630 HEMLOCK WAY.PDFiiiiiiiiii lill
11487
630 HEMLOCK WAY
CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.)
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.
ADDRESS LOCATION OF CONSTRUCTION ..... ....... \A./..A.V .................... ........................................................
.... . ... ...
PROPERTY LEGAL DESCRIPTION --- AA COS- ........ W.A
'0 .... 0- ........................................................ ....... ...............................................
....................... . .......................... . ...................... . ......................................................................................... ................................... ..................................................
................ OWNER AND/OR BUILDERJ...)�F.. --- S.14 . ....... r) () Aj
................................................ .......... Ic . .................... . ............... .......................................
CONTRACTOWS NAME & ADDRESSIY.AJ..�14 ... W..0_n..D .......... EAALEJ9
-------------------- - -------------------------------------------------------
;dbiission Is granted ......... 2 ... ZI .......................... 19-7-2 ' for repair and/or connection of a side sewer to the city sanitary sewer
gnpom in accordance with Cit� of Edmonds ordinances.
ATTENTION IS CAM D TO THE FOLLOWING:
NOTE No. 1—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.
NOTE No. 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—Obtaln full information regaxding Ordin are � 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 % will be permitted '
NOTE No. 5--Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for failure due to improper
work which may develop within one year of completion.
NOTE No. 6—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.
DISAPPROVEDE]. Date ... . ................................... By ................ Date ........ ..... .................. By Date ............... . ................... By ---_----------
e B ...... .......................................................
APPROVED Dat ... . ....... ........ t ---- - --- 7 --------_----------------
- --------- ---- ------ I . . . ...... . . ........ . .... . . . .. .... **'7',-*"* --------- * -------- * ..........
Remarks: .......
..................................................................... . ............................................................................................................................ . ............................................. .........
BOTIPPermit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
hereby certify that the side sewer installation constructed under this permit
*I . . ................... - ---------------------- ---
(Owner of Conimc-�i:n�g--- �rm-��eriGrming Construction)
was installed in accordance with all governing ordinances of the City of Edmonds.
Dated this A LJ ..day of__�l
. ......................... ..........................................................
V V Check BEFORE you dig for: Water C], Gas E], Telephone E], Power [:], Sewer [], Other E] V j
v
APPUCATION
-The City of Edmonds for EASEMENT NO - -------- ---------------------- ------------
SIDE SEWER PERMff
NEW CONSTRUCTION El REPAIRS F-1 LID NO - ------------------ - AsmT. NO - ------------------
OWN P� -------------------- ---- TRA R
------- --------------------------------- CON CTO ------ v -------------_-------_- PERMIT NO.
............. _jLj
JOB ADDRESS .................. .... I - - ----_------------- LEGAL DESCRIPTION: LOT NO. ---------------_---_-----_ BLOCK NO. __ ............. ----------
------------------------------------------------------------------------------------------------------------------------- ----------------------------------------
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iNAME OF ADDITION ........... ................................ ------------------------------------------------------------------------ _
y 7TE
---------------------------------------------------
APPUCATION
The City of Edmonds for EASEMENT NO. ---- --------------------------------
SIDE SEWER PERM
NEW CONSTRUCTION N REPAIRS 0 LID NO - ------------- -- ASMT. NO - -----------
OWNER ---- ----------------------------- --------------- CONTRACTOR
.... . .... - ---------------------------- ---- 7 ........... PERMIT NO.
JOB ADDRESS --- ------- WCS--fl ---- LEGAL DESCRIPTION: LOT NO - ------- --------------------- BLOCK NO . ........ ------------- -------------
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NAME OF ADDITION ------ ----- c=,F= .... EF� ............................
Approved:
DATE I�y ..... - ---- --------
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OM-[1, LIST
� Dl/ID)TNC PE/NIT ��'T'::/
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Utility Fascmcnt Existing
Lot Per SJ`JirisjPlat --- Assessor 7b '
Site Plan O`uc]r6 for Accuracy
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Smpl-ic Tan',
Date
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Culvert P.0
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Soil [w di i F, (1.0W 1"'ater Field /
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Date �
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BU11DING DEPARTMENT VIP,
Applicant Fill
PERMIT APPLICATION Inside Heavy Lines
USE E PERMIT
ZON NUMBER
JOB
ADDRESS
N;kM :JOR NAI�_F_ OF BUSINESS)
VARIANCE OR COND. USE NO. 'ADB
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HEIGHT
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CITY TELE PHONE NUMB R
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]REMARKS
RRa1=05 YARDS
0 FRONT SIDE REAR
ILOT COVERAGE
SIGN AREA
ALLOWED PROPOSED -7
NVIRONMENTAL REVIE�V
0 COMPLETE 0 EXEMPT
NAME
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PLANNING DEPT. APPROVAL
ELEPHONE NUMBER
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LEGAL LOT 11-11 ^111 S_1Zb1VN Nu.
&�YES FIND 5_1 _7
STREET R/W -30
EXISTING STREET R/W FT. DEFICIENCY THIS PROPERTY
COMP. PLAN ST. R/W 10 FT. C>FT.
-HONE NUMBER REMARKS Driveway slope not to exceed those
indicated on Standard prnwing gln'i
LICENSE NUMBER CHECKED BY,
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STREET AND/OR UTILITY WORK R/W PERMIT REQUIRED
REQ'D. 9YES El NO CYES E) NO
UNDERGROUND
WIRING REQ*D. 19 YES C3 NO
TYPE CONNECTION YES VERI IED B
SANITARY SEWER N 0 ui IT Q
SEPTIC SYSTEM PERMIT NUMBER
APPVD BY CITY ENG. YES
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REMARKS
METER SIZE ISERVICE SIZE ICLEARANCE [CHECKED BY
2-7
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REMhR`KS
AS
NEW -RESIDENTIAL F-1 -LINE
NON-RESIDENTIAL SIGN
ADD
DEMOLISH RETAINING
1:1 WALL
ALTER EXCAVATE FENCE
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FREPAIR PRE -MOVE swim
7 INSP. POOL
FIRE ZONE
TYPE OF CONSTRUCTION
ICODE
SPE -T
REQUIRED
C YES 1:1 N07�7
OCCUPANCY
GROUP
OCCUPANT
LOAD
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OFOUEDMONDS. �LOCAL.OSALES TAX
SH LD BE COD D' 31 4_
REMARKS
NUMBER OF STORIES
NUMBER OF
DWELLING
UNITS
NATURE. OF WORK TO BE DONE
PLAN CHECK
NO.
VALUATION
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PROPOSE SF_
PLOT PLAN (INDICATE BUILDING SETBAC S,
ABUTTING STREE��)
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HEAT& GAS LINE
FENCE
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RETAINING WALL
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CITY OF EDMONDS
ENGINEERING DEPARTMEf
APPLICATION FOR RIGHT-OF-WAY CONSTRUCTION PERMIT
(AppZicant to Cc.7Zete A & B and Submt in DupZicate)
Permit to be issued to: VN Vt. W �_%J Q V, -t CC" r,
For work at: (address or vicinity) 0C_ Lcl� x
Type of work to be done: S e \-!-�
(Attach Drawing When Applicable)
Time Required -- Etart: Finish: 4- P
Owner: P... VIT*- V- dt-
Name
. pot
Mailing Address
0-4 N , ,
City State
Contractor: Lv w p
--/ 2<�p we
Name
at, S( ? z/--
Mailing Address
city State
Telephone Number
State License Number
Telephone Number
INDMITY: 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 applicant or the City of Edmonds, or any of its.departments or employees,
including but 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 acceptancq
of the restoration by the Engineering Department.
'Work subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by the Engineering Department.
Call 775-2
Signatu�L-4.�-,� >
Owner or Agent' Date Signed
DO NOT WRITE BELOW THIS LINE (To be completed by I88uing Agency)
Permit Issued (DateZTO Uri. 810971
Fee:. S I Z I t5t)-
Time Authorized:
Permit Number 77-140
Bond:
W;
-11-7-7
DATE
10�177 0 0