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23620 76TH AVE W
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STREET ADDRESS FILE
CITY OF EDMONDS
7110-210TH ST.S.W. - EDMONDS, WA 98026 - (206) 771-0235 - FAX (206) 744-6057
COMMUNITY SERVICES DEPARTMENT - PUBLIC WORKS DIVISION
I
September 25, 1996
Mrs. Cathem Davison
23620 - 76th Ave. W.
Edmonds, WA 98026
Dear :Mrs. Davison
BARBARA FAHEY
MAYOR
I have reviewed your account and will allow a credit in accordance with our City polic, y.
The policy states that the customer will be billed at the retail rate based upon the average
water consumption for the same period during the previous year. In addition, the excess
water lost from the leak will be billed to customer at the City's wholesale rate with a 15%
surcharge added for administrative cost. Only one leak credit will be granted in any three
year period.
Should you have any additional questions after you receive your new billing, please
contact Ilene Larson, Utility Billing Clerk, at 771-0241.
Sincerely,
Scott Highland
Acti ng Water/Sewer Supervisor
RH/lk
cc: Ilene Larson
Utility Billing Clerk
wordata\water\credit96\#506325 I Incorporated August 11, 1890
Sister Cities International — Hekinan, Japan
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UMMASMNT City of Edmonds PAGE 1
09/23/96 14:09 Print Master File Account Details
Account: 5-06325
Screen I
Tenant Information Owner Information
01 Name HAYDEN OR OCCUPANT 09 Name HAYDEN PHIL
02 Care of 10 Care of
03 Addr 1 23620 76th Ave W 11 Addr 1 23615 86TH AV W
04 Addr 2 12 Addr 2
05 City Edmonds 13 City EDMONDS
06 State WA 07 Zip 98026-8804 14 State WA 15 Zip 98026-8910
08 Phone (000) 776-8089 16 Phone (000) 077-1666
18 Water 195.87
===Meter Reading Information— 19 Surcharge 11.26
17 Location 23620 76TH AV W 20 Sewer 36.20
Current Previous 21 Previous Due 0.00
24 Curr 141 25 Date 08/14/96 26 06/14/96 22 Current Due 243.33
27 YTD 182 28 Rdng 856 29 715 23 Balance 243.33
32 LTD 228 30 Rdng 0 31 0
33 Meter #: 4704 35 Extension Dt 00/00/00
34 Location 36 Acct Setup 00/00/00
N D/W NE COR PROP BY S/W 37 Last Pay 07/11/96
38 Last Bill 09/04/96
39 Due Date 09/30/96
40 Status A
Screen 2
Misc Codes Rate Codes Units ***Meter Info***
01 Status A 14 Water 001 5/8 R 15 1.00 22 Meter BrndSR
02 Type 13 16 Surcharge001 TAX 17 1.00 23 Meter #; 4704
03 Cycle 02 18 Sewer 001 RSEWR 19 1.00 24 ID Meter
04 In/Out 1 20 Misc 000 NOCHG 21 0.00 25 Type M A
05 Sort Cd 0000 26 # Readings 1
06 Est Flag N 27 Meas Code HCF
07 #Tenant 1 28 Install Dt 01/21/85
08 #Owner 29 Shutoff Dt 00/00/00
09 Respon? T 30 Route 502
31 Sequ 3700
10 Penalty N 32 Codes SE1 B
11 Past Note B 33 ADDR-CODE 1 00
12 Shut Note B 34 ADDR CODE 2 00
13 Account Info
L LE, NIC i
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UMMASMNT
City of Edmonds
PAGE 2
09/23/96
14:09
Print Master
File Account Details
Account; 5-06325
History
1)
Water Surcharge
Sewer Misc
Fees
DEP:
Unapp
Total
2)
DEP:
Balance
Read Date
Sery Days
Read 1 Read 2
Read 3
Consumptio
Avg/Day
[Memo] --------------------------------------------------------------------------
09/04/96
Water
08/14/96
61
856
0
0
141
2.311
B 1
195.87
11.26
36.20
0.00
0.00
0.00
243i33
Balance:
243.33
