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1100 12TH AVE N.PDF1111111111 604 1100 12TH AVE N .00.ESSIIDO 12� G�rF 1.1 TAX ACCOUNT/PARCEL NUMBER: 00 9 0 [ 000 0 1)--1O BUILDING PERMIT (NEW STRUCTURE): 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): PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: . • SEWER LID FEE $: LID SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DA SIDE SEWER PERMIT(S) SOILS REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER 1TAP CARD DATED: c41:;� / ( 1 OTHER:�V LATEMMI)STsTonnAStreet File Checklist.doc BUILDING DEPARTIWNT PERMIT APPLICATION T NAME (OR NAME OF BUSINESS) yI MAILING ADDRESS ri W ADDRESS r' , Cr CITY T� Q e t/��J�� uJI)s W NAME [ k._q_* yr I F�LJu I I v 0 A DR SS t.i 111 stye-fAie E CITY r 0 0 U STATE LICENSE NUMBER 223-01 �13-c:0-N(--�i��Z1vc, Legal Description of Property (Show Be Z 0 I- IL E U VI W 0 J Q U W J Applicant Fill Inside Heavy Lines ZON _ NVMNC F ET: EILF Joe (� LEGAL LOT OYES ONO, A "401111116, UODIVISION NO. PUBLIC RIGHT Of WAY r[R,OROINANCR NO. / EXISTING RIGHT OF WA W is, PROPOSED RIGHT Or WAY DEFICIENCY OF RIGHT OR WAY LEPHONE NUMBER 7�� _ / _� "JI�J . STREET/UTILITY WORK RCOUIR9O ; QYCb SNO PERMIT FOR WORK IN ►VSLIC of*"' fAYfO ONO ]TELEPHONE NUMBER 54z— UNDERGROUND WIRING REOUIR[O. AY[b ONO CONNECTION TO SANITARY SCWCR� `.; ,.'Svcs ❑NO 1 fJ SEPTIC TANK PERMIT REOUIRCO , Ovau MNO SEPTIC TANK PERMIT NO. SEE MEMO DATED. 10/L V TELEPHONE NUMBER REMARKS -774 - 4� 33 N A. CITY LICENSE NUMBER CHECKED BY ow or Attach Four Copies) METER $IZE BUILDING SUPPLY 512E I SIGN AREA ENV. RCVI[W ALLOWED. I PROPOSED COMPLETE [X[MPT REMARKS VARIANCE OR CU N[W ll "" 11 ADO ❑ ALTER REPAIR RESIDENTIAL ❑GAS LINE aNON-RESIDENTIAL ❑ SIGN ❑ DEMOLISH ❑ RETAINING WALL Q ORCAVATE FILL FENCE X—�) NSP. �. POOL YARDS A�FRONT FIRE ZONE ITl SPECIAL INSPECTOR REQUIRED ❑ YES ❑ NO PLAN CHECKED BY Z NUMO[R OF •TONIC! NUMBER OF REMARKS O 2 DWELLING I. J UNITS a NATURE OF WORK TO OR DONE (A �V W 0 m O PLAN CHECK FEE STREETS) BUILDING PLUMBING AADVVTyTIwN'G' III+� m O MECHANICAL 1 FENCE 0 `Appiir os. iafl bdulf of hk or her spouse, heirs, assigns and SIGN SUCCV11i6l0 14 11;0101. ogled to Indemnify, defend and hold harmless i C the hV 04W1111001111. Wathington, its officials, employees, and RETAINING WALL E Q wAII_ (i+%Ab •.Ay 1r11d OQ claims for daI11AKCs Of whatever nature, S Z b#Ida$ d0 t1b 4" "ITC11Y from the issuance of this permit. Issu- SWIMMING POOL 0 stnro :t "Al twfWt thatt Nit be deemed to modify, Naive or reduce • �� � .' � :: +!1' :,;I!Inanr�• non limi! in .ul�' wav '!r' PLANNING REVIEW BY DATE LOT COVERAGE LQ/ SIDE as REAR OF CONSTRUCTION CODE HEIGHT IGROUP IL.OAD THIS SITE IS LOCATED IN THE CITY OF EDMONDS. LOCAL SALES TAX SHOULD BE CODED 31.04. VALUATION ( FEE OUBLIC WORKS DEPARTMNr C.HECfQ Z Date BUILDING PEIZNiLT -REviEw L V)6 12 AVII Address. Street. Right -of -Way. Existing OIS/zS- REQD Access Easements Existing 1, Ic r—T" REQD Utility Easement Existing '-hxs 2r 3p �.. REQD --� Lot per Subdivision . Plat Assessor Map Site Plan Checked for. Accuracy - CrZmq & X Underground Wiring Regd. M Check Accuracy of Legal.. -Description Envirormentally'Sensitive Area Environmental.Checklist Regd.n Flood Hazard Zones Shoreline Management Area Slope, Soil, Vegetation Stream, Creek, Drainage Basin p Existing Zoning~ Per- Code.,- Amenities Design Board Approval Regd.'. (p AM # Approval Board of Adjustment Approval.Regd•(� Review Bv: - t`l Date �LS Existing Water 'Main Size �'�� ,� • Water Main Reqd. Service Line Regd. Pe Hydrant Size Existing D� Hydrant Reqd. Per Fire Code Size.: Detector Check Meter Reqd. ,ya Cross Connection Inspection V E) Fire Department Comments Water Meter Charq,,Regd.IF Date: 912-% Review by: Septic 'lai-& Septic Tank Permit Reqd. Permit No. Sanitary Sewer Availability � Proj. x Drawing No. File No. X 4,10 w Side Sewer Availability tJyl w Sanitary Sewer Connection Fee Reqd. o ,$E ;AA%0 "6 . 1Z)/�4j Review By ",-"/s Date K. Open 'Ditdi ExistingReqd. �. Culvert Reqd. &-4,v en Size c� Catch Basin Reqd. Indicate on Site Plan Shoulder drainagecmi.ntain collection an swale open runoff. H , :lu-tiole regd. Indicate on Site Plan - Soil Conditions and Ground Water field Checked I;evi cw by 4r.� Da Street Paving Reqd._&VZ� H — Curb and Gutter Regd.-� w Sidewalk Reqd.�- w Curb Cut for Driveway Reqd. x, Right -of -Way Construction Permit Reqd. AOO H Bond Reqd. for Public In-provements Street Nar�e Sign Reqd. cn Other Signing Reqd. /fit A Pre Permit Site Inspection r-nde o o BY: SS TER U =a c WATER ~, ? STREET NIGINEE NG l Special RequireT:-aZts listed in P oim to Cormamity Development Department, Building Division. BY Da to o All itars filled in on Building Perndt Application BY Date a' -Ehawi.ngs Staimbd and Notations 1kide w BY Date Approved by Public 1•76rl;s Dcp;.n-n-xnt: a. Revised: 1v 10-1977 r DATE, MEMO TO: Building Division Community Development Department FROM: Engineering Division Public Works Department SUBJECT: l?� AVE After review of the subject building permit application, we have the following comments: (1) Coordination of the location of any structure with respect to uti sties, streets, property lines and driveway grades is the responsibility of the contractor. 2) The contractor is required to keep the abutting streets clean- ed of dirt and debris caused by the construction. (3) A "Right -of -Way Construction Permit" is required, from the Engineering Division of Public Works, for any work within the Public Right -of -Way or public easement. (4) Driveway slope not to exceed 140. PW 5/77 APPLICATION The Cityof Edmonds "�` FIL for 1 SIDE SEWER PERMIT NEW CONSTRUCTION ❑ REPAIRS ❑ EASEMENT No ........................................... OWNER------ 16Ud---------- 0............................................................... CONTRACTOR.--•-----•--•-•----..................--•---..........-•-•-•-------•-•-•........................... PERMIT No. ADDRESS --•/ii.� Q......hc............. V F x .............................. LEGAL DESCRIPTION: LOT No. ...................... ....................... BLOCK No............................................. s NAMEOF ADDITION..-•----------•--•--...----•---••............................•--••--•--.............•-•--•-•--........................................... Approved: DATE................................................ By .......................................... a.......... MW PERMIT BUILDING DEPART NT Applicantill Z16r. NUMBER PERMIT APPLICATION Inside Heavy Lines JOB ^ NAME (OR NAME OF BU,SIN S) ADDRESS / / P O — / --a /' /7--/, E M ILI W Z � 0 CIT h U ADDRESS W h I U CITY E a NAME E ADDRESS 0 h U a E CITY h Z 0 W 1 STATE 111 escription of Z 0 1- a Ir U VI W a J a V W J ' LEGAL LOT $YES '� ❑ NO PLAT NAME SUBDIVISION NO. l PUBLIC RIGHT OF WAY PER ORDINANCE NO. ELEPHONE NUMBER - � •' , 21 Y EXISTING RIGHT OF. WAY PROPOSED RIGHT OF WAY DEFICIENCY OF RIGHT OF WAY Q STREET/UTILITY WORK REQUIRED ❑YES NO PERMIT FOR WORK IN PUBLIC R/W UNDERGROUND WIRING REQUIRED ❑YES ❑YES NO NO TELEPHONE NUMBER CONNECTION TO SANITARY SEWER SEPTIC TANK PERMIT REQUIRED ❑VES DYES NO NO �) SEPTIC TANK PERMIT NO. SEE MEMO DATED TELEPHONE NUMBER REMARKS JMBER 'CITY LICENSE NUMBER CHECKED BY 1 ow Below or BUILDING SUPPLY SIZE SIGN AREA ALLOWED I PROPOSED REMARKS VARIANCE OR CU YARDS ElNEW ❑ GAS RESIDENTIAL ❑ LINE FRONT FIRE ZONE ❑ ADD O TIAL❑ SIGN E ❑ ALTER DEMOLISH . EXCAVATE ❑ WA `LINING FENCE SPECIAL NSPECTOR REQUIRED ❑ YES ❑ NO ❑ I' X—FT) PLAN CHECKED BY ❑ REPAIR �Ns MOVE aPWOL O Z NUMBER OF STORIES NUMBER OF REMARKS ' 0 DWELLING F UNITS NATURE OF WORK TO BE DONE i U N W 0 m PLAN CHECK FEE 0 PROPOSED USE rLUT PLAN (INDICATE BUILDING SETBACKS, i ABUTTING STREETS) BUILDING U N W PLUMBING In 0 MECHANICAL FENCE m "Applicant, on behalf of his or her spouse, heirs, assigns and � successors in interest, agrees to indemnify, defend and hold harmless SIGN f the City of Edmunds, Washington, Its officials, employees, and RETAINING WALL cr 1 agents from any and all claims for damages of whatever nature, a I arising directly or indirectly from the issuance of this permit. Issu- SWIMMING POOL ENV. REVIEW MPLETEf EXEMPT H PLANNING REVIEW BY DATE LOT COVERAGE SIDE REAR OF CONSTRUCTION CODE 1HEIGHT 4 OCCUPANCY OCCUPA GROUP LOAD THIS SITE IS LOCATED IN THE CITY OF EDMONDS. LOCAL SALES TAX SHOULD BE CODED 31.04. VALUATION I FEE 0 Y K 0 3 U_ J m 7 IL CI W h a 3 h Z W F F K a IL W 0 h Z W i a, 0' J W i W 0 h_ Z i i 0 U ❑I ana• of IIIis nennit shall not be deemed to modify, waive, nr reduce REGARDING: 1100 - 12th Avenue North (laa -6?aoo (address) R E C O R D O F C O N T A C T S DATE NAME, PHONE -NO., $ ADDRESS of CALLER COMMENTS ACTION TAKEN INITIALS 5/l/74 Howard Olds Certified Letter No. 406349 sent Letter received. TE requiring hook-up within 60 days. 5/2/74 Please dye test property. We are Scheduled dye test. TE on sewers. 5/6/74 Returned Certified Letter. Insists TE Jhe is connected. ...� 5/7/74 D.T_O_S_ TE 6/5/74 Certified Letter No. 406491 sent Letter received. TE rescinding previous letter. Uj -0 1 CITY of EDMOND$ '. 00porrmont of Public Warka � +. 200 D©yloo otrool - 0rlolon0or Woh. 00090 C77. 082 OLDS HO o gl�.._.30� ( RF- , FD00tNDS I2TwQpn Q- r' MO H V E . NCER' RT EI . .P 7WA SHING-roN OPTIOMAL SERVICES p Fj O • N�RFO l D�EE tt RECEIPT Shorys OR q p 9 2 0 SERVICES 2. Sho Wrth Qehoe antl tlateOdAL FEES SVER 7D gDDRESS .. With 0 horn. Cate addressee oretl ...... 15. \ PS AC DELIVERY EE. DNLY elivery to addresvSeee tlehveretl 65¢' - Farm (e,r}ra ( • 35 .:. APr. 2971 380Q d) ........... NO INSURA .................. 50d N NCE COV ..... :� OT FQR INTERNA AGE PROVIDED_ 1 ' pppp pp NAL IWA11 (Se e ther ®R d SENT 70 O 1' G •. STREET AND' N0. I,I 0� E I ZIP .CODE `7 ES O T FEES P:O., STATE 15¢ • ADDIT{ONAL 65¢ Iil SERVICES FOR date delivered ` OPTIO Al who erynto addressee only. e : 35¢ t- Shows to elrvesed .• With delve and Where d 85¢ RETURN 2• Shows to W hom, date ddressee on Y 50d RECEIPT Wdh delivery . a ) +' .::.................... ......... Side) ONLY (See other SERVICES ADDRESSEE ee re4��redl PROVIDED— ggls58 t DELIVER TO DVERAGE '°'°° ERY (extra ( Il 4 GPO' $FINDER ISE fo fo!/ok, ( .FUR- �1Vdl(dg4rydad�tStroEnR[V�ICQ'h�w.t ATops on ofhF „side. 'Bete/ nuntbRECkIP% . --•-ram - st alwaY filled in NY SENDER Be sure fo follow insfructions on other side :ASE FURNISH SER`JICE(S) INDICATED, BY CHECKED BLOCK(S) • (Additional charges Tequired for these services) - Denver ONLY., 0 ` ' •i SPECIAL DELIV �0 11lSURANCEI��ERNAiIONAI to Show address to addressee 7 1 FOR a where delivered I y Ps Form ggoo a0 RECEIPT � I�1 Apr. 1971 - Received file numbered article described below ►-ctrtudTURE OR NAME OF t DDRESSEE (Must ajv.ays be fitted in) ; REGISTERED N� '`.CERTIFIED NO 40 INSUBEP NO•. DATE< DELIVEI it (`• ;ty. �p•w� .-.� ti..��'.{',�•�•�v�v+•-.--..�r'��.. .. .-r.�l^'�- �'"��-.,d.iNtia*'��''�.✓.j��n:iv.,l�i �i.-.'-v'��'l:r�s t'`•J"i^C ����iaUS+tw ��r,.,t�....^,.�ri;"rw^'vti..•,:�ti..--cv�;,:-��'1�•��'r•F''��fi ''("..,...;., r., City of Edmond RIGHT-OF-WAY CONSTRUCTION PERMIT Permit Number. �- 9 1( Issue Date: A. Address or Vicinity of Construction: 1100 12th Avenue N I8B. GTE to place, operate, and maintain a buried service Type of Work (be specific): e 90 19 from 1100 12th Avenue N. then north to a resi ence at 1100 12th Avenue NO. GTE to plow 20 feet, and push nod ed sketch. Marilyn Holmgren, Permit Coordinator R.O.W. Footage 50 feet. C. Contractor: Contact: Dennis Alexander 206/771-9036 mobile 388-1358 MailingAddffik'C Address: Fvar6,tt' W Casi no Road Phone: WA 9R9114-1440 Marilyn 906/71(1-11786 or 488-1628 State License #: 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-Famijy ❑ Single Family ❑ Other 2100-9P001D6 242310 INSPECTOR: INSPECTOR: J L- , . F. Pavement or Concrete Cut: ❑ Yes SNo G. Size of Cut: H. ai-ge� ' r Please see attached. ske c . APPLICANT TO READ AND SIGN 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 of its departments or employees, 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 FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH m IS COMPLETED BY CITY FORCES, AT WHICH TIME 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 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. I have read the above stateme sand understand the permit requirements and thepink copy of the permit will be available on site az l t� r in eetion purposes. Siansture: p�/6% F()R David Soui res, Date: 3/219/97 (6MVr(Wftffl*�.Agent)Sec Mgr -Access Design CALL DIAL -A -DIG _PRIOR TO BEGINNING WORK COMMENTS: DATE: 'R.ECEIPT ;FEE: ISSUED BY:: , -" NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991 z . a ..' to rn - LEGEND POLES O RbAD 80AES OYEAHEAD LINESr- -- 1.0. UTILITY WHOLE C7 UG TRENCHING —UCi-- V The City of Edmonds Side Sewer Drawing EASEMENT NO- ..................... ----------------- NEW CONSTRUCTION 0 REPAIRS F-1 LID NO_ ------------------ - ASMT. NO. .................. OWNER --- ..... ............. CONTRACTOR ---L� _S C-n<. --L --------- PERMIT NO. JOB ADDRESS --- ------------------- LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO Ahw-,-55��-F- --nvt 17 ................................. t-1 ... � r-� -4 � ............................................ ....... ( ............................... NAME OF ADDITION .................................... PWW-0001 - 11/75 (REV. 11/78) ................................................................ By.. ..... ....... CITY OF ,•EDMONDS PUBLIC` WORKS DEPA�1` SIDE SEWER PERMIT FOR INSPECTION CAz,1010 permit TH? 775-2525 Ext. 220 Issue Date PERMIT MUST BE POSTED ON JOB SITE 1. Address of Construction he(*. ?. ;,, 1+` 2. Prope'rty Legal Description (include all easements) AVY4 3. Single Family Residence Multi -Family No. of Units Commercial 4. Owner and/or Builder AIR> 5. Contractor & License No. 6. Invasion into City Right -of -Way: No Yes (If Yes Right-of- way Construction Permit Required - Call Dial Dig (342-5344) before excavation). 7:i` Cross other private property: Yes No Easement required - attach legal description and county easement number. READ THE FOL.LOWI,NG AND SIGN: a. Property owners must obtain a permit to install side sewers on 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% (1.150) and maximum grade of 100% (450). f. No turn in side sewer greater than 45° (1/8 bend) is allowed between cleanout. All 90 turns must be constructed of a 45° (1/8 bend) and wye with removable cap. g. No down spouts, footing drains or floor drains can be connected to side sewer system. 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. DATE: "1 Z t 7 1 Lek ! t I certify that I have read and shall comply with the above E PERMIT FEE: - Cuwj I Z DISAPPROVED By: Date: .0w By: -Date: CONNECTION FEE:b APPROVED By: Date: * PERMIT MUST BE POSTED ON JOB SITE IT rl AQ, 1.k� Ts NI'll VOL, S. iE;ZT 3-e. 00 'TO Q 71 U T14 I 4 o The City of Edmonds y -------•-----•-----------------+ NEW CONSTRUCTION REPAIRS ❑ LID NO ................... ASMT. NO... ....... ........ U OWNER C _ �.. ?..' a �.. '_�:.� CONTRACTOR .. _ .._.._.... y------------ PERMIT NO. �. �� �A'�� _ t LEGAL DESCRIPTION: LOT NO. __.____ ........................ BLOCK NO. �.��) z' __.. JOB ADDRESS _.._... �a�° ct'x`a�................................. ( .................................................. ------------------- .... Privo:c R oac APPLICATION for SIDE SEWER PERMIT EASEMENT NO. ____ NAMEOF ADDITION-------------------------------------------------------------------------------------------------------------------•--- '*-W4tGr Service tv,v%e �Siae. Sewer 4 � P.V.C_> I ! it'. (51 Cu. Pipe. 1� .,gac%- Flow Prevev�rter C 2cieep� I ,t 1 a' o c.o �2'deap) 10- i Zr%spectioh Tee. C �'dee��) 2niine wi-tl� S-E. Co(--. o F House.. I� 6" PV•c- I-catcw0j —Lw-,-tcV- Service Nletev- wy< i jApproved: DATE`:3_?.'�,; -M---.. By 11/75 • CITY OF EDMONDS PUBLIC .WORKS,. DEPA"T FOR INSFECTION CAI • permit T¢a0997 SIDE SEWER PERMIT 775-2525 Ext. 220 Issue Date, PERMIT MUST BE POSTED ON JOB SITE 1. Address of Construction Q �Q� m� (� 1 1. 2. Pr perty Legal D1escription'(include all easements) 1 1 Elri U 1 3. Single Family Residence(/Multi-Family No. of Units 1 Commercial t" w cv K 4. Owner and/or Builderye-e- Ere' �•SC� �1 � 5. Contractor & License No. 6. Invasion into City Right -of -Way: No A_'Yes (If Yes Right -of- , way Construction Permit Required - Call Dial Dig (342-5344) before .� excavation). 1 F' 7. Cross other private property: Yes No Easement required v attach legal description and county easement number. 1 1• a READ THE FOL.LOWI.NG AND SIGN: 1 d a. Property owners must obtain a permit to install side sewers on 1 >4 their property. A licensed side sewer contractor must be employed to 1 construct side sewers in the public right-of-way. 1 w b. The side sewer contractor assumes full reponsibility for each 1 + h installation for one year. I i aC. Commercial establishment requires a minim h (6") 1 side sewer line. O d. Side sewers may not be ins ohs HDIALdWGy inc es (30") 1 u to any structure. _ u` py - "S HOURS 1 e. Side sewer lines must be 1 i, `.a m m � �f 2� 1.150) 1 ' and maximum grade of 100% (450). " g YOU DIG 1 H f. No turn in side sewer grea er ( 0al owed between cleanout. All 90 turns m t n tr cted a 45 ( /•8 1 bend) and wye with removable cap. &4-16w'"n"�'" g. No down spouts, footing dr oorS MtsH�40MYc nnected 1 to side sewer system. OTILITTCOOWINATINGCOUNCIt 1 h. Pea gravel is required for aing wen installing sewer lines 1 through other than granular soil. 1 i. Cleanouts are required at 30"-60" from each plumbing exit line 1 ' and at minimum intervals of 100' along sewer line run. j. Trenches within City right-of-way must be restored to original 1 conditions. Contractors shall be responsible for right-of-way failure 1 due to poor compaction of fill. 1 k.. Side sewer must be left uncovered until inspected and approved 1 by City. 1 1.� Inspection during normal working hours only. Two V) working day tice required. . DATE c,f d I certify that I have read 1 and shall comply with the above g PERMIT FEE: • DISAPPROVED By: Date: By: Date: CONNECTION FEE: APPROVED By: Date: o P * PERMIT MUST BE POSTED ON JOB SITE 1. :I'_ 4.0 1 PUBLIC WORKS DETA1ZI` 04T. CHEM-, IST -�I Zq, Date BU ILI)ING PER"4iT R• eiwrm1"r--r r-ii r- �LCb 1 Z **� A1L nl Address Street Right -of -Way Existing Z S - --REQD-- Access Easerents" Existing ► S' r___r-- REQD Utility Easemmt Existing REQD Lot per Subdivision Plat . Assessor Map Site Plan Checked for Accuracy Underground Wiring Reqd. Check Accuracy of . Legal Description 9 �;�q /7 X Environmentally ; Sensitive Area -H a Envirorcrmtal`Checklist Reqd. Flood Hazard Zone ­ Shoreline - -n Shoreline KmaAemetit Area �--►n Slope, Soil, Vegetation Stream, Creek,*Drainage Basin Existing Zoning � Per Code Amenities Design Board Approval Regd. p ADB # Approval Board of Adjustment Approval Reqd. Review By..•�� Date: Existing idater ► Sain Size Water Main Read. Service Line Reqd. 1�_* � Hydrant Size Existing 0t-- ' Hydrant Regd. Per Fire Code Size Detector Check Meter Reqd. Cross Connection Inspection A .�X) Fire Department Camimts _ Water Meter Charq,,RegQ Review by: --r'-. n���� s�XXXA3C�SXX3iT�3CiLr�X3LXXX9C3S"AMIC XXXXICIrX,. Septic ai c �sitp Approve Date: Septic Tank Permit Reqd. _____ Permit No. Sanitary Sewer Availabilil{�/ Pro J• x DrawingNo. w File No. 1,610 ., Side Sewer AvailabilityyrA? / 99-6f- w Sanitary Sewer Connection Fee Reqd, ocl>G . Revim4 By: �� Date: K. G O 10 D E P A R T M E N 7PERM17T Applicant Fill USE RMIT zoN _ I NUMBER - PPLICATION Inside Heavy Lines — JOB rr�y \ ADDRESS/I1V 0—) /01•� Tl _ �I NAME (OR NAME OF BUSINESS) /�)/t \/ LEGAL LOT -' PLAT NAME ODUDIVVISIO�N✓ PLAT NO. W MAILING ADDRESS 1 llJ El YES El NO , ' ` Q//�/1� �_)1"� • CITY TELEPHONE NUMBER PUBLIC RIGHT OF WAV PER ORDINANC[ NO. e-D&I!`+`tAVI^, `O3 t, 1w& - !J ^74 _ 4&� EXISTING RIGHT OF WAY W , NAME PROPOSED RIGHT OF WAY 1— I•I DEFICIENCY OF RIGHT OF WAY STREET/UTILITY WORK REQUIRED QVE6 INNO N VADDRESS = �� 3 PERMIT FOR WORK IN PUBLIC R/W �V[8 ❑NO Q 3 U., I CITY TELUuEE�rP''HONE NUMBER UNDERGROUND WIRING REQUIRED AVEE .; ONO U CONNECTION TO SANITARY SEWER, - AVEs ❑NO m NAME SEPTIC TANK PERMIT REQUIRED ❑Y[s *NO a SEPTIC TANK -PERMIT NO. O A DR SS/���� Q M C� Y j6 e vfl• J{` l•J fV(' SEE MEMO DATED FCITY TELEPHONE NUMBER '774 REMARKS �aA. o , —4-- 33 U STATE LICENSE NUMBER CITY LICENSE NUMBER CHECKED BY 223 - o I A� - c 0 - Nc. �F1fitpLNOOR'¢ Legal Description of Property (Show Below or Attach Four Copies) METER IZE BUILDING SUPPLY SIZE - r > (� :EEC- W REMARKS F Q z ; O_ F a_ SIGN AREA ENV. REVIEW ADD NO. Ir U ALLOWED PROPOSED COMPLETE EXEMPT In. W SHORELINE 0 J , G REMARKS W W J VARIANCE OR CU PLANNING REVIEW BY DATE YARDS / ' LOT COVERAGE , SIDE REA 9HEIG�1�FRONT NEW RESIDENTIAL EIGAS. -a ElNON-RESIDENTIAL LINE SIGN FIRE ZONE TYPE OF CONSTRUCTION JCODr HT ADD ❑ ❑ DEMOLISH ❑ RETAINING WALL SPECIAL INSPECTOR AREA REQUIRED OCCUPANCY OCCUPANT ❑ ALTER ❑ EXCAVATE FENCE '� OR FILL a ( X FT) ❑ YES ❑ NO GROUP LOAD PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY PRE -MOVE swim .[PAIR ❑ INSP. POOL OF EDMONDS. LOCAL SALES TAX SHOULD BE CODED 31.04. Z NUMO[R OF STORIES NUMBER OF REMARKS F DWELLING Z UNITS W NATUR[ OP WORK TO BE DONE - f llGj�� i W 0 IL � { m W Q O PROPO[[D s[ PLAN CHECK FEE VALUATION FEE mz SIDC E W PLOT PLAN IINOICAT9 BUILDING SETBACKS, a {{I ASUTTING STREETS) BUILDING Q PLUMBING Q • \ „i`�-�`I�V • ` "_ ' O 1 _' ' I MECHANICAL Q • •. FENCE -- y Z N 'ApfUm , on bchoif of his UI her spouse, heirs, assigns and SIGN fNrCtv►rpr b IMl6tn1. ��la>t to indemnify, defend and hold harmless Y. IM My 6f AdMt»ut0•, Washington, Its officials, employees, and RETAINING WALL � �! $$Ot• QLa4'l, aBr ind all Calms for damages of Whatever nature, U I - ,:� lei. -� ttaij i'!+IIY float IhC ISsll;l lll'C UI this ))Crmll. Issll- aWIMMING POOL _ �.._ 1'Y OF EDMONDS qV8 I PUBLIC WORKS DEPARTMENT RIGHT - OF - WAY CONSTRUCTION PERMIT FILE Wit No. Issue Date A. *Address or vicinity pof Consiruction • Permit Issued To: 'I' V ' y'i • Owner: t� 1. : �,a ; E �'. ; • Type of Work to be Done: Name • Work in Connection With: Mailing Address ❑ Sub or Plat ;(] Single Family ❑ Comml. / Ind. ❑ Apt. Condo. City, State, Zip Code • Pavement Cut: ❑ Yes Ei No • Contractor:'y'� Name YrL Mailing Address State License Number City, State, Zip Code. Telephone Number it 1r 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 at. -the job site for inspection purposes at all times. Signature: 6 %L°t' �,s +a f1"^✓". '" Date ' Owner or Agent r yt ,k THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES CALL DIAL - DIG PRIOR TO BEGINNING WORK C. Issued By: _- Time Au' thorized: Void after days Special Conditions: Ammendments: Permit Fee: Security Deposit: Receipt No.: Fund III Fee: Street Cut Dimensions X = * * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * * Eng. Div. December 1978 Ena. Div. December .1978 f (.f//JJ i VSt 806 13 BUILDING DEPAyTMENT Applicant Fill zON I NVMpER ' PERMIT APPLICATION Inside Heavy Lines n^ AOORE55 /I V -� /'�,� [i(J NAME JCR NAME OF BUSINCSS) V II11 .. IWI C LLYES LOT VrLAT NAME SUBDIVISION NO, C y J� MAIJL�I1/NZS ADORES S♦ IO ONO mow/ - y (� ,K yL�1lh:_ L•f • PUBLIC RIGHT OF WAV PER ORDIN(NCENO./ CITY CLEIHONE NUMBER J J s./ EXISTING RIGHT OF \•:AY CL� i NAMEPROPOSED RIGHT OF WAY �•�� I DEFICIENCY OF RIGHT OF NAY > V �I tr vr`-' hl ST REET(UTI LITY WORN REQUIRED OYES ONO W A BRCS$ PEFMIT FOR WORK IN PUBLIC RJW ❑NO V ' Q CITY TELEPHONE NUMBER sbsYES VNDCRCQOUND WIRING REOVIREO YYEs ❑NO ` �A E f_' CONNECTION TO SANITARY 5�\YER AYE$ NO NAME SEPTIC TANK PERMI: HEOUIRCO OYES �No 1 1 n�S�f11 /'1 lO� SEPTIC TANK PERMIT NO. • O r < A OM SS V i ll SkYun)E Vp-• • SEE MEMO DATED Q . C CITY TELEPHONE NUMBER RL'MAR KS F a�J -774 - 4-I 33 ��• 0 0 V LI S NVMB N Clr♦ LIC[NS/. NVMOCR CHECKED BY 223 - o I ILb (0 - N( . r �z t vc }i7A1tRNDORF Legal OBScripliOG of Pl OperIV (Show Below or Attach Four Copies) wIRSN zC BUILDING wPPLY 112E // 111 z REM R S t�fZEy�t!�G RE{,�L�arcR REQD. 0 1,. SIGN AREA EN V. RCVIC\y ADD NO. a PROPOS[O COMPLCT EXEMPT -. N ALLOWED ` . I IV rz SHORELINE W J < REMARKS u W • •r VARIANCE OR CV PLANNING RNICW BY OATS f. i "AR�DSS LOT'COVERAGE FRONT ' SIDE pREA R� O ►'C Y E N[V R[SIDCNTIl.: � GAS\\ LINE FIRE zt). TVrE CF CONtST CJO/C�•7 HEIGHT r• ❑ NOM•R ESI D!: r.TIAI El 1 (SIGN `RUCTgN �- N I�t `� J�s ADD O RETAINING O DEMOLISH SPECIAL u`SiCROR AREA O�U►�I HCY CCCUP2 LOAD �wT WALL �Iq 7 z�` -I --+ •.%. . .ALTER EXCAVATE FCNC[ OR FILL. 1_ x�rrl PL.. CHECKED BY THIS SITE IS LOCA ED IN THE CITY S-1- El OF '_DMONOS. LOCAL SALES TAX SHOULD BE CODED 3/.Od, { RCPAtA ;gsPMOVC PnOL RCMARK3 Z NUMBER OI STORIES " BCR OI l.p� D[CP�1►SAGE FbQ C)RO• (114 D 3 IoWELUNa UNITS I b ` NATURC OF WORK TO SC DONE L IUSULAltCA31 ►DER F1•B. q8 a a s r Ea-,o GorZ N ..� O PLAN CHECK Fee VALUATION ICC -_ -_ I PROPOSCO Vne GO -- %, R��IDC!JCE i _ PLOT PLAN INDIC AST O•U ILDINa SETBACKS, 6O Z 09 _ 1 C ATYING STRCC.SI BU• BUILDING — f •fit' p L� -}� SUP M�/K ReD. PL'JNOIN{:139 - — t O Q O O MECHANICAL .V — - �s - ICPIcc = ''-.• A 6GInl on behalf n( his or her spouse, heirs, assiTru and pF SIGN — r,... '�-• n suc tsars in interest, agrees to indemnify, defend and hold harmlea WALL I — — ip`: J i the City of Edmonds, W shington. its officials. employees. and RETAINING z agents from any and all claims for damages of-hatc-r nature, y — — /Jib DD arising directly or indirectly from the 1 suaere of this permit, Issu- _ a ante of ;his petmi: shall not be deemed to modify, waive or reduce - -- any rcgmrcment of any city ordinance nor limit in any way the -• F' z Ci:ys ability to enforce any ordinance provision. TOTAL AMOUNT DUE `�� - I hereby acknowledge that I have read this applications that the in- I fo:matien given is correct; and that I am the owner, or the duly auth :- "•�;. ized agent of the owner. I agree to comply with city and state laws raga- ATTENTION I APPLICATION APPRIWAL • lating construction; and in doing the work authorized thereby, no person wUlbe employed in Violation of the Labor Code of the State o` Wassington I THIS PERMIT c I lds application is not a pennit -. " relating to Workmen's Com envtior? Insurance. r AUTHORIZES until signed by the Building Official or �+ NOTE: Permit limit One YearlE.eent u1:>wu nuxs and Fiu. ONLY THE his Deputy; and fees are paid, and PER"VITS without conditional use permit, wnich shall be completed in 90 -IRK NOTED receipi is acknowledged in sp:::e pro - days: >IO�'El) IN BUILDINGS shal: be completed in six monthe.) tided, SIG 'ATURC (OWNER ORIAGENTt OATC SI/GNE"D] I.CS.PECTION DEIARTMENT DIRECT (� 1. I /� 1- 1-7, ITV OF i - EDMON DS DATE This Permit O1k to be done on pri►ate property ONLY. 775-2525 +.. Any construction on tt{pltblic domain (curbs, sidewalks. driveways, e marquees, ate.7 Will repuim separate pwmhsion. as - ORIGINAL —Fite YELLOW — Iropl..:or fi ATTENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE PINY" — L>.vn.r GOLD — A,M ar ." UNTIL A_FINAL INSPE17 t1.) PEAS SEEN RINDF_ AND APPROVAL_ OR � � Zk 'Y Pik. G I Yr ✓. :� 5:�..F'�I ;1S?1 �'� i r.�J, :1��� - $ - Asj •�.32 G�� ma c S '- i t`,:',. •"'re-e SA r1 t'�` '` AL`U� r' 7�.:�.'Y ! 7 FV',' rl-. G ,"t, - �''-r. ..t- .., 7' e • ��{ J • ! P � F3.1 Ti�'� �„?''c t jr1V��Tl-i�•'•' '� ���ic��l � • r !• , . ittit SPtCTi4NS UNDATh" "ri -- " i ;rn- j;• " 'r^v Houma ,r:r,.i ...._---= - ' • ~-,i.;.�,;5. Reim;-Ilc! W1•it` tislEn:4Si Sys*. EM O , ;E .fit fl�tAL ' r A' c r Ir rr Sd`.4v y°1Ts FyT-I I JUILDING DiipARTilENT !'ERMI'f 4UKBE R ;� rl �6v6S 2 • ;; Ii�sescTCK - DATE INSPECTION ��o I-1ci HMIs-,VA7 •i _4 li ± 1 If 1 9 � 1 1 i ' 1 1� c � �I 1 I Sticet It'SPi:CTIOt! REPORT OF EDMONDS CITY p '•r ;•� 1100 YRoJ'r:i r }: VN_ TER ADDRESS -- : DESCRIPTION •1. .t,5 �-�1�4 FjU It.01 t.lC� -fj$ Svc ti . TANL�I E I •.N �Tryy.W • i '30,MA./ I�j patvt.\ OtZ ij" QAZVM �pv:yG; .0t4 - a • Phi 0 .;p qi Qj X )41 17 011 --A LEGAL DESCRIPTION: THE SOUTH HALF OF WEST HALF OF TRACT 27 PUGET SOUND MACHINERY DEPOT, FIVE ACRE TRACTS, ACCORDING TO PLAT THEROF RECORDED IN VOL. 5 OF PLATS, PAGE 47, RECORDS OF SNOHOMISH COUNTY, WA.; EXCEPT WEST 80.00' THEROF & EAST 132.00' THEREOF; SUBJECT TO EASEMENT FOR INGRESS, EGRESS & UTILITIES OVER SOUTH 15' OF ABOVE DESCRIBED PORTION OF SAID TRACT 27; SITUATED IN SNOHOMISH COUNTY, WA. PROPERTY ADDRESS: 1100 12T" AVENUE NORTH, EDMONDS, 98026 Recev AN24 ': PERMIT COUNTER eX!�frrl�r� Pam= Tt+Ru eon a "It I I I � O I 7 I l f1M CM W NOTE .� 'M — NI=vA WAL.V> FI u,14 -r�t �GA � 2� 3 6 - - 00 _X►�nn►�r �x� P FP E. NF-W INTr-pIof<_ - Fj5Ac lE E-11,V ►Nbr VJAI-I-t, (NON-eC-APq r) h F-A T L� EKl�it'6t. P I 4 X IZ Y�-ANy r------- EXI'�/ni:�T-7 1 I �ikIRS 0 7��\t =1REP�Ac.E AeART}}- \ \ bo (2'" pt'►-e__ N PRESTIGE BUILDERS I NCORPORATED 18427 88th Avenue W. • Edmonds, WA 98026 • (425) 774-7971 • Lic #PRESTB1024MA September 15, 2004 City of Edmonds Development Services Department Building Division RE: BLACKHAM PLUMBING APPROVAL PLUMBING PERMIT # 2004-0705 Dear Building Official: RECEIVED SEP 16.2004 PERMIT COUNTER When our rough -in plumbing was inspected and passed on 8-26-04, Mike Snook informed us that we would need a separate note of approval from your department regarding our use of "Studder" vents for two of our kitchen sinks. This letter is our request for such approval. I have attached a copy of our kitchen plans for reference (building permit #2004-0579). As you can see, there are three sinks in our kitchen project with sink #1 being the primary sink. Sinks #2 & 3 are prep sinks which will be used less frequently. # 1 is vented conventionally through the existing vent system through the roof. We are proposing the use of the Studder vents on #2 because it is an island sink and on #3 because it would require opening finished walls and ceilings upstairs in order to penetrate the roof. Would you please approve the use of these vents? I expect to request our framing inspection for 9/20/04 and would like to have your approval to show the inspector. Thank you for your prompt attention to this request! Sincerely, Michael A. Powers President, PRESTIGE BUILDERS, INC. (;ems o"26� -- 765= ao01 Rv ti •>.