21220 SHELL VALLEY RD.PDF11111111111111
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21220 SHELL
VALLEY RD
a a
ADDRESS
TAX ACC(
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: F1 Conditional Waiver [] Study Required n Waiver
DISCRETIONARY PERMIT #'
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
P-�.wd
SIDE SEWER AS BUILT DA
SIDE SEWER PERMIT(S)
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DSTs\Fonns\Street File Cheeklist.doc
BUILDING DEPARTMJJ
PERMIT APPLICAT14
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EXISTING STRREI R/W FT. DEFICIENCY THIS PROPERTY
COMP. P*_AN ST. P/W FT. FT.
LEPHONE NUMBER REMARKS Driveway slopes not to exceed those Z
indicated on Standard Dvia. No. (03 Ll.
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T"W"NECTION VERIFIED By
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APPVD ON' CITY ENG. /A-- ELI N 0 1W
REMARKS
I�Azg A�I*L METIER SIZ-_--FSU'.RViCV SIZ E jCLEAR^NCr ICHECKED By
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SWIMMING POOL
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I hereby acUnowledge th�t I have read Zh!s Ippec.ation; tbzt thtehin-
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lormutfor NO. le .— r the duly au
gIven Is correct: and that I er.
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!�-d ger,'. of the _ner. X agree to comply with CRY
to doing the �Ork authortzed thereby, no ;)argon
ATTENTION
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APPLICATION APPROVAL
I"Ing constructloc; —d
�Jlj be =PIOYrd in %*j.l.tl.a Of LI, Labor Code of the &Lata Of WCAII-ogton
THIS PrRT
This application Is not a perridt until
re:atlng M Workm�.'z Compeniatlen Idjurance.
AUTHORIZES
signed by the Building Official or his Dep-
NOVE: Permit Limit One Year (E.,ept DEMOLITIONS �'hlch
ONLY THE
uty; and fees are paid, and receipt Is ac-
i'OL
s " It In.
ahall be completed 1. W.,ty day.: MOVED-�N nUILDINGS Ih-11 be �m
VCK NOTED
Unowledged in S a provided.
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p! d 1 1. 1—)
, ��7_ . V
7"-. 1 OWNER DATU SIGNED
0 EP.RT1ICNT
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OtRLCTO S GN TU
C11"f OF
. . . . . . . .
EDMO1*DS
DATE
NOTE: Applicant Subject to Flan Check Fee 775-25,25
Thi Permit covers work to be done on Private property ONLY.
Any cOnstruction on 'the public domain (curbs, sidewalks, drivewn),s,
ORIGINAL - �, YELLOW -
marqu, -S, etc.) will require separate permi . SSiOn.
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�IGINEERING DEPT.
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The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION REPAIRS E] LID NO . ................... ASMT. NO . ..................
OWNER .... WIS, L- <-- K f-:� Rli t--A F-:S� tlA
-------------------------------------------------------------------------------------------- CONTRACTOR --------------------------------------------------- --------------------- PERMIT NO - --------------------
JOB ADDRESS at2.2.(:2) t5HE-:--�L- \JLLL-r--Y ... RPI�,-C3 LEGAL DESCRIPTION: LOT NO . ..... 2-77
------------------------------------------------------------ ----------- ........ --------------------------------- BLOCK NO - ------------------------------------
0
0
F-1
L
0
NAME OF ADDITION - ------- ------- 2 . .................
---------- ----------- TUYK
................................................................ oirwrik(m "P/m BTjxxmm ........ Walaker ... Uomen ....... Inc . . ........ .................................. ....................
coynL&cTows NA.T*= & ADDRESS .... C .... & 5 - 2nd Ave. W...�� d
............ . .................................. .... ....
Pennission is granted ......... Xay.=ber ... 9 ... . ............ 19 ... 74 for repok am/or oonlawtim of a side sewer to the city sawltvy sewer
rl-� In accordance with City of Edmonds ordhumces.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1--The owners of the property may 6btsAn a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must be employed to construct
aide sower in street area. Do not cover any portion of sewer before it has been, inspected.
-E No, 2—All worl, performed In city right-of-way reWires an Invasion of RIght-of-Way Permit obtalneble from the City Engineer's office.
V No. 3—Obtain full Information regarding Ordiaxwo 11.16.030 and Regulations governing side sewerx when you got permit.
MiTV No. 4—Top of side sewer must have at least 30 Inches coverage at property line and IS Inches inside property I . Ine; minimum grade of 2%. Me bands In grade
shaxper than % will be permitted.
NOTE No. &—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure du* to Improper
work which may develop within one year of completion.
NOTE No. 6--It to 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 its agfKatenancog except to in-
sert the pipe into the wye.
DISAPPROVED n Date . .. ................................... By ................ Date. ................. By ................ Date. .............. . .. . ............... ...... .........
14C.
APPROVEDE] Date ..... Z (.W ................................. By._ ... . ........... . .. . .. ........................................................................................
Remarks: ....... . ...... . .............................. . .......................................................................
............. S- T-REET .... LE_--**"-"**.'.'.---
............. I ................................................... . .. . ........................................................................ .......... . ............................... ........ ..............
BOTH Permit C rmin
�_yples MUST Be Signed By Owner of Firm Perfo g Construction PRIOR To Request For Inspection
.... ...... ..... �.. .... .... hereby certify that the side sewer InsW lation constructed under this permit
or of Contracting Firm orming construction)
was InstaUed' accordance with governing ordinances of the City of Zdmonds.
DatedtbJ& ...... ....... . ........... day of ................................................................. 19 .........
APPLICATION
The City of Edmonds for
SIDE SEWER PE IT
NEW CONSTRUCTION REPAIRS E]
OWNEP - ----- W ... -------- �6-jine-1 - ------------------------
JOB ADDRESS -------- 2-1-0-2-69 ........ .... X--� ....
EASEMENT NO . .................. .........................
LID NO . .................. . ASMT. NO - ------------------
CONTRACTOR .............. C-5�7�� ------------------------------------------------------ PERMIT NO.
LEGAL DESCRIPTION: LOT NO . ...... ---- BLOCK NO - ------------------------------------
,2-7 -----------------
............................... . ........................................................................
NAMEOF ADDITION .......................................................................................................................
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Approved:
DATE............................................ By ............................................................
11/75
22
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90-00 -
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TR A C-r 00
JOINT
,�QCES5 � UT�LIT'(
E N S IEM E N"r
E'S�T�cLLA RESIDENCE
212R CK.
-0 SHELL VALL RD,
EDMONDS W46
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