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18301 ANDOVER ST.PDFIIIIIIIIIIIIII 10181 18301 ANDOVER ST CITY OF EDMONDS Call IPR..Pect 6-1107 ,he. work CIVIC CENTER — WATER-SI61VER DEPARTMENT is ready for inspection. (No Inspee- tions Saturday, Sunday or holidays.) -N? 26 1 SIDE SEWER PERMIT .... .. .. ....... .. .. ADDRESS ---------- 18-3-0.1 --- And.o.ve-r ... S.tre-e.t Glenn Granger (Buildei,) .......... CONTRACTOR.. R Allen OWNER ............. . .................... A ----------------------------------------- .0 ... 9y ................................................................... Permission is granted JANUARY ..... * ........ 5 ..... 19 ... �P, for ........................ days to REPAIR or CONNECT a side sewer with City Sewers in accordance with application on file and governing ordinances. ATTENTION IS CALLED TO THE FOLLOWING: NOTE 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 not cover any portion of sewer before it has-been inspected. 492—Obtain full Information regaxdlng Ordinance 11.16.030 and Regulations governing side sewers when you get permit. o. 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%. 0 No bends In grade shaxper than % will be permitted. NOTE No. 4—Trenches In street must he water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to Improper work which may develop within one year of completion. I NOTE No. 5—It Is unlawful to alter or do any 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 wye. ..__..___..District ""� 4X City of Edmonds --- Water Department - - TAP CARD Meter No ....... Size... :1 __ /Y ---------- Mfgrs. N�p ................................ 4 For ....... �2.K Date.... TapSize ............... * ...... ........ ....... Style ............ . ;1_� �� .5-- �� .................................... .0 ........ ............... .................... LotNo ........................................... Blk. No ................... Add. ............................................. 5VIRES ..... Service Location ................ ..... .............. MeterLocation . ......................................................................................... . MakeTap ..................................................................... ........ . .......... . ................ . .. .................................................. . .................................. . ....... ........ . ....... . ................... . Pressure.............................. lbs. Test .................................... % SendBills to .......................... . ................................... ................. ................ . ..... Date of Work .. Foreman Guar.' Voucher No ........................... . .............. $ ........... . ...................... . ..... Remarks: .... . . ..... OUTGOING Index ......... Reg ....... Route Bk.....--StenciL ..... Card..._ INCOMING Index .... . ... Reg ...... Route Bk ... . ... Stencil. ..... Card..-_ Material Chargeable to Installatioreeters No'� SIZE DESCRIPTION'- RATE .............. .......... Meter ................... i .................. .... -AMOUNT .............. .......... Meter Box .............................. .............. ............. . . ....... .............. .............. .......... .......... Meter Plate - , , --- � ­ , "'77: ------ 7TTI: ----- Check Valve ......................... -------------- .............. -- - --------- - - --------- ---------- ---------- .............. .......... Pipe, Galv.,,5crew .................. .............. .. . ......... .......... .............. .......... Nipples .................................... .............. . ......... .......... .............. .......... Bushings ................................ . .............. T,,,-.. � ..... T .......... ............... .......... Plain Ells .......................... .... ................ . ...... .... .......... .......... . ... .......... St. Ells .................................... .......... ... ...... I ..... .......... .......... . ... .............. .............. ............... ............... ............... --------------- ........ z ..... .......... .......... .......... .......... .......... .......... ..... I .... . . T ......................................... ...................................................... ..................................................... ...................................................... ...................................................... ........... .......................................... ...................................................... ...................................................... ............... .............. .............. .............. ............... .............. .............. ............ ............. I ............ ............ ........... . ......... ............ ------ --------- .......... .......... .......... ........... .......... Material Chargeable to Taps Connected NO. SIZE DESCRIPTION RATE ' AMO NT .............. .......... Pipe, Black Screw .................. ............. ............. ......... .............. .......... Pipe, Galv. Screw .................. ............... ............. ......... .............. .......... Lead Connections .................. .............. ........... . ......... .............. ........... Curb Cocks ............................ .............. .......... . ......... .............. ........... Corp. Cocks ............................ .............. ............. ......... .............. .......... Unions .................................... .............. ............. I -------- ............... ..... .... Saddles ..... .......................... ... .............. ........... - --------- .............. ........... Niovles .................................... ......... _.. ............ ......... ............... ......... Bushings , .................................. ....... ...... ............ .......... --------------- ---------- Plain Ells ................................ ............ ............. .......... .............. .......... Street Ells .......................... ... ............. ............. .......... ............. .......... Tees .......................................... .............. ............ .......... .............. .......... Curb Boxes ............................ .............. ............. .......... .............. .......... S. 0. Extensions .................... .............. . . .......... ........... ............... .......... Gates .. ...................................... ............... ............. ........... .............. .......... Plugs ......................................... ............. ............ .......... ............... .......... Couplings ----- * ........................... .............. ............. ......... ........... I .. .............. .............. .............. .............. .............. .......... .......... .......... .......... .......... ........... Gate Boxes ............................ ..................................................... I ....... ............................................. ........................................................... ........................................................... .......................... ......................... .............. ............. .............. ............. ....... ...... .............. ............ . . ......... - - --------- ------------ ............. ............. ........... ---------- -------- ......... . ....... .............. .............. .... . ........ ............. ­ ........... .............. ........... ..... .......... .......... .......... .......... .......... ............................................................ ................................... . . ................... ........................................................... .................... : ...................................... I .................................. v ....................... ........................................................... Hours Time —Day Men ........ .............. .............. .............. ................ .............. .............. .............. .............. ......... -- .............. ............ ........... ............ ..... ...... . ........ - -------- .......... .......... . ........ .......... ........... .......... ......... Hours Time —Monthly Men .. ............... ------------ - --------- . ............ Hours Time —Auto ................ .............. ............ .......... .......... ................ :'S6perinte�dence .. ....................... .............. ............. .......... ............... ........ . . Total .................. 1.,, ... .... ....... . ... .... TAX ACCOUNT/PARCEL BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) bz�)tb CRITICAL AREAS�-/2 DETERMINATION: []Conditional Waiver OStudyRequired KWaiver DISCRETIONARY PERMIT #'S:V- a") DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS (OTHER): jqj� -71 IOU PLANNING DATA CHECKLIST DATED: 4 SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT. FILE: (Dp . (,e,+ LOT: BLOCK: SIDE SEWER AS BUILT DATED: - SIDE SEWER PERMIT(S) #: GEOTECH REPOR I DA I ED: "I STREET USE/ ENCROACHMENT PERMIT#: — FOR: La"ItAcic%un), WATER METER TAP CARD. DATED: OTHER: LATEMP\DSrs\Fomis\Street File Chccklist.doc -C. Jb7- #P20 City. 61tdmonds Development Services Department Planning Division Phone: 425.771.0220 Fax: 425.771.0221 The Critical Areas Checklist contained on this form is to be filled out by any.per§on preparing a Development Permit Application.for the City of Edmonds prior to his/her submittal of the application to tile 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 heeded to- complete the Checklist � should be.,easily, available fi-orn observations of the site or data available at LRRFMsMMaaps._or. soil APPLICA PON PM, i n-Qt%- Date Received: ( 111-1 City Receipt M Critical Areas File o. Critical Areas Checklist Fee: $13500 Dat,qMayly.6�q Applicant: F�— Z - 2_-oc)Q A property owner, or his/her authorized representative, must fill out the checklist, sign and date it, and submit it to the City. The City will review the checklist,.make a precursory site visit, and make a determination of the subsequent steps necessary to complete a development permit application. Please subn-dt a vicinity map, along with the signe d copy of this form to assist City staff in finding and locating the specific piece of property described on this form. In addition, the applicant shall include other pertinent information (e.g. site plan,, topography map, etc) -or s tudies in con unction with this Checklist to assistant staff in, completing their preliminary assessment of the site. The undersigned applicant, and his/her/its heirs, I and asE�s, in consideration on the processing of the application agrees to release, indemify, defend and hold the City'.of Edmonds harmless from any and all damages, including reasonable attorney's fees, . arising from any action or infraction based in whole or part upon false, misleading, inaccurate * or incomplete information furnished by the applicant his/her/its agents or employees. By my.signatur�, I certify that the information and exhibits herewith submitted are true'and correct to the best of my knowledge and that I am authorized to file this application on the behalf of the owner as listed below. SIGNATURE oF APPLIcANT/AGENT /�ffd DATE: Property Owner's Authorization By m y- signature, I certify that I have authorized the above Applicant/Agent to apply for the subject land use application, and grant my permission for the public officials and the staff of the City of Edmonds to enter the subject property for the purposes of inspection and posting attendant to this application. SIGNATURE OF OWNER DATE PLEASE PRINT CLEARLY Owner/Applicant: . W i I I wm.4, L, Name Street Address C� IbO2,� city State Zip Telephone: 14 2 -5 'M � ­6 ( C 7-2-- . Applicant Representative: Name - Street Address City State Zip Telephone: Email address (optional): b,,af6(-e1p__f aL r Address (optional): #P20 CA File No: &M -.06 - W3 Critical Areas Checklist Site Information (soils/ topography/ hydrology/ vegetation) 1.. Site Address/ Location: 2. Property TdxAccount Number: IA OLA t 000t� b 2-SDID 3. Approximate Site Size (acres or square feet)- --.14.�- 4. Is this site currently dev- eloped? Zyes; no. If yes; how is site developed?. yLk(x Jel." 5. Describe the general site topography.'!Check all that apply. V" Flat: less than 5-feet elevation chanze over entiresite. Rolling- slopes on site generally less than 15% (a vertical rise of 10-fe6t over a horizontal 77 distance of 66-feet). ITIA1 Vit NO I'l �1 51;6ss 0 t -lirp -1 d (a joveitiai djj(Lf eet Hilly: slopes present on site of more 1 has I I ni over. a horizontal distance of 33 ro ater than 30%'present on'#t Steep: grad . es� of gre erti cal -iO'e rdf�ilkf e&ef by 7 ,er hdriidntal� -feet). distance of less than 33 Other (please describe): 6. Site contains areas of year-round -standin water: o .9 Approx. Depth.. 7. Site contairmareas of.seasonal standing water: Approx. Depth: What season(s), of the y6aA 8. Site is in the-flood,,,My floodplain 'a watercourse. 9. Site coiltais a creek or an area where water flqws across the grounds surface? Flows are yea�r-round? Flows are seasonal7, AJO— (What time of year? 10. Site is primarily: forested meadow shrubs n-dxed urban landscaped (lawn, shrubs etc) 11. Obvious wetland is present on site: For City Staff Use 6dy -4 M56- 1. Plan Check Number, if applicable? 2. Site is Zoned? 9,5-(o 3. SCS mapped soil type(s)? & - Al tte rw. A k, JA,-A LIWL9�, 15 % J I-P-ej 4. Critical Areas inventory or C.A. map indicates Critical Area. on site? No 5. Site within designated earth subsidence landslide hazard area? DETERMINATION STUDY REQUIRED WAIVER Reviewed by: Date: G'/ 2-1 a& Zone Setbacks Front Sides Rear Other Height r7/11 STREET FILE -ce CAI 0,1 5014 W1191 4:, f (b 144-- 1) rL? a!k- &' 30 H io Comer Flag� Reguiredp(.,,. Actual 0 01 M -0- T APPROVED* BY PLANNING APPRO S NOTED ER D4e. RECEIvED- JUL 19 20)6 DEVELOPMENT SERVI(js CTR. CO OF EDMON 0 �7= �j ,A (Q uj LL. ' 7 LU 'A CJ2 W6- LU C= Cu C14 zal"w, � 0 I'* FILE' romy OF EDMONDS 13UILDING DEPARTMENT woox AnnRESS-,�=4 YA9�� 2,57- APPROVED DATE.- 10 BLDG. OFFICIAL CT6A�;,a,- --i'm PERMIT NUMBER aozz L 7-6,F11 COPY RECEIVED OCT 2 2 2001 BUILDING DEPT, E PLANNING DATA STREET FILE NAME: I- P64-Aet &�� DATE: 81AIO& SITE ADDRESS: IR301 A-'eL4tr Sf�- PLAN CHK#: Z,40& - c�n, PROJECT DESCRIPTION: -fe-nu Am 4.,-4-c REDUCED SITE PLAN PROVIDED?: &I No) MAP PAGE: '35-& CORNER LOT: FLAG LOT: (Y—es �/ ZONING:_ (ZS - 10 —CRITICAL AREAS DETERMINATIONM 2-dD4 - 0103 LJ Studv Reauired: 21 Waiver QConditional Waiver SEPA DETERMINATION: LJ Fee L1 Checklist L3 APO list w/ notarized form Li SNeeded for . 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger) [&Exempt SETBACKS: Required Setbacks: o Street: Left Side: Right Side: Rear: Actual Setbacks: Street: Left Side: Right Side: Rear: Street map checked for additional setback required? (Y s/No/DRA) Q PETACHED STRUCTURES: f L3 ROCKERIES: Lff FENCEsrrRELLISES: L3 BAY WINDOWS / PROJECTING MODULATION: LJ STAIRS/ DECKS: Ala-_ C 1w, PARKING: Required: 2- Actual: - LOT AREA: LOT COVERAGE Calculations: BUILDING HEIGHT: Datum Point: Datum Elevation: Maximum Allowed: /0 Skew,) 'V Actual Height: V A.D.U. CREATED?: (No / Yes) SUBDIVISION: LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED: (Yes / No OTHER: * M Plan Review By: .L4 F-tol 17. 3a, o 35,. c. 1. 1 L,,-7g- - ?- ". ti 45"17. - Ok- NewBPPlanningDatfforrn. DOC "21 - 7- '0 ON �LL M" f)70559 HILDING AppUCIMt ZIU [OR P pERMIT APPLICAT f A,, 11, NARZ Oy JJU&��) ariasT a=MACK SETIIA IS VA 9 U.3 0 NO ZMv- v 4" (b 101 41! er D.FLCI=CT -M 0 0 wra= R/%r comp. P�v ar. R'w dl N"JI 6 &= am CA A= X"O'pc By % A 4", .22 46 Tye% CON.'COLMON 4IM-1 RP I z 'm'"VZD muz zm" Or E3 TZO 13 TIc 0 LLIE G" E] t o 88= ADD E.WMO WALA. N DEMOLUM 0 CAVAT)c ALTM: ZT. El on FILL ffonu r'MOVz or �WrLJXIG RX A v V r� cb-t 'T blITF VMLDLNO 40- A, -v 7 FLON33ING a V"T A GAM tmm �7( a R=AnUVO WALL o svrntml.40 POOL p pmx, x OMVME 10� Ll EXCAVATION OR M-L Ll DEKO—, TOTAL AXOU�. DCE —I.dV _jIo sod ATTX--.-nw% APPLICATION APPROYIAL:'�' latinx —tr�: —1 Twa rzz= o, Co�' of =applicati= is not a peradt WIt" W AUTHOSEM$ sign th. B.UdMg OfnAW Or bin DeP- w W.�' 0.�r Tm uty- and fees aIv Patd- ROd recelPt 's me - it One Yeaf 0,'c"t D"OLMON's wOmR.M711M j��edged ta apse. p-Tid- ermit Um -.0 NO E: 5uamLw �n ,0 o CTI-Y or D� 0 EDMONM ri pl_ Cbeck Fre ru �Ilv NOTE: A-hplicant Su�jtcl 10 to 1� � — , Y,*.:x 9� o— fto—o OV ED_4 1P 4'' PHONE: (425) 771-0220 - FAX: (425) 771-0221 CITY OF EDMONDS, 121 5TH AVENUE NORTH - EDMONDS, WA 98020 STATUS: APPROVED ENG20130187 Encroachment Permit Permit Number: ENG20130187 Address of Public Use/Encroachment, 18301 ANDOVER ST, EDMONDS PROPERTY OWNER BUSINESS OWNER 18301 ANDOVER STREET EDMONDS, WA 98026 flowering plum trees in row (originally permitted in 1975) STREET USE. Placement of any temporary or movable objects in any portion ofpublic space or City right-of-way. shall meet all code requirements as setforth in thefollowing chapters of the Edmonds Community Development C6de. ENCROACHMENT.- Permanent structures encroaching upon any portion ofpublic space, City right-of-way or easement area shall meet all Code Requirements as setforth in thefollowing chapter of the Edmonds Community Development Code. CODE APPLICATION. Chapter 18.70, 17.65, and 17.70.040 of the Edmonds Community Development Code. All terms of the adopted ordinance are incorporated herein as ifsetforth in full and this permit therefore is subject to the terms of those chapters. FOR THE TERMIN WHICH THIS PUBLIC USEIENCROACHMENT IS IN EFFECT, THE 0 WNER SHALL COMPL Y WITH THE PERMIT CONDITIONS SET FORTH BY THIS PERMIT. NOTE. The issuance of this permit is understood by the owner to be of a temporary nature, shall vest no permanent right and shall be issued and may in any case be revoked at the sole discretion of the City per ECDC 18.70.040. Applicant is responsible to provide a copy of the insurance certificate to the City at the beginning of each calendar year, no later than the 21st day of January. INDEMNITY.- The Applicant understands and agrees to hold the City of Edmonds harmlessftom any injuries, damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the applicant or the City ofEdmonds, or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs, court cost, and altorneyfees by reason ofgranting this permit. In addition, the applicant understands that helshe shall provide and continually maintain during the term of the permit a ceritificate of insurance naming the city as an additional insured, with respect to liability, andproviding that it shall be primary as to any other policy of insurance. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE CITY ENGINEER OR HISMER DEPUTY: AND FEES ARE PAID, AND RECEIPT IS ACKNOWLEDGED IN SPACE PROVIDED. Printed: Friday, April 12, 2013 RELEASER BY N I DATE F-1 FILE COPY - F-] INSPECTOR COPY F-1 APPLICANT COPY STATUS: APPROVED ENG20130187 CONDITIONS The proposal will not adversely impact public space open to vehicular or pedestrian travel. Architectural Design Board Approval has been granted or the process has been administratively approved. The proposal will not unreasonably interfere with the rights of the public. The proposal either benefits the public interest, safety or convenience (e.g., supports or protects the city street) or is an accessory structure such as fence normally associated with residential use of ihe property as fully complies with the requirements of criteria above. Applicant shall repair/replace all damage to utilities or frontage improvements in City right-of-way per City standards that is caused by or occurs during (the permitted project. Sound/Noise originating'from temporary construction sites as a result of construction activity are exempt from the noise limits of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with the noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120. Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend.and hold �ar'niless the City of Edmonds, Washington, its officials, employees, and agents from any -and all claims for damages of whatever nature, arising directly or indirectly from the issuance fo this permit. Issuance of this permit shall not be deemed to modify, waive or reduce any requirements of any City ordinance not limit in any way the City's ability to enforce any ordinance provision. INSPE-CTIONS I 0 None STREET FOE CITY OF EDMONDS ENGINEERING DEPARTMENT 505 BELL STREET EDMONDS, WASHINGTON 98020 APPLICATION FOR STREET USE PERMIT Name of Applicant:- Gu 0 1 'RECEIVED MAY 19 1975 - Mailing Address: &301 JqAJ DO Oe- Telephone Number: -7 7 C/ - (o -1 C) 3 Date: 15- Description of Public Place or Portion thereof desired to be used: (exhibit may be attached) Oy-act- if-) dv:c Rx? e- AJ C e- Type of Use desired to be made of Public Place:__L6,,j A JC /tIC3 C.0 e AL L4 ti -Fo- e- eg If applicable, attach plans and specifications for any utility or.structure to be erected and/or maintained on the Public Place: TEMPORARY PERMIT: Unless otherwise designated herein, this permit is understood by appTicant to be wholly of a temporary -nature, that it vests no permanent right whatsoever. If the permitted use becomes dangerous or such structure shall become insecure or unsafe, or shall not be constructed, maintained or used in accordance with the provisions of this title, the same may be revoked and the structure and obstructions ordered removed by order of the City Engineer.' If this application is for a specified period of time, the terms of said application is: INDEMNITY: Applicant unde * rstands' 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 descrip- tion whatsoever, foreseen or unforeseen, that may be made against the applicant or the City of Edmonds, or any of its departments or employees, includinq but not limited to the defense of any legal proceedings including defense costs, court costs, and attorney fees by reason of granting this permit. In addition, applicant understands that the City shall be provided a certificate of insurance to indemnify and hold the City of Edmonds harmless from all claims and/or property damage, naming the City of Edmonds as an also i,nsured. APPLICATION OF CHAPTER 6.40 OF THE EDMONDS CITY CODE: Applicant warrants that he has read, or had the opportunity to read, Chapter 6.40 of tE—e dmonds City Code, attached herewith, and understands that all terms of that Ordinance are incorporated herein as if set forth in full and this application and permit therefore are subject to the terms of that Chapter of the Edmonds City Code. Applicant's Slignature Date 11/7/74 rev. City of Edmonds Engineering Department APPLICATION FOR STREET USE PERMIT Page 2 Approval (and Agreement, if applicable) of Abutting Pr operty Owners: Siqnature, Printed Name Address n. Da te —13-95 DO NOT.WRITE BELOW THIS LINE (To be completed by I ssuing Agency) City Council Approval (Attach Minute Entry): Permit Fee: Annual Fee: due January 1, 19 Amenities Design Board Approval'(if applicable). Attach, Minute. Entry: Building Offici'al Approval (if'applicable),: A4 Si�nlature Date Provision floe Indemnity: Terms and Provision of Performance Bond, if applicable: (Reference 6.40.050 of applicable Ordinance) PERMIT AUTHORIZATION BY.CITY ENGINEE R:( Is;2--170 Signature .,Date PERMIT -NO.- DATE__;�- '1'.11/7174 rev. 40 It 1­7 - 1 4__ - J 10 j- - A, 1 11 Fl4 —4-4 I owl 44 L P4 i T + Li Jr 4 tt cu A T_ I t A T -40 —i J -i T t -4- + 1-41 Fttt It t I p it- -4 1-4 T-- I TT 7-7, -4- 4- i Ek"OFFICE copap.&OCAWS OATE May 19, 19 75 TO Rod Garretson FROM Leif Larson Director of Parks & Recreation City Engineer SUBJECT: Street Use Permit -Application -- Kenneth D. Hood Attached is a.copy of subject application which requests approval -to landscape and plant flowering plum trees on Andover Street. Please submit this application for consideration and comments to the Street Tree Committee and return at your earliest convenience. . rf Attachments RECEIVrD MAY 2 2 1975 r�o V Wands Engr. Dept -e *a NURKS DEPART= BUILDING PM,,aT REVIEW Y6� 176 Date 0 Z FA Z Z j6\tLrx�,yL—_�Address Street Right -of -Way Existing' REQD. Access Easements Existing REQD Utility Easement Existing REQD Lot per Subdivision Plat Assessor Map' Site Plan Checked for Accuracy Underground Wiring Reqd. Check*Accuracy of Legal Description Environmentally Sensitive Area Environmental Checklist Reqd. Flood Hazard Zone Shoreline Management Area Slope, Soil, Vegetation LAI Stream, Creek, Drainage Basin I\J (A Existing Zoning Per Code Amenities Design Board Approval Reqd. ADB # Approval Board of Adjustment Approval Reqd. Review By Date: Existing Water Main Size Water Main Reqd. Service Line Reqd. Hydrant Size Existing Hydrant Reqd. Per Fire Code Size Detector Check Meter Reqd. Cross Connection Inspection Fire Department Cxxmients, Water Meter Charge Reqd. Review by: Date: Septic Tank Permit Reqd. Sanitary Sewer Availability Drawing No. Side Sewer Availability Sanitary Sewer Connection Fee Reqd. Revie%T By: Date: Permit No. Proi - File No. k� . R -i Existin eqd. en Mtcl Culvert Reqd. Size v4 :Catch Ba,,�in Reqd- Indicate on Site Plan. 0 Shoulder &-ainage. maintain collection on swale open rLU-1off tn r.eqd. Indicate on . Site Plan Soil Conditions and Ground Water Field Cliecked Re,-\rieA'7 by TX- I te Ccreet Paving Reqd- Curb and Gutter Reqd. Sidewalk Reqd. Curb Cut: for Driveway Reqd. Ri . ght-of-Way Construction Permit Reqd.' Bond Reqd. forPublic Improvements Street Nam Sign Reqd. Other Simin- Reqd. Pre Permit Site Inspection made on 0 BY: SEWER U WATER H STREET ENGINE ERING 5 Special Requireny-,nt:s listed in mem to Con=i�y- Developn-ent Department, �Building Division NBY Date o All items filled in on Building Permit Application BY Date p-, Drawings Stan-ped and Notations Made BY Date d by Public 14orks DeparLiTo-it: ,jApprove Revised: J.v 10-1977 -HOOD C2 The City of Edmonds APPLICATION Ly� �, for J. NT SEDE SEWER PERMIT EASEMENT No . .......................................... NEW CONSTRUCTION 0 REPAIRS [3 (�/ OWNER Af-If-vftl-A ... --- Te ....... * ......... ij CONTRACTOR ...... 11M�-?.� .......................................... PERMIT No. ADDRESS .... ....... . .................. LEGAL DESCRIPTION: LOT No . ............... ............................. BLOCK No . ....................... ............. NAME OF ADDITION ......... SO, 9 ....... . . ..... "A7 LL Lu Lu cc APP, %:A?4 5 j9tw Approved: DATE .. ... .......... By DY—r F y1bb"O" cq - IL ^k . 414 7vA calox F, 7K 7, T/W