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21615 78TH AVE W
STAFF ACTION
BUSINEOLICENSE APPLICATION REVERSE A P P L. IN 0.: -7 -2 d
A0 SIDE
CITY OF EDMONDS �00 D A T E : !�I_ "? /-!2 Ll -2 zi-
250 5TH AVENUE NORTH
EDMONDS, WASH. 98020 rAPPNLICATION FOR:
F, 7
, E rLI LF
TELEPHONE (206) 775-2525 'C SE
INSfW(YTf0ffr_ - - ' I
PRINT APPLICABLE LICENSE CLASS, FEE AND PENALTY PAID
IN ANNUAL FEE BOX AT RIGHT PENALTY DUE ON RENEWALS
RECEIVED BY CITY CLERK AFTER FEBRUARY 15.
NEW BUSINESS: COMPLETE ALL LICENSE APPLICATION BOXES.
LIC. RENEWAL: REVIEW LICENSE INFORMATION BELOW. PRINT
CORRECTIONS AND ADDITIONS AT RIGHT.
-�IGN AND RETURN APPLICATION WITH FEE (AND PENALTY).
LICENSE WILL BE MAILED TO YOU UNLESS YOU ARE NOTIFIED
10 APPEAR FOR APPLICATION REVIEW.
LICENSE RENEWAL
R VIEW BELOW INFORMATION, PRINT CHANGES AT RIGHT.
NEW YEAR
V, BUS. RE
OFFICIAL N V
LICENSE NUMBER ACTION� LA NEW BUS
AKI'KI"Al C:CC:Q I An f LB RENEWAL
TYPE BUS. CLASS FEE PENALTY
L I , I I I I I
LC . CHANGE
TE -
.
7CLASS1
YEAR
I L11C. EFFEC' DATE
I REASG LIC NO
SPEC
HOME A $10.00 s 5.00
SMALL B 15.00 7.50
rr
*GENERAL C 50.00 � 25.00
RECEIPT NOJ
DATE PAID
A,
'OVER 10 EMPLOYEES, OR EMPL WORK
OVER 120 MAN -MONTHS PER YEAR.
zlIA
q,21 f, 711
PRINT W
IN SPEC. BOX
FOR ISSUE OF
CORRECTED
CLASS
FEE PAID
PENALTY PAID
FEE PA,ID
PENALTY PAID
LICENSE WITH
ACTION.
BUSINESS IDENTIFICATION
ISINESS NAME
�PITURE OF BUSINESS
I
BUSINESS PHONE
.',ASH. STATE TAX NR.
EMPLOYEES
ORGAN.
JOCCUPANCY
TYPE ORGANIZATION
IF BUSINESS IS:, TYPE
HOTEL/MOTEL L
APT.BLDG. A
OFFICE BLDG. 0
RESTAURANT R
HOSP./NURS HOME H
SCHOOL S
CAPACITY,
NR OF ROOMS/UNITS
NR OR APTS
NR OF OFFICES
NR OF SEATS
NR OF BEDS
NR OF STUDENTS
C CORPORATION
L LTD. PART
P PARTNERSHIP
S SOLE OWNER
L BUSINESS ADDRESSES
',IJSINESS ADDRESS
iCENSE MAILING ADDRESS
LICENSE APPLICATION AND CHANGES
"",,PLEASE PRINT CLEARLY
2. APPLIC NT
LAST NAME, FIRST INITIAL
ITY NUMBERJ
�ja I I I I I
-M)'(1y� yQ Jyj 1Y
�114 19il
DATE OF BIRTH PLACE OF BIRTH
MO. DAY
IYE �ITY :S!T;ATE]
I 1 11 10 ILI 'I", VI �L I L I E'l I I I I I I I c
I
HOME ADDRESS
BLDG. NUMBER
701 1 1
I rSlREET
1 W, AIL IfN U I T I I
I
APT, NO,
" L_
CITY
STATE
ZIP CODE
EIIDIMIO�IIDISI I'll I I I I I
I'l
A
19181012il)
/3. BUSINESS IDENTIFICATION
BUSINESS NAME (FULL)
SIT 121 VC-, IN IS, P A Ill IV, I T, Qw INI
HI Q ul;i I I I I
OF BUSINESS (DRUG STORE, CPA, ETC)
FN,�TURE
AI P I A I R, � 1,11 il, 1111 T,
WASH. STATE TAX NR. ANTICIPATED
GISTRATION) NR. EMPLOYEES
TYPE OF OCCUPANCY
ORGAN. TYPE CAPACITY
A
It ENTER APPLICABLE. TYPES AND CAPACITY t__ I
4�_BU�SIINFSS, ADORE—SS--
BLDG. NUMBER STREET
2.1 1 6, 1,5 11 ?�3 X..H 1 4 , V
BLDG. NUMBER
CITY
STATE I I ZIP
NO.
5. EMERGENCY NOTIFICATION (IN EVENT OF FIRE, BURGLARY, ETC.)
EMERGENCY NOTIFICATION LAST NAME, FIRST INITIAL AREA CODE TELEPHONE
I
NAME, AREA TELEPHONE
d 15 .1-,3 1
LAST NAME, FIRST INITIAL AREA CODE EPHONE
12
__L
(2) 7,
"I -_ "I P I I I w i I
OFFICIAL USE ONLY 5S OFFICIAL USE ONLY
,J.F.I.R. CODE BLDG. PERMIT , OCCUPI U. F. 1. R. I �RIM. UNITS BU . .
CODE Olbvoo
I 1/ 16
U. PERMIT AND USE I ZONING C0111D. USE PERMIT NO USE
T . I I'l L,-Lj EJ =
CLERK'S
SICNATURF
r'-'PRovFn El DISAPPROVED DATE C�B
LICANT'S
IATURE
TITLE
BLqG. PERMIT
76
OCCUP. G
ZO ING
8
DATE `/ _-
STREET FILE
MEMO TO: Harry 14hitcutt
Building Official
FROM: Richard H. Allen
Assistant City Engineer
SUBJECT:
After review of the subject building permit application, we have the following
comments:
MIRMSMAN N
x I W SMOG
Att
MAN
0035%
MON
ON T. 11�ez-a-3AN 4RIIOL�
L1415 A FINAN-1-
DATE PERMIT ADDRESS 21(o ts-iPTN A-Ve IV\/
LEGAL DESCRIPTION
BUILDING PERMIT REVIEW - ENGINEERING DEPARTMENT CHECK LIST
Reviewer's
Initials
1. This lot included in Subdivision
2. Site Inspection made on:
3. 14hat are ground water and soil conditions?
4. Site nrainage Checked?- '
5. Storm Sewer Availabilii—v.-
Roadside Ditch
of No. No. 1520
___Pro
6. Gradinq Final Contours:
7. Septic Tank System Design Approved: KJLA-
8. Sanitary Sevier Availability Sht. of Nip. NoI044(o ProjectLIO I
Side sewer availability: 'I (P- L -
9. Sanitary Sewer Connection Fees?
10. Uater Mains ?A Fire Rydrants (Indicate Size Main) Qetk,
.0
Check Fire Dept.'s Comments
11. Sidewalks: (Site inwctimshows conditions of sidewalks as follows)
I % es, � A )G=r�k — � . . -1 - . . . AC-
12. Curbs: JLY%jnT
I grade and width):
Curb_Cuts/2.riveways (f.heck driveways for safety, Incation,
13. Underground Vi ri np:
14. Street Riqht-of-way & Bldg. setbacks: -ht
- R&� 1�nFlr,
15. Existinq Utility Easements? et'Mmmsmoz
16. Access Easements:
Street Lights:
of nfficial Street Map.
