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21124 SHELL VALLEY RD.PDF111111 lill lill 13050 21124 SHELL VALLEY RD ADDRESS: �4(,w 00 0 TAX ACCOUNT/PARCEL NUMBER: BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) FOR: CRITICAL AREAS: DETERMINATION: E] Conditional Waiver Fj Study Required E] Waiver DISCRETIONARY PERMIT ff'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PLANNING DATA CHECKLIST DA SCALED PLOT PLAN DA' SEWER LID FEE $: SHORT PLAT FILE: LOT: SIDE SEWER AS BUILT DATED:— 7?- SIDE SEWER PERMIT(S) #: GEOTECH REPORT DA STREET USE / ENCROACHMENT PERMIT #: WATER METER TAP CARD DATED: LID BLOCK: LATEMP\DSTs\Fomis\Street File Checklist.doc BUILDING _DEpARTMIN A Plicant Fill 7 80 1 _40 PERMIT APPLICATION inside Heavy Lines j a ADDRESS OF BUSINESS) LOT AREA A:_L_1_r­4, v oN No. Z 0 yes ONO 31 - T, STREET R/W CITY ELEPHoNE NUMBER 7 EXISTING STREET R/W 4 a 1. DEFICIENCY 111; PR.IrITY NAME COMP. FLAN ST. R/W 4 0 FT. PT. REMARKS U L_ '2 W ADDRESS cHcc ED uy it cl TELEPHONE NUMBER STREET AND/OR UTILITY WORK REQ-D. RED NAME YES ZNO 0 YES No WIRING REIVD. 1PYEs ONO 0 AU —DRESS TYPE CONNECTION SANITARY S_1WER DYLS VEPIFIED By 0' CITY 0 NO I- ELEPH I�TNUMBCR SEI`TIC Sy3TEI.. �j z APPV*D By CITY ENG. Y E s ERMiT NUMBER I NO sT 71�'C--Sc -U-"- CITY NUMBER -.-A--S /� -11);7­1 Lt-_7 .7_� 0 Le DPscri of Prc-pertv (Shc,� BLlr-v or ttach Four Copies) ETER ZE pUIL, rial Pscri 'y ING SUPPL% SIZE z st L i SIGN ARCA u ENV. REVIEW ADB No o ILLOWED PROPOSED COMPLETE I EXEMPT w a J REMARKS w J VARIANCF'CR ­­CU_ Pt��NNI G REVIEW BY DATE YARDS GAS. 4F R 0 N T 1.1y f slot LOT COVURAGE LIN ____7 5" REAR ----RES.-.NTIALj[_� F..- FIRE ZONE T_yFEOF CONSTRUCTION CODE HEIGHT ADD _TT- I —_V_ - P I ci 775 ­5o, rj sH [J— RCTAl"ING sPEI,7- I.-PEcToR —IA;- WALL OCCUP ZC�UPANT X VATE D -LT.- [] . .,, I o 11 F1 LL FENCE je,,,c, G Ej I_ X_F11 PLAN :;-;74..'KCD Z,, REPAIR PRE -MOVE Yl::t�_Slll, 1�1 - CATED -HE CITY INSP . oL OF tD ItS.OLICAL 'SAL' S TAX NUMBrR O��,IIES NUMBER o El Pso"m REMARKS SHOVf.l) IE CODED 31 04 DWELLING U NITS NATURE o z I —ts To BE DONE G_ I- t7(4- PROPOS 7o —u$e-- z — --------- �VALIJA:�:'-=N cc 2 P.- !N I 7--_____T1_NDICATE i—UILUING SETBACKS, 143 - W 9Lo PLAN ,4 ABUTTING STREETS) SUIL.DoNG PLUM811`1 1z .5 0 > HEAT & GAS Id o FENCE > t SIGN z RETAINING W, SWIMMING POOL U I hereby ack.nnwlcdgc th.1' I have read this aWicalion; that the in- TOTAL A OLINT formation give &I DUE n is correct; and that I am tile o - e r. or the duly author- IG7 ized agent of the owrlotr. I 39rce to comply with"city and state !aws regu. lating construction: nrid in doing the work authorized thereby, no person ATTCNTIC,i� APPLICATION APPROVAL will be cm ployed ;.I violation of the LzboT Code of the State of wasiti,,9ton THIS PERMIT relating to Workmen's ComPel,sation Insurance. 'his application is 1ILt I pernlit NOTE: Per, Mi4 Limit One Yeq(Lxccpj DEMOLT FIONS and F AUTHORIZES timil signed �y the Building Official or PERNIIIS I,-' -ILL ONLY TI4E ' De ,hout condition I u c� . mit,.. hich shall be completed in go WORK "oleo his eputy; and fees are paid - and days; 61 , IN 'I Iva completea in si.x months.) receipt is acknowledged in sn2ce pro. SIGN jURc ow F-R+oR Ge'T.) _1D.T. 1­1 1 INSPECTION vi ed. N L CPARTMC"T OIR OR' N T CITY OF l,uMONDS DATE NOTF., Applicant Subic& to plall Cfeck 1-ce 775-2525 i his Permit covers WOrk to be dene on pri � property ONLY. Any construction on the nublic domain (curtIvsatmcfewalks, driverways, ORIGINAL F& YEI LOW marquees, etc.) will require saparatoi permission, - Inspector GOLD - Asset-sor PINK Owner APPLICATION The City of Edmonds for EASEMENT NO . ............................................ SIDE SEWER PERMIT NEW CONSTRUCTION REPAIRS F� LID NO . .................. ASMT. NO . .................. UffVNER .......... P-L"77-�---V:�;Fl—, L� ---------------------------------------------- =;& ADDRESS --- LL. pu ;I 0 -�=— . PERMIT NO. CONTRACTOR --------- LEGAL DESCRIPTION: LOT NO . ............. 2`5 .. . ............... BLOCK NO - -------------- --------------------- NAME OF ADDITION ..... ------------------------------------ Approved: DATE ..... (5-2�/-7,5 ..................................... CITY OF EDMONDS SIDE SEWER PERMIT WATER-SEVVTR DEPA.RTNZNT 7 PERMIT CaU 775-2525 for side sewer inspections BEFORE covering any portion of the Construction.1 Inspection will be Provided within 24 hours after requst. NO SO., Sun., or holiday inspections.i AMOREgg XW&MON OF Oftormary LEGAL DESC MW - --------- .............. ­ .......... . .... -------- - -- ----- ------- - -------------------------- ---------------------------------------------- -_ - --- - ------- - -- - ----------------------------------- OWNERAND/OR BUIMER ......... ........................ ............................. .................... &ACTOR'S NAAM ADDRESS ....... . .. _Z11 ................. _ ....... accordarme w" CRY 19­7:_-�, for I*Palr FAW/Ur connection of a side sewer to the city anitsry sewer of FAUe" ordinances. A% -MON X8 MIZZID TO THE rojjoWM(;: No' '—'Th* owners Of the Property May obtain a permit to const dds sewer In street area. Do not cover any portion of se ract sewer inside Property line. A licensed Side Sewer COntractor must be e4loyed to construct 100 CU _wa, wer before it has been inspected. X0_ 2—All Work Peffformed In city ri t-of V requires an I ft UvesiOn of Right -of -Way Permit obtains e from the City Engineer's office. I'M I­Obtoln full Inf—tion -Carding ordinance 11.16.030 and Regulations governing side sewers when You get permit. No. 4—Tbo of side sewer must have at least 30 inches coverage at property line and 12 inches Insid property line; minimum grade of 2%. 'No bends I. grade shSaVer than % Will be Permitted No. 6—lYftches in abOft MuSk be water *settled and surface of street res o Vwk which WAY develop Within one Year of completion. t red to original condition. Contractors shall be responsible for failure due to Improper No* G�—It Is unlawful to alter at do any other work than Is Provided for in the permit or to do any work on the main sewer or its appurienan e But the pipe into the Wye. Ces zqBpt a Is- 0 Datp� .. . ...... . ...................... . ... W ............... mte� .......... . .. ............. _ By ............... Date .......... . .. . .. . ............... . By ............... AA*MVM ...... At�' -------------------- Jay -- — __ ....................... .......................... J� . . . . . . . .. . . . .... . ..... . .. . .. . .. . ........................................ .... ..... . ............................................. ...... . ........... . ...................................... ........ .. . ... ............................................. . ­...� . ......... . .... ........ .. . ....... ...... . ....... . . .. ....................................................................... ...... ............................... . ... ... ..................................... ............. BOT]"ermit Copies KI&ST Be Signed By Owner of Firm, Performing Construction PRIOR To Request For ion ..... .......... . (owner or Coro 4 jng.