615 12TH AVE N.PDF1111 lill 11
643
615 12TH AVE N
STREET FILE
File Copy
A -
CITY OF EDMOP40S
200 DAYTON ST. - EDMONDS, WASHINGTON 98020 - (206) 775-2525
DEPARTMENT OF PUBLIC WORKS
August 4, 1981
Jerry R. Burdett, D.D.S.
20006 50tfi West
Suite A-4
Lynnwood, Washington 98036
Dear Doctor Burdett:
SUBJECT: FENCE AT 615-12TH AVE. NORTH
HARVE H. HARRISON
MAYOR
I again visited the site and inspected the fence which you
questioned in your letter dated July 6, 1981.
The 10 foot public -right-of-way is south of the Hi ' lger property
at .615-12th Ave. N. and has never been improved nor opened to the
public. The path which had been used was across the Hilger's property.
If Mr., Kilger had fenced his southerly boundary, it would be physically
impos"§ible to safely go westerly from 12th Ave. to Sierra Place.
It is�the City's policy to retain ownership of all rilght-of-way
which could be improved for walkways and to allow abutti.ng property
owners to use this property, thru a permit process, until -the im-
provements are completed.
If you desire to have the right-of-way opened and a walkway
constructed, the procedure is to establish a local improvement district
(L.I.D.) of all the properties which would benefit from the improvement.
P,lease discuss this with your neighbors and if you wish to have
the pathway constructed thru the L.I.D. process, please write to me
and I will schedule a public hearing on the matter.
JEA:ges
cc: Planning Department
Parks and Recreation Department
Mr. Hilger-615 12th Av N.
711w
n �da' Ma Mc h ��kl
Sincerely,
*JA S E. S
a
ySEngineer
JERRY R. BURDETT, D.D.,S-�-`
V
20006-50th W., Suite A-4
LYNNWOOD, WASHINGTON 98036
General Dentistry TELEPHONE (206) 776-i 191
-EIVED
REC�
July 6 1981
_jM 7 - 1981
Dear Mr Adams
Dir. Of-Public:Works
I called you when you -were out of town to discuss our deciAon-
concerning the fence that is framed in at 615 - 12th Ave. North
--in Emerald Hills, which blocks. out -the- -public use. of -the., path
between 12th and Olympic Avei When I called June 1, 1981, you
felt also -it was inconsistent with the 1980 board decision to not'
give up this property and you would drive to the access and review
the permit.
A-671-had said there was a hearing last summer that the neighborhood
attended which was to decide if Mr. Hilger would bjxy the public
path -next to his -property. The'Planning Department denied his
-request. A, few months later he has been given the -permit to.fence
,the public out. He now has what he requesteAoriginally at.no cost.
The fence- is still framed in; ..children. -of the.area are losing public
6,afe'access to-schools,,play grounds, boys club, and Edmonds in
�gene iali This is an excellent short cut'for avoiding dangerous
-traffic-,_,of -other. routes both Pow,and in,the,.future. There.are
numerous community acces's areas that are undeveloped at this time
which are used and are not blocked offf
Why -do we take the time, energy, and money to post notices and
call open council hearings to make these decisions,just to have
them reversed.�y one or two individuals who do not know or use
these public areasl
We -are -quite concerned with andearly decision on this matter -
which would benefit all parties.
-1
your time -and intere
Thank you for*
UA
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P! .47
CITY OF EDMONDS Wr STFjEET FILli
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. oAddress or vicini'ty of Construction
5 15 12 AV N
0 Owner: WASHINGTON NATURAL GAS CO
Name
805, 156 AV NE
Mailing Address
Bellevue, Washington 9800
City, State, Zip Code
W.Frrnit No. Zf-__ -:1 AA
Issue Date ;;,, - _<_� ;7 9
o Permit Issued To:
9 Type of Work to be Done: Install New Servi
0 Work in Connection With:
El Sub or Plat Single Family
El Comml. / Ind. El Apt. Condo.
0 Pavement Cut: El Yes El No
9 Contractor: THASHINGTON NATURAL GAS CO
Name
805 156 AV NE
Mailing Address
�7anhinaton .5GO07
City, State, Zip Code
State License Number
747-0-650 ex. -244
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMITY: 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 City of Edmonds, or any of it's 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 to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220. f-,
I understand that this pr�`Irifii must be - ailal/lat
011pf CLY
tv TC
Signature: —
-Owner'
nt 4
site for inspection purposes at all times.
-Date
THIS PERMIT MUST BE POSTED AT -THE JOB SIT FOR INSPECTION PURPOSES
'e� - __,111�
CALL DIAL - DIG��PRIOR Tb,�BEGINNING WORK
f
C. Issued By:
L after
Time Authorde`d�. Vol days
Special Conditions:
Ammendments:
Permit Fee: —.-,-
Security Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimensions
X
*,,-NO WORK TO BEGIN PRIOR TO PERMIT-, SSUANCE
Eng. Div. December 1978
FIELD INSPECTION
ES (Fund. 111 - Ro ute conv to Street Dept.
Comments:
Diagram:
Contractor called for inspection, Yes
I Date:
,A7ork Disapproved BY:
Work Approved By:. —Date:
Bv: Date -
Inspector:
EncT. Div. December 197P
A
*BIC
1,URKS DEPAFUIT�= CHECIU:Iss
Date
1LEBu
=ING PER= REVIEW
STK-s r
ddress
Street, Right -of -Way Existing
REQD Ot
Access Easements Existing
REQD
Utility Easement Existing .1 t
REQD
Lot per Subdivision Plat Assess Man
Site Plan Checked for Accuracy
Z
H
Underground Wiring Reqd.
01
Check Accuracy of Legal Description
Environmentally SensitiveArea
Environmental Checklist Reqd.
Z
1-4
Flood Hazard Zone
Shoreline, Kmagement Area
4:4
7-
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Existing Zoning Per Code le.-- Wit>
Amenities Design Board Approval Reqd. &'�*ADB #
Approval
Board of Adjus Approval Reqd. 10
Review By: Date:
Existing Water'INTAin Size k;' 2 Cb I
Water Main Reqd.
Service Line Reqd.
W Hydrant Size Existing.
Hydrant Reqd. Per Fire Code Size
Detector Check.Meter Reqd. AAr
Cross Connection Inspection Au&'Y�
Fire Department Comments
Water Meter Char ': ge Reqd (�K
Review by: Date:
I /
Septic Tank Design Akpp-rov-e-d- -------------
Septic Tank Permit Reqd. Pe=*t,No.
Proj.
Sanitary Sewer Availability
C4
Drawing No. File No. tc%
V
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
"'94/
Review By: Date:
I
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BUIOIND DEPARTMENT
USE PER
ZONE W
Applicant Fill
N
"PERMIT APPLICATION 7'lnside Heavy Lines
JOB
ADDRESS
N A (OR NAME OF BUSINE -
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SUBDIVISION NO.
P LAT NAME
ASSESSOR MAP NO.
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MAILING ADDRESS
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'CITY
ffiFLEPHONE NUMBER
PUBLIC RIGHT OF WAY PER ORDINANCE NO.
KId 2-
EXISTING 14IGHT OF WAY
Is
PROPOSED RIGHT OF WAY
NAME
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DEFICIENCY
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OF RIGHT OF WAY
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STREET/UTILITY WORK REQUIRED YES "NO
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PERMIT FOR WORK IN PUBLIC R/W E
-1 YES NNO
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CITY
ITE LEPHONE NUMBER
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UNDERGROUND WIRING REQUIRED *YES ONO
CONNECTION TO SANITARY SEWER :9 YES El NO
SEPTIC TANK PERM�T REQUIRED 0 Y Es ';IND
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SEPTIC TANK PERM T NO.
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TELEPHONE NUMBER
REMARKS
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-MATE LICENSE NUMBER
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CHEIKEIBIT
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Legal Description of Property (St-(b* Belo o tt c h F ou r Copies)
METZ SIZE
BUILDING SUPPLY SIZE
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RENfARKS
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REMARKS
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PLANNING REVIEW BY
DATE
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2rRESIDEN'TIAL
YARDS
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FIRE ZONE
TYPE OF CONSTRUCTION CODE
NON-RESIDENTIAL SIGN
HEIGHT
ADD
DEMOLISH RETAINING
WALL
P CIAL INSPECTOR
REQUIRED
AREA
OCCUPANCY OCCUPANT
ALTER EXCAVATE FENCE
OR FILL
0 YES- 0 NO I
GROUP LOAD
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PLAN CHECKED BY THIS SIT E IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
REPAIR PRE -MOVE swim
INSP. POOL
SHOULD BE CODED 31.04.
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NUMBER 0 STORIES
NUMBER OF
DWELLING
REMARKS
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION.
PERMIT
Permit Number.
Issue Date:
A. Address or Vicinity of Construction: — 615 12th AV N 4"..
GTE to place, operate, and maintain a buried service
9 tal # 5732 located at
9 C) is. lyge of Work toe specific): wi re f rom exiping
767 —a-r—e—s TcTe-n- e4Te2 GTh to plow-50
61 12th AV N then north A th AV N.
feet, pushing no roads. R.O.W. footage 3 feet.
Mary A Bower, Permit Coord.
Contractor: GTE Northwest Incorporated Contact: Denni s Alexander 771 -9036 �or mobile 388-1358
Mailing Add 22118 20th AV SE, Suite 130 Phone: Mar
ress: Botholl, WA 98021
State License #: Liability Insurance: Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. EJ Commercial F] Subdivision F1 City Project C Utility.(PUD,(�EE) WNG, CABLE, WATER)
F1 Multi-Faniily Sin gle Family Other 2100-9PO01DB 242310
JL
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: D Yes [X]No G. Size of Cut: /'X H. Charge$
Please see attached sketch. '_9
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to-hdld'the City ofEdmonds harmless from injuries, damages, or
claims of any 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 legalproceedings including defen se costs, and attorney fees by reason ofgranting thispermit.
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 RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORQES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
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 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.
IhaVeread-the above statements pnr"V�erstandthep'ermit requirements and thepink copy of thepermit will be
available on site at all In S fTr,!PMPP&A��es.
Signature: John H. Stewart Date: March 11, 1996
(Contractor or Agent) oprns Supv-OSP Engrg.
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED, BY: . ..... k "JA RIGHT OF.WAY DEPOSIT
TIME, 'AUTHORIZED: VOID AFTER DAYS
S PECIAL CONDITIONS:
COMMENTS:
ffx#-:g
DISRUPTION FEE/FUND I 11:
RESTORATION FEE:
PERMIT FEE: 50. L-20
TOTAL FEE:
RECEIPT FEE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO
SSUANCE
Engrg. Div. 1991
-C
FIELD INSPECTION NOTES
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(F�und 111 - Route copy to Street Dept.)
YES
Date:
Date:
11 NO
ro
ch
LEGEND
0
z
PERMIT SUBMITTED BY
GTE
-T
PEDS 0
POLES 0
ROAD BORES
OVERHEAD LINES
I.D. UTILITY POTHOLE 1=1
UG TRENCHING ---UCT-
Y
R.O.vv.
-------------------------------------------
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9 FILEWPY
STREET FILE
CITY OF EDMONOS HARVE H. HARRISON
200 DAYTON ST. - EDMONDS, WASHINGTON 98020 o (206) 775-2525 MAYOR
DEPARTMENT OF PUBLIC WORKS
October 29, 1980
H. M. Hilgers, M.D.
615 12th Avenue North
Edmonds, Washington 98020
Dear Dr. Hilgers:
SUBJECT: STREET USE PERMIT APPLICATION
Your Certificate of Insurance in connection with your
Street Use Permit has been received from Alexander & Alex-
ander,, Inc. The certificate, however, was not filled out
properly. Would you kindly have your agent issue a new
certificate containing the following clauses:
1) Cancellation statement reading: Should the above -de -
,scribed policy be cancelled before the expiration date
thereof, the issuing company will mail a 30-days written
notice to the City of Edmonds by Certified Mail.
2) Hold Harmless clause: It is understood and agreed that
the Citv of Edmonds is named as an additional insured,
and hel� harmless from all claims and/or property dam-
age as pertains to the above -named permit.
Additionally, Dr. Hilgers, the coverage should be
$300,000 Bodily Injury and $100,000 Property Damage.
0
As soon as the Certificate of Insurance is properly
written up with the required coverage and clauses, we shall
be happy to approve your permit.
Sincerely,
JAMES E. ADAMS,,P.E.
City Engineer
j f
STREET FILE
CITY OF EDMONDS, PULIC 14ORKS DEPARTMENT
200 DAYTON SqCREET
E�DMONDS, 14A - 98020
775-2525
11963
1A 101 STREET USE PERM�T
=��1111�1�Tlll
flame of Applicant:.__*
Mailing Address:
_ X, zV
,Ielephone Number: -,fZ/,o 0 Date:
1'2
I I )escri pt ion of Public Place or Portion thereof desired to be used: (exhibit may be
clttach�d)
/0
Type of Use desired to be ' made of Public Place:
If applicable, attach plans and specificat�ipns for any uv or structure to be erected
z,nd/or ma-in-tained on the Public Place: e,
l,*EMPORARY PERMIT: Unless otherwise designated herein- thivs permit is understood� by v
applicant to olly of a temporary nature, that it'vests no permanent right whatsoever.
If the permitted use becomes dangerous or such structure shall beco(ne-insecure or unsafe,
or shall not be constructed, maintained or used in accordance with'the provisions of this
title, the same may be revoked and the structure and obstructions ordered removed by order
of the City Engineer. If this application is for a specified period of time, the terms
of said application is:
J;NDEMNITY: 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 descrip-
tion whatsoever, foreseen or unforeseen, that may be made against the applicant or the City
of Edmonds, or any ofJts departments or employees, including but not limited to the defense
of any legal proceedings including defense costs, court costs, and attorney fees by reason
6f granting this permit. In addition, applicant understands that the City shall be provided
ci certificate of insurance to indemnify and hold the City of Edmonds harmless from dll
claims and/or property damage, naming the City of Edmonds as an also insured.
APPLICATION OF,CHAPTER -- 6.40 OF THE EDMONDS CITY C I ODE: Applicant warrants that he has read,
or had the opportunity t-6--read, Chapter 6.40 of t dmonds City Code, attached herewith,
cind understands that all terms of that Ordinance are incorporated herein as if set forth
in full and this application and permit therefore are s to the ter '1�0 f that Chapter
6f the Edmonds City Code. U�� ?/
i\ppiicant-s �Ign ure
-2,
Date
11/7/74 rev.
A.-
City of Edmonds , Public Works Dept.
APPLICATION FOR STREET USE PERMIT Page 2
Approval (and Agreement, if applicable) -of Abutting.IP,roperty.O'wne�s:,..
Signature Printed N ame Address Date
DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
City Council Approval (Attach Minute Entry):
Permit Fee: Annual Fee: — due January 1, 19
Amenitie's Design Board Approval (if applicable) Attach M4nute Entry:
Building Official Approval (if applicable') .
Signatp
-re Date
Provision or ty.:
T'erms and -Provision of Perf6n�iance Bond, 'i f appl icable (Reference 6.40. 05 1 0 6 f appli cable
Ordinance)
PERMIT AUTHORIZATION.,B.Y P W. DT--REC_T,0TZ,:
Signature Date
--PE : RMIT NO.' DATE
Remarks:
11/7/74 rev.
STREET FILE
Alexander & Alexander Inc.
1414 IBM Building
P. 0. Box 21388
Seattle, Washington 98111
Telephone 206 623-7070
TWX 910-444-2299 ALEX ALEX SEA
2j
October 17, 1980
F City of Edmonds
James E. Adams
200 Dayton Street
L Edmonds, Washington 98020
Nexander
AL 11 a
&Nexander
RE: H.M. HILERS, MD.
CERTIFICATE OF INSURANCE
SAFECO INSURANCE COMPANY
We are pleased to enclose the following insurance documents:
Insurance Policy No.
El Endorsement No. for Policy No.
Certificate of Insurance. per your request.
Loss Payable Form.
Audit.
ED Binder.
ED Document for your records.
D insurance Company document to be completed and returned.
El Invoice No.
D Credit Memorandum No.
R1 cc: H.M. Hilgers
DE; de
Encl.
If you have any questions regarding the enclosed, please advise.
YT 0 very truly,
'y
y
Zex2an6de% �Ale!�ancler Inc.
Debbie Elduen
Personal Lines Dept.
B I NNW
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NAME AND ADDRESS OF AGENCY
COMPANOES AFFORDING COVERAGES
ALEXANDER & ALEXANDER INC.
COMPANY
A
1414 IBM BUILDING
SEATTLE, WA 98111
LET`TER Safeco Insurance Company
TEL: 623-7070
-
COMPANY FO-)
L
NAME AND ADDRESS OF INSURED
H.M. Hilgers, MD
COMPANY
LETTER
COMPANY
.615 12th Ave. Nofth
Edmonds, Washington 98020
LETTER
COMPANY
LETTER
ThIs is to certify that policies of insurance listed below have been issued to the insured named above and are in force at this time. Notwithstanding any requirement, term or condition
of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the
teims, exclusions and conditions of such policies.
Limits of Liabil
ty in Thousan
s (000)
COMPANY
LEITER
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION DATE
EACH
AGGREGATE
OCCURRENCE
GENERAL LIABILITY
BODILY INJURY
$
$
COMPREHENSIVE FORM
PREM IS ES-0 PERAT IONS
PROPERTY DAMAGE
$
$
F] EXPLOSION AND COLLAPSE
HAZARD
UNDERGROUND HAZARD
PRODUCTS/COMPLETED
OPERATIONS HAZARD
BODILY INJURY AND
CONTRACTUAL INSURANCE
PROPERTY DAMAGE
$
$
F-1 BROAD FORM PROPERTY
COMBINED
DAMAGE
INDEPENDENT CONTRACTORS
PERSONAL INJURY
PERSONAL INJURY
$
AUTOMOBILE LIABILITY
BODILY INJURY
$
(EACH PERSON)
$
COMPREHENSIVE FORM
BODILY INJURY
Q OWNED
(EACH ACCIDENT)
PROPERTY DAMAGE
$
HIRED
BODILY INJURY AND
NON -OWNED
PROPERTY DAMAGE
$
COMBINED
EXCESS LIABILITY
UMBRELLA FORM
BODILY INJURY AND
$
$
PROPERTY DAMAGE
Fl OTHER THAN UMBRELLA
COMBINED
FORM
I
WORKERS'COMPENSATION
STATUTORY
and
EMPLOYERS' LIABILITY
r $ (EACHACCIDENT)
OTHER
A
Premises Liab.
