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13599
714 VISTA PL
.CITY OF EDMONDS
,�,.`,-P.UBLIC WORKS DEPARTMENT FOR INSPECTION CALL Permit Ho. _.
SIDE SEWER PERMIT 71149Y�2A Ext. /2VO Issue Date
1 _ ?n? 2A�
PERMIT MUST BE POSTED ON JOB SITE =� EDMONDS
1. Address of Construction r7l 4 TREATMENT PLANT
2. Property Legal Description (include all, easements)
3. Single Family Residence V, Multi -Family No. of Units
Commercial t `
4. Owner and/or Builder
5 . Contractor & License No. �� - WE - LAZ -- A_ l LAk a
6. Invasion into City Right -of -Way: No V, Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig ,fhA(Y- 5'NA) before
excavation).
1-800-424-SSSS
7. Cross other private property: Yes No )t, Easement required -
u attach legal description and county easement number.
a READ THE FOLLDWLNG AND SIGN: 'R F! E
T FILE
a
F: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
construct side sewers in the public right-of-way.
w b. The side sewer contractor assumes full reponsibility for each
H installation for one year.
wC. 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.
M e. Side sewer lines must be laid at a minimum grade of 2% (1.150)
O and maximum grade of 100% (450). 0
E- f. No turn in side sewer greater than 45 (1/81bend) is0allowed
between cleanout. All 9b 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 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:
�
T1 certifytha-t I have read
and shall comply with the above
P _PERMIT FEE:, 3n, 00
0 wFA f 1'-f n A - ha m m2 S 05
� CONNECTION FEE:
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* PERMIT M1
DISAPPROVED By: Date:
B Date:
APPROVED By : , Date:
T BE POSTED ON JOB SITE
V�
The City of Edmonds
Side Sewer Drawing
EASEMENT NO- ---------------------- -------
NEW CONSTRUCTION REPAIRS ❑ LID NO . .................. ASMT. NO.... ...........
OWNER JAOMEA-A-JAD ..... 140 NVES ...... IIA-C .............. CONTRACTOR ----- 7BLn—DQ�]M-G ............ PERMIT NO. 719-1
JOB ADDRESS .714 ...... \lusm%. - - - -P i .. .......... .................... LEGAL DESCRIPTION: LOT NO. -.-.z ............................ BLOCK NO. ---------------------- -------------
.................................................. --------------------------- ...... ............................... ---------- ---------------
NAME OF ADDITION ------------------------ 14ARBO-2---- LAME.----
------ ----at ----------
8-comc. MAm
3e -ra 7,r" AVE.
¢'C-0,wm y
450
S20
0
Approved:
PWW-0001-1 1/75 (REVA 1/78) DAT"WlY I)YA ----- Byld---j . ....
VIS—M F)LACF— :ot--
105p. 15!1 'R-tAOLLAm E. AV.Al3
CITY OF f DMONDS
ASSET INFORMATION SHEET
LJ NEW
•
❑ ADDITION
❑ RETIREMENT
STREET FILE
ASSET N0.
ADDITION TO ASSET NO.
DESCRIPTION /, l
SERIAL NO.
LOCATION / DEPT. NO
*'"PURCHASE ORDER NO. _
PURCHASE ORDER DATE
COST
*PROJECT NUMBER "u:=s
PROJECT COMPLETION DATE 0,
COST
B.A.R.S. ACCOUNT NO.
• ESTIMATED LIFE_
INITIATED BY DATE APPHOVLU by
**SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
LJ DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
• G.L. ENTRY
REFERENCE
DATE
VERIFIED BY
PROCESSED
BATCH NO. _
INITIAL
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DEPARTMENT FILE
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CITY OF EDMONDS
_ �K � u«,�. low�o=. w�����.C H E C h
SINGLE TA11ILY MULTIPLE COMMERCIAL
nF.vIavv
PROJECT NAME �'
A*'t,��6//L±m,:/ %t1iyes CONTACT HIL'tE b TELEPHONE NUMBER
ADDRESS 7�'�j� lArr i � /I4r
ACCESS SLOPE AND VEHICLE ACCESS
DRAINAGE PLAN
STREET FILE
LEGAL DESCRIPTION VERIFICATION
-,QUIT CLAIM/DEDICATIONS
EASEMENT - PUBLIC/PRIVATE
CALCULATE SETTER CONNECTION IF NO LID Il
STREET PAYING REQUIRED
CURB AND GUTTER REQUIRED
SIDEWALK REQUIRED
CURB CUT FOR DRIYEWAY. REQUIRED
RIGNT-OF-WAY CONSTRUCTION PERMIT REQUIRED
BOND REQUIRED FOR PUBLIC IMPROVEMENTS
STREET NAME SIGN REQUIRED L/ /
OTHER SIGNING REQUIRED
(ADDITIONAL COMMENTS ON
EXISTING WATER MAIII SIZE I',D,
WATER MAIN REQUIRED AP4
SERVICE LINE REQUIRED
HYDRANT SIZE EXISTING
HYDRANT REQUIRED PER FIRE CODE /ira SIZE
CROSS CONNECTION INSPECTION
WATER METER CHARGE REQUIRED 3%�, o e)
REVIEW BY DATE (ADOITIDUAL C(*KNTS ON e
Lam—
¢
SPX17ARY SEWER DWI1NG UUM-BER
FILE tWIBER
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3
SIDE SEWER AVAILABILITY
SANITARY SEWER
CONNECTION FEE REQUIRED
W
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OPEN DITCH EXISTIIlrt
REQUIRED
; CCCULVERT
REQUIRED 1E t{2
r P MGA,) 0 r � � d � lU,
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SIZE
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CATCH BASIN REQUIRED ' t
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'' INDICATED OM SITE PLAN
=
SHOULDER DRAINAGE RAI NTA1N
COLLECTI011 ON SHALE OPEN RUflOFF
DATE:
MEMO TO: Building; Division
Community Development Department
FROM: Engineering Department
SUBJECT: %I- k/.Sr•4 / Z44e
After review of the subject Building., Permit application,:
the following comments:
1. Connection to City water system required
2. Connection to City sanitary sewer system required
we` have
3. Right-of-way Permit required for ,any work on City property.
4. Driveway slope not to exceed 14;0.
S. Backwater valve required if clomist airs plumbing; is below
elevation of iTstream manhole.
6. Water and sewer lines to be separated by 10 foot minimum.
7. Builder/Owner responsible for containing all temporary run-
off and erosion on site and may not impact neighboring
Sig ature
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LEGAL DESCRIPTION CHECKI
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SUBDIVISION NO.
4
LID NO.
MAILING ADDRESS
PUBLIC RIGHT F WAY PER OFFICIAL STREET MAP.
CITY
TELEPHONE NUMBER
EXISTING REQUIRED DEDICATION
PROPOSED
z
NAME
RIGHT OF WAY CONSTRUCTION PERMIT REQUIR1.ED LJ
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STREET USE PERMIT REQUIRED ❑
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ADDRESS T1
�D CA
SEE ENGINEERING MEMO DATED`Wd
SEE PIW DEPT. REVIEW CHECK LIST DATE _
CITY
McALIRLD
TELEPHONE NUMBER
REMAR
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NAf�oCAQ�.�&k�(��MES
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ADDRESS
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METER SIZE
BUILDING SUPPLY SIZE
FIXTURE UNITS
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CITY
TELEPHONE NUMBER
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REMARKS
STATE LICENSE NUMBER
CITY UCE SE NUMBER
f_v1 A
SIGN AREA
ENV. REVIEW
ADB NO.
ALLOWED PROPOSED
COMPLETE EXEMPT
SHORELINE #
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Legal Description of Property • include all easements
(show below or attach four copies)
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VARIANCE OR CU
PLANNING REVIEW BY ,
DATE
YARDS
7i
FRONT SIDE REAR
LOT COVE A
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REMARKS
NEW RESIDENTIAL PLUMBING
ADD/ALTER NON-RESIDENTIAL MECHANICAL
REPAIR RETAINING WALL SIGN
EXCAVATE FENCE
CHECKED BY
TYPE OF CONSTRUCTION
CODE
HEIGHT
DEMOLISH OR FILL (_x_FT)
❑PRE -MOVE INSP./ ❑ SWIM
COMPLIANCE INSP. POOL
SPECIAL INSPECTOR
REQUIRED
AREA
OCCUPANCY
GROUP
OCCUPANT
LOAD
SIDE SEWER WATER LINE
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I'1 YES NO
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REMARKS
❑ ❑ ❑
2
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NUMBER OF STORIES
NUMBER OF
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DWELLING
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
,A D
vll/CJ
VALUATION
FEE
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
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successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
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employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be 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."
C eC
rA
o d
TOTAL AMOUNT DUE
S
I hereby acknowledge that I have read this application; that the
information riven is correct: and that I am the owner, or the dUly
ATTENTION
APPLICATION APPROVAL
PL D T FLAN
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