19217 93RD PL W19217 93RD PL W
•
•STREET FILE 0 4
PUBLIC WORKS DEPAR71MENT CHEamiST
BUILDING PERMIT REVIEW LA
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(address) ate
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Street Right -of -Way Existing
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Access Easements Existing
REQD
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Utility Easement Existing
REQD
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Lot Per Subdivision
Plat Assessor Map
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Site Plan Checked for Accuracy
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Underground Wiring Reqd.
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Check Accuracy of Legal Desc
'ption o I�
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Review by
Date
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Existing Water Main Size
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Water Main Required
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Service Line Required
Hydrant Size Existing
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Hydrant Reqd Per Fire Code
VC 5 Size
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Detector Check Meter Reqd.
Cross Connection Inspection
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Fire Department Comments
Water Meter Char e Regd.
Review by
Date ,
Septic Tank Design Approved
--- Date
Septic Tank Permit Reqd.
Permit No.
Sanitary Sewer Availability�
Proj. L. Q
Drawing No. �— kn
File No.
Side Sewer Availability
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Sanitary Sewer Connection Fee Reqd. N
3
Review by
Date '-I 2
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Open Ditch Existing
Regd.
Culvert Reqd.
Size
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Catch Basin Reqd. �(/►
Indicate an Site Plan-
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Shoulder drainage maintain collection on swale open runoff
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Manhole reqd. ��,��
Indicate on Site Plan
Soil Conditions and Ground Water Field Checked C
Review by
Date .
Revised: 1v10-1977
Paget �, , _ _ „ U
Street Paving Reqd.
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Curb and Gutter Reqd. � (�
w Sidewalk Regd._V/(�',�-,,ice
w Curb Cut for Driveway Reqd.iCT $
x Right -of -Way Construction Permit Regd.
H Bond Reqd. for Public Improvements
Street Name Sign Regd..
Other Signing Reqd. Arm
A Pre Permit Site Inspection made on
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BY: SEWER
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H H STREET
�X4 ENGINEERING
Special Requirements listed in memo to Comrnmity Development Department,
Building Division
BY Date
o All items filled in on Building Permit Application
w BY Date
P4 Drawings Stamped and Notations Made
a BY o Date
Approved by Public Works Department
Revised: lv 10-1977
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BUILDING DIVISION
• PERMIT APPLICATION
NAME (OR NAME O/JF, BUSINESS)
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MAILING ADDRESS
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CITY
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Applicant Fifl
Inside Heavy Lines
JOB
ADDRESS
ELEPHONE NUMBER
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!r CITY TELEPHONE NUMBER
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NAME
0 ADDRESS
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E CITY TELEPHONE NUMBER
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U STATE LICENSE NUMBER CITY LICENSE NUMBF
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�.`..// ' .7i//l.v
Legal Description of Property (Show Below or Attach Four Copie
LEGAL DI
iTUM BE Fi"
3
:RIPTION I SUBDIVISION
197�
v'
-7 SHORT SUB NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING
PROPOSED
DEFICIENCY OF RIGHT OF WAY_
PUBLIC IMPROVEMENTS REQUIRED
❑'
DRAINAGE IMPROVEMENTS REQUIRED
❑ ,
DRAINAGE PLAN REQUIRED
❑
UNDERGROUND WIRING REQUIRED
❑
CONNECTION TO SANITARY SEWER
❑
SEPTIC TANK PERMIT REQ'D' ❑ NO.
ELEVATION OF PROPERTY CORNERS
❑
& FOOTINGS REQ'D
SEE ENGINEERING MEMO DATED
CHECKED BY
` / I BUILDING SUPPLY SIZE
SIGN AREA ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE
REMARKS
VARIANCE OR CU PLANNING REVIEW BY DATE
YARD? ' 1 LOT COVERAGE
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L�J RESIDENTIAL
GAS
LINE
FRONT D SIDE � 5 REAR
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
HEIGHT
1 1
❑ ADD
❑ ALTER
❑ NON-RESIDENTIAL
DEMOLISH
❑❑
❑ ORCFILLTE
0 SIGN
RETAINING
WALL
❑ FENCE— X_FT)
SPECIAL INSPECTOR
REQUIRED
❑ YES _ ❑ NO
AREA
OCCUPANCY
GROUP
OCCVPAI
LOAD
PLAN CHECKED BY
THIS SITE IS LOCATED IN THE CITY
❑ REPAIR
� PR,EINSPMOVE
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POOL
OF
SHOULDO EDCODED S. A31 04LES TAX
REMARKS
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NUMBER OF
DWELLING
UNITS
a NATURE OF WORK TO BE DONE
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N
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PLAN CHECK FEE
VALUATION
FEE
—
PLOT PLAN
BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
In "Applicant, on behalf of his or her spouse, heirs, assigns and
In
W successors in interest, agrees to indemnify, defend and hold harmless
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f the City of Edmonds, Washington, its officials, employees, and
¢ agents from any and all claims for damages of whatever nature;
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x arising directly or indirectly from the issuance of this permit Issu-
o ance of this permit shall not be deemed to modify, waive or reduce
RETAINING WALL
SWIMMING POOL
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