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1004 VIEWLAND
WAY
CALL. Permit
Issue,,::Date
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Side Sewer Drawing
The City of Edmonds
EASEMENT NO- -------------------------- -----------------
NEW CONSTRUCTION REPAIRS 0 LID NO- ---------- ---------------------------
OWNERAl
-TL-V - - ----- NA uo-hlkl -------------------------------- CONTRACTOR --- ------------ PERMIT NO.
JOB ADDRESS-1004— ------- ViE-WL-JAN
-D ---- - - — ------- LEGAL DESCRIPTION: LOT NO. ----- (��--------------------------- BLOCK N T EDMONDS 4
L-REATMEttT-T PLAN
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❑ ADDITION
❑ RETIREMENT
ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION
DEPT. NO.
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**PURCHASE ORDER NO. _
PURCHASE ORDER DATE
COST
*PROJECT NUMBER W -; :rr l3 ,?
PROJECT COMPLETION DATE / 2--3 0 ^ Sr 3
COST 2 g' :z o IV �"
B.A.R.S. ACCOUNT NO. �—
• ESTIMATED LIFE 2�
INITIATED BY DATE APPROVED BY
**SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
C DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT _
• G.L. ENTRY
REFERENCE
DATE
VERIFIED BY
PROCESSED
BATCH NO. _
INITIAL
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DATE : �/ % J d 3
14EMO TO: Building Division
Community Development Department
FROM: Engineering Department
SUBJECT:
After review of the subject Building; Permit application, we have
the following comments:
1. Connection to City water system required.
2. Connection to Citv sanitary sewer system required.
3 Right-of-way Permit required for any work on City property.
4. Driveway slope not to exceed 14%.
5. Backwater valve required if downstairs plumbing is below
elevation of upstream manhole.
6. Water and sewer lines to he separated by 10 foot minimum.
7. Builder/Owner responsible for containing all temporary run-
off and erosion on site and may not impact neighboring
properties in any way.
Signature
CITY OF E®MONDS
,.` CIVIC CENTER • EOMONOS. WASHINGTON 9W20
SINGLE FAMILY MULTIPLE COMMERCIAL
PROJECT NAME rZWA1rL
ADDRESS % ()n (/ d(o.
ACCESS SLOPE AND VEHICLE ACCESS
DRAINAGE PLAN
STREET FILE
LEGAL DESCRIPTION VERIFICATION
QUIT CLAIM/DEDICATIONS
EASEMENT - PUBLIC/PRIVATE
CALCULATE SEWER CONNECTION IF NO LID A
ENGINEERING d
PR0JECT°
C H E C K
PUBLIC WORKS
REVIEW
LIST
CONTACT NAME & TELEPHONE NUMBER
(-dS--
STREET PAVING REQUIRED A
CURB AND GUTTER REQUIRED U
SIDEWALK REQUIRED
CURB CUT FOR DRIVEWAY REQUIRED
RIGHT-OF-WAY CONSTRUCTION PERMIT REQUIRED v
BOND REQUIRED FOR PUBLIC IMPROVEMENTS //
STREET NAME SIGN REQUIRED
OTHER SIGNING REQUIRED
(ADDITIONAL COMMENTS ON BACK)
EXISTING WATER MAIN SIZE C ,
WATER MAIN REQUIRED ��[{
SERVICE LIVE REQUIRED 3Z,y�
HYDRANT SIZE EXISTING 7 y
HYDRANT REQUIRED PER FIRE CODE IV14 SIZE
CROSS CONNECTION INSPECTION —
HATER METER CHARGE REQUIRED
REVIEW BY DATE (ADDITIONAL COMMENTS ON BACK)
SANITARY SE14E.R DZAI•IING NUMBER
SIDE SEWER AVAILABILITY
FILE NUMBER
SANITARY SEWER CONNECTION FEE REQUIRED
OPEN DITCH EXISTING ;� 1 \ REQUIRED
CULVERT REQUIRED ppiwvE I7 1 gnl ►opc,� }�SIZE
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USE PERMIT
CITY OF EDM0NDS
ZONE v •+ NUMBER
CONSTRUCTION PERMIT APPLICATION
NAME OR NAME OF BUSINESS)
JOB
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ADDRESS t✓
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LEGAL DESCRIPTION CHECK SUBDI ISIO NO. NO.
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MAILING ADDRESS
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CITY TELEPHONE NUMBER
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PUBLIC RIGHT 1V%AY PER OFFICIAL STREET MAP.
3s
v A(� / 301
EXISTING "LOU IRED DEDICATION
PROPOSED �
NAME
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED
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ADDRESS
STREET USE PERMIT REQUIRED ❑
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SEE ENGINEERING MEMO DATED '-J
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CITY TELEPHONE NUMBER
SEE PIW DEPT. REVIEW CHECK LIST DATED _.
NAME
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ADDRESS
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METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS
¢
CITY TELEPHONE NUMBER
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NUMBER
REMARKS
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S TE LICENSE CITY LICENSE NUMBER
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SIGN AREA ENV. REVIEW ADB NO.
Legal Description of Property - include all easements
ALLOWED PROPOSED COMPLETE EXEMPT
(show below or attach four copies)
SHORELINE N
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a
lot #
VARIANCE OR CU PLANNING REVIE BY DATE
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�V.� S ��� C ,�f G S�jJ ��
YARDS ?�% /U / Z LOT COVERA
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FRONT SIDE REAR
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REMARKS
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F?�LEW
lkIfiESIDENTIAL PLUMBING
DADDIALTER D NON-RESIDENTIAL ( MECHANICAL
'
DREPAIR D D
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RETAINING WALL SIGN
EXCAVATE FENCE
D D D
CHECKED BY TYPE OF CONSTRUCTION HEIGHT
a.;
DEMOLISH OR FILL ( x_FT)
7E
❑PRE -MOVE INSP.I El SWIM
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
COMPLIANCE INSP, POOL
REQUIRED GROUP LOAD
DNO
D D
REMARKS
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SIDE SEWER WATER LINE
D D D
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CC
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NUMBER OF STORIES NUMBER OF
m
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DWELLING
l m1>
UNITS
NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
VALUATION FEE —
.
PLAN CHECK FEE
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BUILDING
y,
PLUMBING
.!
MECHANICAL
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This Permit covers work to be done on private property ONLY.
GRADINGIFILL
(
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
an
successors in interest, agrees to indemnify, defend and hold
,
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harmless the City of Edmonds, Washington, its officials,
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employees, and agents from any and all claims for damages of
IC)214 V1, IcLn
FM- T-DKF�
;E-1 IDAYTOl
ta)MCQDS, I �Tl Oki R)V2 o
Lo
nIT FL/W
OCT 19 1983
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