20212 84TH PL W.PDF111111111111
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20212 84TH PL W
N,
City of Edmonds Permit No:. 97
RIGHT40"T-WAY CONSTRDff-TION PERMIT,, ',-Issue Date:
A. Address or Vicinity of Construction:
B. Type of Work specific): Wx4-P 5 5/1
Ve I -, N.-
t&,/ d /o , a J � -.5 / / %- �1:9L � -d
C. Contralcton.6 0 kC 65T F- wA S LAe4�_ Contact: Aerpm I
Mailing Address: A35e,14 24�Phone: -2-43.5
State License #:- Liability Insurance: Bond:$
D. Building Permit (if applicable): Side Sewer Permit (if applicable):
Commercial El Subdivision El City Project EUC (PUD, VERIZON, PSE, A-T&--T, OVWD)
Multi -Family El Single Family Other
INSPECTOR: 1164 04L PL9 / /Vl- rn
F. PAVEMENT CUT: El YES R3 NO G. SIZE OF CUT X
CONCRETE CUT:' El YES H NO
AN'LICANT TO IZEAI) ANI) SIGN
INDEMNITY: Applicant understands by hislher signature to this application helshe holds the City of Edmonds harmless ftom
injuries, 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 but not limited to the defense of any legal proceedings including defense
�.co sts and attorneyfees by reason ofgranting this permit.
NTHE 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 W!LL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BYCITYFORCES, AT WHICH TIMEA DEBITOR CREDIT'WfLL BEPROCESSED FOR ISSUANCE �O THEAPPLIC4NT.
* traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained. as required by (WAC) 296-155-305- and must. have certification verifying completion of the
required training in their possession.
* Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt� or *City -
approved material prior to the end of the workday - NO EXCEPTIONS.'
* Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
1 HA VE READ THE ABOVE SIATEMENIS AND UNDERSTAND THEPERMIT REQUIREMENTS AND ACKNOWLEDGE
THA TI MUSTMAKE THE PINK CQP-,,OF THE PERMITA VAILABLE ONSITE A TALL TIMES FOR INSPECTIONS
Signature: Date:
(Contractor or Agent)
FOR CITY USE ONLY
Approved by: Right-of-wayFee: $i6no0+$1_5_n0
laillie f f2tw king
Time Authorized: Void After 12nw4, /12d /=6 Disruption Fee/Fund 111: W-0
Special Conditions: Pow in film. and/orhetter conditi n. Restoration Fee: $50.0
Mi ---- es. Vew- Total Fee:. S225-00
muintaft, 5'Nfirr setback f10111 all eity Of Fdffl6ttdS 41 liti f;5-
% Receipt No -
ctent, bureemasings. eall for laefkfe9 of All 4464"Witi6s ffig;40 a r
. .. . 1. . Issued
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
. I
INSPECTION IS. REQUIRED PER CHAPTER 48,00 OF, THEEDMONDS
COMMUNITY DEVELOPMENT COT (,PhonQ)425-771,_022!0, Ext. 1326)
OF PERMITTED WORK.
FINALAPPROVAL 'JA a�P,/JA DAtE:
�nspector:#,'S'ignature
For inspection requirements see Engineering Inspection Information handout.
0
DAMy Documents\Forms\Engnmg\ROWpermit_.doc . I T_ I
APPROVED AS NOTED
BY ENGINEERING
r
Open trench in shoulder of ROW
for approx 31'and bore driveway
approx 24 ft, and set carson to
extend and bury CATV service
drop
f'^��ncf ^f%AIA ln�
152575 th Street SW
Suite 200
Everett, WA 98203
Contact: Kermit Benson 425-263-5362
North Drop
Node: EM 14
2021284 th PI W - City of Edmonds
Date: YI& 2- /Q <-
'-7
E24 HR. NOTICE REQ.
!FOR INSPECTION- I
NORTH NOT TO
SCALE
Work Details
Open trench in shoulder of ROW for approx 31 feet, bore driveway approx 24 ft and set car'son to extend and bury CATV
service drop to 20212 84th pl W. Install cable at 36" depth.
All disturbed areas will be restored to existing or better conditions.,
Backfill material will be mechanically compacted to 95% of maximum density as specified by the City of Edmonds In tight
corridors hand trenching will be utilized to ensure protection of other utilities. Contractor must locate all existing utilities
impacted by this project.
Please see attached plans for restoration, erosion control and traffic control. Erosion control will consist of placing filter
fabric fence and/or sandbags along curbs and catch basins where necessary. Keep drainage system clean and
functioning. Remove all debris from the work site. Streets and roads will be cleaned both during and after installation of
work.
Ccomcast
PROJECT'S TIMELINE AND PROPOSED HOURS OF OPERATION:
Timeline - Up to 30-days past the issue date.
Work Hours -The entire project area will be conducted from 7:00 AM to 7:00 PM or
as specified by the Inspector.
Traffic Control Plans
1. The standards and guides of the latest version of the MUTCD or as set-up per
Code shall be followed at all times.
2. A copy of the Permit and Traff ic Control Plan shall be on -site with all
contractors during the project.
3. All contractors will avoid parking on sidewalks and shoulders and will take the
lane and follow the proper traff ic control set-up for the given situation.
4. Pedestrian access shall be maintained through or detoured around all work
sites.
5. Please find attached the traffic control plans for the various types of work
sites that will be encountered during our project.
6. Flaggers will be used only when all other methods of traffic control are
inadequate to wam and direct drivers. Only licensed flaggers will be used on
the project.
7. If situations occur when questions arise about proper traffic control set-up the
solution will be determined in the field with the Comcast Construction Rep.
and the Inspector.
4
..:&6si6h Co
If curb and gutters in project area:
• Filter bags will be placed in catchbasins downstream of work site, and
• Small check dams of pea gravel filled sandbags will placed within the
gutter upstream of the catchbasin.
Traffic control set-up for minor encroachment
100i
JJeuo!1doJ
N
Truck Mounted
Attenuator
(optkml)
113 L
200' A
Traffic control set-up for lane closure
Bul
100,
sace
FLAGGER STAVION
W,
Depth, Cleaning, Containment,
Compaction, and Restoration
Depth =
* 36-inch minimum
9* Compatible w/
other utilities
Shoring required
at 4-ft +
Pavement Cuts =
T-cut 1 -ft wider
than trench
4 Neat -line saw -cut
or jack hammered
edge
All trench backfill shall be mechanically
compacted to 95 percent of maximum density
using 1 -ft loose lifts with whacker or 2-ft loose
lift with a hoe pack.
if proper compaction cannot be achieved with the
native material, new import material is required at
the 95 percent rate.
As an alternative, CDF can be used in a design
mixture approved by the Engineer.
Ccomcast
CLEANING: All Streets and roads are required to
be cleaned and swept both during and after the
installation work.
* Mechanical Vacuum is preferred method
CONTAINMENT: All un-restored shoulders or
material storage areas are required to be contained
with reflective barricades.
All disturbed areas shall be restored to
existing or better conditions
Trench parallel to road:
• Shoulder - Match existing surface conditions
• Pavement - 6 1/2 inches of crushed surfacing material
and asphalt concrete Class B at 2- inches minimum or
same thickness if greater..
Trench across road (immediate cold m�ix patch):
• Asphalt - Permanent hot mix patch at same thickness
or 2-inches and sealed within 30 days.
• Concrete - saw cut and pored with mastic joints, eight -
sack mix, either type Il of HI cement, within 30 days.
CITY OF EDMONDS
ASSET INFORMATION SHEET
91 NEW
E] ADDITION
0 RETIREMENT
STREET FILE
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
v t
SERIAL NO.
LOCATION
DEPT. NO.
q
F :�r e�
"PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
PROJECT N U M BE R L..� 2.
PROJECT COMPLETION DATE 12- - 3.1 -
COST 5"Y' . -7 2—
B.A.R.S. ACCOUNT NO. 401 - '=C'C' - al,57- 3 -(!;-- CS01
ESTIMATED LIFE 2 -s'
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
1:9 DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
0 G.L. ENTRY
REFERENCE
DATE
VERIFIED BY
PROCESSED
BATCH NO.
INITIAL
t�np
DEPARTMENT FILE
.-ZCITY OF. EDMONDS
FOR INSPECTION CALL 161 Permit 0
PUBLIC WORKS DEPARTOT
775-2525 Ext'. 220 Issue Date
SIDE SEWER PERMIT
PEP -MIT MUST BE POSTED ON JOB SITE
.J2.
3.
4.
5.
6.
Address of Construction
Property Legal Description (include all easements)
Aj
Single Family Residence Multi -Family
Commercial
Owner and/or Builder
Contractor & License No.
Invasion into City Right -of -Way:
way Construction Permit Required
No X Yes
Call Dial
- � q__1 �
No. of Units
(If Yes Right"of-
Dig (342-5344) before
excavation).
7. Cross other private property: Yes No/1(11 Easement required -
attach legal description and county easement number.
�4 READ THE FOLLOWING AND SIGN:
44
a4
0:4 a. Property owners must obtain a permit to install side sewers on
>4 their property. A licensed side sewer contractor must be employed to
construct side sewers in the public' right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
c. Commercial establishment requires a minimum of a six inch (6")
P4
z side sewer line.
0 d. Side sewers may not be installed closer than thirty inches (30")
to any structure. 0
e. Side sewer lines must be laid at a minimum grade of 2% (1.15
and maximum grade of 1001% (450).
0 0
f. No turn in side s8wer greater than 45 (1/8ibend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and Wye with removable cap.
g. -No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
I i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer 'line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspeition during normal working hours only. Two (2) working
days notic ulred.
DATE:
and shall comply With the above
PERMIT FEE: DISAPPROVED BY: Date:
H
094 By: Date:
CONNECTION FE0 0-b
APPROVED _!�����Date: p
PERMIT MUST BE,PQSTED ON JOB SITE
NOTICE:
a C C-Ur-a
:Nb---warr h y 0
The information'shown on the attached
map(s) was cOmPiled for use by the City of
Edmonds/ its Employees and Consultants.
Th.e CIty of �Edrn.onds does not warrant.the
accuracy of anything set for.th on these
rnap(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding th*e inform-ation shown on
-map(s), including, but not Jimited to,
th . e lociation 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`o-yee-s o-r office-rs -sh-a-11 be 11a.b-'Fe for the
information given on this rnap(s), nor for
ovided based
any one representation pr
upon said map(s).
Side Sewer Drawing
The City of Edmonds OMONDS
-WATMENT FLAN-r ASEMENT.NO . .............................................
NEW CONSTRUCTION REPAIRS 0 ID NO. !�.�!'Y ........ . ASMT. NO . ..................
OWNER ..... SAeJ.:� ..................................... PERMIT NO.
......................................................... CONTRACTOR .... > ..... .............
JOB ADDRESS .... LEGAL DESCRIPTION: LOT'NO, . ............ ...................... BLOCK NO . ....................................
.................................................................................. .......................... I
................................. ....................
NAME OF ADDITION
1Z.,
. . ..................
17..S to
PL
PWW4)001-llt75 (REV.11/78)
Approved:
DATE B ........ ........ ..................
-3-UnDING FERK1T ITNTEW �
I I) - -
BUIL DING ADDRE S S ji��_ _2
;?/C>
BLDG. DEPT. SUSPENSE DATE
C1 OFFICE ADMIN.' PUBLIC
CITY ENGINEER (check)
-Now
INITIAL
IKS LOG IN
U17MIT
- Muliiple
.Commercial
DATE
0- �
0 Access Slope and Vehicle
Access
.j
13 Drainage Plan
U. E]Street File
[:]Legal Descript16n
ru
1JQuit Claim
Easement
O�PCAlculate -.Sewdr. -Connection
Ek/SEWEA D IVISION,',:.",�';
ter, Size,
P,
P6qonplei��Buildi�j ermit
Review
STREET:'
'DIVISION
77 4
Lvl�_,omp I e t e 'Building Permit,Review
0OFFICE ADMIN', LOG OUT,Tb
-------------------------------------------------------------------------
BLDG-.-'DEPT.
ra-16UILDING PERMIT APPLICATION'(COMPLETE).
COPIES OF SITE PLAN
2 COP*IES OF FIRE PROTECTION PLAN
(PREVIOUSLY 'REVIEWED BY FIRE DEPT.)
3 COPIES OF DRAINAGE PLAN WITH CALCULATIONS
REQUIRED BY SUBDIVISION El
GREATER THAN 2POOO SQ. FT.
IMPERMEABLE SURFACE 13
LESS THAN 2,000 SQ. FT. Q
CHECK ZONING.'RE-QUIREMEIITS'(SETBACKS)'
I COPY OF EN i GINEERING CIIECK.LIST
1 COPY OF'PUBLIC'.'WORKS MEMO
/[]/,��TIPLE OR C014MERCIAL
YES E] `:(ATrACH:COPY OFADB APPRMAL;INCL.' AIL D.PA!,TIWS)
NO
SUBDIVISION YES NAME.
DATED RECORDED
NUMBER
NO (ATDkCH.-Copy'Of -aMUIRMENTS,)
R DRAWING AND ATTACH COPY
CHECK SE14L
IS DEDICATION.REQUIRED YESQ (OBTAIN QUIT CIA110
CITY CODE
NO
'DOES CITY HAVE EASEMENT ON P POPER(TY
YES
(ATTACH COPIES OF DRAWINGS)
NO
CHECK L GAL ACC 4GRES,4�� UTILITIE
ESS It
YgE�SV YE�,a
n'
N NO
HAS SEWER qSESSMENT BEEN PAID
YES L.-I'D. NO,
/P PLAi NO.
SUBDIVISION'
"IF MULTIPLE: INCLUDE NUMBER -OF UNITS
L._JjT`C0MMERCIALf. INCLUDE NUMBER OF FIXTURE UNITS
____ -W.
PUBLIC WORKS DEPAMOT CHEaCLIST
BUnDING PERMIT REVIEW
(address) (da de)
Street Right -of -Way Exist' 11,r �-6 1 W_Qr���
Z
Access Easements Exist WAD
Utility Easement Existing -7 _REQD
94
Lot Per Subdivision Plat Assessor
Site Plan Checked for Accuracy
Z
Underground Wiring Reqd.
