21910 84TH AVE W (2).PDF111111111111
7946
21910 84TH AVE W
GITY,,O�, EDMONDS
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PER
A. eAddress or vicinity of Construction
0 Owner:
Name
Mailing Address
flEET FILE
City, S ta te, Zip Code
e Contractor:
Name
Mailing Address
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< City, State, Zip Code Telephone Number
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0. NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
0.
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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.
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.
0
F_
Permit No
Issue Date
0 Permit Issued To:_�
i I I
Type of Work to be Done:
9 Work in Connection With,:
El Sub or Plat 9. Single Family
0 Comml. / Ind. 0 Apt. Condo.
e Pavement Cut: El Yes F--1 N o
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State License Number
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 the job site for inspection purposes at all times.
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Signature: Date
Owner or Agent
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 —days
Special Conditions:
Ammendments:
Permit Fee: '*,, `-`1',' v
Security Deposit:
Receipt No.:
Fund Ill Fee:
Street Cut Dimensions
X —
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
FIELD INSPECTION NOTES (Fund 111 - Route cony to Street,T)eT)t.1)
Diagram:
Contractor called for inspection Yes NO
Work DisaPoroved By: Date: Bv: Date:
Work Approved Bv: D a t e
Inspector:
Enq. Div. December 1978
1018
REV 12179
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DATE- GRANTED
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TYPE IS-V G I N'W �N&. IROM
DATE A MOUNT-
CXTV NO'.'.", t4KE OFF POL-E
SUB�TAJION CIRCUIT �o.
DATE WORK "COMPLETED By �JFOREMAN
Stxempt NOT EXEMPT
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*PUBToIC WORKS DEPARTMENT, FOR INSPECTION CALL
775-2525 Ext. 220
SIDE SEWER PERMIT
Permit
Issue Date ZI-1) 14*
PEP -MIT MUST BE POSTED ON JOB SITE
1. Address o7w7onsmtwruc3t7oh
2. Property Legal Description (include all. easements)
3. Single Family Residence Multi -Family No. of Units
Commercial
-1k
4. Owner -and/or-BuIl-der 1---)a k �0
5. Contractor & License No. 0 (JL) M E_
6. Invasion into City Right -of -Way: No Ve 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 mikhte
construct side sewers in the public right-of-way. UnNftft to
b. The side sewer contractor assumes full repAEORE -V1%tjo0;Sch
Ickv
installation for one year.
C. Commercial establishment requires a minimuml ;§09 s�42AAZG
Ime (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% (450). 0
f. No turn in side s8wer greater than 45 (1/8obend) 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.
1. Inspection during normal working hours only. Two (2) working
days notice required.
A
DATE: ef� 3 o
'I certify that I have read
and"shall comply with the above
rJOAG VICY -1 q t�'AA
60[*
PERMIT FEE: ROVED BY: Date:
DISAPP
B Date:
CONNECTION FEE: APPROVED B&�Date�
P4
PERMIT MUST BE POSTED ON JOB SITE
The City of Edmonds Side Sewer Drawing EASEMENT NO . ............................. ..............
NEW CONSTRUCTION REPAIRS LID NO. .1�9 ..... ASMT. NO . ......
OWNER ..,DAY.id ...... FO.W --- /e.po ..................................... CONTRACTOR .....
....... .............
------------------- PERMIT NO.
JOB ADDRESS
5)
---- — ---------------------------------------- ............... LEGAL DESCRIPTION: LOT NO . ...................... ............... BLOCK NO . ........... ........................
/ - -3 q - 79 Lp4 -:$- -1
............................ ............ /.S ..................................................................................................................
6 4 . - A ve- -W
PWW-0001-11175 (REV.11/78)
NAME OF ADDITION .........................................................................
Approved:
DATE 911. 01
.i,
rBUILDING DIVISI
�PERMT APPL,CATw,O,
NAME (OR NAME OF BUSINESS)
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W ADDRESS
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NAME
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USE ERMIT
-7-Applicant Fill ZONE NUMBE
Inside Heavy Lines WREET FILE
JOB
ADDRESS
cuoy_jp�R_ LEGAL DES DIVISION SHORT SUB NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RLEPHONE NUMBER
EXISTING I�v
DSPROPOSED
tl�:7
DEFICIENCY OF RIGHT OF WAY
0
PUBLIC IMPROVEMENTS REQUIRED
�f
M
DRAINAGE IMPROVEMENTS REQUIRED
DRAINAGE PLAN REQUIRED 0
0
LEPHONE NUMBER
UNDERGROUND WIRING REQUIRED
.j
M
CONNECTION TO SANITARY SEWER
C) V-\ CA C_!r I I/JL
SEPTIC TANK PERMIT REO'D 0 NO.
ELEVATION OF PROPERTY CORNERS 0
& FOOTINGS REQ'D
TELEPHONE NUMBER
/Y 7 -X0
W�53
SEE ENGINEERING MEMO DATED
(A
NUMBER
_9 -
CITY LIMNSE NUMBER
-
CHECKED BY
of Property (Show Below or Attach Four Copies)
METER SIZE
13UILOING SUPPLY SIZE71
.3, 11
;/4
W
REMARKS
SIGN AREA
REVIEW
ADB NO.
A
ALLOWED PROPOSED
JCOMENV.
PLET q EXEMPT
REMARKS
ID=61 1
V AR 'A
VARIANCE OR CU
PLANNING REVIEW BY
.
I
DATE
I
J
—
Y D S
A 1
YARDS
2.5 FRONT -7, SIDE REAR
LOT COVERAGE
MNEW
ADD
ALTER
RESIDENTIAL
NON-RIESIDENTIA
DEMOLISH
_1 EXCAVATE
r OR FILL
GAS
LINE
SIGN
RETAINING
WALL
FENCE
, FT)
I . ")
— x—FT)
FIRE ZONE
TYPE
OF CONSTRUCTFN
Vj
CODE
HEIGHT
SP L
SPECIAL INSPECTOR
REQUIRED
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YES No
AREA
10C CUPANCY
GROUP
OCCUPANT
LOAD
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
REPAIR
PRE -MOVE
EIINSP
swim
POOL
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
Z NUMBER OF STORIES NUMBER OF REMARKS
0 DWELLING
-,jUNITS
MATURE OF WORK TO BE DOME
VI
W
0
0 NPLAN CHECK FEE
I — __ _. __ I VALUATION FEE
BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold harmless
I the City of Edmonds, Washington, its officials, employees, and
agents from any and all claims for damages of whatever nature,
x arising directly or indirectly from the issuance of this permit. Issu-
RETAINING WALL
SWIMMING POOL
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a I ance of this permit shall not be deemed to modify, waive or reduce
-j -nv renuirement of any city ordinance nor limit in any way the
DATE: /), - / �7 - 49 *
MEMO TO: Building Division
Communitv Development Department
FROM: Engineering Division
Public Works Department
SUBJECT: C,
After��evi'ew'of the subject Building Permit application, we have
the following comments:
1. Connection to City water system required.
2. -Connection to Citv sanitary sewer system required.
3. Ripht-o f-way Per mit required for any work on City pro-erty.
4, Driveway slope not to exceed 14%.
5. Backwater valve required if downstairs p1timbing is below
elevation of upst�eam manhole.
6. Water and sewer lines to be separated by 1G.foot minimum.
E
---'Signature L
Z & 0
PUBLIC WORKS DEPARI= CT1EC1<LIS`r
0
I q 40 yj 1.2- -N- OCO
(address) (date)
0
Street Right -of -Way Exist
Z
H
Access Easemmts Exist
04
Utility Easemmt Existi
lot Per Subdivision S-3�� Plat
Assessor 30
Site Plan Checked for Accur
Z
Underground Wiring Reqd.
Check Accuracy of Le 1 Description
Z
Review by
Date
Existing Water Main Size
Water Main Required NIA
Service Line Required
Hydrant Size Existing_
1:4
Hydrant Reqd Per Fire Code ' &1A
Size
Detector Check Meter Reqd.
Cross Connection Inspection &/A
Fire Departnmt Com-nents
Water Meter Charge Reqd.
Review by
Date
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.. eA
Sanitary Sewer Availability
PrOi 119 2-
Drawing No. Zcf�f :Z 7
File No. 4,,
Side Sewer Availability
Sanitary Sewer Connection FeeR�qd.
)OZ�
:2:
Review by,
Date
OV
Open Ditch Existing__ A
... L2�z_
---Reqd..
Culvert Reqd. 9"-e—
Size
c4
Catch Basin Reqd.
Indicate an Site Plan
0
Shoulder drainage maintain collection on
swale open runoff
En
Manhole reqd.
Indicate an' Site Plan
Soil Conditions and Ground Water Field Checked S4 a,,/
Review by.
Date
Revised: lv10-1977
Page 2
Street Paving Reqd.
Curb and Gutter Reqd.
Sidewalk Reqd.
Curb Cut for Driveway Reqd.
w Right-of7Way Construction Permit Reqd.
H Bond Reqd. for Public Inpravenents
to Street Name Sign Reqd.
Other Signing Reqd.
P, , Pre Permit Site Inspection made on
z
0
BY: SS%7ER
WATER
F4 Z STREET
ENGINEERING
Special Requirements listed in mew to CoT�mmity Development Departnent,
Building Division
BY Date
0 All items filled in on. Building Permit Application
BY Date
Drawings Stamped and Notations Made'
BY Date
Approved by Public Works Department
Revised: lv 10-1977
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
J PERMIT
Permit Number. 17-14- /.A
W.e Date: (�2
EET FILE
37 W
c
A. Addr§TPi inity of Construction: 91910 84MAITEMIE
B. Type of Work (be specific):
890 SERVIGE DROP FIR M
9 C) r-TR 121 AM= TRI RRHO
PED 906 AT 21908 TO 21910 84TH AVE W. SEE ATTACHED SKETCH,
C. Contractor: GTE NORTHWEST INCORPOItATED Contact: BAMAM TOLLEFSON, PEMIT- GOOP&I-NATOR
MailingAddress: 271ig ?()Tw AMp.- gy q11TTy. 13PJ'one: R-A—RE 488-1642
State License #: BOTHFu., WA 9R()? I Liability Insurance: _ Bond: $ .0
D., Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. Commercial 0 Subdivision E] City Project M1 Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family 0 Single Family Other
-7- ,,2100-9POOIDB 242310
INSPECTOR:- INSPECTOR: wt 1 Te*FFF
F. Pavement or Concrete Cut: ' []Yes PNo G. Size of Cut: x- H. Charg(�_$
APPLICANT TO READ AND SIT N
he .1
INDEMNITY. Applicant understands and by his signature to this application, agrees to ho he City ofEdmonds ha I fr u es dama es, or
-nst I
0
claims of any kind or description whatsoever, foreseen or unforeseen, that may be m I d e he City of Ed=411 A e artments or
a *nst t
employees, including or not limited to the defense of any legal proceedings including def� e osts,and attorney fees by reason 0 gran in thispermit.
. n
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS F6R ?PERIOD OF ONE YEAR 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 WILL BtPR SSED FOR ISSUANCETR T��VANT.
V q�k'l
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.
7'raffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above Istaments an understand thepermit requirements and thepink copy of thepermit will be
m
available on site at all t es_fori &sction purposes.
Signature: Date: 4/18/94
(Kntracf@rr'9ra0q&t)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments:
I Diagram.:
CONTRACTOR CALLED FOR INSPECTION YES' El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
PHONE #: � 7 4- L4
CONTRACTED:YES (9)
GTE CREW: t -el�
pERtq 7- SUBW 77ED B Y
6 rc
GTE CONSTRUCTION NOTES
B-WIRE PLACEMENT
PERL41T REQ'D: Qlb� c� LOCATE #: Tq
ROW FOOTAGE: CALL BARB 488-1642
CUSTOMER NAME: 2�,lq Ic -
pi
I
-------------- --------------------------
-----------------------------------------
OF
PDLES 0
RL7AD BORES
OV,CRHCA.D LJACS
1.10. UrILITY pahCLE
L16 rRENCHIAC
ONF [ON
ORDE*
CITY OFVJAWERLE c
CIVIC CENTER - EDMONDS, WASHINGTON 98020 - (206) 775-2525
F-1 PURCHASE REQUEST INVENTORY REQUEST WORK REQUEST
V
STREET DIVISION
E
N
D
0
VENDOR NO.
R
THIS NUMBER MUST APPEAR
ON ALL INVOICES,
PACKAGES, BILLS OF LADING
AND CORRESPONDENCE.
SHIP PREPAID TO (OR SERVICE LOCATI
REQUIRED
SHIP VIA
DOCUMENT NO.
ORDER DATE
BATCH NUM
IDATE
I
1 0 77 r" 11 /11
1 5/20/81
1
0
PLEASE FURNISH THE FOLLOWING ITEMS:
L
I
N
E
QUANTITN
UNIT
CATALOG
NUMBER
DESCRIPTION
UNIT
COST
TOTAL COST
ESTIMATED ACTUAL
STREET PATCH FOR METER
INSTALLATION
190-0
4,a
6—;2
SUBTOTAL
TAX
TOTAL AMOUNT
150.00
REQUESTED BY:
MPH
APPROVED BY:
RECEIVED BY:
E
1
CODE
411, 000. 850. 986. 01 38
PROJECT
AMOUNT
ESTIMATE ACTUAL
150.00
2
3
41
5
6
7
8
9,
10
11
1121
NO)
TOTAL AMOUNT
150.00
CITY OF EDMONDS
lil NEW
E] ADDITION
E] RETIREMENT
AS%T INFORMATION SHEET
STFILE ASSET NO. 00
ADDITION TO ASSET NO.
DESCRIPTION
A-2 -- 5 dw z
SERIAL NO.
LOCATION DEPT. NO.
,12 F,-)-o
"PURCHASE ORDER NO. —
PURCHASE ORDER DATE
COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
*PROJECT NUMBER 6e,,' 2-
PROJECT COMPLETION DATE 3 a - 6,' /
COST 4f - OR �
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST.--
"7
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT %
ACCOUNTING ONLY
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
0 G.L. ENTRY
REFERENCE
DATE
u
q VERIFIED BY
PROCESSED
BATCH NO.
INITIAL
vp)
DEPARTMENT FILE
NOTICE:
-Nb---war-ran y
The inform atio n'shown on the attached
Map(s) was compiled for use by the City Of
Edmonds" its Employees and Consultants.
Th.e City of �Edrn.qnds does not ' wa rra nt t,
accuracy of anything set forth on t * hese
Map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform-ation shown on
..___tFe -map(s), including, but not Hmited to/
th . e lociation 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-1-o-yee-s o-r office-rs sha-'H be Via.b-Fe for the
information given on this map(s), nor for
ided based
any one representation proV
upon . said map(s).