612 9TH AVE S.PDFIiiiiiiiiiii
9949
612 9TH AVE S
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C)
CITY of EDM-0NDS SIDE SEWER PERMIT
For Inspection Call 771-32.02 8 T LP: T F L E PERM.IT NO. 07000
Address of Construction: 612-- q S '�74 6", WJ 4�;_
Property Lega-1 Description (Include all easements):
Owner and/or Builder: /� J) - #7 U " J 6-).-1 .
Contractor & License No:
663
EDMOND5
ITREATMENT PLANT]-
Single Family Residence X
Multi -Family (No. of Units
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permi-t required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description -and county easement number.).
PLEAS-E--RE-A-D THE ITEMS LISTED ON THE BACK
I deftify ihft'I have read and shall comply
with the items listed on the back.
Permit Fee: go- vp Issued By:
Trunk Charge: Date Issued: "17171n
Assessment Fee: Receipt No.:
P-/'
�-7,0 tv
Date
Partial Inspection:
Comments Date Initial
Final Inspection Approved: 77 - 13 -Rot-4 VAc),LA t,
Date Initial
Rejected:
son
** PERMIT MUST BE POSTED ON JOB SITE **
Date Initial
Wh.ite Copy File Green Copy - Inspector
Buff Copy - Applicant
NOTICE:
Nb---warranty--of ac�curacy-
The Information *shown on the attached
map(s) was compiled for use by the City Of
its Employees and Consultants.
Edmonds, ,
The City of �Edrn.onds does not . warrant the
accuracy of anything set for.th on these
map(§-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the Inform'ation shown on
.�-_tFe -map(s), Including, but not limited to,
th . e loc'ation of any sew-er 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
e m pl- o-y e e-s o -r o ff I C, e,r-S, s h a I- I b e 1 .11 a 1-3.11 e f o r t h e
information given on this map(s), nor for
any 'one representation provided based
upon said map(s).
Side Sewer Drawing
0. It
The City of Edmonds
EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION Z REPAIRS E LID NO - ------------------ ASNff. NO . ..................
OWNER -.F',--.D ..... M-utsu--50W4 ------------------------------------------------- CONTRACTOR .... 0-1,4me� ..................................... ...................... PERMIT NO.
JOB ADDRESS ------- 6--a --------- ....... sx- .................... LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - - ------------------- * -------------
EDMONDS
--------------------------------------------------------------------------------------------------------------------- .......... I-IREATKERT-PIANT
�W/
If
0*1
NAMEOF ADDITION -------------------------------- -------------- .................................................................
0
J, . 4
Approved:
DATE ... --------------- B y *�-- - - �j /11�1 I -------------
go - loo
Q ity, of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number.
Issue Date:
A. Address or Vicinity of Construction: — 612 9 AV S 99721772)
B. Type of Work (be specific): Install Service
C. Contractor: Puget Sound Energy
MailingAddress: 1122 75 St SW, Eyerc-tt
State License #: - 98203
D. Building Permit # (if applicable):
Contact: —Mariamne Kingsbury
Phone: 356-7540 X7596
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. E] Commercial E] Subdivision F1 City Project Utility (PUD, GTE, WNG, CABLE, WATER)
F1 Multi -Family 0 Single Family EJ Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: 0 Yes 0No G. Size of Cut: x H. Chargi�_$
APPLICANT TO READ AND SI�N
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold t" City ofEdmonds harmless from 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 ofany legalproceedings including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MAT i ERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITYFORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BEPROCESSED FOR ISSUANCE TO THEAPPLICANT.
Con]itiuction. drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statem-fents and understand thepermit requirements and thepink copyof thepermit willbe
available on site at ali times for insperwn purposes.
Signature: J /J 1%�& Date:
("�On I tiactor or Ageift)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE.ONLY
APPROVED BY: 11411 RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS DISRUPTION FEE/FUND III:
SPECIAL CONDITIONS: MA
RESTORATION FEE:
PERMIT FEE: ;3191 00
TOTAL FEE:
COMMENTS: '14 RECEIPT,FEE: A
DATE: ISSUED BY -
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
[I YES
Date:
Date:
E] NO
I
PUGET
SOUND
ENERGY
1, "Gas Main
Addendum To: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
New Customer Construction
Puget Sound Energy
# 356-7-500 EXT. 7596
1
M
(a I?, C3 &, -,j <�:�
oz 917-
Key:
-W-
Water
-G-
Gas
-SS-
Sewer
-SD-'
Storm Drain
1�
=11
I
Pi I(jol ! - ;otilif I I Ili f, IV - I I' 1�1 Pill I 1� W - 1,v(!fI:1I, WA !)W'()'i
I I
PUGET ;Ik bi
SOUND
ENERGY
Addendum To: City qf Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
New Customer Construction
Puget Sound Energy
# 356-7500 EXT. 7596
Key:
( .0 1 z 155 14, --j IS3.
IJOVS 90?-2-177Z
Gas Main -WI Water
-G- Gas
-SS- Sewer
.SD-' Storm Drain
I �. Ij
00-
3
T 7,
City, of. Edmonds-
RIGHT -
OF -WAY CONSTRUCTION
I - -
rr_j1UV1.t -U_ Pen3fit Number' -2-2- 14 62'
Issue Date:
A. Address or Vicinity of Construction: 2- c3 T H A.V E 5 4w;
7*q�'W�o C - M PIJ Lr,,-
,e- 8 9 0 1 9 C) B. Type of Work (be specific): 1k15'rA_L1_ D(ST'C_,& S F
W SIDE '7Tk&VIE 5 AT 617. APP"Y, Ss-1
C. Contractor: C_HAMRf_f_.S / SVIPEP-10LOA Contact:
Mailing Address: 5-33 MX(AJ ST . Phone:
-ro K AmOrz-W-co N
714-5746
State License #: 50 PEIZ CC 16 10 A Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
5� WATER)
E. F1 Commercial El.,.Subdivision Ej CityProject g Utility (PUD, GTE, )ANG(69L
Multi-Farni�ly 0 SingleFamily Other
INSPEffbR: I14SPECTOR: Wg%-rc.%jT-(
F. Pavement or Concrete Cut Yes RNo. G. Size of Cut: x H. Chargq�,$
1j, UAILCSS \N1KfD6_W1_,,NErz_0AEr),sAS DV_7-A7-1E0 (3 %e
APPLICANT TO READ A $1C.NL_au-Tv_s,,4vr�%/u77Lrn i�_s
A
INDEMNITY. Applicant understands and by his signature to this application, agrees fo rhold the bty ofEdmondg harmless from�iqjuriesjdamages, or
I
claims of any kind or description whatj�otveyj, foreseen or unforeseen, that may be made against the City of Edmonds, or �tn� 4 its de06rtm4nts or
employees, including or not limited to the defense ofany legalp�r_oceedings including de�ense costs, and attorney fees by rea8onofgrantingthi8permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance4th City regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS. .12
Ihave read the abovestatements and understand thepermit requirements and thepink copyof thepermit willbe
available on sj:tjt all .m"r inspection purposes.
1-0"
Signature- )* %__ Date:
(Contr_aJto;7`or Agent)
CALL DIAL -A -DIG. PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVEDBY:
TIME A UTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND 111:
RESTORATION FEE-
AL-t-owe'D IN 141-% Av1E PERMIT FEE:
Av I ki CC)
COMMENTS:
DATE:
TOTAL FEE: —
RECEIPT FEE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
El NO
7 7H V
K`,, 0 L L ID 8 N V
08/23/1995 16:25
7752299
CHAMBERS CABLE
PAGE 01
C. I
4AMSERS
C.- &-,OLE
PAX MESSAGE
rDATE 53
AT�(
TO
C IW
OMPANY:
Ily
PAX PlIONE
tf
CC:
ON
FROM T7---
:, W
SUBJECT:
OF -,�Nc—.UDING THIS COVER SHEET)
OF PAGES
4�
yr r vr I, %I . 7� I"')
AUG 2 3 1111195
E NG I N E E h � NG�
iF YoU Dc -4-1,1T RECEIVE ALL PAGES,, PLEASE CALL BACK IMMEDULTELY-
voICE: (2,1i)774-S146 FAX: (206)775-2299
(2r-61774
08/23/1995 16:25
8 90 1 9 q
C. Contractor: i,.
Mailing Addm,-2:
State Uceose #;
7752299
CHAMBERS CABLE
City of Echnonds
RIGHT-OF-WAY CONSTRUCT101N
PERMU Permit NambW.
Luut V21e*
PAGE 02
Au G 2 3 1995
A. AddrcsS Of VicinitY Of C0d9=ct'O['. L' f ?_ OjT�-, 6.VF- 5
a. Typo OfWofk ft specific): tkiST,&LL 01Sr CA _e�, F_e, PtJLr.-
w sirx 1IT114VI!, 5 AtT&i1_A-kYAAX 11"
C1 pE p Contact. !3 A A M 0 rr R �-O
Phone: '774- 5"IA(Z,
Liability Iasuranc= 31oud- $
D. IRWIdi"9 P1117Fnit # (i f Side Scwc;r p"mit # (if s"licabl&):
E] City ptoject [g Utility (pUD, rjTE, WN(;Xk" WATER)
E. 0 C**umf%;iW
C] multi-Farnil- Ingle FsLr0y Other
INSPECTOR'—.., INSPECTOR- _Jbil
EI Yes OND 0. SizC Of Cut'
F. Paveme-Ot Or 0)J1rl:!1 t U 9 LIZ55. \,N I N D6 �� N-17 ru 0 C'M) A
APPLIr—ANT TO READ AND SIGN I—ICA7 C
,,dbyhi..ignatureloth"w.viicahon,agreeatuhilldthLICItYvtF,d—ndv &rm&e#fr4pm jouwiex, day—ges, or
nv,p,P.avvsrt*: Applirow — -1 -1; - 11 a or
ataiins dif ariv kirld I#r Ics- ;I f9reseen or unforesem fhW MaY bg mctdc the "'y of "Momls' or �y of its dMwfm
PAHftt1fL
d4emc Gpfany legal pfoceedinlls blefu4ting defeme OP4118, a" aftnrfmy fuw* k
Tffr Fo;z wORKM�w-WIP AND AIATERMI-q FVX A pERIOn OF ONE YRAR FOLLOWING TH.0 FINAL
C0Nrf0<*j,f)H 1,q �4�, rffF pS WIIL BE ffr%j) UV7'1 r, I 11E FINA L 5 7H&E T I 'A I CH
WORK. EMMA TED RESTORA Tfo;V pF
TO THEAPPUCAAM
k'/ wHICil TIMEA DEBITOM CREDtTWLL REPROICE330P FOR V%9VAN(,_P,'
1re)sect work required wAn perM cLvv V
Pleua call the Engineering Division, 771-0220.
A Z4 how- notice is v
Work and matexi al. ��
I ff)r inspection;
( n Bpe*tad during progr"s and at completion.
Restoration iiq to 61 ij
rdance with CitY Codes.
Street shall be kept, -.- �;
Traffic Control and I
i 1 11 fixnes,
-;vfety oballbe in accordanca with City regulations as required by the City Engineer,
City approved material prior to the en d of the working day;
All street cut ditxbr:i
1)oLtched with asphah or .
NO EXCFPTIONLI4,
rs ta nd the permit req uirements a nd the pink co py of the per mit witt be
1have read th4i cbui;-
o,nis and unde .
available On sit�,`d
an'�hr in spaction purpo8es.
Date:
Signatura:
"?v,�or or Agent)
( !-1,.!J, DIAL -A -DIG PRIOR TO BEGINNING WORK
Volt CITV USE ONLY
AppR0VEl)BY;_.- T .....
TIME AUTROK12ET p7ER
S
I' AV!
Commr,N]'St __..
QATE:
RIGHT oF wAY DEPOW
DIDItUMON FjUKtVtjND U11
REMRATION FEE:
PERMIT FEff.
TxYrAL FVA-
RWElPr YZE,
.
MUED
�A
4 ORK SHALL BEGIN PRIOR TO PERMIT
ANCE Eng, Div. 1994
:QTREET FILE
M E M 0 R A N D U M
April 23, 1986
MEMO TO: Ilene Larson
FROM: Bobby R. Mills
SUBJECT: 612-9th Ave. S. - Acct. #107-12300
Please make an adjustment on the above subject account to reflect
the average plus City cost for water. I have talked with Archie
and we agree this is justified.
If you have any questions, please call.
4MC�H � �D T
L
<1 ce
13o Mv
'or (ZI-r
JY.
51,fo 2- o
6 4 1
ao� z-,Wc_o-la - -
,r� a4 :-�/ c-c4"e&-- 4
e4."Ia46t, ce� ag��
.916(
16?w e;t
c evtlz�-
f CITY OF EDMONDS-UTILITY BILLING
I ()
ACCOUNT NUMBER 108-03700 107-12300
SERVICE ADDRESS 0 612 SITH AV S
M A
IN A D --2+6-tf3---7*&Tt"Ve--w_
'A I D
M L ft-�E�D_Wb N D S ",9",o
E I E
NS
GS
TELEPHONE � 74-8-412 2
METER SIZEO 3/4 NO. OF UNITS 0 SEWER CHARGE 14.91
WATER BASE 3 CONNECTED� YES
4_44
SUPPLIER S CODING ll� A W U RAE DTOS :1 A
METER NO. LOCATION
_T/v
DATE
READ
CONS.
NOTE
DATE
READ
CONS.
NOTE
00
CT
'12 7
c//o
7
APR
JUN04
eol
z
/5�.;
0402
783
-
.2(oa
DATE COMMENTS
1-
AIX'4
.:Z11
00
C)
EI_VgD�
CITY of E DM ON OS -
For In t* C 11 771-3202 14 1986
PUBLIC WORKS
Address of Construction: 49/2--
Property Legal Description (Include all easements):
S I D E
SEWER PERMIT
RMIT NO.
EDMONDS
TREATMENT PLANT
Owner and/or
Builder:
G kj
8o Lij e,-`�
Contractor &
License
No: L.
Single Family Reside�nce
Multi -Family (No. of Units
Commercial (No. of fixture Units
Invasion into City Right -of -Way: No Yes (If Yes, Right -of -Way
Construction Permit required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes (If Yes, easement required,
attach legal description and county easement number.)
PLEASE READ THE ITEMS LISTED. ON THE BACK
V_
I certify thht r--Kave read and shall comply Date
with the items listed on the back.
Permit Fee: 30 Issued B
y _C���C_6�
Trunk Charge: Date Issued:
Assessment Fee: Receipt No.:
Partial Inspection: Comme nt I s Date Initial
Final Inspection Approved:
Date I nitfal
Rejected:
Keason
Date -T-nitial
** PERMIT MUST BE POSTED ON JOB SITE **
Wh-ite Copy - File Green Copy - Inspector
Buff Copy - Applicant
40-.7-1 tf
a
Side Sewer Drawing
The City of Edmonds EASEMENT NO - ----- ------------------------ ........
NEW CONSTRUCTION [Z REPAIRS [:] LID NO - ------------------ ASMT. NO - -------------------
OWNER ... G-kR-'J ..... ---------------------------------- CONTRACTOR -.L-uT-z-'s ..... Bp,,c�- K - k7A..cQ--.. -* ------------------- PERMIT NO. 74-SQ ----
JOB ADDRESS --- ratz ........ 9 ------------- --------- LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - - ------- -EDMOND-S ....
I TREATMENT PLANT
-------------------------------------------------------------------------------------------------------------------------------- ---------------------------------
PWW-0001-11175 (REV.11/78)
NAMEOF ADDITION ----------------------------------------------------------------------------- ........
S
61 z 9 Tl�l S,0 -
allcappc
r- (D I
C-.O.C^%P 1.5 OP.
� C)
's,op. 4W"c-0-W!bl6
9�
4"c- 0 - CAP
-ro SURF-^Cf_
Approved: By, /-iff0f.- ...............
DATE I #.-J . ....
APPLICATION
for
The City of Edmonds S11DE SEWER PERMIT EASEMENT No . ..........................................
NEW CONSTRUCTION n REPAIRS
108-03700
OWNER........... Roy-dohn-ld.l.b.ams ............................................... ----- CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ........ 6.1-2------9t4--AVenue ... Srtr ................................................ LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAME OF ADDITION
DYE TESTED OPI SEWER
JULY, 1972
Approved:
DATE................................................ By ........................... ..........................................