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1048 B AVE.PDFIIIIIIIIIIIIII 10194 1048 B AVE ------- ---- � . - ,Distaff . City o f Edmonds ---Water '16� TAP CARD - Department ` 963 " Date. August 28, 1 No... ................ No ................ ...................... Tap Size......3.L4..`.'............ Size. ............... ...................... Mfgrs. No..- n........:..................................... Style ................................ ...... For IW -..B.. Street ..................... _...__....._ W; H. Kcdo achie ......................................................................................._................-......._....---....----...... LotNo ........................................... Blk. No ........................................... Add-------------------------------------------................................................ ServiceLocation........................................................................... _..... ........ Meter LocationA1,11..... CQ1i°1�1..e,!�.....Pf?o o 2_Tey. Make Tap Pressure..............................lbs. Test .................................... % SendBills to.........................._--------------------................-----.._......._..........._..._..... Date of Work .................. Foreman Guar. Voucher No ........................................... $............ ...............---- --.... Remarks........................................................_.....------------................._..---............... .......................................... . ....... .. ................... .J ... n ETFLE ......................... ..................... . 0 ...... . ....... . ....... . . . . . .............. OUTGOING Index ........Reg.......Route Bk....._.Stenal..... Car&...... INCOMING Index ......... Reg ....... Route Bk... _... Stenal.—Card..._... NAirial Chargeable to Installation NW1.51, NO. E DESCRIPTION RATE AMOUNT Meter = - ------------- ---------- Meter Box .............................. .............. ----------- .--......... -.: --------------- --•------- Meter Plate ............................ ----•---••---- ........... .............. •--------- Check Valve .......................... .............. ............. _........... .......... .............. --------- Pipe, Galv. Screw .................. .............. ---......... .......... ••-----•-- ............. --•-----•- Nipples .............................. ------ -------------- ---------- * -•-------- .------------- ---------- Bushings .................................. .............. ............. .......... -•---------••. .......... Plain ' Ells ................................ .............. ----•••-- -- --••--•--- St. Ells ................................ •-- ...................... ................ -------------- -------------- .............. ...... ---------- .......... --------- Tees ........................................ ............................ ................. ...... ...................................................... ...................................................... .............. ••---•------•. ............ ............. .......... •-•-•----- Material Chargeable to Taps Connected NO. SIZE DESCRIPTION RATE AMOUNT -------------- .......... Pipe, Black. Screw .....1 ......... •- -------- .---- •-----------• --------- ............... -----•---- Pipe, Galv. Screw --•-•---•------•-- •-••---.------ •----------- ............... ----•----- Lead Connections ------------------ ------------ •----------- ... -- .-----•... ........... Curb Cocks ---------------------------- .............. •--•-------. ......... -••••-•------- ........... Corp. Cocks ------------------- ............. .............. .......... Unions .------••-•-•----------------------- •------------ ••-------- Saddles ................ -.... -..... •--- •--------•-•-• .......... Nipples .................................... ............... ......----- - ............... ......... Bushings -----------------------•---- .---••-•--•---- ••-------- Plain Ells -------------------------------- ---------•- ------------- -----••--- Street Ells --••-----•-•-----•--••---- ... ......_...... .......... -------------- ---------- Tees .......................................... ......... -.... ... - .... - ------•------- -•--•-•--- Curb Boxes -------••---•-••------------ -------------- .............