19102 DELLWOOD DR.PDF11111111111111
10893
19102 DELLWOOD
DR
ADDRESS:
TAX ACCOUNT/1"ARCEL NUMBERfo4l,�raWaoo
BUILDING PERMIT (NEW STRUCTURE) -
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver 0 Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S)
GEOTECH REPORT DATED:
STREET USE /ENCROACHMENT PERMIT
FOR:
WATER METER TAP CARD DATED
LID sm
LOT: 15 BLOCK:
LATEMP\DSTs\Fomis\Street File Checklist.doc
APPLICATION
for
The City of Edmonds S11DE SEWER PERMIT EAPEM-1
NEW CONSTRUCTION REPAIRS
C) Q -8 0 0 ��
- - — ---------- ...... ------- CONTRACTOR .4�Z ..... . .... PERMIT No.
............................
ADDRESS. IYZA0 .. 2— T4�� ..... .................. LEGAL DESCRIPTION: LOT No. .............. ------- ----- BLOCK No . ............................................
. ......... I .........
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APPROVED
DATE ...... I.Y.1 By . . ........ ...................
CITY OF EDMONDS W , ' I PWermitNo.
COMMUNITY SERVICES DEPARTMENT sue Date
RIGHT-OF-WAY CONSTRUCTION PERMITSTREETFILE Is
. 1�1
A. e Owner: Washington Natural Gas Co B. 0 Contract6r:
156 AV NE
Mailing. Address.
BelIevue, WA 98007
City State . Zip
Address or Vicinity of
Type of Work to be E
Work in Connection With:
Z
.e Pavement Cut: 0 Y 0 N
Same
Name
Mailing Address
City State Zip
.447-0700
State License Number
ce installation
Telephone Number
El Sub or Plat 0 Single Family El City Projects
U
APPLICANT TO READ AND SIGN'
ot 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, court costs, and attorney fees by reason of granting 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.
0
U Funds held from the Security Deposit (estimat,ed'restoratio'n fee) will be held until the final street patch is completed
W by City forces, at which time a! d6it ot-�redit*
,will.b,e,i)r,oc.esse4,fpr.is.s.uan.ce:.to, the applicant.
0
* A 24 hour notice is required for inspection; Please'call Public Works: 771-3202
9 Work is to be inspected during progress and at completion.
* Restoration to be in accordance with City Code.'
0 Street to be kept clean at all times. . q
*-Traffi� 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.
Z
0
W
U
I understand the above and that this permit must, be available at the job site for inspection purposes at all times.
OVA.
Signature: J Ah- A A 44 Date:
Owlel%0���
T his
Pe t Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
ISSUED BY: n 54e_u,�Z�
Time Authorized: Void after days:,
Special Conditions:
Amendments:
PERMIT FEE: 400.
-Secur.ity-.-Dep6sit�.
Receipt No.:
Fund I I I Fee'
Street Cut Dimensions:
X
NOWORK TO BEGIN PRIOR TO'PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTIONAES IRund I I I - Rout
e copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY:- Date:
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. ...... Servi
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Wis granted ......
F'b
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Or ----------------------- days
iiith' City' Se-w- s" in" ....... 17 CONNECT a side
er ''" r lto� REP41R.'o
w on file and: rdinances. sewer
o
A TTFNln N-1
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ALLED TO �THVFOLLOWING:
NOTE.No. 1_�ije 6wn6rs�
'of the tgPPertY Ina I Y� ob , 1
he employed' tain, a :permit to conBtruct,sewer Im
to con Me Pro"y.,ilne:
s. ctside�sew�r,in A licensed
NOTE�No. 2-LOltairi fu:1] info' tj street: ar a.'L Do "'o I er:sn I beSld� Sewer Contractor must
07 Y'POrt on 0.f'siwer before It has en me
rms� LOP � reg"ing, Ordifiance'11. 16.030 'Regl�lations 'governl pected.
NOTE 44-.- 3��Top of s14 and.
Je :Sewer mnst ha' ng side s4jw wh
ve at least 30 inches - covera en You get permit.
N61 bends in grade Sharri the,
ge at property line. and: 12 i
r %-'will be. Permitted: IcIeSAnslde property, line; Mini
NOTE No'
,�N 4-7Tre-ches i, �tle Inum grade of 2%.
t nInst be water settled and'"
failure, qne,to P s-face of st t 'r�Stored to orig n
im MP�ii work which Msy'dev�lop within, ree ina]'Condition Co tractors shan, be
5--,It is,� unlaVjft� L to one Year.Lof Completion. responsible fo
e alter or. &'any'othr work than is Provided for in the perml
Purteil . an6es except to in—. the Pipe into the Wye. t, Or. to.do any. work On the m
ain sewer or its
ap