625 ALDER ST.PDF10056
.625 ALDER ST
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: [] Conditional Waiver E] Study Required E] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN -DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DA'
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORTPLAT
SIDE SEWER AS BUILT DATED: --
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DA
STREET USE / ENCROACHMENT PERMIT
FOR:
WATER METER TAP CARD DA'
OTHER- 49)(11 ?�Q-24�0
LID #:
LOT: BLOCK:
LATEMP\DSTs\Forms\Street File Checklist.doe
APPLICATION
The City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
105-03650 NEW CONSTRUCTION F-1 REPAIRS LID NO - ---------------- .- -ASMT. NO . ..................
OWNER ............... Wi.1.1-i-am --- K-..--Dms.00n-..Jr ------------------------------- CONTRACTOR ------------------------------------------------------------------------------------ PERMIT NO - --------------------
---- - - - ---- -- - --------- ------ ......
JOB ADDRESS ..... 6.2.5--Ald.e.r ... Stree.t ..........................................
.. . .. ....... . .. ----------- --
-0
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LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
..................................................................................................................................................................
NAMEOF ADDITION ............................ ..........................................................................................
DYE TESTED ON SEWER - February 27, 1976
By Jim Jensen
Approved:
DATE............................................ By ---------------------------------------------------
City.of E.d.m.oh'dso
RIGHT�-OF_WAY CONSTRUCTION
PERMIT
PermitNumber.
Issue Date:
A. Address or Vicinity of Construction: 675 Alder ST (9622102)
B. Typ"f Work (be specific): Insta1l Service.
(9�9 0 9 C�
4
C. Contractor: 1jaghiington MajL3ural Minn q, ,,C,, Ontact: Nxiri�mnp_ K1[ngabuU
Mailing Address: 11 . 22 7S St SW RvArp-tt Phone: 356-7500 X7596
State License #: 98203 Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. [_1 . Commercial 0 Subdivision El City Pr9jPct R) Utility (PUD, GTE, WNG,- CABLE, WATER)
E] Multi -Family SingleFamily n 0 ther
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: 0 Yes MNo G. Size of Cut: x H. Chargq-$
APPLICANT TO READ AN, 'EkfGN
INDEMNITY: Applicant understands and by hi88ignatureto this application, agree8tO hold t)�Ae City ofEdmondsharmIe88fr0Mirqitrie8, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen,. 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 legalproceeding8 including defense costs, and attorney fees by reason ofgrantirtg 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 TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
Construction drawin# of proposed work required with permit application.
A 24 hour notice is required fori.nspection; Please call the Engine�'ering,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 atall 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 asphalf 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 will be
available on site at all hTes for inspectiojz purposes.
Signature: Date: 9=27-96
T�ractor -or
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME'AUTHORIZED: VOID AFTER DAYS'
SPECIAL CONDITIONS:.
X1jMM:4a&3
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
RECEIPT FEE:
DATE: ISSUED BY:
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NO WORK SHALL BEGIN PRIOR TO PERMIT N81JANCE E . ng. Div. 1994