224 3RD AVE S.PDF111111111111
4960
224 3RD AVE S
CUTY OP
200 DAYTON ST - EDMONDS, WASHINGTON 98020 (206) 175:'Y�5
DEPARTMENT OF PUBLIC WORKS
March 16, 198;1
311J 133HIS
Dear Resident:
HARVE H. HARRISON
MAYOR
On February 17, 1981, the Edmonds City Council passed
Resolution 488 for construction, reconstruction and repair
of deteriorated sidewalks. A PUhlic hearing will be held
in the Council Chambers at the"Civic Center on April 21,1981
at 7:30 P.M. You are invited to at.t.q.nd this hea�,ing-
,for.
d
-t e riorate ewalk
discussing r'epa—ir of portions,of-de
abutting yout- proper ty.- - ThL,"impr6iiic''mi�'Ii't',- —,o,f"�t,`Mewal ks in
need of repair at the expense of the abutting propertv
owner is provided by City Ordinance, Chapter 7.20 and.
Revised Code of Washington, Chapter 35.68.
The areas needing repair have he -en marked 'in paint on
the sidewalk adjoining your property. Reconstructio'
n�and
repair of these sidewalks Must be completed on or before
September 1, 1981. In the event impro'vements!
,are not
completed within the above specified time, the City �ill
perform and complete the improvements at the expense�of the
abutting property owner.
This action is in response to many citizen reque . sts
and pedestrian falling accidents which have been increasing
in recent years as a result of sidewalk deterioration and
increased pedestrian traffic.
Sincecely,
FRED F. HERZBERG
Director of Public Works
BU
CITY of EDMONDS
Civic Center Edmonds, Washington 9
City Clerk Phone 775-2525
iNSTRUCTIONS:
All items must be completed
or application will not be ac-
cepted.
Sign and return application
with fee. Renewals received
after February 15 must pay
penalty in addition to fee.
NEW BUSINESSES AFTER
�OES, E� 9N, P Lt Q, 0 N D'A0 LICENSE NO.
8020
AKIKI I r L,
[C�LASSrYEAR
I L,1C.
EFFE.C. DATE JREASG.
LIC :. NO.JSPEC.
RECEIPT NO.J.
DATE PAID
A —
—PRINT'X'
/I/I/ f"A
IN SPEC. BOX
FOR ISSUE OF
CORRECTED
FEE�PAID
P NALTY PAID
LICENSE WITH
um F_ F_
PENALTY AFTER FEB.
11 HOME OCCUPATION
$10.00 (A)
ADDITIONAL.$5.00
0"
SMALL BUSINESS
$15.00 (B)
ADDITIONAL $7.50
0.'_1
El Business with 10 or
more employees
ADDITIONAL,$25.00
0
$50.00 (C)
NEW APPLICATION (LA)
0 RENEWAL
(LB)
.0 CHANGE
(LC)
JULY 31, 1/2 FEE. (PLEASE MAKE ANY NECESSARY CHANGES) 0 DELETE (LD)
NAME OF FIRM BUSINESS PHONE NO. OF EMPLOYEES
Zzz
MAILING'ADDRESS NATURE OF BUSINESS
_5
_kUSINESS-ADDRESS
INDIVIDUAL PARTNERSHIP CORPORATION
(S) (P) P
HOME ADDRESS
HOMEPHONE DATE OF BIRTH JPLAC
EMERGENCY NOTIFICATION: (1) NAME & TELEPHONIE
(PLEASE LIST TWO) (2) NAME & TELEPHONE
OF BIRTH SOCIAL SECURITY NUMBER
?
WASHINGTON STATE TAX NO_;n4/w A P P L I C A N T'S S I G N AT U R E
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW:
FILL IN LAND USE CODE, LIFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE LAND USE CODE ZONING CODE
P-W-PPROVE El DISAPPROVE
SIGNATUREV P 9_AAJat91U I I Q1, Iry) I d I j
CONDITIONAL USE PERMIT
COMMENTS
DEPARTMENT
O"I"JILDING
DATE
APPROVE El DISAPPROVE
SIGNATURE AZA
Building
Permit
0 Hotel/Motel
Apt. Bldg.
