21906 76TH AVE W.PDF111111 lill 11
6343
21906 76TH AVE W
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ADDRESS: 9,1 IOU f7 11 Y-vl )qW-
TAX ACCOU NT/PARCEL #: 600 /7/&/ 11:-16 AZ- 663
BUILDING PERMIT (NEW STRUCTURE) M
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: [-� Conditional Waiver E] Study Required E] Waiver
CRITICAL AREAS #: DETERMINATION: E] Conditional Waiver E] Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
V
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID#:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED-jFTI�JK4
SIDE SEWER PERMIT(S) M P761,1� (0
GEOTECH REPORT DATED:
STREET USE/ENC ROACH M ENT PERMIT M
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc
PLANNING DATA Street
SIGN PROPOSAL F12e
Name: Dir. 70114-431 /Eotmond-f2 :6t3c, A54
Review Date:
Site Address: D (P 7 0-ftl A\rr, VV
Permit Number: BLD.20
Project Description: Q si8 vi
Zoning:
Comp Plan:
Corner Lot: (YES /tt6)
Fla 9 Lot: (YES
Variance-
Shoreline:
ADB:
UP:
FC
P're-App:
LLA:
Plans Match ADB Approved: (YES / NO)
Lot Aggregation Required: (YES
Legal Nonconforming Land Use Determination Issued: (YES �00
Total Are Per Sign
......... S
.........
Type of Sign
Allowed in
zone?
Matrix
conditions met?
Allowed area
. .
per unit
. Unit
"TOTAL sign
area allowed
for this sign
roposed sign
)area
Example
Wall wlinternal
illumination
Yes, with
conditions
Yes
I sq. ft .11ineal
ft. attached
wall
41 ft. attach ed
wall
zz:=�7
41 square feet
20 square feet
Sign # 1
M onuffleft
No
ye.'�
g4v
2-4
Sign #2
Sign #3
TOTAL Sign Area'for:TenantlSite
Max Permitted. 16
Previous Total:
Proposed Total:
Sign Height
Sign Type:
Max Permitted:
Actual Height:
Sign Type:
Max Permitted:
Actual Height:
Sign Type;
Max Permitted:
Actual Height:
Sign Lighting
Sign Type:
Proposed:
Allowed in Zone:
Sign Type:
Proposed:
Allowed in Zone:
Sign Type:
Proposed:
Allowed in Zone:
Sign Colors
Proposed:'
Acceptable? Requires ADB Approval?
Sign Location
If freestanding and 3-feet or over meets setbacks? < 96 !> I
C1+
Required Setbacks
Street: Side: Side:
Actual Setbacks
Street: Rear:
Landscaping for Freestanding Signs
Size: C) kv �ipn- bf S�
Critical Areas Determination #:
El Study Required
*Waiver
Other
Plan Review By: Gina Janicek, Associate Planner
City of Edmonds
Traffic Impact Analysis Worksheet
Name of Proposed Project: Brian Takagi Office Remodel
Owner/Applicant
Brian Takagi
Name
21600 HWY 99, Suite 230
Applicant Contact Person:
Colleen Erskine / Mark Adolphsen
Name
10 11 SW Klickitat Way, Suite 102
Street/Mailing Address Street/Mailing Address
Edmonds WA 98026 Seattle WA 98134
City
Telephone: 206.799.8998
State Zip
City
Telephone: 206.623.6832
State Zip
Traffic Engineer who prepared the Traffic Impact Analysis (if applicable): C' ?I
N/A N/A
Finn Name Contact Name
Telephone: N/A E-mail: N/A
THRESHOLD LEVELS OF ANALYSIS
Project Traffic Levels
Sections to Complete
1. Less than 25 peak -hour trips generated
I and 7 only (Worksheet/Checklist)
11. More than 25 peak -hour trips generated
All sections
1. PROJECT DESCRIPTION
a. Location - Street address: 21906 76th Avenue West, Edmonds, WA, 98026
(A ttach a vicinity map and site plan.)
b. Specify existing land use: RM-2.4
c. Specify proposed type and size of development: Renovation to Existing 3,610 SF Commercial Bldg
(# of residential units andlor squarefootage of building)
Revised on 6124110 E82 - Trafjic Impact Analysis Worksheel STREET FU.age I of 5
t 1 0 0
d. Date construction will begin and be completed: Begin: November 2012
Complete: March 2013
e. Define proposed access locations: Existing Entrance/Exit off of 76th Avenue West
f. Define proposed sight distance at site egress locations: Existing, No Change.
2. TRIP GENERATION
Source shall be the Eighth Edition of the Institute of Transportation Engineers (ITE) Trip Generation
manual. For independent fee calculations, the current edition of the ITE manual may be used.
ADT = Average Daily Traffic
PM Peak -hour trips (AM, noon or school peak may also apply as directed by the City Engineer)
a. Existing Site Trip Generation Table:
Land Use
Daily (ADT)
PM Peak -Hour
Trips
IN
OUT
720 - Medical Office
b. Proposed Project Trip Generation Table:
Land Use
Daily (ADT)
PM Peak -Hour
Trips
IN
OUT
720 - Medical Office
c. Net New Project Trip Generation Table:
Land Use
PM Peak -Hour
Daily (ADT) IN
Trips
OUT
d. State assumptions and methodology for internal, link -diverted or passby trips:
Revised on 6124110 E82 - Traffic Impact Analysis Worksheet Page 2 of 5
0
3. TRIP DISTRIBUTION
Prepare and attach a graphic showing project trip distribution percentages and assignments. For
developments that generate over 75 peak -hour trips, the City Engineer reserves the right to require
trip distribution to be determined through use of the City traffic model. 1
4. SITE ACCESS ROADWAY/DRIVEWAYS AND SAFETY
a. Have sight distance requirements at egress location been met per AASHTO requirements?
b. Intersection Level of Service (LOS) Analysis:
Intersections to be evaluated shall be determined by the City ofEdmonds Traffic Engineer
Existing Conditions
LOS
Delays
Year of Opening
LOS
Delays
Five Years Beyond Change of
LOS]
Delays]
Land Use
c. Describe channelization warrants:
(Attach stripingplan.)
d. Vehicle Storage/Queuing Analysis (calculate 50% and 95 % queuing lengths):
50%
95%
Existing Conditions
Year of Opening
Five Years Beyond Change of
Land Use
e. If appropriate, state traffic control warrants (e.g. stop sign warrants, signal warrants):
f. Summarize local accident history2 (only required for access to principal and minor arterials):
Available upon request at City of Edmonds Development Services Department
2 Available upon request at City of Edmonds Police Department
Revised on 6124110 E82 - Traffic luipact Analysis Worksheet Page 3 of 5
0 0
5. TRAFFIC VOLUMES
Provide the following and other planned development traffic within the city. 1
a. Describe existing ADT and peak -hour counts (less than two years old), including turning
movements, on street adjacent to and directly impacted by the project.
b. Describe the estimated ADT and peak -hour counts, including turning movements, the year the
project is fully open (with and without project traffic).
c. Describe the estimated ADT and peak -hour counts, including turning movements, five years
after the project has been fully open (with and without project traffic).
d. State annual background traffic growth factor and source:
6. LEVEL OF SERVICE (LOS) ANALYSIS
a. Summarize Level of Service Analysis below and attach supporting LOS analysis documentation.
Provide the following documentation for each arterial street or arterial intersection impacted by
ten or more peak -hour trips. Other City -planned developments' must also be factored into the
LOS calculations.
LOS
LOS
Existing Conditions
Existing
Delays
Year of Opening
With Project
Without Project
Five Years Beyond Change of
Land Use
With Project
I
I
Without Project
I
I
b. Note any assumptions/variations to standard analysis default values and justifications:
1 A list of planned developments are available at the City upon request for public records
Revised on 6124110 E82 - Traffic Impact Analysis Worksheet Page 4 of 5
0 0
7. MITIGATION RECOMMENDATIONS
State recommended measures and fees required to mitigate project specific traffic impacts. Traffic
impact fee shall be calculated from the Edmonds Road Impact Fee Rate Study Table 4 (attached)
and as identified in ECDC 18.82.120, except as otherwise provided for independent fee calculations
in ECDC 18.82.130.
0 CHANGE IN USE
Fee for prior use shall be based on fee established at the time the prior use was permitted. If the
previous use was permitted prior to the adoption of Ordinance 3516 (effective date: 09/12/04),
the 2004 ECDC 18.82.120 impact fee shall be used.
Units in
ITE Land Use Category Per Unit square feet,
Fee Rate # of dwelling,
vfp, etc.
New Use CR � $ X
Prior Use $ X
Fee
New Use Fee: $ 0.00 Prior Use Fee: $ 0.00 $ 0.00
0 NEW DEVELOPMENT
New Use
K OTHER
ITE Land Use Category Per Unit
I Fee Rate
$0.00
KI
Units in
square feet,
# of dwelling,
vfb. etc.
MITIGATION FEE RECOMMENDATION:
$ 0.00
INDEPENDENT FEE CALCULATION: $200.00 (+ consultant fee)
$
TOTAL TRAFFIC IMPACT FEE,
$
City of Edmonds,
Date
' No impact fees will be due, nor will a credit be given, for an impact fee calculation resulting in a net negative.
Revised on 6124110 E82 - Traffic Impact Analysis Worksheet Page 5 of 5
qe .
0 0
VICINITY MAP:
RIS
cowty Ps
40
Lymdale
Park
-ftft a avv
P.
"NA Ot OV f0lih 61 ON Lynnwood im- sk i vW
of
dm ds
PkKR*e
Edmonds.
Park muri*al --am 0 SW
'GotfCo_
*% MOSS:
Pin
t
NighL
Wood."
PMECT L=WN
2M ferrace
'Oreek Park
Mour"lake
Sherwood
Forest
IF 2300111taw
N2=h8t 104
4L
PROJECT ADDRESS: 21906 76TH AVENUE WEST
EDMONDS, WA 98026
PARCEL J: 00461000202003
127.36' N 88* 44* 29" E
x
PROJECT ADDRESS
>
21906 76TH AVENUE WEST
r-r - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
EDMONDS, WA 98026
15'-0"
15'-0'
NOTES
SETBACK
SETBACK
EXIST ENTRY TO BE REMOVED & REPLACED
>
W/ NEW VESTIBULE.
F---I
ril
F - - - - - - - - - - - - - - - - - - - - - - - - - - -
> EXIST CONC. WALK.
EXIST BUILDING FOOTPRINT
> EXIST LIGHT POLE.
L- -
- L - - - - -
PROPERTY LINE
> EXIST 6* CONC. CURB.
> EXIST SIGN TO REMAIN.
> EXIST TRASH ENCLOSURE.
> EXIST CONC. PATIO, STAIRS & LANDING.
Ll
UP >
U
-31P - - - - - - - - - - - - - - - - - - - - -
b
EXIST WOOD FENCE.
>
EXIST CONC. ADA RAMP.
>
EXIST ROOF OUTLINE ABV.
>
N
DEMO EXIST ADA RAMP HANDRAIL & PROVIDE
>
NEW METAL HANDRAIL.
<12 6,
> EXIST LANDSCAPING TO REMAIN.
RAMP
SLOPE
Lu
7
>
EXIST ASPHALT PARKING LOT
(19 PARKING STALLS)
3
[3�
<TYP
10
@ @ @ 9
> TYP.
X x
127.36' H 887 4701 : E
CONCEPT SITE PLAN N
SCALE: 1"= 20'-0" T
0' 10' 20' 40' 80'
1011 sw Kkutt W"
%dw 102
S.dft WA SM34
Tm Zoo-e23-om
F" 205-02-34"
0 2012
$tot. -w,.d
PERMIT MW
zo E NUMBER
CITY OF EDMONDS M 'AJ 860482
N .7,
CONSTRUCTION PERMIT APPLIC-01ON Joe
NAM15 COA NAME OF siuSINESS) ADORM
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Are, '0;!75r.
ry TEL PHO.NCNUMSER
.ZrY1010 Y�,
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TY ITELEPHONE NUMBER
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iclude all easements
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Z 4A 2b 116dl
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RESIDENTIAL
El PLUMBING'
1:1 1004ILTER
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MECHANICAL
REPAIR
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El
EXCAVATg
OR FILL
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REMODEL
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SEE ENGINEERING MEMO DATED
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METER-SI-9 JOUILDING
SUPPLY SIZE ]FIXTURE UNITS
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ENV. REVIFW
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VARIANCE OR qU
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REMARKS
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TYPE Of G STRUCTION
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IC5 0
S ECIAL INSPECTOR.
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PEOUIRED
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OCCUPANCY
OR Due
OCCUPANT
LOAD
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Pilo & JIE-,c, I WlEcrrlo P45
PLAN CHECK FEE
BUILDING
INUMBING
MECk%NtCAI.
This F`irmit Covers work to be done on private Pjo y ONLY.
Xwalk3,
Any cqnstruction on the public domain (curbs,
driveways, marquees, etc.) will req:jire sepaTte EelssIon.
SATE SURCHARGE
'�ermit Application: 180 Days
ENERGY CODE
Permit Limit: I Year - Proyided Work is Stated Withlo,*80 Days
..A pi cant, an behalf of his or her spou.,e, heirs',psigns and,
I "r ,
81 ,
succ ssors In Interest, agr as to indemni:y, deft end hold
6ffl.1
haimless the City of Edmonds, WaShinglon. als.
employees, and agents from any and all claims foftamages of
"t)ie
whatever nature,arising directly Or Indire6ti-, from Issuance
of this permit. I 3 of this permit sh3II not bn deemed 10
PL�N CHECK DEPOSIT
_uance
modify, waive or reduce any roquiremeW of any cip'ordinance
nor limit In any way. the City's abilit e, enl�orce afy ordinance
T6TAL AMOUNT DUE
provision.
I hereby acknowledge that I have read t6lslapplicatlon; that the
ATTENTION
infornTation given is correct; and that I am thgowilef, or !he duly
of the Owner. I agroa to Comply with pity and
THIS PERMIT
thorizei agent
:t`ai*!aAis regulating constfultic' . Prid In doing I he work aulhoriz.
AUTH RIZEA
ad thereby, no person will �Nioy6d In vlol.tlon-6f the Labor
Code of the State of Washingir- Ing to Workmen's Compariss.
ONL� THE
WOFtK NOTED
tiQn Ins-jrgnC2/ --- . :..
I rQWf1EA OR AGENT) QAIL ',�UNO
J�IU I UA� I'D
INSPECIPON
o EPAnT1eFN,T
CITY OF
I
EDMONDS
771-3202
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUC TUR E
BEEN MADE AND APPROVAL OR
UNTIL A FINAL INSPECTION HAS
A CERTIFICATE OF OCCUPANCY 14AS BEEN GRANTED.
UBC
CHAOTER 3.
i q 7. oca 1 6 7r,
-S-,6:3 z
APPLICATION APPROVAL
This appiicntion is not a permit until
signed by the Building official or his
Deputy� and fees are paid, and receipt Is
acknowledged in space provided....
FFWI�L*51"At- OE
ELEASED BY: AT
ORIGINAL — :ile YELLOW inspector
PINK — 0.npr GOLD � Assessor
k
L'e g, I
Descrip"4on
THE NORTH rME
0 F I.(:
wITH THE NORTH
60 FMT
OF THE SOUTH
I!)
lf"T "l,), 'IALOCK 2. HADLEY
3
ACRES, ACCORDINU
III VOLIP-1E
9 OF
PLATS, PAU,' 3Q.
Qcxss
1A
RECORD OF INSPECTIONS,
Date Passed
q
F6UNDATioN
House.
Porches, piers.
Retaining walls
F INA-1
i ily:
-Garage, ca-mort
Building
Date
PLUMBING
UnIderpround
Rough.,in
Water service
HEATING SYSTEM
-to
FRAMING
-ja
WALLBOARD
FINAL
TT
U S I. PERMIT
ZONE NUMBER
CIONSTRUI
Orl+BUSINESV'-.' ,
—e4
Z
9
MAILING AOL—
.07
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TELEPHONE N
CIT-7 MBEA
NAME
ADDRESS
CITY NUMBER
ITELEPHONE
0
ADDRESS'
/ � (,
i-0�1
7ELEP NUMBER
STATE LICENSE NUMBER
L at Description of rty - include all easergaInts
IST10. below or attacrio.1 copies)
z
ElNEW E1'RESJQENTu,L PLUMBING
I
ADIDIALTER, COMMERCIAL MECHANICAL
EI I
E) F1
REPAIR RETA;N.,Nn W SIGN
EXCAVATE Fi;�CE
DEMOLISH OR FILL I _x
=V.E IN S swim
REMODEL IPNJSP. POOL
EWOOD STOn I D
J INSERT APT. B�LDG Ej RENEWAL
imm"ER OF STORIES
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
dF— h
This Permit Covers work tq be done on private properly ON Y..
Any qonitruction on the public domain.(curts, sidewelk
driveways. mprquees, etc.) will require separate permission.
Permit Application: 180,Day;; 9 ..
Permit Limit: 1 Year. Provided Work Is Started Within 1500ays'
-Applicant, on behall'of his o; her Spouse, heirs, assigns and
successorg in interest. agreel, to Indemnify, defend and hold
harmless the City of 'Edr.-.znds. Washington its 6fficials,
employees, an agen!s Irom any and all clai m s ior aamagis.of
whatever nature, arising directly or Indirectly from the issuance
of this permit. 113uance of this permit shall not be deemed to
modify. waive or reduce any requirement of any city ordinance
nor limit in any way the City*s ability to enforce any ordinance
provision."
I hereby acknowledge that I have read thI3 application; that -the
Information given is correct; and that I am !he owner, or the duly
authorized agent of the owner. I agree to comply with city and
state-lawt regulating conSliuction; and in doing the work authoriz.
ad thereby. no person will be employed In violation of the Labor
Code of the State Of Washington ret�tlng to Workmen's C6mpqnsq.
lion Insur ance.
1 OAT, 71'cz-
0" -
ATTENTION
-- --W. -7 -0,
, -C;0()67 t-, --Ae
EGAL DESCRIPTION CHECK SUPDIVISION t4C.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING--- KOUIFIEDD�D:CATION--
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED t 1
STREET USE PERMIT REOUIRED C -
EE ENGINEERING MEMO DATED
EMARKS
ETER E�IZE
BUILDING SUPPLY SIZE
IXTURE UNITS
IF
EMARKS
SIGN AREA
P
ALLOWED ROPOSED
ENV. RiVIEW
COMPLETE I FX9MP(
APB NO.
SHOGkLINE
ARIANCE OR CU
PLANNING REVIEW BY
DATE
ARDS
RONT' SIDE
REAR
EIGHT
LOT COVERAGE
IEMARKS
HECKEO'BY
TYPE OF CONSTRUCTION UYUt
KWU 11,.
iLOAD
RECIAL INSPECTOR
IEC,UIREo
0 YFA E NO
ARILA
JOCCU ANCY.
OCCUPAI
VALUATION
FEE
ILAN CHECK FEE
'LUMBIP . �G 07)
AECHAINICAL
3RA+FILL
STAIESURCHARGE
:NERr?Y COPE
PLAN CHECK OEPOSIT
z
TOIAL.AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
PERMIT
This application 15 niol a permit Until
I ;HOAIZES
ONLY THE
signed, by thq' Bullding Official or,,his
,.40PK NOTED
Deputy: and fees are paid, and recelPt Is
ackno dged In s"rovi.et
a � L-ARTMENT
OFFICIA [G(,*T TE
Z—flot
CITY OF C7
EDMONDS
771-3202
LE Y�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE RIGINAL — Fit , e YELLOW — Insp . actor
'JNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OF; U
A CERTIFICATE OF 'OCCUPANCY HAS BEEN GRANTED. UUC; PINK — Owner GOLD — Assessor
"41.kPTER 3.
0 0 0',
'�N
�ECQRQ OF INSP ECTIQNS',.�,�;'�__n
F AL 'APPRI
F?IYALAPPROVAL blVM BY:
r
'FOUNDATION
il
B L
Building
House
i
F m
Fire D�,opt.
F'Evgineerin-
P.orchzs, piers
Pl--n:-
.Lig
g
-----------
c:imor:
PLUMBING . .....
e::�i4AA�L_ LeAX- Under-pund
PL0JL4e,60__
1-=� Napmn_
Rough -in
Water service
HEATING SYS1*EM
FRAMING
WALLBOARD
FINAL
Pre CIT,
Dr.VCLOP KEgr EAU19.
I OF EbMUN08,
S
ZONE
I T'O
P C
CONSTRUCTION PERMIT Aapti,CATION.
I A
JOB
J
NAME (OR NAME OF BUS 91
_!NE S)
A
ADDRESS
2 9e&,. 7,10
ZLEGAL
0 RIPTIOR SUBDIVISION
NO.
CC —
MAILING ADDRESS
-76, Aw, W JA
CITY
ILL�ONENUMOER'
PLIBLIC RIGHT OF. WAY PER qFFICIi0kt, STAg�T MAP.
