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JUN i v995
PERMIT COUNTER
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APPRO PLANNING
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City of Edmon'.ds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
PermitNmben
hsueDate:
A. Address or Vicinity of Constructibn: 603 3 AV N .(9605654)
B. Type of Work (be specific): Install Service
C. Contractor: Washington Natural Gas
Mailing Address: 1199 75 Rt SW Firprett
State License #:. 98203
D. Building Permit # (if applicable):
Contact: Mariamne Kingsbury
Phone:
�j-j6_7sn() x7�_596
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):..
E. Commercial E) Subdivision El City Project a Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family Single Family E] Other
INSPECTOR: INSPECTOR:
Size of x
F. Pavement.or Concrete Cut KlYes []No G. Size of t: H. Chargi�_$
APPLICANT TO REA SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees tc� _4t
ftQ City ofEdmonds harrWess&,i, ;n inxi-ies;da'ffinges, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of.,Edm6nds, or any of its d�partments or
employees, including or not limited to the defense ofany legalproceedings including fle costs, and attorney fees b�reaqon ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR 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 TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
Construction drawing of*proposed work required with'Termit application.
A 24 hour notice is required for inspection; Please call the EngineeringDivision, 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.
Ihave read the above statements'and understand thepermit requirements and thepink copy of thepermit will be
available O'n-,sit�. at all times for inspection pui�o es.
Date:
S*gnature: ')0 1-5-96
9 '_7(eon1t_ractOr �r )--�7
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: _xAJL'Af__*i RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER N kLC H 11 DAYS DISRUPTIONFEE/FUND III:
SPECIAL CONDITIONS: 4e�,*e_,ydAe L"-)I'k
J4 Z 6 9 7-'0-
COMMENTS:' C,4 _fA I-10A A,0 5,
DATE:
RESTORATION FEE:
PERMIT FEE: - 3 t�2 . t) 0
TOTAL FEE:
RECEIPT FEE:
ISSUED BY:
01
NO WORK SHALL BEGIN PRIOR TO PERMI.T.-IRSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
I Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund Ill - Route copy to Street Dept.)
C3 YES
Date:
Date:
TWOM M 466%n 1
Natu -1 Gals
AVValwx*)n EnergvCbrrvffv
I
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Migineering Aide
Washington Natural Gas
1356-7500 X7596
oo
A V
Key: -w- Water
Watei�main depth -G- Gas
-SS- Sever
&- � Water hydrant
-4- gas main .0. Water valve
Washington Natural Gas Company
1122 75th Street S.W.. Everett.' Washington 98203. (206) 355-3331
Drawing
The City of Edmonds \A] W-) Q C- e— EASEMENT NO . ............................................
NEW CONSTRUCTION F-1 REPAIRS F� LID NO . .................. ASMT. NO . ..................
OWNER---------------------------------------------------------------------- -------------- CONTRACTOR .................................................................................... PERMIT NO . ....................
4� f2-p i4Z'
JOBADDRESS --- — --- ................ . ............... ......................... LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
NAME OF ADDITION ..............................................
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PWW-0001-1 1175 (REV.1 1178) DATE (� . .................... ............. ............. 1�7 ....................................
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COUP A Pjlr
FILED FOR RECORD AT REQUESr OF
CHICAGO TITLE INSURANCE COMPANY IVA S ftET80VFtCq6R RECORDER'S USE
19725 40TH AVUNUZ WEST, SUITS A ) 414 mA q
LYNNWOOD, WASHINGTON 98036 868
Sjj0H6mjSjj i'Vis r Y,
WHEN RECORDED RUTURN To
ALICE M. DAY
--im- 111087 PIPELINE AVENUE
POWNAI CA. 91766
4Z 3.2).
- q,43 0
STATUTORY WARRANTY DEED
THE GRANTOR Chicago Title Im CO.
JAN HELLEREN, AN UNMARRIED MAN AS HIS SEPARATE ESTArz
REAL ESTATE EXCISIg TAX
for and in consideration of ISALE PRIC�E
TEN DOLLARS ($10-00) AND OTHER GOOD AND VALUABLE CONSIDERATION RECOPT NO.
in hand paid, conveys and waffants to
ALICE M. DAY , AN UNMARRIED WOMAN
MAY 16 1994
KINE 19148, bo Tj"&jj
the following described real estate situated in the Count'yof SNOHOMISH State of Washington:
ALL THAT PORTION OF GOVERNMENT LOT 2, SECTTON 24, TOWNSHIP 27 NORTH, RANGE 3 EAST,
W.M., RECORDS OF SNOHOMISH COUNTY, AS MORE FULLY DESCRIBED IN EXHIBIT "All ATTACHED
--MKZTO AND MADE A PART HEREOF.
