16211 70TH PL W.PDFIIIIIIIIIIII
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16211 70TH PL W
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City of Edmonds .•
RIGHT-OF-WAY CONSTRUCTION
PERMIT nn
• Permit Number. T
;• Issue Date:
A. Address or Vicinity of Construction: 16211 70th Place W.
GTE to lace operate, and maintain a buried service
f B. Type of Work (be specific): wi re from existing edeetal 03208 located at 16215 .
h c. 1$9 . 70th Place W. then west to a residence at 1b ace o p ory 0 feet,
push 1 driveway and push nd road:, R.O.W..Footage 100 feet.
Marilyn Holmgren,.Permit Coordinator , '
C. Contractor: GTE Northwest lncor ore,ted` Contact: Dennis Alexander 206/771-9036 mobile 388-1358
Casino -Road
Mailing Address: Everett, WA 98204-1440 Phone: Marilyn 425/710-0786 or 425/488-1628
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable):
I E. ❑ Commercial ❑ Subdivision
❑ Multi -Family ❑ Single Family
INSPECTOR:
Side Sewer Permit .# (if applicable):
❑ City Project ® Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Other
2450=9PO01DB 642310
F. Pavement or Concrete Cut : ❑ Yes f U No G. Size of Cut:u-' x He Charge
Pl se see attached sketch.
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands pnd by his signature to this application 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.
6THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPT,4VCE 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 FOOSSUANCE TO THE APPLICANT
Two sets of construction drawings 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. -
AIl street cut trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read th a tove s t then and understand the permit requirements and the pink copy of the permit will be
available`on , t allinspec ' urposes.
Signature: David Squires Date: Z
tractor or Agent) Sec. Mgr, -Access Design
CAL DIAL -A -DIG PRIOR TO BEGINNING WORK
shy,,, ,`--, ITY USE ONLY
APPROVED BY Kw RIGHT OF WAY FEE:
TIME AUTHORIZED: VOID AFTER ZO DAYS DISRUPTION FEEIFUND I 1 L•
SPECIAL CONDITIONS: NA.. _ RESTORATION FEE:
0.00
T OTAL FEE:
RECEIPT NO.:
ISSUED BY: �^
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
I;o
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: Date:
FINAL APPROVAL BY: Date:
LEGEND
PERMIT SUBMITTED BY
GTE
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116.211
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
R F c " ^PERMIT �1
Permit Number.
0 C T 3 1 1996 Wue Date:
ENGINEERING
A. Address or Vicinity of Construction: 16211 70 Pl B (9701690)
18
9 p B. Type of Work (be specific):,, Install Service
- 1 9 .
C. Contractor: VashiugtOu Natural Gas Contact: !larlamne Kingsbury
Mailing Address: 1122 75 ' St SW Everett Phone: 356-7500 X7596
State License #: 98203 Liability Insurance: Bond: $ A
D. Building Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision
❑ Multi -Family ❑ Single Family
INSPECTOR: k.,_
F. Pavement or Concrete Cut : ❑ Yes F]No
Side Sewer Permit # (if applicable):
❑ City Project P Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Other
INSPECTOR:
G. Size of Cut: z H. Charge $
APPLICANT TO READ AN !I
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 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.
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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 statements and understand the permit requirements and the pink copy of the permit will be
available on site at all times for inspeet'o purposes.
Signature: � Date: 10-24-96
1 / ontraet r or Age , )
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
-FOR CITY USE ONLY
APPROVED BY: Rw - RIGHT OF WAY DEPOSIT:
TIME AUTHORIZED: VOID AFTER 1 1 F-A '4- DAYS DISRUPTION FEE/FUND I It:
SPECIAL•CONDITIONS: NA - RESTORATION FEE-, - .--
PERMIT FEE:
TOTAL FEE: ' 00
COMMENTS: RECEIPT FEE:
DATE: ISSUED BY.
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
ft
FIELD INSPECTION NOTES
Comments
Diagram;
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
❑ YES
Date:
Date:
❑ NO
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Watermain depth
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Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596
16
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Job 01(03v
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Key:
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Water
Gas
Sever
Water hydrant
Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett. Washington 98203, (206) 355-3331
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STREET FILE
CITY of EDMONDS --- PUBLIC WORKS DEPARTMENT
Routing of Building Permit Applications
Proposed Property Address of Application: 16211 - 70 th Place W.
DEPARTMENT
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COMMENTS
DATE
WATER
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STREET
SEWER"
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BUILDING - r.
DEPARTMENT COMMENTS
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RECEIVED
USE
PERMIT `
BUILDING DEPARTMENT
Applicant Fill
ZDNE.
NUMBER
SEP 2 3 1976
PERMIT APPLICATION
inside Heavy Lines
JOB
ADDRESS
NAME (OR NAME OF BUSINESS) -
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❑YES ❑ NO
MAILING ADDRESS•
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VARIANCE OR
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CITY TELEPHONE: NUMBER
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REQUIREMENTS
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TELEPHONE NUMBER
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NAME
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ADDRESS
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COMP: PLAN ST. R/W
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REMARKS
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CITY
TELEPHONE NUMBER
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
CHECKED BY
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Leggy Description of Property (Show Below
or Attach.Four Copies)
STREET AND/OR UTILITY ❑ YES
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WORK. R-EQ'D
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UNDERGROUND
❑ YES
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TYPE CONNECTION
VERIFIED BY
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❑ YES PERMIT
NUMBER
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SEPTIC SYSTEM
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METER.SIZE
SIZE .CLEA.RANCE
CHECKED BY
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REMARKS,
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RESIDENTIAL
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LINE
FIRE ZONE
TYPE OF CONSTRUCTION CODE
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NON-RESIDENTIAL
SIGN
❑ ADD
❑ DEMOLISH. RETAINING •
SPECIAL INSPECTOR
REQUIRED
AREA
OCCUPANCY
GROUP.
OC.0 V'PANT
LOAD
WALL
❑ ALTER ❑ EXCAVATE FENCE
OR FILL 1 X FT1
❑ YES ❑ NO
PLAN
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CHECKED BY
THIS SITE IS LOCATED IN THE CITY
REPAIR a INSP. POOL
SHOULD. BE CODEDCAL SALES TAX
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REMARKS
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NUMBER OF STORIES
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NUMBER• OF
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DWELLING
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NATURE OF WORK TO BE DONE
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VALUATION
FEE
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PLAN CHECK
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PLOT PLAN INDICATE BUILDING SETBACKS,
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BUILDING
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PLUMBING
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HEAT& GAS LINE
FENCE
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STREET FILE
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fl f'0 TO:. I►arry ►lhitcutt
Buildinn Official
FROM: Richard H. Allen
Assistant City Fnnineor
SUBJECT: BUILDING PERMIT APPLICATION FOR 16211. Oth P1 ., The Pldg
Co.
After review of the sub,irct huilelino nermit anplication, �!,p have the fol
1 ow'i nq commen is
1) Connection to sanitary sewer required.
2) Underground wiring required.
3) Lot drainage to he contained on site or diverted to City
storm system.
4) Right-of-way Invasion Permit required for driveway and
curb cut.
WJN : RllA : mj r
DATE Z PERMIT ADDRESS �(,i' v,Q PL
t LEGAL DESCP.I N a -
BUILDING PERMIT REVIEW - ENG,INEERING DEPARTMENT CHECK LIST
Instruction:
Check Accuracy of Legal Description
Check Against Assessor's Map for Legal Subdivision
Does it conform to City Approved Subdivision?
Reviewer's
Initials
1. This lot included in Subdivision/ lat U.MN
2. .Site Inspection made on:
3. What are groundwater and soil conditions? m
4. Site Drainage Checked?
5. Storm Sewer Availability: sht-_2LOf ►wq. No.�&Project
Roadside Ditch f,I
6. Grading & Final Contours: 4&tl
7. Septic Tank System Design Approved: Arm
8. Sanitary Sewer Availability ht. of Dwq. No Project
Side sewer availability:
9. Sanitary Sewer Connection Fees?
10. 11ater Mains & Fire Hydrants (Indicate Size Main) �� r
Check Fire Dept.'s Comments
11. Sidewalks: (Site inspection shows conditions of sidewalks as follows)_
12. Curbs: r Curb Cuts/Driveways (Check driveways for safety, lncation,
grade and width):
13. Underground Hiring: Street Lights: �.
14. Street Right-of-way & Bldg. setbacks:ow , Sht. of rfficial Street Map.
15. Existing Utility Easements?
16. Access Easements:
17. Site Plan checked
18. Special Requirements listed in Memo to Bldg. Dept. „ N1.0"
19. Commercial & Apt. Requirements form completed? •
20. Drawings stamped & notations made?
21. All Items filled in on Bldg. Permit Application? 2
22. Bonds posted for site work?
23. Right-of-way Invasion Permit require
COMMENTS:
Rev. 7/1/76