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FOR INSPECTION CALL'0
PITBLIC WORKS DEPARTMENTPermit
SLDE'svR EMT-�. Issue Date
* PERMIT MUST BE POSTED ON JOB SITE--
�.r l�YNNWpoo LINE
1. Address of Construction , %f "� ..NE
2. Property Legal Description
(include all easements) °?M`
Xrw1 `�`" (iJ 1� riff Ie'� r ■ RU
3. Single Family Residence _j_ Multi -Family No. of Units
Commercial
4. Owner and/or Builder )M �S17-i
5. Contractor & License No.
6. Invasion into City Right -of -Way: Now_ Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
7. Cross other private property: Yes No k`,r Easement required -
attach legal description and county easement number.
READ 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 to
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")
side sewer line.
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)
and maximum grade of 100% (450).
f. No turn in side sewer greater than 45° (1/8 bend) 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 uncoveret'until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
DATE: CA 3
I certify t at -have Ereaa
and shall comply with the above
PERMIT FEE: :'<:: <.'
CONNECTION FEE:
_.
* W.101VT
DISAPPROVED By: Date:
By* Date:
APPROVED By Date: G.9_93
PASTED 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).
of Edmonds
Side Sewer Drawing
The a •
tY EASEMENT NO- -------------------•-----------•---•----- ••
= NEW .CONSTRUCTION REPAIRS ❑ LID NO. .................. ASMT. NO_ ....... w M
OWNER .....rHOM ....... 1"T-.......................... -------------------- CONTRACTOR .__ t__l:.l-------- r-,O.N15T--..................................... PERMIT NO. 7 .--
*7
JOB ADDRESS ... ___ .10 ~___ PL,-------•------------ LEGAL DESCRIPTION: LOT NO....-'-:: -------.................. BLOCK NO. -
CYNNINOOD l�0E
----------•--------------------------------------------------- .. ......................
" A& 3 - %09 F
NAME OF ADDITION --Fo P-RSST__--_R_I)-ee- --- F—smkTr—s_------ ---------------------------
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m •� `� f Pl.
• f
3'T4RM DRAIN 3.5'—ICAPP
� �•�tfi SAS�N
Approved:ell
7108 i'75T~ PL. DATE .h2 :� -_ B,.�,-�---------•...............
PWW0001-11/75 (REV.11178) - .................•-•- y
R
CITY OF EDMONDS ya f�� ASSET INFORMATION SHEET
0 NEW ASSET NO. �
•
❑ ADDITION ADDITION TO ASSET NO.
❑ RETIREMENT
DESCRIPTION
S isle v
SERIAL NO.
LOCATION DEPT. NO.
-7 t o? ? S ' �` Sw ( y o
"*PURCHASE ORDER NO. _
PURCHASE ORDER DATE
COST
*PROJECT NUMBER L<j 3 J ^SSd 66
PROJECT COMPLETION DATE (G - 3 / -83
COST 6 1. 3(.
B.A.R.S. ACCOUNT NO. -S = aG - �3
•ESTIMATED LIFE aS
INITIATED BY DATE APPROVED BY
**SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
12 DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT _
• G.L. ENTRY
REFERENCE
DATE
VERIFIED BY
PROCESSED
BATCH NO.
INITIAL
DEP.'1IFMMENT FILE
01
BUILDING ADDRESS
BLDG . DEPT. SUSPZIVbr, VATL
OFFICE ADMIN. -- PUBLIC WORKS LOG IN
INITIAL
Multiple
Commercial
DATE
5CITY ENGINEER (check)
❑ Access Slope and Vehicle Access
❑ Drainage Plan
❑ Street File
❑ Legal Description
❑ Quit Claim
❑ Easement
cal Sewer. Connection
1 s ,
E S WATER/
•. �':�•�,��E;� WER DIVISION :;� ; • ' '
+i;.QlIDeternine' Meter Size
NT •.�f '. y�. `I• ,,•��'• 1.1'•1'.2 1•: .. "y' 11' y1. 11 / � �
�''tiI111' '' �1'��''3' �'!;•.7. Cormplete I Building Permit Review
TREET DIVISIONit
omplete;Building Permit•:Review
OFFICE ADMM, — LOG OUT TO BLDG;'DEPT.
-------------------------------------------------------------------------
BUILDING PERMIT APPLICATION (COMPLETE).
0 2 COPIES OF SITE PLAN
- ❑ 2 COPIES OF FIRE P
ROTECTION PLAN
(PREVIOUSLY REVIEWED BY FIRE DEPT.)
Qom' COPIES OF DRAINAGE PLAN jz14z11 —_,6 _P-uz _n_T:rr)N_S
REQUIRED BY SUBDIVISION
GREATER TITAN 2,000 SQ. FT'.
IMPERMEABLE SURFACE ❑ ;'�'
LESS THAN 2,000 SO. FT. ❑ l�'
❑,CHECK ZONING REnUIREMENTS (SETBACKS)
lJ 1 COPY OF ENGINEERING CHECK LIST
',. 1 COPY OF PU:'_LIC WORKS MEMO
❑ MULTIPLE OR COMMERCIAL
YES P,'-(AMCH COPY OF ADB APPROVAL INCL. ALL DRAWINGS)
N O
� SUBDIVISION -- YES ❑ NAME. • 7
DATE RECORDED
NUMBER ...
N0 ❑ (ATTACH -COPY 'OF •REQUIREM 11VTS� -- -
CHECK SEWER DRAWING AND ✓' ATTACH COPY �'ri =%�
JTIS DEDICATION REQUIRED YESO (OBTAIN QUIT CLAR-0
( CITY CODE )
NO ❑
❑ DOES CITY 1tkVE EASEMENT ON PROPERTY
YES[] (ATTACH COPIES OF DRAWINGS)
NO ❑
❑ CHECK LEGAL ACCESS — INGRESSF UTILITIES❑
YES,[] YES-[]
❑ NO ❑ NO []
HAS SEWER ASSESSMENT BEEN PAID
YES ❑ L.I.D. NO.
PLAT NO.
SUBDIVISION_ NOS
G ; IF � MULTIPLE : . INCLUDE NUMBER OF UNITS' •• • ..
❑ 'IF COMMERCIAL: INCLUDE NUMBER OF FIXTURE UNITS'
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4.
DATE: /—/'—S3
MEMO TO: Building Division
Planning Department
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.
3.
4.
5.
6.
Connection to City sanitary sewer system required.
Right-of-way permit required for any work on City property.
Driveway slope not to exceed 14%
Backwater valve required if downstairs plumbing is below elevation of
upstream manhole.
Water and sewer lines to be separated by 10 foot minimum
BD 6/82
P[IDLIC WORKS DEPARTMEN7 CHECKLIST
BUILDING PERMIT REVIEW � �' ���(��P� /-/ y f—
(address) to
Street Right -of -Way Existing .�
REQD C
Z
'
Access Easements Existing
REQD
N
a .
Utility Easement ExistingI
READ
w
Lot Per Subdivision Plat
/i=,�;' -' �� Assessor Map
w
Site Plan Checked for Accuracy. -
-
Z
Underground Wiring Reqd.
H
Check Accuracy of Legal Description
-
'
Review bye' -r
- Date
w
Existing Water Main Size
Water Main Required
Service Line Required '
Hydrant Size Existing
a
Hydrant Reqd Per Fire Code
Size
w
Detector Check Meter Reqd.
Cross Connection Inspection --
Fire Department Comments
¢
A
3
Water Meter gg-Regd.
Review by
Date
Septic Tank Design Approved
Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
Proj.
Drawing No. '—
File No.
Cc
Side Sewer Availability
W
Sanitary Sewer," Confection Fee Reqd.
--
3
Review by /7 . i "� -•'' - '
Date
Open Ditch Existing ,� �/ �"
Regd.
Culvert Reqd. 2r= Q
Size
c�
Catch Basin Reqd.
Indicate on Site Plan
Shoulder drainage maintain collection on Swale open runoff
H
N
Manhole reqd. n P L T
Indicate on Site Plan
Soil Conditi Ground Water Field
Checked
Review by
Date
Revised: 1v10-1977
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
'16E//
MAILING ADDRESS
CITY_ TELEPHONE NUMBER
C�ii �✓�'�l�-s 7 %G 2 y y
NAME
Q ADDRESS
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CITY
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0
OI STATE LICENSE NUMBER
(show below or attach four
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NUMBER
USE 'WIT
ZONE ` /7 NUMBER
JOB (x
ADDRESS -71 0 . � , 7 6 i-h 3 / �� e P_
.EGAL DESCRIPTION CHECK SUBDIVISION NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING _ �r REQUIRED DEDICATION r
PROPOSED q—
RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
STREET USE PERMIT REQUIRED U
SEE ENGINEERING MEMO DATED "
SEE PIW DEPT. REVIEW CHECK LIST DATED
METER SIZE
BUILDING SUPPLY SIZE
FIXTURE
UNITS
TELEPHONE NUMBER
REMARKS
CITY LICENSE NUMBER
SIGN AREA
ALLOWED
PROPOSED
ENV. REVIEW
COMPLETE EXEMPT
ADB NO.
-include all easements
: les)
SHORELINE M
77
VARIANCE OR CU
PLA LONG RE IEW BY_,
DATE
(+
/
YARDS
-- FRONT
LOT
SIDE !�l,� REAR
COVERAGE
_
IV I
1 /V NEW I�J RESIDENTIAL
ADD/ALTER �❑ NON-RESIDENTIAL
REPAIR RETAINING WALL
DEMOLISH OR FILL
PRE -MOVE INSP./
COMPLIANCE INSP.
U PLUMBING
1:1MECHANICAL
SIGN
(( FENCE x—FT)
SWIM
POOL
CHECKED BY Tl
SPECIAL INSPECTOR
REQUIRED
CI YES I I NO
SIDE SEWER
El WATER LINE
D
REMARKS
NUMBER OF STORIES
FNUEROFLING
NATURE OF WORK TO
BE DONE (ATTACH
//PLOT PLAN)
PLAN CHECK FEE
BUILDING
PLUMBING
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.
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
"Applicant, on behalf of his or her spouse, heirs, assigns and
,n successors in interest, agrees to indemnify, defend and hold
J harmless the City of Edmonds, Washington, Its officials,
5 employees, and agents from any and all claims for damages of
cr whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
0
o modify, waive or reduce any requirement of any city ordinance
= nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
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
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
lion nsuranc INSPECTION
SIG URE (OWNEF) AGENT) DATE E IGNED DEPARTMENT
CITY OF
THIS SITE IS LOCA ED IN THE CITY EDMONDS
OF EDMONDS. LOCAL SALES TAX 775.2525
ATTENTION SHOULD BE CODED 31.04.
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-TB
GROUP
VALUATION
FEE
HEIGHT
OCCUPANT
LOAD
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
w
a
3
DATE I I
ORIGINAL — File YELLOW — Inspector U
PINK — Owner GOLD — Assessor
Ramon N,mmg • E.—... W. • Y?5N"