22220 98TH AVE W.PDFiiiiiiiiiiii.
9690
22220 98TH AVE W
0000�'
-"%4E0WP- C) 03
9 0 - 19
C.-ontractor:
t I .
City -of �Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number- _/&O
Usue Date:
- 6
A. Address or Vicinity of Construction: A v.
B. Type of Work (be spec ific): S 0 P, el &0Ab tqf�"Ay) ro(Z
SF_C00hAtk1 sc�lvkcc
SWAQMsSkl (QQQr�l- Contact: So4 Kxr�-&I'cy
Mailing Address: 2 10 k K I-JQJ 'i!J Phone: _(o 70 2 1-4
StateLicense#: EINMOIJbS . UA 9�07-(, Liability Insurance: Bond: $
D. Building Permit # (if applicable):
E. F1 Commercial 0 Subdivision
C] Multi -Family E] Single Family
INSPECTOR:
Side Sewer Permit # (if applicable):
El City Project VJ Utility (PUD, GTE, WNG, CABLE, WATER)
El Other
INSPECTOR:
F. Pavement or- Concrete Cut: 0 Yes &]No G. Size of
APPLICANT TO READ
I
x H6Ch rli� 3$
I GN
. Al
INDEMNITY. Applicant understands and by his signature to this application, agrees to h6ld M)i City ofEdmondg 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 legalproceedings includirAkd�-fin8gf08ts, and attorney fees by'r'.ason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND,MATFfJALS FOR A PERIOD OF G[NE YEAR.&OLLJOI&�'r.4E fINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RERF6XVIOWEES WILL�iEHiLl) UNTIL THE FINALSTREET PAD5I�
IS COMPLETE-0 BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO TJ1kfAPJbLIbAi6-*"J - '-'/S
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 Cityapproved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be;
available on site at all times for inspection purposes.
4�- / - 4. - 20 - qC
Signature: I'- - . - 7 Date:
1 ze-4: : 2�
a (Contractor:'o-r Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME AUTHORIZED: VOID AFTER DAYS�
SPECIAL CONDITIONS: No A,5PHA4 cvr S
k.LoWF_Q I AJ fZOA19',VAY* 'WC-60A) OF-
19-111 A\F- VJ ft rAiS PF44117
COMMENTS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND III:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT I I SSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES 1:1 NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
cri
'1416
PUBLIC UTILITY"DISTRICT. NO.1 OF SNOHOMISH COUNTY RE'y. 7/87
A v
LOCATION zo L co u 4,11-Y'. AREA
:3z-
POLE NO. 1/4 S T 27 R 3 DATE 10 q(. W. 0. NO.
REASON FOR WORK W S -17A L SEC. elsEEP, jSoRE ENGINEER K A, K A L F-' Y DWG. NO. I t Soi 9 5.
RoAt-,� ia�4D 'SE-r PEr), V'og VIbe—ts DRAFTER U. G. NO. I": so,
G SCALE
DATE WORK COMPLETED DATE PRINTED
1APPROVED
FOREMAN
FEES REQ'D AYES 0 NO
PRIMARY OVERHEAD
• RESIDENTIAL
• COMMERCIAL
LEO#
I@ s- /=s
SECONDARY OVERHEAD
BASIC FEE S
- / .:@ S �- / =$ z
METER/CONV. POLE,,,4-
PRIMARY UNDERqWOND
• RESIDENTIAL
• COMMERCIAt
/� BASIC FEE
r �,;. / @ s— /= s
SECONDARY UNDERGROUND
BASIC FEE S 500
/ a$ ./- S — —
UNDERGROUND PLAT
BASIC FEE 9
FT. @
STREET LIGHTING
tFT. @ S
WORK IN Rl,Gi`IT OF WAY
0 PRIMA.�Y,-
0 �ADARY
FT. 0 S_
MISCELLANEOUS FEES
VAULT
PERMIT S
$
TOTAL DUE S
DATE PAID
RECEIPT# _
NEW SVCE APPLICATION#
ENVIRONMENTAL ANALYSIS
0 EXEMPT -0 NOT:EXEMPT-
PARA. 18 ITEM - C
O.H. U.G. COND. 7, Z KV
ADD CKT. FT. PH
REM CKT. FT. PH
NET CKT. FT.
O.H. U.G. COND.
ADD
REM
NET
PERMITS
• TREE TRIM
• STATE
• COUNTY.
• CITY F-b'O%OMDS
0
EASEMENTS
0 REOUIRED
KV
CKT. FT. PH
CKT. FT. PH
CKT. FT.
(DATE GRANTED)
P�NOT -REOUIRED
DATE RELEASED
FOREIGN CONTACTS
* GTNW JPN#
* CATV JPN#
* JOINT TRENCH GTNW & CATV
0 JOINT BORE GTNW & CATV
0
POLE STENCILING
FROM TO
TAKE OFF POLE .
PRE-CONSTR. REOUIREMENT7
* TREE TRIM 0 PUD LOCATOR
* BACKHOE M FLAGGING
0 ONE CALL DATE
_.LNDEX POLES PLAT_
LOGS U-MAPI I
XFMR C-MAPI I
LOCATION MAP PAGE _+!�4 G -7
SUBSTATION r- -s--r a, A -r I,
CIRCUIT NO. PHASE
N
6os KAKALEY
(.070 - sz k4
2(0- 8S88
51S - -S�84
(C- '—;, �-' W r
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-7 ' A<PQ Al —r IQ A A r,
E-r PEII:�, AS STAKco
IWST&LL S" r-oNoot-r FROM kIS-EiR TO: PF-C*
100.' 0 F .4 0 F P,,o A X FAk- To D
u N
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In
AC�EPTABLE TIGHTLINE MATEaL
N-12 ADS
Sch 40 PVC
SDR 35 (AST p
Prli Z- -
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FILE
k
0
to
0
Tn
VL
PLANNING DATA
2
SITE ADDRESS:-Z-2- 2- 00 A< - 1J. DATE: 311 8'/�/,
ZONING: "-9 PLAN CHK#: �6-27
PROJECT DESCRIPTION:
SETBACKS:
Required Setbacks:
Front: 2-5' Left Side: -7 �i' Right Side: 7/L Rear:
Actual Setbacks:
Front: 25' Left Side:-��' Right Side: 0'9'Rear:.
CORNERLOT t3p (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED---&—(Y/N)
LOT COVERAGE: (1, 1 & 3 + 1213 : Z117,
Maximum Allowed: Actual: —bs-3.
BUILDING HEIGHT:
Maximum Allowed: 2-5, Actual Height: z 5-1
Datum Point: Mm kole W. Datum Elevation: 391.74
SUBDIVISION: j.,. 91- 4,L
j
CRITICAL AREAS #: 99 - 2-4� q -
SEPA DETERMINATION: W
LOT AREA: 96�5-3- 7- 0
OTHER: �t &tq p M
Plan Review By:
PERMIT APPLICATION REQUIREMENTS
ro: Applicant
From: Lyle Chrisman, &gincering Ifispector RECE
0wrier. rV4 12M,77C7� s-7
Plan Check No:
,kddress,
—=—Ve ex� Date:
kfter review of the subject permit application, the following requirements must be met
1. Construction hours are:
WEEKDAYS — 7:00 A.M.40:00 P.M.WEEKENDS/HOLIDAYS — 10:00 A.M.-6:00 PrvL
!. A separate RIGHT-OF-WAY CONSTRUCTION PERMIT is required for all work on p ublic property. (ECDC 1&60) .
Truck haul route plan must be submitted and approved prior to permit issuance.
I
Builder/owner is responsible for containing all temporary runoff and erosion control on site.
(ECDC 18.30.030d)
NO WORK SHALL BE DONE WITHIN 15 FEET OF STREAMS OR 10 FEET FROM ANY CLOSED DRAINAGE
FACILITY. BUILDER/OWNER IS RESPONSIBLE FOR IDENTIFYING CONDITIONS ON THE DRAWING. (ECDC
1&30.50G)
FILTER FABRIC FENCE SHALL BE INSTALLED AND INSPECTED PRIOR TO CLEARING AND CONSTRUCTION.
(ECDC 18.30)
INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEMS, TIGHTLJNES AND CATCH BASIN
INSTALLATIOX INSPECTIONS ARE REQUIRED PRIOR TO RACKFILLING. (ECDC 1830) �
Rqm& or replace all.defective, existing curb, gutter and sidewalk adjacent to the property. If an Intersection is Involved, a handicap ramp
may be requirrA Contractor shall mod with the City Engineering staffto determine the extent of repair prior to Issuance ofthe permit.
(ECDC 1&90)
Driveway slope shall not exceed 14% without a waiver. Every attempt should be made to keep die slope below 14%. Waiver granted to
- % (ECDC IU0.0601)) . -
). Driveways must be paved fmm pro" line to City RIG[rr-OF-WAY. A separate permit Is required. (E'CDC IU0.060C) . . .
i. INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SMEWALKS PRIOR TO AND AFTER POURING. (ECDC 18.30)
L No burning Of construction refilise without a Permit filom the Fue Department.
1. Connection to City water system is required. nae is a separate charge for the water MeW.
(ECDC 7.20)
1. A back water valve Is required if downstairs plumbing is below the elevation of upstream manhole. . (ECDC 7.20)
Water and sewer main lines should be separated by 10 fed minimum. (ECDC 1&10)
Connection to the City sanitary system is required. A separate permit Is require&
LID# Fees paid: Yes No— Chargq__________�_ (ECDC 1&10�.
6N W51?
Underground wiring is required an all new construction, and for addition; alterations, and repairs that exceed 50% of the total assessed
value of the structum (ECDC 1&90)
A FINAL ENGINEERING INSPECTION IS REQUIRED PRIOR TO THE BUILDING DIVISION GRANTING OCCUPANCY
OF THE BUILDING OR STRUCTURE. (ECW 18.90)
r%171
o , REET FILE
PROJECT REVIEW CHECKLIST -14- 6 1 -re7
PROjEc;Rhv9"
PLAN CHECK #:-aLL--R7
ROJECT ADDRESS: cPa2n - 570'a -.,dj2r- zk) RECEIPT DATE:
EYIEW
0 .'BY:.'.(njt!aI/ ate,
PLAN
WATER
1 1
COMMENTS
FIRE -:1
13.1-131G.". .1.,
S;EwER:STREET%-*.. EN,G-**
Reviewed.By:
FIRE PLANNING ENGINEERING PUgLIC WORKS
STR61 -: E T F ','L' E:
FILE:DATAl 23/PROJCKL8.SFN
STANDARD DRAINAGE DETENTION SYSTEM
WORKSHEET I
owrim VIV I WE P61
ADDREss to 3 q
CALC BY:
PHONE:
7 ki 0 LT�wo( -7 0 JO
DATC- 4
'"DESIGN DATA*****
IMPERVIOUS AREA PIPE DIA PIPE LG
RIM ELEV
4" 0
I'MIN COVER
2*MAX COVER
SLOPE
INV ELEV--
OFFER CA rCH
BASIN
ORIFICE 3(4'
INV ELEV-
CONrROL CATCH
BASIN
SYSTEM CROSS SECTION
SPACE
ROW ELEV FROM
CONTROL
CUTLET
0 PIPE MIN.
r - �_; :1 y", - I
R k�
RUNOFF SPREADER
OUTLET
/2
2�'3!EEP, 4% 6" OUARRY SPALL S
DEEP, 3/4- CRUSHED ROCK
FROM CONTROL
OUTLET
RIPRAP OUTLET
7
ORIFICE
�Ict //
WASHED GRAVEL
,,,OUTF TRSNCH, MIN 10' LONG
TOP AND 4 PERF PIPE TO BE LEVEL
W
4 PERF PIPE .,C.-�
ECF.IVED
- 'FEB.1 3 1996
PERMIT COUNTER
FOOTING DRAINS SHALL NOT AnT'T CONNECTED -70 DETENTION SYSTEM
NOTES.- V "
1. Call Engineering Division (771-0220) for a tightline and detention system inspection
before backfilling and for finalj�5pq4l�opj-
E Tf
2, Responsibility for operation arZinainteriance d Firl L �tems onprivate property is the
inage
responsibility of the property owner. Material accumulated in the storage pipe must be flushed
out and removed from the catch basins to allow proper operation. The outlet control orifice
must be kept open at all times.
a-Z X)af� -
APPROVED BY
&4 1-6
DATE
REV 2/92 6
PLANNING DATA
SITE ADDRESS:-2-?- 2 Zo - V- lfvei-J DATE: 212-2 /9�,
ZONING: P-S-9 PLAN CHK#: 96- 2- 7
PROJECT DESCRIPTION: ��te 61,�.
U �j
"'., "" O'� ��
SETBACKS: ff- p -P-�
Required Setbacks:
Front: 7-S' Left Side: 7 Right Side: 7 ��2- Rear:
Actual Setbacks:
Front: Left Side: Right Side: Rear:
CORNERLOT No (Yes/No)
3 -
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED ',J _(Y/N)
4"10)A
14 S-1/ 'q- 9 1 Z -2-666
LOT COVERAGE: — 17.
Maximum Allowed: 35-17. Actual: (-71. 5-- 135,oi
BUILDING HEIGHT:
Maximum Allowed: Actual Height: 2c,
Datum Point: k-u- 0, Datum Elevation: 38 4,72-
SUBDIVISION: - 6K-4-�W- ��R "'A Atp(p, (as tvN A. A-pLew
�,X-j 4- A, . AfVA-1 't. A.,C 6—� OL.4u,0,4 '91 fbAA
CRITICAL AREAS #:
SEPA DETERMINATION:
95 - 2-4�-
LOT AREA: %G3,2- to
OTHER: k a-!:� 4a �p Aw-aw--A fl,�
Plan Review By:
C)
CD 7-" C)
LQ
25'
pp
6
TOP�3784
I.E.= 37-/ M-)
p 84
I.E.=3711.971
12" ("ON'
+
Tt)P385.64
I.E.= 383.54
R-8*400
<
.2
2
Ld
CL
30'
30'
'-r')P=384 72
:.E.= .371 .48
R-8400.
/C_;j .4f
T
T
9- L
_4Tnn_�/ �9&
> 0
DRAINAGE NOTE
THE PROPOSED SHORT PLAT WILL SUBDIVIDE A 0.47 ACRE PARCEL INTO TWO SINGLE FAMILY LOTS.
THE EXISTING PROPERTY IS ALREADY DEVELOPED, NTH A SINGLE FAMILY HOME, A. GARAGE;
> WALK -WAYS, AND-K DRIVE -THROUGH TYPE DRIVEWAY. THE -LAN * DSCAPING CONSISTS OF GRASS -LAWN
NTH SEVERAL FIR AND OTHER DECORATIVE TREES. THE EXISTING IMPERVIOUS AREA ON THE
PROPOSED NEW LOT IS 2,600 SF, THE ENTIRE AREA OF THE GARAGE AND DRIVEWAY. . THIS IS
APPROXIMATELY THE SAME AREA AS WOULD BE COVERED BY A NEW RESIDENCE AND DRIVEWAY.
THE EXISTING DRAINAGE PATTERNS INCLUDE POINT DISCHARGES FROM ROOF DRAINS AND SURFACE
RUNOFF FROM THE DRIVEWAY PAVEMENT. THIS IS TYPICAL FOR MANY OBSERVED HOMES IN THE
GENERAL AREA OF THE PROJECT. SURFACE FLOW ON THE SITE TRAVELS INTO THE NORTHWEST CORNER
OF THE PROPERTY, THEN CROSSES THE WESTERN END OF THE NORTH PROPERTY LINE. RUNOFF THEN
CROSSES AN OFFSITE GRAVEL DRIVEWAY, AND WITHIN 50 FEET ENTERS A SEMI -NATURAL RAVINE.
THE RAVINE APPEARS TO BE THE CONCENTRATION POINT OF RUNOFF IN THE GENERAL AREA. NO
EVIDENCE OF EROSION WAS OBSERVED.
DUE TO THE LIMITED SCOPE AND LACK OF IMPACT OF THE PROPOSED DEVELOPMENT
DRAINAGE IMPROVEMENTS MAY NOT REQUIRED ISCC24.16.0801 SINCE THERE IS NO APPARENT
EXTRAORDINARY RISK OF ADVERSE DRAINAGE IMPACT. ISCC 24.16120 (2)(A)l
PRELIMINARY DRAINAGE PLAN-
FOR
GARY L. AND MARIYLN DYE.
IN NW1/4,SE1/4 OF SECTION 25,T.27 N.,R.3. E.,W.M.
SNOHOMISH COUNTY, WASHINGTON
Lsmirms
NMI �W
�m 0
Lovell —S auerland & Associates,- Inc.
Engineers/Surveyors/Planner*s/Development'Consulta'nts
19400 33rd Avenue W., Suite 200 -.Lynnwood, WA 98036 - (206)775-1591 - (206)340-0830
DRAWN CHECKED I DATE �F.B. I SCALE I FIE NO. I . .
J. T. T. I C.M.C. 05-15-95 78, P.79-80 1"= 30' 95-3365
RECEIVED
FEB 1 3 1993
PERMIT COUNTER
DEVELOPED .1
) c—
u R T N E R :7j, H
V D L U N/1 E -11
s, C)
RS-8
71
-L" A 0
/\ p G
EX. FIRE HYDE
P L A
NORTH LINE OF TH 0 SOUT
CITY OF EDMONDS �F OF'
: P F HA
Wo"*GWN N 88*17 7
In'
5' .... . .. L . R
I .........
SNOHOMISH COUNTY r-
18" 00
7 a
-17-770
... ... ....
iol
j
z
u'
�A E X. SHED
ol
LLJ
2 10,056 S.F. <
zo c" NO DUPLEX
q o:5
I--oo
PROPOSED
0
N
L 12NJ
uj
0
cn
0
:N
ON
0
c— "EACN,
< ...........................
U561-1
LLJ
.................. N
U-
------ R-8400 Oro ui
RUNOFF SPREADER
Lj
Z
TIGHMNE
0
_j
F-
V)
0 0: 0: LLJ
9,'6 5 3 S. F. Llo
NO DUPLEX
< 0: Lud
PROPOSED a_:0
0:-
LLJ
TO BE REMOVED
F-7.
............................... .........
.... ......
N 6
SOUTH LINE OF BLOCK — �NORI F
------ 3 TH LINE OF E
OF BLOCK 3
L
R-8400 EX. HOUSE
1APPROX. SIZE & LOCATION)
DEVELOPED
o
D_
SCALE :71'-'=30'
2
0' 10' 20' 30' 45' 60'
224th STRFFT q
EX. FIRE HYDRAN f
i :—)
c�
<(
C)
C)
LQ :-Q
7:�, U
25 25' 1 L'Ll
NORTH 6NE OF THE SOUTH HAIiF OF qLO
C�, 3
V, TOP�-3*78.
1. E. = 3 77.
7_17
5" smossmom
7
f
18' 1 R,//
<
Ln
�.^A�Y FIR X
< C7) U_
>
W <
,056 S.F. ssmli
DUPLEX wa
L o �s 111pp=384.271
ROPOSED I.E.=371.97
Uj 0
, , U :Ile
V)
_c
W
CON RETE
I C)
81 Nl�l
COMCRETE
Uj WA
01
0.
CL
WAL�
.......... 20' .
0)
C13
52" TOP:=385.64
C5
1,E,=1131*14
20- Cj------------------
SPREADER 7
Ll! Uj
MHTUNE
R-8400
LLJ < P Ly
9,653 S.F.
< W.:
Lqz 00 11 n i -
of NO DUPLEX .......... to 1 Z : I <
r-- to 3:
< O:LJ 11) Li
U PROPOSED a-:o I
U mi3xi
c): Ld
V) UT al C.
P co
VED
L
LL W
....... ............... 20'
Lr,
....... CL
......... ...
N '681,752" -,r4d. 0 V . . . . . . . . . . . . ...
\JE OF BLOCK 3 0
NORTH LINE OF' SOU TH 201FT
OF BLOCK 3 ci
30
Ld
F 30'(1 30'
c 'vl t-i
T _)P=384.72
C
:.E =.'3*7.
EX. HOUSE
(APPROX. SIZE LOCATION)
i)ED
rL_ - -
14—A - - -------------- LU
> cn
<
p
lz
c— R-8400
4�
00
or)
T
th STREET
N 88*18'2.5" W
>
a
LD
L
CL
0
i
L
C)
DRAINAGE'NOTE
_1
THE PROPOSED SHORT PLAT WILL SUB
0
THE EXISTING -PROPERTY IS ALREADY [
>
WALKWAYS; AND A-0RIVE--THROUGl9—T-'
WITH SEVERAL FIR AND OTHER DECOR;
PROPOSED NEW LOT IS 2,600 SF, THE
APPROXIMATELY THE SAME AREA As 1%
THE EXISTING DRAINAGE PATTERNS INC
RUNOFF FROM THE DRIVEWAY PAVEMEt
GENERAL AREA OF THE PROJECT,, SU;
OF THE PROPERTY, THEN CROSS TH
CROSSES AN OFFSITE GRAVEL DRIVEW/
THE RAVINE APPEARS TO BE THE CON
EVIDENCE OF EROSION WAS OBSERVED
DUE TO THE LIMITED SCOPE AND LACI,
DRAINAGE IMPROVEMENTS MAY NOT RE
EXTRAORDINARY RISK OF ADVERSE DR
PRELIM11
GARY L.
IN NW1/4,SEl/4 Of
SNOHOMIS
19400 33rd Avenue W., Suite
AWN I CHECXED I DATE
J.T.T. C.M.C. 05-15-
� 8 9 0 . 19 1 -
Datez
To:
Subject
Transmitting:
CITY OF EDMONDS
M - 517#1 AVE OL - EMAOMS. WA 98= PW 77J-0220 e FAX (2D61771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning * Parks aiimf Recreation * Engineering
I A Div w Nor@-)-* -w 1141AZW1
January 5,-1996
Eric Sundquist
23209 84th Ave. West
Edmonds, WA 98026
Critical Areas Checklist
Recelveo
FEB 1 3 19sd
PERAVTCOU�TER
I'
CT?'r IF�S17�pw"
1!
For your informatiow xy(
As you requested:
For your file:.
Comment and return:
Note attachments:
comments: Please bring in a copy of the Critical
Areas Checklist when applying for a building
permit.
Planning Division
Cunningham
im Incorporafed Augusf 11. 1890
Sister Cities International — Hieldnan. Japan
ago .1941-
City of Edmon&
Critical Areas Checklist
Ile Critical Areas Checklist contained on
this form is to be filled out by any person
preparing a Development Permit
Application for the City of Edmond$ prior
to his/her submittal of a devc1olimbin't
permit to the City. -
The purpose of the Checklist is to enable
City staff to detennine whedw any
potential Critical Areas are or may be
present on the subject property. 7fhe
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 checklistj 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. .
With a signed copy of this forni, the
applicant should also submit a vicinity map
or plot plan, for individual lots of the parcel
with enough detail that City staff can find
arid identify the subject parcel(s). In
addition, the applicant shall include
other pertinent infomriation (e.g. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assitA
staff in completing their preliminary
assessment of the site. '
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best.O'f my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name
Street Address
CAII-tOMA�" 6t--a" �'&)-
City, State, ZIP -.47opm
/pe
Signat
od">U
Date
Applicant Representative:
Nune
Street Address
City, State, ZIP
Signattire
Phone
Date
In
CA 1-1 LE NO. QJA -L(!�) - tl-�
Critical Areas Checklist
Site Information (soils/topography/h /vegetation) -
a r/
1. Site Address/Location:
2. Property Tax Account Number: 5----Lf.�O 7— 00 3- cto-o��
3. Approximate Site Size (acres or fed): 3
"D
4. Is this site currently developed? no.
!�bf k Q
If yes; how is site developed? - lyces
5. Describe. the general site topography. Check all that apply.
Flat: less than 54eet elevation change over entire site.
Rolling: slopes on site generally less d= 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet)-
Hilly: slopes prese�t on site of more than 15% and less than 30% a vertical rise
of 10-feet 16w a horizontal distance of 33 to 66-feet).
Steep: grades oijreater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less dm 33-ted).
Other (please describe):
6. Site contains areas of year-round standing vrAer: Approx. Depth:
7. Site contains areas of seasonal standing water. Approx. Depth:
VVhat season(s) of the year?
S. Site is in the floodway floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Ad Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow _;shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wedand is present on -site:
For City Staff Use Only
1. site is Zoned?
2- -SCS ampped soil type(s)?
3,:�:::--.-:W-etIsjid inventory or CA. inap indicates viedand present an site-9
4�,'-.-.:::'.-.-CnticaI Areas inventory or C-A. amp indicates Critical. Area an site? C=�
designated earth subsid=6.1-ndslide han area?
-:::,:-Site within'
..-,�Slte designated on the EnviroomentAlly Sensitive Amu Map?
.DETERMINATION
....STUDY REQUIRED CONDITIONAL WAIVER
WAIVER
Reviewed by: 1)
Planner V— oate
ACV01104M4
CERTIFICATE OFSEWER AVAILABILITY
RETURN TO: Snohomish County - Planning & Development Services
Land Use Section - 5(h Floor Administration Bldg.
3000 Rockefeller Avenue, M/S #710
Everett, WA 98201
(206) 388-3311
Q (.71 /PZ�3. -
FILE NUMBER: - 69
APPLICANT: C-f+q:�j
PROPOSED USE: '-�-Wcylc T
LOCATION1
SEWER AGENCY INFORMATION
1) a. Sewer service will be provided by side sewer connection only to an existing 0 size
�e —we r Q
_C, feet from the site and the sewcr system has the capacity to serve the proposed
Use.
170-D
b. Sewer service will require an improvement to the sewer system of
(1) feet of sewer truck or lateral to reach the site; and/or
(2) the construction of a collection system on the site; and/or
(3) other (describe)
2) a. The sewer system imp rovement is in conformance with county approved sewer
comprehensive plat.
OR
b. Thesewer system improvement will require a sewer comprehensive plan amendment.
3) a. The proposed project is within the corporate limits of the district, or has.been granted
Boundary Review Board approval for extension of service outside the district or city.
OR
b. — Annexation. or BRB approval will be necessary to provide service..
4) Service is subject to the following: S TA Al J9 ff ,2 J (Jl L 6 P-- .9t-XWC�Z -90"Z UI C
7- L.V
-T A P'qupe - N�'C-1coapd-o"J 4.1 -<7-'94f-'C1e
0 / 4 -IM, C.r
a. Connection tbargize. 4 4. EAQ,, / r/t!5 45g:�- J 125!�2�
b. Easement(s):
C. Other: Fllvlsv ="cws'
&o-J eL&)V4-�r-le-2 377*77.
lyt
I hereby certify that the above sewer agency information is true. This certi 1 ati shall be valid for one year from
date of signature. J
a-youg,
Agency Name
Title
p3mer.doelmd
S S.
atory Name
Date
Y
CERTIFICATE QFWATEII AVAILABILITY
RE,TURNTO: Snohomish County - I'laiming & Developmew Services
Land Use Section - 51h Floor Adiniiiistration Didg.
3000 Rockefeller Avenue, M/S #710
Everett, WA 98201
(206) 388-3311
FILE NUM13ER:
APPLICANT:
PROPOSED USE: i
LOCATION:
WATER. ['-Ult.VL-Y.Olt.INI-'OltMA'I*ION
a. '---—WaIcr will be provided by service connectioll only to III exisfilig
wi(er main
feet froill tile site.
OR
b. Water service will require all imprommid to lite wa(cr systcm of.
(1) rcct of water main to rcach (lie site; and/or
(2) (lie construction of a distribution systcm oil the site; and/or
(3) other (describe)
2) a. �Fhc propose(] project is withiii (lie corporate limits of (lie district, or has bccn grantcd Boundary
Review Board approval ror cxtcnsion of service outside the district or city, or is within the County
approved service ni-en of n ptivate water purvoyor.
'Olt
b. Annexation or BRB approval will be necessary to provide scrvice.
3) a. L------Wntei- is/or will be available ni the rate or r1ow and duration indicated below at no less than
20 psi mcasurcd at (lie ncarcst fire livdrant feet rrom (lie building/property
(or as marked oil (lie a(lached map).
Rate of FlQw
less than 500 gpin (app. __ gpm)
500 to 999 gpm
1000 gpm or more
OR
b. Water system is not capable of providiiig fire flow.
Duration
less than I hour
FOR 1-2 hours
2 hours or more
COMMENTS/CONDiTiONS: AJ,/4 L 0 P tP .5 (--0- LJ 4 3' '7
1-�,Aj aPP e-
!� 0 JF-
A lVb' & L L- 2= P�-C/ I-) —IIL-)IJ C j5/-WL6-&Tj $-^,AD /K 6r)� j=J9
I hereby certify that tlic-above water purveyor iiirormitim is true. This certificatim shall be valid ror one year ftom
date of signature.
Agericy'Namc riatory IName
2�44-,09-4- ILA
Title Mile
HEICwHT C!ALC'5
:3 7q,�
TIOTA L 3 7
4 I'so
A103,5
APPROVED BY PLAWING
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.51TE PLA-W
C Irv,
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flah 110
IWO
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$&41.72 Tor
OWN
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME NAME OF BUSINESS
a: V, Olt' / V6 Ak-0 xgr Jo C
W MAR INC, ADDRESS f
f 0-
CITY ZIP TELEPHONE NUMBER
I
L yo ri w-vul
NAME
ADDREP
ui
11� C, X
cc CITY ZIP TELEPHONE NUMBER
NAME
��o of
CITY ZIP I TELEPHONE NUMBER
STATE LICENSE NUMBER EXPIRATION DATE
Al 7 _2 j 6- i7
Legal Description of Property - include all easements
Z
2
16
V I IS 002-
Property
Tax Account
00 6100
Parcel No.
(=�
Ld2KPLUMBING
Ljj
NEW
RESIDENTIAL
E]
El
Z�MECHANICAL
ADDI ri ON
COMMERCIAL
APT. BLDG.
El SIGN
REMODEL
—
FIREPAIR
0 ,
Apti�
Gf
E] FENCE
CIDS.
._FT)
El WOODSTOVE
SWIM POOL
F
DEMOLISH
INSERT
HOT TLIB/SPA
GARAGE
CARPORT
RETAINING WALL/
ROCKERY
El RENEWAL
(TYPE OF USE. BUSINE�SS OR ACTIVIT�.)-PXPLAIN
USE
ZONE PERMIT
NUMBER
9 60;Z R
JOB
ADDRESS c
SUITE:APT #
k -y
J J
,EGAL DESCRIPTION CHECKI
SUBDIVISION NO.
LID NO�
04/0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCIP Approved 11
RW Permit Required b,
EXISTING — REQUIRED DEDICATION
Street Use Permit Req'd El
PROPOSED
Inspection Required It9l
Sidewalk Required 0
M�T R SIZE
LINE SIJE
NO. OF FIXTURES
uj
PRV REQUIRED
919
,
I I '�5
YESXNO 0
Z
0
REMARKS
Z
cc
W
7 Z
W
V S
0
Z
ENGINEERING MEMO DATED REVIEWED BY
1AILIel-
SIGN AREA
SEPA REVIEW
ADB NO.
ALLOWED PROPOSED
COMPLETE EXEMPT
SHORELINE It
EXP
VARIANCIfOR, CU
PLANNING REVIEW BY
DATE
.3> /I
SETBACKS — FEET
HEIGHT LOT
COVERAGE
SIDE REAR
Z
FRONT
<
REMARKS
ECKED BY TYPE
1 SPECIAL INSPECTOR JOCCUPANT
REQUIRED 12; �:: 5 -- CAD
11 YES 1:. A.— 11 2_0__6k fl�l M. h V", 9 1
PROGRESS INSPECTIONS PER UBC 305
NUMBER/
NUMBER OF
DWELLING
I
CRITICAL
AREAS
-7(
OF
STORIES Y;L
UNITS
NUMBER
C'
DESCRIBE WORK TO BE
DONE (ATTACH PLOT PLAN)
4", ild tv,
FINAL INSPECTION
REQUIRED
ptei,v
-f§ePV1TT---,5
I
-
r5_1ZA14b�T__
IV
VALUATION
FEE
T--
I N f-:::Pfr.
PLAN CHECK FEE
I � P-,,
4Z A/
70
BUILDING
10 ? 141
A
HEAOURCE:
GLAZING
4 r_1 IN)
17
PLUMBING
Plan Check No. 12
MECHANICAL
/2
GRADINGIFILL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curts, sidewEllks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
q 77,
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days ,
STORM DRAINAGE FEE
50
ENG. INSPECTION FEE
30
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
and agents from any and all claims for damages of
�1_ 6AZ Cj4C_' Ct(-
41-i'T �r'
1_�
PLAN CHECK DEPOSIT
5
73-
employees,
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
norlimit in any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
I
I hereby acknowledge that I have reaU LhIs application; that the
information given is correct; and that I am the owner, or the duly
n ' n
0 r
ATTENTION
APPLICATION APPROVAL
a authorized agent of the owner. I agree to comply with city and
u '
THIS PERMIT
T his application is not a permit until
state laws regulating construction; and in doing the work authoriz-
st a tc
AUTHORIZES
.
signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor
ed ti�
Code of the State of Washington relating to Workmen's Compensa-
ONLY THE
WORK NOTED
Deputy; and fees are paid, and receipt is
Lh,
ion Insurance andRCW 18.27.
t ti
INSPECTION
acknowledged in space provided.
S E GENT) DATE SIGNED
r
DEPARTMENT
CITY OF
OFFICIAL*S ATURE DATE
�k
te, -6wll
EDMON DS
'14
116
/
CALL FOR
RELEASEDIEBY- DATE
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
3.
PINK — Owner GOLD — Assessor
CHAPTER
t-%'E C 0 t-,*'%
STATEMENT ON ACCESSORY DWELLING UNITS 96 APR -16 AM 11: 32
Property Address:
Legal Description
Fo/ M (-) tq 0� S.
0
V0 10 � g �
VO ON -
Cu Y, �'
T 0 R
N 0 11 com 1'�'J i c (I L) H I Y. S I.I.
DEPI-11 Y--
I have read the requirements for accessory dwelling units contained in Chapter 20.21 of the
U1 Edmonds Community Development Cod� and understand that an accessory dwelling unit,
including a second kitchen, is prohibited for two years after occupancy by the current owner is
granted and until after a conditional use permit has been approved by the City of Edmonds
Hearing Examiner.
I also understand that approval of a conditional use permit is subject to a public hearing, and
neither this statement nor the issuance of a building permit shall act to limit the discretion of
M14 the City review in the review of any application for a conditional use permit
Property Owner Name J'A16— we'�Z:L� F
103 C(-- I-V ti
Date
STATE OF WASHINGTON
COUNTY OF SNOHOMISH
I certify that I know or have satisfactory evidence that
signed this Instrument and acknowledge it to be his/her free and voluntary act for the uses and
purposes mentioned In this instrument,
Da td 9 '9
signature of
Notary Public
Title 6,q.,e- y
My appointment
Expires:
THIS DOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY
AUDITOR
ACDUSTM.DOC
8 go . 199
Citv of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number- 96 20/
Issue Date: -7
A. Address or Vicinity of Construction: - 22220 98 Av W (9617694)
B. Type of Work (be specific): Install Service
C. Contractor: Vashington Natural GAs
MailingAddress: 1122 75 St SW Everett
State License #: 98203
D. Building Permit # (if applicable):
Contact: Mariamne Kingsbury
Phone: 356-7500 X7596
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. E] Commercial [J Subdivision 0 City Project FL] Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family F] Single Family F1 Other
INSPECTOR: INSPECTOR: UJLI'.
F. Pavement or Concrete Cut Yes 0No G. Size of Cut: x H. Charg4�_$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmondg 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 costs, and attorney fees by reason ofgranting thispermit.
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 BY CITY FORCES, AT WHICH TIMEA 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 abovestatements and understand the permit requirements and thepink copyof thepermit willbe
available on s 11 ' es for inspectio rturpos
Ate at a yrn
Signature: Ajkw// -7 ",64 ",,4 J Date: 7-22-96
��ntractor ror Agent) —/
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME A . UTHORIZED: VOID AFTERSOEq AYS
7.
SPECIAL CONDITIONS:
COMMENTS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND 111:
,RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
RECEIPT FEE:
DATE: ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT kISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
DiaLrram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
DYES - * E] NO
Date:
Date:
Addendum to: City of Edmonds
Right of Way
Permit -Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
0356-7500 X7596
Mill
W
3 ob q (--o I -�- Ca 34
E'-z '2- -Z, 0 3 5
<E�� Kj
Key; , I tvi
-W- Water
-G-
Gas
-SS- Sewer
-& Water hydrant
0 Water valve
P-6 N'
AWaftVbnEr*wGwv-N
I
VA
t'�I
(0
Watermain depth NO'
c c.
gas main
-1 1., * . . . Washington Natural Gas Cpmpany
1122 75th Street S.W., Everett, Washington 98203, (206) .355-3331
017001,90010017 1 D-70, _1190—
T4(,, VCiRMAL
City -of Edmonds..-, ..cu'r 9,ot\ts G%VEt4
Roy wq,k -r C U"r -r OAA
zer-11 �* RIGHT-OF-WAY CONSTRUCTION
PERMIT
PermitNumber.
. . .. ..... Issue Date:
Ay
A. Address or Vicinity of Construction: 22-220
890 9 C) B. Type of Work (be specific): C)qrU rime PwAwl 18" Ay� roki
I - R rz %,ro% e RQ.
t - )A SIE C Ot-31S AM SIERYI.Cf Ar-cyre CUMPLE-rE.
6 i Contractor: Contact: Sall J<AXA%_V_1
Mailing Address: I C) k 3 \1 CJ C1 Phone: L,76 12 14,
State License #: 10A M)2(0 Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. F] Commercial 0 Subdivision El City Project 0 Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family F] Single Family Other
INSPECTOR: INSPECTOR: _j.A k,
F. Pavement'or Concrete Cut Wes 0No G. Size of Cut: x H. qh4r7q�,$_
0
APPLICANT TO READ AND WN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmondg 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 legalproceedings including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTOA-746N FEES WILL BEffkrD UNTIL,THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
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 completiom
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 copy of thepermit will be
available on site at all times for inspection purposes.
Signature: Date:
0'(Conir" to -or
a c r � �en t)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE "ONLY '�
APPROVED.' BY: -
TIME AUTHORIZED: VOID AFTER '16AYS
SPECIAL CONDITIONS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND III:
RESTORATION FEE:
PERMIT OtE:-
A TOTAL FEE:
COMMENTS: RECEIPT FEE:
ISSUED BY:
DATE:
NO WORK SHALL BEGIN/pRI(M TO PERMIT.,19SUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
I Comments:
I Diagram
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES 0 NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
,"I 'Ps
F-P
41476 -
L N S -TA LL 0 L E.
.Y
PUBLIC UTILITY'DISTRICT NO.1 OF SNOHOMISH COUNT'
RE q V. 7/37
L6cX:r16N* 'Z 2- 0 'E.
_5ou-1ti
co
-we %7r
u &J"r Y AREA
POLE NO. F_ 1/4, s 2- 5 T 27 R 3 DATE
-10
W.O. NO.
32-
olpetll� cv"r 3Z' AS Pq A L7- RoAC�
REASON FOR WORK s -r.A� L I- s Ec. R i stP, iloRE ENGINEER
K & K A, L F_
DWG. NO.
4rl RC cc -r PC r, cf^Q 'p. — p MD A =0
0 P T,% A IC cz
a
u M;d m
GA, SCALE
DATE WORK COMPLETED DATE.PRINTED
APPROVED
FOREMAN ENVIRONMF-NTAL ANALYSIS
N EXEMPT -0 NOT EXEMPT -
FEES REQ'D -AyEs 0 NO SUBSTATION r--s-r cA-r e
PARA. 18 ITEM - C
PRIMARY OVERHEAD O.H. U.G. COND. 7.2 KV CIRCUIT NO. PHASE
• RESIDENTIAL ADD CKT. FT. PH
• COMMERCIAL REM CKT. FT. PH
LEO#
s I=$
SECONDARY OVERHEAD
BASIC FEE S
METER/CONV. POLEX
PRIMARY UNDERG
,W6ND
• RESIDENTIAL
• COMMERCIAt
BASIC FEE $
LEU#, -'
/=s
SECONDARY UNDERGROUND
BASIC FEE $ 500
/a$- - /_� $
UNDERGROUND PLAT
BASIC FEE S
(L FT. 0 S
STREET LIGHTING
t FT. @St�
WORK IN RP4T OF WAY
• PRIMAPI,
• SECOKADARY
(L FT. @
MISCELLANEOUS FEES
VAULT S
PERMIT S
f)(ress ko&ej BORE $
z
$
TOTAL DUE $..,5(-*0
DATE PAID
RECEIPT# _
NEW SVCE APPLICATION#
NET
CKT. FT.
O.H. U.G. COND.
_KV
ADD
CKT. FT. PH
REM
CKT. FT. PH
NET
CKT. FT.
PERMITS
(DATE GRANTED)
• TREE TRIM
• STATE
• COUNTY.
