19001 DELLWOOD DR.PDF10877
19001 DELLWOOD
DR
0-0-
ADDRESS: 1q001- 6d� wcoJ, �)Rimt)
TAX ACCOUNT/PARCEL NUMBER:W419MM31 00
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS.:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
..SCALED PLOT. PLAN -DATED:—
SEWER LID FEE
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
DETERMINATION: [:]Conditional Waiver E] Study'Required 0 Waiver
LID #:
LOT: BLOCK:
LATEMP\DS'l7s\Fomis\Street File Checklist.doc
ljhe City of Edmonds
w,
-04500
APPLICATION
for
Sl1D SEWER PERMIT
OUTSIDE INSIDE [:] REPAIRS
CARDNo . .......................................
EASEMENT No/....
1--,&,Z - el--F,
OWNER.. L.J ............... ............................................. ..' CONTRACTOR --- 0 . ..... .. . .... OU . ..... ..... '.. PERMIT
STREET
......... AVENUE LOT No . ................. 5-1 .................. ............................ BLOCK No . .....................................
HOUSE No . ..... 3A0 --- I --------- fc)� ...... ........ J:2,4 . . ........
uj
.j
U.
LLJ
LLJ
cr)
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .............................................
SEWER WORK ORDER ISSUED ..........................................
DATE ...... By
-.11 '7. 0.� 14 .........................
-�CITT�rdrlbmbkD
-Call PRospeft 071167, when woA
C-.CFWTER.� i-WATE.WSEWEW'DEPA.BTAIENT a r
eady for insiiecu6n., (N4! inspec-
IA�
17167
tions Saturday or.hoUda*s.),
R PE R"MIT
s:
19001 Dell�qood ive
ADDRESS........... ............. . .......... ..................................... ............................. ----------- ------------------------ ................................
J W Coniad PiY 1 ................ F.T! g .....................
0� ........... ------- .. . .................................... . . ....... ............. CONTRACTOR- 6 Vie
4ern.isslon is. granted .__._Aar,Cb --- 10 - ------------ *-.-,. IL9.5:7, for ......... I ...... ........ dAYSj toMEPAIR or CONNECT a side:sewer
with Cit_�� Se,�ers in'accordance with application on file and governing ordinances.
A'rl ENTION IS CALUED: TO..THE FOLLOWING:,.
-ty line.' A��`Iicoensed �jds. Sewe _.�V�6ntractor must.
NOTE No. I —The, owners of , the. property, may cob a permit to construct sewer inside.propei M
13�be employe& to:c6nstruct 'side sewer treet,area. Do not cover any portion of sewer i>6fore,itl�bas been- Inspected.
NOTE No. 2—Obtain full information regarding, Ordinance 11. 16. O�O -and Regulations governing side sewers when you get permit.
NOTE No. .3—Top of side sewer must have at least 36 inches coverage at property.l�ne and'12 minimum grade of 2%.
No bends: in grade, sharper.. than, will be �pernuitted.
NOTE No. 4--�Trenches in street must .. be water. settled and surface of str�k. restored.,to original condition. Conir,actors" shall beresponsible for
failure due� to improper,ii�ork- wlitch.ma, dev lop within one y6s:Fof 60nipletiom,
Y,
NOTE No. 5--;It: is uwa,�4�ii,toL &'I't,er, or',doany,:othei. work than is provided- for the' permit, or to do anV�vork'�'on the��inain sewer;or,t"
enahces i:kcept. to, insert the pipe izi�6 the v��e.
T
T,