21807 76TH AVE W.PDFIIIIIIIIIIII
6339
21807 76TH AVE W
E
0
When recorded mail to:
City Clerk
,City of Edmonds
121 Fifth Avenue North
Edmonds, WA 98020
DUPLICATE
CO'NFORMED COPY
200211210003
11/21/2002 09:16 AM Snohomish
P.0005 RECORDED County
ji
APPLICANT IS: SPACE ABOVE THE LINE FOR RECORDERS USE
g Property Owner AssessWs Parcel No.: - P/ ? XO 40& 00
OK Business Owner Applicant: - A 4Xz-R
I-e-Sal. 64?0,-T'�27, /q OX/
ENCROACHMENT AGREEMENT
This ENCROACHMENT AGREEMENT ("Agreement") is'entered into between the
CITY OF EDMONDS ("City") and VIP5 OAL�F-=-&
("Owner[s]"), in accordance. with Chapter .18.70 of the Edmonds Community Development
Code.
I The ProDer-hy. owner is the owner of that certain real property
41-
xe=L- 40L C=r,7— ------------- widun the Uty of
Washington, Assessor's Parcel Number - 0,�) q
a/ 7 Mo of
'particularly described in Exhibit "A" attached hereto and incorporated herein by
Business owner,
the business owner of that certain real property noted above
located at
Edmonds,
and more
reference.
2. The Easement. TheCity currently owns an existing easement over, under,
and across Owner's property for street, alley, sidewalk, other ( &A -
which is described in Exhibit "B" attached hereto and incorporated by reference.
.3. The Encroachment. The City hereby covenants and agrees and grants its
permission to Owner or Business Owner to allow '41z7mod ;u-, /1
to remain in a portion of the City right-of-way/easement. A plat map showing the location of
the encroachment is, attached as Exhibit "C" and incorporated by reference. This Agreement
is subject to the following terms and conditions:
a. The encroachment shall be. installed and maintained in :a safe and
sanitary condition at the sole cost, risk, and responsibility of the owner and its successors in
interest.
- 1 -
Vl-
b. The Owner shall agree at all times to indemnify and hold the City free
and harmless from any and all claims, demands, losses, damages or expenses resulting from
the construction, maintenance, use, repair or removal of the structure installed hereunder,
including any loss, damage or expense arising out of (1) loss or damages to property and (2)
injury to or death of persons.
I C. The. Owner must remove or relocate any part of the encroachment
within ten (10) days or such other time as specified in the notice after receipt of it from the
City Engineer, or the City Engineer may cause such work to be done and the reasonable cost
thereof shall constitute a. lien upon the property
d. Whatever rights and obligations were acquired by the City with respect
to the easement shall remain and continue in fall force and effect and shall 'in no way be
affected by city's grant of permission to construct and maintain the encroachment structure.
4. Entire Aueement. This Agreement constitutes the entire agreement between
the parties with respect to the subject matter hereof and supersedes and replaces all other
agreements, oral or written, between the parties with respect to the subject 'matter.
1 5. Notices. Any notice which is required or may be given pursuant to this
Agreement shall be sent in w6ting by United States mail, first class, postage pre -paid,
registered or certified ' with return receipt requested, or by other comparable commer6al
means and addressed as follows:
If to the Ci :
City Engineer
City of Edmonds
121 Fifth Avenue North
Edmonds, WA 98020
If to the Owner:
I )Avtl) eAkP 11
g1l
a
which addresses may be changed from time to time by providing notice to the other party Mi
the manner described above.
6. Waiver. City's consent to or approval of any act or omission by Owner shall
not constitute a waiver of any other default by Owner and shall not be deemed a waiver or
render unnecessary City's consent for approval to any subsequent act by Owner. Any waiver
by City of any default must be in writing and shall not be a waiver of any other default
concerning thesame or any.other provision of the Agreement..
-2-
. 7. Successors and Assigns. 'This Agreement shall be binding and'inure to the
benefit of the parties hereto and their respective -legal representatives, successors, and assigns.
Owner agrees to incorporate this agreement by reference in any. subsequent deeds to the
property, but any failure to do so does not invalidate thisi provision.
8. Capaci . Each -party represents that the person(s) executing this Agreement
on behalf of such party has the authority to execute this Agreement and by such signature(s)
thereby. bind such party.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement on this
day of 20_Cj?,
OWNE (S) BUSINESS OWNER(S):
By.
STATE OF WASHINGTON
COUNTY OF - _<4-40F�0 M 1154+
�� 4
This day, personally appeared before me,":", - � 7�c �r
to me known to be the personN who executed the within and foregoing document and that
(helshelthey) OE' signed the s 'e Iherltheir) free and voluntary act
a� men ned.
and deed for the uses and purposes therp
DONA 8, �11 E
ned,
FGTAHD NA 13 W"'IT
0
N 0 y Notary Public
Y PUBLIC
PU
S TATE OF ASHIN
TATE OF WASHINGTON
COMMISSION EXPIRES
S PT MB� 9 Typed or Printed Name
SEPTEMBER 9,2004
My Commission e*xplre's: ?9K20 9/'
CITY OF EDMONDS
By..
ENGINEERING DIVISION
L%TEMP3UMDUqGULANI)OUT%ErauachAg=.doc — I —
EXHIBIT A
Legal Description
THE WEST 121 FEET OF. THE NORTH HALF OF THE NORTH HALF
OF TRACT 43, SOLNER'S 5 ACRE TRACTS, ACCORDINGTO PLAT
THEREOF RECORDED IN VOLUME 7 OF.PLATS, PAGE 25,
RECORDS OF SNOHOMISH COUNTY, WASHINGTON; EXCEPT THE
NORTH 30 FEET THEREOF CONVEYED TO SNOHOMISH COUNTY
FOR ROAD.
IL
1wilpff tplf.lp sipi
, ti
0 tot px6al
.00,
Wk
AV.
ol t,
When recorded mail to:
City Clerk
City of Edmonds
121 Fifth Avenue North
Edmonds, WA 98020
DUPLICATE
CONFORMED COPY
200211210003
11/21/2002 09:16 AM Snohomish
P.0005 RECORDED County
APPLICANT IS: SPACE ABOVE THE LINE FOR RECORDERS USE
W- Property Owner Assessoi�s Parcel No.: ./-/0/ 40& 00
6K Business Owner Applicant:_ - AAKg�&
-7%2 7, 0X/
ENCROACHMEENTAGREEMNT
This ENCROACHMENT AGREEMENT ("Agreement") is'entered into between the
CITY OF EDMONDS C'City) and
("Ownerfs) in accordance. with Chapter 18.70 of the Edmonds Community Deve . lopment
Code.
The Pr'overty. Owner is A the owner of that certain real property located at
within the -. City of Edmonds,
Waslungton, Assessor's Farce Num er 0V q,01 7 000 ffi�#
.1 b .00 , and more
particularly described in Exhibit 'W' attached hereto and incorporated herein by reference..
Business owner, DAV-1 is
the business owner of that certain re�l property noted above.
2. The Easement. The City currently owns an existing easement over, under,
and across Owner',s property for street� alley, sidewalk, other
which is described in Exhibit "B" attached hereto and incorporated by reference
The Encroachment. The City hereby covenants and agrees and grants its
permission to Owner or Business Owner to allow 4ZWt&-9411
to remain in a portion of the City right-of-wayleasemient. A plat map. showing the location of
the , encroachment is. attached as Exhibit "C" and incorporated by reference. This Agreement
is subject to the following terms and conditions:
a. The encroachment shall be. installed and maintained in -a safe and
sanitary condition at the sole cost, risk, and responsibility of the owner and its successors in
interest.
NE
T'A-
4
b. The Owner shall agree at all times to indemnify and hold the City free
and harmless from any and All claims, demands, losses, damages or expenses resulting from
the construction, maintenance, use, repair or removal of the structure installed hereunder,
including any loss, damage or expense arismig out of (1) loss or damages to property and (2)
in ury to or death of persons.
J
C. The. Owner must remove or relocate any part of -the encroachment
within ten (10) days or such other time as specified in the notice after receipt of it from the -
City Engineer, or the City Engineer may cause such work to be done and the -reasonable cost
thereof shall constitute a. lien upon the property.
d. Whatever fights and obligations were acquired by the City with respect .
to the easement shall remain and continue in full force and effect and shall in no way be
affected by city's grant of permission to construct and maintain the encroachment structure.
4. Entire Agremen . This Agreement constitutes the entire agreement between
the parties with respect to the subject matter hereof and supersedes and replaces all other
agreements, oral or written, between the parties with respect to the subject matter.
. 5. Notices.. Any notice which is require d
Agreement shall -be sent in writing by United States
registered or certified. with return receipt requested, or
means and addressed as follows:
If to the C
City Engineer
City of Edmonds
121 Fifth Avenue North
Edmonds, WA 98020
or may be given pursuant to this
mail, first class, postage pre -paid,
by other comparable cornme . ial
which addresses may be changed from time to time by providing notice to the other party in
the manner described above.
.6. Waiver. City's consent to or approval of any act or omission by Owner shall
.not constitute a waiver of any other default by Owner and shall not be deemed a waiver or
render unnecessary City's consent for approval to any subsequent act by Owner. Any waiver
by City of any default must be in writing and shall not be a waiver of any other default
concerning the -same or any other provision of the Agreement.
. 2-
7. Successors and Assigns. 'This Agreement shall be binding and -inure to the
benefit of the parties hereto and their respective -legal representatives, successors, and assigns.
Owner agrees to incorporate this agreement by. reference in any. subsequent- deeds to the
-property, but any failure to do so does not invalidate thia provision.
8. Capaci Each -party represents that the person(s) executing this Agreement
on behalf of such party has the authority to execute this Agreement and by such signature(s)
thereby. bind such party.
IN. WITNESS V;BEREOF, the partiesh ' ereto have executed this Agreement on this
day of 20_C2,?,
ONWVNE S) BUSINESS OWNER(S):
B Y.
By-
STATEPF WASIENGTON
COUNTY OF 0 Flzl) M
This day, personally appeared before me,
-to me known to be the personN who executed the within and foregoing document and that' -
(halshe,lthey) 14LI" signed the same ��hislherltheir) (4 j- S free and voluntary wt..
:he
er
and deed for the uses and purposes I I C In ned.
DONA B. WAITE
ned.
Notary Public.
NOTARY PUBLIC [ - -
STATE OF WASHINGTON _:T?o 4 A, ':B�
dOMMISSION tXPIRES
SEPTEMBER 9,2004 Typed or Printed Name
My Commission expires:
CITY OF EDMONDS
B
ENGINEERING DIVISION
doc - 1; —
EXIMIT A
Leg�l Descr.iption
THE WEST 121 FEET OF THE NORTH HALF OF THE NORTH HALF
OF TRACT 43, SOLNER'S 5 ACRE TRACTS, ACCORDING TO PLAT'
THEREOF RECORDED IN VOLUME 7 OF.PLATS, PAGE 25)
RECORDS OF SNOHOMISH COUNTY, WASHINGTON; EXCEPT THE
NORTH 30 FEET THEREOF CONVEYED TO SNOHOMISH' COUNTY
FOR ROAD.
. lk
lot.
EA
ww*
I.L
10
00
io
PERMIT #jUj9 -
DATE APPLICATION RECEIVED: 0 2-
ADDRESS OF PUBLIC USE:
PROPERTY OV,[NER:
ONCE YO UR RE VIE W IS TE.1
COMPLET , PLEASE ROUTE TO THE NEXT
DIVISIONIDEPARTMENT ON THE LIST.
**Doe
PLEASE R 0 UTE IN THE ORDER SHOWN *
PLANNING DIVISION
-Pt,
P�JBLIC WORKS
ENGINEERING DIVISION
VW DS ADMINISTRATION
" V1, 0
Date Stamp Received: "EIVED.
SCP i;002
IL
cvpy.
Date Sta Pceived: RECEIVED
OCT 1 6 2Q/.
PUBLIC W0RKS D
*P'l
Date St . amp Received: RECEIVED .
OCT 2. 2 2002
Date Stamp Re eived: ENGINEEFdNG. DIVISION
APPR OVAL SIGNA TURES AA7) REMARKS OR COMMENTS ARE TO BE MADE
UNDER THE "DEPARTMENT APPRO VALS"SECTION ON THE PERMIT.
RAengr\fbrms\Encroachment permit routing
E D
2X2 -00a7
#59
SED
2fln.,
ENCROACHMENT PERMIT APPLICATION.
PROPERTY OWNER NANIE: ILUI/C.4 )O(WOP 9�0f( Phone Cqw-) -74-17f'l
ERTY
'PROP OWNER MAMING ADDRESS: 11967'
BU SINESS NANM for Commerical applications: 9how
ADDRESS OF PUBJJC USE: V-N kye-
Describe the portion of public space, City right-of-way or easement area to be utilized (i.e., overhead space of
sidewak 10 foot City utility easement along north property line, etc):
Describe the type of encroachment or use desled (i.e., fence 6 feet by 150 feet, awning 3 feet wide bN 7 �yet
long, etc.): 6APIPT 114d -2 1 *9 q 5/7'e, PO low.$ vicuelffs /tow I -s
Specify the length of time for use (i.e. awning for life of building, espresso cart for summer months, etc.),
NOTE: The issuance of this. permit is understood by the applicant to be of a temporary nature and that no vested right is granted.
flVDEMNHY.- The applicant understands- and by hislher 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 but not limited to the defense or
any legal proceedings including defense costs, court costs, and attorney fees by reason of granting this permit. In addition, the
application understands that the City shall be provided a Certificate of Insurance to indemnity and hold harmless the City of
Edmondsfrom all claims andlor property damage, and naming the City of Edmonds as an additional insured.
CODE APPLICA TION.- By signingte application below the applicant warrants that s1he has read or had the opportunity to read
Chapter 18.70 of the Ed I mends Coftnunity Development Code and s1he understands that all terms of the adopted ordinance are
incorporated herein fi;forth 14fidl and this application andpermits therefore 'are subject to the terms of that Chapter.
TY OWNER/BUSINESS OWNER
L-Teffip:Building:Handout:Encroachho.docjWO2
rM
CRITERIA OF PERAHT APPROVAL
Th . e applicant shall follow the noted conditions on the building permit. For applications that do not require a
building permit the, following criteria shall be maintained at all times.
> Provide . safe pedestrian travel for sidewalk encroachments. Maintain a clear zone of 44 inches mui
See definition of clear zone below.
> Exterior light fixtures, banners and flags must be a minimum of 7 feet above City right-of-way.
> Maintain clear landmgs on the exterior side of all required exit doors of 44 inches. or no less than width of
door, measured toward the street.
> No projections into City alleys� are permitted unless the projection exceeds 15 feet above pavement
surface.
> Do not block illumination from City light fixtures or hang objects from City light standards.
> Architectural projections from buildings must be approved by the Design Board and conform to Uniform
Building Code requirements. A building permit shall be requirrd for such projections.
