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20424 79TH AVE W.PDF11111111111111 1-5255 20424 79TH AVE W Ai CITY OF EDMONDS 90 1 9 c�z SIDE SEWER PERMIT PERMIT Address of Construction: Av-e- W Property Legal Description (Include all easements): 600 - 90 (1 - ( )00 M \P -1 Owner and/or Contractor: G le -e A Iea- CoA sk!�$ o-, State License No. Gg_ 9— tq C 10 1 191q — Building Permit No. 9 qo �o Single Family Invasion into City Right -of -Way: No 11!� Yes Multi -Family (No. of Units—) RW Construction Permit No. Commercial Cross other Private Property:,X No El Yes El Public Attach legal description and copy of recorded easement I certify 1hat I have read'and shall corV with all city requirements as indicated on the back of the Permit Card. //,9/5 /.I/*, Da/ / * CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION * OFFICE USE ONLY FOR INSPECTION CALL 771-MM, PUBLIC WORKS DEPT. - #1 0 Permit Fee: Issued By Trunk Charge: Date Issued: Assessment Fee: Receipt No.: Lid No.:— A) //)t Partial Inspection: Date —Initial — Comments Reason Rejected: Date —Initial — Final Inspection Approved: Datdo lnitiad�l PERMIT MUST BE POSTED ON JOB SITE White Copy: File Green Copy: Inspector Buff Copy: Applicant Re��sed 3 90 0 0 The City of Edmonds Side Sewer Drawing NEW CONSTRUCTION OWNER................................................................................................ cx-L I L - �7q .-!. .. 4 ... . ..... JOB ADDRESS . . ..... .j ... ... ........ . ............ "Z�� rY, PWW-0001 -11/75 (REV. 11/78) e,tfP.V.& e-0. V944f. - co? — 5x4sn.," ecowe'.— c 1� I j 2 VMS - EASEMENT NO . ........................................ V, REPAIRS F� LID NO . .................. ASMT. NO . .................. CONTRACTOR.................................... ............................................... PERMIT NO. LEGAL DESCRIPTION: LOT NO . ............ ......................... BLOCK NO . .................................... i - .................................................................... ................... I .......... ....... I .............................. NAMEOF ADDITION ....................................................................................................................... '7 go.— + 1 90 f —6 — ;Zc>+z 4- - -7 V, 4d e- 4--, , (,5 Cal 1, J>ecr — R o -7 9'rO 4 G v4. Approved: DATE /..e ......... ..... By The City of Edmonds Water Service Drawing EASEMENT NO . ................. .......................... NEW CONSTRUCTION Rd REPAIRS LID NO . .................. . ASMT. NO . ............ OWNER ..... ....................................................... CONTRACTOR ...................... ............................................................. PERMIT NO. 9AN-P-V.. JOB ADDRESS 20 .424 77 5 .............................. ............. LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . .................................... NAMEOF ADDITION ..: ..... .................. [ ............................................................................ .............. 2,04-2-4- '79 -r H Ave. W. 1-7— 9 1 1 - '��A NOR-r�� =-M. —fl� rF'y PLANNING DATA W, SITE ADDRESS:- --B��PATE:— ZONING: DESCRIPTIO SETBACKS: Reauired Setbacks: Front: Z5 Left Side: -7 Right Side: Rear: Actual Setbacks: f Front: !Z '-p Left Side: Right Side: Rear: FLOOR AREA: LOT COVERAGE: Maximum Allowed: BUILDING HEIGHT: Maximum Allowed: 1'7�72, 15 Actual Height: 7Q�l SUBDIVISION: CRITICAL AREAS #: � - / : t2 SEPA DETERMINATIO OTHER: Z� 9) -,? — /-) n , �', P)<D --/ PERMIT APPLICATION REQUIREMENTS To: Applicant From: Lyle Chrisman, Engineering Inspector Owner: afok)�"p Plan Check No: Address: �0 Date After review of the subject permit application, the following requirements must be met: 1. Construction hours are: WEEKDAYS - 7:00 A.M.40:00 P.M.WEEKENDS/HOLIDAYS - 10:00 A.M.