1027 CAROL WAY.PDF1027 CAROL WAY
00-
ADDRESS: I V z'
TAX ACCOUNT/PARCEL
0
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA'
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: �5BLOCK:
SIDE SEWER AS BUILT DA
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:)
OTHER.2IO� �, `E' 2—C I II� 1 �'I �� I ? )
LATEMP\DSTs\Forms\Street File Checklist.doc
(ern •�.�
__
.,Permit APPL' No: i� �.. a l
AppLICATION �SUILOING TERM , -
� �Permit�limit, °°� vim,
1 c
• Building: Department •'
GRX OF'EDMONDS
-- with the acoom
the following work, m accotdance
"'AYt®N is hereby made for permit to cbnstruct
APPLh, y
herewith foi approval
panying plans and specifica-tio-. Two acts are submitted
rev Y alter s' �rG/Y�r� -• Parking,: ;"
i e
�Vozk addrt repair .......x. • G"•-....1.... .......
�..:.... Fire zone
. const. type ................................ Use zone ........' ...... .................
Occupancy ✓
Addn...f�L.d' :5...............
}
{,
tBlk..
A'G..�... �........... I,o...... .-:.•
(
Seprc t. nk. �z (-z f-
Lot frontage . Area ....... ..._.................. .
... ....
1. side.:..•%../..,L- ... rear...G��
s
Bldg. set backs - front.... ..... r. side ......:......
� No�..P
• Aaaress/..D.l�.:'./or''./��L ...'Tel
�.�y�rs�.r .......... ....
h
...
E ........ Address ...................
Builder.::�19�
:. ........:. Tel.. No .......:....:... .......:::.: .
Address--•--.............................. ., .;
Plans.... .............� ---.... .
...................................................:
. .
Remarks. .. .. "^..
:k
...................................
C�
•
.......... ................................................................ .....
-ulatiri g,. ;=,,�
:.
p with all applicable Codes and :State,laws"retc
and I a ec to\com Comply PP ::yv Z
g.
The above is a correct statement,
work iL
Date/e �/ i
i•
4 t•.�ywrr?G.!sv:..-nadrrss..................
Signed Owner/P.g� Ll•.-t........... '
a
a roved, subject to the above conditions, and to oompliaace with the ap�
PERMIT for the above work is hereby PP ent thereon
notations
and Building Depurtmr
prated plans and specifications,
1
by ..
Valuation Permit fee ....... ...... .......... . Recd. . ..........................
.............. .
Date ..............
Building �' i7 // /.� ✓
.�4f•P�LL _
City. of Edmon , -
RIGHT-OF-WAY CONSTRUCTION
} PERMIT
Permit Number.
Issue bate:
A. Address or Vicinity of Construction: 1027 Carol Wy (9609432)
B. Type of Work (be specific): Install 240' 2 "MPE IP from 219' E to
459'E C/L 10 Av W on Carol Way
C. Contractor: Washington. Natural Gas Contact: Mariamue Kingsbury
Mailing Address: 1122 75 St SW Everett Phone: 356-7500 X7596
State License #: 98203 Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project RJ Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR:
r
F. Pavement or Concrete Cut: ® Yes ❑No G. Size of Cut: , x 2 H. Charge $
(% cut ) /`
APPLICANT TO READ ANDS GN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold 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'df its departments or
employees, includi;�r or not limited to the defense of any legal proceedings including defense costs, and attorney fees'by reason of granting this permit.
f
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.
6 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.
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 regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
4K
I have read the above statements and understand the permit requirements and the pink copy of the permit will be
available on site at all times for inspection purposes.
Signature: Date: 9-16-96
(Contractor or ent
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY., USE ONLY
APPROVED BY: l:)6iAc.-,r1
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS: wA
COMMENTS:
DATE:
RIGHT OF WAY. DEPOSIT
DISRUPTION FEE/FUND Ill:,
RESTORATION FEE:
.PERMIT FEE: l
TOTAL FEE:
RECEIPT FEE: _
ISSUED BY:L.�� _
e99
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
C`
FIELD INSPECTION NOTES
Comments
Diagram;
'-'• (v-.yam- ..
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
1027 Carol Way
STREET FILE ~
October 31, 1979
M E M O F O R R E C O R D
The following is a list of calls received during the
heavy rains during.November of 1973 and March 1979. Some
were only for covered inlets, others for plugged drains and
creeks. During the week of October 22 to October 26, 1979
all of these addresses were checked for possible plugged
or trouble problems. Nothing was found to cause a problem.
These addresses were checked by Leadman Bill Stroud.
Bobby M_TFls '-
Street Foreman
01,0
............................District
of Edmonds ---Water Department
TAP CARD
MAY 1 19 G 2
Date .............
MeterNo ............................... Tap ............
Size ..............................
Size............:............_.
Mfgrs. No .... X, ......... Style ..........
.........................
For ........... ... ...... .............. - L.
LotNo ........................................... Blk. No.....................................................
Add. ............................................................... ........... .................................
Service Location .... 10.A.7
... .................
..........................................................................................................................................
MeterLocation ........................................................... I ......................................
........................................................................................................................... . ..............
MakeTap .............................................................................................. I ................
.................................................................................................................. !` . ... . ..........
Pressure .............................. lbs. Test ............................
SendBills to... ......................................................................................................
................................ *"*'* ...... ...
'"17
Date of Work ��� . . ... ................. . ............................
................................................................................................................ Foreman
Guar. Voucher No ........................................... $ ..........................................
Remarks: ..................................................................................................................
............................. ................................................................................... . ....... . ..............
ST .. .73
........................................... ...........
tET ..... FILE ......................
.............................................................................................................. ...... ...............
........................................................................................................................... ...............
........................................................................................................................... . ..............
.................................................................................................................. . .......................
.....................................................................................................................................
OUTGOING Index .......... Reg ....... Route Bk ......... Stencil ...... Card ......
INCOMING Index .......... Reg ....... Route Bk ......... Stencil ...... Card ........
9(01
1972 .N
�3r
v
Q
SSW IP 1;15
. 3a5
1
1
- CB.
lD
?pOP. 2-"Mf3c-- IPMAIQ
T-I 1✓ r 1 t'd
Cho L =
VV
a
19 —
NI rn
01
olol
1
i
I
102+
-
�l
1 ` -
r8.r .
_ _
cum►•► � �a..:� � o � .
v.eo2lc��aDi►,1ca Pot
I
ZZpI 04.01
I
Notes: The City of Edmond
1)
Fbld loco" an utnium
G� TN1S JOB Ttb (sjt✓
Cap 1-800-424-5555
15Y D I REC>-10h16.1. ��pQ E.
24 hours before dipping.
2)
Survey is not required
-4) • Mo. i ETA 1 t`1 A KA I tj . 3 ' SE.P
8Tvv $,I - EDCaE 04-�' Sf2E-&,tn
3)
Maintain a mk*num of 5'
C. ►uYEe--T ANY G4:=)"-1ST—
horhmntel and 3' vertical
R► aGfl owl fvts Tr�PJAI.S .
clearance from all city
utilities and appurtenances.
f�G-t� I O - c� - cJ �
4)
Cuts In paving are drown aa0
POD' fl• uSITA�p
5)
i cuts In paving anticipated.
No.
DESCRIPTION
DATE
BY
APP'D
REVISIONS
AS BUILT INFORMATION
FITTER OR CONTRACTOR:
COORDINATOR:
F
DATE COMPLETED:
PERCENT COMPLETED:
E
TEST
INSTALLATION / RETIREMENT
SUMMARY
TYPE OF TEST:
PRESSURE:
L
DATE ON:
TOM ON:
I / R
MAN SIZE
WTERI<AL
TOTAL FOOTAGE
D
DATE OFF:
TIME OFF:
TYPE OF PIPE:
PIPE MANUFACTURER:
[TESTED BY: _
AvbO�r>�on6'°IpyCanosM
OP MAP. -- ((00-0G2
PLAT MAP. I (o2- O G7
1/4SEC: 1VE ZA- Zi-'S
ORKAREA:
PROPOSED
MAIN
FOOTAGE
EMERGENCY SEC. No.:
MAN SIZE
MATERIAL
TOTAL FOOTAGE
DESIGN PRESSURE: Psis
D
2"
M PE
Zoo '
SYSTEM MAOP. amc
PS1c
E
PERMITS: EDMOtv,Oe,
S
G
N
2'' M P� I 'P t o I til I o
-r0 cEE;�e a e;. :
1-1 C2 -:7-
CRAWN:
CHECKEC -" .! �/� ���
CRAWING YO- p 1
A?OROVE-o'