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19131 84TH AVE W
ADDRESS: Aw R/
TAX ACCOUNT/PARCEL NUMBER: 60o�g / �y 00 it 00 goo
BUILDING PERMIT (NEW STRUCTURE): /q&7— ol� ?
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: []Conditional Waiver Ej Study Required E] 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
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED: & / /Ov,
SIDE SEWER PERMIT(S) #: a3 V,;z-
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED: A-0
OTHER:
LOT: BLOCK:
LATEMP\DSTs\Fonns\Street File Checklist.doc
APPLICATION
The City of Edmonds for
SMEEur RLE SIDE SEWER PERMIT
NEW CONSTRUCTION [] REPAIRS M
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EASEMENT N . o.
... . ... .... ... ... .... .....
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OWNER ...... 4,9!51-2��r .... ...................... ............. CONTRACTOR .............. ...... C ...... PERMIT No.
................ ........... ...... III!! lf� -
ADDRESS ....... 1.9. /.- 3.1 - Lt-7.1... ........................... LEGAL DESCRIPTION: LOT No . .......... 17 — --------------------------- I BLOCK No - --- --- ......
... ... .... ............................. .............
NAME OF ADDITION ....... ........ Ic—
e i . .... :,i� .....................
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APPROVI!�`O
JUN
4:)
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Approved:
DATEJ:� ......................................... By
NOTICE,
N'o ... warranty' --of a`ccuracy.-
The Information'shown on the attached
map(s) was compiled for use by the City of
its Employees and Consultants.
Edmonds,
The city of �Edm.onds does not - warrant the
accuracy of anything set for ' th on these
map(s). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the Information shown on
-map(s), Including, but not limited to,
th . e loc'ation 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 City of Edmo'nds nor its
e m pl- o-y e e-s o -r o ff I c e r h. a I- I b e I. 'I a. b[e f o r -,I h e
information 'given on this ma p(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS
Call illo.Peet 6-1107 when work
CIVIC CENTER — WATER -SEWER DEPARTMENT Is ready for Inspection. (No inspec-
tions Saturday, Sunday or holidays.) N2 2342
SIDE SEWER PERMIT
ADDRESS ------------------------------- Le-ster.-Ilunmire-
OWNER- --------------------------------- W _--_---------------- CObWTRAC"R ............. SeaVie-W
I aission is granted ------- June._.12.,. .............. ig --- 6.7, for ---------------------_- days to REPAIR or CONNECT a side sewer
with City Sewers in accordance. with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do nut cover any portion of sewer before it has been Inspected.
NOTE No. 2--Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—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 sharper than % will be permitted.
NOTE No. 4—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. 5--It 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 appur-
tenances except to insert the pipe into the wye.