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18330 72ND AVE W
ADDRESS:
TAX ACCOUNTMARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver E] Study Required E] Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED.
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORTPLAT
SII)E SEWER AS BUILT DATED: W /,
SIDE SEWER PERMIT(S).#:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
LOT: BLOCK:
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PERMIT EXPIRES.
SIDE SEWER PERMIT,
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Address of Construction: A � 30 .11 LYD #
Property Tax Account Parcel No..
Attach copies of all access and utility easements Verified and Approved b
Owner and/ r Coniracto ii�;'ti 4e
Contractor License Building Permit
2rSooingle Family
Multi -Family (No. of Units
F1 Commercial (No. of Units
E] Public
Invasion into C.ity *Right -of Way: 0 Yes 21
*RW Construction Permit #
'�No�
Cross other "Private Property: El Yes
**Attach legal description.and copy. of recorded easement.
Owner or contractor signature and acknowledgement statement:
By signing for this permit I certify that I have read the'City's public handout entitled
Side Sewer Specifications, and shall comply with all City requirements outlined therein.
W CALL DIAL -A -DIG (1-800-425!"5555) BEFORE ANY EXCAVATION. W�
FOR INSPECTION CALL 425-771-0220 extension 329� W
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
.. .... .... . . ..... . .........
.. . . ....... .. . ... . ..... . FOR OFFICE USE ONLY
....... .. .. .......
Permit Fe e$ Repair Fee Issued By:
Trunk Charge $ Date Issued:
Assessment Fee Recei0t No:
City Permit Surcharge'Fee $5.00 Total Fees Paid
NOTE: IF JOB SITE IS NOT READY -FOR. INSPECTION WHEN.
INSPECTOR ARRIVES A $45 RE -INSPECTION F EE WILL BE CHARGED.
Job Site Ready YES NO Date:. --)nitial:
Partial Inspection: Date,: Initial:
Partial Inspection: Initial:
Date:
Off As -,built to Street File: 'E]
FINAL INSPECTION APPROVED: Date: Initial:
T� PERMIT MUST.BE.POSTED ONJOB SITE T,!�
White Copy: File Green Copy: ln�pector Buff Copy: Applicant
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CITY OF EDMONDS SIDE SEWER AS -BUILT
ADDRESS
PERMIT
18330 - 72nd Avenue West
9480
HOMEOWNER
CONTRACTOR
Point Construction
DATE
DRAWN
June 12th 2001
BY Jim Roberts
'y")
V
1".2 C. 1 S 9 U
City of Edmonds,
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number.
Lssue Date:
A. Address or Vicinit . y of Constructiow 721*1f
B. Type of Work (be specific): /V
C. Contractor: `�Z4 4z d
Mailing Address: 0 61T --- - — -----------
State License #:
Contact:
Phone:
Liability Insurance:
Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):,
E. [J Commercial El Subdivision 0 City Project A Utility.(PUD, GTE, WNG, CABLE, WATER)
FJ Multi -Family El Single Family Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: '0 Yes 0No - G. Size of Cut: x H. Chargq,,$
APPLICANT TO. READ AND SIGN
INDEMNITY: Applicant understands and by hissignature to this application to holdthe City ofEdmonds harmlessfrom injuries, damages, orclaims ofany
kind *or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, including or. not limitedto the definse ofany legal proceedings including defense costs and atiorneyfees by reason ofgranting thisperniii.,
,THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND AIA TERIALS FOR A PERIOD OF ONE YEAR FOLLOT17ING THE FINAL INSPEC-
TION 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 W11 L BE PROCESSED FOR ISSUA AICE TO THE APPLICANT
Two sets of cons ' truction drawings of proposed work required.with permit application.
A 24 hour notice is requiredfor 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 timesfor inspection purposes.
Signature., Date:
(Contractor or Agent)
CALL DIAL -A -DIG,. PRIOR TO BEGINNING WORK
FOR CITY USE ONLN'
APPROVEDBY., RIG] IT OFINAY FEE:—
TIME.AUTHORIZED: vOID.AFTER DISRUPTION FEE/FLIND
.....Jaw 11==17 DAYS, . ..... .. ... .
SPECIAL CONDITIONS: RESTORATION FEE:—
TOTALTEE:
RECEIPT NO.:
J
NO WORK SHALL BEGIN PRIOR -TO PERMIT ISSUANCE. Eng. Div 199'7
-77-77
FIELD INSPECTION NOTES (Fund.1111 Route copy.to Street Dept.)
Comments: -
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date: