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17632 69TH AVE W
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-8-VI-LbING DEPARTMENT Applicant Fill
ZONE
PERMIT
NUMBER
PERMIT APPLICATION
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Inside Heavy Lines
JOB
ADDRESS 17632-69th Ave. W.
NAME (OR NAME OF BUSINESS)
H & H liol"LIF'si DIC.
VARIANCE OR COND. USE NO.
ADB NO.
HEIGHT
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MAILING ADDRESS
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P. 0. Box 644
YARDS,�
OT COVERAGE
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CITY
ELEPHONE NUMBER
FRONT SIDE
9./
REAR
Lynnwood
775-1916
I _G N AREA
ALLOWED PROPOSED
ENVIRONMENTAL REVIEW
EXEMPT
NAME
COMPLETE
R.�MARKS drtVewaj OPCS
i-ndicated on S andard
Fiat to exceed triose
D"g. No. 103;
U
W
ADDRESS
I-
PLANNING DEPT. APPROVAL
DATE
Ul
0:
TELEPHONE NUMBER
<
ICITY
I
LEGAL LOT
LOT AREA
SUBDIVISION NO.
gWYES 01401
1
PL-A
T
NAME
STREET R/W
Same
.0
EXISTING STREET R/W "ej
FT. DEFICIENCY THIS PROPERTY
0
ADDRESS
COMP. PLAN ST. R/W �Y 0
FT. FT.
0
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—
REMARKS
Driveway slope
not to exceed those
CITY
TELEPHONE NUMBER
z
indicated Standard
Tliraj,�zjng
0
U
STATE LICENSE NUM13ER
CITY LICENSE NUMBER
on
CHECKED BY
223-01-9080
Legal Description of Property (Show Below or Attach Four Copies)
STREET AND/OR UTILITY
R E Q'D. 0 YES
WORK
NNO
R/W PERM I T REQUIRED
0 YES 4*NO
Lot 8 VievrridFe #6
UNDERGROUND
Z
WIRING REQ'D. 4�YES ONO
0
TYPE CONNECTION
SANITARY SEWER
fU YES
0 NO
VERIFV 4'�—1 N
Q--) �j
Ir I
U
0
SEPTIC SYSTEM
APPVD BY CITY ENG.
YES
NO
"[P
ERMIT NUMBER
W
REMARKS
W
METER 777VICE
SIZE
ICLEARANCE
I CHECKED BY
REMARKS
X
Mv NEW RESIDENTIAL
GAS
LINE
FIRE ZONE
TYPE OF CONSTRUCTION
A D NON-RESIDENTIAL
El DEMOLISH
EXCAVATE
ALTER F� OR FILL
El SIGN
RETAINING
EIWALL
E] FENCE
I— X—FT)
I
I
ICODE
SPECIAL INSPE C TOR _rWT_
REQUIRED
0 YES El NO
A
JOCCUIANCY
GROUP
OCACDIANT
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
0 REP�AIR PRE -MOVE
1:1 INSP.
swim
POOL
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
i'lew construction
PROPOSED USE
z
0 Single fami-ly resi-dence
P
!: PLOT PLAN (INDICATE BUILDING SETBACKS,
It ABUTTING STREETS)
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Ln
W
spe attached - - -
0
1
PLAN CHECK
NO.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
VALUATION I FEE
0
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Z
W
W
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m
W
F.
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or E, T-
APPL I N
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-J e Cit�,� of
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V
''EASEMENT
SIDE SEWER PERMIT
NWf"'
. ...........................
NEW CONSTRUCTION
REPAIRS
LID NO . .......... ASMT. NO .
.......
..............
OWNER ... ............
---------------------------------------------------------------------
CONTRACTOR 4-'sZ-*2
--- ---------
------------------ PERMIT NO.
"7- L—
t
LEGAL DESCRIPTION: LOT NO.
BLOCK
ADDRESS
............... ..... ------------
-------------------------------
NO . ..................
..........
-----------------------------------------------------------------------------------------------------------------------------------------------------
NAMEOF ADDITION ---- ----------
------------- ----------- ...... ---------------------------------------
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Approved:
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DATt'� .......................... .......... . .......................... .........................
Y,
+
-1
A
/:7
`7
7
CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
F FLE
EE
PERMIT
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 ......... ........................ . .......... . ......................... ............
U; . ........ ......
............. --------------
PROPERTY LEGAM DESCRIMON ........... .. . ........................................ . ...................
.................................................... .......... - ---------- . ........................................................................................ . .................................. . ..................................................
7'
MDER ............ �.44_9 ........ L.621.1 . . .......... . .............................. . ... ................
....... . ....................................................... Olrtrlc�,VWOR BU ...
CONTRACTOWS NAME & ADDRESS .......... ------------- !!�5� . . ........ --- - -- - --- ---------------------------------------------------
Permission is granted ......... ........... ............ 19171, for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with Cit)r of Edmonds ordinances.
NTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtaln 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
shaxper than % will be permitted.
NOTE No. 5—Trenches In street must be water settled and surface of street restored to original condition. Contractors shall be responsible for fallure due to Improper
work which may develop within one year of completion.
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-
rt the pipe into the wye.
se
DIISAPPROVED E] Date .............. By ................ Date -------- .......... By _------------- Date ................ ................... . By ................
APPROVED 0;-�Date_
... 7 .. rr .. .................. By-
- -- - ------------------------------------ * .......... * ........ * ..............................
Remarks: ....... . ................................... .. . .......................................................... . ....................................... ............... ...................................................
..................................................................... . .......................................................... ............................. . .................................. . .......................................................
BOTH P it Copies ST Be Signe By Owner of Firm Performing Construction PRIOR To Request For Inspection
I,. tify that the side sewer installation constructed under this permit
- - ---- ---- - ..... .... hereby cer
wn.r of Contracting Firm Performing Construction)
%,-.,installed n accordance with all governing ordinances of the City of Edmonds.
Datedthil.4/rl'.. of ................................................................ 19...
N/ Check BE FORE you dig for: Water Gas Telephone [3, Power 0, Sewer Other C]
Copies
IF r of _.ntrsct�ng
Zone Corner - VIRS.,
Setbacks LeguLinqd Acill STREET FILE
Front C- 1& 3
Sides :-T �hfj "NbtA4 in this perrAh'approval proem aWl be
Rear -j.5 -L-, -2: C.- irAOWeted 88 aflowing or permi-tt,.�ig the
Other i-".= a maintenance of any currqrfty exwung ii
nonconforamg or t,
__LJ �A
'or site condition ",so
wftica alside the. sco e
germit application, ofwhet
YW4 structure or condition is
sitepl
_�n or drawing. Such bud"di
-APPRO,VED BY PLANNING conchtion may be the 90ject oj7
enforcement actiolLn
& I b
ft
T
da",
T) C
er 9WA-0
OA
R�E EIVE
SEP 2 2 2015
DEVELOPMENT SERVICES CTR-
CITY OF EDMONDS
APPLICATION
The City of Edmonds for
EASEMENT NO . ............ ....................... .......
SIDE SEWER PERMIT
IT F ILE
blREE NEW CONSTRUCTION REPAIRS E] LID NO . .................. ASMT. NO. _ ................
OWNER SEL V_� 1—
.... ............................................................ .............................. CONTRACTOR I ��' L_�
.......... . ............... ..................................... PERMIT NO - -----------------
7
JOB ADDRESS .......... / ----------------- ............... LEGAL DESCRIPTION: LOT NO� ......... ......... _ ...... BLOCK NO . ............................ .......
NOME- NOWARRANTY0FAYdRACY The information s�nwn cjjhp_
aftachad map was compiled fil,�ucz byft, C':y of Edm:-�, i, .......................................................................... ..............................................................................
and consultants. ThG My of Edr.ionds doz--, nc�v!uiz-.; t'* OF ADDITION 1. C F--- Cl
anything set forth on the map. ft Pn;Gc.l c� cnta�y Or
shlci�'c conduc' ar, indeper,��ai inq!,,'�'Y reg,, t1r. in�irc,,, ii _f�.- c1l
the includ!ng, but no, llniRck' tu. tha loca':sr) of zn-,
L: U .1 (2.
suc., Slu��' May O� wi f104 C;ftt and may cr rn--y
th,- lo,;aL*"._-i. , snxwil, Neithe- the City. of Edmonds nb- its -cs C,
offiu,;. �i shZ`l b,-- 1;abla foi the. infoitnallon g�!vcl; cn this map, ncr tcr znly or,
provided bassed upo, i said m&p
Approved:
-7;,
ByIjATE .... Z,�� . ..... ____/ --------- .......... ........
11/75