520 FORSYTH LN.PDF11111111111111
11342
520 FORSYTH LN
A
*Y OF EDMONDS RF Permit No. At
CF
�COMMUNITY SERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date
r1% I k t
Z
0
U
W.
0
W.
A'.' e Owner: - C6A(_S �1 B. e Contractor: Cbi4S, (Del bb
Name Name �' tllf
— _-5- lrv':5� ly. (4)
Mailing Address Mailing Address
'E�j ruy /7 91/
City Stit-e Zip City State Zip
01-61 - r_ Ig - d �x )w E y �?
State License Number Telephone Number
C. Address or Vicinity of Construction:
Type of Work to be Done:
D. 0 Work in Connection With: El Sub or Plat 2r Single Family
0 Commercial El Multifamily
E. 0 Pavement Cut: 1�ry El N F., 0 Size of Cut: _,/ 'zl / X —
0 City Projects
0 Utility
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, fors ee,n 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 attorneyfees 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.
Estimated restoration fees 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 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.
• 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 above and that this permit must be available at the job site for inspection purposes at all times
Signature: Date: nC7 Z .)77/
Owner 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 Authorized: Void after —10 days.
Special Conditions:
PERMIT
Restoration Fee:
Receipt No.: 14 93 9
Fund I I I Fee;
Street Cut. Dimensions: — x — = $
RELEASED BY: Atc Date :io �/'?:/ INSPECTED BY Dat,
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
�ng. Div. March 1989
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dep")
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 1985
jFRy
CITY OF EDMONDS ZONE PERMIT
NUMBER 69
CONSTRUCTION PERMIT APPLICATION
OWNER AME/N E OF BUSINESS
ADD.FIESS SUITE/APT
MAILING ADDRESS LUAL,DE5CRIPTION CHECK SUBDIVISION NO.
LID No.
0 7- 1� 5 y y X,
CITY ZIP TELE PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. T1:SCP
EXISTING (P APPROVED BY
C) '776 REOUIRED DEDICA
0 TION
VA —ME
.0 _A11RISS RIGHT OF WAY CONSTRUCTION PE Ito )UIRE
STREET USE PERMIT REQUIRED 0 GX
U------------
M ---- RCVIEW CRY
< CITY NONE NUMAPP SEE EN�GIN�EERJNG MEMO �DATED z
REMARKS
NAME
ADDRESS
L) METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
x CITY IF TELEPHONE NU
�BER
z
8 REMARKS
STATE LICENSE NUMBER
SIGN AREA ENV. REVIEW
ADB NO.
Le a, =pion of Property include ail easements PROPOSED COMPLETE EXEMPT
(g ALLOWED
z Ow or attach two copies
0 7 (—,o A -p
SHOBEAANE#
for 0 3 gL a
VARIANCE OR CU
ej 4.1 .1-1,0 P N
Air )J-t NI G YVMV�60Y T
5' 19 1 1, —/ I — I ! . i
0r7 AV
8, 0 aw, SETBACKS — FEET
Wlg()VE�GE
Ig_
Tax Account Parcel No. iFtONT 6 SIDE REAR z
EM
NEW 1z] RESIDENTIAL
PLUMBING S-2xv—
nADD, LTER COMMERCIAL MECHANICAL 1�e
"'-REPAIR APT.BLDG.
SIGN*
EXCAVATE, FILL�.
CHECKED By TY OF CONSTRU TION
DEMOLISH OR GRADE FENCE.. CODE HEIGHT
CARPORT L_ X _FT)
swim
REMODEL E POOL SPECIAL INSPECTOR I AREA WULIPANCY
WOOD STOVE1. RETAINING WALU REQUIRED GROUP OCCUPANT
INSER 0 YES I' NO LOAD
z ROCKERV RENEWAL REMARKS
;0 (TYPE OF USE, BUSINESS OR rivITY) E P)`1OqRESS INSPECTIONS PER UBC 305
.8 NUMBER OF STORIES
G co
DWELLIN
0 UNITS
OAK TO BE DONE ATTA H PLOTPLAN)
FINAL INSPECTION REOUIRED
PLAN CHECK FEE VALUATION FEE
BUILDING
PLUMBING
Plan Check No.
341 F MECHANICAL
This Permit covers Work. to be done on private prop
Any conStrUC I erly ONLY. GRADINGIFILL
Ion On the public domain (Cui&i�, sidewalks,.
driveways, Marquees, etc.) Will ranuira -ion.
Permit Application. ou uays STATESURCHARGE
Permit Limit, 1Year - Provided Work is Started Within 180 0 ys ev
"Applicant, On behalf of his Or her spouse, heirs, assigns and 1Aj5;op5;r70.j q�E
successors in interest, agrees to in
I harmless demnify, defend and hold
the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages
whatever nature, arising directly Or indirectly from the Issuancoet
of this permit. Issuance of this permit shall not be deemed
modify,. waive Or reduce any requirement o to PLAN CHECK DEPOSIT
nor limit in any way the City's ability f any city ordinance
provision."' to enforce any ordinance TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the
nformation given is correct; and that I am the owner, or the duly ATTENTION
wthorize.0 agent of the owner. I agree to comply with city and APPLICATION APPROVAL
;late laws regulating construction; and In doing the work authoriz- THIS PERMIT
�d thereb y no person will be employed in violation of the Labor AUTHORIZES This application is not a permi
State of Washington relating to Workmen's Compensa- signed by the Building Official or his
,ode of th� 0 N LY THE t until
on Insurance. WOR N OTED Deputy; and fees are paid, and receipt is
fGNATU E(OWN 0 A3E:'7!' 'NsP C, acknowledged in space Provided.
DATE SIGNE E TION
DEPARTMENT
F CI L'S SIGNATURE
0
CITY OF DATE
rTENTION )NDS
RELEA
CALL FOR DATE
INSPECTION
S UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
rIL. A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-3202
CERTIFICATE OF OCCUPANCY HAS BEEN ORIGINAL File YELLOW — Inspector
\PTER 3. GRANTED. UBC
PINK — Owner GOLD — Assessor
STREET- FILE:
*'D 7.
LLJ
0
LL
w
0
8
od
LLJ
0
LL
z
<
0
C\l
LO
PERMIT APPLICATION REQUMEMENTS
TO: Permit Coordinator, Building Division
FROM: Lyle Chrisman, Engineering Inspector
OWNER: PLAN cK#-.:T4 7
ADDRESS: 670 �*45Y7MS-4-4 DATE:
After review of the subject permit application, the following requirements mustbe met.
1. Construction hours are: WEEKDAYS .......... 7:00 A.M.-10:00 P.M. WEEKENDS/HOLJDAYS ..... 10:00 A.M.-6:00 P.M.
2. A separateRIGHT-OF-WAY- Construction Permit is required for all work on Publicproperty. (ECDC 18.60)
3. Truck haul route plan must be submitted and approved prior to permit issuance.
4. Builder/Owner is responsible for containing all temporary runoff and erosion control on site. (ECDC 18.30.030d)
S. NO WORKSHAUBEDONEWH7HN 15 FEET OF STREAMS ORIO FEET FROMANY CLOSED DRAINAGE FACIL-
ITY BUILDERIOWNER IS REPSONSIBLE FOR IDENI=NG CONDIZ!ONS ON ZHE DRAWING (ECDC18.30.50G)
6. FILTER FABRIC FENCE SHALL BE INSTALLED AND INSPECTED PRIOR TO CLEARING AND CONSTRUCTION.
(ECDC 18.30)
7. INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEM, TIGHTLINES, FOUNDATION DRAINS, AND
CATCH BASIN INSTALLATION. INSPECTIONS ARE REQUIRED PRIOR TO BACKFILLING. (ECDC 18.30)
8. Repair or replace all defective existing curb, gutter, and sidewalk adjacent to the property. If an intersection is involved a
handicap ramp may be required. Contractor shall meet with the City Engineering Staff to determine the extent of repair prior to
issuance of the permit. (ECDC 18.90)
9. Driveway slope shall not exceed 14 % without a waiver. Every attempt should be made to keep the slope below 14
Waiver granted to %. (ECDC 18.80.060D)
10. Driveways must be paved from property line to City RIGHT-OF-WAY. A separate perimit is required. (ECDC
18.80.060C)
11. INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIOR TO ANDAFTER POURING.
(ECDC 18.30)
12. No burning of construction refuse without a permit from the Fire Department.
13. Connection to City water system is required. There is a separate charge for the water meter. (ECDC 7.30)
14. A back water valve is required if downstairs plumbing is below the elevation of upstream manhole. (ECDC 7.20)
15. Water and sewer mainlines should be separated by 10 feet minimum. (ECDC18.10)
16. Connection to the City sanitary system is required. A separate permit is required.
LID# &92- 30'f> I Fees paid: Yes No Charge (ECDC 18. 10)
17. Underground wiring is required on all new construction; and for additions, alterations, and repairs that exceed 50% of the total
assessed value of the structure. (ECDC 18.05.010)
18. A FINAL ENGINEERING INSPEC77ON IS REQUIRED PRIOR TO THE BUILDING DIVISION GRAN77NG OCCU-
PANCY OF THE BUILDING OR STRUCTURE. (ECDC 18.90)
19.
20.
I
pq
I*
The City of Edmonds
APPLICATION
for
SIDDE SEWER PERNaT
OUTSIDE E] INSIDE [:] REPAIRS E]
CARDNo . ......................................
EASEMENT No . ......................................
R ........ Lxle- .....................
114, .J0 .. r .......... A-1 .............. PERMIT NO.
OWNE .... ......................................... CONTRACTOR ......... ...........................
STREET
HOUSENo - ----- ��o --------- ----------- --*-* ------------------ ...................... AVENUE LOT No . ..... SZ .. ....... .................... BIA)CK No . .........................................
NAMEADD . .......................................................................................................................................................
LOA
BACKFILL WORK ORDER ISSUED ........
SEWER WORK ORDER ISSUED ...............
APpROVEO
i;�
;SEP 10 1.9,64
Date ............... DEPOSIT, $ ............................................. Approved:
BY --------
... . ... .. ......
........................ DATE .. ................. ....... ................
'Eldl s9T x aouaq; c
aouqq4 9 6009 14 gouaq4 4 IST 9
Is '009 aouaql gadl ',oge S a
40C a aDUaELL r DuaEl-17
2UTUUT29g OSTe t/T MN 't/T MS 6,19uzoo , ,
aOd q4aoN aouqq4 6 MN
SUT S Douqqj 6 60ST M DOU9EU 6 jOST a a3uaq4
'19Ua03 MN 40 7 , t/T MK 't/T MS
08't pue S-.SLE ONINMI03a jo
:Lt Ju-
92 ue�j I LZ dt'
MSUM01 9 SZ UOT439S
q1;T_Y_,d.F' EDMOt4lPS
can F" a�4,6,i vvei-, w6rh
CIVIC CENTEW— WATER-SEWEWDEPARnUENT.
No
tions. satu
'ER PERMIT
APD41E*5 -_--------- 520 Forsvth Lane
------------------------- . .................................................................................................. ......................................... ......
_1A
Aj
OWNER ........... ..... '...Simd .................................. - --- ----- CONTRACTOR___-� ....... ......
. ...........................
pe: Sei3temb r-1 ...................... d;LYS, -or�,CONNECT '-a S, e'sew.erl.—Ill
Anission: is gran --- - ---- - ----------- .... ... 9 ---------- P ILO!L., for to REPAIR
I and 'rdjjj=
with -City S�wiars in aecorAance with application on e governing,o ces.
ATTENTION IS� CALLED TO. FOLLOWING:
NOTE No. i—Tii6 owners of the property may obtain a permit to construct sewer inside propeqy line� A license cle Sewer Contracto:'r must, -
he employed.to construct.side sewer in street axes- Do not cover. any portion of sewer beforelt has been irispect�,&d.
NOTE No. 2—Obtain full information� regarding ordinance ii.is.ow and Regulations governing side 'sewers when"you get permit.
NOTE No. 3—To . p of side sewer must have at least 30 inches coverage at property line and 12 inches inside,pioperty line; mirilinuxii. gr�adp of, 2;1/,.
No bends"in grade -sharper than % will be permitted.
'NOTE No. 4 Trenches. In 'street must be water settled and surface of street restored -to original condition. 'Contractors shall be i6iPonsxbIi�;,,-j'fqr
failuiie dui'to. improper work which Easy develop within one year of CoMpletion.
sewer its
I�OT& No. 5—It is unlawful to alter or do any other, work than is'provided for in the permit, or to do any work on the nialn or:. 14p_.;
puftenandes except to insert the pipe into the wye.
— Existing Hydrant
F 0 R S'Y T H E L N
_77
ea� U4 S'&IS
-Flu I Rl�q-
Existing, V ult
Existing P.P
-Ex.is '-ting J7 New Driveway C'>
Driveway
N'e w. a
rs
Ne B eezewa,
IZA
Existing Vault,
Pvh�fln � 9) 0
I I __z:1
Existing Out —building.,
eols. 0
-ror 41gi. 6
SYSTEM CROSS $ECTION
+210
V45- 3/,q
AV _S
SVC-
APPROV AS NOTED,
01
Rf §
U
MIT COUNTM
OTHET FILE