 1 S
_Tle PI-OPOsO r L' - - u 117 _n
(a) Generation of additional
vehicular movemellt?
EHOCts on existing Parking
facilities ' or demand for IILw
parking?
(C) Impact uPOn existing trans-
Portation systems?
(d) Alteratiolls to prLsellt
patterns Of cil:culacion 017 moVe-
Ment of People and/or E,
'Oods?
(e) Alterations to waterborne,
rail or air traffic?
-35-
1
2
31
4,
5
6
7
8
9
10
11
12
13
14
15
16
17
18
,9
20
21
22
23
24
25
26
27
28
29
30
31
32
33
,34
35
36
37
38
39
401
41
42
43
44
45
46
147
48
49
50
51
52
53
54
55
56
57
58
59
60
61
0.
Yes Maybe No
,(f) Increase in traffic hazards
to motor vehicles, bicyclists or
pedestrians?
Explanatio n: -T.�VMZ M A-'� Be e=.6NF_ I Ai r-ME All
(14) Public Services. Will the pro-
-effect
F67;_a1_I:�Yv_ea11 upon, Or
result in a need for now govern-
mental services in any of the
following areas:
(a) Fire protection?
(b) Police protection?
(c) Schools?
(d) Parks or other recreational
facilities?
(e) Maintenance of'public facili-
ties, including roads?
(f) Other governmental services?
Explanation: mp,�j t4 V_ & ; C. 0 r. 14T
EIF
IECT'
c.Apor-1- ALL -rk*V- AWkirz P(A :to -rk4rL
0 j�;'- - is JrA." I &A IE S -
(15) Energy. Will the proposal result in:
(zj) Use of substantial amounts of
fuel or energy?
(b) Demand upon existing sources
of energy, or require the develop -
menu of new sources of energy?
Explanation:
(16) U. L i I i t i e s . Will the proposal
restTE—TPE. a need for qvstems,
or alterations to the following
utilities:
(a) Power or natural gas?
(b) Corrmiunications systems?
(c) Water?
(d) Sewer or septic tanks?
J-1
(e)_. St orm water drainage?
(f) " Solid waste and disposal?
Elxplanation:
-36-
10 A L�_
j=,4M I C. I q�Q
I-0 C) "
2
2
2
2
2
2
2
2
2,
31
3'
31
3.'
31
3!
R,
3?
38
39
40
41.
42
43
44
45
46
47
48
49
50
51
52
.53
54
55
56
57
58
59
1 (17) ' Human
--�Wwill tile Proposal
12 rcs—ul-t--i 1-1 L reation of ;Illy
*3 health Ilaza
'a
I - Cle Potential health
41 hazard (excluding mental health)?
5
61 Explanation:
10
11
[2
L3
L4
�5
.6
.7
.8
9
0
1
2
3
4
5
6
7
(18)
Aestlicti.cs. Will tile proposal
F—CsUYE —in the obstructi.oll of any
Scellic vista or view open to the
Public, or will the proposzll rc-
Sult it) the creation of all
aesthetically offensive site open
to public view?
Explanation:
(19) Recreation. Will tile proposal
j7
esu L n an impact upon the
quali.t:y or quanCity of existing
recreational opportunities? .
Explanation:
(20) Archeolq_CL�,a i pli %torical. Will the
—ro —P0 -11; -i -11 fLcraLion of
F0 "GTC�111 iri—T
a significJ"t archeolOgical Or his-
.torical site, structure, object
or building?
Explanation:
Ill. SIGNATU1071
Yes No
- Y,
. I, the undersigned, state that to tile best of iny knowl.ed8c
the above informaLioll is true and
that tile. lead aAency may withdraw cor'l) 1 c t C - It is understood
ficanCe that any declaration of non-signi,
th C "ll-Olt issue in reliance upon this cllCcl-liSC
should er be any misrepresentation or lack of fuII disclosure
on Riy part.
Proponent:.
14AC 197-1.0-370 WITHDRAIIAL
any tj.rne OF AFFIR;,IATIVE TINIFS11OLD
after thefentry of a declara-
tion of sipnificance, tile pi:oponent modi ics Che proposal
-1 t I
So t"' jUdL1;111C'nL Of tile lead, a
adverse enviro11111(,1lt,.�,I i111- j, c, ncy, 'III SiP,"i.ficant
ated, k)a c t� resulcill '
the declaraLion of sii'llif i R, therefrom are elimin-
and a declz1r,1t:i0n of 11011-Signi cance �Illall be withdraial
le"d �'V,011U Shall. al f'"'Ice c"ItOred instead. The
public informati so revise tile re 9'st-"Qrs at its SEPA
ponent on conLer accordingly- If tile pro- '
shall 11 of a PrOPO:'111 * is z1 Private appl.icant he proposal
OV be collsidered modi.fic!d until 11.1 ii,
tiOns for the propo cellse DPplica-
sal are revised to reflect tile modification.
-37-
9
CITY. OF - SOMONDS
CIVIC CGNTER - CI)MONDS, WASHINGTON'98020 - (206) 775-2525
COMMUNITY DEV�LOPMENT DGPARTMF_NT
DATE: April 19, 1978
T 1 0: Sterling A. I'liller '
19423-86th Ave. West
Edmonds, Wa.98020
HARVG H. HARRISON
MAYOR
13 Unit Condominium
-SUBJECT:
19515, 19519 and 19523-86th Avenue West
TRANSMITTING: Copy of Specifications for Fire Protection
,System Check Valves, Vaults.and Appurtenances
AS YOU REQUESTED:
FOR APPROVAL:
FOR YOUR FILE:
REVIEW AND COMMENT:_
.COMMENT AND RETURN:.
FOR CORRE CTIONS AND
RE -SUBMITTAL:
REMARKS:
BUILDING DIVISION
chment
atta 2ji,
CITY OF EDMONDS
CIVIC CENTER - EDMONDS, WASHINGTON 98020 * (206) 775-2525
COMMUNITY DEV2LOPMENT DF-PARTMENT
DATE: April 18, i97,q
TO:Mr. Sterling A. Miller
19423-86th Avenue West
Edmonds, Wa. 98020
HARVE H. HARRISON
. MAYOR
SUBJECT: 13 Unit Condominium-19515, 19519 and 19523-86th W.
TRANSMITTING: copy of Engineering Requirements
AS YOU REQUESTED:
FOR APPROVAL:
FOR YOUR FILE:
REVIEW AND COMMENT: x
COMMENT AND RETURN:
FOR CORRECTIONS AND
RE -SUBMITTAL:
REMARKS:
BUILDING DIVISION
attachment
0
MEMO TO:
DATE: 411-1 lie
Building Division
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT: k9rp IS)' 1 19515 11c)523 - G6::>n AN a LOT I S - I
I Ir's U N t T C-0 tJ r-)QV I KJ I U IV\ --STE5 Q- U K)C-7 rV'
After review of the subject building permit application, we have
the following comments:
_(l) Coordination of the location of any structure with respect to
utilities, streets, property lines__a_n_J_J`Hiveway grades is
res_ponsibility of the contractor.
2) The contractor is required to keep the abutting streets clean-
ed of dirt and debris caused by the construction.
(3) A "Right -of -Way Construction Permit" is.required, from the
Engineering Division of Public Works, for any work within
the Public Right -of -Way or public easement.
_(4) Driveway slope not to exceed 14%.
10 EE C)mm !:kmm nr- EGI-VT OF WAY 2EMI q=M ON A T* -AN& W-
(C-OSITE DWtJ"g 29M APPRCNM QWK66 ff- PLAN 0" FILF,-
(3) EYMO 0 U pil-ANAM MAI W 0 N S-UM ME W EQ*1 EKAkSE&W
rrynr-�Le CE:� me Cffar=9_M,K[M ANO F)Q�ff WYDPAr�31 R154D,
(10) r)0 M I Rr'D ForL I JIE� [M PQO\lg M BMIS So pw I
C05T 8�511MA-Jy==
PW 5/77
0
9
CITY OF EDIVIONDS
CIVIC CENTER - EDMONDS. WASHINGTON 98020 (206) 775-2525
FIRE DEPARTMENT
April 4, 1978
Mr. c-uad Mrs. Sterling A. Miller
19423.- 86th Avenue West
Edmonds 7 WA 98020
HARVE H. HARRISON
MAYOR
RE: .13 UNIT CONDOMINIUM, 19515, 19519, 19523 - 86th AVENUE WEST
Dear Mr. and Mrs. -Miller:
Please note the following changes required by the Edmonds Fire
Department:
1. Install standard hydrant as indicated on Sheet 1 of Print,
per City Code 10.10.060 (F).
2. Provide fire extinguishers accessible to each unit as
indicated on.Sheet 1 of Print. Extinguishers must have
a UL rating of not less than 2:A, 10:B'C.
All extinguishers shall be protected from the weather. To accom-
plish this, boxes with break -glass fronts should be installed.
Yours for a safer community through fire prevention.
Jack F. Cooper
Fire Chief
C oo-��
Gary (4-1cCoinas
Fire Marshal
GM/wrim
cc: Building Department
David L. Kinderfather, Architect
61 Ty Cofpy F I LE
CITY OF EDMONDS
CAVIC CENTER - EDMONDS. WASHINGTON 98M (206) 775-2525
FIRE DEPARTMENT
April 4 7 1978
Mr. and Mrs. Sterling A. Miller
19423.- 86th Avenue West
Edmonds, WA .98020
HARVE H. HARRISON
MAYOR
RE: 13 UNIT CONDOMINIUM, 19515, 195199 19523 - 86th AVENUE WEST
Dear Mr. and Mrs. Miller:
Please note the following changes required by the Edmonds Fire
Department:
1. Install standard hydrant as indicated on Sheet.1 of Print,
per City Code 10.10.060 (F).
2. Provide fire extinguishers 'accessible to each unit as
indicated on.Sheet 1 of Print. Extinguishers must have
a UL rating of not less than 2:A, 10:B,C.
All extinguishers shall be protected from the weather. To accom-
plish this, boxes with break -glass fronts should be installed.
Yours for a safer community through fire prevention.
Jack F. Cooper
Fire Chief
? (JA��
."�" / � 1AC
Gary VcComas
Fire Marshal
GM/amm
cc: Building Department
David L. Kinderfather, Architect
PROJECT NAME
DAT". I I TTE D G - 76
ENVIRO,"INEINTAL ASSESSfIENT
In order to meet the requirements of the State Envi ronmental Policy Act of 1971,
the responsible official must make a declaration of environmental impact as early
as possible in.the process of eva.luating a project.
The inforniation in this form viill be used to determine whether it will be necess-
ary to r tal imoact statement. If an impact statement is
not required, a Statement of Negative Declaration will be placed in the file.
If an impact statement is required, a draft statement must be filed with this
office, public notice given and a revie,,,i period of 30 days allowed. The final
statement and comments must be. filed with the Department of Ecology, Office of
the Governor and t.�ie Ecological Commission.
The Edmonds Planning Staff will assist you in any way vie can in accumulating
this information and %�ie would appreciate your cooper'ation.
1 . Land:
Area in acres I - E>'9
1i INJO SEP'"c-
Soils type 113 "A\/*-?-T0FSo1L -TO OARDFAN Limitations (WILLF, JE
Description of topography (% slope) SL-OPIE 1Z L4 P /-11 �4 C-1
f4 Fe>rZ-r0t--b _00 -TRE.
>E
Grading: estimated cubic yds.
NOTE: If g' rading or filling
% exceed 500 cubic yards
Filling:* estimated cubic yds. -4 -a grading and filling plan
must be submitted 4i'Lh the
2. 1,i6,t'e r: application.
Stream - estimated flow (cubic feet per second)
Will stream be altered?
To what degree? - W I _#_ -
Impact on storm drainage (increase in run-off) = �k F_ D
,FF
<��"A- L-C LA L')Mq� 10 t4 "� bk IE oTs
Estimated area to be paved -Z B A. C_ 1Z r=. 5 % -7
Estimated area in open space 00 A-. C (UE _1> %
Shorelines: within 200 ft. of 'clean Hig;ier High I -later
Adjacent to shorelines zone tth-�
Environmental A page 2
3. Vegetation:
Type of trees % to be removed- 70
Minimum diameter of trees to remain tl o 10 % m LA M
Ground cover —,!5,1ZASS % to be removed S07o
Proposed landscaping, if any -5F—E. A1-T"TA.C-1-k-rZ'> 11O-rTF— FITLAIW -
4. Existing Land Use within 300 ft. radius of proposed development.:
Vacant
Single
Family
Mu I ti -
Family
Comm.
Other
North
Sout-II
East
Vies t
5. Ci rcul ati on:
Estimated increase in auto trips daily
Estimated demand for public transportation 4So " F—
Ar.�,omot-4A,(-
Degree of change on adjacent streets -4-5 --rf?-Yps r>'Asc-(
0 b4 4S7-rz-E IZ-7
6. Area of imoact:
neighborhood — I X
ci ty-vii de
regional
7. Effect on air quality:.
8. thanges in noise generation: MJt41MA.L-
f
f�ECORDEQ
T
780377
780378
780379 -3 A14 10" 5 6'
1978 MAY
'RY 8. WHALEN. AUDIT
DECLARATION OF RESTRICTIVE COVENANT HIN OR
SNOHOMISH COUNTY.WASH.
C:)
We -
Or
WHEREAS,
CD
are the owners of the following described real estate in the-..
City of Edmonds, to -wit:
T=
ea 10 ph% 'Qt-r kA V—_- As
\-46 r--- -5 40 4.vr-lr q___ ve- VD V= 16 0 % le F"i a I;E:-% wt
Z-2
S -ft,-r A.
V-4 I=- C- "29 V\
3S
0*. ia
57 44- iF— A56 1=;'*, -5_7 Ab,- -& = -4,9
V-1 A" lz� '�L ea- S9 le_E 006. T> \,5—% A.. '0- k04-030!
5;9' e AQk.
WHEREAS, the above named owners are desirouso
imposing a restrictive covenant upon said premises in compliance
with Section 11.02.036 of the Edmonds City Code.
AVITNESSETH: that for and in consideration of the
premises, the above named owners do hereby declare and grant to
the City of Edmonds as Grantee the following restrictive
covenant, to -wit:
That at the time of the execution of this Covenant
the Grantors have agreed or the Ordinance of the City of Edmonds
provide that no building for multiple family housing may.be
erected on subject property containing more than V3 units.
19 C)
ic-S V-t7 rZ C-=- c' ;z
;
-T- V-A 'E--_ %-.x c;z--
S
.
e- r-_=
VV
-3 73� S3 4. 7.
7B
Z2!
DECLARATION OF RESTRICTIVE COVENANT - 1
78 0 5030197
antor
STATE OF WASHINGTON
ss.
COUNTY OF SNOHOMISH
On this day personally j�ear;ed before me
and A
to me known to be the individuals descridic, in and who executed
the within and foregoing instrument, and acknowledged that
they signed the same as their free and voluntary act and deed,
for the uses and purposes therein mentioned.
GIVEN under my hand and official seal this At
day of 197q
Notary Public in and for the Sta—te
of Washin t iding at
a
DECLARATION OF RESTRICTIVE COVENANT 2
.7805030197
PROJECT
CITY OF EDMONDS
BUILDING DEPARTMENT
Apartment & Commercial Plan Review Checklist
OV-SIT . of
DATE RECEIVED PRELIMINARY
ADDRESS
OWNER
ARCHITECT
USE
CODE
-7803-79
FINAL PLAN
PHONE
FIRE ZONE OCCUPAI I 4CY (501)-,4 NO. STORIES
TYPE OF CONSTRUCTION OCCUPANT LOAD
1. 'AREAS & VALUATION
BASEMENT
SQ.FT.@
SQ.FT.=
$
lst FLOOR
SQ.FT.@ S Q.FT.=
$
00
2nd FLOOR
SQ.FT.@—
SQ.FT.=
$
3rd FLOOR
SQ.FT.@
SQ.FT.=
$
OTHER SQ�FT.@ 5
SQ.FT.=
$
6 0
TOTAL:
PERMIT FEE
PLAN CHECK FEE
$
2. PLUMBING
NO. FIXTURES
DISTANCE TO METER
BUILDING"SUPPLY SIZE
MATERIAL
FIXTURE UNITS
METER SIZE
PER14IT FEE $
'77 asd
CITY OF EDMONDS
BUILDING DEPARTMENT
Apartment & Commercial Plan Review Checklist
PROJECT V-�)' UOIT' kC)ODO
DATE RECEIVED
4- UM Cr
7803-78
FINAL PLAN
ADDRESS
OWNER
ARCHITECT
USE
FIRE ZONE
TYPE OF CONSTRUCTION
1. AREAS & VALUATION
PRELIMINARY
CODE
PHONE
OCCUPANCY (501) NO. STORIES
OCCUPANT LOAD
BASE14ENT SQ. FT. @ SQ. FT. = $— -
lst FLOOR —::�:?�SQ.FT.@ SQ. F T - = 4
2nd FLOOR SQ.FT.@---- 45 SQ.FT.= $ 30
3rd FLOOR -.SQ.FT.@ SQ.FT.= $
OTHER—(,q SQ. FT.@ SQ.FT.= $
TOTAL:
PERMIT FEE PLAN CHECK FEE $-/10
2. PLUMBING
NO. FIXTURES
DISTANCE TO METER
BUILDING'SUPPLY SIZE
MATERIAL
�� ulirr
.&FIXTURE UNITS
METER SIZE
PER14IT FEE
177 asd i � -1-
780377
Ll> CITY OF EDMONDS
BUILDING DEPARTMENT
Apartment & Commercial -Plan Review Checklist
PROJECT Tb (4 vorr
DATE RECEIVED PRELIMINARY FINAL PLAN L"/
ADDRESS
OWNER �,J �A I L Lt-V-
ARCHITECT v t�. J L It, PHONE 77S— Cl'�,9L
n L.
USE- QVvIlin CODE -7-
FIRE ZONE OCCUPANCY (501) NO. STORIES
TYPE OF CONSTRUCTION OCCUPANT LOAD
1. *AREAS & VALUATION
BASE14ENT ___2eb00 - SQ. FT.@ SQ.FT.= N
Ist FLOOR *30"A4 SQ.FT.@ 16-75 SQ.FT.= $ Lo,
2nd FLOOR *36 �O SQ.FT.@ SQ.FT.= 361
3rd FLOOR - 'SQ.FT.@ SQ.FT.= $
OTHER
.SQ. FT. $
TOTAL: $
PERMIT FEE $ e--2 93 -PLAN CHECK FEE
2. PLUMBING u_Q A Lq- AA4��
NO. FIXTURES !av�,
SQ. FT. @
U./�� �_x )
FIXTURE UNITS
DISTANCE TO METER -qD (o 6 t METER SIZ
BUILDI14G SUPPLY SIZE vk W 1;�� -
-Z= PER14IT FEE
MATERIAL
c
77 asd
fa�
e2, 9�
__ __ a 14 -1-
+ :T3og.
P��" t-4 L;7
TI&XV
yi
44
I iie the
orner.
5 284,*,fW-:-f
T1
id
w6i
`l 4
anc c
91 W
79 44-0
nc
0;3 x L 0. .5 7 1744 it
1, 9 'the
t
5 9r.
rp. cv.
0
i�tsil*�e� 4 9-# 1,
0
ekiriti.int
J9.-%, !0_Y,4,
I a
ESS t fie .3*%
W6n�
0
EV.
P5
"TAXE-N
1"')
4t;. jj ".M'
nnjjj,, A
;"q J 'r.0 M� th 6
Orner.. a
"O-F,3 5 0 a r a
Sa: ,
id
I'Z
91.
14
rl r al
'pk
"0
03
bj�
8 ,5
4e 1 7'v74"` J,
nc of -'174"
19 S"�O
of' 4, �f lene
e.
3 ID
e
A,- A
o, 4 4,7",
- N1,
7
J
-4,44.
tl* -:U
t6
h
d",
Vo
tr� 6it,:�,
Q'� 3 5
"L. c
r
orner,
Al
'd E",6&rp-'j- k
0 S4
N 0 3 5 2 8:4, -W .9' 1
6UU1146
-cant t, "i
G-t4nCQ- bf-
14.9 f
03',
0A
a.:
f 6.4 t
d
01 :sA
303,
"E6, the.
. . . . . . . . ...
V
W r? ICAI'5S
V -
PET'...
0
k E-N,
IF
K
R r"p,
4 -1 11
Of
?
to, jc,
L, eg
Ovo
tiegi.
Pcv nt,i- 6
R "!
6 35
CO'rii'dr.
ccal ti 'i
fi
99,
OTC 03
%I �
One
. . 1.
th 8
'A. 1:
a f S,10'�+3P.�--�--�,j��;.
1 (7)
t
tha-Pbin''
the.,, -
A
30
pof
N,5:-M, .
4, 3.
. 41+
2 s AJ��
4XPOU UWT:5 Q-)
Vf
2,y
C) (D
P2,
No 0 Tfl"
TO PERMITTEE AND/OR OWNER
n PARTIAL APPROVAL
F-I VIOLATION
><CORRECTIONS REQUIRED
PERMIT
NUMBER�79();�)pjq]K-
Fjo,, V=-� � — s,> 4-c';—Aue - W -
FNO PERNaT — STOP WORK — REMOVE CONSTRUCTION OR OBTAIN
J PERMIT AND MAKE WORK COMPLY WITH BUILDING LAWS.
CONSTRUCTION IS NOT IN ACCORDANCE WrM APPROVED PLANS
AND PERMIT — STOP WORK. MAKE EXISTING WORK COMPLY WITH
kPPROVED, PLANS AND PERMIT OR REMOVE IT.
T
s� OP WORK — UNTIL AUTHORIZED TO CONTINUE BY INSPECTOR,
CORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN
BE APPROVED.
0 WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED.
CONTACT INSPECTOR AND
ARRANGE FOR APPOINTMENT. RECALL FOR INSPECTION
CU '!:-; —to AL-t-
LA ik--;—i I L-- 'EF
a LA Rc-
iLL
S f) AC 6-7- 0 AJ P C—�e- L
1
ACA-01S t--tC-L b,
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED
WITHIN .................... DAYS OR PENALTIES IMPOSED BY LAW MAY BE
APPLIED. FOR INSPECTIONS CALL: 775-2525.
BUILDING DIV.
INS -TR PUBLIC WORKS
VC F
CITY OF —719 Tj FIRE DEPT.
EDMONDS DATE 0.
NO T' C E
TO PERMITTEE AND/Olt OWNER
F� PARTIAL APPROVAL
F� VIOLATION
CORRECTIONS REQUIRED
PERMIT
NUMBER
I I
JOB ADDRESS
NO PERNaT — STOP WORK — REMOVE CONSTRUCTION OR OBTAIN
PERMIT AND MAKE WORK COMPLY WITH BUILDING LAWS.
CONSTRUCTION IS NOT IN ACCORDANCE WITII APPROVED PLANS
El AND PERMIT — STOP WORK. MAKE EXISTING WORK COMPLY WITH
APPROVED PLANS AND PERMIT OR REMOVE IT.
F-1 STOP WORK — UNTIL AUTHORIZED TO CONTINUE BY INSPECTOR,
ECORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN
l BE APPROVED.
F-1 WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED.
CONTACT INSPECTOR AND
ARRANGE FORAPPOrNTMENT
0 RECALL FOR INSPECTION.
61
rill) U 1,A V, Ai-t
L,�,, A L�-
- -SO �%-H
L,-, iZZS 7 /?
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED
WITHIN .................... DAYS OR PENALTIES IMPOSED BY LAW MAY BE
PLIED. FOR INSPECTIONS CALL: 775-2525.
J!�BUILD]Nd DIV.
PUBLIC WORKS
CITY OF A --vc)
EDMONDS DATE FIRE DEPT.
N 0 tg'(
TO PERBEITTEE AND/OR OWNER
PARTIAL APPROVAL
VIOLATION
CORRECTIONS REQUIRED
PIRMIT
NUAMER
JOB ADDRESS
FNO PERNaT — STOP WORK — REMOVE CONSTRUCTION OR OBTAIN
PERMIT AND MAKE WORK COMPLY WITH BUILDING LAWS.
CONSTRUCTION IS NOT IN ACCORDANCE WITH APPROVED PLANS
AND PERMIT — STOP WORK. MAKE EXISTING WORK COMPLY WITH
APPROVED PLANS AND PERMIT OR REMOVE IT.
STOP WORK — UNTIL AUTHORIZED TO CONTINUE BY INSPECTOR.
ECORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN
l BE APPROVED.
WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED.
CONTACT INSPECTOR AND RECALL FOR INSPECTION.
ARRANGE FOR APPOINTMENT.
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED
WITHIN .................... DAYS OR PENALTIES IMPOSED BY LAW MAY BE
APPLIED'.,FOR INSPECTIONS CALL: 775-2525.
�&BUILDING DIV.
-1 PUBLIC WORKS
lj"p c-toR F
CITY- OF A F] FIRE DEPT.
EDMONDS DATE
REGARDING:
(File Title)
R E C 0 R D OF C 0 N T A C T S
DATE
NAME: PHONE NO. &
ADDRESS OF CALLER
COMMENTS
ACTION TAKEN
INITIALS
Cm At
all
ui
mums
U.
U3
i-,)r,-Fq
kir 1780
CITY OF EDD101
RECEIVEL-D
MET
DESIGN CRITERIA SThs EU
MI I TLER -1978
7
A. 10 Year Return Frequency
Public Works Viept.
B. Total Acreage (.93 Ac.)
EXISMIG CONDITIONS
Q - CIA
Q - Flow Allowable MEYRING & ASSOC., INC.
- Runoff- -Coefficient
I - Rainfall:Intens,ity,.In./T1r. 23423 Highway 99
A = Area Acres Edmonds, WA 9'8020
T - time of Concentration
Qo - Allowable Flow/Acre P., 0. Box. 32 Lynnwood, WA 98036
To 10 + 3 23 7) 17. 6V�n.
14 778-3101
0-1 CFS
QO Q .22 .38
(A) (Future C) .93 .63
Use Formula for Orifice outlet Condition. FUTURE C
Area Dev. 11C11
T - -25+ P 17621.Qo 13tal new asph parking lot .28 Ac. .9
4M9 Total- new roof area 29 Ac-.- _9
= -254) 1762/( i.38 .57 Ac.
vs - Storage/Acre Area,Undev.. ;1C11
.36 Ac.'
Vs 2820T 40 QoT
T + 25
3
vs �820( 4.3��,62 40 4-3'.09 C .38 1.1.29.8Ft. /Ac..
743. d,9'' ) + 25 -
FUTURE C 57) (.9) + (.36)(.2) .63
V Total Vs X A x Outure C) .93
V 1129 A .63 93 662 Ft.3 CITY OF EDMONDS
P. W. DEPT. ENGINEERING DIV.
EXAMINED
ORUIM DE -SIGN DATE
By
.62'(Sh�rp Edge Orifice) REMARKS
Q Allowable .- .62 a) 2g h
h Vert. Dist Between Headwater Surface and Ctr. line of Orifice
a Q
.,62 ? 2 gh
a p22 '.Ft..
.62 (64.4) 2. 5
.19 Ft. 2.26 In.
d 4 .03
CL,
.r.
IJ Z, f A-, P.
M �-,m
An
m M,
t--�--RBENUON/DETENTION BASIN LUUA11.UNS
ITYEAR-DESIGN
STORM
-25 YEAR DE
IgN STORM-
AREA
TYPE -OF OUTLET�..'
'.PEA-K STORAGE
(MINUTES.).-
MAXIMUM
STO%G5
PEAK STORAGE
'TIME
;MAXIMUM(STO
TIME
.VOLUME.(FT3
AC
(MINUTES)
VOLUME
FT
1%G5
AC
RENTON'
ORIFICE.WITH H(AD,
T 25 L1�7!6 2
0
s
.2820 T
—T—+Tg--
40
QOT
-25+ 2138
v s
3420 T
Q0
QOT
t'SEATTLE
-T+2�
vs
elk�
CONSTANT FLOW
1175
T 25
2820j
60
;42
:5:
-T=-25 7-�o
v s
3420 T
Qo
T+25
QOT
T+25
-761
Q-
0
--
T=-25 411175
0
Vs
3000 T
40
2194
T 2 5 �n.
V s
3 510 T
rp
ORIFICE WITH HEAD
- Qo
T+2!�
QOT
Qo
QOT
TACOMA
T+25
CONSTANT FLOW
�1250
VS
3000 T
11:4 6 3
v
T 2 5 n
Q0
T+25
QOT
-T �5 n
Q 0
3510 T
—
T+25
60
QOT
NO"H
ORIFICE WITH HEAD-
f 22-55
T=-25+
Vs
3.6W T
TE27
v s
4329 T
T+�!5
40
QOT
T= 25+ 00:67
Qo
T +25
4 0
QOT
BEND�:
CONSTANT FLOW
1503
T=-25+ TflQ:00T
VS
3607
60
QOT
T=-2)5+ fjl��804
V s
4329 T
T�25
Qo
T+25
60
Q
SNOQUALMIE*
ORIFICE WITH HEAD,
-25 + 4 0, �16
T= n_
Vs
6522 T
40
QOT
5013
2 5 Tho
v s
80 20 T
40
T+25-
-'
QO
T+25
QOT
PASS
CONSTANT FLOW
2718
T --2 5 --
vs
6522 T
334?2
T=. 25. -
v s
.8020 T
oo
T + 2'5—
60
QOT
(yo
T+25
60
QOT,
ORIFICE WITH HEAD...,T=-25-
.172E6 O�3
Qo
Vs
4-1-64 T
40
QOT
T�=-25+ 3 �7:5�
v s
4920 T
40
QOT
T+ 2!T
Qo
T+25
VS
'CONSTANT FLOW
T 2 5 - 7 3 5
4164 T
60
QOT
705:0:
T!=-25+
v s
492Q T
T+25
0
Q0
T+25
60
QdT
TABLE 1
REET FILOOS90
STra
RUNOFF.FACTORS FOR STORM SEWERS
FLAT ROLLING
10-S%
UNDEVELOPED LAND
Wood & Forest
0'. 10
0.1s
Sparse Trees Ground Cover . . . . .
. 0.15
0.20
Light Grass to Bare Ground. .. . . . .
. 0.20
0.2S
DEVELOPED AREA
'Pavement Roofs.
-0.90
--A -90-
Gravel Roads & Parking Lots . . . . .
. 0.75
0.80
.City Business . . . . . . . . . . . .
. 0.85
0. 90
Apartment Dwelling Areas . . . . . .
. 0.80
0.85
Industrial Areas (Heavy) . . . . . .
. 0.70
0.80
Industrial Areas (Light) . . . . . .
. 0.60
0.70
Earth Shoulder .... . . . . . . . . .
. 0'.S0
O.So
Playground . . . . . . . . . . . . .
. 0.25
0.30
Lawns, Meadows & Pastures
0.20
0.25
Parks & Cemetery . . . . . . . . . .
. 0.15
0.20,
SINGLE FAMILY RESIDENTIAL
(Dwelling Unit/Gross
Acre)
1.0-1.5 DU/GA . . . . . . . .
. " " " ....
. 0.30
1.5-3.0 DU/GA . . . . . . . .
. . . . .
. . 0.35
3.0-3.5 DU/GA . . . . . . . .
... . . .
. . 0.4iO
3.S-4.0 DU/GA . . . . . . . .
. . . . .
... 0.4S
4.0-.6.0 DU/GA . . . . . . . .
. . .... .
. . O.So
6.0-9.0. DU/GA . . . . .. . . .
