519 4TH AVE S.PDF111111111111
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519 4TH AVE S
APPLICATION
Tht City of Edmonds for EASEMENT NO - ------------------------- ------------------
StDE SEWER PERMIT
NEW CONSTRUCTION N REPAIRS F� "LID NO. -----ASMT. NO
OWNEP - ------- --- ---- ....... ----- CONTRACTOR ....
............. ------------------------- --- PERMIT NO - --------------------
JOB ADDRESS -- ---------- -------------------------------------- ............... LEGAL DESCRIPTION: LOT NO - ------------- ---------- ------ BLOCK NO. ---------------------------------
............................................... ................................................... --------------------------------------------------------------
NAME OF ADDITION ------ -
.................................................... ........................................................
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Approved:
DATE --- 4—;?ZV4;� .......... B . . . ........... ..
y
7
CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
Call 775-2525 for side sewer Inspections BEFORE covering any portion of the con truction,
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday Ins"pections.)
.1 �`i` Snlyti)_
ADDRESS LOCATION OF CONSTRUCTION ....... IS � -.P .................. ) ................................... 1,
...................... I .................. . .......................................................
(,-4
PROPERTY LEGAL DESCRIPTION ............. S;D t_-ft...
....................... ................................................... . ............................................................................................................................ . ..................................................
1-l'. Co.
................................................................ O-1,VNERAND/OR BUILDER .... ................................................. ............ .......................................................
CONTRACTOR'S NAME & ADDRESS ....... ..................................................................................
Permission Is granted .................. ........................... ) 19...M, for repair and/or connection of a side sewer to the city sanitary sewer
sy-tem In accordance with City of Edmonds ordinances.
A -r611TION IS CALLED 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 be employed to construct
side sewer in street area. Do not cover any portion of sewer before It has been Inspected.
NOTE No. 2—All work performed In city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtaln full Information regaxding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—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 'A will be permitted.
NOTE No..& --Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 67-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 appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED E] Date.._ By ................ Date ........ ........ OF— ............ By ................ Date .................................... By ................
APPROVED Date ......
e.. /.Z . ........ BY_ .7,1.� ............. . ............................... .......................................................
AX ........ * 4;,Z� "
Remarks: ................................................................................................................................................................... . ...................................................
............................................. I ....................... . ............................................................................................................................ ........................................................
BOTH Permit Co ' s MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
'OpI
....... ...... **"*** -------------------- * .. .... hereby certify that the side sewer installation constructed under this permit
'liv.,instal (Owner of Contracting Firm Performing Construction)
w - led in accordance with all governing ordinances of the City of Edmonds.
Dated this .......... 6,7- -- -.% I-
.... I ......... day of ...................... r..;x Z. ....................
Check BEFORE you dig for: Water E], Gas E], Telephone [], Power E], Sewer E], Other Cj V -V
APPLICATION
The City of Edmonds for EASEMENT NO - -------------------- -----------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS F� LID NO.....7.-% ... AsmT. NO - -----------------
OWNER ----------------------------------- CONTRACTOR --- 13al .......... ------------------------------------------- PERMIT NO - --------------------
T+
JOB ADDRESS -------- ............................ LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
-----------
------------------------------------------------------------------------------------------------- .................. .............................................
NAMEOF ADDITION -----------------------------------------------------------------------------------------------------------------------
,,/, -7 J7 qpe- S
Approved:
DATE................................ By ................
..................................
11175
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gruno
Electra-Rt*de'
LL'Ill?
Tuming
Houses,
Rark In tn
Homes!
Yl
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Pw
jOIBRUNO
for your independence
IN'
Superior Styling
Elegance
A
A stairlift that reflects the taste
and sophistication of the most
elegant homes, the Electra -Ride
Elite sets the new standard for
residential accessibility. When
marvelous features complement
classi design, the result is
uncompromising quality.
7,
Refinement
-Ride Elite
The Electra
represents more than a decade
of research and engineering.
With a honeycomb rail design
for improved stability, and
visual coded diagnostics to
instantly analyze the unit's
operational status, the Elite
is the epitome of form and
function.
