22902 74TH AVE W.PDFIIIIIIIIIIII
5881
22902 74TH AVE W
0 0
ADDRESS: &P bu
TAX ACCOUNT/PARCEL NUMBER: a
5
BUILDING PERMIT (NEW
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:— 0,; -- 10 4 — DETERMINATION: n Conditional Waiver E] Study RequiredXWaiver
DISCRETIONARY PERMIT #'S: 11 -05 - &# (SUIX06)
"I
DRAINAGE PLAN DA'
PARKING AGREEMENTS DA:
EASEMENT(S) RECORDED
PERMITS (OTHER): IYUtZU-_7
PLANNING DATA CHECKLIST DA:
SCALED PLOT PLAN DA:
SEWER LID FEE
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S)
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DA'
- ()3 - 3:22
LID #:
LOT: BLOCK:
LATEMP\DS'l7s\Fonns\Street File Checklist.doc
0
to
STREET FILE
477.86' L29TH ST 2W
N 88 1'64 __W
ASPH PVMT
EX'G PLANTER —
93.80'
ASPH
LOT 8
1 105.6 C14
9,264 SQ. Fr.
0.2127 AC. q (714
to
C14 (714
GRASS
0
C.O.
to
14.
Alo�l
23.64
IC41 EX'G
04
SHED 1" EXISTING HOUSE
105"'(DEMO) 10 PR POSED
1454 SQ. FT.
------ ILY
528 SF .0
go
05 . 8
EX'G GARAGE
264 SQ. FF.
.0
Zone _ qs =2 — ComerZFla*g_
19"c j�t�ured —A—ctual
Front (5) an-s'
Sidq(S) xz�
±!�&ht 25 lq- 91
*A ~vI (v- --j� -Q,
�,ed
sw
+. 61.
CONC. RETAINING
WALLS
L=47.62'
R=25.00'
A=109*08'00"
pwD
V,
CIS
00
IE14' 2j.
10 �tu, �p "y
Glee& -10,� 70 000, 1 C
1104 41( 0444/4,0' p EX G ASPH /DR
1.5 PG Jol
4or 158
.2
WATER LINE OWNER/CONTRACTOR IS RESPONSIBLE
-GAS -GAS GAS LINE FOR EROSION CONTROL AND DAMAGE
s —s — SEWER LINE
_�SEWER
INSPECTIONS REQ'D.
CALL, 425-771-0220 EXT. 1326
IMPERVIOUS SURFACE CALC
EXISTING BUILDING ROOF OUTLINE 1988 SF. (j3vILr)e4iqSgi
BUILDING AR
EXISTING RESIDENCE
1454 SF.
EXISTING DRIVEWAY 660 SF i&,zss'
EXISTING GARAGE
264 SF.
EXISTING PATIO "(SZ)
112 SF. ? LA r tj
PROPOSED RESIDENCE ADDITION
920 SF.
EXISTING ENTRY PORCH 28 SF. ulwir-I IqS6) PROPOSED COVERED PATIO
148 SF.
PROPOSED ADDITIONAL ROOFLINE 1583 SF.d(6-
PROPOSED ENTRY PORCH
115 SF.
PROPOSED COVERED CARPORT
235 SF.,
U-QM' PROPqSED ROOF LINE INCLUDES ALL (6)
NEW AREAS.44CARPORT, ENTRY, AND PATIO COVER
TOTAL LII AREA
2374 SF.
ARE OVER EXISTING CONCRETE & ASPHALT AREAS.
ADDITIONAL COVERED AREA (3 SP)
498 SF.
ALL "EXISTING" AREAS ARE CONSTRUCTED IN 1955.
APPROVED AS NOTED
BY ENGINEE
Date:
_esV>ft"_TFl Sgursp_
relzat-T R-ewwzb
APPROVED BY PLANNING
LOT COVERAG
3136 SQ. Fr (33.85%)
LOT AR
9264 SQ. Fr.
ucsr si"O� . , ,
.SITE PLAN,
PROPERTY OWNER: KIRK BLEVINS
PROPERTY ADDRESS: 22902 74th AVE. W
TAX ACCOUNT PARCEL #: 00441500200100
DATUM
+102.
TOP C
HYDRA
WATER
METER
WTE
SCALE: 1 20'
0 a to 20
A = 105.8'
8 = 105.6'
C 405-6-, to 3 .31
D teii-13' t OS, it
AVE. GRADE = 105.08'
ACTUAL HT. = 120.00'
MAX. HT. = 130.08'
MAR 3 12006
PERMIT COUNTER
STREET FILE
-7q, Y-" 0-,ke, U)
Lwi ti s
k4z o
'�ATC I`L&N3
MAR 3 12006,
PERMIT COUNTER
0
CA-FileNo:
Critical Areas�* Checklist
Site Information (soils/ topography/ hydrology/vegetation)
1. Site Address'/Location: 272 9 Q Z 174'm Ave.,
2. Property Tax Account Number: L( I Spo Zo 0 100
3. Approximate Site, Size. (acres or square feet): —9 14 A
4.. Is this site currently Aeveloped? Zyes; — no.
If yes; how,,is:site developed?, In"=-1 2"-'4;;:
5. Describe the general site to p*ogr"a
phy. Check,all'-fhatapply.
Flat: less than 5-feet
elevation.changd ovef entire site.
Rolling: slopes, on - site �.generkl� `1�ss'than 15% (a vertical rise of 10-feet over a horizontal
distance of 66-feet).
Hilly: slopes presen.- on site of more than 15% and less than 30% (a vertical rise of 10-feet
over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: WO Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway N1 0 floodplain KA 0 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
KAO Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc)
11. Obvious wetland is present on site: - N1 ()
For City Staff Use Only
1. Plan Check Number, if applicable?
2. Site is Zoned? 9,
3. SCS mapped soil type(s)? c�l _C4 L
4. Critical Areas inventory or C.A. map indicates Critical Area on site?
5. Site within designated earth subsidence landslide hazard area? b,,jM+
Y, I C, M:�h, C
a.1 _PPA
DETERMINATION
STUDY REQUIRED >< WAIVER
Reviewedby.-, �_ C)-, Date:
Critical Areas Check] ist.doc/4.22.2003
0
-V. 10,
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
The Critical Areas Checklist contained on this form is t(
be filled out by any person preparing a Developmeni
Permit Application for -the City of Edmonds prior to
his/her submittal of the application to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The informatior
needed to complete the Checklist should be easil)
available from observations of the site or data available al
City Hall (Critical areas inventories, maps, or soil
surveys).
Date, Received:--
City.Receipt#: 2- 2:!4as
Critical Areas File M
Z OC2
Critical Areas Checklist'Fee:.-, $135.00
Date Mailed to Applicant:_ X—ZI-03
A property owner, or his/her authorized representative,
must fill out the checklist, sign and date it, and, submit it
to the City. The City will review the checklist, make a
precursory .site visit, and make a determinatiolq' of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed copy
of this form to assist City staff in finding and locating the
specific piece of property described on this form. In
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.-- -
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, aris * ing from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANWAGENT
DATE Qi�:
Property Owner's Authorization
By my signature, I certify that I have authorized.the above Applicant/Agent to apply for the subject land use!application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
DATE.-7-Z-Z-0,�S
Owner/Applicant.- Applicant Representative:
V, I P, V— s Lo Q I M-�Z
Name
2--Zq0-Z- 9 L+rk Age- \A/
Street Address
E�Dry�oiqDS ,
City State Zip
Telephone: (q Z-9 ) 13-7(,- &q�qLl
Email address (optional):
MGM-
Street Address
City State Zip
Telephone:
Email Address (optional):
Critical Areas Checklist.doc/4.22.2003
PLANNING DATA STREET FIL
SINGLE FAMILY RESIDENTIAL
Name: % Date:
Site Address: 929na - Yq4l, Ave- \A/ Plan Check #:
Project Description: CooA�ck-vo,-� cP -a-% SGG Akso
Cj>,�L,P-k -b.- cove-ra porc-St) S^ &.,,d C.:b-v-p
Reduced Site Plan Provided: NO) Zoning:
Map Page: Corner Lot: QW NO) Flag Lot: (YES
Critical Areas Determination #: 20M -0t0G
11 Study Required
waiver
SEPA Determination: jE5cej-*cA-
,9 Exempt
0 Needed (for 500 cubic yards of grading or site within 200 feet of Puget Sound or Lake Ballinger) - N/A
0 Fee [I Checklist 0 APO List with notarized form
bd5etbjeks'?K� &�-A
Strev.t:. W44% Ave- A
Sid Sid Row, ,!�Mek
.1 V
CM Pal (V 7.6' (0 GQ V-,06
.-Actilal ks,* .Add,
Street: Sid(�,_ Side2 Rea,,,
Does street map require additional setbacks? (YES WO DNA)
Detached Structures:
Rockeries: Na,,,e
S�O,C,f\
El Fences/Trellises:
El Bay Windows/Projecting Modulation:
0 Stairs/Deck:
Datum Point: 0
Maximum Height Allo wed:
Parking Required:
Lot Area: e3� h A i i
Lot Coverage Ca Icu laitions:.. "' - I "" �
0(\ -a.-% Jm 6— re4-mwed
Y t
eigh
Datum Elevation: + c?
Actual Height:
Parking Provided:
Maximum Allowed Lot Coverage: 35% Proposed:3Y7
re r rooln, sits d* r
N4.". �,X� "M 23;�"5
dP:V-!,� ac,04 �2 I �- Loft
ADU Created: �YES 313(o
Subdivision: E
V—ex-no-,�
Legal Nonconforming Vand Use Determination Issued: (YES /G)
C,
omments,
EX OCAee-
A -a-c ce.
O/e
r -Q V-
Ir ALP- ?M?ow-w
Plan Review By: Planhing Data Form 2-7-06.doc
ST.
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14 229
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NOTICE: NOWARRAN7YOFACCUPACy 11he Information shmm on the--_,
21'1�t+-d man, was compiled for use VW Ckyot Edmond,,%, i-:� C7-:"1fa-_s
The City of Edmonds does not, warrc- '
sel forth on the map. Any person or entity
cjildjct an Independent Inquiry mgarding the Infw,
to rzj, including, but not limited to, the location of an;
8! SuO S, 'ier stubs may or may not e)dst and may or c;: C;
th:' 104a6c.', shcviin, Neither the City of Edmonds nor Its
be liable for the Information given on this map, nor for zjjV'P!4'i
provided based upon spld map
M r
5
::30
m
m
477,86' 229TH ST SW
N 8871-1'04^ W
ASPH PVMT CONC, RETAINING
ASPH
EX'G PLANTER 93.80'
LOT 8
1 105.6 C*q
9,264 SO, FT.
Ln
0.2127 AC.
GRASS
25' B.S.O.L. f .0 VCA. 2 '5 Ir
14.
to 'w
40Z ri - I J'�
23.64 Al I
EX
co, SQ iod
E
16.42
105-
(A
Z�
m
m
6
iT. C= M
r m
z 0 m
m -n 0
m
m
13EM
m C-)
c m
C) m
T
m
SF
3.1-
'J.4 L. -- ar, -.,
LJ4 Z
14.
o/
�o
A
0 .8
5 EX'G GARAGE
264 SO,
P-)
V EXISTING HOUSE
1454 So. FT.
'Llb.
D
105.1
�--oo
.0 0
10 �' .2.1 Or Zo 64
o.nA' --
L�.247.'62'
2 5 Do'
109,08,00"
C)
'Do. 11 c
fj EX'G AS7H
ro I /DR
Z/r 8441ily, 0.
1,04 1,5 po c'-R
40), la
DATu—.PT.
0'+102.9
TOP OF FIR
HYDRANT
wATFR
m
mw
z 0
--I
m
0
-:F z
METER
-p
N.
0
�o
W
V)
CL
0
K
Li4ne
Ty�pe
Area (square feet)
1.
Non-Re:gulatWed
71, 7
Exempt
Regulated
2.
Replaced
3.
4 4.
New (Post 1977)
Total Regulated bnpervions Area
Mitigation required if in excess of 2000sf
'M
+
5.
6.
Total Area Ntigated b�y Existing Stormwater Mana ment System(s)
IMMUMAWWWWl"
Regulated Area Not Yet Afitigated
7.
Pro jga
Armea Propposed to be Nfitigated by ILow Impact Development Techniques
8.
Area Proposed to be Ntigated through Conventional SWM Techniques
Vftgfte�"E
EXISTING DRIVEWAY
EXISTING PATIO
EXISTING ENTRY PORCH
PROPOSED ADDITIONAL ROOFUNE
HEIGHT CALC
A = 105.8'
8 = 105.6'
C = 1103.9
0
AVE. GRADE - 105-08,
ACTUAL HT. = 120.00'
MAX. HT. = 130.08'
1988 SF. (sujtn,4iq59
660 SF. �80)1Wtril(i vzss-�
112 SF. :z U 'j oss)
28 SF. ultr(r-* "TS-S)
1583 SF.
UM- PROP9SED ROOF LINE INCLUDES ALL (6)
NEW AREASIMRPORT- ENTRY, AND PATIO COVER
ARE OVER EXISTING CONCRETE & ASPHALT AREAS.
ALL "ExisTING* AREAS ARE CONSTRUCTED IN 1955,
BUILDING AREAS
EXISTING RESIDENCE
14�4 SF.
EXISTING GARAGE
264 SF.
PROPOSED RESIDENCE ADDITION
920 SF.
PROPOSED COVERED PATIO
148 SF.
PROPOSED ENTRY PORCH
115 SF.
PROPOSED COVERED CARPORT
235 SF.
TOTAL LIVING AREA 2374 SF.
ADD17IONAL COVERED AREA (3 SP) 498 SF.
LOT COVERAG
3136 SO. FT (33.85%)
LOT AR
9264 SQ. Fr.
r% nww
Uor'5"R.,
4 fo
.SITE PLAN,
PROPERTY OWNER:
PROPERTY ADDRESS:
TAX ACCOUNT PARCEL #:
Lf.M 1VVe5f.LtC
22902 74th AVE. W
00441500200100
0
0
Not6s:
1. All signs and spacing shall conform
to the MUTCD and City of Edmonds specs.
2. Work zone is 225' e/o c/I 75 AVE W
& 16's/o ch 230 ST SW
3. Flaggers will control alternating
one-way traffic.
4. Alert affected residents
5. Ch ' annelizing 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.
1 0
Z
D '
N TO
SCALE
230 ST SW
E St
M. . . . . . . . . . . . . .
IF
50'-100"'
.9 X.
F 50' T 50' ' F 50'
* �0
0 0
Z
Pilchuck Contractors, Inc.
HE V:9 Job #107018273
Mj Mj
0 0 1 Dec 03
r\j Sheet 1 / 1
0 J. Buss
4 National Barricade Co
Y /
?41 /
CHANNELIZING DEVICE SPACING (FEET)
TAPER
TANGENT
20
20
LEGEND
WORK AREA
28" TRAFFIC CONE
--0- EXISTING TRAFFIC FLOW
�Z SIGN LOCATION
FLAGGING STATION
PROTECTIVE VEHICLE
ORWORKVEHICLE
. STANDARD GAS CONSTRUCTION NOTES:
229 ST' EW
`77
END MAIN 485'N C ' IL
& WE CIL (230 ST S;,
(m__ 1)N_ C-111
(—')E CIL
PROP.'Z' -PE- IP MAIN WE CIL
(--')E CIL
PROP. Z' PE IP MAIN 16'S CIL
(__ *)S - CIL
TIE- IN (Z' X 150
SHORT STOPPER H17190)
225-E CIL &- 16'S"CIL-
(--')E CIL
I O)s CIL
230 ST SW
_W
IP GAS FLOW
46
CS go 04 16to
to
Ex. e STW 1P le's
�__ - u@_.M."ISS
7ZC288 7km
cf/
N
PIN
7413
V4
1�4
W
T T
S�
,!41
Z' TRANSITION & TEST LEAD
225-E CIL & 16-S CIL
(--')E CIL
4
rik/ (--')S CIL
SEE CROSS
SECTION DETAIL
60'
W
R/)F E
R/)F so..
W.
16. 14-
14- 161
PAV.IhU
PAVIM
FITTER (CHECK BOX IF COMPLETE)
GRASS
GRASS
GRAVEL
GRAVEL
Work area left in Clean & Safe ond-i'lion
Complete - all -Pipe Tables - and- Gas Pressure Stamp
El
16.9 r
Field changes Red —Limed on as —built
EX. -WATER
Material verified - and -Changes - oted- c -i paperwork-
22-W C/L
All Valve & rie—in - Locations lioted on as —built
Note beginning of Main, EOM -&-Line. of Main locations
El
Show Rope Locations & Cul—de—sac Ra(lius
CROSS- SECTION'OF
74 AVE* W
Foreman's Signature
SCALE: 1" = NTS
Company , Employee - ID #
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. CALL "ONE -CALL" TWO WORKING DAYS PRIOR TO CONSTRUCTION,. IN
WESTERN WASHINGTON CALL: 1-800-424-5555.. IN KITTITAS COUNTY CALL 11-800-553-4344
2. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS AND GAS FIELD PROCEDURES.
3. EROSION- AND SEDIMENT CONTROL SHALL BE PER, PSE STANDARD PRACTICE *. 0150 3200- TECHNIQUES FOR - TEMPORARY
EROSION AND SEDIMENT CONTROL AND ANY ADD11IONAL LOCAL JURISDICTION RE461REMENTs.
4. NOTIFY PROPERTY OWNERS ADJACENT TO PROPOSED CONSTRUCTION ACTIVITIES A MINIMUM OF TWO WORKING DAYS
PRIOR TO -BEGINNING -CONSTRUCTION. USE ISF TO DISTRIBUTE FLYEIRS'IF JOB IS -LARGE . OTHERWISE HAND
DELIVER FLYERS BE SURE TO INCLUDE THE LIST OF FREQUENTLY ASKED QUESTIONS A�D INFORMATION ABOUT
THE OPPORTUNITY TO PURCHASE AN EXCESS FLOW VALVE WHEN 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 FACILITIES. 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
OPERA71NG STANDARD 2525.2500.
9. VALVE MARKERS SHALL BE INSTALLED AND RECORDED BY THE WNTRACTOR PER PSE GAS OPERATING STANDARD
2525.2600 FOR ALL HIP VALVES IF THE LOCATION IS NOT REDfiY ACCESSIBLE, AND FOR ALL VALVES MERE
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 = _4L PSIG
12. RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION.
13. GAUGE AND MONITOR USE OF ALL STOPPERS AND SQUEZIES 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 252&1200.
z
15. COORDINATE INSTALLATION WITH CORROSION CONTROL. ED VOOGT PHONE 206-396-2799 X6313,',-
GAS MAIN INSTALLATIONIRETIREMENT
Type/Work
Pipe Size
Type
Estimated.
Length
Actual
Length
Manufacturer
INSTALL
2-
PE IP
350'
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
DATE 0
'TIME OFF'
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
DATE OFF-F—ITIME
OFF
Design Press 60
1 SYS MAOP 45
PROJECT PHASE
NOTIF#
ORDER#
ca
SAP Superior
Serv'ce/Meter
Service/Meter
Service/Meter
Ind. Service
Ind. MSA
Dis. Reg. / FT
HP Svc/MSA
Relocate
etirement
X326083595
107018273
Vicinity Map
WORK SITE
zz (St sw ta
W I
� :T-.
iN,6-th- R I SW -
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ally Z32 00
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99. __J
Bal n_qe - r-,Wy244th 31 SWI.
Owner I Developer Contactinfo
IRK BLEVENS
22902 74 "IE W
EDMONDS, WA-98026
ATTN: CHRIS ROGSTAD 425-876-6944 office
Conu actor CONS I RUC , nim cos , coutza:
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
NIA CITY OF EDMONDS
031-103-1 1
1
1
Project Manager-Conta Infornat n:*
PATTI NESS
CELL- 425-327-2783
REV#.
DATE.
BY
DESCRIPTION
FUNCT`t0N.
CONTACT.
PHONE-
DATE-
3
PROJECT MGR
PATTI NESS
425-327-2783
11111117103
2
ENGR-GAS
1
DRAWN BY
R. CONNER
206-853-2277
11124103
CHECKED BY
PATTINESS
425-327-2783
�-ay-
&�'L
COUNTY
SNOHOMISH
EMER SECT
5
GAS WK CTR
MCNSEG
APPROVED BY
PATTINESS'
425-327-2783
4(- A� -
ISY-A
FITTER #1
1/4 SEC -
NW 34-27-04
OP MAP
164.068
PLAT MAP
166.07
FITTER42
MAPPING
F
JOINT FACILITIES ARRANGEMENTS
UTILITIES
%,Uri I ALI I
PHONE#
SAP Superior Order:
PUGET. KIRK BLEVENS 107018273.
SOUND P.0 Drawing Number:
EMGY 2 PE IP MAIN EXTENSION )VIA
22902 74- A V.E W-,- EDMONDS, WA- 98026 SCALE. 1PAGE'
DESIGNED BY PILCHUCK CONTRACTORS INC. 1,0=501 1/1
7
...........
'Ago,
Permit No:
Cit� of E'dmonds
RIGHT-OF-WAY CONSTRUCTION PERMIT, Issue Date: ICP.291�5
A. Address or.Vicinity of Construction: �Alve.
B. Type of Work (be specific)-inh n'-ZACA' I C9 P Z� T' P ) )I
7q U). 425c
-) I I L -75 au4_W -4- 1,'5 at 4-
'"74 flip 1(0 ter_ J L 76 49'; 'V 31 L *50 '57
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C. Contractor: �P_55g_ Contact: U 6 S5 i cro C
Mailing Address: 15 2536 L) k) Phone: ,�66- qig-U,3-�
State License d C 1-- 101 (VIV2 Liability Insurance: Bond: S
D. Building Permit # (if applicable): -Side Sewer Permit # (if applicable):
E. F1 Commercial El S�bdivi'sion' City Project. F] EUC (PUD,�VERJZON, PSE, AT& T, OVWD)
Multi -Family 6Sngle Family Other
INSPECTOR:
F. PAVEMENT CUT: YES NO SIZE OF CUT X
CONCRETE CUT: El YES El NO
Al"I'LICANT 'ro IZI','Al) ANI) SIGN
INDEMNITY. Applicant understands by his/her signature to this application helshe holds the City of Edmonds harmless ftom
injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made agqinst the City of
Edmonds or any of its departments or employees, including but not limited to the defense of any'legal proceedings including defense
C -os and attorneyfees by reason ofgranting this permit.
ts
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE )EAR FOLLOW[NG THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES 97LL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT 97LL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Traffic control and public safety shall be in accordance with City regulations as required by the City.Engineer. Every
flagget must be trained as required by (WAC) 296-155-305 and must have certification verifying �ompletion- of the
required training in their possession.
4 Restoradon 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
THAT I MUST MAKE THE PINK COPY OF THE PERMITA flAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
16 - _11-S
Signature: CA- Date: 10
(Contractor or Agent)
FOR CITY USE ONLY ro
Approved by: . 10'i//X1 Right-of-way Fee:
Time Authorizoll Void After '40,14 ZkW Disruption Fee/Fund ill:
Special Conditions: Ml^-r AtANTAit4 5 # A41N SF r- SA k Restoration Fee:
� - - -.4, - —
F-R-D-Ad /W o CprV Q r ?q9WQ " QV un tj riec S . J�A IL, rop- Total Vee: Pee76.
Lor Arip -im� ALc ox A Frrereo je5_ry apqr�Regeipt No:
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/UOST'NAVE x4z . Aes 7n R'r, 0 .,Issued by:
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UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER'18.00 OF THE EDMONDS
-771-0220, Ext. 1326)
COMMUNITY DEVELOPMENT CODE'(Phonq 42��
FINAL APPROvAL OFPE.RMITTED WORK. DATE:9-�-5--Oq
Inspector's Signatur--,,'
For inspection requirements see Engineering' Inspecti . on Information handout.
.%P:\My Documents\Forms\Epgnmg\ROWpermit Am