718 12TH AVE N.PDFlill lill 11
646
718 12TH AVE N
C!Ty OF EDMONDS R E(, Permit ,No:
COMMUNITY SERVICES DEPARTMENT EIVED 5 _9
JUL
RIGHT-OF-WAY CONSTRUCTION PERMIT. . Issue Date �.
1 5 1991
A. • Owner: waahingtnn Wa.tnral Gas COB. aEs".LNG:
Name. Name
R1 S MernAr street gal
Mailing Address. Mailing Address
:Seattiq 0, S i% 9Bi11
City State Zip jo, t City State Zip,
STREETFILE VU31 State License Number Telephone Number
C. • Address or Vicinity of Construction: 71 R 12 AvAnnA Worth
Type of Work to be Done: Install WAS,, Service
D. • Work in Connection With:. ❑ Sub or Plat ❑ Single Family ❑ City Projects
❑ Commercial ❑ Multifamily C Utility
E. • Pavement Cut: ®Y ❑ N F. • Size of.Cut: 2 X 4 1 @ Gas
1 APPLICANT TO READ .AND SIGN
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, forseen or unforseen, 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, co(urtc�sts, a d attrney fetes by reason of granting this permit. .
l THE CONTRACTOR IS RESPONSIBLE. FOR V� �K'MANHI� AN CATERIALS FOR A PERIOD OF ONE
I! YEAR FOLLOWING 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 time a debit or credit will be
processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Enginldri ig: 771-3202
•. Work is to be inspected during progress and at completio
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature: E Date: July 1,�1991
Owner or Contractor
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: RV1%
Time Authorized: Void after t days.
Special Conditions: A% a
RELEASED B
Date =7- k�g,/
PERMIT FEE:3e�—�
Restoration Fee:
Receipt No.:_
Fund III Fee:
Street Cut Dimensions:
INSPECTED BY Date
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
rng. urv. marcn iyay
FIELD INSPECTION NOTES (Fund III - Route copy to Street Dept,.)•=
Comments: V
lf
I Diagram:
R1
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. I
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M
M�
AV&dvgmn &-e W CaTV&N
716 I2 W Q
WNG to wind
Addendum to City of Edmonds
Right of -Way
Permit Application
Submitted by: Kerry Walsh
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager 995-6914
I Ca x4�) E� C--.� -
t ��±
k'° .I.
Key:
Water main depth,* -w- water
unknown -g- gas
-ss- sewer
" gas main $ water hydrant
O water valve
815 Mercer St. (P.O. Box 1869), Seattle, WA 98111(206) 622-6767
e CITY OF EDMONDS zoNE PERMIT d r NUMBER
CONSTRUCTION PERMIT APPLICATION. i1OB
OWNER NAME/NAME OF BUSINESS MADDRESS
W
Z
Ot-A
MAI.ING ADORES-
`
"
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
RW
EXISTING REQUIRED DEDICATION Street
Approved ❑
Permit Required ❑
Use Permit Req'd ❑
C , ZIP
TELEPHONE NUMBER
—
PROPOSED Inspection
$itleelk
Required ❑
Required ❑ OAr,VL,?
NAME �
REMARKS
W
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ADORESS
I S, AAA1lJ -SFr,
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CITY ZIIP
PHONE NUMBER
�S� .�. l•V/�� • CJ��
—VJ8
NAME
1`
ENGINEERING MEMO DATED - REVIEW BY
ADDRESS
U-
METER 512E
BUILDING SUPPLY SIZE
NO. bF FIXTURES
W
CITY ZIP
TELEPHONE NUMBER
C
O
Igko
REMARKS ;
STA'r LICENSE NUMBER
I _ L
SIGN AREA
ALLOWED PROPOSED
SEPAREVIEW
COMPLETE EXEMPT
ADS NO.
Legal Description of Property - include all easements
ZCA,OI&J.6.EXP
SHORELINE e
F
a
-
VARIANCE OR CU
PLANNING REVIEW BY
- D E
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66
SETBACKS — FEET -
HEIGHT
LOT COVE GI!. __
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FRONT �[ SIDE /O REAR h�
2�
3S �O z
Tax Account Parcel No. 27O ��y�
REMARKS a
ClNEW RESIDENTIAL C� PLUMBING
ADDIALTER COMMERCIAL MECHANICAL
-
CJ REPAIR APT. BLDG. SIGN
CHECKED BY
TYPE OF CONSTRU TION
CODE
HEIGHT ,
CJ l❑-GRADING O FENCE NCE
DEMOLISH CYDS. X—�
�JC
r7I
REMODEL GARAGET. CJ BPOOL,
C] WOOD STOVE RETAINING WALL/
INSERT ROCKERY RENEWAL
SPECIAL
RED INSPECTOR
O YES
AREA OOCCCCUPPANCY
�-
OOCCUUPANT'
AD
REMARKS
S(TYFE
PROGRESS INSPECTIONS PER UBC 305 c
OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
AAI
NUMBER OF STORIES NUMBER OF
N
o
DWELLING
,
UNITS
•'
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION
REQUIRED
VALUATION
FEE
PLAN CHECK FEE
BUILDING
97111r: ,�,5/b�'dy r
PLUMBING
L
Plan Check No.
MECHANICAL'
This Permit covers work to be done on private property ONLY.
GRADINGWILL
Any construction on the public domain (curbs, sidewRlks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate perml$sion.
Permit Application: 180 Days
Permit Limit:1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
' Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
in interest, agrees to indemnify, de)lend and hold
wsuccessors
harmless the City of Edmonds, Washingtbr)t ,its officials,
employees, and agents from any and all,ctaims'for damages of
whatever nature, arising directly or Indiiectiy from the Issuance
of';his permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
omodify,
x
waive or reduce any requirement of any city ordinance
not limit in any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
I horeby acknowledge that 1 have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with City and
' state laws regulating construction; and In doing the work authoriz•
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa•
THIS PERMIT`
AUTHORIZES
ONLY THE
WORK NOTED
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
ti n Insur nce.
SIGNAL URE 10 NER OR AGENT) SIGNED
INSPECTION
DEPARTMENT
acknowledged in space provided.
JOATE
l 1- I I^ `► 1
CITY OF
EDMONDS
OFFI $ $I TUBE ATE
�� 9
ATTENTIONCALL
IT IS UIILAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL !, FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. USC
CHAPTER 3.
IozsT
FOR
INSPECTION
771-3202.
�/�
REL A DATE
s
"ORIGINAL - File YELLOW - Inspector
PINK - Owner GOLD - Assessor
EET FILE
STREET
1RXc:r_.1,VgjD
JUN 6 -
PERbUT COUNTER
9I PC YAJW
2G7TeA(,K
4 UTILITY
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EX15TI1,15
KjX_KEKY
gr. od
N 0, 101 5!?b
EXISTING' C019
CONNECT45
ALLNe,,v,/
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CONNECT TO
TIGHTL-INE
rjWrIwi
oOwN6pou*r
FZr=M0%,(E MM-r PECK
TGµ`LluE
AS FM5LUIFED FOR
gDDITI Ohl
EXI6"TINCi CONCRETE
SITE PLAN
A, OF C4tZRST>`
0 70 ESE K.0404W
EXIST LA"DecolInwn IOLGI
RE, F;FGLUIIWD
'01VE YARD
SETBACK
41 -Ew-cm'' _NEMLL Q�5
A00ITIO
rK1 W,&
MIST. SLE6 4
z
7707
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S)eRv ice
7
KEe4MW_E
AL L_
KMF
Typ
GNiMNEY
ILI
IL
IL
9r.. od
=6T. SIDEWALK
12-TH 1NVENUE= N.
A 1234 0 Wd
HOUSE ADDITION
Hax-'a KeloveL.
0 EXISTING HOUSE
RUDE RESIDENCE REMODEL. ADDITION
719 12TH AVENUE NORTH
<Aw
JUN
Amin out Ora.
N 0, 10, 516
F --
F-Xv&TIIJ6
90-KLRY
A, OF CONCRETE
0 TO BE K.Ia4mm;p
O EXIST L;NwDecAAW4 L,
IoLll oFuisTING, COLIC. PxriD AS RE04JFMC loo
CAPE lrAI� C71DE YARO
c�C-TeA&K 6 E-T IMOCK
EA4 UTILITY -4&
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i i ex«,-r. ate. _
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Afo MQUI
7 7-
N 14ALL NEW
DC: TO
,T r=T aro.
CONNsr,T TO -nGHTLINE
15916TIN6
tPOWN51°ou'r REMOVE e4ST DECK
TIGHTUIJE -Alb REQUIRED FOR
AVC21TIONI
E-Nilo-rINCI CONORJF-M
MVEWNY
AOOMVN..--
MST SLIM.
s)eRv ICE
KESOMNr-E
f,-Typ
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J2TH AVENUE N.
PLAN KEY
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SITE PLAN Fi0tr5E KEMOP61-
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RUDE RESIDENCE REMODEL & ADDITION
718 12TH AVENUE NORTH
rl
d)
APPLICATION
The City of Edmonds rj-r for
RE E FILE SIDE SEWER PERMIT EASEMENT No. ....................... ..................
NEW CONSTRUCTION REPAIRS
-F 4-7 OWN GR ....................................... ........................ .................................... .... CONTRACTOR -2:1
ERMIT Na.-..: ........ �:
ESS- - -('.7
.; ............ : ......... w ........................ -LE G-A-L.-DESCR-I-PT-ION-:- -LOT - No. ................................ BL0CK-, Nn- -
onf
............ .............................................................................................
,oved:
DATE ..... ......
Y;� ... Y
.
...........................
'{CITY `,-��VF::-..ED
N DS,,
4�" r "'0" �4t AVC] E W1 i DEPAXTM04W*""
K AJj;.-'.',
T:.,
T? i
�.N�j A
t
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4.
si e . sewer jmgtpeCliAg;* WeR 0 1 ti
within'
24 fiour9:.aiter ;re9ust: NO silt: LI
P
Y.
:0-A lie k,
��j............T.......
........................
7.
PROPERTY LEGAL DESCRIPTIONJi,Add.tfdhLs.j................................. .,....,...
.................. ................ ............ ....... .........................
cE':
. . . . . . . . . .............. . ........ . . . . . . . . . . . ........ ............ ..... . ........
........ .....
BCf
ZACTOR'& ,S NAIVlk�ADDRESS.
.',_
f "A
.3.e.rY. I,C
. .. ....... . ..................... . .................. .......... ... . ... ......................
--.jc
.,74:',
. ............ . ............... br,'c6jfiiibcti6h*.l'da, side sewer J6 the: citY:-s&z*-z
'f�'Jj*Edmonds L
system'.Mj?,qqor, dhceyith�.Ci f
p tjoyer,�y P37iop *evF.r qejore it.inhsai se, b.pere(?nPenr!spepcnte�d� �A ".7 ic' enJ s- e" c'o'fitracto'r'LbjiL t'.Ve employe .-. iF;,47i 6btiinable 'Qbn the'cityingineer'soffl6k; `
t
NOT'
F a4njull. information-,reg, rd anRegulations, governing) side seIvers'.,n-he'n �,bu 'get i;� it
7 NOTE No 4.'-Tep•of'side sew and
No
•A NOTE No Trenches in sfreet.•musty bewater. settled and surface ^of street restored :to original condition Contractors stiali.be, responsitile'tor fai I n,
e 'dUet
rtenances'
............ 7. ....... .....
K, VED4;:Fj, .Date ... L ..... ......By t
. ........ . ...................... .... ..
%
W,
Roemar. .......................... ................ .......... ... . ...................................... ........ .
yf,
.J
..........
..........
. ................ ............ .................. ................
V Pic
H' ffiwicb C, :]Ke i
-Sit'-'.BOT
pi�e!�,MIUST-f 61ASig�ned',,By�O%Viiei��6f-y..�Firffi
_t .9,7)ii4lg.,-,,9nst!7ucti6ii.-PR161R
i�'S ;4rK.3;.r.� ; ! ? - hereby,. ceitify that the'. side sewer..installation constricted.under "`f' ,'•
- Pt,
,-,d"City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS
OWNER...... ....... C1.71 ........................................... I ........................
ADDRESS ..... ....... 1 . . ...... ....................... ..........
EASEMENT No . ..........................................
"p2q.
CONTRACTOR ................................................ cl r-
.............. ................. ............... PERMIT No. -1171—!21
LEGAL DESCRIPTION: LOT No. .......... ------------------------------- BLOCK No. .......... ...........
NAME OF ADDITION .................
:: ........... !�G/. .....................................................................
i d �_, ;,-"] P,,-. /V � Approved:
DATE................................................ By .....................................................