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623 2ND AVE N.PDFiiiiiiiiii 1 11 4815 623 2ND AVE N ADDRESS: TAX ACCOUNT/PARCEL NUMBER: OW2201190000(om BUILDING PERMIT (NEW STRUCTURE): 1953 1 cco� COVENANTS (RECORDED) CRITICAL AREAS:— q5, u3f) _DETERMINATION: r] Conditional Waiver Ej Study Required N(waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: . 10 Y4,05— PARKING AGREEMENTS DA EASEMENT(S) RECORDED FOR: PERMITS PLANNING DATA CHECKLIST DATED: 05 SCALED PLOT PLAN DATED: 4-15 -q(p '1109), 10 'J'05 SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: �0 BLOCK: SIDE SEWER AS BUILT DATED: 66 SIDE SEWER PERMIT(S) #: Z11,2p GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD DATED: OTHER: k)w ?2. is) CEO%) LATEMP\DSTs\Fomis\Street Filc Checklistdoc FOOD% a"-'r-4rv* i ISTj W, 16: &0 -E ATr losuLA, muT *t-3 Fr. ONNER/CONTRAc; RESpr' ON r- cr jq 1: EROSION 0c.tv)-Ti-, nLANDD;jA-'.AGE 'Rkno -FbOL- ra z pr i re=-Kic'e To C H?,h POOL A L k�ftf`41146% W"L Awtorenc -ro R E� S U B Xjo -1—� FI- el --pli 5 k1w e MAR 2 9 2007 t 3,!5 F� 13UILDING UEPfARTMENT Z P "p CITY29F EDMONDS CD U) C) LL) C\j 3: co PC- Ljj FOc& U) < wo" Z--'�: Z Z11" No 7D VIP, m: co Z 0 &Ad u) LU aw loci X # V:m UB PL. /-\'\I sc. 156.'P7 OCT 7 2005 i- 1,, 0 VILDING DEPARTMENT CITY OF EDMONDS ca 10 OA-9 + 5.�'T APPRU�ED AS NOTED BY ENG"'I EERING E MT, r? P 0� Date: t .45- Qms U) 0-4 it v -Z5 I=T,. 1� W U] 03 Fr j C4 0 :3: ILE OF EDMONDS WASHINGTO BUILDINOPERM-IT Applicant'hereby.,.6ertifie's that a plot, plan, dra�vings, and sufficient details:to indicate the interition to fuM aU requirements of this code are attached hereto. App�cation is hereby made for permit to do the followin,- work:' .......... ........... ........ ....... ................. ..... . ......... . ......... . .. . ... ........................................................ .............. ............ . ........................... . ............................................................ * .................... . . .......... . .. ........................................................................................................................................ ..... . .............................. ....................... . ...... ......... . ......... ... - --------- ........... ............ Block ...... ...................................................... LOL ........... ............... ......................................................................................................... . .... . ......... ..................................................................................................................................... ....... ......................................... .... .......... ........ at ........... �Lz..a- __0 . . ... ............... . .. . . .... . .... 7 ----------------------------- ----------------------------------- - 1.,Building dimensions ................................ X ..... .......................... * /a e-9 — 2. Lot dimensions ................................ .............. 3. Building will be .......... / .......... stones. 4. Basement ........................ 5.* Occupancy of building will.be.,.� ........... e04:� .................................. .. .......... d* line. 6 . .. -" - I frorq thyeea#st a Joxnm�_ 7. Own . .......................... :/__52 - -------------------------- .17 �z 8. Owner's Address....-..;;2�-_ X— ........... .. . ........................... . ................ . .......... . ... "Builder's Add ...... 9.. Builder .............. .. ------------- * -------- 10. ............... 401 Date_ —2f ............... ........................................ )wner- or. his igent), 6 Nrmisssi' is'hereby granted to do the .%�6�k'de'sc'ribed:hereon", "acc*ordig to theapi)roVed'..'r)la;ni: and s C�8� on subject 'to compliance- with the ordinances'of the City of Edmonds' PERMIT NO, 10.00 1. Ile building permit fee which applicant pays when permit is issued shall be based on estimited cost of the proposed etructure, at ihe rate Oi $'2'.6040reftch $1000.00 of case.' If the actual cost of the stricture, when finally determined, exceeds the estimated cost by.more than 5%, applicant aitrces to pay an.additlow he of $2.00 for each $1000.00 of such excess cost. 2. Whenever a contract for construction Is executed for any structure costing more than $1000.00, for which a licensed architeccor engineer' is not nMulred by the Building Code of tLe City of Edmonds, the application for a building permit 3hall be accompanied by a copy of the contract. and 'a copy of the detlaed specifications. 3. Prior to employing Pay labor or commencing work, notify the Industrial Insurance Division of the Department of Labo� and Industries, giving an ettlasateof the payroll and make monthly teports of payrolls. Full Instructions should be obtained from the neircit office of the Department of Labor amd Industries. Brim final payment. the owner should obtain a release from the general contractors who in turn should obtain rele-,Lse from all sub -contractors. 'Me releases should be attested by the Department of Labor and Industries. Ile above procedures are requirements of the State Industrial insurance Act. J_ ILA - a vv 1* 7 0 /- ol f-or RAWla + A LLIL,1&1, TZ) 4EDC I ',,T, LV— Fr POOL- 9 Fr OINNER/CONTRAcTol IS RESPONSIBLE FOR EROSION C0m,!-,." 'Pwno 'root- iOL AND DAMAGE z fir pr I P�EKY-G To �,,c L F. X, (IA T,: Vomom6i WftL 1 0 S, X ? ts�& Fr .0 10 U) C) c\j LU C:) S LO& 3:,Co CD co > < 4ZI Poe, t 12�: r Z < 7D 0 T- 0- ell, + (.'7,5 rr co Nis z LLJ Ln 0 C3 LU co 0 > T- C) V R F.'s u B f4 Pr .4,04 14,5 PL. OCT 7 2005 I Avic, 156:'P 7BUILDING DEPARTMENT * t�. . 'r CITY OF EDMONDS fgo\l toe, aem�k-T LD ?66L WASTF...,. APPPLOVED AS NOTED cc j BY ENG N L11 E 10T, :bICINEERING E Date: 0 G;k i sr?, p 0� f .45 LD LD U% k v 11% Fr' j 5 94 0 C, STREET FILE 0 PLANNING DATA NAME: t-ttAakI W1 IbOPI DATE- Dg/()q/2_00_J;' SITE ADDRESS— 3 2_0 d A Ve, AL PLANCHK#:Q6- q(0 PROJECT DESCRIPTION: N.P_m/ ewimmivia 6_f)_t_)T_T_jjZ v Atz v 0"N REDUCED SITE PLAN PROVIDED?: &Yes No) MAPPAGE:_ 7esi CORNER LOT: (yes FLAG LOT: (Yes ZONING: P-5 - (j2 — CRITICAL AREAS DETERMINATION #: Study Required - Waiver Conditional Waiver 'K w1occ, 4tA-f L SEPA DETERMINATION: Ll Fee U Checklist a �p L] APO list w/ notarized form LI (Needed for 500 cu . bic yards of grading, Shoreline Area- site within 200 ft- of Puget Sound or Lake Ballinger) Exempt of SETBACKS: Reguired Setback§,� # IV '51 5 '51 W t, Street' ?Y! Mft Side: — fttght Side: Rear: Actual Setbacks: N 1 .5 W I E; Street: JN Left Side:- q I Side:— -jRear: q Street map checked for additional setback required? (Yes I No I&D) DETACHED STRUCTURES: (P000 otm Q ROCKERIES: A CC , VE75 Dry r7tru' M W1 U FENCE SITRELLI SES: /—(000 U BAY WINDOWS I PROJECTING MODULATION: C.4 Y' STAIRS/ DECKS: PARKING- Required: 4*"-Actual: Nk, WA d pool LOTAREA: (SIVI-10) LOT COVERAGE Calculations: BUILDING HEIGHT: Datum Point: —Datum Elevation: Maximum Allowed: —Actual Height: A.D.U. CREATED?: 60) Ye,$) SUBDIVISION: LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: fff�_S& Plan Review By: QW,-r2' Z LAnA"_ NewBP P lanning DataForrn, DOC 0 0 6 9 0 - 19 q - City of Edmon& Critical Areas Che cklist The Critical Areas Checklist contained on this form is to be filled out by any person preparing a Development Permit Application for the City of Edmonds prior to his/her submittal of a development permit to the City. The purpose of the Checklist is to enable City staff to determine whether any potential Critical Areas are or may be present on the subject property. The information needed to complete the Checklist should be easily available from observations of the site or data available at City Hall (Critical Areas inventories, maps, or soil surveys). An applicant, or his/herrepresentative, must fill out the checklist, sign and date it, RECEIVED JUN 2 3 1995 and submit it to the City. The City will review the checklist, make a precursory site visit, and make a determination of the subsequent steps necessary to complete a devetopment permit application. With a signed copy of this form, the applicant should also submit a vicinity map or plot plan for individual lots of the parcel with enough detail that City staff can find and identify the subject parcel(s). In addition, the applicant shall include other pertinent information (e.g. site plan, topography map, etc.) or studies in conjunction with this Checklist to assist staff in completing their preliminary assessment of the site. I have completed the attached Critical Area Checklist and attest that the answers provided are factual, to the best of my knowledge (fill out the appropriate column below). Owner / Applicant: -Applicant -Ikepresentative:- Narne71—_ Street Address t,/A G —Ex , _i_ City, State, ZIP Phone 21 I ature Date Name _,A4-2� LMO.OX 0� StrerA Address City', State ZIP Pho 'I; a Arno 4WDatre Signature CA *No. *tical Areas Checklist qGi3s- Site Information (soils/topography/hydro o2v/vegetation) 'A��1. Site Address/Location: 2- 2. Property TaxAccount Number: -5-2-0 0 000— 0 0& cx-je-,� 3. Approximate Site Size (acres or square feet): X/ yes; no. 4. Is this site currently developed? If yes; how is site developed? 5. Describe the general site topography. Check all that apply. Flat: less than 5-feet elevation change over entire site. Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal distance of 66-feet). Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of 10-feet over a horizontal distance of 33 to 66-feet). Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal distance of less than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water: Q 0 -; Approx. Depth: 7. Site contains areas of seasonal standing water: ;Approx. Depth: What season(s) of the year? 8. Site is in the floodway. 00 floodplain of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? Flows are seasonal? k) 6 (What time of year? ki�*Pt'�� . ; meado 10. Site is primarily: forested w _; shrubs mixed urban landscaped (lawn,shrubs etc) 11. Obvious wetland is present on site: 0 0 . ........ -----ForCity Staff UseOnly------- 1. Site is Zoned? 2 SCS mapped soil type(s)? .( 05ML AML 3. Wetland inventory or C.A. map indicates wetland present on site? 4. Critical Areas inventory or C.A. map indicates Critical Area on site? 5. Site within designated earth subsidence landslide hazard area? 6. S ite, designated on the Environmentally Sensitive Areas Map? /I/b DETERMINATION STUDY REQUIRED CONDFrIONAL WAIVER V WAIVER,," Reviewed by:_ Planner Pate Rev 0 1/0494 OL TECH C'ONSTRUCTION 9114 21805 98TH AVE. WEST Vic eak 5(,m,mmw— t kDL- FGi--* 9114 A/dr"7rao EDMONDS, WA 98020 �500&07741-- 1),4y N OT TO ,'CLEAN 0 RESIDENCE CLEANOUT WITH 45m ::�BEND AND CAP 100 CLEANOUT <WYE WITH'CAP AND LOCKING LAMPHGLE Cl 12'+1- -7— '*—WATER TIGHT CAP RISER 12h S�EEZC 6" RISER 4' OR .6' SIDE SEWER GENERAL CLEANOUT DETAIL 6' WYE AND AND 1/8 B APPi'loVE AS NOTED BY E � I IN _U6G EERI G . _,4*L Z DOW; to -- fcV- ftL Ot6cttft"s UJI DtW.(,-r 6w&r,&cTjom r,4aT V) �&AAVnVD. 00-1w /20�PKING LAMPHOLE COVER z MIN. -j 6" CITY STUB 4' OR 6' SIDE SEWER-J 12, CLEAN OUT DETAIL AT PROPERTY LINE ASPHALT SURFACE LOCKING LAMPHOLE VCR (EAST JORDAN IRON CWOORKS CO,) (MODEL #: 00366f-Inc" ,7 6' RISER 12" PVC SLEEVE 0:0 C . I�F PV CAF 7 7 PVC CAP NOTE. OF.9 SIDE SEWER JOINTS SHALL BE TYPICAL C7LNOUT tUNDER ASPHALT GASKETED OR CONCRETE - 1-1 1 /-46114 u A-\ M L) 2�" Lai 9= � FF 6r� l8jo,�900 7 , d I V , r - " 5F=WER CLEANOUT DETAILS The City of Edmonds APPLICATION for sEDE sEwER rERMT OUTSIDE [-] INSIDE 0 REPAIRS E] CARD No . ..... EASEMENT No. OWNER Yy!�q.lt7-CONTRACTOR ... A .. ..................................................................... PERMIT No STREET .... ... 6 ...... ........................... AVENUE LOT No . ................................. Y ............................... BLOCK No. ki'a r HOUSE No. ...... ff - -t NAMEADD . .................... ....... ............................................................................... ;.0 .j LL. A BACKFILL WORK ORDER ISSUED ... SEWER WORK ORDER ISSUED .......... rl Date Approved: ........................ DEPOSIT, $ ............................................. ........................ DATE ..... C. JL4 APPROVED I UL 8 1964 ul i A&M BY......................................... I ........................ i e4. APPLICATION CARD No . ...................................... The City of Edmonds for SIDE SEWER PERYaT EASEMENT No . ...................................... OUTSIDE E] INSIDE REPAIRS 2 1 :AJ V OWNER .... LIA ��/Y ----- ................ �14 - -- ---------- Z .................... CONTRACTOR --------- 4?.R� ..... ......... (L,� ................................... PERMIT No. STREET ......... HOUSE No . ..... ..... ......... .......... AVENUE LOT No. ..... BLOCK No . ...... ........................................ NAMEADD . .................................................................................................................................................... 0 Date BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ ................................... SEWER WORK ORDER ISSUED .......................................... Approved: DATE ... / ....................... BY PPROVED U L 10 1964 APPLICATION for The City of Edmonds SEDE SEWER PERNaT EASEMENT No . .......................................... NEW CONSTRUCTION E] REPAIRS E] 112-09500 OWNER......... Ahi.tmati-Perham -------------------------------------------------------------- CONTRACTOR .............................................................................. ................... PERMIT No . ...................... ADDRESS ...... §?3 2nd Avg, N. . ............................................................................................. LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................ 10 46' 0 NAMEOF ADDITION ......................................................................................................................................... Dye Tested On Sewer 1972 Approved: DATE................................................ By ...................................................................... I 11/67(" DEC - 2 2006 BUILDING DEPARTMENT CITY OF EDMONDS STREET FILE Wilson Residence Addition 623 2nd Avenue North Edmonds Washington 3/4396 FT4ect umffenmalHem Tax # 13794 sf lot area 5201-000-006-0000 Legal Description: Lot 6 Morse Addition to the City of Edmonds, According to the Plat thereof, Recorded in volume 15 of Plats page 16, Records of Snohomish County, Washington Existing Eave I - 2126 sf existhig Lot 13794 sf 1 story house Exst House 2226 sf 1pon 7, c. v v VA Owner: Hugh & Jenny Wilson Contact Person: Steve Grant 485-3838 sf addition APPROVED BY '10, 4 p4t .10 Ot 4P '0 __.-O' P've 0 0 N APR 1 1996 0, Plot PlalnScale:� 1'=2-0' N ..j PERMIT COUNTER j Wilson Residence Addit. ion 623 2nd Avenue North Edmonds Washington AP PLANNING 13794 sf lot area Existing Deck Existing Eave ........... 2 100 sf existing 1 story house : -142 ::under sf Nook/entry addition existing roof L Existing Eave -Yxisting patio-'. --E isting Dtiv x 1110" 4A 04r Plot PlanScale: F=201 N UITO�(Boz HMffb1rM&%fl@M Tax # 5201-000-006-0000 Legal Description: Lot 6 Morse Addition to the City of Edmonds, According to the Plat thereof, Recorded In volume 15 of Plats page 16, Records of Snohomish County, Washington Address: 623 2nd Avenue North Edmonds WA 98020 Areas: Lot 13794sf Exst House 2 100 sf Addition 142 sf Owner: Hugh & Jenny Wilson Contact Person: Steve Grant 485-3838 IRIECRIVED JUL 18 1995 M nema W"OUNTER F. Z U >4 2 I 0 U 0 F� >4 0-4 Z 0 >0 U 1:4 0 Lr� CITY OF EDMONDS PermitNo. COMMUNITY SERVICES DEPARTMENT Date I Issue RIGHT�_OF-WAY CONSTRUCTION PERMIT --A. 0 Owner: Washington Natur;ql Gas B. 9 Contractor: Name - Nanfe) 805 156 Av NE 0 ro r�-- M Ying Address Mailin AdU _' Bet evue, WA 98007 9 P/1 rt- City State Zip City Siate Zip 447-0700 State License Number Telephone Number ris 9 Address or Vicinity of n ructiqn/2-vA.22 9 Ay N Type of Work to be Doft. ermi uested to instal a 2" plastic gas main in ,9Aion,is,req 2 Av from 23'N C/L Cas 0 X!MAL Casper St. P.A.D 893-107 (60433, 1g) Work in Connection With: 0 Sub or Plat 1:1 Single Family 0 City Projects 1-1 Commercial 0 Multifamily IN utility Pavement Cut: 0 Y 0 N 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, forseen or unforseenj 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 attorney fees 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. Funds he Id from the Security Deposit (estimated restoration fee) 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 Public Works: 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. • Traffi6 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: 11-21-88, Owner or Contractor This Permit Must.Be Posted at the Job Site For Inspection Purposes Call DIAL -DIG Prior To Beginning Work ISSUED BY: Q//2. oylrx'a-a) I i �f - Time Authorized: Void after ( k�_-30 —days. Special Conditions: Amendments:, PERMIT FEE: Security"Deposit: Receipt No.: Fund I I I Pee: Street Cut Dimensions: X NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE. Efig. Div. July I FIELD INSPECTION Comments: Diagram: I I I - Route copy to Street Dept.) 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 wo 24W '. I f -1 f*O /lr- i I - lwl 0 is um(w ' 0owse., I I oil - M4 6c)6 p*-11 Av� c ft";� — ��I- S4JID kJF- O� et� Nko 0 C�> I vi Ae RA7. - L)ort Dkt'VAA 100, 00 too + I op. + top top. 00 kueAka- 23 8 311A 133UIS.,", -,.,APPROVED BY PLANNING > cn Lr) LU oft I LLJ LIJ cr I- C/3 IV Av I LOCATMAI WIL 3,OA1 96:5 10C-AlCif- Sri" IV 9 V S-c)'46 "' W /59, 3 LSO UMD9R & AUOC. TN I-T-bl #DZISE LOZA-rlpm /-i barslncs WALL L IW67, / 7� 0 0 6 3 Alp 7' f�4,p KI lj� VGf2 hi-A.AIA D r tbbr. City of Edmonds. Permit No:d4Z—z(0 RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: C1 19 OPL Q.A) Address or Vicinity of Constructiom 0?'YA P'e., 1U Ek�xd.s 6(,A qgUzo (9. Type of Work (be specific): R C C_ Af- w e-- Ulm /hf'C'qIc-_ cu� C, IV,( rc a) acc_ wl�� I e+ QContractor Ak-&.Q& 161- A6P Contact: 49,1� 7r,�,PV_ Z5�,e 4!�' ) ' ' qJ V Mailing Address: Szz - 4�_� S- 2— Phone: State License #:-el&k -A"q�r 3,2 5ez Liability Insurance: Bond: $ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable)-. RECEIVED E. Fj Commercial 0 Subdivision EJ City Project EUC (PUD, VERIZON, PSE�ffftq )ff) Multi -Family Single Family Other y INSPECTOR: GILSOZ ENGINEERING DIIJISION T- CoA ne-1 F. PAVEMENT CUT: [I YES El No G. SIZE OF CUT X CONCRETE CUT: YES NO Al'I'LICANT TO IZEAI) ANI) SICN INDEMNITY. Applicant understands by his/her signature -to.this application helshe holds the City of Edmonds harmless ftom injuries, damages� or claims of any kind or description whatsoever, foreseen or un/breseen, that.may be made against. the City of. Edmonds or any of its departments. or employees, including.but hot limited to the defense of any legal proceedings including defense costsa"nd attorneyfees by reason ofgranting this permit. JHE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD. OF ONE YEAR FOLLOWING THE FINA L INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES 97LL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED B KCITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WfLVBE PROCESSED FOR ISSUANCE TO THE APPLIC4NT. Traffic control and public safety shall be in accordance with City regulationslas required by the City'Engineer. Every :flagget. must".be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the their possession. required training in Restoration is to be in accordance with City, codes. All street -cut trench work shall be. patched with asphalt or City- 4". 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. CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK . . : I I HA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE THAT I MUST MAKE THE PINK COPY OF THE PERMITA VAILABLE ON -SITE A TALL TIMES FOR INSPECTIONS FOR CITY USE OM Approved by:. 1r.ime";iut'hotized: Void After �pecial Conditions: V�eIT) 141F� 1?J �WOP WA V Date: Y Right-od-way. Fee: 10 Disruption Fe e/Fund. 111: Restoration Fee: Total Fee: Receipt,No. &05,Vq_ Issued by:�'�I.- A 4EP UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL.��.. INSPECTION IS REQUIRED PER CHAPTER 11 18.00 OF THE'EDMONDS COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326) FINAL APPROVAL OF PERMITTED WORK. DATE: Inspector's Signature For inspection requirements see Engineering Inspection Information handout. 1K I DAMy Documents\Forms\Engnmg\ROWpermit doe S44! WaL I EW M,911V 3'PR$r 5 R R vle- c- (�) . - . S� 0 911 CR57PER 7—St IN p rirm—r 7mrm Ii WJ, rilk'3 $7W. -3 "v lk- o' k"l 0) CALL 2 DAYS BEFORE YOU DIG*, 1.800-424'555-5, tk( lo —3 I 2- /F MRIAI 6, Itv 9 8 7 6 5 4 1c, 2 tt 'noe�19-CER- w /Z s 7o- �-16o I IT TEM QUANT.r DESCRIPTiON STOCK NO. BILL OF MATERIAL PERMITS: 1/4 SEC: lvkl 0 4 " 2 7 PLAT. 142— f--,/ 0 6& OP MAP: %A NaturN Gais A\�b�to� Erergy Coffparry AREA: TAX CODE. SQQ- D.G.Rl 17- 1% 2 *17141. Z-A 7-F N S M N 7-0 5RAVC- lq v DWN: f3l;7-rPAI C H K'D: 7 SCALE: Ap�: IR I�OqY-3 RR jOB `7 NO. DESCRIPTION DATE BY APP'D DRAWING 37/ 7 -j� RE I VISIONS