17521 72ND AVE W.PDF111111111111
5639
17521 72ND AVE W
STRE-11 FILE
DATE:
MEMO TO: Building.Division
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT: I I C; ?i - I I or) Ab
11
After review of the subject building permit application, we have
the following comments,
11) Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is the
responsibility of the contractor.,
2) The contractor is required to kee
ed ot dirt and debris caused by t
) the abutting streets clean-
e construction.
(3) A "Right-of-W*ay Construction Permit" is renuired, from the
Engineering Division of Public I%Iorks, for any work within
the Public RiKht-of-Way or public easement.
_(4) Driveway slope not to exceed 14%.
PW 5/77
W41W
Aff R-Affra"ra- 724-0-0-3 :0 -
A A A
f 0 tMIC WRKS DEPARTMWr CHECKLIO Date
BUILDING PER,,aT REVIEW
t752-1 - 7 Z Address
Street Right-of-Way.ExistiXig,
REQD
Access Easements Existing,
R
!EQP
Utility Easement Existing
REQD
Lot per Subdivision Plat Assessor
.4
Site Plan Checked for Accuracy
Z'
Underground Wiring Reqd.
94
Check Accu-racy'Qf...Legal Description
Envirortmentally Sensitive Area
Environmental Checklist Reqd.
Z
-Flood Hazard Zone
�-4
Shoreline Management Area
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Exist" Zoning Per -Code
Amenities Design Board oval ReqO.
AT)11 #
L 14L Approval
Board of Adjustment Approval Reqd.-
Review By: '01
Date,:.-,
Existing Water Main Size 1,11
Water Main Reqd. A) N
Service Line Reqd.
Hydrant Size Existing 01(--
El
Hydrant Reqd. Per Fire Code
Size
<C .
Detector Check Meter Reqd. K)o
Cross Connection Inspection X.)O
Fire Department*Co�mments
Water Meter Charge Reqd. * 3GV
Review by:
F OF
Date:
Septic T
Septic Tank.Permit Reqd. AI)A-
Permit No.
Sanitary S�wer Availability el,"
.Proj. fte 7"7—
P4
Drawing No.
File No.
Side Sewer Availability
W
Sanitary Sewer Connection Fee Reqd.
vat,
Er.
Review By: W/S
Date:
&K.K.
0-
Open Ditch Existing Ye--r ro�Lm �',eReqd. Ye—r
�4 Culvert Reqd. iz
od S e
C4 Catch Basin Reqd. Lidicdto on Site Plan
0 Shoulder drainage n-kiintain collectioii on swale open ruioff
Mai-diole rcqd. Indicate on Site Plan
..Soil Conditions and Crowd Water Field Checked
Revicna by
Street Paving Reqd.
Curb and Cutter Reqd.
Sidewalk Reqd.—
Curb Cut'for Drive�,ra Reqd.
y
P�. Right-of-1-.1ay Construction Permit.Reqd. Vic
Bond Reqd. for Public Inprovermnts �74- . �,7
-me Sign Reqd.
Street Na
Other Sip-iing Reqd.
0 AIR
Pre Permit Site Inspection made on
Ly I
�0
0
BY: SLI,.IER j
TATATER
S=- T
ENGINEERING
�4
Special Requirements listed in mew to
ConTi='ity-"De"�v'elopMent DeparoTent,
Building Division
BY
Date
c)
All items filled in on Building Perrdt
Appli-cati'on
P4
BY
Date f7�
P4
Drawings Stanped and Notations Made
PA
BY
Ddte
dApproved
by Public 1.1drks "Deparn-kent:
Revised: Iv 10-1977
SU"3ED" RLE .0
DATE:
MEMO TO: Building Division
Community Development Department
FRONI: Engineering Division
Public Works Department
SUBJECT:
T52
After review of the subject building -permit application, we have
the.following comments:
_(l) Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is tF—e
responsibility of the contractor.
The contractor is required to keep the abutting streets clean-
ed of dirt and debris caused bv the construction.
(3) A "Right -of -Way Construction Permit" is required, from the
Engineering Division of Public Works, for any work within
the Public Ri��ht-of-hlay or public easement.
