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SINGLE TA14ILY HULTIPLE COME ;C I AL C H E C K L I ST
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PROJECT WE 114 A-Oz— CONTACT KME & TELEPHONE NUMBER
ADDRESS 5e XV 042 /,1
ACCESS SLOPE AND VEHICLE ACCESS
DRAINAGE PLAN
STREET FILE
LEM DESCRIPTION VERIFICATION
-,QUJT CLAIM/DrDICATIONS
1ASrmrXT - PUBLIC/PRIVATE
CALCULATE SEWER CONNECTION IF NO LID I
STREET PAVING REQUIRED
CURB AND GUTTER REQUIRED
SIDEWALK REQUIRED
CURB CUT FOR DRIVEWAY.REQUIRED it v 11
RIGJ4T-OF-WAY CONSTRUCTION PERMIT REQUIRED
BOND REQUIRED FOR PUBLIC IRPROVEMENTS
STREET NAME SIGN REQUIRED
OTHER SIGNING REQUIRED
(ADDITIONAL COMENTS ON SAC
14"
IXISTINC- WATER MAIII SIZE /9,
WATER MAIN REQUIRED
SERVICE LINE REQUIPED
HYDRANT SIZE EXISTING
HYDRAIlT REqUIRED PER FIRE CDOE SIZE
CROSS CONNECTION INSPECTION
WATER PIETER CHARGE REI)UIAED
REVIEW By DATE (AW I T I MAL . COMEmTS ON
SAB17ARY SEWER OWING IIL*O.BER
FILE WiBER
SIDE SEWER AVAILABILITY SANITARY SEWER COIIIECTION FEE REQUIRED
OPEN DITCH REQUIRED
CULVERT REQUIRED
SIZE
CATCH BASIN PEQUIRED L INDICATED ON SITE PLAn
SHOULDER DMINAGE )VINTAIN COLLECTI011 ON SHALE OPEN RUfIOFF
DATF: �7--// - r4
14EMO TO: Building Division
Corununity Development Department
FROM: Engineering Department
SUBJECT: gotz,-2' 41ff-o 7* OZ
After review of the subject Building Permit application, we have',.
the following comments:
1.
Connection
to
City
water system
required.
2.
Connection
to
City
sanitary
sewer system required.
3. Right-of-way
Permit
-required
for any work on City property.
4, Driveway slope
not
to exceed
14','..
5. Backwater valve required if (lownstairs plumbing is below
elevation of upstream manhole.
6. Water and sewer lines to be separated by 10 foot minimum.
7. Builder/Owner responsible for containing all temporary run-
off and erosion on site and may not impact neighboring
properties in any way.
Signature
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LEGAL DEScRTFTiON CHECK
LC+ 7
SUBDIVISION NO.
LID NO.
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MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REOUI RED DEDICATION
PROPOSED_
CITY
WL�
TELEPHONE NUMBER
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NAME
RIGHT OF WAY CONSTRUCTION PERMIT REQUIREK
STREET USE PERMIT REQUIRED C
ADDRESS
SEE ENGINEERING MEMO DATED
SEE PIW DEPT. REVIEW CHECK LIST DATED
CITY
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TELEPHONE NUMBER
R;E MK S /4 W
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NAME
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ADDRESS
METER SIZE
BUILDING SUPPLY SIZE
TURE UNITS
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CITY
TELEPHONE NUMBER
REMARKS
STATE LICENSE NUMBER
CITY LICENSE NUMBER
SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADB NO.
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Legal Description of Property - include all easements
(show below or attach four copies)
SHORELINE #
-1), Ocl -e -,
L0+
VARIANCE OR CU
PLANNING REVJEW BY
P
DAT�-
YARDS
FRONT SI REA
LOT COVER E
R
REMARKS
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ADDIALTER 1:1 NON-RESIDENTIAL 19—M.*E'CHANICAL
REPAIR 11 RETAINING WALL 1:1 SIGN
EXCAVATE FENCE
DEMOLISH OR FILL I x —FT)
PRE -MOVE INSP./
COMPLIANCE INSP. SPOW01M.
CHECKED BY
TYPE OF CONSTRUCTION CODE
I I
HEIGHT
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SPECIAL INSPECTOR
REQUIRED
0 YES NO
AREA
OCCUPANCY OCCUPANT
GROUP LOAD
17-1�—
V'l SIDE SEWER WATER LINE
REMARKS
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NUMBER OF STORIES
NUMBEROF
UWLLLINU
UNI16
NATURE OF WORK TO BE DONE (ATTACH PLOTPLAN)
VALUATION
FEE
PLAN 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, marquees, etc.) will require separate permission.
GRADING/FILL
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
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"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
modify,, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision." I
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TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the
information qiven is correct: and that I am the owner. or the dulv
ATTENTION
APPLICATION APPROVAL
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PAGE 1. OF 2
for
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plan by
phone --s %:� 27—
d ate -
DESIGN DATA
Trench Perc LF per Imperm Trench
Number Rate 1000 sq.ft. Area Req.
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the responsibility
of the property owner(s). Preventive
maintenance consists of preventing
soil and other materials from entering
trench during construction as well as
after construction. Catch basins should
be cleaned of floating material and
sediment at regular intervals (at least
twice per year).
�54
CITY OF EDMONDS
CITY OF EDMONDS
CITY OF EDMONDS
FOR INSPECTION CALL Permit
PUBLIC WORKS DEPARTMENT 0
11/1#-N5120� Ext. ffib Issue Date
SIDE SEWER PERMIT 7 171 - 11 �9fil 9011�
PEP -MIT MUS-T BE POSTED ON JOB SI! EDMONDS
�AEF-AWAMW�EW ) TREATMENT PLANT
1. Address of Construction '�, .'. -4 1 , I I . - r7
2. Property Legal Description (include a11 easements),"'',,.�1.3
3. Single Family Residence,' A'Mi"ulti-Family No. of Units
Commercial
4. Owner and/or Builder
5. Contractor & License No.
6. Invasion into City Right -of -Way: No Yes (If Yes Right-of-
way Construction Permit Re-quired - Call Dial Dig bYWA-0144d) before
excavation) 1-800-424-5555
E-4 7. Cross other private property: Yes No Easement required -
attach legal description and county easement number.
�4 READ THE FOLLOWING AND SIGN:
04
a. Property owners must obtain a permit to install side sewers on
>I their property. A licensed side sewer contractor must be employed to
construct side sewers in the public' right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
C. Commercial establishment requires a minimum of a six inch (6")
P4
side sewer line.
0 d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
0
e. Side sewer lines must be laid at a minimum grade. of 2% (1.15
0 and maximum grade of 100% (450). 0
f. No turn in side s8wer greater than 45 (1/8,bend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system. I
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 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: rD
that I have read
cert
and shall comply with the above
PERMIT FEE:
DISAPPROVED BY: Date:
"e— By Date:
CONNECTIONIFEE: APPROVED By:,4
Date:
0 IMSP IB5 V;W" W44
PERMIT MUST BE POSTED ON JOB SITE
446
The City of Edmonds Side Sewer Drawing EASEMENT NO - -- ---------------------- ----- ............
NEW CONSTRUCTION REPAIRS [:1 LID NO.. � -------------- - ASMT. NO . .. ............ .
OWNER ------ Rov-0-F - ------ ------ -------- ---------------------- CONTRACTOR -------------------------- PERMIT NO. 71-f.( -9-
.8 .
JOB ADDRESS --------------- LEGAL DESCRIPTION: LOT NO . ......... 7 ------------------------- BLOCK NO - ------------------------------------
....................... EDMONDS
E g -ANT-
--- * ------- ------- NT
TREATMENT PCA
NAME OF ADDITION ...............
PWW-0001-1 1/75 (REV.1 1/78)
V OP. C.0.cpw
Q;,cj0.W!jF- AT
Limr.
Approved:
DATE ..... By .4-ION .......
INSP. lE3!5 IROP4
NOTICE:
. N W'- T__
a r-ra n
formation 'shown on the attached
The -in
map(s) was cOm,piied for use by the CitY Of
Edmondsl its Employees and Consultants.
Th,.e City ofEdmonds does- not. warrant the
t these
accuracy of anything set for, h on
rnap(s�. An . y person or entity *requesting a
copy should conduct an independent
inquiry regarding the information shown on
-map(s); including, but not limited to, -1-
er stub shown. SUC
the lotation of any sew
sewer stubs may or may- not exist. and may
at the location shown.
or may not exist
Neither the City of Edmonds nor its
ernp-1-o-yee*s or offi-ce-rs -shal-1 be 1--ja-b-1--e for the
information give-n' on this rnap(s), nor for
any one representation provided based
upon . said. map(s),
CITY OF EDMONDS
ETNEW
FIADDITION
RETIREME-NT
ASSET INFORMATION SHEET,
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION DEPT. NO
"PURCHASE ORDER NO. —
PURCHASE ORDER DATE
COST
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
*PROJECT NUMBER eq
PROJECT COMPLETION DATE
COST 60 -0,57
INITIATED BY'' DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL -PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
E3/D`EPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANN.UAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE DATE
�,4j
VERIFIED BY
PROCESSED
BATCH NO. -
INITIAL
(yp)
FINANCE
'�Sll
CATCA BASIN:
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STANDARD DRA,;NAGE. PLAN
INFILTRATION SYSTEM
PAGE I OF 2
for -&hd &127A:-:— —
I oc at ion aogj -!t? I - XS9;2,U4- 40
plan by
phone 2=-7
date
DESIGN DATA
Trench Perc LF per Imperm Trench
Number Rate 1000 sq.ft. Area Req.
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and final inspections.
2. Responsibility for operation and
maintenance of drainage systems on
private property is the responsibility
of the property owner(s). Preventive
maintenance consists of preventing
soil and other materials from entering
trench during construction as well as
after construction. Catch basins should
be cleaned of floating material and
sediment at regular intervals (at least
twice per year).
994
CITY OF EDMONDS
Zc
STREET FILE
P,