22053 98TH PL W.PDF11111111111111
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22053 98TH PL W
0
0
APPLICATION
for
EASEMENT NO . ...................... ...........
Fl
The City of Edmondk*,-. LA: SIDE SEWER PERMIT
7�,,�) -6) NEW CONSTRUCTION El REPAIRS LID NO . ........... ------ ASMT. NO . ..................
OWNER - ------------------------------------------------- CONTRACTOR ............................................................. ---------------------- PER -MIT NO. —4��f ----------
........................
JOB ADDRESS ...... ...................... LEGAL DESCRIPTION: LOT NO . ...................................... BLOCK NO . ...................... ............
.................................................................................
NAME OF ADDITION ...................... ---------------
Approved:
DATE............................................ By ............................................
rT%a
P13BLIC TACIRKS DE ST
BUIIDItTKMuF1LE �2205?) ess) L Wt t-
Street Right -of -Way Existing
REQD
Z
I
Access Easements Existing__N 0 W_V
I;EQD
1-4
r4
Utility Easement. Existing_h)nAL
REQD -jk
Lot Per Subdivision Plat
Assessor
Site Plan Checked for Accuracy
Z
Underground Wiring Reqd.
Check Accuracy of Legal Description
Z
Review by_
Date
Existing Water Main Size
4
in Required
a a in Requ* -red
r
Service q red
4�
i 7
Hydrant Size Exist
P4
j
Hydrant Reqd Per Fire Code-
,.--'size
W
Detector Check Meter Reqd-
Cross Connection Inspection
Fire Department C`07���
Water Meter ge Reqd.
'-ter g e
Review
w
Date
Ic ank r ov ed
eptic Tank Design Approved
S ep t T s g n Ap p
i-t
Date
T ank Pe R d
Sep Tank Permit Reqd.
Sep eq
Permit No.
7
a n t ary Availabjlity-
ewe
Sanit ewer Availability.
Proj.
D w . g No.
ra m
File No.
S - r 1 . jty
Side 3
Availa i ity
Zeewer _
S S i S Co ctj
anitary Sewer Connecti Fee Reqd.
'100�
Review by
Y
Date
Open Ditch Existing_
___Reqd.
Culvert Reqd.
ize
P4
Catch Basin Reqd.
dica Site P
— Tndi rp . on Site Plan
0
Shoulder dr;h���e maintain collection on
swale open runof
P
1
Indicate on Site Plan-",*�
:qd.
ti
;�O�Con ons and GroundTATater Field Checked
Review by
Date
Revised: lvlO-1977
P-a-ae 2
lz�-
09
010
reet Pavving Reqd._
C
Cu�rb Gutter Reqd.
Sidewalk Re:q
Curb Cut for Driveway Req
Right -of -Way Comnstructi t eq
WjtR
Bond Zeqd. fo ic Improvements
t
M Stree Sign Reqd.
jM
er Signing Leqd.
Pre Permit Site Inspection made on
0
B
WATER
P4
STREET
G�_
Special Requirements listed in niffm to Commmity Development Department,
Building Division
BY Date
o All item filled in on Building Permit Application
42L4k %
P4 BY 77:7
P4 Drawings Stanped and Notations Made
P-4 BY A N Date
`�4 jApproved by Public 1%lorks Department I
Revised: Iv 10-1977
0
NOTICE:
No..Wa
The Jnform ation'shown on the attached
piled for use by the City 01
MaP(S) was COM '
Edmonds/ its Empl.oyees and Consultants.
Th,.e CItY of 'Edrn.ond:s does - n ot. warrant the
these
accuracy of anything set for.th on . *
r entity -requesting a
Map(s'). Any person
copy should conduct an -independent
orm'ation shown"c
inquiry regarding th8 inf'
I
-t-He -rn a P (S) I including, but not i'mited to
er stub shown. Su(
e otation of any sew
t h. I
sewer stubs may or may* not e.xist and ma�.
t at the location shown.
or may not exis
,�jty of Edrn0*ndS, nor its
Neitheir the f
empto-yee-s 0'r off.
information given c)n this Map(s)) nor for
ion p Ided based
3ny one represe-ntat rov
upon . said map(s).
POO" IPTA
APPLICATION CARD No . . ... ........
Ir Lt for
Tim City of Edmonds 9T, SEDE SEWER PERMff EASEMENT No . ................. ... ........ .
OUTSIDE 0 INSIDE 0 REPAIRS 0
OWNER ... .......... �Yl:�.z .. ............................... CONTRAC4 .4.o ......
.................. PERMIT No.
STREET.
6�,5 ...... . .......... 7�;OW-- -'t
HOUSE No. -,4 ............................................... AVENUE LOT No . ....... ................................ ............ .. .......... BLOCK No. ............... ... ......... .... .........
NAMEADD ....... ........... V/.C.W ........ ........................................................ .........................
q?
0
APPROVED
APJR 19 1963
Date Approved:
BACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, $ ......................................................
... . ... ... .......
SEWER WORK ORDER ISSUED ....... ........................................ DATE.