634 GILTNER LN.PDFiiiiiiiiiiiiii
11400
634 GILTNER LN
CITY OF EDMONDS SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.)
Inspection will be provided within 24 hours after requst. 1�0 Sat., Sun., or holiday Inspections.
13 ............... C-70 F
ADDRESS LOCATION OF CONSTRUCTION ....... &:!X-4 .......... ......................... L.A..K-j ... .......................................................
PROPERTY LEGAL DESCRIPTION .... Q e) F-l' n -t- Z. F A s 7- C-, e) J 4 /) T, <:
.......................................................................................................................................................................
1- C..., 4 _- -1 ' ':S E -I-
...................... . .......... . .......... . ........................................................................ E A �4 F_
TZ- - 03. M
................................................................ OWNER AND/OR BUILDER__.::=.js._' Fjq TZ \ . ........ . .
; .................. . ........................ ; . ......................................................
CONTRACTOR'S NAME "DRESS ------ ........... . ............... . ... .......................................................
Pern-iission Is gTant-ed ....
..... ................. . ............ 197 , for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with dl� of Edmonds ordinances.
AlftTION IS CALLED TO THE FOLLOWING:
NdlWo. I —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.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3--Obtaln 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
shaxper than 'A will be permitted.
NOTE No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6--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[:] Date ... . ........... . I;Wze . .............. By ................ Date ............... . ................... By ................ Date ............... . ................... . By ................
zg// �/,_
APPROVED Date.-, ................................
. .. . .......................................................................................
...... 7 ... t_-7 I
Remarks: ........ ...... . . ....................................................................................... ..................................................................
................................................................. . .. . ........................................................................................ . .................................. . .......................................................
BOTH Pe it ICLopies MUSVBrl�igned By Vwner of Firm Performing Construction PRIOR To Request For Inspection
...... ......... ... ...... .... .... ......... ... , hereby certify that the side sewer installation constructed under this permit
(0 er ontracting Firm Perf r g Cc ruction)
�JW (r �4),
led in acco ance with all gov:ern"in rdinances of the City of Edmonds.
Datedthis ..................... ...... day of ................................................................. 19 .........
Check BEFORE you dig for: Water F], Gas [], Telephone E], Power C], Sewer E], Other E] V V
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STREET FILE
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STR7',EET FILE
PUBLIC WORKS EUVIROINMENTAL REVIEd
ASSESSMENT DATED: ist 151-78
AN ENVIRONMENTAL REVIEW OF THE PROPOSAL HAS BEEN
COMPLETED AND THE FOLLOWING DETERMINATIONS HAVE
BEEN MADE:
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PREPARED B DATE: . ... ........... .
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APPLICATION
'-We City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS F-1 LID NO - ------------------ ASMT. NO . ..................
OWNER ------ CONTRACTOR .......... PERMIT NO.
JOB ADDRESS ...... . ..... LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO . ....................................
0
.............................................. :E��Y-T -------------------------------------------------------------------------
NAMEOF ADDITION ------------------------------------------------------------ ----------------------------------------------------------
By..........
11/75
APPUCATION
-The City of Edmonds for EASEMENT NO. -- -------------- ---------------
SIDE SEWER PERM
NEW CONSTRUCTION REPAIRS LID NO - ------------------ - ASMT. NO ------------
OWNER C,,,J ---------------------------- CONTRACTOR ------ --------------- PERMIT NO.
JOB ADDRESS ------ - — ---- --------------------- k ---- �j4,*�47 LEGAL DESCRIPTION: LOT Nq - -------------------------------------- BLOCK NO - ---------------------- ----------
azW�
............... .............. -------------------------------------------------------------- --------------------------------------------------------------------
NAMEOF ADDITION -----------------------------------------------------------------------------------------------------------------------
Of
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Approved:
DATE-------------------------------------------- By --------------------------------------------------- yi7.yg
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THE WESTERLY 80.00 FEET OF THE EASTERLY 243.00 FEET OF THAT
PORTION OF GOVERNMENT LOT 2 IN SECTI61N 24, TOWNSHIP 27 NORTH,
RANGE-E EAST, W.M., DESCRIBED AS FOLLOWS:
BEGINNING AT THE NORTHEAST. CORNER OF SAID GOVERNMENT LOT 2;
THENCE WEST FOR'30.00 FEET; THENCE SOUTH FOR 30.00. FEET TO THE
CORNER OF -THE PAVED ROAD AND SEVENTH AVENUE NORTH PRODUCED IN THE
CITY OF EDMONDS;.THENCE SOUTH 001210011WEST, AONG THE WEST LINE
OF SEVENTH -AVENUE NORTH PRODUCED FOR 233.61 FEET TO THE'TRUE
POINT OF -BEGINNING; THENCE NORTH 8903910011 WEST, ALONG A LINE
DRAWN PARALLEL WITH THE NORTH LINE OF SAID GOVERNMENT LOT 2 FOR
611.07 FEET TO AN INTERSECTION WITH THE EASTERLY MARGIN OF THIRD
AVENUE NORTH; THENCE SOUTH 2901810011 WEST.. ALONG SAID EASTERLY
MARGIN FOR 86.85 FEET; THENCE SOUTH 89039100" EAST, FOR 653.71
FEET TO AN INTERSECTION WITH THE WEST LINE OF SEVENTH AVENUE
NORTH-PRODUCED;-TH.ENCE NORTH 0012'001' EASTo ALONG SAID WEST LINE
FOR 76.00 FEET TO THE TRUE POINT OF BEGINNING.
