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17210 77TH AVE W
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CITY'OF EDMONDS
,-'(tOM'MUNITY SERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION PERMIT
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A. 9 Owner
Mailing Address
Seattle WA 98111
City State . Zip
RE.-CE I V F.
MAY - 2 1�S]
B. 9 Contractor:
Perm it No.
Issue Date*
Name
Maili*Address
City �t State Zip
HEETFILIj State License Number Telephone Number
C. 9 Address or Vicinity of Construction: 17210 77 Avenue West
Type of Work to be Done: Install New.Service
Washington Natural Gas Company
Na e
815 Mercer Street - k F k < TA e--, r
C,13)cl I
D. 0 Work in Connection With: 0 Sub or Plat 0 Single Family 0 City Projects
0 Commercial 7 Multifamily Jk Utility
E. 0 Pavement Cut: [N Y D N F. 0 Size o f Cut: 2 x 4 (1) @ Gas
APPLI CANT TO READ AND. SIGN
INDEMNITY: Applicant understands and ' 'by hig' signdttu ir ' e to this application, agrees to hold the City of Edmonds
harmless from any injuries, damages, or claims 61f ai�yj�i�n , C
6r' description whatsoever, forseen or unforseen, that may
or en
't, I Atolne'y'i f,e'es by reason of granting this permit.
be made against the City of Edmonds, oriany of its departme iployees, including or not limited to the defense
of any legal proceedings including defense., costs, court, &bg
THE CONTRACTOR IS RESPONSIBLE FOR WOR�KMANSHIP AND(MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION A&,1'T-&-CtPtkNe-E,'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.
• A 24 hour notice is required for inspection; Please call Engine 1 771-3202
Fring-
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with CitylCode.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with it' ity regi,ilations.
A All street -cut ditches must be patched wit,,�h aspha.lit or City approved material prior to end of working day;
NO EXCEPTIONS.
I understand the above and that this permit ry ust be available at the job site for inspection purposes at all times.
Signature: M Date: April 18,* 1991
Owner or (=tractor,
This Permit Must be 70!osted at the Job Site For Inspection Purposes
Call DIA '.A -DIG Prior to Beginning Work
.L,
APPROVED BY:
Time Authorized: Void after i WL�71
Special Conditions: NA .
RELEASED BY.'-_11� Date
7
NO WORK 'TO
PERMIT FEE:2>1�,__
-days. Restoration Fee:
Receipt No.:
Fund I I I Fee:,,��,;
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Street Cut Dimensions: $
INSPECTED BY Date
EGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. March 1989
Eng. Div. July 1985
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Addendum to:
City of Edmonds
Permit Application
Engineering Aide: Kerry Walsh
Washington Natural Gas
622-6767 x2761
th unknown
Ke�:
:s- squitary sewer
w- water
-g- gas
water valve
hydrant
815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767
CITY OF EDMONDS
ASSET INFORMATION SHEET
I* Ld NEW b I flt:F-T FILE ASSET NO. o r, 2 -:�;- 1 2- -
L ADDITION ADDITION TO ASSET NO.
RETIREMENT
DESCRIPTION
A Edd -,,;7 i? /2 u a L if ---4f"4Wff7
SERIAL NO.
LOCATION DEPT. NO.
p -ro
"PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
0
*PROJECT NUMBER
PROJECT COMPLETION DATE
COST
B.A.R.S. ACCOUNT NO. q11 - 0 1,5- - 3 11�5-,oc,
ESTIMATED LIFE /? -6,
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
Wl DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
DATE
VERIFIED BY
PROCESSED
BATCH NO.
INITIAL
k�np
DEPARTMENT FILE
The City of Edmonds Side Sewer Drawing
STRC!CT. Fig Fo EASEMENT NO - ----------- - --------------------------
GI; I 44rW CONSTRUCTION REPAIRS Ej LID NO. It-M4 ..... . ASMT. NO. - ----------
OWNER ------------------------------------------------------- CONTRACTOR J—"Y""V00.-C>EZX -------- . .......... PERMIT NO. 4-44.74,m
JOB ADDRESS 0;11-- . --W-- . . ...............
LEGAL DESCRIPTION: LOT NO - -------- --.4 ------------------------ BLOCK NO.
14AME OF ADDITION .... -------- 4-:r=-%J0 — ------------------------------------------------------------
Approved: - -- ---------------- By -------- 9
DAIM ... J ...... 12'n # j - - < I.: � P .... rdm
CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
SIDE SEWER PERMIT
FOR INSPECTION CALL
775-2525 Ext. 220
Permit
Issue Date f)r-r /7 7,
PERMIT MUST BE POSTED ON JOB SITE
1. Address of 7onstruction 17771(
2. Property Legal Description (include all, easements) 4_0T
3. Single Family Residence A,111� Multi -Family No. of Units
Commercial -g 0
4. owner and/or Builder +
5. Contractor & License No. Liuf�woob V SEPT,*C LY—JVA)—W_,�—T3310.r
6. Invasion into City Right -of -Way: No t,��'Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
E-4 7. Cross other private property: Yes No&,� Easement required
U attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
P4
a. Property owners must obtain a permit to install side sewers on
>4 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[EWTIT-tepo 1 Age -La ach
installation for one year. -DIG
DIAL
C. Commercial establishment,requires a m f a s4Bxmdm!th (6"
04
side sewer line. BEFORE
s
0 d. Side sewers may not be installed lose a t OW)
U to any structure. 4 o U lvm lops
W 0
e. Side sewer lines must 0 be laid at de. of (1.15'
0 and maximum grade of 100% (45
f. No turn in side s8wer greatertha
between cleanout. All 90 turns must be ce LjvV C NQ1116MUNCIL
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 1001 along sewer 'line run.
j. Trenches within City right-of-way must be festored to original
conditions. oi�tractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k.. Side sewermust be left uncovered until inspected and approved
by the City. 6L
1. Inspection during normal working hours only. Two (2) working Ed I
days notice required.4e_o6rF_o xvsP.Poc
DATE:
I� certify that I have read
J—pE�panjd*shall comply with the ab
A) u i r9n 6 O�T
19 V r(�! VIM I -C
PERMIT FEE: -D BY: Date: CD
Aj tC YISAPPROVE CfD
By: Date:
CONNECTION FEE: �0. W.
APPROVED By:
Date:
0
PERMIT MUST BE POSTED ON JOB SITE
---- --------
TO
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----- ------- --l-2-:1 la �,
CITY OF 'EDMONDS
FILE mw,;m
Building Departevent
RM NO. MEM, 88T
SEND PARTS 1 AND 3 WITH CARBON INTACT, PART I IS RE -TURNED WITH REPLY
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy'of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location of any sewer stub shown. Such
se . wer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers sha-11 be Hab-le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
STREET FILE
[-TUWAY MESSAGE]
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SUBJECT: DATE Z�- 41-
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DATE:
SIGNED
CASCADEG Ll-C2375 PRINTED IN U.S.A.
SENDER: DETACH THIS PART AND FILE FOR FOLLOW UP.
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. . . . . . . . . . . .
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VURKS DEPARU= CHEMIST STREET FILE
BUILDING PERIvaT REVIEW
(address) kf:)
(date)
Street Right -of -Way Existing.
REQD
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Access Easenients Existing
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Utility Easement Exist:*Lng_____C2aU
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Lot Per Subdivision Plat
sessor Map
Site Plan Checked for Accuracy
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Underground Wiring Reqd.
Check Accuracy of Legal Description
Review by
Date
Existing Water Main Size
Water �tin Required YVIA
Service Line Requited
Hydrant Size Existing_
Hydrant Reqd Per Fire Code Size
Detector Check Meter Reqd. /Y
Cross Connection Inspection
Fire Department Coni-nents
Water Meter Charge Reqd.
