17417 71ST AVE W.PDF11111111111111
14946
7417 71 ST AVE W
�'o . W RECEIVED MW
CITY OF EDMONDS Permit No. '�F)
PUBLIC WORKS DEPARTMENT MAY 2 0 1981 ellr /L,� Ae
RIGHT - OF - WAY CONSTRUCTION PERMIT o i AE�T
Dir. Ot Pun
A. *Add ress-or-vicinity-of-Construction---� 9 Permit Issued To:
• Owner: C r DQ IDA A) (97 Type of Work to be Done: Rocv�,�-�,v
Name
Work in Connection With:
Mailing Address 0 Sub or Plat Family
fr- -tv"i 1) iv 0 V Vj 41, 17K 0-2 0 ) I
Cit - - State, Zip Code El Comml. / Ind. 0 Apt. Condo.
Y, Pavement Cut: El Yes No
• Contractor:- 5(-.o7 —i A I a p 56 rC
Name e 7,C. /I S, C"Ir 0 rc Z- �r S'CA Prlvc,
Mailing Address State License Number
6,11-616 AJ 9S tuhl' �fO. 2, 0 7,
Z
<1. City, §tate, Zip Code Telephone Number
U
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
co
C) INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
t�'4 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.
0
U Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
.W4
following the final inspection and acceptance of the restoration by the Engineering Division.
0
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.
Z
0
LU
C/)
:D
U
C4
C
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 must -be available atothe�job,�site for inspection purposes at all times.
Signature:
OW'ner or/Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALLDIAL - DIG PRIOR TO BEGINNING WORK
C. issued By: Permit Fee:
Time Authorized: Vc;ld after days
Special Conditions:
Ammendments:
Security Deposit:
Receipt No.:
Fund 111 Fee:
Street Cut Dimensions
X
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. December 1978
1w w %k
FIELD INSPECTION NOTES (Fund 111 Route cony to Street Dept.)
Comments:
Diagram:
Contractor called for inspect Yes 4'�10
Work DisaT3proved By: Date:--3
2 /-� �, , By-:�����Date:
Work Aporoved By: /Date:
Inspector:
Enci. Div. December 1978
<17A
N 0 71 C E
TO PERMITTEE AND/Ola OWNER
RT AL APPROVAL
VIOLATION
CORRECTIONS REQUIRED
VI(
p
PERMIT
NUMBER
JOB ADDRESS
17�//7- 7/ W
VPE
0 PE X
0 PERMIT — STOP WORK — REMOVE CONSTRUCTION OR OBTAIN
P MIT A
ERMIT AND MAKE WORK COMPLY WITH BUILDING LAWS.
CONSTRUCTION IS NOT IN ACCORDANCE WITH APPROVED PLANS
D AND PERMIT — STOP WORK. MAKE EXISTING WORK COMPLY WITH
APPROVED PLANS AND PERMIT OR REMOVE IT.
STOP WORK — UNTIL AUTHORIZED TO CONTINUE BY INSPECTOR.
CORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN
BE APPROVED.
WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED.
ECONTACT INSPECTOR AND RECALT FOR INSPECTION.
ARRANGE FOR APPOINTMENT.
ll,�4<1 )//, �
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED
WITHIN ..... 2 . .......... DAYS OR PENALTIES IMPOSED BY LAW MAY BE
APPLIED. FOR INSPECTIONS CALL: 775-2525.
0 BUILDING DIV.
-IV-SPECTOR R.PUBLIC WORKS
CITY' OF
DAlfE FIRE DEPT.
EDMONDS A
STREET FILE
Critical Areas Checklist'
Site Information
Project Name: COO Per Permit Number
SiteLocation: 1,1q0q-'71 jqLy
Property Tax Account Number
Approximate Site Size (acres or square feet): E'V56
Have you filled out a Critical Areas Checklist for a project on this, site befo re?
General Site Conditions
1. Has the site been cleared or logged? e-S Date of most recent action:
Soils / Topography
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)? Alduwmd- 0AW-7 IW,,d
3. Describe the general site topography. Check all d'W apply. covftriex) ?- -f�oe rei-1-ei7t -r-/vPcr
-// --flat less than 5 feet elevation change over entire site. .
—Rolling.- slopes on site generally less than 15% (a vertical rise of 10 feet over a
horizontal distance of 66 feet.)
My. slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10 feet of hor izontal distance.)
