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17151 SEA LAWN
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TAX ACCOUNT/PARCEL NUM13ER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: Conditional Waiver E] Study Required Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:.
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER)
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE
SHORT PLAT FILE: LOT:.
SIDE SEWER AS BUILT DA:
SIDE SEWER PERMIT(S) #:
SOILS REPORT DA
STREET USE / ENCROACHMENT PERMIT #:
FOR--.
WATER METER TAP CARD DA
OTHER:
LID #:
BLOCK -
L-\TEMP\DSTs\Fonns\Sbw File Checklistdoc
The City of $*wonds
APPLICATION
for
SWE SEVW= PERMT
NEW CONSTRUCTION E] REPAIRS
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EASEMENT No.
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CONTRACTOR-------------------------------------------------------------------------------------------------- PERMIT No . ......................
LEGAL DESCRIPTION: LOT No . ........... 8 ................................. BLOCK No . ............................................
NAME OF ADDITION .... oty isiom- 5 -,5,400 n,-..Tg r ............................................................
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APProved: C4
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for
SIDE SEWER PERMT
monds
EASEMENT No . ............................
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NEW CONSTRUCTION 0 REPAIRS
.............................. .......... PERMIT N
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. ...... . LEGAL DESCRIPTION: LOT No
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............ ...... .......... . ....... .................................... BL.,OCK No. _V1 ... .......
NAME OF ADDITION .............................. ..............
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CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT 6220
Call 7,76-1107 for side sewer Inspections BEFORE covering any portion of the construction.)
Inspection will be provided within 24 hours after request. NO Sat., Sun., or holiday Inspections.
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ADDRESSLOCATION OF CONSTRUCTION ......... ...... ................. ......... ......... ................................................ . .......................................................
Un-
PROPERTYLEGAL DESCRIPTION ........................................................................................................................................................................................
.......................................................................................................................................................................................................... ..................................................
......................... 0'*' IVNER ANDJOR BUII�DER ......... �-1� .......................................................................................................................
........................... ................
........ ---------- S.-
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CONTRACTOR'S NAME ADDRES .................................................. . ....................................... ------------------------- --
Permission is granted .................... ......... 119 ......... for repair and/or connection of a side sewer to the city sanitary sewer
----------------
tem in accordance with City of Edmonds ordinances.
]��ENTION IS CALLED'TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer In street area. Do not cover any portion of sewer before it has been inspected.
----')T-E No. 2—Aii work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtain -able from the City Engineer's office.
�)TE No. 3—Obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit. <
"NOTE No. 4—Top of side sewer must have at least 30 inches coverage at property line and 12 Inches inside property line; minimurn grade of 2%. No bends in grade
sharper than % will be permitted.
NOTE No. 5—Trenches in street must be water settled and surface of street restured to original condition. Contractors shall be responsible for failure due to Improper
work which may develop within one year of completion.
NOTE No. 6—It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVEDf-1 Date ... . ................................... By ................ Date ......................... By .............. Date ............... .................... By ................
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APPI ? — -----------------
t tOVED Date.. By ....... e. I
............................................................................
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Remarks: ...................................................................................................................
..................................................................... .............................................. ...................................................... ............................................................................. .
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
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.... .... hereby certify that the side sewer installation constructed under this permit
Firm P crming Construction)
(S�.e,of �C.iitr"�" /.�ing'
was installed in accordance with all g erning ordinances of the City of Edmonds.
Dated this ... --------------- day If----
------------------ -------------
Check BEFORE -you dig for: Water Gas Telephone Power SeiVer Other E]
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117 C. I
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City, of E,
RIGHT-OF-WAY CONSTRUCTION --
PERMIT, Permit Number.
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Issue Date:
A. Address or Vicinity of Construction: 104'zt�
B. Type of Work (be specific):
C. Contractor:
Mailing Address:
State License #:
D. Building Permit # (if applicable):
Contact:'
Phone:
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. 11 Cominie ' ial E] Subdivision El City Project Utility (PUD, GTE, WNG, CABLE, WATER).
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El Multi -Family EJ Single Family F] Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut 0 Yes E]No G. Size of Cut: x H. aaigE
APPLICANT TO READ AND SIGN
INDEMNITY- Applicanlund�rstands and by his signature to this application to hold the City o
f Edmonds harmlessftom injuries, damages, or claims ofany
kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its�departme'nts or
employees, including or not limited to the defense of any legal proceedings including defense costs and allorneyfees by reason of granting this permlit.
THE CONTRA C TOR IS RESPONSIBLE FOR WORKAJA NSIIIP A ND AIA TERIA LS FOR A PERIOD OF ONE YEA R FOL LO WING THE FINA L INSPEC-
TION AND A CCEPTA NCE OF THE WORK ESTIMA TED RESTORA TION FEES WILL BE HELD UNTIL THE FINA L STREET PA TCH IS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Two sets of construction drawings of proposed work required, with permit, application.
A 24 hour notice is required for inspection. Please call the Engineering Division, 771-0220.
Work and material is to'be inspected during progress and atcompletion.
Restoration is to be ' in accordance with City Codes.,
Street shall be kept clean a ' t all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the ahove statements and understand the permit requirements and the pink copy 9f the permit will he
availahle on site at all timesfor inspection purposes.
Signature: Date:
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: ova a
RIGHT OF WAY FEE:
TIME AUTHORIZED: VOID7AFTER d;Z Z;;5; /C DAYS
DISRUPTION FEEIFUND I I L.
SPECIAL CONDITIONS:
RESTORATION FEE:
JOTALFEE: ... .... .. .... . .
NO WORK SHALL BEGIN PRIOR TO -PERMIT ISSUANCE
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