23828 74TH AVE W.PDFIIIIIIIIIIII
5922
23828 74TH AVE W
PLANNING D
NAME: t2vlqu� AA�f
SITEADDRESS: ?-3eze- 71 Amt. U.-DATE:
ZONING: PLAN CHK#: 9 9 2-
PROJECT DESCRIPTION: ra-
V, tv.,,
Ak- , V
-Plan Review By�'.
F
CAHLENO. —zoo
4_0
Critical Areas Checklist
------- ------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: Z3182.iB -7 q 'a' -A 0 e! W , 00MA OJ DJ
2. Property Tax Account N umber: 14 88 6 - 60(o — 0 03 — 0 1 0,)_
3. Approximate Site Size (acres or square feet): 15 00 0 (75(-Y zoo
4. Is this site currently developed? ',� yes; _ no.
If yes; how is site developed? I— 5To4j4 fnPiezuF -FA-AA
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 I 0-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a verti . cal rise of
I 0-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: . Ale Approx. Depth:
7. Site contains areas of seasonal standing water: 14c Approx. Depth:
What season(s) of the year? " /4
8. Site is in the floodway. floodplain Nu of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? ko . Flows are seasonal? AJIA (What time of year?
10. Site is primarily: forested -, meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: KOO t�-
------ ---------
aff:Use: n y �; ; I " .... I — -
------------ 0 1 .. .. ..
- ------------------- ----------- For CitySt
ite �2
S::Z
4..: -Critical Areas inventory -or C.A...map.indicates.Critical Area on sile?LNE
:51, .. ::.�::Site:.within::designated::earth::subsidence::Iandslide:.h.a:w.d,ar,ea?.. X-A 2
Ar 6is
Map�
:.6.: i,Sjte:de ated'6n4he.::,,E vrb rnent 11 iS t
sign prim ive
n i . n, a
iv!�'Jt/9�f
-ca-chkAoc; Rev 10/03/97
RECEIVED
JUL 161999
City of Edmonds DEVELOPMENT SERVICES
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
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 sub ect 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 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 fon-n. In addition, the applicant shall include
other pertinent infor m-ation (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 Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
Qnar--*�- [4Ak-&i5
Name
1-39Z�B -1t4 AJa u).
Street Address
e-nKtoaids (X�A'
city State . Zip
Applicant Representative:
Name
Street Address
city State Zip
47-G (o-7-z-z4qq0 kJ*j Ce,'L_
Telephone Telephone
Signature SiLynature
Date
crecepfion\janakad.doc
Date
(over)
13
't � �)
4*2 C. 1 S9
Robert Harris
2382874 th Avenue West
Edmonds, WA 98026
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
July 20, 1999
Subject: Determination regarding Critical Areas Checklist # 99-200
Dear Applicant:
BARBARA FAHEY
MAYOR
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
... ..... . .. ......
IMPORTANT INFORMATION TO BE NOTED:
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED To SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIS OR CRITICAL AREAS STUD
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL
001. 000RAM A ODI 1JftA'r1r%A1C- - %1^1 M A r%f"kl 1^ A 'r10%&1 %A111 I kl-� - - - - - - - - - - -
Permit applications include the following:
Enc: Determination
* Architectural Design Board
C:Reception\Jana\CRLTR.doc
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Planning Secretary
Incorporated August 11, 1890
Sister City - Hekinan, Japan
.4.;
DRECEIVE[)
ATE
�PERMMEXP
T
I;ES�
USE PERMIT
ZONE
CITY OF. EDMONDS NUMBER ZQQ�#Si_
CONSTRUCTION PE RIM APPLICATION JOB
SUITE/ PT#
ADDRESS
"1 7), 1. 1 2.,� — q t/i_'k Av C', UZ
Q"ER NAME/NAME OF BUSINESS
PLAT NAM E/8U BDIVI SION NO. OT NO�
4<0WrC1- M i r- RtL ksoz a S LID NO.
MAILING ADDRESS
W T. LID FEE $
TESCP Approved
I -Tq Ave PUBLIC RIGHT OF WAY PER OFFICIAL S'T1IiEET MAP RW Permit Required D
0
Street Use permit Req'd [3
CITY ZIP EXISTING — PROPOSED Inspection Required
rTEI�EPHONE : I a,
:ZA fW W) I I .. , Sidewalk Required 0
REQUIRED DEDICAT ION FT Underground .
ng required 0
NAME
s�Atpts ��)IfTqE�� IZE
LINE.SIZE NO.! TURES PRV R40UIRED z
YES CI
x ADDRESS - Am REMA I RKS
z
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE 1/r13
CITY ZIP TELEPHONE ,v 14-
NAME
-7
ENGINEERING REVIEWED/ ATE
ADDRESS
0
I- V17
C.) 7
C -seems,
cc BY ......... DATE
I" CITY
z ZIP TELEPHONE Lu
0 5
LL
%:
STATE LICENSE NUMBER .... . ..... VARIANCE OR PU SHORELINE OR ADBC", '!'INSPECTION j BOND
CHECKED BY I 11�1� -
REO'D IPOSTED
j W
< PROPERTYTAX AC OUNTPARCELNO. REVIE HEIGHT
C COMPLETE� ',EXEMPT ALLOWED- PROPOSED ALLOWED -1 PROPOSED
ILI
EXP-1- MAI /"0 S
NEW &r'IRESIDENTIAL-t PLUM BING7 ME6H` LOTC9,VER'
AGE REQUIRED SETBACKS (FT;) :'PROPOSED SETBACK
FRO , S (FT.
'ALLOWED `--I5AOP6§1ff1[Y 'FRdNf""§iDE'"REAR NT URSI E'REAR
2"ADDItTION -COMMERCIAL ,C]",COMPLIANCE OR 19"s- 177
-,),, 011�/ z
Jer.11'-"*� 1j_* 7
CHANGE OF'U§E lfo#7
z
PARKING LOT AR A [PLA�eNING WE D`BY /0-
MeREMODEL 0 E
__.E1_SIGN DED'
FENCE ;>
REPAIR [3 GYD4qG CY' S E] 27
ED T)
.046- O� D X F EMARKS
M� DEMOLISH 0 j4tiK OTHER
�GARAGE R
R=NIN
Y3 W
z CARPORT _ALL RENEWAL
R 0
2
(TYPE OF USE, BUSI!��E5S OR ACTIVITY) EXPLAIN:
HECKEDBY1 JTYPEO�PONSTRUQ
Ftlr(Ll �P,(n , C C�n OCCUPANTr
U NUMBER OF CRITICAL GR
N MBER
- ----- REAS
:. AREAf.-
OF DWELLIN A 'SPECIAl!-INSPECTOR; H�A OCCUPANT
o STORIES UNITS NUMBER RE6UIRt6, 97 f rz
.0,YES" .LOAD
DESCRIBE WORK TO BE DONE
I'KUUKES.s INSPEC '_NSPtCTI0N.REQ"D 0
cz - 4444
dej &-yr D`6�4r4'�-_"t'_P_
z1f.
&jj L'J�;
g0A lqew _2_10
?
Icv
��L6ATiQN FEE
. . ..... .. .... .. 6_11 ;4val; 3t u vV,
PLAN CHECK FE
E
LOT SLOPE %
GLAZING'*
BUILDING
PLAN CHECK N0- VESTED DATE PLUMBING
w
MECHANICAL
THIS PERMIT. AUTHORIZES ONLY.�THE,w6RK.NOTED.-THIS,PERMIT C4OyERS_WOfIK
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON'THE PUBILIC
DOMAIN' (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE GRADING/FILL
j
'SEPARATE'PERMISSiON:---'--'-,'-I
STATE SURCHARGE
w PERMIT APPLICATION: 180 DAYS
P
PERMIT LIMIT. 1 YEAR - ROVIDED WORK IS STARTED WITHIN 180 DAYS
G. REVIEW FE Sb
SEE BACK OF P_f?ik_0EFfikffFOR MORE INFORMATION— ES
'APPLICANT, ON BEHALFOFHIS OR HER SPOUSE�� HEIRS. ASSIGNSAND,SUCC t ENG� INSPECTION -FEE
SOR . r, ;� �t,�', � �,. �'r" _� , "
REST, AGREES TOANDEMNIFY DEFENO,AND.HbLD'k4RML�:S���THE;-Cit�Y�10F���"
i��61�DS, WASHINGTON, ITS.6F�Ibl�LS;��M�LOYtE�.A�6AGtNTS I �1`16M-ANYAN
E R LYO
R INDI
ALL CLAIMS FOR DAMAGES &WHAT VE ;NATURE;,ARISING DIRECT INGP GN-r
ECTLW
ECEIPT
FROM THE ISSUANCE OF THIS:PERMIT�, IPSVANCE,OF THIS PPRM!T SHALIL Not PE�t�fr�`
I I P
,jr
DI E'
Q _j to�,,',�, "A ; - �
!DEEMED to MODIFY, WAIVE ORREDUCE ANY,REQUI REMENTOF ANY, Cl 4N 6HECKLDEPOSIT
Y .9 NANC
VISION:��v.
