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Catch P(,;uiI-e(I Indicate on '7i':c PI an
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NG DEPARTMENT
PERMIT APPLICATION
Applicant Fill
Inside Heavy Lines
USE __41VMRIQ�
ZONE NUMBER
PR
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ADDRESS
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NAME (OR NAME OF BUSINESS)
LEGAL LOT
Q;YES 0 NO
LOT AREA
SUBESIVISION NO.
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MAILING ADDRESS
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CITY ITELEPHONE NUMBER
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STREET R/W
EXISTING STREET R/W Fr. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W FT. FT.
NAME
REMARKS
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ADDRESS
CHECKED BY
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TELEPHONE NUMBER
STREET AND/OR UTILITY WORK
REQ'D. 13 YES 19'N
R/W PERMIT REQUIRED
0 YES NO
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NAME
UNDERGROUND
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ADDRESS
WIRING REQ'D. 12 YES ONO
TYPE CONNECTION PYES JVERIFI[D f
SANITARY SEWER
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CITY
TELEPHONE NUMBER
SEFTIC SYSTEM YES 'PERMIT NUMBER
APPV*D BY CITY ENG.
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STATE LICENSE NUM13ER
CITY LICENSE NUMBER
REMARKS
WALAC- �Z 15-1 5T
Legal Description of Property (Show Below or Attach Four Copies)
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METER SIZE
.314" 1
BUILDING SUPPLY SIZE
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REMARRS I
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ALL -OWED PROPOSED
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REMARKS
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VARIANCE OR CU
NNING REVIEW BY
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DATE
YARDS FRONT SIDE REAR
ILOT COVERAGE
E W ESIDENTIAL GAS
4 LINE
D N N-RESIDENTIALIE] SIGN
ADD 1:1
El DEMOLISH RETAINING
1:1 WALL
ElALTER EXCAVATE FENCE
F� OR FILL E] I— X—FT)
FIRE ZONE
TYPE OF CONSTRUCTION
I
ICODE
-
ECIAL INSPECTOR AREA
REQUIRED
0 YES 13 NO
JOCCUPANCV
GROUP
I
CCUPANT
LOAD
I
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
El REPAIR PRE -MOVE swim
1:1 INSP. POOL
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
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PLAN CHECK
NO.
VALUATION
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PROPOSED USE
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PLOT PLAN (INDICATE BUILDING SETBACKS.
ABUTTIN G STREETS)
BUILDING
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PLUMBING
HEAT & GAS LINE
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FENCE
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CITY(')F
EDMONDS -
SIDE S'-VER PERMIT
WATER -SEWER DEPARTMENT
I
PERMIT N? 5 9 6 5
4
Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction
Inspection will be provided within 24 hours after requst. NO S Sun.,_or holiday Inspections:)
ADDRE CATION OF CONSTRUCTION...'
........... . ........
PROPERTY LEGAL DESCRIPTION .... :Z-! ... ? - ... ....... ... . .......................................................
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....... . ....................................................... OIIVNER)�D/OR BUILDER
f---TTRACTOR'S NAME & ADDRESS ..... W -
. . ....... .............................. . ...........................................................
Permission Is granted.j.1 ... . .... Li.� ........... .... 19_7�7�,) for repair and/or connection of a side sewer to e city
sanitar wer
system in accordance with 'City of Edmonds or th y se
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the Property may obtain a Permit to construct sewer inside PMperty 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—All work performed In city right-of-way requires an Invasion of RJght- , of -Way Permit obtalnable from the City Engineer's Office.
NOTE No. 3--ObtaJn full Information regarding Ordinance 11.16.030 and Regulations govern.ing side sewers 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; minimum grade of 2%. No bends In grade
sharper than % will be permitted.
NOTE: No. 5—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. 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 maln sewer or its appurtenances except'to in-
sert the pipe into the wye.
DISAPPROVED[I Date ... . .............................. .... By ................ Date .................................... BY ................ Date ................ ................... . By .....
APPROVEDC] Date ... . .......................................................... BY ---- ------------------------------- -- - ...........
Remarks: ....... . ...... . ................. ........................................................
......... . .. . .......................................................... . ...................................... . ...................................................................
............................................. ....................... . I ........................................................................................................................... . .......................................................
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Cons a PRI IR To Request For Inspection
....... . .. ..... ..... ... .. ... . ... .. ...... ..... ... .... . .
O—e - r .. of .- con . t - ract - I . ng .. Fi . rm --- P . erf . Or - ming .. Con . str - uctio - n hereby certify that the side sewer installation constructed under this permit
was installed in accordance with allgoverning ordinances of the City of Edmonds.
Datedthis ............................ day of ................................................................. 19 .........
(V Check BEFORE YOU dig for: Water E], Gas E], Telephone Op Power E], Sewer E], Other E] V V
04
CITY OF E D M 0 N D S
SUSPENSE DATE:
TO:
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MAYOR
As We Discussed
Investigate
and report
MAYOR'S ADMIN. ASS'T.
CHIEF of POLICE
Take Appropriate
CITY ATTORNEY
Action —
Prepare Letter/Memo for
My Signature
Mayor's Signature
CITY CLERK
COMMUN. DEVELOP. DIR.
FINANCE DIRECTOR
Previously Ref'd
FIRE CHIEF
Status of Action?
For your Information
Note & File
Return to:
PUBLIC WORKS DIRECTOR
.COMMENTS:
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W/VAY
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40 065sq.
GAR.
ILL
182
7 7
4�
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0
X
1.3,750/SQ.ft.
0 / f BUISING a,
/Z TYPICAL
ENVELOPE
4)
41
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10,250 sq. ft.
c�
C-)
'e;
11500 Sq. Ft.
DAVID M. LARSON
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cli
Nio
(i o
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j� a JOYCE DUNN
jOSEPH
*ft T FR C—T
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ol
pU�ET SOUND SERVICE
CORP.
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ry
I D
REVISf
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CITY of EDMONDS
1.1ti, V`411
Edmonds, Washington 98020 Telephone (206) 775-2525
Civic Center
Building Department
December-28, 1977
�jj
Walcker Homes, Inc.
P.O. Box 356
Lynnwood, Wa. 98036
BUILDING PERMITS #770582-21225 SHELL VALLEY ROAD
#770583-21221 SHELL VALLEY ROAD
With the recent new plat in the Shell Valley area it is
necessary to change the street name of Shell Valley Road
to Pionee 1� Way in regard to the two -above addresses.
/Z / " - . 1.
lz-M-17
John LaTourel.le, Director
Community Development Dept.
HMW/ae
Bid . Off. Dt.