Steep: grades of greater than 30% present on site.
Comments
Hydrology/Vegetation
4. Site contains areas of year-round standing water No
5. Site contains areas of seasonal standing water /\J 0 ---,Approx. Depth:
6. Site is in the floodway N-1c, floodplain &k-- of a water course.
7. Site contains a creek or an area where water flows across the grounds surface? flows
are year-round? Flows are seasonal?
8. Site is primarily: forested meadow ;shrubs _;mixed 1/
9. Obvious wetland is present on site: t\! o
10. Wetland inventory or map indicates wetland present on site: NC)
11. Critical Areas inventory or map indicates any Critical Area on site: Ak)
For City Use Only
Rev 3127/92
0 4
9 0 19
City of Edmonds
Critical Areas Checklist
The Cfifical Azeas ChedWist contained on
this form is to be filled out by any person
preparing a Development Permit
Application for the City of Edmonds prior
to his/her submittal of a development permit
to the City.
The purpose of the Checklist is to enable
City staff to determine whether any potential
Critical Areas are or may be present on the
subject property The information needed to
complete the Checklist should be easily
available from observations of the site or
data available at City Hall (Critical Areas
inventories, maps, or soil surveys).
An applicant, or his/her representative, must
fill out the checklist, sign and date it, and
submit it to the City. The City will review
the checklis% make a precursory site visit,
and make a on of the subsequent
steps necessary to complete a development
permit application.
With a signed copy of this form, the
applicant should also submit a vicinity map
of the parcel with enough detail that City
staff can find and identify the subject
parcel(s). in addition, the applicant is
encouraged to include any other pertinent
information or studies in conjunction with
this Checklist to assist staff in completing
their preliminary assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate.column below).
Owner / Applicant:
<- I
Name
Title
17 q-cq - q I
Street Address
F(AMO-il(l, 9 K, qJ-1i -)s .
City, State,'ZIP . Phone
Signatuk Date
Applicant Representative:
Name
Title
Street Address
City, State, ZIP Phone
Signature Date
303— OPOS'O
-Q7REET FILE
c7— -R 6 —77
(0 1 Z9171
%'OMS P:TIT. WT-Cl, LIST
1j"PILMNG, PI-11"UT PTA'117s'
Street RxistinF RIT) 0 f*J go
% Access I-asmmits Existing ON) 15 RIY)1)
1-4
Utility Emscinciit Faistin�a TZFOD
Lot Per Suhdiv;sion plat Afscssor i
Site Plm C:cd�cd for Accuracv
Pn(lcmorouncl ',.i rjr,�,, !cod.
bvt
by
Existill'- 1"'atur �Iajll Si-C.
-1cd 11A
,c- I pie-
HY-dra!!t
P-tuctor (1ccl:
ib,l ri)
f!I-Tcrc!
Septic Tan!:
szninn, Avdlaidlity
I �V-ct
cdze
F
n,I i t
File '7o.--
sid", scv:cr Availabilit-
S(-,-cr Fcc Pcollirod
In- I)Zl � C,
0!--C!1l Ditch Ven l'in"(1
clilvort Renuired S -J. 7 c
Catch P
Indicate oil ,�il:c 111�nl
n in �;w(dc
Soil Conditions [-I Ground i.:ater Fic](1 C,110.61.cd
Ilzu'.,fole req Ili oil Sito "Im"
Revic.", I;\. It -Ito
-7,
-10 ------ — ( )
,BUILDING DEPARTMENT
Applicant Fill
USE
ZON
E6��
PERVIT
NUMBER
4
PERMIT APPLICATION
Inside Heavy Lines
JOB
ADDRESS / 7 7 J
N AME (OR. NAME OF BUSINESS)
LEGAL LJOT
BYES 0 NO
LOT AREA
SUBDIVISION NO.
W
MAILING ADDRESS
z
7,7 /V
13
STREET R/W
EXISTING STREET R/W o FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W FT. 0 FT.
0 k"di
ELEPHONE NUMBER
?2
12 -),/ f
NAME
REMARKS
z
W
U
W
ADDRESS
CHECKED By
W
U
M
<
0
z
W
CITY
ELEPHONE NUMBER
STREET AND/OR UTILITY WORK
REQ'D. 0 YES &NO
R/W PERMIT REQUIRED
1:3 YES 451`140
NAME
UNDERGROUND
WIRING REQ'D. 21YES ONO
0
U
Z
0
ADDRESS
TYPE CONNECTION 111YEs IVERIFIED,,BY
SANITARY SEWER
NO
CITY
TELEPHONE NUMBER
SEPTIC SYSTEM OYES
APPV'D BY CITY ENG.
PERMIT NUMBER
U
STAT LICENSE NUMBER
CITY LICENSE NUW_BER
REMARKS
,6',q-1VV-016
Legal Description of Property (Show Below or Attach Four Copies)
METER SIZE
BUILDING SUPPLY SIZE
m
W
REMARKS
z
2
L t
SIGN AREA
ENV. REVIEW
ADS NO.
U
W
ALLOWED PROPOSED
COMPLETE EXEMPT
.J
'REMARKS
VARIANCE OR CU
PLANNING REVIEW BY
DATE
'YARDS _1FRONT SIDE / /REARI
C� S7 .5,
LOT COVERAGE
—1 N GAS
rEW R:SIDENTIAL LINE
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
N N-RESIDENTIAL SIGN
0 ADD 11 11
E] DEMOLISH RETAINING
1:1 WALL
r-1 ALTER EXCAVATE FENCE
OR FILL I— X—"
F� REPAIR PRE -MOVE WIM
INSP. SO 0 L
I I
-
SPECIAL INSPECTOR
REQUIRED
C3 YES 0 No
JOCCUPANCY
OCCUPANT
LOAD
I
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
REMARKS
—
z
NUMBER OF STORIES 7UMBER
"I
N OF
D D WELLING
U NITS
NATURE OF WORK TO BE DONE
A 5
CL
W
PLAN CHECK
NO.
VALUATION
FEE
z
2
z
W
PROPOSED USE
IL
m
U
(A
W
PLOT PLAN NDI BUILDING SETBACKS,
ABUTTING STREETS)
L
7
BUILDING
I
IL
0
J
W
>
PLUMBING
HEAT 8, GAS LINE
0
W
FENCE
Z
SIGN
RETAINING WALL
0
u
SWIMMING POOL
Cit�'of Edmonds
RIGHT-OF-WAY CONSTRUCTION'.
PERMIT
Permit Number.
"I I Lss�e Date:
OCT 3119%
eN13ft*ftfb%Gnity.of Construction: 17417 71 st Av W
GTE to place, operate, and maintain a buri-eU —seVVi6e
B. Type of Work (be slecific): wi re f rom exi sti ng pol e #230 1 ocated at 17414 71 st
9 0- 1 oc) AV W then.north to a residence at 17417 7lat AV W. GTE to plow 130 feet, and
push one rodd 21�feet. R 0 W 195 feel -
Mary A. Bowe r, Permit Coordi-nator Contact:
C. �bntractor: GTE.Northwest1ncorporated Dennis Alexander 771-9036 mobile 388�1358
2312-C W. Casino Rd
Mailing Address: g,,Orott, Wa 9220'1-111110 Phone: Mary'2064488-1628 or. 730-4130
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. Commercial El. Subdivision El City Project Q Utility (PUI)k�`TE WNG, CABLE, WATER)
Multi -Family EJ Single Family E] Other 2850-9POO1 DB 242310
INSPECTOR: INSPECTOR: &AJ
F. Pavement or Concrete Cut 0 Yes [flNo G. Size of Cut: H. ( h $
Please see attached ske.tch.
APPLICANT TO READ ANAN
INDEHAFITY. Applicant understands and by his signature to this application, agrees to hold the City'ofEdynondg harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or uo�reseen, that may be made.pgainst the City of Edmonds,�orldny of sdepartmentsor
employees, including or not limited to the defense of any legalproceedings including d4ofen.1 costk, and attorney fees b� r'ea'so-n ;jgr'aniing this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
Construction drawing 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 at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Tz-affic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EkCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at all7jr� �ctiourposes.
Signature: John EL—Stevart Date: October 22, 1996
(Contractor or Agent) Sec. Mgr. -Access Design
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS:
P-0 A S-9C-r' 0 AJ
COMMENTS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND III-.
RESTORATION FEE:
RECEIPT FEE:
N
DATEPi ISSUED., BY:� t��
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
I Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES - E] NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
cb
0
z
Lo
0)-.
rq
PERMIT SUBMITTED BY
GTE
I
PEDS
POLES 0
ROAD BORES
OVERHEAD LINES-
-I.D. UTILITY POTHOLE =3
UG TRENCHING ---MT-
&X R. 0. W.
r
- - - - - - - - - - - - - - -
-----------------------------
-f ------- EOP
ZI
-----------
----------------
I CUTS. �
r)
al
d
z
PERMIT SUBMITTED BY
GTE
Lx�
PE—DS ca
POLES 0
ROAO BORES
OVERHEAO LINES
I.Q. UTILITY POTHOLE--
UG TRENCHING --JMT—
61 R Is 0 w
r T
---------------
---------------------------------— -f ------- EOP
-7 /B I/E A/
�Tp
---------------------------- — ----——--- oft -- -----------------
8y
I
1 CUTS.
f �Edmonds_,__
C . y
9 0 9
RIGHT-OF-WAY CONSTRUCTION,
PERMIT.:_
Permit Number.
R F C" F 1 V77 D
Wue Date:
MAY 2J
reA9Ad 0%,cnty of Construction: J*V/7. /l/sr
IYE _- (bespecific): 8J)ft_y A ZE h) OWTV
13. YPAMq
Contractor: Contact: J4AJDJT9_<,6A)
MailingAddress: SUR IDA-MI-Sr Phone: f71h1--�_,s'JqZo
Staie License #: n JP
A5'J? (1P 16 J 10 J4 Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. [-] Commercial E] Subdivision city Project_ �V, Utility,(PUD, GTE, WN CABLE
0 Multi -Family E] Single Family Other
INSPECTOR: 114SPECTOR: V'J
F. Pavement or Concrete Cut Yes G. Size of Cut: x H. Chargq-$
APPLICANT TO READ A D
T_
-INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmondg harmless from 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 its departments or
employees, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIA1'ALSN,);J6'PER1OD OF ONE YZ�R-ALLOWly(3 THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please callthe Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall he in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
aboQq.sta -and understand the pd�Mit re�quirements.and the pink copy of thepqrMit will be
_':Jha.ve.,read. the, tements
available "on sit t all ti for inspection purposes.
Signature: Date:
-(&o'yitrdctor or- Ag-ent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE,ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT,
TIME AUTHORIZED: VOID AFTER DA YS DISRUPTION FEE/FUND I 11:
SPECIAL CONDITIONS:, RESTORATION. FEE:
PERMIT FEE:. :r 00.
COMMENTS:
DATE:
TOTAL FEE:
RECEIPT FE A
ISSUED BY:
NO WORK SHALL BEGIN PRIOR . TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:�
I Diagram
(Fund I I I - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION 0 YES El NO
I
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL. APPROVAL BY: Date:
I r75-�k PL W
lqql,7 ?16FAVE �J
&tl- beoP &jm+
I q6' DTb Rd -Io
1/7 54-k PL- W
<I
M -7d ,.tt5 Jj /
4'17-T�ru
COG, 7q
9 /7
LU
M -ld \tv5b I
APPLICATION
The City of Edmond- for
EASEMENT NO - --------------------
'L�-ft IJ SIDE SEWER PERMIT ........... ------------
NEW CONSTRUCTION REPAIRS E] LID NO - ------------------ ASMT. NO - ------------------
OWNER .... 9?C;� ...... --P� PERMIT NO. t5
--- --------------------------- CONTRACTOR
JOB ADDRESS
-------- ------------------- LEGAL DESCRIPTION: LOT NO - ------------ 15 ---------------------- BLOCK NO. - ----------
P.
------------------------------------------------------------------------------------------------------------------------------------------------------------------
NAME OF ADDITION ---- 5R�- ---
-------------
Approved:
DATE
By- - -- - -------- ----
7
RMA I T*,
M1D,,.,,SEVMER �`PE
0 F E QMV 0, Ni
SEW
-,WW-T-ER- ER'. DMiRTMENT,,.
T RHI-
E
4_6
'for, -sldi sewer':1 , nspectionst BFFORE -coverlilki'an
y P?rt oni-.oft�e -con-struct'on*.
0::Sat., :Suni,-�or'h6ltria "I b I
�:b,, proyided,.withi 4' Ir - our" a ft - er reclust �N nipe t ons�.)_�
Inspectlow will
t
A IA .... ............ .......................
UOTION...,
..................... .......... ......
1'� 4
E SCA I P' T 10 N..
............. ........... ...... .... .....
............ .................. ...........
**�,* ..................... . ....... ................. . ..................................
............. ........................
.............. ..................... .............................
...... .................... ,Bp, ILDER ............ 15
.................... ION"ER ANWOK,
..........
-X C. TO '*4bDRESS.
ONTRA W&NONE, .......
............... ........... ...........
kvigr . an PC
.. ..... .0 e a ita
f r, r p lr':and/ork'connecti6n�-'iof'-a�,i§ide�.sewer,-,.�toi.th6,.'-dity,,-s�iii T
r K'
�1%6co _Cl��xoV Edmonds: ordinances.
ft�_-j�N.TTON, ISI-CkLLEWTO THE'FOLLOW1
NG
,,-,,-NO'fE,N6Lv u t-se' -.Sewer :Contractor Must ibe,eznploye&toicon;irt]icr,
c wer inside propefty,,Iine., AT:-licensed,Side
.-:sIdeOewer.An- street iarea. 'Db4not;,cover any',portion. of. sewer',before,lt.. has,,been lns�ectedl
' !'.--...-A�lil,wor�',�'erf���edt;in�'.city�-right'-oirivay:.req'uir*es-,an invaslon� bf.-IFLight-of-Way �PerTit�,,obta'jn!-�bl'6'ii-6�i';ih�,�tty-;,Fn�ineer's�offic�:,�
n g. Ord Inance'-1 11. 16.,030;.an d-. Reg u Is t lons.-:govern Ing *side, sewerw: when yqw: get permit.,
O'�E*l�Nof',,4��T�pic;f��id�'Ci6we*r�iri6st',Iiave,at;.IeOt,30.'Incbe�s cov 12 inches, lnsf46prope�t�,,fine�, Int end's.iln�'g�ade,
erage',at, piroperty .11ne:and
h h- m
;,�a arPerilt an-rAi,*iIItjbe'permitted.' mu grade ovi%::, '.'Nojib
,t4,,
streeV,reritored� Ao original' condition. Contractors sball; �be, �responiible�'_' for. fallu're�dtie�,to.W
t
one, year of !completion., - j . r - oper..
ev
elop; within
aA I;
unla*t*to�,�altei.'or,,..db�-any�-other'work ih As�' rovided;4or In the'1permit,.'ov to, 'a�y,-Iwork- on,',,the, main iewer-,or,it6,,appurten'ances,1,122�ci*
:,,,*eNOTEl;.1Nc �u
'�ye pt
. . ........ .. ....
5DISAPPROVED t&—, By
....... Date ................ . ...........
.... ...........
AP
'APPRO
.......... .. ..... ........ ....... ........ ..... ........ ................
Ay . . . ..................................................................... .
.......................................
4, ........................... ................ . .......................................................
................ .............. ................................
................. ............... ............ .... ..
............... . . ............. ....... 7 ........... 7� ........ ...... .................... ...... ...... ....... 7 .............................................
d" y n F g,- o ru ont-PRIOW.'To. R sRec dont
P I C
iii-�,'�'P�rfoririiin nst' cti e4uest*,F�r:'J.h' 'it"
Ite ............
.........
Afl'.'a �-- ..... ... ....... . ...... ......... -herebyxertify th, atAkfe',sidb: sewe;r- ins W lation.*-consi'r-,ucted�!,�,n"d'er'.*!thisf,permit�,�
A .. 6.n_.iruction)-*
,i-.z(Owner4ofZiContr�dtingi,Fi*rm P 1.,�In
�,,��-i��w—�installedCin�,h6cordhneei,Nl�itk.�l�i'.governing',ordinaiie6s,,6f*�tlie',*�C'it -of -Edmond&,"
this ............................... .......... .......
.......................
!Cheek.�*'BEFORE;:,:�,odidig-,fot,:, Water,.) (G�4' T 'on Pioweillb,:_ se,,� eulli I
!t Weph er Oth "'VI.V,�_:.
al
APPLICATION
The City of Edmonds for
SIDE SEWER PERMIT
EASEMENTNO - --------------------------------------------
NEW CONSTRUCTION REPAIRS LID NO - ------------------ ASmT. NO . ................
OWNER - ---------------------------------------------- CONTRACTOR ------ PERMIT NO - ------------- K; ---
JOB ADDRESS ------------ -------------------------------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO . ....................................
------------ ve-A...V . ... ........ .............................................................
0
NAMEOF ADDITION .......................................................................................................................
Approved:
DATE
... By ............................................................
11/75