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1108 12TH AVE N.PDFiiiiiiiiii 610 1108 12TH AVE N r PUBLIC WORKS DEPARTMEN r"I,-"'Single Family BUILDING PERMIT -REVIE p BUILDING ADDRESS TREE ce eal BLDG. DEPT. SUSPENSE DATE INITIAL DATE JTE: ❑ OFFICE ADMIN. -- PUBLIC WORK G L IN CITY ENGINEER (check) �� l ® Access Slope and Vehicle Access ❑ Drainage.Plan ❑ Street File APPRa✓�� ��T ❑ Legal Description & gzvel ��iilj' ❑Quit Claim PANS #fT4C#e0 []Easement ❑ Calculate. Sewer Connection WATER/SEWER DIVISION ® Determine Meter Size ❑ Complete Building Permit Review ESTREE DIVISION WComplete Building Permit Review []OFFICE ADr:IN, — LOG OUT TO BLDG. DEPT. nmimMOMHaBMW:am%anim%emmaacmeMM %an am�a®oa�aWNIM EMaa=maama=amamacmaamean ®a®■®a®■asoa®aa:Asa®a®a=aa�aa®aaaeamm amosaa,a®o®oa�ea�a®a®amma= ®omoma®aam BUI�-L-�DIINNG PERMIT APPLICATION (COMPLETE) _! 70 tti"2 COPIES OF SITE PLAN 1 ® 2 COPIES OF FIRE PROTECTION PLAN (PREVIOUSLY.REVIEWED BY FIRE DEPT.) 3 COPIES OF DRAINAGE PLAN WITH CALCULATIONS REQUIRED BY SUBDIVISION ❑ GREATER THAN 2,000 SQ. FT. IMPERMEABLE SURFACE ❑ LESS THAN.2,000 SO. FT. ❑ ❑ CHECK ZONING REQUIREMENTS (SETBACKS) _ ❑ D`` r 1 CO... OF ENGINEERING CHECK LIST ❑ 1 COPY OF PUBLIC ?JORKS MEMO ® MULTIPLE OR COMMERCIAL YES ❑ (ATTACH COPY OF ADB APPROVAL INCL. ALL DRA?•TINGS) U/ NO — SUBDIVISION YES NAME ���� ,C�� DATED RECORDED NUMBER NO ❑ (,ATTACH COPY OF REQUIRE 4ENNTS) CHECK SEWER DRAWING AND ATTACH COPY 9IS DEDICATION REQUIRED — YES❑ (OBTAIN QUIT CLAIPI) ( CI'KY CODE ) y� N0,,ff vlX l "I ❑ DOES CITY HAVE EASEMENT ON PROPERTY /f YES ❑ '(ATTACH COPIES OF DRAWINGS) CITY OF EDIW DS USE MI ZONE BER BUILDING PERMIT APPLICATION JOB ADDRESS f /.. 13: NAME IOR NAME OF BUSINESS) ��/� f) `� ` ro �.~-J L LEGAL DESCRIPTION SUBDIVISION SHORT SUB NO. Z MAILING ADDRESS CITY ELEP7HONE NUMBER (� y 3 7/ f PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING /JT rii G n 4' NAME /7 r PROPOSED 2A DEFICIENCY OF RIGHT OF WAY E W Z 'U W I W t[l, uj, ADDRESS J C E ED Y SEE ENGINEERING MEMO DATED It It a CITY Seu-1Z'� TELEPHONE NUMBER NAME E z 0 a E r Q `ry �' % I (..- METER SIZE BUILDING SUPPLY SIZE FIXTURE UNITS It 1. Q ADDRESS �% �✓© Ix CITY TELEPHONE NUMBER REMARKS U SIGN AREA ENV. REVIEW ADB NO. STATE LICENSE NUMBER CITY LICENSE NUMBER 1413 ) 7 / S/ :.. 0 T, V ALLOWED PROPOSED COMPLETE EXEMPT SHORELINE Legal Descfiption of Property (Show BelowOror Attach FourCopies) O O '4? 1 I, Y-� T�I VARIANCE OR CU PLANNI EVIEW V Z 0 F L N JOAT // / rl l7 Z Z Q _ `—S Q' YARDS FRONT ) SIDE y REAR LOT COVE AG REMARKS / J W D,<l� A7 T Z G © NEW RESIDENTIAL ❑ PLUMBING ❑0 NON-RESIDENTIAL � MECHANICAL ADD ❑ DEMOLISH ❑ SIGN ALTER ORCFILLTE ❑ FENCE ❑ REPAIR PRE-MOVEINSP./swim COMPLIIANC E INSP. POOL Z OJ m CHECKED BY TYPE OF CONSTRUCTION CODE HEIGHT SPECIAL INSPECTOR REQUIRED ❑ YES ElNO JAREA UPANCV GROUP GROUP -LOAD OCCUPANT REMARKS NUMBER OF STORIES / NUMBER OF DWELLING F a (/ UNITS NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN) W � 0 m O PLAN CHECK FEE VALUATION FEE BUILDING PLUMBING MECHANICAL This Permit covers work to be done on private property ONLY. Any construction on the public domain (curbs, sidewalks, driveways, FENCE marquees, etc.) will require separate permission. SIGN Permit Application: 180 Days Permit Limit: 1 Year- Provided Work Is Started Within 120 Days RETAINING WALL N i "Applicant, on behalf of his or her spouse, heirs, assigns and successors in interest, agrees to indemnify, defend and hold harmless the City of Edmonds, Washington, its officials, employees, and SWIMMING POOL agents from any and all claims for damages of whatever nature, DATE MEMO TO Building Division Community Development DepartmenL fiROM: Engineering; Division Public Works Department SUBJECT %/Oi /' After review of the subject Building Permit application, we have the following comments: 1. Connection to City water system required. 2. Connection to City sanitary sewer system required. 3. Right-of-way Permit required for atly work on CiLy property. 4, Driveway slope not Lo exceed 1.6 - a. 5. Backwater valve required if dokgii scair.s plumbing; is below elevation of upstream manhole. 6. Water and sewer linos -to he senarated by 1.0 foot minimum. ,l PUBLIC WORKS DEPAR'IIENT CHECKLIST 0 L"� AVr1V (ad ess Street Right -of -Way Existing z Access Easements Existing j/o 1;=D H Utility Easement Existing w Lot Per Subdivision Plat Z_0 Assessor Map fez ,;7V' W Site Plan Checked for Accuracy z Underground Wiring Reqd. H Check Accuracy o Le 1 Descripti z Review by Date w r, Existing Water Main Size 1s , Water Main Required NA Service Line Required040 Hydrant Size Existing ..5 a Hydrant Reqd Per Fire Code ,e//,q Size w Detector Check Meter Reqd. Cross Connection Inspection Fire Department Comments 3 Water Meter Char e Regd. ,9 - OM Review by Date O 0 Septic Tank.Design Approved Date 7 210 Septic Tank Permit Reqd. Permit No. Sanitary Sewer Availability mo.]o pp Drawing No. / ,Q /L.�-l' /��2 ` f0 File No. Side Sewer Availability a w on e Sanitary S r ectie Regd. 3 Review by Date p w M Open Ditch Existing__- Regd. Culvert Reqd. Size w Catch Basin Reqd. Indicate on Site Plan 0 Shoulder drainage maintain collection on swale open runoff H N Manhole regd. Indicate on Site Plan Soil Conditions and Ground Water Field Checked Review by agneA Date Revised: 1v10-1977 CITY OF EDMONDS .PUBLIC WORKS DEPARAT FOR INSPECTION CALL Permit 775-2525 Ext. 2'2'0 Issue Date SIDE SEWER .PERMIT J-6 PERMIT. MUST BE POSTED .ON JOB SITE FILE f' ,-Address"f of �Constructiori 2.. Property'L6gal Description (include -all, easements) d� & 3. Single Family Residence Multi -Family No. of Units Commercial 4. Owner and/or Builder o !9 C d 0 cc V r llf 15 5. Contractor & License No. _ A Ize, /� 6. Invasion into City Right -of -Way: No Yes (If Yes Right -of way Construction Permit Required - Call Dial Dig (342-5344) before excavation). 1 7. Cross other private property: Yes No V Easement required - attach legal description and county easement number. -1 READ THE FOLLOWING AND SIGN: a. Property owners must obtain a permit to install side sewers on H their property. A licensed side sewer contractor must be employed to construe} side sewers in the public right-of-way. 4 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. d. Side sewers may not be installed closer than thirty inches (30") to.any structure. e. Side sewer lines must be laid at a minimum grade of 2% (1.150) D and maximum grade of 100% (450). o f. No turn in side sewer greater than 45 (1/8,bend) is°allowed 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. .l. Inspection during normal working hours only. Two (2) working days notice required. DATE s. , Vic" - , 0%�A 62:�:� I certify t at I h a read and shall comply with the above r": PERMIT FEE: 'A-AK"`Ao- CONNEGT*GN F-RE : 0 * PERMIT MUST BE DISAPPROVED By: Date: By: Date: APPROVED By Date: POSTED ON JOB SITE 0 • • s The City of Edmonds Side Sewer Drawing EASEMENT NO. NEW CONSTRUCTION REPAIRS ❑ LID NO ................... ASMT. NO. .................. OWNER------...0/L/f -----' W4MI----------------------------------------------- CONTRACTOR .---..✓ HN....WNiE�......---------.......................... PERMIT NO. / / LEGAL DESCRIPTION: LOT NO........ BLOCK NO . .................................... JOB ADDRESS----1�� .1./...................................... .... ,w PWW-0001-11/75 (REV.11/78) ------------------------------------------------------------------------------------------------------ ----------------------------------------------------------- NAME OF ADDITION .... ------------------------------------- -- ------ - - Approved: DATE %�%-Z1�7............. By ----- -------.--------......-------- . -- I -CITY OF EDMONDS © NEW • ❑ ADDITION ❑ RETIREMENT ASSAN FORMATION SHEET ASSET NO STRE;&IJOILASSET NO. ©o-V 306 O DESCRIPTION Nrlw Si3at�/ic4 SERIAL NO. LOCATION _ DEPT. NO. ) !.t V if 65`0 "PURCHASE ORDER NO. *PROJECT NUMBER W 1- 7,50 PURCHASE ORDER DATE PROJECT COMPLETION DATE 1 2 ~ 3 / COST COST % 7z - B.A.R.S. ACCOUNT NO. Y (--�� o m ��� "3 �! • ESTIMATED LIFE Z S' 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 DATE VERIFIEIYB'q I PROCESSED BATCH NO. INITIAL (§np DEPARTMENT FILE •'+...v.J,,.... ..-niis5.n ,.f�. #tt..f,.o.,. ,�v r�i�F*M1fiiWf4-+"'T� •sTs`•ar;.p�4.Y4�..$=��'1 i.�.,�ly;: ai�:a q�i,. t. ,. „ r'r .,-� < � ._r.� ,�.. Edmonds - TRE T FILE City of RIGHT-OF-WAY CONSTRUCTION I —0000— 90-19C� PERMIT Permit Number. 'o? 0 rj 3 Issue Date :2 -rL 9- 3 A. Address or Vicinity of Construction: 1108 12 Av. N. (9319847 ) B. Type of Work (be specific): Tnat•al 1 NPw Sprvi ray C. Contractor: Washington Nat'l. Gas Co. Mailing Addressgl 5 M .re _r Ct. Caa _t1 _, Wn. State License #: 8g111 D. Building Permit # (if applicable): Contact: Frank an Phone: 9 9 A-9 9 7 R Liability Insurance: Bond: $ r Side Sewer Permit # (if applicable): E. ❑ Commercial ❑ Subdivision ❑ City Project a Utility (PUD, GTE, WNG, CABLE, WATER) ❑ Multi -Family ❑ Single Family ❑ Other h i INSPECTOR: INSPECTOR: — F. Pavement or Concrete Cut: :B Yes []No G. Size of Cut: 1 2 x 4 Cttt H. Charge $ M' /w ai�er APPLICANT TO READ AN SIGN INDEMNITY: Applicant understands and by his signature to this application, agrees t o he City of Edmonds harmless fr � es or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made a ainst the City of Edmonds, or any o s departmen s or employees, including or not limited to the defense of any legal proceedings including defense costs, and attorney fees by reason of granting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATIO�FE1qS WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL SEC�SSF_D FOR ISSUANCE��HE,4P-PLICAYVT. Construction drawing of proposed work required with permit application. A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.. Work and material is to be inspected during progress and at completion. Restoration is to be in accordance with City Codes. Street shall be kept clean at all times. Traffic Control and Public Safety shall be in accordance with City regulations as required by, theiCity Engineer. All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day; NO EXCEPTIONS. I have read the above statements and understand the permit requirements and the pink copy of the permit will be available On site at all times for inspection purposes. Signature: _ ,� < .<. Date: 116111 15, 1993 (Contractor or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY APPROVED BY:. TIME AUTHORIZED: VOID AFTER °I " 2 if - 9� DAYS SPECIAL CONDITIONS: j COMMENTS:, DATE: RIGHT OF WAY DEPOSIT DISRUPTION FEE/FUND III: .4 a NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991 FIELD INSPECTION NOTES (Fund 1 t 1 - Route copy to 'Street DPpx.) Comments Diagram CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: h= �h AV.W. Va+E I: Addendum to : City of Edmonds Right of Way - Permit Application _ _ _ _ Submitted by: Guyla Connors Engineering Aide Washington Natural Gas D v �2 � �--1 521-5248 �%,cQ7 N ' N WNG to window Water main depth Key: 7 " d -w- water -g- gas gas main. -ss- sewer $ water hydrant O water valve 815 Macs St. (P.O. Box 1969), Statue, WA 98111 (206) 6n.6767