7011 175TH ST SW.PDFiiiiii lill 11
1076
7011 175TH ST SW
City of Edmonds Permit No: . 57-0101
RIC7HT-OF-WAY CONSTRUCTION PERMIT Issue Date: 4_cZ_0!5__
A. Address or Vi I cinity of Construction: -76 11 0- 1 S t
B. Type of Work (be specific):
C. Contractor: LJ v-
D
E
Mailing
- .1 -7 'A
State License #:- /11 V i�_-:
P(510*ty Business License #:
Building Permit # (if applicable): -
Commercial
Multi -Family
INSPECTOR:
/ i
Contact: Li 0 V1 V_J� V
Phone: :1 c 6, &
7 k T_ Liability Insurance/.' �'�'Bond: $
AS-ide Sewer Permit # (if applicable):
F1 Subdivision [:1 City Project F1 EUC (PUD, VERIZON, PSE, COMCAST, OVWSD)
Single Family F-1 Other
F. PAVEMENT CUT: El YES El NO G. SIZE OF CUT x
CONCRETE CUT: YES n NO
G. F� Mail Approved Permit 41all for Pickup e'� /V&7rb
INDEMNITY. Applicant understands by his/her signature to this application helshe holds the City of Edmonds harmless from
injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of
Edmonds or an-v of its departments or employees, including but not limited to the. defense qf an-v legal proceedings including defense
costs and attorneyfees by reason ofgranting this permit.
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 TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
* Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
+ Restoration is to be in accordance with City codes. All'street-cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday - NO EXCEPTIONS.
* Three sets of construction drawings of proposbd work are required with the permit application.
'I k "� 7 , k., ! / I I � � "', I Lxv_--
CALL DIAL -A -DIG (1-84 -424-5L55)PR1ORT9 BEGINNING WORK
I HA VE READ THE ABOVE STATEMENTS AXD UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MAX&TJ1E PINK COPY OF TOE -PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature:
(Contractor or Agent)
Date: 4 - 9(,- 0)—
OR'CITy_-:LJSKONLY -
Right-of,*4y;Fe :.XI&C
Approved b 11#1 r_._ , _ �-, & 4
Y: Ild
Time Authorizgd: Void After, _L L;" 3 0 *7'j/ �2�, 0a< Disru'ptiQnT&/Vuhd1H: 010P,
Special Conditions: 1�)izE gcyy zi I A-c iRspecti6n.Fee: 2 9
8 tc TTF 1z rr;AJ,&17,1 lofu &I rc, Lz gA —rc Tota I Fee:
4P P, o\lr h AN,� 'A",)� TZkFric- 0r)o.4-riatu- Receipt:No:
Is,,
A Lc �2 LexAr-r-s Pt�:L-46� ,sued 4'.
M 7-1�4 -,7-A Q -r'A tv 6 Ar —n-4r F&a_ Or T'k4c� 0 ise
REQUIRED INSPECTIONS: 0 I'lZAFtcIC Cn,-T-t,?_0L-
Pl NAL
Z-2 420w 4?FST-0Je)47-J()/-1.
7
Call 425-771-0220, Ext. 1326for a 24-hour voice -recorded inspection request line.
FINAL APPROVAL OF PERMITTED WORK: �-� V i,-C j1 r vi v.41 k DATE:
'Inspector's Signature
.... ....... . 1 .1-1
CADocurnents and SettingsTurtisNy Documents\Fonns\Engnrng\ROWpertnit_,doc
Revised 10/01/03
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APPROVED AS NOTED
BY ENGINEERING
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City of Edmon*'ds* PERMIT NO: OW
PERMIT EXPIRES <91QI05
SIDE SEWER PERMIT
Address of Construction: —loll I :z 5D, S�l LID
Property Tax Account Parcel No. Cy)5i31o00I439(V
Attach copies of all access and utility easements Verified and Approved by
Owner and/or Contractor: Vx V e V I TKC,
Contractor License#: jc) N vF, 1 1 -.4 61 ci 5 K-7 tjder Building PermitA
NEA Single Family
Multi -Family (No. of Units
E] Commercial (No. of Units
Invasion into City *Right -of Way: KYes E] No'
*RW Construction Permit #
Cross other P . rivate Property,: El Yes No
Attach legal description and copy,of recorde easement.
r
Owner or con0i"actor signature and acknowledgement statement:
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.
_�_ - j - 0 J107
Date
2 CALL DIAL -A -DIG (1-800-411��5555) BEFORE ANY EXCAVATION 2
Iff FOR INSPECTION CALL 425-771-0220 extension
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
FOR OFFICE USE ONLY
Permit Fee $ Repair Fee IssuedBy:
6D Date lssued.'��
Assessment Fee $ Receipt No: 30
City Permit Surcharge Fee 15.00 Total Fees Paid $
NOTE: IF JOB SITE IS NOTREADY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION -.FEE WILL BE, CHARGED.
Job Site Ready YES NO Date: Initial:
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED:, Date: Initial: A's-built to Street File:
_r� A4 A _-�RCJ
15, PERMIT MUST BE POSTED ON JOB SITE'�j-
White Copy: File Green Copy:. Inspector Buff Copy: Applicant
L;temp;bldg,forms,sspermitjlg4/00
67-
NOTICE:
No warranty of accuracy.
The information shown on the attached map(s)
was compiled for use by the City of Edmonds,
its Employees and Consultants. The City of
Edmonds does not warrant the accuracy of
anything set forth on these m.ap(s). Any person
or entity requesting a copy should conduct an
independent inquiry regarding the information
shown on the map(s), including, but not limited
to, the location of any sewer stub shown. Such
sewer stubs may or may not exist and may or
may not exist at the location shown. Neither
the City of Edmonds nor its employees or
officers shall be liable for the informatio'n given
on map(s), nor for any one representation
provided based upon said map(s).
RONDS, 'SIDE -SEWER" PERMIT
WATER�SEWWER.'DEPARTMENT
PERMIT
(,,C.a., 1 775-2525 for side. sewer' In spect ions: BEFORF� -covering. any' "portion, rof' -the' construction
r�ctlon will be providedl within 24' hours after r.equst.* NO- Sat . Sun.. :or' holiday Inspections)
4N
ADDRESSyLOCATION)OF CONSTRUCTION ...... �f.k .............. ...... i ... P.M ....... ....... ..... ........................................................ ....... ......... ......... ........
PROPERTY,,.LEGA,L*,DES�CRI-P.�TION ...........................
....................... .............................. .......
....................... ........ ..... ......
.............. ........... ......... ................................................................... . .............. ............. ............................................ I ............
....................... ..........................
. ....................................... ...... ........... ..... OXVNER,��D/OR'. BUILDER—, .. .................... 245�$V� . . . .......... I ........... 7 .... 7 .....
y.... ............................
,CONTIVACToR,§,,N�im�E�.&:A�DDRESS ......
...... ................................ ........ ........... ........... ------------- ....................... 1--� ...........
C
Penytission ls.,grantiad,,_...,.� .... . .............. :> ......................... 19�._ f6r.repair a;ndVor.- onnectidn. rof a to',Alie;�Oty
y
ar?" M,
system iw accordanc,64lih-1—City,of Edmonds' -ordinances.
A _.4TION M CAM;kb��TO. THE -FOLLOWING:
NOTE No.� I�Tfie' =nersrof , th:t property. may --obtain a,permit to :construct sew en, .1 nslde�,prcperrty Iine� A' licensed, Side Sewer -Coritractor,.muit,;b6,employed-:to�'construct
V, side sewerltw.stre area,. Do not cover any,portion of:sewer,'before, it �haa,beewlnspected;.
-All, -way, re4ulrss::a:n Inva�sion, �of' Mgitt� ablb.Jb6m,the, City, Engiheer�
]�OTR No._14—, work,,Performed�..int,city,right.-of of Way,P6rrnit!'obtaJn s'offlcie':
formatio n.regaxdin n
NOTEi No�.�Z? btaln-Juffin' g Ordina, �e-11'4.630! aha; Aegulations: 'governing.,side-gewers'wfien you,ijet pei-rnit�.
'NqTF ak 30,,Inche's �covera ajtd['1M?Inches Inside,'propertj line; minimum;
,No��,4—,Top:of,�side sewen"must �have at -le gq ;.at.property�llne lgrad�,��of',2%.,� No.bends, In�igrkde,,
shsurper,than'��14 '_w
Ill belpermitted,..
res e resp?iisible; for�.f, I iduel',tci,, Irnp;roper
NOTrE No. &Z-Trenches iw,'street must,.be water,settled andt:surface of: street tored tot,orikinali conditlom Contractors� shall b a fure'
work which may"develop� within. -one- yea� of �compl6tioir.
NOTE No. 6—It is unlawful.,to,,alter,or,doi,&ny, o her work than Is provided for, In: Alfe,,permit, -or, to, do�,any/ work on:the.mal� ii,-,sewer��orl.its�'aLpp6rtlenances; excepVtol, In-,.
sert'the pipi;.Jntw the.wye��..'
By Da e ..........
E] Date ... .................................. By_� .............. Date ...... ......................
y ......... .
'By
_'APPROV.
..................... ......... ......................... ....... .................
ED ......
Remark .. .... 4/1
7 ......................................... ......... ...... .................. : .............. ............. ...... ................. ................... ..............
........................................... .................... ....... ............................. ............. .............. ............................................................. ............................... ....... ..........
BOTH Permit,1Co�ies,MUj ST'Be:Signed By'�Own6r,'o Performing,�Cbnstruction.'�PRIOR,,To,'�Regii6st-.F�or Inspection -
I ...... -00 �N ........... b rtif-yt,'hzit,t-he�sidie�,s6wiar,-In,�t� ljation,constructed�,,tin 'er', "i"'
.: ... .... P ........... ere y ce d :th ��Perxnit�
(Owner of �LContracting,, Firm- �Perf orming, Construction-)!,
W1
h, _,,Stalledln� accordance with:'all�-goveriiing,,.ordinaiices�6f'.,�-he,iCit-�. OVEdni6nds1.,
D 9�
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........................ ...... "Y of., ................................... ....... ....... ........
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Check, BtI.F-ORE,,youdig'-for,:.,'--Watei,Ej,,, ho erEl. ro�V�r.ih-,, �ewe �E]'�,, -'Otl e 'El'
APPUCATION
The City of MmoroSTREET FILE for EASEMENT NO - --------------------------------------------
SIDE SEWElt PERMIT
NEW CONSTRUCTION REPAIRS 0 LID NO - ------------------ 'ASMT. NO. -----------
OWNER - - ----------- ------------------ --------- - - k� CONTRACTOR ----- PERMIT NO.
JOB ADDRESS ----
- -------------------------------------------------------------------- LEGAL DESCRIPTION: LOT NO. ---------------------------------- BLOCK NO - -------------------- ---------------
...................................................................................................................... -------------------------------------------
NAME OF ADDITION ..... ......
.................. ---------- ..................................................
The City of Edmonds
APPLICATION
for
SIDE SEWER PERM
NEW CONSTRUCTION A, REPAIRS E]
OWNER
.A ---- ---- ----------------
JOB ADDRESS ---- Tall ----- A/ ----------------------
V
Lrf*-
I \
A
EASEMENT NO - --------------------------------------------
LID NO - ------------- .----,ASMT. NO - ------------------
CONTRACTOR --------- ---------------
LEGAL D T NO. ---------------_--- BLOCK NO.
................. --------------------------------------------------------------------------------------------- _----------
NAME OF ADDITION ------- & .-P!91 ..... --- er ------------
Approved:
DATE
By--------------------------------------------------- i.i7yg
Ul I -Vi- t.u,..0i�AJJ
b1l)-G. DEPT.
CONI[_)ITIONAL PERN11T
W _OR K
-
jfy
ADDRESS--/Ot/
V 6 4. 1�,
OWNER-
APPRO%,*ED
BY
BLDG. CAl-T-lir"l
K'EEP 'i S'T"' ��wIPED
1 .1
PLA� S
_11�_�,',��E 10(,R
ALL
FERMI IT No
OF
Ui
27
GLENDAN CONST.
P.O. BOX 303
EDMONDS. W,N. 90020
-I �p - OD,
-�) E c V,
CITY OF EDMONDS' V
P. Vf. DEPT. ENGINEERINU UIG v '
E-AMIN
B y E Etj� 'J"',�DATE
REMARKS
�Z9 1
R E_ C E IN E D
E C ') 9 1977
,:,�y LF
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690 -199-
City of Edmon& -
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.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (e.g. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the, best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name
K,
Street Address
City, State, ZIP -4,,.Phone
signatu Date
Applicant Representative:
Naine
Street Address
City, State, ZIP Phone
Signature Date
^-rr%
a i mEET
FILE
Critical
CA FILE NO.94- 53
Areas Checklist
Site Information (soils/topography/hydrology/vegetafion)
1. Site Address/Location: 2c-) I � q c---, <�,
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? -X— yes; — no.
If yes; how is site developed? �A,� Ot I S C ct p'r. C'4 —,Lo .-I
5. Describe the general site topography. Check all that apply.
-feet elevation change over entire site.
Flat: less than 5
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater tha n 30 % present on site (a vertical. rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round st��ding water: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway N j c-,) floodplain N 0 of a water course. rV U
9. Site contains a creek or an area where water flows across the grounds surfaci? Flows are year-
round? N Flows are seasonal? AJ 0 (What time of year? AJ I A
10. Site is primarily: forested meadow _; shrubs mixed
urban landscaped (lawn,shiubs etc)
11. Obvious wetland is present on site: rV i�
CA FILE NO.94- 53
Critical Areas Checklist
Site Info'rifi-a66 ii.,,-,'(spils/topography/hydrology/vegetation)
1. Site Address/Lo6ation:
-Z
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? -X-yes; — no.
If yes; how is site developed? 'S C
ck -.r 71 .-1
r
5. Describe the general site topography. Check all that apply. � V-(
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15 % (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15 % and less than 30 %. ( a vertical rise
of 10-feet over a horizontal distance of 33 to 66-feet). ,
Steep: grades of greater tha. n 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: (�J Approx. Depth:
7. Site contains areas of seasonal standing water: N 0 Approx. Depth:
What season(s) of the year?
8. Site is in the floodway N c,� floodplain NJ 0 of a water course.
9. Site contains a creek or an area where water flows across the grounds surfac�? Flows are year-
round? f \j 6. Flows are seasonal? AJ C, (What time of year? Lkj I A
10. - Site is primarily: forested meadow ;shrubs
mixed
urban landscaped Qawn,shrubs etc)
11. Obvious wedand is present on site: rV iL�
ACYtewea.jDy:
..;Da
RcV 01/0494
a, -go - 199 -
City of Edmon&
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 Edmondsprior
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,
0�-
and submit it to the City. The City will
review the checklist, make a precursory site
visit, and make a determination of the
subsequent steps necessary to complete a
development permit application.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (e.g. site
plan, topography map, etc.) or studies in
coidunction with this Checklist to assist
staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Applicant Representative:
Name Name
Street Address
City, State, ZIP hone
LS -E \,A
Signatu 0, Daite
r
Street Address
City, State, ZIP Phone
Signature
Date
7'�
�Utyof Edmonds.
RIGHT-OF-WAY CONSTRUCTION
PERMIT
A. Address or Vicinity of Construction:
Permit Number-'9
Wue Date: 7 A .
'14' 4'M�,
Inc. 'JS<)QJ B. Type of Work (be specific): M P r
C. Contractor: E20 _T_y1C. Contact: GA %A
:Y-i
MailingAddress: Phone: li-'�(%,O)
State License #: S�nz= 4 1 C g :z Liability Insurance: v/ Bond: $ !)OC7-00
D. Building Permit # (if applicable): � d
Side Sewer Permit # (if applicable):
E. F-1 Commercial 0 Subdivision 0 CityProject F I
] Utility (PUD, GTE, WNG, CABLE, WATER)
EJ Multi-Famil4N_o Sing e anu y E] Other
INSPECTOR: INSPECTOR: 10
F. Pavement or Concrete Cut: 0 Yes 3QNo G. Size of Cut: x H. Chargt�_$
APPCICANT TO READ AND SIG'N
INDEMNITY- Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany
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 legal proceedings including defense costs and atiorneyfees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings of proposed work reiluired with permit application.
A 24 hour notice is required for inspection. Please call the Engineering Division, 771-0220.
Work and material is to be'inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in a�cordance with City regulations as required by the City Engineer.
All street cut trench work shall be patched with asphalt or City approved material prior -to the end of the working day;
NO EXCEPTIONS.
I have read the above sWements and understan 17he pert" it r
d quirements and the pink copy of the permit will be
available on site at al * esforinrsponpur es.,,,,
Signature: A ;A/1 A
f.t_dl Date:
CALL DIAL -A -DIG PRi/OR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME AUTHORIZED: VOID AFTER QQDAYS
SPECIAL CONDITIONS10m..J.. w-W 41,PT
QQ'1414— 1�2ti- e A re'61
. f/
RIGHT OF WAY FEE: 3 0
DISRUPTION FEE/FUND I 11:
RESTORATION FEE:
T OTAL FEE:
RECEIPT NO.:_� G)
ISSUED BY:
Gw
NO WORK SHA , LL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Di� 1997
FIELD INSPECTION NOTES
I Comments:.
I Diagram.:
(Fund 111 - Route copy to Street Dept.)
� 0
CONTRACTOR CALLED FOR INSPECTION El YES NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
f" . I
OFFICEe 12061 778-2557
I
, r, CONS I RUC I IUN UJIvirt"'y 1, 11'v (206) 881-2577
Consultants / Drainage Contractors / BODINC* 3 32BT FAX: (206) 672-2434
6009 - 212111 St. S.W.
Lynnwood, WA 98036
SCOTT WARREN
7011 — 175TH ST. SW
EDMONDS, WA. 98026
PH: 743-7086
FIELD REPRESENTATIVE
STEVE BODINE
NOVEMBER 14, 199/
BID B-1114D7
PROPERTY ADDRESS
7011 — 175TH ST. SW
EDMONDS, WA.
BODINE CONSTRUCTION COMPANY IS PLEASED TO SUBMIT THE
FOLLOWING BID PROPOSAL FOR YOUR REVIEW.
PROBLEM DRIVEWAY DRAIN DOES NOT DRAIN, OVER FLOWS BACK UP
INTO -GARAGE.
RECOMMENDATION
CONNECT 1 EACH 12" X 12" CONCRETE CATCH BASIN INTO 4 INCH PVC
RIGID TIGHT LINE DRAIN PIPE. OUTLET TO STORM DRAIN AT
STREET. UPON COMPLETION OF JOB, ASPHALT DRIVEWAY,
LANDSCAPING, WALKWAYS AND BUILDING SITE TO BE REINSTALLED AS
CLOSE AS POSSIBLE TO ORIGINAL CONDITION.
WARRANTY AND CERTIFICATION: THIS DRAIN SYSTEM, LOCATED AT
7011 — 175TIl ST. SW EDMONDS, WA., SHALL BE UNDER WARRANTY
FOR 15 YEARS FROM DATE OF COMPLETION. BODINE CONSTRUCTION
COMPANY, IN., WILL MAKE ANY NECESSARY CORRECTIONS TO THE
ABOVE SAID DRAIN SYSTEM IN THE UNLIKELY EVENT OF MALFUNCTION
TO THIS DRAINAGE SYSTEM.
BID AMOUNT: $2,250.00 PLUS TAX
SPECIAL NOTES: A) SAWCUT ASPHALT DRIVEWAY
B) PIPE TO BE SDR 35
C) BACK FILL MATERIAL TO BE CRUSHED ROCK
D) SEAM SEAL EDGES
F) _?
'InCIwAed SIGNED COPY OF BID
TERMS: UPON BID ACCEPTANCE PLEASE RETURN
WITH ALL ACCEPTED ITEMS CIRCLED AND INITIALED. A 30-0i, DEPOSIT
------ — JN COMPLETION.
IS REQUIRED TO SCHEDULE WORK, BALANCE IS DUE UP(
ACCEPTANCE DATE:
ACCEPTED BY:
S1 CERELY,
STEVE BODINE
BODINE CONSTRUCTION
COMPANY, INC.*
JOIA10 'S
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USE PERMIT
CITY OF ED O-NDS ZONE NUMBER 4
CONSTRUCTION PE RUIT APPLICATION UITE??APT
JOB
ADDRESS
OWNER NAME NAME OF BUSINESS 7o Ll
V111 et\j 9- e.r--j -DESCRIPTION CHECK SUBDIVISION NO ILID NO
MAILING AUVHtbb
Z EET MAP TESCP A
3- -4 Cj \7� PUBLIC RIGHT OF WAY PER OFFICIAL STA Iwo�ed
I, Requ.'ed
0 CITY ZIP TELEPHONE NUMBER W Par'! Req'd 0
EXISTING REOUIRED DEDICATION — S Use P.-it ROQ'd C3
.i'.'I)6.'CU2e. P*Z.�rad 0 <<v
F_t')'CV\0NbS 91�.0-2_6 ILI "a 1 F( PROPOSED Sidewalk Required 0 M
NAME $�i
METER SIZE LINE Sl E NO, OF FIXTURES PRV REOUIRED
YES 0 NO 0
ADDRESS Z
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ZIP TELEFHONE NUMBER 3 'Rf,41,
CITY 0
NAME
ADDRESS Y�
R=ED By
JINORINP MEMO -7-T7 17112.1,1,77
CITY ZIP f ." TELEPHONE NUMBER -0 DATED REVI Y
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STATE LICENSE NUMBER EXPIRATION DATE 51ON AREA SEPA REVIEW ADS NO.
Legal Description of Property - inciuce all tillsen ...... ALLOWED PROPOSED COMPLETE 1EXIMPT SHORELINEN
Z C.IA I. I'—p j I _
VAR ANCE OR CU
PLANNING REVIEW By DATE
EIGHT LOT COVERAGE Z I
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SETBACKS — FEET
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0 FR�NT SIDE
Propert REMARKS
Tax Acdount t;l\ 110 G T�,_2_ (0 0 9
Par�ell No.
NEW R1 RESIDENT'IAL PLUMBING
ADDITION E-1 COMMERCIAL' MECHANICAL
FIRE MODEL El APT.BLDG. SIGN CHECKED BY T
[3 GRADING CYOS. FENCE x. FI)
REPAIR
' .. E SRECLAL rj.EJT�� I ARqAt OCCU�ANT
lOODS7OV ..t LOAD
NSE:IT REOUIRE
13YES'
GARAGE RETAINING WALL/ REMARKS
CARPORT I I ROCKERY El RENEWAL Z
Z PROGRESS INSPECTIONS PER USC 305
9 (TYPEO USE�BU HE I EXPLAIN:
<
NUM R ARIT
W NUMBER OF - CRE ICAL
AS.1
0 OF DWELLING
M STORIES UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLANI
1-r- FINAL INSPECTION REQUIRED
VALUATION FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE: GLAZING %
PLUMBING
MECHANICAL
Plan Check No.
This Per it covers Work to be done on private property ONLY. GRADINGIFILL
Any Construction on the public domain (curts. sidewplks.
drivOWavS. Marquees, SIC) will require Separate permission. STATESURCHARGE
Permit Application: 180 Days SfORMO"INAbEFEE
Permit . Limit: 1 Year - Provl�dlltl woikli Started W, Ithin 118�0_Days
"Applicant, on 5 or her spouse. heirs, assigns anG END. INSPECTION FEE
s cceSSOfS in interest, agr a to indemnity. defend and hold
UrMlesS the City of
h Edmonds, Washington. its Officials.
ims for damages of
employees, and agents from any and all Cis
PLAN CHECK DEPOSIT
whatever nature, arising directly or indirectly from the Issuance
x of this permit. Issuance of this permit shall not be deemed to
M )r reduce any requirement of any city ordinance
odify. waive I By the City's ability to enforce any ordinance TOTAL AMOUNT DUE
Ox nor limit in any w
provision."
fhliiieby acknowledge 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
regulating construction; and In doing the work authoriz- AUTHORIZES signed by the Building official or his/her
state laws ONLY THE
ad thereby. no person will be employed In violation of the Labor Deput * and fees are paid, and receipt is
pensa- WORK NOTED Y.
Code of the State of Washington relitling to Workmen's Corn acknowledged in space provided.
INSPECTION
DEPARTMENT
Si NATURE (UWNEA ORA DATE
Li C1 CITY OF
L
EDMONDS RELEASED Sy�
CALLIFOR
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR'OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS QEEN MADE AND APPROVAL OR 771-0220 ORIGINAL — File YELLOW — Inspector
A 'CERTIFICATE OF OCCUPANCY'jHAS BEEN GRANTED. USC oiNK — Ox,.e, GOLD — Assessor
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Ob-b--ALTA Commitment, Page 2
Order No. A73518
LEGAL DESCUPTION
That portion of Tract 143, MEADOWDALE BEACH, According to the plat thereof recorded in
Volume 5 of Plats, page 38, Records of Snohomish County, Washington,.described as
follows:
Beginning at the Southeast corner of Tract 143;
THENCE North 1037130" West along the East line of said Tract 143, a distance of
454.78 feet to the Southeast corner of the Plat of Brockman Park, According to the
plat thereof recorded in volume 37 of Plats, page 119, Records of Snohomish County,
Washington;
THENCE South 880334128" West along the South line of said Plat of Brockman Park, a
distance of 216.38 feet to the true point of beginning of this description;
THENCE continuing South 88034128" West, a distance of 76.00 feet to the Southwest
corner of Lot 2, said Plat of Brockman Park;
THENCE South 11025134"* East along a line drawn parallel with and lying 30 feet
Easterly of the centerline of 71st Avenue West as conveyed to the City of Edmonds by
instrument recorded under Auditor's File No. 2078769, records of Snohomish County,
Washington, a distance of 99.83 feet to the point of curve of a curve to the left
having a radius of 20.00 feet;
THENCE Southeasterly along the arc of said curve -to the left and consuming a central
angle of 75048100" an arc distance of 26.46 feet;
THENCE South 87013134" East a distance of 17.66 feet to the point of curve of a curve
to the right having a radius of 353.48 feet;
THENCE Easterly along the arc of said curve to the right and consuming an angle of
6036112", an arc distance of 40.74 feet;
THENCE North 9039100" West, a distance of 122.67 feet to the true point of beginning.
(ALSO KNOWN AS Lot A of Surveys under Volume 8, page 25 of Surveys, recorded under
Recording No. 7808100283.)
REGARDING:
7011 - 174th Street S.W. '303 -o&/60
_ssT
Ta—d Tr—e
R E C 0 R
D 0 F C 0 N T A
C YS
DATE
NAME, PHONE NO., &
ADDRESS of CALLER
CONVIENTS
ACTION TAKEN
INITIALS
5/l/74
George Lindsay
Certified Letter No. 406201 sent
TE
requiring hook-up within 60 days.
5/10/74
Can't pick up letter from P.O.
Typed letter of release.
TE
5/20/74
Letter returned. Not claimed at P.O.
Referred to Jack for hand
delivery. TE
7/1/74
Certified Letter No. 406520 sent
Letter received.
TE
requiring response by July 12.
7/11/74
Lynnwood Sewer came into office and
TE
obtained permit #4958.
7/11/74
Cgpnggtion cgM eted.
TE
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-sid
SHAI D.ER:., Si:.s tire' fo".1 0i I)b W `in,i! r.u.c.'f*icl.n s otli,obthcr*� �.6
CKE
PLEASE FURNISH'SERVICE(S)
I NOICAT
'i(.4dditi0)z(t1 churi�es J-e� it i I ed fo,�*
-ess,,.. e I
Shciw,aa�di
.1:11]1' ver— LY-*_;�;*,-,�`,�
tn;td aidi: ressee;,
where deliVe*re%d�
::R tGE1 OT
I-fic
Reeiived. f he -numbered Icdes;cribqd4bcI0W'��1*"%
'SIGNA I UR� ORJNAME OF ADDRESSEE (Mbs 'ah�ays,'be filled --in)-,
TEGISILRED NO. t
CERTIFIED NO.
-ANY
S,IG-NATURE-,o,r,ADDRMEE,',S-AGIK\IF
IN91JRED. NO.
y
UATE DELIVERED, -SHOYI.. WHERE ELIVERED - - inc1udeiZ1,Pi;Cod0�-,,
RECEIPT FOR CERTIFIED MAIL-30� (plus postage)
SENI TO POSTMARK
OR DATE
CD I. AND NO.
P,0, STATE AND ZIP CODE
A
OPTIONIAL SERVICES VOR ADDITIONAL FEES
RITU and date delivered .6 0
1. Shows to w�_on_i
REC IPIT With delivery to addressee only
," 2. Shows to whom, date and where deli
SERVICES With delivery to addressee only
DELIVER T ADDRESSEE ONLY ...
SP�.(,IAL DFF1V_fRY (extra foe required)
PS Form NO INSURANCE COVERAGE PROVIDED— (See other side)
Ap r . 1971 3800 NOT FOR INTERNATIONAL MAIL QP0: 1070 0-397-460
RECEIPT FOR CERTMED MAIL-30� (plus,postage)
FIVIARK
303-061ou 0 Tr
L I NDSAY , GF H KG L-
Q p,
7011 F14TH ST SW
rQ1
t D M I) N 1) S It 1W A S H I N G T 0 N
980
OPTIONAL SERVICES fRLI�_DITIONAL FEE
xJ ............ 15
RETURN w 11 dc�ivery to adijressel? (it, 65
� 1. shows to wl om and dite doliverp
RECEIPT 2. Shows to whom, dilto and where delivered .. 350
SERVICE With delivery to a(ldresson only ............ 850
DELIVER TO ADDRESSEE ONLY .......... ...... ............................. 50d
SPECIAL DELIVLRY fee —,.q,,ied) ..".7 . ......... I I I
PS Form 3800 NO INSURANCE COVERAGE PROVIDED— (Soo other side)
Ap . 1971 NOT FOR INTERNATIONAL MAIL OPO: 10700-397-4130
PUBLIC WORKS DEPAMM CFEMIST
BUILDING PER111IT REVIEW ST sw_
(address)
o%awr%r-r-or Pall Ps
i Irl bb
�date)
St IRF -PWting
N-X
Access Easements Existing_ ki
C� to Iff jEQD_hL&_
p�
Utility Easement ExistingLZ&�E;
REQD_&&_
W
Lot Per SubdivisioA;75�-J�Plat
Assessor
Site Plan Checked for Accuracy�__
Underground Wiring Reqd.
Check Accuracy of Legal Description
Z
Review by
Date
Existing Water Main Size
Water Main Required. G " D-T
Service Line Required -?A
Hydrant Size Existing
r,%'
Hydrant Reqd Per Fire Code Ya-:�>
Size
Detector Check Meter Reqd. j.�
Cross Connection Inspection Q0
Fire Depart=t Conuients
,4ater �tter Charge Reqd
Review by Vkx�
Date 1--2,-7 -76
Septic Tank Design Approved
Date
Septic, Tank Permit Reqd.—
Permit No.
Sanitary Sewer Availabili�y
Proi . f'&A 7-
Drawing No. I
File No. 7 7-1
Side Sewer Availability_
Sanitary Sewer Connection Fee Reqd.
�3:
Review by K4Z--��
Date
Open Ditch Existing
Reqd.
::E�
qd.
�V*/�� 0-"p
/
C 'Vl�agln Reqd. i4l
/Infftate on Site Plan
C) —
'S�-
oulder drainage maintain collection on swale open runoff
Tllai�ole reqd. A117,
Indicate on Site Plan
Soil Conditions and Ground Water Field
Checked
Re�view b
—Date
Revised: lvlO-1977
BUILDiNG WARIMENT
Appli . cant Fill
ZONE NUM B i ER
APPLICATION
Inside Heavy Lines
JOB
ADDRESS 07011
.7 5 J14.o1I
ED,(O.R �,F� M E 0 F 13�U S I N E
cr;u
LEGAL LOT
JWYES 13 NO
9
LOT AREA
SUBDIVISION NO.
W
Z
MAMII�M ADDRESS
CITY TELEPH45NE-NU MBER
STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
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C) r
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COMP. PLAN ST. R/W -30 FT. FT.
NAME
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W
ADDRESS
CHECKED BY
U
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CITY
ONE NUMBER
STREET ARD/OR UTILITY WORK
R/W PEZRMIT REQUIRED
REQ'D. :::: 7N
a Y :E-S NO
YES
19 YES ONO
UNDERGROUND
WIRING REO'D, PYES
NO
0
U
ADDRESS
TYPE CONNECTION 9;YES
SANITARY SEWER
VERIFIED BY
B
<
ONO
I Y
TELEPHONE NUMBER
SEPT C SYSTEM P
OYES PERMIT NUMBER
0
APPVI'D BY CITY ENG.
JaNO --------
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STATE LICLN __
SE NUMBER
CITY LICENSE NUMBER
REMARKS
-LLA k
Legal D criiption o�Pqrty
'_0
(�ho�jelow or Attac- our Copies)
METEr SIZE
BUILDING SUPPLY SIZE
tj
SIGN AREA I COMP�NV. REVEIEW ADB NO.
ALLOWED I PROPOSED LETE I XEMPT I
R F
REMARKS
V A
VARIANCE OR CU
PLANN ING REVIEW BY
DATE
NE W
RESIDENTIAL GAS
A
YARDS
C�5_ 1 FRONT
SIDE REAR
LOT COVERAGE
0 ADD
ALTER
El REPAIR
F-1
LINE
NON-RESIDENTIA SIGN
Ll
N.NG
DEMOLISH RETAINING
EXCAVATE OWALL
OR FILL FENCE
_X FTJ
I— X—FTl
PRE -MOVE swim
INSP. POOL
I R*
FIRE ZONE
TYPE
OF CONSTRUCTION
ICODE
HEIGHT
SPEC
SPECIAL INSPECTOR
E Q
REQUIRED
0 YES El N 0
OCCUPANCY OCCUPAI
GROUP LOAD
LA
P N '-HhC:KE:D BY
THIS W 1 1: 15 LOCATED IN THE CITY
OF EDMO N DS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
NU BER OF STORIES
INUM BER OF
REMARKS
OWE LL. NG
UNITS
N ro B
Zi�
—
I=
Uh5
D USE
1 In
U LDING S
E 8 IL
ABUTTING STREETS)
PLAN CHECK
NO.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
VALUATION
FEE
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E ?C PERMIT
BUILDING DEPARTMENT
NUMBER 900/9
in
PERMIT APPLICATION
;i e Heavy Lines
U0
-
08
DDRESS
N,
M OR JAME OTIF11TUSI.EM
GAL LOT
LOT AREA
ISUBDIVISION NO.
VEM ONO
MAILING
ADDRU55
III
Z
STREET R/W
EXISTING STREET R/ w FT. DEFICIENCY THIS PROPERTY
0 CITY
COMP. PLAN ST. R/W FT. FT.
13
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REMARKS
NAME
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W
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TC;H�
�ECKED By
W
W
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ADDRESS
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STREET AND/O UTILITY WOR
'PERMIT REQUIRED
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CITY
TELEPHONE NUMBER
REQ'D. MYES ONO
EYES ONO
UNDERGROUND
"ME
WIRING REQ'O. R'YES 0 No
0
ADDRESS
'CT'O
TYPE CONNECTION -4 ES
SANITARY SEWER N YES
VERIFIED BY.
VERIFIE�
_7
0 No
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SEPTIC SYSTEM 0 Y E S
S
PERMIT NUMBER
P
TELEPHON NUMBER
_,TY
APPV*D BY CITY ENG.
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CITY LICENSE NUMBF R
REMARKS
STATE LICENSE 14UMUM-
SIZE
arty o Four Copies).
Legal Dqscription oi Pro er h elow or Attach
METE SIZE
BUI ING SUPPLY
W
RE MA
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W AT ERR 9-10 t
2
SIGN AREA
SNV. REVIEW
ADO NO.
IL
ALLOWED
PROPOSED
COMPLETE
EXEMPT
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REMARKS
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VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS
r
LOT COVERAGE
C4
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f
GAS
El
J. FRONT REARI
SIDE
HEIGHT
NEW
RESIDENTIAL
LINE
FIR E ZONE
TY PE OF CONSTRUCTION
CODE
073
ElNON-RESIDEN IAL
El SIGN
V
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ElRETAINING
7 D DEMOLISH El WALL
SPECIAL INSPECTOR AREA9
REQUIRED
OCCUPANCY
GROUP —1
OCCUPANT
LOAD
0 YES TrNO
D ALTER EXCAVATE FENCE
[_� OR FILL El I— X—FT)
PLAN CHECKED By THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
F� REPAIR PRE -MOVE swim
El El POOL
SHOULD BE CODED .. 31.04.
INSP.
REMARKS
NUV6ER.OF STORIES
94UMBER OF
DWELLING
0 C, C -T I C) N S
Z
61
OF WORK(O BE DONE
UNITS
—n * Pal— OW18
0
N KTRE
A
VALUATION
FEE
PROPOSED USE
PLAN CHECK
7
Z
0
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PLOT PLAN (INDICATE BUILDINCm SETBACKS,
ABUTTING STREETS) 1.11
BUILDING
7-7
C
U
PLUMBING
W
M
HEAT & GAS LINE
0
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
I hereby acknowledge, that I have read this application; that the in
TOTAL AMOUNT DUE
0
3ct
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-
ATTENTION
APPLICATION APPROVAL
lating construction; and in doing the work authorized thereby, no person
is a
will be employed in violation of the Labor Code of the State of Washingto
THIS PERMIT
This application not permit
relating to Workmen's Compensation Insurance.
AUTHORIZES
until signed by the Building Official or
NOTE: Permit Limit One Year(Except DEMOLITIONS and FILL
ONLY THE
his Deputy; and fees are paid, and -
PERMITS without conditional use permit, which shall be completed in 90
WORK NOTED
receipt is acknowledged in space pro -
days; MOVED -IN BUILDINGS shall be completed in six months.)
I NSPECTION
vided.
SIGNATURE,lOpVNER OR AGENT)
DATE SIGNT
DEPARTMENT
DIRECTO SIGNATU E
CITY OF
—DATE
EDMONDS
NOTE. Applicant �ubject to Plan Check Fee
775-252.5
2
This Permit covers work to be done on private property %31-4L. ORIGINAL - File YELLOW - Inspector
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission. GOLD - Assessor PINK - Owner
CONDl-f;',0NAL PEIjk'MIT
WORK-
ADDRESS-'�011 ll'o
id.
OWNER -
APPROVED ATE.1
BY
BLDG. Oi FICIAL
KEEP -11----SE STAMPED
jOSSITE F
PLANS N OR
ALL lj'c-'�FECl-10Ns
PERMIT'NO. SHEET
�>OF /*
LIL41
IN, L �07R
vo
ZONE
SEVI-)
Iff
THEIR --
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/7,
HE GHT
CU t —
17-5
- ------ DEC 9 1977
CITY OF EUMONDS
GLENDAN CONST.
P.O. DOX 303
EDMONDS, WN. 90020
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