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21121 77TH PL W
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City of Edmonds
R.IGHT-OF-WAY CONSTRUCTION
� I PERMIT
a a
STREET F111
A. Address or Vicinity of Con!
B. Type of Work (be specific):
Permit Number. q4.
C. Contractor: Contact: wi/'/ L'&-s ex I
Mailing Address: !t 24 Phone: 146- 7—ZsP, 446,
StateLicenw#: Liability Insurance: 370
5rxAF feATZ;
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. K Commercial Ej Subdivision El CityProject F
] Utility (PUD, GTE, WNG, CABLE, WATER)
F1 Multi -Family E] SingleFamily F1 Other
INSPECTOR:LYI-E CMRJ�A40AI INSPECTOR:
F. Pavement or Concrete Cut: KYes []No G. Size of Cut: __4k_ x __4__ H. Chargq�_$
APPLICANT TO READ AND §1 G
INDEMNITY. Applicant understands and by his signature to this application, agrees to ho 'ty ofEdmonds har�$tVftes, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made =athe City of Edmon I epartments or
employees, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgranting thispermit.
PERIOD OF ONE YE�rl? FOL" h�Wik�( THE FINAL
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR,A L
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FV4 4L1 T PA TCH
_,BCHELD UNTIL THB�FINIL_�YR'Af
IS COMPLETED B Y CIT Y FORCES, A T WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANOE TO THE Aj-]�LICA NT.
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 -material is to be -inspected during progress and at completion.
Rte ' storation is to be in accdfAnce 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 by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end ofthe working day;
NO EXCEPTIONS.
Ihave read the abovels se�nts. npeunderstand thepermit requirements and thepink copy of thepermit will be
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available on site 9�t all/ime tion purposes.
C/1V Date:
§ignature: .74
(Contracto Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSI
TIME AUTHORIZED: VOID AFTER DAYS, DISRUPTION FEE/FUND,111:,
SPECIAL CONDITIONS: 'RESTORATION FEE:
,,PERMIT FEE:
TOTAL FEE:
COMMENTS: -RECEIPT FEE:
DATE: Sle 1194='.n ISSUED BY-
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NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991
4
FIELD INSPECTION NOTES '(Fund lil Route copy to Street Dept.)
Comments:
Diagram.:
I
N
CONTRACTOR CALLED FOR INSPECTION E] YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Dqte:-.
I \
The City of Edmonds
Water Service Drawing
�k
EASEMENTNO . ............................................
NEW CONSTRUCTION REPAIRS E) LID NO . .................. . ASMT. NO . ..................
OWNER
........ CONTRACTOR .................. _ .......................... ..................................... PERMIT NO . ....................
JOB ADDRESS.Z.1.1.2.1 ....... 77:3N ... Rt, ... wr ............. - LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
Nola.-T-4A
V, GlIPA33
77 Ir H PL. w.
PWW-0001-11/75 (REV.11/78)
V1
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C-q
Approved:
DATE 2 -2-4.-.9.4 .....
.................. .. .... . ...... By ... . ....... ............
A( ......... - --- —
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), in . cluding, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
8 90 9
VIA BALLINGER
LIIR STATION _
CITY OFEDMOND ISIRE SEWER P.E.,.R M
PERMIT N-0. 08595
Address of Construct . ion: o? 77 00;,1
Property Legal Description (Include all easements):
Owner and/or Contractor: , 4.&Emr
State License No. :n b=.,ea I-C4= Building Permit No. — 9�3 0 7�,7_
El Single F . amily Invasion into City Righ . t-of-Way:2(No El Yes
9/0M'ulti-Family (No. of Units �J RW Construction Permit No. '
0 Commercial Cross other Private Property: 0 No &/Yes
11 Public Attach legal description and copy of recorded easement
I certify that I have read and sh Y-1 comply with all city requirements
as indicated on the back of the Permit Card.
Date
* CALL DIAL -A -DIG (1-800-,424-5555) BEFORE ANY EXCAVATION *
OFFICE USE ONLY
* FOR INSPECTION CALL
Permit Fee: 3 6
Trunk Charge_ C___70 0
Assessment' Fee: q)
Uri Nr) : Z/1
PUBLIC WORKS DEPT.
Issued By
Date Issued:
Receipt No.:
-rAP r,.7-914 v�. k.
