17003 65TH PL W.PDFIIIIIIIIIIII
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17003 65TH PL W
APPLICATION
_. for
The City of Edmonds SIDE SEWER PERMIT
EASEMENT No...........................................
NEW CONSTRUCTION REPAIRS ❑
� ,Awe � �I�`, 1C_1C�
OWNER .... ..'.....1 " N................ CONTRACTOR <-.tom" `S.- L�t-iuvw PERMIT No.
ADDRESS .1% � — `G ...... F�...' "....E.. w . LEGAL DESCRIPTION: LOT No :......:....................................... BLOCK No.................--. c
IRE .IvE S
NAME OF ADDITION ...........L—Is....•••........................_........:.................:.....
L ME: NO WARRAMY Of ACCURACY The informaVon shmvn rm the
attached map was compiled for use by the City of EdmVles, i:s
andconsultantL The City of Edmonds does nct w rrc" A to, of
anything set forts on the map. Any person or eatity a cc,+
should conduct an independent Inquiryregzrdinn the inforr-fJon s;:_:.n c:o
the m2p,-acludigg, but not limited to, the location of eay s:wcr stub
shown. Such sewer stubs may or may not c:jst and may cr r, _y not Ernst at
the location cootm. Neither the City of Edmonds nor Its om loyeas or
o"it—i tj silalt be liable for the Infarmatfon Civan on this map, nor for zry cr,
^Qntdon provided based upon saidm*
ti
Appro
DATE
Cz. oEmfP-3
v
ed:
-./..9.3 y :-.
G
0
'OAF ,IE, �' AYI, ' ; t' I IA 'S S'I DE .'S'E)WER' . !PE'RrM�IT' .
e.� WATEALSE,WiER,1D
EPA
RTM•ENT"
s
" y 'P'ERIM``I'T; 2
-
1'/ - alll'778=1167 'tor. side sewer inspectlona+ •AECOREI •coverlh ' r �; ,any ,portion of ',the. -+construction.
2..fir, `tInapection wllld:be+•pioylded wlthlnt:24! hours,after+request- . NOdSaf d$un:' a['Iholiday ilnapectiona��-' c ,.M
17� 3 fay#'lc: 1.; ..,.
ADDRESS}�LUCATIONh(OF' iCONS'1'RUCTIOM....:.. .... ^ ..........
..............................
1PROP.ERT.Y.�LEGA�L DESCRIETIUN .......:...........?.:.... ...... -
Nf t ...... .....
.i. , .:..!O,WNER't ANW-OR',+BU'I'LDER'.-...... i 1 i 1 i
ACONTRACTOR;SfN+AMEI&ADDRESS 4 .ICJ E>I4il 1 V 1}ti l'i (�tltf}t7CS
P' Perini`ssion�is�igranted; S't�t�?Il]J} -4
fs ordancei`withuCity of Edmondsaordinances 91 ,jfor'rep4r;and%or, connegtion of aisi$etsewerto) hthe,pity sanitary sewer
ystemkini acc
r A^ VTIONj I9YCAL LEDt;TOS THE! •FOLLOWING s
.pro .S �18he,,toownerst;of-Ahe+iproperty�+may-obtain-.a.�permlt+fo;;construct,aewer ;Inald'e,propei?ty/,line:, �p�;llcensed+� - ••
e er-inlsfreetiarea.,'•DoLnot'cover. an.y'.portion oflsewerybefore it 'hasl;been;.Inspeoted'.;. Side: $ewer�Contraetor mustsbezemployedlfoaconatrucf
�,.NOTE;�No 2—Ail]hwork,Sperformedt.imdcity,-,right of way'requires,•an Invasion . of •ftlght-of-.Way•,Eermlt•.robtalnableofrom•4he• Cllty:Engineer;syotPlce.auf
4 NOTE!}No . 3. ',ObtalniifullUinforrimafdon regardingsOrdioance ]•1'.l'8.030:,and' Reg'ulattons'tgoverning side sewers• when you.:get', 1.t
1 <
NOT&No.- 4 'Top+iof ,side,.aewerhmuat have Cat desst:30 inches'�coverage:;ab property line;•a.nd+ l2,lnchea lnsld'enproperty. line;
-.minimum f rade�0 20,
sharperithan ��,twllll?beipermltted. = g ;,. J Nw!bendstlmtgrade
.. .
r„ 1 NOTE,'No , 5---Trendies im street must bey water aetlledi-ands.aurface:of-•street :restored! do, �arlgmalficondition (Contractors-shailt:be', responsible for ;faliure+,due rtol Improper
w,ork',whibhr•may,,developiwithin one•year-,of'completion'. - - -
1 1; NOTF7):No &-.ip rt tunlawfull to.ithe ye do!lany other;work.•than�ls•;providedi for, itheupermit- or'�fo.doiany,�•,work on:•tthe,. main'newer'ior'ytaleappui,tenanceauexcept,tto,•Ip', .'
sett the'. P1pe, Intot tfie wye
DIS'APPROMED) I,y 'iDate .. BY Date
AIPPRU�V DP',Date r 1 y? /f Dato By(
Ronlarks
-- ;BOTH!Pe it op` si S e Sgnedl'B. ;Owner aof' Film Performing Construction PRIOR' Too Reque"st For'<Inspection},
I �(.bwner• o ,, - orh ct g. �Fiem� •Perfcrming, •Conatruc... ...•_�1 hereby certify that ithe'sYde�tsewer installatiomreonstruete&4n lsl�perrrtit .
der dth
nstalled' inuaccordance with all governing ordinances, of the City 'of •Edmonds.:;'
:<�? 1
...
Dated this- day, lof .�,lr� .:: � 9,
.l1 J/ Check:BEFORE; you +dig for,: Wa£er ;�; Gas tp,, ` Telephoner Power Sever, ;' .Other
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
— NEW CONSTRUCTION REPAIRS[:]
EASEMENT No ...........................................
LID -Iql
OVtTNER --- 2r,.P ...... --------------------------------- CONTRACTOR %.4, .. V .......... PERMIT No . ....444�..................
...........
ADDRESS .... ........ i�3 - - ------- 1/9Z ..... 1--L' DESCRIPTION SLOT No..... ........................ BLOCK No. ............................................
NAME OF ADDITION .........53-a-,uz--e . ..... - ------ r41-.,5 ... . ................................
ti
lY "'WAWMOFACCURACY. VinInfo rmtiel
218d"dM*wwCoWjledforuc,3 byt,�DC:�jof E,,,7
ed c0rdubft ThO City of z:"curacy of
anything set foo on the ri;:;).
should conduct tnir,4 —3c,l Cr C.-I"""'Y requesvng a copy
00 M2"),
, , Egon sham C,,,
b,
t;cz.',"on Of P-T'Y Mier stub
0t'.','jstandrWormaynotWstaj
City of Edm=ft nor its employees or
n Gn ft map
ncr for L,,,y c:�
Approved:
DATE.................................. ....... By ......................................................................