21815 76TH PL W.PDFlill 11111111
6489
21815 76TH PL W
*7
STRE& FiLE'-- e RECEIYED
PR
Claim MUST be presented to the City Council and Mel with the City Cljk wlthi�
ay
.:AVED
from the date of Accident or Accrud of Damngc6. 0If. 01 Pubhc Works
TO M CITY COUNCIL OF THE CITY OF EMONDS:
PLEASE TAKE NOTICE* THAT Cle4l
�if married, Give husband.'s najne)
WHO NOW RESIDES A
�State pres6ht_Wctua1_addrcss by str'ect number and cit
AND WHO FOR six moirms- PRIOR TO DATE OF ACCIDZNT HAS RESIDED 'AT
Give residence by street, number and city
CLAMS'DMIAGES OF AND FROM THE CITY OF ED14ONDS IN THE SUM OF 8'
arising.out of the following circumstances:
Describe Cla�m, giving
DATE and TIME injury or 4-e
.damage occurred, PLACE
-e
arld full F.a.rticulars.
Accurately locate and
de:icribc defects caus-
ing injury or damage
and all acts of ncgl'i-
gen�:e claimed.*
Ke e
C
Accurately describe
injuries or damage
V
State -items of damage
claimed. Itemize all
expenses and losses. -J.
(Claim must be sviorn to by claimant)
7
(,Signature of Claima�t
.5 u LYK R I B ED AND SWORN 110
XL-)
befoie me this d ay of 919
Uotarye'Public.in Lind for the State of
a6hington, residing at
T
0
i
0
B
A
T
'11� Su4jra"Zally O� ::�olz' -�Zeja '/*(C�
JO OATI:
0
NAME
ADDRESS
ZIP CODE
CITY' ij
V - --
ADDRESS
PtIONE CONTACT
AN10UNT
PURCHASE ()RDER N 0.
CUSIOMER SERVICES-
Ni I S C E L L A N E 0 U S
MAI ERIAt
STATESALESTAX
TOTAL
CASH:.
CHECK
PERATOR'S NA
JOB DETAILS AND REMARKS,-
U SINK LINE .-
n?� SIjjE- SEWER
0 -1 UB s1lovvri3
L_j OUT. SINK. L-j Wk I R
[I -E�IJER VENI El Gil FASE
0 ioo! s Ej i-oul) 11 U
El s L. Li 1) G F- El 1, N'
11il. Sj'IlVIC.r IS ACCE,I)l Alit. F. AND VVII L BLPAIOIN FULL AS SF`Fc1f IED ABOVE. If: NOT
THE PURCHASERAGIALLS TO PAY ALL COSTS INCUIMLD 10 FACAL17AIL COLLECII(M.
PLEASE PAY ON THIS I NVOICE SURVICL CHARGE PER MONTH AFTLR 30 DAYS.
x
C u
RETAIN INVOICE TO V . ALIDATE GUARANTEE
C �� � S T � 1: , 1,:', C -,�) PY
STREET FILE 0
C I T Y 0 F E D M 0 N D S
- SEWER DEPART?vM -
STOPPAGE OF SANITARY SEWER MAIN REPORT
DATE: L_ 41 /979 -TIME CALL RECEIVED: /.'co 4,44.
LOCATION OF STOPPAGE:
6?)� 2110c, �L&
TIME OF ARRIVAL ON THE JOB SITE:
7&?V,4v. ezr.
/A *0-6 4, A-.(.
TIME.NORMAL FLOW OFSANITARY SEWER REESTABLISHED: * //.' �-O 4 IA4 -
CAUSE OF STOPPAGE: 0e44'-s'
ACTION REQUIRED TO CLEAR MAIN AND/OR LATERAL: pz�144_,E49 0A'�:o
kfc�lj,o",�— AV-4,16 1&44�7CX_1a4-,d57
CITY CREW ON STOPPAGE CALL OUT (Personnel Involved):
LOCATION OF RESIDENCE AFFECTED: '7&
NAME, ADDRESS, AND PHONE NUMBER OF PROPERTY OWNER:
_IZ1915- -74, f-;v 4<,r
S., -
DESCRIBE DAMAGE TO PRIVATE PROPERTY: 24J
OF
baA:.o�:�e�5
0 P? r
RECEIVED
�,,C,4
TREET FILE P �: 7 - I d
' P S
Claim MUST be presented to the City Council and filed with the City Cleh itJ JR
_IVED
from the date of Accident or Accrual of DinaGeu. 01r. of Public WAr s
TO THE CITY COUNCIL OF THE CIV OF ED140MS:
PLEASE TAU NOTICE, THAT F1JT!nr1a,.'.1ty Clej,j,
(if married, give husband's name)
WHO NOVI RESIDES AT��
'(State present actual address by street, number and city)
AND WHO FOR SIX MotrIHS PRIOR TO DATE OF ACCIDENT HAS RLSIDEED AT
(Give residence by street, number and ci�ty)
CLAI�LS DARAGES OF AND FROM THE.CITY OF ED14ONDS IN 'THE SUM OF
arising out of the following circumstances.
Describe Claim, giving
DATE and TIME injury or
.damage occurred, PLACE
and full particulars. e &zve
Accurately locate and
describe defects caus-
ine injury or damage
and all -acts of ncgli-
gen�:e claimed.
-7
7Z
Accurately describe
injuries or damage
Z
1,-2
State -items of damage
claimed. Itemize all
expenses and losses.
001,
(Claim must be sworn to by claimant)
Y
ignature of Cla
C3UWC7Jq1,BED AND SWORN TO
befor� me this day
of
tary�/Public in and for the State of
�ashingtonj residing
441y I've.
JOIS 04�
B NAME
L ADDRESS
L
T CITY ZIP CODE
i
0
e ADDRESS
A PHONE CONTACT-
T AMOUNT
PURCHASE ORDER NO.
CUSTOMER SERVICES -
MISCELLANEOUS
MATERIAL
STATESALESTAX
TOTAL
. .1 —
CASH: ...............................
CH EC K:
JOB DETAILS AND �R��MARK��J'
SINK LINE OUT. SINK HAIR
SEWER VENT GREASE
SIDE SEWER
FOOD B/U
ROOTS
TUB -SHOWER DSLUDGE T/X
11 jj; SE RVICE IS ACCEPTAnLF-. AND WILL BE PAI D IN FULL AS SPECIFIED ABOVE. I F NOT
1 k PU- RCHASER AGRE ES TO PAY ALL COSTS INCURR ED TO FACILITAI E COL LECTION.
PLEASE PAY ON THIS INVOICE 1% SERVICE CHARGE PER MONTH AFTER 30 DAYS.
x
CUSTOt'll. 14 SIGNATURE
RETAIN INVOICE TO VALIDATE GUARANTEE
CLJSTOMN�'S COPY
* STREET FILE I -
C I T Y 0 F E D M 0 N D S
- SEWER DEPARTMENT -
STOPPAGE OF SANITARY SEWER MAIN REPORT
k —
DATE: A/ A? 79 TIME CALL RECEIVED:
LOCATION OF STOPPAGE: 4 7- A4,,Q A-f /w_/
42Y= 2,1 9 & e 7& CYAW-V. ezf.-
TIM� OF ARRIVAL ON THE JOB SITE: . 14,0,6 4, A..C.
TIME NORMAL FLOW OF SANITARY SEWER REESTABLISHED: 'd'A4 -
CAUSE OF STOPPAGE: 'e44'-S,, 'eg 9 Q, lr-
ACTION REQUIRED TO CLEAR MAIN AND/OR LATERAL: 4:::;)X4
ezIA7,6 14—f (�)A=-
.AAX4A-1A1,0Z-�
14ae.) B4114,r ep
CITY CREW ON STOPPAGE CALL OUT (Personnel Involved): Z46eY t!1,-2;4467
;�b�r- C.4;t� -4
LOCATION OF RESIDENCE AFFECTED: C.21001:5-
NAME, ADDRESS, AND PHONE NUMBER OF PROPERTY OWNER:
-24,915- -7&fW �F-L &r "E-.c)A-,4'cx-rps,
DESCRIBE DAMAGE TO PRIVATE PROPERTY: 61��CI20,LJ
apg W.
�, 1-.-0 7m,0.i
,Jar
9 /7c
k APPLICATION
The City of Edmonds for
2: SIDE SEWER PERMIT EASEMENT NO - ----- --------------------------------------
NEW CONSTRUCTION REPAIRS LID NO. A'��)-2 ------ ASMT. NO.
OWNER ��E-7TH ---------- P�-T P�-N
---------------- -------- ----- -- --------------------- CONTRACTOR - ----------- --------------------------------------- ----------------------- .. PERMIT NO. ��P5.4
JOB ADDRESS --- Z-keSk!:5 ---7<:2,— PL-LLC---
- - - - --- --------------------- ----------------------------------- LEGAL DESCRIPTION: LOT NO - --------------- lff�� ------------------ BLOCK NO - ------------- -----------
------------------------------------------------------------------------- ------------------------------------------------------- -- -----------------------
NAME OF ADDITION ------ CL�:-R LEE— R
I ------------------------------------------------- I ---------------------------------------- ---------- -------
Approved:
DATE
------------ - ----- -------- By ... .. ..
The City of Edmonds
OWNER 1\,ezp�� --------
JOB ADDRESS -cl�
APPLICATION
for
SIDE SEWER P
NEW CONSTRUCTION 7 REPAIRS
EASEMENT NO - ---------------
LID NO. ----- ASMT. 0. Y'�/
PERMIT NO.-��O&y
CONTRACTOR Za-E
LEGAL DEkRIPTION: LOT NO. - ------------------- I ------ BLOCK NO - ------------------------------------
------------------ ------------------------------- ---------- ........................... --- ---- - ----------------------------------------------------------
NAME Of ADDITION ------
------------------------
ApProved:
DA'a
RECEIVED
OCT 11974
--- By ....................
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 of E - dmonds 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), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exi and -may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers shall be liable 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
PERMIT
Call 77 -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.
ADDRESS LOCATION OF CONSTRUCTION .... 9. J4 ....................................... . .........
PROPERTY LEGAL DESCRIPTION .... L.Pt-.5-n ... (Arabe Park
..........................................................................................................................................................
................................................... . ...................... . ........................................................................................ . .................................. . ..................................................
................................................................ O1ArN`ERA.ND/OR BUILDER-EFIRIM-1 P17TPPcZ1j�,1 ,
.... . .................................. . .......................................................
_,,IMACTOR'S NAME & ADDRESS .... 0-1.4.RTP -------------------------------------------------- I .................... . .................................. . .......................................................
Permission is granted ----------- f)#--:-nktzt- 7
........ . ................... 19.71A. .... for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
A'—.:t,'NTION IS CALLED TO THE FOLLOWING:
NOTE 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.
NOTE 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--Obtain 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 originaJ condition. Contractors shall 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-
sert the pipe into the wye.
DISAPPROVED E] Date ... . ................................... By ---------------- Date ........
...........
APPROVED Date ... ....... By. �- .. ....... Date ............... . ................... BY ----------------
---; ........................
By ................ ...............................................
K
Remarks: ........................................... . .............................................................. . .............................. I
....................... ;;,..v ............................... . ................................... ...................................
.................. . ..............................................
L- B4�Tzz 16e
.. 1. t Copies MlfST #e By Owner of Firm Performing Construction PRIOR To Request For Inspection
", r�i .0
------- �-- - — �.�ereby certify that the side sewer installation constructed under this permit
wner of Contracting Firm Performing Construction)
-L7;�(er offotraeti—
w.- installed. in accordance with all governing ordinances of the City of Edmonds.
Dated this ...... 0 .................. day o ....
f . ...... ........... ...................
-V V Check BEFORE you dig for: Water E], Gas Telephone Power Sewer Other El At J
January 17, 197,14
Mr. Kenneth PetGrG0n
21 5 1
Edmofids,"washington 98020
SUBJECT: Sewer Hook-up for Beneficial Use Local,'ImpllovemOnt
District 192 Sanitary sewers
Ths,City Engineer has approved the sanitary t-ewer main
construction in the vicinity of your home as usable for sewage
disposal. It in, therefore, permissible for property owners to
begin connection of their houses. Each home owner should secure
the services of a city -licensed side sewer contrector,and obtain
-ts me
a side sewer permit. Side sewer information and permi. y be
obtained at the Public Works Department. 200 Dayton Strvet,
telephone 775-2525. office hours are from 8 a.m. to 5 P.m.
As soon an all sewer main construction has been *ow-
pleted in the Chase Lake area, the City will hold a hearing to
establish the final assessments. This hearing should take p1ree
sometime in late spring. Upon passage of the L.I.D. Ordinance,
all home owners must connect to the sewers within 60 di-sys. This
advance notice is sent at the present time for the convenience Of
the home owner in the event septic tank problems exist and to allow
hook-ups over a longer period of timeo
If you'have any questions regarding the L. 1'.. D contact
the Engineering Department; for 'side sewer information, contact,
Public Works, Either department may be reached at the above
telephone nurber.
Yours very truly,
cirf or EDMONDS
LEIr R. LARSON
city Engineer
LRL: mir
cc: Public Works Department
76 PL Wes
WA
ul
rV"
si
�ia
M4
NZ
Or