21032 SHELL VALLEY WAY.PDF14416
21032 SHEEL VALLEY WAY
ADDRESS:6�q LZ 164-4 -/ V(Zel Lt,�- fee -., -/
TAX ACCOUNT/PARCEL NUMBER: 1,17
BUILDING PERMIT (NEW STRUCTURE):
V - t
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: 0 Conditional Waiver 0 Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR: -
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #: 0
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:,
FOR:
WATER METER TAP CARD DATED:
LID #:
LOT: BLOCK:
LATEMP\DS'Ps\Fonns\Street File Checklist.doc
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APPLIC ION' job
ION'.PERMIT' �UoAjss
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NAA1 R hAME U..,
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SEE F.GINEERI'a ME.C. DATED..-
31 E44 SEE p,W ot PT REVie'. C. E C� LIST o
CITY AEM KS F,
OPP
ADQUkSS ETCH WE bUILDI G SUPK,f 5'.
'3/4
EMARKS
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Ails IN
Elk. Y:.
st 7 LICE"E Mu. t
Legal Do C loll It cj proPerly'. Include all easements
-01 lach our COD1,1151
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4
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NEW. rIESIDENIT
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14. wTq',equ,te'SeQdrate Def'Y'S610A.4
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Per m,t.A Pollcat�o]n:
Permit 0(i'lit"; Year - aovioec V.,QIK .5 gi4rteJVA�Rln 180 DaY
.. i�l lot SDOuse nifirs. ass-grtrand
qjicant, or, t-eha,l of,11's Of I ; I no and MAC
lgreas-lo,inoemn-ly. CO e
SuCCeSSofS ir, njq,es%. i ;Is 0111c.ais,
Affnitos jyj�� C.jy o! Eumon;3S. Was"InglOn-
""41oviei. anc agents tfoM any Ana'bil Clairnb to.
a . Icllecl,�I!Iom Mitylssuarice
hale,er nij,re. a�,Slng d"kil, -
$Mail no! , e , oeemeJ 10
,t This pt(M;t 1%,st,ange Ot It olo'S'ArIce co
modijj, j.ve Of feoyCe anv ieCuifement (Z' a,y C V ow:rance TO?kL A%j0j.*qT OU
C,�Y-s en-orce a- �,a nanCe 10.
not timil"I a"� way 1M."
j r me OVAL
I More * 0 Inis applic TTt-f4TIO:? ATION APPR
Dy acknowledge that I have tea A APPLIC.
rjecl, ant) that I am the o4ner. Of me duly
WormallOn given is 001 1 - :'.5 pt.—
n -The ov, at. I.agrae lb Ornpl) wlln cill, anJ. �hm application IS h0l A Permit
aulh6ilieo. agent .01 v and in COMC IMO..Ork authCtf:- tly.the Buil4ing. Ificial -or his
Clio
state laws regulating constfuClIO -oiat.cr. of the L&Dqf
1�loy 00 tn. Deputy: &no teas are gaid. nd iece,Pl is t.
ad there*. no-oo,son will 09 off i4t,ng to Vio,kmim,3 Compeoss. acknowledgeill-lin $Pace pro,,1ded
coqe of the State Or wash)ngt.on re
1ICIAt 5 61 TU.L
C111; -OFF
EDMOND
IRIS SITE tS LOCATED IN THL lITY 0 4.
EDMONDS LOCA6 SALE. S TA
OF
ON SHOULD BE CODED 31 OA
ATTENTT . '86 INd'OR STRUCTURE' YECLOW.'.`— lnsp'�00`
I I IL TO.USE OR OCCUPY A 1I.0 ORIGINAL. File
:I.T IS UNLA:WFL
FINA& irvSPECI ION HAS -BEErl KJADE AND AFIPAO\�AL OR
UNTIL A. IFICA-TE OF OCCU-PAKCY HAS. B�EN. GRANTED, UBC .'PINK . O-n6f GOLD A656160f
A CERV
CKAPt ER 3
CITY OF EDMONDS
ASSET INFORMATION SHEET
wl
N NEW
1:1 ADDITION
F� RETIREMENT
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION DEPT. NO.
c, -3 2- V4-L-L- 1?-( 4wo
"PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
*PROJECT NUMBER w 1 10 ? -7 --
PROJECT COMPLETION DATE
COST '?
