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City of Edmonds STREET FILE
RIGHT-OF-WAY CONSTRUCTION
PERMIT
A. Address or Vicinity of Construction:
Permit Number: 3 -o6_(o
Issue Date: 3-
6820 176 St. SW (9309498)
B. Type of Work (be specific): Install New Service
C. Contractor: —Washingotn Nat'l. Gas. Co. Contact: Frank Swan
Mailing Address: 815 Mercer St.Seattle, Wn" Phone: 224-2278
State License #: 98111 Liability Insurance: _ Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. Commercial [] Subdivision El City ProjectXfibff tility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family E] SingleFamily n Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut 0 Yes PNo G. Size of Cut: x H. Charge$
APPLICANT TO READ AND k ?4
'damag es or
INDEMNITY. Applicant understands and by his signature to this application, agrees to ho 0 Ch�,-qf �drnonds harmless.�wm"iWj�iW
claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the City'ojEdmonds, or any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings including defense costs, and altorneyfees by reason of granting this pet7nit.
77LE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIPAND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOW[yp THE FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MA 7ED RESTORA 77ON FEES wiLL BE HELD UN77LsTHE FINAL STREET PATCH &COMPLETED BY
C17Y FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO 7HE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Departms-
Work is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes. 771-0220
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 ditches shall be patched with asphalt or City,4pproved material prior to the end of the working day;
NO EXCEPTIONS. ) � -'� I I '�
I have read the above statements and understand the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signature: lv, �IZV,- Date: 3/1103
(Contractor or Agent)' -
CALL DIAIA-DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
. ...... .......
APPROVED BY�: Xxx RIGHT.OF.WAY_DEP.0SIT:: . . . .....
.. ........
TIME AUTHORIZED: VOID AFTER.. DAYS. ....DISRUP.TIONFEE/FUND.1.1.1:.
...... ... ..
AAL;I�v U141VIN.):: ............... i
P .... ..........
. ..... . .................... ...... .... ... . ... .. ....... . ........ ..
.... ....... . - ............
............ ....... ...... ...... . ......
PERMrr.FEE:.
T..,O,TA,,L,FEE:,,
0
DATE: ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUAN
Engrg. Div. 1991
FIEL15"INSPECTION NOTES
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
0 YES
'i
(Fund I I I - Route copy to Street Dept.)
�Z- .4.
0 NO
�z
Date:
Date:
Fna MV' InIv IM
e
Addendum to City of Edmonds
Right of Way
Permit Application
------ - -Submitted by:
Engineering Aide
Washington Natural Gas
k-C) RS�J/k& CLI-F
EXISTING
JAWNG to window
Water main depth �Y: -w- w . ater
unknownZ,V'4 -g- gas
ILI— it gas main -ss- sewer
-e- water hydrant
0 water valve
815 Mercer St. (P.O. Box 1869). Seattle, WA 98111 (206) 622-6767
EET FILE
HARVE -H. HARRISON
CITY OF E DMONDS MAYOR'
CIVIC CGNTER EDMONDS, WASHINGTON 98020 - (206) 77572525
COMMUNITY DEVELOPMENT DEPARTMENT
October 4, 1978
H & H Homes
P.O. Box 644
Lynnwood, Wa. 98036
BUILDING PERMIT #770205 - 6820-176th S.W.
This is.in regard to my letter of September 20, 1978,
and your subsequent telephone call. I discussed the
matter with the Engineering Division of the Public
Works Department and they inform me that the require-
ment for underground electrical servic.e remains. valid.
Please indicate your schedule for completing the
installation before October 16, 1978. Lacking this
the legal action referred to in my letter of September
20, 1978 will be made.
0,1L,
Harry M. Whitcutt
Building Official
BMW/ae
cc: Bill Nims
Public'Works
NOTICE:
No warranty of accuracy.
The information shown on the attached map(s)
was compiled for use by the City of Edmonds,
its Employees and Consultants. The City of
Edmonds does not warrant the accuracy of
anything set forth on these map(s). Any person
or entity requesting a copy should conduct an
independent inquiry regarding the information
shown on the map(s), including, but not limited
to, the location of any sewer stub shown. Such
sewer stubs may or may not exist and may or
may not exist at the location shown. Neither
the City of Edmonds nor its employees or
officers shall be liable for the information given
on map(s), nor for any one representation
provided based upon said map(s).
r
APPLICATION
The City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS F� LID NO - ------------------ AsmT. NO - ------------------
OWNER ------ ........ V-.-A-P t�A F—=. 'S�- ------------------------------------- CONTRACTOR PERMIT NO.
JOB ADDRESS ----------- LEGAL DESCRIPTION: LOT NO - -------------- ----------------- BLOCIX NO . ....................................
1�1
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15
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L-4=>-r —S
..................................................................................................................................................................
NAME OF ADDITION ----- \AV--=\^4 >
....................... ------ �z ........................................................
--4 d'
3-7
ir'll
Approvgd:
DATE ... . ... ........ B
.. ..................
7 06-77
7--IN 7-
17 t�l
4
J MO 'IT*
009 0 N
WATER-SkWER'DEPARTMENT,,
V7
PERMIT
N. 5850
Call, 775-2525 for side sewer inspections IIFFORE covering any portion of the constructiom)
Inspection will be provided within 24 hours after. requst. NO Sat., Sum, or holiday Inspections.
'"DRESS: LOCATION, Ql� ONSTRUC-TION ........ A-
........................................................... .........................................
............
,:",PROPERTY LEGA,,4DESCRIPTI N ....... t ...... ............
0 ................................. . . . ........... f ............... i ............. ........... ..................... : .................
........................................... .................................................................................................................................................................................. 7 ..............................
..................................... ......... ................ OWNER AND/OR BUILDER ......... 1� . ............... ( ............... i ...... Y?7�� ............... . ................. ............... ...........
C'
CONTRACTOR'S NAME'& ADDRESS ........ I ....... ............................................ � ....... ... ................................................ ..........................................................
j, :Hssion Is granted... ........
....................... ......................... p 19 ....... forTepair and/or connection of a side sewer to the city sanitary. sewer
9)r�oem in accordance.., with 451iy- of'Edm-onds ordinances.
ATTENTION IS CALLFDwT,O THE, FOLLOWING:
NOTE No. 1—The owners,,of I �the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor* mus'-t be employed to Construct
side, sewer ih,street area:, Do not cover any portion of sewer before it has been Inspected.
NOTE No. 2—All, work �,lJeiformed, in � city right-of-way. reqpires an. Invasion of IU ht-of-Way Permit obtaln-able from -the, City Engineer's office
NOTE No. 3_—Obtilri) fuii`Mn'for .9,
mation rekaxding Ordinance 11:M030 and Regulations; governing side'sewers wlien you get permit.
NOTE No. 4—Top of side s6wer,must:have at, least 30 inches coverage at property Ilhe and 12 Inches inside property line; minimum grad6,�f"2%% N; bend's An gr'ade
"harper than .-JA WIJIL be permitted.
NOTE No. 5--TrenAes in ' �street* must *be water settled and surface of street restored to original condition. Contractors shall be responsIbIePr*-falIure' due., to Improper
work which may develop within one year'of completion. ma 11, ;_r , - P,' , 1%
NOTE No. 6—It is unlawful to alter or do any other work than. is provided for In the permit, or to do *any woiii on! the Mal n 'sever orAtsLIappuitenances -ekcept.to'in-
sert the pipp.into,the wye.
DISA.PPROVED r-1, Date ... /..� ...................... By ................. . Date ...... .................... By ................ Date ................ . ................... By,.: .............
ZZ.7/ ............ By_/0�--_;:_T ...................... .. . ...................
APPROVED Dal ....... 1:22 ....................................................................
Remarks: ............ ............................................................. ............................................................................................... ....................... ...............
..................................................................................................................... ................................................................................... ......... : ..........................................
d By Owner of Firm Performing Construction PRIOR To Request'For Inspection
BOTH Permit Copiell Signe9l
s MUST Be
I,: side.
..................... t .................... ...................... ... hereby certify that the sewer installation constructed under this permit
(Owner of Contracting
Firm Performing Construction)
was installed in accordance with all governing ordinances of the City of Edmonds.
Dated' thl ............................. day of .... ....... ........ ............. .......................
Check.'BEFORE you dig for.:, Water.E],: �,Gas-. Telephonei'.-O_ PoW.er, Ot,
?!1;1:- .' her-;
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION [:] REPAIRS E]
EASEMENT NO - ------- ---------------- -------------------
LID NO. � ----------------- - ASMT. NO
OWNER ---
------- ----------------------------- CONTRACTOR --------------------------- ---------- PERMIT NO.
JOB ADDRESS -10/eat) --- — -------- t24-45t� ------------- LEGAL DESCRIPT---I-: LOT'NO. ------------------------ - BLOCK NO - ---------------
................................................... :Z -----------------------------------------------------------------------------------------------
NAME OF ADDITION .... -----------
Approved:
DATE-------------------------------------------- By ---------------------------------------------------
yuf6
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I-T5
TtC IIIAIT. LIST =FrIT
911
I;PTI-W,':G
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Pl:f?x:T ITYNT
7-77
Stre(et Jdplit-oE-1�1'av Existing—
izj,.nj) L
Access 17asomonts Existing
Enscment Yxistinv,
�jUtility
Lot 11cr Subdi visi oil at
;itc Plan (I%ccI-.cd for Accurac-�
11ndcrground ".'iring Ruid.
I�CVJ cn-! by— Datc
rxistin,(i i'.,atcl- :�!nijl Si::c
1'."Iter "ain Pcmlirc(l
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(;cptic Taill. Desj�,,n j�,,yrovcd
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Pori'lit !To.
Scptic T.,1111r: Pemit
"init, "To
in, Ilewer Availaldlitv
File '10.
Drx:ijIfI No.—
(;i.(Ic cv.-cr Mai la))J h t,
PCquirec
Saidtary I)ever Cbiiw�ction 1ec
h- !late
R.'en D;tch Pecul.1-00
LON,
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0 i
I— Catch Pecluired Indicate oil :I�itc Plan
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ro,mired
I/D �j --bidicnte on S;tc' Plail-A—
Soil Conclitions F, C-oun"I 111ater Fichl ('11CCII,ccl
"cv-icl-I by R"ite
V—
USE PERMIT
ZONE NUM 8 ER
BUILDING DEPARTMENT
Applicant Fill
F APPLICATION
Inside Heavy Lines
JOB
ADDRESS
6820-176th St. S.W.
,,ERAIT
NAME (OR NAME.OF BUSINESS)
14 & H HOME S , RJC .
VARIANCE OR COND. USE NO. JADS
NO.
HEIGHT
W MAILING ADDRESS
Z
3: P. 0. ]3ox 61�11
"'eSeOr-YARDS
I I /
ILOT COVERAGE
0 CITY
TELEPHONE NUMBE�____
q ;' SIDE /'�_/REAR
FRONT 3-
Lynnwood
775-1916
SIGN AREA
ENVIRONMENTAL REVIE;;�
ALLOWED PROPOSED
0 COMPLETE El EXEMPT
NAME
REMARKS
U
W ADDRESS
PLANNING DEPT. APPROVAL DATE
U
it CITY
TELEPHONE NUMBER
LEGAL LOT
AREA
No.
&YES El NO
ILOT ISUBDIVISION
L-A-T
NAME
STREET R/W
Same
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
'510
COMP. PLAN ST. R/W 5 FT. FT.
0 ADDRESS
U
<
CITY
-
TELEPHONE NUMBEF?
REMARK
sDriveway slope not to exceed those
Z
indicated on Standard DrawinjR 103.
0
STATE LICENSE NUMBER
CITY LICENSE NUMBER
CHECKE Y
223-01-9080
1 1 UTP_
Legal Description of Property (Show Below or Attach Four Copies)
STREET AND/OR UTILITY WORK
R/W PERM ' T REQUIRED
R E O'D. 0 YES WNO
0 YES IRNO
Lot lo i1jewridgp #6
UNDERGROUND
z
WIRING REO'D. O�Y ES 0 NO
0
]METER
TYPE CONNECTION Y E s
SANITARY SEWER NO
V E R I I
�BJTJ
U
(A
SEPTIC SYSTEM
0 YES
P ERMIT NUMBER,
W
0
APPVD BY CITY ENG.
EINO
I�A
J
REMARK
W
J
SIZE ISERVICE SIZE ICLEARANCE [CHECKED BY
Z
0
U
III
W
0
1
L9
Z
Z
01M
Z
III
m
ILI
REMARKS
EW RESIDENTIAL GAS
N 1:1 LINE
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
NON-RESIDENTIAL SIGN
ADD
RETAINING
SPECIAL INSPECTaW -FW-E-
__
A
JOCCU ANCY
-CCUP ANT�
1L.A.
DEMOLISH
REQUIRED
GROUIP
ElALTER EXCAVATE
OR FILL
ALL
FENCE
0 YES 0 NO
PLAN CHECKED B
PRE -MOVE
El REPAIR EJ INSP.
swim
POOL-
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
New construction
Sin'r?le forn.ily residence
PLAN CHECK
NO.
PLOT PEAN (INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
see attached - - -
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
IL
THIS SITE IS LOCATED IN THE CITY W
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04,
Z
VALUATION I FEE