535 3RD AVE N.PDF111111111111
4897
535 3RD AVE N
7-
:,OF DIAN P,
IT
_F
A' ME"—
C�"
PERMIT W4
Call 775-2525 for side, sewer inspections BEFORE covering any portion of the constr etl n
(Inspection will be: provided -within � 24 hours after requist. 140 Sat., Sun., or holiday Insp u I tioo
ec, ns.)
26
ADDR91§S*---iOVABON; OF CONSTRUCIkIoN... .... W,.7...
Y'LEGAL'DESCUIPTION ............... I ..........................
PROPERT,
................. ............. a ........................................................................................................................................................................................................................
................................................... OWNER AND/OR BUILDER ......... G.14� ... awa . ..................................... . .......................................................
CMAI�OR'S� NAME'& ADDRES'S .... ................................................................................................... ...................................................
P6rml6iloiri Is grafiteA January ... 1.94 ......................... 1910, for repair and/or connection of a side sewer to the city sanitary sewer
vitenulaiwiirdiancowlth:C, Ity, of Edmonds ordinances
Is CALLED TO THE FOLLOWING:
NOT]k'i&.� 1��The owners bf.ths, p ' erty� may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must be employed to construct
ilde�,sa*erin street �rxoepa. Do not cover any portion of newer before It has been Inspected.
NOT1,;, No� 2—All.wo rk, 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 ful I 1�`Informitibn 'regarding Ordtna;n(!e 11.16.1Q30 and Regulations governing side sewers when you get permit.
NOTE No.' 4—T6p of aide 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 b..permitted.
NOTE, No. 5LTr6fichii,jK's'tre'et; must be water nettled and surface of street restored
'Work Which may dev lo within one year of completion. to original condition. Contractors sha 1 11 be responsible for failure due to Improper
a p
NOTE No. 1�—Itla unlawful to alter or do any other work than Is provided for in the permit, or to do any work on the maln sewer or its appurtenances except to in-
sert the�plpe, Into the i wye.
D18AkPAdVED',� Date .................. By ................ Date... By .... ........... Date .............. . ................... By ................
D ...... .... i;�r� ...... . ............................... ........................................................
�PROVkl): .. .......... 13Y ......
AP
iiemarks: OIL ............................ X
.................................................................................... .................................................... ....................................................
*Intt Cbl)ies:MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
.................. ....... ........ ....................................... ...
�(O`fteri�of,`Coniracting nrin Performing Construction) hereby certify that the side sewer installation constructed under this permit
with, all governing ordinances of the City of Edmonds.
Datedthis ...... I ...................... day of .................................................................. 19 .........
"16, Y "di Gas Tele'hone%n, Po r: E], Sewer [], Other
on 9 0
we
APPLICATION
I np City of Edmonds for EASEMENT NO . ............ ...... --------- ............
SIDE SEWER PERMIT
NEW CONSTRUCTION E] REPAIRS 0 LID NO . .................. ASMT. NO. -----------------
mg 4='
OWNER--------------------------------------------------
------------- ---------------------------------- CONTRACTOR ------------------- ------- --------------------- --- PERMIT NO;.,..
---------------------
JOB ADDRESS
---------------------- LEGAL DESCRIPTION: LOT NO - -------------- ----------------------- BLOCK NO . ............ ----------------------
Approved:
ATD -------- By - -- ------------- ------------------
y
-The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW- CONSTRUCTION E] REPAIRS F1
EASEMENT NO. .
LID NO. ASMT. NO . ..................
6;
OWNER........ -------- 4 .............. -------------- ---------- CONTRACTOR ----------------- .................................................................. PERMIT NO.
JOB ADDRESS ............. J ......
------------------- ... ....... : --------------- LEGAL DESCRIPTION: LOT NO . ............................... ...... BLOCK NO - ------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------
NAME OF ADDITION
--------------------------------------
RECF!\.I'zr)
JAN 1 09 1976
Publjc VVOM� Pey_--
N
Approved:
DATE................ ........................... By ------------------------------------------------------------
APPLICATION
for
The City of Edmonds SEDE SEWER PERMT EASEMENT No . ..........................................
NEW CONSTRUCTION [:) REPAIRS 0
113-05100
OWNER.......... ------------------------------------------------------------------- CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ...... 535 ... 3.rd..Ave....11 . ............................................................ LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAMEOF ADDITION .........................................................................................................................................
0
Dye Tested On Sdwer 1972
Approved:
DATE................................................ By ......................................................................
CA FILE NO.
Critical Areas Checklist
-Site Inforum
�L#6ii (soils/topography/hyd.rology/vegetation)
C_' ra
teAddr n.
2. Propetty Tax Account Number: _Z
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes; no.
K yes; how is site developed?
5. Describe the general site topog6phy.' Check -ill dw apply.
-X - Flat: less than 5-feet elevation change over entire site.
R fti* ge�irally less than 15% (a vertical rise of 10-feet over a
�q mg: sl6pes; on site
horizontal distance of 66-feet).
Hilly:,, slopes present on site of more than 15% and less than 30% a vertical rise
o f -f -f
.10. eet over a horizontal distance of 33 to 66 eet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33 eet).
Other (please describe).
6. Sk6contains areas of year-round standing -Vn�er. zVe9 Approx. Depth:.
7. Site contains areas of seasonal standing water: &'t�y ; Approx. Depth:
Whafseason(s) -of the year.?
ain of a water course.
S. Site is Mi the floodway f[0041
9. Site Contains a or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped Qawn,shrubs etc)
ll.. Obvious wetland is present on site:
For City Staff Use Only
-Site'is Zoned7
'1naPPM 'I tYPe(S)?
CS s0i
inventory or CA. map indicates wedand present on site?...
'rifical. Areas inventory or C.A.- map indicates -Critical Ana on site? A10
�itk� withi n* designated earth subsidenc6 landsli& hazard area?
.4,,-..--:.,;:-SiteJesign" on the Environmentally Sensitive Areas Map;? AJO
DETERMINATION
lir"REQUIRED CONDITIONAL WAIVER
VER.
."Revit by::
Pla�n)r
!1.
Rcv01M4f94
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AW I& iww it-*%
:P.P;'COMMUNITYSE
j,
1
di., -
CIS .4
City of Edmon
V. Woy V
S. C
Critical Are
The. Critical Arm ChecHist contained on and submit it to the Cit
. I .. 1-1 -1-1- - -1, . . � y. 'Me City
t aeciclist,
this form is to be Mled out by -an� ji�� makea precursory -site'
preparing a Development Permit �W and hiake'ai'detiiinination of the
-Prior
Application for the City of Edmonds �subsequenftteps:fie 6eissary t� `66mplete a-
. 1 .1
to his/her submittalof adevelopment
permif application.
permit to the City.`
C ;,mb 'ith a signed copy of this form,* the
The purpose of the Checklist is to enable !MHcant should also submit a,vicinity map
City staff to determine whetheir 'adf' or plot plan for ind ual lots of the parcel
potential
with enough detail that City staff can find
praient on the subje& p WW4
information needed to compleie the-,-., addition, thie ippliCailt shav liadwo-4
Checklist should be easily available from offier pertinent information (eg.-sftepy
observations of the site or data availabli-id--7-
.4 topogmphy map, etc-) arstuffieslin
City 11-M (Critical Arms invaiiorici; �Qti�itionw'ith-thiis' Cheddk to iks�iit�
,or soil surveys).
staff in- completing theii preliminM"I
t of *the site..
An applicant, or his/her representative,
must fin 'out the checidist, sign and dik it,
I have comoleted the'attached CritiEil-
factual,46 the b6si of MY laii�Midji-(fiif "out appropriate column below).
Owner Applicant: Applicant Representative:
Name
Name'.
Street Address Street Address
Xl�
10,
'00
'. 44.,
qr�� Qty,.State,.ZIP-.-
Z ,
Date,,�
Signature Date
V
It
RECEIVEC).
NO
ze. V 0.2
UNITTSERVICES
S
0-90 -lL99,7
City of Edmonds'
Critical Are a. s - fte." kla'
The Critical Areas ChwJdist on:
'and'submit it to the City. The . City will
this form is j6b6 fined oioltb� iii'p-erson
:141M� the 46hecklist� th;ft a precu�or� site
prqxning a Development permit
'�W �iul malma deb-mmination of the
Application for the City of Mmonds.prior
subsequent steps necessary to complete a
to his/her submittal of a development
development permit 2pplicadon-
permit.;Q the City.
The purpose , of the CbwJdist is to enable
Vrith a Aped copy of this form, the
should also submit a vicinity map
City staff todetermineViethetany ""' ''
.!ffllicant
or plot plan for individual lots of the parcel
potential Critical A�eas aht ornia' be;
y
enoug
-with" i - h detaCd that City staff can find
presenton-ftsut4aFWPMtY_
and ided* ii�e" suticaparcWs). 11,
120ecW 101complete the
adMon,' the applicant shall include
Checklist should be easily w4ailable fiom
other pafiment information (eg. she
Observations of the site or data available at
Pill*. topagmphy map, etc.) or studies in
City IM (Critical Awai inveitoxies, maps,
C00jundion with thU Cheddia to as"
or soil surveys) -
staff in completing their unmary
oftheti
ite.
An applicant, or his/ber iiepresentative.
must fin 'out the cheddist, sign and date it,
I have -completed the ittached Critical Area Checklist and attest that the'answers'provided'are-
facUW,46 thi b6it'4 ffly'kii6iwedge (fili out the appropriate column below).
Owner I Applicant
Nam
Street Addrew
27
..Applica�mt'.Repramfttive:
Nam
Street Address
Phone City, State. ZIP
Phone.
Date Signature Date
-4
CAFILENO.
CtificalAreas Checklist.
iw
Site Informat*l (s6ils/topographyMidiii��lo'gy/vege�afion),- - N-*
1. w�,Site-Add�e
�4;
ovq— Oc)- 0 7�
2. Property Tax Account Number:.'
3. Approximate Site Size (acres or square'feet):
4. Is this site currently developed? no.
14KYes;
If yes; how is site develo
5. Describe the general site topog��y!. thatapply.
Flat less than 5-feet elevation change over entire site.
Rolling: slo 'on site g eq'erally'�* less than 15 % (a vertical rise of 10-feet over a
horizontal diitan6P.a").
Hilly: slopes pres�'en't*�ite`:of more than 15% and less than 30% a vertical rise
o -f
f 10 eet overa, horizontd distance of 33 to 66-feet).
Steep: grades of greater d= 30% present on site (a vertical rise of 10-feet over a
i horizontal distance of less than 33-feet).
Other (please d
6. Site contain- areas of year-rou�d vraec. Al.---:9 Approx. Dcpdr.,,
7. Site contams areas of seasonal stakWmg watw. Approx- Depth:
What season(s) of the yea&-
8. Site is in the floodway of a water course..
9. Site contaiV a
,preek or sin ares wb Pre water fi n i i is across the grounds surface? Flows are year-
round? 44 Flows are seasonaP.._ (What time of year?.
10. Site is primarily: forested ;meadow _;shrubs rnixed
urban landscaped Qawn,shrubs, etc)
11. Obvious wetland is present on site. �7�
Staff Use 4 My
mapped s6il qks)? All
inventory or C.A-, map indicates wedand presenton site?.,: AJO
C66-W Areas inventory or C—&-map-indicates 6itical Am on site?
designated -earth jLA,
Sitd desigiiatbd on the Fjivironmentdlysiisifivi�Affm Map?
-RETERMINATION:.
--�;�-ZU0NDMbI4AL'%Y
Di
f-PI tj
R.W61101094,
V,) L
UT(71: LIST
1W
'G PI'll"UT r) -T!7 Y
IT
FJV�ay Existin, RIT),T)
Street Pdght-o CT
T
Access 1-asemmits Existinf, m,n,)
k)n WISE
Utility Eascinent Existinf,
Lot Pcr Suhdliv;sjon P1 at ----n Assessor —91)
Sitc Plan (J,ccl�ccl for Accuracv epJ.Q5-f
6, (:1�� Pail f oul et
i
i0V
1
Witer "all red
-1 r -i
P', t S i- V 15 L 1.!,
.1"t —,.O�vcrrlwcoc�c
Dotector (1,(-c1:,-Ctcr Pcr.,,zircd
--- 1 7 c
("'Itic Tzml: 1k::Nlio;1.
scy. � j c
Sanivin- Avai 7—'
Ir. ".-c' A,
NO.
SIOC Sewer i
�11 r %%I i
(;,III cy Cc),,-,ncct-icjn1 Fcc Pcoldyl-cc,
0,11vort Peca
Catch BnF;i11 Pcrmirctl
T I
,7
C)pk:�O CCU)
I I
NZ11111ole required
SOil collclitiO115�-
q1- :
,round 1-:atcr Field Owc,'IcO
1 Ze
i
lo nn i t '7o
r �Oi
File "o.
-- Vc(liirec,
size
llidicnte
R-1 t c
111�w�
-."gigila
,Fmgw�w��
c oil 7itc Plan
M M,.
Strcct Paving, Uccluircd
Rim (,',,,i-t_tcr Nccidrcd
Sidcwalj� Pco.11ircc!