B. A. R. S. ACCO U NT N 0. 1-f a, - L/
ESTIMATEDLIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
STREET FIL
KI DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT -
0 G.L. ENTRY
REFERENCE
DATE
VERIF , IFIDeOY
PROCESSED
BATCH NO.
INITIAL
(yp')
DEPARTMENT FILE
Tele-Vue Systems, Inc. aka AT&T Broadband
Replace Drop @ 21032 Shell Valley Way
Open Trench and road bore under Shell Valley Way including sidewalk for
approximately 48 feet mA in the ROW for replacement of the damaged direct
buried service drop (no hard surface trenching).
2. Install new conduit @ 36".
3. Backrill: Native material, if allowed by jurisdiction and compacts to 95 %.
If not: Import materials compacted to 95%.
4. All disturbed areas will be restored to existing or better condition.
5. Clean and sweep job site during and after completion of project.
00 77
C14
0
Cq Road bore
Driveway 27 feet
including
All Bark Set Carsola
box
Gravel
Driveway Open —
trench
eq
fet-4.
Existing
pedestal Open
trench 12
feet
All Bark
Driveway
t
N
Not to scale
AT&TBroadband
. AT&T Broadband
Trenching and Restoration
* Install conduit at 36-inch minimum depth.
Backf ill: Native materials if it compacts to the
City Standards. If not, use import materials
compacted to 95%.
Restore all disturbed areas to existing or better
conditions.
Clean and sweep project areas during and after
construction.
Erosion Control: Please see attached details if
drainage ditches and/or curbs and gutters are in
the project areas.
j
�irenc
Depth =
0- 36-inch minimum
Compatible w/
other utilities
Shoring required
at 4-ft +
Pavement Cuts =
W T-cut I -ft wider
than trench
W Neat -line saw -cut
or ackhammered
edge
`L.,Kules
If curb and gutters in project area:
• Filter bags will be placed in catchbasins downstream of work site, and
• Small check dams of pea gravel filled sandbags will placed within the
gutter upstream of the catchbasin.
Traffic Control Plan
1. The standards and guides of the latest version of the MUTCD or the set-up as per the City of
Redmond Code shall be followed at all times.
2. A copy of the Permit and Traffic Control Plan shall be on -site with all contractors during the
project.
3. All contractors will avoid parking on sidewalks and shoulders and will take the lane and follow the
proper traffic control set-up for the given situation.
4. Pedestrian access shall be maintained through or detoured around all worksites.
5. Please find attached the traffic control plan for the various types of work sites that will be
encountered during the project.
6. Flaggers will be used only when all other methods of traffic control are inadequate to warn and
direct drivers. Only licensed flaggers will be used on the project.
7. If situations occur when questions arise about proper traffic control set-up the solution will be
determined in the field with the AT&T Construction Rep. and the City Inspector.
I
j:
a
Tr i[,ii
Fla
R"'
Work along the
road requiring
flaggers:
cone -off work zone
with tapers and place
required signs before
and after flagger
stations.
Flagger Station
MIN
M-FTM&
9r
200 FT WL
SOM FT
FlaggerStation
200;T M/L
dL, I
200-FT LV*LA
.96 4
2M FT MIL
4,
_77
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Us
UMBER oo-`�
8302
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ADDRESS:'
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I ILI CE-St N U. SEP.
Cliv ICEPabE NUMPLA
.�ga.iDescr,pl.onQ1 PVOpe,ty - inc,lude all easeinjImls,
0 t)GIO oratipth OUT.COPles
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LID" 0
161
PL1euC AiG,Y OF WAY PER OFFIC?.1L.STREEf M AP.
,
- to - �ifooiiio`:A , �,O :
PROPOSED
RIGHT OF WAV CONSIRVCTIO� PERYIT AEOU'Pil)
STREET USE PERMIT REOUIPILD: . . '
I S . Ir E?4iG1`IEEQI-0.Ao( MO DATEd' Z'
uf,mw otfIT AfvIEW OfiCK LIST. -0�
FIEW
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AREA
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C'm GUP
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LOAD,
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ILE
L
!:IECI FEE
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Tnis,.�ormil Covets *PII� 10 D" cone on.o0vale ONLY.
G-INIG"Ll
Any.construct�6n:6n the OaDfic doms"n (cuft`u. Side
..-CriVisoovays, marquee5, e!c,) wfil.,requife sociarala Porn, issio
Pefm!,t qi�licallon.
I
PETIT, L rrTiot::I'Ye,,. 'p,ovicia Work is Smile c Wit Ilin'180 0 aY5
"A cant; on Donall of.n,6 0, met sciousii. nelors..ass,gns and
: %PSIG'.. I', To
apoe, to r,,doV,,,,no,1yT Catinl! 'no -Ill
0 herr.jls�3 Ine. Coy o! - Edm.roa, on .15 -.oslicialsk
Tic all claints
agents litim ant, a. oc� qtipages
u
of
=I
emilloiTees. and
halevet.tlawte, �risigj di Toc,ilf or inCireMy from ine,sSojanCil
of th�s'poirrjlj 'Issuance of this oafmij'snatt not tiq doerpe(3
to
quiftiment cl 'ar;y ck:y ordinance
modity:..&,,e.o, recUipe any ores --looly,to
on'
rib, I,rn,i n.any ay Ino'city,3 force an, orc,nofnF8
TOTAL
AMOUNT DUE.
0,
s'A",
h4ret)y dCF:n6wIe0Ce,6&T I nave reaO.MiS aDDIlCal'O 'not the
AiTENTION
APPLICATION APPROVAL
lntorrrtst"d� Given -is correct; and that I am the Q*ner. or ins dot�
authorized :gint ot-imis agree to.comoly with cj�y and.
r gulafinj Constructidn:1a hojil; doing the Work authori..-
FIE
IES
',u ",G`T.,
This application is hot a permit. until
'signed Ey.the.Building OfIlCial or his
o portion will, �6.emp!oieo jn-�Jolajson of ins Law,
ed thetaby.:n "a compensa.
'Cobb of lhe'Stite of Washington rot to g,jo Wo!knIen
c.. oTe:).
Deputy; and Ito areipaild, and receipt - is
'acknow g�.Oins cosprovided.
t.
Ticri Imilwarj(4.
oFfC.A S S IGAIAT�At
..'CITY
THIS� SITE,IS LOCATED, IN THE CITY
OF :EDMONDS. LOCAL SALES TAX
715-2525
*ENTj0 N'': S40ULD BE CODED 3104.
ONLAIloo -T . 0 0 CUpy jo� 13UJLDING OR STRUCTURE
':�IT IS SE OR-OC DE AND APPROVAL OR -
"YINSPECTION"HAS SEEN MA
ORIGINAL.- File YELLOW - inspector
-UNTIL:;k; FINAL BEEN, G . RANTED.
A; CERTIFICATE, OF OCCUIPAI`�CY HAS� UBC
PINK - Ownef, G bl.d Ajilessof
CHAPTER 3.
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FILE
YOST PARK
51.&5�
451
16,
71 ME
#21032
25'
ORIVE
RECEIVED
MAY 3 1 2M
V;o
VEMOIRMT SERVICES CTR.
CMf CF EDMONDS
PLOT PLAN
1,.=30-0.,
5WENSON KEMOPEL
21032 5holl Valley Way
ZONE
S ETB A
F N T
u 1 11-1 ER
HEIGHT
PLOT PLA1,1
MJA
7,L AM /-/2c?..
co
'S C L L E
L: L I- E q
p UR
P Ve C /-/,Z) S F- R
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All 0 Z) kv /9
s C �QL Ic / �- .2 0 /
No
FOR -34 Alk
D t
at
r
4.
DISAPPROVED BY
, A ROVEDEly:
vvin 710i -A
Datt:
te;
'Date,
. . . . . . . . . . .
As-ENjivi
for
The City of �.Edmonds EASEMENT. NO, ................ I -------
SIDE SEWER PERMIT ......... 7C
NEW CONSTRUCTION REPAIRS E] LID ---- - --- ASMT. NO.
OWNER ... ROMF-A-&ND ------ 40.MV-5 ....... I m rl . ......... ...... CONTRACTOR ....... PERMIT NO.
JOB� ADDRESS LEGAL DESCRIPTION: LOT NO. -------------- I ------- ---------- BLOCK NO . .. ....... EDMOrNpS
PLMT,
................................................................................................ ............. .................................... -------
1 .7 - - - - - - - -- - - - -
NAME OF ADDITION AAAQA-lE,. .... C-l=?,F—FK ------------- ............................ ------------------
Tbvvr-st Sax
3'bp 5-0p
2-1032GRELL)JALLF-VVY C.CL WYE C-06W'fE
il4crp
4!'lm'V-c-- rn W^T"
LoT 0 me-Mit
IX
9'
r mo�smjc- =i4 scmvK-rr 1: OP
Annroved:
DATE........... By—�. . ....... ..................
E ILL I i ---'
ZONE
SETBA
rICKS:
,.r)NT
0 1- E R-
HEIGHT ol�l
X
1-Y
mr
PI-OT PLI�IV
P'L A Al
co
'S C L L E
F_ L i
p I/ le A/A _51 ICE R
F,Ao,rd—
�z
en:
1:A
f- D /t// 0 A,1 2) -S- / KI /9
-51 c lqL C / 1�_ .2 0 /
STAR67ARED DRAINAGE PLAN
CATCH BASIX:
MM * I S-30 (0 0. TltrLNCW LWNGTH
WMUA L)
A
U
(00
TltrLNCWLWNGTH
LA
.............................. . ..........
-MIG. UW1Wr
L;;IL
6� PIEPF PIPW CAP
G"TEE W/ 46" LONG LEGS
SYSTEM CROSS—SECTION
-rP,F-NCVA COVER -
3/4 WAS VA ED
GRAVEL
6" DIAM FERF P1
TRENCH CROSS—SECTION
APR 2 11983
INFILTRATION SYSTEM
PAGE I OF 2
for
location
2�
plan by
phone
date
DESIGN DATA
Trench Perc LF per Imperm Trench
Number Rate 1000 sq.ft. Area Reg.
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).
11171 171 = a v; I I I a I Vil I
(address) f/da tp)
0
Street Right -of -Way Exist' REQD
Z
H
Access Easements Existing, REQD
Utility Easemient Existing
_REQI�_
Lot Per Subdivision Pla 01 ?)---4'ZXAssessor 14ap
Site Plan Checked for Accuracy— L/ W?
Underground Wiring Reqd._
6-4
0
Check Accuracy ol?gal Descrip/Vion /7/,-
Z
Review b 111"d46 Date
Y-----74
W,
1 / / .g
Existing Water Main Size -
Water Main Required
Service Line Required
Hydrant Size Existing_ -5A
W
Hydrant Reqd Per Fire Code Size
U3
Detector Check YSeter Reqd.
Cross Connection Inspection
Fire Department Comnents
'dater Meter Reqd - ' >
Review by Date
Septic Tank Design Approved Date
Septic Tank Permit Reqd- Z/ Pe it
rm NW
/Z
Sanitary Se%,nr Availability Proj*.
Drawing No. File No.
Side Sewer Availability Lih 161
Sanitary Sewer Connection Fee Reqd.
:x
Review by Date
w
Open Ditch Existing d.
Culvert Reqd._ Size
te.
Catch Basin Reqd. Indicate an Site Plan
Shoulder drainage maintain collection on swale open runoff
W
Manhole reqd. Indicate on* Site Plan
Soil Conditions d Ground Water Field Checked
Da e
Review b=, t
Revised: lvlO-1977
Page 2
Revised: lv 10-1977
00
00
DATE
MEMO TO: Building Division
Planning Department
FROM: Engineering Division
Publ ic Works Department
SUBJECT:
After review of the subject Building Permit application, we 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%
Backwater valve required if downstairs plumbing is below elevation of
upstream manhole.
6. Water and sewer lines to be separated by 10 foot minimum.
Fil
BD 6/82
ONE
A
SETBI-1
CKS:
PLOT P/-,47/,/
U
H E I G H T
Cli
17
00
"S C L L E,3
,T,C L L E
p VIP c A/A -17 r_ R
E c R E E
A//
r
-) .20
PUBLIC WORKS DEPARIONO
Single Family
BUILDING PERMIT REVIEW Multiple
Commercial
BUILDING ADDRESS C�,2/0,:f�6Z 1,V7P// 0011-ea AJOL/
BLDG. DEPT. SUSPENSE*DATE
INITIAL
DATE
ZOUTE: [I OFFICE ADMIN. — PUBLIC WORKS
LOG IN
0 CITY ENGINEER (check)
C1 Access Slope and Vehicle
Access
11 Drainage Plan
E]Street File
OLegal Description
OQuit Claim
ElEasement
13Calculate Sewer Connection
WATER/SEWER DIVISION
13Determine Meter Size
DComplete Building Permit
Review
STREET DIVISION
13Complete B uilding Permit
Review
[JOFFICE ADMIN. — LOG OUT TO
BLDG. DEPT.
r. in 1= M I= a. M51MIM I MOM = on = on
0--B-UILDING PERMIT APPLICATION (COMPLETE)
3'2 COPIES OF SITE PLAN 3
2 COPIES OF FIRE PROTECTION PLAN
(PREVIOUSLY REVIEWED BY FIRE DEPT.)
COPIES OF DRAINAGE PLAN 14ITH CALCULATIONS
REQUIRED BY SUBDIVISION 0
GREATER THAN 2,000 SQ. FT.
IMPERMEABLE SURFACE 13
LESS THAN 2,000 SO. FT. []
1
21 ,ClfECf( ZONING REQUIREMENTS (SETBACKS) �112- M
V-1 COPY OF ENGINEERING CHECK LIST
,0 1 COPY OF PUBLIC WORKS MEMO
MULTIPLE OR COMMERCIAL
YES (ATMCH �COPY 'OF ADB APPROVAL INCL. ALL DRAT,1INGS)
NO
SUBDIVISION — YES[] NAM
E
DATED—RE-W—RDED
NUMBER
NO (ATFACH COPY OF REQUIRCIENTS)
-.�HECK SEWER DRAWING AND ATTACH COPY
IS DEDICATION REQUIRED — YES[] (OBTAN nUIT CLAIH)
CI 1Y CODE
NO,Z]
,bIDOES CITY HAVE EASEMENT ON PROPERTY�Z
YES[:] (ATTACH COPIES OF DRAWINGS)
NO
A�CHECK LEGAL ACCESS INGRESS
UTIL�ZES
E
YEM YES
NO [3 NO [3
11AS2SEWER ASSESSMENT BEEN PAID
L.I.D. NO.
PLAT NO.
SUBDIVISION NO
IF�,4ULTIPLE: INCLUDE NUMBER OF UNITS
IF,IPMERCIAL: INCLUDE NUMBER OF FIXTURE U14ITS
0
lalmoirm men 0
City of Edmonds omrn riurmitNo: a
AIGHT-OF-WAY CONSTRUCTIONTERMIT IssueD, at,,e:' OF
A. Address or Vicinity of Constru I ction: Vo I I'? W W a L4
B. Type of Work (be specific
-:she.i I va o ui
LA
'C. C;ntracto OelMjjoc
Mailing'AddresplixV,
PA"
— �1 _. A I —
StateLicense#:_ Liability Insurance: Bond: $
_V_ I
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. Commercial Subdivision City Project El EUC (PLJD, VERIZON, PSE, AT& ][,AVWD)
Multi -Family Single Family El Other 0 do
INSPECTOR: V-1
x
F. PAVEMENT CUT: El YES NO G. SIZE OF CUT
CONCRETE CUT: YES NO
INDEMNITY. Applicant understands by his/her signature tarihis application halshe holds the City of Edmonds harmlf ss from
injuries, damages or claims of any kind or description whatsqever, foreseen or unforeseen, that may be Made against the City of
Edhionds or any of its departments or e?nployees, including bui qot limited to the defense of any .19gol proceedings including defense
costs and,attorneyfees by reason ofgranting this 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 RESTORATION FEES 97LL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCES#D FOR ISSUANCE TO THEAPPLICANT
* Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
+ Restoration is to be in accordance with City codes. Ail street -cut trench work shall *be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEPTIONS.
# Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ TiIE ABO VE STA TEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND A CKNO WLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Signature.
e)-,eo,
(Contractor or Agent)
Date: 7-
FOR CITY USE ONLY
Approved by:. MZMAW Right-of-wayFee: __)0�f
Time Authorized: Void After % C> 0 _2_ Disruption Fee/Fund 111:
Special Conditions: V, 4. AJ W,?= CJJ�J kestoration Fee:
OjGffj��JN)(% -rO U�P_ (-?— TotalFee:
11� S1ftDkLX_ J� Qft4Aft61L'D/ Receipt No:
IL MO%tk-, aOLft Ck, I �J fU LL L-S kV)TJfjA Issued, b y F
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)
FINAL APPROVAL OFPERMITTED WORK.- Clkima Petini� - DATE: IdI01077
Inspector's Signature rS
-6)cpir,_� cyl 10/11/6-2— ot)
For inspection requirements see Engineering Inspection Information handout.
NO W01M SHALL BlJ;1N iiuoiz i,o i)i,�izmrr ISSUANC171
DAMy Documents\Forms\EngnfnB�ROWpermit—.doc