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16621 76TH AVE W.PDFIIIIIIIIIIII 6159 16621 76TH AVE W !`.'F„'�„*•,. �.,^I'^ga►T1I7�� •. f...� � A:•� ems' ::i'-' rl►�^ytn "'^ - T� -—'a�+@u',�.rr9s�.i���•,�.-�m,.,..�—.--�.- .. �..,1^�.•. — a. :City of Edmonds RIGHT-OF-WAY CONSTRUCTION PERMIT Permit Number: Issue Date• A. Address or Vicinity of Construction: 16621 76th Ave. W. GTE to place, operate, and maintain a buried service B. Type of Work (be specific): wi re f rom exi sti na pol e # 3270 1 oeated at 16621 76th Ave. W. then east to a residence 4t 16621 76th Ave. W. GTE to plow 1251, push 0 driveway and push no road. R 0.11f. footage: 5' C. Contractdr: GTE NW, Marilyn Holmgten, Permit Coord. Mailing Address: 2312C W. Casino Rd. State License #: vere t, WA 98204-1440 D. Building Permit # (if applicable): Contact: Jerry Scott - 774-5921 or Chuck Roberts, 771-9036 Phone:Maril.Yn: 425/710-0786 o 488-1628 mbl: 388-1358 Liability Insurance: Bond: $ a Side Sewer Permit # (if applicable): E. ' ❑ Commercial ❑ Subdivision ❑ City Project © Utility (PUD, RTX V;NG, CABLE, WATER) ❑ Multi -Family ❑ Single Family ❑ Other R W INSPECTOR: INSPECTOR: GTE W.O. # 2850-9P001DB 242310 F. Pavement or Concrete Cut : U Yes UNo G. Size of Cut: il x H. Charge $_ APPLICANT TO READ AND SIGN INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmless from injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, 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 proceedings including defense 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 THE FINAL INSPEC- TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED .BY CITY FORCES, AT WHICH TIME,A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT Two sets of construction drawings of proposed work required with permit application. . A 24 hour notice is required for inspection. Please call the Engineering Division,.771-0220. Work and material is to be inspected during progress and at completion. Restoration is to be in accordance with City Codes. Street shall be kept clean at all times. Traffic Control and Public Safety shall be in accordance with City regulations as required by the'City Engineer. All street cut trench work shall be patched with asphalt or City approved material prior to the end of the working day; NO EXCEPTIONS. I have read the above statements and understand the permit requirements and the pink copy of the permit will be available on site at all times for inspection purposes. Signature: Date: 10-27-97 David,Squires, (Contractor or Agent)Sectidn Manager -Access Design CALL DIAL -A -DIG PRIOR TO BEGINNING WORK PPROVED BY F, W FOR CITY USE ONLY RIGHT OF WAY FEE: TIME AUTHORIZED. VOID AFTER ' "Li',� DAYS DISRUPTION FEE/FUND 1 H: SPECIAL CONDITIONS: �i Pr RESTORATIONTEE: T OTAL FEE: RECEIPT.T N ISSUED BY: • . :.NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997 s ' 1' FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.) Comments• Diagram CONTRACTOR CALLED FOR INSPECTION 0 YES O NO Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: LEGEND PERMIT SUBMITTED BY GTE Z PEDS 0 POLES 0 ROAD BORES OVERHEAD LINES -- l.D. UTILITY POTHOLE O UG TRENCHING ---UCT R.C.W. E Q P - - - - - - - - - - - - -------------------------- No s' o v f ro pos J Ww - w w . - - w - - - r - - - - - - - - - - - - - - - - - - - - - l J - - - - V . .r - - - - - - - - - r - - - - - --w �� � - w � � l Z O r A rurs.m CI CITY of EDMONDS RECEIVED. SIDE SEWER PERMIT For Inspection Call 771-3202 J U L 519g�' i PERMIT NO. PUBLIC WORKS 1. LYNNW.00D LINE Address of Construction: Property Legal Description (Include all easements): Owner and/or Builder: Contractor & License No: Single Family Residence Mul ti-Family Commercial (No. of Units ) (No. of fixture Units ) Invasion into City Right -of -Way: No >— Yes (If Yes, Right -of -Way Construction. Permit required. Call One -Call -Center (1-800-424-5555) before any excavation.) 0 Cross other Private Property: No �_ Yes (If Yes, easement required, attach legal description and county easement number.) PLEASE READ THE ITEMS LISTED ON THE BACK I certify that I ave read and shall comply Date with the items listed on the back. Permit Fee:k3p,& Trunk Charge4, . , Assessment Fee: Issued By: Date Issued: Receipt No.:� Partial Inspection: Comments Date Initial Final Inspection Approved: C 1. Date Initia oRejected: Reason, Date Initial **{"PERMIT MUST BE POSTED ON JOB SITE ** a White Copy - File Green Copy - Inspector Buff'Copy - Applicant o Side Sewer Drawing The City of Edmonds ]EASEMENT NO- ------------ ------------------ NEW CONSTRUCTION REPAIRMSEAD.COKU. 1 LID NO. -ZIO----,ASMT. NO. ------------------ OWNER -------- ------------- CONTRACTOR ----- 0-%jt4-N-.ER ------------------------------------------------- I ------- PERMIT NO. 7 JOB ADDRESS ... -------- TIA 76 ------------------ LEGAL DESCRIPTION: LOT NO..--___-_____-___--____-_______-___-_-_ BLOCK No. ------------------------------------------------------------------------------- LYNfV1NO0D LINE -------------------------------------------------------------------------------- ME OF ADDITION N-1 -r14 %62A c7b tit 4 S' • 10.5 X ..................... ....... . .. ... Vbp- Irfib. 5 'I's IN, C^P 110P. 47 z P76 7- ACE - W. Approved: PWW-0001 -11/75 (REV. 11/78) 99Z CITY of EDMONDS SIDE SEWER PERMIT For Inspection Call 771-32OISTRE Z �ILE PERMIT NO. 07343 Address of Construction: zz�,z/ Property Legal Description (Include all easements): Owner and/or Builder: Contractor & License No: Single Family Residence �S Multi -Family (No. of Units ) Commercial (No. of fixture Units ) Invasion into City Right -of -Way: No >— Yes (If Yes, Right -of -Way Construction Permit required.- Call One -Call -Center (1-800-424-5555) before any excavation.)' Cross other Private Property: No �_ Yes (If Yes, easement required, attach legal description and county easement number.) PLEASE READ THE ITEMS LISTED ON THE BACK A " I certify that I ave read and shall comply Date with the items listed on the back. Permit Fee: Trunk Charge: C:5��" Assessment Fee: Partial Inspection: Issued By: Date Issued: Receipt No.. Comments Final Inspection Approved: Date Initial Rejected: Reason ** PERMIT MUST BE POSTED ON JOB SITE ** White Copy - File Green Copy - Inspector Date Initial Date Initial Buff Copy - Applicant 4 SIDE SEWER PERMITS 1. 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. 2. The side sewer contractor assumes full responsibility for each installation for one (1) year. 3. Commercial establishment requires a minimum of a six inch (6") side sewer line. 4. Side sewers may not be installed closer than thirty inches (30") to any structure. 5. Side sewer lines must be laid at a minimum grade of 2% (1.150) and maximum grade of 100% (450). 6.- No turn in side sewer greater than 450 (1/8 bend) is all.owed between cleanout. All 900 turns must be constructed of a 450 (1/8 bend) and wye with. removable cap for Cleanouts. 7. No down spouts, footing drains or floor drains can be connected to side sewer system. 8. Pea gravel is required for bedding when installing sewer lines through other than granular soil. 9. Cleanouts are required at 30"-60" from each plumbing exit line and at minimum intervals of 100' along sewer line run. 10. 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. 11. Cleanouts at property line and at house.will have risers.installed to within 12" of surface grade with removable cap. 12. Water test is required. 13. Side sewer must be left uncovered until inspected and approved by the City. 14. Inspection during normal working hours only. One (1) working day notice required. _ r r STREET FILE DATE:3�Zo 1-7R MEMO TO: Building Division Community Development Department FROM: Engineering Division Public Works Department SUBJECT: &(ADZ/ -7rD74+ A49 We MARK SIM MISOM After review of the subject building permit application, we have the following comments: (1) Coordination of the -location of any structure with respect to utilities, streets, property lines and driveway grades is the responsibility of the contractor. The contractor is required to keep the abutting streets clean- ed of dirt and debris cause e construction. _(3) A "Right -of -Nay Construction Permit" is required, from the Engineering Division of Public 1,1`orks, for any work within the Public Right -of -Way or public easement. 4) Driveway slope not to -exceed 14%. R � L lye. 101 • _ �C 4; " 3 6 + = C it _ G!-. 1L � . ►� � �� bj�. _ ..�•• P P, -hV ' �; ► �._. ► �,1 • `e� a I► , =� ll ► :.. �� PW 5/77 alp A - L :.PUBLIC WORKS DEPAR CHECKLIST BUILDING PERMIT REVIEW 74 /4.**40 W s (address)to Street Right -of -Way Exist' QD j 0 Z Access Easements Existing. QD___N.A _ p4 Utility Easement Existing_ REQD W Lot Per SubdivisiA - 4-1 --Z:;o Plat Assessor.11ap W Site Plan Checked for Accuracy" My ykj#*�e W ma Pei cc H Underground 'Wiring Reqd. % ". *Y . .5., Y E7 Check Accuracy of Legal Description .Z Review by Date 3 S -70 Existing Water Main Size — Water Main Required Iv Service Line Required Hydrant Size Existing CC r4 Hydrant.Reqd Per Fire Code Size D etector Check Meter Reqd. 00 Cross Connection Inspection 00 E-4 Fire Department Com-nents 'dater Meter Charge Reqd. 50 Review by Wts Date Septic Tank Design Approved Date -711I 7-7 Septic Tank Permit Reqd. Permit No. 77— AW. Sanitary Sewer Availability Proj. Drawing No. File No. Side Sewer Availability -- A-,/ . 'Sanitary Sewer Connection Fee Reqd. :3:. Review by wasDate JU. K. Open Ditch Existing_o Reqd. Culvert Reqd. d5gz c4 _,�A7 Catch Basin Reqd. .e Indicate an Site Plan 0 Shoulder drainage maintain collection on swale open runoff 4mag H A!;AX e4ggi&,dw ag Ze —&.1094X -CA Manhole regd. Indicate Site Plan Soil Conditions and Ground Water Field Checked Review 4 Call 0*00 Revised: 1v10-1977 Page 2 Street Paving Reqd. N)Y- H Curb and Gutter Regd.TA(,V= w Sidewalk Regd._ f- w Curb Cut for Driveway.Regd. x Right -of -Way Construction Permit Reqd.J E, Bond Reqd. for Public Improvements Street Name Sign Reqd. Other Signing Reqd. Q ...Pre Permit Site Inspection made on' z a off BY: SEWER H w ^wWATER i 1 4 V H H STREET ENGINEERING Special Requirements listed in memo to Comrunity Development Department, Building Division BY Date o All item 'filled in on Building Permit Application P4 BY Date ilia a' Drawings Stamped and Notations Made w BY N Date Approved by Public Works Department . . 4 p - Revised: lv 10-1977 ruUJ...1l.I Y'�\/lU� LiLlL]1\LIVL.l 1..l1LwWlaJl BUILDING PERMIT REVIEW (address) to 0 Street Right -of -Way Existing REQD z Access Easements Existing REQD H a Utility Easement Existing REQD w Lot Per Subdivisiors lat Assessor Map w Site Plan Checked for Accuracy z Underground Wiring Reqd. S H U Check Accuracy of Legal Description S 7� z Review by and Date 5115 I9 w Existing Water Main Size 8 ".DZ Water Main Required N D Service Line.Required N Hydrant Size Existing 0 ° c� Hydrant Reqd Per Fire Code Size w Detector Check Meter Reqd. w p Cross Connection Inspection 00 H Fire Department Comments 3 Water Meter Charge Req��A 3 Review by — Date 20 8 Septic'Tank Design Approved Date `7 // ?-7 Septic Tank Permit Reqd. Permit No. 77^ 3g(. Sanitary Sewer Ava-'-lability A/ 0 Proj . Drawing No. /(% File No. Side Sewer Availability a w Sanitary Sewer Connection Fee Reqd. .lJD 3 Review by i/ Date 3 2v 78 w X.K.K. Open Ditch Existing_/o Reqd. o Culvert Reqd. /1:5�- c4 Catch Basin Reqd. Indicate on Site P an Shoulder drainage maintain collection on swale open runoff H , 11inhole ., re d q /��' �-- Indicate Site Plan Soil Conditions and Ground Water Field Checked Review by Date Revised: 1v10-1977 BUILD 1 N 6 DEPARTMENT Applicant Fill ZONE a X NUMBER �7 ` : PRIifiIT APPLICATION Inside Heavy Lines JOB ADDRESS -' (OR NAME OF BUSINESS) �a J _ 4 JNAME LEGAL LOT LOT AREA SUBDIVISION NO. MAILING ADDRESS ®YES ❑NO z / _ STREET R/W 4- . EXISTING STREET R/W � FT. DEFICIENCY THIS PROPERTY COMP. PLAN ST. R/W FT. 10 FT. CITY ELEPHONE NUMBER ME REMARKS Z W F u 3 20 '18 W Z ADDRESS CH CKED It Q CITY V�lfY TELEPHONE NUMBER 2� STREET AND/OR UTILITY WORK REQ'D. IN YES ❑ NO PERMIT RE VIREO R/W ® YES Cl No z W NAME UNDERGROUND WIRING REQ'D. IF YES ❑ NO !r Q I• U Q ADDRESS _ / / TYPE CONNECTION ❑YES SANITARY,SEWER ®N O VERIFIED BY E ZAPPV'D CITY TELEPHONE NUMBER SEPTIC SYSTEM 16YES BY CITY ENG. ❑ NO. PERMIT NUMBER U STATE LICENSE NUMBER CITY LICENSE NUMBER REMARKS Legal Description of Property (Show Below or Attach Four Copies) METER ZE /i7 BUILDING SUPPLY SIZE H Q REMA KS Z o- F d SIGN AREA ENV. REVIEW ADB NO. ; !Y U to W 0 ALLOWED PROPOSED COMPLETE EXEMPT J Q REMARKS Q W J VARIANCE OR CU PLANNING REVIEW BY DATE YARDS r'I jy� FRONT / 1 "� SIDE �,5 /REAR LOT COVERAGE RESIDENTIAL ig NEW GAS LINE ❑ NON-RESIDENTIAL ❑.SIGN ❑ ADD DEMOLISH ❑RETAINING WALL ❑ ALTER ORCF LLTE � I ENCE X_�) FIRE ZONE TYPE OF CONSTRUCTION CODE . HEIGHT SPECIAL INSPECTOR AREA REQUIRED ❑ YES ❑ NO - OCCUPANCY GROUP OCCUPANT LOAD PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY REPAIR swim INSP. POOL OF SHOULDO EDS. CODEDASALES TAX 31 04. REMARKS F. NUMBER OF STORIES NUMBER OF DWELLING UNITS / Z W - F NATURE OF WORK TO BE ,DONE _ S L W z Q / 0 f zW PLAN CHECK NO. VALUATION FEE PROPOSED USE d U W 0 m Q PLOT PLAN INDICATE BUILDING SETBACKS, ABUTTING STREETS) BUILDING f d QJ W > W 0 PLUMBING HEAT a, GAS LINE FENCE Y I z SIGN f RETAINING WALL O u SWIMMING POOL TOTAL AMOUNT DUE 1 h. roh•. �r4nn• �A­ thot 1 h—, .. 1 thic—li—tinn• th•.I tha in- U� 1Jf IUfdi1� PUBLI$OKS DEPARTMENT, ENGINEE[JOWIVISION APPLICATION FOR RIGHT-0F41AY QNSTRUCTION PERMIT THIS PERMIT MUST BE AVAILABLE AT TFIE JOB SITE FOR INSPECTION PURPOSES Applicant to Complete Parts A and A, Permit to be issued to: Fo r Wo rk a t : (address or vic Type of Work to be done: ! Z ,� „ - 4-- uJAfio—L ke -W= le±! � (attach drawing when applicable) �— Time Required -- Start: Owner: Name 17 Ma.1. Address . , 2Z/� w , City State Zip Contractor: A t Z LAV0SC410;p -k4 CoA157_%, Name 6 0 2 9.3 �u1 Mailing Ad ress et; Ali City State Zip Finish: Telephone Number 2Z3- ( A-f ��.� Z -b State License Number or w. n... t)--11 Telephone Number ** NO WORK TO BEGIN PRIOR TO.PERMIT ISSUANCE ** B. 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, foreseen or unforeseen, that may be made against the applicant or the City of Edmonds, or any of its departments or employees, including.. or 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 Division. Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at which time a debit or credit will be processed for issuance to the applicant. Work is subject to inspection and restoration in accordance with City Code. A 24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220. I understand that this permit.mu t be available at the job site for inspection purposes at all times. w Signature: Date:_�— Owner or Agent TO BE COMPLETED BY ISSUING AGENCY: Date Issued: 7 Permit No.: 77 Fee �o -- Security Bond: Time Authorized: ��0 �,r ✓_t APPROVED BY `. Date : rn M. M � 1 =� CITY OF EDMONDS �� .PUBLN lk.aKS DEPARTMENT, ENGINEE�t'I*DIVISION APPLICATION FOR GHT—OF-CO,dSTR C 0FILE THIS PERMIT'MUST.BE_-AVAILABLE AT THE JO B .SITE FOR INSPECTION .PURPOSES J -pplican-7 to Complete Parts A and-B A, Permit to be issued to: For Work at:(address or vicinity) (z-2 4, IF r) .r/ Type of Work to be done: ,Br p,� (attach -drawing when -applicable) Time Required -- Starth. Finis: Owner : .SNn CAS Name ` Mailing Address 77 City_ tate Zip Telephone Number Contractor: Name State.License Number Mailing Address City State Zip r :Telephone.Number Be INDEMNITY: 'Applicant understands and by his signature to this application,.agrees ., to'hold the -City -of Edmonds harmless.from an injuries- damages" or claims of an Y J g � y kind or description whatsoever, foreseen or unforeseen, that may be against_ made the applicant or -the City of. Edmonds,.or.any of -.its department's -:or employees-,: " including or limited- 'the not to 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-'worlamanship and _. ' -materials fora period of ,o'ne year-foliowing .th ' . final inspection and; acceptance of the restoration by. the Engineering ' Division: Funds held from the Security Deposit' -(estimated restoration' fee)' will -beheld until the final street patch is completed, at which time a debit or credit will: be processed for issuance to the applicant. Work is subject to inspection :and restoration in accordance with City Code. A 24-hour. notice is required for inspection by Engineering. Call.,.775-2525, ext.-:220.. I understand that this permit must be available at the job site for: inspection" purposes at all times. / Signature:y- p; Date: Owner or Agent C, TO -.BE COMPLETED BY ISSUING AGENCY: Date Issued: Permit '1x-.�ajj�_Fee fs-- Security Security Bond: Time Authorized: APPROVED BY Date: i n— 7 7 1- 11 s 1018 PUBLIC UTILITY DISTRICT No.l of Snohomish Countyat,1T1-+ L nIA1,111v°AREA Rev.10177 Location 1. 1 -7L� � _. '+A!=, ''�" ''��¢ `' Date .1-1_7--TR W.C1.No. 8S. (- � N F- 1/4 S Z---7—T R Revision '"" Scale 1 Rea�son for work z t\I �T F� tom, 1� � %'� _ Engineer &A-1: ; 421 r. As Built - U.G. File No PERMIT REQUIRED FOREIGN CCINTS" Type ' , t 'i *�' .` " ^ - *:� • Company J.MA.Na. Date Granted Fees required Yes® No❑ Log Posted nventory '�"'� ITung 'P-i- T-DK -r- i Transf.Card I Pole Dept. JDate? I Map Poste Circuit Map Approvals i . EASEMENT =' ENVIRONMENTAL ANALYSIS Grantor Pote Granted Exempt under District SEPA procedures, Section III -A Paragraph, Items s Date ' /"I Interpretation Referred To: Date Released For Construction I Date By Date Work Completed By Foreman Circuit Number j � ^- �`�- Substation a:- r ,7,"P I O.H. U.G. Cond ? Add Water Sewer Gas Backhoe .:i 1 � r,VC- � 42 I WI '� i I�Ca2t I C�S,t-F'f" PH Ckt Ft PH Ckt Ft 0 W.O. No. 'S �" a <o � I Y • 1018 PUBLIC UTILITY DISTRICT No-1 of Snohomish County� n(I -r4 L "r"A},T ¢'AREA ' Rev.10177 Location -7 h 7 �} _ �1 z \, � :_� R.3 - Date -1 - 1-7 - -7 s W.O. No. 8 9 -2, � IN � 1/4 -7 5 2-_T _R Revision Scale_ Reason for work 1 fvI SM F' 7J '"%� Engineer Er^X-I d-- As Built t mc:-' K l -.^ raj U.G. File No. Approvals _ I PERMIT REQUIRED Type L 11'!, , 772, 4 ! Date Granted Log Posted Inventor Transf.Card Pole Dept. pyian Posted I Circuit Map 4� FOREIGN CON TS" Company- J. RN. N0. Fees required YesS No❑ Type 7' i + T-nA-t" - Date 7.r'1 11 Amount 2-1 , EASEMENT Grantor Dsate' Granted Date Released For Construction Date Work Completed By Foreman Circuit Plumber 11 Substation I¢ 1` I =i A P 23C>y ENVIRONMENTAL ANALYSIS Exempt under District SEPA procedures, Section III -A Paragraph R, Item I Date_ '/'1-7 By v h rt, tom; Interpretation Referred To Date By O.H. U.G. Cond _�„�_. Add C PH I Remv� ' ` Ckt Ft PH Net, ..- Ckt Ft water Sewer Gas Backhoe a� � 4 I LV I 1(nto21 i I i !s, CM bU T *� �. F- Z 0 9 X S 1i T . -7 V)7 a BUILDING DEPARTME Applicant Fill � �/))) ",,,,,1 ZONE a �( X BER �i Inside Heavy Lines PERMIT APPLICATIO t �06 ADDRESS _ NAME (OR NAME OF BUSINESS) �a3' µo3V LEGAL LOT LOT AREA NO. - W'r 0 Z MAILING ADDR SS / _ //� IN Yes ❑ NO SUBDIVISION J-47. 0 STREET R/W EXISTING STREET R/W �� FT. DEFICIENCY THIS PROPERTY COMP. PLAN ST. R/W A _,D FT. 10FT. l� CITY o ELEPHONE NUMBER �s = TfAME REMARKS Z W W ADDRESS ICICKED W Z U U C CITY TELEPHONE NUMBER STREET AND/OR UTILITY WORK REQ'D. ® YES ❑ NO R/W PERMIT RE42UIRED a YES ❑ NO Z W NAME UNDERGROUND WIRING REQ'D. YES ❑ NO E Q H Q ADDRESS _ V TYPE CONNECTION ❑ YES SANITARY SEWER NO VERIFIED BY E Z Q CITY TELEPHONE NUMBER SEPTIC SYSTEM NYES APPV'D BY CITY ENG. ❑ N O PERMIT NUMBER V `� U STATE LICENSE NUMBER CITY LICENSE NUMBER REMARKS ' Legal Description of Property (Show Below or Attach Four Copies) METER IZE BUILDING SUPPLY SIZE REMARKS'F- Q Z 0 ; SIGN AREA ENV. REVIEW ADS NO. C ALLOWED PROPOSED COMPLETE EXEMPT U W W Q J Q REMARKS L9 W J VARIANCE OR CU PLANNING REVIEW BY DATE YARDS a�l FRONT I /X SIDE -.2 .5/REAR LOT COVERAGE NEW RESIDENTIAL ❑GAS LINE ❑ NON-RESIDENTIAL ❑ SIGN ❑ ADD DEMOLISH WALL ElDEMOLISH ALTER F-1 ORCFILLTE El I —FENCE X—Fr) FIRE ZONE TYPE OF CONSTRUCTION CODE HEIGHT SPECIAL INSPECTOR AREA REQUIRED ❑ YES ❑ NO OCCUPANCY GROUP OCCUPANT LOAD PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY PRE -MOVE swim ❑ REPAIR El INSP. El POOL OF EDMONDS. LOCAL SALES TAX SHOULD BE CODED 31.04. REMARKS f. NUMBER OF STORIES NUMBER OF DWELLING UNITS / Z W I- NATURE OF WORK TO BE DONE - S I Q 6 W Z Q / — o I- Z W PLAN CHECK NO. VALUATION FEE PROPOSED USE IL E N W O m Q 0 PLOT PLAN INDICATE BUILDING SETBACKS, ABUTTING STREETS) BUILDING IL 0 J W > W 0 PLUMBING HEAT & GAS LINE FENCE 1. Z SIGN 3 f TEET FILE RETAINING WALL Q u SWIMMING POOL ,, II. ,r I h.:,. ., „+ .t,,, •,n„li -,ti„n that the in. TOT AL AMOUNT DUE r�: =f o•, Li ew STREET FILE ZONE (i �'-0 _._...-SE��AKS: FRONT -i Azl g SzD OTI.-IE,F� _.. HEIGHT M WE Tll)oftwAry M(W PE P&LCCAWD CITY OF EDMONDS P. W. DEPT. ENGINEERING DIV. EXAMINED -._...._.. I .. .'' k :.......:.............___`.`:.:,..�:.�..:....:..._:.:.... BY DATES REMARKS 78032 Civic Center • Edmonds, Washington 98020 Telephone (206) 775-2525 Office of the City Engineer APPLICATION FOR A SEWAGE DISPOSAL SYSTEM PERMIT (Submit 3 Copies) Permit to be issued to: Mr: & Mrs. Mark Simonson; 9404 - 232nd St. S.W. Edmonds, WA 98020 ......................................... • For installation at: (stree� address) ......................... ...-----....--------- *............. P.to ............................. :. See Attached Legal) Addition or Subdivision ._Meadowdale_.Beach................................................................ Lot ....... 94.... Block ................ Type of Building: New....?...... Existing ............ Single family residence .....?......... Number of bedrooms ....... 3........... Other: (specify type or use)----------------------------------------------------------------------------------------------------------------------------------------------------- Builder------------------------------------------------------------------------------------Address------..............---------------------............-----..........------.......... Designer Reid, Middleton & Assoc, Inc. Address 324 Main St. Edmonds, ... WA 98020 ..... .... . .. Soil Log Hole No. 1 .P-1-.-0'-'-. 8"...G.r.a.v,;d 1.y....$a-ndy---Loam..G4�r.s-.,...2$I---.36'.'.__Coa.rse-....ravel-1_y.-Soi 1 ............)------------------------------------------------------------------------------------------------------------------ Soil Log Hole No. 2 ..P#2 0"-22" Gravelly Sandy Loam, 22"-34" Coarse Gravelly S.O.i 1 3�t"...1.1..y.., Q.CaY.�1..1.y.... 5.QU....W/sma-j-1-- c1.ay....globs....------------------------------------------ Elevation of Water Table, if encountered. (Distance from ground surface) ..... 5.&.34'-'... ep.ish................................ Corrections to control surface water if needed .......... ....... None.......................................................................................... Specify if any removing or grading of topsoil in field area.............None .............................................................................................................................................................................•----.......---............ Percolation: Test Hole No. 1 — Average Rate 5m i n/ i n @ 36: Depth (Fall in minutes/inch-bottom 6" test hole) Test Hole No. 2 — Average Rate 4,.6.7..mi.n/-in..@--- 3.4'.::..Dep.th-.(Fall in minutes/inch-bottom 6" test hole) 5 9 mi n/i n @ 36'' Depth (Fall in minutes/inch-bottom 6" test hole) Test Hole No. 3 —Average Rate .....'.... / Average percolation rate on which to base drain field design .... 5... mi-n./..i.n..................... Date Taken.1.l... June ....1977 Septic tank requirements based on present rules and regulations: �`9 Septic Tank Size ....1 UOQ.............. gallons. ��� Amount of Square Fed of Disposal Field .... 555..sy - t;� 4 c` � ..------- Date ..1.6.. J.un.....1.9.77.r Signature —Designer .....:. ; , .y.,r ,. c.�-- .. ........... DO NOT WRITE BELOW 7 HIS LINE (To be completed by Issuing Agency) Q/ / Permit Number ........�.. ...72.� ...................................... 77 Permit issued (date) ............. /�./.. /..7 Remarks: --- c.%z.......... ... .../- .................................... .......................... .........................................................