23513 76TH AVE W.PDF111111111111
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23513 76TH AVE W
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OW E
,511 NAMEINAME OF BUSINE�V
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MAILING ADDRESS
VIN 6 ^V 1),rl
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PERMIT
:49 NUMBER
7 -- J -7 — 7 1 ZI
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved 0
CITY
F -'J&ELEPHONE " UMBER
RW Permit Required 13
I—VAWIJ OD
-7,74;4,2,101
EXISTING — REQUIRED DEDICATION —
Street U" Permit Req'd 13
I
InspectiorlRequiled 0
NAME
_.�L
y RIC'k- 6,4tu�
ROPOSEO
Sidewalk Required 0
REMARKS
NUMBER
ADDRESS
CITY ZIP TELEPHONE NUMBER
STATE LICENSE NUMBER EXPIRATION DATE
Legal Description of Property - include all easements
Lk;EsT 1/-z-op -rs445 AJOWT14 65*FlEY*roF:L41r/0
- A -1
E3 Le) C- K * I- fk V"F Is 'T�LL 1 rvcv*-- W- I- A70c;zoamMl
Picirr 5ug r),vt sloAl Alo, I A5 PEjL pLovr itF-
COseoe"D /A/ V 0&- � FL-07-5 ti",+4�rcr� t) I 1'5Yj
-ef60AD3 OF SAJO*C0115-14
Property
Tax Account
Parcel No.
NEW RESIDENTIAL PLUMBING
ADDITION COMMERCIAL MECHANICAL
DREMODEL APT. BLDG. SIGN
GRADING FENCE
CA REPAIR CYDS. I x _FT)
WOODSTOVE SWIM POOL
13 DEMOLISH INSERT HOT TUB/SPA
EGARAGE r7 RETAINING WALL/
R CARPORT L_J ROCKERY RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
S / IV 67 /_ &�- C_ #qx' 6Ae116C
NUMBER OF STORIES NUMBER OF
I DWELLING
UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
-r'_1 I , I � __ ., I /I /I
SIGN AREA SEPAREVIEW ---APB NO
ALLOWIEDt:PR70POSED� COMPLETE JE EMPT
SHORELINE
EXP 'X
VARIANCE OR CU r
,�.ING REVIEW BY DATE
T �xryle- I & -,F
SETBACKS - FEET HEIGHT I LOT COVERAGE
'V�_l
FRONT - SIDE 7 '/7 'REAR
CHECKED BY TYPE OF CONSTRUCTIO CODIC. I HE.. ,
-V: -- /Z , I X S, 145'�,v
�PECIAL INSPECTOR AREA OCCUPANCY IOCCUPANT
REQUIRED C3 YES GROUR;V ILOAD
MMARKS
PROGRESS INSPECTIONS PER USC 305
FINAL INSPECTION REQUIRED
A Rac_k
lz�A i� s ', o c , r
/")I
No E�t C(MZIC,
PLAN CHECK FEE
BUILDING
H_5kT SOLIF@ Nolyc
GLAZING %
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curts, sidewpiks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant. on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
ut
successors in interest, agrees to Indemnify. defend and hold
2
1
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
PLAN CHECK DEPOSIT
5
whatever nature. arising directly or Indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
OX
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the
Information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
tate laws regulating construction; and In doing the work authoriz.
d thereby. no person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa-
THIS FERMI
AUTHORIZET
ONLY TWi
WORK NOTED
tion Insurance.
SIGNATURE (OWNER OR A-90-1114T) SIGNED
INSPECTION
DEPARTMENT
JDATE
wi e- 7Z
CITY OF
EDMONDS
ATTf,KTION
CALL FOR
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
10247
N
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
2—
ORIGINAL - File YELLOW - Inspector
PINK - Owner GOLD - Assessor
STREET FILE
890 .194
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 thi's form, the
applicant should also submit a vicinity map
of the parcel with enough detail that 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:
Nwne
- Ot,--611A,�- /Z-
Title
:;), 3 5-1 -3 76
Street Address
Applicant Representative:
Narne
Title
Street Address
t
CitV. State, ZIP Phone City, :6ate, ZIP Phone
Signature 4 6ate Signature Date
2c)
,J
fritical Areas Checklist RECENE-D
Site Information
Project Name:
Permit Number:
Site Location2-3-5-13 Property Tax Account Number:
Approximate Site Size (acres or square feet):
Have you filled out a Critical Areas Checklist for a project on this site before?
MAY 2 0 1992
PERMIT COUNTER
1')o
General Site Conditions r�:>
1. 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)? /P� 141)e(1J0J of LM k'"J
3. Describe the general site topography. Check all that apply. e"yf'P-'X Z— 0'%'
X —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.)
