635 HEMLOCK WAY.PDFIIIIIIIIIIIIII
11488
635 HEMLOCK WAY
APPLICATION
for
The City of Edmonds SME SMIM PFJIBM
NEW CONSTRUCTION 0 REPAIRS 0
105-06800
OWNER-------- ............ ------------------------------------------------ CONTRACTOR ........................................... . . ltjllooiilw, SOL
ADDRESS .... 635 ... m.-He-MloCk ... WAY. ---------------------- ------------------------------ LEGAL DESCRIPTION: LOT No . .......... IMWVXWMk�
NAME OF ADDITION ............................
A%
DYE TESTED ON SEWER
JULY, 1972
Approved:
DATE ..................
U
Z
kLIC 14ORKS DEPA =,, 4T I CHECKLISO Date
B�=NG PEw-aT REVIEW
5b5 Address
Street'Right-of-Way Existing
REQD
Access Easerrients Existing 1=n Et �'PEE S--�!-M REQD
Utility Easement Existing REQD
Lot per Subdivision 4P ussor
Plat Map
Site Plan Checked for Accuracy
:III
Underground Wiring Reqd.
Check Accuracy of Legal Description
Environmentally Sensitive Area
Environmental Checklist Reqd.
Flood Hazard Zone
U Shoreline Management Area L) �:�
Z 4 Slope, Soil, Vegetation
Stream, Creek, Drainage Basin CD LJ
Existing Zoning Per Code
Amenities Design Board Approval Reqd. Not\) ADB # Approval'
Board of Adjustme- t Approval Reqd.
Review By: Date: t 1-76
I � �L-) K�A �-' �] 11 �'
Existing Water Main Size 4"'c--r-
Water Main Reqd-
. Z
Service Line Reqd. 7��z/
�-Hydrant Size Existing
;�-Hydrant Reqd. Per Fire Code Size
Detector Check Meter Reqd.
Cross Connection Inspection A_.,,e,->
Fire Department Comments
Water Meter Charge Rqqd"
Review by: 7`71-
Date:
�)eptic -i-=,, oesign Approveci A1114- Date:
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availabili Proi. Z- I.C) -7
Drawing No. V File No. 3 2-) .
Side Sewer Availability 07-1
Sanitary Sewer Connection Fee Reqd.
Review By:
Date:
USE: WIT
BUTMUNG DEPARTMEN Applicant Fill ZONE ER
'PERMIT APPLICATION Inside Heavy Lines JOB
N (OR NA OF [NESS) ADDRESS
.6 -3s- tq em lock Ujg=�=/
e
_2
SUBDIVISION NO. PLAT NAME ASSESSOR JAAP NO.
W 7AIL91N�GADDRESS
3': 1,3WD 1,3Z,
0 C ITY jlTELEPHONE NUMBER PUBLIC RIGHT OF WAY PER ORDINANCE NO.
EXISTING RIGHT OF WAY
NAME
PROPOSED RIGHT OF WAY
<�z
DEFICIENCY OF RIGHT OF WAY 0
U
.
—
W ADDAESS
STREET/UTILITY. WORK REQUIRED WYES 11 No
It
U
PERMIT FOR WORK IN PUBLIC R/W IRYES El NO
'UNDERGROUND WIRING REQUIRED M YES 1:1 NO
0
U
0: CITY
cc
TELEPHONE NUMBER
CONNECTION TO SANITARY SEWER 19YES ONO
SEPTIC TANK PERMIT REQUIRED OYES NENO
D
IL
NAME
X
SEPTIC TANK PERMIT NO.
0 ADDRESS
I-
U
SEE MEMO DATED
CITY
TELEPHONE NUMBER
REMARK
z
A
0
U STATE LICENSE NUMBER
CITY LICENSE NUMBER
CHEJKE)13�
Pn,
AA&n
Legal Description of Property (Show Below or Attach Four Copies)
METER SIZE(j
BUILDING SUPPLY SIZE
W
REMARKS
z
0
'd
SIGN AREA
ENV. REVIEW
ADB NO.
U
ALLOWED PROPOSED
COMPLETE EXEMPT
V)
W
REMARKS
W
.J
VARIANCE OR CU
rLAN NING REVIEW BY
DATE
I
YARDS
FRONT 45 SIDE REAR
ILOT COVERAGE
E W GAS
RES.DENTIAL LINE
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
HEIGHT
NON-RESIDENTI]
TIAL SIGN
ADD
I
E] DEMOLISH RETAINING
1:1
SPECIAL INSPECTOR
AREA
OCCUPANCY OCCUPANT
WALL
ALTER EXCAVATE FENCE
REQUIRED
YES
I
GROUP LOAD
I
OR FILL
ET— X—FT)
N 0
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
REPAIR PRE -MOVE swim
OF EDMONDS. LOCAL SALES TAX
INSP. POOL
SHOULD BE CODED 31.04.
NUMBER OF STORIES
-NUMBER OF
REMARKS
DWELLING
I
UNITS
z
W
N E OF WORK T E DONE
CL
W
PLAN CHECK FEE
VALUATION
FEE
PROPOSEiT:US
z
2 /,
z
I-
W
PLOT PLArf (INDICATE BUILDINg SETBACKS,
i;E
it BUTTING STR �S)
BUILDING
CL
U
0
ILI
PLUMBING
>
W
0
MECHANICAL
FENCE
>
t
z
SIGN
RETAINING WALL
0
U
SWIMMING POOL
f
loll a
rmit No: ,�1-0243
City of Edmonds NUe
RIGHT-OF-WAY CONSTRUCTION PERMIT , issue Date: 1� ht /0(
A. Address or Vicini Construction
_7R OL
B. Type of Work (be specific):___1__11'_e1 I
-(o d'i 5 V-1 Q�
_V_ Az- �-v \ x o 'i I-P �, � I 1/d iA ICA
L tK ke- c)
+aygiz�
't- "o-V 0
e�
J
1,,Cx7c_.x -e_7'4�4
1P
�CL dcs
LAS �Ckj(3
C. Contractor:— t I C�_
f\
Contact: - Q FN (:Vkd�- U C1
k
Mailing Address: 1!�tof'0
U%J 0_
Phone: 46 (D4S-q.;?,34
State License#: P, L�.e�Ac,
I() I MCA,_
Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. Fj Commercial Subdivision F] City Project [—] EUC (PLTD, GTE, PSE, CHAMBERS, OVWD)
Multi -Family Single Family F-1 Other
INSPECTOR-
— I Ae
F. PAVEMENT: Q2YES F] NO G. SIZE OF CUT =,Z X '-1 H. Charge: $
CONCRETE CUT: YES NO
e
IDEMNITY. Applicant understands by his/her signature to this application helshe holds the City of Edmonds 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 but not limited to the defense of any legal -proceedings including defense costs and
attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR.: WORKM4NS1I1P,;4ND,,MA TERJALS- FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILLBE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BYCITYFORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT
* Traffic" control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
+ Restoration is to be in 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.
IRAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
(Contractor or Agent)
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
FOR CITY
Approved by':
Time AuthorizeJ:' Void After
Special Conditions:. M&111111'IN FF4 AA
ALL P_
M U -Tc-b gfsvm, , -p- - 0 - W
O&V s-rgNnAF4)5-
E ONLY
ee,
Right-of-way Fee:
Disruption fee/Fund 111:
Restoration Fee:
Total Fee: ? 5'
ReMpt No:_�
issued 6y:-L
o
UPON COMPLETION OF PERMITTED.WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER I CHAPTER 18.00 OF THE EDMONDS
-COMMUNITT"DEVE1jOPMENTCODE.
FINAL APPROVAL OF PERMITTED WORK. (2 lMida eu4- Rmpii� -
INSPEC14OR'S SIGNATURE' DATE: 1nn-?1b;r
For i nspection requirements see Engineering Information Handout.
NO WORK $11ALI, BEGIN PRIOR TO PERMIT ISSUANCE
I
VICINITY MAP
PROP 1— 1/4" PE IP MAIN
9's
LOC EOM
15 WE 9'S
C/D LOC
627 EDE
SCALE
1"=40' ON 00
100
1
1/4 r
1P
HEMLO
0100
00 3X4 CUTS
00
SQUEEZE & FUSE
1091E9 91S
EX EOM 110'E
LOC
STANDARD NCC CONSTRUCTION NOTES:
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. CALL "ONE— CALL" 48 HOURS
PRIOR TO CONSTRUCTION, 1-800-424-5555.
2. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS
AND GAS STANDARDS PROCEDURES MANUAL.
3. INSTALL MAIN VALVES OUT OF TRAFFIC WHERE POSSIBLE.
4. ANY CHANGE IN ROUTE, TIE—IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE
APPROVED BY PSE REPRESENTATIVE.
5. COMPLETE "PIPE CONDITION REPORT" ON ALL EXPOSED EXISTING PSE
FACILITIES. CHECK BOX ON REPORT FOR WIRE BOX (TEST LEAD)
INSTALLATION.
6. INSTALL ONE POUND ANODE FOR EVERY 1000' OF LOCATING WIRE. INSTALL
ANODE AND TEST LEAD WIRES PER PSE GAS OPERATING STANDARDS 14.2 AND
14.5.
7. MAINTAIN CATHODIC 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 WIRES AS REQUIRED PER PSE GAS
STANDARDS PROCEDURES P0201 AND P0303 AND PSE GAS OPERATING STANDARD
10.2. TEST LEAD WIRES ARE REQUIRED ON ALL TRANSITION 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 AND 6.17.
11. COORDINATE INSTALLATION WITH CORROSION CONTROL.
12. EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE
0150.3200 TECHNIQUES FOR TEMPORARY EROSION AND SEDIMENT CONTROL
AND ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.
JOB SITE -
WAY
POWER' TEL, CABLE OVERjjEAD
�2
07-
AV�
F17ER (CHECK BOX IF COMPLETE)
Work area left in Clean & Safe condition
Complete all Pipe Tables and Gas Pressure Stamp
Field changes Red —Lined -on as —built
Material verified and Changes oted on 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
Clompany
Employee ID#
IAlder St
Widnul
St
0
Holly Dr
Cedar St
Spruce St
Heml-ack V.V--
Hemlook St
1-3urel St
Pine St
Cj
yth Ln
FF a r7*7
M
a
>(A
t
1>
,C
CA
Fir Pi
Fir St
GAS MAIN
INSTALLATION /
RE71REMENT
I R
SIIZE
PROP.
LENGTH
ACTUAL
TYPE
MANUFACTURER
1 174
50,
PE
PROJECT ORDER # NOTIF #
PHASE
GAS MAIN
107012214
X807546279
SERVICE
10RI17677A
GAS MAIN PRESSURE
& TESTING
TYPE TEST.
I PRESSURE;
TIME ON:
I TESTED BY:
�AT I F1 5N:
DATE OFF.
TIME OFF:
DESIGN: 60 PSIG
SYS MAOP: 45
PSIG
7
CONSTRUCTION
COST CODES
03-1
HELEN DUNNIGAN
635 HEMLOCK WY
EDMONDS, WA 98020
425-774-4930
CALL 1-800-424-5555
2 BUSINESS DAYS BEFORE YOU DIG
THIS SKETCH NOT TO BE RELIED UPON
FOR EXACT LOCATION OF FACILITIES
REAL ESTATE/EASEMENT
N/A
PERMIT
EDMONDS
FUNCTION
CONTACT
PHONE NO
DATE
PROJECT MGR:
DOUG USITALO
(206) 418-4236
10/21/01
ENGR — GAS:
DRAWN BY:
PEGGY SHULL
(206) 418-4253
10/21/01
DATE
BY
DESCRIPTION
CHECKED BY:
DOUG USITALO
(206) 418-42-36
County
SNO
EMER SEC
5
Work Center
MCNSEG
APPROVED BY:
FOREMEN #11:
NW-25-03-27
OP MAP
�1 64.062
PLAT MAP
164.066
FOREMAN #2:
rMAPPING:
JOINT FACILITIES ARRANGEMENTS
UTILITIES
DESIGNED BY PILCHUCK
PUGET
SOUND
ENERGY
CONTRACTORS, INC.
HELEN DUNNIGAN
2' PE IP MAIN EXTN
635 HEMLOCK WY
EDMONDS
PROJECT#
107012214
SCALE: 1' = 40