19504 82ND PL W.PDF111111111111
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19504 82ND PL W
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ADDRESS: &
�O�Z— Z/O
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: Fj Conditional Waiver [] Study Required [] 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
LID #:
SHORT PLAT FILE:
LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
V
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DA
OTHER: A"
b.
1A
LATEMP\DST's\Forms\Street File Checklist.doc
OF EDMONDS. Sir":, SEWER PERMIT
WATER -SEWER DEPAx—MENT
PERMIT N? 4364 , -
Call 776-1107 for side sewer inspections BEFORE covering any portion of the construction.N
Inspection will be provided within 24 hours after request. NO Sat., Sun., or holiday inspections.1
19500 & 19502 - 82nd Place West
ADDRESSLOCATION OF CONSTRUCTION .............................. ................................ 6W ............................................ . .......................................................
lgv�q ...................................................................
PROPERTY LEGAL DESCRIPTION ......................................................... LQ.t ... pf.-Mu. od
...................... : ........................... . .................... . . ........................................................................................ . .................................. . ..................................................
........ ....................................................... OWNER AND/OR BUUUDER. NORD CONST., 5 W. Harrison, Seattle 98119 -
....................................... ................................... . .......................................................
CONTRACTOR'S NAME & ADDRESS ... ... 15QQ9 98020 ...........
je ... Rd�t ...... EdmAnds . . ...... .................................
Permlisslon Is granted .... fty ... N1 ..... _ ------ - ------ 1 19-1a, for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City of Eai�o ordinances.
ATTENTION 18 CALLED TO THE---VOLLOWINO:_ - - - _ - . - - - - . . . . — - - - - - __ I . � _
NOTE rio. 1—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—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's offloe.
NOTE No. 3--Obtaln full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE. No. A —Top of. aide sewer must have at least 3G inches. coverage at property line and 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 responsible for failure due to Improper
work which may develop within one year of completion. a
NOTE No. 6--It is unlawful to alter or do any other work than Is provided for in the permJt, or to do any work on the main sewer or its appurtenances except to in -
Bert the pipe into the wye.
DISAPPROVED0 Date .. . ................................... By ................ Date ............... . ................ ". By ................ Date ............... . ................... By ................
APPROVEDDate .... .......................................................... By ... . .............. . .............. . .. . .. ............................... . .....................................................
FINAL INSPECTION PENDING RECEIPT of -EASEMENT
Remarks: ....... . ...................................... . .......................................................... . ...................................... . ...... . ...... . ............................................... j� ...
..................................................................... ......................................................................................... . .................................. . ............................................. .........
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection t
....................................................................................... ... , hereby certify that the side sewer installation constructed under this permit
(owner of contracting Firm PerfGrming Construction)
was installed in accordance with all governing ordinances of the City of Edmonds.
Datedthis ............... . ........... day of ................................................................. 19 .........
Check BEFORE you dig for: Water F], Gas Telephone Power Sewer Other Ej V 4
rifv Af FrImain
RIGHT-OF-WAY CONSTRUCTION
PERMIT.
Permit Number.
STREET FILE Issue Date:
A. Address or Vicinity of Construction: 19504 82ND PLACE WEST
9 0 1 C) B. Type of Work (be specific): OTE TO PLACE BURIED SERVICE �i,AE FROM
PEDESTAL #7653 TO CUSTOMER, PLOWING 60—FT WITH 1 DW PUSH. SEE SKEi6H.
C. Contractor: GTE NORTHWEST INCORPORATED Contact: BARBARA TOLLEFSON, PERMIT COORDINATOR
MailingAddress: 22118 20TH AVE. SE SUITE IY&one: BARB 488-1642
StateLicense#: BOTHELL, WA 98021 "�"Liability Insurance: _ Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. El Commercial D Subdivision El City Project M Utility (PUD, GTE, WNG, CABLE, WATER)
FJ Multi -Family [:] Single Family Other W.O.# 2100-9POOIDB 242310
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut 0 Yes lidNo G. Size of Cut: x H. Chargt�_$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hQ14dthe City ofEdmonds harml�s�'-frQLnI'nJuriqs, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds; -6r3any of its depaHments or
employees, including or not limited to the defense ofany legal proceedings including Oflense �!ostsf . and attorney fees by reason of nting 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 WI.LL BE HELD UNTIL THIJ�FJIY2�LA;TTIJEET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT W) 11 . ED FOR ISS rol;, �%A N T.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
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 Cif3-FEngineer.
All street cut ditches shall be patched with asphalt or City approved material prior to tli�e end of the working day;
NO EXCEPTIONS.
Ihave read the abovestatements and understand thepermit requirements and thepink copyof thepermit will be
available on site at all times for inspection purposes.
Signature: z'1'4z=zz'—'P a Date: 3-14-94
(Contractor or Agent)ll .
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY VSE ONLY
APPROVEDBY:
TIME AUTHORIZED: VOID AFTER I m F-AiL— DAYS
SPECIAL CONDITIONS: yJ &
COMMENTS:
DATE:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND III:
RESTORATION FEE:
PERMIT FEE:
TOTAL'#EE: t20 t -26��
RECEIPT FEE-.
ISSUED BY: a:0 �O
�-w
V&
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
r)
ITY
CITY of EDMONDS
Civic Center - Edmonds, Washingt
City Clerk Phone 775-25:95
INSTRUCTIONS:
• All items must be completed
or application will not be ac-
cepted.
• Sign and return application
with fee. Renewals received
after February 15 must pay
penalty in addition to fee.
NEW BUSINESSES AFTER
B S
"20
L 1 CAT 0 LICENSE NO.
o n,
FlEtANNUAL
FEES'
PENALTY AFTER FEB. 1.5
0 HOME OCCUPATION
CLASS:YEAR LIC.
EFFEC. DATE REASG. LIC. NO.JSPEC
$10.00 (A)
ADDITIONAL $5.00 0
SMALL BUSINESS
RECEIPT.140.
DATE PAID A-
$15.00 (B)
ADDITIONAL $7.50 0
1/11/4
INTX
A
J L -11 �2 SPEC' Box
OR ISSUE OF
0 Business with 10 or
FEE PAID
PENALTYPAOD- CORRECTED
more employees
ADDITIONAL $25.00 0
LICENSE WITH
$50.00 (C)
_g NEW APPLICATION (LA)
0 RENEWAL
(LB)
0 CHANGE
(LC)
JULY 31, 112 FEE. (PLEASE MAKE ANY NECESSARY CHAN�. ODELETE (LD)
NAME OF,,FIRM BUSINESS PHONE NO. OF EMPLOYEES
5� 1&7
MAILINO ADDRESS NATURE OF BUSINESS
7 f
BUSINESS ADDRESS
INDIVIDUAL
PARTNERSHIP CORPORATION
Xt A4
r1b q_1 61.4-0 6 8-:.2 0q
(S)
(P)
OWNERS NAME
HOME ADDRESS
,;"/e
117ff
HOME PHONE
DATE OF BIRTH
1
PLACE OF BIRTH
SOCIAL SECURITY NUMBER
. 6�497n-77Xe-_
u_).4
1 . _r3k-540 3&�3
EMERGENCY NOTIFICATION: (1) NAME & TELEPHONE `XS' T. 4 - A"A -7 44.r- -r)IJ6."
(PLEASE LIST TWO). (2) NAME & TELEPHONE AMS &-7V 1711 - 7 3 -, t-
WASHINGTON STATE TAX NO. APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, LIFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
*AW
PLANNING DEPARTMENT DATE (o -Ili -29 LAND USE CODE ZONING CODE I
�a AOPROVE El DISAPPROVE
SIGNATURE n 6' d:&AaDb-�
CONDITIONAL USE PERMIT
COMMENTS
BU#tDING DEPARTMENT DATE Building El Hotel/Motel
6Z APPROVE. 0 DISAPPROVE Permit (L)
SIGNATURE 0 Apt. Bldg. (A)
171 -1 d 11(01 ED Office Bldg. (0)
COMMENTS: Occupancy 0 Restaurant (R)
Group E3 Hosp/Nurs Home (H)
E:I=I2 CAPACITY: (NO. UNITS, APTS., OFFICES, 'SEATS, BEDS, STUDENTS) 0 School (S)
FIRE DEPARTMENT DATE U. F. 1. R.
)<APPROVE .0 DISAPPROVE SIGNATURE
ell
COMMENTS:
POLJ.C-� DEPARTMENT
b--'A'PPROV'E 0 DISAPPROVE DATE ; 42- Zcz-2_5 SIGNATURE' /\J
COMMENTS: 1-Y
PUBLIC WORKS DEPARTMENT
-Er'APPROVE E) DISAPPROVE DATE 7f SIGNATURE
COMMENTS:
PLEASE RETURN TO CITY CLERK
APPLICATION
U= for
The City of Edmondsim
SIDE SEWER PERMIT EASEMENT. -No -
ES
...........................................
NEW CONSTRUCTION REPAIRS
OVtrNER—N.-.- FS .5;;7rl.-QN ................ CONTRACT'OR ........................... ...................................................................... PERMIT No.
. I LEGAL DES
-,�.Z . ..... L-—A J..�
ADDRE ......... LOT N
ss ... ............................... .............. .......... . ........... CRIPTION
0 ...... ....... ........ B11"K No. ....... i
NAME OF ADDITION. CF M
.......... ................................................................ ............................................ .............
NA ES:t
Approved:
DATE
APPLICATION
for
The City of Edmonds SIODE SEWER PER EASEMENT
NEW CONSTRUCTION ��REPAIRS 0
- t4
OWNER .. . ..... ..... ------ t.� --------------- PERMIT
. ................... ........ ......... .......... 61 -------------- CONTRACTOR --- ;.�/ .. T.S;7
ADDRESS LEGAL DESCRIPTION: LOT No . ............
...................................... fZ / &t 7e- ------------- ................ BLOCK No . ............................................
NAME OF ADDITION ............... / - / ........ —eve--501e2
.. . ... .... .... .................................................................
FM
Approved:
DATE................................................ By ................ .....................................................
NOTICE:
Nb-warrantyof 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.onds does not ' warrant the
accuracy of anything set forth on these
map(§-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
-map(s), Including, but not limited to,
th-e 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
e m p-'I- o-y e e-s o -r o ff ic- e,r s h a. 11 1 b e !1 a. b`re' f o r -,I h e
information given on this map(s), nor for
ation provi ded based
any one represent
upon said map(s).