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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number.
STREET FILE Issue Date:
A. Address or Vicinity of Construction: 17924 75 P1_W (9403702)
B. Type of Work (be specific): Tristal l New Service
C. Contractor: Washington N_ err r.al r�� i�mm�nnn
Mailing Address:
State License #: 8111
D. Building Permit # (if applicable):
a.�
Contact: Frank Swan
Phone: 994--2278
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project U Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: ❑ Yes QNo G. Size of Cut: x H. Charge $
APPLICANT TO READ ANQSIGN // � ))
'''mI
INDEMNITY: Applicant understands and by his signature to this application, agrees top ` t e City of Edmonds harmlel.'IrJbe ges, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be mpd ygainst the City of Edmonds, or any of its departments or
employees, including or not limited to the defense of any legal proceedings including deff"'_V $t and attorney fees by re� prt �gantingtAjs permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FYORtt A LPERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES ,WILL BE HELD UNTIL T•� , FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BF, PROCF,S7SF,D FOR ISSUANCE TO THE AP10CANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
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.
I have read the above statements and understand the permit requirements and the pink copy of thepermit will be
available on sit��7
for inspection purposes.
Signature: � --a � � Date: b irembnr 23 1993
(Contractor Or Agen
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: ► AA. RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER — A DAYS
SPECIAL CONDITIONS:
COMMENTS:
DATE:
DISRUPTION FEE/FUND 1-,11:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE: i ODD
RECEIPT FEE.-,
ISSUED BY: 4���+�/
i
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. I)iv. 1991
FIELD INSPECTION NOTES
Comments
Diagram
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
❑ YES ❑ NO
Date:
Date:
7
ddendum to : City of Edmonds
I Right of Way
Permit Application
Submitted by: Guyla Connors _
Engineering Aide
J G� 02 Washington Natural Gas
521-5248
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815 Macs St. (P.o. Box 1869), Scattk, WA 98111 (206) 622-6767
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CA
CITY OF EDMONDS •� ��
PUBLIC WORKS DEP*MENT FOR INSPECTION CA* Permit =w 0__
SIDE SEWER PERMIT 411 -7
775-2525Ext. 22Q Issue Date
PERMIT MUST BE POSTED ON JOB SITE *'
1. Address of Construction T1I27-4 — -L 77 Q_
A), 4VA oue44
2. Property Legal Description (in/cpplu��de all easements)
3. Single Family Residence p'rMulti-Family No. of Units
Commercial p� r
4. Owner and/o-r_-Bui.l.der 1i� a �- Ln;yn,
5. Contractor .&.-License .No. �l�G 7 hca"M rep a-)
6. Invasion into City Right -of -Way: No Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
7. Cross other private property: Yes No Easement required -
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
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 public right-of-way.
b. The side sewer contractor assumes full reponsibility 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% (1.15°)
and maximum grade of 100% (450).
f. No turn in side sewer greater than 450 (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 is required 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 I
by the City. I
1. Inspection during normal working hours ,only. Two (2) working
days notice required.+
DATE: 11 l A _ •fir �il� ,` 'tfr . �. `y 6.
Q I'certifytt at I have read
and shall comply with the above-' '
H PERMIT FEE: ti
O�
O CONNECTION FEE:
O'
fj+
DISAPPROVED BY: Date:
nntth B Date:
U�9 ti�AF.EROVED By: � Date:
** PERMIT MUST BE POSTED ON JOB 5I *MUST BE POSTED ON JOB 5I
��...DF...ED,Lj�ti
City of Edmonds
Development Services Department
} '` <•
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Critical Areas File #: ao00 G 14
Critical Areas Checklist Fee: $45.00
Date Received by Dev. Serv. Dept: 60
City Receipt No:
Date Mailed to Applicant: y : J orn
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).
PLEASE PRINT CLEARLY
Owner/Applicant:
Name c/
Street Address
City State Zip
20
Telephone
Ignature
Date
Applicant Representative:
Name
Street Address
City State
Telephone
Signature
Date
Zip
d:reception/jana/CACLHandout.dac Revised 4/10120oo
%_/i FILC /VLA (,tT —U U — IWZ
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: _ /7 LZ- 41 �% 5- 'A -t
2. Property Tax Account Number: _ ���% ma
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes; no.
If yes; how is site developed? _ 710fj S.E�
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: /I/Q ; Approx. Depth:
7. Site contains areas of seasonal standing water: ; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway !_ V .floodplainof a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? ./f/'O Flows are seasonal? (What time of year? ),
10. Site is primarily: forested ; meadow ;shrubs ; mixed
urban landscaped (lawn,shrubs etc)
IL . Obvious wetland is present on site: /6-D
------ ----- -:F,or C�tyStaff>Use Only-
.. --- -
1. Site is Zoned? fC `'
n
2: SGS mapped soiltype(s)?` AL-�V�iQIUp\jC.C_'�'—,1qpY ::l_OA.1Y1;: .jam
DETERMINATION
^ua chk.doc; Rev 10/03/97