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1148 A AVE S.PDF11111111111111 10006 1148 A AVE S e�� tN�r T _.._.-.District • Ci of Edmonds ---Water Department TAP CARD .. 19,92 ...... NO2.17.1 .......... No .................. . ..................... Mef& Tap Size.: 3.............. Size .................................... .. Mfgris. No. .. ..... Styl e. ........ . ................. ... For . .......... . ... .. .. ... .... . ........ ...... . . ..... . .. ....... . .. ........... . ..................................................................... ............................... ................ LotNo ........................................... Blk. No ......... ......................................... 8ic-rvfc,e Location ......... //.�.1lf- ...... I .............. .................................... :.:.: ... ........ . ................................... . .............. . . ....... ........ . ............ . Miter1,66a-tio-n- . ............................... ....................... . ...................................... . ..................................................................................................................................... MakeTap ......... ........ : ................................................. ......... . . I .................. o ............. ................ 7 ........ ..................................................................... ........... s ..... ....................... ,Pressure .... lbs. - Test. .................. % .................. Sendt 31 0 ........................... . ............................................. ....... . ................ . ..... ------- ----- ..................... ... . .. . . . ...... . .............. bate of Work ................................................................... ; .......................................... Foreman Guar. VoUc*,her No..-----.._ ................................ $.:..:.............................. ...... e aiks: ..: ............................ .................................................................................. ....................................................................................................................................... ........... ........................................................................ ........................ . ... ................. ...................................................................................................................................... .................................................. . ...... . ....... . ... . ........ ............................ . ....... . .............. OUTGOING I n-d' e-x'.. * ........ Reg ....... Route Bk ......... Siencl ..... Card. -- INCOMING Index -..--...'....Reg ........ Rduie Bk ......... StenciL.—Card ...... MWial Chargeable to Installation 1�I rs NO. ' DESCRIPTION. RAT MOUNT Meter ........ �..sl- O ----••-••---.. .......... Meter Box ................... ----------- - == X •-•-•------ ............. ----- Check Valve .......................... •--...----- •---_ --- -• - -•- --------••-•-- -•-••---- Pipe, Galv. Screw .................. .............. ...:.........••-•-- _-. ......-- Nipples .. ------ ----------- •--...._. ......•. ..... Bushings .......... Plana 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 Ills; . . Tees " .......... Curb Boxes ................. S. O. Extensions -------•-•- ........ *Gates ....................................... ............... - ......... . -- Plugs.....................' i ............ •-----••. •------- --• ____.___ Couplings " --------•-• ---•-•--••---- . -----------• ----•-•---••• --•--- .......... .......... ....... -----••--- Gate Boxes --•-•-------•-•----•----• .................................................... .......................................... .......................................... ........................................................... .............. ............. --•----- ............. .._ ..............»__ ........... -_.... _... -----• ......... .... -•-- ........... -------- .... .....i --------•-••-- ..__.._._.. ------------- .............. .............. ----••--•- ...... ---•------ _........ -........ ............................................................ ............................................................ ........................................................... ........................................................... Hours Time —Day Men ........ ---•--------• ............... .............. --••-•---•-••-• ............... -•--- ...... ...•••.. ............ ............ --•-••------ -......... ... I..... ...... _.. .......... ..... ...... .............. _........ Hours -Time —Monthly Men ................ .....: ..... :._... ............... .......... Hours Time=Auto ............ --- -----•.... --.... _... .......... -•--...----•----••-.-- Superintendence ...................... ... _........ ------- Total .(. ADDRESS: 11 TD A A(/P/) u t, TAX ACCOUNT/PARCEL NUMBER: �V / (/U71 1T BUILDING PERMIT (NEW STRUCTURE): l 9 to 2 O 3 I' COVENANTS (RECORDED) CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: -10k2 SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT WATER METER TAP CARD DATED:_._. i L:\TEMP\DST's\Forms\Street File Checklist.doc A� h� ' PAT PERMIT 'AppL No., ..... AFFU ION U 10m ING ............... crry ov Mdfti Build `-Debartment. tPermit - lirii;*.�,:�,Or 6r. APPUCATIO". is'lieziby.macle'for a permit to.coristruct the follq*wing work, inaccordance vhthzthe,aaccotri, approval:. panying Plans and specifications. Two sets are -submitted; herewith Off'si. 42 igw--' alter T kiri ...... ... ............... . . Work - addr repair .......... .... ................... . ............ 9'' Const. type ........... Occupmcy ......... ..................... ............. Use zone" ----------- Fir"!,zone_ ,., ....................... -4Lk Address ....... // Addr ...................... Lot ...... .............. Blk.'. ......... * ......................... Lot frontage ------------------ -------- ....... Area ...................................... ..... Septic Bldg. set -backs— f ront. ...= . ............. r: side ....... ......... 1. side-_- ..... .. rear.. ............... I ...................... Tel. Owner..Je ...................... ICIez64 Address....- . Bidder......................... --------- ..................... ......... Address- Tel.. No..-I.I"-'.'_.�; ........... Plans byN -- 71 Remarks............................................................ ..................................................................................................... ------------------- - ................................................................... ................................................ .................................. ...... ........... ........... ......... I The above is a correct stamment, and I agree to comply with all applicable Codes and S!tate "laws, re&L*n-g lit.,'.t@s--""-,,�,� work: Signed Owner /Agent.., ate ........... �_,_ PERM for the above work is hereby approved, subject to the abovecohditio'ns;- and to comp ,'-i proved .plans and specifications, and Building Dep'a=cnt notations thereon: Valuation .... ... ............ Permit ............... ... �ecdb�; .... . ..... ................... . . .... ..... Building Department; By ...................................... ........ Date ..... ...... a NOTE —`this bermit does not cove-,- plumbing, sewer, or electrical installzio-is-nO.7 does it permit".'ary-Work.to. done in the Right of Way, areas. Driveways - and, wdlkways must be planned,to'meet the qficiargradeie6psfr e and alleys, and plans for future sidewalk development. 0 APPLICATION for SIDE SEWER PERMIT OUTSIDE El INSIDE El REPAIRS El Aa CARD No . .......................................... EASEMENT No . ....... ....................... I ........... The City of Edmonds OWNER ............................ .................................................................... ' 4" //Yp - 'z' HOUSENo . ............................................... .. . ........................... Date Approved: BACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, $ ...................................................... ................ SEWERWORK ORDER ISSUED ................................................ DATE .......... �� I-S - BY ........... .... ................................................