621 CAROL WAY.PDF1111111111 lill
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621 CAROL WAY
ADDRESS: cy A I (��01 wv-,ti-,
TAX ACCOUNT/PARCEL NUMBER: 0 0 () ob 0300
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREASDA —1 /;g DETERMINATION: Conditional Waiver Study Required Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: .17,61-
t 0-L
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED: E2
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED: 10 %2
OTHER:
LATEMP\DS'rs\Fomis\Street File Checklist.doc
ROUTING SLIP
NEW SERVICE INSTALLATION
A ��nUOQ.
LOCATES
LOCATE REQUEST NUMB . ER,
DATE CALLED:
FOREMAN/CREW, �FUTURE SERVICE: YES NO
COMMENTS BORE: CUT:
DRAWING LOCK- DATE:
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TAP CARD I MPTPR.ql4F.'PT APPLICATTON/
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Reading: Date -/j
Meter No. No.
IZ Tap
{Size
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110 Ties
Serv. Add. 62-1 C a-r 0-1. wo-
Lot No'.
No.
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Other:
Meter LocationL :S 6. . -�
Service Material:
PressPre__�Ibs- Test
Date of Work '/ - 1 -7- os
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Guar. Vouc' ,,or man.,
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OUT.GOING Index
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Pressure—_Ibs. Test
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Date of Work 1 -7 -
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AUG - 8 2002
BUILDING DEPT.
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City of Edmonds
Plan Review Corrections
Plan Check 0: 02-317 - Date.- 5 ftlMh-or J002
ProJect Name/Addresst DWI 1621 CAMI W.0
Contact Person/Address/Fax:
Reviewer,. JzW# Division: EABbAc&g
During review of the subject suhmittal it was found that the following Informationg corrections, or
clarifications will need to be addressed:
I - Tbe two proposed infiltration systems have been approved, by Don Fiene, for application at this site, We do however,
nftd you to olarify on the drainage plan which sections of the house will be draining to which system, As proposed, the
two systems will equally sham in the infiltration of the impervioas "face runoff for the site.
Please resubmit 3 copies of the revised plans/documents to a Development Services Coordinator.
DATE FAXED_ (Attach fax transwIttal)
review-=mmant mstr.doc
PAGA OF -
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KING COUNTY, WASHINGTON, SURFACE WATER DESIGN MANUAL
FIGURE 4.5.1A ROOF DOWNSPOUT INFILTRATION SYSTEMS
R-A rA v
Ne, A9r-
(il" V14 vjwak�o p
0 re
plaw
I=-- vkf-=v4 —Lu— I
wo 40)*
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5�:el-l.vvev No+"(
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to-Klt 424,-C" vle- )
fVWX V%'Al 44f (��k)
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AT0115 Poe 41001,00
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1,0
4.5.1-3 1/90
ow
KING COUNTY, WASHINGTO N,-,SU,RFACE,WATER DESIGN MANUAL
0 Filter fabric shall be wrapped entirely around trench drain rock prior to backfilling.
Method of Analysis/Length of Roof Downspout InfWration Trenches
The length of trench required Is based on the assumption of providing a bottom trench area sized to
infiltrate at a rate equal to the rainfall Intensity for the peak 10-minute time step for the 10-year, 24-hour
duration design storm event (Time stop 460 to 470 minutes, 5.4% of total storm volume P,,, see Table
3.5.1 A), and by the maximum Infiltration rate Q.) which Is based on the $oil Texture Class by the United
States Department of Agriculture (U.S.DA) designation system (see Figure 4.5.18 and Table 4.5.1 A). The
length of trench required is determined by dividing the required Infiltration area (A) by 4 feet, (the two -foot
trench w)dith plus one foot on either side for side wall Infiltration). A, Is com"puted using the following
equation:
AR = (0 .064 P10Q/10 Im
a ; 7) "4
110-2 our design storm total precipitation, inches (from Figure 3.5.1 E)
Where:
P10
IM
the maximum Infiltration fate from Table 4.5.1 A. min./inch.
area of the roof tributary to the system, fe. (Note: a typical single-family residence has a.
roof area of approArnately 2,000
Therefore. the trench length required Is:
L . (A114 (fast); in feet
TABLE 4.5.11A MAXIMUM INFILTRATION RATES FOR ROOF DOWNSPOUT
INFILTRATION SYSTEMS
Maximum Infiltration Rates Qm)'
Son Texture Class (U.S.D.A.)
Onches per Hour)
(inches Per Minutes)
1. Coarse sands or Cobbles
20.00
�'_Ogsk-
2. Medium sand
3. Fine sand, loamy sand
&27
2.41
0.040
4. Sandy loam,
1.02
0.62
0.0 17
0.009
5. Loam
*From a study of over 5,000 soll samples under -carefully controlled procedures by the U.S.D.A.
(Rawls, Brakensick and Saxton, 1982).
Example: Proposed residence located at Kent East HIP
Roof arm (Ap) - 2,0W square feet; Soll Texture ss = loamy sand;
Im = 0.040 Inches per Mintite', V,, �=. 2.9 in=cheS
= (0.054 PION/10 Im = ((0.054) , (2.9)(2,000))/((10)(0-040)) - 783 fe
K = J�/4 = (783) /(4) = 196 fee - (Note: could b�`acoomplished by two trenchs).
A
4.5.1-2
KING COUNTY, WASHINGTON, SURFACE WATER DESIGN MANUAL
(4) The rates .�z 16,r, all one -inch times are then averaged to estimate the maximum Infiltration rate (Ij. ThIs
process Is repeated three times, and the average of the three tests used to compute the maximum
Infiltration rate (Ij for the test using the equation shown above for surface Infiltration tests.
Methods of Analysis
Use of IM In Hydrologic Analysis: Once 1, for a given soll surface elevation has been computed It may be
used to develop a stage/discharge curve for use In the 'level pool routingo method described in Section
3.5.4, In Chapter 3. At a given stage the discharge can be computed using the area of the surface through
which Infiltration will occur using the following equation:
01 = 1, .41/720; (720 converts Inches per minute to feet per second),
where: the outflow due to Infiltration, In fe/sec.
.A, = the area of the Infiltration surface, In ft2.
The area (Aj available at each stage Is determined by planimeter or noted from the areas of contours used
In developing the storage available at each stage. Note: for design of proposed Infiltration tanks or ponds
a factor gi allift of 2.0 must be applied to the potential infiltration discharge by dividing by 2.0 (0,/2.0) for
each stage on the stage/discharge curve.
4.5.2-2 1/90
0
0
KING COUNTY, WASHINGTON, SURFACE WATER DESIGN MAN -UAL
4.5.2 MAXIMUM INFILTRATION RATE TESTS
The following maximum Infiltration rate tests are required In order to provide a conservative esdinate dthe
potential outflow rates for: existing areas providing Infiltration, such as closed depressions/wetlands; ard,
for proposed Infiltration facilities. In general, the maximum Infiltration rates determined through the$& tggs
should not be significantly faster than those shown in Table 4.5. 1 A for the given soil texture class. If ithey
are significantly faster, the testing procedure, the soil texture classification (Figure 4.6.1 B) or the speaff�
site conditions should be reassessed.
Surface Maximum Infiltration Test
The surface maximum Infiltration test Is used to estimate the average surface maximum Infiltration rate VJ
of the surface soils In a closed depression, retention pond, detention pond, Infiltration pond, or In a
proposed ponding area that will be constructed by berming (as opposed to excavating). The test Is
designed to almulate the physical process that will occur during design storm event conditions, therefc)re,
a saturation period Is required to approximate the soil moisture conditions that would occur during a rujor
storm event. A Pipe Is employed to allow only the vertical maximum Infiltration to be measured so that R
may be used to compute the rate of Infiltration over the area of Infiltration.
TestIng Procedure
(1) Without removing loose top soil and surface debris, a 4-foot-long, 6-inch-inner-diameter sedlon of
pipe is driven Into the soil a depth of 6 Inches.
(2) The pipe Is filled and kept to a minimum depth of at least one foot of water above the ground
surface, at the bottom Inside the pipe, for a period of not less than 4 hours (the saturation period),
(3) Following the saturation period, the pipe Is filled to the top and the time required for the water to fall
every Inch, down to 6 Inches below the top of the pipe, Is recorded.
(4) The rates for all one -inch times are then averaged to estimate the maximum infiltration rate 41,). This
process Is repeated three times, and the average three tests used to compute the maximum
Infiltration rate (IJ for the test using the following equation:
1. - E (IJ,x3/3), Inches/min
Sub -Surface Maximum Infiltration Test
The sub -surface maximum innitration test is used to estimate the maximum sub -surface vertical Infiltration
rate at a particular level In the soil horizon that corresponds with the lowest finished grade elevation of a
Proposed Infiltration tank or pond. The test Is designed to simulate the physical process that will occur
during design storm event conditions. therefore, a saturation period Is required to approximate the soil
moisture conditions that would occur during a major storm event. A pipe Is employed to allow only the
vertical Infiltration rate to be measured so that -the computed maximum Infiltration may be used to compute
the rate Of Seepage over the area of Interest for varying head.
Tesfing Procedure
(1) A hole Is dug to the finished grade elevation of a proposed infiltration tank or pond and of sufficient
diameter to allow a 64nch-Inner-dlameter section of pipe to be placed In the hole and driven Into the
soil at test elevation a depth, of 6 inches.
(2) The pipe Is filled and kept to a minimum depth of one foot of water above the real alevallon, 01 Ipp
bottom Inside of the pipe, for a Period of not less than 4 hours (the saturation period).
(3) Following the saturation period, the pipe is filled to the top and the time required for the water to fall
every Inch, down to 6 Inches below the top of the pipe, Is recorded.
40
4.5.2-1
PLANNING DATA
TE
SITE ADD
PROJECT
REDUCED SITE PLAN PROVIDE as No)
MAP PAGE:Z57
'�7 CORNER LOT: ff-es-tija) FLAG LOT: ffRLKR�)
Z0NINGA2_S_'._6 CRITICAL AREAS DETERMINATIONM 02— 112—
U study Required:
O'Con'ditional. I Waiver
SEPA DETERMINATION:
Fee
Checklist
L3 APO list wl notarized form
L3 eeded for 500 cub yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
Exempt
SETBACKS:
Required Setbacks:
Street: 20 Left Side: Right Side:. Rear:
Actual Setbacks:
S ' treet. Left Side: Right Side: —Rear:
Street map checked for additional setback required? (Yes ad��N D)
L3 DETACHED STRUCTURES: kZ�
tw�*OCKERIES:
L3 FENCES/TRELLISES:
Ll BAY WINDOWS I PROJECTING MODULATION:
L3 STAIRS/ DECKS:
PARKING: Required: '7- Actual:
LOT AREA:
LOT CO ERAGE'
t4_9066=L� - V—
calculations: (5DO 70q --t NO'
BUILDING HEIGHT:
Datum Point: H F+ (a 41 Datum Elevation: (1767.10
Maximum Aflo ad: ActualHeight: 4rZ1?1.,9&f
n 0j'o
A.D.U. CREATED?A_ Yes)
SUBDIVISION:
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED
OTHER:
Plan Review By.
NewBPPIamh�gDataForm.D0C
QA File
No: Da
Critical Areas Checklist
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location:
2. Property� Tax Account Number: 0 C)5_ L� 16 06 6 260
3. Approximate Site Size (acres or square feet): 0 0
4. Is this site currently developed? yes; no. --
If yes; how is site developed7
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 10-feet over a horizontal
distance of 6.6-feet).
HWy: slopes present on site of more than 15% and less than 30% avertical rise of 10-feet
. over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal
distance of less than .33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: W Q Approx. Depth:
7. Site contains areas of seasonal standing water: 0 Approx. Depth:
What season(s) of the year?
