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BUILDING DIVIS14FW Applicant Fill
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PERMIT APPLICATION nside Heavy Lines
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LEGAL DESCR'IPTION
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PUBLIC RIGHT OF WAY PER OFFICIAL
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DEFICIENCY OF RIG.HT OF WAY
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PUBLIC IMPROVEMENTS REQUIRED
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DRAINAGE PLAN
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TELEPHONE NUMBER
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UNDERGROUND W� . G
CONNECTION TO SA . I T A R ftE,�
NAME
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ELEVATION OF PROPERTY CORNE IRS
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STATE LICENSE NUMBER
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Legal Description of Property (Show Below or Attach Four Copies)
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"Applicant, on behalf of his or her spouse, heirs, assigns and
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j successors in interest, agrees to indemnify, defend and hold harmless
2 the City of Edmonds, Washington, its officials, employees, and
M agents from any and all claims for damages of whatever nature,
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x arising directly or indirectly from the issuance of this permit. issu-
RETAINING WALL
SWIMMING POOL
SIGN AREA ENV. REVIEW
Al A WED I PROPOSED �COMPLETJ EXEM PT
REMARKS
VARIANCE OR CU 1PLANNING REVIEW BY I DATE
YARDS I LOT COVERAGE
SIDE REA
NSTRUCTION I CODE —THEIGHT
OCCUPANCY OCCUPANT
GROUP I LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION FEE V�E�
0 ance of this permit shall not be deemed to modify, waive or reduce
�! inv reflidrement of any city ordinance nor limit in any way the
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BLIC WORKS DEPARA"cnST
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(address) (date)
Street Rig�it-of-Way Existin _.�REQD_
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Access Easements Existing /low
—REQD—
Utility Easement Existing
lot Per Subdivision Plat Assessor �tp
Site Plan Checked for Accuracy---e�
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Underground Wiring Reqd.
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Check Accuracy of Legal Descr* t'
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Review by Date
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Existing Water Main Size 9 " 0).
Water Main Required
Service line Required
Hydrant Size
P4 Hydrant Reqd Per Fire Code &,4 Size
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Comments
b e90 -
1"Water Yeter' Charge Reqd. st
Review by Date
Septic Tank Design Approved I./ 1A1 Date
Septic Tank Permit Reqd. Permit'No.
Sanitary Seuner Availability Proj.
e-c'n-6., 1
Drawing No. File No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
'-c Review Date.
Open Ditch Existing___.� �,!1?4/r=�...�Reqd.
Culvert Reqd. Size
C4 Catch Basin Reqd. Indicate an Site Plan,
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Shoulder drainage maintain collection an swale open runoff
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reqd.
Indicate an Site Plan —
Soil Conditions and Ground Water Field Checked___,�,
Review by. Date.
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�evised: lvlO-1977
CITY OF EDMONDS
FOR INSPECTION CALL
PUBLIC WORKS DEPAR*NT Permit
SIDE SEWER PERMIT 775-2525 Ext. 220 issue Date
PERMIT MUST BE POSTED ON JOB SITE
1., Address oFF onstructi7n T 77, r i 7 -71,7? �777
2. Property Legal Description (include all easements)
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3. Single Family Residence v,**' Multi -Family No. of UnW,,
Commercial
4. Owner and/or Builder
5. Contractor & License No.
6. Invasion into City Right -of -Way: No X Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
7. Cross other private property: Yes No V-11, Easement required -
attach legal description and county easement number.
READ THE FOLLOWT,,NG AND SIGN:
a. Property owners must obtain a permit to install side sewers on
their property. A licensed side sewer contractor must be employed to
construct side sewers in the public' right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year. 0
C. Commercial establishment requires a minimum of a six inch (6")
side sewer line.
d. Side sewers may not be installed closer than thirty inches (30")
to any structure. 0
e. Side sewer lines must be laid at a minimum cfxa 15
LA 40
and maximum grade of 100% (450). 0 ft 2-1 ON*
f. No turn in side sSwer greater than 45 (1/8 1
4�W
between cleanout. All 90 turns must be constructegEr"I )_I-d-
bend) and wye with removable cap. 1- 800 - 562-6478
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 100' along sewer line run.
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
by the City.
1. Inspection during normal working hours"Aniy�.'/Two (2) working
days notice,required.
DATE:
-I certify thd-t/ I have read
and shall comply With the above
PERMIT FEE:
CONNECTION FEE:
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PERMIT MUST BE
DISAPPROVED BY: Date:
By: Date:
APPROVED By: L&ZA�_�Date:,?Zr"
ON JOB SITE *
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The City of Edmonds
Side Sewer Drawing
EASEMENT NO. - ..........................................
NEW CONSTRUCTION REPAIRS 0 LID NO . .................. ASMT. NO . ..................
OWNER 4-;
97 -K ............ .... �'V'O.kA- PERMIT NO.
.......................... CONTRACTOR aW.4-C-V t
JOB ADDRESS ...... ------------------------------------------------------- LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
PWW-0001-11/75 (REV.11178)
..................................................................................................................................................................
NAME OF ADDITION .......... ..................................................
Approved:
DATE ......... B y ..... . 0----
CITY OF EDMONDS
NEW.
ADDITION
ASSE19NFORMATION SHEET
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ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
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SERIAL NO.
LOCATION DEPT. NO.
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*PURCHASE ORDER NO. *PROJECT NUMBER (ji
PURCHASE ORDER DATE PROJECT COMPLETION DATE 3 Y
COST COST 3
qt;
B.A.R.S. ACCOUNT NO.
Amift ESTIMATED LIFE
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INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
El DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
INITIAL
DATE
VERIFIED BY
PROCESSED
BATCH NO.
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DEPARTMENT FILE
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PERMIT APPLICATION
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JOB
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LEGAL DESCRIPTION I SrVISION SHORT SUB NO.
PUBLIC RIGHT OF WAY PER OFFICIAL ST�EJT MAP
LYPHONE NUMBER
r
EXISTING
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PROPOSED / Al
DEFICIENCY OF RIGHT OF WAY
PUBLIC IMPROVEMENTS REQUIRED 0
DRAINAGE IMPgVEMENTS REQUIRED 0
ELEPHONE NUMBER DRAINAGE PLI RED 0
;7 —7V683 UNDERGROL
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CONNECTION TO SANI-rft�El
SEPTIC TANK PERMIT REQ'O 0 4rjz,0
ELEVATION OF PROPERTY CORNERS ch
FOOTINGS REQ'D
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ELEPHONE NUMBER SEE ENGINEERING MEMO TED
161- 33(�6 /7 od
[TV I CHECKED 13Y All / A/
or Attach Four Cooies) j8MLTLR SIZE: I BUSUDMG SUPPLY
REMARKS
SIGN AREA JCOMENV. REVIEW I ADB NO.
ALLOWED I PROPOSED PLETI EXEMPT I SHORELINE
REMARKS
VARIANCE OR CU lPt-ANNING REVIEW BY I DATE
YARDS ILOT COVERAGE
NEW
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REQUIRED
U. R E D
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YES N 0
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LA N K E�
PLAN-C-HECKED BY
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PR E-MOV E
INSP.
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PLAN CHECK FEE
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BUILDING
PLUMBING
MECHANICAL
FENCE
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SIGN
In "Applicant, on behalf of his or her spouse, heirs, assigns and
0
W successors in interest. agrees to indemnify, defend and hold harmless
j i the City of Edmonds, Washington, its officials, employees. and
M agents from any and all claims for damages of whatever nature,
4
I arising directly or indirectly from the issuance of this permit. lssu-
RETAINING WALL
SWIMMING POOL
SIDE REARI
NSTRUCTION I CODE lHEIG7T
AREA IOCCUPANCY
LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
a I ance of this permit shall not be deemed to modify, waive or reduce
-j
rl any requirement of any city ordinance nor limit in any way the
DATE:
MEMO TO:' Building Division
Community Development Department
FROM: Enginee . ring Division
Public Works Department
SUBJECT .. ILI
After review of the subject Building Permit application, we have
the following comments:
1. , Connection to City water system required.
2. -Connection to City sanitarI sewer system required.
.3
Right-of-way Permit.required
for any work on City property.
4,
Driveway slope not
to exceed
14%.
5.
Backwater valve required
if
downsLairs p1timbing is below
elevation of upstream manhole.
6."'- Water and sewer lines to be separated by 10 foot minimum.
-7/0- ro 0 01 k, 0/ rz 0 ki dA 41 on ca I/
'S igf7a-t- u, r e
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PUBLIC woRKS DEPARTMM CHECKLIST
BUILDING PERMIT REVIEW Ia6 rtr AL ce.,
(address) _Tdate)
0
Street Ri&%t-of-Way Exist :ix�04
REQD
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Access Easen-ents Exist
�T-Qp -
cd
Utility Easement Existl
REOD
Lot Per Subdivision Plat
Assessor Map
Site Plan Checked for Accuracy__,�4�........
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Underground Wiring Reqd.
Check Accuracy of Legal De t*on
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Review by 7A*7�2
_Pate
Existing Water Main Size_
Water Main Required ZJA
Service Line Required
Hydrant Size Existing
W.
