622 ELM PL.PDF11111111111111
11153
622 ELM PL
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Persuit Number.
Wue Date: W5�9'
A. Address or Vicinity of Construction: 622 EU4 PLACE
-%.A- -1 E to,placa'oporate 8 maintain a buried service wire
1200P �) B. Tyr of Work (be specific): PT
17c- droo existi g d
n p '01 OA948, located.,8t 623 EU4'PL.., then south to a residence at 622 ELM PL.
GTE to plov 80 ft., push I driverjay 250 and pash 1 oad 26 ?V6 K.U�W� yootage is 106 foot.
C. Contractor: GTE NORTHUEST INCORPORATED Contact: Linda ALden, Permit Coordinal-nr
Mailing Address: 2323C U. Casino. Rdo, EverottDtIA Phone: 425/710-0945 ENGR3TERRY AMDERSON 425/771-8683
State License #: . 98204FIRU Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. - El Commercial 0 Subdivision Cily, Project; N Utility (PUDrGTE,)WNd; CABLE, WATER)
n Multi -Family 14 Single Family..",_"� -�,bther'
GTEI�1:0.0.12100-9POOIDB 2423.10
INSPECTOR: INSPECTOR:
F. Pavement or L;oncrete Lut I" les LJINO U. 31ze or t_uu C!;!, x %_nargt�'.p
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and hy his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany
kind or description whatsoever, foreseen or unforeseen, that may he made t�gainst the City of Edmonds, or any of its departments or
employees, including or nbt limited to the defense of any legal proceedings including defense costs and attorneyfees hy reason of granting this permit.
THE CONTRA CTOR IS RESPONSIBLE FOR [FORKMA NSHIP A ND M4 TERIA LS FOR A PERIOD OF ONE YEA R FOLIO WING THE FINA L INSPEC-
TION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PA TCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings 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 with City regulations as required by the City Engineer.
All street cut trench work 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 and understand the pe -nu . t requi . rements and the pink copy of the permit.will be
available on site at all timesfor insp ur;
yoftion p
Signature: Diave PlauRl ns,
Date: 7/19/99
; CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVEDBY:_ RIGHT OF WAY FEE:
TIME AUTHORIZED: VOrD AFTER 0 DAYS DISRUPTION FEEfFUND I 11:
SPECIAL CONDITIONS: RESTORATION FEE:
T OTAL.
IS5,UEPPY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
FIELD INSPECTION NOTES
I Comments:
I Diagram
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES ONO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
wftb 1*
PERMIT SUBMITTED BY
GTE -
------------
LEGEND__
1 PEDS 0
POLES 0
ROAD BORES
OVERHEAD LINES—
I.D.UTILITY POTHOLE C3
UG TRENCHING --UGT—
I R.o.w.
---------------------------- EOP
rit — c — — — p — — — — — — — — — — — — — —
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THE FOLLOWING INFO TO SE PROVIDED
RICHT OF WAY LINES.EOP OR FACE OF CURB. EXISTING SIDEWALK. POLES. ROAO CUTS ANO THE UTILITY UNDER ROAD CILI'-
A80VE GROUND FACILITIES,(ie:) PEDS,BOXES.CABINETS. ETC..UNDERCROUNO TRENCHING AND OVERHEAD LINES,
FOOTAGE OF WORK IN R.O.W.
LEGEND
I PEDS 0
POLES 0
ROAD BORES
OVERHEAD LINES-
I.D. UTILITY POTHOLE C:l
PERMIT SUBMITTED BY UG TRENCHING --UGT—
GTE
I R.O.w.
---------------------------- EOP
't I - , If
-------------- L ----------------
THE FOLLOWING INFO TO BE PROVIDED
RIGHT OF WAY LINES.EOP OR FACE OF CURB. EXISTING SIDEWALK. POLES, ROAO CUTS AND THE UTfLITY UNDER ROAD CU
A60vE GROUND FACILITIES,(Ie:) PEDS,BOXES.CABINETS. ETC..UNDERCROUNO TRENCJ41NG AND OVERHEAD LINES.
FOOTAGE OF WORK IN R.O.W.
I
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STREET FILE PERMIT COUNlER
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CITY of EDMONDS SIDE SEWER PERMIT`�'\
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For Inspection Call 771-3202 0MCCd MLE: PERMIT NO. 070
Address of Construction: (.Ogg, (Eini
Property Legal Description (Include all easements):
Owner and/or Builder: +4oyndanci ktpyyy_s 19
Contractor & License No:
Single Family Residence y I EDMONDS I'
Mul ti-Family
(No.
of
Units
TREATMENT PLANT
Commercial
(No.
of
fixture Units
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE
D ON THE BACK
/Jfy/,fhaVI 0 read and shall comply Date
I _V,
w he Xtei/s 't d on the back.
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Permit Fee: Issued B
Trunk Charge: iDate Issued: ///:�; IV
Assessment Fee: Receipt No.: 7
Partial Inspection:
Comments Date Initial
Final Inspection Approved: 1)_( Ox 4
Dale'- Initial
Rejected:
Reason —6-5—te _Tn—itial
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy - File Green Copy -'Inspector Buff Copy - Applicant
a . -
The City of Edmonds Side Sewer Drawing EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION REPAIRS Fj LID NO - ------------------ - ASMT. NO - ------------------
OWNER ...... -------- CONTRACTOR ------------------------------------------------------------------ Z
----------- PERMIT NO. 0 -----------------
JOB ADDRESS (e .. ------ ----- ----------------------------- LEGAL DESCRIPTION: LOT NO - --------------------------------- ---- BLOCK NO - ------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------
NAMEOF ADDITION ------------------------------------------------------ ----------------------------------------------------------------
ITREATMENT PLANT I
(2A p jusiu— 4w
V
CA ?\ - Approved: /1 110,
2 ez� 4�--
PWW-(1001-1 1/75 (REVA 1/78) DATEI-J--a ...... U --------- ------- By ------------------------------------------------------------
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I D IE! E R P E, R M I T
CITY of EDMONDS S
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For Inspection Call 771-3202 PERMIT NO. 07812
Address of Construction: Eln) P1 C:C( h mids
Property Legal. Description (Include all easements):
Owner and/or Builder:
Contractor & License No:
Single Family Residence
Multi -Family (No. of Units
Commercial
(No. of fixture Units
Invasion into City Right -of -Way: No Yes (If Yes, Right-of7Way
Construction Permit required. Call One-Cal.1-Center (1-800-42.4-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,.
attach legal description and county easement number.)
PLEASE READ T
I �dy�ffy tha
wi tK /the kf terF
HE/ITEMS )ISTED ON THE BACK
I p read and shall comply
s li/st d on the back.
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Permit Fee:
i ! Z, �5,�
Issued By:
7,/
7
Trunk Charge:
Iss
Date Issued:
Assessment Fee:-
Receipt No.:
rV 7
fz�'V 7
Partial Inspection: ; 0 m Zme �nt s Date Initial
Final Inspection Approved:
Date Initial
Rejected:
Reason
—ffa--te Initial
PERM6,MUST BE POSTED ON JOB SITE
Wh-ite Copy - File Green Copy_ -'Inspector Buff Copy - Applicant
S
SIDE SEWER PERMITS
1 Property owners must obtain a permit to install side sewers on their property.
A licensed side sewer contractor must be employed to construct side sewers
in the public right-of-way.
2. The side sewer contractor assumes full responsibility for each installation
for one (1) year.
3. Commercial establishment requires a minimum of a six inch (6").side sewer
line.
4. Side sewers may not be installed closer than thirty inches (30") to any
structure.
5. Side sewer lines must be laid at a minimum grade of 2% (1.150) and maximum
grade of 100% (450).
6. No turn in side sewer greater than 450 (1/8 bend) is all.owed between
cleanout. All 900 turns must be constructed of a 450 (1/8 bend) and wye
with."removab.le cap for cleanouts.
7. No down spouts, footing drains or floor drains can be connected to slide
sewer system.
8. Pea qravel is required for bedding w h e n i n s t a 1 -1 J. -§ e w 6 ra �1 i n: fi�-,o—u gj 8 �-tthh -6 Tr'
than granular- sgi-L..
�A_
9. Cleanouts are required at 301"-60' --from each plumbing exit', line and at minimuT�,-
i'nterval s of 100' along sewer 1 i n'ig, run.
10. Trenches within City r'ight-of�-*Way";must �be restored to original conditions-.
Contrattors shal 1: be responsib,M�."�fodr right-of-way failure due to poor compaction
of fill.
11. Cleanouts at pro:p�rty 1 in e and at,,, h*b use will have risers installed to within
12" of surface'�grade.with removablje cap.
12. Water test is requi
r
5 0 u g6veirre -inspected and approved by the City.
13. Side sewer must, I t h unti 1
14. Inspection durti., - _r ha6rs only. One (1) working day notice
9'
required.
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CURB AND GUTTER REQUIRED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
Homeland Homes, Inc.
cr
W MAILING ADDRESS
Z
'30: 221 James St., Suite 100
Edmonds - 4. 1775-2033
McNurlen Design Group
ADDRESS
221 James St., Suite 300
CITY TELEPHONE NUMBER
Edmonds 771-2592
Homeland Homes Inc.
ADDRESS
221 James St., Suite 100
CITY TELEPHONE NUMBER
Edmonds 775-2033
STATE LICENSE NUMBER
HO-ME-LHI*174KE
Legal Descriptio , n of Property includeall easements
(show below or attach four copies)
Lot 12, Elm Place
Edmonds, WA
NEW
I yl RESIDENTIAL
Ll PLUMBING
ADDIALTER
COMMERCIAL
MECHANICAL
REPAIR
RETAINING WALL
SIGN
DEMOLISH
EXCAVATE
FENCE
REMODEL
OR FILL
PRE-MOVECINSP.1
El
x—FT)
SWIM
COMPLIAN E INSP.
POOL
WOOD STOVE/
INSERT Fj APT.BLDG
RENEWAL
NUMBER OF STORIES NUMBEROF
DWELLING
I'T.70 UNITS One
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
To construct a single family home.
USE \,�ERMIT
ZONE RS-6 ppj) NUMBER
Ess 622 Elm Place
DESCRIPT16 DIVISION NO.� LID NO.
E!5/Z Z 79
p t 12 '7�7P-9-8_� I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING — REQUIRED DEDICATION
PROPOSE6)7Ly/_y,jjjj�- 10
I Z
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED EJ W
W
STREET USE PERMIT REQUIRED C Z
Z
SEE ENGINEERING MEMO DATED W
METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
cr
LU
REMARKS
SIGN AR EA ENV. REVIEW ADS NO.
ALLOWED PROPOSED COMPLETE i EXEMPT
I I SHORELINE#
VARIANCE OR CU PLANNING REVIEW BY . I DATE
YARDS HEIGHT I LOT COVERAGE
Z
FRONT SIDE REAR Z
REMARKS (L
CHEC KED BY
YPE OF C
T��ONSTRUCTION
CODE
HEIGHT
14/
'T
/Y
/,7
SPECIAL INSPECTOR
AREA
OCCUPANCY
OCCUPANT
REQUIRED
GROUP
LOAD
0 YES 0 NO
AEMARKS
PROGRESS INSPECTIONS PER UBC 305 Z
_j
_2)KWLP6C1W6 A 25,e4 6 V co
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewplks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
ENERGY C ODE
"Applicant, on behalf of his or her spouse, heirs, assigns and
I
EARX fCjE
successors In interest, agrees to indemnify, defend and hold
31 harmless the City of Edmonds, Washington, its officials,
employees, and agents'from any and all claims for damages of
E 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,.walve or reduce any requirement of any city ordinance
TOTAL AMOUNT DUE
nor limit In any way the City's ability to enforce any ordinance
provision."
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
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authorlz-
THIS PERMIT
AUTHORIZES
ad thereby, no person will be employed In violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tion InsurEnco..
INSPECTION
DEPARTMENT
SI NATLIRE( ERO A
DATE SIGNED
�-/0-87
CITY OF
EDMONDS
VALUATION I FEE
_16V-00
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL'S SIGNATURE DATE
ATTENTION 771-3202
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
RELEASED BY:
ORIGINAL — File -YELLOW — Inspector
Li
PINK — Owner GOLD — Assp�snr