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1105 8TH AVE S
USE
ZONE �' r PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
dOWNE"AME/NAME OF SuSINESS ADDRESS S- SUITE/APT I �
C �
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LEGAL DESCRIPTION CHECK
SUBDIVISION NO. ':
LID NO,
'
PUBLIC.RIGHT OF WAY PER OFFICIAL STREET MAP,
TESCP Approved
RW Permit Required
D
O
ZIP TELEPHONE NUMBER
7130 ZO
EXISTING REOUIRED DEDICATION
Street Us Permit Req•d
D
PROPOSED
Inspection Required
Sidewalk Required
O
O
E
—�-�
METER SIZE
LINE SIZE
NO.OF FIXTURES
PRV REQUIRED
YES O NO ❑
C'
REMARKS
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P
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SS
Lc.)
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ZIP TELEPHONE NUMBER
1,M I-331-5-
LICENSE NUMBER
J-5, Ay
EXPIRATION DATE
/6(, L../R I(',
Description of
Property - include all easements
!'"en
Gv f
TeX Aceount / ,. O/ O -, 6v p
Parco1 No. W
�r—y���
El
NEW
LJ RESIDENTIAL
PLUMBING
ElADDITION
El
❑
COMMERCIAL
MECHANICAL
APT. BLDG.
REMODEL1:1
LJ SIGN
a GRADING
2REPAIR
O FENCE
CVDS.
I_ x _Fn
TOVE
DEMOLISH OODSSWIMPOOL
❑
INSERT
HOT TUB SPA
GARAGE RETAINING WALL/
CARPORT ROCKERY
RENEWAL
TYPE F US; " E. B S ESS OR ACTIVI V) EXPLAI
ex� H
(UIv��,Efi•r' NUMBER OF
CRITICAL N
)P° DWELLING /7Alf
AREAS /14
MORIES UNITS (//I�i
NUMBER
)ESCRIB�RK T07 THE (AT CH PLOT PLAN
MEMO DATED
SIGN AREA SEPA REVIEW
ALLOWED PROPOSED COMPLETE EXEMPT
�'EXP' V/
' FRONTCK �i F`7 SIDE I V 'REAR (/� HEIGHT LO7
�43F D I�
BY
REGUIREO I YES .7.�V (Q I LOAD
❑ �\
EMARKS
PROGRESS INSPECTIONS PER UBC 305
v OA GG
FINAL INSPECTION REQUIRED
VVVV 6
VALUATION
FEE
--.=
PLAN CHECK FEE
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VC�
BUILDING
Si4-vim\
ILJJ IIJJ
l.)
HEAT SOURCE:
GLAZING
d/0
'
PLUMBING
Plan Check No. �/ - /
9
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.
STATE SURCHARGE
v 5v
Permit Application: 180 Days
Permit Limit: I Year - Provided Work 10tarted Wlthln:.180.Days
STORM DRAINAGE FEE
"Applicant, on behalf of his of'hei spouse, heirs, assigns and
ENG. INSPECTION FEE
N
successors in interest, agrees to indemnify, defend and hold
J
harmless the City of Edmonds, Washington• its officials,
x
employees, and agents from any and all claims for damages of
iwhatever
nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
c
i
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's to
q sU
ability enforce any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
Information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and in doing the work authoriz•
AUTHORIZES
This application is not a permit until
ad thereby no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of State of Washington relating to Workmen's Compensa•
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Insarimals and Pro1
INSPECTION
acknowledged in space provided.
(GNAT (OWN AD 1 DATE SIGNED j,
.. I ^y V
DEPARTMENT
CITY OF
TURE //��� E
/
EDMONDS
ZMW
ENTIO
CALL FOR
INSPECTION
ELEA �Eb a-, i DATE
` ( �' ✓ 7 -,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
.', y,U
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
��� _O�wo
1
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CITY v -C(OPY
SEP 0 s 1994
Efl�" COUNTER
r
APPLICATION
The Cityof Edmonds for
SIDE SEWER PERMIT
NEW CONSTRUCTION ❑ REPAIRS ❑ EASEMENT No ...........................................
107-08100
OWNER......... F®---A,--•B j.41'i sen------------------------------------------------------------- -- CONTRACTOR.........------------------------------......---.................---.............................. PERMIT No.......................
ADDRESS..... 1.1.0--rJ---- --- 8th... Avenue ... S-s------------------------------------------------
J
40
LEGAL DESCRIPTION: LOT No ............................................... BLOCK No.............................................
NAMEOF ADDITION...................•--------••-•---•---------•--------...----..............--•--.......------............................................
DYE TESTED ON SEWER
JULY, 1972
Approved:
DATE................................................ By --..................•........
g-r vn
NLy,
=s
?D l vS�.DG6 c>�JYIIr i
RC OE1VED
PERIe�(i Li
ZONE a5 - 1 /�
SETar"%CKS:
FRONT
SIDE 91O
REAR
OTHER —
HEIGHT G1
CITY OF EDMONDS
BUILDING DEPARTMENT
WORK le -
ADDRESS
OWNER _ ✓%w�4L-s�,C�.f
APPROVED DATE:
BLDG. OFFICIAL -
PERMIT NUMBER
95QC),38
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The�City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
0YA" � NEW CONSTRUCTION �[]
OWNER ----- -------------
- -
---------------------------------------
JOB ADDRESS -j,LCD'�-::>
. ............................................. --------------------------------
•
•
EASEMENT NO- --------------------------------------------
REPAIRS LID NO. ASMT .......
CONTRACTOR SEWER ER ...... PERMIT NO.
LEGAL DESCRIPTION: LOT NO . ............ I -OP -------------------- BLOCK NO.
Approved:
,
DATE . . . ;Z"
. .. ............ �.(e By
............... .;477�4
"4',The. '-Ci'Edmonds"
ty of .,—
.0" :ER
0-41� — --------------------------
-jOB:'ADDRM. J:
-------------------
----------
APPLICATION
for
--------- - ------ E ----------
SIDE SEWER:. PERMIT''NEW 'CONSTRUCTION"'[] REPAIRS LID NO. ------------------ ............
------------------- CONTRACTOR --------- a�,------------------- PERMIT 0
------------------- LEGAL DESCRIPTION: LOT NO. ------- ---------------------- BLOCK NO.
------------------------------------------------------------------------------------------------------------------------------------------------------------------
L/
,9,,�-"'\NAME OF ADDITION --------------- Ja-0 ------- /-0-5-f ........
A
Q s /
Approved:
AN
. ..........
7`1 -----------
CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER. DEPARTMENT `
PERMIT _
1 _ K
'{ Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction. Inspection will be
provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.�
ADDRESS LOCATION OF CONSTRUCTION__...
•• -
PROPERTY LEGAL DESCRIPTION ...... V-)I"�' ft� � ^ � — m
. ;,.
......................."......................
.... _...................... __ _..................
- -
..............................� ._.......---..__._—............... . .
r �______________ .
-------- ---------------------- OWNER AND/OR BUILDER...... 1 1r��iF ?Q i lid
a o ..........
:••-•--•-- --•-
'S NAME &ADDRESS. �e7,
-- ... _ ..................................
ACTOR
n...
-------- t> e7
Permission Is granted.. c - r u_._ �__ 19� � for re ---
Fs/{/\ in accordance with City oftEdmonds ordinances. ' � and/or connection Of a side sewer to the city sanitary sewer
A ION Is CA •- - .. - LLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside side sewer in street area. Do not cover a Property line. A licensed side Sewer Contractor must be employed to construct NOTE No. 2—All work any portion of sewer before it has been inspected. >_ .5;•
performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office. _
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit. _
r r 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
sharper than % will be permitted. grade
work which may develop within one year of completion.
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 -
_
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 Its appurtenances except to in-
sert the pipe into the wye.
'i DISAPPROVEDDate,
❑ ..__......._... BY •-
'-----------------•--- ...-----•----- Date. ' •
�� By..._..•--•_-.... Date-------------------••----•--••_-•__ BY
APPROVED Date__._ ......... l' :��..
