23626 79TH AVE W.PDF11111111 lill
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23626 79TH AVE W
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 for * th on these
map(s). Any person or entity -req uesting 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 officer-'s) S13hall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
APPLICATION
The City of Ed I monds for
Flo SIDE SEWER PERMIT EASEMENT NO . .............................
Lt: NEW CONSTRUCTION REPAIRS LID NO . .................. ASMT. NO
OWNER 'CONTRACTOR ... jb.� ----- ------ CZ-�-.. PERMIT NO.
JOB ADDRESS ........... LEGAL DESCRIPTION: LOT NO . ............ 4 . .. .................. BLOCK NO . .....................................
................................................................................ ................ I ........................................... -------------------- -
NAME OF ADDITION ------- \,t� ------------ I ---------------------------------------------
9
F*
proved:
7
LTE...... .. . ......... . ........ ..... By -------- I I wiH
-------------------
V RIT
'S111D,E,` SEWME 1
ITY. t0F`1ED!MV'0N1Q,$ Ri PERM
WATEWSEWEM DEPANRTMENV
Z.. -M -T.:
TER
P
'�rl �..i 0!, tl�e.,.c ons truct on
fo`r'. s ; lder.s�wer 7inspection , s*, ;BEF0IU,;*.
_oui4:afier�req6i� N 18at. ',Sun!, or: holiday,, . Inspe
"(tingpectlo�,.will-jbe 6r��ided'j -,ctlns.
'T
:3
4.0 �,5
-ION ................... \A1 (D
�:,;MDDRESS�',I?:dCA-nON�'-'OF:,CONSTRUCT . ........................... I ....................... .............. .............................. .........
7
..........................
-',PROIPERTY�',LkiGkL;i�DE'SCRIP-T-ION-.'...
.......... ............... ...........
.............................. ............................
).A
........... ................. ............................................................................................ 7
.................... ..... . .................................................. .......
..'� ................... .......... :7 .... �.:�
....... ............ .............................. ........... O."EX AND/OX.BUILDEM....
014,T]WAC- TORI S Ts ............... 77'
............ ........ ............................. . ......... -------- ............... ................
ss W q� .. .......................... ........... 19'
9 1or-,repair.-4fid/or4.,co ne-dt
&n,,fn)�,b�ecordiL'ne'e'lliiiiili; It �oV-Edmond'
s. or inances.,..:
AT.TENTION.IS,ICA-L?LED;T6YTHF'.F(jLLOW114r,:
'.-NOTE.,No,, 'J�Tbcowne�rs1t,,of"the. pr�periy may obtain -perrr�itl'to. construcf. sewer Inside; property. line.- A:'71 I censed' 'Sewer.,-Codractor must *be �m�loy.ed:zf&:6oristruct'
'side sewei�ln ,
str6et.,area.,'1Do; not cover any portlon� of sewer before it. has ibeen. Inspected-.
-NOTE: No. 2—.-All- wor perfo medi in,icity right of _i�mif obt �,Ine�r:'s,,offlci�-
r -of'way, requires,an! Invmlod4of PJ�ht' -Wiy-P akmbl& from.,the . City,":E,,
I . I si . '
,.NOTE',* -No: 3 �ObtiELin:.:i6ll;"'inf6rm�ti6�,*ieg&rdi.ng.'Ordt�.ine'e�,111�l, '6�930 and�-Regulatlon ::governing glde,�sewer�; whs�'- you :get. permit.,.-
',:-NOTE[,No��.4�—Top�ic;f-i�f�'e";s�w�r!�ihust,�h'�veitle"t,.30'inchesficoy� ge,��ep6operty line, ELnd:.12., Inches ins. de ..property. ,line:, M'inimum,Fadlei 2,;/,., ;No�,be�dg, 1.',',jia�e
..Of
w'1II;be.*permItted.
.�sh�rpen�
VOTE: No�,*:,,�'
T�erichei!flntfstreeV�must�be wafer.'settled and, surfac6of, itreet,. restored,` fo.�orlginaj, 'conditloW.1 .�Contractors - shall,.*,be responsibW for, fa�lur6, due� mproper
:1.'work'whl'ch-,may develo* ..within.one year.of 6omplistlon�
p
�.6r' In:,the permit, or, to.do -any'work':on'the main* sew�rl:o purtenancest�except.,to in-
N i,i�nl�wf�ll,.to�j�ii��'lor:,do-�any other work$:th�&W.ls -provide& r4tw.ap
iert4hel,�plpel.into�the. Wye:
a e ..... .... ...... Date ..... " ...... ..................... .......
D X ......
............. B'
. . ........
"By,
...............
A PRO� ............ .......................... .................................
... . ....... 7 ...... ...........
V 77 .....
Reniarks:��*..;.` .............. ..................... ........... ................... .............. .................... ..................................... ........... ..
.. .......................................
................................ .......... ...... ............................................................ ....................................
.................. ...... .... ...... 7.
1.'Firm "P-erf'orming'.C'Ons�i-��t�on,,,,iP.14jk)T'o.-,Re . qu . e . st -For;- , In' spe'A.io.�,:'C,-,��':-
BOTWPer.mitt& opiesi MUST- BeSikned By bwner .6f
01.