0 NOR LIMIT IN ANY WAY:THE CIT 'SAIJILITYTd:ENF6RCEANYoAbINAN EPR
x
RECEIPT tv'RAR,41
TOTAL AMOUNT DUE I 5b
I E REBY ACKNOWLEDGE �THAT41'HAVE READ, THIS AP.PLICATION; THAT THE'INFORMATIONi!
-AL
GIVEN IS CORRECT, AND -THAT ItAM THE OWNEF3, OR THE DULY, AUTH0131ZED AGENTOF,� At P P L I CATTI 0 N 'AF) P R'OLV
THEOWNER. I AGREE TO,COMPLY,WITH CiTYAN6STATE LAWS RtbyLATiNd,b6NSf46C'!`
,stm�`,i�66'uipermit u
pis appli� ntil signed by the
K AUTHORIZED'THER CALL
TION; AND IN DOiNr,.Tkt woR EBY,�,NO PERSO14.WILL BE
. I I . I lb I 1. 6 ' L " r qmP.LOYEb'�'.,, 1,Building Officji��&��ii/Qr D6p`6iy.`and Fees a�e paid. iiind
ON QFTHE`1�A8PF, �ATI NG, Tor
NSURARC�E� AND RCW 18 �v.. - ;.'
INNIOLATI :r GDE, OIP-:TH'EL STATE'OF WASHINGTON -RE FOR r ,,v�4j�rece PHS acknow edged inispace provided.
�ORKM�,NWCOMPENSATION INSPECTION.:.,
A
�F NAT DAT A�,t�V �1
�I G R WNE—R)DR AGENtj
DATE�AI,GNED:,`,tz`1
P �(425)
0F_
F C RTC
AREAS
UMB
N
, E,�EC
71G RAG�ENT)
20 RELEA P E
_77t-02
A' I7,ENTION
EXT131,
9
2—
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDINGOR STRUCT,
UFIE-UNTIL.�. j
-OR 2
A FINAL INSPECTION HAS BE.EN"'MADE�'�.ND'APPROVAC `ACERTIFW'.;i'
CATE OF I OCCUPANCY HAS'BEEN L G RANTED. UBC SECTi6NA09 .'OLRIIGINAL FILE -YELLOW - INSPECTOR
TAX
vI ,,4, t_PiNK-'b NE� VOLD'- ASSESSOR
5/98
............
Fii� -FT- r�, v i o u Is- SURFACE '-Al C'-'
. ... .. 71
E X IS 111"i G
"A Rl G E 32-0
A S PH.4\ 1.3
Lij
r
PA RKI N G
AREA
N 0 RE T E
,e-,R.:-,TA I N I N:*3
J: WALLS
EXI: BLDG PAD
1015
R-) . Af);�'!Trjrl IS Tf FL
212
it if 9-NDFL
30
EXT DECK
147
PKlP DECK
369
EXT. GARAG'E
1144
PARKING AREA
14,11-4,
DRIVEWAY
12 6
'EXT!''OU.: WALKS
2
C IN (7, C-7A R A G E A P R C N
7 8-
EXIST. iMPEPVIOUS
5365
P RO PO S E- 13 G ROS� S
611
NET
539
L C, T A 15 0 0 C-1. 0
EXIST !NG COVERAGE 1994 * 1 3%
PROPOSED ii P- 2 ---) 6 1.5*/-
TAX PARCEL "t-4K68-006-003-0102
Owwwmmil IS RES
EROSION CONTR'
OL AND
NORTH
GE HEIG-,HT CALCS
A
1053
B
106'25"
c
I O�, 3""
ID
1056
AVE GRADE
105'6.5"
MAX
1,30'. 6-5�'
INSPECTION REQUIRE'D
PFOMSED "'ND FL
A 300
AM ITION
i D E-C, X 1 -,- - I I'l /" . I
14i'$ I I,j \,�
HoI-:-
t7
PROPOSED FIRST FLOOR
-.1)DITIONS' -za 0
J
EXISTING
WALKS
........ -PROPOSED DECK 3&9
4-
ROBERT- M ICHEL HARRIS
23828 - 74 AVE W
425-672-4490 HM
11 418 9 9 11 CELL
19 5 2
1976
1952
I'D 5 2
1 CA 5,-,�
1976
MAY
DEVELOPMENT
CITY OF SERVIC'Es
EDMONDS
m
:--r ss'vo Seveolckrf-P
uwwA PT lool
7� 7
USE
ZONE MIT.
'EDMONDS'.� NUMBER
CITY 0,F";
CONSTRUCTION- .0 ER AP,LICATI.0 OB. ITE/APT #
SU
OWNER NAME /NAME OF BUSINESS ADDRESS'
Ale,
LEGAL DESCRIPTION CHECKI SUBDIVISION NO. LID NO,
Lu MAILING ADDRESS
z A11,4
0 Z38zo PUBLIC Fil H,T:,.OF WAY PER OFFICIAL,STREET MAP. TESCP Approved ylt�_s
CITY
ZIP TELEPHONE NUMBER RW Permit Required ,v/,
REQUIRED DEDICATION Street Use Permit Req'dNJ3
U Inspection Required -/er5 Q_
0-4) M 0 Oil, z1_(9"1Z4q9p : I
NAME PROPOSEO
Sidewa.1k Required IVL� C3 cr
W
PRV REQUIRED
METER SIZE: LINE SIZE
10. OF FIXTURES
YES 13 NO
LOU 'ADDRESS
0
".4 REMARKS
ul
I TELEPHONE NUMBER. W
CITY` z
IA14
Ae 0.5 /1-1 AJ e P L_
z
NAME
V ng
cr ADDRESS
0 ENGINEEPING MEMO DATED EWEDBY
REVI
CITY ZIP NE.'NUMBER
z FIR.E MEMO DATED REVIEWED BY
STATE LICENSE NUMBER EXPIRATION DATE .
SHORELINE#
,.VARIANCE OR CU
Legal Description of Property - include all easements -
',SEPA REV EW
I SIGN AREA HEIGHT
z C9MPLETEL EXEMPT, ALLOWED PROPOSED ALLOWED PROPOSED
X
LL E
LOT COVERAGE REQUiRED,SETBACKS
Lu (7.) PROPOSED SETBACKS (FT.)
ALLOWED I PROPOSED. FRONT:'SIDE 'REAR .. FRONT UR SIDE REAR
_j
-7 X14 IZ3 zz
L' Property
Tax Account LOT AREA PLANNING REVIEW BY
Parcel No. 14: V /11, 1UP
REMARK&
. I . �!� L
NEW
RESID ENT14L
ADDITION COMMERCIAL' COMPLIANCE 6R A )Z_ .
CHANGE'OF USE I
7.
APT.,BLOIG..' .
NPEMODEL -SIGN.
HECKED BY TYPE OF. CONSTRU ION OCCU NT
GRADING , I CODE_ _84N'E_
FENCE
E REPAIR CYDS Ej x -FT).
WOODSTOVE POOL INSPECTOR AREA 'PA
ElDEMOLISH.' INSERT,.'. .'HOT TLIB/SPA REQUIREI OdCU
El D.
LOAD.
13
3ARAGE� RETAINING WALC YES
RENEWAL REMARKS
EJ RPCKE�
z
2 ITYF�E OF Y��.��USII`40P,OR PLA N::�'� PRO.GRES.SINSPECTIONS PER VEIC 168
rL
CRITICAL
uj NUMBER NUMBER OF
DWELLING
6�. AREAS d/.A
NUMBER
STORIES UNITS
itl E
0
DESCRIB WORK TO BE DONE (ATTACH PLOT PLAN) 4C
11%. AD oll _rl 0J fINAL 114SPECTION REOUIRED.
.,,,VALUATION FEE.
PLAN CHECK FEE
jall
yl LDING
G
HEAT SOURCE: I I f, I
%
PLUMBING,
MECHANICAL
Plan.Check.N
This Permit covers work to bb-done on priviite�propertyONLY. GRADINGIFILL
Ariy'constructiog p6',th1;,,,pu,bIlc do.rgaip (curts,, sidewalks,
driveways,"marquees, etb.)'Will ie�uinibeparateLperrnl sion..-
7 a ion. STATE SPRCHARGE�-
Permit A
pplication:.180 Days
STORM DRAINAGE FEE!
Permit'Llmit: 1,Year - Provided Work Is Started Within: 180..Days 50
"behalf of his or. her spouse, heirs, assjgrks an IkNG� INSPEC�IOIN FEE
"Applica"rit,'On
succ . essorS in interedt, agrees tb:lnd6mnil ; del eind and �hold
y
'n harmles's the City 'of Edinonds, Washin t9noits officials,
f '"' '4 L g I . - I
2 employees, and. agents r.om any -and A a! M. ir'darnad.bs of
-whatever nature rising directly or Indirectly f rom, the issuance
a
of this permit. Issuartm'ofthis permit shall not,.be deerged to'.. PLAN CHECK'DEPOSIT
modify, waive or reduce any'.requ remen't f Ord hince
Ox nor limit,ih an e.City's ability 10."q�orran ord:nahce
'I pro TOTAL AMOUNT1DUE
y way th
Aj,.
vision."
I hereby acknowledge that I havelreiW thlsiapplicafloh� WiiIt4he.
ri�give ' ni L a L c o r ieic' t'; an d -T �.�'APPLICATION' APPROVAL
Informatib that) titm,t.e.owner, or t e u y �AT ENT19N.
-.authorized agent of,th6 owner. I agree to.comply
THIS IFERMIT,
Thi licati6n is not: a permit until
itaie-IaWs regulating construct on; aind in doing.'the Work authoriz' AUTHORIZES _ is: app
ed thereby; go person will be ernplo' 3d,ih-violation.-6f th L , ONLY THE signed -by the Building Official or. his/her
e r
Cod6.of the State of Wash I ngtoq�relai Ind to-Workmen!s.C6rri6e'g a.*' WOR * k'NOTIED'. Deputy;,and fees are paid, And receipt.is
tionAss to RCW 18.27.-. - acknowledged in space provided.
INSPECTION
GENT).'� ID�TEz.SIqNEDL'_ DEPARTMENT
OFFICI §IG XRE .?ATE
CITY', 0 F
EDMONDS.
1W
56;—
ELEAS B TE
TO.R:.:�
INSPECTI C
ATTE,NTION':
OR UP" J �i
.IT IS UNLAWFUL'TO USE C Y A BUILDINd::6R,STRUC E
P R� 'ORIGINAL File Y E 6VV inql6p Or
UNTIL A FINAL )NSPECTION HAS BEEN MA'DE':AND�;.A'�ROV '77T. P02
� I . OCCUL Cy HA 120' �: . . LL Ct
A . CERTIFICATIV OF PAN S BEEN GRANTED.. UBC:.,
SECTION 109 'PINK Own er . G OLD . Assessor
102-87
6
L.Li
Ljj
LA-
0
RECEIVED
JUL 2 7 1999
DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
1 T i N G
GAF G E 3'
AS'PHALT
i Ij
PA R i(I N! G
A R EA
!LtL4L4 0
ii. �CNCRETIE
F !E-1 -A I f, I I W.3
W ALI
3 q,
K
7
C'
Ex I s W..:,
WALKS --A
0(0-
m
FIE
EXT BLDt,-FIAD
AiDiDITION !STFL
I -l-) . 1952
212 P(4 1)
N D L
30
EXT D Er,
7
)2
PKIP D EC. K
369
1+
E X CA R A ',-,E
I 1 44
1976
PA-F?Klr-,Ir-, AINIFA
14
19 5 12-1
DRIVEWAY
126(',�
19 5 2
EXT WALKS,
7
195").
C 0 N C GA R A G; E A PR C N
78
1976
EXI.ST. IMPERVIOUS
3 6 5
P RO PO Sc ED It G ROS S
611
NET
539
I-C"T* AIRCE-A\ .. 15000 0
EXIST ING) COVERAGE 1994
PROPOSED if 2 2 3 6 15
'TAX PARCEL 'o'489-8-006-00-3-0102
HEIGHT CALCS
A 10 �),3
B 106'2.5"
C I O-� 3"
NORTH> D 105'6"
AVE GRADE 105'6,5"
MAX 130'615r'
APPROVED BY PLANNING
PRMYQ!�F'D 2ND RL.
4YTTION' _;o 0 _ � � � h/l&
V
F �7,El' FIRST FLOOr
-PROPOSED DECK 31-9
ROBERT-MICHEL HARRIS
23828 - 74 AVE W
425-6- ' 72-4490, HM
it 418 9911 CELL
i'VE
5
Diwovp, pr 100
WA14�1 Cc Ou -1
41,Dl?,f1l64 4
ws
F C-' T
T H 4 v E
-7!4 A va W.
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
9 0 o 9
"D-URMIT
=4111z
sor R L. " I E
Permit Number.
Issue Date:
A. Address or Vicinity of Construction: 23828 74 Avenue West (9406863)
B. Type of Work (be specific): TnAtall New Service
C. Contractor: -Washington Natural Gas 8ompany
MailingAddress: 815 Merver qt-rinipt,
State License #: Seattle WA 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 994-997A
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
ip
E. F] Commercial Subdivision 0 City Project []J Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family E] Single Family E] Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: 0 Yes [JNo G. Size of Cut: x H. Chargc�
APPLICANT TO READ AN4DJN
INDEMNITY. Applicant understands and by his signature to this application, agrees to h t 'City OfEimonds harmlg 81 damages, or
, 1 4 8 r I' I
claims of any kind or description whatsoever, foreseen or unforeseen, that may be-fifa—de t the City of Edmonds,�oky oi)f gis departments or
employees, including or not limited to the defense ofany legalproceedings including de ens as s, and attorney fees by rjason)ofgr7tif� thispermit.
I
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATIOIVPPE��.WI�L BEHELD UNTIL TaFFINAI I
,STREET PATCH
.. �K'
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
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 clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required �y theCity Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihaue read the aboue statements and understand thepermit requirements and thepink copyof thepermit will be
auailable on site at all times for inspection purposes.
Signature: — A- �/ 1 . I f 7 . A Date: December 29, 1993
(Cdn'O&'610 r jr'AgeW 0' '
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
TOTALFEE: Z��- 420 64Z&
COMMENTS:. —RECEIPT FEE:
DATE: ISSUED BY:
'4
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE EnArg. Div. 1991
FIELD INSPECTION NOTES (Fund 111 Route copy to Street Dept.)
Comments:
I Diagram 1:
CONTRACTOR CALLED FOR INSPECTION El YES NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
MWhkqjton
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Addendum to City of Edmonds
Right of Way
Permit Applicaiion
Submitted by: MITCHELL S.-LANKFORD
Engineering Aide
J, c �) r" 'Washington Natural Gas
# -'-521-�5246
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F15 Mcrccr St. Mo. Box 1969). ScAnk. �'.,A 98i 11 (206) 622-6- 7
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CITY OF EDMONDS
COMMUNITY SERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION PERMITETN"EET ME,
A. * Owner: Washington Natural Gas Company ' B. *Contractor:
Ngn
Ig kercdr Street
Mailing Address
—Seattle WA' 98111
'City State Zip
Permit No.
Issue Date -9
'Name
Mailing Address
City State. zipv,',
State License Number Telephone Number
C.- Address or Vicinity of Construction: .23828 74 Avenue West L 89.03684 .006
Type of Work to be Done: Repair Leak
D. 0 Work in Connection With: El Sub or Plat
0 Commercial
E� 0 Pavement Cut: R1 Y El N F. 0 Si2
Ij
APPLICANT TO READ AND SIGN
0 SingIpwiIiily 0 City Projects
El Multifamily EX Utility
of Cut: 2 X .4
INDEMNITY: Applicant understands and by his signature to this applicationj agrees to hold the City of Edmonds
harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or uhforseen., that may
be, made against the City of Edmonds, or any of its departments qr-,ernployees, . including or hot limited to: the defense
of any legal proceedings including defens . e costs, court costs, and aHotrf�? fe40y reason of granting this permit. -
THE CONTRACTOR JS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION. AND ACCEPTANCE OF THE WORK.
Estimated restoration fee's will be held until the final street patch is completed by City forces, at which time a debit or credit will be
processedfor issuance to the Applicant.
• A 24 hour notice is required for inspection;. Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City'Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
All street -cut ditches must be patched with asphalt. or City approved material prior to end, of working day;
NO EXCEPTIONS.
I understand the.above and that this permit must be available at the job site for inspection purposes at all times.
Signature: A4 a AAA Z -------- Date.:—. August 31, 1990
IV.—
� Owner or Contractor,
This Permit Must be. Posted at the Job Site For. Inspection Purposes .
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: RW PERMITFEE: tSO _XC) 1e6T__ _Eskt_�
Time Authorized: Void after 60 days. Restoration Fee:
47 Special Conditions: NA Receipt No.':— #
Fund I I I Fee:
Street Cut Dimensions:
RELEASED B*Y: ChO.-aZ Date 0�lLlq-() INSPECTED BY
NO WORK TO BEGIN PRIOR TO'PERMIT ISSUANCE
Eng. Div. March 1989
V, .1:
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Depf.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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APPLICATION CARD No . ........................
for
City of Edmonds SIDDE SEWER PERMT
The . . I OUTSIDE El INSIDE REPAIRS EASEMENT No . ......................................
OWNER ................. 1. ........ AZ ..................................... CONTRACTOR .......... Ct)-11.77 T No.
------------------ PERMI
ur
-&qq+Effi
............................... ................. AVENUE LOT N.
HOUSE No. ........ .............
0 4!-L -f-AgeULOCK No . ...............................................
NAME ADD. C ... . . ............................................................
------------------- . .... .....
Date
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ ................................... .........
SEWER WORK ORDER ISSUED ...........................
Approved:
DATE By ...............
CITTOF
-;EDMONDS 'Cal
4 l PRospect..6. i167 24.hours (plus
Saturday, -Sup4ayr and 0
CITY -HA . L.L.7.-W. AT ER -SE . W . 8R: DEPART' Inspection.
-110lidays):15e..
A MENT fore Work is riody for'
IDE
W,�fERMIT
a
ADDRESS
OWNER 0
t
CONTRACTOR
-Peiniissi
On is granted
With Cit�, Sewers in. for to REPA14� or:C6�j , jqh
lictor4neb. W1 ap�ff�ajti' d gqviernin CT as d
on on n e.sewer
or, ihances.
ATTENTION IS CALLED TO THE
FOL.LOWING
NOTE No. 1-�-The o
wneis of the Property" may obtain a Perin I it to I construct, sewe
must be employed :t�.-construct -, in a r inside
side. sewei street 0 not. Cov , Property2 line. A
. .11 rea. D er.,a licensed Side -Sewer-Contract6j,
NOTE No.'2—Obtain. full i my POitiorf.of sewer before A
T-formation regarding, Ordinance i,t.has been,, nsfi6eted.
VOTENo..3— 11.16.030 and Regulation ': ` -1 ' . I I
s governing side
Top,of� side sewermust have'.at least 30 inches sewers when� You get --permit
2%.,No-.bends:in grade sha,p t will be coverage t_ Property line and 12 imbes insiq�
er ban 1/s
permitted: Pr9pert ine; minirnum grade of
Y
NOTE No. 4�Trenches in street must be water settl I q,arid surface of street restore
failure due�'jo improper work which ma
d to original cothlit! n.
�y develop within one Year of completion. 0 iContraPtors shall be responsible for
-:N01TE No. 5—It is. unlawful � to alter or do any other' work than is provided for
Purtenances exqePt-to t In th
insert he PiPe'int6 the wye. e permit, or to do: anY'work on the' rna
in sewer or its ap-