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404 9TH AVE N
BUILDING DE► AI TMEq
KNIT APPLICATION
TION
NAME IOR NAME OF NMPNESS,
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CITY_ "
NAME
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NAME
ADDRESS
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U STATE LICENSE NUMBER
Leoal Description of Property (Show Below or Attach Four
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Applicant -Fill
T
ZONE ER
USE ow,.
Inside Heavy Lines
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ADDRESS D
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. LOT
ESEl NO
PLAT NAME-
SUBDIVISION NO.
PUBLIC RIGHT OF WAY PER ORDINANCE NO.
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EXISTING RIGHT OF .WAY
PROPOSED RIGHT OF WAY
ELEPHONE NUMBER
DEFICIENCY OF RIGHT OF WAY
STREET/UTILITY WORK REQUIRED ES ❑NO,
PERMIT FO R'WORK IN PUBLIC R/W ',YES El NO
UNDERGROUND WIRING REQUIRED %YES El No
ELEPHONE NUMBER
7
CONNECTION TO SANITARY SEWER )dYES ❑NO
SEPTIC TANK PERMIT REQUIRED El YES rV0
SEPTIC TANK PERMIT NO.
SEE MEMO DATED
ELEPHONE NUMBER
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REMARKS
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CHECKED BYE^
%1
ITY LICENSE NUMBER
METER SIZE'
3/4 u
I BUILDING SUPPLY SIZE
REMARKS
SIGN AREA
ENV. REVIEW
ALLOWED
PROPOSED
COMPLETE EXEMPT
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REMARKS
VARIANCE OR CU
YARDS
1
ZU FRONT
❑ NEW RESIDENTIAL ❑ GAS
LINE
FIRE ZONE
TVI
❑ NON-RESIDENTIAL SIGN
❑
3
❑ ADD
SPECIAL INSPECTOR
REQUIRED
RETAINING
DEMOLISH 1:1
WALL
ALTER EXCAVATE FENCE
CST ❑ OR FILL ( X FT)
❑ YES ❑ NO
PLAN CHECKED BV
^❑
swim
❑ REPAIR
INSP.PRE-I ( POOL
�UUJ
R RKS
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Z NUMBER OF STORIES
NUMBER OF.
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DWELLING
F
UNITS
a NATURE OF WORK TO BE DONE
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PLAN CHECK FEE
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PROPOSED USE
PLOT PLAN INDICATE BUILDING SETBACKS,
ABUTTING STREETS)
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BUILDINGIr
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PLUMBING
0
0
MECHANICAL
FENCE
SIGN
m "Applicant, on behalf of his or her spouse, heirs, assigns and
W Successors in interest, awrees to indemnify, defend and hold harmless
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i the City of f;dnninds, Wilshinglon, its officials, employees, and
RETAINING WALL
tt agents from any and all claims for damages of whatever nature,
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T. arising directly or indirectly from the issuance of this permit. Issu-
SWIMMING POOL
0 ance of this permit shall not be deemed to modify, waive or reduce
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f1•Itmi-villvnt of any city ordin::nr;• nor limit in any way the
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0 any
- , ,;d. . I I 1,:,woi -
PLANNING REVIEW BY
ADB NO.
HORELINE
DATE
r. . LOT COVERAGE
S SIDE REAR
F CONSTRUCTION CODE HEIGHT
AREA OCCUPANCY OCCUPAN'
I TI GROUP 3 LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE .CODED 31.04.
VALUATION I FEE
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7
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CITY Ole' H1.)' l0IIDS •
- PIl(iLIC l1011l;S I)i�;hf+R`IT•1Et`PP
SUBJECT:AN P,
Subdivision -2-`1q Plat P11D
Multiple Coil unerci al
(3EI'JERAL Rl_Q)lf • 1ElTFS
Coordination of the location or anY stricture with resnert to utilities, streets, property
lines and driveway grades. is the i-esponsib:l.it.y of the comp ictor.
The ccnstra,;tor is required to keep the abutting street cleaned of dirt and debris caused
by the construction 7.30.200 Violations - Penalties 7.30.290.
A "Right -Of -Way Construction Permit" is required from the Fiia neering Division of Public
Works for any work within `the Public right -of -gray or public easement . 7.30.01.0 Violations
Penalties 7.30.290.