C ;t.!the:sideisewer.jhstaI c nstructed' un er, hisi permit'
a Iati� d'
....... ....... . . 117 ................ ki:erei3y ertd h
'Aing, e
,ner' f CbntdL irm' truction),
d
'�nr
dUn -y-with. all-gov inalibes!c6f* h6�'City* -of-'Edmon s;.-..
�w'as'ilnsitalfe erni4g, bfds 't
..... . "Anz/z �z
A .. ......
Date& .,Aay:c�V.
j
�o�41'n',-�4-wlv
he ek -BEi --You*-Aik� foi.;iVitef'
T6 e'o
APPLICATION
The City of Edmonds for
SIDE SEWER PERMff EASEMENT No - --------------------------------------------
NEW CONSTRUCTION REPAIRS LID NO - ------------------ - ASMT. NO. - ---------------
OWNER - ----------
------- CONTRACTOR ------------ T
51 -------------- --- PERMI NO - ------ �4�
&-&GAL DESCRIPTION: LOT NO.
JOB ADDRESS -------- ------ -------- BLOCK NO - ------------------------
----------
I------------------------------------------------------------------------------------------------------------------------------------------------------------------
NAME OF ADDITION
Approved:
DATE-------------------------------------------- By
ST, REET FILE
INSPECTION RECORD
CITY OF EDMONDS, PUBLIC WORKS DEPARTMENT
DATE: 3/1 Ina PROJECT: C-,-,,ri
771-) ik'
, IJoq_ uj.
re
x ( .1c CL
BY:
1/781v
PUBLIC WORKS DEPARUV CHECKLIST
BUILDING P=T REVIEW.
�2_:; L_,-2_G lk� r16- ArVe VV
V(address) (date
Street Rig�&OP-W'�Ixisting
5 Qr'��O REQD h�
Z
Access Easements Existing______
F4
jJtility Easement Exist.
Lot Per Subdivision Plat
Asse sor Map
Site Plan Checked for Accuracy___�_��.
Underground 14iring Reqd.
Check Accuracy of Legal Description
Review by_
Date
Existing Water Main Size
Wa lain Required
at lain R
t quired
I
Service .., iin quired
L i jr
Li
Hydrant Size Exis t
t S t
c4
Hydrant Reqd Per Fire Co
ant Re
,,��Ize
ctor Ch . Met r
Detector Check Meter R.eqd.
Cross Connection Inspection
Fire Department Comments
:3:
Water Mete g e Reqd.
,7.
:RRe Y.
y
Date
,-Septic
Tank Design Approved
Date
S Sep Ic Tank Permit Reqd,.
ar& rrrmt Reqd.
ep T Pe
P rnit No.
Permit No.
an �
Sanit ewer Availability
t y e A labj_T
ew r i i;
Proj.
oj.
bra No.
m g
w %
File No.
. 1. ty
S it
Side Sewer Avai I y
anitary Sewer Connec n
S S i S w r c Fee Reqd.
�3:
Review by
j
Date
Open Ditch Existing
Reqd.
Culvert Reqd. .17
:!�Size
P4
Catch Basin Reqd.
T_A4_ on Site Plan
0
Shoulder draina maq-�intain collection
on'swale open runo
Manhole qd.
Indicate on Site Plan
Soil ditions and Ground Water Field Checked
ew by
Date
Rev�sed: MO-1977
Page 2
Strw,t,Paving Reqd.
Curb -and Gut d.
Sidewalk Reqd._
Curb Cut for Driveway Reqd.
P41 Right-of��Way Construction -t Reqd-
Bond Reqd. for- mpravements
�r_ c I
Stx>eet-��S i ' gj� Reqd.'
frther Signing Reqd..
t Site Inspection made on
S
.0
�-4 7BY:SEWER
E-i
U
W WATER
z S=T
E NGINEERING
Special* Requirements.� listed in memo to Comnmity Development Departnent,
Building Division
> BY Date
c) All items filled in on Building Permit Application t
BY Date.
P4 Drawings Stamped and Notations Made
P4 BY Date
Approved by Public Works Department
It
Kevised: 1v 10-1977
1111 11 EDMONDS
PUBLIC%KS DEPARTMENTj ENGINEE�ft IVISION
—.�A RPi d nffimj F n P PTCHT.;-.n�-:14AY (-wjqTP1-1rT-TnN PFPMTT
RMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION PURPOSES
Applicant to Complete Parts A and B
A. Permit to be issued to: r
For Work at:(address or vicinity)
V.3 6��(
-/-7 9/"
IVA 90W 0
Type of Work to be done: —
(attach drawing when applicable)
Time Required Start:
Owner: � - o'
Name
Mailing Address
City State Zip
Contractor:
Name
:..-Mailing Address
City State
Finish:
Telephone Number
-a / -� V -- 415 -e-e
State License Number
Zip Telephone Number
B. INDEMNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages, or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including or not limited to the defense of any legal proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspectionand acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call '775-2525, ext. 220.
I understand that this permit must be available at the job site for inspect ion
purposes at all times. -
Signature: Date:
Owner or Agent
TO BE COMPLETED BY ISSUING AGENCY:
Date Issued: Permit No.: F e e
.Security Bond:
Time Authorized:
10-771v (RPviqPd)
-7e
71Z
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