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7077
19129 80TH AVE W
61TY OF EDMONDS aa— 5a �i
Permit No.
,.�,c6MMUNITY SERVICES . DEPARTMENTSTREET FILE
R161T-OF,�.WAY CONSTRUCYION PERMIT Issue Date
A. 9 Owner:' CAGL-1.2—
NM
Mailing Address
City .'State Zip
1_�4 C_ C
B. Contractor:
Name.
'5
Mailing Address
City State Zip
�4 C C-C % �.io
State License Number Telephone Number
C.'* Address orVicinity of C . onstruction: �ci 1-2 q Q67%, 1114— \A/-;—= I
Type of Work to be Done:
I
YINC,
1). 0 Work in Connection, With: El Sub or Plat 0 Single Family 11 City Projects
0 CommerciNA 0 Multifamily ,0rutility
E. 0 -Pavement Cut: El Y F. 0 Fxi4eA)f Cut: x
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his -signi
harmless from any injuries, damages, or claims of any
be made against the City of Edmonds, or any of its dc
of any legal proceedings including defense costs, court
THE CONTRACTOR IS RESPONSIBLE FOR WOf
YEAR FOLLOWING THE FINAL'INSPECTION AN
Oaplie ti-4n, agrees to hold the City of Edmonds
natsoever, forseen or unforseen, that -may
9AMployees,'incI4ding ori�n&- limited to the defense
— I .
attorney fees by reason of giranting this permit.
gq RIALS FOR A PERIOD OF ONE
,1.JFME WORK.
Estimated restoration fees will be held until the final street patch is,completed by City forces, at which time a deblit or credit will be
processed for. issuance to the applicant.
• A 24 hour notice'is required for inspection; Please call E 771-3202
• Work is to be inspected during progress and af Ulgel tion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times. No,/
• Triiffic Control to be in accordance with_City regulations.
.0 All stfeet-cut ditches must be patched with asphalt or City.approved material prior to'end of working day;
NO EXCEPTIONS.
I understand t e above and that this permit must be available at t he job site for inspection purposesat all times.
Signature- rk Date: In
Owner or Contractor
T T
N Permit Must.be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
Iry
APPROVED BY: PERMIT FEE: hr 1HU
Z Time Authorized: Void after —4ays. Restoration Fee:
0
W Special Conditions: Receipt No.:
Fund I 'I Fee.
Street Cut Dimens*
rn
ate
RELEASED BY:111&.A_A INSPECTED BY ..Date
NO WO RK TO BEGIN PRIOR TO PERMIT ISSUANCE
rrig. "IV. IvIdii:11 Iyo�
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street De t.)
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
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CITY of EDMONDS
For Inspection' Call 771-3202
Address of Construction: ,
E
SIDE S ER P E R M I T
A OR A 1985
ERMIT NO. WON
PUBM MR.-C
Property Legal Description (Include all easements): Io74 2�-
Owner and/or Builder: "A?
Contractor & License No: /0 6?-j cf 2- tv 9
Singl:e Family Residence
Multi -Family (No. of Units
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No Yes .(If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No V Yes (If Yes, 'easement required,
attach legal description and county easement'number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
I certify that I have read and shall comply Date
with the items listed on the back.
Permit Fee: 30,-00 issued By: (:�-7gA
Trunk Charge: -2-6-,00 Date Issued: ?z -3 Ar-s.-
Assessment Fee: Receipt No.: Zo
Partial Inspection: V=tr�s-r` ioo' 4-2.6-95 14,
. Comments Date Initial'
Final Inspection Approved: 419-85 Ifl(W E. A k A u
Date IniAal
Rejected:
i -ti a I
Reason Date
PERMIT MUST BE POSTED ON JOB SITE
Wh-ite Copy File Green Copy - Inspector Buff Copy Applicant
NOTICE:
No warranty of accuracy.
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of 'Edmonds does not warrant the
accuracy of anything set for ' th on these
map(s�). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
th-e map(s), including, but not limited to,
the loc'ation of any sewer stub shown. Such
sewer stubs may or may, not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
emp-l-o-yees or officers 1-13hall be H-lab-le for the
information given on this map(s), nor for
any o ne representation provided based
upon said map(s).
The City of Edmonds Side Sewer Drawing EASEMENT NO - ---------------------- --------
NEW CONSTRUCTION REPAIRS LID NO. 13-9 --- ASMT. NO - ------------------
OWNERSReRWPQ-0 ----------------------- CONTRACTOR ........................................ I ----------------------------------- -------- PERMIT No.
JOB ADDRESS ----------- W --- mt4 ---- Av � � -V.: ----------
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LEGAL DESCRIPTION: LOT NO. J --------------- ---------------- BLOCK NO.
-------------------------------------------------------------- -..S.:7E0 ------ 78 ----------------------- ----------------------------------------
NAMEOF ADDITION ----------------------- ---------------------------------------------------------------------------
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1912-9 180AVE.
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WOOD FUMCC
PROP. LIOS
Apjroved:
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PWW-0001-1 1/71 (REVA 1/78) DATE ..................... By,460 --, .... ... -E�AVAU
----------------
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CITY OF EDMONDS ASSET INFORMATION SHEET
STREET FILE
ONEW
ASSET NO*.
ADDITION ADDITION TO ASSET NO.
RETIREMENT
"PURCHASE ORDER NO.
PURCHASE ORDER DATE
INITIAL
kvp)
DEPARTMENT FILE
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FRONT
VEEP THESE STAmPED
SIDE -7Y',2
MAtAS ON jOBSITE FOR
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STREET FILE
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STREETFILE
ENGINEERING & p LISLIC woRX
CITY OF EOMOpjOS
IVU01103.
PROJECT REVIE
IA41,14GIO,,
SIN GLE FAMILY MULTIPLE COME RC I Al
C H E C K L S-T
PRDJECI NAME
ADDRESS
CO . NTACT Nkfif TELEPHONE N"ER
L
CCESS SLOPE AND VEHICLE ACCESS
DRAINAGE PLAN
STREET FILE
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LEGAL DESCRIPTION VERIFICATION
QUIT CLAIM/1XVICATIONS
CD
EASEMENT - PUBLIC/PRIVATE
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CALCULATE SEWER CONNECTION IF NO LID
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STREET PAYING REQUIRED
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CURB ANO-GUTTER REQUIRED
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SIDEWALK REQUIRED
CURB CUT FOR ORIVEWAY.REQUIRED
RIGHT-OF-WAy CONSTRUCTION PEF411T REQUIRED I'll
0"
BONO REQUIRED FOR PUBLIC INPROVEMENTS
STREET NAME SIGN REQUIRED
OTHER SIC-41NG REQUIRED
(ADDITIONAL COMEnTS On E
1XISTINC W.kyfR KAI,, SIZE o"-
WATER MA IN REQUIR[p jg'�:
SERVICE LINE REQUIRED
HYDRAUT SIZE EXISTING
HYDRAUT RfqUIRfo PER FIRE CODE
CROSS C(INNECTIOn INSPECTION SIZE
WATER 11fTER CHARGE REQUIp,[D
REVIEW By
DATE ------------
SANITARY SEWER DVJIIMG IILAIBER (AbDITIO11AL COPKXTS 02( W
SIDE SEWER AVAILABILITY FILE WIBER
- - - - - - - - - - - - - - - - - SANITARY SEWER CONNECTION FEE REQUIRED
OPEN DITCn EXIS1111a
CULVERT Rf9UIRED -".. R1:7D
I"DItATED Off SITE PLAN
SHALE OPEN RUtIOFF --------
SOIL CONDITI INDICATED 0.1 Sly[ PLAN
0 1LATrR F CHECKED . ......
REVIEW By
PAT[ (011,
DDITIONAL COWNTS ON BAC
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USE
CITY OF EbmONDS ZONE
CONSTRUCTION PERMIT APPLICATION- joe
NAME (OR NAME OF BUSINESS) A Do D- R E S S
7 91.)-9
CITY
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N AME
ADDRESS
CITY_
.k��
NAME
PERMIT
NUMBER
LEGAL DESCRIPTION CHECK SUBDIVISION NO,
3 L Ot -21, 1 S 52- Zel
TELEPHONE NUMBER PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
f4,6 EXISTING 40 REOUI RED DEDICATION
PROPOSED--,"
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED El
SEE ENGINEERING MEMO DATED -
TELEPHONE NUMBER SEE PIW DEPT. REVIEW CHECK LIST DATED -
ADDRESS
3
CITY .47
STATE LICENSE NUMBER
7 12 2-6
METER SIZE BUILDING SUPPLY SIZE
TELEPHONE NUMBER
REMARKS
CITY LICENSE NUMBER
,5 d W C " -7 Z ilva I
)escription of Property - include all easements
below or attach four copies)
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NEW Unk RESIDENTIAL El PLUMBING
ElADDIALTER NON-RESIDENTIAL MECHANICAL
REPAIR RETAINING WALL SIGN
EXCAVATE FENCE
ID DEMOLISH OR FILL (-X-FT)
F--j PRE -MOVE INSPJ swim
SIDE SEWER
0 WATER LINE
ID
NUMBER OF STORIES
-FNUMREROF
U_tLLINU
U. 116
NnRE OF WORUIBE DONE JATT�CH PLOT PLANY) 1 /7
SIGN AREA I ENV. REVIEW
ALLOWED I PROPOSED COMPLETE i EXEMPT
VARIANCE OR CU IPLANNING REVIEW BY
YARDS ;515—' 7tt:1 /I
FRONT SIDE
D BY I TYPE OF CONSTRUCTION
SPECIAL INSPECTOR
REQUIRED
0 YES f-: NO
PLA14 CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
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
u) successors in interest, agrees to indemnify, defend and hold
'U0j harmless the City of Edmonds, Washington, its officials,
r. employees, and agents from any and all claims for damages of
< whatever nature, arising directly or indirectly from the issuance
X
ell C7'E
of this permit. Issuance of this permit shall not be deemed to
a
We
modify,, waive or reduce any requirement of any city ordinance
0
X nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
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
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and in doing the work authoriz
THIS PERMIT
AUTHORIZES
Ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tion Insurance.
SIGNATUR (OWNER.ORhGENT)
nATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
GROUP
VALUATION
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9
UNITS
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ADB NO.
SHORELINE#
A
LOT COVERA
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FEE
OCCUPANT
LOAD
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APPLICATION APPROVAL
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.
OFFICIAUS SIGNATURE
ATTENTION 771-3202
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 1:
0
Z
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. Ij
CHAPTER 3. uBc SEP 2 0 1984 . PINK Owner GOLD — Assessor
102-78
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AUTHORIZED
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pTy� '7021,50238
'OF EDMONDS U
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Page Ot J� ENGINEERS -SURVEYORS PLANNERS
324 hiain'Siroal 0 Edmonds, Washinglon 98070
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OES.'ID'j. DATE 8/4/76 , FILE NO.
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BUILDING DEPARTMENT
WORK ig
41-46,6-
ADDRESS / �? 12- 9 9L9 A� RI
OWNER skewooj--
APPROVED DATE: ////&,/
BLDG. OFFICIAL — 32ES
PERMIT NUMBER
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