21819 82ND PL W11111111111111
15364
21819 82ND PL W
CITY OF EDMONDS
PUBLIC WORKS
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Aaaress or construction LI X I I X Lpj'j Vll , 1=dVkdY1Qs' `1XU LU
Property Legal Description (include all easements) LOT?
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Single Family Residence Multi -Family No. of Units
Commercial �A 0'1 II Zo3(, Aj w S_6rH
Owaammund/or Builder D nU L l e c'l L yyc_ 0VL S� }12 g 007
Contractor & License No. bD- V B —LT —* Z Z bJ'L
Invasion into City Right -of -Way: No P--" Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
7. Cross other private property: Yes No�asement 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% (1.15°)
and maximum grade of 100% (450).
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 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 work4hhou o Two (2)working
days notice required.
DATE: 3 ,� ati y t a ave reahall com y with the above
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PERMIT FEE: _'3S
CONNECTION FEE:
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W * PERMIT MI
� .,)ISAPPROVED BY: Date:
// By: Date:
APPROVED By: Date:
ON JOB SITE *
IIt1, 0RKS DEPART`-= CHECKLI* %Z-1 `C-1 K Date
UTLDING PERMIT REVIEW
STREE z1Y X9 - VZ- address
Street Right -of -Way Existing
sC�&C) REQD .�
Access Easements Existing
REQD
Utility Easement Existing
�2 �LA_T REQD
Lot per Subdivision
Plat Assessor Map
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Site Plan Checked for Accuracy
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Underground [,firing Reqd.
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Check Accuracy of Legal Description Y-I y
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Environmentally Sensitive Area
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Environmental Checklist Reqd.
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Flood Hazard. Zone
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Shoreline Management Area
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Slope, Soil, Vegetation
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Stream, Creek, Drainage Basin
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Existing Zoning Per Code
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Amenities Design Board Approval
Reqd. _ADB # Approval
Board of Adjustment Approval Reqd. WD
Review By : L Date : 1Z 1X-11{
Existing [,rater �1ain Size �" ��. ( ,
Water Main Reqd. /�
Service Line Reqd. I =?/Y
w Hydrant Size Existing
H Hydrant Reqd. Per Fire Code AIA Size
Q Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department C Tments �-
Water Meter Charge Reqd.L212 6�
Review by: Date :
Septic `l' c sign pnrove ate:
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Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability Proj.
Drawing No. File No.
Side Sewer Availability ve. S
Sanitary Sewer Connection Fee Aegd.
Review By
Date: -/ %;7 - 79
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BUILD N G D E P A R T M E N Applicant Fill
USE ^ T
ZONE
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PERM PPLICATION Inside Heavy Lines
JOB
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ADDRESS (/� �^j•,
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NAME (OR OF BUSINESS)
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MAILING
LEGAL LOT
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PLAT NAME
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PUBLIC RIGHT OF WAY.PER, ORDINANCE NO.
EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY
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TELEPHONE NUMBER
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NAME
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DEFICIENCY OF RIGHT OF WAY
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ADDRESS
STREET/UTILITY WORK REQUIRED �J YES El NO
PERMIT FOR WORK IN PUBLIC R/W YES NO
UNDERGROUND WIRING REQUIRED "XYES El NO
CONNECTION TO SANITARY SEWER IQ YES El NO
SEPTIC TANK PERMIT REQUIRED ❑ YES O
TELEPHONE NUMBER
NAME
SEPTIC TANK PERMIT NO.
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ADDRESS
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SEE MEMO DATED
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CITY
TELEPHONE NUMBER
REMARKS A
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STATE LICENSE NUMBER
CITY LICENSE NUMBER.
CHECKED BY
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Legal Description of Property (Show Below or Attach Four Copies)
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ER SI E BUILD I G SUPPLY SIZE
REMAR S
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SIGN AREA
ENV. REVIEW
ADB NO.
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ALLOWED PROPOSED
COMPLETE EXEMPT
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SHORELINE
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VARIANCE OR CU
PL.ANNING REVIEW BY
DATE
YARDS , I ' LOT
FRONT SIDE '� REAR
COVERAGE
NEW RESIDENTIAL ❑GAS
LINE
❑ElNON-RESIDENTIALSIGN '
ADD
DEMOLISH ❑ RETAINING
WALL
❑ ALTER ❑ ORCFILLTE ❑ FENCE X—�)
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
HEIGHT
SPECIAL INSPECTOR
REQUIRED
❑ YES ❑ NO
AREA
OCCUPANCY
GROUP
OCCUPANT
LOAD
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
REPAIR PRE -MOVE SWIM
INSP. El POOL
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
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NUMBER OF STORIES
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114QMBER
DWELLING I
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UNITS 1
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NATUR O ORK TO BE DONE
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PLAN CHECK FEE
VALUATION
FEE
PROPOSED USE.
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PLOT PLAN INDICATE BUILDING SETBACKS,-0
ABUTTING STREETS)
BUILDING
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PLUMBING
MECHANICAL
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FENCE
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SIGN
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"Applicant, on behalf of his or her spouse,'heirs, assigns and
successors in interest, agrees to indemnify,defend and hold harmless
the City of Edmonds, Washington, Its officials, employees, and
RETAINING WALL
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agents front any and all claims for damages of Whatever nature,
arising directly or indirectly from the issuance of this permit. ISsu-
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SWIMMING POOL
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ance of this permit shall not be deemed to modify, %waive or reduce
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