1051 9TH AVE S.PDF111111111111
9916
1051 9TH AVE S
'WORK tciRDER
D. OlD LUST.
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DATEEl
CHW'
S
Q
_ ,. • niE e
NEW CUST. CASH
AO''
031
PLUMBING&� HEATING
PRospect} $1 119
PROMISED
[)All:
A.M,
P.M.
P. O:, BOX 216 LVi�1NWOOD, WASH.: 98036
7 -DAY = 24 HOUR SERVICE
NAME__ f I' l I
.. —
"i off + ,r _ `_ .-�- • HUME RHONf`"+/ - 7
BUS. PHONE'
ADDRESS_
---
_-CITY
WORK AI_,
t'
HOME Ill I0NI:.._,._.
__rt ��
~!
LABOR,MATERIAL
_...._.._.. __..._..,...� _ ..__._. _ _ ._._.
ONLY
AMOUNT
DAY
FROM
10
IiOUNS
- , r", , 4
TOTAL HOURS
FLAT RATE SERVICE (_ fr, _ •y �(�'.'�
CALL $ •� r"J _
Jr ASE PAY FROM THIS INVOICE TOTAL MATERIAL b
- 10 OUR CUSTOMERS Sorvlca bills are duo old payable upon complollon of work and servicemen Is au-)•Cl.e'
TOTAL LABOR f thorizod to receive payment for same. If sarvico is not salisfactory In any way; ploose phone our office TOTAL LABOR Immedlotely.
1s Work performed on or about plumbing fixtures, supply lines, drainage and heating systems, sowers, otc., is not guaronleed against stoppages, ' PERMITS
1 damage In the removal of foreign objects, backups, floodln�I s breakage, fractures or freezing. Now fixture installations are guorantood against 5
faulty materials ar workm enship-for a period of ONE YE Ad from date of Installation.. --_
Highest legal rate of Interest charged after maturity. If, however, this occount Is not paid os agreed I Two) ogroo to pay in addition to the fora SUB iOTAI.
ggoing, a reasonoble attorney's fee, or If this account is placed in the hon�I'Of O collection agency„ I (we) acknowledgye that you will be damaged
I thereby to the extend of the collection charge ogninsl you and I (we) therefore agree to pay to you, as liquidated rlornagos, an amount came
to SALES `TAX
the amount charged you on sold collection by sold collection agency. not uxcogding, however, Oft percent .of he amount unpold thereon, and
also a roosonoble attorney's too. At the option of the holder hereof, iho '.van Jo .4t sold- suit mdyba•loid In the county soot, of the holder of this TOTAL "
Instrumonl. ,
Al1THURILEU
M OOIE BUSINESS FORMS, INC.—M ,. .CUSTOMER'S 5ISiNATU RE ,
-
,
..-. ..._._ .._�-..... __.. —__�, '. -. .. •,. it
f
APIAXAMN
CARD No. ................. ..........
'Edmolws.
ST BEET
for
SEDE SEWER PERMT
FILE
................................
OUTSIDE 0 INSIDE 0 REPAIRS 0
EASEMENT No. .............
OWNER ...........................
.............................. CONTRACT .................
OR . ...................
...................... ER� No.
STREET
.........j ...
HOUSENo....................... .. .
.. .................................
..
............................ AVENUELOT No.. ......................... ..... . ................................
BLOCK No . .................. ............. ...........
NAMEADD ...... ................ .......................... .....................................
.................... ............... ...................
.................
LALC
BACKFILL WORK ORDER ISSUED ...........................
F ORDER ISSUED ......... ......
A%pproveu-.
......... DEPOSIT, $ .... . .. .............. ...................... 4
............. ...... -: BY
- STREET FILI:AIM FOR DAMAGES 41+,�II 1 2 1y7�.
NOTICE �:•I1" O �.�;nvivu
i 7u °) Y.......
(� Claim MUST be filed with City Clerk and presentedto tEie"Ci'ty"4B6iin-d`i""
within 120 days from the date that the damage occurred or the injury;
was sustained.
TO THE CITY COUNCIL OF THE CITY OF EDMONDS r
PLEASE TAKE; NOTICE, THATi` - - A - a;�� �?,N'CLAIMANT, .
(if married, -give both wife and sbandvs name-)
WHO NOW RESIDES AT /G' 'g-I — 9-44 C24,,,� �o .
(Stato present actual address by, street,'.number & city)
AND WHO FOR SIX MQNTHS LAST PAST HAS RESIDE AT �.
Give residence by street, number and city
CLAIMS DAMAGES OF
OF AND FROM THE CITY OF EDMONDS IN THE SUM OF
$ �7 arising out of the following eireumstancest
-"- ,) - �--.0 i o -17/_
a
Describe defect, giving e� ;2-�� ' •z !�Z+c ,.e�Zy,;,
a- DATE and TIME injury or v U
r damage occurred, PLACE
and full particulars.
Accurately locate and
describe defects caus-
ing injury or damage
and all acts of negli-•
genee claimed.
,71z,
Accurately describe
injuries or damage.
State items of damage S
claimed: Itemize all
expenses and looses.
(Claim must be sworn to by claimant)
• (Signature of laimant
- SUBSCRIBED and SWORN TO
before me t h i s /,� �� day of . is ' , ,..19 •
Notary Public in and for the 'S ate of
-` Washington, residing at,,«c��_��'��:��a.r/.
Discuss ions;, --of 7/29/71 with Ron Whaley brought out the following information
aKnxim concerning this claim., Investigation n was needed to determine whether:
ur•,constrtict,on contract might be involved. Ron indicated that the storm sewer
�runningJparallel to the sanitary sewer'(about 2' away) stub was reversed graded
under'"the storm sewer. City crews made some storm sewer corrections and repaired
lateral. Damages not due.to'9th Avenue construction under the UAB project.
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