Pu
77
EXISTING— REOUIPED PADICATION.—.-
PROPOSED
MAMA
z
RIGHT Of WAY CONSTRUCTION PERMIT REOUIRED I
ADDRESS
STREET V.SEPERMIT REQUIPEDI�
SEE ENGINEERING MEMO DATED
CITY
ELEPHON9 NUMBER
REMARKS'
NAME
4
cc ADDRESS
O-Lq 1
____SI . ZE
IBUI�PINP SUPP LT�SJZE
CITY
!�TATE LICENSE NUMBER
SIGN AREA
ENV. REVIEW
ADO NO.
ALLOWED
PROPCSED
COMPLETE
EXEMPT
Legal Description of Property - Include 611 easement
SHOA�-.INC#
C.h.. below or attach four COP16S)
i
M
VARIANCE OR.CLI
PLANNING REVIEW BY
DATE
a
YARDS HEIGHT
LOT'GOVERAGE
z
FRONT SIDE REAR
t
REMARKS'
_NEW-
RESI PLUMBING
APOI�LTFFI
MECHANICAL
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CHECKED B Y TY,E OF CONSTRUCTION HEIGHT
D.. E XCAVAT� FENCE
EIR FILL
.
IC90E
jqS7
PRE -MO . VE INSPj Smy.
POOL
SPECIALINISPECTOR I AREA
REOUIREO
'UPANCY
G 0 P
2-
OCCUPANT
LOAD
REMODEL COMPLIANS;Ejysp�
0 YES,.; "-No
WOOD STOVE!
INSERT APT.BLC4
'REMARK
10'
rr
;;7,jaERGIP�STORIEG:
INUMBEROF
DWELLING
UNITS
Y�^W�RIE OF WORK TO BE OO.NE 4AT7ACH.PLOT "N)
3 !�,41_
AA,0 41,�? 410 19, 01-JI
ALUATION
FEE
PLAN C C,K FEE
BUILDING
PLUMBING
MECHANIC�L
7-
This Permit poibri Work to be d;;. on prliate'prOpOrlly ONLY.
GRADINdIFILL
Any_ponstru;tIon on Ape public domain (curts. Ilid.ew.,lks,
driveways, marquees, etc.) will r6quire'separite permission.
PTAIIESLIRPHARPE
Pirm , stAppucaoon 80Days
R Y CODE
ENE. G
Permit Limit: A.Year-provided Work Is StartedANithin 180 Days
Aopiieant, 'on behalf of his 'or her-ippuie, heirs. assigns and
succesSo I I'S in interesl� ig - Teas to Indemnify, defend and. hold
harmless the City 0 1, Edmonds, Washington. Its officials,
employees, jand-agentS from any and all claims for damages Of
whatever nature, grislhg directly or InOird'ttly frorn-the Issuance
PLAN CHECK DEPOSIT
of.this pe rMit.f6jiJin�e Of this permit Oall not be deemed to
modify, waive or reduce any reqviremitof any city ordinance
nor limit In anv way the City's ability jQmforce 4ny ordinance
TOTAL AMOUNT DUE
,2
provision. -
I hereby ackhowfod9d that I havisead t11%,appkation; that the
ATTENTION
APPLICAMN APPROVAL
Information given Is, correct: and that I am�the owner, O[r thf, duly
authorizzO agent of the owner. I agree to c6mPlywith City ano:
THIS PERMIT
This applioat[on it. not a permit until
State laws rijulIgtinli construction,, and In dpIngathe wgor� quthorlz-
I
'no
AUT14ORIZES
ONLY 7 HE
signed by th� quildIng Official or*hi$
ad thereb y person will be employed In MID koh I the Labor
code the Ststeof Washington relating !o-Wor�mqn's (:;q! npens4-
WORK NOTED
bepuly; and fees are paid, and receipt Is
of .
tion insurance.,
JrSl?,NXTUR� (OWNER 9 AGENT) !OAT� SIGNED
INSPECIION
DEPARTMENT
CITY OFS
Ocknowledged In space provided.
OFFICIAL'S SIGNATURE IfATE
24-64-
EDMOND
L
LL
020MIP111111111111"
771-3202
rHEL8A5FD BY: DATE
ATT- ENTION
TO USE CoR OCCUPY A 8 !NG OR STRUCTURE
AT IS UILD
. UNLAWFUL ,
UNTIL A FINA('IN$PECfION HAS 13EEN -MADE AND APPROVAL. OR ORIGINAL Fite YELLOW — Inspector
'A CERTIFICATE OF OCCUPANCY HAS BEEN, GRANTED.
UBC
PINK Owner GOLD — Assessor
CHAPTER 3.
42-?8
M,AL APPROVAL GiM. BYJ
Initials. 'Date
Building
Fwe Dept.
Planning (ADB)
FOUNDATION ...........
House
Porc". Phrs
Retaining walls
Ceram caroort
PLUMBING
Underground
h-in .....................
Water service
HEATING SYSTEM
FRAMING
WALLBOARD
FINAL
I - 4
OnT t F: I F-0 t-
74
RUM
CO RUCTION PERM 11,APPLICATION 40a
NAME (OR NAME OF BUSiNESSj ADDRESS 2 90�)
LEGAL DMRIP710'NCHIECK SUBDIVISION NIT— JLIO NO.
MAILO�G ADDRESS
/Y
CITY TfiCEPHONi NUMBER PUBLIC RIGHT 00 WAY PER OFF:ICIAL STREET MAP.
EXISTING — REOUIREDDEDICATtON-
NAME
PROPOSED
R GMT OF WAY CONSTRUCTION PERMIT REQUIRED Ll
.1r.
ADDRESS
STREET USE PERMIT REQUIRED r'
z
ItLEPHUNt: NUMBER
SEE ENQtNFERING MEMO DATED
z
CITY
RFM.RKS
1,14 Ae at /W
NAME
J411111
ADDRESS
0
METER SIZE rUILDING SUPPLY SIZE
2
CITY
IFIXTURrU-N—ITS
REMARKS
STATE LICENSE NUM8"
Q5
SIGN AREA
ENV: REVIEW
ADS NO.
Descripti
L 8 0.1 Of Property - include all easements
ALLOWED
PROPOSED
COMPLETE
EXEMPT
101-11 below or attach four copies)
0
I
SHORELINE*
VARIANCE OR CU
PLANNING FiEVIEWSY
DATE'
<
YAqPS A.fp HEIGHT
S!DE REAR
LOT COV ERASE
z
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ElNEW
1:1
'PLUMBING
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COMM ERCIAL
MECHANICAL
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[j OEK;OUSH E] EXCAVATE FENCE
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CHECKED BY
E OF CONSTRUCTION
ITYP kLF-9
J/V
CDD E HEIGHT
PRE -MOVE IN5Pj swim
FkSM.00EL El
SPECIAL INSPECTOR
AREA OrCUP.NCY
OCC
COMPLIANCE INSP. POOL
. I
REQUIRI'D
LOADPANT
V0 00 IP STO El
.0 RENEWAL
C YES n NO
R MARKS
INSERTV APT. BLDG
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7 7
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cc
NUMPER OF STORIES
NUMBER OF
OW ELLING
[UNITS
NATYI4E OF WO" To BE j3NE (ATTACH PLOTPIAN)
/5e,
ON
FEE
PLAN CHECK FEE
Ae
SUILOIIG
PLUMBING
1>
MECMANICA�-
TniiS PerMit covers work to be doAe on private property ONLY.
GRADFNGIFILL
Any CQ65truCtion on the p4iblivdnmain (Curt$, sidew.,Iks.
drivewak marquees, etc.) will require Separate permission,
STATj SURCHARGE
Perrr�li - Application: 18Q Days
ENIIR�Y CCfE
Permit Limit: 1 Year - Provided Work 13 Started Within 180 Days
"Applicant. on behalf of his or her spouse, heirs, ar�signs an6
successorsAn interest. agrees to indemnify, defend and hold
harmless the City of Ed nonds.* Washington, its officials,
iiI
empI6y,-e;I, and agents from any and at: claims for damages of
whatever nature, arising directly or Indli'actly from the Issuancp
.
x
of this permit. Issuance If this permit shall not be deemed to
PLAN C�HECK DEPOSI T
0
0
m ocify, waive or reduce any requirement of any city ordinance
nor ;imit Iri any way thi City's ability to enforce any ordin-ance
TOYkI. AMOUNT DUE
provision."
1 heraby acknowledge that I have read this applicaVon; that the
,
Information given Is correct: and that I am the Owner. or the du;y
ATTE :NTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
state laws regulating Con4tructlon; and In doing the work au thoriz.
THIS PEnmiy
AUTHORIZES
This application Is not a permit until
.ad thereby, no person will be'employed In violation of the Labor
0' .
ONLY THE
signed by the Building Official or his
Code of the State of Washlngt on relating to Workmen's Compensa
C
WORK NUTED
Deputy; and fees are, paid, and receipt Is
lion Insurance.
i IN ECTtON
acknowledged In space prcvidi.,d.
sir?NAIURE,1.OWI�EI,# OR A�!ENTI DAT5 SIGNED.
L
.:.CITY
T
OFWV�L*S SIGNA DATE
Dh AONDS
771.3?02
RELFIASED BY: DATE
A17ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE.
UNTIL . A FINAL . INSPECTION HAS SEEN MADE AND APPROVAL -OR ORIGINAL — File YELLOW — Inspector
U
A CERTIFICATE OF OCCUPANCY' HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK Owner GOLD — Asaossot
102 It
J7
4
CITY 9WEDMONDS LARRY-S. NAUGHTEN
MAYOR
EONIONDS. WAHINGTON 98020 (206) 771- 3202
250 51h AVE. N.
PETER E. HAHN
COMNIUNITY SERVICES
OJAEC.OR
ft
August 27, 1987
Zend/Johnson Medical Cltnic
21906 76th Avenue -,West
Edmonds, Washing n 980.20
RE: Sprinkler Permit #8�60769
Section 20.8 of the Uniform Plumbin.g an inspection on
Code requires
limits. According
sprinkler Systems installed within the Edmonds City
tO building division I records you have failed to obtain the required
inspections consisting of: 1) a backflow preventer test form, and
n in the Water Department.
tion by Lee Willeikse
an inspqc
lve this
Please contact Lee Willeiksen at 771-3202 extension 294 to reso
matter.
Thank you,
Jea,:.One L. Graf
Permit Coordinator
JLG:amm
PUBLIC WORKS PLANNING PARKS ANQ RECREATION ENPINEERING
7 —77 7— 7, ''.P,
INTER -OFFICE CORRESPONiENCE�
DATE—&—n-R-7
To_ e-uN(c-
SUBJECT
Soer717
A w Z
r-w v 1,L 0 l<
Tops FOW 1232
SEP 10
VERBAL ORD S DOFT �RJ LMCOJUSA
77,
El
,V
CITY OF EDMONDS STREET ADORtOWE
PUBLIC WORKS DEPARTMENT - 7110 — 210TH ST. S.W. - EDMONDS, WA 98026
(425) 771-0235 - FAX (425) 744-6057 - E-MAIL: k1ein@ci.edmondsma.us
�tt? C. 1 S (4 \J WEB SITE: www.ci.edmondsma.us
February 7, 2000
Dr. Alan J. Zend, D.O.
2190676 1h Ave. W.
Edmonds, WA 98026
Subject: Water Leak Credit Account #451170
Dear Dr. Zend:
I have reviewed your account and will allow a credit for the billing period between
September 15, 1999 through January 22, 2000 in accordance with our City policy. The
policy states that the customer will be billed at the retail rate based upon the average water
consumption for the same period during the previous year. In addition, the excess water
lost from the leak will be billed to customer at the City's wholesale rate with a 15%
surcharge added for administrative cost. Only one leak credit will be granted in any three-
year period.
Should you have any additional questions after you receive your new billing, please
contact Denise Burke, Utility Billing Clerk, at 771-0241.
Sincerely,
Jim Waite
Water/Sewer Supervisor
JW/lk
cc: Denise Burke
Utility Billing Clerk
wordata\water\2000credit\#45 1170
0 Incorporated August 11, 1890 *
Sister Cities International — Hekinan, Japan
0
0
CLIFFORD J. JOHNSON, D.O. ALAN J. ZEND, 0.0.
STEVENS OSTEOPATHIC MEDICAL CLINIC
FAMILY PRACTITIONERS AND SURGEONS
21906 - 76TH AVE. WEST
EDMONDS, WA 98026
TELEPHONE: (425) 775-4437
FAX: (425) 77 1-2554
February 1, 2000
Jim Waite, Water/Sewer Supervisor
City of Edmonds
7110 210" St S W
Edmonds, WA 98026
Dear Mr. Waite,
FEB 0 4 200C.
PUBLIC
Thank you for you letter of November 22, 1999 regarding the water leak in our system.
We have two meters for our property, and I believe the meter that was shut off due to this
problem was account #4-51170.
I have enclosed an invoice from Turf�o Services for the repair of the leak in our irrigation
system. This is what was causing the excessive water usage. I understand that the City
of Edmonds Combined Utility adjusts the bills when a leaking problem is found and
rectified. In this regard please go back as many months as you can identify for the
leaking inigation system. We appreciate your concern in this regard, and again, we are
appreciative of your consideration.
Sincerely,
Alan J. Zend, D.O.
NAME
ADORESS
CITY
WORK ORDER
zip (I-) & ,
�,a- )PHON
DATECALLED
DATE OF/RORKkEPAIIRMAN
10-1
T=RMS: PAYMENT UPON COMPLETION OF WORK XASLz
1 .5*/. SERVICE CHAPGa PS; MONTH ON PAST DUE ACCOUNTS
DESCRIPTION OF VVORK PERFORIMED
k
n-T
IT:(4 M:D
L�) VrIl IV
QUANTITY
PA PTS CESC F-.1 PTION
UNIT PRICE EXTENSION
!leo
V-L2 -4-
---k
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$ 68.50 'PEE�� 'HOUR
S ��%/l C, C A LL LA 8 0 R
LC
sup_
TOT'l i
SA LEE S,
TAX
L
D By
TOTAL
41 PC. 1 S911
July 1, 1999
40
0
CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT - 7110 — 210TH ST. S.W. - EDMONDS, WA 98026
(425) 771-0235 - FAX (425) 744-6057 - E-MAIL: k1ein&i.edmondsma.us
WEB SITE: www.d.edmondsma.us
Stevens Osteopathic Clinic
c/o Dr. Zend & Johnson
21906 76" Ave W
Edmonds, WA 98026
Subject: Water Leak Credit Account #451160
Dear Dr. Zend & Johnson:
STREFT
BARBARA FAHEY
MAYOR
I have reviewed your account and will allow a credit for the billing period between
March 18, 1999 through July 18, 1999 in accordance with our City policy. The policy
states that the customer will be billed at the retail rate based upon the average water
consumption for the same period during the previous year. In addition, the excess water
lost from the leak will be billed to customer at the City's wholesale rate with a 15%
surcharge added for administrative cost. Only one leak credit will be granted in any three-
year period.
Should you have any additional questions after you receive your new billing, please
contact Denise Burke, Utility Billing Clerk, at 771-0241.
Sincerely,
Jim Waite
Water/Sewer Supervisor
JW/lk
cc: Denise Burke
Utility Billing Clerk
wordata\water\credit99\4451I60
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
CLIFFORD J. JOHNSON, D.O. ALAN J. ZEND, D.O.
STEVENS OSTEOPATHIC MEDICAL CLINIC
FAMILY PRACTITIONERS AND SURGEONS Rfte�ve
21906 - 76TH AVE. WEST rn
EDMONDS, WA 98026
TELEPHONE: (425) 775-4437
FAX: (425) 771-2554
June 23, 1999
Jim Waite
City of Edmonds
Combined Utility Department
7110 21 St S W
Edmonds, WA 98026
Dear Sir,
JUN 3 0 Iggg
PUBL/C
I am writing this letter in response to a conversation that we had with Lori and Denise on
June 22, 1999. IMe conversation was centered on the fact that our water bill was
inordinately high. IMe records showed that the water usage in our clinic had jumped to
about double its usual volume. We were told that if we could identify a water leak that
the City would write, off half of the charges on the bill. The City was kind enough to
come out and inspect us and they did find a creeping water meter indicative of a small
leak. A copy of the inspection is enclosed for your reference. We are rectff�ring the leak,
and we are requesting an adjustment on our billing. In fact, I am requesting that you go
bark to the prior billing period and inspect it for inordinately usage. When I received the
prior bill I also called the City of Edmonds, and I was told that the relatively high water
bill was due to a rate increase. I let it go, at that. Upon fiirther prodding from myself the
City did identify this increased water usage. t therefore, am asking for consideration of
an adjustment of the previous billing period as well if your records show an unusually
bigh rate of volume compared to our bistorical norms.
I appreciate your consideration in these regards.
sincerely,
Alan J. Zend, D.O.
Encl.
40
0 COPY
CITY COMMENT SUMMARY SHEET
CITY OF: TODAY I S DATE A-1 -
TO THE DEPARTMENT OF
RE: CLAIMANT NAME: DATE OF LOSS
LOCATION OF INCIDENT:,=�19e(�
The above claim/incident has been reported to the City. Please review
and investigate the alleged incident and provide your comments and
review of the situation and
RETURN THIS SHEET WITHIN 3 WORKING DAYS TO:
DEPARTMENT COMMENTS: Cc �,,�c r — �-� C-&-f(
Name(s) of City Personnel
Involved
Name(s) of OTHERS Involved
Work
Department Phone
E V 1 '-P1S--7-7/-0Z31�-
Address Phone
MANAGEMENT COMMENTS: I
&Ja2ei t:,,, +-b -�e�rlz
N
dA C k �)-Jf Cma-Tki
� fv& c-.j �+t—%.k I � F-, i,,4 4h, C.'
L4-L�
SIGNED: b2��tc PHONE 7-71-c--L3-4 DATE 12/Q-8/96,
Title I 9-f�,!-T-ca Dept.
0 0
MEMO FOR RECORD
December 28,1998
Re: Sewer Blockage at 21906 — 76 th Ave. W.
City crews flushed the line at 21906 — 76 th Avenue West on October 21, 1998. At
this time the lines were clear. On November 9, 1998 we received a call that the
sewer had backed up again. A crew was dispatched to the above address where
they found a blockage of what appeared to be some sort of paper towels
bunched together in the end of the customer's side sewer where it ties into the
main line. Crews then used the sewer cleaner to removed this blockage which
was shown to the doctor and explained to him that their problem is being caused
by what had been flushed down the sewer, not a problem with the City's line.
Recommendations were given to the owner to try to stop these type of items from
being flushed and also maybe flushing twice to help keep these items from
gathering up and plugging the line again.
Due to these circumstances, I would recommend the denial of this claim.
C, a,) C-4,2=24 0-2a-9e)
Chad Cross Date
Sewer Lead
Wordata\Sewer\JohnsonZend
Side Sewer Drawing
, /rhe City of Edmonds NO . ....... . . . ........ .. .......... ......
NEW CONSTRUCTION REl"Aliks 1.11) NO. 119 .... .. ASNIT. No - ----------------- -
IF E DM
M�DSITNIII No. 75.60
OWNERbP, DR.,A0t4^,TVA-hN- Z-F-I CONTRACTO
TH ISLOCK NO . ......... ......... .........
LEGAL DESCRIPTION: LOT NO . ............................... ... -
JOB ADDRESS21-9-0-G-76a .......
T
,a
(�;,C.G. c RP " W5 E
.Dp
I
9
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12 z
0
is
0
0
CUIRB Lill-JE
'pWvJ-0001-1 1175 (REV. 11/78)
NAMEOF ADDITION ................................................... .... - -- .................... ........... ............
ro"C.0.4
1, UP
as op.
Ic
419/
1 0
-Vr "D' SewER GPUNDE
Approved: HG-W -D cz -
-U - a . . . ............ .. ...
T)A-Fr:) - tUMT5 By
r-7(r-) A, -,Y e- � \,I, �,19 2 rT . ...
The City of Edmonds
Side Sewer Drawing
FAWN11 N'l NO.
NI:W (:()NSTRM:Tl()N IMPAIRS
11) No. 119
k-IH "so Dr> .
r7_55-Cc)o
.1011 Al )DK _SS Z 9 r7 6
Bl ()(j, [qO. I A UALLN-W�Ei(
LIF1 S
C. 2.norr)
1�5'DP.
13 b
Lo CarKo'l cd.- to L', a
13.5'
JE
L) V, 1�
Appvcd:
6 X�p
-Fp- e
1 AQ I
(k'2- 2,6-W �
Admin. Services 0 City of Edmonds
D"klir'wnrioz nirprtor 0
r4f C im for Damages r0rM n F C i S `19-98
P I &LsVtaWXA e t h at —1-kl� lVf ��r le, /1,17- )-f", /-- - / C—
who resides at -;?,/
mailing address —1':,e
residence address for six (6) months prior to date of this claiT---=Z-1 --e--
, home phone # -- work phone #
of and from the City of Edmonds in the sum of: $ vt* --
RECEIVED
5; ;;k?j-5- , claims damages
This claim for damages arises out of the following circumstances listed below. .5 f
'09
Date of Occurrence: I /Ff Time:
Location of Occurrence: fy"4
i
DESCRIPTION:
1. Describe occurrence explaining the nature of the defects or acts of negligence causing damages.
Aj � /' - C' fa"" P, �'4 CA/ ee'e <./,/) /- , ^j c — - P V /t � r"m
V
(attach an extra sheet for additional Inform needed)
2. Provide a list of witnesses, if applicable, to the occurrence including names, addresses, and phone numbers,
0---
3. Attach cooies of all documentation relating to
and/or estimates for
"Additional Information Required for Automobile Claims Only" /L//Z-1
License Plate # Driver License # Type Auto _ (Year) (Make)
Driver: Owner:
Address: Address:
Phone:
Pastengers:
Address:
Phone:
Address:
Owner's Insurance Co.: Policy Number: 5 VA4
Have you submitted a claim for damages to your insurance company? Yes — No
01
CLERK
�'7 Vl---
(Model)
lot a
Note: This form must be signed and notarized
being first duty sworn, depose and say that I am the claimant f& abcalta �*�-�that I
have read the above claim, know the contents thereof and believe the sam e. . ......
