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DATE
Ile i
CITY OF EDMONDS
FEE
HEARING EXAMINER
RECT
APPLICATION FOR VARIANCE
A POIS
HEARING DATE:
VAL -I
C I ADDRESS_ /,3'3
1 K
CITY & ZIP PHONE
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INDICATE TYPE OR DEGREE OF INTEREST IN PROPERTY
LOCATION OR ADDRESS OF PROPERTY &&�,-Lt,
LEGAL DESCRIPTION OF PROPERTY
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VARIANCE REQUESTED:
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FOAFFICE USE ONLY: USE ZONE:
ZONING ORDINANCE REQUIREMENT:—
Release/Hold Harmless Agreement
The undersigned applicant, his heirs and assigns,,iln consideration for
the City processing the application agrees to release, indemnify, defend and
hold the City of Edmonds harmless from any and all damages and/or claims for
damages, including reasonable attorneys' fees, arising from any action . 11
or inaction is based in whole or in part upon false, misleading or incomplete
information furnished.by the applicant, his agents or employees.
Permission to Enter Subject Property
The undersigned applicant grants his, her or its permission for Public
officials and the staff of the City of Edmonds to enter the u C,ect perty
for the purpose of inspecti d posting att�ant to thVia . licaUn'l.
S�ghatui��'ot AppIrcant, u-�mer o
Representative
2.
3.
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4.
5.
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7 jor
DECLARATIONS OF APPLICANT
Please answer all questions
What are the physical characteristics,.(i.e. topography,
shape
of lot, etc.) which create a hardship for you in regard to
"lopment of your property?
0/'�. It " 7t CA "0
How does your property differ from other property,in the
same
vicinity?
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Wi7ithis variance be detrimental to palic or daffiagineto
other property or improvement *n the vicinity?
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What hardships will 'result to you if the variance is not
grantec
Will these hardships have been caused by your own action?
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Can you make reasonable v�'e of your property without the
varianc
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CITY CIE EDMONDS
P. W. DEPT. ENGINEERING DIV.
EXAMINED
BY DAT E et i-
REMARK
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REID. MIDDLETON & ASSOCIATE5. INC,
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PLICABLE ONLY IN CALIFORNIA FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: IT ISUNLAWFULTO IAIPKESENTOH CAUSE TOOZPFIESENTED.AI)lY, AL E I
i—OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS UNDER A CONTRACT OF INSURANCE: ID) PREPARE, MAKE OR SUBSCRIBE ANY WRITING.WITHINTENI TO PRESENT OR USE THE SAME, ORALLO ITT �
BEPRESENTEDOR USED INSUPPORTOF ANYSUCHCLAft0. EVERYPERSON WHO VIOLATES ANY PROVISION OF THISSECTION ISPVNI'P'�ILE fly IMPRISONMENT IN THE STATEPRISONOR BY FINE NOT EXCEEOING.*-�
ONE THOUSAND DOLLARS. OR BY BOTH.
FOFF ICE USE ON. w
�ILEAUTOM01 CLAIM NUM13ER
3/2
OCLAIM REIDORTI 11 &&d I,&
1� INSURED'S NAME lost fint POL BASE NUMBER T. CODE I CHG. CODE ICAR.NO.
NO.' C11rel
ADDRESS number and gr city state zip mcfe DATE OF BIRTH EIUS� PHONE
6oZ
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q 7 HOM H N
STATE ZIP CODE
DATE TIME OR HIGHWAY CITY OR CO NTY
IINIEAHD T La%fljSTREE
PLACE OF 51
/OR LOSS A
L
3 ACCIDENT -SV gVEHICLE I LDFr4:TIF 14CAT ION NUKIBER
INSVIED E141CLE
otr
PRIOR DAMAGE? IF YES, DESJITBE IS THIS THE EXPLAIN.
5 oNO []YES DYES El NO
BUS. PHONE
DRIVER last first midd o initial OCCUPA ION AGE
HOMEPHONE
AOrSS numb;r am street city state IONSHIP TO INSURED
It
UNDER WHOSE AUTHORITY WAS VE141CLE BEING DRIVEN? WAS DRIVER ON MISSION FOR OWNER? PURPOSE OF TR IP
Ej YES
NO
9 PRI T OF PACT DRIVE IN SERVICE? F,YES, OFFICE WHERE IS VEHICLE?
NO. YES
OTHER VEHICLE-vear-m 041411 WTiC$-bCKIY Style LICENSE NUMBER
10
OMER first ADDRESS number and street city suite BUS. PHONE
HOME PHONE
DRIVER Ia%t ADDRESS number and greet city Mtn BUS, PHONE
12 HOME P140NE
PRINCIPAL DAMAGEMOINT OF IMPACI DRIVE-IN SERVICE' IF YES, OFFICE WHERE. IS VEHICLE
13 NO [:] Y E S --j---jPOLICY NUMBER
14 NAME OF INSURMACE COMPANY ADDRESS
ACCIDENT.ITHEFT FACTS
15
—Gel
I NANCE (IN FEET) FROM OTHER SPEED LIMIT 11 EA SPEED WHEN DANGER FIRST NOTED SPEED AT IMPACT. SIG ALGIVEN?
'111 �Sl 0 1 ED
SP'
CAR WHEN DANGER FIRST NOTEDI OF ACCIDIENT, "T
_EH
�VEH.2 VEH.1 VEW 2 ONO F]YES VEH.I NOE] YES-VEH, 2
ROAD CONDITIONS HEADI-IGHTS ON' 0EPPIECIATION ITEM PORTION
_I ORC NDITION� OEOUCTI
2 EINO 0vF'., VE-H 1:1 NID El YES-VE�(?L
TRAFFICCONTROLI IFYFS,TYPE V'.'ERE POLICE THE911-7 PQ�ICIE DEPT REPORTING ACCIC ENT VIOLATION -%%HO RECEIVEDT ICKET?
'T
]NO OYES
30NO El YES [F
T %1E -TE -�riuc ES, DATE
THEFT' IF PARIIAL.NAME 1TEM PLACE . lL-,%,i4 07PTCERS No'WFtc), I E: S:ZATE] LE RECOVERED? IF Y
YES
4 o ENTIrit] ','F 14tC.Lf E] PAP I I'll I YES NO
INJURIES? 1; YES. IUE',T1FV
5 EE011
E140 01 yrs
------- - -- — -------
INJURIES' iFYES
bir (=—. —4 0 NO 0 �'Es
WITNESSES? 1� YES, IDENTIPYNIAME ANDADORESS
I he,ebv d,rwe that 14c th�s ieliort are true and acc�ujte.
81 INSURED DRIVER
SIGNHERE X DATE ISIGN HERE X OATE
COI�FRAGF IN F 0, R, C iNVO,".1 :.-v n %GENT
FIE,
NO 0 YES
REPORT
P qo�jT
A(Y
Po 7
DATE
HeRVFHICLrASSIGN
L,..N r E FD TO
G 4684n 12 Piinied in U.S.A. 'V USE OTHER SIDE IF NECESSARYVF
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VED
REC E I
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FEB I t)
4 Um:its EtV. DtIL K
I T Y E A S E M E N T
U T I L
The t; �L-rslsnec
c' bprefiTs to accrue -.a -.h4;Nqran.?Fs here nd
and
C Y
orm,nenT ZU'L'�-;AT
ru L I v Or i'_ NGS, a
cDcrat�on, anl ra:ntenwrico of
w-,ktqr Innin
!on,
ovar, zcro;;s, r.nroi.,jr. arc oumo -:,.c �co :oo-
z.r-.ni:r rignT to rc"avo trees, bushes, undorg-Dt7n
7y, 3nz Ita t
a C,
'interfering with the location, construction and maiintehanc f 114,!
6N.2- oz
DIN. 0., _sTr6%:t'onS 7.,f
Ot' utilities.
in 'he County Of SnOhOmlsh,
rig*,:_,3j_wjy horeay grantud is locatud
jnJ
of ri"n;n;zon, ind is mra particularly Gosc ibod as follows: 14
State
2_
fg".
The North 7.50 ft. of Lot 3. lack 3, Lftke Ballinger
s Pint Subdivision No. 1. necording to plat
Land Comprinic
pli ts, pages 57 and 38, 4 1'r
thereof recorded in VOlUMe "i
records of Snoliomish County, Vinshit g ton -
of
"D
NO SALES TAX
>:
REQUIRED
APR 6 197G
Cmd
rVi X �S'
C'
> jqm fly/ 't ty
VCU
7 No c: a Lj 3 r c a r o s I o r o T 0 S L s a n -r y
he original condition s�;ch :m- ri Itri.
nancc i2nd ropair of laid I
as 3rj Q:stur�ce cL;rin; me construcTion, rrj;nt,
a GranTors, Ita r hc!rS 0:' j?t;;gnS z;�.al I not con-
prov;k:c_. tn
17
srrLc, - jr-y perninariT sTrucTorj ovars upon or wf -.n� n Ino pormanonT Zilt;On,) -
1"�Z C7 /o'
DATED In:& 7 7'V day of )=4e, 19 76
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IATE OF
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..December 9, 1983
TO: ames M..Driscoll
Hearing Examiner
FROM Duane V. Bowman
Assistant City Planner
SUBJECT: ADDITIONAL COMMENTS FROM ENGINEERING DEPARTMENT ON V-.;16 83
i� "1V
During the hearing on December 1, 1983, you requested additionalcom-
ments from the City Engineer's Office in regards to the carport var.ia I nce
#V-16 -83.
Specifically, your request involved looking.at the fact that the en
trance to the carport will be from the south and that the cars will
be turning head first into traffic along 75th Avenue West. The,.City
Engineer's office is not necessarily opposed, if all turnarounds are
done on -site.' This means that on the west side of the carport., some
of the fence, wall, etc. will need to be installed.
If you should have any further questions, please feel free to contact
AV
me.
DVB/tq
cc: File #V-16-83
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