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1140 SIERRA PL
ADDRESS: I I�Lo 5k,09
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHERV'—
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMITS) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
L:\TEMP\DST's\Forms\Street File Checklist.doc
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
EASEMENT No ...........................................
NEW CONSTRUCTION 0 REPAIRS 0
118-06300
OWNER.......... M.....................................................nll............................................ CONTRACTOR..........---...................--.....................-----........................---------..... PERMIT No.......................
ADDRESS ......1.140Slerrd.-Pl.dCe...................................................... LEGAL DESCRIPTION: LOT No. .............................................. BLOCK No.............................................
4
0
NAMEOF ADDITION .............................................. _................... ......................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By......................................................................
The City of Edmonds
OWNER...... ........................ r.........7A.!✓r.r1.E...................--
HOUSE — A�A i' xe— ., - �r- i 1
0
APPLICATION
for
SIDE SEWER. PERMIT
OUTSIDE ❑ INSIDE ❑ REPAIRS ❑
.......... CONTRACTOR ........... ....ter?^.
STREET
A S TLMAT TT. T AT AT..
CARD No. . ........................................
EASEMENT No.. ...............--.........
................................ ........................ PERMIT No..(.�,-7.
APPROVED
BACKFILL WORK ORDER ISSUED ........................................... DEPOSIT, $ .................... ........... .......................
SEWERWORK ORDER ISSUED ................................................ DATE .... ..............�P......... BY...........................................................................
n� .
PUBLIC WORKS DEPARDIENT' "IST
BUILDING PERMIT REVIEW
o
(address) to
'Street Right -of -Way Existing
REQD
Access Easements Existing
REQD
H
Utility Easement Existing Il
'� �� REQD N-�-
w
Lot Per Subdivisiar<-7-- 7 Plat
—' Assessor Map T
w
Site Plan Checked for Accuracy (
-7 `7
z
Underground Wiring Reqd.
H
Check Accuracy of Legal Description
Il 2 -7-1
z
Review by Tj f\j
Date
w
Existing Water Main Size
Water Main Required
Service Line Required 51/
Hydrant Size Existing
Hydrant Reqd Per Fire Code
Size
w
Detector Check Meter Reqd. IVO
a
Cross Connection Inspection NO
H
Fire Department Conments
Water Meter Charge Reqd. -
,
Review by /��
Date H
Septic Tank Design Approved VA
Date
.Septic Tank Permit Reqd. AIA
Permit No.
Sanitary Sewer Availability Y�5
Proj .
Drawing No.
File No. SOZ?
Side Sewer Availability TO
w
Sanitary Sewer Connection Fee Reqd.
3
Review by 44KJ"
Date i 9 7
w
Open Ditch Existing_ZVeA,5
Regd. —
Culvert Reqd. �D„� y[�(
Size
c4
Catch Basin Reqd. iy�„�,
Indicate on Site Plan
O
Shoulder drainage maintain collection on
swale open runoff
H
`"
Manhole regd. -404��
Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
Review by 49akie!�: _
Date
Revised: lv10-1977