1055 EDMONDS ST.PDFiiiiiiiiii lill
10939
1055 EDMONDS ST
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:m�,2,42t)4a)o O2,
BUILDING PERMIT (NEW STRUCTURE): 191�51
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
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PLANNING DATA CHECKLIST DATED:
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 #:
FOR:
WATER METER TAP CARD DATED:
LID #:
LOT:2I BLOCK: ` 2—
LATEMP\DSTs\Forms\.Street File Checklist.doc
.no. 1 %91j
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City of Edmonds PERMIT NO: 9761
SIDE SEWER PERMIT PERMIT EXPIRES_ ' '/
Address of Construction: »S� FQ"7p v.Q S 52r_ LID #
Property Tax Account Parcel No. ✓
Attach copies of all. access and utility easements VerifiM'and Approved by
Q.Rw er nd/or Contractor:
Contractor License #: i o Building Permit #_
jaso'ingle Family
❑ Multi -Family (No. of Units
❑ Commercial (No. of Units )
❑ Public
Invasion into City *Right -of Way::❑ Yes No
*RW Construction Permit #
Cross other .**'Private Property: ❑ Yes No
**Attach legal description and copy of recorded easement.
Own Contractor �.
O er or cPnctorsignature and acknowledgement statement: Dat
By signingthis permit.I certify that I have read the City's public handout entitled
�ide Sewer Specifications, and shall comply with all City requirements outlined therein.
2 CALL DIAL -A -DIG (1-8004'T-5555) BEFORE ANY EXCAVATION W
R FOR INSPECTION CALL 425-771-0220 extensions
24 HOUR NOTICE REOUTRED FOR ALL INSPECTION REQUESTS
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
:.r
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO Date: Initial:
Partial Inspection: Date: Initial:
I
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: 111 M03 Initial:_-�&__As-built to Street File: ❑
11, PERMIT UST BE POSTED ON JOB SITE'
White Cop . File Green Copy: Inspector Buff Copy: Applicant
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CARPORT
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GARAGE C.O. IN ABS
EDMONDS ST
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Way A RNA-7,
ADDRESS
1055 EDMONDS
HOMEOWNER
SHAFER
DATE DRAWN
9/9/03 BY I. ABILA
SCALE
ST NTS
CONTRACTOR
DOCS PIPELN PLMNG INC.
PERMIT
NO. 9761
The City of Edmonds Side Sewer Drawing EASENITENT NO .................................
218-02410 NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO. - ............... ASMT. NO. ...........
OWNER ....1YJN, HOUGI-i'I l - - • - - CONTRACTOR ....... •....................................................... -.................... PERMIT NO. ....................
JOB ADDRESS ----- 10.5S..E='-lCCDS-.ET--------------------------------------------- LEGAL. DESCRIPTION: LOT NO. ...................................... BLOCK NO. ....................................
........................................ ---•••---------•---•.......•--------•-----•----------•---•-------•----••••-•------•-------•----•---------•--....----.----
NAMEOF ADDITION--------------------------------------------------------------------------------------------------------------•--------
0
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i
DY.E TEST OZ SEt,1ER
Approved:
DATE .--•-------------------------•--- ... By............................................................
PNfWflOgt-1 ,l7.: (REV.11t78, --•---
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
EASEMENT No . ..........................................
NEW CONSTRUCTION ❑ REPAIRS 0
118-02410
OWNER ........... Robert ... C....B: iyer.Ar-.----------------
ADDRESS ....... 1M..E(j[T Q05... t-t...........................
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.............................. CONTRACTOR.--•-------••------••----........................--••-•-----...................................... PERMIT No.......................
......................... LEGAL DESCRIPTION: LOT No............................................... BLOCK No.............................................
NAMEOF ADDITION......................................................................................•---...................--•---......................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By.....................---..............................................