-6:00 P.M. 2. A separate RIGHT-O&WAY CONSTRUCTION PERMIT is required for all work on public property. (ECDC 1&60) 3. Truck haul route plan must be submitted and approved prior to permit issuance. 4. Builder/owner is responsible for containing all temporary runoff and erosion control on site. (ECDC 18.30.030d) 5. NO WORK SHALL BE DONE WITHIN 15 FEET OF STREAMS OR 10 FEET FROM ANY CLOSED DRAINAGE FACILITY. BUILDER/OWNER IS RESPONSIBLE FOR IDENTIFYING CONDITIONS ON THE DRAWING. (ECDC I&30.50G) 6. FILTER FABRIC FENCE SHALL BE INSTALLED AND INSPECTED PRIOR TO CLEARING AND CONSTRUCTION. (ECDC 18.30) 7. INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEMS, TIGHTLINES AND CATCH BASIN INSTALLATION. INSPECTIONS ARE REQUIRED PRIOR TO BACKFILLING. (ECDC 18.30) 8. Repair or replace all defective existing curb, gutter and sidewalk adjacent to the property If an intersection is involved, a handicap ramp may be required. Contractor shall meet with the City Engineering staff to determine the e*xtent of repair prior to issuance of the permit. (ECDC 18.90) 9. Driveway slope shall not exceed 14% without a waiver. Every attempt should be made to keep the slope below 14%. Waiver granted to - %. (ECDC 18.80-060D) 10. Driveways must be paved from property line to City RIGHT-OF-WAY. A separate permit is required.'(ECDC 18.80.060C) 11. INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIOR TO AND AFTER POURING. (ECDC 18.30) 12. No burning of construction refuse without a permit from the Fire Department. 13. Connection to City water system is required. There is a separate charge for the water meter. (ECDC 7.20) 14. A back water valve is required if downstairs plumbing is below the elevation of upstream manhole. (ECDC 7.20) 15. Water and sewer main lines should be separated by 10 feet minimum. (ECDC 18.10) 16. Connection to the City sanitary system is required. A separate permit is required. LID#_ Fees paid: Yes— No— Chargt-. (ECDC 18.1 01 17. Underground wiring is required on all new construction, and for additions, alterations, and repairs that exceed 50% of the total assessed value of the structure. (ECDC I 8.9o) 18. A FINAL ENGINEERING INSPECTION IS REQUIRED PRIOR TO THE BUILDING DIVPION GRANTING OCCUPANCY OF THE BUILDING OR STRUCTURE. (ECDC 18 90) 1 F I r I-& tsk-,) 1�>WFA'MW r "ta5 o4 "5�1 5P. Aloo" PERMIT APPLICATION REQUIREMENTS To: Applicant STREET FLE From: Lyle Chrisman, Engineering Inspector Owner: PlanCheckNo: Address: go *Z4- Date:—b�fwq* After review of the subject permit application, the following requirements must be met: 1. Construction hours are: WEEKDAYS — 7:00 A.M.40:00 P.M.WEEXENDS/HOLIDAYS — 10:00 A.IVL-6:00 P.M. 2. A separate RIGHT-OF-WAY CONSTRUCTION PERMIT is required for all work on public property. (ECDC 18.60) 3. Truck haul route plan must be submitted and approved prior to permit issuance. 4. Builder/owner is responsible for containing all temporary runoff and erosion control on site. (ECDC 18.30.030d) 5. NO WORK SHALL BE DONE WITHIN 15 FEET OF STREAMS OR 10 FEET FROM ANY CLOSED DRAINAGE FACILITY. BUILDER/OWNER IS RESPONSIBLE FOR IDENTIFYING CONDITIONS ON THE DRAWING. (ECDC 18.30.50G) 6. FILTER FABRIC FENCE SHALL BE INSTALLED AND INSPECTED PRIOR TO CLEARING AND CONSTRUCTION. (ECDC 18.30) 7. INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEMS, TIGHTLINES AND CATCH BASIN INSTALLATION. INSPECTIONS ARE REQUIRED PRIOR TO BACKFILLING. (ECDC 18.30) 8. Repair or replace all defective existing curb, gutter and sidewalk adjacent to the property. If an intersection