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11922
1031 MAIN ST
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION 9g _ 1 g-7
A.
B.
f h C.
189�
PERMIT permit Number.��"'
Issue Date• -I ( 0
/'-
Address or Vicinity of Construction: /AV
Type of Work (be specific): -�g � ✓J fI v e Lc/ 0t�
C. Contractor: 1 t_L. Contact:
Mailing Address: 1 1,3 ,,>n(a F rn.y,rtjS Phone:
State License #: n r) o -rors n g re Pi Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ❑ Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family Single Family ❑ Other
INSPECTOR: INSPECTOR: \
F. Pavement or Concrete Cut : ❑ Yes )]No G. Size of Cut: x H. Charge $
-APPLICANT TO READ AND SIGN
1
INDEMNITY: Applicant understands and by his signature to thisiapplication to hold 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 any of its departments or
employees, including or not limited to the defense of any legal proceedings including defense costs and attorney fees 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 _STREET PATCH IS 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 required with permit application.
A 24 hour notice is required for inspection. Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance 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 statements and understand the permit requirements and the pink copy of the permit will be
available on site at•all times for inspection purposes:
Signature: Date: -7
(Contractor or Agent) —'—
CALL. DIAL —A —DIG- PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY
TIME AUTHORIZED: VOID AFTER JId!6J �9 DAYS
SPECIAL CONDITIONS: lei ilk S j4 au U v
/e-4)V l} lee '► I V►�.ue � iezt
4�
RIGHT OF WAY FEE:
3 Q
DISRUPTION FEE/FUND I It:
RESTORATION FEE:
TOTALFEE: mil) .�V
RECEIPT NO.: el 1 / 0p
ISSUED BY : ?
?'
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
�.-�... "T.en-+."?t4"-- * KT'+c. ,R,ugES3 �;�.s VR..a ,—..,y w• i ws�'-.wT'^ -v^ . ",.^--T- ..-'�..R'.,..ye.�7
777
7
7
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
CA FILE NO. qp 2-.
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 1 D _3 MAl.20 S�, 1. � DO A OS
2. Property Tax Account Number: i!3 12, —O qo -03a - 0009
T
3. Approximate Site Size (acres or square feet): ( J&jl , ,aov,c.
4. Is this site currently developed? Z yes; no.
If yes; how is site developed?
5
G.1
Describe the general site topography. Check all that apply.
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 than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: /u a ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway
�c floodplain i-J' of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? A.)0 /- e_ Flows are seasonal? ,vU (What time of year? VV ).
10. Site is primarily: forested ; meadow ; shrubs : mixed
urban landscaped (lawn,shrubs etc) ✓
11. Obvious wetland is present on site: /Jc $ -P-
.G�NDITIONAL y!AIUER-
Date .
?S-
7v�
^a, chk.doc; Rev 10/03/97
City of Edmonds
FIECEIVED
MAY 0 6 1996
PIANNiNG DEPT.
-ftT 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 f ll 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).
Owner/Applicant:
Name
Street Address
L nm a (Jos . W n qev---,o
City State o�ola — 5 , 5 &qq Zip
G� 1'70 C-'+4
Telephone
Signature
Applicant Representative:
Name
e 11,2 ok o �,0,.6L,J
Street Address
City State Zip
Ws -. o)s-o1.?1/
Telephone
Ci
Signature
Date
Date
(over)
loc. 1890
May 20, 1998
Sherry Shriver
1031 Main St.
Edmonds, WA 98020
CITY OF EDMONDS BARBARA FAHEY
MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771.0220 - FAX (425) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works • Planning/Building • Parks and Recreation - Engineering • Wastewater Treatment Plant
Subject: Determination regarding Critical Areas Checklist # 98-132
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
IMPORTANT INFORMATION TO BE NOTED:
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
y You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL 40
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB" Land Use Applications
Any other development permit applications.
Enc: Critical Areas Determination
`Architectural Design Board
Thank you.
Sharla Graham
Acting Planning Secretary
C:ReceptlonUana\C RLTR.doc
• Incorporated August 11, 1890 •
Sister Cities International — Hekinan, Japan
PLANNING DATA
NAME: ✓ �� �'�
SITE ADDRESS: �°1� DATE: I
ZONING: K-57 ( PLAN CHK#: 7q - 1 7 J
PROJECT DESCRIPTION:
CORNER LOT & (Yes/No)
SETBACKS:
FLAG LOT I -lb (Yes/No)
Required Setbacks: S- -I
Front: 20"'Left Side: 5 Right Side: Rear: 1S
Actual Setbacks: / / -11
Front: Z-D Left Side: 410 Right Side: S Rear: SS
Street map checked for additional setback required? Mwl (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED `� (Y/N)
LOT COVERAGE: ��
Maximum Allowed: -75 Actual:
BUILDING HEIGHT:
Maximum Allowed: 2 Actual Heifls
Datum Point: Datum Elev ' rf��
A.D.U. CREATED?: Na7 L r�Cc2vJ� ��
s�.
SUBDIVISION:
CRITICAL AREAS #: C4
SEPA DETERMINATION: PAS 15Svep
� 11717,
LOT AREA: hll z °��
OTHER: Iflb:s
r
Plan Review By: l a:-rau-7
c:Viles\permit\^plandatdoc
0iVAf eZ ��G7 '/) Ri1A/N77�/✓ e%XbSivJ GoNTIZOL
0 WAI &t 26a 'D iv co..i /" p5r vlads . 5 o e' ivsB
_ 6LOW
IMOIN IOCA4 @SANG
W SETBACK
LEVEL LOT
�ti r
EXI5TIW3 RE6IDENCE
Lai
1
J
/d ENTRY
20' SETBACK LINE
5'- • W-Im•
PROPERTY LINE TYPICAL
6100'
50EWALK
,p-o-vj• Pam,
ee� 1-D
MAIN 5TREE-
�2L D
I6'-a•
DRIVEWAY
,0Rq/0k0
BUILDING
JUN 8 1998
PROPOSEp
GARAGE
9 352 5OF
n
320 4 ,,•7P
9 �
N
APPROVED AS NOTED
I D (0 20 74 9 - 5 iq 6 4,
t�-�L- Ln-rs 32 � 33 Bc-� �o �-ITY ��- �D►-��uDS
\/O -
ow�� - .Sft�.��Y 3�►-t�I��.
89p-194
STREET RLE
CITY OF EDMONDS AURA M. HALL
250 - 5TH AVE. N.. EDMONDS, WA 98020 • (206) 771-0220 • FAX (206) 771-0221 MAYOR
COMMUNITY SERVICES DEPARTMENT
Public Works . Planning . Parks and Recreation • Engineering
January 14, 1993
Sher_ry_Ness__
1 031-Main Street--
Edmonds, WA 98020
Dear Ms. Ness:
I have reviewed your account and will allow a credit to your account
according to our City policy: the average consumption for the same
period during the previous year charged at normal customer rates, plus
the excess usage charged at the City's cost, plus a surcharge of 15%
applied to the excess only. Only one leak credit will be granted in
any three year period.
Should you have any additional questions after you receive your new
billing, please contact Ilene Larson, Utility Billing Clerk.
Sincerely,
Ron Holland
Water/Sewer Supervisor
RH/lk
cc: Ilene Larson
Utility Billing Clerk
#219125/TXTWATER
• Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
46J.
VL-11 5/62 PRINTED IN U.S.A.
i
8go 19C'
CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-3202
COMMUNITY SERVICES:
Public Works • Planning • Parks and Recreation • Engineering
September 23, 1991
Sherry Ness
1031 Main Street
Edmonds, WA 98020
Dear Resident:
LARRY S. NAUGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
On October 11, 1991, the City of Edmonds Water Section will be
increasing your water pressure to your residence to approximately 120
pounds per square inch.
If not already existing (as required in the plumbing code, Chapter
19.30.020 in the Edmonds City Code Book), you or your plumber must
install a pressure regulating valve to protect your water lines and
fixtures. This will allow you to adjust the pressure to your needs and
protect you from pressure surges.
If you have any questions regarding this matter, please call me at
771-3202, extension 317 or Scott Highland at extension 318.
Sincerely,
P,-"" !I.ZD
Ron Holland
Water/Sewer Supervisor
RH/lk
Enclosure
WPRESS/TXTWATER
0 Incorporated August 11, 1890 •
19.30
CHAPTER 19.30
PLUMBING CODE
19.30.000 ADOPTION OF UNIFORM PLUMBING CODE
Uniform Plumbing Code, 1988 Edition (including Appendices
A,B,C,D,E and H, but excluding Appendix I), copyrighted in 1988
by the International Association of Plumbing and Mechanical
Officials, is adopted and by.this reference incorporated herein
as if set forth in full as the "Plumbing Code for the City of
Edmonds," subject to Chapter 12 of said Code relating to fuel gas
piping being superseded by the Uniform Mechanical Code as set
forth in section 19.25.000. [Ord. 2725, 1989]
19.30.010 BOARD OF APPEALS
Section 201 of the Uniform Plumbing Code, adopted by this
chapter, is amended as follows:
201 Board of Appeals. The Board of Appeals created and
established in Chapter 10.15 of the Edmonds City Code shall act
as a Board of Appeals in making a determination of any appeal
arising from actions of, or interpretations by, the
administrative authority. [Ord. 2725, 1989]
19.30.020 PRESSURE REGULATORS
4
A. Residential. An approved type of pressure regulator preceded
by an adequate strainer shall be installed on all residential
occupancies, adjacent to the water shutoff on the interior of
any such occupancy which shall reduce the pressure to eighty
psi or less. For potable water services up to and including
one and one-half inch regulators, provision shall be made to
prevent pressure on the building site of the regulator from
exceeding main supply pressure. Approved regulators with
integral bypasses are acceptable. The strainer shall be
readily accessible for cleaning without removing the
regulator or strainer body or disconnecting the supply
Piping. All pipe size determinations shall be based on
eighty percent of the reduced pressure.
B. Other. Section 1007(c) of the Uniform Plumbing Code as
previously adopted is amended as follows:
(c) Any water system provided with a pressure regulating
device or check valve at its source or other water system
(09/30/89)
203
CITY OF ED'MONDS
F/ NEW
❑ ADDITION
❑ RETIREMENT
DESCRIPTION
ASSEAF ORMATION SHEET
hi:L F L
ASSET N0. Do 2 G 1 5-
ADDITION TO ASSET NO.
SERIAL NO.
LOCATION DEPT. NO.
10,31
°*PURCHASE ORDER NO. _
PURCHASE ORDER DATE
COST
*PROJECT NUMBER
PROJECT COMPLETION DATE 6 - 3o - $ o
COST a 6 V • .s7
B.A.R.S. ACCOUNT NO. q// " ooG - O ��` - 3 -LI5-
® ESTIMATED LIFE a
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
® DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
INITIAL _
REFERENCE
VERIFIED BY
PROCESSED
BATCH NO.
DATE
The City of Edmonds Side Sewer Drawing EASEMENT NO. -- ---------------------------------------
NEW CONSTRUCTION ❑ REPAIRS X LID NO. -145f;--- AS NO --
_V9. -----------
OWNER ----- ...... f= ----- CONTRACTOR ------ <=)j .................................. ........... PERMIT NO.
JOB ADDRESS --- L(='-� L= ... 1, �-tv--A ..... LEGAL DESCRIPTION: LOT NO. ..... BLOCK NO. .......... 4<Z>
PWW4)001-11f75 (REV.11178)
DATE ---- 5 --- --- Z Z:e- By ............
..................................
CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT FOR INSPECTION CALL Permit 6 ,
SIDE SEWER PERMIT 775-2525 Ext. 220 Issue Date
PERMIT MUST BE POSTED ON JOB SITE
it
1. Address of Construction A931 / cby ,' ' `�2-0
2. Property Legal Description (include all easements) 0 T 1;: 2 4 3 3
BU' 4-0 _. Cam n F Cdvnondr
3. Single Family Residence Multi -Family No. of Units
Commercial
4. Owner and/or Builder
5. Contractor & License No. �('j4,¢JG�t?(� '��B ]�&40
6. Invasion into.;City Right -of -Way: No A. Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
z 7. Cross other private property: Yes No Easement required -
u attach legal description and county easement number.
H
a READ THE FOL.LOWI,.NG AND SIGN:
a
� a. Property owners must obtain a perm1=5 ins a on
>4 their property. A licensed side sewer con ract us b (�Mc�Q o
A construct side sewers in the public right- f-w a8 HOURS
W - b. The side sewer contractor assumes ull i ii€Eea h
w installation for one year. �� qt6
w
c. Commercial establishment requires mi a ")
:4 side sewer line.
o d. Side sewers may not be installed c
to any structure. S�H c0
%V
M e. Side sewer lines must be laid at a ra ltIkNAt t6
and maximum grade of 100% (450) .
H f. No turn in side sewer greater than 450 (1/8,bend) is0allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil. _
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be -responsible for right-of-way failure
due to poor compaction of fill.
k.. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
tio7- IzeA0 f` �• DATE: / p' t t , • `` : \
.I- certi
,_yc.��S �V'� y that I have read
p, . ✓ V ���®/a0 and shall comply4with the above
PERMIT FEE: -� ,-aj
U W
O CONNECTION FEE:
DISAPPROVED By: Date:
APPROVED By fp,*,Date:
Date: �p
* PERMIT MUST BE
TED ON JOB OTTe
CITY OF EDMONDS 4prmit No. _ —6) 9
7.
t
PUBLIC WORKS DEPARTMENT � G � � � � � Issue Date
RIGHT - OF - WAY CONSTRUCTION PERMIT v
A. *Address or vicinity of Construction • Permit Issued To.' h
•T Owner: hia441"� �i�.'�5 ' �- :�c2s�% • Type of Work to be Done:-7721,1✓ie211 + ',a'1,-.'E' i,--
Name p p '
/''� ate' • Work in Connection With: -- v
Mailing Address ❑ Sub or Plat +C Single Family
E:,01/ ?O/P%A_ U;;4, 9,czn ❑ Comml. / Ind. ❑ Apt. Condo.
City, State, Zip Code • Pavement Cut: ❑ Yes No
• Contractor:��/1�
Name
Mailing Address State License Number
CdZJ City, State, Zip Code Telephone Number
a * * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
a
¢, B. APPLICANT TO READ AND SIGN
O INDEMITY: Applicant understands and by his signature to this application, agrees to hold t rmless
from any injuries, damages, or claims of any kind or description w atsoever, fores n o made
against the City of Edmonds, or any of it's departments or emplo es, in;:�' or t li i1WAL!! n y legal
proceedings including defense, costs, court costs, and attorney fees y reas ' f ti g t 's peP1$titHouRS
t BEFORE
WUpon issuance of this permit, the contractor is responsible for workm and a� riaf io of`o a year
0 ! following the final inspection and acceptance of the restoration by he En isio .
E~ �
Funds held from the Security Deposit (estimated restoration fee) 1 f ed, at
which time a debit or credit will be processed for issuance to the ar p 1 cart �C�A �g SNOHO �ISH COUNT
�°il 5344 UTILITY COORDINATING COUNCIL
Work is to be inspected. Restoration to be in accordance with Cityo e. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this permit must be available at t
Signature:
~Owner or Agent
for inspection purposes at all times.
ate (Q ��0/t-()
* * THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By: Permit Fee: , It-) Y"i� fz-7
Time Authorized: Quid after days Security Deposit: A • P
Z Fy �.
O Special Conditions:.ARC"l� i�` + r - nrri t + f � Receipt No.: M6'
Law�lflr!" v,� +1 _-Pi�- nAla Uii-19 r. Fund 111 Fee: N% -A
-Ammenclments: a 4, . 0-") 1 n r'' Street Cut DimensionsLt
to 3 ye- X
it
Lc.
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. December 1978
FIELD INSPECTION OES
(Fund. 111 - Route cony to Street Dept.)
Diagram:
Contractor called for inspection Yes No
Work Disapproved By: Date: Bv: Date:
Work Approved By -_--=___—Date: Z171f"*.a
Inspector:
Enci. Div. December 197P
CITY OF EDMONDS Permit No. '.
PUBLIC WORKS DEPARTMENT_ Issue Date 'x: 4 f1' �
RIGHT - OF - WAY CONSTRUCTION PERMI ,, ET P L E
A. *Address or vicinity of Construction • Permit Issued To:
• Owner: \ aJ 0+ 1 DPI • Type of Work to be Done:
Nam e „) ,� � 1 U '4 101. �,. � v`D 1 tti; � � 1
1' D t) u� • Work in Connection With:
Mailing Address ❑ Sub or Plat A Single Family
❑ Comml. / Ind. ❑ Apt. Condo.
City, State, Zip Code • Pavement Cut: ❑ Yes :54 No
• Contractor: �9- o U0, D to vjN•'
Name
Mailing Address State License Number
City, State, Zip Code Telephone Number
* NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
INDEMITY: 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 description whatsoever, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this permits must be available at the,j
Signature:
Owner or Agent 1
ite for inspection purposes at all times.
11 -'"
tit THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES yt yt
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By: ,! • �� • (�'!�
Time Authorized: Void affter ��' ��1 days
Special Conditions:
Ammendments:
Permit Fee: -
Security Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimensions
X =
* NO WORK TO BEGIN PRIOR TO PERMIT1SSUANCE
Eng. Div. December 1978
FIELD INSPECTION NO S (Fund. 111 - Route copv to Street Dept,.)
Diagram:
Contractor called for inspection Yes No
Work Disapproved By: Date: By: Date;
Work Approved By: �� Date: �—
Inspector:
Ena. Div. December 1978
it
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Ai
t5 N.,tr {-f�, -.� .a., 'R., yr: ��'. .iv. • y.• M! TIr J� lid 1
JJ OC AT IQNr _ ' + `-,i�+` ' 'DATE.
n
P No. �^I...; REVISION . G. fttE NO.
REASON FOR WOR1� p l t'S, C �, ENGINEER '• AS ISUIIIT r
DRAFTER SCALE
.,..�._=fit4 -tic.tik_-•:t�s_.'t�i- gpfppovnLs -_; -; , jr�a���—.--'—:.•
7f. PERMI R U`"�t� �- - c• • ,. a O►1,4WNAL :,ANALYSIS .>
TYPE • , Ut1tE0 QT REQUIRED❑TREE TRlfNM1N_ GWATfRMPT.` f a_ NOT EXEMPT
�D{AL DIG -'SEWER• 4- r
..:r.—.—.,t.. - -1 PARA I T;m
F DATE GRANTED- Q*UD'LOtATOR :TOGAS
T2 RELEASED -O. H. r G `COND. _ �_KV
BACK HOE
"-FOREIG04 CONTACTS NCIC�IG ;` "ADD ,CKT. FT.,�,�__FK
to fBES RfQt1iRED - Yf`S °.N F 0. L cmy _,.�� KT ` FT. 4r,PH. .;
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FORTANTI Prerl Firmly While Writing A rlicationl
• �ermit
Building Relocationo
plicant Fill
�S(_;i� �, 1,11 u w PERMIT
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Heavy Lines
�(-,� 'jrjl i NUMBER 2-80
OWNER'S NAME
NEW SITE ADDRESS
Daniel E. Engbretson
Fs_1031 Main Street j
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MAILING ADDRESS
EDMONDS PRE -MOVE
INSPECTION 800008
1035 Main St.
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CITY & ZONE
TEL NO.
PERMIT NO.
FIRE I
1 2 3
ZONE
BLDG.
FOWORKMIT NO.
AT NEW SITE 800057-
Edmonds Washington (778-5764
MOVING CONTRACTOR
MOVE CONTRACTOR'S INSURANCE COVERAGE
Ohio Company
STREET ADDRESS
FG SURETY
PROVIDING OF& �- '1
P.D. COVERAGE (
10503 268th Ave N.E
CITY & ZONE
TEL. NO.
STREET ADDRESS
Carnation, Wash. I
788-3485
,�nl c���rt /�,�,l,See attached
CONTRACTOR'S
Ch-10—C-216CE
_
SS
SNO.
CITY,
ZONE & STATE'STATE
_
LICENSE NO.
NSEEEF
VALID INSURANCE POLICY CHECKED BY:
DATE
SITE DESCRIPTION
Roxanne McBride
I 4-11-80
ADDRESS OF PRESENT BUILDING SITE
2 g.�1�. 6tr Seattle, Washington
Nag.
BUILDING DESCRIPTION
Legal;encA, r.n oT Preee Site — (Show below or attach four copies)
DESCRIBE BASIC CONSTRUCTION & PRESENT USE OF BUILDING:
20 Vrs old-Gond i2andit pn
OVERALL LENGTH OF BUILDING: C, FT.
ADDRESS OF NEW BUILDING SITE
HEIGHT AS LOADED WIDTH AS LOADED BLDG. AREA
1031 Main Street
14 181111 FT. 231 FT. I C>C'/i SQ. FT.
Legal Description of New Bldg. Site — (Show below or attach four copies)
Lots 32&33, Blk 40, Cityof Edmonds
POLICE DEPT. AZOVA F MOVING ROUTE
By: < Q
C
DATE
Time Commence Moving: ...5!..a Q am ..........................
Line 2 Pq 39. S no t re�,,ords
4 -13 — 8 0
0
MOVING ROUTE
Time to Finish Moving: .... •..
MP r r i ci A i n to 6 tY1 t f7 ? 2 n t-)1
FIRE DEPARTMENT CLEARANCE OF R TING
By:
DATE
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down 220th to 84th to Main &
down Main to 1031 Main.
ENGINEERING CLEARANCE
�,
DATE
r
CLEARED BY:
RELOCATION
PERMIT
RECEIPT NO.
A
4 —1— 8
Power Company .......................
Telephone Company - an. 15 8 --. .......
FEE 10.00
:
NAME OF OWNER OF PRESENT BUILDING SITE
ATTENTION:
PERMIT APPROVAL
Lloyd Engbretson
THIS PERMIT
THIS PERMIT DOES NOT BECOME
MAIL OR HOME ADDRESS
1035 Main Street
AUTHORIZES
VALID UNTIL SIGNED BY THE
ONLY THE
RELOCATION
BUILDING OFFICIAL OR HIS DEPU-
TY, THE FEES ARE PAID, AND RE-
CEIPT IS ACKNOWLEDGED IN THE
I hereby acknowledge that I have read this application; that
the information given is correct; and that I am the owner, a
OF THE
SPACE PROVIDED
duly licensed moving contractor, or the authorized agent of one
BUILDING
of these. I agree to comply with city and state laws regulating
NOTED
building relocation; and in doing this work, no person will be
employed in violation of the Labor Code, State of Washington
relating to Workmen's Compensation Insurance.
--•'•'.-----•..-••••---••'•••••--
Director's Signature
Signature of Owner,
BUILDING
Contractor, or
Authorized Agent....................................................................................
vSPECTION
R416
4 —11— 8 0
Date ........ .... . ....... . ..... . .... . ......................
Signer's Phone
CITY OF
Address........................................................... No. ...................................
T'40NDE[)
DISTRIBUTION OF COPIES
City......................................................................................... .. ..............
1cf7YP(R. 1b"g NUS
WHITE — File (Bldg. Dept.)
PiANNiNG Utpp.
YELLOW — Move Inspector
Date..................................................................................
GREEN — Asses
GOLDENRODsor
Police Dept.
PINK — Movine Contractor
R/ csm. IN Eanwm MOM 676-
EDMONDS,WASHINGTON
REVISION NU A
L V�coi n� 11
RECEIVED
APR 11 '80
CITY Of EDMONDS
PLANNING DEPT.
f
ALE
DATE : 2- 4 -0
HEM TO: Building; Division
Community Development -Department
FROH; Engineering; Division
Public Works Department
SUBJECT: '_/03/ i'LIA/I1I S%
After review of the subject building; permit application, we have
the following; comments:
1 _ / 0�1/1�i��vH 7`O C/fi1 wA/P�- S✓s/phi ►?�.ii l''�1'
Art
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BUILDING PERMIT REVIEW 10 31 MA I K Sr z-4-86
(address) —(3to
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Street Right -of -Way Existing _ �iD
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Access Easements Existing,
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Utility Easement Existing_,
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Lot Per Subdivision Plat
— Assessor Map G,
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Site Plan Checked for Accuracy
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Underground Wiring Reqd.
N
Check Accuracy of Legal Deso4ption
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Review by
Date
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Existing Water Main Size
Water Main Required
Service Line Required
Hydrant Size Existing
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Hydrant Reqd Per Fire Code
Size
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Detector Check Meter Reqd. IYZA
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Cross Connection Inspection
Fire Department Conuents
d
3
Water Meter Charge Reqd. Q ��
Review by y �e-awl
Date - --5 - ,6 a
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
Proj,
Drawing No •
File No.
Side Sewer Availability
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Sanitary Sewer Connection Fee Reqd.
3
Review by,
Date
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Open Ditch Existing �y
Regd.
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Culvert Reqd. ,�� „r .<--'
Size
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Catch Basin Reqd. ,�� -e_.
Indicate an Site Plan ----
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Shoulder drainage maintain collection on
swale open runoff
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Manhole re d.
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Indicate on Site Plan _
Soil Conditions and Ground Water Field Checked u/
Review by
0'
Date
Revised: lv10-1977
Page 2 • •
Street Paving Reqd. jp
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Curb and Otter Reqd.
w Sidewalk Reqd. r
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a Right -of -Way Construction Permit Reqd. c/
H Bond Reqd. for Public Improvements?�—
Street Name Sign Reqd.
Other Signing Reqd. fYU /Ii
A.. Pre Permit Site Inspection made on
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ENGINEERING
Special Requirements listed in memo to Comzamity Development Department,
Building Division
BY Date
o All items filled in on Building Permit Application
a BY Date
r'' Drawings Stamped and Notations Made
w BY Date
d
Approved by Public Works Department
Revised: lv 10-1977
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USE WRMIT
BUILDING DIVISIONr Applicant Fill ZONE UMBER
PERMIT APPLICATION Inside Heavy Lines
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ADDRESS A S 7
NAME (OR NAME OF BUSINESS) �}
_ LEGAL DESCRIPTION SUBDIVISION SHORT SUB NO,
ly MAILING ADDRESS J� —�
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0 7-JJ PUBLIICC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY ELEPHONE NUMBER
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NAME PROPOSED
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ADDRESS
PUBLIC IMPROVEMENTS REQUIRED
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DRAINAGE IMPROVEMENTS REQUIRED ❑
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CITY TELEPHONE NUMBER DRAINAGE PLAN REQUIRED
UNDERGROUND WIRING REQUIRED X
NAME
CONNECTION TO SANITARY SEWER
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0
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ADDRESS ❑
ELEVATION OF PROPERTY CORNERS
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& FOOTINGS REQ'D
FCITY
TELEPHONE NUMBER
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SEE ENGINEERING MEMO DATED-
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STATE LICENSE NUMBER
CITY LICENSE NUMBER CHECKED BY
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Legal Description of Property (Show Below or Attach Four Copies) METER SIZE BUILDING SUPPLY SIZE
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TYPE OF CONSTRUCTION
HEIGHT
❑ NON-R ESIOENTIAL
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SIGN
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ADD
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SPECIAL INSPECTOR
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OCCUPANCY
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OR FILL
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PLAN CHECKED BY
THIS SITE
IS L CATED IN THE
REPAIR
PRE -MOVE
INSP.
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SWIM
POOL
CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
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NUMBER OF
DWELLING
REM/ARKS
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VALUATION
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BUILDING
PLUMBING
MECHANICAL
FENCE
"Applicant, on behalf of his or her spouse, heirs, assigns and SIGN
W successors in interest, agrees to indemnify, defend and hold harmless
J Washington, g employees,
f the City of Edmonds, ashin ton, its officials, em to ees, and RETAINING WALL
aagents from any and all claims for damages of whatever nature,
x arising directly or indirectly from the issuance of this permit. Issu- SWIMMING POOL
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USE PERMIT
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' NUMBER
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ADDRESS I31
.CONSTRUCTION
OWNER NAME/NAME OF BUSINESS
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SUBDIVISION NO.
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Legal Description Of Proertyy: include all easements
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REMARKS
PROGRESS INSPECTIONS PER UBC 108
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NUMBER
NUMBER OF
CRITICAL
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STORIES
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NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
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VALUATION
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BUILDING
HEAT OU E:•
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Plan Check No.-ii7-^/ �yi
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
r
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
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successors in interest, agrees to indemnify, defend and hold
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harmless the City of Edmonds, Washington, its officials,
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employees, and agents from any and all claims for damages of
PLAN CHECK DEPOSIT
a
whatever nature, arising directly or Indirectly from the issuance
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of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
°
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision.'
tYr�
I hereby acknowledge that I have read this application; that the
informationgiven is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and in doing the work authoriz• AUTHORIZES This application is not a permit until
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees arepaid, and receipt is
lion Insurance aria .27. INSPECTION acknowledged in space provided.
SIGNATURE (OWNER Ok42ENTV DATE SIGNED DEPARTMENT
�t CITY OF OFFI I IG RE DA
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• EDMONDS ,�
ATTENTION CALL FOR RELE' Y; ATE
INSPECTION it G
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE O� 0 IGINAL — File YELLOW Inspector
UNTIL A FINAL INSPECTION HAS BEEN MADE.AND APPROVAL OR 771 1wo
—
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109 �� A PINK — Owner GOLD — Assessor
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