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-I, PERMIT APPLICATION REQUIREMENTS
To: Applicant STREET FILE
From: Lyle Chrisman, Engineering Inspector
Owner: PlanCheckNo: ql-103
Addresip Date:--7//-3/?110(-
After review of the subject permit application, the following requirements must be met:
1. Construction hours are:
WEEK.DAYS — 7:00 A.M.40:00 P.M.WEEKENDS/HOLIDAYS — 10:00 A.M.-6:00 P.M.
2. A separate RIGHT-OF-WAY CONSTRUCTION PERMIT is required for all work on public property. (ECDC 18.60)
3. Truck haul route plan must be submitted and approved prior to permit issuance.
4. Builder/owner is responsible for containing all temporary runoff and erosion control on site.
(ECDC 18.30.030d)
5. NO WORK SHALL BE DONE WITHIN 15 FEET OF STREAMS OR 10 FEET FROM ANY CLOSED DRAINAGE
FACILITY. BUILDERIOWNER IS RESPONSIBLE FOR IDENTIFYING CONDITIONS ON THE DRAWING.* (ECDC
18.30.50G)
6. FILTER FABRIC FENCE SHALL BE INSTALLED AND INSPECTED PRIOR TO CLEARING AND CONSTRUCTION.
(ECDC 18.30)
7. INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEMS, TIGHTLINES AND CATCH BASIN
INSTALLATION. INSPECTIONS ARE REQUIRED PRIOR TO BACKFILLING. (ECDC 18.30)
8. Repair or replace all defective existing curb, gutter and sidewalk adjacent to the property. If an intersection is involved, a handicap ramp
may be required. Contractor shall meet with the City Engineering staff to determine the extent of repair pr . ior to issuance of the permit.
(ECDC 18.90)
9. Driveway slope shall not exceed 14% without a waiver. Every attempt should be made to keep the slope below 14%. Waiver granted to
%. (ECDC 18-80.060D)
10. Driveways must be paved from property line to City RIGHT-OF-WAY. A separate permit is required. (ECDC 18.80.060C)
11. INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIOR TO AND AFTER POURING. (ECDC 18.30)
12. No burning of construction refuse without a permit from the Fire Department.
13. Connection to City water system is required. 'Mere is a separate charge for the water meter.
(ECDC 7.20)
14. A back water valve is required if downstairs plumbing is below the elevation of upstream manhole. (ECDC 7.20)
15. Water and sewer main lines should be separated by 10 feet minimum. (ECDC 18.10)
16. Connection to the City sanitary system is required. A separate permit is required.
LID# 0 11 W 17 Fees paid: Yes No Charge�
(ECDC 18.10)'
17. Underground wiring is required on all new construction, and for additions, alterations, and repairs that exceed 50% of the total assessed
value of the structure. (ECDC 18.90)
18. A FINAL ENGINEERING INSPECTION 4
0 0
PRIOR TO THE BUILDING DIVISION GRANTING OCCUPANCY
OF THE BUILDING OR ST
IS rEDIE(
1 $1 TO TWO -heau
PRMntEQRDOT
STREET FILE
PLANNING DATA
SITE ADDRESS4*64�> 140-AWA1. DATE: ZI A?
ZONING: e,5 -,!5 PERMIT#: -
PROJECT DESCRIPTION: W- A/ ripy"c- -
SETBACKS:
Reguired Setbacks:
Front: ZO Left Side: Right Side: Rear:
Actual Setbacks:
Front: .2!5 Left Side:_14,_ ��Right Side: A�Rear:
FLOOR AREA:
LOT COVERAGE:
Maximum Allowed:-:� Octual:
BUILDING HEIGHT: /,2 41 fo �777 /� //-z' 5�
Maximum Allowed: le )Actual Height: 1;?1,z5--
L /
SUBDIVISION:c - r _- - �� -4�2 —1:51, (D
CRITICAL AREAS #: -7 --:�s
SEPA DETERMINATION: -
LOT AREA: 7 C),3 '57
OTHER:
4,ZONE PERMIT 940486 t
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION SUIT
[OWNER NAME I NAME OF BUSINESS ADDRESS _�2 -'A 4,)A=-
R-d- AV
PUBLIC RIGOT QF WAY PER'OFFICIAL STREF.,MAp. TESPCP,,Ap
RW
EXISTING (00 AEOUIREO DEDICATION Street
PROPOSED 4-0 Inspection
L
'ad I
I P':q
R uiled
Use Permit Req'd 0
Required
Required 0
CITY Lip
,Q1kP 6 ;116
I tLEPHONE NUMBER
4AME
PD, To � i,
Sidewalk
IF
MW
I LINEJ&ZE
I NO. OF FIXTURES
PRV REOUIRED
YEA NO 0
ADDRESS
1?601 -2 3
REMARKS
/
'ITY ZIP
ITELEPHONE NUMBER
4AME
ADDRESS
ENGINEERING MEMO DATED XEWED BY
CITY ZIP
TELEPHONE NUMBER
672--;>ok6
M"M'm
FIR MEMO DATED REVIEWED BY""
STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA
ALLOWED PROPOSED
PA REVIEW
COMPLSEETE EXEMPT
EjP 1
loll 140,
Legal Description of Property - include all easements Zy
_W14
S 77
0
VARIANCEjbR CU
P IN YIEW BY
GAT
SETBACKI§ — FEET
FROI, -7 REAR 10(2'
16 SIDE
HT
LOT,C ER E
C.? .0
Ta)(Actiount -.:I$a
Parcel No. T�- c/ 6 00 1 (-,,o o302-
N.EW RESIDENTIAL PLUMBING
1:1 ADDITION COMMERCIAL MECHANICAL
0 REMODEL APT. BLDG. SIGN
FENCE
El REPAIR M12— ':'-I' I x _FT)
04 DEMOLISH 0 WOODSTOVE SW OOL
INSERT HOTIMTPUB/SPA
GARAGE RETAINING WALL/
OARPeFlirw 1:1 ROCKERY F RENEWAL
NUMBE IN Ell OF ITICAL
UNIT R `
OF DWELLING AREAS
STORIES ILU 6 UNITS I CNUM13ER
DESCRIBE WORK TO BE DONE JATTACH PLOT PLAN)
By
SPECIAL INSPECTOR I AREA J17 AFN OCCUPANT
8P
VRrEOU'RE' 1/0
13 YES LOAD
MARKS
P PR
ROGRESS INSPECTIONS PERUBC 305
;%e
4m.4i- qw-)q* xl-,%cz 11-0/4 6z e"ODE
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
BUILDING
/-� P I/ V/
HEATSO URCt:
%
.
