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21820 84TH AVE W
e APPLICATION
The City of Edmonds for EASEMENT NO.
SIDE SEWER PERMIT
NEW CONSTRUCTION N REPAIRS LID NO. ASMT. NO.
OWNER L� - --------- ------ --F .... ................ CONTRACTOR -------------------
------------------------- T-� ........ ......................... PERMIT NO.
-------------------
JOB ADDRESS 7- 1
... ............. .................................................................... LEGAL DESCRIPTION: LOT NO. BLOCK NO - --------------------------- --------
0 .
0
I NAME OF ADDITION .......................................................
....................... ........................................
P VA
VIA,
DATE.- -------------------------
AMUCATION
The City of Edmonds for EASEMENT NO.
SIDE SEWER PERMff
NEW CONSTRUCTION [:] REPAIRS E] LID NO. -19-4�-ASMT. NO.
OWNER -------- N! ....... Y\-Q_tkt-If� ------------ ----------- CONTRACTOR ------------------------------ T
------------------------------------------------------ PERMI NO.
JOB ADDRESS ---- — ----- -,4 SA. -0- LEGAL DESCRIPTION: LOT NO - -------------------------------- ----- BLOCK NO - ------------------------------------
------- -----
.........................................
NAME OF ADDITION
RECEIVED
JUL 18 1974.
7441
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&V
0 7
5�7
All,
Approved:
DATE-------------------------------------- --- By --------------------------
0
NOTICE:
Nb---w-arranty--(
The -information 'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
Th,e City of �Edm.onds does not * wa rra nt the
accuracy of anything set for.th on these
rnap(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform - ation shown on
tFe Including, but not limited to,
th'e location of any sew-er stub shown. Such
sewer stubs may or may, not exist and may
or may not exist at the location shown.
Neither the �"ty of Edmo'nds nor its
emp'fo-yee-s o-r office-rs -shalrl be l-`1a-b--1Fe for -11-he
i n 5 ma p(s), nor for
information give' on thi,
representation provided based
any one
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.
Inspecti5on will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.)
ADDRESS LOCATION OF CONSTRUCTION ............. ................
................................................................................ . .......................................................
'7-� 01" ,
PROPERTY LEGAL DESCRIPTION ..... 1.* 1 _. 4 b I, � . k �IT - �� -.4) 4,� '17-6 C 1"
...................................................................................................................................
................................................
TL
.......................................................................... S E_ .. . ......... .......................................... --------------
........ ....................... .................................................
................................................................ OWNER AND/OR BUILDER ......... 1�
.......................... . ..................................
. ......................................................
CONTRACTOR'S NAME & ADDRESS ----- n ,:s t
....................... ........ ........ ....................... . ................................. ....... m .......... ------------- * -------------------
Permission is granted ...... P; .......................
---- 9 .... ......... 1 19. for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
TION IS CAM D TO THE FOLLOWING:
w
side s�wer in street area. Do not cover any portion of sewer before it has been inspected. A licensed.Side, S�*ir'Contfacio�'must be employed to construct
Nt.— No. I —The o ners of the property may obtain a permit to construct sewer inside property line.
NOTE, No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from' the Ciiy Engineer's office.
NOTE No. 3—Obtairl -full information regarding Ordinamce 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 ajul 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 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 madn sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED E] Date ---- ------ ........................... By ---------_ Date ------- , By ----_--------- Date ............... . ................... By
e --- -- -- - -----------
I- ................
APPROVED Date-_ .......... 2�
............................. ........... ...........................................
Remarks*: ................. .. ......... ) .
............ . .. . .................................. 15;� -------------------- . ...........................................................................................................
............................................................... ..... . .................................... ......................................... .....
V............. .......................... . .......................................................
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
.... .. . .. ..... ...... ... .. ...
....... ( - Ow . ne . r .. of _. Con . tract - i . ng _. Fj . rm ... P - erf . or . ming .. Con . str - u . ctio . n .... hereby certify that the side sewer installation constructed under this permit
W, �t ailed in accordance with all governing ordinances of the City of Edmonds.
Datedthis ............................ day of ................................................................. ig .........
V A/ Check BEFOREyou dig for: Water 0, Gas E], Telephone 0, Power E], Sewer 0, Other