15621 70TH AVE W.PDFlillIIII 111111115492
15621 70TH AVE W
WE
TAX ACCOUNT/PARCEL NUMBER:�jDt�2% (�
BUILDING PERMIT (NEW STRUCTURE): ! q j23Cp
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: % l q 77 DETERMINATION: ❑ Conditional Waiver ❑ Study Required 01w aiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED: �3 09
SCALED PLOT PLAN DA
SEWER LID FEE $:
LID #:
SHORT PLAT FILE: 015 LOT: 2 BLOCK:
SIDE SEWER AS BUILT DATErD: o
SIDE SEWER PERMITS) #:_Tl
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED: t_�
OTHER:
LATEMP\DSTs\Forms\Strcet File Checklist.doc
IISE PERMIT
"T ZONE NUMBER 'ti.'BUILDING DEPA
Applicant Fill
Inside Heavy Lines JOB
PERMIT APPLI ADDRESS -76
'ky; IOR NAME OF NO.
"A' LEGAL LOT LOT AREA SUBDIVISION
01 IA ES ❑ NO -7 Co
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STREET RI.-:$i(�'o FT. DEFICIENCY THIS PROPERTY
0 C M IFT.
COMP, PLAN ST. R/_&__A0 FT.
U M R REMARKS
M CITY TELEYHONE UMBER Driveway slopes not to exceed those
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METER SIZE SIERVI E ZE CLEARANCE- CHECKED By
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PLAN CHI: Ely,
10 SITE I THE CITY ul
IS '_ATED IN
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F�4IM,NOS LOCAL SA
SALES TAX
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NUMBER STORIES NO LIM BLIH OF WELLING
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NATUVE OF.WORK TO 13E DONE
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VALUATION FEE
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PROPOSED USE
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BUILDING
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RETAINING WALL
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SWIMMING POOL
I hereby acknowledge that I he,. lead this application; that the In:
TOTAL AMOUNT DUE
ft
formation given !a Correct; =d that I — the owner, or the duly author
laws
t u.
I agree to comply wl h City suld state mg
Ized agent Of the owner. 1
led thereby, no erion
ATI'ENTION
APPLICATION APPROVAL
lating construction; and In doing the work author 1,
will be employed In Violation Of the Labor Code of the State of Washington
THIS PERMIT
This application is not a permit until
7
rel&tlOg to Workmen's Compensation Insurance.
AUTHORIZES
ONLY THE
e1gned by the Building official or his Dep-
NOTE, -Permit Limit One Year (Except DEMOLITIONS which
NOTED
uty; and fees are paid, and receipt is ac
k".
shall be Completed In ninety days; MOVED -IN BUILDINGS shall be com.
'ORK
I owledged in Space provided.
•
p,,,,d In six month
ATSIGNED
INSPECTION
FER OI)t � !
DEPARTMENT
E SIGNUR
CITY OF
L
EDMONDS
NOTE: Applicant Subject to Plan Check Fee.
775-2525
DATE
-7�
This Permit covers work to bo done an private property ONLY.
:any construction on the public domain (curbs, sidewalks, driveways,
ORIGINAL - File YELLOW - ln6 )ec;oi
t
marquees, otc.).will require separate permission.
PINK-Ov,)er COLD- Asse,so,
• #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.
0
Date Received: q G flb
City Receipt #: 6
Critical Areas File #: GA•05,0g3-
Critical Areas Checklist Fee: $135.00
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
subse uent she s necessa to co m lete a development
The purpose of the Checklist is to enable City staff to 9 p ry p
determine whether any potential Critical Areas are, or permit application.
may be, present on the subject property. The information Please submit a vicinity map, along with the signed copy
needed to complete the Checklist should be 'easily of this form 'to assist Citystaff in finding'and locating the
available from observations of the site or data available at specific piece of property described on this form. In
Citv Hall itical areas itufMING
' s, .1, ddition, the applicant shall include other pertinent
sunformation e. site. plan, topographyma etc. or
WNCVRD"cLNT n p si )
studies in conjunction with this Checklist to assistant staff
in ompleting their preliminary assessment of the site.
-APP.I.E.A.I. .1.0. GNU P I#
The undersigned applicant; and hi.Aerhtts�heirs, and assigns, n 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 as listed below.
