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651 MAPLE ST
BUILDING DEPARTMENT
PERMIT APPLICATION
NATE (OR NAME OF BUSINESS)
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Inside Heavy Lines JOB
ADDRESS s
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Legal Description of Property (Show Below or Attach Four Copies)
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PUBLIC RIGHT OF WAY PER ORDINANCE NO.
EXISTING RIGHT OF WAY
PROPOSED RIGHT OF
DEFICIENCY OF RIGHT OF WAY
STREET/UTILITY WORK REQUIRED
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PERMIT FOR WORK IN PUBLIC R/W
INVES
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UNDERGROUND WIRING REQUIRED
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CONNECTION TO SANITARY SEWER
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SEPTIC TANK PERMIT REQUIRED
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SEPTIC TANK PERMIT NO.
SEE MEMO DATED -7 721.
REMARKS
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BUILDING SUPPLY SIZE
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ALLOWED PROPOSED
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TYPE OF CONSTRUCTION
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SPECIAL INSPECTOR
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NUM13ER OF
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NATURE OF WORK TO 13E DONE
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PLOT PLAN (INDICATE BUILDING SETBAL;Kb,
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0 "Applicant, on behalf of his o . r IlCr SI)OLISC, heirs, assigns and SIGN
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(r al!ems I - ro!it :my alld :111 clainis for danjages of Whatever nature,
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OCCUPANCY OCCUPAI
GROUP LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION
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MEMO TO:
FROM:
SUBJECT:
Date 4-VA
Building Division
Community Development Department
Engineering Division
Public Works Department
(42 � I AAA RLE - -na -,
After review of the subject building permit application, we have the
following -comments:
XT Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is the
responsibility -of the contractor.
,<7 The contractor is required to keep the abutting -streets cleaned
of dirt and debris caused by the construction.
The "Right -of -Way Construction Permit" is tequired, from the
7 Engineering,Division of Public Works, for any work within the
Public Right -of -Way or*public easement.
7ZDriveway slope notto exceed 14%.
- Connection to sanitary sewer required.
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7 Septic Tank Permit required, submit design.
Fire hydrant required, submit design.
Site drainage per code # See approved plans
/_7 'Curb /_7 Sidewalk ?C7 Paving required
/_7 Bond required for public improvements. Submit cost estimate.
Underground wiring required.
/_7 Approved Engineering Plans required when applicable.
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rF.- Herzberg, P.E.
City Engineer
Department of Public Works
Rev. 7/78
PUBLIC 14ORKS DEPARIMENT CHECOST Date.
BTinDiNG PER,,aT REVIEW
Address
Street Right -of -Way Existing C:)
REQD
Access Easements Existing
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,ptility Easement Existing
REQD
Lotper Subdivision Plat
Assessor Map
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Site Plan Checked for Accuracy
Underground Wiring Reqd. zt�
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Check Accuracy of Legal Description
Environmentally Sensitive Area
Environmental Ch ecklist-Reqd.
Flood Hazard Zone
Shoreline Management Area
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Slope, Soil, Vegetation r4c)
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Stream, Creek, Drainage Basin
Existing Zoning.Per Code.
Amenities Design Board Approval Reqd. z-�M ADB
# Approval
Board of Adjustment Approval Reqd.
Review By: Date:
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- - - - - - -- I - - - - - - - -
Existing Water Main Size
Water Main Reqd. 4) 0
Service Line Reqd.
Hydrant Size Existing 0 <-
Hydrant Reqd. Per Fire Code Size
Detector Check Meter Reqd.
Cross Connection Inspection X.)O
Fire Department CaTments
Water Meter Charge-Reqd.
6w by: Date:
eptic T sign prove ate:
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Avail6ility Proj. 4-'J'C> :9.91
Drawing No. File No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd. 41-)&Oze
Review By: Date:
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bpeii Ditch Existing,,&-
Reqd.
Culvert Reqd. A,. Size
rN4 -C a tch Basin Reqd. Indiczite,on, Site Plan
0 Sl,i,ouldcr drainage niaintain collection on s�%7ale open runoff
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InTicate on Site Plan
.-I-Uil�ff rcqd._
Soil Conditions and Ground Water Field Checked
Reviea by� Date '1114 /4��
Street Paving Req'd.
Curb and Cutter Reqd.
Sidewalk Reqd.
Curb Cut for Drive�,ray Reqd.
0� Right -of -Way Construction Permit'� Req�.
Bond Reqd. for Public Inproven-ents
Strbet.Nan)e.Sign,Reqd.
10ther Signing Reqd
Pre Permit Site Inspection made on
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BY: SD,.1ER
WATER
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STREET
El GINEERING
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Special Requirements listed in memo to Com=ity Development Department,
Building Division
BY Date
All items filled in on Building Permit Application
BY Date
Drawii*s Staimed and Notations Made
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Approved by Public '%,!oH-,s Deparniv-nt
Revised: IV 10-1977
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STREET
L WORKS--DEPARTMEt4T..,,ENGINEERING DIVISION
FILE
N FOR RIGHT-OF-WAY CONSTRUCTION PERMIT'
ATEL I CAT I Of
TRISFPERMIZ MUST BE AVAI-LABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B,
A. Permit to be issued to: Snohomish County P.1J.D. #1
For Work at:(address or vicinity)
IP 4) 1A L_ YZ'711�_ tL
Type.of Work,to be done: '74Z.\-F -AJ L \A
(attach drawing when applicable)
Time Required -- Start: 1-day Finish:
Owner: Snohomish County P.U.D. #.I
Name
21018 hwy 99
Mailing Address
. Lynnwood, IVA 98036
�City State Zip
77/4-2112
Telephone Number
Contractor: same as above
Name State.License.Number
�Mailing Address
City State zip- Telephone.Number
B, INDE1,1NITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any in I juries, damages, or claims of any
.kind or description whatsoever, foreseen or unforeseen, thatomay 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 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 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 available at the Job -site 'for inspection
purposes at all times.
Signatur,-6.— Date:
Owner or Agent
C. TO BE COMPLETED.BY ISSUING AGENGY:
Date Issued: Fee:
Permit No.
Security Bond: —
Time Authorized:
APPROVED B
1.:0 - 1 7 1 - f D ., _ -r - - A N '---
Date: