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18629 79TH PL W
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Permit No.
MET FILE
CIT.,VOFEDMONDS r. I o i H
COMMUNITY SERVICES DEPARTMENT
RIGHT-OF-WAY . CON STRUCTION PER MIT Issue Date
A. 0 Owijep n e-
Nam
Mailing Address
_Einfands
City , State Zip
C. * Address or Vicinity
Type of Work to be
D. 0 Work in Connection With:
Iq /V
B o Contractor:
N�me
420 _,;Z 6
Maili
yfig Address
City' State. zip
�tate'License Number Telephone Number/
_7X
/�Fl, lat Y Single Family 1� City Projects
El Commercial
11 Multifamily 0 Utility
E. 0 Pavement Cut: [I Y El N F.'* Size of Cut: — X
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City,f0f 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 thi's permit.
THE CONTRACTOR.IS RESPONSIBLE FOR WORKMANSHIP AND. MATERIALS, FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
Estimated restoration fees will be held until the final streetrpatch is completed 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 Engineering: 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 above and that this permit must be available at the job site for inspection purposes at all times.
Signature: Date: —
Owner or Contr/ctor
This Permit Must be Posted at the Job Site For Inspection Purposes
/Call DIAL -A -DIG Prior to Bog , inning Work
'r /./ // - I .
APPROVED BY:
Time Authorized: Void after days.
Special Conditions:.
RELEASED BY!
PERMIT FEE:
Restoration Fee:
Receipt No..:
Fuhd I I I Fee:
Street Cut Dimensions:
INSPECTED BY
NO WORKTO BEGIN" PRIOR TO PERMIT ISSUANCE
Date
Frig Div. March 1Q8Q
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.) �
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 11 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
Date:
Date:
� I
Eng. Div. July 1985
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds,, its Employees and Consultants.
The City of'Edmonds does not warrant the
accuracy of anything set for * th on these
map(s). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
the rnap(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may'not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
emp-l-oyees or officers Shall be Ha-bl-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
APPLICATION
for
fhe�City of Edmonds sypEET FILE S11DE SEWER PERAHT
NEW CONSTRUCTION A REPAIRS F1
,/C:� �,,
WN' PLANT
EASEMENT No . ..........................................
Z?2!
OWNER -----
/.. NTRACTOR ............... .......................................... ...... PERMIT No<��)
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ADDR ,ss .........
...... . ........................ .................... LEGAL DESCRIPTION:
LOT No . .............................................
BLOCK No . ...................... .....................
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NAME OF ADDITION ..... ................ MONTE &LL0 09kv,
............ ........ ja .........................................................................................
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Approved:
APPROVED
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#'e —
DATE ........... BY .................
:CITY OF EDMONDS
i,,,,:-C1V1C CENTER — WATER -SEWER DEPARTMENT Call PRosPect 6-1107 when work,
is ready for Inspection.
(No inspec-
tions Saturday, Sunday or holidays.) No 2226
SIDE SEWER PERMIT
-ADDRESS ................................... 18629 - 79th Place Wes
IC......... ................................. I ............................. t .........................................................................................
�_-,-,-.OWNER ............... jamq�p ... TA mqqrp�$ .... Jr ...................... ......... CONTRACTOR ........... Owner,
................... ......................
Permission i's grant&] .... ... Nay.J1,Q_ .......... ......... 19.Az, for ...... : .................. days to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinancesi
ATTF14TION 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 axea. Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—Obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
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
. 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 %vye.