21106 SHELL VALLEY RD.PDFiiiiii iiiiiiii
13044
21106 SHELL
VALLEY RD
ADDRESS:
TAX ACCOUNT/PARCEL NLTMBER:9—)7 76
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver 0 Study Required R Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR: —
PERMITS (OTHER): / 7 / /-
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: LOT: BLOCK:
SIDE SEWER AS BUILT DATED: z
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARDDATED:
OTHER:
LATEMPTSTsTorms\Street File Checklist.doe
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STREET ANO/OR UTILITY WORK Rl" PER' Z
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AP;1VD By CITY ENG.
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�[I heeby ackno,lcdge that I h.,%,c react .his appli�lj,,n; that the in -
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"ven is zoltect: anti thot I arn the owne-. or duly auLl.,
forination 91
i iz f
zzd agent of the owner. I agree to comply with city and staie If.ws egu
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1� , -,on ' -
la I '.rIg cru.-._ruction; and in doing th� o.k authorized the:eby. no person
in v
I ill be crrployc� in violation of the Labor Code of the Star, of Washingto-i
_.:iating to NVorknicn*s Corripc:,sation Insurance.
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NOTE- Permit Urn"It One Yecrfi-.%ccpt 131',%IO�MONS m16 FILI
T 'cJ,. shali be compl—ed 1;) 90
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RMITS wfthout condit sje),iritt, %yhl
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zVOTE: Applicant 3'."biec' �O A"M Ciec, Fee
Tl-:s Perini t c2.ars work to be ion! on P""te propeltY ONLY.
Any construct;o-i on the public d 0 a,, (curbs, sidewal�s, drivevaYs,
e c.) i" 'c' . separzta pertnission.
rn.;quinrs, I uIle
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PL,,N CHECK
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SIGN
RETAIN!NG WALL
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,L AMOUNT DU
,47TENTICIN
APPF.ICATION APPROVAI.
THIS PER—T
This application is not a p(-rmit witil
AUT-OR-ZCS
IsIgned by the Buildilig official or h:s DCp-
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f OTCO
Ut. . fees are paid, tsld receipt is ac-
,: alli
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k�cwledgcd in space provided.
D�PAR:TI.OlrFNT
5 S I _NA T R C
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CIT
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Z13MONDS
AT
775-2525
ORIG!NAL YELLOW -
GOLD % - Pi14K-C,7
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CITY OF EDMONDS - SIDE SEWER PERMIT
WATER-SLYWER DEPARTAIFIff
PERMIT 5769
Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.)
(Inspection will be Provided within 24 hours after requat. NO Sat., -Sun., or holiday inspections.
v---- ---------------------------------------
........... . ...... . ............................ ------------
....... Lot ... Kall!�YZX
..........................................................................................................................
.................................... OWNER AND/019 BUHMER ------- .... . ...... ........... I ........... ... ............ . ........ ........... ..... .......... .
s ......... Ly ... Con.,= . ...... .... .... . .................. . ... .. . ......................... . ...................
NAME & ADDRES
0ONTRACTOWS
r' jpsg7,13f"on is granted ......... I -- ----- Aprj-1-2-8 -- - ------------ 19-17, for repair mWor connection of a side sewer to the city flAdts'7 sew*t
in saxwdanIce wkth City of Edmonds ordinances.
ATTENTION IS CALLED TO FOLLOWING: on ae or must be Yed 0 comAnl0t
'"M No. I —The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer C tr t eMP10 t
side sewer in street area� Do not cover any portion of sewer before it has been Umpected.
JMTE No 2—All work -of-W&Y Permit obtainable from the City Engineer's Office.
performed in city right-of-wav requires an Invasion of Right side sewers when you get permit.,
XOTS No. 3—Obtain fun information regarding ordinance 11.16-030 and Regulations governing Inimum grade of 2%. No bends in gm4o
t rag at property line and 12 inches inside property line; m
1*0" No. 4�--TDp of side sewer must have at leas 30 inches cove e
ahsAl)er than % will be permitted.
MOM 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 impropiw
work which may develop within one year of completion.
NOT* NO. 6-1t; 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.
V-- A)"Ov" 0 Date .. . ................................... By ----------------
k0VED--------- -------------------------
ReUlDIUS: ------------- ------------------ ------ --- - ----------------------------
11ty---------------- Date ------------------------------- BY ........
I e I
t �'
................................. . .......... . ....................
BOTH Pernult Copies MUST Be Signed By owner of F`irm Performing Cons"tion'PRIOR To Request For 1%pection
------ hereby certify that the side sewer installation conIftucted under this permit
--- --- ----------- .. ..................
Fing PerfGrmin'g Construction)
wis instaUed in accordance with an goverlung ordinances of the City of Edmonds -
Dated tids ..... Q - -- - ---------- ASY Of ....... .............. ........... . ... ... * 19- .......
-j Check 11EFOI&E you for: Water Clas Taephone 0, Power 0, Sewer 0, Other 0
APPLICATION
The City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION E] REPAIRS E] LID NO . ........... ...... . ASMT. NO
OWNER. ....... ......................................................... CON�RACTOR ............ PERMIT
JOB ADDRESS ... . ...... ------- DESCRIPTION: LOT NO - --------
. ..................... BLOCK NO . ....................................
----------- O-A
Y ---- ------- DIU ------- N.Q ....... --------------------------------------------------------
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NAMEOF ADDITION .......................................................................................................................
WSWED ,
APR 9 8 1977
Public Works VepL.
Approved:
DATE............................................ By ................................................... fi7.ff
APPLICATION
The City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS E] LID NO . .................. ASMT. NO - ---------------
................... .......................................... CONTRACTOR
OWNER ...... Ff C�:- t-A ..........
----------------------- ..................... PERMIT NO.
JOWDRESS ...................................................................................... �'�EGAL DESCRIPTION: LOT NO . ............. ................ BLOCK NO.. -----------------------------------
........................................... ......................................................................................................................
-a� c: "'J 2-
NAME OF ADDITION ..... ----- -A.�—.= ......... D�
loco,
DATE .... j2jZ1r.6, /=/
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