19028 DELLWOOD DR.PDFIIIIIIIIIIIIII
10890
19028 DELLWOOD
DR
ADDRESS:
TAX ACCOUNTIPARCEL NUMBER: 04=xoy�-06—
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditionat Waiver [] Study Required [j Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
�17 rl
SEWER LID FEE $: LID #: /law
SHORT PLAT FILE: LOT: B L*OCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE ENCROACHMENT PERMIT
FOR:
WATER METER TAP CARD DATED:
L\TEMP\DS'l7s\Fonns\Street File Checklist.doc
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The City of Edmonds
1� /,-'/ —co �/ 0(
APPLICATION
for
SEDE SEWER PERMIT
NEW CONSTRUCTION E] REPAIRS E]
LYNN PLANT
--------EASEMENT No . ...... ...................................
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OWNER ....
...........
ADDRESS ... )17�2 ..... RJ� ........ aglzw..P�.P.Al ..... );.) ................... CONTRACTOR ...... ....... 51gpli.e . ...... S..* ..... e .............. PERMIT No.
LEGAL DESCRIPTION: LOT No . .......... ........................... BLOCK No . ............................................
NAME OF ADDITION ........ D. n- 11. W. -el ......... .................................................
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APPKOVED -j
FEB
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Approved:
DATE 9(l.7.y --)q--.(lu ....
......................
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"e,2.i work
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PN7 CTOR .... ............ -d Septic -Ae rvim
:,Permlssion is.grante(f_,..,,_�
............ for
with I city � Sewers ifi�- , accordance with apilicaft0n,on file ................. I ..... days, to'RE r sewer
PAIR.0 CONNECT a'side
g overuing ordinancm
ATTENTION IS CAT-i
. P TO THE 'FOLLOWING
NOTE N6.'i—Th'
be e owners of the. property MaY,- ob
�,emPloyed to construct side Wn a. permlt to �ponstruct sewer inside prope
sewer in street , qy line. A licensed Side Sewer contractor -must.
N 2---�-O , I I I .. . . area! 'DP.nOt cover any Portion Of sewer before it has been inspect
' I -,�tan full In
formation. regarding ordinanc ji.16.0�b and'ReSul ed.
e
No., 1. 1 ations governing side sewers when you get�permjt
Top Ot side sewer must have at 1 21, -
: east'30 inches coverage.st propij
bends in. grade sharper: than % will be Permi rtY line and 12 inche'
tied. 3 inside
NOTE: 14:-4-7'�cnehes-in,s property 11m; minimum grade.6f
'failure treet must_be.water settled- d 2%.
due,to,tm, -er — �r street restored. to original . condition. Contracto
!Fork �,hich� may develm�p I One,year of To Shall.
completion. be responsible for'
NOTE No. �Llt - is u��wtul ito'altei -or dc� any otier
purt, work than is provided, for In the permit, Or to do'"
insert the Pipe into the,'wye.
Y, work on the Main
sewer or Its,ap-