17. Site Plan checked for accuracy?
18. Special Requirements listed in Memo to Bldg. nept.__
10. Commercial & Apt. Renuirements form comp'leted?-&54, t�-59!E Ej U25.
20. Drawings stamped notations made?
21. All Items filled in on Bldg. Permit Application? (a( 19-7to !�M'K El LJ5-
22. Bonds posted for'site work? fr i LRO rbn MLos� - DMM
23. Right-of-way Invasion Permit required?
24. Check Accuracy of Legal Description
25. Check Against Assessor's Map for Legal Subdivision y4Ee>-
26. noes it conform to City Approved Subdivisio ns? 77
COMME11TS:
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11-77
CITY of EDMONDS --- PUBLIC WORKS DEPARTmENT
Routing of Building Permit Applications
Proposed Property Address of Application:
DEPARTMENT
COMMENTS
DATE
W A T E R
S T R E E T
47
6Z
S E W E R
N 0 T E S
BUILDING
DEPARTMENT COMMENTS
I
M
9/l/71
-4,Jk
loq -
=UILDING DEPARTMEN
Applicant Fill
USE
ZONE
NUMBER
AUG 2 19:7
PERMIT APPLICATION
Inside Heavy Lines
JOB
ADDRESS
61-re—
rd—dw—&orKS P
ME (OR E OF BUSINESS)
LOT
LOT AREA
SUBDIVISION NO.
PLEGAL
0 YES NO
I
I I
W MAILING ADDRESS
z
3:
VARIANCE OR
ADB NO.,
0
COND. USE NO.
0
_7EIGHT
CITY
TELEPHONE NUMBER
77
PROPOSED YARDS
E
Z
FRONT
S171C REAR
Z
NAME
ALLOWABLE
PR6POSED
J
IL
1,
U
SIGN AREA
OTHER
;SIGN AREA
W ADDRESS
1 Id/1 y
U 2�3 t
REQUIREMENTS
PLANNING. DEPT. APP�,.�
DATE
m City
<
TELEPHONE NUMBER
�7'7-5
C z>'v
-
L.
NAME
(Al
0 ADDRESS
U
M CITY TELEPHONE NUMBEii
z
0
U STATE LICENSE NUMBER CITY LICENSE NUMBI
Legal Description of Property (Show Below or Attach F.our CopilE
4
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U
(n
W
a
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W
J
STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W FT. FT.
REMARKS
ICHECKED BY
STREET AND/OR UTILITY 0 YES
WORK REQ'D NO
UNDERGROUND YES
WIRING REQ'D 0 NO
TYP . E CONNECTION IVERIFIED . BY
YES PERMIT NUMBER
SEPTIC SYSTEM
APPVD BY CITY ENG. NO
REMARKS
METER SIZE ISERVICE
SIZE
ICLEARANCE
JC.HECKED.BY
REMARKS
NEW
RESIDENTIAL
GAS
EILINE
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
NON-RES IDENTIAL
SIGN
ADD
FALTER*
I
DEMOLISH.
EXCAVATE
OR FILL
RETAINING
WALL
FENCE
El I— X-1 11
SPECIAL INSPECTOR
REQUIRED
1:1 YES 0 N 0
ZEA
JOCC PANCY
U
GROUP
LOAD
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
.
OF EDMONDS. LOCAL SALES TAX
REPAIR Li I R 14 — V E
INSP. POOL
Li
SHOULD BE CODED 31.04.
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
VALUATION
FEE
PRO POSED USE
z
PLAN CHECK
0
NO.
PLOT PLAN (INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
U
PLUMBING
W
HEAT & GAS LINE
m
0
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
0
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APPLICATION
The City of Edmonds for
SIDE SEWER PERMIT EASEMENT NO - ------ ------ --- --- -- --- - --
NEW CONSTRUCTION REPAIRS LID NO. --- ASMT. NO - ----------- -----
OWNER ------ - ----- -------------------- ------------ CONTRACTOR ---- -------- E---P-q -=� - ---------------------------- PERMIT NO.
JOB ADDRESS - ---------- W-=-S-r ------------------ LEGAL DESCRIPTION: LOT NO. -kl ----- 4EL ---- (Z - ------ ----- BLOCK NO - --------------------- -------------
NAMEOF ADDITION --MnFP'E= - ---------- ----------------------------------- ---------------------
Approved:
�422,k .............
DATE ----------------- ------ By 11/75
---------------
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
�7
fly, CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
4
PERMIT
caii 775-2525 for side sewer inspections BEFORE covering any portion of the construction.)
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.
ADDRESS LOCATION OF CONSTRUCTION ......... Z1615 - 78th W.
.......................................................................................... . .......................................................
PROPERTY LEGAL DESCRIPTION ........................ Lots 11 & 12 - M�_ 10bre
...............................................................................................................................................................
.................................................... ...................... . ......................................................................................... . ......................................................................................
................................................................ OWNER AND/OR BUILDER ....... Bruce Wardal
................................ .................................. . .......................................................
K & D Sewers, Box 299 Ly=Amd, Wa.
CONTRACTOWSNAME & ADDRESS ...... .. ........................................................................... ............................... . .. . .......................................................
Permission is granted ..... Wce&ber 8
...... .................... I ----------- - ------------ 19 ... 76, for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
__eENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside prop_erty line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer before it has beeii Inspected.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right-of-Wfi�V Permit obtainable from the City Engineer's office.
NOTE No. 3--Obtain full information regarding Ordinance 11.16.030 and Regulations go4erning pide sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12.inches inside property line; minimum grade of 2%. No bends In grade
sharper than % will be permitted.
NOTE No. 5---Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for fallure due to improper
work which may develop within one year of completion.
NOTE) No. 6—It is unlawful to alter or do any other, work than is provided for in the permit, or to do any work on the maln sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED E] Date__- By ................ Date .............. - ---- ----- By -----_--------- Date ............... . ................... By ------ : .........
APPROVED $(-Dat
A ------ 7-e ---------------- BY --- - ---- . . .. .......... . ... ... .......................................................... : ............................
Remarks: ....... . .................................. . .. . ................................... ------------------ - -------------------------------------- - -------------------------------------------------------------------
. ..................................................................... . .......................................... .................................................................................. . .......................................................
BOTH Permit Copies MUST Be Signed By OiA/er of Firm Performing Construction PRIOR To Request For Inspection
-15 ... . ...................... ... I hereby certify that the side sewer installation constructed under this permit
(Owner of Contracting Firm Performing -Construction)
,.--j installed in accordance with all governing ordinances of the City of Edmonds.
Datedthis ............... . ........... day of .................................. ............................. 19 .........
V Check BEFORE you dig for: Water F], Gas 0, Telephone E], Power E],v` Sewer Other
The City of Edmonds
APPLICATION
for EASEMENT NO - ----- — ------------------------------------
SIDE SEWER PEWIT
NEW CONSTRUCTION E] REPAIRS 0 LID NO - -------- ASMT. NO - ------------------
- 71 ----- - A
CONTRACTOR
lQ ----------- --- ----------- -------- RMIT NO.
'E'R 14 1-j A Ji ID Jq I-
OWNEI L -- ---------------------------------------------------------------------------------
8
JOB ADDRESS ---- ------------------------------------------------------------------------------- LEGAL DESCRIPTION: LOT NO - ------ 1-1 ...... 1-1 -------- BLOCK NO - -----------------------------------
11
---------------------------------------------------------------------------------------------- -----------------
NAME OF ADDITION .... M".O'") ---------- Ad d RC
...................... — ........
Approved:
DATE-------------------------------------------- BY
,97REET FILE
DATF:--. t 4. 01L
HU-10 TO: Harr\, 11hitcutt
Buildino Official
FROM: Richard H. Allon
Assistant CitV Fnni.nepr
SUBJ ECT: R11ilding Permit Application for Fruce 1%larhol at 21615 Mth Avenue
U. - 10-1.1nit Apartments
After review of tho suhjptt hUildinn nermit anplication, we have thp fol-
lot,,linq com1flents:
The plans submitted are incomplete; please have applicant resubmit
plans indicating1ocation, tYpe, size of utilities.
t,!N:R11A:m,ir
I
PERMIT ADD
Dat LEGAL DESCRIrrION
STREET FILE
BUILDING �ERMIT REVIEW - ENGINEERING DEPARTMENT CHECK LIST
Instruction:
Check Accuracy of Legal Description
Check Against Assessor's Map for Legal Subdivision
Does it conform to Cify'.Approved Sr�division?
Rrviewer's
Initial%
1. This lot included in Subdivisi
2. Site Inspection made on:
3. What are around water and soil conditions? 8
4. Site Drainage Checked? 5 13 1 'YO
5.. Storm Sewer Availab'i4iTV--.,RT5 --silt of Dwg. No. ectIT 1;1
�0 roj
Roadside Ditch
6. Grading & Final Contours-: 59480 �J
7. Septic Tank System Desinn Approved:
8. Sanitary Sewer Availability 'fll[3 Sht. of Nig. NoJ,'
Project L
Side sewer availab . ility: -r es
9. Sanitary Sewer Connection Fees?
10.. 14ater Mains & Fire Hydrants (Indicate Size Main)W'"oAct-w awsTitgA
Check Fire Dept.'s Comments
11. Sid ection shows conditions of sidewalks as follows)
12. Curbs: Curb Cuts iv r safety, Incation,
e Vbs ,Cht�driveways fo
grade and width):7
13.. Underground 11iring: Street Lights:
14. Street Right-of-way Bldg. setbacks:-V. rsht. of ()fficial Street Map.
15. Existing Utility Easements?
16. Access Easements-
17. Site Plan checked for accuracy?
18. Special Requirements listed in Memo to Bldg. Dept.
19. Commercial & Apt. Rpouirements form comp eted?
20. Drawings stamped.& notations made?
21. All Items filled in on Bldg. Permit Application?_
22. Bonds posted for site work?--
23. Right-of-way Invasion Permit required?
COMMENTS:
ENGINEERING REQUIREMENTS FOR COMMERCIAL
AND APARTMENT BUILDING PROJECTS CC%
FILE
Name WARHOL 10-Unit Apartments at 21615 78th Avenue W.
Date August 4. 1976
STREETS AND ACCESS
1. Right -of -Way Requirements: 50-ft existing
Road Bed Width: 36-ft existing
3. Turn Around: Required on Site
4. sidewalks: 5-ft concrete sidewalk require d
5. Parking Strip: None
6. Access Easements: None
UTTT.TTTF..q
1. Water Mains: Existing
2. Fire Hydrants: Existing
3.. Sewers or Septic Tanks: Connection.to sanitary sewer required.
4. Drainage: Install all necessary storm sewers -and drainage ftLcilities
per drainage plan and City Standards. Where drainage is across adjacent
private property, all parties having any.ownership interest in the lands
being developed shall provide, as a restriction on.the title running with
the land,that the City of Edmonds shall be held harmless from any and all
cl aims for damages which may be occasioned to adjacent land by-r6ason of the
construction and operation of the drainage system, unless, releases of .
damages and/or drainage easements are obtained from the other.property owners
affected by said drainage. Any drainage problems created by c hange of contour
during development must be corrected prior to occupancy permits or release
of performance bond. Final approval (or release of b6nd)-will be withheld
until actual drainage as installed has been inspected by.the City Engineer.
,2123a
7-Engineering Req ments for Comm'l &
Apartment Build*Projects - Page 2
5. Utility Easements:
6. Underground Utilities: To be provided in accordance with Ordinance No. 1387.
Street Lighting shall also be provided with the necessary street light
standards and underground wiring.
TOPOGRAPHY
1. Excavation and Grading: Excavation and grading shall conformto the requirements
outlined in.Chapter 70 of the Uniform Building Code, latest adopted�edition,
Vol. 1. Where extensive grading and fill are involved in the development, a
grading plan and specifications shall be prepared.
QUOTATION FROM THE CITY CODE REGARDING IMPROVEMENTS
11.02.025(f) Utilities and Street Improvements. No.building permit shall.be
issued for the construction of any building or.structure of any kind or
description unless the plans and specifications include the construction for
curbs, gutters, sidewalks, paved stre'ets, necessary water lines, sewer lines, and
storm drainage necessitated by the new construction or improvement, to be built
to applicable City standards, provided, however, if found by the City'Engineer
to be impractical to construct at the time of application for said building permit,
construction may be waived by the City Engineer and in lieu thereof a performance
bond filed with said engineer to cover the estimated cost of construction to City
standards for said improvements, provided further, in areas zoned single family
residential at the time of said application for building permit in which the
applicant has received final approval for a plat or sub -division and has compiled
with requirements -therein compliance with this subsection shall be deemed by
compliance with the sub -division or plat requirements.
COMMENTS
Rev. April 2, 1971
2123 b &2124 a
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