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21915 96TH AVE W
ADDR-E I SS: Ve. W,
TAX ACCOUNTIPARCEL NUMBER: 3-7 3 (p C)0-7' 0 0 0 (.Oo
BUILDING PERMIT (NEW STRUCTURE): L3ddAa&6 q(,�R5 [9-77-0138
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: 0 Conditionat Waiver F] Study Required F] Waiver
DISCRET - [ONARY PERMIT #'S: QCJ a - C)OO�73<6- (oq (C A Wd-rl�6k 61CIR F
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DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER): �Q (FM lqqz-oz K6)
20OLe- ll<�-cd Woodjz�)lle)
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: In / / /
SEWER LID FEE
LID #:
SHORT PLAT FILE:,?)e-
LOT:
(P BLOCK:
SIDE SEWER AS BUILT DATED:
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SIDE SEWER PERMIT(S).#: 5-1,9 -7
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:-
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C I T Y 0 F E D M 0 N D S
- PUBLIC WORKS DEPARTMW -
Routing of or Subdivision Applications
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Proposed Property Address: 19 5 2 5
DEPARTMENr
CONWNrS
-TN-ITIAL
& DATE
W A T E R
S E W E R
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B U I L D I N G
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P L A N N I N G
ADDITIONAL INFORMATION:
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B-0 I LDI NG DEPARTMENO Applicant Fill
Inside Heavy Lines
PERMIT APPLICATION
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USE PER MIT
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FAAILING ADDRESS
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COVERAGE
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TELEPHONE NUMBER
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ISTATE LICENSE NUMBER
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STREET'AND/OR UTILIT Y WORK
R E Q'D. DYES 0 N 0
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El REPA . IR INSP. El POOL
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TYPE OF CONSTRUCTION. 1CODE
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SPECIAL INSPECTOR JAREA
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YES 0 N 0
CUPANCY
GROUP
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OCCUPANT
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iu-
REMARKS
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IIUN113ER OF STORIES __JNUMBER
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NATURE OF WORK TO BE DONE
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7 (s.) ror" V FILE
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CITY (;LEEDM0NDS
USE PERMIT
ZONE NUMBER 94 0904
LIS —8
CONSTRUCTION PERMIT APPLICATION
0 OF BUSINESS
NAME/NAME
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LEGAL DESCRIPTION CHECKTESUSDIVISION
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LID NO.
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MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved 0
CITY ZIP
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TELEPHONE NUMBER
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EXISTING — REQUIRED DEDICATION
AW Permit Required 0
Street Us. Permit Fleq'd 0
NAME
PROPOSED
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Sidewalk Required 0
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ADDRESS
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CITY ZIP
ITELEPHONE NUMBER
alvat"?
NAME
J-1 13, (2 cD X)
ADDRESS
ENGINEERING MEMO DATED
0032
3?/,7 wel, Le D -
METER SIZE
BUILDING SUPPLY SIZE
NO. OF FIXTUR ES
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CITY ZIP
TELEPHONE NUMBER
REMARKS
STATE LICENSE NUMBER
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SIGN AREA
SEPA REVIE
ADB NO.
Legal Description of P �rty - include all easements
ALLOWED
PROPOSED
COMPLETE
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SHORELINE N
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VARIANCE OR CU
LANNING REVIEW BY
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SETBACKS - F�ET C Vy"n e r I of HEIGHT
COVERAGE
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FRONT SIDE Rfi)(9
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ADDIALTER
COMMERCIAL
MECHANICAL
,4 v 7,
APT.BLOG.
REPAI R
SIGN
GRADING CE
Q DEMOLISH . - CY.S E] I FEN x
CHECKED BY
TYPE OF CONSTRUCT' ON CODE
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HEIGHT
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C RPORT
REMODEL GARAGE 2Z
SPECIAL INSPECTOR
OCCUPANCY
OCCUPANT
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GROUP
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INSERT ROCKERIY RENEWAL
RTM_ARKS
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
PROGRESS INSPECTIONS PER UBC 305
NUMBER OF STORIES NUMBER OF
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DWELLING
UNITS /141�
DESCRIBEWORKT9 DONE (ATTACH PLOT PLAN)
'914pi CA P4e,
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
Plan Check NO. 4�
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewpiks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Z/
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
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
m
employees, and agents from any and all claims for damages of
5
whatever nature, arising directly or Indirectly from the issuance
of this permit. Issuance of this permit shall not be dee d to
me
PLAN CHECK DEPOSIT
6
modify, waive or reduce any requirement of any City Ordinance
X
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
45_2
provision."
I hereby acknowledge that I have read this application; that the
Information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
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 the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are p9id, and receipt is
tion Irisuraft,"
INSPECTION
acknowledged in space provided.
R AGENT) DATE SIGNED
DEPARTMENT
16
CITY OF
AL IG�NA
S S G T RE AT
EDMONDS
;OFFIC
TTENTION
CALL FOR
L AS
ELE F.,!
ASED
A44�
INSPECTION
77":,�e
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IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-3202
UNTIL A F:NAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL - File YELLOW`- inspector
A CERTIF CATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK - Owner GOLD - Assessor
NOTICE:
Wa r r a t7--auc-ura-W
No-w
shown on the attached
The informat On
piled for use by the City 01
map(s) was corr! '
Edmonds,; its Empl-oyees and Consultants.
Th,.e City of 'Edm.onds does. not. warrant the
accuracyof anything set for.th on t. * hese
M a P (s). A n . y person or entity -requesting a
copy should c:onduct an -independent
inquiry regarding the infcbrmatlon shown, c
tF�e -map(s)i including, but not J'm*ted to,
the location of any sew-er stub shown. Su(
sewer stubs may or may' not e.xist and ma�,
or may not exist at the location shown
,�jty of Edmo-nd-s' nor its
Neitheir the %1_.. f t h
emp-1-0-yee-s 0-f- officers -s
information given on this map(5), nor for
any one representation provided based
upon'said map(s).
APPLICATION
The City of Edmon for EASEMENT NO - --------------------------------------------
t SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS F� LID NO - ------------------ AsmT. NO - ------------------
CONTRACT -A -I
OWNER --- -J ------- K % C---t - 4 .................................. OR ----- . . ....... . .......... ------- PERMIT NO. ------------
JOB ADDRESS LEGAL DESCRIPTION: LOT NO - ----------- \-< - -------------------- BLOCK NO - ------------- ----------------------
- -- ------------
'511
..................................................................................................................
Czir-- a I I t.— I � --- r� —�= b- i
—.— ............................................
Approved:
DATE ..... 4.11-VI ........... B /y ......
1 1/7 5
WER, ff"
S IDE S -PERM
-ITY. 'OF: E-15A ON IDS;
M
WATEWSEWER
,.REPARTMENT;_�,
PERMIT,
4:7
57
call
7-75-U25: for side sewer inspections: BE FORE., dov�ring�, 4my Portion ;of -the constructi6
(Inspection will, beprovided within 24 hourw,after requst; �;'O,Sit., Sun.;,or� oliday inspectio n, Y:
N h
ns�
�ADDRESS� L OCA1nON'-OF 'CONSTRUCTION.
................. �Af ..........
. ..... 7 .................... ............ ...................................................
MOPERTY'LEGAM, DESC RIPTION.: ............... ..SEE A'rTACHLD
..............
.........................
.................. .................. ! ..........................
� I'. ', 7. 6
............ .....................
.......... ..................................... I .................................. : ...........................
7 ...... .......................... ............................. .
.......................... ............................ ............ OANWER ANb/OR' BUI ILDER ...... ... DICKENSON (Builder
......... : ...................... 7 ....... e ............... R;MMO� ... Pyi.ardin)
COI-TTRA' ......
CT.OR&N-AME;*ADDRESS ..... :..R8.0 ... xe�tbp, H
......................
........................................ I ..................... ......... I ...... I ............. ...... ...................
Pe—AssiOn'N grauted Anril 5.
.... ....... ............. 19:17-,, for repalr'and/or,,connection of a Sid
ce ....... e. sewer to the c1ty,�"4axdtjjr 'Sewer
��,In, accordan with, City of ZdMon s ordinances. Y�
ATTENTION. M CA-LLED,TO,�THE FOLLOWING:
NOTE No. I—Th,��*��%�ners,�of"the�-propertk,may obtain
a Perinitlto,cbnstruct sewer. -inside, Property itn'e. A lic
�side sewee,,in,;sfre.et,aree., Do,not c.oyer any Portion of sewer before �it 'has, beem inspected., - ensed,: Side sewer Contractor, must,be,,employ� - clitoconstruct
XOTE'No.. 2—AIIL o
worl�;Ijcrformed 4n,�city right -of'
4,;, -way requires, an,,Invasion of Right -of -Way- Permlt��O'btalnable fr'om"the, City,'
NOM No. 3—'Obts�l fujirihf6r"mation, regarding -:Ordinance 11 Err
gineer's -off Ice;
.16.036,,an6-Regulations, jgoverninj side,Jewer& whim, you, get, permit.
NOTE, No_ 4—Top of side.
' ' . sewer� must �have at least.'30'inches, coverage at property
'0h&rPer-,tb&n,Y.. will',be,'Permitted.
ide 'property line; minimum, red of 2 ',N&Oenda, !in, grade
NOTE NO. 6—�renches, In, street mustbe, w
ater settled 'and"urf ace; of street restored, �io ori g�lrrsX conditi'
work which,"may,develbp within one�year:,of comPletion� on� Contractors shall,,.be responsible, for� falluJrd, dupj),to, Improper
NOTE No. 6---�ItAs, bnlawfui(.to,�Iier oi� do,�any other -worli'than is ' -' 1. 1 -1: 1 1
sertjhe,�plpef Into) the wye., Provlded� for in� the permit, orjo idu a . ny : work,%on the main sower or its.appui I . --eke . ept to, in-
tenances
7
DISAPPROVED
....... .. Date 00A -".4
B'Y..: .............. Date ............... By .............. .
APPROVE
a
..............
jX.' -,,4 .........
. . ...................... .............................. .................
Remlrks�-:','." Jnvasionr of Riaht�afWay Permit Roouired
..............
.... 00 ................... ................................ .................... .
..................... ...................................... ...... ..... ......
................ .........................
............................ . .............................
BOT e. it,.,CoPieE'V MUST'Be -Sig'
ned By Owner,
of -Firm Performing Cbnkruction'PRIOR Ta Request F
or lns�,e6tion
. .. . ......... .......... .... ......................... _ hereby certify that �the side- sewer installation constructed under this permit
wrier o 'Contracting Firm Performing Construction)
Was installed,", � accordance with all governing ordinances of the City. of,
Edmonds.,
Dated, thJ& ............. .......... day oi: ...........
............ : .............
V Check BEFORE, you di
9 for: Water C], Gas !0, -Telep4qne�,E]_ Sewer
Power E]
.................. . M ........
Other X,
The Cify of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION QI- REPAIRS F1
OWNER--------------- -1 ---------------- ------------------------------- .........
JOBADDRESS --------------------------------- -----------------------------------------------------
i
EASEMENT NO - -------------------------------
LID NO.
NO.
CONTRACTOR
42t4 --------------------------------------------------- PERMIT NO.
LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
.............. -------------------- --------------------------------------------------------------------- ....... rr— ...................
NAMEOF ADDITION ---- 4a� - ------------- -------------------------------------- APR ------ 5--!W ----------------
PUW WOO WO--
Approved:
DATE............................................ By
------------------------ YiNg
r
BUILDING 'DEPARTMENWJ� Applicant Fill
USE PERMIT
ZONE NUMBER -
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PERMIT'APPLICATION
Inside, Heavy Lines
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JOB Z! y
-;71
ADDRESS 7:;;---
NAME�'(OWNAFAE OF BUSINESS)
7
-VARIANCE OR COND. USE NO. '_7D
B* NO.
HEIGHT
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MAILING ADD R ESS
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PROPOSED YARDS
LOT COVERAGE
0
-EIT'y ..ITELEPHONE
NUMBER
FRONT SIDE REAR
61)
A-/
Al_.� S, -
SIGN AREA
AVIRONMENTAL REVIEW
ALLOWED PROPD.S!ED
0 COMOLItTE k�,ExEmPT
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NAME
REMARKS
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ADDRESS
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PLANNIPIG DEPT. APPROVAL, DATE
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CITY
ONE NUMBER
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LEGAL LOT'
LOT AREA
NO.
YES
]SUBDIVISION
NAME.
STR,EET R/W
EXISTING STREET R/W 0 FT. DEFICIENCY THIS PROPERTY
(n
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ADDRESS
COMP. PLAN ST.'R/W C) FT. FT.
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CITY
TELEPHONE�NUMBER
REMARKS
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STATE LICENSE.NUMBER
CITY LICENSE NUMBER —
CHECKED BY
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ST EET AND OR UTILITY WORK
R/W PERMIT REQUIRED
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Legal Description of Property (Show Below or Attach Four Copies)
Ao T, 7, / fc*'�', ( I.?, "
R E Q'D. OYES 0 NO
ffYES El NO
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UNDERGROUND
WIRING REQ-0. D YES 23 No
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A-t of/" W AS i, , , .,
TYPE C ONNECTION D YES
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SANITARY SEWER NO
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SEPTIC SYSTEM YES
APPVD BY CITY ENG
PERMIT NUMBER
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REMARKS
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METER SIZE
SIZE
ICHECKED BY
JSER�I�E
1CLEARANCE
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RETARKS
ED NEW
RESIDENTIAL
GAS,
EILINE
FIRE ZONE
TYPE OF SONSTRU5:TION
CODE
NON-RESIDENTIAL
SIGN
AD D
RETAINING
DEMOLISH M
SPECIAL INSPECTOR
REQUIRED
OCCUPANCY, OCCUPANT
G ROUP LOAD
WALL
ALTER EXCAVATE FENCE
OR FILL x_F-r),
F] El
El Y E s El, iqO
JAREA
-
PLAN CHECKED B� THIS SITE IS LOCATED IN THE CITY
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REPAIR PRE -MOVE swim
EJ El
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31,04,
INSP. POOL
REMARKS Y
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NUMBER OF STORIiS
OF
C DWELLING
UNITS
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-7
NATURE OF.WORK TO BE DONE
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PROPOSED USE
VALUATION
FEE
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PLAN CHECK
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PLOT PLAN IINDICATE BUILDING SETBACKS,
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ABUTTING STREETS)
BUILDING
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PLUMBING
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HEAT Sc GAS LINE
A0
FENCE
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SIGN
RETAINING WALL
SWIMMING POOL
:CITY OF 'E'DMONQE&w,,
EXECUTIVE DEPARTMEN APR 12 1977
TO:
SUSPENftbM-ftrX5 Uov%.
Dorothy Drobiner LU
0
MAYOR
MAYOR'S ADMIN. ASS'T.
As We Discussed -
BUILDING OFFICIAL
Investigate
and report
CHIEF of POLICE
Take Appropriate
Action
CITY CLERK
Prepare Letter/Memo for:
CITY ENGINEER
My Signature -,
CITY PLANNER
Mayor's Signature
FINANCE, DIRECTOR
Previously Ref'd
Status of Action?
FIRE CHIEF
For Your Information X
PARKS & REC. DIRECTOR
Return to: -
PUBLIC WORKS DIRECTOR
COMMENTS:
Permit #770138 - A. S. Dicksinson
New address is 21915-96th Ave. West.
aaaress was 9525-J220th St. S.w.
FROM: Bldg. Div. DATE: 4-12-77
(8/76)
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CITY OF EDMONDS
COMMUNITY SERVICES DEPARTMEN�
RIGHT-OF-WAY CONSTRUCTION PERMIT
EET FILE PeIrmli t-,, No. o
Issue Date C/
A. 9 Owner: B. e Contractor:. AC_-,V-%C--
c_�%C3
Mailing Address Mailing Address
City State Zip City State Zip
?A'0_ N �7cc_ \ 6q-,)
State License Number Telephone Number
C. 9 Address or Vicinity of Construction: _r
Type of Work to be Don'e:
C�5
D. 0 Work in Connection With
E. 0 Pavement Cut: El Y 0 N
APPLICANT TO READ AND SIGN
§ ACI �'l at
D Commercial
F. 0 Size of Cut:
I C_'�_
ED Single Family
0 Multifami ly
— x
El City Projects
�Otility
NN
INDEMNITY: Applicant understands and by his signature to this app!ication, agrees to hold the City of Edmonds
harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or unforseen, that may
� , 4
be made against the City of Edmonds, or any of its departments, or employees, including or not limited to the defense
of any legal proceedings including defense costs, court cos't's,'and �attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONS.IBLE FOR WORKMANSHIP AND MATERIALS FOR A 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 be
processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Engineeringil 77'1-12b2
• Work is to be inspected during progress and at completion.
0 Restoration 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 4yrd"that this permit must/be available at the job site for inspection purposes at all times.
Signature:
Date:
Owner or
Thisyermit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: )I , -K)" A't&'t') PERMIT FEE:-036— ;6� ZLP
Time Authorized: Void after t-o 0 days. Restoration Fee:
Special Conditions: ---- (!f� Receipt No.:
1;45 M%
F—Al;TElt-s� c:f= L 1, J Fund 111 Fee:
x
Street Cut Dimensions:
Date
RELEASED BY: Date INSPECTED BY
NOW. ORK.TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. March'1989
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Mpt.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P. W.:
13 YES
E] NO
Work Disapproved By:
FINAL APPROVAL BY:
Date:
Date:
Eng. Div. July 1985
0
Is
(jf---5 20,
60,
196
6,
0
PUBLIC WORKS DEPARTOT CHECKJ#T r
MOV IA
-Boc'fILDING PERNIT REVIEW a W
�tte)
(ad&ess
STRFFT FILE
0
Street Right -of -Way Existing CpCD4&
-___�EQD
Z
I
Access Easements Existing_ MOWS
I I .
QD
p4
Utility Easement Existing___�_
-A
Lot Per Subdivision Plat
Assessor Map
Site Plan Checked for Accuracy
Z
Underground Wiring Reqd.
Check Accuracy of Legal Description
Z
Review by
Date
Fxisting Water Main Size
Wate in Required
Service �Lnre 'red
Hydrant Size Exist*
ing
P4
Hydrant Reqd Per Fire Code
Size
r4
Detector Check Meter
'Cross
Connection spection.
Fire Dep t Comments
Water Meter Charge Reqd.
Review by
Date
tic Tank -Design Approved
Date
Sept Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability.
Proj
b w.
ina 0.
raaw,ding N .-,
File No.'
Side Sewer Ava ility
Sanitary Sewer ion Fee Reqd.
�3:
Review by
te
Open Ditch Existing
Reqd-
Culvert Reqd.
Size
I
1:4
Catch Basin Reqd.
i e o
Indic n Site Plarn��
0
Shoulder t���e maintain collection on
swale open rund
op ru 0
E--4
M
reqd.
Indicate on Site Pla�n
3Manhol
So* Conditions and Ground Water Field Checked
L—
ew by
Date
Revised: MO-1977
Page 2
'St�et Paving Reqd.
Curb an tter Reqd.,
Sidewalk Reqd.
Curb Cut for Drivew�ayRe�qqd.
P4 Right -of -Way Construction Permit-lReq
Bond Reqd. for: PublicJgpfovements
Street Name Sign Rd", .
Other-S, ii—'- g-Reqd. qd
z �erSite Ihspe tion de
mit Site Ifispection rpade on
BY: S
W W WATER
z STREET
ENG=RING
�-4 Special Requiren-ents listed in n-Lemo to Comumity Developnient Deparunent,
Building Division
BY k) 0 Date A A
All item filled in on Building Permit Application
BY Date.
Drawings StaTrped and Notations Made
A4 BY Date
Approved by Public Works Department
Revised: Iv 10-1977
72��I�i ts-
7il— r,",j -m c, r-(
e Ny
T—tc>r
0 ae
d 9 0 . I o 4 -
A-
W *' City -of Edmonds I*
IGHT-OF-WAY CONSTRUCTION
rJLCPermit Number:
Issue Date: 0 -
Address or Vicinity of Construction: 21915 96 Avenue West
Type of Work (be specific): Ius tall New Service QJ
C. Contractor: Washington NAtural Gas Company Contact: Frank Swan
MailingAddress: 815 Mercer Street, Phone: 224-2278
State License #: Seattle, WA 98111 Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
I
E. F! Commercial El Subdivision El City Project E2 Utility (PUD, GTE, WNG, CABLE, WAT ; ER)
F-1 Multi -Family El Single Family Other
INSPECTOR: INSPECTOR: KoY WH17C.U71
F. Pavement or Concrete Cut 0 Yes BNo G. Size of Cut: __x H. Charge$
r. % 0�
APPLICANT TO READ Arp'SIGN 41 q/ � J�
"W'old the City of Edmonds
INDEMNITY. Applicant understands and by his signature to this application, agrees r harwilessfrom es, damages, ;gr
claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the City of Edmonds, or any of its departments or employ-
ees, including or not limited to the defen se of any legal proceedings including defense costs, and attorneyfees by reason of granting this permit.
THE CON7RACTOR 14 RESPONSIBLE FOR WORKMANSHIP AND MA TERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MATED RESTORAT[ON FEES WILL BE HELD- UNT(L THE FINAL STREET PA TCHIS COMPLETED BY
C17Y FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of propo�ed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Department- 771-�202.
Work 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.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the CitT.�ngineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working Hay;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspeM* &pA"2L4_4V
Signature: Date: April 24, 1992
(Contractor or Agent)
CALL DIAL A -DIG PRIOR TO BEGINNING WORK
................ .... ....
. .. ....... .... ......
... ....... ......
APP
ROVED�BY::: ........ ..:RJGHT:(
.......... ..
.............. ....... ............ ............. ...... ............. . . ...... . . .....
...... .. ..... .. . .....
.. . . ... ..... . ... ...
. .. ..... . .. ..........
... .........
... .. . :�JrAP- i::DAY -:::..s:D1SRUP
::,..TIME:ALTTHORIZtb-.,YoiD:AFriER.. S,:
.................
PERMrr. FEE:.,.
. .. . ...... . ..... ...
....................... . ........ .... ......... ............ .... .........
. .... ....................
......... .
.. .... .... . .............. ....... ....... .......... . ............... ......... .....
........ UCEIPT � NO,..
:-:.:DATE::.:.: ISSUED:BY:..
NO WORK SHALL BEGIN PRIOR TO PERMIT
Engrg. Div. 1991
FIELD INSPECTION NOTES
Comments:
Diagram:
(Fund I I I - Route copy to Street Dept.) '
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 1985
Wa '�rGjg�ff
Nat
Av4Wvv-&XqWC-
WNG to window
Water main depth
unknown
�z 11 gas main
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: Kerry Walsh
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager
�do
4,10 4k- 14
Z%ey;
-w- water
-g- gas
-ss- sewer
water hydrant
815 Mercer St. (P.O. Box 1869), Searde, WA 98111 (206) 622-676' ,