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1003 DALEY ST.PDFiiiiiiiiiiiiii10711 1003 DALEY ST ADDRESS: l 0 d TAX ACCOUNT/PARCEL NUMBER: b C- L4-�-� () n(� BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) CRITICAL AREAS -9 G-U-70 DETERMINATION: ❑ Conditional Waiver ❑ Study Required Xwaiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER): lq v l b z- PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DA SEWER LID FEE $: 1 LID #: SHORT PLAT FILE: LOT: ' BLOCK: SIDE SEWER AS BUILT DATED: ksS I Q 7 Z SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD DATED: I Z S S bw LATEMP\DSTs\Fomis\Street File Checklist.doc , ­�7 "N" k­�­ ty ITY.VF EDMOrvUS. WASHINGTON DEPARTM" OF BUILDINGS BUILDING PERMIT hat, a piot, plan, drawings, and sufficient details to indicate requirements of this code are attached hereto. ejor.perfftit 'to do the following work: ..... .................. .......... ............ .......... ------ ----------- - ---- (Screcc mryijkr cc to and block oumierv) i�'l �Builcling`.'dirnensirxis are_ / . . ......... are_...._.L7.0 ........... .. x --------- 0 .... . ............. 3 '-;Build g. ! "i in I be....... -._ ..............stories stories in height. 4- Number of basefnent&_._ �citjan6y. of bwljipg will be_.__ . .... .... r`�t fronl inng loz i- ----- --------------------------- 1-) J 7- .. . 8. Ownersdd'._..____.._............. fir ':Builder..__......._ I ........ . .. ry 10': Builder's Addrem ..... . ----------- I - z A :D 0 z nT Estimated cost Group No:...._:: _-` . ..... .... ........................ .11. Architect or eng;neer-..­... .. .......................... ......................... ...... ............. ......... ...... Life of perful s..* Date....- ... ........ 194__a? Applicant's Signature ......... ................ . .. ...... ................. 1`13n_- filed: Yes Ur 'No . . [] . ., . . (Ovreer or his V 0 Pcrfnssion is hereby granted to do the work d=nl)ed hereon, according to the approved plans and specificati6.0 pertaining-hexet6, 41 subject to orrriphance with the ordinances of the City of Edmonds. This copy is your rempt, for. the follo,iving feis:,-, 41 1. Building permit fee_.._......_ . ............................. .. . . . .......... . .. . ... .... "ki Y,', 2. Sewer pciTnit fee ........... ........... .. .. . .... . .... . .... 3, lnspection and supervision fte .............. ................... . ....... 4. Tcftl ..... . ..... ..... ........................................................... . .......... $ ReX,lly Departmenc of`16tilclinki 7iERMIT N? 455 Q'ty oPEdinunds- U, .0 1. The kmilditti; permit fee which applicant pays when permit ;a issued shall be based on euntsat&I < a of the proposed srructt.m, at the race of $1.00 far each S1000'0C of anr. she If . M..j coltof the structurre, when finally Jeserml-4, exceeds; the estimated curt by mm man Sc, applicant agrees to pay m suldid-2 for I of S200 for each $100n.00 If such zxcrss con. In such c,rent no s— permit rball be issued until such -discrepancy fee" is paid. 2. WL—er a "maserfor construction Is rxccmcd for any suoursom costing mom than S1000.00 for wbids 2 :kcased architect or cissioter is not requited by. the BriUdi.ir C�de of he (Up .1 Edmunds, c. application for a bu-udiag permit bjU br, accompmird by a cWy of the oomract and a copyof the detsited" 'Pecificadoess. I labor or commencing —k, oc�.;fv be industrial 1--ce W.Woo of the Departmes, of Labor and Indstsries, jcih%g an estintso, of mike monthly reports J'payiolls.,17h11 instructions sboutd be obc,ined from the ruaras:N f the Depxrmes t of Labor and Inh Jes. Before fm.1 p.y.,.r the'a—ser should obtain . r`eteasefrom the (agent �uutiac6n who is tZm- abucj2tc;btiiss =1 from "I sub —cm rs. The rd— should be anzattJ by the Department of Labor and Industries. 7b:r aborre prbredi--m are requimtii,;nts of the Ssate Industrial L—ce Act. r 41t 9- . 'city". a Edmonds Checklist -C rRidal Areas• The Qidcal Areas waist contained 6in thisfonn is to be filledout by my and submit it to the city. The City will prTaring a DeMopment Pemlit Pww' review the checklist, maim a precursory site visit, and make- a determination of the Application for the City pf.Edmonds'P prior: subsequentsteps,neccompletey to complete a to his/her submittal of a development dwd%mient perrkapplicafiom permit to the a!y. ...With a Ammel copy. of this form, the The purpose of die ChwMest is to c ble 3PPficWshould also submit a,vid*ymap ' City staff to.deterafiw.wbether any .-IMPOplan 15-r WdivJdiffES-5rVzVREa potential Critical. Ann are or may detail. that City stqcan find present on the subject property...The __.!,-,! and idenWi& julfiject .-I . W-�- ormaion needed to complete wthe '.db,pplt shaIZ�- ` Checkist should becaiiljxya"Ie f;n. other Perfilent Mfft�"__ (e ... , W&SMS60"'JAM Obsuvations of the fft or data available at - plan, — _4.sUe phy map, es In.. LPJFDWM City Hall (Cl ificalAreas inveftode;;,maps, . fl-,-1104 With this U sijjijiiist or soil surve staff In completing their pregod4aij .'assessmeat of the site.,.-, An fill or MAW must Mthe sign and-dateit, Ihave eom&Wtote ato how to" beacfk M �., , , Qjj, MOO . . . . . . . . . . . . . . . . . . . Ki Ot Sk"Mdiiii , MY— .......... 14. -11MV , gm 11V APPLICATION for The City of Edmonds SIDE SEWER PERMIT EASEMENT No ........................................... NEW CONSTRUCTION ❑ REPAIRS ❑ 118-04150 OWNER...........G.....K..-..-Earrens................................................................. CONTRACTOR....--------------------------------..........------.........----................................. PERMIT No....................... ADDRESS ....... ®03...Ddley- St................................................................ LEGAL DESCRIPTION: LOT No............................................... BLACK No............................................. • • NAMEOF ADDITION................................................................................................................................... l� `,U1 Dye Tested On Sewer 1972 Approved: DATE................................................ By.................------............................................... '/�"�t�^v�f�P.7�= '�,'Yt�+'1Si=� �`�c u+�.�;7� j:r�'�,.+�•apr�,.a v+ry .y .-ter . w� »•c .�J ��.'::. ..7+o°s•u•%� City of Edmonds RIGHT-OF-WAY CONSTRUC ION 9 PERMIT Permit Number: Issue Date: .2 Q� A. Address or Vicinity of Construction: 1003 Daley Street (9405307 ) 18 C� o B.. Type of Work (be specific): Install New Service bd 9 0 - 1 9 C. Contractor: Wg.,,hingtnn Wntiiral rac f?nm as ny Contact: Frank Swan Mailing Address: 815 Mercer St. s iieattl e. WA Phone: 224-227A State License #: 98111. Liability Insurance: Bond: $ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. ❑ Commercial .❑ Subdivision ❑ City Project ® Utility (PUD, GTE, ft CABLE, WATER) ❑ ❑ ❑ Multi -Family Single Family Other R INSPECTOR: INSPECTOR: EET FIL F. Pavement or Concrete Cut : ❑ Yes o) G. Size of Cut: x H. Charge $ APPLICANT TO READ AND SIGN 1 INDEMNITY: Applicant understands and by his signature to this application, agrees to Athe City of Edmonds harmletislf�om itUd1-2 damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be mainst the City of Edmonds�r ayoj i��s partments or employees, including or not limited to the defense of any legalproceedings including deats, 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. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL B� P R�yS ED FOR ISSUANCEII'O TIIyPyLICANT. Construction drawing of proposed work required with permit application. A 24 hour notice"is required for inspection; Please call the Engineering Division, 771-0220. Work and material is to be inspected during progress and at completion. �41'• Restoration is to be in accordance with City Codes. Street shall be kept clean at all times. Traffic Control and Public Safety shall be in accordance with City reguterial ations as required by the Cityy Engineer. All street cut ditches shall be patched with asphalt or City apl9f�owec �riaprior to the end 61t14e *W—ng day; na NO EXCEPTIONS. I have read the above sta_te� nts and understand the permit requirements and the pink copy of the permit will be available on site at llmes f �urposes. Signature: T)nty• Tlnramhar 1 R t Q9R (Contractor or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK .FOR CITY USEONLY APPROVED BY: RIGHT OF WAY DEPOSIT TIME AUTHORIZED: VOID AFTER (&Je1J— DAYS DISRUPTION FEE/FUND III:.,, SPECIAL CONDITIONS: d RESTORATION FEE: PERMIT FEE:, .COMMENTS: DATE: .. TOTAL FEE: N SIl—'- RECEIPT FEE: ISSUED; BY: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991 Adilk • VAmVr n -- Na Uru Gas ti...,. - wwrnoa+6�rprcoRoen,� . Addendum to City of Edmonds Right of Way Permit Application by: MITCHELL S. LANKFORD Engineering Aide Washington Natural Gas /� 521-5245 0' window /'Water maindepth A unknown . " gas main Gi0 P�S�-I. ul -w- wrier -g- gas .. -ss- sewer $ water hydrant O _water valve 815 Macs St. (P.O. fox 1669), Seattle, WA 98111 (206) 622.6767 • CITY OF EDMONDS ENGINEERING DEPARTMENT • APPLICATION FOR RIGHT-OF.-VIAY C0!VSTRUCTION-'PERMIT (Applicant to Ccmolete A'd B and Submt in, DurVcate) A, Permit to be issued to: �%L � /4A5 E For work at: (address or vicinity) JyD 3 ` ✓1 Q\ Type of work to be done: !//"/Z),5 ( -Xl S%--jVG �1\p1 U� �� ! (Attach Drawing ?+'hen Applicable), - Time Required -- Start:S- a/- Finish: �✓��/�/e Owner: Name STREET FILE 1003 J)14L-/=� sT Mailing Address City" _ ;��< ,State Telephone Number Contractor:,. Name State License :umber Mailing Address City State Telephone Number B. 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, foreseen or unforeseen, that may be made against the applicant or`tlie`City of Edmonds, or any of its departments or employees, including but 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 Department. Work subject -to -inspection and restoration_ in accordance with _City Code. A 24-hour notice is required for inspection by the Engineering Department.` ,Call 775-2525. -- --- Signature: �...�-e- g— �- 7Z Owner or Agent Date Signed C DO NOT WRITE BELOW THIS LINE (To be conTZeted by Issuing Agency) Permit Issued (Date) L3 i�'77 Permit Number -7 7 Fee: Bond: Time Authorized: p d C y GINEER'S APPROVAL /77 ................... _....... Distr;MAY 12 19�p Al p City of Edmonds ---Water Department TAP CARD Date................................................ No............................... TapNo......................................... Meter Size.............................. Size ........................................ Mfgrs: ..�.���...:.. � : �°--... r..7/.. Style ............................................ . r. For t -..;; t...... ............................................................ i ...... LotNo ........................................... Blk. No............... ................................ Add.................................. ......................... .; ==:, ..... �'....................................: _. Service Location .,, ..''.. ,.:1..: ..:. } ...........r .................. C/ ................................................................................................................................. ` Meter Location ..................................................... _. .. . ......................... Make Tap Pressure..............................lbs. Send Bills to ......................... ..................................... I.................... Date. of Work ............ ............................................ Test ................................% L5' : Foreman Guar. Voucher No ........................... _.............. $..................................... ....... Remarks: ........................................................................................................... . ..... ............................................................................................................................ ...................................................................................................._................_.............. EI ...........................................:........ .... ........................._........... OUTGOING Index ......... Reg ....... Route Bk......... Stencil ...... Card .... INCOMING Index ......... Reg ....... Route Bk......... Stencil ...... Card ........ d ,\.-I/terial Chargeable to Installation .'---'ters NO. SIZE .......... DESCRIPTION Meter .............. Meter Box RATE Zo -- AMOUNT - ----- 77 .............. ....... - Meter Plate ................. : .......... .............. ............. .......... Check Valve .......................... .............. ............. . ......... .......... .............. ......... Pipe, Galv. Screw .................. .... ......... . .......... ....................... Nipples .................................... .............. ............. . . ......... ....... _ .......... .............. .......... Bushings. ..... ............................---------- ......... - .......... Plain Ells ................................ .............. ............ .......... St. Ells .................................... .............. - ---------- --- ............... .............. .............. .............. ............... ............... ............... ............ .......... .......... .......... .......... .......... .......... .......... .......... Tees ......................................... ...................................................... ..................................................... ...................................................... ...................... ............................... ...................................................... ...... I ............................................... ...................................................... ............... .. 11 .......... .............. .............. ............... .............. .... ......... ---------- ... I ............ ............ ............. I ........... ......... .. I ........... ............ --- I ........ ............. .......... .......... ......... .......... .......... ......... ........... ........... ........... Material Chargeable to Taps Connected NO. SIZE DESCRIPTION RATE AMOUNT .............. ........... Pipe, Black, Screw .................. ............. ............. ......... ........................ Pipe, Galv. Screw .................. ............... ............. ......... .............. ..... . ;;g Lead Connections ........................ Curb Cocks .......................... ..... Corp. Cocks .......................... ....... ZiL ...... .... .......... Unions .................................... ......... .... ..... ....... .......... ........... .......... Saddles ............................... .............. ............. .......... .............. .......... Nipples .................................... ............... ............ ......... ............... ......... Bushings .................................. .............. ............ .......... ............... .......... Plain Ells ................................ ............ ............. .......... ............. .......... Street Ells .......................... ... ............. ............. .......... ............. .......... Tees .......................................... ............... ............ .......... .............. .......... Curb Boxes --------------------------- --------- * ---- ------------- ---------- .............. .......... : S. O. Extensions .................... .............. ............. ......... .............. .............. .j ........ .......... .... . ��Z�' Gates ........................................ Plugs ........... e ..... .................... Couplings ..... ........ .............. .............. ............... ......... ------- ...... ...... .............. .......... Gate Boxes ....... .................... .............. ............ .......... , P-1, . ................ .. .......... . . ....... I ---------------- ....... ........... .. ........... ......... .............. .... . ............. * --------------- * ...................... ........................................................... .................................. ........................ .......... ........... ........ . .... .......... ...... .............. .......... ........... .......... ....................... ................................. . ........................................................... .............. ............... ....................... ............ ........... .............. ............ ........................... .......I....... .... 7 ..... .......... ................... ........................................................... ........................................................... 1..... eg�ff--l. ..�. .......... Hours �ime—Day Men ................... ............... ............... ... .. .......... ............ .-.--..-.- .... .......... I. ......-..-..-..-..-..-.. - .............. Z) Hours Time —Monthly .................... ............... ........... Hours Time —Auto ......... Superintendence ............... ...... ......... .......... Total .... ........