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19024 83RD AVE W
NOTICE:
Nb--warranty-Of aCC_u_.r_a_c'Y_-
The -inform atio n'shown on the attached
map(s) was compiled for use by the City Of
Edmonds,, its Employees and Consultants.
The City of �Edm.onds does not . warrant the
accuracy of anything set forth on these
ity-requesting a
rnap(�_). Any person or ent'
copy should conduct an independent
ation shown on
inquiry regarding the
-map(s), Including, but not limited to,
t
th-e lociation 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 �jty of Edmonds nor its
ernp-to-yee-s o-r officle-rs sha-1.1 be 111a.b-'Fe for the
information given on this map(s), nor for
ation provided based
any one represent
upon . said map(s).
CITY OF EDMONDS — SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
_' ,- , �b
PERMIT .. /_16
Call 715-2525 for side sewer inspections BEFORE covering any portion of the constru tion.)
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspectclons.
ADDRESS LOCATION OF CONSTRUCTION ......... t �'6 2 4 1 n i i, r- r,
------------------ W4 ------------------------------------------------------------------------------- - ----------------------------------- * ........
;,nd I-,
PROPERTY LEGAL DESCRIPTION ............. i ..... . ... i ...................................................................................................................................................
................................................... .......... . .......... . ........................................................................................ . .................................. . ..................................................
14
....... . ....................................................... 0*tWERANDIOR BUILDER ...... Garold 1,1. Fb, I
.................................. . .................................. . .......................................................
CONTRACTOWS -NAME & ADDRESS .......... -------
...................................................................... ... .............................. . ... ... ............................ ................
for repair and/or co�nection of a side sewer to the city sanitary sewer
Permission is granted ..... --- 2t._
------------------------- 11913 ...
system In accordance with City of Edmonds ordinances.
AT,- TION IS CALLED TO THE FOLLOWING:
N6 1—The o ners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
__/o side swewer in street area. Do not cover any portion of sewer before it has been inspected.
NOTE_No. 2—All work perfarmed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from. the City Engineer's office.
NOTE No. 3--Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—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
shaxper than % will be permitted.
NOTE No. 5—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.
NOTE No. 6--It is u nlawful to alter or do any other work than is provided for in the permit, or to do any work on the maln sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED E] Date ... . ................................... By ................ Date ............ - - ------ Date ............... . ................... By ................
#7 -------
"PROVED Date ..... By---- jo� ----------------------------------------------------------------------
Remarks: ....... . ....... . .......................... . .. . ................................. ... X ...... ......................................................... I ................................................
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
I, hereby certify that the side sewer installation constructed under this permit
honi;-�. "�in_�Ift__fio",�'; g6onsi"r".ciio'n_)
WC7 talled. in accowa��ce with all governing ordinances of the City of Edmonds.
IDated this ............................ day of ................................................................. 19 .........
Check BEFORE you dig for: Water E], Gas E], Telephone E], Power C], Sewer E], Other C]
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CITY OF EDMONDS ermit No'.
COMMUNITY SERVICES DEPARTMENT
. Issue Date
STREET FILE P
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. e Owner: Washington Natural Gas B. 0 Contractor: S ame
Name Name
19a AV NE
M'ailifig Wddress Mailing Address
Be] em - ie WA_ - 98007
City State Zip City State Zip
447-0700
State License Number Telephone Number
9 Address or Vicinity of Construction: 10924 — 83 AV W, Edmonds
Type of Work to be Done: New gas service installation
Work in Connection With: F-1 Sub or Plat El Single Family El City Projects
0 Commerciar 11' Muitifdrnfiy� M Utility:
Pavement Cut: 0 Y 0 N
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
harmless from any injuries, dainages, 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 this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS'FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
Funds held from the Security Deposit (estimated *restoration fee) will be held until the final street patch 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 Public Works: 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 und&st�ihd -tfi�a6iovle "and"that 'thi's -permit', must: b e' available at the job siie't6i4nip—ection pu-'r-p-o'ses at �il iim*e_s___"
Signature:
Date:
Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
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ISSUED BY:
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Time Authorized: Void
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Special Conditions:
Amendments:
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V a-2 —days
PERMIT FEE: 0-�Q, bo, bi\W
Security Deposit:
Receipt No.:
Fund I I I Fee: �
Street Cut Dimensions:
X
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION F-1 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY:
Date:
Eng. Div. July 1985
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APPLICATION
for
The City of ]Edmonds SIDE SEVIFER PEB3M
opteo NEW CONSTRUCTION REPAIRS 0 E ASEAM-Fr No.
CONTRACTOR
OWNER ................ o4e:p,
......... .......................................... ..................................... PERAM No..7 ...................
ADDRESS 24-
....... ...... - LEGAL
... ............................ ...................... DESCRIPTION-: LOT- No,.:.5k.�JE , lise�
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T Tlp� /City of Edmonds
APPLICATION
for
SIDE SEVVIM PFJDM EASEMENT No - ---------------
NEW CONSTRUCTION V-1, REPAIRS C] I --
OWNER ....... C.CS0 ..... Ek.j .........................
CONTRACTOR ...... G.e.C-Q.td ...
-PERMIT N 6—�,
............
ADDRESS ...... 1.9.1.0aq ...... .......
LEGAL DESCRIPTION: LOT NOS
........ 5..f�AAA ............. ....
BL()CK No. ..... 190 . ...........
NAME OF ADDITION ............ .0 ...........
5Y.�:Zlcl 4vl'llj�
Approved:
DATE................................................ By ....................................... ..............................
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REGARDING: 19024 - 83rd Avenue West
(address)
R E C 0 R D 0 F C 0 N T A C T S
DATE NAME., PHONE NO, & COMVIENTS ACTION TAKEN INITIALS
ADDRESS of CALLER
5/l/74 'Gerald Ebel Certified Letter No. 40623S sent Letter received. TE
requiring hook-up within 60 days.
6/S/74 Certified Letter No. 406477 sent Letter received. TE
rescinding previous letter.
Discovered permit #451S had been
issued 10/23/73. 0omnec-tim-i cgMleted 11/7/73.
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SENDtR: Be sure to follow inWructions, on 'of her side
PLEASE FURNISH StRVICE(S)- INDICATED BY CHECKED BLOCK(S)
(Additional charges requirid.for these services)
di
Show' address De iver ONLY'
where, de1iv'e'?ed,1 -Lnj.to addri
RECEIPT'.
''Receiied the n-timbeied-aificle-describid,b�io'-w-
-�41%ISTERED NO,
'SIGNATURE OR NAME OF ADDRESSEE (Mus-i-'a-tways.15 filled h),
ERTIFIED NO.
IF ANY
SIGNATnE -9F.,XDDnSSEE'$ AGENT C\J
10 6
IN U D, NO.
7, i—d Z -.Qode).j- J�-
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SEND Be� sure to'
itruc4ions on Other sid
ER. follow, ir,
PLEASE -FURNIS14 INDICATED BY CHECKED BLOC
.t5ERVICE(S)
�es re-o-a-ir 'for these services)
(Add tional char:
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Sho,
�k addr��st
i Ddliver'ONLY
0� to ;id6essee
PECEIRt
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0i�.ed the n 'h
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CERTIFIED -M'
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SIGNATUR -NT, IF-
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IMURLD No..
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DATE DELIVERED
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RECEIPT FOR CERTIFIED MAIL—W
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70
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OR
306-06800
1�; 1Z,- C�-
EBEL, GERALD
19024 83RD AVE.
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EDMONDS, WASHINGTON
9802
—413b-ITIONAL - FEES
�OpTIONAL SERVICES IFOR
154
Sh ris Whol and date delivered — .. ... .
