18000 ANDOVER ST.PDFIIIIIIIIIIIIII
10158
18000 ANDOVER ST
0 ROUMG SLIP
NEW SERVICE INSTAU,
ADDRESS: dbao� �Axigk
DATE:
FOREMAN
DIAL A DIG #
P.U.D.
Q-Tr3c9:T 911 P
TELEPHM I L— goo
CABLE T.V.
in) n iL
GAS %YJUV Uvuu L=l
STORM SEWER
OTHER
FUTURE, SERVICE INSTL: YES
BORE: CUT:
CREW
LOCK
DATE: INITIAL:
UNLOCK
DATE: 7 -() -,q (7' INITIALA
METER SHOP
ACCOUNT NUMBER:
SUPPLIER:
FOREMAN
TREATMENT PLANT
B L T
FOREMAN
INITIAL: DATE:
UTILITY
BILLING
TAP CARD
METER SHEET
APPLICATION/
DISPATCH
7/76
EW_ District
0
CitX of ondS _ Water Department
rAEW-R 'rIZAASRS-RED -ro' r-Ar vi t_oc^-rio W
CTAP CARD
Reading: C31 I — Date
No.2D74 No.
Meter {Size Tap {Size 1"52wa -6/42'
Mfgrs. No. Style IRW SP_
Purchaser: �+F_Nxw
Serv.Add. )SCOP OVLCW.QA- ��Kui
Lot No.
Add.
Residential:
Other:
Blk. No.
Meter Location?'So. G-2C-E or- nPiVE —
t,�op_T_B mc_--Tr-_R or- !2,
Service Material: I" 01-mot- Rok-n -'SPLIT '3/
Pressure-lbs. Test
W D f Work 7 -R7
Foreman
Guar. Voucher No. $
Proj. No: 1111 �Y 5 0 8 3
Remarks:
OUTGOING I ndex- Reg. -Route Bk. Stencil- Card
INCOMING index Reg. - Route Bk. - Stencil- Card
\Ij
TAX ACCOUNT/PARCEL NUMBER: 2Z41�cojoq
.1Q0
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: Conditional Waiver 0 Study Required Ej Waiver
DISCRETIONARY PERMIT #'S: V (A
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S.) RECORDED FOR:
PERMITS (OTHER): 1964 Q4 Z% (&")I
i j
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE
SHORT PLAT FILE: LOT:
SIDE SEWER AS BUILT DATED:,-+.%
SIDE SEWER PERMIT(S) #: On 2a 2-6�jq
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER: 2,5Z C W E
LID #: 151
BLOCK:
LATEMP\DS'Ps\Fomis\Street File Checklist.doc
C I T Y o f E D 0' S REC E1V'EQ' S E W E R P E'R M I T
6P
For Inspection Call 771-3202 JUL OG 1981 PERMIT NO. 07727
Address of Construction:
Property Legal Description'(Include all easements):
Owner and/or Builder:
LU
W Contractor & License No:
C* Singl:e Family Residence
T.REAEDMONDS
7
TREATMENT PLANT
Multi -Family (No. of Units
Commercial (No. of fixture Units
invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Cal 1 -Center (1-800-424-5555), before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
I ckrtify that I have read and shall comply Date
with the items listed on the back.
Permit Fee:
3o.00
Issued By:
Trunk Charge:
�,Date Issued:
7
Assessment Fee:
Receipt No.:
W2_
Partial Inspection:
7-G-9?
-R. 1A.
Comments
Date
Initial
Final.Inspection
Approved:
'-7 - a sr J r �i
Date —ti a 1
00
Rejected:
CD
Reason
Date
PERMIT
MUST BE POSTED ON JOB SITE
White Copy - File
Green Copy - Inspector
Buff Copy
- Applicant
The City of Edmonds Side Sewer Drawing EASEMENT NO - ----------------- ----------------
RF- 1:tou-rc- or S tVE- SeW ck
NEW CONSTRUCTION E] REPAIRS t< LID NO. -1-5-1 ----- ASMT. NO - ---------------- -
OWNER SlG-V-e/SVF--tA ------ �Aet-vem - ------ ------ ------------------- CONTRACTOR -B-41A ------ C!Z�N:T-R TpR�5 ----------- --------- PERMIT NO. 7VT-Z-7-
JOB ADDRESS -18X-Q� ... P\NZ.0�4ER ---------------------------------------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO --- -----------
I'vit,
4
fn
c ATC14
3.510P
,6z
,io ZE
ll�n0. CAP—
p.
PWW-OqOl-11/75 (REV.11178)
I -T
-------------------------------------------------------------------------------------------------------------------------- E ! F
NAMEOF ADDITION -------------------------------------------------------------------------------------------
NORT-H I Illn-51"m 1 0
.1 F-Y. t ST t N 6
_.-' 411 c o M c -
4' 0. V4 3 Z4 6
3.5 DR
"Rmefk 411c.o.W5C
0.4' a ; CAP
I Op
I VA�"rp a,
71
0 *DP
V 2.7'
'*0 %VjcA Vbur.
In—Z,
CORMCP.
Ugoved:
r,Alt.
DATE�h .. 6:yA,87 ---------- By --- ----- --- --- --------------------
Al�
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS
OWNER........ ... C.k ...............................................
7-
. . .... ......................
ADDRESS 1.0 .. U-0. C2 ........... / e-4t
U-
uj
cn
A P P R O'TE D
JAN 2 5 1968
EASEMENT No.
21
CONTRACTOR ....... .. ......... PERMIT No.
LEGAL DESCRIPTION: LOT No .. .............................................. BLOCK No . ............. I ...............................
NAME OF ADDITION ..... x n ..... 7.r .......................
Approved:
/_1-16 -C r, - �;.; ��e � f .. :��
DATE .......... 1. 0 ........... BY
...........................
CITY OF EDMONDS
III 11spect 6-1107 when work
CIV?C CENTER — WATER -SEWER DEPARTMENT ,, ready for inspection. (No inspec-
'ions Saturday, Sunday or hondays.) N2 2699
SIDE SEWER PERMIT.
ADDRESS................. 18.0.0.0 ... M.d.over ... street ......... ......................................... . .......................................................................
W*J& Struck ' Western Sewer &.Const,
O'WNER .................... ......................................................................... CONTRACTOR ................................................................................
Permission is granted ................. jan.UA:PY --- 2.5, 19.AA., for ........................ days to REPAIR or CONNECT a side sewer
with City Sewers in ac6rdance with application on file and governing ordinances.
I
ATTENTION IS CALLED TO THE FOLLOWING:
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 nut cover any portion of sewer before It has been inspected.
is No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit. I
NOTE No. 3—Top of side sewer must have at least 30 inches coverage at property line and 12 Inches Inside property line; minimum grade of 2%.
No bends in grade sharper than % will be permitted.
NOTE No. 4—Trenches In street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
,v failure due to improper work which may develop within one year of completion.
o. 5--It Is unlawful to alter or do anj other work than is provided for In the permit, or to do any work on the main sewer or its appur-
tenances except to insert the pipe into the virye.
PUBLIC 'WORKS DEPARIJOT rHFQaT T
BUILDING PER1,,1IT REVIEW
fxxff
w .(address) te)
Street Right -of -Way Existing
REQD N-jsf4)ffl.
Z
Access Easements Existing_9jM4qt2�6,bNje5,je5
1"�REQD
P4
Utility,Easement-Exist
Lot Per Subdivisio6t:l�_ lat
Assessor
Site Plan Checked for Accuracy
Z
Underground Wiring Reqd.
Check Accuracy,of Legal Description
07 -44
Review by
Date
OR
sting Waterr Main.Size
:e
tWater Required
Service Line d
Hydrant Size Existing,---.�
P4
Hydrant Reqd Per Fire CodeL _,,O-'—Size
Detector Check Meter Reqd..'
Cross Connection Inspe j
Fire Depart W�M_0, nts
:3:
Water 1,16-ter Charge Reqd.
Review by.
Date'
'-,,Septic
Tank Design Approved
-
Date
T ank rm'7-
Pe t
Sep i Tank Permit Reqd.
Sep-Reqd.
Permit No.*
S J__
.t
an e r Av
Sanit ewer Availability
ailabj -ty
Proj.
Draw�g No.
File No.
1 1 2 _t
S S_
ide Sewer Avai I Y_
:r
S S j y S r Com c
anitary Sewer Conned n Fee Reqd..
j
Review by
e
Open Ditch Existing _ ><
Reqd.
Culvert Reqd.
— Size
P4
Catch Basin Reqd.
In ate m Site Plan-
0
Shoulder draina���incollect ion on
f
swale open ff
.
Manhole r
.19�_
Indicate on Site
Soil ditions and Ground Water Field Checked
ew by
Date
3
n
n
T1
R,6ised: lvlO-1977
Page.,2
Re
Stree qd.
Req
Cuarb and Gutter -
Sidewalk Reqd.
Curb. Cut for Dri eway Reqd-_,.-���
�h Wa Pe
t-of- y lic rm
P4 kight-of -Way Cons lon.Permit Reqd.
:Bond Re or --Public' Improvements
t m
eet'Nanee Sigmn Reqqd.
Other Signing Reqd.
:P Inspection made oh"':�'
r7e Perrrm.
z
0
14 H BY: SEWER
E-4
W W
W W AT:ER
P4,,
H STREEf.
ENGINEERING
Special* Requireme'nts' listed in memo to Comamity Development Department,
ion
Building Divisi
By Date- -!I
o- All items filled in on Building Permit Application
BY Date 7^,
P-4
Dr�wings Sta[Ted and Notations Made
P4
BY Date
Approved by Public 'Works Department
10
�evised: lv 10-1977
0
9
iri" TV
7
A" 2140 —9?00,w
8AT_5701V
C -of-EdinonAom
it
'R, Y CONSTRUCTION.
IGHT OF -WA
PKIMIT
Permit Number. 6?17
Issue Date:
17
A. Address or Vicinity of Construction: A404V 14AII0011ER ,Sr
B. Type of Work (be speci Arpm-w S AEZEW1,0609
x mn& 17�f A4,= e-
C; Contractor: Contact: wtall-YAl dL��
MailingAddress: Z-;1,2Q 14). AD Phone: OL2 71,0 c?,K
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. Commercial Subdivision''. E] City'Project IM Utility (PUD,6;FE,)WNG, CABLE, WATER)
Multi -Family. [M Single Family E] Other 1001P2100-CIP601 PF-09 I? Yd 0
INSPECTOR: -so,, 4 INSPECTOR:
x
F. Pavement. or Concrete Cut [I Yes JKNo G. Size of Cu - t: A1111
h7NCh4.;4 0A,9W/,V 44
APPLICANT TO READ. AND SIGN
INDEM)VITY.- Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom 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: departments or
employees, including or not limited to the defense of any legal pr* oceedings including defense costs and attorney./ces h� reason of granting this permit.
THE CON IRA C TOR IS R ESP ONSIBL, E FOR WO R KMA NSHIP A ND MA TER JA L S FO R A P E R IOD 0 F ONE, YEA R FO L L 0 WING THE FINA L INSP EC-
TION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APkLICAA4
ECEIVED
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. OCT,i-4".1997
Work and material is to be inspected during,�prpgress and:at completion.
Restoration i's to be in accordance with City Codes. MVNEERING
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as *required by the City Engineer.
Al I street cut trench work shal I be. patched with asphalt or City approved material prior to the, end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand I rmit *requirements and the pink copy of the permit wi/1 be
'r i�sp
�ctio
available on site at all times for insp tionLppur �Iw
AWdkIALr Date. -
(contractor or Agent) See, M6& -A CC&" 0=16#
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
Signature.- _
FOR CITY USE ONLY
APPROVED BN� -6 woz— RIGHT OF WAY FEE:
TIME AUTHORIZED: VOID AFTER <35Z DAYS DISRUPTION FEEIFUND I 11:
4'PECIAL CONDITIONS: RESTORATION,. FEE:
TOTA-LFE,E: 30 - 00
RECEIPTNO.:
ISSUEDBY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997