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23611 78TH AVE W
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I CITY OF EDMONDS
REQUEST FOR PUBLIC RECORDS
PLE LSE PR]NT CLEARLy
Requester Name: -jz0-t,>G—a7T- Cjo0z>MPKD
Address: -Z-3(011 �o u) q7()7(2
Phone Number: -7-74-'�34& oe E4z-sif-7
Request Made By: In Person In Writing
Date of Request: 9�
L
Nature ofR'equest:
�)V- Ace Po I (ow I Qo� 0
10 J041
.41 . wz.-
,"610-
-04-
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7,50 WUav- c�
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is i request to be used for commercial purposes?
<-� —4'�r
Signature o%que �e
FOR OFFICIAL USE ONLY
ACTION ON REQUEST FOR PUBLIC RECORDS MUST BE TAKEN WITHIN FIVE
(5) BUSINESS DAYS (SEE R.C.W. 42.17.320)
APon taken:
H Request Granted
Acknowledgment
Estimated Response Date Provided (See No. 4)
Record Denied (See Nos. 5 & 6)
Record Withheld in Part (See Nos. 5 & 6)
CONTINUED ON REVERSE SIDE
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2. Request forwarded to attorney for review: Yes Date Forwarded []No
3. Notification of Action Taken to Requester Date of Notification:
a) fi� Request granted
b) Need for additional time How long?
c) Request denied L
d) Record withheld in part
4. If additional time needed, explain why: - ac,0�6-
5. If request denied or record withheld in part name the exemption contained in Chapter
42.17 RCW which authorizes withholding or denial:
6. If request denied or record withheld in pan, explain how the exemption applies to this
record:
7. Request receivep b Department: c44
Date:
FEES
0 - 5 copies free
Standard copy charge @ $.20 per page:
Charge _ pages @ $.20 per page $
Other (Refer to current Records Index & Fee Schedule) $
Applicable Sales Tax
Total Fees: $
DOCUMENTS PROVIDED: DATE:
MAELED:
PICK UP:
RECEIPT #:
DATE:
2361
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4 LONG LF-Gs
SYSTEM CROSS-SECTION
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CovER
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TRENCH CROSS-SECTION
STANDARD DRAINAGE PLAN
INFILTRATION SYSTEM
PAGE I OF 2
for
location
plan by
phone
da te
DESIGN DATA
Trench Perc LF per ImPerm Trench
Number Rate 1000 sq.ft. Area Req.
2- &V
NOTES
I - Call Engineering Division (77!_3202)
for prebackfill and final inspec7jo,s.
2. Responsibility for operation an.4
maintenance of drainage systems On
priyate property is the
of the property owner(s). pre
maintenance consists of prey "ve
Soil and other materials Ircm
trench during construction as wel! a -
after construction. Catz,� basins shc,-,id
be cleaned of floatinq na-prial ar..-
sediment at regular intervals (,,c ;e!s:
twice per year).
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE 'WPERMIT
ZONE 0,-- NUMBER
A0 2
joe
AUUKtSs 7,? . . . . : -,'.cdbmuo ds, Wa.
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3:
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NAME (OR NAME OF BUSINESS)
W.R.Hanson Censt.__
LEGAL DESCRIPTION CHECK
SUBDII ISION NO.
r- 74
LID NO.
1,0F1
PAILING ADDRESS
19519 99th Ave S.S.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — REQUIRED DEDICATION —
PROPOSED:3�'"F
0
7:
CITY
Snehomish,, Wa.98290
TELEPHONE NUMBER
1 481-1521
LOU
t:
NAME
Design ConSUlt2ntv
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
STREET USE PERMIT REQUIRED 0
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ADDRESS
903 10th
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SEE ENGINEERING MEMO DATED
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CITY
Mukilteo
TELEPHONE NUMBER
7454569
REMARKS
741
0
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8
NAME
Same
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ADDRESS
METER SIZE
BUILDING SUPPLY SIZE FIXTURE
UNITS
M:
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CITY TELEPHONE NUMBER
STATE LICENSE NUMBER
WMRHAB*2h6KO
REMARKS
SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADB NO.
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Legal Description of Property - Include all easements
(show below or attach four copies)
SHORELINEN
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VARIANCE OR CU
PLANNING REVIEWJSY
DATA
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YARD�
FRONTW REAR
HEIG
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REMARKS
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NEW RESIDENTIAL PLUMBING
FIADDIALTER COMMERCIAL MECHANICAL
REPAIR RETAINING WALL SIGN
EXCAVATE FENCE
E] DEMOUSH 1:1 OR FILL x _FT)
PRE -MOVE INSPJ swim
REMODEL COMPLIANCE INSP. POQL
CHECKED BY
TYPE OF CONSTRUCTION CODE
X 7V 1
HEIGHT
SPECIAL INSPECTOR
REQUIRED
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AREA
OCCUPANCY
GROUP 0_:Z
OCCUPANT
LOAD
WOOD STOVE/
INSERT APT. BLDG RENEWAL
REMARKS
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NUMBER OF STORIES
Tri-level
DWELLING
[UNUM BER OF
NITS one
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
Construct and build new
VALUATION
FEE
residential house.
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Perm ' it covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
_�ermlt
GRADINGWILL
STATE SURCHARGE
Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
ENERGY CODE
2
"Applicant. on behalf of his or her spouse, heirs, assigns and
successors In Interest, agrees to Indemnify, defend and hold
harmless the City of Edmonds, Washington, Its officials,
employees. and aaents from any and all claims for damaoes of
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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).
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CITY of EDMONDS SIDE SEWER PERMIT
' TREET FILE
For Inspection Call 771-3202S — PERMIT NO. 07513
Address of Construction: 7S YIA BALLINGER
LIFT STATION
Property Legal Description (Include all easements):
Owner and/or Builder:
Contractor & License No: u) n I V 1,4 q 13 t -2 C'
Single Family Residence VX
Multi -Family (No. of Units
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No v--" Yes — (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
I certify that I have read and shall comply
with the items listed on the back.
Permit Fee: ��70, 00
Trunk Charge: 5_, 00
Assessment Fee:
Issued By:
Date Issued: (,I&IS6
Receipt No.: 6`36, ;X
1/7' (/� - 11�1 6
Date
Partial Inspection: 6-169� D&� �s -
Comments Date Initial
Final Inspection Approved: -11-9 6�1 '&i.
Date Init�ial
Rejected:
eason
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy - File Green Copy - Inspector
Date Initial
Buff Copy - Applicant k
cn
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CQ
Th, nty ^f Felmnnelc
Side Sewer Drawing
EASEMENT NO . ............................................
NEW CONSTRUCTION REPAIRS LID NO. 1.0.8 ------- - ASMT. NO . ..................
OWNER N4-11A-APSM ...... "Alt4.50 ..... C.0145711-2� ------- CONTRACTOR .................................................................................... PERMIT NO. 7715.12�.
W *4
JOB ADDRESS .......... 78-."-AWF . .. . . ......... LEGAL DESCRIPTION: LOT NO. ko ................................. BLOCK NO . ..... (A11ALLMER
wFT STATION
.................................
............................................................... ... %K--L ............................ m9fl
NAME OF ADDITI
PROP. C-CAMER
"Z�
Ai Ir Ls I ap
Is
3f
7710 2-31WH
-0001-11/75 (REV.11/78)
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VOR 4"c-*-cRP
4'
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3. rl'opt
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L-117
3V If
16*
213(009
719-rm AvE. Access -ra
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Approved: CO-10-Sro
DATE......... ............
213(oll 'Is'pos.
178 -rK Ave- -
A - 46.
Crid%'JP-Z-Us Rkfikfist-
Site Information
Project Name: - 7:�-TR&f' Permit Number
Site Location: 25&111 29 OL- kvi�- '�A/Property Tax Account Number. f Z10 - 0 0 CD- 0 / 0 -L70
Approximate Site Size (acres or square feet):
Have you filled out a Critical Areas Checklist for a project on this site before?
General Site Conditions
1. Elas the site been cleared or logged?
Soils / Topography
Date of most recent action:
2- In the Snohomish County Soil Survey, what is the mapped soil typc(s)?
2,q-10
3. Describe the general site topography. Check all that apply.
t less than 5 feet elevation change over entire site -
Rolling: slopes on site generally less than IS% (a vertical rise of 10 feet over a
horizontal distance of 66 feet.)
Ifilly.- slopes present on site of more than 15% and less thari 30'Yo ( a vertical rise
of 10 feet of horizontal distance.)
;Steep: grades of greAter than 301/6 present on site.
Comments
Hydrology/Vegetation.
4. Site contains areas of year-round standing water: /t)o
S. Site contains areas of seasonal standing watec /)0 --Approx. Depth:
6- Site is in the floodway /0`�' floodplain of a water course-
7. Site contains a creek� or an area where water flows across the grounds surface? /,ro flows.
are year-round? A,"O Flows are seasonal?
8. Site is primarily: forested - meadow shrubs _ ;mixed
9. Obvious wetland is present on site: XT)
10. Wetland inventory or map indicates wetland present on site: ,e)o
11. Critical Areas inventory or map indicates any Critical Area on site: —10-(D
41� - &
9
City of Edmonds
Critical Areas 'Checklist
ne Critical'ozeas aimuist co ntained on
das f
onn,s to be fined out by any person
Prqmdng a Development permit
APPlication for the CitV Of Edmonds prior
tO his&cr submittal of a development permit
to the city.
711C Puqx)sc of the Checklist is to enable
City staff to determine whether any potential
Critical Areas am or may be present an the
sabied PrOPCItY. IMC information needed to
comPletc the Cheddist 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
fillout the chocIdist. sign, and date it, and
submit it to the City- The City will review
thcchccldist,ma a pr(=mry site visits
and make a determinationof he subs
.equent
steps n=-'SsarY to complete a development
permit application -
With a signed copy of this form, the
Vplicant should also submit a vicinity map
of the parcel with cnou& 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 sttidies in conjunction with
this Checklist to assist staff in completing
their preliminary assessment of the site -
I have completed the attached Critical Area Cheddist and attest that the answers providedare
factual. to the best of my knowledge (fill out the appropriate column below) -
Owner / Applicant:
Name
0-56- / / 70
Title -
Street Address
City. State, Zip Phone
Applicant Representative:
Name
Title
Street Address
City. State, Zip
Phone
Signature
Date Signature
Date
CONSTRU,CTI
OVP�R NAMEINAME OF
'r.V
0&. rr
MAILING ADDRESS
2S.011
us
ZONE PERMIT
OF EDMONDS NUMBER
1 PERMIT APPLICATION
JOB S IT&A
[NESS ADDRESS
100-D 1�0 LEGAL DESCRIPTION CHECKI SUBDIVISION NO LID NO
TESCP A r ad
ADDRESS
'ITY
ZIP
4AME ow oe
kODRESS
CITY zip
STATE LICENSE NUMBER
Legal Descri qion of Pro rty - incluc
E NUMBER
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING - REOUIRED DEDICATION
PROPOSED
pp IN
RW Permit Required 13
Street Use Permit Rq'd 0
Inspection Required D
Sidewalk Required 13
REMARKS
E NUMBER
ENGINEERING MEMO DA
6 7�fllj
METER SIZE
BUILDING SUPPLY
SIZE
1
TELEPHONE NUMBER
REMARKS
EXPIRATION DATE
SIGN AREA
ALLOWED I PROPOSED
SEPA
COMPLETE
EXP
REVIEW
JEXEMI
all easements
VARIANCE OR CLI
F
P764A7
By
SETBACKS - FEET
HEIGHT
Property
Tax Account
0 6 0
FRONT SIDE REAR
EMA K
ParZ No.
