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ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE)JRQMI-,�
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:— 95 - 2�q DETERMINATION: E] Conditional Waiver [-] Study Required Cg4faiver
DISCRETIONARY PERMIT #'S: a R. g5* 22-1 UC q5 A
DRAINAGE PLAN DATED: q 2,5 .9 5
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
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PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: ct . 2%. q5
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER: M 1) qtQ. o.54 &m ',ea
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LATEMP\DSTs\Fbrrns\Street File Checklist.doc
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE PERMIT
ZONE NUMBER 96000
UITE APT
ADDRESS 3 Ic-llmovd-s la�
2 —3 -7/
OWNER NAME NAME OF BUSINESS
h n4- '�er� II, ) IiiiA
LEGAL DESCRIPTION CHECKI
SUBDIVISION NO
LID NO
Ovwiiso
MAILING �ODRESS
,7qoq /v 6 -)o�A 1-�
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — REOUIRED DEDICATION —
TESCP Ap ON 0
R .1 Raqu-d
W Par. N,
Street Use Permit Req-d IN,
InsPection Required
city ZIP
TELEPHONE NUMBER
1 419
NAME
PROPOSED
Sidewalk Required
A.
METER S,z E
UNE SIZE
F XTU E�
NO P1
PRVREOUIRE
U
ADDRESS
I
YE NO 0
6,15 3
REMARKS Z
T
CITY ZIP
NUMBER
0-4. Wolfo"- ��L). 'WZ
ITELEPHONE
171 k- 1141, 903
0?
Z
IS
NAME
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ADDRESS
-'? 9ov lvrr -FF--7
ENGINEERING MEMO DATED
(-P t4-v q
CITY TELEPHONE NUMBER
Z
0
FIRE MEMO D ATED REVIEWED BY
0
V-1A Ir 1?6
STATE LICENSE NUMBER EXPIRATION DATE
4, L 0
SIGN AREA
SEPA REVIEW
AOB No
Legal Descripti n of Property - include all easements
ALLOWED
PROPOSED
COMPLETE EXEMPT
Z
ed
I
7
SHORELINE a
a
A. JAJ
A
EXP
VARIANCE OR CU
PLkNNLt�q REVIEW BY
D�TE
L.--- 4-k- 1. P�- j 011—
A,
4�
43 1
FEET
(41 1%,.4-
SET11111S - HEIGHT
CO VERAGE Z
X
Property V
FRONT SIDE REAR
JLOT
Z
T x A count
P:..l No. -C)O(, -0i:n '010 1
REMARKS 77 Q.
[R
11
NEW
RESIDENTIAL
PLUMBING
CC-'
/40,
ElADDITION
El
r? 2— ogwu; r, q
COMMERCIAL
MECHANICAL
5?v
4rAA&r1y1rr"1AW,FC
El REMODEL
APT. BLDG.
L SIGN
I
,
EIREPAIII CIDS. FENCE
CHECKED BY
TYPE OF CONSTRUCTION CODE
UPANT
OCCU
GOG 21 OC UU
x —FT)
S SWIM POOL
DEMOLISH WOODSTOVE
IN ERT HOT TUB/SPA
AGA
IV
SPECIAL INSPECTOR JAREA
REOUIRED
13 YE 25&
OCCUPANT
LOAD
GARAGE RETAINING WALL/
S
CARPORT ROCKERY RENEWAL
RtMAHR5
0
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
PROGRESS INSPECTIONS PER UBC 305
rl �!A'f J( 4
NUM13ER
NUMBER OF
CRITISAL
0
M
OF
STORIES
DWELLING
UNIT
AR
NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
0
HEAT SOURCE
GLAZING
BUILDING
Z/ (1) 2 17
4) �2
PLUMBING
...
e�w
Plan Check No. ?6--170
MECHANICAL
96 -OA M 7, e
&UT
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
371
Any construction on the public domain (Curbs, sidewpiks.
driveways. marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 160 Days
STORM DRAINAGE FEE
Applicant. on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE Z117
Suc c essors in interes I , agrees to indemnify. defend and hold
harmless the City of Edmonds, Washington, its officials,
m
employees, and agents from any and all claiTs for damages of
whatever nature, arising directly or Indirectly f-rbm 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 ordinan a
nor 1.1mit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision ...
1 hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APP 0
R VAL
information given is correct: and that I am the Owner, or th.e duly
authorized agent of the owner. I agree to comply with city and
a tate laws regulating construction; and in doing the work authoriz.
THIS PERMIT
AUTHORIZES
This application is not a permit until
ad 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 Workm
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Insurance and RCW-18.27.
INSPECTION
acknowledged in space provided,
SI9):y,.,RE iOWNER OR AGENT$ DATE SIGNED
DEPARTMENT
CITY OF
0 ICIAL S SI NATURE E
EDMONDS
ATTENTibN
CALL FOR
INSPECTION
NELE EDL/ DATE
IT S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
7
,4
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL — Fiie YELLOW — Imspector
771 - 9�20
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
CHAPTER 3.
00 w,- t? PINK GOLD - Assessor
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Seattle, WA 98155
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Figure 25 25 AAAAMAKI, BORDEN & ASS .. INC%
ISOPLUVIALS OF 2-YR 24-HR PRECIPITATION IN 6141 N.E. E othell WaY
TENTHS OF AN INCH Seattle, WA gal 55
(206) 485-9711
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30 RAM K1, BORDEN & ASSOC., INC.
-ALS I W 100-YR 24-HR PRECIPIT TION 4 5055 65 6141 E. Bothell Way
S OF AN INCH Seatnt WA 98155
(206) 5-9711
123 .122 121
3Z
11
OAMAKI, BOADE I & ASSOC.. INC.
6141 N.E. Bothell Way
Seattle, WA 98155
(206) 485-9711
SPECIFY STORM OPTION:
S.C.S. TYPE-1A RAINFALL DISTRIBUTION
ENTER: FREQ(YEAR), DURATION(HOUR), PRECININCHES)
2 24 1.5
----------------------------------------------------------------------
TYPE-1A DISTRIBUTION
2-YEAR 24-HOUR STORM 1.50" TOTAL PRECIP.
------------------------- 7 ------------------------------------------
ENTER: A(PERV), CN(PERV), A(IMPERV), CN(IMPERV-), TC FOR BASIN NO. 1
0.04 90 0.28 98 6.3
DATA PRINT-OUT:
AREA(ACRES) PERVIOUS IMPERVIOUS TC(MINUTES)
A CN A CN
.3 .0 90.0 .3 98.0 6.3
PEAK-Q(CFS) T-PEAK(HRS) VOL(-CU-FT)
.10 7.67 1400
0
ENTER *d:§*path§fi1ename ext§ FOR STORAGE OF COMPUTED HYDROGRAPH:
ulr2ex
c
----------------------------------------------------------------------
ENTER: A(PERV), CN(PERV), A(IMPERV), CN(IMPERV), TC FOR BASIN NO. 2
0.11 86 0.21 98 6.3
DATA PRINT-OUT:
AREMACRES) PERVIOUS IMPERVIOUS TC(MINUTES)
A CN A CN
.3 .1 86.0 .2 98.0 6.3
PEAK-Q(CFS) T-PEAK(HRS) VOL(CU-FT)
.08 7.67 1172
ENTER *d:§*path§fi1ename*.ext§ FOR STORAGE OF COMPUTED HYDROGRAPH:
ulr2pr
OPAMAKI, BORDE14 & ASSOC., INC.
6141 N.E. Ecinel Way
Seaftle. WA 98155
(206) 485-9711
SPECIFY STORM OPTION:
I
1" o sro/yy-)
S.C.S. TYPE-1A RAINFALL DISTRIBUTION
ENTER: FREQ(YEAR), DURATION(HOUR), PRECIP(INCHES)
100 24 3.3
----------------------------------------------------------------------
S.C.S. TYPE-11A DISTRIBUTION
100-YEAR 24-HOUR STORM 3.30" TOTAL PRECIP.
------------------------ 7 ---------------------------------------------
ENTER: A(PERV), CN(PERY), A(IMPERV), CN(IMPERV), TC FOR BASIN NO. I
0'04 90 0.28 98 6.3
DATA PRINT-OUT:
AREMACRES) PERVIOUS IMPERVIOUS TC(MINUTES)
A CN A CN
.3 90.0 .3 98.0 6.3
PEAK-Q(CFS) T-PEAK(HRS) VOL(CU-FT)
.25 7.67 3445
ENTER *d:§*path0ilenameo.ext§ FOR -STORAGE OF COMPUTED HYDROGRAPH:
ulrlOOex
c
----------------------------------------------------------------------
ENTER: A(PERV), CN(PERV), A(IMPERV), CN(IMPERV), TC FOR BASIN NO. 2
0.11 86 0.21 98 6.3
DATA PRINT-OUT:
AREA(ACRES) PERVIOUS IMPERVIOUS TC(MINUTES)
.3 .1 86.0 .2 98.0 6.3
PEAK-Q(CFS) T-PEAK(HRS) VOL(CU-FT)
.23 7.67 . '3105
ENTER *d:§*Path§filename*.ext§ FOR STORAGE OF COMPUTED HYDROGRAPH:
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6-32 HANDBOOK OF HYDRAULICS
Thble 6-2. Diameters of Pipes in Inches, from the Man i S
Formula, n - 0.012 (Continued)
droP to hYdmulia arscLient Per foot
.00011.00021.0004
--
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6.9
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14.5
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13.8
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22.7
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18.9
18.4
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21.2
20.4
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19.1
18.6
18.2
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22.7
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20.5
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19.6
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7
35 8
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27.4
25 . 4
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22.3
21.7
21.2
20.7
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32.8
28.8
26.7
25.3
24.3
23.5
22.8
22.2
21.h
21.3
19.8
9
39.1
34.3
30.1
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20.6
25.4
24.5
23.8
23.2
22.7
22.3
20.7
10
40.7
35.7
31.4
29.1
27.5
26.4
25.6
24.8
24.2
23.7
23.2
21.6
12
43.6
38.2
33.0
31.1
20.5
28.3
27.3
20.5
25.9
25.3
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40.5
35.6
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20.0
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42.6
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34.7
32.8
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28.2
27.7
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is
50.7
44.6
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30.2
34.3
32.9
31.8
30.9
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20.6
28.9
26.8
20
82.7
40.3
40.7
37.7
35.7
34.2
33.1
32.2
31.4
30.7
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27.9
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68.4
60.1
62.7
48.9
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44.4
42.9
41.7
40.7
39.8
39.0
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45
71.5
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55.1
51.1
48.4
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44.9
43.0
42.5
41.6
40.8
37.8
60
74.4
65.3
67.3
63.1
60.4
48.3
46.7
45.3
44.2
43.3
42.4
39.3
66
77.1
67.7
60.4
55.1
52.2
50.0
4S.4
47.0
45.8
44.8
44.0
40.7
60
79.6
69.9
61.4
56.0
53.0
51.7
50.0
48.5
47.3
40.3
45�4
42.1
65
82.1
72.1
63.3
68.6
65.8
63.3
61.6
60.0
48.8
47.7
10.8
43.4
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84.4
74.1
65.1
60. 3
67.1
54.8
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61.4
60.2
49.1
48.1
44.6
75
86.6
76.0
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58.6
56.2
64:3
52.8
51.5
60.4
49.4
45.8
80
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77.9
68.4
63.4
60.1
57.6
55.7
64.1
52.7
51.6
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46.9
85
90.7
79.7
70.0
64.8
61.4
58.9
66.9
55.3
64.0
62.8
61.7
48.0
90
9J. 7
81.4
71.5
66.3
62.8
00.2
68.2
56.6
55.1
53.9
62.9
49.0
100
90.4
84.7
74.1
68.9
65.3
62.6
00.5
58.8
57.3
56.1
55.0
61.0
110
99.9
87.8
77.1
71.4
07.7
o4.9
62.7
60. 1
111-4
6a 1
67 01
62.681
120
103
00 ' 7
70 6
73 8
69 0
67 1
'.'i
'3.0
01.4
60: 1
58:9
54
180
too
03 41
82'41
1
76*01
72: 1
. 1
00*
66.8
04.9
63.3
1
61 .9
1
60 7
68 : 2
40 -1
1 - 09 1
96: 1
84'.
78.2
74.11
71.01
68.7 1
66.7 1
86.1
83.6
.
d2.4
67.8
=I
PIPEIS
-Table 6-2. Diameters of Pipes in Inches, from thO k116114tius
Formula, n - 0.012 (Continued)
Discharge 0 w I s. drop in hydraulic Vadisali VW 10CA
to cubic
f=act
W5 .0w 1.007
.008 1 0W
.01
001
to
-ml
.01 .06
I a.e 3.5 3.4 3.3
2 4.7 4.5 4.4 4 .2
8.2 8: 10
4.1
a 0
8:0
2
8:1
71
2.7
2.6
2
0
8:4
a 8.8 6.2 5.1 4.9
:4 6.1 5.8 5.6 a 5
i'd,
4 8 4 7
5:4 1:2
4.6
1.1
4.2
4:21
4.0
'-'
4.9
a 9
' 3
r
4.7
8.7
A ' 2
4.6
4
8:06
4
6.6 6.4 6.1
7.1 6.8 6.6 6.4
7 5 7.2 7,0 0.8
5 8
. 8.7
6.2 6.1
6.60 6:5
3
1 1,
9
. 1.1
6
4.0
.8 7:9 7.8 7.3 7.1
.0 8 3 7.0 7.7 7.4
5. 5 8
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8.7
7.0
6:,
2
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6.7
6:8
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6
3.0
6.1
5,4
6.7
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6.4
8 6
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8.5 8.8
9 8,5
8 .8
1.2 0.2 8.8
1 9.0 "
1 4 8
7.1 1.4
8 ':4
8�6 8*4
8 6 1
6
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9
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6.8
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to: 10. 101
:.
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2
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9.
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11:8
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11.9
10.9
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10.9
7 17.8 17.1 16 .5 16.0
8 18.7 18.0 17.4 16.9
19.6 18.8 18.1 17,1
114,11
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17,11, to,
16.0
16.8
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14 6
18:8
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18 0
14:51
12.6
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so 80 7 29 27.7
2380-25 20.3
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as 32:6 31:62
40 84.2 32.8 81.7 80.5
80.1 29:4
28.8
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22
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35.7 34.5 33.6
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1 1 39.
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so 4 , 4-2 40
It
43:6 40.9
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as
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9 80
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50.0 48.0 4 4 45
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7
1 87.7
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7
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0 35.2
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2.6
110
0 46:5,
1 4
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o 4
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1
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2 $5.7
4 87
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7
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a U :19
9 37:
-
U:11
0
SUBJECT: Site history for proposed Berglund Building
SITE ADDRESS: 23713 Edmonds Way
DATE: September 22, 1995
Proposal is for one commercial building on a previously
fully -developed site. The site presently contains two
buildings, one permanent and one temporary in nature. The
remainder of the site is paved with asphalt concrete and
cement concrete.
The main building on -site is a one-story Quionset hut type
metal building containing approximately 3,360 sf. This
building was constructed_in 1944, per Snohomish County
Assessor's office data.
J
Additionally, an expresso stand building i.s on -site,
containing approximately 150 sf. This structure seems -to be
portable in nature and deemed to be temporary. No date of:'
construction was listed for this structure.
The balance of the property is paved as described above. The
exact date of this paving is uncerta-in. Information from
Olympic View Water District (OVWD)-indicates that sewer was
provided to this property in 1968, and extended in 1979.
Patching of the pavement exists from the 1979 extension, but
none from the initial sewer excavation in 1968. Therefore,
our conclusion is that the paving dates after 19.68 but prior
to 1979. Testimony from employees of OVWD places the
original paving date approximately 1970.
ARAMAKI, BORDEN & ASSOC., INC.
6141 N.E. Bothell Way
Seattle, WA 98155
(206) 485-9711 .
8 *�� C� 03
9 0 . 19
C E
?dino'no
RIGHT-OF-WAS"CONSTRUCTION
PERMIT
Permit Number. 4� 242
A. Address or Vicinity of
B. Type of Work (be speci
C. Contractor: 0LA0P(_c_ Vj��f )AIME97 D�
Mailing Address: 2_:`57� ebmaj
State License #:
D. Building Permit # (if applicable): —
Phone: ' -7-74 -7'14
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. [-] Commercial E] Subdivision F1 City Project K Utility (PUD, GTE, WNG,
F1 Multi -Family F] Single Family n Other
INSPECTOR:
F. Pavement or Concrete Cut:
INSPECTOR:
Yes 0No G. Size of Cut: A- X1.5, H. ChaFgo,
/*
APPLICANT TO READ ANDWiNT,
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City ofEdmondg harmless from 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, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgranting thispermit.
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 FORO-OS, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
Construction drawing of proposed work required with permit applicdtion.
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.
Ihavereadthe bove statements and Understand the ermit requirements and thepink copy of the permit will be
p
ri I - /_�
available on si Leat all't es n_VepL!�a"urposes.
Signature: Date:
ontractor or Age4nt�, f
-A- IG P OR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVEDBY: IAI)11�4�_18
TIME AUTHORIZED: VOID AFTER `13UPIG 10—DAYS
SPECIAL CONDITIONS: Tr"Etcf (:'VAI-21 I:)'(-
WS D0_T
COMMENTS:
DATE:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FU`ND Ill:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
RECEIPT FEE-
ISS UED BY:
NO WORK SHALL BEGIN PRIOR TO' PERMIT ISSUANCE Eng. Div. 1994
WA LK WAY
FROFC6
m
---,5
713
OLY-moc Vew #00
oe+ %7
0
1 16 if DT W#EWA�
- WO&
\/\/AY
City of Edmoto
RIGHT-OF-WAY CONSTRUCTION
, I
Permit I Number. 19 t/" 0
L-sue Date: 161
u
A. Address or Vicinity of Construction:
Q5 B. Type of Work (be specific): —rr-,P" C
8 9 0 9 C� bli a m J
set- go 10 /16.'-a J
C. Contractor: Contact:
- C/Qu"& A -AD )-21_a e Ar Oe4
Mailing Address: Q Phone: Z30?/
Lola A"J54 99'
State License #: it4;W070.74 W4 Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. F] Commercial E] Subdivision 0 city Project P,'d'tility (PUD, GTE, WNG, CABLE, WATER)
J
Multi -Family [:] Single Family EJ Other
INSPECTOR: INSPECTOR:
F. Pavement or L;oncrete t-ut Li Yes LJINO Lir. bize or t_'ut: x n. txargq��
APPLICANT TO READ A �SIGN
INDEMNITY: Applicant understands and by his signature to this application, agre4s'td 441d the City of Edmonds harmless from injuries, damages, or
ghi or its 4&
hat may be madt,a Mt the City of Edmonds, or "y
claims of any kind or description whatsoever, foreseen or unforeseen, t 1 14, , _ ' itments or
employees, including or not limited to the defense of any legalproceedings including defense costs, �nd attorney fees by, reason of �rantingthispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE!FINAL
ESTIMA TED RESTORA TION FEES WILL BE HELD UNTIL THE FINAL STREET�PA TCH
INSPECTION AND A CCEPLANCE OF T11kWORIKI '4 , .
1SCOMPLETEOBYC[TYFORCESATWHk I&A(DEBIi-dWCRkDIi-147iALgk3P]iOC-Ek�Eb 'F'.'O"R'(ISSUA'N'�CE"T.O.�TifEANP"PLICANT. I
( <�_ �.v
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
available on site at all times or * s ection purposes.
Signature: Date:
�Vo7n�tractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: I_A_)� 4 e-26 RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFIER DAYS DISRUPTION FEE/FUND 111:
SPECIAL CONDITIONS: W.A: RESTORATION FEE:
PERMIT FEE: 6M2
TOTAL FEE:
COMMENTS: RECEIPT FEE -
DATE: ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
1
, N-
8 9 0 - 19 C) -
cit, o®r
y of, Edm
.4. .1 � 00
RIGHT-OF-WWCONSTRUCTION
PERMIT
PerwitNumber.
Issue Date:
A. Address or Vicinity of Construction: 23713 lKdmorLds Va (9608228)
B. Type of Work (be specific): Install Service
C. Contractor: -Wia%zhington Natural Gast
Mailing Address: I 1;_2 75 St SW Everett
State License #: 98203
Contact: Mariamne KlngsbuKy
Phone: 356-7500 X7596
Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. E] Commercial [-] Subdivision El City Project ER Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family E] Single Family Other
INSPECTOR: 114SPECTOR: C-JH-
F. Pavement or Concrete Cut R1 Yes ONo G. Size of Cut: X H. Chargik,$
APPLICANT TO READ AND'SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmondg harnilessfrom injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be ma�e ".�g�inst the City of Edmonds, of-an'y bf it's departments or
employees, including or not limited to the defense ofany legalproceedings including defense Costs, and attorney fees by reason ofgranting thispermit.
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�b ROCESSED FOR ISSUANCE TO THEAPPLICANT.
L,A,
Construdion drawing of proposed work required with permit application.
A 24hour 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
available on site att all dmes for inspection purposes.
2-22-96.
Signature: Date:
(C":'ntractor dr AFentY7
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: A 1�,
TIME AUTHORIZED: VOID AFTER AIN(- 2-8 DAYS
- I
SPECIAL CONDITIONS: \105 Q2 =RAPF1(—
Q 6 5 1
COMMENTS:
DATE:,
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND III:
.RESTO.RATION,FEE:,
PERMIT FEE: 0
-3
TOTALYEE: oc)
RECEIPT FEE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
ILAM
V
=; VG I � �V
Addendum to: City of Edmonds
Right of Way
Permit Application
V-25-4 I %��, SOMOWDC-6 W-"
,.IOF-5 9&OBZ258
z C4-rrs C>Q§-= IKI CAMWALV-
.c>t-jjv-- it�j TV-Aae� L. LA-�4p-
Watermain depth WmAcr-4L'�� SL-r-
Key:
-V-
-G-
-SS-
0
gas main
Water
Gas
Sever
Water hydrant
Water valve
'Submitted by: Marianne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596 .
06
0110
PIZOP 1�4" Pe
4SVC
550-t Q . INMee-st:Cnow
car ISV4 i�
Amw� * 0
on
NaturilGas"O'
V.N
Z--5-405, MOMOWDC-a W-A�y
,-�OF!;, 9&OBZ258
Z C4-MS OKIF- I Q CA MWAL14-
c->r-jjr-- ma TVIAYe� L. u&-�4e
Vatermain depth BL-rr-
-L-� gas main
Key:
-W- Water
-G- Gas
-SS- Sever
-& Water hydrant
0 Water valve
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Marlawne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596
th
1010
��101110
pac>p 1 �411 Pe
,Svc
?>5C)t. Q - lt�rmg�Gsjcnow
e--,r =tA j
.0
Crity of Edmon,
PGH? F-WAY CONST TfON
RE V I V5 PERMIT Permit Number.
FE B 2 1 1996 Issue Date:
ENGINEERING
A. Address or Vicinity of Construction: ZE_'Pj",9.�,rj� I -AD,.
B. Type of Work (be specific): S I' A 10 (-6n k la & 1P_ Ie e2ex 2 J_-
IA90 r
C. Contractor: i2ec-i 4�1 &'W'y'f Contact: A"I",
Mailing Address: 3711 Zg&�� 944 _vwey9J Phone: _�3 9,Z1
State License #: C /_ 2��r e) (" / P
D. Building Permit # (if,,applicable):
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. >\' Commercial E] Subdivision El City Project [-] Utility (PUD, GTE, WNG, CABLE, WATER)
F1 Multi-Famil yl�] Single Fa n Other
INSPECTOR: 4�74q�WA INSPECTOR:
F. Pavement or Concrete Cut : MYes ONo
0 Size of Cut: _y x 5-" H. Chargf�_$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from 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, including or not limited to the defense ofany legal proceedings including defense costs, and attoFney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATIONFEES 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
available on siteiot all times for inspection purposes..
Signature: L�) elptE Date:
(Contractor or Akent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
I T� , �XTT X7
run Ul
APPROVED BY:
TIME AUTHORIZED VOID AFTER DAYS
SPECIAL CONDITIONS- Z� �70_%�
COMMENTS:
DATE:
��_ -1- .
RIGHT OF WAY DEPOSIT*10
DISRUPTION FEE/FUND
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE�o
RECEIPT FEE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSiJANCE
Engrg. I)iv. 1991