21210 SHELL VALLEY RD.PDF11111111111111
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21210 SHELL
VALLEY RD
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TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: F] Conditional Waiver [] Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA'
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #: �ao
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
FOR:
WATER METER TAP CARD DATED:
LID #:
LOT: BLOCK:
LATEMP\DS'rs\Fonns\Street File Checklist.doe
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Applicant Fill
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780
PERNAN APPLICAPOR
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ADDRESS
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OT AREA
SUB ISION NO.
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STREET I
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CITY
TELEPHONE NUMOER
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NAME
REMARKS
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CHECKED By
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E NUMBER STREET AND/OR UTILITY WORK
REW-0. A RMIT REQUIRED
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NAME
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TYPE CONNECT -ON OyES VERIFIEn a
SANITARY SEWER
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TEL�PHONE NUMBER sE,r..
APPV-0 SY CITY ENG.
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Description of Property iSh,w f3clo M��.ER SUPPLY S.ZE
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SIGN AREA ENV. REVIEV.' ADB NO.
72 ALL.W�L' POSED COMPLETE
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VARIANCE OR ------ fPLA.NNING R
By
YARDS I LOT
GAS I — FRONT _7'� SIDE .10 /REAR
NEW �I.ENIIIL LIIIF FIRE ZONE TYPE OF CONS7RUCTION 1CODa G H
-.N-R..JDENT.AL SIGN
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ADD S
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-ET ... IN- ECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
WALL RrOUIREO NO IZ30M GROUaT ;U-_ I LOAD
ALT-11 EXCAVATE FENCE C] �S
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N C. K Y THIS SITE IS LOCATED IN THE CITY
E] REI'AIR E] 1----.Vr E] SWIM OF* EDMONDS. LOCAL SALES TAX
INSP� POOL SHOULD BE CODED 31.04.
=MOE REMARKS
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LOT
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PLUM13ING -1
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HEAT GAS LINE
FENCE >
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SIGN
RETAINING WALL
SW I MMING POO'_ U
hercl,y acknowledge that I hive read fl is -1plication; that the in- 'TOTAL AMOUNT DUE
formatiGn yjwr k corre-t: and that I am the own'er. or !he cluly author-
" the owner. I agree To comply %�itjj city and state laws reglu-
ized agent or
lating construction: and in doing the work authorized th "Ob" person ATTENTION AIILIIA'IIN APPROVAL
will be employed in iolation of the Libor Code
of the St3l T,
.1 i �IP,0,hingwn 'i
NV K, 's C, nrmsation insurarice. THIS PER AIT , "" ion is not a perinit
P, i ii,
cl t ng 10 o,,m,n 'a,
AUIHORIZES until signed by the Building Offirial or
NOTE: Permit Limii One Yvsr(Except DEMOLITIONS and FILL s Deputy; and fCes are paid, and
PERMITS without conditioral use pe.-mi't. which shall be complezed in 90 0 N LY NT., "E"
WO:
d3y'S; MOVED -IN be completed in six months.) receipt ;S in Space pro -
SIGN led.
U '"S".CT'O" VIC
'P-IITMIZ.T DIRECT > s r,
'DS
CITY OF
ED
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VOTE Applicant Sub cc,, io Plall (11L, Fec 77.;-2525
This Per - it covers WOrk to be on! o Private propsrty ONLY.
AnY Construction On the PLbI7, dom:m (rclurbs, sidewa!ks, drivnways, ORIGINAL File YELLOW inspector
marquees, etc.) -.11 requir separate permission. GOLD - Assessor PINK CWner
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The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION [-] REPAIRS F�
OWNER. ......... f� -----------------------------------------------------------------
JOB ADDRESS
- ------------------------------- ..........
EASEMENTNO - --------------------------------------------
LID NO - --------------- ASMT. NO - ------------------
CONTRACTOR ...... S-cj�,te-,L ------------------------------- PERMIT
LEGAL DESCRIPTION: LOT NO - ------ ---------------------- BLOCK NO - --------------- --------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------
NAME OF ADDITION .. JLl T-;��,A -------------------------------------------------------------------
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....................................................................................................................................................................................................................................................
................................... OwNEXAND/09 BUJ3WEu ...... ................. . ....................................... . ... ... .
0ONTUAC"UPS NADIE AINDFAMS ......... ...... W .. n.(-
1:� ............ t .. IM ............. . .. . .......................................................
Permission Is graoted .... Z.-M-AR ................... . ............ 1928N,, for repair &WIor connection of a side Sewer to the city sanitary 08Wer
oystm in aowrftnco with City of Edmonds ordinanem
J"__��NTION IS CALLMD TO THE FMXOWING:
No. 1--The ownM of the property may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must be employed to eonstruct
side sower in street area. Do not cover any portion of sewer before It has been inspected.
X� ALble from the City Engineer's office.
No� 2—All work performed In city ritht-of-way requires an Invasion of Right -of -Way Permit obtain
Nuglo No. 3—obtain full information roxu*vx ordinance 11.16,030 and Regulations governing side sewers when you got permit.
NOTE No. 4—Top of side sewer nj� 1wvo at least 30 inches coverage at property line and 12 Inches Inside property line; minimum grade
,,. No bonds In grade
sharper than % will be porsaitted. 'a"
,or Alure due to improper
Y No. 5--Trouches in streat nvA* be vmAor settled and surface of street restored to original condition. Contractors shall be responsible fQ
worlt whielk may 0*aejap� W#htanna year of completion.
NOTE No. 6—It is unlawful to "W 4v,4a.*jW other work than is provided for in the permit, or to do any work on the main sewer or its enanees except to in-
sert the pipe Into the YrjW W 10100�
DISAPPROVED0 Date .. . .. .. . .............................. By ................ Date .............. . ................... By ................ Date .............. _- M .......... By ...............
APPROVED ......... By .. ....... .. IN: ........................................................................................
F.
Roomwhx: ....... . .. . .............................. . ...................................................................................................... . ........................ .................................
7Permlt es MUBT Be Signed By Owner of Firm Performing Construction PRIOR To Requesfrof Inspection
installation constructed under this permit
..............
I". .... ......... I ......... .. . . ... ... .! ...................... .... hereby certify that the side sewer
15" '�Owpor of coutrsvth�t;�P��;eririo�rmLng construction)
v.,'. 'xistoned in accordance 02 governing ordinances of the City of FAmonds.
Datedthb-__ ............... day of ..... ..... .. ............................................ to .........
.4 v check'BEFORz you, dig for: water U 04w 13. Tdophone [3, Power 0,' Sewer [], Other [I -V V
APPLICATION
The City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION N REPAIRS F-1 LID NO . .................. . ASMT. NO - ------------------
OWNEP - ------- ---------------------------------------------------- CONTRACTOR ----- Z f �-\ 4 q. I E:—:�- -- ------------ PERMIT NO. —<LLvCP-D7,j
JOB ADDRESS ---P—'�- LEGAL DESCRIPTION: LOT NO . ........... ................. BLOCK NO - ------------------------------------
0
0
NAME OF ADDITION ....... - — --------- ...... = .......................................
Approved-.
DATE...... . ---------------- -----------
11/75
0 CITY OF EDMONDS 0
PUBLIC WORKS DEPARTMENT, ENGINEERING DIVISION
APPLICATION FOR RIGHT-OF-WAY CONSTRUCTION PERMIT
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
ADDlicant to Complete Parts A nnd R
A. Permit to be issued to:
For Work at :(address or vic
Type of Work to be done: W
(attach drawing when applicable)
Time Required -- Start:
Owner:
AMC-- n5 e5elo4t)
Name
Mailing Address
Finish:
ON ri 9 RON,- M
City State Zip Telephone Number
Contractor:
ame
'n q L 1
Mailing A�drelss
City State Zip
Pfi- -Ad- 25,5La
State License Number
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-u Date:
A,4� 7)1u�
Owner or Agint
TO BE COMPLETED BY ISSUING AGENCY:
Date Issued: 2—/'Q —zp Permit No. :'7R-2-Z F e e
Security Bond: k) ///'-Yr
Time Authorized: 136
APPROVED B
Da te
PUBA
WeS
CITY OF EDMONDS
DEPARTMENTj ENGINEANGOVISION
APPLICATION
FOR
RIGHT-OLWAY
CONSTRUCTION
PERMIT
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
A. Permit to be issued to:
For Work at:(address or vic
Type of Work to be done: A /Z F de 6J
(attach drawing when applicable) . -1/
Time Required -- Start: S 1� Finish:
Owner: 4&A - �'a I
Name STREET FILE
C(oq oo S-
Mailing Address
SiAJJA4,
- _ (�1�3 - C�
.City State Zip Telephone Number
Contractor:
Name State License Number
Mailing Address �e
City State Zip Telephone Number
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE *7
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 Owner or Agenv'
TO BE COMPLETED BY ISSUING AGENCY: C P cc
Date Issued: 9-1717t:&I' Permit No. Fee:
Security Bond(
Time Authorized:
1 0- 7 71 - (D-4 -A*%
APPROVED B
'7 0 4
4 4 A
Date:
06
00
* 0
DATE: 10
MEMO TO: Building Division
Community Development Department STREET FILE
FROM: Engineering Division
Public Works Department
SUBJECT:
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 tH—e
.responsibility of the contractor.
The contractor is required to.keep the abutting streets clean-
ed ot dirt and debris caused bv the construction.
-(3) A "Right -of -Way Construction Permit" is required, from the
Engineering Division of Public Works, for any work within
the Public Right -of -Way or public easement.
(4) Driveway slope not to exceed 14%.
C11WOM
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MR. 75 1
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PW 5/77
Punic wom DEpmm* awsT
BUILDING PERNIT REVIEW MW
0 SA�ILLOU,,"a�D
(addres7s -To
Street Right -of -Way Existing 4-M NA
Z
I
Access Easements Existing, 0,=,M CM I;n tyl REQD
H
&.0 %,,o I I I 'i — %wr— V - ____4
04
Utility Easement Existing, REQD __..
Lot Per Subdivision aw_-� Plat Assessor Ma
Site Plan Checked for Accuracy
Z
Underground Wiring Reqd.
H
0
Check Accuracy of Legal Description i a)u -ia
Z
Review by Date
Existing Water Main Size
Water Main Required A)4-
Service Line Required "9,.,
Hydrant Size Existing 67,C
1:4
Hydrant Reqd Per Fi-re Code /.).4 Size
W
Detector Check Meter Reqd. ItAD
Cross Connection Inspection A,)O
E-4
Fire Department Comnents
:3:
Water Meter Charge Reqd. W2_90ar_>
Review by. *IS Date a
%Mug,
Septic Tank Design Approved X�1)4 Date
Septic Tank Permit Reqd. It.,',4 Permit No..
Sanitary Sewer Availability 4�� Pr0j.
Drawimg No. File No. 4ge 70 0 gE,-V
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
:3:
Review by Date
Open Ditch Existing Reqd.
Culvert Reqd. —Size
P4
Catch Basin Reqd. AW_ Indicate an Site Plan
0
Shoulder draina maintain collection an swale open runoff
��ol - reqd., on Site Plan
Soil Conditions and,�,round Water Field Checked "a4""
Review by ._Date
Revised: MO-1977
Pagge 2
Street Paving Reqd. Azj�z
Curb and Gutter Reqd..'__
Sidewalk Reqd.
Curb Cut for Driveway Reqd.
c4 Right -of -Way Constructim Permit Reqd.
E-4 Bond Reqd. for Public Inprovements-4
Street Name Sign Reqd.
M
Other Signing Reqd.
4
C�* Pre Permit Site Inspection made an
z
0
BY: SEWER
WATER
04
U)
z STREET
ENGINEERING
'4 Special Requirements listed in mew to Conmmity Development Department,
Building Division
BY f� 0 Date
c> All items filled in on. Building PerniLt Application
BY Date
Drawings Stan-ped and Notations Made
P4 BY Date
Approved by Public Works Department
Revised: lv 10-1977