19500 82ND PL W.PDF111111111111
7627
19500 82ND PL W
0 0
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT
DRAINAGE PLAN DA'
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED: -
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER: A�& !2 2 —o,55—
DETERMINATION: 0 Conditional Waiver 0 Study Required [] Waiver
LID#: /YV
LOT: BLOCK:
SIDE SEWER PERMIT(S) #:
LATEMP\DS'rs\Forms\Street File Checklist.doc
11
The City of
r
APPLICATION
for
SWE SEWER PERNaT
NEW CONSTRUCTION 0 REPAIRS n
EASEMENT No - -----------------
CONTRACTOR
............................................................
... ..... 3:.=�l
.. N .............. PERMIT No. -4 ................
-W4.EGAL DESCRIPTION LoT-N,.,- 4, 4. 1 =.>- -
ADDRESS .... ................................... .............................................................. -BLA)CK No.
............................................ . . .. ......... .... . ....... ......
NAME OF ADDITI--"'-
ON .. .....................................................................................................
-------------------
NOTICE:
No Warranty -Of a.-ccuracy.
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The city of �Edm.qnds does not ' warrant the
accuracy of anything set for.th on these
map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
-map(s), ' I I
t including, but not limited to,
the lociation 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
ernp-1-o-yee-s o-r officer- h-aH be 1--',1a-b-'Fe for +he
i n
information give on this map(s), nor for
ion pr *ded based
any one representat* ovi
upon . said map(s).
CITY OF ED
SIDE SEWER PERMIT
DEPARTMENT
PERMIT
Call 7�76-1107 for side sewer Inspections' BEFORE covering any portion of the construction.
NO Sat., Sun., or holiday inspections.1
(Inspection will be provided within 24 hours after request. N
ADDRESS LOCATION OF CONSTRUCTION .......... �K-'�"'��-- 7
..........................................................................................................................................
PROPERTY LEGAL DESCRIPTION ...............................
.................................. ... ...
.......................................................................
. ......................................... . ................................................................................................. . .............. . ......................................................................................
,, 1"", "1 ��. I , .4 ,- 7.
...................................................
.......... OWNER AND/OR BUILDER ....................... ! .. ..........
...... ... ................................... ... : ...................................................
RE . ........... ................... .................................... I
CONTRACTOR'S NAME &ADD SS... '�� �% 'i�"':
.............. ........
----------- ........................................
Permission Is granted ............ . ................................ . ............
system in �accordance with City of Edmonds ordinances. for repair and/or connection of a side sewer to the city sanitary sewer
Af VION IS CALLED TO THE FOLLOWING:
1� o. 1---Th. 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—All work performed in city right-of-way requires an Invasion of RJght-of-Way Permit obtainable from. the City Engineer's office.
NOTE No. 3—Obtain full Information regarding Ordinance 11.16.030 and Rergulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at leazt 30 inches coverage at1property line ajid 12 inches inside property line; minimum grade of 2%. No bends in' grade
sharper than % will be permitted.
NOTE No. 5—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be respon . sible for fallure due to improper
work which may develop within one year of completion.
NOTE No.. 6—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the malin sewer or Its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED E] Date.-. ............. By ................ Dte ............... . ... I .............. By ------------- Date. i .............. . ................... By --------- -
APPROVED Date 41::)�) --
.. ........ ----- : --------- BY- , 0
......................................................
Renlark,: ....... . .......................... A
. . ......... ................ . ...................................................................
.......................... .............. ;n ............ . .............................. --------------------------------------------------------------------------------------------- - -------------------------------------------------------
BO'rne'Pern
A Co T Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
-rl P/S 15n
tr - u ' ctio - n .... hereby certify that the side sewer installation constructed under this permit
istked in a nances of the City of Edmonds.
Datedthis ............................ day of ................................................................. 19 .........
V V Check BEFORE you dig for: Water Gas Telephone 0, Power 0, Sewer 0, Other
6WQF EDMONDS 1K h I V tTermit No.
�'COMMUNITY SERVICES bEPARTM�TNEET FA 2 4 199;
" - -' )-"9
RIGHT-OF-WAY CONSTRUCTION PERMIT..' ssue Date
\ENGINEERIKIrz
Z
0
W
U
W
0
P.
A. 9 Owner:
Name
Mailing Address
City. State Zip
B. 0 Contractor: CwM" MIS CA ISURal0k &A
rt to L/ Name 5-53 MA4A) &WqSO-DS�
Mailing Address "k
C-Dr-i-oJ05 tAIA 17802-C)
City State Zip
soprse.jr-c- 101 GLA 774 - 5714-4.
State License Number Telephone Number
C. o Address or Vicinity of Construction: tC1566 SZ-wOPLW
Type of Work to be Done: REP L AC V_ OF-F- EC Tl VF_ C,& 7-0 LE-T"f P- IAIMA A& PLE
D. 0 Work in Connection With: 0 Sub or Plat El Single Family 11 City Projects
0 Commercial El Multifamily 0 utility
E. 0 Pavement Cut: El Y 9 N F. 0 Size of Cut: X
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his 'signature to this a
'ry cation, agrees to hold t e Ci�
pli Edmonds
6
that may
harmless from any injuries, damages, or claims of any kind or descQti6u whatsoever, fors;;�)OT
be made against the City of Edmonds, or any oPits departments or employees, including or not limited to the defense
of any legal proceedings including defense costs, court costs, and attorney fees by reason otgranting 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.
Estimated restoration fees will be held until the final street patch is completed by City forces, at which time a debit or credit will be
processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in acco'r',dance with City Code.
• Street to be kept clean at 'all times.
• Traffic 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.
I understand the above.afid that this permit
be available at the job site for inspection purposes at all times
Date:
Owner or Contractor
Thil Pernuf Must be Posted at the Job Site For Inspection Purposes
7 Call DIAL -A -DIG Prior to Beginning Work
FA VA
APPROVED B Y: :�;w PERMIT FEE:
Time Authorized: Void after EAR- ----days. Restoration Fee:
Special Conditions: W Receipt No.:
Fund I I I Fee:
Street Cut Dimensions:
RE11EASED BY:_e�_ INSPECTED BY
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE. -
Date
Eng. Div. March 1989
FIELD INSPECTION N (A I I I - Route copy to Streetoe�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 19
0
1(�411 70 195tY3 6ZNP PL,W,
7714-,
WSTALL 9-4-'-
SZO P 3 U& r-A
N
Z
_�211 �717
CITY of EDMONDS B4WS LICENSE APPLICATION 1189LIDIJ LICEN"SE NO.
Civic Center Edmonds, Washington 98020 ANNUALFEES
City Clerk Phone 775-2525 QTp=Cgr r,,## PENALTY AFTER FEB. 15
ro <� HOME OCCUPATION
CLA dtC*EW=AjE ISPEC- $10.00 (A) ADDITIONAL $5.00 E)
INSTRUCTIONS:
• All items must be completed IXSMALL BUSINESS
or application will not be ac- RECEIPT NO. DATE PAID PRINT 'X' A.- $15.00 (B) ADDITIONAL $7.50 0
cepted.
IN SPEC. BOX
FOR ISSUE OF 0 Business with 10 or
FEE PAID PENALTY PAID CORRECTED more employees ADDITIONAL $25.00 0
• Sign, and return application LICENSE WITH
with fee. Renewals received L I ZIA?V91 'LC'ACT1ON. $50.00 (C)
after February 15 must pay NEW APPLICATION (LA)
penalty in addition to fee. 'D RENEWAL (LB)
NEW BUSINESSES AFTER 0 CHANGE (LC)
IULY 31, 112 FEE, (PLEASE MAKE ANY NECESSA,RY CHANGES) 0 DELETE (LD)
NAME OF FIRM 'BUSINESS PHONE NO. OF EMPLOYEES
A
MAILING ADDRESS NATURE OF BUSINESS
/rBUSINESS ADDRESS . INDIVIDUAL PARTNERSHIP CORPORATION
C, 6?
F 1 (S) (P) P
HOME ADDRESS
Z_ / r,7 t, -7 C
HOME PHONE 7DAITE OF BIRTH PLACE OF BIRTH SOCIAL'SECURITY NUMBER
16
_4 _3
75 1 1- 0;� I _�;, -- - - 6,
7 r
EMERGENCY NOTIFICATION: (1) NAME & TELEPHONE L
(PLEASE LIST TWO) (2) NAME &TELEPHONE
WASHINGTON STATE TAX NO. APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, UFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL,, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE ;L - -q a- - 9 2 LAND USE CODE ZONING CODE
)2'APPROVE 0 DISAP PROVE SIGNATURE _n E_1_ . -1 1 IP1101 I
CONDITIONAL USE PERMIT
COMMENTS E=
I[LDING DEPARTMENT DATE a -,-!)3 z 2 �
APPROVE 0 DISAPPROVE SIGNATURE
COMMENTS:
E:]�CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
FIRE DEPARTMENT DATE ��;7
0 APPROVE DISAPPROVE SIGNATURE
COMMENTS:
POLICE DEPARTMENT C---
DATE SIGNATURE
VAPPROVE R.DISAPPROVE
COMMENTS:
PUBLIC WORKS DEPARTMENT
Er -APPROVE 0 DISAPPROVE DATE - _3ZI 17f SIGNATURE
Building
El
'K-
Hotel/Motel
(L)
Permit
Apt. Bldg.
(A)
17 131011171
0
Office Bldg.
(0)
Occupancy
0
Restaurant
(R)
Group
11
Hosp/Nurs Home
(H)
[ K
0
School
(S)
FIRM Elam 00
COMMENTS: L/
M I r— A e% � r� I I � 0 0 -r -, t- I j