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20829 HILLCREST
PL
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NIS ADDRESS
CITY ZIP .. TELEPHONE
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NAME
CITY / / I P( TELEPHONE
NAME /c
ADDRESS
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CITY ZIP TELEPHONE
77Sje
a ffit- 9?1e3 X6-� 7-e3417
STATE LICENSE NUMBER Exp` RATION DATE I CHECKED B
F1l,coc_)&oRo 11411141101 _ltlll�l
j PROPERTY TAX ACCOUNT PARCEL NO.
T�y
0 HE
RESIDENTIAL
0 PLUMBING I MECH
0 AD
COMMERCIAL
f
o COMPLIANCE OR
CHANGE OF USE
0 RE7M.DEL0
APARTMENT
0 SIGN
REPAIR
0 GRADING
FENCE
Cj
CYDS
I X FT)
0 DEMOLISH
TANK
OTHER
GA "
C "A'
A.P.RT
0 IT
OCAIN�ING WALL
K
0 RENEWAL
P (TYPE OF USE. BUSINESS OR ACTIVITI:V
M
NUMBER
OF
UM.EF.F
DW LLING
AREAS
fCR lICAL
STORIES
U NITS
U MBER
DESCRIBE WORK TO
BE DONE
�1: I PERMIT EXPIRES 0.12FIZO/
USE
ZONE PERMIT
NUMBER
JOB
ADDRESS AlIc ",5;, )Q
SUITE/APT,
PLAT NAME/SUBDIVISION NO. I LOT NO.
L�D NO,
L D FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
T&SCP �w 0
EXISTING — PROPOSED
ul.
cl
REQUIRED DEDICATION— FT
0
U..,
CI
METER SIZE LINE SIZE--[ . OF FIXTURES
PRV REQUIRED
I
YES 0 NO 0
REMARKS
OWNEMONTRACTOR RESPONSIBLE FOR EROSION CONTR( LIORAINAGE
FIRE MARSHAL
.-MUST BE PRESENT FDR
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADS. INSPECTION S;ND
REO'D I POSTED
ES ONO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
:Xp I I
LOT COVERAGE REOUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
z
PARKING LOTAREA 11 LANNINO REVIEWED By DATE
REO'D I PROVIDED :L
CHECKED BY j=STFTION CODE
GROUP
OCCUPANT
SPECIAL INSPECTOR JAREA OCCUPANT
REQUIRED [3 YES LOAD
IEMARKS
PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REO'D
42 PImir e^ Irlt VIC
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING '1* LOT SLOPE %
4/p.
PLAN CHECK NO: IVESTEO DATE
_BUILDING
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BEDONEO PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE UBLIC
DOMAIN (CNURDS, SIDEWALKS, DRIVE AYS. MARQUEES. ETC.) WILL REQUIRE
:5
GRADING/FILL
SEPARATE WERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 160 DAYS
PERMIT LIMIP. I YEAR - PROVIDED WO K IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE SAC K OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGE14TS FROM ANYAND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
r
IRECE IPT
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
-
TOTAL AMOUNT DUE
'J"'30-7 I CC,
1 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
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRU C'
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
Ti,,. pp�.. ..I . P.—I - .-g-.d by
d,.g 0116-1 ., D-vuly: -d F ... ... -d.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION .,pt a .,kn..I.dg.d.� v v,od.
WORKMEN'S C OMPINSA�R�URANCE AND RCW IB.27.
SIGNAT
(425)
C F.FICIALS S7 E 27
A
771-0220
Nctl��
FELEASEDBY
ENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL-FLE - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
5f9B
CITY OF EDMONDS
PUBLOOORKS DEPARTMENT, ENGINEE*3 DI v's'
T
APPLICATION FOR RIGHT-OF-WAY CONSTRUCTION PEqF RLE
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
Permit to be issued to:
A. 62 1141k 12i-e- s- "P,
For Work at :(address or vicinity) "ao
Type of Work to be done: (I -�,12 ka 14 /0 , y y a kyd- - a d;
(attach drawing when applicable)
Time Required -- Start:
Owne r: Chap-lesl,
Name
2-0'?'2q 1411ICees-�
Mailing Address
hi 0y, A-c Id LJ g-62-6
City State Zip
Contractor: 0/
dOlUk4oh- 79�4hj
Name ' ' J
0 - '-I3.bx I
Mailing Address
Lq 11 A
City State Zip
Finish:
-7 -7 (, - -7 a 2, :z
Telephone Number
.2-13 - 0/ - OL- I)E- 0 -3 17,60
State License Number
-7 -7 ?- 3 1?-K
Telephone Numbe'r
B. INDEMNITY: 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 applicant or the City of Edmonds, or any of its 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 subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220.
I understand that this permit must be available at the job site for inspection
purposes at all times. "V4 ate: 7e
Signature: 0
Owner or Agent
TO BE COMPLETED BY ISSUING AGENCY:
Date Issued: Z/Z�Y"__Permit No. 7 Fee:
Security Bond:/
Time Authorized:--yo OAe-s-
APPROVED BY Date:
10-771v (Revised)
171Z
o I -
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION & REPAIRS
EASEMENT No . ..........................................
/_ /, 0 , //-- j e,:: � �9,o
OWNER ---- e .. . ................. ...................... CONTRACTOR ......... ----- 7t . ........................ PERM IT No.
ADDRESS ........
........ .................. LEGAL DESCRIPTION: LOT No . ......... ............. .............. BLOCK No . ..... .....
61
NAME OF ADDI
TION .......... ...................................................
W 4liL—.—
DATE .7 ........
..........................
CITY OF EDMONDS
/-CIVIC CENTER — WATER -SEWER DEPARTMENT
SIDE SEWER PEIZMIT
Call PRospect 6-1107
when work
Is ready for inspection. (No Inspec.
t,OnS Saturday,'Sund" or holidays.)
N2 3591
ADDRESS ............................... 20829 Hillcrest Place
........................................................................................... . .............................................................................
OWNER ........... Chax,
LLeWaLrXje .............
.............................. CONTRACTOR ..... R.R.B. Excavators
...........................................................................
Pern'd ' sSion Is granted ..... ..................... 19 ... �9, for ........................ days . to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and
governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
Do not cover MY Portion Of sewer before it has been Inspected.
be employed to construct side sewer in street area. 81 rt I
NOTE No. 1—The owners of the Property may obtain a permit to construct sewer in de Prope Y I ne. A licensed Side Sewer Contractor must
NOTE No. 2—Obtaln full information regarding Ordinan
ce 11-16.030 and Regulations governing side sewers when You get permit.
NOTE -No. 3—Top of side sewer must have at least 30 Inches coverage at property line and 3.2 Inches Inside Property line; minimum grade of 2%.
. No bends In grade sharper than % will be Permitted.
NOTE No. 4—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.
NOTE No. S—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 appur-
tenances except to Insert the pipe into the wye.