20703 80TH AVE W.PDF111111111111
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20703 80TH AVE W
.4 A
CRY Of Edmonds
Critical Areas Ch* ec'klist
'Me, cdtical A=as ClImuist contained on
this fornt is to be fillod out by any pcmon
& ---. a Developmmt permit
Application for 4he City -of Edmonds pdIDr
t* hiOw cubmiftd of a development permit
to die city -
"he Puqx= Ofthe Cheddist is to —able
City staff to dacruinic Whether my potmtjal
Critical Areas are or may be present an the
sabject propaW IhO information needed to
COMPIC(c dw Ch=Mist should becsily
'a
"M ble fiam Observations -of the site or
daft available at City Hall (Critical Areas
inventories'. maps, or soil surveys).
An zpplicant� or his/her representative, zaast
fill out the chocIdist, sign and date it.,zmd
submit it to the City. 1he City Will review
the chocidist, a precamory site visit,
and make a determination ofdle subsepent
stcPs n0ccssaLY to complete a development
Permit application -
With a signed copyof this form. the
aPPlicant Should also submit a vicinity 132ap
ofthe parecl Vith cuou
'gh detail dw City
staff canfimd and identify the. =bject
parccl(s)- In addition, the applicant is
encOuragod to include any other pertinent
information or sbidics in conjutiction with
this Checklist to assist staff in completing
their preliminary assessment of the site.
I have completed the attached Critical Arm Chccldist and attest that the answers provided -arc
factual. to the best of my knowledge (fill out the appropriate column below) -
Owner/ Applicant: Applicant Representative:
WA IJA,z
M=c V I
Ownef)'/
Title -
� J00b V -fk
Street Address
VmIrril 1')," q2W
City. State. Zip ' Phone
Wa
Td - 9 - &- ; 4 ol
Name
Title
Street Address
City, state, Zip
Signature
Phone
Date
Celtical Areas 'Checklist.
Site Information
Project Name: - P.01.1alk.t Sf. permit Number.
Site Location: c AVE 0 Property Tax Account Numb
Approximate Site Size (acres or square feet): .. 5-0 5,a4-
Have you filled out a Critical Areas Checklist for a p4nt an this sitc; before?
Gemeral Site Conditions
1. Has the site boen cleared or logged? k Date of most recent action:
Soils I Topography
2- In the Snohomish County Soil Survey, what is the mapped soil type(s)?
3. Describe the general site topography. Chock 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 fect over a
horizontal distance of 66 fccL)
slopes presenton site of more than 15% and less than 30'Yp ( a vertical rise
of 10 feet of horizontal distarim)
Steep: grades of greAter than 30Y* present on site.
C.�mmcnts
HydrologyfVegetation.
4. Site contains areas of year-round standing water
5. Site contains areas of seasonal standing water: 114 -- —Approx- Depth:
6. Sitc is in the floodway t4 c:;, floodplain_______9f a watercourse.
7- Site contains a creek or an area where water flows across the grounds surface? lqc�� flows
are year-round? Flows are seasonal?
8. Site is primarily: forested - meadow shrubs _; mixed
9. Obvious wetland is present on site:
10. Wetland inventory or map indicates wctland present on site:
11. Critical Areas inventory or map indicates any Critical Area on site: �+D
Oetermination- -Number
Rev'3127192
)r.GtY V�f_-Clni.ly.
Stua U.re-quip-e
Revie,
er
�12nncr ate
46LIC NORKS DEPART= CHECKL10 2��7 Date
KiHMING PER,1IT REVIEW .1
0
Z
1-4
Z
F-4
U
Z
W
E-4
k A -1-2-
Street Right -of -Way Existing 7'e4 c: > REQD &V�g
Access Easements Existing REQD
Utility Easement Existing REQD
Lot per.Subdivision E3 Plat AAA11--d AssessorMap !�R See —
Site Plan Checked for Accuracy
Underground Wiring Reqd.
Check Accuracy of Legal Description
Environmentally Sensitive Area
Environmental Checklist Reqd.
Flood Hazard Zone
Shoreline Management Area
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Existing Zoning Per Code
Anienities Design Board Approval Reqd. ADB # Approval
Board of Adjustment Approval Reqd.
Review By: Date: C--lia"46
Existing Water Main Size
Water Main Reqd.
Service Line Reqd.
Hydrant Size Existing
Hydrant Reqd. Per Fire Code
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Comments
Water Meter Charge Reqd.
Review by:
bepr-3-c ianK Lhesi-gn Approvea
Septic Tank Permit Reqd. _
Sanitary Sewer Availability
Dral4ing No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
Review By:
Size
Date:
klqj���
Date: '
Permit No.
Proi -
File No.
Date:
n�
0 0
-A-2 S-M-M-8-1
Open Ditch
Culvert Reqd. Size.
P� Catch Basin Reqd. Indicate on Site Plan
0 Slioulder drainage n-kiintain collection on swale open runoff-
0
C
I
u
,e
1
t
v
c
TP�Ca
0 Shou
U)
1,1-inhole reqd. Indicate on Site Plan
S j
oil Conditions and Ground Water Field Checked
Revie%,l by Date
Street Paving Reqd.
Curb and Cutter Reqd.
Sidewalk Reqd.
Curb Cut for Drivevay Reqd.
P4 Right -of -Way Construction Pern-Lit Reqd.
H Bond Reqd. for Public In-provements
Street Nam Sign Reqd.
-qd.
.10ther Signing Re
Pre Permit Site Inspection made on
0
BY: SMER
TAlATER
U)
STREET
ENGINEEPUNG
0
P4
P4
Pq
Special Rcqi_Lire1Tk-_nts listed in mew to Commaity Development Department,
Building Division
BY Date
All itei-ns filled in on Building Permit Application
BY
Drawings Stamed and Notations Made
BY
Approved by Public lvlorks Deparmient:
Revised: IV 10-1977
Date
Da*te
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 Edmonds does not warrant the
accuracy of anything set for ' th on these
map(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
-fh-e -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-oyee-s o-r officle-rs -sh-a-111 be H-la-b-l-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
APPUCATION
The City of Edmond for EASEMENT NO - --------------------------------------------
8- T EET FILE SIDE SEWER PERMff
E NEW CONSTRUCTION 0 REPAIRS LID NO. _J _ASMT. NO.
CONTRACTOR:�
-------------- ........ -NO.
OWNER --- - -------------------------------- - - -----
_-------------- ---------------------------------- PERMIT --------------------
JOB ADDRESS ----------------------------------------------- :.... LEGAL DESCRIPTION: LOT NO - ------------------- ----_----------_ BLOCK NO - --------------------------------------
APPLICATION
The City of Edmonds for EASEMENT NO - ----------------------------- _ ------------
SIDE SEWER PEItAff
NEW CONSTRUCTION [Ej,- REPAIRS 0 LID NO - ------------------ - ASMT. NO. --- -------------
OWNER ---- ........ -------------------------- CONTRACTOR --- jg.0-�.
--------------- ---------------------- -------- PERMIT NO.
JOB ADDRESS ---------------- -------- U ..................... LEGAL DESCRIPTION: LOT NO. —
... ---------- Y -------------------- BLOCK NO . ........
--------------------------------------- --------------------------------- ----------------------------------------------------------------------------------------
NAME OF ADDITION .......... A125?h ........ 14� ... -----------------------------------------------------------------------
-� 11"&
'?0-1
c al
Approved:
DATE-------------------------------------------- By
E6
. . k
City of Edmonds
' 0'
RIGHT-OF-WAY CONSTRUCTION
raiff FILE PERMIT Permit Number.
J
Wue Date: r
z 7
A. Address or Vicinity of Construction: 20703 80 Ay. W,
go b. lypeol Wo—kWspecilic): Install A rE IP Mnin in go A11- u f,-- ga's
to 323'S c/1 of 206 P1. SW Inst. 5/8r PF TP Ss-rj� 1;0 90A03 80-Av. S
Per Attached Drawillg: V4ZIIJ7
Contractor: -Washingtou Nat'l. Gas Co. Contact: Frauk Sumn
MailingAddress: 815 Mercer St -,Seattle WA Phone: 224-2278
981H
State License #: Liability Insurance: Bond:$
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. E] Commercial El Subdivision El CityProject ;@xUtility(PUD, GTE, WNG, CABLE, WATER)
F] Multi -Family ER SingleFamily F] Other
INSPECTOR: INSPECTOR:
2 4 YT d-
VVLll,-Lkt %J1 IL�l L=r L L-ja-
-T-1--cut)
APPLICANT TO READ AND �SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hoo �khe qty ofEdmonds harmlqsqf
rQm injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be mad� against the City of Edmondl, 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 FJ�ES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANC� TO THEAPPLICANT.
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
available on site at all times for inspectiGn-virrPoses..
Signature: Nov. 4, 1994
Date
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: Vj � -� � tAAA
TIME AUTHORIZED: VOID AFTER `-)fAn DAYS
SPECIAL CONDITIONS: tv 4, —
COMMENTS:
I 171WA
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND Ill:
RESTORATION FEE:
PERMIT FEE: - qtg . "D (:)
TOTAL FEE: -
RECEIPT FEE:
ISSUED BY: -
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. I)iv. 1991
FIELD INSPECTION NOTES
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
El YES
Date:
Date:
\PJA-fe.�Z,
�30-r f:outlr.>
NO. DESCRIPTI(
iREVISIONS
I
NOTES: EDMONDS
2.) �IZLD`LOC ATE ALL UTILITIES
CALL 1-800-424-SSSS '
48 HOURS BZFORZ DIGGING
2.) INSTALL LOCATING WIRE OVER
ALL PE DIRECT BURIAL PIPE
3.) INSTALL A ONE POUND ANODE FOR
EVERY 1000' OF LOCATING WIRE
4.) SURVEY IS NOT REQUIRED
S.) MAINTAIN A MINIMUM OF S'
HORIZONTAL AND A 31 VERTICAL
CIMUkANCE FROM ALL CITY - '
UTILITIES AND APPURTENANCES
6.) CUTS IN PAVING ARE SHOWN AS
7.) CUTS ANTICIPATED
8'. COMPLETE EXPOSED PIPE CONDITION
REPORT WNG FORM #S63.13 (D-1)
10
8
7
6
4
3 5?-- 0 o ( Ocb 0
to— oc >
,jESCRJP7'l0N S7C)CK NC,
BILL OF MATERIAL
PERI�,`;TS
p Lo --3 (.c,
A'rl E A:
TA X COD E
czacava- -exam=
0. C,
NaturM Gas"--'�
20-703 AV W
DATE BY APP'D CHK[j- O.".nert4s,
SCALE. t" �'5&
94, IR
RR
JOB
to /2-7 71� DRAWiNG
App.
L--�j f
e--) 4-2, -7 /1
NOTES: EDMONDS
\rjA-vg;Iiz' '441'VF's
IN 0. DESCRIPTION
REVISIONS
1.) FIELD LOChT2 ALL UTILITIES
CALL 1-800-424-5555
48 HOURS BEFORE DIGGING
2.) INSTALL LOCATING WIRE OVER
ALL PE DIRECT BURIAL PIPE
3.) INSTALL A ONE POUND ANODE FOR
EVERY 1000' OF LOCATING WIRE
4.) SURVEY IS NOT REQUIRED
5.) MAINTAIN A MINIMUM OF 5'
HORIZONTAL AND A 3' VERTICAL
CMJLXRANCE FROM ALL CITY
UTILITIES AND APPURTENANCES
----- - ---- -
6.) CUTS IN PAVING ARE SHOWN AS
7.) 1 CUTS ANTICIPATED
a.) COMPLETE EXPOSED PIPE CONDITION
REPORT . WNG FORM #563.13 (D-1)
10
9
8
7
6
4
3
ev- CAF'
5?-- 0 o Cos,
Oc_� cvc>`D 4,z?
PV- 1-tev_-
7 E V,
GU 777-
_;:`iP_
�10N
N(,
BILL OF MATERIAL
4 S>E- - -Zc:) - -_-7 - 4-
T Lo -a. - (c,
--4PLA
0P tV A I coo, - c,2iE5
A --'I Z: A
92=747cm
a
wwtdngwn
Natura Gas'�
D P.
-ro ee*kve,
20-70 3
AN( W
RR
DWN: K le, /94,
i jOB
DATE "D C H K D � 0. t o -2- -7 -,DRAWING
f
SCALE. A P c-) 4.2-
t'lo-r f:-ouIs4,r_>
NOTES: EDMONDS
.2.) FIELD LOCATZ ALL UTILITIES
CALL 1-800-424-5535 *
48 HOURS BEFORE DIGGING
2.) INSTALL LOCATING WIRE OVER
ALL PE DIRECT BURIAL PIPE
3.) INSTALL A ONE POUND ANODE FOR
EVERY 1000' OF LOCATING WIRE
4.) SURVEY IS NOT REQUIRED
S.) MAINTAIN A MINIMUM OF 5'
HORIZONTAL AND A 31 VERTICAL
CLEARANCE FROM ALL CITY
UTILITIES AND APPURTENANCES
6.) CUTS IN PAVING ARE SHOWN AS
CUTS ANTICIPATED
COMPLETE EXPOSED PIPE CONDITION
REPORT WNG FORM #563.13 (D-1)
i 0
9
8
7
6
4
:)UA.N7
BILL OF MATERIAL
4 S S>F_� - -�O - 2_77 - 4—
A T, I Lo --3 — ce,
0 p M"A p
AnZA
J�� - a 2,t
ACM220-49ME"
lc� ' E*
X CCD
?-13 - -D 4-
20-703 A,\ t W
le, /94,
T I CHK D:
NO. DESCRIP'l ojN. DATE i BY APP-D 0. r3el t4 2- 7
REVISIONS SCALE. 1" 150' APP-
R R p,
tcjB
DRAWING
954-2,1-13_7