405 9TH AVE S.PDFIIIIIIIIIIII
9940
405 9TH AVE S
APPLICATION
The City of Edmonds for
SIDE SEWER PERMIT
EASEMENT No . .....................................
NEW CONSTRUCTION REPAIRS 0
103-07000
OWNER ...... B. Olson
............................... .................... .............. ................. ............. CONTRACTOR ................................................................... .......................... PERMIT No. -... ..................
A�DRESS ....... 40.5 ... . ... 9th ... Aveaue ... S ....................................................
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ..................
NAME OF ADDITION
DYE TESTED ON SEWER
JULY, 1972
Approved:
DATE. ............................................... By ......... ............................................. ..............
96
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:City of Edmonds
,I EErfff-0E-V11&l�WTRUCT10N
PERMI Permit Number: e;�D
JAN 14T02
Issue Date:
ENGINEERING
A. Address or Vicinity of Construction:
B. Type of Work (be specific):
C. Contractor: Contact: k
_4 Phone:
ress:
Mailing Add,
Liability Insurance: Bond: $
State License #:
D. Building Permit # (if, applicable): Side Sewer-�P'err"' (if a'�plicable):
El Subdivision City Project E] Utility (PUD, GTE, WNG, CABLE, WATER)
Commercial
F1 Multi -Family Q Single Family Other
INSPECTOR: LYA-9 CHXISA4A&� INSPECTOR:
F. Pave=4, or Concrete Cut 0 Yes 0 G. Size of Cut: x H. Charge$
APPLICANT TO "AD AND,SIG§
INDEMNITY., Applicant understands and by his signature to this applicad to h Id the City of Edmonds harmlessftom injuries, damages, or
a��y at the Clty qJ'F#monds, or any of its departments or employ -
claims of any Idnd or description whatsoever, foreseen or unforeen, that m �be!eagll 0
ns,
ees, including or not limited to the defense of any legal proceedings incl ense cos I fi b ofgrandng this permit.
ees y reason
'7, an . a7o
THE CONM CTOR IS RESPONSIBLE FOR WORKWANSHIP AND 4'A NE YEAR FOLLOWNG 7WE FINAL INSPEC7YON
LL
AND ACCEPTANCE OF THE WORK EST[MATED RESTOR,47TON FEES BE HELD UN77L 7HE FINAL S7REEr PATCH IS COMPLETED BY
Cf7Y FORCES, A T WHICH 71ME A DEBIT OR CREDIT WLL BE PROCEMS, ED FOR ISSUANCE 70 THE APPLICANT
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Department- 771-3202.
Work is to be inspected during progress and at completion.
Restoration is to be in'accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and�'Public S I afety 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.
I have read the above statements"4d um I �erstand the permit requirements and the pink copy of the permit will be a�ailable
JC_
on site at all tim�sfor insp ction urpos Le ' $.
Signature:
Date:
(ContraptoLor Agent)
CALL DIAIA-DIG PRIOR TO BEGD4NING WORk
nvi
APPROVED
'�:DAYS
TIME:x HORIZ
AVT
M,
77 7
7 Engrg. Div. 1991
Eng. Div. July'1985
640
f-67,
Kj(
44
Sol
Pilchqqk Contractors, I
Job #
Paie-�
. -�*o
Sheet I Of I
NAME I'AA
MHOM
WON
. C139013
Hminws
"INSIN /
0
WORK AREA
IN PARKING LANE
- U-
LEGEND
2 8_:
8" TRAFFIC CONE
AF
W Wo
ORK AREA
M"', . ,
TPAFFIC FLOW
WORK VEHICLE
SIGN LOCATION
APPROVED AS NOTED
BY EN INEERING
Date: 401
H
Notes:
1. All signs and spaclng�toconform
to MUTCD & City of LOLL -
Traffic Control specs.
2. Channelizing devices are 28"
traffic cones.
3. All signs are 48" x 48" 8/0 unless
otherwise specified.
4. Alert affected residents.
5. Work to take place between 9 a.m.
And 4 p.m.
6. Maintain two 1 V lanes.
7. Work area will be q I I U\/ of C/L of
— A kV6,8 & C�Wld of C/L of
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SIGN SPACING
MPH
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35
350,
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200'
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100,
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50-I.Sec"e)
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b((200'SeaTdc)
ROAD
WORK
AHEAD
CHANNELIZATION DEVIa SPACING
MPH
TAPER
TANGENT
50/70
40
80
35/45
30
60
25/30
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CA FILE NO.
Critical Areas Checklist
---------------- ---------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
I . Site Address/Location: q 5— Q+ 1, N ,�c 5 -
2
3
4
5
6.
7
Property Tax Account Number: !tf� �Y_,g 0
or zo
Approximate Site Size (acres or square feet):
Is this site currently developed? yes; _ no.
If yes; how is site developed? e V\c) yn e
Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of I 0-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% a vertical rise of
10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
Site contains areas of year-round standing water: ; Approx. Depth:
Site contains areas of seasonal standing water: ;Approx. Depth:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- No
round? Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site:
.. . . .. ....... . ... ..
------------------------ � ------------ -------------------- — ------ ---
Site.is.Zon
G L, 0 Pe,
.1. Wetland inventoryor.C.A.. map. indicates wetland presenton site9
Critical. Are.a.s....10ventory,or C.A. map. indicates.Critical Area...on....s.ite?..
..........
:::5_:,:: Site.mithin &�ig pated��earth�subsidenize.laiftdslide.:hazard:: ea?
............ ... .....
.... .... ...
.... .. ..... ..... ........
:6.*' Sit6,designat�d:6n�.ihe:EnvirbilibeiitAlly Sensitive Areas Map9 .... .......
DtTEIMNATION
Aca.chk.doc; Rev 10/03/97
ED
City of Edmonds
. . . . . . . . . .
Development Services Departinent
...... . . . . . . .
Planning Division
Phone: 425.771.0220
I J)C.
'D
Fax: 425.771.0221
Critical Areas File #:
Critical Areas Checklist Fee: $45.00
Date Received by Dev. Serv. Dept:
City Receipt No: -
Date Mailed to Applicant:
CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City of
Edmonds Prior to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The
information needed to complete the Checklist should
be easily available from observations of the site or
data available at City Hall (Critical areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
PLEASE PRINT CLEARLY
Owne plicant: Applicant Representative:
paw
Name Name
qO5 K�E 5
Street Address Street Address
6MO 4 O.S WN
City State Zip
C qze) -7-7 0!9
TO!7e V��c��
CVOI�
Signature
Date
d:receptiontjanatCACLHandoLd.doc
City State Zip
Telephone
Signature
Date
Revised 4/1012000
THESE MINUTES SUBJECT TO
UST 7, 1990 APPROVAL
EDMONDS CITY COUNCIL MINUTES
JULY 24, 1990
(WORK MEETING)
The regular meeting of the Edmonds City Council was called to order at 7:00 p.m. by Mayor Larry
Naughten at the Library Plaza Room, 650 Main St., Edmonds. All present joined in the flag salute.
I
PRESENT
ABSENT
Larry Naughten, Mayor Steve Dwyer,
John Nordquist, Council President Councilmember
Roger Hertrich, Councilmember Bill Kasper,
Jo -Anne Jaech, Councilmember Councilmember
William Kasper, Councilmember
Jeff Palmer, Councilmember
Jack Wilson, Councilmember
rnN,r,FNT AnrNnA
STAFF
Bobby Mills, Public Works Supt.
Peter Hahn, Comm. Svc. Director
Arvilla Ohlde, Parks & Rec. Mgr.
Bob Alberts, City Engineer
Ron Schirman, Asst. Fire Chief
Scott Snyder, City Attorney
Jackie Parrett, City Clerk
Margaret Richards, Recorder
Items (B), (K), and (N) were removed from the Consent Agenda. Item (D), Authorization to pur-
chase from Allied Body Works one flatbed, crane, and tool boxes, to be installed on 1990
Chevrolet cab and chassi for sewer division ($5,247.17), had been withdrawn from the agenda by
Staff because the informal quotes were above the $5,000 limit so formal bids are required. Item
(H), although approved, was discussed during the Council portion of the meeting. COUNCILMEMBER
WILSON MOVED, SECONDED BY COUNCILMEMBER JAECH, TO APPROVE THE BALANCE OF THE CONSENT AGENDA.
MOTION CARRIED. The approved items on the Consent Agenda include the following:
(A) ROLL CALL
ACCEPTANCE OF QUIT CLAIM DEED FROM MABELLE KOSCO FOR 9 FOOT RIGHT-OF-WAY DEDICATION
ADJACENT TO DRIFTWOOD LANE AT 9th AVE. N.
(E) REPORT ON BIDS FOR CIVIC CENTER BASKETBALL COURT RENOVATION, AND AWARD OF CONTRACT TO
LAKESIDE INDUSTRIES ($19,609.34, INCLUDING SALES TAX)
(F) AUTHORIZATION TO CALL FOR BIDS FOR CITY-WIDE SLURRY SEAL PROJECT
(G) AUTHORIZATION TO HIRE RELIABLE FLOOR COVERING TO REPAIR SENIOR CENTER FLOOR WITH TILE
($6,720.50, INCLUDING SALES TAX)
. C.Z_A-1__ —
(H) AUTHORIZATION TO DISPOSE OF USED CENTRIFUGE FROM OLD TREATMENT PLANT AND TRADE FOR HAND
TOOLS
(I) AUTHORIZATION FOR MAYOR TO SIGN HOLD HARMLESS AGREEMENT WITH HARBOR SQUARE ASSOCIATION
J"4A TO END TRIPLETHON AT HARBOR SQUARE
P��
AUTHORIZATION TO OBTAIN APPRAISAL FOR PURCHASE OF CIVIC CENTER PLAYFIELD FROM EDMONDS
SCHOOL DISTRICT FOR IAC GRANT APPLICATION
(L) AUTHORIZATION FOR CITY ATTORNEY TO PROCEED WITH NEGOTIATIONS FOR ACQUIRING LAND FOR
§ PUBLIC WORKS FACILITY
(M) FINAL ACCEPTANCE OF WORK BY HILLTOP CONSTRUCTION COMPANY FOR OLYMPIC VIEW DR. AND
64j_ �,A� SUNSET WAY/GOLDSKITH CORNER PROJECT
gxl,R�11_ -
APPROVAL OF MINUTES OF JULY 17, 1990 [ITEM (B) ON THE CONSENT AGENDA]'
Councilmember Palmer removed the minutes from the Consent Agenda because he was not present at
the July 17 Council meeting and would abstain from voting.
COUNCILMEMBER NORDQUIST MOVED, SECONDED BY COUNCILMEMBER HERTRICH, TO APPROVE THE MINUTES. MO-
TION CARRIED WITH COUNCILMEMBER PALMER ABSTAINING.
CA FILE NO.
Critical Areas Checklist
------- ------------------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
I Site Address/Location:
2. Property Tax Account Number:
3. Approximate Site Size (acres or square feet): Zo
4. Is this site currently developed? yes; — no.
If yes; how is site developed? I ��,\ e V%,o vb e-
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of I 0-feet over a
horizontal distance of 66-feet).
Hilly; s-lopes present -on site of more -than 15% and.les.s than 30% (.a vertical rise of
10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: Approx. Depth:
I\) 0
What season(s) of the year?
8. Site is in the floodway. floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- 140
round? Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs etc) X
11. Obvious wetland is present on site:
.. .... ... .
- — -------- For::City::Staff.:Use:0n1Ym --- r ----- ----------------------
Jf. 60::
�Site,is,Zon .. .....
litAkMINATION
Aca-chkAoc; Rev 10/03/97
ED
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
Critical Areas File #:
Critical Areas Checklist Fee: $45.00
Date Received by Dev. Serv. e t '7-
City Receipt No:_
Date Mailed to Applicant:
CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City of
Edmonds Prior to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The
information needed to complete the Checklist should
be easily available from observations of the site or
data available at City Hall (Critical areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklis t, sign and date it, and submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed
copy of this form to assist City staff in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e.g., site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
PLEASE PRINT
CLEARLY
Owner/A plicant:
Applicant Representative:
Name
Name
q OE) C)- 1-1\ C- 5
Street Address
Street Address
6MO f4 O.S C)
City State Zip
City State Zip
C qZ�;) -7---� 1 - 0
T07 e
Telephone
Signature
Signature
Date'
Date
d:reception/jana/CACLHandout.doc
Revised 4110/2000
PARKER
SEATTLE / LYNNWOOD
PROPOSAL 426) 742-82-77.
JARYSVILLE / EVERETT
CUSTOMER 360) 6634226 (425) 268-0254
PREMIER RESPONSIBLE Fax (360) 653-12265
PREMIER
F
LFE N C E FOR PERMIT
0.130 M lilt
P. 0. Box 66 Marysville, WA. 98270 WHERE
ry
4608 .136 ST,.N.E., Marysville DATE Noy&Mber 6 2000
EM
State Lie. PREMIF*09SJ4 ONE REQUIRED.
ZC
SETBACKS: LENGTH: HEIGHT
FRONT 212' 61
SIDE
CUSTOMER Dawn Parker
ww
ADDRESS 405 9th AMO S e:fi!E MAn.
CITY Edmonds WA. 98020 (0 1 .... 1x6' 0
RES. 425 771 0886 Bus. Double rit
FAX lie" x4 1/8" Pressure Treated Post�) r'-\L,
q 1 �618" Gal. Steel Frame Gates included
-STYL E
C or,,)Qr
1x4 morilFIED PANEL _0
4'0 -15 -
POWER
AVAILABLE
CIOAR #1 T. K
GRAVE
HOUSE
CONICRM
7 0 Cwt
YES
F. A[RSTEP
FRONT
I. -
OUT
POST 50.
8' max
35'
SET
ONLY
BASE J111V1L)dV1 10Z
COMPLIETE
YES
J� ...... ......... I ....... VIP
0
WIRE CAM
i-w-e '? -�A ,�e 5 96-1 't5
PAYMENT IN FULL DUE ON COMPLETION
SAM WIRE C1 amm adws" aw awmw Mo i*Wr* AD OMW an 0*"w - or d"M at am oww - of go pmwv dowrill" hwwm.
CUSTOAMP ASSLWS FIJU RESPONSWUrY FOR LOCATION OF FENCE Sold f9rf" ft Of CU110m6ris fth WIPW� d9fWW
rEN. WORE GA and hold A*~ Fw" COMPaRY hWM%gg f*V*C0V d8bw Of 6nCMChfflWM C11161111I Of dill 9 90 UndWW=Wd Memo",
wowar any ~ ch*m brou"I an accouN of do ww* iwreftab" doscrftd CUSTOMW AGREES TO PAYFOR SM
LABOR AND UATEf"LS IN FULL UPON COAMETION. FurOw, custww ecknowkId9w WW ogre" Owt AR dw Qvwd Of
TERMINAL
00016cow of qmpisqLert popnew abggs*w hw*undor Is piwed In On hwi* of an anarmy, cwsMw SW poyd0unw"
rem wW cg*t cwts2!M nwmakaW Roblift few and 1.0% pow awth wX &W be scoweed.
LIM POSTS ARPRO APPROVED AND AotaYeE I V r= 0
VED BY EN �U�AIING :
3234.03\0 N DATE or-M mf no ANIKIINOM
TOP
RAIL 2'ALES TAXI 278.12 ]AN 3 0 2001
S ---1 � .- e-��
Mpfftiff
3790.25 SALES REPRESEAITATIVE Jim WOIJWF
LITILMIS Dat�.-
FIL
E-0_40NOS
DEPARTMENT
B L9 Lx
WORK
AM�Ess
fP,-7_,V2_-D DATE:—.
0�
� .;I -PiCIAL
PE,P,,hV,,OT NUMBER
COMPLAINTS KJST BE WRITTEN: NO VERBAL COMPLAINTS WILL BE ACCEPTED.
THIS FORM MUST BE.COMPLETE.
DATE zz
CITY OF EDMONDS
AX-01VIR-111
Nam: DA A) Phone:
Address:
ADDRESS OF PROPERTY TO BE INVESTIGATED:
Name of Owner:
Address: Phone: mt v-
1110;0maluiu*Nlrelm��
RESULT OF INVESTIGATION;
DATE: 6 - Z;;2 - �, /
S-1 In a-e--c-4pr,
rY USE ONLY
99�0 ���
---r
INVESTIGATED BY: 5�
e)-lf
31.4--t—
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CIT FCEIVED
OF EDMONDS Permit No. 91— -334
COMM ' UNITY S�RVICE FILE-� 7 0 3 -91
S
S%
6
fflAg�IT.
RIGHT-OF-WAY CON ERMIT Issue bate: lo 3
AJ t.(Jel_q416�
A. *,Owner: 1_5 P4 2 KE B. 0 Contractor:
Naml� Na .9/ SIL-
Tto -2
Mailinj�Addre Mailing Addre
e 7) 01vu WA gqc,20 5,UCf/6M1P7 WA
City State Zip City State' Zip
"rawmbc I.To TIT 2 (11
State License Number Telephone Number
C. is Address or 'Vicinity of Construction: q rd S
CA 14 1P P1 P C u RB -S
Type of Work to be Done: -SQDCR)1442�1, LA)Hed RAI
D. 9 Work in Connection With: [�I-Sub or Plat, 0 Single Family -,E] City Projects
0 Commercial El Multifamily 0 utility
E. 0 Pavement Cut: 0 Y EIN -F. 0 Size. of Cut: x
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this, application, agrees to hold the City, of Edmo�ds
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 d/epaWt�mehts or, employeesI 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 ATERIALS FOR A PERIOD OF ONE.
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTAN�,E, OF THE WORK.
Estimated restoration fees wilf 6e 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 required for inspection; Please call Engineering: 771-3202
• 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.'
e Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
I understand the abovAd that this available.at the job site f6if 12ns-pection purposes at all times.
iL I
Signature: UU4M Date:
wner or Contractor
This Permit -Must be Posted at the Job Site For Inspection Purposes*
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY:
Time Authorize& Void after <� -days.
Special Conditions:
RELEASED BY: Date
-J C.7v
PEkMPT FEE�.-\?
Restoration Fee:.
R eic ei i p i Nor.
Fbhd, I I 1/13eet
Street Cut Dimensions:.. -
A,
INSPECTED BY Date
NO WORK TO BEGIN PRIOR T'O.PERMIfIS'SUANCE
Fng. Div. Mardi 1989
T,
A"
" Zft
FIELD INSPECTION NOTES
Comments:
Diagram:
(Fund III - Route copy to Street Dipcl
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
� I
Eng. Div. July 1985
COnCE10t.
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CUSTOM BUILDING DESIGNS
momm 2812 Colby Evereft, WA 98201 (206) 252-6932.
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CITY OF EDMONDS
USE PERMIT
ZONE a45 (
. NUMBER 92-0D2A
CONSTRUCTION APPLICATION
,--a
-PERMIT
JOB 9 711,_ SUITEiAPT
ADDRESS 7 r.�-
ddl, :5
#
OWNER NAME/NAME OF BUSINESS
6 Av/v A4 R efs
LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
LID NO,
a:
W
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MAILING ADDRESS
0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved 13
ZIP
TELEPHONE NUMBER
_771 -7q69
EXISTING REOUIRED DEDICATION
RW Permit Required 11
Street Use Permit Req*d 0.
C1
NAME
M/6—
PROPOSE
inspection Required
Sidewalk Required 0
0
CIE
REMARKS.'t
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ADDRESS e--) -7
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ITELEPHONE NUMBE5�,
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ENGINEERING MEMO DATED
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METER SIZE
BUILDING SUPPLY S1ZE_rF
FIXTURES
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CITY _ZIP_
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TELEPHONE NUMBER
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REMARKS
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!�TATE LIWSE NUMBER
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SI,GN AREA
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Legal Description of Property - include all easements
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Tax Accpunt Parcel No
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REMARKS
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RESIDENTIAL
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CHECKED BY
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[ ]. CARPORT SWIM
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SPECIAL INSPECTOR
REQUIRED ' .
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OCCUPANCY
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OCCUPANT
LOAD
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FWOOD STOVE'1,jUI RETAINING W��L/ RENEWAL
MARKS
. INSERT ROCKERY
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:-.,;-.,_
PRO.GRE,SS INSPECTIONS PER UBC 305
NUMBER OF STORIES NUMBEROF
to
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DWELLING
UNITS
0
71
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION
REQUIRED
VALUATION
FEE
1 14
PLAN CHECK FEE
BUILDING
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, 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
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
to
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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,
2
employees, and agents from any and all claims for damages of
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whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
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modify, waive or reduce any requirement of any city ordinance
I imit in way the City's ability to enforce any ordinance
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nor any
TOTAL, AMOUNT DUE
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provision."
12 11110
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz-
THIS PERM I IT
AUTHORIZES
This - application is not a permit until
ed thereby, no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of th State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
n Insurle.
INSPECTION
acknowledged in space provided.
NATU Ft OR A9,ENTj DATE SIGIJIED
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DEPARTMENT
I I /.
CITY OF,
OFFICIAL'S SIGNATURE DATE
EDMONDS
ATTENTION
CALL FOR
WLEASjD&/ DATE
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
7711-3202
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL — File YELLOW — Inspector
Ll
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK Owner. GOLD Assessor
City of Edmonds Permit No: 02,00s- a?o
.-RIGHT-OF-WAY CONSTRUCTION PERMIT. Issue Date:
A. Address or Vicini.ty of Construction:
-D
B. Type of Work-.(b'e specific): .� I
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C. Contractor: 'Nc�nucl�� .01-OV4 contact: SWQ, i D i ck—
Mailing Address: �Ph ne'
e.
State Licen . se #: ?I LCH Olt 7 1 Liability Insurance: Bond:$
City Business License #: '1�
41
-D. Building. Perrriit # (if applicable) 31 Side Sewer Permit # (if applicable):
E. F� qommercial El Subdivision E] City ProJect [I EUC (PUD, VERIZON, PSE, COMCAST, OVWSD)
Multi -Family 2--'slin le Family F-1 Other
rNSPECTOR: ea"J,6 Z /t/c
PAVEMENT CUT: 2-YES El NO G. SIZE OF CUT x
CONCRETE CUT: [-I YES El NO I V- k,
V� C1
F,
G. Fl Mail Approved Permit Call for Pickup
INDEMNITY: Applicant understands by his/her signature to thls� application helshe holds the. City: of Edmo�nds harmless from
injuries, dama es or claims of any kind or description whatsoever, foreseen. or unforeseen, that may k� made hgainst the City of
Edmonds or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense
costs and ati��neyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR �FOLLOWING -THE. FINAL
INSPECTIONAWD A CCEPTANCE OF THE WORK. ESTIMA TED RESTORA TION FEES WILL BE HELD UNTIL THE FINAL STPEET i� TCH IS
COMPLETED B Y CITY FORCES, A T WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLIC.4NIe
Traffic control and public safety shall be in accordance with City regulations as required by.,the City Engiiieer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification". verifying completion of the
required training in their possession.
Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end Of �he workdiiy. -,NO EXCEPT][QNS. ' . _1�
Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ tik'ABO VE STA TIMENTS AND' UNDERSTAND THE PERMIT REQUIREMENTS AND A C)U9JaX,0GE
THA�IMUSTMAKE THE PINK COPY ORTHE PERMITAVAILABL I E ON SI . TEAT ALL TIMES FOR'INSPECTIONS',
Signature:
A /3 I -A, LL Date:
(Contractor or Agent)
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Approved,by:. U,4M-.ZL'
1 Fe"O/ V uh d, - f
Time Authorized: Void After I
Special Conditions g� g F_ ion
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jo& -AFj:�!e Iss'u-ed`*
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Ba4pvA t rn <rNit Duz_e AU K I�E&1) N Pv e:L\
REQUIRED INSPECTIONS: ZKNPPJC_ ('0 1,4 7-7,Zo Z_
N AL
Call 425-7.71-0220, Ext. 1326for a 24-hour voice -recorded inspection request line.
FINAL APPROVAL OF PERMITTED WORK: DATE:
Inspe4or's Signature
EAJ
NO WORK SHAI.L BEGIN PRIOR TO PERMIT ISSUANCE
CADocuments and Settings\Curtis\My Documents\Fonns\Engnrng\kOWpermit_.doc Revised 10/01/03