338 3RD AVE S.PDFiiiiiiiiiiii
4969
338 3RD AVE S
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: Conditional Waiver Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
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
FO
WATER METER TAP CARD DATED:
LATEMP\DSTs\Fomis\Street File Checklistdoc
0
4
APPLICATION
for
The City of Edmonds SIEDE SEWER PERNaT EASEMENT No . ..........................................
NEW CONSTRUCTION C] REPAIRS 0
OWNER.... .................................................................. CONTRACTOR .................................................................................................. PERMIT No . ......................
rd
ADDRESS . ............ Ava ...... 5 ........................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAME OF ADDITION ..........
JUI)e-j /97a
Dye - -fes*o-d. On k5a war
Approved:
DATE................................................ By ......................................................................
CITY OF EDMONDS
PUBLICWORKS DEPARTMENT
Wmit No,
STROTET REIssue Date
222"
?
RIGHT - OF, - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Construction 9 Permit Issued To:
338 3 AV S Plat 164-65.002 1
e Owner: Washington Natural Cas Ca
Name
805 156 AV WE
Mailing Address
Bellevue. Wasbington 9800
City, . State, Zip Code
e Contractor: Same As Above
Name
0 Type of Work to be Done: Install New Service
9 Work in Connection With:
11 Sub or Plat 19 Single Family
0 Com ' mi. / Ind. 0 Apt. Condo.
0 Pavement Cut: El Yes El No
Mailing Address State License Number
Z
< City, State, Zip Code Telephone Number
U
::i
0.
0. NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
an
INDEMIT`Y: 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 kin ' d or description whatsoever, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of it's 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.
0
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Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
0
Funds held fro ' m the Security Deposit (estimated restoration fee) will be held until the final -street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this per ust be available at *the
Signature
Owner t
site for inspection purposes. . at all times.
Date 10/17/79
THIS PERMIT I MUSI�BE POSTE . D. . AT THE JOB . SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR.TO BEGINNING WORK
19
C. Issued By:
Time Authorized: Void after
—days
Special Conditions:
Ammendments:
Permit Fee:
Security, Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimensions
X —
** NO WORK TO BEGIN PRIOR,T0 PERMIT ISSUANCE **
Eng. Div. December 1978
FIELD INSPECTION WES (Fund. 111 - fute cony to Street Dent.
Comments:
Diagram: -P let
40
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Contractor called for inspection Yes ��-D
Work Disapproved By: Date: Bv: Date:
Work Approved BY: D a t e Z
Inspector:
Encr. Div. December 1978