7105 210TH ST SW.PDF11111111111
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7105 210TH ST SW
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The CitY Of Edmonds
Side. Sewer Drawing
NEW CONSTRUCTION
OWNER
JOB ADDRESS _ZZe s
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REPAIRS EASEMENT No.
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CONTRACTOR
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LEGAL DESCRIpnON: LOT No . ...... . ...... PERMIT No.
BLOCK NO.
NAME OF ADDITION
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Appmved.
DATE
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CITY OF EDMONDS
121 5TH AVENUE NORTH • EDMONDS, WA 98020 • (425) 771-0220 • FAX (425) 771-0221
Website: www 6edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning • Building • Engineering
August 22, 2006
MEMO TO:
Edmonds School District
Verizon Northwest
SNOCOM Police and Fire Dispatch
SNOPAC
Snohomish County E911
U.S. Post Office
Snohomish County Assessor's Office
Snohomish County Information Services
Snohomish County P.U.D.
Puget Sound Energy
Edmonds Fire Department
Edmonds Police Department
Edmonds Utility Billing
Edmonds Public Works
Edmonds Building/Street File
Edmonds Address Files
Lynnwood Disposal
Comcast Cable
Waste Management Northwest
GARY HAAKENSON
MAYOR
Please be advised that the attached address has been added to the Edmonds address
system:
7104 210'h St. SW (Lot A) Previously one parcel addressed 7105 2101h St. SW. Lot
B will remain 7105 2101h St. SW with existing home.
Occupancy: R3 Tax ID Number: (for short plat): 00566900100601
Subdivision: S-05-13 Lots #: A & B
If you have any questions regarding this letter, please contact me at 425-771-0220 or
Zulau.f@ci.edmonds.wa.us. Please contact me if you wish to be removed from this list.
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Department
L\Temp\DST'sWaster Letters\New Address8/22/2006
• Incorporated August 11, 1890 •
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#P20 - 1
Critical Areas Checklist CA File No:
Site Information (soils/topography/ hydrology/ vegetation)
1. Site Address/ Location l U Z 0 5 .7
2. Property Tax Account Number: 0 0 1- 00 (0 - Q Z
3. Approximate Site Size (acres or square feet): l 11 6)41� L/
4. Is this site currently developed? yes; no.
If yes; how is site developed?
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 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-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal
distance of less than 33-fee401.
Other (please describe):
6. Site contains areas of year-round standing water: N o ; Approx. Depth:
7. Site contains areas of seasonal standing water: jN 0 Approx. Depth: _
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-round?
j� 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: M a
For City Staff Use Only
1. Plan Check Number, if applicable?
2. Site is Zoned? F—. 1M t . S
3. SCS mapped soil type(s)? OL i6�: N ..�oc�C � l'.b� 1���c> At—���� >�
4. Critical Areas inventory or C.A. map indicates Critical Area on site?. .
5. Site within designated earth subsidence landslide hazard area? AQ? - jy%Cp j0�1 d bA k
C t: n o --kco Y7npo.4a.t y Uant3 o�
DETERMINATION
STUDY REQUIRED % WAIVER
t'N i
Critical Areas Checklist/3.25.2004
#P20
�~C� of 6D0�0 City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
W3 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 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).
Date Received: vL25I6VtV-1% I f I ci Los
City Receipt #: co -7 1
Critical Areas File #: <ns— o `7
Critical Areas Checklist Fee: $135.00
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 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.
Please submit a vicinity map, along with the signed copy
of this form to assist City staff in finding and locating the
specific 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, 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 based in whole or part upon .false, misleading,. inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
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 file this application on the behalf of the owner as listed below.
SIGNATURE OF APPLICANT/AGENT
DATE
Property Owner's Authorization
By my signature,) certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and pos ' g attendant to thi. application.
SIGNATURE OF OWNER DATE —
/ -03
PLEASE PRINT CLEARLY
Owner/Applicant:
�71401-5r—
a /D% 14�; � . S
Stree ddress d
City State / Zip
Telephone:19,�L-- 77 % (6Zl�
Email address (optional):
Applicant Representative:
Name
Street Address
City State Zip
Telephone:
Email Address (optional):
CITY OF EDMONDS _
PUBLIC WORKS DEPARAT FOR INSFECTION CALL • Permit E�
ShDE SEWER PERMIT 775-2525 Ext. 220 Issue Date
�* PERMIT MUST BE POSTED ON JOB SITE
1. Address of Construction �cUJ [:�dMOA
2. Property Legal Description (include all easements)
3. Single Family Residence `/ Multi -Family No. of Units
Commercial �FU U BEET FLE
4. Owner and/or Builder U -5
5. Contractor & License No.
6. Invasion into City Right -of -Way: No `/ Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation). /
7. Cross other private property: Yes Noy Easement required -
v attach legal description and county easement number.
H
a READ THE FOLLOWING AND SIGN:
a. Property owners must obtain a permit to install side sewers on
>4 their property. A licensed side sewer contractor must be employed to
°q construct side sewers in the public right-of-way.
w b. The side sewer contractor assumes full reponsibility for each
F' installation for one year.
wC. Commercial establishment requires a minimum of a six inch (6")
side sewer line.
o d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
e. Side sewer lines must be laid at a minimum grade. of 2% (1.150)
and maximum grade of 100% (450).
N f. No turn in side sewer greater than 45° (1/8.bend) is°allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k.. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
DATE:
I certify that I have read
and shall comply with the above
+ PERMIT FEE: 'S?(? ; DISAPPROVED BY: Date:
B Date:
CONNECTION FEE: APPROVED BY Date: 3
O
w * PERMIT MUST BE POSTED ON JOB SITE
JSEWER DISTRICT
NOTICE
ALLOW EIGHT WORKING', HOURS FOR PROCESSING SIDE SEWER PERMIT
Side Sewer Address ! 10-5 o1�+� SW noel
I
Lot No. Block Plat Name
Owner 1-�n Ut'j a l Side Sewer L t Z S 9,qc/� ko6 Se�V i c-e—
Contractor
APPLICATION FOR SIDE SEWER PERMIT NO.
PERMIT FEE PAID
Res. New
Revision
Commercial No. of Units
Monthly Service Bills To
(FOR USE OF SEWER DISTRICT ONLY)
Assessed: ULID No. HUILOA
Billing Start Date
Application
Approved By
Date Approved
Ledger Made
Inspection Date(s)
Inspectors)
Pipe Make Size
Test: Air Water
Final Permit Book Entry
NORTHEAST LAKE WASHINGTON
SEWER DISTRICT APPLICATION
FOR SIDE SEWER PERMIT
The undersigned hereby applies for permission to construct or repair a side sewer as indicated on the reverse
of this sheet, and agrees to construct subject to the following stipulations:
1. That all regulations and requirements set forth by Resolution No. 1966-3-3, as amended by
Resolution 1969-2-4, and further amended by Resolution 1973-6-4, of the Northeast Lake Washington
Sewer District, be complied with fully and completely. Resolution No. 1966-3-3, as amended, is by this
reference, included in its entirety as a part of this side sewer permit application and the issuance of this
permit and acceptance by the owner or -his agent, have read same and agree to its terms and stipulations in
their entirety. (Copy available upon request).
2. The owner hereby agrees to maintain the side sewer constructed under this permit in accordance
with the rules and regulations of the Northeast Lake Washington Sewer District, and further will permit
access with entry by authorized representatives of the Northeast Lake Washington Sewer District on the
property described in this permit at any reasonable time for the purpose of inspection for compliance with
all sewer district regulations.
3. The owner is hereby notified that the Northeast Lake Washington Sewer District sewerage system is
of the sanitary type system and he agrees that he will not at any time connect storm water drainage from
any source to.the District's system; this includes, but is not limited to the following: (a) roof downspouts,
(b) building footing drains, (c) springs or under ground water from any property, (d) any outside
ground -water drains. A penalty could be imposed for violation.
4. The owner and his contractor hereby agree to accept full responsibility, and to hold Northeast
Lake Washington Sewer District harmless, for any liability, damage and/or costs which may accrue from
prosecution of side sewer work under this permit.
5. The owner and/or his contractor hereby agree to safeguard the work done under this permit in such
a manner as to prevent injury and/or damage to the public. Such precautions shall include the employment
of all necessary ditch ; safeguards such as lanterns, barricades and safe access or egres through the
working area.
6. The owner and/or his agent agree to employ a side sewer contractor approved by Northeast Lake
Washington Sewer District, licensed by the State of Washington and covered with adequate and satisfactory
liability insurance, for all work to be prosecuted on public roads, rights of way and private property.
7. No backfilling shall be/done until the work has been inspected and approved by the District's
authorized inspector. The owner and/or contractor must call for inspection upon completion, before
backfilling, of any portion of the side sewer.
8. The owner and his contractor agree that all street cleanup and road, restoration will be made to the
satisfaction of the governing authority, i.e., City, County, ,or State Highway, etc. and Northeast Lake
Washington Sewer District.
9. The owner and his contractor agree to obtain at no cost or liability to the District all necessary
permits for construction work to be accomplished under this permit.
10. The property owner hereby agrees to hold .Northeast Lake Washington Sewer District harmless
under any situation or condition which develops in the owner's side sewer lateral which lateral is the subject
of this application whereby sewage fails to flow, backs up and/or is deposited on the premises of the owner.
Also, that a notice of occupancy or change of ownership shall to furnished to the District immediately
upon sale and/or occupancy of said property.
OWNER'S NAME (Print)
OWNER'S SIGNATURE
ADDRESS
OWNER'S AUTHORIZED AGENT
SIDE SEWER CONTRACTOR'S SIGNATURE
PHONE NO
DATE
ADDRESS
PHONE NO.
•
0
, The City of Edmonds IFT
iA A
Side Sewer DrawingLE
EASEMENT NO. ............................................
NEW CONSTRUCTION REPAIRS LID NO. NO ................
OWNER
. ......i.da-1 ..................................................................... CONTRACTOR ........ .................... PERMIT No.
JOB ADDRESS ....... ................... ......... LEGAL DESCRIPTION: LOT NO ....................................... BLOCK NO. ........... ........................
.........
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F
................................................................................................................................
NAME OF ADDITION ........................
Va+
4161
9 . ............ ;�-
Approved:
v.
DATE ...... ........... /
PWW-OWl-1 lf75 (REV. 1 11/78) . .... ....... By