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CITY OF EDMILMIDS
CONSTRUCTION PERMIT APPLICATION
USE RMIT
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ADDRESS
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NAME (OR NAME OF BUSINESS)
LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
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11_11 N
161
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
PEXISTING ROPO E REQUIRED DEDICATION
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CITY TELEPHONE NUMBER
NAME ��! �/�� /J //
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RIGHT OF WAY CONSTRUCTION PERMIT REOUIRED�J
STREET
STREET USE PERMIT REQUIRED I I
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ADDRESS
SEE ENGINEERING MEMO DATED / ✓'
SEE PIW DEPT. REVIEW CHECK LIST DATED _.
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CITY
jTELEPHONE NUMBER
REMAR/KS//
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ADDRESS
METER SIZE
BUILDING SUPPLY SIZE FIXTURE
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CITY
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TELEPHONE NUMBER
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REMARKS
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STATE LICENSE NUMBER
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CITY LICENSE NUMBER
SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADB NO.
SHORELINE #
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Legal Description of Property - include all easements
(show below or attach four copies)
VARIANCE OR CU
PLANNI RE EW B
DAT
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YARDS
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LOT COV�E,R•AGE
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REMARKS
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_NEW RESIDENTIAL LUMBINGFl
ADD/ALTER NON-RESIDENTIAL KLECHANICAL
REPAIR RETAINING WALL El SIGN
EXCAVATE FEN E1:1� //
DEMOLISH El OR FILL l ! x -,' FT)
❑PRE -MOVE INSP./ ❑ SWIM
COMPLIANCE INSP. POOL
.
CHECKED BY
TYPE OF CONSTRUCTION CODE
HEIGHT
SPECIAL INSPECTOR
REQUIRED
IiYES NO
AREA
OCCUPANCY
GROUP
OCCUPANT
LOAD
�-7
IDE SEWER:RWATER LINE
REMARKS
(7
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wNUMBER
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OF STORIES
NUMBEROF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) IV1
VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
GRADING/FILL
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
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"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
PUBLIC WORKS LEPARIl= 41LIST
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�BUIIDIlJG PERMIT REVIEW/,�% _5 4,6 ,S• / •Z,/•
(address) to
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Street Right -of -Way Existing -Slp "
REQD
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Access Easements Existing ,tf//9
READ
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Utility Easement Existing e2- 4,V2
REQD__
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Lot Per Subdivision f-,J-- Z Plat
Assessor Map
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Site Plan Checked for Accuracy 1,7k
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HUnderground
Wiring Reqd.
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Check Accuracy of Legal scri tion % , ej-
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Review by � T
Date / v
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Existing Water Main Size "
Water Main Required
Service Line Required
Hydrant Size Existing
9
Hydrant Reqd Per Fire Code
Size
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Detector Check Meter Reqd.
Cross Connection Inspection
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Fire Department Comments
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3
Water Meter Charge Read. ,,Q, °�✓
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Review by
Date
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
Proj.
Drawing No.
File No.
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Side Sewer Availability
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Sanitary Sewer Connection Fee Reqd.
3
Review by
Date
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Open Ditch E ' ting
Reqd.
Culvert Reqd. p Apg e(1
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Catch Basin Reqd. I ` l
`) Indicate on Site Plan
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Shoulder drainage maintain collection an swale open runoff
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rbnhole reqd. 17
91i ;ate on Site Plan
Soil Condi.ticns�d Ground Water Field Checked
Review by �Q
Date
Revised: lv10-1977
•
•
MEMO TO: Building Division
Planning Department
FROM: Engineering Division
Public Works Department
DATE.: J`— 2z/�5
,
SUBJECT: �1,/.�- /�, � GZ,.e
After review of the subject Building Permit application, we have the following
comments:
1. Connection to City water system required.
2. Connection to Citv sanitary sewpr cvctom raniiirn(i
3. Right-of-way permit required for any work on City property.
4. Driveway slope not to exceed 14%
5. Backwater valve required if downstairs plumbing is below elevation of
upstream
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 apy why.
BD 6/82
AIT 7 79'
CB 4?
1(-)A
VTY OF, E-6-PRO-i-OW
SLOG. DEPT,
CONDITiON*AL PtAlIvilf
WORK.
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OWNER--
APPROVED CA;
A E.
-201 rill
BLDG. OFF;
MAX 7S'S
Q) KEEP THESE
STAMPED
c;
ru "U" PLANS ON jOi3SrTE FOR
MAW'FLk. e 720. >1 N ALL INSPECTIONS
CAP — — — — — — — — — - —
FL Z/ co
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PERMIT NO. j SHEET
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1/�97_
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7, INV-
20/. 70 - 8 /V
PLUG
03
10
ZONE Av,s - I/ A.
OF
APR 2 8 -1983
CITY OF EDMONDS
❑ NEW
•
❑ ADDITION
❑ RETIREMENT
STREET FILE
ET INF RMATI HEET
ASS 0 0N S
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
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SERIAL NO.
LOCATION DEPT. NO.
3 Z ! 40
*PURCHASE ORDER NO. *PROJECT NUMBER w 3 .1 S' �g 73
PURCHASE ORDER DATE PROJECT COMPLETION DATE -3
COST COST 2 37. 3 6
B.A.R.S. ACCOUNT NO. It -Imo - o / v - 3 �/ 5� -c� o - 6
• ESTIMATED LIFE 2 s�
INITIATED BY DATE APPROVED BY
*SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
`SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
L� DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT _
G.L. ENTRY
REFERENCE
INITIAL
VERIFIED BY
PROCESSED
BATCH NO.
DATE
DEPARTMENT FILE /
CITY,OF.EDMONDS
�PTJBLIC WORKS DEPART FOR INSPECTION CALL •Permit g�
1P 45�- q2 �Ex't. ssue
2%2 "S270 I,Date SI),,)E SEWER PERMIT _ — �r��s �u
PERMIT MTST" SE-PTED 01r-MB SITE
' "Aft EDMON09
-1. Address of Construction I3i.� 12--n4 Aim. 0, TREATMENT PLANT
2. - Property Legal Description (include all easements) ir.o4 c�.
�,� t. 7 ,S gi 1. ff i S 9, f? z
3. Single Family Residence Multi -Family No. of Units
Commercial
4. Owner and/or Builder WQQQCi2Ar-r
5. Contractor & License No. In/nn�ieui l �(a d
6. Invasion into City Right -of -Way: NoYes (If Yes Right=of-,
way Construction Permit Required - Call Dial Dig (342-5344) before °
excavation).
H 7. Cross other private property: Yes No Easement required -
attach legal description and county easement number.
H
a READ THE FOLLOWT,,NG AND SIGN:
a. Property owners must obtain a permit to install side sewers on
>4 their property. A licensed side sewer contractor must be employed to
construct side sewers in the public right-of-way.
w b. The side sewer contractor assumes full reponsibility for each
H installation for one year.
aC. Commercial establishment requires a minimum of a six inch (6")
X side sewer line.
.0 d. Side sewers 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)
O and maximum grade of 100% (450). o
H f. No turn in side sewer greater than 45 (1/81bend) is0allowed
between cleanout. All 90 turns must be constructed of a 45 (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. Two (2) working
days notice required.
DATE: 7DN/9(3
t I certify that I have read
and shall comply with the above
PERMIT FEE: ='AL zsv-" ���' DISAPPROVED BY: Date:
c� w d By • Date: _
CONNECTION FEE:
o APPROVED By :. Date: 8- 83
* PERMIT MUST BE POSTED ON JOB SITE
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The City of Edmonds
Side Sewer Drawing
EASEMENT NO, ------- ----------------------- ------------
NEW CONSTRUCTION REPAIRS Ej LID NO- ----------------- - -ASI%ff. NO. --------
OWNER OO.M-C.RP.FT ---- VkOKSS ------- 1MG .................... CONTRACTOR RULLI)IO-7-1-M.-C7 ----- PERMIT NO. :Ml(0...
JOB ADDRESS --- ---- - --- - ---------- LEGAL DESCRIPTION: LOT NO. 134-2-2 - ---------------- BLOCK NO. .1 - ----- -- F _j)%4j0j4C6-. , I
TREATMENT PLANT,
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NAME OF ADDITION VIEWIAMD ....
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Approved:
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CITY OF EDMONDS
70
PUBLIC WORKS DEPAR FOR P TION CALL 41 Permit � 11
xt. 220
S�iDE SEWER PERMIT � 5 Issue Date
* PERMIT MUST BE POSTED ON JOB SITE *
1. Address of Construction
-ryi
f-DMONDS
TREATMENT PLANT
2. Property Legal Description ( include all easementss)-'ERiu;-r # r.33OZ71
{
3. Single Family Residence Id Multi -Family No.t.of Units
Commercial
4. Owner and/or Builder 1A)yd(Z--.12AFf /-tom/ U.-S
5. Contractor & License No.
6. Invasion into City Right -of -Way: No Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
7. Cross other private property: Yes No Easement required -
attach legal description and county easement number.
READ THE FOLLOWING 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. Commercial establishment requires a minimum of a six inch (6")
side sewer line.
d. Side sewers 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% (1.15°)
and maximum grade of 100% (450).
f. No turn in side sewer greater than 45° (1/8,bend) is0allowed
between cleanout. All 90 turns must be constructed of a 45 (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. Two (2) working
days -notice required.
DATE:
I certify that I have read
and shall comply with the above
PERMIT FEE: �CD�
7? UA✓Z
CONNECTION FEE:
* PERMIT
DISAPPROVED By: Date:
B y: Date:
APPROVED By : Date - _g3
T BE POSTED ON JOB 5 TE
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Side Sewer Drawing ;
The City Of Edmonds EASEMENT -NO.. ................................ .
NEW CONSTRUCTION (_' REPAIRS ❑ LID NO..:::::, _:..:,.:.;ASMT. NO. ....::.:..:..:_._.
OWNER.�OQnGRAF---E.-.-I-.0nF-S ...... INO...................... . CONTRACTOR;RU.L.LL147-J.N.G......PERMIT NO. 70.1140..-
:,. JOB ADDRESS ...1 .,. ::..:-...1 �.-.--.--.A�IE LEGAL DESCRIPTION: LOT NO. _ZZ................... BLOCK NO. .._...__._E pp.._. '
4 TREATMENT PLANT
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..........-- .------•--------•--•.... -----------------•---- •
NAME OF•ADDITION AIIEW.L-AJ4�.... i ►Gl1..1.......................................
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