1100 EDMONDS ST.PDFIIIIIIIIIIIIII
10940
1100 EDMONDS ST
0 i
ADDRESS: I ED edmoNdc, �
TAX ACCOUNT/PARCEL NUMBER: We5c I D00000000
BUILDING PERMIT (NEW STRUCTURE)] (`'11P�pz -2�
COVENANTS (RECORDED)
CRITICAL AREAS:
DISCRETIONARY PERMIT #
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DN
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED: 2
SIDE SEWER PERMIT(S) #:�
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
WATER METER TAP CARD DATED: l �Z 1(05
LID #:
LATEMP\DSTs\Forms\Street File Checklist.doc
PLAN FILE NUDIBEI. BUILDING
�1l1'dll! Per�It. A hcation AppHcaut Fill / / PERMIT / A -7
r... _... 9.� pp Inside Heavy Lines NUMBER �403 / 2
NAME (OR NAME..OF BUSINESS) JOB ADDRESS
i:.
I✓R%�f ircx i C e .tr s r Cep i� i r� At D
..
Ill A rr.ral
i dADDRESS SIDE YARD gP;T L':.CK REAR YARD
%TF,LvPHONE NUMBER. USE ZONE. MAP NUMBER VACANT SITE
I'J�LYES ❑ NO
BUILDING, AREA LOT AREA VARIANCE NUMBER
D
HEIGHT ALL BUILDING SETBACKS
NOTE' TO EAVE LINE6
TELEPHONE NUMBER REMARKS
rrtror5l: -
Encroachment Permit PERMIT NUMBER I STREET GRADE CHECK
Required
❑ YES ❑ NO
TELEPHONE NUMBER METER SIZE SERVI E SIZE CLEARANCE CRN71
BY
E{lLICENSE NUMBER CITY LICENSE NUMBER REMXRKS
BLOCK TRACT
ALI-
TYPE CONNECTION VERIFIED
fY y e.—
{'' ' PERC. TEST PERMIT VUMB
I `
'. FIRE 'LONE TYPE OF CON$j'F�UCTION STREET IMPROVED
r(,// I .
� x. - _. f' [],YES ❑ NU
SPECIAL INSPECTOR REQUIRED (OCCUPANCY GROUP
❑ YES ❑ NO
PLAN CHECKED BY
is ,_• <✓ r 1
.WORK TO BE DONE
b
NO. OF BLDGs. PERIBLOG. TOTAL FEE. -
BUILDING <
I VALUATION
BUILDING PERMIT
NUMBER OF STORIES 2 FEE
NEW ❑ DEMOLISH h tPLUMBING
ElADD 3 PERMIT FEE
HEAT & GAS LINE r +
ALTER I RESIDENTIAL NUMBER OF 4 PERMIT FEE t J U
DWELLING
11 REPAIR NON-RESIDENTIAL UNITS DEMOLITION
5 PERMIT FEE
PROPOSED USE
e` / r, e— e- 1 ff /j r1 C ✓ 0 AMOUNT DUE
I hereby acknowledge, that I have read this application; that the In.
formation given is correct; and that I am the owner, or the duly author- ATTENTION APPLICATION APPROVAL
ized agent of the owner. I agree to comply with city and state laws regu- THIS PER:1tIT This application is not a permit until
;ating construction; and In doing the work authorized thereby, no person
AUTIIURIZE$ i
will be employed in violation of the Labor Code of the State of Washington ONLY THE signed by the Director of Building Inspec_
n�
relating to Workmen's Compensation Insurance. WORK NOTED tion, or his deputy; and fees are paid, and
NOTE: PERMIT LIMIT ONE YEAR receipt is acknowledged in space provided.
si A RE ( NER OR AGENT) DATE SIGNED INSPECTION DIRECTOR' IONATUBE
/ DEPARTMENT
CITY OF "'er
I PL LA CHECK t> SAP OVED
EDDfONDS D •rE
F71=
M
a
APPLICATION
torCARD No . ................. ....................
the City of Edmonds SIDE SXIWM PE MT
OUTSIDE EASEMENT No.
❑ INSIDE ❑ REPAIRS ❑
EASEMENT -------- ...... ................
OWNER
�p-
oO. .......................PERAIT No
STREW
HOUSE No. -------- -
AVENUE LOT No. ...... ---- ----------- ------- * ..... BK No - - ----------------------------------------
NAME ADD. .....
JUaLe Approved:
BACKFILL WORK ORDER ISSUED .......... ......... . ............. . :DEPOSIT, .............................................
SEWER WORK ORDER ISSUED .............................
.......... ... DATE
-- ---------------- ------------------
CITY. OF EDMONDS
CIVIC CENTER — WATER -SEWER DEPARTMENT
I
INSIDE SEER PERMIT
Call PRospect 6-1107 when work
is ready for inspection. (No luspec-
'AT Q O
Lions Saturday. Sunday or holidays.) l�
ADDRESS--------------- 110----------0 ---- -----Edmonds- •-• •-•---• ---- • --• - re Street ..------...----•--•-•-----.................................. -• ---• ---•--•--••---..............-......----.........
OWNER ..... Gordon ... Henrickson............................................ CONTRACTOR ............ I,ee Wooley.---------...•.-----•..................--
g y 6 1s.65--, for ...................... days, to REPAIR or CONNECT a side sewer
Permission is granted ..._.eb-�'>rtar-...�.---f.-••------•,
with City Sewers In accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
i' NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side sewer Contractor moat
be employed to construct side sewer in street area. Do not cover any portion of sewer before it has been inspected.
(I, No. 2—Obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
No. 3—Top of aide sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%,.
No bends in grade sharper than % will be permitted.
NOTE No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
permit, or to do any work on the main sewer or
NOTE No. 5—It 1s unlawful to alter or do any other work than is provided for In the s ap-
purtenances except to insert the pipe into the wye.