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19115 88TH AVE W.PDF111111111111 8385 19115 88TH AVE W ADDRESS: / qzz�� 1�?e -1�6 awaw , 4��2 TAX ACCOUNTIPARCEL NUMBER - BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) FOR: CRITICAL AREAS: DETERMINATION: [-I Conditional Waiver 0 Study Required E] Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED PERMITS (OTHER): PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: SHORTPLAT SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: WATER METER TAP CARD DATED: OTHER: LID #: LOT: BLOCK: L-\TEMP\DSrs\Fonns\Street File Checklist.doc BUILDING DIV 'PERMIT Applicant Fill USE MIT TR ZONE M 13 E R Er-WrFILE tj APPLICATION Inside Heavy Lines JOB NAME (OR NAME OF BUSINESS) ADORE 5S 2 J- t I e, It i0- �i a- r A kasen LEGAL DESCRIPTION ION SHORT SU13 NO. - MAILING ADDRESS z ' (:W-94 7 41'44 fiv G 0 ILEPH*11 "U1 IR PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING V Ld 6 men PROPOSED NAME DEFICIENCY OF RIGHT OF WAY U W t ADDRESS PUBLIC IMPROVEMENTS REQUIRED z U DRAINAGE IMPROVEMENTS REQUIRED El 0 3: M CITY EILEPHONE NUMBER DRAINAGE PLAN REQUIRED El U UNDERGROUND WIRING REQUIRED NAME CONNECTION TO SANITARY SEWER M SEPTIC TANK PERMIT REQ'D NO. 0 I- ADDRESS ELEVATION OF PROPERTY CORNERS E) U D & FOOTINGS REO'D n) n r -17 Y TELEPHONE NUMBER z SEE ENGINEERING MEM"ATED-74 0 T7XVr-L-1dYWS-E HUM13UR CITY LICENSE NUMBE-FF- - CHECKED BY "it" - I z 0 I - IA W 0 .J .j Description of Propertv (Show Selow or Attach a-y o + J? OL - I C� I BUILDING SUPPLY SIZE SIGN AREA ENV. REVIEW ALLOWED I PROPOSED I COMPLETE1 EXEMPT REMARKS VARIANCE OR CU YARDS M71 NEW RESIDENTIAL E] GAS FIR FRONT ADD MON-RESIDENTIAL ID LINE SIGN . FIRE ZONE FIRE ZO' E DEMOLISH RETAINING r SPECIAL INSPE �C.A L INS, ALTER EXCAVATE WALL FENCE REQUIRED RE_U- RED 0 YES 0 N 0 C:) - . S OR FILL X —FT) PLAN CHECKED BY PLAN CHECK [REMARKS REPAIR PRE -MOVE swim INSP. POOL IEM Z NUMBER OF STORIES NUMBER OF OWE LLING UNITS on e- WORI TO 1311 DONE TURE 11 0 0 U . M W a M 01 PLAN CHECK FEE BUILDING PLUMBING MECHANICAL FENCE ISWIMMING SIGN "Applicant, on behalf of his or her spouse, heirs, assigns and successors in interest, agrees to indemnify, defend and hold harmless i J the City of Edmonds, Washington, its officials, employees. and RETAINING WALL it agents from any and all claims for damages of whatever nature, < I arising directly or indirectly from the issuance of this permit. Issu- POOL AOB NO. DRELINE PLANNING REVIEW BY I DATE ILOT COVERAGE SIDE REAR '6F CONSTRUCTION CODE HEIGHT OCCU PANCY OCCUPA GROUP LOAD THIS SITE IS LOCATED IN THE CITY OF EDMONDS. LOCAL SALES TAX SHOULD BE CODED 31.04. VALUATION I FEE a Iance of this permit shall not be deemed to modify, waive or reduce anv renuirement of anv citv ordinance nor limit in anv wav the DATE: MEMO TO: Building Division Community Development Department FROM: Engineering Division Public Works Department SUBJECT: After review of the'subject Building Permit application, we have the following comments:' 1. Connection to City water system required. ' 2. Connection to City sanitary sewer system required. 3. Right-of-way Permit required for any work on City pr . op er . t . y I 4. Driveway slope notto exceed 14%. 5. Backwater valve required if downstairs plumbing is below elevation of upstream manhole. 6. Water and sewer lines to be separated by 10 foot minimum. . ........ .. 7z, n#e- lAzy SignatuTe 40 PUBLIC WORKS DEPARII-= CHECKLIST aij its) iz eny ot,*.,4 y q wkwtp i pol Z ILI-5- ft a (address) (date) Street Right -of -Way Exist Z Access Easenients Exist Utility Easement Exist Lot Pei'Subdivision Flat./,4&#A#,,fW Assessor Map Site Plan Checked for Accuracy Z Underground Wiring Reqd. H Check Accuracy of Le a Description 0/( Z Review by_ Date 1�2-1z-k Existing Water Main Size Water Main Required L-SOL-) Service Line Required -N4 11 Hydrant Size Existing /Ao 0-"C- (2- =1-12 P -Z ZY-1- c4 Hydrant Reqd Per Fire Code ----Size Detector Check YEter Reqd. 00L.�ir-_ Cross Connection Inspection UC>L-JF, Fire Departnmt ConTnents 4 A A 1 4 A Water �leter 0-40 Review by Date j�2�-10,Lfo Septic Tank Design Approved- Date Septic Tank Pern-ft Reqd. Permit No. d2l Sanitary Sewer Availability Yroj cl-lefz!z. Dra:wing No. File No. P4 Side Sewer Availability W Sanitary Sewer Connection Fee Reqd. :3: Review by. Date Open Ditch Existing__& Reqd. Culvert Reqd. Size C4 Catch Basin Reqd. Indicate on Site Plan 0 Shoulder dralIM2 maintain collection on swale open runoff 9 Manhole reqd.1V-I/ Indicate on' Site Plan Soil Conditions and Ground Water Field Checked ev. . Review by Date Revised: lvlO-1977 Page 2 Street Paving Reqd. Curb and Cutter Reqd. Sidewalk Reqd. Curb Cut for Driveway Reqd..e&-� 94 Right -of -Way Construction Permit,'.,Izeqd, A C-01'4 4 Band Reqd. for Public Inpravements- Street NaTw Sign Reqd._ Other Signing Reqd. Pre Permit Site Inspection made on z 0 BY: SMR WATER CL4 En H z STREET ENGINEERING Special Requiren-ents listed in mem to Commmity Development Departnent, Building Division BY - Date c) All items filled in on Building PernfLt Application BY Date Drawings Stanped and Notations Made P4 BY Date <4 Approved by Public Works Department Revised: lv 10-1977 VI) C). a o -57-C A C'K.. ----- -- ------ Im. La 05, ---- -- - V ............... ... 7. .. .. .. .. .... --17 1 Ll (3-zlo -U2�6 _ion 7 % % a Z- ol SCt?'O'JC]3 -�o A-Ll�) _LV 0-1 A 0 �.l d d NOTICE: ..War-ranty ... oi. N'o tached The information shown on the at map(s) was compiled for use by the City of Edmonds/ its Employees and Consultants. The City of �Edmqnds does not. warrant the y of anything set forth on these accura M a p A n . y person or entity -requesting a copy should conduct an independent -ation shown on inquiry regarding th*e inf rm, tRe -map(S)i including, but not limited to, -h wer stub shown. Suc the location of any se sewer stubs may or may, not exist. and may hown. or may not exist at the location s. . . r-;ty of Edmoinds, nor its Neither the %1_11 emp'l-o-yee*s o*r offi-ce-rs -sh-a-11*1 be Viab[e for the information given on this map(s), nor for any one representation provided based upon'said map(s), TY OF EDMONDS FOR INSPECTION CALL P 1�,RLIC WORKS DEPARTOT Permit 'SIDE SEWER PERMIT 775-2525 Ext. 220 Issue Date PERMIT MUST BE POSTED ON JOB SITE I 1. Address of Construction 2. 3. U. I-- Lu 4. Uj - 5. 6. co Property Legal Description (include all,easements) Single Family Residence Multi -Family Commercial Owner and/or—BuIlder, kl�rl.awr4 Contractor & License No. (' _C>-jj+VrAC_6V1 UtAd Ct- 9U e_? C"o, No. of4Units _LZI r_ i C-k e Invasion into City Right -of -Way: No ��,__-_Yes way Construction Permit Required - Call Dial Dig EDMONDS TREATMENT PLAR]C (If Yes Right-of- (342-5344) before excavation) . 