404 4TH AVE S.PDFlill 11111111
5074
404 4TH AVE S
it'
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CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 , FAX (425) 771-0221
Website: www.dedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
August 17th, 2009
Michel Construction
7907 212" St SW #102
Edmonds, WA 98026
MEMO TO:
Edmonds School District
Ven'zon Northwest
SNOCOM Police and Fire Dispatch
SNOPAC
Snohomish County E911
U.S. Post Office
Snohomish County Assessor's Office
Snohomish County Information Services
Snohomish County P.U.D.
Puget Sound Energy
Edmonds Fire Department
Edmonds Police Department
Edmonds Utility Billing
Edmonds Public Works
Edmonds Building/Street File
Edmonds Address Files
Lynnwood Disposal
Comcast Cable
Waste Management Northwest
GARY HAAKENSON
MAYOR
Please be advised City addresses of 318 Walnut St, 320 Walnut St and 404 4"' Ave S
have all been demo] 1 shed/removed from the City map book, the NEW ADDRESS of 316
Walnut Street has been assigned to the property (for a proposed 7 unit condominium
project Pen -nit number BLD2008-003 1).
TaxIDNumber(s): 27032300414400,27032300413800, and 27032300414900
If you have any questions regarding this letter, please contact a City of Edmonds Permit
Coordinator at 425-771-0220. Please contact our office if you wish to be removed from
future address change notifications.
Sincerely,
eresa Umbaugh
Senior Pen -nit Coordinator
Edmonds Building Department
L\Ternp\DST's\M aster Letters\New Address8/17/2009
Incorporated August 11, 1890
Sister City - Hekinan, Japan
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CITY of EDMON DS STI"i"EIET FILE S I D E SEWER PERMIT
For Inspection Call 771-3202 PERMIT NO. 07146'
RLL;EiVED
o
Address of Construction:
Property Legal Description (Include all easements): F -1
Owner and/or
Builder:
1:'(/V,,J&p Arv[)A'er1L(
CON57
Contractor &
License
No:
Zq4)1
Single Family Residence
Multi -Family
Commercial
(No. of Units 3
(No. of fixture Units
TREAI'�ENT PLAN-F
Invasion into City Right -of -Way: No 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 X Yes — (If Yes, easement require8,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
5�W-140 � S�O
I cE�rtify that I havr4eead and shall comply
with the items listed on the back.
Permit Fee:
Trunk Charge: 7!!�- , Cc
Assessment Fee:
Partial Inspection:
C_
Issued By: X)
Date Issued: /';� - 6 7 -
Receipt No.: 9 �-' 70
17- 1-7
Date
Comments Date Initial
Final Inspection Approved:
Date Initial
Rejected: Reason —Ta—te —T—nitial
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy - File Green Copy - Inspector Buff Copy - Applicant
The City of Edmonds Side Sewer Drawing EASEMENT NO. — -------------------------- — ------------
NEW CONSTRUCTION 2/" REPAIRS F� LID NO - ------------------ - ASMT. NO - ---------------
OWNER — ------ --------------------------------------------- ---------------------------------------- CONTRACTOR ---- �kV4-0 ------- VYVi
------ PERMIT NO.
JOB ADDRESS ------ L+'1-111 --------- So -- ----------------
to
0
tot
Ne-ke
(Mo
E .4
T9
PWW-0001 - 11/75 (R EV. 11/78)
LEGAL DESCRIPTION: LOT NO - --------- ---------------------------- BLOCK NO - ------------------------------------
-------------------------------------------------------------------------------------------------------
----------- i ---------
.. . .................
NAME OF ADDITION ------------------------------------------------------------------------ - Lyplu
L Mu-r S-r.
Approved:
DATE ................. By
�i
1,- T#I-v ld-
\ 0
CITY OF EDMONDS
D/NEW
ADDITION
RETIREMENT
41-
S'�'i�,.,-J=ET FILE ASSET INFORMATION SHEET
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
Z" IVL
SERIAL NO.
LOCATION Q4�Pj. N
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
PROJECT NUMBER
PROJECT COMPLETION DATE
COST z /- 6- z
B.A.R.S. ACCOUNT NO. 00e) - q ego
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
E'DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. E
REFERENCE
VERIFIED BY
PROCESSED
BATCH NO.
DATE
ttnp INITIA
F_
Z
U
0
U
0
H
Z
0
W
U
9
0
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ft. QJ
CITY OF EDMONDS Permit No. 0 ()
COMMUNITY SERVICES DEPARTMENT Issue Date to- (c, Y'�
RIGHT - OF - WAY CONSTRUCTION PERMITO i I-,EET FILE
r
A. *Owner: Fwva) . &(11&4_
Name
-ZIQIQ 74:,"Ad- W*
Mailing Address
W�\ qq'oz?)
City State zip
e Address or Vicinity of Construction: 1/ 11
B. e Contractor: -PIAI&JED
Name
2JPIC) 7�Jh AVE- CAJ
Ma ing Address
f illmaw LIA
City State Zip
"�PNNGMC INJYJ -7 7.S- LIWO
State License Number Telephone Number
Type of Work to be Done: &V*/9JN'rj5 k�0�,IM Pf--190 LM--� tZO(4f_,� 7"n 6t!—z748Z)S,4
NEA ttt—_uA-PQA1S
Work in Connection With: El Sub or Plat El Single Family El City Projects
0 Commercial 4E]—Multifamily 0 utility
Pavement Cut: 0 Y V�rN /�Ovyo /-�)— le —'et?
APPLICANT TO READ AND SIGN
INDEMNITY: 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, forseen or unforseen, that may
be made against the City of Edmonds, or any of its 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.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed
by City forces, at which time a debit or credit will be processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Public Works: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
no exceptions.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature: yxaf� A'Oftlzt. Date:
Owner or ontractor
This Permit Must B/Posted at the Job Site For Insvection PurDoses
Call DIAL -DIG Prior To Beginning Work
ISSUED BY:
Time Authorized: Void after e�o 0 —days
Special Conditions:
Amendments:
PERMIT FEE:
Security Deposit: _91yZ2
Receipt No.:.
Fund I I I Fee:
Street Cut Dimensions:
X
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTION NOTES
.0
(Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES El NO
Partial Work Inspection by P. W.:
Work Disapproved By:
Date:
FINAL APPROVAL BY:
Eng. Div. July 1985
#P20
IE ED
City of Edmonds
'P Development Services Department
Planning Division
Phone: 425.771.0220
10 01� Fax: 425.771.0221
The Critical Areas Checklist contained on this foriit is�' to
be filled out by any person preparing a Development
Permit Application for the City qfEdmon',ds, prioT to
his/her submittal of the application 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).
Date Received: & / a h
City Receipt #:
Critical Areas File #:
Critical Areas Checklist Fee: $135.00
Date Mailed to ADDlicant:
X 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
precu I rsory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signpd.copy
of this form to assist City staff in finding and locating the
specific piece of property described on this form. In
addition, 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 completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including r6asonable
attorney's fees, arising from any action or infractioh.,based in whole or part upon* false, misleading, inaccurate or
incomplete information ftimished by the applicant, his/hei/its agents or employees.
By my signature, I certify that the information and exh&ts herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file thyi appli *
'gation. on the b�epalf of the owner as listed below.
'00
SIGNATURE OF APPLICANTIAGENT
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
A
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this -#npiic ti
A6
SIGNATURE OF OWNER DATE
�ILLASE PRINT CLEAF
Owner/A licant:
7-- 11,�) 1:9 &/ C-�
Name
7W7- �a/�2`t SJ 7`1-e2-
Street Address
City State Zip
Telephone: S- -2 -7 2- 2-11
Applicant epresentative:
Name
22d 7
Street Address
L�dMtg-nz& �Z� e)&) 2Z
City State Zip
Telephone: - A -5
V-3 1 :2 7 Z
Email address (optional): Email Address (optional):
#P20 CA File No: O(P
Critical Areas Checklist
Site Information (soils/ topographW
. �ogy/ vegetation)
1. Site Address/ Location: 16 S , ? / ? V_- 2 ac) 7-
2. Property Tax Account Number: c�? 70 3,), 3 0 d411 3 ?66 �Y7 00 4A 0
3. Approximate Site Size (acres or square 06
4. Is this site currently developed? _Xyes; no.
If yes; how is site deve loped? a!,- S /,: � "- I 7-tLIAeCI&
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
t /< 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
over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site iiin"the flo6dway flo-odpl*
of a Water,�qur`se.
9. Site contam*'s a creek or an area where �vater flows'across the grounds surface? Flows are year-round?
Flows are seasonal? (What time of year? Y
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc)
11. Obvious �Vetland"is -present on site:
For City Staff Use Only
1. Plan Check Number, if applicable?
2. Site is Zoned? P_M�Z, 4
3. SCS, mapped soil type(s)? 2--7 W, o-ka. fL.,&
9'- A i o-cr _4ea , v-t,,, (t_z,
4.
Critical Areas inventory or C.A. map indicates Critical Area on site? No
5. Site within designated earth subsidence landslide hazard area? &j . �
DETERMINATION
STUDY REQUIRED
.�hmjjm
C41e�
WAIVER
Reviewed
Critical Areas Checklist/3.25.2004
VA
CITY OF EDMONDS Permit No.
COMMUNITY SERVICES DEPARTMENT 0-r" Issue Date
RIGHT-OF-WAY CONSTRUCTION PERMIT 0 1 IIEET FILE
A. 0 Owner: B. 0 Contractor
Name
_71010 7��"AUE CA)-
MailimAddress
- L I) , &S w A I
City Stite Zip
':�A A10
Name
Mailing Address
City State Zip
Pi Wlc-Me 17 q�_� -7 1 S_ - qI '�()
State License Number Telephone Number
q
Address or Vicinity of Construction: vb9-- 9DW01VO-S
Type of Work to be Done: P4il-ceAt-Jr) C0 ., efZrsr, A)A(A)VT Z y rt R TZL-jy e't4
tM AUL-1 t1JLn7"-0F P&PL"��J 1-0
IJ-01 tlUE' kA---7 0 ' t7'1) 0 P � '
Work in Connection With: 0 Sub or Plat 0 Single Family 0 City Projects
0 Commercial Multifamily ED Utility
Z
Pavement Cut: A Y 0 N
U
APPLICANT TO READ AND SIGN
04
04
-< INDEMNITY: 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, forseen or unforseen, that may
be made against the City of Edmonds, or any of its 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.
.4 THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
"4 YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
2
0
U Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed
by City forces, at which time a debit or credit will be processed for issuance to the applicant.
0
• A 24 hour notice is required for inspection; Please call Public Works: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
no exceptions.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature: 56�fA — Date:
Owner or Contr ctor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
IVA
>� ISSUED BY: PERMIT FEE:
Z Time Authorized: Void after— ::2 C) —days. Security Deposit:
0
Special Conditions: -V/,P&LiEt- lk-7 Receipt No.: !2 (-/Z,
r( "V r'e/z "//v "y -/ r' --el�,VY"Fund I I I Fee:
Amendments: 4ErezC ZI-21 //L/J;r,-/ f0.4L/ Street Cut Dimensions:
U
04 X
0
V4 NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
Date:
Date:
Eng. Div. July 1985
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JUL 7 1988
PERMIT COUNTER
OWNER.,
APPROVED DATE-
y2xW,,21j1,1 y
BY S11Z /
BLDG. OFFICIAL
KEEP THESE STAMPED
PLANS ON JOBSITE FOR
ALL INSPECTIONS
PERMIT NO� SHEET
OF
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FRONT —1,5"
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