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21003 88TH PL W
CITY -OF EDMONDS Permit No. J
._;�U'drlC WORKS DEPARTMENT Issue Date
RIGHT - OF - WAY CONSTRUCTION PERMIT QT
V I REET FILE
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A. eAddress or vicinity of Construction
0 Owner: L&D 62P C') w CL
Name
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Mailing Address
City, State, Zip Code
Contractor:'�' ',A,. () '� w z� �A, (,
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Name
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Mailing Address
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City, State, Zip Code
9 Permit Issued ToP 'Ok 0 1�.C. k k
0 Type of Work to be Done:
0 Work in Connection With:
11 Sub or Plat ]�Q, Single Family
D Comml. / Ind. D Apt. Condo.
0 Pavement Cut: 0 Yes .0 No
State License Number
7 4 IJ J
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 permix,-must be available at the. job site for inspection purposes at all times.
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Signature: D 4 ;
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Owner or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Vold after days
Special Condition s:
Ammendments:
I '-- fAl
Permit Fee:
Security Deposit:
Receipt No.:
Fund 111 Fee:
Street Cut Dimensions
X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
FIELD INSPECTION NOTES
(Fund 111 - Route cony to Street.,��.ept . .
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Diagram:
Contractor called for inspection Yes
T
,Alork Disa.pproved BV: Date:
Work Approved By: —Date:
Inspector:
Bv: Date:
7
Encr. Div. December 1978
AltEA'-
PUSLI.0 UTJU
1018 TY DISTRi-CT No.1 of Snohomish County-
Rr. 10177
LocqtiOn-:--�,\Q 03 72 -,_Date NO.
'isio —..,S 1.
Cc!
As built
vior tngineer
.,R�ason*for
G t�\P, C- IW. File No.
r als
1 3 K Vy App ov
Date Work CO forenvat
Circuit Numb �p Substation 0 12
<
Gas
Bo4hoe
CITY OF EDMONDS
F/I NEW
Fi ADDITION
R RETIREMENT
IPTION
I LOCATION
/ 040
74-
ASSET INFORMATION SHEET'
STREET FILE
ASSET NO.
ADDITION TO ASSET NO.
I LL4,
NO
SERIAL NO.
DEPT. NO.
F s—
"PURCHASE ORDER NO. *PROJECT NUMBER 21 -7
PURCHASE ORDER DATE PROJECT COMPLETION DATE 3o - e o
COST COST
B.A,R.S. ACCOUNT NO.
ESTIMATED LIFE
�lcl
itnp
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
F1 DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
INITIAL
REFERENCE
VERIFIED BY
PROCESSED
BATCH NO.'
,U,LI,, wR,, ��m,�,kc$TjpEff FILE
BUILDING PERMIT REVIEW 21605 887' & 9-7-96
(address) (date)
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Street Right -of -Way Existir���..._REQD
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Access Easemmts Exist
Utility Easement Exist
Lot Per Subdivision S-53--M Plat
Assessor YAP
Site Plan Checked for Accuracy SU,6,P1V1S-#OK
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Underground Wiring Reqd. .5
Check Accuracy o; Legal Descript
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Review by
Date 2-7-�-O
Existing Water Main Size
Water Main Required Ve
Service Line Required
- -
Hydrant Size Exist'
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Hydrant Reqd Per Fire Code A
—Size
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Detector Check Meter Reqd. 0
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Cross Connection Inspection___&/�........
Fire Department ConTnents
Water Meter Charge Reqd. s _6"O, e—,6,
Review by
Date
Septic Tank Design Approved— Aj/ '49
I
Date — —
Septic Tank Permit Reqd. LA_
Permit No..
Sanitary Sewer Availability
Proi
Drawing No. I r7:0
File No. 15-- _� 7- - (2 -2- - 7
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Side Sewer Availabili
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Sanitary Sewer Connection Fee Reqd.
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Review
Date Z
Open Ditch Existing___,�VO/v e-
Reqd.
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Culvert Reqd. ,OV 0 Al e__
-Size—
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Catch Basin Reqd. A-' 0 A., e--
Indicate on Site Plan
Shoulder drainage maintain collection an
swale open runoff a. A, e_
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Manhole reqd. 410
Indicate on' Site Plan 7
Soil Conditions and Ground Water Field Checked
Review by
Date
Revised: lvlO-1977
Page 2
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Street Paving Reqd. I'
Curb and -Gutter Reqd. 5:
Sidewalk Reqd. zV, 0
Curb Cut for Driveway Reqd. 5.7-,
94 Right-9f-:Way Construction Permit Reqd.
F4 Bond Reqd. for Public Improvements V
En Street Name Sign Reqd.
Other Signing Reqd.
Pre Permit Site Insp ection made on
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BY: SE14ER
WATER
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STREET
rX4 ENGINEERING
Special Requirements listed in n-mam to ComTunity Development Department,
Building Division
BY . Date
o All item filled in on Building Permit Application
P4 BY Date
Drawings Stanped and Notations Made
BY Date
Approved by Public Works Department
Revised: IV 10-1977
DATE: 2 - ZI-FQ
MEMO TO: Building Diviqion
Community Development DepirL,,nc,,,L
F ROM Engineering Division
Public Norks Department
SU BJECT: 210 0 3 ag 7-A I-Oz.
After reviex, of �he subject buildinp
the following comunencs:, , permit Ippli.cation, �-.,e'have
(ittf—NAter .5y-strg, Yquie-ecl
MICC&" s;%W%[%w Cew-er
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IF
; -1 BUILDING DIVISIOIJ
PERMIT APPLICATION
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UISTATE LICENSE NUMBER
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USE W R M I T
Applicant Fill
ZONE BER
Inside Heavy Lines
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JOB
ADDRESS
rEGAL DESCRIPTION
SUBDIV ISION
SHORT SUB No.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
'ELEPHONE NUMBER
EXISTING .15y, —
PROPOSED 5;e7 —
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DEFICIENCY OF RIGHT OF WAY
PUBLIC IMPROVEMENTS REQUIRED E3
DRAINAGE IMPROVEMENTS REQUIRED
DRAINAGE PLAN REQUIRED
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'ELEPHONE NUMBER
UNDERGROUND WIRING REQUIRED
CONNECTION TO SANITARY SEWER
SEPTIC TANK PERMIT REQ'D C] NO.
ELEVATION OF PROPERTY CORNERS El
& FOOTINGS REO'D
'ELEPHONE NUMBER
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SEE ENGINEERING MEMO DATED
:ITV LICENSE NUMB7FR
CHECKED By
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METER -SIZE BUILDING SUPPLY SIZE
REMARKS
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SIGN AREA
ALLOWED PROPOSED
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REMARKS
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NEW rIAL
SIDE,
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LINE
FRONT
FIRE ZONE
TYPE OF CO
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SIGN
ADD
R DEMOLISH
ALTER EXCAVATE
OR FILL
1:1
RETAINING
WALL
FENCE
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SPECIAL INSPECTOR
REQUIRED
0 YES 0 NO
ARE)
PLAN CHECKED BY
REPAIR PRE -MOVE
INSP.
swim
POOL
REMARKS
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NUMBER OF
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DWELLING
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i NATURE OF WORK TO Gq DONE
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PLAN CHECK FEE
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BUILDING
PLUMBING
MECHANICAL
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FENCE
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SIGN
"Applicant, on behalf of his or her spouse, heirs, assigns and
W successors in interest, agrees to indemnify, defend and hold harmless
i i the City of Edmonds, Washington, its officials, employees, and
2: agents from any and all claims for damages of whatever nature,
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1 arising directly or indirectly from the issuance of this permit. lssu-
RETAINING WALL
I
SWIMMING POOL
ENV. REVI:W I ADB NC
MPLETI EX MPT I -SHORELIN
PLANNING REVIEW By DATE
[LOT COVERAGE
SIDE REARI
NSTRUCTION I CODE INEI
GROUP LOA
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
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a Iance of this permit shall not be deemed to modify, waive or reduce
any reouirement of any city ordinance nor limit in any way the
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CITY OF
NOTICE:
, ! �!!� � I'll a
N'o---W*all!!�l���!;ant!,V...U.-
ation 'shown on the attached
The inform
map(s) was compiled for use by the City Of
Edmonds/ its Employees and Consultants.
Th,.e City of 'Edmonds does. not. warrant the
accuracy of anything set for.th on these
rnap(s�. An . y person or entity a
copy should conduct an independent
inquiry regarding th*e inform-ation shown on
including but not limited to/
tB-e -rn a p (s),
the lotation of any sew-er stub shown. Suc
sewer stubs may or may- not e.xist. and may
or may not exist at the location shown
Neither the City of Edmonds nor its
empl-o-yee*s o,roffice-rs -sha[l be 1-Ja-b-1--e for the
information given' on this map(s), nor for
any one representation provided based
upon'said map(s)*
The City of Edmonds Sewer Drawing EASEMENT NO - -------------------------------
MEET Ft ------------
NEW CONSTRUCTION REPAIRS El LID NO - ----- U-01 ----- ASMT. NO - -------------
OWNER ........ 4:::c=��-TTNUr—MV4311-4 ----- CONTRACTOR --- 1250B
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. ......................................... PERMIT NO. 4d4c:204
JOB ADDRESS ............... LEGAL DESCRIPTION: LOT NO - ------ -------- 4 ................... BLOCK NO . ........... S.
....................
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...................... A, ............................................................
NAME OF ADDITION ---- bhl
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.... Jtjl%tM,4%0-By.-,:F- �-- -- -------------- W"-,.
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PWW4)001-11175 (REV. 11[78) DATE.
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CITY OF EDMONDS
PUBLIC WORKS DEPARTIOT FOR INSPECTION CALL 16 Permit
SIDE SEWER PERMIT 775-2525 Ext. 220 Issue Date �;,Dr
PERMIT MUST BE POSTED ON JOB SITE * 4
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1. Address o77ons"t7ruction -.;_Rl 0()3 - - -->< (1�7_ 11 0 8OLo
PL W -
2. Property Legal Description (include ali easements) L(D--7—
f_� L-k 5 — 0 1 (Jevygood, 01 ow o v, "o , c�
3. Single Family Residence Multi -Family No. of Units
Commercial
4. Owner and/or Builder z , 5-3 V
5. Contractor & License No. �X_Aje_ L2 048
6. Invasion into City'Right-of-Way No 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:
/1?
a. Property owners must obtain a permit to install side sewers on
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 reponsibilit
installation for one year.
C. Commercial establishment requires mi 0 01AU-TRIMP
side sewer line. 48 HOURS
ose
d. Side sewers may not be installed cre hi t WOREs
.BEpOREs '30
to any structure. YOU DIG 0
e. Side sewer lines must be laid at a min e
and maximum grade of 100% (45
f. No turn in side sSwer greater than
between cleanout. All 90 turns must be c 0 No Is"100 T y
bend) and wye with removable cap. AW UTILITY COORDINATING COUNCIL I
g. No down spouts, footing drains or ns 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.
DATE: eo
I certify that I have read
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PERMIT FEE:
CONNECTION FEE: I\j -
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dr. and shall comply with the above
rev4li L
Aj DISAPPROVED BY: Date:
By: Date:
APPROVED By: Date:
T MUST BE POSTED ON JOB SITE
+ +1
100
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