7111 165TH PL SW.PDF1111111111
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7111 165TH PL SW
ENGINEERING DEPARTMENT
AP L CATION FOR RIGHT-OF-',"'�Y OfdSTR�r ON
c� I ��"REET FILE
(AprZicz-,t to CC'-nZGta A & cnd S!&rmt ir: Gupi c.te)
a, Permit to be issued to:� r-�`,yic �'f)'�37 1-
For work at: (address or vicinity)
Type of work to be done: 11�= C~UvI�/-J fr' �j%/lJC Lt %;- t"a
(Attach Drawing 411en Applicable.)
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Time Required -- Start: ILI''C)G) ZZ`y/ Finish:
Owner: 1• 7/LZ
Name
Mailing'Address
City, State
Contractor:
Name
Mailing Address
City
State
�- J % 5Z�
Telephone [dumber.
1716 - - - zg , ) ;mil i�/7
State License 'Number
Telephone Number
B� INDE`1;NITY: 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, or any of its departments or employees,,
including but not limited to.the defense of any legal proceedings including 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 acceptance
of the restoration by the Engineering Department.
'Work subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by the Engineering Department.
Call 775-2525. X aa.e)
Signature: �'7 _} `Q,
`Owner Qr Agent Date. Si.fi e'd"
DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
Permit Issued (Date) Permit Number 7 %
Fee:_ if 1 Z. so Bond:_
Time Authorized: S C
EI:R' S APPPOVAL
_1
DATE
5 it)
I
I-IST
CMIUMN(l, �TT PMITE"
1010/ a 4Z-L
STR F�'' �,n�
Street Rj.glht-of-',-.`--iv Existing
1150
Pi -D T)
Access J:,isements, Fx istinp
N 0 � VF
N
H
Iltilit\ 1"iscment Yxisting
nn t4-4-)t
II
—]Zj'
Lot Pcr Subdivision- --Plat
Assessor
11m)
Site 1*11,m Cl,.ccl:c(l for Accurio,
•,-
Th(lergrOLind I'dr, ing, ].cod.r-'a-Liful
li
Ofix"al Dauriplibr'.
'U",
110vi ("..:
PLiteII
e--
Fxistill� 11"'ater "."lin Size
'!,-lill Required
�r-
-
— ----------
1 k-dr;l!"t S i- .-C j'x i 5 tinz Wy C)
I'milired pC)r Fire Cr'de,
Dc-tector (,iccl, "cl-cr Rcquired
CoPric"Its
j,J re
Pate 2 —
Scptic Dcsif,,n Approved �j fc)r- Date
II Septic TrTrine:11cmit Pccitured Mi t 'To.
it Sanitnn, '�cv:cr Availahility Teo
P.- �'% Pro-i . L �
0 —1 AC) Fi I c 'b.�i`�.'_�L�— � _. i
Side !Pvcr Avoihibilit",
Sanitary Sewer Connection Fee llcclldrccl—�j 00
i2= L22�
(ii)cvj nitdi T-aistiml Peouirml.
Culvert P.00,111iml Size
Catch Dnsi n !'Zormired Indicate on ''ito Plan
(IOLl"01(tole— mc In SLLale. I've,
zop��i-i ran
Nanhol(., ronuired, Tndicntc m Site :11m
--k 0 —4-j—
Soil Condition.,; F, (,i-otuid Water Ficld (1,0.cl,ccl
"ovi u by ---Date.
..B ��I L��I LDING DEPARTMENT Applicant Fill ZONE `J NUMBER
�/' I APPLICATION Inside Heavy Lines ��� l �'
PERMIT JOB
NAME (OR NAME OF BUSINESS) ADDRESS
d"T
VARIANCE OR COND. USE NO. JADB NO. HEIGHT
C �
W MAILINOFADDRESS _ \J
Z - PAD YARDS LOT COVERAGE
F
U
W ADORE
f
I
U
IC CITY
Q
NAME
!Y
0 ADDRE
F
U
Q
E CITY
F
Z
U tTGTF
D scription of
ELEPHONE NUMBER
FRONT SIDE
REAR
/✓SIGN
AREA
ENVIRONMENTAL REVIEW
�J
ALLOWED PROPOSED
Z
❑ COMPLETE ❑ EXEMPT Z
REMARKS
Z
Q
J
a
i
LEPHONE NUMBER
TELEPHONE NUME
CITY LICENSE NUI
7Y
low Below or Attach Four Cc
t
L5t .t1� e
PLANNING DEPT. APPROVAL DATE
LEGAL LOT LOT AREA SUBDIVISION NO.
❑ YES ❑ NO
STREET R/W r
EXISTING STREET R/W 'SD FT. DEFICIENCY THIS PROPERTY
COMP, PLAN ST. R/W JQ FT, O FT.
REMARKS Driveway slope not to exceed those
indicated on STandard Drawing #103.
C ECK�
STREET AND/OR UTILITY WORK R/W PERMIT REQUIRED
REQ'D. ❑ YES 44'N0 ❑ YES ONO
UNDERGROUND
WIRING REQ'D. nYES ❑NO
TYPE CONNECTION YES VERIFIED BY
SANITARY SEWER ❑ NO
SEPTIC SYSTEM ❑ YES PERMIT NUMBER
APPVD BY CITY ENG.
® NO NA
REMARKS
METER SIZE ISERVICE SIZE ICLEARANCE CHECKED BY
JORESIDENTIAL
REMARKS
J❑GAS
El —LINE FIRE ZONE TYPE OF CONSTRUCTION ICODE
ADD
❑
❑ ALTER
❑ NON-RESIDENTIAL
DEMOLISH
EXCAVATE
❑
❑
❑
SIGN
RETAINING
WALL
FENCE X—FT)
SPECIAL INSPECTI
REQUIRED
YES❑ED
PLAN
CHEC KB
❑ REPAIR
PRE -MOVE
SWIM
INSP.
❑
POOL
REMARKS
NUMBER OF STORIES
NUMBER OF
/
DWELLING
UNITS
NATURE OF WORK TOO BE DONE
PROPOSED USE
Z
0
L PLOT PLAN INDICATE BUILDING SETBA
It ABUTTING STREETS)
U
N
W
0
m
0
PLAN CHECK
NO.
BUILDING
PLUMBING
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
_Z
W
W
W
Z \
Z
am,
E
W
F
a
3
1
OCCUPANCY
OCCUPANT
GROUP
LOAD
F
THIS SITE IS LOCATED IN THE CITY w
OF EDMONDS. LOCAL SALES TAX 0
SHOULD BE CODED 31,04,t7
Z_
_J
7
m
VALUATION I FEE
r�
•
STREET FILE
DATE: 1119,QM
ME^MO TO: Harry !,!hi tcutt
Building Official
FROf1: Richard H. Allen
A.ggiqtpnt r.ity Fnninaar
SUBJECT:
�-0'1- 11 �tolLIYON V S-1
After review of the subject building permit application, we have the following
cor-,dents :
r PIA3LIC ''OPu S I)I;PT. (71ECF; LIST.. Y l
11I1ILDINK.1 PER"UT P.TY1 1
SO
r
Street Right-of-l-,'ay Existingy � � IT D � 7►d I
Access Easements P.xi.sting R1:f1T1 N
Utility Easement Existing REOTI
Lot Per Subdivision Plat Assessor ?',ap j
Site Plan Mcclxd for Accuracy
ihiderground i'diring Rcgd.
Older' R•cctrray off. p( a_7� prdbn ._
Review by
Existing U'ater Main Size
Water Main Required
5Cf�1 I,ne p'c4ju+recl
11N,drant Size Exi.stin
2Z
Ilyc?rant )lcc;uireclY ilre Coda UO —Size
I)ctector Mcck ?'etcr Rcouircd
Cross C6nne-dibn 1i),
"Fire l)cmartment Cop.nents
Sc? tic Tanl: )esiTI A*,�l�rovec? _ -_ T?atcP\r—A-
Septic Tank Permit Required —_!� Permit ?-To.
Sanitary Sever Availability T'(] �_ �� Proi.PL,!
Dra •ring IT -ilc 'Io. ;
Side Sewer Availabilit
Sanitary Sevier Connection T'ce Required.�� `! l"
P.evicv. by_L ,--� �.. Pate
Open Pitch Existing Reoui.rec?
o
Culvert Required '� Size
N Catch Basin Renuirecl 0 Indi.cate on "ire Plane"_
.Shouldee d "maIC T ivy Co legion in %vct2E
Fr-
�I _open run v PF -
i wv iolc required CV)� _____Indicate on Site Pl.an�j
Soil Conditions F, (;round Water Field (Iocked
j I Review by � s� %/ Date 4Jw
- �7p
Street Paving R'cquired �NG:1_
ftirb and Glitter Required � EYMST I v (
Sidev"'IR 1equired
Curb (lit for Driveway 'Required,v_G vq>
Ri.g lit-of-!'lav Construction Pci-mi.t Reouired`F�e)6L
Bond Required for Public Improvements
Street Nark Sign Required�_
Other Signing Requirccl
Pre Permit Site Inspection made on
BY: SC1,17er — -
Water
Street
Engineering_����
Special Requirements listed in, memo to Building Pe.partment
By 7 Date ----
/ill items fillet] in on Building Permit A1'nlication
By pate___
1)raw'i.ngs Stxq)ed and ;?otations 1 1"Idc -
B , ' Rite
Approved by Public 1,'orks Department
C.
APPLICATION
The City of EdmonZMEff Fff-F for
SIDE SEWER PERM EASEMENT NO. ----------- --------------------------
NEW CONSTRUCTION N REPAIRS El LID NO. ------------- - ASMT. NO. ------------------
------- PERMIT NO.
OWNER --- CONTRACTOR - ----- --------------------------- -----------------------
---------
JOB ADDRESS ------------------ LEGAL DESCRIPTION: LOT NO. -------- ------------------- . BLOCK NO.------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------
ON
NAMEOF ADDITION ------ --------------------- — ----------------------------------------------------------
Approved:
X
DATE------------ ------ 91
APPUCATION
The City of Edmonds for
SIDE SEWER PERMIT EASEMENT NO. ------------------ -------------------------
NEW CONSTRUCTION REPAIRS ❑ LID NO. ------------------ - ASMT. NO_ ------------------
OWNER ------ ---------- (9CONTRACTOR
- - ------- ----- PERMIT NO.
JOB ADDRESS ------- ------- is�-t2 ----------------------------- LEGAL DESCRIPTION: LOT NO. --------------------------- BLOCK NO. ------------------------------------
................... .......................... ........................... ........................................
NAME OF ADDITION --------- -
........ ---
RECEIVED
�AY 13 1977
Pi iblic works Dept.
Approved:
DATE-------------- - ---------------------------- By --------------------------------------------------- iw-5re
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).
CITY OF EDMONDS - SIDE SEWER PERMIT
` WATER -SEWER DEPARTMENT
PERMIT
iCall 775-2525 for side sewer inspections BEFORE covering any portion of the construction.
\Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.)
ADDRESS LOCATION OF CONSTRUCTION ----------- _.165th Plata S.W.
.....................................•-................... _._.... __. _...----.._........_....----.......----•-•---....... __...----.....
PROPERTY LEGAL DESCRIPTION .......................... Lgt;... 1 L..._HOr gz.on ..WeAt
_........................................................................ .. .......... ..... ................................... ............_.......
....... _........ ----------------------------------------------- OWNER AND/OR BUILDER------- QPI II�TS-•-C:ONSTRtJCTI�N.•-CQI P 1.......__.....:............._...
CONTRACTOR'S NAME & ADDRESS ------- R71 9,--:TOb QY1.......................................... .................... ....._...-- ---
---
--------------------
Permission is
��............ -• �1�y---�----��_a__._._., 1977._, for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
A-..:ENTION IS CALLED TO THE FOLLOWING: - -
NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2 q . No bends in grade
sharper than 'A will be permitted.
NOTE No. 5—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6—It is unlawful to alter or do any other work than is provided for In the permit, or to do any work on the main sewer or its appurtenances except to in-
sert the pipe into the wye. -
DISAPPROVED E]� Date .... .. ... �`... By ...... Date
............. .
............ .................... By..
;�k�
APPROVED Date..._... ._ �----------•-__-�
_ Re.................................._............_......_....---....---...._......_....._...._....._..._...._...
mar
. ................._.._...............---......------._.......................................................
— BJTJ P / it Co /�IiiS�Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection —
----------------___ _._, hereby certify that the side sewer installation constructed under this permit
Perf'rming Construction)
all governing ordinances of the City of Edmonds.
Dated this../..... ... ........... day of.. .. .. ............................................. 19
72
Check BEFORE you dig for: Water p, Gas p, Telephone �, Power �, Sewer p, Other