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21417 92ND AVE W.PDF8906 21417 92ND AVE W �l KJ_ 00 C) V) CITY of EDMONDS S I D E SEWER PERMIT N I '19 8Y Inspection Call 771-3202 PERMIT NO. U10-3.3 P_U,QL_J0JVRK$� EDMONDS StEET FILE 11 �"-Ad TREATMENT PLANT Address of Construction: 1� / 7 9,9 4 L,--e U) I Property Legal Description (Include all easements): Z,07— _/5— Owner and/or Builder: Contractor & License No Single Family Residence C r HC ptk 6-'e, 4'c Mul ti-Family (No. of Units &ckAo<!! Commercial (No. of fixture Units Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way Construction Permit required. Call Onle-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 44.0 1 c'ertify'that IUave read and shall comply with the items listed on the back. , ke r - I M n t (I,-/? -a) Date Permit Fee: Issued By: Trunk Charge: Date Issued: Assessment Fee: Receipt No.: Partial Inspection: Comments Date Initial Final Inspection Approved: Date Initial Rejected: Reason Date _Tn-itial PERMIT MUST BE POSTED ON JOB SITE Wh.ite Copy File Green Copy Inspector Buff Copy - Applicant NOTICE: ... of-a--c-CU-5' No The information shown on the a map(s) was compiled for use by the CitY Of Edmonds, its Employees and Consultants. Th,,.e City ofEdrn.onds does. not. wa rra nt the accuracy of anything set for.th on these r entity -requesting a map(S"). Any person o copy should conduct an independent inquiry regarding the Inform'ation shown- or -t-Fe -M a P (S) / including, but not limited to, c ion of any sewer stub shown. SucI the lo' at' sewer stubs may or may not e.xist and may or may not exist at the location shown. the city of Edmo'nrlqs nor its Neithel. empl-o-yee-s o-r office-rs -shal-1 be l--`1a-b4-e for iffie I n on this map(5), nor for information g'v e' . 1ded based any one representation prov Upon'sald map(s). Side Sewer Drawing 1. 0 The City of Edmonds EASEMENT NO - ------------------ ------------------------- v NEW CONSTRUCTION REPAIRS 0 LID NO . .................. ASMT. NO... ................ OWNER ------- ------- CONTRACTOR ----- ....... ................... PERMIT NO. .77G-13S JOB ADDRESS Z-1-417T ------ 9- Z- ----------- LEGAL DESCRIPTION: LOT NO. ---Is -------------- -------------- BLOCK NO. EDMOND$.... MANE' --- --- NT PLANT ......................................................................................................................................... -------- ------------ NAMEOF ADDITION .......... ----------------------------------------------- ------------------------------------------------------------ ?,1417 92,NDA"ac.W. 35 IS 2.S It _-z c-o.CAP _S C,, AppTmed: PWW-0001-1 1/f5 (REV.1 1/78) DATE� "..2.&1.9.87. By,,�L# ) -- -- ------- ------------------- CITY OF EDMONDS STREET FILE ASSET INFORMATION SHEET E�ZNEW ASSET NO. 0 ADDITION ADDITION TO ASSET NO. RETIREMENT DESCRIPTION SERIAL NO. LOCATION I cll/ D 4V2�� * * PURCHASE ORDER NO, PURCHASE ORDER DATE COST B.A. R.S. ACCOUNT NO. ESTIMATED LIFE INITIATED BY DATE PROJECT NUMBER PROJECT COMPLETION DATE COST Q:-�, '?� APPROVED BY "SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST *SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT ACCOUNTING ONLY DEPRECIATE e�'� - - - VERIFIED BY MONTHLY DEPRECIATION AMOUNT PROCESSED ANNUAL DEPRECIATION AMOUNT BATCH NO. 40 G.L. ENTRY REFERENCE DATE ttnp INITIAL DEPARTMENT FILE PROJBCT REVIEW CHKIMIST PRwE&r ADDRms: PRO= NAME: Mew'YzC41 APPLICATION'"RECEIPT DATE: RevIewed by:,�Jinitial/ZE Cot =1 PLANNING WM/SWR ENGMG FIRE BUILDING 111111177 hult- 7777777/t/ sn%,= PAKMY/KXT1PLE/CM1MCLAL - (Circle One) vwu/ SETBACKS CHEMD - Plamning ////I//// WMAY17 111711 VARIANCE/SETFACK ADJ. 'oe 77T77T 7T41111711 CONDITIONAL USE PERMIT 777T77 ADB REQUIREMENTS CHECKEI) �/O 3 TTRTT 117111111 7777777-7 77777-77777 - OTHER &WING REQUIREMENnS 4 -1 TTI 7 -77 7 7 7 k, ENVIRON41MV, FEATURES �6 ACCESS SLOPE VEHICLE ACCESS 777IMT77111111. 11WM1 - J7 /7T/T 7 -- DRAINAGE PLAN (On Site) 4JI //////// 7 77777T777777777 17�TIIF17 771, TF1 T STREET FITZ LEGAL DESCRIPTION WRIFICATION 711117111 '1711,1171, 9 77 QUIT CIAIM/DFDICATIONS //////// �11 11 10 7PTIT777 TFIT777T 7 7 7 7 7 7 77 EASEMbNT - PUBTITC/PRTVATE 77TRT' CALMA17E SLWM CMECTION IF NO LID# www 11111m 12 z 17 PLAT/SUBDIVISICN REQUIREMWPS -// W 7TI T1 7 T1 T I f111-1 13 1217T RIGHT-OF-WAY CONSTRUCTION PFI;d4TT REOD 14 77P777777TI7 111717777 /T//`///",7- BOND REW FOR PUBLIC IMPROVE24FIM -----TI71-Tf 117 SOILS XMITIMS & GROUND -IT1711111 FlEfl) CHECKED n//2WATER 16 7-177171717171171 SIMET PAVING, RM)IRED 17 7TI711- -11IMPT 11111-T177 C"M MD GlYrTER REQUIRED 77Fff17777T1777T17- SIDEWALK RbMTRED CURB CUP FOR DRIVLWAY REM 7T7T77777777 ////// ///////// 777='-- ///////// 4 � 171711 20 '-77TF77777 171111171 777T777777 bqfREET NAME STGN REM 21 O711ER SIGNING RkX)D 77777 ////// 7777R7V ///////// 111111711-4L, ///// -M7111117 22 SIDE SEWER AVAILkBTLITY 1-777 17771 23 EXISTING WPER MATN SIZE 7ff,r77T/T/7/-777 7111777117 24 !T977 1111171111 — WATER *342TR SIZE ////// ///////// 25 7= 7Tff= 17711111 TIT17-IT97 7 SERWCE LWE SIZE W1111111 26 17117771 7TITF='� HYDRANT RELVIRED //////// -77777777 27 — -ITI-TIT 777TIfl7f IIIIT17TR HYDMvP SIZE EXISTING //////// -171-7777-777177[ 28 —. CROSS CONMCTION INSPECTION REM TIT17T 77777 1111114114 29 IWER METM CWORM REM 30, -77797T 77777TIT 7111111171 FIRE LINE CHARGE REOD - SPRINKLER ///////// 31 STREET CUT 32 OPEN DrTCH E<ISTING 33 77TIT 7TTIT111 N7 REQD 34 777-77 77777777/7777/77// CULVERT REM ////// ///////// ///////// 35 111711 7777777777TF/77T/I SIZE 36 CATCH BASIN REM 7TTFIT ITITTFR7"111111111 37 T71777 TF1 T T1 If T/777 7TTTUI T nMICATED CN SITE PLAN ////// ///////// ///////// 38 SHOULDER DRAINAGE MAI1?rAIN 117711 111117171 171111111 SHALE OPEN RUNOFF 39 MISC: 40 -1 zp fIg ."IM, I 41 7777--�7- EMU,, L" -7*F F.- MEMO.TO: Building Division FROM: Engineering Division SUBJECT: After review of the subject building pern-Lit application, we have the following ccnmients: 1) Connection to City water system required. 2) Connection to City sanitary sewer system required. 3) Right-of-way permit required for any work on City property. 4) Driveway slope not to exceed 14%. 5) Back water valve required if downstairs plumbing is below. elevation of upstream manhole. 6) Water and sewer lines to be separated by 10 foot minimum. 7) Builder/owner responsible for containing all temporary runoff and erosion on site and may not impact neighboring properties in any way. BLDGREVW/TX'ITURMS CITY OF EDMONDS ZONE CIGNSTRUCTION PERMIT APPLICATION JOB PERMIT NUMBER 11 ME (OR NAME OF BUSINESS) ADDRESS I 1,1_1 N CITY TELEPHONE NU-MBER EJ 4s80 I NAME RDn JO-m-sorl ADDRESS 1ci(,c)1 �3v-d Nub CITY TELEPHONE NUMBER i 5 Lf�.__ , NAME woodcrof+ Horncs loc ADDRESS 303 - Av C) NI TELEPHONE NUMBER CITY fEjh1cri6ts -1 D 15) - 4SD I STATE LICENSE NUMBER W Dbf)Ct4T � P A on of Property - Include all easements attach four copies) ,r,6�2 NEW RESIDENTIAL PLUMBING ADDIALTER COMMERCIAL MECHANICAL REPAIR RETAINING WALL F] SIGN EIDEMOLISH REMODEL EXCAVATE OR FILL PRE -MOVE INSPJ COMPLIANCE INSP. FENCE ( x _FT) swim POOL WOOD STOVE/ INSERT APT. BLDG RENEWAL 5 NUMBER OF STORIES NUMBER OF DWELLING [UNITS NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) fl--/ I am, Aj - _L LEGAL DESCRIPTION CRECK _A�z _ - 'SUBDIVISION No. LID NO. r 144 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP, EXISTING RED IREDDEDICATION PROPOSED RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED El STREET USE PERMIT REQUIRED 0 SEE ENGINEERINGi MEMO DATED METER SIZE ISUILDING SUPPLY SIZE IFIXTURE UNITS REMARKS SIGN AREA ENV. REVIEW AD"O. ALLOWED I PROPOSED I COMPLETE I EXEMPT I N I I I SHORELINE 0 VARIANCE OR CU PLANNING REVIEW BY DATE/ YAR HEIGHYILOTCOVERAP(E FR:;TtS I REAR BY ITYPE OF SPECIAL INSPECTOR REQUIRED 0 YES 0 NO PLAN CHECK FEE BUILDING PLUMBING MECHANICAL This Permit covers work to be done on private property ONLY. Any construction on the public domain (curbs, sidewalks, driveways, marquees, etc.) will require separate permission. Permit Application: 180 Days Permit Limit: 1 Year - Provided Work is Started Within 180 Days "Applicant, on behalf of his or her spouse, heirs, assigns Brick GRADING/FILL STATE SURCHARGE ENERGY CODE o successors In Interest, agrees to Indemnify, defend and hold 21 harmless the City of Edmonds, Washington, its officials, x. employees, and agents from any and all claims for damages of < whatever nature, arising directly or Indirectly from the issuance of this per It. Issuance of. this permit shall not be deemed to PLAN CHECK DEPOSIT modify,.walve or reduce any requirement of any city ordinance 0 x nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE provision." 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- THIS PERMIT AUTHORIZES ed thereby, no person will be employed In violation of the Labor ONLY THE Code of the State of Washington relating to Workmen's Compensa- WORK NOTED tiQRln uronce., INSPECTION SIGNATURE N AGENT) DATE SIGNED DEPARTMENT 7 CITY OF EDMONDS i�� AT/rENTION U 771-3202 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE JIJ/0 7 UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 0 A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC CHAPTER 3. 102-78 .;UNSTHUCIIUN UOUFLI,& HEIGrT 0---, 1W ),�AA REA OCCUPANCY OCCUPANT GRO LOAD 4_7 VALUATION FEE 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 [ REL EASED BY: DATE I ORIGINAL — File YELLOW — Inspector PINK — Owner GOLD — Assessor I . ......... 2-3,1,00- ,,,.,,,PRIVATE (SHAIZ' M %J A6ft 96d Go WITH LAU 110 . 00, 2 1� I .53' 27.90' Oil .1 oIGHAP-L/,G- \\ \ (D - 201 SHAQWAHAKJ VIQA J. LAUReQGG It 0/-\ 0 L C) - , D o a; C:WG S41j,,r4QY s 0 :2 -QT SK4)-r < eo.q (01 EX. IS' STOpLA 6FVjER eASCKAP N LL Tqp F-A exis-i- 10, S _1,4 10, Y- 411 v ci EXISTIUG- eX15T OWE Lu %J) STORY HE N d) N F;2AUF- HOUSE iz, 3 G' .67, \ —4— 0 0 113 201 10, ol m In m 3 1> GTP-PHGQ m 40S - K., eoep-;ZT JOHQ G. WIL-LIAkAG L'AFpG2TY HgwSEL w