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304 9TH AVE S
'E SME'ff- PERMIT'
YV-_ OF �TVMOMOS.
NVATER-SEW F;AiefM-ENT`J-%
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o1i",
_40
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ChlICT76-1107'. foi.;sIde, -de%�,er' ins eo rlhg� any portion _'q�.Ahe' con�stru ti
p ons, . j1EFORE-,coVe 0 0
thspeiction WIII be' provided' within'-'�,V'hciurs,-i:fter7,request.'� �iwsat_ �-Sun:OF�Ii6llday inspect ons..
I .............. ......
ON ... . ...............
ONm,6t.-CONSTRU1,014' .................... ............
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.,,�P,90r.ERTY�!L�EaA�L".'DES*C-RIP-TION ..................... ................................................... ...................... .................................. ...... .....................................
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............. ............. ........ ........................ ................................
. .......... ............................ .......... .......... ONVNEWANP�,OR, BUILDER-...�..� .......... ........................ ...... :-:� . ......................................................... ...... ........
-.ONTRA�OT-OWS.-NAME's&�-A�DDRkss..:'....:..�� .............. ................................. ...... ...................... ............ ................. .....................
W
er
,-e'6riydg§ioil�.1s�granted".-.' L for repair and/or'.�monile�etiohof a si to,j e7eify, ary, -sew,
I 11t ., -1 � 3 * - h
4 ............................................ ........
"'I.S _telin�� Jf',aCtCjjdajjb6r *ith- City'�df Edmonds..ordinances.
"Y's
IS CA-LLED TO'THE- FOLLOWING:
7 Nb., I- .'The,�oWners of,fhe:%propqrt�_, may,bbt�in�a, pern�it` t A,Iic-hseA,'Sid . o'Sewe'r 6ntr�ctor m* st�;66,;�'��n�loy'�dl.tc;-,�cons , truct,
,,NdTE _9�:constructl�sc� lind:
of.sewei.Vefore ii:'hai; been lnsp�cted.:
-area., Do not cover aiiy- p6rti6n
side. iewer:f� street
it
E`No--2'—'AII- ork,.perforniedlin city:rlght-of-way requires',an..1 1of..Iu�hVrof-Way`P' r bbtainable:'from the-City'Engineier' office..
w nva�sio& c M S.
'din :full Information' regard I 6g Ordinance: 11.16.0 0 an& is'aN;,ors,
.�.keTE,No.',3— i ' c ou'g6t permit:' I
Ob 3 'Ilegul'atlo�nsl, g6v r�ln�'fdde w h c n %'.y" 7. W
age:i
6TE� No. r..�n `ihcfios� -cover. tt�.w4er�y, line !Ln"1� iiiside prpp�er�y Aine*: _'Minimurh�' gradb,,of. 2i%.. -N�oL'bends,,�in Igrad
'N �,Topvo V. side sewe ust.1have.at least*,36 d Anfilies
sharper than Ih,will--be.permitted...
�NOTE',No I i �5--,Trench`esln�,,street- 'Must: be wat�er'settled and, iiurface- of-'!;tre ' e ' t icA , or�d, �t�.'orlgln'al- cb'n�lflon.. Confrix&;rs' '.hall, bd: iresponsiblei.,for fallur'e;,due to -,,Impr6pei-.
-work, which-fmay develop. within one -year of- completion.
NOTE, No, (i�—ICIS'u�law'f.L,tq Aler -or'do�dny.;other'woNt Ahan. Is proyide&.16r, ln-�.' he.'permlt,,)�o�40*�do.fkni. �work--orixhe_-main s6ver;or, its dppurtenances�,bx6e_'
i�t& the �pt to,inr
sort, the -pipe �Wyc
VER-0, - Dat( ...; ... .. .............. .-7 .......... ......... /,By'- ....'D te ........................ By-
4."DISAPPRO y elDate.._ ........................... a . ..........
,PPRO,V.,E
.......... . .
...................
....... -:By
Remarks: .. ............... .......... ........................... ............................ ........ ........ ....................... .. .......... ......................
........... ............................................ ......... ....... ............. ...... ........ ...... ................................
............. A ... ...... ..................
!BOTH -PIP
.............
V:�4
(Ownep/.
ledt- 'ac
s,lnstal. d
-."dpies-, Sj�,B, Ow er�of Fi'tlii,.�Performing�,,t.C6nstruction- �PRIOR;To;,Req�e�t.F.,6i�,I.h��e�tion
e Signe&-By . n
b` -c
. ............... 'd
;.. , , —2' lat; ctedi�uiider,'-.thistpermit':'.
.......... ....................... ............... . :,-,.here y;., ertify thatthe:si a-sewer;instal Jow-constru
of,-Edinonds;
anc, governing,or inan
ontracting, Firm��Performing:-.Ponstruction)�,,
7,
D" '..;day, �K..'. ... . . ........ ....... ......
P,0� its. z
ifffor". ;%�ater El Te
tee BEFORR�yowd i3m 1eph6n6f,,E),-: ... �ver,
STREET FILE
CITY OF EDMONDS LARRY S. NAUGHTEN
MAYOR
DEPARTMENT OF PUBLIC WORKS (206) 771-3202
Edmonds, Washington 98020
Administration — 250 - 5th Avenue North Maintenance & Operations — 200 Dayton Street
April 5, 1985
Mr. John Cheney
304-9th Ave. S.
Edmonds, WA 98020
Dear Mr. Cheney:
SUBJECT: CROSS CONNECTION/IRRIGATION SYSTEMS
An irrigation system located on your property may be
in violation of State of Washington and City of Edmonds
ordinances related to backflow prevention. To protect the
potable, or drinking water supply, an approved backflow
device is mand�tory on all irrigation systems.
Please call the Water Department Cross Connection
Inspector, Lee Willeiksen, at 771-3202, extension 294,
for information -or an appointment for inspection of your
irrigation system.
Requirements to meet State and City Codes need to be
completed within thirty days (30) from receipt of this
notification.
LW/ml
Sincerely,
PR S_I_`E� - I R �EN A
Water/Sewer Division Supervisor
WILLEIKSEN' DT MARCH DT
AFFLWAVON
for
The city of Edm
SIDE SEWER PXBMT
tv, NEW CONSTRUCTION REPAIRS 0
? /,2 0
Owmm ..... cl-p . . .........
ADDRims .... 342.9e ................ ....... .. Olf
0
a
]MAZZ31EITr No . ....................
CONTRACTOR
............ PER31IT No.
LEGAL DESCRIPTION: LOT No. lzp:;k� ------ A/ ...................... BLOCK No - ----- 2-,.< . . . ....................
60f-d---�
I
L T
_T, �V_
City of Edmonds
ET F16Y-:G
HT -OF -WAY CONSTRUCTION
PERMIT
Permit Number:
""3 1 ssue Date: 15;�_.19
A. Address or Vicinity of Construction: 304 9 AV. S.
B. Type of Work (be specific): Install New Service
19 9 0 - �19 C�
C. Contractor: —Washington Nat'l. rag rn. Contact: Frank Ru ;an
Mailing Address: 815 Mercer St.Seattle, Wn. Phone: 224-2278
State License #: 98111 Liability Insurance"' Bond:$
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. F-1 Commercial 0 Subdivision EJ City Project [j] Utility (PUD, GTE, WNG,' CABLE, WATER)
f_� Multi -Family El Single Family F1 Other
INSPECTOR: INSPECTOR: WL'%Vol
F. Pavement or Concrete Cut 43Wes E]No G.. Size of Cut:(3) 2 x 4@Wtr. H. Charle $
Gas & Pay.
APPLICANT TO REA, A SIGN
INDEMNITY. Applicant understands and by his sig nature to this application, ag hold the City of Edmonds hat Sft j damages, or
Z'—�nst the City of Edmonds 2
0 t-'
claims of any kind or description whatsoever, foreseen or unforeen, that may be m or 21of i2deptJen'ts or employ-
ees, including or not limited to the defense of any legal proceedings in� I luding defense, cosis,,3nd a f ukneyfees by reason of
granting this pet.mit.,
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK. ES77MA7ED RESTORA77ON FEES WILL Bkhi�tN77L THE FINAL STREET AZTCHIS-C6M_�LETED BY
I I I ..
CITYFORCES, ATWHICH TIMEA DEBITOR CREDITWILL BE PROCESSED FORISSUANCE TO THEAPPLICANT.
Construction drawing of.proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Department
Work is to be inspected during progress and at completion. '15fil-02W
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.
J. All street cut ditches shall be patched with asphalt or.City approved- material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statement s and understand the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signature: Date: Jan. 28, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
PRO VE D B Y RIGHT: OF WAY,: DEPOSIT:,.;.
.. . . .. ..... ..... .... .
TIME. AUTHORIZED: VOID AFTER A DAYS DISRUPTION FEE/FUND 1.11:_
VATE: . . . .. ..... ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
o D
FIELD INSPECTION NOTES (Fund I I I - R6te copy t Street., ept.)
Comments:
I Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. L)iv.,Ju
'V S
WNG to window
Water main depth
nown
C71! � -1
11 gas main
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: Rjr gAp
- �D h,LL_ApD
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager 9W-,(,BG
Uri A&C -n) � el
\/r4' 1-15 IOLM L4 4E�
-rD -1 P-A FFI c
815 Mcmer St. (PO. Box 1869). Seattle, WA 98111 (206) 622-6767
-w-
water
-9-
gas -
-SS-
sewer
-e-
water hydraLnt
0
water valve
, )q
CA FILE NO. qO —/ '7 -7 1
Critical Areas Checklist
----------------- --------------------------------------------
Site Information (soil s/topography/hydrol o gy/vegetati on)
1. Site Address/Location: 3,t i q -19,1�, 1W,< S-
2. Property Tax Account Number: �:YqZ 07-1 OZ-0 OD
3. Approximate Site Size (acres or square feet): 00 0
4. Is this site currently developed? yes; — no
If yes; how is site developed? 6V q-,YL "o, t(zt V 5-e-
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 IS% (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 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 I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):_
6. Site contains areas of year-round standing water: jK/0 ; Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway AJ& floodplain 1U0 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? /Al/a Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) L--
11. Obvious wetland is present on site: AJ 0
---------------- — ----------------------- ----------- *For City Staff Use Only ---- --------------------------------------------------
'8*6 1 Z ned!
I IS 0
SCS mapped soil type(s)l 5
:3'* Wetland inventory or C.A. map indicates wetland present on site? /4
or C.A. map indicates Critical Area on site?
4. Critical Areas inventory
:'5. Site within designated earth subsidence. landslide hazard area?
Sitedes - ignat'e'd on the . Environmentally Sensitive Areas Map? A/b,
DETERMINATION
^ca—chk.doc; Rev 10/03/97
City of Edmonds
-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 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).
J .
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and s u*bmit 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 fonn to assist City staff in finding and
locating the specific piece of property described on
this fonn. 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 Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
M-44 NA-6, M AJS-a tJ
Name
-3,6 Y-
Street Address
city State Zip
f-f L 4�- -7 ') L C k I �
Telephone
Signat��e
Date
c:recepflonNjana\cac1.doc
Applicant Representative:
Name
Street Address
City State Zi P
Telephone
Signature
Date
(over)
Mr. Gary Haakenson
304 9th Avenue South
Edmonds, WA 98020
Subject:
Dear Applicant:
CITY OF EDMONDS BARBARA FAHEY
MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 FAX (425) 771-0221
COMMUNITY SERVICES DEPARTMENT
Pu blic Works e Planning/Building e Parks and Recreation 9 Engineering e Wastewater Treatment Plant
June 26, 1998
Determination regarding Critical Areas Checklist # 98-177
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 MAYNEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIS OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
mo, You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL 40.
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Enc: Determination
* Architectural Design Board
C:ReceptIonUana\CRLTR.doc
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development pennit applications.
Thank you.
Sharla Graham
Acting Planning Secretary
a Incorporated August 11, 1890 *
Sister Cities International — Hekinan, Japan
City of. Edmonds.
-OF -WAY CONSTRUCTION
RIGHT
PE11MIT Permit Number.
I[ssue Date:
A. Address or Vicinity of Construction: 304 9th Ave South
/,q B. Type of Work (be specific): Remove concrete patch 'ar ound
pola to install now underground drop
A
C. Contractor: bhambeits/Superior Contact: lom Anderson
MailingAddress: 1QQ W nnvi-nn 89 1 Phone: 275-750A
State License�, I #: SUPERC_*CIQ1Qa Liability Insurance: Bond:$
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. Commercial F] Subdivision 0 City�project )(jd Utility (PUD, GTE, WN(j( CABL
�./, WATER)
Multi -Family E] Single Family n Other
INSPECTOR: INSPECTOR: 6W
F. Pavement or Concrete Cut x:p Yes 0No G. Size of x 2 H. Chargq-'s
APPLICANT TO REAWAND-SIGN z
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims �fany
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 proceedin g-s including defense costs and atiorneyfees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAi 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 sets of construction drawings of proposed work required with permit application.
A 24 hour notice is required for inspection. Please call the Engineering Division, 771-0220. 21A
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 and the pink copy of the permit will be
available on site at all timesfor inspection purposes.
Signature: Date:
-TContractor or Agent) 1
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: W
TIME AUTHORIZED: VOID AFTER NotM, so DAYS
RIGHT OF WAY FEE:
DISRUPTION FEE/FUND I 11:
SPECIAL CONDITIONS: pJ Ar RESTORATION FEE:
T OTAL FEE:
RECEIPT NO.:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997