21228 SHELL VALLEY RD.PDF11111111111111
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21228 SHELL
VALLEY RD
0 0
ADDRESS
1A-X ACCOUN 11FARULL NUNWER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: F] Conditional Waiver E] Study Required 0 Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DA'
EASEMENT(S) RECORDED
PERMITS (OTHER):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
SHORTPLAT
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
OTHER:
LID #:
LOT: BLOCK:
LATEMP\DS'l7s\Forms\Street File Checklist.doc
APPLICATION
The City of Edmonds for EASEMENT NO . .......................
SIDE SEWER PERMIT .....................
F-- NEW CONSTRUCTION REPAIRS E] LID NO . ..................
ASMT. NO. - ................
OWNER
............. ........................................................... CONTRACTOR ...... F—=Xc--
..................................
.......................... PERMIT NO. 15<-
'212-2
JOB ADDRESS ............................................................................... LEGAL DESCRIPTION: LOT NO. -... 2-0
.. ...................... BLOCK NO . ....................................
..................................................................................................................................................................
NAME OF ADDITION F-Wm;w C:-:o 1.-41 r=,.t pt,4
... ... ... ............. ... ..... .. ......... .... ... --- -----
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0
11
Approved:
DATE j,
. .........
uj
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U.N.
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The City of Edmonds
APPLICATION
for
SIDE SEWER PER IT
NEW CONSTRUCTION R 7 REPAIRS F-1
ft ----------------------
OWNER ----- ------- T. - - .......
2
JOB ADDRESS ------------- . ........... ------------------ I ------
EASEMENT NO . .................. .........................
LID NO - ------------------ IASMT. NO - ------------------
CONTRACTOR ----------- -------------------------------------------------- PERMIT NO. Z:�-7-
I
LEGAL DESCRIPTION: LOT NO . ...... 792 ..................... BLOCK NO - ------------------------------------
------------------------------------------------------------- ------ 4'-', ...............................
NAMEOF ADDITION .......................................................................................................................
4�� 5 _u
LL.
Approved:
DATE............................................ By --------------------------------------------------- j-j7.y!y
PEHMrr
(Call "44M for Sids, soWar ftWMCtIM$ RKWOM 00000*0 400� Portion of the Conatructiou'l LU
Inspection I will be provided within 24 hours attar rollUbt. i*6 W., MO., Or holiday insPectiOne-1
LLJ
ADDRESS L4DCATION OF
MUM LEGAL DESC
. ........ ............. ........................ I ...............................................
........................ .......................... . ................. .... . ... I ..................................... I ......... . .................. . .....
AXD/OR BUHMEB ........... Walcker-Zomes . . ..... ............... I ............. . . .....................
. ................................... OWN=
C & X Excay.-Mrs, 15015 - 2nd Ave. W., Lynnwood
........................
CONTRACTORPSNAM J% ADDRESS ............... . ....................................................................... .................................. . .. . ..........................
'er".19 ....................
d ....%0_VeML for repah and/or oDaawtign Of side sewer to *a cW amaltowy sewer
P7="a=c"e ;�iih City of Edmonds ordins�
ATTENTION IS CALLED TO THE FOLLOWING: Sewer Contractor must be sesolor0d to construct
the property May obtain & permit to construct newer insidex;nly line
NoTS No. I —The owners of set area. Do not coyer any portion of sewer before It has Wit. A liconsod Side
aide sewer in six
-of-Way Permit obtainable from the City Ensinear's office.
NOTZ No. 2—All work performed in city right-of-w&Y requires an Invasion of Right
Ordinance 11.16.030 and Regulations governing 414110 "w*rx when You got P it -
NOTE No. 3--obtain full information regarding
vemge at property lim and 12 inch" inside property line; minimum grade of 2%. No boods in grade
No. 4—Top of side sewer must have at least �30 inch** eo
sharper than % will be permitted.
No, II, --Trenches in street must be water settled and surface of street restored to original condition. Contractors shall bo ro*Pougib* for f4aws dft to improper
work which may divelop within one Year of completion. do any work on the main sewer or its appogunsaoso oagopt to In -
NOTE No. 6--it in unlawful to altor or do any othor work than is provided for in the permit, or to
sort the pipe Into the wye.
DISAXIMOVEDE] Date .. ..... ............. BY .............. Date ..... .................. By ................ D9 . ........................ ....... IV .... ...........
APPROVED0 Date..__. ............... BY--- . ............ . .. . .. . ................. . ..... ...................................... .......................
Remarks: ....... . ...... . .............. 7 ...... . .................................................................. . ....................................... ...........
. .. . .............................. . ..................
.............. .............................. . ...................... . ................................ ........................................................ ..................................
orming Constructi;n'PRIOR To Request For Inspection
BOTH Permit Copies MUST Be Signed By Owner of Firm Pe
t .0
. .. ...... I .... ... , hereby certify that the side Sewer inntsliation constructed und*r this permit
g or
orm 9 Ion)
was Install__��wno
in a ernin dinances of the City of Edmonds.
Datedthis, ...... . ...... . ........... d&Y Of ................................................................. �p .........
Check BEFORE you dig for: Water GOP Power 13, Se%ver 0, other 0
.........
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