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1014 12TH AVE N.PDF1111111111 600 1014 12TH AVE N i ADDRESS: TAX ACCOUNT/PARCEL NUMBER: ri ,r 2ZrreM2 ...��r BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED), CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DA' EASEMENT(S) RECORDED FOR: PERMITS PLANNING DATA CHECKLIST DA SCALED PLOT PLAN DATED: SEWER LID FEE $: LID SHORT PLAT FILE: Q LOT: BLOCK: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: 6U , ?2 SOILS REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD DATED: OTHER: LATEMP\DSTs\Forms\Street File Checklist.doc 0 ROUTING FOCI TO. Lzitiai Date 4 .. APPLICATION Th City of Edmonds for ,,� E T FILE SIDE SEWER PERMIT EASEMENT NO_ ____________________________________________ S- NEW CONSTRUCTION REPAIRS ❑ LID �NO................... .ASMT. NO_ __________________ OWNER NOS -cam cc��vsT..--.................................. CONTRACTOR .�--�vwo�flp-r►G -----------•----.....--•-••----•-------------•----.......---._...__.....--••----•-•----------•------••--------------•---•---- PERMIT NO. ----•-•-•--•----.... JOB ADDRESS ----- - I - -- L�v� . ----------------------- LEGAL DESCRIPTION: LOT NO_ ______________________________________ BLOCK NO. ----------------------------- ------ • 11 /75 The City of Edmonds APPUCATION for SIDE SEWER PERMIT NEW CONSTRUCTION F] REPAIRS E] OWNER --- 4400/�-- ----- ------ 4w;t --------------------------------- CONTRACTOR JOB ADDRESS -/4-11-r - — ------------ 4:2.01.q IV .... ---------------------- --------------- LEGAL DESCRIPTION: LOT NO. d EASEMENTNO- ----------------------------------- LID NO. --- ---- 0 - ------------------ PERMIT NO. ----------------------- BLOCK NO. ------------------------------------ -------------------------------------- ...... .... --------------------- --------------------- -------------------------------- NAME OF ADDITION .-� --- ---------------- ---------------------------------------- IV/ r Approved: DATE-------------------------------------------- By --------------------------------------------------- s . . of Maintenance & Operation Public Works From: City Engineer. Subject: Sewer Connection Charges Date Auqug _ ?. ig76 RECEIVED AU G 3 1976 Public Works Dept. Legal Description: All.that portion of Lots 3 & 4 of Wagners Addition. lying west of the.following described line; beg at a paint on the south line of Lot 3 that is. 2-ft west of existing retaining wall measured at right angles to the wall, thence northerly on a line 2-ft from said wall to north line of Lot 4; All in Snohomish County WASHINGTON Commonly known as: 1014 12th Avenue N. Owner: Paul Nolan NOTE: Sewer installed by Plat Development Trafton/Wagner Z.F.F. Calculation: ( ) Z.F.F: X ( ) _ $ _ Connection Fee ( ) Lateral X ( ) _ $. Lateral Charge ( ) Unit X. ( $25 ) _ $ 25.00 Trunk Charge $ 10.00 Permit 35.00 TOTAL CC: ` 2108 I CITY OF EDMONDS - SIDE SEWER PERMIT /l 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. NO Sat., Sun., or holiday inspections. ADDRESS LOCATION OF CONSTRIICTION ............ C I ���? T' d.��—?.......�.:....... ..:........... - .................................................•..... PROPERTY LEGAL DESCRIPTION ............... .............................. OWNER AND/OR BUILDER _.r-� ..._....................................................... _..-� r.... CONTRACTOR'S NAME & ADDRESS----_------- -- - -� a r- mission Is granted ----------- ------ .......................... 19 +-l._;�for repair and/or connection of a side sewer to the city sanitary sewer s- ' aavn in accordance with City of Edmonds ordinances. J ATTENTION IS CALLED TO THE FOLLOWING: NOTE No. 1—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—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit. n 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 2q,. No bends in grade sharper than % 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...-........ By---------------- Date............... �...... By-... Date.. -............... B ❑--------------------- ..... By ................ APPROVED Date... .._ � � ................... By...