22517 72ND PL W.PDF1111 lill 1111
5732
22517 72ND PL W
11
APPLICATION
CARD No . ......................................
The City of Edmonds
I
- "E
for
SIDE SEWER PER311T
EASEMENT No
V—'rnl� --
OUTSIDE
INSIDE REPAIRS
. ....................................
o
OWNER)50-dd ....... ................................ ......... ...................
CONTRACTOR .... j --- P ...................................................................... PERMIT No. I!::::
No. ............
4��.a . ......
_ndHOUSE
STREET
-LJE LOT No . .............. ........................
AVEN --------
BLOCK No . ................. ......... ...................
NAMEADD . ......... ....................... - . ................................................................................................
Date
A
BACKFILL WORK ORDER ISSUED ........ ..........................
SEWER WORK ORDER ISSUED
tz.
APPROVED
EP 19 1963
Approved:
DEPOSIT, $ .................. ..........................
DATE --- ................. V,,7
... By�x ------------
0 0
File No. 01.1.12
�Stre-et-File,,
MEMO FOR RECORD
SUBJECT: OVERFLOW REPORT - TRACTION RIGHT-OF-WAY, BALLINGER
AREA - 24" SEWER MAIN
On January 5, 1983, the City of Edmonds Water/Sewer Division
crew was notified of sewage overflow along the traction right-
of-way in the vicinity of 225th S.W. Larry Ogle and I
investigated this (between 2:00-3:00 p.m.) and found sewage
overflowing from M/H #14-56 in the traction right-of-way near
22521-72nd Pl. In checking downstream M/H's, we found them
all backed up but not overflowing from 226th Pl. to 23211-
74th Ave. where our 24" sewer line enters the Mountlake
Terrace system. We drove from there to the Terrace lift
station near 7409 Lake Ballinger Way where we found Moose
City Service Electric working on one 6" pump with 2-6" pumps
still operating.
We found no apparent blockage in the City sewer main. The
combination of high rainfall, increasing infiltration, and
the Terrace lift station running below capacity seemed to be
the cause of sewage back-up and overflow.
Returning to upstream M/H's, we found the water level had
dropped several inches indicating the overflow problem had
passed its peak.
On January 6, 1983 (between 3:00-4:00 p.m.), Ronny Holland
and Marty Burns were dispatched to clean up overflow debris
in the -right-of-way between houses and backyards where the
overflow occurred. On January - 7,, 1983, they were dispatched
to clean up the backyard of (212517-72nd Ave. W'.
Y�l L)414Z
Scott Hig�A and
Water/Sewer Division Leadperson
SH/ml
4/13/83
cc: Finance
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STREET PLE
21TY OF EDMONDS
PUBLIC WCRKS — EICINEERIM
ACTION REPORT
N? 2626
SUSPENSE DATE:
Date: Time: File#
Attachments: =Yes
REQUESTOR:
NAME:
ADDRESS:
Lj
PHONE:
REQUEST RECEIVED
BY:
T ELEPHONE
CONTACT IN
OFFICE
r-1
01
OTHER:_
RECEIVED BY:
ON"
M"i
All Concerned Notified
Action Completed/File
STREET FILE
CITY OF EDMONDS
1.10
- SEWER DEPARTMENT -
STOPPAGE OF SANITARY SEWER MAIN REPORT
DATE: j j
- 1-1 -Z
TIME CALL RECEIVED:
—ej o
LOCATION OF
STOPPAGE:
TIME OF ARRIVAL ON THE JOB SITE: *,.15
TINE NORMAL FLOW OF SANITARY SEWER REESTABLISHED:
CAUSE OF STOPPAGE:
ACTION REQUIRED TO CLEAR MAIN AND/OR LATERAL: r
1'4�- OU" V-'!
J
CITY CREW ON STOPPAGE CALL OUT (Personnel Involved):
LOCATION OF RESIDENCE AFFECTED: 7 -) - '.j J'�
NAME, ADDRESS, AND PHONE MMER OF PROPERTY OWNER:
DESCRIBE DAMAGE TO PRIVATE PROPERTY:
REMARKS:
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Street & No-
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P.O., State & ZIP Code
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Postage
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Certified Fee
Special Delivery Fee
Restricted Delivery Fee
Return Receipt Showing
to Whom & Date Delivered
Return Receipt Showing to Whom,
Date, & Address of Delivery
TOTAL Postage
& Fees
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Postmark or Date
IS
98020
sam Wa Lk(er
4*795 Fairway Dr* 4928
rW-1T1IV.?r-t Parks, CA 9
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CITY OF EDMONDS
250 - 5TH AVE. N. * EDMONDS, WA 98020 9 (206) 771-3202
COMMUNITY SERVICES:
Public Works * Planning * Parks and Recreation e Engineering
890 . 194
CERTIFIED MAIL
April 24, 1991
RE: Problems with venting of your plumbing fixtures
Dear :
LARRY S. NALIGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
The City's sewer cleaning records show that the home at this address is
experiencing problems with the venting of some of your plumbing fixtures
when the City crew is conducting cleaning operations of the City sewer line
in front of this address.
The City's cleaning operation is essential for both you and your
neighbors. It cleans debris in lines to prevent plugs, prevents corrosion
and potential future collapse, and achieves a better flow characteristic in
the public sewer lines. We need to do this often -- perhaps even 3 times a
year -- in some critical areas. The City's cleaning operation typically
involves the utilization of a high pressure water jet.
The problem which occurs at the home is the result of a high pressure surge
through your internal plumbing system. A properly constructed plumbing
system is designed to easily vent this additional pressure without any
visible impact at your residence. An undersized venting pipe (or not
having enough vents) cannot handle the pressure surge, and the only release
that's available is then through your toilet (or another fixture). The
Uniform Plumbing Code typically requires a 2" vent, and further requires a
separate vent for each plumbing fixture which is connected to the sewer (a
toilet, a sink, a shower). Your home clearly does not have an adequate
venting system (you either have a 1-1/4" vent, or not enough of them), and
you therefore may continue to experience the pressure surges.
The City does not have a choice as far as discharging its responsibility in
cleaning the public sewer line. It is therefore up to you to take
corrective measures as to how to properly vent your own plumbing system.
The City has come up with two options that will remedy your problem:
Option 1: Upgrade stack vents for toilets and other fixtures which
are experiencing problems to required sizes.
0 Incorporated August 11, 1890 *
Sister Cities International — Hekinan, Japan
Page 2
Option 2: Install a clean -out outside of house per attached
specifications. Enclose box so it can vent properly when
excess pressure is put on house lines. This option would be
the cheapest and simplest way of correcting this problem.
At the same time, it would allow access to sanitary sewer
lines if stoppage should occur. This vent clean -out would
allow a place for backup in lines to go before entering your
house and causing costly damage.
The City would appreciate your expeditious cooperation in this matter. The
City must continue proper maintenance of its sewer lines, but we obviously
do not wish to see continued problems occurring on your property because of
poorly designed vents. It is your responsibility to correct these
deficiencies.
We cannot keep notifying you each time we come out to clean the line. It' s
up to you to have a plumbing system that conforms to code. Option 2 is a
relatively simple one to construct.
Should you have any questions on these options, please call Everett Akau,
Scott Highland or myself at 771-3202, extension 317 or 318.
Sincerely,
Ron Holland
Water/Sewer Supervisor
Enclosure
SEWERVEN/TXTSEWER
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Sift iw"tion ------
I. Site Addrosa/lmeart ;k;b,71'7 7a pt aw
0:1
2. Property Tax Account Numba! o i o a -3 AUG'2 2 1997
3- APPfoxhnafts SW Sm (acres air squan feet): 7, a a t�
4. Is Lhb site curmtly dCvQ0pgd? A yea; _ rU.
If yes; how is site developki? __eX5 i jr;;Ys ko4A3e_
S.,. Dowribs, dw Vneral site toMraphy. Cho* an ftt apply.
Plat IM dm 54eet olovat�m chmp am sum site.
ROUT. st"a an do garmally loss am 13% (a ver"ad "m of jofim over a
HICY: 86POO Pfftalt an *0 duon Ow 15% =W Im dw 30% (a vadcal
nee of 104M am a haftontal distorwe of 33 tD Wfw),
Stoop: -grades of greater thon 30% pf eme an sito (a vuftd des of mw ovw
a harizorttol distance of less than 336foo).
Odur (plesse, doe.
6. Site conWAns mu of year-mund s*Mh* wat"V_. NW
To, 7., Site cmtdm arom of s0000rW stutding W&tw.
What seUCII(s) of " year?
8- Site is in *W fl=fWAY M10 floodpbft of a water 6urse..
9 Site Contains a cmk as an w*s wherie water flows across tM va%mds onface? Flows us
you -round? f-0 Plows an ""and? - (Who dw of year?
10. Site is Prinurdy: f0mored _; madow shrubs ; ndxod
urban landWAped (lawmbnft ex)
11. Obvious wadavid is Present on site:
For offf shff use
2. Sibr is Zorwd? _7STT
2. SCS mapped sad M*a)? 1qIdAA!�P*d-VftW
woww trimm" arc.& maptutionsweiand; u �-aasitpz A4
An
4. CrftW Amu Irmentm or CA. map bulkafes Crftal Am an d%? —
5 30 WOM doWAW MWO VabrigloM WWOWW MIUd AM? - dA
6. Site duipated-on the Fjiviz=nwftIIy Sonaidve-ArituMip? -110
STUDYItRQUIMM CXNMTflOWAL WAIIAW
WAIVER
RrAmedby: 7IZ�0,j__/'ZrL-fNV4Arr '7
10*d -qns eu�ts"bLjS W009ZO to-91-8"V
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Ajpg-113-97 06:90A Shoreline Sub. 206 706-2129 P .0 2
City of Edm'onds
CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on ihis form is
to be filled out by any person prqwing a
Development Permit Application for the City of
Edmonds prior to his/ber submittal of a development
permit to the City.
The purpose of the Checklist is to enable City st4ff to
determine whether any pmential Critical Areas ue,,or
may be, presmi on the subject property. JU
information needed to complete the Checklist should
be easily available from observatiom of the site or
data available at City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklist. sign and doe it, -and submit it to the,
City. The City will review the checklist. make a
PrecunOrY site visit, and make a determination of the
subsequent steps nms3ary to complete a development
permit application. '
PICUC subinit a vicinity map along with the signed
COPY OfAir- form to assist City stoff in fWding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e,&,, site plan, topography
MAP, CU.) or studies in conjunction with this Checklist
to Wist BUZ in completing their prcliminay
assessment of the site
I have completed the affacited CrI&W Areas Chackhot and attest ft the answers provided = factual, to the
ut the appropriate column below).
best of my knowledge (fill a
NIL;"
Owner/Applima
.*_1V,c140C-L- 'L RCLCC tk)94&�4T
Name
;) zx4;�- (-?. 7;L Pi -
but Addmos
Z"-C> Y"-n cpiu 0 1 L--),4 9 TO &.,&
city State Zip
Telephone
siguum
r— 16 - 9:z
Date
Applient Rspruenta"yq.
an, lug
Name AUG 2 2 19-97
Streit Address.
city state Zip
Telephone
Signature
Date
(over)
PLANNING DATA
NAME: Wrl�
a
SITE ADDRESS:— -DATE:
ZONING: PLAN CHK#: �-7- 710
PROJECT DESCRIPTION: &U417i
CORNER LOT -4) —(Yes/No)
SETBACKS: L,�Arf
Required Setbacks: -7 I/b Right Side: Rear:
Front: 75 LeftSide:_ -7
Actual Setbacks:
Front: 5� Left Side: 17 Right Side: Rear:
Street map checked for additional setback required?—' (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE: 35).
Maximum Allowed: Actual:
2-2, /',
BUILDING HEIGHT:
Maximum Allowed: ActukahiThta&
Datum Point: m4f-A Datum Elevation: _MS
A.D.U. CREATED?:
SUBDIVISION:
CRITICAL AREAS #: ��_ 135 upte-
SEPA DETERMIN ATION: � *0K
LOT AREA: � o0o
OTHER:
Plan Review By:
cAfiles\pemitkAplandai.doc
6,
CA FILE NO.-_
Critical Areas Checklist
------------------------------------- -----------------------
Site Information (soils/ topography/ hydroloi�/ vegetation)
1. Site Address/ Location: cP erg g4 o�vl,_ I
2. Property Tax Account Number: 0 0 C, 0 0 00 -3
3. Approximate Site Size (acres or square feet): 7
, 0 -c> -3 Q F-'r
4. Is this site currently developed? 2< yes; _ no.
If yes,, how is site developed? - fXS?�-6iy6 tLio'_X56
5. Describe the general site topography. Check aH 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 gTeater than 30% present on site (a vertical rise of 10-feet over
a horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: 0 __.; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway—L12— floodplain— of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are,
year-round? M'0 Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow
;shrubs mixed
urban landscaped (lawn,shrtbs etc) . X L�"Pf?4
11. Obvious wetland is present on site: KLID
For City Staff Use Only�
Site is Zoned?
2. SCS mapped soil "(s)? 2-
3. Wetland inventory or C.A. map indicates wetland.preserit on site? I Alb
4. Crttical Areas inventory or C.A. map indicates Critical Area on sitee? Wn
5. Site within designated earth subsidence landslide hazard area? 1yo
6. Site designated on the EnvironmentalJy Sensitive Areas Map?
DETERMINATION
STUDY REQUIRED CONDITIONAL WAIVER
4"f WAIVER
Reviewedby:
Planner 'Dite
^ca_ChkdnC; RpvC12/11/97
10*d 6ETE-90L 902 'qnS Ou!-LO-A64S V00:L0 Z6-9j-6nV
Aug-18-97 06:58A Shoreline Sub.
206 706-2129 P.01
City of FAmonds
CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City of
Edmonds prior to his/her submittal of a development
permit to the City.
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 available from observations of the site or
data available at City Hall -(Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map along with the signed
copy of -this form to assist City staff in fmcling and
locating the specific piece of property 'described on
this fom. In addition, the applicant shall include
other pertinent information (e.g,, site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
-A - I f c 14 6 C t ce b-) P44 & �4 T
Name
1 -7. 7.D_ Fl-
Street Address
City State Zip
e4 2.57 — 7 7 4� - �/ ( ,
Telephone
Signature
Date
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date
C:MCCPdonkjww�Cnc1.dcc (over)
"'Ic. is(0
8-20-97
Michael & Alice Wright
22517 72nd Pl. West
Edmonds, WA 98026
CITY OF EDMONDS BARBARA FAHEY
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 MAYOR
COMMUNITY SERVICES DEPARTMENT
Public Works e Planning/ Building * Parks and Recreation o Engineering - Wastewater Treatment Plant
Subject: Determination regarding Critical Areas Checklist # 97-135
Dear Applicant:
Enclosed please find a copy of the Critical -Areas Checklist you submitted. The "DETERMINATION" reached by the City is
located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
�MPQRTA,iN�t'INFPRMA'Tl*.ONT.OBEN.6-t��..D.-
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOUMAYNEEDTOSUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
molo. You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINA TION WITH ALL
PERMIT APPOCATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Diane Cunningham
Planning Secretary
Note Attachments:
* Architectural Design Board
C:Reception\Jana\CRLTR.d0C 0 Incorporated August 11, 1890 a
Sister Cities International — Hekinan, Japan
USE.,
CITY'�OF, EDMONDS ZONE PERMIt
:NUIII
'S
CONSTRUCTIQNI� t?EFIMIT APPLICAY16W,�
B_
JO
OWNER NAME/NAMEbF'BUSINESS
ADDRESS �,Jj
7 01APT III
14 T E
L GAt�DESC�IPT!OWCHEC
SCRIPTION.CHECK SUBDIVISION�NO. -NO.,
MAILING:ADDRESS LID
Z
30:
�CITY TEL PUBLIC RIGH �017 WAY,PER'OFFICIAL STREET'MAP:! -A
ZIP PHONENUMBER 'T. JESbP PPrOved
EXISTING REQUIRED DEDICATION RWIPennitReq0red 13
Streelu-'Pe
P-A (12 11 Re4*d
NAME R
Inspection I 04Uired
Sidewalk R4uired
LINE SIZE NO. OF PIX I LIHES PRV REQUIRED
M
Al
'ADDRESS
Q-
V 0
S
NO'0
REMARKS.