SIGNATURE OF APPLICANT/AGENT
DATE
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
Owner/Applicant:
Name 0
2 7�
Z�Z . , (
Str ddress -2
City State "Zip,
Telephone: / 02 ;�_ — %�'— LD�l
Email address (optional):_
Applicant Representative:
..x r.
Name
Street Address
City a State Zip -
Telephone:
Email Address (optional):
#P20 5 — 9 7
Critical Areas Checklist cAFiIeN°:
Site Information (soils/topography/ hydrology/ vegetation)
? 1. Site Address/Location: / / n � l � F U)
2. Property Tax Account Number: 0 0 `�3% 6 0 o n �/ 6 9
3. Approximate Site Size (acres or square feet): `I 741
?`
4. Is this site currently developed? )(yes; no.
If yes; how is site developed? e ` o ,z ('
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation changeover entire site.
Rolling: slopeson 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%y.and less than 30% (a vertical rise of 10-feet
over a horizontal distance of 33 to C6-feet) r 4;
� 1
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over.e a horizontal
distance of less than 33-feet). p ¢: ' "kr rja lr�,
Other (please describe):
6. Site contains areas of year-round standing water: ; Approx, Depth:
7. Site contains areas of seasonal standing water:_ ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway _� floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round_ /a
Flows are seasonal? (What time of year? ).
10. Site is primarily: forested ; meadow ;shrubs ; mixed
urban landscaped (lawn, shrubs etc) X
11. Obvious wetland is present on site:,
For City Staff Use Only
1. Plan Check Number, if applicable? P G' 05 .5 0 F
2. Site is Zoned? P-5' 17 .
3. SCS mapped soil type(s)? 5 A l d-ervvVOOd U V O" L CL41 d GO vv1 DI f_x
4. Critical Areas inventory or C.A. map indicates Critical Area on site? yes 2iI�D DYl 1�1 a �iGtrd
Gl/1(ei Q/
5. Site within designated earth subsidence landslide hazard area? ( 1/ None, 1 G1eyA-t1f 1'e01 — PjV4-
POwMk&�"A Offiaal to mati-e -Real detevrnihabova
DETERMINATION �(
STUDY REQUIRED X WAIVER
Reviewed bv: (I vo"a-i G<ZAA�L� Date:_ n-4-1 V1-/ 0 F5_
Critical Areas Checklist.doc/3.25.2004
•
PLANNING DATA
DATE:
SITE ADDRESS: I H16
PROJECT DESCRIPTION:
r t—tl I U./L.
PLAN
REDUCED SITE PLAN PROVIDED?:
MAP PAGE: 5_ O-1 -CORNER LOT: (Yes / o) FLAG LOT: ()Les / o)
ZONING: R-5.12• CRITICAL AREAS DETERMINATION #: O5• 3-
❑ Study Required:
Waiver
❑ Conditional Waiver
- 20
SEPA DETERMINATION:
❑ Fee
❑ Checklist
❑ APO list w/ notarized form
❑ (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
Exempt
'SETBACKS:
l Required Setbacks- f �j . S . E .
W. Street:_�te* Side: IQ' RigtR Side: 1 �I Rear: ?�5
Actual Setbacks: I I 2`
Street: Leff Side:SIQ Right Side: Rear:I
Street map checked for additional setback required?
❑ DETACHED STRUCTURES: Num Sk1owo
❑ ROCKERIES:
❑ FENCES/TRELLISES:
❑ BAYINDOWS / PROJECTING MODULATION: L i 5r- ofIII '
STAIRS / EE Mu � �va (*--t� l� r L,
PARKING: Required: 2' Actual: C.,�i
./ LOT AREA: O - Z (pt.Y 4L�5"`i�hor)
< LOT COVE Y . O
Calculations: tp T
UILDING HEIGHT:
Datum Point: C/ Datum Elevation:
Maximum Allowed: Actual Height:___
A D.U. CREATED?: No Yes) NJy
SUBDIVISION:
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: (Yes (No)
OTHER:
Plan Review By: •
New13PP1ann1ngDataFor n.D0C
CITY of EDM*DS
For Inspection Call 771-3202
Address of Construction
ECEIVE'D
SSE P ' - 31985
EUBUC
1>/ TT
S*V SEWERERMIT
PERMIT NO
ETRLE !: NNWOOD LINE
Property Legal Description (Include all easements):
Owner'and/or Builder: ZV I � Z-z.-?2 - Z -d
Contractor.& License No:
Single Family Residence _X
Multi -Family (No. of Units )
Commercial (No. of fixture Units )
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
1-certify that I have read and sharl comply Date
with the items listed on the back.
Permit Fee: Issued By:
Trunk Charge: o?-S_-t0 Date Issued: 8_30 ,?-5
Assessment Fee: Receipt No.: '5729`9?-
Partial Inspection:
Comments II Date Initial
Final .Inspection Approved:
Date Initial
oRejected:
Reason Date Initial
a�
** PERMIT MUST BE POSTED ON JOB SITE **
a�
White Cop
y.- File Green Copy - Inspector Buff Copy - Applicants
Side Sewer Drawing
The City of Edmonds
EASEMENT NO. ---------- -------------------------------
ffleAp. cotmA.- V %
NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO. Ak) ------ ASMT. NO. ------------------
4- OWNER ... UJ.;A;.V%.*V -------- L ....... CONTRACTOR PERMIT NO. '73( ..o. ......
-------------------
J9B ADDRESS --- L&L-13— ............ 7 ------ RUC .... W ........ ........ LEGAL DESCRIPTION: LOT NO- ------------- ....... ---------------- BLOCK NO. -------------------------------
j
.LYNNWOOD
WU . . . . . . . . . . . . . . I M!.0 I? NAME CF ADDITION --------------------------------------------------- ------------------------------- ---------------------------------
4
T� i T
4"
A
C4., 1
T
1-4 17 'S'
1 Wj
'C/6
Approved:
f
DATE.1.7 3 -'95 ............ By ----- - -------- ... ........ . ...... ........
9l� j��
15518 III
a _ o
r i
15520 15515 7215 ISSOB 7111 7107 h01 703t -
y 7009
156iH ST SW
Isms 15602 7724 .. _— - - p
—
7222 3 ..I. _ 1560,p O
7100 6eii'.
15615 W
_ rozfi tssoo 1
7I20 15621 6816 ® s
15604 Q 71 t0 6815
15625 15610 Z d
n 7029 I 7019 15M1 6812 = 68" q
• 15820 I 7119 7117 10
1563 t
? ) 15'03 15705 / 0
15700 15620 t5715 15702
0 0 \
' 15706 1`i70i 15719 15712 I ^� 15709 15707 6901 } 1 6808 /
15714
15722 15721 - 15728 1572a
15729
15730 15725 ro 15720
15730 15732 i
15810 400
7324 I 15808 15800 I 1515808 1
809 15814 1
i 15812 15821
15911 15814 15870 15818
15824
3 15825 15915 15824 W 15827 15826 15828
15908 11 15805
s
= QO
159t1 15907 15902 15904
15910 � 15825 15917 15910 �� p
r
15927 15902 15915 6907 15908 15906
15912 15917
d n
7427300 15920
9 6921 F-6-�-t5926I
78000 \
m 15931 16Mi ST SW
16123 16121
16006 16012 ® �� 7220 16W8 16010 6970 6910 6820 16032
Isooe 1
6924 � 3 ��^ �t6 6828 t603a
ro 16116 16119 18115
.(
6020 16IXi1 6960
16010 cl� 6920 16038 16038
v 1 16105 16105 oA 16118
m
16106 !\ ` 6918 � 6909 6803 `
ISM r �^ 0 �6 6912 69M
0 �6 ism1
6 •�48,22 \ ,00
� 16131 18127 / � 56 t211 18116
162ND ST
16202 16209�^ 18218
1820 16214
t1 V 6925
16206 `
16220 16236 Q 16220 2�9
F+' 16221 E 2 , �6 A 6g2� BBOt d
N O� 1Z \ 6ws E
18310 - 16238 1` 76228 �6 6q!
d
16311 7212 14 0 18222 16232
16315 18318 -� 16315 18320
16330 3 7316 a 16319 i
.....16319 yNy N 6801
31LL
6340 n id 7108 jZ 16323 16322 16321
I ro
H C'f C1N
iRGT,.'
� 0 8904,i
m.
