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470 ADMIRAL WAY.PDF............. . .. . _.—District City of Edmonds --- Water Department TAP CARD W/ t/F, - ",-) P 0,/) Date ........ . . No.,..Z2_ 2-:5 No ......................................... M te T e r _-7­*'1'""1"*"* I I Si-ze_.,/.�� I Si ze ....... . ...................... Mfgrs. For ... ....... Style ........... . ....... . ....... . ........... - Lot No ........................................... Blk. No. Add. ................................................... . ................. ... Service Location ................................... . ..... Meter Location ..... LJ ..... aLt4 ...... I ........................ . ..................................... . ........... MakeTap .................................................................... ........ . ............................. .................................................................... .................. .............. ........ - ----- ........ Pres*sure ..................... . ........ lbs. 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Meter Plate Che'ck Valve ........................... -------------- ............. ------------- . ........... ---------- .......... .............. ......... Pipe, Galv. Screw .................. .............. ............. .......... ­----------- ---------- Nipples ..................................... . ------------- . . ......... .......... .............. .......... Bushings ------------- .......... ---------- I ------- : ------ F.I. . -- ----- ----- ---------- .......... Plain Ells ------------------- ­ - -------- -------------- ........ 7 .... ........... ............... .............. .......... St. X11i .................................... .............. ........ I ..... . ......... ............... .............. .............. --------------- ............... ----­-------- .............. .......... .......... .......... --- ...... .......... I ----- ---- .......... .......... 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Pipe, ba'iv'.'Screw .................. .............. ............. ......... .............. .......... Lead Connections . .................. ......... z .... ... --------- -- ­­" .............. ........... Curb Cocks ............................. .............. ............. ......... .............. ........... Corp. Cocks ............................. ............. I ............. ......... .............. .......... Unions ..................................... ......... __ ............. .......... ............. .......... Saddles -------------------------------- --- -------------- ------------- * --------- .............. .......... Niobles ..................................... ................ --------- ............... ........... Bushings .................................. .............. ------------ ---------- ---------- Plain Ells -------------------------------- ------------ ------------- ---------- -------------- .......... Street hils --------------_--------- — ------_-_- ------_--_ ---------- .......... Tees ............. .. ............ --- .......... ............... ............ .......... -------------- Curb Boxes ----- ------------- * -------- -------------- I ------------ ----- ---- ...... S. .0. Extensions .................... .............. ............. .......... ............... ........... Gates ---------------------------------------- ------ 7 ------- ------------ --- ------- ---- I .......... .......... . Plugs ....................... ................ ------------- ............ ------ I—. --------------- ---------- Couplings ----------------------------_ -------------- - - --------- --------- .............. .............. .............. .............. .............. - - - - - - - - - - - - - - .......... .......... .......... .......... .......... - - - - - - - - - - Gate Boxes ............................ ..................................................... ........................... . ..... I ------------------- .............. ............................................ .. ........................................................ - - - - - - * ------------------------- 77 ....... * ----------------- .............. ............. --------------- .............. .............. - - - - - - - - - - - - - - ............ . . ......... ............. ............ ............. - - - - - - - - - - - - - ---- - ---- ........... .......... ..... m ---- ......... - - - - - - - - .............. 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Hours Time -Monthly Men .. .............. ............ ......... HoursTime —Auto ............ ... .............. ------------ ---------- Superint4�:ndence . ...................... .............. --------_-- ----------- .............. .............. ......... . Total.................. .............. ............ ....... —AbNEW SFRVICE JNSTAIM-1�11 ADDRESS: DATE: DfAl, 'A DTG,# U. 1). ELF11HONE, &OVI -,p CABLE. (0001 cy-� GAS FoRl'%\N STORM SEWSTREET FILE FUTURE Sl:[\'VrCE TNSTI Y EIS FO)-- BORE: CUT: SURCHARGY: YF S N 0 LOCK INITTAL: g, �oc AT'l W� t i. I e;2, TN I T I A 1, ,m-:'rER SHOP ACCOUNT NUMBER: (90/ - /0 o SUPPLTE'R: C I V1 1, F , N GR TREATIMENT PLANT SIDE -SEWER PERMIT 1) RA VT S I tA N 1, T S U PERT. NT EN 1) ENT I N ITI A L: DATE: I I ) - TA CAR�D — METER SHEET IAPPLICAT[ON/ 0 is TAX ACCOUNT/PARCEL NUMBER: BUILDING PERMIT (NEW STRUCTURE): COVENANTS (RECORDED) FOR: CRITICAL AREAS: DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: — PERMITS (OTHER): PLANNING DATA CHECKLIST DATED: DETERMINATION: [] Conditional Waiver F] Study Required E] Waiver SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: WATER METER TAP CARD DATED: LATEMP\DST's\Fomis\Street File Checklist.doc