18424 92ND AVE W.PDFIII 1�1.1 III 111
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18424 92ND AVE W
ADDRESS: J�N-2-4 YZ I'J9
TAX ACCOUNTIPARCEL #: Q��6�6D /0 /901
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS(RECORDED)FOR:
CRITICAL AREAS #: DETERMINATION: 0 Conditional Waiver 0 Study Required El Waiver
CRITICAL AREAS #: DETERMINATION: El Conditional Waiver El Study Required El Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT
FOR:
WATER METER TAP CARD DATED:
OTHER:
LffEMPOST'skForms\Jana's Street File Checklist 5-14-08.doc
UTREET HLE-
APPLICATION
The City of Edmonds
0 co
for .
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS cl
EASEMENT No . ..........................................
Y,
OWNER ........
...............................................
.. . ............................................
CONTRACTOR ......................... ....... ............................
PERM IT NO—'
-T! j* ---------- ............. .
...... ...... . ---------- --------
LEGAL DESCRIPTION: LOT No. ........
BLOCK No. ;-k .......
NAME OF ADDITION ...................... ............ ....................................................
......................................
AFF,
Approved:
... ..... .....
DATE ... ...............
---- - - ----
APPLICATION
for
The CitY of EcImonds SIDE SEWER PERMIT
� - T FIL R'D EASEMENT No . ..........................................
CNEW CONSTRUCTION REPAIRS
307-07900
OWNER ........... H . e . r . b . e . r . t .... M ....... L . a . r . i . o n ...... 1-1 ....... ............................ CONTRACTOR ...................... .........
................................. PERMIT No . ........... ..........
ADDRESS 18424 92nd Avenue W.
................................................................................................... LEGAL DESCRIPTION: LOT No . ................................ ............. BLOCK No . ..................... ......................
NAME OF ADDITION ................
Dye Tested On Sewer 1972
Approved:
DATE
NOTICE:
..Wa -r a nty ... 0 -a--c- C
N'O"'
The information shown on the attached
pHed for use by the City Of
map(s) was com
Edmonds- its Employees and Consultants.
Th,..e City of`Edrn.onds does. not. warrant the
f anything set forth on these
accuracy 0
M a p ('�). A n . y person or entity a
copy should conduct an independent
inquiry regarding th*e inform'ation shown or
-map(s), Including, but not limited to,
-er stub shown. Sud
the lotation of any sew
ewer stubs may or may- not exist and may
or may not exist at the location shown.
Neither the city of Edmonds nor its
ernpl-o-yee's o*r office-rs -sh. a-1-1 be 1--ia-b-l'-e for the
I n on thi5 map(s), nor for
information give'
any one representation provided based
upon said map(s).
CITY OF EDMONDS
CIVIC CENTER — WATER -SEWER DEPARTMENT Call ]PROSPect 6-1107 when work
is ready for inspection. (No inspec-
SIDESEWER PERMIT tions Saturday, Sunday or holidays.) N2 2667
ADDRESS ...... 18421 - 92nd Avenue West
....... .......................................................................................................... . .................................... :"* ----------------------- -------
OWNER ................ H-erb-e.rt .... liar - i . on ------------------ MCW Inc.
-- ------- -- ---- ....... .. .... ....................... CONTRACTOR ------------------- 9
Permission is granted ........... �14;!Mgry -------- 9 ..... 19..A8 for ------------------------ days to REPAIR or CONNECT a side sewer
With City Sewers in accordance With application on fi'le and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
1 No. I —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.
NO ' TE 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; minimum grade of 2
No bends in grade sharper than % will be permitted. %.
NOTE No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
NOTE No. 5—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 appur-
tenances except to insert the pipe into the wye-
%TREL7 FILE
PUBLIC WORKS REVIEW ROUTING
SITE ADDRESS:
TYPE:
BUILDING PERMIT (CHECK ONE)
SIDE SEWER PERMIT
SINGLE FAMILY
RIGHT-OF-WAY PERMIT
MULTIPLE
STREET USE PERMIT
COMMERCIAL
STREET TREE PERMIT
FENCE
SEPTIC TANK DESIGN PERMIT
E�GRADING
NEW METER/WATER SERVICE
DEMOLITION
E.I.S.
RELOCATION
OTHER:
SUBDIVISION REVIEW
PLAT/PRD REVIEW
DRAINAGE PLAN
IN
OUT
Reviewed By: Date Reviewed- I
(See Comments;=01
CITY ENGINEER
LEI
DRAINAGE ENGINEER
A - 2- -1 -61
WATER/SEWER DIVISION
STREET DIVISION
En
P.14. RECEPTIONIST
WORK ORDER COORDINATOR
UTILITY BILLING
DIRECTOR/ADMINISTRATOR
El
RECORDS (FILE.).
0
F--j
OTHER:
COMMENTS:
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p p )2.0�(
LIM IT5
F I L-L
12-1
Lo
USE
CITY OF EDIVIO�W ZONE ks .07
BUILDING PERMT APPLICATION JOB
S
0
E
N E
0 .
NAME JOR NAFAE/OF BUSI��,,Ss) ADDRESS
/ rvo
LE SHORTSUB
L.EGAL DESCIRIPTION .7.4
Z MAILING ADDRESS IUBO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TELEPHONE NUMBER
0 Fe _7 7, /13 EXISTING
I I 1�1 _ ' ;70
I-
U
W ADDRESS
I-
U
It CITY
iNAME
0 ADDRESS
U
M CITY
I'_
Z
0
U STATE LICENSE NU
Legal Description of Properly (Shc
Z
0
U
W
W
j
ELEPHONE NUMBER
ELEPHONE NUMBER
PROPOSED
DEFICIENCY OF RIGHT OF WAY
CHECKED BY I SEE ENGINEERING MEMO DATED
REMARKS
METER SIZE I BUILDING SUPPLY SIZE I FIXTURE UNITS
CITY LICENSE NUMBER
'm B E R
SIGN AREA
5 I G N A
ENV. REVIEW ADB NO.
OWED PROPOSED
A LLO E 0
COMPLETE EXEMPT
SHORELINE
Ow Or Attach Four Copies)
S)
7
[PLANNING REVIEW
I
top.e
VARIANCE OR CU
BY DATE
",Y�ARDS
OT COVERAGE
FRONT
SIDE REA RIL
R M S
EMARKS
M
F-1 NEW RESIDENTIAL F-1 PLUMBING CHECKED BY TYPE OF CONSTRUCTION I CODE
NON-RESIDENTIAL
0
MECHANICAL
0 ADD
DEMOLISH
0
SIGN
SPECIALEINSPECTOR
REQUIR D
AREA
1_� ALTER
EXCAVATE
FENCE
0 YES El N 0
OR FILL
0
(_ X—FT)
REMARKS
0 REPAIR
�RE-MOVE INSP./
swim
COMPLIANCE INSP.
1:1
POOL
NUMBER OF STORTiT7NUMBER
OF
0
r
D
- WELLING
I-
U L NITS
NATURE OFWORK TO BE DONE (ATTACH PLOT PLAN)
M A.
U
Z7
P A
-AP
LAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways,
FENCE
marquees, etc.) will require separate permission.
SIGN
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 120 Days
RETAINING WALL
LA
LA
"Applicant, on behalf of his or her SI)OLIse, heirs, assigns and
SWIMMING POOL
W
successors in interest, agrees to indemnify, defend and hold harmless
-I
2
the City of Edmonds, Washington, its officials, employees, and
agents from any and all claims for damages of whatever nature,
I
arising directly or indirectly from the iSSLIalICC of this permit. Issli-
0
ance of this perinit shall not be deeined to modify, waive or reduce
TOTAL AMOUNT DUE
any requirement of ail), city ordinance nor limit in any way the
.
0
I
City's ability to enforce any ordinance provision."
ATTENTION
I hereby -acknowledge that I have read this application; that the in-
V 0 w 'e
e In ' 3 ck n
'e
formation given is correct; and that I am the owner, or the duly author-
I Or In a I i on g' ve n s c 0..
THIS PERMIT
ized agent of the owner. I agree to comply with city and state laws regu-
d It - W n e
e. ge 0
AUTHORIZES
lating construction; and in doing tile work authorized thereby, no person
s ti. n ' and
ONL.Y THE
will be employed in violation of the Labor Code of the State of Washington
l viol.
WORK NOTED
relating to Workmen's Compensation Insurance.
L'
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
_1!4SPECTION
F11:DEPARTMENT
3 - po R
CITY OF
E6MONDS
THIS SITE IS LOCATED IN THE CITY
775-2525
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304,306.
102-78
OCCUPANCY
VALUATION
FEE
HEIGHT
OCCUPANT
LOAD
APPLICATION APPROVAL
This application is not a permit
until signed by the Building Official or
his Deputy; and fees are paid, and
receipt is acknowledged in space pro-
vided.
DIRECTOR'S SIGNATURE
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor