18715 88TH AVE W.PDF111111111111
8362
18715 88TH AVE W
City of Edmonds
Critical Areas Determination
Applicant: Determination
Project Name: Permit Number:
Site Location: 1 18715 88th Ave W. Property Tax Aect #: F4 _ __,6-0106 1
Project Description:
Determination: Conditional Waiver
Based on a letter that I have received from Steve Negri at the Department of Fish &
Wildlife, I am granting a Conditional Waiver for . your project. Apparently, Mr.
Negri has seen your plans and discussed options regarding tree removal and
potential replanting.
I have enclosed the letter sent to myself from Mr. Negri discussing his
recommendations. It is my believe that this letter be used as a reference guide in the
future when considering tree removal.
If you have any questions please contact me at 771-0220.
Sinzer—efvO
7
J J n Tourtellot
Tourt
ode Enforcement Specialist
S
State of Washington
DEPARTMENT OF FISH AND WILDLIFE
Mailing Address: 600 Capitol Way N, oiympia, WA 98501-1091 - (206) 902-2200; TDD (206) 902-2207
Main Office Location: Natural Resources Building, 1111 Washington Street SE, Olympia, WA
October 8, 1997
Jason Tourtellot
City of Edmonds Planning Dept.
121 5t' Ave. N.
Edmonds, WA 98020
RE: Paul Trombley demolition of existing house and construction of new residence at 18715 8811
Ave. W. address. File #CA-97-191.
Dear Jason,
I have spoken with Rob Michel of Michel Construction concerning Mr. Trombley's property within
650 feet of the Hutt Park #517 bald eagle nest and the desire to demolish an existing cabin and
construct a new residence at the above address. My primary concern was the removal of larger firs
on site. I visited the property on October 8, 1997. Mr. Michel explained that he believed that a total
of 4 trees would need to be removed and marked them on a map. There is 1 fir tree approximately 31
inches diameter at breast height which is located 50 feet from 88 1 Ave W. that should be saved if
possible. If this tree cannot be saved, 1 would ask that 1 douglas fir be planted in an area on the lot
that will not become a danger tree and provide long-term habitat.
Based on the distance and screening between the nest and the proposed activity, I do not believe this
project will have any significant impact to the'eagles or their habitat. It is my understanding that they
would lilke to begin as soon as possible and most of the heavy construction should be completed prior
to the birds returning in early February and therefore no timing restriction or other. conditions will be
requested by my department.
Please call me (425) 379-2301 if you have additional questions.
Sincerely,
Steve Negri
Wildlife Biologist
I mfll�
a 9 9 C�
City of Edmon&
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 developmftt
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,
RECEIVED
SEP 2 9 1997
COMMUNITY SERVICES
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.
NNrith a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for 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 information (e.g. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assiA
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: Applicant Representative:
....... . ....
"� 4, / � �1-0 91,7
Name Name
/Lf 7/�L rJ- -7 71- 11A,
Street Address
City, State, ZIP Phone
Signature Date
Street Address
City, State, ZIP Phone
1 Ak�c"l —G)- ��— P>I-
77 17
Signature Date
� -iq
CA FILE NO.
Critical Areas Checklist
Site Information (soils/topooraphy/hydrology/vegetation)
0 --/
1. Site Address/Location: 12 7 / S-? //
2. Property Tax Account Number: 1--,, cn:j
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes; no.
If ves- ho is site developed? _<
5. Describe the general site topography. Check all that apply.
V"� 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 presiat on site of more than 15% and less than 30% ( a vertical rise
of 10-feet'6ver a horizontal distance of 33 to 66-feet).
Steep: grades oUgreater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please de -scribe):
6. Site, contains areas of year-round standing watex: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway IYO floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow _; shrubs mixed X,
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: A10
For City Staff Use Only
1. Site is' Zoned?
2.: -SCS n-tapped soil type(s)? ENj�;
34:':.: :�Vetland inventory or C.A. map indicates wetland present on site? A16
- ' 4 C ritical Areas inventory or C.A. nmp indicates Critical Area on site?
azard area? //IV
---,..:Site within designated earth subsidence: landslide fi
0--v a 110�04
Water Service Drawing
The City of Edmonds EASEMENT NO . ............................................
NEW CONSTRUCTION 12 REPAIRS r�j LID NO . .................. . ASMT. NO . ..................
PERMIT NO-?�W6�
OWNER .............. Tft.m.aue> ......................................................... CONTRACTOR
LEGAL DESCRIPTION: LOT 1,10 . ...........................
JOB ADDRESS ....... .......... . ........ BLOCK NO . ....................................
....................................................................................................................................................................
NAMEOF ADDITION ..: ....... .............................................................................................................
F-1
4 1
X
70
NFICE: No WARRAMY OF ACCURACy M
e Information shown on the
8Wched map was compiled for use by the City of Edmones, Its enployees
and consultants. The City ot Edm
anything set forth 0 Onds does not warrant thn, pccL,—,.y of
n the map, An
shc.ulld conduct an Independent Inqui Y person or entity requc.,,,,*-,-j, a c-,vpy
rY regarding the Inforilictlen 0, Own on
the Map, Including, but not limited to, the location Of any setrer stub
shovJn, Such seuer stubs May or may not Wdst and may ormz:y not e)d.,t at
the locatiop stCII1,1, Nelh* the City of Edrnond� nor its emplo. 0s or
Officers sh:01 be liable for the infOr"natiOn given on this map, nor for 'a
rsWsc",441, Provided b2zed upon said map an y orr I
PVAV-0001 -11175 (REV. 1 1178)
4
M
00
P%)
I S?715 98-rK A'--VF-.W.
Approved:
D, 'rE .... ? ............. ..........................
. ............
........ .. . .... . .....
NOTICE:
N*o---W'a r-r a niy ... ut
The information shown on the 8ttached
iled for use by the City of
map(s) was cOMP
Edmonds,; its Employees and Consultants.
Th,.e CitY ofEdm.onds does not. warrant the
cy of anything set forth on these
accura
Map(�-). An I y person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform-ation shown on
_�Fe -map(S)l including, but not limited to, -h
th . e location of any sewer stub shown, Suc
sewer stubs may or may* not exist. and may
or may not exist at the location shown.
,-lty of EdmbndS nor its
Neitheir the �'.j r the
ernp'fo-yee-s o-r office-rs -sh-a-11] be Viab-lfe fo
information given on this map(5), nor for
any one representation provided based
upon said map(s).
OCT
IS
:AA
ME
9 1
. KIECORDEP IN
14
9217
517 5465-9217
P: 75
,EE COPEO
i
30
LU
C-
00
HEIGHT CAM
A=328.44
13=329.60
C=330.29
P=332.40
TOTAL=1320.73/4=3,30.18 AVERAGE GRADE
DGE
PLANNING DATA
NAME:--T-r—()" �L I.
SITE ADDRESS: 1187 /5
-DATE: 0 '7
ZONING: PLAN CHK#: 353
PROJECT DESCRIPTION: we-41- SF7�-
CORNERLOT �O -(Yes/No) FLAG LOT- �16 _(Yes/No)
SETBACKS: AG, -A-,
Required Setbacks: 2'..5
Front: 7-5 Left Side: Right Side: 10 Rear: Z-V
Actual Setbacks: q�-
Front: 2-5 Left Side: Right Side: -Rear:—ZX
Street map checked for additional setback required? tor±- _(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED — (Y/N)
LOT COVERAGE: �,s I,
Maximum Allowed: Actual
/Z 7.
B UILDING HEIGHT:
Maximum Allowed: Actual Height:
Datu m Poi nt: M aJ Datum Elevation: �3 19, 7
A.D.U. CREATED?: 1VV
SUBDIVISION:
CRITICAL AREAS #:
SEPA DETERMINATION:
LOT
OTHER:
Plan Review By:
qq-111-
12, o/
cAfiles\pcmit\�plandaLdoc
CA FILE- NO. 9,� -10)
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetafion)
L Site Address/Location: 12,7/s-
2- Property Tax Account Number:
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes; no.
If yes; how is site developed?
5. Describe the general site topography- Check all that apply.
11_�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 pres�nt on site of more than 15 % and less than 30 % ( a vertical rise
of I 0-feet '6'ver a horizontal distance of 33 to 66-feet).
Steep: grades o�ireater 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: AI-49 Approx. Depth:
7. Site contains areas of seasonal standing water: A2 ;Approx. Depth:
What season(s) of the year?
8. Site is in the floodway Mn floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? 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
:1. -...:.Site is' Zoned?
2.: �..SCS inapped soil type(s) 7-8-z
?
3.:':.::*:�-::.WetIand inventory or C.A. map indicates wetland present on
Critical Areas inventory or C. A. map indicates Critical Area on site?
�.Sitd within'designated earth subsidence:- landslide 67Ard area?
6.* 'des ignated on the Environmentally Sensitive Areas Map?.
;DETERUMATION
STUDY REQUIRED . 7�CON D 11TI ON 7ALWA I V ER
WAIVER
tTReviewed by:
Planner Oate
V/ CIO V<,#"
Rcv01AW94
& 9 0 . 1 '9 O� -
City of Edmon&
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 developmftt
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
pre -sent 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,
RECEIVED
SEP 2 9 1997
COMMUNITY SERVICES
and submit it to the City. The City will
review the checklist, make a precursory site
visit, and make a determination of the
subsNuent steps necessary to complete a
development permit application.
Mrith a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for 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 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 Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
'Owner 1,,�pplicant: Applicant Representative:
Name Name
00 '7-1
/,,f 7 //a P-9- ' /01 F- a-.)
Street Address
City, State, ZIP Phone
Signature
Date
Street Address
City, State, ZIP Phone
Al� 177 fftrl A� 17 —0)- ��— P>I-
Signature Date
City of Edmonds
Critical Areas Determination
Applicant: I Rob Michel Determination CA-97-191
Project Name: Permit Number: I
Site Location: 1 18715 88th Ave W. I Property Tax Acct #: 4346-000-016-0106
Project Description:
Determination: Conditional Waiver
Based on a letter that I have received from Steve Negri at the Department of Fish &
Wildlife, I am granting a Conditional Waiver for your project. Apparently, Mr.
Negri has seen your plans and discussed options regarding tree removal and
potential replanting.
I have enclosed the letter sent to myself from Mr. Negri discussing his
recommendations. It is my believe that this letter be used as a reference guide in the
future when considering tree removal.
If you have any questions please contact me at 771-0220.
; si e y
4(�"— f
T
7
J n Tourtellot
J our
ode Enfortcement Specialist
State of Washington
DEPARTMENT OF FISH AND WILDLIFE
Mailing Address: 600 Capitol Way N, Olympia, WA 98501-1091 - (206) 902-2200; TDD (206) 902-2207
Main Office Location: Natural Resources Building, 1111 Washington Street SE, Olympia, WA.
October 8, 1997
Jason Tourtellot
City of Edmonds Planning Dept.
1215" Ave. N.
Edmonds, WA 98020
RE: Paul Trombley demolition of existing house and construction of new residence at 18715 8811
Ave. W. address. File #CA-97-191.
Dear Jason,
I have spoken with Rob Michel of Michel Construction concerning Mr. Trombley's property within
650 feet of the Hutt Park #517 bald eagle nest and the desire to demolish an existing cabin and
construct a new residence at the above address. My primary concern was the removal of larger firs
on site. I visited the property on October 8, 1997. Mr. Michel explained that he believed that a total
of 4 trees would need to be removed and marked them on a map. There is 1 fir tree approximately 31
inches diameter at breast height which is located 50 feet from 88 ` Ave W. that should be saved if
possible. If this tree cannot be saved, I would ask that 1 douglas fir be planted in an area on the lot
that will not become a danger tree and provide long-term habitat.
Based on the distance and screening between the nest and the proposed activity, I do not believe this
project will have any significant impact to the'eagles or their habitat. It is my understanding that they
would like to begin as soon as possible and most of the heavy construction should be completed prior
to the birds returning in early February and therefore no timing restriction or other. conditions will be
requested by my department.
Please call me (425) 379-2301 if you have additional questions.
.Sincerely,
Steve Negri
Wildlife Biologist
CA FILF NO.
Critical Areas Checkfist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: 77/
2. Property Tax Account Number: f CP 0/ 6� 0106
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? yes; 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.
Rolling: slopes on site generally less than 15TG (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes presint 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 o�g'reater 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: ALO Approx. Depth:
7. Site contains areas of seasonal standing water: A/C Approx. Depth:
What season(s) of the year?
8. Site is in the floodway
Q floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year? Y
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
:1. .1-Siteis'Zoned?
2.:: ..-SCS mapped soil type(.;)?. ac� 6,14X 74
...'.."Wetlanid inventory or C-A. map indicates wetland present on site? &�6
�:Critical:Areas inventory or C.A. map indicates Critical Area on site? i
4
-.::...-,SiW within desigmted earth subsidenc6-landslide hazard area? Alc,,
6.'*,'*,:i:.�:�:�*.-Sit�-d�sikhited on the Environmentally Sensitive Areas Map? Alb
:DETERMINATION
STUDY REQUIRED CONDITIONAL WAIVER
WAIVER
Rev'i&��ed by: - :�)A5q.� �Ovv-ur",O-r
Z -3
Planner Oate
RevolffiV94
VC4"
6ii
8 9 0 - 1 '9 1� -
City of Edmon&
Critical.Areas Checklist
RECEIVED
SEP 2 9 1997
COWUNITY SERVICES
The Critical Areas Checklist contained on and submit it to the City. The City will
this form is to be filled out by any person review the checklist, make a precursory site
preparing a Development Permit visit, and make a determination of the
Application for the City of Fdmonds prior subsequent steps necessary to complete a
to his/her submittal of a developmftt development permit application.
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,
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for 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 information (e.g. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assiA
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).
"0 ner �.�pplicant: Applicant Representative:
A"
Name Name
Street Address
City, State, ZIP Phone
Signature Date
Street Address
,e7-- /
, "�r'6,4
City, State, ZIP Pho ne
—C)-
Signature Date
.City of Edmonds
Critical Areas Determination
Applicant: Rob Michel Determination
Project Name: I Permit Number: 1
Site Location: 18715 88th Ave W. Property Tax Acct #:
Project Description:
Determination: Conditional Waiver
Based on a letter that I have received from Steve Negri at the Department of Fish &
Wildlife, I am granting a Conditional Waiver for your project. Apparently, Mr.
Negri has seen your plans and discussed options regarding tree removal and
potential replanting.
I have enclosed the letter sent to myself from Mr. Negri discussing his
recommendations. It is my believe that this letter be used as a reference guide in the
future when considering tree removal.
If you have any questions please contact me at 771-0220.
Si e y
J n Tourtellot
ode Enforcement Specialist
.,,"T AT.
18@9
State of Washington
DEPARTMENT OF FISH AND WILDLIFE
Mailing Address: 600 Capitol Way N, Olympia, WA 98501-1091 - (206) 902-2200; TDD (206) 902-2207
Main Office Location: Natural Resources, Building, 1111 Washington Street SE, Olympia, WA
October 8, 1997
Jason Tourtellot
P
City of Edmonds Planning Dept.
1215" Ave. N.
Edmonds, WA 98020
RE: Paul Trombley demolition of existing house and construction of new residence at 18715 88th
Ave. W. address. File #CA-97-191.
Dear Jason,
I have spoken with Rob Michel of Michel Construction concerning Mr. Trombley's property . within
650 feet of the Hutt Park #517 bald eagle nest and the desire to demolish an existing cabin and
construct a new residence at the above address. My primary concern was the removal of larger firs
on site. I visited the property on October 8, 1997. Mr. Michel explained that he believed that a total
of 4 trees would need to be removed and marked them on a map. There is I fir tree approximately 3 1
inches diameter at breast height which is located 50 feet from 88' Ave W. that should be saved if
possible. If this tree cannot be saved, I would ask that 1 douglas fir be planted in an area on the lot
that will not become a danger tree and provide long-term habitat.
Based on the distance and screening between the nest and the proposed activity, I do not believe this
project will have any significant impact to the* eagles or their habitat. It is my understanding that they
would 'like +to begin as soon as possible and most of the heavy construction should be completed prior
to the birds returning in early February and therefore no timing restriction or other. conditions will be
requested by my department.
Please call me (425) 379-2301 if you have additional questions.
Sincerely,
Steve Neg�ri���
Wildlife Biologist
4,� - (4)
C. IS
CITY OF EDMONDS BARBARA FAHEY
121 STH AVENUE NORTH - EDMONOS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 MAYOR
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning/ Building e Parks and Recreation - Engineering * Wastewater Treatment Plant
October 3, 1997
Rob Michel
8022 212th SW
Edmonds, WA 98026
Dear Mr. Michel:
This letter is in response to the Critical Areas Checklist that you recently submitted
to the Department of Community Services. Your checklist was assigned to file
number CA-97-191.
While ' researching the site address it was determined that the property is located in
a critical area. The site is actually located within 650 feet of a bald eagle's nest,
which is considered protected eagle habitat. Because of the relationship of your site
to this critical area, all projects must be evaluated by the Department of Fish &
Wildlife to prevent damage to the eagle's habitat.
Currently, the determination given for your checklist is that a study will be
required. However, if you submit either a completed SEPA Checklist, a habitat
management plan, or a letter from the Department of fish & Wildlife stating that
the proposed project will not impact the critical area of concern, then your project
will be conditionally waived.
Your contact at the Department of Fish & Wildlife is:
Steve Negri
16018 Mill Creek Blvd.
Mill Creek, WA 98012
(425) 379-2301
If you have any further,questions please contact myself at 771-0220.
;Sincerely, 7v��
son Tourtellot
Code Enforcement Specialist
0 Incorporated August 11, 1890 9
Sister Cities International — Hekinan, Japan
T7 :-T 'F�-
it? C. lsok)
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number.
Wue Date:
A. Address'or Vicinity of Construction: -r2;:
B. Type of Work (be specific): 23 , /,, �- IX-4 u) et
C. Contractor: 42 2f,�ZL'Ad-4V-4 Contact:
17
Mailing Address: 6 Phone:
State License #: Liability Insurance:
D. Building Permit # (if applicable):
E. n Commercial E] Subdivision
Multi -Family Ej Single Family
INSPECTOR:
F. Pavement or Concrete Cut: [I Yes [IN
A D1D1
Side Sewer Permit # (if
E:1 City Project YUtility
E] Other /
,, GTE, WNG, CABLE, WATER)
WOO, V9�
G. Size/of Cvtf x 14. Chargq�,$
XND SIGN
INDEMNITY- Applicant understands and by his signature
a P)fcatiolto hold the City of Edmonds harmless�rom injuries, damages, or claims ofany
Pp
0 r
kind'or description whatsoever, foreseen or u nffo seen
7 r se n
, t mly be madeagainst the City -of Edmonds,,,.or any qf i(s,deptirtments or
6
employees,ineluding or not'limitedto -the-defense
q any e proce Ings- includink defense costs and allorheyfies by reason of granting this permit.
pr
n g�Re
y eg oc�
I
THE CONTRACTOR IS RESPONSIBLE FO WO
elothn'
M. NSHIP
D MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
I
TION AND ACCEPTANCE OF THE WORK STI TEDRE ORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEB�, 0 CREDI T ILL
L BE PROCESSED FOR ISSUANCE TO THE APPLICANT
i
Two sets of construction drayvi�"gdof pro osed work required with permit application.
A 24 hour notic is requir d for inspeco?n, Please call the Engineering Division, 771-0220.
Work and malctial is to bx-rispected/during progress and at completion.
Restoration is Jo be *' apor d �Emceyith City Codes.
Street shall be kdri at all ti e,
s
Traffic Control and'LElic Sa I ty s,�all be in accordance with City regulations as required by the City Engineer.
ept C �'
Allsti�eetcut.tr nc�hworksh Ebe patched with asphalt or City approved material prior to the end of the working day;
'S
NO EXCEPTIO, S
I have read the above 11atements and understand the permit requirements and the pink copy of the permit will be
avadable on site at a�l timesfor inspection purposes.
Signature:
Date:
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY FEE: 0
AUTHORIZED: VOID AFTER 1-76AYS DISRUPTION FEEIFUND I 11:
SPECIAL CONDITIONS: RESTORATION FEE:
TOTAL, -FEE:
R ECEI PT NO.:. /9
ISSUED BY.:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Di� 1997
FIELD INSPECTION NOTES
I Comments:
I Diagram.:
f
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION .'El YES El NO
Parti al Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
CITY OF EDMONDS
PUBAT WORKS DEPARTMENTj ENGINEM, NG DIVISION
STREE7 FILECATION FOR RIGHT-OF-IJAY CONSTRUCTION PERMIT
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
A.* Permit to be issue,d t o: L) Al 1r R C', rn o17 C1
V - �� S C& kv e,.,-
For . Work at :(address or vicinity) )60' /4 vrl
Type of Work to be done: ell
(attach drawing when applicable)
Time Required -- Start: & -Finish:
Owner: Re C 0,1 i,� -17EAo'd2 h, -I'S e I
Name
'2 Q 17
Mailin2 Address
Q 0,S
A 9 7
City State Zip Telephone Number
Contractor: Z.4',rl � ;,,2 IJ Se 1,11/
Name State,License Number
s - *-
Mailing Address
k D e- r Wa r \IV A gO 36 /2 441 2) ROO'
City State Zip Telephone Number
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 no.tice is required for inspection by Engineering'. Call 775-2525, ext. 220.
I understand that this permit must be available at the jo site for inspection
purposes at all times.
Signature at t e
%w,n e e or ��e A
TO BE COMPLETED BY ISSUING AGENCY:
Date Issued:- /::�7 Permit No. Fee:
Security Bond:), -
Time Authorized:
APPROVED BY
1 n 1 -7 1 . . / n - . . . I *,
D a t e : &g�w ?2
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