1012 WALNUT ST.PDF11111111111111
13629
1012 WALNUT ST
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. 9
Issue Date:
A. Address or Vicinity of Construction: 1
B. T of Work C a� TJ i't-..H N.0 0 I Ai r�JT'R ► N a(.
f n �ci S 9 0 Type (be specific)
- ..
AT "I a�_; VJI; .NOT —1 4E lj 3cxu l-1 a t t:.et\r_a FtT' l o
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GTE T-0 !-A JVV �1v-, FT`
C. Contractor('-'-�-N 1�1 ��� �7 Contact _ 1 ' G
Mailing AddresV? yV Lptr i N r) R-1) _ Phone: (� g131-" ; H N�' 1 MAN 42 G -' M - �� � Z 1
State License #: C-VC t?e T,'it-0 Liability Insurance: Bond: $
4
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project) Utility (PUD GT , WNG, CABLE, WATER)
❑ Multi -Family )Z] Single Family ❑ OtherW P ; J r 63 Pr- r)l D3 4:2
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut : ❑ Yes `PNo G. Size of Cut: x H. Charge $
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application 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 FOLT �1 NSPEC-
TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE IIELD UNTIL THE FINAL STREET PAT PLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLIC '1 7 18
Two sets oconstruction drawings
A 24 hournoticeis requi ed for spec i n. Ple se all he Engineering Division, 771-0220.3 rt ►tl
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 ratement an erstand the permit requirements and the pink copy of the permit will be
available on site at al es fo ins e t' n
Signature: Date:
(Contract or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
U.r.
FIELD INSPECTION NOTES
Comments•
Diagram
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION ❑ YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
❑ NO
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LEGEND
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PERMIT SUBMITTED 8
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NO. 962
rLASHINC BEACON SHALL BE INSTALLED AT
EACH SIGN FOR NIGHT-TIUX USE.
2. DISTANCES WAY VARY AS APPROVED OY THE
ENGINEER.
3. FLAGGERS REQUIRED TO CONTROL TRAFFIC
WHENEVER THE CONTRACTOR MUST INTERRUPT
TRAFFIC FLOW TO ACCESS THE WORK SITE
WITH MATERIALS OR EWIPLENT.
-LEGEND.-
al CONE OR CHANNNELI21NG DEVICE
WORK AREA
ti7�;Jri�VS?S?SI
TRUCK WITH
FLASHINC OR WITH<s
BEACON
?o:• JO'
i
50' MIN
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200,
SHOULD -
WON:K
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TRAFFIC CONTROL PLAN
sNoUUNR wows
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9
Critical Areas Checklist CA File No:CIA
'�-�.5
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 2A,t,,L)WY- 2-- C' 674_
2. Property Tax Account Number: 7n .-3.2 o� f r..) h <� p
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? 2< yes; no.
If yes; how is site developed? Anti i a oxi 1c, FY-1 CT )rr- /0
5. Describe the general site topography. Check all that apply.
D� 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):
6. Site contains areas of year-round standing 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 floodplain of a water course.
9. Site cpntains 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 ; meadow ; shrubs ; mixed.
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site: �
1.
2.
3.
--------------------------- For City Staff Use Only
Plan Check Number, if applicable? b j &
Site is Zoned? _9a,,—(D
SCS mapped soil type(s)? F—y af-ayzlv s3t,�dy It,-,m O Ao `l
4. Critical Areas inventory or C.A. map indicates Critical Area on site? Nn _
5. Site within designated earth subsidence landslide hazard area? _ —No.
DETERMINATION
)]�WD WAIVER
Reviewed
Critical Areas Checklist.&02.17.2004
3 X11
0y ED4f
°`�o City of Edmonds Date Received: �,
Development Services Department City Receipt #:
Planning Division Critical Areas File #:
Phone: 425.771.0220 Critical Areas Checklist Fee: $135.00
r o Fax: 425.771.0221 Date Mailed to Applicant:
�c, 189
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 the application 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).
A property owner, or his/her authorized 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 assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees,
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT �Q DATE
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
I-IGNATURE OF OWNER- y DATE
PLEASE PRINT CLEARLY
Owner/Applicant': /
Name
? o/2- &AL-A)i2 r 67-
Street Address
City State Zip City State Zip
Telephone: C' -7 7 & - 7
Applicant Representative:
Name
Street Address
Telephone:
Email address (optional): FV,A f1►CR1.Ae-&-A)67—Email Address (optional):
February 17, 1970
Memo to: Leif R. Larson
City Engineer
from: Ronald L. Whaley
Asst. Director of Public Works
Sanitary sewer lateral servicing 1012 Walnut Street lies
approximately 12-inches below road grade. We have made a temporary
repair in order to replace a broken tile. At such time that the
surface is torn on the U.A.B. project, this entire lateral should be
lowered.
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RLh' : ` c
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No. — .......................................
NEW CONSTRUCTION ❑ REPAIRS
108-09100
OWNER ........... Ufll..1..am..... jC.._Kee-9dl1------- ------------------------------- --------- CONTRACTOR ....--------------------....------------------------......------......................... PERMIT No. ----------------------
ADDRESS -------- 10.12.. Ua 11LUt--S-t•--------------------------------------------------------- LEGAL DESCRIPTION: LOT No. ...................... ....................... BLOCK No. ............................................
NAMEOF ADDITION ............................................. .........................................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ BY .....................................................................