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1031 CAROL WAY.PDF1031 CAROL WAY TAX ACCOUNT/PARCEL NUMBER: V 005 Z0 DWODSE-k) BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER):—. • • �.! PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: WATER METER TAP CARD DATED: q I , OTHER: L:\TEMPOS'Ps\Forms\Street File Checklist.doc ...........................District City of Edmonds ---Water Department r TAP CARD Date`"' A"'...... r� MeterNo ............................... ,Tap No ......................................... Size.............................. Size ................. ...................... Mfgrs. No. ......................... Styl .......:....................... .......... For.. ....... .............. . ............. ..........................................................................................................................._.............. ......................................................................................_.................................._.............. j. Lot No ........................................... Blk. No ................................................... Add............................ ......... ......... ..... Service Location; ./ 2..::�'-......... ......... MeterLocation.................................................................... ........... ............ ... MakeTap.............................................................................................................. ........................................................................................................ _....... ....... ............. _.. Pressure..............................lbs. Test .............................. ,.....% SendBills to.................................................................................................._..... .....................~ . ........................ .�._ 'Date of Work �� 1��.... .......... ............................................................................................................. Foreman Guar. Voucher No ........................................... $.......................................... Remarks: ......... _....................................................................................................... ..................................................................................................._......._......._.............. .............................. OUTGOING INCOMING Index .......... Reg ....... Route Bk......... Stenc iL..... Card ..... _. Index .......... Reg ....... Route Bk......... StenciL..... Card....... 77- 'Material Chargeable to Installatic Meteri's- N 0. �ZE DESCRIPTION Meter ............. RATE AMOUNT. -----I....... ..... ) ..... .......... Meter Box ......................... . ............ .......... 4P.O... ............... ... ...... Meter Plate ............................ ----- -------------- ------------- -- * ------- 1 Check Valve ..................... ** .......... ... .............. ........ Pipe, Galv. Screw ............. ------------- ---------- Nipples .................................... .............. * — --------- -- .............. .......... Bushings ................................. I — ........... - - * ............... .......... Plain Ells ................................ ............. . ........ ......... .......... St. Ells ................................ .............. ............ . -------------- J ---------- ... Tees .......................................... .. ................ ............ .......... .............. P ------ ........ ............ ....................... ..... ---------- ------------- * - :L .............. ---------- I'll ............. ....... ......... ............... ....... ........... .... ........... ................ - -- ---------------- - ---- ------- .............. --------------- ............ ------------ .......... ---------- ......... -- --------- - ------- -------- .... .... ----. .... . ........................... ............... .... --------- .............. .. ............ ...... ...... ........... ........... Material Chargeable to Taps Connected NO. SIZE DESCRIPTION RATE AMOUNT .............. I .......... Pipe, Black Screw .................. ............. . .............. .......... Pipe, Galv, Screw ..... ............ ............... ------------ * ............. .... *'"*' ......... .............. .......... Lead Connections .............. ... .............. .............. / ------ ..... .. .. Curb Cocks ----...................................... ---------....... Corp. Cocks ........................... - ........... . ........... ------------ ......... ... ........................ Unions .................. .............. .......... Saddles ................................ .............. .......... Nipples ..... ...... * ....................... ...........*------- -------------- ------------ ............... ......... Bushings . .......... * -------------------- . ......... ......... --- ---------- I .......... Plain Ells ............................ .......... .......... Street Ells .................. * ------- --- ------------- . .......... Tees --------- ............................... .............. .......... Curb Boxes ........................... .............. .......... S. O. Extensions .................... .............. ............ ............... .......... Gates ........................................ .............. I ............ .......... .............. .......... Plugs ............ .... ........... ........... . / . Couplings . . . . ..... ............... ............. ......... ........... .............. ............. .............. I .... .... .............. ;;Ai�.. .......... .......... .... ..... .......... .......... .......... Gate Boxes ............................ ..................................................... ....................... ............................ ....................................... ................... ........................................................... ........................................................... ............... .............. ............... .............. .............. .............. ............. ............ ............ ............ ............. ............. ........ . ........... .......... .......... ......... ......... ............ . ..... I ........ ............. .............. ............. . ............... .............. ........... .......... .......... .......... .......... .......... .......... ......................................................... . ........................................................... ........................................................... ........................................................... I ................ w ......................................... ........................................................... Hours Time —Day Men ........ ..... ........ ............... ..... ......... ............... ............... .............. ............... ............. ............ ............. ............ ............ ............ ............ .......... . ........ .......... .......... .......... .......... ........... 'Z.4. .. AZ ... Hours Time —Monthly Men ................ ............ ........... ............ .......... Hours Time —Auto ............ ... .............. ............ .......... ......... ..... .......... Superintendence ... .................... ............. ............. .......... ............... I ........ :': Total ............. — -- . . ....... ............ I .......... -A f ;l Lt Aar. APPLIDATION C, BUILD.ING PERYIT . : IFeNrmoit lima, ore;Y 1 Building Department. . CITY OVETWONDS APPLICAT[ON is hereby made for a permit to conatrttct the follovnng work to accordance yiith the accom �rcations. Two sets are submitted herewith for approval• 2 �� P ariYing plans and spar_ Off •St Parking ' u�v ✓ alter p r �i�i�c!.... ......._. 7 Work addn repair 7✓ ' kfxtt" i j i1 C� lot.......... •/ vFire zonr'Use one..-..�.'......... Const. type ........................... Occupancy ................. G ........... AddoBlk............. — ............... , /� eptic tank....... Qr�` Area..:..... .. y Lot frontage....... __ ... rear .... c ' r side. •-•--.. 1. side ................. ' S y front--. Bldg. setbacks — .....- . 6 �d dress.../.. Tel No.: C_G.-o.-....`.�. �..-----:.... owner- - ....:...:.... Tel' ,No ............. .----- . +R Address .....................................' , 4 Builder .............. ...................._Tel bNo ............ f. •' . ....................................... Address...................... Plansy........:.................. ............................ Ijt:TM�; The above is a correct statement, and I zgree to comply with'all applicable Codes and State laws regulating this r �w ,Z A ' work...- Y ... ...... Date ,..... .. .. Address.............. ...... .. , Signed"Owncr/Ageet�y`; ii��uu i a you'd, subject to the above conditions; and to comphartcz_ a ap PieRMff for the above work is hereby PP rwWcarions, and Building Department notations thennrt. _ proved plais and .. - Iccd. by... Permit fce-..�.3i................... l Valuation .... 1':.......::.... Building Department,' BY ........................... ��i E'T"•............... Date. ,�-•� nor does n P.�++nu any atwk , ` NAB _ This permit does not cover plumbing: sewer, er elerrical installatw*rs, ff•• gr. r w done in the Right of Way areas. Driveways and 'walkways must be'plarined to me't the o rnal odes of tr�tts a a for future sidewalk development• and alleys, and plans • l The City of Edmonds Side Sewer Drawing EASEMENT NO . ............................................ 216 - 0 6 8 0 0 NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO ................... ASMT. NO................... OWNER------.STUART.._I�IAXIN----------------------•--------- CONTRACTOR-------•--•--------•--•---•------.....--•---•-------------------•--------•---------- PERMIT NO. .................... ADDRESS ...... 1-031... CAROL --- 4AT--------------------------------------- -- LEGAL DESCRIPTION: LOT NO. -------------------------------------- BLOCK NO. .................................... .............•--------•---.........---------...---------• •------------•-------•-••-------------------------•---•---------------•-------•---------•------.......... NAMEOF ADDITION--•--•-•--......--•--•-•--•--•....................................................•-•-----•-------•------------•----•-- s a DYE TESTED ON SEWF-.R Approved: PWW-0001-11175 (REV.11178) DATE -------------------------------------------- BY------------------------------------------------------------ %661 o ty i1 0 0 c 441 ��1L Ifo61 O o Qw N L o O Mbb! ebc �e� , _ . •�,, Hass :z �y '� �. � g01� - '�- � 6 I a u L 86/ L ao S�8 3 n SB6i oLbl 01 M LEE �-a 31 Q V /`,rx..•Y'ti.' :'fi `i � �`n�•"'(rt�•�vr: ^.'�:,'ar,.r..i`+'. ti, i . .- ..n ,�., , City of Edmond R "I . -OF-WAY CONSTR CTION iLE: , PERMIT permit Number: Issue Date: 2.... A. Address or Vicinity of Construction: C Aent wra u . a�mp,,,r ,e O B. Type of Work (be specific): P-�jr / p_ 4,4�5 � " )mfrA pia 9 1 9 w fits tJE'u.I !!I-" Nc- 4x]9,s^cy- p2h,a ' IZ'' nze.ju1 C. Contractor: 'J?::,oc>ir, G►�jS-T'P.Jcn'Y[1oCa.1Nt„Contact: _P31 01l l..l'`(L Mailing Address: (.�2,1Z -?�� .,,)- Phone: Ito State License #:o l K-Y-- Liability Insurance: Bond: $ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. ❑ Commercial ❑ Subdivision ❑ City Project ❑ Utility (PUD, GTE, WNG, CABLE, WATER) ❑ Multi-ly ❑ Other a INSPECTOFamilL INSPECTOR: F. Pavement or Con ❑ Yes Mo G. Size of Cut: x H. Charge $ APPLICANT TO READ AND IGN INDEMNITY: Applicant understands and by his signature to this application; agrees to ! th_e City, of Edmonds harmless from nes Jbiim es, or claims of any kind or description whatsoever, foreseen or unforeen, that maybe made against e'City"bf Edmonds, or any of its departments or employ- ees, including or not limited to the defense of any legal proceedings including defense costs, and attorney fees by reason of granting this permit. u THE CONTRA CTOR 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 UN77L THE FINAL STREET PATCH IS COMPLETED BY CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. Construction drawing of proposed work required with permit application. A 24 hour notice is required for inspection; Please call the Engineering Departme w1-3202;y Work is to be inspected during progress and at completion. +1o0220 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 atched with asphalt or City approved material prior to the end'of the working day; NO EXCEPTIONS I have read th abo'e statemen and understand the permit requirements and the pink copy of the permit will be available on site at all t m s r inspe i t purposes. Signature: Date: ontractor or AQen0 CALL DIAL -A -DIG PRIOR TO BEGINNING WORK . NO WORK SHALL.BEGIN PRIOR TO, PERMIT ISSUANCE Engrg. Div. 1991 FIELD INSPECTION N F`l11 =Route copy fo Streeiept:);Y Comments: Diagram: 0 } CONTRACTOR CALLED FOR INSPECTION O YES 0 NO Partial Work Inspection�,by P. W:: Work Disapproved By: Date: FINAL APPROVAL BY: Date: i Eng. Div. h L�o�J►J�cr L 44 Qr24v _ N WAY -ram ,A STEVE BODINE r' 1 (206) 778.2557 ?;tu as C4)44La- FAX: 672-2434to - DDINE CONSTRUCTION COMPANY INC. Drainage Conaullenfa/ Dralnage Confrecfora Crawls ace Dralnlleld; Basements Site Drains IIN 8212 C 9378T - 2041h 3. W. Lynnwood, WA 98036 City of Edmofids WPermit No:2CO3 RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: A. Address or Vicinity of Construction: aJcxr� CA U) 4 B. Type of Work (be specific): uv I O.t k\- _he_�A iA, �,A(A, DiU. Contact: 3'Q\ t dL Mailing Address: Phone: State License #: LC t =T= Liability Insurance: Bond: $ D. Building Permit # (if applicable), Side Sewer Permit # (if applicable): 7 E. El Commercial El Subdivision ❑ City Project E:1 EUC (OUD" VERIZON, PSE, AT& T, CiVWD) Fj Multi -Family Single Family F1 Other p INSPECTOR: F. PAVEMENT CUT. YES El NO G. SIZE OF CUT x CONCRETE CUT: YES Al"I'LICAN'r 'ro IZEAI) ANI) 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 Edthonds 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. 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 BYCITYFORCES ATWHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. ♦ Traffic controfekand pub I lic safety shall be in accordance with City regulations as required by the 'City Engineer. Every nagger. must,.'Oe..',!rained as required by (WAC) 296455-305 and must have certification verifying completion of the required training in their possession.. Restoration,is toffie in,accordanie.. with City. codes., All,s.treet-cut. trench Work shall -be -patched. with asphalt or City of ay Nd]EXCEPTIONS.: the workday ♦ �_approv material -prior to. h kd Three sets of construction Orawings ofproposect-work are required -with the permit apolicati&n. 'tALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK HAVE READ THE.ABO VE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND A CKNO WLEDGE THAT I MUST MAKE THE PINK COPY OF THE PERMIT AVAILABLE ON SITE AT ALL TIMES FOR IN ECTIONS Signature: Date: (Contractor or Agent) FOR. CITY USE ONLY Approved by: T Time Authorized: Void After 10 ./ 2-4 ZW 3 Special Conditions: Right-ofLway Fee Disru*ptionFee/Fund lll: *Qx Restoration Fee: Total F Receipt Issued I UPON COMPLETION .OF PERMITTED WORK, `AN ENGINEERING FINAL INSPECTION IS REQUIRED PER CHAPTER 18.00 OF. THE. EDMONDS COMMUNITY DEVELOPMENT-. CODE (Phone'425:-.771-0220, Ext. * 1326) FINAL APPROVAL OFPERHITTED WORK. DATE: Inspect6r!s Signature For inspection requirements see Engineering Inspection Information handout..- .)DAMy Documents\Forms\Engnr!ig\ROWpermit_.doc