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CITY EDMONDS - SIDE SE �AR PERMIT
WATER -SEWER DEPASTMENT
PERMIT N?
STREET FILE 5964
(Call 775-2525 for side sewer inspections
Inspection will BEFORE covering any Portion
be Provided within 24 hours after reolust. No Sat of the construction.
or holiday inspections.)
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ADDRESS LOCATION OF CONSMUCTION ..... -Z /. -'-z_ - - S
PROPMTY XXGAL DESCRIMON. ............. I .... ........ .......... .. . ....... .......... ... ........ . .
------------ ......... b.j.�t ............ . .. 2 . ......
...... ......... .......... --- hi. ....... ......
..........
.........................................................................
/on BUIUDEU.- W
------- %&L.K�R
'TMAMOWS NAME & ADDIRE,
1. 1 -- --------------------- .................................. . ..................... . ..........................................
�-�on is grm" of j�� ...... ........... ....... ... .. . ...................................................
:7::� ..... 1,5
"WAm IR Aeftrdence with ... . .. . ............ 19 --- :?" or "'Pair -W,'Or connection of a side sewer to the city sanitary er
ordUumce,
ATTENTION IS CAIJ.XD To TUE FOLLOWNr: sew
NOTE I. 1-7he own— Of the propert
side sewer in street- t
area. D any Portion or sewer before I has been ne Ine.
NOTE No, 2—All work I :% 0:,tn a permit - �--tr-Ct --werl Inside property I A licensed Side Sewer Contractor must be employed to construct
no= No- 34)btaln f Performed in city right_of_vay reoluires an Invasion of Right -of Pected.
ull information regarding Ordlinance 11-16-030 and Regulations _Way Permit obtainable
sharper than % will be Permitted. from the City Engineer's office.
NOTE No. 4—Top of side sewer must have at least 30 inches Coverage at governing aide sewers when you get permit.
Property line and 12 inches inside Property line,, minimum grade of 2%.
NOTE No. 5—Trenches in street must be water settled and surface of street restored NO bends In gra4e
work whlcb may develop within one
NOTE No. 6--It to unja 7ear Of completion. to original Condition. Contractors a I
wful to alter or do any other w. r
o_k
th �,ro,.e
or I.
Is Provided for in the permit, or to do any work on the main sewer or its aVDurfn.
Bert the pipe into the Wye. bal be responsible for failure due to improper
the
"IAPPBOVED Date ... ................................... BY -------------- jute V1 EO in -
A "PROVED Date ... ... .................................................... BY .. ....... . ...... . ......... * ------- * BY ---------------- Date .............. . ................... By ...............
"PRO
Remarks: ....... . .... .............. . .. . .. ............................... ......................................................
............................................. .. . ................ ..................................... I ............. . ...................................... . ...... . ....... ........................ I .................
. . ............ .. .. .. ........ - - -- ------ ---- --- ----- ---
BOTH
�f Permit Copi e s: MUST Be Si gned 13Y 0 w er of - Fi - rm - p .............. . .............. . .............................. . .. . .. . ............................................................
....... ...... erforming Construction PPJOIK To Request For Inspection
:: --------- - ---------------------- ---- hereby
(9wner of —ntracting Firm i�erformmg construction) certify that the side sewer installation
was installed In accordance with all gOverniag Ordinances Of the City of pdmon&. cOrlstructed under this Permit
D ted 7 "Y f
ated this .............. . ........... day of .. ...
.............
...........
V C�hec�EFO]a
k B Z you g f . ...................................
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I Check BEFIDIZE You dig f(m.: Water 0,
as 0, T D 19 ---------
6" 0' e1ePhOne 0, Power 0, Sewer C1, Other 0 " 'I
BUILDING DEPARTMEPh
PERMIT APPLICATION,
Applicant Fill
71nside Heavy Lines
ZONE ajMBER -7
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JOB
ADDRESS
NAME (OR NAME OF BUSINESS
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GAL LOT
LOT AREA
SUBDIVISION NO.
MAILING ADDRESS
10YIES ONO
P1 'AV
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0
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STREET R/W
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W So FT. FT.
CITY
1, te, 149WOO
ELEPHON' NUMBER
T-2 16 1 r=)
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NAME
REMARKS
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ADDRESS
CHUW
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W
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CITY
ELEPHONE NUMBER
STREET AND/OR UTILITY WORK
REQ'D.
1-1 YES
R/W PERMIT REQUIRED
YES NO
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NAME
UNDERGROUND
owwezz
WIRING REQ'D. WYES ONO
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ADDRESS
SANITARY SEWER
TYPE CONNECTION UY:S JVER[M
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0
city
TELEPHONE NUMBER
SEPTIC SYSTEM
APPV'D BY CITY ENG. 0 YES
42NO
PLERMIT'NUMBER
STATE LICENSE NUMBER CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four Copies)
L&rw' Flele V
REMARKS
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0
METEq SIZ BUILDIN SUPPLY SIZE
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REMARKS
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SIGN AREA
ENV. REVIEW
ADD NO.
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W
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ALLOWED PROPOSED
COMPLETE EXEMPT
J
EMARKS
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VARIANCE OR CU
PLANNiNG REVIEW BY
DATE
YARDS
FRONT SIDE REA
LOT COVERAGE
GAS
NEW RESIDENTIAL LINE
FIRE ZONE
TYPE OF CONSTRUCTION
ADD NON-RESIDENJTIAL ED SIGN
DEMOLISH RETAINING
ALL
ALTER EXCAVATE FENCE
OR FILL I— X—M
D REPAIR PRE -MOVE WIM
INSP. SPOOL
1CODE
CIAL INSPECTOR AREA
REQUIRED
0 YES 1:1 NO
OCCUPANCY
GROUP LOAD
I I
PANT
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
W
NUMBER OF STORIES
I
NUMBER OF
DWELLING,
UNITS
I I
REMARKS
NATURE OF WORK TO BE DONE
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P LAN CHECK
VALUATION
FEE
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PROPOSED USE
0
;:�i�
NO.
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PLOT PLAN (INDICATE a UILDING SETBACKS,
ABUTTING STREETS)
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BUILDING
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PLUMBING
HEAT & GAS LINE
0
FENCE
SIGN
RETAINING WALL
0
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SWIMMING POOL
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