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20305 87TH AVE W
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City of Edmonds PERMIT NO: 9705
PERMIT EXPIRES
SIDE SEWER PERMIT - / 7
Address of Construction: cz LID N
Property Tax Account Parcel No. (D (zz�, 5 k3 Q- 04
Attach copies of all access and utility easements Verified and Approved by
Owner and/or Contractor: M U)),P ttv -S C UV ig .
Contractor License #: --- k, b D -R, (z I C I L) � Building Permit
M /Single Family
F-1 Multi -Family (No. of Units
E] Commercial (No. of Units Cross other "Private Property: E] Yes -VNo
/__*11
El Public "Attach legal description and copy of recorded easement.
Owner/Contractor
Owner or coniractor signikure and a&no-wledgement statement: Date
,.m.Bv signing for this permit I certify that I have read the City's public handout entitled
3ide Sewer Specifications, and shall comply with all City requirements outlined therein.
F-1,
Invasion into City *Right -of Way: El Yes P(No
*RW Construction Permit #
9 CALL DIAL -A -DIG (1-800-41,4-5555) BEFORE ANY EXCAVATION W
V FOR INSPECTION CALL 425-771-0220 extensiowWt�V
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REOUESTS
Permit Fee $
Fee $ t 122 Issued By: —
Date Issued:
Assessment Fee $
City Permit Surcharge Fee $5.00
Receipt No: eg .1 r_;4
Total Fees Paid $
NOTE: IF JOB SITE IS NOT READY FOR INSPECTION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job Site Ready YES NO —Date: Initiak
Partial Inspection: exacho's —Date: q1?-kI3 Initial: T)�
Partial Inspection: Date: Initial:
FINAL INSPECTION APPROVED: Date, ' q
itial:
uilt to Street File:
t- PERMIT MUST BE POSTED ON JOB SITE t-
White Copy: File Green Copy: Inspector Buff Copy� Applicant
L;temp;bldg,forms�sspermitjlg4/00
The City of Edmon.SM-- FILE
OWNER ..
ADDRESS
7
.................. :�.�
.........................
9
APPLICATION
for
SII)E SEWER PERMIT
NEW CONSTRUCTION B---' REPAIRS 0 EASEMENT No . ..........................................
CONTRACTOR ... ... —22%-A.�C ..... ................................. PERMIT No.
LEGAL DESCRIPTION: LOT No . ......... ................................... BLOCK No . ............................................
NAME OF ADDITION ... .... . ....... .............. 2 . . . . . . ................
........... .... ...............
�r- * I 's-e-a;c-ra
APPROVED
AUG 11969
Approved:
DATE....... r: ......................................
By ............
J.
...........
E.D*
4 0
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CITY OF EDMONDS SIDE SEWER AS- BUILT
ADDRESS
20305 87TH AVE W
HOMEOWNER CONTRACTOF
MUDERN
DATE DRAWN PERMIT
2/13/03 13Y 1. ABILA NO,
SCALE
NTS
SEWER COUP
9705
0
NOTICE:
Nowa rr a n. t. -y� � o ra c
The information . shown on the attached
rn a p (s) was compiled for use by the City of
Edmonds/ its Employees and Consultants.
s not warrant the
Th.e City of *Edm.onds doe, these
accuracy of anything set for.th on
Map(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform-ation shown on
..___t_Fe -map(S)i Including, but not limited to, -h
the lociation of any sew-er stub shown. Suc
ex st and may
sewer stubs may or may not 1.
or may not exist at the location shown.
ts
Neitheir the City of Edmonds nor i
ernp-l-o-yee-s o-r offi-ce-rs -shal] be 11a-b-'Fe for the
I n on this map(s), nor for
information g ve
e representation provided based
any on
upon said map(s).
CITY OF EDMONDS
CIVIC CENTER — WATER -SEWER DEPART74ENT Call FRospect 6-1107 when work
Is ready for Inspection. (No inspec.
SIDE SEWER PERMIT tions Saturday, SUndaY or bolidaWs.) N? 3363
ADDRESS ........................ 20305 - 87th Avenue West
--------------------------------------------------------------
OWNER ........................... A�LYPR --- q!t --- A44� ----------------------- CONTRACTOR ..............
Permission is granted ................. Avgu;M__! ...... ig-U, 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. I —The owners of the Property may obtain a Permit to construct sewer Inside property line. A licensed Side Sewer Contractor must
be employed 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 retarding 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. 5—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.
8 go - 19()-
Ctty of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number- W
Issue Date: -7
A. Address or Vicinity of Construction: - 20305 87 " W (9712576)
B. Type of Work (be specific): Install Service
C. Contractor: Puget Sound Energy
Mailing Address: 1122 75 St Sw Everett
State License #: 98203
D. Building Permit # (if applicable):
Contact: Mariamne Kingsbury
Phone: 356-7500 X7596
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. 0 Commercial [J Subdivision El City Project ;0 Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family 0 Single Family n Other
INSPECTOR: INSPECTOR: �L.J
F. Pavement or Concrete Cut 0 Yes [INo G. Size of Cut:,., x H. Chargq�_$
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmondg 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 oftuty legalproceedings including defense Costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF 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 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 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.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at all times for inspection purposes.
Signature: —LIZ-f"Z& Ae&; Date: 4-4-97
(90tractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
APPROVED BY: ��w
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAIL CONDITIONS: P
COMMENTS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND III:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
w V
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.)
E] YES
Date:
Date:
El NO
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Wateraain depth Q/-A
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Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
kngineering Aide
Washington Natural Gas
'ZI 0356-7500 X7596
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Key:
-V- Water
-CV- Gas
-SS- Sever
-& Water hydrant
0 Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331
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AWh#*VkDnEnwWCDnV" Addendum to: City of Edmonds
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Watermain depth Q/A
141- gas main
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Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
ingineering Aide
Washington Natural Gas
ISVV 0356-7500 X7596
20
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Key:
-9- Water
--G- Gas
-SS- Sever
-& Water hydrant
0 Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 98203. (206) 355-3331