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1034 B AVE.PDFiiiiiiiiiiiiii 10191 1034 B AVE ADDRESS: I V,,!!10 -4VZ-Irl US—, TAX ACCOUNT/PARCEL NUMBER:n 1 gZZ 6644001 BUILDING PERMIT (NEW STRUCTURE): I L 6 05 3 / (5M COVENANTS(RECORDED)FOR: CRITICAL AREA DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver DISCRETIONARY PERMIT # DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PLANNING DATA CHECKLIST DATED: Avp1w SCALED PLOT PLAN DATED: 114 � SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: 3 BLOCK: SIDE SEWER AS BUILT DATED: — SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD DATED: L:\TEMP\DST's\Forms\Street File Checklist.doc 1 u:L PERMIT n U � � t BUILDING DIVISION APPlieantFil!. zoNE Nu,nHER �/�,-,�j• C""a'" PERMIT APPLICATION nAMl J,OR NAME OF BUSINESS) ItJ3`T `B f"1' ''r,1",-�•'lla, - /J-� [,�Mt LI NGR E33rTL7-H NU ICI MBER . rl �L®ByyY ADUR ESS 1 y< CITY G � j f/CI 4-05 5 Z� TE LE.—ONt NUMBER 0 U _ STAT LI NS NUM BCR CI .ICENSE HVMBE H ` I Legal Description of Property (:;hnw Below or Attach Four Copies) SCE /� il�cNtb ' H ' L u� • N W 0 — — NEW RCSIDCN TIAL ❑ L�HC r❑ lNTIAL ON Lj ADO ❑ NING O ' - DlMOLISH WALL ❑ AL'TER D ORGFILLTE ❑ i ENCE )t_Frl .RCr•AIR OVC nPOCL IR.M ' ' Z 0 NVMB!! I.STORIES NUM BCR OF DWELLING UNITS NATU [ OI" ORH TO BE Don[ o _GAL OESCRIPTIOrr SU HDIV1310N' L— SNORT SUS NO. P•JBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EA,STING �D — OEFICIENCY OF RILIT OF sVAY—.—G e LIC a PpOVEMe.NTS REOUIRLo ❑i DRAINAGE ,VIPR7VERIEIITS REOU nEO ❑ DRAINAGE PLAN REOUIRCD. ❑ -11 UN OE ROR OUNO WIRING -.-"D CONNECTION TO SANIT—Y SEWEP CONNECTION SEPTIC TANK PERMIT REO.O ❑ No. r1_ ^LCVATION Or PROPERTY CORNERS ❑ A ro OTINGS REO'o Sc. ENGINEERING MEMO CHECKED HY E M 01 SIZE BUIILING Sul PLY S,Z[ .�. R[MAI:nS Przjs,,t pa Ra�u�ator (L�2n SIGN Al— ENV. REVIEW AO. ALLOWED XP tOp3,�'�M PLCTEJ EXEMPT II I SHOwC RCMAwNA�I � I� / VARIANCE OR CUNNING REVIEW BY GATE / LOT ^OVERAGE YARDS ^ Qr/ .L� FRONT S SIOE js REA V II E ZONE- TYPE OF CONSTRUCTION I CODE SPECIAL INSIECTOR AREA OCCUPANCY GROUP OCCUTANT IAAO .- 0 IttsCC ❑ YES ❑ NDJ �. PLAN CHecls[o BY THIS SITE IS LOCATED IN THE CITY" OF EDMONDS.LOCAL SALES TAX SHOULD BE CODED-31.0c. " REMARKS Mtemt,�_ itJwL. Mo 1,,tAlre coos LOT ofLA LG Pen. I I' PCZo(� �s �-15Pc-C•Ti.o1.>s E:G2D Il;r l t;�l OL AN CHECK FEE PLAN VALUATION IE[ _--- •;' '"'� �Ii'LOT PLAN _�_ _ •'.-Jj.,Sl:fj-,'_"• ---�-} BUILDING 13 �y r .J� S G PLUMBING �j - J —o y Y'1�''• 1, ' 1 MECHANICALPENCE 7 A `° ,•N"(c4ki'' "Applicant. on behalf of his or her spouse, heirs, assigns and sleN :,-+ successors in interest, agrees lu indemnify, defend and hold harmless ' i the City of Edmonds, Washington, its officals, employers, and ! a ents frcm an and ail claims for damages of Is na uHe, E g y g wrr ,_NIHe WALL u tsr`� 4 I ` - 2 arising 0ireclly Or Indirectly from the Istuancc JI this permit Issu-{•s�`l�{s'., SWIMMING POOL - DF F -v:-�f''''��c?-�"t ckl 0 ante of this permit shall not be deemed to modify. waive or reduce J ' nor limit in any way the fUU� -125 .A11 $oo4Z3` '`Y-" - any requirement of any city ordinance iCity s abihty to enforce any ordinance provision." _ �d . • �r 1 w 1 hereby acknowledge that I have read this application: that -the in TOTAL AMOUNT DUE 21 tyb formation given is correct: and that I am the owner, or the duly author- I to comply with city and state laws re u- Y g ' s�Y-sr.,•.. i ! �} �`'• ized agent of the owner. agree ag lJ p ATTEyTI'')N APPLICATION APPROVAL . -.'� ;.. ' lating construction; and in doing :he work authorized thereby, no person willbe employed in violation of the Labor Code of the State of Washington THIS PERMIT This application is not 3 -permit `� '- :'•=i; `U� relating to Workmen's Compensation Insurance. AIi366S UED urt;il signed by the Building Official Or NOTE: Permit Limit One Tear(Except DEMOLITIONS and FILL ONLY THE his Depury;.and fees are paid,, and ^+;';fit,. PERMITS without conditional use permit, which shall be completed in 90 a N DftK c4"80 P g P pro - receipt is acknowledged in space'MOVED-IN days: BUILDINGS' shall be completed in six months.) vided. 'I f1aM Uw[ OWN[R a� IO IIIFTMD iIerN r AIll DlweeTow•s vanATvne i`• .^- f �,.r1 � IS • I ". �' EDMONDS OAT[ • r er Thla Pmit work to b. deRs. on privet. property ONLY. 775-252$ on . { Arry converucticn�the public domain (curb., sidewalks, drirewsVs, • "'. nurpuall, alp.) will require aeparate perminlon. YELLOW Impactor {' ATTEf1 rION'' - 13R A BUILDING OR STRUCTURE ORIGINAL -File PINK - Owne, GOLD - Assnsnr •' 'S'q IT IS UNLAWFUL TO USE• OCCUPY t , LINT A'FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ' A C ;51FILAT OF OCCUPANCY HAS BEEN GRANTED. UBC 304. 306. L. (� 3 R 'D DtC Y a t %f,�L,r a. vww a!RY.'.A-ua3a 104 + i s( L'I —.b4 ul- 00 CITY OF EDMONDS FOR INSPECTION CALL Tip PUBLIC WORKS DEPAR. ermit _ Q' SLDE SEWER PERMIT - • 775-2525 Ext. 220 Issue Date.. si PERMIT MUST BE POSTED ON JOB SITE, 1. Address of Construction 7;7t;�,�,�: ` MAR 2 7 198:1 2. 3. 4. 5. 6. Property Legal Description (Vµinclude all, easements) Single Family Residence Multi -Family No. of Units Commercial STREET F Owner and/or Builder ,l/� ( /�! /1: j 0 41 !LE Contractor & License No. 0 (V 3• 1 -� 61y Invasion into City Right -of -Way: No--V Yes (If Yes Right-of- way Construction'Permit Required - Call Dial Dig (342-5344) before excavation). 7. Cross other private property: Yes No V Easement required - attach legal description and county easement number. f READ THE FOLLOWING AND SIGN: a. Property owners must obtain a permit to install side'sewe-r--soon their property. A licensed side sewer contractor must be employed to construct side sewers in the public right-of-way. b. The side sewer contractor assumes full reponsibility for each installation for one year. C. Commercial establishment requires a minimum of a six inch (6") side sewer line. d. Side sewers may not be installed closer than thirty inches (30") to any structure. e. Side sewer lines must be laid at a minimum grade of 2% (1.15°) and maximum grade of 100% (450). f. No turn in side sewer greater than 45° (1/8 �)4sped between cleanout. All 90 turns must be constructed t 5 ��cc bend) and wye with removable cap., BEFORE YOU DIG g. No down spouts, footing drains or floor drains can De connected to side sewer system. 1- 800 - 562-6478. h. Pea gravel is required for bedding when installing sewer lines through other than granular soil. i. Cleanouts are required at 30"-60" from each plumbing exit line and at minimum intervals of 100' along sewer line run. j. Trenches within City right-of-way must be restored to original conditions. Contractors shall be responsible for right-of-way failure due to poor compaction of fill. k.. Side sewer must be left uncovered until inspected and approved by the City. 1. Inspection during normal working hours only. Two (2) working days notice required. 