(L)
(A)
1*7161
0 Office Bldg.
(0)
COMMENTS:
Occupancy .
0 Restaurant
(R)
Group
0 Hosp/Nurs Home
(H)
CAPACITY: (NO. UNITS, APTS., OFFICES, SEATS, BEDS, STUDENTS)
El School
(S)
F1 DEPARTMENT DATE /—/ - Z� - �, I U. F. 1. R.
2APPROVE 0 DISAPPROVE SIGNATURE A::�Z, Zr�-61
COMMENTS:
POLI(��2 DEPARTMENT
DATE SIGNATURE L)z( zi2�� Z"" 73",
NPPROVE 0 DISAPPROVE
COMMENTS:
PUBLIC WORKS DEPARTMENT
0 APPROVE El DISAPPROVE DATE SIGNATURE
--COY M_ENTS:
The City of Edmonds
APPUCATION
for
SIDE SEVM PERMff
NEW CONSTRUCTION �� REPAIRS
EASEMENT NO - --------------------------------------------
LID NO - ------------------ - ASMT. NO. - ----------------
OWNER ...........
C49A)S-7 ------- a�P,
CONTRACTOR - -- - - -----------
, j
JOB ADDRESS ---- ai�_x --------------
------- S-6 -----
LEGAL DESCRIPTION: LOT NO - --------------------------
---------- . BLOCK NO - ------------------------------------
........................................... --------------------------------------------------------------------------------------
NAME OF ADDITION ----------------------
0
Approved:
DATE-------------------------------------------- By
4
4
APPLICATION
The City of Edmonds for EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS E] LID NO.
OWNER .......... ------------ - CONTRACTOR --- F54-1750� ----------
- -------------------------------- PERMIT NO.
JOB ADDRESS Zzze-i
------------------------------------------------------------------------------------ LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - ---------------- -------------------
--------------------------------- -------------------------------------------- ...................................................................................
XTAIX�, A�'rT�XT
-----------------------------------------------------------------------------------------------------------------------
)I
k
roved:
TE - ----- - - ------------ B ......
---- ------------- ,
T
7 .-W
JMV IT'
4F Do 1! � MA 0. N
-:-,,S1
IRTMJEN�
Wit-DEkA'
WATEWSE
W
T !T9
-M
DR IT
M,
t
m2 Afispe`ctt� s,.-BE'FORE covering portion ofi.
C n
!,all,: .77,1 525. for sewer
�Afie. 'constr uc * I o!?.
S�
r
.(Inspection.:will-be ..provided, within 21� st�%.::N0,1 at.; Sun., or;-�6iiiiay 16i
r, pec6 ns:
* ........... . . ... ....... .
AMDRES§�L&Mft6N "bi
— --- - - �, : ;" — r .....................
..hPROf T1Y'-tEGA1,-D
IER ESCRIPTION ............ ............ ..................................... ...................................................................
. .................................................. ......... . ..
..................... .......
................................ ............... ............................................... .........................
.......................... ...........................
........................... ........ .. ;.'.OAVN-ER AND/OR BUILDER,——
V I., .. ....................................
................ .. ......
WRACTOWSi�NAMEI
7 S ...... ..... J.06
.................. ....................
.................. ................................
;jfgnted,� ... 1 161.7, for r�i��air- and/or-.coiii6�66ow-toVa- side.:§e�er 4b---ihe!:-c1ty_ �'iainitiiary',.sewerl�.
f 'W_ Jot
��`,Cl y�of Edrnorids ordinances. -
triii—cor ance-wit �ffi,
N.
-A--ENTIO J�*jq� ��Plq��THE-,-FOLLOWIN6*
btain a per*rnit*'to construct sew In d-Side Sewer.:Contractor* must �be�eniplo d-to, conkr�u
a er side propeftyi line*.':. A, license
-An street--ieea.:'Dw noto -any' 0 -�iiewer� befoie �it
"'I eisewer cover. pohion f -been-Anspected
-ya.y. req� I re� i a n w�as'
-t.-o , from the City'
ned,lnlc'i�y�ri�� _ 5
!71 ..; .. � , 1?9,�of, 114ght Englneer's'offic6."
rdiniiirici�
No', �3 �Ob6:lAlfull6nfZr "'t .1,1-.I'A�030,',ind"R6�ulati6ns:.,9
�Z- � Tp,!?�.,rqWdIng 0 ei��you:,get Permit:':
NOTE "No
elat property It r4o� b i g rad e
ne amcl-"12"irichiiii inslde�iop6rey. IIne':*1zninImuM grade; 0i" 2 ends.' n'
NOT 0
EN e Iiiirii,diue 'to' Imprope . r:,-�
s F et- restored�.to -original-c"brii'ition'; :Contiactors shall'be'r�sponslbl� f6r,*&I
T,
-N -,No o�ided' for. in the perralt,� or to do-ary'.w6rk,joh the, main' -appuft
sewer� or Its enanc.es except , to I n
J
:;DISAj1PRO!YzEDY,: E),'; Date._ . . ......
V51, ... ..... ...... By.:: ......... D' 'B. . ................ Date.': ... *.* ..........
ate ...... Y
B,
....................................
.7
''Reln . ii , arks:..
.............
......................................................... ........................................
...............................................................................
.....................
...................... ..... .... .. . ............................ ....... ........ ........................ ............. ............
Upie Fi5r��Jpsp
U g,,Signed.'By. "'Own e�r,,ofl�-irm*. Perf�iiiliiik,b si c n: PRIOR T64Ceqiiest ec:ion,:
h b
ere y �certify�thdtt.the.*'�idi���eWer�in �Ilatibn- c6n9trmcted-,und6r this pe'rmit:�;.-.',i
9
-Sewer:.,[:], O'he'rb1':_1/-,V.1
t
r
C.
;N
.BUILDING DEPAT AEF
PERMIT APPLICATION
NAME (OR NAME OF BUSINESS)
W MAILING ADDRESS
z
�j -, -3 SOuth
0 1. � 1, ". t 11 ; I ,
CITY
NAME
u
ADDRESS
u
0!
CITY
Applicant Fill
Inside Heavy'Lines
ELEPHONE NUMBER
o
FLEPHONE iN;UMBER
NAME
ont-; I (.�I% I'll i 1 0-1111-k-t-of
0
7DDRESS
u
Q j,
IL
CITY
TELEPHONE NUMBER
z
0
U
STAT;
E LIZ 'R.E NUMBER
CITY LICENSE NUMBER
Legal Description of Property (Show Below or Attach Four CoFie—s)
4
All tha.." 1.)orl-1911 or oil-,-.',, of
Z
�outheclst quaxter of
'7 North, Range 3
U
UI
foil 0�.!:; - T'��?:
from J..'he Out -it- oornev of' _T�-tyton n-rld
W
ov
W
feet; 1--herice ml-11) .00 a
'15
foot'. to
El
NEW RESIDENTIAL GAS
El LINE
E]
ADD NON-RES DENTIAL SIGN
DEMOLISH RETAINING.
WALL
ALTER EXCAVATE FENCE
OR FILL
REPAIR PRE -MOVE. swim
E] INSP.- POOL
NUMBER OF STORIES
7—
NUM13ER OF
DWELLING
UNITS
NATURE OF WORK TO BEDONE
penthoi.l�.�,o at '.3ra
_VROPOSED
USE
2
CL BUILDIN—GSETBACKS,
m * ABUTTING STREETS)
IJ
In
ILI
0
t
USE PERMIT
ZONE NUMBER
JOB
ADDRESS
CZ
COND. USE NO. ADB NO<tg::� G
-1 ?
PROPOSED YARDS
5
ILOT COVEITA'Ver—
D
FRONT SIDE. 1;
REAR
SIGN AREA
ENVIRONMENTAL REVIEW
ALLOWED PROPOSED
AcomPLETE 1".
6-EXEMPT
REMARKS
PLANNIN_�,DEPT. APPROVAL DATE
LEGAL LOT
')!fly
LOT AREA
'J N 0.
E S Ej No
q ,-I
100
STREET R/W I
EXISTING STREET R/W(60,4(i)0 FT. DEFICIENCY
THIS PROPERTY.,
b
COMP. PLAN ST. R/W6-'(�(,VK) FT. FT.
REMARKS
opf�s n ot to (Mceed those
CKED BY
) 3- �J-
STREET AND/0,R UT IL
/W PERMIT REQUIRED
R E O'D. YES
UYES NO
UNDERGROUND
WIRING REQ'D. DYES ONO
TYPE CONNECTION 0 YES
SANITARY SEWER 1:1
VERIFIED BY
SEPTIC SYSTEM
1:1 YES
PERMIT NUMBER
APPVD By CITY ENG.
NO
4A
REMARKS
METER SIZE
BY
REMARKS
FIR ZON
tE OF CONSTRUCTION
COD
;>
SPECIAL INSPECTOR
REQUIRED
JOCCUPANCY
OCCUPANT
JAREA
G R,�U P
LOAD
0 YES
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL
SALES TAX
--SHOULD BE CODED 31,04,
R,E M A R K.7)
AV
C)
4�z
VALUATION FEE
PLAN CHECK
NO.
19-1
BUILDI NG 7, 7 12�
PLUMBING
HEAT 8, GAS LINE
FENCE
SIGN
*NGIN8ERING REQUIREMENTS F10 C*RCIAL
�AND APARTMENT BUILDING PROJECTS
Name JASPER 4-PLEX APARTMENTS AT 224 3d AVENUE SOUTH
Date October 18; 1976
STREETS AND ACCESS
STREET', FILE
1. Right -of -Way Requirements: 60 f t existing
2. Road Bed Width: 40 ft existing
3. Turn Around,: Required on site for access safety
4. Sidewalks: Existing is in poor'con-dition and reolacement is recommended.
5. Parking Strip: None,
6. -Access Easements: None
UTILITIES
Water Mains: 8-inch C.I. existing
2. Fire Hydrants: Existing
3. Sewers or Septic tanks: Connection to sanitary sewer required.
4. Drainage: Install all necessa . ry storm sewers and drainage facilities
per drainage plan.and City Standards. Where drainage is -across adjacent
private property, all parties having any ownership -interest in the lands
being developed shall provide, as a restriction on the title running with
the land, that the City of Edmonds shall be held harmless.from any and all
claims for damages which may -be occasioned to adjac * ent land by reason of the
construction and operation of the drainage system, unless, releases of
damages and/or drainage ea-sements are obtained from the other property owners
affected by said drainage. Any drainage problems created by change of contour
during development must be corrected prior to occupancy permits or release
of*performance bond. Final approval (or release of bond) will be withheld
until actual drainage as 'installed has been inspected by the City Engineer.
2123'a
Engineering Requo'me ts for Comm'l &
Apartment Build 4cts - Page 2
00
5. Utility Easements: None
6. Underground Utilities: To be -provided
Street Lighting shall.also be prov ided
standards and underground wiring.
in accordance with Ordinance No.-1387.
with the necessary street light
TOPOGRAPHY
1. Excavation and Grading: Excavation and.grading shall conform to the requirements
outlined in Chapter 70 of the Uniform Building Code, latest adopted edition,
Vol. 1. Where extensive grading and fill are involved in the development, a
grading plan and specifications shall be prepared.
QUOTATION FROM THE CITY CODE REGARDING IMPROVEMENTS
11.02.025(f) Utilities and Street Improvements. No building permit shall be
issued for the construction of any building or structure of any kind or
description unless the plans and specifications include the construction for
curbs, gutters, sidewalks, paved streets, necessary water lines, sewer lines, and
storm drainage necessitated by the new construction or improvement, to be built
to applicable City.standards, provided, however, if found by the City Engineer
to be impractical'to construct at the time of application for said building permit,
construction may be waived by the City Engineer and in lieu thereof a performance
bond filed with said engineer to cover the estimated cost of construction to City
standards for said improvements, provided further, in areas zoned single family
residential at the time of said application for building permit in which the
applicant has received final approval for a plat or sub -division and has compiled
with requirements therein compliance with this subsection shall be deemed by
compliance with the sub -division or plat requirements.
COMMENTS
Rev. April 2, 1971
"�_cj 7t,
Engineer
2123 b &2124 a
/— f'-77
CITY of EDMONDS --- PUBLIC WORKS DEPARTMENT
Routing of Building Permit Applications
Proposed Property Address of Application: 224 - 3rd Avenue South
DEPARTMENT
COMMENTS
DATE
W A T E R
vel
S T R E E T
117
S E W E R
6:
7e-
74�1'
I.
N 0 T E S /10 — /,�/
BUILDING
.DEPARTMENT COMMENTS
0
V,
DATF: October 18 1976
IIEVO TO: Ifarry 11hitcutt
Ruildino Official
STRIEF'
FROM: R i cha rd H. Allen
Assistant Citv Fnnineer
SIJR,I ECT: DU I I-D I NG PERMIT FOR nAVTP JASPER,AT 2-2 4 3d Ave. S. 4-PLEX UNIT
After review of the suh.inct huildtnn Permit anplication, i.,e have the fol-
1 owi rig com'ments
.1) Coordination of location of building �,Iith.utilities- is the
responsibility of the contractor.
2) Connection to sahitay�y.sewpr required.
:3) Underground wiring.required...
4) 1,5'torm drain available at rear of;property (old 15-inch sanitary
sewer).
Driveway slopes not to exceed 14 percent.
6) Existino curb cut and drivewaY to be abandoned; curb cut must
be replaced with standard curb and gutter.
7) Right-of-way permit required for driveway.apron and Paving
work.
8) Fire Pepartment should 0.1". access drive wi.dth of 10-foot
prior to permit release.
.9) Sidewalk is deteriorated and should he ren��qed..
A
111�/� � q1,11
RIIA:m,ir
$DATE 10 .1
PERMIT ADDRESL,'*2(2�3-A W
.LEGAL DESCP W, 7C7—
?ji 8! J! -I=.11.
V
INEERING DEPARTMENT CHECK LIST
Instruction: 7_5144"It'A
CneCK Accuracy of Lenal Description
Check Against Assessor's Map for Legal Subdivision
Does it conform to City Approved Subdivision?
Reviewer's
Initials
1. This lot included in Subdivision/Plat No.:
2. Site Inspection made on: 1A
BUILDING PERMIT RFVIEW
. A POW..A *a-, I
3. Ohat are pround.water and soil conditions?
4. Site Drainage Checked? .0 �-b � [ 4- V —1,& -
5. Storm Sevier Availabilitv:XE� "� �)it. of Ng. No.
Roadside.Ditch /KJ In k rf�L _L_ JP_2,AE6 ProJec
A
6.
Grading & Final Contours: AC!5 �5
A
Septic Tank System Desinn A d
T�
IN
-its -
8.
Sani tary Sevier Avai I abi I i tie V-. U�- nt.
of' Owq. No.
Project
Side sewer availability:,
9.
Sanitary Sewer Connection Fees�
10.
11ater Mains A Fire Hydrants (Indicate Size I -lain) @;14
Check Fire Dept.'s Comments
—
11.
SideVialks: (Site inspection shows con di tions
of sidewalks as
follows)
W1w-%i a A i A
12. Curbs: Curb Cuts for safety, location,
YV,QZ&!Y �&k ddifs
grade and width):
13. Underground llirinq:
Street Lights:
14'. Street Riqht-of-way & Bldg. setbacks.-?/Il Sht. of nfficial Street Map.
15. Existing Utility Easements?
16. Access Easements: X I rnl'l—�7-
17. Site Plan checked for accuracy? �O 1 1Anrr7Xb
18. Special Requirements listed in Memo.to Bldg. Dept.'
19. Commercial &-Apt. Requirements form completed?
20. Drawings stamped A notations made?
21. All Items.filled in on Bldg. Permit Application? 10 15t6_
22. Bonds posted for site work?
23. Right-of-way Invasion Permit required?__*9�OQ
COMME NT�.�-�� PMOV'i . Ph Ir I I )I i A k incEt- 49�W P`�� AA _Y)
Rev. 7/1/76
STREET FILE
MEM TO': 11arry �Ilhit I cutt
Bui 1'di no 'Off ici a 1
FRO11:, Richard 1!. Allen
Assis'tant City Fn(iin(.,.,(.,r
SUBJECT: BUILDING PERMIT F. P.
X___PAV1n JASPE
DATF':.. Octo ber 18, 1976
"12 A 3d Ave. F. 4-PLFX MITT
After review of the suh.inct buildinn Permit anplication, �,!P have the fol-
lowinq comments:
.1) Coordination of location of'building.with utilities is the
re5ponsihi.lity of the contractor.
