510 3RD AVE N.PDF111111111111
4893
510 3RD AVE N
APPLICATION
for
The City of Edmonds SIODE SEWER PERMIT EASEMENT No - ------------------------------------------
NEW CONSTRUCTION 0 REPAIRS 0
113-o6600
D. A. Knutson CONTRACTOR ---------------------------------------------------------------------------------------- ......... PERMIT No . ...................
OWNER ........... ................................................... ... .......................... ...............
ADDRESS ---- .................................................. ................
.... 3.nL-Aye. N. LEGAL DESCRIPTION: LOT No - ---------------------------------------------- BIA)CK No - --------------------------------------------
NAMEOF ADDITION -------------------------------------------------------------------------- * --------------------------- "**,-* -------------------------
S E L E
I
Dye Tested On Sewer 1972
Approved:
DATE...... �.:- ------------------------------------ By .................................... -----------------------
�1,q C. is 9 \3
CITY OF EDMONDS
121 5TH AVENUE NORTH.- EDMONDS, WA 98020 - (425) 771-02W - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
May 25, 2000
Mr. Erich Tietze, PE
EOTA
18530-766'Avenue West, Suite B
Edmonds, WA 98026
SUBJECT: Prop6sed Short 10W for-Knutsi-w at 510-Thi rthIS-00-015)
Dear Mr. Tietz.e,
The Engineering Division reviewed your Pivil site design. The review team�. notes. th e*
following revisions/corrections. Please contact the review team members directly for
questions regarding their comments.
,Storm Drainaeg- - Don Fiene. Assistant OU Engineer at (425) 771-0220, Ext 323
See comments in attached drainage report.
Provide profile of detention pipe to,scale. Profile the detention pipe, outfall line..
and show other utilities.
Provide separate erosion control plan with sequence of construction, details, ESC
notes, etc.
Provide'a CB -at the northerly end of the detention pipe.
Lraai Trqfflc Engineer at (425) 771-0220. Ext, 328
:c MajyAnne Zuk�wski.
The required pavement width is 12 feet plus a 24" wide by 2'� 1 high thickened,
asphalt edge. The standard paving section is 2" ACP on 2" CSTC and 4" CSBC..
The power pole. on Sixth Avenue North may need to be relocated to provide safe
ingress and egress to Lots 2 and 3.
Prior to work in the public. right-of-way, the City's Traffic Engineer must approve
a traffic control plan�
An on -site turnaround is required on Lot 1.
o Provide standard details for residential driveway and sidewalk construction.
WaterlSewer - Jim Waite, WaterlSewer Manag-er at 025).771-0235
0 Provide a'cleanout at the property line
p 0 A new tap will be required if the existing side sewer stub is 4".
Incorporated August 11, 1890
Sister City - Hekinan, Japan
Enich 0. Tietze, P.E.
May 25, 2000
Page 2
When the revisions, are complete, please return. the attached redlined plans and
calculations together with four sets of revised lans for additional review. It will be
P
necessary to provide a construction cost estimate for City staff to determine the
Engineering Division fees. If you, have any other questions, please contact Gordy Hyde
at 425-775-7744.
Sincerely,
4t,
JAMES C. WALKER, P.E.
City Engineer
JCW/GCH/cmc
Enclosures
c: Per Zinunerlund; 73YPine Street; Edmonds WA 98020
Douglas Knutsen; 2160 Cove Road; Ellensburg, WA 98296
R:\ENGR\CTORDY\00 I 5a.DOC
Water Service Drawing
The City of Edmonds EASEMENT NO . ..................................
NEW CONSTRUCTION REPAIRS L-1 LID NO . .................. . ASMT. NO . ...... ...........
................................................. PERMIT N0-'ZC0..A.V4..
OWNER............................................................................................ CONTRACTOR
JOB ADDRESS .. -:';�N.o ....... &1� ..... ........................... LEGAL DESCRIPTION: LOT. NO . ............................. ....... BLOCK NO . .................... ..........
NAMEOF ADDITION ................... .................................... ....... ........ ..... ..............
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MvV-00ul-1 1175 (REV.1, 1178)
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Date: August 1, 2000
To: PSE
From: Maryanne Zukowski Traffic Engineer
Subject: Traffic Control Conditions of Approval
Traffic Control in the Cily Right-of-Wa
All signs, barricades and related equipment and their use must be in accordance with
Part IV, "Traffic Controls for Highway Construction and Maintenance Operations," of
the Manual on Uniform Traffic Control Devices, as prepared by the National Joint
Committee on Uniform Traffic Control Devices and per the City of Edmonds
Developmental Standards. Reasonable accommodations. shal I be made for distance
requirements in signage for geometrical conflicts.
Coordination with the City Inspector prior to all work.
Particular attention should be made to the following items:
There shal I be at all times, reasonable pedestrian and vehicular access to and
egress from the properties adjacent to the project, so far as possible.
Signs and barricades, shall be supplemented by flasher units during the hours of
darkness, at construction sites close in proximity to vehicular and pedestrian
ways.
The Public Safety Department (police and fire), 771-0200, 771-0215
Community Transit, 348-7191, and Edmonds Public Works Department 771-
0235 shall be notified 24 hours prior to construction.
Any asphalt concrete pavements, crushed surfacing, gravel base or water
required for maintaining traffic during the life of the project shall be placed by
the contractor immediately upon request by the engineer and/or inspector.
All unattended e,xcavations shall be properly barricaded so as to prevent
accidents.
MUTCD plans apply.
City of Edmonds
PUGET
SOUND
ENERGY
510 — 3 AV N
Order # 106051811
Date: 7/24/2000
NOTE:
1. DISTANgE BETWEEN SIGNS SHALL
BE 100 FOR RESIDENTIAL
STREETS (25 MPH)
2. FLASHING BEACON SHALL BE
INSTALLED AT EACH SIGN FOR
NIGHT—TIME USE.
3. DISTANCES MAY VARY AS APPROVED
BY THE ENGINEER.
4. FLAGGERS REQUIRED TO CONTROL
TRAFFIC WHENEVER THE CONTRACTOR
MUST INTERRUPT TRAFFIC FLOW
TO ACCESS THE WORK SITE WITH
MATERIALS OR EQUIPMENT.
5. SIGN SIZE PER MUTCD.
LEGEND:
CONE OR CHANNELIZING DEVICE
(SEE STD 702)
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TRAFFIC CONTROL PLAN
City of Edmond
Submitted by:
Juliano NgOyen
Engineering Planner
425-290-7026
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CITY OF EDMONDS' SIDE SEWER PERMIT
90 9 c� PERMIT fj`� 2 9 111
LCI(
Address of Construction: J
Property Legal Description (Include aR easements):
-ctl C�rz CV 6v, COKd 0--1 0 451ro 3C,4arl W. 4 zv; K=
Are fz
Owner"and/or Contractor: _Z/M0t4&-V4/�-1a/
State License No. Building Permit No. 4-
)(Single Fam ily
Multi -Family (No. of Uh'its
El Commercial
Public.
EDM
T ONDS
T T TM NT I)S 7N
_R
REATMENT PLA T
Invasion into. City Right-!of-WayX No 0 Yes
RW Construction. Permit , No.
Cross other Private Property: KNo 11 Yes
Attach legal description and copy of recorded easement
I certify thai'l have rbestzaao shall c9Aply with all city requirements:
as indicated on the back of the Permit Card.
Date
CALL DIAL —A —DIG (1-800-424-5555) BEFORE ANY EXCAVATION
OFFICE USE ONLY
FOR INSPECTION CALL 771-82ft, PUBLIC WN R.�KS DEPT.
%
Permit Fee: Issued By
Trunk Charge: Date Issued: OD
Assessment Fee: Receipt No
Lid No.:
Partial Inspection: Date I nitial
Comments
Reason Rejected: Date -Initial
Final Inspection Approved: Date Initial
PERMIT MUST BE POSTED ON JOB SITE
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3.190
or
The City of Edmonds
Side Sewer Drawing
EASEMENTNO. - .........................................
NEW CONSTRUCTION REPAIRS F-1 LID NO . .................. ASMT. NO. -- ..............
c
OWNER.. ------------------------------------------ ........ .......................................... CONTRACTOR .................................................................................... PERMIT NO. 9 ................
JOB ADDRESS ... 4vp ...... rle ....... 4e ...................... LEGAL DESCRIPTION: LOT NO . .............. ....................... BLOCK NO . ....................................
NAMEOF ADDITION ...................... ................................................................................................
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PWW-OU01 -11175 (REV. 11/78) DAi F, ......................... By
CA FILE NO. c! (5
Critical Areas Checklist
-----------------------------------------------------
Site Information (soil shopograph /h drology/vegetation) 01 '6/�
Y Y
1. Site Address/Location:
2. Property Tax Account Number: Z'51Z 1U5 — Z — Q&
Z —
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? J�yyes; — no.
If yes; how is site developed? --C(ZM OQ 5e
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 vertical 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 I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: l'YO_; Approx. Depth:
7. Site contains areas of seasonal standing water: 1�b
Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site contains a c -" or an area where water flows across the grounds surface? Flows are year-
round? V)T Flows are seasonal? _ (What time of year?
10. Site is primarily: forested meadow ;shrubs mixed
urban, landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: Alo-
- ---------------------- W ------------ W ------------------ For City StafflUse' 0 1
n y ---- --------------------------- w -----------------------
. .... .....
:1. Site is ZoneO
.2'. SCS mapped soil type(s)?.
wetland inventory or C.A. map 'indicates wetland present on —site?...
4. Critical Areas inventory or C.A. map indicates Critical Area on site?
.......... .... ........ .... ..... .
Site within designated earth Subsidence landslide hazard area?
Site designated on the.Environmenta y Sensitive Areas Map!
%�_chk.doc; Rev 10/03/97
10
City of Edmonds
N�W CIRJTICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person prepaiing 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
th&-thecklist, 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 infor in-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*
Name
kco /t/,
Street Address
city State Zip
ZTeleonee
Sipd6e
Date
Applicant Representative:
Ao"C)-
Name
4W
Street Address
city Stafe' i
7W) Upoa
Teleph,wr
Signature /,' . -" I
Date
(over)
creception\janakaddoc
00000,-
Doug Knutsen
2160 Cove Road
Ellensburg, WA 98926
Subject:
Dear Applicant:
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
August 3, 1999
Determination regarding Critical Areas Checklist # 99-215
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 NOTEW.' .... ..
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED 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.
,00. You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION IWIT H ALL
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Enc: Determination
cc: Estate of Jeanette Knutsen
* Architectural Design Board
C:ReceptionUana\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
0
COTY OF EDMONDS
200 DAYTON ST. - EDMONDS, WASHINGTON 98020 - (206) 775-2525
DEPARTMENT OF PUBLIC WORKS
December 3, 1980
Mr. D. A. Knutson
510 3rd Avenue North
Edmonds, TJashington 98020
Dear Mr. Knutson:
HARVE H. HARRISON
MAYOR
The City.of Edmonds, is currently engaging in a program
to improve its sewage wastewater treatment system. One of
the major parts of the program is reducing the volume of flow
into our Treatment Plant. A major item ' contributing to this
problem is the infiltration of stormwater runoff from roofs,
drains, etc. into our sanitaty sewers.
A series of tests were completed by an indeDendent engi-
neerifi-g* firm. They pumped smoke into sewerlines and recorded
where it was escaping, thereby locating the stormwater infil-
tration sources.
Your property contains such a source and the City now
requires, by Ordinance No. 1580, that this problem be corrected.
Included with this letter is the "Disconnect Handbook" which
describes 5 possible solutions to this problem as suggested by
the City. These solutions will either direct storm water into
the City storm water system, or into other parts of your yard.
In either case, the removal of this water from sanitary sewer
system will heip to reduce the volume of our often overtaxed
Sewage Treatmen� Plant.
Please contact Dan Smith or Bob Franklin at 775-2525,
extensions 220 or 252 when you have "disconnected". Your
cooperation will be greatly appreciated.
Sincerely,
AA
kl�J S E. ADAMS, P.E.
C-3:tf-y Engineer
DS:jky
Enclosure
PLANNImr-t DATA
NAME:ZAW"d,&�..
SITE ADDRESS: DATE:
ZONING:
--�PLAN CHK#: el"),)
PROJECT DESCRIPTION: KVL,)
CORNER LOTL--LJ—(Yes/No) FLAG LOT
-----(Yes/No)
SETBACKS:
Required SeLback
L
Front: Left Side:-6' Right Slde:___J�' - Rear:-Zj'
Actual Setbacks:
Front: ':�� Left Side:--ZV _Right Side: Rear:?�
Street map checked for additional setback required? , (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE:
Maximum Allowed: Actual:
BUILDING HEIGHT: -7
Maximum Allowed: If -
Actual Height: 75.
Datum Point: Datum Elevation-
66y
A.D.U. CREATED?:
SUBDIVISION:
CRITICAL AREAS #:
SEPA DETERMINATION:
LOTAREA: frlW�,
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A/0 7-e : IOWNERICONTRACTOR IS RESPONSIBLE FOR
EROSION CONTROL AND DRAINAGE
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CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
March 7, 2000
Mr. Per Zimmerlund
737 Pine Street
Edmonds, WA 98020
SUBJECT: Proposed Short Plat for.Knutsen at 510 Third Avenue North
(S-2000-015)
Dear Mr. Zimmerlund,
GARY HAAKENSON
MAYOR
in order for the City Traffic Engineer to make a det.emination on the completeness. of
your application, we must know your intent in regard to your proposed Lot 1. Relocation
or expansion of the existing curb entrance onto Third Avenue North (SR524) will require
review by the Washington State Department of Transportation for conformance With their
Access Management guidelines. We must know if you intend to utilize this curb cut for
access only to proposed Lot I and ifyou have any intent to make any change.to its
existing configuration.
Your rapid response to this issue will allow me t o continue review of this application..
Thank you. If you have any questions, do not hesitate to contact me at (425) 775-7744.
Sincerely,
'GORDON C. HYDE
Development Services Engineer
GCH/cmc
s 0 Incorporated August 11., 1890
R:\ENGR\GORDY\00 I 5.DOC
Sister Citv - Hekinan. JaDan
Date:
To:
From:
Subject:
MEMORANDUM
June 16, 2000
Zimmerlund Construction
Maryanne Zukowski Traffic Engineer
Right of Way Permit.traffic control conditions of approval
Traffic Control in the City Right-of-W
All signs, barricades and related equipment and their use must be in accordance with
Part IV, "Traffic Controls for Highway Construction. and Maintenance Operations," of
the Manual on Uniform Traffic Control Devices, as prepared by the National Joint
Committee on Uniform Traffic Control Devices and per the City of Edmonds
Developmental Standards. Reasonable accommodations shall be made for distance
requirements in signage for geometrical conflicts. Note the addition of aflagger may he
needed or signqgefor "no left turn" southbound 3rd onto A Ave N.
See all red line notesfor additional corrections.
Coordination with the City Inspector priorto all work.
Particular attention should be made to the following items:
There shall be at all times reasonable pedestrian and vehicular access to And
egress from the properties adjacent to. the project, so far as possible. Contact the
affected homeowners directly to prevent conflicts.
The Public Safety Department (police and fire), 771-0200 and 771-0215,.
Community Transit, and the Edmonds Public Works Department. 771-OZ35
shall be notified 24 hours prior to the lane shift for construction. Proper
provisions.shall be made for public convenience, safety and travel.
Any asphalt concrete pavements, crushed surfacing, gravel base or water
required for maintaining traffic during the life of the project shall be placed by
the contractor immediately upon request by the engineer and/or inspector.
All unattended excavations shall be properly barr icadedso as to prevent
accidents.
Construction along or across the City right-of-way shall be as per the contract
documents, City of Edm o'nds Standards, or as directed by the engineer and/or
inspector.
City of Edmonds
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City of Edmonds Permit NO: "Zoo - 31
RIGIIT-OF-WA�7CONSTRUCTION PERMIT Issue' Date:.(Otall._00
A. 'Address or Vicinity of Construction: Act e. - A/.,
B. Type of Work (be specific): /5VS ;;-,4 t- t- 74 e - zx-,,� 4,� 5
s. �n 3 -& A cle . Al, a-C6av-d6tC-e_ t,.1;A4 C�AV_VOaC,,�
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-C. Contractor: Z", ms" 14- AW-1cl 6�_r k C_. Contact: QV` d
-73 Phone: - -774- /V32_
Ma.il.ing Address: -3 e5�. 42-S
State License#: Liability Insurance: Bond: $ /8 800
.420o4&4 Side Sewer Permit # (if applicable):
D.. Building Permit # (if applicable).-
-0015
t,5_.00 (". " C',
E. Commercial Subdivision F
City Project., F],EU_QPUD, GTE, PSE, CHAMBERS, OVWD)
Multi -Family ;K *Single Family, E] Other
INSPECTUR*
- F PAVEMENT: x .10 H. Charge:
;5YES NO G. SIZE OF CUT
CONCRETE CUT: YES NO
APPLICANT TO READ AND SIGN
IDEMNITY. Applicant understands by his/her signature to this application helshe holds the'City of Edmonds harmlessfrom injuries,
damages or claims of any kind 4 descr tion whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
. ip
any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and
attorheyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORAMANSHIP'AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE -.FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH is
COMPLETED BY CITY FORCES, A T . 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 Cit� Engineer. Every
y
flagger must be trained as requited by (WA4ffJ. 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 street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday - NO EXCEPTIONS.
+ Three sets of construction drawings of proposed work are required with the permit.application.
I HA VE READ THE ABO VE STA TEMENTSAND UNDERSTAND THE PERMIT REOUIREMENTS AND'ACKNOWLEDdE
11iA T I MUS�T MAKE THE PINK COPY OF THE PERMITA PAILABLE ON SITE A I -ALL TIMES . FOR INSPECTIONS
Sig "=nm 4�
ture: Date:
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
FOR, CITY USE ONLY
d by, e__1(NM167nn1&
Approve Right-of-way Fee:
Authorized7: Void After 4; / 2-4 / o I Disruption Fee/FujidJJJ—_'__1_01P —
S , pecial Con I di I tions: A'�?:rI2 0: v k.� c> I . kestoration Fee:'L— J 7-
CONS-TQAk(,-T(o0 71�>,R-fwA 0(n S V(AL 11511130 Total Fee:
Issued bx-.
V,
UPON COMPLETION'OF PERMITTED WORK; AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMITTED WORK.. rfx11Q 'ILA
INSPE CTOR` 'S SIGNATURE 6AwrE:- III
For inspection requirements -see Engineering Information Handout. 11101
NO WORK SUIALL BEGIN PRIOR TO PERM 11' ISSUANCE
5 EIR CEIVED
NO RMIT
PERMIT
USE ooqk
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CITY -OF E.DMONDS,
..NUMOER.
CONSTRUCT104 P.ERMIT'APPL.1,CATION
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OWNER NAME/NAME OF BUSINESS
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11417A4,EkL
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LID FEE $
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MAILING ADDRESS
PUBLIC RIGHT, OF WAY PER OOFICIAL.STREET MAP
TESCIP Approved
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REMARKS
PROdRtStsINSPECTIONS PER UBC-109MINALlNSPECTION REO'D
"new 0A
11i)WIL.3'rd Wee., -11`1195 VIAO'A.
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PLAN CHECK FEE.
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:4
VESTED DATE
PLAN CHECK NO:,", PLUMBING.
MECHANICAL
T141S PERMIT AUTHORIZES:ONLY,.THE WORK�NOTED...THI S, PERMIT CO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION.ON THE PUBLIC .
GRADING/FILL,
S'L
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEE ETC.) WILL REQUIRE
SEAkRATE PERMISSION..
STATE SURCHARGE
Lu PERMIT APPLICATIOW, 180 DAYS :
PERMIT LIMIT. I YEAR - PR OVIDED WORK IS STARTED WITHIN 180 DAYS.,,% EN G:RE 'VI E W- FEES
k'PERMIT'IFOWMORE INFO 0
SEE BACK OF,PI,N RMATI911:�`.".:
ENG:INSPECTION FEE
'APPLICANT, ON BEHALFOF HIS.OR.HER SPOUSE. HEIRS, ASSIGNSAND SU&*S6RS�. Y;7; PSO
U) IN INTEREST'AGREES TO INDEMNIFY, DEFEND AND.HOLD HARMLESS THE CITY,OF .
_j LIMIMSelill"Nd
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES,'ANDIAGENTS FROM ANY AND.
4
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE,, ARISING'DIRECTLY OR INDIRECTLY .
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF.. IS PERMIT SHALL NOT, BE -�PLAN C HECK DEPOSIT
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY OR DINANCE,
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE,4Y ORDINANCE PROVISIOW� RECEIPT
TOTAL AMOUNT DUE 7*%
6�� T) A I q Q 7'-�:h-()
I
I HEREBY ACKNOWLEDGE THAT I HAVE.READ THIS APPLICAiI6N;T.KAT THE INF6�MAfiON APPLICATION APPROVAL�:
GIVEN IS CORRECT AND THAT I AM THE OWNER, OR THE DULY -AUTHORIZED AGENT,OF-.
I
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONS . T
RUC� This application is not a permit until signed by the
CALL
TION;.AND IN DOING THE WORK AUTHORIZED THEREQY; NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are * paid. and
IN VIOLATION OF THE LABOR CODE OF.THE STATS OF WASHINGTOW RELATING�TO FOR- INSPECTION receipt is ack owledged in space provio�'q.
A
WORKMEN'S COMPENSATION INSURANCE AND.RCW118 .27.*
OFF141jili SIGNATURE E.
SIG&URE;�WN RORAGENT) 0 E:SIGNE9 '(425) \N
gimlet
771-0220:.
R S BY DAT&,
ENTIO EXT 333
.
A OR STRUCTU RE
L TZOSE OR OCCUPY B UILDING UNTIL.
IT IS UNLAWFU 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ACER F - ORIGINAL - FILE. - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR
,
5/98
Jr
4
:1N,
I , 1�
RIGHT-01
City of Edmonds
WAY CONSTRUCTION PERMIT
A. Address or Vicinity of.Co'nstr
B. Type of Work (be -specific):--,-
FROM,,�±155'N C/L OF
TO
110 '' 3 AV N
Permit No-_20co -OzGs
IssueDate:
PERMISSION IS REQUESTED TO INSTALL A 5/*" PLASTIC MAIN TIE—IN
AV N AND ±21'W C�J
OF 3,AV NE CONTINUE EAST TO THE PROPERTY LINE.
,1�
C. Contract�j� _LUGET SOUND ENERGY Contact: .DOUG USITALO
MailinR Addiess: 1122 75th ST sW Phone: 425-356-7520
Liability Insurance:
State License #: Bond:,
c
Building Permit # (if applicable), # (if appli"a5fe): ;,4
D. §ide-Sew err�u
E. Co! . nmercial' EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
Su division City Project
Multi -Family Single Family Other
INSPECTOR-
F. PAVEMENT: YES R No x 4, H. Charge: $
G. SIZE OF CUT
CONCRETE CUT: YES FX-1 No
-IDEMNI-rd Applicant unde6iands by hislher signature to this application helshe holds the City ofEdmonds harmlessfrom injuries,
damages or claims of any kind or, description whatsoeverlIfilreseen or unforeseen', that may be made against the City'bf 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 ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE POR"WOR'KMANSHIP AND MATERIALS FOR A PERIOD'OF ONE YEAR FOLLOWING THE FINA L
INSPECTION AND A C . CEPTANCE OF THE woik IkShMA iED. RESTORA TION FEES WILL BE HECb UNIII! THE FINAL STREETP4 TCH. IS
COMPLETED B Y CITY FORCES, A T 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 ac60"' lrda�nci?. with, C
gy codes. Allitreet-cut trench.work shall be patched with.asphalt or City-
w
n�4- -the. "oi�',kday,--�'N-OW�?CCrPTIONS.,
a r ved raterial pHbr'to the o Ai.
TIVr6e set's of construction drawings of proposed work are required with the permit application.,
IHAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMITREQUIREMENTS AND ACKNOWLEDGE
.,THATIMUSTMAKE THE P&K COPY OF THE PERMIT AVAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Signature: Date:
y1g CO&_
(Contractor or Agent)
CALL DIAL -A -DIG (1-8001-424-5555) PRIOR TO BEGINNING WORK7-
FORICITY.USE ONLY.
il Ri ht-of*,a Fe,'
roved b.,,:, 9 y e-,
Timek'-uthlc *zel Void After �a (a* /01 Disruption. Fee/Fund 111: "200
ecial Conditions:, C Ut=L, aJM Restoration Fee:
MEL C-11MAIRAIS . JMQIUt� 0 Ps), Totaffee:,"'.
AmW avAllaz4F� 9.61 N ;f h Receipt No
L�F, k uh ML I�sqed_by:
9a M__
-menw - 00�c_ W_ 1(z" CH
..........
UPON: COMPLETION-OF-PERMV7ED WORK)'-'AN�ENGANEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER fg.'00 OF THE EDMOND,$�:,'
COMMUNITY DEVELOPMENT COD
FINAL APPROVAL 0 F PERMITTED WORK.
INSPECTOR'S SIGNA TORE' DATff
For inspection requirements see Engineering Information Handout.
WORK SI-IAI.I_.
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ONVER - ZIMMERLZIND C0NS7Rl1CW6W INC
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60Y6MOS, WA. 98020
77ZZ. 206-774-10J2
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(' ERICHO. TIETZE AND AsSOCIATES, INC.
UP ENGINEERS AND CONSULTANTS
18530 76TH AVENUE WEST SUITE B EDMONDS, WA 98026 425-771-6212 FAX 425-775-0236
1 612100
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