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714 PUGET LN
ITY OF EDMONDSrmit No.
` 'PUBLIC WORKS DEPARTMENT STREET FILE
RIGHT - OF - WAY CONSTRUCTION PERMIT 0 d
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A. *Address or vicinity of Construction Permit Issued To-1TQ (A AA e) C1A C- (—Ifr la-,-;
�,
• Owner: �J<�_VZ� c- � :")��_'�Cn..t ��,.��f- i� �� • Type of Work to be Done:
Name. b
• Work infConnection Withf)
Mailing Address ❑ Sub or Plat Dingle Family
❑ Comml. / Ind. ❑ Apt. Condo.
City, State, Zip Code • Pavement Cut: ❑ Yes ❑ No
• Contractor: Abal C o 'n f�, R,0
Name
Mailying Address > ti State License Number a I i
City, ' State, _ Zip Code Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN —
INDEMITY: Applicant understands and by his signature to thi
agre to C�tOVf and
harmless
from any injuries, damages, or claims of any kind or descripti n ats\
for Fen o r� th may be made
against the City of Edmonds, or any of it's departments or emp yees,
o not imite �ef se of
ny legal
proceedings including defense, costs, court costs, and attorney fe s by r
a ing his 'G
t1
Upon issuance of this permit, the contractor is responsible f work
s ma Fria s a period of
e year
following the final inspection and acceptance of the restoration b the
ee g tv sion.
Funds held from the Security Deposit (estimated restoration fee)
t thcs �
co ► 0to
ed, at
which time a debit or credit will be processed for issuance to the a �tt'�
q?,I
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
. 775-2525, extension 220.
I understand that this permit must be available, a the job site
"I-,,
Signature: . ,. .. _h. `
-
Owner or Apent
purposes at all times. '�
Date / 0/ � o / / 5
THIS PERMIT -MUST''BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C: Issued By: �-,�'� . _ f_ Permit Fee: /S'
Time Authorized: Void after days Security Deposit: A
p i Receipt No.:
Special Conditions: ( �� �.� � + � � �
-, U1q ri\PP� Ij Fund 1I1 Fee:
Ammendments I:':.+' �o U �f. P+n- a Street Cut Dimensions
.O_ X —
* NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
FIELD INSPECTION AES
(Fund 111 - Route copy to Street Qei* . )
J
rnmmnntc
Diagram:
Contractor called for inspection Yes 4;
Mork Disapproved By: Date: By: Date:
Work .Approved By: ,-I-;F5r _ Date:
Inspector: �C
Eng. Div. December 1978
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EXPIRATION DATE
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SIGNED
CASCADE:® L1-C2375
SENDER: DETACH THIS PART AND FILE FOR FOLLOW. UP.
PRINTED IN U.S.A.
1
ST _EFT.F 1 _-CITY :OF EDMONDS� -----
"1.5 ' .PUBLIC WORKS DEPARTMENT, ENGINEERING DIVISION
APPLICATION' FOR RIGHT-OF-WAY CONSTRUCTION PERMIT
THIS .PERMIT MUST BE AVAILABLE AT.THE JOB SITE FOR INSPECTION PURPOSES
Applicant to.Complete Parts A and B
A. Permit to be issued to: Snohomish County P.U.D. #1
For Work at.:(address or vicinity) ig0/41?6 )ex> .4' .yeorie¢
' e. OG W. ,97- 7/¢ PG/��T �• G�/. O. 9RL 73/ /Vr/Cn�J _ �tC�,rr��rr� .
Type of Work to be done:
(attach drawing when applicable)
Time Required -- Start: 1-day- Finish:
Owner: Snohomish County P.U.D. 41
Name
21018 Hwy.99
Mailing Address
Lynnwood, WA 98036 774-2112
City State Zip Telephone Number
Contractor: same as above
Name State .License Number
Mailing Address
City State Zip Telephone Number
B, INDE:LNITY: Applicant.understands and by his signature to this:application, agrees
to hold the City.of Edmonds harmless from any.injuries, damages, or claims of any
kindor description whatsoever, foreseen or unforeseen, that may be made.against
the applicant -or 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, court costs, and.attorney fees by -reason of granting this..permit..
Upon issuance of this permit, the contractor is responsible for workmanship and.
materials for a period of one 'year following the final inspection and acceptance
of the.restoration :by the Engineering Division.
Funds .held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit :.or credit will be
processed for issuance to the applicant.
Work is subject to inspection -:and restorationin accordance with City Code. A
24-hour notice is required for inspection by Engineering. Ca11'775-25.25, ext. 220.
.I understand that this permit must be available at the job site for inspection
.purposes at all times.
Signature: �Q/Qj�� Date: 2-%- 72
Owner or Agent
C, TO BE COMPLETED BY ISSUING AGENCY`:
Date Issued:_ 2_ 2_ mac/ Permit No.: _1 Fee:
Security Bond:
Time Authorized:
APPR 'ED BY�� Date: a 9
J-1
W018 .. - BLIC UTILITY No. 1 of S Mish-Coulity��CLJ_7t-i COLJNIYAREA'�
Rev 10177 - I
N F_ � F—: NA Date F, — 79 w.o: No. q R 2-7 --Z,)
Location - -71 + EL-11 Ca E 7 IF, et
t:-:> \,N 1/4 l?..> -S Z:j !T -" A Revision Icale III
..Reasoofor .work Engineer As Built'
U.G. File No.
Approvals
-PERMIT REQUIRED :FOREIGN -CONTACTS 'EASEMENT ENVIRONMENTAL -ANALYSIS
r
T `F Type Company Exempt � under District SEPA
IRN.No. procedures Section III -A
Grantor Date Granted quired 'Yeso Noo Paragraph Item
Fees re
InventorLog PostedlType + T-MT. ?ctWdranted_ Date ?-�/Q y A,��Q I
I Transf.Cardl I Pole n &_ ZZ10 A--..—& P I ]Interpretation Referred To:
�jMapfts" Circuit Ma
Date Released For. Construction
Date Work Completed By
Circuit :Number Substation
oemcimn
O.H. U.G. Cond
Add
R mv
emv�
Ckt FtPH.
Ckt Ft
Sewer
Gas
Backhoe
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CITY
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PUBLICOFWORKSNDEP ML T � "TI Permit �'�� . _ o 28
SIDE SEWER PERMIT -�77 c;5 Ext. 220 Issue Date ��•`
PERMIT MUST BE POSTED ON JOB SITE
1. Address of Construction
2. Property Legal Description (include all, easements)
3. Single Family Residence d.�' Multi -Family No. of Units
Commercial
4. Owner and/or Builder �`:�5 '•����� �.�c.
5. Contractor & License No. ��� .� C •�� .':2`4�.a�
6. Invasion into City Right -of -Way: No ✓ Yes (If Yes Right-of-
way Construction Permit -Required - Call Dial Dig (342-5344)' before
excavation).
7. Cross other private property:. Yes No L-'' Easement required -
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
a. Property owners must obtain a permit to install side sewers on
their property. A licensed side sewer contractor must be employed to
construct side sewers in the public right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year. ,'
c. Commercial establishment requires a minimum of a six inch (6")�
side sewer line.
d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
e. Side sewer lines must be laid at a minimum grade, of 2% (1.15°)
and maximum grade of 100% (450).
f. No turn in side sewer greater than 450 (1/8 bend) is allowed
between cleanout. All 90 turns must be constructed of a 450 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system. _e
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing'exit line
and at minimum intervals of 100' along sewer line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k.. Side sewer must be leftiuncovered until inspected and approved
by the City.
1. Inspection during nor✓ 1 working -hours only. -_Two (2) working
days notice required.
DATE: Sri. ('1S
I certi y that I have read'
and shall comply with the above
=cam ,•
PERMIT FEE: "�' DISAPPROVED By: Date:
U W By: Date:
oCONNECTION FEE: OVED By : Date:
F*r ANN&TED
ON JOB SITE
0 STREET FILE 4
CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT, ENGINEERING DIVISION
APPLICATIOiN FOR RIGHT -OF -MAY CONSTRUCTION PERMIT
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTI'ON PURPOSES
Applicant to Complete Parts A and B
A. Permit to be issued to:
Fo r Wo rk a t : (address or vicinity)
Type of Work to be done: 3es• � � �u���t� \'1•w � aZ
(attach drawing when applicable)
Time Required -- Start:
Owner: ��\1a►��\��5.__
Name
Mailing Address
.City State Zip
Finish:
Telephone Number
Contractor: ��.��, `.`� .Q3 . Z!Aa \"N
Name State License Number
Mailing Address
City State Zip Telephone Number
`F NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B, INDEMNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or 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, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance'
of the restoration by the Engineering Division.
Finds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220.
I understand that this pe _t must be ai e at the job site for inspection
purposes at all times.
Signature: - Date:
Own r.Agent
TO BE COMPLETED/BY ISSU NG A ,INCY:
Date Issued: �(! (�� ermit No.-2.^%�_Fee:
Security Bond: N �_
Time Authorized:
APPROVED B }tLjjjjjfta ' ate, I�
STREET
FILE
USE PERMIT
BUILDING D E P A R T M E N T
Applicant Fill
ZONE VJ NUMBER
PERMIT APPLICATION
Inside Heavy Lines
JOB
ADDRESS
I • i�'�^
NAME (OR NAME OF BUSINESS)
SUBDIVISION NO.
PLtj NAM[
A[1[[[OR MAP NO.
W
MAILING ADDRESS 11
�.
\ \,... W ♦
PUBLIC RIGHT OF WAY PER ORDINANCE NO,
CITY ELEPHONE NUMBER
Z�
EXISTING RIGHT OF WAV
PROPOSED RIGHT OF WAY
DEFICIENCY OF RIGHT OF WAY 4
to
N
S
Y
STREET/UTILITY WORK REQUIRED IV vat ONO [
0
U
W
ADDRESS
1-
=
PERMIT FOR WORK IN PUBLIC R/W Wvas ONO
O,^�
UNDERGROUND WIRING REQUIRED lJ Y[■ NO U
U
C
CITY
TELEPHONE NUMBER
Q
I-�
CONNECTION TO SANITARY SEWER �IY[[ LJ NO m
SEPTIC TANK PERMIT REQUIRED ❑YE[ Ir NO I\
NAME
SEPTIC TANK PERMIT NO.
0
ADDRESS
SEE MEMO DATED /
REMARKS
It
CITY
TELEPHONE NUMBER
o
CHECKED BY
�
V
STATE LICENSE NUMBER
CITY LICENSE NUMSYER
•
METER IZE
„
BUILDING SUPPLY SIZE'
C
Legal Description of Property (Show Below or Attach Four Copies)
W
F
REMARKS Q
Z
0
\ _
�\ \ fir\ \h
SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADD NO.
F
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W
0
REMARKS
J
Q
W
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VARIANCE OR CU
\i-37- 78
PLANNING REVIEW BY
DATE
YARDS
LOT COVERAGE
ryEW
L I RESIDENTIAL
GAS
❑LINE
aS/ FRONT !O SIDE as REA
FIRE ZONE
TYPE OF CONSTRUCTION
CODE -
HEIGHT
1 � I
❑ NON-RESIDENTIAL
❑ SIGN
❑ ADD
❑ ALTER
REPAIR
DEMOLISH
EXCAVATE
R OR FILL
PRE -MOVE
RETAINING
❑ WALL
FENCE
I X FT)
SWIM
SPECIAL INSPECTOR
REQUIRED
❑ YES ❑ NO
AREA
OCCUPANCY
GROUP
OCCUPANT
LOAD
PLAN CHECKED eY
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04. _
INSP. L_j POOL ,
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
"
NATURE OF WORK T EDONE
PLAN CHECK FEE
VALUATION
PEE
PR
Z
0
a PL
E
U
VI
W
0
m
0
i DICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
I '-
APPLICATION EDMONDS
The Ci of Edmonds for TREATMENT PLANT
SIDE SEWER PERMIT LSEMENT NO- --------------------------------------------
NEW CONSTRUCTION a REPAIRS ❑ LID NO....I_ _----..ASMT. NO- ------------------
OWNER --N O s-o vi --- t--- e"-e A .ftO---- P\C CONTRACTOR --'. nA 1 e--- QS------C k?h- .................. PERMIT NO.
JOB ADDRESS ._.- e -----L c----------------- LEGAL DESCRIPTION: LOT NO. ----- 2--------------------------- BLOCK NO.------------------------------------
�A
------------------------------------------------------------------------------------------ ----------------------------------------------------------------------
NAME OF ADDITION .....H.Vh 2{r$...... 6� 1-6-p-h----------------------------------------------
PU G -T LONE
�JateY Sere- Line conrhructed OF 3 "A-6•S .
I (00 P.S
Water Serv. M etcr _%r ' Sd, • 40) T (. 3' e C.v. P i p
Side Sew cr Co v s.-te v c-tecl o f 4- " P V•C -
Pipe- Sc1,• 3034) � 2I-«-
S 4�1� o
4 "e•0• ST* Bend � S deep)
cv J ow n ---b- �y
t -
t
Ex'trem9 Se.we.v Ma:%N le •�—
n l i Y% e w itk Slw C-ov. of
House• CAtprox. ld`ckcp) EDMONDS
TREATMENT PLANT
Water Serv. Line was v►ot
#- Vis 161 * Zvnspected bi. Me .
The Serv. live woks C�oveV-cd
OLV%d -'Vie above lvlporw *_*i0vk
CUPPlied by Mike 13ev►e.de.t4•o
owner of Pr-opeot j .
Approved:
DATE ..A-/-�= - 1--. ....... BY -- (.; ......
11 /75
bo+t' �3 •IC Zti�RKS DUVT CHECO Date
. • . BUII.DING PERMIT REVIFZJ -
=_ Address
Street Right -of -Way Existing P - REQD -
Access Easements Existing-' . ' f, �€ ' ` '�REQD
Utility Easement Existing READ
a
Lot per Subdivision Plat Assessor MapCID
z Site Plan Checked for Accuracy
H Underground Wiring Reqd. On
W Check Accuracy of Legal Description ? Z
w. Environmentally Sensitive Area
w EnvirorIInental Checklist Reqd.
H Flood Hazard Zone L�l
sa
u -Shoreline Management Area
_ _ z Slope, Soil, Vegetation
w Stream, Creek, Drainage.Basin lg� -
.Z-asting Zoning' Per Code ' '
Amenities Design Board Approval Reqd.ADB Approval
Board of Adjustment Approval Reqd. --
Review By:
Existing Water ;lain Size 4'"C-X
Water Main Reqd. N Ae-
-.' Service Line Reqd. -- - - -
w : Hydrant Size Existing:
Hydrant Reqd. Per Fire Code Size
¢- Detector Check Meter Reqd.- N0 ~
Cross Connection Inspection
Fire Department Comments
Water Meter Char�,i Reqd. 3 SO
Review by: If r Date: ?/2 5-/79
Septic 1'ar�tc 'sign ��pprovec� ate:
Septic Tank Permit Reqd. Pennit No. 4A
Sanitary Sewer Availability �,�ao Proj ..
Drawing No. File No.
w�- -
.7 Side Sewer Availability
w-- Sanitary Sewer Connection Fee Reqd.
�^ Review By: Date: "71zS/�jf
t
04 0• .
I - )eii 'Ditch Exist in :. Reqd. a �q
�. Culvert Reqd. t!siz
e w
c4 Catch Basin Reqd ue�' cea{ra�rar4s dic on Site .Plan --
Shoulder drainaf;e mzintain collectio[; rn1 Swale open runoff
H '
-,' uwdiole regd. �[, Indicate on' Site Plan*
Soil Conditions and GrOU11d Water Wield Checked C
Review by Date
Street Paving Reqd.
H
Curb and Gutter Reqd.
W Sidewalk Reqd. /(/L
W Curb Cut for Driveway Reqd.
P Right -of -Jay Construction Permit Reqd. j
H �-�
Bond Reqd. for Public Inmrovmmts `�
Street Narm Sign Reqd.
Other Signing Reqd. /jf
A Pre Permit Site Inspection made on
p BY • SE[:TER
U WATER
TE
P.
STREET
ENGIN :EKING
Special Rcquirel. nts listed in mom t0 CnmimiLy:Do-velopment Department,
t
Building Division
BY � , Da to
o
All iturs filled in on Building Peimi.t Application
13Y Date
n'
Drawings Stan-ped. and Notations 1,1-ide 7�
w
BY Date
.
_
Approved by ibl.i:c %,!or.1 s Department
JcQvised: 1v 10-1977
Date
MEMO TO: Building Division
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT:
After review of the subject building permit application, fie have the
following comments:
Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is the
responsibility of the contractor.
/ The contractor is required to keep the abutting streets cleaned
of dirt and debris caused by the construction..
The "Right -of -Way Construction Permit" is required, from the
Engineering Division of Public Works, for any work within the
Public Right -of -Way or public easement.
/7
/7
Driveway slope not to exceed 14%.
Connection to sanitary sewer required.
Septic Tank Permit required, submit design.
Fire hydrant required, submit design.
Site drainage per code See approved plans
Curb /% Sidewalk /L-110
Paving required.
Bond required for public improvements. Submit cost estimate.
Underground wiring required. lien v��LJ�
Approved Engineering Plans required when applicable.
For re F. erzberg,P.E.
Ci y Engineer
Department of Public Works
Rev. 7/78
STREET FILE
sXjof.k oilqnd/ QTYF ED
MONDS
ENGINFEERNG Di
LU
EXAM 11N
,3AI.3038 r:5y`Wh��E2 _
—
REMARf S-
s C7 s
III%LLIINDATION
IE SEWEREPYI K
WATER SERVICE
;� RE PROTECTIW4
Zr AINAGEt
SITE IMPROVEKIV4't�
CL. El INSPECTION NOT R'QUIReb