711 4TH AVE S.PDF111111111111
5095
7114THAVE S
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
EASEMENT No.......-....
NEW CONSTRUCTION 0 REPAIRS 0
OWNER...... }-.RX . ................................ ................................ CONTRACTOR .... .............................................................................................. PERMIT No . ......................
...... ........... LEGAL DESCRIPTION: LOT No .. .............................................. BLOCK No . ..............
ADDRESS .... 7.1.1 .... ........ . .... ............................ ............
NAMEQFADDITION ................... .................................................... ............. ..................................................
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Jun q,
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Approved:
DATE................................................ By .......................................................................
i' t
fnc. 1g9v
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number: 9
Issue Date:-6— it 91
A. Address or Vicinity of Construction: V-J
B. Type of Work (be specific):
C. Contractor: _ _y IOW"
Mailing Address: M&.x 41:yt'�t. g-
State License #: P V-12 `:J L
D. Building Permit # (if applicable):
Contact: E�' 'a
Phone:
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ❑ Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family 2 SinglleFamily (Other
INSPECTOR: L� A!16;)— ,,.�.,,�- INSPECTOR:
F_ Pavement or Concrete Cut : [I Yes [2 o G. Size of Cut: x H. Charge $
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application to hold 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 or not limited to the defense of any legal proceedings including defense costs and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION 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.
Two sets of construction drawings 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 trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
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 times for inspection purposes.
Signature:
Date: J o ii e I `, • 9 -1
(Contractor or ,4gent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: ' zy b't'l 4
TIME AUTHORIZED: VOID AFTER % LA " ') 8 DAYS
SPECIAL CONDITIONS: #/1/" ( c 014 1 f # r,
01 Al
RIGHT OF WAY FEE:
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
T OTAL FEE: ,�f el"!?
RECEIPT NO.: 115 y�
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div 1997
—,.
FIELD INSPECTION NOTES
Comments
Diagram
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION ❑ YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
❑ NO
. s JOS
v
�'scc�l
Patrick G. Gipson
Construction inspection Service
711 41h Avenue So.
Edmonds, WA 98020
(206) 774-8874
The City of Edmonds
Water Service Drawing
EASEMENTNO . ............................................
NEW CONSTRUCTION F] REPAIRS ' LID NO . .................. ASMT. NO . ..................
OWNER ................ CONTRACTOR .................................................................................... PERMIT NO. 174�47Y
JOB ADDRESS ......... ...... 5 ...................... LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO. ....................................
.... ....... ....
WAMF OF AT)nT-rTC)N - .................................................................................
MO. --t- - - - I
Approved:
PWW-0001.11/75 (REV.11/78)
................. By ............... ... .... ..................
jl�....
J
110
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION joe
nwNFR NAME NAME OF BUSINESS I
ADDRESS
LING ADDRE55
I i -/i Z/V
NAME
�_ /j l�Y,g 1
A�RESS
CITY
STATE LICENSE NUMBER
CAffI'l
I anal Description of P
PERMIT 02- -q
NUMBER _/ 9
5a
!ECKI SURDIVISION NO. ILID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP,
EXISTING REQUIRED DEDICATION
PROPOSED
TESCP Approved ❑
RW Permil Required ❑
Street Use Permit Req'd ❑
Inspection Required ❑
Sidewalk Required ❑
ZIP
TELEPHONE NUMBER
4
,7,7 —SV I�
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO ❑
E NUMBER
u s—
ZIP TELEPHONE NUMBER
E lye -,
EXPIRATION DATE
_. .
Iv - include all easements
Tax Account,,.'}
Parcel No
�" f...4� 7 /
/Jf if
�_.
NEW
�f�Xl1�
w& J RESIDENTIAL
(PLUMBIN EQIb6
ADDITION
COMMERCIAL
COMPLANCEOR
CHANGE OF USE
REMODEL
El APT. BLDG.
SIGN
REPAIR
GRADING
CYDS.
FENCE
C� I--x—FT)
DEMOLISH
WOODSINSERT
SWIPOOL
HOT
HOT TUB SPA
CARPORT
ROCKERYRETAININWALL/
❑ RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
:57, -
NUMBER
OF
STORIES`
NUMBER OF
DWELLING ;4
UNITS
CRITICAL
AREAS
NUMBER • '
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
A Am VI V 411,V? Of"
ENGINEERING MEMO DATED
REVIEWED BY
SIGN AREA SEPA REVIEW ADS NO.
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE
EXP
VARIANCE OR CU PLANNING REVIEW BY DATE
SETBACKS — FEET HEIGHT LOT COVERAGE
FRONT SIDE REAR
CHECKED BY TYPE OF CON5THUCIIVN! wut A vuuur %L
Jo1��}T .iS �! f,� 7 —GRO .�
SPECIAL INSPECTOR AREA TT OCCUPANT
REQUIRED LOAD
❑ YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108
film a! oK %je q-y-97
FINAL INSPECTION REQUIRED
k
r / �
/`',�'t/i
PLAN CHECK FEE
HEAT SOURCE:
GLAZING
B/D
BUILDING
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require Separate permission.
STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE
Permit Limit:1 Year - Provided Work is Started Within 180 Days .
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
tn successors in interest, agrees to indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
of this permit.
modify, waive or reduce any requirement of any city ordinance
Vf1
= nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
Information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and in doing the work authoriz-
AUTHORIZES
signed by the Building Official or his/her
ed thereby, no person will be employed In violation of the Labor
ONLY THE
WORK NOTED
Deputy; and fees are paid, and receipt is
Code of the State of Washington relating to Workmen's Compensa-
acknowledged in space provided.
tion Insurance and RCW 18.27.
INSPECTION
IGNAT RE (OWNE ) DATE SIGNED
(� � _
DEPARTMENT
CITY
OF SI NATURE AT
0
EDMONDS
CALL FOR
ELEASED BY: DATE
ATTENTION`,,
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
��� 0220
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
PINK —Owner GOLD —Assessor
SECTION 109