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CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMQT
w , REET FILE
A. eAddress or vicinity of Construction
Owner:
Name
Mailing Address
City, State, Zip Code
Contractor: � 'le'o , " ,�, ',(r�c .
Name
"D a'
Mailing Address
T, i
City, State, Zip Code
,Permit No. 2 Z
issue Date I
0 Permit Issued To:
0 Type of Work to be Done: A 50JLII'� -
• Work in Connection With:
Sub or Plat 0 Single Family
0 Comml. /Ind. 0 Apt. Condo.
• Pavement Cut: El Yes A, No
State License Number
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
kt
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any injuries, damages, or'claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand th I at this permit must be available at the job site for inspection purposes. at all times.
Date
Signature: I
Owner or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Vold after -ZO —days
Special Conditions:
Ammendments:
Permit Fee
Security Deposit:
Receipt No.:
Fund ill Fee:
Street Cut Dimensions
X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
!7
FIELD INSPECTION NOTES
(Fund 111 - Rout�e cony to Street Dent.
Comments:
Diagram:
Contractor called for inspecticn- (�;D NO
T
,Ajork DisaT)proved By: Date: Bv: Date:
Work Anproved By: -Date:
Inspector:
Ena. Div. December 1978
a�
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UVILITY'DIS
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Reason'' for�w` C:pj'v, Efig
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Co �4_ S TIR. C 0. a 3 K W
'Apl1s
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'kONMENTAL ANALYSIS
PERIAIT REQUIRED FOREIGN, CONTACTS EASEMENT INVI
TYP Col'llso fit- IE'c fien4cvAer�.Dijitrlct SIPA
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procedut*s;i4ction I I I -A
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L Posted LA
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40 'D6teB--X0Anvo�-fiL4,_\S00 Intowpre�tatibn Referred To
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CITY OF EDMONDS
an
PUBLIC WORKS DEPAR & NT FOR INSPECTION CALL10 Permit NO. 6395
SIDE SEWER PERMIT 775-2525 Ext.� 220 Issue Date
i* PEP -MIT MUST BE POSTED ON JOB SITE * I
W01WftF i .
alown
LL
2.
LU
LU 3.
I C
.C. 4.
co 5.
6.
Address of Construction
Property Legal Description (include all, easements)
Single Family Residence 1--�Multi-Family No. of Units
Commercial
Owner aad7zer Builder
Contractor & License
Invasion into City R
way Construction Permit Required
excavation) .
N o L-*-
Y A
(If Yes Right -of-
- Call
Dial
Dig (342-5344) before
7. Cross other private property: Yes No Easement required -
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
a. Property owners must obtain a permit to install side sewers on
their property. A licensed side sewer contractor must be employed to
construct side sewers in the public' right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
c. Commercial establishment requires a minimum of a six inch (6
side sewer line.
d. Side sewers may not be installed closer than thirty inches 00")
to any structure.
' - . 1 0
e. Side sewer lines must 0 be laid.at a minimum grade of 2% (1.15
and maximum grade of 100% (45
f. No turn in side s8wer greater than 450 (1/8,bend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer 'line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k.. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice iequred.
DATE: 9
I;-4g&tify that I have read
and shall comply with the above
PERMIT FEE: 'D SAPPROVED BY: Date:
094 j By: Date:
In CONNECTION FEE: APPROVED By: Date:
PERMIT MUST BE POSTED ON JOB SITE
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CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT-, REET FILE
RIGHT - OF - WAY CONSTRUCTION PERMIT OT
A. *Address or vicinity of Construction
e Owner: N-) z,
Name
Mailing Address
City, S ta te, Zip Code
-I r
f Contractor:- � ly t %
Name
- -� � �) 1�? I A ri �1'
Mailing Address
�_ �Ljlli;) (4, �',' h 31,
City, State, Zip Code
rmit No.
Issue Date
�p , � (�, .1�i "
0 Permit Issued To: 1�
9 Type of Work to be Done: 'i � �Z �� - M � 14 , ;,, L,
0 Work in Connection With:
El Sub or Plat Ff�, Single Family
El Commi. / Ind. 11 Apt. Condo.
0 Pavement Cut: 11 Yes El No
State License Number
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this �e.rTlt,m,ust be
Signature: ,': ' A Y'VE
Owner or Agent
lable,.at the job site for inspection purposes at all times.
41 4
THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorizkd Vold after —days
Special Conditions:
Ammendments:
Permit Fee:
Security Deposit:
Receipt No.:
Fund 111 Fee:
Street Cut Dimensions
X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE'* *
Eng. Div. December 1978
FIELD INSPECTION NOTS (Fund 111 7-te conv to Street 1jent.
r�mm�"+- � -
Diagram:
Contractor called for inspection., Yes
I
Work Disapproved By: Date: By: Date:
Work Approved By: Date
Inspector:
,Enq., Div. December 197P
CITY OF EDMONDS LAURA M. HALL
MAYOR
7110 - 210TH ST. SW - EDMONDS, WA 98026 - (206) 771-M5 4 FAX (206) 744-6047
COMMUNITY SERVICES DEPARTMENT - PUBLIC WORKS DIVISION
9 0
June 8, 1995
Mrs. Sandy Po.irier
20116 80th Ave. West'
Edmonds, WA 98026
Dear Mrs. Poirier:
I have reviewed your account and will allow a credit for the March billing period in
accordance with our City policy. The policy states that the customer will be billed at the
retail rate based upon the average water consumption for the same period during the,
previous year. In addition, the excess water lost from the leak'will be billed to customer at
the City's, wholesale rate with a 15% surcharge added for administrative cost. Only one
leak credit will be granted in any three year period.
