18205 76TH AVE W.PDFIIIIIIIIIIII
6238
18205 76TH AVE W
SU BIJECT:
DATE
11-7
Alo
SIGNE6(�
y
-SIG
�IGNEDI
CASCADEG Ll-C2375
PRINTED IN U.S.A.
$ENDERI pErACH THIS PART AND FILE, FOR FOLLOW !J.P,
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City. of -Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Nuifiber: 7&
Lssue Date:
A. Address or Vicinity of Construction:
117 B. Type of Work (be specifi6):
C. Contractor:
Mailing Address:
State License #:
D. Building Permit # (if applicable):
Contact:
Phone:
Liability Insurance: Bond:. $
Side Sewer Permit. # (if applicable):
E. E] Commercial F] Subdivision El City Project Utility (PUD, GTE, WNP, CABLE, WATER)
n Multi -Family El Single Family F1 Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: Yes []No G. Size of Cut: x H. Chargq_$
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany
kind or description whatsoever, f�reseen or unforeseen, that may be made against the Cit)) of Edmonds, or any of its departments -or
employees, 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 WORKMA NSHIP AND MA TERIA LS FOR A PERIOD OF ONE YEA R FOLIO WING THE FINA L INSPEC-
TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS 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 permit requirements, and the pink copy of the permit will be
available on site at all times for inspection purposes.
Signature: Date:
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY.
TIME AUTHORIZED: VOID AFTER J!7— t7 DAYS
SPECIAL CONDITIONS:
RIGHT OF WAY FEE:
DISRUPTION FEE/FUND I 11:
. I RESTORATION FEE:
T OTAL FEE: 3,--) , co
RECEIPT
ISSUED.B.Y.:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
FIELD INSPECTION NOTES (Fund 111 Route copy to. Street Dept.)
Comments:
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X r attaChed map Was w.�-Ued for =oe by the City Of '-Z-3 tri
anc, consultants. The City drE-d-inon—dq_does not a I"
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an�lhinv set forth on the map. Any psisowi-oi�entfty r�,:
[A widuct an indepe9dent Inquiry regarding the
th, rcizp, including, but not Urnited to, the location ofany Z
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(n CDOj 6) siouk-m. Such sevvel stubs may or may W eAst and may or rnz';�rcl c: --t J - 0
OD th', Nei hei ft) City of Edmonds nor Its
elll'i�--' c::,: b!; habletm the informdon gi-.*�,! c.� this ma�, nortQt zn, QT;t'-
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CITY of EDM.ONDS S I D E S E W E R F; E R M I T
M TZ
For Inspection Call 771-3202 PERMIT NO. 07294
ILE LYNNWOOD LINE
A d 51ff�! r Fuc t i o �n.: / s' — 7 6 zt71141
Property Legal Description (Include all easements):
k a",/- � - _� do
Owner and/or Builder:
Contractor & License No:
Singl:e Family Residence N/
Multi -Family (No. of Units
Commercial (No. of fixture Units
invasion into City Right-of'Way: I No Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
I certify that I have read and shall comply Date
with the items listed on the back.
13d 0--0
Permit Fee:
Trunk Charge:
Assessment Fee:
Partial Inspection:
Issued By
Date Issued:
Receipt No.:
Comments Date Initial
Final Inspection Approved: .3 -2-7-8-5-
Date Initiap
Rejected:
Reason Date -Tn i -ti a 1
** PERMIT MUST BE POSTED ON JOB SITE **
Wh.ite Copy - File Green.Copy Inspector Buff Cop.y - A l' t*
ican
Side Sewer Drawing
The City of Edmonds
EASEMENT NO - ----------------------------
NEW CONSTRUCTION REPAIRS LID NO - -------- --------- - ASMT- NO - ----------------- tl
OWNEP - ------ BF_L - ------ I-J-0 Y
.f
----------------------------------------- CONTRACTOR
---- ------ Cap4
- ------- PERMIT No.72,94
...... ....
... G..Tl
JOB ADDRESS JR2-0-5 ------- 7 AN - - ---------- LEGAL DESCRIPTION: LOT NO - -------- 4 ------------------------ BLOCK NZ
IL i4w.00011W[
----------------------------------------- ----------- --------------------------------------------------------------------------------------- ---------------------
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PWW-0001-1 1/75 (REV. 11/78)
NAME OF ADDITION ------------
714 W.
18205 r7(,,,,..-
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WNPOC
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C.O. CAP
14.5'
Approved:
DATE
---- 44- -----------
CITY OF EDMONDS
NEW
ADDITION
ASSET INFORMATION SHEET
STREET -,FLE'�.
"ASSET NO.
ADDITION TO ASSET NO.
1:1 RETIREMENT
DESCRI PT 0
SERIAL NO.
LOCATION
DEPT 0
"PURCHASE ORDER NO.
14
.PROJECT NUMBE
PURCHASE ORDER DATE PROJECT COMPLETION. DATE
c
,ACCOUNTNO. 4111-,0. 40 0 -0.
ESTIMATED LIFE
INITIATED BY DATE BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENt REQUEST,
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT"
ACCOUNTING ONLY
EIDEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
CG.L. ENTRY
REFERENCE
COST
B.A.R.S
VA I tom 14Y.
DATE .7
INITIAL
%np
DEPARTMENT FILE
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STREE
CITY OF EDMONDS
I ov-c Qfttla - lowoftos, 0 G ION
41L COMfqCIAL
jSlh'GLE IA14ILY IIULTIP COME qC I Al
PROJECI NME
ADDRESS
171".
ACCESS SLOPE AND VEHICLE ACCESS
DRAINAGE PLAN
STREET FILE
LEGAL DESCRIPTION VERIFICATION
,QUIT CLAIM/DfDICATIONS
CASEMENT - PUOLIC/PRIVATE
CALCULATE SEWER CONNECTION IF NO LID 0
STREET PAVIxa RtQt
CURB AND GUnfR RE
SIDEWALK REQUIRED
CVRB CUT FOR DRIVE
Al CMT-OF-WAY CONST
I& I ALYWA RLL)
Ow u XtqUIR1D FOR P Ll
STREET xAmE SIGN REQUIP
OTHER SIGNING REQUIRED
NOINEERING A
P R 0 J E C T
PUBLIC WORKI
REVIE'
CHECK-- LIST
CONTACT NA.'IE & TELEPHONE NUMBER
(ADDITIONAL COMMENTS On 8
1XISTINC. WATER MAIII SIZE
WMR MAIN REQUIRED
A/ � /4
SERVICE Ulf REQUIRED
HYDRANT SIZE fXISTII(G
HYDRAJIT RfqUIRED PER FIRE coo( SIZE
CROSS.CMNECTION INSPECTION
WATER fIfTER CHARGE REQUIRED
REVIEW BY
DATE ZZ 1� (MOITIOILAL COPKNTS ON I
SANITARY SEWER MING IIUVBER FILE WIBER
w SIDE SEWER AVAILABILITY SANITARY sEwcR COIIIECTIOII FEE REQUIRED
co
>. OPEN DITCH EXIST111r, REQUIpfo
CC CULVERT REqUIRED
< SIZE
CATCH BA -SIN F-EQUIRED INDICATED On SITE PLAN
SHOULDER MANAGE 10MAIM COLLEC71orl ON SWALE OPEN Rutoff
ImMoLl REQUIRED J,
ir INDICATED ON SITE PLAN
0 SOIL CONDITIONYAHIAROWD 140ER FIELD CHECKED if
co ?.EVIE'w By
PAT[ 2,17-.&S (ADDITIONAL COMENTS'
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
7-
MAI G ADDRESS
'q A-g&
C TELEPHONE NUMBER
C, ,� - / &I
]�117_30
NAME
0 ILI
A RESS
Do Cy '? 0 (�p 5,
USE IWPERMIT
ZONE�CS _j g, NUMBER
JUB
ADDRESS
to
LEGAL DES? OIT
SUBDIV ISION NO
NO.
,�Kj
L
ILID
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
PROPOSED
Z
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED CJ W
STREET USE PERMIT REQUIRED 0 W
Z
SEE ENGINEERING MEMO DATED —
SEE PIW DEPT. REVIEW CHECK LIST D ED
REMARKS,#
METER SIZE IBUILDING SUPPLY SIZE IFIXTURE UNITS
CITY TELEPHONE UMBE9, C
7? REMARKS
STATE LICENSE NUMBER CITY LICENSE NUMBER I
Legal Description of Property - Include all easements
(show below or attach four copies)
NEW RESIDENTIAL
PLUMBING
ADDIALTER
NON-RESIDENTIALJ
MECHANICAL
REPAIR
RETAINING WALL
SIGN
1:1
E]
EXCAVATE
FENCE
DEMOLISH
OR FILL
x _ FI)
r_7 PRE -MOVE INSPJ r--j swim
1:1 SIDE SEWER
El WATER LINE
El
1:1
1:1
1:1
NUMBER OF STORIES
NUMBER OF
I IUWhLLINU
UNI I S
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
SIGN AREA ENV. REVIEW ADEI NO.
ALLOWED I PROPOSED COMPLETE I EXEMPT
SHORELINE #
VARIANCE OR CU JP�ANNING REVIEW BY A
YARDS 04 LOT CQVERAG�,
f'16 FRONT SIDE li")0 A) 6 REARI.
REMARKS
wll� CAIL)t)E,
CHECKED BY ITYPE OF CONSTRUCTION ICODE I HEIGHT
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP LOAD
0 YES 0 NO I I I I
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
cation: 180 Days
1 Year - Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
u)
successors in interest, agrees to indemnity, defend and hold
20
harmless the City of Edmonds, Washington, its officials,
m
employees, and agents from any and all claims for damages of
POD C',
a:
<
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of. this permit shall not be deemed —
modify,.waive or reduce any requirement of any city ordinance
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nor I.imit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authoriz-
AUTHORIZES
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code.of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tlQ,qlnsurpncg.
INSPECTION
S1IG_�ATU,REjWNER OR AGENT) DATE IGNED
DEPARTMENT
CITY OF
EDMONDS
ATTENTION
771-3202
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
VALUATION
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL'S SIGNATURE
DATE JAN 2 11981)
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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DATE:
MEMO TO: Building Division
Planning Department
FRO,M: Engineering Division
Public Works Department
SUBJECT:
After review -of the subject Bui . lding Permit application, vie have the following
Comimen�Ls
1. Connect ion to C i ty via ter s ys tem requ i red
2. Co nnection to Ci ty san i tary s-ewer sys tem requ ired..
3. R I ght-o F-way permi t requi red for any work on Ci ty property .
4. Oriveway slope not to exceed 14".
-instairs plumbing is beloa elevation of
Back%,ia'er valve required if do�.
upstre m manho e.
6. I -later and sewer lines to be separated by 10 foot minimum.
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MEMO T(61 g Official
Building Department
FROM: City Engineer
Engineering Department
SUBJECT: SEWER CONNECTION CHARGES
18205 - 76th Ave. W.
(Street Address)
Wayne Meyer
Owner)
DATE: Marchal 1982
Single Family Residence x Subdivision Plat
PRD Multiple Commercial
LEGAL' DESCRIPTION: Lot 1 of Snohomish County Subdivision of
Lot 5, Block 3, Admiralty Acres, Section 18, T27N, R4E.
I
Z.F.F. Calculation:
87.8151 Z.F.F. x ( .5.50 $ 482.98
Lateral x( $
Units(s)x( $25.00)
jak
cc: Owner
Street address file
C�?--I�j 3/5,�, /tr2-,�
Rhdnda March' ,' Dt
Assessment
Lateral Charge
Equivalent Count
(when applicable)
Trunk Charge
Permit
TOTAL