561 12TH AVE N.PDF1111111111
637
561 12TH AVE N
F-SQJECT 6229555
q2l 12th AVE NORTH
E�MONZ'75, ^A c15020
oriNrg
CHRIS 4 Er;l CLOUC��
q2l 12TH AVE NORTH
e:;�MONPS, ^A 115020
'7'75 - -40,11
R Ez I V E It
CITY COPY
11 M) i ( co -U,� Z. c->
ec-0
5C,OFF. OF PROJECT:
-7
EXTENO KITCHEN, BREAKFAST 4 VININC PELrwm A
AREA ( 2 1 cl 60 FT). REPLACE ANO AC�O WIH#tA)4
PECK (442 50 FT). ALL. �NOKK
ON UPPER LEVEL OF RE51ngNCE.
TAX SO 5010 - 0000 - 0 1,1 - Coo5
L-M&AL, V155C,91FITION:
LOT 1 41 HAFLEkNOOr:> VILLASE 1. vOL 20; FCv, b(o
ZONE R5 - 12
CONTSACTOK
FRE5TISE SUIL-'7ER-5
15421 55TH AVENUE
EOMONV5, ^A 115026
CONTACT: MICHAEL A. FO�NERS
(=06) 7-74-1171
LIC: PREETS, 205KL
Exr. 5-1-16
LOT CoOl15RAC7e-
LOT SIZE: 12,000 SOFT
EXISTINS COVERAGE: 5,01 1 50 FT 2 5 010
PROPOSEP APOITION: 2111 SOFT
PROPOSEV PECK: 442 SOFT
HEAT SOURCE:
GAS
f2ANITARY SERVICE:
SE^F-R
!�RAVIN&- NONE
PROJECT COST: $40,000.
APP OVED BY PLANNH
MR,
17
12-+h A\/ rf �
4
RECEIVED
Critical Areas Checklist- JUN 2 9 1993
Site Information PERMIT COUNTER
Project Name. --k o 0 R F775 D 6V(-'FT ermit Number-.
Site Location: 2-Al- 4vp At Property Tax Account Number. 4W? —00 0 ---031
Approximate Site Size (acres or square feet):
Have you filled out a Critical Areas Checklist for a project on this site before? do
General Site Conditions
1. Has the site been cleared or logged? Date of most recent action:
Soils / Topography
2. In the Snohomish County Soil Survcy� what is the mapped soil type(s)?
3. Desm-be the gcneral site topography. Check all that apply.
Flat less than 5 feet elevation change over entire site- 0#
Rollinw. slopes on site generally less than 15% (a vertical rise of 10 feet over a
horizontal distance of 66 feet.)
)Mlly.- slopes present on site of more than 15% and less than 30'Yp ( a vertical rise
of 10 feet of horizontal distance.)
Steep: grades of grezktcr than 30% present on site.
Comments
Hydrology/Vegetation. -
4. Site contains areas of year-round standing water: &/0
5. Site contains areas of seasonal standing water- -/�o Approx. Depth:
6- Site is in the floodway floodplain of a water course-
7. Site contains a creek or an area where water flows across the grounds surface? A flows
are year-round? Flows are seasonal?
..... ........
9.3 - i �5- Reviewer
.Number-..
-not require
d
Determination :,aA
A
Critica:: n�:: :i4tu-'.Y�js:..
Planner ()at,
Rev 3127192
-of .*90 - 1941
CRY Of Edmonds
Critical Areas Chec'kfist
The, Critical Ann Che&Jist contained on
this foun is to be filled out by any person
prcparing a Development Permit
Arplication for the City of Edmonds prior
to his4lcr submittal of a development permit
to the City -
Ile purpose of the Chccidist is to enable
City staff to dammmewhether any potential
(kitical Arew are or may be present on the
subject property. 7he information needed to'
cOmPlft the ChcCidist should be easily
a 'lable f
Val rom observations of the site or
data available at City Hall (Critical Areas
inventories, ruaps, or soil surveys).
An applicant, or his/her representative. must
fill out the chocldist, sign and date it, and
submit it to the City. The City will review
the chadMist, xnake a Precursory site visit�
and Vaake a determination of the subsequent
stcPs necessary to complete a development
permit application.
With a signed copyof this form� the
applicant should also submit a vicinity map
of the parcel with cuoukh detwil dw City
staff can find and identify the subject
Parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information or sttidies in conjunction with
this Checklist to assist staff in completing
their Preliminary assessment of the site.
I have completed the attached Critical Area Cheddist and attest that the answers provided -are.
lactual, to the best of my knowledge (fill out the appropriate column below) -
Owner/ Applicant:
"ROM�T R. -ko 6
Name
7-1de
SP Ave
Street Address
67ty. State, �jlp Phone
1�� --.. � L-41q3
Signature Date
Applicant Representative:
Name
ritle
Street Address
City, State, ZIP Phone
Signature Date
PLANNING DATA
SITE ADDRESS: 560 1 12 tL Ad,- Al DATE:
ZONING: 9�5 -12, PLAN CHK#: V5 -102-
PROJECT DESCRIPTION: 9Mr7O&)
SETBACKS:
Required 5 1.1ba-MIKs:
Front: Zl��2 Left Side: 10 Right Side: / 0 Rear:
Actual Setbacks:
Front: '2, 1 Left Side: Right Side: t�) Rear: A7n>l
C'.
CORNER LOT
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED
LOT COVERAGE: "I"
MaximumAllowed: 6?2(. (3-5 )Actual:-(, .3w
BUILDING HEIGHT:
Maximum Allowed: )Actual Height: 1446
JM , Z�2 ( I
SUBDIVISION:
CRITICAL AREAS#: q�3 - /,F5
SEPA DETERMINATION:
LOT AREA:
OTHER:
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number.
4
STREET FILE Issue Date:
A. Address or Vicinity of Construction: 561 12TH AVE NORTH
9 0 C� B. Type of Work (be specific): GTE TO PLACE 75-FT OF B-WIRE FROM TEM
#2300 TO HOUSE, PUSH ONE DRIVEWAY. PLEASE SEE ATTACHED SKETCH.
C. Contractor: -GTE NORTHWEST INCORPORATED
MailingAddress: 221.18 20TH AVE. SE SUITE I
StateLicense#: BOTHELL, WA 98021
D. Building Permit # (if applicable):
Contact: BARBARA TOLLEFSON. PERMIT cOORDIMTOR
Mione: BARB 488-1642
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. 0 Commercial
EJ Subdivision
F-1 City Project
F&] Utility (PUD, GTE, WNG, CABLE, WATER)
n Multi -Family
[:] Single Family
[:1 Other
W.O.# 2100-9POOIDB 242310
INSPECTOR:
01
INSPECTOR:
t"6i
F. Pavement or Concrete Cut : 11
(es RJNo G. Size of Cut: X_
APPLICANT TO READ AND SIGN
H. Chargq_$
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from 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 its departments or
employees, including or not limited t o the defense of any legalproceedings including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR 101OLLOWING THE FINAL
INSPECTION AND ACCEPTAN�CE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL ME FINAL STREET PATCH
IS COMPLETEO I BYC'ITYFORCES, A T WHICH TIMEA - DEBI I T OR CI&D)T WILL B17 PR &ESSED FOR ISS E"TO-MF�A�24ICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the eiAd of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at all times for inspection purposes.
Signature: '�&� //'t_ Date: 4-27-94
(Contractor ollAgent) k,
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
VnR V.lq'V TTQF. nTJI.V
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Fngrg. Div. 1991
FIELD INSPECTION NOTES (Fund 111 Route copy to Street Dept.)
Comments:
Diiagram.:
5 . ,
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
PER141 T SUBW T TED B Y
GTE
STREET FILE RECEIVED
Critical Areas Checklist- JUN 2 9 1993
Site Information PERMIT COUNTER
ProjectName: koo Pr-5/DrWrr-+ernitNumber.
Site Location: 4ve Property Tax Account Number,�W --oo 0 --631 —OZ40
Approximate Site Size (acres or square fcd): �S-o 0
Have you filled out a Critical Areas Checidist for a project on this site before? 0
General Site Conditions
1. Has the site been cleared or logged? 40-- Date of most rec;ent action:
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)?
