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1592 9TH AVE N
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The City of Edmonds
APPLICATION
for
®s:¢ SIDE SEWER PERMIT
A y_) FUM CONSTRUCTION p REPAIRS p EASEMENT No.............
OWNER .' .... ...-.-...e!.G............ CONTRACTOR ...-....-...y..C'
.--•-------.... PERMIT N ........-... ..
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ADDRESS ..../....-. l "..-..... .. LEGAL DESCRIPTION: LOT No.. �?�- ... BLOCK No .............................................
NAMEOF ADDITION.....................•--•---..................................................................................................-..-........
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Approved:
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DATE ... 5............ By ....... ... �-.....
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CITY OF EDMONDS
CIVIC CENTER — WATER -SEWER DEPARTMENT Is
ready
for In ection when work
is ready for Inspection. (No inspeo- i�0 2879
(•J
SIDE SEWER PERMIT tions Saturday, Sunday or holidays.) 1®
ADDRESS ......... 1592 - 9th Avenue North
..............•----••-------•---.....................------•---•--•------........................................--------•---.......................------•---•-------.........
OWNER FRED ....LSTE.CKER ............................................ CONTRACTOR ............................-.. M, Inc..
............................................
Permission is granted ....................... Apri 1 3 19..6 8, for ........................ days to REPAIR or CONNECT a side sewer
,with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—Obtain full Information regarding Ordinance 11.10.030 and Regulations governing side sewers when you get permit.
No. 3—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%,.
_. No bends In grade sharper than % will be permitted.
NOTE No. 4—Trenches In street must be water settled and surface of street restored to original condition. Contractors shall be respoc
failure due to improper work which may develop within one year of completion.
NOTE No. 5—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or
tenances except to Insert the pipe into the wye.
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OF EDP
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
1ac. J gqo 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: 61 0 11 0-7
City Receipt #: l 5
Critical Areas File #: (NU1,00101311
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
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 form. 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 assess I nt 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 fill t is applicationin the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT A '4k A711111i DATE 1416,7
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 ✓`- CJ*1-1—��` DATE ' S V 7
PLEASE PRINT CLEARLY —
Owner/Applicant:
�91n� C.h� :s�e�seh
Name
Street Address
EAmoA5 WR 9202D
City State Zip
Telephone: t2S' 71 � • 275S
Applicant Representative:
Name
FPO -jofc 775 5 Z,
Street Address
S-erH e Wtigt 81 7 %
City State Zip
Telephone:
204 - 30� - 904,/
Email address (optional):
Critical Areas Checklist.doc/4.22.2003
Email Address (optional):
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 159-L c � AV-(- N
2. Property Tax Account Number: \\\00
3. Approximate Site Size (acres or square feet):dcra-
4. Is this site currently developed?-�( yes; no.
If yes; how is site developed? _ S , F , '?- ,
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
CA File No: 0-7 - / �1
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 �r
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: V10 ; Approx. Depth:
7. Site contains areas of seasonal standing water: VV0 ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway ro floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
AD 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: o
For City Staff Use Only.
I Plan Check Number, if applicable?
2. Site is Zoned? —I
3. SCS mapped soil type(s)? $:�PikeiYPs% gr�V21I(, I Cindy IoLZm „$ —Ia � IopeSh
5 a1dt.vwvod uvl0avl land c'um leX 2-0 510 cs
4. Critical Areas inventory or C.A. map indicates Critical Area on site? 0-
5. Site within designated earth subsidence landslide hazard area? N 0•
DETERMINATION
STUDY REQUIRED WAIVER
Reviewed by: Date: 09 , 7-(P . ?i 00_+'
Critical Areas Check] ist.doc/4.22.2003