16530 76TH AVE W.PDFIIIIIIIIIIII
6152
16530 76TH AVE W
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
STREET FILE Permit Number.
Issue Date:
A. Address or Vicinity of Construction: 16530 76 Av W
j 8 C B. Type of Work (be specific): Install 1k" PE IP Mainin 76 Av W from 14114
9 19 to 201W centerline of 76 Av W per job & drawing #9308324
C. Contractor: Washington Natural Gas d1ompanv
Mailing Address: 815 Mercer St, Seattle, WA
State License #: 9811
D. Building Permit # (if 'applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
is
E. ❑ Commercial ❑ Subdivision ❑ City Project J�R Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR: t Ai ; 4r,v!,M
V
F. Pavement or Concrete Cut : ❑ Yes BNo G. Size of Cut: x H. Charge $
APPLICANT TO READ AND SIGN' ;
INDEMNITY: Applicant understands and by his Signature to this application, agrees to h 'l th City of Edmonds harm % m u `a, damages, a
claims of any kind or description whatsoever, foreseen or unforeseen, that ma be ma ; t the City of Edmonds, p ( y y any of s departments a
employees, including or 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 PATCI
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED 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, 771ti0220.
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. "1 '''`
}
I have read the above statements and understand the permit requirements and th.epink copy of thepermit will bt
available on site at al es/brin ecti.on purposes.
Signature: Date: November 4, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: �� RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER �X.� +' U DAYS
SPECIAL CONDITIONS: f b
DISRUPTION FEE/FUND Ill:
RESTORATION FEE:
PERMIT. FEE:
TOTAL FEE: �� Aa"4
COMMENTS: RECEIPT -FEE:
e'
DATE: ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES
Comments
Diagram
t
(Fund 111 - Route copy to Street4. De n.)
CONTRACTOR CALLED FOR INSPECTION ❑ YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY:. Date:
❑ NO
0 on
).� I it •� � � S— - ��`SC
1
CoMMoAj -)RLA
16 5�
1
NOTES: EDMONDS
1.) FIELD LOCATE ALL UTILITIES
CALL 1-800-424-5555
48 HOURS BEFORE DIGGING
2.) INSTALL LOCATING WIRE OVER
ALL PE DIRECT BURIAL PIPE
3.) INSTALL A ONE POUND ANODE FOR
EVERY 1000' OF LOCATING WIRE
4.) SURVEY IS NOT REQUIRED
5.) MAINTAIN A MINIMUM OF 5'
HORIZONTAL AND A 3' VERTICAL
CLEARANCE FROM ALL CITY
UTILITIES AND APPURTENANCES
6.-) GUTS !N PAVIN6-A�t$ evn m re
7.) O CUTS ANTICIPATED
8.) COMPLETE EXPOSED PIPE CONDITION
REPORT WNG FORM 1563.13 (D-1)
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_ CITY OF EDMONDS ,
PUBLIC WORKS DEPARTMENT
SIDE SEWER PERMIT
FOR INSPECTION CA
775-2525 Ext. 220
Permit il,.D
Issue Date
PERMIT MUST BE POSTED ON JOB SITE�AIV*_
1. Address of Construction /6-53 0 " i 9- " fye we4
2. Property Legal Description (include all easements)
�_ vt 3 _ L' 6 ov k VFS'
3. Single Family Residence Y Multi -Family No. of Units
Commercial _ (�
4. Owner and/or Builder �e o d- C1e ova - 26l j -7to
5. Contractor & dense No. kE - CL- -A Z-7? 9
6. Invasion into City Right -of -Way: No11*/1 Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
H 7. Cross other private property: Yes No X Easement required -
Uattach legal description and county easement number.
