18723 94TH AVE W.PDF111111111111
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18723 94TH AVE W
ADDRESSJ�7,W3 4v '�Kalrz
TAX ACCOUNTMARCEL NUMBER: —
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: n Conditional Waiver F] Study Required 0 Waiver
DISCRETIONARY PERMIT #'S:— Z- L9-,41 - 7 7
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID
SHORT PLAT FILE:— LOT: BLOCK:
SIDE SEWER AS BUILT DATED: c-Q /c 52
SIDE SEWER PERMIT(S).#: 769, V-A,-p
GEOTECH REPORT DA
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
LATEMP\DS'Ps\Fomis\Street File Checklist.doc
T NO: :9605
City of Edmonds
PERMIT EXPIRE' S1
zo 466k� .
SIDE SEWER PERMIT L/
Address of Construction:M23.q41-1-ke-w- LID #
Property Tax Account Parcel No.cp 4;k� am Mn 03
Attach copies ofall access and utility easements Verified and Approved b
Owner and/or Contractor: �Alqweft\�, %Vol , '141
Contractor License 0)1k VTS zvla Building Permit #
U Single Family
F-1 Multi -Family (No. of Units
R Commercial (No. of Units
[__j Public
1�= j
Invasion into City *Right -of Way: [:1 Yes No
*RW Construction Permit #
Cross other "Private Property: -F� Yes No
"Attach legal description and copy of recorded easement.
(J`wnerAr 06ritrktot"signature and acknowledgement statement:
By sigl4ing 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.
2 CALL DIAL -A -DIG (1-8004.C.-TI-446-3555) BEFORE ANY EXCAVATION W
W FOR INSPECTION CALL 425-771-0220 extensional4w
24 HOUR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
FOR OFFICE USE ONLY
... . ...... . .
.............
Permit Fee 'Repair Fee $ Issued By: z_ 1"o kA ma,
Trunk Charge $ Date Issued:
Assessment Fee $ Receipt No: z
City Permit Surcharge Fee $5.00 Total Fees Paid $
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO Date: Initial:
Partial Inspection: IM6A A.6.1 W —Date: ':11k5 IM—Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: 41,1411a Initial:_ KR As -built to Street File:
1,� PERMIT MUST BE POSTED ON JOB'SITE 1,�
White Copy: File Green Copy: Inspector Buff Copy: Applicant
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94TH AVE. W.
CITY OF EDMONDS.
SIDE SEWER AS -BUILT
ADDRESS
18723 94TH AVE, W,
PERMIT
NUMBER) 605
HOMEOWNER xxxxxxxxxx
CONTRACTOR EAGLEWOOD
HOMES
DATE
2/25/02
DRAWN
BY
ISMAEL ABILA
LEG-E N
CITY OF ED,`�ONDS SP#I;5-2,001-_
-flr7rr-r,T- jF�069 OF EX15T)N(*
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5ANITARY SEWGR ALL EXPOSED SURFACES TO N
MANHOLE BE COVERED WITHIN 2 DAYS FlIGHT-OF-WAY CONSTRUCTION PERMIT 181�1 5T. S.W. sr 5w.
AND INSPECTION REQUIRED SITE
FOUND MIC CONC. 1104 ST 5-W, .
vWZ1, 5RASS DISK
MAXIMUM DRIVEWAY SLOPE LO
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ir +
EX15TING P\Or-KF-?Y--.rf>R WATER & SEWER
INSPECTIONS REQ'D
CALL 425-771-0220 EXT. 1326 mA 6 T, w
PROPOSED ROCKGRY
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PROPERTY LINES 19729 94th AVE, W.
2)FOR CLARITY TH15 PLA N P6 E5 2'/2" CLASS 8 ASPHAL7 Date; EDMON05i WA q9020 07lv'EL0i",'-TNT SEFAI!C'ES CTIR.
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LAND 3(-jRVr--YJKl6, INC, SHORT A-T 9 5 C1,10 FOR
SUBDIVI51 ON MAP rok COMPLUG DONNA L. BRGSKE P. -P,
ROCKZ R\r EAGrL�WOOD HOMES INC.
51TE. I�W-vTuRG5.- to ". 14712 M �A 00 W R 0,
7Hj00--NE-D 6:D6E .0\ LYNNV\i0007 IA/A 90613`3
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EM9RALD LAKID S(ARVEYING, Wc, ASPHALT -DRIVEWNY PAVEMENT JDETAIL 'A -A" ptimE: +25- 747--6386 5E 1/42 NE/47--sc. J3, T01P. 27N.) R. 3E, w1m.
NOT TO SCA LtZ FAX: 425-7ai-q330 SCALE: If$ =20'-1 DRAWN: 10- 18-01 1 5WEET I
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L VANWOOD� WA 9BO37
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HAVE 1� M1141MUM DEMSITY Of'
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2) THE LON6 DIMENZION QF.ALL
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TIER BELOW
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FEW40NDS) WA q6020
ACCE55 DRIVGWAY PROF)LF- ge D ETA I LS
FOR
EA&LEW000 HOMES INC
sa Y404 NF- _V41 'SEC, 13 Wom.
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6TREET FILE
—7e,23 q4l� 6bx 0
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McConnell, Jeanie
From: Highland, Scott
Sent: Friday, June 13, 2003 12:14 PM
To: McConnell, Jeanie; Gilbert, Danielle
Subject: 18723 94th Ave Settlement
Hello,
Was going past 18723 94th today and noticed that the patch where the contractor installed a hydrant is failing.
I know its still under a year *,old. Can we still get ahold of them for repairs?
Thanks,
Scott
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19
18723 94th
;ettlement.RG (88.
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City of Edmonds. Permit No: Ot 633
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: 470L,07--
A. Address or Vici nity of Construction:
B. Type of Work (be specific): UTICA'nES 40AV? ?)?a
J
A�
C. Contractor: 5(XRWOQ� NVA 'IPL, Contact: (AN 6" r
I
Mailing Address: IWI 01%stgi Phone:
State License Liability In surance: Bond:$
D. Building Permit# (if applicable): Side Sewer Permit # (if applicable):
E, 1_1 Commercial
r-1 Multi -Family
fNSPECTOR: Me4a
Sub-div'i`sion-----* [_1 CityProject E] EUC(PUD,VER14?5'N,-P.8,E,CAT-&-T,OVWD)
El single Family NL Other rAT
F. PAVEMENT CUT: El YES -E] NO*
. CONCRETE CUT: '[I YES El NO
G. SIZE OF CUT X
INDEMNITY. Applicant understands by hislher signattiie to this. application. helshe holds the City of. Edmonds harmless from
injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of
Ed?honds or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense
costs and attorneyfiees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWfNG THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES HILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BYC[TYFORCES, 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 construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THATIMUST AKE THE PINK COPY OF THE PERMITA VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
Signature: Date:
(Contractor or Agent)
FOR CITY USE ONLY q
Approved by: Al�-C
Time Authorized: Void After Kt> IW03�
Special Conditions:
. m4nou,
Right-of-way Fee: "70 4 Turc-Pizi
Disruption Fee/Fund 111:
Restoratiow. Fee:
Total Fee: *15,
Receipt No: I OJ 157
Wow -TO 100A A4vmzewelo R404:s -Issued by:
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)
FINAL APPROVAL OF PERMITTED WORK. DATE:
� Z ki, 14'tm 4 � i A
Jnsprcto�'s Yiitiature-
I For inspection requirements see Engineering Inspection Information handout.
I No W01ZK SHAIJ_ 11lJ.lN viiiiii,ro Fi-,kma ISSUANCE
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2. Temporary erosion control measures to be in place and inspected prior to any
construction or site clearing.
3. Contractor is to provide dust control measures as required including daily street
sweeping.
4. Rough grade, install utilities & storm system per plans.
5. Design engineer shall inspect key project aspects during construction.
6. Final grade. pave and hydroseed per notes & details.
7. Remove TESC facilities per city approval.
PIC L9FA VE acqvv7
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GRADING QUANTITIES
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ADJACENT TD ROCKGRY.
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NATIVE 1-4AT991AL-
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PREPiqRSD 8Y:
W /I L, SR �SKE7 P. P,
1411Z MEADOW RD.
