18226 85TH PL W.PDFIIIIIIIIIIII
8051
18226 85TH PL W
0 0
ADDRESS: !S,2D-(, W -
TAX ACCOUNT/PARCEL NUMBER: 00-7-7&c� 0000 1 t
BUILDING PERMIT (NEW
COVENANTS (RECORDED)
IN w
I mf ON,
CRITICAL AREAS:- qq— 0 1 -?1 - DETERMINATION: F] Conditional Waiver n Study Required �4,waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER): gc) Ljj
PLANNING DATA CHECKLIST DA
SCALED PLOT PLAN DATED: �j 0� I qq
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED: Q /& /cqc00
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DA
LID
LOT: BLOCK:
LATEMP\DSrs\Fomis\Street File Checklist.doc
I
The City of Edmonds
Water Sorvice Drawing
I-ASEMENT NO . ...........................
NEW CONSYRUCTION KEPAIRS Lji; 110 . .................. ASMT. NO. - .................
OWNER..................................... . .......................... I ........................ ... CONTRACTOR ................................. ..............................
JOB
Or
i
to
r-j
�?vuq �\ 11,EGAL DESCIUPTION: LOT. NO . . ................................
A * t
r4
t",)Tlr,,'E: NO WARRANTY OF ACCURACY. The information shown on the
adackd map was compiled for use by the City d Edmonds, its employees
Pend consultants. The City of Edmonds does not warrant the accuracy d
cnylhing set forth on the map. Any person of entity requesting a copy
conduct an independent inquiry regarding the information shown on
tha map, including, bit not limited to, the location of arry sewa stub shm
Such sewer sbbe may or may not e)dst and may or may not exist at the
Imlion showfL Neither the City of Edmonds nor b employees or officers
shall be liable for Ow information given on We nuy% nor for arry oral
felxeset" paAded bued W= aW 991PL
PViV4-00U1- 11175 (REV. I V78)
NAMEOF ADDITION ............................................ .........
Uj
P.-
Approved:
DATE...................
CITY OF EDMONDS
8 9 0 � A 9"
Address of Construction:
Property Legal Description (Include all easements):
L
1! 0- "N
Tmr 1W
SIDE SEWER
PERMIT N 0-
Owner and/or Contractor: S 42� C,4 %7V 0 A^ �1 S:
State License No. /"I Building Permit No.
6k
&Single Family
0 Multi -Family (No. of Units
El Commercial
El Public
,90 DW).15
PERMIT
9120
Invasion into City Right-of-Way:,n\No El Yes
RW Construction Permit No.(
Cross other Private Property:Z2LNo El Yes
�ttach legal description and copy of recorded easement
CEDMONOS
#2A T 7ihuA r 2. n
JJ
I certify that I have read and shall comply with all city requirements Date
as indicated on the back of the Permit Card.
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION
OFFICE USE'ONLY'
FOR INSPECTION CALL.771-aM, PUBLIC
Permit Fee: Issued By
Trunk Charg Date Issued:
Assessment Fee: Receipt No.:--/—,
Lid No.:
S DEPT. *
Partial Inspection: Date Initial
Comments
Reason Rejected: Date —Initial
Final Inspection Approved: Date Z-2-20 _� Initial"91-111,
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3190
i
The City of Edmonds
Side Sewer Drawing
EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION Z REPAIRS Fj LID NO . .................. ASMT. NO . ..................
OWNER ...................... .......... ......................................................... CONTRACTOR ... .... g
..... iil� ........................ PERMIT NO.
JOB ADDRESS ----- Z$12.6y:7 ... 6 --- .......................... LEGAL DESCRIPTION: LOT NO. BLOCK NO . ....................................
NAMEOF ADDITION --------------------------------------------------------------------------------------------------------------------- -
Approved:
0
40
PWW-0001 -11/75 (REV.1 1/78) DATE .2-2.72000 ..................... B — --------------------------
NOTICE:
NowarrantyOT ached
The -information'shown on the att
map(s) was compiled for use by the City Of
Edmonds., its Employees and Consultants.
Th.e City of �Edm.onds does not - warrant the
accuracy of anything set for.th on t hese
rnap(�_). Any person or entity -requesting a
copy should conduct an independent
0 -ation shown on
inquiry regarding the inf rm
_tFe -map(s), including, but not limited to, -h
th'e lociation of any sewer stub shown. Suc
-not exist and may
sewer stubs may or may
or may not exist at the location shown.
o nor its
Neither the City of Edm 'nds
empl-o-yee's o'r office-rs -shall be 1-lia-b-Ife for the
n on this ma p(s), nor for
information give
any one representation provided based
upon said map(s).
