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658 ALDER ST
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ADDRESS: t 0�9 46wi
TAX ACCOUNT/PARCEL NUMBER: nb��5qloq%lbb
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: L/I DETERMINATION: F-1 Conditional Waiver F] Study Required [] Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (C
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PLANNING DATA CHECKLIST DA
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
C3
Y7*0
LID #:
LOT:' I'l— ?-0 BLOCK: 04 4
LATEMP\DSTs\Fomis\Street File Checklist.doc
401,
The City of Edmonds Side Sewer Drawing EASEMENT NO - ----------------------- ....................
105-02800 NEW CONSTRUCTION El REPAIRS [:] LID NO . .................. ASMT. NO - ------------------
OWNER..... SYLVIA.-GOTON ........................................................... CONTRACTOR .................................................................................... PERMIT NO - --------------------
JOB ADDRESS ...... 6.58-ALDER-ST - ----------------------- .......................... LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO . ....................................
NAME OF ADDITION ..............................................................................
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DYE TESTED ON SM,4FR
Approved:
PWW-0001-11/75 (REV.11178) DATE ............................................ By ....................................................
-for
'" "W-44
_Cjty n
-OF-WAY CONSTRUCTION
RIGHT
PERMIT Permit Numb,,
Issue Date:42 - /a - 2_5'
A. Address or Vicinity of �C . onstruction: 658 Alder S t (9603976)
890 9 C� B. Type of Work (be speqfic): Insiall Service
C. Contractor: washinaton Hat-ur-21 Cas
Mailing Address: ]122 75 St SU F.-irprett
State License #: 98203
D. Building Permit # (if applicable):
Contact:
Phone: 156-75nO X7596
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. Commercial [J Subdivision 0 City Project g) Utility (PUD,-GTE, WNG, CABLE, WATER)
Multi -Family EJ Single Family n Other
V,J I
INSPECTOR: INSPECTOR:
F. Pavement or ConcreteCut 0 Yes [MNo G. Size of Cut: x H. Chargq,$
APPLICANT TO READ AND N
4D
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from injuries,- �geslo
claims of any kind or description whatsoever, foreseen or unforeseen, that may be "�aiainst the City of Bdmond�l or ar�y�,,OfJift t8 or
en
employeiii, including or not limited to the defense of any legalproceedings including defens�i costs, and attorney fees by reason ofgran ngthispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATER1ALdF6li'?A, PERIOD OF ONE YEAh)7OLLOWING 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.
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.
Tr-affic 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 asphalt 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 alUirl-es7fo rposes.
Signature: Date: 11-27-95
(contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT
TIME' AUTHORIiED: VOID AFTER I �dF-A—L—DAYS DISRUPTION FEE/FUND Ill:
SPECIAL CONDITIONS: RESTORATION FEE:
PERMIT FEE:,
COMMENTS:
TOTAL FEE:
RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994