Steep: grades of g7rter than 30% present on site.
i
I '
Comments 0A 7� CK
Hydrology/Vegetation
4. Site contains areas of year-round standing water:
2
.5. Site contains areas of seasonal standing water: pprox. Depth:
6. Site is in the floodway 1�1-2 floodplain of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? flows
are year-round? Flows are seasonal?
8. Site is primarily: forested meadow shrubs _;mixed
9. Obvious wetland is present on site: /VC)
10. Wetland inventory or map indicates wetland present on site. AID
11. Critical Areas inventory or map indicates any Critical Area on site:
For City Use Only
C�'
Z
0
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0
0
CITY OF EDMONDS 1W
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PE&TREET FILE
A. eAddress or vicinity of Construction
23513 76 NV West Plat # 167-070,1
0 Owner: Washingtm Natural Gas Co
Name
805 156 AV NE
Mailing Address
Bellevue, Washington 98007
City, S ta te, Zip Code
Contractor: Same As Ahcue
Name
Mailing Address
City, State, Zip Code
Wit No. Ro - / ( , -tl
Issue Date !xf4- ggR/A-0
0 Permit Issued To:
9 Type of Work to be Done: insta1l, New se—r�—air---e
e Work in Connection With:
11 Sub or Plat k] Single Family
0 Comml. / Ind. 0 Apt. Condo.
0 Pavement Cut: El Yes El No
State License Number
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
It be a
I understand that this pernp
Signature: —
Owner or
Oable f t/he
c!-v V - j
for inspection purposes at all times.
te Sept 25, 1980
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By -
Time Authorized: Vold after,-900 days
Special Conditions:
Ammendments:
Permit Fee:
Security Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimensions
X —
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng, Div. Decembcr 1978
INIrl.'-OFFICE COMMU(�-�CATI�,NS
STREET
TO Herb
SUBJECT: Utility Charge.
202-02800
Carl A. Oberg
23513 76th Ave. W.
FROM
DATE
July 13, 1972 19
Dorothy
,Ken went to check on a leak at.the above address - at that time
Mr..Oberg told him they had an apartment in the basement that is
a rental unit. We now only bill for one residenceg for....ItilltY
.. .... ....... ....... ...
charge.
Your assistance please.
L0 lot, fr,.,e- ^--) c-,M, 4- &PAZ-C " 1
TZ>
STREET FILE 6.20.030
EXCESS CHARGES
All water consumed In excess of seven hundred cubic feet
shall be an additional charge to the
consumer at the rate of
twentY-five cents per one hundred cubic feet .
The above rates are exclusive of taxes.
New service line and meter installation charges are hereby
fixed as follows:
(a) 3/41, inside city limits
. . . . . . . . . . . . . $125-00
(b) 3/411 outside city limits
. . . . . . . . . . . . 150.00
(c) 1" inside city limits
. . . . . . .
(d) ill outside city limits . . . . . . . . . . . . 150-00
(e) All . 175-00
. . . . .
over ill to be charged for at total actual cost of job.
Cost of street restoration (all surfaced streets) to be
added to any meter installation
charge where applicable.
When approved by the city engineer, new service lines
installed by developer on
plats shall be credited as follows:
(a) 3/41, lines . .
. . . . . . . . . . . . . . . . . $ 60.0o
(b) ill lines . . . .
. . . . . . . . . . . . . . . 70-00
(Ord. 1457 §1, 1970: Ord. 1385 §2, 1968: Ord. 1263 §1, 1967:
Ord. 901, 1961: Ord. 786 §2,
1959).
6.2 3?
�ou ilit char �es A. Generally. The utility
charges hereinafter set forth Lhall
be added to and made a part
of monthly rates for water supplied through the
before
set forth: meters as herein
NOT CONNECTED CONNECTED
(a) Residence, single $2.00 per month. $3.00 per month per unit.
family, duplex,
per unit.
apartment houses
and other multiple
units, except hotels,
tourist camps,
trailer parks and
motels.
(b) Hotels
--- $3.00 plus $-50 each room.
(c) Tourist courts --- $3.00
motels, trailer plus $1.05 each unit.
parks
M Schools
--- $20.00 per month minimum
Plus $.20 per month per
student, based on the
architect's rated capacity
of the school; if double '
shifting is effected, then,
in that event the student
count will be'the average
daily attendance for the
month preceding the billing.
57 (Edmonds 5/15/70)
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).
APPLICATION
ILE for
Th. Croma 5 SIDE SEWER PERYaT EASEMENT No . ..........................................
NEW CONSTRUCTION E] REPAIRS
OWNER ..... 6f r/i . ...........
... ..... ......................................... CONTRACTOR P30RMIT NO—l'?,V
ADDRESS Z2,r ... . ........ Z6 ...... ......... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
ILNAME OF ADDITION ..........................................................................................................................................
11
0
*0
Approved:
DATE .... ....... By . .....
C
E
0
APPLICATION
for
The City of EdmoF'Ugb' SIDE SEWER PERMIT EASEMENT No . ..........................................
Q'IREET NEW CONSTRUCTION REPAIRS n
2
OWNER ... -./c . .......... .............................. -- .......... CONTRACTOR ..... ............. ...... .......... PERMIT No.
- !�F
ADDRESS ... . ......... 2.5�
... . ............... LEGAL DESCRIPTION: LOT No . ............................................. BLOCK No . ............................................
NAMEOF ADDITION ............................... ......... ....................................................................
Approved:
................................
DATE ..Ltk—/471J�0 ......... By I.-
CITY OF EDMONDS
CIVIC CENTER —WATER -SEWER DEPARTMENT Call PRospect 6-1107 when vrork
is ready for inspecumoL (No inspec-
SIDESEWER PERMIT tions Saturday, Sunday or holidays.) N2 1627
ADDRESS ............ R-J. *.Z, X. � 7 n
W ..... .................................................................................................
OWNER ............ .... --------------------------------- CONTRACTOR ...... . . ..........................
Permission is granted ...... 19.4 for ...................... days, to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on Kel and governing ordinances.
ATTENTION IS CALL D TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must
N be employed to Construct side sewer in street area. Do not cover any portion of sewer before It has been Inspected.
,OTE No. 2—Obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—Top of side sewer must have at least 30 Inches coverage at property line and 12 inches inside property line; minimum grade of 2%.
No bends in grade sharper than % will be permitted.
NOTE No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shaIl be responsible for
failure due to Improper work which may develop within one year of completion.
NOTE No. &—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its ap-
Purtenances except to Insert the Pipe into the wye.
49 �
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0
9 0 0 0
k i
Parcel (a) :
That portion of the Morth ?5,00 feet of Lot 6.9 Block 3.9
Lake Ballinger Land Companyts Plat Subdivision No. 1., =cording to
plat thereof recorded in volume 9 of platsq pages 57 and 58., records
of Snehon-ish Cmmtyp Washingtons described as folloTTS-
Beginning at the Northwest cofner of said Lot 6; thence South 890
45t30t' East along the Notth line thereof MoOO feet;.
thence South 012hI3011 West 75.00 feet/thence North 89*45130" West 13.6,73
feet to the East margin of Battle Drive; thence North 30519019 East along
said road margin 75.14 feet to the point of beginning.
$MEET
FILE
APPLICATION
for
CARD No . .....................................
The City of Edmonds
SEDE SEVw7,R PERNEIT
OUTSIDE INSIDE M---'--REPAIRS E]
EASEMENT No . ......................................
OWNER ----------...... 1:! ------ ...........................
..........
CONTRACTOR ......... ... Yglk-" -------------------- --- ...... PFluY[IT No.
HOUSE No . ........... A�� -------- - ---------------------
7 ......
STREET
AVENUE LOT No . ...... ---------- ------------- /11.7-
----- 13LOCK No - ---------- 475� ------------ .................
NAME ADD - ----------i ----------- -/ -------
JT4
APPROVED
2-1963
Date Approved:
BACEFILL WORK ORDER ISSUED ................ — ................ DEPOSIT, $ ................. ....................
SEWER WORK ORDER ISSUED ----------------- __- ............... .. DATE
..... 13Y -------- .. ......
Garagel�rea to be Reblkt 284 Sq Ft
<E
R P H��,fW rjt'C 10,
12,w1bomwo, 10,
lul I I 1-111L
95 Feet
73
57' Siolewatk to Garage
14'
85
Feet
Y 3 6'
31' Sidewa�k to
House
1
7 1 '2
4.5'
Portion to
be Relouilt
llrigina�
Garage
2 4'
11
— 15.5'—
Lega( Description: West 112 of the North 85 Feet o-F LOT 10
BLOCK 4 Lake Ba[linger Land Company P(ot Subdivision # I
As Per Mat Recorded in Vo(, 9, Ptats, Pages 51 & 58
Records o-P Snohomish County
Garage RebWd 23513 76th Ave W
Rick Grove 774-2901
R E C E V,:
J U N ',, i,
GTREET HLE PERMIT