18915 94TH AVE W.PDF9186
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City of Edmonds
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RIGHT-OF-WAY CONSTRUCTION
EET FILE - PERmIT Permit Number-
Wue Date:
A. Address 6PVidMty of Construction: c? 4 -r�4 Au rz.- W
B. Type of Work (be specific): IeRTRcAcdC D014:0cri ME U6 OR-eloo
6 3 ' 141-0 &J6 C- VDf- d r- 94rf(AOC (AJ
C. Contractor: -C4.UAt?4A-5 /5' 444140- C,4 Contact: -rdK A,4j J)g 4e ST IJ
MailingAddress: 5-33 A4AfM S7- Phone: 774-5-146
StateLicense#: SUPoEW-CC�1Q1QA - Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. [J Commercial E] Subdivision El City Project [g Utility (PUD, GTE, WNG, WATER)
n Multi -Family [J Single Family n Other
INSPECTOR: INSPECTOR: w4;4r,&,ff—
F. Pavement or Concrete Cut: 9[Yes []No G. Size of Cut: 2-t x 4- H. Chargq�_$
APPLICANT TO READ A D GN
f'.9
t th'.�.0 t. ::�d.-ages, or
d ainst the City of Edmor 'S
INDEMNITY. Applicant understands and by his signature to this applicati=ees t I the City of Edmonds harm
claims of any kind or description whatsoever, foreseen or unforeseen, thi be W., tments or
employees, including or not limited to the defense ofany legal proceedings including dl4efernsc osts, and attorney fees by reason ofgranting thispermit.
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THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR,� PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND A CCEPTANCE OF THE WORK. ESTIMA TED RESTORA TION FEES WILL BE HELD UNTIL THE FINAL STREE T PA TCH
IS COMPLETED BY CITYFORCES, AT WHICH TIME A DEBIT OR CREDIT WILLBE PROCESSED FOR ISSUANCETO THE APPLICANT.
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Construction drawing of proposed work'required with permit application. �. ty- 71
A 241hour notice is require f9yn ti Please call the Engineering Division, 771-0220.
c ion;
Wotk and material is tze inspec uring progress and at completion.
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L <:��Awstsw,-60 isAb+@ -1hJWc:7c-61da"Ae' 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 q. ity.Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end-ofthe woAQ day;
NO EXCEPTIONS.
6
Ihave read the above statements and understand thepermit requiren!�)Tts and thepink copyof theperm.it willbe
available on site at all times for inspection purposes.
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Qgnature:--5—�,,,-� a�� C&t4 Date:
(dontractor or Agent) ' 111�1
CALL DJAL-A-DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: W4; RIGHT OF WAY DEPOSIT
TIME AUTHORIZED': VOID AFTER d5VT 28 DAYS
SPECIAL CONDITIONS: e-o,��12,otmAM WITH
L20t /IV HIS w-4y. aT KIN(1-
AS5*00ATeP
COMMENTS:
DATE:
DISRUPTION FEE/FUND III:
RESTORATION FEE:
PERMIT FEE: '13c) , "do"
TOTAL FEE:
RECEIPT FEE:
ISSUED BY:
. -A
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991
FIELD INSPECTION NOTES
I Comments:
I Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Datb:
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Side Sewer Drawing
The City of Edropn0t-.
EASEMENT NO . ............................................ *-
NEW CONSTRUCTION REPAIRS 7 LID NO - ---------- ....... ASMT. NO . ..................
OWNER ...... C--*-)4-1 ------- PIC ..... ------ CONTRACTOR.. --- j3x�-� ...... P-R-1-In ......... ....................... PERMIT NO.
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JOB ADDRESS ..... . ..... .... ..... ... ------------------------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO . ....................................
NAME OF ADDITION ........................................................................
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4- rX.C. skic Sewer--/'
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Approved:
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PWW-0001 -11/75 (REV. 11/78)
DATE
CITY OF EDMONDS
PUBLIC WORKS DEPAMENT
SIDE SEWER PERMIT
FOR INSPECTION CALO
775-2525:Ext. 220
P ermi t .1 d 10, �11)31 0
Issue Date
PERMIT MUST BE POSTED ON JOB T:1�
6 VWA� ANWA�ANWA�A�AWFAWAMFA�A=�AMWA�AMW �,�"'Aft
1. Address of Construction
2. Property Legal Description (include all easements)
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3. Single Family Residence Multi -Family No. of Units
Commercial
4. Owner and/or Builder
5. Contractor & License No. 4"3,
6. Invasion into City Right -of -Way: No Yes (If Yes Right-of-
way Construction Permit Required Call Dial Dig (342-5344) before
excavation)-.
7. Cross other private property: Yes No Easement -required';
attach legal description and county easement number.
READ THE FOLLOW!-.NG 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 fuli 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")
U to any structure.
N 0
M e. Side sewer lines must be laid at a minimum grade, of 2% (1.15
0 and maximum grade of 100% (450). 0
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.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
htough 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: A, A-
I certify that I have read
and shall comply with the above
PERMIT FEE: DISAPPROVED BY: Date:
b%_: Date,
CONNECTION FEE:
P4 �:) . APPROVED By: L_AKI� Date: F1111.1 17-
0
44 PERMIT MUST BE POSTED ON JOB SIW*
CITY OF EDMONDS
aPUBLIO� WORKS DEPART- u�4 I Lt 1979
m
RIGHT - OF - WA TgTFXfJTF1LE
A. oAddress or vicinity of Construction
0 Owner:
Name
Mailing Address
city, State, Zip Code
�It
ut 1:,Liouc Worl,,s
Permit No
Issue Date
0 Permit Issued To:
• Type of Work to be Done:
• Work n Connection With:
El Sub or Plat 0 Single Family
11 Comml. / Ind. 0 Apt. Condo.
• Pavement Cut: 0 Yes El No
State License Number
Z
< Clty� State, Zip Code Telephone Number
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NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any 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 it's departments or employees, including or not limited to the defense of any legal
proceedings defense, costs, court costs, and atiorriey fees by reason of granting this permit.
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W Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
ca following the final inspection and acceptance of the restoration by the Engineering Division.
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0 Contractor:
Name
Mailing Address
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this permit must be available at the job site for inspection purposes at all ti
imes.
Signature: Date
Owner or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
. CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Vold after days
Special Conditions:
Ammendments:
Permit Fee:
Security Deposit:
Receipt No.: —
Fund 111 Fee:
Street Cut Dimensions
X —
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng, Div. December 1978
FIELD INSPECTION NOITS (Fund 111 - Route conv to Street Den
I Comments: .1 1
Diagram:. -
Contractor called for inspection Yes G�
Work Disapproved By: Date: Bv: Date:
Work Approved By: —Date: -3
Inspector:
Ena. Div. December 197P
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OBLIC 4-ishCounty �Z>QLJTH CC!
UTILITY DISTRICT
'No�._ I of Sn
A rld T'Y'A It I A
Re�.10177
Location
n-2� 161v Fa A -r7:> r,-A.
Date
-7 C4 W.O. No.
!a��A S__Z�T__=5_,R_
Revision
—.Scale I H 1:0 0
Reason for work N)
T- lz� E C,--
Engineer�
As:Built
KA C- C-��N tl ,N.! I a
4:1r, x) r,77 -7 j�a 6.
U.G. File No.
Approvals,
PERMIT REQUIRED
FOREIGN CONTACTS
EASEMENT
ENVIRONMENTAL ANALYSIS
Type (:::� I - -
'_TiaL_
Company (--TEW
-I'----
Exempt under District SEPA
J.P. N. No.
procedures, Section � I I I -A
Date Granted
Fees required 'YesS N 00
Grantor--
Paragraph Item
Log Posted I linventary
Typ t- 7� T-.
Granted
Date &/& By �a A, I a-=L�
-Transf.Cardl I Pole Dept.
Date '�'/H Amount.
Interpretation Referred 1o,:
Map Poste4 I Circuit Mapj
Date— By
n Released For Construction
Date Work Completed
By
Foreman
Circuit Number
Substation MAE'LEVV(DC
Dy
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v
O.H. U.G. Cond V
Add C_"t_PH
PH
F--7 +:=-, �_T-
7 4-S6-,-r
REMOVE . ............. . .............
........ ... .. .. . ..... . .. ... ...
HANG A..�_ Q KVA,7200
1201;'240 V. TRAN'F-
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Remv—,�CIct Ft_PH
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Water
Sewer
Gas
Backhoe
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W.O. No.-
BUILDING DIVISI01r
USE PERMIT
pplicant Fill
ZONEJ�� NUM
PERMIT APPLICATI ON ide Heavy Line
ECT C11
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JOB
ADDRESS
!NAMIK JOR NAME OF BUSI NESS)
LEGAL DESCRIPTIO N
SUBDIVISI N
SHORT SUB NO.
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-^ILJr'1W -ADDRESS
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ELEPHONE NUMBER
PU13LIC RIGHT OF WAY PER OFF C L STREETMAP
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7 4, 4 Lf
EXISTING
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NAM
PROPOSED
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DEFICIENCY OF RIGHT OF WAY
W ADDRESS
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PUBLIC IMPROVEMENTS REQUIRED
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M CITY
DRAINAGE IMPROVEMENTS REQUIRED
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TE . LEPHONE NUMBER
DRAINAGE PLAN REQUIRED El
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UNDERGROUND WIRING REQUIRED
NAM E
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CONNECTION TO SANITARY SEWER
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21
0 ADDRESS
SEPTIC TANK PERMIT REQ'D El NO.
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ELEVATION OF PROPERTY CORNE RS E]
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& FOOTINGS REQ'D
CITY TELE PHONE NUMBER
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SEE ENGINEERING MEMO DATED__�q-1 1-19
U STAT LICENSE NUMBER
CHECKED BY
Legal Descriptio n of Property (Show Below Attach
METER
. or Four Copies)
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BUILDING SUPPLY SIZE
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SIGN AREA
ENV.REVJ EW
ADB NO.
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ALLOWED PROPOSED
CO MPLETE
EXEMPT
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SHO:tELIN��
REMARKS
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VARIANCE OR C: 11
PLANNING REVIEW By
DATE
YARDS
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LOT COVERAGE
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N w RESIDENTIAL
x
GAS
11 LINE
FRONT SIDE ).5 REAR
FIRE
1:1 NON-RESIDENTIALI
SIGN
ZONE
TYPE OF. CONSTRUCTION
CODE
HEIGHT
ADD
ElDEMOLISH RETAINING
EIWALL
SPECIAL INSPECTOR
REQUIRED
AREA
OCCUPANCY
OCCUPANT
EJ ALTER EXCAVATE FENCE
1:1 OR FILL 1:1 1— X—FT)
E) YES El NO
GROUP
LOAD
ED REPAIR PRE -MOVE swim
PLAN CHECKED BY THIS SITE IS LOC
OF EDMONDS.
INSP. EJ POOL
LOCAL SALES TAX
SHOULD
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NUMBER OF STORIES
N U M
UM BER OF
BE CODED 31.04.
REMARKS
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NATURE OF WORK TO BE DONE
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PLOT PLAN
PLAN CHECK FEE
VALUATION
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PLUMBING
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MECHANICAL
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"Applicant, �n behalf of his or her spouse, heirs, assigns and
SIGN
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successors in interest, agrees to indemnify, defend and hold harmless
2 the City of Edmonds, Washington, its officials, employees, and
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RETAINING WALL
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It agents from any and all claims for damages of whatever nature,
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7: arising directly or indirectly from the issuance of' this permit Issu-
SWIMMING POOL
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ance of I hi.� perj,�ij shall not he (l..-cjjjt:d it) ol r'cdt'we
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CITY OP f'; IJI UL,
OPHRU , C WORES IARI.11-i TI
f "J 11 ,J 11-1 1 It 11 1 ) I V 1 11 " I( )I i
Subdivision
Multiple -1 �c i 1.
(JEJERAL
Coordination of the location or an',I �7,tructurc, with rr-,,�;nc,rf tr) utilities, sti-i,ets, nrobprtv
lines and driveway grades is the of' th(,
The ccnstra,�for is required to . k-eep the abut(Iting street clend-ied of dirt Tid debr.15 caused
by the construction 7.30.200 Violations - Penq1t`ies 7.30.290.
A "Right -Of -Way. Construction Permit" is required from the Dij-,in-erinrr I)Ivi-licn of Public
Works.for any work within the Public rig;ht-of-wa-y or, public 7.30-01.0 Violations
Penalties 7.30.290.
SPECII�lc BEQUIREIIEHE)
UNDERGROUND PO'�,ER
UndergroLu-id Wiring Req d Not ReqId
oA.NITARY SEI-ER (Fla,IIT REQ I D)
Connection to Sanitarl, Sewer ReqId El Back U'ater Valve Re�q'd.on Side "")ewer
Septic Tank, Permit Rea.1d.. Desim Approval Reqld
Approved Dt. PC'ITLit 14UTber
STOFU4 SEWER SYSiL-.l (1UR CITY CODE
Drainage Plan ReqId
Site Drainaf-,,e to be Contained on Site
Z�K - -
ROADWAY E-IPRO`VE-iLITI'SQ AJ�FL) DRIVE,WAY
Driveway Slope Not to Exceed-111`�
Driveway Favi-ng ReqId
Vertical Curb ReqId
Street Faving, ReqId
El F )rainn.�-,c Pl,-ui �.rrrovecl I)t-
EJ Sitp Drainalrp t..,) bo to City System
Drivei%la 12! 1
Culvert I',--q'cl Size_
El
EJ
.,UhMit CoF.A. F:itimat e
0 Bond ReqId for Public Improvements
Note:
Inspections Ren I d. , Engineering Division
rIQr
LPO 'Foundation, Side &-,wer Septic Tank
WatCSr Service
�El Fire Protection /-J Drainage
Site Impro.verrvents
-'�e�,A 24 hour notice is required for inspection hy Engineering4c., 775-25253
extension 220.
F IT
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T-. I ---.RZBERG, P.E.
City Engineer
1*1-i-or)��,i- or v, 11,i i -
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LtC DEPAFd= CHFCK4 Date
BLiuziNGPmvaT REviEw
tKAddress
Street Right -of -Way Existing
Access Easements Existing
Utility Easement Existing
Lot per Subdi
Site Plan Checked for Accuracy
REQD
REQD
REQD
Plat Assessor Map
Underground Wiring Reqd.
Check Accuracy of Legal Description
Environmentally Sensitive Area
Environmental Checklist Reqd.
'Flood Hazard Zone
Shoreline Management Area
Slope, Soil, Vegetation
'Stream, Creek, Drainage Basin
-Existing Zoning Per Code
5
.0 00119-107.21TU rmllll_qM"�01
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Amenities Design Board Approval Reqd. ADB # =Approval, ----
Board of Adjustment Approval Reqd.. (/A
Review By: P-) Date: ----7- 1'�5
Existing Waterl�in Size 4 't S -r ,,, -e-4
Water Main Reqd.
Service Line Reqd.
Hydrant Size Existing
Hydrant Reqd. Per Fire Code Size
Detector Check Meter Reqd. A_..)O
Cross Connection Inspection /G-0
Fire Department Cxmnents
Water Meter Charge Reqd.
Review by WIS
Date:
I 3ePLJ IJaL:e:
-C lalul�. Jeslgn iypruvea
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability jqA-) Proi
Drawing No. File No. s-2-,:)
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
V11 Review By: W/S Date:
. I A.K.K.
04
N'Open Ditch Eyistm'g____,&
Reqd.
Culvert Reqd. Size /2—
C4 Catch Basin Reqd. Indicate on Site Plan..
0 Shoulder drainage n-nintain iKollection on swale open runoff
y 5
U) -'-1,u-Jiole reqd. Indicate on Site Plan
Soil Conditions and. Groupd WaLer Field Checked
RovieA,7 by 4Z&:;�6 _rx. I te-4Z-7
I - /7 7Z�--
QStreet Paving Reqd.
Curb and Cutter Reqd. Z14 Z-,!g=
Sidewalk Reqd.
Curb Cut for Driveway Reqd.
r4 Rig1it-of-Way Construction Permit Reqd.
Bond Reqd. for Public Improveme-i-its
Street Nam Sign Reqd.
..10ther Signing Reqd.
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Pre Permit Sire Inspection made on
0
BY: S3,7ER
J%IATER
STREET
ENGINTEERING
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Special Requireuv_nLs listed in mem to Conuunity Development Departrrent,
Building Division
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BY W —Date..,,, /
All items filled in on Building Permit Application L
BY
DmAngs Stan-ped and Notations 1,1-ide
BY
Approved by Public lvlorks DeparLim-it
Revised: Iv 10-1977
Date
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CATY OF Ev. -It
PERMIT
CITY OF EDMI(D
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CATY OF Ev. -It
PERMIT
CITY OF EDMI(D
Eyamined by—
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REGARDING:
(File Title)
R E C 0 R D OF C 0 N T A C T S
DATE
NAME: PHONE NO. &
ADDRESS OF CALLER
COMMENTS
ACTION TAKEN
INITIALS
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1-96-P
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