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1141 A AVE S.PDF1141 A AVE S ENT'D . ... _........ _.... ___... District City of Edmonds ---Water Department TAP CARD QU SEP 17 1962 . Date..... No............................... No ................... _..................... Meter Tap It Size....:h/ ..... �> Size ...................................... Mfgrs. No---------------------------------------------------- Style..................... ..................... _ For ........... ......................... _........................ . LotNo ........................................... Blk. No .................. ...... Add- .................................................. _.................................................. 1. Service Location...................................................................... Meter Location Make Tap Pressure .................... -........ lbs. Test .................................... % SendBills to .......................... ...................................................... -................ _... .. .....................................................r......�..............................»................................ Dateof Work--------.��---........- '� ............................................... _................. ................................. --............................................................................. Foreman Guar. Voucher No ........................... _.............. $................................... _..... Remarks: .............................. .......................... .................................. . ............. . ... . OUTGOING Index ........Reg......Route Bk .... ....Stencl..... Card........ INCOMING Index ..... _... Reg ......Route Bk ......... Stencil. ..... Card .._... M&ial Chargeable to Installation MV&s NO. SIZE DESCRIPTION RATE AMOUNT ... Meter ............. ....Y 2.. 0 .............. .......... 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 • • ADDRESS: 114l A AV (/I1 V, TAX ACCOUNT/PARCEL NUMBER: BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) CRITICAL AREAS: DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED PERMITS PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver SEWER LID FEE $: LID #: SHORT PLAT FILE: J�" / LOT: BLOCK: SIDE SEWER AS BUILT DATED: �1 �Y / �P SIDE SEWER PERMIT(S) #:" / GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD DATED: / // 7 LATEMP\DST's\Forms\Street File Checklist.doc 0 APPLICATION JAILDORC . PERMIT APpl. No. �?_•��--/ 0.-�:-• l CITY OF EDMONDS Building Department Permit limit, one year � APPLICATION is hereby made for a permit to construct the following work, in accordance with the accom- panying lans and specifications wo sets are submitted herewith for approval. P new alter�� Off-St. �Verl` i repair ...-.i ........................•---....._ Parking _....... Occupancy' ............. Const. tYPe: ....... -__ Use zon...................... Fire zone_-____. f A Let Blk._... -U Ads' n........_.. Address.-/ 7:•�.. •! /.-.._...... •---•- •-• G \� � Se;tic tank. (�vvC Area Se; tic Lot frontage------------------------------ --------- _ —front ....__-.___._.._'r. side _..-•---�.- _.----•--•-- 1. side ------- ................ ra ••-•-----•-=-•--... Bldg. set -backs _.._....... Tel. _. . "............D L _. Address ........ CAvner..:t1eL �. Builder--------------- --__-_ Address ------------------- -------------------------------- Tel. No.----------------------.... Plansb---------------------------------------------------------------------- Address ----------------------------------------------------- Tel. No ............................. ___________________________________________________ Remarks--------------------------------------------........................ S The above is a correct statement, and I agrc, t9 comply v;ith all app,icable Codes and State laws regulating this work. 9 Signed Oviner/Agent. -_. Ly--- -/ "�✓� —A - Date ........................... �J. Pi:i Mff for the above work is hereby approved, subject to the above conditions, and to compliance with.the ap' proved plans and specifications, and Building Department notations thereon. Valuation ................ ��.-�•-•• Permit fee--- -- ............ Recd. B&iilding Department, By ................................................ .... Date._.' a ...•• •--- - ................... c NOTE — ?his permit does not cover plumbing, setoer, or electrical installations, nor does it permit any work to be done in the Right of Way areas. Driveways and walkways must be planned to meet the official grades Of streets . and alleys, and plans for future sidewalk development. The City of Edmonds IA.1� OWNER * ...... HOUSE No . ....... d'"..41" ... . ....... ... . f.. ....... it ...... Lli Lu co I APPLICATION for SIPE SEWER PERMIT OUTSIDE: W" INSIDE 0 REPAIRS 0 CARDNo . ..... ......... ......................... EASEMENT No . ............................................ ......................................... CONTRACTOR ............. ........... .............. ..... -.1 ............ ..... PERMIT No. STREET ......................................... AVENUE LOT No . .... ............................. ................. BLOCK No . ................. .......... ..... . NAME ADD ........................ 1: .......... ............................................................ Date UACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, $ SEWER WORK ORDER ISSUED ................................................ I 22- I s. I - q "4&XA - APPROVED 'Ak�p " �T Ll " 19B2 Approved: .............................. DATE....... ... By - ... .......... -An'4-f �,.+�.� T"^,� r s . n i�'+v"� Tom::-¢.:w..,ry .�,e+ o-eRy,r^..,rT.-,.r `3C 1Pna.. � _ ,rR. _ . ,i..yC:, 'ar+"►_. ,r I"a'_.-v,�,�• .T inC 1SoQ A . City of Edmond RIGHT—OF—WAY CONSTRUCTION PERMIT permit Number. Issue Date: �— 9 A. Address or Vicinity of Construction: 4V4 �//j�� • [) B. Type of Work (be specific): iliy%,�C /' �/1�lZl a�. C. Contractor: P S • Mailing Address: State License #: D. Building Permit # (if applicable): Contact: Phone: Liability Insurance: Bond: $ Side Sewer Permit # (if applicable): E. ❑ Commercial ❑ Subdivision ❑ City Project ❑ Utility (PUD, GTE, WNG, CABLE, WATER) ❑ Multi -Family ❑ Single Family ❑ Other INSPECTOR: INSPECTOR: F. Pavement or Concrete Cut: ❑ Yes []No G. Size of Cut: x H. Charge $ APPLICANT TO READ AND SIGN INDEMNITY. Applicant understands and by his signature to this application to hold the City of Edmonds harmless from iT juries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or employees, including or not limited to the defense of any legal proceedings including defense costs and attorney fees by reason of granting this permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC- TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. Two sets of construction drawings of proposed work required with permit application. A 24 hour notice is required for inspection. Please call the Engineering Division, 771-0220. Work and material is to be inspected during progress and at completion. Restoration is to be in accordance with City Codes. Street shall be kept clean at all times. Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer. All street cut trench work shall be patched with asphalt or City approved material prior to the end of the working day; NO EXCEPTIONS. I have read the above statements and understand the permit requirements and the pink copy of the permit will be available on site at all times for inspection purposes. Signature: Date: (Contractor or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLti'