1030 BROOKMERE DR.PDF1030 BROOKMERE
DR
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER: ?-M�+ to C�t1.4b
BUILDING PERMIT (NEW STRUCTURE): � "L�I O L 24
COVENANTS(RECORDED)FOR-
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS (OTHER):I%D&CA4 SfP,)
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
LID #: "{-:�
SHORT PLAT FILE:s�' 2a - to I LOT: ti BLOCK:
SIDE SEWER AS BUILT DATED: .319 I(ocI
SIDE SEWER PERMIT(S) #:s Z,!Jg
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LATEMP\DSTs\Forms\Street File Checklist.doc
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CITY OF ,.
EDMONDS�
CIVIC CENTER WATER -SEWER DEPARTMENT
Call Pitospect s I10'7 why :work
is ready for inspection. (No insp¢c. .
S6DE S9WER PERMIT tions'6atnrday, Snnda<p ur Lolidays.) I�fi° 3
239
'9 DDREss r-0-Q 4'e Drlpe
OVVN]ER Mom.. -Poster C'II1
-•-------- -
------- ----------------- CONT A
Permission is' _____:Northwest Sewer
granted March 7
with City' Sewers in actor ------------ ------- 19.-.69 -
dance with a & ,for ..-- ----------
PP cation on file. and YS to REPAIR or CONNE
.ATTENTION IS:,CALLED TO T73E FOLLOWING..' . gOVer11171g :OrdiDanCes` CT aside sewer -
NOTE No. -I Theeowners of the Property - I be. 'employed to cons p�Y may obtain a permit to construct sewer inside
NOTE No. 2 tract side sewer in sheet area- Do not P y line. A licensed Side Sewer
—Obtain'.full info cover Pro ert
NOTE No- Information re gardi Y Portion of sew0 ander before it has been ins Contractor 3—Top, of side sower must have at least 30 ineheslcovea Coverage at Regulations actor must
governing side pecte,-
i No bends' in grade sharper g sewers when you get permit.
arper,than.Vs will be permitted. Property line and 12 inches inside
ro• 4—Trenches in street must be Property _
- failure due to im ro water settled and surface of Y line; minimum grade of 2q,.
NOTE No. p Per work which may street restored to on
5—It.is unlawful to y develop within one year of c ginal condition. Contractors sbal] be res
alter or do any other work than is °$pletion. POnsible for
tenances.except to insert thePipeinto the R.ye• '`
provided for in the permit, Or to do any work on the main 'sewer
\ ..
or
J.
its aPPur-
f`I $` POSTED ON KROLL YAP NO.: PERMIT
hZJMflSR 740 1'2.1 1
"• L .0 I L %D lit G DEPARTMENT I Applicant Fill
\ 4 AP1 Inslds Ae. Lines
PLKA ON 1TB nuDHEss . `
I.NAMI:• lOR"�1,-�'7�.�� _ REAR. YARD SETBACK 'I
��t� L` --- :ilUE YARD SETBACK
I STREET SETBACK
7 IJ�f !L' 2 \'
MESA .LINO ADDRE98 -- -- LOT AREA VACANT RITE ; 1
USE ZONE I i
�o_Io❑ YEB ❑ NO
a.1TY I TELEPHO:)E NUMez:R
^ �? 4 -40�4 HEIGRT BVILDINO AREA I VARIANCE NUMBER a
I f
" hhI NAPE PLOT PLAN APPROVED
U 1
wDUREtlO
STiI
• � � EXISTITI NGG S STREET R/W .......... FT. DEFICIENCY THIS PROPERTY'-
- U ---. TE1.EP`1UNE NUI+SHEH ■
CITY � COMP. PLAN BT. R!N ...... _.... Fr- — I
REMARKS �
' NAM�E I k
De CHECKED HY
KI--_- '. ELEI':tD. NUMHEN
'•. ! L y'� �JD METER SIZE SERVICE SIZE. I CLEARANCE I CHECKED BY
STATE xiCENBE NUMHlslt I l'1TY LICENSE N D'R — p7
RElTAKd �
` o Ir
Legal Description t Yrope[ty (Show Btlow Or Attach Pour Cuples) j
TYPE CONNECTION I VEP.IFIED BY � •"
I
a t Ov ♦t/l,PERMIT UMR
Ec. TEST eY%P j l
hi
f w `� c Si3/O fOtisi S(y. C'Ou.ti / Gt/itsh//✓G f0 RZ1 AP.KB m
.t o rHr aer7 po, oo. FE6 N E t
'~se 7-
/� '��.-t- - / F1HE 2 TYPE OF NBTRUCTION STREET •IMPHOVEU I i
yiVG .'� n•�i/.O .�,� �e�{-�. ' rode /9 I� TER NG "
0 -rES L L`:dPECTNo REQYYUIREDII�VJI OCC"'C
GAS rEs NoY GROUP
a RE9IDENTIA:• LLNE C(�HE,C�}KS IIY
t.
EPLAN
i NW-
❑ NON'-RE2IDE\Tr.tLJ ❑ 31CN iJ
® ADD ❑ RETAINING REMARK
S
DEMOLISH WALL
FENCE
ALTER URCAVAFILE (.._.....x_........ Ft.) t,
REPAIR �i PRE-MOVF. POOL lilt J5�T 17 F�..� l.'�II ^`va ;1
u INSP. --hh__ t
NUMBER 07 RTORIES I NUMBF:H OF
DWELLING
UNITS
NATURE OF WORK TO BE DONE Valuation Fee Receipt No., I
Plan Cbeek No....._._.._..
BUILD"
t :NG 2 •� -- 1 f
�1r.l
i PRO.POSLD USE; II
a PLUMBING -� 11
I
1 I L LAN indicate Bullaing setDncke, eDptting streets) KEAT k GAS LINE
FENCE I
nI SIGN
RETAINING WALL `
-
`j I� 1 BNZMMIN6 POOL
f — —
i`` (y� DEMOLITION
Q PRE -MOVE INSPECTION
" EXCAVATION OR FILL _ —I
TOTAL AMOUNT DUE
I hereby eUtabwledge that I Rave read this appilcatlpn: that the In-
formation given is correct: and that I athe owner, or the duly Wthar-
m NTION I - APPLICATION APPROVAL
ilea agent of trio owner. I agree to tromply with city and state laws -egu-
ATTE
latlog construction: And in doing the work authorized thereby, no person 1
TTt18 PERMIT This 8ppllt.aUOn !8 not 8 permitlDSti1
wlti be employed In violation of the Labor Code of the State of Washington
relating to workmen's Compenaallon Iazuranx• AUTHORIZER signed by the Building Of3Cial or his Dep-
�VLY THE lacy; and fees are paid, and receipt iE Re- ;
NOTE: Permit limit One Year (Except DEMOLITIONS which WORK NOTED
shall be completed m ninety 11-YI: MOVED -IN SUILDINCs ,tall be com- l(noWledged in space provided• .'.j
Dieted is six montlu.) INSPECTION
d1CNAT tE (OWNER A^.)TE C[G\ED. DIRECTOR'S BIONAT
t/f/!/J/ DE?ARTME`IT
CITY OF DATE
ED31ONDS
NOTE: Applicant Subject to Pldr.t Check Fee pit 6.110, �� 2
TNs Yermit coven work to be due, on private property ONLY.
Aa: muslructlon on the public domAin (_be, sidewalks, drlveways,
marquees, eta.) ww rmulre separate permission,
The City of Edmonds
•
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION ®� REPAIRS
EASEMENT No ......................
7
CONTRACTOR ............... �- � ................................... PERMIT Nb.... WY�
LEGAL DESCRIPTION: LOT No......�'�.................................... /�...............
...--.................
1-7 of
NAMEOF ADDITION ...................-...-.......---..................................................................................
Approved:
DATE ................�!. ...../........... BY .. Aol�l