22121 76TH AVE W.PDF11111111 lill
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22121 76TH AVE W
C wis
City of Edmonds
SIDE SEWER PERMIT
Address of Construction: V_& I L
Property Tax Account Parcel No
Attach copies
Owner
Contractor License
utilitv
O�ingle Family
Multi -Family -(No. of Units
Commercial (No. of Units
F� Public
,4LIF Aj
PERMIT NO: 9M,
PERMIT EXPIRES
Verified and Approved by
ilding Permit
Invasion into City *Right -of Way: 0 Yes 7ERgo
*RW Construction Permit #
Cross other "Private Property: El Yes jj&No,
**Attdch legal description and copy of recorded easement.
0wrW6'rMtractffr %naitur'e �nd acknowledgement statement: Date I
By signing for this permit I certify that I have read the City's public handout entitled
ide Sewer Specifications, and shall comply with all City requirements outlined therein.
W CALL DIAL -A -DIG (1-800-42,1�-_�5555) BEFORE ANY EXCAVATION W
R FOR INSPECTION CALL 425-771-0220 extension ON
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
V
NOTE: IF JOB SITE IS NOT -READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A: $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES —Date: Initial:
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: 51-71o*Z Initial: As -built to Street File:
t, PERMIT MUST BE' POSTED ON',1013 SITE t,
White COPY: File Green Copy: Inspector Buff Copy: Applicant
L;temp;bldg,forTns,sspermitjlg4/00
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CITY OF EDMONDS
SI.DE SEWER AS -BUILT
ADDRESS
22121 76TH AVE
PERMIT
NUM13ER 9612
HOMEOWNER xxxxxxxxxx
CONTRACTOR ROTO ROOTER
DATE
05/05/02
DRAWN
BY
ISMAEL ABILA
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 forth 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 s.hown.
Neither the City of Edmonds nor its
employees or officers shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
--- -------4
#P20 CA File No:
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location: d9 2t/ 75 Ar. WeS r
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet): 5- ae-re-.
4. Is this site currently developed? I,,\ no.
yes;
if yes; how is site developed? 11?e3 q4w C:�:e
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slo es on. site
genera less. than 15%
lly (a; vertical rise of, 10-feet over a horizontal
distance of 66-f6et).
-Hilly_,;� slopes present on site of more than 15% and-46ssthan 80% (a vertica'd'rise'of 10-feet'
over. aJhorizontAI distance, of -33 to 66-feet).
Steep: grades of -greater than- 30%,present on site (a vertical rise of 10-feet over a horizontal
distance of less than 33-feet).
Otber.(please describe):
6. Site contains area's of year-round standin ter: rox. D th'
_g wa. P., ep
7. Site contains areas'of seasonal standing wqte�: Appro
04
What season(s)'of the year?
8. Site is in the floodway
_AJI floodplain of a water course.
9. -Site contain's a creek or an area where water flows across the grounds' surface? Flows are.year-round?
&6 Flows are.seasonal? . (V�hat time of year.?
10. -Site is primarily: forested ',�rrteadow shrubs n-dxed
urban landscaped (lawn, shrubs etc)
11. Obviou.s,wetlAndis.'present.onsit�:
For City'Staff Use Only -
1. P Ian -Check. Number, ff applicable?
.2. Site is Zoned? C 69 2-
3. SCS mapped soil type'(�)?
J.7
. il
4. Critkal-Areas inventory or C.A.'map'indicate.� Criticail Area on site? NO
5. 'Site �'w' ithin'd6isignated eiirth subsidehc6 la �ndslide hazard area?
DETERMINATION
STUDY REQUIRED WAIVER
Reviewed by:
Date:-
Critical Areas Checklist/3.25.2004
#P20
of ED
. . . . . . . City of Edmonds
Development Service4MCIMI V Fv�
Planning Division
Phone: 425.771.0220 NOV 1 "0" 20C15
-loc. 189Z Fax: 425.771.0221,
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 the application 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 lof the site or data available -at
City Hall . (Critical areas inventories, ma s, or soil
p
surveys).
Date Received: / 1 0 12- 0 Q 9-
City Receipt #: 12-
Critical Areas File #:
Critical Areas Checklist Fee: $135.00
Date Mailed,to ADDlicant:
A property owner, or his/tier authorized representative,
must fill out the checklist, sign and date it, and submit it' -
Jo the City. The City will review the checklist, make a
precursory �ite visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signied'c'o'py
of this form to assist City 'staff in'finding and. locating.1he
specific piecc -of property -'described- on tl-ds fortri. In
addition, the applicant. shall include other pertinent
information, (e.g., site plan, to ography map, etc.)' or
� p
studies in corijunction' with this Checklist to assistant staff
in completing their preliminary assessmentof the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the, processing of the application agre es
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's f6es, arising from any actioni or infraction based in whole, or,part, upon false, misleading, inaccurate or
incomplete information ftirnislied by the'applica' ht, histher/its agents or employees.
By my signature, I certify that the information and exhi bii� 'here th.subihitt�d are'true and correct 16 the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPMANWAGENT DATE
Prope"rty OWnei's Ai�thori2atioin
By my signature, I certify that I have authorized the -above Applicant/Age'nt to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the. subject property for the
purposes of inspection sting atteiidatit,to.�4is-4pplicati6n.
Name
Street Address
City State Zip
Telephone: -��?
Email address (optional):
DATE U-
Applicant Represen tative:
ame
57-OIVE 1ACIF-1 AMR
'Street Address
cs)�47
City State Zip
Telephone:0�0�—\.�4v& ?-J�34/7 .
Email Address (optional):
i
APPLICATION
for
The City of Edmonds
SEDE SEWER PERNaT
NEW CONSTRUCTION REPAIRS E]
Lf
I.A
EASEMENT No . ..............................
OV*rNER .... 170-219A).0 ........... ��av-r- -tv ......................... CONTRACTOR ---- //
Zle .. ............... PERMIT N(
ADDRESS ............ . ... . ................................ . LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAME OF ADDITION ..................
.........................................................................
NOV
9
PA
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Aj c�
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Approved: I c-� /-
DATE ... ............. By 40 . . ..... L%�V ..........................
Date: — June.23, 1970
Memo to: Ron Whaley
Assistant Public Works Director
From: Leif R. Larson
City Engineer
Subject: Sewer Connection Charges
Legal Description:
RT-12 TH PTN of W 1/4 NW 1/4 NW 1/4 SW 1/4 DAF BEG NW. Cor NW
1/4 SW 1/4SD SEC TH S 910161E 501 FT TPB TH Cont S 910161E 90 FT
TH S 890361 E 230FT TH N 910161W 46 FT TH N 890 N 89!35'W 72 FT
TH N 910161W 44 FT THN 890381 W,158 FT tpb EXC WLY 30 FT / FOR
Commonly known as: 22121 76th West Owner: Roland Clinton
Mailing Addr6ss-!�9424 Gals�on Drive
Santee, California 92120,
Z.F.F. Calculation:
96.7 Z.F.F. x $7.50 $ 725.25 Connection Fee
Unit x ($ 25.00) $ 25.00 Trunk Charge
$ 10.00 Permit
760.25 TOTAL
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LICENSE FOR CONSTRUCTION OF 76TH AVE. W.
1.3 -(01)
ARBAN ARTERIAL CONTRACT NO. 8-1 9
'T
I (We) the undersigned, being.the owner (s),of the following Oescribed.
p rop!a rty
That po rt ion of the West half of the Northwest q ua rte r of the Northwest�quarter.
.of the Southwest quarter of Section 29,' Township 27 North, Range 4 East, W.-M.-
'i A" ...Ides6ribed as fol lows: ' Beginning at -the Northwest corner of the Northwe�t
-29; thience S 01*16'East, for -
.,quarter of the Southwest quarter of said,Secti'on
501 ."00, feet to the true Po i nt' of beginning; thence continue S 0 1 0 161 E, io r*_'�'
'90.00 feet; thence S 890381E, for 230.00 feet; thience N' 0 10 161 West fo r-,46.'60
t..
st for 7�.00 feet; thence N 01'15'West fo'r.44.00.f6b
.#eet;,+he'nce N 89'38'We'
rue'point of begInningi 'EXC
-;t -for 158.00 feet -to the t
thonce,N 890381 We!. EPt
-Orly 30 fe.et for road.
the Wesl
wi.
ty of Edmonds as Contracting Agent permission o enter
Do hereby grant the Ci
r the purpose of constructi-ng necessary cut and/or
upon said property fo
slopes, during the construction of 76th Ave. W. between 218th Street S.W. and
.242nd Street S.W., said slope not to extend more than feet
-of-Way.
beyond.the street Right
"it is understood that this document will be used only for that purpose
described above and will expire upon the completion of said improvements.
WNER
M-L"Wo-
OWNER
DATE
UW N E _R
........ .. . .
..........
0
CITY OF EDMONDS
CIVIC CENTER— WATER -SEWER DEPARTMENT Call ]PRospect 6-1107 when work
Is ready for inspection. (No Inspee-
'ions Saturday, Sundav or holidaya.) N? 3868
SIDE SEWER PERMIT
22121 76th Avenue West
ADDRESS.............................................
OWNER� ............. Rq! QUnt(M .................................. CONTRACTOR -------- A ... &.-Z .. Plumbing ..................................
Permission is granted X_Q.v_emb.er_--6. ------ .... 19.70, for ........................ 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 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 % will be permitted.
NOTE No. 4—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.
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 appur-
tenances except to insert the pipe into the wye.
.17
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V1_ 70 IV,
Mr. Roland r. Clinton
9766 Bilteer Drive
Santee. California 92071
March 16, 1971
Re: 22121 - 76th Avenue West, Edmonds, Washington
Dear Mr. Clinton:
In regard to your letter of March 11, 1971, for sewer connection
to residence at 22121 - 76th Avenue West, Ldmonds; the jurisdiction of a
side sewer permit is for that system outside of the house foundation and
the system as installed to the sanitary sower lateral. Our inspection
insures that the side sewer is connected to all plupting stubs extending
from the foundation and that materials, workmanship, and methods of connec-
tion comply with applicable codes.
If, as indicated by your letter, there is something faulty in
the plumbing inside of the foundation area or within the building, it would
be under the jurisdictlon of the City of Edmonds building Official. Your
letter and a copy of this letter have been forwarded to the building De-
partment.
Enclosed Is a copy of the as -built drawing of the side sewer in-
stallation installed by side sewer permit No. 3868 for subject address.
Respectfully,
CITY OF EDMONDS
RONALD L. WhALLY
Director of Maintenance
Operation - Public Works
RLW:eau
Enclosure
cc: City of Edmonds Building Official
0
4
4,
STREET FILE
Memo to: Ron Whaley
Assistant Public Works Director
From: Leif R. Larson
City Engineer
Subject: Sewer Connection Charges
Date: June 23- 1970
Legal Description:
,"'RT-12 TH PTN OF W 1/4 NW 1/4 NW 1/4 SW 1/4 DAF BEG NW.COR NW 1/4 SW 1/4
'SD SEC TH S 010161E 501 FT TPB TH CONT S 010161E 90 FT Th S 890361 E 230
FT TH N 910 161W 46 FT TH N 890 N 890351W 72 FT TH N 910 161 W 44 FT TH
N 890381 W 158 FT TPB EXC WLY 30 FT FOR
Commonly known as:, -1221'2.1�76th West Owner: Roland Clinton
Z.F.F. Calculation:
96.7 Z.F.F. x ( $7.50 $ $725.25 Connection Fee
1 Unit x ($ 25.00) $ 25.00 Trunk Charge
$ 10-00 Permit
#MO.29
$760.25 TOTAL
%'A Gd;Dd Customer Is Worthy of Every Consideration"
WESTERN UhafIES SUPPLY CO.
Waterworks, Industrial & Heating Supplies
r 1�—
P.O. BOX 3524 5409 OHIO AVE. SO.
SEATTLE. WASH. 98124 ROckwell 2-7025 SEATTLE, WASH. 98134
"A Gqqd Customer Is Worthy of Every Consideration"
WESTERN -U11IJ1ES SUPPLY CO.
Waterworks, Industrial & Heating Supplies
P.O. BOX 3524 5,109 OHIO AVE SO.
SEATTLE. WASH. 98124 ROckwell 2-7025 SEATTLE. WASH. 98134
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