17632 OLYMPIC VIEW DR.PDF17632 OLYMPIC
VIEW DR
x CITY OF EDMONDS- STRWT FILE'
PUBOC WORKS DEPARTMENT, `ENG I N I NG D LVI S I
..... - i� • � /APPLICATION, FOR IGHT-OF-11,AY CONSTRUCTION T.
.
THIS./PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
A, Permit to be issued to: _1�1 gyp, Ca. D _
For Work at :(address or vicinity) /� Q9/�G ���
wv. 0, /t/D , 5�,P
Type of Work to be done:
(attach drawing when applicable)
Time Required -- Start: %— D,-(�j Finish:
Owner: �s�i/�, Cp • /� /% 10
Name
Mailing Address
7.71 — Z /! Z
City State Zip Telephone Number
Contractor: `YI &, Q S q�jp�/Pi
Name State License Number
Mailing Address r
City State Zip Telephone Number
B, 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, foreseen or unforeseen, that may be made against
the,applicant or 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.
i Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220.
I understand that this permit must be available at the job site for inspection
purposes at all times.
Signature: //�Gy�/GG Date: 1— S—
Owner or Agent
TO BE COMPLETED BY ISSUING AGENCY: -
Date Issued: Permit No.: 7 q_/a/ Fee:/S—�
Security Bond:_
Time Authorized: O ��
APPROVED B
Date r
-1018
LI.C.UTILITY DISTRICT
L ish County -0-11OUTH CC)UIAT�ZARIEA
N0.1of ;-, Sn
fbe,. 10/77
Vi
*-11
Location - 1-7 Co 3Z C�
L.-T, C_ y I y\/ 1::;T_*
Date. Z — -7 q
W,0. No. Z 2- S
VV 1/4 R
'Revision
--Scale
Reasc").for work
T-- car_
En9ine*r;C-_rA1:)FMbC!
As. Built
"RA .S-r
T.--- _4" — .
U.G.,File No.
Approvals
PERMIT REQUIRED
FOREIGN CONTACTS
EASEMENT
ENVIRONMENTAL ANALYSIS
Type C-im'-e ap. at;.,bd
Company A rL I
Exempt under -District SEPA
IRM.No.-
procedures, Section III -A
Date Granted
Fees required Yes® Noo
I
Grantor
Paragrapher_,Item
Log Posted
In tory
I TV- 0 -Pr� 1:�. .. 1_-�'?41'
PoteGronted
7- B y -C=: �A
Date , X , - _L��,
Transf.Cord
Pole Dept. I
I.Date ZJZ. Amount. 21M.
Interpretation :Referred To:
Mop Pos
Circuit Mapj
t.ee
Released For Construction
DateBy
—
Date Work Completed
y
Foreman
Circuit Number
Substation
O.H. U.G. Cond V
j
Add—C PH
Remv-_,_1- Ckt Ft PH
Nac' Ckt Ft
Water
Sewer
a s
B h
ackhoe
0 >
0.
Z
0-
< F-
(A
c-7-
A L'I F_1� 17r_)
W.O. No.
m
PI1f:1 IC il.-OPU;S P]iPT..0 Fr, LIST ' 71�i ,7 I�ZJ ��y �' P►� _
DIUDI`;C PITNUT PM'I]"! . fa f:'a:J�. .. ►.%i+ j~�
STR
Street Fight-of-l:ay Existing r RIM
z I Access _ Easements 1'xisting� FEnn ,
F„r
a !� L'tilit,? F..ascment 'Existin * MAD_ T2T()uz T1
Lot Per Subdivision Plat ssessor.1an !
zN � .
Site Plan Cl:ccLed for Accuracy
I,
lmdergrcund ;:'iri.n; )cod.
w �l Cir�z l turcy ,1�Cegc.( Ltu-rjplion:..AL woodby Date
' •. .:.
—
IxiStiJh ('�;iter :•�Sl.n S1�.
it
3:at in Pec�uircd
I,
a ll If; dr.L;t S? zc I:z�..
Hydrant "cr;uircd l�?r t-ir
I� Detector r7ic Ctcr Fccuircd
I, Revi cr: I •
II --
Size
,
L
Ikrtc
+I� Srptic Tn]Anhroved mite
ec ntit "0Spcmit Penuired Pei
I
i
C' +I Sanitan, Sc,':cr Availa a '
Side Scver ,1vai11bilit,
v' i Sa;iitary Set e Inert Pcc PcPuired
I ,I ;cn 1�itcl+ Fri.stjr.g
� rs Ii
o ij Culvert P.Cgj
E� �) Catel► i'I red
. � In mc��.•,•,I:�I��
Opoo
P .zn]rolc rec+uircd
Soil tions F, (;rowu] t;ater Field 010c]:cd
Review by
roi.
Pate
Roqui. rc c,
Si. ze
!.cite on `7ite p1ml
n sL.c., al E
Indicate or ." ]'Irui
Rite
IOtlicr Sinnim, I'c�ui red
+� P n.iit Sitc Insncct-on .nadc on
c
hatcr _
iStrcct__
l inginccri n
i I Special R.cr,uircmcnts 1 istcd in memo to .liuilcdnc; I\chartrent
l�v _ 1)atc_ _
I
! All itcms fill.cd in on 13uil.cli.nl; I'cYr;it Application — J
y h; -- - -=— — - Date+` --- —
c
j I)ra;:in�;s Str;ttpcd and ,'otations 0`7
Da t
nl%l)rcvcd l)), Public V.'orks hcl)artricnt
G