21006 82ND PL W.PDF111111111111
7661
21006 82ND PL W
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9 0 - 1 9
City of Edmon&
STRORERUF-my CONSTRUCTION
PERMIT C/ V-
17111 er.
Issue Date: -31 -9,V
A. Address or Vicinity of Construction: - 21,006 82 PI W (9408046)
B. Type of Work (be specific)
Install New Service
C. Contractor: Washington Natural Gas Company Contact: Frank Swan
Mailing Address: 815 Mercer St. Seattle, WA Phone: 224-2278
State License #: 98111 Liability Insurance: _ Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. F1 Commercial E] Subdivision El City Project g] Utility (PUD, GTE, WNG, CABLE, WATER)
F1 Multi -Family E] Single Family E] Other
INSPECTOR: 114SPECTOR: 1 06A �'-A
F. Pavement or Concrete Cut 0 Yes [jallo G. Size of Cut: x H. Chargq�_$
APPLICANT TO READ AND S N
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold ty ofEdmonds,harmle8slI
I , ?r�i igiFA%mages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made ago nst the City of Edmo
nds, or any of its debartments or
ts. a t
employees, including or not limited to the defense of any legalproceedings including defense co ts, and attorney fees by ieason ofgranting this permit.
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 PA TCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO�THRAPPI,16ANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please, call the Engineering Division, 771-0220.
Work,and,,r6terial 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 the City Engineer.
I N f tl�e
All street cut ditches shall be patched with asphalt or City approved material prior to the 2dyo - wor�ingday;
NO EXCEPTIONS.
Ihaue read the above statements andunderstand thepermit requirements andthepink copyof thepermit willbe
available on site at all ti or i��oses.
Si--na ture: ?Z: - Date: January 2% 1994
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE EngTg. I)iv. 1991
FIELD INSPECTION NOTES
Comments:
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:
wi"vton
Addendumto Civ of Edmonds,
Right of Way
Permit Applicaiion
Submitted by: MITCHELL S.-LANKFORD
Engineering Aide
Washington Natural Gas
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815 Mercer St. (P.O. Box 1869), Scank, WA 99111 (206) 622-6767
__ -.11 1- — _�qs
ITY OF EDMONDS
PUBLIC WORKS DEP
SIDE SEWER PERMIT
FOR INSPECTION CALL
7 15m2w9a64amb. r@ 00 Im
Permit N?"- _' - 6206
Issue Date k t - 7_1 -I iaz�
* PEP -MIT MUST BE POSTED ON JOB SITE *
l.. Address of Constructio i o 7Z wec-r
2. Property Legal Description (include all. easements)
OP 4A 10A N
3. Single Family Residence k- 'Multi -Family No. of Units
Commercial
4. Owner and/or Builder 8J0 kAl T4 VZ-_JZ_41 IJV
5. Contractor & License No. ( T jE 1— 7— - T - k� I � or 4—
K, Yes (If Yes Right -of
6. Invasion into City Right -of -Way.: No
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
7. Cross other private property: Yes I No k Easement required -
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
a. Property owners must obtain a permit to install side sewers on
their property. A licensed side sewer dontractor 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 re . quires a minimum of a six inch (6")
side sewer line.
. 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
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.
l.- Inspection during normal working hours only. Two (2) working
days notice requi ed. '_j
DATE:
I certify that I have read
and shall comply with the above
PERMIT FEE: DISAPPROVED By:' Date:
By:F Date:
CONNECTION FEE: APPROVED By: —Date: //,_47/2W
PERMIT MUST BE POSTED ON JOB SITE
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Street Right -of -Way Existing
Access Easen*-ents Existing —
Utility Easement Existing
Lot per Subdivision ---- —
KbV !Bq
STvIr
:IT
7XXX X ,, � J&
;:5 REQD
dw� IL REQD
12
Site Plan Checked for Accuracy
Underground Wiring Reqd.
Check Accuracy of Lp-gal Description
Environmen tally Sensitive Area
F------
,nvironmental Checklist Reqd.
Flood Hazard Zone -------
Shoreline Management Area
Slope, Soil, Vegetation ------------
St:re,Tn, Creek, Drainage Basin
0
Existing Zoning Per Code
I Amenities Design Board ' Approval Reqd.
4 Board of Adjustment Approval Reqd-_
A-1 L '\ -,
Review By.:
�CXX I& JTLA- -#� — — 7—
Existing Water Main Size T-
Water Main Reqd.
Service Line Reqd..
Hydrant size Existing
Pa d Per Fire Code
rIYU.L,:U L Ii *
Detector Check Meter Reqd-
cross Connection inspection
Fire Department CaT�ts
Water' Meter Charg , e Reqd.
Review by:
�tic 'rai-��.
qd.
Septic Tank Permit Re
Sanitary Sewer Availability
A""-,
Drawing No.
Side sewer Availability -M 5-;�e2
Sanitary Sewer Connection Fee Reqd.
Review By
Date:
Date:
?j.XNtddress
Map
ADB Approval-..
Size
Date:
permit No.
Proj .
File Nci--� -L�E
C)
C"
Date: 5
CD
CD
cj
ON
C\j
.. -1- - - - - W. X A
LDING DEPARTMENJ Applicant Fill
USE PERMIT
"" , 12. S_ S_ R
PERMIT APPLICATION Inside Heavy Lines
JOB
ADDRESS a /oo (0 L
NAME (OR NAME OF BUSINESS)
SUBDIVISION NO.
NAME ASSESSOR
MAP NO.
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IPLAT
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(A
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MAMING ADDRESS
A�
PUBLIC RIGHT OF WAY PER ORDINANCE
EXISTING RIGHT OF W I AY
PROPOSED RIGHT OF WAY
DEFICIENCY OF RIGHT OF WAY
CITY
ELEPHONE NUMBER
W
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NAME
h/ Ilk ��&/
STREET/UTILITY WORK REQUIRED YES ENO
PERMIT FOR WORK IN PUBLIC R/W -1 YES NO
UNDERGROUND WIRING REQUIRED WYES NO
CONNECTION TO SANITARY SEWER OYES NO
SEPTIC TANK PERMIT REQUIRED D YES SNOI
SEPTIC TANK PERMIT NO
ADDRESS
CITY
ITELEPHONE NUMBER
717r 1'2S
NA
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SEE M EMO DATED
ADDR S
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3,22
CITY
TELEPHONE NUMBER
7 2
REMARKS
CHEJKE�
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
2-2 2
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ME I IEK Si2q
BUILDING SUPPLY SIZE
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Le7gal Description of Property (Show Below or Attach Four Copies)
REMARKS
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SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADB NO.
REMARKS
VARIANCE 0 R CU
IPLANNING REVIEW BY
DATE
YARDS do / /
. ipl�� FRONT SIDE REAR
LOT COVERAGE
GAS
NEW RESIDENTIAL LINE
FIRE ZONE
TYPE OF CONSTR UCTION
HEIGHT
El NON-RESIDENTIALI 0 SIGN
ADD RETAINING
D DEMOLISH WALL
EXCAVATE FENCE
F] ALTER OR FILL
PRE -MOVE swim
0 :REPAIR El INSP. El POOL
I
I
ICODE
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SPECIAL INSPECTOR
REQUIRED
D YES D N 0
AREA
1 --1
OCCUPANCY
GROUP
—
OCCUPANT
LOAD
—
PLAN CHECKED BY THIS SITE IS LOCATED IN THE,CITY
OF EDMONDS. LOCAL SALES TAX
S HOULD BE CODED 31.04.
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
CL
W
01
PLAN CHECK FEE
VALUATION
FEE
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13
0
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PROPOSED USE
PLOT PLAN (INDICAT 14 131JILDING SET C KS
ABUTTING STR E ETS)
BUILDING
PLUMBING
MECHANICAL
>
FENCE
t
z
SIGN
RETAINING WALL
U
SWIMMING POOL
- _C'.
MEMO TO:
FROM:
SUBJECT:
0
STREET FILE ,
DATE:. �5)03) 178
Building Division
Community Development Department
Engineering Division
Public Works Department
After review of the -subject building permit application, we have
the following comments:
_(I) Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is TTTF
responsibility of the contractor.
(2) The contractor is required to keep the abutting streets clean-
ed of dirt and.deBris caused by the construction.
_(3) A"Right-of-Way Construction Permit" is required,,from the
Engineering Division of Public Works, for any work within
the Public Right -of -Way or public easement.
_(4) Driveway slope not to exceed 14%.
LJ1,Y -
ft COX4 �11 A;Nr
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W_V��x =
W-0, ov.
PW 5/77
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46LICIJOP
YS DEPAM= CHECKLO
BUILDING PERffr REVIEW.
Street Right -of -Way Existing
Access Easements Existing _A1
Utility Easement Existing —
Lot per..Subdivision
Site Plan Checked for Accuracy
REQD
all t3lE REQD
PLA Ed REQD
Plat WOOO P
LA14 AA4& Map
W.% / t
Underground Wiring Reqd.
-Check Accuracy-of*Legal Description
Envirorm-entally Sensitive Area
'Envirormiental Checklist Reqd.
Flood Hazard.Zone
aA Da te
ddress
Shoreline Management Area
Z Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Existing Zoning Per Code'.
Amenities Design Board Approval Reqd._,N=J!�_ ADB # Approval
Board of Adjustment Approval Reqd. Lin KM
Review By - IF!) Q 1",r!, Datie:
Existing Water Main Size c- r-
Water Main Reqd. Q All.
Service Line Reqd.
Hydrant Size Existing o r-_
Hydrant Reqd. Per Fire Code
Size
Detector Check Meter Reqd.
00
Cross Connection Inspection
)VO
Fire Department Cxx=ents
Water Meter Charge Reqd.
Review by: W/S
Date: Skg 1 /29
Septic T sign prove
A-44
ate:
Septic Tank Permit Reqd.
tl,4
Permit No.
Sanitary Sewer Availability
Vx--.o
Proi.
DrMfing No.
File No.
Side Sewer Availability -M!merXgqXA
L�"F_
Sanitary Sewer Connection Fee Reqd.
04,;61X_Le
Cn Review By: WIS
Date: 5J3 -7
ILK.K.
0
q)en Ditch Existing
X ?; XXX?;
Reqd..
.E:
Culvert Reqd. At
Size
P�
Catch Basin Reqd. X�
Indicate on Site Plan
Shoulder drainage mkiintain collection
on swale' open runoff en,
lu-�hole recid.
Indicate on Site Plan
Soil Conditions and Ground Water Field
Checked
Re\rie,.,7 hy�
llitee�p
sew
Street Paving Reqd. I
Curb and Cutter Reqd.
Sidewalk Reqd.
Curb Put for Driveway Reqd.
p4
Right -of -Way Construction Permit.Reqd.
Bond Reqd. for Public In-proverwnts
treet Narm Sign Reqd.
(n
Other Signing Rcqd. OKI&
Pre -Pern-Lit Site Inspection made on
0
BY: SLIZR,
I 7ATER
A
STREET
ENGINE-EP
JNG
Special Requiren-pants listed in mem to
Com=ity Development Departrmnt,
Building Division
BY 610 .
Date
o
All iteim filled in on Building Permit
Application
BY
Date- 78
P"
Drawings Stamped and Notations Made
PL4
BY JW
Date
Approved by Public Works Departim
Revised: IV 10-1977
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