17336 72ND AVE W.PDF111111111111
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17336 72ND AVE W
y'.0f. Ednidnds
RIGHT -OF WAY CONSTRUCTION
PERMIT
Permit Numb 3 2,19
er: q2
TREETPon
I-ILE Issue Date: 42
A . Address or Vicini I ty of Construction: _j 70 6 72AJ(21 6VE LAJ
16. A C
B. Type of Work (be -specific): I W3'rA (.L CA-rV D,9ri P.- .44
9 0 - I
9( 5 I)L.JN, Vj 516iff k'" AV a W, -ra L-,j
2, rZ
C. Contractor: CHAMOorlEj C_A,15w1e0qe C-A Contact: �IACte_ (SA,4 6
MailingAddress: .533 MA,14 -57- Phone: 7 74t -'S7q6
State License #: _'</,0iF/z ce-, tol QA Liability Insurance: Bon& $
D. Building Permit # (if applicable):
t. 'F1 Commercial F� Subdivision
F-1 Multi -Family- E] SingleFamily
INSPECTOR:
'Side Sewer Permit # (if applicable):
0 City Prbject EK Utility (PUDj GTE, WNG,
n Other
INSPECTOR:
� r LE WATER)
L
F. Pavement or Concrete Cut CKYes . []No . G. Size,of Cut: x 4- 1 H. Charge $
0 �j (-,r I F L-0 r A-ric _s 0 CTA-rff OV95AZ y-r/ Cq-r, j5 _S. —7
APPLICANT TO READ AND ON
INDEMN&Y. Applicant understands and by his signature to this application, agrees to hold ihi'City, ofEdmonds harmlessftom injune damages, or.
claims ofany kind or description whatsoever, jb�eseen..or unforeen, that may be made against ihe,City,ofEdmonds, or any ofits departments or employ-
ees, including or not limited to the defense ofany legal proceedings including defense costs, -and att6meyfees by reason ofgranting this permit..
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PER[(5V'bF1OAE YEAR FOLLowt -THEFiNliNsPEC776N
AAD ACCEPTANCE OF THE WORK. ES77MA7ED RESTORA 77ON FEES WILL BE HELD UN77L THE FINAL S7REET PATCH IS COMPLETED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO 7HE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Dpartni
Work is to be inspected during progress and at completion..
771-0210
Ikestoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by th�e/Q, jy
&eer.
All street cut ditcfies.shall be 'atched with asphalt or City approved:' material prior to the end ohi� working day;
P
NO EXCEPTIONS.
I have read the above statements and utCderstand thipermit req I ui . rements and the pink copy of the permit will be available
V
on site at all tiinesfor inspection
purpos s—
Date:
Signature:' \N 1"\Z::-01�
Ccon)r�ctor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
NO WORK
NJ
Engrg. Div. 199.1
FIELD INSPECTION NOTES (Fund I I I - koute copy to Street Qib
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. Jul
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02/04/1993 10:01 7752299 CHAMBERS CABIE PAGE 07
8 .0 0 . 1 9 9 -
City,of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT PumilNumber;
uUms Daim
A. Address or Vicinity of Censtrmfion: 17,;t"N.- 7Zkji:) V e- L-j
B, Type of Work (bo ap=ific); -5rAL.1— r—Alry Doift. ef-- 16 f A C-4* S
9,S D wN W SIDE PZ.IJQ AUIE W, -71&�',j
zz I peo
'C' contractor; 4 14A.A4 C A /Igife -:1 Q1 C contoct: J A Qk 64A 0
Mailing Address: 5 3,14 MAt 4 5r Phone: -f 7 4- - S-7 a 6
State License #: CC, 'QU2A Liability Insunu=
�D. Building FerrniE # (if applicable): Side " Sewer Pormit # (ii(applicahle).
Commercial [I Subdivision City Project [K Utility (j)UD, GTE, wNr,, 5,t� WATFI)
M.lti-Faredily [] SingleFarnily C3 Other
INSPF-CTQF-:
INSPECTOR: — I
F. Pavement or Con . crete Cut Yes []No 0, Size of Cut: 4,1141 H,� Charge $
x
�h'v
APPLICANT TO RE JVL-0
AD A� � -( I
daiw qf any hM orde�crfpl(On 4440tveP.fiftsem Or unforrLn,' that may b4e P#4de agalmr the 01y ojEdmonk, or any ojiu deparmenu or employ-
ra, McW�g or noz fim(ted io rhe deftrue qf any kgat prurceaUngs inctudinS deferwe "a, and agomeyfftv �y remon of grandng Jus pen"k.
7-rL- C0NMCT0RjSWP0jVS181,EF0R WORWANSIMPAND HATENALJFQX-4'QI61yb?VAZ Y&JtF0UOWTNG 71(CFTM jrN5PZC`n0JV
AND ACCEpTjNCE oF TrIE WORK E377Am TED RESTORA ITON FEES WIU OF H&LD V.Y7M ME MAL STREET PA FCH IS COMPL87ED
CrTY FORCES, A7 WHICH 77ME A nExroR cxEorT wzURE PROCEUM FOR ISSUANCE TO THE APPLICA1.7
Construction drawing of proposed work required with permit application.
A 24 hour notice is requdrcd for iropmtion; Please call the Engirm!cring Dcpartm
VP Wf-:!" W1.
Work is to be irispected during progress and at completion.
Re-itoration is to be in accardartm %ith City Codes.
Street shall be kept dean at all times.
Traffle Control and PAlic Safety shall be in accordance with City rqpdations as required by the Ciq Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have rcad the above statemeM* and understand the permit requiremsents and the pink copy of the permit will be available
on site at all jitnafor ittspecrion purposq.
Sipature- Dstm
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGMING WORK
FOR CrrY
APMOVED BY' .0&�d
TWE AUTHORIZED. VOID AFrER /422 DAYS
SMIAL CONorrioNs:
COMMENTS.
NO WORK SHALL BEGW P
EAM, Div. 1991
APPLICATION
0
The City of Edmonds tor EASEMENT NO . ............................................
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS D LID NO. ... 4 ........ ASMX. NO.
OWNER ........ V-1 L�l P21 L- Iss C�t--4 7T- t"I E�!>F
---------------------------------------------------------------------------------------- CONTRACTOR ------- . ........................................ �9�ERMIT NO.
(,=:. - -7Z-- - \".
JOB ADDRESS --- (7 ----------- ----------------------------------------------- ------------------ LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
.................................... ....................................................................................................... ---------------------
7-Sl
NAME OF ADDITION .... ------- . ...............................
-- - - ---------
.1
DATE ...... 4��,
........... By . ..... 4
APPLICATION
for
The City of Edmonds SEDE SEWER PERMIT EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS 0
R.4 .................................................................... CONTRACTOR ... f:71? E..q ...... fPERMIT No.
OWNER .. ........ 5'-VICIV 5 5' OAY
ADDRESS ............................... LEGAL DESCRIPTION: LOT No . .......... ............................... BIA)CK No.
NAME OF ADDITION .... X(..l ........ ........
..................... .........................
)XZ
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RECEIVED
JUN 14 1974
Approved:
DATE................................................ By .......................................
�-7 T-
4,
144
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j.N' QTFY IN
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Tj, f,-VO'E(AEDMQ � V E R M, I M
'�',,-�-�W.iATE;WSEW,ER"li.�DEPARTM-ENT
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it, v�rin�;:;a� c�constru tf
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Insp. e`c' -J�iiiovldedl.%�ithlni 2,I_hours':afterjre,4
it,14 tion,�wllll4be o ay. ns
., 1_i.l , I " — * P-,s-. , q ji jj�.. Rectlons:� . .... .
VA -A-I
At, �`7?:*n -8.Winue--l-west.
CATIOW.OF ..................... 1.,
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tibb' 47522
.. ........ ............. __!� . .... .................................... ..........................................
.................................
iri�p�g n: iW.: �;;-Mr- repair: andY lio'�:414'�.Si&. �eW�r.-,46, 'the,'C'4j,imnitdr. y,sewee,
............................ or connpq_
t 1� rij,a. or anee,%vi ds,;,6r( inances. v
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,J.TION�:IS,CAtL�,'DT�T*O�THEeFOLl,'OWING: ::,�f
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c,propert"
ruct-L" �'l h S'I il
:,N 4, '.The,.owner8�iof-the-,pr�p�ily�!Tay,�opta q*,a:-perm.It-,to.,,c.on.4t Sewer y��Ilnc.",A'i,`C�6i� r
-Do, not cover any- portion':of: hkwl6i.� bef6re' It. Aia�s,'been,'Iniipected. .
z6il:�ight-.of-�ViLy,�pd�-mit�'�6t�i'n'ab,le)fromkithe',Clty..-i�'itn'c�r:�',ofilee:" - T,
,�,NOTt_
�J&, 3—.Obtain-�fullilin,f,ori,nE�t ew.eit;
�,Ny .�w yopI;get,,perj K;—,
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ave.'at least:46',in,��-ei. c;;�'craje.ao!
property,-_ Ilne,and 1. Inc es,ins c P,2 No, bends!
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.rtenan xcqpt;��w
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................... ............ ................... ......................................
orm 'Request
gii�d-;-By,lx wn,er `i:F ri`s p.'q'�A
SOTEF P eryn i t' OC61j.4ep. -AlU SY eW l9lie 0 or"j,
X" " /.W,
-erei6y4�,46�rtif,�.,,
-.iliatiheVsi�d sew.*&i-installatiblii6ops,
g Perfcrmln* IC6�str*uctt6�-)i�':,;,;-"-""*-.',�'..',
'ni' di
v -w gpver Jor iniiftceskof-thb� I.:.6f-Edmonds.
nstalleaQVdccordbErfd6..' i ng L,
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44
teffitfilst .......
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Yoih,digAorn'f� ater.lEg
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REGARDING: 17336 - 72nd Avenue West &0 3 - 0 6 1/7,5-
(address)
R E C 0 R D 0 F C 0 N T A C T S
DATE NAME,, PHONE NO, & CO"V1ENTS
ADDRESS of CALLER
5/1/74 Karl Svensson Certified Letter No. 406202 sent
requiring hook-up within 60 days.
6/10/74 Frank Lichtenberger came into office
and obtained permit #4848.
6/11/74 Connection completed.
M
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czl=�
LL.
FA
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ACTION TAKEN
Letter received.
INITIALS
TE
TE
TE
RECEIPT FOR CERTIFIED MAIL-30� (pW�oAst�ge
303-06475
--7�R . GST-MARK
R DA�
C\J:
SVENSSON? KARL A.
CD�
C\�,
17336 72ND AVE W
EDMONDS? WASHINGTON
CID,
98020
—OPTIONAL SERVICES FOR ADDITIONAL, FEES �emz
RETURN N 1- ShOWS to whom and date delivered
With delivery to,3ddressee only ............
150
654-
RECEIPT 2. Shows date'and where delivered
P,
350
SERVICES Wittoh dehloivery to addressee only
850
DELIVER TO ADDRESSEE ONLY
SPECIAL DELIVERY (extra f ce required)
50d
PS Form NO INSURANCE COVERAGE PROVIDED— (See other sid
3800
Apr. 1971 NOT FOR INTERNATIUNAL MAIL
GPO: 10700-397.4a6
CITY OF EDMONDS
DEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, Edmonds, Washington
APPLICATION FOR A SEWAGE DISPOSAL SYSTEM PERMIT
(Submit 3 Copies)
Permit to be issued to: ... Floy-D --------- ANDE.-k- '520W . . .............
For installation at: (street address) ......
.............. ... I ------- I ........ .............. ..................................................
Addition or S I ubdivision...'��04.A .. a ...... ViE0 ------- 84.1.6 #�n ............................... Lot----,3 ....... .. Block ................
Type of Building: New. .... X�.... Existing ............ Single family residence ---- Y47��.. Number of bedrooms ........ ..............
Other: (specify type or use) ..................................... ........................... __ ............... ...............................................................
Builder .... F16y.0 ----- ..........................
Address ... /77-Pf .. ..... ....................
Fc1M d:5, /,UA 5/—/
an ....... .....
Designer.... ...............................................................
--_------------ Address .... ----------
............................ ...........
I ........ .....................
Soil Log Hole No. 1 ------ 0 ------ ............
Tq
.... 7 . a..,3 ... .......
A. ......
...
A 4r 04.
............... .......... .... ............... ............. .........................
C.
Soil Log Hole No. 2 ... ........ ...........
37&e .... 150;.4 ........ .........
F ..
.. .... L..O ...............
'33 r
..................... C --- 4 .. ..............
..... ........ 5A
!!�� ....... _4� ........ !1��A
...... ........... 7/if - c1A
................ .......... .............
Elevation of Water Table, if encountered. (Distance from ground surface) .................. ...................................................
Corrections to control surface water if needed .............................. ..........................................................................................
Specify if any removing or grading of topsoil in field area.. .................................. ..................................... I ..........................
...........................................................................................................................................................................
7 ..............................
Percolation:
I
Test Hole No. I
—Average
Rate ..... ............ ... ... .. .
. (Fall in inintites/inch-bottom 6" test hole)
Test Hole No. 2—Average
Rate .... zj.::�'F. fy.! � .....
(Fall in iiiinutes/inch-bottom 6" test hole)
Test Hole No. 3
—Average
Rate ...
(Fall in minutes/inch-bottom 6" test hole)
Average percolation rate
on which to base drain field design # .....
6 ....... Date Taken.!�'? .......
Septic tank requirements
based on present rules and regulations:
Septic Tank Size ......
7049 ..........
gallons.
Amount of Square Feet of Disposal Field .... nm� .... ..... .
Signature — Designer...Y4 �__ . ..... A-- reii ----------------- Date -2-IS-67 . .......
DO NOT WRITE BELOW07HIS LINE (To be completed by ISSUing Agency)
Permit issued (date) ........ .1-i�-4�7_e:-.Perrrkit Number ------ ............... ........
Remarks: .... .....
.................................................. .......... . .....................................................................................
Sly
ZT RIE
Septic Tank.... SEWAGE DISPOSAL P
...... gals. ERMIT
Disp. Field ... CITY OF EDMO
...... Department Of Public Works
sq. NDS MO.
.. .......... ......
Other ----
Name ........
.............. -------- ----------- is hereby authorized to install/
----------
repair sewage disposal system at
.. ... .. .... ...
D a te iss ue d on
DO NOT COVER BEFORE 13Y DESIGNER Opermit expires one Year from ----- .................. .....
APPROVED da Of ls§'ue
R SANITARIAN
I hereby certify this S' stern was installed under MY super
y
Of Edmonds Resolutions.
vision and control and complies with all provisions of the City
of Install
Approved ...... �'.'
/F Disapproved EJ Date- ................... ... Date ..................................
------------ ----------------------- By ------------------
Remark "Otv4pv�
-----------
...................
SANITARIAN 0 -----------
11-11"W@AffiR . ....... -------------
-------------------- - --------------
This permit shall be Posted in a reasona ----- - - ---- ------- - ------------ .............................. ......... Date ...
bly conmspicu
us place on the job until inspection has been completed.