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1030 B AVE.PDF1030 B AVE IoAk •... -........ ..... City of Edmonds --Water Department TAP CARD 'Wefe-6 °'{F Date P�AADDEC 15 1961 -----®....... _.... _._....... _...._._.. No.............. ...:............. No .................._......._...._...... Meter Tap Ste....... .......... .......... .Sim ................. Mfgrs. No..........................................yy�----... _.. Style...:......._......._......._.......... For...... 1...Q.. �.......... ..--/-----....................................... _..._._..._... ,t n LotNo ...................................... v.... Blk. No. ......... ................................ :.... Add-................................................................... ................... .... _... _....... _........... ServiceLocation............................................................................._....._....... ................. MeterLocation............................................_......._......-----...._......._...:_........ MakeTap...................................................................._..............................._........ ........ Pressure..............................lbs. Test :................................... % SendBills to---------------------------...................------.--......................__................_..... Date of Mork .Z-Y.,�-�„a.....�..�..-.. �. Foreman Guar. -'Voucher N Remarks :......... _............ OUTGOING Index ..:...... Reg ....... Route Bk........ Stencil ..... Card......... INCOMING Index .... _... Reg ------- Route Bk ... _...Stenctl.....CarcL.._... 1 eriai Chargeable to Installation fWrs AMOUNT NO. ZE DESCRIPTION RATE ------ --• -• Meter --••-----•--••--•---•---- --- Meter Box---------•-- -----------••- -----�----• x-- -•-••--•------ --••---•-- Meter Plate ............................ .............. •........... --------•-••• .......... Check Valve ------ ................... •••...... �_..._....... ---....... --•-•---•--••• •--•-••-- Pipe, Galv. Screw ..............•... .............. .._......... .......... ---------•--•• •-•-••---• Nipples .................................... ---•-•----••- ........ _... .......... ...... ........ .......... Bushings ................................... ••---••----•-- ..-•-----••---. -••-•--•-- Plain Ells ................................ .............. ---........ ---------- ............... .........• St. Ells ---•----••---•-••---•-•----..... ... ••--••-------- .._........ .......... ............... .......... Tees-----�-•---- .. .................••••••- Material Chargeable to Taps Connected NO. SIZE DESCRIPTION RATE AMOUNT .............• .......... Pipe, Black Screw .................. .............. ............. :.... ... ----••......... .......... Pipe, Galv. Screw .................. .............. .....•-•----. ......... •-•------•-•-- .......... Lead Connections .................. .............. ......_..... .....---- .............. -•••-•---- Curb Cocks ............................ . .-. Corp. Cocks---------------------••••. ............... -----•------ ......: ! Unions • , .............. -----•---- Saddles ................................. ---•-•-------- ......... Nipples ---------•---------------••-••-•-•.. ............... .....----•. ......... ............... •--•----- Bushings .................................. ............... -••------- Plain Ells ------------------- •••--- •••. •---•- .............. -•---•---- Street Ells .-•--•----••................. ............. .... ..... --•----------- ---------- Tees. .......................................... -••--•--------- ........ .. .......... ------------•. .......... Curb. Boxes ............................ ------------ •--------- S. O. Extensions -------------------• ......••. •••. ------------ .... -.... .:-•--••....... .......... Gates -----------------••-••----•---••••---•-- .............. ••.• .......... Plugs ........................................ ---••--•-•••• ---- ...... Couplings ,-•-•---•--•--•-•- ----••-••••••. .......... Gate Boxes ...................... .............. ..... ........ ........................ ........................ ........................ ........................ ..................................................... .................................................................. ........................................................... ........................................................... .............. .............. .............. ....................... ...................... ............ .... ._....... .......... ..-...... .............. ........................ .............. .............. ....... -•-•- .......... .......... ......... . ---•- ............................................ ............... .......................................................................... ......................................................................... ........................................................... Hours Time —Day Men --••••-- ............... ............... •--•----••--. ............. ....... .... ...................... ...................... ....... -... .......... .......... ........... --�----- Hours Time —Monthly Men .. ........... --- ....... -... .....----.. .............. .......... Hours Time —Auto ................ .............. ....... -... ...:---_.. ......j-----. .. Superintendence --------- -----•------ -•---•----.... .... Total ADDRESS: G (»U L�U ,ULZ TAX ACCOUNT/PARCEL NUMBER: p bl(J 6. ! � D d 00A BUILDING PERMIT (NEW COVENANTS (RECORDED) ,5F1!� CRITICAL AREAS DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED PLANNING DATA CHECKLIST DA' SCALED PLOT PLAN DATED: SEWER LID FEE $: SHORT PLAT SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD DATED: LID #: LOT: J BLOCK: L:\TEMP\DST's\Forms\Street File Checklist.doc r r - 1�, l; �L ¢fir • . r P �x^• , . r _ .APM If,">'ai'i�K �; ' ib��LY�Ai/ •. r���R' - ,A L :, t• /� �l�f: :, M .CITY v� wni6ND5 BUDC059 Department Parr% liml4 eme year APPLICATION is h made for a to construct the following —ih is aeamdance uvtth.tbe:ara ®'Y� '' ' tt r j A hereby Pam' ' / ! panying.plans and specifications. Two secs are submitted herewith -far approval. t�1 new Ater Off St t A "try Work addn repair ... _........ �i �rcG�7'Zt t .�3S9 Occupancy..._ .............. .......... Const. typo-._.._..._ Use tone__.. r . Feteicy 1 7L 4r rr~ i n JliY JQ r� . Address. ._.._......._tr._._.-----'_-.. Rlk....... �... __... t10o •� Lot frontage ................... ................. Asa ._.�!' X / Y.� septic tank.. front AA5 / r. side---__�._._... L aids___,... _.__.__ Bldg. eet•badta/� 12! ._.... _ ..._._._• «.., ' 1.••:•..... �.: —. AddtLa__. v / _ �' TeLwmr f TCL No_:... Plans by_. ......................... -----.,,._-._----._..— ndd as ._._._.._____ _...___..:.._. Tel •No �.::: ._:: �` C y` Y Remarks.__.._......-•------ ------------------------ ........ - -- -- —--------,_ "r i� Thu above is a correct statement, and I agree to comply, with all applicable Codes sad Stara laas:regulatinB - work. All /• .__� ~, r SiSignedOwner/Agent.. .`� .�...4J ... Aadre+c.._____ _ Dete_ /rvy.. , C &: PERMIT for the abcnw work is haze,N hy :roved, suL�•r, totlr^. above alndmoaa, ; nd t000roplurrx voids proved playa and apxifiat ons, and Buu'ding Depart nmt netatiotu thereat Valuation ......zw*..'cf%!:7 _ Permit few.- ,.3.s . ... Build.rot, By. .._. _.u;.�•r•�•:—' .._..-__.-_..• (-••.-•- •w r 0 This Perma don, not cover Plumbing, Sewer or Mectrical instollotions. a+r ln¢ / caw+ 1 y [ 1 i f ..x� APPLICATION The Cityof Edmonds for SIDE SEWER PERMIT NEW CONSTRUCTION E] REPAIRS 0 EASEMENT No ........................................... 107-05400 OWNER........ R•---K•---Ge1711@.r..................................................................... CONTRACTOR-----._..........------------------.........----.....------------------........................... PERMIT No....................... ADDRESS ..... 1-0.30--- --- Street------------------------------------------------------------------- LEGAL DESCRIPTION: LOT No............................................... BLOCK No. ............................................ J s NAMEOF ADDITION......................................................................................................................................... DYE TESTED ON SEWER JULY, 1972 Approved: DATE................................................ By ......................-----........................................--