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ADDRESS: 11 6a V I
TAX ACCOUNT/PARCEL NUMBER: ' I
BUILDING PERMIT (NEW STRUCTURE):�' 0&
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 (OTHER): I !I to 'Q—
jcffa-r)hggl FpAr9) . i
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORT PLAT FILE: sm W615 LOT:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DA'
(9A1i11OQ�2�
A
LID #: (' /
BLOCK:
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CITY OF EDMONDS
COMMUNI JY SERVICES DEPARTMENT
RIGHT-OFf WAY CONSTRUCTION PERMIT
A. • Owner
Washington Natural Gas
Pbgy 156 Av Nit
laTpgvue,Address 1A
City State
• Address or Vicinity of
Type of Work to be D
Permit No.
Issue Date,?) �))s
B. • Contractor: Sam
Name
98007 T g �;�: T Film
ng Address
Zip City State Zip
447-0700
State License Number
Telephone Number
Work in Connection With: ❑ Sub or Plat ❑ Single Family ❑ City Projects
❑ Commercial ❑ Multifamily C Utility
Pavement Cut: ❑ Y ❑ N
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, forseen or unforseen, 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 proceed ngs1ncluding defense costs, court costs, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING, HE FINAL INSPECTION -AND ACCEPTANCE OF THE. WORK.
Funds held from the Security Deposit. (estimated restoration fee) will be held until the final street patch is completed
by City forces, at which time a debit or credit'willf be ;processed for issuance to the applicant..
7_
• A 24 hour notice is required for inspection; Please call Public Works: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
no exceptions.
I understand the above,Aand that thi§,per=rriif"'mus1b�vailable at the job site for inspection purposes at all times.
�. 8-18-88
Signature: Date:
Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
ISSUED BY: ��� .. M ✓
Time Authorized: Void after— ci days.
Special Conditions:
PERMIT FEE: I 3d -�U hC b110
Security Deposit:
Receipt No.:
Fund III Fee:
Amendments:- Street Cut Dimensions:
X =
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
i
FIELD INSPECTION NOTES (Fund II I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July V
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APPMATION ' BUILDING'- PERMIT
CITY OF EDMONDS B04ding' ®epartment 'Permit:* -limit, one y "ear �h. r""
APPLICATION is hereby made for, a permit to construct: the following work, in' accnrdarice ;anth the accom f ` 1
s L
panying plans and specifications: Two sets .are submitted herewith• for approval. �t
new -alter *,
Off •St
Workaddn repair ............... .............................. ,.......................
:.. - , : 1
Paikingr
Occupancy T1 - Const.• type--•---------------•--.._. Use zone_:+d'"� _: Fire zone
Addre_cs........ .1- may 1_� Gt ........................ Blk._..-•-••-••--..-•--•-• Addis .:..::... .......'_-••-•-_---- } rt jj
Lot frontsge -.....------•••-• Are •------•-•••-----•--••--• _------------- Septic tank_.....................:
Bldg. set -backs — front________. .-._._..__. r. side___________ __ /r�2!70 1. side_•___--._. ____�rear' t t g __._.._ �_. - .- � .�__. --•...............
Owne .....................C.� Address__ // 7i eJ
`---••---• .Tel NoT�fl�
Builder ............ •................ Add
ress--------------------------------------------------- Tel No :
Plans by Address
--•-•••----=--•--...• .. Tel.`. No .............. ..:.. + ;� st
Remarks_
-----------•................................................
The above is a correct statement, and Iagree to comply with • all applicable Codes and State laws ;regulating this r {�
work_ j -
Signed Owner/Rg 11 ---- �k�_ Address-----------•-----------•----• ....:........... Dat�✓n:� %'-�.• :}
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PERMIT for the aLove work is herebya rovedconditions,�,.+.;•,.� � sub to the above -
PPand to coin" hence=
proved lens and _ . p p specifications, and Building Department notations thereon. .. ;;.:;�.;;;pr'„ •.v4� 1
Valuation .......... ' _ __________ Permit fee _... r� .................. Recd. b f y...................................................
Building Department, BY - Date_::_.
---------
INSPECTION ' RECORD
Fdn, OK ............... Frame, OK Final, OK.._.:_...::__.:...: "
This Permit does not cover Plumbing, Sewer or Electrical installations. I
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CITY OF EDMO DS
CONSTRUCTION PERMIT APPLICATION
ubt _ PERMIT
ZONE NUMBER
�joa
ADDRESS
NAME"" R NAME OF BUSINESS)
LEGAL DESCRIPTION CHECK
SUBDIVISION NO. LID
NO.
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MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
PROPOSE v
CITY
TELEPHONE NUMBER
Sy 0 3
NAME
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED "
STREET USE PERMIT REQUIRED C
ADDRESS
SEE ENGINEERING MEMO DATED
CITY
TELEPHONE NUMBER
REMARKS
(
NAME
ADDRESS
METER SIZE
BUILDING SUPPLY SIZE
FIXTURE UNITS
a:
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CITY
TELEPHONE NUMBER
REMARKS
STATE LICENSE NUMBER
�L
SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADB NO.
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Legal Description of Property - Include all easements
(show below or attach four copies)
SHORELINE q
VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS
FRONT SIDE REAR
HEIGHT
LOT COVERAGE
REMARKS
NEW R RESIDENTIAL
ADD/ALTER El COMMERCIAL
REPAIR RETAINING WALL
EXCAVATE
DEMOLISH OR FILL
REMODEL COMPLPRE-MOIANCEVE SN6P.
PLUMBING
MECHANICAL
El SIGN
FENCE
( x_FT)—^
POOL
CHECKED BY
TYPE OF CONSTRUCTION
CODE
HEIGHT
SPECIAL INSPECTOR
REQUIRED
0 YES U NO
AREA
OCCUPANCY
GROUP
OCCUPANT
LOAD
E WOO SERT.VE/ APT. BLDG
RENEWAL
REMARKS
PROGRESS INS T]I nf--ER LIBQ 355, gm
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NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
VALUATION
/ PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY. GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year •Provided Work is Started Within 180 Days ENERGY CODE
"Applicant, on behalf of his or her spouse, heirs, assigns and
w successors in interest, agrees to indemnify, defend and hold
J harmless the City of Edmonds, Washington, its officials,
Q employees, and agents from any and all claims for damages of
= whatever nature, arising directly or indirectly from the issuance
MEMO TO: Building Division
FROM: Engineering Division
SUBJECT: /Lf IOW/) V114
After review of the subject building permit application, we have the
following comments:
1) Connection to City water system required.
2) Connection to City sanitary sewer system required.
3) Right-of-way permit required for any work.on City property.
4) Driveway slope not to exceed 14%.
5) Back water valve required if downstairs plumbing is below
elevation of upstream manhole.
6) Water and sewer lines to be separated by 10 foot minimum.
7) Builder/owner responsible for containing all temporary runoff and
erosion on site and may not impact neighboring properties in any
wa.y
8) Construction hours from 7:00 a.m. to 10:00 p.m. on weekdays and
10:00 a.n. to 6:00 p.m. on weekends and holidays.
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SPREADER) ._
SYSTEM CROSS SECTION
SEE P4GE 3 FOR OUTLET CONTROL_ DETAIL_
2' �' o=�p, _ c2Usu_o ROCK
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RUNOFF SPREADER OUTLET
DETEI,!T10H S'�
PAGE I OF 3
ror 31 6�sr
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date
DESIGN DATA
System Imperm Pipe
Pipe
Orifice
Number Area Diam
Length
Diameter
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S10011,S
17p
1 7 g
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and find inspections.
2. Responsibility for operation and
maintenance of drainage sys_ems on
private property is the responsibility
of the property owner(s). Material
accumulated in the stora;a Pipe must
be flushed out and re-o':e' from catch
basins to allow proper o;er=Lion. The
outlet control orifice :m;s- be kept
open at all times.
ai0104.,,c0 GZeQ ✓Jt c�
CITY OF EDMONOS
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No ...........................................
NEW CONSTRUCTION ❑ REPAIRS ❑
119-01300
OWNER........... paVl.d... E•... dililett........................................................ CONTRACTOR .--•-------•--------•-•........................................................................... PERMIT No.......................
ADDRESS .......11.52...V1ewl dnd.-Way LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No.............................................
K I
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4
NAMEOF ADDITION............................................••---.........................---..............---...........................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By......................................................................