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1010 9TH AVE S.PDF111111111111 9905 1010 9TH AVE S ADDRESS: TAX ACCOUNT/PARCEL NUMBER: BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) FOR: —1\ M 1015 CRITICAL AREAS: �`7 lJ� DETERMINATION: ❑ Conditional Waiver ❑ Study Required kaiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS PLANNING DATA CHECKLIST DA SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMITS) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: FOR: WATER METER TAP CARD DATED: OTHER: L:\TEMP\DSTs\Forms\Street File Checklist.doc P-X15TTQr-i PE5 I WA 4A E FXI5TI KV, W Ex 1 STI lice ICI a1145 N - -- GfIO 5F J;�DZv 5F • r R EC-lVE® APPROVE® BY PLANNING FEB 18 2005 ® �o �, J3r!3' F STREET FILE IT COUNTER �^�`,� PERM • • PLANNING DATA NAME: Pan & 7ecAv- 0/4.y- DATE: 3/Dias SITE ADDRESS: 10 /a - 9 stir . 5_ PLAN CHK#: OS - 0 71, PROJECT DESCRIPTION: ,ram 4 REDUCED SITE PLAN PROVIDED?: QQ No) MAP PAGE: 153 CORNER LOT: Wes )/ No FLAG LOT: Yes / N ZONING: AS - 12- CRITICAL AREAS DETERMINATION #:_ .413 ❑ Studv Reauired: OWaiver ❑ Conditional Waiver SEPA DETERMINATION: ❑ Fee ❑ Checklist ❑ APO list w/ notarized form ❑ (Needed for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger) Exempt SETBACKS: Required Setbacks: i 9� Street: Z 5' Left Side: 101 Right Side: 25 ' Rear: (o ' Actual Setbacks: Street: 3 2 • Left Side:5'Right Side: Za' * Rear: 641 a,,; fk, krbAe,q _ j1, Street map checked for additional setback required? (Yes / No / 0 N, ❑ DETACHED STRUCTURES: ❑ ROCKERIES: ❑ FENCES/TRELLISES: ❑ BAY WINDOWS / PROJECTING MODULATION: ❑ STAIRS / DECKS: N— I ti-- PARKING: Required:_2_Actual: 1 % ,h J LOT AREA: S 6,06 " LOT COVE 3a q-d k 96Z Calculations: 2 5.3 9, BUILDING HEIGHT: /do Datum Point: Datum Elevation: Maximum Allowed: Actual Height: A.D.U. CREATED?: No / Yes I,h�, ,tiw a, �^ e r Na IWL4 W K,; f' . ryt" SUBDIVISION: LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: Yes / No) OTHER:' A- 19" - 4 - I c t.a Iv, sf^tu sc>�rc� - ���.,,,�,, �� bw.t� -� 195a Plan Review By: NewBPPlanningDataForm. DOC COLE NO. STREET FILE OCritical Areas Checklist Site Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: i 2. Property Tax Account Number:' 3. Approximate Site Size (acres or square feet): K / 3'd 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-feet). Other (please describe): 6. y Site contains areas of year-round standing water: ii4 ; Approx. Depth: 7. Site contains areas of seasonal standing water: h ; Approx. Depth: What season(s) of the year? 8. Site is in the floodway W-�' floodplain of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? o jV 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: �} Revolroaroa 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 prectwsory site visit, and make a determination of die subsequent steps necessary to complete a development permit application. With a signed copy of this form, the; applicant should also submit a viciniity 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 (e.g. ;site plan, topography map, etc.) 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 providled are factual, to the best of my knowledge (fill out the appropriate column below). Owner / Applicant: Name �f / 0 1 0 Street Address City, State, ZIP Phone Signature Date Applicant Representative: Name Street Address City, State, ZIP Phone Signature Date APPLICATION for The City of Edmonds FILE SIDE SEWER PERMIT 108-01700 NEW CONSTRUCTION E] REPAIRS 0 EASEMENT No . .......................................... cc l OWNER......... E..._..J-.-- - . . rt_......1./..% ............................ CONTRACTOR ............... .................................................................................. PERMIT No . ...................... ADDRESS------.0-1.0...-...9-th--AYEnue... S.................................................. LEGAL DESCRIPTION: LOT No............................................... BLOCK No............................................. I' NAME OF ADDITION • i • DYE TESTED ON SEWER JULY, 1972 Approved: DATE................................................ BY------.......---•-•----•-•---._........................._..........._. Pilchuck Contractors, Inc. aycn•4 Job # 107022841 February 9, 2005 8� Sheet 1 of 1 Rob Inglis '0n°'" 0"I" ) om avow NOT SMOaavN avom TO SCALE Nv 4.,►/j/y�y1n1� a a V fiaJi! 10)C7 3N PINE ST Z Z F 4 go .. � s 03SO10 . NlvmmiS • -11s► N 18" x 24" BM • KEEP • RIGHT • • T SIDEWALK CLOSED APPROVED AS NOTED BY F EERIN Date: CHANNELIZATION DEVICE SPACING MPH TAPER TANGENT 50/70 40 80 35/45 30 60 25/30 20 40 • Notes: 1. All signs and spacing to conform to the MUTCD & City of Edmonds Traffic Control specs. 2. Channelizing devices are 28" traffic cones. 3. All signs are 48" x 48" 8/0 unless otherwise specified. u 4. Alert affected residents. > 5. Work to take place between 9 a.m. And 4 p.m. 6. Maintain two 11' lanes. oe go • 2x24- 18" BM/ • WORK AREA X x 5' IN SIDEWALK • • • O ``) c< > A O 22 � ROAD NARROWS T a) ROAD WORK T AHEAD LEGEND • 28' TRAFFIC CONE ® WORK AREA TRAFFIC FLOW WORK VEHICLE SIGN LOCATION City of Edmonds Permit No: RIGHT-O&WAV `CONSTRUCTION PERMIT Issue Date: =5 — l 'OS ...... w.T,..,_ ,.... w �Q I Q TN S , A°PAddress or Vicinity of Construction: r .,. A vir.., B. T e of Work (be specific): �� ' 1 U5 1 - O`� f 1 C�.S 4�1 At �j L'0 �3 4 Av S h \ti•'A.' J' o CIL r �r ,-ai� a� 13O' S '`: t [L. .� P,vLe- �60 -ice G-70ZZ F-4( or'Q_ c� o C. Contractor: `C'.\1AJ�.C�� i n Contact:.SL Mailing Address: GUk) Phone: State License #:P1 LO—Hor-1di VY1 Liability Insurance: Bond: $ ` t City Business License #: D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): 4 E. ❑ Commercial ❑ Subdivision ❑ City Project EUC (PUD, VERIZON, PSE, COMCAST,-OVWSD) 0 Multi -Family UR Single Family Other �/ INSPECTOR: � (AA /'❑I/� I 4-Q W IN I + S F. PAVEMENT CUT: ® S'^�,❑ NO G. SIZE OF�UT, � X � CONCRETE CUT: S 1�'NO J G. ❑Mail Approved t ❑ Call for Pickup n`{ . APPLICANT TO READ 1 SIGN INDEMNITY: Applicant understands by his/her signature to this application he/she holds the City of Edmonds harmless from injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and attorney fees by reason of granting this permit. vk THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPECTION. AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES 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. f r , ♦ 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 asodit or.City=j approved material prior to the end of the workday — NO EXCEPTIONS. r' - ♦ 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 HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE THAT I MUST MAKE THE PINK COPY OF THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR INSPECTIONS Signature: " l �`` Date: c� -1 q `6 (Contractor or Agent) 1 • s. Approved by: Time Authorized: Void After Special'Conditions: 0HU il'UIXTIVS . V 14rU n L Right of-Way...Fee Dis phon` Fee/Fund `1'11 Ins ction Fee Total Fee:; o a Receipt No" "�`� REQUIRED INSPECTIONS:(1 imnc Karam, n SI,,ap-m K- rz2gm �f 164 Call 425-771-0220, Ext. 1326 for a 24-hour voice-reco �in ection request line. FINAL APPROVAL OF PERMITTED WORK: DATE: O r S CADocuments and Settings\CunisNy Documents\Forms\Engnrng\ROWpermit_ doc Revised 10/01/03 CITY CLERK'CONFORMED COPY CITY OF EDMONDS 121 STH AVENUE NO.' 200504270559 1 PG EDMONDS, WA 98020 04 - 27 - 2005 12 : 52pm $19.00 SNOHOMISH COUNTY, WASHINGTON STATEMENT ON ACCESSORY DWELLING UNITS Property Address: Solo 1111� Ayr 1=t*40t-4ps W-N- `18e32c Edmonds, Washington Legal Description: `flbo i S I 1Lt A-yp -M pL--t- dF Assessor's Parcel Number: Cho (a 19 4t>0 I have read the requirements for accessory dwelling units contained in Chapter 20.21 of the Edmonds Community Development Code (ECDC) and understand that an accessory dwelling unit as defined in ECDC Section 21.05.015 is prohibited until an AccessoryDwelling Unit Permit is approved. I also understand that an Accessory Dwelling Unit Permit cannot be approved unless all the criteria in Chapter 20.21 are met, and all the necessary items are submitted, including an affidavit of occupancy and a covenant to be filed with the Snohomish County regarding the regulations imposed on AccessoryDwelling Units. Property Owner Signature: Property Owner Name (printed): Date: 3 lzq �(0,!�- STATE OF WASHINGTON ) COUNTY OF SNOHOMISH ) I certify that I know or have satisfactory evidence that��`�� (� signed this instrument and acknowledge it to be his/her free and voluntary act for the uses and purposes mentioned in this instrument.. Notap�,'\,mpsure seals must. be smudged. Dated: FtA M. ✓,q' Signature of t ip, Notary Public: D51 �` Residing at: m Z, SLID My Appoint ',i Expires: � a �4-08 2 _ 1 i 0 �nu,���".i��` O(n 1 /SHING� THIS DOCUMENT MUST BE RECORDED WITH THE'SNOHOMISH COUNTY AUDITOR. s ADUstatement %.. STREET FILE CITY CLERK CONFORMED COPY CITY OF EDMONDS 121 STH AVENUE NO. 200504270559 1 PG EDMONDS, WA 98020 04 - 27 - 2005 12 : 52pm $19.00 SNOHOMISH COUNTY, WASHINGTON STATEMENT ON ACCESSORY DWELLING UNITS Property Address: jo10 ,yyr,-� S t-t*40tJps Wk �18e32� Edmonds, Washington Legal Description: %,rvS i S I A -op � 1E--pk0 f-iPS pLA-1-- OF �� - i �c� Af a.-7 , IQaeA-Al-IDk : �inV Assessor's Parcel Number: 00 eo 19 +C>0 I vo 100 _ G7�v J 01C7 Comon�D I have read the requirements for accessory dwelling units contained in Chapter 20.21 of the Edmonds Community Development Code (ECDC) and understand that an accessory dwelling unit as defined in ECDC Section 21.05.015 is prohibited until an Accessory Dwelling Unit Permit is approved. I also understand that an Accessory Dwelling Unit Permit cannot be approved unless all the criteria in Chapter 20.21 are met, and all the necessary items are submitted, including an affidavit of occupancy and a covenant to be filed with the Snohomish County regarding the regulations imposed on Accessory Dwelling Units. Property Owner Signature: Property Owner Name (printed): Date: (05— STATE OF WASHINGTON ) COUNTY OF SNOHOMISH) I certify that I know or have satisfactory evidence that signed this instrument and acknowledge it to be his/her free. and voluntary act for the uses and purposes mentioned in this instrument.. Notaia,',s,pwpsure seals must be smudged. Dated: :t� FiA M. Signature of t jP �,� W°#6rq `.o Ni Notary Public: ,� ' • . '` = 2 % Residing at: �LI% may% GeLIG _ /�ziO.o'a��4���$.��;�0 MyAppointmen _- Expires: lf)7 THIS DOCUMENT MUST BE RECORDED WITH THE SNOHOMISH COUNTY AUDITOR. ADUstatement STANDARD GAS CONSTRUCTION NOTES: PINE ST I y 03 moo: 03 y EOM y 2" PE CAP O 130'S CL & 28'W CL (_')S CL & (_JW CL ® PROPOSED 85' LONG 2" PE IP MAIN y 28'W CL (_7W CL 4N 4y -� 64' I y TIE-IN R/W FUSE 435'N CL & 28'W CL �-- (_')N CL & (_JW CL W � I _ J � y 5r8-429'N w 1991 5 8 4291N V 3 1993 iyy` y c� _ PAS IN 5/18"331'N j 1993 L4 �JJ I co 5/8"288'N IL C7 �- 1999 I y 5/8.268'N 2003 o' FIR ST PLOT PLAN SCALE: 1 50 J NOTE: OVERHEAD POWER 9 AV S PHONE, CABLE 0 28'W ASPHALT S—Bound Lane CL N—Bound Lane W z �' z �' E . 7' SIDEWALK 7' SIDEWALK • PROP. 2" GAS • ° ° • 28'W CL EX. SEWER EX. WATER 10'E CL 30'E CL 64' ROW ROADWAY CROSS—SECTION N.T.S. FITTER (CHECK BOX IF COMPLETE) Work area left in Clean & Safe condition Complete all Pipe Tables and Gas Pressur Stamp Field changes Red —Lined on as —built Material verified and Changes noted on paperwork All Valve & Tie—in Locations noted on a:' —built Note beginning of Main, EOM & Line of '•Rain locations Show Rope Locations & Cul—de—sac Radius_ Foreman's Signature Company Date _. 1. FIELD LOCATE ALL UNDERGROUND UTILITIES. EXCAVATOR TO CALL "ONE —CALL' TWO WORKING DAYS PRIOR TO TO CONSTRUCTION, IN WESTERN WASHINGTON CALL 1-800-424-5555. IN KITTITAS COUNTY CALL: 1-800-553-4344 2. NOTIFY APPROPRIATE PERMITTING AGENCY PRIOR TO JOB START (SEE PERMIT REQURRMENTS). 3. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS AND GAS FIELD PROCEDURES. 4. EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE 0150.3200 TECHNIQUES FOR TEMPORARY EROSION AND SEDIMENT CONTROL AND ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS. 5. 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 LARGE, 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 INSTALLED OR REPLACED PER GAS OPERATING STANDARD 2550.1600. ALLOW ADEQUATE TIME FOR CUSTOMER DECISION AND RESPONSE. 6. ANY CHANGE IN ROUTE, PIPE SIZE/TYPE, TIE—IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE APPROVED BY THE APPROPRIATE PSE ENGINEER OR PSE REPRESENTATIVE. 7. COMPLETE "PIPE CONDITION REPORT' ON ALL METALIC PSE FACILITIES. CHECK BOX. ON REPORT FOR WIRE BOX (TEST LEAD) INSTALLATION. 8. PIPELINE MARKERS AND WARNING SIGNS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR. PER PSE GAS OPERATING STANDARD 2525.2500. 9. INSTALL MAIN VALVES OUT OF TRAFFIC WHERE POSSIBLE. VALVE MARKERS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS OPERATING STANDARD 2525.2600 FOR ALL HP VALVES IF THE LOCATION IS NOT READILY ACCESSIBLE, AND FOR ALL VALVES WHERE PERSISTANT SNOWFALL MAY OBSCURE THE VALVE BOX. 10. TO PREVENT ACCIDENTAL OVERPRESSURE OF ADJOINING SYSTEMS, NO TWO MAINS SHALL BE CONNECTED EXCEPT AS SHOWN ON THIS DESIGN UNLESS APPROVED BY APPROPRIATE PSE ENGINEER OR PSE REPRESENTATIVE. 11. SYSTEM MAOP DENOTED BY: ISYSTEM MAOP = 45 PSIG 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. PURGE POINTS AND PRESSURE TAPS TO BE INSTALLED PER PSE GAS OPERATING STANDARDS 2525.3300, AND 2525.1200. 15. MAINS AND SERVICES SHALL BE TESTED AND PURGED PER PSE GAS OPERATING STANDARDS 2525.3300 AND 2525.3400. 16. IF METALLIC PIPE IS INVOLVED, COORDINATE INSTALLATION WITH CP TECH. --------- PHONE 17. NOTE ALL ACTUAL FOOTAGE, LOCATION AND MATERIAL CHANGES ON THE AS —BUILT IN RED. ( ') DENOTES FOOTAGE BETWEEN FITTINGS. GAS MAIN INSTALLATION/RETIREMENT Type/Work Pipe Size Type Estimated Length Actual Length Manufacturer INSTALL 2" PE 85, GAS MAIN PRESSURE & TESTING TYPE TEST_ __ DATE ON i PRESSURE TESTED B%.' _ - TIME ON DATE OFF TIME OFF TYPE TEST PRESSURE TESTED BY DATE ON TIME ON DATE OFF TIME OFF Design Press 60 SYS MAOP 45 PROJECT PHASE NOTIF# ORDER# O SAP Superior Service/Meter Service/Meter Service/Meter Service/Meter Ind. Service Ind. MSA Dis. Reg. / FT HP Svc/MSA Relocate Retirement X185032706 107022841 X185032549 106146981 Vicinity Map WORK SITE 0 WalnutSCS ' Cedar pl edar St rn eland Or _ eoM dp�,t mute t mlo kWa ll Y mlo4 GkSt — at 5•-� -_ - eau; - — --- 5th- PlneSt 3 216thStSw Q r6 thLn > m a aJ.IrSt a'IM Go c in Z2ath5tSEI �EImSt > O -, o by OG J 81rch It m m r ix Owner / Developer Contact Info JEANNE BLAIR 8205 226th ST SW EDMONDS, WA 98020 ATTN: JEANNE BLAIR 425-672-4796 office Contractor. CONSTRUCTION COST CODES: 051-103.1 Project Manager Contact Information: so2 CALL (800) 424-5555 BUSINESS DAYS BEFORE YOU DIG KIM GRAY CELL: 425-290-2678 THIS SKETCH NOT TU BE RELIED UPON FOR EXACT LOCATION OF FACILITIES EMAIL: kIm.GRAYQpse.com REAL ESTATE/EASEMENT PERMIT N/A EDMONDS REV# DATE BY DESCRIPTION FUNCTION CONTACT PHONE DATE 3 PROJECT MGR KIM GRAY 206-418-4233 2/8/05 2 ENGR - GAS 1 2/16/05 J.T.M. CORRECTED WORK SITE ADDRESS DRAWN BY JOHN MOSS 206-418-4253 2/10/05 CHECKED BY KIM GRAY 206-4111-4233 COUNTY EMER SECT GAS WK CTR APPROVED B KIM GRAY 206-418-4233 SNOHOMISH 5 MCNSEG CP APPROVAL ❑ 1/4 SEC OP MAP PLAT MAP ❑ NW-25-27-3 164.062 164.066 MAPPING ❑. JOINT FACILITIES ARRANGEMENTS ❑ UTILITIES ❑ CONTACT ❑ PHONE# µ PUGET SAP Order: . JEANNE BLAIR 07022tio SOUND ENERGY 2" PE IP MAIN EXTENSION DraMrl NIA mbar: 1010 9"S, EDMONDS, WA 98020 SCALE: PAGE: DESIGNED BY PILCHUCK CONTRACTORS INC. 1" = 50' 1 1/1