SITUATE'IN THE COUNTY OF SNOHOMISH, STATE OF WASHINGTON.
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THE WESTERLY 80.0'0 FEET 00 T ' HE EASTERLY 243.00 FEET OF THAT
POVION Of GOVERNMENT LO,T'2 IN SECTION 24.. TOWNSHIP 27 NORTH..
AANO e EASTo W.M.o DeSCkIB8D AS POLLOWS:
AEGINNING AT THE NORTHEAST CORNER OF SAID GOVERNMENT LOT 2;
THENCE WEST FOR. 30.00 FEET; THENdE SOUTH FOR 30.06 FEET TO THE
CORNER OF -THE PAVED ROAD AND SEVENTH AVENUE NORTH PRODUCED IN THE
CITY OF KDMONDS;-THENCS SOUTH 0012'00" WEST, A40NG THE WEST LINE
OF SEVENTH AVENUE NORTH PRODUCED FOR 233.67 FEET TO THE'TRUE
POINT OF *BEGINNING;. THENCE NORTH 8903910011 WEST.. ALONG A LINE
DRAWN PARALLEL.WITH THE NORTH LINE OF SAID GOVERNMENT LOT 2 FOR
611.07 FEET TO AN INTERSECTION WITH THE EASTERLY MARGIN OF THIRD
AVENUE NORTH; THENCE SOUTH 2901810011 WEST.. ALONG SAID EASTERLY
MARGIN FOR 86.85 FEET; THENCE SOUTH 8903910011 EAST*o FOR 653.71
FEET TO AN INTERSECTION WITH THE WEST LINE OF SEVENTH AVENUE
NORTH,PRODUCED;-T.HgNCE-NORTH 0012'001' EAST.. ALONG SAID WEST LINE
FOR 76-00 FEET TO THE TRUE POINT OF BEGINNING.
SITUATE'IN THE,COUNTY OF-SNOMOMI.SHO'.-STATE OF WASHINGTON.
THE WESTERLY 80.00 FEET OF THE EASTER�LY 243.00 FEET OF THAT
PORTION OF GOVERNMENT LOT 2 IN SECTION 24, TOWNSHIP 27 NORTHO
RANGE E EASTo W.M DESCRIBED AS FOLLOWS:
BEGINNING AT THE ��RTHEAST CORNER OF SAID GOVERNMENT LOT 2;
THENCE WEST FOR 30.00 FEET; THENCE SOUTH FOR 30.00 FEET TO THE
CORNER OF THE PAVED ROAD AND SEVENTH AVENUE NORTH PRODUCED IN THE'
CITY OF EDMONDS;-THENCE SOUTH 0012'00" WEST, ALONG THE WEST LINE
OF SEVENTH AVENUE -NORTH PRODUCED FOR 233.67 FEET TO THE*TRUE
POUNT OF BEGINNING; THENCE NORTH 8903910011 WEST,, ALONG A LINE
DRAWN PARALLEL WITH THE NORTH LINE OF SAID GOVERNMENT LOT 2 FOR
611.07 FEET TO AN INTERSECTION WITH THE EASTERLY MARGIN OF THIRD
AVENUE NORTH; THENCE.SOUTH 2901810011 WEST, ALONG SAID EASTERLY
MARGIN FOR'86.85,FtET; THENCE SOUTH 89039100" EAST, FOR 653.71
FEET TO -AN INTERSECTION'WITH THE WEST LINE OF SEVENTH AVENUE
NORTH�PRODUCED;lHtNCE NORTH 0012100" EAST.. ALONG SAID -WEST LINE
FOR 76.00 FEET TO THE TRUE POINT OF BEGINNING.
SITUATE'IN THE COUNTY OF SNOHOMISH.. STATE OF WASHINGTON..'
