19127 92ND AVE W.PDFiiiiii iiiiii
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19127 92ND AVE W
NOTICE:
n
.. o r--a---c-- c-u- r.:-ac�Y - - - - - - - - -
formation -shown on the attached
The -in
map(s) was c0M ' piled for use by the City of
Edmonds/ its Empl.oyees and Consultants.
Th,.e City ofEdrn.oncls does. not. warrant the
accuracy of anything set for ' th on these
m . ap('�_). An*y person or entity -requesting a
copy should conduct an independent
inquiry regarding th*e inform-ation shown- or
-t-He -Map(s), including, but not limited to,
th*e lotation of any sew-er stub shown. Sud
-not exist and may
sewer stubs may or may
or may not exist at the location shown.
Neither the city of Edmo-nds nor its
emp*1,o,yee*s o*r officers shall be 11a.bte for the
information given' on this map(5), nor for
any one representation provided based
upon'said map(s).
llv� City, of Edmonds
APPLICATION
NINE ff--- Fff-F for
SIME SEVVM FVBh=
NEW CONSTRUCTION El REPAIRS E]
OWNER ----- .........
44 —1p
ADDRES............... Vapl....7 .. ......... ......................
EASEMENT No.
iL-1541)
CONTRACTOR ..............
.. ..... !!� PER
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No.
NAME OF AMMON .......... ......
,?-:� 'Oto "le 5 1,
ApprQved:
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DATE ... Z— ........
. ...........
7"�_��; Wi, 7 7_�
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CITY OF EDMONDS
Call FRospect 6-1107 when work
GIVIC CENTER — WATER -SEWER DEPARTMENT Is ready for Inspection. (No insplec-
tiong Saturday, Sunday or holidays.) N -0 2683
SIDE SEWER PERMIT
ADDRESS .............................. 19127 - 92nd Avenue West
......................................................................................................................................................................
OWNER ............ P ....... M ....... V.h.it.e.loc.k .......................................... CONTRACTOR ...... M C .. . __ W .......................................................
.. .. .. .. .... .. ....... ..
Permission is granted .... ............. I 19_6.8., for ........................ . days to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer In street area. Do not cover any portion of sewer before It has been inspected.
NOTE No. 2—Obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—Top of side sewer must have at least 30 Inches coverage at property line and 12 inches inside property line.; minimum grade of 2%.
No bends In grade sharper than Y8 will be permitted.
NOTE No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
NOTE No. 5—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its appur-
tenances except to insert the pipe into the wye.
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Four Seasfflns
Tree Care, Inc.
A
Alember Internatimial &lrirty of'Arboriculture
& Nati nit Arlwist �ssociation
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Pruning specifications
ISA crown clean/ thin
Other
Tree r oval
V�
Wood cut/ left
Haul away wood
Debri§,disposal
Haul away chips
Leave chips on site
Stump removal*
Type of machine
# of inches
PROPOSAL AND CONTRACT FORM
Proposal submitted to
k Ali
Address
7 _4 �'e� 0
�--ity n Zip
Hm phone Wk phone
Email address
77
Job site
Phone
Map location
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PC.)
*FSTC shall not be liable for damage to underground installations we have not been made aware of prior to commencing work.
We propose to furnish all necessary labor, insurance and materials to perform the work as outlined above
/ V 1A . ."i , -!- .— ,
for the sum of $ )Oe� V
Payable upon completion of job unless otherwise affanged--Thank you!
The price quotation will remain in effect for a period of (30) calendar days unless otherwise stated.
Salesman
Date
ACCEPTANCE
I hereby accept your proposal and authorize the work to be done and payment to be made according to the terms thereof.
Owner -
Four Seasons Tree Care, Inc.
PO Box 82089 Kenmore WA 98028 (425) 771-3176
Contr. #FOURSI*005D9
www.4seasonstree.com
Date
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LICENSI� DETAIL INFORMATION Form
Page I of I
STATE OF WASHINGTON
DEPARTMENT OF LABOR AND INDUSTRIES
Specialty Compliance Services Division
P. 0. Box 44000 Olympia, WA 98504-4000
THE RESULT OF YOUR INQUIRY FOR LICENSE NUMBER SELECTED IS:
LICENSE DETAIL INFORMATION
Current Filter: None
Registration# or License FOURSI*005D9
Name
FOUR SEASONS TREE CARE INC
Address
4202 230TH PL SW
Address
City
MOUNTLAKE TERRAC
State
WA
Zip
98043
Phone Number
4256723647
Effective Date
3/29/2000
Expiration Date
3/7/2005
Registration Status
ACTIVE
Type
CONSTRUCTION CONTRACTOR
Entity
CORPORATION
Specialty Code
LANDSCAPING
Other Specialties
UNUSED
UBI Number
602018130
* * *VIEW CROSS REFERENCE FILE FOR THIS LICENSE* * *-
* * *VIEW PRINCIPAL OWNER(S) FOR THIS LICENSP * *
* * *VIEW CONTRACTOR BOND/SAVINGS INFORMATION * * *
* * *CHECK INQUIRY FOR SUMMONS AND COMPLAINTS* * *
* * * VIEW CONTRACTOR INSURANCE INFORMATION * * *
New inquiry by CITY, NAME, PRINCIPAL OWNER NAME, LICENSE, UBI NUMBER, check the
L&I Contractor Industrial Insurance Premium Status or return to the L&I Construction Compliance Home Page
https://wws2.wa.gov/lni/bbip/TF2Form.asp?License=FOURSI*005D9 6/26/2003
PRINCIPAL OWNERS LIST List
Page 1 of I
PRINCIPAL, OWNERS LIST
SELECT A NAME TO VIEW COMPANY NAMEIBUSINESSES AND OTHER LICENSES ASSOCIATED (IF APPLICABLE).
Fill
. NAME
F LICENSE 11
SEQUENCE_ I[-
ROLE
F -1 ]I-SELBYSCO-r-r
I FOURSI*005D9 IF-
1 �l
Unknown
EL11DAILEY-SELBY,
BARB ::::::IF
FOURSI*005D9 IF
2 11
Unknown
New inquiry by CITY, NAME, PRINCIPAL OWNER NAME, LICENS9, UBJ NUMBER, check the
L&I Contractor Industrial Insurance Premium Status or return to the L&I Construction Compliance Home Page
https://wws2.wa.gov/lni/bbip/PRINCListl.asp?License=FOURSI*005D9 6/26/2003
BOND/SAVINGS INFORMATION
Page I of I
BOND/SAVINGS INFORMATION FOR LICENSE SELECTED
When information is presented in both BOND and SAVINGS, to determine which information is most currrent,
compare EFFECTIVE DATE at BOND information with EFFECTIVE DATE at SAVINGS information.
Most recent EFFECTIVE DATE is the most current infonnation pertaining to BOND or SAVINGS listed for the
License selected for inquiry.
BOND INFORMATION. -
BOND
BOND ][EFFECTIVE
-EXPIRATION
CANCELLATION
IMPAIRED
LICENSE
I COMPANY
NUMBER 11
DATE 1[
DATE
DA TE n
I DA TE
IFOURSI*O CBIC 3/l/2002 JUNTIL
I CANCELLED
IFOURSI*00 CBIC 3/l/2001 JUNTIL
I CANCELL
ASSIGNMENT OF SA VINGS A CCO UNT INFORMA TION
E�l
J�JBANK NAME [WCOU�NTID JEFFECTIVE DATE 11RELEASE DATE 11IMPAIRED F=LAGVm_PAJRED DATE �AMO �LNT
ji
THERE ARE NO RECORDS THAT MATCH YOUR SELECTION INQUIRY.
https://wws2.wa.gov/lni/bbip/ACTP4.asp?License=FOURSI*005D9 6/26/2003
SUMMONS AND COMPLAINTS INFORMATION List Page I of 2
I v
SUMMONS AND COMPLAINTS INFORMATION
License Seq Plaintiff Cause County Third Party Paid By Dismis Compi Compi Judgmnt Judgmnt Paymt Paymt
Name Num Code Code Code Date Date Amt Date Amt Date Amt
THERE ARE NO RECORDS THAT MATCH YOUR SELECTION INQUIRY.
Ex
planation:
Coun(y
Code Ex
--planation:
Summons and Complaints = Complaintsfiled in Superior Court
01
ADAMS
Dismis Date = Case dismissed in Superior Court
02
ASOTIN
gmnt Date = Date of $ award
Jud
03
BENTON
gmnt Amt = Amount ofaward
Jud
04
CHELAN
Pa-ymt Date Datejudgment paid
05
CLALLAM
Paymt Amt Amount paid
06
CLARK
07
COLUMBIA
08
COWLITZ
09
DOUGLAS.
10
FERRY
11
FRANKLIN
12
GARFIELD
13
GRANT
14
GRAYSHARBOR
15
ISLAND
16
JEFFERSON
17
KING
18
KITSAP
19
KITTITAS
20
KLICKITAT
21
LEWIS
22
LINCOLN
23
MASON
24
OKANOGAN
25
PACIFIC
26
PEND ORIELLE
27
PIERCE
28
SANJUAN
29
SKAGIT
30
SKAMANIA
31
SNOHOMISH
32
SPOKANE
-33
STEVENS
34
THURSTON
35
WAHKIAKUM
36
WALLA WALLA
37
WHATCOM
38
WHITMAN
39
YAKIMA
51
OUT OF STATE
52
OUT OF COUNTRY
https://wws2.wa.gov/lni/bbip/SCOMLIST.asp?License=FOURSI*005D9 6/26/2003
SUMMONS AND COMPLAINTS INFORMATION List
Page 2 of 2
https://wws2.wa.gov/lni/bbip/SCOMLIST.asp?License=FOURSI*005D9
6/26/2003
CONTRACTOR INSURANCE INFORMATION Form
4 - .
Page I of I
CONTRACTOR INSURANCE INFORMATION
Current Filter: None
lRegistration # or Lice
FF—OURSI*005D9 I
lFirm Name:
[P—ENN AMERICAN INS--00]
jPolicy Number:
FPAC6218678
lEffective Date: 1F3/7/2003
lExpiration Date:
F3/7/2004
lCancelation Date:
https://wws2.wa.gov/lnilbbip/INSIForm.asp?License=FOURSI*005D9
6/26/2003
4 QQ?2
City of Edmonds Permit No:
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date:
A. Address or'Vicinity of Construction: 19 f o J,
Lk
B. Type of Work (be specific):
AL-
C. Contractor:-V* q�?- _T f�e= G44_�t J6"n"?aft ff- t- ;i,
4
Mailing Address: rV Phone:
# .1 1� , V_E� M 0 Fo- CfX019
State License #:460Zn 1% 1 Liability Insurance: Bond: $
D. ' Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. Commercial Subdivision [_1 City Project F1 EUC (PUD, VERIZON, PSE, AT& T, OVWD)
Multi -Family M-_S�Mgle Family El Other
INSPECTOR:
F. PAVEMENT CUT: El YES lh,�NO G. SIZE OF CUT X
C-6NCRETE CUT: El YES 50NO
AN'LICANT TO ffl,"Al) ANI) SIGN
INDEMNITY. Applicant understands by his/her signature to this application helshe holds the City of Edmonds harmless from
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 its departments or employees, including but.nop limited to the defense of any legal proceedings including defense
costs andattorneyfees by reason ofgranting this permit...
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLL097NG THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES HILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BYCITYFORCES, AT WHICHTIMEA DEBITOR CREDIT 97LL BEPROCESSED FOR ISSUANCE TO THEAPPLIC4NT.
* Traffic control and public safety. shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
* Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday - NO EXCEPTIONS.
* Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ THE ABOVE STA TEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS -AND A CKNO WLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMITA VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature:
V
Approved by:
Agent)
CITY USE ONLY
Time Authorized: Void After >
�Special Conditions:
Date . 6 ;__� q-1 - 0 5
I or% 90
Right-of-way Fee: (41x�
Disruption Fee/Fund 11�:
Restoration Fee: (�p
Total Fee:
Receipt No:
Issued bV5-5'
UPON COMPLETION OF PERMITTED-WORK9 AN ENGINEERING. FINAL
INSPECTION IS REQUIRED PER CHAPTE!� �8%f THE EDMONDS
1
COMMUNITY DEVELOPMENT COD 1 ne 71-0220, Ext. 1326)
FINAL APPROVAL'OF PERMITTED WORK. DATE:'
InspeK5 —gna7ure
For inspection requirements see Engineering Inspection Information handout.
DAMy Documents\Forms\Engnmg\ROWpermit_.doc