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1154 SEA VISTA PL
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ADDRESS: l l `--/
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS(RECORDED)FOR:
CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER): L
PLANNING DATA CHECKLIST DA'
SCALED PLOT PLAN DATED:
SEWER LID FEE
LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED: II
SIDE SEWER PERMIT(S) #: I'' Ij(� l�
GEOTECH REPORT DA
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER
4-3
LATEMP\DST's\Fomis\Street File Checklist.doc
forCARD No. ......................................
SIDE SEWER PERMIT
-A �) OUTSIDE ❑ INSIDE ❑ REPAIRS E] EASEMENT No.
OWNER ----
----------- ........... CONTRACTOR
HOUSE�?
No - ----- // . . ........... STREET PERMIT No - ----- 9VI�21�.
............................... AVENUE LOT No. .......... '11<�
F .................................................... BLOCK No. ................
NAME ADD. ..........
........................ ....... ------- ................................... ......... ........
APPROVED
WN
J;119
Date
BACKFILL WORK ORDER ISSUED ........................ Approved:
........... DEPOSIT,
SEWER WORK ORDER ISSUED m
DATE .- i
. .................................... By ..
...............
CITY OF EDMONDS
Can PRospect 6-1107 when work
CIVIC CENTER — WATER -SEWER DEPARTMENT is ready for inspection. (No inspee-
tions Saturday. Sunday or holidays.) N2 1415
SIDE SEWER PERMIT
ADDREkS.................. U.54L ..... S-e.a ... Vista ..................................................................
OWNER --C—A.—Mc-Connachie ------------------------------- -------------- CONTRACTOR. North ---Fa d.Sept lc --- Tank ----------------------
Permission is granted ... june. ..........7 .......... . ............... 1 19_66-_, for ...................... days, to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do not cover any portion of sewer before It has been inspected.
'No. 2--Obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%.
No bends In grade sharper than % will be permitted.
NOTE No. 4—.Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
NOTE No. &--It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its ap-
purtenances except to insert the pipe into the wye.
APPLICATION CARD No .......................................
for
The City of Edmonds OUTSIDE ❑
SIDE SEWER PERMITEASEMENT No.
INSIDE E) REPAIRS 0
/'? ........... ..
OWNER -C . ........ .... ........................ CONTRACTOR ... PERMIT No.
STREET
................. ...............
HOUSE No. ..... AVENUE LOT No. .......... ......................................................... BLOCK No. ................. — ...........................
NAME ADD. ------ 0 ....... ........................ '— .......................................
-------- vg�1.2
<1'
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .............................................
SEWER WORK ORDER ISSUED .......................................... DATE J ............................ .........