17217 77TH AVE W.PDF6502
17217 77TH AVE W
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city of Edmonds
141 0z"i"IrREET FILE
RIGHT-OF-WAY CONSTRUCTION
(Y 9 0 - 1 9 9 -
5v"rr- PERMIT
V\&"o 60M(7
Permit Number: ?0� q 9
Issue Date: /'-� - / -7�q
A. Address orVicinity of Construction: 17217 77 Avenue West
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Nat'l. Gas Ch. Contact: Frank Swan
MailingAddress: 815 Mercer St. Seattle, WA Phone: 224-2278
State License #: 98111 Liability Insurance: Bond: $
D. Building Permit # (if applicAe),'.
Side Sewer Permit # (if applicable):
E. :_1 F� Commercial 0 Subdivision El City Project MC Utility (PUD, GTE, WNG, CABLE, WATER)
F1 Multi-Faniily El Single Family [-I Other
INSPECTOR: INSPECTOR: VJ
F. Pavement or Concrete Cut IRWes []No G. SizeofCut: (1)2'x',,4@Wt . H. Charge$
APPLICANT TO READ AND6N
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INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmlessfrom 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 attorneyfees by reason of granting this permit.
THE CON7RA CTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA TERIALS FOR A PEkibD,OF ONE YEAR FOLLOWING THE FINAL INSPEC77ON
AND ACCEPTANCE OF 7HE WORK ES77MATED RESTORAHON FEES WILL BE HELD UN77L THE FINAL S7REET 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 Department- 771-3202.
Work 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 sfieet 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 limesfor inspection purposes. J
Signature: Date: 1215192
(Contractor or Agent)
.1 CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
F6R* CITY �USE ONLY
By::�; K4 - —1 1 1 -
:..-.-RIGHT,.,OF: WAN
... ..................... . .
.... ..............
[0RI1Eb::Y0ID A�- .::DAYS�:: DISRUPTION:F]
.- RESTORATION
,TF: : —. .:-ISSUED BY
NO WORK SHALL. BEGIN PRIOR TO PERMIT
FA0
Engrg. Div. 1991
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FIELD INSPECTION NOTES (Fund III - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985 ,
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: MILJ-AP.D.
Engineering Aide
Washington Natural Gas
622-6767 x2761
1"721-7 -7 -2 M nacpar qi.A—itn9z,
hydrant
. valve
815 Ma= St. (P.O. Box 1869). Seattle, WA 99111 (206) 622-6767
Addendum to City of Edmonds
Right of Way
Permit.Application
Submitted by: PtICAA,,P-0 hlLJ-AP-D
Engineering Aide
'Washington Natural Gas
622-6767 x2761
naaer -3w:�-16BG
hydrant
- valve
a
S15 mcma St. (P.O. Box 1869). Seattk, WA 98111 (206) 622-6767
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), in cluding, but not limited to,
the location of any sewer stub shown. Such
sewer 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 s-hall be lia-b-l-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
Side Sewer Drawing
I he %.Ilry OT comon s EASEMENT NO. - .........................................
NEW CONSTRUCTION REPAIRS F LID NO . .................. . ASMT. NO . ..................
OWNER ..... F�-,T ------ M ------------------------------------------------- CONTRACTOR
------- NO.
JOB ADDRESS ......................... LEGAL DESCRIPTION: LOT NO - ------------ --I ----------------------- BLOCK NO . ...................................
............................................................................................................................................ I ................
NAME OF ADDITION .... 7�� -------- 4��-P ................................. -------------------------
DA I h .... --------------- JJY --- - --------- :/--
PWW-0001-11/75 (REV.11/78)
CCITY OF EDMONDS
I FOR INSPECTION CALL
PUBLIC WORKS DEPAR&T Permit IMP 6267
775-2525 Ext. 220
SIDE.SEWER PERMIT Issue Date
PERMIT MUST BE POSTED ON JOB SITE
0
l.. Address f onstruction 107Z 01 q r) Ave 0 Fzdimove4s 27r�.2z
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2. Property Legal Description (include all, easements)
3. Single Family Residence V""Multi-Family No. of Units
Commercial
4. Qwn-er--a.nd-/-&r- Builder L U- A) A) 14110 6-J �.+i r -T/7 L4 V- cn
5. Contractor & License No.0 L*y---"1V-MX---T1R IDS'
6. Invasion into City Right -of -Way: No Yes (If Yes Right-of-
way Construction P rmit Required - Call Dial Dig (342-5344) before
excavation). r�va+c Plat)
7. Cross other private property: Yes No Easement required -
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
P114 a. Property owners must obtain a permit to install side sewers on
�H their property. A licensed side sewer contractor must be employed to
construct side sewers in the public' ri,4ht-of-way.
b. The side sewer contractor assumes full reponsibility. for each
installation for one year.
Pq
4 C. Commercial establishment requires a minimum of a six inch (6")
P4
side sewer line.
0 d. Side sewers may not be installed closer than thirty inches (30")
U to any structure.
W 0
M e. Side sewer lines must be laid at a minimum grade, of 2% (1.15-
0 and maximum grade of 100% (450).
E-4 f. No turn in side s8wer greater than 450 (1/8!bend) is allowed
between cleanout. All 90 turns must be constructed of a 450 (1/8
bend) and wye with removable cap. f;.�
g. No down spouts, footing drains or floor drains can be connected
to qide sewer system.
h. Pea gravel is required for bedding when installing sewer�Plines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer 'line run.
j. Trenches within City right-of-way must be restored to ori4inali.
conditions. Contractors shall be responsible for right-of-way failure*
due to poor compaction of fill.
k.. Side sewer must -be left uncovered until inspected and approve'd
by the.' City.
1. Inspection during normal working hour'sx)lnly . Two (2) working
days notice required.
DATE: �3
I certify that I have read
and shall comply With the above.
PERMIT FEE: 0 Havlav*c I
T DISAPPROVED BY: Date:
By:' Date:
CONNECTION FEE:
P4:=) APPROVED By:_j Date:
0 Mm
PERMIT MUST BE POSTED ON JOB SITE
PERMIT A!TLI�ATION
iside Heavy Lines
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NAME (OR NAME 6`—;:�6USINESS)
Aakwpr%ro
oinc E
F
LEGAL LOT
PLAT NAME SUBDIVISION NO.
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0 YES 13 NO'
"L&.)T UeA
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W MAILING ADDRESS t
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PUBLIC RIGHT OF WAY PER ORDINANCE NO.
0
TELEPHONE NUMBER
;>
EXISTING RIGHT OF WAY !�Lo/s 0
PROPOSED RIGHT OF WAY -
NAYE
DEFICIENCY OF RIGHT OF WAY
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ADDRESS
STREET/UTILITY WORK REQUIRED 5d YES
El NO
> :I-
PERMIT FOR WORK IN PUBLIC R/W YES ONO
UNDERGROUND WIRING REQUIRED WYES NO
U -
x 6TY
TELEPHONE NUMBER
'(19A
Al
q_,5_--'7A41 r3
CONNECTION TO SANITARY SEWER 5dYES NO
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SEPTIC TANK PERMIT REQUIRED OYES NO
NAMTE
SEPTIC TANK PERMIT NO.
I.-
ADDRESS
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SEE MEMO DATED
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(t CITY
TELEPHONE NUMBER
REMARKS
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U STATE LICENSE NUMBER
CITY LICENSE NUMBER
CHECKED BY
A
C b"
Legal Descriptio'n of Property
(Show Below or Attach Four Copies)
M IZE
BUILDING SUPPLY SIZE
7�a
/Z
o 2'—'- 45; /n,
REMAAKS
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SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADB NO.
SHORELINE
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REMARKS
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VARIANCE OR CU
1PLANNING REVIEW BY
JDATE
YARDS I i . A !� I
A5, FRONT /0 SIDE REAR
ILOT COVERAGE
2-<E W
RESIDENTIAL
GAS
LINE
FIRE ZONE
TYPE OF CONSTRUCTION,
HEIGHT
EJ ADD
ALTER
L
NON-RESIDENTI]AL
El DEMOLISH
EXCAVAT . E
OR FILL
SIGN
RETAINING
EIWALL
FENCE
Ell— X — FT)
I
ICODE
ECIAL INSPECT 0 R
REQUIRED
YES NO
AREA
OCCUPANCY
GROUP
OCCUPANT
LOAD
PLAN CHECKED By
THIS SITE IS LOCATED IN THE CITY
REPAIR
PRE -MOVE
F�
F--j SW I M
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
INSP.
REMARKS
z NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
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PLAN CHECK FEE VALUATION7T FEE
PLOT PLAN (INDICATE BUILDING SETBACKS.
ABUTTING STREETS)
8
BUILDING
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PLUMBING
P
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0
W
0
MECHANICAL
F
FENCE
SIGN
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IR
Ln "Applicant, on behalf of his or her spouse, heirs, assigns and
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successors in interest, agrees to indemnify, defend and hold harmless
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2 the City of Edmonds, Washington, its officials, employees, and
RETA INING WALL
0: agents from anyand all claims for damages of whatever nature,
I arising directly or indirectly from the issuance of this permit. Issu-
SWIMMING POOL
a ancc of this permit shall not be deenied to modify, waive or reduce
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any requirement of any city ordinance nor limit in any way the
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7: City's ability to enforce any ordinance provision."
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the in-
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CITY of EDMONDS
200 Dayton Street - Edmonds, Washington 98020 - Telephone (206) 775-252 5
W., -'.t !,�,
Department of Public Works
DATE: e- -1 -7 y
TO: . - `5L D6r-
TRANSMITTING:- �-j Z11 �YF
AS YOU REQUESTED: FOR*YOUR FILE*
FOR YOUR INFO: REVIEW .& COMMENT:
AS IVE DISCUSSED: COMMENT & RETURN:
FOR YOUR APPROVAL:- FOR APPROPRIATE ACTION:
REMARKS.:
PUBLIC WORKS DEPARTMENT
I w—veam.
