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1009 DALEY ST.PDF
iiiiiiIII 11111111 10713 1009 DALEY ST ADDRESS: TAX ACCOUNT/PARCEL NUMBER:M�,n342-0' 4 D?77DO BUILDING PERMIT (NEW STRUCTURE): lg5y-03�� �✓-��� COVENANTS(RECORDED)FOR: CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER): -W1 O 91 D PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATEDZ SIDE SEWER PERMITS) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: WATER METER TAP CARD DATED: OTHER: L:\TEMP\DST's\Forms\Street File Checklist.doc �os APPLICATION for The City of Edmonds SIDE SEWER PERMIT EASEMENT No ........................................... NEW CONSTRUCTION ❑ REPAIRS ❑ 114: O4c2DO OWNER ---- ./Il/ �� ..\./�J ...�.Yl...l�........................................................ CONTRACTOR.........---------.....---.....-----......-•----.....-•-•--......--.................------........ PERMIT No. ...................... ADDRESS .... 1`Q-01.... U.GJQY.... IS-* ............................... ........ ....... LEGAL DESCRIPTION: LOT No............................................... BLOCK No. ............................................ • or NAMEOF ADDITION.......................•---..............--..........................----................................................................ .JurtQ, l9�?��j Approved: D7 � %¢•" ' ed ©l, S'q' wQ.r DATE................................................ By--.....................--..........---................................ OF EDM616, WASH114GTO N DEPARTMENT OF BUILDINGS BUILDING PERMIT certifies tktt a plot,'plan, draxvin,p, and sufficient details to indicate ion ;to fulfill all requirements of this code are attached hereto. in is. hereby made for permit to d the fo vviiig work: .. .......... ............ ................ I ............................ ............ ---------------- - - .... ... ...................... .................. ....... .. . .. . .. ..... .... ... ... ........ .................... ...................................................... _ ......... .......... . ......... . ..................... . . ........................ .... . ...................................................... ..... ..................................... ....... ....... ................... ...... ... ....... .. . ........ ..... : ........... ...................................... ........................................................................ ... ... ................................................... . ........... ............ ..... . .............. . ......... .... . .............. ....... . .. at........................ .................. V41.. ... (street number or ot and Z;Z.-h ... ............... ...... ... . . . ....... are .......... .................... 2-.,.Lot dimensions are ............... Z..:2 C 0 7-5; P 2 0 Z Q cw 10 .E 7z 0 m Cc .0 08 0. Z' U r IL N my 'A .2 4 to rn W.Z . ............ ............................ will be ........... ...........stories in height. 0r D ta.1, -1, A 0 Number of basements ....... . 7 zfilly Clc�6crancy of building vall be__........ ............................................ UZI 6. Building wi.11 feet om, n mteadjoining lot line. :4 Ow, ..... . ...... Owner ....... ....... id Estimate Cost ........ ..... .............. ....... ........... Owner's Address.. .. ......................... ...... ........... -------------- 9. Builder ........... . ........ ......... ..................... .............................................................. 10. Builder's Address Group No ........................................... ..................... .................................. ........ ... ................ * 11. Architect or engineer ..................................... .. ... ....... ... ...................................... Life of permit ... :7 ......... V ..... ..... ........... Date_. ........ F ................. Applicant's Signature ................ I Plans filed: Yes 0 7777777 Permission is hereby granted to do the work described her -eon, according to the approved plans and specificatioris subject to compliance with the ordinances of the City of Edmonds. This copy is your receipt for" thejollowirij.fees:. 1. Building permit fee ....................................................... $ .......... ................... . 2. Sewer permit fee ................................ $ .................... .................. 3. inspection and supervision fee ...... ...... .......................... .......................... ............ .................. ............... 6t 4. Total ........................................................................... ................. $ Z,, Received by ' (Issuing t. 10 -6 Buildings /Z;. PERMIT N? 359 City, of Edmonds ec: ,be, 1. 7le building permit fee which applicant p2yS When permit is issued Shall be based On estimated cost of the proposed structure, it f 411,00 Ior each 31000.00 of eon. If the actual cost of the structure, wKer, finally determined. exceeds the estimated cost by more than 59c, applicant -agree tomie,-o fee each excess cost. In such event no use Permit shill be issued until such -discrepancy fee" is paid. P. -z-h=- of 1.ract for construction Is executed for any structure costing more tban SIODO.00 for which a licensed architect or engineer is not rq.1"ecil 17 ...... Bar Code of the ity of Edmonds, the applicst;on for. a building permit snail be. accompanied by a copy of die contract and a copy, of the, detailed ew ,pecifin its. th)y report of payrolls. Full i—rumcm, bould r 4� giving ance:Pirisio of the Department of 1.1bot ;;ZDndu_zt'n iItim.te Of- 3 iany I.ho' or 'Zm;� notify the 1. Prior to Tpl-yi COmalenc.09- k�n oil and make the payroll be -obtained ..ed — the n office of the tirromarent of Libor and Indua?W. Be(". fi.., P, r Y-enc. the c ".Ald in A release from the 9-crall C.raracr.rs who 4o — should• obtain fels,tie from all subcomzvct6ra."Tb.�Irascs, should. ba and' w,.cd by the Department 0611=1 2 InduitrIm.`rbc above procedures are ie4GImmentsof the State Industrial Insurance Act� 4 'A " qJ gay '10 ............................District 41, City of Edmonds ---Water Departmeni TAP CARD Date.... No......................... I No............'............................ Meter Tap I I Size .............................. I Size.----................... .Mfgrs. N04v ...... . .. ..... ............ / ........ �tyle ............................................. .1 . ................ ........................................................... For ................. ........................................................................................................................................... .......................................................................................................................................... LotNo ........................................... B1k. No.......................-----......----.............. Add. ............................................................. .......... .......... . ..................... Service Location ....... ... ...... . .. ...... ......... ............... 