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16280 68TH AVE W
3 STREET FILE
PUBLIC WORKS DEPARTMENT CHECKLIST
y� BUILDING PERMIT REVIEW pAVE- .zh.
(address) (dto
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Street Right -of -Way Existing ,�D '/.-
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Access Eas�ts Existing /
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Utility Easement Existingr� (;��yp
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Lot Per Subdivision . ' -Plat_ jO&ls-ja�j&l Assessor Map
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Site Plan Checked for Accuracy off'
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Underground Wiring Reqd.
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Check Accu rac of Legal Description
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Review by
Date , Z�
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Existing Water Main Size q") D1,
Water Main Required IV LA
Service Line Required
Hydrant Size Exis ting ,5' • -
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Hydrant Reqd Per Fire Code_ 41j}
Size
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Detector Check Meter Reqd.
Cross Connection Inspection
N
Fire Department Comments
d
3
dater Meter Char e Req d.SU o
Review by
Date
Septic Tank Design Approved ��
Date
Septic Tank Permit-Reqd. �,)�
Permit No.
Sanitary Sewer Availability
Proj.
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Drawing No.
File No.
Side Sewer Availability
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Sanitary Sewer Connection Fee Reqd.
3
Review by ��.�.�t
Date O.
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Open Ditch Existing
Reqd.
Culvert Reqd.
Size -------
r4
Catch Basin Reqd. ¢
Indicate on Site Plan
0
Shoulder drainage maintain collection on Swale open runoff
H
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Manhole r d. �{/L92g
Indicate an Site Plan
Soil Conditions and Ground Water Field
Checked
Review by �� � -
Date
Revised: lv10-1977
i�
�5
BUILDING DIVISION Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
NAME (OR NAME OF BUSINESS)
Sierra West Const. Inc.
pj MAILING ADDRESS
3 1750 -112th Ave :N.E #215
0 CITYEPHONE NUMBER
EL
Bellevue 455-0750
AM
Kinderfather Chaffos & Dunn
U
W ADDRESS
201 5th Ave. So.
U
C CITY TELEPHONE NUMBER
` Edmonds 77509396
NAME
C
0 ADDRESS
U
Q
E CITY
F
2
0
U GTAY
Z
0
I -
a
a
U
H
W
0
J
u
W
J
ONE
Or
SEE ATTATCHED PLANS
Our
USE
ZONE
PERMIT
NUMBER
JOB _ 0 `Q8 f
AODRFSS I�Z8A\^ W�C2T,
LEGAL DESCRIPTIONIO/ SUB�DIV' ISION IISSSHORT SUB NO,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING A?)
❑
SIGN
SEE PLANS
PROPOSED PROPOSED
ADD
DEFICIENCY OF RIGHT OF—WAY
O -
PUBLIC IMPROVEMENTS REQUIRED
DRAINAGE IMPROVEMENTS REQUIRED
-
DRAINAGE PLAN REQUIRED
❑
UNDERGROUND WIRING REQUIRED
❑ ALTERa EXCAVATE
OR FILL
CONNECTION TO SANITARY SEWER
WALL
( X FT)
I—
SEPTIC TANK PERMIT REQ'D ❑
NO,
ELEVATION OF PROPERTY CORNERS
❑
& FOOTINGS REQ'D
SEE ENGINEERING MEMO DATED
JJ
1Z�
�1
CHECKED BY j i'
Z NUMBER OF STORIES
METT SIZE BUILDING SUPPLY SIZE
X
REMARKS
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED I PROPOSED COM PLET J EXEMPT
SHORELINE
REMARKS
VARIANCE OR CU (PLANNING REVIEW BY IDATE
YARDS ILO- COVERAGE
FRONT SIDE REA
® NEW X RESIDENTIAL GAS
IM LINE FIRE ZONE TYPE OF CONSTRUCTION COD
of ante of this permit shall not be deemed to modify, waive or reduce
J .nn, irr „rnr of Inv rite ordinance nor limit in any way the
HEIGHT
i (OCCUPANCY IOCCUPA
GROUP LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
❑ NON-RESIDENTIAL
❑
SIGN
SEE PLANS
ADD
MECHANICAL
FENCE
SIGN
DEMOLISH
Wsuccessors in interest, agrees to indemnify, defend and hold harmless
RETAINING
SPECIAL INSPECTOR
❑ ALTERa EXCAVATE
OR FILL
E]
WALL
( X FT)
I—
REQUIRED
❑ YES El No
PLAN CHECKED BY
DREPAIR a RE-INSP.MOVE
El
swim
POOL
REMARKS
Z NUMBER OF STORIES
NUMBER OF
0
2
DWELLING
_�--
F,
UNITS
n NATURE OF WORK TO BE DONE
Q
IA construction of dwellings
W
0
m
Q
PLAN'CHECK FEE
PLOT PLAN
WA
of ante of this permit shall not be deemed to modify, waive or reduce
J .nn, irr „rnr of Inv rite ordinance nor limit in any way the
HEIGHT
i (OCCUPANCY IOCCUPA
GROUP LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
BUILDING
PLUMBING
SEE PLANS
MECHANICAL
FENCE
SIGN
H "Applicant, on behalf of his or her spouse, heir`s, assigns and
Wsuccessors in interest, agrees to indemnify, defend and hold harmless
J ,
i the City of Edmonds, Washington, its officials, employees, and
RETAINING WALL
Ir agents from any and all claims for damages of whatever nature,
Q
I arising directly or indirectly from the issuance of this permit. Issu-
SWIMMING POOL
of ante of this permit shall not be deemed to modify, waive or reduce
J .nn, irr „rnr of Inv rite ordinance nor limit in any way the
HEIGHT
i (OCCUPANCY IOCCUPA
GROUP LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE