19008 DELLWOOD DR.PDFIIIIIIIIIIIIII
10881
19008 DELLWOOD
DR
00.
010
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER: COOM I qM
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver E] Study Required Waiver
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 $:
LID #: I I?aq
SHORT PLAT FILE: LOT: Iq BLOCK:
S.2"
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER: kbw z -I)?,& G)-Ub)
LATEMP\DS'rs\Fonns\Street File Checklist.doc
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS n
........................ -------------
OWNER., �-. ------ -eo(
ADDRESS ...... ....... 0 ....
10
7
I
A
I
LYN11 PLANT
EASEMENT No . ......... ......................
CONTRACT07�r� . ......... 11,
.4, ........ ..................... ......... PERMIT No.
LEGALI N: LOT No . ............... /./--i ............ ......... BLOCK No . .......... ........
................
NAME OF ADDITION
..........
Approved:
DATE ... BY
7Y...
-WP7ROVED-
AUG 1957
r"Al
0-1 -
City 0: f Edmol&
RIGHT-OF-WAYCONSTRUCTION
PER M.IT
Permit Number.
_ET FILE Wue D- ate:
A. Address or Vicinity of Construction: 19008 Dellwood Dr.
B. Type of Work (bespwific): Replace'Deveeciat4 40'. pole with 45' pole
890 9" set 7k' deep��-& replace.30' pole w/ 30' pole.
C.,* Contractor: -Snohomish County PUD-No. 1
MailingAddress: P.O. Box
State License #:
D. Building Permit # (if applicable):
Contact: Jerry 'dkkington
Phone: (206)347.74414
Liability Insurance-.- BonA:
Side Sewer Permit.# if applicable):
E. 0 Commercial [J Subdivision F1 City Project KA Utility (PUD,.GTE, WNG, CABLE, WATER)
Multi -Family F] Single Family Fl Other
INSPECTOR: INSPECTOR: uAl. cit
F. Pavement or Concrete Cut Yes MNo G. Size of Cut: x H. Chargi�_$
APPLICANT TO READ A IGN
INDEMNITY. Applicantlunderstands and by his signature to this application, agreesi t6 hold the City ofEdmondg harmless from injuriV,
J -dama-geft,-oc—
claims of any kind or description whatsoever, foreseen or. unforeseen, that the City of Edmondsj1,o[' aro 6�.its departments or
may be
Anemployees, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason of tingthispermit.
'�R
.THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS F -A'_)PMIOD OF ONE YEAA�-O*)VIKTHE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH -
IS COMPLETED B YVITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BEPROCESSED FOR ISSUANCE TO THE APPLICANT.
�is
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 at completion.
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 patched with asphalt or City approved material -nnor to the end of the working day;
NO EXCEPTIONS.
I have read the above s tatements and understand the permit requirements and the pink copy of thepermit will be
available on at all times or in ectionparposes.
Signatur Date:. 4/12/95
ntractor qf�Went)
10
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVEDBY:
TIME AUTHORIZED: VOID AFTER DAYS.
SPECIAL CONDITIONS: T %.A I tj
Co of- 10 0%
COMMENTS�-
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND,111:
RESTORATION FEE::�
PERMIT FEE:
TOTAL,FEE:
RECEIPT FEE:
DATE:
ISSUED, BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
Y E'DMON
"CIT
q
WATFM�SEV�VF'
SP t 6-1197,* v��en WOA
to e. p
S10 is rea4
y for inspeed, N
(No hXV
E SEWER PERMIt ti 6as Saturds" su6d�i -or holidsi%ys.) 243`8
ADDRESS ---------- ----- 19008
........... . ... Drive'.
.......... .........
.. . ....... ------ ------ -----
owHA - ------------- - -- - ------------------------
NER ......... 1 Griffith. ---------------
--- ----------- ------------------
-------------------- ------------------------- Lee. Wooley
ONTRACT6A
..................................................
Permission is gTanted ----- A4&.At --- 2-3 ---------------- 19...
with City Sewers in acco ------------------- - --- to RE
r . dan0e xvithapl)hcation,on m6 and governing ordmnees PAIR or, CONNECT a side sewer
ATTENTION IS CAIJED To THE pOLLOWIjjG:
NOTE No. I —The
owners of the P Perty may Obtain a permit to construct sewer
be employed to constrruct I side sewer in street area. Do tie pr zty line. A licensed Side Sewer Contractor must
NOTE No- 2—Obtain full informs not Cover any C. O`o% er before It has been inspected.
� t" regaxding Ordinance II.M030 and hegulations governing aide sewers when you ge't permit.
NOTE N % 3—TOP of side sewer must have at least 30 inches coverage at Property line and 12 inches inside
NOTE No. '.No'bends in grade Sharper than % will be Permitted. Property line; minimum grade of 2%.
4—, Trenches in street must be water settled and surface of st
*failure due I'D i'PrIper work which May develop with,], oureet resto�ed to original conditiolL
NOTE No. e yeax of completion. . Contractors shall be responsible for
5-1t 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 appur7
. ien—ces except to insert the Pipe Into the wye.
MEMO TO: Mayor & City Council
FROM: Irene Varney Moran
City Clerk
SUBJECT: ACKNOWLEDGE RECEIPT OF CLAIMS FOR DAMAGES
The following claims for damages have been received:
NAME ADDRESS
Michael W. Medin, O.D. 19008 Dellwood Drive
AMOUNT,
$ 57.44
I recommend that Council acknowledge receipt of the above for minute
entry at the' MAY 22, 1979 Council meeting*.
Attachment
STREET FILE
NOTICE
CIA111 hA11A(;J-.,;
— - __ 0
Claim MUST be presented to the City Council and filed with the City Clerk.within 120-damA
- - i__)
i� RMEIVE0
from the date of Accident or Accrual of Damages.
Mg 111979 MAY 111979
TO THE CITY COUNCIL OF THE CITY OF EWONDS: I
Ldmorids City Clerk
PLEASE TAKE NOTICE, THAT W Z5,5.
/ YA;Is�/
.(if married, Give husband's name)
WHO NOVI RESIDES AT Z43 &,f5,2s Z)A. defj_)A`701��_I�S
te-pr&�6_nt'a:ctual- address by -street-, -number '6hd-city)
r
-5
AND WHO FOR SIX MONTHS PRIOR TO DATE OF ACCIDENT HAS RESIDED AT
(Give residence by street, number and city)
CLAIMS DAIIAGES OF AND FROM TILE CITY OF M40NDS IN n-M sum OF
arising.out of the following circumstances:
Describe Claim, giving
DATE and TIME injury or
danage occurred, PLACE
and full particulars.
Accurately locate and
describe defects caus-
ing injury or damage
and all acts of ncgli--
gen�:e claimed.
Accurately describe
injuries or damage
State items of damage
claimed. Itemize all
expenses and losses.
(Claim must be sworn to by claimant)
j�//S L - 77r-
5
a,(T- -iz--) 77t-e-
AA,
X.�: /JO7--;' TW15
"J) YE_
SU05CR . IBED AND SWORN 110 (Signature of Claimant)
before me this t& d ay o f
'19
Not,6ry 11,4blic in and for the State of
Washington, residing at
TlI0
:7,
.......... .
/'ry H. Medin or 763
D4,a Michael W. Medin FIRST BANX
C9008 Dellwood Dr. 778-5472 "1-2/1250
STAFF MEMBER
Edmonds, Washingion 98020 ell,
$
q)ogqis
iz;= N'ZIUMOLL AANA ' R/C 00604
DEXTER HORTON BRANCH / SEATTL E 98111
— .1111 1 n r-
UUUU C Ll in -1 F r 0 "1 t3 3
do"?"-6 3 8"000000 S ?L' I.."
JOHNSON SEWER SERVICE
2233 - 197 P1. N E. Apt 1 IC
SEATTLE, WA 98155
Phone 364-4868
FORM 350-1 Available from inc., Townsend, Mass. 01470
7-
. . . . . . . . . .
1"- 11 -
Tanuary 22, 1979
MEMO FOR RECORD
SUBJECT: SEWER STOPPAGE j 9008 DELLWOOD DRT1jF
On S)aturday, January 2
1 0, 1979, at approximatel,1 11: on, p
was contacted by Ron Canne111%ater Watch, that there %,.ras''a
plugged sewer at 1900 -Pellwood Drive.
On arrival at 4:15 p.m. and visual insrection of the above
residence, it was determined that the sto*ppage existed in the
city*sewer main.
The mechanical rodder was picked up and used to try . and clear,
the stoppage which after about 15 minutes was successful.
The stoppa I ge appeared to. be made up of roots, grease and ra-s.
Normal flow was r'e--established at 5:45 P.M. -
The resident at 19008 Dellwood Drive, Dr. Michael Medine-did
not indicate that he would file a claim for damages form.
(The attached ' drawing indicates the approximalte 1 . ocaticn of
the stoppage in relation to the city sewer main.)
LO: kj r
17
WA8-supt Dt.
STREET FILE
-Admin. Dt.
PeW. Director
C I T Y 0 F E D M 0 N D S
SEWER DEPARTMENT
STOPPAGE OF SANITARY SEWER MAIN REPORT
DATE: January 20, 1979 TIME CALL RECEIVED: 4:00 p.m.
LOCATION OF STOPPAGE:
See Attached Drawing
TIME OF.ARRIVAL ON THE JOB SITE: 4:15 P.m.
TIME NORMAL FLOW OF SANITARY SEWER REESTABLISHED: 5:45 P.m.
CAUSE OF STOPPAGE: Roots, rags & small amounts of grease
ACTION REQUIRED TO CLEAR MAIN AND/OR LATERAL:
CITY CREW ON STOPPAGE CALL OUT (Personnel Involved): Larry Ogle and
Ron Canell., Water Watch
LOCATION OF RESIDENCE AFFECTED: "19008 Dellwood Drive J
NAME, ADDRESS, AND PHONE NUMBER OF PROPERTY OWNER:
Dr. Michael Ded ine
19008 Dellwood Drive, Edmonds, WA 98020
DESCRIBE DAMAGE TO PRIVATE PROPERTY:` Water overflowed onto bathroom floor,
but no real damage visable
REMARKS:
ST13FET Ell P
2 /7C
0
I
Continental, Inc.
P.O. Box 476
Lynnwood, Washington 98036
Gentlemen:
This is to certify
the City of Edmonds . has
to the City of
JEM:jw
andards,
1-1
August 29, 1967
at 19008 Dellwood Drivo, within
to the City sewerage system according
Very truly yours,
CITY OF EDMONDS
JOHN E. MORAN
Director of Public Works
W1 7;4V
IV40
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-DISTRICT NO.1 OF SNOHOMISH COUNTY
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