611 3RD AVE N.PDF111111111111
4906
611 3RD AVE N
890 - 19c)
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
,ERMIT
STREET Fee L Permit Number.
Issue Date:
A. Address or Vicinity of Construction: 611 3 AV N- (9408625)
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Natural Gas Company- Contact: Frank Swan
MailingAddress: gli Mprtt*r gt- qqomp
yA Phone: 224-2278
State License #: Liability Insurance: 'Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. [-] Commercial Subdivision El CityProject [T Utility (PUD, GTE, WNG, CABLE, WATER)
rj Multi -Family SingleFamily Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: D Yes [NNo G. Size of Cut: x H. Chargq�
APPLICANT TO READ AWNSIGN
S
h'
INDEMNITY. Applicant understands and by his signature to this application, agrees o t he Ci ty of Edrn o nds ha rmlls s f3rz a es, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be agai ns t the City of Edmonds, or any Of ts epartments or
le
7edings including defen cos
employees, including or not limited to the defense of any legal proce e costs, and attorney fees bv reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEE * S. WILL BE HELD UNTIL THE FINAL,,STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL B9 PROCE'S9ED FOR ISSUANCE Tb THE APPiICANT.
"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.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with C��rSgulations as required bythe Qity�j—iaFineer.
r
All street cut ditches shall be patched with asphalt or City approved material prior to the enFol r Ing day;
NO EXCEPTIONS.
Ihav'e read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at all t' for inspection purposes.
Signature: Date: jananalX26, 1994
rt!;7�tractor o-rVe�7t
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK'
FOR CITY USE ONLY
APPROVED BY: A IL" Ji
TIME AUTHORIZED': VOID AFTER DAYS
SPECIAL CONDITIONS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND Ill:
JOTAL FEE:
COMMENTS: RECEIPT FEE:
0,
01
DATE:
ISSUERBY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. I)iv. 1991
FIELD INSPECTION NOTES (Fund 111 - Route copy to Stieet Dept.)'
Comments:
I Diagram-:
CONTRACTOR CALLED FOR INSPECTION El YES El No
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
VJ4
Nahm-UGas—
Addendum to City of Edmonds
Right of Way
Permit Applicaiion
Submitted by: MITCHELL S.-IANKFORD
Engineering Ai de
Washington Natural Gas.
U 521_�5246
1
V,
U /A WNG to window
Water main depth
gas main
k( 0 C_�� �
wv,'� f" 464
<2 -Z,5 If �_
SA�:T-cx(z L-4,j
Key:
_w-
water
-g-
gas
-ss-
sewer
-e-
water hydrant
0 -water
valve
R15)� =cr St'(P'O' B'_�: 1869)' St'�'ttk, WA 98111 CY06' 0'2-671-.,
STREET FILE
690 - 199-
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
sub'
Ject 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 the checklist, sign- and date k and
submit it to the City. Tle City 'Will review
the checklist, make a precursory I 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
of the parcel with enough . detail that City
staff can find and identify the subject
Parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information 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:
Narne
Title
Street Address
6 d k" V,� 16 �'76 -&'i V 7
City, S te,ZlP Phone
X/ - /cj
'Signature Date
Applicant Representative:
I
Narne
Title
Street Address
-------------
City, State, ZIP Phone
Signature Date
Critical Areas Checklist
Site InformAtion
ProjectName: - -7b,,,., Permit Number:
Site Location: 3.,d dl Property Tax Account Number:
Approximate Site Size (acres or square feet): f./.
Have you filled out a Critical Areas Checklist for a project on this site before?
General Site Conditions
RECE:1VE:6
NOV 1 0 1992
PERMIT COUNTER
-;' 51 -;� 2 e ? — ,�) - 0 e;,.-; 4-
/7 0
1. Has the site been cleared or logged? /70 Date of most recent action:
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)?
3. 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 r ise, 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 of horizontal distance.)
Steep: grades of greAter than 30% present on site.
Comments
HydrologyNegetation
4. Site contains areas of. year-round standing water: n 0
5. Site contains areas of seasonal standing water: n 0 —Approx. Depth:
6. Site is in the floodway i o floodplain of a water course.
7- Site contains a creek or an area where water flows across the grounds surface? ho flows
are year-round? Flows are seasonal?
8. Site is primarily: forested meadow shrubs mixed A
9. ' Obvious wetland is present on site: /7 0
10. Wetland inventory or map indicates wetland present on site: il 6,
11. Critical Areas inventory or map indicates any Critical Area on site: il 0
DeterminationN umber. Ow -
For City Use Only
Reviewe4-2--CX-,U or,�l - ------- W:L W/
Planner Date
Rey 3/27/92
10
40
APPLICATION
for
The City of Edmonds SEDE SEWER PERPMT EASEMENT No . ..........................................
NEW CONSTRUCTION 0 REPAIRS 0
113-05800
OWNER............. a, .... A4�lgbl ........................................................... CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS .......... 6.1.1-3r-d-Ave.....-N .................................................... LEGAL DESCRIPTION: LOT No . .............................................. BI.4DCK No . ............................................
NAMEOF ADDITION ...............................................................................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By .............................................