22300_100TH_AVE_W_(3).PDFiiiiiiii lill 11
15576
22300 1 OOTH AVE W
C)
MEMO ?0 THE FILE
J
April 3b,� 1980
AFTER DISCUSSING WITH BUILDING DEPARTMENT'
ADDRESS WAS CHANGED FROM 1360 9TH AVE.
TO 22300 100TH AVENUE W.
[MEET FILE
APPLICATION
Ae City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
Oz L
b�MEU INILENSTRUCTION REPAIRS LID NO . ...... t..r-- ASMT. NO - -------- ---------
OWNER --------- p
------------------------------------------------------------ CONTRACTOR ---------------------------------------- ------------------------------------------- PE 'MIT NO. -1 ------------------
JOB ADDRESS .... --------------- LEGAL DESCRIPTION: LOT NO - ----------- --:2 -- -------------------- BLOCK NO - ---------------------------------
----------------------------------------------------------------------------------------------------------------------------------------- ------------------------
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...................................................................................
DATE ------- dA-11,1 ... (U ........ By .................. �
- - ----------- fUYE
NOTICE.
a�cz-ur.
No ... wa r.r a. n., - y ... OT
i n on the attached
The Informat'o'
for use by the City 0:
m a p (s) was cOm P*Ied
Edmonds, its Empl.oyees and Consultants.
Th,.e City of �Edrn.onds does. not. warrant the
accuracy of anything set for.th on these
M a P ('s'). A n . y person or entity -requesting a
copy should conduct an independent
i orm'ation shown-c
Inquiry regarding the
including, but not Jimited to,
t e -map(s),
the location of any sewer stub shown, Su(
sewer stubs may or may* not e,xist and ma\
or may not exist at the location shown,
c—ty of Ed mbn r"I.S. nor its
Neitheir the '_' I ic e'r s *s h. a I b e a. b-If e. f o r t h
empjo-yee-s o-r off*
n on this Map(s), nor for
infor . mation g've' Ion pro . vided based
any one represe-ntat
U pon'sa 1 d. map(s).
Y
CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
% PERMIT
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 ....... I . . .... ...................
PROPERTY LEGAL DESCRIPTION ...... LA� ......
C, - ..................... ........ ........................................
.................................................. . ...................... . ......................................................................................... ................................... ..................................................
................................................................ OWNER AND/OR BUILDER ........
CONTRACTOR'S NAME & ADDRESS --------- $_ ........... 64- . .................... . .............................. . .. . .......................................................
T'
Permission Is granted ....... '�N ------ ------------ )19 r repair and/or connection of a side sewer to the city sanitary sewer
15,r—ml In accordance witli 4bity of Edmonds ordinances.
U
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—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 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 ... . .......... . .................. if.- By ................ Date --------- - #4 . By ---------_-_ Date ............... - ------------------- By
-------------- - --------- ------
APPROVED
_7 ................. By ... . A ..... . .. . .. . .. . ...............................................
Remarks: ............................................ . ....
... ...................................................................................................................................................................
..................................................................... . ........... ..................... ...................................................... ................................ .............................................. .........
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
-- -- ------ ----- --- - ---- -
(Owner of Contracti . n --- F1'rm ... P-e r f'G r'm in g" C o n's t r-u-c t i o-n -) .... hereby certify that the side sewer installation constructed under this permit
�Ltalled in accordance with all governing ordinances of the City of Edmonds.
Dated this .......... jr.k .......... day of .........................
V V Check BEFORE you dig for: Water E], Gas E), Telephone Power E], Sewer
Other
APPLICATION
The City of Edmonds for EASEMENT NO - -----------
SIDE SEWER PERM
NEW CONSTRUCTION REPAIRS LID NO - ------------------ - ASMT- NO - ------------------
OWNER --- ------------
4f.!� ........................ ............ ...... CONTRACTOR ---- -----------------
............... PERMIT
JOB ADDRESS ---- 1310 w^f
-- --------------------- ------------------------------------------------------- LEGAL DESCRIPTION: LOT NO - ------- --3 ----------------------- BLOCK NO - ------------------
.......................................................... --------------------------------------- ............................... ------ -----------------
NAME OF ADDITION --------------
----------------------------------------------
S,
Approved:
DATE
By
SIMEET FILE
-2-2-7-30 0-
ot,) -Z
1'q C. - -.Is o �)
Cit '* pf Edm.opds
y
-RIGHT-OF-WAY CONSTRUCTION .
PERMIT
Permit Number:
Wue Date:
A. Address or Vicinity of Construction: .22300 100 Ave '.,N (0#106014855)
B. Type of Work (be specific): InSW1 CJaS SerViA
Contact: FELmA H. Lopw—FuGuiAo
C. Contractor: p0aw SMM alimm (425) 356=7550
Mailing Address: 1122 75th ST SH Everett 98203Phone:
State License #:
D. Building Permit # (if applicable):
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. 0 Commercial E] Subdivision 1:1 City Project 1C] Utility (PUD, GTE, WNG, CABLE, WATER)
n Multi -Family fL] Single Family Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: Yes []No G. Size of C%it- 2 j6�x-r- 4 H. ".Cl(ar"i
APPLICANT TO READ AND SIGN
INDEMNITY- Applicant understands and by his signature to thisapplication to holdthe City of Edmonds harmlessftom injuries, damages, orclaims ofany
kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employqes,,i . ncludingornot limitedto the defense ofany legal proceedings including�defense costs andatiorneyfees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE- FORWORKMANSHIP AWD MA TF-TRIALS'F6R.-A PER16D 01�6'VE Tk�l? FOLEOWING
TION A ND A CCEP TA NCE OF THEwbRK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings of proposed work required with permit application.
A 24 hour notice is required for inspection. Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be
available on site at all times for inspection purposes..
Signature:
Y. t_x.'f_ 7 -
Date: 9/29/98
((-ontractor or Agent) / 'I
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY. R,,,, L, ik'.4 e,+ I —
TIME AUTHORIZED: VOID AFTER D A Y,;
SPECIAL CONDITIONS: PAVED I 9A4
RIGHT OF WAY FEE: so S-0—
DISRUPTION FEE/FUND I 11:
RESTORATION FEE:
0
T OTAL FEE:
RECEIPTNO.: 41 1 —
�0
ISSUEDB)'.:
NO WORK SHALL BEGIN"PRIOR TO PERMIT ISSUANCE Eng. Div 1997
FIELD INSPECTION NOTES '(Fund 111 Route copy to Street Dept.)
Comments:
0
PUGET
SOUND
EN ERGY
Job # 10 LP c) 14
WR #
GAS
01
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Tam Wood
Customer: -Service PlanAer
Puget Sound Energy
425-356-7500 ext. 7587
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Fire Hydrant
Water Valve
pU.get')oundEnorgy * 1122-711thStrPeISM, - EvPretI,WAq8203
SENT-BY:PUGET POWER 9-17-98 ; 3:56PM
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