1114 EXCELSIOR PL1114 EXCELSIOR PL
CITY OF EDMONDS
PU C WORKS DEPARTMENT, ENGIN*ING DIVISION
APPLICATION FOR RIGHT -OF -MAY 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:
For Work at:(address or vicinity)
Type of Work to be done: qwZ) Te ili r 2 D.� GU
(attach drawing when applicable)
Time Required -- Start: Finish:
Owner:
Nam
Mailing Address-77-50
City S ate Zip Telephone Number
Contractor:
Name State License Number
Mailing Address
City State Zip Telephone Number
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 r
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 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 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 permit must be available at the job site for inspection -
purposes at all times.
Signature: ��r�iG Date: ZS -7�
Owner or Agent
C. TO BE COMPLETEJ� j �I �J,ING AGENCY:
Date Issued: 7 Permit No.: 751� a /� Fee:/S
Security Bond:
Time Authorized: .Re
APPROVED BY
t Date:
Role "
Rev. l
P UBLI.0 UTILITY DISTRICT
No.l of Snohomish Count :. -T-s-s CL`L,IN'iY AREA
locat Xzz-e-
�F'L.l LM•
Dot-23--7Ss' W.O. No. 2839-71
/4— 5 -- —=T R
Revision — Scale l u = l nQ
Reason for work T N G,
4-7�'HL rat i I Iv j 'P"
Engineer G"And 1& As Built
U.G. File No. --
z0 k W I= .t--
Approvals 146 -
PERMIT REQUIRED
FOREIGN CONTACTSFDranted
EASEMENT
ENVIRONMENTAL ANALYSIS
Type Q"ry GI= Ei�M .
Company �'►' r . T -
Exempt .under District SEPA .
J.RN.No.
procedures, Section III -A
Date Granted
Fees required Yes® NOD
Grantor -,-,-
Paragraph Z, Item to
Log Posted
Inventor
Type
Date 8�23 By �A1;hL -
Transf.Card
Pole Dept.
Date —Amount.
Interpretation Referred To:
Ma Post
Circuit Ma
Date Released For Construction
Date By
Date Work Completed
By
Foreman
Circuit Number /2-- _-34-
Substation M,ti.pL�WOG?I=?
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W.O. No. 3q-1 I
g
FILE COPY
June 5, 1980
MEMO TO: Building Division
FROM: Engineering Division
SUBJECT: ROCKERIES AT 1116 & 1114 EXCELSIOR PLACE
AND ROCKERIES. IN GENERAL.
Sp9F�TFiIF
This memo is in response to your request for technical*
information regarding the rockery at the specfic addresses
listed above. We cannot, at this point in the construction,
certify the subjcet rockeries as structurally stable. If this
question needs to be resolved, we would require investigation
and analysis of the site by qualified professionals with the
special equipment necessary to undertake subsurface explorations.
Regarding rockeries, in general, we request that we review all
permits prior to issuance to check locations with respect to
underground utilities, easements and drainageways.
BF: jky
BOB FRANKLIN DT.
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BUILDING ','DEPARTVtNT-: Applicant Fill
USE RMIT
NUMBER
PERMIT Inside Heavy Lines
JOB
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ADDRESS
�Iyti_
NAME.(OR NAME OF BUSINESS)
-
40 U111 il
LEGAL LOT LOT AREA JBDIVISION
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MAILING ADDRESS -
YES 0 NO FI:3 -
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STREET R/W
EXISTING STREET Aq%b
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CITY TELEPHONE NUMBER
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FT. DEFICIENCY THIS PROPERTY
COMP. PLAN FIT. FT,E
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TELEPHONE NUMBER
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REMARKS
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METER SIZE BUILDING SUPPLY SIZE
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PLAN CHECKED BY THIS SITE
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INSP. POOL
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NUMBER OF STORIES NUMBER OF
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BUILDING :DEPARTMENT
Applicant Fill
USE PERMIT'
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1
PERMIT APPLICATION
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METER SIZE BUILDING SUPPLY SIZE
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REMARKS
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LOT COVERAGE
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TYPE OF CONSTRUCTION
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❑ YES NO
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PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
ElPRE-MOVEswim
REPAIR INSP. a POOL
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
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NUMBER OF STORIES
NUMBER OF
I N G
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UNITS
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NATURE OF WORK TO BE DONE
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I hereby acknowledge that I have read this application; that, the ' in- TOTAL AMOUNT DUE :.
formation -given is' correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby, no person
`THIS
will be employed in violation of the Labor Code of the State of Washington PERMIT This application is not a permit
relating to Workmen's Compensation Insurance, AUTHORIZES , until signed by the Building Official or.
NOTE: Permit Limit One Year(Except DEMOLITIONS and FILL ONLY THE his Deputy; and fees ace paid, 'and
PERMITS without conditional use permit, which shall be completed in 90 WORK NOTED
, receipt is acknowledged in space pro -
days; MOVED be in
-IN BUILDINGS shall completed six months.) vided.
+ S71ATURE (0W.KF.P R AGENT) JDATE SIGNED INSPECTION
DEPARTMENT DIRECTOR'S SIGNATURE
//
;(2X�.♦� 'rlk"'116r., / 7 7Ir CITY OF
t {' DATE I EDMONDS
�
NOTE: Applicant Subject to, Plan Check Fee 775-2625
This Permit c vers work to be done on private property ON Y.
,.'
„ `'.Any construction on the public domain (curbs, sidewalks, driveways, . ". ORIGINAL •File YELLOW -Inspector. _'
~,.•-marquees,
L.
etc.) will require separate permission. ," GOLD -Assessor PINK -_Owner
:;