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20417 88TH AVE W.PDF111111111111 8463 20417 88TH AVE W Item #: EDMONDS CITY COUNCIL Agenda Memo Originator: James C. Walker For Action: X For Information: Subject: ACCEPTANCE OF A QUIT CLAIM DEED AT 20417 — 88 TH AVENUE WEST FROM NICHOLAS D. HART Clearances: Department/initials Agenda Time: Consent Admin Svcs/Finance — Community Svcs_ City Attorney Engineering LILL-L, - Agenda Date: September 22, 1998 City Clerk Parks & Rec Court Planning Exhibits Attached: Personnel Public Works 1. Quit Claim Deed Fire Treatment Plant Police City Council 2. Vicinity Map Mayor Reviewed by Council Finance Committee: Coin -unity Services Public Safety Approvedfor Consent Agenda: Recommend Review by Full Council: Expenditure Amount Appropriation Required: $ Budgeted: $ Required: $ Funding Source: I Previous Council Action: None I Narrative: As a condition of a building permit, the land owner 20417 — 88 th Avenue West, Nicholas D. Hart, dedicated right-of-way. to comply with the Official Street Map. This deed meets that condition. Recommended Action: Council accept the quit claim deed from Nicholas D. Hart. Counci I Action: Return Address: City Clerk City of Edmonds 121 - 5th Ave. N. Edmonds, WA 98020 QUIT CLAIM DEED Property Address: 20417-88h Avenue West Assessor's Property Tax Parcel No.: 5446 000 0010109 THE GRANTOR, Nicholas 1). Hart for and in consideration of mutual benefits to be derived by the establishment of a public roadway, convey and quit claim to the CITY OF EDMONDS, THE GRANTEE, the following described real estate, situated in the County of Snohomish, State of Washington, including any interest therein that grantor may hereafter acquire: The East twenty (20) feet of the West thirty (30) feet of Lot I less the East 240 feet, of die Plat of Pine Ridge. Volume 13. page 66 of plats, records of Snohomish County, Washington. together with the right to make all necessary cut or fill slopes on the land of grantor adjacent to the above - described real property in connection with the construction, maintenance or improvement of the above -described real property for purposes of a public roadway. DATED THIS DAY OF / STATE OF WASHINGTON) )ss COUNTY OF SNOHOMISH) On this day personally appeared before me Mr- 140 I -A 5- 3 IVA5'7- to me known to be the individual described in and who executed the within and foregoing instrument and acknowledged thaL_hL-�— signed the same as Mi, T free and voluntary act and deed,, for the uses and purposes therein mentioned. UNDER MY HAND AND OFFICIAL SEAL TIJIS A9 DAY OF 19 "OE NOTARY PUBLIC in ank! r the State of W hington, rest ihg at "�OT lip EXHIBIT I 0 0 VICINITY MAP 20316 H 20315 204TH ST SW —L—j ARRFA Tn TED BE DEDICATE ta 8814 8802 20524 20323 c\j 203-50 204TH ST SW 20417 20406 20408 ";j- Q) c\, Q� 114- Q) 14- Q� 8610 c\, c\l 20421 20414 20421 ca c\j I*- 1*- LJ-J �> 20432 20426 cl- Q) Z, 14- Q) c\, -< 20425 20427 — 00 20429 20431 20504 co 20501 00 00 20505 20503 20512 - 205TH PL W 20507 20507 20584 DATESEPT. 229 1998 EXHIE31T 2 I 111P - 0 17 FOUMPATItf-J, -nE- irvw Lxi-;r, t-,rzPlA)P.4.9 F-X t-,Tj M G RoOff- - -1 's �5, 0 �--numwrwj DfzfAtIN-, IUD (9 F DRS"I to S , t = -10 B.0 1 m a JAN 2 1 1, Kr r) C) f:� E, R �� , , L KTI lu G -FrG SCALE STREET FILE DATE RECEIVED .,, -10 rPERMIT AT EXPIRES CITY OF EDMONDS USE PERMIT ZONE -0&7 NUMBER CONSTRUCTION PERMIT APPLICATION JOB SUITEJAPT# ADDRESSC&,�// 9 OWNER NAME/NAME OF BUSINESS PLAT NAME/SUBDIVI SION NO. LOT NO. L�D NO. L D FEE $ 9—ew e— zfay &424n u MAILING ADDRESS z �: ;20z4j' n doe_ _W PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP _TESCP Appi-ed RW Pertnit Required 0 0 EXISTING — PROPOSED Street Uas Permit Req'd 0 lnspect:on Required 0 CITY ZIP TELEPHONE Sldewa k Required 0 F_nM0,.j&5 REQUIRED DEDICATION— FT I Underground ng requ re 0 NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES 0 NO 0 Ir w ADDRESS REMARKS z z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE C3 z Uj CITY ZIP TELEPHONE NAME V",�f-Alfff, PLjAffi8)W6- ENGINEERING REVIEWED/DATE ADDRESS U , L1W FIRE REVIEWED BY DATE uj Cc CITY ZIP J:��Wg= 1142b�- TELEPHONE 77 9'. _i4o Ll L-1 l'- z 0 5 LL VARIANCE ORtU SHORELINE OR ADB#',z�, INSPECTION STATE LICENSE NUMBER EXPIRATION DATE, EPKED By REO'D IPBOND OSTED V1Wjj_T_pjjoq_qCM 1,7- [PC 0 YES 0 No SEPA FIE VIEYV, COMPLETE EXEMPT' "SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED PROPOSED PROPERTY TAX ACCOUNT PARCEL NO. 0 ui _j EXP Ej NEW RESIDENTIAL PLUMBING /MECH r L&COVERAGE., ALLOWED PROPOSED REQUIRED SETBACKS (FT.) 'FRONT. -,SIDE REAR PROPOSED SETBACKS (FT.) FRONT UR SIDE REAR ADDITION 0 COMM I ERCIAL o COMPLIANCE OR, z CHANGE.OF USE REMODEL C3 APARTMENT [:1 SIGN z _j PARKING PROVIDED LOT AREA DATE I PLANNING. REVIEWED BY A REPAIR GRADING FENCE CYDS X FT THER DEMOLISH C3 TANK 0 GARAGE CARPORT .,,RETAINING WALLLL,, OCk Y L/ —RENEWAL R C:] (TYPE OF USE, BUS11 E S OR ACTIVITY) EXPLAIN: P CHECKEP BY TYPE C N TRUCTION COUE OCCUPANT LL cc 1A 0 -7 GROUP NUMBER OF NUMBER OF DWELLING. CRITICAL AREAS UJ I SPECIAL INSPECTO�t JAREA7.1 OCCUPANT '0 STORIES UNITS NUMBER REQUIRED YES�: LOAD DESCRIBE WORK TO BE DONE ------- REMARKS -:2 PROGRESS. INSPECTIONS PER:UBC 108/FINAL INSPECTION REO'D dcln� _fw= yzu VALUATION FEE PLAN CHECK FEE GLAZING % LOT SLOPE % <-- . — BUILDING PLAN CHECK NO: VESTED DATE PLUMBING MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC 2 GRADING/FILL D DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. CHARGE cc UJI PERMIT APPLICATION: 180 DAYS CL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION I 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE W IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING _j 2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE M 4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY RECEIPT x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT a _j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMI�NT OF ANY CITY ORDINANCE 0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* R CEIPT X, TOTAL AMOUNT DUE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLIC ION APPROVAL GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the CALL 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 receipt is acknowledged in space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. 0 1 LS SIGN TURE DATE . DATE SIGNED (425) ;6j, A 1, J A, ) 771-0220 RELEASED BY DA-t ATTATION EXT1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW - INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR 5/98 112 C. 18ofi N 0 T I C E TO PERMITTEE AND/OR OWNER F-1 PARTIAL APPROVAL F-1 VIOLATION Lj CORRECTIONS REQUIRED Permit Number 9 600 ( H A P,-T .0 4:51 Owner Job Address 2-04 P7 89 t /-) F--i No PERMIT -STOP WORK -REMOVE CONSTRUCTION OR OBTAIN PERMIT AND MAKE WORK COMPLY WITH ALL APPLICABLE CITY CODES. LjCONSTRUCTION Is NOT IN ACCORDANCE WITH APPROVED PLANS AND PERMIT - STOP WORK. MAKE WORK COMPLY WITH APPROVED PLANS AND PERMIT OR REMOVE. F-1 STOP WORK - UNTIL AUTHORIZED To CONTINUE By CITY INSPECTOR. 71 CORRECTIONS LISTED BELOW MUST BE MADE: BEFORE WORK CAN BE APPROVED AND/Oft THE NEXT PHASE IS STARTED; To AVOID POSTING OF A STOP WORK ORDER, ORDER To CORRECT, OR ABATEMENT PROCESS. F__j JOB CARD MUST BE POSTED ON SITE AND BE VISIBLE FROM STREET. F-1 APPROVED PLANS MUST BE AVAILABLE To INSPECTOR ON SITE. L] WORK DESCRIBED BELOW HAS BEEN INSPECTED AND Is APPROVED. F-1 CONTACT INSPECTOR AND ARRANGE FOR APPOINTMENT. F-1 RECALL FOR INSPECTION. T-�70 AO ASIleV Fot-L Pf-m� Fi5iwaSS N3-r(Z-A c:7-aA_ D%0 NO-7 OP jQ3PfC-0",&/ or-J Vdicf—� KAL­ Atjl> -51-it r-tEcivLO N�Y—( 4,VAtc_Aac-iZ� 0/-J Fba't- e-'C> P�X-Tlt A C--� (%- -Cyc� CA -7 11 - 0 lt-zo F_�' r A N 0 i� La u a S1 (tz-pac'--(I(Y�j. F-9a)uIES-T —(rj f�F_ K44op- P (Z-ku �_ —L b -7 AM fBX- SAMF-- DA-( irvJ?fFC7_1,,A)J THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED WITHIN DAYS OR PENALTIES MAY BE APPLIED. FOR INSPECTIONS CALL 771-0220. LjBuilding Division El Planning Department ED Engineering Department D Fire Department CITY OF EDMONDS �Lw Inspector /S-(-- Date PLANNING DATA NAME4,6&/a W&i SITE ADDRESS:- _104M&�&IODATE: de;.,�5_AV � - a , ZONING:.-. 1� PLAN PROJECT DESCRIPTION: CORNERLOT (Yes/No) FLAG LOT— AJZ) (Yes/No) SETBACKS: Required Setbacks: Front: �� Left Side: /63.-.Riqht Side: 40 Actual Setbacks: Rear: Front: z1,7, LeftSide: Right Side: Rear: Street map checked for additional setback required? (Yes/No) LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N) LOT COVERAGE: Maximum Allowed: -6, —Actual: B UILDING HEIGHT: Maximum Allowed: Actual Height: Datum Point: QO .0 um Elevation: 10-b y �,Wtl A.D.U. CREATED?: U) JI d4c SUBDIVISION: S %- r% ma. , CRITICAL AREAS #:a I HtET- SEPA DETERMINATION: �� LOT AREA: OTHER: Plan Review c:Ti1cskpermjt%ApjandaLdoc CA FILE NO. Critical Areas Checklist -------------------------------------------------------------- Site Information (soils/topography/hydrology/vegetation) I - Site Address/Location: t,4/ 2. Property Tax Account Number: -S L�' L1_ 6 0) Approximate Site Size (acres or squ7re fleet) 4. Is this site currently developed? _ yes, no. If yes; how is site developed? -S //,Cv,) 44:4 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 I 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 10-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? 8. Site is in the floodway /Vo floodplain of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? Flows are seasonal? (What time of year? 10. Site is primarily: forested eadow shrubs mixed urban landscaped (lawn,shrubs etcEl�! 11. Obvious wetland is present on site: )I/ / b ^ca chk.doc Ray 10/03197 111"ECEIVED 3% Ciq of Edmonds OCT 16 1997 PEFK UNTER eC f Critical Areas Ch ISt '47c. IS9, 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 pen -nit to the City. The purpose of the Checklist is to enable City staff to determine whether any potential Critical Areas are or may be present on the subject property. The information needed to complete the Checklist should be easily available from observations of the site or data available at City Hall (Critical Areas inventories, maps, or soil surveys). An applicant, or his/her representative, must fill out the checklist, sign and date it, and submit it to 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 development permit application. With a signed copy of this form, the applicant should also submit a vicinity map or plotplan for individual lots of the parcel with enough detail that City staff can find and identify the subject parcel(s). 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 Area Checklist and attest that the answers provided are factual, to the best of my knowledge (fill out the appropriate column below). Owner / Applicant: Name Street Address City, State, ZIP Phone Signature Date Applicant Representative: 6�6 Name 2aw-, V; Street Address Orr., I/S City, State, ZIP Phone Signature Date CITY OF EDMONDS REQUEST FOR PUBLIC RECORDS PLEASE PRINT CLEARLY Requester Name: Address: 10 Avc- W, Phone Number: Request Made By: /In Person In Writing Date of Request: �-7 /I Nature of Request: I bid, -t 4rcw e V -t Qktrfn,�E,�.± Is information requested to be used for commercial purposes? 9i'gnat,de 0- f Ilyle ste I FOR OFFICIAL USE ONLY ACTION ON REQUEST FOR PUBLIC RECORDS MUST BE TAKEN WITBIN FIVE (5) BUSINESS DAYS (SEE R.C.W. 42.17.320) Action taken: Request Granted Acknowledgment Estimated Response Date Provided Record Denied Record Withheld in Part (See No. 4) (See Nos. 5 & 6) (See Nos. 5 & 6) CONTINUED ON REVERSE SIDE 2. Request forwarded to attorney for review: Yes Date Forwarded /No 3. Notification of Action Taken to Requester: Date of Notification: a) [ ] Request granted I b) [ ] Need for additional time How long? c) [ ] Request denied d) [ ] Record withheld in part 4. if additional , I time needed, explain why: 5. If request denied or record withheld in part, name. the exemption contained in Chapter 42.17 RCW which authorizes withholding or denial: R 7 If request denied or record withheld in part,. explain how the exemption applies to this record: Request re9eiveA by: Date: Department: FEES 0 - 5 copies free Standard copy charge @ $.15 per page: Charge _ pages 9 $.15 per page $ Other (Refer to current Records Index & Fee Schedule) $ Total Fees: $ DOCUMENTS PROVIDED: DATE: MAILED: PICK UP: RECEIPT 4: DATE: 0�"- -, � '. �� 890 CITY OF EDMONDS 250 -.5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221 COMMUNITY SERVICES DEPARTMENT Public Works * Planning e Parks and Recreation Engineering June 19,1995 Sandra Bean 20402 86th Place West Edmonds, WA 98026 Re: ADDRESS CHANGE LAURA M. HALL MAYOR The City has received your request for an address change at your place of residence. After a site inspection by the Building Inspector, the Building Offical and the Fire Marshall have concurred that such a change would be in conformance with the addressing policies of the City. Therefore, approval has been give to change: 20402 86th Place West to 20417 88th Avenue West The City will notify all applicable City departments of the change. It will be your responsibility to notify all others, including the Post Office. You have 30 days to post new address numbers. Thankyou, Sharon Nolan Permit Coordinator cc. Fire Police Public Works Utility Billing Address Files Street Files Engineering Building Official ADDRESS. DOC/TEMP/BLDG 0 Incorporated Au_qus t 11, 1890 0 Sister Cities international — Hekinan, Japan CITY OF EDMONDS 250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221 COMMUNITY SERVICES DEPARTMENT Public Works * Planning * Parks and Recreation * Engineering 9 0 - 1 9 -9 December 21, 1994 Kenneth Bean 20402 - 86th Pl. W. Edmonds, WA 98026 Dear Resident: LAURA M. HALL MAYOR I have reviewed your account and will allow a credit to your account in accordance with our City policy. The policy states that the customer will be billed at the retail rate based upon the av e*rage water consumption for the same period during the previous year. In addition, the excess water lost from the leak will be billed to customer at the City's wholesale rate with a 15% surcharge added for administrative cost. Only one leak credit will be granted in any three year period. Should you have any additional questions after you receive your new billing, please contact Ilene Larson, Utility Billing Clerk. Sincerely, 0 IC4,t �, Roneljland Water/Sewer Supervisor RH/lk cc: Ilene Larson Utility Billing Clerk wordata\water\#422850 o Incorporated August 11, 1890 0 Sister Cities International — Hekinan, Japan 2 We - RECEIVED DEC 2 0 -1994 PUBLIC WORKS DEp7- y ep pov�&� PV6 APPLICATION F1 for The City of Edmo tt I LE SIDE SEWER PERMT EASEMENT No . .......................................... NEW CONSTRUCTION REPAIRS OWNER ...... "..l.L—.Y .......... FT� ......... .................... CONTRACTOR ...... R-USS ......... ......................................................... PERMIT No. ADDRESS --- — --- ...... PL . ...... \14 ........ LEGAJ, DESCRIPTION: LOT No . ................. I ............................. NAMP, OV AnnTrTOT%T p(NjF--- BLA)CK No . ............................................ E�XC �---PT E. 24C .............................................. ..................... roved: DATE .... ...... 7 ...... B y .. .. ......... I �Z_ . ................ NOTICE: No ...W a Y. 'shown on the attached The -informatiOn map(s) was compiled for use by the GtY Of Edmondsl its Employees and Consultants. Th,e City ofEdmonds does. not. warrant the t these accuracy of anything set for. h on rnap(s�. An . y person or entity *requesting a opy should conduct an independent inform-ation shown- on inquiry regarding th*e t5e -rnap(s)., including,, but not limited to, -er stub shown. Sucl- the lotation of any sew sewer stubs may or may, not e.xist and may or may not exist at the location shown Neither the City of Edmoinds nor its emp-l-o-yee-s o-r offi-ce.rs -s-h-all be I-Jab-l--e for the information given on this map(5), nor for any one representation provided based upon said. map(s). CITY OF EDMONDS SIDE SEWER PERMIT WATER -SEWER DEPARTMENT PERMIT Call 775-2525 for side sewer inspections BEFORE covering any portion of the constructi)on.) Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspecti ns. ADDRESS LOCATION OF CONSTRUCTION ......... ...................................... ----------------------------------------------------------------------------------------------------- - ----------------- PROPERTY LEGAL DESCRIPTION ....... ...... ........... .... ..... : ...... . .... .................................................................................................................................. .................................................. . ...................... . ........................................................................................ . ...................................................................................... ......................... O14FNERkXD/OR BUILDER .... L7LV ............................. ................................... . .................................. . ....................................................... CONTRACTOWS NAME & ADDRESS .......... :� ......... V ................... ........................................... . .............................. . .. . ....................................................... Permission Is granted .......... C--"'* .. i-* -------- --- * ----------------- * ... 119 ... for repair amd/or connection of a side sewer to the city sanitary sewer system in accordance with. Ity . Edmonds ordinances. ATTENTION IS CALT D TO THE FOLLOWING: NO, _'o. I —The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be -employed to construct side sewer in street area. Do not cover any portion of sewer before it has been Inspected. NOi—Ao. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtain -able from the City Engineer's office. NOTE No. 3—Obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit. NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%. No bends in grade sharper than % will be permitted. NOTE No. 5--Trenches in street must be water settled and surface of street restored to orIgInaJ condition. Contractors shall be resl>onsible for failure due to improper work which may develop within one year of completion. NOTE No. 6—It is unlawful to alter or do any other work than Is provided for in the permit, or to do any work on the madn sewer or its appurtenances except to in- sert the pipe into the wye. DISAPPROVED E] Date ... . ..... D ..... By ---------__- Date ................ ................... By ................ Date ............................................................................. APPROVED ..... Remarks: ....... . ....... .......................... . .. . .......... ..................... ................. - --------------------------------------- --------------- --------------------------------------------------- .......................... ;�� ...... ;n ........... ........ . ........................................................................................ . .................................. . ............................................. I ......... BOTIJ(Penji iVCoplesAMST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection ..... W404V hereby certify that the side sewer installation constructed under this permit w­n e r 0­f--- r--a'-cting F�;;�'Zri."'Q�g .. 6,o'n',s,_tr_u,`ct_io_,n_,) ... wM was installe(Un ace ce with a governing ordinances of the City of Edmonds. I Dated this 6W -------------- day of ............ �& . ................................... 1 197 V Check BEFORE you dig for: Water 0, Gas E], Telephone [], Power 0, Svez, ;ther E] V V The City of Edmonds ONMER .... ( ....... .... It: ADDRESS ---------- ............. -5- APPLICATION for SIDE SEWER PERN" NEW CONSTRUCTION et--� REPAIRS 0 EASEMENT No - ----------------------------- ...................... CONTRACTOR .... ... -- - ---- ------------ \ z ,T / . ................ PEP -AM NO. ................... LEGAL DESCRIPTION: LOT No - ----- / .................................... BLOCK No . ............................................ NAME OF ADDITION ...... .. ............... ......................................... DATE................................................ By ...... .............. �991 CITY OF EDMONDS DEPARTMENT OF PUBLIC WORKS 250 Fifth Avenue North, Edmonds, Washington APPLICATION FOR A SEWAGE DISPOSAL SYSTEM PERMIT (Submit 3 Copies) Permit to be issued to: ......................... ....... ........ ............... For installation at: (street address) ........ R04.4 ......... ... ..... . ..... ....... ......................................................... Addition or Subdivision ............ ....... 1.414 04. ?.A' .... / .............. .............. ...................... .. Lot ....... ........ Block ................ Type of Building: New .... X .... Existing ............ Single family residence .... V .- Number of* bedrooms...? .... ...... ....... Other: (specify type or use) ................. -----_---------- _____ ------ __ -------- _ ------------------------------------------------------------------------------ Builder .... e_.J� --- AR ............. ------- ................ Designer ... /1�;.* Al .. .... Aaxal�e ------------------------------------- AddressZp?/ ................................................................. Soil Log Hole No. 1 --- .. /* ----- ................................. ........ ...... ....... ........................................... .............................. Soil Log Hole No. 2 ............ 0=10 .. . .... 4. Sep— 4;�,. Mee ..................... .............................. 1­1 ........... 3a --------- 4v/,re ..... e4� ...................................................... Elevation of Water Table, if encountered. (Distance from ground surface) .... /V441 ...... ........................................ Corrections to control surface water if needed_/e'4.'1/ .............. <0. ^?,lx ....... .............................................. ................. ........................................................ ...................... Specify if any removing or grading of topsoil in field area— ... 1%4 .................... ................................. ............... ....... .................... Percolation: Test Hole No. I —Average Rate... ....................... ­ ... I .. . (Fall in minutes/inch-bottom 6" test hole) Test Hole No. 2 — Average Rate...Z-.0 ............................................ (Fall in iiiinutes/inch-bottom 6" test hole) Test Hole No. 3 —Average Rate__..;&.tV -bottom 6" test hole) ................ ....... ... .. . ..... .. .... (Fall in minutes/inch 'X 11:� Average percolation rate on which to base drain field design Date Taken4 717- .0/ Septic tank requirements based on present rules and regulations: Septic Tank Size. ...... 9 ......... gallons. Amount of Square Feet of Disposal Field ------- ..... ... igner ...... Da Signature — Desi - - �. ............ . .................................... . DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency) Permit issued (date).. . _4� ... ..Permit Number. ... _ 1.71 ................ Remarks:... ............................. .................... ........................................ _ ...................... ......................... ......................... .............. ................................................................................................................... . .......... .... ­­ .................................................................. STREET FILEm SEWAGE DISPOSAL PEKMI Septic Tank .... ....... ...... gals. No. CITY OF EDMONDS .............. Disp. Field. ------- J��.0 ......... sq. ft. Department of Public Works Other ............ Name........... ...... - -------------------- ---------------------------- ---------_-_----- .-is hereby authorized to install/ repair sewage disposal system at ............. ------- --- .... ....... ---------- ................................................................................ Date issued on -------------- Permit expires one year from date of issue DO NOT COVER BEFORE APPROVED BY DESIGNER OR SANITARIAN I hereby certify this,.9ystem was installed under my supervision and control and complies with all provisions of the City of Edmonds Resolutions. Signature of Installer --------------------- --------- --------------------------------------------- Date .................................. Approved".E] Disapproved E] Date ---------------------------------------------------------------- By ---------------------------------------------------------------------------------- Remarks: ..... ................... ----------------------------------------------------------------- SANITARIANOR DESIGNER ------------------------------------------------------------------------------------------------ Date This permit shall be posted in a reasonably conspicuous place on the job until inspection has been completed. �P,