21615 96TH AVE W.PDF111111111111
9415
21615 96TH AVE W
NOTICE:*
-N"0'w.'a'r.ranty ... OT.
The 1 nformation . 'shown on the attached
Hed for use by the City 01
map(s) was com ' pi
Edmonds/ its Empl.oyees and Consultants.
Th,e City of Edrn.ond-s does. not . warrant the
these
accuracy of anything set for.th on
M a P (s). A n . y person or entity -requesting a
copy should conduct an independent
-e infbrmation shown,c
inquiry regarding th
_ffi� -rn a P (S) 11 including, but not J*rn'ted to
er stub shown. Su(
the location ofanysew
sewer stubs may or may- not exist and ma�,
or may not exist at the location shown
r-ity of Edmoinris nor 'ts
Neitheir the �1� I�A --/ t I
e m p` o,y e e's o,r o ff ic e *r s *s h. e balf.e f o r it- h
information given on this map(5), nor for
ion pr *ded based
any one represe.ntat' ovi
upon said map(S).
APPLICATION
The City of Edmonds-
for
-7-7P-7=lQ2-'H->7
EASEMENT NO. ...........................................
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS F�
LID NO. ---- ASMT. NO . ..................
OWNER ......
------------------------------------------
C ONTRACTOR J7�1���t':4EEFS -------------------------------------
PERMIT NO. 55-4�.cz.,�
JOB ADDRESS
— — ----- - ---------
. .......................
LEGAL DESCRIPTION: LOT NO - --------------------------
............... BLOCK No - ------------------------------------
....................................................................................................................
-------------- ------------------------------
NAMEOF ADDITION ..............................................
........................................................................
E
0
4
E S WN/tR.- RMMT�
ITY-01F ED! MY 0, N IDS, -E
PE
WATER -.SEWER, DEPARTMENT.,
P'E,-R. MIT' 5864.
ng: 'anv Portion; jdf� tfie constru tion,.,
(;,Call
side lsewer� inspectionw BEr�oRE, coveri
tio
%e provided within 24� hours, after requ c
St. NO��Sat.i..Su.n,.*,�'or,,holiday' inspee ns).
nue W
ADDRESS L,06��
j�.q"-PF C014ST-RUCTION
......... ................ ...... 1PY,
........................
PROPERTYLEGAM; DESCRIMON ...................
. ........................................................
............. ...... .........
...........................
............................................. ......
............... ...................
............ ......... .....................
.......... ...................... .......... ............
........................... WNER, AND/OR, BU
.......... 0.
................. ..... ...........
................ ...... .......
. I �% .. ...........
0 ONTRACTOW&NAMIE, AMAES S ....... 1j0MWN.E.R ...... _. . , 1. - I I . I'. � . � , -1 , I
...... .. .. ................................................. ...... . I .w ..... '. "
I . . . . 11 1 :� I I - . ............ 0 .......... .............. ..........
il-AIK ........................... 19 7.7.
Sion ls,,grant�4'. ............ 7 2
....... for Pair an�d/or, connection, of a side. sewer to,
ce, wit the city sanitary., sewer
in accordan' h �Cdy- of'Edinonds .�rdihances.,'
ATTENTION IS,Cj�LLED-TO,�THE,�FOLLO'W.ING':
NOTE No. I —The owners, of the:',�roperty- may obtain a permit to construct sewer inside Property line. A licensed Side Sewer
side:sewer in,street are I a., Dc, not cover any portion of sewer before it - has Coritr . actor must be',eMPloyedl.,to,tconstruct
-of-way,requires,-an Invasion of' RJght'-of-Why�j?ermjt obta3n-able from the City 'Engineer's office*i
NOTE' No. 2—A,11�xork. Performed, In city right -,been inspected.
NOTE No. 3—Obtain' full'i'riformatiomregarding Ordinance, 11.16.030 and, Regulations governing, side, sewers, -hen,you get permit.
u
NOTE, NO. 4—Top of Side. sewer.' r .9t have at least 30 inches coverage at property line and, 12 Inches inside, propeky ilne;, mjnjmum� grade of� 2%., "'No ln;:grade
aharp6r.4ham, 'Awilh be,�permltted'
be ds
NOTE No. &--Trench6s; in; street rimet be",water settled, and surface of street restored; to,.,orlgInEUi condition' responsible fo I r. fail : ure
work whi6l,mayj develop within one year of completion� Contractors shall; US)' OL,improper
NOTE No.. 6—It As unla;�full,io, alter: or do,,any'other work �than is �providedf for�.In 1�e'per
sert"the;�.'ipp��into,the�,wy,�. mit, or, to,do;�any work on the madn 'sewer,or, Its appurtenancesi,�xcepit,16� in-
DIS"PROVER, , t
.. ...................................... By ............... Date ................................
........ .. lay ...... ......
..... BY, ................ Date ................
APPROVED ate .......
.. 7 ..................... By
.... ........................... ..........................
-Reinarks,::
.......................................... ................................................................................................... ........ ........ M ................................ 7 ..........
..................................
................ ..................... ................. ......................................
.......................... ..................
................................................... .........
les
BOTH, Permif,C6p,' M!UST Be Signed�.By :ONV-ner of'Firm Performing, Construction �PRIOR'T I o Request For Insp
ec.tion,,
................ ...........
(Owner.,of Contrac i�, * , -, * .... *,"* * ....... * .............. ..... ..... hereby qerfify thaf thersidb; sewerInstaffaLtibn cons fruct edlunder thi�,`permft
.9 Firm Perfrrming -Construction)
-was installedin accordance; with,all governing. ordinances of therCify.
Datedt. this .............................. day
of . . .................................
V '-Cheiak BEFORE you dig,� for:, Water, r?we
Telephone,:E],,�
Sewer :0;. -'.4�Other.
APPLICATION
The City of Edmonds for
EASEMENT NO.
SIDE SEWER PERMrr
NEW CONSTRUCTION jV REPAIRS E] LID NO - ---- -- j� -------- - ASMT. NO - ------------------
OWNER -Ift JC A� -C,, , -r--1
------------ -- ------------------------------ CONTRACTOR ------- �ZZ-J7.? .... 3� -1
JOB ADDRESS ------------------------------------- .. PERMIT
--------------- LEGAL DESCRIPTION: LOT NO - --------- ---------------------------- BLOCK NO - ------------------------------------
45�� rn C) A cy S 7W�.*-.--z -
.............
..T
..... j� ...... 6 ------- I --------- ------------------ 4� --------------------------------- ..................
11
Ilk)
'j�
NAMEOF ADDITION ........................................................................................
,76 Ac. &'-') -
IN
DATE-------------------------------------------- BY --------------------------------------------------- a7ye
C.
CITY OF EDMONDS
PUBLIC WORKS EMINEERING
ACTION REPORT
N9 4260
SUSPENSE DATE:
N& uj�
Date: Time: 06 QM File # !�� LTf-)L'
QS
-j 0 �-Z,"
DO u z
Attachments:
=Yes
Ld 0
0
Do
SUBJECT: L
LL
1- 0
w (,n
< CY
0� W Z
c�21(o 1:5
M 0
�- :E V)
LL 0 La
1 0 �- z :3:.
REQUESTOR: NAME: XIA-10
< U-) M
z -j t--
ADDRESS:
0 cL LL 7)
1.41 00
I.- LLJ U-)
PHONE:
0
REQUEST RECEIVED BY:
Q� Lu
0 0 Lij
TELEPHONE
L) cl�
CONTACT IN 11110E,,X
< Lij �—
OTHER:
0 0� V)
z
14 -, M
RECEIVED BY:C,/�
u- 0 _0
0 ly r�,
0 LIJ
ROUTE TO:
0
4
OPR
N
INIT.
DATE
#
OPR
NAME
INIT.
DATE
Lu
Lij CL LL
.
C:) cn (n
03
:T
9
10
v) z CL. z
5
;
4-j' 5-T t�
LC- �'(K-
Cy- 0 C
ACI ION:
(D 0 Z
uj z �,W .4 F
7- < C:) C
-i L
u
16F.IV.
All Concerned Notified
fmz��,
Action Completed/File
gs
Alt.,
04KA-."
L`7
A4
At4
CA,
Par 7-
FM 9 1 MMLA mlw
7-1 tA/
i5p/UO"P,5f V4 gs-0.2-0
9.
0 6-4-5-0
MUC !.*0!1';',S )):�!'T. %.-
'4a --- -- '., cAl..
r VD --I
Strcet Pdr
vi -f
Access Fascments Existini, pj-,nn
Ef;7
W Utility Fascmcnt ExistinI, Izj:n!)
Lot Per Plat Assessor Iap
Sitc Plm Olicc�.ed for Accurac-v
cu:ic n; ,c(: r
J
Yxistin- I'ater �-Iqi n Sj -c,
1"nt-cr "'dn
TVA.-
Hydnv�t Si-zc V�I'ist�:l!"
Hv('Mmt n-d ze
tector
—V- !-!12
Ritc
')C")'1C
11 Soptic Tnnl. Ilvnr.it Pec:uired !�vnqit
ji Sunitary "Icwcr Availaidlity ro i'.
C
vaj I nbi li t'
;L: Side 5
on rc-'
-'-er C:k'-'7'.:lcc!L- i(!;l 171-1c. I'C'muircd L....)o f6'
Pate
Vcn.".j I-VO
N td) 1A-, c;t; j""
Clilvoyt 1'emdred
0 A�
Catch ]"'isin Pc"illirod 111(licate oil '�;te I I
<
oil Sito "Im"
Soil Conditions F., Growid 1.�'atcr Ficlu Oiccl'cd
Revic..: I)v
6-77
Street Paving, Required
ftirb mid (:,�ittcr Rcquircd
— &ILI
Curb Put for Privowav R'NUircd
Pight-of-I"ay Construction Pcniit Rccluircd
Bond 11,cquirc(l for RiblIc Improvcmcnts
";trcct 'Nanic Si I oil
Other Si ning Pcowii cl
J,rc I)c,,r,,.iit Site Inspcction made on s), -7 -7
c
11
Sci.:cr
Street
?D
s'no-CiA,
Pom". rcricnts listcd
in 11c,17)'O to Bui)(1in, jAcp)-Un'runt
1)'Itc,
ffln( ; PCI-mit Apnlica-�,-.ion
1)"Itc
and, ".'Otations !!"'(1c
P4
Dato
C_.
tk', b)' PLII)1iC R'IMI
use PERMIT 00
DEPARTMENT Applicant Fill ZO-E)�� -U;7 s' —A
PERMIT APPLICATION Inside Heavy Lines JOB
ADDRESS
NAME JOR NAME OF BUSINESS)
.in
U
Z
SF
ON
es —
JOB
E
ADDRE
L L.G L 7�
EGAL LOT T AREA
m YES ONO s`BS!§"7-0:'7
W M Al LI NG 1ADD R ESS
ST
z STREET R/W
0 -71 ZV C EXISTING STREET R/W e-,r_77 FT. DEFICIENCY THIS PROPERTY
CITY ELEPHONE NUMBER
COMP. PLAN ST. R/W FT. FT.
0 9
L �t2�
NAME I REMARKS
U
ADDRESS
CHECKED By
U
M CITY TELEPHONE NUMBER
STREET AND/OR UTILITY WORK
R/W PERMIT REQUIRED
<
REQ'D.
10 YES
1:1 NO
19 YES ONO
NAME
UNDERGROUND
WIRING REQ'D.
iff'-f ES
Im
ea L
0 ADDRESS
TYPE CONNECTION
IMYES
VERIFIEJ BY
SANITARY SEWER
ONO
u. 37,�-71 kE
IX CITY
TELEPHONE NUMBER
SEPTIC SYSTEM
0 YES PERMIT NUMBER
I-
z
APPV'D BY CITY ENG.
19NO
0 S I/
U sTATEIUICENSE NUMBER
CITY LICENSE NUMBER
REMARKS
S f-)?
Legal Description of Property (Show Below or Attach Four Copies)
A —r7—
METER SIZE
_;5� 1
BUILDING SUPPLY SIZE
W
z
0
I-
W
W
j
SIGN AREA ENV. REVIEW ADS NO.
A' I WED I PROPOSED I COMPLETE I EXEMPT I
REMARKS
VARIANCE OR CU
PLANNING REVI , By
KOEWS — 9 F
DATE
YARDS & I I
02S_ FRONT 7 X--)- SIDE REAR
ILOT COVERAbE'
NEW
r AD D D
ALTER
r
r
EJ REPAIR
1:1
RESIDENTIAL
NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FILL
PRE -MOVE
INSP.
GAS
L NE
S:GN
RETAINING
WALL
FENCE
X_FT)
swim
E] POOL
FIRE ZONE
ar
J_ I
TYPE OF CONSTRUCT
_r 77' 1
CODE
/7--/3
SPECIAL INSPECTOR
REQUIRED
0 YES NO
?D
AREA
o
03
OCCUPANCY
1GROU17_
OC CUPA
LOAD
PLAN CHECK 'BY LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE,
'81ki td/A
VALUATION I FEE
PROPOSED USE
PLAN CHECK
z
NO.
PLOT PLAN
(INDICATE BUILDING SETBACKS.
ABUTTING STREETS)
BUILDING
Ir
PLUMBING
U
V)
0
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
0 r—
Z
0:
W
W
z r1(
0 (-
Z
W
31
1'.
z
W
z
W
0
j
W
W
z
3
0
U
T E FR rff�\ RA FR K A D J
WENDELL BLACK
L J4
ROBERT B A LDR D:;E E. SEARS ALLAN S. RA"MM
;P I -IN E ST.
t, L 's� �"o
0
80.00 7 5.0 0' 70.00'
30 30 1 5. 75'
I Story
UJ 0 Fro-e
c�
0 H.Ups ro
W.W. EDDY 0
0 0 13' r-. K.A. TELFORD
A - - f,
'c
8000—sq.ft. �5
192 q-ft. 8392 sq.ft.
J\lj u 1\1 G) E R
80.00 761
����3 8 8 0
0
W) ' T 1 3-3' 3 �8.8 0
2.17 TH. ST. S. W
PAUL E POULIN
Pj _0 (JUNIPER--- ST)
uj
Z
Lj
.20 -f I C) 1\1
> WILLA PAULI Lli
>
LARRY D. WILLIAM 0. KAALD
LARSON
LO
0)
QD
3 0' 30'
_0ES
ENGINEERS 9 SURVEYORS . PLANNERS D11-
324 Ma;n Street - Edmonds, W-isn;nwon 98020 CH.