. . .
0. 6 0
9.0-15.0 DU/GA . . . . . . . .
. . . . .
. . 0.70
14
2 1/1 / 7 7
PUBLIC WORKS DEPART!= CHECKLIST
F LE19523!acsM Aw F.
BUILDING PERMITM, Et I (address) *te
0
Street Rigtit-of-Way Existing
(#-%
%M-*O REQD 10
Z
Access Easements Existing
REQD N. AV
Utility Easement Existing
REQD__N.k
W
Lot Per SU'Ddivisios— Plat
Assessor
Site Plan Checked for Accuracy
Z
Underground Wiring Reqd.
U
1
Check Accuracy of 2! qriptior�_
Z
Review by
Date , IA
4i I
%
Existing Water Main Size 4/ .5.7-
Water Main Required bx-
.
Y
Service Line Required
Hydrant Size Existing �4.k4
c4
Hydrant Reqd Per Fire Code
S i z e -6-kW
0
1-4- Check Meter Reqd.
Cross Connection Inspection
Fire,Deparnnent Connents
------
'dater Meter Charge fqd. 00,P C'/4ZO
45��P-00
Review b
Da te
Septic Tank Design Approv�d AIX
Date
Septic Tank Permit Reqd.
Pen -nit. No.
Sanitary Sewer Availabil' 4_af2__
Proi . 2- XP /-,g/-
Drm,7ing No.
File No.
Side Sewer Availability 1
Sanitary Sewer Connection Fee Reqd. A_15>W_9e_
�3:
Review by
Date V-6,
Open Ditch Existing—,Y,,T
Reqd. Ye r
Culvert Reqd.
ize
P4
Catch'Basin Reqd.
-Indicate an Site Plan
0
Shoulder drainage inaintain collection on swale open rLmoff
Manhole reqd.
—Indicate on Site Plan_�
Soil Conditions and Ground Water Field Checked
-e r e
/
Review by All
Date el - gr - Z±-
Revised: lvlO-1977
BUILDING DEPARTMENT
Applicant Fill
I
NUMUIER
rhA
i
PERMIT APPLICATION
Inside Heavy Lines
JOB
ADDRESS
NAME (OR NAME OF BUSINESS)
L FA t i—L
SUBDIVISION NO.
PLAT NAM9
ASSESSOR MAP NO.
MAILING ADDRESS
0
PUBLI C RIGHT OF WAY PER ORDINANCII NO.
TELEPHONE NUMBER
1CITY
E1>mo"1-->s
I
EXISTING RIGHT OF WAY_ 4-0
PROPOSED RIGHT OF WAY 6c)
NAME —
U
DEFICIENCY OF RIGHT OF WAY
W
U
(t
I(
ADDRESS
&--T#4- XV
STREET/LITILITY WORK REQUIRED 4YES F-1 NO
PERMIT FOR WORK IN PUBLIC R/W IN YES 0 NO
UNDERGROUND WIRING REQUIRED EYES ONO
CONNECTION TO SANITARY SEWER WYES ONO
SEPT:C TANK PERM:T REQUIRED 0 Y ES WN0
0
U
(L
CITY
er�'m 0
TELEPHONE NUMBER
—77 C, 9 1 cl C,
N A
SEPT C TANK PERM T NO
ADDRESS
(61
SEE MEMO DATED
-1111
4 ro
0
U
4
z
0
CL
TELEPHONE NUMBER
REMARKS
A.
S7-A—TE LICENSE NUMBER
CITY LICENSE
CHECK
IBY
z
Legal Description of Property (Show 8elow Or Attach Four Copies)
METER SIZE
LDING SUPPLY SIZE
w
PEMARKS
C-gics XU MU-5,
SIGN AREA
ENV. REVIEW
ADO NO.
U
L9
w
(3
ALLOWED PROPOSED
COMPLETE EXEMPT
.J
REMARKS
ILI
VARIANCE OR CU
NING REVIEW BY
DATE
GAS
NEW RESIDENTIAL LINE
ADD NON-RESIDENTIAL SIGN
DEMOLISH RETAINING
WALL
ALTER EXCAVATE FENCE
El OR FILL
D REPAIR PRE -MOVE swim
INSP. POOL
YARDS /
/5' FRONT /0 SIDE A0 REAR
ILOT COVERAGE
FIRE ZONE
9,
TYPE OF CONSTRUCTION ICODE
1
�"1�3-
HEIGHT
!�PECIA . L INSPECTOR
REQUIRED
13 YES ENO
AREA
OCCUPANCY
GROUP
OCCUPANT
LOAD
P LAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
z
NUMBER OF STORIES
NUMBER OF '4
DWELLING
UNITS
REMARKS
-w
NATURE OF WORK TO BE DONE
LA
CL
ILI
z
0
0
I-
z
PLAN CHECK FEE
VALUATION
FEE
PROPOSED USE
ILI
0�
w
0
PLOT PLAN (INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
0
J
w
>
PLUMBING
MECHANICAL
III
0
w
0
FENCE
>
t
SIGN
Z
RETAINING WALL
0
U
SWIMMING POOL
BUILDING DEPARTMENT Applicant Fil
I
PERMIT APPLICATION Inside Heavy Li
NAME (OR NAME OF
L i K� (A M IL, F rZ
W MAILING ADDRESS
z
C C TY
ITY ONE NUM89ft
EZ>M 0 N t> S-
NAME
U
W ADDRESS
I-
1
U
M CITY
ELEPHONE NUMBER
0 -7-7 R S 9 (o
NA E
0 ADDRESS
<U 14"11110
T c: Y
TELEPHONE NUMBER
z
0
LICENSE NUMBER —E-lTy —LICENSE NUMBEF
0'e - e7 j - I - ft, il
z
0
ir
u
'n
W
z I
r%
Below or Attach Four
Numuz"
not I zONER 122�2
A .. ESS
SUODIMION NO. 1 FLAT NAME -VASSESSOR MAP NO.
'PUBLIC RIGHT 0or WAY PER ORDINANCE NO.
EXISTING RIGHT OF WAY 40
PROPOS90 RIGHT OF WAY (1 0
DEFICIENCY OF RIGHT OF WAY 10
STREET/UTILITY WORK REQUIRED NVES
ONO
PERMIT FOR WORK IN PUBLIC R/W 1111 YES
NO
UNDERGROUND WIRI NG REQUIRED is YES
NO
CONNECTION TO SANITARY SEWER EYES
NO
SEPT:C TANK PERMIT REQUIRED DYES
ONO
SEPT C TANK PERMIT NO.
SEE MEMO DATED
MARKS
_N
CHECKED BY
(1-1
nrAAA A
METER SIZE
ILDING SUPPL "51ilE
— a",
iiEMAHKS
.�>u fz\k-5 4 U_
SIGN AREA
ENV. RE V' EW
ADS NO.
ALLOWED, I PROPOSED
COMPLETE I EXEMPT
REMARKS
VARIANCE OR CU
W
PLANNING =IRIEVIEW BY =DATE
YARDS
LOT COVERAGE
S.DE
0 REAR
PE OF CONSTRUCTION
CODE
HEIGHT
I M3
AREA
OCCUPANCY
I
OCCUPANT
.
rROUP kA
LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
P� NEW N / FRONT
U�RESIDENTIAL GAS
LINE FIRE ZO TY
ADD El NON-RESIDENTIAL El SIGN
DEMOLISH RETAINING SPECIAL INSPECTOR
DWALL REQUIRED
ALTER EXCAVATE FENCE YES 1KNO
OR FILL k
Ell — X—FT) PLAN CHECKED BY
El REPAIR PRE -MOVE swim
INSP. - 1:1 POOL
NUMBER OF Sj'_OF TFE��_UMBER OF REMARKS
2— DWELLING
I UNITS
NATURE OF WORK TO BE DONE
60 " r->om I tJ t CA m <�' D
ED USE PLAN CHECK FEE VALUATION
.AM [INUICATE BUILDING SET ACKS,
ABUTTING STREETS) BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
FEE
0
IL
miW
BUILDING DEPARTMENT
Applicant Fill
PERMIT
NUMBER,
PERMIT APPLICATION
Inside Heavy Lines
r? t)
NAME I MAMIE OF BUSINESSF—
ADDRESS
"5-MQ-Q&i
m
W MAILING
z
BDIVISION
NO.
PLAT I
ASSESSOR MAP Il
;t
0
CITY I E 1 11 111HONE NUMBER
rED"Ori
PUBLIC RIGHT OF WAY PER ORDINANCE No.
EXISTING RIGHT OF WAY 1! (0
t
NAME
'' I'll, 1 11-111''!
PROPOSED RIGHT OF WAY 0
ADDRESS
DEFICIENCY OF RIGHT OF WAY 10
ST"
In
STREET/UTILITY WORK REQUIRE. x
ArYES E) NO
U
M CITY
TELEPHONE NUMBER
IT
PERMIT FOR WORK IN PUBLIC RJW WYES 0
C
Cl No 3:
Ep mo lt�> S
77S -93161
UNDERGROUND WIRING REQUIRED 0
A YES NO I
CONNECTION TO SANITARY SEWER EYES 10 -1
107 m
SEPTIC TANK PERMIT REQUIRED 1:1 YES JkNO IL
OX ADDRESS
SEPTIC TANK PFIiiiiiM
CI V
SEE MEMO DATED
TELEPHONE
z NUMBER
REMARKS
0 loz_ I - 6) &� .
STATE LICEN E NUMBER
CITY LICENSE NUMBER
CHEC ED
L! f i - -A:) y - 1
7
Legal De crip tion Of Property Q�how Below Or TMtnh �F..,Cop,,r,)
METER -SIZE BUILDING SUPPLY Sl
it
—,
z
W
0
TV-E--51l (LC- �-!�Gruil[l
SIGN AREA ENV. REVIEW
I
0
ADB NO.
ALLOWED PROPOSED C014PLETE EXEMPT
REMARKS
VARIANCE OR CU PLANNING REVIEW 13Y
DATE
Y
z
0
:IJ
th
0
1
ARDS
*4
4REAR
LOT COVERAGE
NEW
RESIDENTIAL
GAS
FRONT
1,19 SIDE CaO
ADD
NON-RESIDEN
LINE
SIGN
FIRE ZONE
r�
TYPE
OF CONSTRUC 73;77ci
DE HEIGHT
ALTER
DEMOLISH
RETAINING
WALL
SPECIAL INSPECTOR
REQUIRED
A
ANCY OCCUPAI
E] EXCAVATE
OR FILL
E] FENCE
1- X
E] Y E S MNO
GROUP, LOAD
REPAIR
PRE -MOVE
_FT)
swim
PLAN CHECKED 13Y
THIS SITE IS LOCATED IN THE CITY
INSP.
DPOOL
OF EDMO N DS. LOCAL SALES TAX
I
RE
SHOULD BE CODED 31.04.
MBER OF MARKS
12 DWELLING ;B!M
UNITS
NATURE OF Wo
60 m I I'd I '�4-4 ti
S
it
I INDIEATE �BUILDING
ABUTTING STREETS
PLAN CHECK
IBUILDING
[PLUMBING
MECHANICAL
FENCE
SIGN
VALUATION I FEE
IN
ME =
I"
z
MEMO -TO:
FROM:
VIA:
SUBJECT:
tREET FILE
�d� _Z Z "" '? 2
September 19, 1978
Engineering Division
Ken K. Kukuk '
Water Division Leadman
Jack B. Mitchell
Water/Sewer Superint4&'t�//
MILLER CONDOMINIUM - 19519-86th PLACE WEST
At the present, the water line for fire protection and
domestic service serving the Miller condominium does * not
meet City standards. The discrepancies are as follows:
1. N.o pressure test has been taken.
2. No bacteriological test has been submitted.
3. The installation of the fire line is not
complete.
4. The domestic meter has not been installed.
5. The OS&Y gate valves in the double check
valve vault cannot be opened for lack of
head room.
6. A riser on the vault is required to facilitate
the horizontal movement of the OS&Y gate valves.
With this many discrepancies I feel no funds should be
released to the contractor. If you desire further infor-
mation, feel free to contact me.
KKK/ ls c
0 STREET FILE 0
CITY_ -OF E-131"VIONOS
CIVIC CENTER - EDMONDS, WASHINGTON 98020 - (206) 775-2525
DEPARTMENT OF PUBLIC WORKS
September,14, 1978
Mr. Sterling A. Miller
19421 86th Avenue West
Edmonds, Washington 98020
Dear Mr. Miller:
Subject: PARTIAL RELEASE OF PERFORMANCE BOND
EDMONDS FILE S-16-78
Reference is made to your
requesting partial release of
Account for site improvements
unit condominium.
HARVE H. HARRISON
MAYOR
letter of September 13, 1978,
funds held in a Frozen Fund
for the, development of the 13-
Your bond was required in the amount as indicated below:
Pavement of driveways and
Storm Retention System
Water Supply and Sanitary
walkways $ 7,920.
14,200
Sewer 17,880
$ 40,000
Our inspections reveal that the construction of the pavement
and storm retention -system has not yet begun. The water supply
and sanitary sewer system are approximately 90% complete. Based
upon this, we will release $16,000 of the funds. Release of the
additional $5,212 which you*request can be accomplished if you
desire to submit a Standard Performance Bond for a similar amount.
Yours very truly,
D F. HERZBERG, P.E.
JEA:iak' /��C 7-ty Engineer
�14-7
SSt. C
.E. Dt. n -Ucit 115—t P.W. Dir. Dt*.
N
1,j 0-3
MEET FILE
CZ-
en) b-�
7 R-
V4
v-4. ',J� �A k `7Z AA t--� k K qo-l-
c-, k --T
T- VA Aa,--�-
'k-- -S. 1-4
I;e-- lit.
1 7- Z
-7r->
Vt� \-N,-!
<too.
A-*tl.
7'74- 4SS 7
-STREET FILE
*_U4
A+ �Lc, U .........
J.4.
cLoRA ruc wtee,+. c-
5� kow k�ae�l 4A-".L
7 11--e d cr*Le&L4_-,
TA -a
4
�.A_kLu4 A)MAA—U
LAL cl 6L�
y Lt" L14 V"� 4-o Zot
gml,..p �at.&_a4
QOW YLO —Ptxl$o..k
T
DATE:
MEMO TO: Building Division
.Community Development Department
FROM: Engineering.Divis.ion
Public Works Department
SUBJECT: FINAL.INSPECTION
PROJECT:
APPROVED NOT APPROVED
Engineering.Division
BY:
Water Division
BY:
Sewer Division
BY:
STREET FILE
P, 1" C' 1 1)
C 1 'i"t, 1. 1 C
-,lee
CITI. S
FEDERAL S"I & LOAN ASSOCIATION
1409 FIFTH AVENUE i SEATTLE, WASHINGTON 98101 1 447-6404
June 16,,1978
City of Edmonds
Civic Center
2SO Fifth Avenue North
Edmonds, Washington 98020
Attention: Building Development
Re: Edmonds File S-16-78
Developer Sterling M. Miller
Gentlemen:
JUN 16 W8
Public Woms vuyi..
With reference to the above -identified matter., this will certify that
this institution has a savings account (or loan) for the above-Teferenced
developer for the project so identified. In consideration of the permitted
development of the property, and in lieu of a performance bond, this insti-
tution hereby agrees that it will freeze the following sums of money for the
indicated site improvements pending written authorization for release of said
funds by the City of Edmonds: $40,000.00
The total sum indicated will be withheld by this instituition from any
disbursements -of any kind until written authorization has been received by the
institution from the City of Edmonds to release the sum of money indicated by
the written authorization from the City -
The design, location, materials and other specifications for the indicated
site improvements are those required by the City of Edmonds as appear in the
above -referenced Edmonds file.and in compliance with Ordinance No. 1620.of said
City.
In the event the developer/owner fails to complete the indicated improvements
within 12 months., the City of Edmonds may demand that the improvements. be instal-
led or completed immediately to City standards and the balance -of the funds held
pursuant to this agreement shall be utilized for said installation or completion.
Very truly yours,
Citizens Federal Savings Loan
Approve
L.W.-Hacker
Commercial Loan Officer
Developer7aT_ne r
Z, r
I Fc, - /- -76
70
0
REET F VEWITY FIDDAL SAVINDS LOAN -ASSO
4X�00:
1120 W. E.
g4attle Wash no6wiqolb
*st analysts of popekik
T
by
4,� j4-
-rib
A,
."t"':
Lot.
'RE C.
IECEIV _0,4'
Sur"y
Architect's Fees ge
BUIlding Perm t.
bib
Excavating
7!r
.,�`Toundstion
4 14,-
Drainage Bac
Frsml ng
�71
itabor
Materials
i�z ':-7�
ROD r
k
plumbing. Incl. Waterline
0
Basement Fi or
300
b ' Septic. TWik i
I Sever r
I Wiring I -Z .7"Electrical, F1,
J
1 rnaiiiation
4
A
" -1 -J AI
1 Masonry
Fireplace (noe -of �Fikeplaced, Z
Xxterior BrI6 10040
Masonry
wind Vs
to
11 HeatIni'System (Type
I Sidinj (T
ype:
ibor
�A 4
$7 -
NI
Plastering or Dry,:Yal
Millwork & Finish Carpent
TY
Labor
-4 QaQ
Doors
$
Cabinets
-Trim Iftt sl 1,140oft. F1. nish
.2: Formica
TIle*
ve
24 Floor C6' ring,
Linoleum or
Slate or
V!
Hardwood Total,
iag.: 4 60
Carpets Floor Covering
2J.- Painting
Interior $
Total' Painting, '.3 o So
Exterior
Appliances 3Z 97
2 Draperies 00.
2 Landscaping :-,:77= 7, & 0
Dr:iv.ew&y & WalkIways. 7'9 12-el
2 Firi Insurance 4,24
2 Loim Costs �'nc,4 *1 t--c 18' Ct C f.f,,4 - 16" ck-4 cL'ret, Z A 4227
I
C_ C3
;419.
J.. =gub Total $ at4
0 EAD
P IT
..6 WG.EXPENSE
qM6 I Lr==p
uct 6
At
CIA 063 *4 #.A
`;748.S4-7
AL
Signed"
CASH MQUIPMaXT ANALYSIS
A mount shovn above at "Total"
Adjustments to determine cash' *4ulrem6ts
Land Due on land 0+
Profit (if Other costs not shown on.porm
spec.) (Itemize) $+
Selling expense SaVI r expenses shown on'.
0
(if spe'e.) Form (Iteadze)
Construction Interest If not In
"Loan Costs" $+
NET ADJUSTWn
CASH XCQUIMM. (Total +.or Not Adjustment)
LFM WAN AMOUNT .
ADDITIONAL CASH PKWHED $
C4.
t-A %-I
'15
71
Z4
L) t-0. 40 0 K.1 r-> S,
%-A. tz� -_5"t- 1p_,
T�s
COS+ �-A v 0&,,, 6 41
CL)j__f f UJV%..L Orr
MEMO TO:
FROM:
SUBJECT:
10Z
STREET FILE
DATE: . 4h-i lie
Building Division
Community Development Department
Engineering Division
Public Works Department
a A/ - L__07 I S - 1 (0-1
t\) I T Co fJ r:)QOM I KJ I U Y" -S-rr:5 re- U Kr-7 rvi
After review of the subject.building permit application, we have
the following comments:
(1) Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is the
responsibility of the contractor.
(2) The contractor is required to keep the abutting streets clean-
ed of dirt and debris caused by the construction.
(3) A "Right -of -Way Construction Perrit" is required, from the
Engineering Division of Public Works, for any work within
the Public Rij�ht-of-Way or public easement.
_(4) Driveway slope not to exceed 14%.
MOINAMUNArph-Wo "10
MOW OW ARRONVAR
mv--a
MEMA 61100
PW 5/77
PUBLIC WORKS afECKLIS.r
AV 95
"BUIIDING PER= REVIEW. 19523 -9 & *1 et
(address)
Street Right -of -Way Existl CD REQD 10
ing __
Z
I
Access Easements Existing &)inn REQD NA
1-4
p4
Utility Easement Existing 6 KAI REQD—N.At.
94
swoon -ago
Lot Per Subdivisicg- ilat Assessor Map
Site Plan Checked for Accura
Z
Underground 14iring Reqd.. Y_
Check Accuracy of al Description 44 1 4�
Z
Review by -1
�Date,_�� 4
Existing Water Main Size
Water Main Required Y�tl
Service Line Required
Hydrant Size Existing S'44 A4 -&a
r4
Hydrant Reqd Per Fire Code Size
Check Meter Reqd.
Cross Connection Inspection
Fire Department Conuents
:3:
Water Meter Charge Reqd. /&C)Z> Zoe 44&9 47- 44:1 PCA,44
Review by. Date —78
Septic Tank Design Approved X11f Date
Septic Tank Permit Reqd. IVA Permit No.
Sanitary Sewer Availability 64!5> Proj.
Drawing No. File No. �672_c>
Side Sewer Availability 4Et�: -
P4
W
Sanitary Sewer Connection Fee Reqd.
:3:
Review by ±11 Date 4/-6,
LKA.
Open Ditch Existing__,kr Reqd. ye-r
Culvert Reqd. Aecc. 6ge _,?/_,SjE)Size
r4
Catch Basin Reqd. 2%a _Oa� —Indicate an Site Plan
0
Shouldear drainage maintain collection on swale open runoff
P
�lanhole reqd. Indicate on Site Plan
Soil Conditions and Ground Water Field Checked _,ge,
/11
Review by Date
Revised: MO-1977
Page 2
Street Paving Reqd.
Curb and Cutter Reqd.
Sidewalk Reqd. -49
Curb Cut for Driveway Reqd.
g Right -of -Way Construction Permit Reqd.
Bond Reqd. for Public Inprovements
Street. Name Sign Reqd.
M
Other Signing Reqd.
Pre Permit Site Inspection made on 4[
z
0
�4 BY: SEWER
WATER
P4
S=T
A-P)
ENGINEERING
Special Requiren-ents listed in meTno to Conrunity Developrwnt Department,
Building Division
BY P) " Date-
c) All items filled in an Building Permit Application
BY Date
P' Drawings Stanped and Notations Made
Pq BY Date
Approved by Public Works Departnv-nt
11
Revised: lv 10-1977
'm
BUILDING DEPARTMEW
PERMIT APPLICATION P
11
NAME JOR NAME OF BUSINESS)
MAILING ADDRESS
z
0
F,j>m00'C>S
USE
Applicant Fill Z...
We eavy Lines
r - L'O
NAME
U
L0 ADDRESS
XV -
U
M CITY TELEPHONE NUMBER
F-X>N4 0 W 1-77c, Cr al (4
NAi4E rl 0. N
— . - _w_ - - . — ,
ADDRESS
U
C
z
0
U STATE LICENSE NUMBER
z
I-
U
In
w
Legal Description of Property (Sho�
B
41 1
Dili
"Y-
AT NAME I ASSESSOR MAP NO.
PUBLIC RIGHT OF WAY PER ORDINANCE
NO.
4-0
EXISTING RIGHT OF WAY
(') C)
PROPOSED RIGHT OF WAY
DEFICIENCY OF RIGHT OF WAY
STREET/UTILITY WORK REQUIRED
MYES
P4 0
PERMIT FOR WORK IN PUBLIC R/W
IN Yrs
ONO
UNDERGROUND WIRING REQUIRED
Eyes
0 NO
CONNECTION TO SANITARY SEWER
0 YES
ONO
SEPTIC TANK PERMIT REQUIRED
OYES
*NO
SEPTIC TANK PERMIT NO.
SEE MEMO DATED
4-1 ill
RE . MARKS
LICENSE NUMBER E CHECK
In
0
U
j
m
3
IL
ow or Attach Four Copies
I it
UILDING SUPPLY SIZE
REMARKS
SC -"CS XUL-
SIGN AREA
REVIEW
ADS NO.
I
ALLOWED I PROPOSED
COMPENV,
LETE I EXEMPT
REMARKS
VARIANCE OR CU
YARDS
GAS
NEW RESIDENTIAL LINE
NON-RESIDEN�_] SIGN
TIAL
Ej --)D DEMOLIS;-W RETAINING
A 111ING
OWA�_L
L
El ALTER EXCAVATE FENCE
R FILL I— X—FT)
PRE -MOVE swim,
0 REPAIR F INSP. POOL
FRONT
FIRE ZONE
SPECk*L emww'-7:3
R.
REQUIRED
13 YES
L
PLAN CHECKED 8'
NUMBER OF STORIES
J_
NUMBER OF
DWELLING
A
I
REMARKS
UNITS
NATURE OF WORK TO BE DONE
4- 0 LA
'I r
r
Z
0
_P
U
In
w
a
m
0
USE
(INDICATE SUI�LDINGSETB
ABUTTING STREETS)
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
PLANNING REVIEW By DATE
LOT COVERAGE
J# -
/SIDE RE:,,-'
OF CONSTRUCTION CODE HEIGHT
13
A.TCA OCCUPANCY OCCUPANT
I GROUP " LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
I'_
z
IL
Z
W
CL
0
j
W
w
D
z
3
0
_1U
BUILDING DEPARTMENT A H fill
PERMIT APPLICATION
NAME JOR NAME OF BUSINESS)
-5TV(ZLiKhCA
W MAILING ADDRESS
Z
3:
0
CITY 9LEPHONC NUMi-man
Ex3m 0 N 1>
NAME
u
ILI ADDRESS
I_ -H
1
u
M CITY TELEPHONE NUMBER
E>/-A 0 W -7-7 '�;. R S cl G
NA E
0 ADDRESS
U
It _//R'7//a 3
It I,
I- TELEPHONE NUMBER
Z
0
u
L-1r;PNSE: NUMBER CITY LICENSE W-UMBEF
-Otie -157'
Legal Descriptio 4
n of Property (Shov� Below or Attach Fou� Copies)
z
0
u
U)
W
_j
W
% rt"mil
1 ONE NUMUE"
4C
IIUNOIVISION No, PLAY NAME I ASSESSOR MAP NO.
PUBLIC RIGHT OF WAY PER ORDINANCE- NO.
EXISTING RIGHT OF WAV 40
P"OPOS90 RIGHT OF WAV
DEFICIENCY or RIGHT OF WAY 10
STREET/UTILITY WONK RaQUIRCO byes
ONO
PERMIT FOR WORK IN PUBLIC R/W PYES
0 NO
UNDERGROUND WIRING REQUIRED YES
1:1 N 0
CONNECTION TO SANITARY SEWER YES
0 NO
SEPTIC TANK PERM:T REQUIRED OYES
&NO
I
SEPT C TANK PERM T NO
SEE MEMO DATED 4-1 1 -18
REMARKS
CHECKED BY
METER SIZE
I BIlJILDING SUPPLY SIZE
all
REM
gmcrs
SIGN AREA
NV. RE'
ENV. REVIEW
FCOMPLETE
ADS NO�
ALLOWED I PROPOSED
I EXEMPT
REMARKS
OR CU
PLANNING REVIEW BY
DATE
LOT COVERAGE
SIDE REATR
PE OFCONSTRUCTION
CODE
HEIGHT
M3
.±17
AREA
OCCUPANCY
OCCUPk
GROUP LOAD
JA
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
YARDS
fiEw / 5- FRONT
ULP RESIDENTIAL GAS
EILINE FIRE ZO E TY
ADO NON-RESIDENTIALI 1:1 SIGN �1
E] RETAINING SPECIAL INSPECTOR
DEMOLISH WALL REQUIRED
ALTER EXCAVATE FENCE YES N 0
OR FILL (_
G
L
A
I N
S
r
AL S' G N
RE T A.N.N
El WA LL
G
Y
F
A
I
R
E
SPEC I
E_L
F N C E Y
( _ X__) PLAN CHECKED BY
REPAIR PRE -MOVE swim
INSP. POOL
NUMBER OF STORIE NUMBER OF REMARKS
DWELLING
UNITS
NATURE OF WORK TO BE DONE
60" D'
Z
IL P
x
u
(A
W
0
k%
4DICATE BUILDIN
ABUTTING STREE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
RETAINING'WALL
SWIMMING POOL
VALUATION I FEE
l'-
z
W
(L
W
Z
W
i
0
j
W
W
Z
0
u
0
u
m
it
W
BUILDING DEPARTMENT
licant Fill
P
PERMIT APPLICATI01 I ns Ai.dep H e
NAME I- "AMU OF DUSINESS)
It MIL-LF-Z
W MAILING
z
0
CITY
tz-_r_>mo-4t:,,s :: I 11ONE NU—MBER
NAME
W
W
Z
0
M
N
M
I �
L
r
N
AME
R
A D
N 'A
R
0
L
NU
L
In
s,de �He*,
;>,A-V X4 C>6_7 rZ.F'A-,TH ErZ
U L
W ADDRESS
T*1 xv.
U
X CITY
TELEPHONE NUMBER
Er> MON t� s c73c%&
NA
m
0
U
(r ce Y
I—
z
0
U PSTA,4E LILENSE N U M �BE!R
L-gal uescription of Property IS
z
0
CL
Ir
U
W
W
W
�EP�HN. NU..ER
NUMBER
D
3 —
SUBDI ISION N PLAT NA I' . ASSESSOR MAP N , 0,
,�; - 1 -7
PUBLIC RIGHT OF WAY PER ORDINANCE NO.
EXISTING RIGH T OF WAY 1! � 4�'
PROPOSED RIGHT OF WAY
DEFICIENCY OF RIGHT OF WAY
STREET/UTILITY WORK REQUIRED ONES rto
PERMIT FOR WORK IN PUBLIC R/W AYES NO
UNDERGROUND WIRING REQUIRED AYES NO
CONNECTION TO SANITARY SEWER EYES El NO
SEPTIC TANK PERMIT REQUIRED YES JILNO
SEPTIC TANK PERMIT NO.
SEE MEMO DATED 4,1 1
RE M ARKS
C H ECk( ED J3
5'Z
Below or Attach Four Copies) --.R- �Ee�j
- -
NG SUPPLY SIZE
I ' '
-5
R ARKS
acz
SIGN AR11
S EA
ENV.
REVIEW ADB NO.
A L
LLOWED
op� COMPLETE
I EXE PT
REMARKS
VARIANCE OR CU
IK7 NEW RESIDENTIAL GAS
Inil EILINE
YARDS /
/5- FRONT
ElADD NON-RESIDENTIA]L El SIGN
FIRE ZONE T)
DEMOLISH
RETAINING
ALTER
WALL
SPECIAL INSPE
REQUIRED
EXCAVATE
OR FILL
FENCE
El I_ X FT)
cl YES MNO
REPAIR PRE -MOVE
_
PLAN CHECKED AV
INSP.
swim
OPOOL
NUMBER OF STORIES
12
NUMBER OF
DWELLING
REMARKS
.
UNITS
NATURE F m To 8 E DONE
UtiEo USE PLAN CHECK FEE
it
IT PL WWt��Y,�EVIUIJINGSSETSACKS.
STREET BUILDING
PLUMBING
P
L A
U
N C H
L
E C K
I D I NG
PLU M _' NG
M E C H A N I C A L
C
��f
MECHANICAL
FENCE
SIGN
IRETA[Hi'lf-, NVALI_
PLANNING REVIEW BY ____F.ATE
LOT COVERAGE
SIDE A0 REAR
OF CONSTRUCTION CODE HEIGHT
. lqq�
AREA OCCUPANCY OCCUPANT
GROUP LOAD
.. tTH S SITE 91SLOCE HE CITY
N ATED IN T
OF EOM0 DS. LOCAL SALES TAX
SHOULD 13E CODED 31.04.
VALUATION I FEE
z
W
W
z
W
IL
0
W
W
Q'�,
I-
z
0
3:
U
m
IL
m
W
3:
4
00
STREET FILE
MEMO TO: Engineering Division
FROM: Ken K. Kukuk
.Water Division Leadman
00
September 19, 197.8
VIA: Jack B. Mitchell
Water/Sewer Superintendent
SUBJECT: MILLER CONDOMINIUM 19519-86th PLACE WEST
At the present, the water line for fire protection and
domestic service serving the Miller condominium does not
meet City standards. The discrepancies are as follows:
1. No pressure test has been taken.
2. No bacteriological test has been submitted.
3. The installation of the fire line is not
complete.
4. The domestic meter has not been installed.
OK— 5. The OS&Y gate valves in the double check
valve vault cannot be opened for lack of
head room.
K-6. A- riser on the vaultis required to facilitate
the horizontal movement of the OS&Y gate valves.
With this many discrepancies I feel no funds should be
released to the contractor. If you desire further infor-
mation, feel free to contact me.
KKK/lsc
S -S_u� t. `Dt. A-Cl. S � c . fft.
r
8 9 0 . 199 -
D City of Edmonds
-WAY f_QNS
STRUCTION
EETM
K PERMIT Permit Number: (7,2 0
ENGINEERING P 30.,�/v ^ V ON , . .4
(A Ap� Issue Date:
60 �, 6� V
A. Address or Vicinity of Construction: - 19523 86.Avenue West
B. Type of Work (be specific): Install 1 1/4" *PE IP Main Per Attached
Drawing: 920-180 (2)
C. Contractor: Washington Natural'Gas Company
Mailing Address: 815 Mercer Street,
State License #: WA 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. T! Commercial Subdivision. F1 City Project ki Utility'(PUD, GTE, WNG, CABLE, WAT�R)
F� Multi-Fa,mily Single Family F-1 Other
INSPECTOR: INSPECTOR: Ro-?
F. Pavement or Concrete Cut W Yes LJNo kZ)U. bizeotUut: z x 4 H. unarge ii
18 Water I To*Cross
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmlessfrom injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be,made against the City of Ednionds, or any of its departments or employ -
I �
ees, including 'or not limited to the.defense of any legal proceedings includi6ngfensplcosts, and attorney�ees by reason of granting this permit.
e
f
1 0
THE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA 72fRI FOR A1PZRIJDl0'F ��R FOLLOWING THE FINAL INSPEC77ON
AND ACCEPTANCE OF 77LE WORK ES71MAYED RESTORA71ONFEES WILL BE HELD UN77L THE FINAL STREET PATCH IS COMPLE7ED BY
C177 FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE A PPLICANT.
Construct ion drawing of proposed work required with permit application.
A 24 hour notice is required for inspection;. Pleasecall the Engifieeringj)epaftment- 771-3202.'
Work is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
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 ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO,EXCEPTIONS.
I havi read the above statements and understand the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signature: Date: January 15, 1992
(Contractor or Agent)
CALL DIALA-DIG PRIOR TO BEGINNING WORK
...... .. .... ... . . ..... ..
.1 ............... . . ..... ..... I . .....
. .. . .... ...
;v
.—RIGHT.D.F.W
........ ob—
PERWIT.TEE:
.. ..... ...... TOTALTEE:
COMMENTS:.
I
"I
DATE:,::. !.:..:.:,:ISSUED BY::. 40r,�: - U4:::::"- "`�
.............
BEGIN PRIOR TO
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund I I I Route copy to Street D t.)
-C2Vments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 198
091-006- 1
i1i I zt�
61
71
9 T Xpl/
- jj
x1:5 X.. Olf G
7--7- z --74
0
5 FZ /2 V Z F,/ P117, 2 5 P, A/�
.Z OF
;-)427
-2,01 Zt:57Kt7 ZY1,41 9,,�IOWIW
4,
NAY xr Y-K/
7,
LA�
tN
71
-7-ZOI'�)C77
'2,;7,7
-5
Ik
-ZV-714
XWA61
0 AIP
1�
Computer ID #
BAC.1awgifil" ASSEMBLY
RE:CF-1V50
TEST REPORT U 5
SEP
PUBLIC WQfAKS- DEPT*
RETURN NO LATER THAN
NAME OF PREMISE S- W 6 CeK5- - CONTACT PERSON
SERVICE ADDRESS
�zz
LOCATION OF ASSEMBLY,19 !�4 ��4-r z
ASSEMBLY I ",dL6 A/
000EL SIZE S E.MAL NO.
LINE PRESSURE AT TIME OF TEST LBS.
Reduced Pressure Assemblies
Double Check Assemblies
ist Check
2nd Check
TYPE OF ASSEMBLY
Pressure Vacuum Breaker
Relief Air Inlet Check Va!ve
Valve
Opened al
- psid
Op,
Initial DC -closed tight Closed light ened at
D!d nci open
I Te
RP- Leaked
psid psid
Leaked
I
I an d
i Used
—test Aher DC -closed tight Closed liahl Opened at Opened at
Repa,r RP- _ psid psid psid
AIR GAP INS CTION: R uired minimum air gap separatio
REMARKS:
Yes :i No 'D
psld
Leal�ed I
psto
V.
FIED,.T;) B
THE ABOVE REPORT IS CERTI E T
�'DAT
INITIAL TEST PERFORMED By CERT. NO. E
REPAIRED BY PATE
FINAL TEST PERFORMED BY CERT. NO. PATE
4 J
,404'e-l'or
Computer ID
BACKFLOW PREVENTION ASSEMBLY
TEST REPORT
RF.cvVED
SEP 0 5 1991
PUBLIC \N0jjKS DEPT.
RETURN NO LATER THAN
NAME OF PREMISES rA'0-,(=-Sr(;0NTACT PERSO Ql-f-W
SERVICE ADDRESS
LOCATlrjNOFASSEMBLY,a/— L!i& ag
ASSEMBLY gc&k-4, lyne—ce,
i AVA NLIFAt TURER Mt)DEL 5eE I 5-=.q!AL NO.
LINE PRESSIURE AT TWE OF TEST LBS. TYPE OF ASSEMBLY
Reduced Pressure Assemblies
Double Check Assemblies
1 st Check
2nd Check
Relief
Valve
I I -
initial DC-Ctosed tight Closed Opened at
T c- j
RP- -id Leaked
_ ps psid
Leaked
Pressure Vacuum Breaker i
Air Inlet I Check Valve
Opened a!
psid psid
Did not open Leakec
Used
Ooened
iest After DC -closed tight Closed light j at Opened at
Repair
RP- _ psid ps:o psid psid
I
AIR GAP INSEPCTION: Reauired minimum air gap se
REMARKS: A�jj 9'.- 9 P/ -2
THE ABOVE REPORT IS CERTI
INITIAL TEST PERFORMED BY
REPAIRED BY
FINAL TEST PERFORMED BY
ion provided ... Ye s :1 No �
C E RT. NO. 121-0 DATE
'DATE
CERT. NO. DATE
42
STREET FILE
CITY OF EDMONDS'''' -P-UBLIC WORKS DEPARTMENT SEP
BACKFLOW DEVICE TEST REPORT PUBLIC YI.,
NAME OF
PREMISES
-2 T�fl` 1161- �
( -, /- ef 5- 7-
SERVICE
ADDRESS
IJ
n2-
LOCATION OF DEVICE 1h fr,(, UP 100 �z
DEVICE: 6'c-c-co FOC
M�nufacturer Model Sile Serial No
LINE PRESSURE AT TIME OF TEST BS.
PRESSURE DROP ACROSS FIRST CHECK VALVE
LBS.
CHECK VALVE NO.
I
CHECK VALVE NO.
2
DIFFERENTIAL PRESSURE RELIE F VALVE
INITIAL
1. LEAKED
0
1. LEAKED
1:1
1. OPENED AT LBS.
TEST
2. CLOSED TIGHT
2. CLOSED TIGHT
X
REDUCED PRESSURE
2. DID NOT OPEN
19
CLEANED
El
CLEANED
El
CLEANED
REPLACED:
REPLACED:
REPLACED:
DISC -------------
0
DISC -------------
El
DISC.UPPER ----------------------
0
R
SPRING -----------
El
SPRING -----------
EJ
DISC. LOWER ----------------------
El
E
GUIDE ------------
El
GU I DE ------------
El
SPRING --------------------------
C3
P
PIN RETAINER -----
El
PIN RETAINER -----
El
DIAPHRAGM, LARGE
A
HINGE PIN --------
0
HINGE.PIN --------
EJ
UPPER -------------------------
0
I
SEAT -------------
El
SEAT -------------
0
LOWER -------------------------
El
R
DIAPHRAGM --------
El
DIAPHRAGM -;
El
DIAPHRAGM, SMALL
S
OTHER, DESCRIBE --
El
OTHER, DESCRIBE
0
UPPER -------------------------
0
LOWER ---------------
0
SPACER, LOWER
OTHER, DESCRIBE
FINAL
PENED AT LBS.
TEST
CLOSED TIGHT --- �-
El
CLOSED TIGHT -----
El
REDUCED PRESSURE
REMARKS
THE ABOVE REPORT IS CERTI F 0 B MT
,IINITIAL TEST PERFORMED BY 0 F DATE9
REPAIRED BY DATE
FINAL TEST PERFORMED BY OF DATE
19
1 /7Q
STREET FILE SEP 4 ISKI)'
CITY OF EDMONDS -- PUBLIC WORKS DEPARTMENT
BACKFLOW DEVICE TEST REPORT PUBLN� V.,
E OF PREMISES 6'7fe-- d ;
SERVICE ADDRESS 7 J J ZJ
LOCATION OF DEV-I-CE 1/,,j L J A t. I � - 1j. I -'. j - , 4-
DEVICE: I I Ile /,A" &. A I
Mabufacturer Model
LINE PRESSURE AT TIME OF TEST BS.
i
PRESSURE DROP ACROSS FIRST CHECK VALVE
'? �,, // 6 / // / //,/ " y
Size . Aria] No.
LBS.
7
CHECK VALVE NO.
1
CHECK VALVE NO.
2
DIFFERENTIAL PRESSURE RELIEF VALVE
INITIAL
1. LEAKED
EJ
1. LEAKED
0
1. OPENED AT LBS.
TEST
2. CLOSED TIGHT
K
2. CLOSED TIGHT
)�'
REDUCED PRESSURE
2. DID NOT OPEN
-
CLEANED
0
CLEANED
El
CLEAmNED
REPLACED:
REPLACED:
REPLACED:
DISC ------------- 13
DISC -------------
I--]
DISC.UPPER* ----------------------
0
R
SPRING -----------
0
SPRING -----------
0
DISC. L014ER ----------------------
E3
E
GUIDE ------------
El
GUIDE ------------
0
SPRING --------------------------
El
p
PIN RETAINER -----
0
PIN RETAINER -----
I--]
DIAPHRAGM, LARGE
A
HINGE PIN --------
E3
HINGE -PIN --------
0
UPPER --------- ----------------
C3
I
SEAT --------------
0
SEAT -------------
0
LOWER ------------- ------------
0
R
DIAPHRAGM --------
El
DIAPHRAGM -; -------
0
DIAPHRAGM, SMALL
S
OTHER, DESCRIBE --
El
OTHER, DESCRIBE
0
UPPER -------------------------
0
LOWER ---------------
El
SPACER, LOWER
OTHER, DESCRIBE
FINAL
OPENED AT LBS.
TEST
CLOSED TIGHT -----
El
CLOSED TIGHT -----
0
REDUCED PRESSURE
�EMARKS:
F1
�HE ABOVE REPORT IS CERT1,010L
I INITIAL TEST PERFORMED BY' OF 0 r:�: AQ,0W DATE
ZEPAIRED BY DATE
r-INAL TEST PERFORMED BY OF DATE
1-z 0616
1 /70
-S DEP 1ENT
CITY OF ONDS 11 U R'l. I C: vi 0 I� I,,
SOMEfTer ffWqMFL.OW DEVICL ;EST REPORT
I t- ILL,
NAME OF PREMISES -7-,6-X -4 1"1/ C
SERVICE ADDRESS )JAZ;x 3
LOCATION OF DEVICE ?'o
01
DEVICE: A5z-rQ
R'snufacturer F-41f R-C I e kr i a I No.
LINE PRESSURE AT TIME OF TEST LBS.
PRESSURE DROP ACROSS FIRST CIIi.Cf, VALVL LBS.
INITIAL
TEST
CHECK VALVE NO. I
1. LE.AYED 011
V -')
2. CLOSED TIGHT L
CLEANED
M
REPLACED:
DISC -------------
0
SPR I IM, -----------
ci
CIJ I DE ------------- 0
PIN RETAINER -----
0
11111,'GE PIN ---------
n
SEAT --------------
0
D I APHRAG, I --------
�. d
OTHER, DESCRIBE --
0
CLOSED TIGHT ----- 0
THPABOVE REPORT IS CE
INITIAL TEST PERFORMEC
REPAIRED BY
FINAL TEST -PERFORMED
D 7--
1,1Z E S r
CHECK VALVE-110. 2 DIFFLRENT IAL WRE RELIEF VALVE
LEA."ED 0 1 OPENED AT LBS.
CLOSED T I M IT. I � * D U C (T-p-fc§-s—U F'c
DID �-'JT OPEN E;
CLEANED 0 1 CLEANED L-1
.REPLACED:
DISC -------------- 0
SIT I M, � ----------- C3
M.1 I Df - - � --------- 0
Pill RETAINLI) ------ G
H1Nr,E Pltl.--. ----- 0
SEAT ------------- 0
DIAMIRA11,11 -------- 0
OTHER, DESCRIBE- --0
REPLACED:
D I SC. LIPPFP -----------------------
C
DISC. L(),.-�ER ----------------------
L-.
SPRING --------------------------
c:
DIAMIPALGI-1, LARGE
UPPER --------------------------
L0',-,'LP ----------------------
DIAPIMAGt-1, SMALL .
UPPER -------------------------
R----------------
SPACER, LO',-!FR
OTHER. DESCRIBE
OPENED AT LBS.
CLOSED TIGHT ------ 0 REDUM ORMUfft
m
DATE
DATE
DATE
1-02
-77:
F E DMW I D S
1) Ul'j L I C �
WOR K, S DE P A E�'�T
STIIEET
�,LtBACKFLO'N'
D-1VIC[----;[S-T
REPORT---
tIAME OF PREMISES
TrC Annorrq
P,
3 L r% v
LOCATION OF DEVI�E
C�' f--7 S i Z� S e
DEVICE:
F—A 16f—a A e-
LINE PRESSURE AT TIME OF TEST LBS.
PRESSURE DROP ACRO SS FIRST Pij.-CK' VALVL ----L B s .
'I N I T I A L
TEST
R
E
P
-A
R
F I NAL
TEST
CHECK VALVE NO. I
LEAKED
2. CLOSED TIGHT 'K, L
CHECK VALVIF NO. 2 DIFFFRLMIAL PTFS:URE- RELIEF VALVE
LEAKED ' Y
C L 0 S E D T,,P�,I. T
CLEAHED 0
CLEA111-
REPLACED
DISC ----------- [-�i-
----------
DISC -------
0
-----------
C I J �rl E ------. 0
("ti I ------------
R E T A I I 'E R ------- I--]
PIN R[--jAIM---R -----
)E PiN --: ------ n
HINr',E PIN ---------
SEAT ------------- G
SLAT -------------
D I APHRACJ I -------- El
1) 1 All WAGM --------
OTHER, DESCRIBE -- 0
. OTHER, DESCRIBE --0
CLOSE-D TIGHT ----- 0
1 OrEflF.D
f?[DUCED PRESSURE
2. DID. �,!OT OPEN
CLMIED L
REPLACED:
DISC. llf'PFP ----------------------
----------------------
SPR I ;Kl - -- --- - - - - - - - - - - - - - - - - - - - - - -
DIAPHPAGH, LARGE
L) I'll I-P -------------------------
I-------------------------
SHALL
-------------------------
u 1� P E R
Lol.-IT.R ----------------
SPACER, LO'--!'El�
OTHER, DESCRIH
OPENED AT LBS.
CLOSED TICIIT--.--- 1:1 � " 1), E D U (TD—P R C5-�Rf f
REMARKS:
Th ABOVE REPORT IS CERTI� _ED 0 BE TRU
OF �---=XJ§--DATE3=Zoj
INITIAL TEST PERFORMED BY
DATE
REPAIRED BY DATE
FINAL TEST PERFORMED BY OF
1, 7 .1
C.TY OF -[UHOU�D� -- PUDilC WORKS D[PART��[HT
[�« OS'TREET FILEBACK
;EST R[PRT- \.
UAME OF PREMISES
SERVICE ADDRESS
/
LOCATION OF DEVICE
DEVICE:
-
HdOVf�Clur2r
` ,wuc/
^.^�' /
'-� fa -.
LINE PRESSURE AT TIME OF TE3 S.
' - ' `
pRESSURE*DROP ACRO'SS. FIRST [U[[K V/LYL'
CHECK VALVE 1110.
1
O|LCK VALVE HU �
l. LEAKED
2. CLOSED TIGHT
'
CLEAUED []
REPLACED:
Disc -------- []
8'P(C(-,----------- |j
(-'lU|U[------------ L]
PlH R[T8IU[R7--- []
H}Hl-'E PlH-------� []
S[8T-------_- []
D\8PUK8C1-------- []
OTHER, D[SO(lDE —[]
CLOSED TICUT---- []
REMARKS�
. '
THE ABOVE REPORT IS CERTIFIED
INITIAL TEST PERFORMED DY^- OF
REPAIRED BY ~
FINAL TEST PERFORMED DY OF
[dZZ,���
_------__--_--__'-__-_---
DlFFE!�[iITiAL |/R[S'-:1UR[ RELIEF VALVE
1. OPEH[D AT LDS.
' K[DUCED DRE3sURE
2. DID '40T OPEN
[L[0ED L'
REPLACED;
Dlsc. UPP[R-�-------------------
C\L[R----'--------------
SPk}U6-----------------------
U]8PUCAGH, LARG�7
UPPE1)------------_--__---
LO',-;Lk--_--______________
Dl8PU?AC,'-1, SHV-,L[
UpPER---------______________
L0."[|<---_--_7___
SPACER, 1-011-l[R
| OTHER, DESCRIBE
OP[�ED AT LDS,
R[DUC[D PKC55UKL
DXT
� DATE
DATE
C 1v.1ORKS D E P A R T Pi E N' T
D1,10 N D S
C 1' i''-ST REPORT
'-S
NA L OF PREIIIS_ 5-- 9'(6 LAI/
SERVICE 'ADDRESS 077 o
LOCATION' OF DEVICE JM cj !t 7
DEVICE:*
Nio d e I
Serial No.
Nz ilufacturer
LINE PRESSURE AT T11',11E OF TEST _LBS.
PRESSURL-DROP ACROSS FIRST CHECK VALVE _LBS.
D T _IL -R,:�7SURE PELIEF VAL%`
E _!1C I N I . .,�
CHECK VALV' I ci K V"LVI 1:0. FFEr)"-_-N', _j
I N'I T I AL I L E A IKE D 0 1 LEAKED 1 0 PE f", E 10 AT___________LBS.
D� DUCED PR11_SSUR1:
TEST IGHT 2. CLOSED TIGHT ;,io
2. C L 0 S ED T 2. DID T 0 ,'j E
I C L 'I: A P 1 E7 D
0 1
REPLACED:
DISC -------------
0
R
I , I T
Sr)i NG -----------
0
E
C7U I DE ------------
p
PT."! RETAINER
EL
A
H I iNG E 1 N - --------
El
I
IP
sr
LAT -------------
El
R
D I A P PIR G � 1 --------
11
S
OTHEP, DESCi'-,'.IBE --
0
FINAL
TEST
CLOSED TIGHT ----- 0
CLEANED
El I CLEA�IED
R [ PLA C E'D :
1) 1 S c ------------- 0
S P R I IN G ----------- 0
('� U I DE ------------ 1:1
PTIN RETAINER ----- 11
E PIN
111 NGE -------- 0
SEAT ------------- I--]
D'IAPHRAGM -------- I-]
OTHER, DESCRIBE -- 1:1
R E P L If,. C ED -. I .
D I IS C. i-I P p E R ----------------------
F 1 1 S C'. L (); ';,I" E R ----------------------
sIT , 1! �� ---------------------------
R---------------------------
L0 -------------------------
S�.! " f, , LL
------------------------
---------------
S, P. E R L 0 �. (),
AT LES
DU
CLOSED TIGHT ----- 0 R E
REMARKS,_
THE ABOVE REPORT IS CERTIFIED TO BE T
INITIA�,-TEST PERFORi�-IED BY OF DATE
REPAIRE.0 BY DATE
FINAL TEST PEr',FM-',E_D BY OF —DATE--
I / 7 2
F E D 1-1 OIND S L I C t,'O R K S D E P A R T M E IN T
VILIE
B A CK F L 0',-,' 1) E i7 F I E S T P P 0 R T
I Aol � 7C I"
r ARIO
A E7 ri r D D CM T Q �z c7z 10
SERVICE ADDRESS
pe/v
w
LOCATION' OF DEVICE
DEVICE:
S i z e
Yu *ac t u r e r llodel
LINE PRESSURE AT TIME OF TEST. L3S.
PRESSURE -DROP ACROSS FIRST CHECK VALVE
jiA,
-4elrial No.
CHE7C �11
V11"L VE
L I �j I
CHECK VALVE NO.
DIFFED:Ej'�TTAL PR,S'URE RELIEF VALVE
. I � I . - S
IN ITIAL
TEST
L E AK, ED El
I LEAKED
H 0 PR U
PEW S cU R E
- � "
2. CLOSED TIGHT
2. C L 0 S E D I GHT
E H
DID HOT OPL_
CLEANED 0
C L E Al"! E D ED
C L E A -! E D
k E 1) L A C, E R:
111E PLAC 'ED:
R E P L,A C ED
D 1 S C ------------
1) 1 S C ------------- 0
D 1 S C. U "i) E R -----------------------
R
S r"'R T H G ------------ "I
SMI ING -----------
� 11 0
DISC. LOY,-JER ----------------------
E
GU I DE ------------- 11
(,U I DE ------------- 1-1
s P ") I N �1'1 --------------------------
P
PIN RETAINER ----- E
PIH RETAINER ----- 0
0
DIAPIHIR/'iG�-I, L""'RGE
U P P ER
A
lil,"'GE PIN I]
HINGE PIN --------
-------------------------
I
SEAT -------------- 0
SEAT -------------- 1-1
L 0 I.-l- �� -------------------------
R
D I A P h Rl"'% G 'I -------- L�
DIAPHRAGN — ------- 0
DIAPHRAGi'l, Si'llALL
s
OTHER, DESCRIBE 0
OTHER, DESCRIBE El
U P P E �i -- - - - - - - - - - - - - - - - - - - - - - - - - -
0 E I \1 - - - - - - - - - - - - - - -
S P c R , L 1E R
OT H, E R, , D E QJ C R I B E
FINAL
TEST
CLOSED T I GHT ----- C]
CLOSED TIGH'I' El
OPEI�ED AT LBS.
R E D U El—P
L
REMARKS,
THE ABOVE REPORT IS CERTlIF
INITIAL. -TEST PERFORMED BY OF DATEI—f— 1?
REPAIRE.0 BY
FINAL TEST PERFORIIED B'Y OF DATE
&7-
1 / 7'
STREETFILE
0 11:
E D M 0,N D S i- 'I C 0 R K S D E () A R T il E N' T
A
CK L 0'.-,' D E I C V i E S T R P 0 R T
__B
w
NAME OF PREMIHS
4; 0 ele q- - T 7"" �
SERVICE . ADDRESS AM-a-3 '9 6
LOCATION' OF DEVICE
31
DEVICE: V
eu 'ial' No.
P-1 I-ILU f a C 'L, U -r c -1 - N, o d, e 1 S i 2��e Ser
LINE PRESSURE AT Tli',iE OF TEST LBS.
LOS.
PRESSURE.,DROP ACROSS FIRST �CHECKI VALVE
C i I E CK VAME iNG. I
IN'ITIAL I . L E A 'K' E D Ll
TEST
2. C L O� ED TiGHT
C HECK Vf'\�LVE NO. 7�
I . L EAKE 1) Ll
2 . CLOS E D T I GHT
f� j7
DIF�EPENTIAL PRESSURE I -LIEF VALVE
I 011El"IED AT LBS.
m-DUCL
2. D,l D NIOT OPEN
CLEANEb 0
C 1, E E 0 0
C L 1A -' 11 D
RE P LAC D
IREPLACED:
REPLACED
ID I SC ------------- 11
-------------
1) 1 Sc 0
1. � ----------------------
D I SC. LIPPER
R
SPR'l NG ----------- - Ll
S �) I T P 1(; — — — — — — — — — — — - r-j
M 1".
, I c
[", I SC, L 0'-T R ----------------------
E
CiLi 1 D7 ------------ El
rU I DE ------------ !3
s il r --------------------------
P
P 1 1 R E T A I :N E R ----- Lr]
-
PIN RETANER ----- Ll
.. HRAGN, L�iKE
D I �'� 9"
A
li'li,GE Pil -- --------- F-1
H I i'l C, E pf IN -------- Fi.
UP P E R -------------------------
S E AT ---------------
SEAT - - - - - - - 7 1
L 0 -R - - - - - - - - - - - - - - - - - - - - - - - - -
R
D I A P H R-r"'A G,'! -------- 1:1
DIAPHRAM1 — -------
D T f� 1) tk C, ',I , S �-IiA L L
S
DESCRIBE 11
OTHER, DESCRIBE
U P P F R — — — — — — — — — — — — — — — — — — — — — — — — —
,0THER,
---------------
SP.ACER, L0lv!'C_
0 -i _CcRi -
E 1), , DE J
MIAL
OPENED AT LBS.
TEST
CLOSED TIGI i T ----- Of
CLOSED TIGHT ----- El
R E D U E�__P R�Eq_50_,_E
REMARKS;.
THE ABOVE REPORT IS CERTIFIED�,&�L UE:
-TEST PERFOMIED 0 OF
INITIAL.
REPAIRED BY
FINAL TEST PEPFORi',',ED BY OF
c
DATE
—DATE
D AT E
1 / 7 2
RI C 1.,,'0 R K S D E P A R T Ili E i"I T
EET ILX!,, OF EDNIONIDS -- 1"W"L
B, A C lK F L 0'.,.' 1) E �,' I C L. iEST REPORT
NAME' OF"hEIMISES
SERVICE ADDRESS
LOCATIM OF DEVICE j1PJ k u Acl�
DEVICE:*
Ma n ujlf a c t-"u'(, e r
LINE PRESSURE AT TIIHE OF TEST
PRESSURE -DROP ACROSS FIRST P-IFECK VALVE
M.
/,V oi
ze
LBS.
I fill T I AL
TEST
CHECK V,f',LVE_ '.!rj. 1
1. L E A\'r-- D 0
2. C L 0 E D TIGHT
CHECK VALVE NO. 2 1
1. L EA KE F) 0
2. CLOSED T I GHT
CjIFFE()fEi"IAL PTR�7.-SURE PEL IEF VALVE
1. OPLINED AT LBS.
PF D U C R E C�
2. DID HOT MEN)
CLEANED 0
C L EA 1`� E D 0
CLEICIED
REPLACED:
!,EPLACED:
R, E R C 1: ' 'D:
DISC ------------
Di SC ------------- I
D 1 C Ll Fj PER --------
S . - . E --------------
R
SPR I NG ------------ ED
SPR 1?�!( ------------ F]
D 1 SC. L 0'; �ER ----------------------
E
E
c7tj 1 D7 --------- L]
Ul I D I ------------ Ej
SPP -, --------------------------
P
PIl RE-lr,,,,INElR ----- El
PIN RETAINI.ER ----- 0
Lll�%RGE
A
HINGE PIN -------- [_1
--------
-------------------------
I
SEAT -------------- 0
SEAT ------------- El
L 0 1..: :7 �)
'i - - - - - - - - - - - - - - - - - - - - - - - - - -
R
D I A P i IR G "I -------- 0
D I A P H R A C, i 11 --------
. .
S
OTHER, DESCRIBE -- 01
OTHER, DESCRIBE 0
P F R -------------------------
I-,- p ---------------
S P f "E L 0'- 1E. 1) -
D C j) T L� [7
OTHER, ES L
CLOSED T GHT ----- 0
FINAL
TEST
CLOSED TIGH T----
0 P E!,! E D T LBS.
R D U C S S URI
REMARKS,
THE. ABOVE REPORT IS CERTIFIEJDO all,,11:
INITIAL. -TEST PERFORHED BY 9�z OF t 1241 &A.� DATE//
REPAIRE..D BY _DATE
FINAL TEST PERFORi',lED BY OF DATLE
c c
1 / 72
Mlito F EDMONDS -- PUBLIC WORKS DEPARTMENT
BACKFLOI,,J DEVICE IEST REPORT
NAME OF PREMISES
ce
SERVICE ADDRESS 04,ef7
LOCATION OF DEVICE A
DEVICE: /o
e Mo- Si"z e Serial No.
t�_Au �act6rer del
LINE PRESSURE AT TIME OF TEST
,4 __ �LBS.
PRESSURE DROP ACROSS.FIR,ST CHECK VALVE —.,- 2. __—LBS.
CHECK VALVE NO. 1
INITIAL 1. LEAKED
TEST
2. CLOSED TIGHT
R
F
1)
A
I
R
s
F I MAL
TEST
REMARKS:
CLEAtIED
CHECK VALVE 1-10.
�CCF�REHTIAL PRESSURE RELIEF VALVE
1. LEAKED 0 1. OPENED AT ____LBS.
R1:nUC`E— ESSURE
IT &M
CLOSED TIGi
2 DID NOT OPEN
0 1 CLEANED
REPLACED:
DISC -------------
L-1
SPRING -----------
0
c1ii I D, E- -------------
El
PIN RETAINER
El
HliNGE PIN --------
SEAT -------------
DIAPHRAG',! --------
OTHER, DESCRIBE --
0
CLOSED TIGHT ----- 0
El I CLEA--!ED
REPLACED:
I SC - - - - - 7 - - - - - - - 11
SPR I NG ----------- 0
G�U I DE ------------ 0
1111-1 RETAINER ----- 0
HINGE PIN ---- --- 1:3
SEAT ------------- 0
DIAPHRAGM — ------- 11
OTHER, DESCRIB.E 0
CLOSED TIGHT ----- 0
REP L�CEO:
,91 S C, Ll P P F R ----------------------
P I S C. L 0'-,'E R ----------------------
SPR I NG - - - - - - - - - - - - - - - 7 - - - - - - - - - -
DIAPHRAGIH, LARGE
UPPER-------------------------
L0'�-1 ER -------------- : ------------
DIAPHRAGiM, SjHALL
UPPER--------------------------
1-01-IER ---------------
SPACER, LO'.-IER
OTHER, DESCRIBE
OPENED AT LBS
REDU ED RIMSUNFE
THE ABOVE REPORT IS CERTIFI.ED TO B T R US
D A T E,_E,,/
INITIAL TEST PERFORMED By XX OF raovq a ed
REPAIRED BY DATE
FINAL TEST PERFORMED BY- OF-- DATE--,--.
1 / 7 2
�Al
nor TILFEDMONDS. -- PUBL IC WORKS DEPARTMENT
,
a MEET BACKFLOW DEVIC'E I -EST REPORT
NAME OF PREMISES
SERVICE ADDRESS
� ME t
LOCATION OF DEVICE fl e,
A
DEVICE
V;
Ma 6u f � c"t u-'r e r .000, Model Size S/r/ial ko.
LINE PRESSURE AT TIME OF TEST (I LB.S.
PRESSURE DROP ACROSS FIRST CHECK VALVE LBS.
CHECK VALVE NO. I CHECK VALVE NO. 2
.INITIAL 1. LEAKED 1:1 1. LEAKED E]
TEST
2. CLOSED TIGHT UO'2. CLOSED TIGHT 6�
CLEANED
m
REPLACED:
DISC -------------
El
R
SPRING ------------
E]
GUIDE ------------
El
PIN RETAINER -----
El
A
IlliNGE PIN --------
El
I
SEAT --------------
11
R
DIAPHRAGH
S
OTHER, DESCRIBE
CLEANED
v
REPLACED:
DISC ------------- 0
SPRING ----------- 0
GU I DE -------- 7 --- 13
PIN RETAINER ----- 0
HINGE PIN -------- 11
SEAT ------------- El
DIAPHRAGM— ------- 11
OTHER, DESCRIBE El
FINAL
TEST I CLOSED TIGHT ----- El CLOSED TIGHT ----- El
REMARKS
DIFFERENTIAL PRESSURE RELIEF VALVE
1. OPENED AT--- -LBS.
REDUCED PRESSURE
2. DID NOT OPEN
C.LEA-'-IED
REPLACED:
DISC.UPPER ----------------------
D I S C. L 0',-J'E R ----------------------
SPRING --------------------------
DIAPHRAGM, LARGE
UPPER-------------------------
LO!,-JER -------------------------
DIAPHRAGM, SMALL
UPPER -------------
LOWER -----------
SPACER, LO',-lER
OTHER, DESCRIBE
OPENED AT LBS.
REDUCED PRESSURE,
THE ABOVE REPORT IS CERTIFIED TO;ZB T E : C C.1,jr- / -1510
INITIAL TEST PERFORMED 0 F A�� 44,j V-,Sf DATEn_ 40
REPAIRED BY DATE
FINAL TEST PERFORMED BY OF— DATE
1 /72
9 STREET FILE 'S
CITY OF EDIV73N. DS
200 DAYTON ST. -EDMONDS. WASHINGTON %020-(206) 775-2525
DEPARTMENT OF PUBLIC WORKS
August 10, 1979
Mr. Sterling A. Miller
19421 86th Avenue West
Edmonds, Washington 98020
Dear Mr. Miller:
'-/6 - 9 -? ,
HARVE H. HARRISON
MAYOR
SUBJECT: STREET USE PERMIT - COVERED ENTRANCE
AND WAITING AREA FOR CONDOMINIUMS
Enclosed is an approved copy,of the Street Use
Permit applied for in connection with the above subject.
The insurance certificate has been received and is in
compliance with City of Edmonds requirements.
Thank you for your cooperation in this matter.
Yours very truly,
kFR
� ED F. HERZBERG, P.E.
Director of Public Works
j ak
Enclosure
0
CITY OF EDMONDS, PUBLIC WORKS DEPARTMENT
200 DAYTON STREET 7.�� �10 ED
Z�F_l F
E DMONDS., WA - 98020
775-2525 0 G 1979
APPLICATION FOR STREET USE'PERMIT
Name of Applicant: sterling A. Miller
Mailing Address: 19421 86th Avenue West, Edmonds, -'Washington 98020
Telephone Numbeh 774-4887 Date: - January 26, 1979
Description of Public Place -or Portion thereof desired to -be used: (exhibit may be
attached)
Street Riaht of Wav--See Plan Attached.
Type of Use desired to be made of Public Place: Provide a covered entrance and wai—
ting area -at front cfate into a new, enclosed condominium.
If applicable, attach plans and specifications for any utility or structure to be erected
and/or maintained on the Public Place: . See Attached.
TEMPORARY PERMIT: Unless otherwise designated herein, this permit is understood by
applicant to be wholly of a temporary nature, that it vests no permanent right whatsoever.
If the permitted use becomes dangerous or such structure shall become insecure or unsafe,
or shall not'be' constructed, maintained or used in accordance with the provisions of this
title, the same may be revoked and the structure and obstructions ordered removed by order
of the City Engineer. If this -,application is for a specified period of time, the terms
of said applicatjon is: for the life of the condominium.
INDEMNITY:— Applicant understands and by his signature to this application, agrees to hold
the City of E - d�iionds harmles's from any injuries, damages or claims of any kind or descrip-
tion whatsoever,.foreseen or unforeseen, that may be made against the applicant or the City
of Edmonds, or'any Of its departments or employees, including but not limited to the defe*nse.-
of any legal.proceedings including defense costs, court costs, and attorney fees by reason
of granting this permit. In addition, applicant understands that the City shall be provided
a certificate of insurance to indemnify and hold the City of Edmonds harmless from all
claims and[or property damage, naming the City of Edmonds as an also insured.
APPLICATION OF CHAPTER 6.40 OF THE EDMONDS CITY CODE: Applicant warrants that he has read,
or had the opportunity -to read, Chapter 6.40 of the Edmonds City Code, attached herewith,.
and understands that all terms of that Ordinance are incorporated herein as if set forth
in full an * d this application and permit therefore are subject to the terms of that Chapter
of the Edmonds City Code.
pplic
.� 's Signature
Date
11/7/74 rev.
41 wl
City of Edmonds 'Public Works Dep
APPLICATION FOR STREET USE PERMIT
Approval (and Agreement, if applicable) of Abutting Property Owners:
Signature Printed Name Address Date
k9aZk E3(- 60, z - 5; --t 1�
DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
City Council Approval (Attach Minute Entry):
Permit Fee: Annual Fee: due January 1, 19
Amenities Design Board Approval (if applicable) Attach Minute Entry:
Building Official Approval (if applicable):
Signature Date
Provision for Indemnity:
Terms and Provision of Performance Bond, if applicable: (Reference 6.40.050 of applicable
Ordinance)
PERMIT AUTHORIZATION BY P.W. DIRECTOR:
S1 9"� ,u re Da te
PERMITINO. DATE 61
Remarks:
11/7/74 rev.
ECO
5 S = SAFECO INSURANCE COMPANY OF AMERICA
s] G = GENERAL INSURANCE COMPANY OF AMERICA , C11) PLAZA INSUIPANCE. AGENCYJ, INC.
F = FIRSI&TIONAL INSURANCE C15;10ANY OF AMERICA 02-0 832
HOME COW: 4333 BROOKLYN AVE. N.E., SEATTLE, WASOTON 98.185
HEAD—QLLJC #Wd W&DA: MISSISSAUGA, ONTARIO
he company designated by initial, a stock insurance company herein called the company)
Certificate of Insurance
The company certifies that the insurance policies indicated below are in effect on the date of this certificite.
Name of Insured and Mailing Address (Street, City, State or Province, ZIP or Postal Code)
F
STERLING A. MILLER AND WROYHY MILLER
19421 — 867H AVE1M WEST
EMMM..WASHINGTON 98020 (SN1110HOMISH COUNTY)
Policy Period:
-11
from— JULY 200 1978"
�Rlwdw; I M Eyk. __ - - - I
f-1 12:0 1 A.M. F-1 Noon
Standard Time, at the address of the insured
, 4�:
For each policy -the followin g schedule indicates the basic type of Insurance provided with the limit of the insurer's liability or maxi-
mum amount payable for loss.
This certificate is only a statement of the existenceaf the policy or policies of insurance herein referred to and- neither affirmatively
nor negatively amends, extends or alters the coverage afforded byan y policy described herein. -
Limits of Liability or Amount of Coverage
Policy Number
Type of Insurance
Coverage
One Person
One Occurrence
Aggregate
Liability
Bodily Injury
$
$
$
SCC 850460
Other Than
Property Damage
$
$
Combined
$ 30(),000.
Automobile
Bodily Injury
$
$
Automobile
Property Damage
$
Liability
Combined
$
Perils Insured Against
Coins: %
Limit of Liability
Property
Building(s)
Insurance
Personal Property
Business Interruption
A .1.
Location:
Workmen's
Subject to the terms of the4%;Jb'Q-s 11f
Compensation
Compensation lows of the state in
which policy affords coverage.
Location at risk covered, or description of automobile or contract covered, or description and location at operations or work covered:
In the event of any material change in, or cancellation of, said pal icies, the undersigned company will endeavor to give written notice
to the party to whom this certificate is issued, but failureto give such notice shall impose no obligation nor liability upon the company.
Certificate is issued to: Name and Address 20 day prior notice of cancellation to
certif icate holder has been endorsed to policy No.(s):
CITY OF EDMONDS
EDMONDS.. WASHINGTON
PLAZA INSURANCE AGENCY, iNL,
22905 - 56th AVENUE WEST
MOUNTLAKE TERRACE, WASH. 9804Y
SEA/TJMG
F1 If an x in box - limits of liability have been
increased only for operations or work described
above.
Any statement on
END. #4 ,
By
SAFECO INSURANCE COMPANY OF AMERICA,
GENERAL INSURANCE COMPANY OF AMERICA
FIRST NATIONAL INSURANCE COMPANY OF. AMERICA
CF-781 10174 PRINTED IN V
ADDITIONAL INSURED'
(STATE OR POLITICAL SUBDIVISRS'
PERMITS RELATING TO PREMISES)
(11) PLAZA INSURANCE AGENCY., INC. Ol—'0.032
This endorsement mod if ies such insurance as is afforded
by the.provisions of the policy relating to the following:
BLANKET LIABILITY INSURANCE — COVERAGES A 111 8
COMPREHENSIVE GENERAL LIABILITY INSURANCE
MANUFACTURERS' AND CONTRACTORS' LIABILITY INSUAANCE
OWNERS', LANDLORDS' AND TENAN*S' LIABILITY INSURANCE
STOREKEEPERS' INSURANCE,
PREMILJM
It is --Iq1`PV(1 that the "I"PI'sCals I . tisLired" iwovisioii includes as an in- WAIVED
openings, sidewalk vaults, street banners or decurations atid
sured any state or political subdivisiciii designated in the schedule similar exposures;
below, Subject to lhe following additional provisions: (b) the construction, erection or removal of devators;
I . The insurance for any such insured applies only with respect to
such of the following hazards for which the state or political (c) the ownership, maintenance or use of any elevators coveied
subdivision has issued a permit in connection with premises by the policy.
owned by, rented to or controlled by the named insured and to 2: If Property Damage Liability Coverage is not otherwise affordecl,
which the Bodily Injury Liability Coverage applies: such insurance Shall nevertheless apply with respect to operatioris
(a) the exis ' tence, maintenance, repair, constr6cition, erection or performed by o I r I on behalf of the named insured in connection
removal of advertising ligns, awnings, canop ies, cellar en -
with the hazard for which the permit has been issued subject IL)
trances, doal'holes, driveways, manholes, marqtjees, hoistway the limits'of liability stated herein
SCHEDULE
Designation of State or Political Subdivision:__._CJMjW_. FDMNM
1.11110.�ol Voqwf ty Oarviailv I.i,ltiillfy
NOINO, each occurrence
-3M0QD,.ggregate
Premium $ — INCI I IDED
hiz; r,-Ildor�;enlenl r; execillod by the company stated in the declarations.
IY D AMMERSLA, SECRETARY
COMPLETE THE FOLLOWING IF NOT At TACHED TO POLICY WHEN POLICY IS ISSUED:
GOADONN SWEANY PRESIOLN
INSURED
CO ER
AGE
CLASS
OR CODE
UNEARNED
SR/PR
OLD
(FULL TE RMI
RETURN
PREM IUM
NEw
OULL TERM
ADD TION AT
PR`EMIUM
STERLING A. MILLER, ET AL
FACTOR
I PREMIUM
PREMIUM
IN11011EMENT
("EC,."E 5/7/79 h ia
BI
NIL
_,3
lh� "W"I "I 111� pd,, Y)
T,
POLICY OR BOND -85
7 7 J
NUMBER ISM 0460
PD
POLICY
I; A
1 iTNPUIAREII
_IXPL�TL 7/20/79
-
ENDORSEMENT
N UMBER 3 ACA _J�,M.'_
I 5/25/79
SEA/TJM/BG
SAFfCO INSURANCE COMPANY OF AW RICA
GENERAL INSIJRANL E COMPANY Of AMERICA
FIRST NATIONAL INSURANCE rOMPANY OF AMENICA
0—d __*q h! 1�1 I I BY
TOW IiHOS',
/�2
eM- A INSORMCE AGENCY,fNt
22905 - 56th AVENUE WEST '��6L XANI
L 2111 RI 4167 11110UNTLAKE TERRACE, WASH, 9" PRINTED IN U-S.A.
Monett 8.213A
SAFECC) S = SAFECO INSURANCE COMPANY OF AMERICA
S G = GENERAL INSURANCE COMPANY OF AMERICA
F = FIFAWATIONAL INSURANCE COMPANY OF AMERIC
HOME RWCE: 4333 BROOKLYN AVE. N.E_ SEATTLE, WAOIGTON 98185
DA: MISSISSAUGA, ONTARIO
#ANA
__�cVe o, ro d by the company designated by initial, a stock insurance company herein called the company)
(014) PLAZA INSURANCE AGENCY, INC. 02—
Certificate of Insurance 0832
The company certifies that the insurance policies indicated below are in effect on the clafe of this certificate.
Name of Insured and Moiling Address (Street, City, State or Province, ZIP or Postal Code)
STERLING A. MILLER AND DOROTHY MILLER
19421 — 86TH AVENUE WEST
EDMONDS, WA. 98020
Policy Period:, :! I '
from— JULY 201 1979
to JULY 20, 1980
r_1 12:01 A.M. E] Noon
Standard Time, at the address of the insured
For each policy the following schedule indicates the basic type of insurance provided with the limit of the insurer's liability or maxi-
mum amount payable for loss.
This certificate is only a statement of the existence of the policy or policies of -insurance herein referred to and neither. affirmatively
nor negatively. amends, extends or alters the coverage afforded by any policy described herein.
I Limits of Liability or Amount of Coveroqe
Policy Number
Type of Insurance
Coverage
One Person
One Occurrence
Aggregate
Liability
Bodily Injury
$
$
$
SCC 0850460
Other Than
Property Damage
$
$
Combined
$ 300,000.
Automobile
Automobile
Liability
Bodily Injury
Property Damage
$
$
$
Combined
$
Perils Insured Against
Coins. %
Limit of Liability
Property
Building(s)
Insurance
Personal Property
Business Interruption
Location:
Workmen's
Compensation
Subject to the terms of the Workmen's
Compensation laws of the state in
which policy affords coverage.
Location of risk covered, or description of automobile or contract covered, or description and location of operations or work covered:
BLANKET CONTRACTUAL COVERAGE INCLUDED
in the event of any material change in, or cancellation of, said policies, the undersigned company will endeavor to give written notice
to the party to whom this certificate is issued, but foilureto give such notice shall impose no obligation nor liability upon the company.
Certificate is issued to: Nome and Address 20 —day prior notice of cancellation to
certificate holder has been endorsed to policy No.(s):
SEA: RR/SN
Dated
at
CITY OF EDMONDS
EDMONDS, WA. 98020
SEATTLE, WASHINGTON
SCC 0850460
FLAZA INSURANCE AGENCY ' R@;, If an x'' in box - limits of liability have been
22905 - 56th AVENUE WEST increased only for operations or work described
MOUNTLAKE TERRACE, WASH. 1&42t above.
P-Rosp9d 8.21M Any statement o5*4erse_4efs v6k4f
on JULY 13, 1979 By
CF-781 10/74
SA RA$iCEr_OMPANY OF AMERICA
GEN=ERAL IN UITANCE COMPANY OF AMERICA
FIRST NATIONAL INSURANCE COMPANY OF. AMERICA
PRINTED IN U.S.A.
44
STFIET FILE
CIT Y OF EDMONDS
CIVIC CENTER - EDMONDS, WASHINGTON 98020 - (206) 775-2525
DFIDARTMENT OF PUBLIC WORKS
June 14, 1979
Mr. Sterling A. Miller.
19421 86th Avenue West
Edmonds, Washington 98020
Dear Mr. Miller:
SUBJECT: -STREET USE PERM -IT INDEMNITY
H. HARRISON
MAYOR
A Street Use Permit was applied for by you in connection
with a covered entrance and waiting area on the condominiums at
19421 86th Avenue West. After approving the Street Use Permit
application, you were requested to provide this office with an
insurand * e certificate, which was received on March 6, 1979. The
insurance certificate, however, did not contain the hold harmless
clause which the City requires and further should be a continuous
policy as long as the,street use continues.
At the time of receipt, the insurance agent was notified
that the ' certificate was incomplete. The agent was again called
on April 12 and on May 7, 1979; both times the agent indicated
that a corrected copy would be submitted. To date, this has not
been received.
- Would you please obtain a corrected insurance certificate
prior to issuance of the Street Use Permit; otherwise, we will
refer the matter to our City Attorney for resolution.
'If you have any questions regardingi-this matter,- please
contact the City Engineer's Office, 775-2525, extension 220..
LRL: j ak
cc: Jj_Qhn W lac
City Attorney
Yours very truly,
LEIF R. LARSON, P.E.
Director of Public Works
PLAZA INSURANCE AGENCY
05 56th Ave. W. — P. 0. Box 68
ST REET FILEOUNTLAKE TERRACE, WA 98043
778-2134
to: city of Edmonds .. . .... .. .
Pub:I�Works Dept.
200 Dayton St.
Edmonds, Wa 98020
Y KEARNS
- I
1.1, � - - - - - -----
RECOVE-i)
. . .. .... ..
JUN 2G 19719
0
----------
subject S-t-e-
tha-t--y-ou—s-Poke wi.t-h . ..... o..u.r--..Sa-f e. o-o—
J.-t '-Ed-Higglrk -is
the afo�cg a nd
dditi.ot
----e-nd-ors-e-ment . . .. ... . ......
.T y..-,f�...o-r--th.e--c-o-n.f-usi-o-n-..-a-nd--t-ru.s-t----t..ha-t
--am—s.orr
... . . .... ........
-a
date 6/2-5/79 signed date signe
SENDER: Mail white and pink 6pies with carbon intact. RICEI VER Reply, re tain wh ite copy, re turn pink copy.
v
Vy 0
,f '�k
CITY of EDMONDS BOES Prtn N 0MV12-1 LICENSE NO.
V
Civic Center - Edmonds, Washingto
9ff F
City Clerk n 98020 AN14UAL FEES.
Phone 77 . 5-2525 [�-kHOME OCCUPATION PENALTY AFTER FEB. 15
CLASSIYEAR LIC,EFFEC.D E JREASG. LIC. NO. SPEC. 1,
INSTRUCTIONS: $10.00 (A) ADDITIONAL $5.00 0
All items must be cornpleted # 0 SMALL BUSINESS
RECEIPT No. DATE PAID
or. application will not be ac- PRINTX $15.00 (B) ADDITIONAL $71.50. 0'
1-211 q 'IN SPEC. BOX El
cepted. 407 R ISSUE OF
-A -2-1 1-211 q. Fo
Sign and return application FEE PAID MEN . ALTY PAID ]CORRECTED
.LICENSE WITIH
with fee. Renewals received L /j ig: ,y, I I I 'LC'ACTION.
after February 15 must pay
penalty in addition to fee.
NEW BUSINESSES AFTER
JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANG
NAME OF FIRM
Business with 10 or
more employees ADDITIONAL $25.00'J"'o
$50.00 (C)
jg NEW APPLICATION (LA)
0 RENEWAL (LB)
0 CHANGE (I-C)
ES) 0 DELETE (LD)
BUSINESS PHONE
NO. OF EMPLOYEES
MAILING ADDRESS NATURE OF BUSINESS
kl� sc cv--C- -Two- rX
BUSINESS ADDRES-"/ 5-/ 7- Fl�- 14-�111 zc/ INDIVIDUAL PARTNERSHIP CORPORATION
---------- En (S) (P) P
OWNERS NAME HOME ADDRESS
HOME PHONE DATE OF F�IRTH PLACE OF BIRTH � .1 SOCIAL SECURITY NUMBER
'117 S - S.?- V1 -k I /-) 1/' /W M Nt--e--- k [� x- s k L 10, - C:z �:7 - / /N - cz- -> i
EMERGENCY NOTIFICATION: (1) NAME & TELEPHONE hinn� -��—\,sv.Nesvvw,, 2,-72&
OF? rl %1-1,
(PLEASE LIST TWO) (2) NAME 8, TELEPHONE MA
WASHINGTON STATE TAX NO.
APPLICANT'S SIGNATURE
DO NOT WRITE, BELOW THIS LINE.
STAFF REVIEW: FILL IN LAND USE CODE, UFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT
P-'A-PPROVE 11 DISAPPROVE DATE LAND USE CODE ZONING CODE
SIGNATURE�]-i�-' I I I -F� I I I I �]
CONDITIONAL USE PERMIT
COMMENTS
ING DEPARTMENT
DATE
PPROVE El DISAPPROVE
SIGNATURE
Building
Permit 0
Hotel/Motel
M
0
Apt. Bldg.
Office Bldg.
(A)
(0)
COMMENTS:
Occupancy 0
Restaurant
(R)
�jioup 0
Hosp/Nurs Home
(H)
==:71 CAPACIT (NO. UNITS, APTS., OFF16ES, SEATS, BEDS, STUDENTS)
0
School
1
(S)
FIRE DEPARTMENT
DATE
41-2- -7t'
U.F.I.-R.
APPROVE /APDISAPPROVE
SIGNATURE
COMMENTS:
POVGE DEPARTMENT
4�1�APPROVE 0 DISAPPROVE DATE SIGNATURE
COMMENTS -
PUBLIC WORKS DEPARTMENT
,L��PROVE 0� DISAPPROVE DATE SIGNATURE
COMMENTS:
P1 FACZF7 rITv r,,i r7nv
K
nn q nr-n�anflrPF_dkz_�Q-
(g P-O, T� 05,
vllfl� @95R�. V9 &)�D 0 Q� 0 woo �Wao_w a0k]RIV 6�6100 cq_OWW� t�00 Qmllvi�$ Lffikom M @L*�Vg (1�
1 tl;M3Luw
IM6� Q_:CWMW; loco@§ f"1_0Tr rcczv"110� MWIDD cdf-3 /_W-W iW: lo@NTU�g ffWTUo -:PD Tw Wf� C�9�� 9951 �_D ffa�=
NAME AND ADDRESS OF AGENCY -1 1 � I.,
Plaza Insurance Agency, Inc. 3Y
COMIANOES AFFOR[MG COVIERAGES
COMPANY b%
LETTER safeco Insurance Company
P. 0. Box 68
Mount RKbef W6W3
COMPANY
LET -TER
NAME AND ADDRESS OF INSURED
COMPANY 17,21,Z: E I V
Sterling A. Miller
LETTER
19421 86th Ave. W.
COMPANY N1 AR 6 1979
Edmonds, Wa. 98020
LETTER
G;
COMPANY
LETTER
This is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time.
Limits of Liabil
t X
COMPANY
LETTER
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION DATE
-
CH
OCCURRENCE
AGGREGATE
GENERAL LIABILITY
$300,000
$300,000
X
SCC850460
7-20-79
BODILY INJURY
COMPREHENSIVE FORM
PREM IS ES—OPERAT IONS
PROPERTY DAMAGE
$300,000
$300,000
EXPLOSION AND COLLAPSE
HAZARD
UNDERGROUND HAZARD
PRODUCTS/COMPLETED
OPERATIONS HAZARD
CONTRACTUAL INSURANCE
BODILY INJURY AND
PROPERTY DAMAGE
$ 300,000
300,OOC
BROAD FORM PROPERTY
COMBINED
$
DAMAGE
F]
INDEPENDENT CONTRACTORS
El PERSONAL INJURY
PERSONAL INJURY
$
AUTOMOBILE LIABILITY
BODILY INJURY
$
(EACH PERSON)
$
COMPREHENSIVE FORM
OWNED
BODILY INJURY
(EACH ACCIDENT)
PROPERTY DAMAGE
$
HIRED
NON -OWNED
BODILY INJURY AND
PROPERTY DAMAGE
$
COMBINED
EXCESS LIABILITY
F1 UMBRELLA FORM
BODILY INJURY AND
$
$
PROPERTY DAMAGE
OTHERTHAN UMBRELLA
COMBINED
FORM
UdORKERS'COM PENSATION
STATUTORY
and
EMPLOYERS' LIABILITY
$ (EACH ACCIDENT)
OTHER
DESCRIPTION OF OPERATIONS/1-OCATIONSNEHICLES
Street use permit -covered entrance for Sterling Crest Condominiums
19421 86th Ave. W., Edmonds, Wa. 98020
Cance&)Von: Should any of the above described policies b e cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail '30 days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
City of Edmonds DATE ISSUED: 3-5-79
200 Dayton St.
Edmonds, Wa. 98020
Le
Att: Lief R. Larsonnirecter
of Public W4ks
ACORD 25 (Ed. 11-77)
4 '_
STREET FILE
HARVE H. HARRISON
CITY OF EDMONDS
d MAY
200 DAYTON ST.- EDMONDS. WASHINGTON 98=-(206) 775-2525
DEPARTMENT OF PUBLIC WORKS
February 16, 1979
Mr. Sterling A. Miller
19421 86th Avenue West
Edmonds, Washington 98020
Dear Mr. Miller:
SUBJECT:*_STREET USE PEFYTIT - COVERED ENTRANCE
The Street Use Permit you submitted for the -construction
of a covered ent * rance-and waiting area for the condominiims
at 19421 86th Avenue West has been approved. Before we issue
the 'Permit, however, it is necessary,for you to provide this
'L
Office with an insurance certificate to cover this structure.
Upon receipt of the required certificate, we will then
forward a -copy of the Permit to you. Should you have any
questions regarding this matter, please feel free to contact
this office.
Yours very truly,
LEIF R. LARSON, P.E.
Director of Public Works
jak
Admilh I Dtf.
NA NA
LEGAL DESCRIPTION
FOR STERLING CREST CONDOMINIUMS
That portion of the West Half of the Southeast Quarter
Of the Southeast Quarter of the Southwest Quarter of Section 18,
Township 27 North, Range 4 East, W.M., described as
ollows:
F
REPAIRS TO EXISTING DECKS
Beginning at a point on -the West -line thereof 180.0 ft.,
N 0 35' 28" W from the Southwest Comer thereof, thence
STERLING CIDVIID�ST CONDOMINIUMS Continuing N 0 35'28" W along said West line, a distance of K
149.1 ft.; thence N 88 59' 0" E parallel to the South line thereof,
TH '-K 14�.
19523 86 AVE. WEST a distance of 105.0 ft. ;thence S 0 57' 44" E a distance of 49.97 & RECEIVED
thence N 88 59' 0" E a distance of 104.03 ft. ; N 0 57' 44" W
EDMONDS, WASHINGTON 98026 a distance of 50.07 ft. ; thence N 88 59' 0" E a distance of t1ov 0 11999 VI.NITY MAP
124.80 fL to a point on the East line thereof; thence S 0 35' 55" E
along said line, a distance of 149.1 ft. ; thence S 88 59' 0" W
DEVELOPMENT SERVICESCTR.
a distance of 333.84 ft. to the point of the Beginning. CITY OF EDMONDS
Less the West 30.0 ft. thereof
sl-o' H14H
M N
X_
tTA!!�/
A
t
e!44
C�
lid
.2k
j(.j:
tj �rAICKJW4 Ao� TYr
iL
A*
%
7 . 'N.
r
F-L. 4'rS.1 J
)K�fF
Ex 1.4T -
'77
It'k, -.ILL
ej
ti Ile,
7
Atj
(OPP 44 V)
tv z
':D S07 obllnt�&
7
All\
ip,
;_4 --T MUILZ"�
---------- 7
A
t
1A
-23
WF
VT
4-F
=UZ-1ca
-PJ�4 42.0.0.
4rX�U C
:L
Y� v
�7— 9
X.
�4
17jey
0 A
T 7.47,
V,
V.
F.,
.4-
.4
(T.y
?�, �,, . , . . I , I I . . . — . - , 9 Hne-e ma.
7
V
wry
Y
14
j
=,44',
7.
'T
N.
gt
A- A.
L
7- -17
V
J _7
_21
IT
T
ILI
X5,Z-3
Rece, vj�x)
NO V 0 11999
-06""'OPAIENT SE
Ti( or, RVICe C,
0' '1 s
ONDS
q7-3,?,7
Et I /-C
1"
ocv,jv5D
IDGMU
T 71
w IN T 10 N
MIA 12,21"U'u
F \ v L-0 -
APPROVED ",)- .,
MATCH
cat)rb�g
WQ, FA-C��- !�OVO4
_U
(I
15 � G 7 11 0
1/2, - V-oll
. . ' ' -f "L�AlJTeRW
MATCH
LINE
IWW.
CSOA,P, T.RJAA
4x� VA
�1, IN000
(o IZ G, ov.�� R,
OZ)< 4- r-Z, 6, cf5PAiR
E� AM
OQAL. 5RACNe
&M h I XLAlt*
T
1,01,
�*v 't � +
IT
oil
U-PA R PL'� Wool-,
ri, X W
Oft-, F� 7R I m,
q E
1
PLATE 1 -PLAN - PROFILE- F.A.S.
CLEMPRINT PAPER CO., S. F. CAL.
NO. 1000H-1
IFOR
5.TAF)?,L- m'/A/G fi� I LLER
ZDA101VD5
---AAV�9R Y 19 76
V4
uAll
d
tk'
4r 4,
v
'j
f
771.
J
R FILE
ZE I
all
Is"
MEY'RING & ASSOC,, INC.
2 "'t-D M
ghwav, 99
1-7
d',
q 036
L MO
0
127-0-2
9-77
PUBLIC2UTILITY DISTRICT NO. I of Snohomish Count y
cout,4 A AEA
LOCATION1
E
D AT'
C) U T
CA E)LE
12> REVISION
W.0 No.
SCALE
REASON FOR WORK-
I I\A A p-, — ENGINEER
AS BUILT',
— DRAFTSMAN
U.G. FILE No
D ts'lc) Li
TZ A
FOO
- APPR OVALS
_,�A p -Tp
DATE WORK COMPLETED 'By. OREMAN
eP-1-4 1:',,
------
�q -?)44'
-Tc> tE� p-
�PcADt-vic-->Y�-JT T21At-�'.)ff -
-pr,\ c. F--)
7,2c:><=>
j
ENVIRONMENTAL ANALYSIS —:-
EXEMPT UNDER DISTRICT SEPA,
PROCEDURES, SECTION
PARA L6 ITEM
DATE
INTERPRETATION REFF-RRE6TO,',.
sy
"I U.4. COND KV
ADD. �S,-CKT FT' 1 H
REMV CKT FT H,;
;T
NET��' FT
PERMIT
TYPECXT'� ar-51Y.-
DATE GRANTED
PERMIT
TYPE
V
PA,Tl��G R A N T E D'-
FOREIGN CONTACTS
COMPANY
TYPE
FOREIGN CONTACTS�'
COMPANY, L- T2F-K"� CATV'.
TYPE
EASE MENT�
GRANTOR
DATE GF3ANTED"
EASEMENT'
GRAN
GRANTED
WATER
SEWER
GAS
W.A.R. FORM
DATE REC-
FUSING COORDINATED
�By
LOG POSTED
I ,
I INVENTORY
I
MAP POSTED
I- -LPOLE
DEPT.,
TRANSF. CARD
0