21306 PIONEER WAY.PDF11111111111111
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21306 PIONEER
WAY
APPLICATION
The'City of Edmonds for EASEMENT NO - -------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS F� LID NO - ------------------ - ASMT. NO -----------
OWNER ----------------------------------------------- CONTRACTOR -------- .. ..... PERMIT NO.
JOB ADDRESS
LL
LEGAL DESCRIPTION: LOT NO. - ------- --------- BLOCK NO - ------------------------------------
NAME OF ADDITION -------- — -----------------------------------------
II Approved:
DATE....6//� --- 2711111:��o ----------- By
.............
11/7,
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Approved:
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DATE..... ...................................... By .............................
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CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
(Call -775-2525 for side sewer inspections BEFORE cov ring any Portion of the construction.
Inspection will be provided within 24 hour _e
s after requst. NO Sat., Sun., or holiday inspections.
ADDRES9 LOCATION OF CONSTRUCTION..
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PROPER71Y LEGAL DESCRIPTION ......
4 .. n.777 ....... ...... S)�474- I
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------------------------------------------------- OWNER AND/OR BUILDF ...
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CONTRACTOR'S NAME & ADDRESS
------------------- --.— ...................................................
Permission is granb
ed ..... 7-.:!n
... . ........... ..... . ......
-:F. sYsten' in accordance wftli city of F, . d . monds Ordivanc .1 192?T, for repair and/or connection Of a side sewer
4BS. to the city sanitary sew
er
AVrINNTION IS CALLED TO THE FOLLOWING:
NO.' I —The owners of the Property may obtaln a permit to construct sewer inside pro e-d Side Sewer Contractor must be employed to construct
side sewer in s rest area. Do not cover any Portion of sewer before it has been inspected..
t Perty line. A licens
NOTE No. 2—Ali work performed in City right-of-way requires an Invasion of RIght-0f-WaY Permit obtainable from the City Engineer's office.
NOTE No. 3—obtain full information regaxding Ordinance 11.16-030 and Regulations governing 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
sharper than % will be Permitted.
bends In grade
--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
NOTE No. 5
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 Permlt, or to do any work on the main sewer or Its appurtenances except to in -
Bert the Pipe into the wye.
DISAPPROVED E] Date .. . ................................... By ........
........ Date ......... .. . ....
j ... ...... By ---------------- Date ............... ............... By ........
.... ........
APPROVED
.............
By ............ . ... .......................................................................................
Remarks: ....... . ...... . .......................... . .. . ........
..............
....... ........................ . ...................................... . ....... ...... . ...................................................
...................................................................... ..................................... ................................................ . ..............................
..... ...... ................................................
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Permit Copies xuST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
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(Owner ...................... .... th
r r hereby certify that the side sewer installation constructed under
Construction)
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wpq is permit
install6d in accordance with all governingg ordinances of the City of Edmonds.
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By ......
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....... ------------------------ . ........
............................................
Dated this ........ of .....
....... . ..........
V V Check BEFORE you dig for: 19-24y� ;
Water Gas 0, Telephone 0j power 0, Sewer 0,
Other
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NG DEPARTMEW
Applicant Fill
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ZON'Fp� IWMBER
PERMIT APPLICATION'
Inside Heavy Lines
JOB
ADDRESS
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NAME (OR NAME OF BUSINESS)
111AI 1.1 ,0"
Er. NO
1 LOT AREA
SUBDIVISION NO.
W
M;00 G ADDRESS
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STREET R/W
EXISTING STREET R/W 40 FT. DEFICIENCY THIS PROPERTY
COMP. P LAN, ST. R/W 40 FT. FT.
