19009 92ND AVE W.PDFiiiiiiii lill
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19009 92ND AVE W
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Clity 61f.Edmonds
RIGHT-OF-WAY"CONSTRUCTION
PERMIT PermitNumber.
Wue Date:
A. Address or Vicinity of Construction:— 19009 92 AV W (9620143)
B. Type of Work (be specific): Install service
C. Contractor: -Washington Natural Gas
Mailing Address: 1122 75 St SW Everett
State License #: 98203
Contact: Mariamne Kingsbury
Phone: 356-7500 ext 7596
Liability Insurance: _ Bond: $
D. Building Permit # (if applicable): !y Side Sewer Permit # (if applicable):
E. E] Commercial E] Subdivision El City Project []g Utility (PUD, GTE, WNG, CABLE, WATER)
F] Multi -Family E] Single Family I n Other
INSPECTOR: I INSPECTOR- i
F. Pavement or Concrete Cut laYes 0No G. Size of Cut: 1-111"x H. Chargq�_$
cut
APPLICANT TO READ A4GN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from irduries, 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 or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR 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 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 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.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
110
available on site at all times for inspec n purposes.
Signature: Date: 9-11-96
ntrac'(t�r o_�_Ageht)
CICO
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER M 02 I-L DAYS
SPECIAL CONDITIONS: b) &
DISRUPTION FEE/FUND III:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE: )'00
COMMEN, RECEIPT FEE:
DATE: ISSUED BY -
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
El YES
Date:
Date:
El NO
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Addendum to: City of Edmonds
Right of Way
Pernit,Application,
Submitted by: Marianne Kingsbury,
Engineering Aide
Washington Natural Gas
1356-7500 X7596
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Key:
-w- Water
-G- Gas
-SS- Sever
-& Water hydrant
0 Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331
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Addendum to: City of Edmonds
Right of Vey
Pernit,Application.
Submitted by: Marianne Kingsbury.
Engineering Aide
VwhLugton Natural Gas
8356-7500 X7596
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Key:
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Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331
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CITYaTWS49
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning o Parks and Recreation * Engineering
LETTER OF TRANSMITTAL
Date: June 5, 1992
To: Todd Barrow
19009 92nd Ave. W.
Edmonds WA 98020
Subject: Critical Areas Checklist
Transmitting:
For your information:
As you requested:
For your file:
Comment and retum:
Note attachments:
Comments:
Planning Division
LAURA M. HALL
MAYOR
PETER E. HAHN
DIRECTOR
nianto CiinninqhaW, Secretary Planning —Div.
Incorporated AU9USt 11. 1890 0
Sister Cities International — Hekinan, Japan
11
890-194-
City of Edmonds
Critical Areas Checklist.
'Me Critical Ann ChwMist contained on
this form -is to b� filled out by any person
preparing a Development Permit.
Application for the City of Edmonds prior
to his/her submittal of a developmcntpermit
to the City�
Ile purpose of the Checklist is to enable
City staff to determine whether any potential
Critical Areas am or may be present on the
subject property. no information needed. to
complete the Checklist should be easily
available fi-om observations of the site or
data available at City Hall (Critical Areas
Hs
inventories, maps, or soi urveys).
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,44
the checidist, 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 ihe best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name
Title
�%()k (3\.1'A
Stre;t Address
City State ZIP Phone
Signiture Date
Applicant Representative:
Name
Title
Street Address
City, State, ZIP Phone
Signature . Date
STREET FILE
Critical Areas Checklist
Site Information
Project Name-, NS,,,oj Permit Number:
Site Location: \Rook 10�1�k Xi 40 �kx, Property Tax Account Number. '�4
Approximate Site Size (acres or square feet): Wo t \1�_ ' �)_��00 ��
Have you filled out a Critical Areas Checklist for a project on this site before?
General Site Conditions 11� J - Date of most recent action:
1. Has the site been cleared or logged?
Soils / Topography
Mck
Ile UIC00cX1 Q 1(
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.
X, _Xolling- slopes on site generally less than 15% (a vertical.rise of 10 feet over a
horizontal distance of 66 feet.)
_.�Iilly. slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10 feet of horizontal distance.)
Steep: grades of greater than 30% present on site.
Comments
Hydrology/Vegetation
4. Site contains areas of year-round standing water:
5, Site contains areas of seasonal standing water: �NQ Approx. Depth:
6. Site is in the floodway I floodplain of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? flows
are year-round? Flows are seasonal?
8. Site is primarily: forested meadow shrubs ;mixed El-W
9. Obvious wetland is present on site: V\b
10. Wetland inventory or map indicates wetland present on site:
11. Critical Areas inventory or map indicates any Critical Area on site:
For City Use Only
Rey W27/92
APPLICATION
for
The City of Edmonds L-160 SIDE SEWER PER3M
5REET F NEW CONSTRUCTION P-O' REPAIRS
rraXaAENT PtAwr
EASEMENT No . ...........................
OWNER JXUALtHt .... �.'e.j ..... ;t..049�m ...... ....................... CONTRACTOR ....... Q�PRER . ..................................................................... PER]WIT No..-
rDROM ................ .................
13.0.0 .. .................... ........ Wast ---- FlAio.ADS .... LEGAL DESCRIPTION: LOT N . . ...... 2C ...... Rr-,OCK No . ............................................
i NA31E OF ADDITION --- ....... 8u"w ... ................... . ............
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APPROVED
FEB 2 0 1970
.A-pproved:
...........
. . . .........
OJC.
NOTICE:
n
CI]C-U.r.7
o r--a-. _. a7U.y
The -information on the attached
map(s) was compiled for use by the City Of
Edmonds/ its Employees and Consultants.
Th,.e City ofEdm.onds does. not. warrant the
n these
accuracy of anything set for ' th o . '
map(�). An . y person or entity -requesting a
copy should c:onduct an independent
inquiry regarding the inform-ation shown or
ffi-�� -rnap(s), Including, but not limited to -1
n of any sewer stub shown. Suc
the loi:atio
exist and may
sewer stubs may or may
or may not exist at the location shown.
Neither the city of Edmo'nds nor it5
empl-o-yee-s o-r offi-ce-rs -sh-a-1-1 be 11a-b-]Le for the
Information given on this map(5), nor for
ovided based
any one representation pr
upon*said map(s).
CITY OF EDMONDS
Call PRospect 6-1107 when work
CIVIC CENTER— WATER —SEWER DEPARTMENT is ready for Inspection. (No inspec-
SIDESEWER PERMIT tions Saturday, Sundaq or holidays.) N2 3577
ADDRESS --------------- 19-QQ9 --- !n ... 92ad..Avenue --- We.s.t ......................................... . .............................................................................
OWNER ................... Kenneth C. Linds owner
----------------------------------------- V .......................... CONTRACTOR ....................... ........................................................
Permission is granted ........... 1: 9 b 2Q_., 19.79 ... for ------------------------ days to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE,No. I —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 Bide 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 bend; in grade sharper than % will be permitted.
NOTE No. 4—Trenches intstreet must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due o improper work which may develop within one year of completion.
Nr 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.
STR7L-ET FILE
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