1039 EDMONDS ST.PDF1039 EDMONDS ST
ADDRESS: (`o� 1 �JC.IMCXV
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:_
PERMITS (OTHER):
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DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT: 2 BLOCK:
SIDE SEWER AS BUILT DATED: d(, 6 XP3x
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DSTs\Fonns\Street File Checklist.doc
Side Sewer Drawing
The City of Edmonds EASEMENT NO. ............................................
218-02350 NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO . .................. ASMT. NO. ----.----.--------
OWNER --.- .'VELYN-G. MAGEE-..-----•-•---------•--------------- CONTRACTOR--•--------•--•--•-••-•--------------------••----••--••-------......-----........... PERMIT NO. -•-----•--------- -
JOB ADDRESS 1039..ELIOS--ST--------------------------------------------- LEGAL DESCRIPTION: LOT NO. ...................................... BLOCK NO. ............. -------------------..-
NAMEOF ADDITION ----...----•-•----•---•--•------•----•--•------------------------------•-------•--•------------------------------------
c
M
-4
M
DYE TEST ON SEWER
Approved:
PWW-0001.11/75 (REV.11178) DATE ............................................ BY------------------------------------------------------------
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No . ..........................................
NEW CONSTRUCTION ❑ REPAIRS ❑
118-02350
OWNER---------- M - X.... McLennan .............................................................. CONTRACTOR.------------------.............----..........--............----....---........................... PERMIT No. ......................
ADDRESS ....... -OS9... EdJJM4S---St,........................................................ LEGAL DESCRIPTION: LOT No............................................... BLOCK No. ............................................
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NAMEOF ADDITION...............................................................................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ BY......................................................................
9TREET HU
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS,WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
*PERMIT MUST BE POSTED ON JOBSITE*
STATUS: ISSUED ENG20080005
SIDE SEWER PERMIT (I -Single Family)
Permit Number: ENG20080005 Expiration Date: 3/14/2008
Job Address: 1039 EDMONDS ST, EDMONDS
MAGEE EVELYN G
1039 EDMONDS ST
EDMONDS, WA 98020
BOBBY MILLS
8112 206T H ST SW
EDMONDS, WA 98026
425-778-0974
LICENSE #: EXP:
.JOB DESCRIPTION
Y
REPAIR N PROPOSE TO REUSE LATERAL LID NUMBER:
N
CRINDER PUMP N I PROPOSE TO REUSE SIDE SEWER
SIDESEW ER REPAIR
EASEMENT INFOWNIATION
N
PROJECT CROSSES OTHER PRIVATE PROPERTY
N
I VERIFICATION OF RECORDED EASEMENTS COMPLETE
INDEMNITY.- The Applicant has signed an application which states he/she holds the City of Edmonds harmless from injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds or
any ofits departments or employees, including but not limited to the defense ofany legal proceedings including defense costs and
attorney fees by reason ofgranting this permit.
CALL DIAL -A-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HO UR NO TIC E REQ UIRED FO R ALL INSPECTIO N REQ UESTS
THIS APPLICATION IS NOTA PERMITUNTIL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED.
r
SED BY
G
Printed: Monday, January I
El FILE COPY �z QNS PECTOR COPY F APPLICANT COPY
STATUS: ISSUED
ENG2OO8OOO5
• Refer to City of Edmonds Side Sewer Information handout for approved pipe materials, inspections and other requirements.
• A 6" cleanout with 12" locking cast iron lamphole cover is required at the property line.
• Maintain 10' separation between the sanitary side sewer and the water service line.
• E•Sanitary Side Sewer Inspection
PARTIAL INSPECTION DATE: INITIAL:
PARTIAL INSPECTION DATE: INITIAL:
FINAL INSPECTION APPROVED DATE: INITIAL:
NOTES:
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APPROVED BY PLANNING
AUG 21 2013
DEVELOFMENIAfidiuES M.
CITY OF EDMONDS
STREET
FILE
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