20021 88TH AVE W.PDFiiiiiiiiiiii
8448
20021 88TH AVE W
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
Aft�
Permit Numbe. 9 1�-
FILEPERmT
'7 L
Issue Date: 41-6
A. Address or Vicinity of Construction: - 20021 88 Av W (9414547)
---Nmmm-- C� B. Type of Work (be specific): Initall New Service
9 0 - 1 9 t
C. Contractor: _ Washingabn Natural Gas Company Contact: Frank Swan
Mailing Address: 815 Mercer St. Seattle, WA Phone: 224-2278
State License #: 98111 Liability Insurance: Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. E] Commercial Subdivision n City Project K] Utility (PUD, GTE, WNG, CABLE, WATER)
n Multi -Family Single Family E] Other
INSPECTOR: INSPECTOR: k -f C—V1 T
F. Pavement or Concrete Cut 0 Yes @No G. Size of Cut: x H. Chargq�
APPLICANT TO READ ANIAD2111N
ho t�. i f,.Famages, or
INDEMNITY. Applicant understands and by his signature to this application, agrees to ho t 'tyofEdmo d ha If
g t
d t the City ol 8 mo rm s' 'rQy a or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be ma 7d A. an� +itl.�
.employees, including or not limited to the defense of any legal proceedings including defense costs, and attorney fees by re"on pffrant�tnq ihi ermit.
'Ilse
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERI-10WOF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA 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 i�r 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.
. A
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 t�mes-for inspection purposes.
Signature: Date: April 5. 1994
(Contractor or Agent) I
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: T RIGHT OF WAY DEPOSIT
TIME AUTHORIZED': VOID AFTER IF MS DAYS DISRUPTION FEE/FUND Ill:
SPECIAL CONDITIONS:
COMMENTS:
J
DATE:
RESTORATION FEE:
I
PERMIT FEE:
. TOTAL FEE: JIJ, k)
RECEIPT FEE:
ISSUED BY:
a
NO WORK SHALL BEGIN PRIOR TO PERMIT iS'SUANCE Engrg. I)iv. 1991
1�
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
�I/A
Addendum to CitY of Edmonds
Right of Way
Permit Applicaiion
MITCHELL S.-LANKFORD
_Pubmitted by:
Engineering Aide
Washington Natural Gas
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depth
C_H�, �now�n
0 11 gas main
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Key:
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water
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gas
-ss-
sewer
-19-
water hydrant
0 -
wate---- valve
815 ,ic!rcc:r St. (1 0. 1::,)L 1869). Sc�, WA S � I H %1206) 6-27--'767,
SWEET FILE CITY OF EDMONDS
DEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, Edmonds, Washington
SEPTIC TANK INSTALLATION PLAN
(Yubmit in Triplicate)
'& ......... 0
ADDRESS OF PROPERTY ..... .............. J .. . ..... .......... Lot No ....................... Permit No..A�7�7 ......
Owner-.Ar... Address ......... ............ Phone ........................
Builder V Address ..... ------- ...... Phone ...................
�_� ....... Address ----- S. ...... :;�?--2 - �_hone ........................
Installer. ................ ------- ...................... ............... Address .................................................. .............. ... Phone ........................
I hereby certify the accompanying drawing is an accurate representation of the system installed at the listed
address. I * also certify all 'recommendations and restrictions (concerning plumbing stub elevations, maintenance of
grades, fills, Surface drains, etc.) listed by me on my sewage disposal system permit application dated ................
. ...... I .... ................. ............... have been complied with.
Sign a t u re of 04sipw . . ......... ....
, �,4 _A7— 10 ate Y. -
TO BE FILLED IN BY CITY ENGINEER ONLY
Accepted ...... ........ ...... ...................... 7��Date .... .............
NotAccepted ..... ....... ........ . . . . . . ....... ....... __ .. . Date. . . ..........
Signature of Sanitar—imr--...... ..................................
Remarks: ......................................................................... --------------------------------------- ............... ...... ............................................
INSTRUCTIONS: Use the reverse side of this form for the drawing. Use a scale which will permit the greatest
detail and still contain the entire site on one page.
ATTENTION HOME OWNER:
Your septic tank has limitations! It was designed and installed to care for an average -size family. Over-
loading the septic tank or disturbance of the drain -field may seriously impair satisfactory operation. Points to
n
remember:
1. Have your tank checked periodically to see if pumping is necessary (2 2-3 ye s).
ar
2. Do not channel ground water, surface water, footing drains or downspouts into the t4 k or drainfield.
3. Do not excavate, fill, place a structure, driveway or,patio in, on, or ove'r the &
4. Limit toilet fixture disposal to sanitary wastes and toilet tissue.
5. Detergents and bleaches used in nornial household quantities will not harm the action of the septic tank and
disposal field.
CITY OF EDMONDS
DEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, Edmonds, Washington
SEPTIC TANK INSTALLATION PLAN
(Submit in Triplicate)
C
ADDRESS OF PROPERTY ..... ............... r—. 5 e.. ............ Lot No ....................... Permit No..": .......
Owner--4z - - -------- ---- --- --- .................. Address... . .......... ----------_-- --- ...................... Phone ........................
Builder Address ...... 1!F4
ao ....... ..... Phone ........................
Address. 02�,��de.-"4*41-oeuFhone ........................
Designer 02
Installer------------- ...................................................... Address ........................... ..... --------- .......... ............. Phone .............. .........
I hereby certify the accompanying drawing is an accurate representation of the system installed at the listed
address. I also certify all recommendations and restrictions (concerning plumbing stub elevation7s, maintenance of
grades, fills, surface drains, etc.) listed by me on my scwa--c disposal systern permit application dated ................
......... have been complied with.
............... -----------------------------------------------
Signature of Dovig=er . . Z_,, 7�ae,
TO �BE FILLED IN BY CITY ENGINEER ONLY
Accepted------ - ...... . .......... ....... Date ............................
Not AcceptedZ Date.
Signature of Sanitarian
Remarks: ..................................... ---_-----_---------- --------------------------------------------------------------------------- ................................................
.................. ............. ................. ...................... ........... .............................................. ............................................... .....................
INSTRUCTIONS: Use the reverse side of this form for the drawing. Use a scale which will,��Sfinit the greatest
detail and still contain the entire site on one page.
ATTENTION HOME OWNER:
Your septic tank has limitations! It was designed and installed to care for an average -size family. Over-
loadiril., the septic tank or disturbance of the drain -field may seriously impair satisfactory operation. Points to
remember:
1. , Have your tank checked periodically to see if pumping is necessary (2v2-3 years).
2. Do not channel ground water, 'surface water, footing drains or downspouts into the tank or drainfield.
3. Do not excavate, fill, place a structure, driveway or, patio in, on, or over the drainfield.
4. Limit toilet fixture disposal to sanitary wastes and toilet tissi.ie.
5. Detergents and bleaches used in normal household quantities will not harin the action of the septic tank and
disposal field.
CITY OF EDMONDS
DEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, Edmonds, Washington
SEPTIC TANK INSTALLATION PLAN
(Submit in Triplicate)
ADDRESS OF PROPERTY .... ��#Z �� �
_j .............. s4f,
........... Lot No ..... _ .............. .. Permit No ...
Owner ... A?. ...... Address ......................... Phone ........
Builder.9'.
il� Address.. ....
...... Phone ...........
'Designer . ........ Address .....
.;047%4&�Akt-Phone ..... ..................
Installer,
Address ...............
............ .... ...................... Phone ..................
I here#cer ie--,T=fm�hlillp'4.9anvy'l�nzg"-Tra,w-ing-is an accurate, representation of the system installed at the listed
address. I also certify all recommendations and restrictions (concerning plumbing stub elevations
grades, fills, surface drains, etc.) list , maintenance of
ted by me on my sewage disposal system permit application dated,.. .........
...... ....... _have been complied with,
Signature of Doot .......... ...............
- /ato
TO BE FILLED IN By CITY ENGINEER ONLY
.... ......
To BE FILLEI
Accepted ...... . ... ....... ...... ...
....... Date..
Not Accepted .... ....... _ .... ................... ....... Date ............
Signature of Sianitarl ........... ...........
...................... .......
Remarks:.... ...........
....................... .......................................
.......... ....................... ..................... ...... ......................... ............ ........................
.....................
INSTRUCTIONS: Use the reverse side of this form for the drawing. Use a scale which will permit the greatest
detail and still contain the entire site on one page.
ATTENTION HOME OWNER:
Your septic tank has limitations! It was designed and installed to' care for an average-siie family. Over-
loading ilic-16ptic tank or disturbance of the drain -field may ser
remember: iously impair satisfactory operation, Points to
1. Have your tank checked' periodically to see if pumping is necessary (2y2-3 years).
Do not channel ground water, surface water, footing drains or downspouts into the tank or drainfield.
1. Do not excavate, fill, place a structure, driveway or,patio in, on, or ove'r the drainfield.
4. 'Limit toilet fixture disposal to sanitary wastes and toilet tissue.
5. betergents and bleaches used in normal household quantities will not harin the a tion of e sep c t k
disposal field. c th ti an and
g
CITY OF EDMONDS
DEPARTMENT OF PUBLIC WORKS
250 Fifth Avenue North, Edmonds, Washington
APPLICATION FOR A SEWAGE DISPOSAL SYSTEM PERMIT
(Submit 3 Copies)
Permit to be issued to:..? .... nr� . . . .........
. . ...........
dress) . :3 X
For installation at: (street ad . . . . ....... .... C:* Aj --- 4 ------------------------- , ------ ......................... I ......
Ji N
Addition or Subdivision. Af EX-C..Lpi� ..... a "ad.
-P-7�.Al ..... .... ........ ............ Lot ................ Block ................
14 30 1 4,' 01 /
Type of Building: New....Y�_ Existing ............ Single family residence.... ...... Number of bedrooms ------ ..............
Other: (specify type or use) .................. ----------------------------- ----- 1 .................................................. ...... I .......................... ......
Builder .... ---------- .... Addt'ess_ e ... L, . �j ...................
..... ... ......
Address
C
Despe L
Soil Log Hole No. 1 .....
rol" - ----- - - -------
............................ .............................................. ------ -------- ................ ........................................ ........................... ............ ........
Soil Log Hole No. 2 ........
------ .................................. ...................................................................................................
......................................................................................................... ............... ........................................... 1 ..............................
Elevation of Water Table, if encountered. (Distance from ground surface) ................ .....................................................
Corrections to control surface water if needed-.. .............................................................. I ........................................................
................................................................................................................................................................................... ; ......................
Specify if any removing or grading of topsoil in field area ... ...... ................................. .................................... .....................
............................................................................................................................ ................... .....................................................
Percolation: b
// 6 M
Test Hole No. I — Average Rate,�:r� .......... .................. "—(Fall in ininutes/inch-bottom 6" test hole)
Test Hole No. 2 — Average Rate-3 " / 6 /,-/ - /. Au. _t
..;; ..................... .... ......... S�_;5(Fall in ininutes/inch-bottom 6" test hole)
Test Hole No. 3 —Average Rate._�.. .......... 1.0^�'l �u ....... .. YZ
---"'(Fall in minutes/inch-bottom 6" test hole)
Average percolation rate on which to base drain field design .....
...... Date Taken . .....
Septic tank requirements based on present rules and regulations:
Septic Tank Size ......... '9
..... gallons.
Amount of Square Feet of Disposal Field ........ ..... ..... .....
........... .. .............
Date .......
..........
Signature — Designer...
OVOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
..I e Et issued (date) .............. --- — --- .............. Permit Number ........ ------- ...............
0
07,
Remarks: .. .. . .. .... ............... ............................ ...... .................... ............. ................. ................. .......
................................................................................................................... .................................................................................
CA Q
40
-a s Y)Q
-,M, -IT
SEWAGE DISPOSAL R.,
Septic
Tank .......... . .......
... gals.
CITY F E.D.-M 0 N D S'
N.o.
Disp.
Field ......... 9�a '�i . ..... sq. f t.
�O
Depaitment of �Pubfic Wdr'ks
Other ...............................
— .............
KJName
..............
........ 11( ........ ...... . ......
.........
.... .... ........ .............. ...........
is hereby. iuthori2 mAnstall/
..
.:ed
re air sewage, disposa�:.,,systcrn at
17)
(.-�r '? /
,
__p
$
...........
........... .......
........ �' ....... ... .. ........... ............ ............................
.................................. ........
.. ....................................
Date issued on .............. ..........
Permit expires one -year, 66 date of issue -
DO NOT COVER BEFORE APPROVED BY DESIGNER OR'SANITARIAN
I hereby certify -this system was installed-. under my supervision and control and complies -with all provisibris-:6Nthe City
of Edmonds Resolutions.
Signatureof Installer.. .......................................................................... Date ..................................
ApprovedE] Disapproved Date .............................................. .......... ...... -By .................. .................................................. I
X
Remarks:
SANITARIANOR -.-.DESIGNER ................. ................................................................ .............. Date ...................................... ................... Ai.
This permit shall be posted,in a reasonably conspicuous P�ace on the job -until inspection has been completed.
�!LEThe City of Edmondfil'--��"-�
APPLILATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION e,�� REPAIRS 0
OWNER........................................................
z
ADDRESS ................ aa, - �-
.....................................................
BASEMENT No...
CONTRACTOR ....................................J C
............................................. PERMIT N
LEGAL DESCRIPTION: LOT No . ............ ------------ - ............. BLOCK No . ...... ......
..................
NAME OF ADDITION .... 1Z ........
Approved:
DATE.... .......... By ... ... .................
APPLICATION
for
The City of Edmonds SEDE SEWER PERMIT
BASEMENT No . ..........................................
NEW CONSTRUCTION E�-- REPAIRS
OWNER R�.& --------- .............................................. CONTRACTOR ............................. ..............................
...... .............. -- ............ PERMIT No . ...............
ADDRESS
. ...... . ................. I . . ................................... ........... LEGAL DESCRIPTION: LOT No...... ........................... ............. BLOCK No.
NAME OF ADDITION .....................
Ap
50-7, L
Approved:
DATE......................... ...................... By ........................................................