1576 9TH AVE N.PDFIIIIIIIIIIII9861
1576 9TH AVE N
APPLICATION
for
The City of Ed �.`r ,. SIDE SEWER PERMIT
a I L_: —� NEW CONSTRUCTION ❑ REPAIRS ❑ EASEMENT No ...........................................
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OWNER C}? ..........� tezI.- _._......
CONTRACTOR _....G%✓!<......- X..C.CZ_1�G7 ilk .L.�?ti...--...--. PERMIT No...-......� S�SJ Y-
..........................
'� .. ADDRESS.1_...-.....T.�...-..--...�._...---,fX--Y..�...-..�......................... LEGAL DESCRIPTION: LOT No. ............ .-...-....-..... ......... ....- BLOCK No. ............................................
NAMEOF ADDITION............ ................................--.........---.............................
APp�o�t�
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Approved:
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DATE ... /.....*2 .... .. ? . �, .......... By .......,�.,�
' :CITY OF EDMONDS
CIVIC, CENTER — WATER -SEWER DEPARTMENT
SIDE SEWER PERMIT
�_ y's'•uf=mow-{. _ - - - Cr�ta_4-fit Call PRospeet 0-1107 when weik is ready for Inspection. (No inspec, O 6.5 5
tions Saturday, Sunday or holidays.)
ADDRESS ........................ 1.57.E ... N.�ni h...l�yenue...North............. I .......................
Roth Excavation ..........................
OWNER.........John...B£.G............................
1.9.6.$.., for .......... ............. days to REPAIR or CONNECT a side sewer
Pernlisston is granted .--�dALldY'}T••-2 �ication on file and governing ordinances.
witn City Sewers in accordance with app
ATTENTION IS CALLED TO THE FOLLOWING:e sewer
NOTE No. I—ct sewer
be employed to eon truce side ay obtainsa p rmit to Do construnot cover anylnside Portion Property
ltlhaesbeenldnspected, Contractor must
The owners of er in
NOTE No. 2—Obtain full information regarding Ordinance 11.10.030 and Regulations governing aide sewers when you get permit.
TE No. 3—Nob f side sewer sharper h than lave at least 30 inc r�.ncoverage at property line and 12 Inches inside property line; minimum grade of 2%.
Top
ds
NOTE No. 4—Trenchesduients improper work which settled
ay develop within one year otreet must be waterfrcompletioned to ginal condition. Contractors shall be responsible for
failure
NOTE No. 5—it
ex ePtul oto alter
or do any other the Pipe into the work
than is provided for in the permit, or to do any work on the main sewer or its aPPur-
�;;i Gciod Customer is Worthy of Every Consideration"
MON Mums SUPPLY Co.
Waterworks, Heating & Industrial Supplies
C�
U
1409 OHIO AVE. SO.
P.O. BOX 3524
SEATTLE, WASH.98124 ROckwell 2-7025 SEATTLE, WASH. 98134
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..&9J 199-
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 Hail (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 form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (e.g. site
plan, topography map,. etc.) or studies in
conjunction with this Checklist to assist
staff in completing their prelirnmary
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 / pplicant:
JQS4 1A �na&Ic.lY l^
Name
/s? & -g.*14 AV -f
Street Address
�inncvi('c (� 11 cl rS-G?G k a• 3os3
City, State, ZIP Phone
/C' J=p�
lgnat re el Date
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
Signature Date
CA FILE NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: I S 7 L - rC r`' 4 v-c Yl -
2. Property Tax Account t4umber: 13 a. 70 3 y /O 9 O o 0 3
3. Approximate Site Size (acres or square filet): 4 2000 Sj P,,d-
4. Is this site currently developed? Zyes; no.
If yes; how is. site developed? Q �, s tL u f ►,," I
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
q({-us
RECEIVED
OCT? 4 1994
PERMIT COUNTER
Rolling: slopes on site generally less than 1S% (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
7.
Site contains areas of seasonal standing water:
What season(s) of the year? AJ 1 A
/jr, ; Approx. Depth:
N o ; Approx. Depth:
8. Site is in the floodway N d 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)O Flows are seasonal? (What time'of year? ).
10. Site is primarily: forested ; meadow ;shrubs ;mixed ;
urban landscaped (lawn,shrubs etc)—
11. Obvious wetland is present on site: A) 0
—For .City .Staff Use Only
Q
1. Site is Zoned?. /\ %2
2-- `SCS mapped soil type(s)?
-3. -Wetland inventory or C.A. map indicates wetland present on site?
4. .'Critical Areas inventory or C.A. map indicates Critical Area on site? �(1
5. . Site within designated earth subsidence landslide hazard area? /1/0
S. ..:Site designated on the Environmentally- Sensitive Areas Map?
DETERMINATION
STUDY REQUIRED CONDITIONAL WAIVER
WAIVER
Reviewed by:
Plann Date
Rev 0.%79M 4
hqrnrr4p Pu ip
City. of Edmonds v i im i rILC Permit No: .egoolp-
et4G1KEE1W .-OF-WAY CONSTRUCTION PERMIT Issue Date: 5QF-02-
A. Address or Vicinity of Construction,: 0
B. Type of Work (be specific): r 0 oAye, ,BOSS i b—L I�AIQAK S 1+0 S,0�
M A, 40 Al IX kPj 6A' A,, X/
C. Contractor:
Mailing Address-, P t> 15 1 IfA4,,,- —1
State License #Wh!H I H -Z-ca< < cris
D. Building Permit # (if applicable):
w&ntact: V 0 0 �t,
Wplione: _c) Le Z.
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. r-1 Commercial Ell --Subdivision F City Project El EUC (PUD, VERIZON, PSE, AT& T,..OVWD)
F-1 Multi -,Family El Single Family Other
fNSPECTOR:
F. PAVEMENT CUT: [1:3'1'"ES [I NO G. 'SIZE OF CUT' X
CONCRETE CUT: EIYES [I NO
C 4,
Al"I'LICANT TO IMAI) ANI) SIGN
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 kmdlbr.description whatsoever, foreseen or unforeseen,, that may he madeagainst 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 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 W!LL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Traffic control and public safety shall be in accordance with City regulation's as 'required by the City .Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification. verifying completion .pf 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 WORK
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
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Signature: WU mo k�o Date- 51, qlo'2--(
4
(Contractor or Agent)
FOR, CITY":USE ONLY
Approved by:. D-At L�96V_T Right-of-way Fee; Ila t
Disru'
Time Authorized: Void After /-im, ption Fee/Fund fl I:
Special Conditions:' -R-6 t;J --M 14Ke,-- Restoration Fee:
oa yeTnFf_ RF_:_!=:02G Ar4V LAND
,`71,TotalFee:
106111AAr ge DKT1W.AjEE) TO Receipt N
U4� 09-- 9 T-1 ..Issued byr
it
A
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, OF PERMITTED WORK. Clb.Sinj DU4 Ph rm4 - ixpier at 7/14J)ATE: fo/ra /b-r
Inspector's Signature qulliAs
For inspection requirements see Engineering Inspection Information handout.
NO WOIZK SUIALL IU-ICIN 11MOIZ TO IIIEIZMIT ISSUANCE
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City of Edmonds 10.I UK @ ' r'LL Permit No: e9f9o;L-OR/0
;RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: S 28—OZ
A. Addressor Vicinity ""tr9onstruction: 2-1 2 0 1 Sr SVV
B. Type of Work (be specific): O,- 0ss S W Vim..
s vim_ a 21 '.s 2 0 / Sw
nA,A 114� a� 4434-71/8S�inrn5y-'
C. Contracto'tli_,, td4-2_ _A4 • ftvA"
Mailing Address: PU �lU-6(p�(
State.License #:
130- 11. �vi&C, Lk/,Aq 9 ao 1
F-0c VoQ2
2OG-3cl,--7-
Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
1,
E. ❑. Commercial
t� ❑ Multi -Family
l' INSPECTOR:
F. PAVEMENT CUT:
t. CONCRETE CUT:
2
❑ Subdivision ❑ CityProject ❑ EUC (PUD, VERIZON, PSE, AT& T, OVWD)
❑ Single Family F-1" Other 6Vii,c-n.>!-C..1191;4.•�
[]YES ❑ NO G. SIZE OF CUT 2 X Z-- c► r., ,
[:]YES ❑ NO
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 granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING TIIE 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.
♦ 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 WORK
I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THAT I MUST MAKE THE PINK CO,RY,OF THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS
Signature: Lau I l')le S Date: S l S I U Z
- (Contractor or Agent)
FOR`CITY USE ONLY
Approved by:,. _b I A (LET Right-of-way Fee: '16
Time Authorized: Void After -7 / 2.4 / M Disruption Fee/Fund 111:
Special Conditions:- &MNRE' ('JITU R01A'M LIK: Restoration -Fee:
6R .E'Im-1, CaAD111ONS , QSIS=IZG A143V .LAND ^ Total Fee: 10 #. SLurc{v+�s ._
9. V:: R i;+1r,wriLf.•� �I K Receipt No -
Fr
61- 9.eT 8x ft-finI T10 oi'Vk A0C:MM �� �'` Issued"b
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 OFPERMITTED WORK: Ck,,Q oL,+ Pwm,'+.�-:I/DATE: i0%7/0-7
pector'sSignature I/ZIIO7 9LO�lii(S
.For inspection requirements see Engineering Inspection Information handout.
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` r .City of Edmonds
R E ETT-O -WAY CONSTRUCTION
890 19C)
in<
PERMIT Permit Number. S�
G p000" Issue Date: �� CJ
A. Address or Vicinity of Construction:--` 1576 9 Av N (9325800 )
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Natural Gas Company
Mailing Address: 815 Mercer St, Seattle, WA
70111
State License #:
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond: $
D. Building Permit # (if appcable Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project rxJ Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Fami y ❑ Other
INSPECTOR: INSPECTOR: I Ah IL,,
1 -:;, H:: Charge F. Pavement or Concrete-Cu[]No
t : ❑ Yes No G. Size of Cut: --
APPLICANT TO READ AN
` ldflUZ INDEMNITY. Applicant understands and 6y his signature to this application, agrees to Id th City o%Edmonds harms in damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be ma;�P inst the City of Edmonds, or any of its departments or
employees, including or not limited to the defense of any legal proceedings including deferise costa, and attorney fees by reason of granting this permit.
n
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS. FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. EST/MATED RESTORAT/O,N-FF`F}S W,/T BE HELD UNTIL T11, FiN4L.STR�'ET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME DEBIT OR CREDIT WILL BE FROCKS F.D 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.
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 thepermit will be
available on tip s for inspectiQawfurposes.
Signature: Date: October 21, 1993
ont r a it0 -r57 A7el'?%
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME AUTHORIZED: VOID AFTER ���(„ Sd DAYS
SPECIAL CONDITIONS: 1
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
COMMENTS: RECEIPT FEE: DATE: ISSUED BY: _<</� A_____e
/J
ul
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
z
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments•
Diagram
CONTRACTOR CALLED FOR INSPECTION ❑ YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
❑ NO
I
ji
A�pt�n b+erpv Corrosry
Addendum to : City of Edmonds
Right of Way
Permit Application
Submitted by: Guyla Connors -
Engineering Aide
Washington Natural Gas
521-5248
�,-b8 4- 93Z'5500
N WNG to window
N Water main depth
_ unknown
2-�- " gas main
I (ZX4� CUT
�d CAS
C"e:r�Y JT
Key:
-w-
water
-g-
gas -
-ss-
sewer
$
water hydrant
0
water valve
915 Maser St. (P.O. Box 1869). Seank, WA 98111 (206) 622-6767