20901 83RD AVE W.PDF111111111111
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20901 83RD AVE W
6 9 0 - 1 9 13 -
City of Edmonds
Etf MI-gF-WAY CONSTRUCTION
PERMIT
Permit Number: L-01
Issue Date: 62 - 15 - 12
A. Address or Vicinity of Construction: - 20901 83 Avenue West
B. Type of Work (be specific): Install New Service
C. Contractor: WASHINGTON NATURAL GAS CO. Contact: Frank RwAn
Mailing Address: 815 Mercer StreetSeattle . Phone: 224-2278
State License #: WA 98111 Liabi lity Insurance:' Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applica�le):
E. r-1 Commercial , F] Subdivision El City Project FXJ Utility (PUD, GTE, WNG, CABLE, WATER)
F1 Multi -Family El Single Family M Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut El Yes [5allo G. Size of Cut: ,-) x H. Charge$
APPLICANT TO READ AW,.5[GN
INDEMNITY. Applicant understands and by his signature to this application, agrees to ha*l�d Ite City ofEdmonds harmlessftom injuries, damages, or
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claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the City of Edmonds, or any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings including defense cosLs, and attorneyfees by reason of granting this permit.
THE CO NTRA CTOR IS RESPONSIBLE FOR WOR KMA NSHIP A AD MA TERIA LS FOR'A PERIOD) OF 0 NE YEA R FOLL 0 WNG Zge Fltf4 L INSPE Cil 0 N
AND ACCEPTANCE OF THE WORK ESTIMATED RESTORA77ONFEES WILL BE HELD UN77L THE FINAL STREET PATCH IS COMPLETED BY
C17Y FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Department- 771-3202.
Work 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 regulati * ons as required by th� 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.
1__� /7
I have read the above statements and understatad,,Io-perniit.'r,e,,, _, ents and the pink copy of the perinit will be available
qairem
on site at all timesfor inspection purposes.
Signature: Date: 2214/92
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGMNING WORK
. ............ ......
FOR CITY USE ONLY
APPR 0 V E D BY:_ RIGHTOF WAY.- DEPOSIT:.. ....................... ......
.... .........................
..TL\4E.:AUTHORIZED.:.:.Y.OID::AF.'rER.. ��DAYS DISRUPTIOMFEE/EU.N.D.4.1 111�1..'�,..
RESTORATION::
. .. .......
..PERMIT.FEE:..
. .........
TE: _::::.x.ASSUED:BY:: 4X,I.���A���l.�,�11.11,lt-I��3,1�1.1,�I .44.64 .... 411ZI_
NO WORK SHALL BEGIN PRIOR
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund III - Route copy to Street Dcot)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
0 YES 0 NO
Date:
Date:
Eng. Div. July 1985
Submitted by:
20,--)c> I 0�� AV W
-2-V e) -E-�i-T --3w
,\�)��,WNG to window
Water main depth
unknown
11 gas main
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Right of Way
Permit Application
RIC�-kA,9,D HILL-AQ[)
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager - 9( d3 - I (D%
0 0 � g�)
Key:
-w-
water
-g-
gas
-ss-
sewer
-e-
water hydrant
0
water valve
815 Mercer St. (P.O. Box 1869), SeRnIC - WA 98111 (206) 622-6767
APPUCATION
The City of Edmonds STREET FILE for
SIDE SEWER PERYaT
NEW CONSTRUCTION E] REPAIRS 0
OVs7NER --- - ----- &,OiFelf 5.rp.414c. Y ....... ............................
(2411- qLC,, S-0,07w)
ADDRESS ...... Z014�Z.:7 ....... �ff&.A ....... 4.V4E..n.WE.LJ .................
9
11
EASEMENT No . ...........................
6i�) A-1 b /,
POO
CONTRACTOR ........... �2WAIC& ...................................................................... PERMIT No. cj ...
LEGAL DESCRIPTION: LOT No . ....... ............................. BLOCK No . ............................................