L\�NNWDOD? WA 18037
PHONCE: 42!5 -742-638to
FAX: 425--797-9330
CITY OF EDMONDS
sp* 5 -.01.- ..
APPROVED FOR
CONSTAUCTION
City Engineer Date
cotjm�-m_D
�)^Wf __'_NATIVL--
TREI46H FILLED
viA. WITH 4 $1. 1 IVI
cmp /'0"_'WA_e,0EV
215' m_ _J� " C, RAVEL OR
I PEA GRAVEL
5
DETRNTION PIP9
Br=DDIN6 VETAIL
N. T. S.
1.) ROCK 5tiffi-L. BE- ROQND AND
HAVE A Mit-11MUM DENSITY Of'
J100 poUt4DS PER C-USIC FOOT
2)THE L.01`46 DIMEN51ON OF ALL
RxKS SHALL 13E PLACE0
PERPEN DI C U LAR TO 7HE WA LL.
rEACH RocK SHOULD BF -AR
ON TWO gco5 11\4 THE
TIER 69L-OW
3,)AN\( DEViATION )N ormsi6N
OK IN PLACF-MENT- OF-
AWACIEWT 5Tk1ACTURE.S
musT Ba SUF>M17TE-D WiTh
'THE SEAL OF A CIVIL
ENGINGIRR L-Ic-c-N-S&D /w
1'14E -5Tft17G'oF WASHIN&MON,
VeTGNTON SYSTEM PEI?
ITY OF rz DMONDS RVW. COTS
5 1 -Tr=
i o-zz5 94 ik Avl:-, W
LDMONIDS) WA q6020 CITY OF EDMON05 RVW.&VU.
AccE,c-6 DRIVEWAY PROFILE 4 DETAIL-5
FOP,
EA&Lkwoop HOMES INCI
5F_ Y4, NE 114.1 SEC. i3)_ _TWP. 27N.) R#3E. W'm.
5 C8LE. I" - 2_0' 1 -, D RAw.N: �
o- 19-011 SHEET 7- OF
`9 c7,e`E'Afrqt
C
C
4f
04
4�C,r ' G
2�
NOTE,
A- IF DRIVEWAY WIDTH EXCEEDS
15', INSTALL A FULL DEPTH EXPANSION
JOINT.
DRIVEWAY APRON SHALL BE A MINIMUM
OF 6' THICK AND SHALL BE PLACED ON
2' OF 5/8' CSTC AND COMPACTED GRADE.
CONCRETE SHALL BE CLASS 3- 300OPSI
OR
16' VERTICAL CURB
(TO MATCH EXIST. ONLY)
EXPANSION JOINT
1/2' LIP
6' CURB
CURB AND GUTTER SHALL BE POURED
SEPARATELY FROM THE SIDEWALK.
CITY INSPECTION REQUIRED ON FORM WORK
PRIOR _TO POUR.
STANDARD DRIVEWAY ENTRANCE
18.30.050 Development approval
standards for erosion and
sedimentation control (ESC)
plan.
A- ESC Minimum Requirements. All activ-
ities necessitating a clearing or grading permit
and all utility projects consisting of more than
500 lineal feet of trench excavation shall be
required to control erosion and sediment dur-
ing construction and to permanently stabilize
exposed soil resulting from construction.
Projects involving a critical area may also, be
required to comply with any combination of
the ESC minimum requirements� Compliance
will be demonstrated through the implementa-
tion of an approved ESC plan. Guidelines for
preparing ESC plans are provided in the man-
ual. The plan must address the following
requirements:
Con-
1. ESC Minimum Requirement
siruction Access Route. Construction vehicle
access shall be, whenever practical, limited to
one route. Access points shall be stabilized
with quarry spalls or crushed rock to minimize
the tracking of sediment onto public roads. If
sediment is transported onto a road surface, the
roads shall be cleaned thoroughly at the end of
each day. Sediment shall be removed from
roads by shoveling or sweeping and be trans-
ported to a controlled sediment disposal area
within 24 hours. Street washing shall. be
allowed only after sediment is removed in this
manner.
2. ESC Minimum Requirement - Stabi-
lization of Exposed Areas. All soils exposed
by land disturbing activities shall be stabilized
by suitable application of BMPs, including,
but not limited to, sod, hydro§eeding, or other
vegetation, plastic covering, or mulching. All
BMPs shall be Selected, designed, and main-
tained in accordance with the manual. The
exposed soils shall be stabilized according to
an approved timetable. (TypicaUy9 no soils
shall remain exposed for more than two days
from October I through April 30 and no more
than seven days from May I through Septem-
ber 30).
DRIVEWAY CURB TRANSITIONAL DETAIL FOR
CURB AND GUTTER OR VERTICAL CURBS
3. ESC Minimum Requirement - Pro-
tection of Adjacent Properties. Adjacent prop-
erties shall be protected from sediment
deposition by appropriate use of vegetative
buffer strips, sediment barriers or filters, dikes
or mulching, or by a combination of these
measures and other appropriate BMPs-
4. ESC Minimum Requirement - Main-
tenance. All erosion and sediment control
BUTS shall be regularly inspected and main-
tained by the owne r to . en . sure continued per-
formance of their i , n . tended function. All
maintenance* and repair shall be conducted in
accordanic'e' with the mahuiL.
'Requirement -
.5 :� ..,ESC.Minimum Other
BMPs.'As required by the city, other appropn-
ate BMPS to' mitigate the effects of increased
runoff shall be applied.
6. Erosion and Sediment Control
Requirement - Underground Utility Construc-
tion. The construction of underground utility
lines shall specifically address the following:
a. Erosion control for excavated and
stockpiled materials,
b. The placement of excavated mate-
rial where consistent with safety and space
considerations shall be placed on the uphill
side of trenches;
c. Trench dewatering systems (must
discharge into sediment traps, sediment ponds,
or other acceptable means);
d. Tracking and spilling of materials
on streets due to hauling;
e. Daily cleanup and street mainte-
nance.
7. Additional ESC Minimum Require-
ments for Larger Developments. All new
development and redevelopment that includes
land disturbing activities of greater than, or
equal to, one acre in addition to meeting the
minimum requirements set forth above shall
comply with ESC requirements listed below. -
1
1/4' RAKE PER FIOT FROM
GROUND LEVEL
STURZ ADAPTER
TRAFFIC SAFETY FEATURE. -
BREAK OFF FLANGE, NUTS -
AND BOLTS.
1/2 CY WASHED 1-1/2- MINUS ROCK
WITH FABRIC CL13TH ABOVE
THRUST BLOCK
. N a T E S 1
BASE COURSE
CAST IRON ADJUSTABLE
TEE WITH FLANGED
CONNECTION FOR
HYDRANT VALVE
HYDRANT CONNECTION PIPE TO
BE DUCTILE IRON CLASS 52. ANY
INTERMEDIATE JOINTS TO BE
RESTRAINED
1. 14YDRANTS AND ALL MATERIALS TO BE IN ACCORDANCE WITH CITY OF I EDMONDS
APPROVED MATERIAL LISTINGS, AN EXPANSION STRIP AROUND HYDRANT
HYDRANTS SET IN CONCRETE REQUIRES
BARREL. IN ADDITION, THE INSTALLATION OF THE HYDRANT ON PRIVATE
PROPERTY SHALL EQUAL OR EXCEED SIANDARDS SET FORTH FOR THE INSTALLAT113N
13F PUBLIC FIRE HYDRANTS IN THE CITY OF EDMONDS.
3. PROVIDE FOR VEHICULAR TRAFFIC- PROTECTION.
ALL HYDRANTS SHALL BE PROVIDED WITH (2) 2-1/2- HOSE NOZZLES AND
(1) 4-1/2' NST PUMPER NOZZLE WITH 4' STORZ QUICK COUPLING ADAPTER.
5. STEAMER PORT SHALL FACE THE . STREET OR ROADWAY FOR FIRE ENGINE ACCESS.
6. THREE F130T MINIMUM CLEARANCE SHALL BE MAINTAINED AROUND HYDRANT
WHEN PLACING LANDSCAPING OR RUCKERIES (ETC).
7. FIRE HYDRANTS SHALL BE PAINTED SAFETY YELLOW
.--- I
FIRE HYDRANT ASSEMBLY
ESC Minimum Requirement - Delir-
eate Clearing and Easement Limits. In the.
field, mark clearing limits and/or any ease-
ments, setbacks, sensitive/critical areas and the
buffers, trees and drainage courses. _ Sedi-
9. ESC Minimum Requirement
ment Trapping. Prior to leaving the site,. storm
water runoff shall pass through a sediment
pond or sediment trap, or other appropriate
BUTS. Sediment p6nds.and traps, perimeter
dikes, sediment barriers, and other BM[Ps
intended to trap Sediment on -site shall be con-
structed as a first step in grading. These BMPS
shall b . e functional before land disturbing activ-
ities take . place. Earthen structures, such as
dams, dikes, and diversions.shall be seeded and
mulched according t9an app . roved timetable,
1.0. ESC Miriimum Requirement - Cut
and Fill Slopes. Cut and fill flopes'shaH be
d6si pled� and constructed'i a manner that will
minimize ero'sion. In addition sto . pesshall be'
stabilized in accordance with ESC Require-
ment No. 2.
11. ESC Minimum Requirement - Con-
trolling off -Site Erosion. Properties and water
ways downstream from development sites
shall be protected from erosion. due to
increases in the volume, velocity, and peak
flow rate- of storm water runoff from the
project site.
12. ESC Minimum Requirement - Sta-
bilization of Temporary Conveyance Channels
and Outl . ets. All temporary on -site conveyance
channels shall be designed, constructed and
stabilized to prevent erosion from the expected
velocity of flow from a two-year, 24-hour fre-
quency storm for the developed condition. Sta-
bilization adequate to prevent erosion of
outlets, adjacent stream banks, slopes and
downstream reaches shall be provided at the
outlets of all conveyance systems.
13,. ESC Minimum Requirement -
Stonn 6ain Inlet Protectioa..AR.storm drain
inletr, made operable during construction shall
be protected so that storm water runoff shall
not enter the conveyance syst * em. without first
being filtered or otherwise treated to remove
sediinenL
14. ESC Requirement - Removal of
Temporary BUTS. All temporary erosion and
�ediment control BMPs shall be removed
within �O days after final site stabilization is
achieved or after the temporary BMPs are no
longer needed. Trapped sediment shall be
removed or stabilized on site. Disturbed soil
areas . resulting from removal shall be perma-
nently stabilized.
15. Erosion and Sediment Control
Reqqirement - Dewatering Construction Sites.
Devvatering systems shall discharge into a sed-
imert trap or sediment pond.
16. Erosion and Sediment Control
Requirement - Control of Pollutants other than
Sediment on Construction Sites.. All pollutants
other than sediment that occur on site during
construction shall be handled. and disposed of
in a'Manner that does not cause contamination
of storm water.
17. Erosion and Sediment Control
Requirement - Financial Liability. Perfor-
mance bonding, or other appropriate financial
instruments, shall be required for all projects to
erisure compliance with the approved erosion
and sediment control plan. [Ord. 3013 § 1,
10951.
t
27 'y
CITY INSPECTION REQUIRED ON FORM
WORK PRIOR TO POUR
EXPANSION JOINT DUMMY JOINT
:'A 4. 4 A4
A.
i4
4i
4
4
10, O.C. 5' O-C
PLAN
5' TO 71
4-V
UNDISTURBED EARTH OR
COMPACTED NATIVE MATERIAL
FULL DEPTH 1/2' EXPANSION UNLESS OTHERWISE SPECIFIED
JOINT MATERIAL BY ENGINEER
N 0' T E, SECTION
1. CONCRETE SHALL BE CLASS 3- 300OPSI
2. CONCRETE SHALL BE BROOM FINISHED
3. ',SIDEWALK THICKNESS SHALL BE 5-1/2'.
4. 'SIDEWALK THICKNESS AT DRIVEWAYS SHALL BE 6' THICK.
5. !CURB AND GUTTER SHALL BE POUREJ) SEPARATELY FROM SIDEWALK
6. CONCRETE SHALL BE SPRAYED WITH CLEAR CURING COMPOUND
OR SHALL BE COVERED AND KEPT MOIST FOR 72-HOURS.
CONCRETE SIDEWALK
V R
I'BATTER
4 .
CITY INSPECTION REQUIRED ON FORM
VR WORK PRIOR TO POUR
.44
�4. A
4 4 A
6'
4.
4 4.
44
IS' STANDARD
24-ARTERIAL
NOTES,
1. FORMS SHALL BE TRUE TO LINE AND GRADE
AND SECURELY STAKED.
2. THRU JOINTS SHALL BE PLAC I ED ADJACENT
TO CATCH BASINS.
3, EXPANSION JOINTS SHALL BE EVERY 10 FEET
AND DUMMY JOINTS EVERY 5 FEET.
4. 1 THRU JOINTS SHALL HAVE 1/2' TO 5/81 WIDE
PkMOLDED JOINT FILLER,
5, :CONCRETE SHALL BE CLASS 3� 3000PS1.
6. 'FINISH SHALL BE LIGHT BROOM.
7 CURB SHALL BE SPRAYED WITH CLEAR CURING
COMPOUND OR SHALL BE COVERED AND KEPT MOIST
FOR 72 HOURS.
8, ALL SIDEWALKS POURED BEHIND CURB IN
DRIV,EWAY AREAS SHALL BE 6- THICK OVER 2' OF
CSTC WITH SUBGRADE COMPACTED T13 9,57 MAXIMUM
DENSITY,
§TANDARD TYPE "A" CURB/GUTTER DETAIL
APPROVED FOR
CONSTRUCTION
City Engin-eer Date
CITY OF EDMONDS
5pt 5 - ol - 1(03
SITC-: 10-729 94kAVEE \4,
EEIDMOMD51 WA Ji3o.20
Ask
City of Edmonds Permit No: JY—(-J1 J
RIGHT—OF—WAY CONSTRUCTION PERMIT issue --te: I IMOZ,
A. Address or Vicinity of Construction: '!��411RAve VJ
B. Type of Work (be specific): 'M(Qb� J?P(011JQ, Ina2=&A 7��4"P,
C. Contractor: �041X,04
Mailing Address: 044f111k VltO � f
I -J I
State License hwu\ 10%� v5 C)
D. Building Permit # (if applicable): aW�-DD*10
Contact: CM0, kk"r-
Phone: N�S) -�IN - �%n
Liability Insurance: — Bond:$
Side Sewer Permit # (if applicable):
E. r-1 Commercial El Subdivision E] City Project [] EUC (PUD, VERIZON, PSE, AT& T,,OVWD)
F-1 Multi -Family 19 Single Family 'Other
-INSPECTOR:
F. PAVEMENT CUT: El YES. ED NO G. SIZE OF CUT X
CONCRETE CUT: El YES C� NO
AN'LICANT TO M,"Al) ANI) SIGN
INDEMNITY. Applicant understands by his/her signature,to this application helshe holds the City of Edmonds harmless from
injuries, damqges or claims of any kind or description whatsoever, foreseen or unforeseen, that may He made against the City of
Edmonds -or any of its departments or employees, including but not limited to the defense of any legal proceedings including def n e
costs and aitor,n, eyfees 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 traiiing 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 application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ THE ABO VE STA TEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND A CKNO WLEDGE
THATI MUS"AKE T�fiff PINACCOPY OF THE PERMITA PAILABLE, ON SITE A TALL TIMES FOR INSPECTIONS
Date: %
Signaturel *"1 04101
_(Contractor fir Agent)
FORCITY USE ONLY I $ !r
Approved by: /q,4, Right-of-way Fee: 10 4- &Iec FO'
Time Authorized: Vo.id After NV)1615, 07 05t"IT Disruption Fee/Fund 111:
Special Conditions: 1W 7*5 WOAYT IS Pk*, V& Restoration Fee:
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUI . RED PER CHAPTER 19.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)
FINAL APPROVAL OFPERMITTED WORK. DATE:
Inspector's Signature
For inspection requirements see Engineering Inspection Information handout.
DAMy Documents\Forms\Engnmg\ROWpermit—.doc