SUBJECT Tot EXCEPTIONS SET FORTH ON ATTACHED EXHIBIT "B" AND BY THIS REFERENCE
MADE A PART HEREOF AS IF FULLY INCORPORATED HEREIN.
Dated: MAY 3, 1994
STATE OF WASHINGTON
COUNTY or SNOHOMISH
ON THIS DAY OF MAY , 1994 BEFORE ME, THE UNDERSIGNED, A NOTARY PUBLIC IN AND
FOR THE STATE Oi WASHINGTON, DULY COMMISSIONED AND SWORN, PERSONALLY APPEARED JAN
HELLEREN KNOWN TO ME TO BE THE INDIVIDUAL(S) DESCRIBED IN AND WHO EXECUTED THE WITHIN
INSTRUMENT AND ACKNOWLEDGED THAT HE SIGNED AND SEALED THE SAME AS HIS FREE AND VOLUNTARY
ACT A" DEED, FOR THE USES AND PURPOSES HEREIN MENTIONED.
PRINTED NAMEs DONYA NANETT&--02RUITER
NOTARY PUBLIC IN AND FOR THE STATE OF W4SHINOTON
RESIDING AT BELLEVUE.
My COMMISSION EXPIRES ON 10/15/97
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EXHIBIT "B" TO STATUTORY WARRANTY DEED
UNRECORDED EASEMENT TO CIT OF EDMONDS FOR A SEWER OVER THE SOUTH
'10SO
BOUNDARY OF PREMISES DISC SED BY DEEDS RECORDED UNDER AUDITOR'S FILE
NOS. 968017,"D 968018.
40 0
vu. 9,.912P&GE2441
WARRMTY DEED -VOL 459 m[,3'/8
WAnMWf FORM)
UNDMOUAU
ANDEMN and 0. D. ANDEMN, her husband - - - - - - - -- - -
The Grantor - ----------------------------
residingat ------- "-- ��t ------------------------------------------------------
for and in consideration of- __Mi DOLLARS ($10.00) and other good and valuable consideration,
------------
---------- :-: --------- In hand paid, convey ---- and
- - - - - - - - - - - - - - -
jUPSE and HARY LU HDRSE, his wife
warrantt -----------------------------------------
grantee-&-- the following described real estate
in the COUNTY UF SNOHO111SH, STATE OF WASHINGTON, to -wit,
All that portion of Government Lot 1, Section 23, Township 27 North, Range 3
..a:- L' W. 1j., arid of Government l4t 2, Section 2h, Township 27 North, Range 3 East, W. V
:.-F-critc-d RS follows-
p-3ginning 829.82 feet North of the Southwest corner of said Govmramnt Lot 2;
,hvnee Fast 26.7 feet to true point of beginning; thence anele, left 59022, for 56.7
fee! ; thence angle left 900 for 120 feet, more or less, to Intersection of East line of
.�'ront Strce.; thence North 30028'50' East along said FA3t line to intersection of
'8*!st line of said 6overnment Lot 2; thence North on said West line to the Easterly
linu (.f Great Northern Railway right of way; thence Northeasterly along said right. of
way line to a point 165 feet due South of North line of said Goverruzwnt Lot 2; thence
�art to Westerly line of Third Street; thence Southwesterly along said Westerly line
o' 3fd Street to a point due iAst of true point of beginning; thence West to true 7x)irt
L I' ie.:inning;
EXCEPT portion within Front Street (county road);
�n� for trunk .....
O'�i
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'L 6E ft� d proop-�t�y_�
.�E'J L a o sai
..g th.�S.Outht
This Deed is given pursuant to the terms of a Land Contract, dated
September 3, 19L8, and the warranties herein contained shall, since the date of said
"'ntract, apply only to acts of the Grantors and shall not be deeip-tu to inct.ude taxes,
cr assessments thereafter imposed on said promises or any which were issumed by the
purchasers.
Dated_ ------- � ------------- A- D., 19 - .50
ZZE--------------------
STATE OF WASHINOTON.
County of ---- 11. ��DIVEDUAL ACKNOWLEDGMENT)
S I
d
.9.-& ------------------ Notary Public In and for the State of Washington. residing
at ....... ---------------------------------- do hereby certify that on this --- ----------
day of ------ --------- m_ 19--5a. personalty appeared before me ----------------------------
____U& ..B.�'jKnrLR_c;QN Arid -0, _1L -AXDJRSQV,- Jher- -husbar4t. -T-.= - -_ - _.. - _r� _7_7 - n --
to me known to be the lndlvidu&l_s ---- described in and who executed the within Instrument and acknowledged that
.... .. tb4py --------- signed and sealed the s=a as ---- tkeir ---------- free and voluntary act and deed for the us"
and purposes herein mentioned.
o4rvzN UNDZA MY HAND. AMD PIPICZAL iffAL U-J3 ------------- --_------------------ day of
41 +e
.7 twerott
Notary Public In and for Uw'fta fjf-;WA�� roddi" AL — ------ — — 77-1 ---- — --- ------------ 1. as.1d Co=ty.
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PERMIT APPLICATION JA0000 R F S S 031
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L.1101161411 NUMB OMAN Dri "Way slopes not to exceed those
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ITO99T ^mD10R UTILITV WO RK
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ADD [:] 019TAINING 9QUIRCO OR u L;OAD
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91.161104
IMUNK or WORR To a
VALUATION FEE
PLAP6 CHECK
NO.
CK111.
PLOT F I JESTSTITIA :AW,
PLUM*!" a
BAT & GAS LIMA
Fumes
ON
OSTAl"ING WALL.
SWIMMING POOL
I ANN
M
I hereby ackncwlc that I have read th application: that the In- TOTAL AMOUNT DUE
formation given il Coffee,; and that I am thl 1. or the duly author,
ited agent of hic owner. I Arco to comply W1 city and state laws tOlu" ATTENTION APPLICATION APPROVAL
. no PM
trains ction; and in doing the work authorized thereby. no Pf"
lon"n", to ofw Vo THIS PgRMIT
wWbe employed in violation of the Labor Cod. of the State OfWUhLn8t0 Thin SPPIICIUOn Is not & Permit UnU'
fcleting to Workmen's Compensation Insurance. AUTHORIZES gilgaed by the Building OfficlAt Of W DOP-
nd FILL ONLV THE fees are paid. -d rocelpt is be -
NOTES FUN& Umit OW Ylllff(E�,apt DEMOLITIONS a long NOTED :uty; and
which %hall be completed in 90 knowledged in space provided.
PERMITS without conditional use Permit- A
b; D-IN BUILDINGS -h'II IKI completed in 81 - TonthL) INSPECTION
SIGH,kTURg (OWN R OR AGENT DEPARTMENT T pus TUN
CITY OF
EDMONDS
ct to plan Check Fee 775-2525 L
NOTE: Applicant SuNg
This Permit 00vm work to be done on privateroPwry ONLY. ORIGINAL - f;, YELI OW - 1
0
Any oonfftrvejl�n on the public dornain (curbs, 81 *walks, drivleel",
nuu,queft, etc.),wjil require sepmete PIWINI"lon, GOLD PINK -
7 r, - —7, 7
�cf
PLANNING DATA
SITE ADDRESS: IW2� 19*141� j DATE
ZONING: PLAN CHK#: qjg
.PROJECT DESCRIPTION:
SETBACKS:
Required Setbacks:
Front: Left Side: Right Side: Rear:
Actual Setbacks:
Front: Left Side:— Right Side: Rear:
CORNERLOT— jo
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED
LOT COVERAGE: /q/f (Mvc) +
Maximum Allowed:- 40 ctual: 7,3
BUILDING HEIGHT:
Maximum Allowed:— Actual Heigl
SUBDIVISION:
CRITICAL AREAS #: �6 —6 C)
SEPA DETERMINATION:
LOT AREA: —7 to & (f
OTHER: ID IVN 6b6m!E� A3
Plan Review By:
090-199-
City Of Edmonus'"
-ec
Critical Areas-Ch- klist�,
The Critical Areas Checklist,contained �.;..andstibmit it -to the City.:i.Jhe City win -
this form is to be filled, out by any. review the chepkiiist, make. a precursory site
preparing a Dev6iopmieint Permit Vmt 'a -di! , �Iiition of the'
Application for the City of Edmonds prioF s�6i6q�i�it"'steps"'pecessaryto complete a
to his/her submittal of a development dc" d a6fif_06imit application._--.
opm
permit to the City.
With a signed copy of this form,..the.
The purpose of the Checklist is to enable' applicant should also submit a vicinity ma
City staff to determine whether any 6r- -plot PT—�����
potential Criti6l Areas are or may be %�Fith*enough detail that City staff cini find
present on the subject property. The and identi the subject parcel(s). In
fy . - J
information needed to complete the addition, the applicant shall include
Checklist should be easily available from other pertinent information (e.g.- Site
observations of the site or data available at
I plan, topography map, etc.) or studies in
City Hall (Critical Areas inventories, maps, conjunction ' with this Cheddist to assist
or soil surveys). staff in completing thew preliminary
assessment of the site.
An applicant, or his/her iLepi sentative,
must fill out the checklist, sign and date it,
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:
A
Name
.613 Ave AZ
Street Addrew
4611 1,JS
City, State, ZIP Phone
Date
Applicant Representative: -
Name
Street Addrew
city, state, ZIP . Phone
Signature -
Date
CA FILE NO. q 'J —(00
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site AddressALocation: le;0_1 9,=J...,Aj6g /V _aAINO Alds,
2. Property Tax Account Number: Z- q7 -7 3 —,2 Oe6 2-
3. Approximate Site Size (acres or s uare feet):
4. Is this site currently developed? Tyes; no
If yes; how is site develokd
"V
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rollmg: slopes eWly less than 15% (a vertical rise of 10-feet over a
horizontal diitan66'6f 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% a vertical rise
of 10-fe6t'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 contAms areas of year-round'standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: A10 Approx. Depth:
Vhat season(s) of the year?
8. Site is in the floodway AILI floodplain of a water course.
9. Site contains a eek or an area where water flows across the grounds surface?. Flows are yea-r-
round? Flows are seasonal? IV() (What time. of year?
10. Site is primarily: forested meadow shrub
S niixed
urban landscaped Qawn,shrubs etc)
11. Obvious wetland is present on site:
S-/Vae
RevOl/04/94
CA FILE."NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)'
'd,
1. Site AddressALocation:
2. Property Tax Account Number:'' 4 17, 7:7 0 3 0 _36
3. Approximate Site Size (acres or s uare feet): Z.<"a
4. Is this site currently deve][oped? Tyes;, no
P
If 'yes; how is site develo�ed?;4
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet eliVation changd-o--v'er enti16 -site.
Rolling: glopesohift' ' eiiW th (i cal rise' of 10-&d div eir a
ege� i,* , (j. ly less an 15%:
horizontal distance bf 664M).
Hilly; :slopes. prp",qn, site of more than 15 % and,less than 30%,(.,4 vertical, rise
of 10-fe�io'v'er 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). x,,:
Other (please describe).
6. Site contains areas of year-round standing water: x %
_;�Appro'.. Depth:,
7. Site contains areas of seasonal standing water: Apprqxbepth:
What season(s) of the year?
8. Site is in the floodway A16L of a water course.
9. Site contains eek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? 10) (What time of year?
10. Site is primarily: forested -shrubs mixed
,meadow
,urban landscaped Qawn,shrubs etc)
11. Obvious wetland is present on site:
S- /44e-
Rcv0l/04N4
.9, 0 1 9
eity of Edm6n&'-'*"-'--
Critical Ar'eas'..'..Checklist'.J.,
The Critical Areas Checklist contained on and submit it to the City. ....The �qity will
this form is to be filled out by anyperson Teview the checklist make a precursory site
visit, make a etermination of the
preparing a 6�vi6 Permit d"
Application for the City of Edmonds prior subsequent steps necessary to complete a
to his/her submittal of a development developm6t:pien*nit application.
permit to the City.
With a signed copy of this form, the
The purpose of the Checklist is to enable applicant should also submit a vicimity map.
City staff to determine whether any or plot -pUWro-r-i-n-&-v—ldagl-oig-oT-ffieparceI
potential Critical Az6s'are or may be with enough detail that City staff can find
present on the subject property. The and identify the subject parcel(s). in
information needed to complete the addition, the 'applicant shall include
Checklist should be easily available from other pertinent information (e.g. site
observations of the site or data available at plan, topography map, etc.) or studies in
City Hall (Critical Areas inventories, maps, conjunctionwith this Checklist to mist
or soil surveys). staff in completing thew preliminary
a ssment of the site.
An applicant, or his/her
must fill out the checklist, sign and date it,
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 Applicapft- Applicant Representative:
N&= Name.
rd Ave
Street Address
4(M 42AAS VA M240
City, State, ZIP 2 2- Phone
3
Signature Date
Street Address
City, State, ZIP Phone
Signature
Date
Date
PEPJl1T ADDR.F.� 40%..)
LFCAL f )ESCP. n rr
BUILDING PERMIT PrViat EmniNEERING DEPARTMENT CHECK LIST
Instruction: L4
Check Accuracy of I.eqal nescription
Check Anainst Assessor's Man for Lonal Subdivision,
Does it conform to City Approved Subdivisinn?
Re v i evie r' s
Initials
S_t�j I . Th'is lot includedin 1�uhdivisio I n/Plat No.,:
h 2. Site InspectiQnmadn on--
3. 11hat are oround water and soil conditions?
A
4. Site nraina'qp rhecked?
S. Storm.Spwer Av'ailabilitv. Pro I e c t
Sht. 0�, Ow
I. Tfo
Roads i de Di tch— Xi�
6. Gradinq Tinal Contours,
7. Septic Tank System Posinn Approved: 'A
8. Sanitary S'n.wer �viilahilitv- sht.'N (A Project.
Side jof No.
