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17105 66TH PL W
The City of Edmonds
APPLICATION
for
SEDE SEWER FERMT
EASE ENT No
. ..........................................
NEW CONSTRUCTION REPAIRS
OWNER.............................................................................................................. CONTRACTOR ... JC*4.t'�A'� ................................... PERbUT No . ......................
ADDRESS .... . .. W . ............ LEGAL DESCRIPTION: LOT No . .............. r� ........ .............. BLOCK No . ............................................
"V--- $c:�sH Y c-E.
NAMEOF ADDITION .........................................................................................................................................
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th.� inap, ladv6lig, nt�i Umjtee.
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ds wr 11,13 or
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Approved-
DATE.- lkl-lfj��7 By . ... . ........
'0�
APPLICATION
Sl*3R"v-"E;rl` FILE for
The City of Ednionds SIDE SEVV= PERAM
NEW CONSTRUCTIONtt;---� REPAIRS 0 EASEMENT No . ........
7 -
OWNER 46F
. ........... 4 ........................................................ CONTRACTOR /W .. �S_lr ............ ......... PERMIT NO.
or—c_
ADDRESS .411.10-r ----------- 4�4; ..............
....................................
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LEGAL DESCRIPTION: LOT No . .......... ------------------------------ BLOCK No . .................................
NAME OF ADDITION ...... //I::::
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ig?
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MURCE. . 11 -
iilmwlon show on
'9
1.21121111L41 4h""M—Plidfor' ' '' ' '' 5i��on
use by the City of Edmonds, it�, em
v " s�el-:��
-Intl cOnWbft. The City of Edmonds does not warrzr�-,t the a--- racy of
8nything set foM on the miap. Any person or entity req �"d
uest..'Pg a copy
3k,Uk"COndUct an independent hplLry reWing the Informaton s�, c'
thQ alap, including but not limited to, the loctioq of anj.':c `N4
showti Sucil S'tUbs may or may not Wdst a4 r c
th- dmay
- 10cati0i" Netiar the City of Edmofid,^, W 113 C.-:4"'A
1�zb'j fol
I . the inlormation civen on this map, ncr fcT nv c�,-
' '36,44atic-1 Provided based upoti said map
Approved:
DATE..................... .......................... By ................................. ....................................
z,A
C � I T 0 F`� 1 E D INS,
Irv.
%'10INDS'' it:v-sIEWER) PERA.Vfti-*��_�
L
`9�W_,�R- Di�kR'T_ T�Ti'
WATER.
MIT 44.6-6."'
o 5"
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641-071 ',for side, .,sew4��..insp�*ciions�:,IiE'FOREtteovering'.aily.,iporti6n, of the construction.
i _�, 'x -
a 1-7.7 -
'kk�lnspect Ion" will! be..,providled' within, 24 :hours: after �request. NO. �or�holl day 'I n 8pqcti ons:�)
F1
1,71, '66th
dJ6A-1ftON0OV'(CONSTRU1 ............. ............................... ................................................... ................. ....... .
AMDRESS I C1T_ION1.,._1'
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ION.'
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RAW !.i!�L A RIPT
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............................. 7 ..........
4a s' 6,.-Lewi s
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ON -ILDER ......... ........ ........... .
..................... ...... ...... s... ..... WNER, AWDXOR�BU — . ............................... ......................... .......... .............
4�
R��,S�Poli '16009 -No-'Meddowd'ale Rd.z*-rdmo6d�.--.Wa�sh.-,.'�:98020---
tac-T-OR"Sym
AWWAADDRESS ......... .............. ........
......................... !� .................... W .. . ............ ............. ...... ............................
on r,�, to), 't bei;,Ckyl:
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t A
T6r.niisgioiWAS11P 1 .1 " e .. �,;
........................... ..... :.,jor. repa!r, and/or connectl k.�of. a., side', �Sb�ve (saiiitary %gwer_,
0 n S,
d* -,ordinances..
TJO�,',,IS� ChLL�;"',,Wj THE,.1F',0�hW1W,i-A
r� Inc. iicensed-'Side. Sewer�- Contractor! mus
ay: Permit,obtalhable,4rlorn :the City. -Enj1neer,'s'1joqiq
s wtr . � : - I
e�;cr inside',trope � I t,"6e;er�plc�yedf�to�dohstruct
aylo taln�a-,perrnit toV uc
6 n1street -area., --Po-.npt�co�,er, any-,pbrtlow,,� .e e "before jt
ildepie�vd r iha*s�beeW,Inspectedl.
,'5N6.',Q=A%IIVwork, pe '�,��dljn6�lty,+ight_ 0
1. - � I - �$W- " n, VRJ�h�-o`f-Nk
NjDT-F 'of�w*ay requlres-!afi�
�630 m . nd, Re . gula'f-ions, gov6rning,skde,isewersi,,.whenk'. ow,get -permit..'
'3�—,6bta�ir�'iu.if4LI,�f�rT�ti�n�- egarding,fordinance14,11.16
In; gr�de,
d�e�spwev'-rnust� ��tavLAae'�1east-:30�,inc�ei�' coverage' at',property, Jlne� a�dt, 12�4nches, lnsid�j property,,,, line;r minim
h�� .��ppernjlttedl.
tof-ti 'ac�e,oi%stre�t',lrcsio
J
rnlsiieet =tn�Xltber, wa:tcr4settIed1,and1,surL red to., origins.11 c?�dltion,_30ontractors shall' �be responsible for�'failure,,"due.,toi.linproper�
NOTE! -No, ',&�'Trenches:,,
pj wit
�Nyork,,whl�thi,�rnay I , - . ;� . , . - , . . t
&d hini�oiii�',year�,of-,;�ompletio,n,.,-
'imaAri-,sewer,
t-
W"N -.��,er7fo-r",'do�;any,'�,6'tli&r-,w�6rk�,�thalil-iij',provided' forl;i&,�th6 p&ndf,, or,to,db�jafiy�,wo k ur epancm(exc pt:.�toL;in
on Ahe P
intothiwyc::
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1B T Go ij i e'sr 1
er� -perryfit
'hef6by-,certgk,�t�-�dt,ithe,,siii�i ewwer,46tallatiom6o d tliisl
....... ......................
S
Id,
(Owner,,o n c I g,, irm- Perf6rming; Construc n
(Owner,,o
'th�,alL,gg.vbrning-ordinancesiof,the�,City -ofEdm6nds"
si�'dr 4Min)46
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''Ditedt .......................... ...
v his ... ..... :,Of:.
d Ph6ne
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