11 n/ DATE: I certify that I have read and shall comply with the above E PERMIT FEE: ,-� �, z DISAPPROVED BY: Date: OW By: Date: "I CONNECTION FEE: APPROVED By Date G4 __ * PERMIT MUST BE POSTED ON JOB SITE * ✓� 0, MEMO TO: FROM: SUBJECT: DATE: i Building Division Community Development Department Engineering Division Public Works Department 1D3�� Avg" i After review of the subject Building Permit application, we have the' following comments: 1. 'Conne'ction to City water system required. 2. Connection to City sanitary sewer system required. 3. Right-of-wav Permit required for any work on City property. 4. Driveway slope not to exceed 14%. 5. 'Backwater valve required if downstairs plumbing is below elevation of upstream manhole. 6. Water and sewer lines to be separated by 10 foot minimum. `7..-%i-sei,E mi2.4I,us A Au,a Mutr&rnOW -d?AA :I). Signature The City of Edmonds Side Sewer Drawing EASEMENT NO- --------- ---------- -------- -------------- Vigo NEW CONSTRUCTION REPAIRS LID NO_ .................. . ASMT. NO. ........ ------ ------------------ ....... CONTRACTORCTOR .. 4-4 ... 4-7 .... ..... c ... PERMIT NO. JOB ADDRESS .......... LEGAL DESCRIPTION: LOT NO- -------------------------------------- BLOCK NO. -A -------- ------------------ ........................................................... ................... ........... NAME OF ADDITION ------ ........... 4!.'A .100% . ..... % ..... It- Pww-owl-11176 (REV-11178) Approved: ......................................... DATi ----------------- " APPLICATION for The City of Edmonds SIDE SEWER PERMIT EASEMENT No ........................................... NEW CONSTRUCTION 0 REPAIRS 0 107-05500 OWNER......... Jack..R....J.dni.SAA------------------------------------------------------------- CONTRACTOR......-...-..........--.........----------------.......--------------------------.--------..----- PERMIT No. ...................... ADDRESS.....1034--S--St1eet------------------------•--..-.-----------------------------..---- LEGAL DESCRIPTION: LOT No. ---------------------------------- ----------- BIACK No.. ---------...------------------------------- NAMEOF ADDITION----------------------------------------------------------------------------------------------------------------------------------------- DYE TESTED ON SEWER JULY, 1972 Approved: DATE------------------------------------------------ BY.-...-------...---------------......--------------------------------- '11c. I g9� STREET FILE 1°3" 3, Me 5 CITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS,WA 98020 PHONE: (425) 771-0220 - FAX: (425) 771-0221 *PERMIT MUST BE POSTED ON JOBSITE* STATUS: ISSUED ENG20070036 I RIGurr OF WAY PERM IT (7-EUC Standard) Permit Number: ENG20070036 Expiration Date: 4/30/2007 Job Address: Location: APPLICANT CONTRACTOR Cable Com Cable Com 1222 108th ST SW 1222 108th ST SW Everett, WA 98204 Everett, WA 98204 425.347.5138 LICENSE #: 602-265-572 EXP: 1 1 Request permission to open trench/bore 24 ft, bore 14 ft of the alley and trench 14 ft of the ROW to install and bury CATV service to 1034 B Avenue S. Total footage of 52 ft. DISRUPTION1 ASSESSED VALUE: $0.00 PROPERTY AREA: 0 SIDEWALK: (OXO) DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT: ( 0 X 0 ) PARKING: ( OXO) DURATION IN MONTHS: 0 FEE: $0.00 YEAR OF OVERLAY: 0 FEE: $0.00 ALLEY: ( OXO) DURATION IN MONTHS: 0 FEE: $0.00 INDEMNITY The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries, damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and attorney fees by reason ofgranting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OFONE YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE 0 FTHE WORK. Traffic Control and public safety shall be in accordance with City regulations as required by the City Engineer. Every flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the required training in their possesion. Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City approved material prior to the end of the workday- NO EXCEPTIONS. Three sets of construction drawings of proposed work are required with the permit application. CALL DIAL -A -DIG (1-800424-5555) BEFORE ANY EXCAVATION CALL FOR INSPECTION (425) 771-0220 EXT.1326 24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN SPACE PROVIDED. n Printed: Wednesday. February 14. 20C M TE ❑ FILE COPY ZZINSPECTORCOPY ❑ APPLICANT COPY .Z. - .. STATUS: ISSUED ENG20070036 • Restore ROW to City standards • Restore Landscape to like or better conditions. • Call for locates of underground utilities prior to any excavation. • Alert affected residents and/or businesses prior to work start. • Conform to approved working drawings and Traffic Control plan. • Public utilities maintain 5' separation from City Utilities. • Verify clear bore crossings • Utility patch restoration to be in accordance with Edmonds Standard detail E2.3 • Maintain erosion & sedimentation control. Keep street clean. • Construction hours are Monday -Friday 7am-6pm and Saturdays 10am 6pm No work on Sundays or Federal Holidays. • Call for required inspections as noted. • E-Engineering Final PARTIAL INSPECTION DATE: INITIAL: NOTES: PARTIAL INSPECTION DATE: INITIAL: NOTES: FINAL INSPECTION APPROVED DATE: INITIAL: Z-- Comcast of Edmonds 1525 75`h street SW Suite 200 .Everett, Wa 98203 Contact: Kermit Benson 425-263-5362 North Drop Node: EM26A 1034 B Ave S -City of Edmonds Work Details: ;4.rhuv to a-%*) vvv i cap Y /ENGINEERING / Data: az T w a m Requesting permission to open trench/ bore approx 24ft , bore 14ft of the alley and trench 14ft of the ROW to Install and bury CAN service to 1034 B Ave S. Total footages of 52ft. Install cable at 36" depth. All disturbed areas will be restored to exiting or better conditions. Backfill material will be mechanically compacted to 95% of maximum density as specified by the city of Edmonds. In tight corridors hand trenching will be utilized to ensure protection of other utilities. Contractor must locate all exiting utilities impacted by this project. Please see attached plans for restoration, erosion control and traffic control. Erosion control will consist of placing filter fabric fence and/or sandbags along curbs and catch basins where necessary. Keep drainage system clean and functioning. Remove all debris from the work site. Streets and roads will be cleaned both during and after installation of work. ;. . City of Edmonds RIGHT-OF-WAY CONSTRUCTION PERMIT Permit No: Issue Date: A. Address or Vicinity of Construction: 1 -'-A- YL 0 C. Contractor: � lr+ Mailing Address- EV�iW- f , W ek 2 D State License #: �(9� %� 5772 City Business License #: D. Building Permit #.