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18624 94TH AVE W.PDFiiiiiiiiiiiiii 15512 18624 94TH AVE W E�MJT, PS' SIDESEWEIZ­�P ITT� OF EDADN AT -:SEWER­DEPAR ENT, ER IT P.ERM T jCalI*, 775-2525 for 'side: sewer pections BEFORE covering any- portion of the- construction.). :r�kInspecti,on :will 'be _p . rovided with! - n '24 hours' after requst. NO Sat., Sun., or' hoUilay ln'�pections. DDRESS-L60in-ON OF -CONSTRUCTION ------- A- :.-'>4 TH .................... ------- ......... .......... ........................................... I .......... ....... .......... k6kiTY4,-,i&AL DES T1 Y.� ........ !Wl� 0 -,tc ........... .......................... ......... 7 ................................................................... ........................ ................... . ......................... . . ...................................... ................................... ................................ . ........... 'QV ......... 7 .... ...... VNER.AND/`0`R: BUILDER.':. ............................................................................ .............. ......... ........................... 7 4 - C MACT01i§�N�6194.,ADDRESS .. .......................................... ... ............ .......... X . ......... ......... . ........ ............ .......... 4 for eijll!.ssion ........... ................................ 19*. --repair and/or connection of, a. side -sewer, to, theL 6 y- sanit�ry, seu�er �iy di— t ern lirvOoj� dnb6.,wit6;ICiPy of* -Edmonds -or hiances­ :.-A'­I;NT1ON 1S-CALLED�TO)'THE.POLLOWING: r4d�E, NO.- ILT;e,,6N�fiers�60the-pioperty may obtain a. berm -it' to -construct 'se'wb� tnslde;.property li'ne.'-'A licensed Side Sewer Con , tract6r-m6st be .�mp I ibyed-to.c6nstrue . t "�slileZ'sewer'jn,street.area�. :,Do.not cover'any.portio of� sewer before, It hds.bedn. Inspected — ''NOTE. No: 2—Alf'woiiJ��e'ri6im5�d­l n city� right -Of ir 'an' Ice- 7way requ es Invasl6lrf- of. Right -of-Way Permit, obtainable; fro -th� CitY..1Engi-eer!..,,'.ff % NOTE -.No' 3�—Obtaln- 1�11' lnfo�nnatibh: regaxding Ordinarice.11 16,030'a governink'ii1die' se'wers -when" -get !�d you permit have at least 30 inches 'coverage -at- pr6perty llne,ajtd 12 inches'Inside,pmPerty, line; min*imum grade - Of- 2%.-_ N Sends I�n grade s-har`per.-Ahsn�iA*�"�will -be pe rmitted. o NOTE &4`rre�&s iuf.9tr;c0rmit be. ��ater settled and surface of.strect restored to 6rIgInaX conditiorr.' Contr , actors. sitah be resplonslbl�67--for 'failure due to Improper -,:.%�ork,,whIehmiLy--d6vcIop �wlthin one'year of completibri. I�9TE No., 6�I t, I s unlawful A o alter or do,any other workz than is provided for In the *permit, or to do any'work on t he- main,sewer pr its kppurte nances exec I pt to in- seft"'the,plbeAntb thb:wye. l- DISAPPROVED ........... * ..................... ,By.-: ............ Date. - ....... ...... By ................. Date .......... ......... ............... By ................ PPR VEU� B 1��­A' 0 ...... Y- .................. I ................................... ........ ......................... . .................................. % ....................... ................................................................................ ............................. . ............................ .......................... ... .......................... M .............. ......... M.­ ............ .................... ................... .................................... ...... ........ ...... ............. %6 J�l -Rift To�-Rd'6tie§�% 2kctibn'l� --Insvec on rM e orming, ons� �ijngd',By '.P. B , OTJU-Pe�h�l For. Hatibrix6fis ructedlmnd6r '-p A� 7 ... ...... ..................... ............. ....... .... §��rhnsti 'hereby certif ,that; the; Sid t y (.0��uqr",VICo" ptracting. . Irm Perfcrmipg !Construct lon,)- 'th r n�tal MIM6ordan`de�wi .,all go)�er��ing-grdipa of the� City of.*Edmond "OL . ............. :n .......... ............. D *t d- thisj-'. .............. (14� V 4 c ]lee WMEFORE, vou dig: for:-.oVVafei,- Gas, Telepilione i�Ower 4A APPLICATION the City of Edmonds for SIDE SEWER PERMIT EASEMENT NO . ......... .................................. NEW CONSTRUCTION E REPAIRS F-1 LID NO. j5­1 ........ . ASMT. NO. owNER -_J�� ----------- ........ I ............ .................. T - -CONTRACTOR ���4�NCOP PERMI NO. SS ........ 'SIEE t�OTE JOB ADDRE NOE LEGAL- DESCRIPTION: LOT NO. _ .................................... BLOCK -NO. 1Z�h: �06e( 17' NAME OF ADDITION ------------------- : ------------- w ................. OC n';7 SLl ID LOT �>B_') _V"ENC� :El> .3� 28��' SCUTV-*_--L,--VF -U_­<- > _F_ :�>YE).':D 2 FEEFI-T. -vo 7w t-_ N1 ccD7 -;-NF"ug F_- NN NLO��A C- f�LIC) Gf)k-,AMot--� L\ �,AFE, L, D�S-%RCI -To E>-\N. CX-7 75LIC�, LC)T E�TF-�_ U-< t=\V__lla V)S_Ts"� 5V:: �0.,C 7(f) L:N \N17- NNF�t�AUE�; TWE-t-ICEE �-A a'- lSL0V-AC=, SLID -Y LO-TS, !:�,S _,�N_ 7-0 -V�4E Approved: DATE.-aaw . ........ By OW_A�1_ -------------- - -- -------- V APPLICATION "the City of Edmonds for SIDE SEWER PERMIT EASEMENT NO . ............................................ NEW CONSTRUCTION E] REPAIRS Cj LID NO . .................. ASMT. NO . .................. OWNER .............. ------ ----------------------- CONTRACTOR ------- - PERMIT NO.t: .......... JOB ADDRESS ------- -- ---------------------- I ..................... -------- LEGAL DESCRIPTION: LOT 1�0 - ------- ......... ---------------- BLOCK NO - ------------------------------------- ------------- -------------------------------------------------------------------------------- I ------------------------------------------------------------------- NAME OF ADDITION ................................................................ k> Approved: DATE----------------------------------- ...... . By .. ....... ... ...... .. .... ---- - --- I 0 Z H Z P4 IC WORKS DEPARIMWF CHECKLI% 'Date BUILDING PER41T REVIEW STREET FILE I Efm a! A: Ajjj=_.NA I Address Street Right -of -Way Existing REQD Access Easements Existing Ylpk� REQD Utility Easement Existing REQD Lot per Subdivision Plat Assessor Map Site Plan Checked for Accuracy Underground Wiring Reqd. Check Accuracy of Legal Description Envirorumntally Sensitive Area Environmental Checklist Reqd. Flood Hazard Zone Shoreline Management Area Slope, Soil, Vegetation Stream, Creek, Drainage Basin Existing Zoning Per Code Amenities Design Board Approval Reqd. Board of Adjustnient Approval Reqd. Review By: Existing Water Main Size Water Main Reqd. Service Line Reqd. Hydrant Size Exis ting Hydrant Reqd. Per Fire Code Detector Check Meter Reqd.. Cross Connection Inspection Fire Department Comments Water Meter Charge Reqd. Review by: Septic Tank Permit Reqd. Sanitary Sewer Availability ADB # Date: Date: Size i)ar-e: Permit No. Proj, Drawing No. File No. Side Sewer Availability Sanitary Sewer Connection Fee Reqd. Review By: Date: Approval . Tq)en Ditch ;F. Culvert-Reqd. Size P� Catch Basin Reqd. Indicate on Site Plan S11oulder collection on s�,7ale open rutioff. H U) !-1-.uihole rcqd. Indicate on Site Plan Soil Conditions and Ground Water Field Checked Revie.\, 7 by rb te kUStreet Paving Reqd. Curb and Cutter Reqd. Sidewalk Reqd. Curb Cut for Drive�,ray Reqd. r4 Right -of -Way Construction Permit Reqd. Bond Reqd. for Public In-provenx-nts Street Nam, Sign Reqd. -iing R�cqd. .10ther Sigi C) �jPre Permit Site Inspection made on 0 BY: SS,1ER U W WATER STREET ENGI=RING Special Requirements listed in mem to Com=ity Developn-en t Departa-,ent, Building Division V1 -BY Date o All item filled in on Building Permit Application BY Date Eq:mTings Stamed and Notations Made 'IBY Date -1, Approved by Public 'Noi. s Deparbnenu .Revised: IV 10-1977 NOTICE: Z, "I In .0...W.a r.r a, -a N ched The -information shown on the atta lied for use by the GtY Of map(s) was Comp Edmonds/ its Empl.oyees and Consultants. Th,..e City ofEdm.onds does ' not . warrant the orth on these accuracy of anything set f M a P ('s"). A n . y person or e.n.tity -requesting a copyshould conduct an.independent Inform'ation shown-o inquiry regarding the -m a p (s),, including, but not Jimited to, er stub shown. Suc the lotation of any sew sewer stubs may or may- not exist and may or may not exist at the location shown. r-ity of EdmoncJ(S/ nor t its Neit-heir the %1_.1 h-a-1-1 be l.`1a. b-'Fe h emp-1.0-yee*5 O*r office.rs *s I I n on this map(5), nor for information give' d entation provided base c -iny 0 ne repres upon said map(s'. iiiiiiiiiiii 9159 18624 94TH AVE W I t?c. isq, City of Fdmwnds RIGH T-OF-WAY CONSTRUCTION PERMIT Permit Number. Lssue Date: -7 A. Address or Vicinity of Construction: - I FL22 0'0-p B. Type of Work (be specific): C. Contractor: P114e ;t &)14�,jCL 'FOC2(Q(,Z-Contact: Mailing Address:__ Phone: State License #: D. Building Perrnit # (if applicable): Liability Insurance: Bond: $ Side Sewer Permit # (if applicable): E. F-1 Commercial E] Subdivision El City ProjectX Utility (PUD, GTE, WNG, CABLE, WATER) Multi -Family E] Single Family EJ 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 harmlessftom injuries, damages, or claims ofany kind or description whatsoever, foreseen or unfores�en, that may be made against the City 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 CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL 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 WII L 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 havb 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 APPROVED BN': 14 tA TI M E AUTHORIZED: VOID AFTER FOR CITY USE ONL�' RIGHT OF WAY FEE: F2 e2' 00 DISRUPTION FEFIFUND I 11: .....SPECIAL CONDITJONS: RESTORATION FEE: T OTAL FEE: on ,.,RECEIPTNO.: I SSU ED B)': NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997 FIELD INSPECTION NOTES Comments: Dfiigram.:' CONTRACTOR CALLED FOR INSPECTION Partial Work Inspection by P.W.: Work Disapproved By: FINAL APPROVAL BY: (Fund 111 - Route copy to Street Dept.) El YES Date: Date: El NO