20315 85TH PL W.PDF111111111
8074
20315 85TH PL W
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ADDRESS: �2-0? 15- 8 9'tk P 1, bJ
TAX ACCOUNT/PARCEL MOD 7 �� �7-,9�COOO 56o
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS(RECORDED)FOR:
CRITICAL AREAS DETERMINATION: El Conditional Waiver 0 Study Required aiver
CRITICAL AREAS DETERMINATION: El Conditional Waiver El Study Required Owaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
IBLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET.USE/ENC ROACHMENT PERMIT
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:kTEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc
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APPIOIAM.-D By PLA IZIG
RECEIVED
MAY 1 2
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
i// --.20 /
#P20
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 the application 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 Ahe Checklist should be easily
available from observations of the site or data available at
City Hall (Critical areas inventories, maps, *or soil
surveys).
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/her/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 furnished by the applicant, histher/its agents or employees.
By my signature, I certify that the informati9p and exhibits here"� submitted are true and correct to the best of my
knowledge and that I am authorized to le a licalhcm on b f of the owner as listed below.
SIGNATURE oF APPLicANT/AGENT DATE
Property Owner's Authorization
64—IVI—
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 ff of the City of Edmonds to enter the subject property for the
purposes of inspection and p;, attndan o t i ap 2ation.
SIGNATURE bF OWNER DATE
e-A
Owner/Applicant: Applicant Rep ntative:
-R)Cg,4P,p 19SH 7
Name Name
21a,3) s- 9-,�; 4- PL
Street Address Street Address
W19
city State Zip City State zip
Telephone: �7 - 75-L -7 Telephone:--/
Email address (optional): nc� elf 01�
Email Address (optional):
#P20
Critical Areas Checklist CAFileNo: C�4106009f)
Site Information (soils/ topography/ hydrology/vegetation)
1.. Site Address/Location: PL, (/Ll - , in -1 4 oc YPP 6
2. Property Tax.AccountNun-6er: — 00'73XS MG()6SC)C
3. Approximate Site Size (acres or square feet): - 1,2 , SQ:gl 44
4.. Is this site currently developed? yes; — no.
If yes; how is site developed?. ka)0(,1,v7'1y1L
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: NO Approx. Depth:
7. Site contains areas of seasonal standing water: a Approx. Depth:
What season(s) of the year?
8. Site is in the floodway IVO floodplain //3 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
A10 . Flows are seasonal? 4/0 (What time of year?
10. Site is primarily: forested meadow — ;shrubs— mixed
urban landscaped (lawn, shrubs etc)
1 1. Obvious wetland is present on site: My
1.
2.
3.
Plan Check Number, if applicable?
Site is Zoned?
SCS mapped s
For City Staff Use Only 11
4. Critical Areas inventory or C.A. map indicates Critical Area on site? 6.nj4e-
5. Site within designated earth subsidence landslide hazard area? 4 (-' ,
DETERMINATION
�-z . WArVER
-) L-i - e),8
STUDY
Reviewed
.1 . J
447 C. I g()\)
9 0
GARY HAAKENSON
MAYOR
CIT'Y OF EDMONIDS
1215 1H AVENUE NORTH - EDMONDS, WA 98020 - 425.771.0220 - FAX 425.771.0221
Website: www.cLedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building * Engineering
August 14, 2008
Richard Ash
2031585 th Place West
Edmonds, WA 98026
Subject: Determination regarding Critical Areas Checklist: CRA20080090
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted.
The 'DETERMINATION" reached by the City is located on the reverse side of the form (bottom of
page). It is very important for you to retain a copy of this critical areas "determination" for you
records.
Please examine this Determination for additional requirements. You may need to submit
additional information such as an Environmental Checklist or Critical Areas Study.
The Determination for the Critical Areas Checklist you submitted is a site -specific determination,
not a project -specific determination.
YOU MUST SUBMIT A COPY OF THE CRITICAL AREAS CHECKLIST and DETERMINATION WITH
ALL PERMIT APPLICATIONS OR YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
• Building Permits
• Conditional Use Permits
• Subdivisions
• Variances
• Applications to the. ADB* Land Use Applications
• Any other development permit applications.
*Architectural Design Board
Enc.
