527 HEMLOCK ST.PDF1111111111 lill
11457
527 HEMLOCK ST
3 /N/7
CITY OF EDMONDS SIDE SEWER PERMIT
WATEWSEWER DEPARTMENT
PERMIT
Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holida y inspections.)
ADDRESS LOCATION OF CONSTRUCTION ----_----_---- �S ...... A/ 4e.-mnk ................................... . .............................................
PROPERTY LEGAL DESCRIPTION ................................ -5—:5-7 F..
.............................. ...............
....................................................................
...................... ........................... . ...................... . ........................................................................ ................ ..... ................................................................................
................................................................ O-V17NER,0.kNDjOR BUILDER ............ ... . .......................................................
CONTRACTOR'S NAME & ADDRESS ........... .............................................................. .......................................................
$ 'on is gr= ----------- - --------- 14177.k�;�.U� .......... 19 ......... for repair 'and/or connection of a side sewer to the city sanitary sewer
&in rda with City of Edmonds ordinances.
'TIO, �LL..
7, TO THE FOLLOWING:
NOTE No. I —The owners of the Property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any Portion of sewer before it has been inspected.
NOTE No. 2—All work performed In city right-of-way requires an Invasion of Itight-of-Way Permit obtainable from the City Engineer's office.
NOTE No. 3—ObtaJn full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%. No bends in grade
sharper than % will be permitted.
NOTE No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6—It Is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVEDE] Date ... . ................................... By ................ Date ........... .............. By ------------_- Date ............... . ................... . By ----_----_--
APPROVEDE] DaW.._.jj.1L.h1:�e ................................. By --------------- ------ - ---------------------------------------------- --------------------------------------
i
Remawrks: . ............... ............. . .................................................................. .....................................................
..................................................
........................ ............... . ............................................................................................................................ . ............. 1 .........................................
BOTH Pe it C pi MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
. .... . . ..... .. .. . ........... ........................................... .... hereby certify that the side sewer installation constructed under this permit
qwn r C Ing rm. Performing Construction)
linst d in ac c . all governing ordinances of the City of Edmonds.
Datedthis.7 . . ....................... day of ................................................................. 19 .........
Check BEFORE you dig.for: Water (-], Gas [j, Telepl�onje E], Power E], Sewer [], Other
Ti-E- MEDICI CONSULTANTS PHONE No. : 2064530059 Oct.06 1997 2:49PM P03
................ ................................................. - ...... ................................................ ......
CA FUN0.
Critical Areas Checklist
n-) -------------------
I . Um MdraaaA Location;
rropcM Tax Ag,;ountNvTnWr;
4. Is thig ifte eurrertly dev.61opsd? -yon, no,
*A d5 !ELL,=
Describ& tbt Pnlml afte tDpography. Check all thm apply.
Met: 11955 than 5-fbar elovialaft chwas over ntire site.
P-011ing' slopea on sit* gencrally lost than 15% (a verdtal rise of 14 0-fest over a
'hGri70ntftj digtanal of 66-fasj).,
Hilly: *10pes pftjkaat on site of ta*m thim 15% and kgg than 3GIV6 (a varCCAI rjSe of'
10-fout over m hortmtal dbto4o of 33 to 66-&wX),'
Swal): j;md*g OtSmAter than 30% pment on site (a Veirtical riaim of 10-f6ot over IL
horizontal diNtaree, fif lass than 33-fibt)�
fter (plane desuribe):
6. Site cantalm drem of yeju,-round gtw1ding watw, Approx. Dopth;
7, Site 0011tdins brow of "Nsonal sbmdiDg water: 140 J APProx. Up1h.
What =ason(s) or tht year?
8- ShO Ij W " f160dwMY . floodplain_ of a water cntirs&
9. Site oonialvis a cmck or an irea where water flovm aam the Srounds sur-fa=? FIOWS Rre�yaar-
rowd? PlOws US BUSonall' cWhat time of YoRe.
10. WTO Is primully: fbrestcd meadow ...... Shrubs ......... � mixed.
urban landscaped Oawfl,shrubs otc) >C
It. Obvious wedwd is pratent an sit*,
V;
3
F��om : 7HE MEDICI CONSULTRNTS PHONE No. : 2064530056 Oct.06 1997 7:46PM P02
............... ............................. : .............................................................. I .......... ................................ ................ I ............
5
-I--- C of Edmonds
Critical Areas Checklist
ZOO,
The Critical Areix2 ChcokhBt wntMntd on
this faM is te) bei Alled out by =y person
pmpariog a D*velopment Permit
Application for th.e City of Edmonds prior to
hisiber submitial of a davolapmmt permit t*
ft city.
Tho purpolm of the Chmukh'st 1; to anable
CkY StMT t,6 &tcrralno whether any potentio
CAtIONJ Aroas ars or may te preseAt on tho
kAdQtPr0P9MtY, n.$lV'1CrTnRt10UUG6d0dt*
oomplotV div clwokn3t bhuuld bo Gully
ayannblc 11om abwrvatlons of te six oy
data avallable at City HAU (Critical Areas
Mara, or doil oumoys).
An applicimt, or hfa4icr represectative, rnuvt
1111 " the a6aklla. allp und Aeie It, and
submit It to dw City., The City will teview
tho chacklifft, n-Ake #,preauraory ajw yjaj4
=d n�aka el detcM. filgion of the su6soqutnt
mps necessm7 +10 ooniplete a.development
pmmift applicWon.
With a shzed c:opy of this fom the
appffo=t shwuld also subtrik a vlcbk* map
orpioiphm for iudividuml low of the FAM61
with anough d ".I that City staff cc= find
and identify the vubjcct pamcl(s), lu
additiont the allplicant Shall InClUde other
pemnext Information (eg. site plea,
topgrAphy motpD etc.) or md1im In
QgMdUBSODU with thin Mckull tu most
staff in compIcting their prd1m1wu7
asposammt of the site.
I have complered the aumhOd Cftcal Area Chftklin fmd attest ThO the answ= provided are
faetual; to the boo of &a;y knowle4e, (IM out the appropri4to 9oliunn below).
Owngr / AppNewl
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SwetAddnm
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City, &UG. ZIP phung
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Appamat Roprmcntativoi
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From : Tk;E MEDICI CONSULTANTS
PHONE No. : 2064530058 Oct.06 19137 2:49PM PO4
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CITY OF EDMONDS BARBARA FAHEY
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 MAYOR
COMMUNITY SERVICES DEPARTMENT
Public Works - Planning/ Building e Parks and Recreation o Engineering - Wastewater Treatment Plant
October 23, 1997
Ginger Stinchfield
The Medici Consultants
410 Bellevue Way SE #201
Bellevue, WA 98004
Subject: Determination regarding Critical Areas Checklist# 97-199
Dear Applicant:
Enclosed please find a copy of the Critical Areas Chec . klist you submitted. The "DETERMINATION" reached by the City is
located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
IMPORTANT INFORMATION TO BE NOTED:
PLEASE EXAMINE THIS" DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAYNEED TO SUBMIT
ADDITIONAL INFORMATION SUCH AS AN ENVIRONMENTAL CHECKLIST OR CRITICAL AREAS STUDY.
The 'DETERMINATION' for the Critical Areas Checklist you submitted it a site -specific determination not a
project -specific determination.
7—�M
PTA
Permit applications include the following:
cc: James Crim
Ent: Determination
* Architectural Design Board
CHECKLIST
BE
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Thank you.
Diane Cunningham
Planning Secretary
C:Reception\Jana\CRLTR.doc
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
0 0 -
MEMO TO:PUBLIC WORKS SUSPENCE DATE'
FROM: BUILDING DEPT.
7-5�e:V�5
SUBJECT: SINGLE FAMILY FINAL INSPECTION AT 1&gl,�,,,Z�k
The Buildi,ng Dept.. reque�ts that the Engineering Dept. review the
following items prior to final.occupancy being granted at the above
address.
Initial
4, Date
1.
Sanitary sewer line installed and approved
Water line installed and approved
/s
_bY
3.
Drainage installed and approved
4.
Driveway
5.
Underground wiring installed to home
6.
Other
Yy� n c,
L i"-,f E
DEC 311981
Di u-
PLANNING DATA
NAME: C � I yv)
SITE ADDRESS: DATE: & 3
ZONING: k5
PLAN CHK#,O'
PROJECT DESCRIPTION:
-316
- 6 " / 0 � � �q 6 � 0 C' /2'
CORNER'LOT N� (Yes/No) FLAG LOT- \le5 _(Yes/No)
SETBACKS:
Required Setbacks:
Front: Left Side: Right Side-.-5- Rear:
Actual Setbacks:
Front: :2 Left Side: Z-6 Right Side:- Iq Rear:
Street map checked for additional setback required? (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE: -35).
Maximum Allowed: Actual: �0
BUILDING HEIGHT: -7<
6 () -74?�
Maximum Allowed: —Actual Height:
Datum Point: Datum Elevation:
A.D.U. CREATEW: 14104 li
SUBDIVISION:
CRITICAL AREAS U�(w'
SEPA DETERMINATION: ;A��t
LOT AREA: `7,6-5�
OTHER:
__r—
Plan Review By:—'D 'q50'j
c:TileApemit\�p1andaLdoc
USE
CITY OF EDMONDS ZONE PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEJA
OWNER ADDRESS
,jj4E/NAM,F,OF BUSINESS
Q. LEGAL DESCRIPTION CHECK
BDIVISION NO. LID NO
MAILING ADDRESS ISU
-57-7 4eVLCZ_Y-_ PUBLIC RIGHT OF WAY PEA OFFICIAL STREET MAP. TESCP Apprmd
CITY ZIP NUMBER
m
AT ON
U
Z
Jo
A
0
S
D
E
N
D
E
ESS
UC A -H
F
7
P
t,6 R
N MIT R r
U MB
DIVISION No
TELEPHONE EIER I T OF WAY PER OFFICIAL STREET MAP
EXISTING AIN Permit Required E3
REOUIRED DEDICATION
90 4-ZI; -7 7 1 S 1 Street Use Permit Req-d 0
S. 3
NAME PROPOSED 1. Pectio. Required 0
Sidemik Required , 0
XT
G-:1) 0 I-k 1�, L) L:T 1_�7, :L-; METER SIZE LINE SIZE NO. OF FIXTU��j PRV REQUIRED
ADDRESS I YES 0 NOO
-41 o -t,,, REMARKS
CITY me A
ZIP ITELEPHONE NUMBER ftinF5 d8Z 7,V,*,t4 &16, AAMWD 13Y &an
L)
ENGINEERING MEMO DATE REVIEWED BY
9 CITY ZF_7LEPHONE
NUMBER
Z
0
FIRE MEMO DATED REVIEWED'BY
STATE LICENSE NUMBER EXPIRATION DATE
VARIANCE OR Cu
ADB
SHOREUNEm
Legal Description of Property - include all easements
SEPA REVIEW
COMPLETE
EXI�MPT
SIGN
ALLOWED
AREA
PROPOSED
HEIGHT
ALLOWED [PROPOSE
C)
-74,
I
I
EXP
LOTCOVERAGE
ALLOWED PROPOSED
REOUIRED SETBACKS (FF.)
FRONT SIDE REAR
PROPOSED SETBACKS (I
FRONT UR SIDE RIEJ
7
_7
P"' -aunt
2
'11=;1111 BYrj
03A
7i
TaN '2
Parcel No. C
NEW ED RESIDENTIAL El PLUMBINGYMECH
RE"PKS
-6,07w exirt�.,, 4"Ol't,
COMPLIANCE OR
0 ADDITION COMMERCIAL CHANGE OF USE
C., C P�XA�l 1,00614 C) /,p6n,
ElREMODEL F� APT. BLDG. SIGN
CHECKED By
TYPE OF CO S CTION
Mu.
CODE
114
CUPANT
REPAIR GRADING CYDS. I FENCE X
DEMOLISH WOODSTOIE SWIM POOL
INSERT HOT TUB/SPA
GARAGE E] RETAINING WALU
CARPORT ROCKERY RENEWAL
Z
SPECI
EOUAL INSPECTOR
A RED
A/.7ET� -Q r--r.
ZIC) :.
A�r LL1.5 = _:7
OCCUPANT
LOAD
MARKS
PROGRESS INSPECTIONS PER LIBC 108
0 M (TYPE OF USE, BUSINESPoR ACTIVITY) EXPLAIN:
NUMBER BER OF CRITICAL
OF DWELLING A
STORIES U,N,ITS I NRUEMABSER
DESCRIBE WXK�O BE DONE (ATTACH PLOT PLAN)
� r� I
0- VODUA 0 FINAL INSPECTION
PLAN CHECK FEE
HEAT SOURCE:
GLAZING
8-1-01 NG
IUMEIIN.
Plan Check No. 41? - 7
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewpiks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within lea Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
w
successors in interest, agrees to Indemnify, defend and hold
.
harmless the City of Edmonds, Washington, Its officials
I
employees, and agents from any and all claims for damages oi
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
OT
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 appil,"cati on;.thatthe
Information given is correct; and that I am the owner� or the duly
ATTENTION
APPLICATION APPROVAL
a.th 01 ized agent of the owner. I agree to comply With city and
.late laws regulating construction; and in doing the work authoriz-
THIS PERMIT
AUTHORIZES
This application is not a permit until
ed I hereby no person will be employed In violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of th� State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Insurance aria RCM 18.27.
INSPECTION
acknowledged In space provided.
SIGNATU:RE W��O AGENT) DATE SIGNEED
Ct
DEPARTMENT
A '.
OFF1PP3ALjV,,i1GNAr 'TE
7:7- 0(-T
CITY OF
EDMONDS
ATTENTION
CALL FOR
INSPECTION
RELEASED BY: b�,tfi
7
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FiNAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220 ORIGINAL — File YELLOW — Inspector
A CERTIF CATE OF OCCUPANCY HAS BEEN GRANTED. USC
SECTION 109
10247
PINK — Owner GOLD — Assessor
106
SOV
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NORTH
of-,)
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CY) I ci
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in'
F
15-0" 14'-0"
-N 89*35'23"
113.14'
Ln
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co I
EXISTING HOUSE
N 89*37'03" E
82.86'
LOT A
AREA OF EXISTING HOUSE: 1,966 SQ. FT.
AREA OF ADDITION: 270 SQ. FT.
AREA OF LOT: 7,559 SQ. FT.
SITE PLAN
SCALE: I" = 20'
I u.uu
R= 20'
NEW ADDITION
90'
u
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F-
R=
20"\
90'
ui
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(V-. 0 04
HEMLOCK STREET
From : THE MEDICI MNSLLTRNTS PHONE No. : 2064530058 Oct.06 1997 2:46PM P02
C all
l+,w of Edmonds
Critical Areas Checklist
Th* CriticaL Amals Chcoklist oontainod ot
this form is tb bb filled out 1W any person
preparias a Development Permit
APPlicel"on for the City of EdznoncLv prior w
hit0har subraitml of a devolopmmt pe=lt to
ft city.
7%6 purpow of 1,; Chnklilat Is to enable
city st&t*ftb dctarn�nc whether my potentw
64tichi Areas ft* or may be pregent on the -
kNect Prep*Ay- Ths 61armadmi ne6ded to
0onsplow dw Clwokl6t ahould bo caAly
ayAnblg tNm abmvadoza of The Sim or
daLa available at City HaU (Critical Arou
fitotntaries, r4ara, or aoil =T*yi).
An applicant, or his4icr represect.&jivB, muv t
All 61A dw 911DA115% al&m und date It, and
Submit It to the City. 7%,e City Veill review
the checkligt; MAkc &POG'ArOOry $JT4'VjLjj4
and "a it det=nItmWon of the 3ubso�uznt
maps nocessm!o MiPltte a devalupment
pcnnit application.
With a alved copy of this form the
applIcant should ako subink a vlaino mp
OrPiolFtam for iudividu%l IoW ofthe parcel
with snoush dotmil that City fftdty a= find
and idcnti�r tho arubjcct pe=cj(s), in
additiont the applicant ahjIll Include othor
perfinext iixfomitdon (e.g. lite PIQX4
UpOgrAphy Mkpo etc.) or gVdigs in
vomdunstiva wt& thin ChcckUms to =list
staff in completing their prdjmjnju7
SAIMMM4 of the atte.
I have completed Me auached CftcAl Azea Checklist and attest Tho the Answ= provided am
faotual, to tho betn or usy kz1vwlv49 (fill out the approprimm 9olurnn below).
0WR1W / APP1104no
Nam
15?1-7
&met Ad&=
V YY1 0 �I-D
at;V, Stm, ZIP
SlIgntnre . Dw
Applicant Reprmcuts dye;
4 1"Asir— -1�rT1'4C-Ai91ELX>
NMA
vois vicDlcA
*t> j6g,-L�eyae wm, sr= A* �2^1
Stmo Addms
tg!::�&dUg wjNqsw4 4z6'-46s-%1-Z5q
CITY, 8MM' ZIP Ph=
-From : THE MEDICI CONSULTANTS PHONE No. : 2064530059 Oct.06 1997 2'49PM P03
............... I ......... I .......... ........ ................ 1.111.11'..... .............................
r-4 viLs
CrItIcai Areas Cheddist
--------------------------------------------------------------
Site information (soil.9/topography/hydrologylvcgetation)
2. rroperry Tax AqwUntINwnt7ar; 9 6Z I&S I 5EI 1>6'211
2. Approximate Shv Slac (scrou of Square Ibet):
4. Is this ilte dUrTertlY demblopad? X yen; no.
o'-L- —
1f Y"I h'9W 'A $'to dovV103"?
S. Describe tbe gmeml sfte topoaraphy. Check all th&t apply.
111fit: lass then 5-&w alsvinian chmas over Mdre Site.
Rolling, slopes on sito garterealy lost than 15% (a vertleal rise of D-fest over a
hari7nntal dionnom of 664W).
