1041 6TH AVE S.PDFiiiiiiiiiiii
5382
1041 6TH AVE S
n �. �''"' �a >�y���i�'' �� - '��• s Kiwi
r ... HEET FILE .°
CITY OF EDMONDS RECE1VEIBIDE SEWER PERMIT
MAR 1 1 1994
PUBLIC)INORK3 DE
Address of Construction:
Property Legal Description (Include all easements):
PERMIT gJjO 8566
0�01.-/e� -tea --r1� Tear `/�Z�o2a� �,� /
Owner and/or Co
State License No.
B Single Family
❑ Multi -Family (No. of Units )
❑ Commercial
❑ Public
Invasion into City Right -of -Way: 2 No ❑ Yes
RW Construction Permit No.
Cross other Private Property: C'No ❑ Yes
Attach legal description and copy of recorded easement
I certify that I have read and shall comply with all city requirements
as indicated on the back of the Permit Card.
3Z,�/��.
Date
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION *
OFFICE USE ONLY
* FOR INSPECTION CALLMEMM PUBLIC WORKS DEPT.
30. 771-0220
Permit Fee: Issued By
Trunk Charge: � Date Issued: ,7
Assessment Fee: Receipt No.: � � ;7V
(
Partial Inspection: Date J itial_
Comments
Reason Rejected: Date Initial_
Final Inspection Approved: Datl [ InitialEe,-&—
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: FileGreen Copy: Inspector Bull Copy: Applicant
Revised 3!90
The City of Edmonds Side Sewer Drawing EASEMENT NO_ ---------------------------- ________________
NEW CONSTRUCTION REPAIRS ❑ LID NO_ __________________ _ASMT. NO. _...__._._._._..._
OWNER CONTRACTOR PERMIT NO. .` s�p- r
_------••--------------------••--------------•-------------..----------------------
t I _1 S
JOB ADDRESS .�D- '. 1---- --S e-----------6.-'
-�"-- `-•-•- •------- LEGAL DESCRIPTION: LOT NO. --------------••---------------------- BLOCK NO.---•---------------------•--•------
(,pTtA A V t. S O.
U -1
NAME OF ADDITION-----------------------------------------------------------------------------------------------------------------------
gAI,4�tr
k�
t �,.0
Qe .0
A \�y
AL -Ll� \/,•l Ivlr+;13
PWW-0001 1/75 (REV.11/78)
1,
i 24
s
O — --
�-3 "-��-�- 3 ' ,1
Approved:
DATE `3 �� BY-------------------------------
S;EE'i FILE
PLANNING DATA
SITE ADDRESS: IU"I l to "A45- DATE: lam'{
ZONING: �% � V PERMIT#:
PROJECT DESCRIPTION:
SETBACKS:
Reauired Setbacks:
Front: 20 Left Side:__�5 Right Side: 5 Rear:. 1�
Actual Setbacks: r
Front: -'5 Left Side: s Right Side: i'C Rear: 3�
FLOOR AREA:
LOT COVERAGE: Maximum Allowed:2 � c3 J 0 Actual: Z5 56nz)b
BUILDING HEIGHT:
Maximum Allowed: APe Actual Height:
SUBDIVISION: S - q `5 — 1 6:24
CRITICAL AREAS #: CA — 115 ' 1 74---:�—
SEPA DETERMINATION:
LOT
OTHER:
I --WMNi O
89.0 _ 19°�
• . a- }. ST
�,�::��•.�-•
City of Edmonds
FT FILE
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. n /
Issue Date:
A. Address or Vicinity of Construction: 1041 6 Av S (9410687 )
B. Type of Work (be specific): Install New Service
C. Contractor: Washington [Natural Gas Company
Mailing Address: 815 Mercer St Seattle WA
State License #: 98
111,
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ® Utility (PUD, GTE, WNG, CABLE, WATER)
❑, Multi -Family ❑ Single Family, ❑ Other
INSPECTOR: INSPECTOR: i �wrl
F. Pavement or Concrete Cut : ® Yes []No G. Size of Cut: 2 (2 x 4) H. Charge $
1 @ Avg Tie —In &` I- @ Wtr Mains
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to h d the 'ty o/Edmonds harmless roan injdn, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that maybe made agai t the City of F.ilmonds, or any of its departments or
employees, including or not limited to the defense of any legal proceedings including defense costa, 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
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FENS WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL1BA-PRQCJSSED FOR ISSUANCE TO THE.APPLICANT.
Construction drawing 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 ditches 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 f spection purposes..
Signature: �' ��� A Date: March .3,0, 1994
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS - DISRUPTION FEE/FUND 111.
SPECIAL CONDITIONS: RESTORATION FEE:
PERMIT FEE
TOTAL; FEE:
COMMENTS: RECEIPT; FEE:
DATE: ISSUED BY:
NO WORK SHALL BEGIN. PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES
Comments
Diagram
(Fund 111 - Route copy to Street Dept.)
Ij
CONTRACTOR CALLED FOR INSPECTION ❑ YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
MIMC
ptonAm
N. UZ U i =. ===
Av*"Vcn&*wC*nwy
Addendum to -Citx of Edmonds
'Right of Way
Permit Application •
Submitted by PtkTCHELL S.-LANKFORD
Engineering Aide
Washington Natural Gas
# .'-521-'5246
_n_F_ JQ
\AJT-CZ
F V
WTIZ
Fkia
WNG to window
W in depth Key:unknown _w- water
-g- gas
gas main -ss- sewer
-a- water hydrant
0 -water valve
2!'Ih-,.ccrSt. ..y/ OS11; Q-06) 622--.167
-"{ Cit of Edmonds
LE
��� Y ; �, ,y. RIGHT-OF-WAY ,CONSTRUCTION �
-" PERMIT �.
Permit Number -
Issue Date: (, ^ '
A. Address or Vicinity of Construction: y ✓� r
18 9 0 1 9 C) y B. Type of Work (be specific): INS TALL UG DIST' CA ALDN& KI R/W
FIR ST FM ALILILY W 13U' TD C. R/W 6TRAVI S
C. Contractor: L NA M 13Ek5 / SUPE 2IC1Q CA Contact: -MI-1 AN. DC=R S Q N
Mailing Address: 533 MAIN ST Phone: 774 - 514L.
State License #: S[J12 C(' l U I Q A Liability Insurance: Bond: $
I). Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ) Utility (PUD, GTE, WNG, AB ,WATER)
❑ Multi -Family ❑ Single Family ❑ , Other
INSPECTOR: INSPECTOR:��+r.
F. Pavement or Concrete Cut : ❑ Yes ®No G. Size of Cut: x H. Charge $
APPLICANT TO READ AND �,Aano.
�,rINDEMNITY: Applicant understands and by his signature to this application, agrees to hold ity ofEdmonds harmloee�itamages,oclaims of any kind or description whatsoever, foreseen or unforeseen, that may be made ag inst the Cityof Edmondsds departments or
employees, including or not limited to the defense of any legal proceedings including defense oats 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
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION/ FEESAWILL BE HELD UNTIL THEFIN 4' STIPATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL L(E PROCeES�ED FOR ISSUANCE &,THE APPL/ A T.
Construction drawing 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 ditches shall be patched with asphalt or City approved material prior to the en4G;f'th'1dwoiking 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 at all tiprel for inspection purposes.
0.
Signature: 1-4 Date:
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:y l r
TIME AUTHORIZED: VOID AFTER I 4-9AM.DAYS
SPECIAL CONDITIONS: WO
COMMENTS:
DATE:
NO WORK SHALL BEGIN PRIOR TO PERMIT `ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments
Diagram
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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"""OET FILE
USE
PERMIT
CITY OF EDMONDS ZONE NUMBER Qb�SS
CONSTfIUCTION PERMIT APPLICATION
JOB / SUITE APT v
OWNER NAME NAME OF BUSINE S ADDRESS
LEGAL D SCRIPTION CHLCKI
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iii
SUBDIVISION NO LID
NO
�'
•�
Q
3
Z
2
MAILING ADDRESS /
'1 � `�
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP
/ LT r RW
EXISTING ..(� REOUIRED DEDICATION SUeol
PROPOSED i/� InsPOollon
Sidewalk
Approved ❑
Perm,l Requrred *91
Use Perm,I Req'd ❑
Raqulred
Required ❑
CITY,./ 'ul ZIP
(%/c (.
t �`
TELEPHONE NUMBER
NAME �- / � • ,S
METER$IZ6/SIZE
3, r,
NO. OF FIXTURES
PRV REQUIRED
YES NO ❑
ADDRESS
REM'A/RKS_ 1
LJ• E1
CITY ZIP
_ ter-
TELEPHONE NUMBER
NAME
�� / '/I✓AC.
r/
ADDRESS
/
ENGINEERING MEMO DATED / ��/�� /REVIEWED BY
F /r
CITY ZIP
TY
T•"' // S hGj/}z
TELEPHONE NUMBER
7e51•i'�r,
FIRE MEMO DATED REVIEWED BY
w
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-
STATEL CENSENUMBER EXPIRATION DATE
•�-k 7 - / r-
SIGN AREA
ALLOWED PROPOSED
n
fy
%'
SEPA REVIEW
COMPLETE JEXEMPT
E%P X
ADS NO.
X
i
_
Legal Description of Property - include all easem nts
-' Y /
SHILINE a
e.✓r;5 F, 1�r dpvnn / To Ear a1.��s, HCl/1�Anr Ci
CIF �C/, /rN/XI
VARIANCE OR CU
L'Al NINWRtYIEW BY
D TE
l %
SETBACK -FEET HEIGHT
FRONT / '/ / SIDE / REAR' / 7i I !
LOT OVE GE
7'_— v/%�
Pronerty
Parcel "
(e;' / / r%6- - '_��J
- (r-in �-
�rG�ye/�,
NEW
RESIDENTIAL
ILL-{_-J`PPL.U►MSING
E
ADDITION
COMMERCIAL
MECHANICAL
O APT. BLDG.
REMODEL
SIGN
❑
i- -njjIN /-
FENCE
REPAIR
LvJ CYDS.
)x_F7)
O DEMOLISH
0 STOVE
O
SWIM POOL
O
NSERT
HOT TUB SPA
RAGE
I� RETAINING WALL/
ROCKERY
RENEWAL
z
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER �J NUMBER OF CRITICAL
STORIES (� UNITS DWELLING are NUMBER
OESCRIBfr WORK TO BE DONE (ATTACH PLOT PLAN)
BY
REQUIRED a.c�I�n q OCCUPANT
❑ YES LOAD
MARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
VALUATION
PUN CHECK FEE
BUILDING
HEAT SOURCE, -
GLAZING
PLUMBING
Plan Check No. G31 -20
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADNGIFILL
Any construction on the public domain (curbs, sidewPlks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
"Applicant. on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
3O
N
W
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
x
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
���/ /Gi
9
modify, waive or reduce any requirement of any city ordinance
i
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
So
provision."
r 1
1 hereby acknowledge that 1 have read this application; that the
information given 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
state laws regulating construction; and in doing the work auth0riz•
THIS PERMIT
AUTHORIZES
This application is not a permit until
ad 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 o1.Washington relating to Workmen's Compensa•
WORK NOTED
Deputy; and fees are paid, and receipt is
lion Insurance and RCW 18.27.
INSPECTION
acknowledged in space provided.
SIGNATURE IO��ElFq AGFl1"TI DATE SIGNED
DEPARTMENT
CITY OF
OFF IAL'S SIGNATURE DATE
l//
'
EDMONDS
ATTENTION
CALL FOR
ELE4SED as% I! DATE
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
l
771 0220 ''
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
ORIGINAL - Foe YELLOW = Inspector
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J4ECEIVED
JA N 1 8 1994
PERMIT COUNTER
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ACCEPTABLE TIGHTLINE MATERIAL
N-12 ADS
Sch 40 PVC
STREET FILL
SDR 35 (ASTM D3034) �
H OMee sTYI W c,OkL% r APPRO ED AS NOTED
221 d4r4iS 3T GZ7rtOHD3,W4T0020
(s04) -778-`6CC �X
PERMIT APPLICATION REQUIREMENTS
TO: Permit Coordinator, Building Division
FROM: Lyle Chrisman, Engineering Inspector
OWNER: A �`_PLAN CK # 13- ZZg
ADDRESS: 104-1 S DATE:
After review of the subject permit application, the following requirements mustbe met.
1. Construction hours are: WEEKDAYS .......... 7:00 A.M.-10:00 P.M. WEEKENDS/HOLIDAYS ..... 10:00 A.M.-6:00 P.M.
2. A separate RIGHT-OF-WAY- Construction Permit is required for all work on Publicproperty. (ECDC 18.60)
3. Truck haul route plan must be submitted and -approved prior to permit issuance.
4. Builder/Owner is responsible for containing all temporary runoff and erosion control on site. (ECDC 18.30.030d)
S. NO WORK SHALL BE DONE WI77UN IS FEET OF STREAMS OR 10 FEET FROM ANY CLOSED DRAINAGE FACIL-
ITY. BUILDERIOWNER IS REPSONSIBLE FOR MEN77FYING CONDITIONS ON THE DRAWING. (ECDC 18.30.50G)
6. FILTER FABRIC FENCE SHALL BE INSTALLED AND INSPECTED PRIOR TO CLEARING AND CONSTRUCTION.
(ECDC 18.30) .
7. INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEMS, TIGHTLINF.S, FOUNDATION DRAINS, AND
CATCH BASIN INSTALLATION INSPECTIONS ARE REQUIRED PRIOR TO BACKF LLING. (ECDC 18.30)
8. Repair or replace all defective existing curb, gutter, and sidewalk adjacent to the property. If an intersection is involved a
handicap ramp may be required. Contractor shall meet with the City Engineering Staff to determine the extent of repair prior to
issuance of the permit. (ECDC 18.90)
9. Driveway slope shall not exceed 14 % without a waiver. Every attempt should be made to keep the slope below 14
Waiver granted to %: (ECDC 18.80.060D)
10. Driveways must be paved from property line to City RIGHT-OF-WAY. A separate perimit is required. (ECDC
18.80.060C)
11. INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIOR TO AND AFTER POURING.
(ECDC 18.30)
12. No burning of construction refuse without a permit from the Fire Department.
13. Connection to City water system is required. There is a separate charge for the water meter. (ECDC 7.30)
14. A back water valve is required if downstairs plumbing is below the elevation of upstream manhole. (ECDC 7.20)
15. Water and sewer main lines should be separated by 10 feet minimum. (ECDC 18.10)
16. Connection to the City sanitary system is required. A separate permit.is r fired.
LID# 7¢ Fees paid: Yes No Charge (ECDC 18.10)
17. Underground wiring is required on all new construction; and for additions, alterations, and repairs that exceed 50 % of the total
assessed value of the structure. (ECDC 18.05.010)
18. A FINAL ENGINEERING INSPECTION IS REQUIRED PRIOR TO THE BUILDING DIVISION GRANTING OCCU-
PANCY OF THE BUILDING OR STRUCTURE. (ECDC 18.90)
19. _ ,M�i�i � Li d�J. /S�Wle7� p�v �1. p• li�� 12
20.G1� 7➢ i� G✓ , W l6if, 0 V6r—
444 6vyto —10", '
tREET FILE
RECEIVED
BE 2 9 1993.
PERMIT COUNTER
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APP ROVED Y.PLANNING
NOMfe STYLE COhiS'r
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22� .IANQS ST COMlONfl3,W4.TSDZ.O
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(zoi) ��a•L6Cc
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REchlvlcu
PROJECT REVIEW CHECKLIST DEC 2 9 1993
PUBLIC WORKS DEFT 22
PROJECT NAME:_ S/Cll� JlobAmAol PLAN CHECK #: .T ZZ
PROJECT ADDRESS:_ ID-fl d9 —Ake S RECEIPT DATE:
REVIEW D BY(Initial/Date)
PLAN. WATER
'
COMMENTS
-FIRE
'SLOG. SEWER
STREET
ENG.
Setbacks/Variance/Setback Adjustment
Conditional Use Permit
ADB Requirements
.v•
Other Zoning Requirements
"' Y
4
Underground Wiring Required
Lot Slope 1596,.�
<:x>.:..:.:....
6
SEPA Environmental Checklist/Hydraulics Permit
. ><. :«,� .
Tree Cutting Plan
8.
Plat/Subdivision Requirements —
�,�. ':A��>:�:. <:
•: ,.Y,....<;.�;�..:...,. �,•,
Legal Description Verification
10
Quit Claim/Street Dedications
Easements - Public/Private
Engineering Storm Drain Review Fee ai
„:;.t...;::. ;.h:. ,,..
13 :
Engineering 2.2 Inspection Fee
ors. • . . .'
Drainage Plan On -Site
Setback - Top of Bank, Stream, Water Courses
.. ;., ' ,h •,,
" .r ' / N
16
17
Setback - Storm Drain Line
Open Ditch - Existing"
9
Culvert Required
Culvert Size
21
Shoulder Drainage/Shale Open Runoff
.rirr
Catch Basin Required
22
Driveway Slope & Vehicle Access
«•m..:;° y
Sidewalk Required
Curb & Gutter Required
Curb Cut For Driveway Re uired'
Street Paving Re uired P
Right -Of -Way Construction Permit Required :°.::IAI
28:
Street Name Sign Required �:;, f us���s�:
Other Signing Required `xKh::<>r
Bond Required For Public Improvements ':
3a;
FEMA Map Check /Vllater Table ,:?<..,;.,;�:sf��c;•. ,k;N,
Side Sewer Availabilit ...v,,€.r.. ::/:.
33
Calculate Sewer Connection Fee If No LID # 7 IMX:
...........
.••:;".
Create Street File ><fi;""'<r
:-34::
35
Existing Water Main Size �••. ,
„. ,,
Water Meter Size a ..
:...
�..::::.:...::..
<.
Service Line Size
Water Meter Charge Required ">w
Hydrant Required ;:.,>'>:,v >:>
:s';
Hydrant Size Existing4 '
;.;?�;
41
Fire Line Charge Required - Sprinkler
42
Street Cut
....
Miscellaneous
Reviewed BY:
FIRE
PLANNING ENGINEERING
STD 1LE�
PL1LIC WORKS
' STANDARD DRAINAGE DETENTION SYSTEM
WORKSHEET -z
OWNERh--CALC BY: •� mil! 3Kk�_.4Gi/�TT
ADDRESS PHONE: 778 G Bf.G
DATE:
*****DESIGN DATA*****
IMPERVIOUS AREA PIPE DIA PIPE LG ORIFICE -
2-7_ 71g
OETENTWN PWE LENGTH WAS O GRAVEL
UTFLOM TRENCH MIR IO' LONG
TOP AN0 4'PERr PIPE TO GE LEVEL
RIM ELEV 1'MN COVER C'MIN Sn%CE FROM
2'MAX COVER . am ELEV CONTROL
4 OUTLET N
410 MIN T 4'PERF PIPE W/CAPS
.5%_rA SLOPE 4-0 PIPE WK
t
_ � E
'ORIFICE RUN FF SPREADER
OUTLET
INV ELEV INV ELEV .
fRiiR CAFCN CONrpm CA7CN .
CASIN
AASW
'•2'iWDEEP, 4- 6' QUARRY SPA LLS
SYSTEM CROSS SECTION ■2k3' DEEP, 3i4-CRUSNEO ROCK
FROM CONTROL
OUTLET
RECEIVED
IPR OUTLET
DEC 9 1993
PERMIT COUNTER
FOOTING DRAINS SHALL NOT BE CONNECTED TO DETENTION SYSTEM
NOTES:
1. Call Engineering Division (771-0220) for a tightline and detention system inspection .
APPROVED BY
before backfilling and for final inspections. /
2. Responsibility for operation and maintenance of drainage systems on private property is the
responsibility of the property owner. Material accumulated in the storage pipe must be flushed
out and removed from the catch basins to allow proper operation. The outlet control orifice
DATE
must be kept, open at all times:
Paste 6 of 6
RECEIVED
DEC 2 9 1993
PERMIT COUNTER
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number.
Issue Date:
A. Address or Vicinity of Construction:
8 9 0 1 9 C B. Type of Work (be specific):'_V _V NL�� i,► (_ \ �� �' lJMkL�
Contractor---- �'1 (yA �J �Y r , V . {J Contact:
Mailing Address:. - Phone: (`� ��.0
State License #: 1`�N�U�S, cl&6)VoiabilityInsurance: Bond:$
(o
Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project FY Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family Single \Family ❑ Other
INSPECTOR: N INSPECTOR:
F. Pavement or Concrete Cut: ❑ Yes Wo G. Size of Cut: x H. Charge $
APPLICANT TO READ AND�SIGN a
INDEMNITY: Applicant understands and by his signature to this application, agrees to holdkh� City of Edmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made ao�i�F9,i�nst the City of Edmonds, or any of its departments or
employees, including or not limited to the defense of any legal proceedings including defense'' �{s, and attorney fees by reason ojgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR PJJ ROD OF ONE YEA
R1 Olio TYELFINAL
INSPECT/ON AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES W1 L E HE UNTIL THE Fl AL TRRRT PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work, required,_with permie4vtplication
A 24 hour notice is required for inspection; PIease call tie engineering Division, 7710220.
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 CtyErf gineer.
All street cut ditches shall be patched with asphalt or City approved maari'a6rior 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 ' e at l ti for ins e ' n purposes.
Signature: Date: —��
(Contractor o gent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: A RIGHT OF WAY DEPOSIT:'
TIME AUTHORIZED: VOID AFTER 40 DAYS DISRUPTION FEE/FUND 111
SPECIAL CONDITIONS: RESTORATION FEE:
t
C t Tri 0-r/ e 7-� /P1 61T:FEE:
TOTAL.,F.EE�
COMMENTS: RECEIPT. FEE:
DATE: I ISSUED. BY: �s3 i .� i `
w
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments
Diagram
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
FI UJMM — }
PUBLIC -UTILITY DISTRICT:NO.1 OF SNOHOMISH COUNTY
LOCATION
POLE;NO. NW1/4 S 2 ST 27 R
REASON FOR WORK S�u,.'(,, �\5Ce
�U CO»T
- ._�.-� . � •. __-`_"_� o :._- a .. - � _ :- i .. __.. "_•T"'_'...'?' �k^
1476
REV. 7/87-
So C.
AREA
DATE -NO.
- 4
W.0. - N O.
ENGINEER A�'L� DWG. `N0.
DRAFTER U G NO
€ DATE; WORK COMPLETED
Y
FOREMAN '
ENVIRONMENTAL ANALYSIS
''
FEES REQ D YES
® EXEMPT ❑ NOT EXEMPT
❑ NO
PARA. 18 ITEM C
PRIMARY'OVERHEAD
€
❑RESIDENTIAL
O.H. U.G. COND. KV
❑ COMMERCIAL
ADD CKT. FT. PH
f
LEO#
REM CKT. FT. PH
NET CKT. FT.
SECONDARY OVERHEAD
O.H. P.G. COND. KV
BASIC FEE $ T
ADD CKT. FT. PH
/ ®$ __$..::-� -
REM CKT. FT. PH
METER CONV.7POLE-
NET CKT. FT.
PRIMARY -UNDERGROUND_ -_�
PERMITS (DATE GRANTED)
❑'RESIDENTIAL -`- -
0-TREE TRIM
❑ COMMERCIAL -- -- - -- . ;• .:_ ... ..:.
❑ STATE
........
- -
_
BASIC: FEE. $ . _.. --
❑ COUNTY.-
,$'CITY h C-M
_777
SECONDARY=UNDERGROUND :_ ::_: _,
EASEMENTS
---: : �
BASIC _FEE_$
❑,REQUIRED ��yy NOT REQUIRED
,5`Y
UNDERGROUND--P-LAT ---
--
BASIC FEE, $
DATE RELEASED
FOREIGN CONTACTS
STREET LIGHTING
❑ GTNW __` rJPN#
-� FT. ® - / - -�
$ $ ' ' F
❑ CATV JPN#
JOINT TRENCH GTNW & CATV
WORK IN RIGHT.__OF WAY
JOINT BORE GTNW & CATV
❑ PRIMARY
rF
SECON�AD
FT. 0S-7, 3y.��OLE
STENCILING
,=$
OM TO
MISCELLANEOUS FEES
TAKE OFF POLE
VAULT $
PERMIT $ , 0
PRE-CONSTR. REQUIREMENTS
❑ TREE TRIM ❑ PUD LOCATOR
$
BACKHOE ❑
$
XONE CALL DATE
' TOTAL DUE $
INDEX
POLES
PLAT
DATE PAID - -7--=-
LOGS
U-MAP
-
RECEIPT#
_
XFMR
C-MAP
NEW SVCE APPLICATION#
LOCATION MAP PAGE `1 F -7
SCALE ®!.����
DATE PRINTED
APPROVED
SUBSTATION Q N\- IF `v
1
CIRCUIT N0. PHASE
C.��`���,t�.t� PVC.
9
CO
('T" . Li aA/r
FU25
F ) tR
low 10
FU401
R FU15
F*I-
`��
-a c9L RECEIVED-,
Critical Areas Chec list*
Site Information J U N 2 4 1993
Project Name: - Z"' Permit Number. PERMIT COUNTER
Site Location: _ /061- 4'6 ,qw F $o. Property Tax Account Number_ 6101-006 -006 -0004
Approximate Site Size (acres or square feet): _ 14 400
Have you filled out a Critical Areas Cheoklist.for a project on this site before? //0
General Site Conditions ,
1. Has the site been cleared or logged? /bo Date of most recent action:
Soils / Topography
�✓�2� b�PA✓E
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? 5�9wo v c. n AM _ n,
3. Describe the general site topography. Check all that apply. S`oPE3
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 of horizontal distance.)
Steep: grades of greater than 30% present on site.
Comments
Hydrology/Vegetation
4. Site contains areas of year-round standing water: C
5. Site contains areas of seasonal standing water: A o Approx. Depth:
6_. Site is in the floodway A 1 floodplain_1/6 of a water course_
7. Site contains a creek pr an area where water flows across the grounds surface? flows
are year-round? Flows are seasonal? W.
8. Site is primarily: forested : mea ow ; shrubs✓ ;mixed
9. Obvious wetland is present on site:
10. Wetland inventory or map indicates wetland present on site--.�
11. Critical Areas inventory or map indicates any Critical Area on site:
City of Edmonds
Critical Areas Checklist
The Critical Areas Checklist contained on
this foam is to be filled out by any person
ping a_ Development. Permit
Application for the (pity 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 Hail (Critical Areas
inventories, traps, or soil surveys)_
An applicant; or his/her representative, must
fill out the chocldist, sign and date it, and
submit it to the City_ The City will review
the choddist, make a precursory site visit,
and make a determination of the snbscaquent
steps necessary to complete a development
permit application -
With a signed copy of this form, the
applicant should also submit a vicinity map
of the parccl with enough detail that city
staff can find and identify the subject
parcel(s)• In addition, the applicant is
encouraged to include any other pertinent
information 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:
Name
Title
/O6 / '�✓c— �o
Street Address
City,
Applicant Representative:
Name
Title
Street Address
— 77/-S6R q
9
Pe
'
�020
/ Phone City, State, ZIP Phone
6-2q-93
Date Signature
Date