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LE SIDE SEWER PtPMIT
g, CITY OF MMUNI
PER MIT
12 8 2 C I
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Address of Construction:
Property Legal Description (Incl
all easements): C4.
Owner and/or Contractor: D A >
StateLicenseNo. Building Permit No.
8"Single Family
0 Multi -Family (No. of Units-)
El Commercial
E3 Public
TREATMENT PLANT
Invasion into City Right -of -Way: RilTo 0 Yes
RW Construction Permit No.
Cross other Private Property: E"No 13 Yes
Attach legal description and copy of recorded easement
I certify t4t I have read and shall comply with all city requirements
as indicated on the back of the Permit Card.
Date
* CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION *
OFF
16E�VSE,.ONLY.,�
FOR INSPECTION CALL 771-3202, PUBLIC WORKS DEPT.
Permit Fee:
:;PL/
Issued By
Trunk Charge-
2-5-
Date Issued: 6 -Z 9
Assessment Fee:
Receipt No
Lid No.:-
83
Partial Inspection:
Date -Initial -
Comments
Reason Rejected: Date -Initial
Final Inspection Approved: Date77�_?O Initiaef&
PERMIT MUST,BE POSTED ON JOB SITE
White Copy: File Green Copy: �sfpEntqr' Buff Copy: Applicant Revised 3190
Side Sewer Drawing
The Edmonds
i NEW CONSTRUCTION REPAIRS F�
7'/NER ------ ----------------------------------------------------------------- * -----------------------
,///JOB ADDRESS -01 - ---------------------------------------------
PWW-0001-1 1/75 (REV.1 1/78)
EASEMENT NO - -------------------------------------------
LID NO - ------------------ ASMT. NO - ------------------
CONTRACTOR b"-� . ....... ............................. ----- PERMIT NO.
LEGAL DESCRIPTION: LOT NO - ------- - t>
-------- I -------------------- BLOCK NO - ------------------ -----------------
--------------------------------------------------------------------------- .................................. .............. EDMOPNDS
------- ---
NAME OF ADDITION ------------------ ...................................................... PLANT
.......................... -------------------
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3 'r >-04
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36
Approved:
DATE................. By ...... --------
& STREET
FILE
ISE PERMIT
ZONE gs.,o NUMBER
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT #
ADDRESS LID
OWNER NAME/NAME OF BUSINESS
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0
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LEGAL DESCRIPTION CHECK
SUBDIVISIONP
LID NO,
MAILINU AUUHtbb
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PUBLIC RIGHT OF WAY PER OFFIdIAL STREET MAP.
EXISTING REQUIRED DEDICATION 4,D
PROPOSED
TESCP
APPROVED BY
0
CITY ZIP
TELEPHONE NUMBER
I
NAME
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
W
W"
ADDRESS
10 L -A 4-- 54-
STREET USE PERMIT REQUIRED 0
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zz
0
SEE ENGINEERING MEMO DAT REVIEW BY
CITY ZP, ITELEPHONE
NUMBER
REMARKS
uy-A /I
cr
NAME
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ADDRESS
METER jIZE/
�BUILDING S PPLY SIZE FIXTURE
UNITS
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LAJ
CITY ZIP H3NE NUMBER
z
8
STATE LICENSE NUMBER
REM;U� V
0 A &L Y
SIGN AREA
ALLOWED PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADB NO.
-
Legal Description of Property - include all easements
z
CL
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(show below or attach two copies)
SHORELINE#
",2 'Pi
VARIANCE OR CU
PL�tNING REVIEW BY
?�A Ik
Tax Account Parcel No.
SETBACKS - FEET
FRONT SIDE7�� REAR
HEIGH7
LOT COVERAGE
z
z
REMARKS
0 2"NEW D RESIDENTIAL PLUMBING
1:1 ADDIALTER COMMERCIAL MECHANICAL
ElREPAIR APT. BLDG. SIGN
z
0
EXCAVATE, FILL FENCE
1:1 DEMOLISH E] OR GRADE D (- x -FT)
CARPORT
REMODEL P WO 01ML
GARAGE
CHECKED BY
TYPE OF CONSTRUCTION CODE
HEIGHT
SPECIAL INSPECTOR
REQUIRED
riYES ['.NO
AREA
OCCUPANCY OCCUPANT
GROUP 0,--) LOA
WOOD STOVE I RETAINING WALL/
INSERT ROCKERY RENEWAL
REMARKS
PROGRESS INSPECTIONS PER UBC 305
z
(TYPE OF USE, BUSINUS OR ACTIVITY) EXPLAIN:
0
C0
Uj
NUMBER OF STORIES
NUMBEROF
a
co
0
2—
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REQUIRED
fl. 0-1 �yu -S
VALUATION
FEE
PLAN CHECK FEE
BUILDING
60--On 122 CAMS
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGWILL
Any construction on the public domain (curbs, sidewplks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided WorR is Started Within 180 Days
-
Applicant, on behalf of his or her spouse, heirs, assigns and
(n
0
uj,l
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
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9;5pD fl. vi,
(Z-41 .00
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TO: Permit Coordinator, -Building Division
FROM: Dan Smith, Engineering Inspector
ADDRESS I
OWNER Al/u FL-ANCHECK #
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 mini.mum.
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 downst airs 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.
13. Repair or replace all defective existing curb, gutter, and
sidewalk. If intersection is involved, installation of wheelchair
access may be required.
/V,
BLGPER/TXTFORMS
CITY OF EDMONDS STREET FILE ASSET INFORMATION SHEET
9 NEW ASSET NO.
ADDITION ADDITION TO ASSET NO.
RETIREMENT
DESCRIPTION
SERIAL NO.
LOCATION L4
DEPT. NO.
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
PROJECT NUMBER (,c) e --F.� q� (o 9
f
PROJECT COMPLETION DATE
COST r7s�: oo
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE 2S-
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE DATE
ktnp INITIAL
DEPARTMENT FILE
ux-
VERIFIED BY
PROCESSED
BATCH NO.-
NOTICE"
Hly
-ra � .. 0 1 -a— -C
No ... war
The -information shown on the attached
Hed for use by the CitY Of
map(s) was corn ' pi
Edmonds/ Its Empl-oyees and Consultants.
Th...e City of *Edim.onds does ' not . warrant the
these
accuracy of anything set for,th on
m a p ('S-'-). A n . V person or entity'requesting a
copyshould conduct an.independent
Infbrm'ation shown-o
inquiry regard'ng the
-t-Fe -map(S)1, including, but not J'm'ted to,
the location of any sew-er stub shown, Suc
sewer stubs may or may not e.xist and may
or may not exist at the location shown
Neitheir the �jty of Edrnonlals nor its
emp-1-o-yee-s o.r office-rs -sh-a-11-1 be 1--ja-b-lfe for -111hE
this map(5), norfor
information g ven on Ided based
any one representation prov
u pon'sa 1 d. m a p (S)