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CITY OF It NDS AN ER RE FILE
PERMIT APPLICATION JOB -
-BUILDING
NAMA (OR NAME OF U IN S) ADDRESS 0 3
/I LEGAL DESCRIPTION I SUBDIVIS - ION SHORT SLID NO.
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MAIL114G ADDRESP
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PUBLIC RIGHT OF WAY PER OFF/IAL STREET MAP
TELEPHONE NUMBER
EXISTING_
AME PROPOSED
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DEIqCIENCY OF RIGHT OF WAY
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ADDRESS CHEMY
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SEE ENGINEERING MEMO DATED
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CITY TELEPHONE NUMBER REM KS
NAME
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METER SIZE ILDING SUPPLY SIZE TURE UNITS
ADDRESS
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CITY TELEPHONE NUMBEW REMARKS
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STATE LICENSE NUMBER CITY LICENSE NUMBER SIGN AREA ENV. REVIEW ADS NO,
ALLOWED PROPOSED COMPLETE EXEMPT SHORELINE #
Legal Description of Property (Show Below or Attach Four Copies)
VARIANCE OR CU 7PLANNING REVIEW BY DATE
YARDS GE
COVERA
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FRONT SIDE REA RILOT
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REMARKS
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[Z�RSIDENTIAL PLUMBING
CHECKED BY OF CONSTRUCTION CODE HEIGHT
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ITYPE
NON-RESIDENTIAL MECHANICAL
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0 ADD
SPECIAL INSPECTOR I -
OCCUPANCY OCCUPANT
DEMOLISH SIGN .
1:1
JAREA
REQUIRED GROUP LOAD
ALTER EXCAVATE FENCE YES NO
OR FILL (-
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REMARKS
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PRE -MOVE INSP./ swim
REPAIR COMPLIAN C EINS P. 0 POOL
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-';;UMBER OF STOR DER OF
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-LING
NATURE OFWORK TO BE DONE (ATTACH PLOT PLAN)
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PLAN CHECK FEE VALUATION FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks, driveways, FENCE
marquees, etc.) will require separate permission.
SIGN
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 120 Days RETAINING WALL
"Applicant, on behalf of his or her spouse, heirs, assigns and
POOL
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SWIMMING
in interest, agrees to indemnify, defend and hold harmless
2
successors
the City of Edmonds, Washington, its officials, employees, and
�Ijzcnts from any and all claims for damages of whatever nature,
1A.
2
i . I DATE:
MEMO TO: Building Division
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT:
After review of the subject Building Permit application, we have
the following comments:
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 pi�operty.
4, Driveway slope not to exceed 14%.
5. Backwater valve required if dot,7nstairsplumbinp, is below
elevation of UDSt�eam manhole. ... .......
6. Water and sewer lines to be separated by 10 foot minimum.
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PUBLIC uord(S DEPARTMENr CHECKLISr
BUIIDING PEIVIT REVIEW I/M7 4e t%j
(address) (date)
Street Right -of -Way Existin
REQD
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Access Easements Existing
H
cd
Utility Easement Existi g—
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REQD�_
W
Lot Per Subdivision _j,0 lat
Assessor Map
Site Plan Checked for Accuracy qV
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Underground Wiring, Reqd._
A"
Check Accuracy of Le 1
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Review by_
Date X4
Existing Water Main Size 0 DIJ
Water Main Required &A
Service Line Required —1*
Hydrant Size Existing_
t4
Hydrant Reqd Per Fire Code
-size
Detector Check Meter Reqd.
Cross Connection Inspection AIA�
E-4
Fire Department Conuients
Water Meter Charge Reqd.
Review by
Date
Septic Tank Design Approved
Date Ilk
Septic Tank Permit Reqd.
Permit No.. 6,Ak
Sanitary Sewer Availabili
--?roi - ',-two I
Drm,Ting No.
File No. " t 0 f
Side Sewer Availability
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14
Sanitary Sewer Connection Fee Reqd.
ee 5--.V
:3:
Review by 2=*�
Date I
W
Open Ditch Existing_Z&�;p
Reqd.
Culvert Reqd.
Size
Cd
Catch Basin Reqd.
Indicate on Site Plan
0
Shoulder drainage maintain collection
on swale open runoff/&",Oi�
IF,
En
r LIZ MR
Manhole reqcT Ra�
- 9dicate on Site Ka--,,
Soil Conditions and Ground Water Field Checked lr,—
Review I by
DateO'ZZ
Revised: lvlO-1977
Page 2 0 0
Revised: lv 10-1977
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,CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
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A. eAddress or vicinity of Const t .
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orOUWN� 0
0 Owner: C—'D 01
Name
—wi)-A )k3JO
Mailing Address
City, State, Zip Code
Contractorf U-0,4 k SOD% Uma
Name
01 Q
Mailing Address
L—,(, 0 P W 0 0 o I rp 3)
City, State, Zip Code
Te FrIP'No. 3-7
Issue Date
Permit Issued To: 00" 1) M\JA
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Type of Work to beDone: Tat-7\Jti� =Oev
Work in Connection With-
0 . Sub or Plat Y Single Family
El Comml. / Ind. 0 Apt. Condo.
9 Pavement Cut: 0 Yes );L No
State License Number
*7 7 d?- — C4—),) d—
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMITY: 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 City of Edmonds, or any of it's 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
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this permitmusrbe,;av�ilable a he job site for inspection purposes at all times.
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ature..
YV P AVA AqU�� Date -3
Owner or Agent I
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THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Vold after �, 5! r) days
Special Conditions:
Ammendments:
Permit Fee:
Security Deposit:
Receipt No.: —
Fund ill Fee:
Street Cut Dimensions
X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
0
ITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
SIDE SEWER PERMIT
LL. 2.
LU 3.
Uj
4.
5.
6.
FOR INSPECTION CALL Permit
775-2525 Ext. 220 Issue Date
* PERMIT MUST BE POSTED ON JOB SITE *
AW,�AWAWANWANVAW
Address o7r7ornstruction ' eP
Property Legal Description (include all. easements) 2,o4 _q 5'- f-JIo-
Single Family Residence Multi -Family 'No. of Units
Commercial
Owner and/or Builder
Contractor & License No.
Invasion into City Right -of -Way: No Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation)
7. Cross other private property: Yes No ,�Easement required -
attach legal description,and county easement number.
READ THE FOLLOWING AND SIGN:
04
a4
4 a. Property owners must obtain a permit to install side sewers on
>4 their property. A licensed side sewer contractorfAL AS MGMd to
construct side sewers in the public' right-of-way P
b. The side sewer contractor assumes *AWRflXqUfAJJeach
full re
installation for one year.
Jn- §90 - 562-647§
C. Commercial establishment requires, a minim a six inc (6")
P4
side sewer line.
0 d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
0
e. Side sewer lines must be laid al a minimum grade, of 2% (1.15
0 and maximum grade of 100% (450)-.... 0
E-4 f. No turn in side s8wer greater than 45 (1/8,bend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and Wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 1001 along sewer 'line run.
1�v j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k.. Side sewer must be left uncovered until inspected and approved
byithe City.
1 1. Inspection during normal working hours only. Two (2) working
da�s notice required.
DATE:
I ce)rti'fy that I have read
and s h!alil comply With the above
PERMIT FEE:_��4�:� DISAPPROVED BY: Date:
Date:
CONNECTION FEE:
P4 :::) APPROVED B)?�_ Date:
0 -41 - ! I—-
'220
PERMIT MUST BE POSTED ON JOB SITE
i
The City of Edmonds Side Sewer Drawing EASEMENT NO . .............. : .............................
NEW CONSTRUCTION REPAIRS E) LID NO . .................. ASMT. NO . ..................
OWNER .... ...... ................. CONTRACTOR ...................... PERMIT NO.
................
JOB ADDRESS ....... W ........................ LEGAL DESCRIPTION: LOT NO . ........... 3 ........... .......... BLOCK NO . ....................................
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\9 oo NAME OF ADDITION .................... ...... f .................................................... .......... x ........
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74'
77"':
PWW-WO1.11175(REV.11178)
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Approved:
DATE—,-�
,�0141,1.1.rl ............... .....
4f
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CITY OF EDMONDS
NEW
FIADDITION
RETIREMENT
A*T INFORMATION SHEET
STRFILE ASSET NO. -2 -7 s;—
ADDITION TO ASSET NO.
DESCRIPTION
5
SERIAL NO.
LOCATION DEPT. NO.
Civ
*PURCHASE ORDER NO. -
PURCHASE ORDER DATE
COST
*PROJECT NUMBER cu
PROJECT COMPLETION DATE
COST
B.A.R.S. ACCOUNT NO. -3 qt7
ESTIMATED LIFE
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
INITIAL
DATE
VERIFIED BY
PROCESSED
BATCH NO.
INTER -OFFICE
4���_kX6,
TO FLANKING
PUBLIC WORKS
i4bff "Iti _VtdT =71, :Z-17.
APR 15 1981
COMMUNICATIONS Dir. Of ruum: �vwh�.
�m 41 - LITTLVO
UBJECT: Blueprint Homes - 3 residences
f"',
FROM
DATE - April 8 1981
BUILDING
21917 84th Avenue West - 810033
21909 84th Avenue West - 810034
8319 220th Street S.W. - 810035
O.K. for final approval?
Suspense date: 40P."4-
7 0 0
PUBLIC WORKS REVIEW ROUTING
SITE ADDRESS:
BUILDING DEPT. SUSPENSE IXTE
TYPE: MC. BUILDING PERMIT (CHECK ONE)
'IMGATION/SPRINI�LER
FENCE
GRADING/Fill
DEMOLITION
RELOCATION
lr'FINAL APPROVAL FOR OCCUPANCY
SIDE SEWER PERMIT
RIGHT-OF-WAY PERMIT
STREET USE PERMIT
STREET TREE PERMIT
SEPTIC TANK DESIGN PERMIT
NEW METERMATER SERVICE
E.I.S.
OTHER:
SUBDIVISION REVIEW
PLAT/PRD REVIEW
DRAINAGE PLAN
IN
OUT
Reviewed By:
Date Reviewed -
(See Comments)*mEl
sE3s0iWmzxmr
OFFICE ADL. A
E�]<CUY
ENCINEER,
li�4
DRAINAGE ENGI14EER
El
X]
WATER/SEWER DIVISION
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qg- 0 'K
E:1
STREET DIVISION
WORK ORDER COORDINATOR
UTILITY BILLING
Or_FIM',A1TM.ISMT0R -- LOG OUF
RECORDS (FILE)
OTHER:
COMMENTS: 5-4—)9�
1' 1.7,
STR
EET FILE
MEMO TO: John B. Mitchell, Supt.
Water/Sewer Division
FROM: James E. Adams, P.E.
City Engineer
SUBJECT: SEWER CONNECTION CHARGES
72- q 1 9902,0
(Street Addres—s-T—
(Legal-Dwn—e-rT
Single Family Residence Subdivision Plat
PRD . Multiple Commercial
LEGAL DESCRIPTION:
71� S o-vtp, o L
so-v-+� we 4t uav't.�--e tuckr+e-�-
CL -to Q. 4-FL, LAJ, M,
tu
e-axt S(b� Fee± e-Y-Ce�� tf-0 UJ --Tt
-C-,'0-JtI9 - :�O -Pee-t A Ca Ae
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Z.F.F. Calculation: L I C� I qZ
0 8 Z. F. F. x ( 17--Z-77) $ 3, -5:9 Connection Fee
Lateral x( $ Lateral Charge
$ Equivalent Count
(when applicable)
Units(s)x( $25.100) $ Trunk Charge
$ 10.00 Permit
$ j2-Z2,,5-3T0TAL
jak
CC: Owner
UiiT
-qlcIle
-7 -0-'
.0104 --72
-7 0
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2-1
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67,
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3
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.3 07.
CITY'OF EDMONDSO"
.P. W. DEPT. ENGINEERING Div. ES7-ATE OF EDITH REED
I;XAMINED
py DATE/
�t6Vv:, I N N E 114 0 F S EC T/ 0 N 3 0, T W P.
-7 N -, P. 4 G:., W. M.
REMARKS,,,�, EDMONDS,
WASHINGTON
W4LTE2 SCpEFEe PUSSELL 2.1 LYNNE
WH IrAAA N AUQE'
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C"ANDLEA2 J2. 10'- SANITAey
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CH215 LAHM4NN
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20' 50'-
70.00
140.Z6'
CENreIz.> 01:
SECTION 30
STREET S. W
.. ......................................
BENJAMIN FER. SMITH JC->, HA20LO HOPPE 12. B PYC E
JAMES 5J2 . ..... C4MPBELL
W.
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16'alb
2,
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L Lovell- Sauerland & Assoc
iates.
SURVEYORS
.0 DEVELOPMENT CONSULTANTS
23106 100THAVE W EDMONDS WA 9e= . - PLANNERS
PHONE 775-1593
jc�tCKED lt)ATF. F&E Mo
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CITY OF EDMONDS WATERLINE AS- BUILT
ADDRESS
21917 — 84th Avenue West
CONTRACTOR
Quality Plumbing
DATE DRAWN
8-5-04 13Y K. Haney
HOMEOWNER
Friedmann
SCALE
N TS
WATERLINE
NO. 2004-0631
NOTICE:
N.o ... wa rra n-Ly ... u t - d LAI ''t -A "�'Y
The information . shown on the attached
map(s) was compiled for use by the City Of
Edmonds; its Employees and Consultants.
Th,.e City of �Edm.qnds does not * wa rra nt t, ie-
accuracy of anything set forth on t ' hese
Map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the.inform'ation shown on
-map(s), including, but not limited to,
t
th'e lociation 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
empl-o-yee-s o-r office-rs -sh-a-1-1 be 11a.b-'Fe for the
information given on this map(s), nor for
tation provided based
any one represen
upon said map(s).
NOTICE
TO PERMrrrEE AND/OR OWN=
PARTIAL APPROVAL
VIOLATION
CORRECTIONS REQUIRED
JOB ADDRESS ,-?/Zz
NO PERMIT — STOP WORK — REMOVE CONSTRUCTION OR OBTAIN
0 PERMIT AND MAKE WORK COMPLY WITH BUILDING LAWS.
CONSTRUCTION IS NOT IN ACCORDANCE WITH "PROVED PLANS
ElAND PERMIT — STOP WORK- MAKE EXISTING WORK COMPLY WITH
APPROVED PLANS AND PERMIT OR REMOVE IT.
STOP WORK — UNTIL AUTHORIZED TO CONTINUE By INSPECTOIL
CORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN
BE "PROVED. CTED, AND IS APPROVED-
0 WORK DESCRIBED BELOW HAS BEEN INSPE
CONTACT INSPECTOR AND RECALL FOR INSPECTION
A 13-10 A TIT(IMPOR APPOINTMENT. D
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ol
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED
WITHIN ... /
jV ........ DAYS OR PENALTIES IMPOSED 13Y LAW MAY BE
APPLIED. FOR INSPECTIONS CALL: 775-2525.
lt�!:,
WBUILDING DIV.
MiFe,
c�-
PUBLIC WORKS
CITY OF E] FIRE DEPT.
ATE 13
EDMONDS