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21218 SHELL VALLEY RD.PDF111111 lill lill 13057 21218 SHELL VALLEY RD 00 ADDRESS: TAX ACCOUNT/PARCEL BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) CRITICAL AREAS: DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: DETERMINATION: 0 Conditional Waiver E] Study Required n Waiver PERMITS (OTHER):. 4�76-- 7n��Z�6 :2� 122961-L-1) 111�11 , PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: x SIDE SEWER PERMIT(S) #: f�-�7 GEOTECH REPORT DA STREET USE / ENCROACHMENT PERMIT #: FOR: WATER METER TAP CARD DATED: OTHER: L, U, LA�), / ,f , �- F5 I /Zf5- LATEMP\DSTs\Fomis\Street File Checklist.doc I - - .�­_ — - - ' " _' ' - - ' ' - ' BUII�DING')-EPARTMEMT Appli ... It Fil USE i,cr.MIT Z 0 N Z , vy L, PNAIT APPUCATION Iiiside Heavy Lines JOB ADDRESS N A R,�4 1` 0 NESS iL C7)l LEGAL LOT LOT YES 140 r7 X 5 1pj�1'11" NO, I z gc2x�_�� 0 z - �, __ 4 C IrELEPHONE NUMBER VARIANCC OR ADO NO, CONO. USE NO. 7T-6 4/UC— ONT -31 SIDE OREA Z1. N 4P ALLOWABLE IPRO OSED SIGN AREA ISIGN AREA J, W ADORCSS REQUIREME. 2,19,L lc, ZfITY TELEPHONE NUMSCR VLANNING DEPT. PPROVr.L DATE F2 L L�_� �"AMIZ STREET R/W 4o C1 - EX ISTING STREET R/%, FT. ocriciEN,:Y THIS PROPERTY COMP. PLAN S '. R1W / 0 FT_ FT. LD 0 < -iCITY PHONE NUMBEP RE.AI`KS Driveway slopes not to exceed those z 0 indirptpd on Stanelar� Dyig. 14r). 03 al U STATF LICCNSE NUMBER j�l`ry LICENSE NUM13ER k ",:a?at STREET AND/OR UTILITY D YES ccNal ffescriptGon of Property (Show Below or Attach Four COPiES) WORK REO'D WNo 76-f UNDERGROUND 53�y E S WIRING REO'D NO % z -I, 0 J1 r-, BY YES rE-MIT N- E�F�7 SEPTIC SYSTEM APVVD By CI-Y EP N 0 1W W D C M`L RE DENTIAL GAS LINE ��S, I I1,RESIO"TIAJ SIGN El A-E# DEMOLISH [] RETAINING 'ALL ALTER F-� ..C.VAT. OR FILL F_� FENCF X_F7) REPAIR F] PR.-..V. !NS�. POOL NU OF :ZITIRIICI rwMOER ELLING UN !TS NATURE OF WORK TO CE DONE MET JSERV �E KED By �97 I TYPE OF CONSTRQCTION I I ... /, F 7-S CIAL INSPECTOR occu, �u IRED JARLA JOCCUPANCY G P LOAD j YE > S No kN CHECKED BY THIS SITE IS LOCATED IN THE CITY OF EDMONDS. 'LOCAL SALES TAX SHQULD BE rnr)pr) -" nd �ARKS VALUATION FEE Z PROPOSED USZE 4� -LAN CHECK 2 NO. IPLOT PLAN �re UUILDING,SCrOACKS, - .. AD U TTING STRrLr —===:— U! INS..- '50 1 0, 3 0C U �,d rLU-.--- 01 -.AT 0� SIG N WA�LL POOL I hereby aolinowle,;ge thlt,I have re,ad thl. pP!lC.tI.r; that tbi In- rOTAL AMOUNT DUE: i for.,lailor. gIv n is cor-�.: �d hat . , am tti, owner, Or ths d.ly ..th.r- iz,dm a gent of the owner. I agree -.0 comply with CRY =d ­­ "" "I.- I.t! I; cc=tructloa: and In doing the work ­tbortmad thereby, . per ` ATTENTION APPLIC ATION APPROVAL �1*1.be employed In llolltl= If the L�ab.r Of he state .1 WU.h:.;,., THIS PERMIT rwuranm rela 115 to Wo. Pener.'s COC-PenA&t!,n I This appilcation Is not a permit until AUTHORIZCS 911med by the Building Official or his Dep- NOTE: Permit Limit One Year (r.e,pt nr,,lo1,1Tlo.Ns hleh ONL� THE uty; and feeg are paid, and receipt is ac- shall-be cempleted in n1nty dayii: 31OVED-IN' BUILDIINGS hAII be WORK NOTED Pl,t,-d - ;�,�.nthl� i / knowledged in space provided. I JOW.NC �-R-fAGEN JI?AT INSPECTION DEFARTMENT Ci.Y OF DIREc,.TbR-s IC - LT EDMONDS C -J kirri ff) Plan crieck e C _J --5-2525 / 1 This Permit covers wr,rk to be done on private property ONLY. domain (curbs, driveways, ONGINAL - YELLOW - r Any constructicri on the public sideWalks, morq�ee-,, etc.) Will Yequire sepa-.ato perinission. PI NK COLD - I. UP z r 77� - - qN I f.1 APPLICATION The City of Edmonds for EASEMENT NO - -------------------------------------------- SIDE SEWER PERMIT NEW CONSTRUCTION 0 REPAIRS LID NO - ------------------ - ASMT. NO - ------------------ OWNER --- ------ -------------------------------- CONTRACTOR . ........ . ............................................ --- ---- PERMIT NO. �= ................ JOB ADDRESS ---------------------------------------------------------- P?nNr-A LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------ 0 0 e^ M M -n 17- M .................................... ............................................................................................................................. NAME OF ADDITION ------- ..................................................................... ................ Approved: DATE B��,5eZ�� .......... 0 ............ ADDRESS LOCATION OF CONSTRUCT] [ON ...... 2.1218 .... S!1e11.Va1jgj_.9pA� ..... . ....................... .......... . ........................................... PROPERTY LWAL DESCRIPTION ...... Lot 19. .............. ....... .... ........................................................ . . ................... .............. ........................... . .......... . ........... ..................................................... ................... .............. . .................................. . .................................................. ........ ....................................................... OWN= AND/OR BUILDER_ .................. I .......... . ................................. . ................... & M Excavators, 15015 2nd Ave. W.. L-mnwood TRACTORPSNAME & ADDRESS ........ ................................................. .... ..... ............... . .................................. . .. ....... I ........................................... A44" ted �;jj�r�Cqjyty!40mf lg� � I ... 9 .... ................ 19.7-6.., for repair #AAI*r oamasiction of a side sewer to the city sanitary sewer sr'; in a= Amonds ordinmwes. ATTENTION 18 CATIMI) TO THE FOLLOWING: NOTE No. I —The owners of the property may obtain a permit to construct sewer inside property line. k licensed Side Sewer Contractor must be emptey*d to construct side sewer in street area. Do not cover any portion of sewer before it has been Inspected. NOTE No� 2—All work performed In city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office. NOTE No. 3—Obtaln full information regarding Ordinance 11,16.030 and Regulations governing side sewers when you get permit. NOTE No. 4—Top of side sewer must have at least 30 inches coverage at Property line and 12 Inches Inside property line; minimum grade of 2%. X* bomb In arade sharper than 'A will be permitted. NOTE No. 5,-Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for fallure 4no to improper work which may develop within one year of completion. NOTE No. 6--It to 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 appArtesaaw except to in- sert the pipe, into the wye. DISAPPROVED0 Date ... . ................................... By ................ Date ........... . .. ... .. ...... By ............... Date .......... . .. . .. . ............... By .............. APPROVEDJX, Date -_"a .... ............ ... BY ... . ...... .. . ... .............................. . ................................ ....................... Remarks: ....... . ...... . .......................... . ............................................................................. . ............................... . ... ....................................................... ................................................................ . ....................................... ................................................ . .................................. ............ ... I ............. . ... . . ................ BOTH Permi�_qopies MUST Be Signed By Owner of Firm Performing Cons t RMLt br Inspection I ...... K� hereby certify that the side sewer installation constructed under this permit rM r C...truction) Own f Contract: n F��ing was Insta3led-tti accordance with all o;e mfin'rg ocraditn;aa-Ilces of the City of r4monds. Datedthis ........... . .. . .......... ASY Of ................................................................. 19.. Check BEFORE you dig for: Water D Qsa 0, Talspbom [3, Power 0, Sewer [3, Other 0 .4 X APPLICATION The City of Edmonds for EASEMENT NO . ............................................ SIDE SEWER PERMIT NEW CONSTRUCTION ��REPAIRS F-1 LID NO - ------------------ ASMX. NO - ------------------ CONTRACTOR ........... --------------------------- ...................... PERMIT NO. OWNER -------- . ........ -------------------------- JOB ADDRESS ------- -- ----- -- �r ------- LEGAL DESCRIPTION: LOT NO - ----------- /� ------------------ BLOCK NO - ------------------------------------ ......... ........ 2 . ..................... ......................................................... 0/ NAMEOF ADDITION ----------------------------------------------------------------------------------------------------------------------- 11 I "Lo Approved: M M --I -n r— M DATE............................................ By ............................................................ 11/75 0 Pern-dt No: A001; City JoEdmonds*';�_,,' . .# RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: :7ZV___5Z-0 A. Address or Vicinity of Construction: I exi k& B. Type of Work (be specific): &uuA P5 &-"Qe"'/N 'A�e'-ne_A Ll-,-%- 10) �;o 41- 5 '0 v--'- 0 -,C-^ J4 -444,k�ld S�A "o I 0_�v d/Y C. Contractor: e-, 0- ee n (�JA Contact: 14 ElgfLl Lt Z2 6-7-71 MailingAddress: /5-7,5" ;N7'_4A Phone: (k7,5- _Z4 -21, 56-1-21 State License #: Liability Insurance: Bond:$ City Business License #: D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. Fj Commercial F1 Subdivision F1 City Project 0& EUC (PUD, VERIZON, PSE, COMCAST OVWSD) r_1 Multi -Family El Single Family F-1 Other INSPECTOR: F. PAVEMENT CUT: [-I YES E] NO G. SIZE OF CUT x CONCRETE CUT: El YES El NO G. �J Mail Approved Permit F1 Call for Pickup INDEMNITY. Applicant understands by hislher signature to this application helshe holds the City of Edmonds harmless from injuries, 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 but not limited to the defense of any legal 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 WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED BYCITYFORCES, AT WHICH TIMEA DEBITOR CREDIT WILL BE PROCESSED 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. All 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 HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS Signature: 6445r�e-24 ZMZA__r1&1 Date: 0"'A a", '0' -A , � I I " Z W ff FOR CJTY USE ONLY Approved by: Lzii 2!Z�L' 22 4'/ Time Authorized: Void After L Special Conditions: 4A1aA'e Right-of-wayFee:�GL_.' 7'yAX;,' Disruption Fee/Fund 111: Inspection Fee: Total Fee:, 7_51 (Z Receipt No P LA /,_4 NA I N T;kk / t-it kA kz A I-,, Issued by: ' I:- A A-i "4 /.r V t' A I 1,A "r' I f- OL / rt_rAcr-- f- A J , 7-14 REQUIRED INSPECTIONS: Call 425-771-0220, Ext. 1326for a 24-hour voice-rec!!�S inspection request line. /.