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21621 81 ST AVE W
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APPLICATION
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The City of idmonck- SIDE SEWER PERNaT EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS E]
.............................................
OWNER -------------------------------------------------------------------------------------------------------------- -V .... ...... ( .......... k ...........
CONTRACTOR .... ------- PERMIT No.
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ADDRESS. .................................................................................................
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LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
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q� Tho City of Edmonds
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APPLICATION
for
SIDE SEWER P=mT
NEW CONSTRUCTION 0 REPAIRS 0
EASEMENT No . ..............
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OWNER ---- OR ....................
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CONTRACTOR ... w ....... K.kb , pp.a
-------- c ....... PERMIT No.
ADDRESS ..... ...........
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LEGAL DESCRIPTION: LOT No . .......
6 .................................. BIA)CK No . ............................................
NAME OF ADDITION ..... A-M ------ N-P ------- NK ................
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�-t N APproved:
DATE................................................ By ................................................ ........
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NOTICE:
------N-o--wa--r-r-a--n-t-y--of-a-ccu-ra-cy.-----------�---
The information *shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Ecim.onds does not warrant the
accuracy of anything set for.th on these
rnap(�_)- Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information sho,wn on
''-___Fe t -map(s), including, 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 sh own.
Neither the City of Edmonds nor its
empl'oyee's o'r office-rs sh-a-11 be hia-b-l`e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
71'rr
PERMIT 4673
Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.)
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.
21621 - 81st Avenue West
ADDRESSLOCATION OF CONSTRUCTION ........ ..................................................................................................... . .......................................................
PROPERTYLEGAL DESCRIPTION ....... .............................................................................................................................
........................ ........................... .......... . .......... . ........................................................................ . .............. . ................................... ..................................................
OWNER AND/OR BUILDER ........ REURS'N
.............. ........... ....................... .......................................................
................. * ----------------- * ------ * ........
C(j,_...:RACTOR1S NAME& ADDRESS-�'�R. Knott Construction. 2 109 CVDress Hay. Abjen,�mqd..&Rnar
...................................... ................... i ................. . .............................. I ...............................
Permission is granted ------------ - .. ..................... 19 ... :.Zq� for repair and/or connection of a side sewer to the city sanitary sewer
system In accordance with City of Edm.onas ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
1,,V___\No. I —The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side sewer in street area. Do not cover any portion of sewer before it has been inspected.
M__'No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3—ObtaJn full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—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. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors sball be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6--It 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 in-
sen the pipe into the wye.
DISAPPROVEDF] Date ---- ----------------------------------- By ................ Date ............... - ------------------- By ................ Date ................ ................... . By ---------_-----
APPROVED .......... By ... ........................... ...........................................................
t ...
---------- - --
Remarks: ..... +P ...... g� . ...............
------------------------------------- - ------- -----------------------------------------------------------
.......................................................... . ........................................................................................ . .................................. . ... . ..... .................................
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
4_
tallation constructed under this permit'
I .......... . la,.�.. ......... . ................ .... hereby certify that the side sewer ins
(Owner of Contracting �i�,r_il.'_rming Construction)
Ls installed in accordance with all governing ordinances of the City of Edmonds.
Datedthis --------------- - ----------- day of ---------------------------------------------------------------- 1 19 .........
Check BEFORE you dig for: Water E], Gas E], Telephone E], Power Ej, Sewer E], Other 0 V -V