7037 MEADOWDALE BEACH RD.PDF11111111 lill 11
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7037 MEADOWDALE
BEACH RD
CITY OF EDMONDS
121 5TH AVENUE NORTH EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
Website: wwwdedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
89" Planning - Building - Engineering
November.7,2005
Ken Holland
7037 Meadowdale Beach Road
Edmonds WA 08026
Dear Mr. Holland:
GARY HAAKENSON
MAYOR
In response to your letter dated November 1, 2005, the following is an update regarding the
drainage project which is being designed and that will be constructed on your property:
1) The survey and geotechnical analysis have been completed and the design is
approximately 70% complete.
2) We are in the process of preparing the easement we need as well. The easement should be
mailed to you within the next week for your signature.
3) This is one of many drainage projects that our staff is working on. No one here is aware
of the 60-day completion schedule you mentioned in your correspondence. I apologize if
we gave you that impression- when we met on January 20, 2005, because 60 days was not
a realistic time frame for us to complete the survey, geotechnical analysis, design, plans,
specifications and bid documents necessary to advertise for construction bids.
4) Given our current workload, the earliest the project could -be completed will be in mid to
. late spring of 2006.
Please let me assure you that we will complete this project as soon as we can, considering the
significant workload of storm drainage projects we are working on. If you have any questions
reprding this project, feel free to contact Don Fiene at 425-771-0220, Ext. 1323..Thank you.
ri�erely,
E V. BOWMAN
Development. Services Director
DVB/FDF/cnic
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CITY OF EDMONDS WATER SERVICE AS -BUILT
ADDRESS
7037 Mead, Beach Rd
PERMIT
NUMBER with Short Plat
HOMEOWNER Holland
CONTRACTOR TE Briggs
DATE 04/26/01
DRAWN
BY
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CITY OF EDMONDS SIDE SEWER AS -BUILT
ADDRESS
7037 Mead, Beach Rol
PERMIT
NUMBER with Short Plat
HOMEOWNER Holland
CONTRACTOR TE Briggs
DATE 04/26/01
DRAWN
J McConnell
BY
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RECEIVED
MAR 2 9 2001
ENGINEERING DIVIS'ION'
STREET
FILE
City of Edmonds
Critical Areas Determination
Applicant: Kenneth Holand Determination #: CA-93-50,
Project Name: Permit Number:
Site Location: 7037 Meadowdale Bch Rd Property Tax Acct #: 5131-000-124-0705
1 . I I
Project Description:
Short Subdivision
Waiver, Criteria (all criteria must be found to apply):
XX There will be no alteration of the Critical Area or its required buffers;
xx The development proposal will not impact the Critical Area in a manner contrary to
the goals, purposes, objectives and requirements of the Critical Areas ordinance;
xx The development proposal meets the minimum standards of the Critical Areas
ordinance;-
xx The above findings are based on the following conditions of approval:
1. The applic I a ' nt must comply with any requirements the Building Official
might call for because of construction on steep slopes (ECDC title 19.05,
19.00-LtBC chapter 70).
2. The applicant must folld wl the requirements of the Engineering Division for
erosion control (ECDe- title 18).
3. The, applicant must follow the direction of the Planning.Department- in the
subdivision of this property.
Based'on the above findings and conditions, the requirement for a Critical Areas Study
associated with this development permit is hereby Waived, as authorized by Chapter
20.15B. 150 (B) of the Edmonds Community Development Code.
John Bissell
Name Signature Date
890.199-
City of Edmonds
Critical Areas Checklist
The Critical Areas Checklist contained on
this form is to be filled out by any person
preparing a Development Permit
Application for the City of Edmonds prior
to his/her submittal. of a development permit
to the City.
The purpose of the Checklist is to enable
City staff to determine whether any -potential
Critical Areas are or may be present on the
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).
An applicant, or his/her representative, must
fill out the checklist, sign and date it, and
submit it to the City. The City will review
the checklist� make a precursory site visit,
and make a determination of the subsequent
steps necessary to complete a development
permit application.
With a signed copy of this form, the
applicant should also submit a vicinity map
of the parcel with enough detail that City
staff can find and. identify the subject
parcel(s). In addition, the.applicant is
encouraged to include any other pertinent
information or studies in, conjunction with
this,Checklist to assist staff in completing
their preliminary assessment of the site. - -
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out th6 appropriate column below).
Owner / Applicant:
Kenneth D. Holland
Name
Owner
Title
7037 Meadowdale Beach Rd.
Street Address
743-VSMW*
-Edmonds. WA 98020 743-0914(Wo-�<
City, State, ZIP Phone
Sioatur�..., Date
Applicant Representative:
Narne
Title
Street Address
City, State, ZIP Phone
Signature Date
R E.0 E I V�C.D
Critical Areas Checklist
MAR 0 1 1993.�,
Site InformatiTenn6th Holland PERMIT 'COUNTER
Project Name: Short Subdivision, Permit Number:
Site Location: 70:37' . Meadowdale Beach gi Property Tax Account Number 5131-000-124-0705
Approximate Site Size (acres or square feet): 2 2 A � re s
Have you filled out a Critical Areas Checklist for a project on this site before? No
General Site Conditions
1. � Has the site been cleared or logged?
Yes Date of most recent action: unknown
Soils /Topography Alderwood-Everett
2. . in the Snohomish County Soil Survcy, what. is the mapped soil type(s) ? San y Loams 25-70 perce
3. Describe the general site topography. Check all that apply.
Flat: less than 5 feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10 feet over a
horizontal distance of 66 feet.)
X —Hilly: slopes present on site of more than 15% and less than 30% a vertical rise
of 10 feet of horizontal distance.)
Steeo:,grades of greater than 30% present on site.
Comments
Hydrology/Vegetation
4. Siti contains areas.of year-round standing water: No
5. Site contains areas of seasonal standing -water No N7A
--Approx. Depth:
6. Site is in the floodway No floodplain No of a water course.
7. Site, contains a creek or an area where water flows across the grounds surface? No flows
are year-round? NIA Flows areseasolia!? N/A
mixed
8. Site is primarily: forested L meadow shrubs I ,
9. Obvious wetland is present on site: Nn
10. Wetland inventory or map indicates wetland present on site: No
11. Critical Areas inventory or map indicates any Critical Area on site: No
F6r.Cit'y Use Only
APPLICATION
The City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PEwff
NEW CONSTRUCTION REPAIRS n LID NO. ASMT. NO - ------------------
OWNER ... ---------------------- CONTRACTOR --- ----------------------- . PERMIT NO. !7-� --- — --------
- ------ ---------------------------------------
77 LEGAL DESCRIPTION: LOT NO. ------------------------- ------ ... BLOCK NO - ------------------------------------
JOB ADDRESS ------- ----
----------
k 2-4 4 e-- k Z=--
..................... ------------------------------------------ . ..... --------------------------------------------------------------------- ----------
NAME OF ADDITION -------
.......................... ------------------
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Approvtd:
DATE ... ........... - --------------
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CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
2.
Zl
Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.) 7
No Sat., Sun., or holiday inspections.
(Inspection will be provided within 24 hours after requst.
ROAD
CTION ------- NU .... Mf;AP.QVJDA.L_E ..... B.E.A-CJ ................................... ... ........
......... .. ..
SS LOCATION OF CONSTRU
ADDRE
A PORTION OF ... TRA C T.S .... 124 & ZZIE 125
DESCRIPITON.. - --------- -- -- ---- ------- ... .. ......... .. .........................................................................
PROPERTY LEGAL .............. ------ LOT .... 3. � ---- -- ..........................
MEADMIDALE R'�ACH
.... . .................................. . ....................... .....................
........ . .......... . ........................................................................ . ..........
.. ................... . .......................... . ..
JB EYLANDER
OV#WM AND/OR BUILDER ...... .. . ........................... . .................................. . .................................. . ..... .............
...............................................................
RESS.
...............................
......................... ...................... . ............................... ... ........................
CONTRACTOR' .... E R
S NAME & ADD
sewer.
Permission Is granted ..� --------- ARM! ..... 21— .... . ............ 1917--, for repair and/or connection of a side sewer to the city sanitary
with City of Edmonds ordinances.
I syr-tem in accordance
IS CALI D TO THE FOLLOWING:
A, ENTION A licensed Side S
ewer Contractor must be employed to construct.,
NOTE No. 1—The owners of the Property may obtain a permit to construct sewer inside property line.
side sewer in street area. Do not cover any portion of sewer before It has been inspected.
-of-Way Permit obtainable from the City Engineer's office.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right
--:ObtaJn full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%. No bends in grade
sharper than % will be permitted.
NOTE No. 5.—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for fallure due to improper
work which may develop within one year of completion.
er or its appurtenan
NOTE No. 6—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sew ces except to in-
sert the pipe into the wye.