is involved, a handicap ramp may be required. Contractor shall meet with the City Engineering staff to determine the extent of repair prior to issuance of the permit. (ECDC 18.90) 9. Driveway slope shall not exceed 14% without a waiver. Every attempt should be made to keep the slope below 14%. Waiver granted to %. (ECDC 18.80.060D) 10. Driveways must be paved from property line to City RIGHT-OF-WAY. A separate permit is required. (ECDC 18.80.060C) 11. INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIOR TO AND AFTER POURING. (ECDC 18.30) 12. No burning of construction refuse without a permit from the Fire Department 13. Connection to City water system is required. There is a separate charge for the water meter. (ECDC 7.20) .14. A back water valve is required if downstairs plumbing is below the elevation of upstream manhole. (ECDC 7.20) 15. Water and sewer main lines should be separated by 10 feet minimum. (ECDC 18.10) 16. Connection to the City sanitary system is required. A separate permit is required. LID# Fees paid: Yes— No Charge (ECDC 18.10y 17. Underground wiring is required on all new construction, and for additions, alterations, and repairs that exceed 50% of the total assessed value of the structure. (ECDC 18.90) 18. A FTNAL ENGINEERING INSPECTION IS REQUIRED PRIOR TO THE BUILDING DIVISION GRANTING OCCUPANCY OF THE BUILDING OR STRUCTURE. (ECDC 18.90) 1�>2M^T?W let - 61�9*vfr 'ayA*) 'oe "IdX5 #4 erL. �jUe bc-"� 011-1 pl I—&. f,,k� PRMTREQRDOT , f RECEIVED . �, 7ETEFjLVtZHECKL1ST P R HC 1 11 A P PUBLIC WORKS 0j, PROJECT ADDRESS: Z!�t PLAN CHECK #: RECEIPT DATE: E !�;A' ni�!a IDa . .... .. ... MEN Q� 9= %A I M 94 8'TRFF. Setbacks/Variance/Setback Adjustment n. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . sm Conditional Use Permit AD13 Requirements Other Zoning Requirements - — - - - - - - - - - - - - N. F Underground Wiring Required . . .... Lot Slope IS% SEPA Environmental Checklist/Hydraulics Permit Tree Cutting Plan . . . . . . . . . . . . ------------- ............. ... . .. ... ------ ...... - Plat/Subdivision Requirements Legal Description Verification Quit Claim/Street Dedications ---------- . . . . . . . . . . . ........... .. . ... Easements - Public/Private Engineering Storm Drain Review Fee Engineering_ 2.2 Ins ection Fee XX Drainage Plan (On- ite) Setback - Top of Bank, Stream, Water 'Couirses Setback - Storm Drain Line Open Ditch - Existing Culvert Required Culvert Size Shoulder Drainage/Shale Open Runoff Catch Basin Required Driveway Slope & Vehicle Access Sidewalk Required Curb & Gutter Required Curb Cut For Driveway Required Street Paving Required Riqht-Of-Way Construction ermit Required Street Name Sign Required Other Signing Required Bond Required For Public Improvements . FEMA Map Check/Water Table . . . . . . . . . . . Side Sew;r Availabliq Calculate Sewer Connectfion Fee If No LID # Create Street File ..... . . . . . . . Existing Water Main Size Water Meter Size . . . . . . . . . . . Service Line Size 3,14t Water ±Mjeter Charge Required lkff::� vi S4 P 0 Hydra nt Required Hydrant Size Existing Fire Line Charge Required - Sprinkler . . . . . . . . . . . . . . . . . . . . . . . . . . . . M. ........... ...... ... . . . . . . . . . . Street Cut Z g&- 1`7, . . . . . . . . . M 0: 24 Miscellaneous Reviewed By: FIRE PUBLIC WORKS i� "d TIN G N CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME NAME OF BUSINESS BrAf MAILING RESS ,i i CITY ZIP NE NUMBER W N PL1111 NAME so NAMt A RESS Do 1 k3u"T a" kk 0 vie'r CITY ZIP 48UI TELEPHONE NUMBER 4Z3 at STATE LICENSE NUMBER EXNRAilIOA DATE G,RE �iw (- m ?N /01,?v Legal Description of Property - include all easements La � 3%C-lIZ&.vN ?cILYk Kk�. I k(kork 4,0 V�L -qa� A -,al LtJ4 1� Vot R J R-As kj�, -70 Qx(--"5 2S S K�- Pro& T8X ZCYOunt —006 P.r.el No. 2--()0() — NEW RESIDENTIAL PLUMBING ADDITION COMMERCIAL MECHANICAL ElREMODEL APT. BLDG. SIGN GRADING FENCE REPAIR —40XIL— CYDS. I x —FT) DEMo:LISH GODSTOVE SWIM POOL WINSERT HOT TUB/SPA !N"AGE RETAINING WALL/ CAaQQaW- ROCKERY E] RENEWAL NUMBER GUMBEF! OF CRITICAL 0 OF WELLING AREAS W STORIES UNITS NUMBERI DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN) 0 USE ZONE PERMIT NUMBER �E.—AL-11—�111146EC'KLI/SUBDIVISION NO PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP ::ISTING — REOUIRED DIDICATIO4 OPOSED TESCP APPfayed 0 RW Pefinil Required 0 Street U.. Pe—1 Req d 0 I-ripect.o. Required 1k Sidewalk Required 0 tEMARKS YEs,KNO 0 funq xm-i-2- filo kepo ENGINEERING MEMO DATED REVIEWED BY 191-1 �At / *V— SIGN AREA SEPA REVIEW OPOSED COMPLETE , [XEMPT 7 EX? _p4j,'ANG By SIDE BY &'VV jr7 1 14 —1 ir SPECIAL INSPECTOR C3 I AREAa/ REQUIRED YES REMARKS PROGRESS INSPECTIONS PER UBC 305 RV^41—A?9 /171-f Aoi6i,54 , FINAL INSPECTION REOUIRED AVIW7 -6-0fXe& AI)4X PLAN CHECK - FEE Z-3e SOURCE: GLAZING BUILDING /25; 45.0 ZZ-5 ;S /—'!5 PLUMBING 105- Plan Check No. 1—/ �/ — 16(61 MECHANICAL This Permit covers work to be done on private property ONLY. GRADINGIFILL Z3 Any construction on the public domain (curbs, sidewalks. driveways. marquees, etc.) will require separate permission. STA39 . S�RCHARGE Permit Application: 180 Days Permit Limit: I Year - Provided Work Is Started Within 180 Days STORM DRAINAGE FEE "Applicant, on behalf of his or her spouse, heirs, assigns and ENO. INSPECTION FEE cce3sors in interest, rose to Indemnify, defend and hold th I h armless a C ty of eedmonds, Washington. its officials, 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 PLAN CHECK DEPOSIT 0 waive or reduce any requirement of any City ordinance .,modify, nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE provision." I oereby acknowledge that I have read this application; that the Information given is c6-rrect., nd'that I am the owner, or the duly ATTENTION APPLICATION APPROVAL authorized agent of thecWn:r. l(agree to comply with city and laws regulating construction; and In doing the work authoriz. THIS PERMIT AUTHORIZES This application is not a permit until :late d thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid. and receipt is t�on Insurance and RCW 18.27. INSPECTION acknowledged in space provided. I GNATURE JOWNER OR AGENT) DATE SIGNED DEPARTMENT '3-3 CITY OF E EDMONDS ATUNTION CALL FOR 06 GAT INSPECTION — IE IT S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL — F.1e YELL6w - inspector A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC f. , APTCO -1 - I - -- - . .. a Z Z Z Pt,o T- 146A%K-LA) E r & tf r CA L CIS 001+ OVA 00 LANNING APPROVE Av E 6 Rf%E -::+ 9 F - 99 AcTc&'NL- = 4- =*76 M PO( = + % 2. 3 IM Ah 13 4, :-�044 cr 3t 4- 9 ./%XCM .4) Ve. - li�, qj e4 4c C-16 L6(,AL- 00 Lo� (o c) pr I J eoiwErr' m-- JIMA? Dr:rrkro.. 44,— Ob',.LArr,.ft c3oa..� A% c --;7 Fp GRADING PLAN 20422 79TH AVE WEST IS A FULLY DEVELOPED LOT WITH A VIRTUALLY LEVEL ELEVATION. DUE TO A FIRE IN MAY OF 1994 THE EXISTING RESIDENCE WAS DEMOLISHED AND THE NEW RESIDENCE CONSTRUCTION WILL RETAIN THE EXISTING GRADES. TEMPORARY AND PERMANENT EROSION CONTROL IS PROVIDED BY THE EXISTING VEGETATION IN ADDDITION RESEEDING AND ADDING SOME NEW TOPSOIL AND VEGETATION ONCE THE STRUCTURE IS COMPLETE. WE PLAN TO TARP ANY EXCAVATION DURING CONSTRUCTION. SUEE7 HLE G( DRAINAGE PLAN 20422 79TH AVE WEST HAD AN EXISTING RESIDENCE BUILDING PAD AND DRIVEWAY AND REAR CONCRETE PATIO WHICH WAS DEMOLISHED. THE STRUCTURE AND PAVED AREAS WERE EQUAL TO OR GREATER THAN THE PROPOSED NEW RESIDENCE AND PAVED AREAS. WE PROPOSE TO RETAIN THE SAME DRAINAGE PLAN AS PREVIOUSLY USED , WHICH WAS GUTTERS AND SPLASH BLOCKS. M& CA FILE NO I a ,a eas ecklist - Site Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: ;X&Lt 44�, -7 C1 tk Nw- e 2. Property Tax Account Number: 4 A -�_— o 00 — oo(.—_��00 Lf qq-t7g 3. Approximate Site Size (acres or square feet): S 410 4. Is this site currently developed? _!��yes; no. If yes; how is site developed? &Xllk- _70 Ir IN &,j V-_ 5. Describe0e general site topography. Check all that apply. Noe" Flat:' less than 5-feet elevation change over entire site. Rolling: slopes on sitegenerally 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: 1-4 0 ; Approx. Depth: 7. Site contains areas of seasonal standing water: to Approx. Depth: f What season(s) of the year? 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 urban landscaped (lawn,shrubs etc) )< 11. Obvious wetland is present on site: fq D ; mixed Rev 0.9 , 193 'Y90 - 19,4- City of Edmon& Critical Areas Checklist 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 a development 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, 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. With a signed copy of this form, the applicant should also submit a vicinity map or plot planfor 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 pertinent 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: Name \ Street Address 2:0M4 � W N 0( so City, State, ZIP Phone Signj�e Date e yl� Applicant Representative: 31Y'�— ?—'X)-fC-YC'C (3're�r4LOJ Name \3 �%3(jS- Street Address City, State, ZIP Phone siII&Ire Date I NOTICE: No warranty of accuracy. The -information shown on the attached map(s) was compiled for use by the City of Edmonds, its Employees and Consultants. The City of''Edmonds does not warrant the accuracy of anything set for ' th on these map(s). Any person or entity -requesting a copy should conduct an independent inquiry regarding the information shown on the -map(s), including, but not limited to, the location 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 -sha-11*1 be [ia-b-l-e for the information given on this map(s), nor for any one representation provided based upon said map(s). 8 9 0 - 1 9 C) - City of Edmonds . . r, RIGHT-OF-WAY CONSTRUCTION PERMIT Permit Number: Issue Date: A. Address or Vicinity of Construction: - 20424 79 Av W (9430428) B. Type of Work (be specific): Install NevwService C. Contractor: Washingtoa Natural Gas Compa-ay Contact: Frank Swan Mailing Address: 815 Mercer St, Seqttle, WA Phone: 224-2278 State License #: 98111 Liability Insurance: Bond: $ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. E] Commercial F] Subdivision El City Project Eff Utility (PUD, GTE, WNG, CABLE, WATER) F1 Multi -Family E] Single Family [:] Other INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut 0 Yes BNo G. Size of Cut: x H. Chargq�_$ APPLICANT TO READ ANEt#tGN /0 INDEMNITY. Applicant understands and by his signature to this application, agrees to hodn�eclity ofEdmonds harmless from in'Juries, 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 ofgra4ting' Ois permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED REST6R:4-ft0Jk ' FEES WILL BE HELD UNTIL THE FINAL STREET PA TCH IS COMPLETED BY CITY FORCES, A T WHICH TIMEA DEBIT OR CREDIT WILL BEPMOCESSED FOR ISS'VJNCF� TO ' THEAPPLICANT. Construction drawing of proposed work required with permit application. A-24 hour notice is required fdf 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 abovestatements and understand thepermit requirements and thepink copyof thepermit will be available on site at all times fbi- inspection purposes. Signature: Date: October 4, 1994 (Contractor or Agent) --"I- APPROVED BY: CALL DIAL -A -DIG PRIOR TO BEGINNING WORK *'C FOR CITY USE ONLY TIME AUTHORIZED: VOID AFTER 565- DAYS SPECIAL CONDITIONS: COMMENTS: RIGHT OF WAY DEPOSIT DISRUPTION FEE/FUND Ill: RESTORATION FEE: PERMIT FEE: TOTAL FEE: RECEIPT FEE: X-11 DATE: ISSUED BY - NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991 r Addendum to Cit of Edmonds y M R ght of Way Permit Applicaiion -Submitted by: MITCHELL S.-LANKFORD Engineering Aide Washington Natural Gas # .' -521_�5246 Z042-4- -7 9 A-V W F, IS-, 4 ZZ; I T P_ N/A- WNG to window (_F�yt e in depth Key: ur�0 -w- water -g- gas gas main -ss- sewer -,E)- water hydrant 0 water valve r� 815 Mcrccr St. (P.O. Box 1869). Sc4ttic. WA 98111 (206) 622-6767 C. City of Edmonds RIGHT-OF-WAY 6ONSTRUCTION PERMIT Permit Number: Lmue Date: 4, A. Address or Vicinity of Construction-aO"AA�A '79TIA 13. 1 ype of VY ux r, kbe speci i ic). - I 1-a - go 199 1 JC!A 6& 1 N-1-30 K_U:__�IUA� C� Contractor: PO,n,tLtact: Nf-_J)C:LJ Mailing Address:-:) NoNfj NAt—N 95 Phone: G:2c)- is2LS State License #: 0 i\1 O�>, 1J A, 9 6C 2 Liability Insurance: Bond: $ 1 D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. [3 Commercial E) Subdivision El City Project Kutility (PUD, GTE, WNG, CABLE, WATER) F1 Multi -Family >0 ingle Family F] Other INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut: 0 Yes 0 G. Size of Cut: x H. Chargq�_$ APPLICANT TO READ ANP SIGN or INDEMNITY.- Applicant understands and by his signature to this application, agrees to ho tke City ofEdmonds harmleskr�' J4Qr1 '1�, g claims of any kind or description whatsoever, foreseen or unforeseen, that may be ma& against the City of Edmonds, or any of its departAn'. or employees, including or not limited to the defense of any legalproceedings including defense costs, * and attorney fees by reason ofgranting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YE,4kR FOLIOWN�G ME FINAL INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FE#9_*1Lt,-RFy1ELD UNTIL THE F1JV,4L ST*S�4RJJA TCH IS COMPLETED B Y CIT Y FORCES, A T WHICH TIME A DEBIT OR CREDIT WILL BE PR OCESSED FOR ISS UANCE TO THE APPLICA NT. Construction drawing of p1bposed 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 available onsit t �l timc,or insp rposes. Signature: Jsc Date: C/- y (Contractor or Iff nt) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY APPROVED BY: RIGHT OF WAY DEPOSIT ZQ A5 TIME AUTHORIZED: VOID AFTER 430 DAYS DISRUPTION FEE/FUND 111: SPECIAL CONDITIONS: COMMENTS: DATE: RESTORATION FEE: PERMIT FEE: TOTAL FEE-�_ RECEIPT FEE: ISSUED BY: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991 FIELD INSPECTION NOTES Comments: Diagram.: (Fund 111 - Route copy to Street Dept.) CONTRACTOR CALLED FOR INSPECTION El YES Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: El NO 1476 PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY FXV. 7/57 LOCATION Q0+R,+ -791�', AV e� W C,011"N AREA POLE NO. Se 1/4 S T X7 R DATE ��-gL9-9A- W. 0. NO. REASON FOR WORK12,PL-C, 12 )0: POUC. P-t-AV 'SG(- ENGINEER ��eM OWG. NO. 01:�,T RIED !Fol?— _h M RAR-E)ER DRAFTER T), \_k0A_T U. G. NO. SCALE =1 od DATE WORK COMPLETED 1APPROVED I DATE PRINTED FOREMAN ENVIRONMENTAL ANALYSIS 0 EXEMPT 0 NOT EXEMPT FEES REQ'D YES 0 NO PARA. 18 1 TEM C PRIMARY OVERHEAD 0. H. U. G. COND.__ KV • RESIDENTIAL ADD CKT. FT. PH • COMMERCIAL REM CKT. FT. PH LEO# NET CKT. FT. O.H. U.G. COND. KV SECONDARY OVERHEAD BASIC FEE $_ ADD CRT. FT. PH os s— REM CKT. FT. PH NET CKT. FT. METER/CONV. 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