08/29/96
M-C
BROKEN PIPE/LEAK
07/11/96
R 1
29.47-
1.69-
36.20-
0.00
0.00
0.00
67 . 36-'
Balance:
0.00
07/02/96
Water
06/14/96
63
715
b
0
13
0.206
B 1
29.47
1.69
36.20
0.00
0.00
0.00
67.36
Balance:
67.36
05/08/96
R 1
24.27-
1.40-
36.20-
0.00
0.00
0.00
61.87-
Balance:
0.00
05/01/96
Water
04/12/96
58
702
0
0
9
0.155
B 1
24.27
1.40
36.20
0 .00
0.00
0.00
61.87
Balance;
61.87
03/06/96
R 1
24.27-
1.40-
36.20-
0.00
0.00
0.00
61.87-
Balance:
0.00
03/04/96
Water
02/14/96
61
693
0
0
9
0.147
B 1
24.27
1.40
36.20
0.00
0.00
0.00
61.87
Balance:
61.87
01/09/96
R 1
25.57-
1.47-
36.20-
0.00
0.00
0.00
63.24-
Balance:
0.00
01/04/96
Water
12/15/95
63
684
0
0
10
0.158
B 1
25.57
1.47
36.20
0.00
0.00
0.00
63.24
Balance:
63.24
11/09/95
R 1
24.27-
1.40-
36.20-
0.00
0.00
0.00
61.87-
Balance:
0.00
11/01/95
Water
�10/13/95
58
674
0
0
9
0.155
B 1
24.27
1.40
36.20
0.00
0.00
0.00
61.87
Balance:
61.87
09/15/95
R 1
21.67-
1.25-
36.20-
0.00
0.00
0.00
59.12-
Balance:
0.00
09/01/95
Water
08/16/95
61
665
0
0
7
0.114
B 1
21.67
1.25
36.20
0.00
0.00
0.00
59.12
Balance:
59.12
07/03/95
Water
06/16/95
60
658
0
0
12
0.200
B 1
28.17
1.62
36.20
0.00
0.00
0.00
65.99
UMMASMNT
City of
Edmonds
PAGE 3
09/23/96
14:09
Print Master
File
Account
Details
Account:
5-06325
History
1)
Water Surcharge
Sewer
Misc Fees
DEP:
Unapp
Total
2)
DEP:
Balance
Read Date
Sery Days
Read I
Read 2
Read 3
Consumptio
Avg/Day
(Memo] --------------------------------------------------------------------------
Balance:
0.60.
07/10/95
R 1
0.00
0.00
0.00
0.00
0.00
65.99-
65.99-
Balance:
65.99-
05/31/95
R 1
24.27-
1.40-
36.20-
0.00
0.00
0.00
61.87-
Balance:
0.00
05/02/95
Water
04/17/95
59
646
0
0
9
0.152
B 1
24.27
1.40
36.20
0.00
0.00
0.00
61.87
Balance:
61.87
03/07/95
R 1
61.87-
0.00
0.00
0.06
0.00
0.00
61.87-
Balance:
0.00
03/02/95
Water
00/00/00
63
637
0
0
9
O.i42
B 1
24.27
1.40
36.20
0.00
0.00
0.00
61.87
Balance:
0.00
01711/95
R 1
61.87-
0.00
0.00
0.00
0.00
0.00
61.87-
Balance:
0.00
01/04/95
Water
00/00/00
63
628
0
0
9
0.142
B 1
24.27
1.40
36.20
0.00
0.00
0.00
�61.87
Balance:
0.00
0
CM
CM
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� 98020
P 786 8LO 071
-Certified Mail Receipt
No Insurance Coverage Provided
Do not use for International Mail
,l�� (See Reverse)
Street & No
.;? 3 &
PO . Slate � 71P Code
��12,1
Postage
Cerl.tied. FeE:
Special Delivery Fee
Restricted Delivery Fee
Return Receipt Showing
to Whom & Date Delivered
Return Receipt Showing to Whom,
Date, & Address of Delivery
TUrAL Postage
& Fees
Postmark or Date
3 6-2 76 )4'2tAe_
Phil Hayden
23615 - 86th Ave. W.
Edmonds, WA 98026
06'6 All, aw-e
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CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 * (206) 771-3202
MEW
N��-Wwqw
JWF", COMMUNITY SERVICES:
lqc� PublicWorks 9 Planning 9 Parks and Recreation Engineering
CERTIFIED MAIL
April 24, 1991
RE: Problems with venting of your plumbing fixtures
Dear :
LARRY S. NALIGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
The City's sewer cleaning records show that the home at this address is
experiencing problems with the venting of some of your plumbing fixtures
when the City crew is conducting cleaning operations of the City sewer line
in front of this address.
