17631 69TH AVE W.PDFiiiiiiiiiiii
5284
17631 69TH AVE W
APPLICATION
The'City of Edmonds for EASEMENT NO . ............................................
SIDE SEWER PERMIT
ar"910REET FILE NEW CONSTRUCTION REPAIRS n LID NO . .................. ASMT. NO . ..................
PERMIT NO.
OWNER ...... ........ H.C:�>KA.F ........ I ............................ CONTRACTOR
...................... ... -T
.. ................................ I ----- - -
JOB ADDRESS ---
.. . ...... ------------------------ ---------------------- LEGAL DESCRIPTION: LOT NO . ............. ................ BLOCK NO . ...................... .............
---f5-T ........................................................................................................ r ----------------------------------------------------------
N 114 'U=-W F��kz' ----------------------------------------- .......
URACY-Tfi' 16f
O.F AGC e ivnn en tho
attached map was compile d for use by the City of EdMc7:-.1J`
and consul'ants. The City of Edmonds doe� not
anything se't forth on the map. erson or BnUty j a c_-;y
u idni th
regarftg
inc.luding, but rin't limited to, the location of
shc-:.i. Surda se -vier stub, may or may noi exist and may or r.--,j PC! c:":1 El
;th- lo eat'u;; sh'01"jil, Neither the City of Edmonds nor its Cr
ff'i c!.,;' 6 00 ba liable for tht, information given on this map, nor for Lly
representation provided based upon spid map
f
47
—4�
L-CD-r -B
I
Approved: I L-4::>-r
DATE :5;;;7 --------
3-7 '—\dl
-61
0
CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
0
call 775-2525 for side sewer inspections
BEFORE covering any Portion of the construction.)
(Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.
ADDRESS LOCATION OF CONSTRUCTION .......... _=z
PROPERTY LEGAL DESCRIPTION .......... � --± . ....... W ...... . .......................................................
. ...... 7�� . ....... I ...... CA
. ..... . . .........................................................
.................................................. . ....................... ........................................................................ . .............. . ................................... ..............................
--------------------------- * ----------- --------------- OWNER AND/OR BUILDER ...... ---------------
_A4 --------
CONTRACTOR'S NAME & ADDRESS ......... L " j Y4 Z-� - ----------------
-4- � 1�
1( )11151101 Is granted ......... s 11 - ___ e�_ ____7 ----------------------------------------------------
- _.; .......... .. . ............ 19=,, for repair and/or connection of a side sewer to the city sajfltary sewer
S�`&n in accordance With &�;'Of Edmonds -ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer Insidezo
zferty line. A licensed Side Sewer Contractor must be employed
side sewer in street azea. Do not cover any Portion of sewer before it has inspected. to construct
NOTE No. 2—All work Performed in city right-of-way requires an Invasion of Right-of-way Permit obtain -able from the City Engineer's office.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when You get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%. No bends In grade
sharper than % will be permitted.
work which may develop within one year Of completion.
NOTE No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to Improper
NOTE No. 6—It is unlawful to alter or do any other work than Is provided for in the permit; or to do any work on the main sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED [] Date.__ By ................ a
D
L;_APPROVED -qf Date / ........ / ------------------ .... . .... . .................. By ................ Date .............. . ................ By ...............
B...... 7.7 ---------------------- .. ........................
................................................................... ........ ..........
Remarks: .......... fl -- - ------------------ * -----------------
...............................
------------------------------------------- -----------_------- - ----------------
�111-D ........................................................... . ............................................ # ................................................................................ ....... ; ..................... ................ ...........
BOTHPermit Co ....................................... .........
pies MUST Re Signed ByMwn
X er of Firm Performing Construction PRIOR To Request For Inspection
e
j
.............. %.-
--- .......... ..........
-------------
m Performing Constructio hereby certify that the side sewer installation constructed under this permit
ner o Contracting A'r n)
was installed in accordance with all governing ordinances of the City of Edmonds.
Datedthis ----------------------------- day of ................................................................ 19....
N/ V Check I BEFORE I �Yo U dig for: Water El, Gas 0, Tele"One [I, Power [],
Sewer 0, Other
I
APPLICATION
for
EASEMENT NO - --------------------------------------------
The City of EdmoncI6� --T "LE SIDE SEWER PERMIT
NEW CONSTRUCTION E] REPAIRS F1 LID NO . .................. . ASMT. NO - ------------------
.... . .... .. .... ----- ------
--------- --
OWNER �y .... .. .................. ------------------------------------------------------- CONTRACTOR -- ------ 4el� ...... PERMIT NO.
JOB ADDRESS --------------------------------------- LEGAL DESCRIPTI LOT NO. 1103
................................... BLOCK NO. -0 ---------------- ----------
..................................................................................................................................................................
NAME OF ADDITION .... 1;14-444-1.1 ----------- Le,
.lz 2: -
............. ------- ;;
�z ....................................
Approved:
DATE .—,
By............................................................
11/75
. / L 0� 1) ��5 1--) � u 0 �-. \,j I t-- �\j o t_ J,\ju I (_0
L',) 1 1) -' ) ) �� 1-7) L —7
"Th (e--) �L?,-\j re_w n F�Dn_ 10 /P �--M IT_�;'
P"'J,TC PI]PT. CP(`,' LIST
^UMDF;_Z11N rp= Omega "Man `7
I
u
M
'r T1
I)PILDE"'G, PIT'J 1,TY1,171"
i r.1L
Street TZJ7 1)
sting— n
Access E.iscments Fxlistinp IT011
Utility Enscment Exist.1my, Pl�
. D u
-7
4_7
1""'I tea-1 "ll n Pec:Ili, rcd
111i_-r."j.xistin-_ 7 D,
I !vch-xit Rccili n�d P,-)r Fife. Crcfe, 10 size N-) x��r
!��:?toEtor Cjhcd� �;'Cltcr Required
�J n
y
V7, C7
file ex cul�try-, Kf(Rull"fUi
', , I -,/
�_7 77
S�pti c T"Ini: 1)esj�,,n J�',)nrovcd
10 PY
Septi c T,1111: P(,1-1,1;.,L Ren"drod !,(,nTljt �To.
D lati;
il '�,mitnn- 'lower Avnilfldlity T)TO.
T
-F� L
Soidnry Sc.,,-er Comiection Fee pcqIlj. reci—N-1
"'evicw
P�tch PeciJ.1-00
Culvert Rc011ircO Si.zc
0 1 - K ) /-�- —_ - — -
C,,itch Pisin lZeni.i.ii-c(I Indic"ite oil !7itc 19"M /\j
corlw�cflnrl in -L- rLie
I�Iml:lolc re, ild-rcd NJ Nd-i.c.itc. on S; te PI uji
S'oij Colicli
tion5 F, cround lv�`ClterFicld Chcc`,��Cl DLt
Review
Int Per Subdivision
T ASSCSSCr I ',IT)
Site PJ,in CJ,,ccl-ed for AccumcN
,rlc CIT ound
(j)&c9- P.-ce-arx(i
POV-i c""! by -
V-3
50 (11 0 C—P C'
B ILDING DEPARTMENT
i' '
Applicant Fill
USE
USE
ZONE
Z 0
PERMIT
NUMBER
PERMIT APPLICATION
Inside Heavy Lines
vy Li nes
J 0
JOB
AD
ADDRESS
NAME (OR NAME OF BUSINESS)
17631-69th
Ave. W.
I
1-1 & H HOMES. 1.1-Tc.
jntFN
V
VARIANCE OR COND. USE NO.
ADB NO. HEIGHT
Ir
W
MAILING ADDRESS
I
Z
P. 0. Box 6114
0 CITY
PW0064101194T Y A R D S
1 � t
�ALLOWED
LOT COVERAGE
-1
/.5
TELEPHONE
NUMBER
FRONT SIDE
5
REAR
:17L
1
Lynnwood I
775-1916
SIGN AREA
PROPOSED
ENVIRONMENTAL REVIEW
I-
U
W, ADDRESS
I-
X
U
M CITY
NAME
Same
0 ADDRESS
U
It CITY
z
0
U
L..N�m Numtm" ICITY LICENSE NUMBER
223-01-9080
gal Description of Property (Show Below or Attach Four Copies)
Lot 3 Viewrid-,e #6
Z
IL
Ir
U
0
W
a
.J
0
W
-1
Z
U
0
W
0
1 0 COMPLETE OEXEMPT i
REMARKS dr_1_ve_w__a_y___sIopes not to e xceed tFo-se z
indicated on Standard Dwg. No. 103 _J
CL
[TELEPHONE NUMBER PLANNING DEPT. APPROVAL DATE
B
LEGAL LOT ILOT AREA ISUBDIVISION NO.
OYES ONO 'PLAT
STREET R/W
EXISTING STREET R/W 60 FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W-�:50 FT. r) FT.
REMARKS Driveway slope not to exceed those
indicated on Standard Drawing #103.
I C H
t V (M _
STREET AND/CIR UTILITY WORK R/W PERMIT REQUIRED
R E Q'D. El YES IMNO El YES 4UNO
UNDERGROUND
WIRING REQ'D. INY ES ONO
TYPE CONNECTION Qf-YESIVERIT,
SANITARY SEWER NO
SEPTIC SYSTEM ERMITNUMBER
APPVD BY CITY ENG. YES
N 0 �j4p
REMARKS
METER SIZE ISERVICE SIZE ICLEARANCE [CHECKED BY
1x] NEW El RESIDENTIAL GAS
El LINE
0 NON-RESIDENTIAL SIGN
DEMOLISH RETAINING
WALL
D- ALTER EXCAVATE FENCE
F� OR FILL I- X_F'r)
REPAIR PRE -MOVE swim
1:1 INSP. POOL
FIRE ZONE
:
TYPE OF CONSTRUCTION
7
ICODE
SPECIAL INSPECTOR JAREA
REQUIRED
0 YES 11 NO
OCCUPANCY
GROUP
I
JOCCUPANT
LOAD
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31,04,
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
REMARKS
NATURE OF WORK TO BE DONE
New construction
PROPOSED USE
S_P: 'y residence
PE42.
PLAN CHECK
NO.
VALUATION
FEE
PLUT (,"'amjly
NDICATE BUILDING SETBACKS,
ABUTTING STREETS)
see attached - - -
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
Z I
Z
wim
ILI
Z
6
.J