� .... . C'on - structio - n hereby certify that the side sewer installation constructed under this permit Installed In. accordance with all governing ordinances of the City of Edmonds. Dated ..... day of --------- _1 ...................... ........................... Check YOU dig for: Water 0, exas 0, Telephone Power 0, Sewer Other 3 a �9 0 APPLICATION Ae City of Edmonds for SIDE SEWER PERMIT EASEMENT NO. � ---------------- ---------------------- OWNER ---- NEW CONSTRUCTION Ej - REPAIRS LID NO - ------------------ - ASMT. NO. ------------ ........................ I ------------------------------------------------ CONTRACTOR ---- I-- �-- -------------------- PERMIT NO. JOB ADDRESS ------------- .... Vil LEGAL DESCRIPTION: LOT NO. ------------------------ BLOCK NO - ------------------------ ..................................................................................... ----------------------------------------------------------------- ---------- NAME OF ADDITION --- ---- J" ------------ - -------------------------------------------------------- 1-� ty .. ... ... .. ... . Approved: DATE ----- ------------ By -- CNY OF EDMONDS PUBLIC WORKS DEPARTMENT RIGHT - OF',,I��AY CONSTRUCTION PERMIT A. *Address or v1c I n' ty of Construction West Of 21124 S he, 0 Va I i rio-1-16" rmit No. Is TREET FILE 4P sue Date 0 Owner: General T21e�,,-,hone of the Jr� Name Attl,� , Jack, "Ll- -" k6vi C i P. 0. 1-1�24 Mailing Address 1 0 . C': � �1 Lynm;ood, ',t," ��, '.'I ' City, State, Zip Code 0 Contractor: S f:'� �-� I c Name Mailing Address 0 Permit Issued To: r-"o' 9 Type of Work tobeDone: U n Work in Connection With: Sub or Plat D Single Family 0 Comml. / Ind. El Apt. Condo. o Pavement Cut: El Yes El No State License Number Z 13� City, State, Zip Code Telephone Number U NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE B. APPLICANT TO READ AND SIGN INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from any 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 or not limited to the defense of any legal proceedings including defense costs, court costs, and attorney fees by reason of granting this permit. 0 U Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year W co following the final inspection and acceptance of the restoration by the Engineering Division. 0 Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at which time a debit or credit will be processed for issuance to the applicant. Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call 775-2525, extension 220. I understand that this permit must be available at thV,,job site for inspection purposes at all times. 2: Y Signature: Z� /L Date i Owner or Agent THIS PERMIT MUST BE POSTED AT THE JOB SITE FOR INSPECTION PURPOSES CALL DIAL - DIG PRIOR TO BEGINNING WORK C. Issued Time Authorized: Vold after days Special Conditions: Ammendments: Permit Fee: Security Deposit: Receipt No.: Fund Ill Fee: Street Cut Dimensions X — * * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * * Eng. Div. December 1978 FIELD INSPECTION AS -W of , (Fund 111 - Route conv to Street T)eot. r nrnrn an +- c-- - Diagram: Contractor called for inspection Yes No Nork DisaT)proved By- Date: Bv: Date: Work AL)proved Bv: Date: Inspector: EnQ. Div. December 1978 33-/y 1 mp-- 'r5 7 r4? 0 CITY OF EDMONDS V STRE�T FILE PUBLIC WORKS DEPARTMENTj ENGINEERING DIVISION APPLICATION FOR RIGHT-OF-WAY CONSTRUCTION PERMIT THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES Applicant to Complete Parts A and A. Permit to be issued to: For Work at :(address or vic.inity) Type of Work to be done: (attach drawing when applicable) Time Required -- Start: Owner: Name Mailing Address Finish: City State Zip Telephone Number Contractor:T r.-, Ma ss City State Zip eA - Af -� - E�P -,-6 �4- Q State License N-umler % Telephone Number NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE ** B, INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from 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 or not limited to the defense of'any legal proceedings including defense costs, court costs, and attorney fees by reason of granting this permit. Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year following the final inspection and acceptance of the restoration by the Engineering Division. Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at which time a debit or credit will be processed for issuance to the applicant. Work is subject to inspection.and restoration in accordance with City Code. A 24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220. I understand that this permit must be available at the job site for inspection purposes at all times. Signature(Alo'ea Date: Owner or Adent Z C, TO BE COMPLETED BY ISSUING AGENCY: Dat-e Issued: Permit No. 7)e -2-7-V Fee: An� --S� Security Bond: Time Authorized: — APPROVED BY--t/X Date: 00 STFtEET- FILE DATE: -2>1)10 1-7P� MEMO TO: Building Division Community Development Department FROM: Engineering Division Public Works Department SUBJECT: 2.111-4. Skt?� VAAAZY. 2040 After review of'the subject building permit application, we have the following comments: (1) Coordination of the location of any structure' with respect to utilities, streets, property lines and driveway grades is responsibility of the contractor. (2) The contractor isrequired to keep the abutting streets clean- . ed of dirt and debris caused by the construction. (3) A"Right-of-Way Construction Permit" is required, from the Engineering Division of PLiblic Works, for any work within the Public Ri7,ht-of-IIIay or public easement. (4) Driveway slope not to exceed 14%. AA-& K PW 5/77 0 KM. 1-0- Street Right -of -Way Existina-4014-0 REQD N-4 Z Access Easements Existing___j-AO P4 Utility Easement Exist' REQD— N-A N Lot Per Subdivision Plat X Assessor Map Site Plan Checked for Accuracy_ Z Underground Wiring Reqd. FA 0 Check Accuracy of Legal Description Z Review by_ e) AaNkb Date Existing Water Main Size 6F!"t>j-- Water Main Required Ok Service Line Required Hydrant Size Existing, C�>(<� P4 Hydrant Reqd Per Fire Code Size Detector Check Meter Reqd. �J�D Cross Connection Inspection 00 Fire Departn-ent Connients Water M�ter ��rge Reqd. o V V Review b Date J�19Z29 Septic Tank Design Approved A-) Date Septic Tank Permft Reqd. A) Permit No. Sanitary Sewer Availability k� -`2 Proj. R160 Drawing No. File No. 4-700 JE;u Side Sewer Availability. Sanitary Sewer Connection Fee Reqd. lVc7ee- :3: VIA Review by Open Ditch Existing Reqd. Culvert Reqd. Size r4 Catch Basin Reqd. Indicate on Site Plan 0 Shoulder drainage maintain collection on swale open runoff E-4 -..* (n Manhole reqd.��� Indicate an Site Plan Soil Conditions and Ground Water Field Checked Review by Dae Revised: 1vlO-1977 Page 2 00 00 Street Paving Reqd. Xw= Curb and Gutter Reqd. jfAZ_ Sidewalk Reqd. AI)V-- Curb Cut for Driveway Reqd. A�� P4 'Right -of -Way Construction Permit Reqd. Bond Reqd. for Public Inpravements__A Street Name Sign Reqd. M Other Signing Reqd. 0 94 U r—wr M* Pre Permit Site Inspection made an BY: SEWER WATER 41W."Do ENGINEERING )5 Ai Special Requiremmts listed in mem to Commmity Development Department, Building Division BY 150 Date All items filled in an Building Permit Application in'00' BY Date ) 4 I 20P Drawings Stanped and Notations Made BY 13ON -Date Approved by Public Works Department Revised: lv 10-1977