6914 163RD PL SW.PDFlill lill 11
875
6914 163RD PL SW
CITY OF EDMONDS
ASSET INFORMATION SHEET
12/NEW
ADDITION
RETIREMENT
ASSET NO.
ADDITION TO ASSET NO. -
DESCRIPTION
SERIAL NO.
LOCATION
I - -J
DEPT NO
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
B.A.R.S. ACCOUNT NO. :�Z01--l000
ESTIMATED LIFE
INITIATED BY
DATE
PROJECT NUMBER �22 ;= 0-=a!
PROJECT COMPLETION DATE
COST �ZZ-. -2,:?
APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
[�<DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
e�// G.L. ENTRY REFERENCE DATE
kyp-) INITIAL
DEPARTMENY FILE
VERIFIED BY
PROCESSED
BATCH NO.
CITY of EDMONDETREET FILE S I DE* SEWER PERMIT
-;r
co
For Inspection Call 771-3202 PERMIT NO. UYU6 WO
Address of Construction:
Property Legal_Descriptibn (Include all ease ments):
/ ' t r- A*rg-f 0 60 d a / 65 7-7 /-S
Owner and/or Builder:
Contractor & License No: /7 e- 475 ).AA 0,5
Single Family Residence BE_qF,1VX9Q_
Multi -Family (No. of Units
Commercial (No. of fixture Units pOBLIC ORKS
Invasion into City Right -of -Way: No 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 Yes (If Yes, easement required,.
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
have read -and shall comply Yate
with the items listed on the back.
N
Permit Fee: _k- C)C)
Trunk Charge: 00
Assessment Fee:
Partial Inspection:
Issued By:
Date Issued:
Receipt No.: vo
Comments Date Initial
Final Inspection Approved: E. AKAU
J STU )AP F
Date I itial
Rejected:
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
EASEMENT NO - -----
----------
----------------------
NEW CONSTRUCTION V] REPAIRS F] LID NO - ---------------- - _ASMT- NO - ----------------
OWNER RM,A CO-NIS-V-1-k%�1c A x ----------- CONTRACTOR --- A.,L_L_lS_D ---- JC�� -an r__K"OF - ------------- PERMIT NO.76-779-
JOB ADDRESS --co -A -------- L63-` ------ P-L -------------------- LEGAL DESCRIPTION: LOT NO. ____V0 ---------------------- ----- BLOCK NO. ___ EEEE�fl
----------------------- ............ I ------------------------------------------------------------------- -------------- -----------------_ --------
NAME OF ADDITION -----------------------------------------
G%4 VSPZ PL.
0
3'
5,Dp 13: pum.
4,*vLQrWvF_
2-2. se"a I I
,0,11; --ce`
v
If.
PWW-0001-1 1/75 (REVA 1/78)
DATE+,Z_A6,B87 ..... -,,Ze aj4��/
E, - A ......
4's=pF
NOTICE:
No warranty of accuracy.
The information shown on the attached map(s)
was compiled for use by the City of Edmonds,
its Employees and Consultants. The City of
Edmonds does not warrant the accuracy of
anything set forth on these map(s). Any person
or entity requesting a copy should conduct an
independent inquiry regarding the information
shown on the map(s), including, but not limited
to, the location of any sewer stub shown. Such
sewer stubs may or may not exist and may or
may not exist at the location shown. Neither
the City of Edmonds nor its employees or
officers shall be liable for the information given
on map(s), nor for any one representation
provided based upon said map(s).
PFA7ECT REVIEX amCKLIST
PFIDJECr NAME: A491Y16Y Prdkn= AMRESS:
APPLICATION RECEIPT DATE:
Reviewed by: Uni
ccm%oqisl
PLANNINIG
WIR/SWR STRZEET
FIRE
BUILDING
SI=2 FAMILY/MULTIPLE/COMERCIAL - (Circle One)
SEMACKS CHECM - Planning
VARIANCE/SETBACK ADJ.
1111711
TRIT11TU
CUMITICNAL USE PERMIT
2
77777/
171-77TFI
ADB EQgRDOM CH19CXED
0/m//
3
1117777rR
I T-
OTHER ZONrM REQUIREMENTS
11kV11111
111177
-E-71-
ENVIRONMENTAL FTATURES
//////
/////////
-
5
ACCESS SLOPE VEHICLE ACCESS
J*
77777T/777777
OV/11 1////
/////////
1711111
////////
6
77777777
DRAINA(Z PLAN (On Site) V
7
111117
11777TI7
STREET FILE
////////
-
1
8
7/ 7-777ff
TR 7 7 7 7 /
7R77777
LWAL DESCRTT-`TI(V VFJITFICATION
9
'7M
777R7777
MIT CIAIMIDMTCATIONS
/////////
-fm1111
10
EASEMENT - 111MLIC/PRIVATE
7777,77777
/////////
77777=
////////
1
11
CATMATE MM CIONNEVI* IF NO LTD#
117111111
/////////
-7
12
111171
77TI777T
77TI777T
PLAT/SUBDTVISTON LffUIRDOM
13
RTCJ1T-OF-WAY CONSTRUCTION PERMIT REM
14
777/777/777///////
3= REOD FOR PUBLIC IMPROVE14UM
15
SOILS OCINDITICUS & GTOM
1111111T
,&VER FlEfD C11ErKED
16
SIMP PAVINrl REQUIRED
17
71111?
aW AND GLM" BMTRM____
//////
18
SIDEWALK RBMIRED
777PT
19
7777777M
CURB CUT FOR DRIVEWAY REDD
20
177111111
77M7777
TMEET NAME SIGN REQD -
/////////
/////////
/A
2'1
'77777
111171111
1 -1
11TR797
001ER SIGNIM KLD-
22
SIDE SEWER AVAILABIL ITY
11111111A
11111771.
23
EXISTIM WATER MAIN SIZE
171711
24
WATER MRTER SIZE
25
SERVICE LINE SIZE
1111711
111111111.3
o
26
7777777777
ffYDRAN'r REOUIRED
27
111-771
TM//////
MMW SIZE EXISTING
/////////
s,4"
28
-//////
MISS CONNECTION INSPECTICN REQD
777T/7
?
29
77777
7TF111TF7
aTER MMER CHARGE REOD
30
771111111
FIRE LIM CHARGE REOD - SPRINKLER
31
3TREET CUr
32
)PEN DITCH EXISTIM
33
'777/77
34
77777TR
)MVERT REOD
'7T
35
/7=-
SIZE
-,Iw
36
MICH BASIN REM
%,AV
/ A\
37
INDICATED ON Sn% PLAN
VV
38
*KXUJM DRAINAGE MAIRrArN
SHALE OPIN MAO?
39
,USC:
/////////'7TI7=
140
IEVIEM BY:
PLANNING ENGINEERING MGR. PLMIAC WORKS MGR.
ubt — PERMIT
CITY OF EDMONDS ZONEJij�S. NUMBER
CONSTRUCTION PERMIT APPLICATION JOB .
NAME (OR NAME OF BUSINESS) ADDRESS
6 IZ/�/ 16&eo P,1-6e,6 wokg,
GALDESCRIP - N CHECK SUBI5FV_1S1ONNO. LID NO
MAILING'ADDRESS W /0
1196,9-3 2 2 / 57- _�5W
CITY TELEPHONE NU;
STATE LICENSE NUMBER
1-71 b
Legal Description of Property - Include all easements
(show below or attach four copies)
1 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING -10 REQUIRED DEDICATION
PROPOSE6��
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
STREET USE PERMIT REQUIRED 0
SEE ENGINEERING MEMO DATED
1._14-1?11 1
METER SIZE IBUILDING SUPPLY SIZE IFIXTURE UNITS
SIGN AREA ENV. REVIEW ADO NO.
ALLOWED PROPOSED COMPLETE I EXEMPT
1� - HOREUNE#
CIF rj_
—
e 7- PeZv
7-
VARIANCE OR CU
PLANNING REVIEW BY
DATIt
YARDS
7
FRONT ;: 5 SIDE RE
HEIGHT
I LOT COVERAGE
Z
Z
REMARKS
MA)((�AU�A HT ArUCUEt-_>
[_Q�_
F4':;K
L=�J NEW
ADDIALTEA
REPAIR
E] DEMOLISH
REMODEL
LU RESIDENTIAL
COMMERCIAL
RETAINING WALL
EXCAVATE
1:1 OR FILL
PRE -MOVE INSPJ
El COMPLIANCE INSP.
R PLUMBING
MECHANICAL
SIGN
FENCE
El ( x _FT)
S ;_M
El POOL
_�;Q G7, 0
CHECKED BY
TYPE OF CONSTRUCTION
17:—/1/
CODE
1 /Y-6-
HEIGHT
:��
SPECIAL INSPECTOR
REQUIRED
D YES 0 NO
AREA
OCCUPANCY
GROUP
OCCUPANT
LOAD
WOOD STOVE/
INSERT
[:] APT. BLDG
r_1 RENEWAL
REMARKS
NUMBER OF STO RIES
[NUMBER OF
DWELLING
U U NITS
NATURE OF WORK
TO BE DONE (ATTACH PLOT PLAN)
44; 11,22-
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY.
Any construction on the public domain (curbs, sidewalks,
GRADING/FILL
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
_�ermlt
Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
ENERGY CODE
"Applicant, on behalf of his or her spouse, heirs, assigns and
successors In Interest, agrees to Indemnify, defend and hold
harmless 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 the Issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
wiluuIly.. Wdly or reduce any requirement of any city ordinance
nor limit In any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz-
ed thereby, no person will be employed In violation of the Labor
Code of the State of Washington relating to Workmen's Compensa-
ATTENTION
THIS PERMIT
AUTHORIZES
ONLY THE
WORK NOTED
tiQn Insurance...
INSPECTION
DEPARTMENT
CITY OF
SIGNATUFVE (OWNER OR AGENT4 JDATE
S19NED
EDMONDS
771-3202
ATTENTION
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged In space provided.
OFFICIAL'S SIGNATURE DATE
RELEASED BY:
DATE
17 IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
MEMO TO: Building Division
FROM: Engineering Division
SUBJECT: "Ifz�
After'review of the subject building permit application, we have the
following comments:
1) Connect ion 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 not impact neighboring properties in any
way.
8) Construction hours from 7:00 a.m. to 10:00 p.m. on weekdays and
10:00 a.m. to 6:00 p.m. on weekends and holidays.
f-
AP
4!
fo
S71-
tFUEAkI
Yl
I
+� w we
All
I
14 R*-
A4-