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CITY of E DM ON OS SIDE SEWER PERMIT
. j— - ;41.
For Inspection Call 771-320 tTREET FLE PERMIT NO. HMO
Address of Construction:
Property Lega 1 Descri pti on (I ncl ude al 1 easements)
Owner and/or Builder:
Contractor & License No: cz� *C9//P('AJ
cl�90 3 0
SingTe Family Residence
Multi -Family
Commercial
(No. of Units
(No. of fixture Units
EDMONDS
TREATMENT PLANT,
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: N o Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK J
JUN 08 WU
/)� /-I -) 43
r ce%� that I have read and shall comply PUBLIC WORKS Date
with e items listed on the back.
Permit Fee:
Trun� Charge:
Assessment Fee:
30—
Pssued BY: 1-7-4
!Date Issued: 6- 7- 20
Receipt No.: ZZ513 &
Partial Inspection:
Comments Date Initial
Final Inspection Approved: C,-T
Date -Inifial
Rejected:
ason
** PERMIT MUST BE POSTED ON JOB SITE **
Date Initial
Wh.ite Copy - File Green -Copy -Inspector
Buff Copy - Applicant
jhe City of Edmonds Side Sewer Drawing EASEMENT NO - ----------------- -- -----------------------
NEW CONSTRUCTION Eg REPAIRS Fj
LID NO . .................. ASMT. NO - ------------------
OWNER ... BLUEPRINA-T -7 ------
VAOW)� ----------------------------
CONTRACTOR ---- G-aL.Dr)t-G-ccA- ---------
coNs ------------------ PERMIT NO.
JOB ADDRESS -2,12>0-.Es -----------
LEGAL DESCRIPTION: LOT NO. .2 --------------------------------
BLOCK NO - ------------------------------------
110
4
APPA09 - 2-'DP.
NAME OF ADDITION -------- PLA.,ce ----- ----------------------------------------------------------
Approved:
cDjVj0[VDS
'r4lEtV.r PLA.,
7'49A
-rm-ltv�7`s��T
IMMOW11h
,L4Pj::4-SA
PWW-0001 -11/75 (REV. 11/78)
DATE..G ...... 77 ------ 9-0 ---------
--------------------
CITY OF EDMONDS
VNEW
1:1 ADDITION
El RETIREMENT
ASSET INFORMATION SHEET
HU
ASSET NO. C-,)
ADDITION TO ASSET NO.
It-?o
DESCRIPTION
SERIAL NO.
ILOCATION
West-
DEPT. NO.
4 S-Z,-/
PURCHASE ORDER NO. *PROJECTNUMBER
PURCHASE ORDER DATE PROJECT COMPLETION DATE
COST COST
B.A. R.S. ACCOUNT NO.
ESTIMATED LIFE
INITIATED BY
DATE
APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
VDEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
trp) INITIAL
DATE
VERIFIED BY
PROCESSED
BATCH NO.-
DEPARTMENT FILE
iEET FILE
0
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE PERMIT
ZONE NUMBEFA
JOB SUITE/APT
7n 1, - ze),
#
W
0
OWNER NAME/NAME OF BUSINESS
"IAF
!�LLPFP114
LEGAL DESCRIPTIO Fq CHECK
SUBDIVISION NO.
4 /11 J'AW I C J'f
LID NO.
P-4 I �r?
LU
LU
z
z
W
MAILING ADDRESS
410 ci-LALLC S_
PUBLIC RIGHJOF WAY PER OFFICIAL STREET MAP.
EXISTING . '1240 REQUIRED DEDICATION _e"')
PROPOSED
TESCP
APPROVED BY
CITY ZIP
TELEPHONE NUMBER
- 77 1 9-de, � L_`>
U
NAME
zee-
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
STREET USE PERMIT REQUIRED 0
7ADDRESS
LT ---
SEE ENGINEERING MEMO DATED REVIEW BY
CITY ZIP
TELEPHONE NUMBER
REMARKS
1t,,C-t4111
cc
0
L)
<
cc
z
0
L)
NAME
ADDRESS
METER IZEy
; y
BUILDING S PPLY SIZE
/ V
E UNITS
a:
-
CITY ZIP
1
TELEPHONE NUMBER
REMARKS 1
ftb
STATE LICENSE NUMBER
Ab AJ
SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADB NO,
z
z
z
c'
U
(n
LU
0
_j
Legal Description of Property - include all easements
(show below or attach two copies)
SHORELINE #
- dO 71 :_:2
VARIANCE OR CU
PLANNING REVIEW BY
SETBACKS -FEET
FRONT SIDE 7 ;1-2 1EA
HEIGHT
LOT COVEFIAGE�
Tax Account Parcel No.
REMARKS
CV 7--
CL
(n
W
a
C13
2 NEW EXIESIDENTIAL PLUMBING
ADDIALTER 1:1 COMMERCIAL 0 MECHANICAL
REPAIR 1:1 APT. BLDG. El SIGN
EXCAVATE, FILL FENCE
DEMOLISH OR GRADE I— x _FT)
CARPORT swim
REMODEL GARAGE POOL
CHECKED BY
TYPE OF CONSTRUCTION CODE
HEIGHT
z
SPECIAL INSPECTOR
REQUIRED
n YES L: NO
AREA
OCCUPANCY OCCUPANT
GROUP LOAD
WOOD STOV9/ RETAINING WALL/
INSERT ROCKERY RENEWAL
REMARKS
PROGRESS INSPECTIONS PER UBC 305
(TYP,�OF USE, SINESS OR ACTIVITY) EXPLA?5
A4AA i LA L.7;.S
AKWK rlY-'W, I-Aet- d96 WA ANW-y -c%pc
NUMBER OF 110RIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewcqlks,
driveways, marquees, etc.) will require separate permission.
GRADINGIFILL
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Worl� is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
h.—I ... th. ('11� _f CA —A. 14� -M-1-1-
January 3, 1990
a
TO: Permit Coordinator, Building Division
I
FROM: Dan Smith, Engineering Inspector
ADDRESS
OWNER
PLAN CHECK #
After review of the subject building permit application, we have the
following comments:
1. Construction hours are: WEEKDAYS ........... 7:00 a.m. to 10:00 p.m.
WEEKENDS/HOLIDAYS..10:00 a.m. to 6:00 p.m.
2. A Right -of -Way Construction Permit is required for any work on
City property.
3. Connection to City water system required. Fees paid.
4. Connection to City sanitary sewer system required; obtain separate
permit. Fees paid.
5. Water and sewer lines to be separated by 10 foot minimum.
6. Driveway must be paved a minimum of 20 feet back from City
right-of-way; separate permit required.
7. Driveway slope not to exceed 14%.
8. Back water valve required if downstairs plumbing is below
elevation of upstream manhole.
9. Builder/Owner responsible for containing all temporary runoff and
erosion cont'rol on site. Construction may.not impact neighboring
properties in any way.
10. No burning of construction refuse without approval from Fire Dept.
11. Street to be kept clean of debris, dirt, mud, and construction
materials. Contractor responsible for dust control.
12. Inspection required on drainage system, catch basin installation,
driveways, and sidewalks. A final engineering inspection is
required prior to the building division granting occupancy.
13. Repair or replace all defective existing curb, gutter, and
sidewalk. If intersection is involved, installation of wheelchair
access may be required.
BLGPER/TXTFORMS
DETENTION .- WORK SHEET
STANDARD DRAINAGE PLAN
upp��P'
CA.7r-H
BASIN 09TE4TI011 Pipe LENGTH COWPOI, CATC"
(Vrzt4T) ) �-L- , sks%4
L
CWO V E&
OVTL.9'r
COWT;toe
r //I% 5LOPF---*- 4'
1. 4i -1 1 '17-
-ro OLrrL-ET
(N PRA.P OR
RUNOFF
SYSTEM CROSS SECTION
2' 2' SPALLS (OIL WOUIL)
2' be 3r DEEP, V4*- r-RUS"EV POCY'
11
Woo
FROM
OUT-1-15-17
CON-I'VILOL
RIPRAP OUTLET
wA3HED &XXV61-� rouTFL.OW TKENCvA, MIN 10' LONG,
TOP 4 A- PUFLF PIPE -M as L-F-VWL.
A = 15i-6 +4
!FROM
0Vr6ET
CONTROL
4� pFRF P%pr. WITH CkRS
RUNOFF SPREADER OUTLET
FOOTING DRAINS SHALL NOT BE
DETENTION SYSTEM
for a
location
plan by
phone -21
date —7 C—)
DESIGN DATA
System Imperm Pipe Pipe Orifice
Number Area Diam Length Diameter
NOTES
1. Call Engineering Division (771-3202)
for prebackfill and final inspections.
2. Responsibility -for operation and
maintenance of drainage systems on
private property is the responsibility
of the property owner(s). Material
accumulated in the storage pipe must
be flushed out and removed from catch
basins to allow piroper operation. The
outlet control orifice must be kept
open at all times.
WE X
CITY OF EDMONDS
Page 9 of 9 CONNECTED TO THE DRAINAGE SYSTEM
DATE RECEIVED
FPERMIT
EXPIRES 4!V17AZO-0
CITY OF EDMONDS
USE PERMIT
ZONE NUMBER .26itM.5-
CONSTRUCTION PERMIT APPLICATION
JOB RESS SUITEIAPT#
ADD
NA E/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
7
LID NO.
LID FEE $
DW47R
a
E17 MI-40milf, 2
1
I=
W
'MAILING ADDRESS
PUBLIC RIGHT OF'WAY PER OFFICIAL STREET MAP
TESCP Approved 0
RW Permit Required 0
z
il:
yj
0
EXISTING - PROPOSED
Street Use permit Req'd 0
Inspection Required 0
Sidewalk Required 0
U=rground
CITY ZIP
TELEPHONE
ii�dlr'1111111(k Mu)
REQUIRED DEDICATION- FT
Wiring required 0
NAME
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
YES 0 NO 0
z
FE
LLI
W
1,-
ADDRESS
REMARKS
z
K
x
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
a
0
z
CITY Z17TELEPHONE.
NAME
REVIEWED/DATE
&21 Le,
ENGINEERING:,
ADDRESS
ke AIE
0
F . I RE 'REVIEWED BY DATE
W
CITY ZIP
r
TELEPHONE
31
z
0
M
VARIANCE OR..CU.
-'.,�SHORELINE'OR ADB#. .
INSPECTION
REO'D
13OND
STATE LICENSE NUMBER EXPIRATJON DATE
'CHECKED BY..�,
52-f)F ot
d
OYES ON 0
IPOSTED
COMPLETE 'EXEMPT
`��SIGN AREA
ALLOWED ,PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
e07
W
_j
Ex P
0'
NEW 3--RESIDENTIAL MBING MECH
LO TCOVERAGE:'
REQUIRED. SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
FRONT, UR SIDE REAR
ALLOWED,.�_ PROPOSED
RQNT�:�SIDE., REAR
COMPLIANCE
ADDITION COMMERCIAL OR
0 CHANGE,ORUSE
z
z
PARKING..:.
�0T AhIEA,;
Pi"kiNG"REVIEWED BY �ATE
APARTMENT
REMODEL E] 0 SIGN,.
DED]
REPAIR E] GRADING
E] FENCE
CYDS FT)
REMARKS
DEMOLISH C] TANK 0,.OTHER
z
GARAGE RETAINING WALL RENEWAL .
CARPORT ROCKERY
I=
(TYPE OF USE, BUSINESS OR ACTIVITY)- EXPLAIN:
CHECKED BY
TYP N T U
E,O TR CTION
OCCUPANT
0-
cc
Q
GROUP
NUMBER
OF
NUMBER
DWELLING
CRITICAL
AREAS
W
W
SPECIAL INSPECTOR,
JAREA��, OCCUPANT
'V LOAD
o
STORIES
U NITS
MEE
NU R_ IV14
REQUIRED 0 YES
DESCRIBE WORK TO BE DONE
REMARKS
PROORES&INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
a
Regard . the water system
is open a r do�eo, expension.tanks are
isquirad an allfhot water tanks per
Cifu Coda EOnO 39300904--
f
- .1 .. :_
...
---
PLAN CHECK FEE
H S URCE GeZING LOT SLOPE %
BUILDING
PLAN CHECK NO: VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GaINGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
J.4�41 Irif-
Uj PERMIT APPLICATION: 180 DAYS
(L PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
_j
2 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUI REMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
RECEIFfr
X,
TOTAL AMOUNT DUE
jo=
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRLIC-
CALL
This application is not a permit until signed by the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building bifficial or his/her Deputy; and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSUR�NCE AND RCW 18.27.
0 LS SIGNA E
SIGNATURE (OWNER DATE S I IGNfD
(42
'TURE ZDA
A ,f I
771-0220
REI FASED DA
ATTENTION
EXT/333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771- 0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI_
ORIGINAL -FILE - YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
5/98
RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME/NAME OF BUSINESS
MAILING ADDRESS
Zxa,p It
CITY ZIP TELEPHONE
S*0rv,an&0J
NAME
ADDRESS
-2 77-Y
, 2-1 /-/-7
CITY VJA ZIP TELEPHONE
^// dIZ!r - -7 70
NAME
.zs� 1(se Ir el'<y ma 6!a��
ADDRESS %_ I I
CITY ZIP I TELEPHONE
STATE LICENSE NUMBER EXPIRATIONDATE I CHECKEDBY
PROPERTY�AX IC T PARCEL NO. .. , 'N
00 ON, 0 U
NEW
RESIDENTIAL C] PLUMBING / MECH
C] ADDITION
COMMERCIAL
E) COMPLIANCE OR
CHANGE OF USE
REMODEL
C] APARTMENT 0 SIGN
REPAIR
0 GRADING
CYDS
FENCE
1:1 ( X FT)
DEMOLISH
TANK
0 OTHER
o GARAGE
RETAINING WALL
-]
C_ RENEWAL
CARPORT
OCKERY
(TYPE OF USE, BUSINESS OR AC
T 7_71m:
NUMBER
NUMBEROF
CRITICAL
OF
STORIES
DWELLING
UNITS I
AREAS
I NUMBER NIR
DESCRIBE WORK TO BE DONE
- f - U C'
qL
C;>.& C_ h
PERMITEXPIRES
1'z1w1W6L
USE
ZONE
PERMIT
NUMBER 0-7q I
JOB
ADDRESS
#
61 �� �L 0
PLAT NAM E/SUBDIVI SION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP j" 0
RW Penn Ulf d 0
�App
Street Pe ft Req'd E3
EXISTING — PROPOSED
M W n Required 0
imp
elk ReqFuired 0
REQUIRED DEDICATION—
FT —_.,,O
r9round
...r.un
wiring required 0
METER SIZE
LINE SIZE
NO. OF FIX ES
PRV REQUIRED
YES N 0>1--
REMARKS
z
EROSION CONTROUDRAINAGE
OWNER/CONTRACTOR RESPONSIBLE 5
,ZR z
—I UJ
ENGINEERIP6 REVIEWED/DATE
FIRE REVIEWED BY DATE
I ILOL
VARIANCE OR CU
SHORELINE OR ADB#
INS;rTION
BOND
POSTED
04ES 0 NO
VIEW
SIGN AREA
HEIGHT
4PSEPA
CO LETE EXEMPT
ALLOWED PROPOS
ALLOWED PROPOSED
:XPI . I i
I
,
. LOT COVE4GE
REQUIRED VfBACKS-(FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PR6POSED
FRO IDE REAR
FRONT, LIR SIDE REAR
z
zi
PARKING
PLANNING REVIEWED�BY DATE
REO'D PROVIDED
'�qAREA
Q.
CHECKED BY TYPE OF CO!W, jqfl OCCUPANTIf 4
G
SPECIAL INSPECTOR JAREA OCCUPANT
REQUIRED 0 YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1 Oa/FINAL INSPECTION RE0'Dj go
VALUATION
FEE
CL_ 7-0)u .
PLAN CHECK FEE
HEAT SOURCE ING 9% LOT�P % BUILDING Lj -1 .0-01
Is b4orll
PLANCIPIECK NO:
VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t B E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
9 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
U
STATE SURCHARG
13
PERMIT APPLICATION: 180 DAYS
I
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
0
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
REC
P�-'y
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
a DEEMEDTO MODIFY. WAIVE OR REDUCEANY REQUIREMENTOF ANYCITY ORDINANCE
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
x
R CEI[T�4
TOTAL AMOUNT DUE
0
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECTAND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid. and
IN VIOLATION OF.THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
.
'
0 F IALS SIGNATURE DATE
(0 1 �0
SXIGNrd q
DATE SIGNE.0
,
.,(425)
4
1-7
=RA
--771-022 0
FAspn BY n4T;:
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL-�� YELLOW - INSPEAR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD -ASSESSOR
5198