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1561 10TH PL N
APPLICATION
for
The 'City of Ed'�s=mr-;'F--w SIDE SEWER PERMIT BASEMENT No. ................ I ......................
FILL
NEW CONSTRUCTION E] REPAIRS C]
•
OWNER --- ...... C:�� -------------------------------------------- PERMIT No'
----------- ......................... CONTRACTOR ..................................
0 -A pP ADDRESS .... 1-J LEGAL DESCRIPTION: LOT No. .......... BLOCK No . ................................... .... ................................
------------------- --------
NAMEOF ADDITION ............................................................................................................................................
6 ip7 c_
Approved:
p c-
DATE . .. . .. ....... I ...........
o
CITY OF EDMONDS
CIVIC CENTER — WATER -SEWER DEPARTMENT Can PR—Pect '6-1107 when work
,
la ready for Inspection. (No lnspec-
SIDE SEWER PERMIT lions 6atarday, Sunday or holidO
ays.) N_ 2776
ADDRESS _..1...... -"_.loth Place
i
"North.".
owNER Bingham............
CONTRACTOR_ --:-- Owner.-•------
-'!
Permission is granted .-.�'ebX'll y ---2'_'.'"'"'-•----•-----•---•-------------•
'19.6-�--,
---•--•----, for ....--•................ days to REPAIR or CONNECT a side sewer
With City Sewers in accordance with application on file
and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
�-
_ p., •
NOTE NO. 1—The owners of the property may obtain a permit to construct sewer inside
. be employed to construct side sewer in street area. Do not cover an Property line. A licensed
sewer Contractor must I No. 2—Obtain full
of sewer before
in
it s been inspected,
information regarding Ordinance 11.18.030 and Regulations governing side sewers
NOTE No. 3—Top of side
-
when
sewer must have at least 30 inches cover You get permit.
No bends in grade sharper than % will be �¢ at property line and 12 inches inside groperty line; minimum
of 2
NOTE No. 4—Trenches in street must be water settled andsurfaceof street restored to original condition. Contractors shall be responsible
failure due to Improper work which may develop within one year
'
of completio
NOTE No. 5--It e a unlawful to alter or do an other work than is provided for in the ponsible for
tenances except to insert the Y p permit, or to do any work on the main sewer
pipe into the wy¢.
or
or its appur-
appur-
_,
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1561 loth Pl.
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Edzpnds, Wash 98020 43101-6l�
Special
sec -lot Twp-blk rge Levy.code
13 27 3 152 c210
RT-59-60-66 BAAP ON S LN oOVT LOT S
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89° 471W 268.821FR SE COR TH N 0°381E
1251 TH S 89 47' W 1581 th S 00I
38 W 100
TAP WH IS N 0°381E 25'FR a PT TH IS S
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STREET FILE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
w MAILING ADDRES
c / 0 Th
CITY
1501m
NAME
w ADDRESS
2
U
CITY
NAME
cc ADDRESS ,
03 �'
2 CITY
X y&W
STATE LICENSE NUMBER
ZIP TELEPHONE NUMBE
1176- 420
ZIP I TELEPHONE NUMBE
6ATkd/ 14Dg'
escription of Property - include all
E NUMBER
33/3
EXPIRI,TION
Property
Tax Account
/3 4, 700 -Y- 07�1 0,Y
Parcel No.
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NEW
® RESIDENTIAL
PLUMBING
ADDITION
COMMERCIAL
MECHANICAL
REMODEL
APT. BLDG.
El SIGN
REPAIR
GRADING
CYOS.
FENCE
II x _FT)
DEMOLISH
WOODSTOVE
INSERT
SWIM POOL
HOT TUB/SPA
RETAINING WALL/
F1
❑GARAGE
CARPORT
❑ ROCKERY
RENEWAL
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
NUMBER NUMBER OF CRITICAL
I OF ' 'DWELLING Ow/ pp AREAS
I STORIES UNITS /YV NUMBER 1�1t+
' DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
7v 4e sovi?, f9'k "evelYe
i8NE
PERMIT
)26
NUMBER
JOB
ADDRESS
/� y
LEGAL DESCRIPTION CHECK SUBDIVISION NO.
:a:,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING
oanonscn
REQUIRED DEDICATION
METER SIZE I LINE SIZE I NO, OF FIXTURES
REMARKS
SIGN AREA SEPA REVIEW
ALLOWED PROPOSED COMPLETE ExEM
44,
EXP
,RIANCEIOR CU PLAIIINMG REVIEW BY
a
TESCP Approved
❑
RW Permit Required
❑
Street Use Permit Req'd
❑
Inspection Required
O
Sidewalk Required
O
w
PRV REQUIRED
YES ❑ NO 0
i
O
z
Ir
W
Z
' SETBACKS FRO T(/� FEETHEIGHT
/ V REAR �I �I LOT J�
SPECIAL INSPECTOR I AREA
REOUIRED
❑ YES
REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
VALUATION
Re/OCO _ Aw //�C
�Te
h h
PLAN CHECK FEE
BUILDING
HEAT SOURCE:
s�+Ci rcc/ Ali
GLAZING 11
O V %
PLUMBING
Plan Check No.
1-7
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
STATE SURCHARGE
PermltApplication: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
I harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
•
ENO. INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
3
O
Z
W
OCCUPANT
LOAD
O
2
0
m
I hereby acknowledge that I have read this application, t at t e
information given is correct; and that I am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and in doing the work authoriz•
AUTHORIZES
THE
signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor
ONLY
WORK NOTED
Deputy; and fees are paid; and receipt is
Code of the State of Washington relating to Workmen's Compensa-
acknowledged in space provided. ,
tion insurance and %.
INSPECTION
SIGNATURE (OWNER O AGENT) DATE SIGNED
DEPARTMENT
CITY OF
OFF $ IGNATURE ATE
6<14,1te. i�'�-�.c�.• 9 a9 ?#
�/
EDMONDS
ATTENTION
CALL FOR
INSPECTION
EASED y DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
-� 11
77" O0
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK — Owner GOLD — Assessor