20624 MAPLEWOOD DR.PDFIIIIIIIIIIIIII
14244
20624 MAPLEWOOD DR
CITY OF ED)"
w,v!DS $10E SEWER' PERMIT
T
PERMIT
525 for Bide sewer inspections BEFORE covering any portion of the constraction.i
(1C-=,5-_-2 will be provided'within 24 hours after requot. NO Sat., SUp.", or holiday tnepeetions.1
A=Mg&L*cAfn0X0F0GNft%UC"()N.. 20624 i!api,_wood Drive
................. ... .............................. I . ...................... . .................. ... ........... . ...........................................
. . .............. ... ....... ................................................
PX(WZWY LWAL DIDSCFAIMON ............
. . . ... . ......... ........................... . .......... . .......... . ................ . ......
....... ........... . .............. . .. . .... ................ ............................ .......................................
. . ..... 4 ... .................................... ONMERAWOR BU"IM ...... ..... u.sLIa ...........
................ .......... ............................. ..................
7, 4�
Ampjg% NAM "DBE88 ..... F�pb Win 240,116 - ''., , 1�
Oox"L - 92-nd A, � 011 1
... ...................... 131
........ . ............. .... ....... .... . ...................... . ....... .. . .. . . ........... . ...................................
PernAakm is, gT=bd ............ ....... iJ.U],Y ... 3-5 . .. . ............ z9.214, for
XYI*OM I In aceirdance, with City of Edmonds orMumices. repab ,,, mWor 000meOUou of a side wwor to the city saWi�r , y
A# MON 10 CALLED TO THE FOLLOWING
NOTE No. I —The owners of the property may obtain a permit to construct sewer ins ide.propairty� line. A�
licensed Bide Sewer Contractor mu* be employed to construct
sewer In street area. Do not cover any portion of mower before it hmj� b"* 11210"IM&
NOTZ No, $--All work performed In city right-of-wav requires an Invasion of Right-01!40ir *1014ilt obtainable from the City Engineer's office.
NOT]W� I full Information regarding Qrdinance 11.16.030 ancy Regulations SwelftlaS 40 mower. when you get permit.
Tw of side sewer must have at least 30 inches coverage at property line jj�
460knmr.than % Will be permitted. aA4 � Inches InsUbe property line; Minimum grade of �,,*r No bft&.In gro*
failure due to Iml
ed'in stroot-must be water settled and surface of street restored to original condition. Contractors shell be responsible for'
zlist develop within one year of completion.
*'ftit 6'after or do any other work than is provided for in the permlt� or to do any work on the main sewer or its appurtenances except
Into, the wye.
Date.
By ............... Data. . . ........... BY DgAeL .......... . .. . .. . ............... . ft ...............
..............
AMMIVZ6 Date.._. ........ BY.. ................
A., .....
....................................................
................................. .... . . ..... . . . .......... . .......... . .. . . I .. . ... .................................. .............
'A"Vo Request For InspectioA
DOM.Permit Copies MUST Be ftned Yr of,
Construction
...................... hcrel* iciiify t#4��Sidii mower
IMUd bLtion,constructed under this perWt)6P,'
FIrm Performing,
talled in a=r(=et_ecvthitgh
all governing 6rdinancesof the-tity of Edmonds.
V�
.....................
...... ftz of ......
41
E3
"L-00"er Omer N/
Check Bl"RE you ft 'I" i P
_J
SEP-23-2003 08:57AM FROM-SNO CO PUD SOUTH CO,
425-670-3210 T-435 P-001/002 F-ST3
21018 U.S. Hwy 99
Edmonds, WA 98026
Phone: 4251670-3214
Fax.- 425/267-6231
E-mail: rik2kaley@snopud-com
CC>UN-1rV
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To: Danielle Gilbert From: Bob Kakaley, Customer Engineer
T & D Engineering Services
Fax: Date: September 23, 2003
Phone: Pages; 2
W/o#:
Re: Traff ic control plan lor Maplewood Dr
0 Urgent [I Please Comment 0 Please Reply 0 Please Recycle
MEMO: Hi Danielle!' Followilng is the traffic control plan for the job
at 20624 Maplewood Drive. Give me a call if you need anythin!l
else.
