24109 77TH PL W.PDFIIIIIIIIIIII
6599
24109 77TH PL W
ADDRESS: qloq 17 -7 -/.7,
TAX ACCOUNT/PARCEL M 00(p 1,5(-o00000300
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS M DETERMINATION: E] Conditional Waiver 0 Study Required El Waiver
CRITICAL AREAS M DETERMINATION: El Conditional Waiver 0 Study Required El Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID#:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED: Wf�,
SIDE SEWER PERMIT(S) M
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT M
FOR:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc
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CITY OF EDMONDS
121 5T H AVENUE NORTH - EDMONDSWA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
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*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20080461
SIDE SEWER PERMIT (I -Single Family)
Permit Number: ENG20080461 Expiation Date: 12/1/2009
Job Address: 24109 77TH PL W, EDMONDS
APPLICANT CONTRACTOR
RESCUE ROOTER RESCUE ROOTER
8001 S 222ND ST 8001 S 222ND ST
KENT, WA 98032
KENT, WA 98032
253-872-7940
LICENSE #: RESCURb07Q7 EXP: 10
JOB DESCRIPTION
Y IREPAIR N I PROPOSE TO REUSE LATERAL LID NUMBER:
N GRINDER PUMP FN-1 PROPOSE TO REUSE SIDE SEWER
REPLACEMENT OF SIDE SEWER - PIPE BURSTING FROM CLEANOUT AT PROPERTY LrNETO 90 DEGREE BEND AT SE
CORNER OF HOUSE SEWER REPLACEMENT ALONG EAST SIDE OF HOUSE WILL BE OPEN TRENCH. PIPE BURSTING
SECTION APPROX. 89 IN LENGTH AND 10- ITFEET DEEP.
M U-1 53 101211 IN 0:11 -,111 IN I re
N PROJECT CROSSES OTHER PRIVATE PROPERTY
RO
P!
7NVERIrFICATION OF RECORDED EASEMENTS COMPLETE
INDEMNITY- The Applicant has signed an application which slates helshe holds the City ofEdmonds harmlessftom injuries,
damages or claims ofany kind or description whalsoever, foreseen or unforeseen, that may be made against the City ofEdmonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
allorneyfees by reason ofgranting this permit.
CALL DIALA-DIG (1 -800424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPWnON (425) 771-0220 EXT. 1326
24 HO UIR NOTIC E REQ UIRED FO R ALL INSPECTIO N REQ UES-11S
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY III E CITY ENGINEER OR HIS/HERDEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Monday, December 01
I OV
RELEA SED BY DATE
F-1 FILECOPV
F-] INSPECTORCOPY
SIREET FLE
[--] APPLICANT COPY
7
0 0
STATUS: ISSUED ENG20080461
0 Pipe material for pipe bursting section to be HDPE with tracer wire.
Pipe bursting receiving pit shall be excavation #2, per attached plan.
Excavation pit #3 to be as close to propery line as possible. 6" cleanout with 12" locking cast iron lamphole cover, with 1/2"
hexbolts, required at finished grade.
Contractorto TVsewer line at completion of project and provide copy ofTVvideo to City Public Works Department for
review and acceptance. Sewer pennit will not be finaled until Public Works has approved the installation. Contact Public
Works at 425.771.0235 or 7110 210th St SW.
• Restore ROW to City standards
• Restore Landscape to like or better conditions.
• Call for locates of underground utilities prior to any excavation.
• Public utilities maintain 5'separation from City Utilities.
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
• Maintain erosion & sedimentation control. Keep street clean.
• Construction hours are Monday -Friday 7arn--6prn and Saturdays 10am-6pn-L No work on Sundays or Federal Holidays.
• Call for required inspections as noted.
• Refer to City of Edmonds Side Sewer Information handout for approved pipe materials, inspections and other requirements.
• A 6" cleanout with 12" locking cast iron lamphole cover is required at the property line.
• Maintain 19 separation between the sanitary side sewer and the water service line.
• Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• ESanitary Side Sewer Inspection
• E-Engineering Final
• Pipe Bursting Inspection
• TVInspection
PA RTIA L INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPEC71ON APPROVED DATE: 'INITIAL:
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BY ENGINEERING
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Applicant shall repair/replace all damage to
utales; or frontage improvements in City
Itle's LF
. Fright -of -way per,City standards that Is caused
'0�0 or occurs during the permitted project.
24 HR. NOTICE REQ.
FOR INSPECTION I
OWNER/CONTRACTOR IS RESPONSIBLE
FOR EROSION CONTROL AND DAMAGE
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NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the -map(s), in cluding, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.'
Neither the City of Edmonds nor its
employees or officers shall be lia-b-le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
U
0
APPLICATION
The City of Edmonds for
STREET FILE SIDE SEWER PERYaT
OUTSIDE [] INSIDE [] REPAIRS n
CARD No . ......
EASEMENT No . ......................................
j 0
OWNERT o N A �, 1� .......... ...............
... CONTRACTOR .................................................................................................... PERMIT No.
......................... ........ T ------ ....................
STREET
HOUSE------ ;�2) . ...... VJ ............... AVENUE LOT.No . ............................................................ ......... ELOCK No . ...............................................
NAMP. Ann
T- 1-1
k>-"
APPROVED
Date Approved:
BACKIFILL WORK ORDER ISSUED ................................... DEPOSIT, ...... ......................................
.... By ...
SEWER WORK ORDER ISSUED ...... ................................... DATE,� ---- - -- ....... ..... .. .......................
M
The City of Edmonds Water Service Drawing EASEMENT NO . .................... .......................
NEW CONSTRUCTION REPAIRS 2/' LID NO . .................. ASMT. NO . ..................
OWNER .... ......
.................................. . .... ........................ CONTRACTOR .................................................................................... PERMIT NO.
JOB ADDRESS2..V�q..�-.."7..-?."'..e4.�: ........ W ....................... LEGAL DESCRIPTION: LOT, NO . ...................................... BLOCK NO . .................... ...............
..................................................................................................................................................................
NAMEOF ADDITION ... ...... .............................................................................................................
PWW-0001-11175 (REV.11/78)
I
*'�t
Approved:
DATE ............................................ By ........ . ........ ;
......................................
OV EDA., 0 Q-7
OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS,WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
I'&CO
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20080461
SIDE SEWER PERMIT (I -Single Family)
Pen -nit Number: ENG20080461 Expiration Date: 12/1/2009
Job Address: 24109 77TH PL W, EDMONDS
APPLICANT CONTRACTOR
RESCUE ROOTER RESCUE ROOTER
8001 S 222ND ST 8001 S 222ND ST
KENT, WA 98032
KENT, WA 98032
253-872-7940
LICENSE #: RESCUR*0707 EXP: 11112610
JOB DESCRIPTION
Y REPAIR N PROPOSE TO REUSE LATERAL LID NUMBER.
N IGRINDERPUMP �N PROPOSE TO REUSE SIDE SEWER
REPLACEMENT OF SIDE SEWER -PIPE BURSTING FROM CLEANOUT AT PROPERTY LFNETO 90 DEGREE BEND AT SE
CORNEROFHOUSE. SEWER REPLACEMENT ALONG EAST SIDE OF HOUSE WILL BE OPEN TRENCH. PIPEBURSTNG
SECTION APPROX. 80'rN LENGrH AND 10-12'FEET DEEP.
OEM vil I VON I t I
N PROJECT CROSSES OTHER PRIVATE PROPERTY
M77NVERIJF�ICAATION OF RECORDED EASEMENTS COMPLETE
11VDEMA1ITY- TheApplicant has signed an application which states helshe holds the City ofEdmonds harmlessfrom injuries,
damages or claims ofany kind or description whalsoever, foreseen or unforeseen, that may be made against the City ofEdmonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
allorneyfees by reason ofgranting this permit.
CALL DIALA-DIG (1 -800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPEMON (425) 771-0220 EXT. 1326
24 HO UR NOTICE REQUIRED FOR ALL INSPECTION REQUESTS
TH IS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HIS/HERDEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN
SPACE PROVIDED.
Printed: Monday, December 0 1, 20081
17-// /o
RELEASED BY DATE '
El FILECOPY KINSPECTORCOPY [_-] APPLICANTCOPY
STATUS: ISSUED ENG20080461
0 Pipe material for pipe bursting section to be HDPE with tracer wire.
Pipe bursting receiving pit shall be excavation #2, per attached plan.
Excavation pit #3 to be as close to propery line as possible. 6" cleanout with 12" locking cast iron lamphole cover, with 1/2"
hexbolts, required at finished grade.
Contractor to TV sewer line at completion of project and provide copy of TV video to City Public Works Department for
review and acceptance. Sewer permit will not be finaled until Public Works has approved the installation. Contact Public
Works at 425.771.0235 or 7110 210th St SW.
• Restore ROW to City standards
• Restore Landscape to like or better conditions.
• Call for locates of underground utilities prior to any excavation.
• Public utilities maintain 5'separation from City Utilities.
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
• Maintain erosion & sedimentation control. Keep street clean.
• Construction hours are Monday -Friday 7arrt-6pm and Saturdays l0arn-6prn. No work on Sundays or Federal Holidays.
• Call for required inspections as n6ted.
• Refer to City of Edmonds Side Sewer Information handout for approved pipe materials, inspections and other requirements.
• A 6" cleanout with 12" locking cast iron lamphole cover is required at the property line.
• Maintain 10'separation between the sanitary s ide sewer and the water service line.
• Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is
caused by or occurs during the perrnitted project.
INSPECTIONS I
• E-Sanitary Side Sewer Inspection
• &Engineering Final
• Pipe Bursting Inspection
• TV Inspection
PARTIAL INSPECTION DATE: MTIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: MTIAL:
z� TE PL-A-AJ
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Applicant shall repair/replace all damage to
utNftWs or frontage improvements in City
right-of-way per -City standards that Is caused
�*r occurs during the permitted project
24 HR. NOTICE RK
FOR INSPEC71ON
i4
2
n0WWNER/1CONTRACTOR IS RESPONSIBLE
FOR EROSION CONTROL AND DAMAGE
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City of Edmonds
Permit Application Form
Form A
Permit Application for: E]: , New Single Family
F1 InteriorRemodel: Gcirage/Ca-rport
nFence F] Oealdiniq cyds
F] Tenant. Improvement/C hahge,-Of Use
Rockery/Retaining:,WAIV
Other (Specify)
0 E, ID)
goz
E] New.Com/Apt E] Addition
Ed.Re p*air EJ sigh
E]:Storage/Shed
El Fire System (Specify)
Brief Description: Pf_PL_AuFiv��mf or- SiDL 5Ewg?_
DATE:
SiteAddress: 241oS '114" P 1. 0 Suite #
Sno County Tax Account Parcel #:
Business/Tenant Name (if applicable):
PROPERTY OWNER: 3W kkE V,) M �k N)
Mailing Address: M i 0!j I
City: Ej��M60b S State: Wh zip: 01
Phone: 7-S-) -Z FAX: Amck *jCd,CcvAe_Arr.NE7'
E-mail: ti e-L
CONTRACTOR: 0 Same as Property, Owner .90ther(Name) (?_1FS(_tAF V_ 0 6 I-E Z
MailingAddress: S00k 5. -S�T-,
City: 14.SN�;T State: W Pr zip: Iq '6 0 -� 7-
Phone: (7,5 12 ) '61"L — -7 1 H 0 - F A�X: (bzs 3 Vi -L - 7-$9 0 E-Mail: P0r-aC_arS-C_0"
State License Number: U_5C_LAR*00*7!Q-7 Exp: Date: I t> ity Business License No:
I
APPLICANT/CONTACT: DSame as,.PropertV Owner OSame as. Contractor 00ther
Fill out the following information if "Other".
Name & Mailing Address:
City:
Phone: (_)
State: Zip:
FAX: (_)
E-Mail:
L:\TEMP\BUILDING\WEBchecklists\SFR.COMM.APP.doc5/24/2007
PLUMBING FIXTURE COUNT
Number Fixture Tvpe
Water Closet (Toilet)
Sink (kitchen, laundry, bar, etc.)
Lavatory
Tub/Shower
Dishwasher
Hose Bib
Water Heater
Expansion Tank For Water Heater
Floor Drain
.Pressure Reduction Valve
Water Service Line
Drinking Fountain
Bidet/Urinal
Clothes Washer
Backflow Protection Device
Hydronic Heat In Floor Wall
Other
GAS OUTLETS
AC Unit BTUs Location
Furnace BTUs Location
Water Heater BTUs Location
Boiler BTUs Location
Dryer
Stove/Range/Oven
Fireplace/insert BTUs Location
Outdoor BBQ
L:\TEMP\DST's\FORMS\PLUMBFIX.xls. 8-31-06 update
DETAILED SCOPE OF WORK
Please provide a complete detailed written scope of work, for the proposed
project.
Additions (additional square footage): Specify room use, floor level and square footage and
direction if applicable (i.e. 545 square foot master bedroom/bath room addition on the second floor
with 140 square foot deck and 245 square foot kitchen addition on the main floor at south side of
house).
Remodels (interior renovations): Specify room uses and floor levels (i.e. combine bedrooms 1 and
2 on the main floor to create new master bed room/bath room; replace dining room sliding glass door
with new French doors, reconfigure kitchen with new island prep counter and install new gas fireplace
in the living room).
L:\TEMPNBUILDING\WEBchecklists\SFR.COMM.APP.doc5/24/2007