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IrV OF EDMONDS "REET FILE
COMMUNITY SERVICES DEPARTMW
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. 9 Owner:
ame
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Mailing Address, q
`P_� C,�!" \,\ n"'Nz�� I
City State Zip
B. * Contractor:
Permit No. — q D - L4 Z I
Issue Date 9- IZ-9c)
Mailing Address
City State Zip
State License Number Telephone Number
Type of Work to be Done: I _") 4- - V'7-> \011'
1-Diz 0 2iN �5 - Zn -
D. 0 Work in Connection With: El Sub or Plae... 0 Single Family 0 City Projects
0 Commercial 0_34�plijbBily- 90 Utility
E. * Pavement Cut: El Y F. Size of Cut: X
APPLICANT TO READ AND SIGN
INDEMNITY: 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, forseien or unforseen, that may
be made against the City of Edmonds or any of its departm."entg-*or,,pmployees,'Iiiicl,dding 6f hot limited to the defense
of any legal proceedings including defense costs, court costs, ana attorney fees by reason of granting this permic.
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THE CONTRACTOR IS RESPONSIBLE FqR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPEC1IbN/A-Nb/ACCEPTANCE OF THE WORK.
Estimated res toration fees'will be held until final street.patch is completed by City forces, at which time a debit or credit will be
processed for issuance to the applicant."—' 0
.e A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion. RVV
• Restoratio�n to be in accordance with City Code.
• Street to"be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must, -be patched with asphalt or City approved material.prior to end of working day;
NO EXCEPTIONS.
I understand the above and that thi§�,permit m rst'be available at the job site for inspection purposes at all times.
Signature:
D t
a e:
Owner or
mi t Must be Posted at the Job Site For Inspection Purposes
Call. DIAL -A -DIG Prior to Beginning Work
APPROVED BY: F?VS/
Time Authorized: Void after I YJFAf�
days.
Special Conditions:
PERMIT FEE: $ 3n' 7M - PU;; P-1 i 1 2-
Restoration Fee:
Receipt No.: r4r1!1nTr_n
Fund I'l I Fee: KIAIF I LLJ
Street Cut Dimensions: x
RELEASED BY: C Date!311211d INSPECTED BY
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Date
rng. Div. Much 1989
FIELD INSPECTION NOTES
7 . %
(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: —
FINAL APPROVAL BY:
Date:
Eng. Div. July 1985
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BUILDING D E P A R1%
E N T Applicant Fill
dSE PERMIT
ZONE -NUMBER
PERMIT APPL1Cfff1Qj:jn!e
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JOB
ADDR S
NAME (OR NAME OF BUS`ML`S9)!*�"
.
LEGAL. ......................... LOT AREA J.,SSUBDIVISIZON
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STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
0 41 Lot
CITY
TELEPHONE NUMBER
COMP. PLAN ST. R/W FT.' FT.
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NAME
REMAR KS
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W ADDRESS
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CH;ECKEQ_j3_Y
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TELEPHONE NU . MBER
STREET AND/OR UTILITY WORK R/W PERMIT REQUIRED
REQ'D.
C3 YES' YES �gNo
NAME
UNDERGROUND
WIRING R I EQ'D. YES '&rN 0
0: 6W Ad Al
0 ADDRESS
TYPE CONNECT 0 YES VERI BYa
ION
SANITARY. SEWER
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TELEPHONE NUMBER
P
SEPTIC SYSTEM YE S 814MIT NUMBER
APPV*O BY CITY ENG.
C3 NO
ZjCiTY
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UMBER
ICITY LICENSE NUMBER
REMAF�KS_
Below or Attach Four Copi
BUILDING SUPPLY SIZE
A
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REMARKS
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SIGN AREA
ENV. REVIEW
ALLOWED PROPOSED
COMPLETE EXEMPT
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REMARKS
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VARIANCE OR CU
PLANN ING REVIEW BY
YARDS
LO'
FRONT
SIDE REARF
F� NEW
FIRESIDENTIAL
0 GAS
LINE
FIRE ZONE TYPE OF CONSTRUCTION ICODE
NON-RESIDENTIAL
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SIGN
ADD
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DEMOLISH
RETAINING
WA LL
SPECIAL, INSPECTOR
REQUIRED
ALTER
EXCAVATE
OR FILL
FENCE
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ED YES E NO
PLAN CHECKED By
REPAIR
PRE -MOVE
INSP.
swim
POOL
REMARKS
NUMBER OF STORIES
NUMBER.OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
z PRO I POSED USE
PLAN CHE . CK
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NO.
PLOT PLAN (INDICATE BUILDING ' SETBACKS.
ABUTTING STREETS)
BUILDING
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PLUMBING
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HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING,POOL
I hereby acknowledge that I have read this application; that the in-
TOTAL. A . MOUNT DUE
formation given is correct; and that I am the owner, or the duly.author-
ized agent of the owner. I agree to comply with ciiy and state laws regu-
lading construction; and in doing the work authorizod thereby, no person
ATTENTION
will be employed in vio lation of the Labor Code of the State of Washington
THIS PERM.'IT
elating to Wo,kmen', Comperfsalion Insurance.
AUTHORIZES
NOTE: Permit Limit One Year(Except DEMOLITIONS and FILL
ONLY THE
PERMITS without conditional use permit, which shall be completed in 90
WORK NOTED.
days; MOVED -IN BUILDINGS shall be completed in six months.)
St NATU E (O�NE7 AGE DATYIG;N7E
N�,r;)d
... ... ECTION
DEPARTMENT
-
CITY OF
EDMONDS
NOTE: AKPlicAt Subject to Plan Check Fee
775-25 25.
This Permit covers work to be done on private property ONLY.
Any construction on the public domain.icurbs, sidewalks, driveways,
marquees,,etc.) will require separate permission.
ADB NO.
COVERAGE
k OCCUPANCY OCCUPANT
GROUP LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
APPLICATION APPROVAL
This application is not a permit
until signed by the Building Official or
his Deputy; and * fees are paid, and
receipt is acknowledged in space pro-
vided.
DIRECTOR*S SIGNATURE
ORIGINAL - File YELLOW Inspector
GOLD - Assessor PINK Owner
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.Ehevron
Chev ron U.S.A. Inc.
515 Market Street, San Francisco, CA 94105
Mail Address: P.O. Box 7643, San Fran6isco, CA 94120
Land Department A u�g us t 12 1977
Western Region -
Encroachment Agreement
Everett., Washington Refinery
Pt. Wells Pipeline Right of Way
Snohomish County, Washington
R/W 78021
Mr. and Mrs. Richard L. Lapinski
21825 - 95th W.
Edmonds, Washington 98020.
D'ear Mr,. and Mrs. Lapinski:
Attached, in duplicate, is an encroachment agreement which.is for the purpose of
allowing you to construct a garage and driveway on a portion of our 33-foot-wide
easement. The garageand driveway should riot extend past a line 25 feet measured
at right angles to the westerly boundary'of our 33-foot-wide easement. This should
provide sufficient s�ace_for.your proposed construction.
This agreement should be signedby both of you exactly as your nanies appear before
a'notary public so that your signatures my be ackriowledged on both copies. - Men
this has been completed, you should then return both copies of the agreement -to me
at the above-iridicated address.
As soon as I receive them, I will arrange -to secure execution on behalf of Chevron
U.S.A. Inc. and ' have the signatures acknowledged. I will then return the duplicate
copy to you and havei.the original placed of record. As soon aCs I have the full -
. recording information, I will forward it to.you. I would.have proceeded to secure
the signature for Chevron U.S.A. Inc. However, I did not have time to arrange for
this and. still get this in. the nail to you by Friday, August 12.,
In the event you have any questions concerning the form or if you wish to discuss
any of.the items, please do not hesitate -to let me k1101-T.
Very truly yours.,
W. F. Brady
WFB: fw
Enclosures
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NOTICE:,
VA
... o r-aauc-u- -r-*-.a7u-Y--' - - -
- I -
The-infor mation *shown on the attached
piled for use by the City 01
map(s) was com *
Edmonds/ its Employees and Consultants.
Th,.e City ofEdm.onds does - n ot. warrant the
accuracy of anything set for,th on t ' hese
Map(s). An . V person or entity -requesting a
copy should conduct an independent
orm'ation shown-c
inquiry regarding the infi
tTi�� a p (s), including, but not Jimited to,
n of any sewer stub shown. SU(
the lociatio
sewer stubs may or may- not exist and ma�,
t the location shown.
or may not exist a
Neltheir the City of Ec',m0*n%d4S/ nor its
e m pl-o-yee-s 0-r off rcers'shal] be 1--ia-b-1--e for th
i . nformation given on this map(5), nor for
t* Ided based
any one represe-nta ion prov
upon said map(s'.
0
-A APPLICATION
The City of Edmonds for EASEMENT NO - ------------------------------------- ......
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS LID NO . ................ .- ASMT. NO . ..................
F-L--
OWNER........ L.--V ---.5 .......................................................... CONTRACTOP - ------------------ ----------------------------------------------------------------- PERMIT NO - --------------------
JOB ADDRESS .......... LEGAL DESCRIPTION: LOT NO - --------------- 77. -------------------- BLOCK NO - ------------------- ----------------
----------------------------------------------------------------------------------------------------------------------------------------------------------------
NAME OF ADDITION ----- -------
LTa
C-4
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Approved:
DATE ... . By ......................
I IY75 .
A IF r.
-EDWO, NO'
0 S
S11D.Ev-�.MVIE
MENT
VVATEWSEWER,, DEPART
N
P RUIT 'Y
E -M
'pectionis BEFORE covering� -any Portion of the� construction.
Cail'11754525 for side sewer ns
- s after requst. NO,�Sat Sun-, 'or holiday. inspections.'
24"hour
(Inspection, will be provided, within
%
.................... . ........ ...........
......................... .......
..-...:7 .............
'OF CONSTRUCTION ..........
1'iAbDRESS,
...................
.... .....
'L�DF -PTION ......... .. ............... ........
XG�k SCRI
]�RoPE,RTV,4L
........................... .....................
............ ....................................... ...................
...............
L ..... ................... ................ .......
7 ..... ...
. .........
7Y ............ f
.,,OW ERAND/OR-BU ELDER ............ .
.......... ............. N ... . ...
..............................
................................ ..................
............ . ....... .
�CoyjRA&ijWswAME�,& ADDRESS ............
0 y. sewer,
city sanitar
9 of a side sewer 'to th
......... . .......... 1 ifo—r repair and/or connection
In W
aceblrdhnc4ew JtfirCJity of Edmonds ordinances.,
N�
'I . ��CA,i�CF,D,-TO,-,TH'-E,'�FOLLOWING:
need, Side sewer contractor. must be emplbyedl.to, construct,,
;jhsi,�r8peity may.�obtaln a permit to, c �struct sewer insIde.property,,line. A lice
"sewer. before it has beenAruipected.
*N�: �I—T ofo
T_ tqarei.' Do not cover any portion -Engineer's office*
-Way Permit o6tainable from the City'
Invasion of rUght-of
.4NOTE )No. 2t,='All�,,%�torki,pe�frjrl�ed-,in city right-Of,-WELY requires aw
't;, 'Y"'. '; C rmit.
�; ' tion,*rcgarding ordinance- 11.16 030 and Regulations governing side sewers when you get pe
!I—Obtiiij,�full�ihfdrim�. 'n6hes inside -property line: minimum grade of 2%. No bends�jn 'grade
e
iop, oi;sir';ewerl least 30 inches -coverage at pro�cky ]in and' 11 1
'NOTE!No 4` e must, have at
" '! proper
i/� will be� permitted. tors shall be responsible for failure due, to m
NOTE'No. 5.,�-Trenches' imsLree� must be water settled and, surface of street . restored to original. conditiom Contra . c
��6rk*,".,�hich�,ryiELY,develoP- Within one year of completi n,. cept to in
mIt, or to, do'. any work on the maAn sewer or Its appurten nees ex
t'0',,aIter,or*do�*any other work than is provided for, in the per
4U
:,�.-sert'th�,.',pipe,!into,jthc wye.
j3Y ................
........ Ry ....... ..... .. Date; ...................................
S Date-, .'By.... ......... . Date -
'Ea �&P
............ ................................................
my ....... ...... ........................ .
-4 --- ------------- - - I
A41PROVEb' .. n .....
...............................
X ............. ............................. ...................... M ............ .................
ar S., .........................
Rein k ................ .........
......................
................................ .......... ................. .........
.........................................
............................... ................
est For, Inspection
-To Requ.
0 er. of'Firm P�rf orming-, Construction PRIOR,
op, es: M, y,,Be Signed By WII
_e,
latiori: constrdcted:, under thi's permit I
hereby�,certif ythat the, side sewer instal
. .........
rier.;;o;f,i,�6o'nt'i;PL.,i�,gl� p irm.- e
F rm ng Construction,
ce ' t ds"
" . 1" 0 - C
a I ordin:6=6s f.the Nt� of,'Edmon
wi
e
0
...............
...............
4ay
Dated this..*. f..%
e Other�
Power; Sew r
er -TOPOone El
'Check BEFORE Y,(�u-dlglor Wa't
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT EASEMENT NO - --------------------- .....................
NEW CONSTRUCTION RE PAIRS LID NO. ------- : ----------
OWNER ..... 40. e 421 -------
CONTRACTC ---------
... .. - - - ---------------------------------- PERMIT NO.�F--±f�.A
4�
JOB ADDRESS -------------------- n - - ------ ...... LEGAL DESCRIPTION: LOT NO. -7 ----------------------------- BLOCK NO - -------------------------------------
E
........................... ------------------------------------------------------------------------ .........................................................
VED
NAME OF ADDITION,, -------------------- -------------------
Ap ft 7 971
WAS VOL
DATE............................................... By ............... .............. .................. YUYE.