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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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(OR NAME OF BUSINESS)
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APPROVED BY
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EXISTING 11�0 REQUIRED DEDICATION
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED -------
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SIGN AREA
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Legal Description Of Property - Include aTI easements
ALLOWED
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TYPE OF CONSTRUCTION CODE
HEIGHT
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PRE -MOVE INSPJ swim
REMODEL 0- COMPLIANCE INSP. El POOL
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NUMBER OF ST(_)hM-S-_-'
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UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
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VALUATION
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BUILDING
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This Permit covers work to be done on private property ONLY.- GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
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driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Wor.k is Started Within 180 Days ENERGY CODE
"Applicant, on behalf of his or her spouse, heirs, assigns and
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(n successors in interest, agrees to indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials,
IT. employees, and aqents from any and all claims for rinmAne- e)f
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MEMO TO: Building Div'sion
FROM:
Engineering Division
SUBJECT: 120 /Z7-" AVE: M
A.fter review of the subject building permit application, we have
owing comments:
Connection to City water system required.
4'.'Connect ion to City sanitary sewer system required.
-o f -way pe rm i t requ i red f or a ny work on C i ty property.
R i gh t
4)� -�.�.,-Driveway slope not to exceed 14'10.
9;
5) Back water valve required if downstairs plumbing is below
elevat.ion of upstream manhole.
6Y. 'Water and sewer I ines to be separated by 10 foot minimum.
the
responsible for containing all temporary runoff and
7) Builder/owner
erosion on site and may not inipact- neig�boring properties in a*ny
way.
9)
C onstruction hours from 1:00 a.m. to 10:00 p.m. on wdekdays and
10:00 a.im. to 6:00 p.m. on weekends and holidays.
No burning of construction refuse -wit-hnii-*t-.-np:prmr;,i hir P . i re DeiDt.
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C. A.-rc-H
BA,S%N
(YENT)
DETE�MON POPE LENGTH COVrrROL CATCH
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'176 * 5LOPF-
SYSTEm CROSS SECTION
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CON-�;toe
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TO 0LJTL._E-T
76..(PJ.P.RA,P OR
KUNOTF
SPREADER,)
SEE PAGE 3 FOR OUTLET CONTROL DETAIL
2' (o" Vzz:ix. 4t SpA,%_"
2', 3r �DtE'P, V4'- CAUS$4 E D AO�K
FROM
OLMLET
CON-rROL
�RIPRAP OUTLET
ighANDARD DRAINAGE. PLAN.,4,1i,�-
DETENTION SYSTEM
PAGE I OF 3
for W.+c- -S z 0 1 z A,. tj
D(In Co
location %26 AVC ij
plan by
phone
date —
.DESIGN DATA
System Imperm Pipe
Pi Oe
Orifice:,"::
Number Area Diam
I L en th :.,Diameter,*
At
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NOTES...
1. Cal-1 Engineering Div ' isidn.(771_3202)
for prebackfill' and final inispectio'ni.'
2. Responsibility for `bpirat'fon and.J
maintenance of drainagje:.systems on
private property is -the. . r0sDonsibility
.of the property owner(s).
accumulated,in . the.storage ., pipe mus . t.
be flushed out an d,.-.remov , ed*, f rom:� , -catch'
basins t.oAllow. prope . r I op*e . ration.jhe
outlet con.t. rol. ori fici:*ust- be _kop i
open at -all t,
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R itc.F_ I V E D
jUL 1988
PERMIT COUNTER
CITY OF EDMONDS
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CITY of EDMWDS gep E St W, 'E-1' R M I T'\
PERM.IT,.NO,- -
STREET.FIL
For Inspection Call, 771-3202 07875
Address of Construction:
Property Legal Description (Incl,ude al I easements): me fro
OwIner and/or Builder: er, AL Co ns� li., i o c�
.Contractor & License No: -D 6 IS N 14
fTCCel
-Family Residence
Single
EDN40NDS
Mul.ti-Family (No. of Units T AYMENT PLANT
.Commercial (No. of fixture Units
Invasion into City Right -of -Way: No k Yes (If Yes, Right -of -Way
Constr'uction Permit required. Call One7Call-Center (1-800-424-5555) befbre'any
excavation.)
Cross'other Private Property: No V/ Yes. (I - f Yes,, easement required,
attach legal descri*pti'on and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK.
.7 /91
I certi that T have r-�ad and shall comply Date
with th items listed on the back.
Permit Fee:. Issued By:
-7-ZI
Trunk Charge: Date Issued:
Assessment Fee: Receipt� No.:
Partial Inspection:
Comments, Date Initial
Final Inspection Approved: 101
Date Initial
Rejected:
Reason Date Initial
PERMIT'MUST BE POSTED ON JOB SITE
Wh-ite Copy - File Green Copy. —Inspector
Buff Copy - Applicant
Side Sewer Drawing
The City of Edmonds EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION Ez� REPAIRS F� LID NO - ------------------ ASMT. NO - ------------------
OWNEP - ------------------------------------------------------------------------------------------------ CONTRACTOR—DC-1-1 --------- -- A. ------------------------------ PERMIT NO.
C>
JOB ADDRESS .3-a--b -------- �. ),
------------------------------------------------------ LEGAL DESCRIPTION: LOT NO.
- ---------------------------- BLOCK NO - ------------------------------------
40
0
PWW-0001-11/75 (REV.11/78) DATE 1?-.= ---- t.-
-dig Tyl 4�A
--------------------------------------------------------------------------------------------------------------------------------------------- -------------------
NAME OF ADDITION ---- ---------- \
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W(P-O-C_ 0�0 A'_D490
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Approved:
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........................ By
EDf\A0NbS
TREA'fi'AENT PLANT
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CITY OF EDMONDS Permit No.
COMM.0NITY SERVICES DEPARTMENT Issue Date
RIGHT - OF - WAY CONSTRUCTION PERMITSTREET FILE
A. 0 Owner: Washinqton Natural Gas B. 0 Contractor
Name
ADS-356 Av
M-affi-ng X-dare-s-s'
BP_1_1t-_iriiP.,AWA qRnn7
City State Zip
9 Address or Vicinity of Cor
Type of Work to be Done:
Same
Name
Mailing Address
City
State License Number
3 -2
.0 12 AV N
State Zip
4A7-n7on
TelepSn�e Riiffiber
Work in Connection With: 0 Sub or Plat 0 Single Far9y 0 CityTrojects
4-t
F1 Commercial 0 Multifamily �tility
Pavement Cut: El Y 0 N
APPLICANT TO READ AND SIGN
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 FOLLOWING THE FINAL,INSPECTION AND ACCEPTANCE OF THE WORK.
6
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed
by City forces, at which time a debit or credit will be processed for issuance to the applicant.
• A 24 hour notice is requii ed for"ins6ection Please call Public Works: 771-3202
7 r
• Work is to be inspectediauring,progres
�and at completion.
• Restoration to be in accordance wiih� City Code.
• Street to be kept clean at all times.
4 Traffi� Control to be in accordance with City regulations.
.0 All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
no exceptions.
I understand'the above and that this permit* must . be -a'vailable at , "th� job site for i - nspec ti - on purpo ses . at all times.
Signature:
Date: 09092-88
Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
I Call DIAL -DIG Prior To Beginning Work
ISSUED BY:
fter 3 0 days.
Time Authorized: Void a
Special Conditions:
Amendments:
0
PERMIT FEE:t�:�o "6A
Security Deposit:
Receipt No.:
Fund I I I Fee:
Street Cut Dimensions:
X
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
low
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY-. Date:
Eng. Div. July M33
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CITY OF EDMONDS
[�� ZNEW
ADDITION
RETIREMENT
STREET FILE ASSET INFORMATION SHEET
ASSET NO.
ADDITION TO ASSET NO. -
,Z5� 6�p-
DESCRIPTION
SERIAL NO.
LOCATION D27 NO
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
PROJECT NUMBER
PROJECT COMPLETION DATE
COST
B.A.R.S. ACCOUNT NO.' -e)lgl- oe, !:�,3
ESTIMATED LIFE c-,�
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
[�/DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE DATE
VERIFIED BY
PROCESSED
BATCH NO.
tnp INITIAL
DEPARTMENT FILE