18119 85TH PL W.PDFIIIIIIIIIIII
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18119 85TH PL W
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ADDRESS: Ls I I q s s +," FL VV -700
)�3-31 000
TAX ACCOUNT/PARCEL NUMBER: OC
BUILDING PERMIT (NEW STRUCTURE): 1c(-7()--
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver E] Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
Mom
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:
LID #: ISI
LOT: BLOCK:
N
L\TEMP\DST's\Fornis\Strect File Checklist.doc
C. Contractor:
City of Edinonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number.
Issue Date: — -L — Ll - a
A. Address or. Vicinity of Construction: - 18119 85 P1 V ?1P1;?1d3q
1) C W-11 : C. Tito# -all 9"mpv ^in n u n fi-nm Ar%@W rJT- AR
99 A yp�' 0 lkv� "F� 1.1* .
to 23'E C/L 85 P1 W. & Iustall 2"MPE fr 18'+-N C/L M.D. &
C/L 86 P.1,---V to 215'+-S & 1WE CIL 85 P! 9 818!41--N ell 0 V D
-Washingtou Natural Gas.,",-""' Contact: of Cul De Sac ou 85 F1 W
MailingAddress: 1122 75 St SW.-1-irerett Phone: 356-7500 ext 7596
State License #: 98203 Liability Insurance: Bond: $
D. Building Permit #,(ifapplicaQe)- �"'!z Side Sewer Permit # (if applicable):
E. E] Commer611 -'El Subctjv�;ion '*4- ject Utility (PUD, GTE, WNG, CABLE, WATER)
I El City Pro
Multi�Family.p', Single Family EJ Other
"�INSPECTOR:
INSPECTOR:
F. Pavement or Concrete Cut 12 Yes C]No,-J G. Size of Cut:. "A x H. Chargq
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to thiN�
,j�hcation, agrees to hold the City ofEdmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unfore;een, that may be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA 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 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 ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at all times for inspection purposes.
Sign L, Date: 7-.11-96
tor or A &e)
CALL DIAL-A-D191PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVEDBY: RIGHT OF WAY DEPOSIT
TIME A . UTHORIZED: VOID AFTER 04Q (h %6t DAYS DISRUPTION FEE/FUND Ill:
SPECIAL CONDITIONS: -rizAF�FK- g=e5w-rgAno— RESTORATION FEE:
F= iL C-p QE- - M A s i W 5� PERMIT FEE: (9
lyc'
UT% �-AMK 'P01PAL FEE:
COMMENTS:
RECEIPT FEE:
AV V
158V
to end
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION El YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
El NO
�j, 7, . . . . . . . . . .
POSTED ON KROLL MAP NO.:
-1,0042 1"
BUILDING DEPARTMEN17 ApplI t FW
C�
aside Heavy Lines JUB ADDRESS �.,l
PERMIT APPLICATION
V"NEv
NAME N., '115
F1 -
ACK nREET JETBACK. REAR YARD SETBACK
-s-'D
'MAILIN 'A-DDRESS 2 5"
DA YA(;Azi r SITE
A.REA
TELE NONE NUMBk;R 13 NO Z
LOT
VARLANCF NUMBER
Mil 'Z - 717 711 BUIl,,DING AREA 16
NAME
ROVED
80' 14141. 407'
'00" PLOT P1,AN TPP D r
SA
STREEr R/W
EXISTING STREETR/A,�t DEFICIENC TM
_b
A CITY TELEPHONE
CO',17. PLAN ST. �.PROPERTY
REMAR1.8 Z I
NAME cc
Drivew5jy slope
indicated on Standard Drawing #103.
ADDRESS
Z
1CW
CITY TELEPHONE NUMBER
SM-FER ME s:yAE iz, ELZ cREc"s BY
STATE LICENSE NUMBER CITY LICENSE NUMBER
'RE14J."S
Legal Description of Property (Show Below or Attach F.. Copies)
A7
419 -5e-a- vZe Lti f- -TYPE CONNECTION VEIUFII;D BY
0
-e �50 PFF.C. TEST
PERMIT NUWBO� W
W REMARKS M
j
V TYPE UCTION STREET IMPROVED
_rTR
YES 0 NO
ECTOR REQUIRED
OCCUIAljRW 'T L
GAS 0 TES 0
'ESIDENTIAL
LINE
F W El PLAN CHECKED 13Y
.O�
N_RESIDr
�_ZIAL SIG-q
ADD F-� RETAINING REI�IARKS
'ED DEMOLISH WALL 1. .
Eli ALTER EXCAVATE E
0
El H M.L 0 F. x......n.)
INST. POOL,
1- �IHEI� QV STORIE8 "111111LII OF
DWELLING
U NITS
NATUIU; OF WORK TO BE DONE Valuation Fee Raeelpt No.