Gracefid and Compact
The Electra -Ride Elite offers the finest in
streamlined, ultra -compact design. Its vertical
str-:ght rail installs to within 6 in (152 mm) It, ON- 4N
from the wall. Family members and guests
will have no problem using the stairs. The
seat height, footrest height and armrest
width are adjustable for added comfort. The
armrests can be independently flipped up, for
easy transfer from a personal mobility device,
completing the unit's package of flexible The arms, seat and footrest The Elite's hidden, rack -and -
features. flip up, creating plenty of pinion drive system provides
space to walk up the stairs. a smooth ride, without
hesitation, when the unit
stops and starts.
Quality Craftsmanship
Safety
With a rated weight capacity of
400 lb (181 kg), and sensors that
detect any obstacles on the stairs,
the Elite moves up and down
your staircase with power and
efficiency. The new offset swivel
seat makes the entry and exit
position at the top landing safer
and easier than ever.
Reliable
Equipped with two 12-volt batteries
that are powered by a small,
unobtrusive battery charger that
plugs into any household outlet,
the Electra -Ride Elite provides
uninterrupted performance, even
during a temporary failure of
electrical service to your home.
Electra -Ride Elite Features
The new offset swivel seat The footrest and carriage safety The simple, unique design of The two wireless call/send
makes the entry and exit sensors safely stop you, even if the rail hides all mechanical controls make installation
position at the top landing the slightest obstacle is in the components, and installation simple and clean with no wires
safer and easier than ever! way while you ride! requires no modification to running along the wall.
your staircase.
Exceptional Value
• Locking swivel seat at the top and
bottom of the stairway
• Two remote, wireless call/send controls
• Generous seat size — 17.75 in (451 Trim)
adjustable to 21.75 in (552 mm) between
the arms
• Footrest and carriage safety sensor and
retractable seat belt
• Charging -station indicator lights at
the top and bottom of the stairway
• Onboard audio and visual diagnostics make
service easier and more precise
• Meets all ANSI - A 18.1 requirements;
CSA/C-US listed
• Bruno's Gold Warranty — Five years for
major components and two years on parts
Convenient Installation
• Rail installs to within 6 in (152 mm) of
the wall
• Can be installed on either side of the
stairway
• Standard track lengths of:
16 ft (4.9 in) — two 8 ft (2.4 in) sections
20 ft (6 in) — two 10 ft (3 m) sections
(Custom lengths also available)
Smooth, Powerfml Drive System
• Self-locking worm gear; rack-and-pinion
drive
• Maximum rider weight of 400 lb (181 kg)
• Soft -start, soft -stop for the user's maximum
comfort
Banerv-Powered TechnoloL-v
• Ensures access even during power outages
• Powered by two 12-volt batteries; continuously
charged by a 2-amp battery charger that plugs
into any I I 0-volt household outlet
Comfor
• Adjustable seat height for easier entry/exit
at the top and bottom of the stairway
• Adjustable footrest height for added comfort
• Flip -up arms for easy wheelchair transfers
• Adjustable armrest width
• Contoured seat for maximum comfort
Ask us about our other...
Home accessibility solutions and automotive products
OUTDOOR ELECTRA-RIDE" VERTICAL PLATFORM VEHICLE LIFTS TURNING AUTOMOTIVE
ELITE Model SRE-201 OE LIFT SEATING" (TAS")
The only 400 lb/ 181.8 kg capacity outdoor Model VPL-31 00
stairlift... an INDUSTRY EXCLUSIV0
Founded over 20 years ago, Bruno Independent Living Aids, Inc., is a world-wide manufacturer of accessibility products designed to enhance the
lives of those challenged by limited mobility. In pursuing this goal, Bruno is proud to be the only U.S. manufacturer of indoor/outdoor stairlifts,
interior/exterior scooter, powerchair and wheelchair vehicle lifts and Turning Automotive Seatingi" (TAS") products to be ISO 9001 Certified. This
is one of the most stringent, widely -recognized quality standards in the world and your assurance that Bruno is committed to providing you with the
highest -quality, most reliable products in the industry. Ask your certified Bruno dealer for details on all Bruno independence products.
