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18814 94TH AVE W
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAN E NAME OF BUSINESS
0 rI 04 e(r)
MAILING ADDRESS 1i
CITY ZIP I tLtFHONE NUMBER
E(I Nr,l" 1�3D?L) 7-?:S' /31'4
2U I r("I. r i� AI�A yu �
ZIP '214
ITELEPH E NUMBER
t 1'4 1 A -/ / - Y V3,C)
PERMIT
ZONE &I Z- NUMBER
ADDRESS 19292,lAd 62.1if
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TEWSPC.PiAPiR:�18d 0
i, u D
EXISTING — REOUIRED DEDICATION—
S, —.1 RQQ,d 0
in :0.1:1.uli.. Requi,ed 0
PROPOSED
S,d—lk Req.aed 0
METER SIZE
LINE SIZE
No. OF FIXTURES
PAV REQUIRED
I
I
YES 0 NO 0
09 2-01rd =5Z-5w ENGINEERING MEMO DATED
TELEPHONE NUMBER FIRE MEMO DATED
ENSE NUMBER EXPIRA E
,714 DAT
SIGN AREA SEP,
W 17 LOWED PROPOSED COMPLETE
ascription of Property - include all easementl 0 & AL
la 1 li� EXP
V A R 'A N
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VARIA C cu
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SETBA(;ka— FEET
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EIGHT Lo
T CIVERA
FR 0 N T
FRONT 'Zt� SIDE �2 REA. Z�2
Prope rty
Tax A,,,,nl
P..., No.
Z) 0 C) _.01
M A
REM—b
R E
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N1. RESIDENTIAL PLUMBING
ElADDITION
COMMERCIAL
MECHANICAL
0 REMODEL
APT. BLDG.
SIGN
CHECKED BY
TYPE OF CONST CTION
I
CODE
!?4
OCCL
GRP
GRADING FENCE
REPAIR CYDS. I x _-tFTI)
DEMOLISH
GARAGE
CARPORT
WOODSTOVE
INSERT
RETAINING WALL/
L—J ROCKERY
OOL
SHWOTIMTPUB/SPA
RENEWAL
SPECIAL INSPECTOR
RPOURED C3 YES
F
dcu
LOAD
MARKS
ROGRESS INSPECTIONS PER UBC 305
P p a
NUMBER I NUMBER OF CRITICAL
OF 2 DWELLING AREAS
STORIES UNITS NUMBER 11i
DESCRIBE YVORK TO BE DO�E (ATTACH PLOT PLAN)
';4od � �- iw I si �,, �i d P I - :1 FINAL INSPECTION REQUIRED
PLAN CHECK FEE
BUILDING
4'11!� EM
HEAT SOURCE:
GLAZIN
%
PLUMBING
Plan Check No. 6?—T—1 Z
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, a idewelks.
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days .
STORM DRAINAGE FEE
"Applicant. on behalf of his or her spouse, heirs , ass igns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold -
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
whatever nature. arising directly or indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
C, modify, waive or reduce any requirement of any city ordinance
ZZ: nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT D
provision."
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and In doing the work authoriz.
AUTHORIZES
signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Workman's Compensa.
ONLY THE
WORK NOTED
Deputy: and fees are paid, and receipt is
tion Insurance and RCW 18.27.
INSPECTION
acknowledged in space provided.
SIGNATURE OWNER OR AGENTI 51UNED
DEPARTMENT
SC ATURE DATE
JDATE
CITY OF
EDMONDS
AM
ATTENTION
CALL FOR
INSPECTION
W�E LE A DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL — File YELLOW — inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
1�
0 �) 10 Z10
Bryan Residence
188 14 - 94th Avenue West
Edmnds, Washington 98020
Deck Repair
I O—u
Susan Bryan
19814 - 941h Avenue West
Edmnd3. Washington 98020
(206) M-1338
Architect
Gleason & Amciates. Architects
2013 Fourth Avenue #403
Seat;le. Washington 98121
(206 441-8830
st..p , 3942
JAN K,
STATE OF
D ..I.g
G;,o
N.ject No. Sheer
94-000
.,CITY OF EDMONDS
Ibis —
FOR INSPECTION CALL
'PUBLIC WORKS- DEPARTA— "�Iermit IN?