Partial Inspection: mo comm. A-T gi-Cir, Date(O-8-5+ Initiali--m—
Comments -.ad
Reason Rejected: Date Initi
Final Inspection Approved: DateS-2.4- Initial'". f
PERMIT MUST BE POSTED ON JOB SITE
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3!90
Side Sewer Drawing
The City of Edmonds EASEMENT NO - --------------------------------------------
NEW` CONSTRUCTION Fkf REPAIRS r-1 LID NO - ------------------ ASMT. NO - ------------------
OWNER-------- ------------------------------ ----------------------- --------------------------
JOB ADDRESSZ-1121 ---------- r7-7-:,,., --- PL.--w -------------------------
IN& 13z,
PWW-0001 -11/75 (REV. 11/78)
CONTRACTOR --- S-W�k-O.OW..t-A ---- NO. 85-95-
LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - -------------------------------------
--------------------------------------------------------
-------------------------------------- ...... ..........
FVIA &Z- JVG
F�rE�Lt/ �nl-
QF I �/?
POiv
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0
-H PL.
PART tN& S
Approved: 6-7-94 fk.%A.
(0-9-C)4 JR.
DATE. . ............ ---- — - ---- -------- ------------------------
STREET Fll-,-Fju��
USE
CITY OF EDMONDS ZONE PERMIT
"2,q NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT #
OWNER NAME/NAME OF BUSINESS ADDRESS 7 7-
- 7-0--- T--�� 0 IV 7-/47' LEGAL DESCRI ION7UBDIVISION NO. LID NO.
Uj MAILING ADDRESS
Z 139
AP PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP Approved
0
CITY ZIP TELEPHONE NUMBER RW Permit Required
'fe/— EXISTING — REQUIRED DEDICATION Street Use Permit Req'd 1�3
-7-9 0/ Inspection Required
NAM� 0 PROPOSED
Sidewalk Required 0
REMARKS cc
W
ADDRESS W
4aLq,-�? 7
Z
CITY ZIP [TELEPHONE NUMBER W
1 0, 0 C)'j-
6 7
,NAME
n
ENGINEERING MEMO DATED
REVIEW BY
cr ADDRESS
METER SIZE BUILDING SUPPLY SIZE
NO. OF FIXTURES
cc CITY ZIP TELEPHONE NUMBER M
/ �/-? Uj
Z
' T7 5�dt:5?0 IV 79�T — _-3 V 41 REMARKS
0
UR EXPIRATION DATE
SWE LICEW� NYM
SIGN AREA SEPA REVIEW
L A
PROPOSED COMPLETE EXEMPT DB No..
Legal Description of Property - include all easements ALLOWED -V I
T)eY CT ,A449-7 e,4 SHORELINE#
0. EXP
VARIAN PLANNING REVIEW BY DATE
CE OR cu
)6
76 cx/Y I t e
lo 2 Yt
SETBACK) — FEE I HEIGHTf LOT ZCVERAGE Z
W
'-- Y Z
FRONT SIDE / C' Z
Property REARJ-,) 45 4, <
T.. Ac..u.t 000 _6/,y 00 KtMAHAS I
Parcel No. Q.
O'NEW 2-RESIDENTIAL PLUMBING
ADDITION COMMERCIAL MECHANICAL
REMODEL �APT. BLDG. uo,
El SIGN
GRADING FENCE CHECKED TYPE OF CONSTRUCTION HEIGHT
,�AY CODE
M REPAIR CYDS. x —FT) (4) 5 1�4/ jj I
i C-6 0 1 :1L — ?/ 2-��
FIDEMOLISH WOODSTOVE SWIM POOL SPECIAL INSPECTOR AREA
INSERT 0 HOT TUB/SPA REQUIRED OCCUPANCY OCCUPANT
GARAGE 0 YES ROUP LOAD6 4
RETAINING WALL/ —IG AliRl
EICARPORT ROCKERY E] RENEWAL REMARKS
Z
0 (TYPE OF USE. BUSINE�S OR ACTIVITY) EXP� �IN: PROGRESS INSPECTIONS PER UBC 305 Z
M
NUMBER OF STORIES NUMBER OF d)
W
0 DWELLING
00 UNITS
0
DESCRIBE WORK � BE DONE (ATTACH PLOT PL I 40SMIC we 60~4V7 A�,/n /,5 C)a 9"�
lyev-- Uly I 7_ Af /W/464111 FINAL INSPECTION REOUIRED
=======I VALUATION T FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING
1
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewplks,
GRADINGIFILL
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnity, defend and hold
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
whatever nature, arising directly or Indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of an city ordinance
y
nor limit in any way the City's. ability to enforce any ordinance
provision."
ENG. INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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 with city and
state laws regulating construction; and In doing the work authoriz.
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa-
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
:e.
fNER OR GENT ATE SIG NED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
CALL FOR
INSPECTION
771-0220
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
10247
No
I t-A / U X /e'
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.
FFICIAL'S SIGNATURE DATE
1114e /i) /0/ 2- 7 /'? Z -
E "7 DATE
I.EiSE�,n,/
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor