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23326 74TH AVE W.PDF11111111 lill 5897 23326 74TH AVE W 0-1 ,.City of Edmonds RIGHT-OF-WAY CONSTRUCTION PERMIT A. Address or Vicinity of Construction: Permit Number- q 7 7�a�/ f Usue Date: 5,/7-17 .2,3 3.0,6 - -) A -it fV - w - B. Type of Work (be specific): 890 loo C. Contractor: S'0 a q_ 0 Contact: y zi, Mailing Address: 0 1 Tf Vl*"4\/ "161 Phone: U) o 3 -7jZy--- State License #: . W,� !S . Liability Insurance: Bond: $ D. Building Permit # (if applicable): E. 0 Commercial 0 Subdivision- E] Multi -Family Single Family INSPECTOR- F. Pavement or Concrete Cut : Side Sewer Permit # (if applicable): El City Project 0 Utility (PUD, GTE, WNG, CABLE, WATER) 0 Other INSPECTOR: b(Yes 0No G. Size of Cut: APPLICANT TO READ A. x 11V. H. Charg,��_$_ . F4 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 Edmond8, or any of its departments or employees, including or not limited to the defense ofany legal proceedings 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 I INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD 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 completion. Restoration is to be in accordance with City Codes. Street shall be kept clearr at all times. Tfaffic 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 the4orking day; NO EXCEPTIONS. Ihaue read the above statements and understand thepermit requirements and thepink copyof the�oerm4it willbe available on site at all1imes for inspection purposes. Signature: Date: 3)-)l (CAtractor or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR'CITY USE'ONLY APPROVED BY: TIME AUTHORIZE,D: VOID AFTER, A, SPECIAL CONDITIONS: Fc-t RIGHT OF WAY DEPOSIT DISRUPTION FEE/FLJND.tl I: RESTORATION FEE: PERMIT FE, 5n no TOTAL FEE: COMMENTS: RECEWT. FEE: -DATE: ISSUED',BY:­ NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994 FIELD INSPECTION NOTES I Comments: I Diagram.: (Fund 111 - Route copy to Street Dept.) I X e CONTRACTOR CALLED FOR INSPECTION El YES El NO Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: I j SUBSTATION CIRCUIT NO. a-- PHASE 3 c- 2— P x Pvq -T%Al 3218 32" x- 3 42 a -cc- ftok,-Xvv" as� 2-5 P-13040 F Im c— 14- q_'L 4�_ 4� SNOHO t6 V-z A� mi�i uNTYTUBIlC UTILXrY DIS'MCT NO. -I u"i 27 M,70 A:,; ck t -4 JET c� A -1476� kov. 12/94 Ap �L' 331 _�L� SO LOCANTION: .2--3-S 2-(- 6,y ev c- 'POLEI�-g 1/4 SL�,TT_) R Z4 DATE W.O. # eltql\\ _3 W ENGINEEl'i-T-Or'6�< DWG. # 19 _S1 REASON FOR WORK DRAFTER U.G. # Th., SCALE. it DATE WORK COMPLETED FOREMAN ADDonvpn DATE PRINTED FEES REOUIRED: 0 YES 0 NO ENVIRONMENTAL ANALYSIS 0 EXEMPT 0 NOT EXEMPT PARA. 181 ITEM C PRIMARY OVERHEAD O.H. U.G. COND. KV URESIDENTIAL U COMMERCIAL ADD _CKT. FT. PH LEO REM _�CKT. Fr. PH $ NET —CKT. Fr SECONDARYOVERHEAD O.H U.G. COND. KV BASIC FEE. $ ADD CKT. FT. PH /@$_/ = $ REM — CKT. FT. —PH NET _CKT. FT. METER/CONV. POLE s PERMITS (DATE GRANTED) U TREE TRIM PRIMARY UNDERGROUND U RESIDENTIAL U COMMERCIAL BASIC . FEE $ 0 STATE LEU # $ U COUNTY Is CITY $ u EASEMENTS $ Cl REQUIRED U NOT REQUIRED SECONDARYUNDERGROUND BASIC FEE. $ $ UNDERGROUND PLAT DATE RELEASED — BASIC FEE $ $ FOREIGN CONTACTS U GTNW JPN #_ STREET LIGHTING U CATV JPN # $ *JOINT TRENCH GTNW & CATV *JOINT BORE GTNW & CATV WORK IN RIGHT-OF-WAY U PRIMARY 0 POLE STENCILING USECONDARY ofit 0 $ FROM —TO TAKE OFF POLE MISCELLANEOUS FEES PRE-CONSTR. REOUIREMENTS VAULT $ PERMIT $ 13 TREE TRIM 0 PUD LOCATOR $_ UBACKHOE U FLAGGING $ 0 ONE CALL DATE TOTAL DUE: $ INDEX 1POLES1 I PLAT DATE PAID LOGS U-MAP I -R-F—MR C-MAP RECEIPT # LOCATION MAP PAGE NEW SVC APPLIC. # 2-10 d\- 3321 3319 3322 //z/ 4. )o cr W5 13, 3L2 6� 2 ��3407 m fA pol it - v) 2-68 Z404 CA FILE NO. 9 q-_1 1--" -, STREET FILE Critical Areas Checklist Site Informat,ion (soils/topography/hydrology/vegetation) 1. Site Address/Location: 2. Property Tax Account Number: /7(9#e -0-)" 3. Approximate Site Size (acres or square feet): 41Y - RECEIVED 4. Is this site currently developed? X yes; no. APR 1 2 1994 If yes; how is site developed? PERMIT COUNTER 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). .­;�e Hilly: slopes present 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:. _�ao Approx. Depth: 7. Site contains areas of seasonal standing water: NtO Approx. Depth: What season(s) of the year? 8. Site is in the floodway )gJ2 floodplain of a water course. 9. Site contains a crpek or an area where water flows acrgss the grounds surface? Flows are year- round? Flows are seasonal? (What time of year? I ; meadow 10. Site is primarily: forested shrubs mixed urban landscaped (lawn,shrubs etc) 11. Obvious wetland is present on site: DETERMINATI -STUDY REQUIRED.; CONDITIONAL WAIVER: :WAIVER 4- Reviewed Rev 01A)V94 &-00 . 199 - City of Efton& Critical Areas Checklist The Critical Areas Checklist contained on this form is to be filled out by any person preparing a Development Permit Application for the City of Edmondsprior to his/her submittal of a development permit 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 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, RECEIVED APR 1 2 1994 PERMIT COUNTER 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 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 information (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 / Apolicant: /_ Y L L E, iaXA Zl,� Naxne 23 33 -7!Z 7-4 Z, 0 Street Address Appficant Representative: Nam Street Address , e4 & (tJd 7X- -� K_ � F - ;, City, State, ZIP - Phone City, State, -ZIP ,<,av Sffnapfe Signature Phone Date 1 \t)f-7 STREET FILE ril 0 M W N 0 76- t? U 0 1-3 1)t� I U C 0 0 M- ZI, ro JO M 0 0 :LAI rn 0 0 M P P (A CA 0 MITE, NOWARRAMYOFACCURCY Th ir attached MaP Was COMPRed b Use by the Cit 8 Information shown on' *9�� IA!4 (A yofEdmond�,J-,--, 40m; consultants. The MY 01 Eftends &-es neh -M4MiMset-jorth-j)n-jhe-fiVg- - -931OU UlQc' , - —my POrso ore fity requ-,. L"'; Eon duct an Independeid k*lry r@ n 9ardlngthelnfurtii,-j--,�.,,,- Includipg, but not ImIted to, the location of an- Clc.,J Such sevier stubs may Or may not Me and mayor ir, J zt, shr,';In, Neither the CRY of Edmonds nor its C'_,-,� -3 O'� t-3 hble foi the InformaIon given on this map ncr fc; Pr�vlded based ur,(,, r., T ?�- L C% ff "M F, FA 4 0 �U M 0 0 0 U1 M C 0 z 0 0 % C. City of dmonds RIGHT-OF-WAY CONSTRUCTION. PERMIT Permit Number. qq (A Lssue Date: A. Address or Vicinity of Construction: 23326 74th Ave W (107006750) D f W-Ar ft- Install a 2" PE Plastic Pipe gas main in 73rd /I? c_1 S AW-W; tie rrito—�Rottnq main @ 218IS U/1 -65f Elr&Mie-y- M a7z,'W of tkO edge of paving in 73vd Ave.W; extend main M'S to reeve target.. Contractor: PUGET SOUND ENERGY Contact: DOUG USITAEA) 1122.75th St SW Everett, 982%one: (425) 356-7520 Mailing Address: .. 11 4 State License #: F t - Liability Insurance: Bond:$ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. Commercial Subdivision El ;eity"*rbject F Utility (PUD, GTE, W&G,`�'CXB�E, WATER) Multi -Family E] Single Family FJ O�h* er, INSPECTOR:' 114SPECTOR: F. Pavement or Concrete Cut: 0 Yes [NNo 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 ofEdmonds 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 allorneyfees 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. 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 gets of construction drawings of proposed w ork required with permit application. A 24 hour notice is requiredfor 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; NO EXCEPTIONS. I have read the above statements and understand the permit requirements'�md . the pink copy of the permit will be available on site at all times for inspection purposes. Signature:. d4" 14, 14�-IV I Date: 3/z4/V!0 (Contractor br Agent) PEEM El - LCEM-FUUG1W CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY APPROVED BY�. RIGHT OF WAY FEE: //0.00 TIME AUTHORIZED: VOID AFTER 1 '10 DAYS DISRUPTION FEE/FUND I 11: SPECIAL CONDITIONS: M A. - RESTORATION FEE: T OTAL FEE: 00 RECEIPT NO.: ISSUED B)�'-- NO. WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997 FIELD INSPECTION NOTES I Comments: I Diagram (Fund 111 - Route copy to Street Dept.) CONTRACTOR CALLED FOR INSPECTION El YES El NO PartW Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: NOTES: c 1--[— ;2 ID 13 -0 T -EF'O 7Z _Y ID 110- 2. CITY OF EDMONDS: Maintain a minimum of 5' horizontal and 3' vertical clearance from all city utilities and appurtenances. Cuts in paving are shown as L 4:�A I _T1_ ----- cuts in paving anticipated. Notify Engineering Division 24 hrs i 1 11 1 1 prior to construction - 425-771-0220 1 331 3 1 3. PROJECT MANAGER: DOUG USITALO - 425-356-7520 SCALE: I"=50' �?t4 ROPES AT EDGE OF PAVING 4 !241 0 [402 C1.1 C'J 0 C\? co 216's- 00 1979 C12 TIE-IN 0 218'S 2'W EDGE PAV. 2" PE IP MAIN 2'W EDGE PAVING­"�' END MAIN 369'S 2' W EDGE PAV.—,".,� 1 —B 0 0 —.4 P_ 4� --f5 5 G cD_ DESCRIPTION DATE I BY I APF REVISIONS AS -MILT IWORMATION FITTER OR CONTRACTOR I COMIMTOR DATE COMPLETED % COMPLETED INSTALLAWIMM TYPE (IF 7M "TE am TIME ON MAIN six MATERIAL TOTAL FOOTA DATE OFF THE OFF TYPE OF PIPE PIPE HAWFACTIM WTED BT op wp 164.68 PUGET nAT mAP 166.70 SOUND ENERGY ,.=NW-32-27N-0, EMER160 SEC 0 PROPOSED mAiN FOOTAGE CUTS" rRESWRE aw sizE I mmut. I TOTAL rwAK sum uw 2" 1 PE I 15U' I Pmas rnK4nNT)q 2" PE IP MAIN EXTENSION TO SERVE: 23326 74 TH AVE W.