21716 96TH AVE W.PDF111111111111
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21716 96TH AVE W
NOTICE:
Nowa r-r a n ty ... OT
Theinfor . mation'shown on the attached
MaP(S) was compiled for use by the CO 01
Edmonds/ its Empl.oyees and Consultants.
Th,.e City ofEdrn.onds does ' n ot. warrant the
accuracy of anything set for.th on t. * hese
Map(s). An . y person or entity -requesting a
copy should conduct an independent
rm'ation shown-c
Inquiry regarding the info'
-m a P (S) i including, but not hrn'ted to,
n of any sewer stub shown. Su(
the lociatio
exist and ma�,
sewer stubs may or may
or may not exist at the location shown
C-ity of Edmoind-s' nor its
Neitheir the 1_1 icers -sh-a-1.1 be 11a-b-'Fe- for th
empto-yee-s 0-r off*
information given on this map(5), nor for
any one representation provided based
upon . said map(_s').
The rify Af ;:rlmnnf4c
Water S.,,rvice Drw�,ving
EASEMENT NO . ........ .. ............. ..................
NEW CONSTRUCTION REPAIRS R(' LID NO—. ........... --ASMT. NO . ..................
OWNER ... LOA.-Off .... ffr t?
.. /j CTOR .................................................................................... PERMIT NO.
.-E-T-H ........................ ............... CONTRA
TH
JOB ADDRESS .... A.VC., ... W ...... I ........... LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
7H
NAMEOF ADDITION ............................... ............ ? .............................................................................
Approved:
te Peee
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PWW-0001-11/75 (REV. 11/78)
DATE .................... By ..........
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
FILE PERMIT
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Permit Number: —0.
ssue Date: 7-3
A. Address or Vicinity of Construction: - 21716 96 Av. W. (9317634) — .
B., Type of Work (be specific): Install New.Service
C. Contractor: Washington Mit'l. Ga
Mailing Address: 815 Mercer St. Seattle, Wn.
State License #:' 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond:
Side Sewer Permit # (if applicable):
E. E] Commercial F1 Subdivision El City Project MUtility (PUD, GTE, W.NG, CABLE, WATER)
E] Multi -Family El Single Family F1 Other
INSPECTOR: 114SPECTOR:
F. Pavement or Concrete Cut t3 Yes E]No 1 G. Size of Cut: ( x 4 Cut - H. Charge$
@d 12�2_
as i Asphalt Walk
APPLICANT TO READ A1,41VII&A al
467co
INDEMNITY. Applicant understands and by his signature to this application, agrees to hGe City of Edmonds harinles T. ini�,fnes, aumages, or
claims of . any kind or description whatsoever, foreseen or unforeen, that may be made aj'aiv the City of E . dmonds, or any of its departments or employ-
ees, including or not limited to the defins4 of any leg al proceedings including defense c I.,- N � .1 as;
'g�sj,�
.ffattorneyfees by re on - of6jran*�nf,, this peWi
7HE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR At PERIOD k OF ONE YEAR FOLLOWfJyG 7HE&NAL INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MA7EDRESTORA77 I ON FEES WILL BE HiiliVh JYIE FINAL STREET PAIC6 rS 66�f*__-3rED BY
C17Y FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required with. permit application.'
A 24. hour no$ice is required for inspection; Please 611 the Engineering Departm
Work is to be inspected during progress and at completion.
Restoration.is to be in accordance with City Codes. 771-0220
Street shall'be kept clean.at all times.
Traffic Control and Public Safety shall be in accordance with -City rSgulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the 6iid of ihe`wQrking day;
NO EXCEPTIONS.
I have read the ab ove statements and understand the_pernTirreguirements and the pink copy of the permit will be-av*ailable
on site at all timesfor inspection purposes. x. Y. T;--
Signature: Date: 6/11/93
(Contractor or Agent)
1� A Y Y "Y A Y A "Yl� rPi-I WPOYMXTYXU� WnlDlLr
FOR CITY USE ONLY
APPROVED BY: LA-0 Ilk �6v-H RIGHT OF WAY DEPosrr:
0
DATE: — ISSUED BY:
NO WORK SHALL BEGIN
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 11
6
Addendum to City of Edmonds
Right of Way .
Permit AnnIje-z*4nn
-..Submitted by: Guyla Connors
Engineering Aide
Washington Natural Gas
521-5248
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WA1&4Wq517&34
IC-4\
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N%w
WA WNG to window
NIAWater main depth
unknown
gas main
I (ZX4)CUk-T 4;r C-74,S
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Key:
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water
-g-
gas -
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sewer
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water hydrant
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water valve
815 Mercer St. (P.O. BOX 1969). Seattle, WA 99111 (206) 622-6767
Cl�(
APPLICATION
FILI: for
The City of Edmonds SIDE SEWER PERMT
NEW CONSTRUCTION F-] REPAIRS 0 EASEMENT No . ..........................................
109-03500
OwNm ............ W ... e-s.l.e_v ... S. Miller
............................................................................ CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ....... --- 9.6th.-Ave....-W . ............................................. LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAMEOF ADDITION .........................................................................................................................................
0
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................
,-,ECEIVED
10 M Ay
1996
V
CITY OF EDMONDS
ZONE
PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
jos
ADDRESS zl;7110
" 9k
UITE/APT
W
#
0 ER NAME/NAME OF BUSINESS
00, 7 tj r 0 A,,q Pj al �j Z�l &41
LEGAL DESCRIPTION
CHECK
SUBDIVISION NO.
LID NO,
D MAILIJG AWRESS
10,3 0 r
/1
PUBLIC RIGHT OF
WAY PER OFFICIAL STREET MAP.
TESCP Approved
RW Permit Required
0
0
CITY ZIP
TELEPHONE NUMBER
—;,
I
7,
EXISTING —REQUIRED
DEDICATION —
Street Use Permit Req'd
E3
j
PROPOSED
Inspection Required
Sidewalk Required
13
13
W
NAMZ
r4) _<-,rTl-�
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRVXR OUIRED
,E
'E NO 13
�1� ADDRESS
t)
REMARKS
CITYr/72 ZIP
)5 W � t2ol
16iVt
TELEPHONE NUMBER
�9y. � 02
NAME
ADDRESS
CITY
ST;4aBE
SE N - LIM A/0
Legal Description of Property - include all
Propert
Tax Account
iq olf-aq-cI2
Parcel No. -5
� f.
-
0 NEW
RESIDENTIAL
1.0
PLUMBING
ADDITION
COMMERCIAL
MECHANICAL
REMODEL
APT.BLDG.
El
SIGN
21
GRADING
E]
F�
FENCE
REPAIR
— CYDS.
X — FT)
DEMOLISH
WOODSTOVE
ETINSERT
E]
SWIM POOL
HOT TUB/SPA
GARAGE
RETAINING WALL/
C
ROCKERY
RENEWAL
�TYPE OF USE. BWINESS OR ICTIVITY) EXPLAIN:
-Sr IKe.5
I de-ja-
ENGINEERING MEMO
SIGN AREA I COMPSEPA REVIEW ADB NO.
ALLOWED I PROPOSED LETE 1EXEMPT I
I I EXP I I
VARIANCE OR CU PLANNING REVIEW BY I DATE
SETBACKS — FEET HEIGHT I LOT COVERAGE 3
Z
FRONT SIDE REAR Z
REMARKS 5
By
OCCUPANT
GR�e3
SPECIAL INSPECTOR AREA OCCUPANT
S
[RPEOUIRED 13 YES LOAD
MARKS
P pi
ROGRESS INSPECTIONS PER UBC 305
0, NUMBER
0 OF
NUMBER OF
DWELLING
CRITICAL
AREAS
00 STORIES
0
UNITS
4
NUMBER
? DESCRIBE WORK TO BE DONE (ATTACH PLOT PL6 N,
IV�5 (,., t4/,4 r,
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING
I %
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONL
GRADING/FILL
Any construction on the public domain (curbs, sidewplke,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
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
ENO. INSPECTION FEE
successors In interest, agrees to indemnify, defend and hold
2 harmless the City of Edmonds, Washington, its officials,
x 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
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
0
limit In City's to
I nor any way the ability enforce any ordinance
I
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
information given Is correct; and that I am the owner, or th.e duly
ATTENTION
APPLIL;A I IUN APPHILIVAL
authorized agent of the owner. I agree to comply with city and
THIS 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 IV State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Insurance and RCW 18.27. -
INSPECTION
acknowledged in space provided.
SIGNATURE (OWN) OR hGENT) DATE SIGNED
- / f -. //A/
DEPARTMENT
CITY OF
I
OFFIqW' UIIE .,-/0ATE
1
5-
EDMONDS
b7l 3/76
ATTENTION
CALL FOR
LodLEASEV. DATE
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND AP13ROVAL OR
771-0220
ORIGINAL — File YELLOW inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
—
CHAPTER 3.
PINK — Owner GOLD — Assessor
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102-67