4 .................................. ................................................................................................... Meter Location ....... STREET .... FILE ............................. .......................................................................................................................................... MakeTap ............................................................................................................... Pressure............................. lbs. Test .................................... % SendBills to ......................................................................................................... ...................................................... .......... ...... Date of Work ............ —7 . ...... 7 ....................... . ........................... Foreman ............................ 50 ......... ..... 4.4 -1 Guar. Voucher No ............. ............................. $ .......................................... Remarks: ............... 7'*",**'**'***"* ............ ........ ........ . .................................................. .. . . ............. .................................................. ....................................... ....... .......................................................................................... ......... ... . ..................................................................................................................... . ........... .... ...... ............................................................................................................... . . ......... .. ............................................................................................................ 7 ............... .................................... ................. .................................................................................... .............................. I .................................................................... I ....... .................... . . .. .. . ............ . ....... ..... .. .. . . ............ ..... ....... . . ................... . ............. .. . ........... ............. . .. ........... OUTGOING Index ........... Reg ....... Route Bk ......... Stencil ...... Card ........ INCOMING Index .......... Reg ....... Route Bk ......... Stencil ...... Card ........ �,iterial Chargeable to Installation., )ters NO. SIZE DESCRIPTION RATE AMOUNT �WMeter ............ ........... ........ ...... ...... Meter Box Y .. . . ............ ............. .............. ...... ...... ............... .......... Meter Plate ............................ .............. ............. . . ....... ............ .......... Check Valve .......................... .............. . . ......... .......... .............. ......... Pipe, Galv. Screw .................. .............. .. . ......... .......... ............. .......... Nipples .................................... .............. . .... . ... .......... .............. .......... Bushings .................................. .............. ............. .......... ............... .......... Plain Ells ................................ .............. ....................... .............. .......... St. Ells .................................... .............. ............ .......... .......... . ... .— .......... .......... ............ ............... .............. .............. .... .......... .......... .......... ........ . .......... .......... .......... Tees ......................................... ................................... .................. .......... I ...... ---I --------------------- ........ ............................................. ........ - ............................................ ...................................................... ....................... .............................. ....................... mftw*w�*�Www .................... ............... ............. -------------- .............. ............... .............. ....... —*-11 .............. ............ ............. ...................... ............. I ........... ......... . ------------ I ........ .......... ......... .......... .......... ........... ...... .... ........ Material Chargeable to Taps Connected No. SIZE DESCRIPTION RATE AMOUNT .............. .......... Pipe, Black Screw .................. ............. ............. ......... .............. ...... ....... .......... .. Pipe, Galv. Screw .................. Lead Connections .................. ............... .............. ....... :�� --------- Curb Cocks ............................ .............. ..... ...... Corp. Cocks ........................... .............. ............. ......... .............. .......... Unions .................................... .............. ............. .......... .............. .......... Saddles ................................. ... .............. ............ ......... .............. .......... Nipples .................................... ............... ............ ......... -1- .......... ......... Bushings .............. ................... -------------- ............ .......... ............... ......... Plain Ells ................................ ............ .......... .. .......... .............. .......... Street Ells ................... ...... .. ............. ............. .. ........ ...... .......... Tees' ........................................... ............... ......... . . .......... .............. .......... .......... Curb Boxes ........ ------------- ------ S. O. Extensions .................... ---- ** ........ .............. * ------ - ............ ---------- ........... .............. .......... Gates ........................................ ............... ............ ........... . ....... I ..... ....... ..... .. / Plugs -------- .......... I . Couplings -------------- -.................... --- *,*,-** -- ----- .............. .......... Gate Boxes ... ................. .............. ------------- ------- - ------------------------ ------------- .............. ....... "�7 ........ . .............. .............. .............. .............. .......... ......... .......... . ........... ................................................ C/ ..... .......................................... Z'7 ........... ........................................................... ........................................................... ............. .............. .............. .............. . . ......... . . ' * Z�' .... ;' . . ........ .............. .............. ............ ............... ......... .......... ....... . ........ ........................................................... ............................. Z7 ........................... . ........ - I - . ............. ...... ....... ..... ............. ............... .............. .............. .......... ............. --- ....... . ........ .......... ............... .............. . ........ -../ ... ........................................................... Hours Time —Day Men ........ .............. .............. ............ ------- 7-7�-� ..... K ..... f.. Hours Time —Monthly Men......___....... ....... ............... .......... Hours Time —Auto ............ ... - ------- .............. .......... Superintendence ..... ................. Total.................. ...............