541 4TH AVE S.PDFlill 11111111
5086
541 4TH AVE S
APPUCATION
The City of Edmonds for
SIDE SEWER PERMIT EASEMENT No - --------------------------------------------
NEW CONSTRUCTION REPAIRS Ej LID
------------------
........................ .. ......
------------------ ---------- - PERMFT-4� --- ---------------
JOB ADDRE
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--- -----------
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................ - ------------
Approved:
DATE ---------
.............................................................. -----------------------
irr-inIVII'l, iN'f Z)uq 4
Call 775-2525 for side sewer inspections BEFORE covering any portion of the constructi n
s.
(Inspection will be. provided within 24 hours after requst. NO Sat., Sun., or holiday Inspectloon ')
ADDRESS LOCATION OF CONSTRUCTION .... 5.4.1 .... it ... 4th..AveAL.��.e—tk .................... . ................... ... .......... .....
PROPERTY LEGAL DESCRIPTION ...... T fie ... W-10.0 ...... oflat ... 4....Black --- 2.....C.i.ty .. ParkAddition .............................................
....... . ....................................................... OWNER AND/OR BUILDER ........ GOGERL.A ... SOUS ................................. . .......................................................
CONTRACTOWSNAME & ADDRESS ....... OVER ................................................................... . .............................. . .. . ... ...................................................
Permission Is granted ... September ... 23, ....................... 197.4 ... for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NC-7! No. 1—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.
No_ No. 2—All work performed in city right-of-way requires an Invasion of RJght-of-Way Permit obtaIrrable from the City Engineer's office.
NOTE No. 3—Obtain full information regarding 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 % will be permitted.
N% No. 5--Trenches In street must be water settled and surface of street restored to origina.1 condition. Contractors shall be responsible for failure due to Improper
work which may develop within one year of completion.
NOTE) No. r�—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 ;: ............ By ................ Date ............... . .. . ............... By ................
APPROVED Date ... . .. . .. . .............................. ........................................................
... J.17..j
IK .By...
Remarks: ............... . .......................... . .. . .................................... /./. .................... . ...................................... . ...... . ...... . .........
..................................................................... . .................. : ..................................................................... . .................................. . .......................................................
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
....................................................................................... ... , hereby certify that the side sewer installation constructed under this permit
Twner of Contracting Firm Perfrrming Construction)
was Installed. in accordance with all governing ordinances of the City of Edmonds.
Datedthis ............................ day of ................................................................. 19 .........
Check BEFORE you dig for: Water C], Gas E], Telephone 0, Power E], Sewer E], Other C] -V V
APPLICATION
The City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION F] REPAIRS n w LID. 140 . ..... 7.4 ....... . ASMT. NO - ------------------
OWNER ....... .......................... CONTRACTOR ---------- 7- ................................ PERMIT NO.',--x�>44
JADDRESS .......................... LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
OB
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NAMEOF ADDITION ------ O� ----------------------- ................................................
Approved:
DATE............................................ By ............. ...................
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PLANNING DATA
NAME:.
SITE ADDRESS: DATE: //qF
ZONING: A041 PLAN CHK#:- 2 -y-)
PROJECT DESCRIPTION: Adjr_(�l
CORNERLOT Alb (Yes/No) FLAG LOT- —(Yes/No)
0)
SETBACKS:
Required Setbackp:
ar <
Front: ZA'Q; Left Side: —Right Side: Rear:
Actual Setbacks:
Front: Left Side: Right Side: Rear: t
Street map checked for additional setback required?— T,,�(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED +.,� _(Y/N)
LOT COVERAGE:
-3
Maximum Allowed: Actual:
BUILDING HEIGHT: 25- &e S � �� -Z.!�
Maximum Allowed: Actual Height:
Datum Point: �() Datum Elevation: /(/0
A.D.U. CREATED?:
SUBDIVISION:
CRITICAL AREAS #: 71 - 9 (,� / ve-,m ,
SEPA DETERMINATION:
LOT AREA:
OTHER:
Plan Review By: 1,7
c:Ti1cs\pemitkAp1andaLdoc
q8-8
RECEIVED
City of Edmonds
JAN 0 6 1%8
Critical Areas Checklist
.(47C. 1 g9\J
The Critical Areas Checklist contained on
this form is to be filled out by any person
preparing a Development Permit
Application for the City of Edmonds prior to
his/her submittal of a development permit 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).
An applicant, or his/her representative, must
fill out the checklist, sign and date it, and
submit it to the City. The City will review
the checklist, make a precursory site visit,
and make a determination of the subsequent
steps necessary to complete a development
permit application.
With a signed copy of this form, the
applicant should also submit a vicinity map
orplotplan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include other
pertinent information (e.g. site plan,
topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
z
Name
Street Address
Applicant Representative:
Name
Street Address
City, State, ZIP Phone City, State, ZIP Phone
6�0 r�01 ;10,25r
ignaturie Date
Signature
Date
CA FILE NO. N_
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soil s/topography/hydrol o gy/ve getati on) /
I Site Address/Location: Zj Z711 -S 1Z_ z -9 <�
2. Property Tax Account Number: 45�e 0 0 to 9
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes-, no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
V/ Flat: less than 5-feet elevation change over entire site.
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
I 0-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water:
.'� C'
; Approx. Depth:
7. Site contains areas of seasonal standing water: /_V 0 ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway -'V 0 floodplain,,V 0 of a water course.
Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? -V 0 Flows are seasonal? A/O (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: 1-U-1
2.. ::.SCS tna - ped:s6it.Npe(s)�
y.
p
3.- Wetland ihventoryor CA. 'map indicates �w'et la . nd present on s . ite'?,
4-1: C ritica 1'. Area's inveniory Gr.C:A..:map:.indicates:CriticaI Area on site..?:
5:,: Sitq�:.W.i . thin.4eiijo�iod ea�th�� subsidence hindMide hazard ar.ea?.:
d. .. . . . ......
6.. :Site..des.iga.�ted�on -the. EnvironmenWly.Sensitive Area�.Map� tjo
DETERMINATION
fta.�chk.doc; Rtry 10/03/97
CITY OF EDMONDS BARBARA FAHEY
MAYOR
121 5TH AV NUE NORTH EDMONDS, WA 98020 - (425) 771-0220 FAX (425) 771-0221
L__� COMMUNITY SERVICES DEPARTMENT
Public Works e Planning/Building - Parks and Recreation e Engineering * Wastewater Treatment Plant
January 20, 1998
Jack Lang
541 4th Avenue South
Edmonds, WA 98020
Subject: Determination regarding Critical Areas Checklist # 98-8
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City is
located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
IMPORTANT INFORMA 0 4TO BE NOTED::'
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINA TION WITH ALL -400
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Enc: Determination
*Architectural Design Board
C:Reception\Jana\CRLTR.doc
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Sharla Graham
Acting Planning Secretary
* Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
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--ter UULU — ASSeSSOr
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CITY OF EDMON'bs
USE PERMIT ...
ZONE
NUMBER
CONSTRUCTION PERMIT APPLICATION
loa SUITE/APT #
ADDRESS 5411 41
yl- �%s
OWNER NAME/NAME OF BUSINESS
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LEGAL DESCRIPT
'07
UBDIVISION NO.
LID NO.
MAILING ADDRESS
Aut—, S...
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — REQUIRED DEDICATION
TESCP Approved 0
RW Permit Required 0
Street Use Permit Req'd 0
Inspection Required
Sidewalk Required
CITY ZIP
, I ED1V(-v\[zZ e9s"O.,u
TELEPHONE NUMBER
74:2-3/
NAME
tu)i
METER SIZE
LINE SIZE
NO. OF URES
PRV REQUIRED W
YES 0 NO 11
ADDRESS
REMARKS
CITY ZIP
TELEPHONE NUMBER
Z
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ENGINEERING MEMO DATED IEWEDBY
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1 -F
E NUMBER
IRE MEMO DATED REVIEWED BY
Cr
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TtLIC SENUMBER PIRA N DA
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VARIANCE OR CU
ADB#
_F_,INE #
Ce-63-1 Description of Property - include all ease (fie-nts
EVIEW
COMPLETE I EXEMPT
EXP
SIGN AREA
�LLOWED P
ALLOWE ED
HEIGHT
ALLOWED IPROPOSED
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LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
/5
PROPOSED SETBACKS (Fr.)
FRONT L/R SIDE REAR
Z
5
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Property
Tax Account
Parcel No. 0
LOT AREA
i PLI&WING REYIEW B
1.""tylar/
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5-1-5 lif
ry
E] NEW IikJ RESIDENTIAL XG�ECH
REMARKS
COMPLIANCE OR
D E]
ADDITION COMMERCIAL CHANGE OF USE
REMODEL APT. BLDG. SIGN
CHECKED BY
TYPE OF CONSTRUCTION
IM
CODE
1 �?-7
OCCUPANT
QkPW-2
GRADING FENCE
E] REPAIR CYDS. I x_ FT)
0
W
WOODSTOVE SWIM POOL
DEMOLISH INSERT HO
M T TUB/SPA
FGARAGE RETAINING WALL/
]CARPORT ROCKERY RENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
&Z>
SPECIAL INSPECTOR
REQUIRED
11 YES
C
CCUPANT
CA
%L P
REMARKS
PROGRESS INSPECTIONS PER UBC 108
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS I'
3E
STORIES C91 1 UNITS INUMB R
DESCRIBE WORK TO BE DONE JATTACH PLOT PLAN)
11ft- ALA
-i -7 f
FINAL INSPECTION'REQUIRED
VALUATION
FEE
FEE
gylyp& eixwt Az
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING
9
PLUMBING
rPla'n Check No.
7
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFIW
Any construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) will require separate permission.,
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work 11 Started Within 180 Days
STORM DRAINAGE FEE
ENG. INSPECTION FEE
To
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4
2:
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"Applicant, on behalf of hiorA41, spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Wastyh)gjon, its officials,
employees, and agents from any and all c141 bj, damages of
rf�, fn
whatever nature, arising directly or indirectly f o theissuance
of this permit. Issuance of this permit shall not be deemed to
I modify, waive or reduce any requirement of any City ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and In doing the work authoriz- AUTHORIZES T . his 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 State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
ion Insurance aria RCW 18.27. INSPECTION acknowledged in space provided.
IGNATURE (OWNER OR AGE;N;To)�� DATE SIGNED DEPARTMENT
0 IGNA
-11,2 CITY OF
EDMONDS
CALL FOR R �E BY:
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 �o GINAL F*iIe YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS SEEN GRANTED. UBC
SECTION 109 PINK — Owner GOLD — Assessor
I