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CITY OF EDMTNDS
CONSTRUCTION PERMIT APPLICATION
SE PERMIT
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L E A L DES,� ION C � E
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PUBLIC RIGHT OF WAY PEF1 OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
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SIGN AREA
ENV. REVIEW
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PROPOSED
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Legal Description of Property - include all easements
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SHORELINEO
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REPAIR RETAINING WALL El SIGN
EXCAVATE FENCE
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PRE -MOVE INSP.1 swim
REMODEL COMPLIANCE INSP. POOL
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TYPE OF CONSTRUCTION
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HEIGHT
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SPECIAL INSPECTOR
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AREA
OCCUPANCY
GROUP
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LOAD
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REMARKS
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NUMBER OF STORIES
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NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
VALUATION
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PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Anyconstruction on the public domain (curbs, sidewpiks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
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
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successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
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employees, and agents from any and all claims for damages of
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DATE: eg
MEMO TO: Permit Coordinator, Building Division
FROM: Dan Smith, Engineering Inspector
ADDRESS:/ o5 -760 A9 w
N ' A I/
OWNER:
After review of the subject building permit application, we have the
following comments:
1) Construction hours are: WEEKDAYS 7:00am to 10:00pm
WEEKENDS/HOLIDAYS 10:00am to 6:00pm
2) A Right -of -Way construction permit is required for any work on
City property.
3) Connection to City water system required.
4) Connection to City sanitary sewer.system required; obtain separate
permit.
5) Water and sewer lines to beseparated by 10 foot minimum.
6) Driveway must be paved a minimum of 20 feet back from City
right-of-way; separate permit required.
7) Driveway slope not to exceed 14%.
8) Back water valve required if downstairs plumbing is below
elevation of upstream manhole.
9) Builder/Owner responsible for containing all temporary runoff and
erosion control on site. Construction may not impact neighboring
properties in any way.
10) No burning of construction refuse without approval from Fire Dept.
11) Street to be kept clean of debris, dirt, mud, and construction
materials. Contractor responsible for dust control.
12) Inspection required on drainage system, catch basin installation,
driveways, and sidewalks. A final engineering inspection is
required prior to the building division granting occupancy.
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CITY OF EDMONDS
STREET FILE ASSET INFORMATION SHEET
EO/NEW
ADDITION
RETIREMENT
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION
DEPW. NO.
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
PROJECT NUMBER
PROJECT COMPLETION DATE 0
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COST 2
B.A.R.S. ACCO . UNT NO. !�-IZI -0 6) 4e(S— 00, 6-3
9
ESTIMATED LIFE- 4-AP45'-
INITIATED BY
DATE
APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
Z�DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
0 G.L. ENTRY
REFERENCE
tnp INITIAL
DATE
VERIFIED BY
PROCESSED
BATCH NO.-
DEPARTMENT FILE
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E:. R. P-E
C I T Y o f EDMONDS I I D. E ,:S I W '�' JR-Ml- I'T
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F o r IgSS 1-3202 PERMIT' -V, 0 On' 7
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Address of Construction: IC W-0-R-I&
Property Legal Description (Include all easements)
Owner and/or Builder:
Contractor & License No:.
Single Family Residence
M u I t i - Fam i 1 y (No. of Units
Comm ercial (No of fixture Units
Invasion into City'Ri�ht-of-Way: No ?�, Yes (If Yes, Right -of -Way .'
Construction Permit requi*red. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No 1�4-- - Yes (If Yes,' easement required,
attach legal description and.county easement number.)
PLEASE READ THE, ITEMS LISTED ON,THE BACK
I certify that I have read and shall comply Date
with the items listed on the back.
Permit Fee: _70 'Issued BY: C-,/
Trunk Charge: 6te Is:sued:
Assessment Fee: Receipt No.:
Partial Inspection:
Comments Date Initial
F*inal Inspection Approved:
Date 'Tnitial
Rejected:
eason
PERMIT MUST BEIPOSTE'D ON JOB SITE
Date. Initial
White Copy - File Green Copy .- 'Inspector
Buff Copy - Applicant
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(The City of Edmonds Side Sewer Drawing EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION REPAIRS E]
LID NO - ------------------ - ASMT. NO - ------------------
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JOB ADDRESS -------- 7-te 'r L4 ---c W�
- -------- & ---------------------------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ----------------------
---------------------- ----------------------------------------------------------------------------------------------------------------------------------
NAME OF ADDITION
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Approved:
PWW-0001 -11175 (REV. 11/78) DATE --------------------- By -- - — ------------------