17509 71ST AVE W.PDFIIIIIIIIIIIIII
14948
17509 71 ST AVE W
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PPLOWORKS DEPARTMENT, ENGINEEJ*G DIVISION
L-%-rr%E 9-"o F1
01M t:l &p-ICATION FOR RIGHT-OF41AY CNISTRUCTinN PFRMIT
THIS PERMIT MUST BE AVAILABLE AT T11E JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
A. Permit to be issued t o : I/V/,( 4 t-?_- Kj- -7 1
For Work at :(address or vicinity) -71
Type of Work to be done: b R Ve�- W -7—o 0, o, v- 7 7b- Z, 4
(attach drawing when applicable)
Time Required Start: Finish:
Owner:
Name
Maili Address
9 7
City State Zip Telephone Number
Contractor:_Z."' e-"/<
Name State License Number
Mailing Address
City State Zip Tel-ephone Number
NO 14ORK TO BEGIN PRIOR TO PERMIT ISSUANCE **
B. INDEMNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages,'or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or 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.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year -following the final inspection and acceptance
of the restoration by the Engineering Division.
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..
Work is subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by.Engineering. Call 775-2525, ext. 220.
I understand that this permit must be available at the job si" te for inspection
purposes at all times.
Signature:edgr'__-'z'6_;�1
bi�Tner or Agene
TO BE COMPLETED BY ISSUING* AGENCY:
Date Issued: P'ermit No. 6 qt�
I 7Y Fee:
Security Bond:
Time Authorized:
F
PPROVED Bj'/
Da t e :
i n- 7 7 1 4 q ... -7 0
0
STREET FLE
q
3
REGARDING: 17509 - 71st A -Venue West -3 0 3 -oz 'Voo
(address)
R E C 0 R D 0 F C 0 N T A C T S
DATE NAME, PHONE NO., & COMMENTS
ADDRESS of CALLER
5/l/74 Harley Mann Certified Letter No. 406213 sent
requiring hook-up within 60 days.
5/22/74 Letter received.
6/7/74 Came into office and obtained
permit #4847.
6/14/74 -Comection cgmpleted.
0
ACTION TAKEN INITIALS
Letter returned unclaimed. Referred TE
N to Jack for hand delivery.
TE
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APPLICATION
0
for
The, City of Edmonds
SIDE SEWER PERMIT EASEMENT NO . ............................. ..............
NEW CONSTRUCTION REPAIRS 7 LID NO. ..... ASMT. NO.
OWNER --- ....... ... ...... ------------- CONTRACTOR -------------
............................................... PERMIT NO - --------------------
_7 lc�
c: U—= - "-N - LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO . ....................................
JOB ADDRESS --- ---------------------------------------- ----------------------------------------
17
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�A NTION, ISWCkULED!
cerfsed �St
-a It -to const r'uct'�-sew'4r,� Ifis de pr6peky�llne�', X ii de, Se%Ve r,'C.�6rac;o,r-.' m, ust' b
It',his�beensin-spect6d� e,.,empio�edVto1icc;nstruct
in
VOTE,-Vo, 112,—k1 Iwo rk'-'.��rf o"Fi�'&V, I M. city., rl gh t -of -w
yasion oU ght of
y Engineer's�,offic6;:"��'.'*'-;. '11'
`�iriiiilb n
r-��-'y'dl'g,-Ordina*n(l�.,i:�:l�-03'0,-
gel at :pr'op'e'rty -:line `��J'Nbt'benidi:l` I w -grade
1A'.,wIII:1be,�ermitt .... .. covers' ne:"m nimum�, gradW?dfe,2�%
e %; -'j
-6 lori k! ri�i"ctn d It ton....; Cont rectors shall; b responsible:-forP failure us tot Improper
ter%.. ""!'',and�surf*a��c"eiofs'trc�t r�sIL6�id ;t
enches4n, street' musi;,�e'wa ' -settled" 1: .' e d:
�,�brk,whlclf, may.divel6p.,withlwone -'Sreai -.'of compliition-,
Ao alt6r�.oi�,�'do�'an�'."other:,work than he,permit;.or to, do
N'Ot� 14o..,*k6,—.*it,.ils,�*u'�ii;�f uij " I " ' '
:,�anyvwork on,the,maJn,gewer-..oz�,�it-E�.app
jnto,-the7,wye., ur enances,.exce to�jn
e,
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ruction, PRIOWT6,)Request-�Forf,�,
BO aD. t gne t�,By(.tOwne nspection.',--,
I , CoPib4MUST.,-Ei� 'S'i d"' t-oi.'-Firm -Pei "rni_ii�j-`,Cb�A
7.
D M
`73
..... ........ ......
b -dia6the-
....... y,;certify
... . .. . .... .................................. ........ i.."""
r(Owne'r"'of, t�a`ctin4'jFiimtPeifc`
C. i rm,ngj,.Cc�ns�ructJpn,
i it�dle�dhirnacco c6,.With�all'governing,�ordin6iid*&�-:bf �th'&,60,�;OVEdni6*�
7," t4 ' - * I . I I �. �,,'k(.,v`�-
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Ditt6di'this!
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of..
'/,i 'i lCheek vBE FORE!
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RECEIPT FOR CERTIFIED MAIL-300 (Plus postage)
303-08400
NPOSTIVIARK
cy) MANN, HARLEY C. TE
17509 71ST AVE W
c\j EDMONDS, WASHINGTON
cb 0
c:) 9802(
RETURN 1. Shows to who and
T11--ONAL —SERVICES ADDITIONAL. FEES
RECEIPT With delivery I date delivered
ddressee only 65
SERVICES 2. Shows to wh6m"dat)e"and where delivered'..
With delivery I addressee only ,.... 154
—DELIVER TO ADD S_SEE 8
14 SPECIAL DELIVERY (extro fee requir . e .. d .......... 50d
PS Form
Apr. 1971 3800 NO INSURANCE COVERAGE PROVIDED— (See other side)
NOT FOR INTERNATIONAL MAIL opo: 10700-397-48e
,;j
SEqDER:' Sum
bidATE'b� BLOCK(5)�'
'86 esiS.,: D'1' 0
ow, addr q,!y,er, NLY-t-
'd*' El
_vvhere� elivered ;Jo addressee_
RECEIRT.,.,'�:,
R'
ecelveci rficle:' escribed:'b*eI6'i/11
d
,REGISTERED IND."..'
G ATUR :0 R' A ME;O FAB DRESS EE- (must alvvays�;bb� filled.
2.
.1
:S G TURE-Or�ADDRESSEEtS;4AGENT,,,IF.,,;ANY-, — —
'INSURED:.:NO;%�
�DATE-kDELIVERED' :,.t ..SHOW�iWHEREi!DELIIVEREDV'-,'(Oiily.if,'riiqitd'ited,,and�i?zclitde,ZIP�C6ddy:*-,;I-',"�:,,
n"
7
APPUCATION
a
The ity of Edmonds for EASEMENT No . ....... --------- --------------
HEET FILE SIDE SEWER PEWff
NEW CONSTRUCTION 0 REPAIRS LID NO. --14- ----- - Awn NO.
OWNER
-------------------- CONTRACTOR --------
-------------------------------------------------------- PERMIT NO.
JOB ADDRESS ------- ------------------------ --- ]LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
------ ------
..................................... S2�� ... ttt,.tika ---------------------------------------------------------------- -----------------------
NAME OF ADDITION
71 5 7- A U�k:r-
Approved:
RECEIVED
JUN 7 1974
DATE-------------------------------------------- By
10
PAYAeLE TO-
1 0`74
sillo V. -JDf COUNTY TREASURER
EVF"E4,WASHING70N 98206 '*'AL ESTATE TAX STATEMENT
FILESNOHOMISH COUNTY, STATE OF WASHINGTON
OF ALL STATE. COUNTY. MUNICIPAL.
SCHOOL, AND ROAD TAXES.
L E V Y ASSE SSED VALUATION T A X
(CODE RATE LAND BUILDINGS TOTAL GENERAL s PECIAL
" _ _ 1. — _/ -11 3 1 0
2 2 �l , 7 2
4
YOUR TAX DOLLAR' WILL BE DISTRIBUTED TO THE FOLLOWING TAX DISTRICTS:
ST�JE COUNTY CITY OR ROAD/LIB. SCHOOL DISTRICT PORT DISTRICT OTHER
T 2 1. 1 7
FIRE DISTRICT HOSPITAL WATER SEWER FOREST FIRE DIKE NO T DRAIN NO.
LEGAL DESCRIPTION
6 NAME AND ADDRESS
L C S f F TT L E T 0 N! CO BEACH
;-4 r- 0'4
D 07
t� I- y C
d I
T
7 "r L AS k—AS
s,. 'r I- r- wf k 1� FAI, 04 A S M, E S A L
S L t,-' DP T P C,
TH 1 3 2 () F L T
S D R 0 15
T �-t 1',!Ly 141 PT
PLEASE PRINT -CHANGE OF TAXPAYER Ij
-
NOTICE: OR CHANGE OF ADDRESS BELOW
--NAME
ADDRESS
ZIP
CITY STATE—CODE-
11
1.
61