Plann Check N . ......... ...
BUILDING
EPROPOSED U.9E
PLUmBr.NG
PLOT PLAN (Indicate Building setbacks, abutting st,eet.� HEAT & CAU LINE
FENCE
sic",
RETAINING WALL
N
SWIMMING POOL
DMIOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL ASIOUNT DUE
I hereby -icktowledge thint I have read this application: that the In-
f _mm -a rect;
a, tion given Is ' and that I sun the —er. or the duly atithor-
,zed agent of the owner. I agree to comply with city and late laws r.
Ku- ATTEN-TIONT APPLICATION APPROVAL
lating construction: and In doing the work authorized thereby, no p11
0, w
willtbe employed In vlolalon of the Labor Code of the Ste ahl.gto. THIS PER3HT This application is not a perndt until
reining to Workmen's Compensation Insu. AUTHORIZE.
O.NLY T11 IsIgned by the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DFIMOLITIONS which WORK NOTEED uty; and fees are paid, and receipt is ac-
.hall be completed In alrety days: 34OVED-Li nUILDINGS sh.11 be corn. knowledged In space provided. r.
pleted In aix months.)
SIGNATURE (OWNER Oft AGEN INSPECTIO.'r
T) DATE SIGNED DIRE I'll OLONA
ARTMEZNT
CITY OF
iffALMOUllumm-9 EDMONDS DATE'
NOTE: Applicant Subject to Plan Check Fee PR 6.1107 Q r7 (D
Thl. P-4t 1-7,—k I. lb�. do.. on private property ONLY.
b. -.. dr
Any construct on on he an .1c dorn.l. (curb.. ldewellz
etc.) :will require epwate permlsslon.
A
APPLICATION
for
The CitY of Edmany SIDE SEWER PERMIT
9TREff FILPE
r�� NEW CONSTRUCTION REPAIRS 0
so 4 - c s (f - I
/J,
................................. .. ............................................
ADDRESS ...... jJ
.................... .............................. y ...........................................
/ ) b
CONTRACTOR..
..............................
..................................... - ........................... PERMIT Nb��
LEGAL DESCRIPTION: LOT No . ...................................... ....... BLOCK No . ................
NAME OF ADDITION......
....... ..................................... ..... ..............................................
I
Approved:
R.E. 'E""VEt-d
JAN
7--
DATE ....
By
NOTICE:
Nowa rra n y of a cc
The information on the attached
map(s) was compiled for use by the City Of
lovees and Consultants.
Edmondsl its Emp , k
The City of 'Edmonds does not * wa rra nt tj ie
accuracy of a.nything set for.th on these
map(�-). Any person or e n.tity -requesting a
copy should conduct an independent
'ation shown on
inquiry regarding the inform
_tFe -map(s), including, but not limited to, -h
th'e location of any sewer stub shown. Suc
sewer stubs may or may* not exist and may
or may not exist at the location shown.
Neither the city of Edmonds nor its
emp,to'yee's o*r office-rs shal] be 11a.b-'Fe for the
information given on this Map(s), nor for
tation provided based
any one represen
upon . said map(s).
CITY OF EDMONDS Call pRospect 6-1101 when vvork
SEWER DEPARTMENT is ready for inspection, (No luspee
C CENTER—WATEW t1ons Saturday, Sunday or bOlidays.) NO 3889
CrVI
SIDE SEWER PERMIT
18119 - 85TH pLACF- WEST ...........................................................................................
---------------------------------- I ---------------------------------------------
ADDRESS------------------------------ -------
OWNER ---------- EpAIR or CONNECT a side sewer
for ------------- ---------- days to R
Permission is granted ---- plication on file and governing ordinances -
dance With aP
with City sewers in accor
ATTENTION is ,LLED TO THE FOLLOWING: inside Property line. A licensed Side sewer contractor must
—The owners of the - obtain a permit to construct sewer f sewer before it has been inspected.
property may er in street area. Do not cover any portion o
1� No. 1 be employed to construct side sew Ordinance 11.16-030 and Regulations governing side sewers When you get permit,
j inside property line; minimum grade of 2T.-
NuTE NO. 2—Obtain full inf ' ormation regarding ches coverage at property line and 12 inches sible for
er must have at least 30 i
NOTE No. 3—Top of side sew than ik will be permitted.
No bends in grade sharper . settled and surface of street restored to Original condition. Contractors shall be respon
eet must be watei -PPur-
NOTE No. 4—Trenches in str ch may develop within one year of . completion. o any work On the main sewer or its 9
failure due to improper work will other work than is provided for in the Permit, or to d
N' No. 5--It is unlawful to alter or do any the wye.
tenanoes except to insert the pipe into
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