(4) Driveway slope not to exceed 14%.
/A
.19D. W-E-71-
KAM It
PW 5/77
MI, ILI
Owiffilro 3 Tamil a�wtk Nii Jul
�11 C I ��Date
BunDING PER�aT REVIEW: -72.
ddress
Street Right -of -Way -Existing REQD
Access Easements Existing Aat
Utility Easement Existing
REQD
Lot per Subdivision Plat Assessor Map
Site Plan Checked for Accuracy..
Underground Wiring Reqd.
01
Check Accuracy of Legal Description
Environmentally Sensitive Ar�
Environmental Checklist Reqd.
Z
Flood Hazard Zone
U
Shoreline Management Area
Z
.:�Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Existing Zoning Per -,Code
Anmities Design Boaid Approval Reqd-.N_()A2i= ADB #
Approval
Board of Adjusmient Approval Reqd.
L IMNL IV
Review By:
Date",
Existing Water Main Size
Water Main Reqd.
Service Line Reqd. 3y,,' ?e
W
Hydrant Size Existing
El
Hydrant Reqd. Per Fire Code
Size
.'e
Detector Check Meter Reqd. A.-90
Cross Connection Inspection
Fire Department Comments
Water Meter charg.7. Reqd.
Review by: Date: 594
eptic T Sign prove
ate:
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
PrOj
01
Drmdng No.
File No.
:3:
Side Sewer Availability Op m�—,
5LA_�
W
Sanitary Sewer Connection Fee Reqd.
Review By: I/S.
Date
XK K.
_-
0 �en Ditch Exis t
A AAAAAAAAA
Reqd.
Culvert Reqd. _111ee E!tAr;k
1&5
Size
c4
Catch Basin Reqd.--- &Alm�
Indicate on Site Plan
0
Slioulder drainage mkiinta:h-i collect , ion on
swale open runoff
!-�u-diole ' reqd. IV,�7
Indicate on Site.Plan
Soil Cbndit'ions and Groupd Water Field Checked CIAO,, InO,_
Review by
Date
Street. Pavin Reqd.
Curb and -Cutter Reqd.
Sidewalk,.Reqd.-
6irb CuC"for Driveway Reqd- Ale ve
p4
Right-of"Way' , Construction Permit Reqd. Aw
�_ e eae�.
E-4
Bond Reqd. for Public Inprovenents,
treet Narm Sign Reqd. AIR
Other Signing Re qd.,
Pre Permit Site Inspection made on
BY: MIER
WATER
STREET
F4 :?-
ENGINTEERINIG
1_4 Sp�cial Requirements listed in mem to Coununity -Development Dep ar't'mnt,
Building Division,-,
BY Date
o All item filled in an Building Perndt Application
r4 BY Date
P4 , brawings Stamped and Notations 1,kide
P4
BY Date
1,1Approved by Public Works DeparLmmt
Revised: Iv 10-1-977
6T, Z ET L. a
17.521 72nd Ave@ West
&1monds, Wa. 96020
Dscember 11 1977
RECEIVED
EcImonds City Council
Pdmonds., Was 98020 DEC 13 1977
Public Works Liepl.
Dear Council Members:
14Y wife Susan, and I are property owners at 17521 ?2nd Ave. West
in the city of Rhnonds. We recently constructed a residence at that
location, and took occupancy on Septe-mber 4'4, I'YR. Y;ftr wish to make
a 'forical complaInt concerning a water draina&s, problem which is dev-
astating cur property and tllxreatening our home.
The situation is as follows: (Please refer to enclosed diagram)
Diring heavy rains, run-off from the area Southeast of us collocte� in
ditches, flows out o�C an uncompleted ditch, an -a' 'traverses the pavement
of 176th S.W. This ruri-off flows through private property adjaec-�it -to
o-ars and ultimately flows above ground across the North and Northe.ast
sections of our 'Lot. This periodic river rages within two feet of the
foundation*of our house,
This'is not the way things should bet At th3 time of purchasing
this lando we wera assixred by the seller and. the City of Simonds that
surface'water was not a problem here. Well, 4t is* We are now suL-gest-
ing a solution to the problem.
The ditch on the South edge of 1?6th S.W. should becontinued
West to the intersection of 72nd West and 170"th S.W. Here a culva-rt
must be installed under the pavement of 176th S.W. Ri�n-cff should
then be directed North along 72nd Ave. Idest. 1;16 have already ditchea
part of ?2nd Ave, West at cur own expense, includlLng installation of
a culvert under our driveway. Ultimately. stcrm run-off must be zrop-
e,l
y channeled down 175th S.W. and through the naw developmen't, ".cnown.
as Glbn Ellen View Loctso
My wife and I feel that this is the best -solut-&.on to -this
problem. - 'W6 realize that projects like this cost money, and must ba
alloted for.in the City budget. We are formally requesting t-hat thu
money be alloted for this necessary, unfrivolous e=enditure as soon
as possible.
The undersigned are property owners in this area who -are in support
of this suggestion. and would like very much for the Bimonlis City Coincil
to allocate funds for the rectification of this water drainag�3 probleme
Thank. you for your time and consideratione
Sincerely
Signatures: Address.;
HIchael, A. Gibb
e 5,L 1 -7,
t
2, Ci 4D..
3- $1, 4 W
4. -7 .2 17 Z'-*
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ALL�Et,) p T. cr
CITY OF EDMONDS FOR INSPECTION CALL 0 -we
PUBLIC WORKS 'DEPAR*T I \ Permit go
775-2525 Ext. (Q -0 Issue Date
'SIDE SEWER PERMIT ___57
PERMIT MUST BE POSTED ON JOB SITE R
WE-sT, 1-Dwov;-
1.1 Address 0 f Construction 1-157-1 7 "R V E�
2. Property Legal Description (include all, easements)-L6-r
OF L e KI V Lj_F W (e-.W LYNNWOOD LIN
3. Single Family Residence Multi -Family No. of Uni
Commercial
4. Owner and/or Builder (-6,e-L
'Cop
JC>�j
5. Contractqr & License No.
6. Invasion into City Right -of -Way No X Yesi_'�"�:('Yf Ye"s, Right-of-
way Construction Permit Required Call Dial Dig before
excavation).
7. Cross other private property: Yes No X Easement required -
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
a. Property owners must obtain a permi.t to install side sewers on
their property. A licensed side sewer contractor must be employed to
construct side sewers in the public' right-of-way. ,
b. The side sewer contractor assumes full repon"sibility for each
installation for one year.
C. Commercial establishment requires a minimum of a six inch (6")
side sewer line.
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.
and maximum grade of 100% (450). 0
f. No turn in side s8wer greater than 45 (1/8fbend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (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 is require d for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer 'line run.
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 &k-n,
days .,-notice required. )g
DATE�:..
I certify tTat I ha
and shall comply With the above
PERMIT FEE: DISAPPROVED BY: Date:
By: Date:
CONNECTION FEE: 2�5;_ APPROVED By: Date:
PERMIT MUST BE POSTED ON JOB SITE
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
EASEMENT NO - --------------------------------------
NEW CONSTRUCTION F] REPAIRS LID NO . .................. . ASMT. NO - ------------------
cbmMmInclu -f-eb SEWElk
""A
OWNER --- ------------------------ ------- CONTRACTOR -RUSS ... J.O-H145AN ----------------------------------- PERMIT NO.
.9.78 .....
JOB ADDRESS --- --- Avg-w ................
;M
'PROP 1.1"r
Ile
61.
rn
1�
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0
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6
V
ra
ast.
LEGAL DESCRIPTION: LOT NO. -AG ........................... BLOCK NO - ------------- ----------------------
LY N -N VV Ua IL
............................................................................................................................. ---------------
NAME OF ADDITION ----- G-4� .... F-1?�nEK.-VIEW. ------------------------------------------------------------
0
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az
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Approved:
DATE ..... ..... !�..83 ........
Ir
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By-, ------
� xl- I i7'5
STREET MLE CA FILE NO..6(4 — (('�
Critical Areas Checklist
Site li6 phy/hydrology/vegetation)
rmafion (soilsftopogra
-17S21 71Z t4O- A\�19 W 60,40t4pS. WA
1. Site Address/1,ocation ..
2.. Property Tax Account Number: 0 0 0 /4 3 0 -3 0 (0
3. Approximate Site Size (acres or square feet): 3,5oo SO , Er
4.. Is this site currently developed? v-' yes; — no.
If yes; how is site developed? EY.IS7114CO lz-'512'r--�466
5. Describe the general site topography. Check all that apply.
Plat: 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
horiiontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: do Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway A)43 floodplain of a water course.
9. Site contains a c�eek or an area where water flows across the grounds surface? Flows are year-
round? A) 0 Flows are seasonal? _ (What time of year?
10. Site is pri , marily: forested Vl**" meadow _; shrubs v,"' mixed t-�'
urban landscaped (lawn,shrutis, etc)
Rcv01/M4
IrA IH 9
0-
& 9 0 . 19 9 -
City of E&mon&
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 Edmondsprior
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,
L.- E.. NOBLITT
12629 - 51st Dr.
MarysvIII9, WA M70
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 v""
orplot plan'lor 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 inf, rmation (e.g. site
gr
plan, topo a 7map, 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 Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant -
Name
17.5 S / -7 12 No AV R-:-' U)
Street Address
Er) HO�40S W
:� !!�J O'Z
City, State, ZIP Phone
Signature
Date
Applicant Representative:
/, . r,' 1,10 at, i -r 7-
Nam
1162!1 51ST DA.) "IE
Street Address
MArfLy9V1L.L,F— Wk '?A3Z70 651?-S411
City, State, ZIP Phone
MAY 34 Iffl-
Signature Date
MA6e
52� 7
ile W
I L" 'i L: L: P-1
IrA
(07
0 �-.�7
.7
4.A
iJ*
67
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13-M
NJ 0 A
71214
C).,Z -;-4
I- .7�
STREET FILE
GAA
TZ
rnff NL E
OF EDMONDS
5E
ZONE
PERMIT 9
t
CITY
K9
.0600
NUMBER
CONSTRUCTION, PERMIT APPLICATION
ip
i B
OWNER NAIVIE/NAME OF BUSINESS
-
Auumtb� 75,42
/jo _ Z�TE/APT
,,7��
0
A2,4 \.// C, (5 A 6 ANIA t4
lqjee
LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
LID NO
G_j
MAILING ADDRESS
Z
3:
0
7,5 7 AJ 0 A V Aff V,/
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved 11
r—CITY
—zip TELEPHONE
NUMBER
EXISTING . REQUIRED
DE DICATION
AW Permit Required 0
Street Use Permit Req'd 0
Rnz t.
Inspection Required C3
NAME
PROPOSED
Sidewalk Required 0
cc
/:iF- k,.f 06 (-,,f 7/7'
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
W
ADDRESS
YES 0 NOD
REMARKS
cc
L)
a:
CITY ZIP TELEPHONE
NUMBER
wuj� Oo I
W
W
;Z
VL Vj L L.F_ WA.
Z,
NAME
L7AV10
cc
0
ADDRESS
7
ENGINEERING MEMO DATED
REVIEWED BY
<
CC
CITY ZIP
E NU MBER
Z
tv 0 01
FIRE MEMO DATED
REVIEWED BY
UJI
0
STATE LICENSE NUMBER EXPI;ATION DATE
1 .1 . .. -
ew t4145,11"IL-1
N AREA
SEPA REVIEW
A;�AO.
Legal Description of Property - �nplucle alVeasements
ALLOWED
OPOSED
COMP LETE
EXEMPT
6Af
4i
7
SHO
�Xp
4\,,r 74 1&-6 C 40 ku V I �-CG 0
VARIANC cu
XINJJI VIEW BY
DA
uj
_j
goo 4— 40 Z 40 0
Z
Z
SETBACKS FEET
��)REAR
HEIGHT JWT,�
,fiV'ER�fty
uj
Property —a,? 06_1
FRONT ///;) SIDE:2
Tax Account
REMARKS
Parcel No.