NAME OF ADDITION .......... Fadcle.T .............. :r,; . — -: 7 7#. P. e., * -, s .................. 0-,A� ....... Az).,) ...........
DATE-/ .706 ... jc....
PROVED
P 26 1969
.............. .... .....
NOTICE:
No warrantyOT aU(,uld�,Y.
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 Edm.onds does not ' wa rra nt the
accuracy of anything set forth on these
map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform-ation shown on
I it
tFe -map(s), Including, but not Hm* ed 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 ,--;ty of Edmonds nor its
111
ernp-1-o-yee-s o-r office-rs shal.l be lia-b'Fe for the
information given on this map(s), nor for
ation provided based
any one represent
upon said map(s).
CITY OF EDMONDS
Can PRospect 6-1107 when work
CIVIC CENTER— WATER -SEWER DEPARTMENT Is ready for Inspection. (No inspec-
tions Saturday, Sunday or holidays.) N2 3478
SIDE SEWER PERMIT
ADDRESS ................ Z99.0-1 ... ..... 8 3xid ... Ave.n_u!?� ... WeAt .........................
.. .... . ... ------- -- -1 ---- -- -- ................ __ ........................................................................
OWNER .................... Stanley Kerr
............... ---------------------------------------------------------- coNTRACTOR.... onwer
............................................................................
Perinission is granted -------------------- ... for ...... ----------------- days to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordhiances.
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 1/s will be permitted.
NOTE No. 4—Trenches in street must be water settled and surface of street restored to origina.] 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.
All,
A 4<f�,7- Z- 4�0'
CA FILEN0. (04
Critical Areas Checklist
------- ------------------------------------------------------
Site Information (soils/topographyjhyclrology/vegetation)
1. Site Address/Location: 20qD1 F3fd Pole V SdmO08 Wll� —mAp 6,r
T6
2. Property Tax Account Number: 5 0 0 0 9 — 0 o C1
3. Approximate Site Size (acres or square feet): -7 34 t
4. Is this site currently developed? _ZYes; _ no.
If yes; how is site developed? Hoose
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 IS% (a vertical rise of I 0-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
I 0-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: W 0 _; Approx. Depth:
7. Site contains areas of seasonal standing water: W C) Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain_q�j_ 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 meado shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: 000 q-.,.
NM
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AM.d&dag Rw IWOM
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Critical Areas File #: 2-0no - c ( (0 4
Critical Areas Checklist Fee: $45.00
Date Received by Dev. Serv. Dept: 14-110-6�9
City Receipt No: z 403
Date Mailed to Applicant: t 0 — (/'0-2nD0
CRITICAL AIRE-JAS 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.
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., s
.jLe �Ian, 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 Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
PLEASE PRINT CLEARLY
6
Owner/Applicant:
Name
2-ogo i �63rd �\\re W
Street Address
n-� o 0 06 W fA W-26.
City State Zip
qZS- -77)-;-73 SZ
T
Signaturl Z6 /00
Date
Applicant Representative:
Name
Street Address
City State Zip
Telephone
Signature
Date
d:receptiorblana/CACLHandout.doo Revised 411=000
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DATE
APPROVED.—
N S - BLDG. DEPT.
MY OF EDMO D
Building Official
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LMJBER/ FRAMING
Framing lumber: K.D. to 19% moisture content, graded per Std.
grading rules per W.C.L.I.B. or W.W.P.A. as applicable.
PLUMBING
ing contractor shall size all lines
& vents per U.P.C.
H.W. tanks shall be sized per industry standards. Max. temp. 120%
Provide 3/411 -diam. lines and spout to large bathtubs.
Contractor shall verify location & maintain reqd distances to
septic tanks & drain fields, and provide modifications to existing
systems as may be req'd by the Health Dept.
Exterior hose bibs shall have vacuum breakers
44
i�� T
WORK
ADDRESS:::,,24n<
OWNER Q�b4 OL
APPROVED DATE:
BLDG. OFFIC"'AL
R 4F'A E T H
RECEIVED
DEC 1 8 1992
PERMIT COUNTER
00�1