21031 SHELL VALLEY WAY.PDF11111111111111
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21031 SHELL
VALLEY WAY
0
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:--2e
BUILDING PERMIT (NEW S
COVENANTS (RECORDED)
P101
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver [] Study Required 21WIriver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED
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) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #
WATER METER TAP CARD DATED:
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TOTAL AMO UNT QUE
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fharqoy gc%npwIoOqe tn&l I hS.0 eaO tNS & I'Cal'On: It"21 in@
a ATT�NT16.-,;
APPLI)CATION APPROVAL
injarm&tlon giv,Gn IS Coffec%i Amp Inal v6M In* no!. or
&pent Of the O.nif, I agrei 10 comp , .In city end
1. —5 -E-11,7
This ojoi.eatton is I%Qt a permit unijil.
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5 agutatm4,dor�struc I' ri� &Aom P&nd I e
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signed Dy the* Building Oi ICISI Of his
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CITY OF
EDMON"A
Ti—IS-SITE IS LOCAT
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-DMONDS. LOC 115 2
OF E
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IT. IS' LIN LAWF.UL TC-USE'OR.OICCUPY-A EUIL&ING.bk.STRIU� �.-bRIWNAI- File YE4 MIN InspeClOf
'UNTIL. K RNAL-Jr4SPECTION.-+� BEIN 0,ADE Ar4D APPFOVAK611
ANTED. C
'-A 'OF HAS BEEN. GR GdLD — ASSIliSSO"
. PINK Owns,
- CE'ATIFIC4TE OCCUPANCY A,
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Critical Areas Checklist CA File No:03,+4
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: 2103) 5�kV\ VcJA,, LJ,.--,
2. Property Tax Account Number: —,4-�: ee -7 Lo t o ogoo -7,o o
3. Approximate Site Size (acres or square feet): 71,760
4. Is this site currently developed? -Zyes; — no.
If yes; how is site developed? -.5�
'k
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 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
over a horizontal distance of 33 to 66-feet).
Steep: grades of greater 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: 4,z, Approx. Depth:
7. Site contains areas of seasonal standing water: KI 0 ;Approx. Depth: -
What season(s) of the year?
8. Site is in the floodway Oo floodplain t� o of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
N 0 Flows are seasonal? tJ e (What time of year?
10. Site isprimarily: forested— meadow shrubs mixed
urban landscaped (lawnshrubs etc)
11. Obvious wetland is present on site:
For City Staff Use Only
1. Plan Check Number, if applicable?
2. Site is Zoned? P_�— 9�
I SCS mapped soil type(s)?AIA , � , - � cl, 111� k C', 5., >-A SLA-A ff!5j��p 0 CD 0 .1
4. Critical Areas inventory or C.A. mapP
-idicates Critical Area on site? L I k CL 0 in
5. Site within desioated earth subsidence landslide hazard 'area?
DETERMINATION
STUDY REQUIRED >� ______WArVER
Reviewed by: 1 0 , - - , na Date: 4 -,=;� 5; - n
Critical Areas Checklist.doi:/3.19.2001
01 ED& City dltdmonds
'P Development Services Department
Planning Division
Phone: 425.771.0220
/7C. I gq,� Fax: 425.771.0221
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 subn-dttal 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
available from observations of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
Date ReceMW 70"-/0-0 8��
City'Receipt#: c-*7-J'79/
Critical Areas File M 0 ;�; —
Critical Areas Checklist Fee:' $45.00
Date Mailed to Applicant:
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
precursory 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 firiding 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, inderrinify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information fumished 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 authorized the above Applicant/Agent to apply for the subject land -use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
t'. purposes of inspection �hd..posting attendant to this application.
9IGNATURE OF OWNER DATE I Is 6VM�k 2_�(ro3
PLEASE PRINT CLEARLY M
Owner/Applicant:
Name
Z1021 -S L'Ll VO-1 L!4 Q2=�
Street Address I I
EX '" L-V P� 9 E-0 Z,1,
city State Zip
Telephone: 7 7 9 - /.!5-3
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email address (optional): - kay-v-�,>a in - - (& zktb � - f,. Email Address (optional):
Critical Areas Checklist.doe/4.4.2003
IMPERVIOUS SURFACE CALC
ITEM SQ FT
NEW ADDITION 480
EX HOUSE & FP 794
EX GARAGE 440
EX & NEW EAVES 282
fbl�l
TOTAL 1996
\0
EXISTING ON -SITE INFILTRATION
SYSTEM APPROVED FOR 2000 SQ FT
EXISTING DRIVEWAY DRAINS TO
STREET STORM DRAIN, DRIVEWAY
T
IS BELOW INFILTRATION TRENCH
71-42'
L<'7, ""Le ogcM
APPROVED AS NOTED koo
BY EN IbIEERIN,G
note:
N
pol/A ON
RON'!
w wo __ w
ZONE - cb
SETRACKS.
FRON
SIDE
REAR
OTHER
HEIGHT
lm
ALA&OSED SURFACES TO
BE COVERED WITHIN 2 DAYS ---,,A
ft 6-4, 0'
77 Q
A4,
30
qoLlf _r
;,E
ho 740
Z7H
�(V "
T rw�;�'%vr
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CT 70 pXIST 8
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SITE PLAN
5CALE 1" = 20'
6I4CLLVALLffWAy
_9165
ficTe e.
Fe Ke 6
PC a &)Stake
'CT,0 Dt-T41,L
6/.l
p7to,V,D By PLANKI)'IG
A?
Er,_- E I V E D
jAN 1 5 ?0014
tv `)ERMIT COUNTFF',
iTREET FILE
"4'
Commercial M
MEAL) ON
LM TMENT
PLANT
4. Owner and/or Builder
5. C, ctor & License No. n4 e
6. into City Right -of -Way: No >4*--Yes (If Yes Right-of-
truction Permit Required Call Dial DigAlft"'
bef
o:
e
7. Cross oth
d ikivate property: Yes No X1
Easement required
attach legal description and county easement number.
h,
READ THE FOLLOUNG AND SIGN:
low
a. Property
owners must obtain a permit to install side sewers rr
>4 their property. A licensed side sewer contractor must be
employed t
Tn
Construct side sewers in the public right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
c. Commercial establishment requires a,minimum of a`hx inch (6"),
side sewer line.
d. Side sewers may not be installed closer thin' thirty inches �"(3011)
to any structure.
e. Side sewer lines must 0 be laid at a minimum gradp,,,Qf 2% (1.150)
and maximum grade of 100% (45
0
f. No turn in side s8wer greater than 45 (1/8,bend) is1W
between cleanout. A 1 90 turns must be constructed
of a-4
bend) and wye with rempvable cap.
No down spouts, footing drains or floor drains can be cohnected
to.side sewer system.
h. Pea gravel is required forbedding�when installing sew* 'lines
through other than granular soil.
i. Cleanouts are required at 3011-60" from each plumbing exit line
and at minimum intervals of 1001 along sewerline run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to -poor compaction of fill.
k. Side sewer must be left uncovered until inspected and approved
''bythe City.
Inspection during normal working hours only. Two (2) working
days notice required.
DATE:
certify that I have read
and shall comply with the above
"IT FEB: S2 0
.00
PRR-Ml T M
DISAPPROVED BY: Date.-
B Datet
APPROVED By: Date:;l
APPLICATION
for
The City of -Edmonds EASEMENT NO . .......
SIDE, SEWER PERMIT --------------------- ... . .........
NEW CONSTRUCTION, REPAIRS [-I. LID NO . ....... I ----------- - ASMT. NO.� ---------------- -,
OWNER -"OtAF-LAt.40 ---- )4PM-lE-S ---- lk4C-.,--.-- ................ CONTRACTOR --M0.N7T7.F-jS ..... D-07ZINI.Gt ...... ----------- PERMIT NO.6956,---
JOB ADDRESS ... W-&Y--- LEGAL DESCRIPTION: LOT NO. ----------------------------- BLOCK NO . .........................
.......... ................................. .............................. ................. ------------------ ----------------------------------------
EDMONDS
NA E OF ADDITION.. ... ............................. . TREArMall-PLANT,
Lcrro 7
7--s I,,"
4'wye a' P
\%�c-o- C.^POI . 'OP
46�
49�
1
2.103.5 #* 6.
wxrER
mll-T"
S"ELL V.ALLEY 'WAY
Approved:
DATE., .... 4-26-- ....... By ... ......... .... ........ 7-ff
0
0
Karissa Kawamoto
City of Edmonds, Planning Division
121 5th Ave. N.
Edmonds, WA 98020
Dear Ms. Kawamoto,
RF-CF-IVF-0
SEP 3 0 1998
pLANilwia- DEPT.
21031 Shell Valley Way
Edmonds, WA 98026
September 28, 1998
We are writing to inform the City of our plan to have two alder trees removed. They are
on property owned by Sherry Weaver. In conversations we have had with you and other
planners, we understand that a permit is not required in this situation, provided that 1) we
have the owner's permission and 2) the trees have been declared by an arborist to be
hazardous.
Enclosed please find a copy of a letter to Ms. Weaver and a report by Tim Waterman, a
certified arborist.
Sincerely,
Wendy A. Harrison
Enc.: letter, arborist report
Robert G. Harrison
sEP 3 0 1998
PLAoaw*%'�' ij J)EPT21031 Shell Valley Way
Edmonds, WA 98026
September 28, 1998
Sherry Weaver
20914 Hillcrest Pl.
Edmonds, WA 98026
Dear Ms. Weaver,
I am writing to follow up on our telephone conversation of 9/10/98 regarding my
concern about an alder tree on your property. With your permission, my husband and I
consulted an arborist (Tim Waterman) to evaluate the health of the tree. I will summarize
our concern: the tree is a double-trunked alder, approximately 80 ft. tall. It is leaning
toward the middle of our house, 'which is approximately 40 feet away. It has several dead
limbs, and it has dropped many large branches over recent years.
The enclosed report shows three trees about which Mr. Waterman expressed greatest
concern. Tree #1 is the double-trunked alder. He noted that it has included bark at the
base, with one stem leaning toward the house. These conditions indicate a hazard. Trees
#2 and 3 are showing signs of having reached the expected lifespan of an alder. The tops
of the trees no longer produce leaves, a condition which indicates a tree in decline.
As we have done extensive landscaping on our own property, including the planting of
several trees, we appreciate the value of mature landscaping and being adjacent to a
wooded lot. We are very concerned, however, for our family's safety, with the potential
for the alder trees on your property to fall on our house.
I would like to request two things:
0 Your permission to remove Trees #1 and 2.
Your sharing in the cost of removing the trees, given the potential for damage
to property and injury to people, if the trees are not removed and subsequently
fail.
I would prefer to speak with you in person to discuss this issue. I will call you next week.
Sincerely,
Wendy Harrison
Enc.: arborist report
cc: City of Edmonds, Planning Division
IDate of Bid
Job Type X No.
Removal
Trimming
Thinning
View
Pruning
Stump
Lot Clearing
Job Type
Size
No.
Alder
7W
-5
Birch
Cedar
Cherry
Chestnut
Cottonwood
Deadora
Fir
Hemlock
Juniper
Laurel
Locust
Madrona
Maple
Pin Oak
Pine
Poplar
Sycamore
I
Willow
Special Hazards I —XI
Bid Given By: Loa-,4e� Invoice #
Job Layout j:P �3
(9
RECEIVED
SEP 3 0 1998
PLANNING DEPT.
