21023 76TH AVE W.PDFIIIIIIIIIIII
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21023 76TH AVE W
c-,CITY OF'EDMONDS
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PUBLIC WORKS DEPARONT FOR INSPECTION CALL Permit Ho. goo?
775-2525 Ext. 22.0, Issue Date
S, DE SEWER PERMIT
P
EP-MIT MUST .BE, POSTED ON JOB SITE
2.
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C====
3
4.
Address of Construction
Property Legal Description
R a A- - , �, , . , / 24- 0in -:z a
(include all, easements)
SingA �amily Residence Multi -Family W"' No. —of Units
Commercial 0 - IMA 61A�L INGER
,T�L
AT
LIFT I
Owner and/or Builder /,s 40 os STATION
Contractor & License No. oi
Invasion 'into City Right -of -Way: No Vl-*' Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation) .
7. Cross other private property: Yes No v,�' 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 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")
side sewer line.
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
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/s
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Clea nouts 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 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 hou Is only. /rwo (2), working
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days notice required.
DATE:
I/ct�,ertify thyt I h-&vVRYead
and shall comply with the above
PERMIT FEE: DISAPPROVED BY: Date:
0-har4e: 1*1/00100 By: Date:
P4 CONNECTION FEE:
APPROVED, 1�����Date:
0
rZ4 '* PERMIT MUST BE POSTED ON JOB SITE
Side Sewer Drawing
The City of Edmonds
'NT
EASEME NO . ................................................
NEW CONSTRUCTION REPAIRS 0 LID NO . ............ ...... ASMT. NO . .................
OWNER........ ....................................... CONTRACTOR ... ...... .............. ........................... PERMIT NO.
JOB ADDRESS ..... ........ LEGAL DESCRIPTION: LOT NO. ........................... ......... BLOCX NO . ...... ..............................
........................
.........................
.................. ....... .......... .....................................................
;P NAME OF ADDITION ......................... . . .. . . . . . . .. . . . . . . I - - - - - - - - - - - - - - -
d.3-
-_7 YIA. ALLMOER
8 1-1-9. UFT TION
f
-3 8'
.43
0
'17 Vc-
G, <72'
P -(7v-
Approved:
P�
WW-0001-11/75(REV.11/78) D.AiE -------
46 .
STREET FILE
k
DATE:
I I I (I i 1,,-,
lEl"10 TO: Bui. L., .;, Pjv,;.,;ioIl
comn'll-illi-L", DevelopmenL flep,-irunciiL
F RON; i itz i . neeri . m7
Public. I,Ioris�s D e, ni L&
SUBJECT
i% L e r r ev i e- o
1) c., I-,
the following cc)j7,rjjejjL.c;:.
u nj (A.2 k V"' n C7!a
_CL_
I �-,�Ja�ieaj—a
--6Ar,
2tp W
wo r4t3
r;> 4
—rQ%nf
0 Put( 1."ORK's 1)EJ1A1M1-1T-.'NC C111-:' Ts-r
"00/ U . 11DING PETI-Rcr RLVIL140 r Addi:(,-
Street RigM-of-1%1ay Existing REQD
Acctess Easemi2nts E-xisting
k -X3 F, REQD
Utility aasement Existing QD
RE
1'ot per Subdivision Plat L_�,Assessor M'_1p
Site Plan Checked for Accuracy
Z;�
Underground Wiring Rjeqd.
Check Accuracy of Legal Description
E -1vi
roruTentally Sensitive Area 6
t
Environmental Checklist Reqd.
Flood Hazard Zone
u Shoreline 'elma-en-�_-nc Area
Slope, Soil, Vegetation (3
r
Stream,. C
reek, Drainage Basii
rk
1�j EKisting Zoning Per Code
Amenities Design Board Approval Reqd. ADB 11 Approval
Board of Adjustment Approval Reqd.
ReVieW Bv Date:
An.
e -4 i;-. I;V? r.
ZY
11('4 E-�isting -1,.Tater Main Size
1,1ater Main Reqd.
/V A
3
Service Line Reqd.
�_l I Hydrant Size Existing .:4;
Ilydrant Reqd. Per Fire Code -Size
4 Detector Check Meter Reqd.
Cross Connection Inspection.
)N
Fire Department Coiirpents
Wlater Meter Charge Re d
Reviex.i by: 17e
)7 e:U Date:
Septic Tank Design `Tprovea
��rl( Septic Tank Permit Reqd. PC, --,nit �b. I) C)
X1
Sanitary Sewer Availability Proj.
Drawing.No. File No.
Side Scnwer Availability
Sanitary Se�-7er Connection Fee Reqd.
Review By:
Date:
4,
BUILDING DIVISIO
—pplicant Fill
PERMIT. APPLICATION InsZ Heavy Lines
NAME JOR NAME OF BUSINESS)
HILLIS HOMES, INC.
w MAILING ADDRESS
z
3:826 S. BROADWAY
0 CITY TELEPHONE NUMBER
EVERETT,
ig WA. 98204 1 355-4492
�-JKINDERFATHER CHAFFOS DUNN PS, INC.
U
W ADDRESS
201 FIFTH AVENUE SOUTH
U
Ir CITY ITELEPHONE NUMBER
EDMONDS1 WA. 98020 775-9396
NAME
HILLIS HOMES, INC.
0 ADDRESS
I'_
u 826 S. BROADWAY
M CITY TELEPHONE NUMBER
I'_
z
o,EVERETT, WA. 98204 1 355-4492
15TATE: LICENSE NUMBER [CITY LICENSE NUMBE7R
223-01—HI—Ilr-IH-337L6 I
Legal Description of Property (Show Below or Attach Four Copies)
z
0
SEATT
(u DIVIS
W
a
J
RNEW
X
RESIDENTIAL
ID
GAS
0 LINE
.
NON-RESIDENTIAL
SIGN
ADD
F]
DEMOLISH
RETAINING
E]WALL
ALTER
EXCAVATE
OR FILL
FENCE
I_ X_FT)
REPAIR
PRE -MOVE
swim
INSP.
POOL
z NUMBER OF STORIES
OF
0
INUMBER
DWELLING
UNITS
4
NATURE OF WORK TO BE DONE
CONSTRUCTION
OF A 4 TJNTT
CONDn—
W
0
MTNTIJM BUILDING
-
(.BUILDING GROUP 2,.SEE SITE PLAN
ATTACHED).
"Applicant, on behalf of his or her spouse, heirs, assigns and
W
-I successors in interest, agrees to indemnify, defend and hold harmless
2 the City of Edmonds, Washington, its officials, employees, and
M
x agents from any and all claims for damages of whatever nature,
7: arising directly or indirectly from the issuance of this permit. Issu-
a ance of this permit shall not be deemed to modify, waive or reduce
USE ERMI1
ZONE ill � MUMBE
I OB I
ADDRESS 1, 1
i . 1� / 0 2 Lve-a-
El LEGAL DESCRIPTION I SUBDIVISION SHORT SUB NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING C=:;=
PROPOSED
DEFICIENCY OF RIGHT OF WAY
PUBLIC IMPROVEMENTS REQUIRED
0
DRAINAGE IMPROVEMENTS REQUIRED
DRAINAGE PLAN REQUIRED
UNDERGROUND WIRING REQUIRED
CONNECTIO� TO SANITARY SEWER
29-4-
SEPTIC TANK PERMIT REQ'D' NO.
ELEVATION OF PROPERTY CORNERS
& FOOTINGS REQ'D
S EE ENGINEERING MEMO DATED -1 7D
CHECKED BY
BUILDING SUPPLY SIZE
I SIGN AREA. ENV. REVIEW AD B NOE.
ALLOWED I PROPOSED COMPLETE1 EXEMPT
S
SH�ORELINE
REMARKS
VARIANCE OR CU
REVIEW By
DAT E
1PLANNING
YARDS
COVERAGE
/,S( FRONT
_)o REA
SIDE R
ILOT
FIRE �ZNE
ITYPE OF CO NStTRUCTION
CODE
HEIGHT
SPECIAL INSPECTOR
AREA
OCCUPANCY j7-
OCCUPANi
REQUIRED
I
GROUP LOAD
I
13 YES, INO
PLAN CHECKED BY
THIS SITE
IS LOCATED IN THE
CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
IPLAN CHECK FEE VALUATION 7 // FE , E
BUILDING 1 934 1
PLUMBING
MECHANICAL
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
0
U
0.1
W
3: