23030 102ND PL W.PDF1111111
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23030 102ND PL W
ADDRESS: ),p]Znd I& �,j
TAX ACCOUNT/PARCEL NUMBER:— (20 &Z67- 0& -0_12�:0,7=
BUILDING PERMIT (NEW STRUCTURE): I qq � - 6(l n,,�
COVENANTS (RECORDED)
CRITICAL AREAS: 61-7 - 2�� —DETERMINATION: 0 Conditional Waiver Ej Study Required Awaiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER): 'I I —
PLANNING DATA CHECKLIST DATED:. _�
SCALED PLOT PLAN DA
SEWER LID FEE $:
LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DA
e6W -q I -IU
LATEMP\DS'rs\Fonns\Street File Checklist.doc
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ZONE NUMGEA
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CONSTRUCT'tON PERMIT APPLICAT;ON
WNcR NAME/NAME 0 ESS AnDRESS ZI(r-)SO 102- tA
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APPP.ovl!t) BY
0
_L *tP REOUIRED OEDICAIION
EXISTING
Pnoposco --------
RIGHT OF WAY CONSTRUCTION PERMIT PEOUIRED 0
STREET USE PERMIT REOUIRED 0
ADDRESS REVIEW, BY.,
SEE ENGI DATED
—,TY zip TELEPHONE NUMBER
REMARKS
NAME
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ALLOWED rROPOSEG tOMPLETE
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(show below or a aCh two CbPICS)
EVIEw y OATE�
VARIANCE OR CU 11IN14INU R
SETBACKS — FSET E
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FRONT SIDE REAR
REMARKS
Tax Account Parcel No.
PLUMBING
NEW RESIOENTIA
J ..CIALTER COMMERCIAL HANICAL
APT BLDG. El SIGN
REPAIR
FILL FENCE CHECKED BY
5-4
O.s. EXCAVATE. x _FT) !,,—
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DEM OR GRADE Z2
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AFT M SPE5,A INSPECTOR j.
PO R U . �1. Slap. . LOAD;
REMODEL E I GARAGC OL EQ RED
Y [2 NO
wo I STOVE/ RETAINING WALL/ 7,
SEPT SOCKERY� F] RENEWAL REMARKS
PROGRESS INSPECTIONS PER io�C,3q!ii`,`�', __I14
11 2 11. —.FUSE. LF..ISS . �ACTIVITY) I.P-IN
,`nz
NUM13ER OF STORIES NUMBER 0
DWELL NO
UNITS
oF woRkk To BE DONE (ATTACH PLOI PLAN'
t AWL FINAL INSPECTION REQLIIRED�, 4
VALUAT TON 11
PI -AN CHECK FEE
BVILOING
PLUMBING
Plan Check No. MECN ANICAL
GRADWGIFILL 4
t covers work to be done on private property ONLY.
THs Pormis -----_7__7
Any con truclion on tho'pubile domain (curbs, Sidowplks,
driveways, marquees; etc.) will require separate permission. 14TATESUPICHARGE
Per.rilt Application: 180 Days
PermitLimit: I Year. ProvidodWork is Sta-ted Within 1800aYs
"Appliesvit, on behalf of his or her spouse, heirs, assigns and 7 1
ornnify, defend and hold tt, I -
successors In Interest. agrOCS to Ind
no th
City of Edmonds, Washington, Its Officials,
employei and agents from any and Oil claims fer damages of
"lose
uanCe
med to
whatever n2uro, arising directly or Indirectly from the IBS
of this permit. Issuance Of this permit shall not be doe PLAN CHECK DEPOSIT
01 modify, waive or reduce any requirement of any fly ordinance
0 a City's ability to enforce Carly ordinanco
nor I!mit In any way th TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that th 'APPLICAtIO.q.-,.APORO
Is correct; and that I am the ownar. or the duloy ATTENTION
Into IT
.u,;ngive i Until
ri�.d g.nt the owner. I agree to comply with city and THIS PERMIT T)IA appil6ation �B not a P041'. 'N
I on; and In doing tha wo Offlclqlq��Ihl�,, 11 ". ,
sta ow3 r gu of Ing construct] rk authortz AOZHOI'� signed by the- Building
! son will be employed In violation of the Labor 1411 T is
od hereb r-O WORK NOTED Deputy: and fees are pRid� and,'recalpt 18�.,
Co a oft Site I Washington relating to Workmen's Compen3a- acknowladgad In spat Ided.
INSPECTION
ti Ins n OAT DEPARTMENT Le
SIG RE 10 N R IaNATURE 10 TE
0 Icl 'B.S
CITY OF
EDMONDS
DATE
CALL FOR 4
I N INVECTION
ATTE
771-3202
1: IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROV;,L OR ORIGINAL — File Y�LL�Wj�IISpo(it , or-
OCCUPAN-�Y HAS BEEN GRAATED. UBC � .1 1 ��, :, �i' " :,.
A CERTIFICATE OF PINK —'Owner GOLD Assesso
. , -, 00
CHAFrrER 3.
214.97'
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cp
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ID
77
VEC. 1514's
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J U L 1 5 1998
PERMIT COUNTER
N
IS, 65�iL -
0 B to 20 30 40
SCALE IN FEET
, Ivy
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138.93'
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ScALE IN FEET
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138.93'—,
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14
ACCEPTABLE TIGHTLINE "RIAL
N-12 ADS
Sch 40 PVC
SDR 35 (ASTM D3034)
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APPROVED A117-1
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jo STANDARD&RAINAGE DETENTICO SYSTEM
WORKSHEET
OWNER 17,A\NCt� N"� CALC BY:
ADDRESS
PHONE:
DATE:
*****DESIGN DATA
IMPERVIOUS AREA PIPE DIA PIPE LG ORIFICE
3500 �� —
IS'torr' �\N� S-�%-
DETENTION PIPE LENGTH WASHED GRAVEL
0
,,OUTFL W TRENCH, MIN 10- LONG
AN
.4-1 TOP D 4"PERF PIPE TO BE LEVEL
RIM ELEV- I'MIN COVER 6'MIR SPACE
2-MAX COVER RIM ELEV- FROM
CONTROL
'OUTLET
4'Q MIN T 4"PERFPIPE W/CAPS
.5% SLOPE 4' 0 PIPE MIN.
ORIFICE RUNOFF SPREADER
OUTLET
INV ELEV- 44*fR CA rCH INV ELEV
BASIN CONrROL CArCH
SASIIV
2'. 2'. 6"DEEP, 4% 6" QUARRY SPALLS
x2*x3" DEEP, 3/4"CRUSHED ROCK
SYSTEM CROSS SECTION
FROM CONTROL
OUTLET
RIPRAP OUTLET
FOOTING DRAINS SHALL NOT BE CONNECTED TO DETENTION SYSTEM
NOTES:
?6#
1. Call Engineering Division (771-0220) for a tightline and detention system inspection
APPROVED BY
before backfilling and for final inspections.
2, Responsibility for operation and maintenance of drainage systems on private property is the
f / -1 -7 �q'p'
responsibility of the property owner. Material accumulated in the storage pipe must be flushed
DATE
out and removed from the catch basins to allow proper operation. Tle outlet control orifice
must be kept open at all times.
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FILE NO. 4 H
Critical Areas Checklist
--------------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1. Site A0dr'ess/Location:.-.
2. Property Tax Account Number: C/ 0 -7
3. Approximate Site Size (acres or square feet): 0 00 a
4. Is this site currently developed? _yes; -;?—I-, no.
If yes; how is, site develop�d? k7,�,t
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of I 0-feet over a
horizontal distance of 66-fe-+N
Hilly: slopes present on site of more than 15%�and less than 30% ( a vertical rise of
I Mee.l: over a horizontal distance of 3 3 %to 66-feet).
