22901 74TH AVE W.PDF5880
22901 74TH AVE W
n
APPLICATION
for
The City of Edmonds SIODE SEWER PERNaT
EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS 0
L -10 C-=-%4
-.-JNMFES3�- HU4
OMWER ....................................................... Gat IN'�
.................................... ------- CONTRACTOR ... ............ PERMIT No . ...... . ..............
T"
ADDRESS ............. wla5� ir . . ................ LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ..... a ................................
RF —N CZ) TION <np=
NAME OF ADDITION 9�84= ......... --F ........... ........... ------ . .....................................................
L tuKF- 02th, L L-1 V-4 cbmFel
FOrrIbL tkF4="4cAlhL
DATE
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P,� C, nr
P E R) MY
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D F, E Df, I D's .-:S EW
'MATEWSEWER.
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IPROj?]�RTY"El E IDESC X-FTION ..................... ........
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,001�xwkm,.6wia� &,,ADDRESQ' --------- ......... ................. ......................................................................... ........ .................................... .......... ..
dv.: ...... ajj(fv�or r,.
iiiWoriviqgYrail 1,9� .'repa �ide-�:sewer`tto,,...the�c t ltarw;�Sew,�
:,,Pen ............... .. ir:, �conn&tion,.'6f
y, . ��a - n.
-kiliholfills--Ordina
-y1th City of
IS ICAILLEDrTOI THE,FOLLOWING
PENTIOW
6�tr66 U"s :We-�e I 6j cons ruct
1'"E' No�. proiicrty'm'ay �6�taln- 6 perml L to.-const ruct sewer '.1 nside. property- line Censed,-Slde:Sekc� or., t p oye& �t. t'
"Be . J�, C I
.�been inaiiecteii.,
'sicie.iewerjn5tr�et area- - bo mot: cov,er;a liort or n of we b fore t has 4
h 0
"NOTE: No,'Y—W-llf'work ',perfpim�dl I ity,:rig t:: 'f;way,lre'qt'�ire'g*an�,Invasion'-,:�of.(i�gfit-6�'Way-P�rmit�6bt'ai�able, from, tho,bt�,4n��j a �!s,` iflce,.,�':
i 9�,Ordir�incei, an Regulations, !gover ise%yeist hen--you;,get permW�
�N0,T-EI?N(�;',i3l----'O�tal-�,,f�lf�information�,r.egELrd n .1-1:.'16r ' Oio� �l n1i
',at -301lipch' '.,ro�erty 11no..and.j2! -11 of-,
''N6TV,-No� '4L;��p�IoP,slde�-:sewer� must-ihave 4east 61
29�covqage��at.�r ne:�!minll r
i ler: I r',.'
-rmist' r.settled�,"&,'surface:�of, t
�N0,T%!,Nol.,,'.��,�renchesl,inystr66tI bcivatc ,street �rcsto�ed; . or.oil�i�al�i�ondit�onl.',-'-�oritractors.'s'hiLI'l" e'.,t .Amproper,
-�,ork�whicWmay�develoW within.:oriely.ear.�i)f;'complbtion�?,�,,'.
1 No: do�.afiy�.other., W.ork�,`,thanejs ��r6,hdb'd; aoj"k-,xv6rk.on,.t nrSewer,.�orzitg�ia,� :ece�btoN�n.
t �the,'.-pipe'-J-n'to,'the:..wye:.
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.................. ....................
"D S"P AM' D --- ....... B B.
I ROMMY, )Date.,.-.�:: Y/*�*- ate!
..........
Date..L-21 ...... e� ....................... y ........... ......................
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:A TRCI,�/ED, ......
............................................................ .
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......................... ............................. ................. ......... .................................................... ........ .............................
';'T
�E Signed'�B*� Ml� I e
, P—e r'm i t .0 orming.J66'ifiuc RIOR, .ofReqi�lesb For&, mspection
P` �f
1MA 1Y.Ol
A
v
r�e 0
!npm ad %
T
respo f�rfa. u
Purt a
h'ei*,eby*��'c�ertif.�,,,t��t:,t�6�:.gi�d6;.�iW,�e�.��il��iallati6i���'consik.0 iiIi
(Owner-,oryCqn!ra:c �Firm A�erf�r�nlng�'Constri 3
c�; n
i a in I iices,;of',bh&.di"
avins Yed6inlaco(W-dafice witht,a-111 jzov�d.rh g., V,,,of'Edmonds-.�`7
7
7",
-Date "-*t
d*.y/ bf—...
d'
"!Other
aS. -c e.p�o� .9! W e r'
AV, C.
ater,:,E;�
for.:,
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMT
NEW CONSTRUCTION E] REPAIRS
OVVNER..... . .......... ...................................
-), " - --- I
q
. .........
ADDRESS .. .. :Z-2 ..... ......................................
e:,j
- S—j
EASEMENT No . ...............................
CONTRACTOR . ..... v�z�4, -�,--PERMIT No. Y
LEGAJ, DESCRIPTION: LOT Z/o . ........... 1-6 ------------------------- BLOCK No . ..... 12 ...............................
NAME OF ADDITION ...... .....................
A
k
t.t4
Approved:
DATE................................................ By ......................................................................
A
Ti
fa, e . 4M --e Al Zlf
1� 4,
coi
LL.
4 1
re
73
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APPLICATION CARD No . ......................................
for
The Cfiy of Edmonds SIDE SEANMR PERNaT EASEMENT No . .....................................
OUTSIDE INSIDE 0 REPAIRS
OWNER ...... ...... ..................................................... CONTRACTOR ........... ;5 ----------------------------------------------------- __ ............ PER34IT N<�_��) - -------
SIPHRE
HOUSENo. . ......................................... ........... .............. .................. AVENUE LOT No . ...................................................................... BLOCK No. _:�� ......................................
-,f
NAME ADD . ..... ....... .... Z,9,(
.... ........................................... .....................
No WARRAW OF
:IP73Ed map was compill RACY The Intwmation, shn
cOnsultants. The ed for u" by lhe.Cky 01.6
'!�g set forth on the Not Warrant tp,,
CO,')dl Any pmon or 11 L
an Independihl - tityr
".f0garding4nekdor,
h1cluding -Put ilot Din IR
�_ttubs 'bd 'D- RhG iWation of any
S Ll s c
th, heitmhearyloremday " Wdst and m
ay
be tj ab I - Orm::Yrcic:'
6 for the Infona ty Of Edmonds nor
uon n C"
Provided based upoll Said g* on this MaP. norf:cr,-,- j.
Map
Date Approved `
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $... ..........................................
. . ......... .........
SEWER WORK ORDER ISSUED .......................................... DATE - 4�v' ------- By A .............