10031 240TH PL SW.PDFiiiiiiiiiiii
4269
10031 240TH PL SW
3�- 2-4f��
TAX ACCOUNT/PARCEL NUMBER: (JlJ -y O O OJ - O 2 (J CD
BUILDING PERMIT (NEW
COVENANTS(RECORDED)FOR:
CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DA
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMITS) #:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER M[ ETER TAP CAM �jDATED:_)
BLOCK:
D- D1-OI-b-1kI-i I i
LATEMP\DSTs\Fom►s\Street File Cheddist.doc
890 _ 19C)v
City of Edmonip '
RIGHT-OF-WAY CONSTRUCTION
PERMIT retract Number: 91(- j
Issue Date: /d'-
A. Address or Vicinity of Con
B. Type of Work (be specific):
C. Contractor: ®LKmi?'C i iky Ct
Mailing Address: 0370E G) &05 M/ Pt
State License #: Liability Insurance:
D. Building Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision
❑ Multi -Family ❑ Single Family
INSPECTOR:
Bond: $
Side Sewer Permit # (if applicable):
❑ City Project [�' Utility (PUD, GTE, WNG, CABLE,
❑ Other /
INSPECTOR: i ,ki4c-Al
F. Pavement or Concrete Cut: WYes ❑No G. Size of Cut:. x 9— H. Charge $
DPI VENq`/ - - -
APPLICANT TO READ AND OL,GN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold 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 or not limited to the defense of any legal proceedings including defense costs, and attorney fees by reason of granting this permit..
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A'PERIOD OF ONE 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.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the bone state nts and u " ers the permit requirements and the pink copy of the permit will be
available on sit a all ti for In a oses.
ESignature: ) Date:
(Co tractor or ent)
C I�AL-A-DI RI(OR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: `� RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS DISRUPTION FEE/FUND 111:
SPECIAL CONDITIONS: ki A,- - P GINS RESTORATION FEE:
y w.01N c li I ti PERMIT FEE:
TOTAL FEE: y 00
COMMENTS:
DATE:
RECEIPT FEE:
ISSUED. BY:, —.
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
L]
FIELD INSPECTION NOTES
Comments
Diaaam
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
❑ YES
Date:
Date:
❑ NO
i
4!'-�->
w4-rE-F-M
cn«Y PP�� 1�
4 f -)
1
t
NOTICE:
No warranty of accuracy.
The information shown on the attached map(s)
was compiled for use by the City of Edmonds,
its Employees and Consultants. The City of
Edmonds does not warrant the accuracy of
anything set forth on these map(s). Any person
or entity requesting a copy should conduct an
independent inquiry regarding the information
shown on the map(s), including, but not limited
to, the location of any sewer stub shown. Such
sewer stubs may or may not exist and may or
may not exist at the location shown. Neither
the City of Edmonds nor its employees or
officers shall be liable for the information given
on map(s), nor for any one representation
provided based upon said map(s).