Use Task Ws 1/1
Comments
6 1" 0-1 (JeS L)A'k
has e- i t-K
r
e, I e,4A1'-'%O _rQiQ1rP Pel-Se -rglk
rre,
recovnvv\-�el,v #�evrt.2cje(_T-ee i<
in Je<1 lr\e
re, ee 1"- -3 1--, %" Al:�I'-.'
-re),8
t %ju r%,ML 1E
Task # Job Type Type Tree Down Haul Cut-up Cost
Brush Wood
2
3
A I
Nameu )OYYI�4 5
Address j
a 1 C)3 ( 5�a y—(a6-4_(Oq 6
ED awrld 7
Hm. PhoneY j�
Z 770--W 1 hereby give authorization for Northern Arboriculture to
Wk. Phone perform outlined work on this bid sheet. Full payment at the Sub Total
Billing Address If Different completion of the work. If after signing this I decide to back
out of hiring them, I understand that I will be required to pay Discount
them 10% for a scheduling fee.
Tax
Signature Date
Late Charges will be added at $25 a week TOTAL
2501
Mdr
r
Cit . y of Edmon.d*
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Numben
Issue Date:
I F' A. Address or Vicinity of Construction: 213b3l Shall Valley Wy (9607613)
9 C) lz� B. Type of Work (be specific): Install 2":MPE IP Main froa 3751E to IVE
C/L Shell Valley Vy an Shell Valley Rd then N to Cul da sac on
Shell Valley Vy
C. Contractor: Washington NatUtal Gas Contact: Marianne KWsbN=
MailingAddrws: 1122 75 St SIR Everett Phone: 356-7500 X7596
State License #: 98203 Liability Insurance: Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. F] Commercial [J Subdivision F1 City Project gR Utility (PUD, GTE, VING, CABLE, WATER)
E] Multi -Family E] Single Family 0 Other ,
INSPECTOR: INSPECTOR: VV
F. Pavement or Concrete Cut: &I Yes []No G. Size o :_x H. Charg4�_$
vDt
( - 4 cuts
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to �Qld the City ofEdmonds harmless froptinjuries, 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 ofany legalproceedings including defense costs, and attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTArVCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Pleii6d cd1l thq Engineering I)ivision, 771-0220.
Work and material is to be inspected during progress and at completio" )-n"-
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 the 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 thepermit requirements and thepink copy of thepermit will be
available on site at qll times for� infpection purposes.
I III
JJJW4� IRE �; 5 � I 507JUr. MWOW, �'i I i � I 07MMAN .1-
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER 'SEPT *!0 1 DAYS
SPECIAL CONDITIONS: MAWTAW C4AS EIS916_
.-�AvtTARY A 007ANI-C OF 10 00
COMMENTS:
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
PERMITFEE: 0 0
TOTAL FEE -
RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
03
ALL EXPOSED SURFACES TO
IMPERVIOUS SURFACE CALC
BE COVERED WITHIN 2 DAYS_,10
ITEM SQ FT
NEW ADDITION 480
EX HOUSE & FP 794 L) ft 64, 0
EX GARAGE 440
EX & NEW EAVES 282 0 — in loll
TOTAL 1996 IP
EXISTING ON -SITE INFILTRATION
SYSTEM APPROVED FOR 2000 SQ FT to
F I-Te 4
EXISTING DRIVEWAY DRAINS TO i
��' k Fe ri cc
STREET STORM DRAIN, DRIVEWAY 4-S0
"'I'_3
IS BELOW INFILTRATION TRENCH 0
0
I�kcr4l L
5
YZ
qwLj �'E
L<7, ""LE &?ZIM 76�0 N
Ap H IV lei
PROVED AS NOTED k" 0
IIIN?
BY ENGIN�EF 7-L
1
L mo 1551
Date: 9
Ckb.01 776
r
0.
COY
CQN�j S'96�
.8'
:s 'EL
ELL
r<,Vr, wom cl,
le
u t-i e
(D. E�� 9V7S
NORTH
SITE PLAN
SCALE 1" = 20'
4'1031 6I4CLLVALL,6Y'WAy
ZONE APPROVE0 BY
SETRACKS:
FRONL_9z_� 4
SIDE -7 c,
REAR RECEIVED
OTHER JAN 15 2004
HEIGHT-2,-- PERMIT COUNTER
CITY COPY
CITY OF EDMONDS
ASSET INFORMATION SHEET
is EdNEW
ADDITION
RETIREMENT
ASSET NO. 00 �71
ADDITION TO ASSET NO.
DESCRIPTION rft,,;.
ffkf Ls I c I e� ef FILF
6LHIAL NO.
LOCATION
DEPT. NO.
21c., 3 U Az� f- ft -t t-col 'r
6 tl C.> I
"PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
*PROJECT NUMBER L.) 3 —1 ff 8-
PROJECT COMPLETION DATE f - T-3
COST f 3
B.A.R.S. ACCOUNT NO. 3 c/'--,' 3
ESTIMATED LIFE 2
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY K
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT -
0 G.L. ENTRY
REFERENCE
DATE
VERIFIED BY
PROCESSED
BATCH NO. -
INITIAL
(tnp
DEPARTMENT FILE
0
DATE:
MEMO TO: Building Division
Planning Department
FROM: Engineering Division
Publ ic Works Department
SUBJECT: I')- / C
Zat 7
After review of the subject Building Permit application, we have the following
comments :
1. Connection to City water system required.
2. —Connection to City sanitary sewer system required.
3. Right-of-way permit required for any wo . rk on City property.
4. Driveway slope not to exceed.14%
5. Backwater valve.required if downstairs plumbing is below elevation of
upstream manhole.
6. Water and sewer lines to be separated by 10 foot minimum.
BD 6/82
STANDARD DRAINAGE PLAN
CATCH BASIN:
A,D3 46 1 S 30 (0 IL TRr.NCW LWNG-rH
VUUAL)
"U
L
64
A
0 "4 *
L
............................. . ..........
7 _nr
. L_1 W
A G U V4 1E L TR C7 �Nr_ H
67 Pr;LF PIPQ� CAP
ro"-rEE W/ (."LONG LEGS
SYSTEM CROSS-SECTION
'T PF- W_ H C OV r= R —
3/4'— IVI" WASWED
G PLAV E L
G" DIAM PFP.F P1
17 1.0 1
TRENCH CROSS-SECTION
INFILTRATION SYSTEM
PAGE I OF 2
for
location-4--r-
In3l yalkvlda�L
pla i by
phone
date
DESIGN
Trench Perc
Number Rate
z,
DATA
LF per Imperm Trench
1000 sq.ft. Area Req.
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the responsibility
of the property owner(s). Preveptive
maintenance consists of preventing
soil and other materials from entering
trench during construction as well as
after construction. Catch basins should
be cleaned of floating material and
sediment at regular intervals (at least
twice per year).
ssj�,__ \tz5 t--A,-
fn
CITY OF EOMONOS
k,
J
0 - 0 0--*
N3
-/'0 -57
clo�
SITE PLAN, SCALE:
ZONE
MAR 8,1983
HEIGHT"- C<l
00
-: -ir
NOTE: DO NOT USE INFILTRATION SYSTEM
ON SLOPES OVER 15 PERCENT (15
.Pn0T---PA-Q-P--4xP-P—lnn r-r-r-!r HAPPANT-Al
k,
I'd
14
I
k
L4
k
L4
STAND�RD ORAINAGE I PLAN
INFILTRATION SYSTEM
PAGE 2 OF 2
CATCH BASIN:
xns 0 13-30 (0 0. TPrLNCW k-1rNG-rH
IMUAL)
hA I
............................. . ..........
f.' -n r. u w iKr L4rVffL T=NCJ4
P E;KkF P I PW CAP
rb"TEE W/ t." LONG LEGS
SYSTEM CROSS-SECTION
-rp,FW_" COVER-
3/4'— 0/2," WASWED
GRAVEL
6" DIAM Fq=-7;ZF PIT
I- ?-1- 0 1
TRENCH CROSS-SECTION
41
STANDARD DRAINAGE PLAN
INFILTRATION SYSTEM
PAGE I OF 2
for Aa,� 71,—�.
location-Z—, 9 kA,�WL,-_
plan by
phone
date
DESIGN DATA
Trench Perc LF per Imperm Trench
Number Rate 1000 sq.ft. Area Req.
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the responsibility
of the property ownier(s). Preveptive
maintenance consists of preventing
soil and other materials from entering
trench during construction as well as
after construction. Catch basins should
be cleaned of floating material and
sediment at regular intervals (at least
twice per year).
CITY OF EDMONDS
DATE RECEIVED /
CITY OPEDIVIONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/"E OF BUSINESS
5,08 ofideWDY 9,4AV,5otJ
MAILING ADDRESS
2 / o 3 1,5,4Fu vALLEY WAY
CITY ZI TELEPHONE
:z&
iff-D"091>5 ?-pop
NAME
A ESS
DDR 33-o PAr7ad 5F. _*�o
CITY ZIP TELEPHONE
�FDHO,ODLS '?fb2-,3 PZ-5--77tv-73,73
NAME
waffiw
ADDRESS
I Z/
PERMIT EXPIRES 2�1 1 49-
USE' PERMIT
ZONEje
,5 NUMBER
JOB sunVAPT#
ADDREgej"
PLAT NAMEISUBDIVISION NO. LOT NO.
LID NO.
A4A P1
- off CAEtc X 7
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL MEET MAP
TESCP Apisov
RW Pamdt Required
Street Use Permit RWId
EXISTING — PROPOSED
trapection Required
Sidewalk Required
REQUIRED DEDICATION FT
UnderWound
WIM9 required
METER SIZE
LI;E SIZE
NO. OF FIXTURES
PRV REQUIRED
1 _7
---
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
B DATE
z
I# REVIEWED BY* N1, DATE
rL
CnN Z10-
T! LEPHONE
-7
R AD�
gO'D
ES 0
POSTED
$
STAT
STATE LICENSE NUMBER
[PROPERTY
z
'60M.
-PROPOSED
HEIGHT
LOIA IED PROPOSED
15 1
TAX ACCOUNT PARCE4,,�10.
720 7�6p,
1:1 NEW 0 PLUMBING,IMECH
COMPLIANCE OR
DITION ;i MMERCIAL
0 col
0 CHANGE OF USE
REMODEL MULTIFAMILY�-SIGN
REPAIR GRADING' FENCE
CYDS FT)
DEMOLISH 0 TANK 0
ROPOSED SETBACKS (Fr.)
A -`�`OAOPOSE E!.111 R FR N7, L/R IDE REAR
LLPWELo`,'
PARKING' E DAT
RE PROVIDE
no
REMARKS
GARAGE RETAININGWALL' PRWkLifl'
. _ ;FIRE 8
z CARPORT :'�ROCKERY:_`�',_',_$� "�131!�FIRPAI�6RM'�_,
o,, 2,
ry)
(TYPE OF USE, BUSINES OR AcTw LAW'S ,
NUMBER OF" RITICAL
NUMBER C IAI
OF DWELLI AREAS
MO STORIES 2- UNITS NUMBER
CHECXED�ffy
ty I � "", .. . ..... . .
GROUP
SPECIAL INSPECTIOI , 4,
REQUIRED,
R&�.;�
Y�
Ile
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS.,,''
04 E136JOiPE bi$,PER I.IBC -,108/FINAL INSPECTION RECVD
1-%r)e06 M NO] N
4461AIETEY M6j>1Fjd,"
40 "001V
AIS
VALUATION'"
fill
101169d0ptlion EE DescrIlption FEE
. . ....
Plad Ch k
State Surcharge
Z1150
HEAT SOURCE
4!5V+S S=A_
GLAZING %
I
FLOTj$LOPE %
i
BuildinoT it
Arm
City Surcharge
PLAN CH C
4—
VESTED DATE
Plumbirij;,
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
tz BE DONE ON PRIVATE PROPERTY ONILX ANY CONSTRUCTION ON THE PUBLIC
a DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPILICATION: ISO DAYS
CL PERMIT 1JMrP I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Grading
Engr. Review
Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit J�_
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF 6/M
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMrr. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY; WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
1W
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPIY WITH CITY AND STATE LAWS REGULATING CONSTRUC- TN9 application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building OMcIW or Nether 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.
WORKMENS COMPENSATION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
SI;GN;A�RE �(OWNERO G DATE SIG)IED ALI
771-0220 RE DATe
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 OR:GINAL-FILE YELLOW-INSPICTOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES PNK-OWNER GOLD -ASSESSOR
"fit
L-0 C,
C)T=V=CE'e;�V
D P, I
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0 0
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p�� p P C-- i P
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IN,
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Notes: The City of Edwn'ds-
1)
Field locate,a.11 utilities.
Call 1 -800-424-5555.
24, hours before digging./
2)
Survey. is not required
3)
Maintain a minimum.of.5",
horizontal and'3' vertical.
clearance from all city
utilities and appurtenances..
4)
Cuts in paving',are...shown as g
5)
4- cuts in paving anticipated.
COUC-1 Lv--A AL�o
ITEM OUANT. DESCRIPTION STOCK NO.
BILL OF MATERIAL
PERMITS:.. F--- C) tA C)Q (D(;�) 1/4 SEC: 1F>\N/ 19 - a--+ - C)4-
PLAT:
OP MAP: t C10
AREA: 1E) I
TAX CODE:
MS SEQ. NU
IN a="G a �==
AVewitvVbon Er*W QnV" D.G.R: -7- - 2,4 - S) C�
2, p M PE, 1P MAI Q E�!X—FE-Q��'((O KA
-70 SePQE;-'- aC)E!) C�DC*J
2-12) 0 3 1 �SH E-=L-L-., V.,L,,, LA-Ey. \.< "T.
DWNI Co IR RR
NO. DESCRIPTION DATE BY
JOEI -5G0-7<-'t:�!)
APP'D CHK'D:
DRAWING:
REVISIONS
SCA11- APP-
1 4
Notes: The City of Edmon*ds
1 Field locate all utilities.
Call 1-800-424-5555
24 hours before, digging.i
2) Survey is not required
3) Maintain a minimum of 5'
borizontal and 3' vertical
clearance from all city
utilities and appurtenances.
4) Cuts in paving are. shown as 0
5) 4- cuts in paving anticipated.
-F- 1P M-6"�Q
-4 C)' KA
E
0
co
-4 0 qA 4o-
0 I'F=
0
F2, C) P E-7—
Z 0=1 I -Z
KA " LA,&-013
7 15,
W
lit
POP-,.
ITE OUAN1. DESCnIPTION STOCK NO.
BILL 01F MATERIAL
PERMITS: 1/4SEC: 1SW 19-2:7-04-
PLAT:
OP MAP:
AREA: 151
TAX CODE:
SEQ. NO:
NaturN Gas SEE
AV&dftlon Eri&W G-rparty D.G.R: -7- - 2-4 -.S)
p M P I P K/1 A I Q F—=><-F1E-Q ��'l 0 KI
2-1 C) 3 1 �S" E—=L-L�
DVVN,. ia TRR
JOB
NO. DESCRIPTION DATE BY APP-D CHK'D: JOB
I I I I DRAWING:
q(-AIF- APP-