(if applicable): E. ❑ Commercial ❑ Subdivision ❑ Multi -Family N Single Family INSPECTOR: F. PAVEMENT CUT: ❑ YES CONCRETE CUT: ❑ YES G. ❑ `Mail Approved Permit ❑ NO ❑ NO � �' Contact: �� Phone: f ZZ 3 4-7- 113 b Liability Insurance: Bond: $ Side Sewer Permit # (if applicable): ❑ City Project ❑ EUC (PUD, VERIZON, PSE, COMCAST, OVWSD) ❑ Other ❑ Call for Pickup G. SIZE OF CUT X cam INDEMNITY: Applicant understands by his/her stgna'iure to athis 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 Edmonds 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 BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. ♦ Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the required training in their possession. ♦ Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or .City - approved material prior to the end of the workday — NO EXCEPTIONS. ♦ Three sets of construction drawings of proposed work are required with the permit application. CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE THAT I MUST MAKE T `COPY OF THE PERMIT AVAILABLE ON SITE AT ALL TIMES JFOR INSPECTIONS Signature: `� — Date: ( ontractor or Agent) REQUIRED INSPECTIONS: -a .Call 425-771-0220, Ext. 1326 for a 24=hour voice=recorded inspection request line. FINAL APPROVAL OF PERMITTED WORK: DATE: Inspector's Signature NO WORK SHALL BEGIN PRIOR TO -PERMIT ISSUANCE CADocuments and Settings\CurtisNy Documents\Forms\Engnrng\ROWpermit_ doc Revised 1001/03 Ce. Ccomcast Traffic controllset=up for minor encroachment PROJECT'S TIMELINE AND PROPOSED HOURS OF OPERATION:Ali (optionall • Timeline — Up to 30-days past the issue date. • Work Hours —The entire project area will be conducted from 7:00 AM to 7:00 PM or tI as specified by the Inspector. Traffic Control Plans OOZ A 1. The standards and guides of the latest version "of the MUTCD or as set-up per Code shall be followed at all times. 2. A copy of the Permit and Traffic Control Plan shall be on -site with all contractors during the project. Traffic control set-up for lane closure FLAGGERSTATION ,00 Bi 3. All contractors will avoid parking on sidewalks and shoulders and will take the . Truck Mounted - lane and follow the proper traffic control set-up for the given situation. `- t Atten 100 (optional)- nal}. j aace 4. Pedestrian access shall be maintained through or detoured around all work sites. j�5 _ FLAGGER STATION It I13L' 5. Please find attached,the traffic control plans for the various types of work sites that will be encountered during our project. E*A 6. Flaggers will be used only when all other methods of traffic control are [ A 200 A - inadequate to warn and direct drivers. Only licensed flaggers will be used on y the project. 