21823 77TH PL W.PDFIIIIIIIIIIII
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21823 77TH PL W
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STREET FILE
CITY OF EDMONDS
250 51h AVE. N. 9 EDMONDS, WASHINGTON 98020 * (206) 771-3202
COMMUNITY SERVICES
June 26. 1987
Don Jones
21823 -77th Pl.
Edmonds, WA 98020
SUBJECT: BACKFLOW PREVENTION DEVICE TESTING
Dear Mr. Jones:
LARRY S. NAUGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
The 1�ackflow prevention device in your water supply system is due for
annual testing as required by State Code WAS 248-54-500. Our -records
show a total * of one device in your system. Please have the testing
performed by a person holding a certif.icate of competency as a cross
connection specialist, issued by.the State Department!of Social and
Health Services (telephone 464-7674)..
If a device fails its test, please have the necessary repai-rs made.
Upon completion of a satisfactory test,* have the certified tester.fill
out the enclosed Test and Maintenance ReDort and return it to this office
within thirty days.
Additional information relative to this matter may be obtained by
contacting our Cross Connection Control Specialist at 771-3202,
extension 294.
Sincerely,
$rch;i�e Brena
Water/Sewer Division Spuervisor
1 k
Enclosure
PUBLIC WORKS PLANNING PARKS AND RECREATION ENGINEERING
STREET FILE
CITY OF EDMONDS LARRY S. NAUGHTEN
2.5.0 5th AVE. N. - EDMONDS, WASHINGTON 98020 - (206) 771-3202 MAYOR
I
COMMUNITY SERVICES PETER E. HAHN
DIRECTOR
June 26. 1987
Don Jones
21823 - 77th Pl.
Edmonds, WA 98020
SUBJECT: BACKFLOW PREVENTION DEVICE TESTING
Dear Mr. Jones:
The backflow prevention device in your water supply system is due for
annual testing as required by State Code WAS 248-54-500. Our records
show a total of one device in your system. Please have the testing
performed by a person holding a certificate of competency as a cross
connection specialist, issued by the -State Department of Social and
Health Services (telephone 464-7674).
If a device fails its test, please have the necessary repai.rs made.
Upon completion of a satisfactory test,, have the certified tester fill
out the enclosed Test and Maintenance Reoort and return it to this office
within thirty days.
Additional information relative to this matter may be obtained by
contacting our Cross Connection Control Specialist at 771-3202,
extension 294.
Sincerely,
Archie Brena
Water/Sewer Division Spuervisor
1 k
Enclosure
c� �Z-30
RM' dt.
PUBLIC WORKS 0 PLANNING 0
-2
L-W dt.
PARKS AND RECREATION ENGINEERING
c§jREET FLE
CITY EDIVIONDS LARRY S. NAUGHTEN
MAYOR
DEPARTMENT OF PUBLIC WORKS (206) 771-3202
Edmonds, Washington 98020
Administration — 250 - 5th Avenue North Maintenance & Operations — 200 Dayton Street
-0
Mr. Don Jones
21823-77th Pl. W.�
Edmonds, WA 98020
Dear Mr. Jones:
April 24, 1985
SUBJECT: BACKFLOW PREVENTION DEVICE TESTING.
The backflow prevention device in your water supply
system is due for annual testing as required by State Code
WAC 248-54-500. Our records show a total of one device in
your system. Please have the testing performed by a person
holding a certificate of competency as a cross connection
specialist, issued by the State Department of Social and
Health Services (telephone - 464-7674).
If a device fails its test, please have the necessary
repairs made. Upon completion of a satisfactory test, have
the certified tester fill out the enclosed Test and Maintenance
Report and return it to this office within thirty days.
Additional information relative to this-'M�atter may be
obtained by contacting our Cross Connection Control Specialist
at 771-3202, extension 294.
ml
Enclosure
WIT-T.E-IKSEN DT
Sincerely,
ARCHIE BRENA
Water/Sewer Division Supervisor
MAACH DT
0 STREET FILE
CITY OF EDMONDS
200 DAYTON ST. * EDMONDS, WASHINGTON 98020 * (206) 771-3202
DEPARTMENT OF PUBLIC WORKS
January 25, 1983
Mr. Don Jones
'21-823-77th-Pl. W.
