21221 SHELL VALLEY RD.PDF11111111111111
13059
21221 SHELL
VALLEY RD
0
ADDRESS:
-t TAX ACCOUNT/PARCEL NUMBER: 7--
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: F] Conditional Waiver [-I Study Required [] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
-w
PERMITS (OTHER)/ � 77 - 6L9,�,/ 4ZL-Q�- 5:�
// L
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE
SHORTPLAT
SIDE SEWER AS BUILT DATED: I
SIDE SEWER PERMIT(S) #: 2 �
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
LID #:
LOT: BLOCK:
LATEMPOST'sTomiAStreet File Checklist.doc
USE PERMIT
S ZONE NUMB1.P
CITY OF EDMOND
CONSTRUCTIONAML 11T APPLICATIO
Adak
JOB
NAME (OR NAME OF BUSINESS)
ADDRESS
2-1 M V,41)ey RW
) 77"
CEGACDES( FV.PTIOWCH ECK SUBDIVISION NO.
NO/
)L
MAII-ING ADDREOS
1"Ll
4
CITY
TILIPHO"E NUMBER
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
-77 t ;�Z 65'
EXISTING REOUIREC, DEDICATION
NAME
PROPOSED-6,-,g-
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
AnDRESS
STREET USE -ERMIT REUUIREU E
Z
SEE ENGINEERING MEMO DATED
Z
CITY TELEPHONE NUMBER
REM S
:��, /_a/v w
ADDqESS
M ER SIZE
ETE "I
DING SUPPLY SIZE
UNITS
CITY
ELEPHONE NUMBER
11BUI IFIXURE
Z
0
REMARKS
J
STATE LICENSE NUMBER
t ,
L uc e, A) E�)
-76
S - IGN ARN
EW_)REVIEVV
ADB NO.
D
Le DescrIptior of Property - In �Iucle all easements
ALLOWED
PROI IOSED
COMPLETE
EX.MPT
(Shgca�, below or atfach folur cc�lqs)
I
SHORELINEI
0
VARIANCE on CU
PLANNING rEVIEW By
DA
Ci Z
YARDS THEIG�T
LOT COVERAG
Z
FRONT' SIDE REAR
MARKS
N
RESIDENTIAL PLUMBING
ALWALTER
COMMERCIAL
MECHANXAL
SIGN
REPA!R 1.51AINING WALL
EXC
OR A ATE FENCE
DEMOLISH F 11 1 x __FT)
CHECKED UY TYPE OF CONSTRUCTION CODE
mv N
IH
PRE -MO ECESPJ SW'Aq
CTOR
P R
S ECIAL INSPE
AREA
GROUP9
OCCUPANT
NSP.
REMODEL COMPLIVAN Pop�L
REQUIRED
��
JOCCUPANCY
LOAD
OwODD STO
[:1 RENEWAL
.0
PEMARKS
INSERTVEI
AFT.BLDG
0
STORIES rNUMBER OF
TA5,-2Z771X< U&
NUMBER OF
DWELLING
'r In
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOTPLAN)
VALUATION
FEE
PLAN C.IECK FEE
I
BU'LDING
r
-t
PLUMBING
MECHANICAL
Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
�This
dr;ve ays, marquees, etc.) will re7,,uire separate permission.
STATESURCHARGE
PT-1
rmit Application: 180 Days
; ENERGY CODE
Permit Limit: 1 Year - Previded'Alork is Started Within 180 Days
I "Applicant, on behalf of his or her spouse, heirs, assigns and,
SuCtGssors in interest, agrees to indemnify, defend and hold
i
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any ar,d all claims for damages of
5
whatever nature, arising directly or indirectly frcm the issuance
I
6e?17
7:
of this permit. Issuance of this permit shall not �)e deemed to
PLAN CHECK DEPOSIT
modify, wz;Ive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce an'! ordinance
TOTAL AMOUNT DUE
provision."
7
I hereby ackncwledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
informa!Ion given is correct; and that I am the owner, or the duly
with city
authorized agent of the owner. I agree to compl� and
state laws regulating construction; and in doing the work authoriz.
THIS PE MIT
AUTHORR!ZES
This application Is not a permit unt!l
ed thereby, no person will be employed In violaflon of the Labor
ONLY THE
S!gned by the Euildint; Officlal or Ws
Code of 1h � State of Washington relating to Workmen's Compensa-
'WORK NOTED
Deputy; and fees are paid, and receipt Is
tlQn Insuronce.
1111112TIO�
acknowledged In space provided.
RE OWNcr. OR EN T
DEPARTM-1
OFFICIAL'S
4"ll
JOATE.SIGNED
C
CITY OF
r
EDMONDS <,
��A*!�
-
771-32;2�_�
RE SED BY: A DA*
ATTENT10
- ,
-- I 0a,
Y_
;T IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A F�NAL INSPECTION HAS BEEN MADE AND APPROVAL
OR ORIGINAL — File YELLOW — Inspector
A CERTIF CATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK -- Owner GOLD — Assessor
02.78
77T 77 5 177 7
7''
. .. . .. . . . -7
ON
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-rctape-t" covcra-))
............................. . ..........
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SYSTEM GROSS-SP-CTIO14
TO f5;!�_ LAI'F-C' , OW
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TRENCH CROSS-SECTION
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77-;
CITY of EDMd",'0S''
SMIE SEWER PERMIT
PERMIT NO. 07635
For Inspection Call 771-3202
Address of Construction:
Property Legal Description (Include all easements):
Owner and/or Builder:
Contractor & License No:
/I
EDMONDS
Single Family Residence
A,
14 -qqw
Mul ti - Family (No. of Units
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required. Cal 1 One -Cal 1 -Center (1 -800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement.required,
attach legal.description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
I_Zertifylt�2y I have read and shall comply Date
with theitems listed on the back.
Permit Fee:
Trunk Charge:
Assessment Fee:
oo
lz;. 00
STREET FILE
Issued By:
Date Issued:
Receipt No.: (a q05
Partial Inspection:
Comments Date
Final Inspection Approved:
_Tn-itial
e
00
Rejected:
C)
Reason Date Initial
4A
PERMIT MUST BE POSTED ON JOB SITE
ce White Copy File Green Copy - Inspector Buff Copy - Applicant
Side Sewer Drawing
The City of Edmonds
EASEMENT NO - ----------------------------------------
NEW CONSTRUCTION X REPAIRS E] LID NO - ------------------ ASMT. NO - ------------------
ER --- 2-12-2-1 ----------------- SHE-LL-NJA"El --- RD— CONTRACTOR ..... Lurz. --- :B.(:�c-KA-0-F . ................... ........ PERM11 NOJG35 -----
(:J:7'DDRESS ----- 140. S ------------------------ LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO. EDMONDS
I TREAT-MENT-PLANT
-------------------- ........................................................................................................ .... . ..............................
D P.
�44&
Z
.3.5
2j�
NAMEOF ADDITION --------------- -------------------------------------------------------------------------------------------------------
2-12,Zl SHELLVALLE�5 Rr).,
27'
-mol:r 415'DP.
&S,tkp
7 1 .
1. 5 'OP.
SHG-LL
VALLE:,l
PWW-0001-11/75(REV.11r78)
40
0
Approved:
... .... ................
—DATE By� e3d�41 -----------------------
51; /:,� e r/�7
APPLICATION
The City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS F� LID NO . .................. . ASMT. NO . ..................
OWNER ........ ------------------- CONTRACTOR ---- ......
------------------ - ..................... PERMIT NO.
JOB ADDRESS DESCRIPTION: LOT NO . .......... 1--2 ----------------------- BLOCK NO - ------------------------------------
11
0
----------
... ...........
w
—j
,_u
�-u
roved:
DATE. f.... By ll,,--� . ...........
4
IT
Ea *M
CITY OF EDMONt* SE�
sz"� D
WATIM- D
'M,
PF,
R�ft �jf-
-N)
STREET FILE
inspectiono, V�i� cove"Ai 0y, portic"�f
515 for side sewer " , 0".. W
will be provided within 24 bours,0W requot. Al
........ . . .
. . . ........
J.........
XDV*UM LOOM" OF 06*0r"MON
. . ..............
MorxUry Ime" DESCUMMOM .... ------- . .. . .......... .........
..... ..............
. ...... .......... . . . ....................
------ -- - ------
APM/019 BUHMM-"-'-" — ----- - - ------------------ ------------------
............
........ . ....
............ . .......... ............... . ........
--- L4-�.A-L-J
side S&Wer to tkW dty saaits" sewer
-101, of 11
in - -- - ------------ 19. repair and/or conne,
City of EdMO=30 ordinances -
a In
A*TWMON W CALLED TO "LLOVnNG. licensed Sift Sewer Contractor muat,be employed to COUStrUct
& _=..to._sr t sewer inside property 1100-
may obtain f sewer before it has bOM tPXPBdOd-
=1a`fW=TVt* not cover any PO I the City Engineer's office.
NUIC requires an Invasion of jUght-,f-W*y pWmit OV-WAMO train
2--AU wM*�pWortotd In city right-Of-W&Y W0vsV*i*W old� "we" when 1 "4 set permit.
3_4�btala full Wosotio, regarding Ordinance 11.16.030 and Regul8tiOns Uns; - NO b-ds in gr"*
who bVerty minimum graA* of 2%
**Tic No. least So ineboX coverage at Property 'in' 40 pr
IWOM no. 4�Tlop of aide MMw must have at shall be responsible for failure due to improper
Mbarpa than * will ba permitted- to original condition, COXItt"t0m
1�—Trenche# in stx I *et must be water settled and surface of Street restored
Alm No. , Wor1L Which May *VVOOV Within — year of -VUAOUIDB� , on the main sewer or it* a4kpUrte"&0W eXcept to in -
other work than is provided, for in the permit, or to do-W wor-k
-*Ora No� $.—It in unlawfajj to alter. or do any
sort ths plVe the rye-
][�Alt4BL ----------- — -- — -- — — ------------- ................
............... note .... ...... ...... BY -----------
............... . .............. ..... . ............... ..............................
7 -- --------------- - - -
... . ..... . .. . .. ....... .................... ... .......... . ....
--- - ---------
-- --------------------- ----- - --
Be Signed ]3y owner W Firm
the
,pjUoR To Request For Iimpection
instanation constructed under this permit I ---
.. ..... 19 .........
sewer 0, OtherD 4 -1
V"
zl�
1-7
)Cz, ,.I.
STREET FILE
CITY OF EDMONDS
ASSET INFORMATION SHEET
10/NEW
ADDITION
RETIREMENT
ASSET NO.
ADDITION TO ASSET NO. -
,,Z:� o /
I
DESCRIPTION
iv
SERIAL NO.
LOCATION
DEPT/NO
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
.1
PROJECT NUMBER Zd,�Z�,o
PROJECT COMPLETION DATE
COST
oll
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
KEL� FILE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
M/DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE DATE
tnp INITIAL
0-1-1
VERIFIED BY
PROCESSED
BATCH NO.-
AvAid MU/I./tIl"
7 77
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DATE : -� 5 --,2 2 - 9 1,;'
MEMO TO Building Division
Planning Department
FROM: Engineering Division
Public Works DeparLment
SUBJECT: 'ef 0,4
After reiie,.-i of the subject Building Permit appl ica,tion, we have the. fol ]owing
Comn, an ts
Connection to Ci ty wa ter sys tem renuired.
2. Connection to Cit sanitary sewer system rLq(iired.
y L
3. Right-oF-way permi t required For any work on City property.
4. Driveway slope not to exceed 1401
5. Backwater valve required if downstairs plumbing is below elevation oil
upstream manhoTa.
6. Water and se-aer lines to be separated by 10 foot minimum.
00 51,82
Rd
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..............................
_W
LC'VWL' TIMNC
P%P'w CAP
TEE Yj/ 4%0%G LEGS
SYSTEM CROSS-SECTION
MIRAFI 140"
op-P =Ulvr--
ro 6e- L-Ayl-=P C
WASH r: 0 - KC�-_ K
-MENC" COV",
3/4 WAS 9 rL 0
G PLAN E I
,,4!ot.A� - FERF F
TRENCH CROSS-SECTION
INFILTRATION SYSTEM
PAGE I OF 2
for
location
plan by
Phone -7
date
DESIGN DATA
Trench Perc LF per Imperm Trench
wmiher 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 owner(s). Preventive
maintenance consists of preventing
soil and other materials from entering
t rench during construction as well as
after construction. Catch basins should
be cleaned of -floating material and
sediment at re ular intervals (at least
twice per year3.
CITY OF EDMONDS
PROJECT REVIEW CHECKLIST
:5
PROJECr NAME - If B //Z E PA e. 5 PMJECT ADDRESS:
APPLICATION RECEIPT DATE: 41-,zr-4?6 Zor
Reviewed by: (initial/date)
COMMENTS
PLANNING
wrR/swR STREET I ENGNRNG
FIRE
BUILDING
177771111
111-17TRII
SINME FAMILY/MULTIPLE/CCMMERCIAL - (Circle One) //////
///////
///////
J///j/
R/m/
BACKS CHECKED - Planning
T1771=7177777
VARIANCE/SETPACK ADJ.
477T111
////////
I
T7T777171-
7777-7-77
CONDITIONAL USE PET441T
2
T/797
REQUIREMENTS CHECKED
3
MM ZONING REQUIIUMM
77777777
////////
111A11111
/ fi'/I / I / / /
4
77/77-7777
or
ENVIRONMENTAL FEATURES
/////////
5
ACCESS SLOPE & VEHICLE ACCESS
7777,77777
177T7TRT7111111t
.6
DRAINAGE PLAN (On Site) 4el.,
7
I/ V
11TfT177T
ITFIT7744
S'PREET FILE
8
fErAL DESCRTnl(N VF
.RIFICATTON JOL 53)
9
QUIT CTATM/DF-DTCATICNS wo S:?f 'K,
77777
//////
7277777777777777
/////////
////////
-
.10
?ASEMERP - PUBLIC/PRI"TE 4&A 5�9-9
1
7R//////
777777TI777111111
2.AJLUATE SnM CONIMMA IF NO LTD#
12
777777
7777777
PLAT/SUBDrVISTON REQIJIRM�UM
////////
13
777777
777717
RTQIT-OF-WAY 0oNMuCrICN PERMF� REQD
//////
/////////
14
//////
71-117777
3OND W rOR PUBLIC IMPROVEI��
//////
/////////
15
SOIIS CONDTIPIONS & GROUND
1111TI
777777777
.4ATER FlEfl) CULCKEI)
//////
/////////
lhil
//// //
16
STREET PAVING3 REQUIRED
17
T/7T/7-f/77/////
111111TR7'
'"IB AND GLYITER REQUIRED
//////
/////////
18
31DEWALX RD()UIRED
77777f
7TTrITR7
�N -
19
7T/-//7
111111711
77TIT177-
-!URB CUP FOR DRIVEWAY REQD
/,/
20
Y� NAME SIGN REM
21
MIER SICVING REM
777TI7
777777�77777777777
ITTITT1777
22
SIDE SEWER AVAILABILITY
23
H-NISTING WATER MAIN SIZE
TITR7
77T/7=
24
1117TIM'
mATER P �. SIZE
25
Tfl777TI7
177T7TR
3ERVICE LINE SIZE
/////////
////////
26
JYDRANT REQUIRED
777717TI777777177777TW
27
JYDRANT SIZE EXISTING
28
117T"1111111111
-MM CONNECTION INSPECTION REM
29
ARTER WM C11ARGE REOD
TfTTF1
7 771-1-17
IRTH11
30
FIRE LIM CHARGE SPRnMM
IT17TI77-1111111171
STREET CUT
32
OPEN D17CH EXISTING
IIIIT1771
/////////
/////////
33
REQD
1111777TITITI-F
TV=
34
/77777
11111111T-1-1-171-1111
CULVERT REM
//////
/////////
35
7 7 7 7 77
TIT71 771
SIZE
//////
/////////
/////////
36
CATCH BASIN REQD
T1 Trff
TTI-fTTF T
7 T/7 T1 7 7 T
37
T1 T1 7 T
T/ TfIT9 7
T/ TFIT 7 7
INDICATEDONSITE PLAN
//////
/////////
/////////
38
SHOULDER DRAINAGE MAIWAIN
HEET
W7771-7FIl
SHALE OPEN RUNOFF
2////////
39
VISC:
40
BY:
I PLAM17NG MM. ENGINEERING MGR.
PUBLIC WORKS MGR-
6
I
ME M 0 TO Building Division
Planning Department
FROM: Engineering Division
Public Works Department
SUBJECT:
DATE : — 9 6"
e X/ 16V4 0
After revie,.-i o f the subject' Building Permit appl ica,tion , vie have the. fol loviing
co -wen ts
1 Connection to Ci ty water system required.
2. Connection to City sanitary sewer system required.
3. Right-oF-way permit required For any work on City property.
4. Oriveway slope not to exceed 1,11I.—
S. Backaater valve required if downstairs plumbing is below elevation olf,
upstream manhol
6. Water and se,,-ie I r lines to be separated by 10 foot mininium.
eARAWTI "Pr zn Mr,
0 V%A,
�A 9 1 " —wI e14 -�O. �A W !91�11�1110111��Jll : T' W -,,511111
I wo .1 _207"P.A j 151, �IQWA
GO 6182
EXHIBIT 2
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pAGE OF Z
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for
location
91 an by
phone
date
OESIG N DATA Imperm rench
LF per Area Req -
irench PerC Sq.ft.
Rate 1000
14umber
t4o.TES aivision (771-3202)
1. Call En9ineerl,nq.nd final inspections.
for prebbclf' for Operation and
2. lte�00nsibility systems on
f drainage
..,�tenance 0 is the responsibility
private property ownerts). 9reventive
of the, property s of preventing .
maintenance consist ,Is from enter'"
soil and other Mater as wall as
construction Ws should
Catch bas
trench during A n . I an
construct O',jing materia
after
be cleaned Of floar intervals (at least
sediment at re u
7e�l - -
twice per
V-%