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MY OF EDMONDS
COMMUNITY SERVICES DEPARTMENT r"OrREET FILE
RIGHT - OF - WAY CONSTRUCTION PERMI-0 -1
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A. e Owner: C""- B. 0 Contractor
Name
iSq-vvA PL_
Mailing Address
4_Dffl0bJ1)5 WA c4i&036
City State Zip
Permit No. 1- 0/ 4
Issue Date 151--9 J
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Name
210VA "WI Cl Cl
Mailing Address
L110myJ001)
City State Zip
y-vp-T iNAA9:r%Q (0-7C) -I-ZO-7
State License Number Telephone Number
C. o Address or Vicinity of Construction: . ISS 20 SS-TR INV
Typeof Work to be Done: ut-JbEZ9_,&P_0VW1) POLE)
R W:J 4�09_.(
-TQ_'etJ(_%A KWS.7riA w 4 = 'qA714 6V U) To �Seuc r4evi 40QSC
D. 0 Work in Connection With: 0 Sub or Plat Poolingle Family 0 City Projects
0 Commercial 0,Multifamily 0 Utility
E. * Pavement Cut: E3 Y 5W F. 0 Size of Cut: — X
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this appl, ation agrees ;o hold the City of Edmonds
harmless from any injuries, damages, or claims of any jrind"it?'Idescript7,n-whitsoe�ir/forseen or unforseen, that may
be made against the City of Edmonds, or any of its departments or eT_P loyees, including or not limited to the defense
of any legal proceedings including defense costs, coutt -costs "i r'ney fees by reason of granting this permit.
nd ail
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 time a debit or credit will be
processed for issuance to the applicant.
_�202
• A 24 hour notice is required for inspection; PleaseqdU_Engineering: 771-
• Work is to be inspected during progress and at completion.
• Restoration to be in -accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
I understand the above and that this permit must be available at the job site for inspection, purposes at all times.
Signature: Date:
Owner or Contractor
This Permit Must be Posted at the Job Site For. Inspection Purposes
Calt DIAL -A -DIG Prior to Beginning Work
APPROVED BY: All
Time Authorized: Void after -days.
Special Conditions: ' NO AsSEB44X CIJIS
PERMIT FEE:
Restoration Fee:
.'�'-'Receipt No.: —
Fund 111 Fee:
Street Cut Dimensions: x $
RELEASED BY: Date —4-15N INSPECTED BY Date 411' TI?l
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div..March 1989
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept?)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION . F-1 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
Date:
Date:
Eng. Div. July 1985
1476
PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY REV. 7/37
LOCATION 12 -7v\ A\) v\j AREA
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CITY OF EDMONDS
COMMUNITY SERVICES DEPARTMENT
RIGHT -OF - WAY.CONSTRU CTION PERMIT
A. o Owner: Washington Natural Gas Company B. o Contractor:
�I,Te mercer street
WailMAddress
ea e WA 98111
Is sue . Date
Name
Mailing Address
City State 'ip City State Zip
STREET FILE
State License Number Telephone Number
C. *Address or Vicinity of Construction: 18920 88 Avenue West
Type of Work to be Done: Install New Service
D. 0 Work in Connection With: 0 Sub or Plat 0 Single Family 0 City Projects.
El Commercial 0 Multifamily utility
E. *Pavement Cut: E] Y RJ N F. 0 Size of Cut: - X - No cuts
APPLICANT TO READ AND SIGN
INDEMNITY: 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, forseen or unforseen, 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, coiirt c66s-,,/Znd',attorAey fees, by reason of granting this permit.
A
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION'�kND "ACCEPTANCE OF THE WORK.
Estimated restoration fees will be held until the final street patch is completed by City forces, at which time a debit or credit will be
processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature:
Date:
Owner or Contractor
January 18, 1991
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: F)
Time Authorized: Void after F-&P\ days.
Special Conditions: N A,
PERMIT FEE:
Re ee:
c t
tl
Fund I
Street Cut Dimensions: $
RELEASED BY: Date INSPECTED BY Date
NO WORK. TO BEGIN PRIOR TO PERMIT ISSU.ANCE
rng. �iv. mdru� i�o�
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO,
Partial Work Inspection by P. W.:
Work Disapproved By:
Date:
Date:
FINAL APPROVAL BY:
Eng. Div. July 1985
do
77
Addendum to:
City of Edmonds
Permit Application
Engineering Aide : Kerry Walsh
Washington Natural Gas
622-6767 x 2588
EDMOINDS C,.,AO -CUT
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KEY:
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TO: Permit Coordinator, Building Division
A.M14 Dan Smith, Engineering Inspector
ADDRESS: a DATE:,
!2/
OWNER: 4&z:�Ae& PLAN CK#
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After review of the subject building permit application, we.have the
following comments:
1. Construction hours are: WEEKDAYS .......... . 7:00 a.m. - 10:00 P.M.
(ECC 5.30.110) WEEKENDS/HOLIDAYS..10:00 a.m. - 6:00 p.m.
2. A separate Right -of -Way Construction Permit is required for any work on
City property. (ECDC 18.60)
3. Connection to City water system required. Separate water meter charge
required.. , �ECDC 7-t-30)
4. 'Connection to City sanitary sewer system required; obtain separate permit.
LID # Fees paid:' Yes No Charge (ECDC 18.10)
5. Water and sewer lines should be separated by'10 feet minimum... (ECDC 18.10)
6; Driveways must'be paved a minimum of 20 feet back from City right-of-way;
separate permit required. -(ECDC 18.80.060C)
7. Driveway slope not to exceed 14%. Waiver granted to
(ECDC 18.80.060D)
8. Back water valve required if downstairs plumbing is below elevation of
upstream manhole. (ECC 7.20)
9. Builder/Owner responsible for containing all temporary runoff and erosion
control on site. (ECDC 18.30.030D)
10. No burning of construction refuse without permit from Fire Department.
11. Street to be kept clean of debris, dirt, mud, and construction materials.
Contractor responsible for dust control. (ECDC 18.30)
12. Inspection required on drainage system,.catch basin installation, driveways,.
and'sidewalks. A final engineering inspection is required prior to the
building division granting occupancy. (ECDC 18.30, 18.80) �
13. Repair or replace all defective existing curb, gutter, and sidewalk. If
intersection is involved,Anstallation of wheelchair access may be required.
(ECDC 18.90)
14. Underground wiring required on all new construction. Also, if the proposed
addition, alteration or repairs exceeds 50% of the total assessed valuation
of the existing structure. (ECDC 18.05.010)
15. AoOkroih
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USE PERMIT
CITY OF EDMONDS ZONE NUMBER STREET FILE
CONSTRUCTION PERMIT APPLICATION IJOB SUITE/APT #
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FWNER NAME/NAME OF BUSINESS ADDRESS 7-
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MAILING ADDHE-5b
CITY
NAME
ADDRESS
CITY
NAME
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ZIP
TELEPHONE NUMBER
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CC CITY ZIP TELEPHONE NUMBER
U STATE LICENSE NUMBER
:5 0 \A \\I � k-F- 9A_
Legal Description of Property - include all easements
(show below or attach two copies)
.EGAL DESCRIPTIO �C7
BDIVISION NO.
LID NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP
APPROVED BY
EXISTING 6to REQUIRED DEDICATION
PROPOSED JG6
RIGHT OF WAY CONSTRUCTION PERMIT REOUIREI)e
STREET USE PERMIT REQUIRED 0
SEE ENGINEERING MEMO DATED
EVI BY
REMARKS
wn Z"I'l 'ew-�w Zzol,
METER SIZE I IBUILDING,#UPPLY SIZE IFIXTURE UNITS
REMAAK,$ A I
MAW rwjo
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED I PROPOSED I COMPLETE I EXEMPT SHORELINE
- D AA (A Z:5M76:S /_07 # 6 VARIANCE OR CU PLANNING REVIEW By DATE
SETBACKS - FEET HEIGHY I LOT COVERA
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FRONT Z� SIDE /0 REAR
Tax Account Parcel No. REMARKS
E� NEW RESIDENTIAL PLUMBING '
E] ADD/ALTER COMMERCIAL MECHANICAL
FREPAIR 1:1 APT. BLDG. El SIGN
EXCAVATE, FILL FENCE CHECKED BY
DEMOLISH OR GRADE x _FT)
CARPORT
TYPE OF CONSTRUCTION ODE HEIGHT
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SPECIAL INSPECTOR
AREA
OCCUPANCY
OCCUPANT
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REQUIRED
GROUP
LOAD
WOOD STOVE/ RETAINING WALL/
n YES 0 NO
S�
INSERT ROCKERY
RENEWAL
REMARKS
PROGRESS INSPECTIONS PER, UBC 305 Z
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
W NUMBER OF STORIES
NUMBER OF
0
DWELLING
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UNITS
1 NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
SF Ae_sidelv�t
FINAL INSPECTION REQUIRED
VALLI ATION I FEE
PLAN CHECK FEE
BUILDING
PLUMBING
Plan Check No. /0/
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domairI (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided WorK is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
0
2
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
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
U282
_2C0
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and in doing the work authoriz-
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa-
tion Insurance.
SIGNATURE (OWNER OR AGENT) JDATE SIGNED
LI
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL'S SIGNATURE DATE
0
EDMONDS
ATTENTION
CALL FOR
INSPECTION
RELEASED BY: DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-3202
ORIGINAL — File YELLOW — inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED.
UBC
CHAPTER 3.
PINK — Owner GOLD — Assessor
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