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Ri�C=IVED
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PERMIT COUNTFR
DATE: /009
MEMO TO: Permit Coordinator, Building Division
FROM: Dan Smith, Engineering Inspector
ADDRESS:
OWNER:
After review of the subject building permit application, we have the
following comments:
1) Construction hours are: WEEKDAYS 7:00am to 10:00pm
WEEKENDS/HOLIDAYS 10:00am to 6:00pm
2) A Right -of -Way construction permit is required for any work on
City property.
3) Connection to City water system required.
4) Connection to City sanitary sewer system required; obtain separate
permit.
5) Water and sewer lines to be separated by 10 foot minimum.
6) Driveway must be paved a minimum of 20 feet back from City
right-of-way; separate permit required.
7) , Driveway slope not to exceed 14%.
8) Back water valve required if downstairs plumbing is below
elevation of upstream manhole.
9) Builder/Owner responsible -for containing all temporary runoff and
erosion control.on site. Construction may not impact neighboring -
properties in any way.
10) No burning of construction refuse without approval from Fire Dept.
11) Street to be kept clean of debris, dirt, mud, and construction
materials.- Contractor responsible for dust control.
12) Inspection required on drainage system, catch basin -installation,,
driveways, and sidewalks. A final engineering in.spection is.
required prior to the'building division granting occupancy:
CITY OF EDMONDS
ASSET INFORMATION SHEET
RNEW
1:1 ADDITION
El RETIREMENT
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION
Al'o.
DVT NO
A/
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
PROJECT NUMBER �64,-;�� o
PROJECT COMPLETION DATE _4� �,--
COST :?-e /1 41-7
B.A.R.S. ACCOUNT NO. 50/
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
Ee/DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE DATE
ttnp INITIAL
DEPARTMENT FILE
VERIFIED BY
PROCESSED
BATCH NO.-
j." ��
C I T Y of EDM ON DS S I D E
For Inspection Call 771-3202
Address of Construction:
,3 re) - 1011ve
Property Legal Description (InE lude all easements):
Owner and/or Builder:
Contractor & License No:
SEWER PE.Rfl,[T
PERMIT NO.
Singl:e Family
Residence
Mul ti-Family
(No. of
Units
AEDPJO��IDS
TrV1E1 r P
TREATMEN LANT
T PLANT
Commercial
(No. of
fixture Units
Invasion into
City Right -of -Way:
No —L.,z Yes
(If Yes, Right -of -Way
Construction
Permit required.
Call One -Call -Center (1-800-424-5555)
before any
excavation.)
Cross other Private Property:
No /111�Yes (If
Yes, easement required,
attach legal
description and
county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
1Z . RECEIVED
44 A rle�
I (�6rtify that I have read and shall comply MAR.3 11589 Date
with the items listed on the back.
PUBLIC WORKS
Permit Fee:
Trunk Charge: 2-5
Assessment Fee:
'Issued By -
(Date Issued:
Receipt No.: /0/77
Partial Inspection:
Comments Date Initial
Final Inspection Approved:
' Date InitiAl
co
Rejected:
CD Reason Date Initial
PERMIT MUST BE POSTED ON JOB SITE
Wh-ite Copy - File Green Copy -�Inspector Buff Copy - Applicant
Side Sewer Drawing
The City of Edmonds EASE E T NO
- --------------------------------------------
NEW CONSTRUCTION Rf� REPAIRS LID NO - ------------------ - ASMT. NO - ------------------
OWNER------------------------------------------------------------------------------- ---------------- CONTRACTOR ---------------- -------- -- ................... PERMIT NO.
JOB AD DRESS ..('105-Lt ------- ------- ............... LEGAL DESCRIPTION: LOT NO - ----- A -------------------------- BLOCK NO - ------------------------------------
0
01
PWW-0001-1 1/75 (REVA 1178)
NAMEOF ADDITION -----------------------------------------------------------------------------------------------------------------------
4! Pi-e-
4 3>
q/
4 ��
Approved:
DATE ............... By
---------------------------------
CITY OF EDMONDS
USE PERMIT
ZONEgS_6 NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
p4/
OWNER N�,E"/NZ OF BUSINESS
. \4_�%M__ (_e k �_
LEGAL DESCRIPTION CHECKI
SUBDIVISION NO.
LID NO.
cc
W
Z
,
MAILING ADDRES
-19 -8-7
C-�e 11-7
0
P�ox
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP
APPROVED BY
CITY
TELEPHONE NUMBER
Pa. V*V\ 0 0
EXISTING QUIRED DEDICATION
PROPOSE6,-o"itry
&R4
NAMF
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED.
W
ADDRESS
STREET USE PERMIT REQUIRED:
III
Z
q03SEE
ENGINEERING MEMO DATED REVIEW BY
Z
U.1
CITY
ELEPHONE NUMBER
�eo
_Z
REMARKS
NAME
cjwnle�
a:
ADDRESS
0
METER SIZE
BUILDING SUPPLY SIZE FIXTURE
UNITS
L)
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CITY
TELEPHONE NUMBER
Z
0
REMARKS
<
3:
STATE LICENSE NL,1BER
C \N9
SIGN AREA
ENV. REVIEW
ADB NO.
Legal Description of Property - include all easements
ALLOWED
PROPOSED
COMPLETE
EXEMPT
(show below or attach two copies)
SHORELINE#
Z
0.
Cf)
VARIANCE OR CU
PLANNING REVIEW BY
E7,
DATE
C�
<
SETBACKS — FEET
HEIGIHT
LOT COVERAGE
LU
FRONT 00 SIDE REAR
25,
3s 96
Z
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—r6l\x kC+
REMARKS
2rNEW 0'RESIDENTIAL 1:1
PLUMBING
1:1
1:1
ADDIALTER
COMMERCIAL
MECHANICAL
1:1
E] APT. BLDG.
REPAIR
SIGN
EXCAVATE FENCE
DEMOLISH OR FILL x FT)
CHECKED BY
TYPI� OF CONSTRUCTION- CODE
HEIGHT
— _
CARPORT swim
REMODEL GARAGE
SPECIAL INSPECTOR
AREA
OCCUPANCY
OCCUPANT
POOL
REQUIRED
GROUP
LOAD
FWOOD STOVE/ RETAINING WALL/
_J
El RENEWAL
0 YES L_.' N 0
REMARKS
INSERT ROCKERY
PROGRESS INSPECTIONS PER UBC 305
Z
0
i=
0
IL
Cn
NUMBER OF STORIES NUMBER OF
W
DWELLING
UNITS
0
NATURE OF WORK TO BE DONE (ATTACH PLOTPLAN)
&A 0CC-UA41VCY 2�rL5;W617b"-1kGh
�y
VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
I VIEL I
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADING/FILL
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 Worl� is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns an
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
m
employees, and agents from any and all claims for damages of
a:
<
whatever nature, arising directly or indirectly from the issuance
X
of this permit. Issuance of. this permit shall not be deemed to
PLAN CHECK DEPOSIT
400
a
modify , waive or reduce any requirement of any city ordinance
0 0
.1
nor 1) it in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision .1.
I hereby acknowledge that I have read this application; that the
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-
AUTHOR IZ ES
This application is not a permit until
thereby, no person 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.
Led
SIGNATURE (or ER OR AGE�NT)K
i D TE S G ED
DEPARTMENT
gm,
: ;� 71; If,
CITY OF
OFFICIAL'S SIGNATURE DATE
pli—
EDMONDS
ATTENTION
771-3202
RELEASED BY: DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLOW — Inspector
Ll
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK — Owner GOLD — Assessor
REam OMMUST
PRO= MME I I,.r::F,4
PROJEcr ADDRESS:
kPPLIO&ION RIMPT D=ii`_�
q�
)B REQUIPMENTS CHECKED
MER ZCNING REQUIREMENTS
IVI MENTAL FEATUM
CESS SLOPE &YEHICLE ACCESS 0/&
AINAGE PLAN
On Site)
TaMT FILE
GAL DESCRIPTION VFRipicATicN
IT 0AIMA)MICATIONS
:!77
3EMENT -_-P1lBT,Tr/ppnrAqw
SaM CMNECTION IF NO LID#
UJT-O -WAY CON,
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