The City's cleaning operation is essential for both you and your
neighbors. It cleans debris in lines to prevent plugs, prevents corrosion
and potential future collapse, and achieves a better flow characteristic in
the public sewer lines. We need to do this often -- perhaps even 3 times a
year -- in some critical areas. The City's cleaning operation typically
involves the utilization of a high pressure water jet.
The problem which occurs at the home is the result of a high pressure surge
through your internal plumbing system. A properly constructed plumbing
system is designed to easily vent this additional pressure without any
visible impact at your residence. An undersized venting pipe (or not
having enough vents) cannot handle the pressure surge, and the only release
that's available is then through your toilet (or another fixture). The
Uniform Plumbing Code typically requires a 2" vent, and further requires a
separate vent for each plumbing fixture which is connected to the sewer (a
toilet, a sink, a shower). Your home clearly does not have an adequate
venting system (you either have a 1-1/4" vent, or not enough of them), and
you therefore may continue to experience the pressure surges.
The City does not have a choice as far as discharging its responsibility in
cleaning the public sewer line. It is therefore up to you to take
corrective measures as to how to properly vent your own plumbing system.
The City has come up with two options that will remedy your problem:
Option 1: Upgrade stack vents for toilets and other fixtures which
are experiencing problems to required sizes.
0 Incorporated August 11, 1890 *
Sister Cities International — Hekinan, Japan
Page 2
Option 2: Install a clean -out outside of house per attached
specifications. Enclose box so it can vent properly when
excess pressure is put on house lines. This option would be
the cheapest and simplest way of correcting this problem.
At the same time, it would allow access to sanitary sewer
lines if stoppage should occur. This vent clean -out would
allow a place for backup in lines to go before entering your
house and causing costly damage.
The City would appreciate your expeditious cooperation in this matter. The
City must continue proper maintenance of its sewer lines, but we obviously
do not wish to see continued problems occurring on your property because of
poorly designed vents. It is your responsibility to correct these
deficiencies.
We cannot keep notifying you each time we come out to clean the line. It's
up to you to have a plumbing system that conforms to code. Option 2 is a
relatively simple one to construct.
Should you have any questions on these options, please call Everett Akau,
Scott Highland or myself at 771-3202, extension 317 or 318.
Sincerely,
Ron Holland
Water/Sewer Supervisor
Enclosure
SEWERVEN/TXTSEWER
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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).
Loi 3 6 —5 w 6 PIT H.
ZONE -45
SETBACKS:
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CATCH 15A.SIM:
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WSUA L )
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CAP
SYSTEM CROSS-SECTION
M112AFI EOOX
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3/4*— 0/2" WASWED
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TRENCH CROSS-SECTION
_� rVol
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.
I J.
I .5i
I ?_ 6
1 Z3.:)o
162-
NOTES
1. Call Engineering Oivision (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the responsibility
of the property owner(s). Preventive
maintenance consists of preventing
soil and other materials from entering
trench during construction as well as
after construction. Catch basins should
be cleaned of floating material and
sediment at regular intervals (at leas,
twice per year)
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CITY OF EOMONOS
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CITY of EDMON DS
For InspectioSTiREET02FILE ion
P, KS
Address of Construction: 79
Property Legal Description (Include all easements):
SIDE SEWER PERMIT
PERLLT—NO-
I AA 13ALLINGER
L_�FT STATION
Owner and/or Builder: 1,
Contractor & License No: K91 P 1"(4 r 0
Singl:e Family Residence 7"
Multi -Family (No. of Units
Commercial (No. of fixture Units
Yes
Invasion into City Right -of -Way: No / _ (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,
att,ach le'ga'l description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
I certify that I have read and shall comply Date
with the items listed on the back.
Permit Fee:
Trunk Charge:
Assessment Fee:
Partial Inspection:
Issued By:
Date Issued:
Receipt No.:
uomments
Final Inspection Approved:
Date 4ii a 1�
Rejected:
Reason
PERMIT MUST BE POSTED ON JOB SITE
Date Initial
— _f _n i t _ia 1
Date
Wh-ite Copy - File Green Copy - Inspector
Buff Copy - Applicant
116&77�77 5t*?
