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23732 80TH CT W
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ADDRESS:
TAX ACCOUNT/PARCEL
BUILDING PERMIT (NEW
COVENANTS (RECORDED)
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CRITICAL AREAS:. q1 L —4P4;�DETERMINATION: El Conditional Waiver [] Study Required
O\Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA'
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED: —
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEAFER PERMIT(S) #:.
SOILS REPORT DATED:
STREET USE ENCROACHMENT PERMIT
FOR:
WATER METER TAP CARD DATED:
OTHER:
Iff 01
LOT: BLOCK:
LATEMP\DST's\Fonns\Street File Checklist.doc
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C,ity of Edmonds PERMIT NO: 9943
PERMIT EXPIRES �)/"
SIDE SEWER PERMIT t
Address of Construction:
Property Tax Account Parcel NA� �_164 MI( 4" le)l.q
Attach copies of all access and tility easements Verified and Approved b
0 wner and/or Con
tractor:y U fitQ2EES
ui Iding Permit
Invasion into City *Right-ofWay: 0 Yes
*RW Construction Permit
No
Cross other "Private Property: Yes oa�o
Attach legal description and copy of recorded easement.
Owner/Conmictor 'Lo/t,/
Owner or contractor signature and acknowledgement 'statement: Date
By signing for this permit I certify that I have read the. City's public handout entitled
ide Sewer Specifications, and shall comply with all City requirements outlined therein.
(Ow,
9 CALL DIAL-A-DIG.(l -8004Z,',015555) BEFORE ANY- EXCAVATION 9
9 FORINSPECTION CALL 425 771-0220 extensior�, ja0a
.24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS
. . ..... FOR OFFICE USE ONLY
Repair Fee $ Issued By
Permit Fee $ k
Trunlk'Charge $ Date Issued:
Assessment Fee $ Receipt No: C
City Permit Surcharge Fee L5.00 Total.Fees Paid 7zi
NOTE: IF JOB SITE IS NOT READY FOR. INSPECTION WHEN
INSPECTOR ARRIVES, A $45 RE'INSPECTION'FEE WILL BE CHARGED,
Job'Site Ready YES NO Date:. Initial:, -
Partial Inspection: Date: Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED. Initial: As -built to Street File:
1,� PERMITMUST BE POSTED ON JOB SITE'6.
Whit6.Copy: File Green Copy: Inspector Buff.Copy: Applicant
L;temp;bldg;fot-ms;sspertnitjlg4/00
Contractor License #: I
;6-Single Family
Multi -Family (No. of Units,
Commercial (N o. of Units
Ej Public
0 0
0
0
CONN TO MAIN
@ 4.5 DEEP
Ila
NOTICE: NO WARRANW OF ACCURACY The Information shown on the
attached map was compiiedfor use by the City of Edmo-,,"-,. i'
andconsultants. The City of Edmonds does not warrzn� U-1, c--_
anything sc'.' forth or, the map. Any person or entity
shou!o Con&6 an indeporident Inquiry regarding the in§1oikw_'1ic,' cl
the mzij, includ'Ing, but noi limited to, the locadon of eny
shoj�jjj Sucii sc-ifici- stubs mayor may not e)dst and mayor maj ccll c:,."_1 :I
the Neither the City of Edmonds ncr its C,
ofljc�,.rs skll b�; liable to; thu inlojination givan on this map, ncr fe, 5) c"',
reprosen� akn provided based upoi i said map I
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238 ST SW
CITY OF EDMONDS SIDE SEWER AS- BUILT
u-1 1ADDRESS SCALE
23732 - 80 CT I NTS
rHOMEOWNER CONTRACTOR
Y" KING PROPERTIES -CAJUN CONST
DATE '�DRAWN PERMIT
01/31/2005 BY SIBREL NO. 9943
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In
OWNER/CONTRACTOR IS RESPONSIBLE
LFOR EROSION CON17,901- AND NMA Q E
ALL EXPOSED SURFA
r
BE COVEREDIWITHIN 2
10.0q.
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MAINTAIN OLAT INSTALLED EROSION
WATER & SEWER(__Z�4
INSPECTIONS, AEQ'D.,
CALL 425-7�1_�i2?.o EXT/1326
ACGEP_f,_�1�6
SDR 36 VATERIAL
SCH 40
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STREET— TILE
OWNER/CONTRACTOR
VIKING PROPERTIES, INC.
P.O. BOX 1034
LYNNWOOD, WASHINGTON 98046
PHONE : 425-670-2711
SS
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PLOT PLAN nt! SEP 2 0 2004
BENCH MARK FOR Vt:L0p"-C)Vr S'-Flt'
THE PROJECT BENCH MARK IS THE CONCRETE C'TyQF �M 'C.ESCTR
MONUMENT IN CASE LOCATED AT THE LOT 1 VIKING HEIGH " "'s
I TTJ
CENTERLINE OF 238TH STREET S.W. AT
APPROXIMATELY THE MIDPOINT OF THE IN SE1/4, SECTION 31, T.27N., R.4E., W.M.
PROPERTY.
ELEVATION : 200.00
DATUM : ASSUMED
APPROVED AS NOTED
BY ENgINEERING
Date:
1.1 T Ur Lum INUZ)
SNOHOMISH COUNTY, WASHINGTON
�Nmj Lovell —Sauerland & Associates, Inc.
En&eers/Surveyors/Planner3/Development Consultants
L�11111 N e-mail: info@lsaengWeenng.com - web: Isaengmeering.com
194M 33rd Avenue T.. Suite 200 Lynnwwd�,Tk 98M (425)775-1591 (425)672-7998 tax
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TEMASSOCIATES, LLC
r*=1 LAND USE PLANNING I CIVIL ENGI14EBRING
1721 Movdtt AvGnU* M SiRe 401 *0 Everett. WA 93201
phone (425)252-2826 fax (425)252-9551
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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 to
be filled out by any person preparing a Development
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 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).
Date Received.
City Receipt #:— (g'�) 0
Critical Areas File #: _-2 o0*_3,--W2_0
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant:_q—//-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 determination 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. hi
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, inderrinify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising 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 cer* that the information and exhibits herewith submitted are true and.correct to the best of my
knowledge and that I am authorized to file he behalf e ,, as listed below.
o
SIGNATURE OF APPLiCANT/AG DATE f:>
Property Owner's A?thor' ad
11
By my signature, I certify I authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for e 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.
SIGNATURE OF OWNER —DATE
PLEASE PRINT CLEARLY-. -
Owner/Appficant:
" 0 W 'J ) /
14ame
-Z 5 C 3 2- 4L- F - �S�
Stvet Address
4��wOV4?5
city State zip
Telephone:
Email address (optional):
Applicant Representadve:
0 R
. ") im) I /
Name
/ 77, / AIL;4yi -rr- Avar
Street Address
. Zf-&&r qT—
city State zip
Telephone: qZ5- 7_572-22�0—'
Email Address (optional): ohl-P o4.-_bt cnx,
Critical Areas Chocklist.doc/3.192001
0
0
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 to
be filled out by any person preparing a Development
Permit Application for the City of Edmonds prior to
his/her submittal of the application to the City.
The puipose 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 inforination
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).
Date Received:
City Receipt#:_
Critical Areas File#: -7-0 03 - cori 2-i
Critical Areas Checklist Fee: $45. 0
Date Mailed to Applicant ��13 —
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 determination of the
subsequent steps necessary to complete a development
pernift 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, inderrinify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information fumished by the applicant, his/her/its agents or employees.
By my signature, I cer* that the.information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file plicatio e owner as listed below.
SIGNATURE OF APPLicANT/AG DATE 't:: . � XZ /0
r
Property Owner's Authori ati
By my signature, I certify I e authorized the above Applicant/Agent to apply for the subject land use application,
and griint my perriiission for e 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.
SIGNATURE OF OWNER
Owner/Appffcant:
I —
DATE
PLEASE PRINT CLEARLY,
"O!V' 'J ) /
14ame I
�Z I C -3 Z
Street Address
e;�PWIIJV95 VC4
city I State zip
Telephone: 4/' i?'l
Email address (optional):
AppHcant Representative:
)q ISA
Name
-77, / AIL;o)i -rr— Acl-;-
Street Address
city State zip
Telephone: 1Y Z5' - 05-2- 22�$Z- 19
Email Address (optional): )oh4-,V okp-bt
V
Critical Areas Checklist.doc/3.192001
0
-V. 1157-
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 to
be filled out by any person preparing a Development
Permit Application for the City of Edmonds prior to
his/her submittal of the applicationto 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).
Date Received: V I 02�9
7U
City Receipt#:
Critical Areas File#:
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant- -5z-�/-eZ3
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 determination 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, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information fiimished by the applicant, his/her/its agents or employees.
By my signature, I cer* that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file
/�Z 4e beh e o er as listed below.
SIGNATURE oF APPLICAN11AG DATE ZO
Property Owner's Author* ado
I ce authorized the above Applicant/Agent to apply for the subject land use application,
By my signature, I cerfi; 7
and grant my permission for ie 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.
SIGNATURE OF OWNER
Owner/AppHcant:
DATE
. I
PLEASE PRINT CLEARLY I
4�fw J)/
Name
-Z � C 3 Z F -:50;e;
Sftet Address
4;6V0JV95
city State zip
Telephone: �0!;-
Email address (optional):
Applicant Representadve:
") oupi I/ hl
Name
-77, Tr- .4a;;'
Street Address
. Z-,-4&r M-
city State zip
Telephone: 1Y 7-570 - Ze�Z
Email Address (optional): )oh4,Pj
U
Critical Areas ChecklisLdoct3.192001
#ILE V0.
Critical Areas Checklist
------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1.
Site Address/Location: .2,M/A S7 SA/. f7
Moo;
2.
Property Tax Account Number:
3.
Approximate Site Size (acres or square feet): IMF
4.
Is this site current ly developed? _ZYes; no.
If yes; how is site developed? Maala- A,71 &AI AM T,,*�
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 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 3 0% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe).:
6.
Site contains areas of year-round standing water: Approx. Depth:
7.
Site contains areas of seasonal standing water: Al",LZ_7 Approx. Depth:
What season(s) of the year?
8.
Site is in the floodway Aja floodplain AZO of a water course..
9.
Site contains a creek or an area where water flows across the grounds surface? Flows are,year-
round? NelVd�r — Flows are seasonal? (What time of year?
10.
Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) gda 7�6� -_zde —a-7V 110WA-,
1. Obvious wetland is present on site:
----- — ------------------------ — -------------------- For City Staff.Use Only ------------- — ------ ------ — --
Siteis oned!
:241_.: SCS -Ta ped,s.oiltype(s :,T -7-
W R
etland inventory or C.A. map indicates wedand present on site?
4.. Critical Areas inventory or C.A. map indicates Critical Area on site� NO
5. Site within designated earth subsidence landslide hazard area? _tdo
6. Site designated on the Environmentally Sensitive Areas Map?
�o_chk.doc; Rv 10/03
0
(3 Ar
City of Edmonds
REC51VED
JAN 0 6 i9jag
COMMLINITY -SERVICES
CRITICALA'REAS.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
Edmonds prior 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, 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 completa.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 infor mation (e.g., site plan*, -topography
map, etc.) or studies in conjunction Arith t his Checklist
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
. -7—ovcd A'16aW4r41z10%
Name _/ -
3 aa h—W
Rtreet Address
S
,4�DiVA,UbS 40ASA-1 M612 o47
city z State Zip
Applicant Representative:
Name
Street Address
city State Zip
q2��_
Telephone Telephone
S i g nt�/e
-Dite
Signature
Date
NA
fr�W,01-1
4 '� �� -S z e- Ck 3vi
OWNER/CONTRACTOR IS RESPONSIBLE
-t r-cR TROL AND Ah
EROSIOY CON'
A 0,1
g,- I /
ALL EXPOSEd SURFACE.,q6
IAG'
BE COVERED WITHIN ?0. y
A
d-O
ell, &js- r-
op
MMTAA�A�IINSTALLED EROSIONi 0
WATER & SEWE6 /10-001
/10*00;
INSPECTION� 'AEQ'D./
CALL 425-771.0220 EXT,/13,,,)6
i32 0
0 gy
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ACCEP-rABL-&'fidi4RNE
MATERIAL
SDR 35
SCH 40
N - 12
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CITY
OWNER/CON TRACTOR
VIKING PROPERTIES, INC.
P.O. BOX 1034
LYNNWOOD, WASHINGTON 98046
PHONE 425-670-2711
SS
Is
cl�f
SCALE : 1"=20'
,ED
NTER
S — -" I V-Z0
PLOT PLAN OF SEP 2 0 2004
BENCH MARK FOR vCLOPMENT SEFV
THE PROJECT BENCH MARK IS THE CONCRETE LOT 1 CITY OF Im ICES CTR
MONUMENT IN CASE LOCATED AT THE VIKING HEIGH ff"' ONDs
CENTERLINE OF 238TH STREET S.W. AT
APPROXIMATELY THE MIDPOINT OF THE IN SE1/4, SECTION 31, T.27N., R.4E., W.M.
PROPERTY.
CITY OF EDMONDS
ELEVATION : 200.00 SNOHOMISH COUNTY, WASHINGTON
DATUM : ASSUMED
APPROVED AS NOTED
BY ENGINEERIN
Date:
�ffmj Lovell — S auerland & Associates, Inc.
En&eers/Surveyors/Planners/Development Consultants
L�N 0 e—mail: info@lsaengineering.com - web: Isaengineering.com
19M 33rd Avenue T., Suite 200 Lyanwood—TA 98M (425)775-1591 - (425)672-7998 far
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JTT I JTT 3.6
01 DATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER N_AME/N INESS
,.AME OF BUS
k', liza PI-IJz2e�-j- �1.0_ C
MAILING ADDRESS
CITY ZIP TELEPHONE
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76
ZIP ITELEPHONE
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USE PERMIT
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NUMBER r4&W—
JOB ') (I
ADDRESS
MT NAME/SLIB SION
LOT NO.
LID NO.
-t"�fa jN��
LID FEE $
PUBLIC RIGW.T36F WAY*jR OFFICIAL STREET MAP
TESC
RW p:r:P.1oVed
Street use Permit Reqi'd
EXISTING PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATIOw---- Fir
underground
Whing required
METER SIZE
LINE SIZE
NO,OF FIXTURES
PRV REQUIRED
I
YE NO C1
0
?5
REMARKS
z
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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r7e.--As I A V-% I . le /A A I r- I e.-\ r-_y7/\r- I �& I
ADDRESS
.-FiAE: REVIEWED BY
TELEPHONE
"CCA L,�45_,
A- I �, VARIANCE OR CU. SHORELINE OR AD§#' [j' INSPECTION
STATE41ENSE NUM EXPIRATION D�ATE I
CHECK N
IiES ONO
PROPE RTY TAX ACCO NT RCEL'
(orNO.
ev
lt
SEPA REVIEW
COMPLETE ,EXEMPT.^
EXP
SIGN AREA
ALLOWED PROPOSED j
NEW RESIDENTIAL r-*.e PLUMBING MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY".
C3 SIGN.
REPAIR GRADIN9 FEN
t-7 0 CYDS gE 01%:'� X ' FT)
OTHER
DEMOLISH TANK
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ET: ROCKERY:-,!"� L-J FIRE ALARM,
LOT COVERAdPNJ��
ALLOWED PROPOSED
:.Lj bC%
REQUIRED SETBACKS (Frj��
FRONT SIDE REAR
PARKING
,.RiQ;b PIRO� IIDEI�
2m. 2—
LOT jkR EWE
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X�:
(TYPE OF USE, BUSINESS
CH
TYPE RUCTIO,
, , T1
M
CRIITICA -3 C;Lz
NUMBER NUMBER OF, ' I" 1 4 -
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
SPECIAL INSDECTION EA
REQUIRE DIP e
ES, 110q
REMARKS'
PROGRESS INSPECTIONS PER UBC 1081.1EIC109/iRC109
Cam F-trk,�,
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0 (/LS/ 9 D 01-1
VALUATION
$
DATE
UX,
BOND
POSTED
HEIGHT
D PROPOSED
D SETBACKS (Fr.)
UR SIDE REAR
I a' wA",
OCCUPANTP 3
GR
OCCUPANT
LOAD
FINAL INSPECTION REO'D
k__3
,�kkEE Description FEE
Plan Ch eiRk ("I\
State Surcharge
HEAT SOU PE ING % " � 'L
'a MAI 4j O-r6LOPE %
"�, X 'A-., "I
11 ' I
"Buildiniff? rmit
p, it y
City Surcharge LAS:
PLAN CHECK NO:
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lumbing
Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUIC
DOMAIN
Grading
e7LI)
(CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
- -
4&
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFN� DEFEND AND HOLD HARMLESS THE CITY OF
a EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIF4 WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due 6V
//X/)/
x 0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
I
Recording Fee
Receipt # e
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
This application is not a permit until signedbythe
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WISHINGTON RELATING TO
WORKMEN!S COMPENSATION INSURANCE AND RCW 18.2
FOR INSPECTION
receipt is acknowledged in space provided.
SIGPWZIREJ��(OWNOR ENT) VDATE SIGNED
(425)
DjTE
771-0220
. . . .............
ED BY DATE�
ATTENTION
CPYABUILDING
Off 1333
ITIS UNLAWFULJOUSEOR Oq OR STRUCTURE UNTILAFINAL
Z&&o
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
ORIGINAL - FILE YELLOW - ASPEC16R
PINK - OWNER GOLD - ASSESSOR'
09/03
nnii LJ A r%r% %ff^l I A MO
RM A WILI^ A ^^1l`%111=fT%
3
C.ity of Edmonds
RIGHT-OF-WAY CONSTRUCT19N PERMIT
A. Address or Vicinity of
B. Type,of 11 Work (be
c-�, U U 0 1 L
C. Contractor:
Mailing Address:
City Business License #:
D. --BuildinrPermit # (if applicable):
Permit No: 44,c-'D
Issue Date.: e�� -
Liability Insurance:. Bond:
Side Sewer Permit # (if applicable):
ZOD(4 -C.0
E. Commercial 0 Subdivision City Project YEUC (PUD, VERIZOAC]EotOMCAST, OVWSD)
Multi -Fan -lily 0 Single Family Other
M (elm
INSPE"CTOR: yu (<1 h S (,J7 t
,,F. PAVEMENT CUT: [M YES F-1 NO G. SIZE OF CUT x
',.CONCRETE CUT: El YES Fj NO
G. Mail Approved Permit Call for Pickup
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands by his/her 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 ofgra'nting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AN ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
D
COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL 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
flagger must be trained,.,.as, required by (WAC) 296-155-305 and, must have certification verifying completion of the
required training in their possession.
+ Restoration is to be in accordance with City codes. All sir6et-cut trench work shall be patched with asphalt or City-
apoidved material prior to t ' he 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
I HA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature: Date:
(Contractor or,Agent)
Approved -by:
Time Authorized: Void After-,-,
Special Conditions: -Stf%ellfir�
MA i tU4Ai M ^4 1-10 �4.01
4;
REQUIRED INSPECTIONS: _
OR, CITYUSE"ON, Ly.
OC
d
ghtrof4ay-F J t
fl,"11065, -Disruption Fet1Fu'fidJ14,
/00
51 &r:dlIJ4 #J7Wnspection:Fee..
JRP-', Total #ee:, SV
lieceipt No...'�"��
I If" A Af
1/ 4. Av.
Call 425-771-0220, Ext. 1326for a 24'-`hbur voice -recorded inspection request line.
FINAL% APPROVAL OF PERMITTED WORK: DATE:
InsDector's Sionature
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
CADocurnents and SettingsTurtisNy Documents\Fonns\Engnrng\ROWpemit_.doc Rcvised 10/01/03
-Pilchuck Contractors. Inc
-Job # 107023421
April 8, 2005
the6t I -of 1 Robilnglisg
Notes:
1. All signs and spacing to conform
-to the MUTCD and City of Edmonds
in -Street Manual.
.2.C.hannelizing devices are 28"
traffic cones.
4. All signs are 48" x 48" B/O unless
otherwise specified.
5. Alert affected residents.
6. Maintain 2 lanes of 11' each.
7. 1 Flagger will control alternating
single lane traffic.
LEGEND
28" TRAFFIC CONE
WORK AREA
TRAFFIC FLOW
CHANNEUZATION DEVICE SPACING
MPH
TAPER
TANGENT
50/70
40
80
35/45
30
60
25/30
20
40
BLACKTOP ASPHALT
ROAD
AHEAD
ROAD
4"
WORK
AHEAD
60
100,
R/W
PRIVATE RD
(TYPICAL)
CONCRETE CONCRETE
W 12' 12' E
5' SIDEWALK S-bound Lane N-Bound 5' SIDEWALK
AP t., -A :A -A A A
A A
PROP. 2" GAS 24' ROW EX. WATER
6'W CL----- ---- --- 11 6'E CL
N.T.S.
EX. STORM DRAIN
@ CL
50'
R/W
00
TYPICAL MAINLINE JOINT TRENCH DIMENSIONS
R1W or Excavated
Curb Sidewalk PROPERTY LINE Width varies per 24" Min. Dirt Pile
Number of Utilities
12- Typical
Final Grade
.'i -1 , L
V I
111121
04
�'�:"OlnalBackfil 36"
(No rinks Cover
over 6' din.
Min.
Min. Sand
Location of roof drain Max.
Intercept (depth varies) 6" Min. Sand 'Shadin Over Power Depth
Shading Over Gas,'4-:.,
3" Sand Bedding
NOTE: Install 12" sand shading over gas If the final backfill
contains rocks greater than 6" diameter. Rocks greater than
10" In diameter are not permitted In the final backfill. Gas
NTS
Phone & Cable ',- Power
NOTE: 4* separation If communications
agree. Otherwise Ir separation are required.
FITTER (CHECK BOX IF COMPLETE)
Work area left in Clean & Safe onclition
Complete all Pipe Tables and Gas Pressure Stamp
Field changes Red -Lined on as -built El
Material verified and Changes oted on paperwork
All Valve & Tie-in Locations noted on as -built
Note beginning of Main, EOM & Line of Main locations
Show Rope Locations & Cul-de-sac Radius
Foreman's Signature
Company Date
STANDARD GAS CONSTRUCTION NOTES:
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: 1-800-553-4344
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 ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.
4. NOTIFY PROPERTY OWNERS ADJACENT TO PROPOSED CONSTRUCTION ACTIVITIES A MINIMUM OF TWO WORKING DAYS
PRIOR TO BEGINNING CONSTRUCTION. USE iSi TO DISTRIBUTE FLYERS IF JOB IS LARGE, OTHERVASE HAND
DELIVER FLYERS BE SURE TO INCLUDE THE LIST OF FREQUENTLY ASKED QUESTIONS AND 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
OPERATING STANDARD 2525.2500.
9. VALVE MARKERS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS OPERATING STANDARD
2525.2600 FOR ALL HIP VALVES IF THE LOCATION IS NOT REDILY 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: I SYSTEM MAOP XX PSIG
12. RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION.
13. GAUGE AND MONITOR USE OF ALL STOPPERS AND SQUEEZES 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 2525.1200.
15. COORDINATE INSTALLATION NTH CORROSION CONTROL: ED VOOGT - PHONE- 206-396-2799-6313.
JOINT TRENCH PLAT NOTES:
1. NOTIFY APPROPRIATE PERMITTING AGENCY PRIOR TO JOB START (SEE PERMIT
REQUIREMENTS).
2. ANY CHANGE IN ROUTE, PIPE SIZE/TYPE, TIE-IN METHOD OR ADDITIONAL MAIN
FOOTAGE MUST BE APPROVED BY THE APPROPRIATE ENGINEER/PROJECT MANAGER.
3. INSTALL MAIN VALVES OUT OF TRAFFIFIC WHERE POSSIBLE.
4. INSTALL ONE POUND ANODE FOR EVERY 1000' OF LOCATING WIRE. INSTALL ANODE
AND TEST LEAD WIRES PER PSE GAS OPERATING STANDARDS 2525.12 & 2525.23
5. MAINS AND SERVICES SHALL BE TESTED AND PURGED PER PSE GAS OPERATING
STANDARDS 2525.33 & 2525.34
6. UNLESS OTHERWISE NOTED: ALL PIPES INSTALLED IN PLAT TO BE 2" PE-IP.
ALL CROSSINGS TO BE YELLOW 4" PVC.
ALL SERVICES TO BE 5/8" PE.
DENOTES SERVICE STUB LOCATION.
DENOTES FOOTAGE BETWEEN FITTINGS.
7. CUSTOMER TO DIG AND BACKFILL ON PRIVATE PROPERTY OR EASEMENT ONLY.
TRENCHES MUST CONFORM TO PSE GAS OPERATING STANDARDS 2525.17,
2525.15 & 2525.16.
8. NOTE ALL RECORDABLE FOOTAGES, LOCATIONS AND MATERIAL CHANGES ON THE
AS -BUILT IN RED.
GAS MAJN INSTALLATIONfRIETIREMENT
Type/Work
Pipe Size
Type
Estimated
Length
Actual
Length
Manufacturer
INSTALL
21@
PE SCAT
20'
'INSTALL
2"
PE JT
700'
GAS MAIN PRESSURE & TESTING
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
CATE OFF
TIME OFF
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
,DATE OFF
TIME OFF
IDesign Press 60
1 SYS MAOP 45
PROJECT PHASE
NOTIF#
ORDER0
L
SAP Superior
Service/Meter
Service/Meter
Service/Meter
Service/Meter
Ind. Service
Ind. MSA
Dis. Reg. / FT
HIP SvcIMSA
Relocate
Retirement
X191654341
107023421
ontractor. CONSTRUCTION COST CODES:
1 031-103-2 1 1 1
Vicinity Map
WORK SITE
Owner/ Developer Contact Info
VIKING PROPERTIES
PO BOX 1034
LYNNWOOD, WA 98046
ATTN:TED COLEMAN 206-335-4222 office
I I
Project Manager Conted Information:
KIM GRAY
CELL: 425-290-2678
EMAIL: kim.GRAY@pse.com
CALL (800) 424-5555
2 BUSINESS DAYS BEFORE YOU DIG
THIS SKETCH NOT TO BE REUED UPON FOR EXACT LWAMON OF FArAUITIES
REAL ESTATEIEASEMENT PERMIT
REQUIRED EDMONDS
REV#
DATE I
BY IDESCR.11PTION
FUNCTION
CONTACT
PHONE
DATE
3
PROJECT MGR
K. GRAY
206-418-4233
3130105
2
ENGR-GAS
1
DRAWN BY
P. MCGHUEY
206-418-4214
3131104
CHECKED BY
K GRAY
206-418-4233
COUNTY
SNOHOMISH
EIMER SECT
5
GAS WK CTR
MCNSEG
APPROVED BY
�_tGRAY
206-418-4233
CP APPROVAL
`1/4 SEC
SE-31-27-04
OP MAP
164.068
PLATMAP
167.069
MAPPING
JOINT FACILITIES ARRANGEMENTS
UTILITIES
CONTACT
PHONE#
SNO. CO. PUD
VERIZON
COMCAST
ROBERT KAKALEY
BOB EMERY
JEN JACOBSEN
425-670-3214
425-774-5921
425-317-9601
PUGET
SOUND VIKING HEIGHTS (26 UNIT CONDOMINIUM)
ENERGY 2" PE IP MAIN EXTENSION
23732 80TH CT SW, EDMONDS 98026
DESIGNED BY PILCHUCK CONTRACTORS INC.
SAP Superior Order:
107023421
Drawing Number
N/A
SCALE:
I"= SW
PAGE:
1/2
PIPE TABLE - MAIN
Location
Pipe
Design As -Built
SAP OR
Materials
.
- . � -- F.
from
- � � -
to
-
. �
Size
. F . - -
1 Type
Length
I.
- I - ... � -- .. ... - -
Location Length Location
TIE-IN
2" SERVICE TEE H-17501
T1
2"
ST
N/A'
14-N CL & 6-W CL
TRANSITION FITTING
T2
2"
MPE
1'"'
N/A
15*-. N CL & 6-W CL
SCAT
MAIN
T1
T2
21
MPE-
6-'"W' CL
VALVE
T3
2"
MPE
N/A
30'N CL & 6'W CL
SCAT
MAIN
T3
C1
2"
MPE
700'
6-W CL
CAP
C1
2"
MPE
N/A
78'N CL & 6E CL
.........
. ...
+
- - -- - -
---------
------
j
Total 1-1/4" Pipe 0'
--- -- -----
Total 2" pipe = 716'
Total 4" Pipe = 0'
Total 6" Pipe = 0'
PIPE TABLE - SERVICES
Description of
Activities
TWIN
TWIN
TWIN
TWIN
Location
LOT
12
LOT
13
Pipes
Size
5/8"
5/8"
5/8"
5/8"
Type
MPE
MPE
MPE
MPE
MPE
MPE
MPE
MPE
MPE
MPE
LenP
35'
15'
35'
15.
35'
Design
Location
')N CL
')N CL
')N CL
')N CL
)N CL
')N CL
')N CL
')N CL
')N CL
')N CL
Length
As -Built
Location
Remarks
2
10
4
1
11
3
TWIN
TWIN,
TWIN
TWIN
TWIN
8
5/8"
5/811
5/8"
5/8"
5/811
5/8"
7
20
19
22
5
21
18
23
15'
10.
15.
35'
15,
TWIN
TWIN
TWIN
SINGLE
24
---15---
16
25
14
5/8"
5/8"
5/8"
MPE
MPE
--MPE —
MPE
35-
')N CL
15.
35'
10.
')N CL
')N CL
')N CL
26
5/8"
— --- ---- -------
- - - - - - - - -
- -
---
---------
Total 5/8" Pipe = 320'
Total 1-1/4" Pipe = 0'
-CRO-SSING CONDUIT TABLE
X-ING
Location
Size
Type
GAS
-
Quantity
------
Length
Location
Remarks (type of crossing)
NO.
to-
(in,)
sched.
each
fq�t)
N-S-E-W
(Gas only, Street Light, etc.)
xi
12
4"
40
1
40'
S
X21
3
10
411
40
1
40'
S
X3
5
8
411
40
1
401
X4
7
8
414 1
40
40'
S
X5
10
20
40
1 S
X6
22,
19
4"
.40-..
4.01
S
X7
24
17
411
40
------- --
- -----
40'
S .
X8---.
.26
15
40'
1 S
X9
X10
x1i
X14
X15
-------- -- -
--- -- --
X16
X17
X18
X19
X20
.
X 2 1
X22
X23
X24
X25
4
- - ------- -
4 1
PSE #2432 7/29197
4* SCHED 40 YELLOW PVC (ft) = 320
8' SCHED 40 YELLOW PVC (ft) = 0
10"SCHED 40 YELLOW PVC (ft) = 0
12' SCHED 40 YELLOW PVC (ft) = 0
Total 4"PVC Plug Caps= 80
Total 6* PVC Plug Caps = 0
Total 10" PVC Plug Cape= 0
Total 12" PVC Plug Caps = 0
Total Glue (Ots.) = 14
GAS ORDER # = LV7019631
Project Manager. PATTI NESS
Crossing Material Delivery By: [ FAMILIAN NORTHWEST on date:
SUNRISE RIDGE
PUGET
SOUND
ENERGY
CALL (800) 424-5555
2 BUSINESS DAYS BEFORE You oiG
THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATION OF FACInIES
REAL ESTATE/EASEMENT iiE—RMIT
REQUIRED EDMONDS
REV#
DATE
BY
DESCRIPTION
FUNCTION
CONTACT
PHONE
DATE
3
PROJECT MGR
K. GRAY
206418-4233
3130105
2
ENGR - GAS
I
DRAWN BY
P. MCGHUEY
206418-4214
3/31104
CHECKED BY
K. GRAY
206-418-4233
COUNTY
EMER SECT
GAS WK CTR
APPROVED BY
K. GRAY
206-418-4233
SNOHOMISH
5
MCNSEG
CP APPROVAL
-
1/4 SEC
OP MAP
PLAT MAP
IMAPPING
SE-31-27-04
164.068
167.069
JOINT FACILITIES ARRANGEMENTS
UTILITIES SNO. CO. PUD VERIZON
-COMCAST
CONTACT . ROBERT KAKALEY BOB EMERY JENJACOBSEN
PHONE# 425-670-3214 425-774-5921 425-317-9601
A PUGET
SOUND VIKING HEIGHTS (26 UNIT CONDOMINIUM)
SAP Superior Order
107023421
Drawing Number
NA
ENERGY 2" PE IP MAIN EXTENSION
23732 80TH CT SW, EDMONDS 98026
DESIGNED BY PILCHUCK CONTRACTORS INC.
SCALE: 50,
in=
1PAGE:
2/2