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PUBLIC WORKS — ENGINEERING
ACTION REPORT,
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M 4125
SUSPENSE DATE:
Date: Time: File
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ADDRESS:
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PHONE:
REQUEST RECEIVED BY:
TELEPHONE
CONTACT IN OFFICE /I-=
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All Concerned Notified
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CITY :OF EDMONDS
PUBLIC WORKS DEPARTMENT FOR INSFECTION CALL permit Nu _ WHO
SIDE SEWER PERMIT ��7,5i 1 5'25 Ext. 270 Issue Date
PERMIT MUST BE POSTED ON JOB SITE * jjjMMONCDS
IMCt41. Address of Construction ji! s 4� F�LANT
2. -Property Legal Description (include all easements)
3. Single Family Residence t" Multi -Family No. of Units
Commercial
STP�,
�..�_•
4. Owner and/or Builder j-�,�y,�j/;: r ,t;d.C/, f
5. Contractor & License No.1V,_, 1 7/; l% 6rii i' .t e'
6. Invasion into City Right -of -Way: No r,. Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (;3,4�2��53,4���) before
excavation) . 1-800-424-5555
7. Cross other private property: Yes No Easement required -
attach legal description and county easement number.
READ THE FOLLOWT,,NG AND SIGN:
a. Property owners must obtain a permit to install side sewers on
their property. A licensed side sewer contractor must be employed to
construct side sewers in the public right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
c. Commercial establishment requires a minimum of a six inch (6")
side sewer line.
d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
e. Side sewer lines must be laid at a minimum grade of 2% (1.150)
and maximum gradeof 100% (450).
f. No turn in side sewer greater than 45° (1/8:bend) is0allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts..are required at 30"-60" from each plumbing exit line
and at minimum intervals of 1001 along sewer line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k.. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice/required.
DATE: =`,�/ �!�^r�� �� �fd'l', : v i� �s"•L.
iI certify that I.,have read
and shall comply with the above
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�-+ PERMIT FEE: \50.00)
o CONNECTION FEE:
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DISAPPROVED By: Date:
By? Date:
APPROVED By: Date:
T BE POSTED ON JOB SITE
The City of Edmonds Side Sewer Drawing EASEMENT NO_ ---------- I ...... I -------------------------
NEW CONSTRUCTION REPAIRS 0 LID NO ................... ASMT. NO. ----------------
41
OWNER --------- N' ica--------------------------- CONTRACTOR NORT-1-IL&KFE - ------ C-0-NCA-C7TV - -------------- PERMIT No. 71.08...
JOB ADDRESS ..... ------------------ LEGAL DESCRIPTION.- LOT NO. -------- z ------------------- ------ BLOCK NO.4 ..........
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-------------------------------------------- -------------------- ----------------------------------------------------------
NAME OF ADDITION --- F-E>A0N.[)5 ---- vi.czw- ...
PWW-0001 -11/75 (REV. 11/78)
MW VIEMLAND WA-j
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Approved:
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DATE .-2--.9.-.84 -------------------- By ...........
II
CITY OF EDMONDS
NEW
❑ ADDITION
❑ RETIREMENT
ASSET INFORMATION SHEET
ASSET NO.
ADDITION TO ASSET NO.
FILE
DESCRIPTION
$ r
SERIAL NO.
LOCATION DEPT. NO.
**PURCHASE ORDER NO. _
PURCHASE ORDER DATE
COST
*PROJECT NUMBER
PROJECT COMPLETION DATE 1231 3
COST % 6 7, c5 (o
B.A.R.S. ACCOUNT NO. y!/�
• ESTIMATED LIFE S
INITIATED BY DATE APPROVED BY
**SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
C7 DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT _
• G.L. ENTRY
REFERENCE
DATE
% RgFIE' Y
,__
PROCESSED
BATCH NO. _
INITIAL
161P1
DEPARTMENT FILE
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OCT" 191933
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DATE:
MEMO T0: Building; Division
Community Development Department
FROM: Engineering; Department
SUBJECT: ID,-,-2n ,v(
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After review of the subject Building Permit application, we have
the following comments:
1. Connection to City water system required.
2 Connection to City sanitary sewer system required.
3 Right-of-wav Permit required for any work on City property.
4. Driveway slope not to exceed 14;0.
5. Backwater valve required if downstairs plumbing; is below
elevation of upstream manhole.
6. Water and sewer lines to be separated by 10 foot minimum.
7 Builder/Owner responsible for containing all temporary run-
off and erosion on site and may not impact neighboring
properties in any way.
Signature
CITY OF EDMONDS
CIVIC CENTER • EDMONDS. WASHINGTON W020
SINGLE FAMILY MULTIPLE COMMERCIAL
q
PROJECT NAME
ADDRESS
s,
ENGINEERING A PUBLIC WORKS
PROJECT REVIEW
CHECK LISP
CONTACT NAME & TELEPHONE NUMBER
ACCESS SLOPE AND VEHICLE ACCESS
DRAINAGE PLAN
STREET FILE
LEGAL DESCRIPTION VERIFICATION
QUIT CLAIM/DEDICATIONS
EASEMENT - PUBLIC/PRIVATE
CALCULATE SEWER CONNECTION IF NO LID 0
If
STREET PAVING REQUIRED -01/ /'�(!l✓(i``,,
CURB AND GUTTER REQUIRED /-'e7
SIDEWALK REQUIRED
CURB CUT FOR DRIVEWAY REQUIRED
RIGHT-OF-WAY CONSTRUCTION PERMIT REQUIRED
BOND REQUIRED FOR PUBLIC IMPROVEMENTS
STREET NAME SIGN REQUIRED
OTHER SIGNING REQUIRED
(ADDITIONAL COMMENTS ON BACK)
EXISTINC WATER MAIN SIZE
WATER MAIN REQUIRED N�A
SERVICE LINE REQUIRED
HYDRANT SIZE EXISTING </
HYDRANT REQUIRED PER FIRE CODE SIZE
CROSS CONNECTION INSPECTION
WATER METER CH RGE RE UIRED 4 '0 5C%, -f- 72 /QD�
REVIEW BY DATE j0�3/fQ3 (ADDITIONAL COMMENTS ON BACK)
SANITARY SEWER DM. WING NUMBER
SIDE SEWER AVAILABILITY
FILE NUI4BER
SANITARY SEWER CONNECTION FEE REQUIRED
OPEN DITCH EXISTING, REQUIRED
CULVERT REQUIRED•{? %a2c,\�1� �� p} ��/�(T P� L� SIZE
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE PERMIT
ZONE S'_�G NUMBER
1OB
ADDRESS
NAME (OR NAME OF BUSINESS)
QMAILING
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LEGAL DESCRIPTION CHECK SUBDIVISIOA NO. LID N0.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING ��' REQUIRED DEDICATION_�
PROPOSED _ JQ ._
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CITY
TELEPHONE NUMBER
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NAME
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
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STREET USE PERMIT REQUIRED Ellz
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ADDRESS
SEE ENGINEERING MEMO DATED '
SEE PIW DEPT. REVIEW CHECK LIST DATED _.
CITY
TELEPHONE NUMBER
REriKs
NAMErc �i/Ir�(i'fiC.(N��
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ADDRESS
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METER SIZE
BUILDING SUPPLY SIZE
FIXTURE UNITS
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CITY
TELEPHONE NUMBER
REMARKS -
STATE LICENSE NUMBER
CITY LICENSE NUMBER
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SIGN AREA
ENV. REVIEW
ADB NO.
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ALLOWED PROPOSED
COMPLETE EXEMPT
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Legal Description Of Property • include all easements
(show below or attach four copies)
SHORELINE #
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VARIANCE OR Cu
PLANNING REVI W BY�
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REMARKS
LJ`NEW {>—J RESIDENTIAL ® PLUMBING
ADDIALTER NON-RESIDENTIAL Ei� MECHANICAL
REPAIR RETAINING WALL El SIGN
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EXCAVATE FENCE
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CHECKED BY
TYPE OF CONSTRUCTION
CODE
HEIGHT
DEMOLISH1:1 OR FILL ( x _FT)
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PRE-MOVE INSP.I ❑ SWIM
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SPECIAL INSPECTOR
REQUIRED
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AREA
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GROUP
OCCUPANT
LOAD
❑ SIDE SEWER WATER LINE
REMARKS
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NUMBER OF STORIES
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INUMBEROF
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NATURE OF WORK TO BE DONE (ATTACH PLOTPLAN)
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VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year • Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
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successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
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employees, and agents from any and all claims for damages of
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