19226 93RD PL W.PDFiiiiiiiiiiii
9069
19226 93RD PL W
C CITY OF EDMONDS
FOR INSPECTION CALL
PUBLIC WORKS DEPAR04T Permit
PU
775-2525 Ext. 220 Issue Date
S, DE SEWER PERMIT
PEP -MIT MUST BE POSTED ON JOB SITE
1. Address of Construction
2. Property Legal Description (include all, easements)
3. Single Family Residence Multi -Family No. of Units
Commercial
JL_
(
4. Owner and-/orBuilder_
5. Contractor & License No.
6. Invasion into City Right -of -Way: No //-,,,---"Yes (If Yes Right-of-
way Construction Permit Required Call Dial Dig (342-5344) before
excavation) .
7. Cross other private property: Yes No&�_ Easement required -
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
a. Property owners must obtain a permit to * install side sewers on
their property. A licensed side sewer contractor must be emp . to
construct side sewers in the public right-of-way.
b. The side sewer contractor assu r o r�e ch
installation for one year. 48 "OWS
C. commercial establishment requi m f h
side sewer line.
C)IG
d. side sewers may not be install d cl t n t es 30")
to any structure. 1.
e. Side sewer lines must be laid ft r d
and maximum grade of 100% (450). us I . al
f. No turn in side s8wer greater t 8V
between cleanout. All 90 turns must b t e cg'l 1/8
bend) and wye with removable cap.
g. No down spou�s, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is require d 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:
I.,"certify that I have'read
7--- and shall comply With the above
I '�' - �11� !'� A .< 3 , t;(e-n'� 71v-e '�
PERMIT FEE: DISAPPROVED BY: Date:
By: Date:
CONNECTION FEE:
C4 �:) APPROVED By: Date:
0,
44 1
PERMIT MUST BE POSTED ON JOB SITE
The City of Edmonds VILE Side Sewer Drawing
i %-I V;�5
i
EASEMENT NO - -------- ----------- ----------------------- �il
NEW CONSTRUCTION REPAIRS LID NO - ------------------ - ASMT. NO.
AE= T-.!e -
OWNER --------------------- CONTRACTOR LxnLA-T-vs:F, ....... PERMIT NO. -<P.42)7.
JOB ADDRESS ... lC-p::k2-2jCX:.. P --- % . ..... W - - -------------- LEGAL DESCRIPTION: LOT NO - ---------------- 0-5 ------------------ BL43CX NO - ------ -----------------------------
XT A Mr nr A nnill"nXT
PWW-OW1 -11/75 (REV. 1 1/7f
..... ....................................................
a
.......... By ... -- ------- --- -------- 11 ------ * -------------
CITY OF EDMONDS
F±l NE�V
ADDITION
RETIREMENT
I LOCATION
1 1 2 2
"PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
svev FILE.
A b
ASSET INFORMATION SHEET
ASSET NO. 0 0 2 7 Lf
ADDITION TO ASSET NO.
SERIAL NO.
DEPT. NO.
FS-6
*PROJECT NUMBER q
PROJECT COMPLETION DATE /3,
COST / 35' . o (,
B.A.R.S. ACCOUNT NO. 4// - a 0 /.!;7 — 3'f oe,
ESTIMATED LIFE
I IA I tu tly DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
INITIAL
REFERENCE
VERIFIED BY
PROCESSED
BATCH NO. —
(Ap
AP%
']hit No.
OF EDMONDS
-'PMLIC WORKS DEPARTMENT Issue Date
hr'EET, FILE
VGHT - OF - WAY CONSTRUCTION PERM?
A., -*Address or vicinity of Construction
Owner:
Name
4-"22 3 fZE 211
Mailing Address
City, State, Zip Code
Contractor:
Name
/,�711,; �2
Mailing Address
Permit Issued To: :22/0
Type of Work to be Done:
Work in Connection With:
7 Sub or Plat % Single Family
El Comml. / Ind. 0 Apt. Condo.
Pavement Cut: El Yes 0 No
State License Number
Ley
city, "State, Zip Code Telephone Number
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. AEPLIC NT TO READ AND 5IGN
INDEMITY: Applicant understands and by his signature to this application, agrees to 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 or employees, including or not limited to the defense of any legal
04
2 proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
0
U
W Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
co following the final inspection and acceptance of the restoration by the Engineering Division.
0
I -
Funds held from the Security Deposit (estimated restoration fee) will 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
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 must be available at the job site for inspection purposes at all times.
Signature: 4, Date—,
Owner or �Azent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Author I ized: Void a/fter days
Z Special Conditions:
0
WJ
�n
S Ammendments:
Permit Fee:
Security Deposit:
Receipt No.:
Fund I I I Fee:
Street Cut Dimensions
X
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
FIELD INSPECTIONWES" (Fund.' i'll., - Pute conv to Street Dept
Comments:
Diagram:
Contractor called for inspection., yps No
T
Kork Disapproved By: Date: Bv: Date:
Work Aporoved Bv: Date: P
Inspector.:
Encr. Div. December 1978
1018-
REV 12/79
PUBLIC UTILITY DISTRICT No I of Snohos county F��'
1 of Snoho
-L�Area
LOCAT ION - I
W.,; E
DAJ-E W. 0. NO
POLE NO. :5
:S;t7--'/4 S' f --5 T 'Z:7
R REVISION U.C. FILE
NO.
REASON FOR WORK
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ENGINEER AS BUILT
7-
DRAFTER SCALE
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APP�bVALS
PERMIT REQUIRED
E&ENT
REQUIRED BNOT REQUIRED
OTR EE TRIMMING OWATER
ENVIRONMENAL
INEXEMPT
ANALYSIS
0NOT
TYPE
E'XFMPT
UDIAL DIG USEWER
DATE GRANTED
CIPUD LOCATOR 0GAS
DATE RELEASED
[:]BACK HOE
FEES REQUIRED
YES NOn
FOREI N CONTACTS
POLE STENCILING
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,TYPE I"=
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FROM TO
DATE
AM OUNT�
CAT-V� NO..
TAKE.OF I F 'POL,E
SUBSTATION CIRCUIT NO
DAT.E-V�ORK COMPlETED By
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DIST. :�� ... -F::� .. . ...... . ..... ...
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SEC'D VOLT.......
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FOREMAN
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TRANSF CARDS I I �-11U-MAPS I
POLE DEPT I ICIRC.
,DATE PRINTED
DISPATCHER POSTED
MAP PAGE
WO�INO
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V4 FfOWAY.- MESSAGE
TO FR
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SUBJECT: DATE
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DATE:
DEG Ll-C23 '5
THIS PART AND FILE FOR FOLLOW UP,
SIGNED
SIGNED
PRINTED IN U.S.A.
TO.
RECEVJVLzD
SEP 20
MmE FILE
CITY OF EDMONDS
250 - 5th North
EDMONDS, WASHINGTON 98020
DEPARTMENT: IML d �1/0
SUBJECT bir, ul 15 REPLY REQ
( 7J) IRC -vio, ks NO DATE
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PLEASE ISIGNED
REPLY
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4DATE SiGNED
FORM NO. MEM. 88T
SEND PARTS 1 AND 3 WITH CARBON INTACT, PART 1 IS RETURNED WITH REPLY T.
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4. BUILDING D I mV I S 1707 'qw
Applicant Fill
USE IT I rl=
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ON W.
'PERMIT APPLICATION
Inside Heavy Lines
JOB
NAME JOR NAME OF BUSINESS)
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h& t=1'1F,/kT— 41714',
LEGAL DESCRIPTION
1 00 ISION
7r-, 1. �
SHORT SUB NO.
W
MAILING ADDRESS
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MAP
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET
ELEPHONE NUMBER
EXISTING_,.;�e2/' — Z_
U E�,/u
W ADDRESS
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M CITY
NAME
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40 SYAY9 LICENSE NUMBER
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Legal Description�of Property (Show Be
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PROPOSED 'r 'Ie C, 6-.� %Z I
DEFICIENCY OF RIGHT OF WAY
PUBLIC IMPROVEMENTS REQUIRED
DRAINAGE IMPROVEMENTS REQUIRED 0 evo
DRAINAGE PLAN REQUIRED
Y.
0
IELEPHONE NUMBER
-7
/_1_7_1
UNDERGROUND WIRING REQUIRED
CONNECTION TO SANITARY SEWER
IL
SEPTIC TANK PERMIT REQ'D 0 NO.
ELEVATION OF PROPERTY CORNERS 0
ek FOOTINGS REQ'O
ELEPHONE NUMBER
SEE ENGINEERING MEMO DATE
ITY LICIENSIE NUMBER
CHECKED BY 1 .1
E I Wk'd t - 7, A %,
or Attach Four Copies) . IMETER SIZE BUILDING SUPPLY SIZE
SIGN AREA ED 1,,,Ef,4V. REVIEW ADB NO.
ALLOWED I PROPOS PLETI EXEMPT I
I SHORELINE
REMARKS
VARIANCE OR CU
YARDS
RESIDENTIAL
GAS
LINE
FRONT
FIRE ZONE
TY
ADD
ALTER
NON-RESIDENTI]AL
DEMOLISH
EXCAVATE
OR FILL
SIGN
R TAINING
WEA LL
FENCE
(_ X—FT)
SPECIAL INSPECTOR
REQUIRED
0 YES No
PLAN CHECKED ETY
0 REPAIR
PRE -MOVE
INSP.
swim
POOL
REMARKS
Z NUMBER OF STORIES
2
14UMBER OF
DWELLING
UNITS
NATURE OF WORK TO OR DOME
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In
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0
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N C H E C K F E E
BUILDING
PLUMBING
MECHANICAL
FENCE
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SIGN
In "Applicant, on behalf of his or her spouse, heirs, assigns and
Ul
ILI
J successors in interest, agrees to indemnify, defend and hold harmless
I the City of Edmonds, Washington, its officials, employees. and
agents from any and aH claims for damages of whatever nature,
x arising directly or indirectly from the issuance of this permit. lssu-
RETAINING WALL
SWIMMING POOL
PLANNING REVIEW BY I DATE
[LOT COVERAGE
SIDE REAR]
NSTRUCTION I CODE IHE
AREA OCCUPANCY OCCU
IGROUP ILJOAD
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
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a I ance of this permit shall not be deemed to modify, waive or reducc
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n any requirement of any city ordinance nor limit in any way the
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PUBLIC VORKS DEPARI= CHEamm
BUIII)ING PERMIT REVIEW M7-�to g3a 72t. vV'
(address) (date)
Street Right -of -Way Exist REQD ;7c)
Z
Access Easements Exist
c4
Utility Easement Existing REQD
W
Lot Per Subdivision NA PlatA-,pp�ALqCV601Z Assessor Map!SF-
W
Site Plan Checked for Accura cy—jal
Z
Underground Wiring Reqd. qre'
0
Check Accuracy of Legal D�scription�y-r_9,AQAtCht-f -
Z
Review by Date IG- 90
Existing Water Main Size t9ij '-4 a
Water Main Required
Service Line Required
Hydrant Size
04
Hydrant Reqd Per Fire Code. IVA Size
Detector Check Meter Reqd.
Cross Connection Inspection NIA
Fire Department Comments
Water Meter a�= Reqd.
Review by Date
Septic Tank Design Approved A11W Date
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availabili Jf Pro*,
ty
Drawing No. :faf) File No.
Side Sewer Availability----4,�.'--:S�
Sanitary Sewer Connection Fee Reqd.
�3:
Review by Date 71
Open Ditch Exist1ng___,ALo�...Reqd.
Z
Culvert Reqd. &" Ov Size
04
Catch Basin Reqd. 'OVC' A0, e--- Indicate on Site Plan
0
Shoulder drainage maintain collection on swale open runoff "C/X'�9-
Manhole reqd. A.-o Ae e-- Indicate on Site Plan
Soil Conditions and Ground Water Field Checked in /<,
Review by Date_
Revised: lvlO-1977
Page 2
Street Paving Reqd. Al 0 IV
Curb and Gutter Reqd. A,- 0
Sidewalk Reqd. Al a /j/
Curb Cut for Driveway Reqd. A/
c4 Right -of -Way Construction Permit Reqd.
Bond Reqd. for Public Improvements
Street Name Sign Reqd.
Other Signing Reqd. Al
Pre Permit Site Inspection made an
z
0
BY: S94ER
WATER
z STREET
F4
ENGINEERING
Special Requirements listed in memo to Com=ity Development Department,
Building Division
BY Date
o All items filled in an Building Permit Application
r4 BY Date
C14 Drawinp';s'Starrped and Notations Made
N BY Date
Approved by Public Works Department
I
Revised: Iv 10-1977
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BLUEPIZiNT
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WORK. rV
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ADDRESs.
OIVIIIER-
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BLDG OFF,,
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KEEP
PLAN�,- "�ITAPED
FOR
M\
OF
I of
9.
IAL-
-2-3 -
DATE:
MEMO TO: Building Division
Community Development Department
FROM; Engineering Division
Public Works Department
SUBJECT: 12� 2L ax = - (a,) --3 - P1J P L
After review of the subject building permit application, we have
the following comments:
0
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. . . . . . . . . . .
MWAIRRIL A ii-�:x aV,
j
NOTICE,
ra'nty ... 0 T -a. u.(., u Y
No..Wa r,
shown on the attached
The information
for use by the City Of
map(s) was compiled
Edmonds/ its Empl.oyees and Consultants.
Th,.e City of *Edm.onds does. not . warrant the
accuracy of anything set for.th on t * hese
Ma P (s). An . y person or entity -requesting a
copy should conduct an independent
orm-ation shown, o
inquiry regarding the inf* imIted to,
_tF�e -map(s)/ including, but not J
c ion of any sewer stub shown. Suc
the lo' at'
sewer stubs may or may not e.xist and may
or may not exist at the location shown.
ris nor
,�'ty of Edmonl.,4 -/ & its
Neit-heir the -1 be I--,, a-b-Ife for thE
I .
empi.oyee-s 0-1- officers shal
I n on thi5 map(5)) nor for
information g've' d
any one representation provided base
upon'said map(S).
1-k
3T,"TET FILE
DATE:
MEMO TO: Building Division
0
Community Development Department
FROM; Engineering Division
Public Works Department
SUBJECT: PL
After review of the subject building permit application, we have
the following comments:
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MEN , R"�, M-0 e - "�Ab
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BLUCPRINT qof-4us, I KIC
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CITY -OF EDMONDS ENGINEERING DEPT.
Examined by /) /r-- I /.
Date — 3 -
Remarks— I A&
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SIGNED
CASCADEG Ll-C2375 PRINTED IN U.S.A.
SENDER: DETACH THIS PART AND FILE FOR FOLLOW LIP.
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