1621 9TH AVE N.PDFIIIIIIIIIIII
9870
1621 9TH AVE N
RECEIVED
OCT 13 1999
DEVELOPMENT SERVICES CTR.
I CITY OF EDMONDS
RECEIVED
JUN 0 2 099
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
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CITY OF EDMONDS a Permit No.
COMMUNITY SERVICES DEPARTMENT U lk� Issue Date 3
p RIGHT-OF-WAY CONSTRUCTION.PERMIT
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A. • Owner: Washington Natural Gas Co B. •Contractor: Same
Name Name
805 I S6 AV NE.
Mailing Address Mailing Address
Bellevue, WA 98007
City State Zip City State Zip
447-0760
f ; i State License Number Telephone Number
• Address or Vicinity of
Type of Work to be E
Work in Connection With: ❑ Sub•or Plat
❑ Commercial
Pavement Cut: ❑ Y ❑ N
APPLICANT TO READ AND SIGN
❑ Single Family ' ❑ City Projects
❑ Multifamily R Utility
1
INDEMNITY: 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, forseen or unforseen, 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, court 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.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed
by City forces, at which time a dbbit oecredit-will be processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Public Works: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
no exceptions.
I understand the above and that this permit must be available at the jWsite for inspection purposes at all times.
T;"
Signature: /&4;4�_Date: 7/ 2 0 / 8 8
Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
ISSUED BY: v
Time Authorized: Void after —days.
Special Conditions:
Amendments:
PERMIT FEE: 0• /-0 —
Security -Deposit:,
Receipt` No.:
Fund 111 Fee: —
Street Cut Dimensions:
X =
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
FIELD, INSPECTION NOTES (Fund III - Route copy to Street Dept.) �.
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved. By: Date:
FINAL APPROVAL BY:' Date:
Eng. Div. July 1985
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17 APPLICATION
The CRY of Edmonds for
SIDE SEWER PERMIT
V -STEW CONSTRUCTION REPAIRS
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EASEMENT No ...........................................
CONTRACTOR PERMIT No.
LEGAL DESCRIPTION: LOT No ............................................... BLOCK No . ............................................
4—
NAMP, OF AT)T)TTTOTT Jj-, 14'-1-7
Approved: QQ
DATE ...
By
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CITY OF EDMONDS
CIVIC CENTER— WATER -SEWER DEPARTMENT Call PRospect 6-1107 when work -to ready for inspection. (No Inspee-
SIDESEWER PERMIT tions Saturday, Sunday or holidays.) N2 3026
ADDRESS............19108 - 100th West__
..........................................................................................
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OWNER ................. ..... Sta..... ....... ..... CONTRACTOR.1d—U)Ond-$... Uladerg oun.d...........................
Permission is granted .......................... Ju11.... 61�. ...... 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 11.16.030 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 2q,.
•�1 No bends In grade sharper than % wlll be permitted.
NOTE No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
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 Its appur-
tenances except to Insert the pipe Into the wye.
( CITY O1-
'l ';;s(•'`.4. 1. U. NOTICE
�y(
EDMONDS
WA'S1-11NGT0N
OF ASSESSMENT
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APPLICATION
The Cityof Edmonds for
SIDE SEWER PERMIT
NEW CONSTRUCTION (:] REPAIRS E] EASEMENT No............ ......................
i2�-nnsno
OWNER ........... D011d� d_.....•....Fel_tFIOUs.....................................•....._....... CONTRACTOR.................................................................................................. PERMIT No.......................
ADDRESS ........ 1.62.1.... 9th._Avenue... R.................................................... LEGAL DESCRIPTION: LOT No............................................... BLOCK No.............................................
NAMEOF ADDITION.........................................................................................................................................
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Dye Tested On Sewer 1972
Approved:
DATE................................................ By....................................................._................
PLANNING DATA
NAME:
SITE ADDRESS:-���-i DATE: l�
ZONING: 0,5- 2 PLAN CHK#: l`���(�
PROJECT DESCRIPTION:
C.4 FILE NO.
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrolo.gy/vegetation)
1. Site Address/Location: l nL-A 1 —I ,— [y 1L_j —4 V VU I K__1
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes; no.
If yes; how is site developed?�T�`ri<'
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
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: ; 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? Flows are. seasonal? (What time of year? ).
10. Site is primarily: forested ; meadow ; shrubs ; mixed
urban landscaped (lawn,shrubs etc) f ( 741
11. Obvious wetland is present on site: C)C�
^ea chk.dm Rev 10/07i97
RECEIVED v ;
JUN 2 81999
Gtv of Edmonds DEVE CITYENT OF SERVICES
EDMONDS CTR.
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 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 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 assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
Or'1
Name
Street Address
%Oot
City State Zip
Telephone
Signature
Date
Applicant Representative:
�LlatlE < a, I i
Name
a ao ab �g i
Street Address
City State Zip
Date
c:receptionljanalcacl.doc (over)
i
CITY OF EDMONDS
121 5TH AVENUE NORTH • EDMONDS, WA 98020 • (425) 771-0220 • FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning • Building - Engineering
July 1, 1999
Hodgson
1621 9th Ave. North
Edmonds, WA 98020
Subject: Determination regarding Critical Areas Checklist # 99-180
BARBARA FAHEY
MAYOR
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
IMPORTANT INFORMATION TO BE NOTED:
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL .401
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB" Land Use Applications
Any other development permit applications.
Enc: Critical Areas Determination
• Architectural Design Board
C: Reception\Jana\C R LTR.doc
Thank you.
Sharla Graham
Planning Secretary
• Incorporated. August 11, 1890 •
Sister City - Hekinan, Japan
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303
CITY OF EDMONDS
`CONSTRUCTION PERMIT APPLICATION
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VESTED DATE
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PITMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
— DOMAIN ICURBS.SIDELYALKS. DRIVEWAYS. MAROUEES;ETC.) WILL REQUIRE
'
SEPARATE PERMISSION.
STATE SURCHARGE
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W PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
STORM DRAINAGE FEES
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w "APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
;
e EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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a ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCEANY REQUIREMENT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
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_ '.OR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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TOTAL AMOUNT DUE
___E=.C-(NOWLEDGE THAT 1 HAVE READ THIS APPLICATION; THAT THE INFORMATION
. . _ _=OD.=,ECT: AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
_,
_ .G THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
, .
TE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION Building Official or his/her Deputy: and Fees are paid. and
- • - .: . =E . _ �.T:O^: INSURANCE AND RCW 18.27.
receipt is acknowledged in space prov'aec.
' .T DATE SIGNED
(425)
OFFICIALS SIGNATURE D T=
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' GRANTED. UBC SECTION 109
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