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SEP 8 2014
BUILDING ®EPARUMENY
CITY OF EDMONDS
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C#TY OF EDMONDS _. Cx& SToa,-('
COMMUNITY SERVICES DEPARTMENT Nov 8
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. • Owner: Washington Natural Gas Company B. • Contractor:
Name
815 Mercer Street
Mailing Address
Seattle WA 98111
City State Zip
Permit No. & /
Issue Date /�% 1 oc M
Name
Mailing Address
City State Zip
State License Number Telephone Number
C. • Address or Vicinity of Construction: 1035 Spruce Street
Type of Work to be Done: Install New Seevice
D. • Work in Connection With: ❑ Sub or Plat ❑ Single Family ❑ City Projects
❑ Commercial ❑ Multifamily autility
E. • Pavement Cut: ® Y ❑ N F. • Size of Cut: 2 X 4 Gas and H2O
APPLICANT TO READ AND SIGN
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 scrAtiP& wha0oevev; forSeen or unforseen, that may
be made against the City of Edmonds, or any of its del artmentor 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.
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 issue to the applicant.
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times. ST•-r
• Traffic Control to be in accordance with City regulations.`' r 1
• All street cut ditches must be patched with asphalt or City approved material prior to 'end of ifng day;
NO EXCEPTIONS.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature: M6/ Date: October 4,
Owner or Contractor
1990
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: R4
Time Authorized: Void after DEC 30_da3Ls.
Special Conditions: �N, A
RELEASED B
Date ff-)
PERMIT FEE: -$120 - tl}- L, '0;;4 -Cl
Restoration Fee: _
Receipt No.:
Fund III Fee:
Street Cut Dimensions:
INSPECTED BY
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. March 1989
FIELD INSPECTION NOTES
(Fund 111 - Route copy to Street Dept)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved By: —
FINAL APPROVAL BY:
Date:
Date:
Eng. Div. July 1985
Addendum to:
City of Edmonds
r
Permit Application
Engineering Aide : Kerry Walsh
Washington Natural Gas
622-6767 x 2588
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KEY:
-as- sanitary sewer
-s- storms
-w- water
0 water valve
CITY(iF EDMONDS • ASSAN FORMATION SHEET
E NEW
❑ ADDITION
❑ RETIREMENT
ASSET NO. p 3 Y 7
ADDITION TO ASSET NO.
DESCRIPTION IL E
SERIAL NO.
LOCATION
DEPT. NO.
6 �r -S- rp u C-G-3 5
SS^ c>
"PURCHASE ORDER NO. _
PURCHASE ORDER DATE
COST
�J
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
*PROJECT NUMBER
PROJECT COMPLETION DATE
COST 213 . S a
-3 y 5 - av - 6
i
25
INITIATED BY DATE APPROVED BY
**SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
a DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT _
• G.L. ENTRY
REFERENCE
DATE
U)
V E R II-E-6ft
PROCESSED
BATCH NO.
INITIAL
Vl
DEPARTMENT FILE
CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. •Address or vicinity of Construction
10-265
• Owner:
Name _
Mailing Address
City, State, Zip Code
• Contractor:
Name
_
)
T
CMaJilinkA d,rgs5 0
Cit , State, Zip Code
Permit No.
Issue Date
• Permit Issued To:
• Type of Work to be Done:'-' -__Nk' 4
Q R— C Li-e -,�. K. L
• Work in Connection With:
-.W-Snb or Plat El Singeamity
�P-)
❑ 'Comml. / Ind. ❑ Apt. Condo.
• Pavement Cut: ❑ Yes No
SiREE7 FILE
State Liceennsee Number
L j
1 �—
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE tit *
B. APPLICANT TO READ AND SIGN
�r
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.
1 understand that this pemit must be ava' able latt'he job site for inspection purposes at all times.
Signatui------------
A 0, ate) ' �—
OVv er or Agent
* THIS PERMIT MUST BE PO TED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Void after
Special Conditions:
Ammendments:
Permit Fee:
days Security Deposit:
Receipt No.:
Fund Ill Fee:
Street Cut Dimensions
M
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
FIELD INSPECTION NOTES (Fund. 111 - Route conv to Street Dent.
r.,,, mT„ 4- o .
Diagram:
Contractor called for inspection Yes Alun
Mork Disapproved By: Date: —T By: Date:
Work .Approved By : � _ _ate:
Inspector:
Ena. Div. December 1978
RECEIVLO PUBLIC WORKS DEPARTMENT
ngle Family
• AU G 4 1981 BUILDING PERMIT REVIEW Multiple
Commercial
BUILDING ADDRESS
BLDG., DEPT. SUSPENSE DATE INITIAL DATE
)UTE : [Z]OFFICE ADMIN . PUBLIC W-04KS LOG IN
r�CITY ENGINEER (check)��
❑ Access Slope and Vehicle Access
❑ Drainage Plan 12 ) ' . ) �
❑ Street File
❑Legal Description PA,
❑Quit Claim
❑ Easement
❑ Calculate Sewer Connection
WATER/SEWER DIVISION
P'1I5etermine Meter Size
E'C Building Permit Review
omplete
STRE T DIVISION
mplete Building Permit Review
Un-OFFICE IF CE ADMIN . — LOG OUT TO BLDG . DEPT . ,
! E7BUILD
I G PERMIT APPLICATION (COMPLETE)
13 Z COPIES OF SITE PLAN
2 COPIES OF FIRE PROTECTION PLAN
PREVIOUSLY REVIEWED BY FIRE DEPT.)
3 COPIES OF DRAINAGE PLAN WITH CALCULATIONS_ 7,?
REQUIRED BY SUBDIVISION ❑
GREATER TITAN 2,000 SQ. FT.
IMPERMEABLE SURFACE ❑
LESS THAN 2 , 000 SO. FT . [30_1
HECK ZONING REQUIREMENTS (SETBACKS)
i1 OP Y OF E14GINEERI14G CHECK LIST
b 1 COPY OF PUBLIC 14ORKS MEMO
❑ MULTIPLE OR COIDIERCIAL
YES ❑ (ATTACH COPY OF ADB APPROVAL INCL. ALL DRX-ZINGS)
NO
❑ SUBDIVISION — YESn_"**`NAME A 1/ 4-�P, 519-rl
DATED RECORDED - _,
NUMBER,f/4g0 O / /�F _ _
NO ❑ (.ATTACH COPY OF REQUIR91ENTS)
,ErrHECK SEWER DRAWING AND ATTACH COPY Pc a.
QG!/. /an
IS DEDICATION REQUIRED — YE(OBTAIN Q T CLAIM)
/����y o6,�A �cd w� t�j ���p;�isior ( CITY CODE )
NO ❑
DOES CITY HAVE EASEMENT ON PROPERTY
YES ❑ (ATTACH COPIES OF DRAWINGS) C
NO Ta —L L
CHECK LEGAL ACCESS — INGRE S UTILITIES
YES YES
NO ❑ NO/0
HAS SEWER ASSESSMENT BEEN PAID
YES ❑ L.I.D. NO. �
PLAT NO.
SUBDIVISION NO. STREW
❑ FILE
❑ IF MULTIPLE: INCLUDE NUMBER OF UNITS
0 IF COMMERCIAL: INCLUDE NUMBER OF FIXTURE U14ITS
P,MLIC WORKS DEPAR'IrM CHECKLIST
BUILDING PERMIT REVIEW
(awes to
Street Right -of -Way Existing i� * &ryee- — /''tet REQD
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Access Easements Existing READ --
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Utility Easement Existing 12//,y- REQD
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Lot Per Subdivision .S - Y/ Plat Assessor Map fc-cfd
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Site Plan Checked for Accuracy o/
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Underground Wiring Reqd. v
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Check Accuracy of 1 Descrip on e
z
Review b &te
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Existing Water Main Size
Water Main Required ,v
Service Line Required
Hydrant Size Existing
P�
Hydrant Reqd Per Fire Code Al Size
W
Detector Check Meter Reqd. A
Cross -Connection Inspection
Fire Department Comments
d
v
Water Meter margre Regd.jy,
Review by Date
Septic Tank Design Approved ///�/� Date
Septic Tank Permit Regd. /1/�i9"� Permit o.
Sanitary Sewer Availability e Pro].
Drying No. / Ae i File No.
Side Sewer Availability�r�e, 71-0
W
Sanitary Sew e ion Fee Regd.
3
Review by Date
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Open Ditch Existing ;��� �✓ �_ Read. --------,
Culvert Reqd. ,l, Size ---
x
Catch Basin Regd. Indicate on Site Plan
0
Shoulder drainage maintain collection on swale open runoff
`n
Manhole regd. t------ Indicate on Site Plan -----
Soil Conditions and Ground Water Field Checked
Review by e Date �Z .,2
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Revised: lv10-1977
PERMIT -
NUMBER
USE
CITY OF EDMONDS ZONE
BUILDING PERMIT APPLICATION JOB
NAME (OR NAME OF BUSINESS) ADDRESS 3L5 r64
V LEGAL DESCRIPTION SUBDIVISI N tV/ll SHORT SUB NO.
NG ADDRESS
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MAIL
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PUBLIC RIGHT OF WAY PEji OFFICIAL STREET MAP
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CITY
ELEPHONE NUMBER
EXISTING
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PROPOSED ✓ V r''
NAME
DEFICIENCY OF RIGHT OF WAY J an ,
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C E D
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SEE ENGINEERING MEMO DATED '/-67/-
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TELEPHONE NUMBER
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NAME
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M R SIZE
BUILDING SUPPLY SIZE
FIXTURE UNITS
a:
0 ADDRESS
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REMARKS
E CITY
TELEPHONE NUMBER
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SIGN AREA
ENV. REVIEW
ADB NO.
U S A E LICEN E NUMBER
CITY LICENSE NUMBER
ALLOWED PROPOSED
COMPLETE EXEMPT
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SHORELINE
Legal Description of Property (Show Below or Attach Four Copies)
VARIANCE OR CU
PLANNING REVIEW BY
DATE
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YARDS
FRONT SIDE REAR
LOT COVERAGE
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REMARKS
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46
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n : EW RESIDENTIAL PLUMBING CHECKED BY TYPE OF CONSTRUCTION CODE
�J NON-RESIDENTIAL MECHANICAL
ADD
SPECIAL INSPECTOR I AREA JOCCUPANCN
Li DEMOLISH
Li SIGN
REQUIRED
❑ ALTER ❑ EXCAVATE
❑ FENCE X—FT)
❑ YES ❑ NO
REMARKS
REPAIR PRE-MCOMP DANCES
aswim
NSP,
POOL
Z NUMBER OF STORIES
NUMBER OF
0
DWELLING
F
UNITS
4 NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
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PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FENCE
marquees, etc.) will require separate permission.
SIGN
Permit Application: 180 Days
-
Permit Limit: 1 Year- Provided Work Is Started Within 120 Days
RETAINING WALL
"Applicant, on behalf of his or her spouse, heirs, assigns and
SWIMMING POOL
W successors in interest, agrees to indemnify, defend and hold harmless
J
2 the City of Edmunds, Washington, its officials, employees, and
¢ agents from any and all claims for damages of whatever nature,
a
x arising directly or indirectly from the issuance of this permit. Isstl-
0 ance of this permit shall not be deemed to modify, waive or reduce
TOTAL AMOUNT DUE
Jany requirement of any city ordinance nor limit in any way the
0
I City's ability to enforce any ordinance provision."
ATTENTION
I hereby acknowledge that I have read this application; that the in-
formation given is correct; and that I am the owner, or the duty author-
THIS PERMIT
ized agent of the owner. I agree to comply with city and state laws regu-
AUTHORIZES
lating construction; and in doing the work authorized thereby, no person
ONLY THE
will be employed in violation of the Labor Code of the State of Washington
WORK NOTED
relating to Workmen's Compensation Insurance.
SIGN TORE (OWN OR ENT) DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
IS SITE IS LOCATED IN THE CITY
775-2525
F EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL HAS BEENOR
UBCAND0VAL 304, 306. 2 9 REM
A CERTIFICATE OFSPECTION OCCUPANCY HAS BEENADE GRANTED.
JUL
1 0 2-7 8
VALUATION
FEE
HEIGHT
OCCUPANT
LOAD
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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ORIGINAL — File YELLOW — Inspector I i
PINK — Owner GOLD — Assessor L
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DATE: f- "_
MEMO TO: Building Division
Connunity Development Department
FROM: Engineering; Division
Public Works Department
SUBJECT: e
After review of the subject Building Permit application, we have
the following comments:
1. Connection to City water system required.
2. -Connection to Citv sanitary sewer system required.
3. Right-of-way Permit required for any work on City property.
4. Driveway slope not to exceed
5. Backwater valve required if downstairs plumbing is below
elevation of upstream manhole.
6. Water and sewer lines to he separated by 1.0 foot minimum.
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FOR
MARK McNAUGHTON
EDMON DS% WAS W I NGTON
L Love11-8auerland & Associates, Inc.
e SURVEYORS 9, DEVELOPMENT CONSULTANTS PLANNERS
23106 TOOTH AVE. W. . EDMONDS ,Y+A 90020 . PHONE 775.1593
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To ASTIA VPF-C. D-30a4
SEWED PLAN
FOR
MARK McNAUGHTON
EDMOW0511 wASPNGTON
L Lovell- Sau arl an d & Inc.
"T • PLANNERS
a SUIAVEYORS .' DDEVELOPMENT CONSULTANTS PHONE 775-1593
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EDMONDS .'YiA- 95WO
23106 loorti AVE. W.
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SETBACKS:
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