- I FINAL APPROVAL OF PERMITTED WORK: DATE:Z/ Inspector's Signature NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE CADocurnents and SettingsTurtisNy Documents\Fonns\Engnmg�ROWpermit_.doc Revised 10/01/03 Comcast of Bellevue, Inc. 1525 75th Street SW Suite 200 Everett, WA 98203 Contact: Kermit Benson 425-263-5362 North Drop Node: EM 19A 21218 Shell Valley Rd. City of Edmonds Open trerich in shoulder of ROW for approx 80 ft and set carson to extend and bury CATV service drop Dv 7 -7/ 7- W/0 5 S E W N NORTH NOT TO SCALE Work Details Open trench in shoulder of ROW for approx 80 feet (m/1) and set carson to extend and bury CATV service drop to 21218 Shell Valley Rd. Install cable at 36" depth. All disturbed areas will be restored to existing or better conditions. Backfill material will be mechanically compacted to 95% of maximum density as specified by the City of Edmonds. In tight corridors hand trenching will be utilized to ensure protection of other utilities. Contractor must locate all existing utilities impacted by this project. Please see attached plans for restoration, erosion control and traffic control. Erosion control will consist of placing filter fabric fence and/or sandbags along curbs and catch basins where necessary. Keep drainage system clean and functioning. Remove all debris from the work site. Streets and roads will be cleaned both during and after installation of work. Ccomcast PROJECT'S YIMELINE AND PROPOSED HOURS OF OPERATION: Timeline — Up to 30-days past the issue date. Work Hours —The entire project area will be conducted from 7:00 AM to 6M PM or as specified by the Inspector. Traffic Control Plans 1. The standards and guides of the latest version of the MUTCD or as set-up per Code shall be followed at all times. 2. A copy of the Permit and Traff ic 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 traff ic control set-up for the given situation. 4. Pedestrian access shall be maintained through or detoured around all work sites. 5. Please find attached the traffic control plans for the various types of work sites that will be encountered during our project. 6. Flaggers will be used only when all other methods of traff ic 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 Comcast Construction Rep. and the Inspector. # Erps.1on .1bon. f'lkiiies- If curb and gutters in project area: Filter ba.-s will be placed in catchbasins downstream of work site, and Small check dams of pea gravel filled sandbas will placed within the .utter upstream of the catchbasin. Traffic control set-up for minor encroachment 100; Traffic cbritrol set-up for lane closure FLAGGER STATION , 01 100, �ace FLAGGER STATION �z AZI Depth = 36-iftch minimum Compatible w/ other utilities Shoiing required at 4-ft + Pavement Cuts T-cut 1-ft wider than.trench Neat -line saw -cut or j kk hammered 4 edge W'. 4t JU. 011-1P 'Y'911 t Depth, Cleaning, Containment, Compaction, and Restoration All trench backfill shall be mechanically compacted to 95 percent of maximum density using 1-ft loose lifts with whacker or 2-ft loose lift with a hoe pack. If proper compaction cannot be achieved with the native material, new import material is required at the 95 percent rate. As an alternative, CDF can be used in a design I mixture approved by the Engineer. Ccbmcast CLEANING: All Streets and roads are required to be cleaned and swept both during and after the installation work. * Mechanical Vacuum is preferred method CONTAINMENT: All un-restored shoulders or material storage areas are required to be contained with reflective barricades. All disturbed areas shall be restored to existing or better conditions Trench parallel to road: Shoulder - Match existing surface conditions Pavement - 6 1/2 inches of crushed surfacing material and asphalt concrete Class B at 2- inches minimum or same thickness if greater.. Trench across road (inunediate cold mix patch): Asphalt - Permanent hot mix patch at same thickness or 2-inches and sealed within 30 days. Concrete - saw cut and pored with mastic joints, eight - sack mix, either type II of III cement, within 30 days. I I I I W_W_W_WWWW A. Address or Vicinity of Construction: 21218 SHELL VALLEY ROAD B. Type of Work (be specific): GTE to Place, operato and maintfiAn a buried service ISC)wl�ire. from existina Dedestal #87ag. lonatpd at 2111n Shp.11 Vallav PA *h— ...4. +­ . ­4A---- 1­& ,ocated at 21218 Shall Valley Rd. GTE to plow !I@ feet, I*** push 1 dt lveway 20', and PUbtT -t road .�G feet. IR.O.W. footage is 20 feet. C. Contractor — Contact:Linda Price, Permit Coordinator Mailing Address:2312C West Casino Rd. Everett- WA Phone: 425/710-4133 State License #: 982041-1440 Liability Insurance: Bond: $ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): ENGR: Robert Chrisman 425/774-5921 or pgr# 425.787-4045 E. El Commercial El Subdivision 0 City Project )0 Utility (PUD(�� WNG, CABLE, WATER) n Multi-Family-m- Single Family r] Other XJ GTE 0.0-ft��100-91POWDB 24 00 INSPECTOR: INSPECTOR: F. X-4VUL111-11L VL lk-UL 1 czi W1,40 U. oize 01 k-ut: x A�;Aargel PLEASE SEE ATTACHED SKETCH. APPLICANT TO READ AND $IGN INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany 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 of any legal proceedings including defense costs and attorneyfees by reason of granting this permit. THE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA TERIA LS FOR A PERIOD OF ONE YEAR FOLLO WING THE FINAL INSPEC- TION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. Two sets of construction drawings of proposed work required with permitiapplication. 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 trench work shall be patched with asphalt or City approved material prior to the end of the working day; NO EXCEPTIONS. I have read the ah( available on Site, at Signature: David Squires, 5ectio CALL D the permit requirements, and the pink copy of the permit will be Date: 6-19-9a r or Agent . Access gesign -A-DIG PRIOR TO BEGINNING WORK NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng, Div 1997 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: 0 NO PERMIT SUBMITTED BY GTE LEGFIND PEDS 0 POLES 0 ROAD BORES OVERHEAD LINES- 1AUTILITY POTHOLE M UG TRENCHING --uc r R. 0. vv. 4- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - E 0 P kc4 - - - - - - - - - - - - - - - - - - - - - - - - - - - — - - - - - - - - --- - - - - 11 - - - - - - - - - - - - - - - - Lj G �lz co a'.,, THE FOLLOWING INFO TO BE PROVIDED '-J*�- Ark, IH- M TS. I OF 64 1 L1141 OR f Ai--( -lJ fl� 'K, '-)iL)E W p, E I A K J L 13UV L U,�GLIIAJ (:A t-�L I rlLj-),bJ A EL.)A- L I (.-,UNUEri6RL)Jflj I HE�,4LHINU APJfJ uvEmfJr-ALJ LlIAL:>- FOOTAGE OF WORK 114 R.O.W. i -j - qp. 09:41 NO. 706 907 I . FLAS" I 14C §111coN $HALL BE I US TALLED AT EACH S,GNqMMR mir.MT-TIW USE. 2. DISTANCES LAAy vARy AS APPROVED BY THE ENGINEER. 3. FLAGGERS REQUIRED TO CONTROL TRAFFIC M-(ENEVER THE CONTRACTOR MUST INTERRUPT TRAFFIC FLON TO ACCESS THE VVQRK SITE WITH WATERIALS OR EQUIPMENT. M CONE OR CHANKLIZING DEVICE (SEE STO 702) W0RK AREA TRUCK Wl TH 01,11- rLASHING OR BEACON t 500 um < zoo SHOULD WORK tv iI-$I 9 TRAFFIC CONTROL PLAN SHCXA-Dai wow W, < 3w 8 9 0 - 1 9 q - City. of Edmoes RIGHT-OF-WAY CONSTRUCTION PERMIT Permit Number. 17 Wue Date: A. Address or Vicinity of Construction: - 21213 Shell Valley Rd ( 9525510 B. Type of Work (be specific): Tnnynil Servinn C. Contractor: -Washington Natural- Gas MailingAddress: 1122 75 St SW Everett State License #: 98203 D. Building Permit # (if applicable): Contact: Frank Swan Phone: 44Y-3284 Liability insurance: Bond: $ Side Sewer Permit # (if applicable): E. C] Commercial F] Subdivision 0 City Project ER Utility (PUD, GTE, WNG, CABLE, WATER) EJ Multi -Family E3 Single Family E] Other INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut FRI Yes []No G. Size of Cut: x H. Charp�_$ 10"Cut fo- APPLICANT TO READ AND'!4IGN INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from injuries, 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 legalproceeding8 including defense coats, and attorney fees by reason ofgranting thispermit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA TERIALSr FOR', A PERIOD OF ONE YEAR IFOLLOW12FG THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE 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 copyof thepermit will be available on site ara-ff-tinlAw!MP inspeytir purposes. '005;- &%v 't444 Signature: Date: Q-A-95 On-tr-ac-tor or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY APPROVEDBY: RIGHT OF WAY DEPOSIT TIME AUTHORIZED: VOID AFTER 15 DAYS DISRUPTION FEE/FUND Ill: SPECIAL CONDITIONS: WA, RESTORATION FEE: COMMENTS: e-- C'�e-3-7J-4' PERMIT FEE: TOTAL FEE: RECEIPT FEE: i DATE: ISSUED BY: I '�J NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994 Washi NaturalGas A WYIw-qt(x) F r'kI.fqYCOf'x)'VYY Addendum to: City of Edmonds Right of Way Permit Application Submitted by: Mariamne Kingsbury Engineering Aide Washington Natural Gas 1356-7500 X7596 "\ � -"� , n 4r, " T-1 I I I \'/ A, I-L� �� P-0 Key: -W- Watermain depth IT' -G- -SS- gas main -& 0 � C) Water Gas Sewer Water hydrant Water valve Washingtori Natural Gas Company 11221 751h Street S.W., Everett. Waslihigloti 98203. (206) 355-3331 0 .. - oc— .04 -oi*4** . V.P. obt 0 1 %/.06017 !-61 6�134*s OP 114.> -k 4p) SIP)IIWP3 All 72 4 .3.LVAINd Oro) 77 9.) �o L UPI 3 Date 0 Z 1-4 94 W Street Right -of -Way Existing REQD Access Easements Existing REQD Utility Easement Existing IREQD Lot per Subdivision Plat ><3 Assessor Map Site Plan Checked for Accuracy e7 Underground Wiring Reqd.- Check Accuracy of Legal Description IAa Environmentally Sensitive,4rea Environmental Checklist Reqd. Flood Hazard Zone Shoreline Management Area Slope, Soil, Vegetation Stream, Creek, Drainage Basin AIA Existing Zoning Per Code SQQJ:) Amenities Design Board Approval Reqd. ADB # Approval Board of Adjustment App =1 Reqd. Review By- Date: 77/ ehe Existing Water elain Size Water Main Reqd. Service Line Read. Hydrant Size Existi Hydrant Reqd. Per F Detector Check Mete Cross Connection In Fire Department Com water meter Charge Keqq. Review by: tieptic 'tanic. L)esign -�pprc Septic Tank Permit Reqd. Sanitary Sewer Availabil Drawing No. -- \11 Side Sewer Availability Sanitary Sewer Connection Fee Reqd Review By: Date: te: Permit No. Proi File No. Date: NOpen Ditc1h E-asting Culvert Reqd. Size Catch Basin Reqd. 94 dicato on Site Plan 0 Shoulder drainage unintaiii collec le open runoff H )4�lja - -Lole rcqd. Indicate on Site Plan Soil Conditions and Groun.d Water Field Checked by — Da to Street Paving Reqd. Curb and Cutter Reqd. Sidewalk Rcqd. Curb Cut for Driveway Reqd.. P4 Rio -it -of -Way Construction Permit eqd. t EL-4 , Bond Reqd. for Public Improv ts Street NaTm Sign Reqd._ 10�her SigninIc-, Rcqd. _ Pre Permit Site Inspection m.-de on BY: SS�.T-R U W WATER STREET ENIGINEEPZING Special Rcquirei:-ems listed in menu to Cor-,iainicy Dovelopment Deparwnnt, Building Division 13Y Date 0 All items filled in on Building Permit Application P4 13Y --Date PL4 Driwings Stanned. arid Notatioi-fs �1-ide BY Wte Approved by Riblic '%-?oH,,s Departim-it RLM-Scd: IV 10-1977