22205 95TH PL W.PDFiiiiii iiiiii
9329
22205 95TH PL W
0 - 0
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: El Conditional Waiver F] Study Required F] Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
0
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DSrs\Fonns\Street File Checklist.doc
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0
City of Edmonds Permit No:
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: //-,5-
A. Address or Vicinity of Construction: Q a Q 9S-, PL L-k)
B. Type of Work (be specific�: LU Q� Ck
:5- L L4 10 6 C� to 5 T t, ilct
C.
Contractor: (f,
Contact: �N V-0.4 /,6-v_A_
MailingAddress: 1:,]
3
Phone: _�,C) (.o - q
State License ot (N
I
Liability Insurance: Bond: $
D.
Building Permit (if applicable):
Side Sewer Permit (if applicable):
E.
F1 Commercial 0
Subdivision
Ej CityProject F1 EUC (PUD, VERIZON, PSE, AT&T, OVWD)
Multi -Family. El
Single Family
Fl. Other
INSPECTOR:
F.
PAVEMENT CUT: El-VES
El NO
G. SIZE OF CUT X 91
CONCRETE CUT: El YES
E3.N0
INDEMNITY. Applicant understands by, his/her signature to this application helshe holds the City of Edmonds harmless ftom
6injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made.�a
,gainst 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"WORKMAN, R Wt
.$HIP AND MATERIALS FOR A PERIOD OF ONE YEA —FOLIO NG THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTiRATED.,RESTORATION FEES 97LL BE HELD,UNTIL`Ti1E FINAL STREET PATCH IS
COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBITOR CRE6fi'*7LL BEPROCESSED FORJSS&A'kE TO THEAPPLICANT.
* Traffic control and public safety shall be in accordance with-Cify—*iQuIations as required by the City Engineer. Every
flagger must be trained as required by (WAC)_296z'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'
IHAWREAD THE ABOVE -STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THATIMUSTMAKE THE PINK COPY OF THE PERMITA VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Signature: L_Kz9__j�* Date: -7/03,
(Contractor or Agent)
FOP. CITY USE ONLY
,Approved by:,
Time Auth I oriz4.-Voiia After 'a./ & 1,04
Special Conditions: 1W4jr%0rA# t,,,� 5 ' 'Cw5-r13Ar_ F90Y
C- I T"14 OF
AFFEC7-66 Pr I oF N -rs, kE -, Tf, P_ r— P.Qvk/ 7-t)
V'2
For inspection requirements see
Right-of-way Fee: $/,T<
Disruption Fee/Fund 111:
Restoration Fee:
Total Fee: Z 75% C-0
Receipt No:
Issued byt
7
Information handout.
NO W011K SIJALL 13EGIN PIUMTO 1'l,'1M IT ISSUANCE
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Pilchuck Contractors, Inc.
Job #107018215
26 Oct 03
Sheet I / 1
J. Buss
National Barricade Co
CA
q
1
1 7
11
f I
C_
Ln
0%
US
72's
220 ST SW
Notes:
1. All signs and spacing shall conform
to the MUTCD and City of Edmonds specs.
2. Work zone is 12'w/o c/I 95 PIL W
& 600' n/o c/I SW 224 ST
3. Flaggers will control alternating
one-way traffic.
4. Alert affected residents
5. Channelizing devices are 28" cones.
6. Tapers will be 50'- 100'and must
contain at least 6 devices.
7. All signs are 48" x 48" B/O
unless otherwise specified.
CHANNELIZING DEVICE SPACING (FEET)
TAPER -TANGENT
20 40
20-7A
RUD
� AHUD
�IW20-4
ROAD \
H K
224 ST S ERAD W
20-1
Q.
Ln
LEGEND
WORK AREA
28" TRAFFIC CONE
-10- EXISTING TRAFFIC FLOW
'SZ SIGN LOCATION
01
rt FLAGGING STATION
110TR PROTECTIVE VEHICLE
OR WORK VEHICLE
U
SW 220 ST
EOM
200 PE
653'N I
PROPOS�
2" PE 1
12'W CL
( --- )IF
TIE—IN
FUSE
573'N C
SW 224 ST
95 PL W
to' CL 10'
GRASS GRASS
i�
it' SH08ULDER
SHOULDE __tL
W S-bound' Lane N-Bound Lane E
01
- C�4
/80570'N
rn
)01
Ln
FITTER (CHECK BOX IF COMPLETE)
Work area left in Clean & Safe ondition
Complete all Pipe Tables and Gas Pressure Stomp
Field changes Red -Lined on as -built
Material verified and Changes noted on paperwork
STANDARO GAS CONSTRUCTION NOTES:
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. CALL "ONE-CALL7 TWO WORKING DAYS PRIOR TO CONSTRUCTION, IN
WESTERN WASHINGTON CALL: 1-800-424-5555. IN KITTITAS COUNTY CALL: 1-800-553-4344
2.' ALL CONSTRUCT10N IS TO CONFORM TO PSE GAS OPERATING STANDARDS AND GAS FIELD PROCEDURES.
3.� EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRAC110E 0150.3200 TECHNIQUES FOR TEMPORARY
EROSION AND SEDIMENT CONTROL AND ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.
4. NOTIFY PROPERTY OWNERS ADJACENT TO PROPOSED CONSTRUCTION ACTIVITIES A MINIMUM OF TWO WORKING DAYS
PRIOR TO BEGINNING CONSTRUCTION. USE iSi TO DISTRIBUTE FLYERS IF JOB IS LARGE, OTHERWISE HAND
..DELIVER FLYERS BE SURE TO INCLUDE THE LIST OF FREQUENTLY ASKED QUESTIONS AND INFORMATION ABOUT
THE OPPORTUNITY TO PURCHASE AN EXCESS FLOW VALVE MEN THEIR SERVICE IS INSTALLED OR REPLACED
PER GAS OPERATING STANDARD 2550.1600. ALLOW ADEQUATE TIME FOR CUSTOMER DECISION AND RESPONSE.
5. ANY CHANGE IN ROUTE, TIE-IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE APPROVED BY PSE GAS ENGINEERING
SERVICES.
6. COMPLETE "PIPE CONDITION REPORT" ON ALL EXPOSED EXISTING PSE�: FACIL111ES: CHECK BOX ON REPORT FOR WIRE
BOX (TEST LEAD) INSTALLATION.
7. ACTIVE SERVICES DENOTED BY-
8. PIPELINE MARKERS AND WARNING SIGNS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS
OPERATING STANDARD 2525.2500.
9. VALVE MARKERS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS OPERATING STANDARD
2525.2600 FOR ALL HP VALVES IF THE LOCATION IS NOT REDILY ACCESSIBLE, AND FOR ALL VALVES WHERE
PERSISTANT SNOWFALL MAY OBSCURE THE VALVE BOX
10. TO PREVENT ACCIDENTAL OVERPRESSURE OF ADJOINING SYSTEMS, NO TWO MAINS SHALL BE CONNECTED EXCEPT AS
SHOWN ON THIS DESIGN UNLESS APPROVED BY PSE GAS ENGINEERING SERVICES.
11. 'SYSTEM MAOP DENOTED BY- ISYSTEM MAOP = 45 'PSIG
12. RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION.
13. GAUGE AND MONITOR USE OF ALL STOPPERS AND SQUEEZES TO ENSURE ADEQUATE FEED. (USE MANOMETER FOR
LP SYSTEMS)
14. PURGE POINTS AND PRESSURE TAPS TO BE INSTALLED PER PSE GAS OPERATING STANDARDS 2525,3400, AND 2525.1200.
GAS MAIN INSTALLATIONIRETIREMENT
TypelWork
Pipe Size
Type
Estimated.
Length
Actual
Length
Manufacturer
INSTALL
2-
PE
80,
GAS MAIN PRESSURE & TESTING
L7PE TEST _L
DATE ON
1PRESSURE
TESTED BY
TIME ON
DATE OFF
TIME OFF
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
,DATE OFF
TIME OFF
IDesign Press 60
1 SYS MACIP 45
PROJECT PHASE
NOTIF#
ORDER#
SAP Superior
Service/Meter
Service/Meter
Service/Meter
Service/Meter
Ind. Service
Ind. IMSA
Dis. Reg. / FT
HP Svc[IvISA
Relocate
Retirement
X780550964
107018215
X043600014
106117642
Contractor CONSTRUCTION COST CODES:
031-1034 1 1 1
Project Manager Contact Infonnation:
PATTI NESS
CELL: 425-327-2783
REV# DATE BY DESCRIPTION
3
2
COUNTY
SNOHOMISH
1/4 SEC
SW-25-27-03
Vicinity Map
WORK SITE
SW
L
SW 217TH ST
217TH PL SW
19TH
L:d
H ST W
All
224'FH
Ownerl Developer Contact lntb
JOSEPH T SAVARESE
22205 95 PIL W
EDMONDS, WA 98026
ATTN: SAME
425-771-2146 office
CALL (800) 424-5555
2 BUSINESS DAYS BEFORE YOU DIG
THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATION OF FACILITIES
REAL ESTATE/EASEMENT PERMIT
CSEA EDMONDS
FUNCTI N CONTACT PHONE I DATE
PROJECT MGR P.NESS 206-418-4237 110i08103
ENGR-GAS
DRAWN BY
CHECKED BY
:R SECT GAS WK CTR APPROVED BY
7 5 MCNSEG FITTER #1
MAP PLAT MAP FITTER #2
164.062 165.067 MAPPING
JOINT FACILITIES ARRANGEMENTS
A UTILITIES
A 11 All Valve & -Re-in Locations oted on as -built CONTACT
A :61 Note beginning of Main, EOM & Line of Main locations E-1 PHONE#
Show Rope Locations & Cul-de-sac Radius
,�S EX. WATER
PROP. 2" GAS 3'E FOG LINE RUGET
12'W CL 60' ROW SOUND JOSEPH T SAVARESE
Foreman s Signature
ROADWAY CROSS-SECTION— EMGY 2" PE 1P MAINEXTENSION
N.T.S. Company Employee ID# 22205 96 PL W, EDMONDS 98020
DESIGNED BY PILCHUCK CONTRACTORS INC.
P. MCGHUEY 206-418-4214 110/20/03 1
P. NESS 206-418-4237 11 � - U, (
P. NESS 206-418-4237 1 1) � fj_�O -A"
SAP Superior Order
107018215 1
Drawing Number
NIA
SCALE: PAGE:
1"=50'1 i/I
I
X:\#PSE—Pilchuck\CAD\NOB\PM\Dwg\Pafti Ness\107018215.dwg, 10/20/2003 01:19:53.PM, \\SN0BFTP1\pnob1n03
RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMITAPPLICATION
OWNER NAMEINAME OF BUSINESS
To s w h 19 e ve 4V 5�va,
MAILING ADDRESS '
1-2- 2- 0 9 /01 PV/
ZIP
NAME
d -, ? //
ZDRESS
.ITY ZIP
NAME-_
,1 7'
ADDRESS
CITY
STATE LICENSE ?#MER"
PARCEL NO.
.EPHON
771-ZIY,
C'w Dt�'qq Ivy,
PERMIT EXPIRES 44"1
USE PERMIT
ZONE t?'�5 t
NUMBER :2,v.
JOB U AFT
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE
TESCP ApOrcived
7UBLIC RIGHT OF WAY PER OFFICIAL MEET MAP RW Porn-ift Reclufted
Street Use Pentift Retrd
EXISTING — PROPOSED trispecdon Required
Sidewalk Required
REQUIRED DEDICATION� FT Undergmund
WhIng r"Wred
METER SIZE LINE SIZE I NO. OF FIXTURES I ' PR� RiOUIREO
YES E3 NO Q
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADE19 I INSPECTION BOND
CHECKED BY REO'D POSTED
d I 13YEs 13NO 11 s
0 NEW lid RESIDENTIAL PLUMBING / MECH
ADDMON 0 COMMERCIAL COMPLIANCE OR
0 CHANGE OF USE
50 REMODEL 0 MULTIFAMILY 0 SIGN
REPAIR GRADING FENCE
CYOS 0 ( _x FT)
0 DEMOLISH 1:1 TANK o - OTHER
GARAGE RETAINING WALL I FIRE SPRINKLER
CARPORT 1:1 ROCKERY 0 FIRE ALARM
TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER OF CRITICAL
DWELLING AREAS
UNITS NUMBER
WORK TO BE DONE
r; - C' Ail
a
z
I
z
$EPA REVIEW
SIGN AR
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
I
I
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIR SIDE REAR
z
PARK114G
LOT AR EA
PLANNING REVIEWED DATE
REO' . D I PROVIDED
I
BY
REMARKS
CHECKED BY
I / I qRO'1P&__-
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REaD
VALUATION
Description
FEE
DescriptIon
FEE
Plan Check
State Surcharge
&"50
H 8 URCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
PLAN C14ECK NO
VESTED DATE
Plumbing
Base Fee
4el"
Mechanical
THIS PERUrr AUTHOREMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
llzo
Grading
BE DONE ON PRIVATE PROPERTY ONLX ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
OERmrr APPLICATION: 180 DAYS
Engr. Inspection
PERMIIT IJMrr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
A10514
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE Crr1rS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee
Receipt #
Z
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION AP ROVAL
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
This application Is not a peffnit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
C
WORKMEN'S OMPENSATION INSURIhCE AND RCW 18.27.
FOR INSPECTION
receipt Is acknowledged In space provided.
81 IER AGENT) r0ATjE SIGNED
1A0
OFFICIALS SIGNATURE
DATE
1-6770
771 0220
%TTENTIO111
EXT 1333
I �T
RE17Z I
ji , .
D�Tv
ell 7
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL (.f
A FINAL INSPECTION HAS BEEN MADE ANDiAPPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL -FILE YELLOW IINAP;:-
09/03 PRESS HARD -YOU ARE MAKING 4 COPVES' PINK -OWNER GOLD -ASSESSOR
15.00' REAR SM'*MA(:-,K
7
I
Y.
OU'rLINE
PARTIAL INTERIOR
REMODEL AT
LOYCK FLOOR
N ECK
r t ry 0
:X VON
r-EXISTIN& DEC' 10
pppqm "IT I
OUTLINE
NJ OF TAIR TO I
L HER FLOOR
--- ---------
—lo
0XISTIN6
7 / 4/t-,
--------------- - - - ---
EXISTIN&
YNIALKHAY
.2p, FRONT SEM6,CK
EXISTINC7
PRIVEHAY
610.0,
APPROX. EVOM
OF PAVI N& --,
415th place, Aest REC,EIVEED
MAR - 5 2004
FILE PERMIT COUNTER
SWEET
220th St SW
3:
4-J
L0
0-)
0
224th St SW
CITY OF EDMONDS WATERLINE AS- BUILT
ADDRESS HOMEOWNER
22205 — 95th Place West I Savarese
CONTRACTOR
Ficsher Plumbing
DATE DRAWN
11-3-03 BY K. Haney
SCALE
N TS
WATERLINE
NO. 2003-0847
NOTICE:
No"War-ra'n
The infor mation'shown on the attached
map(s) was compiled for use by the CitY 01
Edmonds/ its Employees and Consultants.
nt the
The City of *Edrn.onds does. not. warra
acy of anything set forth on these
accur
Map(s). An . y person or e.ntity -requesting a
copy should conduct an independent
orm-ation shown-c
Inquiry regarding the 'nf'
t Fi-�� -M a p (s), including, but not limited to]
n of any sew-er stub shown, Su(
the lotatio
sewer stubs M<-ay or may- not e.xist and ma\,
t the location shown.
or may not exist a
,,-,ty of Edmonris nor its
Neitheir the
emptoyee-s 0-r off rcers shal] be Via-b-Ife. for th
I n on this Map(5), nor for
information g ve Ided based
any one representation prov
upon said. map(S'