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22320 95TH PL W.PDFiiiiii iiiiii 9342 22320 95TH PL W I? OJECT REAl EW CHECKLIST p qg PROJECT NAME: PLAN CHECK #: PROJECT ADDRESS:-- (2� U. RECEIPT DATE: REVIEWED BY: (Initial/136te) PLAN. WATER COMMENTS FIRE. BLDG. SEWER STRFF ENd.,, Setbacks/Variance/Setback Adjustment Conditional Use Permit ADB Requirements -2 3 4 Other Zoning Requirements Underground Wiring Required 5 Lot Slope IS% . . . . . . . . .... 6 SEPA Environmental Checklist/Hydraulics Permit -------------- -------------- ------- 7: Tree Cutting Plan 8 Plat/Subdivision Requirements 9 Legal Description Verification I ol.... Quit Claim/Street Dedications ... . . . . . . . .. .. ...... ................ . . . . . . . . . . . . . . . . . . . . . . . . . . . . Easements - Public/Private ........ ..................................... --- 12 Engineering Storm Drain Review Fee . . . . . . . . . . . . . . Engineering 2.2 Inspection Fee Drainage Plan (On -Site) Setback - Top of Bank, Stream, Water Courses Setback - Storm Drain Line Open Ditch - Existing Culvert Required ...... 19 Culvert Size 20 Shoulder Drainage/Shale Open Runoff . . . . . . . . . . . . . . . ....... 21 Catch Basin Required . 2 . 2 Driveway Slope & Vehicle Access 23 - Sidewalk Required 24 Curb & Gutter Required . . . . . . . . . . 25-� Curb Cut For Driveway Required . ..... :-26 Street Paving Required Right -Of -Way Construction Permit Required 2' Street Name Sign Required i.-29 Other Signing Required Bond Required For Public Improvemenis --- ------- . . . . . . FEMA Map Check/Water7able . . . . . . ....... ..... 32, Side Sewer Availability Calculate Sewer Connection Fee If No LID # . . . . . . . . . Create Street File ............. Existing Water Main Size Water Meter Size Service Line Size Water Meter Charge Required ::40 Hydrant Required Hydrant Size Existing M .. .. .. -�-p 1111�111 .......... 41 Fire Line Charge Required - Sprinkler 42 IStreet Cut "M M.... I�M No, 43 IMiscellaneous 1 44 - Reviewed By: FIRE PLANNING ENGINEERirAra',-:�,,,,.-> Pu#L-lC WORKS JUN 2 b tk�)�J? �ZLIG WORKS ,-" u R E C 0 R D OF C 0 N T A C T S 21 2 22 3 23 4 24 5 25 6 26 7 27 8 28 RW PERMIT # DATE ISSUED RECEIPI # 9 29 10 30 11 31 L 32 PAID $ RECEIPT # DATE . 33 ss PERMIT # DATE ISSUED RECEIPT # i 14-,- PAID $ RECEIPT # DATE 34 15 35 16 36 17 37 METER SIZE PAID DATE RECEIPT # 18 38 19 39 20 40 ZAVALES DESIGN ASSOCIATE�; MILT ZAVALES HEIGHT CALCS AVE GRADE =102.5 1243 N.E. 152nd Street A7— +104 ACTUAL = 127 ZDA Suite 6 B +104 MAX =127.5 Seattle. WA 98155 C +101 362-2992 . D +101 LOT COVERAGE 7//1/1-7 90-00' o" 45' 0" SI 3 SIDE A:-1 UNE OF OVERHANG 'B=: 04 Ir MAX �10 ---------- BLDG. LINE cn GARAGE < =101 WALK D=101 1010 0, IT -(r A.C. U- ORIVEWAY 0 9 b UJ C%& tr. cy) 0 9 -55)6 0 LA- 6J 0 75�.09' x INGRESS, FES 11�7 EASEMENT 95TH PLACE WEST LOT AREA = 9975 S.F. HOUSE & DECKS =1 530 S.F. COVERAGE 1530/9975=15.3% IMPERVIOUS SURFACES HOUSE & EAVES = 1530 S.F. DRIVEWAY & WALKS =1840 S.F. TOTAL = 3370 S.F. LEGAL DESCRIPTION LOT #2 SEE ATTACHMENT ADDRESS: LARRY WAX PHONE # SITE PLAN SCALE 1"=20'-O", 1 1, 111f W-- =1 % APPROVED AS P 6-2 -7- ' % % pn�7 �7 77r Lj (0 0 *"2f ��— .W2 i ig 9� Cl 'U'EL) PROPOSED 10" WDE EASEMENT FOR u-nUlIES L-a�/ WOODJEN%ALON,G PROPE?TY UNE cc ry CA V -Ul Go % 00 0 'o 00 1p r. 11 j,206.00Y F 1.0 + R 20" FIR/ I 1 16,0., + 2bC F;l( a AR % 1701 TIN- +m fp/ 0 C3 �74.25" Q. FT. s 19" Rk Z 25* ;El, - ;o - r IN "L SEW" Ml -jbZ.Do AREA48,024.4 SQ. if 25 'LOT 1 FF=,3112. IS &L lo..*7-.Qo UNLr% dMAIN lAHJ&FrWnr 88�58*47 w 11200.6�— AXU CIA CA co LA � lb c cn co CP cc E co co m� , om q) fv- , , , 1 CITY%t Copl. Qlj ft 4d ZAVA ZDA LES DESIGN ASSOCIATES MILT ZAVALES HEIGHT CALCS AVE GRADE =102.5 1243 N.E. 152nd Street A7- +104 ACTUAL = 127 Suite 8 B = +104 MAX =127.5 Seattle. WA 98155 C = +101 362-2992 D = +101 7111 mi'i .510.0 45' 0" 1 40@ -Ow SI 1E x SIDE A::: UNE OF OVERHANG B=' 04 u6j Ur MAX 310 BLDG. LINE C" GARAGE 0 7-1 1 ItLK D= F C=101 D=101 . 0. 10 0� C-7 9 7*-(r A.C. 1 J'i A�C DRIVEWAY U- z Uj c%1 Al C,7 o = C.V 0 LA- Uj \�p 75.00' 2014 e "4�� -107' x 15' INGRESS, EGRESS EASEMENT 95TH PLACE WEST LOT COVERAGE LOT AREA = 9975 S.F. HOUSE & DECKS = 1530 S.F. COVERAGE 1530/9975=15.3% IMPERVIOUS SURFACES HOUSE & EAVES = 1530 S.F. DRIVEWAY & WALKS =1840 S.F. TOTAL = 3370 S.F. LEGAL DESCRIPTION LOT #2 SEE ATTACHMENT ADDRESS:LARRY WAX PHONE # SITE PLAN SCALE 1"=20'-O" PLAN 1941 E DETENT10 S� 8D DRAINAG AN A HEET WORYKS OP/ & 'DDRESS 111,100, Lo' IMPERVIOUS AREA _Cd " - 1111 11111 IF, 2 �r-� 1.0,97 ACEI�PTCAILE TIGHTLINE Sch 40 PVC SDR 35 0 **DESIGN DA TA ***** PIPE LG PIPE DIA oRiFic.E 31Lf .. LOCKING LID N PIPE LENGTH (TYFICAL) BETENTI MIN ffFARI'OtIAICI�Op OF FINISHED G MINIMUM —1c %CASURE % OR RISER CONC DO 3UTLE1 14 "J d TIGHTLI E To ly. SLOPE 'y� %;�0.040 d*Y OUTLET CONTROL or /t - . .. x MIN. ORIFICE UppEp CONTROL CATCH 13ASIN CATCH BASIN �160194 ON 6'. 01/ r 'M C.ROSS SECTI 43 SYST. OR EQUAL EP, 4-6' SPALLS EXISTING -GRADE FROM CONTROL U I 2,X 2,X '3' DEEP, 3/4' CRUSHED ROCY b m m F= C0031 -ftm W-4 CAI C.n C= ROL OUTLET V QuiF aw RENCH' "I IN 10' L6SG- FROM CON' BE _E' F L PE P p / EN CAPS p p 1 YJIM MIRAF SMALL B LjNtG:0r WASHED URA�N RUCK T N Q PLACF r' AnFR. TRENC" jqlp . RAP OUFL"r pUIVOFF Sr-rN' SYSTEM b'Opy TENTION &I -Ty C D 710 DE C SgALL NOT BE CONNECTEL . . . . . . . . . . . . FOOTING DIWNS . . ........ . I ....... ....... . . . ....... ....... NOTES: and detedOn'systeln, inspection AppROVED By i . Sion (711-02'20) for -a tightrine call Engineering 1) vi jwpections. 1"operty is the before backfillicg and for fiOA1 e systeals on'privo be flushed DATE and maintenance of dtainagwed n Oae. sthr2p 111pe must tlet control orifice IZ UsponsibilitY for oPerat'on Niatenal accutou me OU respon,'ibl"ty of theproperty 0*11' to glo' roper operat' out and rerrLoved fron-i the catch basins at all tb'I'1'1!1I' �,11,11,111,111,111,11��,,��,,��,,��,,��"I'll""I'll"��,,�,�I 6 k!:!- t OJNMILEi� must 0 386-- E 38 6" PVC — Roof Drain @ 1%-2% 383-- C.B. #I Type 1 Rim El. 383+ 18" pipe ZAVALES DESIGN MlLr 1AVAUS 12" 104.0— 192md 91rist ZDA Swig 0 11 WA MISS F511:li 10*0 4T Ir 35'0 i t? I SIDE UK of &MW44 r- Irma kMU14 CARA49- 0 ASSOC IATES�-Vr �--Rqjvl, coui4 LOT COVERAGE 15' jig 49# IN C.B. #2 tl Type I 2 R im. El. )380+ 75.00 1. E. +jgJL1 Orifice 0.7 0.00 6"PVC �t . oi-tle O�) DITCH LOT AREA -a "is S.F. 11OUS1 & DECKS "1930 S.F. COVERME 2 - I — IMPERVIOUS SURFACE.' 110USt & EAVES w 1&" S.F. OnIVEWAY & WALMS wIM S.F. TOTAL w 3310 S.F. LEGAL DESCRIPTIM - LOT Of SEE AtTACHME"t ADDRESS! LARRY WAX g5 �A 11 am a one )I a0#z'4— a M 0 - --00� --� . � 02 ell 0 0 19' 35" [ PLAt) (1321-10 PlAt 7— �7 �77 *77— C of Edmonds ity I RTC_HT_0E-WAV CONSTRUCTION PERMIT Permit Numben Issue Date: A.— Address or Vicinity of Cbristruction: 22320 95 P1 W (9722912) ah D r ur-41 Al. lniztall 170' of 32 MPE IP from 24'S C. A-YF� w IF- 161N c/L 224 St SW @ 401W C/L 224 St.SW, then run north 1301N C/L 224 St SW @ 1VW UIL 95 F! W C. Contractor: Puget Sound Energy - Contact: Mariamne Kinasbury Mailing Address: 1122 75 St SW Everetfhone: 356-7500 X7596 State License #: 9 8 2 0 3 Liability Insurance: Bond: $ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. 171 Commercial El Subdivision E] City Project [N Utility (PUD, GTE, WNIG, CABLE, WATER) F1 Multi-Farnily 0 Single Family Other INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut ElYes LJNo G. Size of Cut: x H. Charge , $ APPLICANT TO READ AN6 SfGN INDEMNITY.- Applicant understands and by his signature to this application to hold the Ci!y o harmlessftom injuries, damages,,or claims ofany - . fE�dmonds kind or description whatsoever, foreseen or unforeseen, that may be made arains,1 .-the-Qly of Edmonds, orlany �y 'its' �epartments or employees, including or not limited to the defense ofany legal proceedings including defense costs and attorneyfiees by reasonipf granting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKAIANSHIPAND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-- TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATICHIS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. Two.sets of construction drawings of proposed work required with permit application. A 24 hour notice is required for inspecti6n. 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 Cify� 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 trench work shall be patched with asphalt or City approved material prior to the end of the working day; NO EXCEPTIONS. I have read the above statements and understand the permit requirements and the pink copy of the permit will be available'on sile at all titnes for'insvection purposes. Signature: Date: 9-26-97 CALL DIAL -A -DIG PRIOR TO. BEGINNING WORK FOR CITY USE ONLY APPROVED BY: RIGHT OF WAY FEE: tzlo TIME AUTHORIZED: VOID AFTER 0 DAYS DISRUPTION FEE/FUND I 11: SPECIAL CONDITIONS: RESTORATION FEE: T OTAL FEE: C RECEIPT NO.: t 0�0 to ISSUE.D.,B)"; NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997 41 0 FIELD INSPECTION NOTES Comm,ents: Diagram: (Fund 111 - Route copy to Street Dept.) CONTRACTOR CALLED FOR INSPECTION El YES E] NO Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: i Cd s4'ci5, �I A'I , \.Oj 2-4'co, 40'%JIj Q 121W P20P, 2—'MP� I P> MA.(" —�— f=1220 M — Notes: The City of Edmonds 1) Field locate all utilities. Call 1-800-424-5555 24 hours before digging. 2) Survey is not required 3) Maintain a minimum of 5' horizontal and 3' vertical clearance from all city utilities and appurtenances. 4) Cuts in paving are shown as Ea 5) 1 cuts in paving anticipated. STANDARD DRAINAGE DETENTION SYSTEM WORKSHEET j U N 2 1997 OWNER CALC BY: ACCEPTABLE TIGHTLINE MATERIAL PERMIT COUNTE-R ADDRESS N-12 ADS PHONE: SCh 46 PVC SDR 35 (ASTIM D3034) DATE: *****DESIGN DATA IMPERVIOUS AREA PIPE DIA PIPE LG ORIFICE Z-t 9 DETENTION PIPE LENGTH LOCKING LID - PICAL) FINISHED G CZJ I L MINIMUM -JFP 6 CVD M�MIN E��ARIIOAMNC TIGHTLI E 7- ASUR fop or CONC BOX OR RISER .5Z TO 1% SLOPE ------ 0 OUTLET L OUTLET CONTROL CJ2 C�— MIN. APPRO UPPER CATCH BASIN RIFICE 00 is6'-2-7 VED AS NOTED CONTROL CATCH BASIN — SYSTEM CROSS SECTION Cn c 2-0 STREET FILE 2'X2'X6' DEEP, 4-6 SPALLS OR EQUAL ce. FROM CONTROL CB 2,x 2'X 3' DEEP, 3/4' CRUSHED ROCK EXISTING GRADE EXISTING GRADE W S FROM CONTROL OUTLET WASHED ROCK "OUTFLOW TRENCH, MIN 10' L6NG. 1.5' PERF PIPE TO BE LEVEL PERF P I PE W/ END CAPS TRENCH SHALL BE LINED WITH MIRAFI PRIOR TO PLACEMENT OF VASHED DRAIN ROCK RIPRAP OUTLEF RUNOFF SPREADER. TRENCH FOOTING DRAINS SHALL NOT BE CONNECTED 70 DETENTION SYSTEM NOTES.- 1. Call Engineering Division (771-0220) for -a tightline and detentioa'system inspection APPROVED BY 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 DATE out and removed from the catch basins to allow proper opertition. The outlet control orifice must be kept open at all times. I I 6 - . Table 1 — Detention Pipe Sizes Impermeable Required Area Sq. Ft.— Vol Cu Ft 2000 50 2500 62 3000 75 --3500 �87 4000 100 4500 112 5000 125 Note: Allowable Pipe Materials: Pipe Diameter 1511 1811 2411 3011 40 28 16 10 50 35 20 13 60 42 24 15 Required pipe 4!ZD .,/4�—.0 18. length in feet 80 56 32 21 90 63 36 23 100 70 40 25 Reinforced Concreter---**' Aluminized Steel Aluminum CMP Asphalt Coated N — 12 ADS (Not permitted on roads) Table 2 — Outlet Orifice Sizes S Impermeable Area Sq. Ft. Outlet Orifice Diameter (Inches) 2000, 5/8 250J0 5/8 3000, 3/4 3500 3/4 4000 7/8 4500 7/8 5000 7/8 Table 3 — Rectangular Catch Basin Requirements Detention Max. size Catch Basin pipe diameter knockout Type < 1811 2011 Type 1, CB 15 18" to 24" 2611 Type IL, CB 16 24" to 36" 3611 Type 11, CB 19 19 (48" Basin) 36" to 42" 4211 Type 11, CB 19 19 (54" Basin) *Source: Assoc. Sand & Gravel Co. Standards 5 Revised 3/16/95 386-- ZAVALES DESIGN MILT WALES ZDA 312to"Ill t4,-9— 132nd 911*@' Sesitle WA 90199 90.W 10*0 4T Ir 35'0 SIDE UK Of 0VWqAM4 tr ism km ullt 4ARA49 OEM 4z F.