21126 78TH AVE W.PDFIIIIIIIIIIII
6658
21126 78TH AVE W
CITY OF EDMONDS
PUBLIC ORKS DEPARTMENTj ENGINEERIP DIVISION
MFFLiUM I I U14 FUR Rion i-uF-imi wioi iww wn rr-r\17! 1 1
TME
TU PFLEMUST BE AVAILABLE At TH . E JOB . SITE FOR INSPECTION . PURPOSES
Applicant to Complete Parts A and B
A. Permit to be issued t o
For Work at:
.(address or vicinity)
Type of Work to be done: A --k
(attach drawing when applicable)
Time Required -- Start:
Owner: 9 .9 ot r- 4 1 19-p t �41y,7,
Name
Mailing Address
ulty
State Zip
Finish:
Telephone Number
Contractor: 11
-D3 - 0tyL4P1C- /V 3 J�) S - 6 S1 71
Name State License Number
Mailing Address
City State Zip Telephone Number
B. INDEMNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from -any injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including or not limited to the defense of any legal�proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and restoration in' accordance with City Code. A
24-ho�uir notice is required for inspection by E . nginee . ring. Call 775-2525, ext. 220.
I understand that this permit must be available at the job site for inspection
purposes at all times.
Si g n a t u r e Date:
O�ner oi7 Ag�-nt
I TO BE COMPLETED BY ISSUING AGENCY:
Date Issued:t--) -7
Security Bond: ;�Ii
Time Authorized: R
Permit No.:7A Fee:) 0 V
-S.
APPROVED BY
Date: 70
--s-1-j1r174r -
I
1-4 'o—,ow.- / - /, 414- aj�c-
41 �- -00,-Ae�k -� 40 __ry .
NOTICE
ST FILEERMITTEE ANI)/OR OWNER
PARTIAL APPROVAL
VIOLATION
CORRECTIONS REQUIRED
PERMIT
NUMBER
DRESS
NO PERMIT STOP WORK — REMOVE CONSTRUCTION OR OBTAIN
PERMIT AND MAKE WORK COMPLY WITH BUILDING LAWS.
CONSTRUCTION IS NOT IN ACCORDANCE WITH APPROVED PLANS
El AND PERMIT — STOP WORK. MAKE EXISTING WORK COMPLY WITH
APPROVED PLANS AND PERMIT OR REMOVE IT.
STOP WORK — UNTIL AUTHORIZED TO CONTINUE BY INSPECTOR.
CORRECTIONS LISTED BELOW MUST BE MADE BEFORE WORK CAN
BE APPROVED.
El �WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS "PROVED.
ECONTACT INSPECTOR AND
ARRANGE FOR APPOINTMENT. F RECALL FOR INSPECTION.
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED
WITHIN ......... DAYS OR PENALTIES IMPOSED BY LAW MAY BE
APPLIED. FOR INSPECTIONS CALL: 775-2525.
F] BUILDING DIV.
INWECT011.-
9PUBLIC WORKS
CITY OF FIRE DEPT.
D"ru
EDMONDS--
0
0
The City of Edmonddss
APPLICATION
STFIEET FILE for
S11DE SEWER PERNaT
OUTSIDE K INSIDE [:] REPAIRS Fl
CARDNo . ......................................
EASEMENT No . ......................................
.... ............................................... ... CONTRACTOR ........ .. .. ..... . ..... llt."4 ......................................... * PERMIT No.
OWNER ...... ..... STREET
o' . .................
HOUSE N -------- ............ ............... ....... AVENUE, LOT No . ............. ------- ---- BLOCK No . ...............................
NAMEADD . ..................... ......... ...........................................................
2 -Z 4. 79 rm Wile ..... ...... #l: ........ . .
t
-a f
A*
'c 4
dp
ry
t APPR0VFp
FE 7 1964
'70
Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ ..................
............ -------
DATE Y
SEWER WORK ORDER ISSUED ............................. ............ L2 B ................
:�� ------------ .............
�� 4--� �
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City ofEdmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the -map(s), in I cluding, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown,.
Neither the City of Edmonds nor its
employees or officers shall be lia-b-le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
Call PRospect 6-1107 24 hours (plus
CITY OF EDMONDS Saturday, Sunday and Holidays) be- 937
CITY HALL — WATER -SEWER DEPARTMENT fore work is ready for inspection.
SIDE SEWER PERMIT
..................................................
I ADDRESS ........... . ....... .......................................................................
45q
OWNER ......... ......
Auntoo.. ................................ ............ CONTRACTO i R ........ A1.=r!05-0--: .............................
I Permission is granted ............. F'bbii ... 1Y ...................... 9 19..,6k for ..* ....................... days, to REPAIR or CONNECT a side . sewer
with City Sewers in accord. application on fRE-5nd governing orilinances.
7:
I ATTENTION IS CALLED TO THY FOLLOWING:
I ' a perm struct sewer inside property line. A licensed Side Sewer Contractor
NOTE No. 1—The owners of the property may obtain it to con
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 regarding Ordinance 11.16.030 and Regulations gov'erning 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 it. r`i0inal 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 pernilt, or to do any work on the main sewer or its ap-
purtenances except to insert the pipe into the wye.