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211 10TH PL N.PDF11111111111111 14865 211 10TH PL N 1 4' . D R jj() A� r M .7 A, �7- 4 " i -h M M CITY OF EDMONDS PUBLIC WORKS DEPARTMENT TO: SUSPENSE DATE: 0 # DIRECTOR Investigate and-Repart- ADMINISTRATIVE SECRETARY Take Appropriate BUILDING & GROUNDS SUPT. Action Prepare letterimemo for my signature CITY ENGINEER EQUIPMENT RENTAL SUPT. For Information STREET DIVISION SUPT. Previously Ref'd WATERISEWER SUPT. Status of Action? Return to: TREATMENT PLANT SUPT. COMMENTS: le Z., ",e 9,62 �/ 7V- 617 PWA4M1-11-78 619 0 - 199 - �,W City.of Edmonds RIGHT-OF-WAY CONSTRUCTION STREET FILIffRMIT. Permit Number:* Issue Date: A. Address or Vicinity I of Construction: 2. 11 1 Vrl-t P B. Type of Work (be specific): 14' P-13 AC -"SS vewA�rrt_ oe PA,4A0_(!Z L- TO (0 P L_ NJ C. Contracton. _C 14" drt.&& dA-15U)0C4161LCA Contact: -A/k-C� <5"13WQ(-4L MailingAddress: 533 A4&1r0 Phone: 7 74-- 5-14-G' State License #: 5(lPIC12- C-e— 101 Liability Insurance: Bond: $ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. `F� Commercial Subdivision 0 City Project X Utility (PUD, GTE, WNG, WATER) D Multi -Family E] Single Farmily F] Other INSPECTOR: INSPECTOR: VJL% F. Pavement or Concrete Cut E I Yes 1KNo G. , Size of Cu \ . " x H. Charge$ APPLICANT TO READ ArJR,�IGN INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City of Edmonds hatwilessfrom injuries, damages, or claims of any ikind or description whatsoever, foreseen or un/breen, that may be made against the City of Edmonds, or any of its departments or employ- ees, including or not limited to the defense of any legal proceedings including, defefi�; costs, and attorney fees by reason of granting this permit. THE CONT??ACTOR IS RESPONSIBLE FOR WORKMANSHIPAND MATERIALSFORA PERIOD OFONE YEARFOLLOWING THEF&AL INSPEC77ON AND ACCEPTANCE OF THE WORK ES77MATED RESTORA77ON FEES WILL BE HELD UNT[L THE FINAL S7REET PATCH IS COMPLE7ED BY CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. 40 Construction drawing 4f �roposed work required with permit aRplication. A 24 hour notice is required for inspection; Please call the Engineering Department-tT.=1112,, Work is to be inspected during progress and at completion.' Restoration is to be in accordance with.City Codes. 7714P�" Street shall be kept clean at all times. L Traffic Control and Public Safety shall be in accordance with City regulations as required by tW 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. ENTS: ..RECEIPT, NO: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991 FIELD INSPECTION NOTES (Fund. I I I - Route copy to Street Dept;) Comments: Diagram: CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO Partial Work Inspection by P. W.: Work. Disapproved'By: Date: FINAL APPROVAL BY: Date: iLll Eng. Div. July Z IS 16 Z 1,7 PW41 LEU9- �51DIW--, 5 3 TA 4, L H Z M�TALL T AL -L f p E- PL C Fz- DE P e L-n LJ6 DUP P P3 3 C- Ar 6 R-t> I S VE P- NC)7 E-,, z-' 6 U LD ML17 W M 'A'T, 2,1 IS7 �4 A5 P �kA J DI TCH I PL M 7D EOM6NOL '5-1. The City of Edmonds APPLICATION for SIDE SEWER PERMT NEW CONSTRUCTION REPAIRS 0 OWNER ... ..................... 0 .. ... . ............ . ...... ADDRESS "1 1/1,111,11-1-1 v- ............ /&,,� . ...................................... 9 0 - —, - --- — -1-4�7 - 0 EASEMENT No . ........................... r , -, -- 17 CONTRACTOR ... I.f 'as-s ............. Y .................. PERMIT No. �� ......... LEGAL DESCRIPTION: LOT No. ....... ........ 13LOCK No . ..... eJtq� ........................ ..... ... ................................ ............. NAME OF ADDITION 1:5. �-140 - -i' leloll RECEIVED CB 2 6 1073 Approved: 0 0 DATE................................................ By ........................................................... 7 APOLIC"AnON. Th4`CR*.�,*f:Ejd mo n s., EET L ��t- 10 �S11DE,7,SkWkA FERlWT",l!," 14. . EASEMENT No . . ...... ............... NEW, NSTRUCTI 1_ R 0 EPAIRS .......... '4JWNER wm.� - --- F R I F-SF-.t--4 DIN"- -L-- CONTRACTOR PERMIT ay -- �� - S? -------------------------------------------------------------------------------------------------------- ----- ....... ......................... No-�-4-!B' ft-- ;ss- 54= 5.--BLOCK-No 4� A-DDR9 .. .................................................................................................... LEGAL DESCRIPTION: LOT No.- . ........................ 7i- ..... NAME OF ADDITION.= ......... 4CI-r%yl av= EEC) m Clt-40=56 ........................................................................................................ Jm w I IV TU0r-TL4eb(4'0M lu �j A, 7 F3 CITY OF EDMONDS- - SIDE SEWER PERMIT WATER -SEWER DEPARTMENT WX:HQaA PERMITN2 4307 Wl 7,76-1107 for side sewer inspections BEFOBE covering any portion of the construction.N Inspection will be provided within 24 hours after request. NO Sat., Sun., or holiday Inspections./ P ........ . .......................................................... .................... ... ........... ....................... ............. . .... ADDRESS LOCATION OF CONSTRUCTION ............... L A,- Ll 14WPIMWYI"AL DESCRIPTION ..................................................... ...... ........... .......... ........ .. . ................................................ ...................... ........................... ............ .......... . .................................................... . ................ I .. ............... .................................. ................................................... A"17 .... OWNERAND/ORBujjDER__. n. rriez:nJahl ........ ..................................... . ...... ........................... . ........... ...... ........ .......... . . . ... ....... . ............................................. `c-:� e Edmonds 4ash 18 )20 i ill U ------ )NTRACTORIS NAME & ADDRESS ------------ ------------------------------------------------------------------------------ - ------------- . ................ ... ........ ..... ..... . .............. . Permission 15 granted .. ........ a --------------- - -- - ----------- 11914., Ur repaIr ad/or maection of sNe wwor to tim city O*Wtry "We* system In seeor0ance with City of FAlmonds ordinances. >EMTION IS CATA D TO THE FOLLOWING: No. I —The owners of the property may obtain a permit to construct. sewer Inside property Hue. A licensed Side Sewer Contractor mritt. be employed to condt" side sewer in street area. Do not cover any portion of sewer before it bas been inspected. NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office. NOTE No. 3--Obtain full Information regarding Ordinance 11.16.030 and lieguiations governing side sewers when you get permit. NOTE No. 4—Top of side sewer must have at least 30 inches coverage at Property line and 12 inches inside property Une; minimum grade of 2%. No -bqpds In gr&ft sharper than % will be permitted. i NOTE No. 5—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improW work which may develop within one year of completion. NOTE No, 6—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 appurtenances except to I*. sert the pipe into the wye. DISAPPROVEDE] Date ... . ................................... By ............ ... Date .............. . ................... By ---------------- Date .......... . .. .................... . By ---------------- "PROVED A Date..-2.::- ;?...? ..................... B; --- - ---- ........................... ..................... ................................................. Remarks: ....... . .. .... .......................... . .................................. . .......... ... . ........................... ........................ ---------------------------------- ------------------------------------------------------------------------------- ------- I ----------------------- * ------------- * - --------- * ......... it co e ST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection - . . ......... - ------ ra P, -------------- --- I hereby certify that the side sewer ineW. lation constructed under this permit .r _g co Fir I gov =1 lg or (Owner 0 9 Firm Performing Construction) Inst7alin a r ce with A111 governing ordinances of the City of Edmonds. Dated this ... 0?7 - - ----------- day of ----- — ---------------------------------------- 19Z� V Check BEFORE you dig for: Water E], GaS Telephone [3, Power E], Sewer 0, Other E] .4 -V "ta 7' aTAa X"