> Maintain � feet of clearance around fire hydrants, standpipes, manholes, water meters, blowoffs,
cleanouts and valves.
.>. Bistro dining tables and chairs must be placed in accordance with City Ordinance No. 3293.
> Merchandise racks, espresso carts, flower planters, benches must not be located within the '.'Clear zone".
> Ramps require a separate building permit and must conform to UBC standards.
Clear Zone Deflnition: Clear Zone refers to an area 7 feet in height and 44 inches in width projding
level, safe walking surface along the �ublic sidewalk (i.e. measuring 44 inches from edge of street tree grates
or newspgper stands toward place of business and from the und Mp to a height of 7 feet).
-------------- w ---- DEPARTMENT APPROVALS --- FOR CITY USE ONLY ------------ -1� ------
Planning Division Approved By ADB# 02- 1610. Date /0 14 62.
Remarks or Comments:
Public Works Approved By Date
Remarks or Comm
Engineering Division Approved By niromaCAUond Date 10-2,f--02-
Remarks or Comm
Certificate of Insurance Verified
Easement Agreement sent to City Clerk for rec
ENCROACHMENT PERMITW- 5;�VAV -
RELEASED BY
() SS �Z_
BUILDING PERMIT # RECORDING #
L-Teffip:Building:Handout:Encroachho.docjlgO6tO2 -56 3
North%Wst Ventists Insurfince Company
1730 Minor Avenue, Suite 1800
Seattle, WA 98101-1499
(206) 343-7800
(800) 662-4075
FAX (206) 343-7100
Named Insured:
Mailing Address:
NORDIC
Northwest Dentists Insurance Company
Businessowners Polity
Declarations Page
Occurrence PoTicy
T. W. Shilling, DDS
21807 76th Avenue W
Edmonds, WA 98026
Policy -Number
BP 3-522087-00
POLICY PERIOD: May 1, 2002 to January 1, 2003 Policy Premium
, at 12:01 a.m. standard time $1118
Change Effective: July,31, 2002 Amended Policy Premium: $1118
Additional or Returned: $0
Location and Property Coverage
LOC. BLDG.
NO. NO. ADDRESS OCCUPANCY LIMITS
1 1 21807 76th Avenue W. Office
Edmonds WA 98026
Building Limits $742,060
Butiness-Personal Property $100,000
Inflation Factor 4%
Unless otherwise specifed subject to a deductible of: $1,000
INCLUDED COVERAGES
Loss of Business Income
Extra Expense
Accounts Receivable Records
.Valuable Papers and Records
Employee Dishonesty
Money and Securities
Welfare & Pension Plan
LIABILITY COVERAGE
Each Occurrence
Aggregate
Fire Legal Liability
Stop Gap Extension
Medical Expense.
Hired Auto & Non -owned Auto
Personal & Advertising Injury
continued on next page...
200213143 002 7/31/02
12 Months
12 Months
$50,000
$50,000
$10,000
$10,000
$25,000
$1,000,000
$2,000,000
$250,000
$1,000,000
$10,000
$1,000,000
$1,000,000
'North;jest Cfentists Insurprice Company
17k Minor Av;nue, Suite 1800
Seattle, WA 98101-1499
(206) 343-7800
(800) 662-4075 NORDIC
FAX (206) 343-7100
Northwest Dentists Insurance Company
Businessowners Policy
Declarations Page
Occurrence Policy.
Named Insured: T. W. Shilling, DDS
Mailing Address: 21807 76th Avenue W.
Edmonds, WA 98026
LOSS PAYEE:
Location: 01 Building: 01
T. W. Shilling, DDS
21807.76th Avenue W.
Edmonds, WA 98026
ADDITIONAL INSURED:
Location: 01 Building: 01
City of Edmonds
Building Division
121 5th Avenue North
Edmonds, WA 98020
COVERAGE FORMS/ENDORSEMENTS
BOP1111/97 BOP1209/97
BOP1409/97 BOP2001/99
IL01570489 IL01730193
BOP1309/97
BOP30 3/02
. Policy Number
BP 3-522087-00
BOP1511/98 BOP1609/97
BOP31 3/02 BPAINSCO09/97
200213143 002 7/31/02
f.
CITY OF EDMONDS 20552,
DEVELOPMENT SERVICES
DATE: 0 0—)
Received of-
Addrem. A 2 S� S
Project Location: 1�9-1
Check No.[,LZZS Cash Total Received
LCZC2
Water Motor Size:
Amount
Water Connection Fee
Street Cut/Restoration Fee (620 Fund)
Sewer Permit/Repalr
Trunk Charge
Sewer Connectlon/UD Fee
R/W Constuction Permit Fee
Street Disruption Fee (111 Fund)
Engineering Inspection Fee
Engineering Specs & Plans Fee
Storm Drainage Fee
-51reetUse Permilt
ISO —
Building Permit Fee - Type
Plan Check Fee #
State Surcharge (622 Fund)
Zoning Application Fee - Type
Landscape Inspection Fee
Shoreline Permit Fee
SEPA Review Fee
Recording Fee
Maps/Books
Photocopies
Traffic Mitigation Fee
Sidewalk ContrlbWon
Received by: —Permh No.
I WE
........ .....
Qqe,-Dbu,61-e,�27a C.-, - b! �W�. 2 � V M
Specifications.
FabruatedAlummum Extrusion Qbmet Wah Hingmg Retasuff Syrftm
Paint Durnnodic Bmxze, Satin Fh".
White Anyhc Face With Copy And Graphia Ar� Out OrTranslucent Blue Irmyl (230-167)
lnmrnaL� Illuminate Cabinet Wah 800MA Fluormcent Lampt,
Two (2) 4 - 4uarr Tube SWort, To Be Painted To Match Cabhwt
NOTF-- Verify Si
,gx PkeetnenL
a INUIN 5�11
End View
Ar,
Side 2
Street
W
NIQ
National
Sign
1255
Westlake
Avenue
North
Seattle, WA
2062820700
Fax
20,6285 3091
This Is An Original
Uxpublijhed Drawing,
Created By The
National Sign
Corporation.
It Is Submitted For
Your Personal Use in
Connection With A
Project Being Planned
For You By National
Sign Corporation. It
Is Not To Be Shown
To Anyone Outside Your
Organization, Or To
Be Used, Reproduced,
Copied Or Exhibited
In Any Fashion.
Client
Baker Dental
lobsite
21807 76th Ave W
EdmonA WA
Representative
Laurie Free
Design No.
02-3339
Designer
Chris fahnen
Revised
Scale
318%1�-Q"
D a t e 713102
Sheet No. I Of I
viijicii nau Deer, subroitted eariier. Dr. Sc'hill' sa h wiil be a
ing id t e ly raised plantin(
probab will be no gras!
ulca�ed, che sign area was satisfactory. A MOTION WAS landscape plans were ready and he would present them at the June meeting. i
SECONDED BY MR. LaFON, TO APPROVE -THE FINAL LANDSCAPE. 'Q. WESTLIN MOVED. SECONDED BY MRS. BERNHOFT, TO APPROVE ADB-9-77 AS planting area to keep pec'
ITTED, SUBJECT TO APPROVAL OF LANDSCAPING. MOTION CARRIED.
p,.,SUBJECT TO PLANTING OF TREES AROUND THE PERIMETER OF
tEVIEAD BY THE PLANNING DEPARTMENT9 AND INCLUDING STREET,_
AND SUBJECT TO SIGN LOCATION BEING CONFIRMED ON 111, will be a one-way system, er
r�,-,'JON CARRIED. r__
There will be 19 parking st"
would be saved and
on the South and east.
said a
Mrs
could be either planting or
said the Engineering Departm
required along 218th, includ
There is some development gol
N1 7^
improvements cou I d prob
--------- ably bf'
Bowman Said a landscape plan
ee� remain as flexible as Possibl
-5,74, / �157H (50"
and when some trees were sugS
------ they could be utilized. Mrs.!,
cannot exceed 30"in height bE'
_ay MOVED, SECONDED BY MR. SELVIC,
Z ADB-9-77. MOTION CARRIED.
W V
4,
W
5 V,
4-we
tcb
;4 W, A4,
-1,
00 Z-
PAO=:
41
Jel-00
all
kZ
!j
POO
0
4
Z
4
7'
7
J
co
AV7
431�0 I/ , 11 - 1 1 - . , , . 0
N 0 L - PZ�� by
Examin
Date
L Remar�s
... . .. . .. ..
f
Z�Z
GL
71-5 IE
>
F4/7
2-011H 6H
AS
71�1 A-1111 3 IN 7- S-r/o, jz�_—
C(
I �kl
/VIEW, 10 CRY OF EDMO
<_ 7>1 01= 0 X INDS
BLDG. DEPL
(V) 11
7
NDITIONAL PERMM
13
Z
A,1� ----------
zaa, 66, q2,4:,; y VORK- _�)aWTA L_ 1-1
CUR ADDRESS
OWNER-,G�j (7-4 0 �_,Z 1L
APP
45 Sy
PLAA DA E
Alop �D L? BLDG- 0
L
PA a DlEpf.
KEEP Tf4ESE STAUPED
T: E,= PLANS ON jOB51-,E FOR
ALL INSPECmINS
PERMIT No. SHEEr
PV 0'/'P* -7-H
L
770643 OF
A
N 07E S
9,,,e-fyAoj le -
cc e, Lo to e),j e-.,Y\ 7
�\� � I
0
I Y\'
/I L.JZ) I )rv, 0// 14-�
-t e-y 'c" o-'u' I d- b
cannot excee
MOVED, SECON
...... -9-77. M
ri ADH
Ramp shall be less than 7" tall where
Al,
y
& located within the required street setback.
W'v'
Wly
WAST6�
C7-v'
WAN
C
.4wymo
r-;e;;M 4,WISS
th
k's 4-0
IR
0
ENGINEERING DIVISION
A
0 ED S NOTE
z
V
7
Date
J
to
0
ami
4� -
41 76
.0 -Ex
K Date
Remarks—
N
. %% '... C' T.
1>
ZZZ GCr
WA 1;-�
W L.
N
>
",P
4)UT
Bel(-
<
xt;j a,
4—
f;Al N . 7- S-r
TROVIY
I_ P Arl, L
10
1' 10 /v4W ly
W 11 Koi C--
W-7 A
4— REET FILE
rc)/- 133a 6 61'. Z172,6 X1 4-111va; ADDRE!
W
Zon Corner ��Flag
OWNER
A
Se--Ibacka R
ual,,,
Front NI&V /S t C� 1"e
SidesO-- /0 /a
Rear
Other
-7 f
Scanned Aff 2 5 �2&114"4
C
r
1A
,7 G7// 4� 11"f C)'Ntml
PUPLICATE
When. recorded mail to:
City Clerk
City of Edmonds
121 Fifth Avenue North
Edmonds, WA 98020
CONFORMED COPY
200211210003
11/21/2002 09:16 AM Snohomish
P.0005 RECORDED County
APPLICANT IS: SPACE ABOVE THE LINE FOR RECORDERS USE
-V& 00
Property Owner Assessor?s Parcel No.: -IIbj 6
OK Business Owner Applicant:
I-e- al: :5'Ro,-n2 1.2, o x/
1 7
ENCROACHMENT AGREEMENT
This ENCROACENENT AGREEMENT ("Agreement") is'enter'
ed into between the
CITY OF EDMONDS ("City") and. 2AY115 - 0A*U-=-,&
("Owner[s)"), in accordance. with Chapter .18.70 of the Edmonds Community Development
Code.
-1. The - Property. Owner is the owner of that certain real property located at
13-1. K01 — -76,74 Av-,,-- - Ws� within the City of Edmonds,
Washington, Assessor's Parcel Number 411)17 00 0 6C& 00
and more
.particularly described in Exhibit "A" attached hereto and incorporated herein by reference.
Business owner, f)A it 10 is
the -business owner of that certain real property noted above.
2. The Easement. The City currently owns an existing easement over, under,
and across Owner's property for street, alley, sidewalk, other �V,4--
which is described in Exhibit "B" attached hereto and incorporated by reference.
.3. The Encroachment. The City hereby covenants and agrees and grants its
0 -
permission to Owner or Business Owner to allow emw /1
to remain in a portion of the City right-of-way/easement. A'Plat map. showing the location of
the. encroachment is, attached as Exhibit "C" and incorporated by reference. This Agreement
is subject to the following terms and conditions:
a. The encroachment shall be. installed and maintained in a safe and
sanitary condition at the sole cost, risk, and responsibility of the owner and its successors in
interest.
T'A-
b. The Owner shall agree at all times to indemnify and hold the City free
and harmless from any and all claims, demands, losses, damages or expenses resulting from
the construction, maintenance, use, repair or removal of the structure installed hereunder,
including any loss, damage or expense arising out of (1) loss or damages to property and (2).
injury to or death of persons.
C. The. Owner must remove or relocate any part of the encroachment
within ten (10) days or such other time as specified in the notice after receipt of it from the
City Engineer, or the City Engineer may cause such work to be done and the reasonable cost
thereof shall constitute a. lien upon the property.
d. Whatever rights and obligations were acquired by the City with respect
to the easement shall remain and continue in full force and effect and shall in no way be
affected by city's grant of permission to construct and maintain the encroachment structure.
4. Entire ALYreemen . This Agreement c ' onstitutes the entire agreement between
the parties with respect to the subject matter hereof and supersedes and replaces all other
agreements, oral or written, between the parties with respect to the subject matter.
. 5. Notices. Any notice which is required or may be given pursuant to this
Agreement shall be sent in wfiting by United States mail, ' first class, postage pre -paid,
registered or certified. with return receipt requested, or by other comparable commercial
means and addressed as follows:
If to the Cit :
City Engineer
City of Edmonds
121 Fifth Avenue North
Edmonds, WA 98020
If to the Owner:
90
which addresses may be changed from time to time by provi .. ding notice to the other party in
the manner described above.
6. Waiver. City's consent to or approval of any act or omission by Owner shall
not constitute a waiver of any other default by Owner and shall not be deemed a waiver or
render unnecessary City's consent for approval to any subsequent act by Owner. Any waiver
by City of any default must be in writing and shall not be a waiver of any other default
concerning the �same or any other provision of the Agreement.
-2-
7. Successors and Assigns. This Agreement shall be binding and'inure to the
benefit of the parties hereto and their respective -legal representatives, successors, and assigns.
Owner agrees to incorporate this agreement by reference. in any subsequent- deeds to the
-property, but any failure to do so does not invalidate thia' provision*.
8. , Capaci . Each -party represents that the person(s) executing this Agreement
on behalf of such party has the authority to execute this Agreement and by such signature(s)
thereby bind such party.