� S ewe r. a va i I'l 1) i I i t.v:
9. Sanitary Sower Connec.ti,on Fees?
10. Vater llains A Fire HYdrants Ondicate Size I -lain)
Check Fire Dept.'s Comments
11. Sidgwalks: (Site inspection shows conditions of sidpwalls 'as follavis)
12. Curbs :__a%A 147 1 K) 0-1-11 Curb.'Cuts/Priveways (Check driveways for safety, lncation,
gradeand R-W—y-vich-1 M
und 11irinq:
13. Underqro treet Liqhts:
14. Street Riqlit-nf-wa.v P, R I dq. setbacksV-W s h t of n'fficial Street Map.
15. Existinn Utility Easements?
16. Access lasem ents:
17. Site Plan chec.ked for, accuracy?
18.. Special Requirprients I i.sted in tlemo to Bldg. Pept._.
19. Commercial & Apt. Rinuirements form completed?
20. Drawings stamped F, notations riade?
21. All -1.tems filled in on- Bldg- Per Jit ��lid=ation?
22. Bonds posted for RE v Ott,.
ZT,
23. Pi ght-of -%,,,iy I nvas i on. PprOt reciuir6d?
COMMENTS:
'*' 8 _*'� () C3
- 9 0 - 1 9
City of Ednionds
RIGHT -OF WAY CONSTRUCTION
PERMIT
Permit Number,
Wue Date:
A. Address or Vicinity of Construction: 603 3 Ave N ( 9420429
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Natural Gas Company
Mailing Address: 815 Mercer street, Seattle
State License #- WA 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance:
Bond: $
Side Sewer Permit # (if applicable):
E. E3 Commercial E3 Subdivision El City Project 0 Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family 0 Single Family E] Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: D Yes 91No G. Size of Cut: x H. Chargq_$
APPLICANT TO READ AND S16N-,"
INDEMNITY.- Applicant understands and by his signature to this application, agrees to holy,, &damag
git'�,?f Edmonds ha es, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made againA the City of Edmol, 4olty7i4i
oifitsfdepartments or
employees, including or not limited to the defense ofany legal proceedings including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATIONIFEE SHILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROC)_�'§§.PD FOR ISSUANCi TOJTffEA'P
qLICANT.
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 isito be inspected during progress and at completion.
Restoration is to be i" accordance with -City Codes.
n
Street shall be kept clean at all, times.
neer.
Traffic Control and Public Safety shall be in accorahnce with Cit�'f-ro6lations as required by th6&3&n"i'
All street cui ditches shall be patched with asphalt or City approved material prior to thhnd of the working day;
NO EXCEPTIONS.
Ihave read.the abovestatements and understand thepermit requirements and thepink copyof thepermit will be
available on site at qlki7Tes for inspection purposes.
June 15 1994
Signature. Date:
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: .1 Ail td
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS: Alk
COMMENTS:
DATE.
RIGHT OF WAY DEPOSIT
iO
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Di�. 1991
.7"
FIELD INSPECTION NOTES
Comments:
Diagram,:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
I
Eva "AGE %Fwa
A rQ0!&WWC*nWV
Addendum to Citty or Edmonds
Right of Way
Permit Applicaiion
_Pubmitted by: MITCHELL S.-LANKFORD
Engineering Aide
Washington Natural Gas
# .'-521-'5246
t
Q/A U-NG to window
YA46x�-kain depth
own
gas inain
Key:
-w-
water
-9-
gas
-ss-
sewer
-a-
watex hydrant
0 -
Watc.-.-' Valve
BIS ',Ic:rcc:r St. (I -'). )::,, 18'19), Sc&td-, WA 5 q) I I %'2D6) 627. '767
Naftjr5l CIWN�
Addendum to City of FAmonds
U Right of Waltr
Permit Appitcaiion
X�TCHELL S--LANKFORD
-Pubmitted by.*
Engineering Aide
Washington Natural 'Gas
V -521-*5246
k-t C:�>
t
Q/A I?N*G to window
YAtAw—z,ain depth
nown
gas main
Key: -w- water
-g- gas
-ss- sewer
-e- watex hydrant
C) v a Ive
815 *,ic:rccr St. (1 38'19), SCUO,�, WA S U11 %1206) 627-7767
Avww. &WWCOTWV
Addendum to City of Edmonds
Right of Watr
PerrAit. Appilcaf-ion
_;UbMitted by: jt�TCHELL S.-LANKFOPLD
Engineering Aide
Washington Natural Gas
# .'-521-'5246 A
c
t
Q/A I IN*G to window
YAt.&�ain depth
k�nown
gas nain
Key:
-w-
water
-g-
gas
-ss-
sewer
-&-
watex hydrant
0
. watc.!-.- valve
B'S ""Crcct Sl- 0 18)9), SC&W':,WA S U J 1 (206) 627.-.767
Av4w. &WWOMWY
Addendum to City,of Edmonds
Right of W
Permit Apploycafion
-PUbMitted by.- jt�TCHELL S.-LANKFORD
Engineering Aide
Washington Natural Gas
V -521-'5246
t ---I V
Q/A 17N'G to window
YAtAr--vain depth
Cr
gas main
Key:
-w-
water
-g-
gas
-ss-
sewer
-&-
watex hydrant
0 .
watc. -.. v a Ive
815 "Ac:rcct Sl- 0 1869). Sc*td-!,WA S 4111 (206) 627..-767
APPLICATION
for
The City of Edmonds SEDE SEWER PERMIT EASEMENT No . ..........................................
NEW CONSTRUCTION 0 REPAIRS
113-05600
OWNER ........... Pj�K!y A. Vasser Sr. ... CONTRACTOR -------------------------------------------------------------------------------------------------- PERMIT No . ......................
.....................................................................................
ADDRESS ........ 6.Q.3 ... 3,r-d ... ........
1,
ft
L-7
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAME OF ADDITION
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................
'W90 - 19.4-,
City 0
Critical Atea's`:�:,
MW Oitical Areas awMist vn ii6d'iAmd it io the City. Mk Oty vM
this form is to �Cfilled out by anyperson
preparing aDevelopmeatrierr&
"-AWsAd iWi i determination of the
Application for ft CWof Edmonds ]prior
1,s*wqucnt steps neoessay to 'complete a
to his/her.submiM of a develTment
is permit volicafion.
pwnit to the My.
Ns' a i4awd c Opy of d& form,
nepM:p=of&eChedftistoeiiW...,
MOStant&MMahowbaftavicinitymp
potential Critical Axcas = or my be
=q& detail. 69 City staffcan find
presentontitestMeaproperty. 7hel'
needed to cwVIft ft
the appficant dwU Indude
ChwIdist shoidd be easily'available fj;m
O&W Petguent Edbrunflon. (eg. sfte
obsuvations of die she or data availabk at
plang n i
&P-410'am Mqh etc.) or Audies in
City EUM (Critical Arm kweataries6 maps,
00-flon vd& this Checldffd to asda
or wn MVCP)-
Mai In complefing their p,,G.&,.,,y
assessment of the site.
An applicant, or Ifisfber
must fill out the checklist, sip end date it,
I
in tits crem
wuuuua
au;m UIL
Ycw-muuu Smuamg W&W.
/t�/
contains
arimas
of
seasond standing water.
at season(s)
of the
yeat? ,
is in
the floodway
AJO BoodpW.
contains
a
creek or
= an whem wom fkms
mwiim t
w
AJ
0
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i
EN
I
42,
Rrn 3/5. -D Na
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323
114
101
Its
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$33
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701 a 700
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910 0 Big 817
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816 817
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829 929
OTC 8"4 o 1 119 el 017
61 '91S
040 641 17"!
931 846 845 r Z� 'A 840 941
944 $41 Big 64 0, Y/ Sal
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Cityo.f-Edmonds-.
RIGHT-OF-WAY CONSTRUCTION
n--- W—%.- f 7
Issue Date:
.1
A. Address or Vicinity of Construction: (.4'()
9 0 19 B. Type of Work (be specific): Y'kench -7 10,na�- a � -ea talt ',I ec)
r4'L 71,v,,4 cA- A10, 141 016 "0rq-;W-- 1�1 1"4 -e-
C. Contractor: C611t-14-A J)Q, 10 Contact: 1)�a el:D?-
Mailing Address: &?/0/)R Phone: 4420— 3-21Y
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. 92-&mmercial El Subdivision El City Project Lk-ldt'ility (PUD, GTE, WNG, CABLE, WATER)
Multi-Farnily E] Single Family Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: gol'es ONo G. Size of Cut: x-
H. Chargq�-$
APPLICANT TO READ AND;6�N
INDEMNIT Y. Applicant understands and by his signature to this application, agrees to hold the City ofEdmondsftarmless 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 to the defense of any legalproceeding8 including defense Costs, and attorney fees by reason ofgranting thispermit.
t� I- I I., .. I') IC,
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A ?ERIOD OF ONE YEAR 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 TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
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.
e City'-Ertgineer.
Traffic Control and Public Safety shall be in accordance with-Cityrejulations as reqzed by-t�
All street cut ditches shall be patched with asphalt or City approved ffiatZridl prioRRI�-6bhlh 6f the-woildhg day;
NO EXCEPTIONS.
