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STREET F I L PERMIr c01j1Vrr;1
City of Edmonds
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.
With a signed copy of this form, the
applicant should also submit a vicinity map
Of the parcel with enough detail that City
staff can find and identify the subject
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information 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:
4kLLAL4, �Llel57 ,Ilysb A/
Name
Title
1Y 3I z 01-ylfi,lc V i0-'/ ✓folk
Street Address
r-70IVoh1af wVI �9vzv 776-g162-
City, State, ZIP Phone
Signature Date
Applicant Representative:
TOO M A-,S M. !-% U P0,1
Name
1� TC cf. 7-
Title
FIBS A `n?e 2-4ni,nl[
Street Address
City, State, ZIP Phone
Signature Date
Critical Areas Checklist-
oe Site Inform-2 fon
—Project Name: /Ittv 6,4-RAe;E permit Number: P(-N0iN(,
Site Location: 421 V1nP/e 1//61, l /Moperty Tax Account Number: �XP510 ooa D I 0 01
Approximate Site Size (acres or square feet): 121-�5
Have you filled out a Critical Areas Checklist for a project on this site before?�
General Site Conditions
1. Has the site been cleared or logged? �,�D Date of most recent action:
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? S wrrw rcw�
3. 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.)
I/ Hilly: slopes present onsite of more than 15% and les
s than 30 /o (a vertical rise
of 10 feet of horizontal distance )
1/ Steep: grades of greAter than 30% present on site.
Comments 14C (�(lU►�El�iy S'�Of SfEEPty DOL,1n11-AI�� FP-dl')l P i-ANC_
Hydrology/Vegetation
4. Site contains areas of year-round standing water: (�
5. Site contains areas of seasonal standing water: 90 Approx. Depth:
6. Site is in the floodway � floodplain � � of a watercourse.
7. Site contains a creek or an area where water flows across the grounds surface? ij� flows
are year-round? _Flows are seasonal? /Vo
8. Site is primarily: forested _ ;meadow ;shrubs ; mixed
9. Obvious wetland is present on site: __ gDi -__
10. Wetland inventory or map indicates wetland present on site: _ �(
11. Critical Areas inventory or map indicates any Critical Area on site: UeS
For City Use Only
;.
9
City of Edmonds
Critical Areas Determination
Applicant: Kristjanson, Douglas Determination #: CA-93-163
Project Name: Permit Number:
Site Location: 18312 Olympic View Drive Property Tax Acct #: 5656-002-010-00
Project Description:
New Garage
Waiver Criteria (all criteria must be found to apply):
XX There will be no alteration of the Critical Area or its required buffers;
XX The development proposal will not impact the Critical Area in a manner contrary to
the goals, purposes, objectives and requirements of the Critical Areas ordinance;
XX The development proposal meets the minimum standards of the Critical Areas
ordinance;
XX The above findings are based on the following conditions of approval:
1. Any future construction must complete a new Critical Areas Review
3. No new construction is allowed west of the eastern side of the existing
Residential - Single -Family - 12,000 square feet of area required per lot house
Based on the above findings and conditions, the requirement for a Critical Areas Study
associated with this development permit is hereby Waived, as authorized by Chapter
20.15B.150 (B) of the Edmonds Community Dev ment Code.
Gf2
John Bissell, AICP
Name S' ature Date
Critical Areas Checklist- STIJEET FILE
�:-'Sife Infor�a
..Ffbject Name: 6,4PA-e E Permit Number.
Site Location: % 5/7 01YtWlC 1110,1 property Tax Account Number: '5(P5(* ooa 01 O ob
Approximate Site Size (acres or square feet): 121 �5 UO SF
Have you filled out a Critical Areas Checklist for a project on this site before?
General Site Conditions
go
1. Has the site been cleared or logged? 00 Date of most recent action:
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)?
3. Describe the general site topography. Check all that apply.
Flat: less than 5 feet elevation change over entire site.
56& Arm rc14Q�
Rolling: slopes on site generally less than 15% (a vertical rise of 10 feet over a
- / horizontal distance of 66 feet.)
f/ Hilly: slopes present on site of more than 15% arid less than 30% ( a vertical rise
/ of 10 feet of horizontal distance.)
I/ Steep: grades of greater than 30% present on site.
Comments 2C Q Fl i y SIOfFS S 116f t n1 L y 06b,'A--f--D FEM, OW o (�( C- -
Hydrology/Vegetation
4. Site contains areas of year-round standing water: u
5. Site contains areas of seasonal standing water: 1 90 Approx. Depth:
6. Site is in the floodway 14 o floodplain A) 0 of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? iJ) flows
are year-round? 1/0 Flows are seasonal? AN
8. Site is primarily: forested :meadow ;shrubs ; mixed
9. Obvious.wetland is present on site: —g
10. Wetland inventory or map indicates wetland present on site: _9_
11. Critical Areas inventory or map indicates any Critical Area on site:es
For City Use Only
City of Edmonds
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).
PERM/r �oU�
rFR
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.
With a signed copy of this form, the
applicant should also submit a vicinity map
of the parcel with enough detail that City
staff can find and identify the subject
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information 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:
, Y
Name F
tJ&)N .
Title -
131 z 01_Yh41°ic v/6W ✓elw
Street Address
4oIVolvVJ' -ri8-?162
City, State, ZIP Phone
AM2
Signature Date
Applicant Representative:
-too h1A-_S M. /-/_0140f1
Name
-12�r+ i rc-c. i
Title
671 �- /"lr s i AVE- . lltjEz �1_AN trli
Street Address
S EAi( lx' W f} c / G 4—
City, State-, ZIP Phone
14
hma-E.
Signature Date
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IL CONSERVATION,SERVIC=
SNOHOMISH CO
SOIL LEGEND
SYMBOL NAME
1
Alderwood gravelly sandy loam, 2 to 8 percent slopes
2
Alderwood gravelly sandy loam, 8 to 15 percent slopes
3 .
Alderwood gravelly sandy loam, 15 to 25 percent slopes
4
Alderwood-Everett gravelly sandy loamy, 25 to 70 percent slopes
5 —
Alderwood-Urban land complex, 2 to 8'percent slopes
6
Alderwood-Urbari land complex, 8 to 15 percent slopes
7
Bellingham silty clay loam
8
Bellingham Variant mucky silty clay loam
9
Cathcart loam, 3 to 15 percent slopes
10
Cathcart loam, 15 to 25 percent slopes
11
Cathcart loam, 25 to 50 percent slopes
12
Cryohemists, nearly level
13
Custer fine sandy loam
14
Elwell silt loam, 3 to 30 percent slopes.
15
Elwell-Olomount complex, 15 to 30 percent slopes
16
Elwell-Olomount-Rock outcrop complex, 30 to 60 percent slopes
17
Everett gravelly sandy loam, 0 to 8 percent slopes
18
Everett gravelly sandy loam, 8 to 15 percent slopes
19 -
Everett gravelly sandy loam, 15 to 25 percent slopes
20
Fluvaquents, tidal
21
Getchell silt loam, 3 to 30 percent slopes
22
Getchell-Oso complex, 15 to 30 percent slopes
23
Getchell-Oso-Rock outcrop complex, 30 to 65 percent slopes
24
Greenwater loamy sand
25
Hartnit-Potchub-Rock outcrop complex, 65 to 90 percent slopes
26
Indianola loamy sand, 15 to 25 percent slopes
27
Kitsap silt loam 0 to 8 percent slopes
28
Kitsap silt loam, 8 to 25 percent slopes
29
Kitsap silt loam, 25 to 50 percent slopes
30
Lynnwood loamy sand, 0 to 3 percent slopes
31
Lynnwood-Nargar complex, 65 to 90 percent slopes
32
McKenna gravelly silt loam, 0 to 8 percent slopes
33
Menzel silt loam, 0 to 3 percent slopes
34
Mukilteo muck
35
Nargar fine sandy loam, 0 to 15 percent slopes
36
Nargar fine sandy loam, 15 to 30 percent slopes
37
Nargar-Lynnwood complex, 30 to 65 percent slopes
38
Nargar Variant sandy loam, 3 to 30 percent slopes
39
Norma loam
40
Norma Variant loam
41
Ogarty-Tokul-Rock outcrop complex, 65 to 90 percent slopes
42
Olomount gravelly loam, 3 to 15 percent slopes
43
Olomount-Elwell-Rock outcrop complex, 65 to 90 percent slopes
44
Orcas peat
45
Oso gravelly loam, 3 to 15 percent slopes
46
Oso-Getchell-Rock outcrop complex, 65 to 90 percent slopes
47
Pastik silt loam, 0 to 8 percent slopes
48
Pastik silt loam, 8 to 25 percent slopes
49
Pastik silt loam, 25 to 50 percent slopes -
50
Pilchuck loamy sand
51
Pits
52
Potchub silt loam,-3 to 30 percent slopes
53
Potchub-Harmit complex, 15 to 30 percent slopes
54
Potchub-Hartnit-Rock outcrop complex, 30 to 65 percent slopes
55
Puget silty clay loam
56
Puyallup fine sandy loam
57
Ragnar fine sandy loam, 0 to 8 percent slopes
58
Ragnar fine sandy loam, 8 to 15 percent slopes
59
Riverwash
60
Rober silt loam, 0 to 15 percent slopes
61
Rober silt loam, 15 to 30 percent slopes
62
Rober silt loam, 30 to 65 percent slopes
63
Skykomish gravelly loam, 0 to 30 percent slopes
64
Snohomish silt loam ,
65
Sulsavar gravelly loam, 0 to 8 percent slopes
66
Sultan silt loam
67
Sultan Variant silt loam
68
Sumas silt loam
69
Terric Medisaprists, nearly level
70
Tokul silt loam, 2 to 8 percent slopes
71
Tokul silt loam, 8 to 15 percent slopes
72
Tokul gravelly loam, 0 to 8 percent slopes
73
Tokul gravelly loam, 8 to 15 percent slopes
74
Tokul gravelly loam, 1.5 to 25 percent slopes
75
Tokul-Ogarty-Rock outcrop complex, 0 to 25 percent slopes
76
Tokul-Ogarty-Rock outcrop complex, 25 to 65 percent slopes
77
Tokul-Winston gravelly loamy, 25 to 65 percent slopes
78
Urban land
79
Verlot mucky silt loam, 3 to 25 percent slopes
80
Winston gravelly loam, 0 to 3 percent slopes
81
Winston gravelly loam, 3 to 30 percent slopes
82
Xerorthents, nearly level
l
City of Edmonds
Critical Areas Determination
Applicant: Kristjanson, Douglas Determination #: CA-93-163
Project Name: Permit Number:
Site Location: 18312 Olympic View Drive Property Tax Acct #: 5656-002-010-00 .
Project Description:
New Garage
Waiver Criteria (all criteria must be found to apply):
XX There will be no alteration of the Critical Area or its required buffers;
XX The development proposal will not impact the Critical Area in a manner contrary to
the goals, purposes, objectives and requirements of the Critical Areas ordinance;
XX The development proposal meets the minimum standards of the Critical Areas
ordinance;
XX The above findings are based on the following conditions of approval:
1. Any future construction must complete a new Critical Areas Review
3. No new construction is allowed west of the eastern side of the existing
Residential - Single -Family - 12,000 square feet of area required per lot house
Based on the above findings and conditions, the requirement for a Critical Areas Study
associated with this development permit is hereby Waived, as authorized by Chapter
20.15B.150 (B) of the Edmonds Community Dev ment Code.
John Bissell. AICP
Name (-aature Date
STREET FIT.
Rec"9 8 V OLYMPIC VIEW DRIVE' � �"
_.
p WIT COUr4 i
ap S o g N .N--� I 1� DUST. SHOULDER .
V1 ,y !v � y IffW.ORIY�WA O
Q� i NO - )t�� .
I 100.0'
08'
� o — --- 100.0'
sZ� 98.0' EE
— — — -� 98.0'
96.0' 96.0'
94.0'
0
' 92.0— ---
m 92.0'
90.0'
88.0'
88.0'
:D
r1 g� m
c�
N m z 86.0'
o NNo r 86.0'
K n
S y O O Ly
D O M O o Sy
N i
84.0'
82.0'
-- _
_ \ 84.0'
_
�" 78.0'co
o
82.0'
tJn Oi <o
T
UI O EA
Wes/ (n � $(� _ • � _ \ _ \ _� �
10 �
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Z . SURL'NCTON NOR STREET_`
� 0 F
O '"'POAO
S
--- : ` CITY OF EDMONDS* STREET FILE
PUBLIC WORKS DEPARTMENT, ENGINEERING, DIVISION �
APPLICATION FOR RIGHT-OF-WAY CONSTRUCTION PERMIT
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A an-d B
0
Permit
at:(address or vicinity)
Type of Work to be done: t,f5
(attach drawing when applicable)
Time Required -- Start: %D�f7 Z Finish:
Owner
VlLy JLate Gip
Contractor:
Mailin
City . State Zip
Ci%
i
/ •
State License Number
Telephone Number
** NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE **
B, 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, foreseen or unforeseen, that may, be made against
the applicant or 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.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Division.
