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PLANNING DATA
NAME: C'�2'
�j
SITE ADDRESS:- 2-04, 3 - 0, -DATE:
ZONING: P-5- 12- —PLAN CHK#:
PROJECT DESCRIPTION: 7sDo
(j V
CORNERLOT AL -- es/No) FLAG LOT /V. _(Yes/No)
SETBACKS:
Required Setbacks:
Front: LeftSide: tOl RiqhtS!de: to, Rear: 05'
Actual Setbacks:
Front: 14S'- LeftSide: -7o, ' Right Side: Rear: 25'
Street map checked for additional setback required? 114 - i-.ic, (Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED Al� -(Y/N)
LOT COVERAGE: �� �- -7sz�
Maximum Allowed:— 3G76/� —Actual: ?11 lx�n ILE,
1
BUILDING HEIGHT:
Maximum Allowed:— 151 —Actual Height:- 151
Datum Point: 5h cer� a-/- kzv., —Datum Elevation: (o2,�z" f -::. 5,2'
A.D.U. CREATED?: No
SUBDIVISION:
CRITICALAREAS#: (�&-it'7- wxyc
SEPA DETERMINATION:
LOT AREA:
OTHER:
Plan Review By:
-7
CA FILE NO. "J�q ) /
Critical Areas,Checklist
---------------- ---------------------------------------------
Site Information (soil shop o graphy/hy drol o gy/vegetation)
1 Site Address/Location: ?L t_j ir— _6
2. Property Tax Account Number: _S_4Lf(o— OOb
3. Approximate Site Size (acres or square feet): — Y,.),
4. Is this site currently developed? & yes; no.
If yes; how is site developed? FAjn,11_�
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 I 0-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 3 0% (.a vertical rise of
I 0-feet over a horizontal distance of 3 3 to 66-feet).
Steep: grades of greater than 3 0% present on site (a vertical rise of I 0-fe.et over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: Approx. Depth:
7. Site contains areas of seasonal standing water: Ajoj�Z—_; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway ^j 0 floodplain �./ �3 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? hi Flows are seasonal? pt (What time of year?
10. S . ite is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: V ;3
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qlafid inyen,tqi� or: qp,.
it
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!)-ET,i9-kM1N'A,'ri0N,:: :
RECEIVED
City of Edmonds APR 2 2 1998
COMMUNITY SERVICES
CRITICAL AREAS CHECKL ST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City o . f
Edmonds prior to his/her submittal of a development
permit 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 City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her 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 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 assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
C37A R -Y
Name -
L [-J
Street Address
ehm-o"��s ul//� oi 4
City State Zip
Lf dl-�-- (-� ) 1� - �' F 7 �
Telephone
Signature
IT
Date
Applicant Representative:
Name
Street Address
C ity Staite Zip
Telephone
Signature
Date
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PERMIT COUNTER
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RECEIVED
City of Edmonds APR 2 2 1998
COMMUNITY SERVICES
NI.-ININEW CRITICAL AREAS CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City o . f
Edmonds prior to his/her submittal of a development
permit to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas axe, 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 City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her 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 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 assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
(::T- A R -S I
Name
Street Address
City State Zip
Lf'4z-
Telephone
'-A
Signature
Lt - J, '�- 11 U,
Date
Applicant Representative:
Name
Street Address
C ity S taie Zip
Telephone
Signature
Date
c:recept1on\jana\cac1.doc (over)
CA FILE NO.
Critical Areas Checkl 'ist
---------------- ---------------------------------------------
Site Information (soils/topography/hydrology/vegetation)
1 . Site Address/Locati.on: SXOCO_� ?'- L--J 1�-' -6 A--%2 L-J
2. Property Tax Account Number: 4 Lf - o o,�) - o c)-'o
3. Approximate Site Size (acres or square feet): Y,�), A t- a r-
4. Is this site currently developed? & yes; no.
If yes; how is site developed? A 13 J_� 9-
5. Describe the general site topography. Check all that apply.
Flat: less than 5-feet elevation change over entire'site.
.1
7.
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 than 15% and less than 30% a vertical rise of
I 0-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on si te (a vertical rise of I 0-fe.et over a
horizontal distance of less than 33-feet).
Other (please describe):
Site contains areas of year-round standing water: ^)o,,,rL- Approx. Depth:
Site contains areas of seasonal standing water: /,/ 0-.-,�2- _; Approx. Depth:
What season(s) of the year?
8. Site is in the floodway ,,j 0 floodplain ki �3 of a water course.
9. Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? A.) '0 Flows are seasonal? o (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: )y 0
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
0-11, _!5T LA7 7
MAILING ADDRESS
Z
20e->O'�- 0 61-7 In" 'PL U11i
CITY ZIP TELEPHONE NUM13ER
� 5? q
'76P Z 71
AME
6AA E)�_" V_- (ws-T
LU'j ADDRESS
5 Dit 4��h 11E C-
CITY ZIP TELEPHONE NUMBER
I�DMQOID� 916()26 IW_776-,3,7
NAME
Wc,
ADDRESS
bfL
)!G 7,6 OL-TM PIC VI
M1 CITY 76()ZIP TELEPHONE NUMBER
Z
0 Ell MWDS
J jj(��771 5-6-7-
STATE LICENSE NUMBER A I TE
6RERM U It 0,WU
Legal Description of Property - include all ease nS&K:,,y
f 1-7 1`--1
Property
Tax Account
Parcel No.
FINEW
EYRESIDENTIAL
PLUMBINGIMECH
52rA'IDITION
COMPLIANCE OR
COMMERCIAL
CHANGE OF USE
REMODEL
1:1 APT. BLDG.
El. SIGN
FENCE
GRADING
REPA'IR
CYDS.
I X Fri
DEMOLISH
WOODSTOVE
INSERT
SWIM POOL.
HOT TUB/SPA
WGARAGE
RETAINING WALL/
CARPORT
ROCKERY
RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
TORIES UNITS I I NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
M(V
i64 PERMIT
[2,S - 1 '2-,- NUMBEII 980750
JOB SUITE/APT #
ADDHESS
AL
.EG GKI SUBDIVISION NO. LID NO.
Al/ Arr /ij 11q
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP. TESCPApproved ;Vlq 0
EXISTING RW Permit Require 0
REQUIRED DEDICATION----- Street Use Permit R
PROPOSED Inspection Required
Sidewalk Required A/ 0
a:
I'_
METER SIZE7F_T� NO. OF FIXTUR=ESPRV REQUIRED <
YE�
YES 0 NO 13
1EMARKS
At o57W7/
tlg'� 11CI-S 77r)/L/ U'i
Z
Z
01WOC AUS_ro*�141-r
.4,ev's /U/t� fv -
ENGINEERING MEMO D#TED REVIEWED BY
t
VARIANCE'QR CU
AD8 #
SHORELINE #
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE
ALLOW D PRO�.�
ALLOWED PROPOSED
EXP
'EQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
lZOV
10 75
Z-5esIly le4
LOT AREA
NNING REVIEW BY
DATE
ovo
lw=ffn
/0 /17
REMARKS
BY ' I TYPE
I
I -
V�4\1
1 —1 1
1 T-- --) — U
SPECIAL INSPECTOR
AREA
OCCUV,�NT
REQUIRE D �
13 YES
!Sca
LOAD
—
REMARKS
PROGRESS INOPECTIONS PER U13C 108
Z
1'.
A I-
IID
FINAL INSPECTION REOUIRED
VALUATION
PLAN CHECK FEE I \1
BUILDING
HEAT SOURCE:
GLAZING
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewplks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: I Year - Provided Work ls'�Itarted Within 180,,Dayk
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, ass*ign!�and
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
20
harmless the City of Edmonds,. Washington, its officials,
x.
employees, and agents from any and all claims for damages of
cc
4
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
0
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authoriz-
AUTHORIZES
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
tion Insurance aria RCW 18.2
INSPECTION
SIGNATUR OW OR AGENT) DATE SIGNED
DEPARTMENT
CITY OF
EDMONDS
ATTENTION'
CALL FOR
IkSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
FEE
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
BY:
DAT
RIGINAL — File YELLOW — inspector
PINK — Owner GOLD — Assessor
PLANNING DATA
NAME: U+
SITE ADDRESS: 2-0 � U I �(Uvl ATE: /0//_� /I -
- --L c�,c - 3 qS
ZONING. P-5-1 - PLAN CHK#:
PROJECT DESCRIPTION: C,, 5, 4 - 5 qt)
- 4-r�rl+Cqta� — 5IAj(. cc Yrotv
CORNERLOT lu —(Yes/No) FLAG LOT /Vd (Yes/No)
SETBACKS:
Required Setbacks:
Front: Z-5 Left Side: /6 Right Side: Rear: 05
Actual Setbacks:
Front: Z,-5 Left Side: RightSide: -Rear:
Street map checked for additional setback required? q
(Yes/No)
LEGAL NONCONFORMING LAND USE DETERMINATION ISSUED , (Y/N)
LOT COVERAGE:
Maximum Allowed: Actual: /Z
BUILDING HEIGHT:
Maximum Allowed: -----Actual Height:
Datum Point: Datum Elevation:
A.D.U. CREATED?: �V-, � L,k� , /, -- Z-z 0 -
F*U4_51 "If RK61,11;
CRITICAL AREAS #: '7� - // 7- CM- / V,�n -
SEPA DETERMINATION:
LOTAREA:
OTHER:
Plan Review By: J&5o,)
cAfi1cs\permit\^p1andat.doc
CA FILE No.
Critical Areas Checklist
- - - - - - - - - - - - - - - - -- - - - - - - - - - - -- - -- - - - - - - - -- - -- - - - - - - - - - - -- --- -
Site Information (soil s/top o graphy/hy drol ogy/vegetati on)
1 . Site Address/Locati.on: 12,2CO-� ;K'�— ? L t--J Ir- -b M--% -0,�D-S 1-j njdo�-/,
2. Property Tax Account Number: '4 Lf 6 - 0 O'�) - 0
3. Approximate Site Size (acres or square feet): Y,), A6 a
4. Is this site currently developed? & yes; _no.
If yes; how is site developed? F A ki, I C I I A (30-� C
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 I 0-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of
10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: ^J0^1k- _; Approx. Depth:
7. Site contains areas of seasonal standing water: AJ 0,,12- _;Approx. Depth: _
What season(s) of the year?
8. Site is in the floodway j 0 floodplain A/ �3 of a water course.
a
Site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? tj (What time of year?
10. Site is primarily: forested meadow_ shrubs mixed
urban landscaped (lawn,shrubs etc)
11. Obvious wetland is present on site: /V 0
-- ------------ CW* Staff Use Only .-!% ---------
---------- ...... 7
7
Site is Zoned?
DET-ItkMINATION' !
r "ECEIVED
%
City of Edmonds APR 2 2 1998
COMMUNITY SERVICES
"W-W CRITICAL AREAS CHECKLIST
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 a development
permit to the City.
The purpose of the Checklist is to enable City staff to
detennine 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 City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her 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 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.j site plan, topography
map, etc.) or studies in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
I have completed the attached Critical Areas Checklist and attest that the answers provided are factual, to the
best of my knowledge (fill out the appropriate column below).
Owner/Applicant:
&AR:y -S'l 7--
Name
Street Address
C:1)M'0,34S �,/A C'- , � 3, cj-" -
City State Zip
Lf dls-- (-� ) ), - 13 F 7 q
Telephone
Signature
Lf
Date
Applicant Representative:
Name
Street Address
C ity State Zip
Telephone
Signature
Date
c:recept1on\jana\cac1,doc
(over)
�t,r) C. 18 9 �)
April 27, 1998
CITY OF EDMONDS BARBARA FAHEY
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221 MAYOR
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning/Building - Parks and Recreation * Engineering o Wastewater Treatment Plant
Gary Stutz
2060386 th Place West
Edmonds, WA 98026
Subject: Determination regarding Critical Areas Checklist # 98-117
Dear Applicant:
Enclosed please find a copy of the Critical Areas Checklist you submitted. The "DETERMINATION" reached by the City
is located on the reverse side of the form (bottom of page).
It is very important for you to retain a copy of this Critical Areas Checklist "DETERMINATION" for your records.
IMPORTANT INFORMATIONTO BE NOTED:
PLEASE EXAMINE THIS 'I DETERMINATION" FOR ADDITIONAL REQUIREMENTS. YOU MAY NEED TO SUBMIT
ADDITIONAL -INFORMATION SUCH AS AN ENVIRMENTAL CHECKLIS ORCRITI LAREASSrUDy.
The 'DETERMINATION' for the Critical Areas Checklist you submitted is a site -specific determination not a
project -specific determination.
MO. You must submit a copy -of the CRITICAL AREAS CHECKLIST and DETERMINA ONWITHAL
PERMIT APPLICATIONS or YOUR APPLICATION WILL NOT BE PROCESSED.
Permit applications include the following:
Building Permits
Conditional Use Permits
Subdivisions
Variances
Applications to the ADB* Land Use Applications
Any other development permit applications.
Enc: Critical Areas Determination
* Architectural Design Board
C:ReceptIon\Jana\CRLTR.doc
Thank you.
Sharla Graham
Acting Planning Secretary
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
NOTICE:
-Nb--War-ranty ... OT ached
The -inform ation'shown on the att
iled for use by the City of
map(s) was cOMP
Edmonds" its Employees and Consultants.
Th.,e City of 'Edim.onds does not * warrant the
et for these
accuracy of anything se th on -
Map(�-). Any person or entity -requesting a
copy should conduct an independent
ation shown on
inquiry regarding the inform
_ffi� -map(s), Including, but not limited to, -h
th . e lociation of any sew-er stub shown. Suc
sewer stubs may or may- not exist and may
or may not exist at the location shown.
Neither the c;ty of Edmo-nds nor its
emplfo*yee's o*r office-rs,shall-1 be 11a-b-'Fe for the
n on this map(s), nor for
information give-
tation provided based
any one represen
upon . said map(s),
L -
APPLICATION
Ae- City of Edmo for EASEMENT NO - --------------------------------- ----------
n§IREET FILE SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS LID NO. ------ ASMT. NO.
OWNER ------------------------------ CONTRACTOR --- L�--- - -A� - - "A ...... 5-7-0 t"1777-l!�-'=-rc=�V-1 ............ PERMIT NO. �� il-
JOB ADDRESS .... F�*"—..----\t-J ---------- LEGAL DESCRIPTION: LOT NO - ----------- 2.5m .................. BLOCK NO . ....................................
0
0
NAMF OF AT)DTTION F='*—AVr`
DATE --------------- By x
ell
�7_
AOINIDS,', "SID "TIT
TTOFERM,
SEMR' PER,�M,
OT
WATEWSEWER. IDEPARTMIE]w!.
PERM
5480"
�tjCall� 7,75-2"� for s�idw s"ewer -In�
sPectionsi BEFORE 'covering any portion, of the con§t ti
ruc ?P.%�
�klIhsp.eqlon,, will: b6-prqvided�'within,,2�:,�hoiirs; after. ieclust. NO),'Sat., Su (or' h'Oliday.. inspectlonsj�
....... .. .. . . ....... ..
"ADDRESS L ...... wwes.t: ......
OCAMM�O#,VCONSTR CTION.: ............
................
'�Or� �N, Rldqlp� ........................................ ......................................... ..................
—PROPERTY LXGAL,(DES,CR1PTTON ... .................. 0.1 ..... ................ lRe...
..............................
.................................. * ...................... : .................................................. ....................................
................ ....... I ................. .......... .........
.............. ........... ...... .... .. ..... OMWER ANDVOR, BUI ILDER ..... ....................................................................
.... .. .... ..........
7111*17 7:' .........
CONTRACTOR'S'T�-AMR& ADDAtSSI ............ wcontractors
...................................... .......... ........... ............ ----------------
................ ..........................
