1219 CORONADO PL S.PDF11111111111111
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1219 CORONADO
PL S
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER: nt-) t p 22 Db v z Duob
BUILDING PERMIT (NEW STRUCTURE): l t am 6J!�
COVENANTS(RECORDED)FOR:
CRITICAL AREAS :tl/ DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DA
SEWER LID FEE $: LID #:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S)
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
Vj
LOT: I - BLOCK: A
LATEMM13ST's\Forms\Street File Checklist.doc
The City of Edmonds Side Sewer Drawing EASEMENT NO- --------------------------------------------
700-07900 NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO_ ------------------ _ASMT. NO. ..........
OWNER ...... WILMER DELONG .. CONTRACTOR---------------------•----------------•--•------------------------------------------ PERMIT NO. .
JOB ADDRESS ---- 1219...CORQNAPO- PL----------------------------------- LEGAL DESCRIPTION: LOT NO. -------------------------------------- BLOCK NO.------------------------------------
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
NAMEOF ADDITION-----------------------------------------------------------------------------------------------------------------------
N
DYE TESTED ON SEWER
Approved:
PWW-0001-11175 (REV.11178) DATE -------------------------------------------- By............................................................
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2 /kn•� '' � � , f e t Y�� �Z y�
N fc^y
AW
t,hc�;� TIAN BUILDING PERMIT G pppl..No1
Permit limi4. one' year: r "r : �•
C&AOF,••EDMONDS" Be_'ading Depc"mt
CATION is.hereby made for a permit to construct the fuilowing work, in•accofdance with the acoom '.
ymg.Plaits' and speafications. Two sets ar: submitted herewith for approval MVx
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pea ✓ alters/•
P-
�• ..._.._.._............__._.._..._.____._. __..- arking
W ork- addn repair _.._..__...._. p
a p ....._. Const. type......_......_.._._....... Use zoneFire %on&
.....__.1 '--� _
. r'`?za-o_ 5 •Lot L_..._
7�?.:. . '/_._.... Arta ..- -- _ _ __. _ __._. Scptic tank. wf a;
•;r
frontage..... •- - ,
' 1. side .... J� _.
Bldg., set backs —front .._ _ rv-•--•-•-. r. side _._._ rf--_.......-.._y....._�reaz....-.. `
No..............
Owner [ •__.._ Ir ._...._ __i,� .ii'.:
bo �, ✓ Tel. No.yq
Tel: _
. Address.._.___--_-_----= -
'Plans by.._.._._......_....._.._.._.__._._._.�_..�. '�• ,
Rcmazka.._.._..............
_._............ _..... .._
laws
a. rct statement, and T agree to comply with all applicable Codes and. State
The above L a •-
; work.
,, C Zc c i .Address.
Signed Owner/Agent_.-_(l�-ail.._ r
..,,
sub ed to the above conditions, and to oompJim= with tine ap•,
PERMIT for the above work is hcreby approved, J notations Charon
proved plans and speacations, and Building Department
D D ' ✓ '�..• i ; r
22 t
Permit fee__..sY� Rood. by__..
Valuation ..._..__. _..............
--.- -,-
/.'!: �/ Date__— ` .�•=_S �bb�1
Building Deparanent, By..._......... _.L' .._---...._............... f;
INSPECTION RECORD
Final, OK.
Fdn, OK - .--_--_...... Frame, OK
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This Permit doe :lot cover Plumbing, Sewer or Ekmical i+urallatioiss. :'ii;
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y, `4�e} 4y�+Y:�TW r7'"jN�^; i.' ('L`:�� %'±►,7� K° �q� ti:t.q :.-���i l' - .. .,. >t�•.:•�
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City of Fdmoli -
RIGHT-OF-WAY CONSTRUCTION
PERMIT
^; ,� Permit Number:
to Issue Date: - C/
ylc=i
A. Address or Vicinity of Construction: -5ee
1 O B. Type of Work (be specific): PVC C'1� mP : �1-
8g0.1.99
C. 'Contractor: W (a -ah • Co. Contact:
Mailing Address:; 8t -Me r u, r St . Z, Phone:. 7-Z4 - 22 -7 R
State License #: q C' t Liability Insurance: Bond- $
D. Building Permit it (if applicable): Side Sewer Permit It (if applicable):
E. ' ❑ Commercial ❑ Subdivision ❑ City Project [A Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR: W4.
F. Pavement or Concrete Cut: 05-1� []No G. Size of Cut: _;Z1 x �l _ H. Charge $
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmles9 firom injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the City 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 MA7ERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPECITON
AND ACCEPTANCE OF 771E WORK. ES77MATED RESTORA77ON 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 Departmen
t :-
Work is to be inspected during progress and at completion. 771-6220
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: Date:
(Contractor or Agent)
CALL DIAL -A -DIG. PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: W� t�t� RIGHT OF WAY DEPOSIT:
TIME AUTHORIZED: VOID AFTER . 061 154- DAYS DISRUPTION FEEIFUND. I.I.i:,.
SPECIAL CONDITIONS:::::. �I-R- _. PE r r1. _ V il/� _ .. RESTORATION FEE. .
• • i
DATE: ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
T:---,- T:.. 1601
NEOERVICE PRE -INSPECTION REORT
WNG 836.8 S 11 /�) '%
SffAVICE ADDRESS
DATE GAS rEQUIRED
I
EX. STUB
LOC.
NO. EX, STUB
FOOTAGE REQUIRED
CONDITIONS
METHOD
STUB
CONC
PS
PUNCH INSERT W/CU OR ST
SOD
DIRT
OPEN TRENCH
EX. SERV
INSERT W/CU
W/ST
NO. EX. SERV
FOOTAGE REQUIRED
TWIN
I J
Q F Fri:
SERVICE
CONDITIONS
METHOD
CONC
SOD
DIRT
PUNCH INSERT
ROCKERY
GARDEN
PLOW OPEN TRENCH
D-a CALLED FOR LOC. OKO
EXCESS OF 3' RULE (RES)
METER
CHANGE MSA LOC.
CUST. VERIFIED MSA CHANGE
S ETC.
SALES NOTIFIED OF MSA CHANGE
EXCESS WAIVED
BACKHOE
BOARD & IRONS EXTRA CONES
EQUIP,
NO PARK BARRICADES
METER HOODS
BORE MACHINE
PLOW
SOD CUTTER
COPPER PULLING EQUIPMENT
REMARKS & SKETCH:
J`i
L
J
it
PRE -INSPECTION BY
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DATE _
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