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20124 81 ST AVE W
S
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T�e City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT LYNN PLA
NEW CONSTRUCTION E) REPAIRS F1
OWNER SYC--ve.w .........................
ADDRESS - '6 ow.v-s: ...............
............................... �4"
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EASEMENT No . ........ ............................
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CONTRACTOR . ....... ......... ............. 1- ....... PERMIT.N
LEGAL DESCRIPTION: LOT No. ............................... BLOCK No . ....... ..........
............
NAME OF ADDITION ........ A..c...
A we *ch
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NUICE: INO WARR MY GF ACCURACT Th� Wimmation showl C. th
aftac'hed map was WImpilad for use by 1he City at Edmonds, iti
and Consultants. The City of Ebnon&� 4oes nu v.,arrant the a,
ajivIdling set forth an the map. Any person or entity req a C , opy
Shou!�j conduct an independent Inquiry Marding the Infori, ivat�`iio-." shovi i or,
th, mao, including, but riot limited to, the lamflon of. any se%,jer sL,,b
56�4jn sevver stubs rpay or m ay w adst and may not e)d�
the JoLation shown, Neither the City Of Eftonds norc, �'Zplayee�'[
ft, e � -, ftl
officers s!-A be liable for theinformation given an ws map, ijor fot any orzi
reprasentLfion provided based upon s--jd.qjr0.
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Approved:
W-11
APPROVED
JUH 22 Iftl
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....... 6? ........... By ............. ......................................................
. .... .... . .... .....
DATE 5. 1/1
.,,-( OF EDMONDS
CIVIC CENTER — WATER -SEWER DEPARTMENT Can PROSPeCt 6-1107 when work
Is ready for Inspection. (No inspec-
SIDE SEWER PERMIT tiOns Saturday, Sunday or holift".) N2 2365
ADDRESS 20124 - 81st Avenue West
.................................................................................... ................................................................ . .................................................
OVVNER ........................... Ralph B. Steven
-------------------------------------------------------- CONTRACTOR .......... rq�h exc.
Permission is granted June 2 2 0 67 . .............................................................
................................ ----------- 119 ......... for ........................ daYs to REPAIR* or CONNECT a side sewer
With City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWINr,:
NOTE No. 1—The owners of the PrOPertY may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must
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be mPloyed to construct side sewer in street area. Do not cover any portion of sewer before It has been inspected.
NOTE No. 2—Obtain full Information regaxdIng Ordinance 11.16-030 and Regulations governing side sewers when You get Permit.
NOTE No. 3—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 sharper than % Will be Permitted.
failure due to Improper work which may develop within 0 e year of completion.
NOTE No. 5—It Is unlawful to alter or do any other work than is provi n st
N, No. 4—Trenches In street must be water settled and surface Of street restored to Original condition. Contractors shall be respon his for
tenances except to insert the pipe into the wye. ded for in the permit, or to do any work on the main sewer Or its appur-
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CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Constr uction
Owner:
Name
- . - I.* - , / - Z-, . , , . � ": - -,�
Mailing Address
Z- 7 a
city, State, Zip Code
9 Contractor:
Name
Mailing Address
City, State, Zip Code
Wermit No.
.11,ueft
MEET
0 Permit Issued To:
• Type of Work to be Done: L�
• Work in Connection With:
0 Sub or Plat ��Single Family
0 Comml. /'Ind. El Apt. Condo.
• Pavement Cut: 0 Yes 0 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 permit must be available at the job site for inspection purposes at all times.
Signature: ate
Owner or Agent
I
THIS PERMIT MUST BE POSTED NAT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
0
C. Issued By:'.
Time ALAorized: Vold after 70 —days
Special Conditions:
Ammendments:
Permit Fee: 100
Security Deposit: ..
Receipt No.: e"',
Fund III Fee:
Street Cut Dimensions
X —
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div, December 1978
FIELD INSPECTION NW,-S Fun d 1 . 1 . 1 R06'e cony t o Street Dept.)
Comments:
Diagram: L,,) D A I
Contractor called for inspection- Yes
('110')
Work Disa.pproved By: Date: BV. Date:
Work Approved By: Date:
Inspector:
Ena. Div. December 1978
0
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131
PUMICIMRKS DEPAEM=,CHEAST Date
BunDING PERaT REVIEW
-�Address
STREET FILE.
Street Right--;of-Way Existing REQD LI-A
A&cess Easements Existing REQD
Utility Easement Existing REQD
Lot.per,Subdivision. Plat Ass.essor Map
Site Plan Checked for Accuracy
Underground Wiring Reqd.
Check Accuracy of Legal Description
Environmentally Sensitive Area
Envirornental Checklist Reqd-
Flood Hazard Zonel
Shoreline Management Area
Slope, Soil, Vegetation
Stream, Creek, Drainage Basin
Existing Zoning Per Code
Amenities.Design Board Approval Reqd- ADB #1 Approval::�
'Board of Adjustment Approval Reqd.
Review By: Date: e42�710
-Z.�xisting Water Main Size
a in Reqd.
Service L* e
Hydrant Size Existing
Hydrant Reqd. Per Fire Code
Detector Check Meter Reqd
Wa
er
�v3
y
ce
t
n
R
e
z
eqd
I xjsti�
[H dran 3ze E g
S3
y r t S
Hydrant Reqd
t
�ect �: ecl
r
C C oss ct� .
ross Conne?cti pection.
F r
ire ent Comments
ater Meter Charge Reqd.,
Re
Review by:
"2-
Septic Tank PLI- . t Reqd.
Sanitary Sewer Ava
Drawing No.
Side Sewer Availability
Sanitary Sewer Connection Fee Reqd
Review By:'
Date;
Size
Date:
Permit No.
Proi -
File NQ--
Date:
n*Ditch Existing. -Reqd.
Culvert Size
P4 Catch Basin Re4d, Indicate..on S
>-t -Ka'n
0 Shoulder drainage miintah-i collec -i swale off
Call
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D
er
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E'
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st in,
eqd
cjr aF
-1 S'q2 le off
0 nk
ain I in ol lec:t-
re dic_1 _0 _I -e Plan
qd In _L_ 01
t
d G�, r 1. i C
nd ate Lld Jjccj,�ed
1,1-u-�iole rcqd. Indicate on -e Plan
j
Soil Condit* and Groui-.id I -later Field G-iecked
[01 ,7 )y _
Cn.,7 by� Mte
�CS'�-reet-izaio�LngReqd.
Curb and Cutter
S.idewalk Reqd.
Curb Cut for Driveway Re
�,4 Right-of-Wa ruction Pe=*t Reqd.
B eqd. for Public Inprovements
Street Nam, Sign Reqd.
Other Sip-iixig Reqd.
�D
.. r:1 Z, Pre e �Ins�pectio�ninade on,
0
BY: SEI,, - R
WATER
STREET
ENGINEERING
Special Requireiients listed in mem to Comunity Development Departrent,
Building Division
BY _ An Na;�� Date_
o All item filled in on Building Permit Application
1-1f D
P4 BY Date— (22� 14-0
PA Drai . Tings Stan-ped and Notations Made
BY Date
lApproved by Pu . blic 1%7orks DeparLT.-�--nt:
Revised: I-V 10-1977
CITY OF EDMONDS
ENGINEERING DEPARTMENT
APPLICATION FOR RIGHT-OF-'V1,-..
$ W411ON P I
(AvrZic�:nt to Cc.-.-olete A & 3 ar2 Subrmt in DurZicate)
A.. Permit to be issued to: I- eg 4
For work at: (address or vicinity)
Ty�e of work to be done:
(Attach Drawing �%`hen Applicable),,
- . -7 1
Time Required -- Start: Finish: EPiGINE[RING DEPT.
Owner:
Name
'Po ' R'a Z I
Mailing Address
City State
Contractor: L v n
Na_r-
X,
Mailing Address
Ci y State
Examined by
D_nt�� ___
Telephone
L /'-'- IVN-- W-5 - (� _? -)
State License Number
e 3-5- 1�
Telephone Number
B, INDE'-INITY: 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 applicant or the City of Edmonds, or any of its departments or employees,
including but 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 Department. I
Vork subject to inspection and restoration in accordance with City Code. A
24-�our notice is required for inspection by the Engineering Department.
Call 775-2525.
Signature: t
Owner or Agent Date Signed
C. DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
Permit Issued (Date)M&&=b Permit Number
Fee:. Bond:
Time Authorized:
Subj. to inspection
No. 1394-A. A 24-linirr n
775-2525, ext..220.
&-restoration. All work to be in -accordance with Ord.
ER'S APPMVAL