OH 119805
10/26/81
$300,000 each occurrence
E__
DES,' RIPrION OF OPERATIONS/1-OCATIONSNEHICLES
Location: Lots 1 and 2, 10 foot walkway,
Higgins addition, Division 1, Edmonds,
Washington. Additional Insured: City of Edmonds
ThAS certificate applies only to the use of this property as a garden spot for
H.M. Hilgers.
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof, the issuing com-
pany will endeavor to mail 30 days written
notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability
of any kind upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
City of Edmonds
DATEISSUED: Se-ptember 30, 1980
James E. Adams
200 Dayton Street
Edmonds, Washington, 98020
a �JMYAMIVE
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INITIATINC-i ACTION 5r-a-,90DATF- 6-IS-SOPAaE oF
OWNER NAME; #-eeb-eet- A4,
ADDRE53*. 615-- 1-1'rl,4Vf, AJ, -.4
APPLICANT NAME: ep i4l -le
ADDRE55: sce 4dfe-
SITE LOCATION OR ADDRE54: Vae-41*11*lf A.6,W,
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LECsAL DESCRIPTIO-N: 15-04.47 A - f4l A ve --A*� ,
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ENV. CHECKLIST REC D 5`0 CITY OF EDMONDS DATE: 12- 96
APPLICATION FOR AMENDMENTS FEE: 50.00 REC'T #. 2_& Z_
HEARING DATE: 7 - to ENV. ASSESSMENT FEE:$25 .00
,?Coto
ZONING ORDINANCE, COMPREHENSIVE PLAN OR OFFICIAL STREET MAP
1&0.)
Cwqaccept,
PROCEDURE: Applications are sent to the Planning Commissi . on for hearing. The Commission will
reject, or revise the proposal contained in the application. This Commission action
will be forwarded to the City Council in the form of a Resolution. After the City Council
receives the ResolUtion from the Planning Commission, they will set a public hearing date for
the final disposition of the case. The Council may confirm, reject, or modify any decision
of the Planning Commission.
APPLICANT: Herbert M. 14ilgers PHONE: 771-5260/365-1010
ADDRESS: 615 12th Ave. N., Edmonds
PROPOSED AMENDMENT TO THE-H44-W6 ORD!NAN , e8?1PRE09!9fVE PtAllt , OFFICIAL STREET MAP. (Line
out incorrect titles). In the case of a Comprehensive Plan Amendment, describe the "use*
designations to be changed (single-family, multi -family, commercial, etc.) and the physical
areas involved.
Vacation of the public walkway right-of.way located between lots 1 and 2
of Higgins Addition, Division #1
REASONS FOR THE PROPOSED AMENDMENT: To allow incorporation of the undeveloped
walkway in the general landscaping schemes of the abutting property
owners.
REQUIRED SUBMITTALS
(Must be submitted at time of application)
1. A drawing or map of the area involved.
2. Names and addresses of all property owners with land abutting a proposed street change.
3. Environmental Checklist, completed, with the $25.00 fee.
ADDITIONAL INFORMATION: The signatures of local residents supporting this application may
be attached to this rorm on a separate page.
APPEAL PROCEDURES: Section 12.16.170(e) - The City Council, pursuant to public hearing
called by them upon written application therefore by any interested
party or upon their own order, may affirm, modify or disaffirm any
decision of the Planning Commission. Syd—written applicat!'o; to
the City Council by any party , other ian the Planning Co on,
must be made within thirty ( o)_Aays/6f the publiS hear* --"before
the Planning Commission.
) /_ / J -) 7,
gnature Ot Applican
RECEIVED
JUN 18 1980
Dir. Of Public
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Property owners within 80' of requested pathway vacation:
Higgins Addition lot:
1. Alf Sorvik
605 12th Ave. N.
2. H. M. Hilgers, M.D.
615 12th Ave. N.
*5. Stanley Hovik
1103 12th Ave. N.
6. Jerry Burdett, D.D.S.
614 12th Ave. N.
7. Stanley Pocock
602 12th Ave. N.
Owner to Southwest of West end of walkway:
Orland Christensen
701 12th Ave. N.
Owner to Northwest of West end of walkway:
Henning Nelson
1142 Vista Place
*Sale of this property is currently being negotiated.
V
RECEIVED
JUN 1.8 1980
,jir. Of PUblic Works
CITY OF ktkbs
EN�IRONMENTAL ASSESSMENT
A"k
PROJEP NAME walkway vacation
12 June, 1980
DATE SUBMITTED
The information on this form will be used to determine the effect of your action upon the
environment of the City of Edmonds. Please answer each question as thoroughly as possible.
1. LAND
Area 10'xl47' Soils Type glacial Limitations none
Description of topography ('11, slope) 15% slope
NOTE: If grading or filling will
Gradip'g: Estimated cubic yards none exceed 500 cubic yards a grading
and filling plan must be sub -
Filling: Estimated cubic yards none mitted with the application.
Estimated area to be paved (including buildings)- none
Estimated area in open space (pervious surface)- none
2. WA T, E
Stream, - Estimated flow (cubic feet per second) nan.,
Will stream be altered? If yes, to what degree?
Other water bodies?
Impact on storm drainage none Method of handling runoff
is 3.
Adjacent to shorelines -zone? none
VEGETATIO':
Type and approximate number of trees
Within 200 feet of MHHW? no
none
M, i n i i-n Lim diametec of trees to remain N/A % of trees to be removed M/A
Groind cover Blackberries and weeds % to be removed l00%
Proposed landscaping, if any Grass and ornamental shrubery (Typical residential
ldndscaping.
4. EXISTING LAND USE WITHIN 300 FEET RADIUS OF PROPOSED DEVELOPMENT:
Single Multi -
Vacant Family Family Commercial Other
North X and X
South X
East X
West X O.KrI X
5. CIRCULATION
Estimated increase in auto trips daily none
Availability.of public transportation none
6. AREA OF IMPACT
Neighborhood ' x City-wide Regional RE-GZ4VE D
7. EFFECT ON AIR QUALITY None
B. CHANGES IN NOISE GENERATION none JUN -18 MU
Dir. Of Public Works
1/78)
ENVIRONMENTAL CHECKLIST
Introduction: The State Environmental Policy Act of
1971, Chip —ter 43.21C, RCW, requires all state and local
governmental agencies, to consider environmental values
both for their own actions and when licensing private
proposals ` The Act also requires that an Environmental
Impact Statement (EIS) be prepared for all major actions
significantly affecting the quality of the environment.
The purpose of this checklist is to help the agencies
involved determine whether or not a proposal is such a*
major action. -
Please answer the following questions as*completely as
you can with the information available to you. Where
explanations of your answers are required, or where you
believe an -explanation would-be helpful -to government
decision makers, include your explanation in the space
provided, or use additional pages. You should include
references to any reports or studies of which you are
aware and which are relevant to the answers you provide.
Complete answers to those questions now will help all
agencies involved undertake the required environmental
review without unnecessary delay.
The following questions apply to your total proposal,
not just to the permit for which you are currently
applying or the proposal for which approval is sought.
Your answers should include the impacts that will be
caused by your proposal when it is completed, even
though completion may not occur until sometime in the
future. This will allow all agencies involved to complete
their environmental review now, without duplicating
paperwork in the future.
NOTE: This is a standard form being used by all state
and local agencies in the State of Washington for various
types of proposals. Many of the questions may not apply
to your proposal. If a question does not apply, just
answer it "not applicable" (N/A) and continue on to the
next question!
Is RECEiVL77)
JUN 18 1980
Dir. Of Public �Vui_
ENVIRONMENTAL CHECKLIST
A. BACKGROUND
1. Name of Proponent Herbert M. Hilgers
2. Address and Phone Number of Proponent 615 12th Ave. N., Edmonds, 98020
Home 771-5260 office 365-1010
3. Date Checklist Submitted 12 Jun*e, 1980
4. Agency Requiring Checklist Planning Commission
5. Name of,Proposal, if applicable Walkway vacation
6. Nature and Brief Description of Proposal (including but not limited to
its size, general design elements, and other factors that will give an
accurate understanding of its scope and nature:
Vacation of a public walkway right of way, 10'xl47',.located between
lots 1 and 2, Higgins Addition, Division 1, in order that abutting
property owners'may inc orpprate the land into residential landscaping.
7. Location of Proposal (describe the physical se tt,ing of the proposal, as
well as the extent of the land area affected by any environmental im-
pacts, -including any other information needed to give an accurate under-
standing of the environmental setting of the proposal):
An undeiteloped walkway right of.way between the residences located
at 605 12th Ave. N. and 615 12th Ave. N., Edmonds
8. Estimated Date for Completion of the Proposal pending approval of vacation
9. List of all Perrits,'Licenses, or Government Approvals Required
Proposal (federal, state, and local — including rezones):
for all proceedinc
Application for street vacation
Application for Amendment to Official Street Map
.10. Do you have any plans for future additions, expansions, or further
activity related to or connected with this proposal? If yes, explain.
No
11. Do you know of any plans by others which may affect the property covered
by your proposal? If yes, explain.
No
..12.,Attach any other application form that has been completed regarding the
4r'oposal; if none has been completed. but is expected to be filed at
some future date, describe the.nature of such application form:
0
c. Alterations'to the course or flow
of flood waters?
d. Change in the amount of surface water
in any water body?
e. Discharge into surface waters,,or in
any alteration of surface water quality,
including but not limited to temperature,
dissolved oxygen or turbidity?
f. Alteration of the direction or r:Ate
of flow of ground waters?
g. Change in the quantity of ground
waters, either through direct additions
or withdrawals, or through interception
of an aquifer by cuts or excavations?
h. Deterioration in ground water quality
either through direct injection, or -through
the seepage of leachate, phosphates, deter-
gents, waterborne virus or bacteria, or
other substances into the ground waters?
i. Reduction in the amount,of water
otherwise available for publi.c.water
supplies?
Explanation:
YES MAYBE NO
11
a
I
X
El
4. �Flora'. Will the proposal result in:
a. Change in the diversity of species,
or numbers of any species of flora (in-
cluding trees, shrubs, grass, crops,
'4" 'flora and aquatic plants)?
micro
b. Reduction of the numbers of any
unique, rare or endangered species
of flora?
c. Introduction of new species of
flora into an area, or in a barrier
to the normal replenishment of exist-
ing species?
d. Recution in acreage of any agri-
cultural crop?
Explanation:
ED
-in
Dir. Of Public works
73-
Al
I
B. ENVIRONMENTAL IMPACTS (Explanations of all "yes" and "maybe" answers are required).
YES MAYBE NO
1. Earth. Will the proposal result in:
a. Unstable earth conditions or in changes
in geologic substructures?
b. Disruptions, displacements, compaction
or overcovering of the soil?
c. Change -in topography or ground surface
relief features?
d.' The destruction, covering or modifica-
tion of any unique geologic or physical
features?
P. Any increase in wind or water erosion
of soils, either on or off the site?
f. Changes in deposition or erosion of
beach sands, or changes in siltation,
deposition or erosion which may modify
the channel or a river or stream or the
bed of the ocean or any bay, inlet or
lake?
Explanation:
2. Air. Will the proposal result in:
a. Air emissions or deterioration of
ambient air quality?
b. The creation of objectionable odors?
c. Alteration of air movement, moisture
or temperature, or any change in climate,
either locally or regionally?
Explanation:
3. Water. Will the proposal result in:
a... Changes in currents, or the course
or direction of water movements, in either
marine or fresh waters?
b. Changes in absorption rates, drainage
.paitterns, or the rate and amount of sur-
face water runoff?
— - /Y\
-2-
0
YES MAYBE NO
10. Risk of Upset. Does the proposal involve
a risk of an explosion or release of hazard-
ous substances (including, but not limited
to, oil, pesticides, chemicals or radiation)
in the event of an accident or upset condi-
.tions?
Explanation:
11. Population. Will the proposal alter the
Tocation, distribution, density, or growth
rate of the human population of an area?
Explanation:
12. Housing. Will the proposal affect existing
Fousing, or create a demand for additional
housing?
Explanation:
13.
Transportation/Circulation. Will the pro-
posal result in:
a. Generation of additional vehicular
movement?
b. Effects on existing parking facili-
ties, or demand for new parking?
c. Impact upon existing transportation
systems?
d. Alterations to present patterns of
circulation or movement of people and/or
goods?
e. Alterations.to waterborne, rail or
air traffic? —
f. Increase in traffic hazards'to motor
vehicles, bicyclists or pedestrians.?
Explanation:
'X
X
X.
! I IL
di
-5-
Dir. Of PUhliC. W,00',S
YES MAYBE NO
5. Fauna. WIll the proposal result in:
a. Changes in the diversity of species,
or numbers of any species of fauna (birds,
land animals including -reptiles, fish and
shellfish, benthic-organisms, insects or
microfauna)?
b. Reduction of the numbers of any
unique, rare or endangered species
of fauna?
c. Introduction of new species of
fauna into an area, or result in a
barrier to the migration or movement
of fauna?
d. Deterioration to existing fish or
wildlife habitat?
Explanation:
6. Noise. Will the proposal increase
existing noise levels?
Explanation:
7. Light and Glare. Will the proposal
produce new light or glare?
Explanation:
8. Land Use. Will the proposal result
in the alteration of the present or
planned land u e of an area?
Explana'tion: P'eo
'V.0a /� CO.
U e
9. Natural Resources. Will the proposal
resuT—t-'in:- -
a. Increase in the rate of use of any
Patural resource?
'b.' Depletion of any nonrenewable
natural resource?
E xplanation:
-A-
YES MAYBE NO
17. Human Health. Will the proposal result
in the cri—ation of any health hazard or
potential health hazard (excluding
mental health)?
Explanation:
18. Aesthetics. Will the proposal result
in the obstruction of any scenic vista
or view open to the public, or will the
proposal result in the creation of an
aesthetically offensive site open to
public view?
Explanation:
19. Recreation. Will the proposal result
in an impact upon the quality or quan-
tity of existing recreational oppor-
tunities?
Explanation:
20. Archeological/Historical. Will the
proposal result in an Ylteration of
a significant archeological or his-
torical site, structure, object or
building?
Explanation:
C. SIGNATURE
1, the undersigned, state that to the best of my knowledge the above -information is
true and complete. It is understood that the lead agen5X may withdra
,iw an declaration
c st
or non -significance that it might issue in reliance.updn'this checl 0 ould there
be any willful misrepresentation or willful lack of/full disclosure my part.
PROPONENT;
RECEIVED
JU N 18 1980
Dir. Of Public Wolnz,
I
YES MAYBE
N 0
. T
14. Public Services. Will the proposal have
an effect upon, or result in a need for
i
new or altered governmental services in
any of the following areas.:
a. Fire protection?
b. Police protection?
c. Schools?
d. Parks or other recreational
facilities?
e. Maintenance of public facilities,
including roads?
f. Other go vernmpetal services?
Explanation: V�'V e) 5 4^
15. Energy. Will the proposal result in:
a. Use of substantial amounts of fuel
or energy?
b. Demand upon existing sources of
energy, or require the development
of new sources of energy?
Explanation:
X
X
1 AM
16. Utilities. Will the proposal result in
a neeTT—or new systems or alterations to
the following utilities:
a. Power'or natural gas?
b. Communications systems?
c. Water?
X
d. Sewer.or septic tanks?
e. Storm water drainage?
-X
f. Solid waste and disposal?
A
Explanation:
-6-
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07
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May 29 19 80
VZeC%V5D.
MEMO TO: Mary Lou Block
Manager, Planning Division
o"
FROM: Irene Varney Moran 'j .1, IDevej.
City Clerk
SUBJECT: PETITION FOR VACATION
Attached is information pertaining to the proposed vacation of
— the public walkway right-of-way located between Lots 1
— and 2 of Higgins Divi'sion #1 as recorded under Auditor's -
File Number 2151814, June 24, 1970.
Please place this on the Planning Commission agenda as soon as
conveni.ent for their review and recommendation to Council.
Thank you.
RECEIVED
Attachment(s) JUN 18 1980
Dir. of Public Works
CERTIFICATE OF SUFFICIENCY
I, Irene Varney Moran, City Clerk of the City of Edmonds, Washington, do
hereby certify that on., May 19, 1980 1 received a Petition for Vacation
of ____ Public.walkway ri-ght-of-way located between Lots 1 and 2 of
Hiqqins Division #1 as recorded under Auditor's File Number 2151814, 6/24/79.
Upon checking ownerships with the Snohomish County Assessor's office, I found
that the petition contains the required signatures for the two-thirds ownership
of the real property abutting the area for which the vacation is requested.
SIGNED AND SEALED this 29 day of May 1980 .
SEAL
V
.Irene Varney Moran, CMC
Edmonds City Clerk
SUBSCRIBED AND SWORN to before me this
day of 192", 1 � )Cr�EiVED
"I Z 1980
Nota ry."Pu bl i c i.n ai I I i :11' State ofpVs irpton,
Dir. Ut U Ir Or
residing at�
PETITION'FOR STREET VACATION
11
TO THE H0140RABLE CITY COUNCIL
OF THE CITY OF EDMONDS, WASHINGTON:
WE, the ' undersigned, owners of two-thirds of the real property
abutting upon that public street described bel.ow, do hereby petition the
City of Edmonds to vacate said street, described as follows:
y- I jG - C� L_ loca-t� 64-L��
"'j z d '. 0.1 - I
Ci. <� � �-" '4 At, aC:60abG=D
OKOGtL 0 tbl % --Tr > 120 Mom6s-e- Jok)a; -7-4, 19
all situate in the City of Edmonds, County of Snohomish, State of Washington,
and request that said City Council by Resolution fix a time and place
when this Petition shall be heard and determined by that authority,
which time shall not be more than'sixty (60) days nor less than twenty
(20) days after the passage of such Resolution.
These pages are a group of pages containing an identical text and
prayer intended by the signers of this Petition to be presented and
considered as one Petition and may be filed with other pages containing
additional signatures which cumulatively may be considered as a single
Petition.
WARNING: Every person wh8 signs this Petition with any other than his
true name, or who knowingly signs more than one of these Petitions, or
signs a petition seeking an election when he is not a legal voter, or
signs a petition when he is otherwise not qualified to sign, or who
makes herein any false statement, shall be guilty of a misdemeanor.
PRAYER OF PETITION: For the vacation of a portion of that street commonly
known as city right-of-way.
,SIGNATURE,�' PRINTED NAME ADDRESS DATE
Z
IV
V - s-41
*See special instructions on cover sheet.
RECEIVED
MAY 10 1980
Edmonds UY Clerk
2086
PT
RECEIVED
JUN L81980
Dir. of Public, Works
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81980
Dir. Of Publir Works
OLYj\./]Plc J-J.E j G j-] TS
--- USE PERMIT
1'3'1� R
1 BUILDING DIVISION ant Fill ZONE N,U M 13 E R
ell
"PERMIT i�. . "y Lines
APPLICATION JOB
A D 1) R F SS
NAME JOR NAME OF BUSiNE S) IJS
NO.
LEGAL DESCRIPTION S ..IVI.IC1 SHORT SUB NO.
LING ADDRESS 6-6q
X
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(' / 5- / � PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITYrW TELEPHONE "IR
EXISTING
'0/0
PROPOSED
DEFICIENCY OF RIGHT OF WAY
IJ
0
ADDRESS PUBLIC IMPROVEMENTS REQUIRED
DRAINAGE IMPROVEMENTS REQUIRED 0
1�'CITY
LEPHONE NUMBER DRAINAGE PLAN REQUIRED 0 U
UNDERGROUND WIRING REQUIRED
NAME CONNECTION TO SANITARY SEWER E3 CL
SEPTIC TANK PERMIT REQ*D 0 NO.
ADDRESS ELEVATION OF PROPERTY CORNERS 0
& FOOTINGS REQ'0
CITY TELEPHONE NUMBER
SEE ENGINEERING MEMO DATED
STATE LICENSE NUMBER CITY LICENSE NUMBER CHECKED BY -P,
Legal Description of Pro rty JShow Below Or Anach Four Copies) METER SIZE BUILDING SUPPLY SIZE
1
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W
A REMARKS
SIGN AREA ENV. REVIEW ADD NO.
ALI-OWED PROPOSED COMPLETE EXEMPT
SHORELINE
It
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REMARKS
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VARIANCE OR CU PLANNING REVIEW BY DATE
YARDS LOT COVERAGE
GAS 11�5 FRONT in S I D E ;;)S REAR
NEW R:SIDENTI E] LINE FIRE ZONE TYPE OF CONSTRUCTION CODE HEIGHT
. N-RESID SIGN I
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ADD
DEMOLISH RETAINING SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
GROUP LOAD
WALL REQUIRED
ALTER XCAVATE FENCE 0 YES 0 N 0 1 1
OR FILL I— X—FT' PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
PRE -MOVE swim OF EDMONDS. LOCAL SALES TAX
REPAIR
INSP. POOL SHOULD BE CODED 31.04.
REMARKS
NUMBER OF STORIES DER OF
NWUMELL..G C/ S
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UNITS
NATURE OF WORK TO BE DONE
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PLAN CHECK FEE VALUATION FEE
0
PLOT PLAN ---
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BUILDING
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PLUMBING
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MECHANICAL
FENCE
SIGN
Applicant, on behalf of his or her spouse, heirs, assigns and
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successors in interest, agrees to indemnify, defend and hold harmless
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RETAINING WALL
the City of Edmonds, Washington, its officials, employees, and
0
from any and all claims for damages of whatever nattirC,
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agents
arising directly or indirectly from the issuance of this permit. Issu- SWIMMING POOL
a
ance of this permit shall not be deemed to modify, waive or reduce
.j
any requirement of any city ordinance nor limit in any way the
0
PUBLIC WORKS DEPARDm afEacup
BUILDING PERMIT REVIEW
14 r-- 9 13 54�"r tj 1 -11 L_ &s P_ _S
cva-ei< !K4�'_/nfn
C,^
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(address) (date)
Street Right -of -Way Existing
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.��.�REQD
Access Easen-ents Exist'
C4
Utility Easement Existing-LL? IS, over akgj
A-t
it REQD
Lot Per Subdivision 12 1-63P
At4 Assessor Map_A�/
Site Plan Checked f�r Accuracy
Z
Underground 14iring Reqd.
Check Accuracy of Leg Description
Z
Review by,
Date
r4'
010,
Existing Water Main Size
Water Main Required
Service Line Required
Hydrant Size Exist'
ln4
Hydrant Reqd Per Fire Code
Size
Detector Check Mater Reqd.
Cross Connection Inspection
APPROVED V^CUUM eP_1FAKSR_ I
Fire Department ConTnents
44
Water Meter Charge Reqd.
Review bye,,E/114a�.cc�_r_-7p
Date
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability�_Proj
Drm,,ing No.
File No. —
Side Sewer Availability —
Sanitary Sewer Connection Fee Reqd.
:3:
Review by
Date
Open Ditch Existing
Z
Culvert Reqd._
—Size
C4
Catch Basin Reqd.
Indicate an Site Plan
0
Shoulder drainage mayi�� colle��_on swale open rLmoff
P
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Manhole reqd.
Indicate on' Site Plan
Soil Conditions an� GrAmd Waf/er Field Checked
Review* by.
Date
�b
Revised: MO-1977
Page 2
Street Paving Reqd.
Curb and Cutter Reqd.
Sidewalk Reqd.
94
Curb Cut for Driveway Reqd.
g
Right -of -Way Construction Perma-t Reqd.
Bond Reqd. for Public Improvements
Street Name Sign Reqd.
Other Signing Reqd.
Pre Permit Site Inspection made on
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BY: S94ER
WATER
P4
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STREET
44
ENGINEERING
Special Requirements listed in mem to
Commmity Development Department,
Building Division
BY -
Date
o
All items filled in on Building Permit
Application
P4
BY
Date
I"
Drawings Starrped and Notations Made
P4
BY
Date
Approved by Public Works Department
Revised: 1v 10-1977
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CITY --0FJDM0.ND3.*---,
BLDG.:'DEPT.
CONDITIONAL PERMIT
REC
WORK.
ADDRESS-�Q15
CITY OF EL
OWNER- PLANNING
APPROVED DATE -
BY
BLDG. OFFICIAL
KEEP THESE STAMPED
PLANS ON JOBSITE FOR'
ALL INSPECTIONS
PERMIT NO.
SHEET
I OF
TED
180
36
)Effs
ZO N E
133 1980 r�?T�7
SETBACKS:
Dir. Of, FRONT
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CITY OF EDMONDS
WATER DEPARTMENT
CROSS CONNECTION rC'.r,`rQ0[
M LU I I KWi%;V-f fel PULUI I LICI I I Ica I Lf 1 1 irioh
is approved on condition the �,)Stetn
protection is provided:
NONIF
AIR - GAP
APPROVED RED11CF0
APPROVED
OTHER
FAEAKE& w6m-F-57- f4F-AP
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Water Department Date
AV /00 Ps/
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MAY 13'80
'01TY OF ED ONDQ
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1980
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V: - - - - - - Side. Sewer Drawina
The Citj 0- f - Edm- onds EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION REPAIRS Fj LID NO . ................... ASMT. NO - ------------------
OWNER CONTRACTOR ----- ---------------------------- ............................ PERMIT NO. -4�-Z-2-Z
JOB ADDRESS . ..... 1�,\
....... 4 .......... LEGAL DESCRIPTION: LOT NO . .................................. ... BLOCK NO . ....................................
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................................................................................................... ..............................................................
NAME OF ADDITION .... ...... . .........................................................
DATE ........... By mg ----------------- :7-� ------
PWW-0001 -11/75 (REVA 1/78)
CITY OF EDMONDS
PUBLIC WORKS DEPARTWIT FOR INSPECTION CALL Permit
SIDE SEWER PERMIT 775-2525 Ext. . 220 Issue Date
PEP -MIT MUST BE POSTED ON JOB SITE
l.. Address of onstruction
2. Property Legal Description (include all easements)
/-o-r
3. Single Family Resildence Multi-Famil-�, No. of Units
Commercial
4. Owneir—amd-/-or Builder -m-or, re-k
5. Contractor & License No. C 2-7-1 LM
6. Invasion into City Right -of -Way: No &__�Yes (If Yes Right-of-
way Construction Permit Required Call Dial Dig (342-5344) before
excavation)
7. Cross other private property: Yes No L,---iasement required -
attach legal description and county easement number.
READ tHE-FOLLOWING AND SIGN:
a. Property owners must obtain a permit to install side sewers on
their property. A licensed side sewer contractor must be employed to
construct side sewers in the public' right-of-way.
. b. The side sewer contractor assumes full reponsibility for each
installation for one year.
C. Commercial establishment requires a minimum of a six inch (6")
side sewer line.
0 d. Side sewers may not be installedcloser than thirty inches (30")
ul to any structure. 0
e. Side sewer lines must be laid at a minimum grade of 2% (1.15
and maximum grade of 100% (450). 0
f. No turn in side s8wer greater than 45 (1/81bend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer 'line run.
j. Trenches within City right-of-way must be restored to original
conditions.. Contractors shall be responsible for ri ght-6f-way failure
due to poor compaction of fill.
k. Side s6wermust be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
-DATE:
I certify that I _HZ/'v'd-rdWd
and shall comply 'with the above
PERMIT FEE:35,ery
i�j- W qz- —
11 '0 CONNECTION FEE:
P�;
cl
PEPMI T
DISAPPROVED BY: Date:
By: Date:
APPROVED By: I Date: -322-F '705
It .
POSTED ON JOB SITE
STREET FILE
DATE: 11�5 le
MEMO TO: Building Division
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT:
After review of the subject building permit application, w.e have
the following comments:
(1) Coordination of the location of any structure with respect to
utilities, streets, property lines anT-J—riveway grades -is the
responsibility of the contractor.
The contractor is required to keep the abutting streets clean-
ed of dirt and debris caused by the construc
I
ion.
(3) A "Right-of-11,lay Construction Permit" is recluired, from the
Engineering Division of Public Works, for any work within
the Public Ri7ht-of-Way or public eas-ement.
(4) Driveway slope not to exceed 14%.
cq �J n
W-L I V11 Klli Q 1�>g U �J MZ:-i )OQ
QUMAM-ID ON SIM-
PIV S/77
0
P4.
P'l
OuBLIC JA70RKS..DEPARn1M CHECKA Date
Bunm%pm,= REviEw.
6 (5 1 ddress
.Street Right-of-Way,Existing REQD
Access. Easements Existing 1W REQD
Utility. Easement Existing REQD It
Lot per., Subdivision Plat'.,, Asses �r Map
si
Site Plan.Checked for Accuracy 440 0
Underground Wiring Reqd.
Check,.Accuracy,.of LegalDesdription
Environmentally'Sensitive Area
Environmental Checklist Reqd.
Flood Hazard Zone
Shoreline Management Area
Slope, Soil, Vegetation
Stream,.Creek, Drainage Basin-.
pow
Existing Zoning Per Code I 0022-e
Amenities Design Board*Approval Reqd. ADB Approval
Board of Adjustment Approval Reqd. OQ I
Review By: "L AAAAb bate:
Existing Water Main Size
Water Main Reqd. k)A -
Service Line Reqd. �/,,e_
Hydrant, -Size Existing
Hydrant Reqd. Per Fire Code Size
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Comments
Water Meter Char
wlp Reqd.
Review by: Date:
Septic Tank Design Approved- -Date:
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability Proj. Zc)
Drawing No. File� No.
Side Sewer Availability
Sanitary Sewer Connection Fee R�qd.
Review By:
NOpen Ditch Existing, Reqd.
Culvert Reqd. Size
C4 Catch Basin Reqd. Indicate on Site Plan
0 c
Shoulder drainage miintain collection an swale open ruioff
Zniole reald. Indicate on Site Plan
Soil Conditions and Ground Water Field Cliecked
4A
Re"llie.,7 by Da t,4�,
Street Paving Reqd. Z&1d!:.::
Curb and Gutter Reqd.
Sidewalk Reqd.
Curb Cut for Drive�.,7ay Reqd.
r4 Right -of -Way Construction Permit Reqd.
Bond Reqd. for Public Improven-&-nts
Street Nam, Sign Reqd.
Other Sip-iing Reqd.
0
,,, ZPre Permit Site Inspection made on
,-I ��)C BY: SBIER
r4 WN TA7ATER
STREET
4., L�, SiGINEEPJNG
Special Requireii-ents listed in mamu to Cbin=it- I y Develop7,ent Departmnt,
Building Division.
> BY Im ---Date—
o All iten-s filled in on Building Permit Application W(
BY
Date
DrmAngs Stamed and Notations I -lade
BY Date
A -)proved by Public '%%Torl,,s Departi-�K-nt
Revised: IV 10-1977