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1516 9TH AVE N.PDFIIIIIIIIIIII 9851 1516 9TH AVE N 0 ADDRESS: / (./� / Ale / V TAX ACCOUNT/PARCEL NUMBER: & ,-;U,o 000 0030003 BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) CRITICAL AREAS: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER): A d l/V PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #:.� SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: 5 L30 i y✓ 7pL� SIDE SEWER PERMIT(S) #: Q � /0 L ' /l7 GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: FOR: WATER METER TAP CARD DA L:\TEMP\DSTs\FOrms\Street File Checklist.doc Z LiJ Q V k..v. J.a ucr-r, CITY OF EDMONDS SIDE SEWER AS -BUILT O ADDRESS 1516 9 TH AVE N HOMEOWNER lCONTRACTOR J. NEWTON DATE 5/3/02 DRAWN PERMIT BY I. ABILA NO. 9610 SCALE NTS t�'•" ^'�� .� .•. -y,; ^y,..��.aw...:t>,..__ _. v'..��ti,�u"v "v:,�,i`Mv .^` .. , 1 ' L'gYKq.vi..�,,.y r'vt�.. .>c'k'1._r.,...-.�v'.t •..t.....^r�_�.t'iltv.rti.,.F�/v��+ro,y�'�: �ih.x;,vwi;. W�•.',�u,.Y' .� y'h..v-.•�..�•.,� "C. I b-7 CityOf Edmo' TidS PERMIT NO: 9s�� SIDE SEWER PERMIT PERMIT EXPIRES ? 6 Address of Construction: h CA C4 "V_ n LID # Property Tax Account Parcel No. nGkao om oos ®o 0 Attach copies of all access and utility easements Verified and Approved by Owner and/o Contractor�.A�� Contractor License #: 1) CAVn f =1 L E - Building Permit # rvp 'Single Family, Invasion into City *Right -of Way: ❑ Yes PNo ❑ Multi -Family (No-. of Units _� *RW Construction Permit # ❑ Commercial (No. of Units ) Cross other **Private Property: ❑.Yes Elo ❑ Public **Attach.legal description and copy of recorded easement. Owner Contractor 1 2-C, Wne n ractor signature an acknowledgement statement: Datefor this permit I certify that I have read the City's public hand ut entitled Ide Sewer Specifications, and shall comply with all City requirements outlined therein. 9' CALL DIAL -A -DIG (1-800-42 -,5555) BEFORE JANY EXCAVATION 9 2 FOR INSPECTION CALL 425-771-0220 extension ixua 24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS FOR OFFICE USE ONLY Permit Fee $Q •Repair Fee $ Issued By: ®"- Trunk Charge $ �/� Date Issued: Assessment Fee $ Receipt No: City Permit Surcharge Fee $5.00 Total Fees Paid $ NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN' INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED. Job Site Ready YES NO Date: -Initial:.. Partial Inspection: Date: Initial: Partial Inspection: Date: Initial: APPROVED: Date: f7 O2 Initial• As -built to Street File: FINAL INSPECTION 5 `f PERMIT MUST BE POSTED .ON JOB SITE 'O� r White Copy: File Green Copy: Inspector Buff Copy:. Applicant L;temp;bldgforms;sspermitjlg4/00 . " The City of Edmonds APPLICATION for SIDE SEWER PERMIT NEW CONSTRUCTION ❑ REPAIRS C] oWNERR k.Y..........1~.....�Z.............................................. c/ ADDRESS.Jr. ...'"'-.../....�H....- ..Y.. ..::-...!x......................... r GTH AI., ri IF L 'Z- EDMONDS TREATMENT PLANT EASEMENT No. ............... CONTRACTOR ..... ��. .% y /�' ......- PERMIT LEGAL DESCRIPTION: LOT No----------3--------------------------------- BLOCK No............................................ NAME OF ADDITION ..IY .R7//........5.7--R.le4,44-........�.�..�!� ��..5............................ w ---- ----------I rr 'T- sue, C v _ 3 G o ( g 3G ti iti<r�d�..i•if �i! MAY 4 Approved: �-z 4-?z-........... BDATE .................... y ---........... OF ,ED1M,,d "NODS` 4'. 'Y, DES SEWER gF�r�. •raaysr 'Vito '•A "" •"&r _•r.,. err+ .. :WATER-SE.VV,•ER) DEPARTMENT rCa11L`.770-110T Yor side sewer Inspections riEFO1tE covering any, portion.,of _the. construction ) \Inspection will -be provided' with1"24 hourw-after request..' NOFSat.:, Sun or, holiday. inspections./ . • .. .. - . DRESS)`LOCATION.:OF.,CONSTRUCTION� �' Rr+ �f���1P !; )i LC1 i .. � . 3 1{ol't �- stream s`� Sias PROPERTY LEG ','DESCRIP.TION... - .- 9 ._... { OWNER AND/O% BUILDER' ('au7 I {r _ , - SWs` ,� can°s ri c tnit 4a{l yhr�010 li'dad6 ��flamaoaily � >�+r - l J)NtTRACTOR'S NAME &.ADDRESS { ...: _ ('��Berinission+is granted,:: ::. , 1+J :•, for.•repair and/or, connection of.a side se��er to_,th© city,sanitary sewer systom',;in accol dancetwith City of jEiimonds: ordinances ATTENTION IS CA'LLED"TO THE• FOLLOWING .IN�OTONo: 1 mThe^owners'=of'the.property-may obtain-.a;-permittto construct sewer;:inside-property line A licensed Slde'Sewer Contractor, must. be employed.'to construct ;sidw� sewer: in, street -area: ' Do not. coyer.any•portion, of sewen,-before �it' has•b6eri inspected - ', _ • ' , �- E' No. 2 A`ll"work performed in city' right-of-way requires an- Invasion -of: Right oP ,Way' PermlCobtalnable,.from the Clty., Engineer s office - _ ;'�1vuTE'.No: 3. -Obtain-fulLintorm_ation^regarding Ordinance 11.16.030 and�Regulation'i governirigslde�sewersDwhenyou get permit.,. - { NOTF� No; 4'-Top<<of `side sewer must have-at.leazi-- 0o 'inehese coverage .at'property-line', and '12,'inches in side'•rproperty;•line minimum grader oPt�2 j No -'bends in. grade - - -sharper than..IN will be permitted. - ' •NOTE No.• 5-Trenches- in' strect:must be water .settled, and surface of str6ei'restor6d to• original condition Contractors: shall be, responsible- for failure. due.'to improper j - work which-may'd'evelop: within one year -of-coinpletlon - - I , •NOTE`No: 6—It,;is,Unlawful:to alter.-or,.do,.anyotherwork.,than'is,ptovlded for int'the permfY or to,iio any .work' on. the. main- sewereor,;Its appurtenanceai,except to,in Bert the pipe:into the=wye.: - - - - 1 DIS'AAPPROVED ❑ Date._. .... ..:.:.:: By, _: Date::: 'Date:. By, i ''1 I 'AAPP.ROVED Date ::..~{ T ......: .. _ BY . 1� �. i Remarks _: I� ............................` 3 1l� r BOTH Permit 'C`opies. MUST .Be :Signed By Ownel =of FirinLPerformmg Constrtictiorn:PRIOR .To Request• For Inspection '•hereb ` y that the side sewer >nstallation Dconstructed under this ermA f �9� ?16� Y scertlf P It, - Owner, of- Contracting Firm Per rming G�on'st uction) ;) -- was lnsfalled•ii1``accordance with all gorning=ordinances of ;the City of Edmonds Dated this % day.xof i(�4 18 y.: —� J J Check, BEFORE' you>d[g for: Wftiter ❑ , .:Gas ,❑ ' ' Te'lephone'0', Powerti❑ Sewer, p;: " 'Other ❑� J J •..v�4�•�-z+Pys�+,'r",��...tY..,.Y...erg...�-'�..�Y.....,�,.�-v-nf".1,.pv.���„�•T'Zrja'�,"_v�',:a�+c'4:rv^"".n•.�J-rv`1:o'�.wH•''Y,�'-os•.'�.'�.,iyr�'+;�'�ti"vXk"ifi''""�.*^�.citz"'Lir'"�(''f"l+rV;�fr•l+w<�4tV'^".ti�rv'Clifn:rvtir�rrtir,, �iJ�1 ^A":.°.n..Y✓',..J ;.,.,.�i CITY OF EDMONDS Permit. No. O �' 7 5 COMMUNITY SERVICES DEPARTMENT ""THE T FIL[� Issue Date �'"° RIGHT-OF-WAY CONSTRUCTION PERMIT I� A. • Owner: Wdshington Natural Gas Co Name 805 156 AV NE Mailing Address Bellevue, WA 98007 City State Zip • Address or Vicinity of Cc Type of Work to be Don 4 to E R/W to se Work in Connection With B. • Contractor: Same Name Mailing Address City '% ;2� 4 State License Number State Zip 447-0 700 Telephone Number " Plastic gas main in 9 AV N at = 1' E 9 9 AV N (883-577/60-433-1g) ❑ Sub or Plat ❑ Single Family ❑ City Projects E. ❑ Commercial ❑ Multifamily ?9 Utility Q Pavement Cut: ❑ Y ❑ N U a APPLICANT TO READ AND SIGN a Q INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds >- harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or unforseen, that may be made against the City of Edmonds, or any of its departments or employees, including or not limited to the defense W.of any legal proceedings including defense costs, court costs, and attorney feesby reason of granting this permit. .-1 THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLI:OWING THE FINAL' INSPECTION AND ACCEPTANCE OF THE WORK. O U Funds held from the Security Deposit ,(estimated restoration fee) will be held until the final street patch is completed W by City forces, at which time a,debit ,or credit will;.be processed for issuance to the applicant. • A 24 hour notice is required for inspection; Please call Public Works: 771-3202 • Work is to be inspected during progress and at completion. • Restoration to be in accordance with City Code. • Street to be kept clean at all times. • Traffic Control to be in accordance with City regulations. .• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day; no exceptions. a 0 W E� U Ix O w I understand the above and that this permit must be available at the job site for inspection purposes at all times. R Signature: Date: 7/2 5/ 8 8 Owner or Contractor This Permit Must Be Posted at the Job Site For Inspection Purposes Call DIAL -DIG Prior To Beginning Work ISSUED BY: Time Authorized: Void after �� days. Security Deposit: Special Conditions: Amendments: Receipt -No.: Fund III.Fee: Street Cut Dimensions: x = R NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. July 1985 FIELD INSPECTION N6TES (Fund III - Route copy to Street Dept.) Comments: Diagram: CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO Partial Work Inspection by P. W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: Eng. Div. July 1985 0 0 Z 3 ,W * I16 � I 6 /N w lEq-- CFI LD LOCATE Qpv,t RD IY4" PI= I MAIN \ _ _ 2'S- N FI' O O NORTHSTREAM EX.2" STW IP10'N S ,ro Ln �--- WTR LANE A. Sat 2a V J I 6' W TR . � �ho 0�, NO. END MAIN 3' PAST SERVICE. O DESCRIPTION REVISIONS • M NOTES: I. CALL 2 DAYS BEFORE YOU DIG 1-800-424-5555 101 6 - - 9 — e 7 52-630 I 17�4' • PE C A P 6 I 1 7-E. ST L"D BOX WITH LIP 50 - 30 7 5 S t # 10 TEST LEAb 85- 930 4 1 IA" TRANSITION FITTING, 78-7 S a 1 IA" SERVICE TEE *H/750/ 78-67/ 2 203'1 # 14 DETECTION WIRE 85�- 940 1 203' 11/4" PE PIPE 70-170 ITEM OUANT. DESCRIPTION STOCK NO. BILL OF MATERIAL PERMITS: EDMONDS 1 /4 SEC: SW 13-27--3 E s MT. PLAT: 16/- OG 6 OP MAP: I60-06z • ! AREA: EOMONDS OEM TAX CODE: �N � SEQ. NO: AVVaMkVlon5WWConffW D.G.R: 5-19-" 1/ y PE IP MAIN EYTENSION TO SERVE DWN: c.GL-AKESL" 7 2 ea IR 6043-3 RR DATE BY APP'D CHK'D:JOB 8d3 5T7 f�f� ORAwINC SCALE: l' =S0' APP: �, ` 8 3 _577