3. Describe the gencml site topography. Check all that apply.
less than 5 feet elevation change over entire site.
ling: 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 of horizontal distanm)
Steep: grades of greow than 301% present on site.
Comments
9 a 1,9
City of Edmonds
Critical Areas Che'c'klist
'Me Critical Ar= ChecMist 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&cr submittal ofa development permit
to the Ci1Y-
The putpose of the Checklist is to enable
City staff to determine whether any potc . ntial
Critical Areas amor may be present on the
subject PrOPCEtY. Ike information needed to
complete the Chodidist 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 represcntatic� m=
fill out the chccldist, sign and date it. and
submit it to the City. Uc City will review
the checidist, mnkc 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
of the parcclwith enough detail that City
staff can find and identify the subject
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information or swdics in c o'nJunction with
this Cheddist 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:
0 F>?�k T 'R . -ko 6
Narne
Title
SP t'2--b4- Ave 14.
Street Address,
--------------- o -7 X
City. State, ZIP Phone
'�?� . � L--�-Jlq3
Signature Date
Applicant Representative:
Name
ritte
Street Address
City, State, ZIP Phone
Signature Date
C.
IN
�4
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
IT -o� �10
LE Permit Number.
STREET F1
Issue Date: q-17,23
A. Address or Vicinity of Coristruction:- 5-& 1 1 2,-r4 'Avrr
8,2 0 1 o C) B. Type of Work (be specific): t?ow",e-r- nx-rcc--rivc U6
Contractor: 'Cla IVRZ SUPUIak-C4 Contact: 70M AktOr.-e-SOk)
Mailing Address: S�33- ��J ST
StateLicense#: 50fiUCC-101WA
Phone:. 774 - S704
Liability Insurance: Bond: $
Permit # (if applicable): Side Sewer Permit # (if applicable):
E. n dm�imercial Subdivision El City Project Ig Utility (PUD, GTE, WNGAJA�LE WATER)
I,--,
F1 MuitPFamily E] Single Family EJ Other
INSPECTOR: "00 SPE OR: t,&&
F. Pavement or Concrete Cut: El YesZ M.No #4r Size of Cut: x H. Charglc�-$
APP ICANT TO READ AND,SIGN
INDEMNITY.- Applicant understands and by his signature to this application, agrees to h Ifi-CityofEdmond8harmle-s8 b urie.-damage., or
nds, t2d
claims of any kind or description whatsoever, foreseen or unforeseen, that maybe maeaga, ttheCityofEdmo nW, e a'tments or
employees, including or not limited to the defense of any legal proceedings including defense co rt., and attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YE�il`l FOLLOWING THE FINAL:
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL -PROCESSED FOR ISSITANCE TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and -Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS. � � U. I- � )
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on-.&ifeZt
< ball tijOs fe)rinspection purposes.
9.3
Signature: -"F �;4414 A4&-f-e�W-A4 Date:
'(C5-ntM'ctor or Agent7
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: I-A-1 IN 1 CASO t RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER
ti, N.�DAYS DISRUPTION FEE/FUND I 'I:
SPECIAL CONDITIONS: RESTORATION FEE:
,,PERMIT FEE:
J . / .-I
TOTAL FEE: 3"9. 1;-
COMMENTS: RECEIPT FEE -
DATE: ISSUED BY:
711
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund 111 Route copy to Street Dept.)
Comments:
I Diagram,:
CONTRACTOR CALLED FOR INSPECTION El YES EYNO
Partial Work -hispection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
F; V
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FIL
'�S[DE* UWtVARMiT ------------
_NEW' `--REPAIRS
CONSTRUC,"
rION
- Z,�_22110
L_. F=l2;k_F2_,
CONTRACTOR PERMIT NO-
------------------------------ -------------------
--------------_------- ------------------------------------------ ....................
... --------
---------------
B AbIjRESS
-- - ------------------------------------------------------------- LEdAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO -
---------------
------------------...............
-------------------------------------------------------------------------------------------------------------------------------------------
a
NAME OF ADDITION -----------------------------
......................................................................
... .......
fell
M=
Approved:
Lt...
F
4;�
41
if-
J
4
7: a
40
F J�, 12
4�
7
;%
E SEWER PERMIT
CITY :OF EDMONDS SID
WATER -SEWER DEPARTMENT
3
PERMIT
_4
Sof FEE FILE
of the construction.
for side sewe inspections BEFORE covering any portion
k, Call 775-2525 NO Sat., sun., or holid_
(Inspection will be provided within 24 hours after requst.
------------------------------------- - -------------------------------------------------------
STRuCTION ........ .........
ADDRESS LOCATION OF CON
..........................................................................................................
N -_-------- ----------------------
PROPERTY LEGAL DESCRIPTIO
..................................
............ . ................................... .......
..............................................................
..... ...................... . ........
..............................................
ER -------- -------- --------------------------- - --------------------------------------------------- .;r.:
.................. OWNER AND/OR BUILD
..........
. . ................................. ...
--------------------- - -------------------------------------------------
S NAME & ADDRES1,; ------------- -J
)ONTRACTOR'
sewer to the city sanitary sewer
4. Permission is granted ------
......... 19 ... !T!�ior repair and/or connection of a side
dmonds ordinances.
accordance with City of E
sy,,�fmn In
IS CAIJ D To THE FOLLOWING:
A!-,�;NTION inside property line. A licensed Side sewer contractor must be empioyed to construct
btain a permit to construct sewer
—The owners of the property may o has been inspected.
NOTE No. 1 portion of sewer before it
rom the City Engineer's office.
side sewer in street area. Do not cover any -of-WELy permit obtainable f
an Invasion of Right
2—All work performed in city right -Of -way requires
NOTE No. overning side sewers when You get permit. bends in grade
NOTE No. 3—Obtain full Information regarding ordinance 11.16.030 and Regulations g
minimum grade of 21/.- No
riches coverage at property line and 12 inches inside property line;
o. 4—Top of side sewer must have at least 30 1
NOTE N
sharper than % will be permitted. condition. Coritraoctors shall be responsible for failure due to improper
OTFE No treet must be water settled and surface of street restored to original
5--Trenches in s
he main sewer or its appurtenances except to in
work which may develop within one year of completion. or to do any work on t
provided for in the permit,
—It is unlawful to alter or do any other work than is
NOTE No. 6
�i— into the wye.
.................. BY
Date ---------------
ED .............. Date ------- ------------- - ------------- --
Dal . . . . . . . . . . . . . .
DISAPPROVED Date...
.......................
..........................................................
........ ...... By --- - ----- C.
APPROVED Date -- ----
4 ::L
.....................................
......... ......................... ...............
rkS.
R4amarks: ........... .......... . ....
......................
.....................................
... . ..................
------------------------- . ...............................
.....................
............................................... . .... : ---------------------------------------------
Signed By Ow ing Construction PRIOR To Request k,or inSpeULiV1L
Copies MUST Be ner of Firm Perform
BOTH Permit
........... .... hereby certify that the side sewer installation construcAVlh is permit
I
.7;
'L;fnstailed
.............. ............
Performing construction)
wner of Contracting Firm ity of Edmonds.
with all governing ordinances of the C
w
in accordance
Dated this ------ ....... -.day ..................................................
Check BEFORE you dig for: Water n, Gas E], Telephone E], Power F], Sewer other 0 -4 -v
��. — � .. _ ,
7_*
APPUCATION
Tho City of Umonds for EASEMENT NO - ---------------------- --------------
SIDE SEWER PERMff
NEW CONSTRUCTION E] REPAIRS E] LID NO - ---------------- - -ASMT. No - ------------------
OWNER
......... ..... . ............................. CONTRACTOR
........ T NO. �V-lft al
v
-------- ................................ LEGAL DESCRIPTION: LOT NO. ---------------------------------- BLOCK NO - ------------------------------------
JOB ADDRESS 9-c -------------------
NAMF OF ADDTTInN
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