23128 76TH AVE W (2).PDFIIIIIIIIIIII
6138
23128 76TH AVE W
GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 FAX (425) 771-0221
Website: www.d.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
c. 9'�' Planning * Building - Engineering
January 29, 2004
Ryan Payne
23128761hAvenue W
Edmonds, WA 98020
Re: Address Change
Dear Mr. Payne:
This letter is to inform you that due to a recent subdivision in your area, it is necessary.
that your address be changed. This is so that your address is in accordance to the City
grid for Fire and Police. Your address has been changed from 23128 761hAvenue W to
7607232ndStreet SW. I will inform all City Divisions including Fire, Police, Utility
Billing, Public Works and Building.
It is your responsibility to inform the Post Office, the Phone Company for Enhanced 911
emergency purposes and all other interested parties of this correction. We apologize for
the inconvenience this may cause you and greatly appreciate your cooperation.
Sincerely,
Permit Coordinator
cc: Fire Department
Police Department
Utility Billing
Public Works
Building Official/Street File
Snohomish County Assessor
L\Ternp\]DST's\Master Letters\Address Change
Incorporated August 11, 1890
Sister City - Hekinan, Japan
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76th
AVE W
CITY OF EDMONDS WATERLINE
AS
-BUILT
ADDRESS:
76th AVE
W
- 23128
PERMIT
NUMBER 2004-0270
HOMEOWNER:
CONTRACTOR,
SWEAZY
I
DATE INSPECTED;
DRAWN BY:
DATE
DRAWN:
4/27/05
L
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.4/29/05
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CITY OF EDMONDS WATERLINE AS:
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AS ADDRESS HOM OWNER
CONTRACTOR SCALE
i890 DATE DRAWN PERMIT
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ED.!�-o CITY OF EDMONDS WATERLINE AS- BUILT
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CONTRACTOR SCALE
DATE DRAWN PERMIT
Zk 1890 -d--2 -7 - 1)4 IBY /Z 6-L INO. 17< .410-bd
.( PC. I S9,j
TERMIT NO: 0009
City of,Edmdnds.,.�
PERMIT EXPIRES W WAaul
ir-nu c!uxi7un Dunvurr
Address of Construction: C�3/,92. 4v-e- LID #
Prn,- TnvArcountParcel-No
Attach copies of all access and utility easements
Owner and/or Contractor: 4, Uteocv
Contractor License #: SCLE a L kc
-7
C2L -Ar cl i
Single Family
Mu:16-Family (No.'of Units
Commercial (No. of Units
F-1 Public
Verified and Approved by—
Q04'.
Building Pe'rm"'44:
Invasion into City *Right -of Way: e s "'iE] No
jog
*RW Constriiction Permit
Cross oth& *Private- Property: El V�i IKINO
**Attach legal descriptioiri and copy of recorded taSement.
Owner/Contractor
OwIneror contractor signature and acknowledgement statement: i, baKe
Bysigning f�r this permit I certify that I have read the City's pu�jic handout entitled
Side. S'�wer Specifications, and shall complyw'i.th all City requirements outlined therein.
.9 'CALL DIAL -A -DIG (1-.800-42V45555) BEFORE ANY EXCAVATION W.
R'FOR INSPECTION CALL 425-771-0220 extensioiMMIR
24 HOUR NOTICE REQUIRED FOR A Lt, INSPECTION REOUESTS
NOTE: IF JOB SI I TEIS NOT READY FOR INSPECTIONWHEN-
INSPECTOR ARRIVES A $45 RE- INSPECTION FEE WILL.. BE CHARGED,
'NO Date: I
Job Site Ready YES nitial:
Partialinspection: YL Date: nitial:
Partial InspecUon: Date: Initial:
FINAL INSPECTI . ON APPROVED: -Da . te' j �JWS !niti aI:___,)2!j_'�L_As-buiIt to Street File: El
15, PERMITMUST BE. POSTED,,ON'JOB SITE. T�
White Copy: File - Green Copy: Inspector B.uffCopy: Applic,ant.
L-,temp;bldg;forms;sspermitjlg4/00
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).
Mb ---
9
.0
Critical Areas Checklist
Site Information
Project Name: P#4YIVE 0(olelL Permit Number:
Site Location: -11Ph' -7 4+1- Ave.0, Property Tax Account Number: r74 7-00 0 -016-loyoo
I., ---
Approximate Site Size (acres or square feet): foo 4-1%-
Have you fille� out a Critical Areas Checklist for a project on this site before? No
General Site Conditions
I - Has the site been cleared or logged? Date of most recent action:
Soils Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)?
3. 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 of horizontal distance.)
StIp: grades of greater than 30% present on site.
Comments S
/Yr, —lk-
Hydrology[Vegetation
4. Site contains areas of year-round standing water:
e01
lrsex* C V-
5. Site contains areas of seasonal standing water: hJ 10 JVC— Approx. Depth:
6. Site is in the floodway Al 0 floodplain Al /,A of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? -110—flows
are year-round? -AID Flows are seasonal?
8. Site is primarily: forested meadow shrubs _;mixed X
9. Obvious wetland is present on site:
10. Wetland inventory or map indicates wetland present on site: go
11. Critical Areas inventory or map indicates any Critical Area on site:
4orCityUse-Onl
7.
Y.
S DY REQUIRED- --C tical areas study is rtjulred..
TU ri
6nditl6hs s
not requjl,�d if s6ecifie.d c, aosrl�4:
CONDITIONALWAlVER- Critkal are*a* iiuq:,`*1:,.
s
.'-WA. IVER- C�idcal areis *std* 0*yls�'not re Wred.
-q
r
-D.etermi n*i6b.11'. Number.' Rev'iewe
Planner. Da'
Rey 3/27192.
'-- do&
e
890.199-
Ciq of Edmonds
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.
With a signed copy of this form, the
applicant should also submit a vicinity map
of the parcel with enough detail dw City
staff can find and identify the subject
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information or studies in conjunction with
this Checklist to assist staff in completing
their preliminary assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Qt2 6 lea, C.
Naine
Title
3 ic;k? —7ol '�4 44
Street Address
OIL
Cit S 'ate, ZIP 779 oV;9=
Signature Date
Applicant Representative:
Name
Title
Street Address
City, State, ZIP Phone
Signature
Date
0
0
0
rPATE RECEI
PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
ZON
NVMBER
CONSTRUCTION PERMIT APPLICATION
JO SUITE/APT#
ADDRESE
L"�j ,
OWNER NAMEMAME OF BUSINESS
PLAT NAME/SUBDIVISION NO.
TLOT NO.
LID NO.
.�4 z4/e!e z etz
MAILING ADDRESS
LID FEE $
0
17fi;7-1 _X z v,
PUBLIC RIGHT OF WAY PER OFFICIAL TREET MAP
Its P A�I.w ov��_
AW uper.
Street Use Pe-amn. Re4d
CITY ZIP
TELEPHONE
EXISTING PROPOSEO—T
InspectIcni Required
-A,
REQUIRED DEDICATION S12. FT
Sidewalk Required 13
I Undertiround
00-rY
WM0 requirea 13
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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19
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YE No 13
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ADDRESS
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY
ZIP
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NAME CBL#
ENGINEERING REVIEWED BY ATE
ADDRESS
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FIRE —REVIEWED BY DATE
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CITY zip,
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TELEPk6hE
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STATE LICENSE NUMBER EXPIRATION DATEO�HECKED
BY
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ALLOWED': PROPOSED
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PROPERTY TAX COUNT, PARCEL NO.
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09:-NEW RE SIDENTIAL_ PLUMBING /,.MECH,
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GARAGE RETAINING WALL_- FIRE SPRINKLER -
CARPORT ROCKERY FIRE ALARM
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(rYPE OF USE. BUSINESS OR ACTIV"'EXPLAIN:
CHECKED BY
TYPE a STRUCTION
2JCON
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OCCUPANT
GROUP
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NUMBER
NUABER OF
CRITICAL
SPECIAL INSPECTION
OCCUPANT
OF
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DWELLING
UNITS
AREAS
91-1
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NUMBER
REOUIREI JAMr,+
LOAD
D6CRf6E WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER URCAOS/FINAL INSPECTION REG'
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VALUATION
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Descriptio'n
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Description
FEE
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Plan Check
State S
State Surcharge
HEAT SOURCE
GLAZ NG %
'#LOT. -SLOPE %
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City Su
City Surcharge
PLAN CHECK 0 STED DATE , I
�Plurnblfig,v
Mechanical e�A
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN
(CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION: ISO DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS 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. Depos
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
W Fire Inspection Receipt #
CLAIMS
ALL FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, 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 PROVISIO
x N.-
Recording Fee Receipt #
HEREB'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
V
G I EN
GIVEN IS CORRECT; AND THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OW
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
10 _
N . AN
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL
Building Official or his/her Deputy: and Fees are paid, and
LTINA
VI OL
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknoy4edged In space provided.
WORKME
WORKMEN'S COMPENSA��INSURANCE AND RCW 18.27.
I OFEI SIG RE DATE
DATE IGNED
SIGNATURMR AGE:�� (425)
771-0220
RELE D BY (DATE'
ATTENTION Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL - FILE YEI LOW INSIDE
04/02 PINK - OWNER GOLD - ASSESSOR
. PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
DATE RECE7/
PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
ZONE NUMBE§&&j/
CONSTRUCTION PERMIT AP PLICATION
JOB SUITEIAPT#
ADDRESS 7 Jj/. �70//41 �
0 ER NAME/NAME OFASINESS
PLAT NAME/SUBDIVISION NO.
OT N��
LJD NO.
LID FEE $
rVA/J WAIT
15
MAKIING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TES��Ap
RW
sPeanittso.
Rhl-<A Ri
.5,
EXISTING — PROPOSED
Streat Use
inspection Required
Sidewalk Required
CITY ZIP
ITELEPHONE
44-4%&VO 19
1-366F 47 0YO
REQUIRED DEDICATION— FT
underground
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NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YEs13 NO 13
ADDRESS
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
0
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CITY ZIP
TELEPHONE
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NAME
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Mk� a
EN2r7 REVI . D BY - DATE
ADDRESS f
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FIRE,,REVIEWED BY ;4f DATE
ILI
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TELEPHONE
0
VARIANCE cocul,1101 RIL PN BOND
POSTED
0
STATE LICENSE NUMBER 1.1, EXPIRATION DATE
Y
CHECKED BY
ABET TO B
SEPA REVI;6-,
COMPLETE fIE R
SIG EA
S911111M PROPOSED
PROPERTY TAX ACCO NT- PARC'YO.
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NEW RESID&nAL [3 PLUMBING MECH
LOTCONk�oAft�JEAM
ALL8WED
CKS (Fr.)
REAR
ADDITION COMPLIANCE OR
COMMERCIAL
P
0
BID -VI AVA I
0 CHANGE OF USE
PARKIM 1) ATAA
REQ`D PROVIDED
TITION,
REMODEL MULTIFAMILY 0 SIGN
SE EMO
INS,
REPAIR GRADING CYDS FENCE
IN BACK.rp-06"CAM'�'
DEMOLISH TANK
Pi OTH"R
FOR' !NWEPHeN
REQU
0 kRAGE %'�RETAJNING WALL "'�FIRE SPRINKLER
CGARPORT [1`,ROdKERY,, �""'Lj FIRE ALARM
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CrYPE OF USE, BUSINESS OR AcTivim ExP
-
6 54.0 1314
CHECKED BY
ITY:��ON
C,
0 C PANT
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NUMBER NUMBER OF CRITICAL
. 1
OF DWELLING AREAS CA -,q
Lu
a
SPECIALINSPE CTION
OCCUPANT
0
STORIES UNITS. .1 NUMBER
I
;REQUIRED [3 YES-
JAREA
LOAD
DESCRIBE WORR ONE
REMARKS
PROGRESS,IkSPECTION&PER UBC 100INAL INSPECTION RECtD
VALUATION
bbicRodn
-'-�e,fEE
Description
FEE
j7f
Plarf 9he, Ck
SUte Surcharge
HEAT SOURCE
GLAZING % �S,./
YL LOPE %
Buildin
City Surcharge
PLAN CHECK NO:
VESTED DATE
j'1PIumbIAg--'
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
t:
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATION: ISO DAYS
Engr. Inspection
PERMIT ILIMIM I YEAR - PROVIDED WORK 18 STARTED WITHIN 180 DAYS
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 INDEMNIF% DEFEND AND HOLD HARMLESS THE CITY OF
a EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
cc FireInspeclion Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
0 NOR UMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee Receipt #
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application Is not a permit until signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Officall or Nether Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Al receipt is acknowledged In space provided.
WORKMEN'S,RBhMNSATION INSURANCE AND RCW 18.27.
SIGNA N E AGENT) DATE SPNE (425)
1 0 a E DATE
7-
=(OW
50911 0 771-0220 1
-1= RI:l EASI
ATTIENTION M 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
ORIGINAL -FILE YELLOW. INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES