20224 83RD AVE W.PDF111111111111
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20224 83RD AVE W
ADDRESS: s,3r-
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE): CL>
COVENANTS (RECORDED) FOR:
DETERMINATION: R Conditional Waiver E] Study Required
CRITICAL AREAS:
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS
&Jkl— J/ X
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: -
SEWER LID FEE LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED:
SOILS REPORT DATED:
STREET USE / ENCROACHMENT PERMIT
WATER METER TAP CARD DATED: —
SIDE SEWER PERMIT(S) #:
s-
Waiver
LATEMp\DS,ps\Forms\Street File Checklist-doc
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425371.0221
The Critical Areas Checklist contained on this form is to
be filled out by a ny. person preparing a Development
Permit Application for, the City of Edmonds prior to
his/her submittal of the application to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property.. The information
needed to complete the Checklist should be easily.
available from observation's of the site or- data ava . ilable at
DDI irt-Amm PEI. i
Date'Received: c,f--V 04'
City Receipt#:
Critical Areas File M 1
Critical Areas Checklist Feb: $135.00
Date Mailed to Applicant:
A property owner, or his/her authorized representative,
must fill out the checklist, sign and. date it, and submit it
to the City. The City will review the checklist� make a
precursory site visit, and -make a deteimination of the
subsequent steps necessary to complete a development
permit application.
Please submit avicinity map, along with the signed copy
of this form to assist City staff in finding and locating the
specific piece of property described on this form. -In-
addition, the applicant shall include other pertinent
information (e.g. -site plan, topography map, etc.) or
studies in conjunction with thisChecklist to assistant staff
in completing their preliminary assessment of the site.
6
The undersign ' ed, applicant, and his/herlits heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damaSes, including reasonable
attorney's fees, arising from any. action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant hii/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my*
knowledge and that I am authorized to fil thi appAcation on the behalf of the owner as listed'below.
SiGNATuRE oF APPLicANT/AGENT DATE
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to -apply for the subject land use application
and grin� my p6mission for the public officidls and the. staff. of the Cit�. of Edmonds to enter the subject property for the
purposes of inspection and pq UnR attendant to,fts application.
SIGNATURE OF OWNER DATE IIJ
J
PLEASE PRINT CLEARLY
Owner/AppUcant: Applicant Representative-
$enn4 F-1 /AcLa C) lot sp-,rj,�'Cef "aX
Name Name
J q� 1`4 Av e IR R, L/a
Street Address Street Address
EArnowNk 10 _04. 1909 �&-,41 e. L) A- q� (o3
city State zip city State zip
Telephone: 0 e_X.."L, 1,�\ I
Telephone: H4,S-- 3Lo— 03-IS-
Email.address (optional): EdialT Rildress (optional):
F E B 3 2 001
CriticW Arm ChecklisLdod4.22.2003
PERMIT COUNTER
CA File No:
Critical Areas Checklist
ite Information (soils/topography/hydrology/vegetation)
q 3 ro( Aj e W f-ZArtiunds
Site Address/ Location:
2- Property Tax Account Number: oW H 31 ��000 oo L03 IM0 01) 4111, DOD CO(p p3
3. Approximate Site Size (acres or square feet):
Is this site currently.developed? yes; no.
lf yes; how is site developed?
5. Describe the general site topography. Check all that apply.
Flat less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of. 10-feet over a horizontal
distance of 66-feet).
Hilly: slopes present on site of more thap, ap. lesj #ja4 30% (a verdqal rise of'10-feet
4
to
over a horizontal distance of 33 to 6&
ertic rise 6
Steep: grades of greater than 30% present on site (a v cjUl" If J�i li Ir
distance of less than 33-feet).
r
'I T11
Other (please describe):
6. Site contains areas of year-round standing water: �j 0 -Approx. Depth:
Site contains areas of seasonal standing water- 00 Approx. Depth:
What season(s) of the year?
8. Site is in the floodway N30 floodplairi k) 0 of A water coursei
9. Site contaips a creek or an area where water flows across the grounds surface? Flows are year-round?
Flows are seasonal? - (What time of year?
10. Site is rima ril rfore=sted meadow shrubs mixed
Cur�ban =a� s �e��
11. Obvious wetland is present on site:
For. City. Staff Use Only
1. Plan Check Number, if applicable? 4 A-
2. Site is Zoned? 1_46
3. scs mappedswitype(s)? Auc> L& fem t- a7p
Atz> CIA V-00 1/ 15-21 X. ee-_,
4. Critical Areas inventory or C.A. map indicates Critical Area on site?
5. Site widtin designated earth subsidence landslide hazard area?. Hc�
DETERMINATION
STUDYREQUIRED WAIVER
T
Reviewed by, :;, Date:
Critical Areas Checklist.dod4.22.2003
rc per P-Loic', Coar4wAv
0 ;Q4 AIOT---� �SCAL-E
RECEtvED
FEB - 3 2004
PWIf COUNTER
SP
NIS
f(oK4j 7—GY-E
s SSAMS.-
FRO
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SIDE
REAR- 15J. - ci
APPROVED BY PLANNING �t
OTHER .7 g-)-- .. Ov
HEIGHT. w SL4
0
PLANNING DATA
NAME: 3�;� t--" C> DATE: 0 '/
SITEADDRESS: PLAN CHK#:_
PROJECT DESCRIPTION:
REDUCED SITE PLAN PROVIDED?: (Yes / No
Z-.t -_
MAP PAGE: CORNER LOT: ffMrNo
FLAG LOT: ffes /19�oO
ZONING: PS CRITICAL AREAS DETERMINATION #: Oq— 1 -7
Study Required:
Waiver
Conditional Waiver
SEPA DETERMINATION:
U Fee
13 Checklist
U APO list w/ notarized form
D ded for 500 cubic yards of grading, Shoreline Area- site within 200 ft. of Puget Sound or Lake Ballinger)
Exempt
L�jzer
SETBACKS:
Required Setbacks: , / .
Street- --5 Left Side: -7.5; Right Side: -7..5 Rear: 115
Actual Setbacks: If
Street: ]>C' LeftSlde: RightSide: Rear: 17-X
Street map chocked for additional setback required? (Yes If No / DNA)
L., DETACHED STRU TURES:
C
r_,� ..
CKERIE
L3 FEN RELLISES:
f
LLJI B W I WS If PROJECTING MODULATION:
STAIRS /
PARKING: Required: Actual:ILO_sc�fffl
lb
LOT AREA: jKZ-7 ('a A ;-e
LOT CO ERAUE: I
Calculations: I L4 S2- -�- -76 bac�-- k'y x S 2_1 7 1 tl
BUILDING HEIGHT:
Datum Point:— D#r-djjm Elevation:
Maximum AllWed: NO I I
��A ual Height:
A.D.U. CREATEDK. (No /�es
SUBDIVISION:
LEGAL NONCONFORMING L AND USE DETERMINATION ISSUED: ffn�
OTHER:
Plan Review By.
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BUILDING DEPARTMENT Appll..tFlU
Inside Heavy Lines
PERMIT APPLICATION
NA N (OR NAME OF BUSINESS)
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TELEPHONE NUMBER
NAME
ADDRESS
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CITY
TE"PHONE NUMBFII
NAMEZ
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ADDRESS
S
Y
TELLPHONE NUMBER
Legal Description of Property (Show below or Attach Four Copl,
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GAB
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NON.FIESIDENTrAL
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nDEMOLISH
WALL
ALT..
. CAVIT '
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On FILL
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..PANt
PRE -MOVE
INSP.
SWI
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NUMBER OF STORIES
NUMB it OF
DWFLL NO
UNITS
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EXISTING STREET n/W ... . ....... FT
COMP. PLAN ST. RAV . .. FT
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PLAN CIrMCM03W —
PERMIT
NUMBER 700057
A_
VACANT SITE
YES (3 NO
VARIANCE NUMBER
.66
THIS PROPERTY
I ;
LECKED BY
LECKED BY
If
IER
8 PRO,
C THEET IM ;Z
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Valuation Fee
!ilw_ I'Ian Check No......
BUILDING 4v,
PLUMBING
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PLOT`TPID�N(I.dllilt. Build1jXiseth"lig, abutting strc-�s) HEAT A GAS LINE
PENCII
SIGN
RETAINING WALL
N
SWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION on FILL
I h111bY lekn.wlcd that I no,. read this nppltcmtion; that the fn� TOTAL AMOUNT DUE
I.r.at"' given Is correct: and that I am the o,wncr, r the duly autho,
l.cd Ittent of the owner. I agree to comply with city and itate laws regu. ATrENTION APPLICATION APPROVAL
latIng construction; and In doing the work authorized thereby, no person
will be a 3 1. violation of the Labor Code or the State of W.,blngt.n THIS PF.n311T This application is not a permit until
1� AUTIIO signed by the Building Official or his Dep-
-p "'d
redatbeg to urinate's Compensation Insurance PUZES
O.VI'y TICE
NOTE: Permit Limit One Year (Fept DEMOLITIONS which WORK NOTED uty; and fees are paid, add receipt is Be
.hall be completed In alulty day.; MOVED -IN BUILDING4 hall be coon. ILnowledgcd In space provided.
pleted In six months.)
RIGRAY11'" COWFI—Ell 6TAUENT) �.DATII IIIIINED INSPECTION DIRECTOR'Ll
DEPARTMENT
c' CITY or
EDMONDS A�T
NCTi. JAPPlicant Subject to Plan Cbeck Fee
PR 6.1107
ThJ. Pererdt env to be done on Pflt. Property ONLY.
1 7 Z* k
Any construct an on the public domain (mr1n, sidewalks. drlvmmqs, FILE
rnarew to.) wilt require -eP--tl P11-1--lea-
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X.,
S. I...'
aW
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d'i
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ou li6w
RECORD OF INSPECTIONS
Date Passed
Foundation Lry t
Plumbing (Partia!)
(Rough)
Frame
FUrnace & Fuel Lines
Final
RECORD OF INSPECTIONS
Date Passed
Drainage
Sewer
Parking
Landscaping
Fire Dept.
llll� APPLICATION
041VE9 for
The City of Edmonb I FILE SIDDE SEWER PERMIT P MElTT No . ...........................
NEW CONSTRUCTION &?/ REPAIRS 0 �s
9
........ El! ......................... PERMIT No.
OWNER ................... .............. Ej .. ................... .C'. &.1
...................................... CONTRACTOR ........... ....................
ADDRESS ............... ..................... cd-..'3 ....... .... LEGAL DESCRIPTION: LOT No . .................. 7 ....................... BLOCK No . ............................................
NAME OF ADDITION ...................... OZ ... 4.:Lc ... . ............... CA ... ............. A�r!!-c ly 07-
0-
0
0
APPROVED
AUG 2b 1969
Approved:
DATE-T-k .. ............... B y ....... ......................................
pro
1�;T:
I
rl
1p +
Alm- -1-0 -SCAt-VF-
m
9.0
Ell]
. Ho"-kse-
RECEtV.ED
FEB - 3 2004
A-MMON—T—EP.
19,
77410���
S C! ".S., ve
ROMT
OTHER APPROVED BY PLANNING
HEIGHT
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
The Critical Areas Checklist contained on this form is to
be filled out by any person preparing a Development
Permit Application for, the City of Edmonds prior to
his/her submittal of the application to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The information
needed to complete the Checklist should be easily
available from observations- of the site or. data available at
mme e^av"#%&o nN% x IYY n 011%
.Date Received: V f4
City Receipt#: 1
Critical Areas File M
Critical Areas Checklist Fee: $135.00
Date Mailed to Applicant:
A property owner, or his/her authorized representative,
must fill out the checklist, sign and date it, and submit it
to the City. Tlie City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed copy
of this form to assist City staff in finding and locating the
specific piece of property described.on this form. In -
addition, the applicant shall include other pertinent
information (e.g. -site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend 'and hold the City of Edmonds harmless fi-om any and all damages, including reasonable
attorney's fees,' arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, hi"er/its agents or employees.
By my signature, I cer* that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to fil thi app the behalf of the owner as listed below.
-�q I
SIGNATURE oF APPLicANT/AGENT DATE 1 1, b L/
Property Owner's Authorization
By my signature, I certify that I have authorized the above Applicant/Agent to -apply for the subject land use application,
and graint my permission for the public officials and thestaff of the City of Edmonds to enter the subject property for the
purposes of inspection and po tm*g attendant to
fts application.
SIGNATURE OF OWNER —DATE
PLEASE PRINT CLEARLY
Owner/Applicant:
1�e_')n%A aJ, &,%rJ,4#n0
Name
A-je W
Street Address
o.,A s 10
city State Zip
AppHcant Representative-
. IACLV-(- 0 ICAS 7fJ,4(,,
Name
WR
StreetAddress
e. L) A- q& (03
city State zip
Telephone: H4S-- 3LO- 03_1S_ Telephone:
RECEIV79
� Efna-IT
Email address (optional): Rildress (optional).
FEB - 3 ,nq
Critiol Arm Checklist.doc/4.22.2003
PERMIT COUNTER
Critica.1 Areas Checklist CA File No:
Site Information (soils/topography/hydrology/vegeta'tion)
�)O.-
1. Site Address/Location: '\.�L Ll q _3 roC A.-i e n
2. property . Tax Account Number: 31 �� 000 0 0 L 0 3 AP) bo 410- COD CO(p C)-3
3. Approximate Site Size (acres or square feet): (0) ODD �4
4.. Is this site currently.developed? N. yes; — no.
If yes; how is site developed?
5. Describe the general site topography. Check all that apply.
Flat less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a horizontal
distance of 66-feet).
Hilly: slopes present on site of more , . AP lesj than 3C
'r� (a vertical rise of 10-feet
to tj
over a horizontal distance of 33
Steep: grades of greater than 30% present on site (a verticat nse o If!; e� 0AW
distance of less than 33-feet). lk'IT A^ I
Other'(please describe
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: 00 Approx. Depth:
What season(s) of the year?
8. Site is. in the floodway �)o floodplairi Q 0 of A water course�
9. Site contaips a creek or an area where water flows across the grounds surface? Flows are year-round?
1 A- Flows are seasonal?
(What time of year?
10. Site is Primaril forested meadow ;shrubs mixed
11. - Obvious wetland is present on site:
Q0
For. City Staff Use Only
1. Plan Check Number, if applicable?
2. Site is Zoned?
3. SCS mapped soil type(s)? Auc> L/� fZ--6 L- WD
ALc> &Iq4a'/ evll� -� r:5 11-CM Plk i 5 - 2 15- 0/-
4. Critical Areas inventory or C.A. map indicates Critical Area on site?
5. Site within designated earth subsidence landslide hazard, area? H C:�)
DETERMINATION
STUDYREQUIRED WAIVER
Reviewed Lv,-, L- (0 CA4— Date C�A-
Critical Areas Chocklist.doe/4.22.2003
NOTICE:
-N'o wa rra nty. of a c
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
Th,,e city of �Edm.onds does not . wa rra nt the
accuracy of anything set forth on these
map(§-). Any person or entity -requesting a
copy should conduct an Independent
inquiry regarding the inform-ation shown on
tF�e *m a p (s) . Including, but not limited to,
th*e 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 r-ity of Edmonds nor its
ern pto-yee-s o-r off kce-rs -shal-1 be 11a-b-'Fe for the
information given+ on this map(s), nor for
ion provided based
any one representat
upon . said map(s).
CITY OF EDMONDS
Call FRospect 6-1107 when work
CIVIC CENTER — WATER —SEWER DEPARTMENT Is ready for impeetton. (No Inspec-
SIDESEWER PERMIT tions Saturday, Sunday or holidays.) N2 3411
ADDRESS ............ �ZQ�24 .... ... 8.3rd-Avenue --- We.q_t
OWNER Snai Safe
................................................ CONTRACTOR .......... .....................................................................
August 28 69 ----
Permission is granted ---------------------------------------- *' _ 19 ........ I 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 FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contramtor must
be employed to construct side sewer in street axea. Do not cover any portion of sewer before it has been Inspected.
NOTE No. 2—Obtain full Information regarding 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.
NOTE No. 4—Trenches 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 year of completion.
NOTE No. Sw—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 appur-
tenances except to insert the pipe into the wye.
't"' t7
City of E&mon&*-- STREETp
RIGHT-OF-WAY CONSTRUCTION I
PERMIT
t9Permit Number.
Issue Date: 'F —
A. Address or Vicinity of Construction: - 20224 83 AV W
B. Type of Work (be specific): Install ServiceV
C. Contractor: -Washington Natural Gas
Mailing Address: 1122 75 IT SW Everett
98203t
State License #:
D. Building Permit # (if applicable):'
Contact: Mariamne Kingsbury
Phone: 356-7500 ext 7596
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. � C1 Commercial [J Subdivision E] City Project E] Utility (PUD, GTE, AING, CABLE, WATER)
Multi -Family El Single Family Other
INSPECTOR: INSPECTOR: WkJw+1
F. Pavement or Concrete Cut: 0 Yes 0No G. Size of Cut: x H. Chargi�_$
APP "CANT TO READ AZ 'N
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harm;es8 from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that ni�y be made against the City of Edmonds, or any of its departments or
I
employees, including or not limited to the defense ofany legalproceedings incliuiing defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLO THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED B YCITYFORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required 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 all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the Cit3�Engineer.
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 thepermitrequir.ements and thepink copy of thepermit will be
available on site at all tim r inspeprign purposes.
Signature: _'�,Or,4 Date: 7-28-95
0�7'trac'tor or Age�t)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK -
FOR CITY USE ONLY
APPROVED BY. RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER A_ DAYS DISRUPTION FEE/FUND III:
SPECIAL CONDITIONS: WOIZK -To 9F- compLerep RESTORATION FEE:
AVOI '104�'. 5-TI(F-15T To 6r- PERMIT FEE- 30
PA,VE9 I �J '19 11 LA%(.
OVF
TOTALFEE:
COMMENTS: -RECEIPT FEE -
DATE:
NO WORK SHALL BEGIN PRIOR TO PERMIT ASUAN'&E'-
Eng. Div. 1994
0:.
0 - 0.
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION E] YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
El NO
0
Washington
Natural Gas
A Waqwyjt"i DvTw Co wkv Tv
Addendum to.- City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596
C) 4 1 -
Key:
Watermain depth
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gas main -&
0
�,)ofS .95-ZZ44-d
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Water
Gas
Sewer
Water hydrant
Water valve
Washington Natural Gas Cornpan%
1122 75th Street S.W.. Everett. Washington 98203. (206) 355-3331
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