1057 WALNUT ST.PDF11111111 lill 11
13645
1057 WALNUT ST
CITY OF EDMONDSf �; SIDE SEWER PERMIT
.890 09 PERMIT :.`� r.,..a�...
Address of Construction: lo57 &1Ae_.,yu — e4 �-J ��e�
Property Legal Description (Include all easements):
RECEIVED
JAN Z 9 1993
EDMONDS PUBLIC WORKS DEpr.
ATMENT PLANT
Owner and/or Contractor: ��% /-tN n
State License No.4,<6/- 2-57 7 KZ"
Single Family
❑ Multi -Family (No. of Units )
❑ Commercial
❑ Public
':5M
f
Gvl 11 "P" ti ri- ,
Building Permit No.
csi
Invasion into City Right-of-WayA. No Wes
RW Construction Permit No.
Cross other Private Property: No ❑ Yes
Attach legal description and copy of recorded easement
1 z2 73.
16l that I have read and shall comply with all sty requirements Date
as indicated on the back of the Permit Card.
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION
OFFICE USE ONLY
* FOR
INSPECTION CALL M
PUBLIC WORKS DEPT.
Permit Fee: �� ni. + Q! By C
__X
Trunk Charge: �1 Date Issued: / _ a a %3
Assessment Fee: I l Receipt No.: 2-1
Lid No.:
Partial Inspection:
Comments
Reason Rejected:
Final Inspection Approved: Date G' �n
p pp �_���InitialG��` A1.0
DI5�__lnitial.
Date Initial
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Green Copy: Inspector Buff Copy: Applicant
,\ 'I Rewsed 3 90
The City of Edmonds Side Sewer Drawing EASEMENT NO- ---------- --------- ----------------- e --..--
NEW CONSTRUCTION ❑ REPAIRS LID NO- ------------------ -ASMT. NO. -------------
OWNER CONTRACTOR.---•------------------------••---•---.----------------------- .................... PERMIT NO. U--r. `f---
JOB ADDRESS ` 0 S. 1 W►4. -lYl�l-------c`= •-•--------•-• LEGAL DESCRIPTION: LOT NO. ---••--------------------------------- BLOCK NO. . --••-------------------------•---.-
NAMEOF ADDITION------------------------•-------------....--...--••--.....------.....--•------................--•--------••----...----•
�. EDP,"�O\i�S
I TREA7(�^SENT PLANT
l.. t \�45 Ro
•
I
PWW-0001-11/75 (REV.11/78)
I
4"P.v.c Go. 3'0«� . (e
G49 t • DeeP i i
a-- I S -�
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Approved:: G� 2
DATE .1..--... .- <.. `J.
By V M . l S..aTiF�S---•-
'9
890 _ lq°�v
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. %
Issue Date:
A. Address or Vicinity of Construction: 1057 Walnut St. (9325837)
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Nat'l. Gas Co,
Mailing Address: 815 Mercer St.Seattle, Wn.
State License #: 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. ❑ Commercial
❑
Subdivision
❑ City Project KI Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family
❑
Single Family
❑ Other
INSPECTOR:
INSPECTOR: , kae'A
F. Pavement or Concrete Cut : &Yes []No G. Size of Cut: 2 2 x 4 Cuts H. Charge $
(2)@ Water In Asphalt (1) @ gas in concrete walk
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees 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
INSPECTION 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.
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 th;�,:permit jeq;�'_lrements and the pink copy of the permit will be
available on site at all times for inspeetigr purposes.
Signature:
Date: Sept. 23, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
�{
APPROVED BY: W�;�C ' ` RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER -p3 DAYS
SPECIAL CONDITIONS:
COMMENTS:
DISRUPTION FEE/FUND III:
RESTORATION FEE:
PERMIT FEE: /
TOTAL FEE: "� 3 �� - i "tom /KtP - 1 E� t�5•e
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.)
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Addendum to City of Edmonds
Right of Way
Permit Application
�_�__ _.__ . _Submitted by: Guyla Connors
--- Engineering Aide
Washington Natural Gas
521-5248
�c�#932s837
� u�# A388�8
WNG to window —
WatST main depth
gas main 21 �S
0
2 �ZX4�
� oC Wc,-�-2 In%lYq
L 0 CTA s Ccwx
LnIuT
-w- watWr
-.g-- gas
-as- sewer
$ water hydrant
0 water valve
815 Mercer St. (P.O, Box 1869), ScUlk, WA 98111(206) 622.6767
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No ...........................................
NEW CONSTRUCTION El REPAIRS p
OWNER...............C�f�-.� Q..1 r.............................................. CONTRACTOR .........�'r.,-i-.'�-%--.....--------------------------------------------- PERMIT No. ......................
Q .............--i/�
ADDRESS ........ Q,�7............... U7 ............................. LEGAL DESCRIPTION: LOT No............................................... BLOCK No. ................. ...........................
NAMEOF ADDITION........................................................................................................................................
Ma
i
k
t
Approved:
r
DATE .-• 9• --1�-`- -4;... ---... By
r
CA FILE NO.
Critical Areas 646k. ist
Site Information (soils/topography/ hhydrology/vegetation)
1. Site Address/Location: -7 W
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes; no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
N 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: _Y ; Approx. Depth:
7. Site contains areas of seasonal standing water:'` ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway j JQ floodplain _ r 0 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? No • Flows are seasonal? (What time of year? ).
10. Site is primarily: forested ; meadow ; shrubs ; mixed
urban landscaped (lawn,shrubs etc)
1 i . Obvious wetland is present on site: N'T`
E
ur
8y0.199-
City of Edmonds
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.
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: Applicant Representative:
Ike -
Name N me
Street Address13
9".Z4,
City, State, ZIP 71
Si aR" Date
Street Address �o�
6
ity, State, ZIP Phone
1.7 /U� 41-7
Date
nnmm��
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
9-9-97
Pat Andrews Smith
P.O. Box 1658
732 Bell St.
Edmonds, WA 98020
Subject: Determination regarding Critical Areas Checklist # 97-174
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.
IMPOR.TANT.INFORMATION TO BE NOTFD:
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.
=00- You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL
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.
Thank you.
Diane Cunningham
Planning Secretary
cc: Basin Tank & Environmental, Inc.
Note Attachments:
* Architectural Design Board
C:ReceptionUana\CRLTR.doc • Incorporated August 11, 1890 0
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