Should you have any additional questions after you receive your new billing, please
contact Ilene Larson, Utility. Billing Clerk, at 771-0241.
Sincerely,
Ron Holland
Water/Sewer Supervisor
RH/lk
cc: Ilene Larson
Utility Billing Clerk
wordata\water\#428250
e Incorporoted August 11, 1890
Sister Cities International — Hekinan, Japan
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T 01 T INSTFINT
PLUMBING
8020 180TH ST. S.E.
SNOHOMISH, WA 98290
HOMEPHONE—
WORK PHONE
SOLD TO:
NAME —
ADDRESS
CITY —
DIAGNOSIS/ SOLUTION
SERVICE RECOMMENDED
WATER PRESSURE PSI:
CUSTOMER INFORMED 0.'.
TTPLU**137QC
PLUMBING -HEATING -SEWERS DATE CONTRACT N
SEPTIC SYSTEMS -PUMPS 0-27918
WATER HEATERS AND MORE...
S I NCE 1979
(360) 743 -5000 (360) 338-0494
(360)486-3029 HOMEPHONE �71- 22217
WORKPHONE
JOB ADDRESS:
NAME a I
ADDRESS—,
CITY �r— Q 6� /a
C113Y OOSL OX7.�_ _2v-73
WORK AUTHORIZATION
AUTHORIZATION TO PROCEED WITH DIAGNOSIS/SOLLITION
1, the undersigned, am owner/authorized representative of the
premises at which the work mentioned above is to be done. I
hereby authorize you to perform Diagnosis/Solution as you deem
advisable. A monthly service charge of 11/2% will be added after
10 days, up to $1,ODO.00 and 11/2% over $1,000.00. 1 agree to pay
reasonable attorney's fees and court costs in the event of legal
action. If your check bounces, you could be liable for 3 times the
amount of the check or $100.00 whichever is more, plus the face
�'�alue*of the check and court costs. I have read, agree to, and"
�Pv. received a copy of the contract and Notice to Owner on
mverse side.
I hereby authorize you to proceed with the work at a preliminary
contract price of:
Signature
WORK AUTHORIZATION
AUTHORIZATION TO PROCEED WITH SERVICE RECOM-
MENDED — 1, the undersigned, am owner/authorized represen-
tative of the premises at which the work mentioned above is to be
done. I hereby authorize you to perform Service Recommended
as you deem advisable. A monthly service charge of 11/2% will be
added after 10 days, up to $1,000.00 and .11/2% over $1,000.00. 1
agree to pay reasonable attorney's fees and court costs in.the
event of legal action. If your check bounces, you could be liable
for 3 times the amount of the check or $100.00 whichever is
more, plus the face value of the check and court costs. I have
read, agree to, and have received a copy of the contract and
Notice to Owner on reverse side.
I hereby authorize you to proceed with the work at a preliminary
contract price of:
Signature
F] CASH E]CHECK ��(C.C.
E] CHARGE APPRVD BY—
REC'D:
TERMS — CASH,6nI... preauthorized. Nei ten (101
days, or per contracted terms, with an approve(
account established with T & T INSTANI
PLUMBING. In the event of default in the payment 0
any amount due there will be added a service charg(
equal to the legal maximum allowed, and ar
additional charge equal to the cost of collectior
including agency and attorney fees and court costi
incurred as permitted by law governing thes
transactions.
WARRANTY
(Details on reverse side)
ACCEPTANCE OF CONTRACT — I find the servirA
and materials rendered and Installed in connectiot
with the above work mentioned, to have beer
completed in a satisfactory manner, and herebj
authorize T & T INSTANT PLUMBING to bill any o
my credit cards, for the. goods or services beinc
provided, and I agree to perform the obligations se
forth in the applicable cai� holder agreement with IN
credit card issuer. I agree that the amount set forth or
this contract in the space labeled 'totar to be the Iota
and complete contract price. I agree to pa�
reasonable attorney's fees and court costs in th(
event of legal action. I acknowledge that I have rea
and received a legible copy of this contract.
Auth rilled Sign
ZU4r
S.C.
FLAT RATE
SUB TOTAL
TAX
TOTAL
LESS DEPOSIT
AMOLINTDUE
Pavment Due U[)on Comoletion
SEATTLE
RICHMOND HIGHLANDS
3801 Latona Ave NE
1108 N 185th
Seattle, WA 98105
Seattle, WA 98133
(206) 632-2129
(206) 542-2164
FAX (206) 634-4657
FAX (206) 546-5746
EVERETT
KIRKLAND
425 E Casino Rd
11835 120th Ave N E
Everett, WA 98204
Kirkland, WA 98034
(206) 353-0663
(206) 823-4455
FAX (206) 290-6233
FAX (206) 823-8765
am
SO. SEATTLE
LYNNWOOD
11455 Des Moines Mem Dr
16920 Hiway 99
Seattle, WA
Lynnwood, WA 98037
ge= 241-0409
061742-4646
FAX (206) 246-1253
FA� (206) 745-4690
RENTON
120 Factory Ave N
Renton, WA
980M) 255-3429
FAX (206) 277-6450
KENT
10234 SE 256th St
Kent, WA 98031
(206) 850-1100
FAX (206) 859-3038
MARYSVILLE
1410 Grove St
Marysville, WA 98270
(360) 659-6253
FAX (360) 653-0944
STORE HOURS
Mon -Fri 7-6
Saturday 8-5
Sunday 9-5
page 1 -m- --X- ]c P4 V C3 -x- -m- -m- -m-
i
SPECIAL INSTRUCTIONS:
7 7
TIME:
1.1,1. j.C,)
SHIP DATE:
INVOICE DATE:
SOLD BY:
C j- ;,I DY
SOLDTO: 7
SHIP TO WAI_I'E!� F,01[�T!.-17)
CUST NO.: LWI
JOB:
CUST PO.: ORDERBY:
SHIP VIA:
V
OTY.
UNII
ITEM NUMBER
DESCRIPTION
PRICE
EXU.NSION
11. 00
P C
CU) 14 10
CEDAR M-10 STY. SIS2E
2'. 46
27. �N..
2.i 04t.
FIC.
.0,9137 1 G
QSB7/16
7.98
15.
2.00
LB
�NLGB16..
NAIL .16D HD GALV. BOX—
LB:
NL_Q3C68.
NAIL 8D RD GALV CASINBE11"
0.98
�1.
1.00
EAC
STAN46500
FWARE STANLEY HPIMYNAN-STEEL
5.
4371.__"&�
SALES TOTAL
5 i7'
FREIGHT 0. 00
MISC + FRGT
01
TAX NO.
�.D
TAXABLETOTAL 'j_ 82
SALES TAX
4.
1k1f-%K1-rAYA01 C-rr%rA! I -A Ch I -A
REC'D BY
TOTAL 5 7.
LOADED BY
CUSTOMER
Q, o
Cj 7-D
71
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THE HOME DEPOT 4707
THE HOME DEPOT 4707
1335 N. 205TH STREET - SEATTLEY WA 9 8131\"l
1335 N. 205TH STREET - SEATTLE, WA 98i
PSJ
STORE MCR-JOHN SAUER (206)546-1900
STORE MGR-JOHN SAUER (206)546 -190C
P S, (I P , ..- -)
IL aLo-
0 c�
\,�j t7�
C-0. 94 ccl,
)po
d oAoG(-
4707 0002.5 20567
05/07/95
4707 00018 43648
05/13)
SALE
370
03:41 PM
SALE
301
10: 521
038561354072
INSERT FTG
0.45
038561351071
INSERT FTG
0.
038561354072
INSERT FTG
0.45
038561353075
INSERT FTC
1.
038561354072
INSERT FTG
0 ' 45J
038561351071
INSERT FTG
0.
025582301475
PLIER
11.41
038753312293
JT. COMPOU
1.
SUBTOTAL
12.76
SUBTOTAL
2.
12.76
TAX WA 8.200
1.05
2.82
TAX WA 8.200
0.
TOTAL
$13.81
TOTAL
$3.
CASH
15.00
CASH
4.1
CHANGE.DUE
1.19
CHANGE DUE
0.�
ORIGINAL RECEIPT REQUIRED FOR A REFUND
THANK YOU FOR SHOPPING AT THE HOME DEPOT
WAREHOUSE PRICES - DAY IN, DAY OUT
ORIGINAL RECEIPT REQUIRED FOR A REFU
THANK YOU FOR SHOPPING AT THE HOME DE�
WAREHOUSE PRICES - DAY IN, DAY OUT
890
CITY OF EDMONDS
7110 - 210TH ST. SW - EDMONDS, WA 98026 - (206) 771-0235 - FAX (206) 744-6047
COMMUNITY SERVICES DEPARTMENT - PUBLIC WORKS DIVISION
June 20, 1995
Mrs. Sandy Poirier
20116 - 80th Ave. West
Edmonds, WA 98020
Dear Mrs. Poirier:
LAURA M. HALL
MAYOR
I have received a second request for a leak credit on your account. This is not
allowed per City policy which states that one leak credit will be granted per a three
year period. Credits will only be allowed for a one or two billing period based on
when the leak occurred.
Your request for an additional credit has been denied due to the fact the leak was
not fixed when you where first notified of a possible problem within a reasonable
amount of time.
Should you have any questions, please contact. Ilene Larson, Utility Billing Clerk at
771-0241.
Sincerely,
Z" g'aj
Ron Holland
Water/Sewer Supervisor
RH/Ik
cc: Ilene Larson
Utility Billing Clerk
wordata\water\#428250
Incorporated August 11, 1890
Sister Cities International — Hekinan, Japan
NOTICE:
No 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 'Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity -req uesting a
copy should conduct an independent
inquiry regarding the information shown on
th-e -map(s), including, but not limited to,
the location 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
employees or officers -shall be Hable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
Nl ION DS
Side Sewer Drawing "" NT P
TREATMENT PLA�NT
The City of Edmonds,,',` j . . . EASEMENT NO.
qJr .... .. .. .... . .... _ -------------
NEW CONSTRUCTION 0 REPAIRS D LID NO. ASMT. NO . ..................
OWNEP - ------ bJ CJ ------ WaJ --------------------------------- ----------------- CONTRACTOR .... L.Lf _N_lV..VJ_aQ_a ...... ........... PERMIT NO. ..63.C/5
.. K e
JOB "DRESS ---- ll__�__78CT" Ave. --- \e\1 ......... LEGAL DESCRIPTION: LOT NO . ..... 19
- ----------------- ................ _ --------------- BLOCK NO - -------------- ---------------------
I......................... .......................... I ----------------------------------------------------------------
I
NAME OF ADDITION .... E7Q-C.,t ------- Ac�;n .......
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seev-vice I; ki e S
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RiW-0001 -11/75 (REV. 11/78)
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EDMONDS
TREATMENT PLANT
6" C-0 (4
Approved:
DATE .... C)_l )39 ......... � By
i�
i
CITY OF EDMONDS
PUBLIC WORKS I DEPAWNT
SIDE SEWER PERMIT
FOR INSPECTION CAL
775-2525 Ext. 220
Permit 110
0 Hog
Issue Date ZI11,21
-----------
*�PERMIT MUST BE POSTED -ON JOB SITE
1. Address o I f Construction.,
2. Property Legal DescriptionAinclude all, easements)
3. Single Family Residence 1---l""Multi-Family No. of Units
Commercial
4. Owner and74or—B.-u-i-Ld-er
5. Contractor & License No.
6. Invasion into City Right -of -:Way:
way Construction Permit Required
excavation).
Aj (a 0 co C
No A (If Yes Right -of-
- Call Dial Dig (342-5344) before
vatu P)
k ved,
E-1 .7. Cross other private property; Yes No sement requ`i-rga -
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
P4
a4 11Q-t
a. Property owners must o�tain a permit to install side sewers on
>I their property.* A licensed side s I ewer contractor must be employed to
construct side sewers in the 'ubli6 ri
ght-of-way.
b. The side sewer contrcictor assumes.full reponsibility for each
installation for one year.
C. Commercial establishment requires a minimum of a six inch (6")
P4
V4 side sewer line.
0 d. Side sewers'may not be -installed closer than thirty inches (30")
to any structure.
0
e. Side sewer lines must be laid at a minimum grade. of 2% (1.15
0 and maximum grade of 100% (45'). 0
E-4 f. No turn in side sSwer greater than 45 (1/8,bend) is 0 allowed
between cleanout. All 90 turns must be constructed of a 45 (1/8
bend) and Wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer 'line run.
I j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k.. Side sewer must be left uncovered until inspected and approved
by.the City.
1. Inspection during normal working hours only. Two (2) working
days notice 7equired.
DATE:
I de0tify that I have read
and shall comply With the above
PERMIT FEE: PROVED BY: Date:
`SAP
U B�" Date:
CONNECTION FEE: APPROVED By: Date:
0
P4 7?
PERMIT MUST BE POSTED ON JOB SITI* PAV-HA
swill
" i - ' "
kjS
I
bmuWwr
15, Mh
70270
File No.
LEGAL D[SCRIPI lOHS F(ji�.PHIL 1ULLUCK SHORT
SUMVISION
LUTIRE I -)ARCEL
L ot 19,—East Edmonds Acres Division No. 2,
according
to Lhe plat
thereof
recorded in Volume 12 of Plats, On Page 66,
records
of Snonomi4h
COuhtY,
Washington.
1-��ARCEL NO I
Lot 19, East Edmonds Acres Division No. 2, according to the plat thereof
recorded ih Volume 12 of Plats; on page 66, records of Snohomish Couaty,
Washingto
ACEPT the East 150-00 UK thereof.
SUBJECT TO an casement for the construction, reconstruction, operation and
maintenance of a sanijary sewer pipeline and water lines Oyer,. under, across,
through and upon the south 10 feet thereof.
PARCEL 110. 2
The West 70.00, feet of the East 15o,00 feet of Lot 19V East Edmonds Acres.
Division No. 2, according to the plat.thereof-recorded in Volume 12 of Plats,
on page 66, records of Snohomish County, Washington.
SUBJECT TO and TOGETHER WITH an casement for the construction, reconstruc
tion, operation and m,iintenance of a sanitary sewer pipeline and water
10 feet of Lot 19,
lines, over, under, across, through and upon the south
2, to the plat thereof recorded
Lost Edmonds Acres Division No. according
Plats, on 66,.records of Snohomish County, Washington;
in Volume 12 of page
LKS the cast 80 feet thereof.
�ALSO TOGLTHLR WITH an casement for ingress and egr ess and for the construc-
tjon, reconstruction, operation and maintenance of utilities, Over, under,
across, through and upon the north 25 feet of the cast 80 feet of Lot 19,
East Edmonds Acres Division No. 2, accordinq to the plaL thereof recorded in
Volume 117 or Plats, on page 66, records of Snohomish County, Wa5hingtOn.
page I of 2 Pages
A.
Legal Des * )Lioii�i for Phil Tti) hick Short ollvislulk V) . 7
PARCEL NO. 3
1he e,i�;L. 80 f(!(!L
of' LoL L9 Lo-;I, I dmond Acre5 Divi.slon 110. iccordlriy Lo
the Plat thereof
recorded in Volume 12 of Plats, on Page 66, records of
Z, -
S1101101"lliSh County,
Washington.
SUBJECT*to an easement
for Ingress in(] cqrcsf; �jn(j for the con5trUC0011, recoil-
sLrLJCti0n, opurdtion
and mainteril-ince of' uLiliUc5, over, under, across,
thrOLUJI1 and upon
thenorth.25 feet thereof.
TOGL
-THER WITH an
casement for the com3truction, reconstruction, operation arid
maintenance of a
Lhrough and
sanitary sesver pipeline and water lines, over, under, across,
the
upon
according to the
SOLIth 10 feet of Lot 19, East Edmonds Acres Division flo.2,
plat thereof,
records of Snohomish
recorded ill Volume 12- of Plats, on paye 66,
County; Washington; LESS the east 80 feet there -of.
qq01-Z-G02A
Pm.le 2 of 2 Pages
m
X14 Z /0//
4:5Z cz�
'No
1,
� I
/N. ell
O-V
J�Z'Wll-lr 4/10
rel 1?1,e1y4AWayo
et4lyz�1,00"
L
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W.99 lye7 t,-
x ACT
+
00
". ee
r
8 go - 199
City,dj kdmonds
RIGHT-OF-WAI�"'CONSTRUCTION
-Permit Number-
RE#ISION 4 Issue Date:
A. Address or Vicinity of anstruction: 20114 & 20116 80 AV V (9612757)
B. Type of Work (be specific): - imstaliL 1-1147 HER LP Main in 80 AV V
from 4831S to south end of *he road
C. Contractor: -Washington Naturkl Gas.
MailingAddress: 1122 75 St SW Everett
State License #: 98203
D. Building Permit # (if applicable):
Contact: Mariamne KJLngsbury
Phone: 356-7500 X7596
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. F] Commercial E] Subdivision o- City Project [N- Utility (PUD, GTE, WNG, C ABLE, WATER)
n Multi -Family 0 Single Family E] Other
I NSPECTOR: INSPECTOR: KW
F. Pavement or Concrete Cut DlYes []No G. Size of Cut: 4 x 2 H. Chargq_$
APPLICANT TO READ A��'N
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the defense ofany 4egalproceedings including defense f9sts, and attorney fees by reason ofgranting thispermit.
THE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEJ�S 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.
Cons - truction;.drawing of proposed work required with permit application.
A 24 hour frotice is requiied 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 ali 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.
Ihaue read the above statements and understand thepermit requirements and thepink copyof thepermit willbe
available on site at alltimes for inspection urposes.
A I - A A P PF-tz
Signature:
Date:
10-31-96
�Uontractor or Agent)
CALL DIAL-A-DIG/PZRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
I Comments:
I Diagram:
CONTRACTOR CALLED FOR INSPECTION El YES E] NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
4kVBLWORKS DEPARIMWr CHE
IC CIU* Date
BL�nDMIG Plq�-aT REVIE14
co ddress
Street Right, -of -Way Existing REQD
Access Easements Existing 12__�) CS-,/,Z -7 R REQD
Utility Easement Existing --s - REQD
Lot per Subdivision *Z.- Plat Assessor -Map
Site Plan Checked for Accuracy q--t �79
Wiring Reqd. LF--.N
Check Accuracy of Legal Description
�..Ehvirbrmentally Sensitive Area
Environmental Check -list Reqd..
:.Flood.Hazard.Zone.
a Shoreline Mapagqn--eent Area
Slope, Soil, Vegetation
Strewn, Creek, Drainage Basin
Existing Zoning Per Code
Amenities Design Board Approval Reqd. -ADB # 'Approval
.Board. of Adjustment Approval Reqd..
-Review � BV: Date: e4—k
4`51- (on Ave -
Size
Water. Main Reqd-. N14
..Service Line Reqd. 3W
Hydrant Size Existing
Hydr'aht Reqd. Per Fire Code .--Size
Detector Check Meter Reqd. 1YI14
Cross Connection.In.spection
Fire, Department Con�nents
Water Meter Charge Reqd.
Review by: Date: .�/-//-77
i4 Sep tic- Dai�,�_ 0
Septic Tank Permit Reqd. Permit No.
Sanitary Sewer Availability
PrO3.
File No.
Drawing'No.
Side Sewer Availability
ection/Fe
Sanitary Sewer Conn e Reqd.
Revia,7 By _/V 92
Date:
(�)en Ditch.E\isting lil Reqd.
