1561 9TH AVE N.PDF111111111111
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1561 9TH AVE N
APPLICATION
for
Jlre City of Edmonds SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS
OWNER......... V..W ....... .. . ................................
ADDRESS ...... ....................----------- ..... ........ .. ......
9
9
EASEMENT No.........
CONTRACTOR........................ ................................................... PERMIT
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ..........
NAME OF ADDITION .............. 4,L�L ..... atf— -.....................................
............................
116
A P j
MAR
Approved:
DATE........... By .. . .. C—S! .............................
City of Edmonds
Critical Areas Checklist
The Critical Areas Checklist contained on
this form is to be filled out by any person
Prcparing 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
Sabject Proparty. The information needed to
Complete the Checklist should be easily
awarlable 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 checldist; 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
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).
Owner / Applicant: Applicant Representative:
Name
Title
Name
Title
Street Address Street Address
City, State, ZIP Phone City, State, ZIP
Phone
Signature Date Signature
Date
RET FILE
Critical Areas Checklist'
Site Infor tionl
Project Nar Permit Number.'
Site Location: 4i— Property Tax Account Number.
Approximate Site Size (acres or square feet):
Have you filled out a Critical Areas Checklist for a project on thi site before? o
General Site Conditions n
1. Has the site been cleared or logged? Date of most recent action: `
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil types)?L, i ww (lu,n,
3. Describe the general site topography. Check all that apply. crib
G c . Flat: less than 5 feet elevation change over entire site.
�j Rolling: slopes on site generally less than 15% (a vertical rise of 10 feet over a
horizontal distance of 66 feet.)
AIU Ifilly: slopes present on site of more than 15% 15% and less than 30% ( a vertical rise
of 10 feet of horizontal distance.)
_Steep: grades of greater than 30% present on site.
Comments
Hyd rology/Vegetation
4. Site contains areas of year-round standing water:
5. Site contains areas of seasonal standing water. �Z u Approx. Depth:
6. Site is in the floodway floodplain of a water course.
7. Site contains a creek or an area where water flows across the grounds surface?��_flows
are year-round? it 1. Flows are seasonal? i� c
8. Site is primarily: forested : meadow ; shrubs ; mixed
9. Obvious wetland is present on site: c\\ o
10. Wetland inventory or map indicates wetland present on site:
11. Critical Areas inventory or map indicates any Critical Area on site:\\ t,
for<Oty Use Only
Rev W27/92
PUBLIOC WORKOSNDEPARTA ME T ����
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Construction
��i l e�til vicinity
i:;l . y 1at 161-066,
• Owner: Tn7c"'• sh ingt on Natural Gals
Name
Mailing Address
Bellevue. Washinaton 9800
City, State, Zip Code
• Contractor: Same As Above
Name
Permit No.
Issue Date
• Permit Issued To:
• Type of Work to be Done: Tn.gi-n 1 1 icr; ^; , ry_3-c:
• Work in Connection With:
❑ Sub or Plat ® Single Family
❑ Comrnl. / Ind. ❑ Apt. Condo.
• Pavement Cut: ❑ Yes ❑ No
Mailing Address State License Number
< City,' State, Zip Code Telephone Number
a
* NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
a
B. APPLICANT TO READ AND SIGN
co
A INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
aagainst the City of Edmonds, or any of it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
O
wUpon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
O
E--
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this perm' ust be avail a t to for inspection purposes at all times.
Signature: Date August 10 � 1931
Owner or ALYInt
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Void after days
Special Conditions:
Ammendments:
Permit Fee:
Security Deposit:
Receipt No.:
Fund III :Fee:
Street Cut Dimensions
X =
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
FIELD INSPECTION NOTES (Fund 111 - Route cor)v to Street Dept.
Diagram:
Contractor called for inspection Yes n1
Work Disapproved By: Date: Bv: Date:__
Work Approved Bv: Date:
Inspector:
Ena. Div. December 1978