H
a READ THE FOLLOWING AND SIGN:
a. Property owners must obtain a permit to install side sewers on
>4 their property. A licensed side sewer contractor must be employed to
construct side sewers in the public right-of-way.
w b. The side sewer contractor assumes full reponsibility for each
H installation for one year.
aC. Commercial establishment requires a minimum of a six inch (6")
side sewer line.
o d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
e. Side sewer lines must be laid at a minimum grade. of 2% (1.15°)
and maximum grade of 100% (450).
H f. No turn in side sewer greater than 45° (1/81bend) is allowed
between cleanout. All 90 turns must be constructed of a 450 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system,.-
h. Pea gravel iiiF equired for bedding when installing sewer lines
through other than granular soil. ,-
i. Cleanouts are required ;ati3"0"-60" from each plumbing exit line
and at minimum intervals of 106— along sewer line-Yrun.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k.. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
DATE: P "- 4 - 77,
I certify that I have read
and shall comply with the above
PERMIT FEE:
ow
"' CONNECTION FEE: 1\J0-A 1
w
* PERMIT MI
rrx i
V,v ( DISAPPROVED BY: Date:
By: Date:
APPROVED By : Date :7_7
* >/v/79
�T BE POSTED ON JOB S -TE
intnrrn,"¢cTM- c1,1-,,— c-i the
f%', us.tt by the Cltj of Ed.-,07'
Th.,City of Edmonds doui nci wa:fz
CITY OF EDMONDS
PUBLIC WO , RKS DEPAI
ENT FOR INSPECTION CALL
775-2525 Exti_220
Permit N?
Issue Date
MUS. tEPOSTED`.ON JOB SITE
T-:
TL
"i �
1. Addrest- f Construction s3 T
ve e S I
2.
Legal Ddscription (include all ,easements)
"It ot Acy -ell
3. S' le Family Residence Multi -Family No. of Units
A",
C.''mercial
4�e 0 610 1_ V
7T,14
1..4. Owner Builderand/o
5. - C6ntract.orL' se No. tE - NN- EL- A Z -9 9 16,
6.. Invasion into City Right -of -Way: No Y(If Yes Right -of- —k— es .0ht-of-
way Construction -Permit Required Call Dial Dig,(342-5344)-before
E-4 7. Cross other private property: Yes No Easement, required
attach..,,.leg4j,.,,descript ion and county easement number.
READ THE OL�LOWT NG AND SIGN:
rk �
a. Property owners must obtain a permit to install side sewers on
their -property. A licensed side sewer contractor must be -employed to
construct side sewers, in the publid right-of-way..
b. The side sewe .. r contractor assumes full reponsibility, for each
E-4 installation for one year..
SA
Commercial establishmient requires a minimumof a six inch, (6 'T
side.>se.Wr
0 N' Side.ewers may no-E,, be -installed closer than thirty inches (30")
to any structure. 0,
e. Side sewer lines must be laid at a minimum grade of 2% (1.15.)
and maximum (45 0
0 ,.g.;7ade of 10.0%.
450 (1/8',bend) is allowed
E-4 ,.No tuin.-in side s8wer greater than 01.
betwAn f cj-,ednou"t. All 90 turns must be constructed of a 45 (1/8
bend), -anc' _ye.with-,,. removable cap
spouts, footing drains or floor drains can be connected
�,34 _9M
bedding when installing sewer lines
1 tou h. other. W U
to -,Aeu stem_:,.
n gra:nular..*so:i
k 41.( W_ ., . i I , -
.? -60" from each plumbiiiO., exit: line,
-a e., requirc Up ar ?ijr ka4
n of 10 16ng sdwer-,-lin
'fic;uts'� 0
and at, tiniMum.in vale.
t 0 re to original
Tr riches. right- f -v4y �mus� -he y.
t cfors'-shall,be'. resp
conditions.' Con ac pndible-.for ri.'4ht-of-way fAilurik:
c_
-
due'- to -vor compaction of• f ll.
1- -
k.: Side, sewer:. mustbe ncovbre'd-unti!1,inspected and approved-
TI by the*.,,City,.
.1.Inspection during.ngrmal.working, hours only.-': '-.TVo--. working
required. -
..days notice 1`11 4
DATE.j.
I. certify:that I have' -read
and shall 'comply with the above..
�..CONNWTION, FEE: m ¢APPROVED
7A
TikMST-4.,B9�, POSTED, .ON JOB,
_,�_Air._PERK S
- r r �- - -
CITY OF EDMONDS RECEIPT N° 6040
Department _ �1 6 Date /— `T— % y
RECEIVED OF
rl
Check 0 Cash ❑ cro
Utility, Charges
Citizen Deposit
Trunk Charges
Qv
Water Meter
Water Turn on/off
Sewer Permit.7 20
Dumpster Permit
Septic Tank Permit -
Building Permit
Curb Cut
R/W Invasion
Recreation Class Fee
Swim Class Fee
Rentals
171 -!1�
Fire Permit
Fireworks Permit
-% LiiW.j
Sale of Maps — Books
Sales Tax
Other % + • Ui P+
uiic Works
By
The City of Edmonds STREET FWf Sewer Drawing
L NEW CONSTRUCTION REPAIRS ❑
EASEMENT NO. --------•------------------------
LID NO- ----------------- ASMT. NO. ------• ---------
OWNER----------------tt---------------.....--------•---------------------------------------------.---•- CONTRACTOR -+<e— .....------- ---- PERMIT NO ------
JOB ADDRESS ..... CJT H j _-1 �! e ' LEGAL DESCRIPTION: LOT NO. ------ 3-----------•-------•----- BLOCK NO-------------------------------------
----------------------------------------------------------------------------------------•---------------------------------•--------------------------------•-• •---
NAME OF ADDITION ------.
f �t
PV.C. Sewer. <
G
cr= �
f /n �.9-S Wate►- Line—(!2'
c-u.a
P« cn� cl er rn
Tec �S `d eeP)
-
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T'H
7b Ave
Approved:
PWW-0001-11175 (REV.11178) DATE U 1`1 P ..� .� .� `4 ._.t By b _._ . - -Ta---- son 6� -
AibsTR
FS
BUILDING DEPARTMENT
Applicant Fill
PERMIT
zoN R D NUMBER 790050
PERMIT APPLICATION
Inside Heavy Lines
JOB
ADDRESS /6 S30 —76 —C�`!w' "w
NAME (OR NAME OF BUSINESS)
Q S.Q,� �{.�!` ( r-+I- iM
{{•• ��CC77
e
LEGAL LOT
❑ V ES ❑ NO
PLAT NAME
SUBDIVISION NO.
W MAILING ADDRESS ,
` (/_
PS
0 1 "' v T
PUBLIC RIGHT OF WAY PER ORDINANCE NO.
EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY"
CITY
�t'"�
�1
1 J ,A A
EPHONE NUMBER
EL-1/ 7
� ? -J _ -/ 2 <)
NAME
r
DEFICIENCY OF RIGHT OF WAY
U
W ADDRESS
r_
STREET/UTILITY WORK REQUIRED ❑YES XNO
=
PERMIT FOR WORK IN PUBLIC R/W ❑YES, KNO
UNDERGROUND WIRING REQUIRED YES ONO
U
E CITY
TELEPHONE NUMBER
CONNECTION TO SANITARY SEWER FKY ES 117 NO
SEPTIC TANK PERMIT REQUIRED ❑YES �NO
SEPTIC TANK PERMIT NO.
NAME e.
/_D
e^n e L_ ^QQ O�`S j1. IC/t .e
!Y
0 ADDRESS
Q+ ��V
`/ fG (J✓
SEE MEMO DATED
`
E CITY
TELEPHONE NUMBER
REMARKS
o ds
7�y y7q�
A
U STATE LICE SE NUMBER
CITY LICENSE NUMBER
CHECKED BY w „'
? 3-01 Jet-A141 Ee-Ark 79 a w
eNoorl ram'
Legal Descr ption of Property (Show Below or Attach Four Copies)
METER S E'/
BUILDING SUPPLY SIZE
�-s 6,14 s
o f ® F (Ze,- UP Ei (ZE(_JJL.ATo2. 2ZGGLO
r
SIGN AREA
ENV. REVIEW
ADO NO.
a_
C
ALLOWED PROPOSED
COMPLET EXEMPT
U
SHORELINE
In
W
0
Q
REMARKS A D WED0 i C j f P%S S .. Q \1
'bit
VARIANCE OR CU O� �1:2.11NNING REVIEW BYDATE
YARDS LOT COVERAGE
JOSIDE -_ REAR
OF CONSTRUCTION CODE HEIGHT
V- N 19AD ZS I M
PY
_A OCCUPANCY I e CCUPANT
GROUP '\LOAD
M R-3
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
PLOT PLAN INDICATE BUILDING SETBACKS,
ABUTTING STREETS) BUILDING
N
W PLUMBING
0
m
0 MECHANICAL
m "Applicant, on behalf of his or her spouse, heirs, assigns and
W
J successors in interest, agrees to indemnify, defend and hold harmless
i the City of Edmonds, Washington, its officials, employees, and
c agents from any and all claims for damages of whatever nature,
a
x arising directly or indirectly from the issuance of this permit. Issu-
o ance of this permit shall not be deemed to modify, waive or reduce
J any requirement of any city ordinance nor limit in any way the
1 City's ability to enforce any ordinance provision."
I hereby acknowledge that I have read this application; that the in-
formation given is correct; and that I am the owner, or the duly author-
ized agent of the owner. 1 agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensatiol Insurance. .
NOTE: Permit Limit One Year(Except DEMOLITIONS and FILL
PERMITS without conditional use permit, which shall be completed in 90
days; MOVED -IN BUILDINGS shall be completed in six months.)
SIGNATURE (O NER OR AG NT DATE SIGNED
/
is Permit covers work to be done on private property ONLY.
A Construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304, 306.
1 02-78
FENCE
SIGN
RETAINING WALL
IIMMING POOL
FUND * 12S
)TAL AMOUNT DUE
V_
VALUATION
Z, 1t-
N
Y
Z
0
3
U_
J
m
0
a
M
W
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Q
3
•
300
ATTENTION
300
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit
AUTHORIZES
until signed by the Building Official or
ONLY THE
his Deputy; and fees are paid, and
WORK NOTED
receipt is acknowledged in space pro -
INSPECTION
vided.
DEPARTMENT
DIRECTOR.P
SIGMA URE�
CITY OF
EDMONDS
DATE'
775-2525
- i _ i ,- —7
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
NEW
P�R ESIDENTIAL ❑GAS
LINE
IF
FRONT
FIRE ZONE
TYPE
❑ ADD
❑ ALTER
❑ NON-RESIDENTIAL
❑ DEMOLISH
❑ EXCAVATE
OR FILL
SIGN
RETAINING
WALL
PENCE °
( X—FT)
v
SPECIAL INSPECTOR
REQUIRED
❑ YES ❑ NO
PLAN CHECKED BY
REPAIR
❑ NSP.
j❑
WIM
I ' POOL
REMARKS
1 T�E,RMnL IN�
Z NUMBER OF STORIES
0 ^
r d
NUMBER OF
DWELLING
UNITS
/
D2F,INI
a NATVRE �J�-�ORK�'O
UUi / (`-'I
BE C E
S '
C
W
0
m
0
PLAN CHECK FEE
" PROPOSED USE
BUILDING DEPARTMT-NT ApplicanfFill
PERMIT APPLICATION Inside Heavy Lin
NAME (OR NAME OF BUSINESS)
A
W MAILING ADDRESS
19-qDc_i��JPs7
CITY TELEPHONE NUMBER
F.
U
F ADDRESS
2
U
K CITY. TELEPHONE NUMBER
NAME 4 L.
AJ
0 ADDRESS
T CITY TELEPHONE NUMBER
U STATE LICE SE -NUMBER CITY LICENSE NUMBEI
_? 3-Of i --A141 E!-A2791c3w
Legal Descr ption of Property (Show Below or Attach Four Copies
( �h
Cr LSY4,i
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N
W
D
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l7
W
J
I
O f�/ 1/. j1 NUM" EET FILE
OB(V�" '!�1 L/`/JDDRESS
EGAL LOT PLAT NAME SUBDIVISION NO.
DYES ❑NO
PUBLIC RIGHT OF.WAY PER ORDINANCE NO
EXISTING RIGHT OF WAY_ • .
PROPOSED RIGHT OF WAY G
DEFICIENCY OF RIGHT OF WAY
STREET/UTILITY WORK REQUIRED
❑YES
IANO
PERMIT FOR WORK IN PUBLIC R/W
[DYES
AND
UNDERGROUND WIRING REQUIRED
YES
El NO
CONNECTION TO SANITARY SEWER
CxY ES
1-1
NO
SEPTIC TANK PERMIT REQUIRED
❑YES
91 NO
/�
SEPTIC TANK PERMIT NO.
SEE MEMO DATED 1-7
REMARKS
CHECKED BY
A11ENK)02tI='
METER Sj2I BUILDING SU PPL V SIZE
SIGN AREA I ENV. REVIEW
ALLOWED I PROPOSED COMPLETEI EXEMPT
IN
REMARKS
VARIANCE OR CU PLANNING REVIEW BY DATE
YARDS If
lO-FRONT
1�[I
Y�
NEW
RESIDENTIAL
a GAS
LINE
FIRE ZONE
TV
❑ NON-RESIDENTIAL
❑
ADD
❑ DEMOLISH
,SIGN
❑ RETAINING
WALL
SPECIAL INSPECTOR
REQUIRED
❑
ALTER EXCAVATE
FENCE
'❑ YES ❑ NO
OR FILL(
❑
X �)
❑
REPAIR RE-❑ INSPMOVE
swim
POOL
PLAN CHECKED BY
Z NUMBER OF STORIES
NUMBER OF
REMARKS
0
DWELLING
UNITS
/
F
a NATURE PF WORK TO BE D E
U "C
U
N
�/
✓� % �LQ
"C
W
m
PLAN
LAN CHECK FEE
PROPOSED USE -
PLUT PLAN IINDICATE BUILDING SETBACKS,
ABUTTING STREETS)
.
BUILDING
U
IA
W
0
PLUMBING
m
0
MECHANICAL
FENCE
m "Applicant, on behalf of IIiS or her spouso, heirs, assigns and
SIGN
successors in interest, agrees to indemnify, defend and hold harmless
f the City of I'.dlllond S, Washington, Its olllclals, employees, and
RETAINING WALL
<
agents from any and all claims for damages of whatever nature,
¢
x arising directly or indirectly front the Issuance of this permit. ISSLI-
SWIMMING POOL
SIDE REAR
OF CONSTRUCTION CODE
AREA OCCUPANCY
LOT COVERAGE
HEIGHT
OCCUPANT
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I .'FEE
W
F
Q
3
01 ante of this permit shall not be deemed to III, waive or reduce
,'
0 MIN, I,lllili'I cni of ally til)' ,1rdi111II1LT Illll Iilllil ill 1111)' \\';,)' the
0
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PUBLIC WORKS DEPAR MWr CHECKLIST
BUILDING PERMIT REVIEW
Street Right=of-Way Existing �p REQD d°
Access Easements Existing �} ��,�� REQD
Utility Easement Existing- �-� J��� REQD
Lot per Subdivision Plat Assessor Map
Site Plan Checked for Accuracy
Underground Wiring Reqd. 5
Check Accuracy of Legal Description
Environmentally Sensitive Area AW
Environmental Checklist Reqd. I
74/ Date
&-Address
Flood Hazard Zone
Shoreline Management Area
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Existing Zoning Per Code R p
Amenities Design Board Approval Reqd. b ADB # Approval
Board of Adjustment Approval Reqd.
Review By: Date: 12—
Existing Water Main Size
Water Main Reqd.
Service Line Reqd.
Hydrant Size Existing
Hydrant Reqd. Per Fire Code
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Conments
Water Meter. Charge Reqd.
Review by:
ep
Size
Date: / - -
���-
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability V Proj.
Drawing No. File No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
Review By: �..p��2' Date: ! 3 '_ 7 9
•
Olien Ditch Existing Reqd.
Culvert Reqd.. ize
c4 Catch Basin Reqd. 2on Site Plan
o Shoulder drai_nat;e n'Llint411 c ion on scan e open r-moff
"' 111--u-lhole re d.
q Indicate on Site Plan
Soil Conditions and Gr and Water field Checked
Retric�a by Trite
Street Paving Reqd..:
H
Curb and Gutter Reqd.
w Sidewalk Reqd.
w Curb Gilt for Driveumy Reqd.
x Right -of -Way Construction Pez q
ve d.
H Bond Reqd. for Public Improv- n
Street NaSign Reqd.
0ther Signing Reqd.
Q Pre Permit. Site Inspection made on
z
a BY: SE[ ;'ER
H
U "
W w WATER �
STREET
H \
ENGINEERING )
Special Require-k nts listed in memo to Community Development Department,
Building Division
BY Date ,
o All items filled in on Build g Permit Application
c� }3Y
Date
Dtawings Stamped and Notations Made
w BY
Date
Approved by Public Works Depar.mm-it
Revised: lv 10-1977
Date Z-3-7i
MEMO TO: Building Division
Community Development Departmonnt
FROM:. Engineering Division
PubllJic Works Department
SUBJECT: �NDE,�SF_I1/ - .�� ,oL�y �S 165-3O 16,
After review of the subject building permit application, we have the
following comments: y.
Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is the
responsibility of the contractor.
The contractor is required to keep the abutting streets cleaned
of dirt and debris caused by the construction.
The "Right -of -Way Construction Permit" is required, from the
Engineering Division of Public Works, for any work within the
Public Right -of -Way or public easement.
Driveway slope not to exceed 14%.
Connection to sanitary sewer required.
T/-7 Septic Tank Permit required, submit design.
Fire hydrant required, submit design.
Site drainage per code See approved plans
Curb /_7 'Sidewalk Paving required.
Bond required for public improvements. Submit cost estimate.
Underground wiring required.
Approved Engineering Plans required when.applicable.
or Fr( F. erzberg, P.E..
City Engineer
Department of Public Works
Rev. 7/78
BEAT BY: ; 4-29-98 ; 2:29PM ; CITY OF EDMONDS- /1 ;# 3
CA FILE NO.
Critical Areas Checklist
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I Site Information (soils/topography/hydrology/vegetation)
C v f- nor •g
1. Site Address/Location: 11,510 �— ,, �-j CQ
2. Property Tax Account Number: -o o o-o o 3-0 o T9Tc-�
3. Approximate Site Size (acres or square feet): _ 114
4. lathis site currently developed? '/ yes; no.
If yes; how is site developed?
S. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire+site.
X,"_ 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 301/c ( a vertical rise of
I O-feet over a borizontal 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 u o ; Approx. Depth:
7. Site contains areas of seasonal standing water: a a ; Approx. Depth:
What season(s) of the year?
S. Site is in the floodway t_py floodplain- a� of a water cotirse.
9. Site contains a creek or an area where water flows across the grounds surface? ,Flows are you -
round? a ,Flows are seasonal? '' ° (What time of year?
10. Site Is primarily: forested _ : meadow�Tshrubs _ : mixed
urban landscaped (lawn,shrubs etc) ' ),I
11. Obvious wetland is present on site: 40_ ,
------------
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)� ..�Jjte is Zoned
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2 SCS.ma`
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3 Wetland inventory, or C;A map4ridt6ates wetlaud`p
t 1— br .3 . ,�°y1'v, „),dam; a•�-Y.,.
k „4 Critical Areas ttiventory or C A-ihap :indteates'Cn -
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5 Site wtthtn designated earth subsidence landslide tie
sm•Y�m,,a',,,s-J°rS�'ka.x5i.
b Site desinated on the )~gvuoniientally`Sens�tive A'
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DETERMiNATIOIY 1 }
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'STUDY.REQU1
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Planner
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. City of Edmonds
Critical Areas Determination
Applicant: Teresa Tartagliowe Determination #: CA-98-138
Project Name: N/A Permit Number: FN/A
Site Location: 16530 76th Avenue West Property Tax Acct #: 6931-000- 103-00
Project Description:
Non project specific
Determination: Study Required
The plat of Brookacres is located in an area of Edmonds which has all of the following
environmental elements:
1. Environmentally Sensitive designation
2. Meadowdale Landslide Hazard 2% designation
3. Steep slope critical area potential
4. Stream and wildlife habitat critical area potential
Your pro perty.is subject to only the Environmentally Sensative and Meadowdale Landslide
Hazard designations. Virtually all development or permit applications on the property will be
subject'to the State environmental review process (SEPA). Any proposed development will also
be required to meet Edmonds Community Development Code Chapter 19.05 Earth Subsidence
and Landslide Hazard Areas.
G
Karissa Kawamoto 1/27/99
Name Signature Date
SENT BY
; 4-29-98 ; 2:28PM ;
CITY OF EDMONDS-4
;# 2
City of Edmonds
MAY 15 1999
COMMUNITY SERVICES
CRITICAL AREAS C_'k1W HECKLIST
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
detennfne 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
thb 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:
L
Name
Street Address
Ca/-..,.,., .b ,J� J-b L -L
City State zip
has 3
Telephone
Signature '
Date
=m"IMMA&W.doo
Applicant Representative;
Name
Street Address
city State' zip
Telephone
Signature
Date
(over)
Inc. 1890
Teresa Tartgagliowe
16530 76t" Avenue W
Edmonds, WA 98026
Subject:
Dear Applicant:
CITY OF EDMONDS BARBARA FAHEY
MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works - Planning/Building - Parks and Recreation - Engineering - Wastewater Treatment Plant
January 27, 1999
Determination regarding Critical Areas Checklist # 98-138
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.
y You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Enc: Determination
* Architectural Design Board
C:ReceptionUana\C RLTR.doc
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Planning Secretary
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
PUBLIC WORKS DEPARTI�IETiI CHECKLIST
BUILDING PERMIT REVIEW
out
Ze Z X- 7;1 Date
lllls `�7 %l �/ Gl'Address
Street Right -of -Way Existing
O
REQD - .
Access Easements Existing )�,�/�
REQD —
Utility Easement Existing ,J , e J��J.�
READ
Lot per Subdivision Z Plat
Assessor Map
Site Plan Checked for Accuracy
Y
Z
Underground Wiring Reqd.
P�
Check Accuracy of Legal Description
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Environmentally Sensitive Area
w
Environmental ChecklistRegd.
Z
H
Flood Hazard Zone
U
Shoreline Management Area
Z
Slope, Soil, Vegetation
w
Stream, Creek,. Drainage Basin
Existing Zoning Per Code
Amenities Design Board Approval Reqd.
ADB Approval
Board of Adjustment Approval Reqd.
Review By:
Date:
17-:7-
4
Existing [,rater Main Size
Water Main Reqd.
c�
Service Line Reqd.
'
-
w
Hydrant Size Existing %l
Hydrant Reqd. Per Fire Code
Size
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Comments
Water Meter Charge Reqd.
Review by:
Date:
/ - - 77
' Septic '1'ai�lc llc�i1 si,Approved / Date:
Septic Tank Permit Reqd: Permit No.
i Sanitary Sewer Availability Lr Proj.
Drawing No. TT File No.
w
Side Sewer Availability
w 4 Sanitarv.Sewer Connection Fee Reqd.
M Review BY: ' �� , ,,.. of Date:
9.UIIDING DEPARTMENT Applicant Fill
PERMIT APPLICATION Inside Heavy Lin
NAME (OR NAME OF BUSINESS)
N Hlf� Q S --I,- - G( C_( r-
W MAILING ADDRESS
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CITY TELEPHONE NUMBER
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NAME •
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K CITY TELEPHONE NUMBER
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NAME / / n �1
*C en it f'� L : �CX ors K. %C-
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CITY nn TELEPHONE NUMBER
U STATE LIC7;e-
E NUMBER CITY LICENSE NUMBER
?3-o --A1NE! A279,1:3w
Legal Description of Property (Show Below or Attach Four opes)
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USE PERMIT
ZON EFI/'R NUMBER
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V�. F/
JOB
ADDRESS
�SUBDIVISION
LEGAL LOT
PLAT NAME
NO.
❑YES NO
PUBLIC RIGHT OF WAY PER ORDINANCE NO
EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY
DEFICIENCY OF RIGHT OF WAY
STREET/UTILITY WORK REQUIRED
El YES
VNO
PERMIT FOR WORK IN PUBLIC R/W
❑YES
�NO
UNDERGROUND WIRING REQUIRED
).YES
NO
CONNECTION TO SANITARY SEWER
�LY ES
ONO
SEPTIC
SEPTIC TANK PERMIT REQUIRED
❑YES
p�1 NO
I�
SEPTIC TANK PERMIT NO.
SEE MEMO DATED
I-3-1
REMARKS
CHECKED BY /I
---JV1 I rAHENOoltr
METjhtE BUILDING SUPPLY SIZE
R EMA
SIGN AREA ENV, REVIEW ADB
ALLOWED I PROPOSED COM PLETEI EXEMPT
SHOREL
REMARKS
VARIANCE OR CU IPLANNING REVIEW BY IDATE
YARDS /
/ O FRONT
NEW RESIDENTIAL
� GAS
FIRE ZONE
ElLINE
NON-RESIDENTIAL
SIGN
ITY
❑
ADD ❑ DEMOLISH
❑
❑ RETAINING
WALL
SPECIAL INSPECTOR
❑
ALTER EXCAVATE❑
FENCE
�R-7EQUIRED
❑ YES ❑ NO
F1 OR FILL
( X_. .1
PLAN CHECKED BY
❑
REPAIR ❑ PRE -MOVE
D POWIM
OL
Z NUMBER OF STORIES
BER OF
REMARKS
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LLING
FUN
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a NATURE F WORK TO 'BE D E
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PROPOSED USE
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PLAN CHECK FEE
PLOT PLAN (INDICATE BUILDING SETBACKS,
Lr ABUTTING STREETS)
BUILDING
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PLUMBING
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MECHANICAL
FENCE
SIGN
m "Applicant, on behalf of his or her spouse, heirs, assigns and
� successors in interest, agrees. to indemnify, defend and hold harmless
f till` Clly of I'd Inond S, Washiligto 1, Its officials, employees, and RETAINING
WALL
a agents from any and all claims for damages of whatever nature,
I arising directly or indirectly from file issu:111CC Of this permit. ISSLI- SWIMMING
POOL
SIDE REAF
PE OF CONSTRUCTION JC09E
AREA IOCCU
LOT COVERAGE
HEIG
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED'31.04.
VALUATION I FEE
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0 ance of this permit shall not be deemed to_nl6dify, waive or rcducC
any rl'Ifuilvw-111 of any .:ilv mthwo ee nor limit in any way the