Culvert.Rcqd. Size
P4.. Catch Basin Reqd. Tndicate on Site Plan
0 ap maincain collectioi o-I le opcn,"?Uloff
ShOLIlde.r dra hi', swa
Al k-
'luiliole 'rcqd, Indicate on Site Plan
Soil CondiCioiis and Cr.oui.id 'Water Fi e 1 d Mocked AIL mI/
gevj. el.'7 by Da to
V&A U A -
Street Paving Reqd.
Curb and Cutter Reqd.
Sidowalk Reqd.
Curb Cut for'Drivoway Reqd.
Right -of -Way Construction Pem, it: Rc-qd.
Bond,Reqd. for Public Inproveme n t s
Street Nai-.)o Sign Reqd.
Other Signing Recid.
A
AAA-
t2l
Pre Permit Site Inspection riade on
0
BY: SOER
w
WATER.
S11UTT
ENIGINEE
'RING
Special Recjuiro-MonLs listed in n u t o Comminity Develdpr,'ent De�artTrmit*'
Buildill'o 'Divis ion
Ily Date
I
All items filled in on Bui" �rmit Application
Dat
I)rawings Stan,.,)ed C11 N tions �L-Idle
(14
)y Date
Approved b/ptilAic 'v!O):ks T)epal.t �X'nt:
r
Rc'viscd: I-v 10-19'77
m
W
PERM IT
0
BUILYIN.G DEPARTMENT A P7 UP, C 1I A T �fflr NUMBER
PERMIT APPLICATION
Insid, e Heavy Lines
K_'Y�
L
JOB
ADDRESS
PL
AU
NAME JOR NAME -OF BUSINESS)
114 12 4 V
LEGAL LOT- —
P C A T N X M
SUDOIVIVON fdo.
III
z
MAILING ADDRESS
ES . ONO
I
'2
's to
.
0
.CITY
TELEPHONE NUMBER
PUBLIC RIGHT OF WAY PER ORDINANCE N
EXISTING RIGHT OF WAY
NAME
'15
PROPOSED RIGHT OF WAY.
DEFICIENCY OF RIGHT OF WAY
ILI
ADDRESS
4
&!Z
STREET/UTILITY WORK REQUIRED
ONO
U
c2,1
PERMIT FOR WORK IN PUBLIC R/W
ONO
0:
CITY
E-9meivo,-5
T ELEPHONE NU
UNDERGROUND WIRING REQUIRED
JW YES
ONO
CONNECTION TO SANITARY SEWER
Ix vas
0 No
NAME
SEPTIC.TANK PERMIT REQUIRED
Ilya 6
NO
1A e
SEPTIC TANK PERMIT NO.
0
ADDRESS
,u,
4171 �2 71- 4 v-,:: 40
SEE MEMO DATED ,:1- - �
X
CITY
TELEPHONE NUMBER
REMARKS
0
U
z
0
111)A141 ' 4_6 D
7
mo
U
CHECKED BY
STATE LICENSE NUMBER
CITY LICENSE NUMBER
�2236/- "J.3 I Pk"
Legal Description of Property (Show Below or Attach Four Copies)
METER IZE,
SUPPLYSIZE
[BUILDING
W
REMARIKS
z
SIGN AREA
ENV. REVIEW
ADD NO.
U
ALLOWED PROPOSED
COMPLETE EXEMPT
In
W
SHORZLINIX
0
j
REMARKS
W
_j
VARIANCE OR CU
PLANNING REVIEW BY ]DATE
YARDS
`-1,5-, RONT r7
T COVERAGE
NEW RESIDENTIAL GAS
SIDE REAI)L0
FIRE. ZONE
TYPE OF CONSTRUCTION
CODE HEIGHT
LINE
El NON-RESIDENTIAL SIGN
F1ADD
DEMOLISH RETAINING.
WALL
SPECIAL INSPECTOR
REQUIRED
OCCUPANCY OCCUPANT
ALTER EXCAVATE FENCE
OR FILL El X—FT)
YES N 0
GROUP LOAD
PLAN CHECKED BY THIS E IS [ nrATF:n IN THE CITY
OF
REPAIR PRE -MOVE swim
INSP. POOL
EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
Z
NUM13ER OF STORIES
UMBER OF
REMARKS
0
DWELLING
UNITS
z
NATURE OF WORK TO BE DONE
W
U
W
IL
W
0
PROPOSED USE
PLAN CHECK FEE
VALUATION
FEE
X�; A/L-
z
MAW
PLOT PLAN (INDICATE BUILDING SETBACKS,
(t
ABUTTING STREETS)
BUILDING
IL
U
In
ILI
A/
0
j
PLUMBING
a
W
In
-
—
>
IALCHANICAL
0
W
FENCE
"Applicant, on behalf' of' his or her spouse, heirs, assigns and
SIGN
z
W
-I
successors in interest, agrees to indemnify, defend and ]told harniless
2
the City of I-Amonds, Washington, its of�icials, employces, and
R I ETAINING -WALL
I't"111 :111v IIA111c,
0
T7�� U
1) 1 H -J A I i',' 1 1*1
CITY 010 F1.1
PUB11K, U010 il: fl,
i U. I
SUWECT:
4e
Av o
Subdivision M
Multiple
(UIEFM RI I'S
Coordination of the location or ariv -,tructurn vitth-ro:�,rx,rf t-.() util-ities, str,-:�ets,
lines and driveway gr?des is the respom--,ib.`.I-iI-.y of' thc contract-ov.
The ccnstra,�i-or is req)-dred to keep the' abuttInF, street cl-r-me-d ordirt raid debri . s cau sed
by the construction 7.30.200 Violations Pen-31ties 7.30.290.
A "Right -Of -Way Construction Permit" is required from th�,' Eni7in--rin- Divi5iCTI of -Public
Works for any work within. the Public rJ-F;ht-of-vja& or public ea�-,errient 7-3,0-01-0 violations
Penalties 7.30.290.
ISI-EC11111C
UNDERGROUI�JD'POIHER
Underg-ound Wiring Req'd Not Req d
SMITARY SEI-ER (FEF�IIT REQ11))
V2� Connection to Sanita-rW Sewer ReqId Fick 1,!-atcr Valve 13(,q'd on 'Z.i de -'-'e:..ie r
Septic Taj-�--, Pennit Ren'd. Desij�n Approval Reql,i
Approved Dt.
STOFM SEWLH ' SYSIU-I WEIR CITY CODE
Drainage Plan Req'd.
Site Drainage to be Contained on i t e
ROADWAY AI,TL) I
Drive,aa- Slone Hot to Excecd.
Sit(, Dra-ill"If7- to 1-�e CCIT,iectej to City System I
Driveway Paving, Req"d Driveway Culv--�J,t. Rcq'd Size
Vertical Curb 'Req d Side".1, Hen, d
Street Paviag Req d
Bond Reql.d for Publi-c Improvements [jSubnlit Els t i ma t e
Note: /,d zazEe nazweva
Inspections 'Ren'd
Fo d
un. ation
Watcsr Servic
Engineering Division
Side. Sewer
Fire Protection
Septic- Tank
Drainage
Site InproverrFents
hour notice is required for inspection hy Eh:glneering all 775-2525,* eytension 220.
13Z
1; 4 RMERC"
_ F
D F. I E, ERG . P. E.-
City Engineer
C T'I 11 1 i 1..I-
JeW 6:
4"PEk'F A 05
TusiNG -�
cc v Me- w 177+
- Ic!
TeENC14 SECTION
*4 Al ff N -r-
710 60- AssUH6W
A y
w Ai 67ts.
DCAINA6E IqWY
CITY OF EDMONDS ENGINEERING DEPr.
Examined bY-
SAU L
Date,
�AJ
ASWCUTES, INCe.
A0 fW it EW .4 5 A10 MMMORS - DEVELOPMENT roNSULTANTS , PLANNERS
100M W. EDMONDS, WA 98020 - 775-IM
- W -71
H go-zo
10
9-4
9 61 C. LC!
........... H q 19
.4 23
Ct
C. 24
uj
4"BYPASS WES
U-- ----
4 "10 Y- wor
22 A�'
cr-
2. - - -- ----- ------
NO 5 04
3:
-7
3
7
.20 6
P 7
.36
4
T E -W-1 91
2
28
0
3
0
-214
4..
Hq-64
5 ..........
oe.
202nd. P 6 ....4''.
7 8. 7.
U
rA
-STI 6 )k.t STI ri
PARK51DE 31.
2
�Tl
13
12
9
TS
HEIGH 4
B LT ADD. 1 NO. 3'\
E
2 3
9
Ck 10
40 6 6
.5 Z 5
12
p N E bw
13 .4
H Sl
17
...... 7L
H 9.. 714
6 5
2 0
Al 15
E 19 0.
A.
20 16
Al.
4
Lot 199 "as t Ed ond s Acres Division i�o. 2, accor'
din-, to the plat thereof.
recorded i n 1 un e 1-2 0 f -Plats on T)a----e 66p record's
Washin,�D Of Snoho.mish Cou
,ton nt,,,,.
Parcel IN' b 2 20116-80th Ave.: West
The �Nest 70.0-3 feet of the L,.a-,--.t 150. 00 feet of L 0*t 19, East Edm-onds Ac. es
Divi-slon Ni o
2,.accordin: to the lat thereof recorded in Volume
e 12 of !�J:jt s
on pa., 61 6 records of Snohc.,iish Co'unty, VI ;�:i s h n.- - t o n.
,Z U r, T
'ECT T 0
u,0 �� �, .0
lon,
an easement for the construct jo n, rtc'onstruc�
operat'on and maintenance of a sanitary -
I in es,
East
sewer pi peline nnd water
over, tinder, across, ih-ou,::.-hand upon th6 south 10 feet of Ot 19
`drr.onds
in VOJUTT:,(3
Acres Divi�l�ion No�.
f Plats,
.9 accO`in:T to the lat thereof rA'
ecorded
L-EIS)S
on* pAge
the e.ast P-0 feet' thereolf.
records of Snoho,r-ish Count `iiashinL,ton;
Y,
A L S
ti on,
IVC ET H E'R 1!1 J.'nli a n 0 --a s e,�l e n t
reconstruction, oPerati-on
for ino-ress and 'e�res., and fcr the c-r*
and cn,ctruc-
*
throu6zh and ljr;on the' norti
riiainitenance of utj,ii�"3f�, OVer, I under,-
25 'P-et of the �-10 -r�,et
Last
_L-� dim,,� nd cj Acres Division 1"o.
e.,
.�st of Lot lc,.*,
2, accordino to the, p-lat the'reof
Voluine 12 of !-.'-'lats*, on ra,:,,e
recorded _J n
'record�, of 01,
Snoh-,-.,iish C 6 - r, t 'Xashin_rtc�
6"
i
.fe',4Z 6: 1 / "- v
.. 1 V711 ?e
ce ..
47'
TRENC14 SECTION.
4"PEZFADS.
TUBING
3 IW?.WASH6D,(;ZAVCL
1V
D,?A.INA66. /0"W.
-1 ml,
"Vftft`rMMMfNTCOKSUdANM- PLANNERS
EMONOS; WA 98020 775-1504
jS:A 70
-A
I If :� 50 /
-�5 E- 1,,/ e5(v'l i Po ` -- ' - - - ' - I
t�om - I-VO
-yl- -7 wi�
000
T-
w
`0,
4
Q0
0
- lu
i�-�
qc-.z
r-- - - � -�, r-4 I I I
Pk2017- ('/,4-" tA Pe� I P AA,5--(r�J
L- t 0 t: A
!cX'se cv%
Li
FNo. DESCRIPTION DATE BY APFID
REVISIONS
-AS BUILT INFORMATION
FrTTER OR CONTRACTOR: COORDINATOR:
F DATE COMPLETED: PERCENT COMPLETED:
TEST,� ION / RETIREMENT
INSTALLAT..
E TYPEOFTEST,:, PRESSLIRE:�i,: SUMMARY
L DATE ON: TIME ON: IIR TOTAL FOOTAGE
MAIN SME MATERIAL
D DATEOFF: TiME-O-FF:
TYPE OF PIPE:
PIPE MANUFACTURER:
ITESTED BY:
&,v
OP MAP:
PLAT MAP
VVad*tgton ........... ..
1/4 SEC:
lftl� Gas
WORKAREA:
PROPOSED MAIN FOOTAGE EMERGENCY SEC, No..
FIM
MAN SIZE MATERIAL TOTAL FOOTAGE DESIGN PRESSURE:
4 Sys PS301
JOE I p TEM MAOP: psto
PERM[ m z) t�l r-> -s
TS:
j.'
Z6114-. ;AV,
IDRAWN: lt)j20/c-% JOBNo.- 0)6p 1 7 5 -7
CHECKED: /ZtF(f DRAWING No.
qG1 ?- 7 5 -7
APPROVED:
I
,35 -IV �5(,IT L�AJC
000 1-1�rr ��Vl/
40
>
0
N
tu)
IS
-- - - — — , I I I I —Ij
Notes: The City., of Union&
1 Field, locate a-11 utilities.
Call 1-800-424..;5555
24 hour's-.befo're digging.
2) Survey is not required
3) Maintai in a min'imum -of 5"
horiz'. ofital''and"T. vertical
clearance f r6m:�811 city
utilifie's-:1 a d a0puetenances.
4) Cuts. in,'paving,arie sh6wn' as'0
5) 1 cuts in paving anticipated.
-------------
NOTES:
CALL ONE CALL Two DAY S* PRIOA,TO DIGGING AT 1-800-424-5656.
9 'CALL SNOHOMISH COUNTY INSPECTOR 48 HRS PRIOR TO
CONSTRUCTION AT
3 1;A 10- EASEMENT EiISTS THROUGHOUT THE PLAT PARALLEL TO RfW 1
LINES.
pit OVI-11. CT 1, T.
At
t� f7
-eck
'/,,I
AAAe-
No.,
DESCRIPTION,
DATE
BY:
APFD
`.".:,REVISIONS
�'AS BUILT INFORMATION:�
FITTER OR CONTRACTOR:,,
COORDINATOR:
F
DATE COMPLETED:
PERCENT COMPLETED:
E
TEST
INSTALLATION I RETIREMENT
SUMMARY
TYPE or- TEST,
PRESSURE:.
L
DATE 014:
TIME ON:
I/RjMA1NSIZ-E
MATERIAL
TOTAL FOOTAGE
D
DATE OFF:
TIME OFF:
TYPE OF PIPE:
PIPE MANUFACTURER:
ITESTED BY:
Naturid GW
AVAmhk0onEnaWCbff jxw
OP MAP: IGO,, (4, S,
PLAT MAP: 9
1/4 SEC:
WORKAREA:
P110POSED
MAIN
FOOTAGE
EMERGENCY SEC. No.:
MAJN SIZE
.— .
�M'ATERIAL
I I. `-q- - 1.
TOTAL FOOTAGE
DESIGN P RESSURE: PM
D
P
SYSTEM MAOP:
PSIG
PERMITS: Z) W D -S'
S
G
N
[Y MAI W-
Z0114 AV,
D DRAWN: 10F LO'? 0
W'
'bj?0/5*
JOBNo.
I-E
C CHECKED:
D RAW I N G N 0.
r Ft7
y
PP 0
APPROVED: