609 5TH AVE S.PDF111111111111
5193
609 5TH AVE S
TAX ACCOUNTIPARCEL NUMBER: = !q:1 3 0 0, 0 c (3 --'-/ 0 0
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:-6�0-7-0/0&�— DETERMINATION: E] Conditional Waiver '0 Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS(OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: 1610-1-
SEWER LID FEE $:
LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED.
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
LATEMP\DSrs\Fomis\Street File Checklistdoc
-C. I b7
"20
city orEdMonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
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 the application to the City.
The purpose of the Checklist is to enable City staff to
deterniine 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 fro in observations of the site or data available at
WH0TreBUWGmKUT
RUGAION PIC
Date Received: &(a A) ?-
City Receipt#:_ A /0 L+ao -19 1
Critical Areas File #: 62&V--�-
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant:- ' ;--/D - 0'7
A property owner, or his/her authorized 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 form.. In
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the owner as listed below.
SiGNATuRE oF APPLiCANT/AGENT
DATE
Property Owner's Authorization
By my signature, I cer* that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject �property for the
purposes of inspection and po * g attendant to this I * ation.
-A-SIGNATURE OF OWNER 10-7
Z� --- DATE
I PLEASE PRINT CLEARLY
Owner/Applicant:
Name
6 0 9 ff 6--t-11 4oc, 5,
Street Address ( 5
��0170X)A
City State Zip
Telephone: (Z-06 ) -5oa
Email address (optional):
3939 W0<5
Applicant Representative:
Name
Street Address
city State zip
Telephone:
Email Address (optional):
#P20 CA File No:_C0U0-)- IDZ-
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/vegetation)
1. Site Address/ Location: C'/ C -5
2. Property TaxAccount Number: 0 0 ±;j' Z -,-:3 0 0 0 0 0 ar? 0
3. Approximate Site Size (acres or square feet)- 60 X\ /7_0 YZ00
4. - Is this site currently developed? Xyes; — no.
If yes;, how is site developed?. :5- 1
5. Describe the general site topography. Check all that apply.
r
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 V!j,; :rise of
JO
41
over ' a horizontal distance of 33 to 66-feet)"' 3
Steep: grades of greater than 30% present on si a ffrtical risk'�. 11
ver a or�
jeet 6
distance of less than 33-feet).
...�W
Other (please describe): �5'�A, T B L_ P 61
MA-) .57— '55� /�
6. Site conWns areas of year-round standing water: ;Approx. Depth:
7. Site contfiris areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway - 106 floodplain of a water course.
9. Site conkims a creek or an area where water flows across the grounds surface? Flows are year-round?
/() () - — Flows are seasonal? — (What time of yearT_
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn, shrubs etc)
1 1. Obvious wetland is present on site: PD
1. Plan Check
2. Site is Zoned?
3.
4.
SCS mapped soil type(s)?
-For City Staff Use Only
ble? 'ZOO-7- 0-7 1 (
Critical Areas inventory or C.A. ma 0 t9'rL
indicates Critical Area on site? _SSi(o G, sZ 2n
r
r
5. Site within desianated earth'subsidence landslide hazard area?
10
DETERMINATION
IT W. V MAM,
Reviewed
IV,
I so 66
CITY OF EDMONDS
CRITICAL AREAS RECONNAISSANCE REPORT
Site Location: 609 5th Avenue S. Tax Acct. Number: 004730000040;
Determination: Study Required Determination #: CRA-2007-0102
Applicant: Leo Kaarrekoski Owner: Leo Kaarrekoski
CRITICAL AREAS RECONNAISSANCE REPORT: STUDY REQUIRED
During review and inspection of the subject site, it was found that the site contains and/or is
adjacent to an Erosion Hazard Area, pursuant to Chapters 23.40 and 23.80 of the Edmonds
Community Development Code (ECDC).
GENERAL CRITICAL AREAS REPORT REQUIREMENTS
Critical Areas Reports identify, classify, and delineate any areas on or adjacent to the subject
property that may qualify as critical areas. They also assess these areas and identify any
potential impacts resulting from your specific development proposal. If a specific development
proposal results in an alteration to a critical area, the critical areas report will also contain a
mitigation plan. You have the option of completing the portion of the study that classifies and
delineates the critical areas and waiting until you have a specific development proposal to
complete the study. You may also choose to submit the entire study with your specific
development application.
Please review the minimum report requirements for all types of Critical Areas that are
listed in ECDC 23.40.090.D. There are additional report requirements for different types
of critical areas (see below).
Note that it is important for the report to be prepared by a qualified professional as
defined in the ordinance. There are options on how to complete a critical areas study,
and there is an approved list of consultants that you may choose from. You may contact
the Planning Division for more information.
General Mitigation Requirements for all Critical Areas are discussed in ECDC 23.40.110
through 23.40.140.
STUDY REQUIREMENT — EROSION HAZARD AREA
It appears that this property contains or is adjacent to an Erosion Hazard Area. Erosion Hazard
Areas include:
0 Those areas with Alderwood and Everett series soils on slopes of 15 percent or greater.
Any area with slopes of 15 percent or greater and impermeable soils interbedded with
granular soils and springs or ground water seepage.
Areas with significant visible evidence of ground water seepage, and which also include
existing landslide deposits regardless of slope.
. J. , . so %
DEVELOPMENT PROPOSALS ASSOCIATED WITH EROSION HAZARD AREAS
Development within an Erosion Hazard Area must meet additional criteria.
For erosion hazard areas with suitable slope stability, the only critical area study needed
is an erosion and sediment control plan prepared in compliance with the requirements
set forth in Chapter 18.30 ECDC as part of the construction documents. This option is
at the director's discretion, per Edmonds Community Development Code section
20.80.050.G.
In areas where the slope stability is not suitable, projects within Erosion Hazard Areas
will require a report by a licensed Geotechnical Engineer or other qualified professional.
Note that it is important for the report to be prepared by a qualified professional as
defined in the ordinance.
Report requirements are given in ECDC 23.80.050, and more generally in ECDC
23.40.090.D.
0 Development standards are given in ECDC 23.80.060 and 23.80.070.
ALLOWED ACTIVITIES
Certain activities are allowed in or near critical area buffers as specified in ECDC 23.40.20. If
you have any questions about whether your proposed development qualifies as an allowed
activity, please contact a Planner for more information.
EXEMPT DEVELOPMENT PROPOSALS
Certain development proposals may be exempt from Critical Areas Requirements (ECDC
23.40.230). If you think that a specific development proposal may be exempt, contact a
Planner for more information.
NOTE: Cited sections of the Edmonds Community Development Code (ECDC) can be found on
the City of Edmonds website at www.ci.edmonds.wa.us.
2
The City of Edmonds Side Sewer Drawing EASEMENT NO - ------------ --- _ --------------------------
104-04900 NEW CONSTRUCTION REPAIRS E] LID NO. ----------------- - ASMT. NO - ------------------
OWNER ------ MART-T-1 ... KARAKOSKI --- -------------------------- -------------- CONTRACTOR ----- ------------------------------------------------------------ ----- PERMIT No - --------------------
JOB ADDRESS ----- 6-Q9 --- :7� ... 5-TH --- AVE-----S --------------- -------------------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ---------------------- -------------
--------------- ------------------------------------------------------------------------------ -------------------------------------------------------------------
NAME OF ADDITION ------------------------------------------------
DYE TESTED ON SEWER
Approved:
PWW-OW1 -11/75 (REV, 11/78) DATE ----------------------------------- ------ - BY ----- ------------------------------------------------------
�Lawler, Patrick I
To: tutmarc@msn.com
Subject: 609 5th Ave. South
Dear Michael Tutmarc,
Regarding your inquiry as to the feasibility and permitting requirements for a proposed rockery at the above address:
• According to the AESI geotechnical report dated July 7, 2009, the proposed rockery is an erosion control structure ,
not a retaining wall.
• The adjoining property owners are sharing the costs and responsibility for the construction and maintenance of the
rockery, and will have a written agreement stating so.
• The rockery is not proposed to be constructed any higher than the existing six foot wall.
• Planning has determined that the lot is in an erosion hazard area, not a landslide hazard area.
• Temporary erosion control measures will be in place for the duration of the project to mitigate erosion hazards.
Permanent erosion control measures to be completed as per referenced geotechnical report (G), page 3.
• Geotech to approve drainage and drain termination, with drain water connected and discharged to an approved
location on site.