Represented by:
k fKISO 9001:2000
KEMA CERTIFICATE
AMWM by
ATM MSI-PM NAP
ACCE&SUMM EQUIPMENT A-61hilbyD.Dtdi
e�. Courelf.AMWOft
BRUNO INDEPENDENT LIVING AIDS, INC.-
1780 Executive Drive, P.O. Box 84, Oconomowoc, W1 53066 BRUNO"
www.bruno.com $1, for vour indeoendence
All illustrations and specifications in this brochure, am based on the latest product information available at the time of publication. Bruno Independent Livinghifs, Inc. reserves
the right to make changes at any time without notice. Electra -Ride Elite Brochure 7/10-10 � Bruno Independent Living Aids, Inc. 2010.
Part#: MKT-SRE-2010
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CITY OF EDMONDS §'EcklVED mit No. T/— 10 (0
PUBLIC WORKS DEPART0F0TR,4—VQ,,&,,"'1A/-/ Issue Date
JUN 4
RIGHT - OF - WAY CONSTRUCT105N PERMI
A. *Address or vicinity of Construction.- jt� ssued To:—
• Owner: y
Name
I 4—d
0 Work in Connection With:
Ma.ilm'g Addrqss F-1 Sub or Plat El Single Family
Ow El Comml. / Ind. *0 Alpt. Condo.
City, Slate, Zip Code 0 Pavement Cut: 0 Yes 0 No
• Contractor: <�UA) 2--3E
Name
15w- %IQ 1014 C— (r- 00
1�jiling Address Sta , te I License Numbe
S 'I —,b
City� State, Zip Code 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.
I understand that this permit must be available at
Signature: (-
Owner or Agent
job site for inspection purposes at all times.
--,-10) —Date 1216pl
THIS PERMIT MUST BE POSTED AT THEJOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. I s s u c d B y:
Time Authorized: V4d after \-2 days
Special Conditions:
0
UJ
Ammendments:
Permit Fee: V � 4
dft
Security Deposit:
Receipt No.:
Fund Ill Fee:
Street Cut Dimensions
— X —
FILEO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. Dccember 1979
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CITY OF EDMONDS 1P RECEIVED Wrmit No. 42
PUBLIC WORKS DEPARTMENT Issue Date L,3
RIGHT - OF - WAY CONSTRUCTION PERMIT AN 4
A. *Address or vicinity of Construction Permit Issued To:
--s- I --1 81 �� I � — d/ , Al J
Owner: I i , 1% Wry
Name
S; 1--� -
M Addrqss
6WI-) W4# Dod-O
City, State, Zip Code
Contractor: C7;20,d) / EE CQW20qZ")
Name
iling ddress
u3p, q go I I
City, State, Zip Code
Type o Work to be Done:
CLAA
(a -
Work in Connection With:
11 Sub or Plat El Single Family
El Comml. / Ind. "X Apt. Condo.
Pavement Cut: 11 Yes El No
C (n 00 -1� I ��-
State License Number
q 8 -1 —�o -�- (0
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICA T 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.
I understand that this permit must be available atAe job site for inspection purposes at all times
Signature:
Owner or Agent
7/J/
THIS PERMIT MUST BE POSTED AT THEJOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: V d after days
Z Special Conditions:
0
—D Ammendments:
Permit Fee: '
Security Deposit:
Receipt No.:
Fund I I I Fee:
Street Cut Dimensions
X
i"IEET
FM WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
H.E;-
Eng. Div. December 1978
.,BUILDING DIVISIO 'W Applicant Fill
—t ---
USE MRIAIT
ZONE MIMPU . BE R
Inside Heavy Lines
PERMIT APPLICATION
-
ADI)RESS
NAME JOR NAME OF USINESS)
LEGAL DESCRIPTION
SUBDIVASIOI�
SUB NO.
W
MAILING ADDRE35
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
NUMBER
r 0�10011:,� -1
ITELEPHONE
EXISTING
PROPOSED
U
DEFICIENCY OF RIGHT OF WAY
W
ADDRESS
PUBLIC IMPROVEMENTS REOU IRED 0
M
DRAINAGE IMPROVEMENTS REQUIRED
0
CITY
HONE NUMBER
M
DRAINAGE PLAN REQUIRED
U
UNDERGROUND WIRING REQUIRED 0
CONNECTION TO SANITARY SEWER El
(0
0
(L
NAME
0
SEPTIC TANK PERMIT REQ*D NO.
ADDRESS
0
I-
ELEVATION OF PROPERTY CORNERS
U
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& FOOTINGS REQ'D
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CITY
TELEPHONE U
N MBER
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SEE ENGINEERING MEMO DATED-
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STAYE LICWNS9 NUMBER
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CITY LICENSE NUMBER
CHECKED fly
Legal Description of Property (Show 6elow or Attach Four Copies)
METER SIZE
LDING SUPP77T
IBU,
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REMARKS
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SIGN AREA
ENV. REVIEW
ADB NO,
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ALLOWED PROPOSED
C OMPLETE EXEMPT
In
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SHORELINE
0
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REMARKS
W
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'VARIANCE
OR CU —7ANNING
REVIEW 13Y
DATE
YARDS
ILOT COVERAGE
GAS
NEW El RESIDENTIAL
FRONT SIDE REAR
FIRE ZONE
TYPE OF CONSTRUCTION
HEIGHT
LINE
ADD 1:1 NON-RESIDENTIAL SIGN
ICODE
I
DEMOLISH RETAINING
SPECIAL INSPECTOR
AREA
OCCUPANCY OCCUPANT
WALL
ALTER EXCAVATE FENCE
REQUIRED
0 YES 0 No I
ROUP LJOAD
F] OR FILL I— X—FT)
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
REPAIR PRE -MOVE swim
1:1 INSP. POOL
OF EDMONDS. LOCAL SALES TAX
-SHOULD BE CODED 31.04.
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NUMBER OF STORIES
—
NUMBER OF
REMARKS
DWELLING
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UNITS
NATURE OF WORK TO BE DONE
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PLAN CHECK FEE
VALUATION
FEE
0
PLOT PLAN
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BUILDING
ST"iEET FILE
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PLUMBING
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MECHAP41CAL
FENCE
SIGN
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"Applicant, on behalf of his or her spouse, heirs, assigns and
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successors in interest, agrees to indemnify, defend and hold harmless
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the City of Edmonds, Washington, its officials, employees. and
RETAINING WALL
agents from any and all claims for damages of whatever natt rc,
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arising directly or indirectly from the issuance of this permit. 11ju-
SWIMMING POOL
o
ance of this permit shall not be deemed to modify, waive or reduce
any requirement of any city ordinance nor limit in any way the
DATE:
TO: Building
('0111111uniLy Developmenc -DeparclilellL
FROH; Engineering Division
Public Works Department
SUBJEICT:
Af-Ler review oF Che subjecL buildillp
c e f 0 ow ng c ommell L s permic application, v.-o have
Vol
P
I A 0
PUBLIC NORKS DEPARTMENT CHECKLIST
0
BUILDING PERMIT REVIEW I-AA�e, J—
(address) (date)
0
Street Right -of -Way Existi
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Access Easements Exist*
H
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Utility Easement Existl
Lot Per Subdivision Plat
Assessor Map
Site Plan Checked for Accuracy.
_
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Underground Wiring Reqd.
0
Check Accuracy of Legal Description
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Review by
r4*
Existing Water Main Size
Water Main Required
Service Line Required
Hydrant Size Exist'
c4
Hydrant Reqd Per Fire Code
Size
94
Detector Check Meter Reqd.
VqC,,9&eAX-e4 Tv 6-- 11J-(-7*Lu5,D F-1,f ATYAC09-
E-4
Cross Connection Inspection.
V#RAt41At- )*/N)Avm P),- llveffeJ AOoYC-
��.Clnl WC1.0-DC 1#jLC-r+ -DisCMARSE
Fire Department Comments
de'
COCA:�j;)—lFWAr C4 I
W*;ree Dw.
'dater Meter Charge Reqd.
Review by.
Date
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer
Drawing No.
File No.
Side Sewer Availability -
Sanitary Sewer Connection Fee Reqd.
:3:
Review by
Date
W
Open Ditch Existing
Culvert Reqd.
Size
c4
Catch Basin Reqd.
Indicate on Site Plan
0
Shoulder drainage maintain collection
an swale open runoff
E-4
Manhole reqd.
Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
Review by.
Date
WvroF,rs
e- , ces.1
8-8-80
Revised: lV10-1977
Page 2
Street Paving Reqd.
Curb and Cutter Reqd.
Sidewalk Reqd.
Curb Cut for Driveway Reqd.
r4 Right -of -Way Construction Permit Reqd.
Bond Reqd. for Public Inprovements
Street Name Sign Reqd.
Other Signing Reqd.
IM Pre Permit Site Inspection made an
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14 Special Requirements listed in mem to Comnmity Development Department,
Building Division
BY - Date
c> All items filled in on Building Permit Application
04 BY Date
Drawings Stairped and Notations Made
BY Date
Approved by Public Works Department
Fzvised: lv 10-1977
1,
'Nothing in this permit I
interpreied as allowing c
maintenance of any cu'r
nonconforming or unpe!
or site condition which I
rmi-t application, reP
Cii%d; structure or cc
Ian or drawing. SL
site W
conttion mw be the st
action."
enforcement
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val pro 9�ha4U be
Ne c',
Mitting FAKK,
existing
m
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aide the scOP Of'the
I of whether
3n is shown On
Lilding, structure or
of a separate
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PLANNING DATA S TR E E T F:I:L:E:
New Commercial / Multi -Family Projects
Name: 9�&_Vlevv (rayh�bs
D t e: lqq
Site Address:o 1 -7 61 q1h Ave S
Plan Check ft: BLD -.2007—
A, _D I&
Project Description: Pe-pAir- de6ks
Use(s) Proposed: Allowed Uscqp NO)
CUP File Number:
To Allow What Uses:
Legal Nonconforming Land Use Determination Issued: (YES / NO)
Reduced Site Plan Provided: (YES / NO)
Zoning: P
Map Page: /57
2—
Comp Plan Designation:
Corner Lot: (YES /�03 64 V
��Ar-s -AS 4 edypz�
Flag Lot: (YE
- - Vw� is RL-;f-
ADB File Number (date waived):
Lot Area:
Plans Match ADI3 Approved: (YES / NO)
Shoreline Required: (YES NO)
Critical Areas Determination #:
El Study Required A4�
El Waiver
SEPA Determination:
>kExempt
El 14eeded (for sites with 500 cubic yards of grading or within 200 feet of Puget Sound or Lake
Ballinger. Requires: (1) Fee, (2) Environmental Checklist, and (3) APO List with notarized form).
Re d Setbacks
Street:
Side: 0
Side: /0 /
I Rear:
ActualSetbacks
Street: Sid
Sid
Rear:
Lot Coverage/FAR Required:
Lot Coverage/FA�Jprovided:
Lot Coverage/FAR Calculations:
Building Height
Datum Point:
Datum Elevation:
Maximum Height:
ctual t:
Subdivision:
Lot Aggregation Required:
Landscaping
Landscaping M!,a�ts ADB Approved:
LandscapiK9, Bid Provided: (YES / NO)
Bond Amount (100% Bid):
Plan Review By:
PLANNING DATA STREET �F�ILE
New Commercial / Multi -Family Projects
Commerciab��arking Analysis
Business Name
Type/Use
Parking
Ratio
Tenant
Area
Required
Parking
Total P.?rking Required.
Total Parking Provided.-
Aftilti-Family Parking Ana!ysis
# Bedrooms per Dwelling Unit
Parking Ratio
# Units
Required
Parking
Studio
1.2/D.U.
I Bedroom
1.51D.U.
2 Bedrooms
1.8/D.U.
3 + Bedrooms
2.0/D.U.
Total Parking Required. -
Total Parking Provided:
Other
Plan Review By:
1S741-1EET FILE
CITY of EDMONDS --- PUBLIC WORKS DEPARTMENT
Routing of Building Permit Applications
Proposed Property Address of Application:
519 - 4th Ave. South
FDEPARTMENT COMMENTS
'MOMS
I �4,e !j,
,,- VA FMONANW-
N 0 T E S
BUILDING
DEPARTMENT COMMLNTS
AI
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USE PERMIT
BUILDING DEPART*ME'IW Applicant Fill ZONE NUMBER MAY 21,1,97161 A
Inside Heavy Lines JOB I
PERMIT APPLICATION ADDRESS L' ANV PubliC
NAME (OR NAME OF BU-S NESS) �of KS
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W M-AILING ADDRL55
Z VARIANCE OR ADLI 0.
0 CONO. USE NO.
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CITY TELEPHONE NUMBER
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FRONT 10
NAME
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0-
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LOAD
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swim
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0
NUMBER OF STORIES
NUMBER I OF
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NATURE OF WORK TO BE DONE:
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I hereby, acknOWledge that I have read this aPpliCation; that thU In-
forMation given. IS Correct; and that I am the owner — th�
TOTAL AMOUNT DUE
A
S, U",)EET FILE
CITY of EDMONDS --- PUBLIC WORKS DEPARTMENT
Routing of Building Permit Applications
Proposed Property Address of Application: _ 517 - --4th Avenue South :55�v - & 0 lzl-
DEPARTM I ENT
COMMENTS
DATE
W A T E R
S T R E E T
vg- J 4
e�7, C—/,
S E W E R
N 0 T E S
BUI LDI NG
DEPARTMENT COMMENTS
-BUILDING
DEPARTMEP
Applicant Fill
USE PERMIT nF.Mril Y17r)
ZONE 1P NUMBER
__ R LAP
PERMIT APPLICATION
Inside Heavy Lines
&AMR
JOB
ADDRESS
- -
NAME (OR NAME OF BUSINESS)
W
Z
0
X1
0
LEGAL LOT
0 YES 0 NO
LOT AREA
SUBDI KS 01
MAILING ADDRESS
CITY TELEPHONE NUMBER
VARIANCE OR
COND.USE NO.
ADB NO.
4o S, �,_ G
E
Z
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J
L
PROPOSED YARDS
FRONT SIDE R
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U
W
X
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NAME
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AREA
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6
OTHER
REQUIREMENTS
CITY
TEUEPHONE NUMBER
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0
U
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0
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EXISTING STREET R/W(,.D/(,O FT. DEFICIENCY THIS PROPERTY
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W
W
z
W
ADDRESS
CITY
TELEPHONE NUMBER
REMARKS
Driveway slopes not to exceed those
indicated on Standard D.wq No. 103
LICENSE NUMBER
CITY LICENSE NUMBER
CHECKED BY
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STREET AND/OR UTILITY YES
WORK REO'D 0 NO
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YN
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0
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TYPE CONNECTION
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NUMBER
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METER SIZE
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W
REMARKS
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L__j
NON-RESIDENTIAL SIGN
F] ADD 11:1
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0 REPAIR PRE -MOVE swim
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FIRE
TYPE .qP<_0NsTRUCT1ON ICODE
f ()a
1q,73
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SPECIAL INSPECTOR JAREA
REQUIRED
El YES NO
JOCCUPANCY_
GROUP
HIF/I
C UPANT
L AD
PLAN CHVCKED BY THIS SITE IS CITY
OF EDMONDS. LOCAL SALES TAX
aj SHOULD BE CODED 31,04.
REMARK
#
L-Dcro
NUMBER OF STORIES
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DWELLING
UNITS
m
NATUR57 CIF WORK TO BE DONE
k , c ('04, �
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