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21324 PIONEER
WAY
CITY OF EDMONDS
ENGINEERING DEPARTMA
STREET FILE
APPLICATION FOR RIGHT-OF-vJAY CONSTRUCTION PERMIT
(Ap-Zicaant to Cc.-molete A & r crd Subm,,t -In Duz)Zicate)
Permit to be issued to: -e'
For work at: (address or vicinity)_,;z
7--
Type of work to be done:
(Attach Drawing IN"hen Ap
,plicable)
Time Required Start: Finish:
Owner:-.
Name
Mailing Address
City State
Telephone Number
Contractor: P;-,,Z 22 3 -'5; Z -��Z
Name State License Number
Mailing Address
)F111kr--7x �/s
City State Telephone Number
IN`DE.,!NI7Y: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including but not limited to the defense of any legal proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and accepta . nce
of the restoration by the Engineering Department.
'Work subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by the Engineering Department.
Call 775-2525. )(;t;L0
Signature: -
Owner or Agent Date Signed
DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
Permit Issued (Date)?&�t:--m 1-% Permit Number
Fee: A Bond:
Time Authorized:
S APPRQVALI - I bAtE
(o
APPLICATION
The City of Edmonds for EASEMENT NO - -------- ---------------- ------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS 0 LID NO - ------------------ - ASMT. NO - ------------------
OWNER ------ ---------------- CONTRACTOR ------- ------------------------------------------ --- PERMIT NO.
JOB ADDRESS --- ...... -------- .... LEGAL DESCRIPTION: LOT NO - ------ ------ \ -4
- --------------------- BLOCK NO - ---------------------------------
-------------------------- ----------- = .....
,---77
- — ------------ --------- By - - --------------
WE
MON',
PPLICAT
The
"Cit*-
.'"06ibnd*
SE MIEN. NO.-
SIDE.SXWER� PERMIT
AN
LID NO.
NEW CONSTRUCTION E� REPAfRS D -- --------------
NO.
7
ER '(0
CONTRACTOR 13.6 4
PERMIT
�OWN * ----------------------------
----------------------------------------------------------
-------- ... ----------- -------------------------------------
NO
JQB ADDRESS:
A 13 ;ZAI �- e w
-------------------------------------------....................
---------- LEGAL DESCRIPTION: LOT NO - --------- N ------------------------ BLOCK
NO - ---------------------
-------------------------------------------------------------------------------------------------------------------------------------------------
..... . ......
NAME OF ADDITION ....... ��A�11 ----------- f4.&P ------- -]7 -- --------------------------
........... ......
ir
k
..........
%
Approved:
A w
4"-
... . ...... . �By ...............
......................... ... ...
w� .... ........... ------
-IJ 75
7
CITY OF EDMONDS SIDE SEWER PERMIT
Y
WATER -SEWER DEPARTMENT
PERMIT
any f the construction.)
sewer inspections BEFORE covering portion o
(Call 775-2525 for side st. NO Sat., sun., or holiday inspections.
within 24 hours after requ
Inspection will be provided
-jeer way ............................. . ...................
ADDRES5 LOCAnON OF CONST RUCTION ............ ----------------------------------------------
PArk #.2
Lot Shell Valley . .. ..... . ... ...................................
PROPERTY LEGAL DESCRIPTION -------------------------------- ------- . .......... .................................
............. . ............. ................. ... . .............
........................ ........................ .. . .......... . .......... . ................... ................................. . ........... ..........
A, lli��.CQNNAC ----------------- --------------------
OWNER AND/OR BUILDER ..... ---
. ..
....... . ............ ...............
Aq� Aklin Backhoe .... ..... ........... ..............................
CONTRACTOW NAME ADD .................................................
S BESS ......
21� connection Of side sewer to the
July .. . ........... I l-971— for repair and/or
r(3tislon is granted -----------. ..............................
Sys" in accordance with City of Edmonds Ordinances
JAI D TO THE FOLLOWING:
1p., -1 mit to construct sewer inside property line. A licensed Side sewer Contractor must
ATT NTION IS CAT
a per
I
—The owners of the property May obtain
NOTE No. 1 Do not cover any portion of sewer bef ore it has been inspected.
Right-of-WaY Permit obtainable from the City Engineer's office.
side sewer in street area.
ires an Invasion of
NOTE No, 2—All work performed in city right-of-way requ n Regulations governing side sewers when you g . e . t permit. m grade of
regarding ordinance 11.16.030 a d ; minimu
line
line jnd 12 inches inside property
NOTE� No. 3--obtain full information
4 —TOP of side sewer must have at least 30 inches coverage at property
NOTE No. fo
than % will be permitted. Contractors shall be responsible
4
sharper red to original condition.
iTlt No. 5---Trenches in street must be water settled and surfaice of street resto
NC -P
work which may develop within one year of completion.
for in the permit, or to do any work on the main sewer or its a
%
NOTt:1140. 6—It is un] awful to alter or do any other work than is provided
1h. i— into the wye.
. . . .. .. .. . ... . ... .. . ...... ... ... .... .
. . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
....................................
.................... .................
city sanitary sewer
be employed to construct
2%. No bends in grade
r failure due to improper
2
purtenances except to in -
By ...........
. ................... .....
By ---------------- Date -------------
By---------------- Date --------------- - -------------
IS
D APPROVED �Pee - -- -----------------------------------
AP .....................
ES
Ro
'2
, Lela - 7.
Date.---.7 -------------------- - 7 ................... ,.60 V-S ........
APPROVED
...... .............................
.......... .
... . ....................
............... . ................
.................... . ..
k,- ............. ........................
...........
Remarks: --------------------------------
....................... .........
........... . ................. ................ . ......................
.............................................................
....................... ......... . .............
...............
............................................
.................
Performing Construction PRIOR To Request For Inspection
er of Firm
it Copies MUST Be. Signed By own
4.
BOTH Perm
that the side sewer installation constructed under this permit
hereby certify
....................... ....
... ...........................
(owner of contracting Firm Performing construction)
f the City of.Edmonds.
was 1
nstalled in accordance with all governing ordinances o
...............
1-14 - - - - - - - - - - - -
Dated this --------- 19.4 ............ (lay of----
er 0
Power E], Sewer
Gas n, Telephone
Check BEFORE you dig for: Water C],
A:,
BEET FILE 7, .4 77
M61.TC 51
11:�!'T. W1575T
P,1'1'.';IT YF_VT,17,:
Street Pdfht-oE-`1-:ay EaistinF
4-o 14-on
Access Easmvits Existing
-(M
pj,
Utility Tascmcnt Existinc,
0 K-1 Z§7
MA
11
Lot Per Suil)division
Plat
A.-scssor "at)
Sitc Plm nicc�.cd for AccuraCN,
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"Geo(d
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T:x j,; t i n", 1*1,atcr !-,ain i> 7-
1:atcr "ain !'c�:-,!ircd
low i";". uirc��t --alKi7e
I llvdl.;I,�t
Hv(lrzint Per.:."in'd rP)C-r-.t_jr%- C-�),:!c Si ze
9
cr AJ
cc;.
scptic T;m�: Date
m i t "o.
1)rOi /�2,7—
Sanitary Ile :cr Avnilaidlity PZ
c :0. 4/700 Z�A/
7�>
S'Llitary �')(,-cr Co-mccticM P
C0111
7:-Z
—Verl! i
C111vort VC-quired
C) Arr
C.'Itch ;,;vr�ili Pt..';I6 red Tildicate oil !'�itc
;T
11"i""1101c requirc0_4 _111dic.-Ite on site Plat"
Soil CO;Iditjoll!; (c, CO-OL111d 1'�*,1tC]' Field CJIIOCI�Cd
Revi ew bv TWO
Strect Pavin,-, I'cquircd /W.4 —
/Vx "((z�
Curb wi(! C,,ittcr 1"Couim
sijc"?all� Pco.uircd
CurD Out for Driveway Rcquircd
rj-ht-ojj7-1.,:ay Construction Pcinit Rcouircd
Boncl Pcquired for Niblic Imiprovu-,,ents
Strcct Naric Sion "Icquired
7
Othcr Sioning Pcci.iij i cl
.-WO
PTC PCI7,'.Idt SitC 111SPCCti011 r, 011
c
j L
> i
BY:
scv:cr
1%,atcr , —
St-rc-t fe�
Ynp,inccrinp,
1
listcd in to Buildil"'o,
Date
oI, 1�,,.141
J L iid,illg' Pei'mit Application
Patc
Stanpcd ".btaticlis
A)"prove'd 'I))' Puldic Worl 's Depart)""ClIt
."7-7
Date
"0-)
BUILDING DEPARTMENT
Applicant Fill
USE PERMIT
ZONE NUMBER
PERMIT APPLICATION
Inside Heavy Lines
—io—g
ADDRESS 4ijd q
NAME (OR NAME OF BU ESS)
tv 1'4 C
PERMISSIBLE ACTUAL % V
LOT COVERAGE- LOT COVERAGE
MAIWNG ADDRESS
PERMISSIBLE HEIGHT PROPOSED HEIGHT
�CITY
Ti
TELEPHONE NUMBER
-7-7yL S N
ACTUAL LOT AREA TOTAL BLDG. AREA
z
REQUIRED YARDS PROPOSED YARDS
FRONT SIDE REAR FRONT SIDE REAR
-
ow
C4
NAME
ell
I
0 f
ADDRESS
00 C,
LEGAL LOT VARIANCE OR CONDITIONAL USE
[] YES 0 NO PERMIT NUMBER
PLANNING DEPT. APPROVAL DATE:
CITY.-
TELEPHONE NUMBER
STREET R/W
..........
EXISTING STREET R/W4.<_;>FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W 40FT. ... 0 ... FT.
NAME
REMARKS
C4
C4
ADDRESS
CHECKED BY
CITY
TELEPHONE NUMBER
METFP SIZE
SERVICE SIZE
CLEARANCE
CHECKED By
STATE LICENSE N1
CITY LICENSE NUMBER
REL&A'RKS
Legal Description of Property (Show Below or Attach Four Copies)
TYPE CONNECTION
VERIFIED BY
q
71
m
<%317MY <XV02-
PERC. TEST
PERMI NUMBER
REMARK
FIRE ZONE
TYPE OF CONSTRUCTION
STREET IMPROVED
C:] YES 0 NO
SPECIAL INSPECTOR REQUIRED
C] YES NO
OCCUPANCY GROUP
GAS
ET RESIDENTIAL LINE
VI NEW
EJ NON-RESIDENTIAL SIGN
FADD RETAINING
DEMOLISH WALL
FALTER EXCAVATE FENCE
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
OR FILL ( x
REPAIR PRE -MOVE swim
El INSP. POOL
-KU—MBER
OF STORIES
NUM13ER OF
DWELLING
—WA-TURE
UNITS
OF WORK TO BE DONE
vv-
Valuation
Fee
Receipt No.
Plan Check No .....................
PROPOSED'USE
BUILDING
FY 0 F L D V1 0 ND S ENGINEERING D E
PLUMBING
PLOT PLAN (Indicate Building setbacks, abutting s
HEAT & GAS LINE
_y ___
Examincd
FENCE
SIGN
XeMarks to
RETAINING WALL
d N
SWIMMING POOL
.... .....
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL