20512 79TH AVE W.PDFIIIIIIIIIIII
6819
20512 79TH AVE W
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 for ' th on these
map(s). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
the -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
emp-l-o-yee-s o-r officers -shaill be I-Jable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS
CIVIC CENTER — WATER -SEWER DEPARTMENT Call Pyt*sPftt 6-1107 when work
Is ready for inspection. (No inspec-
SIDE SEWER PERMIT Itnos Saturday, Sunday or holida,".) N? 2009
ADDRESS ------------ 20512 79th Place West
--------------- - - .. . .. .. .. ............. ...
OWNER ................ Edward H .. .... B o 1 linSe r ----------------------------------------------------- - -------------- - ---------- - — ---------------------------------------------
-------------------------------------------------------------------------- --- CONTRACTOR�1...YmPic View Plumbing
April12, 67 ........................ ............................................
PernAssion is granted ............................................. 19 ......... for ........................ days to REPAIR or CONNECT a side sewer
with City Sewers In accordance with IPPlication on file and governing ordinances.
ATTENTION IS CALL D TO THE FOLZOWING:
NOTE NO. 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 are& DO not cover any portion of sewer before it has been inspected.
NOTE No- 2—Obtain full information regarding Ordinance
NOTE No. 3—Top Of aide sewer must have at least 30 Jae 13L"16'030 and P-egulatiOns governing side sewers when you get permit.
No bends in grade sharper than % will be hes coverage at Property line and 12 Inches inside Property line; minimum grade of 2%.
permitted.
NOTE No. 4—Trenches In street must be water settled and surface of street restored to original condition. Contractors aw
N I failure due to improper work which may develop within one yeax of completion. I be responsible for
No' 5—It is unlawful to alter or do any other work than is Provided for In the Permit, Or to do any work on the main sewer or its appur-
tenances except to Insert the Pipe into the wye.
APPLICATION
for CLYMN PLANr
The Citf of Edmonds FILI:
SIDE SEWER PERMIT EA"M NT No
NEW CONSTRUCTION REPAIRS
'7�111e- 00 4
OWNER ....... ....... CONTRACTOR ...... ............... ........................................ ....... .................. PERM IT No. ..........
ADDRESS .......... LEGAL DESCRIPTION: LOT No. ........
................. .............. BLOCK No. .. ... ... ..
NAME OF ADDITION ....... ............
....... .........
0
r7 4
At
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®r,
: 7
Approved:
APPROVED
APR 12 1961'
DATEa4--,-�12.1.y�.z By ....................
.... ) ...... — ....... -7
- g f `,5al- I
Utl
- u -- &AW
APP�OVED BY PLANNING
-7 9 -T IA A" E- 'S
JAIV2 9
�Penkvr cou 1993
EF
9 a - 19
City of Edmonds
Critical Areas, Checklist
The Critical Areas Checklist contained on
this form is to be filled out by any person
prcparing a Development Permit
Application for the City of Edmonds prior
to his/her submittal of a development permit
to the City.
TIC 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. TIC 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 sofl surveys).
RECEIVED
J A N 1 2 1992
PERMIT COUNTER
An applicant� or his/her representative, must
fill out the checklist, sign and date it, and
submit it to the City- -ne 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
Of the Parcel with enough detail that City
staff can find and identify the subject
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information 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:
Narne
Title
Street Address
City. State, ZIP Phone
�i L4-e
Signature
Applicant Representative:
Name
14610 - 128th Ave. N.r=.
Kirkland, WA 913034
Title
Street Address EA-'04'�-'G��CTION
14610 - 128th Ave. N.E.
Kirkland, WA 98034
City, State, ZIP (2QQAaL-q464--
Phone
Date igna
Date
r:� CT�o CD
1'%Z 0 Z 610W
Ch.
Critical Areas Checklist'
Site Information
Project Name: Permit Number -
Site Location:a-?ar� - ZF�zo��X"roperty Tax Account Number:
Approximate Site Size (acres or square feet): 2C., 245q: ar-
Have you filled out a Critical Areas Checklist for a project on this site before? N-0
General Site Conditions :5�X , -,e
.pll,l ;, W
1. Has the site been cleared or logged? Date of most recent action:
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)?
a
3. Describe the general site topography. Check all that apply.
X Ylat: less than 5 feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10 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 of horizontal distance.)
Steep: grades of greAter than 30% present on site.
Comments
Hydrology/Vegetation
4. Site contains areas of year-round standing water:
5. Site contains areas of seasonal standing water. IV
_Approx. Depth-
6. Site is in the floodway floodplain---Z)�O of a water course-
7- Site contains a creek or anArea where water flows across the -grounds surface? M-0 flows
are year-round? _6LO Flows are seasonal? /10
8. Site is primarily: forested meadow ;shrubs -mixed
Y&I
9- Obvious wetland is present on site:
10. Wetland inventory or map indicates wetland present on site: A/C�
11. Critical Areas inventory or map indicates any Critical Area on site: IMP
i::City;�(-J�e: . .. ...
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWN NAME/NAME OF BUSINESS
)W/-//- 111-17-CAIINSolil
MAILING ADDRESS
A 0,51,;� 7,9
WMV- �' f
ADDRESS
6P tt',? /3 OX 5 76
1ITY
ZIP TELEPHONE NUMBER
NAME
&&2zlv /,-?/?/49),? Y
ADDRESS
��04& 11),E
CITY, ZIP I TELFPHONE NUMBER
elftWA19 ':� ga� q I /� 9(57- 711(4
STATE LICENSE NUMBER EXPIRATION DATE
110K(�, 11-73
Legal Description of Property - include all easements
=unt
ParcelNo.
1:1 NEW
RESIDENTIAL
PLUMBING
KADDITION
COMMERCIAL
MECHANICAL
REMODEL
Q- APT. BLDG.
SIGN
GRADING
FENCE
REPAIR
— CYOS.
I x —FT)
F1DEMOLISH
WOODSTOVE
INSERT
SWIM POOL
HOT TUB/SPA
GARAGE
C
RETAINING WALL/
ROCKERY
RENEWAL_
TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER OF STORIES NUMBER 0
DWELLING
UNITS olve-
7 OES gRl E.�ORK TO BE DONE (ATTACH PLOT PLAN)
4
ed
ZONE PERMIT
zso NUMBER 53o044-
JOB
ADDRESS -205-1 Z :7'7 Ape P,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCIP Approved
0
RW Permit Required
0
EXISTING — REQUIRED DEDICATION.
1'.
Street Use Permit Req 'd
C3
PROPOSED
Inspection Required
C3
Sidewalk Required
0
ENGINEERING
By
METER SIZE
BUILDING SUPPLY SIZE
NO. OF FIXTURES
REMARKS
SIGN AREA
SEPA REVIEW
ADB/NO.
ALLOWED
PROPOSED
COMPLETE
EXEMPT
SHOAELINE 0
EXP
WRIANCE OR CU
P��NING REVIEW BY
I-o"
/-ZTE
/ 9 .7.
SETBACKS — FEET
f
H�EIGH�T
OT COVERAGE
FRONT SIDE
REAR /,S
1�5
23 5�/,,
By ITYPE OF
SPECIAL INSPECTOR I AREA OCCUP
REQUIRED OYES 1.09Y)V., I GROUP
HEIGHT
ZS4
3CCUPANT
LOAD
PROGRESS INSPECTIONS PER LIBC 305
14/-S�F C,
FINAL INSPECTION REOUIRED
VA!=
1
1�17C,Ah':-N
1 PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING
%
PLUMBING
Plan Check NO.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewelks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENO. INSPECTION FEE
successors in interest, agrees to Indemnify, defend and hold
harmless the City of Edmonds, Washington, Its officials,
employees, and agents from any and all claims for damages of
whatever nature, arising directly or Indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
nor limit In any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
I hereby acknowledge that I have rea; this appllcatlorl�,;that'the
information given Is correct; and that I am the owner, or th.e duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz-
ed thereby, no person will be employed In violation of the Labor
THIS PERMIT
AUTHORIZES
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
0- lion Insurande. I
INSPECTION
SIGNATU ER OR AGENT) DATE SIGNED
DEPARTMENT
CITY OF
EDMONDS
ATTENTION
CALL FOR
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
FEE
—?,:-;Io
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
12AL'S SIGNATURE DATE
I#r r-A. ) Z- - 7
R!�E BY; 2 X DATE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
0:
W
a
Z
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102-87
City of Edmonds Permit No:
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date:
A. Address or Vicinity of Construction: ol 0 -1- ot - -7!J
,I
B. Type of Work (be specific): t A \/&71 f 0 1,11 C_� S P /Ic,; / --f re pc� ve h
61A — 4rr 42
C. Contractor: 0' 1 ;a M p I L_ ;� U I C t t: Fr e_-d L-4.
'gi ac
Mailing Address-. 0 Phone:
State License #:. OL�JM �?P 1: 0 Lb Liability Insurance: N/ Bond: $ 00o
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): --
E. r_1 Commercial F1 Subdivision City Project r_1 EUC (PUD, VERIZON, PSE, AT& T, OVWD)
F� Multi -Family P4 Single Family Other
INSPECTOR: MO bl)nd I
F. PAVEMENT CUT: 19 YES El NO G. SIZE OF CUT x
CONCRETE CUT: El YES [KNO
INDEMNITY. Applicant understands by his/her signature to this application halshe holds the City of Edmonds harmless ftom
injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of
Edmonds or any of its departments or employees, including but not limited to the defense of any� legal proceedings including defense
costs and attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES 97LL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BYCITYFORCES, AT WHICH TIMEA DEBITOR CREDIT 97LL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT.
* Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion Pf the
required training in their possession.
* Restoration is to be in accordance with City codes. All street -cut trench work thall be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEPTIONS.
* Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ THE ABOVE STA TEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMITA VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Date: �7 -';�)
(Contractor or Agent)
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)
FINAL APPROVAL OF PERMITTED WORK. :Z2 /.:::;I L*27-MIT DATE-q1!Sj0-?
7nspector's Signature
For inspection requirements see Engineering Inspection Information handout.
No NN'(MK S11,AL1, B[AAN PIUOI�T() 11'10,11TISSUANCU'
D:Wy Doruments\Forms\Engnmg\ROWpermit_.doc