20201 MAPLEWOOD DR.PDFiiiiiiiiii lill
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20201 MAPLEWOOD
DR
CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
Call 7.76-1107 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.)
20201 Maplewood Drive
ADDRESS LOCATION OF CONSTRUCTION .............................................................................................................. . .......................................................
PROPERTY LEGAL DESCRIPTION ..... L.pt .... 1.� .... Grpad.a --- E.s.tat.e.s.(.u.n.re.c-o.rd.e.d) .......................................................................................
.................................................. ....................... . ......................................................................................... ......................................................................................
I�M AN I IM ................................................................. . .......................................................
................................................................ 0 ER DOB BUI ER ...... �qnry Hahn
CAPACTOR'S NAME & ADDRESS..Rq� ... Win Backhoe Svc, 24006 - 92nd Ave. W. Edmonds. Wash. 98020
............................................. ............................ . .............................. . .. . .............. ........................................
Permission Is granted .... 1-2-, ................................ 19.73- for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
A N IS CALLED TO THE FOLLOWING:
N I —The owners of the property may obtain a permit to construct sewer jnslde� 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 * t
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 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 jine; 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 fallure due to improper
work which may develop within one year of completion.
NOTE No. &—It is unlawful to alter or do any other work than Is provided for in the pernift, or to do*any work on the madn sewer or Its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED E] Date .... ... .. ------- By ................ Date ............. ... ............... P . . ............. Date .............. . ................... By ................
APPROVED Date ...... ..... V
. 31 ------------- 111*1*11* ------- ....................
Remarks: ............................ .......................... ......... ... ........................................................... . .............. ....................................................
..................................................................... . ................................... -
.................................................................................. "I .... . .......................................................
BOTH Permit Copies MUST Be Signed By Owner of. Firm Performing Construction PRIOR To Request For Inspection
I ...... .................................................... .... hereby certify that the side sewer installation constructed under this permit
(Owner of Contracting Firm Performing Construction)
We talled in accordance with all governing ordinances of the City of Edmonds.
Dated this -----_---- ZP . ....... day of ................ 45i *_-1e_-'1 --- — -----_--------_-- 19/-73
Check BEFORE you dig for- Water 0, Gas 0, Telephone 0, Power 0, Sewer 0, Other 0 j
ADDRESS
TAX ACC(
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:- DETERMINATION: E] Conditional Waiver E] Study Required *aiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN D.K
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORTPLAT
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(8) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
LID #:
LOT: BLOCK:
LATEMP\DS7's\Forms\Street File Checklist.doc
-1 . v
The City of Edmonds
APPLICATION
for
SEDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS 0 EASEMENT No . .............. ...........................
-CONTRACTOR ..... INAL .15MPERMIT No..44�4%=—bk
OV*rNER .............................................. U ...... .. ............................................. 10-
ATJDRESS PPPC�ll ........ LEGAL DESCRIPTION: LOT No . .................. I ......... .... BLOCK No
.... .......... . .................................... .......
ION ............... _F ..... ------------ - -_ _r
NAME OF ADDIT F—S UTF—CSb
.....................
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Front
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Rear 2!5—
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Other
Height_
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34o
AN
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JUN 2 3 2009
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PLANNING DATA
SINGLE FAMILY RESIDENTIAL
11 STREET:F:I�K]
Name: hA
Date:
SiteAddress: 909DI
M& e- �-00)
Plan Check ff: Q)
Project Description: 9L
106
Reduced Site Plan Provided: QE) / NO)
Zoning:
Map Page:
TC orner Lot: (YES NO)
Flag Lot: (YES
Critical Areas Determination 0
El Study Required
2"Waiver
SEPA Determination:
Exempt
Needed (for over 500 cubic yards of grading)
0 Fee El Checklist El APO List with notarized form
Requireal
Street:
Side:
Side:
Rear:
Actual,
Street:
Side:
1
Side:
Detached Structures:
El Rockeries:
0 Fences/Trellises:
El Bay Windows/Projecting Modulation:
El Stairs/Deck:
Height
Datum Point:
Datum Elevation:
Maximum Height Allowed:
Actual Height:
Other
Parking Required:
Parking Provided:
Lot Area:
Maximum Lot Coverage: 35% Proposed:
Lot Coverage Calculations:
ADU Created: (YES / NO)
Subdivision:
Legal Nonconforming Land Use Determination Issued: (YES / NO)
Comments
Plan Review By: Planning Data Form G4-11-06.doc
6? 9 0 - 1 9 9 —
City of Edmond$ FE,
. L
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Numbe r: 9,--q
Issue Date:
A. Address or Vicinity of Construction: 20201 Maplewo94 Drive
B. Type of Work (be specific): Install New Servicet
C. Contractor: -Washington Natural Gas Company
Mailing Address:. 815 Mercer Street,
State License #: Seattle, WA 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. Commercial F� Subdivision 0 City Project Ma Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family [-] Single Family E] Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut Yes []No (1) G. Size of Cut: 2 x 4 H. Charge $
APPLICANT TO READ 4ND SIGN
INDEMNITY. Applicant understands and, by his signature to this application, agrees to hokilhe City of Edmonds harmlessftom injuries,.damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be made againsts the City of Edmonds, or any of its di . partmer(Is -or employ-
ees, including or not limited to the defense of any legal proceedings including defense costs, and attorney fees by reason of granting this permit.
