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7106 175TH PL SW
CITY OF EDMONDS
ASSET INFORMATION SHEET
L1LJ NEW Nc'ET N'i
ASSET NO. D lob
❑ ADDITION ADDITION TO ASSET NO. Properly of —
'CffY OF €UMONDS
El RETIREMENT No. 0 313 4
DESCRIPTION
SERIAL NO.
LOCATION DEPT. N91
**PURCHASE ORDER NO. _
PURCHASE ORDER DATE
COST
*PROJECT NUMBER ta�T�
PROJECT COMPLETION DATE T
COST - 2-.z
B.A.R.S. ACCOUNT NO. �/& oon0
• ESTIMATED LIFE cl�yi��.?`
INITIATED BY DATE APPROVED BY
**SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
4,CCOUNTING ONLY
.�
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
• G.L. ENTRY
REFERENCE
DATE
4�&)
VERIFIED BY
PROCESSED
BATCH NO,
INITIAL
DE, zs':: ':;;'-.NT FILE
T FOR INSPECTION CALL
PUBLIC WORKS DES Permit
SIDE SEWER PERMIT 775-2525 Ext. 220 Issue Date
PERMIT,MU$T BE POSTED ON JOB SITE
1 Address of Construction ?
2. Property Legal Description ,(include all easement
6THEE
3. Single Family Residence Multi -Family No. of Units
Commercial
4. Owner and/or Builder
4
5. Contractor & License No.
6. Invasion into City Right -of -Way: No"-',,_ Yes (If Yes Right-of-
way Construction Permit Required Call Dial Dig (342-5344) before
excavation).
E-4 7. Cross other private property: Yes No"'� Easement required -
attach legal description and county easement number.
aREAD THE FOLLOWING AND SIGN:
a. Property owners must obtain a permit to install side sewers on
� their property. A licensed side sewer contractor must be employed
construct side sewers in the public right-of-way. to
b. The side sewer contractor assumes full reponsibility for each
E-4 installation for one year.
c. Commercial establishment requires a minimum of a six inch (6")
side sewer line.
0 d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
e. Side sewer lines must be laid at a minimum grade of 2% (1.150
0 and maximum grade of 100% (450 ). 0
E-4 f. No turn in side sewer greater than 45 (1/8,bend) isoallowed
between cleanout. All 90 turns must be constructed of a 45 (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 1001 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 requir d.
DATE: w "'I_ 4L_
I certify that I have read
and shall comply With the above
PERMIT FEE:--- -- 1<1?
DISAPPROVED BY: Date:
W
By: Date.-
CONNECTION FEE--. APPROVED By: Da 62
PEMT MU BE POSTED ON JOB SITE
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).
The City of Edmonds
Side Sewer Drawing
EASEMENTNO . ............................................
NEW CONSTRUCTION REPAIRS ❑ LID NO ................... .ASMT. NO...................
fl-o we- S
OWNER .---•-----'�. •------//----•-•.............. CONTRACTOR _ ...i►___ ---•-C ....................................................... PERMIT NO. _.g03..
JOB ADDRESS .__7�0_.4___.- ___�--._l'__...SLCJ LEGAL DESCRIPTION: LOT NO. ......... 3______________________ BLOCK NO. ....................................
4
1
`• PYVW-0001-11R5 (REV.l lf78)
...........:....................................��__----._��_._-•--••--•-•-•-•--•------.....__.-•-•---...------........_._.---•--••---•--••-----•--•-.-._._......._.....
NAME OF ADDITION .......
Approved:
DATE . 1/.a!�S..............
// —
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By, ............
Y
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ZONE-. R S _ q
SET S C4;S:
FRONT
SIDE --7).:
RE __LS
0 T HE-
HEIGHT
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PROTEC.T 4=0".1NT,
D D E"c. K ItEQv;RE0 SETBR(
F B A C K - _ a�\\\\� �� _ 01\\\ _o �. ZONE .
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R E A F l R 0 P.
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BUILDING ADDRESS ,.
PUBLIC WORKS DEPARTMENT
BUILDING PERMIT REVIE_* Single Family
Multiple
Commercial
;7//'/- i 7. S ly F-D
BLDG. DEPT. SUSPENSE DATE J(
1TE: ® OFFICE ADMIN. — PUBLIC WORKS L G IN
INITIAL DATE
CITY ENGINEER (check)
�s
❑ Access Slope and Vehicle Access
❑ Drainage Plan
❑ Street File
❑ Legal Description
❑ Quit Claim
❑ Easement
Calculate Sewer Connection
WATER/SEWER DIVISION
21-Determine Meter Size
omplete Building Permit Review
CTREET DIVISION
Complete Building Permit Review
[]OFFICE ADMIN. — LOG OUT TO BLDG. DEPT.
®IZrW 1000 M ®ova® ® ®opt®e= dMI®I®eo102801012 ®®yam MEN
�UILDING PERMIT APPLICATION (COMPLETE) 11
e off
1U.3 COPIES OF SITE PLANI/��Y/
2 COPIES OF FIRE PROTECTION PLAN
� / (PREVIOUSLY REVIEWED BY FIRE DEPT.)
0=+ 3 COPIES OF DRAINAGE PLAN WITH CALCULATIONS
REQUIRED BY Q SUBDIVISION
GREATER THAN 2,000 SO. FT.
IMPERMEABLE SURFACE El
LESS THAN 2,000 SO. FT. ❑ �/ 7a,
GjHECK ZONING O � RE UIREr'[EP1TS (SETBACKS)
E >/COPY OF ENGINEERING: CHECK LIST
i3 1 COPY OF PUBLIC WORKS MEMO
''3 MULTIPLE OR COMMERCIAL
YES ❑ (ATTACH COPY OF ADB APPROVAL INCL. ALL DRA1•TINGS)
NO ❑
SUBDIVISION — YESE9XNAME 1Wp- f
DATED RECORDED
NUMBER
NO ❑ (ATTAOi COPY OF REQUIREP'IEIVTS) I
"J CHECK SEWER DRAWING AND ATTACH COPY j
IS DEDICATION REQUIRED — YES[] (OBTAIN QUIT CLA121)
( CITY CODE
NO ❑ ) �—
DOES CITY HAVE EASEMENT ON PROPERTY 1
YES (ATTACH COPIES OF DRAWINGS) •'
NO
21�CHECK LEGAL ACCESS — INGRES UTILITI i
NO YE
NO E3
1 HAS SEWER SSESSMENT BEEN PAID
YES L.I.D. NO.
PLAT NO.
SUBDIVISION NO.__
El
IF MULTIPLE: INCLUDE NUMBER OF UNITS
IF COMMERCIAL: INCLUDE NUMBER OF FIXTURE UNITS �
" USE N
CITY OF EDM S ZONE ER
77T�A_M-�(ORI
NG PERMIT APPLICATION JOB
NAME OF BUSINESS) ADDRESS
9
IJS 7
LEGAL DESCRIPTION
UBDIVISION
SHORT
W
MAILING AD/DRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STRFFF���EEET MAP
-0
-1/1 /��z`/EXISTING /dmollc1s[ELEPHONE
CITY
NUMBER
�7� �Uf
PROPOSED
NAME
FIT
'-'•--
EFICIENCV OF RIGHT OF WAY h—_
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ADDRESS
C ED
F
SEE ENGINEERING MEMO DATED__,
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CITY
TELEPHONE NUMBER
- REMARKS
NAME
0
ADDRESS
METER SIZE
F
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REMARKS
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CITY
TELEPHONE NUMBER
Z
0
BUILDING SUPPLY SIZE I FIXTURE UNITS
U STATE LICENSE NUMBER CITY LICENSE NUMBER t SIGN AREA
.7 ALLOWED I PROPOSED
of Property (Show Below or Attach Four Copies
VARIANCE OR CU
ENV. REVIEW ADB NO.
MPLETEI EXEMPT L.... .
SHORELINE
PLA"ItIG: REVIEW BY I DA
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REAR
LOT COVERA E
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REMARKS
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NEW
RESIDENTIAL
11:1E
PLUMBING
,. CHECKED BY
TYPE OF CONSTRUCTION
CODE
HEIGHT
NON-RESIDENTIAL
Q ADD a
DEMOLISH
❑
❑SIGN
MECHANICAL
SPECIAL INSPECTOR
REQUIRED
AREA
OCCUPANCY
GROUP
OCCUPANT
LOAD
111
❑ ALTER
EJ
❑ REPAIR a
EXCAVATE
OR FILL
COMPLIIANC E'IINSP.
❑
FENCE
( X_FT)
POOL
1 ❑ YES ❑ NO
IREMARKS
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Z
C
I -UNITS
NUMBER OF STORIES
NUMBER OF
ELLING UN A
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
a
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7
0
,:• M
_
ICJ%
? PLAN CHECK FEE
VALUATION
FEE
This Permit covers work to be done on private property ONLY. "
Any construction on the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 120 Days
N "Applicant, on behalf of his or her spouse, heirs, assigns and
j successors in interest, agrees to indemnify, defend and hold harmless
E the City of Edmonds, Washington, its officials, employees, and
aagents from any and all claims for damages of whatever nature,
x arising directly or indirectly from the issuance of this permit. Issu-
o once of this permit shall not be deemed to modify, waive or reduce i!
0 any requirement of any city ordinance nor limit in any way the 'I)
= City's ability to enforce any ordinance provision."
I hereby acknowledge that I have read this application; that the in-
formation Liven is correct; and that I am the owner, or the duly author- I
ized agent of the owner. 1 agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby, no person
will be employed in violation of the Labor Code of the State of Washington
relating to Workmen's Compensation Insurance,
SIGN TORE (OWNER OR AGENT) DATE SI NED
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
ATTENTION
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 304, 306.
10 z-7 e
BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
TOTAL AMOUNT DUE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit
AUTHORIZES
until signed by the Building Official or
ONLY THE
his Deputy; and fees are paid, and
WORK NOTED
receipt is acknowledged in space pro -
vided.
INSPECTION
DEPARTMENT
DIRECTOR'S SIGNATURE
CITY OF
EDMONDS
DATE
775-2525
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
NoV 12 M0
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DATE: 7��,3 "YI
MEMO T0: Building Division
Corununity DevelopmcnL DcpartmenL
FROM: Engineering; Division
Public Works Department
SUBJECT:
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%.
S. Backwater valve required if dow►ZsLair.s plumbing; is below
elevation of upstream manhole.
6. Water and sewer lines to he :separated by 10 foot minimum.
f
Signature
(address) (date)-
0
Street Right -of -Way Exist'
Z
Access Easements Existing
Utility Easement Existing
REQD
w
Lot Per Subdivision Plat AV- j -_Assessor
w
Site Plan Checked for Accuracy
Z
Underground Wiring Reqd. G r
H
0
Check Accuracy o al De ription
��- � �
Z
Review by
to i
w.
Existing Water Main Size �' C -
Water Main Required Ai
Service Line Required
Hydrant Size Existing f
ce-
Hydrant Reqd Per Fire Cade 4y/A
Size
w
Detector —Check Meter Reqd.
Cross Connection Inspection —
H
Fire Department Comments
3
Water Meter Charge Reqd. 3
Review by
Date
Septic Tank Design Approved
Date /
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availabill
Proj.
Drawing No.
File No.
Side Sewer AvailabilityS--
w
Sanitary Sewer Connection Fee Reqd.
�----
3
Review by
Date
w
Open Ditch Existing
Reqd.
Culvert Reqd.
Size
x
Catch Basin Reqd.
Indicate on Site Plan
O
Shoulder drainage maintain collection
on swale open runoff
H
`n
Manhole reqd.
Indicate on Site Plan
Soil Conditions and Ground Water Field Checked
Review by
Date
Revised: 1v10-1977