Hydrant Reqd Per Fire Code " &A
Size
Detector Check Meter Reqd. &4 LA
Cross Connection Inspection
Fire Department ConTnents
, wl-UVII
:3
'dater Meter Charge Reqd. �4 50,
Review by I
Date
Septic Tank Design Approved
Date
Septic Tank Permit Reqd. 1Z. -
Permit No.
Sanitary Sewer Availability
Proj-
Drm,,ing No. 4
File No. 069
Side Sewer Availability
C4
94
Sanitary Sewer Connection Fee Reqd.
e=
:3:
Review by, 41§9a26
Date
Open Ditch Existing___4/e 41r=
Reqd. jgt��
Culvert Reqd.
Size.
C4
Catch Basin.Reqd. &,A=Z=
—Indicate an Site Plan
0
Shoulder drainage maintain collection an
swale open nmoff. Aiil� Z,
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Man�e reqd.<--� 44f...?
Indicate an Site Plan
Soil Conditions and Ground Water Field Checke
Rc-Aew by_
Date
ves.-
Revised: lvlO-1977
Page 2
Street Paving Reqd. A ff
Curb and Gutter Reqd. Aly- _.. -..-
Sidewalk R�qd. 11A
curb cut . for Driveway Reqd. - AS
rd Right -of -Way Construction Permit Reqd.
Bond Reqd. for Public Inpravements
Street Name Sign Reqd.
Other Signing Reqd.
, Pre Permit Site Inspection made an
z
0� BY: SM4ER
1.4 4
WATER
A4
M
z STREET
ENGINEERING
- 4, .417 1
ISpecial RequireTmnts. listed in mem to Conumity Development Department,
Building Division
> BY Date
c> All items filled in m Building Permit Application
cd BY Date
Drm�ings Stanped and Notations
BY Date
.--6proved b�y -Public - Works Department'
Revised: Iv 10-1977
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PLACE"
2529 189th S. E. Bothell, Wa. 98011 485-0080
CONSTRUCTION INC.
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BURYAE ST
NAME
ADDRESSg
CITY
PHONE
ACCOUNT#
LOCATOR #/
DEPTH
FAULTS IN LINE
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DAMAGEDIN
SIDEWALK
GARDEN
ROCKERY
DRIVEWAY
LAWN
GRAVEL
HARD SURFA E FOOTAGE
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RIGHT OF WAY
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FOLLOW SPECS SPECIAL INSTRUCTIONS
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FOR FAULT LOCATOR USE ONLY
Permit No-A1300
City of Edmon& U,
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: 10!=�
A. Address or Vicinity of Construction: ."boto Ffr P44La-_ 10 q -3rd, )�V,_ S
C. Contractor: A-T--T Eat 6ct-dUrt_*Nd' Contact: 62rA A9_ 17 F- A StW
MailingAddress: 15eAcn -75+-k '5f_,`5\N -TO-0
State License #: 7C, 3: CA Wait 6 Y�)
D. Building Permit # (if applicable
Phone:
Liability Insurance: Bond: $ y " - -
Side Sewer Permit # (if applicable):
E Commercial E] Subdivision 2;*'City Project, E] EU C (PUD, GTE, PSE, GRA-MRER-S- OVWD)
-Multi-Family Single Family Other, /4- T+-T
INSPECTOR-
F. PAVEMENT: YES aNO G. SIZE OF CUT H. Charge:
CONCRETE CUT: F� YES
-'PIACANT TO READ ANE
IDEMNITY: Applicant understands by his/her signature to this application helshe holds the City of Edmonds harmless from 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 its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and
attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTIONAND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS
COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
+ Restoration is to be in accordance With City codes. All street -cut trench work shall be patched with asphalt or City-
' f6'the end of the workday — NO EXCEPTIONS.
approved material prior
* Three sets of construction drawings of proposed.work are required with the permit ap-plication.
i HA VE READ, THE ABO VE STA TEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTs AND ACKNO WLEDGE'
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS -
Signature: f�z 1�_/ Date:
(Contractor of Agent)
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
Approved by: Right-of-way Fee:
TimeAuthorized, VoidA&r IlVa 101) Disruption Fee/Fund 111:_
.Special Conditions: gr6mm. g-t).W. Restoration Fee: a(
(1-ru STMWm Total Fee: '79
�r -
Receipt No: A
Issued1by.
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE. %SSnkr141M kyl "VJ �R
. . I � dve-
FINAL APPROVAL OF PERMITTED WORK, SOnnd (-kosma
INSPECTOR'S SIGNATURE DAT�:'
For inspection requirements see Engineering Information Handout.