7002 174TH ST SW (2).PDFiiiiiiiiiiii
1048
7002 174TH ST SW
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).
APPLICATION
40, The City of Edmonds for
SIDE StWER PERMIT
nor Itf.
a3lfef-1 NEW CONSTRUCTION REPAIRS
OWNER ...... -- ------------- : --------------------
JOB ADDRESS .7� ... = ---- r2-. -77�V '. - .............
0
0
EASEMENT NO.
LID NO . ........... ...... ASMT. NO . ..................
, 77C)2)mPf:3--;' JA
CONTRACTOR ... .......... 7- ........ ------ ............. PERMIT 140.
LEGAL DESCRIPTION: LOT NO - --------------- 4 ......................... BLOCK NO . ....................................
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I - � A � - I =t- �� , J�-
--------- -- ---- - ...............
Approved:
DATE ........ By ........... 9-� i �i, 8�
i
. ...................
8� city Sa4iltary sewer
for repair and/or connection of a side sewer ..to th
inissioil isgrarited._1 ..... I ........ P
With-'Clty,Of 'E
in, amordance dmonds.ordiDanecs
1% "tern yed-to construct
CALLFD,.TO THi'FOL'LOWING: nsed Side Sewer contractor must . be, emplo
ATTENTION IS le.propertY line.. A lice
Ly obtain -a permit to construct sewer InsU ted.
NOTE No. 1—The owners of the property- ME . r before It has�been inspee
a I ide'sewer-in street ar 6. 1 Ijo not cover any portion of sewe from the City Engineer's office.
requires an, Invasion of Ri-ght-of-WaY Permit obtaJnable get, permit.
'work perfarmed: in..cIty rIght-of-waY arning'sldejewers when' -You � .
140TE No. 2—All n ' OrdinanC6,11.16.030 and Regulations,,gov, . minimum !grade, of 2 N6� bends In grade
�v tj ' regaidi 9 127.�Jnches ln'slde� property line;,.
3_*Obtjja�,fuII1,,Jfiforma on, I y. line and"
�NOTE� N -sewe , r , M ust. hav - e, at least 30'Inches coverige at proliert -improper
'NOTE No. 4—Top 6f�iid6' failure.:due to
-b itted,. dition. Contractors shall'be responsible for.
shalper�,� than -%,,,will - e,perm
�ttled, and surface, of street restored to original' con
k' street must -be water SE . ' i . . -except to In -
NOTE No. 5�Trenche& ir , within one year of completion. a n. sewer or, its appurtenances
work,whlch�, may: develop In the permit, ,or to,�do ny work on the Mai
'to -alter or � do any other work than Is provided for
I NOTE NO. 6—It is -unlawful
:seft the'PiPeAnto the wye.
. ...... Date ..................................... By ................
.......... By .........
.........
'Date ............ BY ------- ......... ...............
'at("
D1SAPT,ROVM:- n ... . ....... ........ .......... .....................
BY--- . .............
...........................
APPROVED.................. .. ...................
...........................
Rejuaiks: ....... ... . ... ........................ .... ........... I .........
.......... .............................
. . . .......... . ................. .................
.... .....................................
..................................
................ W ...............................
--- ------- n
;
Signed tY owner of'Firm,Performing.ConstructiO
Permit: Co�ies MUST -Be
ZO
-he side sewer installation constructed under this, permit
hereby certif that t
__6 ..............
....... .....
............
........ r truction) :Edmonds.
on.
n�
(owner,of contracting Firf&r4i-ri
governing,ordinances of. the City of
was installed, in Accordance with all ......... 19 .........
.................... 1
Cheek.i3EFORE You dig for:.,Water
Dd this ........... ............. I `d4y 01: ....................................
ate
-S�
Power 9w.
Gag�''D, Tel , cphone! 0i,
APPUCATION
~ ��� �i*� �� �»
..~. ~~.n .,. ��«««wmv�w EASEMENT NO -
SIDE SEWER PERM----'----- ------''
` NEW CONSTRUCTION[] REPAIRS LID NO - ------------------ AG88T.NuI ___---.
-----'--------'-------------------------------------------'-------------'
P4
ILE
STREET F
PIMUC J':�PT- OTP, LIST
:7= 10
L
'11,11LDING, Pl!fl';IT F-VIII.:
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Strcet rdght-o Pv:ay R<isting_ 31015 -0
Access Fascments Existing
fj
Utilitv Fascincnt Existinc, �j ff pj-.n!)
Lot Per Sui)div�sjon Plat Asscssor �'ai)
Sitc Plan n-.c(-.1:ed for Accura
CY 90/771
Y-9
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per twe
Pctector Cj,.ccl: '-C!tcr Pccni-cd
WO
1- 1.'1--;":1'-";:':;1�L CC:-
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'Scr-tic T.-ml: I'vnmiAL !'('mit "0.
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Sb"li.tan, Sci,.-c
--File
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if ('4111 i tal�' f 1"0. TIcoldred A-IJ69 /-1) 16—:7
— Pato
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Clilvort si.ze
0
-ed
Indicate oil '7itc'M'
In",
run
'1:11'.'lole required
oil sito
S-Oil. collditioj"�; F, Ground 1-:atcr Ficld
kview by—Azl$ jute 6 -,2 5--,7,7
BUILDING DEPARTMENT
Applicant Fill
USE PERMIT
ZONE NUMBER
PERMIT APPLICATION
Inside Heavy Lines
JOB
ADDR ESS ?oo.;a /7�
PAME (OR NAME OF BUS114 SS)
LEGAL LOT
LOT ARItA SUBDIVISION NO.
MkULING A DRESS
WYES ONO
I I P
ICITY
STREET R/W
0
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W 0 FT. go F
ELEPHONE PIUM13ER
Sk 5 _— 10 6 o z
N7
REMARKS
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ADDRESS
'ODOZ
CHECKED BY
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TELEPHONE NUMBER
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STREET AND/OR UTILITY WORK
REQ'D. 1:1
R/W PERMIT REQUIRED
Z
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Yes &NO
C1 YES dil-No
N
UNDERGROUND
WIRING REQ'D. ;RYES NO
0
ADDRESS
TYPE CONNECTION "OYES
BY
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0,
IVERIFIED
SANITARY SEWER ONO
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(W
CITY
TELEPHONE NUM13ER
SEPTIC SYSTEM 0 YES
PERMIT NUMBER
Z
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at,
APPV'D BY CITY ENG.
i1NO
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STATE LICENSE NUMBER
—
CITY LICENSE NUMBER
REMARKS
61- -E
k -0 //— -e 2
Legal Description of Property (Show Below or Attach Four Copies)
METER/IZE BUILDING SUPPLY SIZE
W
46�1 dIL"Iez
REMARKS
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0
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CL
SIGN AREA
ENV. REVIEW
ADB NO.
i
U
:�;z q �=&� 14
Al I WED PROPOSED
COMPLETE EXEMPT
0
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REMARKS
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VARIANCE OR CU
]PLANNING REVIEW BY
JDATE
YARDS - I // I - "
COVERAGE
AS
NEW RESIDENTIAL GLINE
C2 5 FRONT �1_ - - SIDE 1.5 REA RILOT
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
NON-RESIDENTiAL SIGN
ADD
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I
DEMOLISH RETAINING
SPECIAL INSPECTOR AREA
OCCUPANCY
OCCUPANT
WALL
ALTER EXCAVATE FENCE
D OR FILL I.— X—FT)
REQUIRED
El YES 11 no I
GROUP
I I
LOAD
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
F� REPAIR PRE -MOVE swim
INSP. POOL
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
NUMBER OF STORIES
NUMBER OF
REMARKS
DWELLING
z
Z_
UNITS
W
NATURF OF WOR�0 TO Bl��DONE
2
F.
VALUATION
FEE
PROPOSED USE
z
PLAN CHECK
0
NO.
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PLOT PLAN (INDICATE BUILDING SETBACKS,
W
ABUTTING STREETS)
BUILDING
U
0
0
J
W
PLUMBING
W
>
10
0
HEAT & GAS LINE
FENCE
>
Z
SIGN
RETAINING WALL
SWIMMING POOL
9 0 9
.10
Citz of Edmonds
RIGHT-OF-WAY CONSTRUCTION
Permit Number.
SNEET HLEPERml"'
Issue Date:
A. Address or Vicinity of Construction: 7406 Z 70 77f —S7- -SW
B. Type of Work (be specific): KrtPLACE DEFU-11 VIE 06 DROP
96ETIOW AFFECTS UW W FM V41E
P PAP AVPgti 7C" 'rl-%Ai nut mira tit
C. contractor: CAAN 594S 150AfftlL ConticV 7z -41 -4 -a'o iU saA i
Mailing Address: -5-33 HAIAI S-7 EDIVOAJDS Phone: 779--57"
StateLicense#: -A-*,,VA2WCC-1o1Q,4 Liability Insurance: Bond: $
D. Building Permit # (if 'applicable): Side. Sewer Permit # (if applicable):
E. E] Commercial F] Subdivision El City Project go Utility (PUD, GTE, WNCX��WATER)
Multi-Farnily' E] Single Family F] Other
INSPECTOR: N7ECTOR:
F. Pavement or Concrete Cut El Yes ZV1No G. Size of Cut: x H. Chargq�_$
AE.MCANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this 0)71ication, agrees to hold the Ci ofEdmonds harmless from injurie.-,'d�amages, or
P claims of any kind or description whatsoever,. foreseen or unioreseen, that may be made agains t%he City of Edmonds, or any of its departments or
employees, including or not 111tited to the defense ofany legal proceedings including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOli'A PER�OD OF ONE YEAR iOLLOWING 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 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.
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 approved material prior to the end of the working day;
NO EXCEPTIONS. % L.
Ihaue read the abouestatements and understand thepermit requirements and thepink copy of thepermit will be
auailable on site at all tl for inspection purposes.
07�
Sig,nature- Date:
rMM
5 A 7g. �n t)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY 0��
APPROVED BY:
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS:
COMMENTS:
RIGHT OF WAY WPOSIT
DISRUPTION FEE/FUND Ill.''
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE: -3n , 0 0
RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Nv. 1991
4
FIELD INSPECTION NOTES (Fund 111 Route copy to Street Dept.)
Comments:
I Diagram .:
CONTRACTOR CALLED FOR INSPECTION El YES NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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