Funds held from the Security'Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time 'a debit or credit will be
processed for issuance to the applicant. -
Work is subject to inspection, and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220.
I understand that this permit must be available at the job site for inspection
purposes at all times.
Signature: V-'ODate: %kIZ174
Owner or Agent
(„ TO BE COMPLETED BY ISSUING AGENCY:
q
Date Issued:7,/p —/a — Permit No.: 70 —oZs 0—Fee .4l,�
Security Bond:
Time Authorized:
APPROVED B
Date:
0
way✓ �� t � old. Q�s
STREET FILE -
. bumiC WORKS DEPART= CHEM-*
BUILDING PERMIT REVIEW
aDate
)L,W`�)Q Address
Street Right -of -Way Existing 6 OZA',q REQD & 6o
Access Easements Existing (INOcLte- REQD
Utility Easement Existing REQD
Lot per Subdivision Plat. Assessor Map
Site Plan Checked for Accuracy
Underground Wiring Reqd.
Check Accuracy of Legal Description
Enviromentally Sensitive Area.
Environmental Checklist Reqd. Lug:
Flood Hazard Zone lu-,
Shoreline Management Area VA,
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Existing Zoning Per Code
Amenities Design Board Approval Reqd.
Board of Adjustment Approval Reqd.
Review By:� Date:
Existing Water '1ain Size
Water Main Reqd.
Service Line Reqd.
Hydrant Size Existing
Hydrant Reqd. Per Fire Code
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Comments
Water'Meter Charge Reqd.
Review by: Date:
Septic Tank Permit Reqd.
Sanitary Sewer Availability
Drawing No.
Side Sewer Availability
Sanitary Sewer -Connection Fee Reqd.
Review By:
ADB # Approval
Size
liate:
Permit No.
Proj.
File No.
Date:
I Open Ditch 'Existing. Reqd.
H Culvert Reqd. Size.
04 Catch Basin Reqd. Indicate on Site Plan
O Shoulder drainage ninintain collection on swale open runoff
H
R-.wtiole read. Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
Review, by Rite
Street Paving Reqd.
H
Curb and Gutter Reqd.
W Sidewalk Reqd.
~W' Curb Cut for Driveway Reqd.
� Right -of -Way Construction -Permit Reqd.e
H Bond Reqd. for Public Improvennts
Street Na-ne Sign Reqd.
cn
Other Sip-iing Reqd.
Q Pre Permit Site Inspection made on
z
BY: SS,,T,R
H
U
W W WATER
a
CIO
~' STREET
H
�' ENGINEEF.ING .
Special Requirements listed in meno to Coimunity Development Department,
Building Division
BY Date
o All items filled in on Building Permit Application
BY Date
R' Drawings Stamped and No atio Made
w BY Date 177
Approve by Public �dorks Deparcincnt
Revised: 1v 10-1977
•.
CITY OF EDMONDS, PUBLIC. WORKS
200 DAYTON STREET
EDMONDS, WA 98020
775-2525
DEPARTMENST"Ee--
il FILE
APPLICATION FOR STREET USE PERMIT
Name of Applicant:
Mailing Address:
Telephone Number: 7;%
Description of Public Place or Portion thereof desired to be used: (exhibit may be
, i- + , - tL, ., A 1
If applicable, attach plans and specifications
and/or maintained on the Public Place:
TEMPORARY PERMIT: Unless otherwise designated herein,'this permit is understood by
applicant to be wholly of a temporary nature, that it vests no permanent right whatsoever.
If the permitted use becomes dangerous or such structure shall become insecure or unsafe,
or shall not be constructed, maintained or used in accordance with the provisions of this
title, the same may be revoked and the structure and obstructions ordered removed by order
of the City Engineer. If this application is for a specified period of time, the .terms
of said application is:
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 descrip-
tion whatsoever, foreseen or unforeseen, that may be made against the applicant or 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, court costs, and attorney fees by reason
of granting this permit. In addition, applicant understands that the City shall be provided
a certificate of insurance to indemnify and hold the City of Edmonds harmless from all
claims and/or property damage, naming the City of Edmonds as an also insured.
APPLICATION OF CHAPTER 6.40 OF THE EDMONDS CITY CODE: Applicant warrants that he has read,
or had the opportunity to read, Chapter 6.40 of the Edmonds City Code, attached herewith,
and understands that all terms of that Ordinance are incorporated herein as if set forth
in full and this application and permit therefore are subject to the terms of that Chapter
of the Edmonds City Code.
Applicant s gn u r e
ate
11/7/74 rev.
City of Edmonds ., Public Works Dept.
APPLICATION FOR STREET USE PERMIT -- Page 2
Approval (and Agreement, if applicable) of Abutting Property Owners:
Signature Printed Name Address Date
DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
City Council Approval (Attach Minute Entry):
Permit Fee: Annual. Fee: due January 1, 19
Amenities Design Board Approval (if applicable) Attach Minute Entry:
Building Official Approval (if applicable):
Signature Date
Provision for Indemnity:
Terms and Provision of Performance Bond, if applicable: (Reference 6.40.050 of applicable
Ordinance)
PERMIT AUTHORIZATION BY P.W. DIRECTOR:
gnTcure
PERMIT NO.
Remarks:
11/7/74 rev.
/G//Z/7,5_
ate
DATE
Se
o
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"NO Pl. 0
STREET FILE jo
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C.
a
CITY:, -OF EDMONDS,_ -
CIVIC CENTER = WATER -SEWER IDEPARTMENT
SIDE' SEWER PERMIT
Call PRospect 6-1107 when work
ls`ready.for Inspection. (No inspeo-
tions Saturday, Sunday or holidays.)
No_: 2688
ADDRESS............. 18312.... 1.Ymp c...View.... rive-----------------•---.........-------------------------:..............................................-----......----------
Ethel Ce Newton Tucker Construction
OWNER ................ ......:....................................................................... CONTRACTOR .......................................................... .............--------
..
Permission is granted ........... J nudrX.... 18..., 19...681 for ........................ days to REPAIR. or CONNECT aside 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. -
NOTE 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 2%.
No bends In grade sharper than % will 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.
;4A
I�
November 12, 1970
Kassler West Mortgage Corp.
822 NE Northgate Way
Seattle, Washington 98125
Attention: Peggy
Mortgage Processor
Re: Property Address; 13312 Olympic View
Drive, Edmonds, Washington 98020
rientlemen :
This is to certify that the house at 18312 Olympic View Drive
within the City of Edmonds, was connected January 18, 1968, on permit
number 2688 to the City of Edmonds sewerage system according to the
City of Edmonds standards.
RLW:rla
Respectfully,
CITY OF EDMONDS
RONALD L. WHALEY
Asst. Director of Public Works
f�,�r� °�� � � °'a4^ii�TM'7Yt°^Y'. ���iwTiv�i7�� w�Ts� � t �f�^'�`�Y�'��iVz�ir'�yx.+S'^Jrr'.� r�;R;•i%Yb�3its^�` � �8'a't��.a
0
8go-199
City of Edmonds
RIGHT-OF-WAY CONSTRUCT% 1`�iE E T FILE
PERMIT permit Number: 9.3 -
GG f�l� Issue Date:
A. Address or Vicinity of Construction: 18312 nt mpic UeW—riS (9400117)
B. Type of Work (be specific): Install New Service
C. Contractor:W,,hin1ZtoIIContact: Frank Swan
Mailing Address: 815 Mercer St., Seattle) WA Phone: 224-2278
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable): '
E. ❑ Commercial ❑ Subdivision ❑ City Project E] Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR:
F., Pavement or Concrete Cut : 0 Yes ❑No G. Size of Cut: 1 ( 2 x 4) H. Charge $
at Gas in Pav Shoulder
APPLICANT TO READ ANrinst
INDEMNITY: Applicant understands and by his signature to this application, agrees to hf Edmonds harmle y& yi ps 11 es, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be mad City of Edmonds, or any, �t depar ents or
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. ESTIMATF,D RESTORATLOA,! FEES WILL. BF, HELD UNTIL THE FINAL, STREET PATCH
'�^ - "7S COMPLETED BY CITYFORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROC1-SSF.D FOR ISSUANCF, M'THF t1 PHIrLCANT.
Construction drawing of proposed work required with permit application.
A 24 hour, notice isregwred for inspection; Please call the Engineering Division, 771-0220.
Work and ater1a1`1s to �e Insp cted during progress and at completion.
Restorationis to be in accordance with City Codes.
Street shalllbe 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'Inaterial prior to the end,of the working day;
NO EXCEPTIONS.
I have rea�the above statements and understand the permit requirements and the pink copy of the permit will be
available nsite at all times r inspection purposes.
4
Signature: -- Date: October 12 1993
M'hctor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: I_AJ6_ ISIA RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER fit^ . DAYS DISRUPTION FEEYFUND,111: -
SPECIAL CONDITIONS• $J Q Ac-P 1 W RESTORATION FEE: "
WP�&DwA-Y PERMIT FEE:
�.
TOTAL FEE:
COMMENTS: RECEIPT FEE:
DATE: ISSUED BV4 A C2
'd
NO WORK SHALL BEGIN. PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES
i
(Fund 111 - 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:
r
Addendum �to.-: City of Edmonds
Right of Way =
Permit Application
t Submitted by: Guyla Connors
_. _.... ... .- .-----•---- - Engineering Aide - - - - -
Washington Natural Gas
521-5248
.. I
N `Q
w N
7 •�
ti
a
- r
0
N WNG to window
Water main depth
(� unknown
,+—" gas main`
ftA,�
-w-
water
-g-
gas -
-ss-
sewer
$
water hydrant
0
water valve
815 Mercer St. (P.O. Box 1869), Scank, WA 98111 (206) 622-6767
OF E MOB
CITY OF EDMON
121 5TH AVENUE NORTH - EDMONDS, WA 98020 INEIT
i o
PHONE: (425) 771-0220 - FAX: (425) 771-0221 F11E
STATUS: APPROVED ENG20130190
Permit Number: ENG20130190
Address of Public Use/Encroachment: 18312 OLYMPIC VIEW DR. EDMONDS
18312 OLYMPIC VIEW DR
EDMONDS, WA 98020
rocks, shrubs for landscaping in the row (originally permitted in 1978)
STREET USE. Placement of any temporary or movable objects in any portion of public space or City right-of-way shall
meet all code requirements as set forth in the following chapters of the Edmonds Community Development Code.
ENCROACHMENT.- Permanent structures encroaching upon any portion of public space, City right-of-way or
easement area shall meet all Code Requirements as set forth'in the following chapter of the Edmonds Community
Development Code.
CODE APPLICATION. • Chapter 18.70, 17.65, and 17.70.040 of the Edmonds Community Development Code. All terms
of the adopted ordinance are incorporated herein as if set forth in full and this permit therefore is subject to the terms of
those chapters.
FOR THE TERM IN WHICH THIS PUBLIC USE/ENCROACHMENT IS IN EFFECT, THE OWNER SHALL COMPLY WITH
THE PERMIT CONDITIONS SET FORTH BY THIS PERMIT.
J
NOTE. The issuance of this permit is understood by the owner to be of a temporary nature, shall vest no permanent right
and shall be issued and may in any case be revoked at the sole discretion of the City per ECDC 18.70.040. Applicant is
responsible to provide a copy of the insurance certificate to the City at the beginning of each calendar year, no later
than the 21st day of January.
INDEMNITY. • The Applicant understands and agrees to hold the City of Edmonds harmless from any injuries, damages
or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the applicant or 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, court cost, and attorney fees by reason of granting this permit. In addition, the
applicant understands that he/she shall provide and continually maintain during the term of the permit a certtfcate of
insurance naming the _city as an additional insured, with respect to liability, and providing that it shall be primary as to
any other policy of insurance.
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Friday. ADril 12. 2013
DATE
❑ FILE COPY ❑ INSPECTOR COPY APPLICANT COPY
STATUS: APPROVED ENG20130190
;} THe,proposal will not adversely impact public space open to vehicular or pedestrian travel.
'_' • Architectural Design Board Approval has been granted or the process has been administratively
approved.
• The proposal will not unreasonably interfere with the rights of the public.
• The proposal either benefits the public interest, safety or convenience (e.g., supports or protects the city
street) or is an accessory structure such as fence normally associated with residential use of the property
as (fully complies with the requirements of criteria above.
• Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per
J City standards that is caused by or occurs during the permitted project.
• Sound/Noise originating from temporary construction sites as a result of construction activity are exempt
from the noise limits of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and
10:00am and 6:00pm on Saturdays, excluding Sundays and Federal Holidays. At all other times the
noise originating from construction sites/activities must comply with the noise limits of Chapter 5.30,
unless a variance has been granted pursuant to ECC 5.30.120.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify
defend and hold harmless the City of Edmonds, Washington, its officials, employees, and agents from
any and all claims for damages of whatever nature, arising directly or indirectly from the issuance fo this
permit. Issuance of this permit shall not be deemed to modify, waive or reduce any requirements of any
City ordinance not limit in any way the City's ability to enforce any ordinance provision.
INSPECTIONS
• None