7. Cross other private property: Yes Nobll�*�Easement required attach legal description and county easement number. READ THE FOLLOWI.NG AND SIGN: 1?V a. Property owners must obtain a permit to inst on >4 their property. A licensed side sewer contractor mudicaMmarto M construct side sewers in the public right-of-way. nv" b. The side sewer contractor assumes full repon-.UrxFj'jomq�ty(=Mr-(n'w'ch E-1 installation for one year. W 1- 800-562-6478 �4 C. Co-wnercial establishment requires a minimum oi a six inch (6") P4 z side sewer line. 0 d. Side sewers may not be installed closer than thirty inches (30") U to any structure. e. Side sewer lines must be laid at a minimum grade. of 2% (1.15 and maximum grade of 100% (450). 0 0 E-4 f. No turn in side s8wer greater than 45 (1/8,bend) is 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 through other than granular soil. i. Cleanouts are required at 30"-60" from each plumbing exit line and at minimum intervals of 100' 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: I*certify that I have read and shall comply With the above PA PERMIT FEE: /0 Nev &1, Z� DISAPPROVED BY: Date: J B Date: CONNECTION FEE: P4 APPROVED Date: 0 PERMIT MUST BE POSTED ON JOB SITE ML--A 67 The City of Edmonds :I_ Side Sewer Drawing I - - � �-, -A ......... 71 -q- _F�F 7, A NEW CONSTRUCTION REPAIRS 1:1 LID ... SMT.-NO.' OWNER— ---------------------------------------------------- CONTRACTOR ..................................................................................... PERMIT NO. JOB ADDRESS ....... .. . .... VY... ... LEGAL DESCRIPTION: LOT NO . ......... t . ....................... BLOCK NO ........ EDM()NGS -------- TREATMENT PLANT ..................................................................................... ......................... ................. .......... NAME OF ADDITION ... //?.0/ Z� ...... ............................................................. L7 t Approved: PWW-0001-1 1/�5 (REV.1 1/78) DATE ........... By,� . .... ......... . .. I .............. CITY OF EDMONDS 61, FOR INSPECTION CALM PUBLIC WORKS DEPOWT Permit N? 6643'p SIDE SEWER PERMIT 775-2525 Ext. 220 Issue Date ?=/ 2,47 / ffa FRI VNR .41 a4 04 z 0 U W M 0 E-4 * PEP -MIT MUST BE POSTED ON JOB SITE * 1. '_�Z-777-- Address of Cons truc tion_Tg=__:U - . C? go ?_0 2. Property Legal Description (include all. easements) L0772- 3. Single Family Residence P"' Multi -Family No. of Units Commercial 4. owner aad,49r- SvA_Ldax.. 5. Contractor & License 6. Invasion into City Right -of -Way: No 1,�Yes (If Yes Right-of- way Construction Permit Required - Call Dial Dig (342-5344) before excavation). 7. Cross other private property: Yes No asement required - attach legal description and county easement number. READ THE FOLLOWT.NG AND SIGN: a. Property owners must obtain a permit to install side sewers on 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 CALL 4&HWI RS(6 side sewer line. d. Side sewers may not be installed closer tha§EfQqyY011hQ (3011) to any structure. I- 80OJ6�-6 e. Side sewer lines must be laid at a minimum grade 50) and maximum grade of 100% (450). 0 f. No turn in side s8wer greater than 45 (1/81bend) 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 through other than granular soil. i. Cleanouts are required at 30"-60" from each plumbing exit line and at minimum intervals of 100' 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: j certify tVt I have read L 10 ),S- I - PERMIT FEE: Lj W CONNECTION FEE: 00 ( �o �e sh Zr+M eat and all comply with the above V44'_C�ISAPPROVED BY: Date: 11 V �-_ By: -Date: APPROVED By: Date: * PERMIT MUST BE POSTED ON JOB SITE * 9 0 City of Edmon(e S", HREET FIL8 i.' RIGHT-OF-WAY CONSTRUCTION PERMIT Permit Number: ?c) - 3d 15 <n~e STA A. 1 11—lo —oil- Issue Date: r A. Address or Vicinity of Construction: 19115 88 Avenu6,West B. Type of Work (be specific): Instal I New Service C. Contractor: Washington Natural Gas Company Contact: Frank Swan Mailing Address: 815 Mercer Street, Phone: 224-2278 State License #: Neattle, WA 98111 Liability Insurance: Bond:$. D. Building Permit # (if applicable): i Side Sewer Permit # (if applicable): E. "n Commercial E] Subdivision F-1 City Project Rk Utility (PUD, GTE, WNG, CABLE, WATER� F1 'Multi-Fan-ffly E] Single Family n Other INSPECTOR: INSPECTOR: V M F. Pavement or Concrete Cut Yes E]No $1) G. Size of Cut: 2 x 4 H. Charge$ APPLICANTTO REA ANR.,-,:,8_1_,GN INDEMNITY. Applicant understands and by his signature to this application, agrees to, holerihe City of Edmonds hatwilessfrom injunes, aamages, or i claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the City of Edmonds, or any of its departments or employ- ees, including or not limited to the defense of any legal proceedings including defense 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 INSPEC17ON AND ACCEPTANCE OF THE WORK. ES77MAYED RESTORA77ONFEES WILL BE HELD UN77L THE FINAL STREET, PATCH IS COMPLEYED BY CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR'lSiUANCE TO THE APPLICANT' Construction drawing of proposed work required with permit application. t A 24 hour notice is required for inspection; , Please call the Engineering Departmen Work is to be inspected during progress and at completion. Restoration is to be in accordance with City Codes. 771-0220 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 them)rking day; NO EXCEPTIONS. I have read the above statements,and understaqd the pe rmit requirements and the pink copy of the permit will be available, on site at all timesfor in I i o n p u rp?,as e/�, Signature: Date: October 14, 1992 (Contractor or Agent) CALL DIAIA-DIG PRIOR TO BEGINNING WORK. kul Engrg. Div. 1991 w FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dep#.) Comments: Diagram. CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO Partial Work Inspection by P. W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: Eng. Div. Jul: 1� Z-1 - 10)115 AWafttgo &vWCMpWV Addendum to City of Edmonds Right of Way Permit Application Submitted by: Mjc�-�9,0 �jj" Aq Engineering Aide AV UX) Washington Natural Gas 622-6767 x2761 pager q( - 1(,05G COL LA) if)?- .5-r- :!5, WNG to windo Water main d unknown - 2- 11 aas mai 11 TI' -w- water -g- gas -ss- sewer -e- water hydrant 0 water valve 815 Mar= St. (P.o. BOX 1969), Sc&ttk, WA 98111 (206) 622-6767 8 9 0 . 199 - City of Edmon4b RIGHT-OF-WAY CONSTRUCTION rV904-M Permit Number: 3A S T RiE E0 I" FILE Issue Date: .':A0 A. Address or Vicinity of Construction: 20.114 88 Avenue West B. Type of Work (be specific): Install New Service C. Contractor: Washington Natural Gas Company Mailing Address: 815 Mercer Street, State License #: Seattle, WA 98111 D. Building Permit # (if applicable): Contact: Frank Swan Phone: 224-2278 Liability,,Insurance: Bond: $ Side Sewer Permit # (if applicable): E. "r] Commercial El Subdivision El City Project R1 Utility (PUD, GTE, WNG, CABLE, WATER) E] Multi -Family El Single Family E] Other INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut Yes EIN91 1 ) G. Size of Cut: 2 x H. Charge$ ', 4 APPLICANT TO READ ANR§IGN INDEMNITY: Applicant understands and by his signature to this application, agrees to,�d�ljhe City of Edmonds hatwileii-ft—)om�ti,(,,,ie6s,;d;;,;;;ag-es, or _'�the Ci or unforeen, that may be made ains claims of any kind or description whatsoever, foreseen ty of Edmonds, or any of its departments or employ- ees, including or not limited to the defense of any legal proceedings including defense costs, and attorney fees by reason of granting this permit. ' kNG THE FINAL INSPEC71ON THE CON7RA CTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA TERIALS FOR A PERIOD OF ONE YEAR FOLLO AND ACCEPTANCE OF THE WORK. ES77MATED RESTORA 77ON FEES WILL BE IiELD UN77L, TIJE FINAL S7REET P,47:cH ifpmf�ETED BY CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO 7HE APPLICANT. Construction drawing of proposed work required with permit application. - A 24-hour notice is required for inspection; Please call the Engineering Department Work is to be inspected during progress and at completion. 771-0220 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 ein"d of the working day; NO EXCEPTIONS. I have read the above statements and understand the pertnit requirenients and the pink copy of the pennit will be available on site at all timesfor in ion pu Signature: Date: October 14, 1992 (Contractor or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK NO WORK SHALL BEGIN PRIOR TO, PERMIT ISSUANCE Engrg. Div. 1991 FIELD INSPECTION 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: FINAL APPROVAL BY: Date: Eng. Div. July 1985 MOW on it- Naftnii FAii��F AVIW go &wWCwWV -2- " I I -+ S E> A V VJ WNG to window Water main de - unknown 41�1 11 gas main : City of Edmonds Right of Way Permit Application Submitted by: Mjr-�-kA,9-0 �tIL-L-Aqq) Engineering Aide Washington Natural Gas 622-6767 x2761 pager q(,,,9 - 1(�05G %0� k 4 40 Key: _w- water -g- gas -ss- sewer -e- water hydrant 0 water valve . 815 Ma= St. (P.O. Box 1869). Seatt , WA 98111 (206) 622-6767 U U 0 E- Z 0 CITY OF EDMONDS PUBLIC WORKS DEPARTMENT RIGHT - OF - WAY CONSTRUCTION PERMIT A. *Address or vicinity of Corgtrqction / ,� ��4 � "', , Owner: Name Mai�ipi Address City, S ta te, Zip Code Contractor: I Name City, State, Zip Code 1-3nit No. .-2F./ - LL-L,"" Issue Date F, Z,7 • Permit Issued To: • Type of Work to be Done: ;e /4 • Work in Connection With: 0 Sub or Plat ��ingle Family El Comml. / Ind. El Apt. Condo. • Pavement Cut: >� Yes El No State License Number Telephone Number * * 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 including defense, costs, court costs, and attorney fees by reason of granting this permit. Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year following the final inspection and acceptance of the restoration by the Engineering Division. 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 I understand that this permit mu be availabi t - -e jo 'Site for inspection purposes at all times. 7' Date 6 Signature:- O�Y(neir 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: Void after days Special Conditions: Ammendments: I'le" Permit Fee: , �� Security Deposit: Receipt No,: Fund I 11 Fee: Street Cut Dimensions RECEiV X n -r n Ou I Z ?-1981 NO WORK -TO BEGIN PRIORTO PERMIT ISSUANCE Dir. of PublIG _s Eng, Div. December 1978 FIELD INSPECTIONOTES (Fun .. 6 111 foute con.v to Street Dept.) Comments: Diagram: Contractor called for inspection es NO T -( —'Y 'es-/ ,A7ork DisaPproved BY: Date. Bv: Work ApDroved-Bv: Date: Inspector: Date: Ena. Div. December 1978 CITY OF EDMONDS F)(1 NEW ADDITION RETIREMENT A INFORMATION SHEET STREET FILE ASSET NO. o 3 ADDITION TO ASSET NO. DESCRIPTION W4-1dP, SERIAL NO. LOCATION DEPT. NO. A *PURCHASE.ORDER NO. - PURCHASE ORDER DATE COST *PROJECT NUMBER C4_) 2— PROJECT COMPLETION DATE COST 66-7 B.A.R.S. ACCOUNT NO. 1 63 ESTIMATED LIFE INI I IAILU bY DATE APPROVED BY "SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST *SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT ACCOUNTING ONLY DEPRECIATE MONTHLY DEPRECIATION AMOUNT ANNUAL DEPRECIATION AMOUNT - G.L. ENTRY REFERENCE DATE VERIFIED BY PROCESSED BATCH NO. INITIAL wp) DEPARTMENT FILE Z 0 U 0 i— Z 0 UJ V) 0 CITY OF EDMONDS 9F PUBLIC WORKS DEPARTMENT RIGHT - OF - WAY CONSTRUCTION PERMSTREET FILE INWit No. Issue Date A. *Address or vicinity of Construction 9 Permit Issued To: A/L, • Owner: 77;.41AI�cY)AJ * Type of Work to be Done: Name o e Work in Connection With: Maifing Address El Sub or Plat X Single Family El Comml. / Ind. El Apt. Condo. City, State, Zip Code e Pavement Cut: El Yes E� No • Contractor:— SA/6, Name Z,101,r IVI111�, 967 Mailing Address State License Number I/ � (<Z /I.. /I./ --7-76;r — ..;- // 7— city, / �tate, Zip Code Telephone 'Number * * 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 including defense, costs, court costs, and attorney fees by reason of granting this permit. Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year following the final inspection and acceptance of the restoration by the Engineering Division. 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 mus,t be available at the job site for inspection purposes at all times. S, J/ 1 /6 Date ignature: )x/- 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:," nr) Security Deposit: Receipt No.: Fund I I I Fee: Street Cut Dimensions X * * NO,,WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * * Eng. Div. December 1978 FIELD INSPECTION TES (Fund 111 - Toute co.r)v to Street DePt. Diagram: Contractor called for inspection Yes NO T ,Alork Disapproved Bv: Date: Bv: Date: Work Anuroved Bv- Date Inspector Encr. Div. December 1978 I PEV 12/79 "mucl UTfuTy Dania No I of Sookomish com"y �-ATU Aroo t QC AT 10 N DATE Sl-'Wo. POLE NQ- WjjA 'S .%j SZ: T Z-�7 RfVlStO" U-C-v f I tE NO. - REASON FOR WORK ohj�L- jm. IM -W � Wo , r . - 11 WAIPTElt APP OvAts =E;T TYPE 4E- 1'ry 2V lip VlWE0 WHOT IF00RE0 w bTRff TRIMMING, OWATfit ANAVStS X 40 mix T ONOT EXEMPT IRWAL Dio 06EWER DATE GRANTED 0 #UD LOCATO* CIGAIS' fARA., - t t F M DATE WFLEASED 'SACK H2! a H- tr, G 'Wi4 D. - K V fk;s ndu4m) vp�ln wc 1, Ott= POLF CXT- FT-Pjj TYPE GTNWNO., -STENCWR6� FROM To R I ICKT FT. -PM. CKT. FT, DATE AAAMNT CATV NO. TAKE OFF Pq�LE toGs POSTED, G, E. C, E SUBSTATION CIRCUIT. No. TRAN5,F C6�g§ DATE WORK CloWifTIED, m cl DATE PRINM C- 1!z, am- DISPATCHfR "TED WO NO-