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21031 70TH AVE W
ADDRESS: �- / 0 3 ) -7 0-1;1 A-Ve. 6,S)
TAXACCOUNT/PARCELM �2,7oqe,600303goo
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: El Conditional Waiver E] Study Required 0 Waiver
.CRITICAL AREAS #: DETERMINATION: Conditional Waiver E] Study Required El Waiver
DISCRETIONARY PERMIT #S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
�-WATER METER TAP CARD DATED:
OTHER:
LATEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc
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USE
ZONE. PERMIT
.CITY OF EDMONDS NUMBER
CONST141LICTION PERM.IT APPLICATION o, SUI E/APT #
OWNERAME NAME 0111 . USINESS ADDRESS
r, 16 LEGAL DESCRIPTION CHECK SUBDIVISION NO. LID NO�
W MAILING ADDRESS
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ALL4 ij b PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved 13-
.CITY' IF TELEPHONE NUMBER EXISTING — REOUIRED . DEDICATION AW Permit Required C3
Street Use Permit Req'd 0
PI) W6 I q!5q PROPOSED Inspection Required 0
N AME, Sidewalk Required 0
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METER SIZTLINF SIZE NO. OF FIXTURES PRV REQUIRED
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RE ARKS Z
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STATE LICENSE N6MBER EXPIRATION DATE U.
rc) 31/1//,7 S -13 — 9 91 SIGN AREA SEPA REVIEW ADS NO
ALLOWED
L al Description of Property - include all easements PROPOSED COMPLETE _ JEX
Z SHORELINE #
EXP
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Tax Account
Parcel No.
RESIDENTIAL
[;�NEW PLUMBINGIMECH
COMPLIANCE OR
EIADDITION ROOC'OMMERCIAL CHANGE OF USE
REMODEL APT.,BLDG. SIGN
GRADING E (oX Y2 # CHECKED BY TYPE OF CONSTRUCTION CODE OCCUPANT
REPAIR CYOS. GRjQUP
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WOODSTOVE AREA
DEMOLISH sw :L SPECIAL INSPECTOR
INSERT Ho T /SPA OCCUPANT
GA . RAGE RETAINING WALL/ REOUIRED 13 YES LO)%D
CARPORT ROCKERY RENEWAL REMARKS
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0 (TYPE OF USE._QUSINES R A TIVITY) EXPLAIN: PROGRESS INSPECTIONS PEWLIBC 108
SO
W NUMBER NU BER OF CRITICAL W
0 OF . DWELLING AREAS
el, STORIES UNITS NUMBER 4qV11,5'
0
QESCRIRI1EWf)RK )NE (ATTACHPLOT PLAN) 01 OeIr
141;�4405 �Q & CO 4;M 7,ED
I varu I 1� a CC e-f
FINAL INSPECTION REOUIRED
0,!:,\UK_ JIS (,LV,-J(l. VALUATION FEE
PLAN CHECK FEE
('&—P A 4 1110,444 BUILDING
HEAT SOURCE: GLAZING
LID 175 PLUMBING
Plan Check No. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADING/FILL
Any. construction on the public domain (curbs, sldewplk�,
driveways, marquees, etc.) will require separate
.permlsslbry.�,,:'.; :STATE SURCHARGE
Permit Application: 180 Days
Pennit Limit: I Year - Provided Work Is Started Within 180 Days STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE
0 Successors in interest, agrees to indemnify, defend and hold
21 h armless the City of Edmonds, Washington, its officials,
2 employees, and agents from any and all claims for da"mages of
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whatever nature, arising directly or Indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed i PLAN CHECK DEPOSIT
0
modify, waive or reduce any requirement of any city ordinanc
0
x nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
Information given Is correct; and that I am the owner, or th.e duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with,city and,
THIS PERMIT
state'laws regulating construction; and In doing the work aut�drii-':` AUTHORIZ This application is not a permit until
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ed thereby, no person will be employed In violation of the Lab6r ONLY THE signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt Is
Aion Insurance and RCW 18.27. 1 NSPECTION'_ acknowledged in space provided.
E SIGNATJJRV OR AG -
IOWNER NT). ]DATE SIGNED DEPARTMENT-1�. OFFITCIS SIG T
TY OF DATE
Cl
EDMONDS
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ATTENTION CALL FOR RELEASED BY: DATE
INSPECTION
'IT -IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORIGINAL — File YELLOW — Inspector
0 P- 771-0220
,j#, CERTIFIC/ATE OF. OCCUPANCY HAS BEEN GRANTED. USC
,�'�'!'$ECTION 100
PINK — Owner GOLD — Assessor
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UTY 0F EDMCII;"�'Ds
STATE FARM INSURANCE COMPANIES
State Farm General Insurance Company
PO Box 5000
Dupont, WA 98327-5000
RENEWAL CERTIFICATE
POLICY NUMBER RENTAL DWELLING SPECIAL FORM I DATE DUE PLEASE PAY THIS AMOUNT
98-BS-3739-6 JAN 11 2001 TO JAN 11 2002 BILLED THROUGH SFPP
'*V01 Coverages and Limits
Section I
J-2451-F486 FIR
CITY OF EDMONDS A Dwelling $83 000
BUILDING DIVISION Dwelling Extension 8:300
250 STH AVE N B Personal Property 4 150
EDMONDS WA 98020-3146 C Loss of Rents Actual Loss I
Insured: MELINE, SHANNON H
Location: 21031 70TH AVE W
EDMONDS WA
A14W
PIP No: 0330113315
Add Ins: CITY OF EDMONDS
BUILDING DIVISION
Forms, Options, and Endorsements
Deductibles - Section R E
Basic 500
Section 11
L Business Liab (per occurrence) $1,000,000
(annual aggregate) 2,000,000
M Medical Payments to Others 1,000
(each person)
Special Form 3
FP-8103. 3
i
Amendatory Endorsement
FE-8247
Debris Removal Endorsement
FE-7540
Annual Premium $234.00
Special Form 3 Endorsement
FE-8320. 1
Amendatory Collapse
FE-8700
Domestic Abuse Endorsement
FE-8710
Premium Reductions
Your premium has already been reduced
by the following:
Home Alert Discount 10.00
Inflation Coverage Index: 164.9
This policy does not provide earthquake coverage. If you are interested in obtaining earthquake coverage,
please contact your State Farm agent for more information concerning the coverage and eligibility
criteria.
��da, eeft~jew-
MINZIE
Telephone (360) 435-2419 Prepared NOV 29 2000
IF YOU HAVE MOVED, PLEASE CONTACT YOUR AGENT. J-2451-F486 F
93
INSURED I MELINE, SHANNON H
POLICY NUMBER I 98-BS-3739-6 RENTAL DWELL 3
t (M UFFIGL U,',E UNLY ]VVV
Prepared NOV 29 2000
N
See reverse side for important information.
Please keep this part for your record.
NOTE: DO NOT PAY - PREMIUM BILLED
THROUGH STATE FARM PAYMENT PLAN.
DATE DUE PLEASE PAY THIS AMOUNT
THIS IS FOR INFORMATION ONLY
21031 70TH AVE W
EDMONDS WA
1509000005
State Farm Insurance Companies
0000
CONTINUED FROM FRONT
NOTICE TO POLICYHOLDER:
cm
For a comprehensive description of coverages and forms, please refer to your policy.
Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this
policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to
this notice are also effective on the Renewal Date of this policy.
Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to
your policy. Billing for any additional premium for such changes will be mailed at a later date.
If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any
questions about Your insurance coverage, contact Your State Farm agent. Rit�
Please keep this with your policy.
138-3076f.4 Rev. 05-1999 Printedin U.S.A. (olfOO8qd)
Sti eet oi R.R.
Township
Is change
State/Plovince
County
E-] Peirnanent F-1 Ternpoiaiy It telTip0i aiy, how m3ny months?
Residence Phone No.
ZIP/Postal Code Business Phone No.
Inside City Limits El Outside City Limits
Mailingaddiesschange only 0 Location change (Plr-m�e ",e YOUI 'rate Fa) in agent)
Do you plan to letUin to your previous address? D Yes [:1 No
ChecK box if change applies to ALL
F-1 State Fair- oli-i— in h k 1A
(Auto Policyholders Only) il Ouse 0
Is the vehicle dri Ven to and frOM Work Is chool' R Yes F No
Iftheanrweris "yes", what is the average weekly n7ileage for such L'se?
138-3076 f.4 Rev 05-1999 Printed in US A (olt()08qd)
a
NAME OF APPLICANT
NAME OF BUSINESS:
MAILING ADDRESS:
/7C T-1 11,E
RECEIVED
STFXET USEPERMIT APPLICATION JAN 2 8 1997
CONTACT PERSON AND PHONE NUMBER:__ d5&, 2�� ---:' // 5/- 7 z5-
�-',PmDS FIRE E)FMT
ADDRESS OF PUBLIC USE: 4163 76 Z"
the public place or portion of public space to be utilized:
Spi��ify the type of use
/1 �- (",/ h/ * /R - /
ex— UA '-" laol- ti- o---
Specify the length of time for use: InM)U���
NOTF-- 77te issuance of thispermit is understood by the applicant to be of a temporary nature and that no vested righ . t is
granted
A-
INDE-WFIT. The applicant understands and by hislher signature to this application, agrees to hold the City of Edmonds
harmlessfrom any injuries, damages or claims of any kind or description 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 defense or any legal procee&ngs including defense costs� court costs. and attorneyfees by reason ofgranting this
pennit. In addition. the application understands that the City shall be provided a Certificate ofInsurance to indemnity
and hold harmless the City ofEdmondsfrom all claims andlor property damage. and naming the City ofEdmonds as an
additional insured.
CODEAPPLXATIOM By signing the application below the applicant warrants that s4he has read or had the
opportunity to read Chapter 18 of the Edmonds Community Development Code and s1he understands that all terms of the
adopted ordinance are incorporated herein as if setforth infull and this application andpermits therefore are subject to
the terms of that Chapter.
STRUSEHO.DOOLG12-95
SIGNATURE OF APPROVAL FROM ABUTTING PROPERTY OWNERS
When applicable, if the street use proposal directly impacts any adjacent business or private property'
owner the applicant must obtain written approval from the affected parties. This requirement is
evaluated by City Staff after the initial submittal of the application.
Signature.
Signature.
Signature.
Signature.
Address
Address
Address
Address
DO NOT WRITE BELOW TFHS LINE --FOR CITY USE ONLY
Planning Division Review: ADB# �11,4
Approved by Date
Public Works Review: Approved DateZ-5-91:
Fire Department Review: ApprovedB Date\/3c)/,R,7
Police Department Review: Approved B -Date
Permit Coordinator Review: Certificate of Insurance Verified
Engineering Division Review: Bond Require� ount $__6_ate`d-
Approved By
Remarks or Comments:
PERMIT# DATE OF ISSUANCE*2,_�aq
RELEASED BY RECEIPT # !�Sc_
B (J. W . t'. *-. q � 0 -1-52-
STRUSEHODOOLG/2-95
Z.F.F. Calculation.-
230's 4 Z. F. F. x S1.50
0 Lateral x 0
unit x S 25
cc: Harvey Robinson
$ 19728.0.0. Connection Fee
0. Lateral Charge
$ ..175000 Trunk Charge.
$ 16.00 Permit
.19913.00 TOTAL
LEIIF R. I ARSON,
EDMONDS CITY ENGINEER
Form 6
a I -
1-0 ft . � %
November 20, 1974
File No. 4673
LEGAL DESCRIPTION FOR HARVEY'ROBINSON
ENTIRE PROPERTY EXCLUDING PARCEL LEASED TO SHELL OIL COMPANY
That portion of the southeast quarter of the southeast quarter of the
.southwest quarter of Section 20, Township 27 North, Range 4 East, 14. M.,
in Snohomish County, Washingtok, described as follows: Commencing at the
southwest corner of said subdivision; thence N 1'47'12'' W, along the west
line of said subdivision, a distance of 184.02 feet; thence N 88'12'48" E,
a distance of 30-00 feet to an intersection with the east margin of 70th
Avenue West, the True Point of Beginning of this description; thence con-
tinuing N 88*12'48" E, a distance of 73-70 feet; thence S 13'1214811 W,
a distance of 15.00 feet; thence S 76'47'12" E, a distance of 120 feet
more or less to an intersection with the west margin of U.S. Highway 99;
thence N 25'12'00" E, along the west margin of the U.S. Highway 99, to
the southeast corner of Lot 4, Hoyt Acres, according to the plat thereof
recorded in Volume 16 of Plats, on page 26, records of Snohomish County,
Wa'shington; thence N 89'53'00'' W, along the south line of said Lot 4, a
distance of 140.65 feet to the southwest corner of said Lot 4; thence
-N 1047'12" W, along the west line of said Lot 4, a distance of 6.70 feet;
thence N 89*53'00" W, a distance of 80.00 feet; thence N 1'47'12" W, a
distance of 7.77 feet to an intersection with the south line of Lot 3,
said plat of Hoyt Acres; thence N 89053'00" W, along the south line of
said Lot 3, a distance of 70-00 feet to the southwest corner of said
Lot 3 on the east margin of 70th Avenue West; thence S 1047'12" E, along
said east margin, to the True Point of Beginning..
REID, MIDDLETON & ASSOCIATES
Engineers ej Surveyors 9 Planners
'324 Main St. 775-3434
EDMONDS, WASHIINGTON
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U T I L I T Y EASEMENT
IN CONSIDERATION of benefits to accrue. to the grantors herein, the undersigned,
and
hereby grant to the CITY _0_FTP171(Y1TffFT,__a Punicinal orrsor-a a nermanent easement
for the installation, operation, and maintenance of
over, across, through and -below the
followring described property, and the further ripht to remove trees, bushes, under-
growth and other obstructions interfering utith the location, construction and main-
tenance of said utility or utilities.
The easenent and right-of-v!ay hereby qranted is located in the County of
Snohomish, State of Hashington, and is more narticularly described as follotis:
The CITY agrees to restore to substantially the orivinal condition such imnroye'�
ments as are disturbed during the construction, maintenance and renair of said
utility or utilities; provided, the grantors, their heirs or assigns shall not con-
struct any permanent structure over, upon or t,!ithin the permanent easement.
DATED this day of. 19—.
STATE OF 11AS11ING70N)
COUNTY OF SNOHOVISH� ss
On this day personally appeared before me
and , to me knovin to be -the individual (_sT
described in and who executed the within i—nd foregoing instrument, and acknowledged
that signed the same as free and voluntary act and deed, for
the uses and purposes therein mentioned.
NOTARY PUBLIC in and for the-Siate o?_
14ashington, residing at
I-