Loi 3 6-5-92 1 Z' lot 0 0 RT H to
--7f,, "'
I I I 1 00 C.I-r-
Side Sewer Drawing
Tho ritu nf Felmnnric
EASEMENT NU . ......................
NEW CONSTRUCTION 2g REPAIRS LID NO. .1-0-8 ------ - ASMT. No - ------ ---------
OWNER ---------------------------------- .......... -------------- ----------------- CONTRACTOR ..-LUTZ:5 ... Er.\cxHoF — ------------------------------ .. PERMIT No.
JOB ADDRESS2-3(
------- r7.(,,,, .... A&G-W -------------- LEGAL DESCRIPTION: LOT NO . .......... :3
--------- 11 ............... BLOCK NO - -------
----------------------- - ---------------------------------- .......... --------------------- ----------------------- --- VIA --- P?M-
�- ��E-jR
A
LIFT STA-Y-16---R --- --------
NAME OF ADDITION ....................... -, _ N
............................................... -------------------
-----------
TH
P\NW-0001-11/75 (REV.11/78)
,7,0r.
4'*cA-W5E
.---,—c O-CAP l'DP
- - NO R-r4-
Approved:
DATE -Z9,19E By
1AW. 8!$ R."".D
CITY OF EDMONDS -ASSET INFORMATION SHEET
ASSETNO'.J.',�'
aNEW
0 ADDITION -,"ADDITION TO ASSET NO
0 RETIREMENT
7
DESCRIPTION
L11
SERIAL. NO.
LOCATION DEPT.
RbjECT
"PURCHASE ORDER NO. E
PURCHASE ORDER DATE -PROJECT COMPLETI
ON. DATE
COST 0
B.A.R.S. ACCOUNT NO .
ESTIMATED LIFE
-,�i'-APP ROVED BY
INITIATED BY DATE-"-.
*SUBMIT ASSET. INFORMATION SHEET WITH FINALPAYMENT- REQUEST-..:..��;-
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE --b0.-'0kOJECT-
ACCOUNTING ONLY
ERIFIED BY,
V
/DEPRECIATE
MONTHLY DEPRECIATION AMOUNT --.-PROCESSED.,.-
ANNUAL DEPRECIATION AMOUNT
BATCH NO.
G.L. ENTRY
REFERENCE DATE
16N
UMB
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MkIlIm
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INITIAL
DEPARTMENT FILE
CATC.H ISA51M:
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'04,
TRrLNCW LWrWCn*rH
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4?EKF Pin.
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SYSTEM CROSS—SECTION
MIP,Aff I SOOX
,—,Cp rr
L_44�
T0 i5FF—:: LAYED e
'T1kF_8CW COVER
3/4'- 0/2" WASWED
GRAVEI
4 01AM FESW P
L s'-04
_� F.0
TRENCH CROSS—SECTION I I
STANDARD DRAINAGE PLAN
INFILTRATION SYSTEM
PAGE I OF 2
for
location
plan by
phone
date
DESIGN DATA
Trench Perc LF per Imperm Trench
Number Rate 1000 sq.ft. Area Req.
