21829 80TH AVE W.PDF111111111111
7206
21829 80TH AVE W
Z
1�
U
�:i
0
U
Z
0
0
1,
CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
RIGHJ�,, OF - WAY CONSTRUCTION PERM5TREET " LE
A. *Address or vic nity of Construction
1% 11 7., ,�
I k k -4 ("', A 2,J
Owner:
Name
1� ell
Mailing Address
City, State, Zip Code
0 Contractor:P ZA. 0.* 1 ��i -",A. Co
Name
f4\ D u
Mailing Address
�- - 0 -�J,w b 9
City, State, Zip Code
emit No.
Issue Date --2
Permit Issued To:
( - I\ " ', -\ -
Type of Work to be Done: 'T
Work in Connection With:
11 Sub or Plat *9 Single Family
0 Comml. / Ina. 1E] Apt. Condo.
0 Pavement Cut: 0 Yes . El No
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, 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
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 permit must. be available at
Signature: f A.& Jfjf'1�0
Owner or Agent v
job site for inspection purposes at all times.
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Vold after -qe-j days
Special Conditions:
Ammendments:
— e) 0
Permit Fee:
Security Deposit:
Receipt No.: .
Fund III Fee:
Street Cut Dimensions
X -
* * NO. WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
Enq. Div. December 1978
STREET FILE 0
IMPORTANT! . Press Firmly While Writing Application!
Applicant Fill PERMIT M
Building Relocation Perm7slde Heavy Lines NUMBER
it a I
OW ER'S NAME NEW SITE ADDRESS
177-S
MOVING CONTRACTOR
c) 14 _� t" C
STREET ADDRESS
CITY & ZONE TEL. NO
EDMONDS PRE -MOVE
INSPECTION
PERMIT NO.
FIRE BLDG. PERMIT NO.
ZONE 1 2 3 FOR WORK
AT NEW SITE
MOVE CONTRACTOR'S INSURANCE COVERAGE
NAME OF SURETY
PROVIDING P.L. &
P.D. COVERAGE
CONTRACTOR'S
CITY, ZONE & STATE
STATE
LICENSE NO.
CITY BUSINESS
LICENSE NO.
VALID INSURANCE POLICY CHECKED BY:
DATE
SITE DESCRIPTION
ADDRESS OF PRESENT BUILDING SITE
BUILDING DESCRIPTION
Legal Description of Present Bldg. Site (Show below or attach four. copies)
DES;C7E BASICCO STRUCTION & PRESENT USE OF BUILDING:
OVERALL LENGTH OF B UILDING: FT.
ADDRESS OF NEW BUILDING SfjLE
HEIGHT AS LOADED
WIDTH AS LOADED
BLDG. AREA
FT.
SQ. FT.
Legal Description of New fildg. Site (Show below or attach four copies) 64
POLICE VING ROUTE
DATE
U
By:
Time to Commence Moving: ./V.!r_ 0 /�11 I; tr ..................... .
16
ING ROUTE
_; ,
'741,
/;�
. Time to Finish Moving: OX .......... .........
FIRE DEPARTMENT CLEARANCE OF ROUTING
By:
DA
ENGINEERING CLEARANCE DATE
RELOCATION REC-1 1 140.
PERMIT
CLEARED -BY:
Power Compan)?"E�
Telephone Companyk� -7-
FEE
4/ (-) y // , 'S '7'/'-'T �- ,
I hereby acknowledge that I have read this application; that
the information given is correct; and that I am the owner, a
duly licensed moving contractor, or the authorized agent of one
of these I agree to comply with city and state laws regulating
building relocation; and in doing this work, no person will be
employed in violation of the Labor.Code, State of Washington
relating to Workmen's Compensation Insurance.
Signature of Owner,
Contractor or
Authorized' Agent 74/ .... ... .......................
Signer's 611 Phone
Add ress
................................................. �� 0 . ..................................
City.......... :�� ...................... .......................... ...... ....... ......... ..................
7,�7
Date ............ I
ATTENTION:
PERMIT APPROVAL
THIS PERMIT
THIS PERMIT DOES NOT BECOME
AUTHORIZES
VALID UNTIL SIGNED BY THE
ONLY THE
BUILDING OFFICIAL OR HIS DEPU-
RELOCATION
TY, THE FEES ARE PAID, AND RE -
CEIPT IS ACKNOWLEDGED IN THE
OF THE
SPACE PROVIDED
BUILDING
NOTED
By........................................................ : ............
Director's Signature
BUILDING
INSPECTION
DEPART31ENT
Date................................................................
CITY OF
EDMONDS
DISTRIBUTION OF COPIES
PR 6-1107
WHITE — File (Bldg. Dept.)
YELLOW — Move Inspector
GREEN — Assessor
GOLDh,'NROD'--- PoliCe Dept.
PINK -- Moving Contractor
FILE
Lo
f�Ce L
on
L4-
I
(lf4!,,
ul
cyl
off,
r.,
IT
0 ut
h
Z- 07 07 A51 0 1,,i�
Ic 1/a
(A IV
0
Z/-� 6
J.
�or
APPLICAVON
The City of Edmonds for EASEMENT NO - ----- -------------------- .................
SIDE SEWER PERMIT
NENV CONSTRUCTION REPAIRS LID NO. Y�!)2 - ------ AS,'L\TT. NO.
ES, C> C2)
OWNER ..WN ------- -'V -- ---------- ------------------------------------ -------------------- CONTRACTOR --------------- -- PERMIT NO. I ..................
74 P"�- - \N' NO - -------------- .....................
JOB ADDRESS .... ... E��P ........................ ................. LEGAL DESCRIPTION: LOT NO . . ............................. ...... BLOCK
SnL-1-TH -?E>' (nv= �-(O-Vs -J, 4 �c)
..... ..................... ....................................................................................................... ---------------------------
NAME OF ADDITION
.. ................................ ...................................................................................
22�
Approved:
DATE ..... /6�W- B) - .....................
-------- ll��
The City of Edmonds
OWNER
JOB ADDRESS ---
.7vro�?,
-?-? - ---------
APPL"Tl()N
for
SWE SEWElt PEItMff EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION n---'REPAIRS E] LID NO. /-/lK -------- - ASMT. NO. 9:q ------
r-/Pl --------- CONTRA7CTOR ------- --- - - - -- ------------- ----------- PERMIT NO.
To 01 , �4 � --------------
DESCRIPTION: LOT NO. ---------------------------------- BLOCK NO . .....
........ .. .... -le� --------- RAO ---------------------------------------- ----------------------------
4 Y- ----
NAME OF ADDITION -#Aael-
0
Approv-d:
u
im
RECEIVED
OV 2 5 19.74
DATE-------------- ............................. By
NOTICE:
No warranty of accuracy..
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
fh-e -map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may'not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
emp-l-o-yees or offiCer-s-) 'shall be liab-11--e for the
information given on this map(s), nor for
any one representation provided based
upon'said map(s).
j
CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
Call 775-2525 for side sewer inspections BEFORE covering any Portion of the construction.
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.)
ADDRESS LOCATION OF CONSTRUCTION ...... 2"I�.;2LI 1'�Zst
............................ .......................................................................... . .......................................................
PROPERTY LEGAL DESCRIPTION ----- 11'.� .... fQ e f L 0 1: S 10, 'Firck 2. lladlc
.... I ......................... ... i ....................................................... v.'.s ... i: ...................................
.................................................. . ................................................................................................. . .............. . ................................... ..................................................
................................................................ OWNER AND/OR BUILDER ---
............. ti.�! ..... ................................... .......................................................
............................... ................................... .....
CONTRACTOWS NAME & ADDRESS ... RIA5.5 ... jC-"i�IsOii iol 1�pJdFle- Road, Edizi�ds , �:
,- -V ------------------------------------- ...................................................
I iission is granted ---------
------ - --------------- 1 19.1�_, for repair and/or connection of a side sewer to the city sanitary sewer
4i Yn in accordance with City of Edmondi-s-oirdinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer inside Property line* A licensed Side Sewer . Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer hefore it has been inspected .
NOTE No. '2—All work Performed in city right-of-way requires an Invasion of Right -of -Way permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain full information regarding ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%. No bends in grade
sharper than % will be permitted.
NOTE No. 5—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6--It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the maAn sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED E] Date / ------- 2 ............ - ------ Date ------------ BY -------_------ Date .......................... By
-- -- ---- --
--------- ----------------
APPROVED 51 1�
Date ------ -- -------- �01
... . .... BY --------
Remarks: ...........................
................ . ...................................... .................
------------------ . ...................................................................
.......................... ------------- ------- - --- ----- 41 -------- I ----------- --------------------------- -------------- ------------------------------------------------------------- -------------------------------------------------------
BO , P it , C ie )Ie,��ed By Owner of Firm Performing Construction PRIOR To Request For Inspection
I .. .. ............. .... --- - - ---- .................... ................. ... I hereby certify that the side s ewer installation constructed under this permit
Owner of ntra ing Fi Perfcr i g Construction)
wa— Inst e in ac danc withal g ning ordinances of the City of Edmonds.
Dated this.,;2-�C ........... day of.
........................................ 1 19.1..
Check BEFORE you dig for: Water E], Gas 0, Telephone E], Power E], Sewer E], Other E] V -V