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CTTY ENGTNEER'S SEWER CONNECTION RECOMMENDATTON
Date -1i u aw I 1 -1
Address of Property to be Connected
Owner Name & Ma iling Address
Recommendation:
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ROUTING FORM
Initial Date
2.
4.
5.
Message:
and �&Janlze-
fc
5 1974
From:
Date:
E-7-72
_Rr Mi Ir r. 63r - r_ 10 r
bJect: Sewer Connection Charges.
]al Description: Al 1 that port . ion of the.South 129' of the East 168' 6f _ihe'-.'
llowing described property: Beginning at the -southwesterly corner of Sectio-n-18-
T,27 N, R 4.E, W.M. and:proceeding thence along the South line of saio.-Sec.' 18.,,-.
S 89042'27" E 1039.92' ; thence along the E 1 i.ne of Government Lot 4. in.'s6id 'Section' 18",
N .0050'00" E 329.52' ; thence W 20' to the Wly margin of the County Rd -and the .1. SET'_�"-
y
corner of the Tract herein described and the TPB; thence along the Wly,margin of the
County Rd N 0050'00" E 154.76' ; thence W 273.66' ; thence S 154.74' ; thence E 271-.-41'.
to the TPB; `TOGETHER WITH THE. FOLLOWING: Beginning at the SWly- corner of Section:-18,
T 27 N, R 4 E, W.M., and proceed.ing thence along the South line of said Section-18
S 89042'27" E 1039.92'; thence along'the E line of Government Lot 4 in said Secti on 8
N 0050'00" E 329.52' ; thence W. 20.0' to the Wly margin of the County Rd and the '.SEly�'
'corner of the tract -herein described and the TPB;_thence along the Wly ma rgin of
'54.76' ; thence W 273-.66' ; thence S 154.74' 0666e 'East 97,1.41'
County Rd N 0050'00" E 1
to the TPB, EXCEPT the South 129' of the East 168 feet thereof.
(Also known.as ai portion of Tract 2, Block 1, Sunset Acres.- unrecorded) J
Commonly known as: 19426 88th Ave.'W. Owner: Robert Jaku'b.ik
Z.F.F. Calculation:
194.10- Z. F. F. x 5 0
Lateral x
Unit x 25
cc: Mr. Jakubi k.�
1W -
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ce oest 20.0 feet ta
U t , 4':Ln�zaid Section 18 Xbrtb OP50'00":East .3p
.52;feet; tuer
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ng;,theuie 91:0na the.Austerl
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44at . Y. RoadNorth &501,00"'East 15��6 feet; thence West 273.66.feat; thence S Utl�"
e tr"u"e- �Oint df.,btginni'nP..1-
271 4'1 f e ato� th
"-4ett* thence Eapt,
A outll 129 fen6t of'the,,East -108- teet.-s-,
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ract
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REGARDING: 19426 - 88th Avenue West
Ta-d Tr—e —ssT
R E C 0 R D 0 F C 0 N T A C T S
DATE NAME, PHONE NO. & COMMENTS ACTION TAKEN
ADDRESS of CALLER
Robert Jakubik Refer to file entitled: "WATER/SEWER: SIDE-SBV..PR CODE VIOLATORS
6 Cases Referred to the Citizens'
Comittee., 197511
INITIALS
JT
84iEET FILL,
Memo to: Director of Maintenance & Operation
Public Works
From: City Engineer
Subject: Sewer Connection*Charges
0
Date May 6. 1974
Legal Description: All that portion of the South 129' of the East 168' of the
following described property: Beginning at the southwesterly corner of Section 18,
T 27 N, R 4 E, W.M.. and proceeding thence along the South line of said Sec. 18,
S 89042'27" E 1039.92'; thence along the E line of Government Lot 4 in said section 18
N 0050'00" E 329.52'; thence W 20' to the Wly margin of the County Rd and the SEly,
corner of the Tract herein described and the TPB; thence along the Wly margin of the
County Rd N 0050100" E 154.76'; thence W 273.66'; thence S 154.74'; thence E 271.41'
to the TPB; TOGETHER WITH THE FOLLOWING: Beginning at the SWly corner of Section 18,
T 27 N, R 4 E, W.M., and proceedi.ng thence along the South line of said Section 18
S 89042'27" E 1039.92'; thence along the E line of Government Lot 4 in said Section 18
N 0050100" E 329.52'; thence W 20.0' to the Wly margin of the County Rd and the SEly
corner of the tract herein described and the TPB; thence along the Wly margin of
County Rd N 0050100" E 154.76'; thence W 273.66'; thence S 154.74'; thence East 271.41'
to the TPB, EXCEPT the South 129' of the East 168 feet thereof.
(Also known as a portion of Tract 2, Block 1, Sunset Acres, unrecorded)
Commonly known as: 19426 - 88th Ave. W. Owner: Robert Jakubik
Z.F.F. Calculation:
194.10 Z.F.F. x $5.50
Lateral x
I ) Unit x ( $ 25 ) =
RECF_IVED
cc: Mr. Jakubik MAY g 1974
$ 1,067.55 Connection Fee
$ -- Lateral Charge
$ 25.00 Trunk Charge
$ -- lo-on Permit
$ 1,102.55 TOTAL
C
NOTICE:
-No"'Warran -y-- of
The -information . shown on the attached
map(s) was compiled for use by the City Of
Edmonds,; its Employees and Consultants.
The City of Edrn.onds does not. warrant the
et forth on these
accuracy of anything s
Map(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform-ation shown on
-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.
,,ty of Edmoin'dAs, nor its
Neitheir the %1_11
M pt 0-y e e-s o -r o ffi c e -r s -s h. a-l' I b e Vi a. b-1--e f o r t1n, e
e I
information given on this map(5), nor for
any one representation provided based
upon'said map(5),
WATER -SEWER DEPARTMENT
CITY OF EDMONDS - SIDE SEWER PERMIT
PERMIT
Call 175-2525 for side sewer inspections BEFORE covering any portion of the construction.
(Inspection will be provided within 24 hours after requst. No Sat., Sun., or holiday inspections.)
2 ........... . .......................................................
ADDRESS LOCATION OF CONSTRUCTION ---------- ..................
PROPERTY LEGAL DESCRIPTION -------------------------- OLATTAPO�P
...................... . ........................... ...................... . ......................................................................... .............. . .................................. . ............... .......................... ........
F . ................
......................... OWNER AND/OR BUILDER.-Rna RT 1AKTRIK ......................... . .......................................
CIONTRACTOWS NAME & ADDRESS ------------- �71W R ......................................................... - ------------------------------ - --- -------------------------------------------------------
Permission is granted ............ Aq-:11.61 .... 12 ..... ............ 19N ... for repair and/or connection of a side sewer to the city sanitary sewer
WiLbe ffn In accordance with City of Edmonds ordinances.
",,.-ENTION IS CAT, LED TO THE FOLLOWING:
perty may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must be employed to construct
NOTE No. 1—The o ners of the pro ny portion of sewer before it has been inspected.
w
side sewer in street area. Do not cover a
NOTE No. 2—All work performed 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. al roper
NOTE No. 5—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for f lure due to imp
work which may develop within one year of completion. ded for in the permit, or to do any work on the maln sewer or its appurtenances except to in -
NOTE No. 6—It is unlawful to alter or do any other work than is provi
Bert the pipe into the wye.
_41 Date ---------------- ------------------- 'BY ----------------
DISAPPROVED [I Date. BY ----------------
.. . ........... . .................. By ..... : ---------- Date --------------- - -------------- ---
"PROVED Date.-.-. ..... ............ .......... ... .. . .......................................................................................
it, ................................. . ...................................................................
Remarks: ............... . .......................... . .....................................................................
. ............ I .........
--------------------------------------------------- --------------- - ---------------- ----------------------- ------------------------------------ - ---------------------------------- - ------------------------------- -
BOTH Permit Copies MUST S* e Owner of Firm Performing Construction PRIOR To Request For Inspection
the side sewer installation constructed under this permit
........ ... I hereby certify that
I..................... ...... .... ....... ........... ...................
(Owner of Contracting, rm. PerfGrming Construction)
vv-d installed in accordance . all governing ordinances of the City of Edmonds.
Dated of ------ .............
Sewcr C], Other E]
Check BEFORE you dig for: Water Ej, Gas E], Telephone E], Power [:],
APPLICATION
The City of Edmonds for EASEMENT NO . ............................................
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS Ej LID NO - -------- ASMT. N16 . ......
OWNER z<44,�r --- 46-4.- .... ........................ CONTRACTOR ----------------- ...... ------ ) -------------------------------------------- PERMIT NO.
LEGAL DESCRIPTION: LOT NO - ---------------------------- ......... BLOCK NO - ------------------------------------
JOB ADDRESS .... . .
----- ----------------------------------------------------------------------- ------------------------------------------------------------------------------------
NAMEOF ADDITION ------------------------- ---------------------------------------------------------------------------------------------
Approved:
DATE.................... ....................... By ............................................................
11/75
0
0
0
Memo C;;;?— L)Trt'!ctor' of Maintenance & Operation
Public Works
From: Asst.City Engineer
Subject: Sewer Connection Charges
RECEIVED
JUL 3
Date July 30, 1976 3 116.
Publicir ?s4pelp)t
Legal Description: Sec 18 Twp 27 Rge 04', RT-18-1)
The S 129 ft of'E 168 ft of the following
described tract; Beg at the SW cor 8ection;
th S 89042' 27" E 1039.92.ft; th NOO 5010011
E 239.52 ft; th W 20 ft to TPB; Th N 00050'00"
E 154.76 ft; th W 273.66 ft; th S 154.74 ft;
th E 27lAl ft to TPB
NOTE: This computation supersedes Sewer Connection Memo of May . 6, 1974;
the following charges have been figured on a portion of the -
previous 1-egal description.
Commonly known as: Robert W. Jakubik Owner: 1942 . 6' 88th Ave. W.
Z.F.F. Calculation:
39.31 Z.F..F. x
Lateral X
Unit x
CC: Robert Jakubik
$5.50 $ 766.21 connection Fee
$ Lateral Charge
$25 25.00 Trunk Charge
$ 10.00 Permit
$ 801.21 TOTAL
2108
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APPLICATION
The City of Edmonds for EASEMENT NO . ............................................
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS LID NO . .................. ASMT. NO.
OWNER ... r ...... — --------------------- CONTRACTOR ---- -- - - ------- PERMIT NO.
JOB ADDRESS - ----- Lbl-4r-= - -� -
----------------------------------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------------------------
..............................................................
Approved -
DATE ----- 2/—�.. By ...
/4;w� ---------------- 7�
CITY OF EDMONDS
ENGINEERING DEPARTMENT
505 BELL STREET TREET FILE
EDMONDS, WASHINGTON 98020
APPLICATION FOR INVASION OF RIGHT-OF-WAY
(Submit In Duplicate)
Permit to be issued to: 1-3 F,--;7 1"A
For work.at: (address or vicinity) Ar�-
IPA ee_ 1/) It
Type of work to be done. al
(Attach Drawing When Applicable)
-74, '/) - --A -77-
Owner:. 1AIR, Ac Ilk- Z:J
Name
Mailing Address
City State
Contractor:
Namde I
-12 Or
Mailing Address
51-�� '9 1., 1/1,14
city State
Signature: q r- F�
Owner or Agent
�-7 1/ -1-/ - (-/ � 5-'ZI
Telephone Number
0 6
Telephone Number
Date Signed
DO, NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
Permit Issued (date) 7(�; Permit Number 7K
Remarks: lkbr-e 4wpte--7-ep (w-r*Al Z w6b-7-11
,ZA
�J
Upon issuance of this permit, the contractor is responsible
for workmanship and materials for a period of one year
following inspection of , the restoration by the Engineering
Dept.
NOTICE:
Work subject to inspection and restoration in ac �ordence
C
with city code. A 24 hour notice is required for inspection.
Call 775-2525
CITY OF EDMONDS
ENGINEERTN'C DEPARTu.NT
WA N
- --------- -
insp D4tjpl-?-Oo, .... - - ------- Rema:rk8
Insp Date, ......... ... �By ----------------------- - ----------
...............................
In,gp Date ...... .... ................ .........................
..... �By ... kri�; ......
inspDqte ------------ . .................. ...................................
... . ..... . ............. . .. .
............ p .......... ..... . .....
Fina[A ............ �Fil.
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CITY of EDMONDS FEB 2 0 1976
Civic Center Edmonds, Washington 98020 Telephone (206) 775-2525
umonds
Office of the Mayor
E`0 010 F I L E
February 13, 1976
Mr. Robert Jakubik
19426 88th Avenue West
Edmonds, Washington 98020
Subject: Side Sewer Connection for Residence aIZ19426 t8th Ast
Dear Mr. Jakubik:
Your letter directed to Mr. Herb Gilbo was received January 29,
and forwarded to my office for determination of course of action. In
reviewing the history of communications with you regarding getting your
residence connected in accordance with the City Code, we find that all of
this started in May of 1974. For almost two years now, we have been
working with you to accomplish this task and have given you several'
extensions because of your personal financial situation.
It is noted that you are no longer a student at.the University
and became employed in December of 1975.
In regard to your request for another extension of time and the
alternatives that you have suggested, the City will extend for one more
time the date in which this connection shall be accomplished. Your
letter indicates that if you have four (4) more months you will be able
to clear up outstanding debts and in a position to obtain financing
as required to pay for connection charges and installation costs for the
side sewer.
Based upon this input, the City's position and actions will be as
follows:
You are hereby granted a six (6) month extension during
which time a moratorium will be placed upon shutting
your water off due to lack of connecting to sanitary
sewers. The connection and all charges and fees connected
thereto shall be accomplished by August 15, 1976. This
is the final and last extension that shall be granted.
If the sanitary sewer connection is not accomplished
by August 15, water supply to your residence will be
terminated in accordance with City of Edmonds' code.
Mr. Robert Jakubik
Page Two
February 13, 1976
Enclosed is a copy of this letter which you are to sign and return
to this Office. Your signature and acceptance indicates that you
fully understand and accept the conditions of this extension of time.
Very truly yours,
JHE CITY OF EDMONDS
Harve H. Harrison
Mayor
RLW/j h
cc J. Herb Gilbo,
. Leif Larson
SIGNATURE:
Robert Jaku.bik.—
Date
t4-,
Ak--,Fz
FILE
nQ L
P
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q 1 56
A4�
STREET FILE Date July 30,1976
Memo to: Director of maintenance & Operation
Public Works
From: ASst.City Engineer
Subject: -Sewer Connection Charges
Legal Description: Sec 18 T%VP 27 Rge 04, RT-18-1)
The S 129 ft Of E 168 ft of the following
described tract; Beg at the SOW cor gectioh;
th S 89042' 27" E 1039.92 ft; th MOO 5oloo,-
F 239.52 ft; th W' 20 ft to TPr,; Th N 0005000011
E 154.76 ft; th W 273.66 ft�, th S 154.74 ft;
t h * E 2 71 �0'4 1. ft to TPR
NOTE: This computation supersedes Sewer Connection Memo of May 6, 1 . 974;
the following charges have been figured on a pQrtion-of the
previous legal description.
Commonly known a s: Robert W'. Jakubik owner: 19426 88th Ave.
Z.F.F. Calculation:
39.31 Z.F.F. x
Lateral X
Unit x
CC: Robert Jakubik
$ 766.21 Connection Fee
$ Lateral Charge
$25 $ 25.00 Trunk Charge
$ . 10.00 Permit
8 01.21 TOTAL
2108
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OITLIC WRKS DEPART= CHECKLO -7 Date
BunDINGPERMITREVIEW
STREET FILE kci4-7-to -aSAIw-�,�/Address
Street Right -of -Way Existing REQD
Access Easements Existing REQD
Utility Easement Existing REQD
Lot per Subdivision
Site Plan Checked for Accuracy
Plat
Assessor Map
Underground Wiring Reqd.
Check Accuracy of Legal Description
Environmentally Sensitive Area
Environmental Checklist Reqd.
Flood Hazard Zone
Shoreline Management Area
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Existing Zoning Per Code
Amenities Design Board-Approval-Reqd. ADB # Approval
Board of Adjustment Approval Reqd.
ReviewBy: Date:
Existing Water Main Size
Water Main Reqd.
Service Line Reqd.
Hydrant Size Existing
Hydrant Reqd. Per Fire Code
Detector Check Meter Reqd.
Cross Connection Inspection
Fire Department Comments
Water Meter Charge Reqd.
Review by:
6eptic -rank i)esi-gn Approvea
Septic Tank Permit Reqd.
Sanitary Sewer Availability
Drawing No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd.
Review By:
Size
Date:
Date:
Pen -nit No.
Proi -
File No.
Date:
Ope'n Ditch Existing Reqd.
Culvert Reqd. Size
P" Qatch Basin Reqd. Indicate on Site Plan
0 Shoulder drainage maintaii-i collection (ri swale open runoff -
!,1--u-ffiole rcqd. Indicate on Site Plan
Soil Conditions and Groupd Water'Field CTiecked
IRO.,,riew br 11i te
�Street Paving Reqd.
Curb and Cutter Reqd.
Sidewalk Reqd.
Curb Cut"for Driveway Reqd.
r4 Right -of -Way Construction Permit Reqd.
Bond Reqd. for Public Irriproven-Lants
Street Naue Sign Reqd.
Other Signing Reqd.
Pre Permit Site Inspection made on
0
BY: SMER
W WATER.
2- STREET
ENGINTEERING
5special Requiren-eants listed in men-o to Cor'munity Developn-ent Departrrent,
Building Division
> 13Y —Date
o All items filled in on Building Permit Application
BY Date
P4 Dra�,Tings Staii-ped and Notations Made
BY —Da*te
I'lApproved by Public 1%lorks Deparmynt
Revised: 1.v 10-1977
M
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114-
,_0
% ET FILE
CITY of EDMOVAE
200 Dayton Street - Edmonds, Washington 98020 - Telephone (206) 775-2525
Department of Public Works
CERTIFIED MAIL
Allied Backhoe
22821 85th Place West
Edmonds, WA 98020
Gentlemen:
September 21, 1977
On August 18, 1976, your Company was issued an Invasion
of Right -of -Way Permit to connect a side sewer in 'the vicinity
of 19426 88th Avenue West. Completion of that work is still
pending with regard to the street as -per City specifications:
i.e. saw cutting, placing base rock, compacting, and hot patching.
Our records show notification to your Company by phone prior
to this letter.
It is necessary at this time for your Company to complete
the work in the street within 10 days of the date of this
letter. After which time, the City will complete the work and
submit a bill for the incurred cost.
is: lv
1. Yours very truly,
LEIF R. LARSON, P.E.
Director of Public Works
I d- z, I I (__� _11*1 7
U A Adrpin. Se'c. date
RECEIPT FOR CERT , IFIED IVIAIL-30�� (Plus postage)
SENT 0
POSTMARK
Allied Backhoe OR DATE
WKELI AND NO.
22821 85th Pl'. W.
�-_O_-.STATFAND ZIP CODE
_-E-dmonds —WA—P, 8 QZp
OPTIOW
L SERVICES - R -Ai AL FEES
-S Jim—
RETURN I h0ws to w m andF-datedehie--red
it delivery to addressee only
': h
RE C E 'PT shows 6150
S V wh date and where delivered 350
ER ICES Wit delive'ry to addressee only ............ 850
Tq DDR!WE ONLY
................ ...... .............
U,
_SVEblAL DELIVE1Y (
.... ....
.... . .. ......
PS Form
Apt. 1971 3800 NO INSURANCE COVERAGE PROVIDED. (See other side)
NOT FOR INTERNATIONAL MAIL
Q>
BUILDING DEPARTM ENT Applicant Fill
PERMIT
NUMBER
RS
Inside
PERMIT. APPLICATION
Heavy Lines
7)
JOB
ADDRESS
NAME 101� NAM F SUSINE5Sj
SUBDIVISION NO,
S _�
PLAT NAME
f �ESESSOR
MAP NO.
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W
MATLING ADDRESS,
Z
PUBLIC RIGHT OF WAY PER ORDINANCE NO.
0
CITY
LEPHONE NUMBER
<.Q
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XISTING RIGHT OF WAY
ROPOSED RIGHT OF WAY
DEFICIENCY OF RIGHT OF WAY
U
STREET/UTILITY WORK REQUIRED C3 YES' F3NO
W
�_D_D R E S S
PERMIT FOR WO RK IN PUBLIC R/W. YES NO.
0
U
M
CITY TELEPHONE
NUMBER
UNDERGROUND WIRING REQUIRED YES NO.
U
CONNECTION TO SANITARY SEWE R El Y I- S ONNO
J
III
SEPTIC TANK PERMIT REQUIRED []YES MNO
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NAME
0
SEPTIC TANK PERMIT NO.
0
AD RE
SEE MEMO DATED.
cc -In
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REMARKS
0:
I-
CITY
TELEPHONE NUMBER
Z
0
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STATE LICENSE NUMBER
CITY LICEN I SE.NUMBER,
A
UILDI . N.G SUPPLY SIZE
Legal Description of Property (Show Bel w or Attach Four Copies),'�
W
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uls
Z
2
SIGN AREA
ENV. REVIEW
ADS NO.
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ALLOWED'
P ROPOSED
COMPLETE
EXEMPT
W
REMARKS,
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VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS,'
T COVERAGE
GAS
FRON SIDE REAR
T
D E
HEIGHT
D NEW
RESIDENTIAL
LINE
FIRE ZONE
TYPE OF CONSTRUCTI
NON-RESID.NTIAL
SIGN
E
1 7
ADD.
7 DEMOLISH E] RETAINING,
WALL
SPECIAL INSPECTOR
REQUIRED
AREA ]OCCUPANCY
GROUP.
OCCUPANT
LOAD
0 YES
ALTER.., . EXCAVATE FENCE
OR F1 LL.. X_FT)
PLAN CHECKED BY. THIS SITE IS LOCATED IN THE CITY
PRE -MOVE swim
El
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
-REPAIR
INSP. POOL
REMARKS -
"UMBER OF STORIES.
NUM BER OF
Z
DWELLING
A QI&A w,,_
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IN TURE.OF WUR bNE
A K TO
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PLAN CHECK FEE
VALUATION
FEE
PROPOSED USE,
I-,
ZI
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0
W1
PLOT.PLAN (INDICATE BUILDING SETBACKS_
ABUTTING STREETS) . -
BUILDING
01
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MECHANICAL
0
>
It
FENCE
ti
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SIGN
RETAINING WALL
0;
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SWIMMING POOL
4
60
TO+AL AMOUNT DUE
I hereby. acknowledge that I have read this application; that the in-
formation given is correct; and that I am the owner, or the duly author
ized agent of the owner. I agree to comply with city and state laws regu-
ATTENTION
APPLICATION APPROVAL..
lating construction; and in doing the work authorized thereby, no person
wiII be employed in violation of the Labor Code of.the State of Washington
THIS PERMIT
This application is not a permit
relating to Workmen's Compensation Insurance.
�,UTHORIZES
until signed by the Building Official or
NOTE:'Permit Limit One Year(Except DEMOLITIONS and FILL
ONLY THE
his Deputy; and fees are paid, and
PERMITS without conditional use permit, which shall be completed in 90
WORK NOTED
receipt is acknowledged in space pro -
days; MOVED -IN BUILDINGS shall be completed in six months.)
vided.
SIGNATURE (OWNER OR AGENT)
DATE SIGNED
INSPECTION
DEPARTMENT
DIRECTOR'S 37NAT R
CITY OF
EDMONDS
DAI -
Thill Permit covers work to be done on private property ONLY.
775-2525
Any construction an the public domain (curbs, sidewalks, driveways,
marquees, etc.) will require separate permission.
ORIGINAL - File YELLOW - inspector
ATTENTION',
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE �PINK �, Owner GOLD - Assessor
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
,', r ? rtlzl:�ATE OF OCCI;P.A'JrY HAS BEEN GRANTED. UBC 304,306
0
The City of Edm
Side Sewer Drawing
E"10 F I L E
NEW CONSTRUCTION N REPAIRS F�
EASEMENT NO. * ..............................................
LID NO . .................. ASMT. NO . ..................
OWNER Ct� CONTRACTOR �A-Tl-.A
.. ........................ PERMIT NO.
JOB ADDRESS LEGAL DESCRIPTION: LOT NO. .......... 2 ...................... . BLOCK NO . .............................
0
PWW-0001 .11/75 (REV. 11178)
..................................................................................................... - ...........................................................
NAMEOF ADDITION ------ .........................................................................
DATE ------
- — --------- 7—
CITY OF EDMONDS SIDE SEWER PERMIT
NT
WATER -SEWER DEPARTME'
PERMIT
Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.)
ADDRESS LOCATION OF CONSTRUCTION ........
. .............. ...................................
.................... . .......................................................
iROPERTY LEGAL DESCRIPTION.:�5;��.��:T-: f�.e!!_zl 4-
--------------------- ..... ---- ............ ................................................... .......................
................................................... ...................... . ............................................................................. I .......... . ................................. ..................................................
1, . I
....... . ....................................................... O'*T17NER,013M/OR BUHMER ...
CONTRACTOWS NAME & ADDRESS ..........
. .... ................................ ....... � _Xn� .....
:1 . .......................................................
F- `iisslon Is granted ........... . .... ................. 197rfor repair and/or connection of a side sewer to the city sanita�ry'sewer
_,�n in accordance with City 'o'i"Edmonds 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
2 side sewer in street area. Do not cover any portion of sewer before it has been inspected.
NOTE No. _All work performed in city right-of-way requires an Invasion of Right-of-W&y Permit obtainable from the City Engineer's office.
NOTE No. 3--Obtaln full information regarding Ordinance 11.16.030 a-nd 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 I I Ins; minimum grade of 2%. No bends In grade
sharper than 'A 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 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 appurtenances except to in-
sert the pipe into the wye.
DISAPPROVEDEi Date ... . ................................... By ................ Dat .................................... Ity ................ Date ............... . ................... . By ................
APPROVED Et Date ... . ...... 4 ....... 1.9 ....... �_) ...........
............ ......................................................................................
Remarks: ....... . ...... . .......................... . ... ........................................................... ....................................... ....... -
....... . ....................................................
----------------------------------------- . ................................... _ ....................................................................................... _... I ,
j....................................................
BOTH Permit Copies MUST Be Si4gnedBy wner of Firm Performing Construction PRIOR To Request For Inspection
..........
�r... hereby certify that the side sewer installation constructed under this perm
(Owner of contr-acting&Fllr.mMPMerf'c"rm*in-g'*Co-- t-r-uct_io-`n-_) .... it
was installed in accordance with all governing ordinances of the City of Edmonds
J�ll 1fa
Date 3 day of....
d thi& ------------- ...... ........... .......................... 19
------ 7 -------------
V V Check BEFORE you dig for: Water 0, Gas 0, Telephone 0, Power 0, Sewer 0, Other 0 Nt -V
I*
NOTICE:
N'o...W.-a r-ra nty...OT -a-Uut Y---1
The information shown on the attached
e by the City of
map(s) was compiled for us
Edrnondsl its Employees and Consultants.
The City of 'Edm.onds does not. warrant the
et forth on these
accuracy of anything s
Map(�-). An . y person or ent1tY requesting a
copy should conduct an independent
inquiry regarding the information shown on
tRe -rn a p (S) I including, but not limited to,
th . e location of any sew-er stub shown, Such
sewer stubs may or may, not exist. and may
or may not exist at the location shown.
�ity of Edmonds nor its
Neitheir the k-1
emp*l,o*yee*s o*r office-rs -sh-all be 1-lia-b-Ife for -41-he
information given" on this map(s), nor for
any one representation provided based
upon said map(s).
V
ity of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT. Permit Number.
Issue Date:
A. Address or Vicinity of Construction: 19426 88 Ax W'_
B. Type of Work (be specific): Trintall 1-114" NPE TP Main in.88 Av W
0 W19 from 16'W to 20'W C/L @ 3301N C/L 196 St SW
C. Contractor: -WashWton Natural Gas Contact: Peggy Floyd
Mailing Address: 1122 75 St SW -'Everett Phone: 356-7500 X7596
State License #: 98203 Liabil ity Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer -Permit # (if applicable):
E. F1 Commercial EJ Subdivision E] City Project ff] Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family 0 Single Family Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: 0 Yes [ENo G. Size of Cut: x H. Chargq��
�_ -2-0 - ct,
kEAD A4' '�IGN
APPLICANT TO 1 1.1)
1 -1 "'-) I -
INDEMNITY. Applicant understands and by his signature to this application, agrees ti)-hold t" City ofEdmondg &Pmle88 froj� injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made airainst the City of Ed4'."16'r any of. its departments or
employees, including or not limited to the defense of any legalproceeding8 includig sts, and attorney fees b nof tingthispermit.
(Near
0, 7
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PA TCH
IS COMPLETED B Y CITY FORCES, A T WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
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 prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at all times for iaspect T'n pur ses.
"h Signature: d.,la I VDate: -1 Q-96
(Cdira_cro�vr n
CALL DU� --A-DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: I hA'�'
RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS DISRUPTION FEE/FUND III:
SPECIAL CONDITIONS: RESTORATION FEE:
PERMIT FEE:. 0 Q
TOTAL FEE:
COMMENTS: RECEIPT FEE:
DATE: ISSUED,BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
YES
Date:
Date:
El NO
6�Qmll
FU246 PAV.
V4 M P4r IP MA Id,
FIA V
I to
Is
/ 'l-) 6 6 T 1!5 W
(0
Notes: The City of Edinonds
1) Field locate all utilities.
Call 1-800-424-5555
24 hours before digging,
2) Survey is not required
3) Maintain a minimum of 5
horizontal and 3' vertical
clearance from all city
utilities and appurtenances.
4) Cuts in paving are shown as E@
5) cuts in paving anticipatedil
No.
DESCRIPTION
DATE
REVISIONS
AS BUILT INFORMATION
FITTER OR CONTRACTOR:
COORDINATOR:
F
DATE COMPLETED:.
PERCENT COMPLETED:
I
E
TEST
INSTALLATION I RETIREMENT
SUMMARY
TYPE OF TEST:
L
__IPRESSURE:
DATE ON:
TIME ON:
I I R
MAIN StZE
MATERIAL
TOTALFOOTAGE
D
DATE OFF:
[TIME OFF:
TYPE OF PIPE:
PIPE MANUFACTURER:
-TESTED BY:
OP MAP:
GaS
PLAT MAP:
1/4 SEC:
WORKAREA: j50M0,4jV'$
PROPOSED MAIN
FOOTAGE
EMERGENCY SEC. No.:
MAIN SIZE
MATERIAL
TOTAL FOOTAGE
DESIGN PRESSURE: PSIG
D
SYSTEM MAOP: PW1
PSX3
E
PERMITS: 0VM0MV_5
S
r
G
N
_)P MA 0-�
- - - -------AV- W_
DRAWN:
151%
JOB N.. �5 :5 1 Z
I
6
DRAWINGNO.
9 (0 13 Is I ?I
IAPPROVED:
.1 1
41
F
450",
130'W
AJ- 6VC16 PAV.
PROP / V4 PC /P /144 //1/
lu - �—�67 C PIA V
11
Notes: The City of Edmonds
1 Field locate all utilities.
Call 1-800-424-5 555
24 hours before digging..
2) Survey is not required
3) Maintain a minimum of 5'
horizontal and 3' vertical
clearance from all city
utilities and appurtenances.
4) Cuts in paving are shown as E@
5) 0 cuts in paving anticipated.'
No.
DESCRIPTION
DATE
BY
APP'D
REVISIONS
AS BUILT INFORMATION
FITTER OR CONTRACTOR:
COORDINATOR:
F
DATE COMPLETED:.
PERCENT COMPLETED:
I
E
TEST
INSTALLATION / RETIREMENT
SUMMARY
TYPE OF TEST:
1PRESSURE:
L
DATE ON: ITIME
ON:
IIRIKWNSIZE
MATERIAL
TOTALF00TAGE
D
DATE OFF:
ITIME OFF:.
TYPE OF PIPE:
PIPE MANUFACTURER: .
FESTED BY:
Habuid 630=�=
AVAW*0W&WWC0ffWWW
OP MAP: /Cc 0 - 6149
PLAT MAP: 161,63'
1/4 SEC: 0-7 - 4
WORKAREA: 0 M OAJ Z75
PROPOSED MAIN
FOOTAGE
EMERGENCY SEC. No.:
MAN SIZE
MATERLAL
TOTALFOOTAGE
DESIGN PRESSURE: P5$o
D
SYSTEM MAOP: ps*
PSIG
E
PERMITS: 0 �JP-5
S
G
N......
MA I
. --ro ........
DRAWN:
61151 ft-
J013 No.
CHE9!f�E
DRAWINGNO.
9�2 13
1APPROVED: