21612 80TH AVE W.PDF111111111111
7188
21612 80TH AVE W
NOTICE:
No 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 �Edmonds does not warrant the
accuracy of anything set for ' th on these
map(�-). Any person or entity -req uesting a
copy should conduct an independent
inquiry regarding the information shown on
th-e -map(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
emp-l-oyee-s o-r officerS) shall be liab-le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
Pi
CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
_7'
PERMIT
Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday Inspections.)
I " - N_Ap��n( (011:_7_1_�,�
ADDRESS LOCA17ON OF CONSTRUCTION ----- ................................................. . ........... .
PROPERTY LEGAL DESCRIPTION ......... M . � � . ve-A - ---------
---- --------------------------
----------------------------------------- * -------------------------- ** ............. * ... .....
....................... . .......................... . .......... . .......... . ....................... V ....
N ,-A ' RA
-- -------- --------- z: --- - -------------- -------- ........ r --------------- -- - --------------------------------------------------
....... - ------------------------------------------------------- OWNER AND/OR BUILDER ......................................... .................................. . .......................................................
CONTRACTOR'S NAME & ADDRESS ............... 2- - 3 -" k"h'is-col
r� ................... zL;.: .................................... . .............................. . ... .......................................................
F ission Is granted ........... �QVkP— .. . ............ 19-7�4or repair and/or connection of a side sewer to the city sanitary sewer
1�� .�n In amordance with Cit)r,-o,f"iii�oi�is--,ordiiiances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —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 axea. Do not cover any portion of sewer before It has been inspected.
NOTE No. 2—All work performed in city right-of-wav requires an Invasion of RIght-of-Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain 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%. No bends in grade
shaxper than % 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 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 maln sewer or its appurtenances except to in -
Bert the pipe into the wye.
DISAPPROVED Date-- By ................ Date .................. ---------------- By ................ Date .............. . ................... By ................
"PROVED ADate.
............... -,5r .................... ..... ....... . .. . ... .......................................................................................
Remarks: ....... . ...... .......................... . .................................
............................. . ....................................... ...................................................................
...................................................................... . ........................................................................................ . .......... ....................... . .......................................................
BOTH Pep#fit Copies "ST)�6 Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
Al Z
.... hereby certify that the side sewer installation constructed under this permit
'_ 7_� 1
�i C -
ord,nc ordinances of the City of Edmonds.
Datedthis ............................ day of ................................................................. 19 .........
V Check BEFORE you dig for: Water Gas E], Telephone E], Power 0, Sewer C], Other
APPLICATION
The City of Edmonds for EASEMENT NO . ............................................
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS E] LID NO.. ............ AswT. No -------
OWNER ---- --------------------------------------------- CONTRACTOR 'Y 9 ell
.... .......................................................... PERMIT NO . ......
JOB ADDRESS .........
-- --------------------------------------------------------------------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO . ....................................
I
------------------------------------------------------------------------------------------------------------------------------------------------------------------
70 70 r- -- /V r.
NAME OF ADDITION ............. ....... .............................
-- - -----------
-V /VF k:-C- 3,f) 7 ,4)� If? L)
Approved:
RECEIVED
juk 10 19-1-5
DATE................... I ......................... By -
,.0
Memo to: Director of Maintenance Operation
Public -Works
From: 'City Engineer
Form 6
V APPLICATION
The City of Edmonds for EASEMENT NO.
SIDE SEWER PERMIT ---------
NEW CONSTRUCTION REPAIRS LID NO - ------------------ ASMT. NO . ..................
�-e-St-,At, ' - --' - -
OWNER -------- K !!�4 ------- 1��� ------------------------------------------ CONTRACTOR ------ 45><2>1-4
-------------- ..................... PERMIT NO.
JOB ADDRESS ----- -E�� . . ..... ---We5W, LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
............ t4li�--Y44 --------- 3 ---- ------------- v --------- ------ t-.4. -- — -------- - ------------------------------
a
NAMEOF ADDITION .......................................................................................................................
7ed:
DATE., .... �. 7- -'� .......... By
�v ------------------------ /-
AUG 18.2003'
City of Edfflmon& Vate:Recd1V'
Devel ,`d(ty Rae
opment Services Department.
I?ta;i*g Djyision 01
Phone: 425.77
,1.0220--
-D
425;77-11.0221
Fax:
T.he Critical Areas Checklist contained on this form isJo A property` ef;,�or`his/h' iu zed`�riep'resentative,
be filled out by any person preparing a Development. �::'Inug.filhb�t kid-jdateJt;� ��Idj submit it
the4�hecklist-�sign
Permit Application for the City of Edmonds prior to to the Cit'-. The 040' iffll' a
y IV, wi yeviei
his/her submittal of the application to the City." -.prftursory-wsii� Msit,-' ial,make,A,,detetihination of -the
-subseqq%�,,steps nepessary,,;
The;purpose of the Ch6cklist"is, to enable'City staff, to p: etO L a velopment
nit application
determine whether any potential Critical Areas are, or Pm.
may�be, present on the subject prope:dy. The, information Please, submit a' vicinit
.y
m#pi. along with the signed copy
needed to complete the Checklist 'should be'edsil� of Qs`i� assist: city'staff ifi findinj �nd: I&ating the
available from observations of the site or data available at 'specific- piece 6f pi6p6iiy a��"ed 6il',,this form.' In
City� Hall. (Critical areas inventories, maps, or soil addition, �Ahd� ppplicant,. shall �inclu& other pertinent
surveys). information,-(e.ig. !iitq�t�pl.a,ni.:tdpogr4phy,m�p, etc.) or
studies in conj�nction�with this Checklist to assistant stiff
-in'completing their prelim. friary assessment. ofthe site.:
The undersigned applicant, and his/her/its heirs, and assigns, ifi'consiideriition 6n the"pr6cessimig of t'h"e application agr'
I - - ees
to release, indemnify, defend and hold the City of Edin , fr
6n4harmless onilanyan&aIldariii luding reaioii�ble
gqs�i�mc,
attoTey's fees, arising from any action or infraction based in whole or part upon false,'n,nisle'adinig. lin,ace, ura,te or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that, I am authorized to file this application on the behalf of thi owner a's listed below.
SIGNATURE OF APPLIcANT/AGENT DATE
Property Owner's Authorization
By my signature, I certify that I have authorized the above Appliciant/Agent tol appl� for the su�"jici land use appli ! cation,
and grant my permission for the public officialk and thestaff of the. City of Edmonds to enter the!'subject pro�e �-Tdrithe
purposes of inspection and po;ting attendant t4 il�"pplication. -
SIGNATURE OF OWNER DATE
Owner/Applicant:
_h�Q 19)D_Z� W
Name
00,*12-
Street Address
aw 0
city State zip
Telephone:
Email a�dress (optional):
Applicant RepresentatiVe
Name
!..Street Address
City State zip
Telephone:
t1fiall'Address (optional):
Critical Areas Checklist.doc/4.22.2003
Critical Areas Checklist CA File No:
Site 1nfor!na�Oh':(SO'i1S*/topog*ra
phy/hydrolo'g`y/ve "Wiop)
ge
1. Site Address/Locati6n- Son,' k%ha IUKJ
2. Property Tax Account Number: 3o1n 641 'ft4 ;DID co-3
3. Approximate Site.'Size (acres, or square feet):
IL
4.. Isthis, site developed? _iKjes; no.
If yes; how is site developed?
5. DesLrib;e the general site topograpNy. Check all that apply.
b�- Flat: less ihan 54eet 9evation ciiiinge over entire site.
N
's Opes,on site generally'less'than 15% (a vertical rise,of 10-feet over a horizontal
Rolling-."i
diitance''of 66-fe�t), '
Hilly: slopes'Oresent on site oflitore than-15% and less than 30% (a vertical rise of 10-feet
o ; ver'a �Otiion , tal , dist I ance of 33 to 66 , -feet).
--j. Steep: `srides of greater than 30%-preserit on site (a vertical rise of 10-feet over a horizontal
distance of less than 334eet)'.
bther (pl��ge'describe):
-A
6. Site contains areas of year-round st#nding water: 0,0 Approx. Depth:
7. Site contains areas of. seasonal standing water: V 0 Approx. Depth:
Wimi se'aso'n(sy of the year?
8. Site is in the floodw�y Y 0 floodplain, of awater course.
9. Site contains a, creek. or'. an, area -where water -flows aa,o'6s the grounds surface? Flows are year-round?
P Flows are s6sonal? (What time of year?
10. Site i's piim�: forest�d ;meadow ;shrubs
mixed
urban lihdscaped,,(Iawn,� shrubs etc)
11, Obvious wetlai4
isprpsertt on site:,
7,,7—For City Stiff Use Only'-
1. Plan 6eci'N'umbet �4a":."'h-
2. Sit�!:i A
3. SCS mapped soil tvm(s)?.
4. CriticAl Areas inventory -or CA.miip indicates Critical Area on site?
5., Site i�ithihdes* ted earth- subsidence landslide hazard area?
W144i, 3
F RM
MF INAT ON
WAIVER
��PQORED
Revie*ed-b3r
Date:
%_nricai fuvw t.;necr11St.C1OC(4.ZZ.ZUU3
Mv SIAEET FILE Date Marr-h 14,-1974
U
Memo to: Director of Maintenance & Operation
Public Works
From: City Engineer
Subjict: Sewer Connection Charges
Legal Description:
S 70 feet, N 170 feet, E 135.2 feet o� NE 1k, SW Ago NE 1k, Sec.
30, T 27 No R 4 E.
Commonly known as: 21612-- 80th Avenue W. Owner: unknown
Z.F.F. Calculation: .
71. 77 Z - F. F. x 7. 50
Lateral x
Unit x 25
cc:
$ 538.28 Connection Fee
$ -0-
Lateral Charge
$ 25.00
Trunk Charge
$ 10.00
Permit
$ �573.28
TOTAL
Form 6
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