1035 BELL ST (2).PDFIIIIIIIIIIIIII
10227
1035 BELL ST
W,
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER: 4067 ly,�6 �,/wlfoo
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: []Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA'
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: 0 I L1 K
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED: 10111,
M
LID #:
LOT: 19-3O BLOCK:4t
L:\TEMP\DSTs\Forms\Street File Checklist.doc
I '['IIAT PORTION OF IA•PS 2R, 29 AND 30, BLLJI:I: $1, F iil)•'Or71S, ACWRDINC TO PIl\T
j THEREOF RECORDED IN VOI.IIMF. 3 OF PI1�'I'S, PACE 39, :corns oT !UXIONI.SH COIDICY,
I•IA311MI'ON, DESCRIBED AS F01.IMS: i
BEGINNING AT A POIIT!' 10. 1 Flilil' EAST O? '111E SOLMII ST CORt101 OF 1,01' 30, SAID POT NC
BEING ON A FENCE LINE LNI'F.RSECPION; '11I1-.NCE EAST 67.00 FEET TO A POTNP 17.1 FI:EI'
EAST OF 1IU: SO171'RP,'S'I' CORNER OF I.01' 23 AND TILE C RNER OF A CONCRIM' MIA.; T111iNCE
NOR'I11 NDMC SAID UA.U, I lO FEET; 'f11P.NCL' IJES'P 67.0 FELT; 111ENCF. SOU11T
Al",IC A F1,34CE LINE 110 Fi;I'.I' TO TILE 11OLNT OF BEGI. NING; EXCEPT TILE NOR'111 5 FEET i
j TIIEREOF.
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I CITY OF cDi.i0ND5I
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CONDITIONAL PERMIT
IWORK- Q'95 ADD I ADDRESS- /OS'S- /344 S
OWNER. Soi-0 ieG h�
APPROVED DATE -
BY
BLDG.OFFIC!AL i
I KEEP THESE STAMP D
PLANS ON JOBSITE R
ALL INSPECTIONS!
1 PERMIT NO.
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City of Edmonds ---Water Department
Date..' . t...... ...........
( Meter No ............................... Tap No .........................................
!: 1
Size.............................. Size........................................
Mfgrs. ��..Y........ %:X ttyle.............................................
rr
For ........ ..................................................
.--•.................................................................................................................................
LotNo ........................................... Blk. No....................................................
Add..................................... ...............--
Service Location .:f-"... t' ...................
.........................................................................................................................._..............
MeterLocation.............................................................. _................................
MakeTap ...............................................
................................. ................................................................................ - ....... ...............
Pressure..............................lbs. Test .................................... %
SendBills to....................................................................................................... -
..................................................................................... ..............
Dateof Work ..................................................
...... .... .
....................
. Foreman
Guar. Voucher No ........................................... $................................... _.....
Remarks: ........................................................ .........................................................
................................................... ^."r ..... ... . ....... . ..........
'EET ...
...............••---..................----.................------.................................
.......---...................
OUTGOING
Index ..........
Reg ....... Route Bk......... Stencil- ..... Card ...... ..
INCOMING
Index .......... Reg .......
Route Bk......... Stencil ...... Card .......
aterial 'Charge able to Installation ✓aers
1 p SIZ DESCRIPTION RATE T
.Meter -•--•-
:�.....
yl._........ _
Meter Box ...
-•---• Meter Pate ....
Check Valve ...---•-••---••----•---•--..............
__.............. ..
•-
Galy. Screw --
Pipe,
•----•- -
Nipples ... ...
....... Bushings -----------------------------------
7.
•................ Plain Ells --.•.
.......................... ... -..........
--------- St. Ells
.................... ............
Tees ..--
-------- -....
.....
-.-----
..............................................
Material Chargeable to Taps Connected
NO. SIZE DESCRIPTION
RATES T
--.........--........................
....._..._ Pipe, Black Screw . .........
Pipe, Galy. Screw ................ ...... _• __ Lead Connections " .............
1-
_.._..
Curb Cocks •. " . .
... Corp. Cocks ----•.....................
-•--. - ............. ..........
.._- Unions --••----•• ...........................
..............
-•---•-- Saddles ......
................
•-----• Nippy
Bushings--.---------•-•--------•--------...-----
Plain Ells ----------
---.. »:
...--..........
Street Ells ........... ...
Curb Tees ......................... .•-•-......._.....
.............
Boxes ............................ .
j----•--•-----
-------- S• O. Extensions ...... ..... ......._.•-- •...
Gates .........................•-•-- -- ....----•
--
plugs
f Couplings
,� '`tom' .. -•
Gate Boxes ------• .................... •----------•-- ;
/................................ ..........
:----... .......
...........................................................
..................--
..........
.........•.......
............................_.. s Men -------- ..........
-.-•-.. Hours Time—Day-.-•_.r...... ......
..----•---- -- �; Hours
Time —Monthly Men.._-......... .
.. Auto ..........
Hours Time —Auto ......_...
Superintendence ...........
. .....Sup Total . .
The City of Edmonds Side Sewer ®yawing EASEMENT NO- --------------------------------------------
218-01400 NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO_ ------------------ _ASMT. NO...................
OWNER ��- H- GREEI`1E----------------- CONTRACTOR PERMIT NO.
JOBADDRESS ----- 1035_.BELL__ST.................................................... LEGAL DESCRIPTION: LOT NO.-------------------------------------- BLOCK NO. ....................................
•
•
------•-------•---------------------------------------------------------------------------------------•---------....---•------------------------------------------
NAMEOF ADDITION..........................•--•--------.......----•---------------•---•--------._.---------------------•--.........----
DYE TESTED ON SEGIER
Approved:
•
PWHV-0301-11/75 (R'EV.11178) DATE ............................................ BY------------------------------------------------------------
y.:, 'Jt .i.r,: l"b�,�vyip•� t ti��J.sn a'-`71 �C�'C'aii�rV�ry";."'G•t��'�fy�'y{q'�'v."`r � •v -I a .. � `YtJ•v •.,�_; �•�(:"-r ^R}'iW ,Y
City of; Edmon
e
RIGHT-O&W_LY CONST CTION
PERMIT
,�. Permit Number.
Issue Date: ��•� f +O 7 y
A. Address or Vicinity, of Construction: 1035 Bell St ( 9502370 )
18 9 0 1 9 B. Type of Work (be specific): Install Net, Service
C. Contractor: Washington Natural Gas Company
Mailing Address: 815i Mercer Street, Seattle
` State License #: WA 981111
r
D. Building Permit # (if
Contact: Frank Swan
Phone: 22472278
Liability Insurance: Bond: $
1 ,
Side Sewer Permit # (if applicable): _
E. ❑ Commercial ❑ Subdivision ❑ City Project ff .Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family J ❑ Other
INSPECTOR: { INSPECTOR: V'J �'•i w 1"1
F. Pavement or Concrete Cut: ❑ Yes []No G. Size of Cut: �`; x H. Charge $
�t
APPLICANT TO READ AN ( 31�N
r:
INDEMNITY: Applicant undera;anda and by his sign ture to this application, agrees to h e City ojEdmonds harm4n, o en/ 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 ep¢r �menta or
employees, including or not limited to the defense of ay legal proceedings including defense coat, And attorney fees by reason of granting this permit.
THE
CTOR IS RESPONSIBLE FOR WORfMANSHIP AND MATERIALS F
RIOD
F ONE YEAR
NAL
INSPECTION AND ACCEPTANCE OF TH WORKI ESTIMATED RF,STORA ON FF.FSS WI/.T1RF. HOLD UNTIL THF. FI'O 'STR%� PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIM A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE. APPL/CANT.
Construction drawing of proposed worq 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.
Ihave read the above statements and understand thepermit requirements and thepink copyof thepermit will be
available on site t MGs or insp ction purposes.
Signature: : Date: November 11, 1994
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
a' FOR CITY USE ONLY'' =`
APPROVED BY: �N� }W RIGHT OF WAY DEPOSIT
TIME AUTHORIZED,: VOID AFTER IF 11- DAYS DISRUPTION FEE/FUND' 1`TIi
SPECIAL CONDITIONS: N A �• RESTORATION FEE:
'-`,�r, S 1 ✓u 1� A l %A I A �� PERMIT 'FEE:
TOTAL FEE: 30 tyO
COMMENTS: RECEIPT FEE:
DATE: ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
•
'MashIng
htaturat Gas
AVA&►rgW&v gvCc YWv
Addendum to :
Right o Way.
Permit Application
Submitted by:
Engineering Aide
Washington Natural Gas
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Water lna f n depth _w water ""
rio- �n .gas main water hydrant
-a Is Maur St. (P.O..Boa,1a69). Seattle. WA 98111 (206).622-6767
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