7317 N m n o
16414 _19411 7404 n ^ n 7114 6803,
7320 7110 7040 ro30 7014
16420 i 18429 1 PL SW 16419 , p@
16431 7406 \ tl
16508 7314 M g+ 7010 681t \
n n 16423 7028 7020 _
8801 Meadl7w11a�e
16570 t - Communiy
f � � 18520 \ 165I0 18500 18501
J
ALSO OPERATING:
ABC BUILDERS
OLSON • PRIDEAUX
INDUSTRIES
C7
PRIDEAUX CONSTRUCTION I P tIYiEP9BZpi. FILE
GENERAL CONTRACTORS
P.O. BOX 240 • LYNNWOOD, WA. 98036
July 25, 1977
Engineering Department
City of Edmonds
Edmonds Civic Center
Edmonds, Washington 98020
Rea Septic Tank/drainfield 15621 70th West
Gentlemen:
Please forward to our office a copy of the as -built
of the septic tank and drainfield on the above
referenced property.
Sincerely,
M
ON TRUCTION CO., INC.
dea x
President
ICPskl
CC: William Zabroski �J4.�• & 455
jJ5 #Q1RL *60-
2�27 FO 0 Ci?FIR,
WeZB17
252-3�0
HOMES
APARTMENTS
COMMERCIAL
RECEIVED
JUL 26 1977
Public WorkS uepi.
y 7 I
Z k
STREETT �x. •
DATE: April !,9, 1976
MEMO TO:* Septic Tank Permit File
FROM: Bill Nims
Asst.'Engr. for'Fiel-d 1 Office
SUBJECT: Septic Tank Inspections
On April 1, 1976, I made field inspections of the following permits:
ddress Permit No
L6O
70th" Ave:'' W ''' 372
70th Ave. W: 374
70th Ave. Vt. 373
The general contractor is Prideaux Construction, Inc. and the septic system
was installed by.Les Wier.
The drainfield on..all. permits were extended beyond the 10 ft: setback from the
property lines which is'a violation of code. Also, footing drains.were directed
to flow in the area of"the`dreinfield's; 'a v
which is also�iolation"`of code. I
did not sign the field copy of the permits because I knew it would take many more
inspections to correct the system.
"text, I called the general contractor and told him that the permits did not pass
inspection and corrections were required. On the same day, I met with Wally
Steinman, the.job superintendent, to discuss the corrections': After we reviewed
the subject permits I was told.that the following permits were ready for
inspection:
7100 - 156th St. S.W.
7124 - 156th St. S.W.
370
371
So, I made inspection of those systems. In regards to Permit No. 370, the
entire drainfield had already been covered and had never been inspected by the
City and is not approved. Also, Permit No. 371 is not approved and corrections
arearequired. I then contacted the developer to inquire as to the corrections-- ---
status.
On 4/8/76, I met with the utility installer at the job sites to indicate. the
corrections:.to be made. The corrections are under way at this time and will be
ready for inspection on 4/9/76.'
WJN:rf
CITY OF EDMONDS 01 RECEIVED
Sh0kKMffiffiUNMhftfflffW JAIL 27 1976
ENVIRONMENTAL HEALTH DIVISION
Court House, Everett, Washington 98201 WHOM
APPLICATION FOR A SEWAGE DISPOSAL SYSTEM PERMIT
(Submit 3 Copies)
Prideaux Const. Inc
Permitto be issued to------------------------------------------------------------•-•--••--...........-•--•...-•------•-------••-------•--------•-•----•......---------•--.---------
For installation at: (street address)..........
-------------------70th--Ave_--W,-___Edmonds_
---------------------
.------------------------
Addition or Subdivision----- 5-•F-•--.It....
1--TS ------------------------
------------------------------------------- Lot
--- Block. ---- ----------
Type of Building: New.x..--- ._. Existing ............ Single family residence; ............. Number of bedrooms .... A----. --------_---
Other: (specify type or use)---------------------------------•-------...---------------------------------------------------------------•-------------•----------------------
Builder... Prideaux Cons---.---Inc.---------------------------------------Address.... P .0 , Box_- 240_1ynnwood_------_------------------
Designer ----J- B._..Friel--b`--o----------------------------------------- Address ----- 2-92-7 --- Rockefeller---- Everett ------- ---------------
Soil Log Hole No. 1...... O"-40" Brown sandy loam
--------------------------
Soil Log Hole No. 2..................same as # 1
Elevation of Water Table, if encountered. (Distance from ground surface) .......... TA9ne....................................................