MEMO TO: Building Division
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT:
After review of the subje . ct building permit application,. we.have the
following comments:
Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is the
responsibility of the contractor.
The contractor is required to keep the abutting.streets cleaned
of dirt and.debris caused by the construction.
The "Right -of -Way Construction Permit" is required, from the
Engineering Division of Public Works, for any work within the.
.Public Right -of -Way or public easement.
/?�I/ Driveway slope not to exceed 14%.
Connection to sanitary sewer required.
/-7 Septic Tank Permit required, submit design.
Fire hydrant required, submit.design.
ZKT Site drainage per code # See approved plans /122�� Rzlz!�:
/-7 Curb /-7 Sidewalk Pavi ng required.
/-7 Bond required for public improvements. Submit cost estimate.
IK7 Underground wiring required.
/-7 Approved Engineering Plans required when applicable.
1-7
F6r.Fred'F. Hdrzberg, P.E.
City Engineer
Department of Public Works
Rev. 7/78
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CLIC.WRKS DEPART�M CHECKLAO
BunDING PEX,11T REVIEW
Date
-7-7A[-\VE-\W. Address
Street Right -of -Way Existing 40/40 REQD
Access Easements Existing T1-40(�AE51— REQD
Utility Easement Existing T-ADNVFI REQD
Lot per Subdivision. Plat -rLLSrjr 6LeHAssessor Map
Z Site Plan Checked for Accuracy
FA Underground Wiring Reqd.
01. Check Accuracy of Legal Description
Environmentally Sensitive Area
Environnmtal Checklist Reqd. T-iC)
Flood Hazard Zone
Shoreline Management Area T-10
Z Slope, Soil, Vegetation -
Strearn, Creek, Drainage:Basin -7-10
Existing Zoning Per Code
Anienities Design Board: -Approval -Reqd. ADB # Approval
Board of Adjustment Approval Reqd. <"L)
Review By: Date: I Z-6---7a5
W4 -
2; Existing Water Main'Size g 12, 1.
Water Main Reqd. 1114
Service Line Reqd.
Hydrant Size Existing
Hydrant Reqd. Per Fire.Code Size
Detector Check Meter Reqd.
Cross Connection Inspection AIA
Fire Department Comments
Water Meter Char e Reqd. 1.,02 9��,
Review by: Date:
ept c T sign prove ate:
Septic Tank Permit Reqd. Permit No..
Sanitary Sewer Availability zes Proi - -
Drawing No. File No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
Review By: Date:
T-NAV VW 23MML 3 =Wir MAMMA—& —AAAAWS
Open Ditch Existing Reqd.
Culvert Reqd. Size
P4 Catch Basin Reqd. Indicate on'Site Plan
0 .Shoulder drainage n-nintain collection (xi swale open
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1
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CaLch
0
_'houlc
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u 10
llu-�hole rcqd._ Indicate on Site Plan
S S03_1 C
oil Conditions and Ground Water Field Cliecked
Re."riCA-i by� 'e,55�g� rx
Street. -Paving Reqd.
Curb and Cutter Reqd.
Sidewalk Reqd.
Curb Cut for Driveuay Reqd. j_
P� Right -of -Way Construction Permit Reqd.
Bond Reqd. for Public Inproven-ents
Street Nami. Sign Reqd.
Or -her Signing Reqd.
ZPre Permit Site Inspection made on
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BY: SS,,IER
WATER
P-A
S=- T
ENGINT--'ERIi\'.G- .
Special Rcquireiaeants listed in mem. to ComT�inity' Devel
opment''Departmnt;
Building Div-ision
BY Date
V
o All items filled in on Building Permit Application
P4 13Y -Date —
C14 Drawings Staimed and Notations Made
BY Date
IjApproved by Public 1%lorks, DepartTm-it
Revised: IV 10-1977
PUBS 14ORKS DEPART= CHECKLIST
BUILDING PERMIT REVIEW
Date -
Street Right-Of7Way Existing �REQD
Access Easements Existing REQD
Utility Easement Existing REQD
IA?t per Subdivision Platl�� Assessor Map
Site Plan Checked for Accuracy
Underground Wiring Reqd.
Check-Accurady of Legal Description
Environmentally Sensitive Area
Environmental Checklist Reqd.
Flood Hazard Zone
Shoreline Management Area
5i Slope, Soil, Vegetation
Stream, Creek, Drainage -Basin
Existing Zoning Per Code
Amenities Design Board Approval Reqd. ADB # Approval
Board of Adjustment Approval Reqd.
Review By: Da te
Existing 'Water Main Size
Water Main Reqd.
Service Line Reqd.
Hydrant Size Existing
Hydrant Reqd. Per Fire Code Size
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Comments
Water -Meter Charge Reqd.
Date:
Review by:
c
Septic Tank Permit Reqd.
Sanitary Sewer.Availability
Drm,7ing No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
Review By:
Date:
Permit No.
Proj .
File No.
Date:
Address