21616 79TH AVE W.PDF6828
21616 79TH AVE W
9FITY OF EDMONDS EaTREEIF FU
COMMUNITY SERVICES DEPARTM
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. 0 Owner: Washington Natural Gas On B. 0 Contractor
Name
A01; 156 AM NE,
Mailing Address
11evue, WA 98007
City State Zip
Permit No. 8 IS -'/�7
Issue Date 1.) //51zi
same
Name
Mailing Address
City State Zip
447-0:ZM
State License Number Telephone Number
Address or Vicinity of truetioiit L12 1 A 1 A 29 AV W
Type of Work to be Done: �rlSta4lation of a new g
Work in Connection With: 0 Sub or Plat 1:1 Single Family El City Projects
T_-T munis"
Pavement Cut: El Y 0 N
U
*-4
114
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
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harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or unforseen, 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, court costs, and attorney fees by reason of granting 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.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed
by City forces, at which time a ddb4 9 vred' will be processed for issuance to the applicant.
0
• A 24 hour notice is required for inspection; Please call Public Works: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
no exceptions.
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,,I.,jnd,qTstan4Jhe,. above,,-and,t* thi4,,perMJt,_.Mqst., available at t, iob, "I ei or. .:-I
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Signature: Date: 1218Z88
Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
ISSUED BY:
0 days.
Time Authorized: V67id after
Special Conditions:
Amendments:
PERMIT FEE;7-
Security Deposit:
Receipt No.:
Fund I I I Fee:
Street Cut Dimensions:
X
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.�
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES El NO
Partial Work Inspection by P. W.:
Work Disapproved By:
Date:
Date:
FINAL APPROVAL BY:
Eng. Div. July 1985
c --I
CA FILE NO. CO -
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
I Site Address/Location: 8Z i ( o I i� - --I q A
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet): Y9 AcIV
4. Is this site currently developed? -,K- yes; no.
If yes; how is site developed?
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 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 than 30% 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:
7
L-' _; Approx. Depth:
Site contains areas of seasonal standing water: D ; Approx. Depth:
What season(s) of the year? 10
8. Site is in the floodway /Vk+ floodplain Mt of a water course.
Z
Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? - /1/.t — Flows are seasonal? — /L41- (What time of year? W#4 -
10. Site is primarily: forested : ceado shrubs mixed
urban landscaped (lawn,shrubs etc) 5
11. Obvious wetland is present on site: — /L)
6. ated-bmth'd�Eh ronmehtally� ehMtive... M
$it.e:design ... .. Ar.easw ap?
bETERMINATION
^u_chk.doc; Rev 10/03/97
E Q
City of Edmonds
Development Services Department
. . . . . . . . . . . .
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
CRITICAL AIMEAS 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/ber 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., 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 Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
I PLEASE PRINT CLEARLY
Owner/Applicant:
i x1, J� 4 m 6:, 4 c- d-�
Na6e
,�zQ t 6 / 6 - q '7-k A ve?
Street Address
FJ 'I'L0,49, L'J A 1� go -L 6
City Siate Zip
a 5-- -7 -7 / - 6 Q 5- i?
Telephone
Signature
Sq- - -
4 �- Z -Z4
Date I
cixeceptioroanatCACI-Handoul.doc
Applicant Representative:
1 5 4k-W-lc
Name
Street Address
City State Zip
Telephone
Signature
Date
Revised 4M =000
-7f
APPLICATION CARD No . ......................................
The City of Edmonds for
SIDE SEIVER PERNaT
OUTSIDE INSIDE f-I REPAIRS E] EASEMENT No . ......................................
OWNER...... F& ... We--, 0 ........................................................... ......... CONTRACTOR ........ ........................................................... .............. PERMIT No.
STREET
HOUSE No ................. AAW�LOT No - --------- :9 ------------------------------------------------------- BLOCK No . ...............................................
2 le. NAME ADD - ------ .............. ...................................................... ........................................
0
r)
0
SA �Sa'
44�,r Wll/
Date
BACKFILL WORK ORDER ISSUED ...... ............................ DEPOSIT, $ .............................. ...............
SEWER WORK ORDER ISSUED ..........................................
APP ROVEC
Approved:
DATE ...... ............... E .... ....
33Y ........
I -- � ��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(s). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
the -map(s), including, but not limited to,
the 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-o-yees or officers sh-all be Via-b-l-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS Call PROspect 6-1107 24 hours (plus
CITY HALL — WATER -SEWER DEPARTMENT Saturday, Sunday and HOIidaYs) be.
fore work is ready for inspection. 960
SIDE SEWER PERMIT
ADDRESS
..................................... ......................................................
OWNER
............ .................... CONTRACTOR ..........
PerJniss!On is granted ... V OVA, - er ..........................................................
................. 19 .... 4for ................. I ...... 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. I —The owners of the Property may obtain a Perm construct sewer inside Property line. A licensed Side Sewer Contractor
must be employed to construct side sewer in street C
it to
NOTE No. 2—Obtain full information regarding Ordinance area. DO not over any Portion Of sewer before it has been inspected.
NOTE No. 3 11-16-030 and Regulations governing side sewers when You get Permit.
—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 'A will be Permitted.
NOTE No. 4—Trenches in street must be water settled a . nd surface of treet restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one Year Of completion.
NOTE No.
5—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 an-
Purtenances except to insert the Pipe into the wye.