------- -....... ... Remarks: ........................................... -............................................ V ------------------------------ --------------- .....................................................................------------------------------•------...-------•--••---........--........................_. BOTH a it Copie S Be Si d By Owner of Firm Performing Construction PRIOR To Request For Inspection — I,- .. ......------------------------------------ ---- hereby certify that the side sewer installation constructed- urider this permit Owner of Contracting Firm Performing Construction) was installed in accordance with all governing ordinances of the City of Edmmoopds. Dated . this----.(�...^-tP . - .- -...day of...........................•----..........-•----•---.....----••-1 192(� Check BEFORE you dig for: Water ❑, Gas ❑, Telephone ❑, Power ❑, Sewer ❑, Other ❑ V J RECEIVED STREET FILE OF EDMONDS EIiGINEERIN(:, DEPAR1[IFNT 505 GFIJ STREET EDMONDS, NASI I I NGTON 98020 APPLICATION FOR STREET USE PERMIT Nance of Applicant: 4;4, Mailing Address:��- % `L L_ f�� �� Telephone Number: %� L272—!1/4,0, 7 2,--l- Date: f AUG 2 5 1976 Description of Public Place or Portion thereof desired to be,t.rsed: ((fix ib1 nay be attached) s�tS', Type of Use desi red to be made of Public Pl ace:__ _ �BCJ 9�GQi�/ S- If applicable, attach. plans and specifications for any utility or structure to be erected and/or maintained on the Public Place: TEMPORARY PERMIT: Unless otherwise designated herein, this permit is understood by applicant to be wholly of a temporary nature, that it vests no permanent right whatsoever. If the permitted use becomes dangerous or such structure 'shall become insecure or unsafe, or shall not be constructed, maintained or used in accordance with the provisions of this title, the same may be revolved and the stn.rcture and obstructions ordered removed by order of the City Engineer. If this application is for a specified period of time, the terms of said.application is: INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from any injuries, damages or claims of any kind or descrip- tion whatsoever, foreseen or unforeseen, that. may be made against the applicant or the City of Edmonds, or any of its departments or,employees, including but not limited to the defense of any legal proceedings including defense costs, court' costs, and attorney'fees by reason of granting this permit. In addition, applicant unde-_rstands that. tide City shall be provided a certificate of insurance to indemnify and hold the .City of Edmonds harmless from all claims and/or property damage, naming the City of Edmonds as an also insured. APPLICATION OF CHAPTER 6:40 OF THE EDMONDS CITY CODE: Applicant warrants that he has read, or had the opportunity to read, Chapter 6.40 of the Edmonds City Code, attached herewith, and understands that all terms of that Ordinance are incorporated herein as if set: forth in full and this application and permit therefore are subject to the terms of that Chapter of the Edmonds City Code. M 0,VS j Ji N/ �ai✓ ___._ AppTi.-In s Sictnature 11/7/74 rev. City of Edmonds Engineering Department APPLICATION FOR STR'EET USE PERMIT -- Page 2 Approval (and Agreement, if applicable) of Abutting Property Owners: Signature Printed Name Address Date DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency) City Council Approval (Attach Minute Entry): zw Permit Fee: Annual Fee:^ due January 1, lg Amenities Design Board Approval (if applicable) Attach Minute Entry: �^ Building Official Approval (if applicable): Signature Date Provision for. Indemnity: Terms and Provision of Performance Bond, if applicable: (Reference 6.40.050 of applicable Ordinance) PERMIT AUTHORIZATION BY CITY ENGINEER? gnature PERMIT -NO. Remarks: ; DATE :1..1,1/7/74 rev. Am" 1-0 �I 6ILL @I�1�zly �U 101�41--��'i�+ An sl lzt Ivr:;P&br'+ on sis I �xx f�fV�D� iN& i%j 64D,4l�A+.� h&o QlYfUdl.� In4aahp�A.P Y'sac1YQR.{a-DrAttCh IS cis S6��OfAK 4 PL*41.1-i 1,0 ow A�Z�F. Ar. Vv, -or wamr A. Ai 0 40 3 : �- 5 774 1 '-1 '5. 7A6 LL 57-t;l 4' Fw 0 V 4rio .1 co Mx I S-r C- iz-2 P/'2 .5 —7,A F- go NJ nz!5 L) -rb 01 LCA, 9 , 415" AVY Ac L� M,r L--4 r .1 . `., A I .. - — - - l/, + `, Yai . A Hn% '40'UA"oo m O.L Lq4-viaiaans m Z 0 r v rr .. Permit Address Zi�4 • Legal Description STREET FILE WArm� &x�p BUILDING PERMIT REVIEW.- E^IGINEERING DEPARTMENT CHECK LIST Reviewer's' Intials 1. Septic Tank System Design Approved 2. Sanitary Sewer Availability)1�5—Sht. of Dwq. No. Project:,Side Sewer Availability: 3. Any Sanitary Sewer Connection Fees 4. Site Drainage Checked Zilwl 5. Storm Sewer Availability: Sht._of Dwq. No. It Project: t�-y� Roadside Ditch_e 6. Grading & Final Contours 7. Sidewalks (Site Inspection shows condition of existing walks as follows): 8. Curbs 9. Curb Cuts_������ 10. Underground Wiring Street Liqhtinq I 11. Street Right-of-way & Bldg. Setbacks: S Sht. . of Dwg. No. tZ of Official Street Map. 12. Existing Utility EasementsOka 39-t�, N 13. Access Easements —�►��� 14. Water Mains & Fire Hydrants (Indicate Size Water Main) 15. Bonds for Site Mork 16. Special Requirements listed in memo to Bldg. Dept. 17. Commercial & Apt. Requirements form completed 18. Drawings stamped & notations made 19. Site Inspection made on 20. All items filled in on Bldg. Permit Application 3 21. This Lot included in Subdivision (List any special requirements): 3/9/76 PROJECT ADDRESS / OWNER: EDITH HAGELIN 1014 12m AVE NORTH EDMONDS 98020 TAX No. 0060 7700 000 300 LEGAL: WAGNER ADDITON TO EDMONDS BLK 000 D-00 ALL THAT PORTION OF LOT 3 AND 4 LY WLY OF FOLG DESC: BEG AAP ON S LN SD LOT 3 THAT IS 2 FT WLY FR MEAS R/A TO BASE OF PRESENTLY EXST. CONCRETE RETAINING WALL TN NLY ON LN THAT IS 2 FT WLY FR MEAS. R/A TO BASE OF SD WALL TO NLY TERM OF SD WALL N-100-10- �a1�� ®�� 53W TO N LN SD LOT 4. ZONE: RS -12 LOT SIZE:.45 ACRE / 19,602 SQ. FT. SCOPE OF PROJECT: ADD NEW 3o DOOR TO LOWER FLOOR RECEIVED FOR FOOT ACCESS TO FLOOR LEVEL. NO NEW LOT MAR 2 3 2004 COVERAGE. NO GRADING. LOT COVERAGE: 1480 SQ. FT. RESIDENCE PERMIT COUNTER 288 SOFT DECK 1768 SO FT 9.0 % CONTACT DURING PERMIT PHASE: KRISTIN HANSON uAmenv nrrl _N �y� 1- IN � 16 o I� io al• I a0N5I a 1 N • 0 ��•1'4 m N � J! D PROJECT ADDRESS / OWAIER- EDITH HAGELIN 1014 12TH AVE NORTH EDMONDS 98020 TAX No. 0060 7700 000 300 LEGAL: WAGNER ADDITON TO EDMONDS BLK 000 D-00 ALL THAT PORTION OF LOT 3 AND 4 LY WLY OF FOLG DESC: BEG AAP ON S LN SD LOT 3 THAT IS 2 FT WLY FR MEAS R/A TO BASE OF PRESENTLY EXST. CONCRETE RETAINING WALL TN NLY ON LN THAT IS 2 FT WLY FR MEAS. R/A TO BASE OF SD WALL TO NLY TERM OF SD WALL N-100-10- 53W TONLNSDLOT 4. ZONE: RS -12 LOT SIZE:.45 ACRE / 19,602 SQ. FT.. SCOPE OF PROJECT: ADD NEW 3o DOOR TO LOWER FLOOR FOR FOOT ACCESS TO FLOOR LEVEL. NO NEW LOT COVERAGE. NO GRADING. LOT COVERAGE: 1480 SQ. FT. RESIDENCE 288 SO FT DECK 1768 SO FT 9.0 % CONTACT DURING PERMIT PHASE: KRISTIN HANSON u A NcnN TL CI!`_IV STREET FILE Nam-- IOZ � 1 a, COO . RECEIVED MAR 2 3 2004 PERMIT COUNTER Ll 1 i �0 10 Iff W i mom l�o' SIDE' ia�'T F>AQ5— SITE PLAN 1" = 20' 491 PROJECT ADDRESS / OWNER: EDITH HAGELIN 1014 12TH AVE NORTH EDMONDS 98020 TAX No. 0060 7700 000 300 LEGAL: WAGNER ADDITON TO EDMONDS BLIP 000 D-00 ALL THAT PORTION OF LOT 3 AND 4 LY WLY OF FOLG DESC: BEG AAP ON S LN SD LOT 3 THAT IS 2 FT WLY FR MEAS R/A TO BASE OF PRESENTLY EXST. CONCRETE RETAINING WALL TN NLY ON LN THAT IS 2 FT WLY FR MEAS. R/A TO BASE OF SD WALL TO NLY TERM OF SD WALL N-100-10- 53W TO N LN SD LOT 4. ZONE: RS 42 LOT SIZE:.45 ACRE / 19,602 SQ. FT. SCOPE OF PROJECT: ADD NEW 3o DOOR TO LOWER FLOOR ,.:4".FOR FOOT. ACCESS TO. FLOOR LEVEL. NO NEW LOT COVERAGE. N() GRADING. LOT COVERAGE: 1480 SQ. #T. RESIDENCE _288 SOF DECK 1768 SOFT 9.0 % CONTACT DURING PERMIT PHASE: KRISTIN HANSON HANSON DESIGN 652 ALDER STREET EDMONDS WA 98020 425 774 7129 425 7713152 FAX hansondesign@hoimail.com CONTRACTOR: POTTER CONSTRUCTION,INC. 5606 CALIFORNIA AVE SW SEATTLE 98136 206 935 9696 WA #POTTEC 1016RL MAR 2 3 2004 PERMIT COUNTER CONSTRUCTION INCORPORATED 5606 California Ave SW Seattle WA 98136 (206) 935 9696 WA General Contractors License YPOITEC1016RL www.potterconstruction.com 1 6i U ~ uj uj O w 0� _ a. U) SCALE: 199 =209 499 DATE: REVISIONS: PAGE: OF I RECEIVED MAR 2 3 2004 PERMIT COUNTER CITY Copy