1011 ALDER ST.PDF11111111111111
10026
1011 ALDER ST
• NOTIr-p EETJ ILE
TO PERMI7TEE AND
❑ PARTIAL APPROVAL
❑ VIOLATION
❑ CORRECTIONS REQUIRED
PERMIT
NUMBER
JOB ADDRESS
❑NO PERMIT - STOP WORK - REMOVE CONSTRUCTION OR OBTAIN
PERMIT AND MAKE WORK COMPLY WITH BUILDING LAWS.
CONSTRUCTION IS NOT IN ACCORDANCE WITH APPROVED PLANS
❑ AND PERMIT - STOP WORK. MAKE EXISTING WORK COMPLY WITH
APPROVED PLANS AND PERMIT OR REMOVE IT.
❑ STOP WORK - UNTIL AUTHORIZED TO CONTINUE BY INSPECTOR.
❑CORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN
BE APPROVED.
❑ WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED.
❑CONTACT INSPECTOR AND
ARRANGE FOR APPOINTMENT. 1 ❑ RECALL FOR INSPECTION.
lip
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED WISON .y
.26,44Y !'L
PENALTIES IMPOSED BY LAW MAY BE APPLIED.
FOR INSPECTIONS CALL: 771-3202.
❑
�%��G%u.�.��
BUILDING DIV.
0�,P/f/ ❑ PUBLIC WORKS
INSPECTOR
CITY OF
DATE ❑ FIRE DEPT.
EDMONDS�
NOTICE
TO PERMITTEE AND/OR O NER
PARTIAL APP
Ei FfLE
❑ VIOLATION
❑ CORRECTIONS REQUIRED
PERMIT
NUMBER
JOB ADDRESS I ^! I A
❑NO PERMIT - STOP WORK - REMOVE CONSTRUCTION OR OBTAIN
PERMIT AND MAKE WORK COMPLY WITH BUILDING LAWS.
CONSTRUCTION IS NOT IN ACCORDANCE WITH APPROVED PLANS
❑ AND PERMIT - STOP WORK. MAKE EXISTING WORK COMPLY WITH
APPROVED PLANS AND PERMIT OR REMOVE IT.
❑ STOP WORK - UNTIL AUTHORIZED TO CONTINUE BY INSPECTOR.
❑CORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN
BE APPROVED.
❑ WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED.
CONTACT INSPECTOR AND ❑ RECALL FOR INSPECTION. ARRANGE FOR APPOINTMENT. ❑
X3-- 4111�
THE ACTIONS OR CORRECTIONS INDICATED ABOVE
ARE REQUIRED WITHIN
'. DAYS OR PENALTIES IMPOSED
BY LAW MAY BE APPLIED.
FOR INSPECTIONS CALL
BUILDING DIV. ,
771-®
INSPECTOR Y.
PUBLIC WORKS
CITY OF DATE
❑ FIRE DEPT.
EDMONDS
��
--District
City of Edmonds — Water Deplfinent •
TAP CARD
Reading: O e® Date
No. •?2 2-® No.
Meter Tap
Size 3/� Size�� --
Mfgrs. No. qS_P 4(8qP7-- Style, sCA1,51'J
Purchaser: O he p'r v W,1414W.4). --
Serv. Add. 1011 hF,
Lot No. Blk. No.
Add. _ - ---
Residential: -
Other -
Meter Location
Service Material:
Pressure lbs. Test-.
�'
Date of Work -. _--- - ---... , -:
: '' Al Aew Foreman . j
- - v // &J"
Guar. Voucher No.-. - $ --
Remarks: R3►zai�,�.►J-- �:- f(�'
s ..
OUTGOING Index Reg. - Route Bk. Stencil - - Card- —
INCOIVI'ING Index -a.r:Reg. -- Route Bk.- -- --. StencilCard- -
_ v,.c_r't :•
stilp -1 - .. 0.
r AT T k'V-'rrNX
oms A
d"Ga
P.U.D.. N�da Cs ST���E;,EILE
NT
TELEPHONE NO W'�
,CABLE:TV-'
GAS
TO REMAN
•
STORM S
OTHER
%
FLITURE SERVICE INSTL: YES
CUT. -
w a 0
-
CREW
I INITAL:
-)UNLOCVK-
DATE; ,"?2_11NITIAL jJ
ACCOUN'NUMBER:
METER SHOP
Ek:J,
SUPPLIER:
TREATMENT PLANT
J�MMAN
B L T
.1A
FOREMAN
INITIAL: DATE:
TAP C
ETER SHEET
A0li6Xli6&,,/`.
uTmuw
OA
00
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER: Dt ` 5 `-IZL L�L;I D2j 10 O
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS V DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DATED: 11
SCALED PLOT PLAN DATED: A� 1 ' Z ?J ' 9 Z
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT:?nj BLOCK:
SIDE SEWER AS BUILT DATED: dI 10jgA
SIDE SEWER PERMIT(S) #: ?j�?
GEOTECH REPORT DA
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED: �I2�' 5 Iq Z
L:\TEMP\DS1"s\Forms\Street File Checklist.doc
ZONE PERMIT S(�
CITY OF EDMONDS use NUMBER �Q..14
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT
OWNER NAXIE,NAbIE OF BUSINESS ADDRESS I E _ -
w MAILING AUGHESS
o
CITY /IP TELEPHONE NUMBER
�mdPC4 -7"-qzz
NAME
J���s Jess
W ADDRESS
It
3►ts-
L' CITY ��rf ZIP ieLE PHONE NUMBER
+ T/T"U cts
NAME 13Y��j
1Z A N L .
ADDRESS
2 CITY ZIP TELEPHONE NUMBER
OOMctiID. cz�. ?/ '-9zz.
O STATE LICENSE NUMBER-
$1211Y I D H— . . .
Legal Description of Property - include all easements
o l.G 'EL -lc 37
G? . O fO f Ll b Apt Cl e-o.!
o
w
J Tax
�Account ParcelNo.�? 3e�2,0^;0.3 _0aCy
j
L � I NEW LJ RESIDENTIAL PLUMBING
OADDIALTER O COMMERCIAL (❑ MECHANICAL
OREPA.IR APT. SLOG. LJ SIGN
DEMO, �G cYDs I❑I FENCE, •%—
El �
CARORT
REMODELGARA��GE,.. L_U POOL:
❑ WOON STOVE/ ❑ •RO KERY AiNING WALL/ . •' O RENEWAL -
IERT z
9 (TYPE OF USE. UUSINES3 OR ACTIVITY) EXPLAIN.- /
a to 01J ZGk \.
x NUMBER OF STO.RRIIE�Sp, NUMBER OFDWEL
m Z ���'�•' r]ief[/iM1�r UNO.
UNITS '
O
• - �' DESCRIBE WORN TO 9E DONE (ATTACH PLOT PLANT
• � ST.¢uc� /Y.Si
LEGAL DESCRIPTION CHECK SUBDIVISION NO L-0
NO
V O
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
APPIWed - ❑
EXISTING GrJ REOUIREDDENCATION RW
SPMI
Permll Repuved 11
U>e Pelmn RPC d ❑
vROPOSED i->Gi In,"Cl
PR AMU
SlderrelX
ReQVirM ❑
REMARKS
UC4- wlO�f TLCEL CLlJi✓ iNsP 2E
f*,rcee- Fib c: P Ashes
ENGINEERING MEMO DATED
II �RF�,EW� v
METERS E / f
BUILDING Sur -PLY SIZE "
NO.OF FIXTURES -
/
REMARlF9�F1� ..
.�((/�KKS:.N
AREA :
SEPA REVIEW
AOB NO.
ALLOWED : - PROPOSED
COMPLETE - / 1:,1jEMOT
EXP )
-
T----
VARIANCE OR CC!
PL NINO REVIEW BY
DATE
SETBACKS rEC I
HEIU(HT
LOT abVERAGE
/
FFONT: SIDE REARIS
REMARK) ..
sw lees cC�+VE �•Iax tFn ar/
CHECKED,BY
TYPE OF CONSTRUCTION
CODE •
HEIGHT
SPECIAL INSPECTOR
AREA, . OCCUPANCY
OCCUPANT
REWIRED'
I1 �YES �r
- GAWR
LOAD
'ATMARKS . _
PROGRESS INSPECTIONS PER UBC 305 .
Tff�irlRG ,Q�/L /9 f sEG
FINAL INSPECTION'REGUIRED
/2 SV G 1c— i _ '�.. - �LI- y .
�G
VALUATION
FEE
3H aas
PLAN CHECK FEE
'
BUILDING -
Z-f, 12B
A
P
S IAlwfi �/V
/
C Yt'
PLUMBING
Plan Check NO.
MECHANICAL
Z-E�
This Permit covers work to be done on private property ONLY. '
GRADINGIFILL
- 45
.
'
Any construction on the public domain (curbs, sidewPlks,-
o•'
- _
driveways, marquees, etc.) will require separate permission. -
STATE SURCHARGE
Permit Application: 100 Days
Permit Limit: 1 Year - Provided Work 19 Started Within 180 Days _
sTo�M DRAINAGE FEE
_
"Applicant, on Behalf of his or her spouse. heirs. assigns and
ENG. INSPECTIONFEE
m
successors in interest, agrees to indemnify, defend and hold,
.
harmless the City of Edmonds, Wasnington, its officials.
-
s
employees, an tl agents from any and all claims for damages of
_
-
a
whatever nature, arising directly or indirectly from the issuance
r
s
of this permit. Issuance of this permit shall not be deemed 10
PUN CHECK DEPOSIT
G
mDo fy waive or reduce any requirement of any city ordinance
i
nor limit in any way the City's ability to enforce any ordinance
-provision."
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the
- '. APPLICATION APPROVAL
-
-
I .Information given is correct: and that I am the owner, or the duly'
AT
'Lauthorized agent of the owner. I agree to comply with City and
- THIS PERMIT
'
state laws regulating Construction; and in doing the work aul horiz•
AUTHORIZES
This application I9 ,not a' permit until
11
ed thereby, no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official Or his/her
Code of the St to Of IN shington relating to Workmen's Compense•
wOAK NOTED
Deputy; and fees are paid, and receipt,is
.
-
ti n Insurance.
- INSPECTION
acknowledged in space Provided:-
_
-
SIG A RE TOWN O AGENT) -
-
DATE SIGNED ..
DEPARTMENT
CITY QF
OFF CIAE'S SIGN UAE., DniE; ,
T
MONDS
- CALL FOR
PELEA DATE
AT NT10
INSPECTION '
L�
- IT IS UNLAWFUL TO E OR OCCUPY A BUILDING OR STRUCTURE
' ���-3ZO�I
' UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL — F;le' YELLOW — 1 Spe or
1
A CERTIFICATE OF GCCUPANCY HAS BEEN GRANTED. UBC
i CHAPTER 3.
PINK — Owne• GOLD — AS sor
DETENTION WORKSfiE`ET
JPPER
' 3faSIN DETENTION PIPE LENGTFI COWROt_ LATCH
YEtvT) EnS�r�
1� MIN 2 MAY COV _P,
i
iOL1TLCT
CONTROL
r � SIX SLOPES ,.� 4.
TO O UT L.J= T.
�fzi PRAP OR
RUNOFF
5P READER)
SYSTEM CROSS SECTION
2' • 2' ■ &Do DC", A- L SPALLS ��■ e0wu) .
i'. 2' K 3" DEEP, '- CRUSIAED ROCK
CON-rRCL
RIPRAP OUTLET
WASHED GRAVEL plrrFL.OW TR[f.ICN, tAIN 10' LONG,
1 TOP < 4' PVaF TD BE LEVEL
.r
FROM
OVTh-ET
CONYRDL _
' 4 PERF PIPE WITH CAPS
;l
RUNOFF SPREADER OUTLET
T 'JDAFRD DRAIN AGE .•PLAN
�_— ETENTION SYSTEM
for PA Dg1i A W51 pEGt
location lull LV—e Z.
S
plan by JAr 123 E%SU PT_,
phone -, 2 Z - 212I
date hW)V,T �TI'
DESIGN DATA
System Imperm Pipe Pipe Orifice
(lumber Area Diam Length Diameter
r=M
NOTES
1. Call Engineering Division (771-.3202)
for prebackfill and final inspections.-
2. Responsibility for operation and
maintenance of drainage systems on
private property is the resoonsibil'tty
of the property owner(s). ,kijte'ri:a,1"
accumulated in the storage...pipe must:;,''
be flushed out and removed from catch;
basins to allow proper operat on 7: e-
outlet control orifice must be !kept.
open at all times.
VUUNT&j.
or
FILE
` .. FOOTING DRAINS SHALL NOT BE
In of 9 CONNECTED --O THE DRAINAGE SYSTEM
�... _ .. .��. .__. __._,..s�,�.- .�:,-x•�..,,^�s�.�.-----:---,mom..__--;
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PLANNING DATA
NAME: tAA4
SITE ADDRESS: IC I I k, _DATE: G '
ZONING: �5`-� PLAN CHK#:
n J �- h
PROJECT DESCRIPTION:
CORNER LOT UV D (Yes/No) FLAG LOT No (Yes/No)
SETBACKS:
Required Setbacks:
Front: 20' Left Side:_Right Side: RearA
Actual Setbacks: ,
Front: 2s' Left Side: /_Right Side: s Rear:_
Street map checked for additional setback required? (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED 41 (Y/N)
LOT COVERAGE: X
r
Maximum Allowed: Actual: Z
BUILDING HEIGHT:
Maximum Allowed: Actual Height: 2S
Datum Point: Datum Elevation:
A P1 71 Artr A♦T r%A. �V�Wf(AAEU Wk
CRITICAL AREAS #: ' V
SEPA DETERMINATION:
LOT
OTHER:
Plan Review
Ckn1c,\9=rtt\^p1 ,du&a
FILE
Revised 3/90
yr
"RTREET FILE
$° CITY OF EDMONDS
89p-19 1O
Address of Construction: I D I I NrL-- Q 2" ,L e"ILFT'
Property Legal Description (Include all easements):
Owner and/or Contractor:
SIDE SEWER PERMIT
PERMIT r''u °'
EDMONDS
PUBLIC WUHKS DEPT.
.. State License No. 4-y T Z B 5 1/ ' , 2- Building Permit No. r. 2 0 4--
Single Family -
❑ Multi -Family (No. of Units )
❑ Commercial
❑ Public
Invasion into City Right -of -Way: ❑ No 0 Yes
RW Construction Permit No.
Cross other Private Property: 2 No ❑ Yes
Attach legal description and copy of recorded easement
I certify th t I have read and shall comply with all city requirements
as indicated on the back of the Permit Card.
3-z-
Date
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION *
OFFICE USE ONLY
* FOR INSPECTION CALL 771-3202, PUBLIC WORKS DEPT.
Permit Fee: -7 C ~ 6%G Issued By �
Trunk Charge: Date Issued:
Assessment Fee: Receipt No.:✓
Lid No.: &'
Partial inspection: Date Initial
Comments
Reason Rejected:
Final Inspection Approved: Dat —(4 v Initial
Date Initial
** PERMIT MUST BE POSTED ON JOB SITE **
White. Copy: Pile Green Copy: Inspector Buff Copy: Applicant
Revised 3,90
The City of Edmonds Side Sewer Drawing EASEMENT NO . ....................................
i NEW CONSTRUCTION Vf REPAIRS ❑ LID NO - ------------------ -ASMT. NO. ------------------
*OWNER------------------------------------------------------------------------------------------------ CONTRACTOR-._-.-------.------.-_.-._---------------------------------------------------------- PERMIT NO.
JOB ADDRESS ---' � —------� ---�-Z-----S-J-- ---------------- LEGAL DESCRIPTION: LOT NO. -------------------------------------- BLOCK NO. ---------------------------------...
NAME OF ADDITION -----------------------------------------------
I— -�IrO5�lr
�L��1 ST• 11
- - -
�
PWW-0 01-11/75 (R .11/78)
Approved:
DATEv-
--------------------- ------------------------------------------------
gg
NT
1,�
WAT959. SEAVIGe
The City of Edmonds Drawing EASEMENT NO- ------------------------------ --------------
NEW CONSTRUCTION IX REPAIRS ❑ LID NO - ------------------ -ASMT. NO...................
OWNER.-�RA0-5,HAW—----------------------------------------------------------------- CONTRACTOR------------------------.-...-------------------------------------------------..---- PERMIT NO. --------------------
JOB ADDRESS 1-0-I--'--------- AI DER-----ST------------------------ ---- LEGAL DESCRIPTION: LOT NO. -------------------------------------- BLOCK NO.------------------------------------
-----------------------------------------
NAME OF ADDITION
L.0
LL
O 1011 At_DER
Lu
uj
FOUNDATION
m � WALL
2., GOPPrw V.
1"SUPE.RVIN
100 P.S.I.
HI•MeL poly PIPE
MtR
Approved:
l� ►-D e R S-r . 4 �o -92
PWW-0001-11175 (REV.11178) DATE ..... �-•-------•---•--•................... BYZr.0C#-./-•---•-------••-----------••------•--
k
I
..-.r: "" it ..-:.� �:-�•�..�-. '.: ..-.-•. r Tf=�� � -r4.1 , �"t.' ?i'T i„•k re7:r .v.�: -h •.. �'
890 • 199-
r� City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number: 702
` Issue Date:
A. Address or Vicinity of Construction: 1 , 1
PN�Zc 2-
B. Type of Work (be specific):'T?-.,Z \N"� C,\ k- LJ
C.. Contractor: —?.1 �)Contact: A Nv'b Z
Mailing Address: PMb 1AL,)-" 61�Phone: 0
State License #: Ephoa 5, 'I6o1%0 Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. • ❑ Commercial ❑ Subdivision ❑ City Project V Utility (PUD, GTE, WNG, CABLE, WATER) '
❑ Multi -Family Single Family ❑ Other ...�
INSPECTOR: 4�0';"A�4*4 INSPECTOR:
F. Pavement or Concrete Cut : ❑ Yes TO G. Size of tt�' _ x H. Charge $
APPLICANT TO READ SIGN
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 unforeen, that may be made against the City of Edmonds, or any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings including defense costs, and attorney fees by reason of granring this p�.it.
A
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A Pek0b)OF, ONE YEAR FOLLOWfk6 THM&FINAL INSPEC770N
AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORA77ON FEES WILL BE HELD UN77L THE FINAL STREET PATCH IS COMPLETED BY
CITY FORCES, AT WHICH 77ME 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 Depi'r ent= ,>
Work is to be inspected during progress and at completion. 771-0220 J*
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 reg Ktior�st as required by the Cit En _jpe r.
All street cut ditches shall be patched with asphalt or City approved ifiaterial prior to the end of the working day;
NO EXCEPTIONS.
1 have read the above statements and understand the permit requirements and the pink copy of the permit will be available
on site at es f ' spe . it purp es `
Signature Date: \ — 1C�
2-
(Contractor or ent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
- :..DATE: --- 1SSUEDBY::
NO WORK SHALL BEGIN.PRIOR. TO PERMIT
Engrg. Div. 1991
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept:)
Comments:
N
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
❑ YES ❑ NO
Date:
Date:
Eng. Div. July 198'.
I _
0 • • 1476
PUBLIC UTILITY `DISTRICT NO.1 OF SNOHOMISH COUNTY REV. 7/87
LOCATION M\\ BLS ,(Z, Jy . _7V AREA
POLE NO. S C 1/4 Sty T27 R 3 DATE B-ID--92 W.O. N0. �2
REASON FOR WORK \SE�_ ENGINEER DEM DWG. N0.
DATE WORK COMPLETED
FOREMAN
`- DRAFTER U.G. NO.
SCALE
APPROVED DATE PRINTED
SUBSTATION
CIRCUIT NO.
PHASE
10\ l
RLUIR
S P-����
P (�k-a-7 -X
-t, -
890 19cl
STR Ecity of Edmonds
L
-OF-WAY CONSTRUCTION
PERMIT Permit Number: aZ - 7
Issue Date:
- x - ��,
A. Address or Vicinity of Construction: 1011 Alder Street
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Natural Gas Company
Mailing Address: 815 Mercer Street,
State License #: Seattle, WA 98111
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project [y� Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR: Rlq%
F. Pavement or Concrete Cut : ❑ Yes @No G. Size of Cut: x H. Charge $
APPLICANT TO READ A IGN =
INDEMNITY Applicant understands and by his signature to this application, agrees tlfe City of Edmonds harnile s'fiom in cries' darRVges, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be madpa-gainst the City of Edmonds, or any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings including defe a costs, and attorney fees by reason of granting &;,s permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A, PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK. ES77MA7ED RESTORA77ON FEES WILL BE HELD UN77L`THE FINAL STREET PATCH IS COMPLETED BY
CITY FORCES, AT WHICH 77ME 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 Department- 771-3202.
Work 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 above statements and understand the permit requirements and the pink copy of the permit will be available
on site at all times for inspection purposes.
Signature: Me Date: June 2, 1992
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
7 p
111-1-1-1-1-DATEISSUEDBY::.9-g D '
Engrg. Div. 1991
Eng. Div. July 1985
1 S
O � �•
`�o�+blwCa�erN
Pf A•WNG= to- window. -
Water main. depth.
unknown.
