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CITY OF EDMONDS
2.
3.
Address of Construction / 9/u V 7,� �.-� :� Al A/ -
Property Legal Description (include all, easements)
%,
Single Family Residence I. Multi -Family. No. of Units
Commercial
4. Owner and/or Builder ;� • !�, /l R X
5. Contractor & License No. i Z) - /4 - 4 Z 3,0 C
6. Invasion into City Right -of -Way: No Yes 4-' (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
zH 7. Cross other private property: Yes No t,� Easement required -
U attach legal description and county easement number.
H
a READ THE FOLLOWING AND SIGN:
a
4 a. Property owners must obtain a permit to install side sewers on
>4 their property. A licensed side sewer contractor must be employed to
construct side sewers in the public right-of-way.
w b. The side sewer contractor assumes full reponsibility for each
H installation for one year.
wC.Commercial establishment requires a minimum of a six inch (6")
z side sewer line.
o d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
go e. Side sewer lines must be laid at a minimum grade, of 2% (1.150)
O and maximum grade of 100% (450). 0
H f. No turn in side sewer greater than 45 (1/81bend) is0allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and Wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer line run.
j. 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.
k. Side sewer.must be left.uncovered until inspected and approved
by the City.-
1. Inspection during normal working hours only. Two (2) working
days notice required.
DATE: 3 /Z 1/ 79 .9-x
-`'I "certify that I% have read
and shall comply with the above
PERMIT FEE: DISAPPROVED By: Date:
w By: Date:
CONNECTION FEE: APPROVED By: Date:
0
w *.PERMIT MUST BE POSTED ON JOB SITE
SU LDING DEPARTME
Applicant FIII
ZO RMIT
ZONE NUMBER
lR IIT APPLICATION
Inside`Heavy Lines
STREETFILE
JOB
-`^7
NA „�R NAME OF BUSINESS)
ADDRESS -
�Q �!T �SW , ,,•,
LEGAL LOT/
PLAT NAME
SUBDIVISION NO.
VES ONO
W
MAILINU ADDRESS
s 1
0
CITY TELEPHONE NUMBER
PUBLIC RIGHT OF WAY PER ORDINANCE NO.
--I- /���
/
'EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY'
NAME
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DEFICIENCY OF RIGHT OF WAY C)
W ADDRESS
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STREET/UTILITY WORK.REQUIRED 19YES NO
U
PERMIT FOR WORK IN PUBLIC R/W >9YES NO
K CITY
¢ 10
TELEPHONE NUMBER
UNDERGROUND WIRING.REQUIRED ❑},AYES XNO
-
"'
CONNECTION TO SANITARY SEWER yp rEs El NO
NAME _1
SEPTIC TANK PERMIT REQUIRED `❑`►YES ;{{ NO
SEPTIC TANK PERMIT NO.
0 ADDRESSy�� �J
U .-'
SEE MEMO DATED
E CITY
o �� Lv
TELEPHONE NUMBER
REMARKS
775— /
U STATE LICENSE NUMBER
CITY LICENSE NUMBER
CHECKED BV
Legal Description of Property '(Show Below or Attach Four Copies)
METEV SIZE
BUILDING SUPPLY SIZE
5 zf i /Ot 7�rX C � �4 L—
z i / •1—
RE A KS
a /
SIGN AREA
ENV. REVIEW
ADB NO.
U
IA
ALLOWED PROPOSED
COMPLETE EXEMPT
W
SHORELINE I
0
J
¢
REMARKS
W
J
VARIANCE ORCU
PLANNING REVIEW BY
'DATE
YARDS
LOT COVERAGE
I iQ NEW
�J
❑ ADD
❑WALL
ALTER
0 REPAIR
RESIDENTIAL
ElNON-RESIDENTIAL❑SIGN
❑ DEMOLISH
EXCAVATE
_ nL OR FILL
PRE -MOVE
•❑"INSP.
❑ GAS
LINE
❑ RETAINING
FENCE,
❑ ( X_F-T
SWIM
a� FRONT SIDE REAR
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
HEIGHT
SPECIAL INSPECTOR
REQUIRED
❑ YES ❑ NO
AREA
JOCCUPANCY
GROUP
OCCUPANT
LOAD
PLAN CHECKED BY
.THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
a POOL
SHOULD BE CODED 31.04. '
Z NUMBER OF STORIES
NUMBER OF
REMARKS
DWELLING
UNITS
4 NATURE OF WORK TO BE DONE
a
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_ PROPOSED USE
-
PLAN CHECK FEE
PLOT PLAN INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
U
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PLUMBING
W
0
' �7—rACC —
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O
MECHANICAL
FENCE
In VI
'nF)7IIC:InI, oil behalf of his or her spouse, heirs, assigns alid
SIGN
J
Successors In interest, agrees to indemnify, defend and hold harmless
.i
the City of Fdnionds, Washington, Its Officials, CIIIPIOyCCS, and
RETAINING WALL
<
agents from any and all claims for damages of whatever nature,
I
al-Isilig directly In' indirccil)' Iru111 the issuance of this helll ill. ISS11-
SWIMMING POOL
!Ilk Ilv, mil llul It nol I••' Ik.cTllod ('. III,)d il'y. \\':I ivc �11 I:'If licc
VALUATION II FEE
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Y
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ENGINEERING REQUIREMENTS I+OR BUILDING PERMIT APPLICATION
CITY OF PU13I,IC t101�1-S I)F:I'AR7T]E(1I'
Fs];LI11!;L:I"s:I:IIi.; Il'f:VI;>II111
SUBJECT:
DATE:-Z---ig
C'-� e—X— ,
Subdivision
Multiple _ -�:�11�V,i PRD
Colllnlercial.
G EI IERAL Rl��)U -I RI17E1 PI :S
Coordination of the location or an:v stru' r: ,
lines and driv�tva ith r^� ,ncct to utilities, streets, nroperty
Y fradcs is the respor-lsib-lity of' the contractor.
The ccnstra,;i-or is.required to keep the abutting street cleaned of dirt and debris caused
by the construction 7.30.200 Violations - Penalties.7-30.290.
A "Right -Of -Way. Construction Permit" is required from i;Ije Lnf.ineerinl; Division of Public
Works for any work within the Public right-of-way or' public easement. 7.30.010 Violations
Penalties 7.30.290.
UNDERGROIJ;dD 'POWER
; I'LCII'IC REQUIRi:I%ElJTS
❑ Underground Wiring Req'd Not Req'd .
SANITARY SEI,IER ( PER;-IIT REO I D )
4c► Connection to Sa.nit wr , -'.'ewer Req' d ❑ Back l,later Valve Rec ' d on Side ide Sewer
Septic Tani: Pel.Mit Reo' d. Desirqj Approval Req' d
Approved Dt.
Perrni f- 1.11 lrrh�—
STORM SEWI1- SYSTG ] (I'ER CITY CODE
❑ Drainage Plan Req'd
❑ Site Drainage to be Contained on Site
ROADWAY L' ]PROVE ILI ] I'S Al FL) DR I VI II• Y R]� 'I.l IRI_: IL11 PS
Drive: -jay, S one Idot to Lxceecl l Fl
Driveway Favi.ng, Req'd
❑ Vertical Cu-rh Req'd
❑-J Street Paving Req'd
❑ Drainage Plan Approved Dt.
Site Drainage to be Connected to City Systel
❑ Driveway Culvert Req'd. Size
❑ Si (ieWalk Req' d
❑ P'AI;)rov(_d De.`:i, I?eq'd
❑ Bond Req' d for Public .Improvements ❑Submit Cost Estimate
.Note: �x��-r��►r_
WAIM~
`. •
,. Lngi.n t':1f I Di visl on
Foundation
Side Sewer
ElWater
Service
❑ Fine
Septic Tank
Site Improvements
Protection
Drainage
A 24
= hour notice is regtiired for
inspection c,Ygineering,
call 775-2525,
extension 220.
. PUSC WORKS DEPARTr1IIv'r CHECOT • 3- I ' 1 Date
.BUILDING PERM[T REVIEW
Lxsr Zg V-Lkv t v--v 1 Cnoq ) S R Z 4l ,Address
Street-Right-of-WayExisting _ ��C�U REQD
Access Easements Existing REQD
Utility Easement Existing REQD
Lot per Subdivision Plat Assessor Map
Site Plan Checked for Accuracy
.Underground Wiring Reqd.
Check Accuracy of Legal Description 7S--I--1Cl
Environtnentally Sensitive Area 'T_iPN
Environmental Checklist Reqd.
Flood Hazard Zone
..Shoreline.Management Area _
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Existing Zoning Per Code
Mw
' Amenities Design Board Approval Reqd. —T(,O ADB # Approval
3.Board of Adjustment A proval Reqd. "�[]
_'Review , By : Date: 3--
iX Existing Water Main Size 1 C, I
Water Main: Reqd. A/A
s-Service Line Reqd.
w Hydrant Size Existing
P Hydrant - Reqd. Per Fire Code IVA Size
Detector Check Meter Reqd. AIA
! Cross Connection Inspection . /YA
Fire Department Comments
Water Meter Charge . Reqd . 5'do 4!;0:5:
Review "by : ! Date: 3 - 17 %
' Septic Tank Design Approved �Jr� llate: " �I p
t Septic. Tank Permit Reqd. 0116,_ ----Permit No.V.
N
Sanitary: Sewer Availability =g Proj . L-_l (2
Drawing No . L — lr.L2 0a File. No., I . C,
is
Side Sewer Availability��
,r
w Sanitary Sewer Connection Fee Reqd. ►J p
LJO Review By: Date:
r4
jShoulder
Open Ditch Existing ��,��
Culvert Regd. ��,�Sy�9 �!-��
Catch.Bisin Reqd. �. -
draisiage maintain collection on
Regd.Ara Q
Size
.. Indicate on Site Plan
Swale open _ rmoff� s
`�'
i ►ii�llol.c req /�
Indicate on :Site Plan -=-�
Soil Conditions .and Ground 1-later Field Checked
1
I.
Revie a by Q
TXlte <
Street Paving Regd. %7p
!
Curb and Gutter Regd.,?p o
w
Sidewalk Reqd.,
Curb Cut for Drive�,ay Reqd._ _
-
Right -of -flay Construction Pemit Redd.-
E�.
Bond Reqd. for Public Inprovemnts
T
Street Name Sign Reqd.
Other Signing Regd.
Pre Permit, Site Inspection made on
zi -
a BY : SLIER
H
U
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wf
STREET
ENGINIF UJNG
4�Special Rcquire-em:s •listed in r.:uin to Comp"niL— Developc;eTlt Depart? nt;`
� Bui:l-cling Di�ri_sion
BY Date
o .1, All - items filled - in on Building Permit Application
R; BY Date
Drm4in ,s Stan ed and Notations T�tide
w E BY
Date
Approved by Public %Torlcs Depai; Limit
Revi:scd:_ lv 10-1977
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