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CASCADES Ll-C2375 PRINTED IN U.S.A.
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TAX ACCOUNT/PARCEL NUMBER: 7
jq7q- 0oo I
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED), FOR:
CRITICAL AREAS:
DETERMINATION: Conditional Waiver E] Study Required -,�(waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DAT
,7D
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S),#: 2�7
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATEP: L-4'- f 0
-J-7� �q-
OTHFIZ &77)
LATEMP\DST's\Forms\Street File Checklist.doc
CA File No: 0 zt/
Critical Areas Checklist
Site, Inforinatio' n (soils'/top6graphy/hydrology/vegetation)
1 SiteAddress/Location: -550 e ^1% 1 WeL4 o ot 5 W A 1:R 0 D, 6
2. Pro I erty Tax Account Number: Q-�,q S'O 0 ;U 0 �5 0 0 it)?) OD oel
P,
3. �:App'ii6xi'i "mate Site Size ('acres or sqtiare feet): q,'5(.0
4.. Is this site currently.'developed? Z; yes; -.:.— no,
If yes; how is. site developed? Pe% j2� ko_
5. Describe the general site topography. Check all that apply.
y Flat' less than 5-feet elevation change over entire site.
\1/ Rolling: slo,
pes on site generally less than'15% (a vertical rise of- 16-feet over a horizontal
distance'of 66-feet)..
Hilly: slopes present on''site of more than Iff and4ess 4iapr. 001(f t
0 0
over a horizontal distance of 33 to 665�fjj�l`
01
Steep; grades of greater' than 30% present on site (a v dal rise of 10-feel F1 I t ontal
distance -of less than'33-feet).
Other (please describe):
6. Site contains aiea& of year-round st�nding water: K) 0 Approx. Depth:
7. Site contains areas, of seasonal standing water: �So i A' pprox. Depth:
What season(s).'of the year?
8. Site Lis in the flood tJ 6' flobd'plam Q of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are y ear-rouhd?
��Jo Flows are seasonal? �J o (V�hat time of year?
10. Site is primarily: forested .,mea&-,� Shrubs mixed
urbari landscaped (lawn, shrubs etc)
11. - Obviolus'wetland is present on site: C)
For City Staff Use Only'
1. Plan dheck Number, if applicable?
2. Site is Zoned?
3. SCS mapped soil type(s)?
4.. Cxitical Areas inventory' or C.A. 'map indicates Critical Area on site? L)Q
5. 5iti within designaiteaearth subsidence landslide 'hazard area?,O�
e-, e--
F-1 4-.' 0 n j.;
DETERMINATION
ST� UDY R
-0 , , "'. L� WAIVER
EQUIRED
Reviewed br.: �\7--Cn"
driticil Areas Checklist.d&J4.22.2003
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City ot4ldwond.s
Development Services Department
Planning Division
Phone: 4�5.771.0220
Fax:- 425.771.02,21.
The Critical Areas Checklist contained on this form,is to
be filled out by. any person preparing a Development
Permit Appli�ation for the City of Edmonds` to
prior
his/her submittal of the application to the City.
The purpose of the Checklist is to. enable City. staff to
determine whether any potential Critical, Areas are, or
may be, present on the subject property. The info , on
needed to co ' leie the Checklist should 'be easily
Mp
available from observations of the site or i at
MAILins, v toil
COMM.=
TPUCRON PIC v./0JS6i_
Date Receiv4
Cii�- Riaicellpt
Critical Area
Critical Are a
Date Mailed'i
z5to Ld
File * MI,
ecklistfee.,'', $136.00
A�Ppli 'bant:..
A property owner,- orlhis/het% authorized repTesentative,
must fill out the checklist, sign and- date it, and:.submit it
to the City'. 'The City 'Will review the checkii6i make a
precursory site visit, and make a detemiinati6n of. the
, subsequent steps necessary *to complete, 4 development
perihit application.
P16a".9e submit a vicinity map, along with'the signedcopy
of this , form to assist City stift in findi
pg and,lo-cating the
specific piece of property described on this form. In
addition, I the applicant shall I include other] pertinent
inf6rination (e.g. site 'plan, topography map,� etc.) - or
studies in conjunction with thisChecklist to assistant staff
in completing their prelinuinary assessment of the' site.
I
The undersigned applicant, and his/her/its heirs, and assigns ' in consideration on the processing of the application agrees
to release, indemnify, defend and. hold the City of Edmonds harmless from, any and all.damages,. ihcluding'reasonable
attorney's fees, arising from any action or infraction' based in� whole'or part upon false, misleading, 'inaccurate or
incomplete information furnished by the applicant, his/hei/its agents or employees.
By my signature,. I certify that the information and exhibits herewith. submitted are true and correct to the best of my
knowledge and that I am authorized to file this application on the behalf of the: owner as listed below'.
SIGNATURE OF APPLIC GENT DATE
Property Owner's Authorization
By my signature, I cer* that I have authorized the above Applicant/A,gent to apply for the subject -land use 'application,
and grant my permission for the public officials and the. staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATURE OF OWNER
Owner/Appficant:
Name
Street Address
2,
Eck 1-1-0 \AJ q '8 0
city State . zip
DATE
Applicant Representative:
Name f
Street Address
Ej -,,C �J -5 uvA-
city State - zip
-7
Telephone: If' ),,5 - 'S 1f 4f -7 Telephone: o— 13 6
Email address (optional): RECEIVEMail Address (optional):
FEB 2 3 2004
Critical Areas Checklist.doc/4.22.2003
PERMIT COUNTER
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FEB: 2 3 200k'
APPROVED BY
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,_TULDING D.EPARTMEi
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
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ADDRESS L C
2V16 [LEGAL LOT PLAT NAME SUBDIVISION NO.
PUBLIC RIGHT OF WAY PER. ORDINANCE NP.
VISA
ELEPHONE NUMBER.
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EXISTING RIGHT OF WAY
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PROPOS ED RIGHT OF WAY
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DEFICIENCY OF RIGHT OF WAY
STREET/UTILITY WORK REQUIRED
WYES NO
PERMIT FOR WORK IN PUBLIC R/W
UNDERGROUND WIRING REQUIRED
%IVES 1:1 No
El YES ANO
ELEPHONE NUMBER
CONNECTION TO SANITARY SEWER
SEPTIC TANK PERMIT REQUIRED
WYES ONO
OYES IN No
SEPTIC TANK PERMIT NO.
SEE MEMO DATED
ELEPHONEf N
U'"k 6
REMARKS
CHECKED
ITY LICENSE NUMBER
or Attach Four Copies)
ME�. SIZE
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BUILDING SUPPLY SIZE
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REMARKS L)
la�Lz>Gr_ SUPP 4
. SIGN
REVI:WPT
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ALLOWED PRO jD
�COMENV.
PLETI EX M
S..R.L.N
REMARKS
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VARIANCE OR CU
YARDS
FRONT
NEW
RESIDENTIAL
10
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LINE
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SIGN
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EXCAVATE
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RETAINING
DWALL
FE NCE
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CIAL INSPECTOA
REQUIRED
YES NC
PLAN CHECKED BY
F] REPAIR
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PRE -MOVE'
INSP.
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REMARKS
Z NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE
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' PROPOSED USE
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PLUMBING
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MECHANICAL
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FENCE
SIGN
in "Applicant, oil behalf of' his or her spouse, heirs, assigns and
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successors in interest, agrees to indemnify, defend and hold harmless
the City of Edmonds, Washington, its officials, employees, and
RETAINING WALL
it
agents from any and all claims for damages of whatever natil re,
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I arising directly or indirectly from the issliance of this permit. Isu-
SWIMMING POOL
PLANNING REVIEW BY DATE
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OT COVERAGE
SIDE REA RIL
'PE OF CONSTRUCTION CODE HEIGHT
AREA OCCUPANCY OCCUPAI
I GROUP 1�_:5 LOAD
THIS SITE IS LOCATED IN THE CITV
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION . I FEE
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01 ance of this permit shall not be deenied to modify, waive or reduce
any requirement of any city ordinance nor limit in any way the
City's ability [A) enforce ally ordinance provision."
161
90-
Date �Z__ I S-1 V
MEMO TO:' Building Division
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT: 1--l"ILL-k
After review of the subject building permit application, we have the
following comments:
Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is the
responsibility of the contractor.
The contractor is required to keep the abutting I streets cleaned
of dirt and debris 'caused by the construction.
'AZ The "Right -of -Way Construction Permit" is required, from the
Engineering Division of Public Works, for anywork within the
Public Right -of -Way or public easement.
Driveway slope not to exceed 14%.
rConnection to sanitary sewer required.
_7 Septic Tank'Permit requir.ed, submit design.
Fire hydrant required, submit design.
67 Site drainage per code # 1'7 See approved plans
/_7 Curb 7 Sidewalk
�F Paving required.
/_7 Bond required -for public improvements. Submit cost estimate.
/_7 Underground wiring required.
�_7 Approved Engineering Plans required when applicable..
1_7
Rev. 7/78
tor i,,rect t'. Herzberg, F.E.
City Engineer
Department.of Public Works
ZONE
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BACKS:'
F61ONT
SIDL-
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HEIGHT
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'EA'ST 0�9 r I -rliD4U—J Hcfi�ll 117 110 S,�-UTw, t,,fdE
Inw1b
5o rT t4' 6 117 i-;
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q&C IN70RKS DEPAMOU CHECKLI-ft
BUILDING PERMIT REVIEW
. /0-/ �'- 7 P Date
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Street Right -of -Way Existing
-530 AleW&et L4A41 ddress
REQD --
Access Easements Existing T-i ON TE- REQD
Utility Easement Existing -r-lo r-4 e� REQD
Lot per Subdivision Plat Assessor.Map
Site Plan Checked for Accuracy
Underground Wiring Reqd. TAO
Check Accuracy of Legal Description 1?--IV-7f?
Environmentally Sensitive Area
Environmental Checklist Reqd.
Flood Hazard, Zone
Shoreline Management Area
Slope, Soil, Vegetation
'Stream, Creek, Drainage Basin
Zoning Ppr,Code
Amenities Design Board Approval Reqd., -rAn ADB # Approval
Board of Adjustment Approval Reqd. �-4p
Review By: - . N Dke�: JZ,44.,"
Existing Water Main Size
Water Main Reqd. NA
Service Line Reqd.
Hydrant Size Existing
Hydrant Reqd. Per Fire Code Size
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Cmnents
Water Meter Charge Reqd.
Review by: Date:
tC Septic Tank Design Approved Date:
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability Proj
Drawing No. File No.
Side Sewer Avail ility
W Sanitary Sewer Connection Fee Reqd.
GO Review By:
Date: 29�
L- -Ald
40-
5ibi)en Ditch Existin" Reqd. &
g -
:E: Culvert Reqd. --Si Ze
r4 Catch Basin Reqd. Indicdto on Site Plan
0 Shoulder drainage n-nintaixi collection on swale open runoff
U) -',Im-�hole reqd. Indicate on Site Plan
,Soil Conditions --Lnd Ground Water Field Giecked
Re.-,ric-.,7 hy
IXite
11111ill 115
Street Paving Rcqd.
Curb and Cutter Reqd.
Sidewalk Reqd.
Curb Cut for Driveway Reqo.
r)� Right -of -Way Construction lye�init'Reqd.
Zond Reqd. for Public Inpro ver,,Qnts
Street Nam, Sign Reqd.
Other Signing Reqd. ",
0 A
n Pre Perinit Site Inspection made on
1
1-7
0
BY: SEJ1ER
WATER
STREET
El\'GINT-EPJNG
- - - - - - - - - - --
F-1
Special. Requiremants listed in mom to Cbmamity-Developinmt DeparWL-nt,
Building Di%rision Date
BY
0 All items filled in on Building Pe t Application
P4 BY, Dat4
PA Drm,7ings Stan-ned and Notations ��-ide
By Ddte
-< 1,"Approved by Public 1%lorks Depart-ment:
Revised: Iv 10-1977
August 28, 1979
MEMO TO: Art Housler, Director
Finance Department
FROM: Fred F. Herzber
Director of Public Works
SUBJECT: REIMBURSEMENT OF STREET CUT SECURITY DEPOSIT -
ORDINANCE #1935-
R/W CONSTR. PERMIT NO.: 79-136
DATE ISSUED: 3-5-79
LOCATION OF 0-0—RK: 530 Hemlock
SECURITY DEPOSIT AMOUNT: --�M.00
RECEIPT No. & DATE: #5 7 3-5-79
COMPLETION DT. OF REPAIR:---6----T3--79
Please prepare a Treasurer's Check in the amount of $
made payable to the following:
Redford-Junacek Cons't.
P.O. Box 353
Lynnwood, Wa. 98036
pki�
0 1
The balance of the deposit in the amount of $ 84.00 is to
remain in Street Division Revenue Fund lll-00U--U00--389-.--l0.
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CITY OF EDMONDS Wallo.
PUBLIC -WORKS DEPARTMENT Issue Date
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Construction 0 Permit Issued To: d.57 �Zra e_1
MM
Ow 0 TypeofWorktobeDone: 110k) 7�1%jari
.0 ner: ex 14 9
Name d' i�'. � S ir-)e
_S3 b Ll
Mailing Address 0 Work in Connection With:
r= El Sub or Plat LJ-Single Family
dr El' Comml. / Ind. EJ Apt. Condo.
City, State, Z45-tode 0 Pavement Cut: P-'fes 0 No
Contractor:- OC
-P^' �CA :TCL e-,
NanP L) - 130 X s 3 bF CIZ L M
Mailing Address State License Number
— 1 14 go to
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city, State, Zip Code Telephone Number
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0. 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 cbsts, and attorney fees by reason. of granting this permit.
0
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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 Elngineefing Division.
Funds held from the Security Deposit (estimated restoration ec)'wil-l- b�' held unti�ihe final street patch i's completed, at
which time a debit or credit will be pr_6
,�e
,�s'ed 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
� —, "Z
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.
qz
I understand that this pe r, t must be avidal5le at the.j6b- , site or inspect4on purposes at all times.
Signaturv�*. ate
Owner or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
AL
C. Issued By: Permit Fee: 0
Time Authorized: Vd(J after Secur' ty Deposit: A) Ck,4 0- Pea a
0
Z Special Condit I ons: I C�A Receipt No.:
0
LU 0, ( le 1pwe be Fu nd- I 11 Fee:
V)
Ammendm ts: Street Cut Dimensions
zz X
U /�/�
N 40�9 %2�t PRIOR TO PERMIT ISSUANCE
Eng. Div. December 1978
v
;7
7f
- -7 —4 cE -
14 7 L�2- a k�-,Ar-
7��
IZ7� /V
,007,0 loo�os7!��
CITY OF EDMONDS
i, PuhIC WORKS DEPARTMENT
U
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RIGHT - OF - WAY CONSTRUCTION PERMIT
A. oAddress or vicinity of Construction
2530 14� to C19D
Owner: Za"- go
Name 47
-S-30
Mailing Address
E cl t-A ��� cN62-0
City, State, Zip Code
0 Contractor:
Na T
Mailing Address
L 4 tj oi vu on C1 go -3
city, 0 State, Zip Code
Wit No. 7� 1-3 6
Issue Date Z -S- -7 �
0 Permit Issued To:
'C I U
9 Type of Work to be Done: !jAAJQ f Wry-,
I. �
• Work in Connection With:
0 Sub or Plat N-5ingle Family
El Comml. / Ind. 0 A Condo.
• Pavement Cut: �� ees El No
CO-44-1 - 1�
k F-- C?-z- (L
State License Number
' 7-7 (a - 19 2-
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 ftartmepts; or employees, or not limited,to Oie defense of any legal
proceedings including d6ense, 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 per_9K must be available�at �the' s I te for
SignatuXre 9—
Owner or Agent
purposes at all times.
-,�'--7
THIS PERMIT MUST BE PCfSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: V
Special Conditions: -
Ammendments:
Permit Fee: -n 0--g�
Security Deposit: — AJCP.A e- Pee
Receipt No.: S -9 U
Fund III Fee:
Street Cut Dimensions
Q"L I X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
c 0
17r 0 V'41
(f Z>
14
See, +40 44wmaop-�,
;9,
11
The City of Edmonds Side Sewer Drawing EASEMENT NO. � ---- ---- -------------- ------ -----------
NEW CONSTRUCTION REPAIRS LID NO . ............... .. ASMT. NO - ------------
OWNER -- ------ c: 2:! CONTRACTOR ---------- <f 3.-Nt-4EEX�- ---------------- -------------- - ---------- PERMIT NO. .4:Z�Z47
JOB ADDRESS ...... --f-STPwrl� ---- ----- LEGAL DESCRIPTION: LOT NO - ----------- -------- ------------- BLOCK NO - ------------------------------------
............. I .............. ........... ------------------------ ----------------------------------------- ------------------------------- ------------------
NAMEOF ADDITION -------------------------------------------------------------- --------------------------------------------------
DATF - --------- ...... — By
PWVV-0001 - 11/75 (R EV. 11/78)
C CITY OF EDMONDS
I� "" * " RW FOR INSPECTION CALL
PUBLIC WGRKS'DEPA r i
775-2525 Ext. 220 Issue Date '3 -X--
SIDE SEWER PERMIT
PERMIT MUST BE POSTE
7AEWAW,� A�
1. Address of onstruction 9-q f) tArl A., n C
2. Property Legal Description (include all, easements)
3. Single Family Residence k,�--!'-Multi-Family No. of Units
Commercial 0 F-3
4. ewnex-and-/or Builder PrA Co v-A — �Tn i nnr a K Cei-vist, i, o.m -1.,4 -116,4
5. Contractor & License No. RF=-QP-D-T-r--7a1Lf'yi 0
6. Invasion into City Right -of -Way: No Yes 57- (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
E-q 7. Cross other private property: Yes No bl'--/ Easement required -
attach legal description and county easement number.
1.4 READ THE FOLLOWING AND SIGN:
04
P4
4 a. Property owners must obtain a permit to install side sewers on
�H 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.
�4 C. Commercial establishment requires a minimum of a six inch (6")
04
z side sewer line.
0 d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
0
e. Side sewer lines mustbe laid at a minimum grade of 2% (1.15
0 and maximum grade of 100% (450). 0
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.
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 hoursonly. Two (.2 working)
days notice required.
DATE:
.,I-'bdrtify th&t-'I have read
,/and shall co"mply with the above
�.AWAWAWA
PERMIT FEE: rt,�Q,-A SAPP ROVE D BY: Date:
By: Date:
CONNECTION FEE: -Uo7-L—ttUaate:
APPROVED By : tkn--4.-dL & 1 "7!�_
0 a / -t .- - --
PERMIT MUST BE P OSTED ON JOB SITE
CITY OF EDMONDS
% FOR INSPECTION CALO
PUBLIC WORKS DEPAPTA *Per'niit N? - -62 - 7
SIDE SEWER PE.kMIT ' 775-2525 Ext. 220 Issiie'Date
PERMIT MUST BE POSTED ON JOB SITE * q
1. Address of Construction Py eAAA
2. Property Legal Description (include all, easements)
3. Single Family Residence Vl--Multi-Family NO. its
Commercial "i1i -At X
4.
Owner a r Builder
5.
Contractor & License No. RE - 0 C-
- 01- C-Z-2
I LM (j
6.
Invasion into City Right -of -Way: No Yes 1,�
(If Yes Right-of-
way Construction Permit Required -
Call Dial Dig
(342-5344) before
excavation).
7.
Cross other private property: Yes
No V/"�Easement
required -
attach legal description and county easement number.
READ THE FOLLOWING 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.
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 00")
to any structure. 0
e. Side sewer lines must be laid at a minimum grade, of 2% (1.15
and maximum grade of 100% (450). 0
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 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 hour only. Two orki
days notice required.
DATE:
IUD 1 EN
certify : a-t—I have read
_�ly With the above
and shall �Km
PERMIT'FEE: S S-C%b
CONNECTION FEE:
TSAPPROVED BY: Date:
By: -Date:
APPROVED By: Date:
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PERMIT MUST BE POSTED ON JOB SITE
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IC 14ORKS DEPAIZI= CHECKI-ft
BUILDING PEPMT REVIEW
I /,?-/ V- 7 R Date
-5-
30 14�oAddress
Street Right -of -Way Existing REQD
Access Easements Existing "ON TE- REQD
Utility Easement -Existing -r-lo N E=— REQD
Lot per Subdivision Plat Assessor.Map
Site Plan Checked for Accuracy 1Z.-ty-1v
Underground Wiring Reqd.
Check Accuracy of Legal Description
Environmentally Sensitive Area
Environmental Checklist Reqd.
Flood Hazard Zone
Shoreline Management Area
Slope, Soil, Vegetation
Strea.m, Creek, Drainage Basin
Existing Zoning Per Code
Amenities Design Board Approval Reqd. Tj() ADB # Approval
Board of Adjustment Approval.Reqd. r-4 0
Review By: Date:
ntsAt�ingg W�at6r �'M�aiinn �Sizzee
Water Main Reqd. NA
Service Line Reqd..
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Hydrant Size Existing
Hydrant Reqd. Per Fire Code Size
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Comments
Water Meter Charge Reqd.-
Review by:' ZRj-,r-e -;P� -
Date: / 4 - //.,;- / -75 �;
JV--jJL-L%.. ICLLLL-, Lit--b.L6LI LippLuveu Date:
Septic Tank Permit Reqd.- Permit No.
-ibility Proj
Sanitary Sewer Availc
Drawing No. File No.
Side Sewer Availability
W Sanitary Sewer Connection Fee Reqd.
Review By:
Date:
TUILDING DEPARTME
4P Applicant Fill
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USE
ZONE
side Heavy Lines
PERMIT APPLICATIO
JOB
ADDRESS 4�m L 0 Cr, W
NAME (OR NAME OF BUSINESS
1% 1 ), A-' f-?l C (C (",I
MAILING ADqRESS
LEGAL LOT
PLAT NAME
SUBDIVISION NO.
PUBLIC RIGHT OF WAY PER QRDINANCIK Ka.
EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY
DEFICIENCY OF RIGHT OF WAY _0
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CITY
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TELEPHONE NUMBER
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ADDREfS
STREET/UTILITY WORK REQUIRED givas No
PERMIT FOR WORK IN PUBLIC R/W UVES ONO
UNDERGROUND WIRING REQUIRED OVES SNO
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CITY
TELEPHONE NUMBER
CONNECTION TO SANITARY SEWER i0vas D NO
SEPTIC TANK PERMIT REQUIRED Dyes 01 NO
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NAME
SEPTIC TANK PERMIT
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ADDRESS
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SEE MEMO DATED
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CITY
TELEPHONE NUMBER'
REMARKS
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�STATELICENSE NUMBER
CITY LICENSE NUMBER
C H E C K E
F--,OLL I C -)� Zia q B
Legal Description of Property (Show Below or Attach Four Copies)—
m E�SER,. SIZE
BOILDING SUPPLY SIZE
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REMARKS IF;tZt...55 L)
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SIGN AREA ENV. REVIEW ADO NO;
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ALLOWED PROPOSED COMPLET EXEMPT
SHORELINE
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REMARKS
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VARIANCE OR CU
NING REVIEW BY
DATE
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YARDS .
COVERAGE
GAS
NEW RESIDENTIAL LINE
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NON-RESIDLENT]IAL SIGN
ADD
EDDEMOLISH RETAINING
DWALL
ALTER EXCAVATE FENCE
EJ OR FILL I— X—F-rl
FRONT SIDE REA
�LOT
FIRE_ ZONE
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TYPE OF CONST UCTION
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cooff
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HEIGHT
SPECIAL INSPECTOR JAREA
REQUIRED
D YES A NO
OCCUPANCY
GROUP
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OCCUPANT
LOAD
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
El REPAIR PRE -MOVE swim
1:1 INSP. E] POOL
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
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NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
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NATURE OF WORK TO BE DONE
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PLAN CHECK FEE
VALUATION
FEE
PROPOSED USE
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PLOT MAN IINDICATE BUILDING SETBACKS.
ABUTTING STREETS)
BUILDING
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"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold harml ess
the City of Edmonds, Washington, its officials, employees, and
agents from any and all claims for damages, of' whatever nature,
arising directly or indirectly from tile issuance of' this permit. Issu-
SIGN
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RETAINING WALL
SWIMMING POOL
01
ance of this permit shall not be deemed to modify, waive or reduce
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any requirement of any city ordinance nor limit in any way the
City's ability to enforce any ordinance provision."
CITY OF EDM'0*NDS
PUBL C RKS DEPARTMENT, ENGINEERI DIVISION
APPLICATION -FOR RIGHT-OF-WAY CONSTRUCTION PERMIT
THIS PERMIT MUST BE AVAILABLE.AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to.Complete Parts A and B
A. Permit to be issued to.: Snohomish Cou'nty PAJ.D. #1
For Work at:(address of vicinity) .5 3 D KLb 'Vc
/wo �N citalk
C-D 9 %TIt-
Type of Work to be done: Tq'� t &J �_vk Va OA-1
-(attach drawing when applicable)
Time Required --_.St'art: 1:-day Finis
.Owner: �Snohomish County P.U.D. #1
Name
21018 fiwy,:99
Mai ling ' A I ddT'ess
Lynnw6l'od.' IVA 98036 774-2112
City State Zip Telephone Number
.Contractor: same as.above
Name State License Number
Mailing Address
City State Zip Telephone 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, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any 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 1ollowing 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 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.
I understand that this permit must be availa at the job site for inspection
.purposes at all times. � 1 /7 A n
Signature:
Ownerfor Agent
Date:--o —JJ --? 9-
TO BE COMPLETED BY.-I-SSUING AGENCY:
Date Iss.ued: Z
Permit No.: 7 5�- Fee:
Security Bond: A-i 11�1
Time Authorized:
APPROVED B
Date: