640 ALDER ST.PDFiiiiiiiiiiiiii
10061
640 ALDER ST
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:Wq3<UQ9Yb/-:3n0
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: q�-/7(j 7fi4jq f - DETERMINATION: [:] Conditional Waiver E] Study Required �Waiver
DISCRETIONARY PERMIT #'S:. 65. 191
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED FOR:
PLANNING DATA CHECKLIS'
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DA
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR
WATER METER TAP CARD DATED:
LID #:
LOT: BLOCK:
I ��, -, AQ - 0; 9/ - 0 b" � 72
LATEMP\DSrs\Fomis\Street File Checklist.doc
4* PLANNING DATA
SINGLE FAMILY RESIDENTIAL
STREET FILE
Name: O'er— Date: :t q1 �1,o
Site Address: qo Plan Check RZ-,() 200 7 OF7
Project Description: ja/-aq e- <
Reduced Site Plan Provided: NO)
Zoning:
Map Page: -Lo 3
Corner Lot: (YES A
Flag Lot: (YES
Critical Areas Determiriation ff: Mq&7
6
El Study Required
aiver
SEPA Determination:
El Exempt
El Needed (for over 500 cubic yards of grading)
0 Fee F-1 Checklist El APO List with notarized form
Required S?tbacks
Street: Side: Rear: IV
Actual Setbacks
Street: Side: Rear: 5—
Detached Structures: caA/c,5 -
Rockeries: JC9 1 - 5-
Fences/Trellises: t,91. �C--
Bay Windows/Projecting Modulation:
El Stairs/Deck: 116.,S /wok
i Height
Datum Point:
Cale_ — /. )
Datum Elevation:
Maximum Height Allowed:
Actual Height: S--
Other
Parking Required:
Parking Provided:
Lot Area: 0 Maximum Lot Cove rage: 35% Proposed:
Lot Coverage Calculations: A z-
ADU Created: (YES
Subdivision: 10q—
Legal Nonconforming Land Use Determination tssued: (YES
Cornatents
6-,Vd-,�
�e IOtA - - , (/
oofto(
Plan Review By: �7/
Ptannog Data form 04-11-06.cloc
y
CA".
0
c I Areas Checklist
a
-Site inforinition (soils/to o&aphy/h' rology/vegetation)
p yd
1. Site Address/Location- -De Lt _'. 5 r
Al
2.-. -Propeav Tax Acoou'nt Number�, 4� 4 2 - 0 3 4 - blS - 00 0 7
3. Approxin�ate* Site Size (acres or square feet):'
JUL
.0.7 1995
.4. Is this site.�urrently`dev*eloped? yes; no.
is site developed? 49144; FAmmy��,
If yes; how
-5..,. Describe.the gen" site topography. Check all that apply.
if jeg_,;hap,_,5-fee6elevation change over entire-eite.:,/,ibtoa,5rD
� OW
iiij; slopes,on sttd en&ally less than rise of 1046a
over a
'66
-feet).
bj44Mjth6i6n6d 6f
t T,1� I
'ZO 54
IN; - .116bes, i
iresent on Ake 6f more than 15% and less dm 169� i.avaftlml ricP
fV. . 0 � J�
33 to 66466Q.
a-Wrii6ntaldistanceoei
hah,30% present on site (a vertical rise -f
C1 Aktt,� of 10 �d over a,"
h iontal diftinkiiof I
oh ess than 33-fp�)'
4f
oi,y ink ihviv, L'! -1, 2�_
er- feai��esci(ibe):,r,�,*,�,,',,,�",�t
o
4... ,.Site,,contains�,-areas-bUyear-round, standing water:.-_ Approx. De
pth:
iiih .`4 .,A iffli-IL 0,
7. Site'coniains keai of siai�n'all stah'ding water: Ajd
.;,�pprox. Depd�:.
"What- te"(s)jpf,�e. y5�q
.0 N V`f' of
��Siw is:M e - bw a water
9.. Site toftwins'al.. =or an area flows across the grounds surface? Flows are year--
�4 al
roundT,,-:.-",:, PO
(W
_Oat time of year?.
gA
f
-shrubC, i m i ied f
10. Sf orested'', meadowl i nt OL,
urban I
11. Obvioils and.'is,,pres on,Mte:'. NV;.,
bvi
sli"si
4
soil i)? de4�
inventory'or C.A. map indicates �vetland
:3.-. W.
;I.,- Obiadi :Dresent an site? Aln
t
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-P
890-19
Ednion'
�-Cit
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q'A l." V44A�T3 .40 5
The Critical Areas Checkristoontaini�d,,,6�k��0�&,,riand.,siibmit,it'aykht�-at�,
cl), is
this form is -to be filled - opt.by
..,W*rson, - w- fW,
r. Yrn L
& kh
! t
L -dp inadoinino
q
eterm
4
uen �s sma essar
.g,, y
Mittel d(gi
to
till,
kpplication - for the',,C
.Wof Edmonds" R. t Omplete.t',
ment pxmit i 1 0 n..,`!*��,
th
permit to. e
av
With gn copy o
e
Ii h6bId'9WsubMit iv—kinit k*.'Map '7"
The purpose'of 'the'' Chec'.1kItst is'to enib �. ,-, :, 0'1�01��
:N, ap
City staff to determine whether any or Plot plawfor -individual,:Iots of the parcel
potential Critical Areas are or may be.., ...... *0 enough detail that City staff can find
present on the subject prop". The t4e su4ject,pap
identifif,
d
-needed to'conioleteft 7 the applicant s all Ind u e,
informati6fi
Checldist should bd iiasily availible from-M-4.," (e. 4� . 4, iite�
1 9
obwmtions.of the site, or data available at,_.� plan.."pography. ` -,4c.,)'-,otstudiesin.'.,".,.,-
mao
City Hall (Critical Areas.mventones,,Maps;;)A,.-,'. yfigon nction'with this, hecldist,tw assist
W.
or soil surveysY0.-, staff in compt Jpg, eir prelunina
3'C,+ S"
An aipplican orhi dr iorc�dntatft;i�,-�,*
-A
must fill'outAhe,,diecklist,.sighl�hd dateIt �r-
'4��heckl d" Ad" ed
I have completed the.*&taqh0.iQritiWAj,
istan a�� answers4provi___,stre,,.A4- i
to th wledge.(fi# qutoe -a—
pf-my-kno- a In
&POO ppropri tebolu ft
Owner 1. Applicant- ApplicancRepresen tivet
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Un TAfj, 1z. A �";Zr
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Name
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ALP
StreetAddress;.,,�.-- "A
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Any request for modification, variance or other
administrative deviation (hereinafter "variance")
_CMa O[Fout
must be speciflually d ide ed. Ap-
proval of any plat or plan containing provisions
which do not comply with city code and for which a
variance has not been specifically identified, re-
quested and considered by the appropriate city
official in accordance with the appropriate provision
of city code or state law does not approve any items
not to code specification.
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CALL FOR
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CA FILE NO.
Critical Areas Checklist
Site Information (soilsftv . ographAydrology/vegetation)
1. Site AddressALocatton:640 4-1 d v- 0--
2. Property Tax Account Number: V,3q;j__0,jy-o13_000-7
3. Approximate Site Size (acres or square feet): '5- 10 0 ZV
V U
4. Is this site currently developed? --k—yes; no.
if yes; how is site developed?. H p Lks
5. Describe the general site topograph y. Check all that apply.
X Flat:* less than 5-feet elevation change over -entire site.
RECEIVED
-AUG 17 1994
F E R I �, I ii T1. G I, VIN T E RI
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than-15% and less than 30% ( a vertical rise
of 10-feet over a horizontal distance of 33 to 66-fed).
Steep: grades of gricater than 30% present on site (a vertical rise of -10-feet over a
horizontal distance of less than 33-fed).
Other (please describe):
6. Site contains areas of year-round standing,�rater: 116 Approx- Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
S. Site is in the floodway /1) V floodplain of a vrjw course.
9. Site contains a creek or an area where water flows. across the grounds surface? Flows are year-
round?. jLj C) Flows are seasonal? (What time of year?.
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wedand is present on site:,
-A C.Ai-nnoittdicatesCritical -Area on sitid?
reaj; inventory or
thiii&§h: ted' rthsubsidmice'*Iandslidt:�hazard-2real.
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RCYO.W-19M
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City of Edmon&
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 -
Ile purpose of the Checklist is to enable
City staff to determine whether any.
potential Critical Areas are or.may be
present on the subject -property. IMe
information needed to complete the
Checklist sh6uld 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 it,
and submit it to the City. Ile City win
review the checklist, malm a precursory site
visit, �and make a determination of the
subse.quent steps necessary to complete a
development permit application.
With a signed copy of this form, the
applicant should also submit a vicinity map -
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (eg. site
plan, topography map,. etc.) or studies in
conjunction with this Checklist to assist
staff in completing their.preliminary
aspessment of the site. - -
I have completed the attached Critical Area Checklist and attest dW' the answers provided are
factual, to the best of my knowledge (fill. out the appropriate column 'below).
Owner Applicant- Applicant Representative:
Name' Nam
0.
Street Addrez
q 60A0
d-<
City, State. ZIP Phone
&t 212f- z
Signature I
(13 Pt A)F—.
Stred Addrem
9 ox-I �
-amry 5, 0411L W --QM ge-ko
d(y-. StAe. ZIP Phone
9//
Signature I Date
APPLICATION
The City of Edmonds for EASEMENT NO. — -----------------------------------------
SIDE SEWER PERMIT
105-02500 NEW CONSTRUCTION [] REPAIRS 0 LID NO - ------------------ - ASMT. NO - ------------------
OWNER ............... Cbe-ste.r..Dep.ew --------------------------------------------------- CONTRACTOR ------------------------------------------------------------------------------------ PERMIT NO . ....................
. .... ...... .. ..... ....
JOB ADDRESS ..... 640 ... A-1-de.r --- Stree.t ............................. -------
-- - ---- -- ------ ---- -
LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
NAMEOF ADDITION ------------------------------ ........................................................................................
DYE TESTED ON SEIVER - March 1,, 1976
By Jim Jensen
Approved:
DATE............................................ By ............................................................
11/75
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City of MmFondtgVt om Permit No: .709'
L6 ENT SERVICES 1 3-622�3
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Dat.:fluy�W_3
A. Address or Vicinity of Construction:
B. Type of Work (be sp�cific): .-Xp 1444�n
.- - fit A- Z_L r.-L-L '1 41 11 __L__ a <
W 0 1'- / 0 7 0 / ( - _1,JA
C. Contractor: F�5E- ZP" 1--h Lte.-k-
Mailing Add,ss:—/ 3 3 _3o _Sfoe) e.,
State License #:-?/z C I-IC41: 101 M 1!�=
D. Building Permit # (if applicable):
Contact: . '51uc_ 0 4MALOALL
Phone:
Liability Insurance:— Bond: $
Side Sewer Permit # (if applicable):
E. E] Commercial E.] Subdivision City Project' EUC (PUD, VERIZO�OAT& T, OVWD)
Multi -Family, E] Single Family El Other
INSPECTOR:
F. PAVEMENT CUT: [I VES RNO G. SIZE OF CUT _ X
CONCRETE CUT: [I VES ONO
IND EMNITY. 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 hut not limited to the defense of any legal proceedings including defense
costs and attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS "SPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECT70N AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL HE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BYCITYFORCES, AT WHICH TIMEA DEBITOR 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.
CALL DIAL -A -DIG (1-800-424-5555) ?RIOR TO BEGINNING WORK
IHAVERF,4D THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THATIMUSTMAKE THE PINK COPY OF THE PERMITA VAILABLE ONSITE A TALL TIMES FOR INSPECTIONS,
Signature: is�� Date: dla to /0,-�
(Coii-tractor or Agent)
FOR CITY USE ONLY.
Righi-*of4viy Fee:1 dr� + isr
ortz bi'siupti6n. 06e'/F�ndl 14:
1111 tIO s: '.i'i6ri6o6 fee;
T dt IF
o a
ect
tas""R eiptNo:,�
issue
. I V.
1114_wz� 32mm d b
fl& Is.,
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7 jl�,
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UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)
FINAL APPROVAL OF PERMITTED WORK.- DATE:
Inspector's Signature
For inspection requirements see Engineering Inspection Information handout.
No \VORK SIIIALL 14JAN I'MORTO VERNI]ITISMIANCF,
DAMy D—fflAF.—\E.g—S\R0Wp..it_.d.
I
I
a** TIME 15:46 *** P.01
-COMM. AL- DATE SEP-16-200
MODE = MEMORY TRANSMISSION
I
FILE NO.= 0131
STN NO. A BR NO
001
STATION NAME/TEL.NO
92064184260
START=SEP-16 15:47
PAGES DURATION
001/001 00:00'43"
END=SEP-16 15:46
Ain 7 4 inn
City of EdrnondtEVELOPMEU SERVICES Permit No:41923 -02 3-3
RIGHT-OF-WAY CONSTRUCTION PERMIT vu-- Datalw—w-e-3
A. Address or Vicinity ofConmction: 6,kj
R. Type of Work (be specific): J?S*Ar_6*'!1Q P
ernM,',- 40 _T17tL4_M1 I a " AlPa '-XP 424AIn
w o 4" /070/ -i�m& P�es 2-,C Ji 'I,-
C. Contracto"_PSE /P"ACA4441-k Contact: -'5uc-
1
mailing Address: 13 3240 -5f0flf-I AVC,_� Al Phone: (.;) C& ) -//,k -42-3 1
SmteLicemeO:-Plt-r-J-IC(-X-7)tlI Mla: — Uability Insurance:_ Bond; S
D. Building Permit #(if applicable): Side Sewer Permit 0 (if applicable):—
E. C3 Commercial C1 Subdivision C] City Project 0 EUC (PUD, VERIZOtOAT& T. OVWD)
C3 Multi -Family C] Single Family C3 Other
I'NSPFC-TOP: AKrh 11, 1:�,t i— 115Q,1, X,7�
0
F, PAVEMENT CU`F! 0 YES ffNo G. SIZE or CUT — X
CONCRETLCUT: CIYCS NNO
INDEMNITY, Applicant understands by his1her signature to this application helshe holds the Clot of Edmonds harmless from
injuries, damages 0, claims of any kind or description whatsoever, foreseen or unli7reseen, that may be made against the City of
Edmond.r or any of its departments or employees, including but not limited to the defente of any legal proceedings including defeate
costs and anarneyfecs by reason ofgronting this permit.
rHiE COWA4C7'OR IS AE.5POxS78U FOR WORKMANSHIP AND MATERIALS FOR A PERJOD OF ONE FEAR FOLLOWING THE FINAL
INSPECTION AND ACCLPYANCE OF THE WORK WTIMATED RrJTOJlAT1ON POW WML BE HELD UNTIL THE FINAL STREET PATCH is
COMPLETED J9YCIrYFaRCE9. AT WNICH TIMEA DEBtrOR CREDIT*= SEPROCESSW FORISSUANCEro TAISAPITIC41VT
9 Traffic tontrol and public safety shall be in accordance with City replations as required by the City Engineer. Every
flagger most be trained as required by (WAC) 296-iSS-305 and must have certification verifying completion of the
required training in their possession.
s Restoration is to be in accordnace with City codes. All street-toit trench work shall be patched with asphalt or City -
approved material prior to the end of The workday - NO EXCEPTIONS.
9 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 TEVENTS AND VNDEASTAND TRE PERMIT REQUIREMENTS AND ACXNOWLED45E
THA T I MUST MAKE THE PINK COPY OF THE PEAMITA VAILABLE ON SITE ATALL TIMES FOR INSPECTIONS
Signature:_ Date.
(Coffractor or Agent)
FORCrrY. USE OnY..
Appr9Ve4i6yg_
ay Feet; ILQ2
o' OF.,
Time Autbotized;.V0 dAl6ir 1k. pill nFe und.11.1:
Fee:
Total Fee:'' b
UAL 'AaIaL�� z4o:
kA5' elpt
_VJL0,L-CU Rf�]IV4 bsued br.
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)
FINAL APPROVAL OFPERHITTED WORK: DATE:
Inspector's Signature
For inspection requirements see Engineering Inspection Informntion handout
I
' 11
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CIT Y OF EDMONDS S lenw 0.
PUBLIC WORKS DEPARTMENT STREET FUE Issue Date
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Construction
Owner:
Name
Mailing Address.
City, S ta te, Zip Code
Contractor:
Name
Mailing Addres's
C1 ty Star e, p Code
* Permit Issued To:
Type of Work to be Done:
• Work n Connection With:
El Sub or Plat El Single Family
0 Comm]. / Ind. 0 Apt. Condo.
• Pavement Cut: - El Yes El No
State License Number
? e-i %
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. T raffic 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.
I understand that this permit must be available at the job site for inspection purposes at all times.
Signature: ate
Owner or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By: 1-f7 6 a rh
Time Authorized: Void after N:'/) —days
Special Conditions:
Ammendments:
4
Permit Fee:
Security Deposit:
Receipt No.: .
Fund III Fee:
Street Cut Dimensions
M
t--! F_ C, �_z 0-11 E D
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * -tjr. cj Pubiic works
Eng. Div. December 1978
FIELD INSPECTI 0 NbTES
Fund 111 0oute . cor)v to'Street Dept]
Comments:
Diagram:
,a
Contractor called for inspection Ye's No
T Date: Bv: Date:
Nork Disa.pproved By:
Work Approved By: Date : &hAk
Inspector:.
Eng. Div. December 1978
STREET FILE-`
HARVE H. HARRISON
CITY OP
200 DAYTON ST. ED1M0NDS_WASf . flNGTON 98020 (206) 175-25�15 MAY0
DEPARTMENT OF PUBLIC WORKS
March 16, 1981
Dear Resident:
On February 17, 1981, the E-dmonds City Council passed
Resolution 488 for construction, reconstruction and repair
of deteriorated sidewalks. A public hearinq will be held
in the Council Chambers at the -Civic Center on April 21,1981
at 7:30 P.M.._Yqu are invited to- a.t.tend_:.,,.t.his hqarJng__Eor.
discussing r&p'a'ir of portions :o'f .ciet,6t:ioratbd,,�*,��.i,(i�i,.���i..k,-.,,'-.,,�/
abutting your -property impr*ovem(---H-t of 9"' 'i n
need of repair at the expense of the abutting property
owner is provided by City Ordinance, Chapter 7.20 and�
Revised Code of Washington, Chapter 35.68.
The areas needing repair have heen marked in pai'nt,on
the sidewalk adjoining your property. Reconstru'ction-and
repair of these sidewalks Must be completed on or, before
September li 1981. In the event improvements are no�
completed within the above specified time, the'Gity��ill
perform and complete the improvements, at the;: (',�xp`�e;nse 'of 'the
abutting property owner.
This action is' in response to many citizen�requests
and pedestrian falling accidents which have been incr , easing
in recent years as a result of sidewalk deterio'ration� and
increased pedestrian traffic.
Sincerely,
FRED F. HERZBERG
Director of, Public Works
V,
rPermit No: 3 -02 ��3
S
City of Edmond'�
CONSTRUCTIONTERMIT IssueDate: JUIW03
RIGHT-.OF_WAY,,
icinity of ConstriicU6 Z e*
A. Address or V
B.. Ty0e of Work (be An gP6,;.
TO,
nt 4t5- 4 1 Q
C. Contractor: C 0
act*
P ne:
Mailing Address: lio
Liability' j i1surance "Bond: $
State License #:
D. BuildingPermit (if apfilkiible): Side Sew'er Permit:# (if.applitable):
OVWD)�
ivisioln 'City P�oject (PUi), VEkIZOOAT& T
E. El Commercial,.
r_1* Multi -Family '.'E] Single I'dinil Other -
INSPECTOR: r_� A
F. PAVEMENT CUT: YES 9�0 G. SIZE OF CUT X,
CONCRETE CUT: YES 19 NO
A131"LICANT'ro IZI`�IAV ANI) SIGN 771-
INDEMNITY. Applicant understandi by hi�lhqr signqture'� to this applicaiion`42yh� holds the City. of gdm�hds,haimless ftom
injuries,. damages or.claims of any kind'br 'description whatsoever, -foreseen or unforeseen, ithat may be made against the Cit� of
Edmonds oi any of its departments 'or eMployqes, including but. not limited to the, defense of any legal proceedings including defense
c 'ts and aitorneyJees by reason of
6s anting thispermit.
THE CONTRACTOR� IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD -OF ONE YEAR FOLLOWING THE FINA L
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES 07LL BE HELD UNTIL THE FINAL STREET PATCH is
COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR, CREDIT 47LL BE PROCESSED FORlSSUANCE TO THE APPLICANT
Traffic control and'public S*af6ty shall be in accordance with City regulations as. required by the City Engineer. Every,
flagg6r must be trained.as required by (WAC) 296-155-30.5'and must have. certification. verifying completion of -the.
required training in their possession.
Rest'oraiion' 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 drawingsof 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 `
TffA T I MUSTMAKE THE PINKCOPY OF THE PERMITA VAILABLE ON SITE A TALL TIMES FORINSPECTIONS,
Signal'ul e Date: 03
(Coii-tractor 6ii'�Age,nt)
]POR 0TYUSE ONLY
Right-of-wayfpe': 66* + 2�_�
�vppro,�ed by: J6�
Time Authorize4.,Void, After I 12AI:J Disruption Fcc/F'pnd''1-11:"
Jr
Special Conditions: M%krrm 01. S� -R-estorationfee:
Total
bNk Fee:
AQN L __C :8-ft !a ,-Reccipt'No:
mu6 &bv:
UPON COMPLETION Of PERMITTED WORK9 AN ENGINEERING FINAL
INSPECTION IS REQUIRED% PER. CHAPTER 18.00- OF THE- EDMONDS
COMMUNITY DEVELOPMENT- CODE (Ph'O nie 425-771-0220, Ext. 1326)
FINAL APPROVAL OF PERMITTED WORK. DATE:
Inspector's Signature
For'insnectio'n reaunrements see Engineeringinsnection In'formation handout.
It
ALL -TO
EXPOSED SURFACE$,
BE COVERED WITHIN 2 DAYS
ki" A We�
fig b ovTot o tA o r- -feu5.
100 Le 0- 0
00 L
-\J
yr
APPROVED AS NOTED
CovyLik+ R5 d/at A BY ENGINEERING
31,K.3' -3�ry(W A-
\9 1 1
vll�- l"QA nnt.
24 HR. NOTICE REQ. w JA Ll (;kle4 L%y*qll Date: IQ 0 -z
FOR INSPECTION 0 pu sVvd v6M HEIGHT CALCULATWNS:
DATUM POINT: BOTTOM OF
TELE POLE AT SW CORNER.
DATUM; 100.01
A: 101.5
B. 101.5
C. 101.5
D. 101.5
406 --.:, 4 = 101.51 AVER. HGT.
uqo PROPOSED RIDGE: 115.59
MAX- RIDGE: 101.5 + 151 = 116.59
—4
(00-01
. .......................
C-VFE4>
--Z0,0
PROJECT ADDRESS / OWNERS:
KEN & BETH COOPER
640 ALDER STREET
EDMONDS 98020
425-774-1557
TAX No: 00434209401300
LEGAL: CITY OF EDMONDS BLK 94 LOT 13 & 14.
T27RO3 S24SW
SCOPE OF PROJECT: NEW DETACHED GARAGE
22'-0" x 20'— 0" = 440 SQ. FT.
GRAVEL DRIVE 450 SQ. FT.
ZONE: RS-6
LOT SIZE: 60'x 110'= 6,600 SQ FT
LOT COVERAGE:
EXISTING HOUSE 1042 SQ FT.
EXISTING DECK: 308 SQ FT.
EX. WAW STAIRS, PORCH(-AJ)9P SO FT
4449 SQ FT.
14t4
PROPOSED GARAGE: 440 SO. FT.
TOTAL: H09, SQ FT
HOUSE BUILT: 1910 Ns�\
IMPERVIOUS:
APPROVED BY PL�N G
6.
7
Zone Lo�-6 Comer
Flag
A2glired
—Actual
Front
.20
Z-0 +
Sides
/3
Rear
Other
E�aht
I 2>
2 8. W16
PRE-1977 HOUSE, WALKS 1350 SQ FT.
POST-1977 DECK
308 SQ FT
GARAGE:
DRIVE
440
450
1198 SQ FT.
GRADING: LESS THAN 20 CU YDS
PLUMB : NONE
STREET FILE
RECEIVED
AUG 2 3.2007
BUILDING DEPARTMENT
CITY OF EDMONDS
PROPOSED 2" MPE—IP MAIN
22-S CA
E.O.M.
2* MPE CAP
229-W, 22-S C/L
M., W04 V
W-w-w-w-w- I W_
20' PAVING
60 20' PAVING
[FR/W
—FUSE TIE—IN
169'W, 22'S CA
ST
EX. 2' MPE—IP 22'S
3' GRASS 1070UB755-00
to
4 1 S/W 8
0
C4
Ot,9
9*9
STANDARD GAS CONSTRUCTION NOTES:
1. FIELD LOCATE ALL UNDERGROUND UTILITIES. CALL NONE—CALLN TWO WORKING DAYS PRIOR TO CONSTRUCTION, IN
WESTERN WASHINGTON CALL: 1-800-424-5555. IN KITTITAS COUNTY CALL: 1-800-553-4344
2. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS AND GAS FIELD PROCEDURES.
3. EROSION AND SEDIMENTCONTROL SHALL BE PER PSE STANDARD PRACTICE 0150.3200 TECHNIQUES FOR TEMPORARY
EROSION AND SEDIMENT CONTROL AND ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.
4. NOTIFY PROPERTY OWNERS ADJACENT TO PROPOSED CONSTRUCTION ACTIVITIES A MINIMUM OF TWO WORKING DAYS
PRIOR TO BEGINNING CONSTRUCTION. USE ISI TO DISTRIBUTE FLYERS IF JOB IS LARGEO OTHERWISE HAND
DELIVER FLYERS BE SURE TO INCLUDE THE LIST OF FREQUENTLY ASKED QUESTIONS AND INFORMATION ABOUT
THE OPPORTUNITY TO PURCHASE AN EXCESS FLOW VALVE WHEN THEIR SERVICE IS ISNTALLED OR REPLACED
PER GAS OPERATING STANDARD 2550.1600. ALLOW ADEQUATE TIME FOR. CUSTOMER DECISION AND RESPONSE.
5. ANY CHANGE IN ROUTE, TIE—IN METHOD OR ADDITIONAL'MAIN FOOTAGE MUST BE APPROVED BYPSEGAS ENGINEERING
SERVICES.
6. COMPLETE "PIPE CONDITION REPORTmON ALL EXPOSED EXISTING PSE FACILITIES. CHECK BOX ON REPORT FOR WIRE
BOX( TESTLEAD )INSTALLATION.
T. ACTIVE SERVICES DENOTED BY:
8. PIPELINE MARKERS AND WARNING SIGNS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS
OPERATING STANDARD 2525.2500.
9. VALVE MARKERS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTORPER PSE GAS OPERATING STANDARD
2525.2600 FOR ALL HP VALVES IF THE LOCATION IS NOT REDILY ACCESSIBLE, AND FOR ALL VALVES WHERE
PERSISTANT SNOWFALL MAY OBSCURE THE VALVE BOX . :
110. TO PREVENT ACCIDENTAL OVERPRESSURE OF ADJOINING SYSTEMS9 NO TWO MAINS SHALL BE CONNECTED EXCEPT AS
SHOWN ON THIS DESIGN UNLESS APPROVED BY PSE GAS ENGINEERING SERVICES.
1111. SYSTEM MAOP DENOTED BY:ISYSTEM MAOP = 45 PSIG I I
12. GAUGE AND MONITOR USE OF ALL STOPPERS TO ENSURE ADEQUATE FEED.
13- RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION.
14. GAUGE AND MONITOR USE OF ALL STOPPERS AND SQUEEZES TO ENSURE ADEQUATE FEED. (USE MANOMETER FOR
LPSYSTEMS)
115. RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIOINAL OR BETTER CONDITION.
PURGEPOINTS ANDPRESSURE TAPS TOBE INSTALLED PER PSE GAS OPERATING STANDARDS 2525.3400, AND 2525.1200.
r—SITE
I � I
J
FITTER (Check Box if Complete)
• WORK AREA LEFT IN CLEANISAFE CONDITION. 1:1
• COMPLETE ALL PIPE TABLES AND GAS PRESSURE STAMP 11
• FIELD CHANGES RED —LINED ON AS—BUILTS. 1:1
o MATERIAL VERIFIED AND CHANGES NOTED ON PAPERWORK. 1:1
• ALL VALVE AND TIE—IN LOCA11016 NOTED ON AS —BUILT. 171
• NOTE BEGINNING OF MAIN, EOM,& LINE OF MAIN LOCATIONS. El
• SHOW ROPE LOCA77ONS & CUL—DE—SAC RADIUS El
Fitter's Signature
Company Employee ID#
GAS MAIN INSTALLATION/RETIREMENT
Type/Work
Pipe
size
Type
Estimated
Length
Actual
Length
Manufacturer
INSTALL
211
MPE
W
GAS MAIN PRESSURE & TESTING
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
DATE OFF
TIME OFF
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
DATE OFF
TIME OFF
IDes i gn Press 60
SYS MAOP 45
PROJECT PHASE
NOTIF#
ORDER#
V)
0
L
SAP Superior
Service/Meter
Service/Meter
Service/Meter
Service/Meter
Ind. Service
Ind. MSA
Dis. Reg./FT
HP Svc/MSA
Relocate
Ret i rernent
X517644856
107017526
X118415693
106113164
Contractor: CONSTRUCTION COST CODES:
031-103-1 1 1 7
Project Manager Contact Information:
PATTINESS
CELL: 425-327-2783
Vicinity Map WORK SITE
0 U11 V/////; i a
liffiar/0 r/W/m/
Owner If Developer Contact Info
KEN COOPER
640 ALDER ST
EDMOND,WA 98020
ATTN: WPN r.nnPF:P office
0.2
�_l
\0
CALL (800) 424-5555 r4I
0 D"CTMCCC nkVC D=n= Vn" n7f'
t—
THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATION OF FACILITIES r-(
REAL ESTATE/EASEMENT PERMIT
N/A EDMONDS
REV# DATE BY DESCRIPTION FUNCTION CONTACT PHONE DATE
3 PROJECT MGRI PATTINESS 206418-4237
2 ENGR — GAS
I DRAWN BY
COUNTY EMER SECT
SNOHOMISH 5
114 SEC OP MAP
SW-24-27-05 160-062
UTILITIES
CONTACT
PHONE#
PUGET
SOUND
ENERGY
DESIGNED BY PILCHUCK CONTRACTORS INC.
CHECKED BY
GAS WK CTR APPROVED BY
MNSNIHIG ITTER #1
PLAT MAP FITTER #2
163-066 IMAPPING
JOINT FACILITIES ARRANGEMENTS
PHUONG DAO
PATTINESS
PATTI NESS
2064184218 8/17/03
2064184237
2064184237
2" MPE-IP MAIN EXT. 107017526
Dra%ving Number
640 ALDER ST EDMONDS, WA 98020 N/A rA CQ
91.4 t-
(COOPER) SCALE: AGE: 41:� ".4
TO = 50' IP 1/1 k