19914 76TH AVE W.PDF111111111111
6276
19914 76TH AVE W
1-3
Side Sewer Drawing
The City of Edmonds EASEMENT NO . ............ ...............................
NEW CONSTRUCTION IS REPAIRS LID NO.. ASMT. NO . ..........
U-Y v).
------------------- PERMIT NO.
OWNER - --------- E H: T E ....... CONTRACTOR - ----- ------
JOB ADDRESS LEGAL DESCRIPTION: LOT NO . ............. t ---------------------- BLOCK NO - ---------------------------
PWW-0001 -11175 (REV. 11/78)
............................................ --------------- ......... ........................................... ...............................................
NAMEOF ADDITION ............. .................................................................
DATE.... ........... By ---- ..............................
CITY
PUBLIC WORKS DEPARTMENT
SIDE SEWER PERMI
FOR INSPECTION CAL*
775-2525 Ext. 220
P. e r m i t 'T'j, 00 oi 6 6
Issue Date Z -5-eo_
PERMIT MUST BE POSTED ON JOB SITE R
kVWA�A�AWA�AWAW
1 Address of Construction Auc. 1A). 190�110
2. Property Legal Description (include all, easements)
nF
3. Single Family Residence Multi -Family No. of Units
Commercial C0jFFe_A )
4. Owner and/or Builder I'm A A -,,A, V b ri -�.e f
5. Contractor & License No-Vg �e_ Rb-,;WA A
6. Invasion into City Right -of -Way: No ��,�Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation) .
E-1 7. Cross other private property: Yes No / Easement required
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN: 90
a4 -
t3o
a. Property owners must obtain� Lit, 0 S�all side sewdis on
>4 their property. A licensed side sewer contractor must be employed to
construct side sewers in the public' ri�ght-of-way.
b. The side sewer contractor assumes_full reponsibility for each
installation for one year.
C. Commercial establishment requires a m' um f 611)
a4 19 i
z side -sewer line. 411 _HOUR4
0 d. Side sewers may not be installed los n t ir es (30")
to any structure.
e. Side sewer lines must be laid at 0
m a 15
and maximum grade of 100% (450).
0
E-4 f. No turn in side s8wer greater th .1 a lowed
bet�qeen cleanout. All 90 turns must be e
bend) and wye with removable cap. Ulds rrw H I y
g. No down spouts, footing drains or floor az=115 I All d
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 1001 along sewer 'line run.
j. Trenches within City right-of-way must berestored 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: Ra. R Is k 0
I certifF7�at�I have r-eFYd
and shall comply with'�Che above
LA,) 0 (ff P I - /__j A � --k q
PERMIT FEE: jo - 0 0
-rn) iu r- pe�� .7 ��p - a C)
CONNECTION ftE:
PERMIT MUST BE
DISAPPROVED BY: Date:
By: Date:
APPROVED By: Date:
TED ON JOB SITE *
The City of Edmonds
Side Sewer Drawing ,
EASEMENTNO . .............................................
NEW CONSTRUCTION REPAIRS 211" LID NO . .................. . ASMT. NO . ...................
OWNER................................................................................................. CONTRACTOR
............................................ PERMIT NO . .....................
JOB . ADDRESS -RIA�? ... . ... I .. .................................... LEGAL DESCRIPTION: LOT NO . ......................... **"*"** ---- BLOCK'NO . ............................
't P../.
..................................................................................................................................................................
NAME OF ADDITION
q i y - -7 I-J 4u
-7 (P -' 'r' YA-V r. . \\,t4 .
I I
tj
t ct oi t -A, -'7 (e -1 14 4o;�.
liq ko
V. c-
4",
,'�/ L)e-p
C - Z: 1-� � A, TO
rVor(c',. i-iTWlecl Ily
C c'r) bF Lypj-jkAvp- CoKT't.
o 0
LoW q- q+
Approved:
PWW-0001-11/75(REV.11/78) DATE .......... By
.............................
6
Side Sewer Drawing
NEW CONSTRUCTION JZ REPAIRS El
EASEMENTNO . ...........................................
LID NO. -J-�!>">'T',ASMT. NO . ..................
CONTRACTOR ....
PERMIT NO
LEGAL DESCRIPTION: LOT NO
. ............. ......................
BLOCX NO - ------------------------------------
....................................................................................................................
NAME OF ADDITION .............. .............................
�.4 c*=-
X3 I
Approved:
Ily .... ...........................
DATE .... ............
L)A, �,-O, WRKb 1); i-i- il::r �L(J
BUILDING PERMIT REA
(addressY'�' (date)
Street Right -of -Way Existing_
REQD—.-.,— 6-1,nj
Access Easeurnt-STR EETA�
- 14- '10)
—REQD
Utility Easement Existing
REQD
Lot Per Subdivision'S-�-1,4--i) Plat
Assessor Nap
Site Plan Checked for Accuracy
c2
Underground Wiring Reqd.
Check Accuracy of 1,egal Description
Review by
Date C
Existing Water Main Size
Water Main Required
Service Line Required
Hydrant Size.Existing Y4
P1.
Hydrant Reqd Per'Fire.Code
Size
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Com-nents
Water 14eter Charge E'qd._.
Review by
Date C_ a N --I!!:_>
Septic.Tank Design Approved vi
Date ki r-1
Septic Tank Permit Reqd. M
Permit No. ri
Sanitary Sewer Availability
W. ___Proj .
Drawing No..-
File No.
Side Sewer Availability
Sanitary Sewer Connection Fee Req.d.
V\
:ii:
Review by_�-�V-kT
Date
Open Ditch Existing &&2.24
eqd.
Culvert Reqd.
Size
V4
Catch Basin Reqd.
Indicate on Site Plan
0
Shoulder drainage'maintain collection
on sw6le open runoff
C\j C/
En
�bnhole reqd..
Zdic ate on Site Plan
—
'7'
Soil Conditions and Ground Water Field a-iecked
Review.b y
Date
Revised:,lvlO-1977
OR
N1
U I-
75ONE NWBER
'BUIL11 IV' ISION Applicant Fill
Inside Heavy Lines
PERh PhICATION
JOB --CAI
ADDRESS Iq -d .
17�
I:t fil A IVI E. 0
7. —E, 10
EGAL DFSCRIP TION SU D I v I cl SHORT SUB NO-
14-
MAI IN ADD
w 5
z
—R
-ET MAP
PUBLIC RIGHT OF WAY PER OFFICIAL STRF
3� ELEPHONE Num jF—E
0 CITY
EXISTING
PROPOSED
NA
DEFICIENCY OF RIGHT OF WAY
0
PU13LIC IMPR.O VE1,01ENTS REQUIRED
0
U
W ADDRESS
DRAINAGE IMPROVEMENTS REQU1RED
u TELE
DRAINAGE PLAN REQUIRED
Cl
—///
UNDERGROUND W IRING REQUIRED
CONNECTION TO SANITARY SEWER
NAME C—
SEPTIC TANK PERMIT REQ'D [:] NO.
. ION OF PRO PERTY CORNERS
ELF
0 ADDRESS
-VAT
& FOOTINGS REQ'D
u 9L
4 ELEPHO NE NUMBER
SEE ENGINEERING MEMO DATE
m CIT
1- 7 -103
Z /7 -7 low-)
0 CITY LI-----
CHECKED By
U STATE LICENSE NUMULN
3-01 or Attach Four Copies)
ER SIZE 13UILDING SUPPLY 51Z.L
m
Legal Description of Property noW belo
REMARKS
Z
0
ENV. REVIEW
SIGN AREA
IL
ALLOWED
PROPOSED COMPLETE
EXEMPT
SHORELINE
-e
u
w
0
REMARKS.
J
III
PLANNING REVIEW BY DATE
VARIANCE OR CU Z
J
LOT COVERAGE
YARDS FRONT SIDE REAR
.2
HEIGHT
GAS
[ja`RE..DENTIAL El LINE
FIRE ZONE
TYPE OF CON RUCTION
CODE
NON-RESIDENTIAL SIGN
ARE oCC . UPANCY
OCCUPANT
ADD DEMOLISH RETAINING
]WALL
SPECIAL INSPECTOR LOAD
REQUIRED GROUP
FENCE
YES 0 N
IS SITE IS LUCA I tu IN I
EXCAVATE
ALTER OR FILL I— X—FT)
1:1 1:1
PLAN CHECKED 8 L
. OF EDMONDS. LOCAL SA
SHOULD BE CODED 311-0�4-
PRE -MOVE. swim
REPAIR El INSP. POOL
REMARKS
z
NUMBER OF STORIltz,
Z
OF
w
UNITS
m
NATURE OF WORK TO BE DONE
U C-4—. C-9
w
N CHECK FEE VALUATION FEE
z
0
PLOT PLAN
w
IL
C-04,
BUILDING
0
PLUMBING
MECHANICAL
FENCE
"Applicart, on behalf of his (Ir her SI)OLIse, heirs, assigns and SIGN
hold harmless
w successtirs in interest, agrees ju indemnify, defend and 11)1()yecs, and RETAINING WALL
the (,ity of Edmonds, Washingt011, its ot'f'c'als' ell
t,()r (laillage., If %viiatever nature,
cc 1,P)III ally and :11, claillis SWIMMING POOL
< ,)III t1w is.�Ilall(T III this pormil- Issil-
&I'-L-Ily w inkhfk:�-Ily f �j%c of Wdllk.'L!
thOdil'V, W
"'ry 0
CITY of EDM ONDS
B%ESS
LICENSE APPLICATION
Civic Center Edmonds, Washington 98020
City Clerk Phone 775-2525
INSTRUCTIONS:
AR
1
FILM.,
E DATE REASG.
LIC. NO.
SPEC.1
• All items must be completed
'?
or application will not be ac-
RECEIPT NO.
DATE PAID
PRINTX A —
cepted.
612, 1# �3�
0
141 -0 1-1171
IN SPEC. Box
El
• Sign and return application
FEE PAID
PENALTY PAID
FOR ISSUE OF
CORRECTED
with fee.' Renewals received
I
LICENSE WITH
'LC' ACTION.
after February 15 must pay
penalty in addition to fee.
NEW BUSINESSES AFTER
JULY 31, 1/2 FEE.
(PLEASE MAKE ANY NECESSARY CHANG
NAMF OF FIRM
MAILING ADDRESS
LICENSE NO.
MW
ANNUAL FEES PENALTY AFTER FEB. 15
HOME OCCUPATION
$10:00 (A) ADDITIONAL $5.00
SMALL BUSINESS
.$15.00 (B) . ADDITIONAL $7.50
Business with 10 or
more employees ADDITIONAL $25.00
$50.00 (C)
0 NEW APPLICATION
0 RENEWAL
0 CHANGE
0 DELETE
BUSINESS PHONE NO. OF E
7 -7
NATURE OF BUSINESS
(LA)
(LB)
(LC)
(LD)
OYEES
IN
U51
V I / 7
INDIVIDUAL PARTNERSHIP CORPORATION
(P) P
OWIVE.
HOME ADDRESS
<�J`
HOME PHONE
DATE OF BIRTH
PLACE OF BIRTH
v k
SOCIAL SEC URITY NUMBER
:5 J j -- 0 -7 el 7--
--
EMERGENCY
NOTIFICATION: (1) NAME & TELE
C
:7 e-1 7-
(PLEASE
LIST TWO) (2) NAME & TELEPHONE
WASHINGTON
STATE TAX
NO.
APPLICANT'S SIGNATURq:---
DO NOT WRITE
BELOW THIS LINE.
'41
STAFF REVIEW:
FILL IN LAND USE CODE, UFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
P.LANNING DEPARTMENT
Q-APPROVE 0 DISAPPROVE
COMMENTS
DATEi*VP----�-1 -q
SIGNATURE-Y) C
LAND USE CODE ZONING CODE
I 1 .1121 C) I I
CONDITIONAL USE PERMIT
P4itDING. DEPARTMENT
V APPROVE 0 DISAPPROVE
DATE -17-1—
SIGNATURE If-7,
Building
Permit
El Hotel/Motel
';< Apt. Bldg.
(L)
(A)
0 Office Bldg.
(0)
COMMENTS:
Occupancy
0 Restaurant
(R)
Group
0 Hosp/Nurs Home
(H)
==E�I-CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
VZ4
0 School
(S)
FIRE DEPARTMENT
DATE
I.I.F.I.R.
,S�.APPROVE 0 DISAPPROVE
SIGNATURE 221-.441zeij�
17
L
COMMENTS:
POI-19.E-DEPARTMENT
0 DISAPPROVE f '7
g�-XIPPROVE D AT E 2 SIGNATURE
COMMENTS:
PUBLIC WORKS DEPARTMENT
11 APPROVE El DISAPPROVE DATE SIGNATURE
MMENTS:
P I r r, - F n 17-7 T I I P 1� TY) r I -I- v r, I r n t.,