122 SUNSET AVE N.PDF11111111111111
13341
122 SUNSET AVE N
890 - 19C)..
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PE,,//RMIT Permit Number. i 3 _
Gvr- / ' 110 Z' v Issue Date: '
A. Address or Vicinity of Construction: 122 Sunset Av. N. (9316636)
B. Type of Work (be specific): Install New Service
C. Contractor:Washington Nat 11 . Gas Co -
Mailing Address:
State License #: 9811
D. Building Permit # (if applicable):
Contact: 29auk Swan
Phone: 994-9978
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project 5JgUtility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR: C*
F. Pavement or Concrete Cut: Vlres ' ❑No G. Size of Cut r x s H. Charge $
1-@Wate 1-JN PAVING
APPLICANT TO REA A . ( c U T ,!Z o
INDEMNITY: Applicant understands and by his signature to this application, agrees old the City of Edmonds harm-f�.g'19s, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may ¢e against the City of Edmonds, or anyof1departments or
employees, including or not limited to the defense of any legal proceedings including defeia& c sis, and attorney fees by r a�an of ranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR
�FOLLOWING
�THE FINAL
INSPECTION F THE
UNTIL T
S COMPLETED BY CITYFORCES, AOT WHICHOTIMEA DEBIT OR CREDITWILLGGOBEFPRtS� SF.D FOR ISSt1ANCE TO TI F APOL.4CANTET PATCH
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 regula ' by ngineer.
All street cut ditches shall be patched with asphalt or City app*r6ed inaf erial prior to the cnd of tYw 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 for inspection purposes.
Signature:
Date: May 20, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPYOVED BY: VJ-44u*4 RIGHT OF WAY DEPOSIT _
TIME AUTHORIZED: VOID AFTER DAYS DISRUPTION FEE/FUND 111:
SPECIAL CONDITIONS: h)
COMMENTS:
RESTORATION FEE:
PERMIT FEE:
31D ==
TOTAL FEE:
4 3 ?.,.:.
RECEIPT FEE:
#A
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Nv. 1991
FIELD INSPECTION NOTES
Comments
Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by
Work Disapproved By:
FINAL APPROVAL BY: _
P.W.:
(Fund 111 - Route copy to Street Dept.) .
❑ YES
Date:
Date:
❑ NO
r I Addendum to City of Edmonds
Right of Way
Permit Application
_. Submitted by: Guyla Connors
Engineering Aide
Washington Natural Gas
521-5248
A\j K i
WNG to window
Water main depth
_ unknown 20"a
gas main
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Key:
^' -w- water
-g- gas
-ss- sewer
$ water hydrant
O water valve
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PLOT PLAN
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RECEIVED
APR 0 7 1993
PERMIT COUNTER
Site Information
Project Name:
Critical Areas Checklist
Permit Number.
Site Location: 1Z Z �5-y 1J S 6-T 6 V G Property Tax Account Number.
Approximate Site Size (acres or square feet): 7 ZO O
Have you filled out a Critical Areas Checklist for a project on this site before?
General Site Conditions
1. Has the site been cleared or logged?
Date of most recent action:
Soils / Topography eQLL�"T��..�eal7 t�R1yt N
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? LdNP GO,AtM-rN 2 -&
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°/p ( a vertical rise
of 10 feet of horizontal distance.)
Steep: grades of greAW than 30% present on site.
Comments
Hydrology/Vegetation
4. Site contains areas of year-round standing water:
5. Site contains areas of seasonal standing water. 1'u 0 Approx. Depth:
6. Site is in the floodway MO floodplain tLQ of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? flows
are year-round? Flows are seasonal?
8. Site is primarily: forested : meadow ; shrubs ; mixed
9. Obvious wetland is present on site: r(D
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 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 cheeldist, sign and date it, and
submit it to the City. The City will review
the checldist, make a precursory site visit,
and make a dct= ination 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
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 st6dies 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:
Qo'612T You M6
Name
Title
ll l o r\) , t S1-N
Street Address
City, State, ZIP Phone
6, lu � -
�3
Signature Date
Applicant Representative:
Name
Title
Street Address
City, State, ZIP
Signature
Phone
Date
APPLICATION
The Cityof Edmonds far
SIDE SEWER PERMIT EASEMENT No ...........................................
NEW CONSTRUCTION ❑ REPAIRS ❑
112-04300
OWNER .........----1111d--- tle1SOn---------•..................................................... CONTRACTOR------------..........----------...--...........---.........----................------------...... PERMIT No. ......................
ADDRESS ...... 1Z2..S.onset..AYe............................................................... LEGAL DESCRIPTION: LOT No. .............................................. BLACK No.............................................
NAMEOF ADDITION.........................................................................................................................................
• Lu
LL—
•
Dye Tested On Sewer 1972
Approved:
DATE............................................... BY .............................................