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L= m' PERMIT
CITY OF EDMONDS
ZONE S_ ^ NUMBER
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CONSTRUCTION PERMIT
APPLICATION
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NAME (OR NAME OF BUSINESS)
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LEGAL DESCRIPTION CHECK SUBDIVISION O. .. LID NO.��
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MAILING ADDRESS
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ITV TELEPHONE NUMBER
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
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EXISTIN UIRED DEDICATION
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RIGHT OF WAY CONSTRUCTION PERMIT REQUIRED 0
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STREET USE PERMIT REQUIRED C
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SEE ENGINEERING MEMO DATED
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CITY TELEPHONE NUMBER
SEE PIW DEPT. REVIEW CHECK LIST DATED
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METER SIZE BUILDING SUPPLY SIZE IXTURE UNITS
CITY TELEPHONE NUMBER
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REMARKS
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STATE LICENSE NUMBIER CITY LICENSE NUMBER
SIGN AREA ENV. REVIEW
ADB NO.
Legal Description of Property • include all easements
ALLOWED PROPOSED COMPLETE EXEMPT
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VARIANCE OR CU PLANNING REVIEW BY
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YARDS ��
LOT COVERAGE
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FRONT SIDE REAR
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PLUMBINGEl
ADD/ALTER NON-RESIDENTIAL
MECHANICALEl
REPAIR RETAINING WALL
SIGN
EXCAVATE
FENCE
CHECKED BY TYPE OF CONSTRUCTION CODE
HEIGHT
DEMOLISH OR FILL
( xFT)
DPRE -MOVE INSP./
COMPLIANCE
SWIM
SPECIAL INSPECTOR AREA OCCUPANCY
OCCUPANT
INSP.
POOL
REQUIRED GROUP
LOAD
SIDE SEWER 19
0 YES L NO
REMARKS
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WATER LINE
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NUMBER OF STORIES NUMBER OF
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NATURE OF WORK TO BE DONE (ATTACH PLOT PLAN)
VALUATION
PLAN CHECK FEE
BUILDING
"JISOZAD PLUMBING
MECHANICAL
This Permit covers work to be done on private property ONLY. GRADING/FILL
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
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
emnlovees. and anents frnm anv and all claims fnr r1nmanae of
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CITY OF EDMONDS
CwC CtwtEft - 11M*05. w+W"wGTCN 98M
SINGLE FAMILY MULTIPLE COMIE;CIAL
PROJECT NAME
ADDRESS
ACCESS SLOPE AND VEHICLE ACCESS
DRAINAGE PLAN
STREET FILE
LEGAL DESCRIPTION VERIFICATION
,,QUIT CLAIM/DEDICATIONS
EASEMENT - PUBLIC/PRIVATE
CALCULATE SEWER CONNECTION IF NO LID of
ENGINEERING i
PROJECT
PUBLIC WORKS
REVIEW
CHECK LIST
CONTACT HAVE b TELEPHONE NUMBER
C"ENTS
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STREET PAVING REQUIRED
CURB AND GUTTER REQUIRED
SIDEWALK REQUIRED
CURB CUT FOR DRIVEWAY. REQUIRED
RIGHT-OF-WAY CONSTRUCTION PERMIT REQUIRED
BOND REQUIRED FOR PUBLIC IMPROVEMENTS
STREET NAME SIGN REQUIRED
OTHER SIGHING REQUIRED /
(ADDITIONAL COMMENTS ON BAC
EXISTINC WATER MAIN SIZE q " C ;(,
WATER MAIN REQUIRED
SERVICE LINE REQUIPED
HYDRANT SIZE EXISTING
HYDRANT REQUIRED PER FIRE CODE SIZE
CROSS CONNECTION INSPECTION
HATER LIFTER CHARS eel
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REVIEW BY DATE (ADDITIONAL COMMENTS ON 9M
SANITARY SEWER DWIING I1UyBER
FILE KMER
SIDE SEWER AVAILABILITY SANITARY SEWER CONNECTION FEE REQUIRED
Y
OPEN DITCH EXIS1111A REQUIRED
DATE: -IS el
MEMO 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 City sanitary sewer system required.
3. Ri,ht-of-way Permit required for any work on City property.
4.
Driveway slope not
to exceed
14;0.
5.
Backwater valve required
if
downstairs plumbing; is below
elevation of upstream manhole.
6. dater and sewer lines to be 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-
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f CITY OF EDMONDS _
PUBLIC WORKS DEPARTMENT FOR INSFECTION CALL permit d10
7`�5--2652i5 Ext. Z-H Issue Date
SIDE' SEWER_ PERMIT
.PERMIT MUST BE POSTED ON JOB SITE
Address . of Construction j C; - L�q°, ��, EDMONDS
ILegal Description (include all, easements) TREATMENT PLANT
Property�
Single Family Residence Multi -Family No. of Units
Commercial
Owner and/or Builde
Contractor & Licens
6. Invasion into City Right -of -Way: No >< Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (AA42149A W) before
excavation) . 1-800-454-5555
7. Cross other private property: Yes No X Easement required -
v attach legal description and county easement number.
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a READ THE FOLLOWING AND SIGN:
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4 a. Property owners must obtain a permit to install side sewers on
>4 their property. A licensed side sewer contractor must be employed to
construct side sewers in the public right-of-way.
w b. The side sewer contractor assumes full reponsibility for each
H installation for one year.
aC. Commercial establishment requires a minimum of a six inch (6")
z side sewer line.
o 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)
0 and maximum grade of 100% (450). 0
H f. No,turn in side sewer greater than 45 (1/81bend) 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.
1. Inspection during normal working ho rs only. o 0 ) w rkin
days notice re uired.
DATE:
I certify t a I have read
775 - 94-0 0 and shall com ly with the above
PERMIT ' FEE : .30 , O C) DISAPPROVED BY: Date:
w I7 G! q k �,ha lrge. -33-- 00 By: Date:
CONNECTION BEE: APPROVED
� By: _94918 Date:
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* PERMIT MUST BE POSTED ON JOB 5ITE
CITY OF EDMONDS
NEW
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❑ ADDITION
❑ RETIREMENT
ASSET INFORMATION SHEET
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ASSET NO.
ADDITION TO ASSET NO.
DESCRIPTION %� L
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SERIAL NO.
LOCATION DEPT. O.
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"PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
*PROJECT NUMBER
PROJECT COMPLETION DATE f`
COST�-
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B.A.R.S. ACCOUNT NO. �l '00(� _ ~O� • �
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ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
VERIFIED BY
DEPRECIATE
MONTHLY DEPRECIATION AMOUNT PROCESSED
ANNUAL DEPRECIATION AMOUNT BATCH NO.
•
G.L. ENTRY
REFERENCE DATE
INITIAL
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DEPARTMENT FILE
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