Thank you,
Planning Secretary
Incorpoiated August 11, 1890
Sistcr City - Hekinwi, Japan
ILANNING DATA STREET FILE
SINGLE FAMILY RESIDENTIAL
Name: Date: 09
Site Address: li-4 C
ZQ 3 PlanCheck#.
'r
Project Description: A �ro"J
Reduced Site Plan Provided: VE' NO) Zoning:
Map Page: Corner Lot: (YES /655) Flag Lot: (YES
Critical Areas Determination #: no& - C _t 0
El Study Required
V-Waiver
SEPA Determination:
W.—Exempt
Needed (for over 500 cubic yards of grading)
0 Fee 0 Checklist U APO List with notarized form
RequIred tbacks
St e t: Z
Side,
Rear.
2s-,
Street: Side.- 4- ar.
Detached Structures:
Rockeries:
Fences[Trellises:
Bay Windows/Projecting Modulation:
LdlStairs/Deck: q?_" q6C)LLe_ _qrbu�_A�
Datum Point-
Datum Elevation:
Maximum Height Allowed:
Actual Height-.
Other
Parking Required: 111A
Parking Provided:
Lot Area: Iz, (n v�
Maximum Lot Coverage: 35% Proposed:
Lot Coverage Calculations: 7/o
OD L,6
ADU Created: (YES
Subdivision:
Legal Nonconforming Land Use Determination Issued: (YES NZ)
Cof77rnents
Plan Review By-
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OCT 2,3 1984
OCT 2 3 1984
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*AND'ARD DRAINAGE PLAN
INFILTRATION SYSTEM
PAGE I OF 2
for
L
location_,_,�,Ino
plan by
phone
date -
DESIGN DATA
Trench Perc LF per Imperm Trench
Number Rate 1000 sq.ft. Area Req.
NOTES
1. Call Engineering"Division (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the responsibility
of the property owner(s). Preventive
maintenance consists of preventing
soil and other materials from entering
trench during construction as well as
after construction. Catch basins should
be cleaned of floating material and
sediment at regular intervals (at least
twice per year).
FA T WA., I LO �
CITY OF EDMONDS
#P20
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 the application 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).
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 firiding 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/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indermify, 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 furnished by the applicant, histher/its agents or employees.
By my signature, I certify that the information and exhibits herew true and correct to the best of my
14 submitted are
knowledge and that I am authorized to file a licT o=f of the owner as listed below.
SIGNATURE OF APPLIcANT/AGENT DATE 'JS-��-49
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 for the
purposes of inspection . and p;osi 7a o t i ap i ation.
SIGNATURE OF OWNER 7 DATE
Z) LA
PLEASE PRINT CLEARLY
Owner/AppHcant: Applicant Rep s ntative:
9)Cg,4Ap 19-5H ' 7
Name Name
PL
Street Address Street Address
city State Zip City State zip
1-7
Telephone: ?S1 / Telephone:
Email address (optional): Y')C� 6, o,� Email Address (optional):
#P20
Critical Areas Checklist CAFileNo:
Site Information (soils/ topography/ hydrology/vegetation)
1 Site Address/ Location: �5 FS W- PL UL/ i,,, o
2. Property Tax Account Number: CO'7-3;),S Wooloscic
3. Approximate Site Size (acres or square feet): 1.2
4. Is this site currently developed? X- yes; — no.
If yes; how is site developed?.--- kCT)Dcw7'6,9L-
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: Alf, Approx. Depth:
7. Site contains areas of seasonal standing water: C Approx. Depth:
What season(s) of the year?
8. Site is in the floodway *0 floodplain A� of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
A10 . Flows are seasonal? A10 (What time of year?
