18122 85TH PL W.PDFIIIIIIIIIIII
8048
18122 85TH PL W
0 . 0
ADDRESS: / 7L c� YS -LD 1p L VU
TAX ACCOUNT/PARCEL NUMBER: cc�o 3--31 ooc�� 0 (0 0 0
BUILDING PERMIT (NEW STRUCTURE): �ZO — G c;?::7 C
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: 0 Conditional Waiver Ej Study Required 0 Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER): Ig-1 0 — 6a] 19 (TLOM.0 1 01) -0
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED: -70
SIDE SEWER PERMIT(S)
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
LATEMP\DSTs\Forms\Street File Checklist.doc
APPLICATION
STREET FILE for
The City of Edmonds SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS 0
OWNER
.......... ..........
. ..............
IP4-
ADDRESS . ............. . . .........
() '4 tv
No")
EASEMENT No . ..........................................
CONTRACTOR ............... PERMIT No..,
A ::1.. Jill ........
LEGAL DESCRIPT16N: LOT No. ..................................... BLOCK No . ......... ........
NAME OF ADDITION ... ....... 4-7 177 Vd; 7 .............................. .................
DATE ^,.%J ......... B�y
1-1
NOTICE:
u F.d
No ... w a r.r a n ty. - 0 T Y
The information . shown on the attached
map(s) w,3s compiled for use by the City of
Edmonds/ its Employees and Consultants.
Th,e City of �Edrn.onds does not ' warrant the
accuracy of anything set for.th on t * hese
Map(�-). Any person or en.tity -requesting a
copy should conduct an independent
'ation shown on
inquiry regarding the inform
ffii� -map(s), Including, but not limited to,
-er stub shown. Such
the lociation of any sew -not exist and may
sewer stubs may or may
or may not exist at the location shown.
Neither the city of Edmonds nor its
emplfo-yee-s o-r office-rs -shal*l be 1--ia-b-IFe for -"Lhe
n on this map(s), nor for
information give'
tation provided based
any one represen
upon said map(s).
CITY OF 'EDMONDS
CIVIC CENTER — WArEl;_-SEWtR DEPARTMENT Can FRosPect . 6-1107 when work
, ,, ready for inspection. (No inspec.
SIDE SEWER PERMIT. 10ns Saturday, Sunday or holidays.) N2 . 3811
ADDRESS ............................ 18122
OWNER ----- ------------------------------------------------------------ ..........................
---- --------
Permission is --------------------------------- -----_----------- CONTRACTOR .......... Pj Umbi
granted A .119 ---------------------------
With CRY Sewer UgUS-t --- 25 ------------_- 197101 for .....
s in accordane-e with applicati ...................
,.r_ing .,dinanee.. ONNEOT a side sewer
ATTENTION IS CALLED To THE -POLLOWING: on 01 11 and go, days to REPAIR or c
NOTE No. I —The owners of the Property MaY obtain a Permit to construct sewer inside Property line A licensed Side sewer contractor m
be employed to construct side sewer in street area. Do not cover any Portion Of sewer bef'ore It has been inspected. ust
NOTE No. 2—Obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—Top Of side sewer must have at least 30 inches coverage at Property line and 12 inches inside ProPertY line;
No bends in grade sharper than % will be Permitted.
Contractors shall
N, No. 4—Trenches in street Must be water settled and surface Of street restored to original condition Minimum grade of 2%.
failure due to improper work Which may develop within one
NOTE No. 5—It Is unlawful to alter or do any Other Year Of completion. be responsible for
tenances exe work than is provided for in the Permit,
ePt to insert the Pipe Into the wye. or to do any work on the main sewer Or Its appur-
BUILDING 0EPARTMENT
Applicant Fill
PERMIT APPLICATION
Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
MAILING ADDRESS
- — V ��
CITY
TELEPHONE NUMBER
7,�
NAME
Z_ /Z
ADDRESS
CITY
TELEPHOSE NUI IBER
NAME
&
cc
ADDRESS f
CITY
TELEPHONE NUM
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0
I- �_o 7—
R.SI..NTIA1
F-I
AS
LINE
NON-RESIDENTIAL
F�
SIGN
ADD
0
DEMOLISH
0
RETAINING
WALL
0 ALTER
EXCAVATE
E CE
F(
F-�
OR FILL
..Ft.)
.."AIR
D
PRE-1.`OVE
INSP.
P I
SIVI I
OOL
UMBER OP STORIES
""', OF
D%VI,L
1
UNITS
ATURE OF WORK TO BE 0 1
za,
,ONE
C
LAP NO.;
MUMBER
-L I STREET SETBACK REAR.
)270
�O
e451.1, 0 N 0.
�,.Y.�18';REET R/W 50 IT. DEFICIENCY '17118 PROPERTY
COMP. PLAN ST. R/W50FT. FT.
Driveway slopes not to exceed those
indicated on Standard Drawin5z #103.
METER SIZE I SERVICE SEihi
31,, "
,�5-E:wEfL
SPECIAL INSPE 0 QUIRED I OCCUPANCY,GRO
E] YE -�- 1", cr-
PI.. Check N . .....................
,I BUILDING
PROPOSED USE
:d PLUMBING
PLOT PLAN (indicate Building setbacks, abutting streets) HEAT & OAS LINE
FENCE
RETAINING WALL
C SWIMMING POOL
DEMOLITION
P--..V. 1-SI.CTI.-
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; tht the I. -
formation gtvri Is correct: and that I am the owner, or the duly auLh
treel agent of th. owner. I agree to 1—ply Ith city arid late to" r,g,l. ATTENTION
lating construction: and in doing the work authorized thereby, no persom
W. 11 be employed in violation of the Labor Code of the State of Washington THIS PERMIT
ralatlnf to Workmen's Compensation Insurance. AUTHORIZZS
ONLY THE
NOTE: Permit Limit One Year (Except DEMOLITIONS which WORK NOTED
rhall be completed In ninety days; MOVED-I.N BUILDILNGS shall be com-
pl,tcd 1. M mouth.,.)
SIGNATURE (OWNE4 OR AGENT) SIGNED INSPECTION
DEPARTMENT
4 JDATF
CITY OF
ED31ONDS
NOTE: Applicant Subject to Plan Check Fee PR . 6-1107
This Permit covers work to be done on private Property ON`1,7.
Any construction on the)pob;c domain (curb.. sidewalks, dllve.�.,
—1.11 Z -I� leI.Ire separate P-.Is.1—.
Valuation I Fee
00
z
PRUVED
0 NO
:%
J
Receipt Nb*
n�
14
14
t`r4?.Z
APPLICATION APPROVAL
This application is not a pernitit until
Signed by the Building Official or his Dep-
uty; and fees are paid, and receipt is ac-
knowledged in space provided.
I- /. - / 0'- /9", 10,
FILE