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APPLICATION
for
ST FILE SIDE SEWER PERMIT
The City of Edmonds KEtl NEW CONSTRUCTION Z--- REPAIRS r-1
EASEMENT No . ..........................................
/- j �13
OWNER -------- / � ........ ......... 0 17 -/� ......................... CONTRACTOR f'PERMIT No.
RIPTION: LOT No . ....... tL./ ................................ BLOCK No . .................... .......................
............. 142,
ADDRESS . ..... ......... . .......... - ... LEGAL DESC
"'66-07
NAME OF ADDITION ........
.... .... .... ........ .. ......
`2
DATE....... By .. .. ............................
if
NOTICE:
No warranty of accuracy.
The -information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set for ' th on these
map(s). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
emp[oyees or office-r-'s) shall be I-Jab-l-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
,%—.ITY,OF EDMONDS Can PRospect 6-1107 when Work f
CIVIC CENTER — WATER -SEWER DEPARTBIENT is ready for Inspection. (No Insper,
tions Saturday, SundiW or holidays.) N2 1855 i
SIDE SEWER PERMIT
— 78th Place West ...................................................
ADDRESS....... �05-1-4 .............. ........................ .......................................................................................
Moore ... ..........
....................................... CONTRACTOR ------- ..............
OWNER ......
Pern-Assion is granted ------Mc.krCh --- 2)4 ................. P 19.1-U., for ...................... days, to REPAIR or CONNECT a side sewer
ith City Sewers in accordance with application on file and governing ordinances.
wi
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside property line. A licensed Bide Sewer Contractor must
be employed to construct side sewer In street area. Do riot cover any portion of sewer before It haa been Inspected.
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; minimum grade of 2%.
No bends in grade sharper than % will be permitted.
E 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. sewer or its ap-
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 aln
purtenances except to Insert the pipe Into the wye.
Tr -,�,v3m_r 4��, i V",
whErEs"I "Mr.
CITY OF EDMONDS
USE
ZONE p PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/N.�ME OF BUSINESS
JOB SUITE/APT #
ADDRESS
4A%ZY Awpeasotll
.79
LEGAL DESCRIPTION CHECK SUBDIVISIO N NO. LID NO.
MAILING ADDRESS
Z
0 Vj P ">,r
00609 7.03
TESCP
CITY ZIP I TELEPHO.NE NUMBER
PUBLIC RIGHT QF WAY PER OFFICIAL STREET MAP. Approved 0
2 RWPermit Required 0
eVti o 1.) QS 7* or
tXISTI N*G REOUIRED DEDICATION' Street Use Permit Req'd 0.
PPOPOSED Inspection Required 0
NAME
Sidewalk Required 0
a
REMARKS
Z
E
W
UUJ ADDRESS
cc
CITY, ZIP J_TELE�7HONE NUMBER
uj
-51.) % I
NAME
ENGINEERING MEMO DATED k % REVIEW BY
ADDRESS
0
'L -11, 1; so
SIZE
METER SIZE BUILDING SUNFjP'L7 NO. OF FIXTUR ES
4 CITY ZIP BER
cc _WPHONE NUMBER
I
ac
k i.Z? it
z A a L 10 "J Iq I <1 - 5
0 5 41,2
—
REMARKS
Uj
,
<
STATE LICENSE NUMBER C, ttc*,
7
SIGN AREA SEPA REVIEW ADS NO.
Legal Description of Property - include.all easements
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE 4
0 .
-------
EXP
VARIANCE OR CU P NING REVIEW BY DATE
ILL/, eje7)6 D-- cpe:;I Lo
I .
SETBACKS — FEET HEIGHT OT COVER AGE
Uj
FRONT &-251 SIDE T/;X, REAR 1V
Z
Z
Tax Account Parcel No.
HIMAHK5
DNEW.
RESIDENTIAL PLUMBING
Ex ADDIALTER COMIkIRCIAL MECHANICAL
APT. BLDG.
REPAIR SIGN
GRADI NO FENCE
CHECKED By TYPE OF CONSTRU TION, HEIGH
DEMOLISH, CYDS. L_ x_ FT)
ICODE
Z
CARPORT swim
ETREMODEL GARAGE POOL.
SPECIAL INSPECTOR kREA OCCUPANCY OCCUPANT
REQUIRED 13 YES GROUP LOAD
WOOD STOVE I RETAINING WALL/
RENEWAL
REMARKS
INSERT ROCKERY
2 (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
PROGRESS INSPECTIONS PER USC 305
IT( A
-e % — I - XZ�
M . Kill
�S NUMBER OF STOF31ES NUMBER dF
AF/449
M
ui
a * . DWELLING
I
00 Z - UNITS
- DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
Amp Set_ojD jrje- y ge,,D"opf �fr RW 7/./
FINAL INSPECTION REOUIRED
VALUATION FEE
7-F
PLAN CHECK FEE
BUILDING 4LO
PLUMBING
Plan Check N 0.
C�)
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curts, sidewpiks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: Days
.180
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE'
"Applicant, on behalf of his or herspouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend 'and hold
harmless the City of Edmonds, Wash In gton,"'Its .off ic ia s,
employees, and agents- from. any and all claims for damages of -
'�6
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< whatever nature, arising directly or indirectly from the Issuan
a:
PLAN CHECK DEPOSIT
of this permit. Issuance of this permit shall not be deemed to
e6
0
modify, waive or reduce any requirement of any city ordinance
0
nor limit in any way the City's ability to enforce any ordinance
TOTAL 'AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
SLIfffffm=
ATTENTION APPLICATIOiq' APPROVAL.
Information given Is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
THIS PERMIT This applic . ation is not a permit until
state laws regulating construction; and in doing the work authoriz-
AUTHORIZES
signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor
ONLY THE.
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED Deputy; and fees are paid, and receipt is
tiOn Insurance.
INSPECTION acknowledged in space provided.
SIGNATU E N OR kGENT) DATE SIGNED
�DEPARTMENT
L's �.SIGNAT RE, D TE
CITY OF
�DFFC
EDMONDS
D By DATE
CALL FOR
ATTENTION
Vs
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL — File YELLOW InsPector
112 W
A CERTIFICATE OF OCCUPANCY HAS, BEEN GnANTED. UBC
:
771-0220
GOLD -- Assessor