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21630 84TH AVE W
CITY OF EDMONDS
STREET FILE ASSET INFORMATION SHEET
@ NEW
ADDITION
RETIREMENT
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
Aje-j
SERIAL NO.
LOCATION 2r6 3o q 7cl, A wd DEPT. NO.
"PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
*PROJECTNUMBER bjgT--T� 3/
PROJECT COMPLETION DATE / 2-- 31 -
COST 3,9 S - :::,a
B.A.R.S. ACCOUNT NO. 3 V,5- -
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT -
0 G.L. ENTRY
REFERENCE
DATE
VERIFIED BY
PROCESSED
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INITIAL
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DEPARTMENT FILE
CITY OF EDMONDS
Permit No.
PUBLIC WORKS DEPARTMENT,
RIGHT OF CONSTRUCTION
Issue Date
FIL
- -'WAY
L
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A. *Address or vicinity of Construction
9 P�rmit Issued To:
14 164-068,4
Owner: H-a&bJ_t=CX1 _14af-11r.0
Qn, Work to be Done:
Type of
Name
LISWI 14,enq Servia�
805 1�6 AV 12,'
Mailing Address
'Work in Connection With:
0
Sub or Plat
Single Family
WASh pc�tnn
City, State,
98Uf)7i 0 Comml. / Ind. 0
Zipt"'
ode Pavement Cut'.
Apt. Condo.
Yes El No
Contractor: �3-_A*� kxJyP_
Na e
Mailing Address State License Number
City, State, Zip Code Telephone Number
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
>.,
B.APPLICANT D 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
2
Proceedings including clefense,costs, court costs, and attorney fees by reason of grand this � permit.
fig,
U
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
.7
following the final inspection and. acceptance, of the restoration by the Engi 0S,Dtvision.
neets
s
Funds held from the Security Deposit (estimated re'toration fee) will beJhcId until the final street patch is c leted, at
OMP
which time a debit or credit will be process,ed.for issuanct to' the applicant,
Work is to be inspected, Restoration to be in accordance with City Code. Traffic ControLto be, in accordance with Traffic'
Section of City Code. Street to' be kept clean at all times., A 24 - hour no- ed for inspection by Engineering. call
tice is requir
775-2525, extension 220.
I understand that this �Derrni e availi I be,job 'it for'inspection p al
urposes at I times.
nX
Sigr 3
iature. :r, Date, JM4 1, 4 1 9;�4:;Z
Own or Age
THIS PERMIT,��MUST B)POSTE AT THE JOB SIT FORINSPECTION PURPOSES
CALL DIAL - DIG PRIOR, To BEGINNING WORK
C. Issued By: Ar Permit Fee;—
>-
Time Authorized: Void after day's Security'Deposit:
Z
Special Conditions: Receipt No.:
Fund I Fee,
Arnimendments, Street Cut Dimensions
X
NOW ORK" TO BEGIN PRIOR TO PERMIT ISSUANCE
F ng,
FIELD INSPECTION NOTES (Fund 111 - Route cony to Street Dent.
rnmmoni-q-
Diagram:
40
Contractor called for inspection Yes No
work Disa.pproved Bv: Date: Bv: Date:
Work Apuroved Bv: v A -1 2
Inspector: F
Encr. Div. December 1978
CITY OF EDMONDS SITH5
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Construction
L
Owner:
Name
Mailing Address
City, State, Zip Code
Contractor: —
Name
2, <_7
Mailing Address
Permit No.
Issue Date
0 Permit Issued To::P`�—
• Type of Work to be Done: J
• Work in Connection With:
El Sub or Plat I Single Family
El Comml. / Ind. El , Apt. Condo.
• Pavement Cut: 0 Yes
State License umber
-4-
City, State, Zip Code 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
:Z proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
0
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.
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0
A�
2
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 per it must be available at thrj
-9b site for inspection purposes at all times.
Signature:'-,-,,.
ate
Owner or�A
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
TimeAuthorized: Voidafter
days
Special Conditions:
Ammendments
Permit Fee:
Security Deposit:
Receipt No.:
Fund 111 Fee:
Street Cut Dimensions
- X
9
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng, Div. December w8
FIELD INSPECTION NOTES (Fund 111 - Route cony to Street Dent.
O�Mm�"* 0 -
Diagram:
Contractor called for inspection., Yes No
Work DisaPproved By: Date: �p Bv- Date:
Work Approved By-- Date: 19, -
Inspector:.
Enq. Div. December 1978
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CITY OF EDMONDS W-mitNo. 3;k-1-702-
PUBLIC WORKS DEPARTMENT D Issue Date
RIGHT - OF - WAY CONSTRUCTION PER�l = FUE
A. *A ress or vicinity of Construction
r14
0 Owner: t>"Z2,61140
Name
11 W
Maili
-aAddress
16CRMO \M A '90
City, S ta te, Zip Code
e Contractor:
Name '
I'll 0 P-3 14 v C91
ail� I
C41 State, Zip Code
0 Permit Issued To:?OP
e Type of Work to be Done: C14 R /W 11
Work in Connection With:
El Sub or Plat -:�< Single Family
0 Comml. / Ind. 0 Apt. Con�q.
e Pavement Cut: 0 Yes <��o
State License Number
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, of 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
I
Signature:
it must be availible at thkob site for inspection purposes at all times.
Owner
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By: q1 Permit Fee:* 30, 0 0
Time Authorized: Void after S�.nU days
Special Conditions:
Ammendments:
Security Deposit:
Receipt No.: -
Fund Ill Fee:
Street Cut Dimensions
X —
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. Dccember 1978
!�.ITY OF EDMONDS
0 FOR INSPECTION CALL Permit 680
PUB "§tff T
P A
to 775-2525 Ext. 220 Issu6fDate
P E. IL
PERMIT MUST BE POSTED ON JOB SITE
1 . Address of Construction2_1 -2
(9 (�j
2. Property Legal Description (include all easements)
b� (01n (R2 0 Mr,2
3. Single Famiti�y j Residence Multi -Family No. of Units
Commercial
4. Owner and/or Builder
5. Contractor & License
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 FOLLOWT,.NG AND SIGN:
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 publici right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
c. Commercial establishment 'requires 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% (45'). 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 1001 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. I
1. Inspection during normal working hours only. Tv�o (2) work ing
days notice required.
DATE: -,4 It _Xtt
I certify that I havd,read
and shall comply Wit� the above
V
F P ERMIT FEE: OC) DISAPPROVED BY: Date:
0 By: Date:
CdNNE'CTI ON' FEE: _���Date:./ 77;
'i.00 APPROVED By�_,
PERMIT MUST BE POSTED ON JOB SITE
41
Side Sewer Drawi EDMON&g
The City of Edmonds
.,EASEMENT NO . ............................................
NEW CONSTRUCTION REPAIRS C3 LID NO . .................. . ASMT. NO.
OWNER ... A4 ....... 14/t..`/*/"/.a,.--.n.s ........ CONTRACTOR ...... C�� ...... .............. PERMIT NO.
................
JOB ADDRESS ....
............................ LEGAL DESCRIPTION: LOT No . ...................................... BLOCK NO . .....................................
0
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I/ .I FV . (-
4(
....................................................................................................................................................................
NAME OF ADDITION
Jr 41
� A/, 511,
Approved-
rWW-000 1 .11175 (R EV. 11178)
DATE
/* .. /
Al2
....................................
00
STREET FILE
3 . 0 -
RENTON CONCRETE PRODUCTS, INC. P.O. BOX 917 - 7th & RAINIER - RENTON, WASH. 98055 - (206) 255-1521
May 28, 1982
Butch Phillips
SHERSTAD & WILLIAMS
11250 Kirkland Way
Kirklandq WA 98033
Dear Mr. Phillips:
This letter is to certify that the Renton
Concrete Products #577 Vault and Cover meet
or exceed the H-20 loading specifications,
See attached calculations.
If we can be of further assistance feel
free to call on us.
Sinc rely,
Deanne Erickson
DE/1 j
Enclosure
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