412 9TH AVE N.PDF14822
412 9TH AVE N
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CIVIC I CENTER - EDMONDS, WASHINGTON 98020 - (206) 775-2525
PURCHASE REQUEST F] INVENTORY REQUEST
V STREET pTvTqToTj
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0 VENDOR,Nq
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CONFIRMATION
ORDER
Ei�wORK REQUEST
I WlJSPr25
THIS'NUMBER MUST APPEAR
ON ALL INVOICES,*:
-PACKAGES, BILLS OF LADING
-AND CORRESPONDENCE. ::I
-SHIP PREPAID TO (OR SERVICE LOCATION)
SERVICE LINE @ F412 9th Ave. N.
OATE-RE
SH.IP,VIA....
_�,[OfTE
BATCH.N.UMBE R'
PLEASE FURNISH THE FOLLOWING ITEMS:
QUANTIT�
UNIT
CATALOG
NUMBER
'UNIT"
ST",
j, TOTAL COST'-1,
-ESTIMATED 'ACTUAL
STREET PATCH FOR METER IN&PAT�T,ATT014
PAID
150-0
ZZ
SUBTOTAL
9p 4r
TAX
TOTAL AMOUNT
REQUESTED BY:
APPROVED BY:
RECEIVED BY:
BE
CODE
411. 000. 850. 986. 01 313
PROJECT,
AMOUNTI
_,_-ESTIMATE :.ACTUAL
150.00 e- 2 2.
2
3
4
5
6
7
9
10
ttnp TOTAL AMOUNT 150 .00
Z
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0
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0
0
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1
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C11'Y OF EDMONDS
PUBLIC WORKS DEPARTMENT STMEET FILE
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Construction
. 4 � 1-41 `� _n 'N 0 �i u
Owner: Th f" L'.� T �? w t
Name
i.,) f) 'i � k- 3 b
Mailing Address
City, S ta te, Zip Code
9 Contractor:p C-V U P31
Name
8 \ Q LA
Mailing Address
City, State, Zip Code
Permit No.
Issue Date
9 Permit Issued To: ie. LA - 0 �� I ') b, �,)q i; I % k�, _�4
Type of Work to be Done: 'T L(? 0 PC 1q.11
• Work in Connection With-:
D Sub or Plat Single Family
El Comml. / Ind. El Apt. Condo.
• Pavement Cut: El Yes -9 No
State License Number
r7 7 4 - .4 1) -4-
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMITY: 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, 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.
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.
Funds held from 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 permit must be available at -the job site for inspection purposes at all times.
SIP'nature: 61KAIA xj Date
Owner or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By: A),-w rA,,
Time Authorized: Vbid after ?eo3l days
Special Conditions:
Ammendments:
Permit Fee: IWS
Security Deposit:
Receipt No,: -
Fund 111 Fee:
Street Cut Dimensions
X__
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
FIELD INSPECTION NOTES (Fund. 111 - Rout.e conv to Street Dent.]
Comments:
Diagram:
Contractor called for inspection yes, No
T Bv: Date:
Nork Disapproved Bv: T)ate:,
Work Approved BY: Date:,�
Inspector:
Eng. Div. December 1978
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_c"S.FATCHER POSTED
MAPYAGE,
W.O. NO.
-r---'CITY OF EDMONDS
FOR INSPECTION CALL
PUBLIC WORKS DEPARTMENT Permit
775-2525 Ext. 220 Issue Date
SIDE.SEWER PERMIT
PERMIT -MUST BE POSTED ON JOB SITE "EET RLE
,VWMW_
�mw,mw�mw,mw,mw3w3MV2MV"ANWA��WA�
1. Address of Construction &wg — &75�Al
2.
Property Legal Description (include all easements)
L-A
R I_
);:�/Al Ir
3.
Single Family
Residence >/ Multi -Family No.
of Units
Commercial
EDMONDS
4.
Owner and/or
Builder S Yt t-e-) ,'A./
TREATMENT PLANT
5.
Contractor &
License No. 9hy- v 5 o 5r n
6.
Invasion into
City Right -of -Way: No Yes (If
Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
E-1 7. Cross other private property: Yes No X Easement required
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
a. Property owners must obtain a permit to install side sewers on
>q their property. A licensed side sewer contractor must be employed to
construct side sewers in the public' right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
UAUR
C. Commercial establishment requires a minimum ULL 9% rlYan-S(6
P4
side sewer line.
0 d. Side sewers may not be installed closer thanBRM YOU "'(30
U y
to any structure. 800
W 0
M e. Side sewer lines must be laid at a minimum grade f 2% (1.150)
0 and maximum grade of 100% (450). 0
H f. No turn in side s8wer greater than 45 (1/8�bend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and Wye with removable cap.
g . No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer 'line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k. Side sewermust be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
DATE: Al V eu_��
I certify that I have read
and shall comply With the above
PERMIT FEE: OC) DISAPPROVED BY: Date:
U r4 By: Date:
cn CONNECTION. FEE: aA:5_.. Oc)
P4 :D APPROVED By D a t e
PERMIT MUST BE POSTED ON.JOB SITE
Side Sewer Drawi
-T�e City of Edmonds
"STPH"'EET FILE EASEMENT NO . ............................................
NEW CONSTRUCTION X0' REPAIRS E]
LID NO . .................. NO . ...................
OWNER ----- 27��W.LrS ................ .................................................. CONTRACTOR ---- .................................................... PERMIT NO.
tk
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JOB ADDRESS ....................... .................. LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
.. . .. .......................
'.01's . ..................... ............................ ...
NAMEOF ADDITION .........................................................................
kl�
PWW-0001-11/75 (REV.11/78)
q 2 �--/V /Y
Approved:
DATE.:7;�� .......... B ........ ...
.............
CITY OF EDMONDS
PUBLIC WORKS DEPAR A NT FOR INSPECTION CALL10 Permit NO 668
SIDE SEWER PERMIT 775-2525 Ext. 220 Issue Date
PERMIT MUST BE POSTED ON JOB SITE Z� LE
77 mw 7
mw 7��, "
1., Address of 7onstr`uc`t`7ion yjl,, � I V
2. Property Legal Description (include all. easements) 20A 37, 5 S,
RI-114 ZZ/ r:5X1"1ftAA91T1
3. Single Family Residen6e Jr— Multi -Family No. of Units
Commercial
4. Owner and/or Builder S JL C,,ej I'A-1
5. Contractor & License No. gh—r-S-1-11f V 3 0 Ir 12 B
6. Invasion into City Right -of -Way: No_X Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation). RECEIVED
E-4 7. Cross other private property: Yes No_,K_ Easement required -
MAY 13 1981
attach legal description and county easement number.
�4 READ THE FOLLOWING AND SIGN:
44 Dir. Of Public �Vorks
a. Property owners must obtain a permit to install side sewers on
>4 their property. A licensed side sewer contractor must be employed to
construct side sewers in the public' right-of-way.
b. The side sewer contractor assumes full reponsibility for each
Eri installation for one year.
W
4 C. Commercial establishment requires a minimum "jL'4&H0URS(6
a4
z side sewer line.
0 d. Side sewers may not be installed closer thazP_UUL0=8EyY0UhDJG('30")
U
to any structure. 1-800
e. Side sewer lines must be laid at a minimum graae j�6A-6A7450)
0 and maximum grade of 100% (450). 0
Eri f. No turn in side s8wer greater than 45 (1/8;bend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
�:hrough other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k.. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
DATE: sr e4_4��
certify that I have
and shall comply With the above
PERMIT FEE: 04) DISAPPROVED BY: Date:
By: -Date:
C9NNBe1R3EG FEE: OA5% .06
A APPROVED By: Date:
P4 K—.W
PERMIT MUST BE POSTED ON JOB SITE
CITY OF EDMONDS ASSET INFORMATION SHEET
ST 7HE ET F I L E
NEW ASSET NO. 0 0 A-?,R 6
ADDITION ADDITION TO ASSET NO.
E] RETIREMENT
DESCRIPTION
A�v e-- —t,, -5,d4 Ls I c-,? 6,,,f
SERIAL NO.
LOCATION DEPT. NO.
F ') —c)
"PURCHASE ORDER NO. —
PURCHASE ORDER DATE
COST
0
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
*PROJECT NUMBER 6e
PROJECT COMPLETION DATE
COST
3 4, �5--
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 —
� -10 G.L. ENTRY
REFERENCE
DATE
w
M ' "VERIFIED BY
PROCESSED
BATCH NO.
INITIAL
M-9
DEPARTMENT FILE
j-'>0 Fe"crv,"-f
BURY REQUEST
NAME' Jo D24y- I-
ADDRESS � 12
CITY ED tA oM P S
PHONE N`S) )F7/- 1/7&
ACCOUNT#
941q,? 3 10
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LOCATOR #
DEPTH
FAULTS IN LINE
DAMAGED IN
SIDEWALK
GARDEN
ROCKERY
DRIVEWAY
LAWN
GRAVEL
HARD SURFACE FOOTAGE
RIGHT OF WAY
/ 5- F T-
To Ir PiL-
FOLLOW SPECS / SPECIAL INSTRUCTIONS
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FOR FAULT LOCATOR USE ONLY
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PUBLIC WORKS REVIEW ROUTING
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SITE ADDRESS:
TYPE:
BUILDING PERMIT (CHECK ONE)
SIDE SEWER PERMIT
Dds INGLE FAMILY
RIGHT-OF-WAY PERMIT
MULTIPLE
STREET USE PERMIT
E=l
COMMERCIAL
STREET TREE PERMIT
FENCE
SEPTIC TANK DESIGN PERMIT
GRADING
NEW METER/WATER SERVICE
DEMOLITION
E.I.S.
RELOCATION
OTHER:
SUBDIVISION REVIEW
PLAT/PRD REVIEW
DRAINAGE PLAN
IN
OUT
Reviewed By: Date Reviewed:
(See Comments)
E�
CITY ENGINEE R
DRAINAGE ENGI14EER
F-1
WATER/SEWER DIVISION
STREET DIVISION
P.14. RECEPTIONIST
E::]
WORK ORDER COORDINATOR
UTILITY BILLING
DIRECTOR/ADMINISTRATOR
El
RECORDS (FILE.).
OTHER:
COMMENTS:
2/3/81
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DATE: '2 -,;? 0 -S�')
MEMO TO: Building Division
Communitv Development Department
FROM: Engineering Division
Public Works Department
SUBJECT:
Z"
After, revi"ew'of' the"subject Building Permit application, We have
the following comments:
1 Connection to City water system required.
2. -Connection to City sanitary sewer system required.
3. Ripht-of-wav Permit required for any work on City property.
4. Drivewav slope not to exceed 1.4%.
5. Backwater valve required if do%qn�,;t-airs, P -s I e
_pltimbin , i low
elevation of upstream manhole.
6. Water and sewer lines to be separated by 1.0 foot minimum.
Signature
REC;EIVED
19 7 9
N
/*
REC RD OF SHORT SUBDIVISIO�
D;,r. Of Puhl;c Vior:,,s
This is to certify that the properties as shown on the attached map (E),,hibit "A") an(
described as follows:
See Exhibit "B"
have been divided under the provisions of che Edmonds Subdivision Ordinance (Sec,12..'
File No. S-2-79 subject to the following conditions and requirements:
1. Exhibit "C" Hold Harmless Agreement
2. Connection to City water main required.
3. Fire hydrants per Fire Code.
4. Connection sanitary sewer required.
5. All wiring to be underground in accordance with City standards.
6. Excavation and grading in conformance with requirements outlined
in Chapter 70 of the Uniform Building Code.
7. As-builts r ' equired.
8. Tree cutting restrictions required on all trees 8" in diameter or
over per Section 12.10.050 (c) (2).
AEL--REQUIREMENT�STMUST-BE-,MET-�'AND ALL IMPROVEMENTS MUST: --BE INSTALLED'PRI
_T G" PERMITS.
Td S'�UAN"d'E�-7--OF�-"B-'U"ILDIN"
I/we certify that I/we are the legal owner(s) of the property,described above. I/we
warrant that all representations are true and correct and understand that in the evet
of any misrepresentation or failure to comply with the conditions and regulations set
forth hCprein, the City of Edmonds shall have the right to declare the subdivision voJ
and record a statement to that effect in the Grantor -Grantee's Index in the office of
the Snohomish County Auditor.
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A
DATED this_:2,e,,o day 19
C,TATP OP t,7A(ZUTN1rTr)XJ 7-
COUNTY OF SNOHOMISH� ss:
On this day personally appeared before me— Don Finnigan, Lauri.A. Finnigan
and Ruth M. Murphy, William J. Murphy , to me known to be the individuals des(
in and who.executed the within and foregoing instrument, and acknowledged
D
signed the same as —free and voluntary act bnd deed, for the uses and p�pc
therein mentioned.
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PIJBIJC WORKS DEPARMIM CHECKLIST
BUIMING PERIIT REVIEW 41A A ver
(address) —(aTte7
Street Rig�ht-of-Way Existing 60" 'S,-2i2A6V 9 'REQD 01
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Access Easenmts Existing
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—REQD
Utility Easement Exist REQD�_
lot Per Subdivision -2- Plat �s Assessor Map
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Site Plan Checked for Accuracy
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Underground 14iring Reqd. YE7.5
Check Accuracy of Legal Description 0,kC-6Vr,,-D
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Review by Date
Existing Water Main Size
Water Main Required */,4
Service Line Required VII/ //
Hydrant Size Existixig,
r4
Hydrant Reqd Per Fire Code &A —Size
Detector Check Meter Reqd.
Cross Connection Inspection 41A
Fire Departnr-nt Comnents
1,jater Yleter Char Re d. ZI - 7
6,9.
Review by_ Date --!311-9Ze
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Septic TL:nk Design Approved 00 Date 2,12,01i<l
Septic Tank Permit Reqd. k) 6 Permit No.
Sanitary Sewer Availabill 11-f C, Proj. 1,1 �) :�/
Drawing No._ 1-1-� 0 Tile No. ----
Side Sewer Availability
S!ni"a:�Sewer Connection Fee Reqd. Wo
Review by Z Date 0 / ;-70
Y
Open Ditch Existingd�2�...�Reqd._ ZZ
Culvert Reqd. Size —
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Catch Basin Reqd. Indicate an Site Plan
0
Shoulder drainage maintain collection an swale open rLmoff
E-4
�bxihole reqd. Indicate an Site Plan
Soil Conditions and Ground Water Field Checked
Review by Da te
�71
�evised-
MO-1977
Page 2
Street Paving Reqd. FZ6t7-�
Curb and Cutter Reqd.
W Sidewalk Reqd.
Curb Cut'for Driveway Reqd.Ye�S-- A4-cu)
Right -of -Way C;onstruction F'e�t Reqd.
Bond Reqd. for'Public 1mprovemtmits7;t
Street Nam Sign Reqd.
Other Signing Reqd.
, Pre Permit Site Inspection made on
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1-4 BY: S94ER
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Special Requirements listed in mem to Com=ity Development Deparment,
Building DiVision
BY Date
o All iteris filled in an Building Permit Application
P4 BY Date
Diawings Stamped and Notations Made
BY Date
-JApproved by Public Works Department
0
Revised: 1v 10-1977
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MFrWDF EDMONDS
BUILDING PERMIT APPLICATION
14��MiE (OR NAME OF BUSINESS)
wh- �i
MAILING A�DR SS
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CITY
TELEPHONE NUMBER
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NAME
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TELEPHONE NUMBER
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LEPHONE NUMBER
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IVRESIDENTIAL
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PLUMBING
NON-RESIDENTIALI
MECHANICAL
ADD
DEMOLISH
SIGN
ALTER
EXCAVATE
OR FILL
FENCE
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REPAIR
PRE-MOVECINSP./P.
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COMPLIAN E INS
POOL
z NUMBER OF S
NUMBER OF
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N ATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
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This Permit covers work to be done on private property ONLY.
Any construction on the public d omain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 120 Days
Ln"Applicant, on behalf of his or her spouse, heirs, assigns and
,n
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_j successors in interest, agrees to indemnify, defend and hold harmless
2 the City of Edmunds, Washington, its officials, employees, and
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< agents from any and ali clainis for damages of whatever nature,
I arising directly or indirectly from the issuance of' this permit. Issil-
0 ance of this permit shall not be decined to niodify, waive or reduce
J
0 any requirement of any city ordinance nor limit in any way the
3: City's ability to enforce any ordinance provision."
I hereby acknowledge that I have read this application; that the in-
formation given is correct; and that I arn the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen's 51pensation Insurance.
V;dNATVRE (OWNE)k OP AGENT) JDATE SIGNED
lim,001
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
75.-
708
ADDRESS
PERMil—
NUMBER
ILEGAL DESCRIPTION SUBDIVISION SHORT SL
PUBLIC RIGHT OF WAY PER OFFICI STREET MAP
EXISTING C/ ;��
PROPOSED 61 Q
DEFICIENCY OF RIGHT OF WAY
2�
Zlylgz� By I SEE ENGINEERING MEMO DATED----!
REMARKS
METER SIZE I BUILDING SUPPLY SIZE IFIXTUREUNI
SIGN AREA ENV. REVIEW
ALLOWED I PROPOSED I COMPLETE1 EXEMP T
SH,
IVARIANCE OR CU
*,eLANNING REVIEW BY
YARDS
CO-
,F _e) FRONT
SIDE REAR
ILOT
REMARKS
CHECKED BY
OF CONSTRUCTION I CODE
UISPECIAL INSPECTOR JAREA OCCUPANCY
REQUIRED GROUP
FIE) YES
ON REMARKS
PLAN CHECK FEE
BUILDING
1PLUMBING
MECHANICAL
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
%TTENTION
T IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
JNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
Ot CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304, 306.
02-78*
TOTAL AMOUNT DUE
r . I , .. . i � . , ) 1
r -.ATTENTION,) I
-THIS PERMIT
I)jr nf P,thli, k',forks
AUTHORIZES
ONLY THE
WORK NOTED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
775-2525
VALUATION I FEE
APPLICATION APPF
This application is not
until signed by the BuildinE
his Deputy; and fees are
receipt is acknowledged in
vided.
DIRECTOR'S SIGNATURE
DATE
ORIGINAL — File YELLOVV
PINK — Owner GOLD —
FEB 2 0 RErv'Lh.
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AUTHORIZED X14549W IIJ14 w lloe4ly
FOR
RECORDING ZVOW40 Icll*YIYI"N
CITY OF EDMONDS IN45Z-I'a
ep
By----------
page
Of
90294'
vot 1514 %F64?
77�
City of Edmonds Perinit,No: 77
RIGHT-OF-WAY CONSTRUTION PERMIT I s s u—e— D 1 it F
A. Address or Vicinity of Construction: d,-
B. Type of Work (be specific):
C. Contractor:
Mailing Address� 15215 -75A -5f SW JV ROO
State License #: Tz�_T M W * bM
D. Building Permit # (if applicable): —
Contact:
Phone: 9Z5- Z-6 3-6317
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. F1 Commercial Subdivision [] City Project 09r"EUC (PUD, GTE, PSE, CHXM13ERS, OVWD)
. F] Multi -Family Single Family 0 Other A-I�T_
INSPECTOR-
F. PAVEMENT: YES G. SIZE OF CUT x H. Charge: $
CONCRETE CUT: (_]'KES .1 ANO
APPLICANT TO READ AND SIGN
IDEMNITY. 'Applicant understands by hislher signature to this application helshe holds the City ofEdmonds harmlessfrom injuries,
damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against 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
attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERMLS 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 BYCITYFORCES, AT WHICH TIMEA DEBITOR CREDIT WILLBEPROCESSED FOR ISSUANCE TO THEAPPLICANT
Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. 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 street4ut�'tr'ench'work shall be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEPTIONS.
Three sets of construction drawings of proposed work are required with the permit application.
IHAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMITREQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature:
(Contractor or
A74-�r
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
FOR CITY USE ONLY':
A ed by; Right-of-way Fee: 0�4 6
. 'pprov,., .. " ". I . . _.. � .. ,
Time AuthQriz9&-.-VoidAfter,
U lot Disruption Fee/Fund J I I:
Special Restoration Fee:
ows, i964C, VOL
Total Fee
D Ci's - s �u' e , d" 6y
M1 , /Z ./),W.
UPON COMPLETION OF PERMITTED WORK9AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
IVII
/71 VCOMMUNITY DEVELOPMENT CODE. C�041bv
ctl
FINAL APPROVAL OF PERMITTED WORK:-
INSPE—Cioxs S[GNATURE DATE:_(�1-111,
I V 7
For inspection re4uirements see -Engineering Information Handout.
NO
WORK SI-IAIA, BEGIN
PRIORTO PERMIT ISSUANCE