1008 VISTA WAY.PDF1111111111111113605
1008 VISTA WAY
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j ITY OF EDMONDS
PUBLIC WORKS DEPARTMENT, ENGINEERING DIVISION
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APPLICATION FOR RIGHT-OF-IJAY CONSTRUCTION PERMIT
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete PartsA and B
A.
kattacn arawing wnen applicable)
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Time Required -- Start: Finish: — — 7
Owner1q J3 F/` Nly T `�
Name 1 ET FILE
WnV,ddress �-7 —/
City State Zip Telephone Number
Contractor:
Name
2�� o
State License Number
Mailin ddress
M11174
7 g'� 7 g9Z
City State9Vo Zip
Telephone ,Number
** NO WORK TO BEGIN PRIOR TO PER111T ISSUANCE **
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 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.
Upon issuance of thispermit, 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 Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at'which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220.
I understand that this permit must be available,at the job site for inspection
purposes at all times.
Signature: Date:
Owner o Agent
TO BE COMPLETED BY ISSUING AGENCY:
Date Issued: Permit No.:—/�_ Fee:
Security Bond: tit %q
Time Authorized: _✓/,�
APPROVED BY
1 0 -- 7 '7 1 _ ( T.) _ . ; - , i N 1 17 -7 0 *' " t _ - - , - , I �
(M-C!, LIST
677 *.C`3 1—.L1-7,P
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Street Pdght-o F-Way Kxistinr_ REDID
RAr-
Access Easements T'xistins ts.)
Utilit-k- F.L.SCI1IC11t Jaisting 1 14
Lot Per 1;6)dlivsion Plat x Assessor .'at)
Site Plan r,:ccl.-(,(l for Acctiric-.-,,
Existing 1*1'ate1' �-,,djl
Ir
ii 1""Iter "ain
("Cr r1re co,
iI Potector (1ccl: "'c".cr 1':
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Septic
S��ptic Pon"'it r(-,-:-,1i.rcd !)(-init -0.
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SiOc S(n.:er A,..-,
Sanitali 5w',-cr (7k);,.,.icctic)j1 FCc Ponwire(I
Pate
Open Dit-di 1v-�t4j"-, 4'(1-L, j re (I.--
culk-crt Required —ALA,— C;i,:!c
C) I! --- -- i
I ]I C.:tch i n !?vraii -r()(1Indicate on !,],! ,
li Nmi'lole required 111c"i.c.ite oil "'itc Plan;
S.Oicl'd1di Cco
Revi (nv b% I ti te
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BUILDING DEPARTMENT �Appiicant Fi�1 ZONE D CZNUMBER
PERMIT APPLICATION Inside Heavy Lines JOB I� / l ' l
NAME (OR NAME OF BUSINESS) ' ADDRESS 08 V� T� 1/ Axy
LEGAL LOT v LOT AREA ���SUUBBDIIJJVVISIION NO.
! - WYES ❑ NO PL4C4
W AI ING ADDRESS/� ' Ae�`
Z /V L' ' r IQC'}'�' STREET R/W
3. �� �/L/ GJ ( EXISTING STREET R/W � FT. DEFICIENCY THIS PROPERTY
C T ELEPHONE NUMBER
COMP, PLAN ST. R/W '30 FT. bFT.
REMARKS
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NAME
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LEPHONE NUMBER
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:LEPHONE NUMBER
TY LICENSE NUMBI
Tr Attach Four Coph
Q it/e-_ ry
REQ' D.
YES
UNDERGROUND
WIRING REQ'D.
TYPE CONNECTION
SANITARY SEWER
SEPTIC SYSTEM
APPV'D BY CITY ENG.
REMARKS
METER SIZE I BUILD
KED By
WORK
R/W PERMIT
REQUIRED
❑ NO
1EYES ❑ NO
4aYy EIS•
❑ NO
prYES
VERIFIED BY
❑ NO
1101)
❑ YES
P MIT NUMBER
INO
3
ARKS
SIGV AREA ENV. REVIEW ADB NO.
ALLOWED I PROPOSED COMPLETE I EXEMPT
REMARKS
VARIANCE OR CU PLANNING REVIEW BY DATE
YARDS LOT COVERAGE
C
FRONT SIDE
REAR
T�1 �/may
1 iyerc.W
LJ RESIDENTIAL
6AS
LINE
FIRE Z
TYPE OF CONSTRUCTION
CODE
❑ NON-RESIDENTIAL
❑ SIGN
❑ ADD
SPECIAL
REQUIRED SPECTOR
AREA
GROUP
WALL
PROPOSED USE
PLAN CHECK
Z
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NO.
PLOT PLAN INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
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PLUMBING
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HEAT & GAS LINE
0
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
APPLICATION
forEASEMENT NO. -- -- ----------------------------- ------
The City of Edmonds SIDE for
PERMIT
NEW CONSTRUCTION REPAIRS F LID NO. ------ ----------- ASMT. NO. ---------------- --
OWNER ------ -- ----------------- ------ CONTRACTOR - --------------- PERMIT NO.
LEGAL DESCRIPTION: LOT NO. --- BLOCK NO. ------------------------------------
---
JOB ADDRESS ----- ........ --------------
NAMEOF ADDITION ---------------------------- --------------- ---------- -------------------- ------------
FILL
I
11/75
yr.-... .i�t.!ek e'9rm'win`> �_ �:.+ t-.'G^'S i.j.� <..� �',�, !f:r.i.r:secc ql `' _r4:...'y....l ",...,"r-.• .,•:,R'.
' WATER-SEWER;,DEPAIiTMENT
4�yM l ` - ... I .l <�: ,, .fir J --1 •: t'
• _:+• s- + u "'- - - Call' 775 2523 'for Heide sewer.�inspectlona nFHaORE _coverfngwany 'portfon4'of� the .construction: -
,1.lnapectlon4.will, be,provided'withln 241�houre after-:req6st:.r'N0,3at'risun- or.9h6llday'fnapectlons./
3 6 r t 'T
ADDRESS' LOCATION+sOF CONSTRUCTION .:.. S1 ...... 6 �' �....... r
PROPERTY• L'tGAL,;DESCRIETION..::: ... R e;.. .:..:�
�`�_
OWNER.AND/OR,'rBUILDER�(, r!,:..
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CQNTRACTOR;S�NA�ME; &ADDRESS:; !.' �.rtd �: �' -�p�, d �f t .l : �► L(7
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iT 7issionisfgranted, :y%% -- .,L18 'l,for repair ;and/or connection of a si'dersewer to+;the,,city,,<sanitary sewer
b4 , _e..mxinv�._• �..
itaccordanceiwith,ICityiof,Edmonds ordinances ; t
a
�NTION, I66A* LLED tU THE •FOLLOWING
,NOTErNo •1'-The:''ownera>lof ah'e,aproperty,-may,:obtaid-a' permit. to=constructsewer-'Inside'-property line::'- IA'�-licenaed'side','sewer Contractor -must.,-be: employed'+fo�conatruef -
side"--sewerinstreet area. Do%not cover..any.portion_of-sewer-,before'dt'•has,'beenyinspected.. .r•
NOTE�rNo "2 Alp7work%perforroedhintcity right-of='way.requ ire.. na ,Invaa'ion+;of.•Right:'of=WayaPermlt'obtainable"from•the Ctty Engineers office t.
(NOTE No a,3=Obtalnr,full iinformatlonr,regarding''Ordln'anca, ll•.38Y030+and, Re`gulationsi igoverningr gide isew6rs when;youGget.,permit
NOTErNo:,X4__ Top ot::aide sewer mustrhave ati+least 30 fncheax coverage a}t;property acne :and' 12 inches inside property;Atne; minimum;4gradet of 2 1. ;•No++bends, inflgrade• . k'!
.tF
f sharper than, A;,wIlP:be,permltted:
tNO,TES'No:,,W Trench' ea,indstreeti must ,bey.water •settled -sand` surface of -street restored ,. to orlglnal' condition ; Confractoits •shaltl ;he. responsible,. for ,failure. 'du eT•toi'improper,
work�.whlch`-ma.y.develop+ wlthinpone-year'*of.completion; :^. •.;: .. -
t
.NOTE No :8—It IsuuNawful: to: alter.,or`doj~any other- work than. (s•. provided'. for In she permit;,- or to. dot any :work on'the.'maln ",,'sewer or Its ,appurtenancesrexcept to inf.•
,•'air;.° � laert� the•,pipe'anto; the'•wye.." : i .. .. . � .... - ' t•, .. , ..;�:.
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'DISAPPROVED}.,; p a, Dato 4 By..... ..:Date .: By,.... Date :..: By,.. : t.
APPROVED
�*D ;
I �,.
Renlarks:y ...
-- BOTH'Eermit.,Copies,MUST: Be iSignedl; By^Qwnei of; Firm»Performing iConstruatiolr PIiIUR TorR'equest,'Forc 3nspection -'
�� ✓ s
yAR
. .... a 4i/av!.� eP�.: i eby certify that,the;'side,seweranstallationk;constructedl underc,thi rpermlt;, ;t
Illsss""""'
,.. (Ownertof•!Contracting,:Firrri , irforming++Constructlon+)W f l
was mstalledtinf3tccordance�with':alk'gpverningl'ordinbiicesjof+the City oP Ed'monds _,
,Y ? v, s < + :Datedt this day, of
Check. BEFORE you dig for Water, <Ga Teleph Powerti„; - ewer. ,„, ,Othari Oi:.VI J`
one S
set,-1!.. r -a if�l; .1:. .. .. . ... _ `- ,. .. .. -.,. •�•r � _e_i.�/.-,. .. *. .>.. �P -.. ...,.._r .... -L ... .. ! � r � 1.n-r1�•
r APPLICATION
The City of Edmonds for EASEMENT NO_ .................................. __________
SIDE SEWER PERMIT
NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO___________________ _ASMT. NO. ------------------
OWNER......../...�- � .--•--------• CONTRACTOR ----------- ----- --•--- - •- G
JOB ADDRESS ------•.. ------
uu LEGAL DESCRIPTION: LOT NO- --------------• - --•----------------- BLOCK NO. ------------------------------•-•---
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•------•---•-••--------------••-•-------•--••-•-------......---------•------••--------•-•-------••--•-•----•---•---•------•----•------- --------------------------
NAMEOF ADDITION----••----•----•-------------•----------•--------------------------•-•-•---------•--•--•------ ........................
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Approved:
DATE............................................ BY ......................
NOTKE
TO PERMITTEE AND/OR OWNER
❑ PARTIAL APPROVAL
❑ VIOLATION
CORRECTIONS REQUIRED
PERMIT
NUMBER 7 .
JOB ADDRESS Xeyr,,`�w^ tnr *sc,�j 1 F.-
NO
❑ SAND MAKE COMPLY WITH BUILDINGOLAWBTAIN
LAWS.
PERMIT
❑ CONSTRUCTION IS NOT IN ACCORDANCE WITH APPROVED PLANS
WORK.AND PERMIT - STOP WORK COMPLY WITH
APPROVED PLANS AND PERMIT OR REMOVE IT.
STOP WORK - UNTIL AUTHORIZED TO CONTINUE BY INSPECTOR.
CORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN
El BE APPROVED,
❑ WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED.
❑CONTACT INSPECTOR AND ❑ RECALL FOR INSPECTION.
ARRANGE FOR APPOINTMENT. /
IA
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THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED
WITHIN ..5.~.......... DAYS OR PENALTIES IMPOSED BY LAW MAY BE
APPLIED, FOR INSPECTIONS CALL: 775-2525. BUILDING
Zr DEPARTMENT
I PECTO CITY OF
EDMONDS
DA E
T,e
DEPARTMENT
APPLICATION
UR NAME OF BUSINESS)
µ"LING ADDRES
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71
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NAME
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E CITY
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Applicant Fill
Inside Heavy Lines
NE N
ELEPHONE NUMBER
nkPt e�S
TELEPHONE NUMBEI
Do
[aFA CITY LICENSE NUME
ZONE 5 ,1-'2"NUMBER
JOB�Og �iiSTA
ADDRESS
LEGAL LOT LOT AREA SUBDIVISION NO.
RY YES ❑ NO ��-f-�
STREET R/W7
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
COMP, PLAN ST. R/W "30 FT• C>FT'
REMARKS
HECKED By
STREET AND/OR UTILITYT
RE UIRED
R EQ'D. YES
ES ❑ NO
UNDERGROUND
WIRING REQ'D.
:V:ZjUy;:EE1S::O
JAPPV'D
TYPE CONNECTIONYSANITARY
SEWERSEPTIC
SYSTEMMIT
NUMBER
BY CITY ENG.
R MREMARKS
U I
W
Z O
Z iW
KW,
iption of Property (Show Belo or Attach Four Copies)
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R
R SIZE BUILDIN
ARKS
SUPPLY SIZE
W
W
F
SIGN AREA
ENV. REVIEW
ADB NO.
.
ALLOWED I PROPOSED
COMPLETE I EXEMPT
REMARKS
VARIANCE OR CU
YARDS
�
ICIW RESIDENTIAL
❑ LINE
FIRE ZQbL
11:1 NON-RESIDENTIAL
❑ SIGN
ADD
D DEMOLISH
❑ WALLNIN6
SPECIAL I
REQUIRE
❑ ALTER
ORCFILLTE
� FENCE X—FT)
ES
N CH
PLAN
❑ REPAIR
❑INSP.PRE-
swim
POOL
-
REMARIL.
NUMBER OF STORIES
NUMBER OF
'^
DWELLING
/(J
O
UNITS
NATURE OF WORK TO BE DONE
PROPOSED USE
PLOT PLAN INDICATE 13UILDING SETBACKS,
ABUTTING STREETS) .
PLANNING REVIEW BY DATE
LOT COVERAGE
FRONT SIDE REAR
TYPE OF CONSTRUCTION CODE +'�/�
NSPECTOR AREA OCCUPANCY OCCUPAI
D GROUP T LOAD
IrXN O
ECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
PLAN CHECK
NO.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
I hereby acknowledge that I have read this application; that the in-
TOTAL AMOUNT DUE
formation given is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
Permit Limit One Year(Except DEMOLITIONS and FILL
ONLY THE
NOTE:
PERMITS without conditional use permit, which shall be completed in 90
WORK NOTED
days; MOVED -IN BUILDINGS shall be completed in six months.)
INSPECTION
SIG TURE (OWNER OR AGENT)
DATE SIGNED
DEPARTMENT
CITY OF
EDMONDS
Arn7'c'- An UH t c„),ivrt to Plan C rerk Fee
775-2525
VALUATION' I FEE
APPLICATION APPROVAL
This application is not a permit
until signed by the Building Official or
his Deputy; and fees are paid, and
receipt is acknowledged in space pro-
vided.
DIRECTOR'S SIGNATURE
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This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
ORIGINAL - File YELLOW - Inspector
GOLD - Assessor PINK - Owner