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18403 74TH PL W
PERMIT NO: .93,34'.
City of Edmond
PERMIT EXPIRES (to
14C. SIDE SEWER PERMIT
LID#
Address of Construction:
Property Tax Account Parcel No. 441-26 '000 (62, CIO
Attach copies of all access and utility easements Verified and Approved b
Ownerand/or Contractor: RXW
Contractor Licensek skt-vao e 014 t'j-z- Building Permit
[21Single Family Invasion into City *Right -of Way: El Yes No
F] Multi -Family (No. of Units *R.W Construction Permit #
0 Commercial (No. of Units Cross other "Private Property: E] Yes ;4NO
F-1 Public "Attach legal description and copy of recorded easemeiit.
Ow'neri/Cont_rac_tb)r
Owner or contractor signature and acknowledgement. statement: Date'
B i ning for this permit I certify that I have read the City's public handc��
y Sig
ide Sewer Specifications, and shall comply with all City requirements outlined therein.
2 CALL MAL-A-DIG (1-800-425-5555) BEFORE ANY EXCA.KkTION 2
'WeRis-
WTOR INSPECTION CALL 425-771-022"0 extensionMr-1
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
.. . ... .......
....... FOR OFFICE USE ONLY
....... . ......... .
Isso,
Permit Fee $ 10, -Repair Fee $ ed B 4-4\ C�_
Trunk Charge.$ Date Issued:
Assessment Fee $ Receipt No:
City Permit Surcharge Fee $5.00 Total Fees Paid $ C-)
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION, WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO+ Date: Initial.
Partial Inspection: Date: Initial: -
Partial Inspection: Date: Initial:
4
FINAL INSPECTION APPROVED: Date: Initial:'. D Asrbuiltto'Street'File:
+ 1,� PERMIT MUST BE, POSTED. ON jOB SITE,'M
White Copy: File, Greeri Copy: Inspector Buff Copy: Applicant
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EXISTING 6'
LATERAL
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PROPOSED C/O
22*
EXISTING HOUSE
PROPOSED 61 BEND
LATERAL
CITY [IF EDMONDS SIDE SEWER AS -BUILT
ADDRESS
18403 74TH
PL W
PERMIT
NUMBER 9334
HOMEOWNER DAN GREEN
CONTRACTOR ACORN ENTERPRISES
DATE
xxxxxx
DRAWN
ISMAEL ABILA
BY
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Permit No: 9X I
City of Edmonds
RIGHT-OF-WAY, CON. STRUCTION PEIMIT. Issue Date: -I—lo
A. Address or Vicini of
Tim
B. Type of Work (be specific): EUX ML tA-
-7 4) W - LU -
C. Contractor: Contact:
Mail ing-Address! h\k'08V1L14Q[)AW041Qe: -3q9-C>-7lZ_
�tdte License #: ku:a� F, 4-, c) 14 �J -Z_ Liability Insurance: Bond: $
D. Building Permit # (if applicable): . Side Sewer Permit # (if applicable
E. Fl.Commercial Subdivision EJ City Project F] EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
E] Multi -Family ��Single Family F] Other
INSPECTOR.--
F. PAVEMENT: E] YES 0'*N'O G. SIZE OF CUT �x H. Charge: $
CONCRETE CUT: YES. �20NO
APPLICANT TO READ AND SIGN
IDEMNITY.- Applic�nt understands by hislher signature to this application helshe� holds the City ofEdmonds harmlessfrom injuries,
damages or claims of anj, kind or description whatsoever, foreseen or unforeseen; iWdt may be made against the City of Edmonds or
any*,?f its.departments or-emplbyee�s, 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 TIMEA DEBITOR CREDIT WILL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT.
Traffic control and public safety shall be in accordance 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 'material prior to the end of the workday — NO EXCEPTIONS.
Three sets of c6ustruction drawings of proposed work are required with the permit application.
IHA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMITREQUIREMENTSAND ACKNOWLEDGE
TZIA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
(Contractor or Agent)
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO
04- 05 - 6 /
WORK
FOR CITY USE ONLY
Approved by: Cr4m nAk Right-of-way Fee;
Time Authorized: Void After to / 1 /01 Disruption Fee/Fund 111:
Special Conditions: ('-t+LL Fil(Z INSPEC-7iot
J Restoration Fee:
P910(t -r0,P3,#,(X LL,. IOS16LL _RF_R Total Fee:
,?rrkJ '5Tfto4j�_&. A107-IFt AA��Pt Receipt No- 11715�21_1
as , �D Ai -r.-c , PA io -r4 whfu swtwm Issued by:
S7
esnge R-19.W. -10 4/1�1 'I-L±VJAkQ
.................
UPON COMPLETION OF PERMITTED, WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER- CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMITTED WORJ�i�
INSPECTOR'S SIGNATURE DATE: 4-116ZOI
f If
For inspection requirements see Engineering Information Handout.
NO WORK SI-IALL BEGIN PRIORTO PERMIT ISSUANCE