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T he City of EdLoIPO
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS
0 -75 Q 0
..... ....... ........ .... .......... .. ....
OWNER . -dqs . C ........ 3 . liv-S .. 0 ./V ...................................
ADDRESS ...........
. ... ... .. ... .... ... .. .... .... ... ... ...
.. LYNN PLANT
A,SEMENT No . ..........................................
CONTRACTOR
.................................................... PERMIT No.
LEGAL DESCRIPTION: LOT No . ............................................. BLOCK No . ......................................
NAME OF ADDITION ./V4?4'.C1t-'$00P ........
....................................................................
CITY OF EDMONDS
Can PRospect 6-1107 when work
CIVIC CENTER — WATER —SEWER DEPARTMENT Is ready for Inspection. (No inspec- N2 1621
tIon8 Saturday, Sunday or holidays.)
SIDE SEWER PERMIT
ADDRESS.............. ... 8Qth ... Place ... W.est ...........................................................................................................................
CONTp
oWNER ........... -..Lejslle ... R.-Robiman .............................. ACTOR ...... !?ne.r ............................................................
Permission is granted ..February .. 14 ............... 19167, for ...................... days, to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordin nces.
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 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.
2E 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 ap-
purten&nces except to insert the pipe into the wye.
'f- I
i, P , , -tovED
FLU 1�*. 1067
Approved:
8.,
DATE.1 ............... y .. ..... ....... By ... j ....... .............................
MW
fill
FILE'
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EC E"
CITY OF EDMONDI,, "SIDE, SEWER PERMIT
15 `1993
8 9 0 1 9 c�', PUBLIC WORKS DEPI PERMIT JN2 8 523
Address of Construction:
7-
Property Legal Description (Include all easements): LOT 0"P L S�>exnrp &ALr.�
Owner and/or Contractor:
State License No. Building Permit NO.
O—Single Family
13 Multi -Family (No. of Units—)
El Commercial
El Public
Invasion into City Ri�ht-of-Way: 2"No E] Yes
RW Construction Permit No.
Cross other Private Property: ErNo 0 Yes
Attac),legal description and copy of recorded easement
— 7�4_� -- -
Y(ify'that I have read and shall comply with all city requirements
nclicated on the back of the Permit Card.
N6 V
Date
* CALL DIAL —A —DIG (1-800-424-5555) BEFORE ANY EXCAVATION *
OFFICE USE`bNLY
* FOR INSPECTION
;�O. C) 0 'U. all
Permit Fee:
Trunk Charge.
Assessment Fee:
Lid No.:
Partial Inspection:
Comments
"A PUBLIC WORKS DEPT.
Issued By
Date Issued:
Receipt No.:.
Date —,Initial
Reason Rejected: Date —Initial
Final Inspection Approved: Date'2-__11_-07 Initi6ff
PERMIT MUST BE POSTED ON JOB SITE
White Copy: File Green Copy: Inspector Buff Copy: Applicant Revised 3/90
The City of Edmonds Side Sewer Drawing EASEMENT NO - ------------- ------------------------------- �l
I
NEW CONSTRUCTION E] REPAIRS E�-' LID NO . .................. ASMT. NO - ------------------ -
OWNER------------------------------------------------------------------------------------------------ CONTRACTOR ------------------------------------------------------------------------------------ PERMIT NO.
........ Vf ----------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
JOB ADDRESS --- 1-9-ILL-9 ------ .......
3
I
PWW-0001-11/75 (REV.11/78)
?o
NAMEOF ADDITION ------------------------------------------------------ ------------ ---------------------------------------------------
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Approved:
DATE --- ----- 4..
NOTICE:
No warranty of accuracy.
The information on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of �Edmoncls does not warrant the
accuracy of anything set forth on these
Map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
tf�e -map(s), including, but not limited to,
th . e loc'ation of any sewer stub shown. Such
sewer stubs may or may, not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
emp-l-o-yee-s o-r officerS shall be 11-abile for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
(IS
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city if
VTGUT-OF-WAY
9 0 C�
CONSTRUCTION.
ITPermit.Number:
H,
Wue Date:
A. ,Addre�s,'p'r1' Vicinity of Construction: I 9(S 1 -3 iB(��5 Pl—
B. Type of Work (be specific): I p% I sT r-) t—c, (2) KI oT-) pr n K \ S CZ e)J 10 F_ A T
Z. 00 S —I S L,
C. �Conttactor: \&[1ASkA I K� cTc�, v,3 �P)TuQ A t 4(n A -p Contact: C o KA K-\ I P A y en
,#F
Mailing Address' P, (0 '250Y- 16 4,9 Phone: _S_7_1 SZ-9 a
State License #: Liability Insurance: Bond: $
D. Building Pern-tit # (if applicable):
Side Sewer Permit # (if applicable):
E. El Commercial Subdivision EJ City Project E] Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family Single Family Other
INSPECTOR: INSPECTOR:
F.. Pavement or Concrete Cut Yes [A No G. Size of Cut: x H. Chargq�_$
-SIGN
4 -APPLICANT TO READ AND
'UNDEMNITY: Applicant understands and by his signature to this application, agrees&--th. City ofEdmonds haZ�s i Amages, or
it eparimentR or
4.01
of any kind or description whatsoever, fo�eseen or unforeseen, that may bc� i against the City of Ed o:ffy C'�'t
t Xtpl4ees, including or not limited to the defense a
f any legal proceedings including defense costs, and attorney fees by reason ofgranting this permit.
YEAR FOLLOWIA THE FINAL
THE�CQNTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND,MATERIALSJ�'OR �A PERIOD OF ONE
JNSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
-THil P ICANT.
Ise TO A P/'
OMPLETED B YCIT YFORCES, A T WHICH TIME A DEBI T OR CRE DIT WILL BE PROCESSED FOR ISS L TA NCF
Construction drawing of proposed work required with permit application.
11 1
'de is required for inspection; Please call the -Engineering Division, 771-0220.
A 24�hour noti
Work"and material is to be inspected "dunng progress and at completion.
Restoration is to be in accordance wiih City Codes.
Street s,911 be kept clean at All times'
TraffibControl and Public Safety shdll be in accordance with City regulations as required by the City Engineer.
d' ith asphalt or City approved material priorto the end of the working dayi,
All s�r6et C*ut ditches shall be patche w,1
NO EXCEPTIONS,
Ihave read the abovestaternents and4'nderstandthepermit requirements andthepink copyof thepermit willbe
available on site at all times inspection purposes..
Signature: Date: I — 7-7 -q
V":A�
IMV'ralctor or 4FN77
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund 111 Route copy to Street Dept.)
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
ROUTE & FILE
Ndura'Gas
AWWV)gton E—W C-Y-N
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted Connie Carbon
Field Representative
Washington Natural Gas
521-5264
IBLAC-Y,TOT�
C4
— C-A I
rqlA, water main depth
unknown
z It gas main
.. 0 Nd
F�co -ST SLA-.>
Key:
-w- water
-9- gas
-ss- sewer
-0- water hydrant
0 water valve
WNG 928.1 S (12/83)
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CA FILE NO. 3-
e
critical . Areas Checklist
Site Information (soils/topography/hydrology/vegetafion)
1. Site Address/Location: I S1)Ma"-c,% —
2. Property Tax Account'Number: �500;3_ Coco 1 (0-00
3. Approximate Site Size (acres or square k5 A c- Pm
4. 1 s this site currently developed? X yes; no.
If yes;. how is site developed? gm-L- Tnunu_tj�m A,.PuA,-r b R V-,w*q
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: ___;Approx. Depth:.
7. Site contains areas of seasonal standing water: Allr* Approx. Depth:.
What season(s) of the year?
8. Site, is in the floodway floodplain of.a water course.
9. Site contains a I creek or an area where water flows across the grounds surface? Flows are year-
round? M/Al Flows are seasonal? (What time of year?
10. Site is primarily: forested. meadow ;shrubs
;mixed
urban landscaped (lawn,shrubi etc)
11. Obvious wetland is present on site:
F__ City Staff Use- Only
1. Site is Zoned?
2 SCS mapped soil type(s)?
3. Weiland inventory orC.A. map indicates wetland present on site?
4. Critical Areas inventory or C.A. map indicates Critical Area on site?
5.
S ite within designated earth subsidence landslide hazard area?
6. Site designated on the. Environmentally Sensitive Areas Map?
DETERMWATION
STUDY REQUIRED
_t/
,.�WAIVER
Reviewed by;
Planner \Ij
Rev WN/93
&90 .199-
City of E&mon&
Critical Areas Checklist
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 Edmonds prior subsequent steps necessary to complete a
to his/her submittal of a development 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 pertment 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 / Applicant:
1-MIL-kk
Name
Street Address
.4tfy,c�--,
City, State, ZIP Phone
10 -2-&-7-2
ignature Date
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
Signature Date
PLANNING DATA
NAME:
SITE ADDRESS: DATE:
ZONING: PLAN CHK#:
PROJECT DESCRIPTION:
CORNER LOT___,A(O—(Yes/No) FLAG LOT lVeP —(Yes/No)
SETBACKS:
Required Setbacks -
Front: Left Side: **'7 Y,7� Right Side: '7/��ear: 5
Actual Setbacls-
Front: Left Side: Right Side: Rear:
Street map checked for additional setback required? (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED � (Y/N)
LOT COVERAGE: 90
Maximum Allowed:_'�2�10A?_IVO Actual:.Zq/ E5
BUILDING HEIGHT:
Maximum Allowed: 15"//n',7�Actual
Datum Point:�f� �!E' VVA�,Datum
A.D.U. CREATED?:
/V52
SUBDIVISION:
CRITICAL AREAS #: 1q,37 — 12_� / WA /
SEPA DETERMINATION:
LOT AREA:
OTHER:
Plan Review By:
Height: 1143
Elevationr4- 100 "'
,20qz1.S-
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AP?190VFED
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PLANNING \1 k G
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lli��J.M BY
�EET FILE
,je
s-�
RECEIVED
OCT 2 3 2000
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
lee-156619
'71777 ,,,71�
Fr
A
'bATE RECEIVED
-v-F
PERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
QWK�R NAM9/NAME OF BUSINESS
t> c e. I
MAILING -ADDRESS
+k
CITY ZIP TELEPHONE
Eb ryl 0 a-b C. 9tz& 1.4),Z5 -77K-�XC
NAME
ADDRESS
CITY
NAME
ADDRESS
CITY
STATE LICENSE
ZIP I TELEPHONE
USE
ZONE PERMIT
NUMB
J013
ADDRESS SU!TE/APT#
PLAT NAM E/,tU'BDIVI SION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCIP Approved
RW Per% Required
0
[3
EXISTING - PROPOSED-
Street U Permit Req'd
Inspection Required
0
0
Sidewalk Required
0
REQUIRED DEDICATION:'— FT
Underground
Wiring required
0
METER SIZE.
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YES 0 N
REMARKS
W
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
z
z
lu
ENGINEERING RE E ED D T
FIRE REVIEWED BY DATE
P TELEPHONE I T_.
ELINE OR ADB# BOND
VARIANCE OR CU SHOR INSPECTION
NUMBER. EXfIRATIONPATE CHECKED BY REO;Q POSTED
YES Jb�AO
SEPA REVIEW SIGN AREA HEIaHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT
ALLOWED
PROPOSED
ALLOWED/
'�?
PROPOSED
1 157-75
LU
_j
150(o -3 1(�n 00
EXP
5
1=2.
NEW RESIDENTIAL
0 PLUMBING MECH
ALL LOT COVERAGE SED
OWED PROPO
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT UR SIDE A
. COMPLIANCE OR
-7-
_7 15
z
z
COMME FICIAL
Q&.,�PDITION CHANGE OF USE
PARKING
LOT AREA
PLANNING REVIEWED BY
R EMODEL C] AlPARTMENT SIGN
REO'D PROVIDED
gi� C:] FENCE
REPAIR 1496 GRADI
CYDS X FT)
REMARKS
DEMOLISH TANK 0 OTHER
4
(3 GARAGE C] RETAINING WALL RENEWAL
z
CARPORT ROCKEWt_
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECKEDBY RUCTI" CIE OCCUPAk
AMT I N
GROUP
JTYPEOFGQNST.,
w
a
NUMBER
OF
NUMBER OF.
DWELLING 14J11A
CR ITICAL
AREAS
SPECIAL INSPECTOR
AREA OCCUPANT
'o
STORIES
UNITS
NUMBER
REQUIRED
LOAD
DEABIQE_VORK TO BE DO
'5. C Jr. J<
0
REMARKS z
To
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION FiEQ'D 6
2 -A I rn
mr- m
n)1-)a_1
%D01"hic'M 1_0 BACK OF BAS& T" N b
I of 10 4. Al Ala k 14W
VALUATION FEE
PLAN CHECK FEE
H . EAT SOURCE GQZING % LOT SLOPE %
L
BUILDING
NIA
PLAN CHECK NO: VESTED DATE
PLUMBING
MECHA NICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
PERMISSION.
SEPARATE
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
W
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF OINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
w IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANOSeA'PTMG
_j
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
INSPECT40N FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISI N G DIRECTLY OR INDIRECTLY
ISSUANCE OF THIS PERMIT SHALL NOT BE
/ RECEIPT
CHECK DEPOSIT
x FROM THE ISSUANCE OF THIS PERMIT.
a DEEMED TO MODIFY, WAIVE OR REDUCISANY REQUIREMENT OF ANY CITY ORDINANCE
PLAN
_j WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
0 NORLIMITINANY
RE T
CX9,T I
TOTALAMOUNTDUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL'
by
GIVEN
THE OWNE R. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a,parmil until.signed the
Building Official or his/her Deputy. and Fees are paid. and
TION; AND�IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATiON OF THE LABOR CODE OF THE STATE,OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
D;ATE SIGNE6.�
(425)
QFF/(�IALS SIGNATURE DAiE
SIG OR AQErjT)
!!N�AT?UE(J�O�W 0
77.1-0220
I.RrLEASED
Y
'ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING -OR STRUCTURE UNTIL
771-0221
:L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL 64A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANdY HAS BEEN'GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD - ASSESSOR