23605 76TH PL W.PDFlill 11111111
6496
23605 76TH PL W
APPLICATION
for
The City of Edmonds -0 � 11: �
SIDE SEWER PERMIT EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION REPAIRS Ej LID NO. ...... , ASMT. NO . ..................
ELL
OWNER .... ......... ". E=� ... .............................. CONTRACTOR ------- J�-4EaP;-> . .......... ...... --------- ---- PERMIT NO.
JOB ADDRESS ------------ LEGAL DESCRIPTION: LOT NO - ----------- - —:� --------------------- BLOCK NO - ------------------------------------
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NAME OF ADDITION ----------- f���A --------
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Approved:
-!.-.-7-7
DATE ....... . ...................... By ----
-7
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 location 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 Hab-l-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY
OF. EDMOND$, SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
6 �� � �5
PERMIT 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.)
23605 76th Place TJest .......................
ADDRESSLOCATION OF CONSTRUCTION ..... .......................................................................................................... ..........................
PROPERTYLEGAL DESCRIPTION ................... .... 3 ....... Behgkt.Addi.tiOn ...................................................................... . ...................
................................................................................................
.. ....................... . .......................... . .......... . ........... .......................... 7 ............................................. . .....
OWNERAND/OR BUILDER ..... !A!= ... NOMA ............................... . .......................................................
.0 ---------------------------------------------------------
CONTRACTOR'S NAME & ADDRESS ............ SAIE ............................................................... . .............................. . .. . ........... ...........................................
Permission is granted ---------- AD-r-ij: ... X� ---_----- ------------- 19.77, for repair and/or connection of a side sewer to the city sanitarY sewer
sy--'--m in accordance, with City of Edmonds ordinances.
U
ATTENTION IS CALLED TO THE FOLLOWING: ployed to construct
NOTE No. I —The o ners of the property may obtain a. permit to construct sewer inside property line. A licensed Side Sewer Contractor must be ent
w I inspected.
side sewer n street area. Do not cover any portion of sewer before it has been
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 ge . t 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 ma4n. sewer or its appurtenances except to in
sert the pipe into the wye.
DISAPPROVEDDate ... . ...................... ............ By ---------------- Date .......... ... . ................ By ................ Date ............... - ------------------- 'BY ................
__4 ... 0i.
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APPROVED
P By..._ ............. 0�� ................ ........ .. . ........
- - --------
DiAl,
................ 1Z —0 . ... . ...........................
Remarks: ....... . ... ............ .. ....... W . ......
'0 .... .......................................................... . .............. ........................... ............................ . .. .11.71 ............................
................................................
—.BOTH Permit Copies MUST Be: Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
that the side sewer installation constructed under this permit
................................................... ... hereby certify
(Owner of Contracting FIrm Performing Construction)
WasInstalled in accordance with all goyerning ordinances of the City of Edmonds.
Datedthis ............................ day of ................................................................. 19 .........
Check BEFORE you dig for: Water Gas.[j, Telephone Power F], Sewer Other C] -4 V
The City of Edmonds
APPLICATION
for
SIDE SEWER PaWff EASEMENT NO. — ------ ------------- __ ..........
NEW CONSTRUCTION Air REPAIRS LID NO --- NO - ------------------
OWNER -- --- -- -------- -- .. .. .......................
elf W� ....... CONTRACTOR
--------------------- PERMIT NO.
JOB ADDRESS .. .... LEGAL DESCRIPTION: LOT NO.
Ole---------------------------- BLOCK NO - ------------------------------------
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--- --------- /,q -.111�1-V7 . ..... .......................................................
NAME OF ADDITION
0
0
Approved:
DATE
...... MOVE0 ------------------
APR I JW:
pum woft 9w--
BY--------------------------------------------------- Yi7y6
SOTREET FILE
C I T Y 0 F E D M 0 N D S 77
PUBLIC WORKS DEPARTMENT
Routing of Building Permit, Plat, or Subdivision Applications
Proposed Property Address: 23605 - 76th Place West
DEPARTMENT
COMMENTS
INITI
DATE
W A T E R
S E W E R.
S T R E E T
B U I L D I N G
0 R
P L A N N I N G
ADDITIONAL INFORMATION:
X-71� I-,,,2V-77
I n11 1 /7f,
USE PERMIT REC`7
BUILDING DEPARTMENT
Applicant Fill
ZONE NUMBER
-PERMIT APPLICATION
Inside Heavy Lines
4 1 Q:77
.01 1A 1JI I
13
J013
ADDRES.,�
f-
NAME JOR NAME OF. VUSINESS)
Az,/xI * / 41/
VARIAN CE OR . COND. USE NO.
ADS NO. Pub1jCjH.jEjIGHTuF'*
.Z
w MAILING AqDRESS
.
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PROPOSED YARDS,
LOT COVERAGE
0
T V
TELEPHONE NUMBER
FRONT SIDE REAR
I
ZC1
7
SIGN AREA
ENVIRONM
ENTA L REVIEW-
1-7
ALLOWED PROPOSED'
. . . Z
11 'EXEMPT
NAME
. COMPLETE
REMARKS Z
J
ADDRESS
. IL
LANNING DE PT. APPROVAL DATE
U
(t c I T._X_— ITELEPHONE NUMBER
'LEGAL LOT
LOT* AREA
VISION No.
[3 YES 11 NO
NAME
STREET R/W
m
EXISTING STREET R/W. FT. DEFICIE&CY THIS PROPERTY
0 ADDRESS
COMP. PLAN'ST. R1w, FT. F . T.
REMARKS
m CITY
TELEPHONE NUMBER
z
0
U STATE LICENSE NUMBER
CITY LICENSE NUMBER
CHECKEb. 13Y
W
ur
Legal Description of Property (Show Below or AttWachFF 'Co 'e
STREET AND/OR UTILITY WORK
R/W PERMIT RE-QUIRED W
771
�EQ-D. E) YES 1:1 NO
Ej Y ES O'NO Z
,49 Z7
Z
—.I—
UNDERGROUND.
z
WIRING REO'D.
0 YES 1:1 NO
TYPE CONNECTION El. YES
VERIFIED BY
SANITARY SEWER 0 No
U
V)
SEPTIC SYSTEM 0 Y
PERMIT NUMBER
APPVD BY CITY ENG.
NO
REM ARKS
W
METER.SIZE
SERVICE SIZE'
BY
1CLEARANCE
ICHECKED
REMARKS
ZNEW
INRESIDENTIAL
GAS.
LINE
FI�R E ZONE
TYPE OF. CONSTRUCTIO N
NTIAL
NON -RESIDE_]
SIGN
ICODE.
.
ADD
F. RETAINING
DEMOLISH El
SPECIAL INSPECTOR
REQUIRED.
OCCUPANCY OCCUPANT
GROUP LOAD
WAL L
ALTER. E CA V ATE FENCE
D OXR FILL X--.,-F'r)
E! YES NO
JAREA
I
j
PLAN CHECKED BY THIS SIT E IS LOCATED IN THE CITY
REPAIR PRE -MOVE swim
El
OF EDMONDS. LOCAL SALES TAX
INSP. POOL
Ell
SHOULD BE CODED'311.04.
REMARKS
NUMBER OF STORIES
NUMBER' OF
D Wr
�LLING
J
UNITS
N E-)OF WORKJ6D BE DON q�/--
VALUATION
FEE
PROPqS
z
PLAN.CHECK
NO.
j PLOT PLAN (INDICATE BUILDING TBACKS,
ABUTTING STREET
BUILDING
U
tn
P LUMBIN9
0
HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMINGPOOL