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TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED: —
PARKING AGREEMENTS DA'
EASEMENT(S) RECORDED F1
DETERMINATION: 0 Conditional Waiver Ej Study Required [—] Waiver
PERMITS (OTHER): /f 5-;01�
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #: 61�2!3
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
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I hereby ,kcknowledge that I 113%'e read hi, pplication: 1 ul,.,!ih.--
formation g,,er is ,rrect: anj Liar I ajj�. the owll�r. Or the o APPLICATION APPRO AL
izecl agert of the owner. I agree tu c3ir"PlY with cily and state laws Tcgu- ATTENTION
. ri. a, d in doing the wor� au!l.ori.,.ed therebY.. no person a
lating conStructIc f wa.,1.1ijigien ",V; IERMIT This aPP';c3ti I is lot perinit
I - I signed by C.ie Buil, -
wiU b, crnOIOYcd il IiOi:tion of tile Labor Code of tl�e St3IcO und dine Official or
relating to Workmen's Compensation Insurillce. AUTI ORIZE!' . fcC3 are paid. and
NO-,E- Permit Limit One Year. pt I)EMOLITIO"'S and I:ILL ON,, THE his Deputy; an(' d i to-
��h �hujj be cOjnplco�cd in 90 %:OqIJ NOTCO recei t is acknojvlc�gc in rp3CC P
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PERMITS -ino9t conditional use. P f )) vi
'hat" �c :.er�ipletcd in si\ InOnth�.) AT RE
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DFPARTMEN.
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C.TY OF
I EDM.O-3S DATE
sirm^�U'RE
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775-2525 7,P
VOTE.- App"ficallt S11 C7 to plvz C71erk Fee L
I. C`O pri.ate PlLeer7 LINLY. ORIGINAL Fde
=,B�,.ersgork to b. do, in I', cl,i�,eWays, - OWrzr
I, h. public do I. ;c.rl�, �idewa- I COLD ;\ssessor PIPM
Any narqupcs, PIC i Will rprqui,e s�eparst- perrnission.
APPLICATION
It The City of Edmonds for EASEMENT NO . ............................................
SIDE SEWER PERMIT
NEW CONSTRUCTION E REPAIRS F� LID NO - ------------------ IASMT. NO . ..................
CONTRACTOR ------------ - - -------- PERMIT NO.
OWNER .......... PIL, ------------------------------------------------
JOB ADDRESS ---- LEGAL DESCRIPTION: LOT NO . ............. . —A -------------------- BLOCK NO - ------------------------------------
0
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------------------------------------------------------------------------------------------------------------------------------------------------------------------
NAME OF ADDITION ----- -----------------------------------------------------------
Approved:
DATE............................................ ....... ; . ....................
CITY OF EDMONDS SIDE S
EWER PERMIT
WATER -SEW= DIWARTMZNT
PERMIT 612.3.
C&H 773-240 for side sewer inspection$ RFFORE covering any Portion of the construction)
1009"Um Will be Provided within 24 hours after requgt. No Sat., sun., or holiday inspections.
LOCATION OF CQNMRUCT1ON_._.-C_..Z� .... /-4.L.4e�7-
...... ......
~PXRWY LWIAL DESCRWTION-.. .... 2-0.2 ........... 4 --------_---- e_
... . .............................................. ........ ................... ................................ ............... . ... ......... ... . . . .. . . . ........... . .......... . . .....................
...........
4- 20
. . . . . . . ..... . ................................... OWNER,& /oB B1[j]]EMER ........ ,o4
. . . .. . .............. . .. . .............. . .. . ..... . . ...........
CONTUAMOR'S NAME ADDRESS....
-------------
19.2-kfor repair and/or connection of a side mwer to the, city sanitary
...............
pmInisslon b granted...
In accordance with City of ordinances.
ftMION IS CALLED 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 cogs§
side sewer in street area. Do not cover any portion of sewer before it has been Inspeclad.
MOTE No, 2—All work Performed In city right-of-wav requires an Invasion Of Right-Of-WaY Permit obtainable from the City Ungineer,X office.
390TE No. 3--40btain full information regarding Ordinance 11.16.030 and Regulations governing side 68wers when you get permit,
NOTE No. 4—Top of side sewer must have at least 30 Inches coverage at property line and 12 inches inside property line; rulaimura gmde, of J'W. pro be"A In
sharper than % will be permitted.
No= No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible fo failure due to
work which may develop within one year of completion.
�X*rE No, 6--It is unlawful to alter or do any other work than Is Provided for In the permit, or to do any work on the main sewer, or ij;& appurtenances, except A
1jert the pipe into the wye.
DINAPPROVW [j Data - - -------- - -----_-_-------- - --- By ---------------- Date ..... ------ r
- ------- Dale� ...... . . . . . .. ............ — By..
A"BOVM ... . ........ ......... ........ ........ .
-t ............ . . -------------------- - . . . ............... . . .......
4
Remarks: --------------------------------- - ---- --- -------------------------------------------- ....... ... . .............. . .......... . ........... . .... . . .. . .. . ............. . .....
................................ . .................. .... .................. . .................................................... . ............. . . ... . .......................................................
Permit Copies XUST Be Signed By Owner of Firm Perfornling Construction PRIOR To Request For Inspection
11 . .... ... --- --- - ----- ---_-_---_- ---- hereby certify that the side sewer installation constructed underUdsper-Wt
(Owner Of con, 149 orming Construction)
Instal ed in accordance with all governing ordinano,60,of the City of Rdmonds.
Datedthis ................ .... day of_'.___C9 ........................................ . .. . . .
Check BEFORE you dig for: Water 0, Gas 0, Telephone 0, Power 0, Sewer 0, Other[) V 4
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APPLICATION
The City of Edmonds for EASEMENT NO . ............................................
SIDE SEWER PERMIT
NEW CONSTRUCTION E] REPAIRS Ej LID NO. - ............... ..ASMT. NO . ........ .........
................... ------------------------- .......... ----------------------------- PERMIT NO.
OWNER - -------------------------------------------------------------------- CONTRACTOR .....
JOB ADDRESS --- LEGAL DESCRIPTION: LOT NO. ...... ---------------------- BLOCK NO - ------------------------------------
--------------------------- ------ -- ------
---------------------------------------------------------------------------------------------------------- -----------------------
NAME OF ADDITION --- ----------------------------
-----------------------
Approved:
DATE............................................ By ------------------------------------------------- ..........
11/75
THE NORTH 120 FEET OF THE SOUTH HALF OF THE WEST HALF OF THE
SOUTHEAST QUARTER OF THE SOUTHEAST QUARTER OF THE NORTHWEST
QUARTER OF SECTION 30, TOWNSHIP 27 NORTH, RANGE 4 EAST, W.M.;
except THE WEST 220 FEET THEREOF. also, THAT PORTION OF THE EAST
17 FEET OF THE SOUTH HALF OF THE WEST HALF OF THE SOUTHEAST
QUARTER OF THE SOUTHEAST QUARTER OF THE NORTHWEST QUARTER OF
SECTION 30, TOWNSHIP 27 NORTH, RANGE 4 EAST, W.M.; except THE
NORTH 120 FEET THEREOF; and except THE SOUTH 30 FEET THEREOF
CONVEYED TO SNOHOMISH COUNTY, WASHINGTON BY DEED RECORDED UNDER
AUDITOR'S FILE NO. 220318.
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CITY OF EDMONDS
PUBLIC WORKS DEPARTMENTj ENGINEERING DIVISION
APPLICATION FOR RIGHT-OF-WAY CONSTRUCTION PERMIT
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
A. Permit to be issued t o !2, , yA4 A&
For Work at :(address or vicinity)
Type of Work to be done:
(attach� drawing when applicable)
Time Required -- Start: —Finish:
Owner: 13AMe— 145
Name STREET FILE
Mailing Address
City State Zip Telephone Number
Contractor: erra
�n
aV 17r— State License Number
�2v X)
Maiting Ai�dress
'._A"4W4 ____ __,a - --- - I
City State Zip Telephone NumE-er
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE **
B. INDEMNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including or not limited to the defense of any legal proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
.Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspect -ion and acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection.and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220.
I understand that this permit must be available at the job site for inspection
purposes at all times. A'w A. I Date:
Signature:A 9- 1 7.);'
Ow�er or AVent
TO BE COMPLETED BY ISSUING AGENCY:
Date Issued: Permit No. : 29 -Z?-7 Fee:
Security Bond: —
Time Authorized:
APPROVED
Date :5;"- -,?&9
PUBLIC WORKS DEPARMIM J&CKLIST
BUILDING PERI= REVIEW
(address) t
0
Street Right -of -Way Existing
4-614-0 REQD NA
Z
Access Eas�ments Existing K�
_-N
Q 9: REQD
_F4.
H
_N-,fp
p4
Utility Easement Existing, KA
REQD N. A.
Lot Per Subdivision Plat
Assessor Map_
Site Plan Checked for Accuracy
Z
Underground Wiring Reqd.
Check Accuracy of Legal Description
-78
Z
Review by i6
Existing Water Main Size
Water Main Required /./A -
Service Line Required
Hydrant Size Existing c_>C
1:4
Hydrant Reqd Per Fire Code
—Size
Detector Check Meter Reqd. oLAO
RTPI;PT EILE
Cross Connection Inspection Ve?
Fire Department ConTnents
T
Water Meter Charge Req�._*
W/S
Review by
Date ;3Z9 LZE
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availabilla LZa-
Proj.
Drz,Ting No. Z
File No. 4-200 4F—.IV
Side Sewer Availability >� e
Sanitary Sewer Connection Fee Reqd.
X
4/S
�3:
Review by
Date 1�491-76
Op en Ditch Existing_,4(&—
Reqd.
Culvert Reqd.
—Size
C4
Catch Basin Reqd.
Indicate on Site Plan
0
Shoulder dr i ige maintain collection
on swale open runoff
1,1-mhole reqd.
Indicate an Site Plan
Soil Conditions and Ground Water Field Checked,
Review by
Date
Revised: lvlO-1977
00 00
DATE:
MEMO TO: Building Division
Community Development Departmentt%
oTREET FILE
FROM: Engineering Division
Public Works Department
SUBJECT:
After review of the subject building permit application, we have
the following comments:
(1) Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is tF_e
responsibility of the contractor.
(2) The contractor is required to keep 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-14,lay or public easement.
(4) Driveway slope not to exceed 14%.
d
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PW 5/77
PUBLIC WORKS DEPARMO C&CMIST
- BUILDING PER!= REVIE�
M-0 Avi I . I'm
Street Right -of -Way Existing.—
4-61 r 4-0
Z
Access Easements Existing &10
_�EQD
REQD Aw
r4
. . . . . .
Utility Easement Exist'
_N-
--REQD
N
Lot Per Subdivision do— Plat
Assessor MAP
W
Site Plan Checked for Accuracy.
sl!�� I
Z
Underground 14iring Reqd.
Yle
H
0
Check Accuracy of Legal Description
4::�) -78
Z
Review by
Date 5 1!9 119
Existing Water Main Size-IF3 ,Dx
Water Main Required AIA-
Service Line Required 4�
Hydrant Size Existing, C->C_
1:4
Hydrant Reqd Per Fire Code
Size
W
Detector Check Itter Reqd. �-)O
Cross Connection Inspection VV
E-1
Fire Department Conmmts
Water Itter Charge Reqd. 7-9o"5>
;)V/S
Review b
Date �3/9
Septic Tank Design Approved A
Date
Septic Tank Permit Reqd. A-) A
Permit No.
Sanitary Sewer Availability -5
Proj. 117�-
Drawing No. Z
File No. 4-200 4E/V
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.—A,191A�
PY/S
Review by -
Date 73
Open Ditch Existing
Reqd.
Culvert Reqd.
Size
r4
Catch Basin Reqd.
Indicate on Site Plan
0
Shoulder dr i ige maintain collection
on swale open runoff
Manhole reqd.
Indicate on Sit Plan
Soil Conditions and Ground Water Field Checked,:r4& re,,.7- 4a,
Review by
4-11
Date
Revised: MO-1977
-Page 2
'U-
00
Joe
Street Paving Reqd. Z(Ar=
Curb and Cutter Reqd.
Sidewalk Reqd. NAI-,-
Curb Cut for Driveway Reqd.
P4 Right -of -Way Construction Permit Reqd.
Bond Reqd. for Public Irpravements_L
Street Name Sign Reqd. . A�4L
Other Signing Reqd. ks�=
* * Pre Permit Site Inspection made on
z
0
BY: SEWER
WATER
STREET
FX4 ENGINEERING
Special Requirements listed in mem to CoTmunity Development Department,
Building Division
BY Date
c) All items filled in on Building Permit Application
P4 BY 80 Date
P" Drawings StaTrped and Notations Made
PL4 BY f3 (Q Date
Approved by Public Works Department
Revised: 1v 10-1977