17006 TALBOT RD.PDF11111111111111
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17006 TALBOT RD
APPLICATION
for
The City of Edmonds SIDE SEWER PERMT EASEMENT No ..........................................
NEW CONSTRUCTION REPAIRS
OWNER ............................... E 2 �. CONTRACTOR ... R.I.,.I �� ................................N.��! ��11
w�-�T `1' ........... PERMIT No.`..r.'4.........:.
ADDRESS �% ...... T LEGAL DESCRIPTION: LOT No..Q L>_C ► 1E�. BLOCK No . .............................................
NAMEOF ADDITION.----••--•--•---•------•................................................................................................................
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�C<ITwY'-tO+Fi.: iE MV , + ,''�NI r'• 5', 'SIID,EV �S;EaWER'.: ,P�ER'N11T't
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r l WATER='SEWEit�wDEPAARTMEE T r'
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44 55
t (.Calll'778=11071 for�tslde isewer.tinspectlonsl4ilri EIicovering�levy .poition fof the wnetructlon
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i A!`tInspecfion will) lbetlprovided4wlthln `24'thourst after- •,r nest NOIBat 8u'rit,. or rhoiiday,lnspectl'ons:/
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�ADDRESSILUCATIUN1tOF'+CONSTiiU,CTIUN :P.?t��1 (t:01
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PROPERTYPL'EO`ALr.DESCRIPTION Seez1'�Lat... a i
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ter.
OWNER; ANID%UR, BUILDER':: .
,,r �iTRA°CTOR'S1NIAME & ADDRESS �tiSst...!... ..I:YSi°/t" . P�..i.7U, ................... N. t� 1�1 ICI s I1141f C�5a I dS Sty :
Pemnissionrisygranted.' ���'qf .::;�1 187 pa r
,I for ire it and/or.,connectionl+of, a, side�%sewer toa fthe, city ;sanitary) sewer
:;systemfinpaccordancetw WCity)�of.jEdmondsflordMances:,;.
,, A: rION,-ISi'CAIL-LEDI-TO THEvFOLLOWING .'„
N,0�1-x,�No r 1=The>towners tof-1the,�properfy,.•.may_robtairto per[rilt ;toli6nstruct:sewer ttnside,ipropertyeltne. , �w�•tltcerisedi+SldelSewer.•tCon'tractor,musNdbe,:employe3ttfo,toopstructt�
t sld'evsewer in, street larea Do•. not cover iany,,portiom,of',sewer;,before, It hasNbeen inspected -`,.
•?NC TEt,IJo-.,2=AIll work,:•performed!'d_mfcity:a'Ight of way, �requlresiiamrInvaslont�of.'>Right-of=;Way��PerinititobEalnable. from''the,IClty/Engin' eresi,officc; , `' •-
NOTE]No a 3 > Otitaln'full!IinformactonPregardingiOrdtnancet-1dt18P030t(andi;<Regulatlonsrigoverntngiteider+sewerer;whenG;youi;get -permit.; `
NOTEj,No 14 ''Top),of•;side sewer )must shave ;at least ;30 iinctie's,icoverage; at property, Fl(ne fand412Fitriches (neide, property. line t}minimum] grade oPti2'%:r>+NorbendeUlnL,grade,
sharper ahan ?/e,.wtllltbe. permitted i .: ' ,; r
NOTE No 15 Trenchesan:!street,must:be•watersettled!landl surface,of, sEieet restored] toiorigiriall,condlti6n:, tiContisetocs sha1111b'e1'responsible. for fall`urexdue !tm im ro en
work,;wtiiohiimayidev'elop,:withfn�'onet:year'tof.icomPletlon:.- "'!" • .
,Pp
•NOTE No--J6—;Iticlsnunlawful .�to,!alter or--do.tariy other-.�wock Ahanti.ls provldedi,for' In . LherpeemfE,1•oit{to�doiany awork+ on'+the maim. sewer.aor .lts�:appuctenancest except ito,'dn-,-
:sect •the;-pipe•7nto� the• wye - . ,
DISATTRO� ED I❑k,. Date „.By' Date + 1� Date:...- By
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A�PPRO,V�EDt ��y ;>Date s. �' �y'.. :�r.
R _n rks • "
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BOT .t t , it { op es;,M!UST Be ;S fined' By r,Ownel~.Oi Performing, iConstru - Oni- pRIOR'M Request For tInspeotiorn —
'.:.Firm'.-
I, .: �'E ' ••• " , hereby certifylthat ith6.1sideysewerr.instalia_tion+xcbh,structedl under StAistpe* nh
.1 C ntracting Firm..Performing C,onstructlon),,-. . {
�Jsta1 ed!imiaccbr' ncewithttall+.goverriing,!ordinanoesr,of tthe. C tyf tof;tEdjh6n$sb
i L. '� - 3__ r •fit
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d1 ithis days tof a 19 r
)Date :.
J 1Cheok BEFORE ou di for Water' n ; Gasrt, Tele honeu r t' Power ]Other
JGJ' Y g t i❑ ❑ I P 1p„ ❑, Sewers 3 , ,,❑� Jt J
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
EASEMENT No . ...........................................
NEW CONSTRUCTION 0 REPAIRS 0
OWNER ................. ........ ..................... Jae!�- , .............. CONTRACTOR .jF-4KS.s ......... ---------------------- PERMIT No.
ADDRESS .... ........... DESCRIPTION: LOT N .. .... ................................... BLOCK No . .......................... .................
o..-
NAMEOF ADDITION ......... .......................................................... ...................................................................
1973
�jw
Approved:
DATE............................... ........ By ....... ...... ......
............ ..............
•- „.- APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
BASEMENT No . ....................................:.....
NEW CONSTRUCTION ❑ REPAIRS
/ 1� (N �. � - % CONTRACTOR ..../. .............�. ..- \ %C PERMIT No .......................
OWNER ...... ........................... .......-�.............- .--............... lter•• (.........
ADDRESS .. U�J �••,�<•Z b.T�-...[..- +% 1.J-.-•--/-� ' LEGAL DESCRIPTION: LOT No . ............................................. : BLACK No.............................................
NAMEOF ADDITION.........................................................................................................................................
SEC 07 TWP 27 RNG 04 RT-5A) BEG 1150.5FT W & 294.13FT N OF E COR SEC
TH N 45 43 lOW 483.62FT TO GOVT MEA LN TH N 46 02 45E 100.05 FT
TH S 45 43 10E 480.51 FT TH S 44 16 50W 10OFT TO POB.
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Approved:
DATE.............. :... -............................ By. ............... .......................................................
CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Construction
• Owner:
Name
Mailing Address
City, State, Zip Code
rr _L L • Contractor: �.1;/�
Name
Mailing Address /
City, �� S�tate,y Zip Code
Mmit No.
Issue Date
• Permit Issued To: �`� %� > Z:> r. / i
• Type of Work to be Done: r7�r—�� • �//� 1
• Work in Connection With:
❑ Sub or Plat J Single Family
❑ Comml. / Ind. ❑ Apt. Condo.
• Pavement Cut: ❑ Yes R No
State License Number
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMITY: 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, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this permit
Signature:
be available at the job site for inspection purposes at all times.
/.1 . , ,
Owner or Agent
to
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES *tit
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By: ' . K --
Time AuthorizeVdid after days
Special Conditions:
Ammendments:
Permit Fee:
Security Deposit
Receipt No.:
Fund III Fee:
Street Cut Dimensions
X_
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
FIELD INSPECTION MITES (Fund 111 - TIFTzte cony to Street Dept.
Diagram:
Contractor called for inspection Yes r1o�
Mork Disapproved By: Date: By: Date:
[cork .Approved By: ' Date: - /,1,2 _
Inspector:
Ena. Div. December 1978