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S E W E R E R M I T
MIREETTI. E I D'E
CITY of E D M 0 N IS-
-ror-'Inspection Call 771-3202 1 PERMIT NO.
Address of Construction: . ?, / �� I ;) q 3 14 # k/
Property Legal Description (Include all easements):
Owner and/or Builder:
oi�4,h ik PS--�
Contractor & License No:
Single Family Residence LTREATMENT PLAUT
Multi -Family (No. of Units
D�
L-ri?EA -rq
Commercial (No. of fixture Units EN-r
PLAIV
PLAIV.r
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: No Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
Al 4, J,— 3 � e7o
4'ax- 0A APR 3 0 '1��U
I ctrtif�_tKat I ha�eread and shall comply Date
with the items listed on the back. VXRKS
Permit Fee:
Trunk Charge:
Assessment Fee:
Partial Inspection:
�Issued By: a, ;V�
Date Issued: e-1 - J 0 - /* 6
Receipt No.:
Comments Date Initial'
Final Inspection Approved: ea#
Date Initial
Rejected: Reason _ffa—te Initial
Wh.ite Copy - File
PERMIT MUST BE POSTED ON JOB SITE
0
Green Copy -'Inspector Buff Copy - Applicant
The City of Edmonds Side Sewer Drawing EASEMENT NO. --- --------------------------------------
NEW CONSTRUCTION 0 REPAIRS Fj LID NO . .................. . ASMT. NO . ..................
OWNER -------------------------------------------------------- CONTRACTOR ...................... PERMIT Nc,.Dk!--1 ---
---------------------
---------------------------------- BLOCK NO - ------------------------------------
JOB ADDRESS t - ---------- q--" LEGAL DESCRIPTION: LOT NO. .---
N� () tl,: -I iA
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to, o F cz-m4t�
PWW-0001-11/75 (REV.11178)
----------------------------- ------------------------------------------------------------------------------------------------------ -----------------------
NAMEOF ADDITION --------------------------------------------------------------------------------------- Mth ---- DS
T PLAN-r
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Approved: q
c
DATE.-.� ............ 3 ......... . ................. By
17
----------------- .............. ..............
NOTICE:
No ... W'a'r.r a n t. aco-y-
The -information on the attached
map(s) was com ' piled for use by the City Of
Edmonds/ its Empl.oyees and Consultants.
e
Th,..e City ofEdm.onds does. not. warrant the
accuracy of anything set for.th on t * hese
r entity -requesting a
Map(s"). Any person o
copy should conduct an independent
orm . ation shown-c
inquiry regard'ng the infi
I I
ff�e -rn a p (S) / including, but not hrn'ted to,
c ion of any sewer stub shown. Suc
the lo' at'
sewer stubs may or may' not e.xist and may
't at the location shown
or may not exis
on' -A
,�'ty of Edrn ris nor its
Neitheir the "-, I
emp-to-yee-S o.r off i-ce-rs -sha-H be 1--iab-lf-e for -41-hE
n on this map(5), nor for
information give d
any one representation provided base
upon'sald map(s).
CITY OF EDMONDS
ZZ
NEW
El ADDITION
1:1 RETIREMENT
1-4
ASSET INFORMATION SHEET
ASSET NO. � 16 f
ADDITION TO ASSET NO.
DESCRIPTION %
SERIAL NO.
LOCATION
2,1312, — 9 3 P
La-ce U
DEPT. NO.
rd
* * PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
PROJECT NUMBER uj(3j-s r) qq
PROJECT COMPLETION DATE q-0-
COST o 6
B.A.R.S. ACCOUNT NO. Lf I ( - 000 - 0 ILI -3 If 9- . ()n
ESTIMATED LIFE 2- s- V
INITIATED BY
DATE
APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
V /DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
0 G.L. ENTR
REFERENCE
n t-
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VERIFIED BY
PROCESSED
BATCH NO.
DATE
(vp) INITIA
DEPARTMENT FILE
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5 ITE PLANJ MAR - 6
LOT ki 0 L-Ym P I C- P L- 4. C. G--
CIT-f OF=- eVMONW-5
'5t-40H0H%cJH CO., WA-- HIEC.HT CA.LC5
98.2. PERMIT COUNTER!
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PACIFIC LASERS, iNc
Lake Oswego, Oregon Redmond, Washington
f503J 620-5�2-44 t2o6j 883-1100
(800J 444-5814 t8OOj 444-5844
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CONSTRUCTION LASERS — SURVEYIAI(-, A TO IAA�AITC
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CITY OF EDIVI ONDS I
CONSTRUCTION PERMIT APPLICATION JOB III%
OWNER NAME/NAME OF BUSINESS ADDRESS 243 12 9,3rd 4e P
LLEGAL DESCRIPTION CHECKI SUBDIVISION NO. LID NO.
Uj MAILING ADDRESIS
Z 4073
3: -;;�A
0 1"5 q /1 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCP
CITY ZIP EL PHONENUMBER EXISTING REQUIRED DEDICATION APPROVED BY
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EX'S
PROPOSED
NAME
RIG HT OF WAY CONSTRUCTION PERMIT REQUIRED 0
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STREET USE PERMIT REQUIRED C3
U, ADDRESS
S REVIEW
14' SEE ENGINEERING MEMO DATED
�k CITY ZIP I TELEPHONE NUMBER
NAME
cc ADDRESS
0
cc CITY
Z
8 STATE LICENSE NUMBER
w4s�-
TELEPHONE NUMBER
Legal Description of Property - include all easements
(show below or attach two copies)
1 "7- —3 0&m,01t AlAtr* I
S E
MET 974
REPRV Reqb
SIGN AREA
ALLOWED I PROPOSED
VARIANCE OR CU
Zzy,:w(770V I?VlRot�
'E IF17TURE UNITS
ENV. REVIEW ADB NO.
COMPLETE j EXEMPT I
NNING REVIEW BY I DATE
SETBACKS — FEET HEIGHT T COVERAGE
FRONT SIDE REAR
Tax Account Parcel No.
REMARKS
0? NEW
7 ADDIALTER
ElREPAIR
DEMOLISH
REMODEL
0 RESIDENTIAL
El COMMERCIAL
1:1 APT. BLDG.
EXCAVATE. FILL
OR GRADE
CARPORT
GARAGE
PLUMBING
MECHANICAL
El SIGN
FENCE
I— FT)
swim
POOL
CHECKED BY
TYPE OF CONSTRUCTION
]'FARE�A
CODE
SPECIAL INSPECTOR
REQUIRED
riYES I:NO
OCCUPANCY
GROUP
WOOD STOVE/
INSERT
Z
r7 RETAINING WALL/
ROCKERY
El RENEWAL
REMARKS
PROGRESS INSPECTIONS PER.UBC 305
0 (TYPE OF USE. WINESS
E
Or ACTIVITY) EXPLAIN:
OCCUPANT
LOAD
L)
L0 NUMBER OF STORIES NUMBER OF 47AV46Y
a
0 DWELLING
M Z� UNITS 0"00VF-
0
1 NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REQUIRED
VALUATION
PLAN CHECK FEE
BUILDING
PLUMBING
k No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: I 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
2 harmless the City of Edmonds, Washington, Its officials,
:r
m employees, and agents from any and all claims for damages of
a:
< whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
a
0 modify, waive or reduce any requirement of any city ordinance
I nor I.imit in any way the City's ability to enforce any ordinance
provision."
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz-
ed thereby, no person will be employed in violation of the Labor
THIS PERMIT
AUTHORIZES
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tion Insuran* t\
0 AG nATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
TEbTION
IS
CALL FOR
INSPECTION
UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-3202
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102-87
FEE
—zoo I Oy(o
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIAL'S SIGNATURE DATE
RELEASED BY:
DATE
ORIGINAL — File YELLOW — inspector
PINK — Owner GOLD — Assessor
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TO: Permit Coordinator, Buildi ng Divi.sion
FROM: Dan Smith, Engineering Inspector
ADDRESS
OWNER.
PLAN CHECK7
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 sy stem re.quired;"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 control 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.
Repair or replace all defective existing curb, gutter, and
sidewalk. If intersection is involved,'installation of wheelchair
ac , cess may be required.
BLGPER/TXTFORMS,
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REC;"IVED
MAR - 6
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PERMIT COUNTER
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CITY OF EDMONDS
SNOHOMISH COUNTYIWASHIN
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