1034 4TH AVE S1033 4TH AVE S
! S7IEET FILE
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Street Right -of -Way Existing ��REQD
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Access Easements Existing p�� p y _18 READ
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Utility Easement Existing +x A ,. . REQD
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Lot Per Subdivision Plat (A Q.3e,,_Assessor Map
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Site Plan Checked for Accuracy. --Z . 20 - -1
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Underground Wiring Reqd.
Check Accuracy of Legal Description
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Review by
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Existing Water Main Sizej"
Water Main Required iv
Service Line Required - "
Hydrant Size Existing
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Hydrant Reqd Per Fire Code i A Size
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Detector Check Meter Reqd. ti i2�,
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Cross Connection Inspection ijll/ ,
Fire Department Conments
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Water Meter ge Reqd.`�-
Review by � ic,� ` Date /2 S- ;7
Septic Tank Design Approved Date -- _
Septic Tank Permit Reqd. Permit No. —
Sanitary Sewer Availability ate, �,��• �� �, Proj . u .�
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Side Sewer Availability P.
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Sanitary Sewer Connection Fee Reqd. r
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Review by-r�n Date
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Open Ditch Existing-----
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Culvert Regd. ,,a Size
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Catch Basin Reqd. ,L Indicate on Site Plan �_ c
Shoulder drainage maintain collection on swale open runoff ;r
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Manhole re d.
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Soil Conditions and Ground Water Field Checked
Review by enf:e. �1 � �: � Date
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avcviacu: 1v1V-1W /
'BUILDING DIVISION Applicant Fill
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APPLICATION Inside Heavy Lines
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ADDRESS to 3S - � r` � S.
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LEGAL DESCRIPTION
SUBDIVISION
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING
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EL,EryPHONE NUMBER
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PROPOSED
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OE FICIENCY OF RIGHT OF WAY
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ADDRESSzie) / /��' �� 6'
PUBLIC IMPROVEMENTS REQUIRED ❑
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DRAINAGE IMPROVEMENTS REQUIRED
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TELEPHONE NUMBER
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DRAINAGE PLAN REQUIRED ❑
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UNDERGROUND WIRING REQUIRED
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CONNECTION TO SANITARY SEWER L�
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NAME
SEPTIC TANK PERMIT REQ'D ❑ NO.
ADDRESS
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ELEVATION OF PROPERTY CORNERS ❑
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& FOOTINGS REQ'D
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CITY
TELEPHONE NUMBER
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SEE ENGINEERING MEMO DATED 10 20- 1y
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tST��AATf LICKNS19NUMBER
CITY LICENSE NUMBER
CHECKED BY
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Legal Description of Property (Show Below or AXAN
METER SIZE BUILDING SUPPLY SIZE
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REMARKS
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SIGN AREA ENV. REVIEW ADB NO.
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ALLOWED PROPOSED COMPLET EXEMPT
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SHORELINE
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REMARKS
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VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS
FRONT SIDE REA R!
LOT COVERAGE
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LINE
FIR! ZONE
TYPE OF CONSTRUCTION
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❑ NON-RESIDENTIAL ❑ SIGN
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HEIGHT
ADD
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WALL
SPECIAL INSPECTOR
REQUIRED
AREA
OCCUPANCY
GROUP
OCCUPANT
❑ ALTER EXCAVATE ATE ENCE
❑ YES ❑ NO
LOAD
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PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
REPAIR PRE -MOVE swim
INSP. D POOL
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
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NUMBER OF STORIES
NUMBER OF
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DWELLING
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UNITS
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N URE OF WORK TO BE
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PLOT PLAN
PLAN CHECK FEE
VALUATION
FEE
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BUILDING
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PLUMBING
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MECHANICAL
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FENCE
SIGN
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"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
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the City of Edmonds, Washington, its officials, employees, and
RETAINING WALL
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agents from any and all claims for damages of whatever nature,
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arising directly or indirectly from the issuance of this permit. Issu-
SWIMMING POOL
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ance of this permit shall not be deemed to modify, waive or reduce
any requirement of any city ordinance nor limit in any way the