19412 82ND PL W.PDF111111111111
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9412 82ND PL W
ADDRESS: AL
TAX ACCOUNT/PARCEL NUMBER:
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:
PERNUTS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED*Zh,3/73 SIDE SEWER PERMIT(S) #: z4T3-1
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
OTHER:
LATEMMSTsTomiAStreet File Checklist.doc
I
APPLICATION
for
The/City of Edmo*nds SIDE SEWER PERMIT
EASEMENT No� .......... ...........
NEW CONSTRUCTION-& REPAIRS 0 ....................
(;;:% �co_
OWNER
... ..... S4
................................. ...................................
................... .............................. NlSll:� t
.... ...... .............. w ... PERMIT
r - -...-I.
ADDR
ESS 0.
................. ................. -LEGA.-L--DESCR- P-T-ION-LOT N : ....................................... BLOCK -No .. ........................
. .......................... .......... ....... ..........
NAME OF ADDITION ....... :w ................... ...
.........................................................................................
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im
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Of,
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Approved:
c 0-
DATTE.. B Y
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'Cl�T�Y''*:QF,.,�,�,Ep�.,'�,!PIN F*
M W`�ER` -:PER,' MY
WA-TEWSEW)ER,.,DE
"IT
�P
ERAMIT.
44
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�(,Calll. 7164107! for side: �geA�ei_inipectloriii B ORE p,,tj6n of' the; constru"etio I
Er covering, ..n,::;
e iled:�,wifhifij,.Z�illo' s, afCuji�quest: ta
InSpection will b' �proyi ur
U.n�,, (or holida Inspec, ons-,
Y,
AMPRESSYLOC AnON OF C()NST_RUCT,.j
.....................
:PROPERTY LEGAL DIESC RIPIMO -P kk
M ......... .. ... LAT... E...'
..............
......................... .......... . .......
.................. 7 ....... ............. - . :. , 1 1.
............. ................. .......... .
............ ..................
. . .............. ................ ................. ......
......... ... 0 CQN.q:TR TT(.)N
R.,.AND/()R BUILDhR' c
.......... ........... . ......... . ...............................
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OR' S� N AME,
& AbDR
E ... t.. Q $.,S -J0HN8-0N`
....... EADMA ........ .. E6K61f4b�-,.`.
q, .......... ...i ... ... ........... .......
............................
Permission, lstgy te& T j
... ........ ............ ...... I
or repkah� and/or.,c6zi on: of.a, sl�e
Sysi* Iii ac4b'qrd4nce,, with,. City,of Edhionds,,�Od nect.1 fsewer� to� tlj
ty
Sewer
A e �TION M CALLED� TO. THE� jrOLLOWING:
N,
:qo.; I—The-,owners.,of the-- Property, May,Obtaln,4a- p�rmi
sidellsewer in, streeV area., t* to.construct seiv6i'jrtsJ& �roperty'llne�:*
�Do,'not tcovert �!�Y,�? -A Il cen sed 'Sid e,Sew'er Cont�aetor`
NO: 2—All I work Periorm ed, in. ��Iow,, dt'gewer,' he'for AC.'has beeh�Anspec I ted. .'must�,.be,.em�lbk.�dr.-.t'o,.�con�truct
'city,--rl ght-of-way.,recitil rest �a n"Invaiji6n, �oj.'.I�e
N6Tj�r.,�q.; '3�08t'&j �ht -'Of-Way Perinjt� obtainable, from"the
. 1, � ru full�,Jnformation- reja�diiik,,,6rdine,`rice� ili-l'�06'�a4le City Enilne4�,B'�bfijCj.'
P�OT-E No..4— tew'er m6st-have�'�t'least
Top��of sj-de.,'
s-, 111unin 9� side, sewers h et- permit
w en,you-g
-a:nd 12AnChes Inside-"P"'
sharper,, than "A will�bwperhiltted. - 30 i.hChes eoversiepai Y. Aid
&O.T'E�Vo, roperty .11 n1e;. rilinum j��-,`�Nwbends` ln�
gr�de,
&__:T�enchesi Im streee-,must 'be wa
ter (settled ajid, surface,of, restored
work whlch�may develop -,within! one y to originaJ� Condition. Contractors, sha,111 be ',responsible f6r.,tailu"
NOTID No. &�It is, unliami earq6f cdrnpjbtjon.'
ret,due,'to-'Amproper,
ILI to alter, or d� any 'other work,,tba' i-
sert the, pipe into the wyt� rt� s,, Provided,- f6rin-ithe Permit, or to do
iiany work on the MaJn-. sew
er,o
i,,§ appurte�41i�ces; ekeept'to'in-
DISI"'
I�RUVIED,
:0 Date. ------- ....... % ------ Dat -I ...... ............
........... .
.. . ......... D
'BY
APPROWED, D te
.............
Rbinarks:;
.............
................ ....... �_; ............. ...........
.......... ................. .... .
..........
.................. .................
...... ... .......
.. .... . ...
............................. ......
.. ov ....
.............
.............
"'itcopi
es- ST. �'R
Yy �Mer�,of 'Firm: pbrformi gi fCO ru ti n%
ns c b 'T64te
—yon,
-�keweri,ilist�lla�ionkcoziS
certif�,, thatAh& 9i
grg� Firmt Per'forming!Constru6ti on i d
..... . (-O--�w�ner f Con . trac ........... ........
wt Stalled- ink accordan�ce,
th� all' g�verni d'
i;tg,,Rr Ina e th -'CitY� OVEdnionds-..
b
Dat6d'..thls
CITY OF EDMONDS
.1 8 go I,)ct 4z)
Address of Construction:
Property Legal Description (Include all easements):
Owner and/or Contractor:
State License No.
D Single Family'
x Multi -Family (No. oWnits-)
Commercial
Public
IFO DP15
SIDE SEWER PERMIT
PERMIT N2 ung 13
LYNNWOOD LINE
oz oc
JAN 4 1-2, M8
PUBLIC WORKS De
P1
Building Permit No.
Invasion into City Right -of -Way: x No 13 Yes
RW Construction Permit No.
Cross other Private Property: [)(No Yes
Attach legal description and copy of recorded easement
I certify that-f1have r1ad and shall fornply with all city requirements
as indicated on the lack of the Permit Card.
" /0,0
IDA
CALL DIAL -A -DIG (1-800-424-5555) BEFORE ANY EXCAVATION
OFFICE,.USE, ONLY—.
FOR INSPECTION CALL 7"--SM, PUBLIC �VPRKS DEPT.
77/-0A5,S- ,
Permit Fee: 0 Issued By
/ (q
Trunk Charge: Date Issued:
Assessment Fee: Receipt No.:
Lid No.:
Partial Inspection: Date -Initial-
Comments
Reason Rejected: Date -Initial
Final Inspection Approved: Date Initial
** PERMIT MUST BE POSTED ON JOB SITE **
White Copy: File Gre,ert Copy: Inspector Buff Copy: Applicant Revised 3190
Side Sewer Drawing
The City of Edmonds EASEMENT NO . ............................................
NEW CONSTRUCTION REPAIRS le LID NO . .................. . ASMT. NO . ......... -- .....
OWNER ..................................................................... f 1-3
..... CONTRACTOR .................................................................................... PERMIT NO. -----------
----------------------
JOB ADDRESS .... ...... PL .................................... LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ....................................
LYNNVIJOCD
...................................................................... ........................................................ ......................
NAMEOF ADDITION .......................................................................................................................
a
82 A/0 PL
.P
lf"CL^'Y To /91foe
3
TO W I
C04L.
Approved:
40
PWW-0001 -11/75 (REV. 11/78)
I
DATE....... / ...... 2-3-9r .................. By ......... OV ... lyhr .......................
NOTICE:
N'o ... warranty of accuracy,
The Information '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
map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
-m a p (s)
t including, but not limited to,
the 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 Edmonds nor its
empto-yee-s o-r offiCe-r_-) S)hdal-1 be 1*-Iab,-11-.e for the
information givei on this map(s), nor for
ion pr 'ded based
any one representat' ovi
upon said map(s).