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6415 170TH PL SW.PDF947 - 6415 170TH PL SW ADDRESS: (-Ag 1-70"tl 2+ SbJ TAX ACCOUNT/PARCEL #: C)C)5 e)9 ? jC-00 00 BUILDING PERMIT (NEW STRUCTURE) #: COVENANTS (RECORDED) FOR: CRITICAL AREAS #: DETERMINATION: El Conditional Waiver E] Study Required Waiver CRITICAL AREAS #: DETERMINATION: Conditional Waiver Study Required Waiver DISCRETIONARY PERMIT #'S: DRAINAGE PLAN DATED: PARKING AGREEMENTS DATED: EASEMENT(S) RECORD FOR: PERMITS (OTHER - list permit #'s): PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID#: 1011 SHORT PLAT FILE: LOT: BLOCK: I SIDE SEWER AS BUILT DATED: =-7 SIDE SEWER PERMIT(S) #: GEOTECH REPORT DATED: STREET USE/ENCROACHMENT PERMIT #: FOR: WATER METER TAP CARD DATED: OTHER: L:\TEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc KI fhe City of Edmonds APPLICATION for EASEMENT NO -- -------------------------------------------- SIDE SEWER PERMIT CONSTRUCTION REPAIRS F� LID NO. ASMT. NO. OWNER .... . ........ ---------------- -- CONTRACTOR ............................... ------ PERMIT NO. -------------------- JOB ADDRESS ...... LEGAL DESCRIPTION: LOT NO . ............... ------- ----- BLOCK NO - -------------------------- ...................................................................... ........................................................................................... NAME OF ADDITION -------- . ......... ........................................................................ Approved: DATE By .............. ----------------- �M-�A% APFUCATION M The City of Edmonds for EASEMENT NO - -------- -------- -------------------------- SIDE SEWER PERMIT NEW CONSTRUCTION Ej REPAIRS LID NO. ------- ASMT. NO - -------- - -------- OWNER --------- ........ NO. 5Z71 - - --------- CONTRACTOR ---------------------------------------------------------------- ......... --------- PERMIT JOB ADDRESS -- ---------- 1.7 .�, v ------------------------------------------ LEGAL DESCRIPTION: LOT NO. NO - ------------------------------------ C—w— ------------------------------------ I ------------------------------------ ......................................................................... E2 NAMEOF ADDITION ---------- .................................. ----------------- ....................................................... Approved: DATE-------------------------------------------- By ------------------------------------------------------------ NOTICE: No warranty of accuracy. The information shown on the attached map(s) was compiled for use by the City of Edmonds, its Employees and Consultants. The City of Edmonds does not warrant the accuracy of anything set forth on these map(s). Any person or entity requesting a copy should conduct an independent inquiry regarding the information shown on the map(s), including, but not limited to, the location of any sewer 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 employees or officers shall be liable for the information given on map(s), nor for any one representation provided based upon said map(s). CITY OF EDMONDS - SIDE SEWER PERMIT WATER -SEWER DEPARTMENT PERMIT _7 Call 775-2525 for side sewer inspections BEFORE covering any Portion of the construction.1 Inspection will be provided within 24 hours after requst. No Sat., Sun., or holiday Inspections.) ADDRESS LOCATION OF CONSTRUCTION ... <,-4. � <n — Irl rk_4 P L_ :�]s ................ : ..................... ......................... .......... . . . ................. ............................................. PROPERTY LEGAL DESCRIPTION .......... — h�,� __ I 4A ........................ CA .......... 4��.4 ....... !� ................ ............................. ....................... . ........................... ........... .......... . ........................................................................ . .............. . .... ................................................................................. ....... . ....................................................... OWNER AND/OR BUILDER_.__S::;��A� n ...... ............................................. CONTRACTOR's NAME & ADDRESS ............ Permission Is granted ............ .......... 19-��for rePair and/or connection of a side sewer to the city sanitary sewer s EdAionds ,Wtem in accordance with City ordinances. k�&NTION IS CALLED 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 lUght-Of-Way Permit Obtainable from the City Engineer's office. NOTE No. 3—Obtain full Information regarding Ordinance 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 unliwful 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. DISAPPROVED C] Date ... . ................................... B Date ....... . ......... By ................ Date ............... ---------- "PROVED jEf Date..._ ---- ............... 'BY ---------------- . . .. ... ........ BY--- .. ............. . ........................................................................................ Remarks: ....... . ... BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection ....... . .. ..... ...... .... .. ... .. .. .. .. . . ..... ... . .... . ....... ( - Owne - r .. of .. Con . tract - Ing - Fi - rm - P . er . f . or . min . g - Con - str - u . ctio . n .... hereby certify that the side, sewer installation constructed under this permit WLItalled in accordance with all governing ordinances of the City of Edmonds. Datedthis ............................ day of ................................................................ P 19 ......... V V Check BEFORE You dig for: Water 0, Gas 0, Telephone 0, Power 0, Sewer E], Other 0 / V City of Ednods b-WAY CONSTRUCOAMt: I I FEB 18 1992 PERMIT 'ENGINEERING A. Address or Vicinity of Construction: Permit Number: Issue Date: '�? 6415 170 Place -,Southwest B. Type of Work (bespecific): Install New Service 9 0 1 9 C_0r1'%P 4-12-o-co-, C. Contractor: -Washington Natural Gas Company Contact: Frank Swans Mailing Address: 815 Mercer Street, Phone: 224-2278 State License #: Seattle, WA 98111 Liability Insurance: Bond:$ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. r! Commercial F] Subdivision El City Project g Utility (PUd, GTE, WNG, CABLE, WATER) F1 Multi -Family El Single Family n Other INSPECTOR: INSPECTOR: VV F. Pavement or Concrete Cut UYes []No( 1 ) G. Size of Cut: --,2 x 4 H. Charge$ APPLICANT TO READ - ; SIGN INDEMNITY. Applicant understands and by his signature to this application, agrees 'khe City of Edmonds haiwdes�s'o'm'm'ju'neqs, knages, or claims of any )Und or description whatsoever, foreseen or unforeen, that may be made against the Ciiy of Edmonds, or any of its departments or employ- ees, including or not limited to the defense of any legal proceedings including defense costs, and attorneyfees by reason of granting this permit. THE CONTRACTOR ISRESPONSIBLE FOR WORKMANSHIP AND I MATERIALS FORA PERIOD OF ONE YEAR FOLLOWV�Q. THi'F[J�AL INSPEC'77ON AND ACCEPTANCE OF THE WORK ES77MA7EDRESTORA77ONFEES WILL BE HELD UN77L THE FINAL STREET PATCH IS COMPLETED BY CI7Y FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. Construction drawing of proposed work required with permit application. A 24 hour notice is required for inspection; Please call the Engineering Dep4rtment- 771-3202. Work 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. I have read the above statements. and understand the permit requi . rements and the pink copy of the permit will be available on site at all timesfor inspecit . on v 0 1 Si nature: XA Date: February 7, 1992 b (Contractor or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK ....... .. :..DATE::-:.:� ...... ASSUED BY:. ISSUANCE Engrg. Div. 1991 FIELD INSPECTION NOTES (Fund I I Route copy to Street D�tplj Co'mments: Diagram: 0 CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO Partial Work Inspection by P. W.: Work Disapproved BY: FINAL APPROVAL BY: Date: Date: Eng. Div. July 1985 W hft� I ASatu 10 AWWvngton Energy Corn;-y b4V� RD �L 5W I IVE M Addendum to City of Edmonds Right of Way Permit Application Submitted by: Kerry Walsh Engineering Aide Washington Natural Gas 622-6767 x2761 pager RR5--�� C'ILO-Cl uoeio D20ss Rp�zv v�,� water gas sewer water hydrant 815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767 2111 2E ERM2NDS PUBI.JC WCPM — EWINEMIW3 ACTION REPORT N? 1.533, STH 7 SUSPENSE DATE: D a t e: T i m e: File # Attachmpntq: r--lyp� REQUESTOR: NAME: ADDRESS: PHONE: 5q b- /(a/.& REQUEST RECEIVED BY: TELEPHONE Ifs, CONTACT IN OFFICE r --- I OTHER: r--j RECEIVED BY(-`�� PmITF M. MM ffmm="Ma��WMMMM umlr��MMMM MM RM Ink, =am MM ACTION: 4AA1,e- W57 -517>e A7 Gq.�7-17oP1-,-,1.,r— 'w0i f"A c> a 14) -0 All Concerned Notified rpli Action Completed/File r-7 'o REGARDING: 641S - 170th Place S.W. 30 0 - 0/,Y/,o 0 (address) R E C 0 R D 0 F C 0 N T A C T S DATE NAME, PHONE NO., & COMMENTS ADDRESS of CALLER 7/17/75 Delton Swain Certified Letter No. 406704 sent US/30/75, —i M/11/75 ta Ui W .- I --- co requiring hook-up within 60 days. Mr. Swain came into office and obtained permit #5277. Connection completed. ACTION TAKEN INITIALS Letter received. JT JT M RECEIPT FOR CERTIFIED MAIL-30� (plus postage) —iIENT TO TMARK OR DATE Mrs_.__D�Q_jton Swain _Mr._Or STREET AND NO. 641S 170 th Place S.W. P.O., STATE AND ZIP CODE Edmonds Washington 98020. C) --PTTONAL —SERVICES FOR ADDITIONAL- FEE 0 1. Snows To whom and date elivered ...... .... 15 "'TURN RECEI PT With deliverY to addressee 0111Y - date and here delivered 50 SERVICES 1 2. Shows to whom ±thydolive'ry to addressee onlY 80 —DELIVER TO ADDRESSEE OR SPECIAL DELIVERY (extra fee required)... .. P S Form 3800 NO INSURANCE COVERAGE PROVIDED— (See other side) Apr. 1971 NOT FOR, INTERNATIONAL MAIL GPO; 1970 0-307-450