16323 71ST PL W.PDF111111111111
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16323 71 ST PL W
APPLICATION
The City of Edmonds "` .��,. for EASEMENT NO. ----•-----------------------•--------------
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS ❑ LID NO- ------------------ ASMT. NO. --_.--_--------_
OWNER - I �- .Mll C-�_Q � t�1.WL1Y CONTRACTOR --- R 1SS Nr�l dl�l----•------- PERMIT NO.
JOB ADDRESS ---t ------------------ LEGAL DESCRIPTION: LOT NO- ------------ 8-------------------- BLOCK NO. _---------------------------- -----
NAME OF ADDITION---------1�/E sTMQTlI-E=W--t--- l--- --
--- ; 1
proved: /7
B- '1---------•--
11/75
0
APPLICATION for
The City of Edmonds "`T FILE SIDE SEWER PERMIT EASEMENT NO_ --------------------------------------------
NEW CONSTRUCTION mil., REPAIRS 0 LID NO_ ------------------ - ASMT. NO. ------------------
OWNER --�--/4(./-) ---- -- ------ ------- CONTRACTOR -
PERMIT NO. - -----------------
JOB ADDRESS A-e---32-3 -------- -- -------------- ---,-.7 ---------------- LEGAL DESCRIPTION: LOT NO . ......... 91 ------------------------ BLOCK NO.------------------------------------
............................... .............................................................. .......... -------------------------------------
--- 46-
NAME OF ADDITION ��L.•�'�J!% ----------------
DATE-------------------------------------------- By --------------------------------------------------- fi7yg
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CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT, ENGINEERING, DIVISION
S T T F�r 0
WA LICATION FOR RIGHT-OF-I4AY cnNSTRIICTION PFRMIT
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
A Permit to be issued to: Yp E'n=ovrS✓ co,
For Work at:(address or vicinity) 3 2 3
Type of Work to be done: Rl� "�-G-.,,j--��RS1��i� fc�RUPi✓«`�!
(attach drawing when applicable)
Time Required -- Start: Finish: —30 cycz ys
Owner:—( ee,A e- c��%5'f-
Name
IZ' 1^ 33— 3 (
�L rWe
Mai ing A dress i
a g3 — 70 2.3
pws 27City State Zip Telephone Number
Contractor: q.-C_ 2 3 3 - 2 3, f —
Nam State License Number
Mailing Address
City State. Zip 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 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 subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220.
I understand that this permit must be available at the job site for inspection
purposes at all times.
Signature:�f✓ Date: //
Owner or Agent
C, TO BE COMPLETED BY .ISSUING AGENCY:
Date Issued: Permit No.: � 'PeFee:��'—`--
Security Bond:—.--' .1-7 /
Time Authorized: .,30{-42
APPROVED B ;' �.�� Date:
10-771.v (Revised)
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P!:PT. WFC-!, LIST
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rdplit-o[-I-:,i,,, Existinr
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Access Easements Existinp
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Utility Easement Existing
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Lot Per Subdivision
Plat
Assessor
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Site Plm Cliccl.cd for Accm-acv
lhidcr-rcxid '.','irin- !Icnd.
&ICi P,:i' L I f a Q �1' Lea a
Date
P7:
Er
li Water "ain Poci!irod
lk'(11-ant 1'Cralired per hre CDcic
II Pctector (11ccl, "C"Or RCC.114-rcd
Pcv'; cv:
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orcR-Itc pll,ic 'F.inl,:
Septic Tail: Pemit Penuircel, IZA Povlit ?10.
Avnilal.il �lro ...........
"0. � RIC 10.
S.i.<!c len-or ;Wd I.-tbi I:i t,7—__ Ll
Szmitary Sover Connection I'c( 11equircd fj nb') 7,EF
Pcvic'.., Pate
�li tell l:x �;I11: - �/ �-- —Rernli rcc'
Culvort P.cquircd Size
C)
Catch "C'elull-N, Indicate on '7itc*Pl,-ji
C—O-TWTi6n in �;Lvclls 54 7:e, �
00illl fctri 3 e
'I'll"llule required ^ /1" Indic.ite. on Site Mm
Soil. (,onditiolls F, Grotuld 1.:Lltel- Field (110c,"C.,
Revi m; bN,
-ite y"
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Strcct Paving; Rcnuired Wei 1/' �
Girl aiu? C;lttcr Rcqui.red r0_/l/ -7
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ISidcwall: Pcmdrecl —
Ciirb (Zit for nrimmy Rloquired
Constriction Pcnni t Rujuircd
lloncl 1?cmii rccl for T'iil)lic Imllrovcri^nts
II
Strcct N.-ric Sian Rcr!i:ircdD----
Otlicr Sinnini, Pc' ui red i
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11rc Pcr,lit Sits Inspection riac?c on ,J
BY: SCI-1-cr
Eater
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Sl:cciril Pcc,u:irc:aents li,,tccl in memo to Bui]din- Iichnrtmcnt
itcr-s filled in on Bid Iding Permit Application �
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BUILDING DEPARTMENT Applicant Fill
PCOW
z m a' t /i t NUMetn
PERMIT APPLICATION Inside Heavy Unes
NAME (OR NAME OF BUSINCSs)
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ADDR[sfl
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L[6AL LOT
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LOT AREA
SUBDIVISION NO.
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MAILING ADDRESS
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cxmr N0 !T R/W V FT. DEFICIENCY THIS PROPERTY
.. OOM} RAN ST. R/Wa PT. Q PT.
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ROAA11".Driveway Slope not to exceed those
CIT .. tL[PHON NUMO[R
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NAME
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ADDRES
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LEPHON19 NUMBSTRt[TAND
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CITY �jQ F716o-(c15
NAME
OR UTILITY WORK
sty= .. " ..ONO
R/W PERMIT REQUIRED
js YES ❑ NO
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UNDCROROUND
WIRING R!Q'D.,,.ONO
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ADDRESS
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TYPE CONNECTION @�YBS jVgRIFIZ
SANITARY SEWIR ONOIJ�
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CITY
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TELEPHONE NUMBER
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SEPTIC SYSTEM ❑ Y!s PERMIT
APPV'O BY CITY ENG.
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NUMBER
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKS
- LL 2_5 LO
.Legal Description of Property Show Below or Attach Four Copies)
METER SIZE
BUILDING SUPPLY SIZE
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REMARKS
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ILSIGN
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AREA
ENV. REVIEW
ADD NO.
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ALLOWED PROPOSED
COMPLETE EXEMPT
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REMARKS
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VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS
�S / FRONT �D SIDE a S REAR
LOT COVERAGE
�jj ❑ NEW RESIDENTIAL GAS
IJV L
L� LINE
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
o NON-RESIDENTIAL a 516N
❑ ADD
❑ DEMOLISH ❑ RETAINING
WALL
❑ ALTER ❑ EXCAVATE FENCE
OR FILL ❑ ( X_FT)
PRE -MOVE swim
REPAIR El INSP. ❑ POOL
SPECIAL INSPECTOR AREA
REQUIRED
❑ YES ❑ NO
OCCUPANCY OCCUPANT
GROUP LOAD
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
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NUMBER OF STORIES
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OF
DWELLING
UNITS i
REMARKS
NA URE OF WO TO BE DONE
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PLAN CHECK
VALUATION
FEE
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PROPOSED USE
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NO.
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PLOT PLAN INDICATE BUILDING SETBACKS.
ABUTTING STREETS)
BUILDING
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PLUMBING
HEAT & GAS LINE
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FENCE
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SIGN
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RETAINING WALL
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SWIMMING POOL
r CITY OF
1 Y
EDMONDS - SIDE SEWER
WATER -SEWER DEPARTMENT
PERMIT
PERMIT o
STREET HLE
Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction-1
(Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections./
ADDRESS LOCATION OF CONSTRUCTION.-..-..-- ---• - A
Ci! �Yc=^✓—�:.`—i7�lA.^..O.a..!--__----_.:1`._—:=.! f.. D.._._...-=
PROPERTY LEGAL DESCRIPTION ............... ="`• �-•
......:�� .................................
.......... _...... ... .............•-----------.......---.._.....
._. j- `- ._.. _:.^ :.:_ ---------------------------
OWNER AND/OR BUILDER........- �.. ! ;-.'- •°"-
CONTRACTOR'S NAME & ADDRESS-------------• ---S
.-- . %-ale ._^_--------------------_--_..-.-_----._-.----_..--------__-.----------_.-.--_-_
i
,ry ---•-• - -_ 19"?'?__. for repair and/or connection of a side sewer to the city sanitary sewer
mission is granted -.----------. _. -
swtem in accordance with City of Edmonds ordinances.
