1243 7TH AVE S1243 7TH AVE S
BOILDING DIVISION Applicant Fill
USE �PE'RMII'
ZONE NUMBER
' APPLICATION Inside Heavy Lines
JOB -
."PERMIT
ADDRESS
�NAM
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IOR NAME OF BUSINESS)
"(
L T- GAL DESCRIPTION
SUBDIVISION -
SHORT SUB NO.
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MAILING ADDRESS L Bao
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PUBLIC RIGHT OF WAY PER 'OFFICIAL ST' EET MAP
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ELLEPHONUE Ne
CITY /
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J�U//+MBER
EXISTING
PROPOSED
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DEFICIENCY OF RIGHT OF WAV
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ADDRESS
PUBLIC IMPROVEMENTS REQUIRED
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DRAINAGE IMPROVEMENTS REQUIRED
DRAINAGE PLAN REQUIRED ❑
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CITY
TELEPHONE NUMBER -
Q
UNDERGROUND WIRING REQUIRED
CONNECTION TO SANITARY SEWER
NAME
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SEPTIC TANK PERMIT REQ'D ❑ NO.
C
'9"91ne
ELEVATION OF PROPERTY CORNERS ❑
- 0
ADDRESS
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& FOOTINGS REQ'D
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CITY
TELEPHONE NUMBER
4
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SEE ENGINEERING MEMO DATED
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
_
CKED BY ..{
Legal Description of Property (Show Below or Attach Four Copies)
ER ZE BUILDING SUPPLY SIZE
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A
Z
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A
SIGN. AREA
ENV. REVIEW
ADB NO.
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ALLOWED PROPOSED
COMPLETE EXEMPT
SHORELINE
-
N
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0
J
REMARKS
Q
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VARIANCE OR CU
PLANNING REVIEW BY JDATE
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'(/I NEW
RESIDENTIAL AS
LINE
YARDS '
aFRONT
FIRE ZONE"
LJ
NON-RESIDENTIAL
❑
❑ SIGN
ITY
❑ ADD
❑ ALTER
DEMOLISH
ORCFILLTE
RETAINING
❑ WALL
❑ I ENCE X_FT)
SPECIAL INSPECTOR
REQUIRED
El YES NO
PLANN CHECKED BY
❑ REPAIR
PRE -swim
NSP.
POOL
REMARKS'
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS '
Z
0
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4
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NATURE OF WORK
TO BE DONE
-
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PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
FENCE
N "Applicant, on behalf of his or her spouse, heirs, assigns and
SIGN
W successors in interest, agrees to indemnify, defend and hold harmless
J RETAINING WALL
i the City of Edmonds, Washington, its officials, employees, and
tt agents from any and all claims for damages of whatever nature,
ItSWIMMING POOL
I arising directly or indirectly from the issuance of this permit. Issu-
0 ante of this permit shall not be deemed to modify, waive or reduce
J any requirement of any city ordinance nor limit in any way the
0
1 City's ability to enforce anv ordinance provision.'_
LOT COVERAG
/SIDE REAR
OF CONSTRUCTION JCODE HEIG
AREA (OCCUPANCY IOCCUPANI
GROUP LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE .
..._...- .... .. �,...._ ._..�''�' _ -tr-. .. .. -. � ± ' ` 1, "• C.!
72
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ENGINEERING REQUIREMENTS FOR BUILDING PERMIT APPLICA`l'ION
CITY OF FF!1..10NDS
PUBLIC WORKS DEPAHU4ENT
EPd , I I IF,ERIP1r i D FVI S I ON DATE: LA •�,t'j � 'j
SUBJECT: `% G�3 - �j. S
Subdivision 'S. .'1'7 Plat PRD
Multiple
Commercial
GENERAL REQUIRU4ENTS
Coordination of the location or any structure with respect to utilities, streets, property
lines and driveway grades is the responsib'lity of the contractor.
Thy ccnstraJ7or is required to keep the abutting street cleaned of dirt and debris caused
by the construction 7.30.200 Violations - Penalties 7.30.290.
A "Right-Of-k4ay Construction Permit" is required from the Engineering Division of'.Public
Works for any work within the Public right-of-way or public easement. 7.30.010 Violations
Penalties 7.30.290.
SPECIFIC REQUIRF1.1ENTS
UNDERG ROUT M POIHER
Underground Wiring Req'd ❑ Not Req'd
SANITARY SENF-R (PEE,1IT REQ I D )
,91.Connection to Sanitary Sewer Req'd ❑ Back Water Valve Req'd on Side Sewer
❑ Septic Tani. Permit Reg'd. DesiJpi Approval Req'd
Approved Dt. Permit Plumber
STORf4 S -J-Zi SYST E-1 ( PER CITY CODE
❑ Drainage Plan Req'd
Site Drainage to be Contained on Site
ROADWAY L1PROVIJ i1`1'S AND D13.ffE•]AY RE00IRFTr1DFPS
Drive,, -ray Slope Not to Exceed 14
❑ Drainage Plan Approved Dt.
❑ Site Drainage to be Connected to City System
Drive,,iay Paving; Req'd d ❑ Driveway Culvert Req'd d Size I
,® Vertical Curb 13eg' d � Sidewalk-Req'd
QStreet ?avii"l,i; Req'd ®p Approved Design Req'd 4-" /3`7%
Bond Regld for Public Improvements XSubmit Cost Estimate ()t4'1-1(_e
Note: C-154 -.: s 11�90, f.C'%�
Inspections, TF" cl',1. , Engineering Division
Foundation e�—Side Sewer N� Septic Tank
69- Water Service ❑ Fire Protection Drainage
--Sire I.Ifpr'ove riy nts
A 24 - hour• notice .is required for inspection :)y Engineering, call 775-2525, extension 220.
I;Ti' D F. IU-TZBERG, P.E.
1....
0
Z
F_+
el PUBLIC INURKS DEPAM=C aiECKLIST v
BUILDING PERMIT REVIEW
Date
1 4 Address
Street -Right -of -Way Existing REQD
Access Easements Existing REQD
PEE
Utility Easement Existing REQD
Lot per SubdivisionPlat Assessor Map
.,.,.-f:;,:
4 Site Plan Checked for Accuracy
Underground Wiring Reqd.
J;.Check Accuracy.,pf Legal Descr',i4tion
Envirorunentally Sensitiv& Area
Environmental Check -list Reqd.
;.Flood Hazard Zone
3" Slioreline Management Area KA C"A
CD
I'SlOpe, Soil, Vegetation KJp
Stream, Creek, Drainage Basin,
Existing Zoning Per -Code_ g —s c4=1
Amenities Design Board Approval Reqd. &)cn ADB # K-)c:!, Approval
4.Board of Adjustment Approval Reqd. hj d
e
EbE Date:--
iqw'.'By: Rev
'
,'
k.
-Existin'g" Water A?ain Size
,i.Water Main Reqd..
..,-Service Line Reqd.
r4
Hydrant Size Existing,
Hydrant Reqd. Per Fire Code
'e4 Detector Check Meter Reqd.
Cross Connection Inspection
Size
Fire Department CaTuients
Water Meter Charge Reqd.
Review by: Date: 7
Septic Tanlz, L�-_sign i�pproveci Date:
�1 Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability -5-11 Proi
PF - :5
Dr ft. -A Ok ri
Drawing No. File No.
Side Sewer Availability TW
Sanitary Sewer Connection Fee. Reqd.
Review By: Date:
Open Ditch Existing- /f/,�.v,G Regd:—L�/�kF
Culvert Reqd. 4/ 4ii- Size
P Catch Basin Reqd. A/e:lyE . Indicate on Site Plan —
Slioulder dra':nage n1L intai.n collection on swale open .runoff �-
i Ialahole regd. /a,,V,_ Indicate on Site Plan _
Soil Conditions and Ground Water Field Cliecked
by Ikate
t.
I
k' Street Paving Reqd.:..,
Curb and Gutter Reqd: v // r
w o Sidewalk Reqd.
,c(/rrrC
w Curb Cut for Driveway Reqd. .^ ,
t
C4 Right -of -flay Construction Peimdt Reqd.
[-F Bond Reqd: for Public Inprovemmts
Street Name Sign Reqd.
Other NIV
�Spignink jR1[ejq�d. w, . `i:=w."L:'e: ��rL 2� "'r3�w�'L+S .dti�ic'�►'�6 �+s°6r-��?��"+c"7� ' � n �. f"' �'� �+ S �r rNyry�- .. . y!. pr��.,��;��rd
Q � .Pre Perinit Site . Inspection made on
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t� w WATER Q
P;
S'11 ET
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EI'GINEEPSNG
.���!S^�^i��L_�i$ i•n�'i�'" �7:: ,"s��' L"�i� �.i��`��i$" 7iC 3ii �: SS� `1Z�Yii�:k£ �b �Za�ii ��a ri"'i'vl:. � :. i
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'��Special Requireiw_nts' listed in mcm-o to Colnmmity Developl-a-_nt'nepartmik--rit,
Building Division
13Y Date
o All i-tc-'irs filled in on Building Permit Application
.
14 BY Date
P4 T
Drawings S I to rimed and � _ � i .Potations i•1-rde
wt
BY Date
Approved by Pub l.i.c Forks Departrmt
Al
Revised: I.v 10-1977
BUILDING DEPARTMENlIF
Applicant Fill
ZONE 4 BER
PERMIT APPLICATION
Inside Heavy Lines
,ff'n UU
JOB
ADDRESS .(
p� �i -�
NAME (OR NAME OF BUSINESS) qj�j� 'TIRE
EE
r--a
T F
0
iShq BPIVISION NO
PLAT NAME
C
ASSESSOR MAP NO.
W
MAI ING ADDRESS
Z
3
0
PUBLIC RIGHT OF WAY PER ORDINANCE NO.
EXISTING RIGHT OF WAY
CITY
TELEPHONE NUMBER
vL
PROPOSED RIGHT OF WAY 15
NAME
F
U
DEFICIENCY OF RIGHT OF WAY O
W
F
ADDRESS
STREET/UTILITY WORK REQUIRED ®YES NO
N
U
PERMIT FOR WORK IN PUBLIC R/W ®YES ❑NO
tr
0
3
CITY
TELEPHONE NUMBER
CC
Q
UNDERGROUND WIRING REQUIRED i 1YES ❑NO
U_
CONNECTION TO SANITARY SEWER ®YES ONO
SEPTIC TANK PERMIT REQUIRED ❑YES NO
J
m
IL
NAME
/
SEPTIC TANK PERMIT NO.
0
ADDRESS
F
U
SEE MEMO DATED 4-1" A-iCJ
-/e
!+`1
(t
F
CITY
TELEPHONE NUMBER
REMARKS
Z
0
,
U
STATE LICENSE NUMBER
CITY LICENSE NUMBER
CHE ED
3
T11T
Legal Description of Proper y (Show Below or Attach Four Co Ies)
METER IZE
BUILDING SUPPLY SIZE
'
REMAIRKSF
Z
c
a
SIGN AREA
ENV. REVIEW
ADB NO.
U
n
O?/��.
`J ✓✓
ALLOWED PROPOSED
COMPLETE EXEMPT
W
0
�
J
�
Q
REMARKS
J
VARIANCE OR CU
PLANNING REVIEW BY
DATE
NEW RESIDENTIAL ❑ GAS
LINE
YARDS !
,� D FRONT / SIDE /5 REAR
LOT COVERAGE
FIRE 20NE
TYPE OF CONSTRUCTION
CODE
HEIGHT
NON-RESIDENTIAL ❑ SIGN
❑ ADD ❑
DEMOLISH ❑ RETAINING
SPECIAL INSPECTOR
REQUIRED
AREA
OCCUPANCY OCCUPANT
❑WALL
ALTER D EXCAVATE FENCE
OR FILL ❑ ( X FT)
❑ YES ❑ NO
GROUP LOAD
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS.
❑'
REPAIR PRE -MOVE swim
a INSP. POOL
LOCAL SALES TAX
SHOULD BE CODED 31.04.
NUMBEROFSTORIES
NUMBER OF
REMARKS
-
`! fis l
UNITS LING
/
Z
W�
NATURE OF WORK TO BE DONE
a
IL
W
0
PLAN CHECK FEE
VALUATION
FEE
PROPOSEDUSE
Z
O
�//�
�L C /i�� �_�
h
Z
a
Il✓
PLOT PLAN IiNDICATE BUILDING SETBACKS,
W
T
ABUTTING STREETS)
BUILDING
d
U
to
0
PLUMBING
41a
W
O
J
W
m
W
0
MECHANICAL
FENCE
>
F
SIGN
Z
f
RETAINING WALL
F
0
U
SWIMMING POOL
•
STREET FILE
DATE: 4I241-1p)
MEMO TO: Building Division .
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT: 1.2 4—1 TH_ AmE-S-
After review of the subject building permit application,.we have
the following comments-
(1) Coordination of the location of any structure with respect to
utilities, streets, property lines and driveway grades is
tFie
responsibility of the contractor.
(2) The contractor is required to keep the abutting streets clean-
ed of dirt and debris caused by the construction.
(3) A "Right-of-Wav Construction Permit" is required, from the
Engineering Division of Public Works, for,any work within
the Public Right-of-1,'ay or public easement.
(4) Driveway slope not to exceed 140.
12iiii!�M-Iffi-V%
+ ► . ,i a W107,a� ►• a
Pw 5/77
I'm VnIvirdr"Walm
I.
PUBLIC WORKS DEPARTMENT CHECKLIST
BUILDING PERMIT REVIEW
1
ANR 41Z NA
(address) to
Street Right -of -Way Existing 5O
REQD
z
Access Easements Exist ing_�e� Q
REQD
H
x
Utility Easement Existing
W
Lot Per Subdivisions--� -1 - Plat
Assessor Map �+
W
Site Plan Checked for Accuracy
z
Underground Wiring Reqd.
H
0
Check Accuracy of Legal Description
4- 21
z
Review by.
Date
W•
r ..
Existing Water Mai ize
Water Main Required
Service Line Required
Hydrant Size Existing
P4
Hydrant Reqd Per Fire Code
Size
W
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Conments
n,
Water Meter Charge Reqd.
Review .by .
Date ZI -78
ILK..
a
Septic Tank Design Approved
Date
Septic Tank Permit Reqd. 1014
Permit No.
Sanitary . Sewer Availability l���b
Proj .er
Drawing No. /
File No.
Side Sewer Availability %—a
~
W
Sanitary Sewer Connection Fee Reqd.
3
Review by W/S
Date 2" 7
W
K.K.K.
Open Ditch Existing
Regd. —
Culvert Reqd.
Size —
r4
Catch Basin Reqd. —
Indicate on Site. Plan
O
Shoulder drainage maintain collection on swale open runoff =
H
`n
Manhole re d. q ��
Indicate an Site Plan —
Soil Conditions and Ground Water Field Checked
Review by
Date _//
Revised: 1v10-1977
Page 2
• • t
Revised: lv 10-1977