Engineering Permit FormRIGHT OF WAY MINOR PERMIT
PERMIT NUMBER
City of Edmonds
www.cityofedmonds.gov
Description: TOLLEFSON -CONCRETE DRIVEWAY AND CONSTRUCTION ACCESS FOR
ISSUED: 12/30/2021
ADU
Address: 633 WALNUT ST EDMONDS WA 98020-3421
EXPIRES: 12/21/2022
Permit Type: RIGHTOF WAY MINOR Permit Subtype: RESIDENTIAL 7[Parcel Number: 00434209402900
NAME TYPE NAME ADDRESS PHONE
APPLICANT LEE MICHAELIS 1 (425)830-1046
CONTRACTOR LEIF HELLEREN CONSTRUCTION INC EDMONDS WA 98020-6132 (425)774-8815
OWNER TOLLEFSON SKIPPER & BARBARA 633 WALNUT ST, EDMONDS WA 98020
FEE INFORMATION
DESCRIPTION AMOUNT PAID
CITY TECHNOLOGY FEE CHARGED PER PERMIT $40.00 $40.00
RIGHT OF WAY MINOR PERMIT FEE $110.00 $110.00
REQUIREMENTS
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.
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.
RELEASED BY
THIS DOCUMENT IS NOT VALID UNTIL FEES ARE PAID AND THE CITY ENGINEER OR HIS/HER DEPUTY HAS SIGNED BELOW
DATE
Printed: Thursday, December 30, 20218:48:59 AM 1 of 2
WAY MINOR .UM PERMIT
PERMIT NUMBER
City of Edmonds
..• • 1 14'
www.cityofedmonds. ov/425.771.0220
CONDITIONS
CONDITION TYPE
It is the owner's responsibility to repair/replace all damage of utilities or frontage improvements in
DAMAGE TO FRONTAGE
City right of Ways or Easements to City Standards caused by or occurring during the permitted
IMPROVEMENTS
project.
ESC REQ
Maintain erosion and sedimentation control per City and SWMMW standard requirements.
Sound/Noise originating from temporary construction sites as a result of construction activity are
exempt from the noise limits of ECC Chapter 5.30 only during the hours of 7:OOam to 6:OOpm on
SOUND OR NOISE
weekdays and 10:OOam and 6:OOpm on Saturdays, excluding Sundays and Federal Holidays. At all
other times the noise originating from construction sites/activities must comply with the noise limits
of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
All utilities shall be located prior to any excavation. New locates shall be called for if at time of
UTILITY LOCATES
excavation, original locates are no longer identifiable.
INSPECTIONS
INSPECTION TYPE DATE
RESULT
COMPLETE
A-1 TESC AND MOBILIZE
X-2 ENGINEERING FINAL"
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