Conclusion: Based on the above information and ECDC 19.05.010, no permit is required for the proposed rockery.
Pat Lawler
Plans Examiner
City of Edmonds
Aftciated Eirdi Sciences, 9c.
M FE, N
Ce(Wra6n
C�er.25 Vapy ofSeMee
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July 7, 2009 7 L) —I TA,&(Z_c_,
Project No. KE090247A
By Design Rockeries
P.O. Box 1694
Duvall, Washington 98019
Attention: Mr. Gordon Vigus
Subject: Rockery Recommendations
609 5' Avenue South
Edmonds, Washington
Dear Mr. Vigus:
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At your request, Associated Earth Sciences, Inc. (AESI) is pleased to present this letter
summArizing our observations and recommendations at the above -referenced site. This letter is
based on our visit to the site on June 22, 2009, and discussions with you. This letter has been
prepared for the exclusive use of Mr. Gordon Vigus and his agents for specific application to
this project. Within the limitations of scope, schedule, and budget, our services have been
performed in accordance with generally accepted geotechnical engineering and engineering
geology practices.in effect in this area at the time our letter was prepared. No other warranty,
express or implied, is made. It must be understood that no re ' commendations or engineering
design can yield a guarantee. of stable slopes. Our observations, findings, and. opinions are a
means to identify and reduce the inherent risks to the owner.
The purpose of our work was to perform a visual evaluation of the area in which there is. a
rockery proposed to replace a concrete masonry unit (CMU) wall. The existing wall parallels
the property line along the east side of the property, has a maximum height of about 6 feet,' and
is out of plumb at this time.
The approximate 10-foot-wide driveway is at the base of the wall for nearly the full length, and
there is a small shed/garage at the southeast corner at the base of the wall. In this location, the
shed is about 3 feet from the toe of the wall. It is our understanding that the grade in front of
the new rockery will remain the same.
Currently.the area at the top of the wall is landscaped and is level. Near the center of the
length is a residence that is set back about 10 feet from the top.
Kirkland Everett Tacoma
425-827-7701 425-259-0522 253-722-2992
www.aesgeo.com
0 0
No explorations were performed at the time of our site visit, and there were no exposures on
the slope. However, the native soils in the area are mapped as dense glacial till. There were
no seeps or areas of high moisture observed in the slope on this date.
The new rockery will have a maximum height of 6 feet. The rockery will taper down to the
north from the southeast corner. It is our opinion that this plan is acceptable with the
following recommendations. A typical rockery detail/sketch is attached as Figure 1.
It should also be noted that, although rockeries are commonly used, they should be considered
a long-term maintenance item.
A) The base of the rockery should be started by excavating a trench to a minimum
depth of 12 inches below subgrade into firm, undisturbed ground. If loose, soft, or
disturbed materials exist at the base rock location, they should be removed and
replaced with free -draining sand and gravel or crushed rock.
B) 'The base rock should have a minimum width (perpendicular to the line of the
rockery) of 40 percent of the height of the rockery. All rocks should also meet the
following weight requirements:
Height of Rockery Minimum Weight of Roc
5 feefor less 50011,000 pounds, graded, top/bottom rocks
Above 5 feet 500/2,200 pounds, graded, top/bottom rocks
Q The rock material should all be as nearly rectangular as possible. No stone should
be used that does not extend through the wall. The rock material should be hard,
sound, durable, and free from weathered portions, seams, cracks, or other defects.
The rock density should be a minimum of 160 pounds per cubic foot.
D) Rock selection and placement should be such that there will be minimum voids and,
in the exposed face of the wall, no open voids over 8 inches across in any direction.
The rocks should be placed in a manner such that the longitudinal axis of the rock
will be at right angles or perpendicular to the rockery face. Each rock should be
placed so as to lock into two rocks in the lower tier. After setting each rock course,
all voids between the rocks should be chinked on the back with quarry rock to
eliminate any void sufficient to pass a 2-inch square probe.
E) The soil behind the rockery shall be compacted to a firm and unyielding condition at
or near the optimum moisture content of the soil.
F) A drain consisting of rigid, perforated, polyvinyl -chloride (PVC) pipe enclosed in a
12-inch-wide pea -gravel trench should be placed behind the lower course of rock to
remove water and prevent the buildup of hydrostatic pressure behind the rockery.
The remainder of the rockery backfill should consist of quarry spalls with a
2
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maximum size of 4 inches and a minimum size of 2 inches. This material should be
placed to a 12-inch minimum thickness between the entire wall and the cut material.
The backfill material should be placed in lifts to an elevation approximately 6 inches
below the top of each course of rocks as they are placed, until the uppermost course
is placed. Any backfill material falling onto the bear' surface of a rock course
Ing
should be removed before the setting of the next course.
G) The areas above rockeries should be planted with grass as soon as possible after
rockery construction to reduce erosion.
We appreciate the opportunity to be of service to you on this project. Should you have any
questions regarding this letter or other geotechnical aspects of the property, please call us at
your earliest convenience.
Sincerely,
ASSOCIATED EARTH SCIENCES, INC.
lKirldand, Washington
A.
Al WAS
4
/STE 0
NAL
Matthew A. Miller, P.E.
Senior Associate Engineer
Attachment: Figure 1 - Unreinforced Rockery Detail
MWAd
KE090247AI
PrqjecLs\20090247W,nWP
3
li
6
12"
FIRM UNDISTURBED SOIL
SEE NOTE 2
NOTES:
NO ROADWAY, PARKING LOTS
OR BUILDING FOOTINGS
IN THIS AREA
I'MIN
2 OR FLATTER
1 F- -
�jl
I
MIN VWIDE LAYER OF 2"-4" QUARRY
SPALLS ADJACENT TO ROCKERY
STABLE CUT FACE IN NATURAL MATERIAL
SEE NOTE 5
1" OR LESS DIAMETER WASHED GRAVEL
MIN 6" COVER OVER PIPE,
2" GRAVEL UNDER PIPE
MIN 4" DIAMETER PERFORATED RJGID PVC PIPE
MIN 1 % CONTINUOUS SLOPE TO OUTLET
1. ROCKERIES HIGHER THAN VSHALL BE CONSTRUCTED OF ROCKS OF GRADUATED SIZES FROM 5-MAN TO 2-MAN,
FROM BOTTOM TO TOP. ROCKERIES OF VOR LOWER SHALL BE CONSTRUCTED OF 3-MAN TO 2-MAN, FROM
BOTTOM TO TOP.
2. INSPECTION OF SUBGRADE, PLACEMENT OF BASE COURSE AND DRAINAGE, AND FINISHED ROCKERY BY ENGINEER
IS REQUIRED.
3. ROCK SHALL BE SOUND AND HAVE A MINIMUM DENSITY OF 160 POUNDS PER CUBIC FOOT.
4. THE LONG DIMENSION OF ALL ROCKS SHALL BE PLACED PERPENDICULAR TO THE WALL. EACH ROCK SHOULD BEAR
ON TWO ROCKS IN THE TIER BELOW.
5. ROCKERIES ARE EROSION -CONTROL STRUCTURES, NOT RETAJNING WALLS. NATURAL MATERIAL MUST BE STABLE
AND FREE STANDING IN CUT FACE. MAXIMUM HEIGHT OF 3 FEET FOR ROCKERIES FACING UNREINFORCED FILL SOILS.
6. SEE TEXT OF REPORT FOR ADDITIONAL RECOMMENDATIONS.
ROCK
L.B.
AVG. DIMENSION (IN.)
I -MAN
50-200
12 TO 18
2-MAN
200-700
18 TO 28
3-MAN
700-2000
28 TO 36
4-MAN
2000-4000
36 TO 48
5-MAN
4000-6000
48 TO 54
A - -Li- FIGURE I
ObuLlaLc Z Science jitc.
X'
al
u RE -I r0ritau ROCKER T UE: I IAIL
609 5TH AVENUE SOUTH DATE 7/09
EDMONDS, WASHINGTON PROJECT NO. KE090247A
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0 -Nothing in this Permit approval 0
interpreted as alln . Process shall be
Wmg or, permitting the
tenance of any U',renflY eiiisting illegal,
nonconfornj�ng or unporm-AW building, structure
Pe=t application, repaAnj
building, structure or con(
site plan or d.—awing, &1cl,
conclition may be the subj(
enforcemeni action."
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0 PLANNING DATA
SINGLE FAMILY RESIDENTIAL
0 11 STREET FILE 11
Name: K Ot CL NY L9.4
Date: S ( �O7
------
Site Address: 0� S- ",44 5
Plan Check # -. 200 -7- 0 r-? I (
Project Description: A�, , o(r r ol) �rq,, 1,4 �,j r- c- (n aAd
r'a 7
Le 001
C QA Crd e- Of CW
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Reduced Site Plan Provided.- (9/ NO)
Zoning: S
Map Page: Corner Lot: (YES Flag Lot-. (YES
Critical Areas Determination ff: 7,w -)0 510,0 ho
Ed -Study Required �(01 Ic all �r wey- 1-�\) -1 /LJC, CeI4
11 Waiver
SEPA Determination:
V-Exempt
El Needed (for over 500 cubic yards of grading)
0 Fee 0 Checklist El APO List with notarized form
(Al.) Required
Street: Side�43' Side.
Rear:
1
Actual Setbacks
Street: to Side: 16 Rear: 63
11 Detached Structures:
Rockeries:
Fencesfl-rellises:
El Bay Windows/Projecting Modulation:
El Stairs/Deck:
Buildili Hetqht
Datum Point: Datum Elevation:
Maximum Height Allowed:
Actual Height:
Other
Parking Required:
Parking Provided -
Lot Area: -
Maximum Lot Coverage: 35% Proposed:
Lot Coverage Calculations:
ADU Created: (YES /(N-30)
Subdivision -
Legal Nonconforming Land Use Determination fssued: (YES / CO
Comaients
Plan Review By: 4�� ek9Z7_
Plannog Data Form 04-11-06.doc
0 �T .11 -'R,1'..-"."T F 0
9LE
CITY OF EDMONDS
250 5th AVE. N. - EDMONDS. WASHINGTON 98020 - (206) 771-3202
COMMUNITY SERVICES
June 26, 1987
William Pedersen
609 5th Ave. S.
Edmonds, WA 98020
Dear Resident:
LARRY S. NAUGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
The City of Edmonds is currently engaging in a program to improve its
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 sanitary sewers.
A series of tests were completed by an independent engineering firm.
They pumped smoke into sewer lines and recorded where it was escaping,
thereby locating the stormwater infiltration sources.
Your property has been identified as having a roof drain connected to
the sewer and the City requires, per the Community Development Code,
Chapter 18.10, Section 18.10.030, that this problem be corrected.
Please contact myself or Everett Akau of our Water/Sewer Section by
July 24, 1987 to provide you with further information and to answer
your questions. Member of the staff will be glad to advise you as to
your best solution.
Your assistance in disconnecting this source is requested no later than
August 7, 1987.
Sincerely,
Archie Brena
Water/Sewer Supervisor
AB/1 k
cc: Bobby Mills
RUNOFFL/TXTWATER
PUBLIC WORKS PLANNING PARKS AND RECREATION ENGINEERING
0
C,cATY OF 7--E3M0H13ER3
250 - 51h AVE. N. - EDMONDS, WASHINGTON 98020 - (206) 771-3202
OFFICE OF THE CITY ENGINEER
December 12, 1983
Martti Karrekoski or Resident
609- 5th.Ave. S.
Edmonds, Wa. ;8020
Dear Mr. Karrekoski or Resident:
HARVE H. HARRISON
MAYOR
The City of Edmonds is currently experiencing a serious storm
water problem. Our sewage wastewater treatment system is being
overtaxed by large volumes of storm water from roofs, drains,
driveways, and parking lots. If this water is not eliminated from
the system, the sewage treatment plant will require expansion much
sooner than it otherwise would.
A series of tests were completed, identifying your property
as one of the infiltration sources. This storm water must be
removed from the sanitary sewer system as soon as possible. The
attached drawings indicate several solutions to this problem, one
of which should be applicable to your property.
The City has established this as a top priority project, and
your cooperation is urgently needed. Please contact Dan Smith or
Jerry Hauth at 771-3202 for assistance prior to installation of
your modified system.
Sincerely,
JAMES%,X,J ADAMS, P.E.
City Engineer
DTS/st
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CITY OF EDMONDS
V ON,
0213
�UBLIC S DEPARTMENT., ENGINEERI# I IS1 78L
APPLICATION FOR RIGHT-OF41AY CONSTRUCTION PERMIT
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
uompiete rarts A and b
be issued
at:(address or vicinity)
Work to be done: /,,/ "A"" /,-a I'l-t U.-I, I I --;?I,
drawing when applicable) ___J
uired -- Start: Finish:
Owner:
Name
Mailin- Address
City State Zip
Contractor: 0_,�2
Name
C-6
Maill Address
City State Zip
77S,' - 2Z2
Telephone Number
State License Number
75'
B, INDEMNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including or not limited to the defense of any legal proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor' is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and restoration in accordance wit ity Code. A
t City C 0 de - A
525 , ex
sp ior
wl D
24-hour notice is required for inspection by Engineering. Ca� 775-2525, ex . 220.
az�=
I understand that this permit must be avail for i
,able at the �ob s,te�for inspe ion
purposes at all times.
Signaturejw�z '7�
�"�a t e
Owner or Agent
TO BE COMPLETED BY ISSUING AGENCY:
6
Date.Issued:_ —Permit No. :__,Zy-6x;< F e e 1116-.
Security Bond:
Time Authorized: S,
APPROVED a t e
7
PUBLIC VORKS DEPARTMENT ACKLIST
BUILDING PERMIT REVIEW
(&ddress) (date)
0
Street Right -of -Way Exist'
Z
Access Easements Exist
-------
H
g34
Utility Easement Exist
W
Lot Per Subdivision Plat
Assessor
W
Site Plan Checked for Accuracy
Z
_
Underground Wiring Reqd.
H
0
Check A ur of Legal Description
Z
Review
Date
Existing Water Main Size
Water Main Required
Service Line Required
Hydrant Size Existing
1:4
Hydrant Reqd Per Fire Co
Size
Detector Check Meter Reqd.
Cross Connection Inspecti
Fire Department Comum2Xn
�3:
Water Meter Charge Reqd.
Review by.
Date
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Avail ility
-
Proj.
Drawing No.
File No.
Side Sewer Availability
Sanitary Sewer Connection e Reqd.
:3:
Review by_
Date
Open Ditch Existing
Reqd.
Culvert Reqd.
Size
C4
Catch Basin Reqd./
Indicate on Site Plan
0
Shoulder drainage maintain collection
on swale open runoff
H
W
Manhole reqd.
Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
Review by,
Date
aer,.�
Revised: 1vlO-1977
Page 2
Street Paving Reqd.
Curb and Cutter Reqd.
Sidewalk Reqd.
Curb Cut for Driveway Reqd
P4 Right -of -Way Construction Per�mi
Bond Reqd. for Public LTprov ts
Street Name Sign Reqd.
Other Signing Reqd.
Pre Permit Site Inspection made an
0
o-1 H BY: SEWER
WATER
F4Z STREET
ENGINEERING
Special Requirements listed in mem to Com=ity Development Department,
Building Division
> BY— M () ywgw� Date— -
o All item filled in an Building Permit Application 41211-70
P4 BY Date
Drawings Stanped and Notations Made
PL4 BY EN Date
-4
Approved by Public Works Department
Revised: lv 10-1977
CITY OF EDMONDS
-;J PUBLIAWS DEPARTMENTj ENGINEERftlVISION
APPLICATION FOR EIGHT -OF -WAY CONSTRULTION PERMIT
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
"
Applicant to Complete Parts A and B/ I
'�-47' T Te 76 3: Irk
A. Permit to be issued to:
For Work at:(address or vicinity)
Tfpf-- of Work to be done:
(attach drawing when applicable)
Time Required -- Start,:,- Finish:
Owner: 111-TRT7-1
Name
Mai 7 Addres '
uity
State
7 _2
Zip Telephone Number
Contractor*
Name
May-l" AM
ress-
4�-
City State Zip
6V
I "' 2 3 - 0 / - / / -/ �> - S 1'41311
State License Number
J62 - /3- 7r
Telephone Number
B. INDEMNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including or not limited to the defense of any legal proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220.
I understand that this permit must be available at the job site for inspection
purposes at all times.
Signature: Date: "�k
Owner or Agent
TO BE COMPLETED BY ISSUING AGENCY: W
D a t e I s s u e d Permit No.: Z6 N Fee
Security Bon
Time Authorized: /,C-5-
APPROVED
Date:
10--771v (Revised)
10
4o,11