" gas main
Addendum to City Zdmondsof Zdmouds
Right of Way
Permit Application
Submitted by: KIGNA2G WI _L_ARD
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager a►Cc9-1�pC-j�0
-w- water
-g- gas
-ss- sewer
water hydrant
.815, Mara St. (P.O. Box 1869). Seattle, WA 98111 (206) 622-6767
s
City of Edmonds
REUI -OF-WAY CONSTRUCTION
PERMIT Permit Number: t �- o
Issue Date•
A. Address or Vicinity of Construction:
IQ O B. Type of Work (be specific): 1_-417 `Cie !�/fi9 X�`/�ir)7�D.c� SiS7'E/IJC
C. Contractor: Ly T Z, [1j q c k Pro G_ Contact: V_ c N L. U T 7,
Mailing Address: - -—�,�.o...y...._. Phone:
State License #: % :Z(L5a Liability Insurance: Bond: $
D. Building'Permit # (if applicable): C/ Side Sewer Permit # (if applicable): g 37'3
E. ❑ Commercial
❑ Multi-Fanjj
❑ City Project ❑ Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Other
INSPECTOR:
F. Pavement or 4oncrete Cut : ,51'fes ❑No G. Size of Cut: 3 z 2p H. Charge $
APPLICANT TO READ AND SI9N
.[ 6nesINDEMN/7Y: Applicant understands and by his signature to this application, agrees to hold the rCiry of Edmonds hat
s mages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the City of Edmonds, or any its departments or employ-
ees, including or not limited to th�defense=af dhy;Yegal 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. ES97MATED RESTORA77ON FEES WILL BE HELD UN77L THE FINAL STREET PATCH IS COMPLETED BY
CITY FORCES, AT WHICH 7TME 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 Department -
Work is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes. 771-0220
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance withCity regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved maferial prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit, 'requirements and the pink copy of the permit will be available
on site at all,ti s for inspect' it purposes.
Signature: Date:
Contractor or Agent)
UALL lilAL-A-1JIU YK1VK IV IS LY11NINIINU WVKK
TIME;AU1'HUKIZED: VUIll Ar FEK llAYS;' ........UISKUV1JQr4:khh11 UN
SPECIAIs CONDITIONS RESTORATION FEE:
PERMIT FEE:
- .........
Ov
r,.
DATE::.; :.;:.:_:.;:;ISSUED. BY
NO. WORK SHALL BEGINPRI
Engrg. Div. 1991
Eng. Div. July 1985
P ECT REVIEW CHEUNIERST 4 Z A PROJECT NAME: CHECK #:
PROJECT ADDRESS: RECEIPT DATE:
EVIEWED
3 Y: III
ia Date)
�PLAN.
WATER
COMMENTS
FIRE. --rBLDG.
SEiA)ER
STREE�
ENG. -
Setbacks/Variance/Setback Adjustment
t
Conditional Use Permit
ADB Requirements
-, am
cp
3
Other Zoning Requiremi-n-ts
Underground Wiring Required
- ---------- -
lb kw
5
Lot Slope IS%
6
SEPA Environmental Checklist/Hydraulics Permit
- WIN
7:-
Tree Cutting Plan
8
Plat/Subdivision Requirements
•9
Legal Description Verification
Quit Claim/Street Dedications
Easements - Public/Private
Engineering Storm Drain Review Fee
Engineering 2.2 Inspection Fee
Drainage Plan (On -Site)
Setback - To of Bank, Stream, Water Courses
Setback -Storm Drain Line
Open Ditch - Existing
Culvert Required
Culvert Size
20
Shoulder Drainage/Shale Open Runoff.
. . . . . . . . . . .
Catch Basin Required Lf�-5
Driveway Slope & Vehicle Access
Sidewalk Required
.23;
Curb & Gutter Required
Curb Cut For Driveway Required
. . . . . . . . . . . . . . . .
26
Street Paving Required
Right -Of -Way Construction Permit Required Lie--5
•. . . . . . . . . . . . .
Street Name Sign Required
Other Signing Required
.......................
30
Bond Required For Public Improvements
•31
A
FEMA Map Check/Water Table
. . . . . . . . . . . . . . . . . . .
Side Sewer Availability or-f�: Atc7,-4e-7
Calculate Sewer Connection Fee If No LID # Co
34
Create Street File tlo,3
. . . . . . .
3.5
Existing Water Main Size
..............
Water Meter Size
37
Service Line Size
lb so
38
Water Meter Charge Required
Hydrant Required
. . . . . . . . . . .
Hydrant Size Existing
41'--
Fire Line Charge Required - Sprinkler
42
Street Cut r-,5
. . . . . . . . .
.43'*
,Miscellaneous
WO
4d
Reviewed By:
FIRE
PLANNING
R CEIV
a
Pusl- WVRKS,,l�'i�
xvb
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