8. Site is in the floodway �V Q) floodplain of a water course.
9. Site contains. a creek or,an area where water flows across the grounds surface? Flows are year-round?
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: Mn
Critical Areas Checklist.doc/3.19.2001
City olkdmonds
Development Services Department
Planning Division
Phone: 425.771.0220
'4, 9.91� 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 i s 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).
Date Received�
CityReceipt#: AO.Alle-,
-7r
Critical Areas Fil�T
Critical Areas Checklist Fee:— $45.00
Date Mailed to Applicant.
A property owner, or his/her authorized representative,
must fill out the checklist, sign and date it, and submit it
to the Cit I y. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete'a deve I lopment
permit application.
Please submit a vicinity map, along with the signed copy
of this forn, to assist City staff in finding and locating the
specific I 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, I 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 bas . ed in whole or part upon false, misleading., inaccurate or
lo ees.
mcomplete information furnished by the applicant, his/her/its agents.or emp , y
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) kile,this application the behalf of the owner as listed below.
SIGNATUR VAGENT DATE
E OF APPLIC.AN.
.Prope . rty Owner9s Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land. use application,
Is and the staff of the City of Edmonds to enter the subject property for the
and grant my permission for the public officia
.purposes of inspection and . posting attendant to this application.
DATE
SIGNATURE OF OWNER
Owner/Applicant:
'1-0 t")
Name
§treet Address
0 tO b<
City State Zip
Telephone:
Email address (optional):
1p Ny' q'2-3 '7 7 L-t - 2- 0 6
Critical Areas Checklist.doc/3.19.2001
Applicant Representative:
k--� C�
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
'PERMIT NO. 9,699
City ..O*f Edmonds.
'PERMIT EXPIRES
Q,Tnr QVWVID PFRA41T
C
Address of Construction: k� t,�o \'v A LID #
Property Tax Account Parcel No. L 0 7 �4 C� o 0 06' '300'
Attach copies of all access and utility easei
Owner and/or Contractor!
Contractor License 101
Single Family
EJ multi -Family (No. of Units
Commercial (No. of Units
F], Public.
S
Verified, and Approved b
.�:s G �C-71
M A a0huilding Permit
Invasion into City *Right-ot Way: Ely'es' R, No
*RW Construction Permit
Cross other "Private Property: E:1 Yes 15&-No
'�*Attach legal description and copy of recorded. easement.
e n 'knowledgement state'
Owner or contractor sighatur a d ac menC:
By signing for this. permit Lcertify.that I have read the- City I's public handout entitled,.
Oide Sewer Specifications, and shallc'omply with all.City requirements. outlined therein.
Date
2 'CALL DIAL -A -DIG (1-800-42:
TJ5555) BUORE ANY EXCAVATION 9
FOR INSPECTION CALL 425-771-0220 extension 03a6
24 HOUR NOTICE REOUIRMFOR ALL IN.SPECTION REOUESTS
21
2, 2' deep
garage
14.5'
C/o
fame
exist
femco donut 9'deep
pp exist cone
81
Prvt Drive - Carol -Way
CITY OF EDMONDS SIDE
SEWER AS -BUILT
ADDRESS
PERMIT
621 Carol Way
9699
HOMEOWNER
CONTRACTOR
-
Tom Belt
DATE
DRAWN
1/16/2003
BY J McConnell / J Hawkins
Loot
TOM BELT HOMES PHONE NO. : 425 7742096 Sep. 11 2002 01:45PM Pl
51TE' PLAKI
L'or P AN, Y )�d E, A, ID V ' NJ
C-ITY ale
SsJ.0)-40Ml'5H CO., Wb-
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CLO.0
W ZONE
SETBACKS:
TRA�Cr A, FRON
ouhr.
To -: -��
R-'EiR Q
OTHER
HEIGHT
A OVED ING
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City of Edmonds:
RIGHT. PjF-WAY CONSTRUCTION PERMIT
A. Address or Vicinity of Construction
B. Type�of WqTl� . (be s�ecific): 2-
C. Contractor: VZ> t - I � Y C I UV�kQV%_ %.1 (3. (Vt
Mailing Address: OWO 011-0
State License L01 �k C r
a
- Q I �r -
W116mit No: (:K7400.3 -0 M/
. Issue Date: allclaoo?,
_37o
LSL,� S,1,3*,L(�.
3 6
2
Liability Insurance: Bond:
D. Buildmig Permit # (if applicable): Side Sewer Permit # (if applicable):
E. 0 Commercial 0 Subdivision El City Project EUC (PUD,� VERIZON, PSE, AT& T, OVWD)
X
r_1 Multi -Family. gle Family El Other
'I,' - I
Si.!. . I /� U
X� MtA lee.L_v
F. PAVEMENT CUT: [Z YES Ej,NO G. SIZE OF CUT
CONCRETE CUT: YES 0 NO
INDEMNITY. Applicant understands,�'byv,lhfislhe si __ ature,to this dpplication, helshe hol jthd`� Cit�"'q
�dS Edmonds harmless ftom.
injuries, damages or claims of any in o' 'd, scrip J
k- - d'' r e_` - tion whatsoever, foreseen or unforeseen, Mat may be made against the City of
Edmonds or an� of -its departments or �'ii?mployees, including,but not limited to the defense of any legal proceedings including defense
costs and attorn 'fees by reason of a�?ting this permit.
ey gr
-THE 'CONTRACTOR IS RESPONSIBLE FOR WORKMA AND MATERIA
L�i,,FOR'�'A'-PERIOD--OP-6�Vt,',YEAR'FOLLOtffNG THE FINAL
-!VSHIIFI
INSPECTION AND A CCEPTANCE OF THE4ORK � ESTIMA TED RESTORA TION: FEES, W!L� Bg ,HELD UNTIL THEFINAL STREET PA TCH IS
COMPLETED B Y CITY FORCES, A T WHICH TIME A DEBIT OR CREDIT W1LL BE PROCESSED FORJSSUANCE TO THE 5PPLICANT.
Traffic control and public safety shall be in accordance with City regulations as required'by the City Engineer. Every
. flagger must be trainedl.ps required by (WAC) 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.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ THE ABOVE STA TEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND. ACKNOWLEDGE
THA T I MUST MAKE THE PINK COPY OP THE PERMIT A VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Signature:, ACLt_AA_ Date: �7_
A -A
(Contractor or Agent)
FORCITYUSEONLY
V1 . . I
. Right-d-wity 10
Approved by:. �'Fee:
Time AuthorUed: Void After. 119 2�V Disruption Peeffluind 11 t:,.
Special Conditions: roWVZOL Vlav— Restoration, Fee':Ic
5 T o t A!, F e,e;
RLL YuA-rerz. Receipt No -
UPON COMPLETION, OF PERMITTED WORK. 9 AN ENGXNEERINIG FINAL
INSPECTION IS REQUA RED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425771-0220, Ext. .1326)'.
PINAL APPR 0 VAL, OF PERMITTED WORK. ?et :Q; j< c) - kA w;+ 4=,* U DATE': 10/Z70/07
Inspector's Signature g�11_11o3
For inspection requirements see Engineering Inspection Information handout..
DAMy Documents\Forms\Engamg\RO'Wpermit..doc
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CITY OF EDMONDS
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,6SE PERMIT
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CONSTRUCTION PERMIT APPLICATION'
JOB
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OWNER NAMEINAME OF BUSINESS
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
MAILING ADDRESS
LID FEE $
7
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Req'd
13
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inspection Required
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Sidewalk Required
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13
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NAME
METER SIZE
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GARAGE RETAININGWALL -1 FIRE SPRINKLER
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Description
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Description
FEE
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State Suir6har&
ASHEAT SOURCE
GLAZING %
LOT SLOPE%
I Building Per mit
City Surcharge��'�:
PLAN CHECK
VESTED DATE. -
Plumbing,
THIS PERMIT AUTHORIZES 0 NILY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
BEDONE ON PRIVATE PROPERTY ONLY. ANY CON . STRUCTION ON THE PU LIC
:3
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC�) WILL REG UIRE
6iad1bg
SEPARATE PERMIS SION.
Engr. Review
J
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PERMIT APPLICATION: 1180DAYS.
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT
�Engi., :10spection
FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS F ire. Review Plan Chk. Deposit I
.
IN INTEREST, AGREES TO INDEMNIFY, DEFEND:AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire In6pection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY Receipt #
FROM THE ISSUANCE OF.THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED
TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 C"54",
NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' 4 7
I
Recordi ng Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATI ON; THAT THE INFORMATION
I
GIVEN IS CORRECT.' AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION AP ROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND INDOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE I EMPLOYED CALL This application is not a permit until signed by the
IN vioLATON, OF THE LABOR, CODE, OF THE STATE OF WASHINGTON B
RELATING TO ullding Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is
WORK EN!& COMPENSATION INSURANCE AND RCW 18.27. acknowledged in space provided.
- NATUI (Ow R I AGEN-n DATE ICI LS S DATE
0 A !GNATUR
(425)
7710220 -FgL
bATE t
ATTENTI N EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A 13UILDING OR STRUCTURE UNTIL
A.FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
l..." ORIGINAL - FILE YELLOW- INSPECTOR.
OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 �,)5, "... " I
4w-*. 2
le:� 05 PINK . OWNER GOLD I ASSESSOR
PRESS HARD -YOU ARE IVIAK�NG 5 COPIES GREEN - ACCOUNTING
R/W
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2000
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TIE— IN ELI
2" x i— 114", TEE TAP L1J1
290'N�CL & 18'W'CL M
1 :21
(—')N CL
')W CL
104' S
2"STW IP 18'W(CP)
72C362
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PROPOSED 370'
1�114" PE -IP MAIN
10's CL
(---)S CL
t-lb - M44
PL
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EOM
1— 114" PE CAP
IO'S CL & 352'E CL
(—..)s CL
(_ ')E CL
FITTER (CHECK 13OX IF COMPLETE)
Work area left in Clean & Safe ondition
Complete all Pipe Tables and Gas Pressure Stamp
Field changes Red —Lined on as —built
Material verified and Changes oted an paperwork
All Valve & Tie—in Locations noted on as —built
Note beginning of Main, EOM & Line of Main locations
Show Rope Locations & Cul—de—sac -Radius
Foreman's Signature
Company Empl oyee ID#
STANDARD NCC GAS
CONSTRUCTION NOTES:
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. CALL 'ONE— CALL: TWO WORKING
DAYS PRIOR TO CONSTRUCTION. 1-800-424-5555.
2. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS
AND GAS STA14DARDS PROCEDURES MANUAL.
3. INSTALL MAINYALVES OUT OF TRAFFIC WHERE POSSIBLE.
4. ANY CHANGE IN ROUTE, TIE—IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE
APPROVED BTPROJECT MANAGER.
5. COMPLETE "PIPE COND17ION REPORT' ON ALL EXPOSED EXISTING PSE
FACILITIES. CHECK BOX ON REPORT FOR WIRE BOX (TESTLEAD)
INSTALLATION.
6. INSTALL ONE POUND ANODE FOR EVERY 1000' OF LOCATING "RE. INSTALL
ANODE AND T."ST LEAD WIRES PER PSE GAS OPERATING STANDARDS 14.2 AND
14.5.
7. MAINTAIN CArAODIC PROTECTION FOR STEEL MAINS BY THE USE OF
-CONTINUITY BONDS OR OTHER MEANS DETERMINED BY THE PSE CORROSION
ENGINEER PER PSE GAS OPERATING STANDARDS 10.3
8. INSTALL ANODES AND TEST LEAD "RES AS REQUIRED PER PSE GAS
STANDARDS PROCEDURES P0201 AND P0303 AND PSE GAS OPERATING STANDARD
10.2. TEST LEAD WIRES ARE REQUIRED ON ALL TRANS111ON FITTINGS.
9. - REFER TO PSE GAS OPERATING STANDARD 6.8 FOR MAIN AND - SERVICE COVER
REQUIREMENTS.
10. MAINS AND SERVICES SHALL BE TESTED AND PURGED PER PSE GAS
OPERATING STANDARDS 6.14, 6.17 AND 14.2 AND PSE GAS FIELD PROCEDURE
P0816.
11. CUSTOMER PROVIDED TRENCHES ON PRIVATE PROPERTY SHALL CONFORM TO PSE
STANDARDS.
12. EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE
.0150.3200 TECHNIQUES FOR TEMPORARY EROSION AND SEDIMENT CONTROLAND
ANY ADDITIONAL LOCAL JURISDIC11ON REQUIREMENTS.
13. TO PREVENT ACCIDENTAL OVERPRESSURE OF ADJOINING SYSTEM, NO TWO MAINS
SHALL BE CONNECTED EXCEPT AS SHOWN ON THIS DESIGN UNLESS APPROVED BY
A PSE REPRESENTATIVE.
14. SYSTEM MAOP DENOTED BA SYSTEM MA5P - 45 PSIG.
GAS MAIN IIISTALLA110NIRETUMMEM
TypeMork
Pipe Size
Type
Estimated
Length
Actual
Length
Manufacturer
INSTALL
1-114"
PE
370'
GAS MAIN PRESSURE & TESTING
TYPE TEST
PRESSURE
TEST-ED BY
DATE ON
TIME ON
OFF
TIME OFF
,DATE
TYPE TEST
PRESSURE
TESTEDIBY
DATE ON
TIME ON
DATE OFF
TIME OFF
Design Press 60
Sys mAoP 45
WORK SITE
At
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PROJECT PHASE
NGTIF#
ORDERN
t
SAP Superior
Service/Meter
Service/Meter
Service/Meter
Service/Meter
Ind. Service
Ind. MSA
Dis. Reg. / FT
HIP Svc/MSA
Relocate
Retirement
�X067861875
107015276
X776976111
106099000
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PO
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Ownerl Developer Contact lnfb
TOM BELT HOMES
PO BOX 314
EDMONDS, INA 98020
ATTN: SAME 206-949-9009 ofnoe
Contractor CONSTRUCTION COST CODES:
CALL (800) 424-5555
2 BUSINESS DAYS BEFORE YOU DIG
THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCA71ON OF FACILMES
REAL ESTATEIEASEMENT PERMIT
NIA EIDMONDS
1.0214034
Project Manager Corftct Information:
DOUGUSITAILO
CELL: 425-327-Mi
REV#
DATE
By
DESCRIP1`110N
FUNCTION
CONTACT
PHONE
DATE
3
PROJECT MGR
0. USITAL 0
206-4184236
11215102
2
ENGR-GAS
DRAWN BY
P. MCGHUEY
206418-4214
12/19102
CHECKED BY
D. USITALO
206-418-4236
1:1
COUNTY
SNOHOMISH
EMER SECT
5
GAS WK CTR
MCNSEG
APPROVED BY
0. USITALO
206-418-4236
FITTER #1
1:1
0
1/4 SEC
NW-24-27-03
OP MAP
.160.062
PLAT MAP
162.066
FITTER #2
MAPPING
1:1
JOINT FACILITIES ARRANGEMENTS
El
UTILITIES
CONTACT
PHONE#
PUGET
BOUND TOM BELT
EMGY -1/4" PE IP MAIN EXTENSION
621 CAROL WAY, EDMONDS, WA 98020
DESIGNED BY PILCHUCK CONTRACTORS INC.
SAP Superior Order:
107015276
-Drawing Number.
NIA
SCALE:
11"= 50'
E:
111
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