23312 94TH PL W.PDFiiiiiiii lill
9250
23312 94TH PL W
9 0
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ADDRESS: cQ 3 5 1 L
TAX ACCOUNT/PARCEL NUMBER: on sa C) 5 0o 0 0 0 G
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR: ADU c216-61116613
CRITICAL AREAS: 0& 05 - u DETERMINATION: [] Conditional Waiver [] Study Required aiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
—SA�Ajjl �JWTJ E , �
PERMITS (OTHER):
010TO
PLANNING DATA CHECKLIST DA'
SCALED PLOT PLAN DA
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
LATEMP\DS'rs\Fomis\Street File Checklist.doc
Corner Stake
Comer Stake
0
RECEIVED
APR - 5 2005 STREET F
""T (-()( INTER P. L. 105.0' C�
P. L. - 64.97'
APPRUM gy PLANNIN
210.00
Stake
146.00
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APPROVED AS NOTED
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Date: +Z2-1ze0E-
23312-94th. Place West
Edmonds, Washington 98020
Drawn By: R. L. Castellow
SIZE
E
720fftt.
DWG NO
REV
June 21, 2004
SCALE 1 in =- Oin.
I
S , HEET I OF I
CITY OF EDMONDS
13UILDING DEPARTMENT
WORK
DDRESS
WNER
APpROVED DATE:
BLDG. OFFICIA
NUMBER
_0
STREET
jo RECEIVED
Alt JUL 2 1,2004
N
cm
7.1
4 nr. ttv
BUILDING DEPARTMENT
.—, ^r enunNDS
P. L. 64.97' N
Ci
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23312-94th. Place West
Edmonds, Washington 98020
Drawn By: R. L. Castellow
SIZE
FSCM NO
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July 5, 2004
SCALE 1 .=20'
SHEEr I OF I
0 0
#P20
CAFileNo:
Critical Areas Checklist
Site Information (soils/ topography/ hydr �qgy/vegetation)
L. Site Address/ Location:
2. Property TaxAccount Number: _00,5C) 0,5
3. Approximate Site Size (a&es or square feet):
4. Is this site currently developed?—% yes; — no.
If yes; how is site developed?.
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling- slopes: on, site generally less than 15% (a'vertical rise of 10-feet over a horizontal
distance of 66-feet).
Mat
Hilly: slopes. present on site of more d& I t
horizontal distance of 33
over a
Steep: grades'of greater than 30% present onj" vertical f t horizontal
r ra
a
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: VNQ
Approx. Depth:
7.. Site contains areas of seasonal standing water: V*, K3 Approx. Dep.t1c:
What season(s) of the year?
8. Site is in the floodwav V-t<3. floodplain v,,Q of a watei course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs— mixed
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site:
For City Staff Use Only
1. Plan Check Number, if applicable?
2. Site is Zoned? P:`Z> — 9,
3. SCS mapped soil typ e(s)? (I I.& Q:c�,-P ox!�
4. Critical Areas inventory or C.A. map indicates Critical Area. on site?. t4o
5. Site within designated earth subsidence landslide hazard area? _Wn-�
at 51 1 CL 3L.C.&A =in a bmr- An -f - h,11"M CA
DETERMINATION
STUDY REQUIRED
Reviewed by -
WAIVER
ate:
0 #P20
El
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
-U. 10'
The Critical Areas Checklist contained on this form is to
be filled out by any person. preparing a Development
Permit Application. for the City of Edmonds prior to
his/her submittal of the application to the City.
5-
Date Received: 6
City Receipt
Critical Areas File #:
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant:
A property owner, or his/her authorized 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
The purpose of the Checklist is to enable City staff to permit application.
determine whether any potential Critical Areas are, or
may be, present on the subject property. The information' Please submit a vicinity map, along with the signed copy
needed to complete - the Checklist should be easily of this.form to assist City.staff. in finding and locating the
available from observations of the site or data available at., specific 'piece of property, described on this form. In
City Hall (Critical areas inNiKkimps Ito i a ition, the applicant. shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction With this Checklist to assistant staff
in c rupleting their preliminary assessment of the site.
.0
MW 11 int,_ai&hi� G=71ts and assign , �in c ideration on the processing of the application agrees
ThV Adersigacy ijp Wa S. ons
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees on
ansing from any action or infi-acti based in whole or part upon false, misleading, inaccurate or
incomplete information ftu-nished by *the applicant, his/her/its agents or employees.
By my signature,.I certify- that Ahe inf tiod and, exhibits herewith submitted are'true and correct to th6 -best of my
r
knowledge and that I am authorized to this application on the behalf of the owner as listed below.
SiGNATuRE oF APPLicANT/AGENT 7
DATEA
Property Ownerlys Authorization
By my signature, I -certify that I.have authori I zed the above Applicant/Agent to Apply for the subject land use application,
and grant my permission.for the public officials and the staff of the City of Edmonds to enter the subject property for the
s of inspecti2p . a d posting attendant to*i application.
purpose
SIGNATURV,OF:I.
Owner/Applicant!
L CQ.�,C_ -
Ck
Name
Street Address
city State Zip
Telephone:ZZA�i—
DATE
Applicant Re�resentative:
Name
Ck
Street Address
City State Zip
Telephone.-'Zk) t) -7 C��-
Email address (optional): Email Address (optional):
V,
"�RK N1111111
CTTY CL)MON()s 101#�11111111
C, y OF El 2
iS 0613 1
12 AVENUE NO 01-11-2(
EDMONOS, WA 9W20 )05 01--29pGm $19.00
SNOHOmISH COUNTY. WASHINGTON
-1 TY CLERK
ro,110ND
V U
NO.
STATEMNT ON ACCESSORY DWELLING UNITS
Assessor's Parcel Number: ( CV61?06C)01;Qp2e)n
I bave read the requirements for accesso�r
.y-4;replug uWts contained in Cbapter 20.21 of
the Edmonds Community Developm�at'Co4e--ind.indirstand that an Accessory
Dwelling Unit, Including a snood kittlico�:ls.proilbith-d until after an Accessory
Dwelling Unit permit bas been approv�d.by . 'tb��tj..ofEdmonds.
I also understand that approval of an Accessory DWelling.,Vult permit is subject to
compliance with Identified criteria, to public i�nimeit,.ai#..a;ltbcr this statement nor
the Issuance of a building permit sball act to l6k.the-dil�retloonof the City In the review
of any application for sin A welling Ual
C t
Property Owner Signature.a=Z�22,
....RECEIVED
4 M
STATE OF WASHINGTON) - c:JM -, OYPS*rA'TY CLERK
COUNTY OF SNOHOMMH)
actory evidence . jo 4dll?
I certify that I know or have satisf
signed this instrument and acimowledgc it to be his/her fiec and voluntary act f6r th'i'usib's and,
purposes mentioned in this instrument.
C,
Notal re be smudged. Dated:
X so #I Signature of
ft-/: 0 V. A��
-n', Notary Public:
>
.151, ip Residing at
.......... My Appointment
Expires:
THIS DOCUMENT MUST BE REcORvED Wan TEiE SNOBOMSH COUNTY AUMOR.
0, fITIVET FILE �;e
C
July 14, 2005
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
Website: wwwdedmondsva.us
DEVELOPMENT SERVICES DEPARTMENT�
Planning - Building - Engineering
Richard & Jacquenette
Laura Castellow
2331294 th Place West
Edmonds, Washington 98026
RE: Request for Alternate Design7- Air Admittance Val:�
Dear Mr. Jacquenette & Ms. Castellow:
1 4
GARY HAAKENSON
MAYOR
The City is in receipt of your request for alternate design (reference building permit #2004-1036) for
installation of an air admittance valve on an upper floor island sink in your home at 23312 94 1h Place
West in Edmonds. Reasons for the alternate venting source include that existing beams cannot be
bored due to loss of structural integrity.
The request to use an air admittance valve on the specified upper floor accessory kitchen island sink is
hereby approved with the noted conditions below.
> Install per manufacturer's specifications
Condition of approval of the alternate design request shall include that the plumbing contractor
provide you with written directions as to how to inspect and maintain the air admittance valve
for life. These directions shall be provided to all future homeowners.
Sincerely,
Jeannine L. Graf
Building Official
Incorporated August 11, 1890
Sister City - Hekinan, Japan
5.
City ofldmonds Permit No: _,QQIQL:�
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: 612-16-Q5'
A. Address or Vicinity of Construction: "25,51 2 ?�),5 i P L LYJ
B. Type of Work (be specific): T—C) �j e- \' n �0 (3 -)T LQ) t4i s
1\1 ai �V\ Q ac), -to e-,r v Y,, 444 VU W , Dpv t
n'0 �L- 16 -7 0 L:�k -a SO I
C. Contractor: ,, y
Mailing Address: n)
State License Lo- yo 4
City Business License #:
C_ Kiv'" 19y
Phone: a) (�' - q 151 - J 01 �cf I �, 6 Q - 441 � - 4 33
Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. Commercial Subdi��ision 0 City Project EUC (PUD, VERIZON, PSE, COMCAST, OVWSD)
Ej Multi-Fan-ffly Single"Fari ily-1 R Other
INSPECTOR: /4A Lorz- i tk%,/ Alr & A(C�4_e
F. PAVEMENT CUT: YES El NO G. SIZE OF CUT 3 x S'
CONCRETE CUT: HIYES R NO
G. El Mail Approved Permit F� Call for Pickup
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands by hislher signature to this application helshe holds the City of Edmonds harmless from
injuries, dama es or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of
; 9
Edmonds or any of its departments or employees, including but not limited to the',defense of any legal proceedings including defense
costs and attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF__ONE YEAR FOLLOWING THE FINAL
INSPECTJ�QNAND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBITOR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
Re - storation is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday - NO EXCEPTIONS.
Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I�HEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THATI MUSTMAKE THE PINK COPY OF THE PERMITA VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Signature:
(Contractor or Agent)
Date: 61 — t� b - 6-5-
X,.F')071VClTY::.USE'ONLY a
e -Right-o&way Fee: A16*3.'
Approv d by: /27
$2 Disrupfion'Fe' F''hdJ11--, V. 0
Timie Authorized:'�6id After A r-t,/ .2
Special Conditions:&,- �_r; AAIi2j�o Jiispection,F*.,�z ;To �O =A6 6-0
Total,'Fee:, ov
A4,C9zi- AFEarm-n apatax-N74A. A -(A f m r-A i tA 2V At Aeiii- N
eipt'.] �6.
A4_1 Js�u ed, 'by.,
S(WAMoe. Sr-fAA54k, S_M&4�4 It bseb gig e— izr)t.�N^
A tAAr-i X; 40NrAn1)_.
I IZZ Q T-1 rS At FORC /a P2 t!A,,ee- ?-M^ AJ12A(pee
J
�r A x , I ALsPrze 71 r2 At Pz t)g ro -r#4 ic srog ar-4A a 6Y A j;F T.4,s-
') 7
REQUIRED INSPECTIONS: 7A P F-1 C At -rk c t—
XJ t4 AL RC)W
-1326 r a 24-hour voice-r or d inspection request line.
Call 425-771-0220, Ext.' fP
FINAL APPROVAL OF PERMITTED WORK: f)k DAT
E
Inspector's Signature
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
CADocuments and SettingsTurtisNy Documents\Fonns\Engnmg\ROWpermit_.doc Revised 10/01/03
I'llchuck Contractors, Inc.
Job # 107022501
January 19, 2005
Sheet I of I Rob Inglis
NOT
TO
SCALE
WHY
MHOM
,am
234th ST SW
4-
41
1 .1
CHANNEIRATION DEVICE SPACING
W"
1APER
11ANGENT
50/70
40
80
35/45
30
60
25/30
20
40
9L
* te-s-
AjI signs and spacing to conform
to the MUTCD and City of Edmonds
Traffic Control specs.
2. Channelizing devices are 28"
traffic cones.
3. All signs are 48" x 48" B/O unless
otherwise specified.
4. Alert affected residents.
5. Work to take place between 9 a.m.
And 4 p.m.
6. Work area will be 10' S of 180 Ave SE
THREE
' "0 & 30' E of SE 267 PI.
LOCATIONS
C/)
-06
i LU
on
1 W
00, 100' 1
ce
-C
IS
-C
V
WORK AREA Z x 5' 0�
IN GRAVEL SHOULDER
4 ' U
i,%PPHOVL"U AS NO, /E
I BY ENGI EERING
r
Date:
ICA
WORK AREA
2'x 5'
ROAD
WORK
AHEAD
LEGEND
28" TRAFFIC CONE
WORK AREA
TRAFFIC FLOW
WORK VEIMCLE
SIGN LOCATION
EOM
2" PE CAP
202'N CL & 12'W CL
0)N CL
--- 0)w CL
9515
LLI
c1q
00
60'
R/W
S W 234 ST
MIN
CAD
CAD
`7
IX.4
E
C*J
cy:)
40'
R/W
.Icy
-Boom-
- V W
IIJ LE MOUN
0 tn LAR PAN L
tv lGfE � P_ I+ � b
N to ANODeSMEIS
fu for
IV M�*_ 61W 853_4� IV
M A. 9620777
S 6 e% 4 -
;As
14� 4�y
0
"s-,
PLOT PLAN
SCALE: If �50
C ou
W 94 PL W E
ASPHALT
CL NOTE: OVERHEAD POWER
12' 12' PHONE, CABLE
S—bound Lane N—Bound
EX. WATER
PROP. 2* GAS
13'W CL 40' ROW L14'E CL
ROADWAY CROSS—SECTION
N.T.S.
4#
PROPOSED 220'
2" PE IP MAIN
14 *E CL
(---')E CL
TRANS. FIT. & TEST LEAD
17 * S CL & 56'W CL
-)S CL
1)w CL
TIE-IN
2' SERVICE TEE H-17501
18 'S CL & 56'W CL
--- 1)s CL
(__ ')W CL
FITTER (CHECK BOX IF COMPLETE)
Work area left in Clean & Safe ondition
Complete all Pipe Tables and Gas Pressure Stamp
Field changes Red —Lined on as —built I
Material verified and Changes noted on paperwork
All Valve & Tie—in Locations noted on as —built
Note beginning of Main, EOM & Line of Main locations
Show Rope Locations & Cul—de—sac Radius
Foreman's Signature
Company
Date
STANDARD GAS CONSTRUCTION NOTES:
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. EXCAVATOR TO CALL "ONE -CALL" TWO WORKING DAYS PRIOR TO
TO CONSTRUCTION, IN WESTERN WASHINGTON CALL: 1-800-424-5555. IN KITTITAS COUNTY CALL: 1-800-553-4344
2. NOTIFY APPROPRIATE PERMITTING AGENCY PRIOR TO JOB START (SEE PERMIT REQUIRMENTS).
3. ALL CONSTRUCTION, IS TO CONFORM TO PSE GAS OPERATING STANDARDS AND GAS FIELD PROCEDURES.
4. EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE 0150.3200 TECHNIQUES FOR TEMPORARY
EROSION AND SEDIMENT CONTROL AND ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.
5. NOTIFY PROPERTY OWNERS ADJACENT TO PROPOSED CONSTRUCTION ACTIVITIES A MINIMUM OF TWO WORKING DAYS
PRIOR TO BEGINNING CONSTRUCTION. USE 1Si TO DISTRIBUTE FLYERS IF JOB IS LARGE. OTHERWISE HAND
DELIVER FLYERS BE SURE TO INCLUDE THE LIST OF FREQUENTLY ASKED QUESTIONS AND INFORMATION ABOUT
THE OPPORTUNITY TO PURCHASE AN EXCESS FLOW VALVE WHEN THEIR SERVICE IS INSTALLED OR REPLACED
PER GAS OPERA71NG STANDARD 2550.1600. ALLOW ADEQUATE TIME FOR CUSTOMER DECISION AND RESPONSE.
6, ANY CHANGE IN ROUTE, PIPE SIZE/TYPE. TIE-IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE APPROVED BY
THE APPROPRIATE PSE ENGINEER OR PSE REPRESENTATIVE.
7. COMPLETE "PIPE COND11ION REPORT' ON ALL METALIC PSE FACILITIES. CHECK BOX ON REPORT FOR WIRE
BOX (TEST LEAD) INSTALLATION.
8. PIPELINE MARKERS AND WARNING SIGNS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS
OPERATING STANDARD 2525.2500.
9. INSTALL MAIN VALVES OUT OF TRAFFIC WERE POSSIBLE. VALVE MARKERS SHALL BE INSTALLED AND RECORDED BY
THE CONTRACTOR PER PSE GAS OPERATING STANDARD 2525.2600 FOR ALL HP VALVES IF 'THE LOCATION IS
NOT READILY ACCESSIBLE, AND FOR ALL VALVES WHERE PERSISTANT SNOWFALL MAY OBSCURE THE VALVE BOX.
iO. TO PREVENT ACCIDENTAL OVERPRESSURE OF ADJOINING SYSTEMS, NO TWO MAINS SHALL BE CONNECTED EXCEPT AS
SHOWN ON THIS DESIGN UNLESS APPROVED BY APPROPRIATE PSE ENGINEER OR PSE REPRESENTATIVE.
11. SYSTEM MAOP DENOTED BY: FSYSTEM MAOP = -45- PSIG
12. GAUGE AND MONITOR USE OF ALL STOPPERS TO ENSURE ADEQUATE FEED.
13. RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION.
14. PURGE POINTS AND PRESSURE TAPS TO BE INSTALLED PER PSE GAS OPERATING STANDARDS 2525.3300, AND 2525.1200.
15. MAINS AND SERVICES SHALL BE TESTED AND PURGED PER P§E GAS OPERATING STANDARDS 2525.3300 AND 2525.3400.
16. IF METALLIC PIPE IS INVOLVED, COORDINATE INSTALLATION NTH CP TECH.
PICK KESSLER , PHONE 206-571-7908
17. NOTE ALL ACTUAL FOOTAGE. LOCATION AND MATERIAL CHANGES ON THE AS -BUILT IN RED. DENOTES
FOOTAGE BETWEEN FITTINGS.
GAS MAIN INSTALLATIONIRETIREMENT
Type/Work
Pipe Size
Type
Estimated
Length
Actual
Length
Manufacturer
INSTALL
2"
PE
220'
GAS MAIN PRf-S';IJRE & TES"'ING
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
DATE OFF
TIME OFF
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
DATE OFF
ITIME OFF
Desion Press 60
1 SYS MAOP 45
PROJECT
PHASE
NOTIF#
ORDER#
SAP Superior
Servioa/Meter
Servioe/Meter
ServioalMater
Service/Meter
Ind. Service
Ind. MSA
Dis. Reg. / FT
HP Svc/MSA
Relocate
Retirement
X181635457
107022501
XIBI636231
106145042
X182379565
X182384589
Contractor CONSTRUCTION COST CODES:
051-103-1 1 1
Project Manager Contact InforrnatIon:
KIM GRAY
CELL: 425-290-2678
EMAIL: kim.GRAY@pse.com
REV# DATE DESCRIPTION
Vicinfty Map
2301
-7
v� 14 04. _'-p.
ST
Owner/ Developer Contact Info
RICHARD CASTELLOW
11332 34 AV NE
SEATTLE, WA 98125
ATTN: SAME 206-546-2011 offloe
CALL (800) 424-5555
2 BUSINESS DAYS BEFORE YOU DIG
THIS SKETCH NOT TO BE RELI ED UPON FOR EXACT LOCATION OF FACILITIES
ESTATE/EASEMENT PERMIT
N/A EDMONDS
TION CONTACT PHONE DATE:
3
PROJECT MGR
K. GRAY
208-418-4233
WWI
2
ENGR-GAS
DRAWN BY
P. MCGHUEY
206-418-4214
1/24105
CHECKED BY
In . GRAY.
206-418-4233
COUNTY
EIMER SECT
GAS WK CTR
APPROVED BY
Yn K. GRAY
206-418-4233
El
ID
SNOHOMISH
5
MNSNHG
CP APPROVAL
1/4 SEC
NE-36-27-03
OP MAP
164.062
PLAT MAP
166.067
MAPPING
JOINT FACILITIES ARRANGEMENTS
UTILITIES
CONTACT
PHONE#
PUGET
SOUND RICHARD CASTELLOW
MMGY 2" PE 1P MAIN EXTENSION
23312 94 PL W, EDMONDS 98020
DESIGNED BY PILCHUCK CONTRACTORS INC.
I
SCALE: AGE:
I"= 5o, r ,,,
-60
00
CITY CLERK
CITY OF EDMONDS
121 5TH AVENUE NO.
FD,MQN0S, WA 98020
4'31TY CLF-RK
nr- EDMONDS
AVENUE NO.
DS, -JVA 980
20
200501110613 1 PG
01-11-2005 01:20pm $19.00
SNOHOMISH COUNTY. WASHINGTON
STATEMENT ON ACCESSORY DWELLING UNITS
Property Address:
RECEIVED
MAR 2 -5 26195
EDMONDS CITY CLEW
Edmonds, Washington
Description: 6ecZ60> 3.6 7owxmA 4;0 2 7 -)Pa,0n,0 OA- AZF
11yeX44 Re"(4p.;
Assessor's Parcel Number: 00,5?0600e)oQ2ne)
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 Vnit, including a second kitchen, Is prohibited until after an Accessory
Dwelling.Unit permit has been approved by the City of Edmonds.
I.also understand that approval of an Accessory Dwelling Unit permit is subject to
compliance with Ide'utifled criteria, to public comment, and neither this statement nor
the Issuance of a building permit shall act to limit the discretion of the City In . the rev . lew.
of any application for an Acc000ft 1)welliva Unit Dermit
Property Owner Signatui
Date- //
C—�t ze-, ?-09C
RECEIVED'
2004
-STATE OF WASHINGTON LLDMONDS CITY CLERK
COUNTY OF SNOHOMISH)
I certi fy that I know or have satisfactory evidence tilhat
signed this instrument and acknowledge it to be his/her free and voluntary act for the uses and
purposes mentioned in this instrument.
19
0
-on :A
7
I st be smudged.
s, Signature of
�'/ Notary. Public:
Dated:
Residing at:
My Appointment
Expires:
THIS DOCUMENT MUST BE RECORDED wITH THE SNOHOMISH COUNTY AUDITOR.
10