Cuilb (.),it for Pfivc,-,av Rlcquircd
lc�iii
"ittcr
ir)
cc,
Construction Pcil'u., ilred
Boncl Rcmdred for Ril hvrovcpients
Strect �gjl 'Recil,
13-poci,,1 Pe '1I.-Ilo to Buildin,(,, J�cpnrtincmt
c;uirc-m-its listcd in me
IIV Date
w—t--m3n% 0--
itc;�,s filled ill Lj Pon it Apnlicat,-.1an
P"Itc
Stanpcd zmnldll '-�'Otaticns
T )ato
Approvc(l by Public 1.orhs R�pzlrtj,.Icnt�
<:
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE PERMIT
ZONE NUMBER
cs 3"_d 1UITE,APT I
ADDRESS
111b
W
Z
3.
0
OWNER NAME NAME OF BUSINESS
LEGAL DESCRIPTION CHECK
SUBDIVISION NO
LID NO
MAILING ADDRESS
--? - :�r.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — REOUIRED DEDICATION
PROPOSED
TESCP Approved 0
RW Permit Required 0
Street Use Permit Req'd 0
Insp ction Required 0
Si ewalk Required 0
d
Cr
CIT�Y�
1 it'll
NAME
cc
METER SIZE
hl�
No. OF FIXTURES
PRV REOUIRED
YES 0 NO 0
0
ADDRESS
REMARKS
Z
Z
CITY ZIP
TELEPHONE NUMBER
a
Z
NAME
ADORE
-7
C
L)
Z
0
0
ENGINEERING MEMO DATED REVIEWED BY
ci ZIP
1 Aft"
TELEPHQKE NUMBER
FIRE MEMO DATED REVIEWED BY
W
IK
W
STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA
SEPA REVIEW
ADB NO.
1
01: �� 4 �� ,-o,?
ALLOWED PROPOSED
COMPLETE EXEMPT
I
SHORELINE N
Legal Deschpti6n of Property - include alf easemenah�
Z
9
EXP
-
L)
U)
u.1
D
VARIANCE OR CU
PLANNING REVIEW BY
DATE
SETBACKS - FEET
FRONT SIDE REAR_
HEIGHT jL6T
COVERAGE
Z
Z
Property
T Account
ax
0
REMARKS
Parcel IN 7&7-032:2!9�00
0.
NEW L—J RESIDENTIAL PLUMBING
ADDITION COMMERCIAL MECHANICAL
REMODEL APT. BLDG. SIGN
GRADING FENCE
REPAIR CYDS. I x —FT)
C ECKED BY
TYPE OF CONSTRUCTION
itir
I . 00,10
Mill
CODE
OCCUPANT
GROR
r 3
WOODSTOVE SWIM POOL
DEMOLISH INSERT HOT TUB/SPA
GARAGE RETAINING WALL/ RNAlf
CARPORT ROCKERY Relife"We
SPECIAL INSPECTOR JAREA
REOUIRED 13 YES
OCCUPANT
LOAD
-
REMARKS
PROGRESS INSPECTIONS PER. UBC 305
Z
(TYPE QE USE. B�;PINESS OR ACTIVITY) EXP[AIN:
5
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS ,,Ie
CRITICAL
JAREA
NUMBSER
0
co
0
DES WORK TO BE DONE (ATTACH PLOT N)
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING %
PLUMBING
Plan Check No.
MECHANICAL
GRADING/FILL
This Permit covers work to be done on private property ONTY.
Any construction on the public domain (curbs, sidewolks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
ENO. INSPECTION FEE
ow
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 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
waive or reduce any requirement of any city ordinance
PLAN CHECK DEPOSIT
0
modify,
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
authorized agent of the owner. I agree to comply with city and THIS PERMIT This application is not a permit until
state laws regulating construction; and in doing the work authoriz- AUTHORIZES signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor ONLY THE
Code of t�ie State o�Washington relating to Workmen's Compensa- WORK NOTED Deputy: and fees are paid, and receipt is
tion I nsul'aace an0ACW 18.27. INSPECTION acknowledged in space provided.
SIGNA R OW11 150 �DATE SIGNED DEPARTMENT OFFICI - f S SJGNATU�E DATE
CITY OF
EDMONDS
'0
CALL FOR RELEASED By- DATE
ATTENT10f4 INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL - File YELLOW - inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
CHAPTER 3. PINK - Owner GOLD — Assessor