Corrections to control surface water if needed .... _............ _none
---------------------------- -------------------------- ------ --------------------
Specify if any removing or grading of topsoil in field area ............ none --------- _---------------------------------------------------------------------
------------------------------------------------- ------.................----------------------------- •-•------•-------------------------•-----------------------------------------------------------------
Percolation :
Test Hole No. 1—Average Rate ... 3....... (Fall in minutes/inch-bottom 6" test hole). Depth of hole --- 3-6."--:-
Test Hole No. 2—Average Rate...3....... (Fall in minutes/inch-bottom 6" test hole) . Depth of hole......36
Test Hole No. 3—Average Rate... 3 ...... . (Fall in minutes/inch-bottom 6" test hole) . Depth of hole-.
Test
Average percolation rate on which to base drain field design -------- ........... Date taken.... Dec..._.7.5_,19.75
Septic tank requirements based on present rules and regulations:
Septic Tank Size.. 9. 00 gallons.
Amount of Square eet of Disposal Yield........ 345 with 24" Trench
—DesignSignature ---- .:_.. r'----------- Date---- j`A_-2sVM-----------------
DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
Permit iss ed ( //a -/.. .. P it Nu er j t t-
Remarks -= �date) . (1 i --- �-
...--- ri=1� G n� o�d�. 0 =fig
K&H 39652
1
1
1 � i
� 1
N +
25: c+ i {�
1
t Q�
+! ALL CaMtt.�. _ �'^."..''�'O L.► :5-_-_
2•. -_l P DES, ` ►J ! c..t-4, G s� �._ CALL
-'Pf=.2C-.(-{O.f�S }.};�vc F3EE+J GOUE2t�f�
'Loc
-CITY OF 'EDMONDS = ENGINEERING DEPT.
Examined by,
Date SCALE;-) L-_ �� - APPROVED BY: DRAWN BY
_ Remarks DATE: REVISED '
p�1:��1✓Avx _.=Cc�Ns�
DRAWING NU[MBBR
Tl
•
I,
m 7P
SEWAGE DISPO.SVA"tITFILE
Septic Tank ....... fap --------- gals— WMT
CITY - OF E D M O N D S No. ..;;�.71 ......
Disp. Field ... !��e - ------- ft. Department of Public Works
Other ..........
....... ... ! --------------------------------------------------------------------- is hereby authorized to install/
repair sewage disposal*system at
............ ... . ....
---- ----------- ... ....... _4V ------------- ------------------ ......................................................................................
Date issued on ................. tl
Permit expires one year from date of issue
DO I NOT COVER BEFORE APPROVED BY DESIGNER OR SANITARIAN
I hereby certify this system was installed under my supervision and control and complies with all provisions of the City
y
City of Edmonds
505 Bell Street Signature of Installer .............................................................................
Edmonds, WA, 98020 Date
ApprovedDisapproved El Date ---------------- : ----------------------- -----_----_---- By ................................................................................... .
Remarks:
SANITARIANOR DESIGNER ---------------------------------------------------- ------------------------------------------- Date
This permit shall be posted in a reasonably conspicuous place on the job until inspection has been completed.
L
DATE:. April 9, 1976
MEMO 0 :
�,. T Septic Tank Permit -File
FROM: Bill Nims
Asst. Engr. for Field & Office
SUBJECT: Septic Tank Inspections
On April 1, 1976, I made field inspections of the following permits:
Job Address Permit No.
�.. K:• ,,
;.. ,,. .15631 - 70th Ave. W. 372
15621 - 70th Ave. W. 37
.15601 - 70th Ave. W. 373
The general contractor is Prideaux.Construction, Inc. and the. septic system
was installed by Les Wier.
The drainfield on all permits were extended beyond the 10 ft. setback from'.the
property lines which is a violation of code. Also, footing drains were directed ;•
to flow in the area of the drainfields, which is also a violation of code. I
did.not sign the field copy of the permits because I knew it would take many more.,,
inspections to correct the system.
Next, I called the general contractor and told him that the permits did not pass .'?a'
inspection and corrections were required. On the same day, I met with Wally
r Steinman, the job superintendent, to discuss the corrections. After we reviewed_
the subject permits I was told that the following permits were ready for
inspection.
7TOO - 156th St. S.W. 370
7124 - 156th St. S.W. 371
°r So, I made inspection of those systems. In regards to Permit No. 370, the -
entire drainfield had already been covered and had never been inspected by the
City and is not approved. Also, Permit No. 371 is not approved and corrections
are:trequired. I then contacted the developer to inquire as to the corrections
status.
On 4/8/76, I met with the.utility installer at the job sites to indicate the
corrections to be made. The corrections are under way at this time and will be
ready for inspection on 4/9/76.
WJN: rf
w
�o
a�
r
r5791 .
33
HILL
gars
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Notes:
1. All signs and spacing shall conform
to the MUTCD and City of Edmonds specs.
2. Work zone is 100' s/o c/I 156 ST SW
& 1 V e/o c/I 70 AVE W
3. Flaggers will control alternating
0 one-way traffic.
z 4. Alert affected residents
NOT TO 5. Channelizing devices are 28" cones.
SCALE 6. Tapers will be 50' - 100' and must
contain at least 6 devices.
7. All signs are 48" x 48" B/O
unless otherwise specified.
156 ST SW►
•
- - - - - �.0 .
' 200' 200' 200'
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ot
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IV
® > 157 ST SW' I
a-- I
100, I
Pilchuck Contractors, Inc.
Job #106103160
8 Mar 03
Sheet 1 / 1
J. BUSS
National Barricade Co
rfav�rvu vO
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CHANNELIZING DEVICE SPACING (FEET)
TAPER I TANGENT
20 1 40
is
c%
N
20-7A
ROAD
,, W20-4,
ROAD
VIIORK
A W20-1
LEGEND
WORK AREA
28" TRAFFIC CONE
�► EXISTING TRAFFIC FLOW
Q SIGN LOCATION
r1r FLAGGING STATION
PROTECTIVE VEHICLE
® OR WORK VEHICLE
. ; City of Edmonds Permit No:
3
r:
RIGHT—OF—WAY CONSTRUCTION PERMIT Issue Date: S'C�,•3
A. Address or Vicinity of Construction: 0..V
B. Type of Work (be specific):
J� G C> CJ .
C. Contractor:
I
$1
Mailing Address:
State License #:
D. Building Permit # (if applicable):
E%- ❑ Commercial
\ `-❑ Multi -Family
INSPECTOR:
F. PAVEMENT CUT:
CONCRETE CUT:
Subdivision
❑
. Single Family
YES
❑ -NO
❑ YES
❑ NO
Contact: I t o,
Phone: LI
Liability Insurance: Bond: $ `
Side Sewer Permit # (if applicable):
❑ City Project ❑ EUC (PUD, VERIZON, PSE, AT& T, OVWD)
❑ Other
G. SIZE OF CUT oZ X `1
INDEMNITY. • Applicant understands by his/her signature to this application he/she holds 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 but not limited to the defense of any legal proceedings including defense
costs and attorney fees by reason of grdnting'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 W!LL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
♦ Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
♦ Restoration is to be in. accordance with City codes. All street -cut trench work shall be patched with asphalt or City-
approved material prior to the end of the workday — NO EXCEPTIONS.
♦ Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -;A -DIG (1-800-424-5555) PRIOR TO BEGINNING WO
R
I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND. ACKNOWLEDGE
THAT I MUST MAKE THE PINK COPY OF THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS
Signature:
.-Ay,
Date: :3 /13 k 3 t
(Contractor or Agent)
FOR CITY USE ONLY
Approved by: ( ll g a_l— Right -of --way Fee: 14
Time Authorized: Void After 5-/ 12 / 6 3 Disruption Fee/Fund 111:
Special Conditions: iZ>Sih`CI.WttK Restoration,Fee:y
KEW e;,T9Mr UM,' 0 OA rC v d F A'L(, ,*, Total Fee: -75
r,Q?41 0 A LL rjfk P IAA I I t���» 1 dN f� Receipt No: '
Q•
71 4�7? ' k 1: �� t N("� 1':�,�1C""Phsued bv:
1 � i
UPON, COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF. THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)
FINAL APPROVAL 0FAOMI'] ED„WORK: e145, ta eU, I f DATE: 10125167
nspector's Signature. li it$
For inspection requirements see Engineering Inspection Information handout.
NO WORK �l-IALL l3ECIN Plt101t TO PF.ItMI"C ISSUANCE
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heN! APPROVED BY PLANNING'
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