Thanks!
gad ��4414
5 20 TH ST SW 6 5
4
4
6 3-111
0 3-13
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SL-1777-D
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3
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SORE -0 071 P L S W'-
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SL-2�
3-11 -22312
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< 25-2G508
GIIA CAS-r SIpIE 01V SL-28151-F
C-IG51 2 3 4
-ro WF-5-r slor- air
S L - 17 7�G -�.D SL-1775-D
� n - - I - /—n< -)-7 innnn I I
Vate: US/28/03
User: RJKakal
Field View
Time: 07:38:38 AM
Scale:
V4
SEP-23-2003 09:57AM FROM-SNO CO PUD SOUTH CO. 425-670-3Z]O 1-4�� F.UU�/UU4 t-O(J
POAD
OmSTRUCTION
H r A >0
(Vr
(w2a.-i) SEE NOTE 1
30
ROAD
NARROwl
(ws - 1)
30' SEE NOTE I
TAPER LENGTH
cTADLE A)
TABLE A
—
SPEET,
(MPH)
TAPER LENGTH
(FT )
CONE SPACING
ALONG TAPER
(FT)
OFFSET WIDTH
10,
12,
25
100
120
25
30
150
180
30
35
200
240
35
40
;�70
320
40
�5
NOTE1
DISTANCE BETWEEN SIGNS SHALL
BE 100' FOR RESIDENTIAL
STREETS (25 MPH). AND
200' FOR ARTERIAL ROADWAYS
2. FLASHING BEACON SHALL BE
INSTALLED AT EACH SIGN FOR
NIGHT-TIME USE.
3. �ISTANCES MAY VARY AS APPROvED
By THE ENGINEER.
FLAGGERS REQUIRED TO CONTR ' CIL
TRAFFIC WHENEVER THE CONTRACTOR
MUST INTERRUPT TRAFFIC -FLOW
To ACCESS THE WORK SITE WITH
MATERIALS OR EQUIPMENT.
LEGEND
E] CONE OR CHANNELIZING DEVICE
On (SEE STD 7-14)
Dr
L
1 V
MIN
coi E —
111' 01
IN E
8
S
WORK AREA
7RUCK WITH
rLASHIN6 OR IT H
I I
DCACON t <s;w>o
TAPER LENGTH
(TABLE A)
SEE iqOTE I
SEE NOTE I
Q
POAl,
C O"S".;
_S' ION
(W20-1)
30"
TRAFFIC CONTROL PLAN 3-t-95 f
lul
2 LANE ROADVAY: PARTIAL LANE CLOSURE z1ate
CITY OF LYNN\,/OOD - PUBLIC WORKS DEPARTMENT
'Critical Areas Checklist CA File No: oR -A3 D
Site Information (so ils/ topography/ hydrology/ vegetation)
1. Site, Address /Location:
0 603' -,Of
.2. PropL ty Tax-Account;Number: - -
C700
3. Approximate Site Size (acres or square feet):
4. Is this site currently developed?4L. yes;'_ no.
If yes; how is site developed? �gA
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolhng: slopes on site generally lew than.,15% (a vertical rise of 10-feet over a horizontal
distance of 66-f6et).
Hilly: slopes present oin site of more than ' 15% and less than 30% ( a vertical rise of 10-feet
over a horizontal distance Of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal
distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain. of a water course.'
9. Site cont a creek or- anarea where water flows across the grounds surface? Flows are year-Tound?
Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs n-dxed
urban landscaped
IT Obvious wetland is present on site: -II(JC9
06
TIT
A
Mli WHIP". WE
7�p, n'&.I(�'Numveri4.lr,,app'�able?,.
41
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ATION
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Critical Areas Checklistdoc/3.19.2001
V.ED
City 'bf ' Edihoods.
Development Services Department'"
Planning Division.
Phone:. 425.771.0220
Fax::- 1425.77Y022,1
The Critical Areas Checklist contained on this form is to
be filled out by any per.son.p-r-p-paring - - a Devel . o . p` 'men . t`�'
Permit Application for the City of Edmonds nor 40"
his/her submittal of the application to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas a re, or
may be, present on the subject property.. The information
needed to complete. the Checklist should be easily
available from observations of the site or data available at
City 'Hall (Critical areas inventories, maps, I or soil'
surveys).
I . � '1 6,,( 1 11 U C__
Date. Receive&
Cii� F�eceipt M 71 Q -tY
Pritical Areas File M -
C 'A s
riti6ar teas, Checkki t!r66: $45.00
,,!Pate�Mafled t6A0plJ,,.c.a9�
A. pr9perty,-.- owneri . or -his/her allthorized yepresentative,
must fill out the checklist, sign and date it, and submit it
to'the.-City-. The'City! W�`ill 'review- the 'checklist, -make a
,,,1pyepursory site visit, and: make. a determination of the
subsequent steps necess&y�,to complete a development
erim pp
ta i h6ation.
Please submit a vicinity mqp, plong'w
fh
,,.�ilie signed copy
of this form to assisf,'Gity staff in �nding locating the
�, 1,0, , I- VY :)
speqific piece of'prooeft-y' escribed on this form. In
�; 'inpl '
a��Ition, the '' applicant siki'�'/ ude other , pertinent
)c . . I . � '. t'y I _?`
informition' (e.g. site' plan, topogr4phy. map, etc.) or
studies in conjunction with this,Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indernnify, defend and hold- the City ofEdmonds harmless from any and all damages, including.reasonable
attorney's fee's, arising from any action or infraction 'based . in whole or p�art upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/hdr/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that fam authorized e behalf of the owneras 1* dbelow.
SIGNATURE OF APPLICANVAGENT DAT E
-7
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for the public n roperty for the
_Wicials and the staff of the City of Edrt.o ds to enter th6 subje6t p'
purpo ses of inspectio n and posting lication.
SIGNATURE OF OWNER : #%_� ec.
DATE
Owner/Applicant:
Name
,�06
Street Address
wk -
City State Zip
Telephone:
Email address (optional):
Critical Areas Checklist.doc/3.19.2001
Applicant -Representative:
Name
Street Address .
City State Zip
T61,e,pho.ne:__
Email Address (optional):
APPROVED AS NOTED
BY ENGINEERING
Date:
STREET FILE
. CITY -,Do !."ED,v,
Bul DING DEPA
WORK
ADDRESS
OWNER— -Ll� Ali A-)
1163.14?
Fia)w kkUcT EE LOM-FeV
-MENNT
APPROVED DATE:
BLDG. OFFICIAL���
PERMIT NUUMER
�aEs;� It AOV
Mr�*KGD nums
I
T.-W,
a"
5�011e� t- 30,
C.
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APPLICATION
The City of Edmonds for EASEMENT NO - -------------- --- ---
SIDE SEWER PERMIT
IGI E�> I
NEW CONSTRUCTION F7 REPAIRS N LID NO . ........... ASMT. No
OWNER
------- I ............................................. ...................... ------- CONTRACTOR -------------- I .............................. . .......... I ...... ----------------- PERMIT NO . .. .............
JOB ADDRESS .... t-ANPLF-=\N000 DRIN�7- TEGAL DESCRIPTION: LOT NO . ............. -------------------- BLOCK NO . ..... * ... ... ... .... ... ... ...
--------------------------------------------------------------------------------
---------------------------------------------- ...................... ................................ I -----------------------------------------------------------
NAME OF ADDITION �-A \ L-- I - -�-:>
........................ -.- ...................... ............................................. ------------------
0
I
.... 14 y
lolwlaw-
DATE -
APPUCATION
The City of Edmonds for EASEMEJ-4T NO - -------------------- -----------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION E] REPAIRS P- LID No. / -------- - ASMT. NO.,30
OWNER 07Wa .......... /��-Z/.� ------------------------------------- ------------- CONTRACTOR ---- 30-4 ..... -------------------------- -------------------- PERMIT NO.
JOB ADDRESS .;;40;w ... . ... ------------------- LEGAL DESCRIPTION: LOT NO - -------- 3 -------------------------- BLOCK NO - -----------------------------------
n
------------------------------------------------------------------------------------------------------------------------------------------------------ -----------
NAME OF ADDITION ...... /tj ..............................................................
Approved:
DATE................................ ........ - By ---------------
REGARDING:
20624 Ma-plewood Drive 41),;� - Q'76 CC>
(address)
R E C 0 R
D 0 F C 0 N T A
C T S
DATE
NAME, PHONE NO... &
COMMENTS
ADDRESS of CALLER
5/l/74
Gail Leslie
Certified Letter No. 406341 sent
requiring hook-up within 60 days.
6/5/74
Received letter stating Bob Aklin
was to install.
7/1/74
Certified Letter No. 406580 sent
requiring response by July 12.
7/5/74
Mr. Leslie requested an extension
to 8/l/74. Contractor unable to
install at this time.
7/16/74
Bob Aklin obtained permit #4940.
1/27/75
Mieted,
Connectign cp
ACTION TAKEN
Letter received.
Letter received..
Ext granted and letter signed
INITIALS
TE
TE
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0
CITY of EDMONDS
200 Dayton Street - Edmonds, Washington 98020 - Telephone (206) 775-2525
Department of Public Work8
Mr. Gail C. Leslie
20624 Maplewood Drive
Edmonds, Washington 98020
Re: Property —at 2,0624 Maplewood Drive, Edm nds
Dear Mr. Leslie:
In reference to your receipt of a Certified Letter of May 1,
1974, requesting you to connect your property to the Edmonds sanitary
sewer within sixty days; due to the hardship stated by you and indicated
below, You are herewith allowed an extension to August 1, 1974
in order to make the subject sewer connection"
Time Extension Requested Because:
Owner is unable to employ a side -sewer contractor
at this time to make the necessary sewer connection.
Si ncerely,
CIT, EDMONDS
GILBO
D i r e C t ror
V
JBM:te
ACKNOWLEDGED BY PROPERTY OWNER:
PROPERTY ADDRESS: c;� a 6 ;� L/
MAILING ADDRESS:
ACKNOWLEDGEMENT DATE:
LCSLlrl_= RC-AL'_',*'Y. NC. —Sin ce 191 4 MoplewooJ, Dr. '
r. 20621
nves-Ementg 1R. I- c r. I Qmonl, Wagkington 980'2Ci
JUN r; 1974 778-5890
,;2 1_7 2,131,7
P-r
-ellze
0
SENDER: Be sure to follow instructions on other side
"�pEASE FURNISH SERVICE(S) INDICATED BY CHECKED BLOCK(S)
(Additional charges required for these services)
Show address Deliver ONLY
where delivered to addressee
RECEIPT
R6ceive e number# arficle�-describp-"ow
REGISMREO*6O.---- I NATU RNAMEOFAQ SEE (lAu always be fill d in)
G R NfAE OF A E (lAu a,
-406,341 2 SIGNATURE OF ADDRESSEE'S AGENT, IF ANY
14&1�Rff NO.
(071!V ifreq aested, and i7tclugN �IP C;de)
SHOW WHERE DELIVERED
SENDER: Be sure to follow instructions on other side
LEASE FURNIS H SERVICE(S) INDICATED BY CHECKED BLOCK(S)
(Additional charges required for these services)
]Show address Deliver ON
where delivered to addressee
El
Received the numbU.Cd ?ilrlie described b5m"O'\
REGISTERED NO. lk SIGNATURE OF ADORES E (mus ays be filled in) ��I
I'M
CERTIFIED NO. =SF- m �/ I �-
ve X-fs-so -SIONATURE OF ADDRESSEE'S AGENT, IF ANY
fN&WD NO.
A
DA'.F-E- DELIVERED A SHOW WHERE DELIVERED (only if_requested, and include,7J17 6o—de) i'
'7
-400 (pl-us postage)
PdrSTk1ARK
OR DA
(See other side)
'-I-;AV111II0AII MAIL *�O- 1970 0-397-.58
loe (PIUS postage)
POSTMARK
OR DATE
j A *46 0
1AMINV"'Irle ohly Y
!411IJAI, j)j'LjVIpy - mj'-
.............
0 00 roqi)lrod) ......
.........................................
. ... ..... .... . .....
Or- 1071 3800 No INSURANCE COVERAIIIIIIIII PR 0 V 1 0 ED
(So Othor side)
NOT FOR INTERNATIONAL MAIL apo; 0 1070 0-397-41sfI
Permit No:
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date:
A. Address or Vicinity of Construction: lt*014 VVqq&)0:;kP EXL.
B. Type of Work (be specific): C-14 r-A010
C. Contractor: AM/4".4o— 5' 7;f C, Contact:
Mailing Address: A. 0. 90Y S&q rj�m �-k�Z kk 8dq*4-
State License #:-AFA 4AW-1 10) Liability Insurance: Bond: $
D. Building Permit # (if applicable):
E. r-1 Commercial' Subdivision
El Multi -Family Single Family
INSPECTOR: AILWnT
F. PAVEMENT CUT: El YES El NO
CONCRETE CUT: El YES El NO
Side Sewer Permit # (if applicable):
E] City Project E] EUC (PUD, VERIZON, PSE, AT& T, OVWD)
El Other
G. SIZE OF CUT . X
INDEMNITY.- Applicant understands by hislher signature to this application helshe holds the City of Edmonds harmless from
i . ni . uri . es, damages or claims of any �ind or, description whatsoever, foreseen or unforeseen, that may be made against the City of
Edmonds or-.gny of its departments or employees, including but not limited to ihe defense of any, legal proceeding�,Jncluding defense
costs and attorneyfees by reason ofgranting this permit.
THE CQNTRACTOR IS RESPONSIBLE FOR. WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLL007NG THE'FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES W!LL BE HELD UNTIL THE FINAL STREET PATCH IS
'COMPLETED BYCITYFORCES, AT WHICH TIMEA DEBITOR CREDITW(LL BEPROCESSED FOR ISSUANCE TO THEAPPLIC,4NT,
# Traffic 'Control and public safety shall be in accordance with City regulations as required by the City Engineer.. Every
flagger must be trained as required by (WAC) 296-455-305 and. must have certification verifying completion of the
required training in their possession.
* Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City
appr�oved material prior to the end of the workday - NO EXCEPTIONS.
Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
IHAVEREAD THE ABOVE SLT4.T�EMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THATIMUSTMAKE THE PA&eOPY OF TVE PERMITA VAILABLE ON SITE A TALL TIMES FOR INSPECTIONS
or
'FOR CITY USE ONLY
Approved by: AV -
Time Authorized: Void After. /0
Special Conditions: _ft-4J A~CD
4#n6g.,,� 4u�
a VJ
Right-of-way Fee:
Disruption Fee/Fund 111: A XN40
Restoration Fee:
Total Fee: 0 &1 so
Receipt No:
Issued by:
12
Z 4 x TIAL
UPON COMPLETION OF PERMITTED WORK, AN, ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)
FINAL APPROVAL OF PERMITTED WORK. M11 DATE: 411YLjq�-
Yns�ector's Siinattire'
For inspection
see Engineering Inspection Information handout.
NO WOIZK SI-IAI.L lH-,1(,1N NZ101Z TO PlAZM IT ISSUANCE
DAMy DocumentsTorms\Engnrng\ROWpermit_.doc
77
City -of Edmonds Permit No:62oz- Q25 G
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: &
A. Address or Vicinity of Construction: zo(o Z
B. Type of Work (be specific): KOAD MOkE_ r- 'K 0 A\ PEVNF_s--#AL oN) rA'5'7- 5i4�,C*
OA� i" -ro' 0� 030,;ZjF� 4A/,.) _7_�.Z)rAjC1.[ q7,,,V0r4_,,,
-ro '6r5C_,,F or' AI.E W -aR J Vc'&,.)AY N)o �4 C�y P,-- a 5- —,1 4.
C. Contracto r: Mo. C6. Contact:
Mailing Address: 2 10 i '9 14 k)Y 7 ri�' A%OAA A WAPhone: S_ - 69> 70
t
State License #: Liability lns`urance':-,._ Bond:,$
D. Building Permit # (ifapplicable): Si�e"§e"w'ei Permit #,(.if applicable):
E. �' 30'mmercial El Subdivision El City Project. El"EUC (PU,D, VERIZON, PSE, AT&T,'OVWD)
1% PLAIr +be
' Z
Muilti-Family El. Single Family Other
_x,
fNSPECTOR:, M�(010A_Ak, Jfl;AW!:AL11
F. PAVEMENT CUT: El VES NO G. SIZE OF CUT x
CPNCRETE CUT: [I YES El NO
INDEMNITY.- Applicant understands by his/her signature'to this 'application belshe holds.the City of Edmonds harmlegsfirom�
'in damages or claims of any kind or description whatsoever, foreseen or unforeseen, that m
juries; ajv be made against the C of
Edmonds or any of its departments or employees, including but not limited to, the d6fense of any legal proceedings including defqnse
costs and attorneyfees by reason of an
gr tingthispermit.
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 *7LL 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
I( A
Traffic control and public safety shall be.in accordance with City regulations as required ' by the City'Engin&r. Every
flagger must be trained. as required by. (WAC) 296455-305 and must have certification verifying completion of the
r iired training in their possession.
equ
Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday - NO EXCEPTIONS.
Three sets of construction drawings of proposed work are required with the permit application.
CAIIL DIAL-A-DIG-(1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ THE ABO VE STA TEMENTS AND UNDERSTAND. THE PERMIT REQUIREMENTS AND A CKNO WLEDGE
THATIMUSTMAKE THEPINK COPYOF 711EPERMITA VAILABLE ONSITEATALL TIMES FOR INSPECTIONS
Signature:,
(Contractor or Agent)
FOR CITY USE ONLY
pproved -by:
Time Authorized: Void After
Special Conditions: WS-M W D(k) PUL eAT V" QAW'4gDC;-
ReMIM A 09 DM996D LAODe.CAPE Ut� 0A,'WP1aQ_
Date. 7-/7-0S
Right-of-way Fee: t54'
Disruption Fee/Fu ' nd 111:
Restoration. Fee:
Total Fee :
Receipt No: A
Issued by:
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER .18.00 OF'THE EDMONDS
COMMUNITY DEVELOPMENT,COPE (Pho e 4425-771-0220, Ext. 1326)
DATE: 1/q_1fM
FINAL APPRO VAL OF PERMITTED WORK.
Vinspector§ Slignature
For inspection requirements see Engineering Inspection Information handout.
NO WOIZK SHALL 1H,(;1N I'MOR TO NAZMIT ISSUANCE
DAMy Documents\Forms\Engnml3\ROWpermit_.doc
. ... ..... 7 .7 77
'p.;
PERMIT EXPIRES 1:?j
CITY OF EDMONDS
USE
ZONE PERMIT
CONSTRUCTION PERMIT APPLICATION
NUMBER Z0044
JOB
OWNE�N;AME/NAME OF B U$INESS
\r\Q_�NeArev,_ AA1110�111`1
ADDRESS E/A
2064::�_-r 1;14,aei
PLAT NAM E/SUBDI VISION NO.
LOT NO. .
LID NO.
MAILING AUUHESS
ox
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved _0
RW POnnit Required
Street Use Permit Req'd 8
CITY
ZIP T�El 2
HOSE
�C)
C T)T 7T
EXISTING — PROPOSED — Inspection Required 0
Sidewalk Required 0
REQUIRED DEDICATION— FT Ud. . .... d
NAME
Wiring required
METER SIZE. f__��j NO. OF FIXTURES _FPRV REQUIRED
ADDRESS
YES I
YES 0 NO 0
cc
REMARKS Uj
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CO z
NTROUDRAINAGE a
CITY ZIP
I TELEPHONE
___1 z
W
NAME
ADDRESS
CITY ZIP _FTELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE
I CHECKED BY
PROPERTY TAX A11UNT PARCEL NO.
0 0c)
NEW
RESIDENTIAL
0 PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
0 REMODEL
APARTMENT
0 SIGN
0 REPAIR
GR CYDS
M-1
FENCE
X FT)
0 DEMOLISH
0 TANK
OTHER
CGARAGE
3 CARPORT
0 . RETAINING WALL
ROCKFRY
0 RENEWAL
(TYPE OF USE. BUSINESS OR ACT
�Y)EXPLAIN:
-� ,
NUMBER
/NUMBER OF
CRITICAL'-j
OF
DWELLING
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
, \k mcr-- ark. uai'
HEAT SOURCE GLAZING % !LOPE %
PLAN CHECK NO:
IVESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
E EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF OHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
c FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT E
DEEMEDTO mobIFY, WAIVEOR REDUCEANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANYORDINANCE PROVISION,*
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WIT� CITY AND STATE LAWS REGULATING CONSTRUC-
TION: AND IN DOING TH§NqRK A]UTIVJIIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF T R 099,o0F THE STATE OF WASHINGTON RELATING TO
FLA R
WORKMEN'SCOM N�) ONI�14 YNCEANDRCW18.27.
EE , —
SIGNATURI�,PWR 0
'�VW _ _ /
I DATE SIGNED
%TTENTION
r is * UNLAWFUL TO USE OR occupy A BUILDING OR STRUCTURE UNTIL
, FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
:ATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
)8
, "j'r
ENGINEERING,"
FIRE REVIEWED BY,� DATE W
!E
U.
VARIANCE OR CU SHORELINE OR ADB# INSPECTION I PBOND
REO'D OSTED
0 YES 0 NO
SEPA REVIEW
I SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED
PROPOSED
ALLOWED PROPOSED
EXP I
I
,
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
z
PARKING
LOT AREA
I PLANNING REVIEWED 13Y DATE z
5
REO'
CHECKEDBY ITYP CONSTRUCTION OCCUPA�Z.
a" l2y4TGROUP
SPECIAL INSPECTOR JAREA OCCUPANT
REQUIRED E: LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADING/FILL
STATE SURCHARGE
ENG. REVIEW FEES
ENG. INSPECTION FEE
LANDSCAPING
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
CALL
FOR INSPECTION
(425) 0
771-0220 RE
EXT 333
771-0221
FAX PC -
VALUATION I FEE
1 1-5-611 1 ) 2 0-
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
DAT
AFIIALS SIGNATURE E
_L
LEASVEDY DATE
ORIGINAL - FILE YELLOW - INSPECTOR
� PINK - OWNER GOLD - ASSESSOR N
0 0
^61
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retainirig Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ....................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment ..................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
00
OCCUPANCY ..................
440 il7jr P/