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1004 DALEY ST.PDF1004 DALEY ST ADDRESS: TAX ACCOUNT/PARCEL NUMBER: O04�5 2bgE5,O�(�, BUILDING PERMIT (NEW STRUCTURE): I Ci ✓J D`t"✓`Cl� COVENANTS (RECORDED) CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER): jq-7�b!��((,)WdSk)Vp� 19 t)qD7- L-Auc� icmo--,55LmL PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: BLOCK: 43 SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: WATER METER TAP CARD DATED: OTHER-'&Uj �6 d� ��,cL b Y9 i/Ylow L:\TEMP\DSTs\Forms\Street File Checklist.doc D5 :-2 .. ....... . .. RREFAW Z CITY�OVEDMCPwDS. WASHINGTON - DEPARTM.Lf OF BUILDINGS BUILDING PERMIT lidikit¢iambykertifies that a plot, plan, draxvings, and sufficient details to indicate lion m, - 0 to'Afj�lfijl all';requiret�ents of this code are attached hereto. ppfi4anon lshereby,made for pe rmit to do die following work: ..... . . .................... : .. ..... .................... ................................................... . ......... z > .......................... .......... ................................................. . ......... ........... . .......... > . . . .. . .......... . . . .... ....................... ...... ........................................... .. ...... C x. 74 ........................................... ........... ............................................. ...................................... ......... ................... .. ................... ...... ..... ........... ............................................... U . .......... .. c: . ........................ ................ .................. ... ... . ..... ........................................... .... Iz --- - ------ ­­* -- - ----------------- c: 0 ........... .. ..... . .... ...... . ........ . .......... 1 _2� - - ----- - ----------- - ------------------------- - r z at10 -0 -� ........ ........... ................................... (street or tot and block ..beta) r A A T -7 o dim"itxis a 6 rr . .. .......... 3 ............... Du .............. __7­1 ......... z �yy ot dimensions are....!6_5? . .... . .... ...... . x .... .... . -- ........_ A > C w- . ............... stories in height. I- 0.o 0 --Numbei.of basements.....:- a 1z Z :,%Occupa`ncy%of buildi will be----__- ... ------------­--------------- j ro �? ' . . I I., - , .. a Ing lot e. t '"' e .. . ...... ...... ..... ..... ...... .............. cost . ........... B . ..... �=g . .... ..... per tFis . . ....... .... Owners, :Add ress ...... -3!� . .......... ........................................... .............................................................. Builder ....... Group, No... 10. Builders Address. ... . .............................................. . .................................................... incer .. ......... 11. Architect or en g .... ..................................................... .................... ...... Life of permit.: ... ................... due Date .... ........... 1957.§ Applicant's Signature ... ..................... . ........................................................... Pians filed: Y(�sim-,,;No [],, - (Owner or his agent) 'n F", .hereto,. -.bjcc, to compliance with the ordinances of the City of Edmonds. This copy is your receipt for the following fees., Permission is hereby granted to do the work 6escribed herernz, according to the approved plans and specifications pe�i al1�� • 1. Building permit fee_.----....._ ............................ .............. ... ..... ............. 2. Sewer permit fee ....................... ............ ............ .. . ..... $ . ..... .............................. e_, 'v 3. Inspection and supervision fee ..... . ................................. $ ............ ........... ............ .... 4. Tot al ..... . ........... ............................. . .. ... ............... ... ..... .... ............. ..... . ..... $... Rcc, I (fastios OfSct,)*.`,� I PERMIT N? 454 .Department of Bi�ildid,_ City, of Edmonds 1. The building Permit fee urluch applicant p." Then permit is is­edshall be based on estimated con of the proposed structure, at the rest of $1.00 for e*6 000.00 of cost. If the small cost 4 the structure, wh- fi..Ily determined, exceeds the estimated coast by more than 5� o, applicatnt agrees to pay an additional fee of f2.00 f.r'czch $10.0.00 of such excess tux. in such ­ 110 UJe Permit shall he issued until web "diie,eptacy fre" Is paid.. 2. W!­­ . corar.. for I. ­­d !or mating more than $1000-00 for which a licensed architect or tatlacer Is riot r*q6lmd by "_ PuLldi,,g Code of the (Nry of Edf;.ocstls, •the application for a building perooit,'sbzfl bc'a kled by a copy of the contract and^x copy of the dettitial , 3. Frfm,,to ernployinj way labor or commencing work, vocify the Industrial Insurance Division of the Department of Libor and lodustries.-gMag an "am,.f -7:: d' l, yiro)=d make m=rhJy'revor%;,pf,P2Yxo4 Full im­uction, should be obtained from the ocarest office of the Deparmomt of Labor and Industries. -.Befm fil payment, the owner should obtain a H­ jt from the enerxl ­­ who in turnthould obtain relreleasefrom all sub-contracross. The -releases should be attuned 7b theDtfsrnment of Labor and Industries.triIndustries.­ en T1. boi, procdare rquirem:, of the state I.R6.1 InsuranceInsuranceAtt. . _ APPLICATION for The City of Edmonds SIDE SEWER PERMIT EASEMENT No ........................................... NEW CONSTRUCTION O REPAIRS 118-04400 owrrER........... aer..t.-L.... ear. on ................................ --------------------- CONTRACTOR.--------------................-----......................------.................-----..........-- PERMIT No....................... ADDRESS ....... W04... Dd 19Y...-St•............................................................... LEGAL DESCRIPTION: LOT No............................................... BLOCK No. ............................................ • NAMEOF ADDITION......................................................................................................................................... Dye Tested On Sewer 1972 Approved: DATE................................................ By.....................---............--................................ CITY OF.EDMONDS' 'Permit No. 0, COMMUNITY SERVICES DEPARTMENT RIGHT -OF -SWAY CONSTRUCTION PERMIT Issue Date A. • Owner: �� N �� —\O t_ L B. •Contractor: 1Z1> % OyJ�� wl.- City State Zip City State Zip tits-Ru-S�i.1 u I MF' (d'12� 094�� State 'LJicense Number Telephone Number Y' C. • Address or Vicinity of Construction: IDUE� �t�0 Type of Work to be Done: eugt� Q2! W1pUA(_ D. • Work in Connection With: ❑ Sub or Plat )6 Single Family ❑ City Projects ❑ Commercial ❑ Multifamily y ❑ Utility r E. • Pavement Cut: ❑,Y N F. • Size of Cut: X 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, court 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. • A 24 hour notice is required for inspection; Please call Engineering: 771-3202 " • Work is to be inspected during progress and at completion. • Restoration to be in accordance with City Code.. STREET FILE • • 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 abov and )Re r -lit be available at the job site for inspection purposes at all times. Signature: Date: 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: AIL4 Time Authorized: Void after �7 days. Special Conditions: RELEASED BY: Date q' PERMIT FEEpso� ` Restoration Fee: Receipt No.: !:!2 Fund III Fee: —_ Street Cut Dimensions: x = $ INSPECTED BY A6 Date NO WORK TO BEGIN PRIOR TO PERMIT tSSUANCE Eng. Div. Marche 1989. FIELD INSPECTION NOTES (Fund I I Mkoute copy to -Street Dept,) Comments: Diagram: CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO Partial Work Inspection by P. W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: Eng. Div. Jul MAY 12 ............................District City of Edmonds ---Water Department TAP CARD Date........_ ...................................... No............................... No......................................... Meter Tap I Size."............I ............... I Size..................... ................. Mfgrs................... Style ............................................. 7 For .................................................... ................................................................................... j .................................... . .............. Lot No ........................................... Blk. No..................................................I.. I.. Add. ................................................. ............. Service Location .. .... *.".�-.;,.�'.i,s.l ...................... .............. ................................................................................. ................ ....................... MeterLocation ................................................................................. ................ .......................... Make Tap ................................................................... ...................................... r... ............. . .......... Pressure.............................. lbs. Test ..................................... % SendBills to ................................................................ r ....... ......................... . ..... ........... PK ....................... ............................. ........... Date of Work ................... . 7 ......... I .... f , 6' ... .........'........s'................. .. .... .. .. . .... .. . ........... ......... Foreman Guar. Voucher No ........................................... $ .............................. Remarks: ........................................................ . .......................... ; .............................. .......................................................................................................................... . .............. ....................................................... JT ...................... 0 .. J..REET­'E1EE­­* ................ OUTGOING Index .......... Reg ....... Route Bk ......... :Stencil ...... Card ...... . INCOMING Index ......... Reg ....... Route Bk ......... Stencil ...... Card ....... M,,.rial Chargeable to Installation M,_,rs NO. S= DESCRIPTION RATE- AMOUNT, 7— ...... 7/11Meter .......... ........... ...... —. jop- Meter Box ....... ............ .............. ....... .............. .......... Meter Plate ............................ .............. ............. .......... .............. .......... Check Valve .......................... .............. . ........... .......... .............. ......... Pipe, Galv. Screw .................. .............. ............. .......... ............. .......... Nipples .................................... .............. . ......... .......... .............. .......... Bushings .................................. .............. ............. .......... ............... .......... Plain Ells ................................ .............. ............ ......... : ............... .......... St. Ells - ---------------------------------- -------------- ............ .......... .......... .... .............. ------------- .......... .... - - - - - - - - - - - - - - - ............... .......... .... .......... .......... .......... ..... .... - - - - - - - - - - ...... .......... Tees ----------------------------------------- ...................................................... ........ ............................................ ...................................................... - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7Z . . . . . . . . . . . ........ ................ ........................... ............... .............. .............. .............. . . . . . . . . . . . . . . . ............ ............ ............ ............ . . . . . . . . . . . . ---------- ......... .. ....... ......... . . . . . . . . . Material Chargeable to Taps Connected NO. SIZE DESCRIPTION RATE AMOUNT .............. .......... Pipe, Black Screw .................. ........ I .... ............. ......... .............. .......... Pipe, Galv. Screw ----------- ------ -------------- .... -------- ---- .............. --------- . .................. Lead Connections Curb Cocks ... ........................ .............. ........... .. -- ....... ...... ....... I .... Corp. Cocks .... ....................... .............. ........ lv�z ...... ............. Unions .............. .................. ......... ------------- .......... Saddles -------------------------------- --- ------------ - ------------- ---------- .............. .......... Nipples .................................... ............... ............ --------- ............... ......... Bushings ---------- ------ ---------------- -------------- - ---------- ---------- .......... Plain Ells ................................ .... ------- ------------- ---------- .............. .......... Street hils -------------------------- --- ------------- ------------- --------- .......... Tees ------------------------------------------ --------------- ------------ ---------- .............. .......... Curb Boxes .......................... . .............. ............. .......... S. O. Extensions .................... -------------- -------------- ---------- .......... Gates ------------------------------------ --- --- ..... .. . ------------- ----------- .. ...... _j ....... .... .. . Plugs ............. A .......... ............ Couplings .1.. o �.. ----- --— ------------ 1.............. ............ ....... .......... Gate Boxes � --------------------- ------ -------------- ------------ ---------- .................. . .... .. . ............. ...... -------------- - - ----- ....... -------..... . . ............ ........... ............. .......................... ............ .......... .......... .... ..... .......... .................................................. .............................. ....................... ........................................................... ........................................................... ........................................................... ........ woo — ........ .............. .............. .... ... . ...................... _w--e .......... ........... ---- I ......... .......... .......... .......... .......... . i ..... ............................ ........................ ................................ .......................... i7 ............... ;i5 ..... .. ........... .............. ------- ......... I........... ............ . I ........ I......... ------ .............. .......... H t's Time —Day Men cK ... -- -------------- --------- 7- ............... Hours Time —Monthly Men --I ............... ............... .......... ' 0 ........ ... .. Hours Time —Auto Superintendence Total . .............. ----- .......... ----- . ............ ..........