A- ENTION IS CALLED TO THE FOLLOWING: permit rtline. A licensed aide Sewer Contractor must be employed to construct
NOTE No. 1—sde ow ers of the street ropertDo not cover ann a ortionoofosewerabeforeriti has been pinspected.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit. No bends in grade
NOTE No. 4—TOPmust have a
Ofrstha.n'/uer be permitted. 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%._
ed to original condition. Contractors shall be responsible for failure due to improper
NOTE No. 5—Trenches in street must be water settled and surface of street restor
work which may develop within one year of completion.
work than is provided for in the permit, or to do any work on the main sewer or its appurtenances except to in
NOTE No. B—It is unlawful to alter or do any other -
sert the pipe into the wye. .
- Date .._....... By ---------------- Date ---------------- ------------------- By -------------•--
DISAPPROVED ❑ Date --- _................ ............
By ••-•- -------
APPROVED Date..._........ - --•--• .
.......... By ... _... ---._---------------------------------------------------------------------------------------
._.._ _.._.._. ...............
Remarks: ------- _------ _..................................... _.._-_.... ...........................
......... .... ............ .
�-- BO Perm .. Co ies T Be Signed By Owner of Firmf' Performin g Construction PRIOR To Request For Inspection —
`-� ............................. .... hereby certify that the side sewer installation constructed under this permit
(Ovmer of i I' c tra
_ Per rming Construction)
,v.,zs instal i ctor cwithFall erring ordinances of the City of Edmonds.
a;� j-7
day of.- 19�/ �/
Dated this..-- .6 ---------------- y ...............---------
❑� Telephone Power ❑, Sewer ❑, Other ❑ J J
Check BEFORE you dig for: Water Gas ❑, P ❑�
9
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City o`Edmonds.
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number.' - 8�
Issue Date: (p
A. Address or Vicinity of Construction: 16323 71 st Place Bi.
f _ - • B. Type of Work (be specific): GTE to pl ace,operate & mai ntai n a bu•ri ed servi ce- wi re
17C, 1$9 from an existing pedestal, located at 16 .,. tr en west to a residence at the same
address. GTE to plow 40 feet, push nodriveways R.O.W. footage is 10 feet.
C. Contractor: GTE NORTHWEST INCORPORATED Contact: Linda Price,,Permit Coordinator, 425/710-4133
Mailing Address:2312C W. Casino Rd.,Everett WA Phone: ENGR: Terry Anderson, 425/771-8683
State License #: 20 - 40 Liability Insurance: Bond: $
D. Building Permit #. (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑, Subdivision ❑ City Project ® Utility (PUD, ETEWNG, CABLE, WATER).
❑ Multi -Family ® Single Family ❑ Other
#0199P001DB 2423.10
INSPECTOR: INSPECTOR' (� cJ' /f
'Y r%.f - I1 Vac rvm. r Ci7P of stilt!-
PLEASE SEE ATTABIM PRINTISKETCH.
APPLICANT TO READ AND SIGN
INDEMNITY.- Applicant understands and 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.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
.TIONAND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BF�HELD UNTIL THE FINAL STREETPATCH IS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE 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.
All 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 the above statements and understand the pe mit requirements and the pink copy of the permit will.be
available on site at all times for insp!�qtion purpo."�
Signature: Date: 10-20-98
Dave ftlKINS, SEdfifflti9Ek R � DESIGN
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: 1t`J
TIME AUTHORIZED: VOID AFTER i Q DAYS
SPECIAL CONDITIONS: N �'
RIGHT OF WAY FEE: U . 0
DISRUPTION FEE/FUND I11:
RESTORATION FEE:
T OTAL FEE: zu
RECEIPT NO.:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments
Diagram
m
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
1
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PEGS cm
POLES O
ROAD BORES
OVERHEAD LINES
I.D. UTILITY POTHOLE O
UG TRENCHING ---UGT—
R.O.W.
THE FOLLOWING INFO TO BE PROVIDED
Ii:NT 4F w.. r �IyL�.L 0►' ;��? f a� E uF �• Jn_ • t r : ir4o _i,5-WALK, ?
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