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7107 210TH ST SW.PDFiiiiiiiiiiii 2668 71-07 210TH ST SW � DATE RECEIVED [PERMIT , s,- � „a..,, v 5 EXPIRES USE PERMIT CITY OF EDMONDS ZONE NUMBER - CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT# ADDRESS ^-� Z .2 I O ` / / s'Gd OWNER OF BUSINESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ RNNA•MEi/NAME %' /mil /✓L_ L� w MAILING ADDRESS PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PerTESCP mit A Required wed 0 3 � / a ? 2- U /� S j j '�'+� O EXISTING PROPOSED Street Use Permit Req'd 0 Inspection Required 0 CITY ZIP TELEPHONE �t7�t4o �j`S- 771- Z4/0 7 REQUIRED.DEDICATION FT Sidewalk Requlretl 0 Underground Qti�j / Wiring required 0 NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED t, YES ❑ NO ❑ z W ADDRESS REMARKS z z OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE ¢ a z w CITY ZIP TELEPHONE NAME � C �"v rl.�-Q_ ENGINEERING REVIEWED/DATE ADDRESS o¢ U U ¢ ' FIRE REVIEWED BY DATE W CITY ZIP TELEPHONE Z ¢ O W U VARIANCE OR CU. SHORELINE OR ADBN INSPECTION BOND STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY . REO'D POSTED ❑ YES ❑ NO SEPA REVIEW COMPLETE EXEMPT SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED PROPOSED PROPERTY TAX ACCOUNT PARCEL NO. uj 6'bo90J-1007.-0 0/00-00083 0"ia1 I I EXP ❑ NEW ❑ RESIDENTIAL ❑ PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR r7 ❑ AUDITION ❑ COMMERCIAL ❑ COMPLIANCE OR z CHANGE OF USE REMODEL APARTMENT ❑❑ ❑ SIGN a REO'D ARKIPROVIDED LOT AREA PLANNING REVIEWED'BY DATE REPAIR GRADING CYDS ❑ FENCE X FT) REMARKS ❑ DEMOLISH C-71 TANK ❑ OTHER GARAGE ❑ CARPORT ❑ RETAINING WALL ROCKERY ❑ RENEWAL z O (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: H CHECKEDBY TYPE OF CONSTRUCTION OCCUPANT a U S���- ]CODE rfiT (,}�'I GROUP Z NUMBER NUMBER OF CRITICAL w �! P+ V t 1 F J SPECIAL INSPECTOR JAREA OCCUPANT to OF DWELLING / AREAS 00 JIk/ O STORIES UNITS NUMBER REQUIRED YES LOAD ` l f DESCRIBE WORK TO BE DONE REMARKS c7 PROGRESS INSPECTIONS PER UBC 108/1FINAL INSPECTION REO'D o C, t Vw! ✓'� .P.••� O ✓T S i c.C:_ t�� S i ."'�-?v+"�-. VALUATION FEE ��� _ / �,•� �G��'rT`v 9 PLAN CHECK FEE. Q ` -CG_ G�OU E , GLAZING % LOT SLOPE % BUILDING P 2— 1C{�'i:�=Ai{iJlY11>L✓ (=:> 7.w PLAN CHECK NO: VESTED DATE PLUMBING MECHANICAL THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO t BE DONE ON PRIVATE'PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC i DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE GRADING/FILL J SEPARATE PERMISSION. f STATE SURCHARGE ¢ w PERMIT APPLICATION: 180 DAYS a PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION (n •APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF ni c oinir, 2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND N E aC7 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY = FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE RECEIPT PLAN CHECK DEPOSIT DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE = NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION." RE PT -•-•t U� TOTAL AMOUNT DUE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL 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 CONSTRUC• CALL This application is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OF CIALS SIGNATURE DATE SIGNWNE OR AGENT) DATE SIGNED (425) ',•- ���� .t 771-0220 R EA ED BY DATE ATTENTION EXT 333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 I 1 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE YELLOW • INSPECTOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK • OWNER • GOLD - ASSESSOR 5/98 e EDA, 189� `�y Y "° CITY OF EDMONDS E� i SINGLE FAMILY ADDITION/REMODEL COFZTF/LE �qc. Directions: Applicants are to complete the information in the WHITE BOXES ONLY (Shaded boxes are for City use only). This cover sheet must accompany each building permit application for a single-family residential addition/remodel project. APPLICANT �DG� PLAN CHECK # D' DATE ;RECEIVED PROJECT ADDRESS -71j% PROPERTY TAX ACCOUNT PARCEL # DESCRIPTION OF WORK�dhjj� OWNER PHONE CONTACT PERSON LS p /VSeWPHONE E-MAIL MAILING ADDRESS FAX FAX CORRECTIONS 0--`MAIL CORRECTIONS E-MAIL CORRECTIONS I BY SIGNING THIS STATEMENT I UNDERSTAND THAT I AM THE CONTACT PERSON FOR THIS PROJECT. IT IS MY RESPONSIBILITY TO COORDINATE ALL SUBMITTALS WITH THE CITY AND ONLY I CAN MAKE INQUIRIES ON THE STATUS OF THE APPLICATION. I UNDERSTAND IT IS MY RESPONSIBILITY TO DETERMINE IN ADVANCE OF PERMIT SUBMITTAL ANY DISCRETIONARY PERMITS THAT MAY BE APPLICABLE TO THIS PROJECT. I ACKNOWLEDGE THAT TO THE BEST OF MY ABILITY I HAVE SUBMITTED ALL NECESSARY DOCUMENTATION IN ORDER TO MAKE A COMPLETE APPLICATION AND NO DISCRETIONARY APPROVALS ARE REQUIRED. SIGNATURE � 7 / �D`-�-Q�. DATE (�'— vZ / 0 0 ZONING INFORMATION ZONE ,�%}'j %. LOT AREA NUMBER -OF DWELLING UNITS -! EXISTING DEMOLISHED PROPOSED DISCRETIONARY APPROVALS CAL Determination SUBDIVISION CU VARIANCE SHORELINE SEPA Expires OTHER L:\temp\building\forms\Add_rvw.vsd -- 7/00 ...... .... . . ENGINEERING INFORMATION DRIVEWAY SLOPE % GRADING CYDS EASEMENTS,t�yrrT� EXISTING IMPERVIOUS AREA CONSTRUCTED BEFORE 1977 SQ.FT EXISTING IMPERVIOUS AREA INSTALLED 1977 OR LATER SQ.FT. PROPOSED NEW NET IMPERVIOUS SURFACE qO7 SQ.FT. (City Use Ong SIDEWALK REQ'D ❑ YES ©NO DRAINAGE PLAN REQ'D []YESBNO LID# UNDERGROUND WIRING REO'D []Y'ES[]NO STREET DEDICATION AJy FT. STAFF COMMENTS: BUILDING CONSTRUCTION INFORMATION -- CODE E-DITIONS 1997 UBC, UMC, UPC, WSEC, VIAQ WITH AMENDMENTS DESIGN CRITERIA WIND EXPOSURE B WIND SPEED 80 MPH Floor Live Load 40 Roof Snow/Live Load Floor Dead Load / 0 Roof Dead Load ZD SEISMIC ZONE 3 Balcony Live Load 410 Balcony Dead Load l'o NUMBER OF STORIES 1 BASEMENTS FLOOD ZONE LOT SLOPE % Si 15 �l� . SOILS REPORT PRO � FLOOR AREA (Measured to face of exterior wall) Existing Proposed %Total q Living Space Garage Carport Deck/Cov. Porch Other NMI 1:1 YES f:] NO (City Use On Ceiling Insulation Window U-Value Wall Insulation — �9�9 Skylight U-Value . ( 3 Floor Insulation K— (-1 Glazing % 2191Z Door U-Value 40 Slab Insulation i- Ene9y_ [$` Prescriptive ❑ Target ❑ Systems Whole House Ventilation System Req'd JKYes ❑ No, Any request for modification, variance or other administrative deviation (herinafter "variance") must be specifically called out and identified. Approval of any plat or plan containing provisions which do not comply with the city code and for which a variance has not been specifically identified, requested and considered by the appropriate city offical in accordance with the appropriate provision of city code or state law does not approve any items not to code specification. _ .... ... -. ; __..__ .... �w .. _ _. _...__. _ - - _... _ . .. _.. _..... PERMIT ISSUANCE APPROVALS (City U my PLANNING REVIEW & APPROVAL DATE CONDITIONS OF APPROVAL: 7ivn / 2 n ,-. , ; S4uT o4� Valves j7��va`s APPROVED �E2 rMENT Vrm FEB - 5 20DI DEVELOPMENT SERVICES OTR: CITY OF EDMOND& � i4 , HLE RECEIVED FEB - 5 2001 DEVELOPMENT SERVICES CTR. CITY OF EDMONDS 4ATOKE DETEr rnrcc uT+ f�TTTRFD THROii(;HOUT EXISTING RESIDENCE TTRC 310.9.1.2 THE ISSUANCE OF THIS PERMIT REQUIRES UPGRADE OF SMOKE DETECTORS IN THE FOLLOWING LOCATIONS: ® IN EACH SLEEPING ROOM. ® CENTRALLY LOCATED IN HALLWAYS OR AREAS ACCESSING SLEEPING ROOMS. WHEN SLEEPING ROOMS ARE ON THE UPPER FLOOR, SMOKE DETECTORS MUST BE INSTALLED NEAR STAIRWAYS- 0 MINIMUM OF ONE INSTALLED ON EACH FLOOR, INCLUDING THE BASEMENT. aa23 S �t, ay Lod Co uQrq ,e__ g - - Lo-t Ar2q -Tel 1. 0.CCovh \ �i �rttlt� $��900-1o�l-oyog-3�4l00-00o8-o`fo3 Cr�1`�Ql tCL�i1Q OD-111 Lo-+slopes 6'7o FLat Cx%ousp. built 1%01S I a3Ls9f f ro osea da,}`.oti 0-S, s .-Vf, 03io* ` v- 0 V oseA Ggge un�Pctir4 339I I SVo-y *`C- Y,O�G, --- \O 0 0 4- 1 a3 6 s 5 rt 0-7 i i - am Any request for modification, variance or other administrative deviation (hereinafter "variance") must be specifically called out and identified. Approval of any plat or plan containing provisions which do not comply with city code and for which a variance has not been specifically identified, requested and considered by the appropriate city official in accordance with the appropriate provision of city code or state law does not approve any items not to code specification. ALL NEW; EXTENDED E-BUILT OR RELOCATED ELECRIC'AL UTILITY AND/OR SERVICE SRgk q PLACE UNDERGROUND Nol Q&'D TO 16io 1ANfleF60,0Qi � ., 4u -e s /�,ny ��w" S PK14SL, is BNV.E 6, � -Wry In To Ei AOKE. , --W '01STt W—F, � 6P W14NO, tS DeC-RZA-S{NG ► 0-, .. O .arse► /o%7/w T H E3� 1' I WORK�b�i A00 ,,ass AP! DATE: - � l:... y •_ 6 J ! g-'...�� Ij 61 IS E Ili 10� t 3b 514 1qw ���,�,j ey9.5 asa �t GG�.y-A . 331sc. try -a1 NA .e; I�� CC16 �f1oo C_ �102k co,,. . -a e a �Ftc�l � 1��� RECEIVED SEP 2 0 2000 BUILDING DEPT. --____— 12NI 1� 5 SETBACKS: FRONT SIDE �� I REAR 1 OTHER HEIGHT col Elai vNe-Yoole 710-7 atoSt•s`-' yJgs1.�. �� I APPROVED BY: BCALE:� � I DATE: S`. `1 a QO° gr,�.►s KoV,eP\,ns�c: of y- @M0 W DRAWING NUMBER I o-P S ", ATE S RECEIVED , / D PXPIRE C�?'�'T 5 CITY OF EDMONDS USE , PERMIT ZONE i NUMBER CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTN ADDRESS �! �^� �7 1074L, S S (nJ G• OWNER NAME/NAME OF BUSINESS /''''`) � t/ /%&S PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. 4e� LID FEE $ w MAILING ADDRESS PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP prme RW PerTESCP mit RequiredQ C / / V / . -2 / Q � 4 S EXISTING PROPOSED Street Use Permit Req'd Q inspection Required Q CIT ZIP TELEPHONE /�Jj :x".1p/V,� �r//® C VI "� Cam'„ , _/ �i 77 /- REQUIRED DEDICATION FT Sidewalk Required Q Underground .'_S . �^�• /� Wiring required NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED YES ❑ NO ❑ r, z W t- - ADDRESS REMARKS z z z OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z W CITY ZIP TELEPHONE NAME < ENGINEERING REVIEWED/DATE ADDRESS ix O F V FFIRE REVIEWED BY DATE CITY ZIP TELEPHONE z _¢ O LL U VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D POSTED ❑ YES ❑ NO SEPA REVIEW COMPLETE EXEMPT SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED PROPOSED PROPERTY TAX ACCOUNT PARCEL NO. -C%O® ^C7��`17Ci I I J�G lD0_ it7(37 yw YC.•'�Db EXP rn ❑ NEW RESIDENTIAL Ry PLUMBING / MECH LOT COVERAGE ALLOWED PROPOSED REQUIRED SETBACKS (FT.) FRONT SIDE REAR PROPOSED SETBACKS (FT.) FRONT UR SIDE REAR 10 Q� AUDITION ❑ COMPLIANCE OR COMMERCIAL ❑ CHANGE OF USE z B'']• ❑ ❑ ❑ REMODEL APARTMENT SIGN a PARKING REO'D PROVIDED LOT AREA PLANNING REVIEWED BY DATE ❑ REPAIR ❑ GRADING CYDS ❑ FENCE X FT) REMARKS OTHER ❑ DEMOLISH ❑ TANK ❑ CARPORT GARAGE RETAINING WALL ❑ RENEWAL z O (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY TYPE OF C�Q NST.RUCTION �.. C E OCCUPANT a V_. �y GROUP NUMBER NUMBER OF CRITICAL w n SPECIAL INSPECTOR JAREA OCCUPANT OF % l DWELLING / AREAS 00 -1Y1 OSTORIES UNITS NUMBER REQUIRED ❑ YES LOAD DEW.RIBE WORK TO BE DONE , r O REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 9 �/v.ri%`�-l� L!•� 'C aT•-War+• /di Gt!%%�, 5 ,S c.-'- ✓,'c c. T� ' fT oT' � rc.--T�..�.� �v.� Nsec: G�i+e�.. L Hegardless of whether ie wa er sys em is open er closed, expamsion tanks are PLAN CHECK FEE PLAN CHECK FEE HEAT SOURCE GLAZING o LOT SLOPE o � �. BUILDING PLAN CHECK NO: VESTED DATE PLUMBING MECHANICAL a0 THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE GRADING/FILL 75 SEPARATE PERMISSION. •MTC-SURCHARGE r� �• �C1 w PERMIT APPLICATION: 180 DAYS . a PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SEE BACK OF PINK PERMIT FOR MORE INFORMATION y 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE W IN INTEREST, AGREES TO INDEMNIFY; DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING S EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE o PLAN CHECK DEPOSIT RECEIPT i DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE = NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' RECEIPT 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 APPLICATION APPROVAL THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC• CALL This application is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. SIG TU OWNER RAGENT) DATE SIG//�lED (425) OFFI ALS SIGNAT RE DATE ` 771 -0220 RELEASED 8 -- ATTENTION EXT/ 333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771'0221 A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL -FILE YELLOW. INSPECTOR FAX PINK -OWNER GOLD -ASSESSOR 5/98 AL Side Sewer Drawing The City of Edmonds EASEMENT NO. --------------------------- . . .......... . NEW CONSTRUCTION tE- REPAIRS F-1 LID NO. ASMT. NO. --------------- -- OWNER L - --------------------- ---------------------- ............. CONTRACTOR - -cll-�ll ----------------------- .............................. PERMIT NO. JOB ADDRESS .... 7 ---- - --- ------ ........................ LEGAL DESCRIPTION: LOT NO . .................. i -------------------- BLOCK NO - ------------- ...................... L.0y & 5.6"d PWW-000 1 - 11/75 (R EV. 11178) ......................... ----------------- ------------------------------------------------------------------------ ............................ NAMEOF ADDITION .......... ----------------------- ........................................................................ Fit ,7A8,A NG is sp T j 4,2•d L LI TA t,� `?-, I :s 'r Approved: DATE ------ 0 0 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). RECEIVED CITY OF EDMO IDS CONSTRUCTION PERMIT APtPLICATION OWNER NAME/NAME OF BUSINESS (Y1 S � l0 � Poop W MAILING ADDRESS os-F. S,W CITY C�� ZIP TELEPHONE AW\.o V4 8oa,(6. I 1i2,s-? ? I - a icon ADDRESS .j ' C CITY ZIP TELEPHONE ) v1c.1-_ ® Qd-)) s gas 3s3-1 � 9 NAME �—Q� • PERMIT EXPIRES USE PERMIT / ZONE NUMBER JOB / SUITE/APT# ADDRESS 7/ PLAT NAM E//SUBUDIVISION NO. LOT NO. LID NO. LID FEE $ CP PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pe Approved rmlt Required Street Use Permd Req'd EXISTING PROPOSED Inspection Required Sidewalk Required REQUIRED DEDICATION FT 1Underground ng required METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRE] YES O NO REMARKS O`� W�NER�/CON�TRACCTOR RESPOONSSIIBLE FOR , E`� RI-OSIIOON CCONTROU�pDDRAAIIINAGE �W'V �� G/u/1- OwV) NC /� ENGINEERING REVIEW�7ED/DATE l � ADDRESS FIRE REVIEWED BY DATE "' - W LL CITY ZIP TELEPHONE `VARIANCE�OR CU �.� SHORELINE OR ADBN ; INSPECTION RE 'D ❑ YES O BOND POSTED - - STATE LICENSE NUMBER EXPIRATION DATE: CHECKED BY SEPA REVIEW COMPLETE.'EXEMPT EXP, SIGN AREA ALLOWED PROPOSED HEIGHT ALLOWED PROPOSED PROPERTY TAX ACCOUNT PARCEL NO. S6( 0o-Io07-oy.003 ,�/ ❑ NEW SIDENTIAL Imo, PLUMBING / MECH COMPLIANCE OR I SAUDITION ❑ COMMERCIAL ❑ CHANGE OF USE. f-^ ❑ REMODEL ID APARTMENT ❑ SIGN GRADING FENCE ❑ REPAIR ❑ CYDS ❑ ( X " FT) ❑ DEMOLISH ❑ TANK ❑ OTHER .. GARAGE ❑ :RETAINING WALL ❑ ` CARPORT RENEWAL "LOT COVERAGE .; ALLOWED PROPOSED. 'v ` REQUIRED SETBACKS (FT.) `FRONT SIDE. REAR 1 I I O ' PROPO; SETBACKS (FT.) FRONT R SIDE REAR I 1 ( �� I� i Z S ' PARKING REO'0,';- PROVIDED. LOT AREA. °" IPLA G REV] ED TE RK -HAtuTAWS) Dt�, -S Emoc Ks (TYPE OF USE. BUSINESS OR ACTIVITY)EXPLAIN... - r` CHECKED BY TYPE OF N ' ` CODE' OCCUPANT GROUP Z 'o J 5 NUMBER OF STORIES I NUMBER OF DWELLING UNITS I CRITICAL , • . AREAS // NUMBER SPECIAL INSPECTOR REQUIRED ❑ YES AREA OCCUPANT LOAD DESCRIBE ORK TO BE DONE d REMARKS PROGRESS: INSPECTIONS PER UBC,108/FINAL INSPECTION REO'D j� j r TE 00 Ole u VALUATION FEE PLAN CHECK FEE 7 1 — GHEAT SOURCE I GLAZING k © SLOPE % BUILDING o! ! PLAN CHE K NO: VESTED DATE PLUMBING 1770 [��j MECHANICAL r� THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC GRADING/FILL DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE J SEPARATE PERMISSION. -0 � STATE SURCHARGE W PERMIT APPLICATION: 180 DAYS a I PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG. REVIEW FEES SU SEE BACK OF PINK PERMIT FOR MORE INFORMATION y 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE so W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF . EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY ANDrIN ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLYFROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BEDEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCEP051T6/V`= NOR LIMIT IN ANY WAY THECITY'SABILITYTOENFORCEANYORDINANCEPROVISION.aEC-cIPUEI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATIONGIVEN PLICATION APPROVAL IS CORRECT;AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OFA THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYEDBuilding Official or his/her Deputy: and Fees are paid. and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TOCTION receipt is acknowledged in space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OF ALS SIGNATURE DATE SIGNAT E (OWNER R A ENT) DATE SIGNED )it'��'�20 ED E DATE. ATTENTION EXT 333 lk�11 l IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771'0221L.-r W " A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL •FILE YELLOW -INSPECTOR CATE OF OCCUPANCY F� X PINK •OWNER • GOLD •ASSESSOR *7:1 CITY OF EDMOND,fly L SINGLE FAMILY ADDITI Directions: Applicants are to complete the Inl6latolioR 10 to This cover sheet must accompany each bVII01#019 $toit 6 ,APPLICANT PROJECT ADDRESS _11jP7 M PROPERTY TAX ACCOUNT PARCIL I DESCRIPTION OF WORK j0AAY7590AJ OWNER CONTACT PERSON . . . . . . . . . r E-MAIL 'FAX 1, MAILING ADDRESS 4 Lj FAX CORRECTIONS L!TMAIL COARICTION11 BY SIGNING THIS STATEMENT I UNDERSTAND THAT I AM THE CONTACT PINSON 000 T#ts PAN COORDINATE ALL SUBMITTALS WITH THE CITY AND ONLY I CAN MAIZE INOYIR114 ON 1144 St UNDERSTAND IT IS MY RESPONSIBILITY TO DETERMINE IN ADVANCE OF PERMIT $Ulkllf?AL Allif I" A MAY BE APPLICABLE TO THIS PROJECT. I ACKNOWLEDGE THAT TO THE 9161 OF MY A1111111,ITY I "A - - t110 V AIE MAGI DOCUMENTATION IN ORDER TO MAKE A COMPLETE APPLICATION AND NO 011601111110ONANY APPNOVAL Alit. MIIOOIAIOj SIGNATURE .ZONING INFORMATION ZONE LOT AREA .'N*EUM6'R.'OF D'WEL-LING.UNITS EXISTING DEMOLISH go DISCRETIONARY; APPROVALS .: c Determination VARIANCE SHORELINE SEPA Expires OTHI LOT COVERA EJNFORMATION PROPOSED D So wrrw ,I FiON INFORMATION Snohomish County A ,MAX 12,15 Public Works Road Maintenance 4TION NTSIDE -­ -16 67 81 D.P. Dennis Konopinski NT - -SIDE 101 Disffict 11-E Lead Worker QNO -FLAG LOT YES NO 'EOUIRED 0, YES.� ®N0- RECORDING (360) 862-7528 Cell (425) 290-2259 7, 1 -BOD-562-4367 FAX (360) 862-7537 I-rvw.vsd 7/00 1201 Bonneville Ave. M fy TO IN. 1 THAT i ENGINEERING #i j DRIVEWAY SLOPE % GRADING CYDS EASEMENTk-,77ti✓*rZ- EXISTING IMPERVIOUS AREA CONSTRUCTED BEFORE 1977_ SQ.FT EXISTING IMPERVIOUS AREA INSTALLED 1977 OR LATER --- SO.FT. PROPOSED NEW NET IMPERVIOUS SURFACE q;r 70- SQ.FT. .(City Use On DRAINAGE YES NO -SIDEWAL S'[D NO PLAN REO'D S LID# NO DEDICATION Ales ;:FT. UNDEROR I opal YES -STAFF COMM/NTSI , I3U L C609 10i1'PW 1997 UBC, UMC, UPC, WSEC, VIAO WITH AMENDMENTS DESIGN 80 MPH SEISMIC ZONE 3 WIND EXPOSURE B WIND SPEED Floor Liv#;Losd Roof Snow/Live Load P,!55_ Balcony Live Load 0 Floor Dood Load Roof Dead Load to Balcony Dead Load NUMBER OF-STON111 BASEMENTS FLOOD ZONE LOT SLOPI SOILS REPORT PROVPED YES El NO r 110TI-40110 (67 o wa a , 0" x FLOORA Mw ou"i to r*,.. 1111161ingi Proposed Total Living 11paillf,1- 09 Geroge Carport Dock/Covo Porth Other (City Use Only) Ceiling Insulation Z-3D Window U-Value Wall Insulation 12- M Skylight U-Value ..1108 Fioor Insulatio Glazing % 'Door U-Value Slab Insulation Ehergi:' re' iscri p, t I vie. V Target':_,:❑Systems Whole House Ventilation System ri -,..,,yes 0-ho Any request-jor sit"I1lig11601, vallit"Worother administrative deviation (herinafter "variance") must be specifically called out and Identill OC- AP I I, 611,dr'01404ontaining provisions which do not comply with the city code and for which a variance hos_."I requested and considered by the appropriate city offical In accordance with the appropriate- pfevllt"_61401 ".floto-law does not approve any Items not to code specification. PERMIT I CON011111 RX0" 1 a 1. 1 CONDIT 1 -.2184 AI `-'Jc. 1 %9� City of Edmonds Development Services Department Planning Division Phone: 425.771.0220 Fax: 425.771.0221 Critical Areas File #: 0 (-)=( 4T_ Critical Areas Checklist Fee: $45.00 Date Received by Dev. Serv. Dept: City Receipt No: el L",_ Date Mailed to Applicant: 026 CRITICAL AREAS CHECKLIST The Critical Areas Checklist contained on this form is to be filled out by any person preparing a Development Permit Application for the City of Edmonds Prior to his/her submittal of a development permit to the City. The purpose of the Checklist is to enable City staff to determine whether any potential Critical Areas are, or may be, present on the subject property. The information needed to complete the Checklist should be easily available from observations of the site or data available at City Hall (Critical areas inventories, maps, or soil surveys). An applicant, or his/her representative, must fill out the checklist, sign and date it, and submit it to the City. The City will review the checklist, . make a precursory site visit, and.make a determination of the. subsequent steps necessary to complete a development permit application. Please submit a vicinity map, along with the signed copy of this form to assist City staff in finding and locating the specific piece of property described on this form. In addition, the . applicant shall include other pertinent information (e.g., site plan, topography map, etc.) or studies in conjunction with this Checklist to assist staff in completing their preliminary assessment of the site. I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the best of my knowledge (fill out the appropriate column below). PLEASE PRINT CLEARLY Owner/Applicant: Name Street Address City/ State Zip Telephone Signature Date Applicant Representative: Name Street Address City State Zip Telephone Signature Date d:reception/jana/CACLHandout.doc Revised 4/10/2000 CA FILE NO. C, j -OD - 141 Critical Areas Checklist `7 --------------------------------------- ----------------- ite Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: % 10 -2 - a t U c. t S ,). 2. Property Tax Account Number: :�5 6, 6 9 o O -/ o o 7vl o o —e o o - o S/o- 3. Approximate Site Size (acres or square feet): �, y 4. Is this site currently developed? _1 yes; no. If yes; how is site developed? S 1= R, Describe the general site topography. Check all that apply. Flat: less than 5-feet elevation change over entire site. Rolling: slopes on site generally less than 15% (a vertical rise of l0-feet over a horizontal distance of 66-feet). ` Hilly: slopes present on site of more than 15% and less than 30% (a vertical rise of 10-feet over a horizontal distance of 33 to 66-feet). Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal distance of less than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water: /yd ; Approx. Depth: 7. Site contains areas of seasonal standing water: /t/ f� ; Approx. Depth: What season(s) of the year? IQ 8. Site is in the floodway floodplainC of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? /i�o Flows are seasonal? -,Lt (What time of year? 10. Site is primarily: forested lVd ; meadow /w : shrubs _ : mixed urban landscaped (lawn;shrubs etc) 11. Obvious wetland is present.on site: /l�Q Reviewed by S E P ::2 0 2000 ... Planner Date BUILDING DEPT. ^ca chk.doc; Rev M03/97 i CITY OF EDMONDS SINGLE FAMILY ADDITION/REMODEVIC0. Directions: Applicants are to complete the Information in the _ This cover sheet must accompany each building permit application for a sla$14 f601 p . " APPLICANT PROJECT ADDRESS 71Q7 PROPERTY TAX ACCOUNT PARCEL # DESCRIPTION OF WORK ,OM17.//JA.) - 'tees only). it project. 771 OWNER PNONE;..�;.� CONTACT PERSON PHONE . E-MAIL FAX MAILING ADDRESS_=#;..r.s FAX CORRECTIONS DIMAIL CORRECTIONS AIL 0011AECTIONa BY SIGNING THIS STATEMENT I UNDERSTAND THAT I AM THE CONTACT PERSON FOR TNIa.4NO411141 ,i141,,Yr4011%4NI11a1LITY TO COORDINATE ALL SUBMITTALS WITH THE CITY AND ONLY I CAN MAKE INOUIRISa ON TNe 1TATiiI)Afl'TME=APpL10AfilON, I UNDERSTAND IT IS MY RESPONSIBILITY TO DETERMINE IN ADVANCE OF PERMIT SUIVITTAL ANY 0110A1TIONAIIY P1ArITa THAT MAY BE APPLICABLE TO THIS PROJECT. I ACKNOWLEDGE THAT TO THE BEST OF MY AGILITY-1 NAvf wSr11"11'ALL 11101SaARY DOCUMENTATION IN ORDER TO MAKE A COMPLETE APPLICATION AND NO DISCRETIONARY A//IIOVAL1 API, N1OYIIl10l SIGNATURE 7 V :;ZONING INFORMATION - ZONE LOT AREA g. ;NUMBER OF DWELLING UNITS EXISTING DEMOLISHEDI!AOlfOEEO DISCRETIONARY APPROVALS CA4�/ Determination_ SUS01V1S101111 CU_ VARIANCE SHORELINE SEPA Expiroe ' O.. LOT COVERAGE INFORMATION < - PROPOSED SF "7 r TOT LI�NINFORMATION Snohomish County MAX :ri5 r Public Works TION Road Maintenance DESIDEDennis Konopinski2j(ja`-, SIDESIDED►sWt 11-E Leod Worker NO '=FLAG LOT'': 'YES NO �� LN - k_'' ' Q FT. YE s NO RECOR01N0 - (360) 862-7528 Cell (425) 290-2259 ='< 1-800-562-4367 FAX (360) 862-7537 rvw.vsd 7/00 a - 1201 Bonneville Ave. ° Snohomish. WA 982% _._. _.._ _._ DRIVEWAY iLOPI,% GRADING CYDS EASEMENfS7, EXISTING IMPERVIOUS ARIA CONSTRUCTED BEFORE 1977 SO.FT EXISTING IMPERVIOUS AREA INSTALLED 1977 OR LATER SOFT. PROPOSED NEW'NET IMPERVIOUS SURFACE t SO.FT. 68UIL014 �TiOK INFORMATION CWAR T; 1007 UBC, UMC, UPC, WSEC, VIAO WITH AMENDMENTS OtSIONOII;/�lI±A' WIND EXPOSURE B WIND SPEED 80 MPH SEISMIC ZONE 3 Floor Live Load Roof Snow/Live Load __-95 Balcony Live Load Floor Dead La-0 Roof Dead Load to Balcony Dead Load to NUMBER OF -STORIES BASEMENTS FLOOD ZONE LOT SLOPE !ft I �"� . SOILS REPORT PROVIDED ❑YES NO FLOOR ARIA (MesivrodU ftbe of exterior wall)" 1tlsting Proposed Total Living Space e < Garage 44 Carport ..,. Deck/Cov. Porch Other C (City Use Only) Ceiling Insulation_ Window U-Value1. Wall Insulation �— jgjg Skylight U-Value . tp8 Floor Insulation Glazing % 2l %) Door U-Value . 140 Slab Insulation .Energy: Prescriptive ❑ Target ❑ Systems Whole House Ventilation System Req'd KYes ❑ No Any request for inodif selion, variance or other administrative deviation (herinafter "variance") must be specifically called out and Identified. Approval of any plot or plan containing provisions which do not comply with the city code and for which a variance has not boon 1poolfleally Identified, requested and considered by the appropriate city offical in accordance with the appropriate proviNOn Of oliy.:oods of state low does not approve any items not to code specification. _1 110 NOR PERMIT tS11VANCIllAPPROVALS (City �Uxf my PLANlillia �� A�iR"OVAL DATE 'COND[TtONi 0 �ROVALis EIVGIN>4loRl 0Y1>DIY APPROVAL/�%�..r�►.y� DATE COivDItONi 01► A! OVAIri s v tL 0 na a APlROVAL DATE -CONDIT ONS IRoYALs` CA FILE NO. CA - 60 I N Critical Areas Checklist �7 -------------------------------------------------------------- Site Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: 71 ©-? — oa k U 2. Property Tax Account Number: `5-6, 6 9 0 - / o 0 D/ oo 3. Approximate Site Size (acres or square feet): 4-; 919 4. Is this site currently developed? _V yes; no. If yes; how is site developed? S t1- IZ 5. Describe the general site topography. Check all that apply. _ Flat: less than 5-feet elevation change over entire site. Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal distance of 66-feet). Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of 10-feet over a horizontal distance of 33 to 66-feet). Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal distance of less than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water: �� ; Approx. Depth: 7. Site contains areas of seasonal standing water: A10 ; Approx. Depth: What season(s) of the year? 8. Site is in the floodway /V U floodplainof a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? /y0 Flows are seasonal? -141LI) (What time of year? ). 10. Site is primarily: forested /Uy ; meadow /L-'O ; shrubs ; mixed urban landscaped (lawn,shrubs etc) 11-e sI / 11. Obvious wetland is present on site: /y O DETERMINATION ^ca_chk.doc; Rev 10/03/97 City of Edmonds Development Services Department Planning Division Phone: 425.771.0220 Fax: 425.771.0221 Critical Areas File #: C" C0 0 - 1239 Critical Areas Checklist Fee: $45.00 Date Received by Dev. Serv. Dept: City Receipt No: l Co O 1z oZ Date Mailed to Applicant: 8' 3l - loop CRITICAL AREAS CHECKLIST The Critical Areas Checklist contained on this form is to be filled out by any person preparing a Development Permit Application for the City of Edmonds Prior to his/her submittal of a development permit to the City. The purpose of the Checklist is to enable City staff to determine whether any potential Critical Areas are, or may be, present on the subject property. The information needed to complete the Checklist should be easily available from observations of the site or data available at City Hall (Critical areas inventories, maps, or soil surveys). An applicant, or his/her representative, must fill out the checklist, sign and date it, and submit it to the City. The City will review the checklist, make a precursory site visit, and make a determination of the subsequent steps necessary to complete a development permit application. Please submit a vicinity map, along with the signed copy of this form to assist City staff in finding and locating the specific piece of property described on this form. In addition, the applicant shall include other pertinent information (e.g., site plan, topography map, etc.) or studies in conjunction with this Checklist to assist staff in completing their preliminary assessment of the site. I have completed the. attached Critical Areas Checklist and attest that the answers provided are factual, to the best of my knowledge (fill out the appropriate column below). PLEASE PRINT CLEARLY Owner/Applicant: Name Street Address li City State Zip 4.'!;t--)-)/- --�;4E1 Telephone Signature Date Applicant Representative: Name Street Address City State Telephone Signature Date Zip d:reception/jana/CACLHandout.doc Revised 4/10/2000 CA FILE NO. C tI - 00 -141 Critical Areas Checklist --------- =-----------=- ----------------------------- ---------- ite Information (soils/topography/hydrology/vegetation) 1. Site Address/Location: 7 10 2. Property Tax Account Number: `J 61 6. 9 o p — o o 7-4�,/U .� 3. Approximate Site Size (acres or square feet): 4. Is this site currently developed? V_ yes; no. If yes; how is site developed? _ S fi R 5. Describe the general site topography. Check all that apply. Flat: less than 5-feet elevation change over entire site. Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal distance of 66-feet). Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of 10-feet over a horizontal distance of 33 to 664eet). Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a horizontal distance of less than 33-feet). Other (please describe): 6. Site contains areas of year-round standing water: /yd ; Approx. Depth: 7. Site contains areas of seasonal standing water: /t/ 0 ; Approx. Depth: What season(s) of the year? ,4 a 8. Site is in the floodway ---�_ floodplain—Z—VCl of a water course. 9. Site contains a creek or an area where water flows across the grounds surface? Flows are year- round? /yd Flows are seasonal? 141L0 (What time of year? ) 10. Site is primarily: forested /t/J meadow /w ; shrubs ; mixed urban landscaped (lawn;shrubs etc) _ v� 11. Obvious wetland is present on site: /l//Q ^a chk.doc; Rev 10/03/97 ")C. 1 %9, City of Edmonds Development Services Department Planning Division Phone: 425.771.0220 Fax: 425.771.0221 Critical Areas File #: 0 d Critical Areas Checklist Fee: $45.00 Date Received by Dev. Serv. Dept: City Receipt No: Date Mailed to Applicant: 8 CRITICAL AREAS CHECKLIST The Critical Areas Checklist contained on this form is to be filled out by any person preparing a Development Permit Application for the City of Edmonds Prior to his/her submittal of a development permit to the City. The purpose of the Checklist is to enable City staff to determine whether any potential Critical Areas are, or may be, present on the subject property. The information needed to complete the Checklist should be easily available from observations of the site or data available at City Hall (Critical areas inventories, maps, or soil surveys). An applicant, or his/her representative, must fill out the checklist, sign and date it, and submit it to the City. The City will review the checklist, make a precursory site visit, and _ make a determination of the. subsequent steps necessary to complete a development permit application. Please submit a vicinity map, along with the signed copy of this form to assist City staff in finding and locating the specific piece of property described on this form. In addition, the applicant shall include other pertinent information (e.g., site plan, topography map, etc.) or studies in conjunction with this Checklist to assist staff in completing their preliminary assessment of the site. I have completed the attached Critical Areas Checklist and attest that the answers provided are factual; to the best of my knowledge (fill out the appropriate column below). PLEASE PRINT CLEARLY Owner/Applicant: Name %/� 7 '-;�/67 5-/ .S cJ Street Address CityState Zip // Telephone Signature Date Applicant Representative: Name Street Address City State Zip Telephone Signature Date d:receptimUjana/CACLHandout.doc Revised 4/10/2000 CITY OF EDMONDS HARVE H. HARRISON MAYOR 200 DAYTON ST. • EDMONDS, WASHINGTON 98020 • (206) 771.3202 OFFICE OF THE CITY ENGINEER December 21, 1981 Mr. and Mrs. Ralph D. Ehrlich 15716 Heatherstone Lane Bothell, Wa. 98011 ST N`EET FILE Dear Mr. and Mrs. Ehrlich: SUBJECT: L.I.D. 206 - SANITARY SEWER CONNECTION RE: PROPERTY LOCATED AT 7107 210TH ST. S.W. City of Edmonds records indicate that you are the owner of property located in the College Place Area, and that the .sanitary sewer service is now available to your property. Residents abutting this sewer main are required to be connected per Edmonds City Code (18.10.010). In consideration of the completion of the sewer system and the aforementioned code, you are hereby advised that you should make arrangements to make the necessary sewer connection within sixty (60) days. If you have any questions, please contact Jerry Saterlie at 775-2525, extension 259. Permit and connection information may be obtained at the Building Department, at 505 Bell Street. Sincerely, JAMES E. ADAMS, P.E. City Engineer JR: j ky CITY OF EDMONDS _ FOR INSPECTION CALL PUBLIC WORKS DEPART. T • Permit Ho SIDE SEWER PERMIT 775-2525 Ext. 220 Issue Date J* PERMIT MUST BE POSTED ON JOB SITE * 1.' Address of Construction W 2. Property Legal `Description (include all easements) 3. Single Family Residence \ Multi -Family zrr ��,��Ui�s FL Commerciale 4. Owner and/or Builder 5. Contractor & License 6. Invasion into City Right -of -Way: No X Yes (If Yes)Rightl of way Construction Permit Required - Call Dial Dig (342-5344) before excavation). 7. Cross other private property: Yes No Easement required - v attach legal description and county easement number. H VIA BALLINGER a READ THE FOLLOWING AND SIGN: LIFT STATION a. Property owners must obtain a permit to install side sewers on >4 their property. A licensed side sewer contractor must be employed to construct side sewers in the public right-of-way. w b. The side sewer contractor assumes full reponsibility for each E-' installation for one year. ac. Commercial establishment requires a minimum of a six inch (6") z side sewer line. o 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 H f. No turn in side sewer greater than 45 (1/8 bend) is0allowed 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 connecter 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: ' I certify that I have read 1 and shall comply with the above . PERMIT FEE:I CONNECTION FEE: ? t) 0 w * PERMIT MUST BE DISAPPROVED By: Date: By: so Date: APPROVED By : Date :.�'" ON JOB SITE `� •;'.-LE M-'In 6-NCE COMPANY RECORDEW3 US X1 r4 0, CAM RY S. "?"i of Plats, 0%�C' 'ur (a... ed :-, it ': L ? ., - . -, to 1: 11k P] at v.. 11g southerly c. (tbeasuv-ed !.;I Said Waclz J 'A 4 f eet; thpavo th- so,it' (,t --iAd Lot., f1,) of J-k.'t air';, 1,71YOtE': Live cove-nants 1:� 'rOf'oA, it 'Pre side -,Z) fsecreury) ST81-7 of WDO-i- wtu,), *1-i co-trnivsiorad* and w"On, 4. t to ix: 1'.., Piresident Sf.rrvlai i, resjectively, of '0 gvp,41, 1;Uv '�:0 fOr;jgf71A,,j .—itrurn-,nt, fod th-u U,10 13SU 1AMLI-It 1-') ba th- free and volun- %.t.c Jrio of .old corpotatie—, for of, uses and PW• or, oath statc,,, that ml.,, oI ized to tfnccl-toi the said see- Ofixec' is ilsi, Lo-rmuite seei of ;on. o :`.',t'.as,vny tt ni wnd offii.tal sca; hereto aff;).oA -?+e day e1w In and ?or State cf kNashmgmn, msic� rvg