Liz"
AP By NG
APPROVED
e5r2,1 rL.
R 13 ", - ; tk T F
TH' LE
c"T R.
f)E\l 011,041
I-Lov OF
F __, q((-f (tozg",-
epO16 a) e
,Vj
W/Nmm �1,qa
Iftj 1111mm
5A-r6c4 Arm
1A P? W,7AW1
ti U-IC4 H I'
A - o,, 14'
F� F3. t F�, AVFIZ) ;�07- '�7
j 1,411 -1 --:- 4- Z 2
.7 1 LPZ
+
flu. 0 1 NAK
MAX IZ112c4— E:
P RO F6 M rZ I DC4 ff
A t%�
PROJECT ADDRESS;
18226 85T" PLACE W
EDMONDS 98026
OWNERS:
BETH AND TONY NAUGHTIN
6526 142"" PL
EDMONDS 98026
TAX NO: 7762 000 Oil 0000
LEGAL: LOT 11 PANORAMA POINT
SCOPE OF PROJECT:
NEW 2 STORY CUSTOM HO ME
2088.7 SQ FT / 2141. 3 SQ FT
793 SQ FT 3-CAR GARAGE
CONTRACTOR:
THUESEN CUSTOM HOMES
18225 85" PLACE W
EDMONDS 98026
425 - 670 - 3669
I LIC. THUESCH020PO
ZONE:
LOTSIZE: 12,197 SQFT
GRADING: 2 1 If.3"CU YDS. +
HEAT: GAS F/A
E
LI
ID:
Critical Areas OldATA#: 17762-000-011-OE'—
New ATAM
New.. Undod Find.. Exit .
..... . ....
Review Number:
ICA-1999-0179
Date Received:
F72-�7
Applicant:
Fhuesen
J
Bldg Number:
Street Name:
185th
Suffix:
JPL Dir: 1W Suite:
Int?:
streets:
DetermDate:
' F7759
Determination:
lWaiver
Staff Person:
IKawamoto
Notes:
77—
AP B' NNNG
Liz"
0
/,Azl�- K.,
RFCF I'VSD
4 1999
Ell"lr,,ES r,-f
Mot4
F-LopUF-14F' ID
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epO16
Co V F-T
r III Ilk
lu
> 1AV af�
f�lcl 4 T
A - 15,14 1 -
P, 5, t F31 AV F R) 4ol. 5,
APPROVED B/)' PL, D - -414 -
12-4 4 .1 2
q7/rvo .71�p 1 Z
+ ZrV
NAK
MAX PlIOC4- E:
04
LE
PROJECT ADDRESS;
18226 85TH PLACE W
EDMONDS 98026
OWNERS:
BETH AND TONY NAUGHTIN
6526 i42'4" PL
EDMONDS 98026
TAX NO: 7762 000 0110000
LEGAL: LOT 11 PANORAMA POINT
SCOPE OF PROJECT:
NEW 2 STORY CUSTOM HOME
2088.7 SQ FT / 2141. 3 SQ FT
793 SQ FT 3-cAR GARAGE
CONTRACTOR:
THUESEN CUSTOM HOMES
18225 85TH PLACE W
EDMONDS 98026
425 - 670 - 3669
LIC. THUESCH020PO
ZONE:
LOT SIZE: 12,.197 SQ FT
GRADING: 2 4 tf,.3CU YOS. +
HEAT: GAS FIA
1 0 C1 - I -I q
CA FILE NO. - �
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/ topography/ hydrology/ vegetation)
1. Site Address/ Location:
2. Property Tax Account Number: -7 '7 U' 2- 0 0 C) C) (D 0
3. Approximate Site Size (acres or square feet)
4. Is this site currently developed? __�Iyes;
no.
If yes; how is site developed? ��_) ckk \J k�z, (0 1\
Q
� 2-a--, o
5. Describe the general site topography. Check all that apply.
��, Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical
rise of 10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over
a horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodwav floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are
year-round? Flows are seasonal? (What time of year? A6�
10. Site is primarily: forested J meadow ;shrubs n-dxed
urban landscaped (lawn,shrubs etc) V t��
T__
11. Obvious wetland is present on site:
- — -------------- - -
-ity Staff: Use: 01 y, ......
For:Q
Site is Zoned.
OET k RM INATI . 0 . N
Aca_clik.doc; Rev 02/11/97
City of Edmonds
'W,W CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City of
Edmonds prior to his/her submittal of a development
pen -nit to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The
information needed to complete the Checklist should
be easily available from observations of the site or
data available at City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a deten-nination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
O.wner/Applicant:
Name
P L W
Street Address
q
city State Zip
L-GZ —3 (a
Telephone
Signature
Date
creception\jaWcaddoc
Applicant Representative:
Name
Street Address
city - State
Telephone
Signature
Date
Zip
(over)
I -�- (3
z? C . 1 S9
July 13, 1999
Eric Thuesen
1822585 th Place West
Edmonds, WA 98026
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building - Engineering
Subject: Determination regarding Critical Areas Checklist # 99-179
BARBARA FAHEY
MAYOR
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is locatqd on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
.................................. : ....................
IMPORTANT INFORMATION TO BE NOTED.,
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIS OR CRITICAL AREAS STUDY,
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL .40
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Pennits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Enc: Critical Areas Determination
* Architectural Design Board
C:ReceptIon\Jana\CRLTR.doc
Thank you.
Sharla Graham
Planning Secretary
Incorporated August 11, 1890
Sister City - Hekinan, Japan
District :� 5-75
City of Edmonds — Water Department
TAP CARD
Reading: D a t e (_,oh &J9 9
No.,A!L-� No.
Meter { Size3j+L, Tap { Size
Mfgrs. No. ff'5'4106&-71- Stvle sc--�Jsus-
Purchaser: et
Serv. Add. 85f h Pb Uj
Lot No. Blk. No.
Add.
Residential:
Other:
Meter Locatio
Service Ma
Pressure
Date of Work (c)ZZL9 9 �
I . V1. Z.J, f) - 2� — Foreman
OUTGOING
Index- Reg.
-Route Bk.
Stencil- Card
T'KTf-t-%AXTXTl-_
T_ J_
CA FILE NO.
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/ topography/ hydrology/ vegetation)
1 . Site Address/ Location:
Property Tax Account Number: -7 �. 41— C
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed? �\Yes; no.
If yes; how is site developed? &
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entirc site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical
rise of 10-feet over a horizontal distance of 33 to 66-feet).
S te�p� grades of greater than 30% present on site (a vertical rise of 10-feet over
a horizontaf-distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contal ns areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain(NC_: of a watercourse.
9. Site contains a creek or an area where water flows across the gro unds surface? Flows are
year-round? Flows are seasonal? (What time of year? A6_�o
10. Site is primarily: forested ; meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site:
ca_chk.doc; Rev 02/11/97
PLANNING D
NAME:
SITEADDRESS: J922,49 35A19ZAIDATE: I
ZONING: PLAN CHK#:
PROJECT DESCRIPTION: MW 9'L-
CORNER LOT---�—)(Yes/No) FLAG LOT —(YesINo)
SETBACKS:
Required Setbacks:
Front: 06 Left Side: IQ Right Side: 119 Rear:
Actual Setbacks:
Front:--7,,!�� Left Side: /,0 Right Side: 10 Rear: !::Z�
Street map checked for additional setback required?_ — 4_1 ' _(Yes/No)
LEGAL NO NCONFORMING LAND USE DETERMINATION ISSUED IQ 0 (Y/N);
LOT COVERAGE:
Maximum Allowed: �2ao (��,?2A&ual:
BUILDING HEIGHT:
Maximum Allowed:- Actual Height:—.
C
Z6
Datum Point: 7 If Datum Elevation:
A.D.U. CREATED?: No
SUBDIVISION:
CRITICAL AREAS #: ff —4�
SEPA DETERMINATION: IVI P
LOTAREA:
4
CoUPT
A A
aj
'71L I
esr-24 ru. W.
0c) R-r H N.-
RF.CF
.IVED
- AUG 2 4 1999
DEVELO,PMEENI . SERVICES CTR.
C Ty OF EDmONDS
1".0
11D
*_000 ohi
Vw
XIA4% Aw
-*, �? 4w'o � I a w
A 14
F� F5 t $,I AV F IZ )- ;�07. c;,'
c ;� co 1
12, S144
12 qq.1 —' 4-- -2;, 1 Lp z-'
+
;� * U.
FIAK lZIPCIE: 10�,&.OZ�l
FROFO-17EV lZlDC4e* 3,sr7.c7
D4k(� PT C-b- 4 -A
PROJECT ADDRESS;
18226 85'"H PLACE W
EDMONDS 98026
OWNERS:
BETH AND TONY NAUGHTIN
6526 142 NbpL
EDMONDS 98026
TAX NO: 7762 000 0110000
LEGAL: LOT 11 PANORAMA POINT
SCOPE OF PROJECT:
NEW 2 STORY CUSTOM HOME
2088.7 SQ FT / 2141. 3 SQ FT
793 SQ FT 3-CAR GARAGE
CONTRACTOR:
THUESEN CUSTOM HOMES
18225 85-m PLACE W
EDMONDS 98026
425 - 670 - 3669
LIC. THUESCH020PO
ZONE:
LOT SIZE: 12,197 SQ FT
GRADING- %A.1-4,SCU YOS. +
HEAT: GAS F/A
Tt\e SIA_e�tq-
Q-1
AUG 2 4 1999
-t4l SERVICES CTR'
DEV%opV"'-o"f' EDMONDS
L i Z" 1,
"T flf"qLE
ss, tE � r�
I
yo
\yx
Wk
Co V F-T
I 'ID.
--------------
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tf,
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5-0
MING,
DMMC
o�-" 7-0 PROJECT AbbREIS; L
rus tic sY57c-7K5r4,,11'7 18226 85TH PLACE W
P&re. EDMONDS 98026
OWNERS:
BETH AND TONY NAUGHTIN
6526 142NO PL
EDMONDS 98026
TAX NO: 7762 000 0110000
LEGAL: LOT It PANORAMA POINT
SCOPE OF PROJECT:
NEW 2 STORY CUSTOM HOME
2088.7 SQ FT / 2141. 3 SQ FT
I�EKC- "1507 793 SQ FT 3-CAR GARAGE
CONTRACTOR:
THUESEN CUSTOM HOMES
18225 85.. PLACE W
iz A - 14 'LfO3-7.-?tITZA-J'�'-c,k,('-EDMONbS 98026
F)ZAVFIZ) ;�01-157' �j C->,
425 - 670 - 3669
3 liz,
-5,
3)o �o 'TAV"o i
LIC. THUESCH020PO
2-7
12. q I Lp Z-, ZONE: ---------
+ ?-�.l LOT SIZE: 12,197 SQ FT
.4 r; U. o P GRADING: 2A6Y CU YOS. +
MAX lZIPCIE: HEAT: GAS F/A
r L - Ll -,A a i-- P--r
r. V-,Ao ( ta �Cr, C-%.
VKF -301,
CITY OF EDMONDS
ZONE PERMIT
NUM13ER 6,G)
CONSTRUCTION PERMIT APPLICATION
JOB 7> SUITEIAPT
ADDRESS
OWNER NAME/NAME OF BUSINESS
T K Cu S 'V\
LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
LID NO.
M
LU MAILING ADDRESS
0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING lCel -5 REQUIRED DEDICATION C2
TESCP Approved C17
RW Permit Required 0-
Street Use Permit Req'dV. 11
CITY ZIP
I
TELEPHONE NUMBER
U 0 � . V%, c" 0__�
IlD 5`10
Inspection Required C3_
PROPOSED
Sidewalk Requirede< 11
NAME
METLEFISIZf
LINEJIZE
NO. OF FIXTURES
PRV REQUIRED
YESX NO
LOU ADDRESS
REMARkS ilV,17 ij
L)
'�11
I,V� P,,- 7';11,,v/
cc
w
w
cc CITY
TELEPHONE NUMBER
av-0 C(
cy.
IL)g I -Se
/7,�/ zgk/ ct� /r-"V,/,--
2
NAME
-;e V/,
M ADDRESS
0
NGINEERII�G M7MO DATED REVIEWED BY
L)
7� V_-9 (:� & 14
C
(r CITY ZIP
TELEPHONE NUMBER
Z
11-r 2 � 1) 0 '� k, �� 7
IRE MEMO DATED REVIEWED BY
Lu
0
L) STATE LICENSE NUMBER EXPIRATION DATE
(-A\ 0-2-c)-20 115 b
VARIANCE OR CU
ADB#
SHORELINE #
Legal Description of Property - include allbasletrients
Z
SEPA REVIEW
COMPLETE EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED IPROPOSED
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT UR SIDE REAR
0
UJI
u.' Property
Tax Account
G C) c,
L A
n, /
R VIEW
ATE
Parcel No.
RI
LIMARKS
-NEW RESIDENTIAL L44 PLUMBINGIMEC.H
02 49.0,7��
A01
awE i
COMPLIANCE OR
E] E]
ADDITION COMMERCIAL CHANGE OF USE
,
�a�)1)7_ AA7<'1)A) 161 A -1;;r
E] APT.BLDG._ F�
)l
REMODEL SIGN
HECKED BY TYPE OF CONSTRUCT!gODI,
— q
CODE
"_
OCCUPANT
GRO4U��
I
FENCE X_
1:1 R 22A CYDS. L_ x
REPAIR —FT)
WOODSTOVE SWIM POOL
DEMOLISH INSERT HOT TLIB/SPA
.
SPECIAL INSPECTOR
AREA
?_ I U,
OCCUPA*N
5�U
REOUIRED 13 YES 126ghllz
1AZA.
LOAD
G ARAGE RETAINING WALL/
RENEWAL
REMARKS
L�aj CARPORT ROCKERY
0
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
PROGRESS INSPECTIONS PER UBC 108
Z
D
4-fzg�-/, j�3 dI
NUMBER
OF
CRITICAL
W
0 OF
[.N.UMBER
ELLING
AREAS
STORIE
UNITS
NUMBER
1144 pg42 199::l j A/i gjt�
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTISN-REOUIRED
N tj Q_
VALUATION
FEE
PLAN CHECK FEE
BUILDING
U1
HEAT SOURCE:
LAZING
7
%
PLUMBING
Plan Check No. qq-
MECHANICAL
GRADINGIFILL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewolks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAG E FEE
I
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
/Ur
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
n
provision."
(0)
I herebv acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
APPLK;ATION APPROVAL
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
T his application is not a permit until
ed thereby, no person will be employed in violation of the Labor
ONLY THE
.
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Insurance aria RCW 18.27.
INSPECTION
acknowledged in space provided.
IG ATURE OnN RPR AGENT) DATE SIGNED
DEPARTMENT
OFFICIAL'S DATE
CITY OF
EDMONDS
SIGNATURE
ATTENTION
CALL FOR
INSPECTION
IRELEA D BY DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL — File YELLO�V — inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBG
SECTION 109
PINK — Owner GOLD — Assessor
V
City of Edmonds Permit No: -1.7.
RIGHT-OF-WAYCONSTRUCTION PEIMIT issue Date:
v"01
A. Address or Vicinity of Construction: & es
B. Type of Work (be specific):
-T KU jp� St'
C. Contractor: f� 6-A STOA/�, Contact: AA
JA
Mailing Address: ( YJ t 1 L L;J - Phone:— L(
State License #: t �-( Q ia � C " o 2- 0 P'O
D. Building Permit # (if applicable):
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. Commercial Subdivision City Project F] EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
Multi -Family Single Family F1 Other
INSPECTOR- W 9 17r_ U
F. PAVEMENT: . . [-]YES aNO G. SIZE OF CUT x H. Charge: $
CONCRETE CUT: E] YES (2 NO
IDEMNITY. 'Applicant understands -by hislher signature to this application helshe holds the City of Edmonds harmlessftom injuri�s,
damages or claims of any kind.or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any of its departnients or e4loi�es, including but not limited to the defense of any legal proceedings including defense costs and
attorneyfees by reason ofgranting this permit.
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 TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
* Traffic control and public safety shall be in accordanc . e with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
* Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved matef ial prior to the end of the workday - NO EXCEPTIONS.
* Three sets of construction drawings of proposed work are required with the permit application.
I HA VE READ THE ABO VE STA TEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND A CKNO WLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature: Date:
(Contractor or Agent)
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
Approved by: Q CI*L- FOR CITY
Time Authorized: Void After /100
Special Conditions:...- Par— A00Ae0yFp- pto�h /'
K —ONLY
Right-of-way Fee: 10-
Disruption Fee/Fund 111:
Restoration Fee:
Total Fee: '70— -
Receipt No: 7-J
Issued by: —
UPON COMPLE ' TION-OF PE ' RMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS RiQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT -CODE.
I
FINAL APPROVAL OF PERMITTED WORK. I -
INSPECTOR'S SIGNATURE DATE:
For inspection requirements see Engineering Information Handout.
I NO WORK SIIAIA� 13EGIN PRIOR TO PERMIT ISSUANCE