1. tleuatdo) 7. If situations occur when, questions arise about proper traffic control set-up the solution will be determined in the field with the Comcast Construction Rep. t:.,''•: z' and the Inspector. - t Erosion Co.ntrol:Rules -- #1 If curb and gutters in project area: - Filter bags will be placed in catchbasins downstream of work site. and • Small check dams of pea gravel filled sandbags will placed within the I gutter upstream of the catchbasin_ I 4.. �.a.. N � I iES1 ' I Depth, C leaning, Containment, Compaction, and Restoration "u-P LIl ♦ 36-inch minimum ♦ Compatible w/ other utilities ♦ Shoring required at 4-ft + - - Pavement Cuts ♦ T-cut 1-ft wider than trench ♦ Neat -line saw -cut or jack hammered edge ♦ All trench backfill shall be mechanically compacted to 95 percent of maximum density using 1-ft loose lifts with whacker or 2-ft loose lift with a hoe pack. ♦ If proper compaction cannot be achieved with the native material, new import material is required at the 95 percent rate. ♦ As an alternative, CDF can be used in a design mixture approved by the Engineer. Ccomcast CLEANING: All Streets and roads are required to -be cleaned and swept both during and after the installation work. ♦ Mechanical Vacuum is preferred method CONTAINMENT: All un-restored shoulders or material storage areas are ,required to be contained With reflective barricades. All disturbed areas shall be restored to existing or better conditions ! ! ! ! ! ! ! Trench parallel to road: ♦ Shoulder - Match existing surface conditions ♦ Pavement - 6 1/2 inches of crushed surfacing material and asphalt concrete Class B at 2- inches minimum or same thickness if greater.. Trench across road (immediate cold mix patch): ♦ Asphalt - Permanent hot mix patch at same thickness or 2-inches and sealed within 30 days. ♦ Concrete - saw cut and pored with mastic joints, eight - sack mix, either type II of III cement, within 30 days. y � .:�^�,.µ��?!t -Y-'i �`)( i 'L _ _ "4.�.� i,s;;^..%� ..:.,�,,..- ^ ,..�-�,-� �r.y,1u'-{�--�^ ;,��-...,M �..�-'1,..��.:••--J...^ f � ��-•..,.,�....- . ,- , . � �� , v�! `t"'r ``'ti �fY-i •1w�`v.,.ar �+oN:/'tiu� .[ ,.r."' �A � A City of Edmond Y CONSTRUCTION RMIT Permit Number: C7 a 130) Q a, Issue Date: 0 A. Address or Vicinity of Construction: 1834 5 - QV E j �199 B. Type of Work (be specific):, kF_ p t_A C E_ I->E-F. DZo p w/ aO 8 9 VG C-A' S TG W I S' A4,Le_Y C20.SI'te/G C. Contractor: eA LS UPC /2 t at CA Mailing Address: 5-3 3 M &I tV 5T a State.License #: 5 u pj:r_ 2 C.C. tyl CJ A. D. Building Permit # (if applicable): �t Contact: ,JA cK GR_A t7 wy H t_ Phone: 7 % Q-- — S 1 4 C� - Liability Insurance: Bond: $ Side Sewer Permit # (if applicable): E. 'T❑ Commercial ❑ Subdivision ❑ City Project ® Utility (PUD, GTE, WNG,(WATER) ❑ Multi -Family ❑ Single Family ❑ Other INSPECTOR: INSPECTOR: W 1A %Tc-vl_T F. Pavement or Concrete Cut : ❑ Yes ZNo G. Size of Cut: �x H. Charge $ 1S k1w AL-c-r'e65e-AVEL� �� AP)LICANT TO READ A IGN ' o&ju5F INDEMNITY. Applicant understands and by his signature to this application, agree the Clry of Edmonds hatnile �u es, amages, or claims of any kind or description whatsoever, foreseen or unforeen, that may be made agai the Ciry of 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. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWfNG THE FINAL-INSPEC77ON AND ACCEPTANCE OF THE WORK. ES77MATED RESTORATION FEES WILL BE HELD VPrflL_7HE FINAL STREET PATCH W COMXE7ED 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 _9 Work 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 acco0ance•,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 workink day; NO EXCEPTIONS. / 1 have read the above st tem nts and,understan the permit requirements and the pink copy of the permit will be available on site at all` imes for i pe ion p poses. / Signature: \`// Date: (Contract f or Agent) T, CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY .:APPROVED.BY.::: W H ITC —VT 1 .::..R1GHT;OF;WAY:DEPOS: TIME AUTHORIZED ';VOID AFTER 1 ,,,,�� E41Z "';:DAYS:" :..- DISRUPTION:.F.EE/FUNI ;SPECIAL CONDITIONS::: RESTORATION FEE:; a FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept.) Comments: Diagram• CONTRACTOR CALLED FOR INSPECTION 0 YES O NO Partial Work Inspection by P. W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: Eng. Div. 1u' --CD 34 B Ail F ID-I4-92- RWH I D 34- CEMENT wM I 1 2(iPLAC-L O.FFECTIV'rz DkO P W/ L EEa 86' - RG - G UG CA` S ;-,-. .;��'• City of Edmonds RECEIVED SIRE&&��F-WAY CONSTRUCTION NOV 0 5 1091 PERMIT ENGIIVEEMh , Permit Number. s-r&eT iZ.- I-7- 9 1 Com/l I _ Z I q2 Issue Date: A. Address or Vicinity of Construction: 1034 8 Avenue j 8� o B. Type of Work (be specific): Install 2" PE IP Main from 156' North 9 0 1 9 centerline Fir Street to 218' South centerline of Pine Street. Washington NAturalA ascCompanywinnt ary w nson = ER C. Contractor: Contact: ' Mailing Address: 815 Mercer Street, Phone: 224-2080 State License #: Seattle, WA Liability Insurance: Bond: $ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. ❑ Commercial ',❑ Subdivision ❑ City Project ® Utility (PUD, GTE, WNG, CABLE, WATER) „0 Multi -Family ❑Single Family ❑ Other INSPECTOR: �y INSPECTOR: Rdy '/ A Dn-ant nr rnnrrara (,it I Vac mmn Mr. Qua of riff• 2 Y 4 N i bnr"P P. APPLICANT TOUWAND SIGN u INDEMNITY: Applicant understands and by his signature to this application,.agrees to hthe City of Edmonds harmless from injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeen, that may be m� against llie Clity o% Edmonds, or any ojiu departments or employ- ees, including or not limited to the defense of any legal proceedings incl ufin defense costs, and attorney fees by reason of granting this permit. 41 THE CONTRACTOR IS. RESPONSIBLE FOR WORKMANSHIP AND MA TI S FORA PERIOD �F ONE YEAR FOLLOWING THE FINAL INSPEC770N. AND ACCEPTANCE OF THE WORK. ES77MATED RESTORA7TON LEES WILL.BE HELD UN77L THE FINAL STREET PATCH IS COMPLETED BY CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSEDNFOR7SSU4NCE T0�71E.APP&CANT. Construction drawing of proposed work required with permit application. A 24 hour notice is required for inspection; Please call the Engineering Department- 771-3ZQ2. Work 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. 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: /VfE Date: October 24, 1991 (Contractor or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK RIGHT OF WAY DEPOSIT: _ TIME AUTHORIZED:: VO1D AFTER:: L11 A N -SJ._Bt*S. ..... DISR ............... N ES ,:: 57UB5 . ZQ -WEST ` 106 Old .......... _....._ _ .:.RECEIPT.;NO: DATE:.. � . ;ISSUED BY NO.WORK SHALL BEGINPRIOR TO PERMIT ISSUANCE t Engrg. Div. 1991 FIELD INSPECTION NOTES <. y,. d`I11. --•Route, copy to Street Dept:) Comments: Diagram: CONTRACTOR CALLED FOR INSPECTION ❑ YES. ❑ NO•. Partial Work Inspection by P. W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: Eng. Div. Jul 1"X 90* PE ELL 154w, fro IE PINE ST do a, 1915 19 Co's 1990 0 - x -5, 0 1990 OD FIR ST til l3' LA WIT I ig I SQUEEZE AND BUTT FUSE '--.PROPOSED PE IP MAU� ft '-i'*y'-)oe Pe ELL - DESCRIP'!ACIN -'NOTES FIELD LOCATE ALL UTILITIES CALL- 1-800-424-5555 48 HouF;tS BEFOREDIGGING a LAY DETECT WARNING WIRE OVER ALL PE DIREGT BURIAL. PIPE 3 INSTALL- ONE POUND X"00E FOR L4Epj %OOC>l OF Lor-ATtt4G .WIRE MAINTAIN A S' HoFk%7-oK-TAL- AND V VF-R'Tlr-A.L CLEMAVAr-F- FROM ALL. GV" VMSTISS 10 9 8 7 6 1.?,. CP043.-3 4 3 -wI4-(BAUC.F- E)ETF-rT WIRE Ss - c) 4-0 SDP,-Il PE PIPE: 70 - Z&O 0-- roo - 41B5 ITEtAl QUANT. DESCRIPTION STOCK NO. BILL OF MATERIAL PERMITS: F_IDtAOtAoS r4w --PLAT: G (o OP MAP- I a4-- (P?- AREA : ?-41 TAX CODE: c N SEQ. NO: Nabuil Gm Away El w-fVY Cc-w>,YN D.G.R: 11-30-191 20 PE I P MAIN EXTENSION —fO-- 10 34— B AV OWN: 10 ICP 91 IR (0043-15 RR JOB C32O-O+7 Wr) CHKT): 1�1' DATE EH AP L L-*-- _F SCALA-- N 2 0- 0+7 -.CI.TY OF EDMONDS PUBLIC WORKS DEPARTMENT STREET HLE RIGHT - OF - WAY CONSTRUCTION PERMIT A. *Address or vicinity of Construction d, i<'i .y , � � 8-`) dP L L -,T - • Owner: 'T(l 0 �.J 3 �_) V,. 1 ti 7) �J Name ), � n �� k 3 ,_'x I a Mailing Address City, State, Zip Code r' e Contractor. 0 S I?J b "ti P) to N Name Mailing Address City, State, Zip Code MWNo. �s " Issue Date a • Permit Issued ToP LA • Q '� \ S R1 b e) D,11\ �0. • Type of Work to be Done: 71 Qi� tV f- 11 62 W • Work in Connection With: ❑ Sub or Plat I'M Single Family ❑ Comml. / Ind. ❑ Apt. Condo. • Pavement Cut: ❑ Yes © No State License Number ° A. D 4 ,2- Telephone Number * * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * * B. APPLICANT TO READ AND SIGN INDEMITY: 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 City of Edmonds, or any of it's 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 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 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 to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call 775-2525, extension 220. I understand that this permit must be available attl e job site for inspection purposes at all times. Signature:"mate ! ~ Owner of Agent % THIS TERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES 1t 1t CALL DIAL - DIG PRIOR TO BEGINNING WORK C. Issued By: Time Authorized: Void after ' days Special Conditions: Ammendments: Permit Fee:��. Security Deposit: _ Receipt No.: Fund 111 Fee: Street Cut Dimensions * NO' WORK TO BEGIN PRIOR TO PERMIT ISSUANCE �r Eng. Div. December 1978 FIELD INSPECTIO'� ES (Fund 111 V.te cony to Street"?)ent.) ('nmmnn+- a - Diagram: Contractor called .for inspection Yes No Mork Disapproved By• Hate: By:_ Date: [cork Approved By : _ Date: Inspector: Ena. nil. December 1978 REV *42l79,_-;'. m L L A)TI LITY DISTRICT V Of - Snohomish Co6nty. 22 A rea:,' ' -3 4 C O.N, L QA !S, T_ -REVISION'� ---- -- - rl R -REASON FOR-WORKo, r �AS -AUILT,: LE:Z* APPROVALS' e 7� 7:77 -7, 7777 PERI OTREQUIRED, blT. RE6TRIMMlNG;WATER ,REQUIRED .M TYPE 'ESDIM DIG -T K. PUD*.. LOCATOR ®GAS, DATE4,r, ED. DATE RELEASED 00ACK HOE',' FEES • ,• C. _�ONTACTSR -) Gj N W,.,NO. 'FROM '7 )AtC%2- .VX AMOUNT `CATvN TAKE.OFF POLE .TYPE: A rLSTr6 CIRCUIT NOi 4D SUBSTATION. DAT.E: WORK COMPLETED FOREMAN ENVIRdNMENAI ANALYSIS, EXEMPT jo NOT '-EXEMPT - - .PARA J ITEM .0 H..:U G.:COND KV ADD` -C,KJ FT,- PH." - REMi CKI � 47. PH. CKlr.'F,T, Lo(5s-POSTED. TRANSF CARDS U-MAPS' POLE DEPT*, CIRC.