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21020 80TH AVE W
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STREET.FILE
*rLJBLIC IJORKS DEPARTIT�= CHECKLIO
Kin,DING PERaT -REVIEW
51917 Date
1:MJ1 AV&Wddress
Street Right -of -'Way Existing REQD
Access Easements Existing NnK) REQD
U�ility Easement Existing o K);9L REQD
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Lot per Subdivisicyn'S-24- Plat Assessor Map
Site Plan Checked for Accuracy
Underground Wiring Reqd.
Check Accuracy of Legal Descri tion
3-p
Environmentally Sensitive Area
Environmental Checklist Reqd.
Flood Hazard Zone
U Shoreline Management Area
Z Slope, Soil, Vegetation
W I Stream, Creek, Drainage Basin
Existing Zoning Per Code
A) 0
11
Amenities Design Board Approval Reqd. KO
S, ADB # Approval.
Board of Adjustment Approval Reqd. K ) Ohl
Review By: KLUIvy, �__ Date: tMAI
Existing Water Main Size
-Wa Ma i Reqd
S=e_Line_Reqd.
Hydrant Size Existing- ---
Hydrant Reqd. Per Fire Code
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Commen
Water Meter e �Reqd.
Review by:
SepLic T sign prove
Sepd_c� Permit Reqd.
Sanitary
lity
Drawing No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
Revia-7 By:.
Date:
Vate:
Permit No.
Proj .
File No.
�17�. -
Nil �Ditch Existing Reqd.
Culvert q Size
P4 Catch Basin Reqd. Jhdi-ca �te on Site Plan
0 Shoulder diainage niaintain c t, I swale open rLuiof f
i Q t c'l
E--1st in--
-- -1
1 ert R�eq
[itvch Basin Reqd
Jouldc.
.2r clL_ 1.1.1,li i -itai -i c
a e ni ii -1
U)
1-1,iiihole req �Inc on, Site Plan
�cj
SOUL, �ndittiions and Ground Water Field Cliecked
b Tkite
Street rig Reqd.
Curb and Cutter d.
Sidewalk Reqd.
r ee t 'rlg Reqd.�
Irb and (�utter
lk
Ld a Reqd .
Curb Cut for Driveway Reqd.
p4 Right -of' -Way Construction Permit Reqd-
Bond . Reqd. for Public rr—ov�enx--nts
u) Street Nam_5joi-Reqd.
Other cy Reqd.
�-6iing
Pre... iiit Site Inspection made on
BY: MR"R.
t Site Inspecti
S 'R
E1,JTL
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WATER
P-'
STREET
ENIGINTEERTNG
- -- - - - - - - - - - - - - - - -
Special Requiremm-ts listed in man-o. to ComTunity Developr-tyant Departrre nt,
Building Division
> By k) 0 Date - 45�
o All items filled in on Building Permit Application
BY—. Date—
P-4 Drawings Staii-ned and Notations �kide
13Y Date
.lApproved by Public 1\1orks Deparwo-it:
Revised: lv 10-1977
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 forth on these
map(s-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
-----fh-e -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'loyee-s o-r offiCers-) -sh-all be liable for the
information given on this map(s), nor for
any one representation provided based
upon'said map(s).
V!
CITY OF EDMONDS
CIVIC CENTER — WATER -SEWER DEPARTMENT
SIDE SEWER PERMIT
Call PROSPect 41-1107 when work
Is ready for inspection. (NO Inspec-
tions Saturday, Sunday or holidays.) N2 1264
ADDRESS ...... ............... 340 - 21st Avenue South
. ......................... ................... ......... ....................................................................................................................
OWNER ------------- Cuma-R.—Pe.t.tell-e .... ..
......... ........................ CONTRACTOR ......... OW11jer
Permission is granted ... .... 4�qly.* 2 9
. ........... I ............... I 10��—"I!Or ---------------------- days, to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALL D TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do not cover any portion of sewer before it has 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.
1-j 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.
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 maln sewer or its ap-
purtenances except to Insert the pipe into the wye.
L
G-
STREETFILE APPLICATION CARD No . ......................................
for
The City of Edmonds S11DE SEWIM PERBM 07 EASEMENT No . ........ #� ......................
OUTSIDE HP- INSIDE Q REPAIRS
OWNER .... 0 --- U.M-A ........ BAF"".7 .................................................... ..... PERMIT No/.-_2
.. .... .. . .. / . .................................. CONTRACTOR ........
STREET
HOUSENo. ............................................ . ...................................................... AVENUE LOT No . ...................................................................... BL04CK No . .............................
NAMEADD . ... .................... --- 0-0.c? ......... ....... .........................
7-,Y 6- 0 CA -s7-
i
BACKFILL WORK qRDER ISSUED
SEWER WORK OR�ER ISSUED -----
.................. DEPOSIT, $ ..............
..................
DATE
Mw
APPROVED
JUL 29 f965
4v,
.. ................
By --- tf-*-
1 601111
�.Glyy 0 e
CITY of EDMONDS BLftESS LICENSE APPLICATION D LICENSE NO.
Civic Center Edmonds, Washington 98020
City Clerk Phone 775-2525 ANNUAL FEES
STREET FILE XA_�M�E�0( C-CtIA _2_� T I ON
NSTRUCTIONS:
All items must be completed
or application will not be ac-
cepted.
Sign and return application
with fee. Renewals received
ff r C 1,
$10.00 (A)
PENALTY AFTER FEB. 15
ADDITIONAL $5.00 0
• SMALL BUSINESS
$15.00 (B) ADDITIONAL $7.50 0
• Business with 10 or
more employees ADDITIONAL $25.00 0
$50.00 (C)
. I e mary 10 MUSL pay �k NEW APPLICATION (LA)
penalty in addition to fee. 0 RENEWAL (LB)
NEW BUSINESSES AFTER 0 CHANGE (LC)
JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE (LD)
NAME OF FIRM
r"V
MAILING ADDRESS
0,P 0 — IKO e. w.
� rom cts , L4-* 4, - (4-7,
BUSINESS PHONE
7 7,S-- 141�Pez.
NATURE OF BUSINESS
M AN -, L LX2�40,�
NO. OF EMPLOYEES
C;�
BUSINESS ADDRESS INDIVIDUAL PARTNERSHIP CORPORATION
a � L),z o - s F5� (S) (P) (C)
OWIRS NAME HOME ADDRESS
_ ) a -�, ��, 'Aladvo - goy� zd ZAy-�
HOMEJ�HONE DATE OF BIRTH PLACE OF BIRTWtA< LA�L SECURITY NUM
3
SOC
?!S7 - I L4 7 -'V- /�:a 4-A I;SY�h9AA,'" 4 5 -3-45
EMERGENCY NOTIFICATION: (1) NAME & TELEPHONff PP.X -r '7 -) q — 9 7;;;�_
(PLEASE LIST TWO) (2) NAME& TELEPHONE CeT(?_VJLL -7 7 '1 —30S4.
WASHINGTON STATE TAX NO.- APPLICANT'S SIGNATURE
STAFF REVIEW:
DO NOT WRITE BELOW THIS LINE
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.
PLANNING DEPARTMENT LAND USE CODE ZONING CODE
APPROVE 0 DISAPPROVE DATE 6 (640
SIGNATURE A)4WC�
CONDITIONAL USE PERMIT
COMMENTS RIO
BUILDING DEPARTMENT DATE Building 0 Hotel/Motel
.ffr'APPROVE 11 DISAPPROVE SIGNATURE -,. JA Permit 0 Apt Blda. (A)
COMMENTS:
I I I CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
ffE DEPARTMENT DATE
A, APPROVE 0 DISAPPROVE SIGNATURE
COMMENTS:
FT7 1 0 Office Bldg. (0)
Occupancy 0 Restaurant (R)
Group E) Hosp/Nurs Home (H)
0 School (S)
[Roo
���MNON
POLICE DEPARTMENT D ATE 2— SIGNATURE
b'"APPROVE 0 DISAPPROVE I -
COMMENTS:
PUBLIC WORKS DEPARTMENT
0 APPROVE 0 DISAPPROVE DATE SIGNATURE )w
COMMENTS:
PLEASE RETURN TO CITY CLERK