20207 84TH PL W.PDFIIIIIIIIIIII
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20207 84TH PL W
14
City Of ' Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number- (a
Issue Date:
A. Address or Vicinity of Construction: - . 20207 84th Place W
INJ GTE to place, operate, and maintain a buried service
e' `w� Q) B. Type of Work (be specific): wire from existing pedestal #A498 located at 20 07
8 9 C)C� 84th PI W then west to a residence at 20207 84th PI W. GTE to plow 50 feet,
ushing no roads nor driyeways. R.G.W. 9 feet.
Mary A Bower, Permit Coord.
C. Contractor: GTE Northwest InnarpnrAted C0ntaCt:QAnnJ% Alexander 771-()03f; nr mohile 388-1358
Mailing Address: 22118 20th Av SE, Suite 130 Phone:
Bethel!, WA 98921 Hapy 206,1488--1628
State License #: Liability Insurance: _ Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):.,
E. F1 Commercial
El Subdivision
0 City Project X0
Utility (PUD, GTE, WNG, CABLE, WATER)
C] Multi -family
Single Family
[:] Other
2100-9POOlDB 242310
INSPECTOR:
INSPECTOR: LA-A-.4
cJH
F. Pavement or Concrete Cut : 0 Yes )QNo, G.\ Size of Cut:. H. Chargq�_$
Please see attached sketch.
A-12
APPLICANT TO READ AND S�D'
INDEMNITY. Applicant understands and by his signature to this application, agrees to h6id,il� City ofEdmondg harmlessfrom injdrie�, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be mad�`against the City of Edmond., of any of it. department. or
employees, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgrunting thispermit.
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 TIMEA DEBIT OR CREDIT WILL BEPI�QQ§SSEDbW IS$UANPE TO THEAPPLICANTU
Construction drawing of proposed work required with permit appli&tion.
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.
,otStreet 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 EXCEPTIONS. I
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at all imes f tion purposes.
Signature: H_ qj-AwArt Date: March 27, 1996
i
(Contractor or Agent) Oprns Supv-OSP Engrg.
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME AUTHORIZED: VOID AFTER !I FAIL— DAYS
SPECIAL CONDITIONS:
COMMENTS:
DATE:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND III:
RESTORATION FEE:
PERMIT FEE: 30.
TOTAL FEE:
RECEIPTFEE-
/7/)X
ISSUED BY:
W
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
I Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
PERMIT SUBMITTED BY
GTE
IN
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LEGEND
PEDS 0
POLES 0
ROAD BORES
OVERHEAD LINES
1ALITILITY POTHOLE M
LIG TRENCHING ---UGT—
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CITY OF EDMONDS
Afr--T INFORMATION SHEET
ED"N E W
0 ADDITION
E] RETIREMENT
STREET FILE
ASSET NO.
ADDITION TO ASSET NO.
f-pperty Wit
-CITY Of EOMON S
NO. I D-3 IM
DESCRIPTION
SERIAL NO.
LOCATION D 5.
"PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
*PROJECT NUMBER
PROJECT COMPLETION DATE
COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
19 /DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT -
0 G.L. ENTRY
REFERENCE
VERIFIED BY
K - P�,� i �D �,
DATE
PROCESSED
BATCH NO. -
INITIAL
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DEPARTMENT FILE
CITY OF EDMONDS
FILE ASSET INFORMATION SHEET
NEW
ADDITION
E] RETIREMENT
ASSET NO. a 0.3 6 sv �,
ADDITION TO ASSET NO.
DESCRIPTION
sdoy
SERIAL NO.
LOCATION DEPT. NO.
"PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
*PROJECT NUMBER Q) g oit C/
PROJECT COMPLETION DATE 12 -Al -45-2-
COST ?& , /2-
B.A.R.S. ACCOUNT NO. q1 r - -nnc� — 3 cil 47 -
ESTIMATED LIFE 2-5
\A
INITIATED BY DATE AAP4ED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT -
0 G.L. ENTRY
REFERENCE
DATE
VERIFIED BY
PROCESSED
BATCH NO.
-.4
INITIAL
ttnp
DEPARTMENT FILE
j%CITY OF EDMONDS
PUBLIC WORKS DEPAR T
SIDE SEWER PERMIT
LL.2.
Uj 3
LU -
I-E- 4.
co 5.
FOR INSPECTION CALL 0 Permit
Ext. 220 Issue Date
.%* PERMIT MUST BE POSTED ON JOB SITE
L
S
Addres 077onstruction Vil i,
Property Legal Description (include all, easements)
Al
JY-- / r ,. � z-- A"i IN 11�;4 rAT �E_ X
Single Family Residence"< Multi -Family No. of Units
Commercial
Owner and/or Builder
Contractor & License No.
T" /
1Y Al
j L_ -2,
6. Invasion into City Right -of -Way: No K Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation)
7. Cross other private property: Yes No�,/ Easement required -
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
04
P4
4 a. Property owners must obtain a permit to install side sewers on
>_4 their property. A licensed side sewer contractor must be employed to
construct side sewers in the public right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
C. Commercial establishment requires a minimum of a six inch (6")
a4
z side sewer line.
0 d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
0
e. Side sewer lines must be laid at a minimum grade. of 2% (1.15
0 and maximum grade of 100% (450). 0
f. No turn in side s8wer greater than 45 (1/8,bend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer 'line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
-1 / L J_�
DATE: tj_�A,
I certify that I have read
and shall comply with the above
PERMIT FEE: DISAPPROVED BY: Date:
0 By: Date:
ANNECT4 00 APPROVED By Date:
VEE: 2 -7--/
0 *X F
rZ4 * PERMIT MUST BE POSTED ON ; 10 *BI T� 1 /9 _21
NOTICE:
ty or
-Nbw-a r-ra n
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 t ' hese
rnap(�_)- Any person or en.tity -requesting a
copy should conduct an independent
'ation shown on
inquiry regarding the inform
-map(s), Including, but not limited to,
er stub shown. Such
the lociation of any sew
exist and may
sewer stubs may or may
or may not exist at the location shown.
Neither the City of Edmonds nor its
emp-to-yee-s o-r office-rs -sh-a-1-1 be Via-b-Ife for -the
information given on this ma p(s), nor for
tation provided based
any one represen
upon said map(s).
1�
(:4L
4 All
iv I I
Side Sewer Drawing
The City of Edmonds EASEMENT NO.
.....................................
NEW CONSTRUCTION J?t' REPAIRS LID No . .................. ASMT. NO . ...................
OWNER ........................................ CONTRACTOR --Z ..... I.' ...
................................. PERMIT NO.
JOB ADDRESS .........
.........
A k. ................ LEGAL DESCRIPTION: LOT NO . .......................... ........... BLOCK NO . ......................................
0
'��-0001-11/7'5(REV.11178)
................................... . ...................................................................................................................
........... .............
NAME OF ADDITION .................
C
33
IDI kV
Approved:
DATE.-
............... B .......
.... ........
USE
CITY OF ED ZO W., E R
r.111 P
BUILDING PERMIT APPLICATION
JOB to
NAME (OR NAME OF BUSINESS) �DDRESS
P_VOL44
_b 0
7- 4�1�1 LEGAL DESCRIPTI6N- SUBDIVISION SHORT SUB NO.
W MAILING ADDRESS
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0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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CITY L EPHONE NUMBER
Sv
EXISTING_ 13
16-dlvel,ld-6, 2 76 --�7 - E
NAME PROPOSED M
W
W
I- DEFICIENCY OF RIGHT OF WAY
U I, E
W
ADDRESS
1224' 71
13
SEE ENGINEERING MEMO DATED
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CITY TELEPHONE NUMBER
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NAME
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METER SIZE BUILDING SUPPLY S177TURE UNITS
ADDRESS
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X
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CITY TELEPHONE NUMBER REMARKS
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STATE LICENSE NUMBER CITY LICENSE NUMB SIGN AREA ENV. REVIEW AD13 NO.
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE #
Legal Description of Property (Show Below or Attach Four �opies)
PLANfdEVIEW
VARIANCE OR CU BY DATE
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2
7A
YARDS LOT COVE6AGE
FRONT SIDE EAR
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In
REMARKS
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13
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NEW RESIDENTIAL E] PLUMBING CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
ADD NON-RESIOENTIAL 1:1 MECHANICAL - I
SIGN SPECIAL INSPECTOR OCCUPANCY OCCUPANT
DEMOLISH El REQUIRED GROUP LOAD
JAREA
F] ALTER EXCAVATE FENCE 0 YES 0 rj 0
OR FILL F-1 I- X -FrT)
REMARKS
r-1 REPAIR PRE -MOVE INSP./ r--j swim
COMPLIANCE INSP. L_j POOL
j
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NUMBER OF STORIES 14UMBER OF
5
0
DWELLING
I
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
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0
-e, PLAN CHECK FEE VALUATION FEE
BUILDING
PLUMBING
MECFI,,',tqlCAL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FENCE
marquees, ate.) will require separate permission.
- SlGrt
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 120 Days RETAINING WALL
"Applicant, on behalf of his or her spouse, heirs, assigns and
In
V,
W
SW IMMING POOL
In Interest, agrees to indemnify, defend and hold harmless
J1ucce,,,,,s
the City of Edmonds, Washington, its officials, employees, and
agents from ally and all claims for damages of whatever 11.111tre,
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SETBACKS:
!7 n
I ONT. c;2sl
r:'.':- A R
ONER
HEIGHT
MIEMO TO: Building Division
Corununity DCVCl0DMcnt DcpartmenC
FROM: Engineering Division
Public Works Deparrmcnc
SUBJECT: 20 Z-Z!�) 7 934 /`/- f"2-
After revi'ew of the subject Building Permit applicacion, we ha
the f011owing comments:
1. Coinection 'to City water systeri required.
2. to City sanitary sewer system require'd.
Ripht-o-f-way Permit required for any wo
rk on City propegty
4. Driveway -slope not to exceed 14%.
5. Backwater valve required if downsuirs eltimbing_ is belo . w
e 1 eva t io-n- of upstr,e�am manhole,
6. Water and sewer lin'(As 'to be SCT)arated by 10 foot minimu*m.
SignaLure
----------- ... .. ..
0
PUBLIC WORKS MPAR2= CHEacun
BUIMING PEM1IT REVIEW ze> ;Z --> 7 / - ZZ 4�
Taddress) (date)
Street Rig�ht-of-Way Existin�.,.��..._REQI�_
�ccess Easean ts Exist
Utility Easenmt Exist /1 /4/ ;e- D
Lot Per Subdivision Plat I-j5r- V,f Assessor
Site Plan Checked for Accuracy
Z
X
Underground Wiring Reqd. AV/ 'p, 'r-
Check Accuracy of Legal Description ler
Z
Review by "Date
Existing Water Main Size C� 0,,r Aig�-
Water Main Required
Service Line Required
Hydrant Size Existing, A,
1 M1 ela r
HYdrant Reqd Per Fire Code Size
Detector Check Meter Reqd._
Cross Connection Inspection- d�l
Fire Department ComTents
Water �bter Char d.
Review by Date
Septic Tank Design Approved Date
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability
--Proj
Drawing No. kllt / jJZ 41, g/ File No.
Side Sewer Availability, !�' e, - 79
94
Sanitary Sewer Connection Fee Reqd.
:3:
Review by. Date
Open Ditch Existing__,dg&jL Reqd.
Culvert Reqd. al&7? Size
04
Catch Basin Reqd. Indicate on Site Plan
0
Shoulder drainage maintain collection on swale open runoff
P
Z� �141 14?11.1
tn
IManhold /eqd. Indicate on* Site Plan
Soil Conditions and Ground Water Field Checked
Review by te
Revised: 1vl0-1977
Page 2 0 0
Street Paving Reqd. ar3,
Curb and Gutter Reqd. lv-ef-!�
Sidewalk Reqd.
Curb CXit for d.
ad Right -of -Way Construction P1;e elt Reqd.
Bond Reqd. for Public Improvements
Street Name Sign d.
Other Signing Reqd.
Pre Permit Site Inspection made an
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BY: Sam
WATER
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STREET
ENGINEERING
Special Requirements listed in mew to Comunity Development Department,
Building Division
BY Date
o All items filled in on Building Permit Appli.cation
ad BY Date
C' Drawings Stamped and Notations Made
BY Date
Approved by Public Works Department
Revised: lv 10-1977
PUBLIC WORKS DEPARTMENT*
BUILDING PERMIT REVIEW
BUILDING ADDRESS Xn 20 -7
BLDG. DEPT ' SUSPENSE DATE INITIAL
ROUTE: C1 OFFICE ADMIN. — PUBLIC WORKS LOG IN
0 CITY ENGINEER ( check)
0 Access Slope and Vehicle Access
,,,Si)rainage Plan aaa-�
E3 Street File
Megal Description
OQuit Claim
13Easement
OCalculate Sewer Connection
11 WATER/SEWER DIVISION
DDetermine Meter Size
DComplete BU4
J-1ding Permit Review
0 STREET DIVISION
13Complete Building Permit Review
OOFFICE ADMIIN. — LOG OUT TO BLDG. DEPT.
,,-"Single Family
Multiple
Commercial
DATE
to
0622IM05 =1m= IMM mom I =on m Ism Ism on mmom no mom m M1 =Mn= M lox mu
DIBUILDING PERMIT APPLICATION (COMPLETE) 61Pq /4-21
0--2---COPIES OF SITE PLAN —3TCT fjaLn-
13 2 COPIES OF FIRE PROTECTION PLAN
(PREVIOUSLY REVIEWED BY FIRE DEPT.)
0--3 COPIES OF DRAINAGE PLAN ttTTE CALCn1ft't8NS L4� )&h2-
REQUIRED BY SUBDIVISION 0
GREATER THAN 2,000 SO. FT.
IMPERMEABLE SURFACE [3
LESS THAN 2,000 SO. F-1.13
fHECK ZONING REQUIREMENTS (SETBACKS) —7
1 COPY OF ENGINEERING CHECK LIST
,11 COPY OF PUBLIC WORKS MEMO
MULTIPLE OR C011MERCIAL
YES E] (ATTACH COPY OF ADB APPROVAL INCL. ALL DTWTINGS)
NO
UBDIVISION NAME
DATED RECORDED
NUMBER
NO 0 .(ATTACH COPY OF REQUIPZ=S) /,,-- A0Z
/,�CHECK SEWER DRAWING AND ATTACH COPY
IS DEDICATION REQUIRED — YESM (OBTAIN OLnT CLAel)
CITY CODE
NO
//11/DOES CITY HAVE EASEMENT ON PROPERTY
YES [I (ATTACH COPIES OF DRAWINGS)
NOZ-13-1,
CHECK ACCESS ING UTILIT
9K,9SL /IESU
YE!5,0 YES
NCC [3 NO,,-ff
/P/� S SEWER ASSESSMENT BEEN PAID
YES 0 L.I.D. NO.
PLAT NO.
SUBDIVISION NO.
:;., 0
0 IF MULTIPLE:
0 IF COMMERCIAL:
INCLUDE NUMBER OF UNITS
INCLUDE NUMBER OF FIXTURE UNITS
7