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16321 70TH PL W
1
• : CITY OF EDMONDS •
ENGINEERING DEPARTMENT
APPLICATION FOR RIGHT-OF-141AY CONSTRUCTION PERMIT
STREETFILE (AvrZicant to Cam-olete A d B and Submit in DuoZicate)
A. Permit to be issued to: (nM_Sd2 CC) hl.,i 7R c D
For work at: (address or vicinity) % 6S.R1 - 7p-14'
Type of work to be done: C� u���,?� 64
(Attach Drawing 1%'hen Applicable)
Time Required -- Start:
Owner: 73pMlgR e-a.VsTR. e-o -
Name
20--- , 302d -
Mailing Address
City State
Contractor: S sgf�F-
Name
Mailing Address
City
7 Finish:
778- 93?3
Telephone Number
Z 23-o/- t90 -1-7,y - Rt=
State License.Number
7*- Z36 8q
State Telephone Number
B. 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 description whatsoever, foreseen or unforeseen, that may be made against
the applicant or 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,.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 Department.
Vork subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by the Engineering Department-:
Call 775-2525.
Signature: .3 .7
Owrre'r or Age • Date Signed
C, DO NOT WRITE BELOW THIS L I N (To be completed by Issuing Agency)
Permit Issued (Date) e 3 4 '7'7
Fee: /2 • 5-0
Time Authorized: 3 O
Permit Number - 7 % �`ZS
Bond: /V /.4
JNEER'S APPROVAL
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PUBJUC ri M.01-
LiS'I /� P�3 ell -I OTB
?L V) 05 1nL/5 7-1
Street Right-of-Iv,'av Existing
Rl -:0 1)
Access Fascinents
unn
utility Easoulclit Yxi-tilln
I)
Lot Per Subdivision
Plat
Assessor ":an
c� Site Plxi Omcl for Accura
151dCr'("rCllnj Nend.
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li 1"Ovie",7 by
!"!"lin Size e-7
"nin Poqui-ed
Si.zC! Existi.'-If
livOralit 1"emli red rNer h
T.Ictector Clied, �;'Ctcr Required
II
Scptic Taal: )esi!,,n Ap,,)roved
liSeptic Tali'll Permit Reallircd
:)aiiit.in, Ile-:er Availabilit
Date
!1(,.ITlit 'To.
"To
..o. r
Ij Sj-(!c Sm-.7cr
Sanitan., Serer Comoction Fee
P("ViCl-! by Pate
t
Reolli.rn(l R)('11 I)-tdi
(.'Iilvcl,t P.eq"lired Si.zcr �j
Cm
i- C;ltdl i"'Isin Renuired V, iIndcate on rite Plan
' '- *
IYV "; In on In %ccde
Nanhoic ru;uired Indicate on Si.tc 111m1
Soil Co;iclitions 'I ('round ll';zjter Yichl Checl.odl
T)
ram,
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BUILDING DEPARTMENT Applicant Fill
;HERMIT APPLICATION Inside Heavy Lin
NAME (OR NAME OF BUSINESS)
tl(')f`-1 a2 c vl.fs Tr?. c o
W MAILING ADDRESS
Z
3 'P . o - .11X 309
0 CITY TELEPHONE NUMBER
LV1✓iJL,)Uor) 778_ c�3?3
NAME
U
F ADDRESS i
2
U
E CITY TELEPHONE NUMBER
a C ✓�- P' E TT, 3,65 3 2 ov
NAME
Ir R'p>; lS CoNo iJE T Z
0 ADDRESS
lu C(�¢ - E� vls rA Pc -
It CITY TELEPHONE NUMBER
I-
0 GDr /oNos 778- c-3c?3
U STATE LICENSE NUMBER CITY LICENSE NUMBER
zz3-of - !30-t`//9-2C--.2.3G 6
Legal Description of Property (Show Below or Attach Four Copies)
//�%— /- IAJcc•fKiT1JT .),-it.
Line
\�,�/ PERMIT
\ NUMBER
FALLOWED
PLANNING DEPT. APPROVAL
OYES ❑NO
DATE
STREET R/W
EXISTING STREET R/W J FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W 50 FT. 0 FT.
REMARKS Driveway slope not to exceed those
indicated on STandard Drawing #103,
CHECKED BY
STREET AND/OR UTILITY WORK
R/W PERMIT REQUIRED
REQ'D. ElYES
�NO
QYES ❑ NO
UNDERGROUND
WIRING REQ'D.
NO
TYPE CONNECTION
YES
VERIFI D BY
SANITARY SEWER
❑ NO
SEPTIC SYSTEM
❑ YES'
PERMIT NUMBER
APPVD BY CITY ENG.
r
NO M
REMARKS
110
REMARKS
NEW RESIDENTIAL GAS LINE FIRE ZONE TYPE OF CONSTRUCTION JCOrE
❑
❑
❑ NON-RESIDENTIAL
ADD
DEMOLISH
ALTER ❑ ORCFILLTE
❑
❑
❑
SIGN
RETAINING
WALL
(ENCE X—FT)
SPECIAL INSPECTOI
REQUIRED
PLAN
CHECKED BY
REPAIR ❑
PRE -MOVE
swim
REMARKS
NUMBER OF STORIES
NUMBER OF -
DWELLING
UNITS
J
1
NATURE OF WORK TO BE DONE
PLAN CHECK
NO.
LAN INDICATE BUILDING SETBACKS,
ABUTTING STREETS) BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
A (OCCUPANCY (OCCUPANT
GROUP LOAD
OF EDMONDS. LOCAL SALES TAX
VALUATION 'I FEE
r
APPLICATION
The City of Edmonds for EASEMENT NO . ............................................
SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS ❑ LID NO_ __________________ _ASMT. NO...................
OWNER-----��M?_._._-.-�sJtVSTR�ICT 1p�y_. CONTRACTOR ...??Vss �HN�N-------------------•-- PERMIT NO. 55�G�
JOB ADDRESS ..13ZIp�' `. P�--C-__\ls. LEGAL DESCRIPTION: LOT NO____________________________________ BLOCK NO. ......... _--------------- .____-____.
TMDc�NT I,,/lE=W
M . -,.-
a,-
. y y c9
Approved:
DATED-✓ ...............• BY ...... ----------- y
11
�/ rw�pwi -�,mp9 �• 'yewad.4nF +"r"'^'^`1�^Wi •rv.y ---- •'•.ars4tr' 4. .. ,_.•--.-: -'.
t. F ; , �M �� -NODS S�IIDaEE. SiEWER ;PERMIT
ITY O F E
.0 u -
.
PERMIT ATER^SEWERDEPARTMENT' r .
855 !I
ET1•
tir r
1 L •
a Call 776;2624 for side sewer Inspectlona BEE( P covering °any portion of the construction'!
1`
i-i• t r ;� ,�-'•,(.Inapectioh.w,ll.'be•'provided•within 24-hours..after requst NO f8atSun.,aor holiday inspections / -
+"ADDRE5SLLOCATIONr OF CONSTRUCTION ....... .
�PRUPrERTI".LEGA�I.:DESCRIPTIUN ;:••`-'`r •t-
... ". .......................... ........... ............
.....................................
BUILDER...
OWN'ER-AND/UR �'�`
r �� � - -......
C +^ ...
t ,
iGNTI
Y � ',ShNs�E &ADDRESS.......-.
fission Isagrantefl', , 19�!�, for'repair+and/or;connection of a side sewer to the eity,saiiitary sewer
,T s�stem�in accordance withi(City of=Edmonds ordirnances
` dTTENTION rI3 iCA�LLED1TOl THE;FOLLOW,ING k
b a1Fi''a - ermit • to, construct sewer insides propertydine. A'licenaed+,-Side: Sewer :Contraetor must be employedrtto construct
" t;of-dhe,- roperty;.may, o t P fed. -
NOTEf No„; 1'=The"ownera P
tir, !;•side sewee�inist reeL�area Do not: cover any portion of sewer before ithasnbeen. inspec
`- NOTE'�No:•.2=A11 work4erformed'�in-city>right-of;way,requires, an•Invasion%:of Right-of-WaY-Pei is die sewers utgethe Cpermitgineer's.office
i, x - governing ' - - -•�
fulk�lnforniatio❑regarding-,Ordinance. 1 i.18.030 and'. Regulations+
NOTF.tNo 4-Top,-of'�aidetisewer -:must-'hage'at_ least 30 inches• coverage 'at' Property -line "and. 12tlnchea ;insider property,']ine; .minimum'r,grade loP 2% No _bends+ in; grade
• ;sharper9tha.n,'s will' be; permitted.. . .
t; .. +
*, N01'E�'No,+S--Trenchesrinislreet muat'be_�water-aettled'and surface•of street restored-tooriginal?.condltlon. :Contra.etors ahalhbe responsible for'fallure�iduet,Co(;improper°
'work- which' may .develop within��one� year •of' completion,. f
,tt�•?NOTD;'No 6--It-Is-unlawful to•ralter or'•do..anY`'other work,than' is provided for-in.'the-permit..or.'to do any work on-the•maiit sewer or its appurtenatices except to' in-r
-.sertrthe"pipg into,*:the; wyc '
;]DISAPPROMED' iol Date -i By ...... D Date By
`A�PPROVEDr, Datec.✓�/ '.... '�.... By. I/ ._. ... .. ..• r ; e
`�'• 4 -� e i'. • !/ ..... ...... ... ,.'fit
Remarks
..
i .. _
...-. .
f i
eg P itt pies 1bI r ST Be •Signed;By Ownel of Firm Perfol7rting; Constructlorit'PRIOR' To Request. For Inspection: f
ation :coristtwtcted under,,this' permit.
1�11 `f� hereby certifyf that. he side sewer In tat
14
.... ..-.
O ner ,of�ontractin .F Pertcrming, Constructiom),
;ter was�inst �d',m accorda ce`•wi alT governing 'ordinances of .the ..City, of; Edmonds
/ da o4., ......
Dated this....... Y
Y
❑ Gas ,❑ Telephone ❑, Po��, r :❑ ; Sewer ,7 ! Other 1❑t Alt f
r J "J, he BEFORE yowdig for f.'Vater 't
1 `. t. �. .. .-_f x ,-:.. __t.____. , -G'; .a. tn,r� +'i rl - { .t > .+. t'�•p ���f�na•1 ar ..e._...;.
so
0
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION U2--- REPAIRS ❑
EASEMENT NO- --------------------------------------------
LID NO . .................. AsmT. NO . ..................
-7 -:- .7
OWNER ------- ------------------------
CONTRACTOR
.......... .......... PERMIT NO.
-
JOB ADDRESS --------..........
—
d 461� --
7 ........
LEGAL DESCRIPTION: LOT NO.
--------_I...._________-__._..._.._ BLOCK NO. ....................................
....................................................... 1 -------------------------------------------------------------------- ------------------ .................
NAME OF ADDITION ....... 1))e. 4 � �. 7 ........... e.
DATE............................................ By ................ I I ..........