1124 C AVE.PDFIIIIIIIIIIIIII
10489
1124CAVE
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER: On (n [ obw O $ C 7�
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: , ��� DETERMINATION: ❑ Conditional Waiver ❑ Study Required 4 Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: c� - d ' q � LOT: 2— BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DA'
y -I 1
LATEMP\DSTs\Forms\Street File Checklist.doc
�• � FILE
Cri ica���"heckl�st
t eas RECEIVED
Site Information J U N 17 1993
Project Name: Gar4L 114,3ose rer"g,le/Permit Number. ER
Site Location: t t 2 y J �G a v P Property Tax Account Number. 619 y- a t 1- o a - o o o 6
Approximate Site Size (acres. or square feet): i T 2 g o
Have you filled out a Critical Areas Checklist for a project on this site before? I1 b
General Site Conditions
J. Has the site.been cleared or logged? h h Date of most recent action:
Soils 1 Topography >
%}It.�Pvw�od� .�l.bwa
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? La..sonoelex 2 -416 70
3.- 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 of horizontal distance.)
Steep: grades of greater than 30% present on site.
Comments
HydrologyNegetation
4. Site contains areas of year-round standing water n o
5. Site contains areas of seasonal standing water n n Approx. Depth:
6. Site is in the floodway h v floodplain n o of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? r1_0_flows
are year-round? Flows are seasonal?
8. Site is primarily: forested ; meadow _L,/- shrubs ; mixed
9. Obvious wetland is present on site: rn o
10. Wetland inventory or map indicates wetland present on site: n o
11. Critical Areas inventory or map indicates any Critical Area on site: n
For City Use Only
� Yf
890 - L99'
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 force, the
applicant should also submit a-vicinitymap
of the parcel 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).
RECEIVED
Owner / Applicant:
V 1w1
Name
O Wn cr
Title
11 2- -1 1.G „ a 1, f E d I•r101, d s
Street Address
NI^ 7?/ -76r8
W14 9 13020 wK 5"13- N6 ? 3
City, State, ZIP Phone
q/Zal y 3
%ignature Date
Applicant Representative:
APR 2 1 1993
NamePLANNING
DEPT.
Title
Street Address
City, State, ZIP Phone
Signature Date
890-19q
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. q44 (a
Issue Date:
A. Address or Vicinity of Construction: J
B. Type of Work (be specific): D ; M '41 Poke I. M
C. Contractor: !J' 4,1 — ig ly0 N C. Contact: T,,,, a x
_!5� Q aac r
Mailing Address: 0.U. 6e A S s 7 -?,? Phone: sy g_ ye, 0 g
State License #: ��8u - k f! Q 6 V L E Liability Insurance: Bond: $
D. Building Permit'# (if applicable):
Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ❑ Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family P1 Single Family ❑ Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut : ❑ Yes tONo G. Size of Cut: x H. Charge $
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 o%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.
f 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 s'te at all times for inspecti n purposes. is
Signatur
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK �.
COMMENTS: ,
DATE:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
S: =i.•-;d.ti: •or•r:t%.�--': ' •+ �;+ � a �,axy.. r. ;l �'A xtl I `k; Y�!rN�`Y^:"�•b+Y4C' a�Fb+'��l �r r.-% "i n �•;;,: �'M^•._� c .ti. �,,w�` .
m •`f' t�r �lr�lfl�i�r'"`y"ti:��"1N'x>�q`��.,y"'.A�d4`F('�t�iC'peTo,�r",�„'(� ,A sri'''�'. 7„rr"eS� •�tS 3":'�'�..�' » '('!iG*at'�Y'+:sM= r i:.;('
I-v-1-4000rp- O
8'90-19()
. City of Edmonds n
RIGHT-OF-WAY CONSTRucfilREET FILE p
PERMIT Permit Number.
Issue Date:.
A. Address or Vicinity of Construction: 1124 C Av. (9325277 )
B. Type of Work (be specific): install New Service
C. Contractor: Washiugton 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 WUtility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family
❑ Single Family
❑
Other
INSPECTOR:
INSPECTOR:
F. Pavement or Concrete Cut : ❑ Yes fiNo G. Size of Cut: x H. Charge $
APPLICANT TO READ AND GN
d� INDEMNITY: Applicant understands and by his signature to this application, agrees t he City o%Edmonds hams fr ju> amages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that maybe a gainst the City of Edmondj'o fltrtments or
employees, including or not limited to the defense of any legal proceedings including defen costs, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIA'G ,kh4 PERIOD OF ONE IyEAR,'ITUNTIL LGOOW/NG THE FINAL
/S COMPLINSPECTIETED BY CITY FORCES, ACCEPTANCE AT WHICH 7MEA DEBIT OR CRF_D/TF THE WORK. HWILGROCE�SF.D FOR /� UANCF. TL7TH/A�P/'�ANTXEET PAT( H
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 Cityingineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihaue read the above statements and understand thepermit requirements and the pink copyof thepermit will be
available on site at all times for inspec �np vdSeS.'y
Signature: j ` 3' Date: gent _ 91t 993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY U
APPROVED BY: lw l� F - ''
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS:
f, f
COMMENTS:
a
DATE:
RECEIPT FEE:
IS�UED BY:
NO WORK SHALL 'BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
The City of Edmonds Side Sewer Drawing EASEMENT NO- --------------------------------------------
NEW CONSTRUCTION F-1 REPAIRS Ej LID NO . .................. ASMT. NO - ------------------
OWNER.... ANNE --- GURREY ............................................................ CONTRACTOR ............................................. -------------------------------------- PERMIT NO. ....................
JOB ADDRESS --- 11.2,4,--C --- AVE - - ---------------------------------------------------- LEGAL DESCRIPTION: LOT NO. -------------------------------------- BLOCK NO.------------------------------------
........................................................................................ ------------------------------------------------------------------------r.
-
NAMEOF ADDITION --------------------------------------------------------------------- ------------------------------------------------•
-
DYE TESTED ON SEWER
Approved:
PWW-0001-1 1/75 4REV.1 1/78)
DATE............................................ By ............................................................
r �
r ;
Nam Gas •
F .
Addendum to : City of Edmonds
Right of Way
Permit Application
_Submitted by: Guyla Connors _
Engineering Aide
Washington Natural Gas
521-5248
11 Z4
\ut14 G ::�,32
r- t e S-F.
Ndd
U rn
IA WNG to window `
n[ Water main / depth unknown p
1—" gas main
lUD Gu-r S
-w-
water
-g-
gas
-ss-
sewer
$
water hydrant
O
water valve
815 Mercer St. (P.O. Box 1869), Seattle, WC 98111 (206) 622-6767
0 STREET RLE
RECEIVED
Attachment A
J U N 1 0 199J
PERMIT COUNTER
GRADING PLAN
Placement of the garage will require an excavation of 301X
501. This will cut into an existing bank and create a
maximum cut height of 6' and removal of 120 yrds. of
material. All material will be used on site to grade the
driveway, improve right of way grade, and backfill the
foundation. Excavation will be completed in the first 3
weeks of the project.
Site disturbance will be kept to a minimum as the existing
vegetation provides the best erosion control. Stockpiled
material will be tarped, as will the cut bank. The newly
graded right of way will be seeded within 24 hrs of finish
grading. The driveway will be compacted and covered with 4"
of crushed rock.
Excavation and fill calculations
excavation 120 cubic yards
drain rock 40 cubic yards
crushed rock 30 cubic yards
total material 190 cubic yrds.
STREET FILE
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• STREET FILE •
J U N 1 0 1993.
Attachment B: Height Calculations
PERMIT COUNTER
Structure is a M-1 attached garage with a second .floor
storage area.
Corner
NE-95'
NW-93'
SE-97'
SW-92'6"
AVERAGE: 94' 4 1/2"
MAXIMUM ELEVATION: 11914 1/2"
STREET FILP
,ob ,o£ ,oz ,ol o,
Paiu., Point 100
O
Waler may.
C ave.
fd P � avl.Nfh �'
v o Graa1 rl9ht of way
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AbCEPTABLEN IG TLI IE N'i�,`1"EHiAL
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AX
93' ao ! • �
APP I AS NOTED
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