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16215 70TH PL W
EITY f1F EDMONDS a .. STR
SET FILE
ENGINEERING DEPARTMENT
APPLICATION FOR. RIGHT-OF-WAY CONSTRUCTION PEP,MIT
L4 cZticr:r.:t to Cc.rplete A. & B mid Subl- t i. DupZLCcte)
A.
Permit to be i.ssi,ed to.
For work at: (address or vici ity)
Type of work to be done:
(Attach Draining 4lien AppJ.11itcaabble)- 1
Time Required -- Mart: , /v Finish: DS ENGIN
Owner: EYamined. by
NameDate
Mailing Address R marks
City.. - State Telephone Number
Contractor:
Name State License rlumb,er
Mailing Address
City., State Telephone Number
B,:
INDEMfNITY: 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, foreseen or unforeseen, that maybe made against
the applicant or the City of Edmonds, or 5ny of its departments or employees,
including but not limited to the defense of any legal proceedings including defense
costs, court costs, and attorney fees by reason of granting this'permit.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following. the final inspection and acceptance
of the restoration by the Engineering Department..
'Work. subject to i9 pec.,oi and restoration in accordance with City Code. A
24-hour notice ia� e� g eo-fo inspection by the Engineering Dertment.
Carl 775-2525./ p
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Signatur
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a Agy t Date Sign cl ,
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DO NOT WR I TE •BELOW THIS LINE (To be completed by Issuing Agency)
Permit 'Issued .(DatR�-—�-f-— Permit Number.---/ -7r
Fee: 'v >i O O Bond:
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Time Author..ized:��
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iNEER S VAL JOATE
:RING DEPT.
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CITY of EDMONDS --- PUBLIC WORKS DEPARTMENT
Routing of Building Permit Applications
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Proposed Property Address of Application: 1621-4-- 70th Place W. 033.3
DEPARTMENT
WATER
COMMENTS
DATE
S T R. E E T
SEWER
N 0 T E S
BUILDING
DEPARTMENT COMMENTS
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BUILDING DEPARTMENT Applicant Fill
PERMIT APPLICATION, Inside Heavy Lines
USE PERMIT
ZONE NUMBER P 16 1916
SE,
.1013
ADDRESS
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NAME IOR NAM.l,.E
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VARIANCE OR COND. USE
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HEIGHT
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MAILING ADDRESS
PROPOSED YARDS
LOT COVERAGE
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CIjT•Y TELEPHONE NUMBER
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FRONT SIDE REAR
SIGN AREA
ENVIRONMENTAL REVIEW
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ALLOWED PROPOSED
❑ COMPLETE ❑ EXEMPT
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REMARKS
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ADDRESS
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PLANNING APPROVAL DATE
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TELEPHONE NUMBER
LEGAL LOT
LOT AREA
SUBDIVISION NO.
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STREET R/W
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EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W FT. FT.
ADDRESS
CITY
TELEPHO E NUMBER
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REMARKS "
STATELICENSENUMBER 'r
CITY LICENSE.NUMBER
CHECKED -BY
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Leg;Description of Property "(Show Below or Attach Four Copies)
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STREET AND/OR UTILITY WORK
REQ'D. ❑ YES El NO
R/W PERMIT REQUIRED
- ❑ YES ❑ NO
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UNDERGROUND
WIRING REQ'D. El YES ONO
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TYPE CONNECTION ❑ YES
SANITARY SEWER ❑ NO
VERIFIED BY
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SEPTIC SYSTEM
APPVD BY CITY ENG. ❑ YES
❑ NO
PERMIT NUMBER
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REMARKS
METER SIZE
SERVICE SIZE
CLEARANCE
CHECKED BY
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REMARKS -
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aQ NEW 9RESIDENTIAL GAS
�j LINE
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
❑ ElNON-RESIDENTIAL Ej SIGN
El ADD
RETAINING
DEMOLISH ElWALL
ALTER ❑ EXCAVATE FENCE
OR FILL I X —1
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❑El REPAIR PRE-MOVESWIM
INSP. ❑ POOL
SPECIALINSPECTOR,
REQUIRED
❑ YES ❑_NO
JAREA JOCCUPANCY
GROUP
OCCUPANT
LOAD
F
PLAN CHECKED BY THIS SITE -IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.i
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REMARKS
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NUMBER OF STORIES
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NUMBER OF
DWELLING
UNITS /
m
NATURE OF WORK TO BE DONE
PROPOSED USE
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a PLOT PLAN INDICATE BUILDING
- ABUTTING STREET
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m
0
PLAN CHECK
NO.
KS,
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
VALUATION FEE