177-3.-
Ln
NEW
RESIDENTIAL
PLUMBING
17
ADDITION
COMMERCIAL
MECHANICAL
1:1 APT.BLDG.
El SIGN
REMODEL
GRADING FENCE
EIREPAIR 11
CHECKED By
TYPE 0 CONSTR TION
7c/
OCCUPANT
GROUP
— CYOS. I x _ FT)
)IN-
- WOODSTOVE SWIM POOL
DEMOLISH 1-1 INSERT HOT TUB/SPA
SPECIAL INSPECTOR
REGUIRED 13
JAREA
OCCUPANT
LOAD
RARAGE RETAINING WALL/
rc,A�RPORT, 'ZR'OCKERY E] RENEWAL
YES
REMARKS
Z
PROGRESS INSPECTIONS
PER UBC 305
0-
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
rL
C-1 70 7-6,1 (A cg�
9xt&,r.ags1&ygy
M. 64(f66i
to
VS
NUMBER
NUMBER OF
RITICAL
W
0
OF
DWELLING
I
]CAREAS
16
0
STORIES /
UNITS;'-
NUMBER
DESCRIBE WORK TO.BE DONE (ATTACH PLOT PLAN)
c 654 "-A �,-, is
FINAL INSPECTION
REQUIRED
1 '7 12, S CP 12 0C 3o
VALUATION
F EE
FEE
PLAN CHECK FEE
—71NG
BUILDING
9
,7
HEAT SOURCE:
%
PLUMBING
Plan Check No. -7 �2
MECHANICAL
This Permit covers work to be done on private , property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewplks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
App,11,1cation: 180 Days
ormit
=ZPer7mll
Limit: 1 Year - Provided Work Is Started Within 180 Days
mit Lim
STORM DRAINAGE FEE
FEE
"Applicant, on behalf of his or her spouse, heirs,,assigns and
ENG.,11SISPECTION
successors in interest, agrees to Indemnify, defend and hold
Tn
harmless the City of Edmonds, Washington, its officials,
m
employees, and agents from any and all claims for damages of
<
whatever nature, arising directly or indirectly from the issuance
PLAN CHECK DEPOSIT
3:
..of this permit. Issuance of this permit shall not be deemed to
0
01
modify, waiv e or reduce any requirement of any city ordina nce
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
C/ 50
provision."
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and in doing the work authoriz-
AUTHORIZES
THE
signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor
ONLY
WORK NOTED
Deputy; and fees are paid. and receipt is
Code of the State of Washington relating to Workmen's Compensa-
acknowledged in space provided.
ion Insurance and RCW 18.27.
INSPECTION
IGNATURE (OWNER OR AGENTI, DATE 'SIGNED
DEPARTMENT
S SI NATURE DATE
< -.�fv i-Y
CITY OF
EDMONDS
HIL
CALL FOR
F
E� E DATE
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAI -Ale YELLOW— Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3.
PINK — Owner GOLD — Assessor
102-87
CITY OF EDMONDS
USE
ZONE PERMIT
NUMBER 0,57C e) 19'
CONSTRUCTION PERMIT A PPLICATION
OB SUITE:APT d
OWNER NAIVE NAME OF BUSINESS
J
LEGAL DESCRIPTION CHECK
SUBDIVISION NO LID
NO
cc
w
Z
3:
0
MAILING ADDRESS
7
/5),
7
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved 0
CITY ZIP
TELEPHONE NUMBER
RW Permit Requtred 0
EXISTING — REQUIRED DEDICATION
PROPOSED Inspection
Street Use Permit Req'd 1:1
Required 0
Sidewalk Required 0
a:
NAME
17-7
f
METER SIZE
LINE SIZE
NO. OF FIXTURES
PAV REQUIRED
Lu
F-
4
YES 13 NO CI
ADDRESS
t
T
REMARKS
Cr.
uj
w
CITY ZIP
TELEPHONE NUMBER
0
Z
NAME
V
RESS
cc
ENGINEERING MEMO DATED REVIEWED BY
0
L)
Cc
CITY ZIP
TELEPHONE NUMBER
FIRE MEMO DATED REVIEWED BY
Z
0
ul
STATE LICENSE NUMBER EXPIRATION DATE
r_ P
0 1�v 'IN
SIGN AREA
PROPOSED
SEPA REVIEW
COMPLETE
ADS NO.
