7003 165TH PL SW.PDF914
7003 165TH PL SW
City of Edmonds ! I
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. Address or Vicinity of
B. Type of Work (be specific):
AE
Mailing Address: .00 &) �( 160,3
State License #:
City Business License #:
D. Building Permit # (if applicable):
P e r mi t N o: 190-ar-0/d 0
Issue Date: & 42 8
I -
R0'4)��,4JC/'a 57+id_f.
Co ntact: E / k AltwdF.
Phone:
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E.' F� Commercial El Subdivision City Project EUC (PUD, VERIZON, PSE, COMCAST, OVWSD)
Fj Multi -Family El Single Family Other
INSPECTOR: t3
F. PAVEMENT CUT: YES NO G. SIZE OF CUT -2/ -X 5-11
CONCRETE CUT: 0 YES El NO Pusl� / sl�'r7,6_)Nk 5--CEct
G. [:1 Mail Approved Permit Calffor Pickup
INDEMNITY. Applicant understands by his/her signature to this application helshe holds the City of Edmonds harmless from
injuries, 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 but not limited to the defense of any legal proceedings including defense
costs and attorneyfees by reason ofgranting this permit.
40 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 BYCITYFORCES, AT WHICH TIMEA DEBITOR CREDIT WILL BEPROCESSED FORISSUANCE TO THEAPPLICANT.
Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and.,must have certification verifying completion of the
required training in their possession.
* Restoration is to b6 in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
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/A VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signa ture: Date:
(Contractor or Agent)
F 'Cl
R- TY.USE"ONLY,
Approved by: "b,_;r7*1Le -W
.'.ght�6f; ayY(
ion.
Time Authorized. vo-d'After
Special Conditions:= RLW'±D: UgZ�7 4NpeVoZ ins
pection.fee 4%
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REQUIRED INSPECTIONS: (L ]�ZW
A�) 47% N A- L -ZC W �245 Sl-r�p.,2A, e� Ai
Call 425-771-0220, Ext. 1326for a 24-hour voice -recorded inspection request line.
FINAL APPROVAL OF PERMITTED WO RK: DATE:
,�nspector's� t�_re
NO WORK SHAI.L BEGIN PRIOR TO PERMIT ISSUANCE
CADocurnents and SettingsTurtisNy Documents\Forms\Engnrng\ROWperrnit—.doc Revised 10/01/03
0
05/16/2006 10:56 SPS CaUCTION OPCEN NO. 843 P02
18URICO SERVICE WIRE REQ
UEST
161we Mato 6 2003
New Service V] Repair DOW. CWA. Due Date-,
CLEC? YIN If yes. please check one of the following; UN� Order Resale Order
Date Request,ed-
lplog Requested By:
ILI
Order Number: Pa9dr i.
4�1f;-. q 7J-! 917;
Customer Name: Customer Phone#: Zg.q-, 7��--
Address-* sIb" City -
OUT
County
Excha 'q
n.,e: Z op
MeasuTed footage from protect9r10 property corner cldi6si to "serving terminal"
Footage (times) $5.00 per foot =�charge quoted customer- ;$, Y/N
Date quoted to customer: Quote Accepted? YN 4P WID, (N involved):
Name of person accepting quote and signature:
Map Book Page: q- -TWN: 1217 /V F SEC..
Tefm # & Address.,rv,?,,,,,
ZZ
Was TrnubI6 Isolatad?/yN Is Troub.le:Located? Y/V
TEMP-7
. �� 75990d'lni'r4rminal?c�ON
YOU -
All Premise Work Comp'lete? YfN lyff: wGuld Man all jKk-WIA4 Gampkft, toned'and UbVed in tervMmpt NtD Inotellme
Right -of -Way Footage. Road: 13or6'FootqV
rodveway Bore Footage: Bsi;� on TqP*ofjG/*i* Y
If BSW Replacement for Repair, Authorization: ig.)
Zone. Coach
SCHEMATIC (IjdiC"a"'t a No 1. rth,01r,9
CtIon) .:p6nimet Log IV &0-
Locate 0
130
0
CanCtOCS W rk M-14te
PSM in,
51A = I
P500 a
S 14A a I
DriveNowwor sign and data
0
Remove Tit* 22PF
Esi. Hand 019 @ 4. 20 PF
ES1. PIOW.BfW. 1.40 PF
B'Qr9 WIG PM - 013.40 PF
13ore W1 No: @17.00 PF
SPIICB Bow: @17.50E-A-
cuuwpek 017.00 EA
Total:
,4
0
,4
Lr)
o'l
PERMIT SUSMITrED BY
GTE
LEGEND
PEDS 0
POLES 0
ROAD BORES
:OVERHEAG LINES
I.D. UrlLITY POT14OLE C:3
_UG TRENCHINC ---iJ(;T-
-- ----------- EOR.
wk
7
THE FOLLOWING INFO TO BE. -PROVIDED
RIGHT OF WAY LINES.EOP- OR FACE OF CURB, EXISTING SIDEWALK. POLES, ROAD CUTS AND THE UTILITY UNDER ROA&CLITS,
ABOVE GROUND FACILITIES,(Te:) PEDS.BOXES,CASINETS, ETC..UNDERCROUND TRENCHING AND OVERHEAD LINES -
FOOTAGE OF WORK IN R.O.W.
0
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
T6 City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS F-1 LID NO - -------------- --- ASMT. NO . ..................
OWNER .... F�L—.l ............. . r'� ----------------------------- CONTRACTOR ---- ...... ----------- PERMIT
-7 --7
JOB ADDRESS ------------------------------------------------------------------------------ LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
4411
..................................................................................................................................................................
- \t4
NAME OF ADDITION ----- -----------------------------------------------------------
T
7 k k(Z)
7n I I - I L--.>
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14-0 PSI
S. V\j
70
Approved:
z� 1....
DATE. ...... By.4�Ar_--� ........... 11/75
el
C -Ir OF: 'EUMONDS. `,S1VE,,--',`SEW,`)ER PERM0 IT'
. TY
DEPARTMENT
TERMIT
AIFT7kZ5Z5;'f'r, side,,iewer I , nspe6flons',,BF , F I OR . E covet�inq.- 'any port , I - on �,o f-*t I he. constructi . 9n:
0
(C
Inspection. will be provided within, 24 hours, after rj'equst. NO Sa
t", or holiday Inspections,
RU................... .................................................... ......
-LEGAL,MESCRIPTION ...... ... . ..... ............. .................
,:PROPERTY,- .4--.-. '1'
... . ........ ......
... ..........................
.............................................
......................... I ............................................. ................................................................................... ...................... 17 .................... ...........
............. OWNER, AND/OR BUI IILDER ......... ................... C111. a
............................... ........ . R__ 4 1
..... .....
.............. ......................
CONTRACTOW& NAME:,& ADDRESS.-.,
I , , I -k �, .....................
. . ... ......
..................................................................... ..........
iorit is ;gr . arte�;
-'Perinisi .................. . 19 ......... Jor rep
........ air and/or �conn&tion 6f,a,side sewerto the,46ity-sanitarly sewer
'tdm4n,,accordance with, Clty�?f Edmond;, ordinances.
sy�
iA —FNTiON IS Cjk-LLED� TO. TH-EFOLLOWING':
N . OTE No, I The , �cw�ers of- the property rrfay . obtain a permit t o. construct sewer Inside property line. Adicens ed Side, Sewer Contrac t or must� be em ployed' to . �con c
side- sew , 6r im street . area.,: Do not cover,any portion of �sewer before It has, been inspected. stru t
6TE No.',2-LAIl' work��rf -of-way, requires, an Inv
_.oq�e&tn,�!�Jty right asion of Right -of-Way.Pe . rmitobtain-able from the'City Englnee�r's office.
NOTE No. 3—Obtain full,informEdibn regarding Ordinance 11.16.030
and Regulations governing, sidesewers when you jet.permit.
N6T`E No. 4—Top of,side-sewer'must have at least 30 Inches'coverage -at property 'line and 1i inch6a inside: proper�y line; minimum
sharper than 'W will'be -permitted. grade of 2 .'No. 8ends In grade
NOTE No. 5—Trenche&jn street must,be water settled and' surface 'of street restorid to original '.co
work which: may:,develop within one year of completion. ndition. Contractors shall be responsible, for failurd. due to Improper
NO TE No. .6--It Is, unlawfLul, to alter or� do any, other, work than is provided' for In the permit, or to do any work on the main sew er or its appurtenances, except to in-
sert the pIp6 -info. the� wye.
DISAPPROVED- E], Date......
.......... .... ......... I.... By ................ Date ........... e_ ... . . .............. By ................. Date ................................ By ...... .........
R 7
Date .... .. .
APP OVE
... ... ...... ........... By ...... . ................................ . .................................... ..................................................
Remarks: ..... ...... ................................................................
......................................................
...................................... ..................................... . ............
........................ ...... ....... ........ ........ ............................... ........................................ : ...............
�BOTH Te C S Signed'By,Owner of Firm -,I�>erfbr-mir�i,:iCbnstruc'tibn PRIOR'To Request. ForInspection-
0
........ .... .... hereby certify,, that. the side sewer- installation constructed under this -permit
(owner of.;contracting tion)
i, .%--,-,Installed in accordance': with all governing ordinances of the Cit��, of. Edmonds.:
;,Dated this.... y of
a
W �
te
.r
], , Te�lp�
C�eck BE�FORE, yo di f E
,The City of Edmonds
APPUCATION
for
SIDE SEWER PERMff
NEW CONSTRUCTION M,--' REPAIRS E]
OWNER ------ -a ------------------------
JOB ADDRESS ---- 7aa,3 --------- ................
0
CONTRACTOR
EASEMENT NO - -----------
LID NO - ------------------ - ASMT. NO - ------ I -----------
---------- .......... PERMIT NO.
LEGAL DESCRIPTION: LOT NO - ------- 7 ------------------------ BLOCK NO.. -----------------------------------
--------------------------------------------------------- Ve ------------------------------ 4� .................. ..................................
NAME OF ADDITION .... -12-040 .......
Approved:
DATE-------------------------------------------- By --------------------------------------------------- YUYE
STREET Fg
C I T-Y-- - 0 F E D 1 g N D S
- PUBLIC 1VORkS DEPARTMENT -
Routing of Building Permit, Plat, or Subdivision Applications
Proposed Property Address: 7003 - 165th Place S.W.
DEPARTMENT
COMMENTS
INITIAL
& DATE
W A T E R
2
S E W E R
".2
S T R E E T
B U I L D I N G
0 R
P L A N N I N G
ADDITIONAL INFORMATION:
,77
V1,
9v,
USE
BUILDING DEPARTMENT Applicant Fill ZONE
PERMIT APPLICATION Inside Heavy Lines JOB
ADDRESS
NAME (OR NAME OF BUSINESS)
Bill VARIANCE.OR
W MAILING ADDRESS
z PROPOSED Y
n5pjq q1N, R. k/Esr
5
PERMIT
NUMBER
JSE NO. AD B NO.
0 CITY ITELEPHONE NUMBER FRONT SIDE
SIGN AREA
EDMOND-5 ALLOWED PROPOSED
NAME
EMARKS
u
W ADDRESS
I- PLANNING DEPT. APPROVAL
U
a: CITY TELEPHONE NU MBER
LEGAL LOT T A
NAM CJ�YFS
STREET R/W
ENOOF TR 055 SURY Illvc, EXISTING STREET R/W
0 ADDRESS COMP, PLAN ST. R/W
REMARKS
CITY TELEPHONE NUMBER
z A � 1, 74
,a
. 'REAR
I
i
ENVIRONMENTAL
REVIEW
z
0 COMPLETE 0 r=xEmPT
z
z
DATE
EA SUBDIVISION NO.
FT. DEFICIENCY THIS PROPERTY
FT. FT.
0
CHECKED BY
C.
U STATE LICENSE NUMBER-A.2)j 'D2
CITY LICENSE NUMBER
1
z
221-01 9r)--b-FIS
I
0:
11)
W
Z
STREET AND/OR UTILITY WORK
R/W PERMIT REQUIRED
Legal Description of 'Property (Show Below & Attach Four Copies)
OYES -
NO
C1 YES NO
R E O'D.
.0
z
UNDERGROUND
WIRING REQ'D.
OYES 0 N o
z
0
TYPE CONNECTION
SANITARY SEWER
1:1 YESIVERI'FIED
0 NO
By
SEPTIC SYSTEM
APPVD BY CIT Y ENG.
YES
PERMIT NUMBER
U
In
W
NO
REMARKS
METE SIZE
SERVICE SIZE
ICL.EARANCF—
7CHECKED BY
.j
EM/AFIKS
4:
%NEW WRESIDENTIAL'
El GAS�
LINE
FIR E ZONE
TYPE OF CONSTRUCTION
NON-RESIDENTIALI
El SIGN
. .
1CODE'
_TOCACUPANT
F-1 ADD
El DEMOLISH
RETAINING
tPECIAL INSPECTOR
REQUIRED
AREA
GROUP LO D
EXCA VATE
ALTER OR FILL
WALL
FENCE
X
C] YES 11 NO
]OCCUPANCY
�_j
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
PRE -MOVE
El
swim
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODE �1,04,
REPAIR
INSP.
POOL
7
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
?
U NI
D
�NATURE OF WORK TO BE DONE
PROPOSED USE
z
0 15JN(f_�E
PLOT PLAN
(INDICATE BUIL-014
AB
U
In
W
0
PLAN CHECK
NO.
BUILDING
PLUMBINd
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
VALUATION I . FEE
r.
JAMt� H. REID
LEROY F. MIDDLETON
C. WAYNE JONES
LLOYD H. NELSON
;Zea
?ft4ffe4g & pfd44e4J&4, *7", ENGINEERS - SURVEYORS - PLANNERS
324 Main Street * Edmonds, Washinitton 9802 . 0 * ,oCo 77-5-3434
December 15, 1976
File No. 6885
LEGAL DESCRIPTION FOR BILL YEAGER
METES AND BOUNDS DESCRIPTION FOR LOT 7, HORIZON WEST (UNRECORDED)
That portion of the south half of Tract 85, Meadowdale Beach, acc ' ording to the
plat thereof recorded in Volume 5 of Plats, on page 38, records of Snohomish
County, Washington, described as follows: Commencing at the southwest corner
of said subdivision; thence S88037'31"E, along the south line of said subdi-
vision, 159-70 feet to an angle point in the south line of said subdivision
and the southeast corner of Lot I in a short'plat as recorded in Volume 873,
page 389, records of said County; thence N000814PE along the east line and
its northerly projection of Lots I and 2 in said short plat, a distance of
204.56 feet to the north line of that parcel as conveyed to the City of Edmonds
by Quit,Claim Deed as recorded under Auditor's File No. 2390337; thence N82020'
13"W, along the said north line, 29.20 feet to the east line of Lot 3 in said
short plat; thence N0008147"E, along the said east line 108-76 feet to an exist-
ing I inch re -bar at an angle point on the north line of the said south half of
Tract 85; thence S89012'58"E along the north line of said subdivision 545.26
feet to an existing I inch re -bar at the northeast corner of said subdivision
And the True Point of Beginning of this description; thence S0048102"W, along
the east line of said subdivision, 184.16 feet; thence N780i8'30"W, 102.46 feet
to an intersection with a curve having a radius of 45-00 feet, from*which inter-
section the radius point of said curve bears N82002100"W; thence northerly along
the arc of said curve, being a curve to the left and consuming a central angle
of 50055146", an arc distance of 40.00 feet; thence N42010'00"E, 170.64 feet to
the True Point of Beginning. (ALSO known as Lot 7, Horizon West, according to
the unrecorded plat thereof).