17019 65TH PL W.PDFIIIIIIIIIIII5222
17019 65TH PL W
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
EASEMENT No............................ .... .
V CONSTRUCTION REPAIRS p _
OWNER 1.�IT�H, C7r1Gp.V--------- .......:. CONTRACTOR PERMIT PERMIT No.
i (f�'21-�.Ca?x PL,/�.E v`IS" _,_ hEGAIz nFseRIPTION: horn rio.-,.::....�••.•)_BLOCK-No
ADDRESS- ...................... ....... BLOCK No.:::...........:._
Cal_] Rom_ _.
NAMEOF ADDITION ..................:................................ ......... ....-----.........._...._...---•--...---..............---....•.................
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NOTICE: NO WARRANTY OF ACCURACY The informetlo- shnv.m on the
atta^hold map was compiled for use by the Ci?;, of E_' ",
an, c_,las:':ants. The City of Edmonds dc:,:aC- r, ,- y ,;
ar' . ; c_t forth on the map. Any per,%.- c, c- :'-,
sh,-- conduct an independent in re c t , -Y
the i.-:P. including, but not limited to,gth2'I:c_._
S,4 ...' Such sewer stubs mayor may not er:ct aa:J may cr c._
th lo�;stion shown, Neither the City of EdmonC-s cc: f,; c:.:;,, c cr
el 1L.•6 shall be Iiabf -%k0te information given on this map, ner for any orz"
re;,.. ,sentation prevWiulbased upon said map
Approved:
DATE ��..� /-LV By . /0-
APPLICATION
for
The City of Edmond5s FILE SIDE SEWER PERAUT
NEW CONSTRUCTION REPAIRS 0
OWNER ...... ........ 4��-
7 0j. ;4W (/
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ADDRESS .......... .... ........................
0
9
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EASEMENT No ......................................
L ................... CONTRACTOR ---- 6i)a �- Zejz!!-,/ Ck- CA'] ............ PERMIT No.
1.......... ..........................................
. ....... LEGAL DESCRIPTION: LOT No . ....................7 ................ BLOCK No...
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NAMEOF ADDITION L- ............................................................................. t�� ...................................
"AMKMIYOFACCURACY Thnlnfnrm---!jc-,,,_
attach rap was compiled for use by the c,', :tfPcithe
c,,.i:
9�onsetants. The city of Edmonds does
nc,
Y forth on the map,
skl, Jconduci &-I i Any Person or c "'Y .
ndependent 'Iw- i
inquiry re --"
garding h,- ir, -
111cluding but not limited to,
C11
the ocation Cj
SuC0 sewer iuft May or mary ad e)dst and ma's
th: lc��:Itiop Q'ijown Neither Y C-T r-,
. either the City f
o Edmonds rc-: i'-'-
-:iah be liable for the informag
rc, •3eniation Provided based upon on gimn On this map. no,,
map
Approved:
DATE................................................ By - ......... .......................... - ........... ............
Tw-
{CIr ' r t F� EOM
u; ; IDS -
' MATEWSE,WEM. DEPAWTMENT
hl
y �r
EC�.F I of PJE4R',MrIT 1' .4 3
Calll 7+76-w525 for-,slde sewer inspeetlons aF,FORE'ecovering'.any porflotn- of 'the, construction ;
- Inspectlon• will •be provided�.;wlthim'2 -
9. hours• after requst NO.•Sal..,,Sun%, 'or;lhoildey 'inapectlonsa�k• -
ADDRESS LUC9ITIONiYUF;'iCONSTRUGTIUN.. 1 p�q { t� i v�Ce
r .....6� lsil' .I�•�W.�S} ` .. -.,r , .. ..
y�PROPERTY"LEG"AL7DESCRIPTIUN g.... r�
Lot •9 S�u7
,
...... ......
....
.. ....
O.WNER'[1 ,N'D%UR BUI'LDER'..ARD,ITH GREAVES
4 't(G NTRACTORSSkm E4�&ADD RESS C1P�#�VPeI..(nnS�--- Cfi.,.. I?J�� T5t Ave*.�.'� , S�'c�ttI@ n .. ...
rPerinlssion�is)granted`,: �t':f �I11�7G�1" _ lg .. for repair and%or':connoctiont of a.aide, sewer am the= city�aanitary. ,ewer'
asystem�'inlaceordan�:with.City�of',Edmond..... narices..
I iTION, ISi CALLED) TO"THE, FOLLOWING:! - ^
N No• 1 The•iowners of the property may obtain•;, Permit - to• construct sewer .inaidea;propertylllne A;llcenaedt'Side•SewerkContracfor must•,lie'•employed".foi�construct•"
fsid6�isewdr;,lm,strbetlarea. Do,mof,coverrany,� port16n of sewer.�before It :has been• fnapected'.
NOTE) No 2 A�llt,work_ performed�an•.city, rlglit-of-way requires. arn`Invasion••of;•R.Ight-of=Way P,erttilt.'obtalnable,':from,fhe•,City Englneer's;offlce:.
NOTEGNo: ,S7 Otitaimffuliglnformatiom regarding ;Ordinance 14':16`030-and Regulations; governing,,sidenaewers whem,you .get perriiit;
;NOTE No: 4 Top,;,oftside-(sewer must'have af-least 30:1nches;coverage;at property, •line,_andt 12ti:dnoheslnalde4'property, line;' minimum_grade oP;2�J,'., NOF�bendaP,im,grade'
`': - 'sharperdtban+:�,y,WIM,be permitted .. r ., -
;NO ,., '' i IS—Trencties,anrstreet!muat be water settled and',.aurtace of )street ,restored, to{•orlglnalp,condiiion rContractors aha] ''
a ,work whlohS',,may4develop'„Wlthln•oneiyear• of%acompl'eLionl,� " - 1, be reapogslble for .fallure due) itoY1'mproper
NOTDI;Noi 8—It ch(1unlawfuli to (alfec ,or do any, ,other 'workr than is+provided' for In the permit or to,ado ariy, ,work on •the .mainsewer.,or ;ita4appurtenances. ex6epf tm.ln-
iser6ftltei plPellinto, the .wy_er
pISA`PP,ROVEDI 4 s, j 'Date :.:.' By' A'„.:...ft:.... ,Date:..d1
J.. ,: .. D e B
WPM - a,V�::2
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BUTHyy It (Copies4!1VIiIST':Be Signed, Byf;Owner' of Fir=,Performing�lConstruet oii4+P,RIUR` To Request For rinspectiont
, . - hereby certify,'that thessldersewer.Installati'on! constructedlunder lth>'sipermt'
(Own r`o-, Ctontracting,+) irm•,•Perfcrming`Cons action) - `
{ nstalled' in accordancerwithtialligoverning;;Ordinances of'tthel City ,of', .`
tedl •this. ................days �Of
BEFQREI youGdig for:: Water'"•p,. ` Gast Telephone_i01;...'Sewer vz�;