000 - 0 10
67 lrjo-r X-x cc--
NEW RESIDENTIAL EJ PLUMBING
El
1167 6.,�/ 7—
ADDITION
COMMERCIA1
MECHANICAL
REMODEL'.
4PT. 81.6.
El S-iGN,
CHECKED BY
TYPE OF CONSTRUCTION
1 I
CODE
6? /
EIGHT
G FENCE
D REPAIR 0 GRAD'N CYOS. I x _FT)
DEMOLISH
GARAGE
OODSTOVE
INSERT-
r7 RETAINING'WALL/
SWIMPOOL
HOT TUB/SPA
SPECIAL INSPECTOR
REQUIRED
E3 YES,
AREA
OCCUPANCY
GRO P 7
U
OCCUPANT
LOAD
MARKS
CARPORT L_J ROCKERY RENEWAL
-Z!
t; .. . ... .... nP Ar.TIVITVW FXPLAIN-
PROGRESS INSPECTIONS PER UBC 305
NUMBER 1WU11lER OF CRITICAL
r
OF 0 :L N. EAS
STORIES UNITS NUMBER
DESCRIBE WORJ§ TO BE DONE (jkTTACH PLOT PLANII
FINAL INSPECTION REQUIRED
EEEEM VALUATION
PLAN CHECK FEE I
HEAT SOURCE:
GLAZING %
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewlilks,
driveways. marquees, etc.) will req� Ire separate permission.
STATE SURCHARGE
PerritfiApolctitloh: 10 Days -* ;I
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
successors in interest, agrees to indemnify, defend and hold
ses
harmless the City of Edmonds, Washington. its officials,
2
employees, and agents from any and all claims for damages of
whatever nature, arising directly or Indirectly from the Issuance
x
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
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
ATTENTION
APPLICATION APPROVAL
Information given is*correct; and that I am the owner, or the duly
:Uthorized ageitt of the owner. I agree to comply with city and
tate laws regiAlating construction; and In doing the work authoriz-
THIS PERMIT
AUTHORIZES
This application Is not a permit until
ed thereby, no)person will be employed In violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of the, St te of shington relating to Workmen's Compensa-
I!, M
WORK NOTED
Deputy; and fees are paid, and receipt is
tioninsuran
INSPECTION
acknowledged in space provided,
DISIGNQUAIE 10 R 0 AG NT) DATE SIGNE
DEPARTMENT
1 0795
&//
CITY OF
, ;r � DATE
2�C� '7
EDMONDS
6r, -
CALL FOR
RELEASED BY DATE
ATTENTION
INSPECTION
IT S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-0220
UN1;IL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL - File YELLOW - inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
C14APTER 3
PINK - Owr-er GOLD - Assessor
171
ASSET INFORMATION SHEET
CITY OF EDMONDS Pr r
CITY OF EDIMOm6s-,
j2"NEW N2 05060 ASSET NO.
ADDITION ADDITION TO ASSET NO.
El RETIREMENT
DESCRIPTION
SERIAL NO.
LOCATION
DEPT. NO.
"PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
i
ttnp
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
PROJECT N U M BER
PROJECT COMPLETION DATE
COST 2,-3�2 -,-2 ---)
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
$DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT -
L. ENTRY
�,�n
INITIAL
REFERENCE
t:!�Zc
VERIFIED BY
PROCESSED
BATCH NO.
DATE
DEPARTMENT FILE
STAN TOP 353-09 1 N
INV. 3 41.94
1+53
X.
EX . CS W —
TOP 353.96
IN %, . S,349-26
INV. EaW. 34 7.36
STA 2+C.
EX.iEE --
EX. 27"STORM SEWE
EX. K" - I
TOP 354.67
INV. 542.22
STA 0+07 EX.TEE —
EX. B-SAN. S
11--
W
W
-,A:Cess
Ease men!
/ Econst.40L.F. 12
Storm Sewer at 5
EX. &H TOP 3 28.70
INV. 323.50
Cones * 40L.F.8"CC,
Son.S.w
er at 8.12'.'
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