7031 156TH ST SW.PDF1111111111
790
7031 156TH ST SW
Cit" of Edmonds
y
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number.
/7- 127
Wue Date:
F A. Address or Vicinity of Construction: 703.1 156th Street SW
GTE to place, operate, and maintain a buried —s7e—rvice
B. Type of Work (be specific): wi re f rom exi sti ng pol e # 6453 1 ocated at 7009 156th
19 9 0 9 Street SW then north to a residence at 7031 156th Street SW. G4E
.0!Wo.p10owf7' feet'
push 1 driveway and push no road, Please see attached sketch. eet.
GTE Northwest Incorporated
C. Contractor: Marilyn Holmgren, Permit CoordinatorContact: Dennis Alexander 771-9036 mobile 388-1358
2312C W. Casino Rd
Mailing AddreSS:FyarAtt_ WA qR204-144n Phone:
State License #: Liability Insurance: _ Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. [-]Commercial []Subdivision F1 City Project E] Utility (PUD,40TE, WNG, CABLE, WATER)
0 Multi -Family Single Family 0 Other GTE W.O. # 2850-9POOlDB 642310
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut 0 Yes QNo G. Size of Cut: x H. Charge$
'Please see attached sket
4 -N
APPLICANT TO READ AN I
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City ofEdmond8 harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may b�.de against the City of Edmonds, or.T� ?f.Jq departments or
I -
reasop bfdrahting thispermit.
employees, including or not limited to the defense of any legalproceedings including defe e—cosla,andattorneyfee86-"
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETEO BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of propo'sed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read theabove statements and understand the permit requirements and thepink copy of thepermitwillbe
a 'I bl at ��,F,.Time,�'*r inspection purposes.
vat a 'e o a
Signatur� y J - David Squires Date: 3/10/97
Joh6Q9r*#ator or Agent) Sec Mgr -Access Design
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY I TqF. ONLV
APPROVED BY: 14LA-JH
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDIT IONS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
PERMIT FEE.
TOTAL FEE:
!�OMMENTS: RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
,� . * -.- 4'
FIELD INSPECTION -NOTES
Comments:
Diaaram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES E] NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
c;
z
A
I'M
70
LEGEND
PEDS
POLES 0
ROAD BORES
OVERHEAD LINES—
I.D. UTILITY POTHOLE C3
JUG TRENCHING --UGT—
THE OLLOWING INFO TO BE PROVIDED
RIGHT OF WAY LINES,EOP OR FACE OF CURB. EXISTING SIDEWALK. POLES, ROAD CUTS AND THE UTILITY UNDER ROAD CUTS.
ABOVE GROUND FACILITIES,(Ie:) PEDS.BOXES,CABINEIS. ETC.,UNDERGROUND TRENCHING AND OVERHEAD LINES.
FOOTAGE OF WORK IN R.O.W.
s-
-1
cn
0
c-
0
1
C,
0
0 oft. —
0qT-TY OF EDMONDS
C
FOR INSPECTION CALL Permit i"Too
.—YUBLIC WORKS DEPARTMENT
7-71-5-2-3-2;-5 Ext. 2--2-0 Issue Date /j, �jq
SIDE SEWER PERMIT 7 7) - 3Z02- . zC19
PERMIT MUST 13E POSTED ON JOB SITE LYNNWOOD LINE
l.. Address of Construction
UJI 2. Property Legal Description (include all easements)
�J c-,,) PY A 7-r-A c-4.1 M
Samos
Lj..3. Single Family Residence Multi -Family No. of Units
.. Commercial
LLk. Owner and/e-r- Builder 8)4.4- k'L4 10�7 Pc -
Contractor & License No. PJ /A
Invasion into City Right -of -Way: No Yes (If Yes Right -of -
CD way Construction Permit Required - Call Dial Dig before
excavation) . 1-800-454-5555
7. Cross other private property: Yes X No Easement required -
attach legal description and county easement number. p7-rA,��qD
READ THE FOLLOWT.NG AND SIGN:
a4
a4
4 a. Property owners must obtain a permit to install side sewers on
>4 their property. A licensed side sewer contractor must be employed to
M -
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")
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 must 0 be laid at a minimum grade, of 2% (1.15
0 and maximum grade of 100% (45 ). 0
E-4 f. No turn in side s8wer greater than 45 (1/81bend) is allowed
between cleanout.' All 90 turns must be constructed of a 450 (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 hours only. :Two (2) working
days notice required.
DATE: /0
I certify that Thave read
and shall comply with the above
PERMIT FEE: DISAPPROVED BY: Date:
B Date:
CONNECTION FEE: bate:Ql Y 7W
APPROVED By:,/Y
PERMIT MUST BE POSTED ON JOB SITE
The City of Edmonds Side Sewer Drawing EASEMENT NO - ---------------------------- ---------------
(fleAC).
NEW CONSTRUCTION E] REPAIRS n LID NO. 9,,10 ------- - ASMT. NO - ------------------
/' ci r
OWNER --------------- ---------------------------------------- CON , MACTOR ----------------------------------------------------- ------------------------------ PERMIT NO.653 I-
.......... 1_5( -r H j� LEGAL DESCRIPTION: LOT NO - ------------- ------------------------ BLOCK NO.
-------------- --- S.W, -----
ADDRESS --- 70 1 -L!!d
T I --------- ------------------------------------------- ------------ -------------- ------------------------------------------------- ------------------------------
9bp. Cc-a-wtor-
C-0. v%p 1.5,pp.
c/)
11/75 (REV.11/7 i )
NAME OF ADDITION --------------------------------- ---------------------------------
SIM
4-c.o.W%F-
C.O.C.Ap l'op
NORT3*--
I,Dp.
Vr-.O.w%JE
45- Be" b
----- -- ------
D A T E G Ct.�, Ay - A84. By"4- al--e: 41 ------------- - -------
UTILITY EASEMENT
IN CONSIDERATION of $1.00 in hand received and other benefits
to accrue to the grantors herein, the undersigned, David F. Olmer
and Denise E. Olmer , husband and wife, owners of Parcel A, hereby
grant to -Willard Kuper and Irmqard Kuper , husband and wife, their
successors and assigns, owners of Parcel B, a permanent easement for
the installation, operation and maintenance of a side sewer over,
across, through, and below the following described property; and the
further right to remove trees, bushes, undergrowth and other ob-
structions interfering with the location, construction and maintenance
of said utility or utilities, together with the right of access to the
easement at any time for the stated purposes.
The easement and right-of-way hereby granted is located at the '
County of Snohomish, State of Washington, and is more particularly de-
cribed as follows:
A ten foot strip of land that is 5.00 feet on each side of the
side sewer as it now exists, or as located in the future.
Within the following described property:
Parcel A:
The West 74.01 feet of the South 300 feet of Tract 55,
and the East 53.88 feet of the South 300 feet of Tract
56, all in Lund's Meadowdale Tracts, as per plat recorded
in Volume 6 of plats, page 26, records of Snohomish County;
EXCEPT the West 110 ffet of the South 115 feet thereof;
AND EXCEPT the South 5 feet thereof as conveyed to the
City of Edmonds by deed recorded under Auditor's File
No. 2032945.
Parcel B:
The North 120 feet of the South 125 feet as measured along
the West line of the East 100.74 feet of the West 174.75
feet, as measured along the South line of Tract 55, Plat of
Lund's Meadowdale Tract, according to the plat thereof
recorded in Volume 6 of plats, page 26, records of Snohomish
County, Washington.
TOGETHER WITH A TEMPORARY CONSTRUCTION EASEMENT OVER THE
aforementioned property. Said construction easement will
end upon the completion of the construction of the side
sewer, or January 1, 1985, whichever comes first.
GRAk7EE
THE agrees to restore to substantially the original condition
such improvements as are disturbed during the construction, maintenance
and repair of said utility or utilities; provided the granto ' rs, their
heirs, or assigns shall not construct any permanent structure over, upon,
or within the permanent easement.
DATED this 7_ day of 19&y
STATE OF WASHINGTON)
COUNTY OF SNOHOMISH)
on his day personally appeared before me
-a� to me known to be the individual (s)
described in and who executed the within and foregoing.�trument, and
h t I— gned the same as
acknowledged t a si
free and voluntary act ald deed—, for the uses and purposes therein
mentioned.
UNDER MY HAND AND OFFICIAL SEAL THIS
DAY OF
19- A/
WV /-,&
1� - FO 6
r
7%j e tJ S AS
Lls- 0
CL FI v
c 'n. C::7
e U L
'IC) 3 1
E/)IrO,Q -4 �'CPO 2-
-7
L rn V�-
-),C- 20 t-, " �
h- ;,:. 71- 0 i--
L G J
0(�
S C) U
0 0 A LE-
7-)f(, 30 L, 7 -/;/ i'
/--5r E 7- 0 r--
/yj F�I j
rWA c7—
A A 71
-7r-Ac-r
I 'A OA --,F AC
a-Ttjee FILE
41 01
CITY OF EDIVIONDS
200 DAYTON ST. - EDMONDS. WASHINGTON 98020 * (206) 771-3202
OFFICE OF THE CITY ENGINEER
August 6, 1982
Tom Hackney
Snohomish Health District
Snohomish County Courthouse
Everett, Washington 98201
Dear Tom:
HARVE H. HARRISON
MAYOR
Enclosed is a copy of, -the drain field as -built
that you requested for 7031 - 156th S.W., Edmonds
If we can assist you further on this, contact
Jerry Hauth at your convenienbe.
Sincerely,
*7EA D &( :, �P�?E
1y En i neer
JH/st
Enclosure
AcTa- M4�lch Dt Jerry Hauth D7F
7--
w 4; . 1. �.
11
I'll
-- ------------
VA
IL
AU %
~Am, , . V, . .. , * L: - , ` -,
411 % f 7
Z
%
AAAkA
vv.&
/.a
448A
�.4
L-2
31601
—we
�T--
7t
77,
lose
x
4
A.14
y�
A
OWNER LEGAL DESCRIPTION
Mr. Mrs. Bi 11 Kuper The north 120' of the south 125'as measured :a I ong' th�' je$ ne*.'
5702 227th St.'S.W. of the east 100. 74' of the -west 174 .75' , -as'M'Gaiured . Sjong',the
Mountlake Terrace, WA south line of Tract 55, Plat of Lund's Meadowdale Trict;:a�cordln
Phone 774-5218 to the plat thereof recorded ih Vplume' 6 of Olats, paqi .266'.
records of Snohomish County, Washington.
DESIGN-bATA
m i-n/ i Insfal-ted with Hydra-Matic #OSV-33
�Rate� 5.0 -n*
Install 1.000 gal. septio tank
PERCOLATION & SOILS DA7A: See attached 0.
Install 170-51-f - x 3' wide dit�hes.
14 sq.
5 7/'.
Total drainfield. area f t AS BUILT, PLAN -:-' FOR...
12" of select fill mat-erial shall be
infield after in-* MR. 'S MRS. BILL'KUPER.
placed over the d;a
stallation and�approval.
IN
The system shall be instafled in accordance EDMONDS WAew1wQTAu
with-City/Ed , md , s
Health Dept.
.r*ules & regu-
lations. -
Re4e. 7&44acaa
11TI.//
rjj�g NO.
zz
ENGINEERS e SURVEYORS 9 PLANNERS
C H
.L�je
--
*CALK
- 0
324 Main Street , Edmonds, Washington 98020
AA
0 Rf CITY OF EDMONDS*
D
:-PUAC W EPARTMENT,, ENGINEERING DIVISION
L&LLLC
ST R, EET-4F I _A�TON �FQR�TGH�T-QF�- �CQNST_) RUCTION -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: -S.IVO a AD.
For Work at:(address or vicinity) -7o3j 1,57e
S7- S.
ar 9S2601
Type of Work�to be done:
.(attach drawing when applicable)
Time Required -,Start: Fintsh:
Owner: 41. L?
b Fa-m e
949
MT11ing Address
go� (0,yAl O!e, 664v 5w36 -77-6 - 211Z�
City -State Zip Telephone Numberl
Contractor: S41WAE
Name State License Number
Mailing Address
City State 2ip 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, orAny of its departments or employees,
including or not limited to the defense of any legal proceedings includin'
g 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 ac\ceptance
.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., ex.t..220.
understand that this permit must be available at the job site for inspection
purposes at all times.
Signature: 14. 41?W09Z�-- Date:
Owner or Agent
TO BE COMPLETED BY IZSUING AGE-NCY:
Date 4ZI,
Issued: Permit No. F e e
.Security Bond:
.Time Authorized: _�F,0
APPROVED B
in-771i, _f0_4__AN
D
a t e
.414
1018
.FR�v. 1.017Z. PUBLIWTILITY.D.ISTRICT No.Lj af OMiS untv- LA T �:(_AREA
-7o
Location H
7 q W.O.'No.
-N-W-1/4 Z5 5 T_ !t R Revision 'Scale -7
-Reason for work =N �;r
Engineer AsBuilt
U.G.FileNo. —
PERMIT REQUIRED FOREIGN CONTACTS
Type C_ I _r Y c_- T= Company L-it-r-w,
J.P.N.No.
Date Granted- d Yes(R NoO',
- .1 . Fees require
Transf.Cardl I Pole Dept. I D`a`te_!Zj�Amount 2) S,
Map Post;R—rc—ir—cuit Moo! i
Approvals
EMENT ENVIRONMENTAL APdAlycle
Grantor
Datetranted
Exempt under District. SEPA
.procedures, Section III -A
Paragraph J�� Item_::�_ I
Date '/Jl- By
Interpretation -Referred To.:
Date Released For Construction - Date —By
Date Work Completed BY Foreman
Circuit. Numbe Substation O.H. U.G. Cond—
Add
;lRemv--,,,----Ckt Ft
Ne.t_=L C*t Ft
70Z S
70-314
77. f-, .\A/.
( R-z
WV0TWr
Sewer
Gas
Backhoe
L—PH
N�
-P
. . ................
oi I -
(A
N, a_�,T__ I+ A Kj M
_7
V�_;, 7 T �.Zo T::> T !E-r�
�--j IL> I KJ �74xL_�L, e--�.s �717r, Z::j
��) ;� I? I - -, i
W.O. No. �_ -1 *�Wf I
0
6 .1. i , k.) , 1, 0 1 1 0 k"J J ,-,
PUBLIC WORKS DE.P&MEINT OENGINEEIRINC, DIVISION
PUBLIC WORKS ENV-11"ONMEENTAL REVIEW
I
NAME: cup-92-
LOCATION: � 0 1 Z�rr a)
STREET
FILE # FILE
E] SUBDIVISION PLAT [-I P.R.D. D HULTIPLE F 1,,11'7'RCIAL
] COMM
AN ENVIRONMENTAL REVIE14 OF THE PROPOSAL HAS BEEN -COMPLETED
AND THE FOLLOWING DETERMINATIONS HAVE BEEN MADE:
caa ',5 c--- yj A c-_ a
�) ,
S7 7 0 -*V-1 A PC) Z, f-=)D U ) L
Ac - ?
ALL-
4V—F— izi�\c _,D
t 7�� A�k=
IP-Q rv----L-m P
:�_cz�
L c t:A
an, LL-1, Z e--- Yz",J� 1;�
N
f FL-'k—L-
c:�:�
Tc)
_14Q0 _M_
PREPARED BY:-. DATE:
P.
BUILDING DEPAR7 T
USE I
vwpu I? M I I Iw I s1himlow 5 9 0
'�
Applicant Fill
ZONE N UM IJC it
PERMIT APPLICATION
inside Heavy Lines
1 0— 1
'Ola -rL. &. d.
ADDRESS 0).
NAME (OR NAME OF BUSINESS)
A4J T K,-4
LEGAL LOT
PLAT NAME
SUIJDIVISION NO.
w
MAILING ADDRESS
z
�:
0
sw
PU13LIC RIGHT OF WAY PER ORDINANCL NO.
CITY
TELEPHONE NUMBER
/A0IL4'Vk0&V1& T40YVO-r-AL
EXISTING RIGHT OF WAY_
PROPOSED RIGHT OF WAY
NAME
,U-
w,1016M C-
DEFICIENCY OF RIGHT OF WAY
W
ADDRESS
STREET/UTILITY WORK REQUIRED [AYES Ll NO
U
1-7 :5
PERMIT FOR WORK IN PUBLIC R/W 19 Y ES El NO
EPHONE NUMBER
r
UNDER'GROUND WIRING REQUIRED INYES El NO
3
CONNECTION TO SANITARY SEWER El YES 4NO
NAME --
SEPTIC TANK PERMIT REQUIRED JVY ES NO
0 Ic
SEPTIC TANK PERMIT NO.
0
ADDRESS
U<
7 IS' L4 /44 (C�*- �J'L-
SEE MEMO DATED
--j-
M
CITY
TELEPHONE NUMBER
REMARKS
z
0
RL-j Yvk a-v% A wo
SS_Z _ .7
'SI.7 0
11STATE
LICENSE NUM13ER
CITY LICENSE NUMBER
CHECK:��..,,,
C (Loo :1 T -f -3� -a-:z
METERJSIZE BUILDING SUPPLY SIZE
I
1 Legal Description of Property (Show Below or Attach Four Copies)
-9 , j I
z
0 (ZF-60LA7T011, REGb-
SIGN AREA ENV. REVIEW ADB NO:
x ALLOWED PROPOSED COMPLETE EXEMPT
U
w SHORELINE
REMARKS
w
J
C EVIEW 13Y DATE
VARIANCE OR U PLANNING R
YARDS /
1
LOT COVERAGE
'� 5- FRONT
14
/0 SIDE as'REAR
I
NEW
RESIDENTIAL
GAS
LINE
FIRE ZONE
TYPE
OF CONSTRUCTION I
CODE
HEIGHT
NON-RESIDENTIAL
ADD
r
SIGN
V- t,3
1q7
-3 O'M A
DEMOLISH
RETAINING
WALL
SPECIAL INSPECTOR
REQUIRED
AREA
OCCUPANCY
OCCUPANT
0 ALTER
F1
EXCAVATE
OR FILL
FENCE
X—FT)
El
----YES L<NO
P)C' 7
GROUP
LOAD
tD BY
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
F-1
REPAIR
E]
PRE -MOVE
swim
H fz
SHOULD
INSP.
POOL
BE CODED 31.04.
Z NUMBER OF STORIES
NUMBER OF
REMARKS
0
DWELLING
1
T IAE V�- M A u
lW5.JLAT1C)W P*—=12- VA.?,. C16
.1
UNITS
NATURE OF WORK TO BE DONE
UV 42 am IS; -#9A I, C'r Q
tw ona ';�k
4r-
w
0
1
M
2 PROPOSED USE
PLAN CHECK FEE
VALUATION
FEE
PLOT PLAN (INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
BUILDING
U
w
PLUMBING
0
MECHANICAL
FENCE
SIGN
in "Applicant, oil behalf of his or her SI)OLIse, heirs, assigns and
V,
w
J successors in interest, agrees to indemnify, defend and hold lijrlllless
2 the City of Edmonds, Washington, its officials, employees, and
Ir
< agents from ally and all Claims for damages of whatever nature,
T arkiny diierik, w mdiw,�Iv frool the is.qjjo(,e of this perillit. Issw
RETAINING WALL
SWIMMING POOL
125 1('0
43
0
U
D
a.
I.
2
z
0
J
w
t
z
0
U
M
w
0
0,
Date
MEMO TO: Building Divis,ion
Community Development Department
FROM: Engineering Division
Public Works.Department
SUBJECT:. .-- 26 3/.
After review of the subject buil-ding 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 streets cleaned
oe7-
of dirt and debris caused by the construction.
The "Right -of -Way Construction Permit" is required, from the
Engineering Division of Public Works, for any work within the
Public Right -of -Way or public easement.
Driveway slope not to exceed 14%.
/-7 Connection to sanitary sewer required.
Septic Tank Permit required, submit design.
Fire hydrant required, submit design.
/-7 Site drainage per code # . See approve.d plans
/-7 Curb /-7 Sidewalk /-7 Paving required.
/-7 Bond required for public improvements. Submit cost estimate.
Underground wiring required.
,L-7 Approved Engineering Plans required when applicable..
17
Rev.
For Fred F. Herzberg, P.E.
City Engineer
Department of Public Works.
7/78
t r
3
4
*?UBLIC 1,70RKS DEPART-= CHECKLO -,7,;? Date
BunDING PERMIT REVIEW
0
Z
Z
Z
W
/5-4r" ddress
�Street Right -of -Way Existing--
6��v REQD
Access Easements Existing
REQD
Utility Easement Existing
REQD
Lot per Subdivision Plat Assessor Map
Site Plan Checked for Accuracy
Underground Wiring Reqd.
Check Accuracy of Legal Description
C)
Environmentally Sensitive Area
7 _-Ab
Environmental Checklist Reqd.
Flood Hazard Zone
Shoreline. Management Area
Slope, Soil, Vegetation
Stream, Creek, Drainage.Basin
Existing Zoning Per Code
Amenities Design Board Approval Reqd.
ADB # Approval
Board of Adjustment Approval Reqd.
Review By:
Date: �5 0 -2,,y
Existing 14ater Main Size 0", A
Water Main Reqd. &4
Service Line Reqd.
Hydrant Size Existing
eHydrant Reqd. Per Fire Code
Detector Check Meter Reqd. _
-Cross Connection Inspection
6-Ay / f
NA Size
Fire Departnient Comments. -
Water Meter Charge Reqd.
Review by: Date:
30 79�
sign Approved Date:
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability Proj.
Drawing No. File No.
Side Sewer Availability AIQ
Sanitary Sewer Connection Fee Reqd.
Revie,7 By: Date:
6
0
C
U
PL4
PA
0
P4
PA
PA
K In !-% - - - - - - - - - - - - - - - - - AV V V S�
nn!ni A AAAAXXXX
Open Ditch Existing -Reqd.
Culvert Reqd. Size
Catch Basin Read. -Indicate on Site Plan
Shouldc,ir drainage maintaii-i collection on ,,i,7al e open rimoff
read. Indicate on Site Plan
Soil Conditions and Grourld Water Field Cliecked
Re,,riew hy� Da te e) —
Street.Paving Read.
Curb and Cutter Read.
Sidewalk Read.
Curb Cut for Driveway Read.-
R ight-of-Way Construction Permit Read.
Bond Read. for Public Inproven-ents
Street N,-mr:- Sign Read. Al- 0
Other Signing Read.
0 1 A- a
Pre Permit Site Inspection made on
BY: MIER
WATER
STREET
ENGINEER11\1G
Special Requireri-pants listed in men-o to Comnmit�y Development Department,
Building Division
BY Date
All items filled in an Building Permit Application
BY Date
Drawing,s Starrned and Notations Made
BY
Approved by Public 1,1orks Deparom-it:
Date
Revised: IV 10-1977
PUBLIC WOM',-S 'R I D I V I S 1. 0 N
FkTAL REVIE
j
NAME:— ---FILE Ir ____
LOCATION: I � n _:�, � I jz�,�.�s �
E] SUBDIVISION r-] PLAT F-1 P.R.D. [-I 11ULTIPLE [] CM14ERCIAL
AN ENVIRONMENTAL REVIEW'OF T14E PROPOSAL HAS BEEN COMPLETED
ANT) THE FOLLOWING DETERMINATIONS HAVE BEEN NADE:
'T
ZA -
ci
4V-F-
r.- Q G__ Lm- P L44F-A&a.- _L&im:tA_ \Mawti
Lk) 92Eeg, V D LA.3 4vx_\a
l't-) k
1 c —
lf�� C_-) LL_7;�t Y2,vl� 0 V-A e--
Tc-) L4vc�.rAc> 7Tzn�Ec—_ V.��
-rt . or-4 , —
PREPARED BY: --DATE:
MJBLIC 14ORKS DEPART*,= IS'r Date
W BMETf ALI 0 . ddress
Street Right -of -Way Existing
REQD
Access Easements Existing
REQD
Utility Easenient Existing
REQD
Q)
Lot per Subdivision Plat Assessor Map
Site Plan.Checked for Accuracy
Z
Underground Wiring Reqd.
Check Accuracy of Legal Description
c)
Environmentally Sensitive Area
Environmental Checklist Reqd.
Flood Hazard Zone
U
Shoreline. Managenient Area
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Existing Zoning Per Code
Anienities.Design Board Approval Reqd.
ADB #
Approval
Board of Adjustment Approval Reqd.
Review By:
Date:
-,2,0
Existing Water Main Size
Water Main Reqd. IYA
Service Line Reqd. -1/V /11
Hydrant Size Existing
Hydrant Reqd. Per Fire Code
NA
Size
Detector Check Meter Reqd.
IVA
Cross Connection Inspection
Fire Departnient Comments -
Water Meter Charge Reqd.
Review by: ;7 L-(,2
-,------Date:.
// - 'Y 0 7,:?
T�IZ
1! ill 1 ;5 1116 L I 11YX4V1e1nSi1::-
1 1! ;
-- 1!1!�
-:
Septic Des-l-gn Approvec
ate
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
'YC/
Proj.
Drawing No.
File No.
Side Sewer Availability
Al 0
7
Sanitary Sewer Connection Fe-e��qd.
Review By:
Date:
BUILDING DEPARTMEW Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
, uV�111AC-4VI N,
W MAIL NG ADDRESS
z
R:
0 CITY ITELEPHONE NUM183ER
+ I& V,& T-0wC,,Lz_
,U- W1 016m G.
W ADDRESS
CITY
NUMBER
NAME
TRA-o-ex- e vvis-re_
0 ADDRESS
I_
<U 7 T x -1 1,4
CITY
LEPHONE NUMBER
z ok 0-,/\ A UQ V)
0
[ 7S:,E� :_-3b -7 0
U STATE LICENSE NUMBER ICITY
I ICENSE NUMBER
C 600 :2 TT S*DL-:z I
Legal Description of Property (Show Below or Attach Four Copies)
z
0
I -
IL
It
U
In
W
a
.J
W
.J
USE IWMIT
NUMUER
JOB
ADDRESS
L AL LOT
N _1
PLAT NAME
SUIJDIVISION NO.
PUBLIC RIGH T OF WAY PER ORDINANCE NO.
EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY�
DEFICIENCY OF RIGHT OF WAY
STREET/UTILITY WORK REQUIRED
UYES EJ NO
PERMIT FOR WORK IN PUBLIC R/W
19YES C1 NO
UNDERGROUND WIRING REQUIRED
IN Y ES NO
CONNECTION TO SANITARY SEWER
OYES %NO
SEPTIC TANK PERMIT REQUIRED
WY ES NO'
SEPTIC TANK PERMIT NO. -
SEE MEMO DATED
REMARKS
CHECKED BY
E BUILDING SUPPLY SIZE
// I
C,,F_6VLA7V()P_ P_F_QC)-
SIGN AREA ENV. REVI EW
ALLOWED I PROPOSED 1COMPLETE1 EXEMPT
REMARKS
VARIANCE OR CU IPLANNING REVIEW BY fDATE
YARDS /
i
LOT COVERAGE
.
�S' FRONT
/0 SIDE ;tsREAR
I
mv NEW
ID
RESIDENTIA L
GAS
EILINE
10
FIRE ZONE
IASJ
NON -RE SIDENTIAL
__�)
TYPE
OF CONSTRUCTION
CODE
HEIGHT
El ADD
SIGN
V -
0
-3 O'M A
DEMOLISH RETAINING
EIWALL
-1
SPECIAL INSPECTOR
REQUIRED
AREA
OCCUPANCY
M- IL
-
OCCUPANT
ALTER
EXCAVATE FENCE
OR FILL
C (- ---'
YES
F'r-, -7 � I
GROUP
P— -3
LOAD
"
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
REPAIR
PRE -MOVE swim
INSP. POOL
SHOULD BE CODED'31.04.
Z NUMBER OF STORIES
NUM BER OF
REMARKS
0
WELLING
UNITS
T A L
IW50LAT101`13 P4512- �A-?,.
NATURE OF WORK TO BE DONE
X
11
(U
14 (tw fee ;�k
W
0
PLAN CHECK FEE
VALUATION
FEE
PROPOSED USE
C:)CC,_ "_Y7 A-1 C
&-e
PLOT PLAN (INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
(1: BUILDING
U IGO
In
W PLUMBING
43
0 MECHANICAL
1 8
FENCE
m
0
IL
m
W
F-
cc
3:
(A "Applicant, on behalf of his or her spouse, heirs, assigns � SIGN
In Ind
W successors in interest, agrees to indemnify, defend and hold harmless
_J
2 the City of Edmonds, Washington, its officials, employees, and RETAINING WALL
(r
agents From any and all claims for daniages of whatever nature,
:oisim)- dilcoly t,r indirccily It,,- i:,:11;11Ice of this pormil. lssu- SWIMMING POOL