18716 92ND AVE W.PDFiiiiiiiiiiii
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18716 92ND AVE W
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CITY OFZDMCINDS'Z�
USE PERMIT
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NUMBER
CONSTRUCTION PERMIT APPLICATION
J B SLITAPT #
I. DRESS OF- 114�
OUWN , NAME NAME OF BUSINES
LEGAL DESCRIPTION CHEC
SUBDIYISION NO.
LID NO.
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MAILINZ ADORESS
PUBLIC RIGHT OF WAYPIER OFFICIAL,STREE��:
EXISTING ___,4�f-ii'OUIRED DEDICATION
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ROPOSED
TESCP Approved 10—.;�
RW Permit Required 0
Street Use Permit Req'd 0
inspection Required -6—
Sidewalk Required 0
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ZIP
1'L1*V"1J11E NUMBER
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ICITY
NAME�
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 0
ADDRESS
4?.1/ 1Vor44,er-.i 43,,
—FL—EP.ONE
REMARKS
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ZIP
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NUMBER
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NAME
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ENGINEE ING MEMO DATED REVIEWED BY
s 7.27 / 9�
CITY 4P
NUMBER
FIRE MEMO DATED REVIEWED BY
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STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA'
SEPA R IEW
ADS NO.
ALLOWED PROPOSED
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COMPLETE EXEMPT
SHORELINE N
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Legal Description.o.f P.roperty - include all easements ,
6 to c Ooj, 3 7
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VA RIANCE 00 CU
PLANNING REVIEW BY
DATE
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P'ope",
T.. A ... nt
Parcel No.
SETBACKS — FEET
FRONTZ5' 'SIDE C) REAR Z51
HEIGHT
Z5'1
L6T COVERAGE
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EMARKS
NEW RESI D*E61AL PLUMBINGIMECH
COMPLIANC OR
ADDITION El COMMERCIAL CHANGEOFELISE
REMODEA.,v El APT. BLDG. SIGN
CHECKED BY
TYPE OF CONSTRUCTION
7A
CODE
ql/
OCCUPANT
GROL-3
GRADING ' FENCE
REPAIR R — CYOS. 1:11A x7____FTI
0
DEMOLISH WOODSTOVt SWIM POOL
El INSERT HOT TUB/SPA
FIGARAGE RETAINING WALL/
C ROCKERY RENEWAL
YPEOF USE. BUSINESS RACTIVI Y)EXPLAIN:
SPECIAL INSPECTOR
REQUIRED E3 YES I
AREA
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER USC 108
NUMBER
OF
STORIES
NUMBER OF
DWELLING ofoe
UNITS
CRITICAL
AREAS J!!�J/ 23;
I NUMBEF17(p
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SCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
-
FINAL INSPECT11ON REQUIRED
Kre- otove- o(-b poi,�k. 1,;j Doer
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VALUATION
FEE
PLAN CHECK FEE
awoerll;�
BUILDING
HEAT SOURCE: GLAZINGr
%
PLUMBING
Plan Check No.
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H , AN , ICAL
GRADINGIFILLI
This Permit covers work to be done on prIvate.property ONLY.
Any construction on the public domain (curbs, sidemiks,
driveways, marquees, etc.) will require separate��perm I as Ion.
STATE SURCHARGE
0
Permit Application: 160,Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
ENG. INSPECTION FEE
,-- "Applicant, on behalf of*his or her spouse, heirs, assigns and
successors in interest, agr I ees to indemnify, defend and hold
ow
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harmless 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
of this permit. Issuance of this permit shall not be deemed to
modify, wa ive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
P /V
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I hereby acknowledge that� 06e read this al:$,Ij�gltlon; that the
iriformation given Is correc"t; a6b that I am the d . �;ner, or th.e" duly A17ENTION APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state laws regulating construction; and In doing the work authoriz- AUTHORIZES This application is not a permit until
ed thereby, no person will be employed In violation of the Labor ONLY THE signed by the Building Official or his/her
Code of th WORK NOTED Deputy; and fees are paid, and receipt is
Otate of Washington relating to Workmen's Compansa.
Bribe and RCW 18.27. INSPECTION, acknowledged In space provided.
PWNER OR AGEtff) DATE SIGNED DEPARTMENT
OFFICI�M /DATE�
CITY �OF 10 7
EDMONDS.
CALL FO R ED BY: 64E
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771 0120 ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109 ?
10247- PINK — Owner GOLD — Assessor
PERMIT APPLICATION REQUIREMENTS
To: Applicant
From: Jamal Mahmoud, Engineering Inspector
Owner: Wa tJ 1� 4 2- ci-v1,10 ev Plan Check No: TRFFT FILE
Date: I'S
Address:—i %-7 1 92- ", L4/- f7
----------------- ; ------------------ - ---- - --- - - - ------------------------ - -------------------------------------------- - --------- - - -------- - -------------
After review of the subject permit application, the following requarements must be met:
I . Construction hours are: WEEKDAYS - 7:00 A.M.-10:00 P.M.;WEEKENDS/HOLIDAYS -- 10:00 A.M.-6:00 P.IVL
2. A separate RIGHT-OF-WAY CONSTRUCTION PERMIT is required for all work on public property. (ECDC 18.60)
3. Truck haul route plan must be submitted and approved prior to permit issuance.
4. Builder/owner is responsible for containing all temporary runoff and erosion control on site (ECDC 18.30.030d).
5. NO WORK SHALL BE DONE WITHIN 15 FEET OF STREAMS OR 10 FEET FROM ANY CLOSED DRAINAGE
FACILITY. BUIELDER/OWNER IS RESPONSIBLE FOR IDENTIFYING CONDITIONS ON THE DRAWING.
(ECDC 18.30.50G)
6., FILTER FABRIC FENCE SHALL BE INSTALLED AND INSPECTED PRIOR TO CLEARING AND CONSTRUCTION.
(ECDC 18.30)
7. INSPECTIONS ARE REQUIRED ON STORM DRAINAGE SYSTEMS, TIGHTLINES AND CATCH BASIN
INSTALLATION. INSPECTIONS ARE REQUIRED PRIOR TO BACKFILLING. (ECDC 18.30)
8. Repair or replace all defective existing curb, gutter and sidewalk adjacent to the property. If an intersection is involved, a handicap ramp
may be required. Contractor shall meet with the City Engineering staff -to determine the extent of repair prior to issuance of the permit.
(ECDC 18.90)
9. Driveway slope shall not exceed 14% without a waiver. Every attempt should be made to keep the slope below 14%. Waiver granted to
(ECDC 18.80.060D)
10. Driveways must be paved from property line to City RIGHT-OF-WAY. A separate permit is required. (ECDC 18.80.060C)
11. INSPECTIONS ARE REQUIRED ON DRIVEWAYS AND SIDEWALKS PRIOR TO AND AFTER POURING. (ECDC 18.30)
12. No burning of construction refuse without a permit from the Fire Department.
13. Connection to City water system is r equired. There is a separate charge for the water meter (ECDC 7.20).
14. A back water valve is required if downstaiis plumbing is below the elevation of upstream manhole. (ECDC 7.20)
15. Water and sewer main lines should be separated by 10 feet minimum. (ECDC 18.10)
16. Connection to the City sanitary system is required. A separate permit is required.
LID#. Fees paid: Yes— No— Charge— 3 0 (ECDC 18.10)
17. Underground wiring is required on all new construction, and for additions, alterations, and repairs that exceed 50% of the total assessed
.value of the structure. (ECDC 18.90)
18. A FINAL ENGINEERING INSPECTION IS REQUIRED PRIOR TO THE BUILDING DIVISION GRANTING OCCUPANCY
OF THE BUILDING OR STRUCTURE. (ECDC 18.90)
PF1sTrAPP.1=
Im wl
APPROVED BY PLANNING
STREET Fil E
16.
A N
ENGINEERING I '-; Bac Add? tal D
ROUTE TQ_a2� Ono- k To ays_Mailed
kESUB #I ON TO Back Add? —Total Days Mailed
RESUB #2 ON TO Back . Add? Total Days
1. Site/Drainage Plan & Calcs
W;A cod-e
OK
2. Grading Plan/Calcs/CYG SEPA? OK 61
3. Driveway Slope % Profile OK c> k
4. Truck Route Plan
5. Street Dedication?
6. Easement
.OK—C) k-
FEET
Type /v'O _OK.
OTHER COMMENTS:
Mailed-
b
Corrections Required Received
3
4.
5.
PW REVIEW Date Sent Back FIRE REVIEW Date Sent Back
PLANNING REVIEW TIME ej TOTAL DAYS **.* ENG REVIEW TIME —TOTAL DAYS
FIRE DEPT REVIEW TIME
TOTAL DAYS PW REVIEW TOTAL DAYS
BUILDING DEPT REVIEW TIME: In -House Outside
TOTAL DAYS
ORDINANCE COMPLETION DATE, COMPLETION DATE TOTAL REVIEW TIME DAYS
PERMIT # ISSUE DATE
*CONTACT PERSON STATEMENT*
BY SIGNING TEIIS FORM I UNDERSTAND THAT I AM THE ACKNOWLEDGED CONTACT PERSON FOR
TMS PROJECT. IT IS MY RESPONSIBILITY TO COORDINATE ALL SUBMITTALS WITH TBE CITY
AND ONLY I CAN MAKE INQUIRIES ON THE STATUS OF THE PERMIT. I UNDERSTAND THAT IT IS
MY RESPONSIBILITY TO DETERMINE IN ADVANCE OF PERMIT SUBMITTAL ANY DISCRETIONARY
PERMITS THAT MAY BE APPLICABLE TO TE[IS PROJECT. I ACKNOWLEDGE THAT TO THE BEST OF
My ABILITY I HAVE SUBMITTED ALL NECESSARY DOCUMINTATION IN ORDER TO MAKE A
COMPLETE APPLICATION.
Signed
Contact Person (Print Clearly)
Y Y
Phone Numbei FAX Number
Date
Mailing Address
ROUTE.DOC/L/Temp/Bldg/Forms-5/96
Critical Areas Checklist
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Site Information (soils/topography/hydrology/vegetation,�
Locat' MGJ
1-d
1. Site Address/ ton:
Property Tax Account Number- 4 *P*td OAA- 06
.3. Approximate Site '-Size:(acres or square feet): 0 CVe
4 Is, this site. ciirrc6tI"eve1opW.
__r yes; DO.
If yes; how is site developed7 koose
5, Describe the general site topography- Check all that apply.
VI"Flat: less than 54�et el�e'v"ation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet -over a
horizontal distance of 6&feet).
Hilly: slopes present on site of more than 1.5% and less than 30% ( a vertical rise
of 10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains arm of year-round standing water- NO Approx. Depth:
A/ Approx. Depth:
7. Site contains areas of seasonal standing water:
What season(s) of the year?
8. Site is in the floodway floodplain of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? 4jo Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow _; shrubs mixed.
urban landscaped (lawn,shrubsetc)
11. Obvious wetland is present on site: A/0
For City Staff Use Only
1. Site is Zoned? -Z_
2- �CS rmpped soil type(s)? M,0 awV4,'M
3. Weiland inventory or CA. map indicates wetland present on site?
4..;*. :-,.Critical Areas inventory or C.A. map indicates Critical Area on site?' Ala
S.. Site within' designated earth subsidence landslide hazard area?
6. Site designated on the Environmentally Sensitive Areas Mao. A10
DETERMWATION
----§TUDY REQUIRED
AIVER
Reviewed by:
Plann.
ReVOMMM
CONDMONAL WAIVER
liate
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4�4
1?9C
-;JUN
2,4199
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_A 4
PERMIT
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R 6 .19
UNTFR
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ri i a eas.t.' hecklist.
'Me Critical Areas Checklist contained ion 'and submit it to the City. The City will
this forin is to be filled out by any person review the chedklist,. make a precursory site
preparing a Development Peintit visi4and make a determination of the
Application for the City of Edmonds pnor subsequent steps necessary to complete 'a
to his/her submittal of a development
development permit application.
permit to the City. .4
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
inforn*iation needed to complete the
Checklist should be easily available from
observations of the site or data available at
City Hall (Critical Areas inventories, map S*,
or soil surveys).
An applicant, or his/her representative,
must fill out the checklist, sign and date it,
With a signed copy of this form, the
2PpfiCant should also submit a vicidi map
or plot plan for individual lotsof the parcel
with enough4etail that City staff can find
and identify the subject parcel(s). in
addition, the applicant shall include
other pertinent infonnriation (eg. �gite
Platt, topography map, etc-) or studies in
conjunction with this Checklist to assiA
staffin completing their prelintinary
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of My knowledge (fill out the Vpropriate column Wow).
Owner I Applicant: Applicant Representative:
alt Ic (A
Name
Narme,
treet Address
Street Address
S
_QJ_ M _CA)d5 I A )Q Y026 17&2
City, State, ZIP ho
n.e City. State, ZIP
Phone
tur
Signatu
Date Signature Date
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number. J7-239
--n
-11- 27
Wue Date: �A
A. Address or Vicinity of Construction: 18716 92nd Avenue W.
co GTE to plase, operate, and maintain a-Vu—rTecF-service
9 0 1 9 C) B. Type of Work (be specific): wire from existing pole #5129 located at 18717 92nd Ave, W.
then west to a residence at 18716 92nd Ave. W. GTE to.plow 120 ft, push no driveways.
R.O.Wi 5 ft. Please see attachad skatch-
Marilyn Holmgren, Permit Coordinator
C. 6ntractor: GTE Northwest Incorporated Contact: Dennis Alexander 771-9036 mobile 388-*358
2312C W. Casino,Road
Mailing Address: Eye rAtt., WA c)R204-1440 Phone: Maril�in 2nA/4RA-16;9R nr 71n-n78f;
State License #: —Liability4mu
':!!!!.r1nc?: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. Commercial []Subdivision 0 City Project Ig Utility (PUD.(GTE3WNG, CABLE, WATER)
Multi -Family [:] Single amily Other .................
21 --§PqNDB 242310
0.' '..' I
INSPECT R: _IN�PECTOR: I A — I
F. Pavement or Concrete Cut Yes
G. Size of
� attached sk#tehN_
TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to�iold the City ofEdmonds harmless from'injuries, damages, or
claims of any 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 thodeflense ofany legalproceeding8 including defense costs, and attorney fees by reason ofgranting thi8permit.
THE CONTRACTOR IS RESPONSIBLE FPR 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 STREET PATCH
IS COMPLETEO BY CITY FORCES, AT W11 CH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
r
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and aQc0j*letion. ,2 — / C?::)
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 pa �lhed 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 copyof thepermit willbe
available on site at all ti inspection purposes.
Signature: John H. Stewart Date: 2/10/97
or -Access Design
__7&4ontrac�t�or Agetnto))rSec Mgr
John Stewart
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED B Y:
DAYS
TIME AUTHORIZED- VOID AFTER
SPECIAL CONDITIONS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND Ill:
RESTORATION FEE:
PERMITFEE: 00
TOTAL FEE:
COMMENTS: RECEIPT FEE:
PATE:
ISSUED BY:
71
NO WdRK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diaaram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES 11 NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
-4
PEOMIT SUBMITTED BY
GTE
PEDS a
POLES 0
ROAD BORES
OVERHEAD LINES
I.D.UTILITY POTHOLE =1
UG TRENCHING ---UGT-
RvOsWo
-----—--------------—--- — ---------------------------- EOP
— — — — — — — — — — — — — — — — — — — — — - =— -t -
- --= 0 - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
711
co
CUTS.
PLANNING DATA
NAME:. W&A
SITE ADDRESS:_1 8 716 dw� tJ DATE:
ZONING. (2— PLAN CHK#: '96 71.,
PROJECT DESCRIPTION: ,1A 6"iA At,.j
CORNERLOT (Yes/No)
SETBACKS:
Required Setbacks:
Front: 2,5' Left Side: to Right Side: /0' Rear:
Actual Setbacks: Oa �z 8" 32-1
Front: Left Side: Right Side: Ale Rear:
Street map checked or additional setback required? A —(Yes/No)
-ew - 6u,*-
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED (Y/N)
LOT COVERAGE:
Maximum Allowed: 3G'7. —Actual: /4 440 14+4-01
BUILDING HEIGHT:
Maximum Allowed: Actual Height: 19'
Datum Point: Mm h�u_ Datum Elevation: (OQ
SUBDIVISION:
CRITICAL AREAS #: 96 - 13 7 — tio—ver
SEPA DETERMINATION:_!���-
LOT AREkl 95 >4"O ) - ( t�0' ) s I 4-44o
OTHER:
Plan Review By:
CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT "REET FILE
RIGHT - OF - WAY CONSTRUCTION PERMID I
A. *Address or vicinity of Construction
18716 92nd Av. W.
e Owner: Washington Natural Gas Co.
Name
605 156th Av. N.E.
Mailing Address
Bellevue, Wash. 98007
City, State, Zip Code
* Contractor:
Name
Mailing Address State License Number
285-9101
Z
< City, State, Zip Code Telephone Number
U
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE.
B. APPLICANT TO READ AND SIGN
co INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
C)
�w from any injuries, damages, or claims of any 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
0. proceedings including defense costs, court costs, and attorney fees by reason of granting this permit.
0
U Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
W
following the final inspection and acceptance of the restoration by the Engineering Division.
0
Permit No. ;,v,
Issue Date
0 Permit Issued To:
Type of Work to be Done:
Install new gas service
Work in Connection With:
El Sub or Plat El Single Family
0 Comml. / Ind. 0 Apt. Condo.
Pavement Cut: 0 Yes 0 No
0
1-
same as above
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering.
Call 775-2525, extension 220.
I understand that this perm avaiIiA4e7,,,&--fhe Job,#e for inspection purposes at all times.
Signature: Date 9-19-83
Owner or Ageni
THIS PERMIT - MUST BE POSTED AT THE JOB SITE FOR INSPECTION ' 'PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued BY:
Time Authorized: Void after —days
Special Gonditions:
Ammendments:
Permit Fee:_-�, -�n
Security Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimensions
� X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
FIELD INSPECTION NOTES
(Fund. 111 - Route cony to Street Dent.
Or%mm�" +-a -
Diagram:
Contractor called for inspection
Work Disapproved By: Date:
Work Approved By:
Inspector:
Yes No
Bv:
Date:
Date:
Ena. Div. December 1978
Toot
00: low
N 4 160.067"
K 63 -- 27- 3-D
4
NOTICE:
a nty ... o T a1c-(---. ar
0*'*w,a
N' r a-ttached
formation shown on the
The -in
map(s) was corn - plied for use by the City Of
Edmonds- its Empl.oyees and Consultants.
Th,.e City of EcIrn.onds does. not. warrant the
n these
accuracy of anything set for ' th o
m a p A n . y person or entity -requesting a
copy should conduct an independent
inquiry regarding the info'rmation shown or
tF�e -map(s), including, but not limited to, -1
the lotation of any sewer stub shown. Suc
ay, not exist and may
sewer stubs may or m
or may not exist at the location shown.
the city of Edrnoinds nor its
Neithel.
empl-o-yee-s o-r office-rs -shal-1 be 11a-b-'Fe for the
information given on this map(5), nor for
'ded based
any one representation p.rovl
upon said map(s).
"RM $1EWEVPE1RMT1%:
ONIDS, Sllbt:
p CITY �:OF E, lik
-WATkZ:SEW.,ER DEPARTMENT
'PERIM V 41H.
IT
itCall-7.70-4107; for side sew6r� inspections, illErORE, covering, any, 'portion, of, the' construction.,I,
within',' Sum;,,or�hollday �inspe6tionsj'
kkkInspdcfjon'wiII,,b& provided 2T'hours, after. request. No)�S&t.,
-V ONSTRU, �CVON ................... ......................... .............. .
................................................................................... ....
P1,
�P-ROPERTY�'�LIEGA�L�,-IDESi,bRl,'PT]ION .... t%": ...... jli� 1, �-s
. ...... ............. .......... ............ ............................ : ................... ............ i .....................................................
.................... ......................... ................ ............. .................................. .............. ...... ............................................... I ..................... ............. ...................................
7
............................................ ........................... o ....... ........
................................... ........ ........... OWNER, AND/OWBUITL DEA .....................
SS .... RaY,
CONTRAC-T-ORS�NAME,,&,,ADDRE .........................................................................................
.................................................................................. ......
Permissioni ls� granted ........ .................................. .................. :19 ......... for repair andyor conneetion'of'.a side sewer t& the city, sanitary Sewer
system in, accordance with,City, of Ediponds, ordinances.,
ATTENTION IS; CA.LLED-T&�THE'FOLLoWING,:
l—The-,,owners,�of"tbe.-pro�erty rn�ay obtain, a permi I "to; construct skver inside.property line. Alicense'd Side Sewer Contractor must be� empl6ked;Toi-construct
;Sideilseiver,-in�'street.areEL.. Do�n6t, cover -an�y,-porfl�n, 6f,,sewer,- before it has,,beew Inspected.
ArE No. 2—A�Ilt�wo�ik,,i�,erformedi�in;6ity,��ig4t--of-way
jr�q4lrestant Invasibh� of Right,-bf-Way. Pdrmit.obta. Inabl&.from. the.'City Engfnecr�s office.,
NOTE,.,No� 3—ObtaialUll' jaf4mition, r.egaxdlng,,Ordln&nc6' 11.16.r0361. an& Reg'ulafions ggverr�ing,-side;sewers,,when,,.youI get 66rmlt,
NOTE. No.i4L—Tovof.'side,�sewer must-iba I ve at le"t.'30' Inches coverage, at.,property llne�,aftd, 12, Inche'sAnside, property,'l . ine;,'mInimtuW,grade-',of 2%. No),bien'tiss,in grade
sharpertthan 1/g- Willf,be'.permitted'.
NOTE No. 5�Trenches, iw 'st be ' ater, settled and surface� of, street restored, to,,origins,11condition. ,dontractors shall be responsible for failure�;du6, itoAmproper
u . w
work which,,may,develop within one year of completiom
NOTE) No. 6- . 14t is,unlawful!Io� alter or do any other work than is -provided for in the.permit, or to do.any w6rk on. the �main * se I wer or its appurtenances except to� in-
sert the pipe into, thet wye.
DISAPPROVED) nF Date--:.....
............................ ..... ................. ....... D t
......... a e..� .... ........................ 'BY .....
...........
-t-e ............... ... . ...............
APPROVED, a By ....... ......
.. ...................................................................
Y ..........
Remarks: . ...............
............................................ ........... ................ ..............................................
....................... .............................................. ........................ ..................................................... ............... .................................... ................................
BOTH. P,ermit,.(qb p`ie&,rM1tj1,STV Be :Signed; Gwner �Of FirML Perfbrming,Cbnstructi - 6 1 n: PRIOX TorReq'uest,.For lnspection�-
..... ..... �h6reby certify �thatthe �sidEi Sewer installation co I nstructed, under, th is, permit
(Owner of
tnru`n e,
Confra.t-;n g 'ir� '"'nin
was, installed in accordance, wi�-h �,ering or, i of the, Ofty. of Edmonds,
Dated! this .. ................ day of ..... R.,�_V_
. ............... . .
V it. , Check.BEFORE: you dig for: Water 6a�s. �E]: Tclephbne E],, 'Power E],, Sew"er.E]; 6ther,E];
4
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For a good and valuable aensidm.110"R tho grartom WW8 HANN and AVEW
HANN. his wlffi hereby prant
�to the owners
and to future o
wners o
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.�ftfpl of Nei
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Dted this 2nd day of May, 1972.
STATE OF WASHINGTON
COUNTY OF SNOHOMISH
$4
s day sonally
V Opp be me
a nd t a mme nown to be the lndlv?3uals
described in d h - 9 nstinment, and
an w Q-e ecuted the within and fo goi
acknowledged that signed the same as and
I
voluntary act and deed, fP the uses abd purposts t ere n mentioned.
GIVEN under my hand and offitial seal this ay of
I 'A.
'75blic in and fdlr e�
State of hi on siding
at
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40
LOMTF�OL NO:
STREET FILE
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