Steep: grades of greater than 30% present on s ite (a vertical rise of I 0-feet over a
horizontal distance of less than 334det).
Other (please de:sd+�ibe):
6. Site contaiAs areas of vearround: standing water:
Approx. Depth:
b
7. Site contains areas of seasonal standing, water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain AZ
Q of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? - Flows are seasonal? (What time of year?
10. Site is primarily: forested \Z _; meadow shrubs mixed
urban landscaped (lawn,shrubs'etc)
IL Obvious wetland is present on site:
------------------------------------------------------ For City Staff Use Only— ------------ --------- — -----------------------
Site i Zon
4. - I is ed? 0.
2. S CS mappe d soil type 5) ? ..AWWWod"�)
3. Wetlan'd inventory or C.A. map indicates wetland present on site? 11fe,
4. Critkal Area's inventory or C.A. map indicates Critical Area on site? If(b
Site w in esignated earth subsidence landslide hazard area?
Sit6desighaied on the Sensitive Areas M ?-. Alt)
Acs_chk.doc; Rev 10/03/97
REC.EIVE:[)
Q_13� 1:
19,97 DEC 3 a 1997
City of Edmonds
PERMITCOU TFII�
N
Critical A" reasChecklis
'�Qc. 199,
The Critical Areas Checklist contained on
this. form isjo be filled o�ut by any person
preparing a Development Permit
Application for the City of Edm,onds p . or to
.his/her submittal of.a developriie-r.it pefmi� to
the Cit
.. y
The purpose of the Checklist is to enable
City staff to determine whetheranypotdhtial
Critical Areas are, or may be present on the
subject property. T�he information needed -to
complete the Checklist should be. -easily
available from observations of -the site or
data available at City'Hall (C.rifi pal Areas
inventories, maps, or soil,:sbi-veys).
An applicant, or his/her representative, must
fill out the checklist, sign and date it, and
.submit it to the City. The'City will review
ite'vi'sit,
checklist, mAe''a: pTec&'so';r'y s'
and. make.:a determination. of sub'sequent
steps necessary to co� lete a developmeffic
p rm
app.. i,, 40on.
f'th' f th
With a �sigh�d p"'6 & a is orm, e
:-:,dpplicant should a4oJSubmit'a&,vicin MOD
orplotplan - for individual lots of the p4Tcel
...,with. enough detailthat City staff can find
.,and identify the, subject parcel(s). In
:Addition, the applicant shall include other
'As
Tertinent hif rimtitlion'(e.g. site plan,
''togo'grAphy map, etc.) or studies, in
conjunctibn%,With 4his.,ch.e.444. to ag'sligi;
.staff in!completiftg, their preliminary.
assessment of the site.
I have completed the attached Critical Area Checklist and attest that theanswers provided are
factual, to the best of my knowledge (fill out the qp
pr9priate column below).
Owner Applicant: Ap licant Representative:
Name
Street Address Street Addres , s
-it
ttlof
L P�O.M/Y/ / � gc/;.
City, State, ZIP Phone icity .. tate,_ ir Phone
7
Signature Date Signature
0 &
",000-
1011
4,�C_()1)
.18
Eric Sundquist
23209 84th Avenue West
Edmonds, WA 98026
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 o FAX (425) 771-0221
BARBARA FAHEY
MAYOR
COMMUNITY SERVICES DEPARTMENT
Public Works e Planning/Building * Parks and Recreation * Engineering * Wastewater Treatment Plant
January 9, 1998
Subject: Determination regarding Critical Areas Checklist # 97-244
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City is
located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
1MO60TA NT IN#ORMA TION TO BE NOTED:
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
or*,. You must submit a copy of the CRITICAL AREAS CHECKLIST and DETERMINATION WITH ALL _411111111111
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Enc: Determination
* Architectural Design Board
C:Reception\Jana\CRLTR.doc
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Diane Cunningham
Planning Secretary
0 Incorporated August 11, 1890 9
Sister Cities International — Hekinan, Japan
N., R.3 EW.M.
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052
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NAME:
SITE ADDR
ZONING:
PLANNING DATA I
16 t�j)'v 4�-
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PROJECT DESCRIPTION: /,�,�v
I qf-z-11
N CHK#
CORNER LOT A10 Yes/No) FLAG LOT .(Yes[No)
SETBACKS:
Required Setbacks: I-- � 5 OA
Front: *� Z-5 Left Side: -7 Right Side: 71/'7 Rear: )<
Actual Setbacks:
Front- -7 1 Left Side: Right Side: Rear: 2,4
Street map checked for additional setback required? YL�,,g,-,-,--(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED
(Y/N)
10 fo
LOT COVERAGE:
Maximum Allowed: 3,5 Actual: /0
BUILDING HEIGHT: 1-1 1-,'
Maximum Allowed: 75' Actual Height:
Datum Point:'SPIV/V rvv
Datum Elevation: 3&7-;�,51
A.D.U. CREATED?: All
SUBDIVISION: �� -Z
CRITICAL AREAS #: CA - 0�7- 2, &/�/ 11,,A (t/M—
SEPA DETERMINATION:
LOT AREA: 00
OTHER:
Plan Review By: N-) oukni-c-C, "V
c:Ti1es\pcmit\Ap1andaLdo6
CITY -OF EDMONDS
USE
ZONE PERMIT
NUMBER
CONSTRUCTION. PERMIT APPLICATION_.�
OWNER NAME/NAME OF BUSINESS
J013: ITE/AFT
AVORF5S :A, 3: 0 3
#
V_0491V-06�1 V\Ork�AVL
LEGAL DESCRIPTION CHECK
SUBDIVISION
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NO.
LID NO.
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MAILING &DRESS
%A
QITY j zip
TELEPIk(ONE NUMBER
PUBLIC� RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCPApproved 0
RW Permit Required 0
"et� \K I%OX
(v�) -rA - fAoi,�
EXISTING REOUIRED DEDICATION
Street Use Permit Req'd 0
_k�
NAME
PROPOSED
Inspection Required __0
Sidewalk!�e 11
,quired
cc
W
i RINE SIZE I
NO; OF FI URES
PRV RE IRED
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1:
ADDRESS
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YES 00
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REMARKS -rj e-
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CITY. ZIP
T
;ELEPFkONE NUMBER
114 5 ptFC 6,,v � tZ C-CWtl t C 0
(D,5704)
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ADDP_ESS I
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ENGINEERING MEMO DATED REVI BY
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-2/9
i2
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CITY
T(LEP",�E NUMBER
-DATED,
IRE MEMO REVIEWED BY
cc
STATE LICENSE NUMBER EXPIRATION DATE
46VtM01k\_15 OK 1� t\ tim
OR CU
y!W6=
#
Legal Description of Property - include All easem6hts
Z
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
A LLOWED :.PRO
'HEIGHT
ALLOWP PROPO SED
EXP
Vl . 71
cc
Lu
LOT COVERAGE
REQUIRED'SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED
PROPOSED
FRONT SIDE REAR
7
FRONT UR SIDE REAR
�IY4
Z
'"j
7Y
Z
Z
Property
Tax Account T\
6r
LOT.ARE6
1W,
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Parcel No. V V11
) /L 7,0
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L e7
M
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REMARKS
LP NEW
RESIDENTIAL
L4N
PLUMBING/MECH
EJADDITION)
. . ....
COMMERGIAt
COMPLWCE OFI�
CHAM qFPSE
REMODEL
APT. BLDQ,,.
SIGN
ru FENCE
REPAIR LAI CYDS. . x ___�Fr)
HEC
TYPE OFCO VRCTION
I A
_T
OCCUPA
DEMOLISH -WOODSTOVE SWIM POOL
INSERT HOT TUEI/SPA
I
PECIAL INSPECTOR
OCCUfANT
GARAGE
1%.A F]. RETAINING: WALIL/.
CARPORT RENEWAL
REQUIRED
REMARKS
4
LOAD
V
ROCKERY�
(TYRP . I§f-. USINESS;OR
qF.LIS -0 TIVITY),"PLAIN.�'
PROGRESS INSPECTIONS.PEWUBC 108
NUMBER
NUMBER OF
CRITICAL
MYOAP Ell ftgt4l
C3
OF
DWELLING
I
AREAS
ca
0
STORIES .
UNITS
NUMBERq7-,;N�
DES9�RIBE WORK TO BE DONE (ATTACH PLOT ZAN),
1_0 o-,\ v.-A �4v
tow
FINAL INSPECTIOkREOUIRED.
LDI--sism (2 0yo
VALUATION
FEE
PLAN CHECK FEE
HTSOURCE: GLAZING %
BUILDING
PLUMBING
Plan Check No.
7
MECHANIC . AL
This Permit covers work to be done on private pr6perty ONLY.�'_`
GRADING/FILL
Any construction on Vhe�publlc domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate peEmIsslon.
STATE SURCHARGE
Permit Application: 180 Days
STORM'DRAINAGE FEE
Permit Limit: 1 Year - Provided.Work Is Started VAthin 180 Days
"Applicant, on behalf of his or her spouse, heirs assigns and
ENG. INSPECTION FEE
d)
"t
successors in interest, agrees.to indemnify, defend and hold
U
Uu'j
u
harmless the City of Edmonds, Washington, its officials,
m
employees, and%agents from. any and all claims for damages of
ir
<
whatever nature, arising directly or indirectly from the Issuance
of this permit. Issuance of 1his permit shallnot be deemed to
PLAN CHECK DEPOSIT
0.
0
0
modify, waive or reduce any requirement of any city ordinance
X
,j,provision."
nor limit in any Way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
FAI
I hereby acknowledge that I have read this applicati th I tb
information given is correct;- dt6jt I am the owner, UI
P_i4
ATTENTION
APPLIcATiON APPROVAL
-c ly�
authorized agent of r
r
I �ig e to compl, :1 y an
fh
THIS PERMIT
state laws regulating :1 nj aF��.d In doing th4 thoriz-
th
AUTHORIZES
This application is not a permit until
ed thereby, no person will be empl8yed 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 paid, and receipt is
t ion Insurance aria RCW 16.27.
INSPECTION
acknowledged in space provided.
S IG 4;
P_(OWNE"R AGENT) DATE SIGNED
DEPARTMENT
/70 6h C/
CITY OF
DA
OFFII I �T
EDMONDS
ATTEATION.,
CALL FOR
RELE DAFE
A
INSPECTION
IT IS *UNLAWFUL TO.USE OR OCCUPY A BUILDING �OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE. AND�.APPROVAL �OR
n4/. A I Ll
771'--0220
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTI04 109
10247
PINK GOLD Assessor
111o,
A
City d Edmon#
-1VED
RECE. JL
d"11' OF WAY CONSTRUCTION
oCT 7
PERMIT.,. Permit Number.
ENGIN
EERIING
Lssue Date: A)
F A. Address or Vicinity of Construction-
B. Type of Work (be sp�ecific): Xad)-&A
C. Contractor:
Mailing Address:
State License #:
D. Building Permit # (if applicable):
Contact:
a
17
Phone,:
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
City 'Utility (PUD, GTE, WNG,. CABLE, WATER)
E. n Commercial E) Subd ivision Project
n Multi -Family [:] Single Family Other e-
INSPECTOR: INSPECTOR: 0,1., (AJ
F. Pavement or Concrete Cut es []Nb� G. Size of Cut: x H. Cbargq-$
'APPLICANT TO READ AND SIGN
INDEMNITY.- Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany
kind or desdription whatsoever, foreseen or unforeseen, that may 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 and altorneyfees by reason of granting this permit.
THE CONTRA CTOR IS RESPONSIBLE FOR WORKMA NSHIP AND AIA TERIA LS FOR A PERIOD OF ONE YEA R FOLIO WING THE FINA L INSPEC-
TION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings 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.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
Al I street cut trench work shall be patched with asphalt or City approved material prior to the end of the working day;
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 t all sforis7gctionpurpo es.
12
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Signature: _ 1,1,9 J
— #.V� "-"- """ - " . . ____ Date: 0a -/Cl/
ew,loel on r�jio� ent)
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4kF_4_U&IOR TO BEGINNING W&K
FOR CITY USE ONLY
APPROVED BY:
D,_1AFTER
TIME AUTHORIZE V 'RQ_!JK DAYS
SPECIAL CONDITIONS:
RIGHT OF WAY FEE:
DISRUPTION tFE/FUND I 11:
RESTORATION
T OTAL FEE:— 11:�Fo 06
RECEIPT NO.: 0 /11
ISSUED BY;
NO WORK SHALL* BEGIN PRIOR TO. PERMIT ISSUANCE Eng. Div 097
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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FILE
,;�;,CIT-,Y OF EDM NDS
COMMUNI TYPSERVICES DEPARTMENT
RIG WAY CONSTRUCTION PERMIT
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A. o Owner: Washington Natural Gas Comp ny B. o Contractor:
JITe Mercer Street
Mailing Address
Seattle WA 98111
City State Zip
No. 31— lt�
Issue Date S -2 3- 91
Name
Mailing Address
City State Zip
State License Number Telephone Number'.
C. Address or Vicinity of Construction: 23030 102 Place West
.Permission is requested to Install 1 1/4" PE IP Main from 11' We
Type of Work to be Done.
to 30' West centerline of 102 Place West To Serve Easement at
23024 102,Place West.. Per Attached Drawing: 912-751
D. 0 Wo�k intonnection' With: (Ef Sub or Plat!` X Single Family' ED City Projects (2)
El Commercial 0 Multifamily El Utility
E. 0 Pavement Cut: El Y UN F. 0 Size of Cut: --- 7— x
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the' City of Edm8nds
harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or unforseen, that may
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 coits, ind attorneyleeqpy reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION A N4 "q, CEPTA54C,131 OF THE WORK.
Estimated restoration fees will be held until the final street patch is completed by City f6rces, 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 Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• 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 and that this permit in I ust be available at the job site for inspection purposes at all times.
Signature- IV16MA &,- "_ April 30, '1991
Date.
Owner or ConTractor
This Permit Must, be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: Sim
A'
Time Authorized: Void after
Special Conditions: �)A=
PERMIT FEE:
Restoration Fee:
Receipt No.:
Fund 1 1.1t Fee:
Street Cu Dimension rA
1!�
RELEASED BY\�, Dateg5 1— INSPECTED BY Date
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Fng. Div. March 1989
w
IRS
FIELD INSPECTION No (Fund I I I - Route copy to Stmet Dmt.)..
Comments:
pimEnl:
STHE
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AV��&*WCOnVaW Date: /0)3
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RECEIVED
MAY
ENGINEERING
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Ej , ig. Div. July 1985
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NOTICE.
. . . . . . . . . . .
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'-'a'r.r a n t. y ... oT -a--Ct,
-N'O'**w
The information shown on the attached
'led for use by the City 01
map(s) was co.m * pi
Edmonds, its Empl.oyees and Consultants.
Th,.e City of'Edm.onds does. not. warrant the
accuracy of anything set for.th on these
'ty-requestina a
nt
Map(s`). Any person or e.
copy should conduct an.independent
onshown-c
Inquiry regarding the 'nf' rrn'ati
tF�e -map(s)., including, but not hm'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,
r-ity of Erld mbin cl-I.S. nor its
Neitheir t1he 11� . h. a I. I b e IJ a. b-'Fe f o r t, h
e m pt oy e e-s 0 -r 0 ff rc e,r s
n on this Map(5), nor for
Information g ve
'ded based
any -one represe�ntation provi
upon said map(s').