2) Connection to sanitary sewpr rpnuired.
.3) .-Underground wiring required�
4) Storm drain available at tear of property (ol.d T5-inch sanitary
sew6r)
5) Driveway slopes not.to.ex6eed 1.4 nercent.
6) Existinn curb cut and driveway to be abandoned; curb cut must
be replaced i.,iith standard Curb and Putter.
7) Right-of-vray:permit required for driveway apron andpavinq
work.
8) rite Department shoul.d O.K. access drive width Of 107fOOt
Drior to permit release.
9) Sidewalk is. deteriorated and should he renl�,qed.
16,
RIIA:mir
APPLICATION
for
The City of Edmonds SEDE SEWER PERMIT EASEMENT No . ..........................................
NEW CONSTRUCTION E] REPAIRS 0
iol - ae24 5e)
OWNER.... M.M.JO.Mbl) ............................................................ CONTRACTOR ..... ............................................................................................ PERMIT No . ......................
ADDRESS Qa4..,3 ..Ava......Sl .............................................. LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
0
E
NAME OF ADDITION ...............................................................
June,, 197a
Dye, Taz-&d
Approved:
On 5�zwax
DATE................................................ By ......................................................................
CITY OF EDMONDS
ENGINEERING DEPARTMENT
505 BELL STREET
EDMONDS, WASHINGTON 98026
APPLICATION FOR INVASION OF RIGHT-OF-WAY
(Submit In Duplicate)
STREET FILE
Permit to be issued to: ep -T L'o C- 42
For work at: (address or vicinity) S, 1-4-aomc""d.)
Type of work to be done: C;
(Attach Drawing When Applicable)
Nwe hell'Al
CITY
Owner: 4 U L/", j A
Name
4
Mailing Address
it d A-1 ej Wd 4- 3 4,
City State
Date --
ING DEPL
Remarks A . v
WPMI tR- P
1 .7�) - 3'� 1:)3
—Telephone -Number
Contractor: (f 0-6 12 (.,4,f W C- 10 '2 -1 1 C. -CZ41LM
Name Cot
/,y,q I q - -7 3 ztl� C
Mailing Address
City State Telephone Number
Signature:
Owner or Agent 9-ned
DO NOT WRITE BELOW THIS LINE (To be completed by Issuing Agency)
Permit Issued (date)-- A�. /J. �2 Permit Number 26 Z zw
Rcm'arks:—FM= 161be
upon isumnce of tt!'Js nn-rm't, Vr2 contractor is
DATE I . I for
PPLYLUIE);S
C. 7ction of
�Sp
tlie E -ee-rin- Dept.
the restcorcdion L FlSii` -
140
00,
0
I
CITY Op EDMONDS
L'NGINEERING DEPARTMENT
Insp Date
Insp Date ........... ..... By .............. . ....... �Remarks
Ir"Sp Date .................. By .............. ........ Remarl?"S.. ......... .... . . . ......... . ............... .............
l,nsp Date ..........
..............
ahal: ............ ;;; ............ BY .... . :�I�effla ....... * ............... , ...... ....................
ENVIRONMENTAL ANALYSIS
E)�EMPT UNDER DISTRICT SEPA
PROCEDURES, SECTION VII,
PA RA- ITEM
DATEL
INTERPRETATION.PIEFERRED TO:
DATE
O.H. U.G. CONK �--�V
ADD K T FT H
REMV --.�—CKTF.T, H
NET---Z-C--*'-',—'CK-r FT.
PERMIT'
TYPE
.)A rr- GRANTED
PE'RMIT
TYPE
_,J>A-T`EG n ANTED
FOREIGN CONTA T.S----
COMPANY
FOREIGN CONTA,_CXS----
COMPAN�
EASEMENT
r2f--- tz;;L
GRANTOR
DATE GRANTED
EASEMENT
GRAN
T T E GRANTED
WATER
SEWER th�
GAS
W.A.R. FORM
DATE REC.
FUSING COORDINATED
BY
LOG POSTED
INVENTORY
MAP POSTED
POLE DEPT.
TRANSF. CARD