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18421 HOMEVIEW
DR
C of Edmonds I'll 10:. 9259
ity PERMIT EXPIRES
SIDE SEWER PERMIT
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Address of Construction: 4o( -, - r— LID #
Property Tax Account Parcel No. !q:Z.7G Con
Attach copies of all access and utility easements , Verified and Approved by
Owner and/
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Contractor License #: WA4V 0 C— I* W,3 0 Z. Building Permit
"[�%Sirig le Family Invasion into City *Right -of Way: El Yes -J?I.No
Multi -Family (No. of Uin.'fi'A, *RW Construction Permit
Commercial (No. of Units Cross other "Private Property: [I Yes ZjNo
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F� Public **Attach legal description and copy of recorded easement.'
Ownee ontractor C;� —0
Owner or contractor signature and acIMowledgeme'nt statement: Date
W_y signing for this permit I certify that I have read the City's public handout entitled
ide Sewer Specifications, and shall comply with all City requirements outlined therein.
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
-Job Site Ready YES 140\'� 0\ Date: Initial:
Partial Inspection: Date. Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: IAVAQ Initial: As-builtto Street File:,,
T,� PERMIT MUST BE POSTED ON JOB SITE t-
White Copy: File Green Copy: Inspector Buff Copy: Applicant
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22* Bend
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CITY
OF EBMONBS
SIBE SEWER AS -BUILT
ADDRESS
18421
Homeview Drive
PERMIT
NUMBER 9259
HOMEOWNER xxxxxxxxxx
CONTRACTOR xxxxxx
DATE
01-07-03
DRAWN
JAIME HAWKINS
BY
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City of Edmonds Permit No.
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date:
A. Address or Vicinity of Construction:
B. Type of Work (be'specific):
C. Contractor: ' -kXXZ#_) L-- Contact: �1 61290`3
Mailing Address A-wftn Phone:- 2cr..
L&*..- 9 %:�, 7-Z- 1
,State License- hLQ92t. - 0 1-4 Z, Liability Insurance: Y.65 Bond: $
D. Building Permit # (if applic�able):
Side Sewer Permit # (if applicable):
E. F_� Commercial Subdivision EUC (PUD, GTE, PSE, CHAMBERS, OVWD)
E] CityProject
F-1 Multi -Family E] Single Family F] Other'
INSPECTOR-
F. PAVEMENT: . . [-] YES ZNO G. SIZE OF CUT x H. Charge: $
CONCRETE CUT: F1 YES O'NO
APPLICANT TO READ AND SIGN
IDEMNITY. Applicant understands by hislher signature to this application helshe holds the City of Edmonds harmlessfrom injuries,
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 departments or employees, includifig4�ut 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 YiAR FOLLOWING'THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL. BE HELD UNTIL THE FINAL �STREET PATCH IS
COMPLETED BYCITYFORCES, 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 Cit Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certific I/-
ation verif�ing 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 construction drawings of proposed work are required with the permit applic4iion.
IRAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUiJEEMENTS AND ACKNOWLEDGE
THATIMUST,MAKE THE, PINK COPY OF THE PERMIT AVAILABLE ON SITE AiALL TIMES FOR INSPECTIONS
Signature: Date:
(Contractor or Agent)
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO ]JEGINNING WORK
FOR CITY USE ONLY,
y,2D0qyb
Ap
, .,proved b Right-of-way Fee:
Time Authorized,:' Void After 4 IS 161 Disruption Fee/iund 111:
$pecial-Conditions:....W04K V, C 0 OA 4 Restoration Fee:
aMJATzF_ 7-.0 "W PF_ie Total Fee:—
!��Inglgp-�-, ACZF_/.� Ah6O�Fle_L. Receipt No: -7 0 F3 -2�
10, VF_ R_ �F4 _50-zz s. kw ZV epas)h�o Issued bv: 9�� 4,!e
l4A?r7.F.-rAYJ4f6 15*UA"T
A
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMIT T-ED WORK.- rvm�"Yval .41
&Y'
I. S-AWA*RE, DATE:
11�SUW : I — T��
For inspection requirements see Engineering Information Handout.
NO WORK SI-IALL BEGIN PRIOR TO PERMIT ISSUANCE
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