NE YEA OW NG L ON
THE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA 7ERIALS FOR A 0 D�O 0 R FOLL I THE FINA INSPEC77
AND ACCEPTANCE OF THE WORK ES77MA7ED RESTORA77ONFEES WILL BE HELD UNTfL THE FINAL S7REET PATCH IS COMPLETED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required witlt permit application.
A 24 hour notice is required for inspection; Please call the Engineering Department�- 771-3202.
Work 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 City Engineer.
All street cut ditches shall be patched with.asphalt or City approved material prior to the end of the working day;
NO.EXCEVrIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspect' 7poses.
f c1rWff1rV7
Signature: -5��w - — Date: June 24, 1992
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:::. RI,G.H,T,,,OF,,WAY,�.DEP.O.S.IT.
. . .. .........
TIME.AUTHORIZED: VOID AFTER ALI(& DAYS. DISRUPTION . FEE/FUND. I
:.SPECIALCONDITIONS: WA RESTORATION.. FEE:...—
. TOTAL FEE:
COMMENTS: ... RECEIPT. NO:....—
�,.:,.DATE: ..... ISSUED BY:_ '71
. �50
NO WORK SHALL BEGIN
Engrg. Div. 1991
FIELD INSPECTION NOMS (Fun?'Ill - Route copy to Street Dept.)
Comments:
I Diagram:
I :
CONTRACTOR CALLED FOR INSPECTION. 0 YES 0 NO
Partial Work Inspection by P. W.:.
Work Disapproved By: Date:
FINAL APPROVAL BY: Pat*:
Eng. Div. July
U& Pik
Av4WwQMnbw9vCbmvww-
"�'ddendum to City of Edmandq
Right of. Way,
Permit Application.
'_i_ " *1
Submitted by�: izIC.WA'szO WIL-LA.RC)
Engineering Aide
Washington Natural.Gas
622-6767 x2761
Pager CIL-9- ILV&.;
I (-Z X -4) 6;—) W
S.
WNG to window ____)
Water -"aim depth
I-IM rjzwn
gas ?nx in
ZO
V414.
Pt-
0 &V - &OW :,>
ztey:
_w- water
-g- gas
-ss- Bawer
water hydrant
815 MOCCSt. MO. BM 1869)..SomWe. WA 98111 C�06) 6=-676-,
CITY OF EDMONDS .5%it No.
0 S � a uiME-- :, 1, I�L� \) r
PUBLIC WORKS DEPARTMENT Issue Date
RIGHT - OF - WAY CONSTRUCTION PERMIT
Z
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A. *Address or vicinity of Construction
20201 Maplewood Drive
Owner: Fa scherrer
Name
20201 Maplewood Dr.
Mailing Address
Edmonds, -;,lash 98020
City, State, Zip Code
9 Contractor:— Olds OlY—M2'c Inc.
Namedba Bchs Paving
P.o.Box 180
Mailing Address
. Lvrrinwood, Wash 98036
City, State, Zip Code
F-7
0 Permit Issued To: Olds Ol%rmpic Inc,
Type of Work to be Done: asphalt paving
• Work in Connection With:
• Sub or Plat 4?F Single Family
• Comml. / Ind. 0 Apt. Condo.
• Pavement Cut: 0 Yes PT No -
223 01 OL DS 0 31780
State License Number
778 3124
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any 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 it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. ' Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this rmit st be available f purposes at all times.
D
Signature. ate ;Z/ Ap
Owner or Agent
MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
THIS P2 i
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By: i:�:�
C/
Time Authorized: Void after 7 days
Special Conditions: Orivewa!w - Me- in
-to
Ammendments: CXC-C- VAmuir-'e LJJL-&
— &0-
Permit Fee: /IS
Security Deposit: AJ - It,',
Receipt No.: aZ3 :3
Fund III Fee: N-P.
Street Cut Dimensions
X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978