--. 385- 6- rvc — Roof Drai @ 1%-2% 383--- C.B. #1 Type 1 Rim El.383+/ . %41 15' 18" pipe 49# C. B. # 2 Type I R im. El. 380+ 75.00 1. E. +jjJL/ 2 El 38) + 0+ Orifice 0. 7 0.00 6"PVC oi,tlet DITCH ASSOCIATES- LOT COVERAGE LOT AREA -a WS S.F. 11OUS1 & VECK9 w1830 I.F. COMA(% IMPERVIOUS SURFACE.' 110US1 & 1AWS in Is" S.F. DRIVEWAY & WAIXI alM S.F. TOTAL w jjyo S.F. LEGAL DESCRIPTIM - LOT ##I SR WACIIME"t AWRESS! LAPRY WAX N 0 to LN W 11 t PLAT) 1340.92 MCA% (1321-10 PLAT PLANNING DATA NAME: 5r,�- SITE A DDRESS:-2237c) 95'10/ DATE: -7 -7- ZONING. PLAN CHK#: PROJECT DESCRIPTION: Cony-k�c.�gvjj c,1'1- c�, 57� /t_ 7C6 1. 411- CORNER LOT IVO, (Yes/No) SETBACKS: Required Setbacks: f Front: e,� r Left Si4e: -7 Right Side: 7ke Rear:' 1'5 Actual Setbacks: took�, 41,,,P- IN f1i Front: 70 Left Side,��D RightSide:X Rear: Street map checked for additional setback required? o ve-� /Vokt— (Yes/No) LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N) LOT COVERAGE: 15-��, Maximum Allowed: Actual: BUILDING HEIGHT: Maximum Allowed: Actual Height: Datum Point: Datum Elevation: A.D.U. CREATEW: ki, SUBDIVISION: CRITICAL AREAS#: � 6 — zo.; �J,4f VCR- SEPA DETERMINATION: LOT AREA: OTHER: Plan Review By: 6 0 /0,)/t-re:7U,0T OfileApermitkAplandaLdoc ZAVALES DESIGN ASSOCIATES MILT ZAVALES HEIGHT CALCS 1243 N.E. 152nd Street A7-- +104 Z 3DA Suite B B +104 Seattle, WA 98155 C +101 362-2992 D +101 -j-e-r -7 // A -7 FI-TI-Tol vo -�- c y- 1 107' x 15' INI 95TH PLACE WEST I AVE MADE =102.5 ACTUAL = 127 2 MAX =127.5 PERMucow; LOT COVERAGE LOT AREA = 9975 S.F. HOUSE & DECKS =1530 S.F. COVERAGE 1530/9975=15.3% IMPERVIOUS SURFACES HOUSE & EAVES = 1530 S.F. DRIVEWAY & WALKS =1840 S.F. TOTAL = 3370 S.F. LEGAL DESCRIPTION LOT #2 SEE ATTACHMENT ADDRESS:LARRY WAX PHONE # �/�,,,,,STREET FILE EGRESS EASEMENT SITE PLAN SCALE 1"=20'-O" PLAN 1941 OCT 20 '97 29:14AM SNO CO PUD P.1/1 0 .. City or. Edmonds h RIGHT-OF-WAY CONSTRUMON -0 PERAM Permit Number- luve Datc A. Ad&*w or Vicinity of Co"tAiction: 22318 IS Iroq In B. 1�1wofVtoik(bospecific). !eqTVrff K./i, IS19RE _ _ROA 0 I AMA J &Uf,-A Contact. C. Contractor ISOM 'KAVALEY R Mai.linz Address: Z 16 1 �j Phone: e.76 - 32 ly 0 r-![ Stats Licmm J;% Ca A b3 bx 86Z(VLiability Inausunces. JIMA. $ Vj I ERING c MGINE D. Ruil4ing Penrit 0 (if offlicabla): Side Sewer Permit N (if upplia-able): _t.. F_ [I Commarcial . [I Subdivision' C) City Project [] Utility (FUD, GTE. WNG, CABLE, WATER) C] Multi -Family J*Single Family Other INSPECrOR; D4SPECTOR; F. P-Iven=torcancreta Cut- [3 Yes YNG G. Size of cut! "PLICANT TO REA N GN AVDEMM�. A�p'licanl understands andby his slirnature to this application to holdthe CiryofFdmomds hor*rIessfrom ipeuries. damages. orclainisafany kind or description whatsoever. foreseeln,or uptfqresaren, that may �e inade against the City . q( Edmonds, or any of its depannzenn or amployees, including or mot.linjited to the defenn'01any-legalprocesdings inc?uding defens� Costs and arrop-oWylees by redson ofgranting thi.? pernift, TH,r CONTRACTOA 1SRBSP0A&1DL9 POR WORKMANSHIP A14D MATEXALS FOA A PERJOD 0JP ON5 YUR FOLLOWING FHE FINAL INVEC- TIONANDdCCEPTANCEOF THE MAK WMAMD RESTORMON FEES WILL BE HELD UNTIL TREJOINAL S7REETP.47CHIS COMPLEUD BYCITYFORCES, AT IMCH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCZ rO THE AppLIcANT Two sets of constmction drawings 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 afl times. Traffic Control and Puiblic Safety shall be in accordance with City regulations as required by the City Engineer. All street cut trench work shall be patched with asphalt or City approved material prior to,the end of the working day; NO EXCEPTIONS. I have read the above statements and understand the permit requirements and the pink copy of dw pernii( will be available on site at all timesfor bapection purposes. Signalure.. J-h- Date: 17 (Gbntra,�Wor Agent) CALL DUL-A-DIG PRIOR TO BEGINNING WORK 0 usfbNi.� r" ...... . . . . . . 4 & JZE ARI., AM sp- ;VIA to V,�. I -V , rvrA, AQA 67'ALZ OICk", &A NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Di, 1997 14, 5 City of Edmonds RI[GHT-OF-WAY CONSTRUCTION PERMIT Permit Number. 9-7-2..7-9 Lssue Date: A. Address or Vicinity of Construction: ZZ -3 1 qs. '01 Pi. LA) 0 — — 1D f W—Ir ft� ificl: oegiovc# /g,) Iq0 it F (Z OA -0 C. ANA 14S-�A&L Powrk Contractor: S tj 6 (70. R) Contact: 1301& 1614ALCY Mailing Address: Wq Phone: — (0 *70 State License #: r,, mo t.,s b x, A _q_aUGLiability Insurance: Bond: $ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. F1 Commercial 0 City Project Utility (PUD, GTE, WNG, CABLE, WATER) ] Subdivision Multi -Family O-SingleFamily F1 Other INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut: 0 Yes IPNo G. Size of Cut: —,L.ilx H. Chargq_$ APPLICANT TO READ ANOIGN ri INDEMNIK Applicant understands and by his signature to this application to hold the City of Ednionds 6armlessftom injuries, damages, or claims ofany kind or description whatsoever, fore seen, or.,y nfa rese eZ� that may'be mada"ag'ainst the"City �f`,Cdinonds, or any of its departments or employees, including or nol.limited'lo the de�ense'6f an.� legal proc'eeilings including defense costs and atiorney.fees by reason of granting this permit. THEr CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC- TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT Two sets of construction drawings 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 progres ' s 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 trench work shall be patched with asphalt or City approved material prior to the end of the working day; NO EXCEPTIONS. I have read the above statements and understand the permit requirements and the pink copy of the permit will be available on site at all timesfor inspection purposes. J . I Signature. - Date: 9-10 -17 or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY APPROVED BY: TIME AUTHORIZED: VOID AFTER DAYS CONDITIONS: RIGHT OF WAY FEE: .300.0o DISRUPTION FEE/FUND I 11: RESTORATION FEE: T OTAUFEE: 340. 00 RECEIPT NO. J ISSUED BY: -0 NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Fng. Div 1997 FIELD INSPECTION NOTES Comments: Diaaram (Fund 111 - Route copy to Street Dept.) CONTRACTOR CALLED FOR INSPECTION 0 YES El NO Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: I 0 Y -.1 71ill k 1:6-.1tV A A Tf llffl N 4T, -� 03 �f 4 'A / . 2ZI t6* WA q8oz SOO-'r,14 Coo&&Y AREA Locaidlk Aw"t, -t. pts, m-c POLE# 1/4 s2S TZ7 R 3 DATE 1?7 W.O. # 0-'7 7:SS f3op-E 20 _ROA C�, vjF_S-r(f9Y PACIFIC- CAS L F_ A-14b -r-P-EIJ C "A KAL DWG. # Z MR WORK _f� -rA L L SiEif COWCRE7-4- P,-b (VOloq REASON-1 A) S -rA CC IA(C S6C UG - P,4tl ENGINEER G 14 SCA OA-S-r Cc, DkAFTER U.G. # �J S-r^ L C r-. -,?e,,4PVC_ .1-ROfA jJ SCALE e10 16 0.7".' 35 1,�C 41- 7 PC K F/IZOA4 P066 0. Fe DATE WOW COMPLETED FOREMAN RL)t-A A_� 4/0 3 5,0 ie c At' AL rwpf-x Ffflom XF/Vl 70 A000f%VCn* nAT= onthrrpn FEES NEQUIRED: ENVIRONMENTAL ANALYSIS 8 YES O'NO W EXEMPT U NOT EXEMPT PARA..l 8 ITEM C PRIMAW- OVERHEAD O.H. U.G. COND. - KV U RESIDBITIAL U COMMERCIAL ADD - CKT. FT. -PH LEO#__ REM-CKr.Fr.-. PH @ $ NET -CKT. FT. SECONDARY,OVERHEAD O.H. U.G. COND. KV BASIC FEE $ ADD CKT. FT. PH $ REM - CKT. FT. PH NET _CKT. FT METEWONV. POLE s PERMITS (DATE GRANTED) PRIMAW UNDERGROUND U RESIDIRTIAL U COMMERCIAL U TREE TRIM BASIC FEE $ U STATE LEU # $ 0 COUNTY a CITY ED $ 0 EASEMENTS: - 0 U REQUIRED 0 NOT REQUIRED SECONDARY UNDERGROUND BASIC FEE $ 500 UNDERSIROUND PLAT DATE RELEASED BASIC FEE $ 4L 0 $ FOREIGN CONTACTS 0 GTNW JPN # STREETLIGHTING U CATV JPN # _411L @ $_, = $ 0 JOINT TRENCH GTNW & CATV 12 JOINT BORE GTNW & CATV WORKM RIGHT-OF-WAY U PRIMAEr 0 POLE STENCILING FROM -TO TAKE OFF POLE e SECONMRY qz , --,OL @ s MISCELLANEOUS FEES PRE-CONSTR. REQUIREMENTS U TREE TRIM U PUD LOCATOR vAULT $ - PERMIT $ 3o $ 8 BACKHOE 6 FLAGGING $ 0 ONE CALL DATE TOTAL DUE: $ INDEX I POLES I- PLAT DATE PAID LOGS U-MAP I RECEIPTS XFMR C-MAP LOCATION MAP PAGE NEW SVCAPPLIC. # SUBSTATION Z5 5-7-G A --f 1� CIRCUI NO. 1Z -'/O(o PHASE 'I (306 KAYALF--Y 7F7-7,TZ3i� y WAX - (, / 76 z u e. ; z 15 9 w 1 go p = :3 % V C3 PROPOSED 10' VADE EASEMENT FOR W000j"JALONJO , PROP TY UNE V in OD N' oa 20"ole R FF11 R 2 FIR 17 + IFIp + W Fl A 74. Q. FT. 0 25" is L n 1 LIN. 1% ;.%&* I 0%. ww-.f%n I.-m" &A 058 *4 7* W 00. ,q r v 114 &ED APPROVED AS N JUN 2 5 6,22- -P-7 3"d PERMIT COUN R qro,;.L �-llew — -- 4K,-e RONALD WLSON to I NO. 9513 c; z 6 R /, ql�)I�V6 SiTR T FILE f RO( N