18112 86TH PL W.PDFIIIIIIIIIIII
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18112 86TH PL W
ADDRESS: ta 70
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TAX ACCOUNT/PARCEL NUMBER: XWO q 60000,3200
BUILDING PERMIT (NEW STRUCTURE):�
COVENANTS (RECORDED)
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
DETERMINATION: E] Conditional Waiver E] Study Required F] Waiver
SEWER LID FEE LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:— 1?1119
SIDE SEWER PERMIT(S).#: -M�
GEOTECH REPORT DA'
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DA
OTHER:
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LEGAL PROPERTY DESCR
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LEGAL DESCRIPTION CHECKED & APPROVED
Use Zone
Kroll Map No.: By Date
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CERTIFICATION: I do hereby certify that I own or have an interest in the above
hat all adjoining property
legally described property, and further, t
which I own or have an interest in, which has not received a prev'Ous
subdivision approval, is included herein. 'Xz / Z;_�
SKETCH: Show below or attach sketch of proposed subdivision per example shown on the
reverse side. Cn subdivisions, where possible, indicate location of existing septic
tanks and drain fields. Include vicinity sketch -of the area per example shown on the
reverse side.
On subdivisions, attach statement of reasons why you propose to divide property in the
manner shown. Include any pertinent information not apparent on the sketch.
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City of Edmonds PERMIT NO: 9794
. PERMIT EXPIRE
SIDE SEWER PERMIT
Address of Construction: LED #
Property Tax Account Parcel No.
Attach copies of all access and utility easements Verified and Approved b
Owner and/or Contractor:
Contractor License#: Rrz-'�(Jukz Building Permit #:
No/
[;]/Single'Family Invasion into City *Right -of Way:,[-] Yes 0K,
R Multi -Family (No. of Units *RW'Construction Permit #
Commercial (No. of Units Cro ss other "Private Property: E] Yes No
"Attach legal description and copy of recorded easement.
wner/Contractor
Owner or contractor signat e and acknowledgement statement: Date
it.'s
By signing for this permitil certify that I have read the C b1901d2tVitled
y pu
Side Sewer Specifications, and shall comply with all City requirements outlined therein.
W CALL DIAL —A —DIG (1-800-4Z9 -5555) BEFORE ANY EXCAVATION W
V FOR INSPECTION CALL 425-771-0220 extension4
241401JR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO Date: Initial:
Partial Inspection: Date:— Initial:
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date: 14/1Zf2-:�_ Initial As -built to Street File: XL
15, PERMIT MUS1 BE POSTED ON JOB SITE t�
a
White Copy: File Green Copy: Inspector Buff Copy: Applicant
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CITY OF EDMONDS SIDE SEWER AS- BUILT
ADDRESS
HOMEOWNER
18112 86TH PL
DATE DRAWN
11/26 /03 By 1. ABILA
SCALE
w NTS
CONTRACTOR
RESCUE ROOTER
PERMIT
NO, 9794
NOTICE:
_C
y .0
ttached
The information shown on the a
iled for use by the City of
map(s) was comP
Edmonds/ its Employees and Consultants.
Th,e City of 'Edmonds does not - warrant the
accuracy of anything set for,th on t . hese
Map(�-). Any person or entity -requesting a
copy should conduct an independent
ormation shown on
inquiry regarding the inf*
including, but not limited to,
tT�e -m a p (s) -h
th . e lociation of any sewer stub sh, own. Suc
sewer stubs may or may, not exist and may
or may not exist at the location shown.
Neitheir the City of Edmo'nds nor its
e rn pl, 0,Y e e-s o -r o ff i -c e -r s -s h- al' I b e a- f o r t h e
n on this map(s), nor for
information give'
e representation provided based
any on
upon . said,map(s),
The City of
APPLICATION
for
SIDE SErVV= PEMM
NEW CONSTRUCTION E] REPAIRS 0
ow�,m ... 4�gl ....... z-a.,4..
............
ADDRESS ........ M44 ......... .....
f
EASEIEW-Pr No.
;I � -
CONTRACTOR ........ 1-ta-eAw ...... c: . ................................ PER3M No
LEGAL DESCRIPTION: LOT No . ....... 3
...................................... BLOCK No . ..................................
. ............ ///
NAME OF ADDITION ... ZZ/ .." ... )- -
Approved:
"NWAW
DATE E
8 9 0 - 19 C) -
Ciq of EdJ&ds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number- 96,-0787
IZue Date:
A. Address or Vicinity of Construction: - 113 111 13 G 'r " PL A,
B. Type of Work (be specific): klEPL DEF DIST CA, SE(L
ATTA04ED L)WL'P.
C. Contractor: 4-14AMM'51-50PUNOL CA,
MailingAddms: 533 MAN 5r
StateLicense#: Eurke-ct-ioiwx
D. Building Permit # (if applicable):
Contact: 76KAND P-C..ON
Phone: 774- S"I+C.
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. F] Commercial [J Subdivision 0 City Project E] Utility (PUD, GTE, WNG, CABLE, WATER)
F1 Multi -Family E] Single Family E] Other
INSPECTOR: I INSPECTOR: i
F. Pavement or Concrete Cut Yes []No G. Size of Cut: 2-' x 195-76' H. Chargq_$
APPLICANT TO- READ AND S194)
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmondg barmless froin, fnjur%�s—,fzmages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made ag�ainst the City Of Edmond$, 0'r any bf its deflartments or
employees, including or not limited to the defense ofany legalproceeding8 including defense costs, and attorney fees by reason ofgranting thi8permit.
/,--, -I
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR PbLL0,W�NG THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BYCITYFORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BEPROCESSEDFOR.ISSUANCE TO THEAPPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engine6fing 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 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 EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available onj.41"t all time o inspection purposes.
Date:
Signature: 0L==!nM--
(Co--n rractor 5-T,4ke-nf)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
TOR CITY USE ONLY
APPROVED BY: 1.4j
TIME A UTHORIZED- VOID AFTER DAYS
SPECIAL CONDITIONS:
TS
COMMEN
DATE:
RIGHT OF, WAY DEPOSIT
DISRUPTION FEE/FUND.111;
RESTORATION FEE:
PERMIT FEE: 00
TOTALYEE:.'
RECEIPTFEE-.
ISSUED, BY-,
41
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
I -
I Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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3FREET'FILIj
CITY OF EDMONDS
DEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, Edmonds, Washington
SEPTIC TANK INSTALLATION PLAN
(Submit in Triplicate)
R. ADDRESS OF PROPERTY../X./**/*�"4 ... . ..... C44 Lot No.....3 ............. Permit N....'o. ...... 7 .....
Owner...... .... ------- --------- ------- ....... .......... Address ... .. .... ...... ................................... ------- Phone ........................
Builder $70�� P,., e
--- ----- ---
Designer.
------------ -------- -- .......... .. A d d r e s Phone._7?��._ �F,7e
Installer,Z7-'
� -e
I hereby certify the accompanying drawing is an accurate representation of the system installed at the listed
address. I also certify all recommendations and restrictions (concerning plumbing stub elevations, maintenance of
grades, fillS, Surface drains, etc.) listed by me on my sewage disposal system permit application dated ..............
....... ... 74$7 ---- have been complied with.
o" el
'O'l ��
...... 0'. -5. _'! ---- -- . .. ......... .......... ..........................
Signature of Zesi�gner Date
TO BE FILLED IN BY CITY ENGINEER ONLY
Accepted ....... ...... --------------------- ---- Date._ _C_
NotAccepted ....... .............................. ........ ........ ate .....................................
Signature of Saviitarian ............. . - ------------------
4
............. .. .....
. ........... . . ...... ------------------------- .......
Remarks: ----- Z0C__C__A__
"C- ...... a"Y .. e'0-A;b&2 ----------------- --------- ...... ---------------------------------------
INSTRUCTIONS: Use the reverse side of this form for the drawing. Use a scale which will permit the greatest
detail and still contain the entire site on one page.
ATTENTION HOME OWNER:
Your septic tank has limitations! It was designed and installed to care for an average -size family. Over-
loading' the septic tank or disturbance of the drain -field may seriously impair satisfactory operation. Points to
remember:
1. Have your tank checked periodically to see if pumping is necessary (2y2-3 years).
2. Do not channel ground water, surface water, footing drains or downspouts into the tank or drainfield.
3. Do not excavate, fill, place a structure, driveway or. patio in, on, or over the drainfield.
4. Limit toilet fixture disposal to sanitary wastes and toilet tissue.
5. Detergents and bleaches used in normal household quantities will not harin the action of the septic tank and
disposal field.
Owl
0 -MA#_
CITY OF EDMONDS 1173 P�
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: ............ Stewart & Potter Homes Inc.
.... ................................................. .
....... . .....
For installation at: (street address)-.. ---------_--- ...... . .............
Addition or Subdivision ....... ftift_y��w
....... ......... -------- _ ..... ..... .......... ............ ................. Lot ...... .... Block ................
Type of Building: New,,.-X ..... Existing --- ........ Single family residence.__Te8_.. Number of bedrooms --------- 3 ...............
Other: (specify type or use) ----- ........................................................... .................. ....................................................................
'Stewart & Potter Homes Inc. 6605 - 200thS.W.,Edmonds
Builder ...... ............ .......... 11-1 ............................... I ...................... Address ................ .. ...................... .......... ...... ......... .................
Designer ... )�qn..Vi�aley..& ... A.s.sqc ................... ................... Address ..... 7301. — _17�th. S. W..J;1�#Ppds
.. .... --- -- - .. ... ..... ...... ......... ............ ..............
Soil Log Hole No. 1 ----- --- coarse,,. . sand_ W/ . gravel,, --- 42!1.!s-4V... gravel & Sa.
Soil Log Hole No. 2 ............ 0 ---- -- 19.11 --- silt ... &-.sa.nd loam. lg.!!.74411 loosa coarse sand -YI/ I
.. .. ..... . .... .... ... .... ................. ....... . .......................................... I ..... ... grAyq�
.......................................................................................................... ...............................................................................................
Elevation of Water Table, if encountered. (Distance from ground surface) ...... ... None . . . . .... ...............
Corrections to control surface water if needed ....... Le.ad,..8.11..surface .. drainage ... away .. fromArainfield...
areas,
..................................................... ................................................... ............. ........................................................... ; ......................
Specify if any removing or grading of topsoil in field area ........ Nq4P ....................... .......................... ........... ............. .......
....................
Percolation:
Test Hole No. I —Average Rate ....... 907 ... 0..3.1 ........... . -bottom 6" test hole)
(Fall in ininUtes/inch
12.1. @ 3211
Test Hole No. 2—Average Rate .... .............................. .................... (Fall in ininutes/inch-bottom 6" test hole)
Test Hole No. 3—Average Rate ....... 7.-_0..@..3.2 ....... ........... .. ....... (Fall in minutes/inch-bottom 6" test hole)
Average percolation rate on which to base drain field design .10i3O min,/#.ck, . Date Taken ... 44��5
Septic tank requirements based on present rules and regulations:
Septic Tank Size ........ _�99 ........... gallons.
Amount of Square Feet of Disposal Field ......... 5N .... . ..... ... ....
Date . 12/10/65
----------------- --------- ... . .. .......
Signature — Designer ......... . ... ... i ..... ...
DO NOT WRITE BELOW THIS LINE (A�be completed by Issuing Agency)
Permit issued (date).... .......... /,??. -_ .................. .-Permit Number ...... .....................
Remarks: . .. ........ .. .. ..... ................... ...........................
'010
...............
'77
Af ojp��Iel
006
J
SEWAGE DISPOSAL'PERMIT
Septic- Tank.._: ...... ... gals. . No. .; .......... ........
C1 T Y 0 F E MON "'D S
Disp. Field .......... D egartment
.,.-...sq. ft. ublic Works.
................ ................. ..........
Name_ ............... ...... ................. is'hereby. authorized to install/
repair sewage disposal 'system -at
.................. .......
.....................................................................................
Date issued on. .... i .......
Permit expires one'. year fr_o'mdat_6'o'f!'is`sue**
DO NOT� COVER BEFORE. APPROVED BY DESIGNER'OR SANITARIAN'
n
I hereby certify this sygtem was installed, under my !supervision and.� control.a. d complies with all provisions of the Cif"
y
Of Edmonds Resolutions.
-----------------
of Installer ........ ..........................................
Signa�ttire` ........................... . Date.,.'
Approved
El Disapproved. R Date .............................................. ---__--- ..... By.: ........................... .........
................ ...........
_R
emarks:...... .............. ................. ...... ..................... ......... . ........ . ...... ...... ...............................
SANITARIAN OR DESIGNER ................ ..................
.............. .......... ..................... ate ...................................... .......................
This pernlit shall be posted in a reasonably conspicuous,place on." the job untif' insp ectiod has been completed.
%
CITY OF EDMONDS 6-1107 when work
Call PRospect
WATER -SEWER DEPARTMENT is ready for inspection. (No insPec- I IkTo 2707
CIVIC CENTER— tions Saturday, Sunday or holidays.)
SIDE SEWER PERMIT
................................................... * ........... * ................
ADDRESS................................. ... Ktb ... F la-ce .. We-st ..........................
Carl Scheuch_,._�p.! ....................................... CONTRACTOR ...... MQKJTkq .......................................................
OWNER..........................................
Pernlission is granted -.February .. 2 ................ ig ... 6a, for ........................ days to REPAIR or CONNECT a side sewer
with City Sewers in lecordanee with application oil file and governing ordinances.
ATTENTION IS CALLFD�TO THE FOLLOWING: property line. A licensed Side Sewer Contractor must
NOTE No. I —The owners of the property May obtain a permit to construct sewer Inside
cover any portion of sewer before it has been inspected.
be employed to construct side sewer in street area. Do not
regarding ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 2—Obtain full information erty line and 12 inches inside property line; minimum grade of 2%.
N" n No. 3—Top of side sewer must have at least 30 inches coverage at prop
No bends In grade sharper than % will be permitted. resto-red to original condition. Contractors shall be responsible for
water settled and surface of street
Nb-,F, No. 4—Trenches in street must be ay develop within one year of completion.
failure due to improper work which m or to do any work on the main sewer or its appur-
NOTE No. 5—It Is unlf),wful to alter or do any other work than is provided for in the permit,
tenances except to insert the pipe into the wye.