20114 80TH AVE W.PDF111111111111
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20114 80TH AVE W
PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
NUMBER
CONSTF�UCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME OF. BUSINESS
c 7
LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
LID NO.
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MAILING ADDRESS
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1 3 9
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
EXISTING
RW Permit Requir-4�� 0
Street Use Permit 0
CITY ZI;
JTELEPHONE
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4_�
REQUIRED DEDICATION
PROPOSED
Inspection Require 0
Sidewalk Required 0
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
CX
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YES 0 NO
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REMARKS
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SHORELINE #
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
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SEPA REVIEW
SIGN AREA
HEIGHT
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COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
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LEGAL DESCRIPTION OF PROPERTY - INCLUDE ALL EASEMeATY
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2-31
EXP
LOT COVERAGE
REQUIRED S ETBACKS(FT)
PRO POSED SETBACKS (FT)
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PROPERTY TAX ACCOUNT PARCEL NO.
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REMARKS
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ADDITION (3 COMMERCIAL 0 CHANGE OF USE
REMODEL APARTMENT E3 SIGN
REPAIR GRADING FENCE
CYDS
( _ X FT)
CHECKEDB
TYPE OF CONSTRUC�T ON
CODE OCCUPANT
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DEMOLISH 0 TANK
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SPECIAL INSPECTOR AJJEA
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0 ROETAINING WALL C] RENEWAL
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0 6 LOAD
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CARPORT R CKEIRY
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
REMARKS
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PROGRESS INSPFCTI NS PER UBC 108
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NUMBER
OF
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AREAS
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STORIES
UNITS
NUMBER
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DESCRIBE WORK TO BE DO NE 1
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FINAL INSPECTION
REQUIRED
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE
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GLAZING %
1 ?_!�: I _2
LOT SLOPE %
--ss
BUILDING.
LA :
P M'dHEM NO:
VE�STEEI DTTE
PLUMBING
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
DOMAIN (CURBS,SIDEWALKS, DRIVEWAYS, MARQUEES,ETC.) WILL REQUIRE
F-
SEPARATE PERMISSION.
2
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
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W
0.
PERMIT LIMIT.,1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
STORM DRAINAGE FEES
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
x ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
a FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
_j
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE PLAN CHECK DEPOSIT
0
x NOR LIMIT INANYWAYTHE CITY'SABILITYTO ENFORCE ANY ORDINANCE PROVISION.'
TOTAL AMOUNT DUE /0
I HEREBY ACKNOWLEDGE THAT � HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATID�SSURANCE AND RCW 18.27. receipt is acknowledged in space provided.
7. DATE SIGNED OFFICI SI TURE DATE
IGN TURE (OWN GENI�) (425)
n7
I ju 771-0220
RJEA D BY—— DATE
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
CITY OVEDMONDS
18 9 0
Address of Construction:
0-1--l. 140 ll�_
Property Legal Description (Include all easements):
v6RA IT
SIDE SEWER
Owner and/or Contractor: %r�_
State License No. Building Permit No.
)9 Single Family
El Multi -Family (No. of Units-)
El Commercial
El Public
PERMIT -No-
10 V A X5.
PERMIT
9100
Invasion into City Right -of -Way: K No El Y.es
RW Construction Permit No. LYNNWQ,0[) LINE
Cross other Private Property: �L No El Yes
Attach legal description and copy of recorded e6sement
I certify that I have read and shall comply with all city requirements
.as indicated on the back of the Permit Card.
bee�_- !?4 �f I
Date
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION
0 FFICE USE ONLY
FOR INSPECTION CALL 771-SM, PUBLIC PT.
Permit Fee: Issued By
Trunk Charge: Date Issued -
Assessment Fee: R ece i pt, No.:
Lid No.:
Partial Inspection: Date -,Initial-
I Comments
Reason Rejected: Date -Initial
Final Inspection Approved: DateA,2- lnitial9;1_�
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Greert Copy: Inspector Buff Copy: Applicant
Revised 3!90
NOTICE:
No warranty of accuracy.
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds., its Employees and Consultants.
The City of 'Edmonds does not warrant the
accuracy of anything set forth on these
map(s-). Any person or entity -requesting a
copy should conduct an independent
---inquiry regarding the information shown on
th-e -map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may'not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or offi(cerzs shall be lialk-)-le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s),
I
The City of Edmonds Side Sewer Drawing EASEMENT NO . ............................................ . %
NEW CONSTRUCTION REPAIRS LID NO . .................. . ASMT. NO . ..................
OWNER------------------------------------------------------------------------------------------------ CONTRACTOR .................................................................................... PERMIT NO.
JOB ADDRESS ............... --Ak� ..... LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO - ------------------------------------
PWW-0001-1 1175 (REV.1 V78)
NAMEOF ADDITION ................................................................ ......................................................
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Approved:
DATE / !?q By�� ----- �4 - ----------
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PLANNING DATA
NAME: C-Argknj
SITEADDRESS: 2-o114- O� —DATE:
ZONING: PLAN CHK#:— 22- 201f
PROJECT DESCRIPTION: Al cl/�
CA FILE NO.
Critical Areas Checklist
------------------------------------------------------------ j
Site Information (soils/topography/hydrology/vegetation) 'ON 2
1 . Site Address/Location: 4/999
2. Property Tax Account Number: 4bl�_ 000 0 0-)
MV
3. Approximate Site Size (acres or square feet):
IC?n X a PD tckr
4. Is this site currently developed? X yes; no.
If yes; how is site developed?
5. Describe the general site topography.: Check all that apply.
Flat: less than 5-feet elevation change over entire'site.
Rolling: slopes on site generally less than 15% (a vertical rise of 1 0-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of
I 0-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet),
Other (please describe):
6. Site contains areas of year-round standing water: _; Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
B. Site is in the floodway floodplain of a water course.
9. Site contains hcree.k or an area where water flows aqro-ss the grounds surface? Flows are year-
round? &) 0 Flows are seasonal? — �J 6 , (What time of year?
10. Site is primarily: forested ; meadow -shrubs mixed
urban landscaped (lawn,shrubs etc) LAcOL).
11. Obvious wetland is present on site:
.§ite d�si' a 6d- 6 thi. Efivir*6*1'2'664�� 8e titive Aieas'Ma
sn i. . . . ..
^0Vh)Ld0C; Rev 10/03/97
C -ty of Edmonds
CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City of
Edmonds prior to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, 'or
may be, present on the subject property. The
information needed to complete the Checklist should
be easily available from observations of the site or
data available at City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/lier representative, must fill out
the checklist, sign and date it, and submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a devel opment
permit application.
Please submit a vicinity map along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this forrn. In addition, the applicant shall include
other pertinent information (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
MA Z-F( 0 1 lfu'l
Name
o Aj C W,
Street Address
&A4- 17
city State Zip
q 2-9- 7 7 2� ( 73
Telephone
Signature
Date
Applicant Representative:
Name 9
?q6 AL�05 Lr �Iz k) F--
Street Address
City State Zip
q2--s-
Tetone
Signature
0
Date
cxcceptlon�anakncl.doc
(over)
�1,r2 C . 1 B 9 1-1
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 '
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
June 3, 1999
David Wailes
Wailes Construction Inc.
3401 East Ames Lake Drive NE
Redmond, WA 98053
Subject: Determination regarding Critical Areas.Checklist # 99-163
Dear Applicant:
BARBARA FAHEY
MAYOR
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION It reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
IMPORM NFINFORMATION TO I§E*'kdTED:
PLEASE EXAMINE THIS" DETERMINATION"FOR ADDITIONAL REQUIREMENTS. YOUMAYNEEDTOSUBMff
ADDITIONAL INFORMATION SUCH AS AN TAL CHEC [ST OR CRTIcAL AREAS SM
The 'DETERMINATION' for the Critical Areas Checklist you submi.fted is a site -specific determination not a
project -specific determination.
You must submit a coDv of the CRITICAL AREAS CHECKLIST and DETERMINATION MTH ALL
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED. .40
Permit applications include the following:
cc: Martin & Kelley Karsten
20114 80th Avenue West
Edmonds, WA 98020
Enc: Determination
* Architectural Design Board
C:ReceptionUana\CRLTR.doc
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Planning Secretary
Incorporated August 11, 1890
Sister City - Hekinan, Japan
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PiJIBLIC Rt;.�H-r OF WAY OCR ORDINANCE NQ.
-Ro�pos - o RIGHT OF WAV
01zF!CIF.NC%" OF Rl(j!':*� OF WAY
�S'Yri_-SY)LfTf' i-':' WORK RFOUIPIED VIES 13 N
V,
P C r.'4 i Z', F C: 0, R K IN PU 3 LI C r,,W KYES. P4 0
C.) WIRING RUCIV-1:1RED IVI Y ES 40
i,7 W:11 76 C17;NN;ECT_!0N �'7, SANITARI 1TTVJ=14 0
71�>
i.EPT'IC TANK rERMIT PEQZJ'9E:D :j YES A.,
SEPTIC TANK PERMIT NO,
('6'lj
OATEr —70
4A
410 SEE MEMO
e 4`7 /J— Ica—
L: ei;F� TELEPHONE NJMBER REMARKS
" . .... vs- o So
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K-L M141
NUMBER CITY LICENSE NUMBER CHECKED BY-,,—,/,
cv;�3
L,3eal D lion of Property JShow Below or Attach. Four Copies) METER/SIZE., 1BUILDING SOPPLYSIZE
. Z IF
�'p �d
REMARKS
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SIGN AREA ENV. REVIEW ADL-
ALLOWED PROPOSED COMPLETE EXEMPT
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REMARKS
VARIANCE OR CU REVIEW, BY
NNING
NEW
RESIDENTIAL
GAS
LINE
NON-RESIDENTIAL
SIGN
ADD
DEMOLISH
RETAINING
El
ALTER
EXCAVATE
OR FILL
WALL
FENCE
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REPAIR
PRE -MOVE
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INSP.
POOL
NU1489R OF 111TO11119111
1 UMBER OF
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DWELLING
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-
UNITS
- NATURE OF,WORK TO Off DONE
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cil "Applicint. on bchilf of his or her spotise, heirs, assigns and
T :wccessots in inmot, agrees to ind em nify,. d e fend and hold harmless
City of Edmondu, Washington, its officials, employees, and
ftoni any and claims for darnages of whatever nature,
rtR 4hck gly )I Indii, from !he isquance of this* permit. Issu-
z-iv,, cr i�.�dtici;
YARDS ( ( % I
-D-5- FRONT 1_� /,;) SIDE IS REAR�
FIRE ZON.E TYPE OF CONSTRUCTION ICODE
SPECIAL INSPECTOR -]AREA OCCUrANCY
REQUIRED GROUP
E) YES 0 N 0
PLAN CHECKED BY THIS SITE IS LOCAT
OF EDMONDS. LOC
SHOULD BE CODED
REMARKS
CHECK FEE
BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
VALUATION
LOT COV-'
-6 1 N T HE
L SALES
31.04.
U A I ' I I I iA I I-1
. .. .........
UITY UP 1 1 E,
R
SUBJECT:
Subdivision
FR:.)
Multiple
f 11 IERAL REQ
Coordination of the location or an�i :7,tructur(l, i%Tttli r,-,nr�ot I 1,n w-ji-ities, strepts, r)ror)prt.v
lines and drivewa.v grades i i the rk�spoimib * lit-1v of' the cot
The ccnstra,�tor is require(] to keep the abutting street cl-alled or dirt Tid debris caused
by the construction 7.30-200 Violations - Penalties 7.30.290.
A "Right-Of-Way.Construction Permit" is reqt-iired f rom the
I n of Nblic
Works for any work within the Public rl.ght-of-wa�y or, public easerient. 7.30-01.0 Violations
Penalties 7.30.290.
UNDERGROU;1D POIVER
UndergroLuid Wiring Req1d No t Req d
mARY S81-ER (FUNIT RLQ1D)
Connection to Sanita-r�
Sewer Reqld Back Uater Valve Rleq'd on Side 'Sewer
Sep'ti.c Tai-�-,- Permit Ren.1d. Desipii Approval Reqld
Approved.Dt. Permit 1jL1,tTj)(21-
STOH4 SEt-L�i 'SYSTE1.1 (11-13 CITY CODE
Drainage Plan Req'd
)K
Site Drainage to be Contained on S ite
IJ
�;ite I-)rainrif7o tn be Coiiliecte.,] to City System
ROADWAY A1,TL) DRIVEI.-I,-'�Y f U.- 1J1Ri-.',UF1'S
Drive,vjay Slope Not to Exceed III"
Driveway Faving Req'd
El
Driveway Culvort Req'd Size
El
Vertical Curb Req-d
EJ
si(ieaaii.: jiew(i
Street Favii-tg, Req'd
E]
Approve,]
-.170t
/N
Bond Req1d for Public Improvements
stimate
ET'Uhmi t C t E,
Inspections Ron',]. , Engi i
neering
Division
Foundation
Side Sewer
E) Septic Tank
atL
W '�r Service
EJ Fire Protection
Drainage
Site Irrproverry-,nts
24
hour notice is rpqujr�-d
for in5pection hy Engineering,
call 775-2525, extension 220.
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175
1978':,-,
Short Subdivision.,
n
Le
gal:'DeS IPtiO* s for . ph il Tulluck
.4
kRCEL NO. 3
ng
to
0 acc.ordi
'ei of Lot 19, E
f
Acres Divisii 6 NO- .2,
ast Edmonds
e me 12 of platsp on page
T h 66 P 0
east 80 fe rec rd.so
the plat thereof recorded.in Volu
Washington.
h Countyq
Snohomis
'tion' recon-
d for the construc
for ingress.and egress an
SUBJECT to avi,easement v
and maintenance of utilities, o er, under, across,
7 struction 9 operation
7:
th ough and upon the north 25 feet thereof
r
d
operation
nt for the.construction, reconstrUctiong
ze over, under, .`acro�s
GETHER,WITH,an easen
pipeline and woter lines,
wer
".-maintenance of' a sanitary se Acres Divisjoh No 2.8"
feet of Lot.19, East Edmonds
h and upon t South 10
he
throug on page 66,
ing- to th
d in vdiume 12 of Plats
e plat thereof, recorde
q � * hereof. -
accord
ty, Washington; LESS the.east 80:feet t
5 of Snohomish Coun
record
7.
7
W-
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4 - PE -OF A 0S...
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to
4
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3/4'f
C-0 V 019- W 177+
TOENC14 6ECTION
ORA / NA 6 6" IqWY
10
CITY OF EDMONDS - ENGINEERING DEP%
Examined
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L11 SAU -91-Ayd
oo, ASSOCIATE99 INC
StRMORS- DEVELOPMENT CONSULTANTS q PLANNERS
7.1108 - IN* EDMONDS, WA 98020 t 775-1594
_70�
7. 7
4k'UBLIC INIO R*KS DEPAr<�F CHECIA
.. BU=T-NG PER,,aT REVIE14
Date
Stmet�Right-of-Way Existing D REQb
Access Easements Existing REQD
REQD
Utility Easement Existing YES�
Lot per-Subd#ision Plat Assessor Map
Site, Plm Checked for Accuracy
Underground Wiring.Reqd.
Check�Accuracy-of Legal Description
Environmentally Sensitive Area
Enviromental Checklist Reqd. AfA
Flood,Hazard Zone
Shoreline Manaaem-ent Area
Slope, Soil, Vegetation
Strewn, Creek, Drainage Basin
Existiri Zorn g Per'Code,-,,-
Amenities Design, Board Approval Reqd... ADB Approval
Board of Adjustment. Ap ro al Reqd.
1-14)p V
,_Reviq'��.. By: Date:,
Exis�ting 1%Tat Main Size
er 5,T ends-f MV-Ave-W-
Water Main Reqd.,
Service Line Reqd.
Hydrant Size Existing, AIM.
Hydrant Reqd.'Per Fire Code Ve Size
Detector Check Meter-Reqd. A/M
Cross Connection Inspection
Fira-Department Comments
Water Meter Charge Reqd.
Review'by: Date:
Septic Tank Permit Reqd. Permit No.
Sewer,AVailability., Proi
I I f I% )'"K Cl File No.
Drmv-ing No.
Side Sewer Availability b
Sanitary Sewer Connection Fee qd- 114t)
Reviw By Date:
Address
(�)en Ditcli Existill" R
C:� eqd.
Culvert Rcqd.
/?"0 Size
r4'-- CciLch Basin Reqd.
Indicate on Site Plan
0
ShOUldCr drainq,,c n-nintain collection on S-11vale open ruioff
M
-,1-Uiole' reqd.
Indicate on Site Plan
Soil Conditions and, Ground Water Field, Checked
Reviu.%7 by U-1 te
I'd Wi
Street Paving Reqd. "Ve
Curb and Gutter Reqd.
Sidewalk Reqd.
14 Curb Cut: for Driveway Reqd.
"I IV
I r� RiE)pt-of7V,1ay Construction Permit Reqd.
Bond Reqd. for Public Inprovements
Street Narin Sign Req-d.
/f/Ax
Other Signing-t:Reqd.
Pre Permit -Site 111spection m- do on
-I BY: SB, 7ER
WATER
Cn
F"-4 ��2 S'11=T
I ENIGINEEIZIPG
Spe'cial Require-iien t:s lisLed in jn,2jj-x):. to. Cor,,11�1.ni t:,
Developr',i--nt:'DepardTen
Jklildinc, I)iVision
BY Date
o All. iten's filled* in on 1� Permit Application
I BY
Ile Drawinq;s Stan-n)ed ai d ot s .1-kide
e
-ati s
BY Date
par
Approved by Public 'Poi. s De Linent
Revised: 1v 10-19"/7
IC WORKS DEPAfvM,-U;7Tr CULCKLISJO.
BbUD.I:NG PLIMIT REVM- 4
Date
Street Right -of -Way Existing e� I/
=Z9�
Access Easements Existing :a -
Utility Easement Existing YES.
REQD —
REQD
IAJL per SubLuvision 'sessor Kip
Plat As
Site. Plan Checked for Accuracy
Underground Wiring Reqd.
Check Accuracy of Legal Description:
Envirorunentally Sensitive Area
Environmental Checklist Reqd.
Flood Hazard Zone
Shoreline Management Area
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Fz�isting Zoning Per Code
Amenities Design Board Approval Reqd. ADB # Approval
Board of Adjustment Ap.j.),roval Reqd.
Review By: Date:
Li��i-ng Water Size
Water Main Reqd.
Service Line Reqd.
Hydrant Size Existing
Hydrant Reqd. Per Fire Code
I D�dtector Check Meter Reqd.
Cross Connection Inspection
Fire Department Camients
Water Meter Charge,Reqd.
Review by:
5
d .,cf
Size
Date: /'/ - // -- 7 �/-7
A.CUU-, LAZZ.11-611 IIPPI.UVVU ua t:e:
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability<����� Proi.
Drawing Nb'. I f) Cl File No.
Si4e Sewer Availability
Sanitary Sewer Connection Fee qd. 9
Review By.:. Date: e4 -16v
�'
Addre,-
.9
BUILDING DEPARTMENI,,, Applicant Fill
PERMIT APPLICATION inside Heavy Lines
NAME JOR NAME Of BUSINESS)
W MAILING ADDRESS
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0 CITY CLEF ONE NUMBEY
1 �5— 08
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ED1n,;')A1bS_ I . F-7 7 7 6 6
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F_ -7 IX $1A 4/,0
U
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U STATE LICEP459 NUMBER CITY LICENSE NUMBER
Legal D rlption of Property (Show Below or Attach Four Copies)
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USE PLHMIT
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ADORES S
LEGAL LOT
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YES ONO
PUBLIC RIGHT OF WAY PER ORDINANCE Ng.
EXISTING RIGHT OF W AY
PROPOSED RIGHT OF WAY -
DEFICIENCY OF RIGHT OF WAY_____jo
STREET/UTILITY WORK REQUIRED YES
NO
PERMIT FOR WORK IN PUBLIC R/W AYES
El N 0
UNDERGROUND WIRING REQUIRED WYES
EINO
CONNECTION TO SANITARY SEWER A ES
[]No
SEPTIC TANK PERMIT REQUIRED Q YES
;kN 0
SEPTIC TANK PERMITNO.
SEE MEMO DATED ca -7)
REMARKS
CHECKED BY
BUILDING SUPPLY SIZE
P
SIGN ARE ' A ENV. REVIEW . . ADB NO.
ALLOWED PROPOSED COMPLETE1 EXEMPT 1.
I SHORELINE
REMARKS
VARIANCE OR CU IPLANNING REVIEW BY I DATE
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CODE
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ITYPE
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DEMOLISH RETAINING
WALL
SPECIAL INSPECTOR
REQUIRED
AREA
OCCUPANCY
GROUP
OCCUPANT
ALT1901 EXCAVATE FENCE
El YES 0 NO
LOAD
1-1 OR FILL X—FT)
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
PRE -MOVE swim
F]
OF EDMONDS. LOCAL SALES TAX
REPAIR
INSP. POOL
SHOULD BE CODED 31.04.
REMARKS
Z NUMBER OF 9TOR us
NUMB ER OF
2
DWELLING
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UNITS
NATURE OF WORK TO BE DONE
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PLAN CHECK FEE
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FEE
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I
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BUILDING
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PLUMBING-
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MECHANICAL
FENCE
SIGN
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0 "Applicant, on behalf of his or her spouse, heirs, assigns and
j jCou6ts In Interest, agrees to indemnify, defend and hold harmless
I the aly.�of Edmonds, Washington, its officials, employees, and
RETAINING WALL
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agents from any and all claims for damages of whatever nature,
1
x itrising d1recily or Indirectly from the issuance of this permit. Issu-
SWIMMING POOL
In ance of Ibis permit %hall not be deemed to modify, waive or reduce
J
vity oidinancx nor lindt in ;my way tile
. . . . . . . . . . . . . . . . . . . . . . . . .
"
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j?nniarks ..—I)A AIJUi..C. c-- z?�74- IQ-
-PM 3 ASSOCIATE% INC.
tz--A NUMORS - DEVELOPMENT CONSULTANTS i PLANNERS
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CITY OF EDMONDS V
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Construction OT14
-0-0 IN A 0 a-v)% U . k 1A).
Owner: L46) 413 V.
Name
Mailing Address
City, State, Zip Code
P. 'At Smj),A, Co�
0 Contractor:— 111�
Name
J-A C) 1�
Mailing Address
�i L;tj e V 6 31,
City, S ta te, Zip Code
#ermit No.
Issue Date 7
0 Permit Issued To:— to LA (3 AA- k
• Type of Work to be Done:
XN
• Work in Connection With:
El Sub or Plat Single Family
11 Comml. / Ind. 0 Apt. Condo.
• Pavement Cut: E] Yes El No
State License Number
Telephone Number
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
against the City of Edmonds, of any of it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time A debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be.in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times� A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this r)epvlt inust-be a
Sig
Ownerlor Agent
the job site for inspection purposes at all times.
M
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authoriz6d: V
Special Conditions:
Ammendments:
after *'-�2 —days
Permit Fee:
Security Deposit:
Receipt No.:
Fund 111 Fee:
Street Cut Dimensions
X
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
C I OF EDMONDS
PUBLIC WORKS DEPARTMElf"' e%wr
.- qkREET FILE
RIGHT - OF - WAY CONSTRUCTION
A. eAddress or vicinity of Construction.'
0 Owner:* J_ J',,
Name -
Mailing Address
..City, State, Zip Code
0 Contractor:
Name
Perm' t No.
Issue Date
0 Permit Issued To:—,
Type of Work to be.Done:
Work in Connection With:
El Sub or Plat 0 Single Family
0 Comml. / Ind. 0 Apt. Condo.
e Pavement Cut: 0 Yes El No
Mailing Address State License Number
I —
OF
< City, S ta te, Zip Code Telephone Number
U
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
co
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
0
U
W Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
cc following the final inspection and acceptance of the restoration by the Engineering Division.
0
Z
Ln
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this permit must be available at the job site for inspection purposes at all times.
Signature:— Date 1
Owner or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C.IssuedBv-
Time Authorize , d: Vold after t 71-�J —days
Special Conditions:
Ammendments:
Permit Fee:
Security Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimension
x -
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. Deccmhcr 1978
UTILITY DISTRICT
CountV., I S,
\Aj.
S
It: Date W-CL a.
ni;-ason for, work
'-4 -,4 C- C Revision N
2 Scole
E �55 RE
'111I File No.
Approvals
PERnIT RE
UIRED FOREIGN CONTAC
Typ C 0 1 P 0 n V1 C--j f I J fa4 L EASEMENT ONMENTAL Aid
!��L 11,7 L view
Date Granted -9 Exenv* -un"dOr
District
Proced '
M GranSer uf*s,.Swction 1
L Posted Invon Fees "reqvireii. vesm NC) raph
r sf.Cord Pole 'S*\/ L Granted
Type Date, Par" ften
bate Date-8 - -24
8 - -10 A N
Circuit Ato lnterpre#o
t10"
Date V&rk Complot Date Released For Construction
Circuit' NU Date--,._Igy
orenmn
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A L W-0. No- 7
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The City of Ednio d Side Sewer Drawing
T 0 r ..... (25.0-2-1.1
REET FILE EASEMEN N . . ...... .... .... ....
NEW CONSTRUCTION REP*AIRS E] LID NO. .1,39
. ..... ASMT. NO . ..................
OWNER ...... ...... W-a
............. * ...... .................... CONTRACTOR .... vi ............ PERMIT NO.
9_4
JOB ADDRESS --- 80TIA.Ye� .. ----- LEGAL DESCRIPTION: LOT No . ...... ........................ 'NO . ............
............ ..................................
BLOCK
.................................................................................................................
NAME OF ADDITION ....
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EDMONDS
TREATMENT PLANT
PWW-0,001-11/75(REV.11/78)
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Approved:
#5vj
DATE ----------- ----------- 1. 1.9 06S-Q�
.. ........ By .................... ...........
CITY OFI.:EDMONDS
FOR INSPECTION CA
PUBLIC' WORKS DEPAWNT Permit N 00
SID t E EWER I PERMI 7 , 7 5-2525 Ext. . 220 Issue Date
N
PEP -MIT MU
ST'BE POSTED ON JOB SITE
0, FOAM W. ;11q80?_0
( iiAe "all, `e '7-
inc atsem'ents)
3.
l..' Ad d i,'e s s', . o f . -C.onstruc.tion__�
Property'Legal Description
Single Family Residence -Lol�Multi-Family No. of Units
Commercial
cjD toe
4. owner aTtd76om=B m-1-11der 'I dc, a ave-
5. Contractor & License No. 1__UAJ"eAJQQe1 LY-NO499 -73:11 Or
6. Invasion into City Right-ofUWay: No 9,0-'eVes (If Yes Right-of-
way Construction PermitQ�Required Call Dial Dig (342-5344) before
excavation) .
7. Cross other priVate property.- Yes No4g'�Easement required
attach legal de'scription and county easemenrMn-umber.
READ THE FOLLOWING AND S2GN:
a. Property owners must obtain apermit to install side sewers o
their property. A licensed side sewer contractor must be employed to,
construct side sewers in the public' ri,,ght-of-way.
The side sewer contractor" assumes full reponsibili�y for each
installation for one year.
C. Commercial establishment requires.a minimum of a six inch -(6")
side sewer
"'sewers may.,not be installed closer than thirty inches (3011)
d. side
to any structure.
e. Side sewer lines must be laid at a minimum grade of 2% (1.150)
0
and maximum grade of 100% (45 0
.f. No turn in side s8wer greater than 45 (1/81bend) is allowed
between cleanout. Ali 90 turns must be constructed of a 450 (1/8
.bend-) and Wye with reN
,Tble cap,,,,
f
g. No down spout 4o�t-i--nql ains or f oor drains can be connected
I side sewer system.
4
h. Pea gravel is jequired for bedding when installing sewer lines
th�-'bugh other than granular soil.;.
fli. Cleanouts are �equire&,.'at 30'1-60" f om ach plumbing exit line
anb at minimum intervais of�1001 along sewe li e run.
Trenches within' CAy right- .,."wa ]be restoried to original
conditions. Contract s- sk5,111—ber ponIff, e fbr right-�of-way failure
due.to poor compactio of fil --- W_1�
2116-ft4 uncovered til ins
�k.. Side-7,sewer--mu ',+be pecteld"and approved
by -the Cit�.--
0 c
U
1. Ins ::tion,` -ing normal working houls only. T�)o (2) working
du ir
.44ys notice 11equired_..
DATE:.,�
T1 C :ttify that I have read
A
d shall comply With the above
L
b 13 T ��i _ - L- ��
- 00 0, R�bvm 11 t
PERMIT FEE: 97 ISAPPROVE D BY: Date:
!=P= 06
C-) 4r I Date:
CONNECTION FEE: Aj V 'S.
P4 . I . If APPROVED By: tn-7,� Date: ?_6
0
*.PEP MUST BE POSTED ON
ZMIT JOB SITE
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A2M
OF
Deccmh�r,15, 19
File No. 7�3-2-70
LEGAL D[SCHIPTIMS F(M.Illilt- TULLUCK SHORT SUBDIVISJOH
LNTIRE PARCEL
Lot 19, East Edmonds Acres Division No. 2, according to the plat thereof
recorded in Volume 12 Of Plats, on page 66, records of Sii0homish COUI-ItY,
Washington.
PARCEL 110. 1
Lot 19, East Edmonds Acres Division No. .2, accordIng to the. plat thereof
r I ecorded ih Volume 12 of Plats, on page 66, records of Snohomish County,
Yashington.
EXCEPT the -East 150-00 feet,thereof.
SUBJECT TO an casement for the construction, reconstruction, operation and
rr-a i n t . enance . of 3 sanitary sewer pipeline and wIlter lines over, under, across,
through and upon tile south 10. feet thereof -
PARCEL 1:10. 2
The West 1 .70.00 feet of the East 150-00 feet of Lot,19, East Edmonds Acre ' 5
Division No.", according to the plat thereof recorded in Volume 12 of Plats,
on page 66, records of Snohomish Countyz� Washington.,
SUBJECT TO a . nd TOGETHER WITH an casement for the construction, reconstruc-
f a sanitary sewer pipeline and water
tion., operation and maintenance 0 10 feet of Lot 19,
lines, over, under, across, through and upon the south
East Edmonds Acres Division Ho. 2, accordingto the plat thereof recorded
in Voium I e 12 of* Plats, Of' Page 66, records of Snohomish Countyl Washingtol . I;
LISS the cast 8o feet thereof.
ALSO TOGETHER WITH an casement for ingress arid egress and for the construc-
t,ion, reconstruction, opQrat-,on arid maintenance of utilities, over., und(�r,
across, . through and upon the north 25 feet of the cast 80 ' feet of Lot 19,
East Edmonds Acres Division Ho. 2, according to the plat thereof recorded in
VOILIMC I2-of Plats, on page 60, records of S110homish County, Washiiigton.
Page I of 2 Pages
Legal Desco- tion3 for Mill TUIttick Short S01VISIU11.
PARCEL NO. 3
The c,i!;L 80 f(!(,L of LoL 19,1 1 dmoiid:; Acres DIvIsIon Ho. t-', occording. to
the plat thercof.recorded in Volume 1.2.of Plats, on page 66, records of
Snohomish County, Washington.
SUBJECT to an casement for ingress and egress and for the constrUCti0fl, rec'Orl-
sLrucLion', Operk-Ition -Ind mainteii-Ince of' utilities, over, under, acros.5,
through arid upon the ;iorLh 25*fcct thercof.
TOG[---THER WlTH an casement for the.construction, reconstruction, opera I tion arid'
maintenance of a sanitary-seyver pipeline and water lines, over, under, across,
thr6ugh and upon the South 10 feet of, Lot 19, East Edmonds Acres Division Ho.2,
according to the plat thereof ' recorded in Volume 12 of Plats, on page 66,
records of Snohomish County, Washington; LESS.the east 80 feet thereof.
A.F±� qcI01-LS02A �
Paqe 2 of 21 P�fg(!s
-T
VA
City o Edmonds
NSTRUCTION
RIGHT-OF-
PERMrr
Permit Number- _Z2
REVISION Lssue Date:
A. Address or Vicinity of CoP struction: 20h4 20116 80 Av W (9612757)
9 B. Typ6 of Work (be specific): - install 1-1/4" NPE IP Main in, 80 Av V
from 483'S to south end of she road
C. Contractor: -Washington NaturAl Gas Contact: —Mariamne Kingsbury
Mailing Address: 1122 75 St SW . Everett Phone: 356-7500 X7596
State License #-. 98203, Liability Insiirance: Bond:$
D. Building Peirnfit # (if applicable): Side Sewer Permit # (if applicable):
E. C1 Commercial E] Subdivision El City Project [N Utility (PUD, GTE, WNG, CABLE, WATER)
C] Multi -Family E] Single Family n Other
INSPECTOR: I14SPECTOR: KW
F. Pavement or Concrete Put: D[Yes []No G. Size of Cut: 4 x 2 H. Chargq,$
APPLICANT TO READ A��N
INDEMNITY.- Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the defense of any legalproceedings including defense costs, and attorney fees by reason ofgranting thi8permit.
THE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FE,�S WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY.CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT.
Conotructiro,drawing of proposed work required with permit application.
Ot
otice is required for inspection, Please call the Engineering Division, 771-0220.
Work and material 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 th� 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.
Ihave read the above statements and understand the permit requirements andthepink copyof thepermit willbe
available on site at ail
,times for inspection purposes. _>ep pg�,Z IDCM6T g.&W;e%-J
. - , A E�TejAr
Signature:
yUontractor or Agent)
CALL DIAL-A-D
,..TIME AUTHORIZED
SPECLAL-�CONDITIC
Date: 10-31-96
TO BEGINNING WORK
-4,
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A
A
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE,
Eng, Div. 1994