State of Washington.
S' ature)
County of jmantj�
Subscribed and -sworn to before me this 19
otary ublic in and for the State of Washingto
c1mdmgfM.d00 12/28/193 —/0-00
�5
CLIFFORD J. JOHNSON, D.O. ALAN J. ZENO, D.O.
STEVENS OSTEOPATHIC MEDICAL CLINIC
FAMILY PRACTITIONERS AND SURGEONS
21906 - 76TH AVE. WEST
EDMONDS, WA 98026
TELEPHONE: (425) 775-4437
FAX: (425) 771-2554
Dec,=ber 1. 1992
Ciih, of Edmonds
Public Works Department
Claims Department
Dear Sir:
We are submitting a claim for damages incurred when the public sewer backed up
causin,,, a sewerage flood in our basement. The first bill rome3 from Rescue Rooter who
was called initially to unclog our drains. The reason thac we cailed them was that the
Citv of Edmonds had done its regularly scheduled wash out of the cit-v Lines one week
prior to this event, and we felt that the back up was probably in our private lines.
However, as it turns out, the backup was in the city's sewer lines, somewhat beyond the
point of washout the crew had attempted the week prior the event. Rescue Rooter who
came out on the date of the flood, November 9, 1998, was not able to find any blockage
in our private sewer lines. We consequently did call the and they did find the
blockage in the,�-Ity�s lines. They then rectified the problem. We appreciate the prompt
service that they gave. but nonetheless,,. we did suffer, darriage in our basement. In order
to clean up the raw sewerage flood we needed to call in Servpro. Thej cleaned the
damage and their billin-- is S203.08. I have enclosed copies of Senpro and Rescue
Roo[Qr*s ($203.63) invoict�s referencing the work done secondary + the public sewer
backup occurrence of 'November 9, 1999. We appreciate your consideration and
reimbursement in this regard.
sincerely,
Alan J. Zen&. D.O.
319047�3
M A i A S 0 S 4E'
F-
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Tf.
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A DRESS.:
ny-
CODE
777777777777�
777777777777" �'
. .... ........... . .. ... ...
p S. I 'Si I ''All C. TER ITORY*:
RES -UMIT '
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OR
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(206)
323-5540
or 1-800-427-7767
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2 19 0 6 7, 6 TH- A v e W
AGENT.
CIT'Y-,ST
:Edmonds,WA 98026
-AT.r 7D 7 Nl
PHO�fE-
:425-775-A-A-37,
:Fandv Comzau
LOSS DATE:
11/09/98
TODAY S 0,k-r-- 11 / 19 9 8
F 41 le 9 8-1 -4 2 9
< < T RAD E T 0 T L S > > >
< < < CCNT-=7.,T--S C-RI"',U?I-z > >
C-EMERGENCY SERV7CES 187.00
-------------------------------------------------------------------------------
SUM�Mz%-RY OF 7'71Y,
I'D- IATE TOTALS
STRUCTURE:
Total Trades 187.00
0 v e rh e a d & Pr o f i t c . co
TAX ic.08
STRUCTURE TOTAL
CONTENTS
GROUP TOTAL 0.00
TAX 0.00
CONTENTS TOTAL
GRAND TOTAL
2 0 31 . 0 80
0 .00
203 .08
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RESCUE ROOTER,
Customer Statement
Bill To: ST443-7
STEVENS OSTEOPATHICNIEDICAL CLINIC
ATTN: SUZANNE
21906 76 AVE W
EDMONDS, WA 98026
Job Site: ST4437
Statement Date: 11/10/98
STEVENS OSTEOPATHIC -NIED I CAL CLLrqC
ATTN:SUZANNE
21906 76 AVE W
EDMONDS, WA 98026
For questions regarding this statement, please contacrAccounts Receivable ar 253-872-3622.
DATE
LN-701 E 11-P.E.
DESC.IZ=.,ON-
-RC
CHA �ES.
CREDITS
11/09/98
054966
Inv
INVOICE - CALL SLIP 113568
Your sarisfaction is our highesr prio?*y!
203.63
Make checks payable to: PLEASE PAY THIS AMOLNNT 203.633
RESCUE ROOTER'
PO BOX 719 TERIVIS:
KENT WA 98035-0719
253-372-3621- f. � : NrET 30 DAYS
State Concr-actors License RESCUR.1-03—Z9
TEL�NK YOU FOR YOUR BUSINT, SS... PAY-INfEINIT IS DUE WITBIN 30 DAYS
NOTE: Payments and invoices dated after 11/10/93 are not shown on this statement.
CLLrrent 31-60 Days 61-90 Days 91-120 Days Over 120 Days
203.63 0.00 0.00 0.00 0.00
W�Jlalo
GALL St_,IP [--I r: n ml
CUSTOMER
AN
-B
1 61 � / '" t'l?b) t I I 1,� , " zL)J) u 1;� JU22 1 -IMU-b0U -6�R
An A Aabca Go. _ F. WA 98035-0719 (206) 282-5563 (253) 272-8800
ri FIC Fivl,, DATE SERV TECH NAME SVC. NO. VAN# CUS*IOMER P.O. NO.
El Wr
HILL 1.1j"
310MER-RAWE 1-! [B
J/
.j,.. 'JU. .. .-
_. 'I r-, I () f�
Uj '... J v
FIC INV# ST#—.
RS CALL SLIP#--
Gily
,r
ZIP
Ju
:.7
i Vl,',;A I I
laa!l� an Ig
iq El SEWER REPAIR
o 1 0 Too
05 0 PLUNGER og [I SCOUR-JETP
0 TRAP Ll FIX
0 1 0 K1 TCHEN SINK
07:U MAIN DRAIN
13'El Fi-oon DRAIN
. I
20 0 Oil TER
1500
0 C/o Lj OTHER
I
:02 1-1 LAUNDRY LINE
08 [1 S I ORM DRAIN
14 Li ri-noR SINK
21 Ll AREA DRAINS
02 Fl 300
06 FJ AUGER
10 El 01 HER
I (A ki AIJ I I I
I
41 BOWL
01 FIT WA,
()Qf -1 POOL DRAIN
16 0 MAIN DRAIN REPLACEMENT
--
FfA0DL.INE
03 CI 700
07 Lj CAMERA I I tj VAPID MACH
, 0 RV
I"A 1.10,
04 F.-I 13AI I I I U13
in 1:1 SE PI 1C, TANK
17 L--1 PLUMBING nErAIR
U PAR FS
08 o SCOUR-JETa
12 0 LINE LOCA1 OR
0 MH
05 r_1 111 IOWER
I I Li UnINAt-
18 Ll WAIEn HEATER
f] Cl FAN-01-11
04 Lj IC165
4000
El O/F
THE ESTIMATED PRICE D(
I OILE 1 12 U C111EASE 11 ?All
—1 1
A ION
NOT INCLUDE SALES OR Oil
TAX, IF ANY, OR COVER UNF(
I IOW MANY MON I I IS
SAME rnoBLEM?
AGO?
D 11 N
YES -
ABLE/BLADE
F)lq-IANCE:
SEEN PARTS OR LABOR, Wl
AF
MAY BE NEEDED TER
ESCRIPTION OF SERVICES AND MArERIALS
PER VISIT,.
ES IMATE
WORK BEGINS, WRITTEN
TOMER AUT14ORIZATION WILL
NO.
j
OBTAINED BEFORE BEGINt
TEN
ANY ADDITIONAL OR EX
WORK.
I AUTHORIZE THE PERI`
MANGE OF THE WORK, SUB,
TO ALL THE TERMS AND CC
TIONS SET FORTH ON -THE I
AND REVERSE SIDE HEREOF, I
ANY TAXES UPON COMPLE'
TI IIS INVOICE IS DUE AND PAY)
ON RECEIPT.
" H()NI
ORIGINAL
ESTIMATE $
x
SIGNATURE
ADDITIONAL
WORK X
INIJIAU
ADDITIONAL
SERVICE
WORK X__
INITIAL'
-1 IIAL'
RECOMMENDATIONS:
ACTUAL 7
SUB TOTAL
TOTAL $
SALES TAX
CAUSE OF BLOCKAGE:
-AMOUNT
to
SIGNATURE
NO
Ofy
PRODU ;1,
,
AMOUN-F
QTY
T
_�MOUNT
ESTIMATE
7Tt(,
TOTAL
PRODUCT
PUFASE PAY
!OU
ty�
DR 00 1 GT
0 DR 002 GAL
TI-if'S,
AMOON]
El DR 003 5 GAL
0 VAPOROOIER
0 OTHER
j.
tt�iqqs nFSGUE 1`1001 F
Estirliate/Customer Copy
'7
C. Ir
CITY OF EDMOP40S
250 5th AVE. N. * EDMONDS, WASHINGTON 98020 - (206) 771-3202
COMMUNITY SERVICES
I
W. R. Hanson, Inc.
2000 124th Ave. N.E.
Suite B-108
Bellevue, WA 98005
Dear Mr. Hanson:
March 23, 1987
I'-
L--7j
SUBJECT: REPAIR OF SEWER LINE AT 21906 76TH AVENUE/'
L RRY S. NAUGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
I am in receipt of your invoice for repairs made at 21906 76th
Ave. in Edmonds at the offices of Drs.'Zend and Johnson. I
question the electrical repair as this is the negligence of the
backhoe operator and should be his responsibility, not the City of
Edmonds.
We will agree to pay for the necessary repairs of the curb and
asphalt.,, The City of Edmonds requests a release from Drs. Zend and
Johnson stating that no claim will be filed with the City of Edmonds in
regards to this incident. Attached is the necessary form for this
request.
If you should have any questions please contact me at 771-3202,
ext. 296.
Sincerely,
'z
BOBBY R. MILLS
Superintendent of Public Works
/cr
Attach.
PUBLIC WORKS PLANNING Q PARKS AND RECREATION ENGINEERING
RELEASE 0
CITY OF EDMONDS ASSURED
STEVENS OSTEOPATHIC CLINIC CLAIMANT
IN CONSIDERATIGN of the sum of Five Thousand four hundredthirty five and 37/100
Dollars
($5 435.37
W R HANSON, INC.
received by V the day of 1987 WE
hereby release and discharge The City of Edmonds
of and from any and all claims which they now have or may hereafter have,
by reason of damage to our property on or about the 4th day of February ,
19 87 , or of any cause, matter or thing whatsoever.
RELEASE
WitnesS�
A. Jonathan Zend, D.O.
Clifford J. JohnSon. D.O.
21906 - 76 h Alle W
1�6�MOII �S WA 98020dress U
77�4437
City of Edmonds agrees to pay for necessary repairs of curbs,
asphalt paving and striping.
C
MILBRANDT, BARKER AIRCHITOS L1EUU1ED*1F "TRUSED"T"MU
IV 11715 SE 5th Suite 100
BELLEVUE, WA 98005
DATE JOB NO.
i,inal ARA.71,an ATTENTION L_
RE.
TO Olt)
L"
WE ARE SENDING YOU X Attached Ej Under separate cover viaj
• Shop drawings ,t� Prints 0 Plans
• Copy of letter 0 Change order 0
7 e following items:
0 Samples 0 Specifications
COPIES
DATE
NO.
DESCRIPTION
V7
THESE ARE TRANSMITTED as checked below:
• For approval
0
Approved as submitted
0 Resubmit -copies for approval
• For your use
0
Approved as noted
0 Submit -copies for distribution
,tIQAs requested
0
Returned for correction�
0 Return -corrected prints
0 For review and comment
0
0 FOR BIDS DUE
19 0
PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY TO
SIGNED:
PROXICT240.2 �InC�Q*kkl.01471. It enclosures are not as noted, kindly notify us at once.
MEMORANDUM OF MEETING AND TELEPHONE CONVERSATION
DATE: Tuesday, September 9, 1986
bit
1 7
PROJECT: Edmonds Clinic
. tj luy
PROJECT #: 86-60
RE: Meeting held at Milbrandt Architects off ice.
Don Reese, Hanson Construction
Irma Kortrighty Milbrandt Architects
Len Milbrandt, Milbrandt Architects
Bill Orth and Greg Dienerg Pacif ic Engineering
1986
1. 1.
MILO, RANW-6AIZ LER ARCI
The meeting was held to review what had been done previously f or the Edmonds
Clinicp and to review the detention and grading provided for the site. Don Reese
indicated that the 53 linear feet of 8" PVC pipe and the catch basin near the end of
this system that had been recommended to be deleted by Pacific Engineering. This
recommendation was not approved yet by the City of Edmonds. Mr. Reese
indicated that the City wanted a reason for eliminating that catch basin and that
length of pipe. We reviewed the grading on site and provided some new spot
elevations meeting the handicap code. Mr. Reese requested that Pacific
Engineering contact the Ci-cy of Edmonds to determine what if anythingg that they
needed for these changes that had been made to the grading and detention system.
I contacted Mr. Jerry Hauth, Engineering Department, City of Edmonds, address:
250 - 5th Avenue North, Edmonds, WA 98020. 1 reviewed with Mr. Hauth the
changes that had been made in the grading and drainage system and the detention
system. Mr. Hauth said that the 531 of 81, pvc pipe and the catch basin near the far
end of the parking lot could be eliminated. Mr. Hauth agreed that the proposed
Type I catch basin near the upstream end of the detention pipe could be changed to
a Type 2 catch basin 48"; a 2411 connecting stub of pipe would then go f rom that
catch basin manhole into the upper end of the detention pipe (4811 in diameter).
The frame and grate provided forp at the orifice control manhole is to be a
standard grate with inlet. Mr. Hauth requested that these revisions although
approved verbally, be provided to him in blueprint form as soon as possible.
T h &ii n I was convey
Wion ed telephonically to Mr. Don. Reese at approximately
5: 6ptember 9, 1986.
A. Diener, P.E.
GAD:amm
cc: Don Reese, Hanson Construction
Len Milbrandt, Milbrandt Architects
CITY OF EDMONDS ASSET INFORMATION SHEET
Property of:
CITY OF EDMONDS
D"N' E W ASSET NO. N2 05121
El ADDITION ADDITION TO ASSET NO.
0 RETIREMENT
DESCRIPTION
SERIAL NO.
LOCATION
DEPT. NO.
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
0
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
INITIATED BY
DATE
*PROJECT NUMBER -&ZlZC=;5 14::�� —
PROJECT COMPLETION DATE
COST -524 --ge(
APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
E��DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
DATE
J�J��
VERIFIED BY
PROCESSED
BATCH NO.-
ttnp/
INITIAL
0
0
�/k
J�
ILE
Memo to: Director of Maintenance F, Operation
Public WIorks
From: City Enqineer
Sub
U.ject: Sewer Connection Charr,es
Da te August 4, 1975
Legal Description: N I-,, Lot 20, Blk 2, Hadleys Acres
Commonly known as: 21902 76th Avcnue W.
Z.F.,F. Calculation:
76.249 Z.F.F. x ($5.55
Lateral x r
Unit S 25
cc.- Paul C. Smith
Owner: Paul C. Smith
S 423.18 Connection Fee
S 100-00 Lateral Charge
S 25-00 Trunk Charge
S 10-00 Permit
$ 558.18 TOTAL
Assistant City Engineer
COAIV,
I 1p /
20
,let
(lr..rgxo
0 le
-,< � 495,.16
tA-fMA4--
lume.,
f UZO14 T
z4r, 00
/40.. 0 Ao
*PLANNING DATA
New Commercial I Multi -Family Projects
II F =1LE I
Name: . :k
?Nc,%CLC� --VA0&a_Q;% -
Date:
I). /s:
Site Address: -1J
46 &Ave-. \01
- . I
Plan Check #: BLD ZA01'�.%010
Project Description: C-4-.c4a CA
X,, cl olne-e-,
Use(s) Proposed: M.
_d;c
Allowed Use: 415) NO)
CUP File Number:Cgj q -f - g:5
To Allow What Uses: Med;ra& ()pQ,,ce
Legal Nonconforming Land Use Determination Issued: (YES
Reduced Site Plan Provided: 01 NO)
zoning -
Map Page:
Comp Plan Designation: M;X"- USf_C.0,%m,&r4 4
d;c--..l 14toy 19 AcAw,
Corner Lot: (YES /(0
Flag Lot: (YES
ADB File Number (date waived):A&,,,��r
Lot Area:
Plans Match ADI3 Approved: (YES I NO)
Shoreline Required: (YES
Critical Areas Determination #: tqlA — Work does- ,ok -ncAve-
El Study Required
El Waiver
SEPA Determination:
AExempt
El Needed (for sites with 500 cubic yards of grading or within 200 feet of Puget Sound or Lake
Ballinger. Requires: (1) Fee, (2) Environmental Checklist, and (3) APO List with notarized form) -
Street:
lid Side:
Rear:
Street eo
?t:(o 10, 4-
Side. (S) f),
Rear:(\,,)
Lot Coverage/FAR Required: qS7
M
Lot Coverage/FAR Provided-
Lot Coverage/FAR Calculatio ns:
ICA- C-4wer a,-� 10;11 be- no�
Datum Point: NIA
Datum Elevation: Ai LA
Maximum Height
Actual Height
NO
Subdivision:
Lot Aggregation R eq uire d
40..
Landscaping Matches ADB Approved: /\J0
Landscaping Bid Provided: (YES I NO) _FBond
Amount (100% Bid):
Plan Review By
PLANNING DATA 0
New Commercial / Multi -Family Projects
S TR EE T F =FLE
commercialParkin4AnI7 IS
Business Name
Type/Use
Parking
Ratio
Tenant
Area
Required
Parking
re"ded d6,4
-to 1)5
Total Parking Reqtdred.
rotal Parking Provided:
ainfly
# Bedrooms per Dwelling Unit
Parking Ratio
# Units
Required
Parking
Studio
1.21D.U_
1 Bedroom
1.51D_U.
2 Bedrooms
1.8/D.U.
3 + Bedrooms
2.0/D.U.
Total Parking Required.
WA
Total Parking Provided.
Plan Review
V_
CITY Of EDMONDS
APPLICATION
to the
lilTECTURAL DESIGN BOARD
0
ER/REPRESENTATIVE ZEHD
DATE_11— '114&15 FILE #
SITE PLAN
BUILDING PLANS (3): ELEVATIONS
LANDSCAPE PLAN
ENVIRONMENTAL DATA RECEIPT P
SIGN EXHIBITS _7_�iEE -�RECPT P
PLAN MODIFICATIONS TO FILE NUMBER:
HEARING DATE
�ql
PHONE- '7 -7 C- +4 S7
RESS 2� 1 �,04- IS W - . "M ON4—>5 WA so - ZIP CODE—
JIM B ej.LEV" -
HITECT/DESIGNER 6-ro.-sr, w4sN. 4kc PHONE 4:54- 7 11W
ADDRESS
PERTY ADDRESS 2.117)Ob 7&rh - AVE k4, - X0110110S 94, ZONING gtl
AL DESCRIPTION—Tl4fL 1J, 114, OF LOT 2D T0QgJH7r=,K 1141TH T_H�� H. &0 1 0F 774E -S- V4 OF
�ID L-o-r 2-0, 1>toc4e_z, 7-0 7-hhE P447'�. N"VF
\IoL. 0 OF - flAT6, .30 gfokz55 or- -�' Nowt-i /.-,/y cau. PJASH
_NS SUBMITTED FOR APPROVAL:
Building Plans - Preliminary Final X
Site Plan X - Landscape Plan —Elevations
Sign Elevations Site Plan Landscape Plan-- )<
Modification of previous approval
STING USE OF PROPERTY T W 67 t!K
dL,F— FAMIL"T' 4-,O'rez,
CRIPTION OF PROPOSAL
ROXIMATE DATE WORK WILL BEGIN ON PROJECT J4NUA&1< No t
IMATED TDIE FOR COMPLETION OF WORK 4 7-0 �5 MQt-�Ut�>
.,FASE/HOLD HARMLESS AGREEMENT: The undersigned applicant, his heirs and assigns, in
.sideration for the City processing the application agrees to release, indemnify, de.fend and
,d the City of Edmonds harmless from any and all damages and/or claims for damages,
-luding reasonable attorneys; fees, arising from any action or inaction of the City whenever
action or inaction is based in whole or in part upon false, misleading or incomplete
�.ormation furnished by the applicant, his agents or eMDloyees.
3MISSION TO ENTER SUBJECT PROPERTY: The undersigned applicant grants his, her or its per-
ssion for public officials and the staff of the City of Edmonds to enter the subject
operty for the purpose of inspection and posting attendant to this application.
4'. ;��; . -
(tig'n-ature of Applicant)CHbh)
0
E
5%
,.V�
0
---4W9 CAf FKOM Z X It VV r-A6aP
-4r)
fACH 4AA- T�f
9
4
J u 4;.. 4'Y,4
.-- I , A ,
S- Of M. f�,
Rm�
ZL
S'.3 1 Y, 3 1 z 0).") 0
4'13 P5
17AIL
11
z X 4�-Mm
-VIWN < IL-
-eb,IL-
f Perr
(� � Ll !3 �-
1;?E:MILS
�-"X MIL's,
AV Fasms i
'2!,',4'TJzlf4
I`x Aft 6zp&lz
070ARVIel
PKOMT PMrM,
12"x(,m %wiLs,
-r-I N - CAMW M
�, VIA - 60tic.
rol*-r m 4�11
C4RAYaL-
IYF
M"AL P&CK. rt-V!V- - t-NP El-�ffv, Vja�,- 110"
.---rC:Nr-f
I r%...I. ---ff MGL05uf�t
Aob Qo.
vair-
ch�-
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).
Side Sewer Drawing
The City of Edmonds
EASEMENT NO - --------------------------------------------
FA&STRUCTION E:l REPAWIS., LID NO. A.1-9 ....... ASMT. NO - ------------------
C WKrr
S5 C-IT5 tj�,cMcjzt
'bP
OWNER CONTRACTOR --- aF-EDmo-MOSERMIT NO. 75.6-0.
JOB ADDRESS 2.1-9-0-ro ... .................. LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
W
0
V'c.cLcPjP lW'W!SE
9-[)P
IN,
9
261
CURS LINE.
NAMEOF ADDITION ............................................................... .................... ----------------------------------
?,I")Oro 7G'"w. No R-T V-�
WW!)E I I DP.
8.510P
t
1-9-5�w 11 9.5
13.5
ro 4'
Approved: NG-\oj LA-TTF-PJkl- 4 RF- AMUs-TeD %IDE SewF-R GPPME
78) DA
Z01-17-75(REV-11/ 7G -rH A-4F-.\-4. �,-1187. By - ---- -- W ---- ------------------------
T�ll -5 -114
Ole
C I T Y of EDM ODS S IRE
For Inspection Ca 1-3202
PUBLIe VVORXS
STREET R
Address of Construction:
S E W E R P E R M I T
PERMIT NO. 07560
FVI�ARAI I TINGER�
Property Legal Description (Include all easements): /�* /'" (_ z LIFT STATION
Owner and/or Builder:
Ale
12,y V
Contractor & License No: 144 f-e�' E
Single Family Residence
Multi -Family
(No.
of
Units
Commercial
(No.
of
fixture Units
Invasion into City Right -of -Way: No Y Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No k Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
I certify that I have read and shall comply
with the items listed on the back.
Date
Permit Fee: go - 0(_9 Issued By: 71—
Trunk Charge: 25-,(90 Date Issued:
Assessment Fee: Receipt No.:
Partial Inspection:
Comments ___�a`te Initial
Final Inspection Approved:
Date -Initial
00
Rejected:
C)
Reason Date 7—nitial
Ln
PERMIT MUST BE POSTED ON JOB SITE
White Copy - File Green Copy - Inspector Buff Copy - Applicant
The City of Edmonds Side Sewer Drawing EASEMENT NO. - ------------------------------------------
NEW CONSTRUCTION tA REPAIRS LID NO. .1-19 ........ ASMT. NO - -------------------
OWNER T)R..A0.HhA-S0t4 .... ........... CONTRACTOR .................... PERMIT NO. r7-5�,GO
-r " 46
JOB ADDRESS2.19-0-cb ....... 77.6 .......... LEGAL DESCRIPTION: LOT NO - --------- ---------------------------- BLOCK NO. .-Y-IA..BALLINGER.
LIFT STATI 0 N
8.5 up
42,"W!I&
C-0.j�ptt)& -%\
64 0,/
. 50.
NAMEOF ADDITION ----------------- -------------------------- ............................................................................
2- 19 0 ro 767.`
40
\00,
OP
F'01111�
c-P%P 1.5'DP-
15
is! 13.5
_741Wt
PWW 0001-11/75 (REV. 11/78)
4D
Approved:
7G A-,/E-. \pj.
I)AT141�1AMX---
By,,,OLe ..... .... ...... ..........................
------ OL
71r
DATE : -:5�— " - ycr
MEMO TO Building Division
Planning Department
FROM: Engineering Division
Public Works Department
/
SUBJECT:
After revie-.-i of the subject' Building Permit application, vie have the following
com-ments:
I Connection to City water system reauired.
2.
Connection to City
sanitary
sewer system required.
3.
Pight-oF-way permit
required
For any work on City property.
4.
Driveway slope not
to exceed
14",-
5.
Backwater valve required
if
downstairs plumbing below elevation
upstream manhole.
-is -of
6.
Water and sewer lines to be
separated by 10 foot mininium.
M
1011
an 9/Q.7
o
%
lie
DATE:
APPLIM SECE
IG
4G
A
Iii One
AL t-
L (Circ
Sn,,aZ FAMILY
pj4ming,
ADJ
VARIMZE/ ETBACK
iUli 13
E Pm*aT
CONDITIONAL US
ADB REQUTJM-0' Yli
REQUI
OTHM ZONING
FE�.TURES
dEss
ST-oPE'-&.%tHICLE'AC
IAN I (On Site) io,
.9
.DRAINAGE P
19
STREET -FILI
FILE
I��TION� 10",
ESCRIPTICO VFBIF /41
LEM"D
7 77 ..........
l?''j-1 J.
IONS
DEbi
WIT CLAIMA
12-
rIt/PRIVA7?_-'
At
SiMENT PTMO
3".
No LIN,
-ONNECTIM
SE
ICt4 REQUI
MAT/SUMIVIS-77-7777—
STRUCTI
EN'.pERMIT REQD
R1Gkf1--Vr-WAjTtCONS
PUBLIC IMF
BC
17,
-TVFS
JND-
SC)Yff -CONDI... & -'GROtV. i
CKEnw—
WATER FIEID
18
REQUIRED,
MING
STREET
77 /:/./T'
19
RED.,
AND6jrJER " ih
J U!L�l Z;7
20
77
SIDEWMX REQUIRED'
!OR-DRIVE%y
CUMCUY!'T
2
Yf STRiMT-'NAME SIUN 1=1% /-/m/
23:
24.,
OTHER SIGMiG REM
fl,
ILITY!, 7 7
jpjj / Ld"If I
h� 2t'AV A 3 Mt
SID
25
SIZE
TER'
-/// / ,
A I ?, -t� /
EXiSTM WX T1
/
/ff
SIZE
27
�:,-WATER
77
"LIkk!SIZE
..'SERVICE
41 , '1 28
REQUIRED
K
MDRAMI
HYDRANT SIZE'EXISTING e
P
'A
ICN
CMINWTICN INSPECI
CROSS
7
20, 3
VELU :,W.
WATER
j40
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CITY OF EDMON7DS
CONSTRUCTION PERMIT APPLICLATION joB
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NAME (OR NAMr V1 BUS.71NSS)
LEGAL DC
LEGAL DE
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TELEPHONE NUMBER
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,HECK SUBDIVISION NO.
----7
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING Zo — REQUIRED DEDICATION
PROPOSED_Z;0�—
RIGHT OF WAY CONSTRUCTION PER IT REQUIRE
STREET USE PERMIT REQUIRED 0 —
SEE ENGINEERING MEMO DATED
METER SIZE
TE EPHONIE NUMBER
REMARKS
SIGN A
ALLOW
ude all easements
M r- VARIANCE OR C
Pe- e--5 YARDS J45��
FRONT
;ROPOSED I COMPLETE I EXEMPT
UNITS
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NEW
RESIDENTIAL
COMM C L
COMMERCIA
13
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REPAIR
RETAINING WALL
13
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CHECKED BY 'n
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EXCAVATE
OR FILL
FENCE
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DEMOLISH
pRE-MOVE INSPJ
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a
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REMODEL _j
WOOD STOVEI n
RENEWAL
INSERT
APT. BLDG
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NUMBER OF sTORIZFF'�INIUMBER OF
D
DWELLING
U Ut�
NITS
WA—TURE OF WORK TO
OF
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit overs vork to be done on priv a property ONLY.
domain (curbs, sidewalks,
GRADINGIFILL
Any construction on the Public
marquees, etc.) will require Separate permission.
STATE SURCHARGE
driveways,
Permit Application: 180 Days
ENERGY CODE
Permit Limit: I Year - Provided Work is Started Within 180 Days
"Appiican on behalf of his or her spousa heirs, assigns and
agrees to lndemnlf� ' defend and hold
suctessors In interest,
harmless the City of Edrnonds, Washington, its officials,
all claims for damages of
-------
employees, a d agents from any and
atever nat n4 ly or indirectly from the issuance
wh ure arising direct
shall not be deemed to
PLAN CHECK DEPOSIT
it. l6uance of. this permit
of this Perm rty requirement oil any city ordinance
modify'. waive or reduce ai
In any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
nor limit
provision."
I hereby acknowledge that I have read this application; that the
I am the owner, or the duly
ATTENTION
Information given is correct; and that
authorized agent of the owner. I agree to comply with city and
In doing the work authoriz-
THIS PERMIT
AUTHORIZES
state laws regulating construction; and
ad thereby, no person will be employed In violation of the Labor
to Workmen's Compensa-
ONLY THE
WORK NOTED
Code Of the State of Washington relating
INSPECTION
DEPARTMENT
)ATE SIGNED
CITY OF
EDMONDS
771-3202
GROUP
TION
H
OCCUPANT
LOAD
y 30 " 1 q9#4
APPLICATION APPROVAL
This application is not a permit until
signed by the Building official or his
Deputy; and fees are paid, and receipt Is
acknowledged In space provided.
OFFICIAUS SIGNATURE
;ELEASED Bi.
uAl.
ATTENTION OCCUPY A BUILDING OR STRUCTURE YELLOW — Inspecl
IT IS UNLAWFUL TO USE OR ADE AND APPROVAL OR ORIGINAL — File
UNTIL A FINAL INSPECTION HAS BEEN M BEEN GRANTED. UBC PINK — Owner GOLD — Assessor
A CERTIFICATE OF OCCUPANCY HAS
CHAPTER 3.
In2-78 ------- --
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2 904 7M Avenue Won. Ednionds. W85 otan United Statin;
A!
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Aluminum W1 Painted Cabinet
PLANNING CONDITIONS:
1) Sign shall not be greater than 3 feet in height.
2) 30 square feet of landscaping is required to be
planted at the base of the sign.
3) No internal illun-tination is penmitted.
WHITE SIGNS
q25-7q5-0760
15107 Hwy 99 #A Lynnwood WA 98037
TeVFax 425-745-0760
WA L1c,# 601 969 398
L & I # WHITEU1976CJ
Efectdc WHITEU1933BP
customer.
Eye Surgical Associates
Address:
21906 76th Ave W
Edmonds WA98026
Date:
Sales Rep:
PhoneQ ."f V
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,PX42,5 745-&,60,
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(,0NDITION5
APPROVED. By PLANNING
1L: r-. OFF—,, 3
Size: H30" x WOO" =Total 12.5 Sq Ft
Face: 16gage Thickness —Aluminurn
Paint: Powder coated finished paint ( Dark Bronze color)
Leftersone side Lettering
Sintra Plastic OrAcrylic 1/2" —1/4" Thickness Whiite Color
" EYE SURGICAL " H4"-1 /2" x 11
" ASSOCIATES" H W-1 /2" x 10
"5rianKTakaei,M0,PLLC" HZ'-1/2"x9
&tdwr I
3/&Jag bolts ; 4 sets for ach pole
RRECEW EV
SEP - 9 2013
DEVELOPMENT SEhvit-;ES UK
CITY OF EDMONDS
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BLDG. DEPT.
CONDITIONAL PERMIT
WORK.
ADDRESS. 71,7"' 40S 11)
OWNER -
APPROVED DATE -
BY
BLDG. OFFICIAL
KEEP STA,11!"PED
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PLANS 011'4 j0BSJ'FE. FOR
ALL. INSPECTIONS
--JSHEET
PERMIT No.
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GENERAL NOTES
.1. CURB AND GUTTER TO BE REPLACED SHALL MATCH -EXISTING CURB AND
GUTTER. EXISTING CURB AND GUUTER SHALL BE SAWN AND THE NEW CURB AND
GUTTER SHALL JOIN AT THE SAME E-LEVATION AS THAT OF THE EXISTING CURB
AND GUTTER AND EXISTING PAVEMENT.
2. THE NEW DRIVEWAY SHALL CONFORM TO CITY OF EDMONDS STANDARD PLAN 10,
CEMENT CONCRETE DRIVEWAY TYPE "D", ALTERNATE 2. CONCRETE SIDEWALK
AT DRIVEWAY SHALL BE 6" THICK.
3. ALL CATCH BASINS SHALL BE APWA TYPE I UNLESS OTHERWISE SPECIFIED,
4. ALL EXPOSED STEEL INSTALLED IN THE FLOW RESTRICTOR/OIL SEPARATOR
SHALL BE HOT DIPPED GALVANIZED AFTER FABRICATION AND ASPHALT COATED,
5. ALL CORRUGATED METAL PIPE SHALL BE OF THE SIZE AND LENGTH SHOWN ON
THE DRAWING AND BE FABRICATED OF 12 GAUGE STEEL, GALVANIZED AND
ASPHALT COATED, TREATMENT No, 1,
6. ALL DOWNSPOUTS AND ROOF DRAINS SHALL BE CONNECTED TO THE DETENTION
SYSTEM.
7. THE CONTRACTOR SHALL EXCAVATE TO EXPOSE THE 12" STORM DRAIN CULVERT
AND DETERMINE ITS I EXACT ELEVATION PRIOR TO CONSTRUCTION OF THE
DETENTION SYSTEM OR LAYING THE 8" PVC DISCHARGE LINE.
8. PROJECT DATUM is 288.6' BELOW CITY OF EDMONDS DATUM, ALL ELEVATIONS
-WITHIN THE PROPERTY LINE ARE SHOWN ON PROJECT DATUM! ALL ELEVATIONS
OUTSIDE PROPERTY LINE ARE SHOWN ON CITY OF EDMONDS DATUM.
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JOB NO. :
85-48
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21W-6
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SETBACK
21906 76TH AVENUE WEST
EDMONDS, WA 98026
127.3W N 880 " 29" E
"Num )4m- r- NOTES
1 EXIST ENTRY TO BE REMOVED & REPLACED
W/ NEW VESTIBULE.
EXIST CONC. WALK.
EXIST LIGHT POLE.
EXIST 6"CONC. CURB.
151-0" Maw
SETBACK > EXIST SIGN TO REMAIN.
> EXIST TRASH ENCLOSURE.
EXIST CONC. PATIO, STAIRS & LANDING.
— — — — — — — — — — —
EXIST WOOD FENCE.
WILDING FOOTPRINT
J PROPERTYLINE > EXIST CONC. ADA RAMP.
> EXIST ROOF OUTLINE ABV.
DEMO EXIST ADA RAMP HANDRAIL & PROVIDE
NEW METAL HANDRAIL.
I EXIST LANDSCAPING TO REMAIN.
— — — — --- — — — — — — — — — — — — — — — — —
> DEMO EXIST ADA PARKING STALL & PROVIDE
>
\T4 ACCESSIBLE PARKING STALL & ACCESS AISLE
7
NN TO ACCOMODATE WIDTH OF VAN.
COMMENT # 1 > PROVIDE wVAN ACCESSIBLE" SIGN MOUNTED
W/ THE BOTTOM OF THE SIGN AT LEAST 60
4�N ABV THE FINISH GRADE OF THE PARKING
N STALL PER ANSI Al 17.1 SECTION 502.7.
N
N
RAMP
NOTE.' TRASH & RECYCLING WILL BE REMOVED
SLOPE
FROM THE BUILDING AND PLACED INTO THE
1,51.0" III -On L5v.o" L EXISTING EXTERIOR TRASH ENCLOSURE FOR PICK
-on UP,
\TRA
SL
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COMMENT#1 x
EXIST ASPHALT PARKING LOT
(18 PARKING STALLS)
11/6/12 PERMIT m SHEET 2 OF 18
GENERAL'N OTES,
1.�
-tX I 8T
CURB AND GUTTER TO, BE� REPLACED SHALL MATCH1 CURB AND'
GU TER, EXISTING CURB AND., GUUTER. SHALL.:AE 'tAWN AND THE. NEW CURB. -AND
GUTTER SHALL JOIN AT THE_SAME ELEVATION', AS','THAT.- OF, THE,.EXISTING CURB
L�4N
AND. -.GUTTER AND EXISTING PAVEAENTI
2.
THE,'.NEW_DRIVEWAY SHALL CONFORM TO:CITY OF,IbAoNDS., 100
-6
C� NT CONCRETE DA'iVEWAY',TYPE "W',. ALTERNA E 2, C NCRETE. SIDEWALK
ME:
AT -DRIVEWAY SHALL -.BE 6 THICK'
3.
ALL, CATCH BAsINS.SHALL- BE' APWA TYPE,l UNLESS OTHERKSE SPECIFIIED,.
4.
ALL' EXPOSED STEEL INSTALLED IN T14E FLOW RESTRICtO-R/OIL,SEPARATOR
SHALL BE HOT'DIPPED GALVANIZED AFTER FABRICATION AND, ASPHALT COATED.
5.
ALL CORRUGATED METAL PIPE SHALL. RE OF THE SIZE.,AND LENGTH SHOWN ON,
THE DRAWING AND BE FA9RICATED' OF 12'GAUGE STEEL., GALVANIZED AND
ASPHALT COATED' �TREATMENT.'No. 1.
ta
6'.
..ALL DOWNSPOUTS.AND ROOFDRAINS SHALL BE, CONNECTEDTO THE DETENTION..
0
SYSTEM.
co
7.
THE CONTRACTOR SHALL EXCAVATE TO EXPOSE THE 12" STORM DRAIN CULVERT
AND DETERMINE ITS' EXACT ELEVATION PRIOR,TO CONSTRUCrION OF'THE
y
DETENTION SYSTEM OR LAYI'NG THE 80 PVC DISCHARGE LINE. -
80
PROJECT�DATUM Is.288,61 BELOW CITY OF EDMONDS DATUM.,ALL ELEVATIONS
THE PROPERTY LINE ARE,SHOWNON PROJECT, DAT,UM;.,ALL ELEVATIONS
OUTSIDE PROPERT Y LINE ARE SHOWN,-ON.CITY OF. EDMONDS DATUM.
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COMMENT#1
EXIST ASPHALT PARKING LOT
(18 PARKING STALLS)
127.36'
f
N 880 44'01" E
PROPERTY LINE
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r-KOJECT ADDRESS
21906 76TH AVENUE WEST
EDMONDS, WA 98026
> EXIST ENTRY TO BE REMOVED & REPLACED
W/ NEW VESTIBULE.
> EXIST CONC. WALK.
> EXIST LIGHT POLE.
> EXIST 6" CONC. CURB.
> EXIST SIGN TO REMAIN.
> EXIST TRASH ENCLOSURE.
> EXIST CONC. PATIO, STAIRS & LANDING.
> EXIST WOOD FENCE.
> EXIST CONC. ADA RAMP.
> EXIST ROOF OUTLINE ABV.
> DEMO EXIST ADA RAMP HANDRAIL & PROVIDE
NEW METAL HANDRAIL.
EXIST LANDSCAPING TO REMAIN.
> DEMO EXIST ADA PARKING STALL & PROVIDE
ACCESSIBLE PARKING STALL & ACCESS AISLE
TO ACCOMODATE WIDTH OF VAN.
COMMENT# 1 > PROVIDE "VAN ACCESSIBLE" SIGN MOUNTED
W/ THE BOTTOM OF THE SIGN AT LEAST 6011
ABV THE FINISH GRADE OF THE PARKING
STALL PER ANSI Al 17.1 SECTION 502.7.
NOTE: TRASH & RECYCLING WILL BE REMOVED
FROM THE BUILDING AND PLACED INTO THE
EXISTING EXTERIOR TRASH ENCLOSURE FOR PICK
UP.
PARKING SPACES REOU I 5z
PARKING SP2ACES PROPOSED.
BARRIER FREE PARKING SPACES.___L_____
Zone—B&I Comer gp Flag,_�
Setbacks Required
Actual v
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9ite lanordrawlng* sub�,IaseParate
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cor OV 0;
enforcement action." NOV 6, 2012
GO ISION
EN AS Date-. E
DEC 12 2012
Ilu T
PERMIT CORRECTIONS #1
REVISION DATE: 12.12.12
11/6/12 PERMIT
III PROJ. No.: 201206
DRAWNBY:CE
CHECKED 13Y:FMA
DRAWING NO:
SHEET 2 OF 18
105
THE NORTH ONE QUARTER OF LOT 20, TOGETHER
WITH THE NORTH 60 FEET OF THE SOUTH THREE
QUARTERS OF SAID LOT 20, BLOCK 2, HADLEY'S
ACRES, ACCORDING TO THE PLAT THEREOF
RECORDED IN VOLUME 8 OF PLATS, PAGE 30,
RECORDS OF SNOHOMISH CO., WA.
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