Edmonds, WA 98020
Dear Mr. Jones:
SUBJECT: BACKFLOW PREVENTION DEVICE TESTING
HARVE H. HARRISON
MAYOR
The backflow prevention device in your water supply
system is due for annual testing as required by State
Code WAC 248-54-500. Our records show a total of one
device in your system. Please have the testing performed
by a person holding a certificate of competency as a cross
connection specialist, issued by the State Department of
Social and Health Services (telephone, 464-7674).
If a device fails its test, please have the necessary
repairs made. Upon completion of a satisfactory test, have
the certified tester fill out the enclosed Test and Main-
tenance Report and return it to this office within thirty
days.
Additional information relative to this matter may be
obtained by contacting our Cross Connection Control Specialist
at 771-3202, extension 294.
Sincerely,
ARCHIE BRENA
Water/Sewer Division Supervisor
ml
Enclosure
_V1
Mf-tCHELL DT WILLEIKSEN 4D_T__CM �RCH DT
[�( ^ CITY 0117 [DHOHDS -- i`U8ilC K0RKS UEPARTHEXT
D8CKFL0� DE`./|[[ iE3T REPORT
. ,
MAME OF PREHlSLS
SERVICE ADDRESS
LOCATIOPIL OF DEVICE A
DEVICE «
/m/u��u/�/'°"=' ~'^^ -- - -
��Y�
LINE PRESSURE AT TIMOil:�� [ �TEST ~- LDS.
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PRESSURE -DROP 8[KUSS FIRST LULLk VALVE
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TEST REDUC:_:f) PRESSURE
OT' ER
TEST' CLOSED TIGHT ----- 0 SED TIGHT ----- 0 REDUCED PRE'SSURE
R[HAKKS,.________
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THE ABOVE REPORT IS CERTlFI�
lNlTlAL'TESTPERFORMEO BY DF D A T
REPAIRF8 ��TE 8Y
FINAL TEST P[RFDR�I[U BY GF DXTE___________
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1/7'N
STREET FILE
CITY OF EDMONDS HARVE H. HARRISON
200 DAYTON ST. - EDMONDS, WASHINGTON 98020 - (206) 775-2525 MAYOR
DEPARTMENT OF PUBLIC WORKS
June 2, 1981
Account No. 425-07024
Don G. Jones
21823 - 77th Place W.
Edmonds, Wa 98020
Dear Mr. Jones:
SUBJECT:,, CROSS CONNECTION/IRRIGATION SYSTEMS
21823 77th Place W.
An irrigation system located on your property may be in
violation of State of Washington and City of Edmonds ordinances
related to backflow prevention. To protect the potable, or
drinking water supply, an approved backflow device is mandatory
on all irrigation systems.
Please call the Water Department Cross Connection Inspector,
Lee Willeiksen, at 771-3202, extension 294, for information or
an appointment for inspection of your irrigation system.
Requirements to meet State and City Codes need to be com-
pleted within thirty days from receipt of this notification.
Sincerely,
ME
LEE WILLEIKSEN
Cross Connection Inspector
Water/Sewer Division
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SUBDIVISION NO.
PLAT NAME
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PUBLIC RIGHT OF WAY PER ORDINANCE NO.
EXISTING RIGHT OF WAY Co
71-Tv
ELEPHONE NUMBER
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PROPOSED RIGHT OF WAY
NAME
W cl.Q K.* 3C/j, 2-Y-2-1
—
DEFICIENCY OF RIGHT OF WAY
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ADDRESS
STREET/UTILITV WORK REQUIRED El YES SN-O
PERMIT FOR WORK IN PUBLIC R/W El YES NNO
UNDERGROUND WIRING REQUIRED E] YES 116NO
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T ELEPHONE NUMBER
CONNECTION TO SANITARY SEWER CJ YES 9NO
SEPTIC TANK PERMIT REQUIRED El YES IMNO
NAME
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SEPTIC TANK PERMIT NO.
01ADDRESS
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TELEPHONE NUMBER-
REMARKS
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LICENSE NUMBER CITY LICENSE NUMBER
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Legal Description of Property (Show Below or Attach Four Copies)
METER SIZE BUILDING SUPPLY SIZE
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REMARKS
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ALLOWED PROPOSED
COMPLETE EXEMPT
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REMARKS
VARIANCE OR CU
PLANNING REVIEW BY
DATE
YARDS
FRONT SIDE REAR
LOT COVERAGE
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FIRE ZONE
TYPE OF CONSTRU CTION
CODE
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OCCUPANCY OCCUPANT
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ALTER EXCAVATE f;�71 F
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REQUIRED
11 YES 0 NO
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GROUP LOAD
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PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
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REPAIR PRE -MOVE swim
INSP. POOL
SHOULD BE CODED 31.04.
NUMBER OF STORIES7LMBER
N OF
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MEMO TO:
FROM:
Date —
Building Division
Community Development Department
Engineering Division
Public Works Department -
SUBJECT: r-A QZ,
After review of the subject building permit application, we have the
following comments:
/VI/0'Coordination of the location of any structure with respect to
utilities, streets, property.lines and driveway grades is the
responsibility of the contractor.
Iv-< The contractor is required to keep the a butting streets cleaned
. of dirt and debris caused by the construction.
/-7 The "Right -of -Way Construction Permit" is required, from the
Engineering Division of Public Works, for any work within the
Public Right"of-Way or public easement.
Driveway slope*not to exceed 14%.
�LT Connection to sanitary -sewer required.
�LT Septic Tank Permit required, submit design.
Fire hydrant required, submit design.'
/7 Site drainage per code # See approved plans
/-7 Curb /-7 Sidewalk Z-7 Paving required.
/-7 Bond required for'public improvements.. Submit cost estimate.
/-7 Underground wiring.required.
L-7 Approved Engineering Plans required when applicable.
FE—t�JC-S-- rA= MO 012-r--Ak�
F; I C
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For Fred.F. H6rzber—g, P.E.
City Engineer
Department of Public Works
Rev. 7/78
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;ILIC NURKS DEPAM= CHECKLIS#
Date
VjIUINGPEIMTREVIEW
L YZ_ -S
_Uddress
Street Right -of -Way Existing <*:a e--i REQD
Access Easements Existing-' REQD ------
Utility.Easement Existing --------- REQD
Lot per Subdivision Plat. Assessor'Map
Site.Plan. CheckedIor Accuracy.
IF
Underground Wiring Reqd.
Check Accuracy of Legal Description
Environmentally Sensitive Area
Environmental Checklist Reqd..,.
Flood Hazard Zone
Shoreline Management Area
Slope, Soil,* Vegetation
Strearn, Creek, Drainage Basin
Existing Zoning Per Code
Amenities Design Board Approval Reqd.. ADB Approval
Board of Adjustment Approval Reqd.
Review Bv: Date:
Existing Water ,,lain Size-- w04 C_X_
Water Main Reqd.
Service Line Reqd.
Hydrant Size Existing
Hydrant Reqd. Per Fire Code Size
Detector Chec� Meter Reqd. 00
Cross Connection Inspection*��S FKF__S.S �Ar�� ZMAeFZ P_F_Qb
Fire Department Comnients
Water Meter Charge Reqd. SV�
. V/S
Review by: ;7-�- Date:� eble
Septic Tank Permit Reqd.
Sanitary , Sewer Availability
Drawing No.
Side Sewer Availability
A'44
te:
tTT9t__No. A -.,IA -
Proj .
File No.
Sanitary Sewer��nection Fee Reqd.
Review By:. !his
Date:
5jq)0ii Ditch Existing�.- ....Reqd.
Cu vcrt Reqd. Size'
Ifidicate on Site Plan
,4 Catch Basin Rcqd.. 7
0 �houlder drainagc n-nint lee I -sWale open runoff
C�
Nol-diole rcq.d. Indicate on Site Plan
-iditions and Ground I -late" Field Checked
So i I Coi r
Roviold b Date
Street Paving Rcqd.
Curb and Cutter Reqd.
Sidewalk Reqd.
Curb Cut for Driveway,Reqd"
7-1-7
C t MCI
C4 Right-of"I,7ay Construction e c1d.
Bond Reqd. for Public In-pr rits
Street Narnm Sign Reqd. 7
10cher Sigiing Read. 7
Pre Permit Site Inspection mde on
0 BY: SO -TER
U,
10 �-1 WATER
STREET'
LNIGINT-EUNG
-- - - - --- - - - - - - - - - -
- - - - - - 1Z 3Z It �X �f X jrWjttf J�- V 3.7. V3
Special Require-,:-icnLS listed in mem to Commmit-y Developmint Departmnt,
BLLilcLing Division
Ily
0 All itcnns filled in on Building Peimit Application
0� 13Y Date
PL4 Drawinp Sta imed'and Notati ns �klide
BY —Dzfte
U, Approved hy Public '%.70rks, Dep:.irtiTYA-1t:
HQvi-Sed: 1-v 10-1977
0
0
APPLICATION
for
The City of EdmoncissTitiEET FILE SIDE SEWER PERMIT EASEMENT NO . ............................................
NEW CONSTRUCTION REPAIRS LID NO . .................. . ASMT. NO - ------------------
OWNER --- -------- e - - -------- CONTRACTOR ------ t,4%-r — FL-Ume!.tt-4ca�
. . .. ................................................................. PERMIT NO.
JOB ADDRESS LEGAL DESCRIPTION: LOT NO - -----
--------------------------------------------------------------- --------------------------------- BLOCK NO - ---------------- �4 ...............
............................................................................................... ------------------------------------------------------------------
NAME OF ADDITION ---- F 4 L - C- —=�'e 75 > � N � P % r---4 S -
..........................................................................................
Approved:
By
DATE ------------ --- 11/75
A
a
a
APPLICATION
The City of Edmonds for
SIDE SEWER PERMIT EASEMENT NO. - ---------- _ ....................
NEW CONSTRUCTION REPAIRS LID NO - ------------------ - ASMT. NO - ------------------
'HAGA N
OWNER --- - - -------------------
-C
-------- C-c ---------------------------- CONTRACTOR --- Qw:�to�.Rvyn PERMIT NO. 54!�52
4elJOB ADDRESS*.-Als -1 -------- ------------------ LEGAL DESCRIPTION: LOT NO - -------------- ----------------------- BLOCK NO - ------
...................................................... ---------------------- I ---------------- ------- .................. ......................................
f- 4
NAME OF ADDITION ------ A�A�-3-
----- ----- -----------------------------------------------------------------
W�
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 Edmonds 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 loc-ation of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers shall be lia-b-le 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'dF:;;RTMENT
PERMIT
-&�. 5 0
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.
ADDRESS LOCATION OF CONSTRUCTION ......... —flu
------------
PROPERTY LEGAL DESCRIPTION ............ 1 ...... e�� ,
.......... ------- ; ------ .
............. ....... N-4.-4! 4,
................................................... . ...................... . ..................................... w .................................................. . ......................... ...........
.......... * ..........................
................................................................. OTWVNERAND/01% BUILDER ...............
..............................
C)NTRACTOR'S NAME & ADDRESS ........... T PIC.)
Permissio n Is granted .......... �hg ..... ;;��
-1 for repair and/or connection of a side sew
s—� '' in .............. 1 1977 6---' er to the city sanitary sewer
7n accordance with City of Edmonds ordinances.
ATTENTION IS CAM D 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 offi
NOTE No. 3—Obtaln full information regaxding Ordinance 11.16.030 and Regulations ce
NOTE No. 4_TOP governing side sewers when you get permit.
of side sewer must have at least 30 inches coverage at property line and 12 inches Inside property I . Ine; 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 main sewer or its appurtenances except to in-
sert the pipe Into the wye.
DISAPPROVED Date ... . ........ ........... By ................ Date ..........
... . ......... By ------------_- Date ................ ................... . By ................
APPROVED Date ... By..,4
......... .....................................................................
Remarks: ...... . .. :... /_
......................... . ......................................................... /I --- -----------------------------------------------------------------------------------------------------------
............................................................. . .................
............................................................... . .................................. . .......................................................
BOTH PermA Copies MUA
T Be Sign d B ner of Firm Performing Construction PRIOR To Request For Inspection
Qw
. ........ * ------------------- 4 ---------- ..... . .. hereby certify that the side sewer in stallation constructed under this permit
...... (_0,'w'_,n_ e-,r --- o' -f ---- & --- n't- m- --- c_tin_9__*F1rM Performing Construction),'
led in accorclance with all governing ordinances of the City of Edmonds.
Dated this ... 114 ......... .
...... If .... I .... day --- --------------
Check BEFORE you dig for: Water 0, Gas [:], Telephone Power E], Sewer E], Other