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421 12TH AVE N
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
ILENEW CONSTRUCTION El REPAIRS E]
%1E IF E T F
P.
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OWNE 4� ...... L:,t ...........
ADDRESS................. .. ......................................
------ ------
EASEMENT No. — ......................................
CONTRACTOR ..............................
............. .......... ... PERMIT No.
------------------------ - i
.. . ............... ..............
LEGAL DESCRIPTION: LOT No . ..... 115 .. .............. BLOCK No . ..............
AV
�.-r ............................................
NAME OF ADDITION
..........
VED
1967
Approved:
DATE ....P ....... ............... By ......
A Y
z�-
77
CITY-DVED
MONDS
CIVIC 'CENTER WAT"ER-SEWER DEPARTMENT Call PROsPect 6-1107 when ,O,.k
is rendY for Inspection. (No inspec
N 2
SIDE SEWER PERMIT t'—s Sat -day, Sanday or houdaaw.) 2425
ADDRESS ..... 421 - 12th Avenu
----------- ----------------------------------- North
----------------------------------------------------------- - --------------------------- ----------------------------------------------
OWNER_ ------- Mr. —Henry ............................................................... CONTRACTOR ..... Lae --- �fqQjf�y
.................................................
Permission is granted ---- Augus.t ... 10 ............ 19-fiT, for ------------------------ days to REPAIR or CONNECT a side sewer
With City Sewers in accordance 'With application on file and governing ordinances.
ATTENTIONJS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the Property may btain a Permit to construct sewer Inside property line, A lice ed ide Sew . er Contractor must
be employed to construct side sewo t
er in stree area. Do not cover any portion of sewer before it ha"s
N No, 2—Obtain s beens inspected.
full information regarding Ordinance 11.16.030 and Regulations governing side sewers when You get permit.
No.'3—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. 4—Trenches in street must be'water settled and surface of street restored to Original condition. Contractors shall I be responsible for
failure due to improper work which may develop within one year of completion.
NOTE No. 5—It is unlawful to alter or do any other work than is provided for in the Permit, or to'do any work on the ma sewer r pp
tenances except to insert the pipe into the wye. in 0 its a ur
W
CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERMIT
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A. eAddress or vicinity of Construction
421 12t Ave. N.
Permit No.
STREET FILE'ssue Dati
9 Owner: General Tel-aphone Of The My
N�me
P. 0. B= 5124
Mailing Address
Lynnwood, WEL. 98036
city, . State, Zip Code
0 Contractor: sarrs
Name
Mailing Address
City, State, Zip Code
9 Permit Issued To:-
• Type of Work to be Done:
• �Work in Connection With:
El Sub or Plat 'd
Single Family
D Comml. / Ind. El
Apt. Condo.
0 Pavement Cut:
Yes 11 No
State License Number
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 whawever, foreseen ot 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 must4e availalSte at the job site for inspection purposes at all times.
Signature: Date 13
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: N -
Time Authorized: Void after days
Special Conditions: rsib-06
I
Ammendments:
PermitFee:
Security Deposit:
Receipt No.:
Fund Ill Fee:
Street Cut Dimensionsf
X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
FIELD INSPECTION NOTES (Fund 111 - Route conv to Street Dept5;
rnMMMn+-C-
Diagram:
Contractor called for inspection Yes No
Nork Disapproved By: D a tp-e—: Bv: Date:
Work Approved Bv: Date:
Inspector:
Ena. Div. December 1978
DEFECTIVE SECTION REPORT
Exchange ?/0
Da te Reported
01 OF
Dated Corrected
Aecord Map. ft
Reported by
Corrected b.
Case - No.
Cab le and Count.26 20.76 9Z cable size and. gauge