---------- ------------ ---------- S. O: Extensions .................... -----------•-- ............ •-•--••--• ••-----•-•----- .......... Gates ........................................ • ---------••--• •.... Plugs---------•--------••--------•---•------- --------•--- --•--•------ ---------- -------------- .......... Couplings ----•----•-----------•--........ .............. ............. -------------- -----•-------- ---•--------•• -•------•---•. ----•--------• .......... .......... -----•---- ----•--•-• -•------•• Gate Boxes ............................ .............................................. ....... ------------•-------------•------------------------- ---••--•••-----•-••--••••••-•••............................ ••••••-••••-•.........-•--•-•---••-••-------••................•----•----• ............. -------------- ............. ---••------- ........ ---- _-......... .... --------- ........ 7- ---------- .......... --•.... r ........................ .............. .............. .............. .............. --•-----•----• ................................................................................... ...... :... .......... .................................................................................... -........ ......................................................................... .......................................................................... ......................................................................... Hours Time —Day Men ........ ............... ............ ............ ------------ ...................... ._.._.._.... ............ -........ .......... ---------- .......... ........... -----------•• -•- - ---.- Hours Time —Monthly; Men-- ••----------- ....... -... ........... ----•--------- ••-••----- Hours Time —Auto ............ --- ••-••--•------ ----- ---... .......... -------•--•--. •---•-•--. Superintendence -------------------•-- .............. Total ADDRESS: TAX ACCOUNT/PARCEL NUMBER: V V(1p L " 1 ftm6 %A BUILDING PERMIT (NEW STRUCTURE): tq�n b i ► Z? (( F6 COVENANTS (RECORDED) CRITICAL AREAS :Q -q-q DETERMINATION: ❑ Conditional Waiver ❑ Study Required V Waiver DISCRETIONARY PERMIT #'S: CJU y " gci. DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER): PLANNING DATA CHECKLIST DATED: 1I `0 SCALED PLOT PLAN DA SEWER LID FEE LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: j eI �J I LQ SIDE SEWER PERMITS) #: U ! b GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: FOR: WATER METER TAP CARD DA OTHER:(W LATEMP\DS"Cs\Forms\Street File Checklist.doc �77 A, Z, ---------- ------ ? - ------------- APPLICATILON & WORK PERMir Application CITY OF EDMONDS Building Department Permit Linim one Year APPLICATION Is hereby made for a permit to construct the foiloveng work in accordanc, with th,&Ccompanylng-plsne' and specifications: WORK New/Addn. ...... C;round Area------ NO.-Storlm—LL. 91, Plans submitted HeAgh --- 9 ..... ........ ..... ... Coast. TX — El Fire LOCATION — Address Use Zone_,_ It 4 dd'n. Recorded Lot. .. . ... . . ....... . A $iF�wWage—_ Go C ...... Lot . Setj- % J 1-honZ LddreW,2 Plansby......._....... -.._.._....___........_..._...... Address __.__._ tr Bldg. by..__ ....... Phone---- Plbg. h) ..... ... ....... . .... .... ................. . ..... Address._ . ........ ......... phone— k� Heatingby .............. . . . ............ . ..... . .. — ------- Address.— 11hone_.— P110he__ Elect. by Addres&___ Remarks .... ............. . .......... ........ IA, .............. I . ....... . ......... . .................. .... . ................... .... . ................ . ......... .7� i;bore Is a correct stotemcit and I agree to con. -ply with an aupUcable Codes and State Laws regulating thi work, PERMIT for the above work is hereby approvod, subject to the above conditions, und towfththe r ...... and 6r�eci;lcatlonfi and Building Department notations thereon. VALUATION PER119T FEES Bldg. .... s— ,Mg. APPROVED: Rest Data._ Elect. .... I.— BUlLDING DEPARTNIEN37 men erbert, Badd TOTAL FEE ...... . ....... .,OjE8: No work requiring Building Department or City E-::1neer`s inspeetl= allan be covered 1>efere Twenty-four (24) hour notice requested. Contact tie City Engineer prior to, construction of an die u Icti curbs, paving, drivewa}T, sewer, water and street conn, ons. '7 r� •0 u a t1-4UF- • 0. N � ♦ , � 5� b cat 4 J U L 2 )n COUNTER _pLor. rLAr� I It = 7.0, APPROVED BY PLANNING rn' 7/3i �s6 STRE09 FILE RUDY --MAnsF-rl- _ r w • va f1Y�Cc� L • , • � � RF.MDV�- �?t tS'j. KF-MOVF. ©c.r? . t3u 11.1:;) 1AF-W R�-P�•�� �xisY. DEUc 5' F-X CS-rik Fes. A L.L_FLY f2LOLA\, 1 APPROVED BY PLANNING 1 = 7W -- 7 3!/9 un M�.ns��t �5. �TrVo _ TR YK p •4-g 13 Avr tgi3 rn.. tr DM Ot4ps, .. WA .. . PLANNING DATA .s NAME: -Tr,.A Ma-d S� SITE ADDRESS: ) d 4-E - [S A e. DATE: 7131 /2 ZONING: R-s -(, PLAN CHK#: 96 - 16 v PROJECT DESCRIPTION: CORNER LOT tV6 (Yes/No) SETBACKS: Required Setbacks: Front: Zo' Left Side: 5" Right Side: 5' Rear: !S' Actual Setbacks: Front: S' Left Side: 5' Right Side: �' Rear: G Street map checked for additional setback required? �zj - Mx- (Yes/No) LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED N (Y/N) LOT COVERAGE: �4I'kz��+����� �G'x3, 1 e 3 f Maximum Allowed: _351 Actual: BUILDING HEIGHT: Maximum Allowed: ZS' Actual Height: ug Datum Point: it-,x �-o Datum Elevation: SUBDIVISION: CRITICAL AREAS #: 9& - 9G - L mwr SEPA DETERMINATION: N, LOT AREA: &0. x !Z s' - ISM OTHER: Plan Review By: 0 CA FILE NO. (chit Areas Checklist Site Information (soils/topography/hydrology/vegetation) I. Site Address/Location: i U '/S' 13 (% 2. Property Tax Account Number: G l 9 1( —. 0 C) , ( o (-' % U 2 j 3. Approximate Site Size (acres or square feet): 4. Is this site currently developed? ./>� yes; no- j If yes; how is site developed? S /'� � '�g6 5. 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 34% 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: IVr-'"'' ; Approx. Depth: 7. Site contains areas of seasonal standing water: /t/O ; Approx. Depth: What season(s) of the year? 8. Site is in the floodway floodplain of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? Flows are seasonal? (What time of year? ). 10. Site is primarily: forested ; m dow ;shrubs ;mixed ; urban landscaped (lawn,shrubs etc) — 11. Obvious wetland is present on site: -- —For City Staff Use Only ----- 1. Site is Zoned. 2. SCS mapped soil type(s)? 3. Wetland inventory or C.A_ map indicates wetland present on site? 4. ,.Critical Areas inventory or C.A. map indicates Critical Area on site? 5. Site within designated earth subsidence landslide hazard area? 6. Site designated on the Environmentally Sensitive Areas Map? .DETERMINATION STUDY REQUIRED WAIVER Reviewed by: ann, r CONDITIONAL WAIVER Dat V Revoiroaroa 0 890 19°' -= City , of . Edmonds C.ri'�tical 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, RECEIVED MAY 8 1996 COMMUNITY Stnv"Uta 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: . IC "' o ►�� s C A, Name /r) 5 14ytz Street Address C o n olvr) S Cti j City, State, ZIP Phone Signature Date Applicant Representative: S1 LiJ'6 � /l�f1�'J}l Name.7._......._.._. /� Street Address }Phone / f Date Jc/ 7- APPLICATION CARD No.. ...................................... . The City of Edmonds IDfor SE SEWER PERMIT OUTSIDE ❑ INSIDE F-1 REPAIRS ❑ EASEMENT No. ............................. z .j� Z--Za5 OWNER ........% ..................... CONTRACTOR .. el�;t rle;l ............. PERMIT N STREET % ...... No. .... BLOCK No . ...... —/, ----------- ....................... HOUSE No. ------------ ..... .......... ...... .......... ------- AVENUE LOT - ----------- NAME ADD. ------ -- ------------- Z'- --------------- --- W., 4 • • G BACKFILL WORK SEWER WORK Of 04A A f City of Edmond -OF-VMY CONSTRUCTION z ­10MON11- o 9 0 199 PERMIT _A5 Permit Number. AY 2 ? 1996 JGIN I EENING, Issue Date: A. Address or Vicinity;of 16onstruction: 1 C)AS IkA IDS 2� �5 NV IE7 B. Type of Work (be specific): 5eq-A-Ll C. Contractor: L�-Jtliwcm c., Mailing Address: 194 1!,4 BCn4aajk, WN State License#. *Lp 1-7. 16,O)r MILLC44?- 04 0 tq, W_'51- 6 LA a-2� Vi Jq-1 Z�' I D. Building Permit 0 (if applicable): Q Contact:, 'o S. Phone:L2- 1,) C1 4 9 - U2_L,=,9 Liability Insurance: Bond: $ Side Sewer Permit-# (if applicable): E. ,YID C&�Imercial ❑ Subdivision El city Project El -utility (PUD, GTE, WNG, CABLE, WATER) E] Multi -Family El Single Family F1 Other INSPECTOR: ~ INSPECTOR: F. Pavement or Concrete, Cut: [I Yes )E]No G. Size of Cut: x' H. $ APPLICANT TO READ AKJj,SIGN INDEMNITY:.Ap on, agi­410ft- plicant understands and by his signature to this application, Id the City of Edmonds harmless from injuries, damages, Or claims of any kind or description u;hd&oe,,er, *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 defen i e of any legal proceedings including costs, and attorney fees by�.79r of a t this per permit. ft, r THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLO I THE FINAL E ' ' — * S L BE MEL_D' &NIVIL-TIJE kXLISYICE - ' H 6RkDIT WIL PE CES ED FOR ISSUANCE TOE APPLICANT INSPECTION AND ACCEPT N A,11`,CE,OF HIS R FTORATIO _p' ai ISCOMPLETEi)BYCITYPORegS,,ATWIIIC.'A, IMEABiBiTbR' MEf T? 0— TEIS41 Construction drawing.,�o4,topqsed-wotl�r;qquired y rjfh fidrinitApplicuion. 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 Ci Engineer. , . the working Engineer. 1 4 All s - tr6et out ditches shall be patched with asphalt or City approved—matenal prior to the en' o he workined-ay; NO EXCEPTIONS. Ihave read the above statemv-os and understand the permit requirements and thepink copy of thepermit will be available on site at a ls ff" r ectioiMVrposes. Pe'o im .p lira Date: (ContractSigt�at or or Agent) 1 CALL PIA,L-A,-DIG., PRIOR T.O. B�GINNING WORK POR CITY USE ONLY APPROVED BY. TIME AUTHORIZED: VOID AFTER DAYS SPECIAL CONDITIONS: CIE E_12� f -mS C-9 CdMMENTS: DATE., RIGHT OF WAY DEPOSIT. DISRUPTION FEE/FUND I 11: RESTORATION FEE: PERMIT FEE. TOTAL FEE: RECEIPT FEE: ISSUED BY: it NO WORK SHALL BEGIN'PRIOR TO PERMIT ISSUANCE Eng. Div. 1994 FIELD INSPECTION NOTES Comments Diagram br (Fund 111 - Route copy to Street Dept.) CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: }., n -i � a.,p>`�4 .�C•e}..����._`�i� _ _ �_�f - '• wv�� �. J(�� 7�r`I r(o� i � ° VZ de W 1� rt , .• �J v C-- ASS 0 PERMTT APPLICATION Z ON REQUIREMENTS To: Applicant STREET -' From: Lyle.Chrisman, Engineering Inspector � Owner. 4aJ S efl Plan Check No: 6 — ( 62- Ad&=s: (4 CZ � -- B /9ye Date 4 !M • \ 9 q6 - After review of the subject permit application. the following requirements must be met - 1. Construction hours are: WEEKDAYS — 7:00 A.M.-10:00 P-KWEEKENDS/HOLIDAYS —10:00 A.M,6:00 P.M. Z. A separate RIGHT -OF WAY CONSTRUCTION PERMIT is required for all work on public property. (ECDC 1&60) . 3. Truck haul route plan must be submitted and approved prior to permit issuamce, t. Builder/owner is responsible for containing all temporary runoff and erosion control on site. (ECDC 1830.030d) i. NO WORK SHALL BE DONE WITHIN 15 FEET OF STREAMS OR 10 FEET FROM ANY CLOSED DRAINAGE FAC LXry- BUILDER/OWNER IS RESPONSIBLE FOR IDENTIFYING CONDITIONS ON THE DRAWING. (ECDC 1830.50G) �. FILTER FABRIC FENCE SHALL BE INSTALLED AND INSPECTED PRIOR TO CLEARING AND CONSTRUCTION (ECDC 1830) '. INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEMS TIGHTLINES AND CATCH BASIN INSTALLATION. INSPECTIONS ARE REQUIRED PRIOR TO BACKFILLING. (FLCDC 1830) Repair or replace all defective adsting auk gutterand sidewalk adjaeant to We property. If an intalaWou is involved, a handicap ramp may be required. Contractor shall meet with die City Ftigibec ing staffte determine the ectbart of (ECDC 1&90) repair prior to issuance of the permit Driv�j!ope shal.1 not exceed 14% without a waives: Every attempt should be made to keep the slope below 14% Waiver granted to 96. (ECDC 18. 8AWD) , 0. Driveways must be paved from property line to City RIGHT-OF-WAY. A separate permit is required. (ECDC 18.80.060C) I. INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIOR TO AND AFTER POURING. (ECDC 1830) 2. No burning of construction refine without a permit from the Fire Department 3. Connecdon to City water system is required. There is a separate charge far Rho water meter. (ECDC 7.20) 4. A back water valve is required ifdownstairs plumbing is below the elevad= of upstream manholes- (ECDC 7.20) S. Water and sewer main lines should be separated by 10 feet mWmum. (ECDC 18.10) Coaaectiom to the City sanitary system is rrquirod. A separate permit is1�, LI03 Fees paW: Ye: No_ Charge 30 - (SCDC 1&l0} i 1• UndoWcuad wiring is required on aU new construction, and for additI value of the shucxnu e, (ECDC 18 90) °0s' repairs that exceed 50% of the total assessed 1. A FINAL ENGINEERING INSPECTION IS REQUIRED PRIOR TO THE BUILDING DIVISION GRANTING OCCUPANCY . OF TBE BUILDING OR STRUCTURE. QxDC 18,90)