21419 92ND AVE W.PDFiiiiiiii lill
8907
21419 92ND AVE W
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CITY of
EDMONDS
For Inspection Call 771-3202
Address of Construction:
SIDE SEWER PERMIT
PERMIT NO. 070@2
116 EDMONDS
A TREATMENT PLANT
Property Legal Description (I nclude all easement�,):
Owner and/or Builder: A4 ic T Hc tA,;-5 M t"),
Contractor & License No: — --------
(Z Single Family Residence
Mul ti-Family (No. of Units
Commercial, (No. of fixture Units
Invasion into City Right -of -Way: N o Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: Nov""' Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
I certify t &� I ve read and shall comply Date
with the items listed on the back.
Permit Fee: 3000 issued By:
Trunk Charge: 25-, CD Date Issued:
Assessment Fee: - Receipt No.:
Partial Inspection:
Comments Date Initial
Final.Inspection Approved: /49-87
Date Initial
Rejected:
I Keason
Date Initial
** PERMIT MUST BE POSTED ON JOB SITE **
Wh.ite Copy - File Green Copy -,Inspector
Buff Copy - Applicant k
NOTICE:
... wa r-r a n ty ... o-.r-a-cCTT-r-
-N'.o 'ttached
The information shown on the a
pHed for use by the City Of
Map(s) was com
Edmonds, its Employees and Consultants.
Th,.e City of �Edrn.onds does. not. warrant the
accuracy of anything set for.th on these
M a P (s"). A n . y person or entity -requesting a
copy should conduct an independent
1 0 ion shown- or
Inquiry regarding the 'nf' rm'at"
-t-Fe -M a P (S) / including, but not Hrn'ted to,
c ion of any sewer stub shown. Sud
the lo* at'
sewer stubs may or may not exist and may
or may not exist at the location shown.
o n,
Neitheir the ty of Edrn ris nor its
I . h. I b e a. b-1--e f o r t h e
employee-s o-r office*rs -s
information given on this map(5), nor for
ntation provided based
any one represe
upon*said map(s).
Side Sewer Drawing %
The City of Edmonds EASEMENT NO - --------------------------- ........
NEW CONSTRUCTION REPAIRS F� LID NO - ------------------ ASMT. NO . ............ ......
OWNER ------- q.OtAS-5 --------------------------- CONTRACTOR .......... B. Ac— V, - H -0— C .............. ----- PERMIT NO. 77. G. 3 Z---
JOB ADDRESS ..2-1-4-1-9 ....... 9ZK'D ---------------------------------- LEGAL DESCRIPTI ON: LOT NO . ......... 4 ------------------------ BLOCK NO. EDMONDS
TREATM�Nt-'PJCANT
11 1 --- J I
.................................................................................................................................................................
NAME OF ADDITION ------ F1.4-MAG-A-.PA�S ........ Laths -F . ................................ ---------------
214 1 c) c) `11 Av e
4"c.*. r-AP
Gr'VICS-T 44�'NORTK
OF CORNER OF GARJkGV
190
A
Approved:
PWW-MOl-11175 (REV.11/78) DATE��. ..... By ----- ... .. .. .............. ......
CITY OF EDMONDS
5�/NEW
ADDITION
RETIREMENT
HLE ASSET INFORMATION SHEET
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION
DE111. �O
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
B.A.R.S. ACCOUNT NO. X111 -6 00
ESTIMATED LIFE
PROJECT NUMBER ZZ')
PROJECT COMPLETION DATE
COST 11pe
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
EKDEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
0 G.L. ENTRY
(§fP) INITIAL REFERENCE
VERIFIED BY
PROCESSED
BATCH NO.
DATE
DEPARTMENT FILE
sTiiEt i FILE
43
A-Z
?>z I I:xp I
zol-o 11
TH
STF&ET FILE
P10JECT ADDRESS: �o ?4-ln
Aevieiw-� by: (initial/date)
CaMMENTS
PIANNING
WTR/SWR ENGNRNG
FIRE
BUILDING
/77777777T7T=77
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//T,7//
FAMILY/KiLTIPLE/CoMMERCLAL (Circle One)
CHECKED - Planning
7TIT7117
17=7MFI-1177
/SLMIACK ADJ.
77777777
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USE PEMOT
2
77TF17
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3
1177,
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�
JUTOMCAL FEATURES
-
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11171777IR7117
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DESCRIPTION VERIFICATION 4t '/' 'P-I-x
////////
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10
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//////
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16
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fl;!�!ET PAVING REQUIRED
17
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NAME SIGN REM
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22
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Tw. SEWER AVAILMMITY
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26
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WICATED ON SITE PLAN
//////
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AN
38
.1MDER DRAMAGE MAINTAM.'-�-"�'
TfTTIT
ME OPIN RUNOFF
139
40
77-EM BY:
PLANNING MM. ENGINEERING MGR. PUBLIe �MKS MGR.
CD
I
IV
MEMD!70: Building Division
FROM:
Engineering Division
SUBJECT:
After review of the subject building permit application, we have the
following camients:
1)
Connection to City water system required.
2)
Connection to City sanitary seuker 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
%ray.
1
BIDGWW/TXTFORM
W�
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
woodcrof-+ -Ijbmcs, I nL
U) MAILING ADDRESS
z
W�) - -3r-d AVe, t�Ov`rh
CITY TELEPHONE NUMBER
Edmoryls
NAME
RW \johnson
RESS
W
L_
x I q (,0 1 - 91,3',
E-15 ITELEPHONE NUMBER
NAME E4
_Wcc"(_r6(f-+ Fbmes, Inc -
ADDRESS
RU �, o-3- BrJ me, t�cwth 41
9 CITY TELEPHONE NUMBER
B I STATE LICENSE NUMBER
—WOO DCHI, I
Legal Description of Pi
(show below or attach
easements
0 NEW
9 RESIDENTIAL
PLUMBING
ADDIALTER
1:1 COMMERCIAL
MECHANICAL
REPAIR
1:1 RETAINING WALL
SIGN
DEMOLISH
EXCAVATE
OR FILL
FENCE
( x _FT)
REMODEL
PRE -MOVE INSPJ
COMPLIANCE INSP.
swim
EIPOOL
F WOOD STOVE/
INSERT APT.BLDG
RENEWAL
.105 NUMBER OF STORIES NUMBER OF
ta
DWELLING
U
10 1 ,
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
ZONE NUM13ER
JOB
AUUHtZ-Z1
?2 IYO
�VE KZ_�57_
LEGAL DESCRIPTIOR CHECK
N-7
SUBDIVISION NO.
LID NO.
14 7__
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
PROPOSE
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
cr
W
Uj
STREET USE PERMIT REQUIRED 0
z
z
SEE ENGINEERING
1�01 DA D
9 IR �
W
111"1112,19 /Vq 27.
METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
REMARKS
13
SIGN AREA ENV. REVIEW
ALLOWED I PROPOSED COMPLETE I EXEMPT
VARIANCE OR CU IPLANNING REVIEW BY DA
YARDS HEIG jLOTCOVER9E7
z
AR
FROW -11 D 0 z
07z
REMARKS r
CHECKED BY
TYPE OF CON CTION
CODE
HEIG,
V-71
I S,-,
kl�y
SPECIAL INSPECTOR
AREA
OCCUPANCY
OCCUPANT
REQUIRED
GROUP
LOAD
0 YES
1.
REMARKS
J7
ry
Ica
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
MGRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
ENERGY CODE
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
J"Applicant, on behalf of his or her spouse, heirs, assigns and
successors In Interest, agrees to Indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
2 employees, and agents from any and all claims for damages of
'M
< whatever nature, arising directly or Indirectly from the Issuance
x of this permit. Issuance of. this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify,.waive or reduce any requirement of any city ordinance
'0
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 th a owner, or the duly
ATTENTION
authorized age nt of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authoriz-
AUTHORIZES
ad 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
tIQn.Insur2ncQ,.,
I NSPECTION
. j SIGNATURE (OWNER OR AUNTL
DATE SIGNED
DEPARTMENT
CITY OF
EDMONDS
ATTLz'NTION
771-3202
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
r*)
U
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL
OR 0
A CERTIPICAT9 OF OCCUPANCY HAS BEEN GRANTED. UBC
6H,05tER 3.
VALUATION
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 — Assessnr
. . . . . . . . . .
TIONS AND GROUW N
LOCA
k4LLW)f 2 WILL BE REMOVE'.
G,SHED LOCATED IN LOT TS 2 AND 4
CILITlES LOCATED WITHIN LO
RM SEWER EASEMENTS AND FA
-jrST0 TE SITING OF HOUSES THEREIN
RELOCATED To FACILITA
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