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17715 76TH AVE W
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SIDE SEWErt'PERMIT-
NEW CONSTRUCTION REPAIRS LID NO.- AS . Aff. �N,@
CONTRACTOR ......
.,OWNER ----------------------------------------------------------------- ------------------------------ -----------
Elk
LEGAL DESCRIPTION: LOT NO..-: ----------------------------------- BLOCK NO. ........
JOB ADDRES� .17 ....... --- — ---- 76;r".
----------
.................................... .......................................................................................................
NAMEOF ADDITION ------------------------------------------------------------------------------------------------
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CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT pi
PERMIT
.... . ........... ...
Call 775-2525 for side sewer inspections BEFORE covering any portion of the constru tion,)
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspectetons.
ADDRESS LOCATION OF CONSTRUCTION ...... ------------------------ ...................................... . ...................... . .......................................................
PROPERTY LEGAL DESCRIPTION ...... A . ..... L�
................................ .......
........................... . ... .. .. .. ..................... I ..............................................................
................................................... . ....................... ......................... ................................
.............................. . .................................. . ..................................................
...................... OWNER AND/OR BUI1.,DER .... .......
.......................................... ............... ................................... .......................................................
CONTRACTOR'S NAME & ADDRESS .... ----------------------------------------------------------------------- . .............................. .... ..................................................
Permission is granted ------------ --- ...... ------- - -- - ----------- 1 19.. for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
Al'. IS CAT-I,ED TO THE; FOLLOWING:
NION
o. I —The o ers of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
N&Z�:A wn
L 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--Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when iou get permit.
NOTE No. 4—Top, of side sewer must have at least 30 inches coverage at property line and 12 inches -inside prp' 'e4y line; minimum grade of 2%. No bends in grade
harper than % will be permitted.
NOTE No. 5—Tarenches in street must be water settled and surface of street restored to original condition. Pontrartors. shall be responsible for failure 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 �d�j;wqrk on, the'maJn sewer or its appurtenances except to in- . .....
sert the pipe into the wye.
DISAPPROVED Date ... ...... By ................ Date ...... ...... Dait6 ............... ................... . By ................
APPROVED Date-- 107-1 ------ By. ..... ..........
........ .. ..................................................................
....... .......
Remarks: ....... . .................................. . ........................................................
...... . ........... ...................... .............. . ...................................................
--------------------------------------------------------------------- - ---------------------------------------------------------------------------------------- . ...... ...........
. ........... . .......................................................
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection Sw
I ............................................... .................................. .... ... I hereby certify that the side sewer installation constructed under this permit
(Owner of Contracting Firm Performing Construction)
talled in accordance with all overning ordinances of the City of Edmonds.
9
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Datedthis ............................ day of ................................................................. 19 .........
Check BEFORE you dig for: Water Gas E], Telephone E], Power E], Sewer F], Other E] -V V
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FA APPUCATION
0 City of Edmonds fcw
SWE SEWER PERM EASEMENT NO - -------------------
NEW CONSTRUCTION 0 REPAIRS E] LID NP - --------------- ASM-r
,,No. .............
OWNER
.................................................. CONTRACTOR ----- &�� ---------------------------------------------------- PERMIT NO.
JOB ADDRESS
-- -----------
------------ -------- LEGAL DESCRIPTION: LOT NO. _cIZI --------------------------- BLOCK NO.
------------- I ------------------------------------------------------------------------------------------------------ .............................................
NAME OF ADDITION
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RECEIV!--
JUL
Approved:
DATE--------------------- ....... ...... ...... BY ------------------------------------------------------------
Da te _july_ 19, 19L4
Memo to: Director of Maintenance Operation
Public Works
From: City Engineer
Subject: Sewer Connection Charges
Legal Description:
Lot 21, Plat of Headowdale Sound View Tracts as
recorded in Vol. 2 ' Page.-51 of Plats, records of
Snohomish County, Washington being within Sec. 8.
T 27 N, R 4 Es, WX
Commonly known as: 17715
76th.Ave. W.
Owner: Brad
Akers
Z.F.F. Calculation:
136.7 Z.F.F.
x ($540
751.85
Connection Fee
0 Lateral
x 0
$ 0
Lateral Charge
Unit
X 25
25060
Trunk Charge
c Mr. Akers
10-00 Permit
786.85 TOTAL
LEIF. R. LARSON, P.E.
EDMONDS CITY ENGINEER
Form 6
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Form 6
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BUILDING, DEPARTMENT Applicant Fill
USE- PERMIT
ZON NUMBER
F8� — I;', 1 '.1 :' .1 . .
PERMIT APPLICATION inside Heavy Lines
JOB
ADDRESS
NAME JOR NAME OF BUSINESS)
kzqf_-� A
SU BDIVISION NO.
PLAT NAME
ASSESSOR-MA.P
Nq�
W MAILING ADDRESS
,z: k77 tS- \A,/
0
PUB LIC RIGHT OF WAY PER ORDINANCE NO,
CITY
TELEPHONE NUMBER
17e4S -08Z-�,
EXISTING RIGHT OF WAY.
1
PROPOSED RIGHT OF WAY
NAME
DEFICIENCY OF RIGHT OF WAY C-13
U
W ADDRESS
STREET/UTILITY WORK REQUIRED OYES
9NO
U
PERMIT FOR WORK IN PUBLIC R/W 41YES
UNDERGROUND WIRING REQUIRED E] YES
1:1 No
&NO
It CITY
TELEPHONE NUM13ER
<
CONNECTION TO SANITARY SEWER EIYES
IN NO
SEPTIC TANK PERMIT REQUIRED El Y ES,
ONO
NAME
SEPTIC TANK PERMIT NO.
ADDRESS
SEE MEMO DATED 0
M CITY
TELEPHONE NUMBER
REMARKS
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7 14' 1 - I SS
STATE LICENSE NUMBER
CITY 'EICENSE NUMBER
CNECKED BY
TO - VV N 1- 13 ZG I L2
-7
Legal Description of Property (Show Below or Attach Four Copies)
METER SIZE
BUILDING SUPPLY SIZE
P\ %_X3 W 1-:) AL SO Q KI n—
REMARKS
z
SIGN AREA
ENV. REVIEW
ADB NO.
Lu
ALLOWED PROPOSED
COMPLETE EXEMPT
U
W
.J
REMARKS
W
.J
VARIANCE OR CU
PLANNING REVIEW BY
DATE
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U
0
W
0
NEW
RESIDENTIAL
GAS
LINE
y
YARDS
a5_/FRONT 0 /SIDE 41 5"R EAR
LOT COVERAGE
FIRE ZONE
F
TYPE OF CONSTRUCTION
HEIGHT
ADD
ALTER
E]
NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FILL
SIGN
RETAINING
OWALL
FENCE
E] I-
ICODE
SPECIAL INSPECTOR
REQUIRED
YES NO
AREA
JOCCUPANCY
GROUP
OCCUPAI
LOAD
PLAN CHECKED BY
P
THIS SITE IS LOCATED IN THE CFT_Y
REPAIR
PRE -MOVE
INSP.
SWIM
POOL
IF
OF EDMONDS. LOCAL SALES TAX
SHO LILD BE CODED 31.04.
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK
0 , x -3.
TO
BE DONE
.
%CA- '�Zk�
PLAN CHECK FEE
VALUATION
I
PROPOSED USE
PLAN (INDIGOKTE BUILDING 5
ABU'KTING STREETS)
BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
RETAINING WALL
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0
U
m
:3
91.
m
W
3:
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PUBLIC WORKS DEPARMU CHE.CO ST., Datd
BUIUING PERMIT REVIE14
!,S7-
Street Right -of -Way Existing REQD
Access Easements Existing REQD
Utility Easement Existing Azaue REQD
Lot per Subdivision Plat Assessor Map
Site Plan Checked for Accuracy
W 0'
Underground Wiring Reqd.
Check.Accuracy of Legal Description
Environmentally Sensitive Area
Environmental Checklist Reqd.
Flood Hazard Zone
Shoreline Management Area
Slope, Soil, Vegetation 46-1,
Stream, Creek, Drainage Basin
Existing Zoning Per Code
Amenities Design Board Approval Reqd. ADB # Appriwal
Board of Adjustment Approval Reqd.
Review By: Date:
?,I� -117
Existing WaterlMain Size
Water Main Reqd.
Service Line Read.
Hydrant Size Existing
Hydrant Reqd. Per Fire Code
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Camients
Water Meter Charge ReqO.
Review by: Date:
Septic Tandc
Size
Septic Tank Permit R7 Permit No.
Sanitary Sewer ility Pr0j.
Drawing No.
Side Sewer Availabilit-
Y-
W Sanitary Sewer Connection
Review By:
=I
File No.
Date: -P
--- - - - - - - - - - - - - - - - - - - - - --
q)en. Ditcl-i Existing__L Reqd.
Culvert Reqd. Size
ci,. Catch Basin Reqd.
Indicate on Site Plan
0 Shoulder drainage n-nintairl collecti swale open runoff
cqd.
Lwdiole r Indicate on Site Plan
Soil Conditions and Ground Vkater Field Checked
by Date
Street Paving Rcqd.
Curb and Cutter Reqd. r
Sidew.alk Reqd.
Curb Cut for Drivew-ay Reqd..
c4 Right -of -Way Construction Pe t:,Reqd.
Bond Reqd. for Public Improvemnts
lame Sign Reqd.
Street N , I
tn RX
Other Signing Read. tog
Pre Permit Site Inspection m.de on
0
BY: S FI,.T- R
P-1 t--1 VIA=
r4
STREET
ENGINEERING .72
Special Requirc-_,:-&�i-its listed in m2ffo to Com-r-Lnicy Dove loprmnt Departnent,
Builc *ng Division
—Date
0 All iteirs filled in on Building Pe'rn-&t Application
BY Wte
PL4 Drawings Stan-ncd and Notations R-ide
BY 2s\1110 "Aft T)dte-
Approved by Public '%.!or1_,,s Dcparti-wi-it:
RQvi-Sed: 1v 10-1977
DATE.
MEMO TO: �Build ing Division
Community Development Department
FROM: Engineering'Division
Public Works Department�
SUBJECT:
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—J'riveway grades is thF
responsibility of the contractor.
(2) The contractor is required to keep the abutting streets clean-
ed of dirt and debris caused by t�e construction.
_(3) A "Right -of -Way Construction Permit" is required, from the
Engineering Division of Public Works, for any work within
the Public Right -of -Way or public easement.
(4) Driveway slope not to exceed 14%.
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te July 19, 1974
STREET- FILE. qa
Memo to: Director of Maintenance & Operation
Public Works
From: City Engineer
Subject: Sewer Connection Charges
Legal Description: Lot 21,, Plat of Meadowdale Sound View Tracts as
recorded in Vol. 2, Page 51 of Plats, records of
Snohomish County, Washington being within Sec. 8,
T 27 N, R 4 Es W.M.
Commonly known as.: 1.7715,
76th Me. W.
Owner: Brad Akers
Calculation:
136.7 Z.F.F.
x ($5i5O
$
751.85 Connection Fee
0 Lateral
x 0
0 Lateral Charge
Unit
x 25
S
25.00 Trunk Charge
$
10.00 Permit
786.85 TOTAL
LEIF
P. LA R-SON, P.E.
EDMONDS CITY ENGINEER
cc: Mr. Akers
Form 6
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DATE HOUR
TO -
WHILE VOEfWERE OUT
OF
PHONE
AREA COD PHONE NUMBER
TELEPHONED
RETURNED CALL
LEFT PACKAGE
PLEASE CALL
WAS IN
PLEASE SEE ME
WILL CALL AGAIN'
WILL RETURN
IMPORTANT
MESSAGE
az,
41GNED_
_�TTLTTLE'S OFFICE SUPPLIES PHONE 782- 1050
E'S OFFICE
*STREET FILE
Date , July 9, 1974
Memo to: Director of Maintenance & Operation
Public Works
From: City Engineer
Subject: Sewer Connection Charges
Legal Description: Lot.21 Meadowdale Sound View Tracts-..
Commonly known as: . 17715 76th-Avenue-W. Owner:
Z.F.F. Calculation:
136.7 Z.F.F. x (.$5,.50
0 Lateral x
1 Unit x $ 25
cc:
$ 751.85 Connection Fee
$ 0 Lateral Charge
$ .25.00 Trunk Charge
$ Permit
$ 786.85 TOTAL
Form 6