ELEPHONE NUMBER
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NAME
REMARKS
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ADDRESS
CHECKED BY
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CITY
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TELEPHONE NUMBER
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STREET AND/OR UTILITY WORK
REQ'D. 9 YES NO
[R/W PERMIT REQUIRED
YES NO
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NAME
UNDERGROUND
WIRING REQ'D. n YES El NO
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ADDRESS
TYPE CONNECTION AYES IVERIFIED
SANITARY SEWER EINO
BY
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CITY
TELEPHONE NUMBER
SEPTIC SYSTEM CIYES PERMIT
APPV'D BY CITY ENG.
NUMBER
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STATE NUMBER
CITY LICENSE NUMBER
REMARKS
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Legil' Description of Property (Show -Below or Attach Four Copies)
METER SIZE
BUILDING SUPPLY SIZE
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REMARKS
SIGN AREA
ENV. REVIEW
ADB NO.
ALLOWED PROPOSED
COMPLETE EXEMPT
REMARKS
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VARIANCE OR CU
PLANNING REVIEW By
DATE
YARDS
/ 6.1
15 FRONT SIDE REARI
LOT COVERAGE
W GAS
NE RESIDENTIAL LINE
El
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FIRE ZONE
TYPE OF CONSTRUCTION CODE
NON-RESIDENTIAL SIGN
ADD El .
El DEMOLISH RETAINING
DWALL
ALTER EXCAVATE FENCE
OR FILL X_FT)
1:1
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SPECIAL INSPECTOR AREA
REQUIRED
0 YES El NO
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OCCUPANCY
GROUP
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OCCUPANT
LOAD
-
PLAN CHECKEF BY THIS SITE IS LOC D IN THE CITY
REPAIR PRE -MOVE swim
El INSP. POOL
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
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NUMBER OF STORIES
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NUMBER OF
DWELLING
UNITS
RE ARKS
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gajatu-_� 14.3
NATURE OF WORK TO BE DONE
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PLAN CHECK
NO.
VALUATION
FEE
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PROPOSED USE
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PLOT PLANIJINDICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
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PLUMBING
HEAT & GAS LINE
FEN CE
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SIGN
RETAINING WALL
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SWIMMING POOL
CITY,OF EDMONDS
PUBLIC WORKS ENGINEERING
ACTION REPORSTREET FILE
N? 2787
SUSPENSE DATE:
Date:---- Time:_ F i I e #
Attachments: r --- 1Yes
SUBJECT: — --INo
77., / - ) F
REQUESTOR:
NAME:
ADDRESS: .A;�l
PHONE: ZV-
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REQUEST RECEIVED
BY:
TELEPHONE
CONTACT IN OFFICE
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OTHER:
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RECEIVED BY:
�10SSIRLC-- L�OCMMN OF LS---Al K,
All Concerned Notified
Action Completed/File
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STREET FU_
MEMO TO: Building Division
Community Dovelopment Department
FROM: Engineering Division
Public Works Department
SUBJECT: "OK�e�EQ\J\JA-y - PA�j T-Ernfir�j
L-0 T- I �, S+t e [-I- PArQA� - D U P Ll-�*� -/
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 the
responsibilit), of the contractor.
2) The contractor is -required to keep the abutting streets clean-
ed ot dirt and de5ris caused by tTi—e cons*truction.
(3) A "Right -of -Way Construction Permit" is required, from the
Engineering Division of Public Works, for any work within
the Public Ri�,Tht-of-1,,,ay or public easement.
(4) Drivei%,ay slope not to exceed 14%.
(7) L-01 IDQAINJLGEg TD r
OKI SITE�v
PW 5/77
PUBLIC WORKS DEPARD-Uff CHECKLIST
BUILDING PERMIT M6
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Street Right -of -Way Existing 4-D
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Access Easenmts Existing_2=_p
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Utility Easenent Existing__AS_<Q-
t::�'V\f K) REQD
Lot Per Subdivision Plat Assessor I -lap
Site Plan Checked for AccuracyL
4-11'2, ft1b
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Underground 14iring Reqd.
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Check Accuracy of Legal Description
4-112,1 aP
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Review by
Date
Existing Water Main Size >:Z,
Water Main Required E> K
Service Line Required %-lo4
Hydrant Size Existing 0
Hydrant Reqd Per Fire Code
Size
Detector Check Meter Reqd. &)o
Cross Connection Inspection Vd2
Fire Department Conments
Water Ile -ter Charge Reqd. Cam -=a%-
Review by.
Date
ILL X. K.
Septi& Tank Design Approved
Date
Septic Tank Pern iit Reqd. 4�u "41
Permit No.
Sanitary Sewer Availability Lc�� t-o
Proj.
Drawing No.
File No.
Side Sewer Availability 7=>
L-401L=_1
Sanitary Sewer Connection Fee Reqd.
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Review . by, W/S
Date
Open Ditch Existing
�Reqd.
Culvert Reqd.
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P4
Catch Basin Reqd. #" 71-
Indicate on Site Plan
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Shoulder drainage maintain collection on
swale open runoff
E-4
Manhole reqd.
Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
Review by. Zgje,�222
Date *-12- -7,E
Revised: lvlO-1977
Page 2
Street Paving Reqd
Curb and Gutter Reqd.
Sidewalk Reqd..
Curb Cut for Driveway Reqd.
P4 Right -of -Way Construction Permit Reqd._
Bond Reqd. for Public Inprovements____4
Street Nam Sign Reqd. A 191--
Other Signing Reqd. Al 191-
Pre Permit Site- Inspection made on
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BY: SEWER
F4 W WATER
z STREET
ENGINEERING
Special Requirements listed in meTm to'Conmmity Development Department,
Building Division
> BY Date-
L4
o All items filled in on Building Permit Application
P� BY Date
0' Drawings Stanped and Notations Made
BY Date
Approved by Public 'Works,Department
Revised: lv 10-1977
STREET- FILE
INSPE.CTION RE'CORD
MONDS, PUBLIC WORKS DEPARTMENT
CITY 017 EDI
DAT E PROJEICT:
�Y:
1. / 78 1 v
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BUILDING DEPARTMENT Applicant Fill ZONE
PERMIT APPLICATION inside Heavy Lines
ME (0 A DRESS
W ILI AD LEGAL LOT.S LOT AREA
Z 19YES SUBDIVisl NO.
3: 0 No
0 CITY PL_
ELE EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
NAME 77 PLAN ST. R/W 4<0 FT. FT.
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NAME
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TELEPHONE NUMBER
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REQ D.
R/W PERMIT R
YES
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YES ONO
----------
IF�JKUUND
NG REO-D.
YES
ONO
TYP
SANIT SEWER
YES VERIFI D 13Y
ONO
TELEPHONE NUM13ER
SEPTIC SYSTEM
APPV'D By CITY ENG.
0 YES
PER AIT NUMBER
CITY LI
ONO
ow Below,or Attach Four oples)
METER SIZE BUILDING SUPFiLy!;,,,
I/C.
SIGN AREA �NV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE I E !=
XEMpT
REMARKS
VARIA, 11��! I!LANNING REVIEW BY DATE
YARDt-,
JEW 121RESIDENTIAL GAS FRONT LOT COVERAGE
SIDE REAR
;9_N 10 LINE
ADD
NON-RESIDENT] L
El SIGN
FIRE ZONE T)
.
ALTER
El
ElDEMOLISH
RETAINING
WALL
SPECI_ L IN E OR
REQUIRED
EXCAVATE
0 OR FILL
FENCE
0 YES
X
0 NO
ElREPAIR
E] PRE -MOVE
_Fr)
INSP.
WIM
PSOOL
NUMBER OF STORIES B ER OF
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L�N�D L� � I"N G12
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UNITS
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TO N
- M UUILDIN
ABUTTING STREE
PLAN CHECK
NO.
BUILDING
PLUMBING
HEAT & GAS LI
FENCE
SIGN
RETAINING WALL
----------
;WIMMING POOL
----------
G�ROUP
THI� SITE IS -LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31-04.
VALUATION FEE
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