0
Check Accuracy of Legal D�scription 1Z-
Z
Review by Date lff_1111145�_O_,
Existing Water Main Size
Water Main Required #/A
Service Line Required
Hydrant Size Existing
v4
Hydrant Reqd Per Fire Code VIA Size
Detector Check Meter Reqd..
Cross Connection Inspection
Fire Department Comments
�3t
4ater 14eter Char Reqd
1 $3
Review by_ Date.
Septic Tank Design Approved Date
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability Pro*
Drawing No * )1Y File No.
V4
Side Sewer A�ailability
94
Sanitary Sewey.-Cannection Fee Reqd.
:r.
Review b Date
Open Ditch Exist' _Reqd - ---------
Culvert Reqd. Size
ce
Catch Basin Reqd. Indicate on Site Plan '
0
Shoulder drairkage maintain collection on swale open runoff
Manhole reqd. 15-1a C__ -Indicate on Site Plan -
Soil Conditions and Ground Water Field Checked- _5,,�2,76/4
Review by Date
Revised: lvlO-1977
CITY OF Eb
CONSTRUCTION PERMIT APPLICATION
USE
JOB
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NAME (OR NAME OF BUSINESS)
ea�
LEGAL DESCRIPTION CHECKISUBDIVISIUN NO.
ILID-NO.
DRESS
V,/
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING - REQUIRED DEDICATION_
CITY
4 0 S
TELEPHONE NUMBER
7 21,-
PROPOSED-
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NAME
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
LOU
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STREET USE PERMIT REQUIRED 0
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ADDRESS
SEE ENGINEERING MEMO DATED -
SEE PIW DEPT. REVIEW CHECK LIST DATED
CITY
TELEPHONE NUMBER
REMARKS
NAME
- 54 M Aye�
ADDRESS
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METER SIZE
BUILDING SUPPLY SIZE FIXTURE
UNITS
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CITY
TELEPHONE NUMBER
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REMARKS
STATE LICENSE NUMBER
CITY LICENSE NUMBER
.
SIGN AREA
ENV. REVIEW
ADB NO..
ALLOWED PROPOSED
COMPLETE I EXEMPT
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Legal Description of Property - Include all easements
(show below or attach four copies)
SHORELINE N
,
P,
L*-
VARIANCE OR CU
.
PLANYING HE
DATE
YARDS
RONT 7 YZ- SIDE REARI
LOT COVERAGE
REMARKS
NEW ESIDENTIAL PLUMBING
ADDIALTER N-RESIDENTIALJ MECHANICAL
E-1 REPAIR RETAINING WALL SIGN
EXCAVATE FENCE
CHECKED BY
TYPE OF CONSTRUCTION CODE
HEIGHT
DEMOLISH OR FILL ( x -FT)
1
7
PRE -MOVE INSPJ
COMPLIANCE INSP. -PW001M.
SPECIAL INSPECTOR
REQUIRED
0 YES (!NO
AREA
OCCUPANC Y
GROUP
OCCUPANT
LOAD
F-1 SIDE SEWER WATER LINE El
REMARKS
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0
co
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NUMBER OF STORIES I
1�7t
-NUMBER OF
DWELLING
UNITS
RE OF WORK TO BE DONE (ATTACH PLOT PLAN)
a',e k/ /Vo-
VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
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su ccessors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
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employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
modify,. waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
I hereby acknowl;-dge that I have read this application; that the
Information given Is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and In doing the work authoriz- AUTHORIZES This application is not a permit until
ed thereby, no person will be employed In violation of the Labor ONLY THE signed by the Building Official or his
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt Is
tion Insurance. INSPECTION acknowledged In space provided.
SIGNATI.&JE OWNER -OR A& I DA:My DEPARTMENT
I
,e2 ,
CITY OF OFFICIAL'S SIGNATURE
M11110111111111
EDMONDS
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX 775-2525 DATE
ATTENTION SHOULD BE CODED 31.04.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. MAY 71982 PINK — Owner GOLD — Assessor
102-78
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DATE:
MEMO TO: Building Division
Corununity DeveloDmcnt Department
FROM: Engineering Division
Public Works Department
SUBJECT:
7Z
After revi'ew of the subject Building Permit application, we-haN
the following comments:
1. Connection to City water system required.
2. to City sanitary.sewer systeni required.
Rigbt-of-way Permit required for any work on City propercy.
4, Driveway slope not to excee(I 111%.
5. Backwater valve required if doi4n.sLairs phimbing is.below
elevation of upstr'eam manhole.
6. Water and sewer lines to he sc2arated by 10 foot minimum.
1;7
Signature