10. Site is primarily: forested ; meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc)
1 1. Obvious wetland is present on site: Alo
For City Staff Use Only
1. Plan Check Number, if applicable?
2. Site is Zoned?
3. SCS mapped s
4. Critical Areas inventory or C.A. map indicates Critical Area on site? 1j.r)j4e-
5. Site within designated earth subsidence landslide hazard area?
DETERMINATION
STUDY
Reviewed bv:
Date: 0 -) 1-1 — e)
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[Ali I LY I 1ULT I.PL COME qC I Al
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PROJE
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ACCESS SLOPE AND VEHICLE ACCESS
DRAINAGE PLAN
STREET FILE
LEGAL DESCRIPTION VERIFICATION
AUIT CLAIMIDfDICAT.IDNS
CASEMENT - PUBLIC/PRIVATE
CALCULATE SEWER CONNECTION IF NO LID I
ENGINEERING &
P R 0 J E C T
PUBLIC WORKS
R E V I E W
CHECK LIST
CO.NTACT NAq I TELEPHONE NUMBER
a
a
STREV PAVING REQUIRED
CURB AND GUTTER REQUIRED
SIDEWALK REQUIRED
CURB CUT FOR DRIVEWAY. REQUIRED
RJUIT-OF-WAY CONSTRUCTIon PERMIT REQUIRED 6( u
BOND REQUIRED FOR PUBLIC IMPROVEMENTS
STREIT NAME SIGN REQUIRED
OT81R SIGNING REQUIRED -------
(ADDITIONAL COMMENTS ON BA(
1XISTINC WATER MAIIJ SIZE D, / 0. a 0 7� -
WATER MAIN REQUIR[p
SERVICE LINE REQUIP.ED
HYDRANT SHE EXISTING
HYDRANT RfqUI-RED PER FIRE CME SIZE
CROSS C(INNICT1011 INSPECTION
WATER 11FTER CHARGE REQUIRED
REVIEW BY I ------------ DATE
(AI)OITIOrtAL COOKHTS ON 8A
SANITARY SEWER DMIJING 11UPBER
SIDE SEWER AVAILABILITY FILE wiBER
SANITARY SEWER CO111ECTIO11 FEE REQUIRED
UPLN DITCH EXIST111r,
CULVERT RIQU ]RED REQUIPEo
CAICH BASIN REQUIRED SIZE
INDICATED Off SITE PLAN
SHOULDER D.RAIHAGE IVINTAIN COLLECTIOn on SHALE OPEN Rutoff
WHOL t A . (QUIRED I INDICATED 0.4 Sly[ PLAN
SOIL CONDITION, VjD
�POWD kATER Fl-EL-0- C-HECULD
I I ;L:-. —
PIVIEV By
PAU (ADDITIONAL CWNTS ON BAC
USE
�-'PE
,U
CITY OF EDMOND§ ZONE NU
CONSTRUCTION FERMIT APPLICATION JOB
NAME (OR NAME OF BUSIN AD
Wve71111-ffl7 6 /75/. LEGAL DESCRIPTION CHECKI SUBDIVISION NO. LID N
6
MAILING ADDIESS 5—
CITY TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
A-01qdly,zl�_ EXISTING _-1�0 REQUIRED DEDICATION O!n
NAME PROPOSED -7::5&)L—
T
ION
e RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
AD S STREET USE PERMIT REQUIRED C1
SEE ENGINEERING MEMO DATED
CITY R
TELEPHONE NUMBER. SEE PiW DEPT. REVIEW CHECK LIST DATED/ e!�
7 �"3 "'— Z's ON REMW
'Of
ADDRESS
CITY I TELEPHONE NUMBER
STATE LICENSE NUMBER I CITY LICENSE NUMBER
Legal Description of Property - Include all easements
(show below or attach four copies)
N
Li
NEW
RESIDENTIAL
PLUMBING
ADDIALTER
NON-RESIDENTIAL
MECHANICAL
REPAIR
RETAINING WALL
SIGN
EXCAVATE
FENCE
DEMOLISH
OR FILL
x _FT)
EPRE
-MOVE INSP.1
El
T COMPLIANCE INSP:
Po`01ML
SIDE SEWER
WATER LINE
NUMBER OF STORIES
NUMBEROF
UWtLLINU
I
_?
UN11b
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
METER SIZE IBUILDING SUPPLY SIZE
REMARKS
SIGN AREA I COMPENV. REVIEW
ALLOWED I PROPOSED LETE I EXEMPT
VARIANCE OR CU
NING REVIIEW BY
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UNITS
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ADB NO.
SHORELINE #
I DATE
YARDS 7 S-1 LOT COVERA�E
.7 --e
FRONT SIDE REARI' J -;--
BY
SPECIAL INSPECTOR AREA OCCUPANCY occuPANT
REQUIRED GROUP LOAD
n YES n NO I I I I
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: I Year - Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
o successors in interest, agrees to indemnify, defend and hold
'Uni harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
4 whatever nature, arising directly or indirectly from the issuance
x
0 of this permit. Issuance of this permit shall not be deemed to
_j modify,.waive or reduce any requirement of any city oidinance
0
nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision.,,
I hereby acknowledge that I have read this application; that the
information given Is correct; and that I am the owner, or the duly ATTENTION
authorized anent of the owner I agree to comply with cit intj
VALUATION
FEE
0 0—C-1
APPLICATION APPROVAL
y 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
tiqrl,4"urance. INSPECTION acknowledged in space provided.
DEPARTMENT
0 1 " 771, , Fm, EDMONDS OFFICIAL'S SIGNATURE
SI ATURE (OWNER OR AG N CITY OF
771-3202 DATE
ATTffNTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED.
CHAPTER 3. uBc OCT 23 PINK — Owner GOLD — Assessor
102-78 1984 P"... �q - E. W A 7 75 9494
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MEMO TO: Building Division
Planning Department
FROM: Engineering Division
Publ ic Works Department
SUBJECT: ';�io:jl
DATE : — I �) zz; VIX i, �—/—
,�J
After review of the subject Building Permit application, vie have the following
comments:
1. Connection to City water system required.
2. Connection to City sanitary sewer system required.
3. Right-of-way permit required for any work on City -property.
4. Driveway slope not to exceed 14%
5. Backwater valve required if downstairs mbinq is below elevation of
upstream manlioT—e------ plu
6. Water and sewer lines to be —separated by 10 foot minimum.
OCT 2 3 1984
CATCA BASIN:
ALM a IS'30(0%. TREMCW LorwCa"rH
WSUAL)
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A! nc k!
Mcp UWK LCVJrL 77tWNC.N
4FffVLF P%pr / CAP
TEE W/ 4�10w-, LEGS
SYSTEM CROSS-SECTION
6co)c.
M I FZAff I _It244
C"*F- C-4.0 U I V L_
TC i5f�- LAYED 6
WASHr—P KO--K
-TILEAC" COVER
3/48- 10�' WASWED
G P-kv E I
,4�01AM FFRF P
I- Z1. e ___�
TRENCH CROSS-SECTION
=� C4
*AN D'ARD DRAINAGE PLAN
INFILTRATION SYSTEM
PAGE I OF 2
<Za,p, �)
for
location --
plan by
phone
date
DESIGN DATA
Trench Perc LF per Imperm rench
Number Rate 1000 sq.ft. Area /Rerq.
rj�
WZ*J.- An.
W'113WRA'
mm�koffi,mw,ti
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the responsibility
of the property owner(s). Preventive
maintenance consists of preventing
soil and other materials from entering
trench during construction as well as
after construction. Catch basins should
be cleaned of floating material and
sediment at re?ular intervals (at least
twice per , ar).
Z71i /3�
CITY OF EDMONDS
CITY OF EDMONDS
EirNEW
11 ADDITION
11 RETIREMENT
SAIEET FILE
AT INF
AS ORMATION SHEET
'ASSEtNO':--
ADDITION TO ASSET NO.:':'l—
fs
DESCRIPTION
SERIAL NO.
LOCATION
DEPT NO
"PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
.�PRO ECTNUMBER
ol
6
PROJECT COM PLET ION DATE,
COST
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
INITIAL
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE,OF PROJECT:
ACCOUNTING ONLY
typ)
DEPARTMENT FILE
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orf
CITY of EDMO&S ILES10. SEWER PERMIT
m? For I Inspection Call 771-3202 PERMIT NO. 07288
PUBLIC WORKS
�kl EDMONDS
Address of Construction t�� A - A r- Krr . pLANT
Property Legal Description (Include all easements): Lof �T
Owner and/or Builder: 4EU__Z_12JEN4 cor-k4z,�:.7__
Contractor & License No: S � v ca C__ �;�C) P, t--A 1-4
Single Family Residence
Multi -Family (No. of Units �
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way.
Construction Permit required. Call One -Call -Center .(1-800-424-5555) before any
excavation.)
Cross other Private Property: No vl*"�_ Yes (if Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
AertlTy tnat i nave reaa ana snaii compiy
w h the items listed on the back.
.1 3-12-- 8 ��_
'Date
777777777,�:;
Permit Fee: 30, Od Issued By: �Iwco"
Trunk Charge: 0 0 Date Issued: Fs —
Assessment Fee: Receipt No.:
Partial Inspection: Comments ___�a_te Initial
-34--Pr ,
Final Inspection Approved:
Date Initial
Rejected:
-Tn -i
ason Date tial
** PERMIT MUST BE POSTED ON JOB SITE **
Wh.ite Copy File Green Copy - Inspector Buff Copy - Applicant
NOTICE:
___ffy__0 ra-oc-u-r-a-uy
-Nb--w-a r-r a n
The inform ation'shown on the attached
map(s) was compiled for use by the City Of
Edmonds/ its Employees and Consultants.
The City of �Edm.qnds does not ' wa rra nt t, ie-
accuracy of anything set for.th on t ' hese
rnap(�_). Any person or en.tity -requesting a
copy should conduct an independent
0 'ation shown on
inquiry regarding the inf rm
map(s), but not limited to
t I -h
er stub shown. Suc
the lociation of any sew
sewer stubs may or may* not exist and may
or may not exist at the location shown.
Neither the city of Edmo-nds nor its
emp-to-yee-s o-r office-rs -sh-a-1-1 be 1--la-b-Ife for the
information given on this map(s), nor for
tation provided based
any one represen
upon . said map(s),
The City of Edmonds Side Sewer Drawing EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION [X REPAIRS E] LID NO - ------------------ ASMT. NO - --------- --------
OWNER ------- comzxt ------------------- CONTRACTOR --- F—\j.lGRG-RGJ&-M ----- PERMIT NO.
JOB ADDRESS -203.A-5 ---------- 851-11 ---- P-L-Wt� ------------- LEGAL DESCRIPTION: LOT NO - ------- 5 ----------------- BLOCK
85111 PLACG S.W.
H-5,
EDMONDS
---------------------------------- ........... ........... --------------------- I ------ -TRE*TM-ENT--PL-ANT
4-AUF, OF ADDITION ---------------------
----------------------------------------- /---- --------------------- -------------------------
2,0 2> 1 -5 8-5-r"PL.
40c.o.wve
-0
70
30' 6,0P.
4!'C^ Grc-0-
Ir CAP To SURF,%rA
)NaM FG—NKS 'PROP, LtmE. LX-,,,r`%R6tA P114
Approved:
PWW-"l -11/75 (REVA 1/78) DATE f&,k /-3
TIM cll-s K^"HOLJE
�w 9-93
2
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TOP - 422.35
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UTIL)ZE EX. 00 TOP - 420.9t
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rSTU13 IF POSS110L INV-416-00
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th PL
TOP�_421-01
_],�JV - 412.00
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RELOCATE GXJGTIWC-7
WATER METER TO
EXIGTIWG HOU6E.
ro
REKAOVE 90013EKJD
AND INSTALL
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.(TYPICAL) WITH BLOCKIW0
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RELOCATE EXI-15TIMG WATER
METER TO EYISTIWG HOUGE g'
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City of Edmonts
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number-
Lssue Date:
A. Address or Vicinity of Construction: - 20315 85th PL W
C. B- Type of Wo rk(besPecific): Intercent existing TV conduit under
Ipavement to install service drop
C. Contractor: Chambers /Super i or Contact: Tom Anderson
MailingAddress: 190 W Dayton St Phone: 775-7504
StateLicense#: �qr1ppgrrJ()J()A Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. El Commercial F1 Subdivision El City Project )C] Utility (PUD, GTE-, W?TG,tCABLE, WATER)
n Multi -Family [:] Single Family Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: XR]Yes 0No G. SizeofCut: x 101
(Includes 2 existing patches)
APPLICANT TO READ AND SIGN
INDEMNITY.- Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany
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 of any legal proceedings including defense costs and attorneyfees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED
A
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings 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 trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
A L
I have read the above statements and understand the permit re�u'irements and the pink,eq�y( of the permit will be
available on site at all timesfqr inspection purposes.
Signature:'-Iou, Date: , 2
) /��O 17
(Uontfactor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY.. RIGHT OF WAY FEE: 100
TIMEAUTHORTZED:VOIDAFTER 4JAe,,, 2,"S DAYS DISRUPTION FEE/FU`ND I 11:
V
SPECIAL CONDITIONS: RESTORATION FEE:
T OTAL FEE: -
RECEIPT NO.:
11 ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
CONTRACTOR CALLED FOR INSPECTION El YES E�] NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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