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20807 82ND AVE W
STREET FILE
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890 .'
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City of E&mon& .
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 Edmondsprior
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,
"Ile
M
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 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 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:
tj I CHL:E I �Aj EU,
Narne
e6 A WA q7ozflms�-x
4z
City, State, ZIP t Phone
Signature Date
AppUcaut Representative:
Name
Shed Address .
City, State, ZIP Phone
Signature
Date
CA FILE NO.
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: "k)tr07 A7A)-g zul� U), 260-40NIOS
2. Property Tax Account Number: ..S* 58 8 -ox - 0 �Q:b S-'
3. Approximate Site Size (acres or square feet): r-T
4. Is this site currently developed? -Zyes; no.
If yes; how is site developed? -*-�, �- tL
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
_jZ 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 tha n 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: W -; Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year? . AJIA
8. Site is in the floodway floodplain of a water course.
9. Site contams� 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
mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site:
Rcv01/M4
I
STREET FILE City of Edmonds
ffttb"t-WAY.CONSTRUCTION
(Y 9 0 . 1 9 4 -
U L 1 2 2 10-91 PERMIT Permit Number: 9/-363
ENGINEEIRING conto 12'- 11 - q Issue Date: / D -
:S -M wa I '- is -9
A. Address or Vicinity of Construction: 20807 82 Avenue West
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Natural Gas ComRany
Mailing Address: 815 Mercer Street,
State License #: Seattle, WA 98111
D. Building Permit # (if applicable):
Contact: Gary Swanson
Phone:, Gary Swanson
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. 'R Commercial E] Subdivision El City Project, [j] Utility (PUD, GTE, WNG, -CABLE, WATER)
F� Multi -Family El Single Family F� Other
INSPECTOR: INSPECTOR: f�C:;,( W�At-Tc-14-TT.-
F. Pavement or Concrete Cut Yes E]No $1) G. Size of Cut: 2 — x 4 H. Charge$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmlessftom injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, �ha�Qq;_�e' ade against, the City of Edmonds, or any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings i:ngchtdtfi' de/ense costs, and atto;�eyfees by reason of granting this permit.
Ci I
THE CON7RA CTOR IS RESPONSIBLE FOR WORKMANSHIP AND LS FOR -A' �Elkl OPIONE YEAR FOLLOWING THE FINAL INSPEC77ON
AND ACCEPTANCE OF 7HE WORK. ES77MA7FD RESTORA77ON FEES W�LL BE HELD UN77L THE FINAL STREET PATCH IS COMPLE7ED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESS4D��bl? ISSUANCE-46'TdE APPLICANT.
Construction drawing of proposed work required with permit applicatibn.'
A 24 hour notice is required for inspection; Please call the Engineering D�partxnent- 771-3202.
Work is to be inspected during progress and at completion. L
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 theworking day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signature: Date: October 10, 1991
(Contractor or Agent)
CALL DIAL -A -PIG PRIOR TO BEGINNING WORK
fa
NO WORK SHALL BEGIN. PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund I I I - Route" copy to Street Do
.pt.)
Comments:
I Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
.4
Eng. Div. Ju13
Washington
Naturald�OWII
A -W-gtcn E-ergy CoivarTy
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: Kerry Walsh
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager 995-6914
I
N
WNG to window—
�--Jj\.water main depth
unknown
2-11 gas main
cz- K4) of�') C-) 1-vs
(C' P)
--p UP
Key:
_w- water
-g- gas
-ss- sewer
water hydrant
815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767
NOTICE:
Nb--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 �Edrn.qnds 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 -m a p (s) , including, but not limited to,
th-e 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
e rn p'l o-y e e-s o -r o ffi cl e -r S -s h. a- 1. 1 b e Vi a. b.-II.-e f o r 11 h e
information given on this.rnap(s), nor for
ation provided based
any one represent
upon . said map(s).
VAPPLICATION
for
Tfie City of Edmonds SIDE SEWER PERYaT
EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS
6�76 4-11)
CONTRACTOR .......... w ..................................................... PERMIT No.
.. ........ ...... ............
OWNER ....... .......................................... . .. ......... .......................
ADDRESS. "? 47
-��o 7 dav wag.. LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
.........................................................................................
PA
NAME OF ADDITION AeAsr,.e.r ....... ,qo^f oos- VIPA ... IS .....................
............... .. ... ....... ...................... .... .......... ... . --------- .......
7x ;S
In
/00
�z
Approved:
APPROVED
NOV 3 1969
DATE .............
;Y --- - -------- -
CITY OF EDMONDS
Call PRospect 6-1107 when work
Cl V I C CENTE R — WATER -SEWER DEPARTMENT Is ready for inspection. (No Inspec.
tions Saturday, Sunftv or holidays.) N2 3512
SIDE SEWER PERMIT
ADDRESS ............... 20.80.7 ... ..... 8 2.n.d ... Ave.n.u.e --- We.s.t ..... ...................................................................................................................
.. .. .... .. .. .... .. .. .. .... .. .. .. .... .. ..
OWNER .......... 3�ArrY ... �PgUIA51 ................................................ CONTRACTOR ....... QYP!�R ........................................................
Permission is granted ....N.o.vember ... 3 ............... 19 ... 6.9, for ........................ days to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—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.
NOTE No. 6—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 appur-
tenances except to insert the pipe into the wye.