21610 85TH PL W.PDFIIIIIIIIIIII
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21610 85TH PL W
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City of. Edmon.ds STREET FILE
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number.
Issue Date:
A. Address or Vicinity of Construction: 2-16-
9 0 1 9 C) B. Type of Work (be specific):
C. Contractor: _10,11*6.4n,
Mailing Address: �il
State License #: _Xal.7A" 0-?_ &V Q 4
D. Building Permit # (if applicable):
Contact: 7_290 dwAk;:� rd�u
Phone: 7_2* — 52 Z&
Liability Insurance: - Bond:$
Side Sewer Permit # (if applicable):
E. n Commercial EJ Subdivision n City Project R Utility (PUD, GTE, WNG, QEffDWATER)
F] Multi -Family E] Single Family [] Other
INSPECTOR: INSPECTOR: 1AIL-11A
F. Pavement or Concrete Cut D Yes JANo G. Size of Cut: x H. Chargq�,$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to h he City ofEdmonds har;X�fWroip
fL" *edamages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made 'n8t the City of Edmo artments or
employees, including or not limited to the defense of any legalproceedings including defe 'i6 sts, and attorney fees by reason of granting thispermit.
I I '' r f
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEA)i FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL19E__P'R&`ES��D FOR ISSI TANCE TO-THRAPP41CANT.
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.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Conirol and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched �vith asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statelft and understand thepermit requirements and thepink copy of thepermitwillbe
available on.$#"t all ti S inspytion purposes.
-00e 141) 1&7 /1 4 4 IV-,CW
Si F F, Ir-17 4%, Date:
J11ri V�w — 0, - -
(Coln, -fracror or 4ent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: A RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER, DAYS DISRUPTION FEE/FUND Ill:
SPECIAL CONDITIONS: VA RESTORAT I ION FEE:
-PERMIT FEE:
-6,
TOTAL FEE:
COMMENTS: RECEIPT FEE:
DATE: ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund Ill Route copy to Street Dept.)
Comments:
I Diagram.:
'. 1.
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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NOTICE:
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The mformation'shc)wn on the attached
Map(s) was compiled for use by the City Of
Edmonds its Employees and Consultants
Inn
y of �Edmqnds does not wa rra nt t, ie
The Cit
accuracy of anything set for.th on these
-sting a
Map(S"). Any person or entity-reque
copy should conduct an independent
inquiry regarding the Inform'ation shown on
---Fe -map(s), Including, but not limited to,
t
er stub shown. Such
the lociation of any sew
sewer stubs may or may not exist and may
or may not exist at the location shown.
nds- nor its
the City of Edmb
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em pl-o-yee-s o-r off ice,rss,ha-l-1 be Viab'Fe for t-he
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information give* .
any one representation provided based
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'EDIA' NIDS:--��SID -ISIEWER--*-"PER�,Mi'liT�,..".'*.
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-DEPARTIVIENT—,
Wxt WSMEW
'NO 41'
PERMIT 18
overing !a�y ortiow of. ;the� construction'.
Call. 7.76-1-101 for-, side sewer, inspectloris� _BEF:0RE p
(Inspection will be�,pro'vid6�,,w�ithir��2i��h6uri� �fter request., NO�'S&t_,Sum, 7,or 'holiday, Inspections.
ace', st -z.Z�)�onds,: Wa'shtngton_ -
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ADDRESS L0CAT-10N,_,0F �CONSTRUCTION...
................................................ ............ ............................................................................ ........ .........
-le owP6 rnk�
........... .................................... ........... ............... .
D ........... ..........
PROPERTY LE&AL.; ESCRIPTION..... Lrj, �3 An
......................... .........................................................
............ ..............................................................................................
.................................... ..............................................................................................
-BUI MANSEN -HOMES,......
.................... i ........... ................................. OWNER, ANWOR LDER—, ...... 1,111 ............................................................ ......................................................
Ta-n.k 0--Box 164- - -Lakb Stevens.
,-.'.',CON-T-RACT-.OR',��-14AM.�E ADDRESS ... La'ster_.'Aar .. I ........... I
................. 7 .............. ............................... 11ash. ,
.... .................................... 7 ............ z ................................ .........
�br ieon�e�tion- of a side -selVer , Ao�Ahe city sanitary sewer
sioivisgranted ................................................ 2:. for ir'
Pel June. 22 e a ari�
p
systern'Inuccordance,with, City of. Edmonds-ordinancei.
IATTE
NTION. iS.CALLED TO THE FOLLOWING:
NOTE No., I —The owners of 'the property, may obtain:,a perrnjt'.toL cons'�ruict sewer jnside:prop6rty:,iirm Amcersed Side Sewer. , Contractor" must'be emp�oyed Ao construct
a6lide sewer, in.street area. Do� not cover-any.p?itlon- 6f,isbwer before if has been -inip6cted. -
)T No.,,.2—M, I work performed In city right-Of7W&k)re S' Way'Perinit, obtainable from. the City Engineer's- office.
t , . qui�� -,an frsvasi�n; of PEI'ght-6f-
\_6TE; N6. 3'-08ta,in, full �Infoimatloh rekaxdirig Ordirsainle; il'.M00'and Aeguiaiions ko - verning �Yoiu.� get �Permit�
'NGTE� No. -4—,Top._of_side,sew�r must :have at,least 30: Inches coverage-zat -.Property- , Iine,;aisd't.12'4nchei, inside -property 41nie; minimum- grhdc o f': 2 '.No bends In -grade
,sha;,rp.er' than. -h Will be, permitted.
NOTE, No; 1�5 LTrenches In rstreet shall 'be
,,must be Water, settlea,and'-suiface,of. street restored-'. to�'briginaY "conditioh: Con tractors ior'f&I1`u�e-.`due% to Improper
wor�k�which may.develop within'one, year'Of. compl6tio.n.,
No.16LLRAs.-unlawful to�alter,or do,.any.other work- than is',provided* for jn . the� permit��'or:16,.do;Aby -work ion. the malff sewer or.'its applurte�&nces, except to in-
serf:Ahe pipe into A e Wye:
h
'DISAPPMVED, i D
U: ........ Da .............. By� ..... ..........
...................... :..�-By
. ......... ............................ ...... ............ .......... ..........
. .. ......... 7.:
............ ........................... ............................ ............. ............................................................. ............................... ....................
. ................ ....................................................... ...... .................................................................................. .......................................... .........
F6r,
—BOTH',Per-mit CopDas!MUST,P�e -.p6r-,fcrriyii,�R.,�'Coifstruction PR10R,,,To,Reque9t Inspectioir-
c.
h ih'[t
.......... re�'ycerbfy., allie:sideseWer-' allation,c6h��trttcted -Linder �Iffls- permit
_'PerformingcConstructiow),
=?e, of �ont,,cting Irm�
I -ii��Actord�heewith,:all',.gpv�ern�iig�qrdinanC63"r,6f,thd!Ci'ty. of -,EdinondS3.'.
mas4nstAl. 66-
%
. ..... �of ......... 19
APPLICATION
EDINTOINDS
for
ATIPV'� S
City, of Edmond PLANT 1
T h'e* SIDE SEWER PERMIT I FTR EAE. ta, � � . , —7
ET F ILE .................................
tv- K
)l -I REPAIRS
CONSTRUCTION
OWN
ER ......... ........ ...................... ................ ... CONTRACTOR ............ . Z
. - /-" ----- 2�� ---------------- -------------------- PER-1, T No..
ADDRESS .... /'0 J,
..... ........ LEGAL DESCRIPTION: LOT No.... ...... ........ BI..4C)CK No.
............................ . ... .......
............................
.....................................
NAME OF ADDITION., ........
-- _ 1 ....... / ... ..........................................................
R
J
u
Approved:
DATE ..... I .................. ...... .............
........... ...... ........... /