Iha ve read the above statements and understand the permit requirements and t pin 665-pi'y�o-fthepermit-will
available on site at all times for pection purposes.
Signature- Date: 'V/ t-,-7
(Co;�—tractor or Agent) I
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME AUTHORIZED: VOID,.AFTER flo. ,DAYS
SPECIAL CONDITIONS:
COMMENTS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEEAFUND 111:
RESTORATION FEE:
PERMIT FE]Ji
TOTAL FEi:�-3
RECEIPT FEE:
71
TE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION'
(Fund 111 - Route copy to Street Dept.)
El YES [I NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
k
60/e, -,'7 C I t-2; A 5-'
Ul
W CS)
CO
I
f2l 7S
Jo"i...
CITY OF EDMONDS
USE
ZONE PERMIT -MO
(, NUMBER
A -
CONSTRUCTION PERMIT APPLICATION
os SUITE�APT a
AUUHtbb
e)
OWNER NAME NAME OF BUSINESS
J_
LEGAL DESCRIPTION CHECK
DIVISION No.
LID NO
uj
Z
I
Z,;Ir or tpv y P,
a
MAILING ADDRESS
0
it 1:rc. Y-li V C�w d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved 0
RW Permit Required 0
CITY ZIP
TELEPHONE NUMBER
t.
EXISTING — REOUIREO DEDICATION
Street Use Permit Req'd 0
C3
C AJ
—
PROPOSED
Inspection Required
Sidewalk Required 0
NAME
U,
ME E
SIZE
NO. OF FIXTURES
PRV REQUIRED
uj
INE
NO
ADDRESS
REMARRS
U
cc
W
W
CITY ZIP___7PHONE
NUMBER.
0
Z
NAME
ADDRESS
M
ENGINEERING MEMO DATED REVIEWED BY
0-
0
4
M
CITY ZIP
TELEPHONE NUMBER
FIRE MEMO DATED REVIEWED BY
W
Z
0
U
STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA
SEPA REVIEW
ADS NO.
ALLOWED PROPOSED
COMPLETE
v14.
Legal Description of Property - include all easements
Z
6) Vr
1EXEMPT
SH04t.LIRE N
AW
Al,, Aj (5 5,1V a IJ 0,41 J 5 #
VARIANCE OR cu
//11
P1jAt4NINrPV,1EW BY
D�TE
/I.W A Y I, Al, E 0' A4 6 IV
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SETBACkS FEET
e-,
HE IGHTILOT
'!5
OVER
Vn
Z
Z
FTRONT SIDE REARIC5
2_ 1:Z3!5
4
Property
REMARKS
a,
Tax Account
04 Z 7- 037 - 0 316, - 0 40
No.
_L.,cel
r%7
NEW RESIDENTIAL PLUMBING
ADDITION COMMERCIAL MECHANICAL
APT. BLDG.
REMODEL SIGN
C ECKED BY
TYPE OF CONSTRUCTION
CODE
OCCUPANT
GROU9
GRADING FENCE
REPAIR CYDS. L__ x _FT)
13/
WOODSTOVE SWIM POOL
DEMOLISH INSERT HOT TUB/SPA
SPECIAL INSPECTOR
AREA
OCCUPANT
REOUIRED 13 YES
LOAD
GARAGE RETAINING WALL/
El RENEWAL
REMARKS
@ARAN"" ROCKERY
Z
0
PROGRESS INSPECTIONS PER UBC 305
0
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
rX
0
CRITICAL
W
0
NUMBER
NUMBER OF
0
OF 7
STORIES
DWELLING
UNITS Jowe
AREAS
INUMBERA?5
03
0
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
SPECTION REOUIRED
ny 0 .5 -r / "V
FEE
VALUATION
FEE
-`7%:5D 2.
A C
0,
HEArURCE:
GLAZING
%
a
,7AS
PLUMBING
Plan Check No....
MECHANICAL
GRADING/FILL
Ar" jr
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (cu.rbs, sidewpiks,
driveways, marquees, etc.) will require sepafate permission.
STATESURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days .
STORM DRAINAGE FEE
ENG. INSPECTION FEE
"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,
0jCL10_ 4:;17f
22
employees, and agents from any and all claims for damages of
5
whatever nature, arising directly or indirectly from the issuance
X
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
a
modify, waive or reduce any requirement of any city ordinance
0
X
nor limit in any way the City's abi lity to enforce any ordinance
TOTAL AMOUNT DUE
P-1
777L7
provision." .
I hereby acknowl;dge 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
THE signed by the Building Official or his/her
ed thereby, no person will be employed In violation of the Labor ONLY
WORK NOTED Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa.
acknowledged in space provided.
tion Insurance and FICW 18.27. INSPECTION
SIGNATURE (OWNER O!� AGENT) DATE AIGNED DEPARTMENT
0 F A IGNATURE DATE
CITY OF
EDMONDS ll� I
AED
#RE
A TE
L S
CALL FOR
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 0 ORIGINAL — File YELLOW — Inspector
77 2 IJ
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. 5_ PINK — Owner GOLD — Assessor
CITY OF EDMONDS
USE PERMIT
ZONE
NUMBER
CONSTRUCTION PERMIT `APPLICATION
JOB ITE!APT
ADDRESS -7
O77RAME NAME OF BUSINESS_
Mi!a,
LEGAL DESCRIPTION
`7'b-
NO
LID NO
Gi
Z
3:
MAILI
;��ArRESS
0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved 0
RW Permit Required 1)
CITY zip
TF-LtF�VNE NUMBER
6 7-,
EXISTING — REOUIRED DEDICATION
Street Us. Permit Req'd 13
E3
PROPOSED
Inspection Required
Sidewalk Required 0
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED.
UW
YES 0 NO 0
L5
ADDRESS
X
REMARKS
cc
uj
Z
CITY ZIP
PHONE NUMBER
Z
W
NAME
ADDRESS
cc
assallal
ENGINEERING MEMO DATED REVIEWED BY
2
L)
<
a:
CITY zip
TELEPHONE NUMBER
FIRE MEMO DATED REVIEWED BY
ui
I'-
Z
0
%
U-
STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA
SEPA REVIEW
I
ADS NO.
ALLOWED PROPOSED
COMPLETE EXEMPT
Legal Description of Property - include all easements
&
SHORELINE 0
EXP
LL
a:
A
VARIANCE OR CU
PLANNING REVIEW BY
DATE
0
Cn
--.5 -
Uj
I
SETBACKS — FEET
HT IL
-
6T COVERAGE
Z
'"j
Properly
FRONT SIDE REAR
Z
REMARKS
Tax Account
4 2 7 2-
Parcel No.
NEW RESIDENTIAL PLUMBING
f7ADDITION
COMMERCIAL MECHANICAL
EIREMODEL APT. BLDG. SIGN
CHECKED BY
TYPE OF CONSTRUCTION
CODE
OCCUPANT
GRO P
GRADING . FENCE
EIREPAIR
CYDS- x _FT)
DEMOLISH WOODSTOVE SWIM POOL
INSERT HOT TUB/SPA
SPECIAL INSPECTOR
REQUIRED
OCCUPANT
LOAD
0 YES
GARAGE RETAINING WALL/
CARPORT ROCKERY REN.EWAL
REMARKS
PROGRESS INSPECTIONS PER UBC 305
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
0
NUMBER OF CRITICAL
OF DWELLING AREAS /7
DSNUMBER
uj
0
STORIES UNITS NUMBER
-
DESCRIBE.WQRK=,D.E,Pppg���Trqt!.f,�
FINAL INSPECTION REOUIRED
4A 9A/y
1W,9 1;V.5A044-.
VALUATION
FEE
PLAN CHECK FEE
g/virr. veyrcp Z6A A towis
-5
BUILDING
HEAT SOURCE:
GLAZING %
PLUMBING
Plan Check No.
MECHANICAL
GRADING/FILL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curts, sidewplks.
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
.
Permit Limit: 1 Year - Provided Work Is Started Within i80 Days
STORM DRAINAGE FEE
ENG. INSPECTION FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors In Interest, agrees to Indemnify, defend and hold
12
harmless the City of Edmonds, Washington, its officials,
x
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
PLAN CHECK DEPOSIT
N CH
'x
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
T
I provision."
I hereby acknowledge that I have read this, application; that the ATTENTION APPLI . CATION APPROVAL
Information given Is correct; and that I am the owner, or th.9 duly
authorized agent of the owner. I agree to 'comply with city and THIS PERMIT This application is not a permit until
L
state laws regulating construction; and In doing the work authoriz- AUTHORIZES
signed by the Building Official or his/her
C
ed thereby, no person will be employed In violation of the Labor ONLY THE
WORK NOTED Deputy: and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa-
acknowledged in space provided.
tion Insurance and RCW 18.27. INSPECTION
"GNA'N:,RE jOWNER OR -AGENT) DATE 51ONED DEPARTMENT
A RE DAIE
. MFSI
4� — yr— CITY OF
CAL EDMONDS
L By ATE
CALL FOR LEA0SErDY:
V-
ATTENTION INSPECTION 71644
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
INSPECTION HAS BEEN MADE AND APPROVAL OR 771 M 0220 ORIGINAL — File YELLOW — inspector
UNTIL A FINAL
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
CHAPTER 3. PINK — Owner GOLD — Assessor