SPECIFIC REQUI101E.I1ri'S
UNDERGROUiZ POKIER
Undergrotnid Wiring Req' d ❑ Plot Reqd
SANITARY SEI ER (PIR.1IT RE()' D)
,
Connection to Sanitary Sewer Red' d
❑
Back l•later Valve Req' d on Side Sewer
I
I
❑ Septic Tank Permit Reo'd. Des.ifgi Approval
Regld
I
Approved Dt .
Permit I hurler
STORM SEt-ER SYSTG I (I'ER CODE #
I
Drainage Plan Req'd
❑
Drainage Plan Approved Dt.
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i
Site Drainage to be Contained on Site
❑
Site Drainage to be Connected to City
System)
ROADWAY EIFRaE�LEIFPS AHD DR:IVE:I.1,AY IRLT.IFJTrS
Drive,ray Slone Not to Exceed III"
i
Drive:•rad Favin Req' d
❑
Driveway Culvert Req' d Size
❑ Vertical Carb Red' d
❑
Sicie,ralk heq' d
❑ Street PlaVil-4, Req'd
❑
Approved Der,.irrli Req'd
�
[❑ Bondliegv d for Public Improvements
❑Submit
Cost Estimate
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1r1s1:ecL Lone; ;-,;:n , o. , wngineer•ing Division
Foundation
❑ Side
Sewer ❑
Septic Tank -
Water Service
❑ Fide
Protection ❑
Drainage
Site Improvonx,nts
A.24
- hour notice is required for
inspection
;-,y Engineering, call 775-2525,
extension 2.20. l
F D IF. }IERZBERG, :P.F..
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Open Ditch Ddstinh
Culvert Reqd.
a Catch Basin Reqd. -
Shoulder drainage mlintai.n 1 /ecti n
Reqd.
Size
Indicate on Site Plan
swale open 'runoff
.
►•.lnhole read.
Indicate on Site flan
Soil Conditions and Gro 1d 6 ter Field
Checked
Rcwie.a by
Date
Street Paving P.egd.
H
Curb and'Gutter Reqd.
w Sidewalk Reqd.
w �� �-J'
Curb Cut. for Driveway Reqd.
4% s
9
N
r,�. 12ight-of-1•1ay Construction Permit Reqd..
SO
Bond Reqd. for Public Inprovem--nts
Street ham Sign Reqd.
Other Signing Read-
P
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Pre Pernri_t Site Inspection made on
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J-` ENGINEERING
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Special Requires ,_nts listed in e;en-O to
Comralnity Developr;ant Department,
13ui_lding Division A
i BY•
Date
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o ,All items filled in on Bui in Permit
Application
a: 13Y
to 1
Date
.
a' t DraWin gs Stanned al otations fide
w
Date
Approved by PU'1)1,i.0 POI"k , DepartT,!e'nt•
Reviscd: lv 10-1.977
RA1,,1OI:KS DEPARTi nTr CHECKLIST ����'i�r Date .
U-ILDING PE -aT REVIEW
�i Address
a Street Right -of -Way Existing �o U� REQD --
a Access Easements Existing -TAMM REQD —
,
Utility Easement Fxisting REQD
Lot per Subdivisions - Plat Assessor Map
z Site Plan Checked for Accuracyel-
,_,. Underground Wiring Reqd. =
a Check Accuracy of Legal Description 3 -Zc1 7�
w Environmentally 'Sensitive Area
Environmental Checklist Reqd.
z
Flood Hazard Zone
A Shoreline Management Area
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin,.
.41 i Fxisting Zoning • Per Code S
Amenities Design Board Approval Reqd. ADB # Approval
Board of Adjustment oval Reqd.. �
' ,Fs .Review. - By : Date : _3 "Zq --
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`t Existing [,later 'lain Size
j
; Water Main Reqd.
f ,
Service Line Reqd.
3�y
1
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Hydrant Size Existing
5�
H
`
►� Hydrant Reqd. Per Fire Code
1/,4 Size
4 Detector Check Meter Reqd.
1�
Cross Connection Inspection
Fire Department Conments
`3
FWater Meter Charge Reqd.
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i
Review by:
Date:
i Septic Tai c Ie�sigzz prove
--� te:
sa
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability
-�/� S _ Proj
Drawing No. Up I'i)
File No. ESP l ct3
Side .Sewer Availability
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Sanitary.Sewer Connection Fee
Reqd. 'rqon _
Revie %T By :
Date:
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