19513 82ND PL W.PDF111111111111
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19513 82ND PL W
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: F� Conditional Waiver E] Study Required [] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED: -
SCALED PLOT PLAN DA
SEWER LID FEE $: LID #: 1,?q
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER MEETER TAP CARD DATED:
OTHER:
LAT'EMP\DSrs\Fomis\Suwt File Checklist.doc
APPLICATION
for
SIODE SEWER PERYaT
EASEMENTN .. ..........................................
NEW CONSTRUCTION REPAIRS
OVsrNER.............................................................................................................. CONTRACTOR ... FSU.SS21 ........ JPHNS'Pt7-4 ......... PERMIT No.
c, PL. W.
ADDRESS ....... LEGAL DESCRIPTION: LOT No . ....................... I& ............... BL()CK No . ............................................
PL—. NAME OF ADDITION.f�.NT <f>c=
.................................................................... .....................................................
0
0
Approved:
0 Otto
........................................
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.onds 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
I ited to
ff�e -m a p (s) , Including, but not Hm*
the location 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-to-yee-s or officers -sha-[l be Via-b.-Ife for the
information given on this map(s), nor for
ion pr 'ded based
any one representat* ovi
upon said map(s).
CITY 017�--cDMONDS - SIDE SEW-t PERMIT
WATER -SEWER DEPARTMENT
PERMIT
Call 7,76-1107 for side sewer, inspections BEFORE covering any Portion of the construetion.N
Inspection will be Provided within 24 hours�after request. NO Sat., Sun., or holiday inspections./
ADDRESS LOCATION OF CONSTRUCTION ...... 19513-.-u' 19515 - 82nd Place, 1-4ast
... * - ----- * - ------------- * ------------------------------------------------------ --------------- ---------------- * --------------------------
PROPERTY LEGAL DESCRIPTION ............... Lot 16, Maplewood
................................................................................................ .........................................................
................................................... . .......... . ..................................................................................... . . ............ . ................................... ....................
s Nord Homes ..............................
................................................................ OWNER AND/OR BUILDER
CONTRACTOR'S NAME & ADDRESS... Russ Johnson Sewer & Plumbing, 150G_9 N. Meadowdale Ile.
.................................................................................... . .............................. . .. . ....................... *
.....................
Permission Is granted ........ "ay 30 73, 'a
... ............................................... 19 -------- for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
A'I, MN IS CALT D TO THE FOLLOWING:
NO'I---f4o. I —The owners of the Property may obtain a Permit to construct sewer inside Property line. A licensed Side sewer Contra tor must be employed t const ct
side sewer in street area. Do not cover any Portion of sewer before it has been inspected. c o ru
NOTE No. 2—All work performed in city right-of-way requires an Invazion of Right -of -Way Permit obtainable from th . e City Engineer's office.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—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 ys will be permitted.
NOTE No. 5--Trenches in street must be water settled and surface of street restored to originaJ condition. Contractors shall . be responsible for failure 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 main sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED Date .... ................................... By ---------_----- Date ......... ..................... By -----------_-- Date ............... . .....
-------------- By ................
APPROVED Date. B
-------------------------------------------------
Remarks: .......... .......................................................................
........................ /� ------ I ------------ -- ................ . ........................................................................................ . ................................... ............................................. .........
�BOT. Mit Co,ie)� T Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
"W- - -- - ------ - ----------------- ....... ..... .... hereby certify that the side sewer
,Jllowner of cp6*t_ ;��I�efcrming Construction')
d (in accor e with all governing ordinances of the City of Edmonds.
Dated this._Aa .............. day of
V V dreck BEFORE you dig for: Water [:], Gas E], Telephone C],
constructed under this permit
.........................................
Sewer [], Other E] Nt V
avow
V)
Wow
%0
PW 89-02M G"W
-i an=
(H.L'80N �- <
0 0
z U)
Notes:
1. All signs and spacing to conform to
LO
the MUTCID & City of Edmonds specs.
2. Work zone is 60'w/o cJI 82 PL W
& 12'n/o c/I 196 ST SW
3. AJert affected businesses.& residents.
4. Ail signs are 48" x 48" E110
unless stated otheryvise.
41
U) CHANNELONG DEME SPACING (FEET)
ce)
TAPER TANGENT
30 1 60 1
W
0:
200'
— — — — — — — — — — — — — — —
82PLW
82 PL W
MM
— — — — — — — — — — — — — — — M/9 Arz X .9c
100Z
f V x bf R/B/W
0
>24 24" J
36" x 24" B/W
GMEVW
CLM
R5-8 A R3-1L
C'j W
18" x 2414" BDNV
Pilchuck Contractors, Inc. 4-7AR
Job #1 0609q3O5
16 Dec 02
Sheet 1 1 tA LEGEND
J. Buss W
National Barricade Co tA 49-3 XX WORK AREA
28" TRAFFIC CONE
EXISTING TRAFFIC FLOW
el SEQUENTIAL
% ARROWBOARD
36" x 24" BfW
PLACED M 84 AVE W1 --
FOR E/B PEDS
*W20-1
,Q 161069 [file:/A\smeramsi \maDs\Gas\Plat\TI.F.\Ql..6.1.06.9..:TI.Fl.. .......
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BOESS LICENSE APPLICATION D
CITY of EDMONDS �LICENSE NO.
Civic Center - Edmonds WashinMon 98020
City Clerk Phone 775-2525
ANNUAL FEES
PENALTY AFTER FEB. 15
qW
-QTPF:PT
C31
9Z
[�r_HOME OCCUPATION
INSTRUCTIONS:
CLASS
YE
LM.
IEFIHA-W" REAW.
111
PEC.
$10.00 (A)
ADDITIONAL $5.00 0
• All items must be completed
ze
I
1171,71
11 11 1 f I 1
71
0 SMALL BUSINESS
or application will not be ac-
RECEIPT
-No.
DATE PAID
PRINTX A.-
$15.00 (B)
ADDITIONAL $7.50 0
cepted.
a V?
L�jld �7V
IN SPEC. x
R E 130
FO ISSU OF
0 Bu.siness with 10.or
• Sign and return application
FEE PAID
PENALtY PAib
CORRECTED
more employees
ADDITIONAL $25.00 0
with fee. Renewals received
LL4
1
I
LICENSE WITH
C' ACTION.
$50. 00 (C)
after February 15 must pay
El —NEW APPLICATION (LA)'
penalty in addition to fee.
E) RENEWAL
(LB)
NEW BUSINESSES AFTER
0 CHANGE
(LC)
JULY 31, 1/2 FEE.
(PLEASE MAKE ANY NECESSARY CHANGES) El DELETE
(LD)
NAME OF FIRM BUSINESS PHONE NO. OF EMPLOYEES
,<-MATLING ADDRESS----- NATURE OF BUSINESS
lffI5 1 ____1
�7,
4 -
3 ef .41 )
OWNERS NAME
INDIVIDUAL
= (S)
HOME ADDRESS
T�x
DATE OF BIRTH PLACE OF BIRT
/'-,/ 7- 3.-- /1
X3 ZI:
HOME,PHONE
EMERGENCY NOTIFICATION:
,(1) NAME & TELEPHON
(PLEASE LIST TWO) (2) NAME & TELEPHONE
WASHINGTON STATE TAX NO.
STAFF REVIEW:
APPLICANT'S SIGNATURE
PARTNERSHIP CORPORATION
SOCIAL SECURITY NUMBER
7-
DO NOT WRITE BELOW THIS LINE
c/.
FILL INLAND USE CODE, LIFIR NUMBERS, ZONING,* ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE 2? LAND USE CODE ZONING CODE
U-APPROVE 0 DISAPPROVE SIGNATURE _y) Efe 1 51 1
CONDITIONAL USE PERMIT
COMMENTS I I =
ILDING DEPARTMENT 5 -.1 IL
APPROVE 0 DISAPPROVE DATE /I If)
SIGNATURE /NAJCZan�_
COMMENTS:
CAPACITY: (N6. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
FIRE DEPARTMENT DATE
C1 APPROVE �j DISAPPROVE SIGNATURE
COMMENTS: rke E
YCE DEPARTMENT DATE
APPROVE 0 DISAPPROVE
COMMENT
;W_�fflm
- �L-- / I SIGNATURE
PUBLIC WORKS DEPARTMENT
P,_A�PROVE 'D. DISAPPROVE DATE SIGNATURE
Buildigg El Hotel/Motel
Permit Apt. Bldg.
M,
(L)
(A)
Office Bldg.
-(0)
Occupancy El Restaurant
(R)
Group 0 Hosp/Nurs Home
(H)
I tc-I :> 0 School
(S)
OHM 10HRE Nwin
COMMENTS:
I limb
City of Edmonds Permit No:2C-n7- 008�
RIGHT-OF-NVAYCONSTRUCTION PERMIT issue Date: L 7-0 -
A. Address or Vicinity of Construction:
B. Type of Work (be specific):
7E -'s c_x- k 0_UJ Gus 's-p— r v I C, -c-.
Contact:
C,. Contractor:
L1 _-Z 0
Mailing Address: Phone-: (0 'S
State License #:- P ttl^_ 10 VVA V-A Liability Insurance: Bond.:$
D. Building Permit # (if applicable): Side Sewer Permit (if applicable):
E. F
Commercial Subdivision El City Project El. J�UC (PUIj, VERIZON, PSE, AT& T, OVWD)
Multi -Family [4--'Single Family El Other
INSPECTOR:
F. PAVEMENT CUT: [0 YES El NO G. SIZE OF CUT c� x
CONCRETE CUT: El YES El NO
Al'I'l.1CANT TO IZF"Al) ANI) SIGN
s tu
INDEMNITY. Applicant understands by his/her igna "re to this application helshe holds the City of Edmonds harmless ftom
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 not limited to the defense -of any legal proceedings including.defense
costs and attorneyfees bv� reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORIW4NSHIP AND MATERIALS,FOR A PERIOD OF ONE YEAR FOLL007NG THE FINAL
INSPECTION AND ACCEPTANCE OFXHE 'WORK. 'ESTIMATED RESTORATION FEES R7LL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED B Y CITY FORCES, A T WHICM TIME A DEBIT OR CREDIT RILL�BE PROCESSEDF6k IjSiJ;&Ck i6TNE APPLICA'NT.
* Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flaggi(r must be trained as required by .(WAC) 296-155-305 and must have certiflcation verifying completion of the
required training in theirpossession.
e1with, City
* Restoration is to be in aiecordanc codes- All street -cut trench work sfi'afi be-p`at'che_d. with asphalt or City-
approved:piatSrial-pri,�r_to the pid_ofthe�workday �. NO�EX;CEOTION9. --J-,
Three sets of""e'onstruefioii,,.dra*�wingg 'of p rioposed wt ork are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ THE ABOVE STtT
,TMENIS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA TIMUSTMAKE THE PINK COPY OF THE PERMITA VAILABLE-ON SITE A TALL TIMES FOR INSPECTIONS
Signaiure: Date: / �L
(Contractor or Agent)
FOR CITY USE ONLY
Approved by: D - 61 (16 ETT" Right-of-way Fee:
Time Authorized: Void After /0,) Disruption Fee/Fund 1' 11:
Special Conditions: 1TV MOOND5, Restoration Fee:
fES-M 99 Q I M41M LWD 5af E -M U r-e ba & -
n-02- Total Fee:
62JD rwo gig, k):xn F-Q LfffmQ t)064&L4 FA qt— Receipt No:
T -
_rb LOM lwzr, 4f 0A1 0 4ETW_r_�.- Wo A UN issued by:
I In I �T, m<. [ S I !amo-m ra-tAmTm I
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY'DEVELOPMENT CODE (Phone 425-171-0220, Ext. 1326)
FINAL APPROVAL.OF PERMITTED WORK. DATE. lol.?6,6-7
-Irdpector's Signature
For inspection requirements see Engineering Inspection Information handout.
NO WOIZK SHALL IIEGIN 131ZIOIZ TO I'EIZMIT ISSUANCE
DAMy Document.s\Forms\Engnmg\ROWpermit—.doc