18711 OLYMPIC VIEW DR.PDFIiiiiiiii lill
12567
18711 OLYMPIC
VIEW DR
ED ON KROLL NAP NO.: �—' PERMIT - t
B U i 10 1 N G. , D E PA R TM E N T ; AppllcHftt Fill / NUMDICR 700396
PER�9�T dPP�ICATIOH Inalde heavy Linen I
JUB All JHEtltl
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a MAt� a nD3nZEs y✓ • I Z l�v )- 1 0� J rh o q " 1 3 -� / �(p .� / 'ills/ '✓ U8N' ''O I LOT ARVCA, , I VACAi;'I''BITE E
•i X t (�. 4i O C1T I TELEPBONE NUMBER I rh I•�. I EYES 13 NO • 7.
' i +s°.Ivy'' (�1��%' _7 � K•l /9C/�2Q/4V,!r� 11IC T _ II B_UILDIN
/R A I O'AraIhUDA.
VARIANCE NUMBER
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PLOT YLA All OVEli
al d'+a' suNl ADDRESS
EXISTING rT `4-,AID FIC Y TitlePROPERTY) 7
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CITY - - T'ELEP ONE NUMBF:I{ T O { H/W ...
COMP., PLAN ST. P./W FT. TI.I V. ' E IENC
' 4 ;f
ILEASALIfS d .... O
t ` NAMY Driveway Slopes not to'exceed those indicate!': i
p ADDRXdS on Standard Drawing #I03 :' z"" I w
<} ���7 CHECKED BY
•,,f C CITY �— ` TELEPHONE NUMBER
�ht _ METEI Bty.E, SERVI E I,bl'LE CLEA.RAI,CE CHE K'D Y
" �K•r' '•1 BTAT LI N C9E BN b1LEtt ;, F: [CITY LICN6I.-NUMBER p I• 0
iI Legal D crlptlo�of Property. (dhow Below or Attach Four Cop—)
`-Pr= TYPE CONNECTION VENFIICD Y' f
1 O,:•.e•I.,v,.i i`, I .: i. I( •_1Fr_ I.I,ty TAB}
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� a R-,. 0 r _ S� i • eh�S.�''I4 .," 'Ik!4. 9r�-.Y?.-' ;.t :
F•1I[E ZZ, TYPE OF CUNST U • 0 BTRE�T I Y
'1 !t - 1: SPECIAL INBI'EC'f01t REQUIRED + OCC.U/PAJCY GROUP.; , r.i ,� 1 '•i�
RE:IDFc TiAL; LINE ❑
{ Yf i � NEW ���-••--tt i PLAN CHEC :U BY , �� . •) I 1 ,.
,
'J NON-RERIDE.��•TIAI.. D SION
❑ ADD - F-- RETAINING' RrtwAn _ , I t.b .i +•++
�y t DEMOLISH I J WALL /-' �7• �j -y' ��7 /�` �I r
i t ALTER EXCAVATE' � ❑ PENCE C:.�/�•I'�� / [.ilZ Vlr•e"� AJ6/-
f ,❑ OR FILL (.. X. ..n t.) T' rr•• f.'� -'i F
REPAIR PRF.•bfOVE 5R11t Iti'GCV/�Lr� .J Tf�fy'. / ��/t'/� J r 1 1•
❑ INSP. POOL I t t {�
NUMB R OF ST— OF:1 N0-- NUV� OF
I /) DWELLING41
UNITE0f, , / � ?p '''i • ' .1.. I i e
d NATURE OF WORK TU IIE UONF -
t VLLluatlon Fri Rerel Dt No.
I1 + • L_ ; ,(j ,� /�.7, • • 1't_e Cneck No............ ,.a"- h I I �+'•.
i _ p i • BUILDING 4 C� • , / ,
}} PROPOSED y{� ar �(� V _j
k E i '..t •. L :' }'i l'p 1 "�'� ' 11 "7 PLUMEINp •p' ' Ci �In !k 1:i. ' - '1'k�
F'LOT PI..'fN (I dleule Building rclDn •nay OuttlnR etroele) HEAT
FN
SIGN
F r #�} j -- • 'h)i'� IiETAININGjWALL
j II 6R?b 1SIr,0 POCL�' t' _ �• �-
♦ J D=OLITION•
a f j E ��1 ' � I r• I y ��
•. r` Kj 4 i+y: if, Ya PRE-MOVEJ.INBPECTION
(. —
' EXCAVATION OR .PILL � �! _ I i � . • '
7 111 i'f ".. L J; ; _ TOTAL AMOUNT DUE I. • - /��w�'�b JW. i }I ,;
t I hel'ebyvaeRnowledgo that I have r n1 lble nDDllcntlon; lMt the In•
�4 1 fermntlon glven,V)eorrett; and tbnt I sill llle'10itTer, rtr the duly atl Dior• _ .� .. - �� 'f.e
lied spot of the •bwnR. I dRree to eomplY,,wilh city and elate ]owe r9Ru' ATfRNTIOY j I y
laling ocnetruatloB: and In doing the wdjk; 6utharited Ulerehy, no tenon A. 1 APPLICATION APPrZ,OVAI.:
I wll: be employed, Infvlo;nlloo of the Lnbor Code of the Slate of Waablogton Tfflfl BERMIT 4•hlb appllcatton is not a permit until:
I f t^ ralat:ng to Workmen's Comyetiaatlo lnaureDu A JTCONZEB , -
t Signed by,tho Building Official or Ws Dep- '
OYLYI.TIIE
NOTE: Permit limit One Year'; (�'ixcDe OINGSI hall wnlc WORK IyoTEn uty; rind fees are paid, and receipt is ac-
• ) shall be eompleted la ninety days; MOVED-LY DUC.nINCS ,Mn be oom- 1 knowledged 1n Space provieed. ` I -
Dleted In eLR ,months.) 1' - -' •.
e1GNATt)lih'(O'.VN 'H OI ACENT) DATE e: L-NED INSPECTION DFItDCTOR' BiONAT
1, . I ll YARTMENT
v A
CITY "iii ! I " ;y N DILONDS DATE t . -
\ NOTE: AhQlicant Su! ]rcl4io Plan. Cbrf•k «
Thle Pernnt raven work to 1» dane on, Dr1-le property ONLY.
t+' 2, �! . my lorletruelloa on J;e Oublie eenel n'teorb., rldnwNke,
rtaJ wit roasts H'Dnrate Vrrnilnknr.' :,;ye .Fhf.E
f t, ril( i}1 • -, j'rtit• 1 1h rtLa�#Y' 1 '�
K' t a,t A ii
• 1. � .]�: .1•)' .�•�:'
mill 1111
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BUILDING DEPARTMEtdT
POSTED ON KROLL :HAP No
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PERMIT . 700526
I NL3SIIER
Applicant Fill
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Inside
PERMIT' APPIICA`�ION-
heavy Lines
JUB ADDRESS
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NAME lOR NAM OF Blltli.\'ESd)
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BUILDINO AREA
CSYES ❑ NO
VARIANCE NUMBER -
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NAME
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PLOT PLAN APPROVED
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TELEYRUNE NUMBI.R.
EXISTING STREET,R/W ......-...PT.
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DEFICffiQ Y TRIS PR
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CHECKED BY
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STATECKED
T CENBE;NUMBEit ,
CITY LICENSE NUMBER -
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MEIC ETtl12E
dCHV10E tllLE CLEARANCE
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CHE BY
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LeTal Deaerlptlon of Property (Show Below or Attnth Four Copies)
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PERC. TEST �' , i
,PERM31 NUMBER
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FIRE ZONE TYPE OF CONSTRUCTION IMPROVED-
❑YES El NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
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VEW
REBIDENTIAI, �-
GAB
LINE
❑ YES O NO
PLAN CHECKED BY
_
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ADD
NON-RESIDENTIAL,
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GIGN
—TAI❑
REMARKS
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DEMOLISH �, -ALINING
11ECE
AVATr
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ALTER, a CHCFILL �'(.N.3.. ... ..Ft.)
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EJ REPAIR O P1R -MOVE Q 9WIi
NUMBER OF STORIES I NUMBER OF
DWELLING
7
UNITS
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NATURE OY WORK TO DE DONTL' —
- '
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Valuntiun
- -
Fen
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Receipt No.
Plan Cheek No ..... _.......... .
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BUMDIN6
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PROPO —USE
see
PLOT PLAN ( irate. Building eetnacke, &butting street.
RZAT d: GAS LINE.SIGN
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PENCE
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RETA:NING WAL:.
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SNI34MIN6 POOL
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DE.SIOLLTION°�.�#rii.
• -
PILE MOVE. INSI{ECTION
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EXCAVATION OIt FILL
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TOTAL AMOUNTI DUE
'
S hereby acknowledge that I Cave read this npDllcatlan; tb•,t•the In.
.
'
formation given le correct: and that I am the owner, or the duly author.-,
axed agent of tha owner. I agree to comply with city and state law, regn-:
ATTENTION
APPLICATION APPROVAL-
'
Wing Construction; and In doing the work authorlred thereby, no person
,
will be employed in vlolatlon of the La]or.Code of the Stare of Wmhingtoa.
THIS PER3UT
This Application is not a permit until
relating to Workmen`. Compensation Inrlrmne.
AUTHOIUZES
signed by -the Building Official or his Dep-
NOTE: Permit Limit One Year (Except DEMOLITIONS whlch
WORE NOTED
uty; and fees are paid, and receipt Is ac-
i
.hall be eompltted In ninety days; MOVED -IN nGtr,nf:vas ,hall be wm-
knowledged In space provided.
I {
Dieted In nz mantneJ
tl ON4TT TVRE OWNEH OR AGE T)
-llA7'E d N¢I —
�7
INSPECTION
DEPARTMENT
I. ,C 0 SKI tx
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-
-
CITY OF
EDMOND'S
DATE
(
NOTE: Applicant Subject to Plan Cberk Fee
�rn
Permit tovrl, work to be done oa pelvate PMPerty ONLY.
.-uoIThis
Any eons r.etlon m me pobUe denial. (.-be. sidewalks. drlveways,
FILE
I
,
r.areuee,, Me.) will rcymre separate perols.len.
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i I �...,•:. • ��.; . •tit ., ,� ... .. _ '1
9y PPUrPERMITT % OO� O IUILDING DEPARTMEN- 711 •
7�
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- PERMIT APPLICATION Inside Heavy L11tea U;t ADrD,tEatl
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` ° L!('ln'
m /� J SI F. YARD k'r3ACK I RLET SETBACK (REAR YARD "ETDACK l
_ t K
M.vfLIN y�ADDRE88 / ,l, 1 t/t {
r%� �. d/ IMF• Ise L g< AREA ... , VACANT. B3T6.
P o cl ry T ONE avE}t . I i. ❑ TEg D No z
TfFY. U -I D NO APY.A - VAR AFiCI� HUND ft
'e NwatM:
�� lMtgl I'for MAN•AI'I•Ituv Ei
DTRY.BT I"
.( EXIBTINa nTREET H/W ....FT. DEFICIENCY TILI8 PROPERTY 1 `
r r O Y TELEPHONE NUMUEIt r,.' �D
r
- COMP. PLAN ST. R ...FT. p �.
r ItEMARHB f. .
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CHECKED DY 1 'V • j
f. ee
CITY
ITIij�F:PRONI: NUMBER
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METER tltLE BEIt'J1C tl1ZE CI.CAIIA NCL CHECKED }I'Y.
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4 I 'fit. •lI,•.1", t .. _�, IQ ' 'STATE LICENSE NUM REI C17Y LICENSE UMbER t 1
a a. I tut .. I C:.y
REMARKS
X.
`• r Legal lltacriptIon of YropertY, (Show below or Attach Foar CODIte)
TYPE CONNECTION VEItiF 1ED $gyy�� a
I.
r tt' -y' ' t_ • r -�� PERC. TEST PERMIT NUMBER
ItEMA t 'Am,•: m
FLIM ZONE TYPE OFicON3T1tUCTION 8TRL'ET ISSPHUVEU ,I 1 -'
YEB" El No
SPECIAL INSPECTGA REQUIRED OCCUPANCY G OUP ^'
1 I W 'RESIDENTIAL ❑ LINE PLAN Cl BCHECKED ❑ YO I � � • ' � ' {� `
r� NEW ///"""��� ,. •' {.. � I 1 r
�t a NON-RESIDENTIALEl ••.-•
❑ ADD BICN
r—, [] RETAINING REMARKS
ILJI ,
� 1 DEMOI.IBH WALL 4 .
,tI.• ❑
t ALTER EXCAVATE PENCE
,T �.•OR FILL (_... s... IN.) 1 - I
t f ❑ REPAIR PRE -MOVE swill
44 INSP.' POOL NUMBER OF STOH1Etl NUMDEIt OF - I p.' • '
7N NF 9 DWI:LLINC
UNl TS
Y
s 't 'NATURE Oil "'OR TO E DONE ,•
rll _ y; '' ( (.tl Vnluel:Jn ' Fee Receipt No. I •
flan Check No..
9 'e tea, e(•—T^ j BUILDING
6 r • Ij,, -
i ,kY OPo9 D USE O —
t, =As• �'`i f a PLVMHINa�.
• (a Ieate• .Idtn iotbacke, abutlln tre t0 6., g ) I BEAT k OAS LINE
} 1q,
FENCE
3 — }
t f —^• o
SIGN
RETAINING WALL
77 4-F��f • ♦ Y' _ r
t yj'}X}� 51� r ( 3r �� • f1 I SWIMMING POOL—f1 .
L •�r.t,'t.. .'r^.1L t .all •:rl ll DEMOLITION
• < 7 . I) PRE -MOVE INePECTION
r N `If
* ttYf �I) I ;r { t �• I EXCAVATION• OR FILL },
a Y tJ et r tq TOTAL AMOUNT DUE `... I .� L'17 /� II
I hereby acknowledge that I hw^- read this ePDll Ion That tha It- i .7' I l t
t' 1
�for!rlatlon oven 1■ eorrcct:tand that I rim the owner, or the}d Illy aIllhon I N
_ :1stt agent u• the Darner. I:ngra,,. to cord ply with city acd etate,law■ regu- F
p nrlE.rrlox �PLICATION APPROVAL
S' 1 bating c.J■tructlon; and; In d01a6 1h0 work authorlred lheriby,; be Demon
`f ,will be employed In ytotittlon of the Labor Code of th. Stateiof Wmhlogton Tnia PF.RMIx This application 4s not a permit untll
relattng to Work c,.,a ctimpen ntloh Imurmu. 1 r AUTHORIZER I'Y' t
f" ovLY Tue Reigned by the Building Official or his Dep- l
M NOTE: Permit limit One Year l£gcept Dr+IOPITIovn an{�h µOnK,NOTED /� uty; and fees are paid, and receipt is ac-
.hall be camDletre In mna:yl"dny■ "MOVED-Ix';nuH U!•. fi'ehsll be cord- knOtvledged In BilACO provided.
.
b ti Dltied In aL: InootN.l & i. t }.'.
tit • INSPECTION
-� .�'TIISNATO:tE (ONh H A Er T) DA ' tllaNxD t: a t I(EGTO 'd tlIC A ' 1LY
I:V
CITY Oil
EDJIONDY nAr apliOTE: cant Jject to Plan Cbtkci noatol
0
Thl• 1•e—it coma work to be, done on Drleal property ONLY.
Any eonalruttlou on •lM1e Do Dlle domain (-nrDa, aid e1W drlacwaya, I 'I i
mereuera. Na.l FILE
wlli raenlre erparele v—N.1on.
S r ` w..�r..ww••. w.Y. _FA • _ _=,':.r Tom_ � _ t,- y`�vv:LC` -emu- ' 4.,..._�
y 3'p c ,`p�'� 1,p fit•'- r r � t� •
ry i 1. s, { .... ,� .-.- .. ' . ..... ``•'' i _ -i. � - �•. 'aq;::..! Y � �,} R .r - .. , q • •
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RECORD OF INSPECTIONS
I
Er
Date Passed
Foundation
Plumbir:g (ParUli
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7��
Frame'
s'
Furnace & Fuel Lines__
a
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Final
RECORD OF INSPECTIONS
Date.Passed
Drainage
Sewer_
9 -
Pa. kin ;
y
Landscaping
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Fire Dept.
City of Edmonds
RIGHT-OF-WAY- CONSTRUCTION
PERMIT Peat Number: a
Issue Date:
A. Address or Vicinity oPConstruction: 1871.5 Olympic View Drive
GTE to place operate, and maintain a buried service
v B. Type of Work (be specific): wire from exi sti n of a #8369 located at 18715 Olympic
t2 C. 1$ 9 View Drive then east to a resicence at 13715101ympic e 90
foot, push no driveway and push no road. R.O.W. Footage 5 feet.
Marilyn Holmgren, Permit Coordinator
Contractor: GTE Northwest Incorporated Contact: Chuck Roberts 425/771-9036 mobile 425/388-1358
Mailing Address: Everett, C0 982042440 Phone: Marilyn 425/710-0786 or 488-1628
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other GTE W.O..#. 21A0 P001DB 642310,
lease see attached sketch.
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut : ❑ Yes QNo G. Size of Cut: x H. Charge $ t
Please see attached ske
APPLICANT TO READ ANZ$IGN'' r
INDEMNITY: Applicant understands and by his signature to this application 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 Ednionds, 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 INSPEC-
TION AND ACCEPTANCE OF'1'HE 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.
Two sets of construction drawings 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 bein accordance with City regulations as required by the City Engineer.
All street cut trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS._
I have read the qboqe st et,
available on site at J11 tilnes
Signature:
C
tand the permit requirements and the pink copy of the permit will be
S.
nw uavig squires
or Agent) Sec Mgr -Access Design
Date: 91-1,910-7
IAL-A-DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: V RIGHT OF WAY FEE:
TIME AUTHORIZED- VOID AFTER 1.2x� DAYS DISRUPTION FEE/FUND 111:
SPECIAL CONDITIONS: RESTORATION FEE:
TOTALFEE: "3a oo
RECEIPT NO.: .
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Dw 1997
FIELD INSPECTION NOTES (Fund Ill - Route copy to Street Dept.)
Comments:
Diagram;
h
t�
0
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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6b:ST L6/LTi60
`'�"^""'�rY'•ri...,-�n.�t-�,o�^Y ..2+.-�a-.....�„ .r�r'� �Mra,,,,.Y��e J '•�..N.�.-v.s,I wbd'^�1r>+A:%"i°„r�a�wT'm"r,l'Kpir^'r.,,.,:..... :e•Wr."..w../'�r.. ..r�..t^;..-L.!`-1, i
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. 9 7-
Jlol
Issue Date: "/ — 8 G /
NJ A. Address or Vicinity of Construction: 18711 01 ympi c Vi ew Dri ve
GTE to placep operate and maintain a buried service
18 B. Type of Work (be specific): wi re f rom exi sti ng pol e # 8369 1 ocated at Ol ympi c Vi ew
9 0 -:1 9 Drive & 187th then east to a residence at 1 ympp c ew Drive. o plow
120 feet, push no driveway or reed. R.O.W. Footage 10 feet.
Marilyn Holmgren, Permit Coordinator
C. Contractor: Qft Northwest Inoor orated Contact: Dennis Alexander 206/771-9036 or mobile 388-1358
Mailing Address: Everett,CWA198204a1440 Phone: Marilyn 206/710-0786 or 488-1628
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision
❑ Multi -Family ❑ Single Family
INSPECTOR:
Side Sewer Permit # (if applicable):
❑ City Project ® Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Other 2100-9P001DB 242310
INSPECTOR:
F. Pavement or Concrete Cut : ❑ Yes ®No G. Size of Cut:'(A i x H Charge,,
Please- see attached sk'etth.—
APPLICANT TO READ AND 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 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. :: a ell {
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 stakmeats and understand thepermit requirements and thepink copy of thepermit will be
available on site t adt�.n�spection purposes.
Signature:
for David Squires Date: 03/28/97
JOk%iWP#Mr or Agent) Sec Mgr -Access Design
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
- FOR CITY USE ONLY
APPROVED BY: kA I N
TIME AUTHORIZED: VOID AFTER 1 2 DAYS
SPECIAL CONDITIONS:
COMMENTS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND III:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
RECEIPT FEE:
DATE:
ISSUED, BY:,
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments
Diaaram
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P-W.:
Work Disapproved By:
FINAL APPROVAL BY:
Date:
Date:
03/25/97 09:52
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ME City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT ,�, Permit Number:
�O0/l��ol, 50� ,�� Issue Date: J� _ 6
A. Address or Vicinity of Construction: 18711 Olympic View Drive
B. Type of Work (be specific): Install 2" nE IP gain in Olymnie View Drive
890 1 9 from 18' Test to 30' East
ZZcenterline olympic Viet Drive. Per
C. Contractor: Washington Na�uua�h�asD�ompaay Contact�2Gat� SIR wanson) (1)
Mailing, Address: 815 Mercer Street, Phone: 224-2080
State License #: Seattle, WA 98111 Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. `❑ Commercial ❑ Subdivision ❑ City Project a) Utility (PUD, GTE, VYING, CABLE, WATER
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR: f%o,(
F. Pavement or Concrete Cut : ❑ Yes ❑No G. Size
a of
Cut: 1 2 x 4 H. Charge $
APPLICANT .TOIREAD jND S�GPter
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 difense,costs�, ajd�attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND M�RIALS 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. U.
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 penmit;will be`available
on site at all times for inspection purposes.
Signature: dl/t Date: December 12, 1991
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
IV Zia d .a., z /-. P / _/
ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street ept.)
Comments•
Diagram:
. :l
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
\sT
EOM LOC.
PROPOSED jw, PE
NO-TF-5
1 FIELD LOCATE ALL UTILITIES
CALL 1-BOO- 424-5555
416 HOUR5 gEFoRE DIGGING
2 LAY DETECT WARtAtkG WIRE OVER
ALL PE DIRECT BURIAL P1PE
3 IN5TALL ONE POUND ANODE FOR
1=VERY 1000' OF LOCATING WIRE
4 SURVEY Rtr_OUM D
5 MAIUTAIN A 5' HOR1ZOKTAL AND 3'
YERTIGAL CLEARAMC-P- FROM ALL
CRK LrnL-rn F-S
\ \ I ROAD VALVE BOX 15 0 - 37 O
1 ROAD VALVE Box BASE
150
-
1 1W' VALVE 50Y, 5UPPORT _
710
-876 ---
- 1`t%/4" PE-_GURB�VALVE
Sao
I75
1 ihtP5.x1Y.t PE REDUGEFt
'72 -
320
iy9GT5 X. %" X-T5 ;4fi iECucEIZ
:7Z-
280- --
i I 4'' x .1 '' PE TE E. ---
—
78
'741----
1Y4'' PE CAP -------
'S_2_G
30
',242: IA* 14 GAUGE DETECT Wk?, 1NA�b WIRE
f85
940
i 242 ' 1V SOR-1\ PE PIPE
.70
1.7.0
EDMON�S NE 13- 27-3
241
12- 17-91 RUSH
ly4' PE
IP
MAIN
EXTENSION
-M - 12 I 1
OLY MPI G
VIEW DR
JBF
II
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REVISIONS