IN WITNESS WHEREOF, the partieshereto have executed this Agreement on this
day of 20_0
OWNE S) BUSINESS OWNER(S):
By: By:
STATE OF WASHINGTON
COUNTY OF - —<.4,4 0 J-�O M 115
This day, personally appeared before me,c—A—Di-�0LI) yg-. z1zThK4=—k
to me known to be the personN who executed the within,and f g document and that
oregoin
(helshelthey) OE' signed the sa ie islherltheir) (4 LS free and voluntary act
h rc
and deed for the uses and purposes I �e en ned.
FDONA E81.. A/HIT
Notary'Public
NOTARY PUBLIC ?
S T
TATE OF WASHINGTON
C CO SSO r
MMI I N _XP
SOMMISSION EXPIRES Typed or Printed Name
SEPTEMBE�R9,2004
1fl ZA�20
My Commission expires:
CITY OF EDMONDS
BY:
ENGINEERING DIVISION
L%TEMPNBUM.DD4GVLANwuTT,...hAgm.doc -3-
EXHIBIT A
Legal Descr.iption
THE WEST 121 FEET OF THE NORTH HALF OF THE NORTH HALF
OF TRACT 43, SOLNER'S 5 ACRE TRACTS, ACCORDING TO PLAT
THEREOF RECORDED IN VOLUME 7 OF PLATS, PAGE 25,
RECORDS OF SNOHOMISH COUNTY, WASHINGTON; EXCEPT THE
NORTH 30 FEET THEREOF CONVEYED TO SNOHOMISH COUNTY
FOR ROAD.
PERMIT #: JC&
DATE APPLICATION RECEIVED:
ADDRESS OF PUBLIC USE:
t+ k V vi +6 1 lltf&%. R a 4k 60
ONCE YO UR RE VIE W IS TE., PLEASE ROUTE TO THE NEXT
DIVISIONMEPARTMENT ON THE LIST. * Doe
PLEASE ROUTE IN THE ORDER SHOWN * *
PLANNING DIVISION
4-pl�l - 19.-2- - I &a
TXPUBLIC WORKS
ENGINEERING DIVISION
DS ADMINISTRATION
01 [�l? I V E.
Date Stamp Received: m
L
SEP 1 2002
jq,4j; DEpy.
Date Sta ceived:
OCT 1 6
U-4.3
PUBLIC�, WonKS
Date St . amp Received: RECEIVED .
OCT 212 2002
Date Stamp Re eived: ENGINEERN G DIVISION
APPROVAL SIGNA TURES AND REMARKS OR COMMENTS ARE TO BE MADE
UNDER THE ""DEPARTMENTAPPROVALS"' SECTION ON THE PERMIT.
RAengr\fbrms\Encroachment permit routing
2,(IVZ --OM-7
OF ED4
#59
Al'zc
SEP I
DEV,pLo�?
'E�Vj.
C17Y o'C SER VIC
'ED'�Q6;8's CT8
S
ENCROACHMENT PERMIT APPLICATION
PROPERTY OWNER . NAME: ILUfff.f 00031hp + 6�ff/( Phone (q?,$)
,PROPERTY OWNER MAILING ADDRESS:
BUSINESS NAME for Conunerical apphcations: 900?
AbDRESS OF PUBLId USE: V14
Describe the portion of public space, City right-of-way or easement area to be utilized (i.e., overhead space of
sidewalk, 10 foot City utility easement along north property, line, etc):
Describe the type of encroachment or use desired (i.e., fence 6 feet by 150 feet, awning 3 feet wide bN 7 �yet
long, etc.): C7&")VD '"'Al A 12 1 )c q 513,f P0 OW5. 1�dcuelffj- fiow 1-6
Specify the length of time for use (i.e. awning for life of building, espresso cart for summer months, etc.),
P EW t�" Lw�
NOTE: The issuance ofthispermit is understood by the applicant to be ofa temporary nature and that no vested right is granted
INDEMNI7Y.- The applicant understands and by his/her 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 but not limited to the defense or
any legal proceedings including defense costs, court costs, and attorney fees by reason of granting th is permit. In addition, the
application understands that the City shall be provided a Certificate of Insurance to indemnity and hold harmless the City of
Edmondsfrom all claims andlor property damage, and naming the City of Edmonds as an additional insured.
CODE APPLICATION: By signingte application below the applicant warrants that s1he has read or had the opportunity to read
Chapter 18.70 of the EdnWnds Colftnunity Development Code and s1he understands that all terms of the adopted ordinance are
incorporated herein as iffftforth 14full and this application andpermits therefore are subject to the terms of that Chapter.
-dZ
TY OWNER/BUSINESS OWNER
L:Temp:Building:Handout:Encroachho.docjlg06/02
#59
CRITERL& OF PERMIT APPROVAL
The applicant shall follow the noted conditions on the build' permit. For applications that do not require a
Ing
building permit the following criteria shall be maintained at all times.
> Provide safe pedestrian travel for sidewalk encroachments. Maintain a clear zone of 44 inches minimum.
See definition of clear zone below.
> Exterior light fixtures, banners and flags must be a minimum of 7 feet above City right-of-way.
> Maintain clear landings on the exterior side of all required exit doors of 44 inches.orno less than width of
door, measured toward the street.
> No projections into City alleys are permitted unless the projection exceeds 15 feet above pavement
surface.
> Do not block illumination from City light fixtures or hang objects from City light standards.
> Architectural projections from buildings must be approved by the Design Board an ' d conform to Uniform
Building Code requirements. A building permit shall be required for such projections.
> Maintain 3 feet of clearance around fire hydrants, standpipes, manholes, water meters, blowoffs,
cleanouts and valves.
Bistro dining tables and chairs must be placed in accordance with City Ordinance No. 3293.
> Merchandise racks, espresso carts, flower planters, benches must not be located within the "clear zone".
> Ramps require a separate building permit and must conform to UBC standards.
Clear Zone Derinition: Clear Zone refers to an area 7 feet in height and 44 inches in width providing
level, safe walking surface along the public sidewalk (i.e. measuring 44 inches from edge of street tree grates
or newgpgper stands toward Rlace of business and from the ground Lip to a height of 7 feet).
-------------- ---- DEPARTMENT APPROVALS --- FOR CITY USE ONLY
Planning Division Approved By ADB# Date
Remarks or Comments:
Public Works Approved By
Remarks or Comments:
�- 06-0-L- —
Engineering Division Approved By �SK(mti4tBond Date 10-2,t.-02-
Remarks or Comments:
Certificate of Insurance Verified . By Le Date Ito —
Easement Agreement sent to City Clerk for recording Date
ENCROAC11MENT PERMIT#
RELEASED BY
F174"I
BUILDING PERMIT # RECORDING #
L:Teffq):Building:Handout:Encmachho.docjigO6/02 Y ap,;�6,!55 o-,,-
7,
'No;h�/estqjentists Insurqnce Company
.17k Minor Av�nue, Suite 1800
Seattle, WA 98101-1499
(206) 343-7800
(800) 662-4075
FAX (206) 343-7100
NORDIC
Northwest Dentists Insurance Company
Businessowners Policy
Declarations Page
Occurrence Policy
Named Insured: T. W. Shilling, DDS Policy Number
BP 3-522087-00
Mailing Address: 21807 76th Avenue W.
Edmonds, WA 98026
POLICY PERIOD: May 1, 2002 to January 1, 2003 Policy Premium
at 12:01 a.m. standard time $1118
Change Effective: July 31, 2002 Amended Policy Premium: $1118
Additional or Returned: $0
Location and Property Coverage
LOC. BLDG.
NO. NO. ADDRESS OCC , UPANCY
LIMITS
1 1 21807 76th Avenue W. Office
Edmonds WA 98026
Building Limits
$742,060
bu's'ine's's.Pe'rson'61'Prooerty,-
.1100,000
Inflation' '.Facto'r
:4%
Unless otherwise specifed subject to a deductible of: $1,000
INCLUDED COVERAGES
Loss of Business Income
12 Months
Extra Expense
12 Months
Accounts Receivable Records
$50,000
Valuable Papers and Records
$50,000
Employee Dishonesty
$10,0010
Money and Securities
$10,000
Welfare & Pension Plan
$25,000
LIABILITY COVERAGE
Each Occurrence $1,000,000
Aggregate $2,000,000
Fire Legal Liability $250,000
Stop Gap Extension $1,000,000
Medical Expense $10,000
H.ired kto-,&.�on7owned.Auto $1,000,000
Personal & A I dvertising Fnjury si,boo�lboo
continued on next page ...
200213143 002 7/31/02
YN
orthliest*bentists Insurfince Company
17k Minor Av;nue, Suite 1800
Seattle, WA 98101-1499
(206) 343-7800
(800) 662-4075
FAX (206) 343-7100
NORDIC
Northwest Dentists Insurance Company
Businessowners Policy
Declarations Page
Occurrence Policy
Named Insured: T. W. Shilling, DDS
Mailing Address: 21807 76th Avenue W.
Edmonds, WA 98026
LOSS PAYEE:
Location: 01 Building: 01
T. W. Shilling, DDS
21807 76th Avenue W.
Edmonds, WA 98026
ADDITIONAL INSURED:
Location: 01 Building: 01
City of Edmonds
Building Division
121 5th Avenue North
Edmonds, WA 98020
COVERAGE FORMS/ENDORSEMENTS
BOP1111/97 BOP1209/97
BOP1409/97 BOP2001/99
IL01570489 IL01730193
Policy Number
BP 3-522087-00
BOP1309/97 BOP1511/98
BOP30 3/02 BOP31 3/02
BOP1609/97
BPAINSCO09/97
200213143 002 7/31/02
f
CITY OF EDMONDS 20552
DEVELOPMENT SERVICES
DATE: C)C3
Received of:
Address:
Project Location: (9-1
Check No.(,4ZZ-t:a Cash Total Received
k7c\J
Water Meter Size:
Amount
Water Connection Fee
Street Cut/Restoration Fee (620 Fund)
Sewer Permit/Repair
Trunk Charge
Sewer Connection/UD Fee
R/W Constuction Permit Fee
Street Disruption Fee (111 Fund)
Engineering Inspection Fee
Engineering Specs & Plans Fee
Storm Drainage Fee
.alaw.Wae Permit Lin (") g)C2 'r
Building Permit Fee - Type
Plan Check Fee #
State, Surcharge (622 Fund)
Zoning Application Fee - Type
Landscape Inspection Fee
Shoreline Permit Fee
SEPA Review Fee
Recording Fee
Maps/Books
Photocopies
Traffic Mitigation Fee
Sidewalk Contribution
Received by: Permit No.
J
-4— Street
$11
1'7'� rx)
"SiZ 1
e, DO ux%�%Ce
T-Z�qa'e��ejo
Specifications:
FabricatedAluminum FA-trusion Cabinet With Hinging Retainer System.
Paint Duranodic Bronze, Satin Finish.
White Acrylic Face With Copy And Graphic; Reversed Out Of Translucent Blue Vinyl (230-167)
Internally Illuminate Cabinet With 800AM Fluorescent Lamps.
Two (2) 4"Square Tube Supports To Be Painted To Match Cabinet.
NOTF-- Verify Sign Nacernent.
a n0and Qn
7'
End View
Side 2
Street
NQ
National
Sign
1255
Westlake
Avenue
No rth
Seattle, WA
2062820700
Fax
2062853091
This Is An Original
Unpublished Drawing,
Created By The
National Sign
Corporation.
It Is Submitted For
Your Personal Use In
Connection With A
Project Being Planned
For You By National
Sign Corporation. It
Is Not To Be Shown
To Anyone Outside Your
Organization, Or To
Be Used, Reproduced,
Copied Or Exhibited
In Any Fashion.
Client
Baker Dental
Jobsite
21807 76th Ave W
Edmonds, WA
Representative
Laurie Free
Design No.
02-339
Designer
Chris Palmen
Revised
7112 2" 39S69��
Seale
318'�: 1 �-Q
Date 713102
Sheet No. I Of
lam
ATE RECEIVED
,.�ZE RE�CEIVED
q
PERMIT EXPIRES
I
CITY OF EDMONDS
USE PERMIT
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAPT#
ADDRESS
7/
OWNER NAMEINAME OF BUSINESS
SAK�k Pavfh
PLAT NAMEISUBDIVISION NO. L OT NO. LID
NO.
MAILING ADDRESS
LID
FEE S
7ft"I ffC, W
TESCP
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP IN
:treat
AP
BPerimilts",
CITY ZIP
TE,1JEPHO
EXISTING PROPOSED Inspecthn
Sidewalk
Use
flecitilred 13
Required 13
8 0 24 1
N 7 779-/ 7,52
REQUIRED DEDICATION Underground
ad 13
NAME
METER SIZE LINE
SIZE
NO. OF FIXTUIR
PR REQUIRED
YES IvI NO 13
ADDRESS
REMARKS
z
z
x
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
0
z
CITY ZIP
NE
NAME
# 17/y jCBL#
REVIEWED BY T
ENGINEERING
cc
0
ADDRESS
0
N ire L (I
M16M 7t f- /0 �Z-
0
CITY ZIP
TELEPHONE
-Zfz,o
FIRE REVIEWED BY DATE
lu
0:
rL
VARIANCE OR CU
SHORELINE OR AD B#
1 IkM-62- 1*6KYEs
INSPECTION
REO'D
BOND
POSTED
STATE LICENSE NUMBER EXPIRATION DATE
CKED BY
ftl 3. .7-23 - o9,3
I ��
ONO
$
SEPA REVIEW
SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT
ALLOWED
PROPOSfD
ALLOwED
PROPISED
4-7
5 V —000— 0113- 01,07—
,
A
1 2j4*
�b
EXP
WEW
RESIDENTIAL
1:1 PLUMBING/MECH
LOT COYERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
FRONT LIR SIDE REAR
COMPLIAN CEOR
ALLOV4ED PROPOSED
N/k, /
FRO SIDE REAR
t-- \j 1
43
3
ADDITION
COMMERCIAL
1:1 CHANGE OF USE
I s'l
F7�s-nHel
z
REMODEL
13 MULTIFAMILY
SIGN
PAAKING
REOD I PROVIDED
PL 11 i REVI&E DATE
FENCE
REPAIR GRADING CYDS x FT)
REMAM
-ryv -P
OTHER
DEMOLISH TANK
o.GARAGE R ETAINING WALL F RE SPRINKLER
1-1 E]
Z
0
E
CARPORT ROCKERY F:RE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
rc
X er-"01 e r,
CHECKED BY
TYPE OF CONST UCTIO14
OCCUPANT
0
I
GROUP
t3
NUMBER
NUMBER OF
'C
CRIT Ayq
M
OF
D
AREj k
/W ��
SPECIAL INSPECTION
AREA OCCUPANT
io
STORIES /V 4
UWELLIN
NITS
NUM a EE
REQUIRED YE
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
z
/W�-r4tt OAA6� 1)"119001-f—fifek: It 1�r ��Iffjo
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D
6MAyNIA
VAI244AI�qN
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HFATSOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK
VESTED DATE
Plumbing
Se.
