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1120 A AVE S.PDFiiiiiiiiiiii 9999 1120 A AVE S PAID DEC — 5 1801 .-----------•-—•----- District City of Edmonds ---Water Department TAP CARD DatA!IRF c ..-. 5..1.9ff ...... Meter No ........ .......... ............. Tap No .................. ..................... Size............................. size .............. ..................... _. Mfgrs. No .................................................... le. .............................. _---- . �a........' For .......,l _............. ...._......._..__....... LotNo .......................................... Blk. No .......... U..............._......._.............. Add-.................................. ................_............................ ServiceLocation ............................................................ :..................... -----------•--..-•........................•-•----------............----......------........._......._........_.._._.............. MeterLocation ............................................ ........ _................ _...... :..._........ --•..................................................................................._-------_.............._r.......-...--•--...... Make Tap ..... Pressure .............................. lbs. Test .................................... % SendBills to.............................................•---••--•--.........----.._......._................_..... Date of Work...oC%�.........7............11n. ....._.................. ............................. ................................................................................... Foreman Guar. Voucher No ........................................... $........---.................--•-•.._..... Remarks: ......... . ............................................. ................. . ................ . ............. -..- ..............................................................................•-----.._................_........_..._._.............. OUTGOING Index ........Reg......Route Bk ........ StenciL....Card........ INCOMING Index ......... Reg ....... Route Bk---- ---- Stencil -..-..Card..._... 1VlStrial Chargeable to Installation MArs NO. S E DESCRIPTION RATE 'AMOUNT 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 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 ----------•- -• ----•-----•--- -- --- .............. .......... Superintendence ........... -• . •. -- .............. ............ -- Total nDoaEss: aA V.P,YILLP, TAX ACCOUNT/PARCEL NUMBER: BUILDING PERMIT (NEW STRUCTURE): "I Le 10 S 6 D COVENANTS(RECORDED)FOR: h, J - � CRITICAL AREAS 0 'd 0CY%��-W8 DETERMINATION: ❑ Conditional Waiver ❑ Study Required Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS ( PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DA' SEWER LID FEE $: SHORT PLAT FILE: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: WATER METER TAP CARD DATED: LOT: LID #: 14 BLOCK: L\TEMP\DSTs\Forms\Street File Checklist.doc p� APPLICATION BUILDING PERMIT Appl. No. CITY OF EDMONDS Ezaiiding Department ' ermit limit, one .year„_. : APPOCATION is hereby.mady: for a permit to construct the following work, in accorda_r a with the .acolm-; parrying plans and specifications. Two sets are submitted her^with for approval new Ater �* �, w'st. J�'�...t.`-�ti!•� ---- Parkin ..................... ; �trc�rk adds repair ................... ........�.............................................................................. /g ^ccupac y Const. type........._.. :x... Use Zone .....!���_..'{�__.... Fire zone ........................ t 'ddress_..-.cl.�� �................ ,xN Let Blk............� Addn._� -- Sept c tank Lot tronrage -ea back.....�.c.... '..........--.. rear...................._...........Bldg. set— r. side ..............% I. side._.. ;• '. yi Owner .............................. �... �....... Address............._._........_.............._....--•---- Tel. No.._:._.: ..... .-----.._.. - - Builder................ ................................ Address .................................................... Tel. Nc ............................ Plansby --------------------------------------------------------- -------- Address ............................................... ..... Tel. No ............................. i Rcmark.L..................................... ..............•-----•..........•----------•••-_.................._.....•-----......._.........---.........._.........---.................`.. f ------------------......... ........................ ................................. -•--•---...._......-•-•--...........----.......------•-------••-----...._........._............ i The abovc is a correct star rnci and 1 agree to comply with all applicahle Codes and State laws. regulating work. 1 i -�L J, Date:_: raj` �__ dress-_. ....... Signet] O•vner,..........._. .... . PERMIT TO &.e above work is hereby approves, subject to the above conditions, and to compliance with therap � $ , proved plans and specifications. and Building Department notations therron. t Valuation �` o t �. Reed M , Pe*-->;t fee ' Building E)cpartment, L?� GEC/ ` Date r qq f fir. This Pennit does not cover Plu;rbing, Sewe,, or Electrical installations. �1 4 - i I 3 � APPLICATION The City of Edmonds for SIDE SEWER PERMIT EASEMENT NO. ............................................ 107-00700 NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO ................... ASMT. NO................... OWNER...............Tom Hawley----.................................................... CONTRACTOR ............................................. .............. --------------------.-- PERMIT NO. ----................ JOB ADDRESS ..- .1120 ''A-' Avenue-------------------------------------------- LEGAL DESCRIPTION: LOT NO.................. -------------------- BLOCK NO. ----------------------------------- 0 CJ --------------------------------------------------------------------------------- --------------------------------------------------------------------------------- NAMEOF ADDITION----------------------------------------------------------------------------------------------------------------------- DYE TESTED ON SEWER - March, 1976 By Gary Raymond Approved: DATE............................................ By------......------------------------......---------ii79a