21917 82ND PL W.PDF111111111111
7686
21917 82ND PL W
CITY OF EDMONDS
.P UB KS..DEPARTMENT
ENGI NEI D-j VIS-1 ON
THIS PERMIT MUST BE -AVAILABLE AT THE
Applicant
to
Complete Parts
A and'B
Permit-
to*"b*e*
issued to:
tA,
WR=T
CkifAgPOSES
k I -A C'D LA J�
For Work at:(address or vicinity)—*-ZIN11
S LC Y? L-'x-j YF3 3 4, 1
Type of Work to be done: J3 b te V 12 95-0 TrZ L _)1J L) 19 we I I'J
(attach drawing when applicable)
Time Required -- Start:
—Finish:
Owner:1 L�. 01 A I �W)_)Vp)lso C2)uti�'-�
Name
Mailing Address
City State zip Telephone Number
9
Contractor:
Name State License Number
Mailing Address
City State Zip Ye—lephone Number
B, INDEMNITY: 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, ioreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or,-a'ny of its departments or employees,
Including or 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 followingthe' final inspection and acceptance
of the.restoration by the.Engineering Division.
Funds held from -the Security Deposit (estimated restoration fee) w ill be held unt , il
the final street patch is completed, at which.time a debit or credit will be
processed for is-suance.to the applicant.
Work is subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call�775-2525, ext. 220.
J understand that this.peXm st be available at the job site for in . spection'
purposes at all times.
Signature: Date:__�
Owner or Agent /T_
TO BE COMPLETED BY IZSUING AGENCY�J
Date Issued: Permit No. -2 F e e :�;O.
Security Bond:
Time Authorized:__?v olev_
APPROVED BY
I n - 7 '7 1
D ate 1717e
lula
Rev. 10/77 PUSLIC.-UTILITT DISTRICT No. Vof-InoboftliSh 01�'-`Z AREA
Location- Ci Aik- (-;.. w I Do#- ilmii"�w_ W.06 No.
K I G, -3 0 T R mw IF P"�
_Rqv1qiO7_____L7 Scale
Rea son f or w4rk S T k S Lf C-- "gineer As Built
S V tf N1 V-� C L L CE �,A
-;�O K\Aj % 3
PHIA-IT -REQUIRED C9-4T-ACT-s' NT
tA-SIME '14VIROIMENVAL:
_�> I
\A C)
WmOt undier DWHO 51.2
utt4� sectlo
J* -0 L
Daie'Grant6d
rantor"
%
Feei r�quiviti `TO'imkod
By-
nvenfory 4
P%bs , X
U., X. ��\ I -
TyPe _L .1r, - - z 4 _ 1 1
AmounL--�ZL\
ftnAtarq. fNI Date Interpretation Referred To:
Mo Pos" I Circuit Mag
Date Released1br Construction.
Dot* Work, CompletegC' Date- y
Cir,cult Numbe -L 0-31 'Substa" an I:z Lz, O.H. U.G� Cond, KV
--Ckt IF t
Add�
t., ft - P
M?
A
-Net "Citt Ft
'Siewbr
Botkhoe.
J, 0
�v -
-4-
J
Y'
j
j�
j. _4i.
UP
,xv
.4
L:
L
_4 - -
A
�74
ju R
A
AY:L
0
J
. ot�
J,:) Oz,
1
4j
U'R'D
,;*nftr
e0o t.
ul
t Map
1
'Wei
40-5
-65 3'_
W. No. - -
T
wer
NOTICE:
No warraffy—o-f—a-c-c-u-r-a-cy--
The -information on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The city of �Edm.qnds does not . warrant the
accuracy of anything set forth on these
map(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the Inform-ation shown on
I I
t-Fe 'm a p (s) I including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may, not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
ernp-1-o-yee-s o-r office-rs sha-H be Via.b'Fe for iffie
information given on this map(s), nor for
'ded based
ion provi
any one representat'
upon said map(s).
APPLICATION
The City of Edmonds for EASEMENT NO - --------- --------------- .............
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS F� LID NO . .................. ASMT. NO_. ...............
OWNER H� __-V I E-_- F; �,E: - -------_---------------- CONTRACTOR --------- ......................................................................... P E R M I T N 0. (D-
JOB ADDRESS --- :2XDA_-L-J�� --- F-::-:' - 2 ---- \_ N_ 1� ------------------- LEGAL DESCRIPTION: LOT NO . ............ .................... BLOCK NO - ------------------------------------
0
------------------------------------------------------- ..........................................................................................................
- � I � - __ . _____ � T-� - . - � k , " . � - � I :u-_
= -------------------------
j
B, ............ ivg
DATE._4 tl�'j ;K::� '?, � --------------- I IT,
"Cli 'S4
1k.
`7
-%VA
4-;SEWER-�;DE. RTM�_
TE �605
RIMIT
2
Inspectionw. BEFORE covering, afiY port lonof� ,�the, construction).,,
/,Callt .7,75-2525 for side, sewer:,
-insrequst-_�''No;,iSat.. .8ui�.�,:or.,holiday,,tnspe6tion
pection� will, b4:, provlde&wIthihk 24!'hoursi after.
via
........... ............
'OF-'iQON5TRU( 4W_ _t
�ADDRESS MbC =Oj4, ........
GAL-M . ...... ....... ........................ ..
PE
ESGRIPTION ............ :P
.....................
............... ...... ....................................... ...........
.... . ..................... . ......... .............................................. ........ ..............
.................. . .........................
..................
-A�Nlj/OR.: -ILU
-BU ER ........
........................ ....................... .................. . &WNER..
`NAMR�&AODRESS .... ........ ........ ........................................... I .......
1,CC -*ACTORliP ............ . ..... ...................... . ............
. ......... of. a. side sewer -to;the. city,,. isnitary's
in a6cor - dan6e,mith,'bA4.",�i o"r"din,ances.
;SYSteM'
A FOLLOWING:
A licerised Side. Sewer Contractor �must be. em�i�yeii-,i6'coristruct,,�;��,,'�'
obtain a'permit to do ' :n�tiuct :sewer. lnildel.property� Ilhe.
1.9 6r'ih�street4are&_Do: ri�t�cover, any,, portion. of sewer,,beforelt has;been insppeted'.
Idw,sew,
VOTE. No. lierfarrhed,jw-city rlgh�t-of-way requiresr an, Invasion, of Rlght-of-W&YF�rmlt,6btaJn-able', from the City Engineer's.offlee..
rdinance'll�.16.036.and,-il�gulatibns governin&. side sewers when you -get perm t.
VOM No. 3—ObIj�ffi%full information regarding,, 0
ches inside pro"pbri, iine; minimum g rade bf 2%. No �bends; in grade,�,�
No= No..--4�ToO7�of-IsIA6; sewer must'have at- least- 30 Inches coverage,at prop.9rty line and .12 In y
4 arp6r'�tlian,%, wIlL`be:.perm1tted. -
NOTE Noi� 5�—Trenches� In steeet.mu't !be water setGed, and surface of �street restored' to original condition. Contractors �ball be responsible for fallurei �due, to, Improper'
-�,woik.'which,ir�ay;.dev�e'1'6p -within one,year of. completiom'
do,any/ oth�x work IS rovided for in the permit, Wfo, dwany work on the, ma -in sewer,or� lts,appqr,tena
NOT-k No:�"' than pi nces!,excppt to in
'ierOthe� pipe�ntethe, wye.,!
'By ..............
DISAPPROY'k][Y Zj; -,Date....: .... .. ........................... By._ ...... Date .................................... ..... Date; ....................... ........... .
......... .., ........... .................. . .............................................. .........
TPROY, D".*
S ...... ...................... ...... ............... .............................. ..
Ren�4rk ........... ....... ........ . ........................... . ................... ....................
............. 7 .... ................ ...... ............. 7 ......
............... ....................................... .... .. 7
...................... ...... ............
hispecUon,
BO _A�T.e`r1�r`nit',05pie9 MUST,Be,Signed 8yOwmr,o' ir e orming�ido'ns'tr.uci-lori,,PRIOR�'I�'6�ke'quest F�or`
er, th*
-�e�r.,eby,c.ertifS�i�afi,t-he�,si'diD er- iristallatiozi�constr�eted(.und er 1 �L�
m P
..................... ..... ..................... ew
- : , I I -
6 odY
'Firm, 'lPerformizig :C nstructi
he&iwaceordanp�',with ali,governffig.�o tg".
-as.instal rdinances,of the,City b Edr1nonds.
-2
f ..................................
.�Dated this ...... ........ fw o
Sewer Otder.;n.;, q jI,
diglor.i. Water :E], -Ga.& Telephone:;E], Pow�r�'JEI
APPLICATION
The City of Edmonds for EASEMENT NO. -- ----------- ----------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION U4--" REPAIRS 0 LID NO. _ ---------------- - ASMT. NO. I --------------
OWNER ------------------------------------------ CONTRACTOR ------ Ra-k -------- ------------------- --------- PERMIT NO.
C11 7 �� --P/ --------- LEGAL DESCRIPTION: LOT NO - --------- 2�; ------------------------ BLOCK NO - ------- ---------------------------
JOB ADDRESS ----- j;?�- -- - --- --- ------------- L, ---
--------------------------------------------------------------------------------- ---------------------------------------------------------------------------
NAME OF ADDITION --- ------------ ------- ARZI� 74 3
---- -------------- ----------------
5:,� L4 c /
E)(57, 9 "'
Z)/
F t � (/-,) I
Approved:
DATE-------------------------------------------- By ------------------------------------------------- -j-j7.y6�
STREET FILE
INSPECTION RECORD
CITY OF EDMONDS, PUBLIC WORKS DEPARTMENT
DATE: /-7S PROJECT:
Z-V:� 1-7 8 7- vNA P L- . W
Sc-%'�L kvA5pct-c--T-%f---ly%
ov-noo-rTV vj'lWvoa-r &-vx-sT-%nct
V-S3.
�IJBLIC WORKS DE AR�:VMT.
BUILDING PEMIT 'th 4.,/-M
(&ate)
Street Right -of -Way Existing
RED
Access Easements Existing
J;F
1\\ EWE 'QD:jj_
p4
Utility Easement Existing
�j REQD
W
Lot Per Subdivision Plat
X Assessor
Site Plan-Checkedfor Accuracy
Underground 14iring Reqd.
Check Accuracy of Legal Description
Review by_ 4A02
Date
Existing Water Main Size -
Water Ma� Required "A
Service Line Required
Hydrant Size Existing
r4
Hydrant Req4 Per Fire Code
Size
Detector Check Meter Reqd. Ajo
Cross Connection Inspection
Fire De partment ConTnents-
'dater ��ter e Reqd.
Review by. 1A
te 2
Septic Tank Design Approved
Date
Septic Tar& Permit Reqd.
Permit No.
Sanitary Sewer Ava�abjility
Proi. �-AC>
Drawing No. 4
File No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
4fzA�Review by
Date
Open Ditch Existing
Req d.
Culvert Reqd.
Size
P4
Catch Basin Reqd.
Indicate on Site Plan,
0
Shoulder drainage maintain collection
an swale open rLmoff
H
1�1-mhole reqj:�r-/
Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
Review by
- ---------
Date ;f Z4e—
Revised: IvIO-1977
BU,ILDING DEPARTMEN
Applicant Fill
USE
ZONE OL
T
WER
PERMIT APPLICATION
Inside Heavy Lines
4
'OB
ADDRESS
" rb,.;-
WAME JOR NAME OF BUSINESS)
LEGAL LOT
LOT AREA
SUBDIVISION NO.
MYES
El NO
MAILING ADDRESS
0
STREET R/W
EXISTING STREET
R/W
C-10
FT. DEFICIENCY
THIS PROPERTY
CITY
TELEPHONE NUMBER
I
COMP. PLAN ST. R/W L-0
FT.
FT.
NAME
W ADDRE . SS
CHEPKED
BY
U
a: CITY
TELEPHONE NUMBER
STREET AND/OR UTILITY WORK
R/W PERMIT REQUIRED
<
REQ'D. -0 YES
&NO
YES VNO
NAMVY
V C-_
Ale Z e t- e /j
UNDERGROUND
WIRING REQ'D,
1:1 YES
=NO
0 ADDRESS
TYPE CONNECTION
*YES
VERI
E BY
U
< 8 6 x-
SANITARY SEWER
NO
I
nj
fou
It CITY
TELEPHONE N I. B - R
SEPTIC SYSTEM
DYES
PERMIT NUMBER
Z
0
0
7 & 7�> 2
^PPV'D BY CITY ENG,
Fm
U STATE LICENSE NUMBER
ICITY
LICENSE NUMBER
REMARKS
/7 __1 / 9 1
0-1 1
Legal Description of Property (Show Below or Attach Four Copies) EMETER SIZE I BUILDING SUPPLY SIZE
z
0
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
U
. �:m
W
.j
< REMARKS
W
.j
VARIANCE OR CU PLANNING REVIEW BY DATE
YARDS
LOT COVERAGE
E9
NEW
GAS
I RESIDENTIAL LINE
5, FRONT SIDE /5"REAR
FIRE ZONE
TYPE OF CONSTRUCTION
HEIGH7
F
mALTER
ADD
REPAIR
NON-RESICENT.A]
JAL
_
DEMOLISH
EXCAVATE
0 OR FILL
PRE -MOVE
El INSP.
11
1:1
1:1
17
SIGN
RETAINING
WALL
FENCE
1— X —FT)
swim
POOL
1
1CODE
SPECIAL INSPECTOR
REQUIRED
1:1 YES 0 N 0
AREA
OCCUPANCY
GROUP
I
OCCUPA
LOAD
P N CHECKED BY
THIS SIT E IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
PROPOSE
z
0
LL PLOT PL)
m
u
In
W
m
0
4DICATE BUILDING �
ABUTTING STREETS)
PLAN CHECK
NO.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
VALUATION I FEE
I-
z
W
L
w
z
W
YE
CL
0
.I
W
W
z
0
U
a
z
m
W
W
E
13
z
W
�; '.# 0
3TREET FILE.
DATE: :�?-h 4-J-18
MEMO TO: Building Division
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT: 'JDLI)rC
W 4
After review of the subject building permit application, we have
the following comments:
(1) Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is the
responsibility of the contrattor. .
The contractor.is required to ke
ed of dirt and d ri-s caused by
) the abutting streets clean-
e. construction.
(3) -A "Right -of -Way Construction Permit" is required,from the
Engineering Division of Public Works, for any work within
the Public Right -of -Kay or public easement.
(4) Driveway slope not to -exceed 14%.
1 "39
IRV
4141hv - W'Fji�" -a -V91 OWN
P; - AFINE. I WNW 0 16
PW S/77
PUBLIC WORKS DEPXME�*iEa<LIS`r
BUIIDING, PERAIT REVIEW
4'
P)
(address) (Ate
Street Ri&ht-of-14ay Existi-I g
-�EQD
Z
Access Easements Existing
c4
Utility Easement Exist
REQD
W
Lot,Per Subdivision Plat-
ly Assessor Map____�.
Site Plan Checked for Accura cy—,—���
t
Z4
Underground 14iring Reqd.-
C)
Check Accuracy of Legal Description
44 -70L
Z
Review by
Date 4;JA
Existing Water Main Size lc�=,
Water Main Required
Service Line Required
Hydrant Size Existing
o�
Hydrant Reqd Per Fire Code
Size
Detector Check Meter Reqd-
Cross Connection Inspection K)CD
Fire Department Comments
Water Meter Charge Reqd-
Review by.
Date -
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
Proj . ID I
Drawing No. 4
File No. I-S-72-
C4
Side Sewer Availability.
- t
W
Sanitary Sewer Connection Fee Reqd.
t3:
Review by.
Date "�41yhg,
Open Ditch Existing
Reqd.
Culvert Reqd.
Size
P4
Catch Basin Reqd.
Indicate on Site Plan
0
Shoulder drainage maintain collection on
swale open rLmoff_,&,0,,,� si"We
Manhole reqd""'
icate an Site PnIn
Soil Conditions and Ground Water Field Checked
Review by
Date
Revised: MO-1977
Page. 2
Street Paving Reqd.
Curb'and Gutter Reqd.
Sidewalk Reqd.—
Curb Cut for Driveway Reqd.
p4 Right -of -Way Construction Permit Reqd. N/2K
ents
Bond Reqd. for,Public TiTprovEnL
Street Nam, Sign Reqd.
Other Signing Reqd. AI'V
Pre Permit Site Inspection made on 4-1 -1
z
0
�4 H BY: SEWER
WATER
P-1
Co
F-4 Z STREET
F A
ENGINEERING
14 Special Requirements listed in memo to Comminity Developnient Departwnt,
Building Division
FBY 2 f� Date
c) All item filled in on Building Permit Application
P4 BY 05 �j Date
VC-0/
Drawings Starrped and Notations Made
P4 BY Date
Approved by Public 'Works Department
Revised� 1v 10-1977