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1121 A AVE S.PDFiiiiiiiiiiiiii 10000 1121 A AVE S PAID, DEC — 51 �Qo ------------- — ---- _.----- District City of Edmonds ---Water Department TAP CARD Dat(P.AM.{}E.E_=.' - =14- MeterTap p No ....................................... Size------------------------------ Size .............. _................... ._ Mfgrs. No .......................... ........ Styl .............................. For............... %./A.......-----` . 4 ._ .. ..........._.......__ _._...__ LotNo....` ..................................... Blk. No U...._................_......._.... ---- Add......................................................................................................_......._......--... ServiceLocation ................................... -...................... _._.... _..... _... ...._._.. .................................................. _.................................. _....... _....... ........ ._.......... .... Meter Location ............................ Make Tap Pressure .............................. lbs. Test .................................... % SendBills to .......................... ................................... ................... ........... ..._..._ Date of Work. .� .. j. ......................................................... _................ .................................... Foreman Guar. Voucher No ........................... _.............. $................. _................ _..... Remarks: --------. . ............................................................... -................ _.......... _....... -SfiREEfi-ftt-E OUTGOING Index ......... Reg ........ Route Bk ..... ... Stencil ..... Card....._. INCOMING Index .... ..... Reg ......Route Bk.... ..... Stencil ..... Card ..._... MWial Chargeable to Installation Mows NO. SIZE 11 DESCRIPTION RATE AMOUNT .../------- Meter --•--------•---•----....•--•-- - _...... .............. .......... Meter Box ---------•-----•-------------- ---------•---- ............. ............... --••------ Meter Plate ............................ ............. .......... .............. -•------•- Check Valve ...... ................... •------•------ —_.... ..... •- .......... -------------- ---•----- Pipe, Galv. Screw .................. .............. ---......... .......... ............. ---------- Nipples -- ................................... .............. -------------- ---------- Bushings .................................. •------•------ - ......................... Plaui Ells ................................ --------•--•-- --------------• ---------- St. Ells ----------------•-••-•-------•-- •---......... .......... ------•-------� ---------•---- ----------•--- ......... ---------- ---------- ••• Tees ------------------------•----•--•-•------ --------------•----------•------•------------•---•---- -------•-----------•---------•-----------•-•---.--•--- -------------- ............... -------•------ ..-----•--..... .._........ ............ ............. ............ .......... .......... --•------- .......... Material Chargeable to Taps Connected NO. , SIZE DESCRIPTION RATE AMOUNT -------------- .......... Pipe, Black Screw ........--------- ..... ..------ •---•.... .--• --.._... .............. .......... Pipe, Galy. 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 APPLICATION a The City of Edmonds for SIDE SEWER PERMIT EASEMENT NO. _____________________----------- 106-09100 NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO. ........ ASMT. NO. OWNER David J_.. Walsh------- -------------------------------------- CONTRACTOR ------------------------ -------------------------------- .--------------------------- PERMIT NO. ------------ JOB ADDRESS ----- 1121.- �-"X'.--Avenue------------------------------------------- Lu __j i W W cc CJHwj _ r LEGAL DESCRIPTION: LOT NO_ _____-------------------------------- BLOCK NO. ----- .----------------------- ---------------------------------------------------------------------- ----------- --------------------------------------------------------------------------------- NAMEOF ADDITION--------------------------------------------------------------------------------------------------------------------- DYE TESTED ON SEWER - March 9, 1976 By Marsh Menne Approved: DATE ----------------------------------•--------- By --------------------------------------------------- --- - - /75 - 1 1 ADDRESS: TAX ACCOUNT/PARCEL NUMBER: BUILDING PERMIT (NEW STRUCTURE): 061 D D COVENANTS(RECORDED)FOR: CRITICAL AREAS : b- v 0LOI DETERMINATION: ❑ Conditional Waiver 0 Study Required Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER):. y60 05#1b o`) lggI Z 61 f,?1&,4 l�-?D r/ U�t_ 4&-, I 1 --?, Zb t & j11Tr., PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT FILE: ' / LOT: qBLOCK: SIDE SEWER AS BUILT DATED;-b� 1 � iom( LM- V SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: FOR: WATER METER TAP CARD DATED: L:\TEMP\DSTs\Forms\Street File Checklist.doc .PS APPLICATION 'PERMIT CITY ^.,;: EDMCNDS Building Department Permit limit', one year 'j 'j APPLICATION is hereby made for a permit to construct the following work, in accorrJance with the accom,�, panying plans and specifications. Two sets are submitted herewith for approval. Off -St. Work- ad,3n repair ........ .... Parking ............... ......... . ......................................................................... ................. ............... Occu-.-)zLnc ....... Const. t Use zone .... ......... f�� Fire zone..------....: y ......................... type.. A Address ....... ............. /1 ....... Lot ............ ... Blk .............. r ....... A d d n.. tank .......... z ................ Lot frontage ........................................ Area_._ Septic ............... Bldg. set -backs — front__.... .... r. side..... .......Iz �-...1. side........... ... ......... rear........ .��....71 . ...... ....... ....... ....... Owner ............... ........... Addres& ......... Tel. No.... ......... T,-.'. No. Builder ................... Addres ........................... ..... .................................................... .. . . . . . ............. Plansby ............................ I ..................................... Address..._._......._.........._...........-----.......__.. Tel. No._........_..._:_.....------- Remarks........................................................................................... ...................................................................................... ............................................................................. ..................... ............................... ........................ .......................... ...... ....................................................................................... ........ .............................. ............................................... ......... ....... T'he above :s a correct statement, and I agree to comply with ali applicable Codes and State, laws re91 A work. Signed Owner/Agent ...................�Z ....... f?kda-ress .......... ............... ........... Date ......................... .. PERMIT for the above work is hereby approved, subject, to the above conditions, and to ompliancewith'the , proved plans and specifications, and Building Department notations thercon. Valuation ................ ...... Permit fee ....... d. by--.. ......................... Recd. ........ .7, Building Depaitment, By. ....................... ... ........... t ..................... Date ........... ........ This Permit does not cover Plumbing, Sewer or Electrical inst,41lati6yis. M is 4 P A aY 'L " Pl. OT FLAN 1- 11- 0n d9a.i99- City of Edmonds Critical Areas Checklist RECEIVED APR 17 1995 COMMUNITY SERVICES The Critical Areas Checklist contained on and submit it to the city. The C iity will this form is to be filled oat by any person review the • tmalae a precursory. site Preparing a Development Permit , and malm a determination of the Application for the City of Edmonds prior subsequent SWPS Y to complete a to hisfher submind of a development �� p application. permit to the City. . .With a_sigaod copy of this form, the The purpose of the Checklist is to arable applicant should also submit a vicinity map City staff to determine whether any 0 potential Critical Areas are or may be _ widr arougL detail that City staff can find present on the subject property. The -• ' ' and identify.the subjectparoel(s):y' 5' information needed to complete the addition, the applicant shall Wade C,hocldist should be easily available from" other per ioent information (e & site , observations of the she or data available at plan; topoIrapi map, etc.) or stakes � CityIIall ((�nifical Areas inventories,nrapS,. oogjaa�on w,itlt this CheckTisito.assist ... or soil surveys). Staff in compleftthelr priGaifnary ..; r..... c� assessment of fire site. .: ..':::�. -, • An applicant, of his/her}ya�y� /p. ... _......... maWIItN.i �W �"'",w`; et 'tv i. .... must fill out the duo , �gn and date it, u . ..._. ... «_._ .... .. ...•si.r7 « s•_^ l% . ..1•t_:,r .r. ., l bare completed factial,16666i S