310 8TH AVE S.PDFlill 11111111
8709
310 8TH AVE S
CITY OF EDMONDS
m
'COMM UNITY;SERVICES DEPARTMFNIF.
RIGHT -OF- WAY'CONSTRU N�
EET lssileDdteL_
CTib FIL.E'
B. 0 Contractor:
A. e Owner: 0 ET- X/1,AJ
Name Name-
Mailirif Address Maiiini
Addiess
city State Zip City ..St9te.'
State License 'Num' her Telephone. Number
C. 9 Address or -Vicinity of Construction:
Type of Work,to be: Done:
D. Work in Connection With: 0 Sub or.'Plai 'Sin I
g e Family City Proj'ects
.0 Commercial, 0. Multifamily 0 Utilit
y
E, O.,'Pavement Cut:'. El Y �]_N -F.6,Size'1 of Cut� x
APPLICANT TO READ AND SIGN
INDEMNITY:.Applicant understands iand his 'sigfiature'.to�. this* application, - agrees to. hold the City of Edmonds'- -
harmless from any injuries, damages, or claims. of. any kind or, description whzitsoever,. forseen,.or. unforseen,`thatxnay�,-
6e- made: against the -City of Edmonds "; or any of' its:dep
artments-or effi s ificluding."or: not -limitedto the defense
.. V. . . . I . oloyeq ' :_ 1�
of any legal proceedings including defensecosts, court costs, and-att6rney fees'by rnson.of granting this':pefffiit..
THE CONTRACTOR IS- RESPONSIBLE FOR wbRKMANSHIP AND'MATERIALS FOR: A -PE . R . I ; 0 . D' OF, .0 , NE_
YEAR'FOLLOWING THE FINAL INSPECTION AND. ACCEPTANCE.Of THE WORK:
Estimated restoration fees will be held until -the final street patch is completed by Cityforces, at,which.time a debit orcredit ill�be
w
processed for issuance to the applicant.
3202
e A24 hour notice is required for inspection; Please. call Engineering: 771-
*'Work is to be inspected during progress and at completion.
e. Restoratio'n to be in accordance with City Code.
e Street to"be kept clean at all times..
0 Traffic Control to be in accordance with City regulations.
0 All-str!eet--cut ditches -must be patched with asphalt,or City approved material prior to end of working day;'
-NO EXCEPTIONS.
understand the above and that this permit must be available at the job. site, for.in'spection purposes at all times..
512
Date:
Signature:
b\Jvner or Contractor
This Pe"rmit Must. be Posted a'Utfie, Job Site ForInspedion. Purposes
Call D1A.L-.*A-DIG Prior to. B.egifining* Work
PERMIT FEE:
APPROVED BY:
ter days. Restoration Fee:
Z� Time Authorized: Void af
Special Conditions: Receipt No.:
V)
�Tund'. I I I :fe
Stfeet'Cut,Dim6nsions:
RELEASED:BY: Date INSPECTED By Dat6-L
0
R1*O
NO, WO]kK'46AVAN', 11 T-61 PtRM TASSUANCE
Fn'g. MafckA989:'.
Date Sent To Engineering
v4l
ENGINEERING APPROVAL FOR OCCUPANCY
MEMO TO: Permit Coordinator
Building Division
FROM: Lyle Chrisman
Engineering Inspector
DATE INSPECTED: //--Z Z-q(f)
SUBJECT ADDRESS: ':�/o 0-
PERMIT HOLDER: PERMIT
-74— PERMIT APPROVED FOR FINAL
PERMIT NOT APPROVED FOR FINAL, SEE REQUIREMENTS
Requirements:
2.
3.
4.
5.
