19008 78TH PL W.PDF111111111111
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19008 78TH PL W
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94
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��173Y Date
Z90109 Address
Street Right -of -Way Existing REQD
Access Easements Existing REQD
Utility Easement Existing L�10 REQD
Lot per Subdivision Plat >�O Assessor Map.
Site Plan Checked for Accuracy A Z re
Underground Wiring Reqd.
Check Accuracy of Legal Description 0 e
En.virortmentally Sensitive Area U0
Environmental Checklist Re
Flood Hazard Zone
00
Shoreline Managen�ent Area LXD
Slope. Soil, Vegetation A
Stream, Creek, Drainage Basin
Existing Zoning Per Code
Amenities Design Board Approval Reqd., -ADB # Approval
Board of Adjustment Approval Reqd. 7
Review By:
I Date:
Existing Water Ma� Size
Water Main Reqd.
Service Line Reqd.
Hydrant Size Existing -
Hydrant Reqd. Per Fire Code
Detector Check Meter
Cross Conn-ection Inspection
Fire DeLpartrnent C=Tneilts
Water Meter Charge Reqd.
Review by:
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Inin-IIIIII-M �
ENGINEER!NG DIV.
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--,ept:ic i'aiv< Lk -sign i�pproveci
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Septic Tank Permit Reqd.
Sanitary Sewer Availability
Drawing No.
Side Sewer Availability
W Sanitary Sewer Connection Fee Req
Review By:
1%`PE!fiJji:V MS KLQUJi�ED
1-FOUNDATION'
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W -fiffle SgORVICE
FIRE PROTEi�-
DRAINAGE
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Open Ditch Existing
Dilvert Reqd.
Catch Basin Reqd.
Shoulder drainai,c miintahi collection
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Req d.
'Size
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W,7
le open runoff;
�wdiole rcqd.
Indicate on Site Plan
Soil Conditions. and Grouild'War-er Field
Checked
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Street Paving Reqd.
Curb and Cutter Reqd.
Sidewalk Rcqd.
Cilrb Cut' for Driveway qqd.
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Rio -it -of -Way Construction Permit R qd.
Bond Reqd. for Public Ir�provcTw/ns
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Street Nam, Sign Reqd.
Ocher SiViinc.1, Rcqd.
Pre P.ermit Site Inspection r-L on
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STREET
ENGINTEEPJNcG
Special RcqLLirc,.,wnt:s lisied -in mom to' Comn-mity Doveloprwnt Deparumnt,
BLLilding Division
By Da te
-o All iturs filled in on Building Permit Application
BY Date
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Di:awirq;s SLaiined and.Uot.ations ILide
BY `)afte
JI'Approved 1by rl�-u�lblic lv�orks Dej).irtiTKnt:
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CITY OF EDMONDS LARRY S. NAUGHTEN
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-3202 MAYOR
COMMUNITY SERVICES: PETER E. HAHN
Public Works e Planning * Parks and Recreation e Engineering DIRECTOR
STREET FILE
August 14, 1991
David L. Bruggman
19008 - 78th Pl. W.
Edmonds, WA 98026
Dear Mr. Bruggman:
I have reviewed your account and will allow a credit to your account
according to our City policy: the average consumption for the same
period during the previous year charged at normal customer rates, plus
the excess usage charged at the City's cost, plus a surcharge of 15%
applied to the excess only. Only one leak credit will be granted in
any three year period.
Should you have any additional questions, please contact Ilene Larson,
Utility Billing Clerk.
Sincerely,
Ron Holland
Water/Sewer Supervisor
BM/l k
cc: Ilene Larson
Utility Billing Clerk
#329400/TXTWATER
Incorporated August 11, 1890 0
If
RECEIVED
NOV 0 5 1991
PUBLIC WORKS DEPT,
.0 c tober 30, 1991
Ron Holland
City of Edmonds
Edmonds Combined Utility
Dear Sir:
I spoke with you. earlier this summer, concerning a water
leak in my water system. The leak had been isolated and found to
be In the main line from the street meter to the house.
The needed repairs were made and a new main line was
installed and rerouted to the house at a cost of approximately
thirty five dollars ($3S.00).
Due to the leak in the main line our water bill was higher
than our normal statement for that same period of time.
We were hoping you could evaluate this and if possible make
some adjustment In our bill.
Thank you
avid L Bruggma
19008 78th Place West
Edmonds, Wa. 98026
APPLICATION
for
SIDE SEWER FERNaT
The City of Edmonds
EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS 0
CONTRACTOR .................................................................................................. PERMIT No.
OWNER ---- j&4dy.q.&.ag . .....................................................................
ADDRESS ... I-Yoo-z — ------- // ................... e .... k/n ................. LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
Is
NAME OF ADDITION .............................................................................
Approved:
DATE................................................ By ......................................................................
P "
Y'0U ETf I L E
6
RECIMMING: 19008 - 78th Place -00/00
�aadressj
R E C 0 R D 0 F C 0 N T A C T S
DATE NAME, PHONE NO., & COMM3ffS .
ADDRESS of CALLER
5/l/74 David Bruggman Certified Letter No. 406271 sent
requiring hook-up within 60 days.
5/10/74 Please dye test 5/13.
5/13/74 Dye test has not been completed yet.
5/14/74 D.T.0.S
6/5/74 Certified Letter No. 406480 sent
rescinding previous letter.
� Is
ACTION TAKEN
Letter received.
Letter received.
INITIALS
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RECEIPT
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RECEIPT FOR CER MA
412-00100 11-30
(Pfffs;.-AQstag
BP,UGGMAN,
I gi DAVID L.
78T�j PLACE APR ATE\
EDMONDS,
wASHINGTON S(y I
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RETURN Nil Cu�� FOI?
1. Sh ol
RECEfpT olys IL FEES
SERVICES 2. she With I 11: 1
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DELIVER To with d'e 1 i ate and here delivere"
_�P_F_cl DE R SEE ONLY to 2ddressee only . ... 3 0
PS For RY (eXtra fee .......................... ........ 5d
req re ......... .. ..... sod
Alar. 197, 3800 NO INSURANCE COVERAG - E ............ .........
Nor FOR IN 011
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RECEIPT FO
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CA File No. M,4 2co-700%
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/vegetafion)
1.. Site Address/ Location: (9 00 6 '7 Picce WesT EdVlAoods OWA q &0
2. Property TaxAccount Number� b - 60 97 a 01 Cc—, 00 1
3. Approximate Site Size (acres or square feet): I �T 1
U
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 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:
7. Site contains areas of seasonal standing water:
What season(s) of the year?
; Approx. Depth:
; Approx. Depth:
8. . Site is in the floodway — 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. Plan Check Number, if applicable?
2. Site is Zonec ks -s
I SCS mapped soil type(s)? SL-141kW-06d W CTA �wc( st��ekx_L2-YX s-leae-)
4. Critical Areas inventory or C.A. map indicates Critical Area on site?
5. Site within designated earth subsidence landslide hazard area?
DETERMINATION
STUDY REQUIRED WIVAIVER.
Reviewed by- Date: 7� ? bAl
#P20
City of Edmonds
Development Services Department
Planm*ng Division
Phone: 425.771.0220
Fax: 425.771.0221
The Critical Areas Checklist contained on this form is to
be filled out by any person preparing a Development
Permit Applicationfor the City of Edmonds prior to
his/her submittal of the application to the City.
The purpose of the Checklist is to enable Cit . y 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 Hill (Critical areas inventories, maps, or soil
surveys).
DateReceived:
City Receipt#: 4
Critical Areas File C P A ? op-7 o o%
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant:
A property owner, or his/her authorized 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 assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/ber/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City.of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false,* misleading, inaccurate or
incomplete information famished by the applicant, histher/its agents or employees.
By my signature, I cer* that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized%o file this application on the behalf of the owner as listed below.
-7
SIGNATURE oF APPLicANT/AGENT mTE (o a00
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for.the public officials and the staff of the City of Edmonds to enter the subject property forthe
purposes of inspection an�,posting attendant to this application.
SIGNATURE Of OWNER DATE
PLEASE PRINT CLEARLY
Owner/Appficant:
7D�- c A 2a �Q
Name J,--J
i9b(98 P\ac-e-We�;T
Street Address
,E6\J\"\00AS � q� C)
city I State Zip
Telephone:
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email address (optional): - Email Address (optional):
CY 9 0 9
City of Edmonds.
RIGHT-OF-WAY CONSTRUCTION
I NU: PERMIT Permit Number:
Issue Date: 7 -3
A. Address or Vicinity of Construction:
19008 78 Place West
ri
B. Type of Work (be specific): Ins t 1k " PE, IP Main in 78 Pl. W " f rom 103 1 N
to 330114 c/l 191 Pl. SW Per Attached Drawing:920-739 (IR #6043-3) (1)
C. Contractor: Wash.. Nat'.1. Gas Co. Contact: Frank Swan
M-;];- Address: 815 Mort -or Qt �0-2=ttja Wn Phone: 224-2278
State License #: 98111
D. Building Permit # (if applicable):
Liability Insurance: Bond: $
Side Sewer Permit # (if appli6able):
E. '-E] Commercial El SuAdivision El City Project KX Utility (PUD, GTE, AING, CABLE, WATER)
F] Multi-Farnily Q Single Family Other
INSPECTOR: INSPECTOR:
F. Pavement or Concre-te-1CUr--'-XP4Yes E]No(2)-G. sizeofcut: 2' x . 4' H. Charize $
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant under -stands and by his signature to this application, agrees to hold the City of Edmonds harmlessftom injuries, damages, or
claims of any Aind or description whatsoever, foreseen or unforeen, that may be made against the City of Edmonds, o r any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings includ�i�n 'e ns�
,fe ecqsts and aitomeyfees by reason. of granting !his,Rermit.
F OR A PERIOD
R
THE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP A ArD MA � �RlAt OF OAE Y , R)70 , 0 NG E FINAL INSPEC77ON
AAE) ACCEPTANCE OF THE WORK ES77MA TED RESTORA77ON FEES WILL BE ki 41,A19-74 THE FINAL S7REET1A"AH1P.C'91tPLETED BY
CITYFORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. ,
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Departxn�
Work is to be inspected during progress and at completion. 771-0220
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 regulptions as required by the City Engineer,.
All street cut ditches shall be patched with asphalt or City approved ma&iAl prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the nut requirements and the pink copy of the permit will be available
OP site at all timesfor inspection purposes.
Signature: Date: July 7, 1992
(Contractor or Agent) ,
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
::APPROVED: BY RIGHT. OF.ff
A
10 DAYS, ... DISRUPTION I
TUAE,-AUTHORIZED:.:-VO.ID AFTER::
SPECIAL.CONDITIONS:, RESTORATION
TOTAL
DATE: .:...:.ISSUED BY:
NO WORK SHALL BEGIN PRI
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Ekppt�)
Comments:
I Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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1.) FIELD LOCATE ALL UTILITIES
CALL 1-800-424-5555
48 HOURS BEFORE DIGGING
2.) LAY DETECT WARNING WIRE OVER ALL
DIRECT BURIAL PE PIPE -
3.) INSTALL ONE POUND ANODE FOR
EVERY 100OF OF LOCATING WIRE
4.) SURVEY NOT REQUIRED
5.) MAINTAIN A 5f HORIZONTAL AND
3f VERTICAL CLEARANCE FROM ALL
CITY UTILITIES
6.) OPEN CUTS ARE SHOWN AS
21X 41 HOLE TYPICAL)
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