215 4TH AVE N.PDFlill 11111111
5023
215 4TH AVE N
S ;;tET:.FlLE APPLICATION
for
The City of Edmonds SEDE SEWER PERMT EASEMENT No . ..........................................
NNW CONSTRUCTION E) REPAIRS r-1
114-00700
Harry J. Eicks CONTRACTOR ............................................................. ... ................................ PERMIT No . ......................
OWNER .......... ........ .............................................................. -------------------------
ADDRESS ....... �_;L5 N ............ I .......
.......................... ..........
0
LEGAL DESCRIPTION: LOT No . ............................ ................. BLOCK No . .................. .........................
NAMEOF ADDITION .........................................................................................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By .......................................... ...........................
Water Service Drawing
The City of Edmonds EASEMENT NO . ............................................
NEW CONMUCTION 0 REPAIRS IN LID NO . .................. . ASMT. NO . ..................
OWNER ...... !��PMOA/D.0 COA�, ..................... CONTRACTOR .......................................... r-rmIT NO. fep..O.y
..................................................
JOB ADDRESS .... Z. 1.57 .... � ............................. LEGAL DESCRIPTION: LOT,.N0 . ............ ......................... BLOCK NO . ........................ ...........
.... . ...... .... ...... ........... .....
NAMEOF ADDITION ..: ...... .................... .......................................................................................
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Approved:
PWW-0001-11175(REV.11178) ;ATE ...... .............. B,
.............. ....... , —, W, *'*** *"*'*
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CiFy—oT Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number-.
LssueDate:,2/_1_
A. Address or Vicinity of Construction:
B. Type of Work (be specific): AsoLLI 4't"J'
C. Contractor: . <�4;�� t-163-11 Contact—te44-l",
Mailing Address:V
.z-a-,7 Phone: -7 -7 :??2
State License #: Uc C to / M Liability Inslurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicab le):
E. F-1 Commercial E] Subdivision
EJ Multi -Family E] SingleFamiIy
INSPECTOR:
F. Pavement or Concrete Cut: 0 Yes
n City Project 't-11
E] Other
INSPECTOR:
No G. Size of Cut:
y (PUD, GTE, WNG, CABLE, WATER)
x H. ChargE�_$
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany
kind or description whatsoever, foreseen or unforeseen, that ma ' y be made against the City of Edmonds, or any of its departments or
employees, includingornot limitedto the defense ofany legal proceedings including dc.fense costs and atforneyfees byreason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIPAND MATERIALS FORA PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings of proposed work re�uired 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.
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 by the City Engineer.
All street cut trench work shall be patched with asphalt or Cityapproved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will..be
available on site at all #fizesfor jWpection purposes.
Signature:
Date
�u
CALL DIAL -A -DIG PRIOR TO BEGINNING
FOR CITY USE ONLY
APPROVED -BY:
TIME AUTHORIZED: vorD AFTER j::1 (-4, 9R DAYS
RIGHT OF WAY FEE:
DISRUPTION FEE/FUND I 11:
WORK
SPECIAL CONDITIONS: RESTORATION FEE:
)E "MA 0 -2 160!J i2i, I el via ro-el V T OTAL FEE: 3� D
RECEIPT NO.:
A Jg, 4qa4,*1i tj
'A 1k; C�Iew;4 ISSUED BY
NO WOPLK SHALL BEGIN PRIOR TO PERMIT ISSUANCE . Eng, Div 1997
flora_ 40�
CITY OF EDMONDS
USE PERMIT 9 r7
ZONE NUMBER .09-07—
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT #
ADDRESS q.77f, AVC IVOILrH
OWNER NAME/NAME OF BUSINESS
a:
F,---I> "zon �-o
LEGAL DESCRIPTION CHECKI
SUBDIVISION NO.
LID NO.
w
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MAILING ADDRESS I
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0
C
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved 0
CITY ZIP,
TELEPHONE NUMBER
EXISTING REOUIRED DEDICATION
PROPOSE
RW Permit Required 13
Street Use Permit Req*d 0
Inspection Required )t
NAME
Sidewalk Required 0
METER SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 11
0
wo
ADDRESS
REMARKS
cr
CITY ZIP
TELEPHONE NUMBER
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NAME
2 C-9
ADDRESS
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0
'�5c) 7 -56&t-
ENGINEERING MEMO DATED 51 _-7, 1 1 RTIEWEDBY
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CITY P
TELEPHONE NUMBER
IRE MEMO DATED REVIEWED BY
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0
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0
STATE LICENSE NUMBER EXPIRAT ON DATE
5/:�Clr 14/ ( (I / 01 f" 7; 9
VARIANCE OR CU
ADB#
1111A
M"RELINE III
Legal Description of Property - include all easements
SEPA REVIEW
SIGN AREA
HEIGHT
Z
COMPLETE I EXEMPT
ALLOWED I PROPOSED
ALLOWED 1PROPOSED
Q.
cc
EXP
LOT COVERAGE
REQUIRED SETBACKS,(FT.)
PROPOSED SETBACKS (FT.)
uj
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
0
Z
Z
5
Lu
Property
Tax Account
o
LOT AREA
PUNNING REVIEW BY
DATE
IL
Parcel No. ___1-24,--t
1:1 W
REMARKS
NEW RESIDENTIAL PLUMBING(MECH
1:1 ADDITION E] COMPLIANCE OR
COMMERCIAL CHANGE OF USE
'9
624 t76 10 6 A 0, /0, 0/0 404exej- 4V
FA 01" /9 0 in Ife V
APT. BLDG.
REMODEL SIGN
CHECKED BY TYPN OF CONSTRUCTION
11�Ww6
CODE
OCCUP I ANT I I
GRCV*
GRADING FENCE
REPAIR CYDS. x _FT)
C?
'ey
1-7
3
WOODSTOVE
EIDEMOLISH SWIM POOL
1:1 INSERT HOT TUB/SPA
SPECIAL INSPECTOR
AREA
OCCUPANT
GARAGE RETAINING WALL/ ge' ?0aggp 10
CARPORT
REQUIRED
F
LOAD
-
REMARKS
ROCKERY I -IN ft
PROGRESS INSPECTIONS PER UBC 108
CD
(TYP�- F USE. BUSINESS OR ACTIVITY) EXPLAIN:
�j i Le X,
0
Ed
W
4F, t�e
0�111t k 7
NUMBER
NUMBER 0 F
CRITICAL
a
W
OF
STORIES
DWELLING
UNITS Z
AREAS
NUMBER
4rye,'A�l e�EOA-t_
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
0e__4 0 It 4,4
1164rl� IL C�l uc_.
INAL INSPECTION REQUIRED
VALUATION
FEE
7 6 iv
CK FEE
i37e
loo
HEAT SOURCE:
GLAZING
V LA
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGWILL
Any construction on the public domain (curbs, sidewolks,
STATE SURCHARGE
driveways, marquees, etc.) will require separ ate permission.
Permit A6plication: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
,n
successors in interest, agrees to indemnify, defend and hold
20
harmless the City of Edmonds, Washington, its officials,
2
employees, and agents from any and all claims for damages of
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whatever nature, arising directly or indirectly from the issuance
:r
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
a
,
modify, waive or reduce any requirement of any city ordinance
TOTAL AMOUNT DUE
ZV
0
r
nor limit in any way the City's ability to enforce any ordinance
provision."
1 &'521
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and T . HIS PERMIT
state laws regulating construction; and in doing the work authoriz- AUTHORIZES This application is not a permit until
ed thereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance aria RPW 18.27. 1 NSPECTION acknowledged in space provided.
S,IGNfTYRE (OWNER OK AGENT) DATE SIGNED DEPARTMENT 4.
OFFICIAL'S SIGNATURE 0 TE
CITY OF
EDMONDS
Z34
CALL FOR DATE
ATTENfl-014
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION Hj(S BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
771-0220
.A CERTIFICATE 00'-OC66PANCY HAS BEEN GRANTED. UBC
SECTION 109
....4 PINK — Owner GOLD � Assessor
n-1-
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number.
Lssue Date:aek
------- A. Address or Vicinity of Construction: A/ -
/,7 C. B. . Type of Work (be specific): Aso4,C1.
C. Contractor: 06-ri— Contact: sp;o
Mailing Address:SQ7 &r_tc_ _C-r-. Phone: ZOd'J-7 -7
State License #: S,64�10_ Uc C (19 1 Al P Liability Insurance: Bond:$.
D. Building Permit # (if applicable):q.7_0ZX2Z. Side Sewer Permit # (if applicable):
E. F] Commercial [J Subdivision 4
I n Multi -Family E] Single Family
INSPECTOR:
F. Pavement or Concrete Cut: 0 Yes �'— No
Ai
El City Project
E] Other
INSPECTOR:
E] !`tii]�'y (PUD, GTE, WNG, CABLE, WATER)
G. Size of Cut: x H. Chargq�,$
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany
kind or description whatsoever' i'foreseen or unforeseen, that may be made against 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 and attorneyfees by reason of granting this permit. .
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WIIL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT
Two sets of construction drawings 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.
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 by' the City Engineer.
All street cut trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO,EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will.be
available on site at al esfor i ection purposes.
I A W-11 -
Signature:
(Go tractor or.
CALL �IAL-A-
Date: hvrl
PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: -6 Wa I ---
TIME AUTHORIZED: VOID AFTER _nL(A-_aT DAYS
RIGHT OF WAY FEE:.
DISRUPTION FEE/FUND I 11:
SPECIAL CONDITIONS: RESTORATION FEE: .0"�
!!Me a APM S ko&-id L T OTAL FEE: -3,0
A d - 4Qm:fi,a!i S �J S W: �Ie tqi4-t&4 RECEIPT NO.:_105,924
i V AAA, +t',Pqd Qfieg. (V9 5F) ISSUED BY: A
NO W6Rk SHALL BEGIN PRIOR TOPERMIT ISSUANCE Eng, Div 1997
'71 "M
t
FIELD INSPECTION NOTES (Fund 111 -.Route copy to Street Dept.)
Comrhenfs:
CONTRACTOR CALLED FOR INSPECTION YES El NO
Partial Work Inspection by.P.W.:
Work Disapproved By: Date:,
FINAL APPROVAL BY- Date:
E/zo/'i-7
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APPROVED
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9 0 - 1 9
City -of Edmonds
RIGHT-OF-WAY CONSTRUCTION.'
PERMIT Permit Number:
, /
Issue Dat e: '2 1
A. Address or Vici I nity of Construction: 215 & 217 4 Ay N (9428793 & 94287�4)
B. Type of Work �be specific): Install New Service
C. Contractor: Ya§hington NarnrAl Gag rnmpany_
MailingAddress: 815 Mercer St, Seattle, WA
State License #: 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 794-9978
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. n Commercial F1 Subdivision EJ City Project 3] Utility (PUD, GTE, WNG, CABLE, WATER)
[] Multi -Family F] Single Family [:] Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: [I Yes [j3No G. Size of Cut: x H. Chargq�_$
APPLICANT TO READ AND_! N
-7
INDEMNITY. Applicant understands and by his signature to this application, agrees to hol Yt(hl ityofEdm ndsharm, C, 7r -mlt(niurte5lafages, or
t
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made agai t the City of Edmonds, or any of its departments or
employees, including or not limited to the defense of any legal proceedings including defense costsfJnd attorney fees by reason'of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALSFOR ATERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATIO KE_� INABE HELD UNTIL THk_k,*,Cf�S?T1WT PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing qfproposed 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.
Res'to*ration 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 �vith,City regulations as required by the City Efigineer.
All street cut ditches shall be patched with asphalt or City approved material prior t6 the end c�fthe working day;
NO EXCEPTIONS.
I ha ve read the above s tatements and unders tand the permit req uirements and the pink copy of thepermit will be
available on site- at all m_$.f
�i�` or inspection purposes.
Signature: 'f�_1_1,1,4 L54 /,
4�7, , Date: September 15, 1994
(NWir-Actor"Or VeWFT"�'-
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME AUTHORIZED": VOID AFTER I NFAIL DAYS
SPECIAL CONDITIONS: bJ A=
COMMENTS:
DATE:
TOTAL FEE:
RECEIPT FEE:
ISSUED BY:
Mn WnPU QT-TAT.T. 1Pt1W-_TN P1?.TO_R. TO PERMIT I9SUANCE
rnlTg. MV. M11
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments:
I Diagram 1:
CONTRACTOR CALLED FOR INSPECTION El YES 0 NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
W-121
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gas 3main
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gar- . -
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Wa.tc-,-.- V�Llve
?JS )AcrcaSt' (F SMI (206)622--�767
WRITE IT... DONYT SAY ITI
a hln� WNG 021.2 S (4/89) O.A.P. 040.1 & 865.3
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September 15, 1994_ To Roy Whitcutt
Date
From Sherri Lang Subject JOB# 9428793 & 9428794
REFERENCE: (Contract No. or I.R. No.) ADDRESS: 215 & 217 4 Av N.
Your assistance in expediting this permit application would be
greativ aDDreciated.
Thank You
622-6767 ext. 2589
Route & File