22408 95TH PL W (3).PDFiiiiii lill 11
9345
22408 95TH PL W
City.of Edmonds.,
RIGHT-OF-WAY CONSTRUdTION.
PERMIT
Permit Number.
Lssue Date:
A. Address or Vicinity of Construction:Z),-'--A0b Ct7S-111 PL VsJ
/n B. Type of Work (bespecificj)�LC*,,�c�k %V-S L%VX elw-60e-c uooc(z
C. Contractor: CQUV41*-, P.Q.DA ( Contact:
MailingAddress: *DL\()\[) 1ALA%-t q9 Phone: (o-7 0 - 3 -Zo
State License #: 96OZIm Liability Insurance: Bond: $
7
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. E] Commercial E) Subdivision
F1 Multi -Family 471 Single Family
IMIL
INSPECTOR:
F. Pavement or Concrete Cut: 0 Yes ANO
EJ City Project Tjt1!;'yJPUD, GTE, WNP, CABLE, WATER)
E] Other
INSPECTOR:--,
G. Size of Cut: x H. Chargq�_$
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessftom injuries, damages, or claims ofany
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 of any legal proceedings including defense costs and attorneyfees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK ESTIMA TED RESTORA TION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED
BY CITY FORCES,A T WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUAN,�E TO THE APPLICANT.
Two sets of construction drawings of proposed work required with perm,it 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 trench work shall be patched with asphalt or City approved material prior to the end of the working day;
1�� 0 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 timesfqr inspection pVrposes.
Signature:
Date: Z - 4c) -1; 6
(Contractoo or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng, Di� 1997
Public Utility District No. I of Snohomish County
14-f6-W Rev, 1 13F
Location: 224V. 95TH PL W EDMONDS 98020 SO CTY Area
Pole No-- tr: 27 N R: 3 E - S: 25 SEI/4 �Date- 2t19/98 W. 0. No.: S32
Reason For V*ft INSTALL SEC RISER AND PED, FOR Engineer AFDEM, RICH Dwg. No.: 123757
KAVERNMO CONST Drafter U.G. No.:
GAS HEAT Scale:
Date Work Cmpleted: Approve
id: Date Print�d_7
I Foreman:
Fee's Reqd: JOYes []No
Primary Ovedead
OResidential OCommercial
LEO No.'
I @ 2 =$ 0.00
Secondary 0wrhead
Basic Pee $0.00
=$ 0.00
Meter/Conv.Able $0.00
Primary Undeground
EIResidential []Gommercial
Basic Fee $0.00
LEU No.:
@ _f =$ 0.00
Secondary t-Werground
Basic Fee $0.00
I @ ------- 2
=$ 0.00
UndergrouncElat
Basic Fee $0.00
c-fte __r
=$ 0.00
Street Lightl1w;
c-ft@ —/,
=$ 0.00
Work In Righbf Way
ElPrimary
ElSecordary
C-ft@
=$ 0.00
Miscellaneoudzees'*
Vault $0.00
Permit $0.00
COST ESTIMITE
2484.00
$0.00
-Mall Due: $2,484.00
Date Pai&
Receipt Nb.:
NewService A4&nffion No:
Environmental Analysis
[]Exempt []Not Exempt
Para. . Item
O.H. I.I.G. Cond. KV
ADD CKT.FT. PH
REM CKT.FT. PH
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
E]State
[:]County
Ncity
11
Easements
EIRequired ONot Required
Date Released
Foreign Contacts
EIGTNW JPN No.:
EICATV JPN No.:
SJoint Trench GTNW & CATV
OJoint Bore GTNW &CATV
ED OONTRACT RD BORE
From TO
Take Off Pole
Pre-Const. Requirements
E]Tree Trim EIPUD Locator
OBackhoe ElFlagging
90ne Call Date
No.:
—index —Pole Plat
I __XFMR C-Map I
Location Map Page 474H-1
Circuit No.:
Enges Tel. #
I (425)-670-5i6_8�
Engr's Pager #
r(-425)-787-7522-]
F_VkJ_7
0 iF
?_ I VJ
22-40%
qv,A PL \,N
Phase:
NOTE' IT IS NOT NECESSARYTO PATCH THE 10'DRIVEWAY IN FRONT OF 22408 9�1 PLW
THIS DRIVEWAY WILL BE INA DIFFERENT L06ATION IN THE FUTURE ,
POLE 4-53 INSTALL XSECONDARY RISER AND TRENCH 8'WEST
BORE ROAD 20'WEST
TRENCH 15'WEST
TRENCH 52'SOUTH AND INSTALL SMALL POLYMER F�El)
FROM PED TRENCH 20'SOUTH AND INSTALL 20'OF 3nFUTURE PVC
RUN 140'OF 350 KCM TPX FROM XFMR TO PED IN 3'CONTINUOUS PVC
cc�t,iz-
or X
F06r,- oc
�Oua&,c
P20
LlhZ
P-,�Lmhj U P
2 2 qlds
9
224 th S't Sw
79 1 �
0
22410 22408
9 5 Ith 0
11
P1 w P4
P
C4
I V I
78
L-7913-X
4-53
22409
P-62
-4-52
It ji
N
Ax
tffOUM, U
(acres.or square 0.
Sir.
A
sitz currently developpd?.
as
. . . . . . . . . . . ite developed? -1, A&L� � e-W." i
T-
�.A
g
Describ6 the general site topogra Check all
lk.
_phy that apAY
ti ite.1,
"over,en we s
Flat�'� less than 549"8�n
Rolling: slopes on site geperally less than 15% (a vertical �"f jO-feet over a
ho ntal disi� 6f ',6�4iw)_
k
"slopes present on keofmorethan 15% and less..t4a. 30% (�a rise�
12 trl s n yerticall
a
`dlb4e�i'dvei` h0rizbi1t9distance of 33 to 66-feet)-.-
ve-- a -
St grades of greater than 30* present on site (a vertical rise of 10-feei'd r
horizontal distance ess than 33-feet).
case describe):,
uq ;51.
6. Site -contains arm of year-round stand' 4niter Ab Approx. Depth:
Mg
7 S 4 ie�son�l stabding.water: Approx.
i�6fiiilng!i ' .,Dp
ke areas �,pth
What s*o�w,4 the yW.
S. Site is in the. floodway floodplain of a water course.
9. Sii��&;�Ins`a creei or an area where water flows across the grounds surface? Flows are year-i,-;�T4
(What time of year?
-round? Flows are seasonal? A
10. Site is'primidly: fbrested meadow ;shrubs
mixed
urban landscaped (lawn,shrubs etc)
11. ' Obvious wetland is present on site:
For City Staff Use Only- 4. 1,
I. site �is,
2- SCS mapped soil type(s)? C5_-A(AU%W_A'-jArjqj., tj,.� La Z -8 f�eu
3. Wetland inventory ort,�_� Anap,indicates.wetland.present on site? 1�6 ( Ae-,'
4;,;,.
,Critical Areas inventory or C.A. map indicates Critical Area on site? N--
--maK
-ik4esignate.d..carth.subsidence landsli& hazard area?
6.. . 'Sita d'esiignated on the Environmentally Sensitive Arm Map;7 (Jo
.DETERMINATION
-*UbYREQUMED CONDITIONAL WAIVER
V' WAIVER
Reviewed by�'
Planner. Date
Re-VOIAMM4 .7-7-7*
. .........
t
v):
w.
119 0.
4 0, WWI$
_9
63
-;O:rE
t Rt
3Z
�I 4z - iotmil"', fie -
N
ea
%
'ne, Clifical, qg.;j A
this form is to be filled out by any per.son
idbidt it tothe The Ci
City. ty wilF."...
."-revww.Ihecheddist makea.p rsory
PMxui.ng?a11De-Mophiea' i—V 17=
t-P f " p I " tj,�, - 'A � X le"i Site
Wstt; utake a inati6n of t107'
Application
for the City of EA
to his�/herzsub * prior
Mittal.-of -a development.
s�u ttePs n==U to complete a
to the
nenipermitap�ji catioic
Permit City.
17W PU of
.][pose Ist is -to enable-,
With �ksV.iedcopy -of this form'� the.-
City staff to def
ciiinli -n'-e'-W--fi-e"t'-h--'e-r-';'-a-n y---"'; ". -
Wlicant should also submit a vicinity map
are or may be
or 010�plon for individuai lots of the parcel
with cimugb dem'il
present on the sqb ect , I I ;. . . that City staff can, ft p4 j;,
j. property;*..Tbo,..!�.-�.;-..;..�.,.�it�t!�i�.-atid, fify the
Wornmflon needed to compi4ae the -
su Ject pared(s). In
Checklist should be easily .. ... - . -
available from ,
2"fi0n* the APPlicant shall inclu&
I0bserV-
atiOns of the site or aft available
-:� -Other Pertinent information (eg., te -
ai
City Hall -(Critical Ar6s'in ventojjt�lt
topoigin-aip'hy amp, etc.) or studies in
4MIUmctioniiisth
I
or Soil surveys).. .J)�f
this Checkl
-*I - iA to assist
Im C=Pkdng their preliminary
An,aPPli6ahtV_6r his/her representative,
""assessmentof the site.
Mwet iSTI + #U
WU e checluist, sign and date it,
I have compliii;d
tical �krea Ch66k]ist and a'tiest that the answers ppovided
factual, to the best, of my knowl0ge (fill out the ap
PFOPnate co umn below)..
t
Owner Applicant:. tive:
'�6 i4 C:� I.A i
Uwe,
Name
.7)
St(W ddress
Street Address
�A,
01S
City, State, ZIP
Phone City, State, ZIP Phone
Sviugr_�e_�
Signature...
Date,,)