RETURN W I , delivery to addressee only .... -
date and where delivered
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RECEIPT 2. Shows. whG' ry to addrE -see only
delivA
851
SERVICES —
DELIVP-P. TO ADDRE�SEE ONLY ...... ... . ... .... * ...........
... ..
Y f, t— f red) ................. . .. .
NO INSURANCE COVERAGE FKUVIULU—
P Form
S
3800 NOT FOR INTERNATIONAL MAIL
,
Apr. 197 1
�.-30� (Plus
RECEIPT FOR CERTIFIED MAII
PS Form 3800
A,,r. 1971
(See� other side)
GPO! 1070 0-397-�SS
fee requireo)
— (Se� other side)
COVERAGE PROVIDE13
tAOT FOR INTERNATIO14AL MAIL
, � 07.
CITY OF EDMONDSw 0 1 55-IlLn
.1-CONSTROCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONENiMBER
r-j" It Afd At
[NAME
ADDRESS
CITY - ZIP ITELEPHONE NUMBER
NAME
40660
cc ADDREq;j
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TELf.PHONE
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STATE LICENSE NUMBER
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Legal Description of Property - include all easements
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7 .77A/v
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Tax Account Parcel No.
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NEW RESIDENTIAL
PLUMBING
ADDIALTER COMMERCIAL
MECHANI-IAL
REPAIR' APT. BLDG,
El SIGN
GRADING
DEMOLISH CYDS.
FENCE
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CARPORT
REMODEL E]
1— x _FT)
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GARAGE
POOL
WOOD STOVE/ RETAINING WALL/
INSERT ROCKERY
RENEWAL
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NUMBER OF STORIES
NU BER OF
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231
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UNITS
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
PERMIT
NUMBER 19f 0,38e
JOB
ADDRESS
LEGAL DESCRIPT107 —CHECKI SUBDIVISION NO.
093
SUIT
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP,
TESCP Approved
0
EXISTING __ REQUIRED DEDICATION
RW Permit Required
0
Street Use Permit Req'd
0
Inspection Required
0
PROPOSED
OlUeWaIK Hequired
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REMARKS
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0 ENGINEERING MEMO DATED REVIEW BY
METER SIZ711UILDING SUPPLY_:��O. OF FIXTURES
REMARKS
SIGN AREA SEPA REVIE7 AQR NO.
ALLOWED I PROPOSED COMPLETE ]EXEMPT
II I EXP I I
VARIANCE OR CU LANPL� REVIEW By ATE
SETBACKS — FEET HEIGHT I LOT COVE�r
FRONT '45'— SIDE/CD REAR 1�5
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ECKED BY
SPECIAL INSPECTOR AREA
REQUIRED 0 YES 1 146
GROUP
PROGRESS INSPECTIONS PER UBC 305
HEIGHT
1A57
OCCUPANT
LOAD
FINAL INSPECTION REQUIRED I
VALUATION '"" T-100"FEE
PLAN CHECK FEE
BUILDING
PLUMBING
Plain Check No. �3q�
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnity, defend and hold
harmless the City of Edmonds, Washington, its officials,
z employees, and agents from any and all claims for damages of
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< whatever nature, arising directly or indirectly from the issuance
of this permit, Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
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1: nor. limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision,"
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and in doing the work authoriz-
THIS PERMIT
AUTHORIZES
ed thereby, no; person will be emp16'yed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tign InsQ nce. I
INSPECTION
SIGNAT4Ff)ii!(OWNER PIR-AUNT) DATE GNED
�9
DEPARTMENT
ATTENTION
CITY OF
EDMONDS
CALL FOR
INSPECTION
771-3202
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND 'APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
102-87
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I �_n I I "-gu �
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
I I .
OF .. �IGNATUFJE DA
W2� :511 !04�- /_
RELEApt�'B TE
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ORIGINAL — File YELLOW — lns�ector
PINK — Owner GOLD Assessor
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