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19510 82ND PL W
ADDRESS: A�V,-22-&`�Izaz-w
TAX ACCOUNT/PARCEL
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: — DETERMINATION: E] Conditional Waiver E] Study Required Ej Waiver
DISCRETIONARY PERMIT
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:
LOT: BLOCK:
SIDE SEWER AS BUILT DATED: wvJ75 SIDE SEWER PERMIT(S) #:
f I
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
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LATEMPOST'sTonnAStrect File Checklist.doc
APPLICATION
for.
The City of Edmonds STREET FILE SIDE SEWER PERMT
NEW CONSTRUCTION REPAIRS 0 EASEMENT No.Z#Zlb�5��
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-RACTOR .......
OWNER-440FRIZ-
.......................... CONT PER311T No..
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1;M DESCRIPTION: LOT No . ..... ................................. -BLOCK No.-..: ....................... .................
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ADDRESS
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NAME OF ADDITION .... F.2. ... . .. . .......................... ......
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Approved:
DATE ... ........ 2-7 ......... By .... . .... . . .. ... ...
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ONDS SIDE SEWER PERMIT
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CITY OF ED
WATER -SEWER �DEPARTMENT
PERMIT -362
call 776-1107 f or side sewer Inspections, BEFORE covering any portion' of the oonstructl
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nspection will be provided within 24 hours after. request. No Sat., Sun., or holiday Inspectl
8;�nd Place e s t
ADDRESSLOCA27ON OF CONSTRUCTION ..... : ........... ........................................................................................ ...... ........................................
Lot 2. P! a ..cf..I'la
PROPERTY I�EGAL DESCRIPTION ................... . ........... t ...... ------ P .1�40p�d ................. ... .......... ............. . ..... .. . .... .................................................
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.......... . ...... . ... ....... . .... . ......... . ........... . ........... 7 ........................................ . .................. . .............. ..... 7 ............ �1-7 ..... . ...
N URI) - UONI S T H, )�rj son-, Seattl e 9' Y 19
....... ................... ......................... ........ OWNER AND/OR BUMDER ................................. .......... .............................................. . .......
RUSS
CON_=ACTOR1*S NAME & ADDRESS ...... ! . ........... ......................
Permisslofi:b tr�.. J,4ay- 16 - 19_731 f
......... . .................... ......... or repair and/or connection of a -side se*er to the dty is�tary-_igi*er
system in aceordanoe with City of Edmo�&'ordinance&
6� ............
0 A licensed Side Sewer_Contractor must be employed to construct
_:�07 N I�The owners of the property may obtain a permit to.construct sewer Inside property line.
NOTE alde,se*- In streefama� Do not cover any portion of -sewer, before it bas been inspected.
2--��An w6ek ierform d�in city right-of-way requires an Invasion -of FUght-of-WLy PermA obtLt=ELble from the City Engineer' a'afflos.
NOtE No. tm�Obtalnz full Information regard!ng.. Ordinance- 1 21.16.030 Lnd..FeI;vIaUcnn governing side sewers when you get permit.
No.: Top ofwslde sewer nl'usi -have; at 'least 30 inches coverage at property line amd 12 Inches Inside property line: mmimum grade of 2�.. No "i -In'
Trefi;�
NOTE No.. 5— hes 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 yeax of completion.
NOTE N' o. 6—It Is unlawful to alterfor 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 0 Date .. ..................... By ....... . ....... Date ........... BV ... . ........... Date .......... . .. . .................... . By ................
7 ....... . ... ...........
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By..
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7 J PL
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was e in ac2o,
S 6, Be Signed By Owner of.7F!r-m Perfom-iing Construction PRIOR ToRequest.For Inspection...
. ..........
hereby certify that. the side sewer installation constructed -under this.permit
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in Perfcrmi;ng metructlon�
with all governing. ordinances of the City 'of Edmonds.
Dated ...
this ...... . ........... day of. ............................ .... . .
4it ello 0
Clr:e6ck BEI70RE you dig for: Water [2,' Gaj [n, Telephone C], Power
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