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1261 7TH PL S
ADDRESS: �v
TAX ACCOUNTIPARCEL NUMBER: 06
BUILDING PERMIT (NEW STRUCTURE): Ci g!e
COVENANTS (RECORDED) FOR:
CRITICAL AREAS:
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
PERMITS (OTHER):.._clpt0
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:) 1:7 /M
SEWER LID FEE S: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:_
SIDE SEWER PERMIT(S) #: g? /
GEOTECH REPORT DA
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DA
OTHER
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PERMIT APPLICATION Inside Heavy Lines
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APPV'D BY CITY ENG.
NUMBER
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
REMARKS -
Legal Description of Property (Show Below or Attach Four Copies)
METER SIZE
BUILDING SUPPLY SIZE
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ALLOWED PROPOSED
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REMARKS
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VARIANCE OR CU
PLANNING REVIEW BY
DATE
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LOT COVERAGE
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NEW �V RESIDENTIAL LINE
❑ NON-RESIDENTIAL ❑ SIGN
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TYPE OF CONSTRUCTION CODE
HEIGHT
ADD
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REPAIR INSP, POOL
SPECIAL INSPECTOR AREA
REQUIRED
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OCCUPANCY OCCUPANT
GROUP LOAD
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OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
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NUMBER OF
DWELLING /
UNITS
REMARKS
NATURE OF WORK TO BE DONE
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APPLICATION
The City of Edmon'STR EET FILE SIDE SEWER PERMIT for EASEMENT NO . ............................................
1 NEW CONSTRUCTION REPAIRS ❑ LID NO . .................. .ASMT. NO. ------------------
OWNER ... R'-� =--------- --------------------------------------- CONTRACTOR ---------- CON T S.. PERMIT NO. -- Z
JOB ADDRESS _.��---- ��----P�--------------------------------------- LEGAL DESCRIPTION: LOT NO. -------------------------- ------- BLOCK NO. ....................................
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N L��lot�S �* 2
Approved: /
DATE ....-------•---- BY ,by �rti,:�. 1! ✓11�.
� 11/75
,.
APPLICATION
for
Th® City of Edmonds SIDE SEWER PERMIT r
EASEMENT No ...........................................
NEW CONSTRUCTION ❑ REPAIRS ❑
OWNER'..AP .P....... ��!(...................................................... CONTRACTOR ...-.....7........_.......—•""-........t•-•----.....--••-------------------•----. PERMIT No..�. Z ..
' !O 1.... �! ..-. ..... . °-••---•..................... LEGAL DESCRIPTION: LOT No.. .--.!...----............•............. BLOCK No......--•---........
- ADDRESS '
NAME OF ADDITION jam. Ll.. .. ��
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....
- - Approved:
•
DATE.................................. BY ... ........... ...............-. --.. "? r
CITY OF, EDMONDS — SIDE SEWER PERMIT
a WATER -SEWER DEPARTMENT
PERMIT „ ,� ? u = '
' Call 775-2625 far side sewer inspections BEFORE covering any portion of the construction.
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• (Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday Inspections./
Ins
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ADDRESS LOCATION OF CONSTRUCTION._..---••-----�• -- .:i. .•...�...._._....._. (j.._..._._ - `
r ?'? i1 ••"- I- tel: ,, ......_. 2 - -----------
PROPERTY LEGAL DESCRIPTION........ -••-- �o .._..--___-
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.......................... ----
_............................................................................. ...
OWNER AND I ...................
/OR BUILDER ---•- ••
qA _______________•----____--_-._
CO..�1'RACTOWS NAME & ADDRESS ----------------- -- - /+e-
T nission is granted ----•+_•••^ - 19--, for repair and/or connection of a side sewer to the city sanitary sewer
a �m in accordance with City of Edmonds ordinances.
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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.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3--Obtain full information regarding Ordinance 11.16.030 and Regulations governing aide sewers when you get permit.
NOTE No. 4—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. 5—Trenches 1n street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper ,-
completion,
;.,. NOTE No. 6—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 appurtenances except to in -
work which may develop within one year of
sert the pipe into the wye. T _
` .. Date.... _ .._..
B ... __ Date ............... —................... 'BY ----------------
DISAPPROVED ❑ Date --- -•••-----... By..-.............
Date. /7
,.
APPROVED a .______._.--•---•--_._.__. By.. ._.�•-••-
- ........ ......
_.... -......................................
- .. - . .. Remarks. .__....__.. __._._..__
... _
-- BOTH Permit Copies MUST Be Signed By Owner of Firm. Performing Construction PRIOR To Request For Inspection
�1� C hereby certify that the side sewer installation constructed under this permit
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(Owner of Contracting Perfcrming Construction)
_ was installed in accordance with all governing ordinances of the City of Edmon
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Dated this-�/ ��.- ...... day of_....�-'--�'_V......................................... . 19�1.
J Check BEFORE you dig for: Water ❑, Gas ❑, Tel phone ❑, Power ❑, Sewer ❑, Other ❑ d
- _
STREET FILE
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301
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RECEIVED
JAN Ol
DEVELOPMENT SERVICES CTA.
CITY OF EDMONDS
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