& A S
PLUMBING
Plan Check No. 103
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADIIIGIFILL_
-Any construction on the public domain (curts, 31dewplks,
driveways, marquees, etc.) will require separate paimission.
STATESURCHARGE
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, def�nd and hold
harmless the City of Edmonds, Washington, its officials,
1' employees, and agents from any and all claims for damages of
4' whatever nature, arising directly or indirectly from the issuance
-of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
0 nor limit In any way the City's ability to enforce any ordinance
TOTAL'AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and In doing the work author'z-
E
'ad
AUTHORIZES
TH
signed by the Building Official or his/her
thereby, no person will be employed In violation of the Labor
" Code of the State of Washington relating to Workmen's Compensa-
ONLY I I
WORK NOTE.
Deputy; and fees are paid, and receipt is
CW
ion Insurance and R 18.27.
INSPECTIO
acknowledged in space provided.
O=
SIGNATURE (OW E NT,
DATE SIGNED
DEPARTMENT
CITY OF
S SIG TIJRE
_711iAly__
IW,-,,4 Y _4t
5-12
EDMONDS
1i
CALL FOR
XELIA 13 DATE
ATTENTION
INSPECTION
IT S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UJIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL — File YELLOW — inspector
�uCE'T' 'CATE OF OCCUPANCY HAS BEEN GRANTED. USC
3EET FILE
STREETFILE CA FILE NO. qq A '6
Critical Areas Checklist
Site information (soils/topography/hydrology/vegetafion)
ress/Location:
L- SiteAda' 23-3.6 zoo-&,& A �C_
. . ' 0
2'. Property Tax Account Number: -79�' SlrqE3 Col 001 t1ZR'02_
3. Approximate Site Size (acres or square feet): 2— Z 0 50.
4. Is this site currently developed? —yes; X_ no.
If yes; how is site developed?
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 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-f6et).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
What season(s) of the year?
8. Site is in the floodway Al d floodplain A-10 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? A, e) (What time of year?
10. Site is primarily: forested ;meadow ;shrubs mixed
urban landscaped Qawn,shrubs etc)
11. Obvious wetland is present on site:
RcVOIA)04
ar 9 0 - 194 -
City of E&non&
Critical Areas Checklist
The Critical Areas Checklist contained on
this form is to be filled out by any person
preparing a Development Permit
Application for the City of Edmondsprior
to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable
City staff to determine whether any
potential Critical Areas are or may be
present on the subject property. The
information needed to complete the
Checklist should be easily available from
observations of the site or data available at
City Hall (Critical Areas inventories, maps,
or soil surveys).
An applicant, or his/her representative,
must fill out the checklist, sign and date it,
v
and submit it to the City. The City will
review the checklist, make a precursory site
visit, and make a determination of the
subsequent steps necessary . to complete a
development permit application.
With a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (e.g. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name
12 &1-6 <&4Jf'e S
Street Address
4 �'8o2-c)
City, State, ZIP h
Signature Date
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
Signature
Date
CA FILE NO.-q4-q'b
C-%OrREET Fdh' kal Areas Checklist
Wn
Site information (soUs/topography/hydrology/vegetation)
1". Site.Address/,Location: 23 6 0 C
2'. Property Tax Account Number: —;Cip Syr C/ E3 co / 0 0 L 0 06
_D 702
3. Approximate Site Size (acres or square feet): / 2,_ 6 W 50.
4. Is this site currently developed? -yes; X— no.
If yes; how is site developed?
S. 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 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise
. of 10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: /11"6) Approx. Depth:
7. Site contains areas of seasonal standing water: /VV Approx. Depth:
What season(s) of the year?
8. Site is in the floodway Al floodplain A./O 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? A/ e) (What time of year? q/ev
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped Qawn,shrubs etc)
11. Obvious wetland is present on site:
RcV01/0"4
690-194
City of Edmonds
Critical Areas Checklist
The Critical Areas Checklist contained on
this form is to be filled out by any person
preparing a Development Permit
Application for the City of Edmonds prior
to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable
City staff to determine whether any ,
potential Critical Areas are or may be
present on the subject property. The
information needed to complete the
Checklist should be easily available from
observations of the site or data available at
City Hall (Critical Areas inventories, maps,
or soil surveys) -
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 the checklist, make a precursory site
visit, and make a determination of the
subsequent steps necessary . to complete a
development permit application.
