1010 3RD AVE S.PDF1010 3RD AVE S
ADDRESS: 1,01'212 z--�A6
TAX ACCOUNT/PARCEL #: DOu�So°�DZ� Dli
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: ElConditional Waiver ❑ Study Required aiver z �— .
CRITICAL AREAS #: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: f �0
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc
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I l j c)EX C, IC I { j 675
ALL �HAL-L
t, c Al C PIC--
!� Side Sewer Drawing
The City of Edmon �, �� t
1, P �,,. -,;, - At, � t-r-.
EASEMENT NO. -------------------
------------------------
NEW CONSTRUCTION REPAIRS❑ LID NO..---------------- ASMT. NO
OWNER -ilkI
-------------------- CONTRACTOR ......
I --- ---------- ---------------------- ------------ PERMIT NO.
JOB ADDRESS JCQIC).--:f5,- 6 ------- LEGAL DESCRIPTION: LOT NO. ----------- � ------------------- BLOCK NO.------
-V-\�D------------------------------
-------------- v
y ---
DATE ... B ;"�- 1-111--( 4
PWW-0001 -11/75 (REV. 11/78)
U w
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Vlii vr--.-7-.77
PUBLIC°'WORKS DERT]NT FOR INSPECTION C��� �-f permit V,4
775-2525 Ext. 220 I.s.siE Date
SIDE SEWER PERMIT
PERMIT MUST BE POSTED ON JOB SITE
1.. Address of Construction
2. Property Legal Description (include all, easements)
u f! Pa."� to ld . C= d ,.¢,>�
3. Single Family Residence Multi Family No. of Units
Commercial
4 Owner and/or Builder Air t./
5., Contractor & License No.
6."_Iriva`sion into City Right -of -Way: No Yes (If Yes Right-of-
way Construction Permit Required Call Dial Dig.(342-5344) before
excavation).
7. Cross other private property: Yes No`_" Easement required -
attach legal description and county easement number.
READ THE. FOLLOWING AND SIGN.:
a. Property owners must obtain a permit to install side sewers on
their property. A licensed side sewer contractor must be employed to
construct side sewers in the public right-of-way.
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% (1.15°)
and maximum grade of 100% (450).
f. No turn in side sewer greater than 450 (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 gravelis 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 r'-ght-of-way must be restored to original
conditions. Contractors shall.;tbe responsible for right-of-way failure
due to poor compaction of
k.. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
DATE:
1 V-'kKL ..A
PERMIT FEE: ��
CONNECTION FEE:
*.PERMIT MUST BE
I certify that I have read
and shall comply with the above
DISAPPROVED By: Date:
By: Date:
APPROVED By : —Date:. 11 67
POSTED ON JOB E
U U •
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE PERMIT
2ONE S6 NUMBER 94b5:3-�..
JOB SUITE -A
ADDRESS O 13Y/d 1 VI L
OWNER NAME NAME OF BUSINESS --
' e r'
LEGAL DESCRIPTION CHECK SUBDIVISION NO
LIONOO
ZMAILING ADDRESS O D `/��p_J
O3 M1Avar
loinCITY
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP,
EXISTING REGUIREO DEDICATION
PROPOSED
TESCP Approved ❑
RW Pe —I Requved ❑
Street Use Permit Rep'd ❑
MspeCuprl Required ❑
Sidewalk Required O
ZIP
TELEPHONE NUMBER
6,3 3
NAME
Qj
METER SQE
LWE SIZE
NO. OF FIXTURE$
PRV REQUIRED
YES ❑ NO ❑
w AO RESS v
T M�
_ ��'/ / a- �r
U
REMARKS»
/
CITY ZIP 77
TELEPHONNEE NUMBER
� l�Iia2.J �i/%) -�/�
NAME —
_
MEMO
STATE
Sw,LICENSE NUMBER 6 'l EXPIRATION
A)O OO
WON AREA
PROPOSED
nl 1
SEPA REVIEW
COMPLETE JEXEMPT
,�
AD NO.
Legal Description of Property - Include all eas mentsALLOWED
Lvt a ��c�k 3
JVIRIANCEOFICU
$A LINE
g
(�FC+�I 40 Z SExP
U , p
O
P IN IEW BY
DATE
O
SETBACKS FEET
_
HEIGHT ILOTCCl1EAAGE1
PropertyP
Tax Account L G -T ParcelNO. J QTEl
it-)-
NEWRESIDENTIAL PLUMBINGADDITION
COMMERCIAL
MECHANICALREMODEL
APT' SLOG.
610N❑GRADING
TYPE OF CONSTRUCTION
CODE
OCT
FENCE
REPAIR CYDS. t_K_FT)_GRO
DEMOLISH WOODSTOVE
INSERT
—/
I (GARAGE RETAINING WALL/
SWIM POOL
HOT TUB/SPA
R AREA
YESuu
OCCU
LOAD
INSPECTIONS PER UBC 305
CARPORT ROCKERY RENEWAL
TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
iu NUMBER NUMBER OF ,( / CRITICAL d
O OF OWELLINO //) AREAS (,/'CSTORIES 1 UNIT$ WNUMBER�t�1
'' DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION
REQUIRED
VALUATION
FEE
PLAN CHECK FEE
BUILDING
MEAT SOUROE':A
GLAZING
�n
0 0/0
PLUMBING
Plan Check No. q I _
MECHANICAL
This Permit covers work to be done on private property ONLY:
GRADINGIFILL
Any construction on the public domain (curbs, sidewplks,
driveways, marquees, etc.) will reQuir 'Separate permission.
STATE SURCHARGE
SO
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
3t�
v,
iu
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
-
f
employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the Issuance
=
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
0CT7
°
modify, waive or reduce any requirement of any city ordinance
i
nor limit In any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision.'
�Z
I hereby acknowledge that 1 have read this application; that the
APPLICATION APPROVAL
Information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authoriz-
AUTHORIZES
This application is not a permit until
ed thereby, no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of the State of Washingt n relating to Workmen's Compensa-
WORK NOTED
Deputy: and fees are paid, and receipt is
tion Insurance and RCW 18.
INSPECTION
acknowledged in space provided.
SIGNAT E (OWNER OR AGENT) DATE SIG ED
DEPARTMENT
8
CITY OF
OFFICIAL'S SIONAT RE GATE
EDMONDS� -
�,� f. 3/.
ATTENTION
CALL F
RELEA BY' DATE
INSPECTION
r —
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
`J
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771 0220
ORIGINAL — Flle YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK — Owner GOLD — Assessor
M
M
CALE NO. (74/— / 6 Q
Critical Areas Checklist
Site Information (soils/topography/hydrology/vegetation)
1. Site Address/Location: ' i O i'--D Ave,SO,
2. Property Tax Account Number: _ 8 aD - 003 — 0 O9 - - 0108
3. Approximate Site Size (acres or square feet): (00
4. Is this site currently developed? ✓yes; no.
If yes; how is site developed? fir. !% k
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10-feet over a horizontal distance of 33 to 66-feet).
e
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33 feet). 1
Other (please describe):_
6. Site contains areas of year-round standing water: NO ; Approx. Depth:
7. Site contains areas of seasonal standing.water: No ; Approx. Depth:
What season(s) of the year? N A,
8. Site is in the floodway 140 floodplain N6 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? A)1) Flows are seasonal? /00 (What time of year? /(gA, ).
10. Site is primarily: forested ; meadow ; shrubs ; mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on- site: Na .
Rcv mmaro4
•
a90-19.y-
City of Edmonds
Critical Areas Checklist
The Critical Areas Checklist contained on
this form is to be filled out by any person
preparing a Development Permit.
Application for the City of Edmonds prior
to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable.
City staff to determine whether any
potential Critical Areas are or may be
present on the subject property. The
information needed to complete the
Checklist should be easily available from
observations of the site or data available at
City Hall (Critical Areas inventories, maps,
or soil surveys).
An applicant, or his/her representative,
must fill out the checklist, sign and date it,
STREET FILE
and submit it to the City. The City will
review the checklist, make a precursory site
visit, and make a determination of the
subsequent steps necessary to complete a
development permit application.
W'ith a signed copy of this form, the
applicant should also submit a -vicinity map
or plot flan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). In
addition, the applicant shall include
other pertinent information (e.g. site
plan, topography map, etc.) or studies in
conjunction with this Checklist to assist
staff in completing their preliminary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner / Applicant:
Name
to Lo ��� �A S
Street Address
City, State, ZIP Phone
$i Date
Applicant Representative:
V,U Cie
Name
l 8 god ve. L0,
Street Address CLgOaQ
i
City, Statip- ZIP Phone
�� Date
CITY OF EDMONDS
7110 - 210TH ST. SW • EDMONDS, WA 98026 • (206) 771.0235 • FAX (206) 744-6047
COMMUNITY SERVICES DEPARTMENT - PUBLIC WORKS DIVISION
I �
890 �
-lg
June 12, 1995
Mr. Jeff Zimmerman
1010 - 3rd Ave. S.
Edmonds, WA 98020
RE: Venting of Your Plumbing Fixtures
Dear Mr. Zimmerman:
LAURA M. HALL
MAYOR
The city's sewer cleaning records show that the home at this address is
experiencing problems with the venting of some of your plumbing fixtures when
the city crew is conducting cleaning operations of the city sewer line in front of this
address.
The city's cleaning operation is essential for both you and your neighbors. It
cleans debris in lines to prevent plugs, prevents corrosion and potential future
collapse, and achieves a better flow characteristic in the public sewer lines. We
need to do this often -- perhaps even 3 times a year -- in some critical areas. The
city's cleaning operations typically involves the utilization of a high pressure water
jet.
The problem which occurs at the home is the result of a high pressure surge
through your internal plumbing system. A properly constructed plumbing system
is designed to easily vent this additional pressure without any visible impact at
your residence. An undersized venting pipe (or not having enough vents) cannot
handle the pressure surge, and the only release that's available is then through
your toilet (or another fixture). The Uniform. Plumbing Code typically requires a 2"
vent, and further requires a separate vent for each plumbing fixture which is
connected to the sewer (a toilet, a sink, a shower). Your home may not have an
adequate venting system (you either have a 1-1/4" vent, or not enough of them),.
and you therefore may continue to experience the pressure surges or you may be
experiencing a plugged vent..
The city does not have a choice as far as discharging its responsibility in cleaning
the public sewer line. It is therefore up to you to take corrective measures as to
how to improve your own venting system.
• Incorporated August 11, 1890 •
Sister Cities International — Hekinan, Japan
1`
N
The city has come up with two options that will remedy your problem:
Option #1 Upgrade stack vents for toilets and other fixtures which are
experiencing problems to required sizes.
Option #2 Install a cleanout.outside of house per attached
specifications. Enclose box so it can vent properly when
excess pressure is put on house lines. This option would be
the cheapest and simplest way of correcting this problem. At
the same time, it would allow access to sanitary sewer lines if
stoppage should occur. This vent cleanout would allow a
place for backup in lines to go before entering your house and
causing costly damage.
The city would appreciate your expeditious cooperation in this matter. The city
must continue proper maintenance of its sewer lines, but we obviously do not wish
to see continued problems occurring on your property because of poorly designed
vents. A plugged vent will be your responsibility to correct these deficiencies.
We cannot keep notifying you each time we come out to clean the line. It's up to
you to have a plumbing system that conforms to code. Option #2 is a relatively
simple one. to construct.
Should you have any questions on these options, please call Everett Akau, Scott
Highland or myself at 771-0235, extension 645 or 647.
Sincerely,
R Holland
Water/Sewer Supervisor
J/
Enclosure
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890-199
W CitY of EdmonqV
RIGHT-OF-WAY CONSTRUCTION
A PERMIT Permit Number: 9 2 � �S
Issue Date: 317 — 9r-P,
G° s
A. Address or Vicinity of Construction: 1010 3 Avenue:, South
B. Type of Work (be specific): Install New Service'
C. Contractor: Washington Natural Gas Company
`Mailing Address: 815 Mercer Street,
State License#: Seattle, WA 98111
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ' ❑ Commercial ❑ Subdivision ❑ City Project Ja Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR: R WJ
F. Pavement or Concrete Cut : ® Yes ❑No (1) G. Size of Cut: 2 x 4 H. Charge $
APPLICANT TO READ AND SIGN Y'
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds hatmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be made against)the , City of Edmonds, or any of its,+depattm�' nts or- employ-
ees, including or not limited to the defense of any legal proceedings including defense cosrs;.and'attorney fees by reason of granting thistpennid
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A, PER/OD OF ONE YEAR FOLLOWING THE FINAL INSPEC770N
AND ACCEPTANCE OF THE WORK. ES77MATED RESTORATION FEES WILL BE HELD UN77Li THE FINAL STREET PATH IS C63fPLE7ED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Department- 771:3202.
Work 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 the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
�/ w
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: dDate: May 27, 1992
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
M.
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M
MRC1L'I
Engrg. Div. 1991
y
FIELD INSPECTI,ON NO (Fun 111 - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION O YES O NO
1
Partial Work Inspection by P. W.:
Work Disapproved By: Date: j
FINAL APPROVAL BY: Date:
Eng. Div. July
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Water main depth:
`'unknown•
!* gas- main:
Addendum to City' of Edmonds
Right, ot� Way -
Permit. Application.
Submitted by:, h. Qw Aea lti,, a'j
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager Jlpe4p
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-ss- sewer
water hydrant:
815 Wmer St. (P.O. Box 1869).. Sew .. WA 98111 (206) 622-6767
CITY OF EDMONDS _
PUBLIC' WORKS DEP**T FOR INSPECTION CA�) permit
SIDE SEWER PERMIT 775-2525 Ext. 220 Issue Date
�* PERMIT MUST BE POSTED ON JOB SITE
L,L!1. Address of Construction /0/0 7!s AV
="2. Property Legal Ddscription (include all. easements)
�- 3. Single Family Residence ✓ Multi -Family No. of Units
G
Commercial
M4. Owner and/or Builder a.rye_
1"-5. Contractor & License No.
6. Invasion into City Right -of -Way: No Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
zEi 7. Cross other private property: Yes No ✓ Easement required -
U attach legal description and county easement number.
H
a READ THE FOLLOWING AND SIGN:
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
F' installation for one year.
ac. Commercial establishment requires a minimum of a six inch (6")
z side sewer line.
0 d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
M e. Side sewer lines must be laid at a minimum grade of 2% (1.150)
o and maximum grade of 100% (450). °
H 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.
1. Inspection during normal working hours only. Two (2) working
days notice required. `y
DATE: �lt�'ll �71 l 2
I certi y 'that I have read
and shall comply with the above
N _PERMIT FEE: �j� "'-
+zs- ie�c�►L DISAPPROVED BY: Date:
OW By: Date:
CONNECTION FEE: APPROVED By: Date:
O
* PERMIT MUST BE POSTED ON JOB SITE
}, t - d 7 ' • by -
� CITY OF /E 110NDS� ,��---,,� REcEivE®
2 'lC*bR KS DEPARTMENT, ENG I N*AV3 DIVISION
REET �- Q- 1 1978
gPPL4CATIO�V FOP RIGHT-O,F:LlAY COPJSTRUCTIO�J PERr�IT {
. Dir. Of Public Works .
THIS PERMIYT''MUST BE AVALLABLE - AT THE JOB, L� B SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
A, Permit to be issued to: ;S (jo H co tN�� S t{ �A
For Work at :(address or vicinity, ) o,tO� 3`"� Hv• 5 c._
Type of Work to be done: -4,fr-
(attach drawing when applicable)
Time Required -- Start:_ o N•_�_ 4 Finish:
Owner: 'Hc_Yv c.YYyso\i
Name
Mailing Address
City State Zip �-
Contractor: P (_& \,)
Name
0 1 C6 v. s M-e y q 9.
Mailing Address
,City State Zip
-7-7G'1"7y'%
Telephone Number
State License Number
'7 -? -1 2 r) `L
Telephone Number
a
B. INDEMLNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages, .or claims of any
kind or description whatsoever, foreseen or unforeseen ,-that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including or not limited to the defense of any legal proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance_.of this permit, the contractor is responsible for workmanship and
materials for;``a period of one year following the final inspection and acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and -restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220.
I understand that this permit must be available at the job site for inspection
purposes at all times.
Signature: / Date: elf 3,�17y
Owner or gent
, TO BE COT`1PLETED BY ISSUING AGENCY:
Date Issued: /02-/-]� Permit No.: %f —Fee:Js
Security Bond: jf/^
Time Authorized:
APPROVED BYSY�' :—Date:L
PUBLIC UTILITY`DISTRICT No.1 of Snohomish County—C"` AREA
Rev.10/77
° . So.
i O I o 3` Nv
Date 3
C�lT7
W.O. L! %Li O
Location
T .3 R
Revisio
', a c o
Scale
Reason for work zN�'� S4�a Q�� ��+
EngineerT°'`\Otl'`
As Built
HAY J
UrG.File No.
23 t•"'�
Approvals
EASEMENT
ENVIRONMENTAL ANALYSIS
PERMIT REQUIRED
FOREIGN CONTAJOD
Type C'`'�y o§ d�a�ba
Company
Exempt under District SEPA
dFIN•No:
procedures, Section I11-A
Paragrapher---, Item Ls
Date Granteders
Fees required Yeses
Granted
Date 11 Y By"iarti'�
-Log Posted
Inventor
Type S'La � 4,V =
Interpretation Referred To:
Transf.Card
Pole De t:
Date 11 2a 1�� Amount"'
Map Poste4
I Circuit Map
Date Released For Construction
Date BY
Date Work Completed By
Foreman
O.H. KV
H. U.G. Con
Circuit Number Substation
Add Ckt Ft PH
Remv Ckt Ft PH
Net Ckt Ft
Water
R�.N lGO o�c"P`3�o Yncw
Sewer
Gas
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Backhoe
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W.O. No.
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PUBLIC UTILITY DISTRICT
No.1 of Snohomish County
"`�'' ` y- AKSA
CI8•
R,,10,77
° �`
Date_�3 ��
W.O. No- mod t -) a `
Location —1 c
3 l iv '- '►.
- --
Scale O J
.�� 1/4 t ` S
n, -7 _T .3 R
SQ�J �`� '�"
Revision v
_ EngineerT° `b"'`
As Built
Reason for work
�ti+S'�
U.G. File No.
HAY J
Approvals
QTjransf-Card
REQUIRED FOREIGN CONTACTS
F �d r+a��y Company
LRN. Mo.
d Fees required YesS No❑
Log Inventor Type `Lg`j a • J
Pole Dept. Date ! z�. Amount% Circuit Ma
EASEMENT
Ma s Date Released For Construction
Date Work Completed By Foreman
Circuit Number Substation
Zr.lsfi A _3 � y2�S�r �N t�,. P01$
RAN tGdc o�#ssn trC�`
-7 Psi
.S�T
2,asT. 3oezoE 3'`S1eal CorlvM�T
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R 13 8%
ENVIRONMENTAL ANALYSIS
Exempt under District SEPA
procedures, Section 11 I -A
Paragraph-+- Item l? _
Date I I Y By --'A-W
Interpretation Referred To:
Date BY
O.H. U.G. Cond KV
Add Ckt Ft PH
Remv Ckt Ft PH
Net Ckt Ft
Sewer
Gas
Backhoe
D't0\\ Did
j-6,/X
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W.O.No. g';�q 7 I
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