1005 7TH AVE S11111111111111
14755
1005 7TH AVE S
_.,_. CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT ^ T m 4344
/Call 776-1107 for side sewer inspections BEFORE covering any portion of the construction.1
\Inspection will be provided within 24 hours after request. NO Sat., Sun., or holiday inspections./
� Vent"' �0U.t..
:
ADDRESS LOCATION OF CONSTRUCTION........I90" .................................................................................... _.._.......... ..........................................
Lot IC . !'os t.s First Addition 0 Ecicrands
PROPERTYLEGAL DESCRIPTION .................... jI7Cf--4...................................................................................................................7...........................
...................... ............................ _........... ....................................... ............................................... ...................... _.......................... _..................................................
................................---................OWNER AND/OR BUILDER-.-..... r£'t S@ � 5i i ......
Ow a£:r -
ACTOR'S NAME & ADDRESS....................................................................................._.............................._.._.......................................................
Permission is granted ...` 1..'..' .....::. ............................... 19---7: , for repair alyd/or connectiqu,9f a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
TION IS CALLED TO THE FOLLOWING:
No. 1--The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
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 failure due to improper
work which may develop within one year of completion.
NOTE No. 0—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 sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED O Date-.._ ................................. By ................ Date..
APPROVED �.-Date..._ _.. ....... �� ........ By..._
00-01
Remarks: .............................=------.................
.. .
...................................,/4 ph.....,
............. By ................ Date ............... -................... By................
�....,r!" ... 4 .44
f
— BOTH P Wffi
Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection —
I ................. ..............., hereby certify that the side sewer installation constructed under this permit
(O o sting Firm Per Construction)
natalled in accordant with all governing ordinances of the City of Edmonds.
Dated this....:i' Al --- ........... day of.......%��.�:/....1.............................. �<
J V Check BEFORE you dig for: Water p, Gas ❑, Telephone p, Power ❑, Sewer p, Other 0 V d
CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
/Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.
\Inspection will be provided within 24 hours after requst. NO Sat., Bun., or holiday inspections.
ADDRESS LOCATION OF CONSTRUCTION........... 5... ..." "'.-1-T-r4 - '" ^=
,........=..e........................................................
PROPERTY LEGAL DESCRIPTION........... ............ Q' ............ ra .....�t. '1.4 ►.....................................
.......................... _............................................................................_.................. ................ .................................... ....................................................
................................................................OWNER AND/OR BUILDER ........ <:Z .� . .. .....
ME...........................
.'.y.i c .Q.............................................
CTOR'S NA & ADDRESS...........................S�Jss��.....................� _ `
......................................
Permission is granted ............ ............................ _.._............ 19......... for repair and/or connection of a side sewer to the city sanitary sewer
SULM In accordance with City of Edmonds ordinances.
A-6NTION IS CALLED TO THE FOLLOWING:
NOTE No. 1--The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
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 failure due to improper
work which may develop within one year of completion.
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 sewer or its appurtenances except to in-
sert the pipe Into the wye.
DISAPPROVED ❑ Date .. . ................................... By ................ Da
APPROVED VDale...,Qa �.2.I ............... By
Remarks:
By................ Date ................ ................... By ................
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection —
h-------••wn-------.Co ----- -- act-ng..•---•-•-------------------Con-_.__-....____ ..., hereby certify that the side sewer installation constructed under this permit
` (Owner of Contracting Firm Performing Construction)
r, installed in accordance with all governing ordinances of the City of Edmonds.
Datedthis............................day of................................................................ ) 19.........
4 J Check BEFORE you dig for: Water ❑, Gas ❑, Telephone ❑, Power ❑, Sewer
❑, Other 0 -*/ N1
TEET FILE
CITY OF EDMONDS
250 - 5TH AVE. N.. EDMONDS, WA 98020 • (206) 771-0220 • FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
_ Public Works • Planning . Parks and Recreation . Engineering
890.199i
LETTER OF TRANSMITTAL
Date: June 5, 1992
To: Greg Selvidge
1005 7th Ave. S.
Edmonds WA 98020
Subject: Critical Areas Checklist
Transmitting:
For your information: X
As you requested:
For your file:
Comment and return:
Note attachments:
Comments:
LAURA M. HALL
MAYOR
PETER E. HAHN
DIRECTOR
Planning Division
Diane Cunningham, Secretary Planning Div.
• Incorporated August 11, 1890 •
Sister Cities International — Hekinan, Japan
. 0/) 4"-�p
RECEIVED
EET FILE MAY z s 1992
<+'a
PERMIT COUNTER
1e90 1,9
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 developmentpermit
to the City.
The purpose of the Checklist is to enable
City staff to determine whether any potential
Critical Arras 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 checidist, 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 the appropriate column below).
Owner / Applicant:
— aq
Name
AJ eA--
Title
Street Address
City, State, ZIP Phone
Applicant Representative:
Name
Title
Street Address
City, State, ZIP Phone
Signature Date
Signature Date
Critical Areas Checklist .
Site Information
Project Name: (5 11199 ��l U �Ye. Permit Number:
Site Location: 106LS' % -Itn Acl e-. S, Property Tax Account Number.
Approximate Site Size (acres or square feet): /2 6 " x ) Sr /
615LI-- 6641,01a --OZ
Have you filled out a Critical Areas Checklist for a project on This site before?
General Site Conditions
1. Has the site been cleared or logged? Date of most recent action .L
Soils / Topography .. .
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? 1V &ZWa (-�U6,gA)
3. Describe the general site topography. Check all that apply.
('oN,p teK
2- -I-c f jv�7G�S
Flat: less than 5 feet elevation change over entire site.
_K^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 of horizontal distance.)
Steep: grades of greater than 30% present on site.
Comments
Hydrology/Vegetation
4. Site contains areas of year-round standing water. 410
5. Site contains areas of seasonal standing water: /c1 J Approx. Depth:
6. Site is in the floodway 1Jv floodplain AZ & of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? �1 flows
are year-round? Flows are seasonal? Cuv
8. Site is primarily: forested ; meadow tiy ; shrubs /UU ; mixed A-)O
9. Obvious wetland is present on site: Ad-0
10. Wetland inventory or map indicates wetland present on site: K_)-0
11. Critical Areas inventory or map indicates any Critical Area on site: ti>O
For -City -Use Only
Rev 3127192
b
DATE Z PERMIT ADDRESS -1 TH ArftS
• LEGAL DESCP.
Se R E ETZILER,MIT REVIEW - ENGINEERING DEPARTMENT CHECK LIST
Instruction:
Check Accuracy of Legal Description
Check Against Assessor's Map for Legal Subdivision
Does it conform to City Approved Subdivision?
Reviewer's
Initials
F al
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1. This lot included in Subdivision/Plat
2. Site Inspection made on: �iN'Z
...
3. 11hat are ground water and soil conditions?_
4. Site Drainage Checked? 4
5. Storm Sewer Availability:
Roadside Ditch
of nwg. No. Proj
6. Grading & Final Contours-:
7. Septic Tank System Design Approved:
8. Sanitary Sewer Availability — Sht. of Dwq. No. ..% Project
Side sewer availability:
9. Sanitary Sewer Connection Fees?
10. 11'ater Mains & Fire Hydrants (Indicate Size Plain)�cis,a
Check Fire Dept.'s Comments
11. Sidewalks: (Sit inspection shows conditions of sidewalks as follows)
12. Curbs: Curb Cuts Pr'veway (Check driveways for safety, lncation,
grade and width): r
13. Underground Miring: Street Lights:
14. Street Right-of-way & Bldg. setbacks: Sht. of official Street Map.
15. Existing Utility Easements?
16. Access Easements:
17. Site Plan checked for accuracy?
18. Special Requirements listed in Memo to Bldg. Pept.HMO
19. Commercial & Apt. Requirements form completed?
20. Drawings stamped & notations made? 2
21. All Items filled in on Bldg. Permit Application?
22. Bonds posted for site work?
23. Right-of-way Invasion Permit required?�
COMMENTS:
t
Rev. 7/1/76
r 1
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CITY OF j✓ I�1j? ,.S IFIL
COMM�� Y' S ENT
RIGHT- - A STRUCTION PERMIT
I►i
Permit No. 1Y
Issue Date
A. • Owner: =z �` e_ v r) B. • Contractor: J 4 ,--
Name ;,, Name
Moling,.Addres ,sr . M �h , "p's C� ` �� i ,r,(1)?
City State Zip City State Zip
State License Number Telephone Number
• Address or Vicinity of Construction:
Type of Work to be Done:���f�'
Work in Connection With: ❑ Sub or Plat ' Single Family ❑ City Projects
❑ Commercial ❑ Multifamily ❑ Utility
Pavement Cut: ❑ Y ;� N
APPLICANT TO READ AND SIGN
INDEMNITY: 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, forseen or unforseen, that may
be made against the City of Edmonds, or any of its 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.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed
by City forces, at which time a debit or credit will be processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Public Works: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
no exceptions.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
��` ate'"
Signature: a �r ' � .r/ � �� Date:
Owner or ontractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
ISSUED BY:
Time Authorized: Void after _1io days.
Special Conditions:
Amendments: t ,
PERMIT FEE:
Security Deposit:
iz Receipt No.: 9 '71 1
Fund III Fee:
Street Cut Dimensions:
X = r`J
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
Date:
Date:
Eng. Div. July 1985
7 / If
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STREET FILE
L�tz� 5!�lvItea�
7 pM�� 9�?0
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION ❑ REPAIRS ❑
OVPNER 11. :.....-.- ?.E /..........................................
ADDRESS.....l..QQ..S.............7.... ...........................................................
•
•
0
Ll
EASEMENT No ...........................................
-7V-
CONTRACTOR ................ � F�............... .................................... PERMIT No.
LEGAL DESCRIPTION: LOT No . ............. Z ...................... BLOCK No........... ..........................
1
N. ............ s.-r---........4 7 _.......... To--
APR 2 3 1973
G4�y
Approved:
DATE................................................ By------....---------.............---...................................
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION ❑ REPAIRS ❑
EASEMENT NO .. .............. ...............................
LID NO ................... ASMT. NO. ..................
OWNER --------- --Y-e-j--•------ P/Ui C-C�----------------------------------- CONTRACTOR .-------------- D ........................-� I
L
-------------------- PERMIT N0..........-
JOB ADDRESS 1 vOs �.... �--
------------------------------------------ LEGAL DESCRIPTION: LOT NO..------.....-f.................. BLOCK NO. -------- --f---------------.:.....
-------------- - -
.......... V
NAMEOF ADDITION----------------------------------------------------------------------------------------------------------------------
Approved:
DATE .....
-------------------------------- BY-----------------------------------------------------------
:Llll�
APPLICATION
for
The City of Edmonds tom+ - �IV SIDE SEWER PERMIT
i �y� ��� ���L�. EASEMENT No. ..........................................
EW CONSTRUCTION REPAIRS f_
LID ?4
OWNER ..0 REG............EL.V ►OCHE..... coNTRACTORW IVER PERMIT No. "�-`'!"?-.
ADDRESS 15X:>5 —77 74 &Vat4UM SC I'U LEGAL DESCRIPTION: LOT No . ................. 10............-•---..... BLOCK No. -......-- !-........---•--•-.-••---.....
I NAME OF ADDITION YOS—M FIRST &M%'T%ON TO EDMONM
.............................................................
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4"40MC. UNE �LO�
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Approved: (Ahool'i"Id=N avLYi scam pmum MIT
DATE ........ By -
2 -
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CITY OF EDMONMu
CONSTRUCTION PERMIT APPLICATION
OWNER ME/NAME OF BU INESS
,P felv l,UsC_
MAILING ADDRESS
/0oT a
CITY ZIP TELEPHONE NUMBER
Co%titoN� 9d'�Lo 7y3-
NAME
ADDRESS
ZIP ITELEPHONE NUMBER
NAME
OWNet.
ADDRESS
CITY ZIP I TELEPHONE N
STATE LICENSE NUMBER EXPIRATION DATE
)erty - incll/Ude/� _all easements
ACl/Q 1'7 rUTO
�14-4 o� 6locfr
O L' .. LA (O
i Property
Tar Account
Parcel No.
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NEW
RESIDENTIAL
PLUMBING
®
ADDITION
COMMERCIAL
MECHANICAL
APT. BLDG.
REMODEL
SIGN
GRADING
FENCE
REPAIR
CYOS.
( x _FT)
DEMOLISH
WOODSTOVE
INSERT
SWIM POOL
HOT TUB/SPA
GARAGE CARPORT
WALL/
'RENEWAL
ROCKERYG
Z
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
cc
S/DftDELLING
N NUMBER OF STORIES
BER OF
m
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/yc
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DES~ TO E DON (ATTACH LOT PLAN)
PERMIT
NUMBER %C)49
JOB SU
ADDRESS
LEGAL DESCRIPTION CHECKI SUBDIVISIQ'4)40. I LID NO
N
5 :1 '1
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved
❑
RW Permit Required
❑
EXISTING REQUIRED DEDICATION
Street Use Permit Req'd
❑
Inspection Required
❑
PROPOSED
Sidewalk Required
❑ 0
Z
REMARKS
W
W
Z
a
Z
W
ENGINEERING MEMO DATED
METER SIZE (BUILDING SUPPLY
REMARKS
REVIEW BY
NO. OF FIXTURES
SIGN AREA SEPA REVIEW ADB NO.
ALLOWED I PROPOSED COMPLETE EXEMPT
SHORELINEN
EXP I "`--
VARIANCE OR CU P NNING REVIEW BY DATE
SETBACKS
��—FEET �^ /�/�/�y� HEIGHT LOT COVERAGE
FRONT a(tj / SIDE.) ' 4 AA
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
Q
C= 2,5)
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
❑ YES
REMARKS
PROGRESS INSPECTIONS PER UBC 305
T�/?lnnL '°P2 /qq 1 W�"CJ
FINAL INSPECTION REQUIRED
LI X
PLAN CHECK FEE
V1W6 00 A.
BUILDING
HEATS URCE:
� v�S
GLAZING
%
PLUMBING
Plan Check No. / n /.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Applica)lon: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days .
STORM DRAINAGE FEE---
.
Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
I successors in interest, agrees to indemnify, defend and hold
I harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
nor limit in an way the City's ability to enforce any ordinance
provision."/
OTAL AMOUNT DUE
I hereby ac n edge that I have read t plication; that the"
information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and in doing the work authoriz.
ed thereby, no person will be employed in violation of the Labor
THIS PERMIT
AUTHORIZES
ONLY THE
Code of the State of Washington relating to Workmen's.Compensa-
WORK NOTED
tl n Insurance.
INSPECTION
SIGNAT E-(O ER" R 717 GATE SIGNED
DEPARTMENT
--!
CITY OF
EDMONDS
ATTENTION
CALL FOR
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-0220
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
10247
W9
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/37 45_0
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFF C L' SI ATURE TE
6 �6%9z---
RELE E � / DATE
ORIGINAL — File YELLOW —'Inspector
PINK — Owner GOLD — Assessor
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