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
Ic
Lu
PERMITAPPLICATION: 180DAYS
IL
PERMIT LIMM I YEAR -PROVIDED WORK IS STARTED WITHIN 1180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF. HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTs FROM ANY AND
Fire Inspection
Receipt
ALL CLAIMS FOR DAMAGES OF WHATEVER NATUR . ARISING DIRECTLY OR INDIRECTLY
fROM THE ISSUANCE OF THIS PERmrr.: ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
0
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
I HEREBY A6KNOWLEDGE'THAT I HAVE READTHIS. APPLICATION: THAT THE INFORMATION
*GIVEN IS CORRECr, AND THAT I AM THE. OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION
APPROVAL
THE OWNgR. I AGREE To. COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC-_
CALL
is ni I a not a permit until signed by the
applica"o
T'
IN DOINQ THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Official or his/her Deputy: and Fees are paid. and
IN VIO !ON OFJHE LABOR CODE OF THE STATE OF WASHINGTON RELATING.TO
IS
FOR INSP ECTION
ecelpt Is ackpowledged In.space provided.
WORKWON
Wo COONSATION INSURANCE AND RCW, 18.27.
SIGNAVRjjOfjR DfAG . EW�\
DATE SIGNED
.(425),
r1A
DATE
-110
771J-0220
Ar
T1fN
M 1333
IT
U
Ist
W L TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL.
A
FINAL INSPECTION HAS BEEN MADE ANDAPPROVAL OR A CERTI Fl-
CATE OF OCCUPANCY HAS BEEN GRANTED. . .UB . C SECTION 109
ORIGIN �11 PF14-
PINK.OWNER GOLD -ASSESSOR
04/02 GREEN ALT,'UNTIN
"A
AARD, !M�'R�MAKMYG_
File.- Ttakber,bentalY'
I- I A M
N
D
H1
21807-76 AvE. VVE:ST ENTER ON 2193TH ST SW
9e, -Do zt,6Y-e,-Aace,
Specifications.-
FabricatedAluminum i5arusion Cabinet With Hinging Retainer System.
faint Duranodic Bronze, Satin Finish.
White Acryhc Face With Copy And Graphics Reversed Out Of Translucent Blue Vinyl (230-167).
Internafly Illuminate Winet With 800MA Fluorescent Lamps.
Two (2) 4 "Square Tube Supports To Be Painted To Match Cabinet.
NOTE. K74fy Sign Placement.
a MAN S�un
End View
V
!APPROVED DATE:
BLDG, OFFICIAL
PERMIT NUMBER
Side 2
A V NING
Street
6TREET FILE—
RECEIVED
SEP 12 2002
BUILDING DEPT.
qq
� 6,-kl
kha
National
Sign
1255
Westlake
Avenue
North
Seattle, WA
2062820700
Fax
2062853091
This Is An Original
Unpublished Drawing,
Created By The
National Sign
Corporation.
It Is Submitted For
Your Personal Use In
Connection With A
Project Being Planned
For You By National
Sign Corporation. It
Is Not To Be Shown
To Anyone Outside Your
Organization, Or To
Be Used, Reproduced,
Copied Or Exhibited
In Any Fashion.
Client
Baker Dental
lobsite
21807 76th Ave W
Edmonds, WA
Representative
Laurie Free
Design No.
02-339
Designer
Chris Palmen
Revised
7112 2" 395102cp
Scale
318 1�-- i �.o
Date 713102
Sheet No. I Of I
t,
7
xow:�5�
RECEIVED
SEP 12 2002
BUILDING DEPT.
STREET Fft�,,.E
JOB
ADDRESS
SHEET NO. OF
national sign Corp. CALCULATED BY f z DATE 2-2�7-et
1255 Westlake Ave N . Seatde,Wa 98109 11 —
P 206.282.0700 F 206.285.3091 SCALE—ILtf �— I 1— 49
OL 1,
r if-wr MAO
Wi
-15
A- -- - - -
i -A-
------- 7�1
j
V
a
UK OF
TRACT 43
VILED SonAog
Fr�
.218TH. ST. S-
iSM'
wamot Lot
_0 ILIL
Pow
' ftes
P&AII RUM
TMM
90:
affif P
.00,
WP4410f Af4p
7.
6
III! M" PRANg
WIT"
"7N PLO.
%
mabolef VAL
Ole
%
%
I'VED By ENGINEERING
APPRU
01
IIIP,, 4A1_ P
UP:
Qft.
sm.* VA.
all
P a
Tom
7
UTILITIES
ROOMbS S"MAW UW1111 SYSTSM t MCA
CHOWN VAUR
VASII us - s XXTUM a" caboamy
gbm=tm COWTV #N&N& I
00 URS"L Tnapmom 'amp*Av
-.LEGAL, DESCRIPTION
Ta Om NJ ft" 0 in we 01 or
Tog MOM MUF ar CRACT ". S01,111111I
FOK am Twom, acc� TO RAT
�OM 0 VOLB89 T CIF 14LA". OWN to.
ISO stco"s 0, soomoom or".
gReg" TWO: mem " " ft" vagnaw Camcm
soommou G"Tv P" saw
GENERAL NOTES
OF to Co*Tooa WMIV"- "0 "a
WI Cof" V 00006 1 M.L.LJM1
saw" amn 0 Pam ms ft 11710. 09 U.
n". - ns�w
6-wv *UU WN RANK UP MM ON
11A. a" WLVR
MAP New"
ILIA WATU VALK
VA. 81 me=
valli 1XISTINS UNKMFOW FACILIT1111 11111011
an TNIS ORMING on m PM OF ASSISTIM&
010 Tw camTVACTOR IN LWATING SAIN FACILITISS IN 11111
IItLg. Toog CWTUCTOR IMAL K FRIP4116011.11 FOR
C1=N1G ACTLA-LOCATIOM 10 TK 1111369 AM CKCUNS
Von APPIAMIAn JdAtwon TANr IM 019 tunwAgym
FACILITIC11 11171114 TK PMJUT LIMITS- TME
31110111. K WELV AnP0011KC FOS My WAtM TO wMalolk'
M
-4
A� WUNDARY AM TOPOGRAM SURM
MR KVISTAD
DR. TOM SHILLING 8 DR. CLARK
IN SW L,4 OF NW L4 OF SECTION 99, T-UN,RAE.JI
WASHING11 LP.M.
SNOHOMISH COUNTIS
PLAPO�
'5�� r'?
(A,je
When. recorded mail to:
City Clerk
City of Edmonds
121 Fifth Avenue North
Edmonds, WA 98020
D.UPLICATE
CONFORMED COPY
200211210003
11/21/2002 09:16 AM Snohomish
P.0005 RECORDED County
APPLICANT IS: SPACE ABOVE TBE LINE FOR RECORDERS USE
Property Owner AssessWs Parcel No.: 401 401�e 00
OK Business Owner Applicant:— - iot5 AAL-tZ
4 e- 5 -?0, 7%2 7, 0 t/
ENCROACHMENT AGREEMENT
This ENCROACIBENT AGREEMENT ("Agreement") is'entered into between the
CITY OF EDMONDS ("City') and 7DA v I A 134,0-=e . .
('Ownerts]'), in accordance. with Chapter .18.70 of the Edmonds Community Deve I lopment
Code.
. —'),/ -1. The Provertv. Owner is the owner of that certain real property located at
X07-76A` Av�,-- Ws� . within the City of Edmonds,
Washington, Assessor's Parcel Number 60 qVI 7 Q,00 ffi�g Ot') , and more
'particularly described in Exhibit "A" attached hereto and incorporated herein by reference.
Business owner, CI>A it 10 is
the business owner of that certain real property noted above
2. The Easement. The City currently owns an existing easement over, under,
and across Owner's property for street, alley, sidewalk, other
which is described in Exhibit "B" attached hereto and incorporated by reference.
.3. The Encroachment. The City hereby covenants and agrees and grants its
permission to Owner or Business Owner to allow e;z7mid /1
to remain in aportion' of the City right-of-way/easement. A plat map showing the location of
the, encroachment is. attached as Exhibit "C" and incorporated by reference. This Agreement
is subject to the following terms and conditions:
a. The encroachment shall be installed and maintained in -a safe and
sanitary condition at the sole cost, risk, and responsibility of the owner and its successors in
interest.
0
b. The Owner shall agree at all times to indemnify and hold the City free
and harmless from any and All claims, demands, losses, damages or expenses resulting from
the construction, maintenance, use, repair or removal 'of the structure installed hereunder,
including any loss, damage.or expense arising out of (1) loss or damages to property and (2)
injury to or death of persons.
� C. The Owner must remove or relocate any part of the encroachment
within ten (10) days or such other time as specified in the notice after receipt of it from the
City Engineer, or the City Engineer may cause such work to be done and the reasonable cost
thereof shall constitute a. lien upon the property-
d. Whatever rights and obligations were acquired by the City with respect
to the easement shall remain and continue in full force and effect and shall in no way be
affected by city's grant of permission to construct and maintain the encroachment structure.
4. Entire Aueement. This Agreement constitutes the entire agreement between
the parties with respect to the subject matter hereof . and supersedes and replaces all other
agreements, oral or written, between the parties with respect to the subject matter.
. 5. Notices. Any notice which is required or may be given pursuant to this
Agreement shall be sent in wfiting by United States mail, first class, postage pre -paid,
registered or certified ' with return receipt requested, or by other comparable commercial
means and addressed as follows:'
If to the Cily:
City Engineer
City of Edinonds
121 Fifth Avenue North
Edmonds, WA 98020
If to the Owner:
which addresses may be changed from time to time by providing notice to the other party in
the manner described above.
6. Waiver. City's consent to or approval 'of any act or omission by Owner shall
not constitute a waiver of any other default by Owner and shall not be deemed a waiver or
render unnecessary City's consent for approval to any subsequent act by Owner. Any waiver
by City of any default must be in writing and shall not be a waiver of any other default
concerning the'same or any other p rovision of the Agreement.
-2-
7. Successors and Assigns. 'This Agreement shall be binding and'inure to the
benefit of the parties hereto and their respective -legal representatives, successors, and assigns.
Owner agrees to incorporate this agreement by rieference in any subsequent deeds to the
property, but any failure to do so does not invalidatethis provision.
8. Capad . Each -party represents that the person(s) executing this Agreement
on behalf of such party has the authority to execute this Agreement and by such signature(s)
thereby bind such party.
IN. WMSTESS WHEREOF, the parties hereto have executed this Agreement on this
day of 20
OWNE (S) BUSINESS OWNER(S):
By: By:
.7r.. .
STATE OF WASHINGTON . 1
COUNTY OF - _<4-4 0 FiO M I 15f+
This day, personally appeared before.me, il) 4.
to me known to be the person(h) who executed the within
d foregoing document and that
(helshelthey) 14E' signed the s 'e a! ilherllheir) Want free and voluntary act
am _,I
and deed for the uses and purposes therp men ned.
FD DONA B. WflITE
NA f-"
0
0 Notary Public
NOTARY PUBLIC P
STATE OF WASHIN(
C MM SS
STATE OF WASHINGTON ? 0 tj A,
COMMISSION EXPIRES P
S PT MB� 9 Typed or Printed Name
SEPTEMBER 9,2004
My Corrunission expir eis:
, L11
CITY OF EDMONDS
BY:
ENGINEERING DIVISION
L%TEMMURDD4GUiANDOUTTaKroachAp=.doc
I
EXHIBIT A
Legal Descr.iption
THE WEST 121 FEET OF THE NORTH HALF OF THE NORTH HALF
OF TRACT 43, SOLNER'S 5 ACRE TRACTS, ACCORDING TO PLAT
THEREOF RECORDED IN VOLUME 7 OF.PLATS, PAGE 25,
RECORDS OF SNOHOMISH COUNTY, WASHINGTON; EXCEPT THE
NORTH 30 FEET THEREOF CONVEYED TO SNOHOMISH COUNTY
FOR ROAD.
ILI
tof sip
rr-
. ... ...... ......
o;j
Atfamoef YAL
Critical Areas C . hecklist CAFileNo:
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: .21901 '4y4f. P/.
2. Property Tax Account Number: -
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed?;yyes; no.
If yes; how is site developed? of��l
5. Describe the 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 10-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 w ater: Approx. D e-pth:
7. Site contains areas of seasonal standing water: 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 ' unds surface? Flows are year-round?
grp.
Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs n-dxed'-
urban landscaped (lawnshrubs etc).
11. Obvious wetland is present on site:
% Z5*
1N tw
8
KP
Op 4'
144 k On;
. . . . . . . . . . . . .
SCS
WWII"
gj .,eh,�p 11 'Vir" bn gul'd
JW
'M
5k" '�k ME Ai-m
W
'7142 HE 21: M. NAMM - M_
W11'su U
5r,
WE 41
wmiqw
�4
Al�
- - - - - - - - - -
Critical Areas Checklist.doc/3.19.2001
C. LWY
City vfE? d'M"i"Oods,
Development Services-Dep
artment
Planning Division
Phone: .425.77.1.0220
Fax:
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 the application to the City.
The 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�,
a . vaiiablefrom observations of the site or data available at
Ci ty Hall (Critical areas inventories, maps, or 'soil
surveys).
Da6'Ri6c6iYed: 0
qity,,ReqeipV#:_... 0
criti.ca"I.-VOsTile M"
Criti , daMreiks Checkl pt� ele: $45-00
. I , �;z,. . i T
Date Mailedlo*A'D D"lic"-ant:
&propeoy. -,owner, or his/her. authorized rep�esqntative,
must fill -6tifthe checklist, sign and �daie "it', and submit it
to.,thd City. The Qity!will review --the checklist.; make a
ite visit,.and make a determination of the
PTF�ur�pry S,
subse1q,u:ent. steps necessary to complete a development
-permit application.
Please submit a'vic'inity map, along with the signed copy
pf-this.form to assistCitystaff in finding and locating the
spq04c,., piece of.property described on this 'fbim. In
a . da.— , ". `*ilil t , I . �, �'. �
ition, e applicant shall include other pertinent
inf6niiation' (e.k.. sit& plan,, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration, on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising firom any -action or infraction based in - whole or part upon false,. misleading, inaccurate or
incomplete information furnished by the applic t,, his)ier/its agents o r-empl6yees.
By my signature, I cer* that the informa . an xhibits herewith. submitted are true and correct to the best of my
knowledge and that I am authorized to file i a pl on on the behalf ofthe 'owner as listed below.
SIGNATURE OF APPLICANT/AGENT x DATE
Property Owner's Authorization
By my signature, I cer* that I have authoriz d the ove Applicant/Agent to Apply for the subject land use application,
4
and grant my permission for the public offici s and 4e staff of the City of Edmonds to enter the subject property for the.
purposes of inspection and posting attendant to this application.
SIGNATURE OF OWNER DATE.
D&V-ey
Name
Street Address
_6dyvla�
City . State Zip
Telep I hone: 4 Z�O T) � — I _7S Z
Email address (optional):
Name
Street Address i
city State Zip
Te�ephone:
Email Address (optional):
Critical Areas Checklist.doc/3.19.2001
July 5, 1978
MEMO FOR RECORD
SUBJECT: CROSS CONNECTION.REQ-UIREMENTS LOCATED AT 7520
218TH STREET SW %- -,Jti, r,+n I Q1 I , , 1, e
After a discussion with the supplier of the P-9 film developer
and the model trimmer in the laboratory area, it has been
found that these pieces of equipment have adequate'internal
air gaps which are sufficient to alleviate any possibility
of backflow into the potable water sys.tem. Therefore, the
requirements noted in our letter dated May 25, 1978, have
been corrected.
KKK: j ac
J.Hattendorf Dt
SM E;
-7
T9/S Supt. Dtor-Admin Sec. Dt.,P.W. Dir. Dt.
STREET FILE
HARV� H. HARRISON
CITY OF F_D_ M"3rJDS MAYOR
CIVIC CENTER - EDMONDS, WASHINGTON 98020 - (206) 775-2525
D�PARTMENT OF PUBLIC WORKS
December 4, 1978
Messrs. Clark K. Kvistad
Thomas W. Shilling
21807 76th Avenue West -7-
Edmonds, Washington 98020
Gentlemen:
SUBJECT: BUILDING PERMIT, DENTAL CLINIC
2-1807- 76TH AVENUE WEST
A requirement of your Building Permit was to provide
public improvements, including asphalt paving of 218th Street
S.W. which provides direct access to your site.
The City of Edmonds has scheduled the roadway for
asphalt paving within the next two weeks. Your share of
this project is $1,000. Upon receipt of your check, the City
of Edmonds will release your bonds for public improvement cur-
rentiv on file.
If you have any questions regarding this paving, please
contact Bill Nims oil the Engineering Division, �75-2525, extension
220.
Yours very truly,
F. HERZBERG, P. E.
/oikty Engineer
WjN:jak
T.E. Dt.. 6A-dTTin SeE7z�_N_r P.W. Dir. Dt.
STREET FLE
December 7, 197.8
MEMO TO: Harve H. Harrison
Mayor
FROM: Irene Varney Moran
City Clerk
SUBJECT: ACKNOWLEDGE RECEIPT OF CLAIMS FOR' DAMAGES
Attached are copies of Claims for Damages from Ken R. Stefenson
of 443 12th Pl. N..in the amount of $360.70; from Clark K.
Kvistad/Thomas Shilling, 21807 76th Ave. W., in the amount of'
$377.88; and from Dorin Ridenour, 720-Brookmere Drive, in the
amount of $800.00.
These claims were received on December 5, 6, and 7, 1978. .
Copies were immediately -forwarded to our insurance agency, City
Attorney, Finance Director, -and the Public Works Department.
I recommend that Council acknowledge receipt of these claims
for minute entry at the Dec.ember 12 Council meeting.
ATTACHMENTS
Claim MUST be pres
ented to the City Council ind filel with the City Clerk within 1�0
RLCEI'
.from the date of Accident or Accrual of VED
TO M CITY COUNCIL OF THE CITY OF" E111OUDG: DEC 197
C.
PLEASE TAKE NOTICE, THAT Ken R. Steferi-son FdM`VJq C 't, Clerk 1)?Aoq
(if married, Give husband's nare) — /', 14 . t,4?z .
WHO NOW RESIDES AT 1-43 1 2th r I. N. Edmonrls? Wnsh In P ton 9R020
TState present actual address by street, number and city)
A11D WHO FO.R SIx �jolr[HS PRIOR TO DATE OF ACC IDZNT HAS RLSIDED AT above
(Give_�_esidcnc�__by street, number and city
CLAIRS DAILAGFS OF A1.11) F'ROH THE CITY OF FJYIOIIDS IN THE SUM OF a '.160.70
a . rising out or t'he following -circumstances:
Dczcribc Claim, Giving
VATE slid TIHE injtj,,y or
darare occurred, P1,ACE
and full rartic:ulars.
Accurately locatp and
describe defects c,.ius-
ing injury or dama[,e
and all icts of negli-
gence claimed.
Accurately describe,
injuries or damage
State i tems of dam.pCe.
claimed. Itemize all
expenses *and lo:�c,63. Labor 6n.00
14 yds,topsoll @ 8.00 112.00
5 yds crushed rock 52.70
5 yds bark @ MO 40.00
t,r
�!a q to r work 8 h rs @ 12 .00 9 6 . 00
a1M Must be st'torn to by c1zitmjnTT—
To ta 1 360.70
On November 3rd., at 9:00 durin
Ps and dphris rn=vprp all
storm drains on 12th Ave. North nnd on
Highland Drive. Since drains were not
clear, a huge volume of , er came down
12th Flice North. Thn storm drain at the
northwest end of the cul-de _�ac could not
handle the additional. runoff T—romthe
entire hill. The water was covering the
sidewalk on the west side of 12th Ft. r.
Sf_�_T_nclies deen. At.thow,11i we nttemT)ted to
divert the vmter back Into the street, I It
flowed over the sidewalk and washed out over
100 1 of crushed 'rock pa th, a I so -wished land.
scaped area, bark and topsoil Into garden area
It also washed out topsoil from garden causing
.hugh ruts.and push . ed topsoil along chain link
tence bVIT18i the fence out 21 in places
totat 0 The F
t�hl , igJorkg,,Degt. was
called at 9 J�m �-_qiies nc, _ P. t e time (I
Tzd—STu=-Ttra I n s
Ave. N. And H10iland DF1 t�us at-
o 2 t 7 ' I ' -
-.LLg-y I 1ALI—at I on W e QJ'this loss
was caused bv leaves clozp
,Jnv the �!rafns,
aot
'in exces's or-viter since .rieH we cleared e
drnFn_.�_, —they 7" "''' , 11 ,
1,11' :: 'I �! I ! 1 0 han a t e run-off
(Incidentally, ninny of these drains are covered
with debris at this time nnd If we'had heavy
rains, this could happen again.
tbignaLure of Claimant)
C "Ar. �7
'-1 113LV AliU OWUP14 1 P11-116
before me this ay of
119 I;F
110t,.Ir'; PUblic in -ind fcr — - -
t ii c" -�s M t n 0 f
Washington, residing at .<,
hr
NOTICE
Claim MUS7 bie presented to the. City Council and filed with the City Clerk wit
from the date of Accident or 'Accrua-1 of Damng�,L;.
DEC.6 1978
TO THE CITY COUNCIL THE.CITY OF EU-JoriDs:
TC�J� �\\e \�t)
PLEASE TAKE NOTICE, TILA
(if married, GiVc hUs nd's nane)
WHO NOW RESIDES AT
State present actual address by street, number and city)
AJID WHO FOR SIX M01MIS PRIOR TO DATE OF ACCIDENT HAS RZSIDEID AT
(Give residence by street, number and
CLAIMS DMLAGFS OF AND rRU-1 TU CITY OF MIONDS IN TKE SLM OF r)
arising out of the following circumst;lnces:
Describe Clain, Gi-,,ing
DATE ani TINE injury or
dLmaFe occurred, PLACE C—Q—N�—
and full Flartizulars. \) 4
Accurately locate and
describe defects caus-
ing injury or damar-
C;�
and all act3 of ncgli-
VAS
gcn�:e claimed. C�
N
r
�A
2-7 --
cr'be
ately dec
Accur.
injuries or damage
�Nl
State items of darnaCe.
claimed. Itemize all
expenses and
(Clailif vist be sworn to by clair,'01,
of
7'
SUWC,RIBED AND SWOPN TO
L 4
'before we this 711'. 7 -C . - )
do" C, (11
1.71 y I'Llhil.c ill '. 11-:1 1 ol—th,e of
).fig qt
2
i
A 7
6, 6
Ia j
L.'-. .3 iJ.L-. iT. 4
Claim MUST be prescrited to the City Council -iiii filal witl the.CiLy Cl-rk witl
lt-b
from the date of Accident or. Accrua-1 of Damrir',�V.
CITY OF EUIONDG: D E 1978
TO THE CM COUNCIL OF THE
J,
PLMSE TAKE NOTICE, THAT Fdmnnde, City Clerk
Uf married, Give husband's name)
viHb FOW RESID&S AT
(Stat! —pre5ent—actua-1 ad,.1rcs3 by strec
t, number an(I city)
AJID 17HO FO.R SIX 1101IT11S PRIOR TO.DATE OF ACCIDENT IMS REZIDED AT
)J r
(Give �residenceby street, numb)—er--an-d--c[i-(t�yJy
CLAIM DAI'LA'J-r.^a OF AUD FROM THE CITY OF EMONDS IN TRE SUt-1 OF-3
f
arising out of the following circumstrinceB: 1) 3
Dcscrib�, Cln-' m, [5-i%-in(;
DATE arid Tltf� 111jury or
-J
- -------
e occurred, - PLACE;
and full Pa ticulars..
r
IN I
--------------
Accurately locate --3nd
� � 'f ,
describe defects caus-
ing injury
i-N
b,,
or damaFse
C-� 4. S ("
.
and a.11 actG of negli-
- -
gen:e claimed.
)kk
A c cu ra tely describe
J.
"14-
injuries or d amage
U
0
4-
ck
I V\1 I 1,-Y 0,11
State itemn of. da m v ge
V �s
claimed. Itcmizc all
7 2 1
expenses and loose3.
(Claim must be sworn to by
claimant) v
'7
U c.).
L
TSGnaLure.of Claimant
&05(�RIBCD AND SV�ORN 110'
LAIL
befor e me this
day of
9-LL -
Vgf�WY 010lic in and for
thc ate of
Washington, residing at
�-'tL
STREET FILE
December 7, 1978
MEMO TO: Harve H. Harrison
Mayor
FROM: I rene Varney Moran
City Clerk
SUBJECT: ACKNOWLEDGE RECEIPT OF CLAIMS FOR DAMAGE
Attached are copies of Claims for Damages from Ken R.'Stefenson
Of 443 12th Pl. N. in the amount of $360.70, from Clark K.
Kvistad/Thomas Shilling, 21807 76th Ave. W., in the amount of
$377.88; and from Dorin Ridenour, 720 Brookmere Drive, in the
amount of $800.00.
These claims. were received on December 5, 6,and 7, 1978.
Copies were immediately forwarded to our insurance agency, City
Attorney, Finance Director, and the Public Works Department.
.1 recommend.that Council,acknowledge receipt of.these claims
for minute entry at.the December 12 Council meeting.
ATTACHMENTS
Claim MUST be p . resented to the City Council nrid filed with tile City Clerk wi,thin 1�
fron the date of.Accident or Accrual of RLCEIVED
DFC
T`O.THE CIT`f COU11CIL OF THE CITY OF EulorlDS: 3978
PLEASE.TAKE NOTICE, THAT Ken R. Stefelqr)n rdm q* Cit, Clerk 117 Aq
(if married, Give husband's narc)
1,43 12 ti, F-1 (1-11 On fis Wn 5z h Inrton 9R020.
WHO NOW RES I DES AT
TState prcscntactual address by street, number and city)
AND WHO FO_R six moirms PRIOR TO DATE OF ACCIDENT HAS RL�SIDED AT above
(Gi�'e _residenc�'by street, number and city)
CLAINS. DAMAGES OF AUD 1R OiM THE CM OF EMONDS IN THE SUM OF
arisi . rig out of the following circumstances:
Dcscribc Cl,aim, givi nf-,
DATE slid TME injury or
danage occurred, PLACE
and full -particulars,.
Accurately 1 ' ocatp and
describe defects cnus-
ing'injury or dama!,-,e
and till ic.*ts, of ncgli-
gen:e claimed.
ACCUrately dcscribe
injuries or damage
State items of dampce
clairled. Itcriinc
expenses and losscs.Lnbor 6n.00
.14 Yds topsoil @ 8.00 . 112.00
5 yds crushed rock 52..70
5 yds bark @ 8.00.
r,iraqtor Work 8 hrs @ t2.00 96.00
k 'laim MUSt be avlorn to. by critm7nt)
Total 360.70
On November 3rd, z�t 9:00 during
.nd H 1hr Is rnvPrpd a I
storm drains on 12th Ave. North and on
Highland Drive. Since drains were no
clenr, a huge vo.ome-o uniter cime down
I 21h 11 1,1ce North. The storm driin at the
northwest end of the cul-de-sac could not
handle the ndditional runoff FT_o_:� —th e
entire hill. The wnter.was coverin,,z the
sidewalk on the west side of 12th -PI . N.
- IE s d e e D . A I thou c,.1,1 we a t t emp t dd to
, UR CT 0
divert the i.m ter back Into the street, I, t
flowed over the sidoualk nnd wished out over
100! of crushed rock prith, also washed land-
scaped areap bark and topsoil Into Rarden area
It also vashed out tO'Psoll from garden causing
hugh ruts and pushed topsoil along chain link
tence bVlf�p the fence out 21 In places
total 0 The F
M I I.
nz �o rk R., Deg t. twa s
P. t e tMe (I hr
trains
2 7t 71A e N. nnO t
I I e v la t I n r :hg_ail un Iyuslal-
s oss
was caused �v leaves cloqp n9l the !rains, pot
nn excess ot-vater sl lvie6 we Jeared t e
drn I ns , th -y were ab I e to honRT-T—e-tun-of f
(IncidcntallY, ninny of these drains nre covered
with debris nt this time.nnd If we hid heavy
rains, this could happe.n agnin'.
kSiGnature of Claimant).
`)-LAJ�,A1L5L4J AUU SWORN I U . I
before me this daZ( o f.. .�V -,7
919
Notary 1,111)lic in and foi- 010,;-Stato 0�
Washington, residing
140TICE
Claim MUST be presented to the.City Council and filed with the City C lerk wit "r7Et%Vr*.rD
from the date of Accident or Accrual of D.Lr.rlrCL;.
E 0 1978
TO THE CITY COUNCIL OF THE CITY OF EDMOUDS:
PLEASE TAKE NOTICE, TILATL
(if married, Giv�e hus nd's na-me)
WHO NOW RESIDFS AT
State present a.ctua-1 address by street,
�z \
nunibcr and city
AJID WHO FOR SIX.M01IF-1113 PRIOR TO DATE OF ACCIDDIT HAS RESIDED AT
by, street, number and city)
rx�
CLAINS J)NtAgES OF Af1D'F`RO?-1'TH.E CITY OF MIONDS 114 TILE SUM OF' 5 r)
axising out of the follovving circumstanc,es:
Describe Clain, Gi%-ing
r\L ilz
DATE and TINE i.nju,-y or
dariaF,e occurred, PLACE C� -a -) -�Yl
full
at'd parti:ulars.
Accurately locate and
CNN-
describe defects caus-.
ing injury or danage
zk��, 7--
and all acts of negli-
gen:;e claimed.
N
'
No,
Accurately descr Lbe
in'uries or damage
State items of dzjmnCC'
C-1
clairicd. Itcrdzc a.13.
exp,ejisc5
r-::� C
and losses.
(Claim must be sworn to
by clair.-,;l1,Li
- S ul -;D
)6CRIBE . AND 5V'ORN TO
7
before me this d a,; C, f �-)A o IQ
1:1?-y I'Lthli.c. ill 11*-� fol—the 3ti\t(� of
v C.ai d j, "tic t
DEC
Non Plar
Pr. MY WWI
ps, Owls ZW
JIM TAKA
77st
l'anp vatir frOn
cXpwl case
vally'd FIVIXIM
L Ont-All, - YOKO
gs
NOW
.,ISO
W" 0:0 6 0, 0 War.
it. too In
yny 0100
WOO d %r W
v nvolol
CIA I I I
Clai m MUST be presented to the CiLy Council ini filed with the City Clerk witli
ft bVdb
fron the date of Accident or Accrual. of Ditmagev. f ".4
f
10 THE CITY . COUNCIL OF THE CITY* OF MiONDG: DEC 7 1 1978
PLEASE TAKE NOTICE, THAT Fdmnndq Ci�,, Clerk
(if warriedi Give husband's name)
WHO NOW RESIDES AT
TStaLe,prescnt actual address by street, number and city)
AND WHO FOR SIX 1.1011TIiS PRIOR TO DATE OF ACCIDE14T HAS RESIDED AT
t -Y'V
(Giv; 7eGidence by.street, number.and city)
CLAIMS DAKAGBS OF MID nOM THE CITY OF EMONDS IN. THE SUM OF 0 (fc2e.7.
arising out of the following circumstances: rl i� t)
3
Describe Cla�n, giving
DATE and TIME injury or . & J
C-1 P
-image occurred, PLACE "k n I
dz
and full particulars +
C, r4ro c�
Accurately locate and n f;
describe defects cius- A \,�3
_7777 T
ing injury or damage
7_5 —7 ry-,
and all actc;
of negli-
ge=e -claimed.
000
C.I. I,\ r I N
Lk A I
Accurately describe
injuries or damage k V% r
V
I e, 1 0.-
I e, t-�,
LL)'!,S
r ut .
a . U-7—
(.1 Y LA; n
State items of damage 1.bt I I
claimed. Iteminc all
2 1
expenses and looses.
.3
3,.
V �Q.
.(Claim must be eviorn to by*claimant)
'7 �i.
Claiant
7SI tUre o�f
'7 SUXCRIBED AND SWORN 1`0
before me this-* d ay of C_
19
2L.
;7
9(arY V6blic in and for the �t- te o�f�
Washington, re8iding at
December 14, 1978
MEMO FOR RECORD
SUBJECT: DRAINAGE DAMAGE CLAIM. 21807 76TH AVENUE WEST
During the.evening, of Friday, November 3,.1978, we received one
of the hardest and.excessive rain storms in many years. Street
Division crews were advised and responded at approximately 7:30
p.m. to emergencv calls reported to.SNO-COM dispatch from areas
throughout the.City. In reviewing.o . ur records of calls received,
none were reported from this address during the. night of the
storm or the following day when Street Division crews were working
on follow-up of' drainage maintenance.*
Buno Construction had installed water main replacement on 218th
Street S11 from 76th Avenue �,.Test, east to street end during,.
September. The.extent of project restoration after installation
is not,known Driorto the November 3 storm- however, all work
should have b�en completed by that date.
No other work had been performed by any City crews in.this area
Drior to November 3.
It is noted that the developer had graded and paved the parking
lot at this address.during the summer season when the existing
swale drainage on 218th Street ST,-� was noted on the Building, Permit
and -corrective measures shbuld-have been provided at that time.
This would have eliminated any street drainage from.flowing onto
the property.
AB: j ak
N=
NOTICE 1978
..Claim MUST b.e presented to the City Council -and filed wi. t.k.'the . �.,.City Clerk with
from the date of Accident or Accrual of Dainntvu.
TO THE CITY COUNCIL OF THE CITY OF EDt4o11Ds:
PLEASE TAKE 140T . ICE, THATC-�J Q\ \4
(if married,
WHO NOW RESIDFZ AT
'��n
\ 0
/ Wvv��
Give hushhnd's
nafne
\06-- P',ezjQT1L acrua-L aclaress by street,
number and city
0 E C .6 1978
4-1-1
"Mnros cit'! C1.*
AND WHO FOR SIX MON-1HI) PRIOR TO. DATE OF ACCIDENT HAS RESIDED AT k�?' c,
ve residence by street, number and city
CLAIMS DMAGFS OF AND FRYT THE CITY OF FMJ0J1DS IN THE SUM OF
arising out of the following circumstances:
Describe Cl,,Jim, giving
DATE and TINE injury.or
.danage occurred, PLACE;
and full particulars.
Accurately locate and
describe defects caus-
ing injury or damar
e
and all act3 of negli-
gen-.e claimed. .
Accurately -describe
injuries or damage
State items of damage
claimed.� Itellize all
expenses and -losses.
W\AQG
C_ 1114Z
V
—\'�4 0-w\
KNA�Z_
Q�Jc>
c1c
\31�.
11
'�z
(Claim must be sviorn to by claimN-n
C,,) Q
Signatur of 1,�' ant
SlJ06CRIBED AND SWORN TO
t .- 71
befor I e'me this _L���day of f
_JT
�tary I'LlbliC ill fpj�--thL,� Gt,�tp
of
11 shington 't
re
N C.
8, v A
1 4 11 F,
DEC
0., 1978
Dr. Clark Kvf�t-vl
0 M-A is I I i 11.1 I:n�
G7 A,; p t-
Fu* mp wn.t r from Firow
OC. Rtintal 'Puimp re" t,;kl 9 149
Lmtk* 1 1 /!5 171 %n Rrint- 8 hrk. fl. P. 00/hr. j!j
cq!. 00
P
STREET FIE
CITY OF EDMINMOS
200DAYTON ST.- EDMONDS. WASHINGTON 98020-(206) 775-2525
DEPARTMENT OF PUBLIC WORKS
January 22, 1979
Messrs. Clark K. Kvistad
Thomas W. Shilling
21807 76th Avenue West
Edmonds, Washington 98020
Gentlemen:
SUBJECT: BUILDING -PERMIT, DENTALCLINIC-11"
21807 76TIl AVENUE -WEST
HARVE H. HARRISON
MAYOR
Reference my letter dated December 4, 1978, copy
attached.
The a . sphalt paving of 218th Street SW is scheduled to
be accomplished as soon as weather permits. Your bond for
for public improvements of $1,500 will be released upon
receipt of your check for $1,000.
If you have any questions, please contact Bill Nims,
Engineering Divi*slon, 775-2525, extension 220.
Yours very.truly,
/ AD F. HERZBERG, P.E.
C City
ity Engineer
JEA:jak
kDt.4s &st 74 5C-- �_E �Dt . —D-t .
MEMO TO: Building Division
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT: FINAL INSPECTION
e
PROJECT:
APPROVED NOT APPROVED
M ���
A4
Engineering Division
BY:
Water Division
BY:
Sewer Division
BY:
h.0- Z.0' A ---
74
e
A_
STREET FILE 0
CITY OF EDMUNDS
200 DAYTON ST- EDMONDS. WASHINGTON 98020-(206) 7752525
DEPARTMENT OF PUBLIC WORKS
Messrs. Clark Kvistad
and Thomas W. Shilling
21807 76th Avenue West
Edmonds, Washington 98020
Gentlemen:
HARVE H. HARRISON
MAYOR
February 15, 1979
SUBJECT: 21807 76TH AVENUE -WEST DENTAL CLINIC
.Receipt is acknowledged of your check in the amount
of $1,000 for vour share of the paving of 76th Avenue West.
Please be advised that the Engineering Requirements
have been met and we have advised the Building, Division to
release your bond. Should you have any questions regarding
this release, please contact the Building Division, 775-2525,
extension 228.
Thank you for your cooperation in this matter.
Yours very truly,
F WEF. HERZBERG, P.E.
City Engineer .
j ak
1h
'0"S-at'erli& Dt. "-Ass- Dt. fn Dt .
P.'W. Dir. Dt.
'Lly 0
CITY of EDMONDS
30 4 7 5
D
B ESS LICENSE APPLICATION LICENSE NO.
Civic Center Edmonds, Washington, 98*20
City Clerk Phone 775-2525
STFIEFT
ANNUAL FEES
PENALTY AFTER FEB. 15
F11
F'
11 HOME OCCUPATION
INSTRUCTIONS:
CLASS
YEAR LIC.
EFFEC. DATE-
ILI
C.
sib.00 (A)
ADDITIONAL $5.00
7.q I
]13`�ASG.
1
1
SMALL BUSINESS
• All items must be completed
15,
1 1 1 1
or application will not be ac-
RECEIPT NO.
DATE PAID
PRINT'X'
$15.00 (B)
ADDITIONAL $7.50 0
cepted.
qj� /1&
'IN SPEC. BOX
�FOR
0 Business with 10 or
• Sign and mtu�r_n _ap`pkication
FEE PAID
PENALTY PAID
ISSUE OF
CORRECTED
more employees
ADDITIONAL $25.00 0
i t ��e �e e nev' r7eived
w R
I
LICENSE WITH
ACTION.
$50.00 (C)
1
y u
al er Lruar 15, pay
0 NEW APPLICATION (LA)
- f e
pl�nalty in addition�o I e.
91 RENEWAL
(LB)
NL!"�BUSINESSES AFTER
0 CHANGE
(LC)
JULY 3
(PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE
(LD)
NAME OF FIRM BUSINESS PHONE NO. OF EMPLOYEES
!<VfSF41) K -)II)S Ps 775-2002 7
MAILING ADDRESS NATURE OF BUSINESS
0ENTAL PER10001\1r[ST
WA 9.8020
0 S
BUSINESS ADDRE
�,C_ 1,jV
A 1,l'
INDIVID UAL
PARTNERSHIP CORPORATION
(S)
(P) (C)
OWNERS NAME
HOME ADDRESS
I F A 0 C
9 114 18 6 T H
P L. S 1.4
HOME PHONE
DATE OF BIRTH
PLACE 6 gi� 1
SOCIAL S'�E 6 R I t7'1ZM E R
4 o 3 /4 0
hFLL 1W;HA�l
U'A
531-3�y-6303
EMERGENCY NOTIFICATION:
(1) NAME & TELEPHONE r;,A L T 13
206-, ?-Lt
(PLEASE
LIST TWO)
(2) NAM E & TELEPHON E V I S I /\ 1)
C
0 `Ij
WASHINGTON STATE TAX NO-2 I � -9 1 �3_. ?28 APPLICANT'S SIGNATURqA
DO NOT WRITE BELOW THIS LINE----` (J47
STAFF REVIEW: FILL IN"LAND USE CODE, UFIRNUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT D A T E 2 07 LAND USE CODE ZONIN G CODE
O'APPROVE El DISAPPROVE SIGNATURE
CONDITIONAL USE PERMIT
COMMENTS
B
,VfLDING DEPARTMENT DATE 3-1-,7f Building E3 Hotel/Motel (L)
VJ APPROVE El DISAPPROVE SIGNATURE L9 Permit 0 Apt. Bldg. (A)
I'LI11 IS, Office Bldg.
(0)
COMMENTS:
Occupancy
Group
0 Restaurant
0 Hosp/Nurs Home
(R)
(H)
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
0 School
(S)
FIRE DEPARTMENT DATE '7
IV'APPROVE D..DISAPPROVE SIGNATURE
U. F. 1. R.
COMMENTS:
�OXCE DEPARTMENT DATE
APPROVE 0 DISAPPROVE SIGNATURE
COMMENTS:
PUBLIC WORKS DEPARTMENT
0 APPROVE 0 DISAPPROVE DATE SIGNATURE
COMMENTS:
--------PLEASE RETURN TO CITY CLERK
%TY 0
SS LICENSE APPLICATION
BU&NE
CITY of EDMONDS
Civic Center - Edmonds, Washingto
City Clerk Phone 775-2525W.STREET FILE
CLASS YEAR LIC. EFFEC. DATE JREASG. LIC. N.O.JSPEC.
INSTRUCTIONS: �q 0
All items must be completed �,l I /I �j � . I
ECEIPT NO.
or application will not be ac- R DATE PAID PRINT'X' A —
)II / (r IN SPEC. BOX
cepted. FOR ISSUE OF
FEE PAID PENALTY PAID FIRECTED
Sign and return application I CLICOENSE WITH
'LC'ACTION.
with fee. Renewals received 11 1
after February 15 must pay
penalty in addition to fee.
NEW BUSINESSES AFTER
LICENSE NO.
PENALTY AFTER FEB. 15
J HOME OCCUPATION
$10.00 (A) ADDITIONAL $5.00
9L SMALL BUSINESS
$15.00 (B) ADDITI
J Business with 10 or
more employees ADDITIONAL $25.00
$50.00 (C)
0 ' NEW APPLICATION (LA)
0 RENEWAL (LB)
[3 CHANGE (I-C)
JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE (LD)
NAME OF- FIRM BUSINESS PHONE NO. OF
SHI'LL ING, TH01'1AS W r)DS MSD 7 7 5-3564
MAILING ADDRESS T1. NATURE OF BUSINESS
'7 6 R-- W. DENTAL ORTHODONTIST
E D M 0 IN 0 S WA 98020
BUSINESS ADDRESS
OWNERS NAME
�M�
,41., HOME PHONE
INDIVIDUAL
(S)
ADDRESS
SHILLING T 9*726 185TH
DATE OF BIRTH PLACE &PPIP
11/23/40 ASHLAIND
EMERGENCY NOTIFICATION: (1) NAME & TELEPHONE MAKI C
(PLEASE LIST TWO) (2) NAME & TELEPHONE.
PARTNERSHIP
= (P)
PL Slq
WASHINGTON STATE TAX NO. APPLICANT'S SIGNATURE
STAFF REVIEW:
DO NOT WRITE BELOW THIS LINE
0 H
PLOYEES
0 tl
CORPORATION
(C)
:�61JIRIVVME
—44-3802
—714-27TT—
FILL IN LAND USE CODE, UFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
.SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT
&`APPROVE 0 DISAPPROVE
eo �"'34 COMMENTS
DATe-
SIGNATURE�Q
'-:BUILDING DEPARTMENT
DATE If
0 APPROVE 0 DISAPPROVE
SIGNATURE
COMMENTS:
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
,x F RE DEPARTMENT DATE
A pp
ROVE El DISAPPROVE SIC',NATURE
COMMENTS:
?,'-. , P
A4 )(?�JCE DEPARTMENT
DATE SIGNATURE
&'APPROVE. 0 DISAPPROVE
COMMENTS:'
PUBLIC WORKS DEPARTMENT
DATE
0 APPROVE 0 DISAPPROVE
SIGNATURE
LAND USE CODE ZONING CODE.
I 177 10 fil L1
CONDITIONAL USE PERMIT
Bulldlng
0
Hotel/Motel
(L)
L-I
Apt. Bldg.
(A)
CIC
Office Bldg.
(0)
Occupancy
1:1
Restaurant
(R)
Group
0
Hosp/Nurs Home
(H)
I-]
School
(S)
R A Ad 591 M I r6d 190
is
COMMENTS:
PLEASE RETURN TO CITY CLERK
Mill M
USJ-L&=6 PERMIT
CITY OF ED zo NUMBER
CONSTRUCTION PERMIT APPLICATIrO�N"
JOB
JNAME (OR NAfAE OF BUSINESS) K y-1 ,
ADDRESS
L L_ _E_
LEGAL _DESCRI�PT�10 —
WCH CK-FS—UBDIVISION-NO.
07 7 ot- \Nkj
CITY TELEPHQNE NUMBER
A
NAME
ADDRESS
CITY TELEPHONE NUMBER
NAME
ADDRESS
0
CIT _fETON
NU
At C% _It :�:
STATE LICENSE NUMBER CITY LICENSE NUM13ER
Legal Description of Property - include all easements
(show below or attach four copies)
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING— REQUIRED DEDICATION
PROPOSED
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 1:1
STREET USE PERMIT REQUIREDO
SEE ENGINEERING MEMO DATED
SEE PIW DEPT. REVIEW CHECK LIST DATED
REMARKS
METER SIZE BUILDING SUPPLY SIZE
REMARKS
SIGN AREA I COMPENV. REVIEW
ALLOWED I PROPOSED LETE i EXEMPT
VARIANCE OR CU
YARDS
FRONT SIDE
NEW 'RESIDENTIAL PLUMBING
ADDIALTER NON-RESIOENTIAL MECHANICAL
REPAIR RETAINING WALL SIGN
EXCAVATE FENCE
El DEMOLISH OR FILL x _FT)
CPRE -MOVE IINSP./ swim
1 COMPLIANCE INSP. POOL
CHECKED BY
TYPE OF CONSTRUCTION
SPECIAL INSPFCTOR
REQUIRED
EJ YES
AREA
SIDE SEWER WATER LINE
REMARKS
E] El
.
NUM13ER OF STORIE9
NUMBEROF
DWELLING
I UNITS
NATURE OF WORK TO BE DONE (ATTACH PLO PLAN)
� or, Y% L I-er < I, XWN
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY. GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
w successors in Interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
5 employees, and agents from any and all claims for damages of
a:
< whatever nature, arising directly or indirectly from the issuance
'r .
of -this -permit.—Issuance of this- permlt-shall-not-b# deemed'11—o
modify,.waive or reduce any requirement of any city ordinance
0
nor limit In any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision." I
I hereby acknowledge that I have read this application; that the
REVIEW BY
OCCUP
GROUP
VALUATION
0-1
UNITS
cr
W
ADB NO.
SHORELINE #
LOT COVERAGE
FEE
HEIGHT
OCCUPANT
LOAD
113
— I - - __ -
Z
Z
n
CL
information given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and in doing the work authoriz- AUTHORIZES This 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
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees arepaid, and receipt is
tion Insurance— INSPECTION acknowledged In space provided.
SIGnE (OWNER GEN I DEPARTMENT
— _LAO JC 1-57 CITY OF OFFICIAL'S SIGNATURE
n e d U I y
y and
horz_
Labo r
p S
L'a n jena
u'
St a
ed
Co
tio'
S,GI
THIS SITE IS LOCATED IN THE CITY EDMONDS
OF EDMONDS. LOCAL SALES TAX DATE
ATTENTION SHOULD BE CODED 31.04. 775-2525
IT,I
S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
";'UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL — File YELLOW — llspect�r
1A CERTIFICATE OF OCCUPANCY - HAS BEEN GRANTED. ''JUN 3-1982
j ICHAPTER 3. PINK — Owner GOLD — Assessor 4
1 2,78 11,
J�; . 1, , . I . . K..yPnP,..g
o
BUILDING PERMIT REVIEW Mul�iple
'IC-Ammercial
I BUILDING ADDRE-SS ''IW' 120-7 _2 4)
.��,:BLDG.,�EPT. SUSPENSE DATE
INITIAL DATE
OFFICE,ADMIN. PUBLIC WOR�S LOG IN
54ITY ENGINEER (check)
—r . __
i''; (3 Access Slope and Vehicle Access
Drainage Plan
0Street File
Chegal Description
OQuit Claim
Easement
Caldiilate Sewer.Connection
WATER/SEWER DIVISION
Determ ne Meter Size
ST)Complete;'Buil#ng �ermit Review
Ek IVISION
11comp'iet e*,Building Permit Review
OOFFICE ADMIN.', LOG OUT -TO BLDG-.-'..DEPT.
--------------------------------------------------------------------------
P-lb-ILDING PERMIT A'PPLICATION�(COMPLETE)-
M--2—'COPIE*S OF SITE PLAN
2 COP*IES OF FIRE PROTECTION PLAN
:(PREVIOUSLY REVIEWED ;BY FIRE DEPT
3'COPIES OF DRAINAGE PLAN WITH CALCULATIONS
REQUIRED BY SUBDIVISION 0
GREATER THAN 2,000 SQ. FT.
IMPERMEABLE SURFACE
.LESS THAN 2,000 SO. FT.
0 CHECK ZONING,'REQUIREMENTS (SETBACKS)
1 COPY OF ENGINEERI14G CHECK LIST
1 COPY;OF PUBLIC*.WORKS MEMO
MULTIPLE OR'COMMER CIAL
YES E] `:(A1TACH:C0PY OF ADB APPRDVAL:INCL. ALL DRAWINGS)
0S. NO E]
UBDIVISION — YES[] NAME.
DATE1Y RECORDED
NUMBER
NO (ATFACH-Copy-OF-REO
IUI
CHECK SEWER DRAWING AND ATTACH COPY
IS' DE . DICATION -.REQUIRED YESQ. (OBTAIN QUIT CLA
-CITY CODE.
NO
'DOES CITY HAVE EASEMENT ON PROPERTY
YES !(ATTACH COPIES OF DRAWINGS)
NO
Cl _CHECK LEGAL ACCESS INGRESS[] UTILITIESE]
YESU YES
NO [3 NO
HAS SEWER ASSESSMENT BEEN PAID
YES Lj L. I. D. NO.
PLAT NO.
SUBDIVISION NO.'
Cl
IF�-MULTIPLE::,INCLUDE NUMBER OF UNITS'
I'F,,COMMERCIAL: INCLUDE NUMBER OF FIXTURE U14ITS
a
C -A(r
C11're L"
CITY OF EDMONDS.
WATER DEPARTMENT
J;, —?OL
CROSS Coj,�,"
e!.ii for p3tc:!ti,31 ation
f er- n vi
voj 0.1 cow.i'Jinn th;E
appr
pr tecti, is
IN,
ZE
LYEIN,
An' '41 V V
OTHER PP*55u" '1114
It
Nv!
ater Department Dat
OYIZA5
0
-Z
F V C
C, �l A ruil
(0
- -- .
--
- k ;
+ r v, Ck 0 V 9 bo-/
a3
> 0
-0
-0
>
0
CS, X
Ok "A o V-C-Y- C%) Vt. 5
M,
z
0 rr,
�o
rn
U)
> z
>r- zcn
0
--- -
r, �
0
r-
0
C%
rin
JUN
18' .1982
rn
Z m E:
U)
M
c M
o' I REET FILE
2ITY OF EDMONDS
PU]BI.JC WORKS — ENGINEERING
ACTION REPORT
SUSPENSE DATE:
Date: Time:- qWJ File # _
Attachments
REQUESTOR: NAM:
ADDRESS: s:�74-16&
PHONE:
REQUEST RECEIVED BY:
TELEPHONE
CONTACT IN OFFICE
OTHER:
RECEIVED BY
NY �4
�O -0, �9
=Yes
=mum
MM
MM
ACTION: (OAIN I W�\S -AC)!—I-) 70
oSsGA11,,,1
L x z) c i n K.N o r-- P L u C, r C P P/-
DE3jX4NJL5h,, concerned Notified
Action Completed/File
STREET HLE
DATE: *ZI-6
MEMO TO: Building Division '
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT: FINAL INSPECTION
PROJECT:
APPROVED NOT APPROVED
Engine�er Divis o
BY:
Water Zivision
B
Sewer Di 's;iyon
BY:
L-F--- LAJ LT-H T'S
IA
CITY . &Pp"FEJa%�S
CIVIC CENTER - EDMONDS, WASHINGTON 98020 - (206) 775-2525
DF=PARTMENT OF PUBLIC WORKS
May 25, 1978
Mr. W. R. Hanson
10335 Main Street
Bellevue, Washington
Dear Mr. Hanson:
HARVE H. HARRISON
� MAYOR
SUBJECT: 'DENTAL OFFICE LOCATED AT 7520 218TIl ST. SW
A cross connection review was made of the plans for the
dental clinic located on 218th Street S.W., Edmonds, Washington,
on 10-7-77. The requirements for proper protection of the do-
mesti.c water sys,tem were noted on the plans and a Water System
Plan Check form was submitted prior to issuance of the Building
Permit.
During an inspection ori May 25, 1978, discrepancies were
noted in the plumbing system and will have to -be corrected prior
to approval and issuance of the final occupancy permit by
the City of Edmonds. I
1. Atmospheric vacuum breaker must be installed in the
P-9 film developer hot and -cold water lines.
2. Atmospheric vacuum breaker is required on the water
line serving the model trimmer in the laboratory area.
3. In regard to the requirement of the Watts 9-D on the
vacuum-pum,p, it has been found that an approved atmospheric
vacuum breaker has been installed as an integral part of that
unit and is acceptable as installed.
Please contact Ken Kukuk, Cross Connection Control Specialist,
775-2525, extension 223, as soon as these discrepancies have been
corrected. If you require any additional information, please
feel free to contact this office.
KKK: j ac
W. Leadman-Dt �/'W'/S Supt. Dt.
Yours very truly,
. SINED
LEIF R. LARSON, P.
Director of Public
S�cl /W
E
Works
J e attendbrf Dt.
cc: CDD
PUBLIC WORKS DEPARTMENT
WATER DIVISION
W A T E R S Y S T E M P L A N C H E C K
PROJECT DENTAL OFFICE
PROJECT LOCATION 7520 218th
NAME W. R. Hanson DATE 10-7-77
( PLANS SUBMITTED BY
ADDRESS 10335 Main Street, Bellevue, Washington
(STREET) (CITY) (ZIP)
PHONE 455-9888
�--N A T ER DISTRIBUTION SYSTEM
PLANS APPROVED
PLANS APPROVED PROVIDED: A WATTS 9-D to be installed on the 1/211 cold water to
Vacuum Pump and an atmospheric vacuum breaker be installed on the P-9 Film Developer
hot & cold water lines.
6/77
E ®R/'S E S(JPFRINTFNPr-:NIT
,ETWR SUPFRTN
err.,.) �-fo&xrvLooUL
W,4 -3 4Z,-�7 XZ- -,e61X1
WA-TrS,
IP
25y-
'/2 CkV 72D V44:f,'
APPROVED
99Mf- —
CHECK VAU E R ED
at this locai on. 1W,5 7-,EE
T
-zr WW 7r- f /--7.5
5.6.
1-21 v,,v
ro
7- W,4 77, C-AZ 77, QA/A 104
Xv��,4 7Z.,e
-7t77- W,4 7-iF�E -7-141V<' 1c-'11r-711VeS- 7,41Z--
STREET FILE
DATE:_
MEMO TO: Building Division
Community Development Department
FROM: Engineering Division
Public Works Department
02 Oro%
SUBJECT:, ALO! %Nor 9
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--t-Tc-
--responsi ility of the contractor.
(2) The contractor is required to keep the abutting streets clean-
ed of dirt and d ris caused by 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%.
0
MAM I
PW 5/77
T
,
IMT!
M'i.'
- ;
�%Fi
9
Nit.: P.>L.&gsmv.:
LIST
—.1,11ILDING PI'll'UT Pj: V 171 1
Street Rxisting-- Pi D P NIL
IL; I! _J1
Access I-asements YXistim
N) A
Utilitv Fascmciit Existina PJK
N A.
Lot Per Sui)diiv�sj.on _P1 a.t Assessor 1' 1
Sitc, Plan for Accuracy -7 !1
u
.!mci-Rraind "'Cod.
&C k 1 U� 0 C,
low- w
p
L'ater 7'�!ki
d'v I e ";Iierct
Hy(lrwit Pc. "'(1 r h re
(1j'CC1' :'ctcr
Povi C�...
smptic Tzml.. ed
Soptic Penrit PcouiTcd
sanitan, 5',cwc
Dnudll-
;�.z 11 Side Scv.�Or -ro
dr
I
Fil", '70.
P/ 4?OPO
ze
"ro i
.0.
Sxiitary W,,:er ['();,..-wc:tic)n Fcc Pcquircd
Date 31-7-7
j)jtC.jj
C111vort Peqitircd
C) tj
Cam) Dasin Indicate, oil Plan
CO
n n I�v (11 C, CAWA &A A6
PA
ki I I L) 1 c requi 3-Cd 111dic.ite oil Site m
"Oil Conclition!; F, Growid I- ' "itc.i. Field (1c6hed
Revicil by— e-_"
Street Paving, Rcciuircd
Curb amct Guttcr Rconim
Sidai-.?'-dh. Pcc.uirccl
9-:4 Cueb nut for Privc,�.,a\ !-"cqui rcd
J?jght-o1)-1":ay Construction Pcndt Rcouired.
Eond Rcquircd for Riblic Imiprovcricnts
Street NLb-.ic Sign Reciiired
OthrCr Sionirig Pcmiirccl
Pre Per.,."it Site InspCCtion. n.'Icic on
c
Sewer
BY:
Water
Street
Ynpinccrinp,
5-.)ol-j,!.! Pccuil-crimits listcd in to ])Uildino 11op"11-trient
e
'Cl ill on
I)e1j,lit �I)-
,ion
L
PA.. Patc
-'?J. I F F) Staj-1ped I-nd ":"Otad.ons "'a(le
C4
By Ra t o
r-, Approx.-recl by PulDlic
STREET FILE
Da te Jantiary 29=1 974
Memo to: Director of Maintenance & Operation
Public Works
From: City Engineer
Subject: -Sewer Connection Charges
Legal. Description: Lot 6, Carabe Park
Reference: Easement granted to the City of Edmonds for installation of
main line sewer across their property for L.I.D. No. 1924
see letter dated August 14, 1973 attached.
Commonly known as: '-2-1--8-07-- 76th Pl. W. Owner: M.J..Coagrove
Z.F.F. Calculation:
($5.55* Z.F.F. x 85.29
Lateral x
Unit x $ 25
cc:
rf
*Z.F.F. charge of $5.55 based on
L.I.D. 119
473.36 Connection Fee
$ Lateral Charge
$ 25.00 Trunk Charge
$ 10.00 Permit
$ 508.36 TOTAL
Leif R. Larson
August 14, 1973
Mr. M. J. Cos grove
21807 76th Pl. W.
Edmonds', Washington 98020
SUBJECT: Easement Across Lot 6, Carabe Park outside of L.I.D.;
Dear Mr. Cosgrove:
The following conditions are agreed to by the City of
Edmonds in connection of construction of sanitary sewers on an
easement across your prcparty:
1. -A connection charge In lieu of assessment for your
property will be as follows: 85.29 zone front foot x
$5�55 = $,473.36. Plus the trunk charge of $ 25 and a.
otal of $ 508.36.
$ 10 side sewer permit fee for the�t
2. A tee will be placed in the new sewer line which
you may use for your sewer 6onnection.
3. There will be no lateral charge added to the
sewer connection charge.
Thank you for your cooperation.
Yours very truly,
CITY or EDMONDS
RICHARD H. ALLEN
As'sistant City Engineer
RHAtmjr
CC: Raid, Middleton Associates, Inc.
. ;, . , I . _7� ,I _ 7
- 1. � I
City of Edmonds Permit No:
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date:
A. Address or Vicinity of Construction: '2'k 8)0 1 :Itop
P. Type of Work (be specific): "Fol-r� 15�161N.
\I&) L-[ttlg 1Z 0, _J
,41A ft or/K &r414,
C. Contractor: Contact: 7_,fr1&VfU11V
MailingXddress: 1135 W" r(*0� Al( A' Phone: 21rz-0-1001,
State License WA-rlisc v D P9 Liability Insur Bond: $
ance� I d
D. Building Permit (if applicable): Side Sewer Permit (if applicable):
E. Commercial El Subdivision El CityProject E] EtJC(PUD,VERIZON,PSE,AT&T,OVWD)
Multi -Family El Other
El Single Family
INSPECTOR:'. N:klld, /7r,> 6 Ue�5PP-1
F.* PAVEMENT CUT: El YIES 0 G. SIZE OF CUT X.
YES
CONICR,kTE CUT: 0
INDEMNITY: Applicant understands by his/her signature io this application helshe holds the Cit� of Edmonds harmless from
injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of
Edmonds or any of its departments or employees, including -but not limited to thedefense of any legal proceedings including defense
costs and attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL 111E FINAL STREET PATCH IS
COMPLETED B Y CITY FORCES, A T WHICH TIME A DEBIT 0 R CREDIT WfLL BE PROCESSED FOR ISSUANCE TO THE APPLIC4 NT.
# Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer.. Every
flagger must be trained as,required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
# Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEPTIONS.
Three sets of.construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
IRAVEREAD�XEAB STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
T ITIMU
HA S KE PINK COPY OF THE PERMIT A VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Signatu're: Date: 119-7-11,07-
(Contractor or Agent)
Approved by: WCLWmy;,WLL_ FOR CITY -USE ONLY Right-of-way Fee: + S'0-r-
Time Authorized: Void After 0
5 Disruption, Fee/Fund 111: A,
Special Conditions: L-OCA110N W"gep Restoration Fee:
MIWAWA 1'131F,�KwN Total Fee: -750,":"
ReieiptNo: ��hx
kT J-1- "a Issued by
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)
4
FINAL APPROVAL OF PERMITTED WORK. DATE:
Inspectc�r's Signature
I
DAMy Documcnts\Forms\Engnmg\ROWpermit doc
WREET FILE
January 17, 1974
Resident
76th Place WL,
Edmonds . Washington 98020
SUBJECT: Advanced Sewer Hook-up Notice for Properties Adjacent
Sanitm Siswers
to Local Imrovement District 192
Upon the approval of the City Engineer of the sewer
main in the vicinity of your residence, it Is now permissible
for some property Owner$ to begin connection of their houses.
Since your property was not located within L.I.D. 192, you,will
be charged a sewer Connection Charge in lieu of an L.I.D. assess-
ment. if you will bring the legal description of your property
into the Engineering Department, 505 Bell Street, your sewer
connection charge can be calculated; this must be done prior to
obtaining a side sewer permit. Each owner shobld then secure
the services of a city -licensed side sewer contractor and obtain
a side sewer permit. Side sewer information and permits may be
obtained at the Public Works Department, 200 Dayton Street, tole -
phone 775-2525, office hours are from 8 a.m. to 5 P.m.
By ordinance, residents adjacent to a sewer wain are
required to connect within 60 days of the official notice.- Notices
will be sent to all properties in this area when the final assess-
vient roll hearing has been completed an L.I.D. 192. which will.
take place sometime in late spring. This advance noticeli sent
at the present time for the convenience of the home owner in the
event septic tank problem exist and -to allow hook-ups over a
longer period of time. If you have any questions regarding this.
feel free to contact our office.
Yours very truly,
CITY or EDMONDS
inr R. LARSON
City Engineer
n
..__._:-cc: Public Works Departme t
-�j 3L1--
Th
e qiiy.,of Edmonds'
Eg FILE
APKICATION
for
SIDE SEWER PERMrr
OUTSIDE INSIDE 0 REPAIRS 0,
CARDNo . ..................... . .............. ..
EASEMENTNo . .. ..... I ......... ............ . .......
'A . .......... . .. PERMIT Nr.lo��
VP— � ...... ........
,OWNER ..... 1� . .......... ............................. .................. CONTRACTOR .....
STREET
43 ..............................
4itic !30 . BLOCK No . .... ...... ..................
HOUSENo. ....... ;../ ......................... ) ...................................... AVENUE LOT No . .... ....... ................................. . ...............
ve. Wes r, Q
j?,D 17 1- NAME ADD ..... ID ..... / .......... . ..... ............ .;; ..... ....................
Date
BACKFILL WORK ORDER ISSUED ............................. .............. DEPOSIT, $
SEWER WORK ORDER ISSUED ............................ . .................
APPROVED
z ve, 56,
Approved:
.........................
................
DATE..y .... e:77 . ..... . ..... ....................... BY .... ...... ... .. ......... ......................
CITY
-z :`Cill PR�Spe'ct,,611-10
Z7%��Iien *ork'
'Wready�Lfor, inspection ��,,,(No!
3 -EN-TERIZ -ATEii�';Sj�.WER�,,.DEPARTMENT'...
MF --'tloY18'Saturday�;Sun'dv4?.i
4.0 9;
Nx
E 'SE
n MR-`
I*,
-Q th- .........
...................
--ADDRESSt ... . . %,
.................. .................... .. ....
71-
.................................................. B
q.mqn,*.;, Ming-ft, &�C6ns. -rub.
OWNER ... :.��MkdkiBv A&- TOR* ............
vT.
ji4
24--,
Is
t prd, qances"
P on; lle,and* -gqy�.Fnft,
YW C�VP�111n�
v
I '���Side'�,'Sew6r,-,Coiitra6tor, iniAt;�_.',
�.;pzlopirfy,,Lii���,-:��'t�t�,.ikl::Ii�.r�mit'..t�,,�6nBtrU t- e
an Inslde�prope ijeense
-se�ve*r,',befori,-,It�h",be6ri,in6�e6ted.'L-
i;t�6loyedt6:'c6nstru6t.'side:siwei -in �detyg�e D y;.'porttbnj oN,
o..!Iot cover�.
No��2,--. qi�tajn 1�41nf�ojjjrajjo� rbkardlrfg.6:r�l�n�,ice� permit.':
fy� guls�ti6n;'�'kovetiil6'�
must�have at lease-*,;3*0:'jncb6i'*cbVerage,�at-pr6perty!lin�'�'�d;-i2"'incii�s,�i'�iide-pr6perty,�ilne';i!minlmum�'grade.-;�f;2i.,-.'�k';�'
ej- -N&:befidjL ifi-_grad6� sh&r�e r �*tha n:- I/s - -%Nil I I t�bi;- peimitt6d
14.6Tt�'No..-A �'Trcnc�fies',Jtit -r�gtor Jili on�. CFo n't racioii shill-,:be'Irespoi�si
failure. due to,* Improper �vo_rk whIcF- inay.� divel6p:.��Itliin one- year"*of- comp
NOTE N o.' 5�it` fi ided:*f6r-,In tlie"pe .1 rk,o h n, se wer' Or
�lai�ul". wfalter,.� or �do. any 'Im
_or o.jdo any o. n, t e,mal
-the the� wye. �7
' C_': pprtinancis eicept, to:lnsert
w.
a .
4
APPLICATION
for
The City of Edmonds," SIDE SEWER PERMT
EASEMENTNo . ..........................................
NEW CONSTRUCTION REPAIRS E:]
J. <=5c=—p-lC)*ll-JE-
..........................................................................
OWNER .............................................................................................................. CONTRACTOR PLU M Bkt A G � -���-UZI�ERMIT No ............
—?<'-� -4 -
7 — C�' PLECF—
ADDRESS ....................................................................... WEST LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . .............................................
NAME OF ADDITION ....... .
..................... ............................................................................................................
F-F)
...............
...................... W?t
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).
Clf#COEDMONDS - SIDI
,,&-EOR PERMIT
WATER -SEWER DEPARTN
PERMIT N? 4585
Call 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 ........ 21.8.07 ..... ... 7.6th .... Pla.ce ... We.sl ...........
PROPERTY LEGAL DESCRIPTION ........... L.o.t ... 6.,..-.Ca.r.a.be .... Pa.rk ......................................
.. . .... .. .. .... .... .....
................................................................ OWNER AND/OR BUILDER ......... KEEL ... 0 ...... C0.5-GRONE
CONTRACTOR'S NAME & ADDRESS ..... POted Plumbin ... &..Sewer.,...2j 07.- ..A e....S..E...._Bathell .................................
.............................. g ... ..............
March 25, 74
Permission Is granted ........... ....... �'i*** ---- - -- ----- .... 119 . ....... for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City Edmonds ordinances.
I
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer Inside property 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 been Inspected.
NOTE No. 2—All work performed In city right-of-way requires an Invasion of Itight-of-Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side 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 I ine; 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, shell be responsible for failure 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 main sewer or Its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVEDDate ... . ...... .............. By ................ Date ....... /... . ............ .. By ................ Date ........... . ... ................... By ................
7. f 7d" 0!"
APPROVEDDate.__� ...... . ..................... By.. . . ............................... . .......................................................
Remarks: ....... . ...... . ...................... 7 ... . .. . .......... ................................................................. ....... ...... . ...................................................
.................... 7
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
a(.;,el -e hereby certify that the side sewer installation constructed undei this permit
tr v. � A-i �0 -
; a ontraeting FIrm. Performing Constructio
was Installed in a ance with all governing ordinances of the City of Edmonds.
Datedthis ...... . .. . .. . ........... day of ....................................................... . .. . .... 19 .........
Check BEFORE you dig for: Water [], Gas [], Telephone [3, Power E], Sewer [j, Other [3 4 4
The City of Edmonds
APPLICATION
for
SEDE SEWER PERNEIT
EASEMENT No . ..........................................
NEW CONSTRUCTION E] REPAIRS E] C VON A)
j .44
_5
7- ...... PERMIT No.
OWNER ----- A.g.'q-k ..... 7 ........................................ �La. I . ................... CONTRACTOR .......
'-7 (, Pi- - 1-4 ... ...............
ADDRESS--- ............................................................ .. LEGAL DESCRIPTION: LOT No . ...... ................................... BIX)CK No . ............................................
NAMEOF ADDITION ....... ... 84 . ................................................................................................
c
Approved:
DATE................................................ By ......................................................................
January 17, 1974
Resident
__21807 76th Place WL,
Edmonds, Washington 98020
SUBJECT: Advanced Sever Hook-up Notice for Properties Adjacent
to Local Im
I)rovement District 192 - Sanit!a Sewers
Upon the approval of the City Engineer of the sewer
main in the vicinity of your residence, it is now permissible
for some property owners t I o begin conneition of their houses.
Since your pr*�Arty was not located within L.I.D. 192, you will
be charged a sewer Connection Charge in lieu of an L*IeD* assess-
ment. If you..will bring the legal description of your property
into the Engineering Departmenti-505 Bell Street, your sewer
connection charge can be calculated; this must be done prior to
obtaining a side sewer permit. Each owner should then secure
the services of a city -licensed side sewer contractor and obtain
a side sewer permit. Side sewer information and permits may be
obtained at the Public Works Department, 200 Dayton Street, tele-
phone 775-2S25, office hours are from 8 a.m. to S p.m.
By ordinance, residents adjacent to a sewer main are
required to connect within 60 days of the official notice. Notices
will be sent to all properties in this area when the final assess-
ment roll hearing has boon completed on L.I.D. 192. which will
take place sometime in late spring. This advance notice is sent
at the present time for the convenience of the home owner in the
event septic tank problems exist and to allow book -ups over a
longer period of time. If you have any questions regarding this,
feel free to contact our office.
=Jr
Public Works Department
Yours very truly,
CITY OF EDMONDS
LEIF R. LARSON
City Engineer
9.
I*%
Memo to: Director of Maintenance & Operation
Public Works
From: City Engineer
Subject: Sewer Connection'Charges
Legal Description: Lot 6, Carabe Park
Date .—Januaxy 29,�---1974
r,ECEIVFD
"JAN 3 , I,--.
i J I Z-4
Reference: Easement granted to the City of Edmonds for installation of
main line sew6k across their property for L.I.D. No. 192-
see letter dated August,14, 1973 attached.
Commonly known as: 21807 - 76th Pl. W. Owner: M.J..Cosgrove
Z.F.F. Calculation:
($5.55* Z,.F.F. x 85.29
Lateral x
Unit x $ 25
cc:
rf
*Z.F.F. charge of $5.55 based on
L.I.D. 119
$ .473.36' Connection Fee
$ --- Lateral Charge
S :25.00 Trunk Charge
$ — 10.00 Permi t
$ 508.36 TOTAL
Leif N Larson
1� I
go
06
7' 7'
Aulnot 14. 1973
Mr. M.J. Cosgrove
21807 .76 ch ri. w.
Edmonds, Washington 98020
SUBJECT* Easement Across Lot 6, Carabe Park Outside of L.I.D.
192
Dear Mr. Cosgrove:
The following conditions am agreed to by the -'ity of
Edmonds In connection of construction of sanitary sewers on an
easement acme your propertys
ction charge in lieu of assessment for your
1. A conne
property i!ill be as follows: 85.29 zone front foot x
$5.55 a $'473.36. Plus the trunk charge of $ 25 and a.
$ 10 side sewer permit fee for the total of $ 508.36.
2., A- too will be placed in the now sewer line which
you may use for your sewer connection.
3. There will be no lateral charge added to the
sewer connection charge.
Thank you for your cooperation.
Yours ver"j truly,
CITY OF EDMONDS
RICHARD H. ALIXN
Adsistant City Engineer
RHA:mjr
CC: Raid, Middleton 9 Associates, Inc.