Review by ----�Date
Septic Tank Design Approved tu
Date '-J
Septic Tank Permit Reqd.
No.
Sanitary Sewer Availability
-Pern-Lit
Proi . 9 C�
Drawing No. —��-�File
No.
Side Sewer Availability -M
Sanitary Sewer Connection Fee Reqd.
:3:
Review by n
Date
Open Ditch Existing
Reqd.
Culvert Reqd. _5 -
Size
Catch Basin Reqd.
Indicate on Site Plan
011
0
Shoulder drainage maintain collection an swale open runoff
Manhole reqd.
Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
Review by
Da tc"�;'
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Revised: lvlO- 197
j'ILDING DIVISION
ARMIT APPLICATION
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OF BUSINESS)
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Applicant Fill ZONE NUMBER
Inside Heavy Lines —
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ADDRESS
LEGAL DESCRIPTION I SUBDIVISION
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ITELEPHONE NUMBER
NE NUMB
� of Property (Show Below or Attach Four'Copies
SHORT SUB NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING
.PROPOSED
DEFICIENCY OF RIGHT OF WAY
In
PUBLIC IMPROVEMENTS REQUIRED
DRAINAGE IM PROVEMENTS REQUIRED
I
0
DRAINAGE PLAN REQUIRED
0
UNDERGROUND WIRING REQUIRED
CONNECTION TO SANITARY SEWER
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SEPTIC TANK PERMIT REQ'D 0
NO.
ELEVATION OF PROPERTY CORNERS
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& FOOTINGS REQ'D
ISEE ENGINEERING MEMO DATED
CHECKED BY
�E UILDING SUPPLY SIZE
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SIGN AREA
ENV. REVIEW
ALLOWED PROPOSED
COMPLETE1 EXEMPT
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]VARIANCE
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REMARKS
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OR CU
IPLANNING REVIEW BY
ADB NO.
DRELINi
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GAS � .5 FRONT M SIDE 1115REAR
Fo--N . W RESIDENTIAL LINE FIRE ZONE PE OF CONSTRUCTION ICODE 1HEIGHT
NON-RESIDENTIAL
SIGN
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ADD
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DEMOLISH
RETAINING
CIAL INSPECTOR
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EXCAVATE
OR FILL
WALL
FENCE
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FT)
REQUIRED NO
YES El
PLAN CHECKED BY
PRE -MOVE
swim
REPAIR
INSP.
POOL
REMARKS
z NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK
TO BE DONE
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PLAN CHECK
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BUILDING
B U I L D IN G
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PLUMBING
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FENCE
[RETAINI,NG
SIGN
0 "Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold harmless
2 the City of Edmonds, Washington, its officials, employees, and
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WALL
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agents from any and all claims for damages of whatever natu re,
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I arising directly or indirectly from the issuance of this permit. Issli-
SWIMMING POOL
OCCUPANCY OCCUPA
GROUP I LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION
FEE
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91 mic" of this permit shall not be deenied to niodify, waive or reduce
PUBLIC WRKS DEPARTMENr CHECKLISr STREET FILL*.
BUIIDI14G PER-ILT REVIEW
(address) (date)
Street Right -of -Way Existing -4-n R:EQD e4
Access Easements Existing_____*���. p. �TQD
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Utility Easement Existi%__ -1 '�._REQD
_4� _jpt^_�
.
Lot Per Subdivision - Plat -1-1 - —7 n Assessor Map_
Site Plan Checked for Accuracy
Z
Underground Wiring Reqd.
Check Accuracy of Legal Descriptione.-, %f:;2
Z
Review by Date —
Existing Water Main Size D'
Water Main Required NIA
Service Line Required
Hydrant Size Existing
P4
Hydrant Reqd Per Fire:Code -
-Size
Detector Check Meter Reqd.
Cross Connection Inspection
E-4
.
Fire Department Coninents
Water Meter Charge Reqd.
Review b Date
Y—.
Septic Tank Design Approved tu Date_�Jjk'
Septic Tank Permit Reqd. Permit No. _Njtt,
Sanitary Sewer Availability Proi.
Drawing No. e M File No.
Side Sewer Availability. --- - P__ !) - 1:1
Sanitary Sewer Connection Fee Reqd.. rl-i
:3:
Review by. Date E:� —
Open Ditch Existing
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Culvert Reqd. Ve-Size
P4
Catch Basin Reqd. Indicate on Site Plan
Shoulder drainage maintain collection an swale open runoff
Manhole reqd. d-&C- Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
S IL
Review by Datdfr"'_._"
110 I 4e
Revised: lvlo--19-7
.Page 2
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Street, Paving Reqd. Jfx0:5.;'1z_
Curb and Gutter Reqd.
Sidewalk Reqd.
purb� Cut., for'Drivew-qy,�Reqd.
r4 Right -of -Way Constructim Permit.Reqd.
Bond Reqd- for Public InprovEnmts-
Street NaTw Sign Reqd.
Other Signing Reqd.
Pre Permit Si�e Inspection ma'de an
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F-4 H BY: SE14ER
WATER
P4
M
H STREET
ENGINEERING.
'4 Special Requirements listed in mew to Com=ity Development Department,
Building Division
BY Date
o All items filled in on Building Permit Application
P4 BY Date
Drawings'Stauped and Notations Made
BY-- Date
Approved VyPublic Works Department
Kev1sed: 1v 10-1977
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AUG - 7 1979 F- -
..,ALDING DIVIS113W
eERMIT APPLICATION
NAME JOR NAM.5 OF BUSINESS)
Ir
III
,JMAILING ADORES
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Applicant Fill 'ZONE
Inside Heavy Lines
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ADDRESS
77-
LEGAL DESCRIPTION SUBDIVISION
NUMB
CD
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DRESS
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NAME
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01 STATE LICENSE NUMBER CITY LICENSE NUMBER
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Legal Descri
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or Attach Four Cop
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SHORT SUB NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING
PROPOSED
DEFICIENCY OF RIGHT OF WAY
PUBLIC IMPROVEMENTS REQUIRED
DRAINAGE IMPROVEMENTS REQUIRED
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DRAINAGE PLAN REQUIRED
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UNDERGROUND WIRING REQUIRED
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CONNECTION TO SANITARY SEWER
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SEPTIC TANK PERMIT REO'D 11
NO
ELEVATION OF PROPERTY CORNERS
FOOTINGS REQ'O
SEE ENGINEERING MEMO DATED
CHECKED BY
tE
BUILDING SUPPLY SIZE
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SIGN AREA ENV. REVIEW
ALLOWED I PROPOSED 1COMPLETE1 EXEMPT
REMARKS
VARIANCE OR CU
YARDS j
RESIDENTIAL
10
GAS
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FRONT
FIRE ZONE
NON-RESIDENTIAL
SIGN
ADD
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0
DEMOLISH
EXCAVATE
OR FILL
RETAINING
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FENCE
X—Fr)
SPECIAL INSPECTOR
REQUIRED
El YES N 0
PLAN CHECKED BY
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
REMARKS
ADB NO.
:)RELINE
PLANNING REVIEW BY DATE
LOT COVERAGE
SIDE 5REAR
OF CONSTRUCTION CODE JHEIFHT
EA OCCUPANCY OCCUPANT
GROUP LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
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agents from any and all claims for damages of whatever nature,
11WIMMING POOL
I arising directly or indirectly from tile issuance of this permit. Issu- t
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TO: F ui 1 cl i.n F
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Co-mniuniLy Development DeparLment
7ngin&erina Division
1,11)1-ic 1-:or':.,s DeparLment
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