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19015 92ND AVE W
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STREET FILEcityof Edmonds
RIGNTMEnWAY CONSTRUCTION
1[3U'"1%4'Trr
U L I Z 2 1991 Penuit Number-.q I - _� 6 6
ENGINEERING Issue Date: In — a a 51—
A. Address or Vicinity of Construction: 19015 92 Avenue West
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Natural Gas Company
MailingAddress: 815 Mercer Street,
State License #: Seattle, WA 98111
D. Building Permit # (if applicable):
Contact: Gary Swanson
Phone: 224-2080
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
-1 Commercial Fj Subdivision
E. -F7 0 City Project []t Utility (PUD, GTE, WNG, CABLE, WATER)
Fj Multi -Family E] Single Family F� Other
INSPECTOR: INSPECTOR: :Roy W
F. Pavement or Concrete Cut : 0 Yes E]No G. Size of Cut: — x H. Charge$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application; agre5 to hold the City of Edmonds hatwilessfirom injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that ma Ye`mad� agaim�t'the City of Edmonds, or any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings includ * �Wefense costs, and atiorneylees by reason of granting this permit.
R1 YEAR FOLLOWNG THE FINAL INSPEC77ON
THE CON7RA CTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA FORI PFilb bF
AND ACCEPTANCE OF THE WORK. ES77MA7EDRESTORA77ONFEES.WILL'BE-HELD.UN77LTq�,fINALS7REETPATCHISCOMPLE7EDBY
- I I I . .
C17Y FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO 771E APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the EngineWing Department- 771-3202.
Work 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 ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have 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: _MeAouo-� Date: October 5. 1991
(Contractor or Agent)
CALL DIA1,A-DIG PRIOR TO BEGINNING WORK
... ... .... .. .... ............... ....
FOR CITY USE ONLY
....................
APPROVED: BY ............. ..............
..RIGHT'OFWAYDEPOSIT�....' -
............ .... .. . ..........
.. . . ..... . .... . .... . . . ....... ...... . ..
TIME. AUTHORIZED: VOID AFTER., ILLNEAR— MAYS. DISRUPTION FEE/FUND
......... .. . .. I ..... .............. ...... ............ ... .......
........... .. .... .... I ... I I ..... I ...... .. ..... .... .. ... . ................
PERMITTEE:; (!o y-ISL
... ...... . . ................................ . - ...................
.......... .
...... . TOTAL.FEE:.
..... ................. ....... ........
...COMMENTS:. RECEIPT. NO:..
DATE:4"3 . . .... ISSUED..BY:
ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept.)
I Tr I
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
Date:
Date:
Eng. Div. July 1985
Washington
Natural GWOC'W�
AVv6gvxjton Energy Cornpany
1'�OF5 5 2— A�',I' \V
qkWNG to window
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: Kerry Walsh
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager 99
0
Key:
t-jWater main depth -w- water
unknown -g- gas
-ss- sewer
2-11 gas main water hydrant
815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767
Roof&
PlrDLlr'!-.'O8Tll;M., -LETLE
DMUHNIG PHNIT MVIFN
Strcct rzight-OE-L'a", R< i ti n TUM
Access Eas'emcnts RxistinT
utility riscment nxistin, Ar
RFO
iot rer Subdivision Plat' Assessor I Tan
Site Pi.m (Iiccl*ecl for Accurn
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u)
1� (ICYCIrCILInd `.'iring Rcorl.
ci:,� A--tij a �1` Leq i, a�kri I -NI b n.
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)cptic Tani. Dc:.qign App roved—
Sorti. an't. PenTLit Rcoui.red-
Sanitan
Side Sei-.-cr Availabi
Saidta ver Comiection Fcc Pcouired
-Vic"! 1
(>lien N.tch FAiSt;rg
Culvert
Catch Basin "X(luired
CLU.I. �.Ifll n
3
111-111'.101C MQII
Conditions F, Growd 1%'ater Ficld Cleckcd.
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PeTnit
Pro.i.
RIC -0.
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�Iclicate on !7i':c Plmi
in %vals
Indicate -M"-SAt.O 13I.-Ul
TbtC
E-
m
Strce ng -Reciuircd'
e
-Ourb and (Cutter Recm.
e LI
Sida"I'llh 1equircd.
Dirb Cut for Priveuavr Rcquired
Pi -Jit�01-1"'av Construction it Rcmdrcd
'1 -0
C
5 ons'truction
-Bond 11 -)ro
.1
on Ilircc, fo )lic in
-Bond Requirecl fo -)lic Improvements
S
tre T -ql 1
tree c Sign Required
I IZC
0 t �j cou C,
t] I C.r. S ir,,n i n f; Pcqui md
C
BY:
Water
Street
Engineering
1-4
Special Pcquircmcnts listed in memo to Building Pcp,-irtment
—7—
jL
. cm--, fill.ccl ill on Bui Ming Pei. it Application
P)v Datc
Dravdn,'Is Stampcd and -'Otations "l-la',
By Datc,
Approvecl by Public Dcpartrient
a i
APPLICATION
for
5 I&M SIDE SEWER PERMIT
The City of Edmonds STREff E EASEMENT No... ........................................
NEW CONSTRUCTION REPAIRS
z f Z
. ........... CONTRACTOR ......... ........................................................... PERMIT No..
OWNER .. ......... . ....... ...... .........
ADDRESS lY . . ...... ........ LEGAL DESCRIPTION: LOT No . ..... 4.0 .... . ...... ... BLOCK No . ............................................
NAME OF ADDITION ..............
-T E7 �'L'T 73
r%J
APPROVED
W 15 1970
..............
He 0 -
1. mw^,r 4--m----jLr ru
t .40 uj %z-
* I I q, 5-rpi - -5 w.
Approved:
72 P..
DATE 11
NOTIC�:
..Wa r ..0uy-,
N'0 ----ranty ... 0T -a-L-k-U-1'
The -information 'shown on the attached
map(s) was com ' pil(ed for use by the City Of
mployees and Consultants.
Edrnonds� its E
Th,..e City of *Edm.onds does. not warrant the
accuracy of anything set for * th on t. * hese
m a p (�_). A n . y person or entity -requesting a
copy should conduct an independent
inquiry regarding th*e info'rm-ation shown or
_�Re -rnap(s), including, but not Hmited to,
er stub shown. Suc
the lo�,ation ofanysew
ewer stubs may or may, not exist and may
or may not exist at the location shown.
Neither the city of Edmoincl.11s nor its
empl-o-yee-s o-r office-rs -s-h-a-1-1 be 11a-b-lre for the
this map(5), nor for
information g ven on
any one representation provided based
upon said map(s).
CITY OF EDMONDS
. — WATE'n-'SEWMR DEPARTMENT
CIVIC CENTEP
SIDE SEWER PERMIT
Call P't"Peft 64107 When work
"I ready for inspection. (NO I
,ons Satur'day, Sunday or hull nspec-
days.) N2 371-9
"DRESS ................................. 190 15
........... :7 ... ��?RCAY�e..West
OMWEP................. Ajo ... Ca S. ... ........................................................................................
Permission is granted .............................. COWMACTOR -------- Owner .......... --------------
"Ith city Sewers in ........ 19 70 .............. ...................
a'ccOrdal,e vith application --- for ........................ ............
ATTENTION IS CALLED TO on filO and governing ord1anya8.ees.REPAft or CONNECT a Side Sewer
NOTE 140, I —The owners of t THE FOLLOWING:
be employed to he Property may
No con obtain a
TE No. 2—obtai Btruct side sewer in trepern"t to Construct sewer inside Property line. A licensed Side sewer Contrae
n full information Ordinan et axes. Do not Cover uny portion
NOTE�N'. 3—TOp Of side sewer mus regarding ce Of sewer before It has been inspected. -tor must
No bends in grade sba t have at least 11-16-030 and Regulations governing side sewer, when
NOT rper than 1,6 .130 Inches coverage at Property line and 12 Inches Inside property
E No- 4—?renChes In street I be Permitted . You get permjt.
NOT failure due to mP must be water gettled and surface Of street restored to original line; minimum
E NO* 5�—It is Unlawful roper work WhIc may develop grade Of 2
tenanCC8 excepttO alter or do any Other Work than Within One Year of condition. Contractors shall be responsible for
to Insert the is completion.
Pipe Into the Wye. Provided for In the permit, or to do any work On the main sewer or Its appur-
5
ml�- ?< / ') 6 4-2�'
OA- 2-0
OEM
- o,
r10
FOR
Jj-
ATE RECEIV�,
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
k1ILLER, Richard & Betty
MAILING ADDRESS
19015 - 92nd Avenue West
0
CITY ZIP TELEPHONE
Edmonds 98020 425-640-2534
NAME
ADDRESS
CITY ZIP I TELEPHONE
ILI ii�
PERMIT EXPIRES'
U S E
Z N
ZONE
0 E
USE PERMIT 2Cz2
NUMBER
JO B
J06 SUITE/APT#
A D D R E S
ADDRESS 0 15 4724 /V6. &0
PL A T N
PLAT NAME/,tUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC 'RIGHT OF WAY PER OFFICIAL STREET MAP
I
EXISTING � PROPOSED
TESCIPApproved 13
AW permit Required 0
Street Use Pemilt Req'd 0
Inspection Required 0
Sidewalk Required 0
REQUIRED DEDICATION_ FT
Underground
wiring required 0
M M T
ETER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED 4
YES 0 NO. 0
Z
IVWARKS
kI NER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
M,,,
UJI
z
z
10
NAME
NORDIC SERVICES, INC.
ADDRESS
9618 Midvale Avenue North.
CITY ZIP
TELEPHONE
Seattle 98103
20 6-522-9570
STATE LICENSE NUMBER
EXPIRATION DATE
/`HE(:rE1
NORDISI180QA
is
01/01/04
PROPERTY TAX ACCOUNT ;ARCEL NO.
00434600003006
is
0 NEW RESIDENTIAL
C3 PLUMBING I MECH
0 ADDITION C] COMMERCIAL
c3 COMPLIANCE OR
CHANGE OF USE
[D REMODEL 0 APARTMENT
C] SIGN
P REPAIR 0 GRADING C3 FENCE
CYDS
( X
DEMOLISH C] TANK
C3 OTHER
GARAGE RMNING WALL RENEWAL
CARPORT El R ERY
(TYPE OF USE, BUSINESS OR.ACTIVITY) EXPLAIN:
single family'residence/ 4bomwt-26&
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING 1
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE 1:�
new trusses & framing for roo� neAA) roo-
-11
acki V\c1'f!5kuUctV�r ,
AN IA)1501 , ')i AGU
HEAT S-CV19U A,,,-j GLAZING % I LOT SLOPE %
PLAN CHECK NO: IVESTED DATE
I I h
ENGINEERING REVIEWED/DATE
FIRE REVIEWED BY DATE
M
CWL
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
REQ'D
POSTED
I
YES [3 NO
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
z
z
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
REO'D I PROVIDED
I
FT)
CHECKED BY TYPE &;��IN14TRUCTION C" OCCUPANT
Ll GROUP
JSF ECIAL INSPECTOR - PEA OCCUPANT
R
REQUIRED[:] YES LOAD
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
N 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
DEEMEDTOMODIFY, WAIVEOR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT INANYWAYTHE CITY'S ABILITY TO ENFORCE ANYORDI NANCE PROVISION."
I HEREBY ACKNOWLEDGE THAT I HAVE READ TH IS APPLICATION; THAT THE 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 STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAQQELqODE OF THE STATE OF WASHINGTON RELATING TO
WORKMO'S CiOMPENS�MN I*RANCE AND RCW 18.27.
SIGN/A� RO A DATE SIGNED
07/08/02.
A17ENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION log
5/98
REMARKS
PROGRES5 INSPECTIONS PER UBC 108/FINAL INSPECTION REO�'D
VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING.
MECHANICAL
GRADING/FILL
STATE SURCHARGE
ENG: REVIEW FEES
ENG. INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE RECEIPT 2
q
APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
FOR INSPECTION
Building Official or his/her Deputy: and. Fees are paid. and
receipt is acknowledged in space provided.
(425)
OFF� LS URE Ez,
..
7�1
fu A
--RELEA
.771-0220
I DA?t
EXT/333
C�6� -711o(O,
-J
771-0221
FAX
ORIGINAL -FILE - YELLOW- IN/pECT01R
PINK -OWNER - GOLD
-ASSESSOR