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1040 A AVE S.PDF- . iiiiiiiiiiii 9994 1040 A AVE S ....------------------..District Edmonds ---Water Department TAP CARD DateR. AC.T..2.g..jqg2.. I.......... p No... ---........ .......................... ..Meter Ta Size.................. Sim ................... Mf9rs. No ............ I For .......... .................... .. ........... ... ... ................................ LotNo ........................................... Blk. No.------.........---................._.............. Add---------------------------------------------------_.............. . ....................... Service Location .......//.... ... ..................... ....................................... Meter Location .......................... Make Tap Pressure .................... ......... lbs. Test---------------...----.....----..... % SendBills to .......................... . ....... ................................... . ......... .................... .., ........... . .................................. . ......................... . ....... . .............. Date of or ....................... ................................................................................................................ Foreman Guar. Voucher No........._ ................................ $ .......................................... Remarks:. ... ;;;;;i .... r. , I ......................... OUTGOING Index ........ Reg ....... Route Bk ......... Stencil. ..... Card.... — INCOMING Index ......... Reg ....... Route Bk .... . ... Stencil ...... Cal&.--.-. i i . • 1 ell _ L f I T__ 11 1K R 1V�Crial \.11drgeaulC LV 1nblallallOn ers NO. SIZE DESCRIPTION RATE AMOUNT _Q? ............ ...... Meter ..................................... ......... ..... ----...-••.... .......... Meter Box .............................. .............. ............. .......... .......... -... •--------- Meter Plate ............................ .............. -- .......:. .............. •-••------ Check Valve .......................... __.... _... -------------- ......... Pipe, Galv. Screw .................. .............. _.......... •-•--•---- -------------• --------•- Nipples .................................... .............. ,....... _... .......... ---•-•--•---.. .......... Bushings.................................. - --------------- .......... Plain Ells ................................ .............. .._......... .......... .......... .... -•--••---- St. Ells .................................... .... .......... _... ............... ............... .......... ---------- -------- Tees ......................................... ...................................................... ...................................................... ............... •---------.... ----.......... -----•-----• ............. ............ .......... .......... •-••------ Material Chargeable to Taps Connected NO. SIZE DESCRIPTION &ATE 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 ..... I.............. .............. ...---................ ............... .......... Gates ........................................ ............... ............ . .............. .......... Plugs -----------------••-•-••---------•--••-- .............. ............ .......... .............. .......... Couplings ...---••-• ...........................-------- ............. .•....... -----------•-- .............. --------••-•-• ------•• ...... .......... .......... -----••-- ..................................................................... Gate Boxes .-----•-••---....• ........................ ..................................................... •...................•--•-•-•-••----•-----•---••..... ............. ........... -• ......... .... ..... _...... ..-•--•-.... ------- ---- ............ .... -.— ........... ---.------ .......... --•--•---••••. .............. .............. •---•-------- •------------- .............. .......... .......... .......... --------•- _........ _........ ...........................••.............................. .........•••-•-•••-•..................-••---............... ........................................................... ........................................................... ........................................................... Hours Time —Day Men ........ --•----------- ............... ............... ............... ............... .............. ------••••-- ............. -••••-...... ....... _... ....... ...•-•--.... - ........ .......... .......... _.... _.. _....... ........... ............... _........ Hours Time —Monthly Men ................ --- :........ ---------. .......... .......... Hours Time —Auto ............ ... ... :.......... ...... ._... .......... .............. Superintendence .........------....... -----•--.. --_...._... ......... -•--••-•.............•--• Total .---•--------.....:.......-•----...---.._.........- SEP 16 1958 PAID ................... — ....... District • City of Edmonds ---Water Department No..------ �' Meter Size ........ Mf grs. For .' 0�:vj LOYA M01 SEP 16 1958 PAID Date................................... _........ - Tap No ................... ....................... Size................. -................._. LotNo ........................................... Blk. No ...................................... .............. Add-................................................................................... .. Service Location ...1 1��T- ................ =-............................................................................................... -....... _........... . Meter`Location.............................................................. _................................ ------------------------------------------------------------------------------------------_......._......._.............. MakeTap-----------------------------------------------------------------•----------.........-----•---•--------........ ......................................................... Pressure .................... _........ lbs. Send Bills to ......................... Date Test.................................... % ,20— ------------- 1(/-----rc�sr..................... Guar. Voucher No ------------------------------------------- $ Remarks:----•................................................................... Foreman ............................................................... _................... .�..+ l..._.; ........... _.............. OUTGOING Index ......... Reg ...... Route Bk ......... Stencil. ..... Card-..__ INCOMING Index ......... Reg ....... Route Bk......... Stencil ...... Card ........ Iftrial Chargeable to Installation Urs NO. j ZE 71 --- DESCRIPTION Meter ..................................... RATE ......... .... AMOUNT __.... _... U� . ----- .......... Meter Box .............................. .............. ... ......SL .ark.. ............... .......... Meter Plate ............................ .............. --......... .............. .......... Check Valve .......................... .............. ........ .......... -------------- ......... Pipe, Galv. Screw ------............ .............. .......... .......... ............. .......... Nipples ---••---••••-•••-•-•-----••--•--- .............. ........ ........ .............. --•••••--- Bushings .................................. .............. --......... .......... ............... ••-•------ Plain Ells ---------------------•--........ .............. ............ .......... ---------- .... _... --•---•--- St. Ells .................................... Tees .................._ .............. .......... .......... j.... ........ ---•-••------ ....... ............... ............ .......... ;� •••. •-----..... .r. l �... -------------- -------•-- ...................................................... .............. .............. ......... ••--•----- 11 ........... -fig. Material Chargeable to Taps Connected NO. SIZE DESCRIPTION. &ATE AMOUNT .............. ..... ---- Pipe, Black Screw .................. •-•--..........--•----•---- --.._... ••--••••................ Pipe, Galv. Screw .................. ............... ••-----•-•--. ......... .............. .......... Lead Connections .................. .............. .--......... --------• .............. ........... Curb Cocks ............................ .............. •---------. ......... ---•-••-•••••• ........... Corp. Cocks ........................... .............. ••------•-•- ..•••-•-...... .......... Unions .................................... .............. ............. .............. ---•-- Saddles ................................ .............. ..... _.. ...- --••-----•- .......... Nipples .................................... ............... --•-••••- ......... ............... ......... Bushings .................................. •-•--------•-- •--._:... .. •-------•-•---- ---------- Plain Ells ................................ ........ f •---•---•-.... .......... Street Ells -•••• ........................ ...•. .. • ....&-/.... _ ------------ .......... Tees ---------.........----••....._........ -- .......... ............ --•-•----- ----------•--- .......... Curb Boxes ................. --......... .............. .... ......... ............. ........... S. O. Extensions .................... .............. ............ .. ............... .......... Gates ........................................ .... -..... -- ------. ------. ------------ ------ Plugs ........................................ ............. -------• .......... ----------- - •--------- Couplings ............................... ........................... --------•--•-- .............. --------••---• .............. .......... ---------• ••-•--•-• .......... Gate Boxes ............................ ..................................................... ------•--•-•--•---••--- ............................ ........................................................... .............. ............. -•------------ ......... ........... ..... -...... -_.... _... -_.... ..... --•-• .... -.... ........... .......... .......... ------•------• ---------- ------------ .............. -•----------• ............... -•-•-•---• ---------- .......... -••••................•-•••---..............---....................... _........ - ........................................................... .-.----••--•-•-------------------------------------------- ............................................................ --•••---•......................................................•••-..... Hours Time —Day Men ----••-- .............. -------------- •----•--•--•-- .............. ............... ............ -------- ..... ............ ............ ............ ------•- --------- .......... ......... .......... - ........ ............... _.. Hours Time —Monthly Men........._...... ....... - ..:. ---------- .............. --------- .......... Hours Time ............ Superintendence ...................... .............. ......._. Total _0. 125.00' i y . Cliff. cola. WAK- — Existing Residence nt1I. co WALK W%lRO N �7 SAW-aJf j REMO/6 tXi3t co Ja, �AJOiJe if►iS / sLA6 AS RR D. Raq J6w AVVZj REXLA6d w/J6w cold. f0 OAT6N aXist • Q In3 °0• New Addittor>� Rp �1o�S of .-. ao.a. ROR Jaw ceJa. �e�odr I '� GAIN-- 1 pvvv,efe�a �R W3 WAY tH18 ADOIIfON j 1- 1 CONSTImIxIm solo" saw•aJf j R6M 6 BXlst ORw6 wA Jg61 Owl O M1 6N gRiyAtOO�f - fATaN w/J6w i — Q X sr. ceJa, •Af e 125.00' PCvslwAY csa J6wivolToJ6' AO/RIf. LOGAfIoJ oR 6,1,0E 6Af a,iJH ;C A SHlft. 9'JIL71n16-t°1-1 SCJ.Gf 2°JG: RS-(X 19a9 APVM,9bJ - 342 SQ.F( Ss' SAc45: w 1sw AOplfiewJ - 231.•5 OQ. Rf. cao.Y 1°' tS1S.S56I.Gf s�v� REAL IS' 649'f Olt6 . -1,4t1.615' 5a.Ff. LOt GA/4RAG� . af9Ss- �atl.d�S- 34.9%v O 0 0 AvrclX.:vaAfvJ oa yist wAf6a: V�JI ai Et.O vpuRY C u1 N SITE PLAN scale 1":10'-0• R_c:-.l • "D APR a i-ni PSMIT COUNTER ZONING SEPA _ SETBACKS o. e 4) LOTCOVERAGE 7 BUILDINGHEIGHT 0,— C SIDEWALKS 41 STREET DEDICATION i SUBDIVISION RED. Q WETBAR STATEMENT p GUEST HOUSE STATEMENT Q FLOOD AREA a nTHFA _.- 1 1Qq IMP APPROVED BY PLANNINU z.....- �. a ppow�,..+; �� ZONE SETOACk FRONT t' ' SIDE REAR t HEli;liF - BUiL08a1 MiPART^�MENT �X WORK F,D 4 AV 24=j' T ADDRESS 16VQ /4 OWNER FLI. - -+ 2 APPROVED DATE, -4� Z. 21 BLDG. OFFICIAL -b'L-'�b`---- NUMBER LPERMIT F —yzzr- north CITY COPY c. O IL . y Z. a WT m i J as LL. C) o Z Q 0 _ fA C) > 3 Z < Vl WrA p� • 0 W v cc O 5AMar mF a ADDRESS: r (l`7 U -A L.A- Z TAX ACCOUNT/PARCEL NUMBER: iyp 6 % TV D ZQ D D4ol BUILDING PERMIT (NEW STRUCTURE COVENANTS (RECORDED) CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver DISCRETIONARY PERMIT #'S: CA l9q' 10( f a c per) DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT FILE: 5 LOT: 4 BLOCK: to SIDE SEWER AS BUILT DATED: SIDE SEWER PERMITS) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT FOR: WATER METER TAP CARD DATED: OTHER: LATEMP\DSTs\Forms\Street File Checklist.doc .0 APPLICATION The City of Edmonds for EASEMENT NO- -------------------------------------- SIDE SEWER PERMIT 107-01100 NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO ................... ASMT. NO. ....- OWNER John Croft CONTRACTOR .--------------- PERMIT NO. -------------------- JOB ADDRESS .....1040 „A" Avenue LEGAL DESCRIPTION: LOT NO.-------------------------------------- BLOCK NO. ------------------------------------ -•-------------------------------------------------•----------•---••-----------------------•---••--------------------------------.-..-----------••-------------- w 0 LU LIJ F-- cn 0 NAMEOF ADDITION--------------•-•--•-•-•--------------••--........-------- .........--............................................... DYE TESTED ON SEWER - March, 1976 By Gary Raymond Approved: DATE--------------------•--------•-•---------••• By............................................................ 11 /75