Milly., slopes pnmant on site of more than 13% and ]orm tian 3011/6 (a Y&rtfam rise of
10-feat over m horLiontal diMnou Of 33 to
Swap: Smd" of venter then 30% prasetwt an $its (a Vertical rise of 10-fabi over
horizontal distmea of lass than 33-fiat).
fter (please desurlbe).-
6. Site cantatns areas of yaar-rbund %tanding water- Approx, Dopth;
7. 3 Ito containo tiroto of Masonal steaftg water: ap Approx. Depft
What =mn($) or Ole year?
B. She U ja trio tModwffy - floodpkirt� ofa water cotina.
9. Site oomains a creA or an stea. where wator flows across the grounds aur&ac? Flows ue:yasr.
round? Plows am swonal7 _ CWrAt TIM0 of Y=Ik
M Site Is primulty: forcstcd moad*w Shrubs mixed'
urban landscaped (Ilawnshrubs otc) )C
11. OWmv wodand is present an shm it
1. 0 -4:
gg,�
o
J96 4
Moo *,ft
"CLA hot IN;
0",
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*From THE MEDICI CONSU-TANTS PHONE No. -, 20645,30W8 Oct.06 1.997 2:413PM PO4
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EASEMENT TO DENETIT LOT
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From THE MEDICI CONSULTANTS
PHONE No. : 2064530058 Oct.06 1997 2:48PM P01
Th., maxe; rnn4ml#&nf4
Transmittal
Ajvhit=t=, Intarivu Dosign, Spoe Planning & Proarainining
To: City of Edmonds Date: 10-6-97
Funning lirnpet Number:
AU011011: Phonc Numbor: 711-0220
Pax Number; 771-0221
Re: Critical areas checklist Pages including 4
Cover Sheet,
Sent via: Mail Courier
Facsimile T4Rnd Carry
Other Overnight Express
Enclosure:
Auaohed Please find completed critical areas cliecklist. The proPosed addition to the structure wHl be
constructod on land that is currently flat and non -permeable as noted on the ske Plan.
Please contact me with queaticns� etc.
Thank you:
�( 1)44 cg ,
Ginger Stinchflold
The, Modici Cnn%ultants
By;
W.
410 Bollovur, Way SF, guite 201, Bellevue WA 99004
Tt3l: (425)433-9298 Varsirnflc (425)453-00$8
Vk
Subdivision
JE. Commercial
Multi -Family Single Family
`TOR:
INSPEC
Issue Date: ho,
A. Address or Vicinity of Construction: 52 7 HEMLOCK WAY
/,r� C. 9 B. Type of Work. (be specific)raTE to DI ace, operate'@ and maintain aburiled service wire ?r
le at 521 Hemloc Wy.,.
rRom existing pole *2607, located at 530 t.O.W. footagd-. 35-feet.
GTE to plow 61 ft,, push one driveway 34
C. Contractor:GTE Northwest Incorporated Contact: L I NbA 425/71 dmow"
ALDEN, PERMIT COORDINATOR
Mailing AddM" Phoneb,,jEggy SCOTT 425/774-5921 or pagee #,206/982-5945
lm2c tirm CASINO ROAD
State LicenLVV!ETT, VIA 98204-1440 Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit #,(if applicable)-
0 City Project T-Iti!"t
Y (PUD,;GTE, WNG, CABLE, WATER)
E! Other GTE W40. 0 2lW-9POOl I DB 242310
INSPECTOR:
F. Pavement or Concrete Cut: 0-Yes. []No G. Size of Cut: 49
H.—Charge
Please see attached sketch/d.rawl.
APPLICANT To READ ANMI,,,�,�,
INDEMNITY Applicant understands and by his signature to this application to hold the Cit� o4dmo�ds harmlessfroT injuries, damages, or claims ofany.
kind or description whatsoever, foreseen or unforeseen, that may be.made againstl the'City of Edmonds, arany'of iPs dejoartments or.
employees; including or not limited to the defense ofany legalproceedings including defense costs and atiorneyfees by,reas6n ofgranting thisp I ermit:
'THE CONTRACTOR ISRESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK ESTI'VIATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL S'TREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE A PPLICA NT
Two sets of construction drawings of proposed work required with oermit-,app�lication.
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 be kept clean at all times.
Traffic Control and Public Safety.shall be in accordance with,City regulations as required by the City Engineer.
2kils,treet cut -trench work shall be patched with'asphalt or City approved material prio r to the end of the working day -
NO EXCEPTIONS.
I have read. e a ove stqtements understand the permit requirements, and the pink copy of the permit will be.
6� f pfi�' ... . I - A .
available on si at all me r ect, r es.
Signature: ",;C,7zu1 Date.--
<onZactor or Agent)
CALL'61AL—A—DIG PRIOR TO BEGINNING �WORK.
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY FEE:
TIME AUTHORIZED: VOID AFTER HAY 15— '1 Y DAYS DISRUPT`ION,FEE/FUND I 11:
SPECIAL CONDITIONS: �J A—, I RESTORATION FEE:
T OTAL FEE: -
RECEIPT NO.:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 199 . 7
FIELD INSPECTIONNOTES (Fund 111'- Route copy to Street Dept.)
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
LEGBND
PERMIT SUBMITTED BY
GTE
- - - - - - - - - - - - - - - - - - - - - - -
30,
HC 11
N PEDS 0
POLES 0
[F
ROAD SORES Rj
OVER14EAC LINES
1.0, UTILITY POTHOLE C=) 03
UC TRENCHINC ---JJCT-
03
'P6419-
7i
�. NK
F
7 � 777
C. is 1`1 w5
c rA I N fA is
— — — — — — — — — — — — — — — — —
4000-�'
%.L% isal
NORTH
3:
0 � -')
0 n
LO
-N 89*35'23" E-
113.14'
Ln
EXISTING HOUSE
N 89'37'03" E
82.86'
LOT A
15-0" 14'-0"
J* - - - - - - - - - --
NEW ADDITION
001
Lq I
001
10.00''
LOT B I
AREA OF EXISTING HOUSE: 1,966 SO. FT.
AREA OF ADDITION: 270 SQ. FT.
AREA OF LOT: 7,559 SQ, FT.
SITE PLAN
SCALE: I" = 20'
R= 20
A= 90*
u
OT
01 U 0
I
01
R= 20",,
go, Vj
cn
0
Lli
V)
Lu
0
c�
C)
0 04
HEMLOCK STREET
Side Sewer Drawing
The City of Edmonds
EASEMENT NO . ...................... ...................
NEW CONSTRUCTION REPAIRS 0 LID NO . .................. ASMT. NO ...........
OWNER ---------------------- CONTRACTOR ------ —k:D"� k---L ............ ... PERMIT NO.
jOh ADDRESS . . ....... . 4.c�� -� ... LEGAL DESCRIPTION: LOT NO . ............ '��S .................... BLOCK NO . ............ - .............
......................... ............................................................................................................................
-7 e=)
NAME OF ADDITION ..... I C - --------
........ ------------------------------------------------ ..........
C�D
PWW-0001-1 1/75 (REV.1 1/78)
2Z!-
ff:-2 ---"L
� 7- kl==
2-2�
-fY)
000-4 �--- R
C-i
3d
Approved: z
DATE ...... � ............ By"Z��..�K--
46LIC PORKS DFPAR7,�nTr CHECKLP e�j Date
BUnDING PERtaT.REVIEW -7 J+M Address
Street Right -of -Way Existing -::!�)
REQD
Access Easernents Existing 2=C-) Ft
PET S REQD
Utility Easement Existing
REQD
Lot per Subdivision ) Plat As essor Map
Site Plan Checked for Accuracy
Z
FA
Underground Wiring Reqd.
01
Check Accuracy of Legal Description
Environmentally Sensitive A rea
Environmental Checklist Reqd.
Flood Hazard Zone
Shoreline Management Area
Slope, Soil, Vegetation
Strewn, Creek, Drainage Basin
Existing Zoning Per Code
Amenities Design Board Approval Reqd.
ADB # Approval'
Board of Adjustme3�t�Approval Reqd.
-0 N)::E:
Review By:
Date: ::11 )`�) I -71S
Existing Water Main Size 4'c--7-
Water Main Reqd. /t,)CD
50.E
Service Line Reqd.
Hydrant Size Existing 0,(�
Hydrant Reqd. Per Fire Code Size
Detector Check Meter Reqd.
Cross Connection Inspection As,��
A_t1e,.)De ar t Cannents
Water Meter Charge ReV--j
Review by: 77—
Date: 7hsz-
z,f
tic Tai-k Design Approved ----Date:
Septic Tank Permit Reqd. A-1/11- Permit No.
Sanitary Sewer Availabi������ Proi. Z, -7
Drawing No. File No. 3 7—) . 0 Ly
Side Sewer Availability, P-2,1
Sanitary Sewer Connection Fee Reqd.
Review BY: Date:
0.)
BVILDING DEPARTMENT
USE PERMIT
Applicant Fill
ZONE NUMBER
PERMIT APPLICATION Inside Heavy Lines
2S
JOB
ADDRESS
N A (0 NAME OF BU E�ss
,OA)
m !�j
SUBDIVISION NO.
S
L
P AT NAME
ASSESSOR MAP J40.
w A LING ADD"
PUBLIC RIGHT OF WAY PER ORDINANCE NO.
0 _-SL/ -3.3
CI Y
TELEPHONE NUMBER
70,
EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY
NAME
U
W
DEFICIENCY OF RIGHT OF WAY
ADDRESS
STREET/UTILITY WORK REQUIRED WYES ONO
U
PERMIT FOR WORK IN PUBLIC R/W 10 YES NO
UNDERGROUND WIRING REQUIRED EYES El
0
3:
M
<
CITY
TELEPHONE NUMBER
NO
U
CONNECT . ION TO SANITARY SEWER 11YES El NO
NAME
SEPTIC TANK PERMIT REQUIRED' YES RNO
3
CL
SEPTIC TANK PERMIT NO.
0
ADDRESS
U
SEE MEMO DATED
CITY
TELEPHONE N MBER
REMAIKS
Z
0
U
STATE LICENSE NUMBER
R
CHECKED B
Legal Description of Property FS-howBelo
METE1::1 !: I:
BUILDING,SUPPI ElEtl
w
z
REMARKS
0
F.
IL
m
SIGN ARE;�
SNV. REVIEW
ADEI NO.
U
0
ALLOWED PROPOSED
COMPLETE EXEMPT
w
.J
REMARKS
w
VARIANCE OR CU
PLANNING REVIEW BY
DATE
I
YARDS
I t
FRONT
ILOT COVERAGE.
NEW EXESIDENTIAL El GAS
LINE
El NON-RESiDENTIAL
OQ(O SIDE /11� REAR
FIRE ZONE
TYPE OF CONSTRUCiTION
CODE
HEIGHT
ADD 11 SIGN
DEMOLISH RETAINING
ECIAL INSPECTOR
REQUIRED
0 C
OCCUPANCY OCCUPANT.
DWALL
ALTER EXCAVATE FENCE
OR FILL I_ X_FT)
0 YES El No
GR:OOUP LOAD
REPAIR PRE -MOVE swim
El
rLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES
INSP. POOL
TAX
SHOULD BE CODED 31.04.
NUMBER OF STORIES
NUMBER OF
REMARKS.
,-.I
A590,)qu
DWELLING
UNITS
z
TUR 3 K BE 00
w
w
z PROPOSEJ? U
PLAN CHECK FEE
VALUATION
FEE
2
z
k IN CAT BU ILDING. SET ACKS,
w
BUTTING STREET
U
BUILDING
I
IL
in
w
0
J
PLUMBING
w
>
MECHANICAL
0
w
FENCE
t
SIGN
Z
RETAINING WALL
'0
POOL.
SWIM�'NG
L)
CHRONOLOGICAL STATUS'REFORT ON THE GWINN
SUBDIVISION (S-'.3-78)*AND'SUBSEQUENT BLDG
539 AND 5
PERMITS AT 5 3 5 @44
21�
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13
�,k
Engineering requirements'deferred to time of building permits.
11-1.
Subdivision recorded'(7-10-78).
Correction notice posted (10-31-78).
Side sewer inspected (11-5-78).
Correction notice posted (3-1-79).
Correction notice posted (6-1-79).
$1,000.00 subdivision -bond released, Tony Pinto maker of
bond (2-20-79).
Memo to Building Dept. coordinating final occupancy (2720-79).
C).
Bob Franklin punch list letter (2-21-79).
Memo to Building Dept. (11-2-79).
Correction �otice posted (11-6-79).
Boras of Bomar Construction asking for occupancy for
client Paul Ghenov (11-21-79).
City Engineer holds water meter for Water line inspection
(11-21-79).
I
0
0
The existing problems at this subdivision site have evolved
for over a year. Each time the contractor attempted to correct
a problem it resulted in a worse situation. At present, Hemlock
Way in the area of this development is a shabby sight.
Initially, Jay Bollinger contacted me at the Public Works
counter�." He was inquiring into,the engineering requirements for
the Gwinn subdivision so as to obtain building permits.
Through the course of events, three builders applied for
permits on four building sites. However, Jay Bollinger made
most of all the contact with the Engineering Dept. regarding
required improvements.
As work-progressed,,and became substandard in the public
right-of-way, Jay Bollinger personally and continually assured
me that he would take.care of the problems. To date', Jay Bollinger
has been working in the public right-of-way without a permit and
without inspections. The physical problems at the site are
worsening under his substandard work causing a large trench at
the entrance to the subdivision.
The subdivision bond was released by me considering that
the basic requirements had been met. Although some corrections
were needed at the time (and have since worsened due to building
activity), Jay Bollinger assured me that they would be corrected.
At that time, I told Jay Bollinger and Tony Pinto (the maker of
the bond) that I would release the bond. However, I stipulated
that the Engineering Division would not approve the building
permits for final occupancy until all problems had been cor-
rected. Both agreed.
At present, Jay Bollinger (the primary developer) claims
CI
responsibility only for work under his own building permits (if
that much). He is now disclaiming any responsibility for work
in the right-of-way by saying that they are not his permits.
Also presently, Bob Bollinger is working in the right-of-
way without a permit in an attempt to gain occupancy for Paul
Ghenov. Mr. Ghenov is illegally occupying 535 Hemlock Way
with no water meter hook-up.
f
M
'"HOW
TO PEMVI�e A 4_
4".,/Olt OWNFR
J,
PARTIAL APPROVAL
0--VIOLATION
'Ali
El CORRECTIONS REQUIRED
PERMIT
NUMBER
%
;2,
q 7" AM
JOB WDDRESS
u_ 61.
.4, Fl 4a
46
_4
STO,p WOMAR REMOVE C0NS7j:jTcT10Z� ol��. omr�lz,�
'IT AIND MAKE WORK COMPLY WITH BUILDING LAWL1. llftiv 1�
PER M
COT&THUMNON IS 140T IN ACCOHIDANCr WITH _A_1IrH0Vmv pjAN�.�
ANN! PUMT — STOP 1.110UK. %fAKE' EXISTITIG INORK CGM PL Y
ALNI) Pt",RMIT M Ri�?I IT. xv
FF
STOP W(MM JrN'_L� .11,jj-j-jj0R;
.Zr,-'..) To CONTINT-Ir 1
_jy
.4
, Ad�-
b, fv� �11
M:T:rX'-,10NA XJST;D BELOW IMUST BE
IMVORE VVOW, C4n A ONE .14
G
4 t - %:, Q
F7 lvofa7, i4,,S IMEN INSPECTED AND IS ATIMOV01
FM(WTACT INMEMOR AND Av"
wT -1
L, All MNCX POn APP0I_.N7.F'M_;_-7,N'V. MCALL ISM INYKV� iu� I 4� -,
pq 4
'i N
"'d
w K
L., Ile
Y4h:
VF:,
"k
J, v
-,vjt j
4V t
A.
0
A
RIP' 41
AC:TIONS OK CORRETMOYS INUICATED A130VE
7,
1_1;%Y�� Ok INI 1, OS 1, 1) BY I.,\%V ��."Y
- 0., 1
-4
F-1 IZOM A K, I r
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min P
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:%
. . . . . . . .....
A,
'0 5
. . . . . . . . . .
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7 9
two wl�: 'WE
w M;
u TEA!
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4 Q
�Y ......
A Kok
y '44107 �po
va
,
N 0 E
pl,
TO PERNIMTEE ANI)IO14 OWQR
PARTI AL APPROVAL
o
IOLATION
-113
Ej CORRECTIONS REQUIRED
PERMIT
ADDRE&B
It
k.
NO PERMIT — STOP WORK, REMON1, CONS7MUC-FION OR OBTAIN
PERMIT AND MAKE WORK COMPLY WITH BUILDING LAWS.
CONSTRU(MON IS NOT IN ACCORDANCE NVITTI APMOVED PLANS
AND PEWMIT — STOP WOHI`.. IMAKh' EXISTING WORK Co'.k PL
I Y WITH
APPPOVED PLAJNS A-N-D PERMIT OR HEIMOVE IT.
S TOr WORK — UNTIL AlMiORIZED To CONTINUE BY INSPECTOp-
(pq
-er) f CREMMONS LISTED BELOW IMUST Bi' PEFOPE WORK CAN
L-f I' E APPROVED.
+
WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED.
4:,
NTAC!T XNSPr M,)It AND
RECALL FOR INSPECTION
A-RF-LANGC FOR APPOENUMENT.
.76-
-24
X, -
Z-s 7'�, ti-;("
CAI.,
Till] ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED
4
0,
WITHIN ......... ......... DAYS Oil PENAI.,TU�S I.MPOSLD By LAW MAY BE
A,
El BUILDING DIV.
PUBLIC �VORKS
/7 -e2
CITY OF
F] F IR E DEPT.
EDMONDS
4�
lei :F1
it !o
41 7''
1.4 it
I'J 0
q;o,v,
WIM0 - 410" 1'1�
q
N 0 T Cm E e
Aly-
To PE1011'rMF AIND,mit OWNER
PARTIAL APPROVAL
VIOLATION
mh
z My
AW
El CORRECTIONS REQUIRED
NUMBER
PERM
V� IT
0i
J�A I
10
J013 DDRE'Sb
4,4,
owl
QW110"MIT — S T() P WORK RE110% 1: C()NSTRUCTIO-N 011*011TAIN
owls" 5,
,20 W ...
I IT AIN 17) N1, A K E Co%jpj�y WIT11 BUILDINC. LAWS,
A;
Ant
sit, CONSTRITTTON is so,r IN' A CCO It 1) A N ( F N%ITH API'H0%'F.D
QW,
VC E! AND PERMIT — �11'01' WORK. %IAkF P:\*fST1Nt*; WORK COMPLY WITH
PI.AN.S, AND PER.MIT (W 1'r.
A PPROVE.1
f.
STOP WORk — T7NT11, A UTI BY JNSI,F(_T0i,. ;4? �v
V7
am
Tit,
LI.STED BELMN' ',IT:.,'l Pi` M X"K IWFORE WORK CAN 1: vs —
RE APPR.CWED
F,
WORK DESCRIBED REI,40�% IIA�- f-7) ANI) IS A.PP1t(J`%1FD.
7k I
CONTAM INSPEC431H AND
EVAIX FOR rNSPECTTON
ARRANGE FOR APPMNTMENT.
El
t, mk, I I
u-,
14
a
win Wum IV'
am
toils. 97,
ON, - If
4
J_Q
to i.
y 4�
N'l
44
4N
\R1)VX' AI(P:
..1. 4 WITH I.,'
1,1A)"; OR PENALTIES HY I.AW MAY PF:
AIWIVIED FOR INSPEMONS CAIX 77SOSH
IN
M.111 OING Div i
L
VUBIff �%;OR�Ks
Qj
A
CITY OF
On X
11141 so I -m' i. DATh: F] FIRE DL111'
EDMONDS
1%
ypp
�i,3 4_
NI''
74 %qy
n yj
to
0-
Of mp 0
10-01 A 1 '4 T. 1
4jue- -7 67,00, 1 u.
foil j vry 4
A 00
513 f
.1 W
Sol
�tp 'N -
PUT, 0051 fmc-A.-
MCI
vq
T7 A- A
x
KNO
FIJI-' �g"'
1A.
K
A .4
4 ......
Jq 110
T.
e
.�o
4c
v I
PL
bf-,- 7757A
0119i f!"
TO PERmrrTEE AND/QR 0"'NER
ovum
410 PARTIAL APPROVAL
t
LATION
si Woo; I! U.,
N
CORRECTIONS REQUIRED
P""T
NUMBER
JOBADMEIN A
ErNo PERYJ�T — STOP WORn UUMOM CONSMINION OR OBTAIN T
to 9-04
PF-MMIT AND MAKE WORK COINIPLY V%'171,
j .4,
--,,.C`0NSTRkjC7rION IS NOT INT AC(-'0i,1)A:-;CF %N ITH
4--
A' CC `LY WITH
NDPERMIT—STOPWORR. ATME UXISTM; AV011�- -)MI
APPROVED PLANS AND PERMIT 0H
OVA
STOP WORK — UNTIL AU7HOMZED TO MMINUE BY INS11LICIror-
low AT— W'v: BE APPROVED.
Rai CORRECTIONS I-ISTED BEL= MUST RE MAD-* NVORK CAN
P cod
"A
14 Awn
WORK DESCIU-BED BELOW HAS BEEN INSPEMAED AND M APPROVLD.
=-,_�IONITACJr rNSPECTOR AND
AnRANCE, MR AXPOn7SIENT. EI FOR 11'1WPECTION
gm T. a 0
'00
k;
IVA
�x -1
:0�
571 MY,
`14
YAM
I q
q, A -0
-q
rN, THE ACTIONS OR CORRECTIONS INDICA110 AMM-, AVE REWWRED
A
�VITHIN DAYS 01%. PENAUMN
I%
FOR 11`�';PECTIONS CAI.,1,: 77.,--*Z,.�'.-,
lam mm; mv. 41
i'IJ:Q1(- 1,YORK", .V
CITY OF
r 0.
j�q� El IViON
-J'
'A
for
kf� q.,� :e
,T�4,yNR 'i T-t
1 A -A PIN - %
zy n
Any!
Qv-
p'.
ie
A
has
oil
Q� M, AW% jmk��
%
FC1001
IT
4
-1. IYAW
f
4,
NM
%G .
AW Jk
"lilt
%
November 2, 1979
MEMO TO:. Harry Whitcut'
Building Official
FROM:. James Adams
City Engineer;.,
SUBJECT: 521 '527 '53�HFZLOCK
The builder's at the above addresses
have rfiade curb cuts and
�i� ei.1'.11''.,
sidewalk and driveway modifications
-i,,hich are not'in accord-
ance with'approved plans and'not to
City standards.
Please withhold final approval for
these buildings un;
corrections have been completed and
accepted by the Engineer-'��"".',,;",
in- Division.
If there are 'any questions regarding
this mattex, contact
Jerry Saterlie at ext. 220.
�tustom Builders
L-,-' ED, Tlv;,ij
SHING7 ON �MX - 1'01) 7-15 2525
24120 - 116th West JAY DRKS
Edmonds, WA. 98020 (206) 546-6782
October 18, 1979
Z/ . . : 1 e 0 ,
Bollinger Construction
24120 116th N.
Edmonds, Washington 98020
K, XA n�"Zj i�--
Attention: Mr. Jay Bollinger
Gentlemen:
SUBJECT: HEMLOCK WAY DEVELOPMENT (S-3-73
HARVE H. HARRISON
MAYOR
You
projecln on
were issued a "Lice requiring correcLion of your
June 1, 1979. A
copy oF Lhe-noKce is aKached.
Please
or submit
arrnnge for a
a schedule
final insnecrion of these iLems
when these
prior
Lo Ocrnhar 25, 1979, showinf!,
corrections will
be comptered.
Yours very truly,
A�,�l E S �74. `A?--DQ, -IS p E
JEA:jak "Ity Engineer
Attachment
I !'r,
February 20, 1979
MEMO TO: Treasurer
VIA:
Art Housler, Director
Finance Department
TROM:
Leif R. Larson
Director of Public Works
SUBJECT:
RELEASE OF CASH DEPOSIT FOR SITE
IMPROVEMENTS
-NNz,, 0 000,
RECEIPT
1. 7
0 TT 9
With,Te�erence
-easurer's
to the above -subject Ti.
Receipt, please
release
all funds being being held to the
following:
Tony Pinto, 539 Hemlock, Edmonds,
Wa. 9,1020
If you
have any questions regarding this,
please contact Jerry
Saterlie,
extension 2110.
j a
t4
-IX
-Wiss C E A min Dt.:�
Sa t�erl ie Dt� Dt.
L nd Surveyor's CertlUcatol
.0 1
a
This short plot correctly represents a survey twde by me
-a wIth the require
or under my direction In conformanr
, ". ., , , , V, .
.4
-'A
. . ........
CITY OF EDMONDS RECEIPT
N9 5724
>/Dupartment
�Z
RECEIVED OF
Check Cash
Utility Charges
Citi-cn Deposit
Trunk Charges
Water Meter
Water Turn on/olf
Sewer Permit
Dumpster Permit
Septic Tank Permit
Building Permit
Curb Cut
R/W Invasion
Recreation Class Fee
Swim Class Fee
Rentals
Fingerprinting
Fire Permit
Fireworks Permit
Sale of Maps — Books
Sales Tax
Other
4 --
B
40*
0
November 2, 1979.
MEMO.TO: Harry Whitcutt
Building Official
FROM: James' Adams
City Engineer'
SUBJECT; 521.- '527 -'535 HEMLOCK
The builders at the above addresses have made curb cuts and
sidewalk and driveway modifications which are not in accord-
ance with*approved plans and not to City standards.
Please withhold final approval for these buildings until
corrections have been completed and accepted by the -Engineer-
ing Division.
If there'are'any questions regarding this matter, contact
Jerry Saterlie'at ext. 220.
JS;vlW
-*`Sa6erlie dt.
DATE:
MEMO TO: Building Division
Community Devel-opment Department
FROM: Engineering Division
Public Works Department
SUBJECT: Szol flVALCU WAN 16-11-0716ft
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 I streets, property lines and driveway grades is the
responsibility of the contractor.
(2) The contractor is required to keep the abutting streets clean-
ed of dirt and debris caused by the construction.
(3) A "Right-of-W,-v Construction Permit" is reguired, from the
Engineering Divisioii of Public lVorks, for any work within
the Public Right-of-1,,lay or public easement.
4) Driveway slope not to exceed 14%.
W'.VrA=- WA -V A LV A -V--- I WA WE ff-UwA�Jv% AIN
PAM FLJ I
AMILARM161217 �&Tal ;4 7A ;_4 M
P11 5/77
V_
A A.!!'
" A A
0
Z
�4
Z
�-4
IC 14ORKS DEPA=Tr CHECKL-q,,, Date
BLbaDING PER,1IT REVIEW
Address
Street Right-of-Way-Eyasting REQD
Access Easements Existing REQD
Utility Easement Existing PML S--25-21S REQD
Lot per Subdivision Plat As essor Map
Site Plan Checked for Accuracy
Underground Wiring Reqd.
'� iption
Check Accuracy of Legal-Descr
Environmentally Sensitive Area
Envircrunental Checklist Reqd.
Flood Hazard Zone
U Shoreline Management Area
Z Slope, Soil,.Vegetation J\j (3
Stream, Creekj Drainage Basin u s —I-a::
Existing Zoning Per Code
A;menities Des*ign Board Approval Reqd. ADB # Approval —
Board of Adjustme t Approval Reqd.
Review By: Date:
�4 Existing Water Main Size
Water Main Reqd. lt,,�cD
Service Line Reqd. -3�ldl
Hydrant Size Existing OAr-
E-1 'Hydrant Reqd. Per Fire Code Size
Detector Check Meter Reqd.
Cross Connection Inspection A_�47
Fire Department Conywnts
Water Meter Char e Reqd. igzn
Review by: Date:
41"
Septic T sign prove a
Septic Tank Permit Reqd. X//IL- Permit No.
Sanitary Sewer Availability Proi. Z- -7
Drawing No. y File No. 7—) Lj
Side Sewer Availability n4 1-1-40�6rlk
Sanitary Sewer Connection. -Fee Reqd.
U) Review By W/S Date: :;7-/—/
W/ .. � J�,- - - 0
R
'e' D'-tch. Existing eqd.
NOZ'vert Reqd. el
—Size--
04 Catch Basin Reqd.. Indicate on Site Plan
0 Shoulder drainage n-kiii-italli c llection on &%vale open runof f ZQZWA4�
U) !��,-a-�hole reqd. Indicate on Site Plan
Soil Conditions and Ground Water Field Cliecked
-P\e.-\ric%,7 by Da te
!gStreet Paving Reqd. —
Curb and Gutter Reqd.
Sidewalk Reqd._ .
Curb Cut for Driveway Reqd-
p� Right -of -Way Construction P,/,mit Reqd.' C"4� X A��.e
Bond Reqd. for Public InprovaTQnts
Street Nam Sign Reqd._
Other Sigiii-ig Reqd.
,,, 50re Permit Sire Inspection made on 6e-1-7
F1 � BY: S0,7ER
0
W WN J%IATER
1-1
STREET
ENGINEERING.
Special RequireiTiants listed in mem to Comunfty Development Department,
A�uilding Division
BY Date
o All iteins filled in on Building Permit Application
BY Date—
P' , Drawings Stamed and Notations �lade
P4
BY D9te
-4 lApproved by Public Works Departm-c-nt
Revised: Iv 10-1977
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M,
NEMO TO:
COMMunj
y
De
FROH:
Fro(j
Iferzberr
Cily Engineer
SUBJI-"C,T-:
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Land Surveyor's CartIficatet
Ttif s short Plat Correctly represents A SlUrvPy made bV e
or , under nTy direction In confornian
ll�ents Of appropriate t,,, '- " With the require-
o r d I n.3 n ca. and County st8tuta and
j:-, 1_2
Date
Short' Plat No.
Cart I f I ca to No. 7&'
Dir
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ENGINEERS . SURVEYORS PLANNERS
71002 68
,/0[ 134.1
T D. A DATF�
9-78 FILE NO.
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