CC z
-ZIP—: TELEPHONE.'NUM
r" - ' _' * '16
<PITY. SERI 'r
yja
0
NAME AA,1A 4.
ADD
RIESS s",
M (4
0
ENGINEERINGWEM0 DATED.
D BY-
(4r 'ZITY- . ZIP
TELEPH ONE; N UMBER:
- -11-1:1 --- �R MEMO -DATED
0 REVIEWED BY
1 LICENSE'NUMBER W -
%
EXPiRATION DATE,
LL
NCE OFJ�C SHORELINE It
VARIA
-ADBN'
Legal Description of PropeRT-inciude alvemements.
1_9 00 SEPA.REVIEW SIbfi AREA HEIGHT
Z, qRhI MPT A Of.
S? EM EXE LL . f�RQPOSED ALLOWED 1PROPOSED
.;,C PrE
CC
LOT COVERAGE .REQUIRED -SETBACKS -.r.)
�.j ALLOWED P FRONT .(F PROPOSED SETBACKS,(Fr.) -
ROPOSED, SIDE REAR FRONT L/R SIDE REAR
a......
Z.
3-3
_1 Pro, e z
P 15
Tax Allunt "w,-L FARE
01 _�_.ELANTtWEVIEWSY
-71 . - — — �7
OV,
0 0 0 J. 0 /0
;-REMARKS-/
NEW: LMJ R�SIDENTIAL, PLUMBIN(WECH'�
COMPLIANCE OR r,
�TOADDiTIO�.: C6,MMERCIAL, El CHANGE OF USE
'AFiT�BLDG7*1��7
REMODEL'
GRADING M.-FENCE . ..... ST CTIOtt-vo CO �o
E IR �Ll I C
GR
R P� CYDS I I x FT)
16EM66SH INSERT
WOODSTOVE, SWjMpOO
is SPECIAL:'INSPECTOR-,.
El V I HOT TUB
REQUIRED 31.5 _57tW-=.,3j S—OCCUPANT
17 �1 LOAD'-:
0�is
RETAINING-WAL
RqrKER*,:' RENEWAL
08"'
V'j7L�pE'OF-'L'iJgg;lEiUSNESS;Q5�ACTIVITY)'EXPLAIN--"' 'PROGRES!�-'IN�PkqT,!P!4P.,,P,,,CR;!,Jqc 14"
7 _j
W, CRITICAL
-DWELLING-� J.A
NREAS
io.STORIES" UNITS---'-- LJMRER% ..
0
DESCRIBF.wciFij( TO BE RqNE I[ATTACH PLOT PLAN)
'FINAL INSPECTION7REOURED'
VALUATION FEE
o
LAN CHECK,FEE
AEAT; BUILDING
SOURCE- IN
GLAZI G
0,; �F-&KAOCF 44
PLUMBING
Ian itheCk No-, MECHANICAL
"A
k -This. Permit; covers Work to be:,done on private property.ONLY.,,.: i -.GRADINGIFILL
A
ny Construct on'dn-:the,'publib�domain,(curbs- sidewAs
s marquees;��etqjwill rqq -permission.
y !&e separate
STATE SURCHARGE
4,60
Pierm .1t.Ap.0116atfoh: 180:Dio
-perinit Limit: I -Year-- Provided Work Is Started withln� 180;Dako, STORM DRAINAGE FEE
,',,Applicant,on behatifoUhis orher spouse; heirs, assigns -and ENG. INSPECTION FEE
4!successors in interestj agrees to.indemnify, defend and:,hold
w armless Ahe City of Edmonds*, Washington; its
.,officials:
mt .imp yeesi�.an,6�agents. from any and:aWclaim or. - mages :0
ir y .10 - S f d
.<,.'-,��hateve'r.,.nat6rLi,r,atisin : suance-
g-ditectly.,Or?indirectly_f.�d?n h :Is . . . . .
t
of this' permit. Issuance of this permit shall not* 6'beemed Q PLAN CHECK DEPOSIT
modIfy;,vI or reduce any r q It Iement Of"a cit;,,,&dl ance.
0 K 1 a U 0. 1 , �
x , nor limitIm any Way the Citq'S. ability. t - ',Y4'A "de
..p ovislon�.!, 0 y;o�t qap TOTAL AMOUNT DUE
IF All
q:,6f rce an
'I ave read this 6pplicdt ldjh;'v that 'the-
heretiy'akk�owl6dde that Ih
,jinforrhationjolven is:correct;-anbAhat Vaim4hd,_bwh6e/6r'tKb duly: A17ENTION APPLICAT647APPROVAL
�,ut ant of. the- Owner. I. agree Ao�zomply,�wlth city and
.A*Plat !s,i,r,e. ulating.c a THIS PERMIT
AUTHORI Z ES n
onstructlon;' nd�ih.doihg:the�workauthc)iii.�.. .
This application is not: a permit Li;tiI
�:ho ijer6oih -Will- be.empl yedsin violation of the Labor ONLY THE signed by, the Building Official'br.his/her,
dre
0
t;
4 ate�of_Washlngton-relatlng to Workmen's Compensa- WORK NOTED Deputy; and fees are paid,* and receiO(is.
.Ai I urAnce.ana,RC%W_-,fl8:27. INSPECTIOti acknowledged in space provided..
ENOVAVNER09 AGEN 1.
TE, SIGNED DEPARTMENT.: Af
0 IGNA
-7 CITY OF D TE
7,t
EDMONDS 7
57
a U,
k T' T EN T 10 N CALL FOR Y:
INSPECTION
r IS!.,UNLAWFUL TO USE OR.00.CUPY A BUILDING OR, STRUCTURE
R'r.'N
NTiL_A*.-FINAL.4NSPIEdTION �HASJBEEW MADE AND APPROVAL''ORI 77:1-02,20, MI -inspector.'
CERTIFICATE 00 % OCCUPANCY' HAS BEEN GRANtED.! UBC.
ECTIOII 109
T.
STATEMENT ON ACCESSORY DWELLING UNITS
.Property Address:
Legal Description:
,,? c? 57,7 -7 --2 - Ft t L i , f-
Edmonds, Washington
Assessor's Parcel Number:- �Cl C) � 00 C) �) ( C-) (-)Q "),
I
I have read the requirements for accessory dwelling units contained in Chapter 20.21 of
the Edmonds Community Development Code and understand that an accessory dwelling
unit, including a second kitchen, is prohibited for two years after occupancy by the
current owner (unless a waiver is granted by the Community Services Department) and
until after a conditional use permit has been approved by the City of Edmonds Hearing
Examiner.
I also understand that approval of a conditional use permit is subject to a public
hearing, and neither this statement nor the issuance of a building permit shall act to
limit the discretion of the City in the review of any application for a conditional use
permit.
Property Owner Signature:
Date:
— -?— —,/ - =, — /OT
STATE OF WASHINGTON
COUNTY OF SNOHOMISH)
I certify that I know or have satisfactory evidence that IVIC-14Bg- �- &J,,,?/G447-
signed this instrument and acknowledge it to be his/her free and voluntary act for the uses and
purposes mentioned in this instrument.
Not4 y.'&,prp�sure seals must be smudged. Dated:
%�110 E 4,11,�,01,
Signature of
LLea-,�
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OTAO
Notary Public: -0
Residing at: VA
My Appointment
Expires: 00
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THIS DOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY AUDITOR.