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1 21121 82ND PL W
OVILDING DEPARTMENT —
PERMIT APPLICATION. M,
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NAME (OR NAME OF BUSINESS)
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Legal Description of Property (Show Below or Attach Four Copies
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SUBDIVISION NO. PLAT NAME ASSESSOR MAP NO.
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PUBLIC RIGHT OF WAY PER ORDINANCE NO.
EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY
DEFICIENCY OF RIGHT OF WAY
STREET/UTILITY WORK REQUIRED
El YES ONO
PERMIT FOR WORK IN PU13LIC R/W
19YES El NO
UNDERGROUND WJRING REQUIRED
a YES El NO
CONNECTION TO SA N ITARY SEWER
GYES El NO
SEPTIC TANK PERMIT REQUIRED
Y ES ON 0
SEPTIC TANK PERMIT NO
SEE MEMO DATED
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AP�
REMARKS If
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CHECKED BY I � . I I
BUILDING SUPPLY SIZE
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SIGN AREA ENV. REVIEW ADB NO.
ALLOWED I PROPOSED I COMPLETE I EXEMPT I
REMARKS
VARIANCE OR CU
YARDS
AS' FRONT
P014
NEW
ADD
ALTER
REPAIR
RESIDENTIAL
NON-RESIDENTIAL
DEMOLISH
EXCAVATE
R FILL
PRE -MOVE.
INSP.
GAS
FILINE
SIGN
RETAINING
WALL
FENCE
I— X—FT'
El SwIl M
POOL
FIRE ZONE
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SPECIAL INSPECTOii
REQUIRED
0 YES NO
PLAN CHECKED 9Y
NUMBER OF STORIES
94UMBER OF
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REMARKS
DWELLING
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UNITS
NATURE OF WORK TO BE DONE
R_es�&,e"t�(A
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PLAN CHECK FEE
PROPOSED USE
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PLOT PLAN (INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
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BUILDING
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PLUMBING
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MECHANICAL
F
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
PLANNING REVIEW BY DATE
LOT COV ERAGE
1; 12 SIDE REAR
OF CONSTRUCTION CODE [HE17H-r
k OCCUPA14CY OCCUPANT
I GROUP I LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL.SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
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AF'U!��4� Date
Street-Right-of-w�y Existing
Access Easements Existing
Utility Easement Existing
Lot -per Subdi��i�ion
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Site Plan Checked for Accuracy
Plat
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REQD
REQD
REQD
Assessor �ap,
Underground Wiring Re�gd.,.
Check Accuracy ofLegal. Description
Environmentally Sensitive Area
Envirormmtal Checklist Reqd.
Flood Hazard Zone
Shoreline Management Area
Slope, Soil., Vegetation
Stream, Creek, Drainage Basin
Existing Zoning Per.Code--
Amenities Design Board Approval Reqd. ADB. # Approval
Board of Adjus7mnt_App3�oval Reqd. L) 0
Review By:
Date:
Existing Water 11,1a1n Size
Water Main Reqd.
Service Line Reqd.
w' Hydrant Size Existing c>
Hydrant Reqd. Per Fire Code Size
Detector Check Meter.Reqd. �,�O
Cross Connection Inspection
Fire Department Cannents
Water Meter Charge ReqO. :2-0) 0
Review by: "k1s
Date:
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w-1Septic Tank -sign Approve ate:
Septic Tank Permit Reqd. Permit No. A.)141
Sanitary Sewer,Availability Proj .
Drawing No. File No. 6-.5-44
Side Sewer Availability 7-C>
, Sanitary Sewer Connection Fee Reqd.
Revia'7 By: Date:
)en'Ditdi Existing --Reqd.
Culvert Reqd._ Size
04
Catch Basin Reqd. Indicate on Site Plan-
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Shoulder drainal.,,c wnintaixi collection on smale open runoff
1-u-diole � rcqd. Indicate on Site Plan
Soil Conditions and Groun.d Water Field Checked
Po\ric-.,7 by Date-
1111! 1111t ii,
Street Paving Rcqd.
Curb and Cutter Reqd.
Sidewalk Reqd.
Curb Cut'for Driveway Reqd.
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Rioit-of-Way Construction Permit Roqd.
Bond Reqd. for Public IrmrovenQnts
Street Naiaa- Sign Reqd.
Other Signing Read.
Pre Permit Site Inspection r-kide on
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BY: SR,,.IER
WATER
SMEET
ENIGINT-ERING
Special Rcquirei-,umt:s list:ed in mom to Conmunicy Doveloprwnt D(-,�partment,
Building Div�.sion
13Y Date—
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All itars filled in on Building Peimdt Application
13Y Date 5r/ac/ /2r 0-1�-
PL4
Drawii-q;s Stamped and Notations �L-ide
BY Darte
Approved by aiblic 'Porks Deoarti,,)ent
Rk-'Vised: 1v 10-1977
0 0 0
175eDATE: S/;2:e+
MEMO TO: Building Division
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT:
After review of the subject building permit application, we have
the following comments:
,(I Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grade's is the
responsibility of the contractor.
(2) The contractor is required to keel) the abutting streets clean-
ed of dirt and debris caused by the construction. -
.(3) A '!Right -of -Way Construction Permit" is.required, from the
Engineering Division of Public Works, for any work within
the Public Right -of -Way or public easement.
(4) Driveway slope not to exceed 14%.
PW 5/77
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ZONE*
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THIS OFFICE ASSUMES NO RESPONSIBILITY AS'TO PHYSICAL -CHARACTERISTICS' 0 F' THE,SOIL,,'�, 'T
�NOR DOE3,I
'ureary ;Ard-aioArv.nr vuncurvDaun nATA IHPPLIVO RY OTHERS. USE OF PLOT-ACKNOWLEOGES ACCIPTANCI�'.
PLAN NO
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OLK
J-OHN 8 N" rRSON, AIA & ASSOC IATE'S
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Date
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Street Right -of -Way Existing
Access Easements Existing
Utility Easement Existing
Lot per Sqdivision Plat
Site Plan Checked.for Accuracy
Underground Wiring Reqd..
Check Accuracy of Legal Description
Environmentally Sensitive Area
REQD
REQD
REQD
Assessor �ap
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Environmental Checklist R�qd.
X-N
Flood Hazard Zone
Shoreline Management Area. On
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Existing -Zoning Per Code",
Amenities Design Board Approval Reqd. ADB. # Approval
Board of Adjust;ment Approval Reqd.
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Review By- XV14 - I I- Date:
Existing Water L-Ia� Size
Water Main Reqd.
Service Line Reqd.
w' Hydrant Size Existing c:>r,_
I_ I Hydrant Reqd. Per Fire Code Size
Detector Check Meter. Reqd.
Cross Connection Inspection �j
Fire Department Comments
Water Meter Charge ReqO. !P ;?—')0
`Vs,
Review by: i.��
Date: E?,
Sep t:ic Tank Design Approve- ate:
Septic Tank Permit Reqd. Pennit No. /_)AZ
Sanitary Sewer Availability Proj .
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Drawing No. File No. 4-6..4
Side Sewer Availability 70
D-3-- Sanitary Sewer Connection Pee Reqd.
tr Reviev By: tylls
Date:
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USE; PERMIT
BUILDING . DEPARTMENT Applicant Fill ZON NUMBER
PERMIT APPLICATI ON, Inside Heavy Lines JOB 4
NAME (OR NAME OF BUSINESS) ADDRESS
SUBDIVISION NO. PLAT NAME ASSESSOR MAP NO.
j-1 MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER ORDINANCE NO.
[CI T Y
ELEPHONE NUMBER
EXISTIN G RIGHT OF WAY
PROPOSED RIGHT OF WAY
NAME
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DEFICIENCY OF RIGHT OF WAY,
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STREET/UTILITY WORK.REQUIRED El YES ONO
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PERMIT FOR WORK IN PUBLIC R/W BYES El NO
UNDERGROUND WIRING REQUIRE. A YES El NO
M CITY
TELEPHONE NUMBER
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CONNECTION TO SANITARY SEWER "YES 1:1140
SEPTIC TANK PERMIT REQUIRED F-1 YES IRNO
NAME
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SEPTIC TANK PERMIT NO.
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SEE MEMO DATED
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CITY
TELEPHONE NUMBER
REMARKS
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CITY LICENSE NUMBER
CHECKED BY
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Legal Description of -Property (Show Below or Attach FOUr Copies)
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BUILDING SUPPLY SIZE
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REMMRKS
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SIGN AREA ENV. REVIEW
ALLOWED I PROPOSED I COMPLETE I EXEMPT
REMARKS
VARIANCE OR CU
YARDS
Pq
MREPAIR
NEW
ADD
ALTER
GAS
LiENLRESIDENTIAL LINE
NON-RESIDENTIAL 10 SIGN
DEMOLISH RETAINING
1:1 WALL
EXCAVATE FENCE
OR FILL 11 X—FT)
PRE -MOVE swim
INSP. El POOL
I
FRONT
FIRE ZONE
I
TV
I
ECIAL INSPECTOR
REQUIRED
0 YES 0 No
PLAN CHECKED BY
NUMBER *OF STORIES
NUMBER OF
REMARKS
DWELLING
UNITS
RE OF WORK TO BE DONE
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PLAN CHECK -FEE
BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
RETAINING WALL
PLANNING REVIEW BY
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I'll, SIDE
AREA
ADS NO.
DATE
REAR ILOT COVERAGE
CODE 7HEIGHT
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THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
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NOTICE:
N'o wa rra nty ... 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 �Edm.onds does not - wa rra nt the
accuracy of anything set forth on these
map(�_). 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 loc'ation 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
ernp-to-yee-s o-r offiCe-rs -sh-a-11.1 be 1--ia-b.-Ife for the
information given on this map(s), nor for
ion pr *ded based
any one representat' ovi
upon said map(s).
DS
OF EDMON
FOR INSPECTION CALL Permit
__1_6BL1C WORKS DEPARTM\1�,T 'Date
"775-2525,
�SWABR PF,?M1T
-1.
2.
PERMIT MUST',BE POSTED -ON JOB SITE 00"I'BEET FILE
Address of Construction 7""
Property Legal Description (include all easements)
3.
Single Family Residence Multi -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 Required - Call Dial
Dig (342-5344) before
excavation)
7.
Cross other private property: Yes No
Easement required -
attach legal description and county easement
number.
READ THE FOLLOWT.NG 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 s-ewers may not be installed closer than thirty inches ('30")
to any structure.
e. Side sewer lines must 0 be laid at a minimum grade. of 2% (1.15 0
and maximum grade of 100% (45 ). 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.
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 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: Y
I certify that I have read
and shall comply.Vith the above
PERMIT FEE:
'4'CONNECTION FEE:
P4
0
PC4 PERMTT MU$
DISAPPROVED BY: Date:
By: Date:
APPROVED By: Date:- _=11:Z
T BE POSTED ON JOB SITE *
Side Sewer Drawing
The City of Edmonds EASEMENT NO . ............................................
F
NEW CONSTRUCTION REPAIRS F� LID NO. — ............... . ASMT. NO . ..................
OWNER ...... ------- � CONTRACTOR ---- PERMIT NO.
JOB ADDRESS ------- 7��:-1 -cl ..... --------------- LEGAL DESCRIPTION: LOT NO . ............ ................... BLOCK NO - ------------------------------------
PWW-0001 -11175 (REV. 11/78)
NAME OF ADDITION .....
..................................................................
-5�'r
Approved:
DATE ....... ................. By ----- J
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