21520 89TH AVE W (2).PDFiiiiiiiiiiii
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21520 89TH AVE W
117 C. 1
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. '99-009
Lssue Date: /�'q qc)
A. Address or Vicinity of Construction:
B. Type of Work (be specific): A/5
I L/ ?
C. Contractor: /,L-
MailingAddress:
State License #: 1-4 C. ".' 46-� '0 2A
Building Permit # (if applicable): Q Ot I
Contact:
Phone:
Liability Insurance:
Bond: $
Side Sewer Permit # (if applicable):
E. Commercial Subdivision El City Project E] Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family Single Family M Other
INSPECTOR: JA10 i -r'_07— INSPECTOR:
F. Pavement or Concrete Cut : 0 Yes []No G. Size of Cut: — x — H. Chargq�_$
APPLICANT TO READ AND SIGN
INDEMNITY.- Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany—
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 and attorneyftes by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings of proposed work required with permit application.
A 24 hour notice is required for inspection. Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
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 trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be
available on site at all.times Arr inspection purposes. Date: 4z q A? 9
,ySignature., g
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Di� 1997
FIELD INSPECTION NOTES
Comments:
Diagram
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES 11 NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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PLANNING DATA
NAME:
SITE ADDRESS:_'�16FQ 0 641 DATE:_S1
ZONING:, PLAN CHK#: qq—z
PROJECT DESCRIPTION: R��l 9�
CORNERLOT �O -(Yes/No) FLAG LOT N (� ___(Yes/No)
SETBACKS:
Required Setbacks:
Front: S5" Left Side: Right Side: '75 Rear: P
AcIgalSetbacks: , VA9-11,
I Front: IV Left Side: Right Side:-/ ' �Rear.
Street map checked for additional setback requiredl I� (YesINO)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED- _(Y/N)
LOT COVERAGE: S—�� Actual:
Maximum Allowed:_0
BUILDING HEIGHT: ZZ� i I
Maximum Allowed:- —Actual Height: -
Datum Point: Lk UJ-C& -SQC- Datum Elevation:-., 61
A.D.U. CREATED?: No - MIX".1, *
SUBDIVISION:
CRITICAL AREASM, OA—Q5_1
SEPA DETERMINATION:
LOT
Plan Review By:
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BE IN PLACE
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APPROVED AS NOTEW
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ATTACHMENT 4
APPLICATION CARD No . ......................................
for
The City of Edmonds STR E tE ql" FILE SIDE SEWER PERAHT
OUTSIDE 0 INSIDE I-] REPAIRS EASEMENT No . ......................................
OWNER ................ -------- \—Jd.414��a
.................. ld.#A-A:Ai��
CONTRACTOR .......... r ...... . R ......... --------------------- PERMIT Iio.
HOUSE No . ....... ---- — ---------
'00
.......... . . .. .... _7 . ....
STREET
'No . ......................................... .........................
AVENUE LOT ----
BLOCK No . ...............................................
'2 a - '* 9 roor
'4'rw - d.
NAME ADD . .............. ....... Zez'�F ............................................................................................
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .............................................
SEVVERWORK ORDER.ISSUED .......................................... DATE ................. .....................
/,--,
..... By ...................................................................
I
Pimur %T)m� 11-TT. LIST
MrILDMIG PEPNIT PEA117, I
a -
Street Pdght-oE4-.' Existin REPT)
Access Easel ncjl?--s Existin
Utility Fascmc lit Existincy—NOW Rrnn
Lot rer Subdivision Plat Assessor I'm)
Site Plm (711ccLed for Accuracy
thic1crarctuid Read.
4. 1
Oicvk pa-araq ��fUqidtAi dart 10,ft
I.',cvi cw b�
)atc
RX i s t i I ig, V.ater '-hin Siz-a
Ml t C in rer-luired
t
I 1%,Jrwit ncnuirnd
Pctcctor (liecl.
1 0 6 �114 rcd
C
-J,; cc, "on
Film
c.ptic Tanl. Dc��,igii AT)provc(l
Soptic T�. �-vrmit RcoaimL
Sanitary Sewcr Availa,
Side Scv:er Aviilabili
smlitary-50� �(-011llciction Fee Pcouirccl,
Size
Date
i3c -0.
Ratc
p0mit
Tlro.i.
Date
"en Ditdi Exist rCT Pecluirccl
r-4
ClOvert -q
E" Catch Bas-'11 ";,enuire(I Indicate on Pitc Plm
CO I n Su" Cd S
o p e-i i at n -3 t v
Nall! required
Soil Conditions Water Field Gwchcd
Review I)%, --
—Indicate oi, Plmi
A-Itc
E-
cr-
r Ilaving lZapired
r
vi
"I "C
'I irc
�-rc(l
rurb 'an'd G,, I lzamdrcd
Nr W,
C;
0 1 rl) al i, t for Driveway, Irl' Z cc, 7(n i i r e d
lzi -ht-o Construction Pc ma-R61tod rc d
llond 1"Cquired for Ic. Improvements
, Street Ij -Sign Requirecl
'troct �T
lcr Ssif- ijl.IT llcqui rccl
i n
Fro
L -"J,
F""
BY: Sm-mr
U Water
Strect
rnginecring,
Special Pcquirmciats 1;1.,;ticd in inei-ao to Buileling f1cp.-irtment
Ily Date
itc,7L-, 'Lill.cd in oil Buildi.111; PCITI-it Apnlication CA)
l3v— Patc
Dravdngs Stmpall and Notatims 7-7
94
BY Date
Approved 1)), Public 1.orhs T)cp arU, lent
CA FILE NO.
Critical Areas Checklist
Sitelnformafion (soils/topography/hydrology/vegetation)
1. Site Address/Location: -Z
2. Property Tax Account Number: Ltit 3 —000
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? ke- yes; no.
If yes; how is site developed?
5. Describe e 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 1-0-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: Approx. Depth:
7. Site contains areas of seasonal standing water: A,-O Approx. Depth:
What season(s) of the year? -
8. Site is in the floodway floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? — (What time of year?.
10. Site is primarily: fbrested meadow mixed
shrubs
urban landscaped (lawnshrubs etc)
11. Obvious wedand is present on site:
ReV011004
& 9 0 . 19 q -
City of Edmon&
Critical Areas Checklist
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 submittal of a development
permit to the City.
Ile 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).
An applicant, or his/her representative,
must fill out the checklist, sign and date it,
RECEIVED
J ON 2 a 1995
COMMUNi i ( 6EFMCEs
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 necessaryto complete a
development permit application.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (eg. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing thew prtliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant.-
J,
Name
Shed Address
Applicant Representative:
Name
Street Address . . . . . 61
tgd��o 577
city, Shae, Z10? Phone' City, Shft, ZIP !Phone
Date Signab=
Date
NOTICE:
a
w
n. --y...
No
The information'shown on the attached
Map(s) was compiled for use by the City of
Edmonds/ its Employees and Consultants.
Th,e City of *Edm.onds does. not. warrant the
accuracy of anything set for.th on these
M a p A n . y person or entity -requesting a
copy should conduct an independent
inquiry regarding th*e inform-ati - onshownon
._--tF�e -map(s)i Including, but not limited to,
th . e lociation of any sewer stub shown. Suc
sewer stubs may or may* not e.xist. and may
or may not exist at the location shown
Neither the City of Edmonds nor its
empto-yee-s o-r office-rs -shal-1 be Via-b-11--e for the
this map(s), nor for
infor . mation g ven on 'ded based
any one representation provi
upon*said map(s),
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME NAME OF BUSINESS
MAILING ADDRESS
CITY zip TELEPHONE NUMBER
1 V11 Ole I J ��02 0 7 7!�---939 I
NAME
Lu
0
cr FC—ITY
4
TELEPHONE NUMBER
NAME
ADDRESS
CITY zip TELEPHONE NUMBER
C VVI C d _S cl IZ02-61 -7 T�-939)
STATE LICENSE NUMBER EXPIRATION
5-
7 44- f�
- include all easements
Legal Description of Property
io-t 4�, ZA11,9 , 1+(,,e
F1,A -7 T
//%, �rot.,2_e 0': p6qi5
0 lez e, o f - -Sv L" - ro. W /+
Property
Tax Account
Parcel No.
NEW RESIDENTIAL PLUMBING
ADDITION COMMERCIAL MECHANICAL
REMODEL E] APT. BLDG. El SIGN
GRADING FENCE
REPAIR - CYDS. L_ x _FT)
WOODSTOVE SWIM POOL
DEMOLISH INSERT HOT TUB/SPA
N ARAGE RETAINING WALL/
�63ARPORT ROCKERY F RENEWAL
(TYPE OF USE. BUSINES�S-OR.AqTIVITY) EXPLAIN
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
I
AREAS
INUMBER
STORIES
UNITS
DESCRIBE WORK TO BE DONE (ATTACH
PLOT PLAN)
A
USE PERMIT
ZONE NUMBER
J013 SUIT&APT is
ADDRESS cz) cl
LEGAL DESCRIPTION CHECKI SUBDIVISION NO LID NO
4 k�__ V /,-;�
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved 1, i'4__-9-
EXISTING RW Permit Required I/C5 ff-
REOUIRED DEDICATION Street Use Permit Req'qV110
PROPOSED Inspection Required
Sidewalk Required �A) 0
Lu
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED F_
YES [] N
Ox
REMARKS Z
Cc
7/, ...
A./ W
Z
AVO� C,
'7/
0 W
JE:7ING MEMO DATED
SIGN AREA
)ALLOWED PROPOSED
#/A 1 P/4
VARIANCE OR CU
V-qq- /Z 5
SETBAUS —FEET
SEPA REVIEW
EXE
COMPLETE 7
EXP I
DL�ZlNr, iVIEW BY
EIGHT. LOT
— 1.9Z11-f
FRONTA�% SIDE
REMARKS
V-1 q - / Z - Atl&dr 0-d I
E=k k 19, -
--�Iqlqq
CHECKED BY TYPE OF CONSTRUCTION CODE, —
I Z6/ 10
SPECIAL INSPECTOR R
REQUIRED Ir IM4
0 YES 'i
L_6w A4
REMARKS I
PROGRESS INSPECTIONS PER 6BC'* 305
FINAL INSPECTION REQUIRED
VALUATION FEE
/ k/,)�_ Z4
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING
PLUMBING
Plan Check No. ry
MECHANICAL
GRADING/FILL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewolks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days .
STORM DRAINAGE FEE
ENG. INSPECTION FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
modifv waive or reduce any requirement of any city ordinance
PLAN CHECK DEPOSIT
REVIEWED BY
_�' 177 1 )
REVIEWED BY
W
701 NO.
SFJORELINE
)V,ERjtGE Z
Z
Z
7-o
GROLIP
OCCUPANT
LOAD
0
nor limit in any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
A
1 1,
_51 ;;;:—] U
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and in doing the work authoriz-
THIS PERMIT
AUTHORIZES
T his application is not a permit until
ed thereby, no person will be employed in violation of the Labor
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
tion Insurance and RCW 18.27.
INSPECTION
acknowledged in space provided.
IGNATUfI6 (OWNER OR AGENT) Z DATE SIGNED,
DEPARTMENT
CITY OF
I
OF�FI�IS" IIGN DATE
EDMONDS
rK 4
ATTENTION
CALL FOR
INSPECT6
�
EL,1EASED Y, DATE
0C
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3,
PINK — Owner GOLD — Assessor
a
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