Mrith a signed copy of this form, the
applicant should also submit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (e.g. site
plan, topography map, etc.) or studies in
conj B unction with this Checklist to assist
staff in completing theik preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name
12
Street Addrem
OeW4 �?862-0
City, State, ZIP RM
d' 9
le�r
Signature Date
Applicant Representative:
Name
Street Addrem
city, State, ZIP Phone
Signature
Date
, 890 - 194
CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning 9 Parks and Recreation * Engineering
LETMR OF TRANSAIMAL
Datv. May-25, 1994
To: Robert Thue
1256 8th Ave. South
Edmonds, WA 98020
Subject: Critical Areas Checklist
Transmitting:
For your information: xxx
As you requested:
For your file:
Comment and return:
Note attachments:
LAURA M. HALL
MAYOR
Comments: —Please bring in a copy of the Critical
Areas Checklist when applying for a building
permi t.
Planning Division
Judy Kenne,y
* Incorporated Au_qust 11, 1890 e
Sister Cities International — Hekinan, Japan
ITR
I
7",
u5t PERMIT
CITY OF EDMONDS
ZONE NUMBER
96
-CONSTRUCTION PERMIT APPLICATION
QB.
ADDRESS
Z 3 5-06 A
OWNER NAME/NAME OF BUSINESS
6,�o ki
LEGAL IIESCIIIPT107SUBDIVISION
NO.
LID NO.
Uj
Z
MAILING ADDFJESS
0
TESCP
CITY WOLZELEPHONE NUMBER
PUBLIC RIGHT OF WAY PER OFFICIAL. STREET MAP
APPROVED BY
EXISTING R UIREDDEDICATION
PROPOSED
NAME
9#10
t, -S 0 ki
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED.
W
LU
Uj
ADDRESS
-5[Hht:i uSEPERMIT REQUIRED:
/j/ tv
REVIEW BY
SEE ENG MO DATED
Z
W
CITY
TELEPHONE NUMBER
ls'e"
-2 2
REMA
74AME
9oA -,e it 7—AC4 e_.
lllfvewlf�
t
01
a:
ADDRESS
0
MET E//
BUILDING S PLY SIZE
E' JNITS
CC
CITY _FTIELEPHONE
NUMB ER
IFIXTUR
Z
0.
U
1<7_S,1- 2-
? - 39
STATE LICENSE NUMBER
�.7 �-,
E74
SIG
ENV. REVIEW ADS NO.
Legal Description of Property - inclOde all e7sementi
A LLOwg
OPOSED
COMPLETE
EXEM
(show below or attach two copies)
SHORELINE#
Z
2
CL
a:
in
- 1r,
VAR CE OF3:.PU
V.,
PL NNING REV�IW B
Ui
Ile.
S?tBACKS
NFEET
HJEHT
LOT COVERAGE
W
-i
-5- V
SIDE REAR I
<
Z
Z
TRY RCCT yval e0l 0 0 7—
BMARKS
CL
'PLUMBING
NEW
ADD/ALTER
COMMERCIAL
MECHANIC\--,
511
F
E] APT. BLDG.
El
REPAIR
SIGN
EXCAVATE FENC
DEMOLISH 11 OR FILL x
CHECKED BY
TYI�E OF CONSIRUCTION �CODE
—r-7—.Z
HEIGHT
CARPORT s
REMODEL El GARAGE PO L
SPECIAL INSPECTOR EA
REQUIRED
Y
OCCUPANCY OCCUPANT
GROUP LOAD
[]WOOD STOVE/ r7 RETAININ WALL/
INSERT El RE\AL'%4'
0 YES 0 NO
REMARKS
RO(
PROGRESS I.NSPECTIONS PER UBC 305
co
NUMBER OF STORIES JMBER OF
"dffs a, L &A ewe
LU
1 NELLING
—77w -o
0
L jITS
-
NATURE OF WORK TO BE DONE (AT 'ACH PLOT PLAN)
... LUATION
FEE
le &i4w,
PILAN.CHECK FEE
Lyi
BUILDING
0 0
PLUMBING
MECHANICAL
j
This Peimit covers work to be done (fn private pro party ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permis Sion.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
ENERGY CODE
"Applicant, on behalf of his or her spouse, heirs, assigns and
In
successors in interest, agrees to indemnify, defend and hold
/3
u
harmless the City of Edmonds, Washington, its officials,
-_7
employees, and agents from any and all claims for damages'of
Cr
X-1
whatever nature, arising directly or indirectly from the issuance
9L
of this permit. Issuance of. this permit.,qhall not be deemed to,
PLAN CHECK DEPOSIT
)Cc),
0
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
�_v
9
//22W
provision.,,
A -7
-9 7
7
1 hereby acknowledge that I have read this application; that the'
information given is correct; and that I am the owner, or the duly
ATTiERITION
"APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
laws in
THIS P�'RWT
This appli)c'ation, is not
state regulating construction; and doing the work auth�Qriz- ,
AUTHORIzES
a permit until
-Official
ed thereby, no person will be em.ployed In violation of the Labpr
ONLY THE
signed by the Building, or his
Code of the State of Washington relating to Workmen's Compen
WORK � NOTED
Deputy; and fees-are-pafd, and receipt is
tion Insurance.
INSPECTIQ�N'
jackno,Wledged in space provided
SIGNATURE (OWNER OR AGENT)
DATE SIGNE
DEPARTMENT
CITY OF
OFFICIAL'S SIGNATURE -.04 E
EDMONDS
ATTENTION i
771-32��
RrLEASE9 BY- E
Y,— — A0
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING bR STRU;TURE
C
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROV�L OR ORIGINAL —'File' YELLOW—hnsp ctor
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
DETENTION WORKSHEET.
C A-rCV4
BAS%N DETENTION PIPE LENGTH COKrROL CATCH
BASIN
I' MIN, 2* MAX COVF-R� --j
OVrL%T
Cot-ITFtoe
% SLOPE-W
70 OLrrL-E'-r
(Sj P RAP OR
P,UNOFF
SIFIREADER)
SYSTEM CROSS SECTION
5A&IL1172"Ic- -
. 2, 3s -o 6 AT
2' x 2' . &D" 0227?, 4�- (6" SPALLS 6 LVU^L)
2fx 2' x 3� DEEP, c-pus"eD ROCK
FROM
=T
OLITLET
CON-rROL
RIPRAP OUTLET
WA5HEV rrRAVUL OUTFLOW 7RENC", MIN 10' LONG,
TOP 4 A- PERF PIPE -M BE L-F-VE:L
"L
FROM
Wr6Er
CON-rKOL
4!' FERF PIPE WITH CARS
RUNOFF SPREADER OUTLET
FOOTING DRAINS SHALL NOT BE
STANDARD DRAINAGE PLAN
DETENTION SYSTEM
for /&2elr- �7-1, I
?5;r 72 2-1
location'7-7,960 '-00�
plan by !�2 0 AZ Re 5-1
phone :57 — 9`2 2—
date
DESIGN DATA
System Imperm Pipe Pipe Orifice
Number Area Diam Length Diameter
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the resvonsibility
of the property owner(s). Material
accumulated in the storage pipe must
be flushed out and removed from catch
basins to allow proper operation. The
outlet control orifice must be kept
open at all times.
-k , 17
ft ',i� �� " � �.' ',� —�)
DEC 1D"l
KIPMIT COUK:1
CITY OF EDMONDS
Page 9 of 9 CONNECTED TO THE DRAINAGE SYSTEM
61 vv 03
v 5yv/ i/VQV
�ryl-Loo---j [�(Py -�
4.rn
4*
,Maw
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aJ5
koo
�lb I �- . 3f\,o 14-1 �q)
%A O'+*OA4-
cl
Ou ?a
cy 19
Q -
I Table 1 - Infiltration Trench Length I
Note:.
This table shows trench lengths for each 1000 square
feet of impermeable
surface draining to the trench.
Perc Rate
Trench Length, in
(minutes
feet for 1000 sq. ft.
12er inch)
of contributing area
1
13
2
18
3
21
4
24
5
26
6
28
7
29
8
30
9
31
10
32
11
33
12
34
13
34
14
35
15
35
Table 2 Detention Pipe Lengths
Impermeable
Required
DiAmetep-----,
Area Sq Ft
Vol Cu Ft
15 /q8" )�,-(249 130"
2000.
C�5�
50
:(62D
28- j6:t::j0
C-,�5.0-- 315 F 29 �S::)
3000
75
60 42-274 15 Required pipe
3500
87
70 49 28 18 length in feet
4000
100
80 56 32 21
4500
112
90 63 36 23
5000
125
100 70 40 25
I Table 3 - Outlet Orifice Sizes I
lmoe meable Area Sa Ft
2000
2500
3000
3500
4000
4500
5000
Outlet Orifice Diameter Inches
5/8
5/8
3/4
3/4
7/8
7/8
7/8
Page 7 of 9
I , I
PERC TEST PROCEDURE
1. Dig a hole with an approximate diameter of 6 inches to a depth
equivalent with the bottom of the proposed trench. The standard
tool to use is the post -hole digger.
2. After digging the hole, it is important to carefully scratch the
bottom and sides of the hole to eliminate any smeared or sealed
,surfaces. Remove all loose material from the hole, and place two
inches of coarse sand or fine gravel in -the bottom. This is to
prevent the bottom surface of the hole from being scoured when
water is poured into it.
3. Many soils will tend to swell and lose percolation capacity
after being wetted for a period of time. The tendency for a
soil to swell is dependent on the quantities of clays having a
shrink -swell potential. Therefore, it is important that those
soils be allowed to swell prior to performing the percolation
test.
4. If a soil is comprised almost entirely of sand (at least 85% of
individual grains visible without magnification), soaking is not
required. If the soil has over 15% of fine material, the.hole
must be soaked a minimum of 4 hours (continuous soaking for 24
hours is preferred). The soaking may require periodic addition
of water. Percolation measurements are made 24 hours after the
start of the soaking period.
5. After soaking, the percolation rate is to be measured by one of
the following methods:
a. If water remains in the test hole, add or remove water so
the water level is six inches above the gravel. Carefully
measure the drop in water level over a 30 minute period. Use
this data to calculate the perc rate in minutes per inch.
b. If no water remains in the hole after the soaking period,
add water to six inches above the gravel. Measure the drop
in water over a 30 minute period. Use this data to calculate
the percolation rate in minutes per inch.
C. If more than 2 1/2 inches of water drains out within 30
minutes, disregard the previous results. Retest by adding
water to six inches above the gravel. Then.measure the time
(using a stop watch) it takes for the water to drop 2 inches
and calculate the perc rate in minutes per inch.
Miscellaneous Notes:
It is important that a six-inch diameter hole be used for perc tests.
Other sizes need to be mathematically adjusted. This infiltration
system is required for downspouts and yard drains. Connection of
foundation footi-ng drains to this system is prohibited.
Page 6 of 9
1/89
PLI'V4
X2.,
bglvct,Av
----------
sr','F� st.�z
(--, p
N A,l
NOV - 6 `M-
PERMIT COUNTER
z OrVG71D R �;-s
lsc--�q ie-- .
September 26, 1989
TO: Permit Coordinator, Building Divisi6rr
FROM: Dan Smith, Engineering Inspector
ADDRESS
OWNER Vl�e, A�64
PLAN CHECK #
After review of the subject building permit application, we have the
following comments:
1. Construction hours are: WEEKDAYS ........... 7:00 a.m. to 10:00 p.m.
.WEEKENDS/HOLIDAYS..10:00.a.m. to 6:00 p.m.
2. A Right -of -Way Construction Permit is required for any work on
City property.
3. CoRde9ti orY to �Ci ty (�ater( systefi rep�ii red( Feks W6
el-tl' 1-"-( 1'7 '01,S17,01cl-
4. C9-n n 4p-t'i 0 Ci saniU-ty--&eWer--syst@iTt�eq-ai-rerd-, obta-in-seppate
�) /- zp7,7 /-?/ -, ill 6-7V 6 IS,,��- �-IC 7-
5. Water and sewer lines to be separated by 10 foot minimum.
6. Driveway must be paved a minimum of 20 feet back from City
right-of-way; separate permit required.
7. Driveway slope not to exceed 14%.
8. Ba k ate ve ui if"�dwnsta.i/s plun#ing is - b�low
c r /fu tA�eam �Oanhol r4�, Ill&-zv 60,1reIZ, 61Sigic
vA�
ele ti on ps
9. Builder/Owner responsible for containing all temporary runoff and
erosion control on site. Construction may not impact neighboring
properties in any way.
10. No burning of construction refuse without approval from Fire Dept.
11. Street to be kept clean of debris, dirt, mud, and construction
materials. Contractor responsible for dust control.
12. Inspection required on drainage system, catch basin installation,
driveways, and sidewalks. A final engineering inspection is
required prior to the building division granting occupancy.
13. Repair or replace all defective existing curb, gutter, and
sidewalk. If intersection is involved, installation of wheelchair
access may be required.
q. t�t. 4t 4,� /f
4
BLGPER/TXTFORMS
DETENTION WORKSHEET.
STANDARD DRAINAGE PLAN
Uppulp-
C A- rr— H
Bbs%t4 VETEWrION PIPE LENGTH COKrl:kOL CA-rC"
(VENT) - -
I SA51N
M 114 , 2 * m Ax CO V EX --- 1 �7
OLrTLr.T
cov4TFtoe
5LOPE-4-
--4
- TO OLITL.E,-r
T I
(N P RAP OR
P'UNOFF
SYSTEM CROSS SECTION SPREADE:V,)
2' x 2' a (D" Ve=?, Z-16" SPALLS 6LV0U^I-)
x 2' w 37" D EE C-RUSI,4ED ROCK
FROM
0 �TL�T
LJTLET
CON-I-ROL
RIPRAP OUTLET
WASHED C-RAYEL-) (-OUTFLOW 7RENCIA, MIN 10' LONG,
70P 4 -4- PE-R-F PIPE -M be u-F-VeL
- k.
FROM
OLMLEr
CONTROL
4" PERF PIPE WITH CA�P.S
RUNOFF SPREADER OUTLET
FOOTING DRAINS SHALL NOT BE
DETENTION SYSTEM
for -77z' , .E.— I
7,�r —2 2— V
location
17
plan by 77
phone
DESIGN DATA
System Imperm Pipe Pipe Orifice
Number Area Diam Length Diameter
NOTES
1. Call Engineering Division (771-32021
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the resDonsibility
of the property owner(s). Material
.accumulated in the storage pipe must
be flushed out and removed from catch
basins to allow proper operation. The
outlet control orifice must be kept
open at all times.
RIV.: 1V
DEC I 11960"
PERMIT COUMM
CITY OF EOMONDS
Page 9 of 9 CONNECTED TO THE DRAINAGE SYSTEM I I I
I Cl Aj
`)/'� ro
le_
01 F4 Q�- plcm
v
7T::i rx ."Vq+ to V-\
A) C �O
0 A)
rK n
— ---------
rj
Soo
Doe,
/t"c)/L/ r-007711J�
It/-S To
(,) AA 19
I �� Table 1 - Infiltration Trench Length I
Note:
This table shows trench lengths for each 1000 square
feet of impermeable surface draining to the trench.
Perc Rate
Trench Length, in
(minutes
feet for 1000 sq. ft
12er inch)
of contributing area
1
13
2
18
3
21
4
24
5
26
6
28
7
29
8
30
9
31
10
32
11
33
12
34
13
34
14
35
15
35
Table 2 Detention Pipe Lengths
Impermeable
'Required
T-4 pj Di4Metep
Area Sq Ft
Vol Cu Ft
15 / 8" - 24'� �30
50
0-28-----,,-16-- 10
-:2
6 2
-50. --, .35; 20 3
3000
75
......
60 -4f24� 15 Required pipe
3500
87
70 49 28 18 length in feet
4000
100
80 56 32 21
4500
112
90 63 36 23
5000
125
100 70 40 25
I Table 3 - Outlet Orifice Sizes I
Imaermeable Area So Ft
2000
2500
3000
3500
4000
4500
5000
Outlet Orifice Diameter Inches
5/8
5/8
3/4
3/4
7/8
7/8
7/8
Page 7 of 9
CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-3202
COMMUNITY SERVICES:
Public Works a Planning * Parks and Recreation * Engineering
, 890 - 199
July 12, 1991
Robert Thue Construction.
1256 8th Avenue South
Edmonds, WA 98020
RE: Permit #9,00486
.SFR at 23506 100th Avenue W
LARRY S. NAUGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
Enclosed is a check for $498.40 which is- 80% of the Building Permit fee
of $623 that was paid on permit #900486. Per the Uniform Building
Code, you are entitled to an 80% refund of this portion of your costs
in'the event an issued permit expires without work ever having begun.
If you have any questions you can tall me at 771-3202.
Sincerely,
.Sharon Nolan
Permit Coordinator
j
I
Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
CITY OF EDMONDS SECURITY PACIFIC BANK WASHINGTON
Edmonds Office - P.O. Box 250
EDMONDS, WASHINGTON Edmonds, Washington 98020 11569
J111V 10 19-3/1250
19 91
PAY
DOLLARS $1 498.40
Robert Thue Construction
TO 1256 - 8th Ave. S.
THE
ORDER Edmonds, WA 98020
OF CITY OF EDMONDS
111OLLS69111 1:12SO00037i: 026034760o TREASURER
CITY OF EDMONDS DETACH AND RETAIN THIS STATEMENT
THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED BELOW
IF NOT CORRECT, PLEASE NOTIFY US PROMPTLY. NO RECEIPT DESIRED
Building Permit Refund. 001-000-000.322.10.00
WARRANTSREDEEMED BONDS & COUPONS REDEEMED
_!PR�IINCIPAI INTEREST DESCRIPTION INDENT NOS. BONDS COUPONS
CLAIMS
SALARY
L.I.D. NO.
L.I.D. NO.
L.I.D. NO,
ME,MORANDUM
June 25, 1991
TO: Devon Drake, Treasury Clerk
FROM: Sharon F. Nolan, Permit Coordinator
SUBJECT: Single Family Residence
Permit #900486
Please prepare a refund check in the amount of $498.40 for Robert Thue
Construction. This is 80% of the permit fee of $623 that the Uniform
Building Code allows us to refund in the event an issued permit expires
without work ever having begun. The receipt number is 12597.
Please send the refund check back to me so I can forward to Robert Thue
with a letter.
Thanks,
Sharon Nolan
Permit'Coordinator
-V
12--�6 9 0,� -S
72-
T (Q
46F -
JiT
G6
-P- - L � -o-r-P-L K-6- - - - - -
N A,.l Pb, C.-
uu G� tL
Ki
NOV - 6 19'b
VERM11, COUNTER
zorvcfo
rn r
pan
rr-
Ki
RECi�IVED
NOV - 6 1989
PERMIT COUNTER
z OrVC7 c) 9 S-8
a,
Cl)
M
rn
--I
rr-
'T9 14:25 WASH M1JTU;L LYI-11-1WOOD P. --, 2
PAC,5! 2
ORDER No. 516280
LEGAL DESCRIPTION:
That porti6n of the South 117.0 feet of Tract 1, Block 1, Richmond Fruit
i.'arden Tracts, according to the plat thereof recorded in Volume 6 of Plate,
page 44, records of Srjohontiah Coarity, Wa6hiligt0fl lyiFlEj WHRI. Of 1.11M. M111011LIA-
King countv line road.
TOGETHER WITH th;Ai- portion of vacated Richmond Avenue adjoining said
to the-! We -St. Atid lying he4-Lwr-e;,ii tbk. Nort-h �irid Snut-h line5.; or 14aia
premises as produced to the West and
TOGETHER WITH thaL portion of vacated forrest atrest adjnining Raid
premises,
Situate in.the County of Snohomish, State of Washington.
F1
STREETFIL E
PROJECT REVIEW CHECKLIST
PROJECT NAME:--TAl� PLAN C'HECK #:JV-1,95 -
P R 0 J E C T A D D R E S S:
RECEIPT DATE:
REVIEW
D BY:.(Initial Date)
PLAN.
WATER
['I
COMMENTS
FIRE
: BLDG.
S EWER, STREET
ENO-'
Setbacks/Variance/Setback Adjustment
Conditional Use Permit
AD13 Requirements
3
Other Zoning Requirements
4
Underground Wiring Required
(f
Lot Slope 15%
HM.
SEPA Environmental Checklist/Hydraulics Permit
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
-'.-'7:
Tree Cutting Plan
8
Plat/Subdivision Requirements
.............. . . . . . . . . . . . . . . .
1*..9
Legal Description Verification -46 -0/0
10
Quit Claim/Street Dedications 5-6 - Ille-
Easements - Public/Private
-5-4:4-?a
Engineering Storm Drain Review Fee
. . . . . . . . . . . . . . . . .
. . . . . . . . . .
Engineering 2.2 Inspection Fee
14
Drainage Plan (On -Site)
Setback - Top of Bank, Stream, Water Courses
Setback - Storm Drain Une
.....
. . . . . . . . . . . . - - - - - - - - - - - - - - - - . . . . . . . .
17
Open Ditch - Existing
. . . . . .
Culvert Required
. . . . . . . . . . . . . .
19
Culvert Size
... 20
Shoulder Drainage/Shale Open Runoff
-Y . . . . . . . . . . .
-:21
Catch Basin Required
22:
Driveway Slope & Vehicle Access
23`1
Sidewalk Required
1
24:1
Curb & Gutter Required
................. ............ .....
IBM
1
25:1
Curb Cut For Driveway Required go 5
now
1
26 1
Street Paving Required
Pight-Of-Way Construction Permit Required
28:
Street NaMe Sign Required
29
Other Signing Required
----------------- ............. ........... ......... . . . . . . . . . .
-:30
Bond Required For Public Imprbvements
31,
FEMA Map Check/Water Table
32
Side Sewer Availability
.33.
Calculate Sewer Connection Fee If No LID
�. i; WIX
Create Street File qg,5
Existing Water Main Size
36-
Water Meter Size
.............
.............
- - - - - - - - - - - - - - - - - - - - - - - - - - - ...37
Service Line Size
fol A al MUM
MM ON
38
Water Meter Charge Required
30.
Hydrant Required
40
Hydrant Size Existing
41
Fire Line Charge Required - Sprinkler
...............
Street Cut
......... ...
X.
jMi cellaneous
44....'
Reviewed By:
FIRE PLANNING
ENGINEERING PUBLIC WORKS
I -
STREET ALE
DETENTION WORKS8Ifhj,,
Kam
0 P G_ P,
C xrc",
BA'StN OrMHTlow Pq UENGTI4 COWMOL CA-rc*i
I'MIN, 2' MAX COVEK ---
OLMLET
raot-rritoC
"I'Z SLOPE—
M OUTL.CT
(FJ P RAR OR
PUNOFF
SYSTEM CROSS SECTION SPREADER)
REcEivED
MAY 2 6 1994
PERMIT COUNTER
2' 2! &"0V3M'P,.,4t-,6" SPAL" (MaV",)
2�' 5"VFrP-.'W- C-RUSIAED ROCK
FV4M
OUrLEY
__7�
CON-rikoL-
RIPRAP OUTLET
WAS14ED &RAVEL
-ow TRet4c". tAIN lo- LoN&
rorOLrPrFL4 A* PEFV= PIPE _r0 BE L-MVIEL
� I
FROM
0VTLE-r
COt47rR0L
4� PERF PIPE WITH CkP.S
RUNOFF SPREADER OUTLET
FOOTING DRAINS SHALL NOT BE
Page 9 of 9 CONNECTED TO THE DRAINAGE SYSTEM
AR,MNDARD DRAINAGE PLAN
Fir it.
DETENTION SYSTEM
for 4Z, 4_-
??V2 2-y
location
plan by /7
phone -;-- �5!� K 72--170
72
DESIGN DATA
System Imperm Pipe Pipe Orifice
Number Area Diam Length Diameter
A ,, -
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the resDonsibility
of the property owner(s). Material
-accumulated in the storage pipe must
be flushed out and removed from catch
basins to allow proper operation. The
outlet control orifice must be kept
open at all times.
VU I-
0 ,
DEC
CITYOFEOMONDS
(A rh PO t, A e,
mill,
66
DAlue
04,j
RE C. E li VT� Q
JUL 1 2
PC:
ERMI I MINTE3
043W.A SP041
w
CC
W
4ur;
> cn
w
iz ;!
t t /
�AJ AL. V
r
(ad,. �) p
X, 0
.........
Ito
/43
- xrcz- 4. �W—
. -4toio'v
R E C E I V E' D
JUL 1 2 )K4
"'�u
)ERMIT COUNTER
0,4
A
4-a
ko
R '" k.'^' -4 i "A 1� D
NOV -
RERMW CENTER
'7"3 -0
U.
Lu
+ APPROVED By q3NNING
1),,w A tio-5 17 to4 -z-5 Ayrext- C�,tA-i
+
7. 2-5
L 01— PL&
STREET FILE
,OA-lo" ;i149-0
I
NOV - 6
PERMIT COUNTER
z 0 rvc 0 9 s- cc9
APPROVED BY PLANNING
'a
ny
X
m
0
C�l
m
rn,
MD
Ado-
rjj. potA e,
r
CC
----------
04,)
'T Fo- K�sb (L)
ARR �9* c E li Vz�s
i U L 1 11,31
PERMH OVOUNTE-3�
AL
W pow-Aspowl
uj
uj
cn
235U, lav'k,
SITE PLAN
File No:
Ownei/Occupant:
Propeity Addiess:
Date of Inspection:
EC930818
Thue/ N/A
N/A (Not Yet Avalaible)
Edmonds, WA 98020
08/18/1993
CITY CLERK
CPA* CUNTIM
AIV 47
7-- A4 Of -V
4- MO
14BZ6 -- ` i
1-A- 14 ZI
V- W4&?d'
wREET FILE
Recelveo
MAY 2 6 1994
PERMIT COUNTER
AV,W,W.A-e 444AC .4CLA4.. Mr*`7417-
5HIZZIM; -A7#44
pr�,f - —OW
1,v x440 AAeo --dW -a 4, r47A.I &.9 4
" 11
W-
- it
,r~;q.w -e --j7c
CAMP& YWAAdw Avwqpj
ewarrW ',,t 39ggO357
IN2
AV. P. W. linVI, rNIGINURING DW.
P LXAMMILO
900515 5 9 ;u NEWIMS AM ftw�clql-
Obl
C/ Z
—00/-00J-0 302-
00/-0 a /,�SDO
L—r G.a.wwd Fom By App.iisol So6m,* Copany (206) 775-3620
................... . .
X-1
�Ipu 01-
co
14 Ile4-
77
CO2
C.
Y-01
-!City-a Edmonds
RIGHT-OF-WAY �Q,'ONSTRUCTION
rVAIrl-11VUL IL
Permit Number.
Issue Date:
A. Address or Vicinity of Construction: a��SNO zi
r\ Nle- nK orx h, x (,N
8 9 0 -.1 9 9 B. lype of km specific): 15.= rM2�
Contractor: Contact:
Mailing Address: 2L\C) L,)-f Phone: 2.
State License #: r-c�MQW k% 98QDL�o Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. 0 Commercial Subdivision El City Project Utility (PUD, GTE, CABLE, WkTER)
F1 Multi -Family Single Family E] Other
INSPECTOR: INSPECTOR:
V
F. Pavement or Concrete Cut VYes 0No G. Size of Cut: x H. Chargq_$
APPLICANT TO READ A GN
INDEMNITY. Applicant understands and by his signature to this application, agrees tih ty ofEdmonds harmless from injuries, damages, or
e 0
claims of any kind or description 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 ofany legalproceedings including defense costs, I i J
and attorneyfees by reason of, gilitntingithispermit.
THE CONTRACTOR IS RESPONSIBLE 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 TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work re6ired with per I miCa'pplication.
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.
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 statements and understand thepermit requirements and thepink copyof thepermit will be
available on site at all timp4jor inspection purposes.
Signature:&'L&�u d=&Qa11A Date:
(Con tra�ior or Aknt)
CAtl, DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME AUTHORIZED': VOID AFTER q 0 DAYS
RIGHT OF WAY DEPOSIT 10 te'011'C-4
DISRUPTION FEE/FUND, Ill:,
SPECIAL CONDITIONS: —RESTORATION FEE:
PERMIT FEE:
TOTAL FEO
COMMENTS:
- RECEIPT.
/ N, _i , ,
DATE:
ISSUED,,BY;
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
'�b - i. --ml
t-4
L4
-R,
1476
7/87
PUBLIG.UTIPTY DISTRICT NO.1 OF SNO HOMISH COUNTY
REV.
06T
L�kY
AREA:
REASON;
---W.O. NO.
T 2-7 R 2� DATE
1/4 S
7
-ow 7-
ENGINEER G. NO.
-U.'G. NO.
DRAFTER
7 SCALE I
DATE PRINTED
.:rMA01 CTCn
rN A TC- UIADV ROVED
�..:BSTATION
!CUIT NO.
C4-
Ln
Tw
- NT/
1A
PHASE
T- --i -T -1 T -7
17
4
L; I'l- L-i
+ -7 T 1
r i
14
T
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Lk
aww gem
L-4.)
IFQbm -T)k 1�
(D,;; � c)c)—X'A k\,M \03 —x C)
1�� lilkfon, ILI .... .....
f M)PRACT KC P-A
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174
L-17833-X*-�o C'L�tT "T I -A Z; L�) lel e (,j
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F
-----------------
'o N-10786,JZ
1-170
FU25
1169
1- 172
L - 10626 - X
1 71
\c\c
21 20 '19- 18
City. of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number.
Issue Date:
A. Address or Vicinity of Construction: I.AJ
89 0 B. Type of Work (be specific): a xr,
C. Contractor: go- yx T�kAw_ Cok"
MailingAddress: 111)S__6 �54)lLr_ W
State License #: fZo Joek 47- yo�N-.,va
D. Building Permit #(if applicable):
Contact: J)j(,N6-01-T q
Phone: K�) -Z --x ya
Liability Insurance:y9,?1,,4w_;,Bond: $
Side Sewer Permit # (if applicable):
El _]� -
Commercial Subdivision C1 City Project E] Utility (PUD, GTE, MING, CABLE, WATER)
EJ Multi-Familyx Single Family Other
INSPECTOR:A4., C I14SPECTOR:
F. Pavement or Concrete Cut: OYes - []No G. SizeofCut:__�? x H.- Chargq,$ MIA
4—
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmlessfrom 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 its departments or
employees, includingornot limited to the defense ofany legal proceedings including defense costs, andattorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE 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 TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
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.
Traffic 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 statements and understand thepermit requirements and thepink copy of thepermit will be
Uvailable on site at all times for inspection purposes.
Signature: z�� -7" - Date: 7he) /9!��
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY� USE ONLY�
I
A/A
APPROVED BY.
RIGHT OF, WAY DEPOSIT
TIME AUTHORIZED- VOID AFTER
430, —.DAYS 'DISRUPTION FEE/FUN D Ill:
Z 1,10FOWQZ�e
EAV"14 IPA/41"'RESTORATION-
SPECIAL CONDITIONS:
FEE:
PERMIT,FEE:
TOTAL FEE.
COMMENTS:
RECEIPT FEE�
DATE:
SSUED BY:
NO WO"RK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
I Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
El YES
Date:
Date:
IN