17819 TALBOT RD.PDF11111111111111
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17819 TALBOT RD
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED: —
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
DETERMINATION: E] Conditional Waiver E] Study Required E] Waiver
LOT:
LID #: / (e
BLOCK:
LATEMP\DS7s\Fortns\Street File Cliecklist.doc
APPLICATION
for
The City of Edmonds SEDE SEWER PERMT
NEW CONSTRUCTION E] REPAIRS 0 EASEMENT No . ..........................................
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...................................................................................... CONTRACTOR ............... r� PERMIT No d42-7
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ADDRESS J7W<_=5..._7h,,.UE?z_QT ........ RC) ....... ................ LEGAL DESCRIPTION: LOT No. F;kWCSL�a:l
............ .......... ............ .............. ......... - BLOCK No . ..... ......................................
NAME OF ADDITION..
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rafter�trequest:.-.NO�.Sat.',I�Sun:.3jor.�holI ayt, nspect ons:
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ANDID, R, E- ....... ............
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k v�i-kd*L DESCRIPTION .. ............................ ............................................................................................................... .. .....
)PROPEJ
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BUILDEW'� .. .................................................................... ...................................... *..
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h--idt�.?(6f:"1E&noJid' -ordinances.-
wfa;�6idani* 66�ivit S,
"ATTEN.
,e m p16�ccl,,.t o-ccorW
'The. lown-ers,,&Ahey -1�rqpe permit Uo,:,constmc
-tx�
t s��vd.' -*8,;,r - -ltne`,.F-A�:)iccn-sed. S w niContractor',must,.be��
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-.�':,�,,sjcle�js�w6f;in,street areaa-,Do'po� �Cov�r:,anypprtlo
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it.;�btalnableifrom,A.e-� Ity:
ormccl�lq�c�ty.,.rlg t.
a permit..
01,
Top,!qf,sld*e4sewer �mj!st: ave Ia
,'sharper.-than."A;.,will..be, permitte
d$
'd- �4�6�fracfors ;shajl!.b6',�isp:onslbl or: fklld
s
�-%N�afer set tle'dliand-sur f &�e,;of.stlre�t`r6 t6�e
NOTE),No�.�'5�,Trenches,in-street,ffiust,bI -1. , -
-onej-year!o �CoM,
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r..,.o.r;'(ao.-an�''other��.�,�rg�th,Lh,�is.,Iirovidedi for�-
�NOTER*No.`6�It,Jslunlawfdh tot
'4 a`lt'e� in;. thel;permlt;ro6to �clo� ln,,sewcr�.or,-.lt p9r. enanc
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OTH-,,,Pe-` C or`lnsPection�,z:.----
T P6rforhiink.�
B a coif�f RIOR-Tol'R
opies,:MUST� e,,* ign
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The City of f;cbnonds
APPLICATION
for
SIDE SEV"M PERMIrr
NEW CONSTRUCTION [] REPAIRS 0
OWNER .. . ........ -----------------------
ADDRESS .. 51 ........ � ........ X-P, .............
WUNTNo . ..........................................
161,
CONTRACTOR Z-.tjlll -------- 6,d.Afi)rPER.. . . ...... Y.��
C
LEGAL DESCRIPTION: LOT No . ...... (� ..... ... BLOCK No . ............................................
NAMEOFADDMON .................
i -'�) 4e
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R EC E
1973
JAN 2 2 1973
Approved:
DATE................................................ By ...................... ...................................................
.1 Of
E.Djo,_
I
TALBOT RD
CITY OF EDMONDS WATERLINE AS -BUILT
A
C� ADDRESS
17819 TALBOT RD
CONTRACTOR
DATE DRAWN
01/31/2005 IBY SIBREL
HOMEOWNER
-CHUANG
SCALE
NTS
PERMIT
NO. 2004-0948
i �"
8 C5
9 0 - 1 9
0 City of Edmono
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number:
Issue Date: 12
A. Address or Vicin 'CO3nstructi6n:r='0q1Zt849 Talbot Rd. (9308789)
,ity lofj
."—'__'f'nsea1'dL.Vew service
B. Type of Work (be specific):
C. Contractor: Washington Nat'l.Gas Co.
MailingAddress: 815 Mercer St.Seattle, Wn,
State License #: 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. F� Commercial Subdivision El City Project [M Utility (PUD, GTE, WNG, CABLE, WATER)
n Multi -Family Single Family n Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut : )Q)Yes E]No G. Size of Cut: ( I ) 9 x 4(a(-,,q,.q H. Charge$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmlessftont injuries, damages, or
claims of any jUnd 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 CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP AAD MA TERIALS FOR A PERIOD OF ONE YEAR FOLLOWNG THE FINAL INSPECITON
AND ACCEPTANCE OF THE WORK ES77MATED RESTORA 77ON FEES WILL BE HELD UN77L THE FINAL STREET 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 Depa
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 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 omdr requi . renignts and the pink copy of the permit will be available
on site at all timesfor inspection purpol
Signature: Date: Feb. 19, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
AFTEV 4�0 -...DAYS. . DISRUPTION FEE/FUND. 111:.�
TOTAL FEE:
RECEIP'T.NO:
DATE: � ISSUED BY
ISSUANCE
Engrg. Div. 1991
"ScErveo
F E B 2 3 1993
ENGINEERING
RIGHT OF WAY CONSTRUCTION PERMIT ROUTING FORM
DATE APPLICATION RECEIVED C� —I?- C;� — 0/ 3
WORK ADDRESS
CONTRACTOR Vu dl (r-
1. DATE TO PUBLIC WORKS FOR REVIEW ?,3
REV/APP BY STREET DIV. dat
REV/APP BY WATER/SEWER:rioa date P - 21- 92:>
REV/APP BY PUBLIC WORKSI�� date 1- 33 -J-.3
2. DATE TO ENGINEERING FOR REVIEW
REV/APP BY ENG. AID date
or
REV/APP BY ENG. INSPTR. hL,-- date 45-,'M r-1-3
3. Return to Community Services front desk
DATE PERMIT ISSUED.?,--') C, - 9'3— PERMIT # 0 �4�4
City' c�f Edmon
RIGHT-OF-WAY CONSTRUCTION
PERMIT
<:� o r-n P 4 - -Lc, - 0�3
ZZ
Permit Number: 7
Issue Date: .2 - 3
A. Address or Vicinity of Construction: 17819 Talbot Rd. (9308789)
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Nat'l -Gas Co.
MailingAddress: 815 Mercer St.Seattle, Wn.
State License #: 9811.1
D. Building Permit # (if applicable):
Contact: 2rank Swan
Phone: 224-2278
Liability Insurance: B so CE--mr!
Side Sewer Permit # (if applicable):
E. Commercial El Subdivision [I City Project [XI Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family [] Single Family n Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut fi)yes E]No G. Size of Cut: ( I � 9 x 40raq H. Charge$
APPLICANT TO READ AND.SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees��",1,4 If
the City a Edmonds harmlesf" Jpfi�t �e�j Amages, or
e
its ep�, rtments-ir employ -
claims of any kind or description whatsoever, foreseen or unforeen, that may be made ai'dXt the City of Edmonds, or any 21
ees, including or not limited to the defense of any legal proceedings including defense " s)
and attorneyfees by reason of nting thi�.permit.
-) I -,%
f_%S41 9
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIPAND MATERIALS FOR A PERIOU , OF ONE YEAR FOLLOWING FHi FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MATED RESTORA71ON FEES WILL BE HELD�UNHL THE FINAL STREET PATCH"IS COMPLEYED BY
1 1, 1 1 1
CITY FORCES, AT WHICH TIME 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 Depar
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 street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS. A&Z 23' r_A13 '�� 3
."-I-h-ave read the above statements and understand the permit requirements and the pink copy of the permit will be available
on ;iievtalll timesfor inspection purposes.
Signature: Date: Feb. 19, 1993
(C(;�Iitrac, I tor or Agent)
CALL DIAIA-DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
A 67 01,F,01
APPROVED BY:
... RIGHTOF WAY..DEPOSIT:
T IME..AUTHORIZED:.VDID AFTER.... DAYS.
DISRUVrION FEE/FVND_1T1:,-.
.::7SPECIAL.:CONDMONS X::: 1::.:�..:-RESTORATIOMFEE...
..................... ...........
. . ...............
........... .......
............. .
..........
................
Ja_—
... ..........
TOTAL.FEE:: ......... .....
........ ....... ...... ........
... . ... ...... .
.COMMENTS:. . ......
RECEIPT
DATE:
ISS (JED BY:....
NO WORK SHALL BEGINYRIOR TO PERMIT. ISSUANCE
NI Engrg. Div. 1991
FIELD INSPECTION
Comments:
11 Diagram:
�' i
I I - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. h
Addendum to City of Edmonds
Right of Way
Permit Application
...Submitted by: GtjvIL.& CDWWCP,!s
Engineering Aide
Washington Natural Gas
'5?, 1 -137-4 A
1-78 19 T4LBOT ZID
(00) CUT
WNG to window
W)A Water main depth
unknown
-Y--- 11 gas main
Key:
-w-
water
-9-
gas .
-ss-
sewer
-19-
water hydrant
0
water valve
815 Memer St. (p.O. Box 1869). Seattle. WA 9811, (206) 622-6767