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19512 82ND PL W
ADDRESS:
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: [] Conditional Waiver F] 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
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
FOR:
WATER METER TAP CARD DATED:
OTHER:
LID #: 1-3q
LOT: BLOCK: z
SIDE SEWER PERMIT(S) #: ,�/ c� ��z&og,
LATEMPOST'sTorms\Street File Checklist.doc
APPLICATION
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for
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SIDE SEWER FERMT 0 Z TP , S v77 e?b o
NEW CONSTRUCTION REPAIRS 0 EASEMENT No . ..........................................
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OWNER ..... <QRS F.2%JU-.0=.7T.%.CZ)N ...... CONTRACTOR F;W.56P .......
12,
........................................ PERMIT No.
A RESS —.4StZ#!!0�L-%*%GAL DESCRIPTION: LOT No. ........................ BLOCK No . ............................................
..... . ..... S.
NAME OF ADDITION ..F=L-..-b& ........... Caf= ......... M ...
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Approved:
EEO
........... ..............
DATE ..... �.� ............. BY —
. The City of Edmonds
APPLICATION
for
SIDE SEWER PERNaT
NEW CONSTRUCTION �� REPAIRS
EASEMENT No. ... '? -D ? 5- J 7&
......................................
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A-40- 3
OWNER ----------- �2A2:�� ... ------------------------ CONTRACTOR- ------- \, ff -,t--Z4 ............................... PERMIt7N . . ....... ... . /
ADDRESS 44? .... . .. . .............. -------
... ......................... LEGAL DESCRIPTION: LOT No . ..... / ................................... BLOCK No . ......................... ..................
--:Zl .... 0—.,
NAME OF ADDITION ....
.........
..... .... .............................
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DATE................................................ By ..................... ................................................
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PERMIT. -
CITY OF -EDMONDS --L.SIDE. SEWER
WATER -SEWER
PERMT A362
6* 0-1 -i�, side, -sewer-. Inspections any portion- ofihe
11 7.7 -11 BEFORE covering'
-eque NO ., 6 or holiday Inspections)
Inspection will be provided within 24 hour& after r st Sat un
19510 & 19508 of"� n d Place West
ADDREW LOCAMON. OF. CONSTRUCVON ..................................................... .................................................... ............ .................................
PROPERTY I�E� DESCRIaMON ..... .-MUlev-od ................. ... .......... .............. . ........ . ..........................................................
......... .......... .. . . ..... . .... . ......... . ........... . ................................................... . .................. . ............... Z ........ ............... . ........... ...............................
arrison, Seattle 99110
................... 0 ER ... �j E�01 'jJ!,...
ER 1P ....
........... XND/OR BUHD ...... ...................... . ................................... .................
. ............
CONTRAVIVW8 NAM & ADDRE 2 1 Ja
SS ..... RUSS .... ....................................
1-" Permlsdoils -.lg .... for repair and/or 6onnection of a -sideieWei to the- elty -sanitary.- s6Wer
- -- - ------------
systm I n accordance with City. of ii�'ordinances.
6�
11 N�_. I -,-The ovPpers:of the j Woperty may obtain a permit to. construct sewer Inside= t 'be, employed to construct.
, _ . . =.. A,Ilcensed Side Sewer�,Contractor m.us
inBtreevc��_pq not,� cover,any, portion ofitewer before it has
'o` ff Ice.
�41tljht -.t-Way ftrtnit obtainable. froxn'thi% City'Engtneer's
Into7pamn, regarding, prol"anc am
governing side irwers when you get permit. -
NoTE! No: 4-::-Top of -aide se;wer must -have at'liast 30 Inche's coverage at property line and'12 Inches Inside propeky line: -1-Imu krade of 2�. 'No bends- In jradi
I P11.09 Off Wt It RIPW
NOTE No.- 5—Trefiihes'in street- must1be 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 ;bxcept to in-
sert the pipe Into the Wye.
DISAPPWIVED. 0 Date� .. ......... ....................... By .... : .. . ....... Date ..... ----------- Date .......... . .. . ........... o ........ By .................
... 77-7
11.1 Mal
.�_.EIUAL .... I.N.SP.E.C10, TER011 J
.t_, .... . ........
------------ : ----- n7 .� ..... . ... ....... I .................. I .................
-* t co 6�, -Be Signed By.r Owner, of.-Firin Performing Construction.PIUOR.To.Request.For Inspection --
-under this
. . .... ....... ...... . .............. .. hereby ceiWy that.the side sewer installation constructed
C permit
g, Perforining. n,
_F1 S
M c with 'rdIn=0e of thb *City '�f Edmonds.
accord' governing,
......................
Dated this ...... A6 . ........... day of...... . .. . ............
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