1102 B AVE.PDF1102 B AVE
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CITY OF EDMONDS
Call PRospect 6-1107 when work
CIVIC CENTER — WATER -SEWER DEPARTMENT Is ready for Inspection. (No Inspec-
SIDE SEWER PERMIT bA 1490
bona SatnrdaY. Sunday or holidays.) 1 \ O
ADDRESS ----------- ----------- ... ---.....1102 "B11 Avenue
. .....
OWNER.......... UQX RasZler..........................................:........ CONTRACTOR ....... Jtee-. Wpoley..................................
Permission is granted ..... November --- 1............ Ig.66.., for ...................... days, to REPAIR or CONNECT a side sewer
wCity Sewers in accordance with application on file and governing ordinances.
A TION IS CALLED TO THE FOLLOWING:
E 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.
E No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%.
No bends in grade sharper than % will be permitted.
NOTE No. 4—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. rr-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 ap-
purtenances except to Insert the pipe into the wye.
0• 00.
ADDRESS: 1102 Aexmp,
TAX ACCOUNT/PARCEL NUMBER: WA L Doc m w-
BUILDING PERMIT (NEW STRUCTURE): G `U//�l�c���/
COVENANTS (RECORDED) FOR:
CRITICAL AREAS :1 —/ 0 DETERMINATION: ❑ Conditional Waiver ❑ Study Required Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA'
EASEMENT(S) RECORDED FOR:
PLANNING DATA CHECKLIST DATED:_✓I��� 0�
SCALED PLOT PLAN DATED:_I
SEWER LID FEE $: LID #:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED: i I Lzjb o
SIDE SEWER PERMIT(S) #:!'L
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DA
OTHER:
LOT: ( BLOCK: R
LATEMP\DSTs\Forms\Street File Checklist.doc
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POSTED ON KROLL MAP NO.: BUILDING.
BUILDING,DEPA'R?MEN-T PERMIT 66�399
Applicant Fill
HERMIT APPLICATION Inside Heavy Lines JOB ADDRESS i n
f N NAME OF BUSINESS). 'O
? z SIDE YARD SETBACK STREET. SETBACK' a: T:AR•:.YARD. SET BACK
MAILING ADD.. ,-ESS ,� . •� I Ci. -�- • I I • ' ��'' %�' - I
I / U$ ONE LOT AREA VACANT BITE
TELEPHONE NUMBER i 61
! r-J�• / rJ p ��.' E FIGHT - BUILDING AREA I VAILIANi,:E.' NUMBER G
NAME
PIA N OVED p" !
S7 ADDRESS
RES
C I CITY TELEPHONE NUMBER -
NA ecE a
REMARK) .. - .
O ADDRESS
METF.R
%SIZE SERVICE CLEARANCE - C_HE BY
S CITY TELEPHONE NUMBER -� ."I I
C I REMARKS 1
O {
STATE LICENSE NUMBER CITY LICENSE NUMBER .. .. �
TYP ON N I VERIFIE 8
Legal Descr:ptlen of Property (Show Below or Attach Four C tea) �I Sx7 ,
— �) I PERC. TEST I PERMI 'a., ��
o C !
F /) FIRE ZONE I TYPE OF'CONSTRUCTION STREET,I_MPROVED
Z _ ❑ YES Q` NO
,y1 SPECIAL INSPECTORREQUIRED( OCCUPANCY GROUP . ,l
Q YES
J
O -. PLAN CHECKED BY
VALUATION TOTAL F'Mr {
BUILDING '
1 WORK TO tlE DONE I VAL'U:.TION _
BUILDING PERMIT `- C
[r
2 FEE
PLUMBING m
z 3 PEP.AuT FEE
C HEAT da GAS LINE O j
l 4 PERMIT FEE
i NUMBER OF STORIES
SIGN SIGN PERMIT
1� I F—j I 5 FEE
Q ❑ ADD DEMOLISH FENCE —
DEMOLITION
C OF NUMBER 6 PERMIT FEE
t a ALTER I a RESIDENTIAL I '
DWELLING PLAN CHECK !
REPAIR NON-RESIDENTIAL UNITS 7 FEE
PROPOSED UeE - - �
i
. g AMOUNT DUE I I
I hereby acknowledge that I have re,-i this application; that the In —
APPLICATION' •APPROVAL
format,lon given Is correct; and that I am the owner. or th! duly author- ATTENTION
ized agent of the owner. i agree to comply with city and state laws regu- THIS PERMIT This application "Is not a pPrhvittlzltil
Iating construction; and in doing the work authorized thereby, no person AUTHORIZES
vAll. be employed In violation of the Labor Core of the State of Washington nvLY Signed by the Director of Building Easpec- j
relaung to Workmen's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are paid, and {
(Excrp[ DemolMons •.ahlch shall receipt is acknowledged in space provided. ?
NO : Permit Limit One Year be completed in ninety days.)
!,
SIGN U (OW R OR AGENT( DATE INSPECTION DIRECTOR'S DIRCTOR'$ BIc3N'ATUR$-%
e DEPARTMENT
CITY OF
FDbiUNDS DATE
NOTE: Applicant Subject !c Plan Cbeck Fee PR 0-1107 /)'a - This Pera•JC coven work to be dune m private property ONLY.
Any construction on the pubic domain (curbs, s1dev7aiks, driveways,Lv
marquees, etc.) will require separate Pe-nnlsnion. ,
CA FILE NO. Cl�
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/to1pograph(�y/hyddrology/vegetatiio--n) ' J_
1. Site Address/Location: I t d 2, R AvC4I u-L./ >( L.tT�
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet
4. Is this site currently developed? yes; .
- ``l— 06 l - if
r
no.
If yes; how is site developed? nrc�SAmt j kcrYle,
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
V i olli:ig: slopes on site generally less than 15% (a verticai rise of i 0-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):
I
6. Site contains areas of year-round standing water: �Q b ; Approx. Depth:
7. Site contains areas of seasonal standing water: UylO ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway �`0 floodplain K, O of a water course.
9.�vflSite 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 eadow ; shrubs ; mixed
urban landscaped (lawn,shrubs etc) _j�
11. Obvious wetland is nresen.t on site:
For.City Staff Use Only ------- --------
I.: Site is Zoned?
.2. SCS mapped soil type(s)? 7 y f
a
3. Wetland inventory or..C.A. map indicates wetland present on site?
.41. 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? r�
DETERMINATION
STUDY R-QUIRED: ,.
_ WAIV
keviewed'by: .
Platter.
City of Edmonds
f
016
RECEIVED
ANH 0 3 Ibl .
W
VQ "w"VN 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.
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:
a4- 0J'\J Ja noo GaaAoe'r-
Namd
e) A
Street Address
Eamo
City Statz Zip
M�"NAM
' ► 04M'--'M--M ffl��
t
Signature
91
Date
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date
c:receptionljana\cacl.doc
(over)
r12c.1So)o
April 9, 1998
CITY OF EDMO DS BARBARA FAHEY
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425),771-0221 MAYOR
COMMUNITY SERVICES DEPARTMENT
Public Works - Planning/Building - Parks and Recreation - Engineering - Wastewater Treatment Plant
Greg & Janna Gardner
1102 B Avenue South
Edmonds, WA 98020
Subject: Determination regarding Critical Areas Checklist # 98-107
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.
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: R eception\Jana\C R LTR.doc
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Gty.of EdmondsPERMIT NO: ` 9253
PRRMiTF.XPiRF.0
I InO _ SIDE SEWER PERMIT
Address of Construction: II D a tt i`�Y,lyY S LID #
Property Tax Account Parcel No. 110.1
Attach copies of all access and utility easements Verified and Approved by
caner a d/or Contractor,
Contractor License #: Building Permit #:
r
Single Family
❑ Multi -Family. (No. of Units, )
❑ Commercial (No. of Units ) .
❑ Public
Invasion into City *Right -of Way: ❑ Yes No
*RW Construction Permit #
Cross other **Private Property: ❑ Yes No
**Attach legal description and copy of recorded.ease ent:
Owner/Contractor
`ibwner or contractor signature and acknowledgement statement: Da e
By.signing for this permit I certify that I have read.the City's public handout entitled,
�ide Sewer Specifications, and shall comply with all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-800-425-5555) BEFORE ANY EXCAVATION 2
2 FOR INSPECTION CALL .425-771-0220 extension.?319.�
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
NOTE: IF JOB SITE 1S NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A145 RE -INSPECTION FEE WILL BE CHARGED..
Job Site Ready YES NO' Date: Initial:
Partial Inspection:. " ate: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROV a e:. Initial: As -built to Street File: ❑
f� PERMIT MUST BE:POSTED ON JOB SITE `,'
White Copy: File Green Copy: Inspector {{��UB,,uu�ff Copy: Applicant
L;temp;bldg;forms;sspennitjlg4/00 Q YV� U` r1/ vjIS 101) iU 0T C0
WP.OK61 .PIjee IYIkT4D?_•I0L 4 Gli0 Wfts 'INI -TiAu.
NS'Trt,l cpv,
0
• PLANNING DA• • TA
NAME:
SITE ADDRESS: Il d Z �IPji� no C DATE:
ZONING: 0; - /. 1 a
PLAN CHK#: ,
PROJECT DESCRIPTION;
CORNER LOT (Yes/No) FLAG LOT
(Yes/No)
SETBACKS:
Required Setbacks- ,
Front• _ Side: _�-- Actual Setbacl�-s,
Front: ,. 7 LeftSide:�f _Right Side: Rear:
Street map chec ed for additional setback required? (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED Y/N)
LOT COVERAGE:
Maximum Allowed: o Actual:__ l�uU
BUILDING HEIGHT:
Maximum Allowed: Actual Height:
Datum Point atum Elevation:
A.D.U. CREATED?:
SUBDIVISION:
CRITICAL AREAS
SEPA DETERMINATION:
LOT AREA: —%M
OTHER:
Plan Review
altllealpmnftNA0Mdudw
The%City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION [:] REPAIRS 0
OWNER...... --------------
ADDRESS ....... ............ � ......... ................
a
APP110VED
NOV 2J 1966
EASEMRNt No . ..........................................
CONTRACTOR ... 2
............. PERMIT NO.
.. ............. ... k � . ...................................
LEGAL DESCRIPTION: LOT No .............................................. BLOCK No . .......
00
....................... .......................................... ..... ...
NAME OF ADDITION
uj
.j
U.
C/
a*-
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Approved:
DATE ............ 2Z
...... BY .... .........................................
y
ACK
PINE ST
CITY OF EDMONDS WATERLINE AS -BUILT
ADDRESS:
1102- B AVE S
PERMIT
NO, BLD20070672
CONTRACTOR; HOMEOWNER: SCALE:
XXXXXX XXXXX NTS
DATE INSPECTED: INSPECTED BY; DATE DRAWN: DRAWN BYi
7/2/07 1 J. HAWKINS 1 7/10/07 I. ABILA