21110 SHELL VALLEY RD.PDF11111111111111
13046
21110 SHELL
VALLEY RD
0
ADDRESS: d 0
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: DETERMINATION: 0 Conditional Waiver F] Study Required Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
LOT: BLOCK:
LATEMPOSTsTomis\Street File Checklist.doc
PERMIT
5768
(Call 775-2525 for side sewer inspections BEFORX covering any on of c I CU n
Inspection will be Provided within 24 hours after requat. port the Ong ru 0
NO Sat., Sun., or holiday Inspections*
ON OF coNsmumON .... Road
PMOPEWY IXGAL DrACRUMON .................. . Lot�.. --------------- - * - - ---------- - -- - ---- -- - ---- ----------------
14 ... a4 ...... ShelL ... Valley .. Div- ---- Z ... . .................................... ...........
... ....... . ...... . ............ . . .. . ...... . .......... . ...... . .. . . ........................ . ........................ . .................. . ...............
.............. I ................. I . . .......
. . .................. . ................................... OWN= AND/Olt BUIMDER ------
............... . ..... ........ . . . ................ .................. . ...........
00NMAMORIS NAME & ADDRESS ... . .......... LV,�nn oo.d ... Sewer..
_& ... ro st, ........
. , _U .. ................. . . . ............................. ..............
P-Vd9ShW Is grMted ........... . .... A
for repdr .d/or
In ace"dwice with City of ........ c0nnftt10n of &,slde Ww"i-the city spaltary sewft
FAbsonds ordinanC43S.
A"WNTION 18 CALLED TO TE[Lr FOLLOWING'
I —re owners of the Property may obtain a
4. sewer in street area. Do not permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to
2_AII .1, PWed . it, right 11 1 Port On of sewer before it h= been inspected.
_Of-vraY requires tan -.6$4*
Invasion
NOTIC No. 'tall' full Information regarding ordinance 11.16.030 and RegufI&Rt1'0gnhSt_0f_waY PerMIt obtainable from the City EnglneW
100TIO NO. 4--TQP of side sewer must have at least 30 inches coverage at property governing side sewers when You get permit a office.
sharper than 3A will be permitted. line and 12 inches inside property line;
work which May develop within one yjar of completion. restored to original condition. contractDrS shall be responsible for failure due to Impr4ow
NOTE No. S--TrencheB in street must be water settled and surface of street MIMIMUM grade of 2%. No heads in
INOTA N I o. 6—It Is unlawful to alter or do any other work than Is provided f or in the Permit or to do any wo
Ber . t the Pipe Into the wye. rk on the main SOV I or or its appurtenances except to 10 1
DISAPPROVeD
APPROVED
0 Datm .. . .......... ................... . ... By -------_------
2:Z" -�
.....................
jUte ...
- BY ------__---- Date ----- - - -- - -- - - - --------------- - By ...
By-
....... ... .. . .. .
.............. . .. . .. . .. . .............................
----------------- . ........... . ..................... ................
I_ -------
......................... .....
: CC:: ! ii::
—:22c:
ROM Permit Copies MUST Be Signed 13Y Owner of Flirm Performing Construction PRIOR To,
Request Pc% Inspection
.. .... hereby certify that the side
9 Firm sewOr installation constructed under, this perMa
!�6
VM Installed in accordance with all governing ordinan�e
_Ao�the City of Edmonds.
Dated this ..... . )
of� ............................ . .... 19 .... . ...
V Check BEXORE you Z.
dig for: Water o, Gas o, Telephone 6, Power 0, ----
Sewero, Other o v v
j
�APPLICATICIN
The City of
Edmonds
for
SIDE SEWER PERMIT
EASEMENT NO . ............................................
NEW CONSTRUCTION REPAIRS F�
LID NO . .................. IASMT. NO - ------ -----------
OWNER ---------
---------------------------------------------------- CONTRACTOR ---------- PERMIT NO.
JOB ADDRESS
LEGAL DESCRIPTION: LOT NO. ........................
BLOCK NO - ------------------------------------
SL'Et-1 ........ r . . ........ 61 --- u ......
0.6-1 --- �:� ...........................................................
NAMEOF ADDITION ...................... ....... ................................................................. ------------------
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RtCEIVED
APR 28 1977
Pubk WO(ks VOPL
Approved:
DATE............................................ By ............................................................
11/75
APPLICATION
The City of Edmonds for EASEMENT NO . ............................................
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS E] LID NO . .................. .. ASMT. NO . ...................
OWNER ....... �-->
......................................................................................... CONTRACTOR
..................... PERMIT NO . ....................
...............................................................
JOB RESS 7- %GAL DESCRIPTION: LOT NO . ............... ��>4 ---------------- BLOCK NO . ....................................
..................................................................................................................................................................
C-D '-J S> (0 �Q :�* r2-
NAME OF A DDITION ..... ..... -A. Z--= L.— � . . ..... ............. k ........ \ ....... \ ...................
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Approved -
By
DATE ....
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