1141 EDMONDS ST.PDF11111111111111
10945
1141 EDMONDS ST
•
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS:
DISCRETIONARY PERMIT #'
DRAINAGE PLAN DA'
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: L2. 5 ]1
SEWER LID FEE $:
SHORT PLAT
SIDE SEWER AS BUILT DATED: -7j ' S 1103
SIDE SEWER PERMITS) #: 7
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
DETERMINATION: ❑ Conditional Waiver ❑ Study Required [j Waiver
LID #:
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LATEMPOS"Cs\Forms\Street File Checklist.doc
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lipAPPLI&-rh WORK PERfk.' Application No. /....._..........
CITY". OF iEDMONlDS Building Department Permit Limit, One Year
APOLICATION is hereby made fora ;it to construct the following work, in accordance with the accompanying plane
. and specifications:
WORK- New/J.,,dd:r. .... 1..�Y......... ....... ................ ......................... Ground Area.................................... No. Stories..:.:.—..
Const. Type.. ...................................... Height ...... . ...... . .......
Plans Submitted. ........ ........
..
I
/ JL /
LOCATION —Address 1:1:7 .�.............. ........._. 'Ise Znne`....1 Fire Zone........_......._..
Recorded Lot ......9 ..._. Block. ....................
ock..................... Add'n...... .. !-...U�C4 ............-�...... Sewerage. . .
'Lot Area :....:........:...................::.... Width............................ Min. Bldg. Setbacks, Front and Rear............................... Sides ................... _._..
Plans by,
Bldg.
!! .............. Address(. ...... .......!lam :. �.... Phone �sa!X/
.......... Address.! :.......% ..............
57
..................... Addres'.e r-t ..... Phon .......................
Plbg. by............................................................................................ Address....................... ................................................ Phone ........................... ...
Heatingby..................................................................................:..... Address....
Elect. by............................................................................................ Address....
Remarks.............................................................................................................
.................................................................................................................................
.......................................................... Phone ....................... ......
....................................................... Phone .....................
The above is a correct statement and I agree to compl th all applicable Codes and State Laws regulating the Vork.
Signed: Owner/Age J ..,.0 .LC.I. �. 1G; .. / - . dress.. ........................................................... Date✓•--• �
PERMIT for the above work is hereby approved, subject to the above conditions, and to compliance with the approved.p'ians
and specifications and Buil.c:ing Department notations thereon.
VALUATION PERMIT FEES
�.a.a;..--/ ....aC'
APPROVED
Date...=/../Cl...s...........................................
BUILDING DEPARTMENT
B ` //6E
Bldg. $......
� ................
Plbg. $... v........................
Heat. ... $........ 3..................
Elect. ... $...........�
...........................
Others ... 3.....
00
TOTAL FEE $.r.G�.�.�.................
NOTES: No work requiring Building DepartmenE or City Engineer's inspection shall be covered before inspection and appro%W..
Twenty-four (24) hour notice requested. Contact the City Engincc: prior to construction of all site utilities, such Hs
curbs, paving, driveways, sewer, water and street connections.
C'. 6
PAck'N
ADDRESS-
0 'Vi N' E R a,-Z,
[0,
,c
K 1711-P
FQl
. 3
AF 770728
L OF
The City of Edwomb
A"LICA"ON CARD No.
for
SIDE SEWER PERAUT
OUTSIDE 0 INSIDE tj REPAIRS 0 EASEMENT No. ........ ...........
OWNER --- D. .. .... ................... ........................... ............. CONTRACTOR 6gry .. . . ....... ... ... .. . ... ........ ........ PERMIT No.
4.1, STREET
HOUSE......................... ... *#.
No........ .. ......... . .......... *5 ........ ............... AVENUE LOT No. .............................................. ... ................ BLOCK No. ............... - ......... ............... .............
NAMEADD . ..... ......... ...... ..... .. *leg..............................................._........
Date
BACKFILL WORK ORDER ISSUED ......................................... . . DEPOSIT, ...................
SEWER WORK ORDER ISSUED ........ .......................................
8
Approv
DATE,-- BY .....
Water Service D rgwing
The City of Edmonds
EASEMENT NO.
NEW CONSTRUCTION ❑ AS ❑ LID NO . .................. . ASMT. NO..................
OWNER CONTRACTOR ..................... ... .............................. ................ PERMIT NO. Z.OQJ*Zq
JOB ADDRESS .��.�......\.�C 5........................... LEGAL DESCRIPTION: LOT. 1VO....................................... BLOCK NO. ...................................
..................................................... ...............................................................................--....................
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NAMEOF ADDITION.....................................................................................................................
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Approved: to -7-71- 00 5VA
PVdAV-00ul•11175 (REV.11/78) DATE ............................................ By ............................................................
PUBLIC WORKS DEPART
IST
BUILDING PERMIT R�IEW 11 4
STREET FILE addressto
Street Right -of -Way Existing
2
Access Easements Existing- �Q j�)
{� REQD
F4
a
Utility Easement Existing kM
JO REQD
w
Lot Per Subdivision Plat Y,
Assessor Map ^
w
Site Plan Checked for Accuracy
(,Q
z
Underground Wiring Reqd.
H
C
Check Accuracy of Legal Description
`7 1
2
Review by N
Date_
w
Existing Water Main Size
Main Required
Service . e Required
Hydrant Size ing
P4
Hydrant Reqd Per Fire
Size
w
Detector Check Meter Reqd.
Cross Connection Inspect'
Fire Department Co is
Water er Charge Reqd.
'ew by
Date
Septic Tank Design Approved
Date
tic Tank Permit Regd.
Permit No.
Sanit Sewer Availability
Proj.
Drawing No.
File No..
Side Sewer Avai 'lity
w
Sanitary Sewer Connec ' Fee Reqd.
3 .
Review by
Date
w
v�
Open Ditch Existing
Reqd.
Culvert Reqd.
'ze
P4
Catch Basin Reqd.
Indica on Site Plan
Shoulder dra' e maintain collection an Swale open runo
H
M
e regd.
Indicate on Site Plan
oil Conditions and Ground Water Field Checked
Review by
Date
Revised: 1v10-1977
Page 2
I.." .. . ................ .
eet Paving Reqd. 1
H
Curb an ter Reqd.
W Sidewalk Reqd.
jt
Curb Cut for Driveway ReqRight-of=Way Constructi t ReqBond Regd. for is Improvements
Stre Sign Reqd.
ther Signing Reqd.
A .. Pre Permit Site Inspection made on
z
BY:
H
W W WATER
Pa
z STREET
ENGINEERING
Special Requirements listed in merm to Con mitt' Development Department,
Building Division
BY U () Date
o All items filled in on Building Permit Application
Pa BY Date
(421
a' Drawings Stamped and Notations Made
a
BY Date
Approved by Public Works Department
Kevised: lv 10-1977
PUBLIC WOWS DEPARMArWIST
BUIMING•"'i_. ,• WE
7 E 1141 : MiSr
FIL (address) *te
Street Right -of -Way Existing
Q REQD
2
Access Easements Existing tjn f,
b- REQD
H
Utility Easement Existing �j�` (�a
P-L REQD
w
Lot Per Subdivision —'' Plat
Assessor Map �—`
w
Site Plan Checked for Accuracy
z
Underground Wiring Reqd.
H
0
Check Accuracy of L'egaa Deescription
z
Review by �c� I
Date �1
w
'sting Water Main Size
Water Required
Service Line ed
Hydrant Size Existing
c�
Hydrant Reqd Per Fire Code
Size
w
'Detector Check Meter Reqd.
Cross Connection Ins on
H
Fire Depar nments
Meter Charge Reqd.
Review by .
Date
is Tank Design Approved
Date
Septic Permit Reqd.
Permit No.
Sanitary er Availability
Pro].
Drawing No.
File No.
Side Sewer Availabi .
w
Sanitary Sewer Connectio e Regd.
3
Review by
Date
w
Open Ditch Existing
Reqd.
Culvert Reqd.
e
w
Catchffditions
Indicate Site Plan
0
Shoulge maintain collection an swale open runof
H
Indicate on Site Plan
Soil and Ground Water Field Checked
Review by
Date
Revised: lv10-1977
Page 2
Reqd.
H
Curb and Gutter R
w Sidewalk Reqd.
w Curb Cut for Driveway Reqd.
a Right -of -Way Construction Permit
H Bond Reqd. for Public ements
Street Name eqd.
cn
0 Signing Reqd.
A.. ermit Site Inspection made on
z
a off BY: SEWER
H
w w WATER
w
U)
z STREET
ENGINEERING
Special Requirements listed in memo to Con=ity Development Department,
Building Division
BY f Date ix
o All items filled in on Building Permit Application I
*7 a BY Date 1
a' Drawings Stamped and Notations Made
a BY Date 177
Approved by Public Works Department
Revised: 1v 10-1977