By ---------------- Date ............... - _----------------
DISAPPROVED Date-_ By ................ Date
------------- ...
B.........................
ate...- ........................
"PROVED
Er
k ---- --------- --- - -- - -- - -------------------------------------------------------------- ...
... ...........................................................................................................
Remarks: ........................................... . ............................................................
................
.................................
.............................................. . .................................. . ......
.............. . .. . ..........................................
...................................................
BOTH Permit Copies r4UST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection -A -
4
Mit
........................ .. .......
L
........ ...................... .... hereby certify that the side sewer installation constructed under this per
(Owner of Contracting Firm Performing Construction)
_s distalled in accordance with all governing ordinances of the City of Edmonds.
Datedthis ................ ........... day of ................................................................. 19 .........
Check BEFORE you dig for: Water E], Gas E], Telephone 0, Power C], Sewer [3, Other C]
APPLICATION
The City of Edmonds for EASEMENT NO - ---------------------------- ------------
SIDE SEWER PERMIT
NEW CONSTRUCTION F1 REPAIRS E] LID NO. -/6-4-----ASMT. NO - ------------------
OWNER --------------------------------------------------- CONTRACTOR ------
----------------------------------------------------------- PERMIT NO. �0(�/
JOB ADDRESS 7 1,4 1-�,o .......
------------------------- ------ -- ------------- -------- I ----------- LEGAL DESCRIPTION: LOT NO - ----- S ----------------------------- BLOCK NO - ------------------------------------
Fo, ?, -F) 02 y .......... 0-,F ..... T--,C--I.c-7 ............. Z
----- -- ------ --- ... .. . ------ . ....... R
-- --------- . E.CEIVED ....... ..................
NAME OF ADDITION ---- ...... 31-a ---------------------- APR-21 ... lw,-: ----------------------
'763 7
M 1-: P a L.,j 13,CP e �4 I? D,
Ptd& Works I fto
Approved:
DATE-------------------------------------------- By --------------------------------------------------- i . i7ire
PUBLIC WORKS DEPART= CHECKLIST
BUILDING PER�ffT REVIEW'
(address) 4 (date)
Street Right-of-W'ay Existing
I REQD
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Access Easements Existing kk�_ I nac.94_5'd
REQD I
Utility Easement Exis
PEQD
Lot Per Subdivision Plat
Assessor �bp
Site Plan Checked for Accurac Y
Z
U nderground W'iring Reqd.
Check Accuracy of-ij2yil Description
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:4
Review by
Date
Existing Water Main Size —
Water Main Required
Service Line Required
Hydrant. Size Existing�__
P4
Hydrant Reqd Per Fire Code
Size
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Conpients
�qater Meter Charge Reqd.
-Z7'
Revi ew7 b
Septic Tank Design ,Vproved
Date
Septic Tank Permit Reqd.
Permit No. --.-
Sanitary Sewer Availability 0 C�A
L-c", C-1
Drawing No. I rD
—proi.
File No..
Side Sewer Availability �Aaa.
Sanitary Sa,7er- Connection Fee Reqd.
:3
Review by -kj-'
Date
Open Ditch Existing
Reqd.
-2:
Culvert Rcqd. 7-
Size
0�
Catch Basin Reqd.
Indicate on Site Plan
0
Shoulder drainage maintain collection on
swale open runoff
1-12nhole rcqd.
-Indicate on Site Plan —
Soil Conditions and Ground Water Field Mocked
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Roview b
Date!
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DRAINAGE j?,IPROVEMENTS REQUIRED
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REMARKS
VARIANCE OR CU JPLANNING REVIEW BY I DATE
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OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04. -
REMARKS
PLAN CHIECK FEE
13UILDING
PLUMBING
MECHANICAL
FENCE
"A�,,],,icani. on behalf (if his or tier spouw. hcir�. :It'd SIGN
success" , n interest. agrees to ind'eilinify, defend and hold liarmle�i RETAI . NING WALL
7 the Citv of Edmonds, Washinpton, its officials, cnlllloyec�. and
- agents from any and all claims for daniages of wlmtc�er witure,
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the issuance of this Per,"it. k911- SWIMMING POOL
I irising directly or indirectly from
0 aIjCC Of thiS PCTIIIit shall not be deerned to modily, waive or reduce
any requirement Of any city ordinance nor limit in any way the
0
T. City's ability to enforce any ordinance provision."
. hereby acknowledge that .1 have read this application: that the in. TOTAL AMOU . NT DUE
fatination given Is coirect; and that I am the owner. or the duly author-
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EXISTING STREET R/W 6C> FT. DEFICIENCY
COMP. PLAN ST. R/W C,00 FT. FT.
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0 YES 0 NO
AREA
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REMARKS
NUMBER OF STORIES
NUMBER OF
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UNITS
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NATURE OF WORK TO BE DONE
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VALUATION I FEE
City of Edmonds STREET FILE
Critical Areas Determination
Applicant: Barbara Holland Determination #: CA-93-50
Project Name: Permit Number:
Site Location:
Beach Rd. (Lots 1 and 2,
Holland Short Plat: S-93-
152)
Project Description:
Non -Project Specific
Determination: Study Required:
Property Tax Acct #:
7037 Meadowdale
Beach Rd. (00 5131
000 124 09) Parcel
for 7103 not found
During review of your recently submitted proposal to build an expansion to your existing
residence at 7037 Meadowdale Beach Road, it came to my attention that you had submitted a
Conditional Waiver. This waiver was only granted for the subdivision process for the Holland
Short Plat. Unfortunately, your current project does not qualify for a Conditional Waiver. This
letter is,being provided in, order to detail the requirements of the Critical Areas Study.
NOT( 'E:—T.his-letter-provides the study requirements for Lot 1, 7103 Meadowdale Beach Rd. and
Lot 2, 7037 Meadowdale Beach Rd lat is currently undeveloped.
The site appears to contain critical areas, including a Steep Slope Hazard Area, and a Wildlife
Habitat Area pursuant to Chapter 20.15B of the Edmonds Community Development Code
(ECDC). Based on these findings, prior to submission of any development permit, you will be
required satisfy the requirements of ECDC 20.15B by completing a Critical Areas Study
consisting of the following:
Steep Slope Hazard Area Delineation Requirements:
To determine if a Steep Slope Hazard Area does exist, a topographic survey prepared by a
Licensed Land Surveyor delineating Steep Slope Hazard Areas must be completed. Any slope of
40% or more with at least 20 feet of rise will be classified as a Steep Slope Hazard Area. A 50-
foot buffer is required from both the top and toe of the slope. A 15-foot building setback is
required from the 50-foot buffer.
For development of any kind which is proposed within the critical area, 50-foot buffer or 15-foot
buffer setback, it must be shown that the development will not adversely impact the Critical Area
or its buffer, by doing one or possibly both of the following depending on the outcome of the
study:
1. For development proposals which will occur within the 50-foot buffer, but no closer than
10 feet from the top or toe of the slope, the 5 0-foot buffer requirement may be reduced to
10 feet if a study is completed by a licensed geologist or geotechnical engineer which
clearly demonstrates that the proposed buffer alteration will have no adverse impact upon
the site, the public or any private party.
2. If development must occur within the critical area, buffer, and/or buffer setback, and is
not identified as an exception per ECDC Chapter 20.15B, a Reasonable Use Exception
and Variance must be obtained pursuant to ECDC 20.15B.170A and 20.15B.040C. ;
NOTE: A survey was previously prepared by Lovell-Sauerland & Associates, Inc. for the
Holland Shortplat, S-93-152. A new survey should not be necessary. However, this survey
will need to be revised to include designation of the slope as described above.
Wildlife Habitat Area Requirements:
Research of the site determined that the entire parcel lies with a City of Edmonds designated
Wildlife Habitat Area. The applicant must contact the Washington State Department of Fisheries
and Wildlife to determine if there is a habitat conservation or wildlife management plan for the
property. Please contact Tony Oppermann with the Washington State Department of Fisheries
and Wildlife at the following address:
16018 Millcreek Blvd.
Millcreek, WA 98012
(206) 227-4682
The Land Surveyor shall enter into a three party contract with the applicant and the City of
Edmonds as required in ECDC 20.15B. 140(D), where the applicant pays for the study. The
applicant may suggest qualified professionals for the City's approval.
If the results of the Critical Areas Study determine that the lot may not be developed, the
applicant may apply for a Reasonable Use Exception and Variance pursuant to ECDC
20.15B.170A and 20.15B.040C.
If the property owner wishes to apply for a specific development permit which they feel
would not impact the Critical Areas located on the site, they may submit their proposal to
the Planning Department for review. If the Planning Department finds that the proposed
development permit will not adversely impact a Critical Areas or its buffers, a conditional
waiver may be issued on a project by project basis. Please call me at 771-0220 if you have
any questions.
Name
Sigfiature
Date
Cited sections of the Edmonds Community Development Code (ECDC) can be found on the City of Edmonds
website at WWW. Ci. edmonds. wa. us.
2
1,4C. 18913
STREET FILE
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
Website: www.d.edmondsma.us
DEVELOPMENT'SERVICES DEPARTMENT
Planning - Building - Engineering
September 19, 2006
Ms. Barbara J. Holland
-Beach Rd--
037MeaddWdale
-Edmonds, WA 98026
GARY HAAKENSON
MAYOR
RE: Chattel Deed for Stormwater Line in Holland Short Plat File No. S-93-152
Dear Ms. Holland
On September 18, 2006, the Edmonds City Council accepted the chattel deed quit
claiming to the City of Edmonds ownership of a portion of a stormwater utility line by
the property owners, of the Holland short plat no. S-93-152.
Enclosed. for your files is a copy of the fully executed and accepted chattel deed.
Sincerely,
DAVID K GEBERT, PE
City Engineer
Cc: Noel Miller, Public Works Director
Sandy Chase, City Clerk
Street File
Incorporated August 11, 1890
CHATTEL DEED
WHEREAS, the undersigned are owners of properties within the short
subdivision known as the Barbara J. Holland Short Plat, City of Edmonds Short Plat File
No. S-93-152, as follows:
Lot 1, 7103 Meadowdale Beach Road, Owners: Craig R. and Julie M. Carney
Lot 2 and Lot 4, 7037 and 7041 Meadowdale Beach Road, Owner- Barbara J. Holland
Lot 3, 7039 Meadowdale Beach Road, Owners: Dennis M. and Julie A Wanner, and
WHEREAS, Tract 'A' is a tract within the short subdivision owned in equal and
undivided interests by the undersigned owners of Lots 1, 2, 3 and 4 of City of Edmonds
Short Plat File No. S-93-152 for the purposes of ingress, egress, and the installation,
operation and maintenance of utilities, and
WHEREAS, the City has constructed a capital project known as the Meadowdale
Beach Road Drainage Improvements project, and upon completion of construction of this
project, a portion of the privately -owned storm drainage system in Tract 'A' wi . 11 now
convey public stormwater from off -site, and
WHEREAS, the undersigned owners of Lots 1, 2, 3 and 4 and the City of
Edmonds have agreed that upon completion of the Meadowdale Beach Road Drainage
Improvements project, the portion of the privately -owned storm drainage system in Tract
'A' that will now convey public stormwater from off -site would be transferred to the City
of Edmonds for ownership and maintenance responsibility, and
WHEREAS, this chattel deed is granted in fulfillment of said agreement to
transfer ownership of that portion of the storm drainage system and in consideration of
the mutual benefits which will be derived by the parties, NOW, THEREFORE
By their signatures below, the owners of Lots 1, 2, 3 and 4 of City of Edmonds
Short Plat File No. S-93-152, do hereby quit claim and grant to the City of Edmonds,
Washington- all right and ownership interest in a utility line structure formerly owned and
operated by these owners as a stonn water pipeline and shown on the attached drawing
Exhibit A, incorporated by this reference as fully as if herein set forth.
DONE this -:5 day of c:
,-- �7, 2006.
Page I
OWNER
By:
Barbara J. olland'
Lot 2, 7037 Meadowdale Beach Road
Lot 4, 7041 Meadowdale Beach Road
STATE OF WASHINGTON)
COUNTY OF SNOHOMISH)
On this day appeared before me Barbara J. Holland, to me known to be the
individual described in and who executed the within and foregoing instrument and
acknowledged that she signed the same as her free and voluntary act and deed, for the
uses and purposes therein mentioned.
DATED:
Nssiolv*...
G'.. 0
C) 0 T4
0,0 - A
0 -A
0
C
W-A
X
�0'
�-mqavt'( WL-T-p
NOTARY PUBLIC Sandra. Lawson
Printed Name: I
My Commission expires:. VJ / ;�-"( [
Page 2
OV,TNERS
By:
C g
Cr g y
Lot 1, 7103 Meadowdale Beach Road
By: 6,61,
Julie M. Carney
Lot 1, 7103 Meadowdale Bea'clbh Road
STATE OF WASHINGTON)
COUNTY OF SNOHOMISH)
On this day appeared before me Craig R. Carney and Julie M. Carney, to me known to be
the individuals described in and who executed the within and foregoing instrument and
acknowledged that they signed the same as their free and voluntary act and deed, for the
uses and purposes therein mentioned. a a -
Notory pubjL�
State of w*SNrVton
DATED: MY RACHELLE A RICHARD$
I /AM0Vn*nt Wes,#4x 26,
NOTARYPUB Q
Printed Name: lat t
My Commission expires: - 1�
0
Page 3
OWNER
0
Ifl
STATE OF WASHINGTON)
COUNTY OF SNOHOMISH)
s M.
.,Wanner
7-039 Meadowdale Beach Road
ji�he A. Wanner
Lot 3, 7039 Meadowdale Beach Road
On this day appeared before me Dennis M. Wanner and Julie A. Wanner, to me known to
be the individuals described in and who executed the within and foregoing instrument
and acknowledged that they signed the same as their free and voluntary act and deed, for
the uses and purposes therein mentioned.
DATED:
iN TAR UBLIQ
Pirintied e:
My Commission expires, Ue
Page 4
NANCE TRACT
(A.F. NO. 1792081)
Ex 4" x 4' CONCRETE
MONUMENT WITH
2* BRASS CAP
.45 s--
�cl
ir
0
0,
I CBS
0
�7
10
E%.,3/fIR PIPE '60.00,
S _ -
E2N
EX 3/4-IRON
cli
PIPE (D
22,381 SF
7103 MEADOWDALE BEACH ROAD
0 3
7037 MEADOMALE BEACH ROAD b 20,171 SF
2
20. SF 7039 MEADOWDALE BEACH ROAD
39.00.
36- 4
TRACT A 15.00, 20.671 SF
11.841 SF
7041 MEADOWDALE BEACH ROAD
CF
106.02,
HOWSE'Y TRACT TY 2 CB 54' INSTALLED BY CITY 170.00.
(A.F. NO. 117JJ20) STEM CONNECTS TO PRIVATE AND PUBLIC STORM LINES
STORMWATER PIPE AND STRUCTURES
f� ol 11) QUIT CLAIMED TO THE CITY 13F EDMONDS
6o 500
EXHIBIT A
NTS
y " /'J Permit No: ;-Z�l
City of Edmonds
RIGHT-OF-WAY CONSTRU, CTION PERMIT Issue Date: '5q /10 /0 f
A. Address or Vicinity of
B. Type of Work (be specific
C. Contractor: -J Contact:
7
Mailing Address-�Rf> 5�) '5�-6 6 lr�' Phone: Liv;
State License #: Liability Insurance: Bond: $
J
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. Commercial X Subdivision E] City Proj ect 0 EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
Multj;�amil� Single Family Other
y
INSPECTOR
F. PAVEMENT: 1KYES f-1 NO G. S.IZE OF CUT X H.. Charge:
CONCRETE CUT: E] YES KNO
APPLICANT TO READ AND SIGN
IDEMNITY. Applicant understands by his/her signature to this application helshe holds, the. Pt, of Edm�nds harmlessftom injuries,
y
damages or claims of �any kind, o'� de�c'hp* tioh w'h'd&oever, fireseen or unforeseen, that may be made against the City ofEdmonds or
any of its departmen'tst or employees, including. bqt,,not limited to the,�defense of. any legal proceedings including defense costs and
attorneyfees by reason ofgranting this permit.
'1HE CON"TRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND A CCEPTANCE OF THE WORK ESTIMA TED RESTORA TION FEES WILL BE HELD UNTIL THE FINAL STREET PA TCH IS
COMPLETED B Y CITY FORCES, A T WHICH TIME A DEBIT OR CREDIT WILL BE PR OCESSED FOR ISSUANCE TO THE APPLICANT.
Trafflc control and public safety shall'be in accordance with City regulations as required by the City Engineer. Every
fl . agger 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-cii t trench work shall be patched with asphalt or City -
approved material prior to the end of the workday - NO EXCEPTIONS.
Three sets of constructionld" gs of proposed work are, required with the permit application.
I RA VE READ THE A B 0 VE STA TEMENTS AND UNDERSTAND THE PERMIT REQ UIREMENTS A ND A CKNO WLED GE
THA T I MUST -MAKE THE.RLNECOP Y OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature:
(Contractor or Agent)
CALL DIAL -A -DIG (1-800-424-5555) PRIOR. TO BEGINNING WORK -
UPON COMPLETION OF PERMITTED WORK9 AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMITTED WORK-
i . �Nk?g()JrS SIGNATURE DATE: t I
For inspection requirements see Engineering Information Handout.
NO WORK SHALL 13EGIN PRIORTO PERMIT ISSUANCE
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