�....�.�:.�,�.-�• ►QED JUN 14 2004 f PBMIT COUNTER 010. N. Tr' �0.1lit � � I J 1 !1 1 I. vur'ed- p i liT. pROfb'W—D 4-z 10 • - - - ... AWIVON oN HAW I' FLOOR -* NO 0-AA-n16E I TD t�rltwlNw�k- , �, 'I t 1 11nn i shoulder of ROW ire driveway approx h 10' and set carson bury CAN service 10012 Ave N. N W E Comcast of Edmonds, Inc. APPROVED AS NOTE® 1525 75th Street SW BY ENGI EERING S Suite 200 �r Everett, WA 98203 NORTH NOT TO Contact: Kermit Benson 425-263-5362 SCALE North Drop ®ate: Node: EM13A Address - City of Edmonds Work Details Open trench in shoulder of ROW approx 95 feet (m/1), bore driveway approx 20 feet (m/I) open trench approx 10 ft and set carson to extend and bury CATV service drop to 1100 12th Ave N. Install cable at 36" depth"' All disturbed areas will be restored to existing 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 existing 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. -- Comcasts PROJECT'S TIMELINE AND PROPOSED HOURS OF OPERATION: • Timeline - Up to 30-days past the issue date. �rpm Work Hours -The entire project area will be conducted from 7:00 AM to or as specified by the,Inspector. S Av- lCam - b fY i. NOSc)Acz-4y- No a Traffic Control Plans 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. 3. All contractors will avoid parking on sidewalks and shoulders and will take the lane and follow the proper traffic control set-up for the given situation. 4. Pedestrian access shall be maintained through or detoured around all work sites. S A F64 r • 5. Please find attached the traffic control plans for the various types of work sites that will be encountered during our project. 6. Flaggers will be used only when all other methods of traffic control are inadequate to warn and direct drivers. Only licensed flaggers will be used on the project. 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. and the Inspector. Erosion C6ii&6 Rules 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 gutter upstream of the catchbasin. Traffic control set-up for minor encroachment ((eumtdo M FLAG( Traffic control set-up for lane closure Depth, Cleaning, Containment, Compaction, and Restoration Depth = ♦ 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. �a �, �..} -.., .r„,'�- w t�„-JLr•., i,:u-� _ �', ,•2�r.. ,zm„^�bl.: RIGHT -OF - City of Edmonds 'AY CONSTRUCTION PERMIT A. Address or Vicinity of Co "t ti B,Type of Work (be specific): C. Contractor: Mailing Address: 1 •� a. Vt,(erb State License #: l City Business License #: v1 r -� �-- t: Sly 3 - r2 D. Building Permit # (if applicable): E. ❑ Commercial ❑ Subdivision ❑ Multi -Family ❑ Single Family INSPECTOR: Phone Liability Insurance: Side Sewer Permit # (if applicable): ❑ City Project [UC (PUD, VERIZON, PSE(COMC ,T,�OVWSD) ❑ Other F. PAVEMENT CUT: ❑ YES ;[-]NO G. SIZE OF CUT X CONCRETE CUT: ❑ YES ❑<NO G. )!� Mail Approved Permit' ❑ Call for Pickup 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 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 ofgranting 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 M KE THE P K COPY OF E PERMIT AV LABLE ON SITE AT ALL TIMES FOR I PE TIONS Signature: Date: 46 Z2 Ma �l (Contractor or Agent) FOR -'CITY USE''ONLY �� « Approved by: Rlght of way Fee '/( /: c`� f AW - , _ � �.... .. � N,......._...... M -.. ...y..., ..1 - - -:-y '� .�.. ..°•'.� �- s *'. � ; w y. � : ;+�a � - �a v-- - � :aSv?`P'il�.'zs.h Time Authorized: °old.After / /'�..C�6' Disruption, Fee%Fund Special Conditions:, =_6 Ty AJKJr--A�niZ i3x i E& Inspection Fee n10 - Receipt No AtsiDFr r-t. C,Atl ►:t- 1z tc4-.�r S, rr`"(a/r,i�'Isuedby pR,o2 g_tu,���,o�.,�rin y U,c2►F�E Cc "A2 obe k N 5 T i=_e- i-i (/ 1-4 REQUIRED INSPECTIONS Call 425-771-0220, Ext. 1326 for a 24-hour voi ce -recorded inspection request line. FINAL APPROVAL OF PERMITTED WORK: L//C O DATE: Inspector's 1 WORK SHAI.L BEGIN PRIOR 1 PERMIT C:\Documents and Settings\CurtisNy Documents\Forms\Engnrng\ROWpermit_ doc Revised 10/01/03