IN CITY
0
EASEMENTS
0 REOUIRED
P�NOT -REOUIRED
DATE RELEASED
FOREIGN CONTACTS
* GTNW JPN#
* CATV JPN#
* JOINT TRENCH GTNW & CATV
6 JOINT BORE GTNW & CATV
0
POLE STENCILING
FROM TO
TAKE OFF POLE
PRE-CONSTR. REQUIREMENTS
* TREE TRIM 0 PUD LOCATOR
* BACKHOE 0 FLAGGING
Z ONE CALL DATE
PLAT
INDEX POLES
LOGS U-MAPI
XFMR IC-MAPI I
LOCATION MAP PAGE _+!�4 G -7
fSos KNKA(_C-i
(o70-3214
2to- 81688
5cs - 3�84
E R (C- 1�, G, U 1 '$ 7 ( �j I tA,,
(o70 - Z 7 It
RISER TO: PF-C>
]:WS7ALL Cot4oucr FROM
:1007
guN CF iz k,0 A0% TO F_ D�
Co N) -r i t4 u o us 3 V C_
So(kE WP,-S A-r-rS^P-rEt�
SO-V Kf-?-r CA04NAG 44,
>
�%� L::)v
.Z4 coew
PROJECT REVIEW CHECKLIST
-/-- S / TZ�77 , - I I
PLAN CHECK #: - --R 7
koutjj�.—
PROJECT ADDRESS:-4RA,�?(-) - (?EEL�- XII)r- RECEIPT DATE:
PEVIEW
D I
BY:(Initia'l
e'
PLAN.
WATER
[SEWER
COMMENTS
FIRE
BLDG.
I
-STRE
ENG]
Setbacks/Variance/Setback Adjustment
Conditional Use Permit
ADB; Requirements
Other Zoning Requirements
4
Underg ound Wiring Required
Lot Slope 15%
SEPA Environmental Checklist/Hydraulics Permit
7
Tree Cutting Plan
. . . . . . . . . . . .
Plat/Subdivision Requirements
Legai Description Verification
Quit Claim/Street Dedications
Easements - Public/Private
. . . . . . . . . . .
----------
Z:1
Engineering Storm Drain Review Fee 3,f>
- - --- -----
Engineerin 2.2 Inspection Fee
9
Drainage Plan (On -Site)
Setback - Top of Bank, Stream, Water Courses
Setback - Storm Drain Line
Open Ditch - Existing
Culvert Required
Culvert Size
Shoulder Drainage/Shale Open Runoff
Catch Basin Required
................
.22
Driveway Slope & Vehicle Access or--
.23
Sidewalk Required
1..::24
Curb & Gutter Required
Curb Cut For Driveway Required &);D
26
Street Paving Required
1-M �g
.27
Right-Olf-Way Co struction Permit Required '121-5
.28
Street Name Sign Required
29
Other Signing Required
. . . . . .
30
Bond Required For Public Improvements
.31
FEMA Map Check/Water Table
32
Side Sewer Availability. 4q��
33
Calculate Sewer Connection Fee If No LID #
Create Street File
34
35
::36
Existing Water Main Size
Water Meter Size
:.37
Service Line Size
--.38
Water Meter Charge Required
39
40
Hydrant Required
Hydrant Size Existing
:::::41
Fire Line Charge Required - Sprinkler
�MITR
P
4
Street Cut
��:.43
'Miscellaneous
FUI
Reviewed By:
FIRE
PLANNING
ENGINEERING
PU9LIC WORKS
FILE:DATA1 23/PROJCKL8.SFN
IN L " u (N u ur uulllh�.13
1
21
2
22
3
23
4
24
5
25
6
26
7
27
8
28
RW PERMIT DATE ISSUED RECEIPT #
9
29
10
30
11
31
12
32
13
PAID $ RECEIPT DATE
33
SS PERMIT DATE -ISSUED RECEIPT 9
14
PAID $ RECEIPT # DATE
34
35
4
16
36
17
37
METER SIZE PAID $ DATE RECEIPT #
18
38
19
39
20
40
090 .199 -
City of Edmon&
Critical Areas Checklist
The Critical Areas Checklist contained on and submit it to the City. The City will
this form is to be filled out by any person review the checidist, make a precursory site
preparing a Development Permit visit, and make a determination of the
Application for the City of Edmonds prior subsequent steps necessary to complete a
to hisfher submittal of a developmbrit development permit application.
permit to the City.
Ile 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,
Willi a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent infor-mation (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 Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner A:pplicant:
el -a C4 t
Name
Street Address
City, State, ZIP
si�!
.,e . Date'
Applicant RepresenUtive:
Narne
Street Address
City, State, ZIP Phone
Signature
Date
CA 1-1 Ll-- NO.- UA
Critical Areas Checkfist
Site Information (soils/topography/h /vegetation)
a 1-1 A - - &Zl
1. Site Address/Location: r=ft5WT ZIMIM — t rl flt-�K
(44ZZ)= - - . -
2. Property Tax Account Number: :� IV I PF0 5- 4 5-07— 003- ct-o-0?0
3. Approximate Site Size (acres or s uare feet): f
4 5- Ft�
4. Is this site currently developed? 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 presM on site of more than 15% and less than 30% ( a vertical rise
7
of 10-feetic&er a horizontal distance of 33 to 66-feet).
Steep: grades oi-jg'reater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: yd -; Approx. Depth:
7. Site contains areas of seasonal standing water: �ld Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? 1� //d Flows are seasonal? (What time of year?
10. Site is primarily: forested ;meadow _;shrubs mixed
urban landscaped (lawn,shrubs etc)
I I.- Obvious wetland is present on site:
City Staff Use Only
-1. Site is'Zoned?
2. -SCS mapped soil type(s)?
�.Vedajid inventory or C.A. map indicates wetland present on site?
4-:- '.Critical Areas inventory or C-A. niap indicates Critical Area on site?
... -landslide hazard area?
:5 . within' designated earth subsldenoe�
designated on the Environmentally Sensitive Areas Map?
-DETERMINATION
STUDY REQUIRED CONDITIONAL WAIVER
WAIVER
Reviewed b,-.
—oat,
Planner a
RXV01/04194
E C 0 i [J'''L.
STATEMENT ON ACCESSORY DWELLING UNITS qFAPP-19 A1411:1)9
0/ uili f 6R
Property Address: 11Z'_A_N01V1M11�"i COUNI'Y'� WASH.�
DE P 1.11 Y_
Legal Description
Vol 10q ggcj
P0 00�_
g e (_ o,,V 6,o,
I have read the requirements for accessory dwelling units contained in Chapter 20.21 of the
Edmonds Community Development Codf and understand that an accessory dwelling unit,
including a second kitchen, is prohibited for two years after occupancy by the current owner is
granted and until after a conditional use permit has been approved by the City of Edmonds
Hearing Examiner.
I also understand that approval of a conditional use permit is subject to a public hearing, and
neither this statement nor the issuance of i building permit shall act to limit the discretion of
the City review in the review of any applic�itlon for a conditional use permit
Property Owner Name L/ 17 C_
I jepl
103 q I, n
Date
STATE OF WASHINGTON
COUNTY OF SNOHOMISH
I certify that I know or have satisfactory evidence that
signed this Instrument and acknowledge it to be his/her free and voluntary act for the uses and
purposes mentioned in this instrument.
Sign ' ature of
Notary Public
Title 6wx y
My appointment
Expires:
THIS DOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY
AUDITOR
ACDUSTM.DOC
WATER. SERVICE INSPECTIONS
REWIRED. CALL 771-0235
oi
-d
0 '-
rl
OPf
K
()010
04 Jj;
go so C.( 0
6 6 %9 00 -,f
40 'o
bj
A&EPTABLE TIGHTLINE MAIT-Eiti—A
N-12 ADS
Sch 40 PVC
SDR 35 (ASTM D3034)
-'�3 A ",� TL 12. �,
ED
�AS
STANDARD DRAINAGE DETENTION SYSTEM
WORKSHEET
OWNM V(kl
3
L
E,
CALC BY: V(,C, --v ej-
PHONE: t�70 - ? -7 ( /
DATE: �--13 -26'
'"DESIGN DATA
COP y,
IMPERVIOUS XREA PIPE DIA PIPE LG ORIFICE-
DETENTiON PIPE LENGTH WASHED GRAVEL
TF TRENCH. MIN IV LONG
I--- AD 4"PIERF PIPE TO BE LEVEL
zk� -
RM ELEV- I"WN COVER 609witt SFVkCE
2'MAX COVER MM ELEV- FROM
CONTROL
L OUTLET
IC 9 AUN .5%-r/.SL0ft T 0 PIPE 69N. 4PERF PIPE w9ecEIVE
hAR j 4 0916
cRina 314" RUNOFF SPREADER R457.5 ues
INV ELEV- INV ELEV- OUTLET PERMIT COUNTI
LFRER CA rCH
BASIN COATROM
6ASZq
/2'.z'x6"OEEP, 4"-6"QUARRY SPALLS
SYSTEM CROSS SECTION x2'. 3' DEEP, 3/4- CRUSHED ROCK
FROM CONTROLL
OUTLET
RIPRAP OU.1
FOOTING DRAINS SHALL NOT CONNECTED TO DETENTION SYSTEM
NOTES."�� lr7"'e
1. Call Engineering Division (771-0220) for a tightfine and detention system inspection
before backfilling and for final inspections.
2, Responsibility for operation and maintenance of drainage systems on private property is the
responsibility of the property owner. Material accumulated in the storage pipe must be flushed
out and removed from the catch basins to allow proper operation. 'Me outlet control orifice
must be kent onen at all times.
APPROVED BY
DATE
REV 2/92 6
HEICHT CALC'5
-51TE PLAW
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m rXL: I &1 3 7 EMN
4 XdXO
APPROVEO BY PLANNING
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— i- —0276
City of Edmond$ Permit No: c2o�
RIGHT—OF—WAY CONSTRUCTION PERMIT issue Date:/I 3
I
A. Address -'or Vicinity of Construction:
B. Type of Work (be specific):
C. Contractoriel)a-kj%';� g9f!:: U123hir-IIIIII U-C Contact: (-!2,01U 010LA_y)r)
Mailing Address:/ Phone: 2Jv3-5qJ2,
_Z�izwl
State License #:
City Business License #:
D. Building Permit # (if applicable):
E. F� Commercial
F� Multi -Fa mily
INSPECTOR:
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
0 Subdivision El City Project �k EUC (PUD, VERIZON, PSE, COMICAST, OVWSD)
E] Single Family F Other
F. PAVEMENT CUT: [] YES b(NO G. SIZE OF CUT x
CONCRETE CUT: F-1 YES §
(NO
G. W� Mail Approved Permit Call for Pickup
APPLICANT TO READ AND SIGN
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 B Y CITY FORCES, A T WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Traffic control a.nd public safety shall be in accordance with City regulations as required by the City Engineer. Every
nagger must be trained as required by (WAC) 296-155-305 and must have certification veTifying 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
IHAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA TI MUST MAKE THE PINK COPY OF THE PERMITA VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Signature:., /7J/L_CL/)_t_,9 Date: Z_5 Za q
I I If
FOR CITY USE,ONLY
Approve&by:, Right�;of�WayFee:-..-/&.'n
Time Authorized: Void:After 1, Disruption!,Fee/Ftiiid�;1'1,.-I�.*.
,,.Special Conditions: 1,1 Al Al. S j�r-,7rAe-k- In spectioin Fee:
W_ F, I & vmed '77 1 i N r,
44a
IDA
�REQUIRED INSPECTIONS: t6) _rVfiJq1'C. CC44Tt26L
0 P, � (on
Call 425-771-0220, Ext. 1326for a 24-hour vibite-recor-ded inspection request line.
FINAL APPROVAL OF PERMITTED WORK: 5 DATE:
ITTector's Signature
CADocurnents and SettingsTunisNy Documents\Fonns\Engnrng\ROWpermit_.doc
J
Af
Revised 10/01/03
22220
Open trench in
shoulder of ROW for
approx 10'and bore
roadway for 20'
Comcast of Washington, LLC
1525 75th Street SW
Suite 200
Everett, WA 98203
Contact: Gary Clawson 425-263-5412
North Drop
Node: EM26
22220 98th Ave W - City of Edmonds
N
W + E
S
NORTH NOT TO
SCALE
Work Details
Open trench in shoulder of ROW for approx 10 feet and bore roadway for approx 20 feet m/I to extend and bury CATV service
drop to 22220 98th Ave W.
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 TIMELINE AND PROPOSED HOURS OF OPERATION:
0 Timeline - Up to 30-days past the issue date.
0 Work Hours -The entire project area will be conducted from 7:00 AM to 7:00 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 Traffic Control Plan shall be on -site with all
contractors during the project.
3. All contractors will avoid parking on sidewalks and shoulders an - d 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 traffic 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.
S
Er:osion ofitt
If curb and gutters in project area:
• Filter bags will be placed in catchbasins downstream of work site, and
• Small check dams of pea gravel filled sandbags will placed within the
Vtter upstream of the catchbasin.
Traff ic, c ontrol set-up for minor encroachment
MIR-
Traffic control set-up for lane closure
a&
t 4�
loptionall
&
Pr'
FLAGGER STATION
4 00
Truck Mounted
Attenuator
foptionaD
V3
L
, 43
200TA
If
B
100,
)ace
FLAGGER STAT10H
N
Ati fl�-
W"I
S T
Depth, Cleaning, Containment,
Compaction, and Restoration
Depth =
36-inch minimum
-Compatible w/
other utilities
Shoring required
�RC44 f
Pavement Cuts
T-cut 1-ft wider
than trench
Neat -line saw -cut
or jack hammered
edge
1+ 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
mixture approved by the Engineer.
Ccomcast
g,
.1dr MOM
CLEANING: All Streets and roads are required to
be cleaned and swept both during and after the
installation work.
N..echanical—N7acuu,-n-,.sp.-efer-r-edmell-hod
CONTAINMENT: All un-restored shoulders or
material storage areas are required to be contained
with reflective barricades.
4'N
ikbratioft-
All disturbed areas shall be restored to
existing or better conditions
Trench parallel to road:
• Shoulder - Matc h 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 rrdx, either type II of III cement, within 30 days.