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the responsibility
of the property owner(s). Preventive
maintenance consists of preventing
soil and other materials from entering
trench during construction as well as
after construction. Catch basins should
be cleaned of floating material and
sediment at regular intervals (at least
twice per yea )
".9/
7
CITY OF EDMONDS
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WORTH 10
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CITY OF EDMONDS
CONSTRUCTION PERMIT APO
NAME ej NAME OF, BUSI SS)
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TELEPHONE NUMBI
j CDC" P 1 7 '7 / - S-9
ITELEPHONE NUMBER
rA
USE PERMIT
NUMBER
ZCrr
Joly
ADDRESS �3G20 AVEOU L \1k
-EGAL DESCRIPTION CHECK UBDIVISION NO. 10 NO�
r
PUBLIC RIGHT OF _AAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
PROPOSED 1
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
OU
STREET USE PERMIT REQUIRED El
SEE ENGINEERING MEMO DATED_
SEE PIW DEPT. REVIEW CHECK LIST DA ED
RE7R7
NAME
—
cac DDRESS
0
METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
fr CITY TELEPHONE NUMBER
z- 4;" -7 7Z
ry
REMARKS
-N
STATE LICENSE NUMBER CITY LICENSE NUMBER
,77,�-01 AllevOuC�t 133L R
SIGN AREA
IR
ENV. REVIEW
Legal Description of Property - include all easements
ALLOWED PROPOSED
COMPLETE EXEMPT
(show below or attach four copies)
I
L C." 7`4-1
VARIANCE OR CU
PLANp(]bG REVIEW Y
Uj
Lq
YARDS
FRONT 1'17, SIDE
LU 1 1;1111
REAR
F0 F-71
UN
NEW RESIDENTIAL PLUMBING
ADDIALTER NON-RESIDENTIAL MECHANICAL
FREPAIR El
RETAINING WALL SIGN
EXCAVATE FENCE
El
CHECKED BY TYPE OF
DEMOLISH OR FILL I- x -FT)
I
PRE-MOVE,INSP.1 SWIM
SPECIAL INSPECTOR
COMPLIAN E INSP. POOL
REQUIRED
SIDE SEWER El
HYES I:NO
REMARKS
z
WATER LINE
El El
2
0
(n
W
NUMBER OF STORIES NUMBEROF
DWELLING
2. 1 1
0
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOTPLAN)
Co 14 5T-,p,\3 (7- OEW i 0 L-e
PLAN CHECK FEE
BUILDING
PLUMBING
This Permit covers work to be done on private property ON77
MECHANICAL
GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
-�ermit
Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
oi
successors in interest, agrees to indemnify, defend and hold
'n
Uj
harmless the City of Edmonds, Washington, its officials,
1�
J:E
employees, and agents from any and all claims for damages of
OCCUPANCY
GROUP
VALUATION
ADS NO.
IORELINE 0
HEIGHT
OCCUPANT
LOAD
M IW
D
cool
Z,/- 3
FMLIC WDM�S rEPARMIENT CHECKLIST
B=IM PM11T REVIEW 23620 7& 7 771
ess) (date)
Street Right -of -Way Exist
Z
Access Easerjo ts Exist
6-4
ce
Utility EaseTgmt Existing_*,/,�,-
.L
�,-? �3c
W
Lot Per Subdivision �'-S`S2- Plat
Assessor Map
W
Site Plan Checked for Accuracy
Z
Underground Wiring Reqd.
0.4
0
gal De
Check Accuracy s crilt
Z
Review
Date
Existing Water Main Size
Water Main Required �Y14
Service Line Required
Hydrant Size Existing,
ce
Hydrant Reqd Per Fire Code
Size
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Departaent Comrients
Water Yleter Charge Reqd.
7
Review
Da te
Septic Tank Design Approved klm Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
_�roj.
Drawing No. Z-
File No.
Side Sewer Availability 441r�"
14
Sanitary Sewer Connection Fa Reqd.
3
Review by_
Date
Open Ditch Existin� �0...._Reqd.
Culvert ReqdV*Re--4FPeo�� P-�-b&)
Size
Catch Basin Reqd.-
Indicate on Site Plan
Shoulder drainage maintain collection on
swale open runoff
Manhole reqd. t-
Indicate an Site Plan
"T
Soil Conditi Ground ater Field Checked
R view b
a y
Date
CATC44 BAZIX:
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CAP
SYSTEM CROSS-SECTION
M I RAT= 1 140 t-J
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TRENCH CROSS-SECTION
11
STANDARD DRAINAGE PLAN
INFILTRATION SYSTEM
PAGE I OF 2
for d_'621v
location
plan by
phone
i date
DESIGN DATA
Trench Perc LF per Imperm Trench
Number Rate 1000 sq.ft. Area Req.
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the responsibility
of the property owner(s). Preventive
maintenance consists of preventing
soil and other materials from entering
trench during construction as well as
after construction. Catch basins should
be cleaned of floatinq material and
sediment at re ular intervals (at least
twice per year�.
40!
