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16721 76TH AVE W.PDF111111111111 6164 16721 76TH AVE W � 890_199- City of EdmondsZoifflEM HLI-.L.-n� RIGHT-OF-WAY CONSTRUCTION PERMIT Permit Number: q 3 -oa Issue Date: � ~ O — q3 A. Address or Vicinity of Construction: 1 (o7Z 1 7& T H A V FZ_ . W. B. Type of Work (be specific): REPLArCE DEFECTIVE UG DROP C. Contractor: Gl�t4Nlf3�25�5(JPLKIUk-C.� Mailing Address: n 3 MAIN S T State License #: SUP EA CG [U 1 QA D. Building Permit # (if applicable): Contact: JAZAe-- G RZADWI314 L Phone: 774 —Sl4 to Liability Insurance: Bond: $ Side Sewer Permit # (if applicable): E. ❑ Commercial ❑ Subdivision ❑ City Project Utility (PUD, GTE, WNG BL , ATER) ❑ Multi -Family ❑ Single Family ❑ Other h INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut : ❑ Yes ®No G. Size of Cut: x H. Charge $ APPLICANT TO READ AND SIGN INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the Ci y of Edmonds harmless from injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the Ciy of Edmonds, or any of its departments or employ- ees, 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 INSPEC77ON AND ACCEPTANCE OF THE WORK. ES77MATED RESTORA7TON FEES WILL BE HELD UN77L THE FINAL STREET PATCH IS COMPLE7ED BY CITY FORCES, AT WHICH 77ME 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 Department- 771-3202;_,, Work 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 dove statements and understand the ern it requirements and the pink copy of the permit will be available on site at all times for in pe ion purp s. Signature: Date: Contra t or Agent CALL DIAL -A -DIG PRIOR TO BEGINNING WORK ..... Q FOR CITY USE ONLY APPROVED BY.: ,` RIGHT OF WAY DEPOSIT: . TIME. AUTHORIZED: VOID AFTER:. L , DAYS. DISRUPTION:FEE/FUND 111::: SPECIAL CONDITIONS:. _ ... RESTORATION FEE:... _.. _. _ ......... .......... DATE: ISSUED BY: 1A11111W.V1e/_11III! I-W DI :4051 V N Engrg. Div. 1991 s� k RIGHT OF WAY CONSTRUCTION PERMIT ROUTING FORM DATE APPLICATION RECEIVED ,-2 ` 5 _ % 3 WORK ADDRESS &) CONTRACTOR 1. DATE TO PUBLIC WORKS FOR REVIEW !3 REV/APP BY STREET DIV. date REV/APP BY WATER/SEWER date REV/APP BY PUBLIC WORKS date 2. DATE TO ENGINEERING FOR REVIEW REV/APP BY ENG. AID date or REV/APP BY ENG. INSPTR. date 3. Return to Community Services front desk DATE PERMIT ISSUED,:.,? - 73 PERMIT # / O og � -,ate-v r�-"--,�•sK.F'--> d ; _ � __.,.,-. :M.•Y`k�--.,.p.�ia+�„�� _ _ 4 .,`�'�,�{,Iva�ny�...(`-Y1M'r ✓.�v v w .. r. . v ,-+� � , , ,• ,- :-m-� � r ..� -.rvl'�.,`^ .'..rrri,-tiL7��i�,•.: �� �{�,�• t1C 'r✓y' n ^`-.^e7• 7...a � .:may.•.... ,Y,_.,,�,,,, ; � , � City of Edmonds RIGHT-OF-WAYCONSTRUCIPFOXT FILE PERMIT Permit Number: 3 Issue Date: r,,? O - 93 A. Address or Vicinity of Construction: 1l07Z( 7&TH A VF , W. cr90-19 B. Type ofWork (be specific): REPLACE DEFECTIVE U6 DWOP C. Contractor: C-t�t/�MC3E25/SUPERIU�2CA Contact: JACK.• GRA0W5HL Mailing Address: 3­3 3 MAIN S T Phone: 774 — S14 to State License 1#: SOW% CC 10 1 dA Liability Insurance: Bond: $ D. Building Permit.## (if applicable): Side Sewer Permit # (if applicable): E. ❑ Commercial ❑ Subdivision El City Project [Utility (PUD, GTE, WNG AB , ATER) ❑ Multi -Family El Single Family ❑ Other INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut : ❑ Yes ®No G. Size of Cut: x H. Charge $ APPLICANT TO READ AND SIGN INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the City of Edmonds, or any of its departments or employ- ees, 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 /S 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 WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. s Construction drawing of proposed work required with permit application. - A 24 hour notice is required for inspection; Please call the Engineering Department - Work is to.be inspected during progress and at completion. 771-0220 Restoration is to be imaccordance with City Codes. ' Street shall be kept clean at all times. y 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 bove statements and understand the ern it requirements and the pink copy of the permit will be available on site at all tim for in=k Signature: Date: r Contr t r or Agent CALL DIAL -A -DIG PRIOR TO BEGINNING WORK NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg.Div. 1991 ./ FIELD INSPECTION NOTES (Fund III - Route copy to Street 'Dept.) Comments: J Diagram. CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO, Partial Work Inspection by P. W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: Eng. Mv. July 1(.7 11 7(o TH A\/ E. W. 2-5-93 R-WH t P,F'FLAC-a QEFC�,'T%IE DROP W1 Z,3.c' R6,- 7 U6 CA ME-ADDWDb,LE- BCVI ED APPLICATION The City of Edmonds for EASEMENT NO . ..................................... SIDE SEWER PERMIT Th"EET Flf-� CONSTRUCTION REPAIRS ❑ LID NO .. ................. . ASMT. NO OWNER P L -, r N ( -- > L —c a ............. JOB ADDRESS ----- --- — ----- CONTRACTOR ........ . ................. LEGAL DESCRIPTION: LOT NO. - ................. ------- .................... PERMIT NO. �Z77� .......... BLOCK NO. .................. ............ ............................................................ - ....... I .......... ............ ................................................ ...... NAME OF ADDITION ........ ----------- ------ (Z�) ---- w ......... ...... - -- ------- I - 1 - �� x CITY OF �EDM`ONDS ­`SID�E SEWER PERiM`IT t WATER=SEWER DEPARTMENT ; �'fm • r � t , � .. • �-,; .•. � . t' � "� <-,��`.f' f �'� -PERMIT NN (Call 775-2528 for aide sewer inspections BEFORE coveririg any portion of the construction.` y•:- Inspection will be -provided within 24hoursatter requaL.`-NO,Sat'.,-$un., or' holiday.inspectlons. r •ti -i is LOCATION OC- ATI- ON- OFCONST-RUCT- rtr�- r-�... ............ . ..-.... .............-EROPERTYrIEGAL-DESCRIPTIQN:.::......-:..........._.._....._..--......................... . .... ... ................................................... ..:. ....................................................... . ........ a......................_.... • ..-.....- ........ ......... ......... ..... ................OWNER AND/,OR BUILDER cz, ....... i`RACTOR'S NAME &ADDRESS- ...... : "E. i i c-. ' u ny t r >l c -----•=----•----.-.... . (; e , ............................................... Pe inission:is granted�.. �lc.�.... -^� ___ r,-c^...,. -- 19--.r....,for repair and/tor connection of .a side sewer to the city sanitary sewer- j system in accordance with City.of Edmonds ordinances: ATTENTION IS CALLU D 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 - r ,side'.,sewer,.m street,,area. -Do not, cover any, portion of sewer. before it has been -Inspected. NOTE 4No.:2—All, work; performed in. city. right -.of -way -requires an Invasion',of Right-of-Way;Permit, obtainable from the City Engineer's office - ` ; in ';.,NOTE. -No. 3=Obtafull'. information' regarding. Ordinance 11.16.030goyerningslde' se. and Regulations 1 wers when you -'get permit... - - ,' '• -j -'+IVOTE�No: 4.-Top.•ot-'side sewer-muat.hav No'bends- eat.least30.inches coverage, at property--line-and -12 inchescinside property line;.-mtnlmum grade. of.2.J:- .in.,grade •.-.J -sharper than 1/s will be permitted. MNOTE, No'. '5-,Trenches-ln street muat' bemater settled and'-surface..of :atreet'restored to orlglnal-condition.. ;Contractors shall be' responsible .for fallure. due Aol', I' open. work which may develop within one year of completion. - - .- r !NOTE No. 6=lh;is,unlawful to alter. or -do any other work than is, provided for, in the permit, or to dp"any work, on the. main sewer or, its, appurtenances except to-ln=;. sert the pipe into the wye. DISAPPROVED .M Date -- By. ..`....--__ Date By :- :.: Date .... By ! .,,—,APPROVED:,: ❑.Dap e ......... ............................... BY • ,1 ...... ..................... Remarks: ...............................................................I................ ......::.......................... .:_.._ X.. ' --:BOTH Peimit `Copies -MUST Be Signed By. Owner -of Firm, PeHbrining Construction' PRIOR To Request,For Inspection ; I- : f`--- ... --.- ------- -------- .................. hereby certify that the side. sewer, installation constructed under this:permit.: LV'�ads'�olnstalled (Owner- of- Contracting Firm Performing, Construction) in -accordance with-all-governing..ordinances of the City :.of Edmonds.: Dated this ............................day of..........--...........-. 19 .,.-..:a? .. 1 =J J J Check BEFORE you dig••for: Water ❑, Gasp Telephone ❑, Power ❑; Sewer ❑, Other p: J ..its, on pg. 38, records of Snohomish County, Washington. III = 40 FEET NOVEMBER 26, 1969 Fl i� nWE :4 o A B /90 '0- I 0 C Via, p ACH OVVDALE6E Mar-05-99 08:38A P.05 C11 F(1 E NO. . Critical Areas Checklist -------------------------------------------- Site Information (soils/topography hydrology/vegetation) I. Site Address/Location: lli'7 �- 76 7 f�V� - (✓-d���� ?. Property Tax account Number.; 1 .3 0,06 — . /0 3y 5 3. Approximate Site Size (acres or square feet): 7- ono T- 4. is this site currently developed'? _Zyes; no. If yes; how is site developed? ( �� 5. Describe the general site topography. Check all that apply. Flat: less than 5-feet elevation change over entire site. e Rolling: slopes on site generally less than IS% (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 664eet). . 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'stand ing water: /Ly ; Approx. Depth: 7. Site contains areas of seasonal standing water: Approx. Depth: What season(s) of the year? D /✓6- 8. Site is in the floodway A floodplain�_ of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? /►' m 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:. ................--- ...... ...-------- --------- For.City Staff. Use -Only-- ---- ..... -- ---... L. Site is Zoned? 2... SCSTriapped.aoil:rype(s)? 6 !y v4.. e ,vim 5�i : ai?it'-�:.. ,Zf 7^ 70 ! sfc`J� 3:. W.ef and.roveptory or C.A: map indicates wetdattd: pre9erX on site? 1 �}. CriticaiAieas inv.enfary orC:A: _map indicate9.CriticafArea onaite? u S.: site within designated earth subsidence landslide hazard area? .-L7 6: Site designated:onafie•Enviro.niuentally Sensitive Areas. Map? AID pETERIy 1NATION` STUDY REQUiREb.:..:. CONDIr10NAt WAIVERAIVER Reviewed by .sso.i I,9us�c-1(1 Al q Planner T� Date. Mar- 05-99 08: 38A tP�.04 City of Edmonds CRITICALAREAS _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 arc factual, to the best of my knowledge (fill out the appropriate column below). Owner/Applicant: 61 7,-ry a Name 1 !4 % 172. S i. S-w Street Address �01,to. 5 . VA -- City State Zip Telephone Signature 96) , Date c:reeeplionlj&nkilcacl doe Applicant Representative: 44 Name I72- k� S ►�. . S kJ Street Address ;�;7,0,n o•r,-D s •,,� 9�j l� City State Zip 7,2 Telephone -�- Signatures,. Date (over) 1nC.1S913 CITY OF EDMONDS 121 5TH AVENUE NORTH.- EDMONDS, WA 98020 • (425) 771.0220 • FAX (425) 771-0221 DEVELOPMENT SERVICES DEPARTMENT Planning - Building • Engineering March 8, 1999 BARBARAFAHEY MAYOR Anthony Agah 7527 172" Street S.W. Edmonds, WA 98026 Subject: Determination regarding Critical Areas Checklist # 98-47 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. y You mus.tsubmit a copy ofthe CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL 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. Thank you. Planning Secretary Eric: Determination. *Architectural Design Board cc: Yvette Ivarson - C:ReceptlonUana\CR LTR.doc • Incorporated August 11, 1890 -Sister City City - Hekinan, Japan