775-2525 Ext. A,S�'-j
SIDE SEWER PERMIT Issue Date
L PERMIT MUST BE POSTED ON JOB SITE
SS Of Co
FET FILE
1. Addre nstruction
2. Property Legal Description (include all easements) EDMONDS
- i'-� - 4- TREATMENT PLAN F
3. Single Family Residence _.�i MUlti-Family No. of Units
Commercial
4. Owner and/or Builder
5. Contractor & License No.
6. Invasion into City Right -of -Way: NoY Yes (If Yes Right-of-
way Construction Permit Required Call Dial Dig (342-5344) before
excavation).
E-1 7. Cross other private property: Yes No Easement required -
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
a. Property owners must obtain a permit to install side sewers on
>4 their property. A licensed side sewer contractor must be employed to
construct side sewers in the public right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
c. Commercial establishment requires a minimum of a six inch (6")
side sewer line.
0 d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
0
e. Side sewer lines must 0 be laid at a minimum grade, of 2% (1.15
0 and maximum grade of 100% (45 ). 0
E-4 f. No turn in side s8wer greater than 45 (1/8,bend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and Wye with removable cap.
q. No down spouts, footing drains or floor drains can be connected
to side sewer system.
I h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 1001 along sewer line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k.. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
DATE:
certify,th4,t I'have read
shall c6mp-1:y With the above
PERMIT FEE:
U W,
CONNECTION FEE:
DISAPPROVED BY: Date:
By: Date:
APPROVED By: ����Date: Z3,L?
1, SITE *
mmm"I"I
CITY OF EDMONDS
NEW
ADDITION
RETIREMENT
--v
STREff FILEASSET INFORMATION SHEET
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
:54,il—u cc --,I
SERIAL NO.
LOCATION DEPT. NO.
8, 4ci A C CKC
"PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
0
-- 45�
*PROJECT NUMBER cc,-, 3 -1 0 / 2—
PROJECT COMPLETION DATE A 9-3
COST C) 4
B.A.R.S. ACCOUNT NO. r c� c> 3
ESTIMATED LIFE 2,--,
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
qDEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
0 G.L. ENTRY
REFERENCE
DATE
VERIFIED BY
PROCESSED
BATCH NO.
INITIAL
tnp
DEPARTMENT FILE
STREET FILE
MEMO TO: Art Housler, Director
Finance Department'
FROM: Jack Mitchell
SUDerintenden't of Public Works
SUBJECT: REIMBURSEMENT OF STREET GUT SECURITY DEPOSIT -
ORDINA14CE #1935
R/W CONSTR. PERMIT NO.: Lt)_3,L:S
DATF ISSUED:_
LOCATION OF WORK:
SECURITY DEPOSIT'AMOUNT:
RECEIPT NO. & DATE: 4//
COMPLETION DT. OF PAIR:
Please prepare a Treasurer's Check in the amount of
made payable to the following:
Gr F--�Z>TD t-�l C 0 0 S 0- C>)
1166014 �Avj y
The balance of the deposit in the amount of $ -7 Zoe> is
to remain in Street Division Revenue Fund 111-000-000-M-3-TOU.
7002
oT
ORDINANCE #1935
UTILITY CUT REPAIR, STREET DIVISION
Permit No. OjZk,
Issue Date
Date Completed
Date Received
Date Processed
Type
of Repair: Asphalt Roadway Conc. S/Wa I k Conc.
Curb
Total
Area Repair - Ft. X
t. , Total Sq.Yds./Ln.Ft.
Total
Cost Summary:
Sq.Yds./Ln.Ft. Minimum Charge
@ $
$
2-
Sq.Yds./Ln.Ft. Additional
@
$
Sq.Yds. Additional Base Lift
@
$
Yds. Additional Base Aggreate
@
$
Total Cost ......................
=
2 i c)0
Fund
#111 Deposit Fee ..........................................
=
$
Total
Reimbursement ............................................
=
Total
Additional Expense .......................................
=
$
This information is to be filed with oriclinal permit.
COMMENTS:
in
0
Ij
The City of EdmondssgrREET FILEside Sewer Drawing
EASEMENTNO . ............................................
NEW CONSTRUCTION j?" REPAIRS Ej LID NO . .................. . ASMT. NO . ..................
OWNER ............ BrY �� ................................................................. CONTRACTOR . ........
. . .......... . ...... PERMIT NO. .......
JOB ADDRESS ............... �e$lll ---- — --- LEGAL DESCR.IP-nON: LOT NO . ...................................... BLOCK,NO . .....................................
................................................. I ................................................................... gqmoms ..........
TOE ... ATMENT PLANT
NAME OF ADDMON ................................ ..................................
.. . ................. .. ...
Approved:
PWW-0001 -11/75 (REV. 11/78) DATE. z B ....... . ...... ...... . I ..............
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