627 MAIN ST.PDF11974
627 MAIN ST
C . 199
RECEIVED
O'CT 0 5 2000
PERMIT NO: 92V
City Of Edmon&ORKS DEPI
SIDE SEWER PERMIT PEIMIT EXPIRES
% oIA
Address of Construction
Property Tax Account Parcel No. 11�_Ilevd e S
Attach copies of all access apn utility easemi
Owner an&6r Contractor:
Verified and Approved by
Contractor License .,6. C, Building Permit #:
E] Single Family
5211(iulti-Family (No. of Units
F-1 Commercial (No. of Units
P
Invasion into City *Right -of Way: 5Kes No
*RW Construction Permit
Cross other "Private Property: Rves No
"Attach legal description and copy of recorded easement.
Owner/Contractor
Owner or contractor signature and acknowledgement statement: Date/
By signing for this permit I certify that I have read the City's public handout entitled
Side Sewer Specifications, and shall comply with all City requirements. outlined therein. mum"
M
TKATMENT PL414T
E#a
W CALUPIAL-A-DIG (1-800-425-5555) BEFORE ANY EXCAV rT
R FOR INSPECTION CALL 425-771-OMO extension-M9 W
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO Date: Initial:
Partial Inspection: 110,4 r7�,4 � 1,leedj f,_AV -uu-1 k-IJ —Date: A� -6?71�0 Initial: C,
Partial Inspection
itial:
FINAL INSPECTION APPROVED: Date: 1� lnitial,`�,� 9- As-builtto Street File:
1,� PERMIT MUST BE POSTED ON JOB SITE t�
White Copy: File Green Copy: Inspector Buff Copy: Applicant
L;temp;bldg,forms;sspennitjlg4/00
Side Sewer Drawing EASEMENT NO - ------------------- -------- - - -- --------
The city of Edmonds --xv, comqTRUCTION W RLPAIRS LID NO-71 ---------- ASMT. NO
OWNER ... -...
...... ---- -- ---- --- ----------------
Okie.) Isf ...... - ..... . . -------- ........
JOB ADDRESS ......... ................ ...... ..... ....
PERMrr No.
OR.....
----------
CONTRACT
LEGAL DESCRIPTION, LOT NO - ----- - ------ .......... BLOCK NO - ---------- ------- - -----------
--- I .................................... ------------------- ----- "I .......................... I ........ ....... ............. I ------------- ............
NAME OF ADDITION — ----------------------------------------
C-A W-AGE
I I -s / -r. co
Approved: f,
------------- By .....
DATE ......
pWW,0001.11175 (REV-11178)
The City of Edmonds Water Service Drawing EASEMENT NO . ............................................
NEW CONSTRUCTION REPAIRS 0 LID NO . .................. . ASMT. NO . ..................
OWNER ................................................................ ............................... CONTRACTOR ....... hA
...... . ................................................ PERMIT NO. 7-0 715-1
JOB ADDRESS ..... ?.Q ..... MPS��N .... �57� ...............
..... . ................ LEGAL DESCRIPTION: LOT.NO . ...................................... BLOCK NO . ....................................
NAMEOF ADDITION ..: .................................................................................
0
7�j 10
Approved:
PWW-0001-11175 (REV. 11/78) DATE ... I . ....................... B y ..........................
RETURN ADDRESS:
City of Edmonds, City Clerk
121 5th Avenue North
Edmonds, WA 98020
COW�ORMED COPY
2000,0020240
JOIO2/2OOO 11:41 All sn0homlsh
county
p . 0002 RECORDED .
Oz"�T R E E T F I L E
.. DECLARATION OF RESTRICTIVE COVENANT
MULTI -FAMILY RESIDENTIAL
Reference #:
Grantor(s): (1j'
e, 7' (2) Additional on pg.-
Grantee(s): City of Edmonds
Legal Description (abbreviated): Sec Rn2'5 Qtr—N5-41—/
OR Lot
.LBlock.__ lat&*Af1VAW_r
Assessor's Tax Parcel ID#(s): (1 V-44 (2)
Assessor's Tax Parcel 1D# not yet assigned
WBEREAS,
are the owners of the following described real estate in the City of Edmonds, to wit:
��i m
Property Address:
Assessor's Tax Parcel ID # (s): / Ad
AUTHORIZED FOR RECORDING
City of Edmonds
By: Date_
Page of
WHEREAS, the above named owners are desirous of imposing a restrictive
covenant upon said premises in compliance with Section 19.00.040 of the Edmonds
Community Development Code. WITNESSETH, that for and in
consideration of the premises, the above named owners, do hereby declare and grant to
the City of Edmonds. as Grantee the following restrictive covenant, to -wit:
That at the time of the execution of this Covenant the Grantors have agreed to the
Ordinance of the City of Edmonds provide that no building for multiple family housing
may be erected on subject property containing more than -units.
Said Covenant shall be binding upon all present and future owners of said real estate and
their heirs, successors and assigns.
DATED this day of
L
GRANTOR
GRANTOR
State of Washington
)ss
County of JU 441415 L) I
I certify that I know or have satisfactory evidence that 0_,M"Z8J Avillim
signed this instrument, on oath stated that e she was authorized to execute the
Wstr meRt and acknpwledged it as the 19 U) HlitO (title) of
PAI I (�"fty_wdtohame of party on behalf on whom instrument was executed) to be
the free and voluntary act of such party for the uses jV purp . oses mentions in this
instrument. Subscribed and sworn to before me this' day of - U —
J
Notary Public in and for the State of Washington.
My commission expires 041aglo 3
19
F 6NSTAN�CE M. CURTIS
Y L AUTHORIZED FOR RECORDING
NOTARY PUBLIC City of Edmonds
) . T W 0 NJ
STATE 10F WASHINGTON By: Dab�_
ComMISSION EXPIRES
APRIL 9 2003 Pag6 of
LATEMP\BUELD1NG\F0RMS\RESTR1CT
PLANNING DATA
NAME: FMA Ce71,,:=AY14&h07-7
SITE ADDRESS: DATE:
ZONING:— PLAN CHK#:
PROJECT DESCR
CORNER LOT_ —IV
Q—(Yes/No) FLAG LOT AO (Yes/No)
SETBACKS:
Required Setbacks;
Front: 15; 'Left Side: Right Side: 10 Rear: t t-��
Actual Setbacks:
Front: F5--LeftSide: 10 RightSide: 10/ Rear:
Street map checked for additional setback required? (Yes/No)
Chon n e4As_
e^e-vX,c,A -"
4p-�4 re-^.*-,
,;-e
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE:
Maximum Allowed
BUILDING HEIGHT:
Maximum Allowed: VP`A�cual Height:
Datum Point: Daturn Elevation:
A.D.U. CREATED?:
SUBDIVISION:
CRITICALAREAS#: t6Za1Ve-y-"--
SEPA DETERMINATION:
LOT AREA:
OTHER: k1 f,-),�wktn
Plan Review By:
17L)-
cAri1es\peffnit%^p1andRLdoc
,PZ Z�l 7-- PZ /9 /V
A,- x,
A) - V:2 cl T
f7 z
L_7'r7-V
12 D
0 L k4 444
z -- AJ
N�.' !, c,
ki
;k
Pq
4- -
7-
7-A
ZI
-X7
J
1%
�Yll
A�l zw
dr,
77/
lio
—
)-WAAI� -
—
4T11;P1,-12 Z)
z)
A41v 1,5
10,4 Z,
19/� &1,4
/7'
A-3
15��
RECEIVED
APPROVEDP SY PL.7N OOG
A-V-3 Z 4 12"Ja
DEVELOPMENT SERVICES CTR. IJW;�ET FILE
CITY OF EDMONDS
wro,F-
L E/
11C
7— 6-��
le6� /3
Ap
es7lr—w-
RETURN ADDRESS:
City of Edmonds, City Clerk
121 5th Avenue North
Edmonds, WA 98020
COMFORMED COPY
200010020240
I j j -. 41 g4 SnohOmish
10102/20000RDED CountY
p . OoO2 BEG
DECLARATION OF RESTRICTIVE COVENANT
MULTI -FAMILY RESIDENTIAL
Reference #:
Grantor(s): (1)"
.,A e!�& (2) Additional on pg.—
Grantee(s): Cily of Edmonds
Legal Description (abbreviated): Sec—A.:�_/—Twn-_A�93 —46- Qtr .15 14�1
OR Lot &3
Assessor's Tax Parcel ID#(s): _(2)
Assessor's Tax Parcel 1D# not yet assigned
WHEREAS, P.N. Z4. 4!!4n0_r-
are the owners of the following described real estate in the City of Edmonds, to wit:
Property Address: :z
Assessor's Tax Parcel ID # (s): ef-r-l'oe'll 410
AUTHORIZED FOR RECORDING
City of Edmonds
By: Date_
Page of
WMREAS, the above named owners are desirous of imposing a restrictive
covenant upon said premises in compliance with Section 19.00.040 of the Edmonds
Community Development Code. WITNESSETH, that for and in
consideration of the premises, the above named owners, do hereby declare and grant to
the City of Edmonds. as Grantee the following restrictive covenant, to -wit:
That at the time of the execution of this Covenant the Grantors have agreed to the
Ordinance of the City of Edmonds provide that no building for multiple family housing
may be erected on subject property containing more than —units.