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STREET FILOi:'�
FILE #
FOJ;Cd FOR [=PDWF1KALj DECLkMTION OF [SIGMIKUWWXONSIGNIFICANCE]
Description of proposal S i ng I e f am i- I y dwe I I i ng
Proponent Thomas & Marily'd Murphy
Location of Proposal 634 G i I tner Lane
Lead Agency City of Edmonds_
1his p-roposal has bccn detemined to Rumor,/not have] a significant ad-
TS
verse impoct upon -the envirormicnt. An E.L [is/is not] required under
10-1 43.21C.030(,-2)(d). This decision was made after review by the lead
agen.-y o1L a comT)Ietcd eviiro.-inicntal chec1dist and other information on
file with the lead agency.
Responsible Official Mary Lou Block
Position/Title Associate City Plannelr
Date May 18, 1978 Signaturey�,k,6Ltl
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DATE:
A $25 fee will be collected by the City of Edmonds for anal . ysis
of the Environmental Checklist and the preparation of a Threshold
Determination. VD-j-e-e will be charged for proposals which would
be categorically exempt if they were not located in an envirdn-
mentally sensitive area.
ENVIRONMENTAL CHECKLIST FORIIII
1. BACKGROUND
1. Naine of PropOnentTAOM A 9'MhZ14.V
2. Address and Phone Nuiiiber ot 11roponent:'
7-76?- e6 Q
3. Date CM—ccl,. ist Submit:ted--
4. Agency Requiring Checklist K .0-e,49r— e/2f� or- E040A) L)LS
5. Naine of Proposal, if applicable:
A-01
6. Nature and Brief Descr (includ-
ing but not limited to its size, genCl7al desigm cle-
ments, and other factors that will pive an accuraLe
understanding of its scope and nature):
7. Uo--cation of Proposal (6escribe the phvsf-c-�iT Te—Lti-I-I-g—of
the proposal, as well as the ext:cnt o�- the land area
affected by aily environit-icnLal irilpacts, including aily
other information needed to give an accurar-, understand-
ing of Lhe environmental setting of the proposal):
& 3,11 6 / L 7 X) C& Z- N 6 6, 0 � �ak 1, D S - —
8. E s —Ei In... I -E-C-a of thu Pro,—Ios-e`a'—I�C—Cion:
9. List of all Perr.IiLS, Licciises or Governmenc Approvals
Required for the Proposal (federal. sLate and local --
including re.zoiies)
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1
2
3
4
5
6
10. Do you hoany plans for future . addition Pexpansion,
or further activity related to or connected with this
proposal? 11 yes, explain:
11. Do you know of any plans Sy ot ers which inay affccE__
7
the property covered by your proposal? If
yes, explain:
A10
9
10
12. Attach any other application form that has
been co—in-
11
pleted regarding the proposal; if none has
been coin-
12
pleted. but is expected to be filed at sonic future
13
date, describe the nature of such application form:
14
A.AQ
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16
17
18
11. MIRO'NZIENTAL IMPACTS
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(Explanations of all "yes" and "maybe" answers
are
20
required)
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Yes
Maybe No
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(1) Larth. Will the proposal result in:
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25
(a) Unstable earth conditions or in
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changes in geologic substructures?
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(b) Disruptions, displacements, com-
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paction or overcovering of the soil?
VI/
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(c) Change in topography or ground
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surface relief features?
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(d) The destruction, covering or
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modification of'any unique geologic
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or physical features?
V/
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38
(e) Any increase in wind or water
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erosion of soils, eithe'r on or off
40
the site?
V/
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42
(f) Changes in deposition or ero-
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sion of beach sands, or changes
44
in siltation, deposition or erosion
45
which may modify the channel of a
46
river or stream or the bed'oE the
47
ocean or any bay, inlet or lake?
V/
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49
Explanation:
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52
(2) Air. Will the proposal result in:
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(a) Air emissions or deterioration
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of ambient air quality?
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(b) The creation of objectionable
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odors?
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(c) Alteration of air movement,
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moisture or temperature, or any
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change, in c' imate, either locally
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or regionally?
V/.
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65
Explanation:
66
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141
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161
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181
191
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261
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Yes Maybe No
I ater. WL L L"C proposal result in:
(a) Changes in currents, or th e
course or direction of water move-
ments, in either marine or fresh
waters?
(b) Changes in absorption rates,
drainage patterns, or the rate and
amount of surface water runoff?
.(c) Alterations to the course or
flow of flood waters?
(d) Change in the amount of sur-
face water in any water body?
(e) Discharge into surface waters,
or in any alteration -of surface
water quality, incLiding but not
limited to temperature, dissolved
oxygen or turbidity?
(f) Alteration of the direction
or rate of flow of ground waters?
(g) Change in the quantity of
ground waters, either through
direct additions or withdrawals,
or through interception of an
aquifer by cuts or excavations?
(h) Deterioration in ground water
quality, either through direct in-
jection, or through the seepage of
leaehate, phosphates, detergents,
waterborne virus or bacteria, or
other substances into the ground
waters?
(i) Reduction in the amount of
water otherwise available for
public water supplies?
S'"L'FAY-Vj cuxej�mj W I L4.-
Explanation: 0/_.,p 140jjSr 7Z
(4) Flora. Will the proposal result in:
(a) Change in the diversity of
species, or numbers of any species
of flora (including trees, shrubs.
grass, crops, microflora and
aquatic plants)?
(b) Reduction of the numbers of
any unique, rare or endangered
species of flora?
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YMMJ
V/
V/
V/
R7-
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Yes Maybe No
(c) Introduction of new species
of flora into an area, or in a
barrier to the norlLial replenish -
merit of existing species?
(d) Reduction in acreage of any
agricultural crop?
Explanation:
(5) Fauna. Will the proposal result in:
(a) Changes in the diversity of
species, or numbers of any species
of fauna (birds, land animals
including reptiles, fish and shell-
fish, benthic organisms, insects or
microfauna)?
V/
(b) Reduction of the numbers of
any unique. rare 'or endangered
species of fauna?
V/-
(c) Introduction of new species
of fauna into.an area, or result
in a barrier to the migration or
movemunt of fauna?
(d) Deterioration to existing
fish or wildlife habitat?
Explanation:
(6) MOi sc - Will the proposal increase
ii�xi—sEing noise levels? AL
Explanat! on:
(7) Light and G1 ' are. 141'. 1 1 the pro-
j;&s-,-TF-prjd—UE`e-n-ew light or
glare? V/
Explanation:
(8) Land Use. V.,ill the proposal
Fj--�—LIFL ill the alteration of the
present or planned land use of an
area?
Explanation:
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0
Yes I!ayb No
2
(9) Natural Resources. Will the pro-
P-0 —5-41-r—r—C i-u-I T —n
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i
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5
increase in the rate of use
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of any natural resources?
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(b) Depletion of any nonrenewable
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natural resource?
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Explanation:
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(10) Risk of I)pset. Does tile proposal
involve
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a risk of ail explosion or
the release of hazardous substances
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(including, but not limited to,
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Oil, pesticides chemicals or
19
radiation) in tile CVCnL of an acci-
dent
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or upset conditions?
V/
21
Explanation:
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(11) P l
L901 at'-011- Will tile proposal
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distribution,
density, or
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growth rate of the
human Population of an area?
V,
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Explanation:
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(12) 11OLIsing. - Will the Proposal affect
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CXi-SET-119 housing availability, or
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create a demand for additional
housing?
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�_v
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Explanation:
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(13) TL-aiisporrnti-.oi,/Ci.rculation.
42
t FIC Proposai_�_rtsuf'tin :
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(a) Generation of additional
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vehicular movelleIM
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(b) Effects on existing parking
laciliVies
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parking? ' or demand for new
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(C) 1mPact uP0Il existing trans-
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portatiot, systeIlls?
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(d) Alteraciolls to present
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Patterns Of circulation or inove-
nle"t Of PCOPle and/or goo(Is?
57
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(e) Alterations to waterborne,
rail or air traffic?
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71
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60
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.(f) Increase in traffichazards
to motor vehicles, bicyclists or
pedesLrians?
Explanation:
Yes Maybe
V/
(14) E�Lljl i.c Serviecs. Will the p�o-
posal-7-Yve -in effect upon, or
re:;ult in a need for new govern-
mental services in any of the
following areas:
(a) Fire protection?
VI.
(b) Police protection?
V,
(c) Schools?
(d) Parks or other recreational
facilities?
(e) Maintenance of'public facili-
ties, including roads?
(f) Other governmental services?
Explanation:
(15) Will the proposal resuic in:
(;I) Use of substantial amounts of
fuel or energy?
(b) Demand upon existing sources
of energy, or require Lhe develop-
menL of.new sources of energy?
Explanation:
V/
(16) Vtilities. Will the proposal
r-j�%ull in .1 need for .1-Y.stems,
or alterations to the following
utilities:
(a) Power or natural gas?
V
(b) Communications systems?
-VL
(c) Water?
V/
(d) Sewer or septic tanks?
Storm WaLCr drainage?
j/_
(f) * Solid wasteand disposal?
E,xplanation:
-36-
a
a
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1-3
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is
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321
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)LC s Maybe� No
-(17) flumati Will, tile pl.,oposal
Te -.,; U- I �ti -11 -LT, C
*-ation of any
health 1i d Potential health
hazard (excluding mental health)? V/
Explanation:
(18) Aestheti.cs. Will the propo al'
: -in
rcsul'L the obstruction Os
f any
scenic vista or view open to the
:Public, or will the -proposal re-
sult it' tile creation of .11,
aestiletically.offensive site open
to Public view?
Explanation:
(19) Re crea c ion. Will the proposal
an impact upon the
qualicy Or (1141"CitY of existing
recreational opportunities?
Explanation: -
(20)
Fr—or)071 Will the
0 , UTI:
n�
.1 LcraLion of
a s4,11ificant archeological or his-
torical site, structure, object
or building?
V/
Explanation:
III. SICNATURE
. I, the undersip
the plLd, state that to tile best of my knowledge
that above informaLion is true and complete. It is understood
tile lead aAclicy may withdraw any declaration of
-lee upon this c1l cllist
ficance that it might issue in rcliai non-sig,ji-
-lisrepresentaLion or lack Of full disclosure
should there be any I C
on my part.
Proponent:. . " M
IAIAC 197-10-370 WIT11DRAIIAL OF AFFIRMATIVE T111:111:,(3111OLD
any time, after tile entry of
ti011 Of sign if icll1c(-,, the PrOPOIlent l-,lodi a declara-
SO that, in tile f'cs t:110 Pr0J)osal'
adverse environw, judgNIC-11t of th I e a d
e ""cy, "]-I sit,1111-ficant
'ited, i1l1plcLs rc, a F, L
the declzi K-a Lion of sign f sulL 'If" therefrom jlrc� Climin-
and a declaraciol, OE i icance 0hall be withdrai..,n
11011-si�.,llificance entered instead. The
le,"d agency siMll 'ISO revise tile registc.�rs -It its
public inforuiatiol-I center accordingl' SEPA
polient Y. If the pro-
of a PI:01)0.;,Il is a private applic,111t,
sh,111 not be collsidered Ifloclif tile proposal
ied until all license applica_
tiOns.for tile proposal are revised to reflect the Modification.
-37-
PROJECT
ITTED
DATE SUBM
ENVI RONMENTAL ASSESSMENT
In order to meet the requirements of the State Environmental Policy Act of 1971i
the responsible official must make a declaration of environmental impact as early
as possible in the process of evaluating a project.
The information in this form .-jill be used to determine whether it will be necess-
ary to require an environmental imoact sta - .-nt. If an impact statement is
not required, a Statement of 1'-1eaative Declaratio-n wil*l be placed in the file.
If an impact statement is required, a draft'statement must be filed with this
office, public notice given and a reviela period of 30 days allowed. The final
statement and comments must be filed with the Department of Ecology, Office of
tile Governor and t�le Ecological Commission.
The Edmonds Planning Staff will assist you in any way vie can in accumulating
this information and ae would appreciateyour cooperation.
I . Land:
Area in acres
Soi Is typ&.YM, o
9AA1,br A4 Limitati ns
Description of topography (% slope) FA7edv 7- 77,*
7-6 Eh&-6-
o1=,TrXEA1&4.—
/5 0 LAJ7- i=7-
Grading: estimated
cubic
yds.
6, 7g, TE: lof grading or filling
_N4 -
wilT exceed 500 cubic yard s
Filling: estimated
cubic
yds.
J41WM& gradi ng and f i I I i ng p i an
6A_4i�must be submitted with' the
2. Water:
/66.6 application.
Stream - estimated
6//',,
flow (c ic
feet p . er secondj
, �p X 3
all W/
(/E V 7-1 CA-4 Aed;D 0 A=4,)3 Jw7- / Al 719
Will stream be altered?
ZZFY
I &7-00Je_X J41fi&7-AX
To what degree? 6VIDEA)
7)WS- AIIL-i—
Impact on storm drainage
(increase in ru-n--o-ff)
Estimated area
-to
be paved
C/
ce, 6, —1b.
Estimated area
in
open space
6LO 3. 0 %
Shorelines: within 200 ft. oil Ilean Higher High Water A1111-
Adjacent to shorelines zone
Environmental Assessment, page 2
3. VeQetation:
4�1
Type of trees I SA,+LL Ce-bIM % to be removed
Minimum diameter of trees to remain F7-
Ground cover to be removed 0,e
,ewu 4 �W72-1#ea t
Proposed landscaping,' if any Cc A -e-
4. Existing Land Use within 300 ft. radius of proposed development:
Vacant
Single
Family
Multi -
Family
Comm.
Other
North
South
V/
East
West
V/
5. Circulation:
Estimated increase in auto trips daily
Estimated demand for public transportation ICIOA.)e-
Degree of change on adjacent streets /V e) A-) f-
6. Area of imoact:
neighborhood /L,,Q A) e5-
ci ty-wi de AJQ
regional
7. Effect on air quality: - . luo.,Ve-
8. thanges in noise generation:
-78
% 4 ;
I-INC 5TA
0 1
,g,$3
sx�
ar
Ll
7-ops'.21
/V
w
k
ro V-11cl-
- TO 7:;,ea F-'K. 7�-Tr-
00, t,4
(,Prg-' T'
2 7
4P
, tw
'79
6CY9 zo
;4&,5 -3 -7
% 6 3 4 C, I CrA)E'P, LAVE
6� Z:7z) Al o A) b s ,
/0.0 U-, k - LEkP- Y CV1,JSrkUr-VW! e%
IT o \8 E7- S (*a of �Wy)
L"z-i
CM-VEj(T 3 F7-,b/,4-rf6-rt--?O-
Ok&
S,2-/ f-7- 6- 7- 14,4.
A AT- Aj&) 0-ok,
73
1 rla-t
E-LE VA 7�,od.
-M
I-F-VEL 07= 677,
fY#/9/7—'27-
WIT
r "000
4r
y
0
Q
wS Tiuj- L�lT FILE
pg%q fig
AC fj�N
b3.
11 WA.r C43,
CITY OF ED . M 0 IN ADES; DEPT.
)y
Examined bY
R.:marks
-'POEIVED
i, Gv 9 1977 /.Ole
,,jbilC MIKS UePL
'V,
PUBT,IC WRKS DEPARTMENT CHEM S
BUILDINtJM i6 OR L E
4- b)�dg"
.(address)
/0-24—
(date)
Street Right -of -Way Existin
REQD Z-0
Z
Access Easements Exist*
QD "/� A-
H
94
Utility Easement Existi C,5
0 1jOk-r1--+-' REQD drt�jl�"
W
Lot Per Subdivision -Z Plat
Assessor
Site Plan Checked for Accuracy 0
Z
Underground Wiring Reqd.
Check Accuracy of Legal Description
Z
Revi . ew by
Date-'
f
Existing Water Main Size
Water Main Required 06LJe
Service Line Required
Hydrant Size Existing
P�
Hydrant Reqd Per Fire Code
—Size
Detector Check Ple-ter Reqd. tJ
Cross Connection Inspection
Fire Department ComnEnts
Water Meter Charge Rek �-Zclo
Review by
Date Z 4
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.—W/61Z
Permit No.
Sanitary Sewer Availabil L
1�ro PL-b
Drawing No.
File No.( KC-27� -;7:?_-
P4
Side Sewer Availability YLIl.
W
9
Sanitary Sewer Connection Fee Reqd.
No /'�"j
�3:
Review by. KI
Date
F
Open Ditch Existing_�O.)ur
Reqd.
Culvert Reqd.. rjo
Size
r4
Catch Basin Reqd.
Indicate on Site Plan ---
0
Shoulder drainage maintain collection on swale open runoff
E-4
Ak
Manhole reqd. A,10
Indicate on Site Plan A)
Soil Conditions and Ground Water, Field
Checked____
Review by
Date
.. Revised: lvlO-1977
Pakp 2
Street Paving Re,,.
Curb and Gutter Reqd.
Sidewalk Reqd. 0) 0
Curb Cut for Driveway Reqd. 0
P4 Right -of -Way Construction Permit Reqd. �J 0
Bond Reqd. for Public Improvements 0
Street Name Sign Reqd. 1J'0
Other Signing Reqd.
Pre Permit Site Inspection nude on
0
BY: SEWER
WATER
PL4
STREET
PL4 ENGINEERIM
Special Requirements listed in me= to Community Development Department,
Building Division
BY Date
c) All items filled in on Building Permit Application
P� BY Date
Drawings Stamped and Notations Made
04
BY Date
Approved by Public Works Department
Revised: lv 10-1977
'u
UILDING DEPARTMENT Applicant Fill
' L DI
USE P
ZONE ME
PERMIT APPLICATION Inside Heavy Lines
PE
'OB
ADDRESS
NAME JOR NAME OF BUSINESS)
N
�R
?
LEGAL I
S NO
LOT AREA SUBDIVISION
I
NO.
0:
W
Z
3:
MAILING ADDRESS
m 'L
,?,4101 J/ — '7 �0,55 7—
STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
-00
COMP. PLAN ST. R/W FT. FT.
0
CITY TELEPHONE NUMBER
c TY
2-1
NAME
REMARKS
Z
0:
W
W
CHEC D
W
ADDRESS
U
0:
<
CITY TELEPHONE NUMBER
STREET AND/OR UTILITY W2RF3f R/W PERMIT REQUIFIED
REG"D.
YES k'KNO 0 YES VNO
Z
W
NAME
Ow lwf-
UNDERGROUND
WIRING REQ'D. ES No
I
0
u
-C
m
Z
ADDRESS
CITY TELEPHONE NUMBER
TYPE CONNECTION V&_ES VERIFAWY__
SANITARY SEWER
. 1:1 N 0
SEPTIC SYSTEM PERMIT NUM13ER
Y OYES
APPV'D B CITY ENG.�/V El NO
0
u
NSE NUMBER
CITY LICENSE NUMBER
REMARKS
Legal Description of Property (Show Below or Attach,Four Copies)
s4P- e� alqet c4A d(
METE/R;SIZE, IBUILDING
suppLysizE
I
W
REMARKS
z
2
SIGN AR EA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADB NO.
i
u
ul
W
REMARKS
VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS I FRONT SIDE /REAR
0
LOT COVERAGE
1
EW RESIDENTIAL [:]GAS
N INE
L
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
HEIGHT
T.A
�N_]L R
ADD . NON-RESIDENTIAL SIGN
DEMOLISH ETAINING
WALL
ALTER EXCAVATE FENCE
OR FILL X—FT)
PRE -MOVE swim
REPAI . R INSP. POOL
I
I'_
Z
W
SPECIAL INSPECTOR
REQUIRED
[:] YES 0 N 0
OCCUPANCY
GROUP
1
OCCUPANT
LOAD
I LAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
NUMBER OF STORIES -114UMBER
2-
OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
I-
AJ
W
!a
VALUATION
FEE
Z
U
In
W
a
PLAN CHECK
NO.
BUILDING
z
W
'I
CL
0
J
W
>
W
PROPOSED USE
PLOT PLAN (INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
PLUMBING
m
0
HEAT & GAS LINE
FENCE
z
SIGN
RETAINING WALL
0
U
SWIMMING POOL
riEE r-FILE
DATE: oc--r -L4- )9-11
F
MEMO TO: Building Division
Community Development Department
FROIM: Engineering DivI sion
Public Works Department
SUBJECT: 6.S4- 6ILTtJL-X_
After review of the subject building permit application, we have
the following comments:
(1) Coordination of the location of any structure with respect to
utilities., streets, property lines and driveway grades is the
responsibility of the contractor.
(2) The contractor is required to keep the abutting streets clean-
ed of dirt and debris caused by the construction.
(3) A "Right -of -Way Construction Permit" is required, from the
Engineering Division of Public Works, for any work within
the Public Right -of -Way or public easement.
_(4) Driveway slope not -to exceed 14%.
W-4AIJA-615' PLAJ r&X— CXVV U06— O�
1 F IA13 PP_40M__ -rz> 66.-rAY,,JIIJ(&
OL'P6.
/7
PW 5/77
P1011C WORKS' DEP�RDRAILCKLIS`r
BUIIDING PER�= REVIEW
4- tkd 9"'
(address) (date)
Street Right -of -Way Existing
'�Z-6
Z
Access Easements Existing
__jEQD
FEQD /J
F4
Utility Easement Existing_ln Sr'
0 -sj /jd 4-r10' PEQP NFAI&-
Lot Per - Subdivision -Z Plat
Assessor
Site Plan Checked for Accuracy__D L/-
Z
Underground 14iring Reqd.
Check,Accuracy of Legal i;scription.
Z
Review by
Date 'to -
if
Existing Water Main Size
Water Main Required
Service Line Required
Hydrant Size Existing
P4
Hydrant Reqd Per Fire Code
Size
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Convients
Water Meter Charge Reqd.
Review by.
f
Date-
Septic Tank Design Approved
Date
Septic Tank Permit Reqd. WW
Permit No.
Sanitary Sewer Availabil Y-n
-]�roj. PL.�.-r
Drmqing No.
File No. L&�70 7
P4
Side Sewer Availability YE1,;
9
Sanitary Sewer Connection Fee Reqd.
/1�1,j A15 r#-u &V�,)
�3:
Review by
Date I
[4
F
Open Ditch Existing_�Jov-juc
--jReqd.
Culvert Reqd.. NO
Size
P4
Catch Basin Reqd. ijd
Indicate an Site Plan
0
Shoulder drainage maintain collection an swale open runoff
-
Manhole reqd. A,)0
Indicate on Site Plan A) 0
Soil Conditions and Ground Water Field
Checked t�i
Review by
Date 0 Z-4--
Revised: 1v10-1977
Page,2
Street Paving Reqd. '�j
Curb and Gutter Reqd.
Sidewalk Reqd.
Curb Cut for Driveway Reqd.
Right -of -Way Construction Permit Reqd.
Bond Reqd. for Public Improvements C)
Street Name Sign Reqd. 1J0
Other Signing Reqd.
Pre Permit Site Inspection made on
z
0
BY: SEWER
WATER
HZ STREET
H
ENGINEERING
Special Requiremerits listed in memo to Conmmity Development Department,
Building Division
BY Date
c) All items filled in on Building Permit Application
r4 BY Date
PL' Drawings Stamped and Notations Made
BY Date
Approved by Public 'Works Department
q
Mevised: .1v 10-1977
I Alk /"-�
BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
0: -7Xo-.rKis e.yA1"1,4W /H
W MAILING ADDRESS
Z
g '71 P1. �0657_
CITY TELEPHONE NUMBER
,a.,_JkV 4--w 1A 1 -7 7r-& 2-1
W
I
U
MICITY TELEPHONE NUMBER
< I
NAME
0 ADDRESS
F.
u
M CITY TELEPHONE NUMBER
I-
Z
01
U STATE LICENSE NUMBER ICITY LICENSE NUMBi
Z
0
U
In
W
Description of Property (Show Below or Attach Four
,�412_ t��, I -A 1#0 C_�A C/
USE ��ERMIT
ZONE NUMBER
q
JOB t
ADDRESS
LEGALj/0T BDIVISION NO.
YES No LOT AREA
STREET R/W _00
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
I COMP. PLAN ST. R/W IZ-0 FT. FT.
REMARKS
CHEC
STREET AND/OR UTILIT W R/W PERMIT REQUIRED A
REQ'D. F C3 YES No
0 YES N
UNDERGROUND
WIRING REQ'D. IXYES NO
TYPE CONNECTION ES VERIF E Y
SANITARY SEWER
El NO z6f�_
SEPTIC SYSTEM C-1 YES PERMIT NUMBER
APPV'D BY CITY ENG. AV I
REMARKS I
METER'S ZE
37411
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED I PROPOSED I COMPLETE I EXEMPT I
REMARKS
VARIANCE OR CU IPLANNING REVIEW BY I DATE
YARDS
GAS A0 I FRONT SIDE /REAF
rv. Ew RESIDENTIAL LINE FIRE ZONE -7-
1 TYPE OF CONSTRUCTION CODE
:1 NON-RESIDEN IAL
D El DEMOLISH.
DALTER EXCAVATE
OR FILL
SIGN
RETAINING
WALL
FENCE
(— X—FT)
.
I
SPECIAL INSPECTOR
REQUIRED
0 YES N 0
PLAN CHECKED BY
MREPAIR
PRE -MOVE
INSP.
swim
POOL
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
e�M-W_' rkv (:��
Ve, &U ki-,SID 6:1U C-
PROPOSED USE
Z
71-
PLOT PLAN NDICATE BUILDING SETBACKS,
ABUTTING STREETS)
U
In
W
a
In
0
n I
I hereby acknowledge that I have read this application; that the in-
formation given is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance.
NOTE: Permit Limit One Year(Except DEMOLITIONS and FILL
PERMITS without conditional use permit, which shall be completed in 90
days; MOVED -IN BUILDINGS shall be completed in six months.)
SIGNATURE (OWNER OR AGENT) DATE SIGNED
NOTE: Applicant Subject to Plar(Check Fee
PLAN CHECK
NO.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
AL AMOUNT DUE
OCCUPANCY
LOT COVERAGE
HEIGHT
OCCUPANT
LOAD
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
ATTENTION APPLICATION APPROVAL
THIS PERMIT This application is not a permit
AUTHORIZES until signed by the Building Official or
ONLY THE his Deputy; and fees are paid, and
WORK NOTED receipt is acknowledged in space pro -
I NSPECTION vided.
DEPARTMENT DIRECTOR'S SIGNATURE
CITY OF
EDMONDS DATE
775-2525
0
Z
W
W
Z
Z
III
M
W
3.
Z
W
W
Z
W
I
IL
0
W
Z
0
U
This Permit covers work to be done on private property ONLY.
Any construction on the public domain lcurbs, sidewalks, driveways, ORIGINAL - File YELLOW - Inspector
marquees, etc.) will require separate permission. GOLD - Assessor PINK - Owner