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412 OLYMPIC AVE
APPLICATION
for
The City of Edmonds SEDE SEWER PERAHT
NEW CONSTRUCTION 0 REPAIRS Fl
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OWNER.......... ...........................
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ACTOR PERMIT No.
....... LEGAL DESCRIPTION: LOT No.....,.
-------------------------------- BLOCK No . .............................
NAME OF ADDITION Wo C, d V I L
................................................... ....
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By ....... ............
DA
Call 7.76-1107 for side sewer inspections BEFORE covering any portion of the construction.)
Inspection will be provided within 24 hours after request. No Sat., Sun., or holiday inspections.
ADDRESSLOCATION OF CONSTRUCTION ----------- -------------- -------------- I -------------------------- ----_-------------------- -------------------------------------------------------------------
PROPERTYLEGAL DESCRIPTION ------------ ----------------------------------- I ----------------------- I ------------- I ................. - -------------------------------------------------------------------------------
I ............... - -------------------------------------- - -------------------------------- -------------- ------------- --------------------------------------- ------------------------------------------------------------ ------------ ------------
%71)�OR BUILDER_- -------- ----------------------- ------------------------------------- - ------------------------ ------------------------------
-------- --------------- - ---------------- ---------- 0 **Tb;ER X1
CONTRACTOWSNAME & ADDRESS -------- ---------- _ ------ -------------------------------------- _------------ ----- -_---------------_---------- - - - ---------------- --------------- ----------------------
Permission is granted ----- ------ ---------------------------------------------- 19 --------- for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
YnTE No. I —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.
N, 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 'A will be permitted.
NOTE No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors sball be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. &—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.
DISAPPROVEDEl D ------------------ By -------------- Dait!� -------------------------- j9Y ...... / ....... D e --------------- - ----_------------- By ----------------
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APPROVED D,� _ _0
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Remarks: ........ ...... . ..... --------------------- -- - ---------------------------------------------------------- - ----------------------------------------------- ------- ---------------------------------------------------
---------------------------- -------------- -------- ------ ---------------------- I ------------------------------------- -------------------- - --------------------------- ------- -- ------ -----------------------------
BOTH Pe it Copies MUST Be Signed I By Owner of Firm Performing Construction PRIOR To Request For Inspection
hereby certify that the side sewer installation constructed under this permit
O__ �er Mg Construction)
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Cer of Con rac� g F1
was installed in accordance the City of Edmonds.
Datedthis ---------------------------- day of --------------- ------------------------------------------- - --- 119 ---------
Check BEFORE you dig for: Water E], Gas E], Telephone 0, Power El, Sewer E], Other
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CITY OF EDMONDS STREET FILE REC,..
PUBLIC WORKS DEPARTMENT OCT 22
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Addr ss o - r vicini7tof Construction
'4
0 Owner: RA."Allf 4 1't/T
Name
Y/ �' lox OV A /'r- V-
Mailing Address"
n. L,&,o-s A
City, . State, Zip Code
9 Contractor:- galiv—eA 134em=k"F
Name
!2�zigmt'
Mailin Address
City, State, Zip Code
Permit No. / — /
Issue Date 0
1981
0 Permit Issued To: 1/k, "X, Z 0 ;a- S J �"
0 Type of Work to be Done: JAA A2,f �v Re 42 1.-x; /I
o Work in Connection With:
El Sul) or Plat N9 Single Family
El Comml. / Ind. El Apt. Condo.
o Pavement Cut: El Yes 0 No
01-7.S /*A4 V - -3 0 er 9 13
State License Number
77y-
Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
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 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 inspection and 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 to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering.
Call 775-2525, extension 220.
I understand that this permit must be available at the job site for inspection purposes at all times.
Date
Signature: �z U
Owner or Agent
THIS PERMIT MUST BE POSTED AT THE JOB SITE FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By: M -
Time Authorized: Vold after
Special Conditions:
Ammendments:
ays
Permit Fee: 4-3,0"
Security Deposit:
Receipt No.:
Fund I 11 Fee:
Street Cut Dimensions
X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978