Legal Description of Property - include all easements
z
0/3 ,
H'0 N- 2-t w
JEXEMPT
SHORELINE It
EXP
L�L_,V 44
VARIANCE OR CU
PLANNING REVIEW BY
DATE'
cn
SETBACKS — FEET
HEIGHT
LOT COVERAGE
Z
w�
FRONT SIDE REAR
Z
<
Properly
Tax Account
REMARKS
Parcel No.
NEW RESIDENTIAL PLUMBING
11 El
ADDITION COMMERCIAL MECHANICAL
El APT. BLDG. El
REMODEL SIGN
CH CKED BY
TYPE OF CONSTRUCTION
CODE
OCCUPANT
P
GRADING FENCE
CYOS. Fn
REPAIR x
::fA
WOODSTOVE SWIM POOL
DEMOLISH INSERT HOT TUBISPA
F
SPECIAL INSPECT R
OCCUPANT
REQUI RED 0 YE
LOAD
O^RAGE RETAINING WALL/
ICQARPORT RENEWAL
.
REMARKS
ROCKERY
PROGRESS INSPECTIONS PER UBC 305
Z
(TYPE OF USE, BUS �SS O�ACTIVITY?)XPLAIN:
r— 1C
A]62� " !2
J,
W
0
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
INUMBER R'1/ -
STORIES
UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REQUIRED
C 9/-/
VALUATION
FEE
7 )1 -7
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING
IN)
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
ENG. INSPECTION FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
,n
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
m
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
x
01
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
ATTENTION APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and THIS PERMIT
his application is not a permit until
state laws regulating construction; and In doing the work authoriz- AUTHORIZES T
.
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy: and fees are paid, and receipt is
tion Insurance and RCW 18.27. INSPECTION acknowledged in space provided.
SIGNAT RE (0 EIR OR AGEN DATE SIGNED DEPARTMENT
OFFICI I ;S? DATE
TU
CITY OF
X_
4
01% EDMONDS OKI 1��N
CALL FOR RELEASED BY: DATE
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL — File YELLOW — Inspector Ll
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — &Aner GOLD — Assessor
102-87
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N.E. 1/4, S.W. 1/4. SECTION 8, TWP.27N., RAE.. W.M.
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A PORTION Or TRACT 143, MEADOMALE BEACK REWMED IM VQLtWE 5.
PACE X RtCOMS Or SM04OMtSH CPJWTT..WASHP0GM
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DAVE CALAVAM - 17521 72W AIWDAX W. - MMOMS, WAgWG�
PER Sy. 46-70
ma""� OF 175TH STREET S.E.
"C 332-130-090
MAC 332-130-100
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2829
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Mary'svllle, WA 98270
176TH STREET S.W.
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RECORD OF SURVEY
FOR
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CONCVEX womMENT FOU�Q
DUNAWAY SURVEYING
23201 AVEMA SOUTHEAST
BOTMIA- WA S*021 -92M
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PLANNING DATA
SITE ADDRESS:- :ZZ!�4igf� DATE:
ZONING: PERMCF#-
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FROJECT DESCRIPTION:
SETBACKS:
Reauired Setbacks:
Front: �Z,5 Left Side: 7 Right Side: -7�1-z- Rear: 16
Actual Setbacks:
Front: -- Left Side: Right Side: Rear:
FLOOR AREA:
LOT COVERAGE:
Maximum
BUILDING HEIGHT: 15 / Actual Height:
Maximum Allowed: /;?—
SUBDIVISION: S-,#& - -76
CRITICAL AREAS#: 1,1-t - /I e) u,4t ve4z
SEPA DETERMINATION:
LOT AR
OTHER:
ZONE -
SETBACKS:
FRONT
SIDE!=:fi=
REAR
OTHER
HEIGHT_
$'T I I ,
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CITY OF EDMd-ND-S------
BUILDING DEPARTMENT
WORK
ADDRESS
OWNER
APPROVED DATE:
BLDG. OFFICIAL— Al�l
PERMIT NUMBER
I
10-1
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47
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L. E. NOBLITT
12629 - 51st Dr.
Marysville, WA 98270
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COIJIVTER
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7 5N0,q0Misj-( L;t5u.�iry'SW01V?� FLA-r 44--7C-,e,5C,01Z011-1G,
'600 4020/0.
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S�--ALE: /'.= �20'0 it APPROVED BY: DRAWN BYIV�06L-
REVI!SEDA4AY31'.'
S 7- IE V)5-104 m (5 [z 6 G (S P. E.
12 T 48 . /-� Oc —(,q 5 6 r S 7.
W, 0 tq.IZ<) *2 7 �Z T"Z
DRAWING NUIA BER
174-
:� �1 �/ J�
C1 TY CF EDMONDS
BUINUANG D_EPA%FiTv'1ENT
/ED DATE:
)FFICIAL
PE R PA 16 BA B.E R -
94
WKS:
RONT
IDE
FAR
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47
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L. E. NOBLITT
12629 - 51st Dr.
MarYsvlft. WA 98270
WALL.
i'lCOVE C 7' L 0 A-77
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. 600 410,2010.
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'175'2/ 72NI7,We \^/, AFOMOt40S,
S,CALE: �2o,.' Z7 APPROVED BY:
DATE'. MAY fS. I ff-#-
S7.
;J 44,—L- 56 �r
INA. al 7 12
fZ,06', 7
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!L
City. of Edmonds
1ON PERMIT
RIGHT'OF-WAY CONSTRUCI
A. Address or Vic'nity of Construction: P1, 5 Z
B. Type of Work (be specific): Aok
C. Contractor: C-
Mailing Addr
State License
City Business
D. Building Permit # (if applicable):
F� Commercial
Fj Multi-Farrffly
INSPECTOR:
Permit No:
IssueDate:
Side Sewer Permit # (if applicable):
El Subdivision F1 City Project rg EUC (PUD, VERIZON, PSE, COMCAST, OVWSD)
LP%
El SingleFarnily , F-1 Other
F. PAVEMENT CUT: El YES D&NO G. SIZE OF CUT x
CONCRETE CUT: El YES KNO
G. Fj Mail Approved Permit F1 Call for Pickup
APPLICANT TO READ AND SIGN
INDEMNITY. .,Applicant under�tands by his/her signature to this application helshe 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 attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FbR 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 TIMEA DEBITOR CREDIT WILL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT.
* 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 HA VE READ THE ABO VE STA TEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND A CKNO WLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES. FOR INSPECTIONS
Signature. e) 6��IC 6L,1 Date:___,41�14
ontractor or Agent)
441?(fi, 1-z�5 214;_
1�4
'0
OR:CITYUSE'ONLY
APprovedby:
Time Authorized: V/6idAiter:
Special Conditions:_9E__,-T'_0#91E.. Pn\Ar 7-p-�ZjkCANI)Mnspectibfi,.-Fee
Yee
r�Z7-76',e c0A(oe=w1y(s).Aj'4gT A FsErmz\ Tota'!,-,
AZF4�,/ DiE 4�f 7--S. &A , rA 1./V S k4., N - Sa. I-- A Aek� jyRecei01-.'N o:�.;N
_4L)CA 7r- A/L U/4 Issue&-bY.': -
A r -
REQUIRED INSPECTIONS:
I C, " ZRC2
Call 425-771-0220, Ext. 1326for a 24-hour
FINAL APPROVAL OF PERMITTED WORK:
uest line.
7 DATE:
's Signature
CADocurnents and SettingsTurtisNy Documents\Fomis\Engnmg\ROWpermit_.doc
Revised 10/01/03
E=MN I
Igo
Open trench in
shoulder of ROW of
approx 56 ft and set >
carson to extend and <
bury CATV service CM
D ICA
drop
Ch
0
El
garage
Comcast of Bellevue, Inc.
1h Street SW -PPROVED AS NOTED
152575
Suite 200 BY ENGINEE ING
Everett, WA 98203 K
Contact: Kermit Benson 425-263-5362
North Drop Date:
Node: EM04A
17521 72nd AVE W. - City of Edmonds 24 HR. NOTICE REQ.
FOR INSPECTION
L2kic
Work Details
Open trench in shoulder of ROW for approx 56 feet (m/1) and set carson to extend and bury CATV service drop to 17521
72nd Ave W. Install cable at 36" depth.
All disturbed areas will be restored to existing or better conditions.
Backfill material will be mechanically compacted to 95% of maximum density as specified by the City of Edmonds. In tight
corridors hand trenching will be utilized to ensure protection of other utilities. Contractor must locate all existing utilities
impacted by this project.
Please see attached plans for restoration, erosion control and traffic control. Erosion control will consist of placing filter
fabric fence and/or sandbags along curbs and catch basins where necessary. Keep drainage system clean and
functioning. Remove all debris from the work site. Streets and roads will be cleaned both during and after installation of
work.
ccomcast
PROJECT'S TIMELINE AND PROPOSED HOURS OF OPERATION:
Timeline - Up to 30-days past the issue date.
Work Hours -The entire project area will be conducted from 7:00 AM to 7:00 PM or
as specified by the Inspector.
Traffic Control Plans
1. The standards and guides of the latest version of the MUTCD or as set-up per
Code shall be followed at all times.
2. A copy of the Permit and Traffic Control Plan shall be on -site with all
contractors during the project.
3. All contractors will avoid parking on sidewalks and shoulders and will take the
lane and follow the proper traffic control set-up for the given situation.
4. Pedestrian access shall be maintained through or detoured around all work
sites.
5. Please find attached the traffic control plans for the various types of work
sites that will be encountered during. our project.
6. Flaggers will be used only when all other methods of traffic control are
inadequate to warn and direct drivers. Only licensed flaggers will be used on
the project.
7. If situations occur when questions arise about proper traffic control -set-up the
solution will be determined in the field with the Comcast Construction Rep.
and the Inspector.
qpy6ERtileg # 1,: -
If curb and gutters in project area:
Filter bags will be placed in catchbasins downstream of work site, and
Small check dams of pea gravel filled sandbags will placed within the
.Utter upstream of the catchbasin.
Traffic control !',et -up for minor encroachment
I
'00� A
_k
lieuo!.,do)
(optional)
01,
.Truck Mounted
Artenuarto
toptional)
113 L
f
200'1
A
rLAG(
Traffic control set-up for lane closure
Depth =
36-inch minimum
Compatible w/
other utilities
Shoring required
at�4=ft_+_ -_ ---
Pavement Cuts =
T-cut 1 -ft wider
than trench
Neat -line saw -cut
or jack hammered
edge
P79,
enc!'hi
',r
.0m
tionK
N A WD S
Depth, Cleaning, Containment,
Compaction, and Restoration
All trench backfill shall be mechanically
compacted to 95 percent of maximum density
using 1-ft loose lifts with whacker or 2-ft loose
lift with a hoe pack.
If proper compaction cannot be achieved with the
native materia� ' 1, new import material is required at
the 95 percent rate.
As an alternative, CDF can be used in a design
mixture approved by the Engineer.
Cqomcast.
e -a
OM
CLEANING: All Streets and roads are required to
be cleaned and swept both during and after the
installation work.
* Mechanical.Vacuum is preferred method
CONTAINMENT: All un-restored shoulders or
material storage areas. are required to be contained
with reflective barricades.
on
-"0 w.
All disturbed areas shall be restored to
existing or better conditions
Trench parallel to road:
Shoulder --Match existing surface conditions
Pavement - 6 1/2 inches of crushed surfacing material
and asphalt concrete Class B at 2- inches minimum or
same thickness if greater..
Trench across road (immediate cold mix patch):
NO Asphalt - Permanent hot mix patch at same thickness
or 2-inches and sealed within 30 days.
Concrete - saw cut and pored with mastic joints, eight -
sack mix, either type II of III cement, within 30 days.