Engineering Permit FormOF WAY PERMIT
PERMITNUMBER,
City of Edmonds
AveRIGHT
9801 1 1 1
www.cityofedmonds.gov
Description: Frontage Improvments and Utility Install for new SFR ISSUED: 06/03/2020
Address: 21328 82ND PL W EDMONDS WA 98026-7433
EXPIRES: 11/30/2020
Permit Type: RIGHT OF WAY
Permit Subtype: RESIDENTIAL Parcel Number: 00467400001100
NAME TYPE NAME
ADDRESS PHONE
APPLICANT SELECT HOMES INC
16531 13TH AVE W SUITE A 107, LYNNWOOD WA 98037 (425)742-6044
CONTRACTOR SELECT HOMES INC
16531 13TH AVE W SUITE A 107, LYNNWOOD WA 98037 (425)742-6044
OWNER CALVARY CHAPEL
2827 211TH ST SW, LYNNWOOD WA 98036-8946 (425)742-6044
EDMONDS/LYNNWOOD
DESCRIPTION
AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00
ENGINEERING INSPECTION FEE
$660.00 $660.00
RIGHT OF WAY STANDARD PERMIT FEE
$330.00 $330.00
• •
REQUIREMENT TYPE NOTES
TRAFFIC CONTROL 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 posession.
RESTORATION Restoration is to be 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
WARRANTY The contractor is responsible for workmanship and materials for a period of one year following
the final inspection and acceptance of the work.
77 INSPECTION SCHEDULING: WWW.MYBUILDING PERMIT.COM
24 HR NOTICE REQUIRED
INDEMNITY
The Applicant has signed an application which states he/she 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 attorney fees by reason of
granting this permit.
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
RELEASED BY DATE
Printed: Wednesday, June 03, 2020 5:43:04 PM 1 of 2
OF WAY PERMIT
lRIGHT
i
-
PERMITNUMBER,
4r
City of Edmonds
Ave Edmonds 1 • • ENG2020-0203
CONDITIONS
CONDITION TYPE
NOTES
Contractor/Owner shall be responsible for repair/replacement of all damage to utilities and/or
DAMAGE TO FRONTAGE
frontage improvements in city right of way per city standards that is caused by or occurs during the
IMPROVEMENTS
permitted project.
ESC REQUIRED
Maintain erosion & sediment control per city standards.
INSPECTION PRIOR TO
Call for all required inspections. All work shall be inspected prior to backfill.
BACKFILL
PROJECT ASBUILT
ROW COMPACT TEST
UNDERGROUND UTILITY
Call for locates of underground utilities prior to any excavation.
LOCATES
INSPECTIONS
INSPECTION TYPE
DATE
RESULT
NOTES
COMPLETE
X-2 ENGINEERING FINAL"
E-7 CONCRETE SIDEWALK
E-7 CURB
E-7 DWY APPROACH
E-7 MAILBOX LOCATION
E-7 PVMT SUBGRADE
E-7 RESTOR LIMITS
E-7 SEWER LATERAL
E-7 STORM MAIN
Printed: Wednesday, June 03, 2020 5:43:04 PM 2 of 2