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630 ALOHA WAY.PDFiiiiiiiiii lill 10154 630 ALOHA WAY PAID JUL City of Edmonds --- Water Department TAP CARD NO JUL MeterNo ................. ............. I size ....... ..................... Date .............. TapNo .............. . . . ....... . ............ I Size ............. . .................. — Mfgrs. NO. ... Style .. . ....... . ..... . . ..... For .......... ............................... . .......................................... . ......................... . ....... . ....... . ....... . ..... . ..... .................... LotNo ........................................... Blk. No.� ...... . ..... . .... Add. ................................... . . . ...... .......... ......... ........ ..... Service Location ........ ....... .................................................. . . ... . .... MeterLocation .................... . ...................... . ....... . ...... . ....... .................................................. . .................................. . ....... ........ . ..... . . . ....... MakeTap ............................................... . .......... . .............................. ..................... .................. .................. . .................. . Pressure .............................. lbs. Test ........ . ........................... % SendBills to .......................... . .......................... . ....... . ....... . .... ... . .... Date of Work ..................................... ez ................ Foreman Guar. Voucher No ....................... 00 .. ............... $-0 ................ I .................. ..... Remarks: ... ...... . ................... I ...................................................... ......................... . ............... . .. :; . . . ..... . ...... . . . ..... ......................................... . ....... . ....... . ....... . .............. ............... . ..... . . . ..... . .......................................... .................................................. . ......................... . ... . ........... . ...... . ........ w ...... . . .......... . ................. . ................ . ...... . ....... . ....... . ......... OUTGOING Index .. . ..... Reg.....�..Route Bk .... —.stendL.-.Car&..— INCOMING Index .... . ... Reg..� ... Route Bk ... . ... Stenal.—CarcL.— M*al Chargeable to Installation M ' NO. SIZE :O�A_ DESCRIPTION RATE AMOUNT ------- rMeter ...................................... .............. . .............. ......... Meter Box .............................. .............. __0L 10.4) ............... .......... Meter Plate ............................ .............. . .... . ... . . ....... .............. .......... Check Valve .......................... .............. . . .... . ... .......... ............ ......... Pipe, Galv. Screw .................. .............. .. . ......... .......... ............. .......... Nipples ...... ............................. .............. . ......... .......... .............. .......... Bushings ....................... .......... .............. ............. .......... ............... .......... Plafii Ells ................................ ............ .. ........ .......... .............. J.1 ........ St. Ells ................................ .. . .............. J* .. ....... ... Tees .......................................... .............. ............... .. . ........ .......... . .......... .......... .............. .............. .......... ....... ?y ...................................................... ..... ii�� .. .................. .... .............. ...... ..... .... . ....... -------- ----- ......... ---- --- ........................................... --- . .......... 1_44F .................................... ------------------------------------ ............... ---------- --- ............ ­­ - ........... ----------- ................ . . . . . . . . . . . . . . .......... . . . . . . . . . . - - - - - - - - 7 - i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . - - - - - - - - - - - - - - 11 . . . . . . . . . . - - - - - - - - - - - - . . . . . . . . . . . - - - - - - - - - - - Material Chargeable to -Taps Connected NO. I SIZE DESCRIPTION RATE AMOUNT .............. I .......... Pipe, Black Screw .................. ............. ............. .... . ... .............. ........ Pipe, Galv. Screw .................. ............... ............. ......... .............. .......... Lead Connections .................. .............. .......... . ......... .............. ........... Curb Cocks .......... ................. ............... .......... . ......... .............. ........... Corp. Cocks ........................... .............. ............. ......... .............. .......... Unions .................................... .............. * ------------ --------- .............. .......... Saddles ................................ ... .............. . ­' ­_ .............. .......... Nipples .................................... ............... ---- - -- — --------- ............... ......... Bushings .................................. .............. .... . ... . .......... --------------- ---------- Plain Ells ................................ ............ .............. .......... Street - Ells .......................... ... ............. .... . .... .. .......... .............. .......... Tees .......................................... .............. ....... . . .......... .............. .......... Curb Boxes ........................... * ----------- * -- -------- * - -- --------- ............... .......... S. 0. Extensions .................... .............. ............ .... . .... ............... .......... Gates ........................................... ............... ............ ........... Plugs"..-' ------------------------------------- -------------- ------- ........... .... . . . Couplin gs- -- -------------- ..... ----- - --- .............. .............. .......... .......... Gate Boxes ............................ ..................................................... .............. ............. ..... . ...... ....... . ... .... . . ........... .............. .............. .............. .......... 44. .......... 7 ......... .......... 0*% .................................................... ....... : ................................................... .................... .. ........................................ ............... .......... . .. ......... . .. .............. .............. " ........ . ... . ......... - .... .......... .......... . ....... .............. .............. .............. .......... .......... .......... ........................................................... ........................................................... .............. ............... .............. ............. .... ... ... ------- - --- l- 10, - -------- ............... ............... U. .......... . ........ Jt ........................................................... .......................................................... Hours Time —Day Men ........ Hours Time Men .............. ............... ........... ....... . ... ....... . ... . ........ . .... . .. .. ..... ..... —Monthly. .. .... i .......... .............. . ........ Hours Time —Auto ............ ... .............. C Q luperintendence .................... . ... ... .......... . . Total .................. ... 0 L:1 TAX ACCOUNT/PARCEL NUMBER: bby,7)U0oom)o6b2- BUILDING PERMIT (NEW STRUCTURE): M LO i 00qq COVENANTS (RECORDED) FOR: CRITICAL AREAS,Z — DETERMINATION: E] Conditional Waiver F] Study Required Ej Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORDED FOR: PERMITS PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: CO BLOCK: SIDE SEWER AS BUILT DATEDDW +C5� SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE / ENCROACHMENT PERMIT #: WATER METER TAP CARD DATED: —7 1 U, I OTHER: L:\TEMP\DSTs\Fonns\Street File Checklist.doc de !Ift PERMIT, APPLICATION P-"BUILDING WY . OF �.EDMOHDS 10.1, A 7' T .V vo. -APO, P p er= ermit, liiilit�l 1h f-Ilowilig work, in a�c��.,*ifh the:, a&om, APPUCATION Ls hm-eby madefur a p=mt to con,,tma e submitted her' m-'th for appr6rA' panying plans and §pedfications. Two sets am �V, 0 -St.. ff new Z"'alter .;Parldng ................ ...... ... ............................ ..... . Work addn repair ...... ---------- zone ............ ... Fire Occupancy ................................ Const. type ...................... ......... Use zone ... .... 7 .... T Address--_-------------- .......... L ..... Blk; ............ .... Addn.. lo A eptic tank ........ .. .................... Lotfrontage ........................................ Area ............................... f, ...... .... ... 1. sidc ........................... ......... ............... r. side ....... Bldg. setbacks — frcmt ......................... 7 el ..................... LIU .......... ...... ./. ...... T ............. Ad ress 0 Builder-------_---------------- 1� ................................. Address ................................... .............. Tel., Tel. No. ........................ ................ Address ............................................. ................ ....... J- Plans by ......................... ...................................................................... ..... Remarks-------------------------------------------------------------------------------------- ......................................................... 'JA ............................... .......................................... .............................. ;L11 xpolicable Codes wid State. laws. r���, %,rl T narpp. fri rnmn1v Wit.'k I Lie 4-b Ove is a corz=t Ltatzm --- -- -- work. ate., lkddrm ............................................ D' ......... .. .... .. . ... . ...... Signed Owner/Agen .. ...... .. J' to the above conditions, and to Wicv a ""ITI for the above work is hereby approved, subject proved plam and specifications, and Building Department notations. thereon. .. ........... Valuation ............ Permit fee ...... ... . .. V ............. ............... Recd bY, Date ..... Building Department, By ................................................ .... .. ............ 1 .7 electrical installations, nordoes, it permit. any tbork; to be-� NOTE This Iperynit does -not cover plumbing, sewer, or et done in the RiVht of Way areas. Driveways and walkwaYs r.-,ust be planned.!o 'me the. official 'grades' Of stTeets and alleys, and plans for futui-e sidewalk development- APPLICATION The City of Edmonds for EASEMENT NO - -------------------------------------------- SIDE SEWER PERMIT 214-09250 NEW CONSTRUCTION E] REPAIRS E] LID NO . .................. . ASMT. NO - ------------------ OWNER............... DOR-,E.� ... MM--j)ri-el ------------------------------------------- CONTRACTOR ------------------------------------------------------------------------------------ PERMIT NO . .................... JOB ADDRESS ..... 6.30 --- Al-oha.j�qy.. .. .... ---- ------- . ........................... .................... LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO . .................................... , fl 0 0 NAMEOF ADDITION --------------------------------------------------- ................................................................... DYE TESTED ON SEIVER - May 6, 1976 By Jim Jensen Approved: DATE............................................ By ............................................................ 11/75