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510 12TH AVE N
STREET FILE
*90-19'4
City of Edmonds
Critical Areas C'hecklist
The Critical Arms Checklist c'
this f ontained on
orm is to be filled out by any Person
PrVaring a Development permit
Application for the City of E'dinonds prior
tO hisfilcr submittal of a development permit
to the city.
The Purpose Of the ChccJdist is to enable
CitYstaff to determine whether anY potential
Critical Areas are or may be present on the
subjea property. The information needed to
Complete the Checklist should be easily
available fi-ornobservations of the site or
data available at City Hall (Critical Areas
inventories, maps, or soil surveys).
An aPplicant. or his&cr representative
', must
fill out the chocuist, sign and date it, and
submit it to the Cily. The City win review
the chceldist, make a precursory site visi4
and make a daermimfion of the subsequent
StePs U===Y to complete a development
Permit application.
With a signed copy of th-, forn:,. the
Is
applicant should also submit a vicinity map
of the pareelWith enou
.9h debuil dw City
staff can find and identify the subject
parccl(s)- In addition. the applicant is
encouraged to include any other pertinent
information or sttidics 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:
Name
Tide ------------
C� 10 A.,
Street Address
11�, �7YP ����Z I �-3
CitYV. State, ZIP . Phone
Signature Date
Applicant Representative:
r o (- e- L --I� ri C��p
Name
Gro
Title i�i�
7 q t9 -7
Street Address
Edmovxjs IJA 966,31- 47,1-03�,
City, State, ZIP
Phone
Signature Date
Critical Areas Checklist'
Site Information
Project Name.- - h -,I k (- r r)-4 &- a-t) -- - - Permit Number
Site Location: 5 10 11*4 A VE A] Property Tax Account Number. 536-16-6000,067-000--
Approximate Site Size (acres or square feet): 13 T,2-
Have you filled out a Critical Areas Checklist for a project on this site before?
General Site Conditions
1. Has the site been cleared or logged? Date of most recent'action: .
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)?
3. Describ e the general site topography. Check all that apply.
&,Jb-`h�61AvA
less than 5 feet elevation change over enlare site. baw
V
Rolling: slopes on site generally less than 15% (a vertical rise of 110 feet r a
horizontal distance of 66 feet-)
X1, )Mlly.- slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10 feet of horizontal distance.)
Steep: grades of greater than 301/o present on site.
Comments
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9 0
�Gity of Edmonds
RIGHT-OF-WAY CONSTRUCTION 1�
P"" IT Permit Number. . a4�r
STREET FILE'"
Issue Date:
& —
A. Address or Vicinity of Construction: 91 19 N. (9315137)
B. Type of Work (be specific): Install New 4Z*gar31JCP
C. Contractor: Washington Nntliral r_q, rn-
MailingAddress: 815 Mercer St-Seatt-1A,Wn
State License #: 98111
D. Building Permit # (if applicable):
Contact: Frj�k Swan
Phone: 224-2278
Liability Insurance: Bond:
Side Sewer Permit # (if applicable):
E. EJ Commercial E] Subdivision El City Project RWtility (PUD, GTE, WNG,' CABLE, WATER)
F1 Multi-Farnily [:] Single Family EJ Other
INSPECTOR: INSPECTOR: JA_
F. Pavement or Concrete Cut: &Yes []No G. Size of Cut: 9 x 4 ri, ts@ H- Chargq�,$
Water 0 Paving
-WSIGN
APPLICANT TO READ AN
INDEMNITY: Applicant understands and by his signature to this application, agrees I theCi ofEdmonds harmLess from iq damages,or
claims o� any kind or description whatsoever, foreseen or unforeseen, that may be the City of Edmon6;Wi qny—of.7t
Z��,�nents or
V;b-fgrantingt spermit.
employees, including or not limited to the defense ofany legalproceedings including d� co s� �nd attorney fees by e._.
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 RESTORATIOXTEES WILL BE HELD ONTIL TH93FINALSTREET PATCH
IS COMPLETED BY CITYFORCES, AT WHICH TIMEA DEBIT OR C . REDIT WILL BE PRO I CE9SED FOR ISSLIANCE 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.
StreA. 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 ditches shall be patched with asphalt or City approved material, prior , to the end of the working day;
NO EXCEPTIONS.
Ihave readthe abovestat�ments and understandthepermitrequireMents andthepink copyof thepermit willbe
ava.ilab,le on site at all times for inspectio I urposes.
Date:
Signature: .-Agil 28,- 1993
(Contractor or Ak�ni)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED4V:,
TIME AUTH I ORIZED: VOID AFTER -7 10 13DAYS
SPECIAL COND ITIONS:
COMMENTS:.
DATE:
RIGHT, OF,WAY DEPOSIT
DISRUPTION FEE/FUND Ill:
RESTORATION FEE:
PERMIT FEE: � &JI-) �(-42-06
61 �—
TOTAL FEE:
RECEIPT FEE:
ISSUMBY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
f Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund 111 Route copy to Street Debt.)..
Comments:
I Diagram:
4
CONTRACTOR CALLED FOR INSPECTION YES NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
'I I Addendum to : City of Edmonds
Right of Way
Permit Application
b : Guyla Connors
y
Engineering Aide
Washington Natural Gas
521-5248
,SIO Iz 4blj. Q
S t E3 t Z77
C2-x4) CILk_
WNG to window
Water main de
unknown 44A"-�
gas main
-w-
water
-9-
gas .
-ss-
sewer
-&-
water hydrant
0
water valve
815 Mercer St. (PO. Box 1869), Seattle, WA 98111 (206) 622-6767
STREET FILE
MEMO FOR RECORD
October 14, 1980
MEMO TO: File
FROM: Lee Willeiksen
Water/Sewer Divison
SUBJ.ECT.: CROSS CONNECTION/IRRIGATION SYSTEM
AT'5-1.,&� 12TN,: NORTA"
The irrigation system at the above address is in
compliance with the State of Washington and City of Edmonds
ordinances per Lee Willeiksen.
N W/Va
LEW/ amm
c c) kL o F- ta
5-f 5' !;Z t4c.>
61 r6 0 U 140 V S r-
1Z iFs cD a. m -r A-Z c/ I & jx_-b -rU
I M SrPf LL GV4 -r7— S ?I A
CITY OF EDMONDBO"- t-1 Dj-__VZP_HARVE H. HARRISON
200 DAYTON ST. - EDMONDS, WASHINGTON 98020 - (206) 775-2525 MAYOR
DEPARTMENT OF PUBLIC WORKS
October 9, 1980
Account No. 220-03605
Mr. Charles-Rezba 77_'-)_`Z32-3
510 12th North
Edmonds, WA,. 98020
Dear Mr.'Re�ba:
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 mandatory
on all irrigation systems.
Please call the Water Department Cross Connection Inspector,
Lee Willeiksen,*at 775-2525, extension 226, for information or
an appointment for inspection of your irrigation system.
Requirements to meet State and City Codes need to be com-
pleted within thirty days from receipt of this notification.
LEW/amm
a
,VS,nS *
c rely,
LEE WILLEIKSEN
Cross Connection Inspector
Water/Sewer Division
The City of Edmondsj ILE
gorjjEe
OWNER ......... ------------ -- — ---------
ADDRESS .............. .. . .. ....... .... ........
.... ........
AN,
APR
APPLICATION
for
SIDE SEWER FERI�HT
EASEMENT No . ..........................................
NEW CONSTRUCTION E] REPAIRS F]
PER T No. 91
............... CONTRACTOR
............ LEGAL DESCRIPTION: LOT No . ...... ------ .................. ..... BLOCK No . ...................... .....................
.............................
NAME OF ADDITION ...... .... .....
Approved:
DAM ...
....................... ............. By .......................... znz_�
7
CITY OF EDMONDS
Call PRospect 6-1107 when work
CIVIC CENTER — WATER -SEWER DEPARTMENT
is ready for Inspection. (N insp—
holidays.)
tions Saturday, Sunday or 0 N2 2914
SIDE SEWER
PERMIT
510 - 12th North
ADDRESS ----------------_ - ---------------------------------------------------------------------------------------------------- . .....................................................................
Paul Roy
OWNER --------------------- ------------------------------------------------------------------------ CONTRACTOR ---- Edmonds Underground Inc.
...................................... ...................................
- - ---------- 1
Pern-Iission is granted .................. ApTil. 17 19. for ---_------------------ days to REPAIR or CONNECT a side sew er
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—Top, of side sewer must have at least 30 inches coverage at property line and 12 Inches inside property line; minimum grade of 2%.
No bends in grade shaiWr than % will be permitted.
No. 4—Trenches in street must he water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of ODMPI ion.
et
NOTE No. 5--It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or Its appur-
tenances except to Insert the pipe into the wye.
CA,
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