18236 ANDOVER ST.PDFIIIIIIIIIIIIII
10179
18236 ANDOVER ST
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District
City of Edmonds — Water Department
TAP CARD
Reading: (000 Date I o-)- ' /I
No. No.'
-!� ti
Meter { Size Tap { Size
Mfgrs. No!. Style .-)qL4)SR
Purchaser: 1!� k t'-9— 14
Serv. Add. le�_-,sLo AL631,�,, Grx_uk
Lot No.
Add.
Residential:
Other:
Blk. No.
Meter Location / 0 "W, OF �W-
ERO,61 FPq DOOR
OA17
Service Material:
Pressure4�5 lbs. Test %
Date of Work 121p,)IRA
ce_C,22�� Foreman
Guar. Voucher. No. $
Proj. No:
Remarks:
OUTGOING Inclex- Reg. -Route Bk. ' Stencil -Card
INCOMING inclex- Reg. -Route Bk. & Stcncil-Card
0 ROUllNG SUP
NEW SERVICE INSTAUATIONO
ADDRESS: l6a5�. L�6uj,(-- aaa±.
DATE: tc�-/t 4 /e e
DIAL A DIG #
P.U.D.
TELEPHONE
STREtT FILE
CABLE T.V.
GAS
FOREMAN
STORM SEw�Ou"ll"
OTHER
FUTURt SERVICE INSTL: YES NO
BORE: CUT:
LOCK
CREW
DATE: INITIAL:
UNLOCK
,DATE: )a--,/aJ44TNITIAL:
METER SHOP
ACCOUNT NUMBER: 3 3 3
SUPPLIER: PrLD Oe//-�
TREATMENT PLANT
FOREMAN
E B OL T
FOREMAN
INITIAL: DATE:
TAP CARD
METER SHEET
APPLICATION/
UTILITY
DISPATCH
I
BILLING
7/76
TAX ACCOUNT/PARCEL NUMBER: 2-7 0 41 S 0016-21 DO
BUILDING PERMIT (NEW STRUCTURE): _1(AgV01-NeFP,)
COVENANTS (RECORDED) FOR:
CRITICAL AREAS
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED: M 3
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:—Q I I � I �
SEWER LID FEE
DETERMINATION: Ej Conditional Waiver E] Study Required [] Waiver
LID #: 131.
SHORT PLAT FILES - z - &%� LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DA
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED: - I
LATEMP\DSTs\Forms\Street File Checklist.doc
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STOARD DRAINAGE PLAN'
DETENTION SYSTEM
PAGE I OF -2
for
qt=4
lotation4wiftle1j" 40
plat) by j4p
phone./—CJ Z—.3le 01 IF
dat -
DESIGN DATA
,.System -Imperm -Pipe Pipe �Orifice
Number c:Area' Diam Length Diameter
- - , -, , � 1 1 A , /I 1 41, / . I I
�kr.fflr__Iasm
NOTES
1. Call Engineering Division (7.71-3202).
jor prebackfill and final inspections.
2. Responsibility for operation -and'. -
maintenance of drainage systems on.
private*property is the resDonsibility
of the property owner(s). Material
accumulated in the storage pipe must
be flushed out and removed from catch
basins to.allow,proper operation. The
outlet control orifice must be kept
op�n.at 11
Wmes.
to 3 ss
4
�'CITY OF EDMONDS
51TE 'PLP-,N
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C 1 -1 T Y o . f E . D M '10 S SIS SEWEIR
For Inspection : Call 771-3202 STREET FILE PERMIT NO.
Address of Construction:
P E R M I T
0
Property Legal Description (Include all easements): La -3 11�s a-252)
Owner and/or Builder;
Contractor & License No:
Single Family Residence �-.L) M 0 N D S
'A�TPMENT PLANT
Multi -Family (No. of Units =�
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No V0'0' Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (if Yes,-6,asement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED ON THE BACK
L)
DEC 151988 Iz-4 02)
1 ce tify that I haN -s-F-a-l17 comply Date
wi't the items listed on the back. PUBLIC WORKS
r
Permit Fee:
;fIssued BY:
Trunk Charge:
tDate Issued:
Assessment Fee':
Receipt No.:
740
Partial Inspection:
Comments
Date Initial
Final Inspection
Approved:
Date Initial
00
Rejected:
b S
CD
Reason
V
tial
_�a_ t _e n -i
PERMIT
MUST BE POSTED ON JOB SITE
Wh-ite Copy Fi l.e
Green Copy -'Inspector
Buff Copy Applicant
City of Edmonds
Side Sewer Drawing
NEW CONSTRUCTION [0
OWNER------------------ ----------------------------------------------------------------------------
JOB ADDRESS .11A.3te ....... -------- S�
EASEMENT NO.
REPAIRS [3 LID NO - ------------------ ASMT. NO - ------------------
CONTRACTOR .... --------------------- PERMIT No.
LEGAL DESCRIPTION: LOT NO - ---------- 13 -------- --------------- BLOCK NO. - - ---- - -- ------------
---------- --
ELD,"v10 DS
-------------------------------------------------------------------------------------------------------------------------- E-T-R-E-ATMENT !-.PLANRT
— _0
NAME OF ADDITION --------------------------------------------------------------------------------------------------------
-------------------
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ID 0 -\/ F— 8"Xfbo SA0014 CONN Approved:
PWW-000 1 - 11/75 (R EV. 11178) DATE ... L-2-6-7.89 ............. By
01
6. 9' F/14VO.
It- of:
Q I MY MON
ONDS
LA-St-0, -795-
- , �NE W
ADDITION
RETIREMENT
STREET Fl�gjoj
. NFORMATION SHEET
ASSET NO. 6--7
ADDITION TO ASSET NO.
DESCRIPTION
SERIAL NO.
LOCATION DfiPT. NO
1s:=p,34- /061y
PURCHASE ORDER NO.
PURCHASE ORDER DATE
rl
kyp)
COST
PROJECT NUMBER' Z, e, /p, --o /. c >
PROJECT COMPLETION DATE
COST glp, ,�
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
**SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
F�DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE DATE
INITIAL
DEPARTMENT FILE
�4L
VERIFIED BY
PROCESSED
BATCH NO.
IT�tDF EDMONDS W
loc. , Wit No. /L9
COMMUNITY SERVICES DEPARTMENT STREET FILE Issue Date
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. 0 Owner: c�;,,ve lholltOlroll
&a
Ilee �/. 4y,
Oddress &no
City StatC Zip
Address or Vicinity of C tru ti
Type of Work to be Done-
B. e Contractor: <*04 e__
Name
Mailing Address
City State Zip
516 V'F1_16Z0y111111
State License Number Telephone Number
I/ -
Work in Connection With: El Sub or Plat X Single Family 0 City Projects
El Commercial El Multifamily 0 Utility
Z
< Pavement Cut: k El N
U
APPLICANT TO READ AND SIGN
a4
a4
< 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, forseen or unforseen, 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 proceedings including defense costs, court.costs, and attorney fees by reason of granting 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.
0
U Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed
W by City forces, at which time a debit or credit will be processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Public Works: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
no exceptions.
I understand the ve that this permit must be available at the job site for inspection purposes at all times.
Signature:, Date: /44/' dc..)
Owvner or -'Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
Zo
>�
ISSUED BY: '2h
PERMIT FEE:
0_�
Z
Time Authorized: Void after 30 —days.
Security Deposit:
0
W
Special Conditions:
Receipt No.: —
Fund 111 Fee:
U
Amendments:
Street Cut Dimensions*
2-1 2
X
0
4� NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTION OS IS I I I - Route copy to Street tept.)J�
Comments:
Diagram:
a
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
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44
CITY OF EDMONDS qW Wit No.
COMMUNITY SERVICES DEPARTMENT STREET FILEIssue Date
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. Owner: Washihqton Natural Gas B. .9 Contractor: S ame
Name Name
805-156 AXT
Mailing Address Mailing Address
WA 8�00 7
city State Zip City State Zip
9 Address or Vicinity of
Type of Work to be E
Work in Connection With
Pavement Cut: 0 Y 0 N
AA7,07on
State License Number Telep'h6he''gumber
gas'seY-iFice-installati.on
0 Sub or Plat El Single Family El City Projects
APPLICANT TO READ AND SIGN
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, forseen or unforseen, 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 proceedings including defense costs, court costs, and attorney fees by reason of granting this. permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND ACCjEPtANCE`bF THE WORK.
Funds held from the Security De posit, (estimated restoration fee) will be held until the final street patch is completed
by City forces, at which time a debit or credit -will be processed for issuanceto the applicant.
o A 24 hour notice is required.for inspection; Please call Public Works: 7.71-3202
e Work is to be inspected during progress and at completion.
9 Restoration to be in accordance with City Code.
* Street to be kept clean at all times.
9 Traffi� Control to be in ac . co.rdance, *ith City regulations.
0 All street -cut ditches must be patched'with, asphalt or City approved material prior to end of working day-,
no exceptions.
I understand. the _14V,,A�d th t thiUp lkvpla
a eTdr'rn tp b �ble at the job site for inspection purposes at all times.
Signature-. Date: 11-16-88
Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
ISSUED BY: C-a�). 0�4,g�
Time Authorized:. Void after — I \30—days.
Special Conditions:
Amendments:
PERMIT FEE: 0 Q A b(- ZttK& CC, —
Security Deposit:
Receipt No�:
Fund I I Pfee:
Street Cut Dimensions:
X
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
Eng. Div. July 1985
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MOSS CONNECTICN INSPECTIM RECD
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/////////
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111777-TUU1777
SIZE
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INDICATED CN SITE PLAN
SHOULDER DIUdMGE MAIMMIN
SfiALE OPI-N RLINOFF
MISC:
ILIC WORKS
7
D
1
2
3
4
5
6
7
9
0
I
12
'3
15
�6
?7
28
29
30
31
32
33
34
35
36
37
38
39
40
REVIEWED BY: /;" elA� —
PD�RNNMNG - MGR. ENGINEE G MGR. PUBUff WORKS MGR.