20517 81ST AVE W.PDF111111111111
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20517 81 ST AVE W
ADDRESS:
TAX ACCOUNTIPARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: -3h Id
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTH
PLANNING DATA CHECKLIST DA
SCALED PLOT PLAN DATED:
SEVV'ER. LID FEE S:
DETERMINATION:E] Conditional Waiver F] Study Required Xwaiver
LID #: / C317
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S).#:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DA
OTHER:
LATEMP\DS'Ps\Fomis\Strcet File Checklist.doc
0
0
Site Information (soils/
2.
3.
4.
Site Address/ Location:
#P20
Critical Areas Checklist
aq.
.CA File No -22001
graphy/ hydrology/ vegetation)
tqo-t zj
Property TaxAccount Number:
Approximate Site Size (acres or square feet)-
- Is this site,cuffently develope
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
--Z���Flat: less than 5-feet elevationichange over entire site.
Rolling- slopes on. generally less than 15% (a vertical rise of 10-fe*et 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-feei-N
Steep: grades of grea * ter than 30% present on site (a vertical rise of 10-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 —. 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 meadow shrubs mixed
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site:
For City Staff Use Only
1. Plan Check Number, if applicable?
2. Site is Zoned? 9-C-!N-5Z
3. SCS mapped soff type(s)? 5 IMF567 111! 1, !1111111 - Q�, -
19 — -;"#I I 111 11, i�, 111, 1, -e
C) -�o m
I -As
4. Critical Areas inventol or C.A. map indicates Critical Area. on site?
5. Site within designated earth subsidence landslide hazard area? ab -
DETERMINATION
REQUIRED
Reviewed bv-
WAIVER
-v. j67
#P20
City. OfIldm*onds
Development Services Department
Plannmig Division
Phone: 425.771.0220
Fax: 425.771.0221
The Critical Areas C hecklist contained on this form is to
be filled out by -any, person. preparing a Development
Pernuit Application � for the City of Edmonds prior to
-his/her submittal of the application 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
availableftorn observations Of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
a
Date Received: c;U tt,1,j1U -71
City Receipt #:
Critica . I Areas File #: t__ U)oe q
Critical Areas Checklist Fee: -$135.00
Date Mailed to ADDlicant: 01j A -7
A property owner, or his/her authorized representative,
must fill out the checklist, sign and date it, and submit it
to the City. The City will review the checklist� make a
precurso ry site visit, and make a determination of the
subsequent steps necessary to complete a development
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 form. In
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, 'in consideration on the processing of the application agrees
to release, inderrmify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or M fraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By. my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE oF APPLicANT/AGENT
DATE
Property Owner's Authorization
By my signature, I certify that I have authonized the above Applicant/Agent to apply for the subject land use application,
and grant my permission forthe public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendapt to this applicatigli.
SIGNATURE OF
PLEASE PRINT CLEARLY
Owner/Appficant:
z, I _�q &DOA e
Name.
1-7
Sftwt Address
city State Zip
Telephone,&�
DATE
Applicant Representative:
Name
Street Address
city State zip
Telephone:
Email address (optional): - Email Address (optional):
R
The City of Edmonds
APPLICATION
for
SIDDE SEWER PERNaT
NEW CONSTRUCTION jlg REPAIRS
T No.
OWNER - ------- ..................... CONTRACTOR ........ A ..... 8-4 ------------------ PERMIT No.
ADDRESS ... ��,2 ------ // -------------------------- BLOCK No . ............................................
---------- � LEGAL DESCRIPTION: LOT No.
NAME OF ADDITION ..... .................................. .......................
........................................................................
0
0
AP�,
MAY 2 I-J8
I
-I Approved:
DATE .... 6 .......... .
?�- �- ----------
NOTICE:-
--------N-o--w-a--rr-a--n-t-y--�o-f--a-c--c-u.-ra-cy.---
The information'shown on the attached
map(s) was com'piled 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
Any person or entity -requesting a
map(�
copy should conductanindependent
inquiry regarding the information sho.wn on
...7--tKe -map(s), including, but not limited to,
n. Such
the location of any sewer stub show
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 office-rs -sh-a-11.1 be Via-b-'Fe 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 PRosPeet 6-1107 when work
Is ready for inspection. (No tnspec-
SIDE SEWER PERMIT tions Saturday, Sunday or holidays.) N? 2952
ADDRESS .......... 2.05-1-7 .... 8.1 - -t.
-s.t ... A.Venue ... W
OWNER .............. �A�Z ity ... 5Ayq.§!qq
------------------------------------ CONTRACTOR ........ S
Permission is granted ....................... Mc 2
..... jy
... ...... . 19.6 ' 8 '., for -------------------_--- days to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on" file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the Property may obtain a Permit to construct sewer inside Property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do nut cover any portion of sewer before it has been inspected.
NOTE No. 2—Obtaln full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
No bends In grade sharper than % will be Permitted. g
NOTE No. 3—Top of side sewer must have at least 30 inches covers, e at Property line and 12 Inches inside property line; minimum grade of 27,
No. 4—Trenehes in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
NOTE No. 5--lt 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.
�e"-ry 0
BUSIN LICENSE APPLICATION
CITY N"
N
Oy
WE
9 2LE
E (206) 775-2525
INSTRUCTIONS I
I . PRINT APPLICABLE LICENSE CLASS, FEE AND PENALTY PAID
IN ANNUAL FEE BOX AT RIGHT. PENALTY DUE ON RENEWALS
RECEIVED BY CITY CLERK AFTER FEBRUARY 15.
2. NEW BUSINESS: COMPLETE ALL LICENSE APPLICATION BOXES.
LIC. RENEWAL: REVIEW LICENSE INFORMATION BELOW. PRINT
CORRECTIONS AND ADDITIONS AT RIGHT.
3. SIGN AND RETURN APPLICATION WITH FEE (AND PENALTY) '
-1. LICENSE WILL BE MAILED TO YOU UNLESS YOU ARE NOTIFIED
TO APPEAR FOR APPLICATION REVIEW.
LICENSE RENEWAL
REVIEW BELOW INFORMATION, PRINT CHANGES AT RIGHT.
2. APPLICANT
SOCIAL SECURITY NO.
NAME
DATE OF BIRTH PLACE F BIRTH
HOME ADDRESS
3. BUSINESS IDENTIFICATION
BUSINESS NAME
SINESS BUSINESS PHONE
WASH. STATE TAX NR. I EMPLOYEES I ORGAN. IOCCUPANCY
ANNUAL FEES
TYPE BUS. CLASS
FEE
PENALTY
HOME A
$10.60
$ 5.00
SMALL B
15.00
7.50
*GENERAL c
50.00
25.00
*OVER 10 EMPLOYEES. OR EMPL WORK
OVER 120 MAN -MONTHS PER YEAR.
�IDPE�NALTY PAID
TYPE ORGANIZATION
IF BUSINESS IS:
TYPE
CAPACITY
0 C CORPORATION
HOTEL/MOTEL
L
NR OF ROOMS/UNITS
APT.BLDG.
A
NR OR APTS
D L- LTD. PART
OFFICE BLDG.
0
NR OF OFFICES
E P- PARTNERSHIP
RESTAURANT
R
NR OF SEATS
s S- SOLE OWNER
HOSP./NURS. HOME
H
NR OF BEDS
SCHOOL
S
NR OF STUDENTS
4. BUSINESS ADDRESSES
BUSINESS ADDRESS
LICENSE MAILING ADDRESS
5. EMERGENCY NOTIFICATION
NAM
A
TELEPHONE
(2)
OFFICIAL USE ONLY
U.F.I.R. CODE BLDG. PERMIT OCCUP1
C.U. PERMIT
LAND USEt��
0�
STAFF ACTION
EREVERSEj APPL. NO.:
S
SIDE
DATE:
a2z]
LICENSE NUMBER
MM LA - NEW BUS
LEI RENEWAL
LC CHANGE
LD DELETE
1 1. 1 CLASS I YEAR I LIC. EFFEC. DATE I REASG. LIC. NO. I SPEC.1
CEIPT NO.
DATE PAID
AL
PRINT W
4
n 16 14 )
IN SPEC. BOX
FOR ISSUE OF
Co RRECT'ED
FEE PAID PENALTY -PAID
LICENSE W TH
'LC' ACTION.
LICENSE APPLICATION AND CHANGES
PLEASE PRINT CLEARLY
'2. APPLICANT
AST NAME, FIRST INITIAL so IAL SECURITY NUMBER
c
/�i iCiLiAiAAAIA_lVi iti I I -!�1617
DATE OF BIRTH
IMO. I DAY I YEAR
Pal lio / 13 A I
HOME ADDRESS
PLA E OF BIRTH
CITY STATE
00- 1 Ki L-A A48 I I i i I I I I C-0
3. BUSINESS IDENTIFICATION
IBUSINESS NAME (FULL)
NATURE OF BUSINESS (DRUG STORE, CPA, ETC)
BUSINESS PHONE J1
.
dh4i Ni 1 17-1 vitki I iA 1-i
i-S YJ Q I/ J(_AL'31
I
I �-' c' g, s
WASH. STATE TAX NR.
ANTICIPATED
TYPE
OCCI PAN
UCAPACCyJTY
(REGISTRATION)
[NR. EMPL06E]S
ORGAON
TYPE
1
31-�,q
I lolold
I I
1
11.
I -t ENTER APPLICABLE TYPES AND CAPACITY T T T I
/5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY, ETC.)
LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
(1) MieiCil�AiAhAil4iAilv) J' f
(2) LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
&Ti A I Ambili Si I I I I I A �) e, 2 M-) I LL—L-0.1
U F.I.R.
CODE
PRIM
- bb UFFICIAL USE ONLY
UNITS .. BUS. I BLDG.PER
0 LAND
I I I
Ml
ZONING
CITY CLERK'S
SIGNATURE
C] APPIq)VI-D E] 01SAPPROVED DATE