24129 78TH PL W.PDF111111111111
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24129 78TH PL W
CITY OF EDMONDS
8 9 0 1
Address of Construction:
Property Legal Description (Include all easiaments):
L6�_ 4\:_ �4 'El�'
I on-�
Owner and/or Contractor: -i�� J I,,,_ P(
Pe I -In
SIDE SEWER rERMIT
State License No. Building Permit No.
CXSingle Family
El Multi -Family (No. of Units—)
El Commercial
0 Public
PERMIT �.12 9128,
Invasion into City Right-of-Way:O-No 2'-Yes
RW Construction Permit No. . . ......
VIA BALLING;ER
LL
Cross other Private Property: t!('No 13 Yed
LIFT STATION
r
Attach legal clescription and copy of rec crad-eas
t" I
A '� H llf_�944AA 0,"'A� L
I certify tl�atlllave reZ"A`n'd'YKaI�co`mpYy with all city requirements Date
as indicated on the back of the Permit Card.
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION
OFFICE USE ONLY
FOR INSPECTION CALL 771-32e2-, PUBLIC WORKS DEPT.
'6"� =3,1—
Permit Fee: Issued By 4",
Trunk Charge: Date Issued: _z
Assessment Fee: ReceiptNo.:_
Lid No.:
Partial Inspection:
Comments
Date -Initial
Reason Rejected: 4 Date —Initial
Final Inspection Approved: Datea__0/_(" Initialac
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy; File Green Copy: Inspector Buff Copy: Applicant
Revised 3!90
The City of Edmonds Side Sewer Drawing EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION [:] REPAIRS X LID NO . .................. . ASMT. NO
OWNER ....................................... ........................................................ CONTRACTOR ----- 2 L Phim,6i
................................ ��J) ..................................... PERMIT NO . ..... �Za -00-
JOB ADDRESS .......... a .... LIJ ... ....... ......... 7.. � ............................ ................ LEGAL DESCRIPTION: LOT NO . .............................. ------- BLOCK NO. ---------------------------
.................................................................................................................................................... ..........
Iq
.jme.
NAME OF ADDITION .......... .... . ...............
0
Approved:
—3
PWW-Ml-1 1175 (REV-1 1/78) DATE .......
.......................
....... By .. .......................................
------ --------
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of'Edmonds does not warrant the
accuracy of anything set for ' th on these
map(s). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
the -map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
emp-loyees or officers ,-)hall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
EASEMENT No . .........................................
.3
MEET NEW CONSTRUCTION E] REPAIRS
0(6
- X
A CONTRACTOP ERMIT No . ............ .......
OWNER ....... ...... -XX ------------------------------
ADDRESS
LEGAL DESCRIPTION: LOT No. ... ....... BLOCK No, ......... ....... ......
.......... .. ..... -z ...... .......... --- /I ................... --- ...............
TIO
NAME OF ADDI
... .... ...
(Y
........ .. .
<
. ........ . ..
Approved:
...........
DATE ........... By . ........ ..
4-
-SE -:,RE
slb&:� i WMER RMIT
Fi F M Go iWD S:
_7
TM
Sk��,ER�PEPA
0
�A C 11 1 V:Jor, sldet'..sawer_:�Ir4ections- isii�I,�011F covering any� p.or Ion,
-InsPectiom wi
e h I ii i"' I h o r s� if t c, r I a 'ins ecti
F�CONSTRUCT ON'
ADDRESSPL
0 C Vn OM.. 0
..........
............................................................
. ..................
PROPEIOA7,.]�i6� �q)ESCR1P'11_ON`_..* .................... ...... ................
.......... . .
........................ ......................................
. .. ....
....................... ......................................... .............................. .......
.............. ........................... .............. .
........................................................................
-Nb/i ',-B
. . ...................... ................ .
.... .......... -OWNER A OR UILDER....
................... .................................. ........ ....... ......
..........
INTRACTORI'Sr
...............................................................................
............ . .................. ............................
a
ZA t on'. of a�-side. sewe to: t )Sarflt.�rY -,.�e�ver
idiritisagranW V forrell ;and/or connec i r the: �1
P" b: .......
or*d* lane' Y
C4..bf kdmohifs' U es.
'K Z
TNTIO I CA- LED��TO-THE FOLLOWINq:
h e rs qji,�t h e,.p ro �c rt'y ni a 0
*No
E, :-i—The ow
qn, y obtain 'a -*permit to�constrbct 'sewer, ins e. property �IM6. . A -licensed Side Sewer C�ntiact r must, be..cmpl6y d to--corfstruct
r p on
�sli:16.,s7ewer,in:street area Do:not cover a ny portion of'sewer before' it --has� been Inspected
'�il work 'perfcr
-NOTE. ' N c, 2— med in city r,lgh t.- of -way requires aw-lnv�.ion- 61' �ight- -W-ay.-Permit obtaln-��Je.f�rorn the clty*
En gi neer's- office.
of*
9T��'1�o:-3— kYtiiin,'f'uli'lniorma:tion�regar�igg,.Ordinance�ll'.16:039.andtj�egulal.iopg:,gn�erni�' sl�e`se��er's�' 6
_O g w en,you, gct,,.p9ri,
"N�,. 4 ' ;� "1 .4 -ler
-�NOTF� qp'jo 'sift..'se mus't`-ha.Ve�*.at leasV30 inches, Cove r*44e'a.Cpr6 k3r, ]I
" � .:.— ��. P� ne and 12 linche_ P o
'sharper,than. 'A will,,be,pen-Aitted. -21 -No., end In.,grade
tjIn m I u M: g.rade of a
NO 'Tic
TE �Nrj:.,&... ncfi�i,iri street' must be water settled -and � surface of*street.restore(I to, original' condition. Contractors
-Work- shall' be responsible' for -faJIur6,due*,*to, im
pr.per.
wbicfi.miiy develoI5 within.rine year of completion*
I�YT E). No- 6-�—It. s u, 11,
I :unlawf, to alter oi d6 any other, work I han-.is- provided for in the permit, orto do a ny work !on the mail
-the
sert, -.pipelAto the wye., ri. sewer or its appurtenances except to, in-,
�,DISAPPR0'VED-'�,'*.;[*]' Date*:
....... .................... By
7 2--
te. . ....... ...... ......
Da
W
.......... .. .
B
Y
............................................
...................................................
.11, 1 S..
......................................
......... .................. . .....................
................................ .
.......................................... ........ ......... ... .... ................. ........................... ......................
... ......
..... . .. ... ..... ...
C
__�;Afox.k.�V&-mIff 0 A'6,,,SAJ�V'�Be Z1:�gned�,+B'y+',()`wner of!Firm,�P.,erfoilin.in& onstruct on�PR1OR:Tb,A'q c- i-+-'++'
les or jnspeii�i'n
e i.
3,
. . . . . . . . . . . . . . . . . . . .
. ...... ..... ............... herebyz-�c6rtify thd6thetside, sewhr. instal lati6n- c- it 't6diu-n"der" h'%'
lCon _'.Fjrni6
(O.wnerP on ruc
C ction-)k , ; , Z.'.: � - + _'. .. �-, i., I- , — + 14_!�!�.-Pe.�-It,�
effcim!4 , onstru t
i n'g'-,;'o I- d ft i a I i 6�
6idfi
of:;Edmonds:
4
Dated
AF
U
W. B 1� F 6A �E di' I W.a'- ieil'r `4C�a' e�v r
'Y
r `4 _4'
'S W1. 3,4:CY---
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:Umbn S
PERMIT, COUNTER
Critica-l-Are s Chec i
I': a ki A-
%9
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 p urpose of the Checklist is to enable
City staff to determine whether any
poiential Critical Areas are or may be
present on the subject property. The
information needed to complete the
Checklist should be easily available
from o,bservations 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,.ands-ubniitittoth�City.,ni6,cit'',.-,i
will revie - the checklist,- mak�
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
infor*mation (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/ Applicant: Applicant Representative:
Z—
Name Name
Street Address
0 AA4 SA
Ci State, Z11P Phone
Signature
4 f Date
Street Address
City, State, ZIP
Signature
Phone
Date
CA FIM46
Area''s'Chekkfist....
Crid6l
IX.
- --------------------------------
rma
sit6jiff .(soil /hydrology/veg6taftion)
tion, s/top6g*raphy
on: 7c&S 4J
2
Pr !rty T
op( cco tint Miinber.
':
�, -!
3.
proximate Site Size (acres or square feet)
4.
Is this site currently developed? _!�/yes; no.
If yes; how is site developed? Z� a,74 e V
5.
Dekribe 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 ho' rizontal distance of 33 to 66-feet).
— Steep: grades of greater than 30% present on site (a vertical rise of 10-fe et 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: Approx. Depth:
What season(s) of the year?
8. Site is in'the floodway, floodplain of a water course.
9. Site conta ms a c e k an area where water flows across the grounds surface? Flows are
year-round? Flows are seasonal? — (What time of year?
10. Site is primarily: forested meadow -shrubs ndxed
urban landscaped (lawn,shrubs etc) &a O'n
11. Obvious wetland is present on site:
For City Staff Use Ordy
1. Site* :Zoned?
2. SCS mapped soil type(s)? 4�, a
3. Wetland m'ventory or C.A. map indicates wetland present o
on site?
4. Critical Areas inventory or C.A. map indicates Critical Area on site7
5. Site.wilhin designated earth subsidence landslide hazard area?
Site designitedon the Environmentally Sensitive Areas Map7
DETERMINAMON
^couchUoc Rev 02/11/97