1448 8TH PL S.PDF1448 8TH PL S
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The City of Edmonds 70 e) ek'!) 0
ke'� � '4ce- tt�-r-
AOLICATION
for
SIDE SEWER PERMIT
OUTSIDE X_ INSIDE 0 REPAIRS 0
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OWNER ...... -5rkarle. ............. Ajo ~ . . ......... .�-c ........................................ CONTRACTOR w
STREET
HOUSE No . ..... �4!P ... . .. 8-4� ....... ...... 1� ................................. AVENUE LOT No. . .......... // ......................................... ....
NAME ADD ....... . ...... ....
................. . ................. ....
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CARD No. Y ...... ...........
EASEMENT No. ... ....................... . ... .........
...... ca.., .................... PERMIT No.
.... BLOCK No . ........................................ ..
APPROVED
'MM A 1%2
Date 0 Approved:
BACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, $ ................
SEWER WORK ORDER ISSUED ................................................ ..... /47. BY. ...............................................
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. 2..
Issue Date•
A. Address or Vicinity of Construction: b
u _
B. Type of Work (be specific): f%(I; 1rj
C. Contractor: Contact:
Mailing Address:1#�,'►+Eyiyt�Phone:�
State License Pi: Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit a (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project JVUtility (PUD, GTE, WNG, CABLE,ATTER) -
❑ Multi -Family ❑ Single Family ❑ Other -
INSPECTOR: INSPECTOR: RC26aBi rumZ
F. Pavement or Concrete Cut : Yes []No G. Size of Cut- xx 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 FOLLOWING THE FINAL INSPEC-
TION 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.
Two sets of construction drawings 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 trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
r
I have read the abgve statements and uuderstand the permit requirements and the pink copy of the permit will be
available on sit4 at all time for in0 t dnomposes. r,
Signature:
r
I
I Date: �• !
"PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: [ [ 1 ii^.uT RIGHT OF WAY FEE:
TiME AUTHORIZED: VOID AFTER DAYS DiSRUPTION FEE/FUND 111:
SPECIAL CONDITIONS: RESTORATION FEE:
TOTALFEE:
RECEIPT NO.:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO�PERMIT ISSUANCE Eng. 1997
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:
I
11-10-1997 12:48PM FROM OLYMPIC UIEW WATER 206 670 18SS
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OLYMPIC VIEW WATER & SEWER DISTRICT
2MS Edmonds Way Phone (206) 774-7769
Edmonds WA sam&B-ci i Fax (206) 670-1856
FAX TRANSMITTAL COVER SHEET
Please deliver this docuut-rit to:
NAMS
ANY. rrJ4
FAX #:`�� d2
DAM:��
TIME:
Number of pages including this cover sleet
This docwier.t is from:
NAME:
;!
1
Board of Commissioners
John E Elsasser
Patricia L Meeker
Lora L Petso
RECE:IV D
NOV 1 2 1997
ENGINEERING
w�
11-10-1997 12:49PM FROM OLYMPIC UIEW WATER 206 670 1856 P.2
ED7..y
City of FAl monds
mny i .�jj7
RIGHT-OF-WAY CONSTRUCTION
PERT , INEL. �.NG
Permit Number:
_ Lwuc Dates
I C.890
A. Address or Vicinity of
B. Type of Worm (bc spcci
C. Contractor.
Mailing Address:
State Licease #:
D. Building Permit # (if applicable):
liability Insursnce: Eclat $
Side Sewer permit # (if applicable):
❑ Gotnmtroial ❑ Subdivision 1 ❑ City Project
❑ Multi -Family ❑ Single Family ❑ other
INSPF-C'rOR: I14SPECTOR:
F. Pavement or Concrete Cott :
'es []No G. Size of Cut:
APPLICANT TO
(PUD, CITE, wNe, CABLE, ATF�i}
•cwj=r— -
z H. Cbarge 5
'AL�-
1ND9A1NITY.- Applicant to demtands and by hissignature to this application to hold the City of monde hcrmlessfrom ityurf[c_pmnages,pr claims of arty
trend or description whatsoever, foreseen or unforeseen, that may be made against the Cl{y of Edmonds, or any of us departments or
emplowes, including or not limited to the defeme of any legal proodedinga including defense coots and attorney feed by reason of gmreting this permit.
THE CONTWTOR IS RESPONSIBLE FOR WORKMANSHIP AND A:UTENALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL IN3P,EC-
77O1i AND ACC'EPT4XCE OF' 7'11L' WORK FSTIM.f D WTOR477ON P'm WILL BE HELL] Uh'711, 7NZ Flh.4 L STRrZT PA7CH 1S COMPLETED
9Y.t trrF0AC9$ Ar strHICH XXI W A DG61r0N CF4DiT WZ4L tfE PROCB$$ED FVR 1$SUAnGC TC TWEAPPLICANT.
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T%vo sets of construction drawings 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 kepYalean,at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as roquirGd by the City Engineer.
All street out trench work shall be patched with asphalt or City approved material prior to the end of the -,vorking day;
NO EXCEPTIONS.
I have read the Bove statements and ujukmtand the permit requir'meats and the pink copy of the perinit will be
available on si atall tim for e t' ..Poses.
7y '�
Signature: Zktte:
; !�� (otrtrgctorW.VRIOR
,,+ �U(j[~AL_ - TO BEGINNING WORK
NO WORK SHALL BEGINPRIOR, OrPERMIT ISSUANCE 0,,& D[, 1997
02TC
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/ Location < <-i �h I .
2. Property Tax Account Number: N"'� o Flo S S 0 DO 0 1 M(D old_
3.
4.
CA File No: U/6
0�
Approximate Site Size (acres or square feet):
Is this site currently developed? yes; no. RECEIVED
If yes; how is site developed? 2.. uooSe— /TcQ,m h MA n I It 20nr
5. Describe the general site topography. Check all that apply. V Flat: less than 5-feet elevation change over entire sitePERMIT COUNTER.
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: N A ; Approx. Depth:
7. Site contains areas of seasonal standing wafter: ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway N10 floodplain t,b of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
N 0 Flows are seasonal? (What time of year? ).
10. Site is primarily: forested ; meadow ;shrubs ; mixed ;
urban landscaped (lawn, shrubs etc) 5 .
11. Obvious wetland is present on site: >
For City Staff Use Only
1. Plan Check Number, if applicable?
2. Site is Zoned?
3. SCS mapped soil type(s)? EV 6t4A*l oe&HtPy W D -T % sw rWS
4. Critical Areas inventory or C.A. map indicates Critical Area on site? Ilk*
S. Site within designated earth subsidence landslide hazard area? f4 b
DETERMINATION
STUDY REQUIRED / OC WAIVER
Reviewed by: 3 Wii L"-D G4c- - Date: #-! rh !S
#P20
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
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).
Date Received: --�/i �?-/os
City Receipt #• nr9
Critical Areas File #:
Critical Areas Checklist Fee: $&�90
Date Mailed to Applicant
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 forma 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 aslisted below.
SIGNATURE of APPLICANT/AGENT DATE 4-
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.
SIGNATURE OF OWNER
PLEASE PRINT CLEARLY
Owner/Appl*cant:
rv-. 000&
Name 6 a3 Co-4zo 1 kADO-k
Street Address
City State Zip
Telephone: .�� - -1�-� - �') (� I7
Email address (optional):
Applicant Representative: .
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
Can—