_71
4 J
fotestets EyRiNc
SSOCIATES, INC. 23423 Highway 99 ,��Edmonds, WA 98020
(206) 778-3101 P.O. Box 32 Lynnwood, WA 98036
May 6, 1982
Planning Department
City of Edmonds
Edmonds, WA 98020
Re: Short Plat-Variance-Bonipart''-','
S-5-82 - V-5-82
Soil investigations have been -completed upon the property involved
in the above stated actions. Percolation tests were conducted in
accordance to Edmonids City Code Chapter 18.30 to determine the
feasibility of using the Infiltration System for.Drainage Control.
The property is generally'level except for a drop in the westerly
portion of the southerly proposed,lot. A bench area exists in the
southwest corner that is.of sufficient size to be used for back
yard purposes and will accomodate.an.infiltration system (see plan).
There are no known concentrations.of surface water or streams on or
through the subject proposed to,face 76th West, which is 11 to 2*
lower than the property. The driveways of Lot 2 and 3 are proposed
to be continguous and will slope into 76th.with the drainage being
directed into the existing curb and gutter.
The sizing of the infiltration system is based upon the elements and
directions found in the "Drainage System Standard Plans, City of ,
Edmonds". The calculations for Lot 2 and 3 are as shown on the Plan.
The lots are of sufficient size to allow a reserve area in the event a
failure occurs after years of use.
Respectfully submitted,
M. B. Mey
President
MBM/ga
Opp'.
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MEMO TO:
FROM
SUBJECT
Building Division
Planning Department
Engineering Division
Public Works Department
Z-36ZC) ;7
4
DATE:
After review of the subject Building Permit application, vie have the following
Comments:
I . Connection to City viater-sYstOn-required.
2. Connection to City sanitary sewer system required.
3. Right-of-way permit required for any work on City property.
4. Driveway slo e not to exceed 147,
p
5. Backwater valve required if downstairs plumbing is belovi elevation of
UPS-f—ri—am t—na--n-h-oTe.--------*------------*-------.-.---.---.----------
6. Water and-sevier lines to, be separated by 10 foot minimum.
7. Bui der/Owner responsible for containi,ng all temporary runoff and er(Lsi-on
— on site and ni not impact neighboring plop - V
_Q.Ltj_�� s 1 n - D-ny_NV__._
1�7
r
N "M
BD 6/82
47 J-664-r-
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
cujs+ -Itzc-
MAILING ADDRESS
4166 y � 101_�4 ST SF
CITY TELEPHONE NUMBER
A0 *Iwl I
USE PERMIT
ZONE NUMBER
jWWtbUN1V11UN CHECK SUBDIVISION NO. LI
L_0+ I 6_16_9)L_ I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING REQUIRED DEDICATION
PROPOSED / /-
IG H T 0 F W
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
S T R EE T U S E I
STREET USE PERMIT REQUIRED 0
ADDRESS
t:
S E E E N G I N E I
SEE ENGINEERING MEMO DATED_
S E E P IW DE P
SEE PIW DEPT. REVIEW CHECK LIST DATED
ir
CITY
TELEPHONE NUMBER
E K
E ARKS
R AR S
NAME.
S7A ik
cc ADDRESS
0
L)
METER SIZE
M ETER SIZE
BUILDING SUPPLY SIZE
FIXTURE UNITS
CITY
TELEPHONE NUMBER
Z
0
REMARKS
M R S
D
STATE LICENSE NUMBER
CITY LICENSE NUMBER
7TO gt :r 1aXZ P0
SIGN AREA
ALLOWED PRO POSED
I
ENV. REVIEW
LETE
COMP MPT
EXE
Legal Description of Property - Include all easements
(show below or attach four copies)
I
I
E�_NEW
RESIDENTIAL
PLUMBING
E] ADDIALTER
NON-RESIDENTIA L
MECHANICAL
REPAIR
E] RETAINING WALL
SIGN
DEMOLISH
EXCAVATE
OR FILL
FENCE
x _FT)
r__j PRE -MOVE INSP.1
swim
SIDE SEWER
WATER LINE
Z
0
a:
0 —
WO NUMBER OF STORIES
a
JUNUMBEROF
WLLLINU
ca .1
0
N11b
1 F WORK TO BE DONE (ATTACH PLOT PLAN)
�,.j4
Islju'i 4 , -rAo-; IV AME I
VARIANCE OR CU
YARDS
FRONT
BY TYPE OF CONSTRUCTION
REVIEW BY
1j, LOT
A:� 4,1
0
Z
cr
1�1
W
Z
a
Z
cc
75B NO.
ORELINE#
0 A TYE
4
RAQF�Z
Z
HEIGHT
,SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
. DYES D NO
REMARKS
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
"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 agents from any and 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 oidinance
TOTAL AMOUNT DUE
nor limit in any way the City's ability to enforce any ordinance
provision."
I hereby acknowledge that I have read this application; that the
information given Is correctiaad-Viat I am the owner, or the duly
ATTENTION
authorized agent of th W 'agree to comply with city and
state laws regulatin A�on s n; and In doing the work authoriz-
THIS PERMIT
AUTHORIZES
ed thereby, no pe on wi employed in violation of the Labor
ONLY THE
Code of the Sta of W ngton relating to Workmen's Compensa-
WORK NOTED
tIon Insurance
INSPECTION
DEPARTMENT
SI '�U�
DATE S71GN
CITY OF
EDMONDS
VALUATION
/0(0
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his
Deputy; and f6es are paid, and receipt is
acknowledgedin'space provided.
OFFICIAL'S SIGNATURE
ATTOTIO 771-3202 DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE I .
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR RIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC NOV 1 198,f
CHAPTER 3. PINK — Owner GOLD — Assessor
102-78
CL
(5
Z
DATE:
MEMO TO: Building Division
Planning Department
FROM: Engineering Division
Public Works Departiiient
771
SUBJECT:
After review of the subject Building Permit application, vie h.ave the following.
comments:.
1. Connection to City water -system required.
2. Connection to City sanitary sewer system required.
3. Right-of-way permit required for any work on City property.
4. Driveway slope not to exceed 14%
5. Backwater -valve required i f downstairs plumbing is below elevatio n of
upstream manhole—.
6. Water and sewer lines to be separated by 10 foot minimum.
BD 6/82
ENGINEERM3 PU13LIC WORKS
CITY OF EOI%AONOS PROJECT REVIEV
awc c4tdT(A - fowo,4DS. IvAS�wGION 000m
S IN . GLE FAliILY HULTIPLE COMME40AL C H E C K L I S-T
PROJECT NAME CONTACT NA.111 & TELEPHONE NUMBER
ADDRESS __jg3 7
ACCESS SLOPE AND VEHICLE ACCESS
llhe�
DRAINAGE PLAN A
STREET FILE
LEGAL DESCRIPTION VERIFICATION
QuIT CLAIMID(DICATIONS
EASEMENT - PUOLIC/PRIVATE
17
CALCULATE SEWER CONNECTION IF No LID I
LL
I -ID LV
w
w
STREET PAVING REQUIRED
0
CURB ANO GUTTER REQUIRED -
z
w
,
SIDEWALK REQUIRED
CURB CUT [DR DRIVEWAY.R[QUIRED
RIGHT-OF-WAY CONSTRUCTION PERMIT REQUIR.
BOND REQUIRED FOR PUBLIC IMPROVEMENTS
STREET NAME SIGN REQUIRED
OTHCR SIGNING R(QuIRID
,a
(ADDITIONAL COMMENTS On 8,
1XIS711ir- WATER MAIII SIZE
WATER MIN REQUIRCO
SERVICE LINE REQUIRED
HYDR.AlIT SIZE EXISTING
HYDRAJIT R19UIRED PER FIRE COqE P�1,4 SIZE
CROSS C15NNECTION INSPECTION
WATER lIfTER CHARrif-RE IRED
REVIEW B . DATE (Ar*ITIOILkL COIMMENIS ON I
cc SANITARY SEWER OWING I1UX-BER FILE WIBER
w SIDE SEWER AVAILABILITY SANITARY SEWER COVIECTIO11 FEE kEr.X)IRED
3: -
ui
OPEN DITCH EXISTLur,
>- Iii f �P -- 1plo
Ir CULVERT REQUIRED lu
<
I- UICH BASIN REQUIRED
ADICATED Off SITE PLAN
ShOULDIR DRAINAGE IV IHTAIft- COLLECT 1011 ON SHALL OPEN Rulloff
IMN01.1 REQUIRED i I
cc - INDICATED ON SIT[ PLAN
0 SOIL CORD ITIO 0 D WAT FIELD CHECKED
l'-
Go P.EVIEW By
VAT[ :(ADDITIONAL COWNTS ON Ut