6915 163RD PL SW.PDFlill lill 11
876
6915 163RD PL SW
CITY OF EDMONDS
19/'NEW
ADDITION
RETIREMENT
STREET FILE ASSET INFORMATION SHEET
ASSET NO. 4� 76P
ADDITION TO ASSET NO.
DESCRIPTION f)
SERIAL NO.
N
* * PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
*PROJECT NUMBER Z61�7�
PROJECT COMPLETION DATE
COST / ��-
B.A.R.S. ACCOUNT NO.
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
O/DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
itnp INITIAL
DATE
VERIFIED BY
PROCESSED
BATCH NO.
DEPARTMENT FILE
-17
REC91-VED-,
CITY of EDMONDS SIDE SEWER
A I O'RREET FILEmIT NO.
Y
Ift
For Inspection Call 771-3202
PUBLIC W K
Address of Construction: 11J
Property Legal Description (Include all easemeRts):
Lcn- 1�p M&OD�0&11e_ 4C,4qk1fS
Owner and/or Builder: 16 t r P LA N)> H-em o7 5. , I /\1 C -
P E R M IT
I L=_'
Contractor & L i cense NO: Z' I -"I
Singl:e Family Residence 4-S-70
Multi -Family (No. of Unlits
07702
Commercial (No. of fixture Units
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 RE D THE ITEMS LISTED ON THE BACK
1 ceftify that'I have rea3�6nd shall comply Date
with the items listed on the back.
3000 't:) NC'
Permit Fee: Issued By:
Trunk Charge: 7-r. 00 JDate Issued:
Assessment Fee: Receipt No.: (0950
Partial Inspection:
Comments Date Initial
Final Inspection Approved: e#-
Date Initial
00
- Rejected:
C) _ffa- t _e Initial
Reason
PERMIT MUST BE POSTED ON JOB SITE
White Copy - File Green Copy - Inspector Buff Copy - App.licant
4
14
The City of Edmonds
Side Sewer Drawing
EASEMENT NO - -------------------------------------------- � 1.
NEW CONSTRUCTION PV- REPAIRS F LID NO . ...... ........... ASMT. NO . ..................
OWNER ------- 1�� VVI", CONTRACTOR ........ F-��t
z st. '7
-------- --------------- -------------------------------- ..................................... PERMIT NO.
JOB ADDRESS ... ...... ........................................ LEGAL DESCRIPTION: LOT NO. ......................... BLOCK NO . .............. .....................
------------- ......... -------------------------------- --------------
ALL PAb aA!�s k, 6�: r,,,V016� NAME OF ADDITION -------------------------------------------------------------------------- ----------------------- . ....
------- ---
�j
L�,4 I �L OtGn
�7'
L �-
-j-
Approved:
PWW-0001-1 1/75(REV.1168) DATE .................... By
-------------------------
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).
I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
NAME
TELEPHONE I
I!rwj
NUMBER
NUMBER fxnve /o/zq/?7-
Z"EW
RESIDENTIAL
U PLUMBING
ADDIALTER
COMMERCIAL
MECHANICAL
REPAIR
RETAINING WALL
SIGN
DEMOLISH
EXCAVATE
OR FILL
FENCE
'I- x �FT)
PRE -MOVE INSP.J
swim
E]
REMODEL
COMPLIANCE INSP.
POOL
WOOD STOVEI []
INSERT APT.BLDG
RENEWAL
USE PERMIT
ZONE L)O:� NUMBER
r_1
JOB 4
okoDRESS 6 V-5 A
.EGAL DESCRIPTION CHECK SUBDIVISION 10. ILID NC
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING 96) REQUIRED DEDICATION
PROPOSED eZ _4"
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
STREET USE PERMIT REQUIRED 0
SEE ENGINEERING MEMO DATED
METER SIZE IBUILDING SUPPLY SIZE
REMARKS
UNITS
a
Z
,C�C,
W
Z
0
Z
W
Cc
LU
SIGN AREA
ENV. REVIEW
ADS NO.
ALLOWED
PROPOSED
COMPLETE
EXEMPT
W C174
SHORELINE#
el
VARIANCE OR CU
PLANNING REVIEW BY
DATI
YARD!2_5
HEIGHT
LOT COVERAGE
FRONT
SIDE
REAR
REMARKS
IL
CHECKED BY
TYPE OF CONSTRUCTION
CODE
HEIGHT
I
I (q95
I Z-5-
SPECIAL INSPECTOR
OCCUPANCY
REQUIRED
GROUP V3
I
JOCCUPANT
LOAD
0 YES 0 NO
NUMBER OF STORIES
NUMBER OF
L05
0
DWELLING
[UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
6c.c
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
This Permit covers work to be done on privat 0 property ONLY.
GRADING/FILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Api5licatl6n: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
ENERGY CODE
"Appl I Icant, on . behalf of hls*or her spouse, heirs, assigns and
successors In Interest, agrees to Indemnify, defend and hold
harmless the City of Edmonds, Washington, Its officials,
i
Cr
<
0
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
modify,.walve or reduce any requirement of any city ordinance
nor limit In any way the City's ability to enforce any ordinance
provision."
PLAN CHECK DEPOSIT
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 ATTENTION
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and In doing the work authoriz- AUTHORIZES
ed thereby, no person will be employed In violation of the Labor ONLY THE
C de f the State of Washington relating to Workmen's Compensa- WORK NOTED
t� �.InsTranco.. INSPECTION
IGNATU E(OWNERORA EN DATE SIGNED DEPARTMENT
CITY OF
7 EDMONDS
ATTENTION' 771-3202
IT 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.
102-78
C
FEE
S�EIIIIIII
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
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
66*060' rX. r-)O/U/CA5F-
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MEMO TO: Building Division
FROM: Engineering Division
SUBJECT:
x57 z
After review of the subject building permit application, we have the
following comments:
1) Connection 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 wee.kdays and
10:00 a.m. to 6:00 p.m. on weekends and holidays.