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11715
514 HOLLY DR
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C of Edmonds.
ity
RIGHT-O&WAY CONSTRUCTION
PERMIT. Permit .1 Numbe . r.
Issue Date:
A. Address or Vicinity of Construction: (9601450) 514 Holly Drr
B. Type of'Work (be specific):. JaSta]Ll SeryjLce
C. Contractor: _Wasthiingtnn mat,IAZ&Ie�aa
Mailing Address: 1122 75
State License #: 98203
D. Building Permit # (if applicable):
Contact:
P I hone: 447-3984
Liability Insurance: Bond: $
4
Si&'Sewer Permit # (if applicable):
E. 0 Commercial F] Subdivision El City Project [ja Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family EJ Single Family E] Other
INSPECTOR: INSPECTOR: �tAAA
F. Pavement or Concrete Cut 0 Yes QNo G. Size of Cut: H. -Chargq_$
APPLICANT TO READ A IGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold t)a City ofEdmonds harmles - s froqfiniurieh, damages, or
I �
claims of any kind or description whatsoever, foreseen or unforeseen, that may be mad.;�gVfnst the City of Edmonds, or anf of its d6�wtments or
employees, including or not limited to the defense ofany legalproceedingB including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS ;40�R,,e��AERIOD 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 BE PROCESSED 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, 7.71-0220.
Work and material 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 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 willbe
available on site at all times Oxinspection purposes.
"O�
Signature: '0#Z,s 76(4�� of Date: 10-30=95
(Co n't rac 157o r , C- e- n-77 ' '
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONtY
APPROVED BY: �_�J RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS DISRUPTION FEE/FUND 111:
SPECIAL CONDITIONS- RESTORATION FEE:
PERMIT- FEE;
TOTAL,FEE:
COMMENTS:
RECEIPT FEE:
DATE: ISSUED BY: -j
NO WORK SHALL BEGIN PRIOR TO PERMIT
ANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagra
(Fund Ill - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION 13 YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
El NO
C—IMS
AV*rIwVk)nEr*WG-CkvV
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Eigineering Aide
Washington Natural Gas
1356-7500 X7596
t�
HO L- L-Y -D �2-
�-) 0 F5 q cp C) I L+ E 0
T-
Key:
-W- Water
Watermain depth -G- Gas
-SS- Sewer
V14 - gas main -& Water hydrant
0 Water valve
Washington Natural Gas Company
1122 75th Street S.W.. Everett. Washington 98203. (206) 355-3331
APPLICATION
for
The City of Edmonds SIDE SEWER PERMT
NEW CONSTRUCTION E] REPAIRS 0 EASEMENT No . ..........................................
104-05950
OWNER........... Uayng ... Q.offev ------------------------------------------------------------- ..... CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS -------- 5.1-4--liol-ly ... Drive ..........................................................
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LEGAL DESCRIPTION: LOT No . .............................................. BIA)CK No . ............................................
NAMEOF ADDITION .............................................................................
DYE TESTED Oil SEUER
JULY, 1972
Approved:
DATE................................................ By ......................................................................
RE GE I V ED'
lqr
00
C)
Ln
CITY of EDMONDS SIDE SEWER PERMIT
001-23 1985
.For Inspection Call 771-3202 PERMIT No..
PUBLIC WORKS
Address of Construction: &amol)e&
Property Legal Description (Include all easements):
Owner and/or Builder: Fabee-t Z)e13CQZ_Z_ CAkC,7� ?I.,Vzf r e011),St
Contractor & License No:
Singl:e Family Residence
Multi -Family (No. of Units
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No )<, Yes I (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (l.-800-424-5555) before any
excavation.)
Cross other Private Property: N o )� Yes (If Yes', easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
I certiEy'that I have read and shall comply Date
with the items listed on the back.
Permit Fee: 30- ev
Trunk Charge:
Assessment Fee:
Issued By:
Date Issued:
Receipt No.:
Partial Inspection:
Comments
Final Inspection Approved:
Date I n i0a 1
Rejected:
'Reason
** PERMIT MUST BE POSTED ON JOB SITE **
--Ua—te Initial
—Fa—te Initial
A/
Wh.ite Copy - Fil,e Green Copy - Inspector Buff Copy - Applicant if
The City of Edmonds
Side Sewer Drawing
EASEMENT NO - -------------------
NEW CONSTRUCTION E] REPAIRS X LID NO - ---------- ------- ASMT. NO.
s
OWNER --- RG-S-ERT ------ DRIC—C-0-LI - ---------------- --- CONTRACTOR ---- T
RC-K-H-Or - ----- ------ PERMI NO-7-40(--b ..
JOB ADDRESS ----------- -------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------
EDMONDS
NAME OF ADDITION -----------------------------
514 HOLL-j DRIVE
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HO L LLj DRtvE- Approved: t&& 23 - )9a5.. By
PWW-OWI-11/75 (REV. 11/78) DATE(% .. ...... -------
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