Additional Comments:
a
q:*1
00
C)
CITY of EDMONDS S I D E S E W R I T
For Inspection Call 771ST2REET FILE PERM
jT-'_Q. 07 2
'45
Address of Construction:
Property Legal Description (Includeall easements):
Owner and/or Builder: J61 4 45 P/?, Ale )4- /An ..r I -
Contractor & License No: BZ_
Singl:e Family Residence
EDMONDS
Ef
N_r PID
Multi-Famfly (No. of Units PL-N
Commercial (No. of fixture Uni t s
Invasion into Ci ty Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required. Call One Call -Center (1-800-424-5.555) befdre any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
REC E IV ED
OCT, 12.1988 F;
I certify that I h�ve read and shall comply.
with the items listed on the back. PUBLIC WOkKS
Permit Fee: 30 00
Trunk Charge: 25, vo
Assessment Fee:
Partial Inspection:
Issued By: J—Z 6
t,Date Issued: 10-12- W
Receipt No.:
Comments
Final Inspection Approved: 42A 64
Date Initial
Rejected:
Reason
PERMIT MUST BE POSTED ON JOB SITE
__9a —te -Initial
I
D Tt67 Initial
E
Wh.ite Copy - File Green Copy -'Inspector
Buff Copy Applicant
it
The City of Edmonds Side Sewer Drawing EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION REPAIRS LID NO . .................. ASMT. NO— - -----------
'Ql
OWNER ............................. -------------------------------------------------------------- CONTRACTOR x;x - ---------
...... ----------------------- PERMIT NO.Q_.�_q._�.;�
JOB ADDRESS ------- IF --------- ------------------ LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
NAME OF ADDITION --------------------------------------------------------------------
Approved:
-------------------------------------------
E 0 N C S
-TIR�l.'-,,%�f:l�t:F��'�F--�*t--A'�T
�m
PWW-0001-11/75 (REV.11/78)
DATE t ......... By ............................................................
t ---------------------------------
C6mputerILWORTREET FILE
BACKFLOW PREVENTION ASSEMBLY
TEST REPORT
RETURN NO LATER THAN
.0 a it CONTACT PERSON
NAME OF PREMISES --, A Jt I
SERVICE ADDRESS
LOCATION OF ASSEMBLY -,AZ tA C01-n e i�
ASSEMBLY
TLIPER MODEL SIZE
RECEIVED
$EP 12 I*U
PUBLIC7-WORKS
LINE PRESSURE AT TIME OF TEST LBS. TYPE OF ASSEMBLY )b C�
Reduced
Pressure Assemblie's
Pressure Vacuum
Breaker
Relief
Double Check
Assernble s--
Air Inlet
Check Valve
1 st Check
2nd C heck
Opened at
psid
psid
Valve
Initial
DC -closed tight
Closed tight
Opened at
Did not open
Leaked
test
Leaked
RP- _ psid
psid
Leaked
Recairs
and
Materials
Used
DC -closed tight
aosed tight
Opened at
Opened at
RP- _ psid
psid
I psid
psio
AIR GAP INSEPCTION: Required minimum air gap separation provided ... Ye s �j
REMARKS: (� 9-tz. —. - -01/
THE ABOVE REPORT IS CERTIFIED.IR BE TRU
Y
INITIAL TEST PERFORMED B
REPAIRED BY
FINAL TEST PERFORMED BY
N o 7j
C E R T. NO. 6Y�7�- 6 Q DATE
CERT. NO,
DATE
DATE
I? ?_C� 0
Permit No. L
Issue Date
B. e Contractor: Pmli,c CAVe (Cw,�s
Name
go. S
M2 blinWAv./
M u ev/9
City State zip
1&16F . cay - � 6.? 6
State License Number Telephone Number
"//)u / S'
nt*SUb--or` Plat 01%ingle Family ity Projects
Itifamily
pplication, agree
ption whatsoever
mployees, includ
rney fees by reas
ND MATERIA
�4CE OF THE W
be held until th
suance to the ap
orks: 771-3262
oved material pri
i
ob site for irispe
Date:—
te For Inspect
1. V �
gInning Work
MIT FEE:
rity Deposit:
ipt No.:
I I I Fee:.
t Cut Dimension
x
ERMIT ISSU
El Commercial El �Mu utility
z
Pavement Cut: Y El N
U04
-4 APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this a s to hold the City of Edmonds
>1 harmless from any injuries, damages, or claims of any kind or descri , forseen or unforseen, that may
be made againsf *the City of Edmonds, or any of its departments or e ing or not limited to the defense
of any legal proceedings including defense costs, court costs;,,4nd atto on of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP LS FOR A PERIOD OF ONE
YEAR. FOLLOWNG THE FINAL INSP�tCTION'AND ACCEPTA ORK.
0
U Funds held from the Security Deposit (estimated restoration fee) will e. final street patch is completed
by City forces, at which time a debit or credit will be processed for is plicant.
0
• A 24 hour notice is required for inspettion*;' Please call Public W
• 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 appr or to end of working day;
no,exceptions.
J
I understand the'A6ve -a' t at this 'permit', m u, st, be available ai`71f he j ction purpos6s at all 1imes.
Signature: /A/
Owner or Contractor
This Permit Must Be Posted at the 4, ob, Si ion Purposes
/CA11 DIAL -DIG Prior -To Be
>, ISSUED BY: — �__S
Z Time Autliorized: -Y,'id
P
Special Conditigni:1
Lo
CITY OF EDMONDS 6TREET FILE
COMMUNIT-YISERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. 9 Owner:
Name,
�rs 3,3 1,N
,Ln&d d r e q"o
)l 1AJA
City State Zip
Address or Vicinity of
Type of Work to be E
Work in' Co*nhe'c�tio*nVithi:
PER
Secu
Rece
Fund
Amendments: Stree s:
U
0
NO WORK TO BEGIN PRIOR TO P ANCE
V . -b *
after days.
Eng. Div. July 1985
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept.)'
Comments:
I Diagram:
�ec I
9
CONTRACTOR CALLED FOR INSPECTION 1:1 YES El NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
*1 "'n o.". �' :r-
'CIVY"bF EDMONDS M E71 Permit No. 0' 9-c2 3 �7
COMMUNITY SEIkVICES DEPARTMENW rl L; ET F I L E Issue Date
RIGHT-OF-W,�Y CONSTRUCTION PERMIT
J le
A. Ownere'J 94 B. *,Contractor: . f oc 41 (Ahlri. 6Q02dox
Name Na
ai ingrAddres ai iV AdMss
M
—%O--ZO
-State Zip City 'v' State 1p
P_ r,( / ILV5:: (41
State License Number Telephone P4u_�&-r7
on*
9 Address or Vicinity of Coii�iructi
Type of Work to be Done-_-,, colle
ts:
r W" 'El' 1(fity'Pr6jec
o'k i �04 �
onhection ith:'
/_;/
0 Commercial 0 Multifamily utility
z
.< P�Lvement Cut: Y 0 N
U
APPLICANT TO READ AND SIGN
a4
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or unforseen, that may
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 costs, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE. FOR WORKMANSHIP AND. -MATERIALS FOR A PERIOD OF ONE
YEAR FOL �LOWING THE FINAL,JNSPECTION AND ACCEPTANCEOF THE WORK.
0
U Funds held-ft6m the Security Deposit, (estimated. restoration fee) will be held until the final street patch is completed
by City forces,,at which time a ae'bit-�r',"dr�dit will be processed for issuance to the applicant.
• A 24 hour notice is required-, for_)in§pe6tioin';1P)e1ase call Public Worksi-77.1-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street1to be kept clean at all ti fnies.�
• Traffic Control to be in accordance with City regulations.
.0 All street -cut ditches must be patched with asphalt or City approved material P prior to end of working day;.
no exceptions.
I und6rstand -the.rabo e-a that this':per ffift must- be-�v'�ailable -at thej6b site for inspe oses at all iimegv
-Signature: Date: —
Owner or Contractor
This'Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
ISSUED BY: PERMIT FEE:
C/
z Time Authori'7ed- Void after- o ays., Security,Deposit:
0
Special Conditions: Receipt No.:
Cn
Fund I I I Fee:
Amendments: Street Cut Dimensions:
U X
0
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTION NOTES (Fund I I I Route copy to Street bept.)
Comments:
Diagram:
a
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: ".Date:
f I
Eng. Div. July 1985