Fx
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Remarks:..---•--�oll
�(��;Q�?--------•---='-fir^1e•R.----��,-�P-•a
------
-------------------
-----------------
---------------
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection — V
�tlhereby certify that the side sewer installation constructed under this permit
wiu installed (Owner in with all governing ordinances of the City of Edmonds.
Dated this ............... -. ,
day of__...._ p
d V Check BEFORE you dig for: Water ❑, Gas ❑, Telephone ❑, Power ❑, Sewer ❑, Other ❑ d
--- -,r.,hl-1 v�a•„r+• .: •.. n.v`� ,•w.,.; y:�irv-•. `k�r�Yd!ittt niw-:7'-•a,..r•y"+w.�wk.+�y,�'µ�r�v^"T+yli1'VK'lr'^$•Srr4.Yrtr �?-��.•ws,y..,v...:-y.
A'
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. 3 -
..`' ...
Issue Date:
A. Address or Vicinity of Construction: 1105 8 Av. S . (93204109
j 8 Q� B. Type of Work (be specific): Install New Service
90 19
C. Contractor: Washington Nat'l. Gas Co. Contact: Frank Swan
Mailing Address: 815 Mercer St. Seattle,Wn. Phone: 224-2278
State License #: Hill 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 INSPECTOR: INSPECTOR: W 1 VV l{-
(
F Pavement nr r-nnrrete t`ut - nYPc nNn Cl- S17E of nIt- (2) 2 x 4Ctt t•R H_ Charae t
- - — — (1) @Tie In ,(1) @ Water v
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his aignatur`e tom his application, afire to Id the City of Edmonds harel 9'0m�samages, or
claims of any kind or description whatsoever, foreseen or uhfopseen, that may 6e ma a against the City of Ede s, or ts defartments or
employees, including or not limited to the defense of any legal proceedings including defense costa, and attorney fees by'reason of granting this permit.
THE
CTOR IS
BLE FOR WORKMANSHIP
D MATERIALS
kA PERIOD OF ONE
THE
INSPECT/ON AND ACCEPTANCE/OF THE WORK ESTIMATEDNRESTORATION FO Ii ALL BE HELD UNTILATFTEO 'N L,kTREET PAI TCH R
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. r
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 be in accordance with City rggulations as requirediby the.City, Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior tathe end of the working day;.
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be
available, on site at all times for inspection purples.
Signature: Date:
„d... , `41 July 9. 1993
�
(Contractor or Agentf-4-�;"'
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
SFOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER 3 DAYS DISRUPTION FEE/FUND 111 ,
SPECIAL CONDITIONS: tJ A RESTORATION FEE:
PERMIT FEE:
y TOTAL ,FEE:
COMMENTS: RECEIPT. FEE:
DATE: ISSUED BY:
1.
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES
Comments:'
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
I
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: Guyla Connors
Engineering Aide
Washington Natural Gas
521-5248
ilc U&VS
q 3204 td
WNG to window
Water main depth
unknown
." gas main,
- . -,
I
2 (2 x 4) Gu7s
O
QC7C7p e t,4 0 GUI <
1`1 E C, C� SS4t2_� l
TO U-r l L_.1Z,E OLD
SEI� ICE,_--_ _--
Key•
-w- water
-g- gas -
-ss- sewer
$ water hydrant
O water valve
815 Marco St. (P.O. Box 1869), Scattk, WA 98111 (206) 622-6767
PUBLIC,:WORKS.DEPAR CHECKLIST
BUILDING PERMIT REVIEW AN F.
A ss 4e
Street Right -of -Way Exist'
Q REQD
z,
H
Access Easements Existing `&).Q'g,.
:REQD ,.
Utility Easement Existing e)
fjigr REQD
w
Lot Per Subdivision '�`' Plat
Assessor
w
Site Plan Checked for Accuracy___ .
z
Underground Wiring Reqd:
'
H
U
Check Accuracy of Legal Description
-79B
z
Review by
. Date
w
Existing Water Main Size
Wat in Required
Service quired
Hydrant Size Exis
c�
Hydrant Reqd Per Fire . -
Size
w
Detector Check Meter Reqd.
Cross Connection ction
H
Fire Dep t Comments
3
Water Meter Charge Reqd.
Review by
Date
Septic Tank Design Approved
Date
tic Tank Permit Reqd.
Permit No
Sanit Sewer Availability
Pro'
Drawing No.
File No
Side Sewer Avai ility
w
Sanitary Sewer Connec . Fee Reqd.
3
Review by
Date
w
Open Ditch Existing
Regd.
Culvert Reqd.
Size
04 -
Catch Basin Reqd.
Indic e on Site Plan
Shoulder dra' maintain collection on
swale open runo
H
ole eqd.
Indicate on Site Plan
Conditions and Ground Water Field Checked
2eew
by
Date
Avised: lv10-1977
Page 2 +
St t Paving Regd.
H
Curb and r Reqd.
W Sidewalk Reqd.
W Curb Cut for Driveway Req .
� :Right -of -Way Construction .Pe Req
!����
E, Band Reqd.,for Publ' rovements
Street N ign Reqd.
er Signing Reqd.
A Pre Site Inspection made on
z
f� BY: SEWER
E-+
w W WATER
a
U)
r-+ z STREET
H
ENGINEERING
Special Requirements listed in menu to Comramity Development Department,
Building Division
BY �A10 Date
o All items filled in on Building Permit Application l
a BY ��� Date `
a' Drawings Stamped and Notations.Made
as BY Date
Approved by Public Works Department
Revised:,`.ly 10-1977
DATF:—:Jamt 9. 1976
HErn TO: Harr\, llhitcutt
r,Ll,i I di no Official
FROI-1: Richard .11. Mon
Assistant Citv Fn(iin(.,Pr
SUBJECT: Ruilding Permit Application for Frank, Leifer at 1109 Sth Ave. S.
After revien,., of the ,W)jpct huildi.nn nermit anplication, wo have the fol
-
lowing comments:
1. Connection to sanitary sewer renuired.
2. Lot drainage contained on site or directed to City storm
sewer system.
3. Right-of-way Invasion Permit requirpd,for curb cut and
driveway. 1 j,%jrj #je. 1% A*"ft*Jb"b cum&
PLker W/.TTP cvAls
RHA: mj r
y
Date lq6
BUILDING PERMIT REVIEW ENGINEERI
Instruction:
Check Accuracy of Legal Description
Check Against Assessor's Map.for Lenal Subdivision
Does it conform to City Approved Subdivision?
Reviewer's
Initials
1. This lot included in 1�uhdlvisio
2. Site Inspection made on:
'sf ffilm-A
..... i &_,.
DEPARTMEi1T CiIECK LIST
4. bite Drainage Checked?
5. Storm Set -ter Avai 1 abi 1 i tv: Sht. �of [10.1 ro•iec
Roadside Ditch Ki
6. Grading & Final Contours:
7. Septic Tank System Design Approved:
8. Sanitary Sewer Availahility Sht. of rh•,g. No. S. Project )
Side sewer availability: )
9. Sanitary Sewer Connection Fees?
10. Uater Mains A Fire Hydrants (Indicate Size 11ain)6"Mf4*M, zuUc111J�
Check Fire Dept.'s Comments
11. Sidewalks: (Site.inspection shows conditions..of sidewalks as follo:•is)
12. Curbs: Curb Cuts/.riveways (Check driveways for safety, location,
grade and width, _Die
.13. Underground Mring:_ y __Street Lights: ---�
14. Street Right-of-way P, I,ldq. setbacks: �_*t.f official Street Map.
I 15. Existing Utility
1G. Access Easements:
17. Site Plan checked
18. Special Requirements listed in Memo to Bldg. Dept.
19. Commercial & Apt. RegUirements,form completed? _
20. Drawings stamped & notations made?
21. All Items filled in on Bldg. Permit Application?
22. Bonds posted for site work?__�
23. Right-of-way Invasion Permit required? VV
COMMENTS:
11
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