Said Covenant shall be binding upon all present and future owners of said real estate and
their heirs, successors and assigns.
DATED this day of 2.4—e 0 _f!
V
k — ;
GRANTOR
GRANTOR
State of Washington
)ss
County of JV IWNI 5 L) 0
1 certify that I know or have satisfactory evidence that Avmyn
signed this instrument, on oath stated that e she was authorized to execute the
megt and.ackngwledged it as the (I UJ H, tile (title) of
(_�S#Qlny�koiame of party on behalf on whom instrument was executed) to be
the free and voluntary act of such party for the uses and purp . oses rn nti this
instrument. Subscribed and sworn to before me this' day of
od 0 .
�A*da&,et :222
Notary Public in and for the State of Washington.
My commission expires -A 4, le). q10 3
: CONSTAWCE M. CLIFITIS AUTHORIZED FOR RECORDING
NOTA'RY PUBLIC City of Edmonds
N
S
ST T 0 W 0 RTJ
)N
STATE OF WASHINGTON By: Date
R
COMMISSION EXPRES
A p IL 9 2W3 Page of
PRIL 9 2W3
L:\TEMP\BUEL,DING\FORMS\RESTRICT
A),4 T/
A.) - Y;2 T
RIF
A T-S
o L A4 i
7— e!!�
�j
r7 -
r --,5; 7.7_-,vz
IV
I'—,--- �vlqd.
L L
I F&M
wl'a
��k. qo' to C-0
U5
.r 7.ry 4_-
it) PRE C E E V L� D
5 a,-- 7--
JUL 2 5
7 .0
DEVELOPMENT SEFiVICES CTR.
FILE CITY -OF EDMONDS
. 4
STANDARD DRAINAGE DETENTION SYSTEM
WORKSHEET
OWNM By
CALC
ADDRESS T PHONE:
DATE:
*****DESIGN DATA*****
IMPERVIOUS AREA PIPE DIA PIPE LG ORIFICE
slz 2--7
�57i�v
-5— C
DE*TENTION PIPE LENGTH LOCKING LID
ICAL)
FINISHED G
M NIMUM
6j MIN &�PREANCfop Or
TIGHTLI E M ASUR )M
.5% TO 1% SLOPE CONC BOX OR RISER
11 OUTL.ET
f::z--- — !.,-
OUTLET CONTROL
—42 MIN.
UPPER CATCH BASIN ORIFICE
RECEIVED CONTROL CATCH BASIN
AUS 2 It Kuor'-)
SYSTEM CROSS SECTION
DEVELOPMENT SERVICES CTR,
CITY OF EDMONDS
2'XZ'X6, DEEP, 4-6' SPALLS OR EGUAL
FROM CONTROL CB 2'X 2'X 3' DEEP,'� 3/4' CRUSHED ROCK EXIST] G GRA E
EXI ST' G GRAIE
51
FROM CONTROL OUTLE*T' W HED ROCK
T
7
UTFLOW TRCNCK MIN 10' LdNG.
F PIPE TO BE LEVEL
11.5. RF
VURR
�5'
P RF PIPE W/ END CAPS
'NTRENCH SHALL BE LINED WITH MIRAF
PRIOR TO PLACEMEN OF WASHED, DRAIN ROCK
,RIPJUP OUTLET
RUNOFF SPREADER -TRENCH
FOOTING DRAINS. SHALL NOT BE CONNECTED YO DETENTION SYSTEM
NOTES:
0 eLT INA
1. Call Engineering Division (771-0220) for a tightline and detention system inspection
APPROVED BY
before backfilling and for final inspections.
2, Responsibility for operation and maintenance of drainage systems on private property is the
responsibility of the property owner. Material accumulated in the storage pipe must be flushed
DATE
out and removed from the catch basins to allow proper operation. Ile outlet control orifice
must be kept open at all times.
a
Table 1 - Detention Pipe Sizes
Impermeable
Required
Area Sq. Ft.
Vol Cu Ft
2000
50
2500
62
3000
75
3500
87
4000
100
4500
112
5000
125
Note: Allowable Pipe Materials:
impermeable
Area Sq. Ft.
2000
2500
3000
3500
4000
4500
5000
Pipe Diameter
15" 18" 240
30"
40 28 16
10
50 35 20
13
60 42- 24
15 Required pipe
70 49- 28.,
18 length in feet
80 56 32
21
90 63 36
.23
100 70 40
25
Reinforced Concrete
Aluminized Steel
Aluminum
CMP Asphalt Coated
N - 12 ADS (Not permitted on roads)
Table 2 - Outlet Orifice Sizes
Outlet Orifice Diameter (Inches)
5/8
5/8
3/4
3/4
7/8
7/8
7/8
Table 3 - Rectangular Catch Basin Requirements
Detention
Max. size
Catch Basin
pipe diameter
knockout—
— Type
< 18n
200
Type 1, CB 15,
18" to 2411
26"
Type IL,,CB 16
24" to 36"
36"
Type ll,'CB 19 .19 (480 Basin)
36" to 42"
42"
Typell,CB19 19(54"Basin)
*Source: Assoc.
Sand & Gravel Co. Standards
6-q
Revised 3/16/95
CA FILE NO. O000 - )o 91,
Critical Areas Checklist
------- ------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: f Wei, 4
2. Property Tax Account Number: do 7� e4
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed?
—L---yes; no.
If yes; how is site developed? Z zaar
5. Describe the general site topography. Check all that apply. R E �� —E I V E D
Flat: less than 5-feet elevation change over entire site. JUL 2 "j, 2000
t�-�R'olling: slopes on site generally less than 15% (a vertical rise of I 0-feet ovev[A'ELOPMENT SERVICES CTR.
horizontal distance of 66-feet). CITY OF EDMONDS
Hilly: slopes present on site of more than 15%-and less than 30% ( a vert . ical rise of
I 0-feet over a horizontal distance of 3 3 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: 116) Approx. Depth:
7. Site contains areas of seasonal standing water: IJ45� Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplai of a water course.
9. Site contains a reek or an area where water flows a!fr?ss the grounds surface? Flows a,
round? Z/o Flows are seasonal? Zy,10 _7
(What time of year? x/
10. Site. is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shr6s; etc)
11. Obvious wetland is present on site:
DEMMINATION
Ac�_dkdK PW 1QWM
-V. I B�
City of. Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Critical Areas File#: 2-0,o.c— c)(,
Date Mailed to
CRITICAL AREAS CHECKLIST
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.
Please submit a vicinity map, along with the signed
copy of, this form to assist City staff in finding and
locating the specific, piece of property described on
this form. 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 Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
PLEASE PRINT CLEARLY
DZ3 IY- 0011M (!�d.AJ
Owner/Applicant:
Z- 412AITAI
Name
?/� IDOI�TF7-*�Oec)ID Z',V
Street Address
city Staie' Zip
T !ne
24
Signature
I � �
Date
Applicant Representative:
Name
Street Address
city State Zip
Telephone
Signature
Date
d:reception4ana/CACLHandoLit.doe RevieW 411 Or,=
CA FILE No. O000 - )o 910
Critical Areas Checklist
---------------- ------------------------------------------- - -
Site Information (soilshopograp* hy/hydrology/vegetation)
I Site Address/Location: eg A�- —2 -
2. Property Tax Account Number: 41�1— �105� 6�1*k—jo,-;�
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.
Flat: less than 5-feet elevation change over entire site.
��011ing: 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 30% 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: Ile) Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway _ Z�-) , fl'oodplai of a water course.
9. Site contains a reek or an area where water flows aTr?ss the grounds surface? Flows are ye
round? Z�o Flows are seasonal? IMC) (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs etc) . IK
11. Obvious wetland is present on site:
09ARMINATION."
-u_cWdw,- Pxv 1WWM
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Critical Areas File#: 2-0-oc— 0)(,
Mailed to
CRITICAL AREAS CHECKLIST
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.
Please submit a vicinity map, along with the signed
copy of this form to. assist City staff in finding and
locating the specific piece of property described on
this form. 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 Areas Checklist and attest that the answers provided are factual, to . the
best of MY knowledge (fill out the appropriate column below).
I PLEASE PRINT CLEARLY I
Owner/Applicant: ORAIA
-A
A/
Name
Z2
)1e, 7, V
Street Address
City Staie' Zip
,4,v
I
Te;7n /L
Signature
Date
d:receptiorilanatCACLHandoLd.doo
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date
RevWed 4/iorm
APPLICATION
for
The City of Edmonds SEDE SEWER PERYaT
NEW CONSTRUCTION E] REPAIRS 0 EASEMENT No . ..........................................
102-04100
OWNER...... Kon,-Alerlyn ......................................... ................................. CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ..62-7 ... Main ... St . ............................. .......................................... LEGAL DESCRIPTION: LOT No . .............................................. BIAD�CK No . ............................................
.0
NAME OF ADDITION
Dye Tested On Sevier
I-aly, 1972
u
Approved:
DATE................................................ By ................................... ..................................
C>19 J4
ju,
0
III-011'r )(6(w .5;32,wpv
-4
rn
jar;�O'l W.. J/ _..,
-.A
Cl)
201 0,
cp C3
A C*'2
waft:l "0
Ell
Arl-
0 .664
Cil
tem-s'lllaor
--i) v4'i
wce.Y. Z/ zVdId'v
7 Z:Iapo
0 Z: 7,911 ,W cz�ly a'17 2��O'. 5V
/N 711?el-41"V V":�5 7L9 "06 2f 9a 7-!W--
1-1-b
=.'7 TJ
5;711-YIn
T
J'�,
,5*23,vp
C&L5
pamr;V
-i-MV
cafkv
77-�nlvv
%
W,
Ql
0, .0
b67
a an
r-n
X
0
0
.:�0
,
rq
0
n
0
�;co
rn
I TF—
to
50
4,
i m
co
0
.3
.....PERMIT-EXPIR S,
E
CITY OF EDMONDS
USE PERMIT
ZONE
NUMBER Q67-St
tICATION jP6 ITE/.AP #
CONSTRUCTIONPERMIT-A 00
7C 0 N! :ADDRESS'
OW TjXAM�F
NA E�
'UBnlVISION*NO.: LOT NO� LID NO.
P At NAME/-,
�BUW�Ss
U) MAILING ADDRES
LID,FEE
TESCP Approved
WAY PER'OFFICI MAP
PUB�,19,R!GHTO? RW Required.,.
gp
0
J�,TREET
Stre= Pemk R d
Cl, 6 1 ZIP
. PR? Inspection Required
PqPS ED
I I I I Sidewalk Required
4EQU)RE . DED,C Underground
I ATION,,— FT Wiring required
, -.1p
NAM
;.METE S1'E LI I N I E SIZE' No. 00. FIXTURES I PRV REQUIRED
0
&0 & 04
W
ri,
A .%
CTOR RESPONSIBLE FOR EROSION'CONTROUDRAINAGE
z
z
W
-IT
ZIP EPI16NE;!�
C, 11 TEL
10 00
w
4F
NAME
it
0
A
ENdFNEERING R
. .....
AD .......
DRESS
f
I
DATE
FIR E; REVIEWED BY
Lu
CIT TELEPVPNE
U.
0
VARIANCE OR CU
SHORELINE OR:ADB#
INSPECTION
�F!EqD- :.'''POSTED
0 YES 0
JR<
BOND
Ab-- 7 tf A00
'B EXPIRATI N TE CHECKE6BY:,-'
M E
STATE LICENSE NQ_
21
HftHT
__e��,.SEPA,REVIEW
COM PLETE EXEMPT
��'!SIGN AFI�A,�:-�
I
.,fl P tD�,
OS 4
A��LOWED
LALLOWE D PROPOSED
-j
PROPERTY TAX MOUNT PARCEL NO.
EXP.
'I;eN gEr-91SiDENTIAL.." ge",5PLUMBING1 MEC14
LOT COVERAGE
-ALLOWED` �'P
REQUIRED,$ETBACKS (FT.)
FRON I T -SIDE: REAR.
PROPOSED SETBACKS jFT.)'
FRONT UR SIDE REAR'.
COMPLIANCE OR
�A�DITION C OMMEROAL!,
�,o
CHAN&,E OFUS E
z
REA �LANNING REVIEV Eb'BY ATE
3. :
CL
RE MODEL SIGN,
RE(XD' �].PROVIDE
Ole.
Aq
i7
FENCE
REPAIR X. FrT)i
F D&6LIS14 7��NK. OTHER
Z
/G-ARAGE RETAINING WALL RENEWAL�
10 CARPORT, ROCKERYm,
4L
row
(TYPE OF'USE 'ACTIVITYJ EVLAJN�
BUSINESS OR
116
B :JT��EoF c6K6tRP,jIgt4 i
EC ED Y
CO 150,
OUP..
Air
'NUMBER
jb
w
0
NUMBER OF CRITICAL
11. AREAS
:.OF. DWELLING NUMBER,,
-SPECIAL INSPEC, 01
JOCCUPANT
ILOA6
IST� UNITS,
RIE&
C
DESCRI
PROOR
SPEA U66 I= 1�' 0
INSPECTION 1081FINA NS ECTION REOD
3
_j
Wst"_, &L
AAaL
_AA4
FEE
PLAN CHECK FEE
i2D
HEAT SOURCE GLAZING LOT SLOPE
BUILD ING Ll E3z
PLAN CHECK�NO: VtSTtb DATE
'PLUMBING
MECHANICAL
THIS P&MIT AU'THORIZESQ NLYT H 1! WQRKNOTED.J�ISMERMIT COVERS WORKTO
BE DONE.01 N PRIVATE PROPERT4 ONLY. ANY CONSTRUCTION ON THEPUdde-
PRADING/FILL
DOMAIN:(PURBS; 61DEWALKS, -DRIVEWAYS, MARQUEES, ETC.).WILL REQUI E .
:3
'SEPARATE PERIMISS1,0N."!
z
STATE SURCHARGE - .44454).
PERMIT APpucAmON: ISO DAYS,
PERMIT1111ilift' I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACKOF OiNk'PER?Alt�FOR'MoFitlikObRk'ATION'�'
...... .....
71
�APPLICAK10N:BEHALF OF HIS OR HER PPOU$E,.HEIR§, ASS12N§ AND SUCCEPQRS
ENO INSPECT ON FEE
I_. .. , - ..� . - �; -,.:
IN'INT&EST, AGREES:,fO�l�bEtA�l�,Y,�'OEF.END�AND,.HOLI)-HAAMLESS�ITHE�CITY.OF
I
2 EDMONDS, 4NASHINGTON. ATS OFFiCIALS;,EMP LOYEES:'AND AGENTStFROM �ANY. AND'
gu— .; �, .1 . .
ALL CLAIMS FOR DAMAGES OFWHATEVER- NATURE; ARISING'DIREbTLY OR INDIRECTLY%.
,
RE CE,1P1F.
f tcPl
PERMlt- SHALL NOT BE:..�l
�c FROM THE is�UANtE'OF,,THIS-PERMIT.,,:,ISSUANCE,,OF THIS'.
OSIT
IJEEMEOTOMODIFY� WAIVEOR REDLkCE ANY, REQUIREMENT OF,:ANY,0ITN:,01F1P!NANCE
_j YWAYTHEdiT�y�SXtlLiT-Y,,T67EN�bACE ANY ORDINANCEPROVISI
0 NORLIMITINAN
RECEIPT I
'A
-
'jJOTAL AMOUNT, PUE,,,,
I HEREBY ACKNOWLEDGE THAT I H=RTHIS APPLICATION.�'�,THAT-.THPIINFQRMATION-
NE ��O TkE DULY AUTHORIZEb�AG' E*NT'
GIVEN IS CORRECT; AND THAT I A W 'Fi` A OF,
APPLICATIQN ' 'APPROVAL
THE OWNER. I IAGREE 'AND STATE,LAW6 REGULATING CO
TO COMPtY WITH CITY NSTRUC-�.
'This.application-is riotii perrnil� 6htii!61�.ed by the
dALL'
TIO EWgAKAUTHORIZtb,TH�FtEBY.�NoiPERto.N�WIL�';BgEM��OYED;
MANDIN G TH
;'RELATING Tb:�_'
IN VIOLATIOIJ OF THE LABOR. CODE OF`THE 'STATE 0 .WASHIN6T09,,',
. .
Buildi Official oi� histherbep6ty: and Faes ire paid. and
I(pow qdIjed in space 0
eceipt is'ad ", rovided�
WORKMEN'S JOMPENSAt 101�,INSURA NCEAND RCW1&�7.
s,
1j.
LSSIGNATUA D TE
DATE n
sidtWE (C&N ER OB PG ENT)' .,SiGWlf
-25).
01 /F
't 0 If
771'' 3220
64
f
A17.T ENTION.
ONTIL
IT IS UNLAWFUL TO U§t.09b UP, R �URP�--
*,BEEN',
2'
771-:02 1
A FINAL INS PECTION. HAS 10ADE!,AND,'AR R,, VAL,,,
ORIGiNAL'� riL�E ::i "YELLOW -INSPECTOR .
N C ECTI bg.,it,
CATE OF OCCUPA CY HASBEEN Gh E6.
AS
PINK - NkA ;V&D SESSOR
FAX
�A �QL
5/98
CITY OF EDMONDS
SINGLE FAMILY/DUPLEX COVER SHEET
Directions: Applicants are to complete the Information In the WHITE BOXES ONLY (Shaded boxes are for City
.As 0 n III. This cover Ghost must accompany each building permit application for a now single-family
residence.
PROJECT, ADDRESS (.0.1-7 P A I 11%,j `i�T-
PROPERTY TAX ACCOUNT PARCEL#
DESCRIPTION OF WORK 0 L
OWNER FHA: PHONE
CONTACT PERSON k tKa. AaLl I H PHONE Lt,�e -1-1'9
E-MAIL FAX
MAILINGADDRESS flci -,DPIFTUyY) Q. 4i j 0)
R FAX CORRECTIONS 11' MAIL CORRECTIONS E-MAIL CORRECTIONS
BY SIGNING THIS STATEMENT I UNDERSTAND THAT I AM THE CONTACT PERSON FOR THIS PROJECT. IT IS MY
R ESPONSIBILITY TO COORDINATE ALL SUBMITTALS WITH THE CITY AND ONLY I CAN MAKE INOUIRIES ON THE
BY A TUB OF THE APPLICATION. I UNDERSTAND IT IS MY RESPONSIBILITY TO DETERMINE IN ADVANCE OF PERMIT
x UBMITTAL ANY DISCRETIONARY PERMITS THAT MAY BE APPLICABLE TO THIS PROJECT. I ACKNOWLEDGE
I H AT TO THE BEST OF MY ABILITY I HAVE SUBMITTED ALL NECESSARY DOCUMENTATION IN ORDER TO MAKE A
COMPLETE APPLICATION AND NO DISCRETIONARY APPROVALS ARE REOUIRED.
SIGNATURE DATE
ZONING INFORMATION
ZONE P, H I . r-,) LOT AREA 4q6O
NUMBER OF DWELLING UNITS'EXISTING_ DEMOLISHED__L PROPOSED
DISCRETIONARY APPROVALS CA Determination
SUBDIVISION CU VARIANCE SHORELINE
SEPA_ EXpiree_ OTHER
City Use Only
LOT COVERAGE INFORMATION
EXISTING SF j,)A4[). PROPOSED SF. TOTAL SF 70DO %.40
HEIGHT CALCULATION INFORMATION
DATUM
H Af-K A 110.2 B..j0q.06c.1b1,'
AVE . i 06 � 514 MAX tj
, , �;�' .' ACTUAL'
EFq 4 11,'allowApice, -Weleva�vnS)W.
SETBACK INFORMATION P-
.7- z
REQUIRED FRONT SIDE SIDE REAR 15
PROPOSED FRONT SIDE SIDE REA
CNR. LOT[] YES FU NO -FLAG, LOT. 13 yts� NO - ILL1111111.4:1 YES R,, NO'�- IT.
ADU STATEMENT REQUIRED '[]YES[MNO' RECORDING 8
STAFF COMMENTS:
addlhanal nz4-fP0 gWeted tZ
ENGINEERING INFORMATION
DRIVEWAY SLOPE % GRADING CYDS ;L5b
EASEMENTS
EXISTING IMPERVIOUS AREA CONSTRUCTED BEFORE 1977 1 Rq0 —SO.FT
EXISTING IMPERVIOUS AREA INSTALLED 1977 OR LATER_ SO.FT.
PROPOSED NEW NET IMPERVIOUS SURFACE
I N'5110yu-00 17UII
SIDEWALK REQUIRED L&jYES []NO DRAINAGE PLAN REQUIRED [3YES []NO
UNDERGROUND WIRING REQUIRED EOYES [-]NO
STREET DEDICATION- N11h UID' FT. LIDIF
STAFF COMMENTS: NO-W---- -ralADC-H ?1ZQFQ6M' AWL -
SPECIAL INSPECTIONS REQUIRED FOR THIS PROJECT (City Use Only)
SOILS& STRUCTURAL:
EDSTART OF WORK OPLACEMENT OF REINFORCEMENT
0 EXCAVATION & GRADING OPLACEMENT OF CONCRETE
0SHORING INSTALLATION A MONITORING []BOLTS INSTALLED IN CONCRETE
OPROOF ROLLING [:]STRUCTURAL MASONRY
PLACEMENT OF FILL & CO . MPACTION C]STRUCTURAL STEEL ERECTION
E]SUBSURFACE DRAINAGE DHIGH STRENGTH BOLTING
D VERIFY SOIL BEARING OWELDING (WABO CERTIFIED ONLY)
OPILE PLACEMENT []OTHER
DEROSION CONTROL
D GENERAL SITE MONITORING BY THE
GEOTECHNICAL ENGINEER OF RECORD
13 GENERAL SITE MONITORING BY THE
GEOTECHNICAL ENGINEER OF RECORD
DURING WET WEATHER CONSTRUCTION
EIFINAL GRADING FIELD REPORT
DOTHER
C��00-��j
APPLICANT DHPir
Cir-a-D-5r.
PLAN CHECK @
DATE RECEIVED
BUILDING CONSTRUCTION INFORMATION
CODE EDITIONS 1997 USC, UMC, UPC, WSEC, VIAO WITH AMENDMENTS
DESIGN CRITERIA WIND EXPOSURE 8 WIND SPEED go MPH SEISMIC ZONE 3
Floor Live Load 410 Roof 57now/L.We Load__4-T Balcony Live Losdjo
Floor Dead Load 10 Root Dead Load 10 BalconyDeadLoad 10
NUMBER OF STj'RIES__,2_ BASEMENTS I FLOOD ZONE
LOT SLOPE % 8, —1 %, — SOILS REPORT PROVIDED [] YES. [0 NO
FLOOR AREA (MEASURED TO EXTERIOR FACE OF EXTERIOR WALL)
Existing 4cipgod, Total
Living Space
I Ono
Garage
.2 24o
Carport
Dock/Covered Porch
Other —
ENERGY CODE COMPLIANCE INFORMATION
FUrL TYPE GAS, OIL [:] ELECTRIC
FORCED AIR [:]HEAT PUMP
ENERGY CpnF METHID 11L ANC4
119 PRESCRIPTIVE: _V.V
1:1 OTHER
13HYDRONIC []OTHER_
11 TARGET UA APPROACH: Provide UA Calcuations
13 SYSTEMS ANALYSIS: Provide Computer Analysis
IN ENERGYIVENTILATION WORKSHEETS PROVIDED
El WINDOW SCHEDULE PROVIDED
FOR CITY USE ONLY
Coiling lnjSUI:tIoR
Wall Inalu all n
Floor lns,:Iat,,l It
Door U_V U 0
Window U-Valus
Skylight U-Value
11
Glazing % 24
VENTILATION CODE COMPLIANCE INFORMATION
KITCHEN FAN CFM 41,W, BATHROOM FAN(S) CFM 6-0 LAUNDRY FAN CFM qJ9
11 EXHAUST OPTION
FRESH AIR TO BE PROVIDED TO
WINDOW VENTS WALL PORTS
EACH HABITABLE ROOM WITH:
EXHAUST FAN TO BE CONTROLLED WITH
24 HOUR TIMER AND SIZED AS FOLLOWS:
I - 2 BEDROOMS: 50 - 7S CFM
4 BEDROOMS: 100 - ISO CFM
3 BEDROOMS: 80 - 120 CFM
5 BEDROOMS: 120-180 CFM
HVAC INTEGRATED OPTION
DEDICATED HEAT RECOVERY VENTILATION
OPTION
SEPARATE PERMITS (City Use Only)
0 RIGHT OF WAY CONSTRUCTION PERMIT E]MECHANICAL PERMIT
E]ENCROACHMENT PERMIT E]PLUMBING PERMIT
MSTATE ELECTRICAL PERMIT 0INATER METER
0FEkCE PERMIT E]SIDE SEWER PERMIT
RESIDENTIAL FIRE SPRINKLER PERMIT 0IRRIGATION (SPRINKLER SYSTEM)
U OTHER OTHER
Any request lot modification, variance or other administrative devietio:rt'hadnafter "variance")
must be specifically Called out and Identified. Approval of any plat or III containing provisions
which do not comply with the city code and for which a variance has not been specifically
identified. requested and considered by the appropriate city official In accordance with the
appropriate provision of city code or state law does not approve any items not to code
specification.
PERMIT ISSUANCE APPROVALS
PLANNING REVIEW & APPROVAL
CONDITIONS OF APPROVAL:
(City Use Only)
DATE
ENGINEERING REVIEW It APPROVAL
CONDITIONS OF APPROVAL:
DATE
BUILDING REVIEW A APPROVAL
CONDITIONS OF APPROVAL:
DATE
I
�Wj
b
0
b
z
BELL ST.
FND. HARD NAIL
-30-
FND.
HARD NAIL
30.00
% 0� -
6
(o
I
I
ALLEY
SET PK NAIL - A9
& TA G N
8566
4.00 - S 89059'15' W
45.00 1
0
C!
0
Olt 0
-A
1A-W
0
9
0
0
Z:�
z
1;�lu
\01101
05
0% P\
SET PK NAIL
& TAG No. 8566
4.00
0
W
0
0
b
WA
ELEVATIONS:
CITY OF EDMONDS DATA - ESR 118 CID64
TOP RIM OF CENTER OF MANHOLE AT CENTERLINE
OF ALLEY 1501 FEET SOUTH OF INTERSECTION
OF 6TH AVE NORTH AND DALEY STREET.
ELEVATION - 77.36
vV
FND. RESAR
0 CAP 108.65
120.20 45.00 134.73
3.0— S *59'15' W 3.0
t-7.0 WIDE CONC. SIDEWALK TBM
CHISELED SOUARE ON THE S.E.
CORNER OF WATER METER ELEV.- 109.67
120.19
-30-
FND. HARD
NAIL
6N ST.
D T
. fl
146.OT
6
S-Iqs
SCALE: I" = 20'
1 i I
20 0 20 40
LEGEND:
DENOTES SET REBAR WITH LS CAP No. 8566
X DENOTES SET TACK IN LEAD IN SIDEWALK
ODENOTES FOUND REBAR & CAP No. 9891
PROPERTY DESCRIPTION:
THE WEST, HALF OF LOT 31 AND ALL OF LOT 32, BLOCK 98, CITY OF
EDMONDS, ACCORDING TO THE PLAT THEREOF RECORDED IN VOLUME
2 OF PLATS, PAGE 39l RECORDS OF SNOHOMISH COUNTY, WASHINGTON.
'ELEVATIONS AT APPROX. CORNERS OF
PROPOSED BUILDING.
NOTE:
This Survey was conducted without the benefit of a Title Report
and therefore does not purport to show all easements or restrictions
of records If any.