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CONSTRUCTION PERMIT APPLICATION
NAME.(OR NAME`OF BUSINESS)
6��e" Vorl
MAILING ADDRESS
,:24, 0 1 � -- 7 cl r1-1 W,
CITY - TELEPHONE NUMB?R
4) 7_3
ADDRESS
CITY ITELEPHONE NUM13ER
NAME
ADDRESS
CITY I TELEPHONE NUMBER
STATE LICENSE NUMBER
PERMIT
NUMBER
WE=
JOB
ADDRESS 7"
LEGAL DESCRIPTION CHECK SUBDIVISION NO, LID NO
e-,S /e 7- ff—
TESCP
PUBI -1 RIGHT — WAY P APPROVED BY
EXISTING REQUIRED DEDICATION
PROPOSEU,�_
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRE[)
STREET USEPERMIT REQUIRED:
SEE ENGINEERING MEMO DATE
REMARKS
METER SIZE IBUILDING SUPPLY SIZE IFIXTURE UNITS
REMARKS
N SIGN AREA ENV. REVIEW ADB NO.
Legal Description of Property - include all easements ALLOWED PROPOSED COMPLETE EXEMPT
(show below or attach four copies) SHORELINE
Z
cr VARIANCE OR CU PLANNING REVIEW BY DATE
467- j-,f- No, 4-
W
A J 7-,-, PY L_ I- iA j e i-- j0I &lTl JOW. P YARDS HEIGHT LOT COVERAGE
4 AOCZ. Of—
4,A V
FRONT SIDE REAR
REMARKS
InJ NEW
RESIDENTIAL
PLUMBING
0 ADDIALTER
COMMERCIAL
MECHANICAL
REPAIR RETAINING WALL
SIGN
EXCAVATE
DEMOLISH OR FILL
FENCE
(__ x _FT)
CHECKED BY
;
7?
TYPE OF CONSTRUCTION
1
CODE
Pe.
1. /Iffs_
HEIGHT
2_--.:�-
PRE-MOVE INSP.1
REMODEL COMPLIANCE INSP.
swim
POOL
SPECIAL INSPECTOR
REQUIRED
Fi YES NO
OCCUPANCY
GROUP Jn -
OCCUPANT
LOAD
WOOD STOVE/
F-1
INSERT APT.BLDG
RENEWAL
REMARKS
PROGRESS INSPECTIONS PER UBC 305
i NUMBER OF STORIES NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
FA
171i�41119 Z- j__A1S11Z_ fi�f�
VALUATION
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
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
I
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnity, defend and hold
harmless the City of Edmonds, Washington, its officials,
2 employees, and agents from any and all claims for damages of
a:
whatever nature, arising directly or indirectly from the issuance
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
:r nor I.imit 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
0
&
- 100 18777
information given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and in doing the work authoriz- AUTHORIZES This application is not a permit until
ed thereby, no p�rson will be employed in violation of the Labor ONLY THE signed by the Building Official or his
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED Deputy; and fees are paid, and receipt is
tion Insurance. INSPECTION acknowledged in space provided.
SgURE OWNER OP AGEN IDATE SIGNED DEPARTMENT
-7 OFFICIAL'S SIGNATURE DATE
CITY OF
A EDMONDS
ATTENTION R _k71ZW?92,-- 0 RELEASED BY: DAIE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
cc
W
Uj
Z
0
Z
W
aw
a
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UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL ORJQN 1988 ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC ,
CHAPTER 3. PINK — Owner GOLD — Assessor
102-87 PERMIT COUNTER
Pln= REVIEW CH]XXLIST
41 A, i -77
--7
PROJWr NAME Ic PROJECT ADDRESS:
//7
APPLiCATION RECEIPT DATE:
COMMEM
MAMM
PLW=
Reviewed
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SETBACKS CMXKED - PIAT)ln
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PERMT.
OntOrTIONMA'AM, A ilk
7Tr[Trf7T7
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111111117
1177711
7111111111
7TI711
-ZCNTNG FX=REMENTS
UMMMENTAL FEATURES
ACCESS SLOPF & VEHICLE ACCESS
11711111
DRAIN7=- PLAN (On Site)
7T/T/7
77T77TITI-
77TR/ 7 7 7
17T17-17TTT171T71-F17771771
-STREET FILE
//////
/////////
/////////
JFP-AL DESCRTPTION VrRTrICATION 1/�rr I
T777-
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7777777/7
7777777T
777777777
111171111
77777-F777
QUIT CTAT.M/DFDTCATIONS yt
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77111111
FASEMENr - PUBLIC/PRIVATE &/V
11
CALMATE S W-ER CONNECTION IF NO LID&WW ---
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T/7T/71////////
//////
/////////
77777T/7—
////////
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1�
//f/r/
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PLAT/SUBDIVISIOU REQUIREMENTS
1
)'(TGJIT-OF-WAY CONSTRUC?ION PERMIT RE(_n
14
171711
711111111
-ITTFITI-17
TFITITI-1
BOND REM rnR PUBLIC lMPROVEVffi2%M.
////////
15
SOILS CONDITIMIS & GROUND
7FI77TIT
WKPER FIETI) Cliff-I(ED
16
T17-117-17TITT17T7777177T
SM= PAVING REQUIRED
1�
117111
CIMB AND GITITER REQOTREX)
//////
18
TI-17TI
7ffrlrl-fl7
7TR77TIT
SlDEUlALK RECUIRED
/////////
/////////
19
/7/77-7/77
CURB CUT FOR DRIVE -WAY RE(V)
/////////
20
7-1777M77
-
S7`REE7r NAME SIGN REOD
21
////T/7/7777777T/7—
1711111171
--
n.ST(NTNG REQ0
22
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EVER AVAILARTLI TY
/////////
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23
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STYNG WPER MATN SIZE
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24
1117il-
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////////'77T/7/-7T/7
WATER MP-M SIZE
//////
/////////
////////
25
7F/T/7
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S01VICE LTNF SIZE
/////////
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////////
26
H11DRAN'P REr-)UTRED
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/////////
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71111117
////////
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-
27
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/////////
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-
HYDRANT SIZE EXISTING
//////
/////////
-6-14'
28
7 TI) 7
T1 TPTR T
-TITI-7TTR7
-
CROS,S CONNECTION INSPOCTION REQD
29
kATER METER MARGE RFk)D
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TF1 7 7 —77
-171-1111-111
30
FIRE LIM CHARGE REn-D - SPRINKLFR
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31
STREET CUT
32
DPEN DIMi EXISTING
33
77 7 T1 7
77 7 77-/ 7 1-77
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REQD
34
777T/77777777//
77777777
CULVERT REQD
//////
/////////
/////////
35
771-17
-17771-1-1-IT
777-777/77
SIZE
36
777TIT
77777-/T/T
77777TIT
CAMI PASIN REQD
AV
37
INDICATED ON SITE PLAN
38
SHOULDER DRAINAGE MAINTAIN
SHALE OPFN RUNOFF
39
MISC: O�W-,-,omegn- ega.
////i//[/-/777T
40
11 a -�v 0 1 IV-5 " i � J'a Ivor 49 o"I Sp S/0, AN
0
REVIEWED BY: 9!z�/z
PLANNING MGR. ENGINEERING MGP. PUBI,;C WORKS MGR.,,
WORKS
BASIN LENGTH COWrROL CA-17CH
(VF
*,TEmTON PIPE
MIN MAX COVEP,
% SLOPE --,-
SYSTEM CROSS SECTION
C0,4TROL!
4'
ro OLIT"E"T
(Pj PRNP OR
P,L)NOFF
SPREADEV.)
K SEE PAGE 3 FOR OUTLET CONTROL DETAIL
�10' LONC-a'.
VIA"HIED Cv."VEL OUTFLOW TRENCIR, MIN -
-rop P E-fkF PIPE -M SE L-mvim 12
M M +4
FROM
OLMLET
CONTROL
4� PEIRF P%pE WITH CAPS
RUNOFF SPREADER OUTLET
RF-CE14"
jum 2 3 1988
PERMIT COUNTER
STANDARD DRAINAGE PLAN
DETENTION SYSTEM
PAGE I OF 3
for P- 4 &-s . 116 d 6t)6d wT
locationl4:1:0 —
plan by Pr H b-
phone
date c�
DESIGN DATA
System Imperm Pipe Pipe Orifice';.,
Number Area Diam Length. Diame e.r,,
Jeo.
":W
MEMO TO: Building Division
FROM: Engineering Division
SUBJECT: IZITII &46r 141.
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 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 pot inipact neighboring properties in any
way.
8) Construction hours from 7:00 a.m. to 10:00 p.m. on weekdays and
10:00 a.im. to 6:00 p.m. on weekends and holidays.
9) No burning of construction refuse withn-ut -apprinsrAl hy Pi -re Dept.
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NOW �ttlits MA �"�; 1", _0
SIDE SEWER. PERMIT
CITY OF EDMONDS
8 q 0 . 1 9 PERMIT 'NO 8 6 4 1
EDMONDS
Address of Construction: T-t;IP A :F F q P
IT-ftANT
T
nts)': Ix", 0 -0 0,
Property Legal Description (Include all easeme It A CrC A/o
''006 —00
RF-CF-IVED
000 C) 1(4 6006-
Owner and/or Contractor:
State License No.
A6ngle Family
El Multi -Family (No. of, Units
El Commercial
13 Public
V./OA-)
NUV 115ilt
PUBLIG WORKS [)Ep I
_14—
Building Permit No. 9 V 0.
Invasion into, City Right -of -Way: 1.!�kl\lo 0 Yes
RW Construction Permit No.
Cross other Private Property:'p No� El Yes
Attach legal description and copy of recorded. easement
I certify that I have read and shall comply with all city re�uirements
as indicated on the back of the Permit Card.
Date
CALL DIAL -A -DIG (1-80,0-424-5555) BEFOREANY EXCAVATION
OFFICE USE ONLY
FOR INSPECTION CALL 771-3M PUBLIC WORKS DEPT.
Permit Fee: Issued By,
Trunk Charge: :g 5 Date Issued:
Assessment Fee: Rec'eipt No.: Z T73
Lid No.: -
Partial Inspection: Date-Initial-
Comm'ents
Reason Rejected: Date -Initial -
Final. Inspection Approved:, Date//_-k-__-�_c_(InitiaI1-_
PERMIT MUST BE POSTED ON JW SITE
White Copy: File Green Copy: Inspector Buff Copy: Applicant
Revised 3/90
0
The City of Edmonds
Side Sewer Drawing
EASEMENTNO . ............................................ '
NEW CONSTRUCTION REPAIRS E] LID NO . .................. . ASMT. NO . ..................
OWNER................................................ ................................................ CONTRACTOR .................................................................................... PERMIT NO.
JOB ADDRESS .... 4.49 ... ...... -to- -;R- - -
..... ..... .... .. ..... . .............................. W .........
PWW-0001 -11/75 (REV. 11/78)
LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO - ------------------- ................
............................................................................................................................... .........................
NAMEOF ADDITION ........................................................................................
i I
I )j"A ?(- .
.14
e-0-4 Peef -
mare;--
DATE .//72L..9fY ...............
!�� .... 4�.�z
WA-mm SeRv%c&
Drawing
The City of Edmonds p%-r EASEMENT NO. - ---------------------------------
R`Et: i FILE
NEW CONSTRUCTION C�S REPAIRS F-1 LID NO - ------------------ - ASMT. NO - -------------------
OWNER----------------------------------------------------------------- ------------------------------ CONTRACTOR ------------------------------------------------------------------------------------ PERMIT NO - --------------------
-440 IZT"' PL. No.
JOB ADDRESS --- - ------- ...... ---------------------------------------------- -------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
I
d(
PWW-0001-
Appp
7- '93
DATE ............................................ By - ------- -
1* -------- / ----------
'F MRF
Vitv Af FAMand4z
-1
RIGHT-OF-WAY CONSTRUCTION
q,5
PERMIT'
Permit Number-.
Issue Date: /0
A. Address or Vicinity of Construction: 71 AV
B. Type of -Work (be specific):
890 oo .of JAe W
C. Contractor: Contact: o9X le-r tI&V 6701f&X*
Mailing Address: Phone: 7 f— 66 7_3
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable) 11�� Side Sewer Permit # (if applicable):
E. [3 Commercial E] Subdivision El CitYProikt 0 Utili D, GTE, WNG, CABLE, WATER)
0 Multi -Family 2[ Sinkl . e Family [:J Other ly, 57.
INSPECTOR. INSPECTOR: 5)
F. Pavement or Concrete Cut Yes []No G. Size of Cut: K-ZIx, H. Charize-$
A APPLICANT TO READ AND SIGN�>
INDEMNITY. Applicant u.,�.Itands and by his signature to this application, agrees to hold the City ofEdmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, thdi may be made against the City of Edmonds, or any of its departments or
employces, including or not limited to the defense ofany legalproceeding8 including defense costs, and attorney fOes by reason ofgranting thispermit.
THE CONTRACTOR IS RESPO�S�I_BL!E-FOR-WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YiAll FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTILTHE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
44
Constructilon- araw'ing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is'to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall b6kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
ve read the aboyustatements and understand the permit requirements and, the pink copy of thepermit will be
I
I ti
available on s es for inspectio rpos S.
Signature:, Date:
Aor or enT
(Coritra
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
i6i &TY—JLS'l�,0' NLY
at
APPROVED BY- RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS 'DISRUPTION FEE/FUND 111:
7.
SPECIAL CONDITIONS: RESTORATION. FEE -
PERMIT FEE:
bAY9 SO al_d-
TOTAL FEE:
COMMENTS: RE16EIPT FEE. Z_L11 1W
DATE: —
I .,.ISSUED BY: '744
NO WORK SHALL BEGIN PRIOR TO PERMIT IS'9UANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diaaram.:
(Fund 111 - Route copy to Street Dept.)
'N I
CONTRACTOR CALLED FOR INSPECTION YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date: