1046 3RD AVE S.PDF1111111111114933
1046 3 R D AVE S
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ADDRESS: ,S� 4&g-s
TAX ACCOUNT/PARCEL #:
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
CRITICAL AREAS #: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED:
SCALED.PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc
.;l The City of Edmond$TREET FILE
E_
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION M REPAIRS ❑
OWNER ---•-- C
JOB ADDRESS _--104 - Isl/�------- -'---•-----------••---
EASEMENT NO. ---___---•-----•----•----------------------
LID N---•--- -- '1' NO. _ -.........
CONTRACTOR .._--JNwOO _..___Ev`! ______________ PERMIT NO. -����� C_
LEGAL DESCRIPTION: LOT NO_ ______________________________________ BLOCK NO. __ ................ -________________-
------------------------------------------------------------
NAME OF ADDITION _________________
woved:
TE.••-•-`-----------• BY - - --•--------- .-. f . .
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.C�K ^31\,Q;Rt ry3*11QeIlJs s� �. ,
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*_ � ; ' � .. • .... � SEWER PERMIT
CITY'" OF EDMONDS - SIDE
+ WATER -SEWER DEPARTMENT `�31
PERMIT
the construction.)
rtton of•
coverin an po..
g Y _ ns BEFORE
sewer ins ectio-
- for side P,
Call 776 E82b,
i
...
o holiday inspections.
(Inspection
will be provided within 24 hours after requst. NO
Sun.,T Y a ..
ADDRESS LOCATION OF CONSTRUCTION ...--••--- �• ..0 ...........�p-�._..-__.�l )�.._...._.__.........................•-•--••
[•*... .-•-._ ...... ........ _....._.....__.-..................
_
PROPERTY LEGAL DESCRIPTION ---------------- ---------
- _._•T
.................__..._.._._......_.._.._....__... _........... ...........
-.. tt _.� ... .... �____ -•-••-•-••
_ ••----....._OWNER AND/OR BUILDER..................:...9-_
( 1TRACTOR'S NAME ADDRESS ... -„! f�.�•�•� -_..................... -.............................. _... .._....
J� n_!�d_-� •.--___.....--, 19- for repair and/or connection of a side sewer to the city sanitary sewer K
Permission is granted ............ ...... _.
system in accordance with City of Edmonds ordinances.
M D TO THE FOLLOWING: _ -
. A o construct
TION I$ C employed ed t
�N t be e A k _ Contractor must P Y
need Side Sewer Contra ,
a permit to construct sewer inside property line. Alice h ,
obtain .r J
may t Pe
of thepropertyYinspected.cz
._ NOTE No. 1 The owners _
t N..
o not cover any portion of sew
er before it has been.. -,
wer in atree t area. D-
side se
.. Engineer's office.
• lCity E
from the ng sable Y
Permit obtainable • ). - _ -
� NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way
NOTE No. 3—Obtain full information regarding Ordinance 11.18.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Tap of side 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 'A will be permitted. _ r
',a ! NOTE No. 5—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. _
its appurtenances except to in -
NOTE No. 6—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or V
Bert the pipe into the wye. _ -
,. Date..._.. ___.. By ................ Date_.-.. _._....._._...._._.. By.._._....- ;
DISAPPROVED ❑ Date ... _.--.._.... By ................
' G By..._ ._ ••-• -•-•--•---•-•--•-••••-'••••••--••-•--------••---•••••--------••-•-......--••---•......................
4
APPROVED Date --- - ---- ...-.._ � 3
Remarks
.......................... -................................................. ............. •.......
t
— BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection —
• ere certify a e side sewer installation constructed under thispermit
I,N(io
- --. hereby tify that the e
r of Contra ing Fi Performing Construction) ccordance with all governing ordinances of the City of Edmonds
�{
Dated this ...._ --�1•�_-...-_.._..daY of..--. .........................................
J J Check BEFORE you dig for: Water ❑, Gas ❑, Telephone ❑, Power ❑, Sewer ❑, Other ❑ J J
ire - - i i... - - _ .-- ,--- - - - -�- ---r -- - - _ -- -
a2-77
PIsTILTC j)EjI'f'. 0!"(1: UST 4- �q -71
"M 1 1) 1L. ' 7(; PIT. Tr 1TVT,11? J
II
Street 1dpht-of-I;!,iy Existing_ REM). gVe
Access Fascricrits Existing IT-,nT)
Utility Enscinent Exi.sti.ng 107ni)
Lot Pcr ciibclivision mat Assessor jfan
�! Site Plan Cled-lod foi- A(�ciiracy /-T-7
thidergrotuid 1.1i.rixg !1cod...
PICvIcur by D"Ite
II
Fxjsti.n�? 11'F',iter '.Inin Size
I';ntcr '!,iin Pomiircd
Existin-.-
HvOrant IC(',Ili red rc-)r- Fif-P
---Sizo
Detector "ctcr RcOilirod A11.1147.
n n e d i ID cj b
1.1-rc
h I eTc r Cl 00
c ptj.c Tmij: Perld-t Permi-red—_ — �)(-.ITIit 'To._
Sanitan, I)cv.,nr Avni.IaIdI.!.I ro.J
Dnrdlig ",To. Filc
Side Availahilit�,
Se,..;cr Connection Foo Poriiiii-ed
I.cvicv., 'Zito
Civil 0-itc-11 Poviii.mi tvpL
011"rert Pecilired S i. z c At .4t)r
111di.cate oil !'i-c PIIIIII C�ltdl '1,151.11 !ZOMI! TO(I
"A; oc
Indicite on Site '111nii
Soil Coildit;lcns Ground 1%,ater Field (]hOc],,,(I_ K�-n c',
Revic.", I)v c Date
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4
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BOIL, ING DEPARTMENT Applicant Fill ZONE _ / NUMBER
PERMIT APPLICATION Inside Heavy Lines JOB Cp
NAME (OR NAME OF BUSINESS) ADDRESS 0—
VARIANCE OR COND. USE NO. JADB NO.
w MAILING ADDRESS
Z Il s .
r
IIZ16
ITY ELEPHONE NUMBER
s_•._
NAME
F ADDRESS
U
CITY TELEPHONE NUMBER
Q
NAME
�`:' G/ &
It
0 ADDRESS
U
C
E CITY TELEPHONE NUMBER
0
!' U STATE LICENSE NUMBER CITY LICENSE NUMBER
_ A
Legal Description of Property (Show Below or Attach Four Copies)
I
Z
0
aU
W
W
J
S -
NEW
El RESIDENTIAL
GAS
❑ NON-RESIDENTIAL
LINE
a SIGN
ADD
❑
ALTER
❑ DEMOLISH
OR FILL
ElOR
❑ RETAINING
WALL
FENCE
❑ ( X FTC
ElREPAIRElPRE-MOVE
INSP.
—
SWIM
POOL
NUMBER OF STORIES
NUMBER OF
.. „
DWELLING
UNITS
,
i.
NATURE OF WORK TO BE DONE
PROPOSED USE --
Z
0
C PLOT PLAN INDICATE BUILDING SETBACKS,
cc ABUTTING STREETS)
U
N
W
0
m .
'0
T
9=94=15 YARDS
COVERAGE
`
�U /FRONT /SIDE /
d d REAR
SIGN AREA
ENVIRONMENTAL REVIEW
ALLOWED PROPOSED
Z
❑ COMPLETE El EXEMPT
Z
REMARKS
Z
a
a
PLANNING DEPT. APPROVAL DATE
LEGAL LOT
LOT AREA
SUBDIVISION NO.
*YES ❑ NO
�� •-�(^J
STREET R/W
%� hh
EXISTING STREET R/W �Ov FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W FT. OFT.
REMARKS
Driveway slope not to exceed those
CHECKED BY
Z
Z
it
STREET AND/OR UTILITY WORK
R/W PERMIT REQUIRED
W
REQ'D. DYES ❑ NO
YES ❑ NO
Z
0
UNDERGROUND
Z
WIRING REQ'D. ❑��I,,N
YES �CO
W
TYPE CONNECTION YES
VERIFI D BY
SANITARY SEWER ❑ NO
SEPTIC SYSTEM ❑ PERMIT NUMBER
APPVD BY CITY ENG. YES
NO V-4i
REMARKS
METER SIZE
SERVICE SIZE
CLEARANCE
CHECKED BY
E
W
REMARKS
H
Q
3
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
SPECIAL INSPECTOR
OCCUPANT
REQUIRED
r7--]OCCUPANCY
GROUP
LOAD
C YES ❑ NO
F
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
W
OF EDMONDS. LOCAL SALES TAX
13
SHOULD BE CODED 31.04.
0
REMARKS
Z_
0
_J
7
m
VALUATION
FEE
PLAN CHECK
NO.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
MEMO TO: Harry !-Ihi tcutt
Building Official
FROM:
SUBJECT:
Richard H. Allen
Accirf;int' ('i+v Fnninoov,
DATE: h�rj2j�28 29- 19'7 ;--)
After review of the subject building permit application, we have the following
comments:
(1) Coordination of the location of any structure with respect to utilities,
streets, property lines and driveway grades is the response 1 lty of the
contractor.
2) The contractor is required to
and debris caused by the cons
the abutting streets cleaned of dirt
1011.
gir , �I r
•
D"1NA4T C$0fK6L.
Pl4 3/77
PIMLIC 1t'0=9 I HPT. 0IP0; LIST
}ll!I LDDiG, PT:R_ `]IT R1iVI l �
>an
Street Right-of-llay Existing �� UPI)
Access Easements Existing � � �� RETI
ca
If Utility Easement Existing ITOT)
Lot Per Subdivisions, 9-40 Plat /Lssessor P;an
7
II f
CJ�ecked for accuracy%�%� I
Site Plan
C)
i( ltndcrgrotuid wiring Rend. Q i
w
I` check'Acw- (a9 ofLequl (?cx.;C:r'ij>1ibn..
by -^-- - llate
IIReview
�I
T:xis'ti.na f,atcr :-!ain Size (o e.s
II
1'datcr `lain Required A.I.
Ilydr.uit Size Existing �.
-
Ilyclrant l:ccluiredr Fire, COje $- Size
IIDetector
Check Pieter Rerniired
Crc,;; Cc�nnectbn .1h,11�e.jian ._ I
Fire
(�
1`CT)artilcnt C0p.tu cnts
�
aOr T1le Q CM 1*� , .erjUir
1I
Rcvi.ec., b" hate 3/77
---of
-
Septic Tan]: PesiJTrt Approved- ---
_ Date
Septic Tank Permit Required !-�/�-- _—Pcrmi.t
Septic
Sanitar}' Sewer Availahil.ity'ye5 "roi
Of
Drawing Io._ + - File '?o. — —_-
Side Sewer Availability
Sanitary Sewer Connection Fee Ponuired LIPS co _
l:e:vict,� li;f Date 'i -99- 77'
I'
q)cn Ditch Existing /L � Required / V^
Culvert Required Size At Pr
o
—�
�I
(:atci Basin Indicate on `'ire Plan,
-!Required_-
S'hOuide ibltlQ�c2 tY1Clt��C�IN CO �[� (On in swale
opes'-) ran D P
nutllolc rcauircd _((//�2 _— Indicate or. Site Plvi�
Soil Conditions F, Ground Water Field (ltecked��0 c" p �
Review by- _-_T)ate _ - I
H.
a:
c.)
Street paving Required
ftirb and Glitter Required
Sidcv.alh Penuired
I Curl) Cut for Priveway Required
Right-of.-l.`a.Construction Permit Requiredl CS
Bond Required for Public Improvements o _
Street Name Siam Required`_—
,
Other Signi-nl;.. Required--
k� I
Pre permit Site Inspection -made on j
BY: Scv;er
H i
Water
Street'�'r
rr �Engineering
•
Special Requirements listed in memo to L'uildinR Pepartment
By 1 � '— Date
A11 items filled in on Building Permit Application
By _ _ ?)ate
Prav:rin,;s Stamped and ;flotations Nadc
By Date —
Approved by Public 1'7orhs Department
• I
STREET FILE Date June 7, 1977
MEMO TO: John B. Mitchell
Water/Sewer Superintendent
FROM: Richard H. Allen
Assistant City Engineer
SUBJECT: SEWER CONNECTION CHARGES
Legal Description:
The south 60 feet of the east 1/2 of Lot 4, Block 3, Plat of
South Park Addition to Edmonds as recorded in volume 8 of plats,
page 13, records of Snohomish County,Washington.
Commonly known as: 1046 3rd Ave. S. Owner: Glen Dale Const. Co.
23728 91st P1. W., Edmonds
Z.F.F. Calculation:
( ) Z.F.F. x ( ) _ $
( ) Lateral x ( ) _ $
( ) Unit(s) x ( $25 ) _ $
$
300.00 Connection Fee(minimum)
0 Lateral Charge
25.00 Trunk Charge.
10.00 Permit
335.00 TOTAL
APPROVED BY:
Lei R. Larson, P.E.
Director of Public Works
CC: Owner
5/1n/77
�0 Al,
Z 3; ,o,.,o.�/�s, ,
✓ r ; o4'�e ,C -+ Qp / T'/;O-•t,/ y`i- Eo.pp e~ 2f
S ', %off Acoi. �rN lld� !g; o � 'P,d-•q-r.
k& GvR-bl! �b� ;SwoHo�iry Co�/l/ , 6t/9s4ra
I 1 } I t
t
i CITY OF, EDMONDS
`PUBLIC WORD DEPARTMENT j
1 I SUSPENSE CONTROL RECORD
SUBJECT NAME SUSPENSE DATE NUMBER
6AV�
FROM c,�- FILE DESIGN r OWN
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