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SUBJECT 0 DATE /47 -2-41—
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DATE:
----�SIGNED
CASCADEO Ll-C2375
SENDER. DETACH THIS PART AND FILE FOR FOLLOW UP.
PRINTED IN U,S.A.
A. *Address or vicinity of Construction
.0 z? -7, -7
0 Owner: (,6444X,_1F-A E_ 4�'— 9:1�� A: -
Name
Mailing Address
f?'P4-
�tate, Zip Code
City,,
9 Permit Issued To:__
6 Type of,Work to be Done:
Oz_-
Work in Connection With:
0 Sub or Plat Single Family
El Comml. /Ind. D Apt. Condo,
Pavement Cut: El Yes No
0 Contractor:- le C C-C 2?_4z D A/
Name
Mailing Address State License Number
I-,,r4 ce-,67/117:a 7—
C ity, Siate, Zip- Code Telephore Number
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLI!,-ANT TO HAD AND S19N
INDEMITY: Applicant understands land by his signature to this
i application, agreesto hold the City of Edmonds harmless
from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of it's departments of employees, including or nor limited to the defense of any le I
ga
0 proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible, for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
0
Funds held from the Security Deposit (estimated restoration fee)*ill be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected, Restoration to be in accordance with City Code, Traffic Control to be in accordance with Traffic
i. . I
Section of City Code. Street to be kept clean at all times, A 24 ., hour notice is required for inspection by Engineering. Call
775-2525, extension 220.'
I understand that this permit mus be available at the job site for inspection. purposes at all times.
A,
Signature:- ZA zl�� ate zz -76
Owner oi�_Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
iiiiii��illilli� IR I'll'! IR iIll�ill,�'lilI""P WIIIIII
C. Issued By: PermitF,ee:
Time Auth tz d: N/oid after 1? 62 —days Security Deposit:
Z
Special Conditions: Receipt No.:
Fund I I I fee:,
Ammendments: Street Cut,Dimensions
X_
NO WORK TO BEGIN PRIOR TO PERMIT, I$
$VANCE
"'A Div. December, I 1)7*`
FIELD INSPECTION 70TES (Fund. 111 - Route conv to Street T)er)t.
Comments:
Diagram:
Contractor called for inspection Yes NO
T Date: Bv: Date:
,Alork DisaPproved BY:
Work Approved Bv: Date:
Inspector:
Encf. Div. December 1978
NOTICE:
'cy
-N'O...W.ar-rant.y..-O-t-a--C--c--u--r-a'
The information shown on the attached
Hed for use by the City Of
map(s) was com ' pi
Edmonds, its Empl-oyees and Consultants.
Th,.e City of �Edm.onds does not warrant the
n these
accuracY Of anything set for.th 0
r entity a
map(S"). Any person o in I dependent
copy.should conduct an
'inquiry regarding the info'rm - ation shown, o
a p (s), including, but not limited to,
the location of any sewer stub shown. Suc
-not exist and may
sewer stubs may or may
or may not exist at the location shown.
ty of Edmonals/ nor its
Neitheir the
e m 0-y e e-S o,r office-rs -shal] be 1--larb-IFe for thE
information given on this map(5)) nor for
entation provided based
any one repres
upon said, map(s).
APPLICATION
The City of Edmonds for
.,.-,,UASEMENT NO - ---------------------- .............
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS F� LID NO. -15.1 ...... ASMT. NO . ..................
OWNER ----- --------------------- ......................... CONTRACTOR ---- 5qMe- Q S ... 0 W P\ e-V ----------------------- 44-08
------ ......... -------------- PERMIT NO - --------------------
94" Ave—AA1- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
JOB ADDRESS ------ -- — -- --------------------------------------------------
Pource- I A
...................................... ) ------ ...... . ...........................................................................
NAMEOF ADDITION ---------------------------------------------------------------------- ................................................
Slae Se-we-r- 'I s c-cv\s+rvc-+ed 6 F: 4-" 19-13 - S
( sc-�t - 4-0)
eep)
18'-+ t
'Laterml +o
3�
Ease-Nevkt brzvewo-�
3
Approved:
DATE By
............ yi7y6
LarrLt
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CITY OF EDMONDS
I . FOR INSPECTION CA16
PUBLIC WORKS DEP A MENT Permit 140,
SIDE SEWER PERMIT 775-2525 Ext. 220 Issue Date
PERMIT MUST BE POSTED ON JOB SITE
k�w7onstruc
1. Address Of 77 LA
772 1 ;z 77
2. Property Legal Description (include all easements)
A S, T AT
OiUN K ea L, V61
3. Single Family Residence Multi -Family No. of Units
Commercial
4. Owner amd-/or�Bui-lder
5. Contractor & License No. 14,'Z�Mgp CAJ*10
6. Invasion into City Right -of -Way: No_4,,,,� Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
7. Cross other private property: Yes No tl,�E'asement required
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN: - -k rA Fo v secoev
q
'd -b wk-t+e 60 OF Se_,tj ey
C:L C(%(�,
a. Property owners must obtain a permit to -install side se(Jers on PeVA(�_.
their property. A licensed side sewer co
r_o
construct side sewers in the public' right-of-w
L-DIG
b. The side sewer contractor assumes
full on ibil
4&; eEch�
installation for one year.
OrF
C. Commercial establishment requires
a mi E
9M
6' 1)
side sewer line.
d. Side sewers may not be installed
0 t a irty ches (30
to any structure.
e. Side sewer lines must be laid at a
and maximum grade of 100% (450).
M
9 IT-4 T NG CO212t
f. No turn in side sSwer greater tha
-
between cleanout. All 90 turns must be constructed of a 450 (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
'line
and at minimum intervals of 100' along sewer run.
j. Trenches within City right-of-wa-y" 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:
—in
I ce if iFead
'r that I have
6k (7,,b__,an comply With the above
PERMIT FEE:_,��
CONNECTION FEE.
00-t SAPPROVED BY: Date:
By: Date:
PPROVED By: Date:
PERMIT MUST BE POSTED ON JOB SITE
STREET FILE
i, 1011 P'I.�COPD
BUILDING DEPARTMENT App�fic:n't F71
U'
LD I NG
DE1
�P� Inside Heavy Li
PE�RMIT APPLICATION
NAME (OR NAN OF BUSINESS)
41,17-elC
W FM A 12L I 7;ADD�RES
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3: -7 74-q Ll- t 0
0
CITY ELEPHONE NUMBER
'F_�,�n IT
or mil 0
nos
W;V " PERMIT
z N NUMBER
JOB
ADDRESS
to,%
SUBDIVISION NO. I PLAT AAM9 JASSESSOR MAP 90.
U
W ADDRESS
U
ONE NUMBER
a: CITY
INAME
0 ADDRrss"y I
U
CITY TELEPHONE NUMBER
z
0
U
Legal Description of Property (Show Below or Attach Four Copies)
z
(U
n
W
0
W
PUBLIC. RIGHT OF WAY PER ORDINANCE NO.
EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY
DEFICIENCY OF MIGHT OF WAY
STREET/UTILITY WORK RGaUIRED
Ovas
1*N0
PERMIT FOR WORK IN PU9LIC RJW 1,
41 Vag
ONO
UNDERGROUND WIRING REQUIRED,;
Ova$
IF NO
CONNECTION TO SANITARY $6WER;
*Vag
ONO
SEPTIC TANK PERMIT Reauenco
Ova$
ONO
SEPTIC TANK PERMIT NO.
SEE MEMO DATED
REMARKS
CHECKED BY
METER SIZE I BUILDING SUPPLY SIZE
I
0
0
3:
U
W
MARKS
ENV. REVIEW ADS NO.
0 TC:'
SIGN AREA
ALLOWED PR POSED OMFLCTa I EXEMPT
REMARKS
VARIANCE OR CU PLANNING P19VICW ey
IDA . TIE
YARDS L40T COVIINAGE
FGAS A 5- 1 FRONT / b SIDE as' '01 It A i� I
,J�N . . El RESIDENTIAL Io LINE FIRE ZONE TYPE OF CONSTRUCTION ICOOK 1114"GH I I
ADD
ALTER
NON-RESIDENTIAL
DEMOLISH
EXCAVATE
OR FILL
SIGN
RETAINING
WALL
FENCE
X_FT)
.
I
SPECIAL INSPECTOR
REQUIRED
El YES El NO
AR
PLAN CHECKED BY
REPAIR
PRE -MOVE
swim
INSP.
POOL
REMARKS
NUMBER5 STORIES
OF
114UMBER
DWELLING
UNITS
NATURE OF WORK TO BE DONE
PROPOSED USE
z
0
PLOT PLAN JINDICATE BUILDIN
- ABUTTING STREE
a:
U
0
W
0
PLAN CHECK FEE
BUILDING
P LUMBING
MECHANICAL
FENCE
SIGN
RETAINING WALL
I GROUP I LO AD
IS SITE IS LOCATED IN THE COT;
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04,
z
L
VALUATION
rug
z
L
0
Z
94
Z
P4
Z
Street Right -of -Way Existing /--517 REQD
Access.Easements Existing I;EQD
Utility EasementExisting FEQD
Lot -per -Subdivision Plat Assessor Map )t6
Site Plan Checked for Accuracy
Underground Wiring Rqqd.
Check Accuracy.of Legal Description
Environmentally Sensitive Area
Da' t' e
4�ZAddress
Environmental Checklist Reqd.
Flood Hazard Zone Uo
Shoreline Management Area )o
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Existing Zoning Per Code
Amenities Design Board Approval Reqd. ADB # Approval -
Board of Adjustnient Approva . 1'Reqd. V L!a!:� -7, Z
Date: '?JtCi /479
Review Bv:
-X Existing Water IMain Size jospr .2
Water Main Reqd.
Service Line Reqd.
w" Hydrant Size Existing 0,t)
E-4 Hydrant Reqd. Per Fire Code Size
Detector Check Meter Reqd.. A)O
Cross Connection Inspection X)O
Fire Department Ca�nts
Water Meter Chagge Reqd.
Review by: Aj('K. Date:
Septic T -si i
Septic Tank Permit Reqd. V1101- Permit No.
Sanitary Sewer Availability Proi.
Drawing No. ./13 File No.
Side Sewer Availability 0* 47e7z2VE
W Sanitary Sewer ConnectionFee Reqd.
Revia,, B)r: VVIS Dat*e: W2-el
<Open Ditcli Existing. d.
Culvert Reqd. Size
C4 Catch Basin Reqd. A(9 Indicate on Site Plan-
0 Shbulder drainage n-ninta ii-i collection on s%�.ale open runoff
M Indicate on Site Plan
.Lwdiole rcqd. jW
Soil Conditions and Ground 1-1acer Field Checked
Revic-.,7 by_� ate
D,
Street Paving Reqd. NbE
Curb and Cutter Reqd.
Sidewalk Reqd. AS —
Curb Cut' for Driveway Reqd.
'4.t c4 Right -of -Way Construction Permit Reqd.
-or Public Improwra--nts
Bond Reqd. f
Street Nam, Sign Reqd.
Other Sip-iing Read.
Pre Permit Site Inspection r�ude on
0
BY: SS,.IER
10 ttl WATER
Ln
S=T
rx� EMIT= P--T,',;G
Special Rcqu_ire.,-.,-ants listed in mo-mo to Commuiizy Dovelopmnt Deparon-_nt,
Building 1)ivision
> 13Y Date
o All items filled in on Building Permit Application
BY Date
Drawings Stan;)ed and Notations R-ide
BY Dorte
Approved hy Public 1.7 rks Dep,,.irt-ixnt
UI .0
on, X__j
R(M.-Sed: IV 10-1977
MEMO TO
FROM:
SUBJECT:
Date
Building Division
Community Development Department
Engineering Division
Public Works Departmen
_fH-
After review of the subject building permit application, we have the
following comments:.
Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is the
responsibility of the contractor'.
The contractor is required to keep the abutting streets cleaned
of dirt and debris caused by the construction.
The "Right -of -Way Construct -ion Permit" is required, from the
T- Engineering Division of Public Works, for any work within the
Public Right -of -Way or public easement.
Driveway slope not, to exceed 14%. \/—I 9 -78
Connection to sanitary sewer required.
-7 required, submit design.
Septic Tank Permit
Fire hydrant required, submit design.
/-7 Site drainage per code See approved plans
/-7 Curb /-7 Sidewalk Paving required.
/-7 Bond required for public improvements. Submit cost estimate.
/-7 Underground wiring required. 4G.C--00AVL4P-A\FA---N-=
L-7 Approved Engineering Plans required when applicable.
a v=T- (2) a�/'&X-, Cal
For Freff F. Herzberg, P.E.
City Engineer
Department of Public Works
Rev. 7/78
UAI t WUKK COMPLETED BY FOREMAN
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ENVI RON MENTAL A14AL YS I S
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Exrv��,t uNDER-D'IS�TRICT SEP I A
PROCEDORES, SECTION Vll,',
�PAAA:
I NTERPIRETATION REVVIR90-TO.-
DATE, BY
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ADD ?'S!d kT'FT
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OtRMIT
TYPE,tlT-y o 1=
DATE GRANTED
PERMIT.
TYPE
._J>XfF--"GRANTEb
FOREIGN, CONTACTS,
'COMPANY F,-Nl -TEL.,-
TYPE
FOREIGN CONTA
COMPANY -
EASEMENT
GRANTOR
DATE GRANT
tASEMENT,,
GRAN R----
T,O,
_.DA'fE- GRANTED
WATER D/AL- 1�) 1
SEWER 0 :
GAS
W.A.R. FORM
DATE REC.
FUSING COORDINATED
BY GAlDP)Ql-5
LOG POSTED
IN v ENT-ORY
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POLE DERT.
TRANSF. CARD