614 2ND AVE N.PDFIIIIIIIIIIII
4814
614 2ND AVE N
APPLICATION
for
The City of Edmonds S11DE SEWER PERMT EASEMENT No . ..........................................
NEW CONSTRUCTION C] REPAIRS 0
112-09400
OWNER.......... ROAPA-ArYf! ....................................................................... CONTRACTOR -------------------------------------------------------------------------------------------------- PERMIT No . ......................
ADDRESS..... 04 --- 2ad .. Ave. .... N ..............................................................
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAMEOF ADDITION .........................................................................................................................................
Dye Tested On SEwer 1972
Approved:
DATE................................................ By ......................................................................
CITY OF EDMONDS
PUBLIC WORKS — EMINEERING,
ACTION REPORT
5635
SUSPENSE DATE:
Date:
Time: /C;l i I e #
Attac ments: =Yes
=No
SUBJECT:
REQUESTOR:
NAME:
ADDRESS:
PHONE:
76, 1,46, &--Z
REQUEST RECEIVED
BY:
TELEPHONE
CONTACT IN
OFFICE
OTHER:
F-1
RECEIVED
n-ITC Tn.
ACTION: P V^ 4, U I I L� �', f, I
v6g-timp— X17 MFTM"&��
t�- V r? e U-s �rrl ti ve,
All Concerned Notified
Action Completed/File
51 'o
%
890 -199 -
,Q4Y.-of Edmonds..
RIGHT-OF-WAY CONSTRUCTION'
PERMIT,
Pe.it Nmber. X2
Lmue Date: Z10
A. Address or Vicinity of Construction: — 614 2 AV N 19613184)
B. type of Work (be specific): Install Service
C. Contracton, -Washington Natural Gas Contact: Mgriamna Kingsbury
MailingAddress: 1192 75 qt. qw Eyprptt Phone: 356-7500 X7596
..'State License #: 98203 Liability Ins�rance: Bond:$
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. Commercial E) Subdivision El City Project [3g Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family F] Single Family Other
INSPECTOR: INSPECTOR:
Pavement or Concrete Cut: Q Yes 0No G. Size of Cut: x H. Charg,�_$
APPLICANT TO READ AND Sh 9 6
INDEMNITY: Applicant understands and by his signature to this application, agrees to ho14 t4qt� ofEdmandq harmlessfrom injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made the City of Edmonds, or any of its departments or
employees, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgranting 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 COMPLETEO BY CITY FORCES, AT WHICH TIMEA DEBIT ORCREDIT WILL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT.
ft Construction drawing of proposed work required, with'permit application.
A 24 hour notice is'required for inspection; Please call the Engineering Division, 771-0220.
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'i�rifh City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material priorto the end ofthe working day;
NO EXCEPTIONS.
Ihave read the above statements"and understand thepermit requirements and thepink copy of thepermit will be
avai lable on site at all 76 es for inspection urposes.
I �,� A�Ahl
Signature.-,'& Date: 6-4-96
'rtractor0r' 4�enti/_"
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVEDBY- VdL64-L4.
"ME AUTHORIZED- VOID AFTER DAYS
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/F0ND. 111:
SPECIAL CONDITIONS -,—MA
RESTORATION FEE:
PERMIT FEE:
COMMENTS:
TOTAL FEE:
RECEIPT FEE:
107.110:9
ISSUED BY
NO WORK SHALL BEGIN PRIOR TO PERMIT, ISSUANCE -Eh�g�". 1994
FIELD INSPECTION NOTES
Comments:
Diap_ram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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Mov"no —
MUNN CTM
AV4dIwxjtcnEr"WCDffP"
Watermain depth
—Z—)- gas main
/I/
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596
114.. � .
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':;EDT
I j !jj
Key:
-w- Water
-G- Gas
-SS- Sever
Water hydrant
Water valve
WashingtoH Natural Gas Company
1122 75th'Street S.W., Everett, Washington 99203, (206)355-3331�
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ALOHA
CITY OF EDMONDS
JSE PERMIT 9GO224,
ZONE NUM13ER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT #
ZDRESS
OWNER NAME/NAME BUSINESS
Aor
EGAL DESCRIPTION CHECK
SUBDIVISION NO. LID. NO.
1 MAILING ADDRESS
141q Me i- fA
PER OFFICIAL STREET MAP. TESCP Approved 13
PUBLIC RIGHT OF WAY
RW Permit Required 0
EXISTING - REOUIRED DEDICATION Street Use Permit Req'd 0
Inspection Required 0
CITY ZIP
7
C_
0 n a/
PROPOSED Sidewalk Required 0
NAME
W
METER SIZE
LINE SIZE
NO, OF FIXTURES PRV REQUIRED
YES 13 NO 0
ADDRESS
0
Z_
REMARKS cc
cc CITY zip _7PHONE
NUMBER
W
0
NAME
-1,56-1yArr
X ADDRESS
ENGINEERINGMEMO DATED REVIEWED BY
< CITY ZIP TELEPHONE
E -
1
NUMBER,
FIRE MEMO DATED REVIEWED BY LL
Z
0
S
1 LL
L) STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA
:SEPA REVIEW
ADB NO
�P'ROPPP40
COMPLETE ,J�XEMPT
Legal Description of Property - include all easements
SHORELINE #
Z
2
EXP
VARIANCE OR CU
PLANNING REVIEW BY
DATE
a:
L)
uj
SETBACKS - FEET
HEIGHT j=VERAGE
0
FRONT SIDE REAR
w
Property
Tax Account
00 6 a,�-00 - 0
REMARKS
Parcel No.
0
EJNEW�
91 RESIDENTIAL
PLUMBING
DADDITION
L Co"jERC ' IIAL
El MECHANICAL
FIREMODEL
�.APT BLDG
El SIGN
I -
GRADING, FENCE
CHECKED BY
TYPE.0f, CONSTRUCTION_
4-
CODE.
1�
OCCUPANT
GRO
3
REPAIR CYOS L_ x _FT)
leuiLe
WOODSTOVE SWIMPOOL
DEMOLISH 0 HOT TUB/SPA
SPECIAL INSPECTOR
AREA
OCCUPANT
LOAD
INSERT
REQUIRED 0 YES
FIGARAGE RETAINING WALL/
CA ROCKERY El RENEWAL
REMARKS
0 TTYPE OF USE. BUSINESS MACTIVITY)tpi�M7
PROGRESS INISPECTION&PEWUM305'
W NUMBER
W
NUMBER OF
CRITICAL
0 OF
co STORIES
DWELLING
UNITS
AREAS
INUMBER
0
DESCRIBE WORK BE DONE (ATTACH PLOT PLAN)
IT
't)l -5
FINAL.:INSPECT.ION:LREQUIREDIL
VALUATION
FEE
PLAN CHECK FEE
BUILDING
HEAT SOURCE
GLAZING
IN)
PLUMBING
ck No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs,,sidewplks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
"Aoplicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
'Wn harmless the City of Edmonds, Washington, its officials,
2 employees, and agents from any and all claims for damages of
a:
whatever nature, arising directly or indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
o:r limit in any way the City's ability to enfor ce any ordinance
TOTAL AMOUNT DUE
Inor
provision."
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and In doing the work authoriz-
AUTHORIZES
signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor
ONLY THE
WORKNOTED
Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa-
acknowledged in. space provided.
tion Insurance and RCW 18.27.
1 INISPECTION
SI AT E (OWNER OR AGENT) DATE SIG E D
DEPARTMENT OFFICIA
SIG TU DATE
CITY OF
EDMONDS
CALL FOR RELEASED
BY: DATE
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR 06CUPY A BUILDING OR STRUCTURE -
BEEN MADE AND APPROVAL OR 771-0220 ORIGINAL File YELLOW - Inspector
UNTIL A FINAL INSPECTION HAS
A' CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3,
PINK - Owner GOLD - Assessor