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311 MAIN ST
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Q 'of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number.
Issue Date:
A. Address or Vicinity of Construction: - 311 Main St (9608237)
B. Type of Work,(be specific): Install Service
718, 910 W19
C. Contractor: Washington MaturalL Gas Contact: Mariamne Kingsbury
MailingAddress: 1122 75 St SM Everett Phone: '456-7500 XZ596
State License #: 98203 Liability Insurance: Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. [3 Commercial El Subdivision E] City Project FL] Utility (PUD, GTE, WNG, CABLE, WATER)
n Multi -Family E] Single Family n Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut [M Yes 0No G. Size of Cut: x H. Chargq�,$
-1-4ut
APPLICANT TO READ A I ND,,;�IGN
INDEMNITY. Applicant understands and by his signature to this application, agn6is to.416 the City ofEdmondg har-i.' . fro,,� ries,#amages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be madelagainst the City of Edmonds, or any of its departments or
employees, including or not limited to the defense ofany legalproceeding8 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 BEPROCESSED 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- mif -spected during progress and at completion.
Restoration is to be in accordance,with City Codes.
Street shall be kept clean at all times.
7'raffic 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 imes for inspecti
/rn purposes.
94
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Signature: Date: 3-11-96
Vontractor 6r Ag�nt)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
AP PROVED BY: 1-2
TIME AUTHORIZED:. VOID AFTER H4Y /-7 DAYS
SPECIAL CONDITIONS: AIA
COMMENTS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND 111:.
RESTORATION FEE:
PERMIT'FEE: 5:0,422
TOTAL FEE:
RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
I Comments:
I Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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AWaO*VIon[mWCcnr"
Addendum to: City of Edmonds
Right of Way
Permit Application
Submit ted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596
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CLA (t,4
-ALA--T=-y
Key:
-W- Water
Watermain depth t-,Nc> It,1t)IC -G- Gas
-SS- Sever
gas main Water hydrant
0 Water valve
Washington Natural Gas Company
1122 75th Street S.W.. Everett. Washington 98203, (206) 355-3331
APPLICATION
for
City ������d�
SmmE UW9oRoFAAm
EAms�ms�vT No .................................
NEW CONSTRUCTION ��s�u�� [] -
OVVNmmm ...................Rm oldDeI
'---'-'-------'----------------- ~~^`^^~^~^~~^----------..................................................
----- PERziuwNo ............
Dye Tested On Sewer
June, 1972
I
—7 — -------
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
-1'6 5 �� A, Y-(, ,-I'
MAILING A�ORESS
CIT. ZIP TELEPHONE NUMBER
. f led 10 0-:)9 637- F 76 4�
NAME
ADDRESS
NJ; -
CITY ZIP TELEPHONE NUMBER
Ai -N3-3763
ZONE PERMIT
NUMBER
JOB SUITE/APT It
ADDRESS . 311 Kka V-1 S I --
LEGAL DESCRIPTION CHECXI SUBDIVISION.NO. I LID NO. ro
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP A�Ploved 11
RW Permit Required 0
EXISTING - REQUIRED DEDICATION
Street Use Permit Req-d 0
Inspection Required 13
Sidewalk Required 11
METER SIZE
LINE SIZE
.0. (jFfjIf;1-URES
PRV URED
1
1ESj?1NO
REMARKS
NAME
v) u E
ja � I VIC
ADDRESS
Ave ,A,,
ENGINEERING MEMO DATED REVIEWED 81)
CITY" zip
? I
SecAc 9 -7 71
TELEPHONE
f) q-
NUMBER
J, q
L
FIRE M 0 ATE D REVIEWED
-7
STATE LICENSE NUMBER
OV� S 07 �L N 0
EXP
RATO
Wrl
SIGN AREA
ALLOWED I PROPOSED
SEPA"REVIEW
c6mPLETf' EXEMp.T
EXP
QA0 NO.
P 7A
Legal Description of Property - include all va—ments
Fno�o D-01- ELY
SHORELINEII
LOT -ATO�
EbrItiv
VARIANCE OR CU
1
PLANN14G_BtVIEW 13Y
1 6- �)
OA�E
3� 71f
SETBACKS - FEE T
FRONT SIDE I
HEIGHT LOT
COVERA6E
Property
Tax Account
Parcel,No.
5� 4 CIL - 017-
-in
REMARKS
El�NEW 'RESIDENTIAL ECH
COMPLIANCE OR
ADDITION COMMERCIAL 0 CHANGE
;Z,EMODEL El APT- BLDG. SIGN
GRADING FENCE
FIREPAIR 1:1 CYDS. E] I x -FT)
WOODSTOVE SWIM POOL
DEMOLISH INSERT 1:1 HOT TLIB/SPA
FIGARAGE RETAINING WALL/
CARPORT E] ROCKERY 1:1 RENEWAL
]PROGRESS
Pilo A
5
CHECKED BY
TYPE OF CQNSMUCTION
I
OCC
SPECIAL INSPECTOR
REQUIRED 0 YES
AREA
occk)P&U'
LOA
REMARKS
INSPECTIONS, PER. UBC 108
1 (TYPE. OF USE, BUSINESS OR ACTIYITY) EXPLAIN:_
N . U�6E�R NWUMBLER OFP� RITICAL A LL6(j14ajj;,--
EL NG IC
OF D AREAS
STORIES UNITS.. NUMBER
DESCRIBE woF(k TO BE DONE (ATTACH PLOT PLAN)
�JFINAL INSPECTION REOUIRED
11-1,�,-LM Cook,',
VALUATION
jy-e<'±Voo o-1
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to
PLAN CHECK FEE
VI-lett Code
BUILDING
HEAT SOURCE:
GLAZ1WG
PLUMBING
'Plan Check No.
MECHANICAL
GRADINGIFILL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curts, sidewelks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
ENG. INSPECTION FEE
7d
"Applicant, on behalf of his or her spouse, heirs, assigns an
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successors in interest, agrees to indemnify, defend and hold
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harmless the City of Edmonds, Washington, its officials,
5
employees, and agents from any and all claims for damages of
a:
<
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
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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; ;hat the
information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and in doing the work authoriz-
AUTHORIZES
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tion Insurance and RCW 18.27.
INSPECTION
t-SIQNA1jURE (OWNER OR, AGENT) DATE SIGNED
DEPARTMENT
CITY OF
EDMONDS
ATTENTION
CALL FOR
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. LIBC
SECTION 109
f".0?
A,
.APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and. receipt is
acknowledged in space provided.
lIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
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