Pennisslon1s� Ma v 9F; I q7A
gyan ...... I., ............................................. .... for- repair and/or- connection of, -a side sewer to, the City sanitary sewer
systemAn, accordancet with!�City� of Edmonds, ordinances.,
AT—aNTION IS -,GALLED, TO THEiFOLLOWING:
7�t
-NOTIRWo�, T�TheowndrsTtol'lh "�'Prt ty' may, obtain, a!,perm o-,construct'jsew�r Inside, property llne�, A' -11densed Sewer Contractor, must be eml5lb�edl to,:co'nstruct
slde,�sewer,in' sere.� aremr Do, nA cover any'portion. of sewer. efore it has been. Inspects&
�.wo'rk'perf I or . m'e , d�lini,clt -of-' axhabI6 from -the City Engln I eer's office,
-of-Way
NOTE: N6..'2—' �Vir yr right way requ ires� �anr, Invasion of'RJght Permit 6bt
pform on reg 0 , 'd ns, governing, sid e sewers-wheni,you get per . mit.,
NOTE�,Nd. 3—'Obt1ai6,fuIl1,I ai�i�, exiling �Ordlnance 1-1:16. 30).a�n ! Re ulatl6
�NOTV, No. A —Top least-.,30 inches -coveraiee'E.Lt property line axtd. 12� fn�cl4s'lnslde 'property, line;,,mlnimum 'grade of, 2%. No be4s.in- grade
sharper thaii %` wlll�,be,,Permifted.
NO-TE',No.-,5—Trenches;in sireet,4nust%b� Nk�ater'settled-,ands rface of stre:et re'
u - stored to original, condition. C6ntractora shall be responsible for failure d'Ue to, improper
Work which may �develop- within, one year, -of compledow.
,NOTE] I No.- 6—It Is unlawfu.IA6, all!er"or dot any other work than �ls provlde&,for,*in, the permit, or to do -any Work on. the main sewer or lts.appurIenan6es- ex6pf to. in-
sert.,therpipe lnto,�the--Wye.,
. ... ...... By .... ............ Dat6 ..... ..........
DIS,&PPROVED. �o Dat 1.41. e__.0.0 By ................ Pate ...................................... �By .................
. . .. .......... .. . ..... ............. ....................... I ........................... .................
-,APPRO� ..J. By, A
... ..........
VED,,:. te,.* . . ....
ar S:'�L ........ :*
............... ..........
Rein k .. . ...............
............................................ .......... ............................ ...................
.............................. .............. ........................ ...............
............ ............. ..................... ........................ ..............................................................
"0 f, rMing
ST�Be'Sfg�edlpy� wnerlid Firm,'Pekd C6nstruction, PRIOR;�T& Request For Inspec
tion
.. . .. ............................. 'hereby certify that,the'sfd&�sewer in stallation constructed under" this:.p ermi t,
��i.'iC�on**,,c�lln,,.".�F"�r�',m Pe rforming Construction,)).
.ni. of
W--:,Install'ed'in:,accor.dELnce,iAdthi, all governing ordinances.ofthe City of Edmonds.
Datedthis ............................ dayof ............ ............................. ................... ...........
�Ch6ck,,BEFORW,you, dig: for:. Water Gas-_E]�1, �Tciephone . Ey; -Power,,[],... Sewer'-,�'� Other �0�
I
The City of Edmonds
APLICATION
for
SIDE SEWER PERMff
NEW CONSTRUCTION )('
EASEMENT NO - ------------ -------------------------------
REPAIRS El LID NO. Jj��/ ------ - ASMT. NO. ------
OWNER
............... ................. .... CONTRACTOR
........... ------ PERMIT NO. ------
JOB ADDRESS .... - — ----- /Z - ------ �L e7
---------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ------------------ -----------------
------------------------------
................... --------------------------------- -------------------------------------
-'V A:Z� UV I I-J
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RFr.Fir-n
MAY 2 6 -1976
Public aorks Liept.
Approved:
DATE -----
BY