1028 4TH AVE S.PDF1028 4TH AVE S
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INSTI:b7 Cam► Pernit { n"
2525 Ext. 220 Issue Date
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Address of Construction
2. Property Legal Description
(include all easements)
3.
Single Family Resideince
�. Multi -Family
No. of Units
Commercial
4.
Owner and/or Builder
a' V
5.
Contractor & License No.
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6.
Invasion into City Right -of -Way: Now Yes
(If Yes Right-of-
way Construction Permit
Required - Call Dial
Dig (342-5344) before
excavation).
7. Cross other private property: Yes No Easement required -
attach legal description and county easement number.
04
READ THE FOL14OWIKG 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.
a
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.
8
d. Side sewers may not be installed closer than thirty inches (30")
to any structure,
e. Side sewer lines musto a laid at a minimum grade, of 2% (1.150)
o
and maximum grade of 100% (45 ). o
E+
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 working hours only, Two (2) working
daysnotice required.
DATE:
d0hrtify that I have read
and shall comply with the above
PIERfi+lIT g'EE s ,
The City of Mmonds Side Sewer Drawing EASEMENT NO- -------------------- --------------------
zv�<� NEW CONSTRUCTION -Ey- REPAIRS ❑ LID NO- ------------------ - ASMT. NO. ----------------
OWNER ----- *lK ---- CONTRACTOR ----- 4wzl/
----------- ..... ----------------------------------- ----- PERMIT NO.
........................ --------------------------
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JOB ADDRESS ... Po..-S ------------------------------------------------------ LEGAL DESCRIPTION: LOT NO. ----------------------- .............. BLOCK NO. ------------ -----------------------
PWW-0001-11/75 (REV.11/78)
............................................................................................
7 NAME OF ADDITION -.ZfK1W ... 44 ------- AW:lf
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MAteo See- fLAT- OF
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Approved:
DATE ------ ll�k --------- ------ B, I
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BUILDING Pf_F: /IIT FROUTItJG
• INITi�L
DATE
BUILDING PERMIT &PPLIG&TION (COMPLETE) ----
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B SPIES OP S17F_= PLLN-------------
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_Z_r�AES`-OF-PL-OFJIB F,iCS%FIRE PROTECTION P1_pN
(MN.�KEID LIP BY FIRE DEP�RTMEhIT)-------
L COPY OF ENE_71WEERINCm C_HF_, LIST ----- — --
7
1 COPY OF PUBLIC WORKS MEMO-------
3 COPIES OF ORLIN&SE- PLdN WITH L&L.LULINT10KAS--
F EC IRED BY SUBDNISIONA-------0
6RE.NTEF, THNW • 2000 SQ. FT
IMPERI.JIELBLE SURF�GE(CODE1a.3p.C7ZQ)—O
LESS THNN Z000 SQ. FT.------[:]
MULTIPLE OR COMMEF?,CINL.
YES O
C1--1EGK At`ID LTTNC:: 1 COPY
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DF t•D. B. I�PPROVpLS
INCL_UDIIJG tit ► DRAWINGS
5UBDN ISIOtJ Y1ES w V [NME
NO 0
DATE RECORDED Z4
NUMEER 79/0ZG 0 L 38
CDPY OF�
CT&r_H
RF�UIREMENT
CHECK SEWER DR&WINO LWO k—MCH COPY — -- -—
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GHECV, OF•FICi,L STREET i./I�P---------
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.IS DEDIC_NTtON REQUIRED YES 0 (OU LlN� MT LWKA)
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MODES CITY I4NVE EASEMENT ON PP,OPES-TY
YES O (L�TTNr_H COPIES OFCF��WINC�S�
NO cs 1
CHECK L�llL biCLESS IN6RESS UTILITIES
YES TEI- YE S aff
NO = NO
H(,S SEWEf� �SSESSI/IE-NT BEEt-_I FL -AC)
5EE fiA - of L4uei .q,VA)YES 0 L.I.D. NO.
NO ED
PLNO.
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SUBDIVISION N0.
EST•
IF NO: UNVE REQUTO UTY E:t l EEI�
( TO CdLLULN7. E. CI AW-Ga V
SIZE OF WpTEPR METER ��?UIPLED 4
JF MULTIPLE; INCLUDE WUMEER OF UNITS
IF COMMERLILI INCLUDE WU.ABER OF FIXTURE UW7"S
ROUTE TO PUBLIC WORKS
I!` M LPL
D&TE
>ff CITY ENGINEER ( 4E Y,)
0 LEC=&L DISCRIPTION ---- — ----
❑ QUIT CLAIM---------------
❑ �SEJ✓1EN?'-----=--------
❑ LNL -C ULL7E -c=F—VJER COIJF.IEr_TICDN FEE— —
QL�S SLOPE UND VEHICLE dCLESS - - -
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—�
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STREET FILE--------�®�'
--t�WL�TER� .WEB DIVISIOFJ 41�
y C01..1PLETE BU I LDIIJ G PERMIT REV IE-\N — — —�.-
STPSEET DIV I SIGN
1 . CO1 AFLETE BUIL0INC5 FERM17 REVIEW —
❑ CSTNF� .
RtCE1VED
�A P R 9 1981
Dir. DI public Works
CITY OF EDMMDS
BUILDING PERMIT APPLICATION
N ! (OR NAME �OF jJ SINESS) LIE
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NAM1
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ADDRESS
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CITY
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NAME,
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O ADDRESS
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E CITY
U STATE LICENSE NUMBER
Legal Description of Property
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EPHONE NUMBER
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TELEPHONE NUMBER
(1 f 1- - kc-1
24
%1 TEL�ONE NUMBER
CITY LICENSE NUMBER
FC
iow Below or Attach Four Copies)
USE
ZONE
MI":_
IBER
JOB
ADDRESS ^
LEGAL DESCRIPTI/lONN7
SUBDIVISION
SHORT SUB NO.
I P- -f-gre
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
,
EXISTING
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PROPOSED
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III
DEFICIENCY OF RIGHT OF WAY Q
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Cy'
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SEE ENGINEERING MEMO DATED
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REMARKS
METER SIZE I BUILDING SUPPLY SIZE I FIXTURE UNITS
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED I PROPOSED COMPLETE( EXEMPT
VARIANCE OR CU
YARDS
FRONT
REMARKS
NXNEW r RESIDENTIAL
El PLUMBING
CHECKED BY
TV
aNON-RESIDENTIAL
ADD a DEMOLISH
MECHANICAL
❑ SIGN
SPECIAL INSPECTOR
REQUIRED
❑ ALTER ❑ ORCFILLTE
� I X—FT) ENCE
❑ YES ❑ NO
REMARKS
PRE -MOVE INP./
❑ REPAIR COMPLIIANCESNSP.
swim
a POOL \
Z NUMBER OF STORIES
NUMBER OF
DWELLING
F
UNITS
C NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
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PLAN CHECK FEE
This Permit covers work to be done on private property ONLY.
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 120 Days
In a "Applicant, on behalf of his or her spouse, heirs, assigns and
W successors in interest, agrees to indemnify, defend and hold harmless
J
i the City of Edmonds, Washington, its officials, employees, and
E agents from any and all claims for damages of whatever nature,
x arising directly or indirectly from the issuance of this permit. Issu-
a ance of this permit shall not be deemed to modify, waive or reduce
pany requirement of any city ordinance nor limit in any way the
I City's ability to enforce any ordinance provision."
I hereby acknowledge that I have read this application; that the in-
formation given is correct; and that I am the owner, or the duly author-
ized agent of the owner. I agree to comply with city and state laws regu-
lating cons coon; nd in d rg the work authorized thereby, no person
will bee oyed i iolatio q1 the Labor Code of the State of Washington
relatin Wor n's o nsation Insurance.
SIGN •Y'UR OWNE R AGENT) DATE SIG ED
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 304. 306.
1 02-78
BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
TOTAL AMOUNT DUE
PLANNING REVIEW BY DATE
LOT COVERAGE
SIDE REA
CONSTRUCTION I CODE IHEIGHT
AREA (OCCUPANCY (OCCUPANT
GROUP LOAD
VALUATION I FEE
ATTENTION
APPLICATION APPROVAL
THIS PERMIT
This application is not a permit
AUTHORIZES
until signed by the Building Official or
ONLY THE
his Deputy; and fees are paid, and
WORK�10
MID
receipt is acknowledged in space pro -
I' % Ec
INSPECTION
DE(P�Ap(J�ttVV��RTMEN1^N,
ACIIYY 4
vided.
DIRECTOR'S SIGNATURE
EDMONDS
DATE
aiy.g)p&�tc V4nrk
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
APR 6 REC0D
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(address) Z to
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Street Right -of -Way Existing �e, REQD `e
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Access Easements Existing �/p�yE READ --
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Utility Easement Existf READ
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Lot Per Subdivision Plat P -7� Assessor Map $ge
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Site Plan Checked for Accuracy 9ff
Underground Wiring Reqd.
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Check Accuracy of ga Description
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Review by Date
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Existing Water Main Size .4
Water Main Required Abi
Service Line Required "
Hydrant Size Existing
a:
Hydrant Reqd Per Fire Codes Size
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Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Comments
d
3
c�
Water Meter Charge Reqd. l ,-�3
Review byDate
Septic Tank Design Approved �l Date-7 g'/
Septic Tank Permit Reqd- �,�} Permit No.
Sanitary Sewer Availability Proj.
Drawing No. File No.
Side Sewer Availability 7r
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Sanitary Sewer ection Fee Reqd.
3
Review by Date - J
w
Open Ditch Existing Regd.
Culvert Reqd. /1/ Size
x
Catch Basin Reqd. �(� Indicate on Site Plan
0
Shoulder drainage maintain collection on swale open runoff
H
Manhole read. Indicate an Site Plan --
Soil Conditions and Ground Water Field Checked
Review by ��., �.. Date AP
Revised: 1v10-1977
Page 2 • •
Street Paving Reqd.
N
Curb and Gutter Reqd.
w Sidewalk Reqd. ,1 /
w Curb Cut for Driveway Reqd. .. -
e; Right=of-Way Construction Permit Reqd.
F, Bond Reqd, for Public Impravemnts
Street Name Sign Reqd.
Other Signing Reqd.
A. Pre Permit Site Inspection made on
z
BY : SEWER
H
w w WATER
a
H z STREET
�"' ENGINEERING
Special Requirements listed in memo to Commmity Development Department,
Building Division
> BY Date
o All items filled in an Building Permit Application
cd BY Date
a' Drawings Stamped and Notations Made
P4 BY Date
Approved by Public Works Department
a
0
Revised: lv 10-1977
•
CI
DATE: 4-7 4/
MEMO T0: Building Division
Community Development Department
FROM: Engineering; Division
Public Works Department
SUBJECT: l0;z8 4 �4 Av6- �-.
After review of the subject Building Permit application, we have
the following comments:
1. Connection to City water system required.
2. -C•onnection to City sanitary sewer system required
3. Right-of-way Permit required for any work on City property.
4, Driveway slope not to exceed 14%.
S. Backwater valve required if dowii:ct,nir.s plumbing is below
elevation of upstream manhole.
6. Water and sewer lines to be separated by 1.0 toot minimum.
i• Ui
Signature
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APR 91981
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-41
VI:.
"CITY OF EDMONDS
NEW
•
❑ ADDITION
❑ RETIREMENT
- ASSEONFORMATION SHEET
ASSET NO. 3 r �� y
ADDITION TO ASSET NO.
S"'."EET FILE
DESCRIPTION
f3 C,
SERIAL NO.
LOCATION DEPT. ((NO.
I G' Z ��vd 6 s- G
**PURCHASE ORDER NO. *PROJECT NUMBER 4� a..
PURCHASE ORDER DATE PROJECT COMPLETION DATE
COST COST 9 4/ .
B.A.R.S. ACCOUNT NO. -3 Y,5^ Gc%
•ESTIMATED LIFE
I •
INITIATED BY DATE APPROVED BY
**SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
❑ DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT _
G.L. ENTRY
REFERENCE
INITIAL
DATE
VERIFI
PROCESSED
BATCH NO. 3
DEPARTMENT FILE