1136 3RD AVE S.PDFIIIIIIIIIIII
4941
1136 3RD AVE S
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ADDRESS: = G4
TAX ACCOUNT/PARCEL #:
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
CRITICAL AREAS #: DETERMINATION:
❑ Conditional Waiver ❑ Study Requited ❑ 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
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PUBLIC WORKS DEPARTMEN,_j
SIDE SEWER PERMIT
FOR INSPECTION CALL
775-2525 Ext. 220
,ermi t
issue Date
Address of Construction
Property Legal Description (include all easements)
3. Single Family Residence Multi -Family No. of Units
a
Commercial
4. Owner and/or Builder
5. Contractor & License No. _
6. Invasion into City Right -of -Way: No,f'-, Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
7. Cross other private property: Yes No X Easement required -
attach legal description and county easement number.
READ THE. FOLLOW'',, LTG 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. Commerc,ial establishment requires a minimum of a six inch (6")
side sewer 1i'ne,�
d. Side`-4ewers 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 grade of 100% (450).
f. No turn in side sewer greater than 45° (1/8,bend) is allowed
between cleanout. All 90 turns must be constructed of a 450 (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 100' 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.Tw6.'(2) working
days notice required.
DATE:
I�rcer.trty,,,,that I have read
sand `s'ha 111 comply with the above
PERMIT FEE : a (), - DISAPPROVED BY: Date:
v W t 't,,t o" B Date:
'n CONNECTION `FE+E: t:-'f APPROVED By • Date
0
w * PERMIT_MUST ,BE .POSTED ON JOB SITE
Thy City of Edmonds Side Sewer Drawing
EASEME
NT NO- ---_-------
NEW CONSTRUCTION REPAIRS E] LID NOz-::70.1� -------- ASMT. NO.---'.'
..................
OWNER
----- . .................................... CONTRACTOR S4m................................................... PERMIT. NO.. ------------
JOB ADDRESS ....... . ........ --- ................ LEGAL DESCRIPTION: LOT NO., -------------------------------------- BLOCK NO . .....................
sew a
---------------------- ...... ........................................ .. ...gas.. ......... ......
/ (
NAME OF ADDITION ............................ ............................................ IAN 0 ......................
IOC%l I i 17A%
Approved:
DATE ........ ........ By
P/z-
THE HOMELAND COMPANY
1047 SkRUCE ST.
EDMUNDS, .WA 98020
PL 776-6569
i
wk
a3aq ZONE
SETBACKS,
3 RD AVENUE SOUTH`
OTHER
HEIGHT
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r CATcm BASIN:
ADS QIS30(OGL TRIGNC►d ►.WN6TH
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— TA6NCM COVIi'A
A O
6' TICs L1Nl� 6C[VIiL. TRGNC-N
(s" P6RF PPE CAP
6"TEE Wf 6" LOW-, LEGS
SYSTEM CROSS-SECTION
T0.ENCH COVER —
3/4�— {I�1WAS FIED
GRAVEL
6" OIAM FERF PI
TRENCH CROSS-SECTION
STANDARD DRAINAGE PLAN
INFILTRATION SYSTEM
PAGE I OF 2
for
location
plan by
phone - .-E;
date---/
DESIGN DATA
Trench Perc LF per Imperm Trench
Number Rate 1000 sq.ft. Area Req.
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the responsibility
of the property owner(s). Preventive
maintenance consists of preventing
soil and other materials from entering
trench during construction as well as
after construction. Catch basins should
be cleaned of floating material and
sediment at regular intervals (at least
twice per year).
CITY
OF a
ONDS
CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Construction
=-J• Owner:
L Name
Mailing Address
UJ
LU ��� W l� Q�•�-�
City, State, Zip Code
i
• Contractor:
Name
Mailing Address
City, State, Zip Code
tD
APR 16 1982
Dir.
�a d
Issue Date
• Permit Issued To: 46rnP-/Qh
• Type ggf �Work to be Done:
!ns-� 1
• Work in Connection With:
❑ Sub or Plat ❑ Single Family
❑ Comml. / Ind. ❑ Apt. Condo.
• Pavement Cut: Vyes ❑ No
State License Number
Telephone Number 1
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any 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, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed- for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering.
Call 775-2525, extension 220. 71 /
I understand that this
Signature:
or
for inspection purposes at all times.
V
—� Date S OG—
* THIS PERMIT IdUST � POSTFJ5 AT THE JOB SITE FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Void after _ 20 days
Special Conditions:
Ammendments:
Permit Fee: 4,3. 0.
Security Deposit: &&hInq bI eon* ;
Receipt No.:
Fund III Fee:
Street Cut Dimensions
X =
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
f
CITY OF EDMONDS
AFORMATION SHEET
STREET FILE
NEW ASSET NO.
❑ ADDITION ADDITION TO ASSET NO. - ?tvpertt of
fCIfiY OE EOMONOS
❑ RETIREMENT N0. Q 31 4 9���
DESCRIPTION
SERIAL NO.
LOCATION / / _ � DEPT 0.
**PURCHASE ORDER NO
PURCHASE ORDER DATE
COST
*PROJECT NUMBER
PROJECT COMPLETION DATE `� G
COST
B.A.R.S. ACCOUNT NO. T`��%U �� ^ �`�`�� �d ' 64'
• ESTIMATED LIFE o��yi�
•
INITIATED BY DATE APPROVED BY
*"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
VERIFIED BY
OR"DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
DATE
PROCESSED
BATCH NO
U1
INITIAL
DEPARTMENT FILE
PUBLIC WORKS DEPARTMENT
single Family
'? +
REVIEW
i,/
BUILDING
PERMIT
Multiple
Commercial
BUILDING ADDRESS ,���y31� �34C�.__
_,li-('_ _,.
BLDG. DEPT. SUSPENSE DATE
L INITIAL
DATE
UTE:
❑ OFFICE ADMIN. — PUBLIC WORKS
OG IN
® CITY ENGINEER (check)
gAl
�VV
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❑ Access Slope and Vehicle
Access
W
t%Drainage Plan
❑ Street File
LL—
❑ Legal Description
LLJ
❑ Quit Claim
uj
❑ Easement
❑ Calculate Sewer Connection
WATER/SEWER DIVISION
❑ Determine Meter Size
0 Complete Building Permit
Review
I�STREET DIVISION
OComplete'Building Permit
Review
OFFICE ADM IN. — LOG OUT TO
BLDG. DEPT.
�e®eoo®�®n®o®�®o®�®■a�ee�■®�®�®�v�����m■®��o®as���o�e�®��
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BUILDING PERMIT APPLICATION (COMPLETE)
13--2---COPIES OF SITE PLAN _2 13
® 2 COPIES OF FIRE PROTECTION PLAN
(PREVIOUSLY REVIEWED BY FIRE DEPT,)
E 3 COPIES OF DRAINAGE PLAN WITH CALCULATIONS
REQUIRED BY SUBDIVISION ❑
GREATER THAN 2,000 SO. FT.
IMPERMEABLE SURFACE ❑
LESS THAN 2,000 SO. FT.
R(CHECK ZONING REQUIREMENTS (SETBACKS) I
1 COPY OF ENGINEERING CHECK LIST
171 1 COPY OF PUBLIC WORKS MEMO
® MULTIPLE OR COI-DIERCIAL
YES ❑ (ATTACH COPY OF ADB APPROVAL INCL. ALL DRA•IINGS)
NO
,❑ SUBDIVISION — YES[] NAME
DATED RECORDED
NUMBER
NO
(.ATTACK COPY OF REQUIM4ENTS)
EYCHECK
SEWER
DRAWIN//G AND
ATTACH COPY
IS DEDICATION REQUIRED
— YES[] (OBTAIN QUIT CLAIM)
1
N0M ( CITY CODE )
DOES CITY HAVE EASEMENT
ON PROPERTY
YES ❑
(ATTACH COPIES
OF DRAWINGS)
NO
/
CHECK LEGAL
ACCESS —
INGRF S�
UTILITIES`
YES- YE,>I[r]
NO ❑ NO ❑
❑ HAS SEWER A SESSMENT BEEN PAID
YES L.I.D. NO. iL
PLAT NO.
SUBDIVISION NO.
D
IF MULTIPLE: INCLUDE NUMBER OF UNITS
0 IF COMMERCIAL: INCLUDE NUMBER OF FIXTURE UNITS
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CITY OF EDM S PADDRESS
P R
R
BUILDING PERMIT LIGATION
•r 3NAME (OR NAME OF BUSINESS) /�/
A _ I f, ESCRIPTION I SUBDIVI
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ELEPHONE NUMBER
V`L- --.)
SHORT SUB P
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING
PROPOSED y-Cyf
DEFICIENCY OF RIGHT OF WAY '� n
CH
jo��
SEE ENGINEERING MEMO
REMARKS
4'
METE SIZE BUILDING SUPPLY
SIZE
FIXTUREUNITS
REMARKS
TELEPHONE NUMBER
JSE NUMBER CITY LICENSE NUMBER
SIGN AREA
ENV. REVIEW ADB NO.
ALLOWED PROPOSED
COMPLETE
EXEMPT
SHORELINE
ion of Property (Show Below or Attach Four Copies)
VARIANCE OR CU
PLANNING REVIEW BY DATE
YARDS
LOT COVERAGE
FRONT ��
SIDE
`..•
REAR
REMARKS
n(I NEW
El
ID
RESIDENTIAL
PLUMBING
CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT
�J
NON-RESIDENTIAL
❑ MECHANICAL
I ]
❑ ADD
DEMOLISH
❑SIGN
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
❑ ALTER
0
ORCFILLTE
i ENCE X—FT)
REQUIRED GROUP LOAD
El YES ElNO
REMARKS
❑ REPAIR
F
PRE -MOVE INP./
INS
swim
POOL
COMPLIIAN C E P.
Z NUMBER OF STORIES
NUMBER OF
0
DWELLING
F-
UNITS
a NATURE OF WORK TO BE DONE (ATTACH PLOT
PLAN)
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PLAN CHECK FEE VALUATION FEE
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BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FENCE
marquees, etc.) will require separate permission.
SIGN
Permit Application: 180 Days
Permit Limit: 1 Year • Provided Work Is Started Within 120 Days
RETAINING WALL
"Applicant, on behalf of his or her spouse, heirs, assigns and
SWIMMING POOL
W successors in interest, agrees to indemnify, defend and hold harmless
J
i the City of Edmonds, Washington, its officials, employees, and
It agents from any and all claims for damages of whatever nature,
a
x arising directly or indirectly from the issuance of this permit. Issu-
0 ance of this permit shall not be deemed to modify, waive or reduce
TOTAL AMOUNT DUE
p any requirement of any city ordinance nor limit in any way the
x City's ability to enforce any ordinance provision."
ATTENTION
APPLICATION APPROVAL
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-
THIS PERMIT
This application is not a permit
ized agent of the owner. I agree to comply with city and state laws regu-
AUTHORIZES
until signed by the Building Official or
lating construction; and in doing the work authorized thereby, no person
ONLY THE
his Deputy; and fees are paid, and
will be employed in violation of the Labor Code of the State of Washington
WORK NOTED
receipt is acknowledged in space pro.
relating to Workmen's Compensation Insurance,
vided.
SIGN TURq(O NEER AGE )
DATE SIGNED
I NSPECTION
DEPARTMENT
DIRECTOR'S SIGNATURE
CITY OF
EDMONDS
DATE
HIS SITE IS LOCATED IN THE CITY
775-2525
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
ATTENTION
ORIGINAL — File YELLOW — Inspector
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
PINK — Owner GOLD — Assessor
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
�� ���^G
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304, 306.
1 02-78
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DATE : <2
MEMO TO: Building Division
CoP.ununity Development: Department:
FROM: Engineering; Division
Public Works Department
After review of the subject Building., Permit application, we h;
the following comments:
,1, Connection to City water s stria required
2. 'Connection to City sanitary sewer system required
3. Right-of-wav Permit required foz• rtny work on City property
4, Driveway slope not to exceed 14%.
S. Backwater valve required if dotan stains nlumbinL i.s below
elevation of upstream manhole.
6. Water and sewer lines to he separated by 10 foot minimum.
�.L,y
lam•'.
"� C a
�.G"5G
iSignature
•
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PUBLIC WORKS DEPART= CHECKLIST
BUILDING PERMIT REVIEW
l
�'— (address) to
Street Right -of -Way Existing ,,,F/
REQD
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Access Easements Existing
oc
Utility Easement Existing —'
REQD
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Lot Per Subdivision Plat
Assessor
w
Site Plan Checked for Accuracy
Z
Underground Wiring Reqd.
N
U
Check Accuracy of Legal Description
Z
Review by rC!��.' `. 'r/�
Date
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Existing Water Main Size e
Water Main Required NIA
Service Line Required
Hydrant Size Existing
c�
Hydrant Reqd Per Fire Code y/q
Size
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Detector Check Meter Reqd. ,yi
Cross Connection Inspection
H
Fire Department Comments
3
Water Meter Charge Reqd.
J,
Review by
Date 'l / -V ,?.
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
Proj.
Drawing No. )(. �/%
File No.
Side Sewer Availability
a
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Sanitary Sewer Connection Fee Reqd.
3
Review by
Date
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1'
Open Ditch Existing
Reqd. �-----
Culvert Reqd.
Size
W
Catch Basin Reqd. �j �?
Indicate on Site Plan �-
O
Shoulder drainage maintain collection
on swale open runoff ,U
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Manhole regd. 7e //,°i,, 4,
P Indicate on Site Plan -
Soil Conditions and Ground Water Field Checked
Review by /'-, ,,-,P .•C %�.. �
Date Zy
Revised: lv10-1977