6612 172ND PL SW.PDF984
6612 172ND PL SW
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APPLICATION
The -City of Edmonds for EASEMENT NO . ............................ ............
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS F� LID NO . .................. ASMT. NO - -----------_----
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R C-1 E V�
OWNER ..... ----------------------------------------- CONTRACTOR ------- PE MIT NO. -----------
JOB ADDRESS .... . .. 774-�jo' .... F? t —.- -? --- LEGAL DESCRIPTION: LOT NO - -------------- I_C�l ------------------ BLOCK NO . .................... ...............
.. ........ -----
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NAME OF ADDITION E �: F T c aT r_: � 2-
- --------- .................................................
Approved:./
..............
DATE .. .. 4�Yg ........ �By .... .........
�7-7,
--7
NIT'
MY JON` IDS'i-t Sl: EkIM,
T-Y
',"OF :E DE SE,
WIATEE�SEWWiR, DEPARTMENT
PERMIT
�(,Cali,, i,j��525 ;for- side se%ver inspecti(lns� �B E . FORE' covering ri f the, constr�ictlo'
any, po Joni, ol
'Inspection will be �pi --aftbr requst., NO Sa Insp flons.
ovIde&.withIn,24 hours, t., Sun:,,,br holiday ec
dc:;,
Jack: ONSTRUCTI ............. ...... .............. ... . .....
AD 41 6FA6 11.. 1.. 7 WAI .... ..... ............... ...............................
;5_ DRESS5%-`
.�;,,'!PKOPERTY L1'E&k.LDESCR1PT10N ............ ....... ............. . ........ .... ..... ........... ............ ........... .........
..................................................... bl ............. ................................ ...................................................................... ........................................ ............................................
UTILD .... ....... %14 ................
.......... ...... ......... OMVNER ANWORB ER
............ .............. ....... ................... .............................
CONTRACTOWS'NAME .....
& ADDRESS ......... ....... 7- ... "Nv .... ...... L.. .......................... ..............
"'Permissionlis granted' ........ ............. 19_.PM.^,f6r`repa1r and/or d6nnedtiort-'of a si d6 -sewer* -to th& city sanitary sewer
s—lem-in accordance with City ofhdi6nds ordinances.
A T NTION, IS CALLED TO, THE FOLLOwING:
NOTE No: 1—The. owners-! of. -the, property may obtain a permit fo -construct sewer Inside property line. A licensed Side Sewer contiactor must. be ernployed, to.construct
side sewer, lnistireet' area. Do.not cover, any portIon of sewer before,it !has beenAnspected.,
N E —All-,work yierfor edi:in,.�clty, right-of-way requirew an InVasion of.R.Jght-of-Way Permit obtainable-from� the City Engineer's office.
OT No. 2 m
NOTE No. 3—,ObWri iulf,information regarding Ordinance 11.16.030�and!'Regulations' governing sid . e sewers when you jet perini - t-.
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NOTE No. 4--Top of slde�sewer must have at least 30 inches, coverage at propert� line and 12, Inches. Inside* pr�operty line; minimum. grade of 2 No bends. in �grade
sharper than 1/s miM.be permitted.
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,'mky.�develop withih one year of completjon�
NOTE) No. 6--it is� unlawful,.Lt6� alter or doz, 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 pip�.intoAh6,-wye,
wi p
DISAPPROVED -'Date ............ . ............... ------ By: ................ Dateii ...... ................. * ........ .. BY .................. Date ..................................... 'By .................
te
----------------------- .. .............. .........
D ........... ............ . By ...... ...... . ...............
�APPROVE aW ....... ..............
Remark ........................................................................ ................
. ....................................................... ......... ... ..... ................. ...............
............................ : .............................. ......... . ....................... .................. ...................................... ............... ............................................... 7 ........................... .........
BOTH P(
( 4vne, M..f eon-®ra
wA�s installed in accordance'
MUST Be Signed By 'Owne� of Firm . Performing. dbristruction ]�RIOR'Tib Request For InslJection
A
at o it
..... ...... hereby, certify that.'the'side-s6wer install. i: n' constructed under, this, perm %
1gr ion)
�' 1" 7 ;� rPor �ing-.nsiruct
th all governing ordinances of the City of'Edmonds.
..day of
Dated, thll,64-.xg� . . . . .. . . . . .. . . . . . . . . ... . . . . .. . . .. . . . . . . . . . . .. . 7 . . . . . . . . . . . . . . . . . . . . . . . . .
Check BEFORE�,ypp� dig for: Watci !,.Gas� Tel�p4i6ne. E],'�- wer, E], Sewer.,,,0,,,', Other E]� 41
_7
Tke City of Edmonds
APPLICA71ON
for
SIDE SEWER PERMIT
EASEMENT NO - ----------------
NEW CONSTRUCTION REPAIRS El LI��O . ......... --- ASMT.jt.,�p - ---- ------------
OWNER 0� - ------- ----------------------- CONTRACTOR --------- PERMIT NO.
JOB ADDRESS ---- — -- ---------- V. LEGAL DESCRIPTION: LOT NO. —.1-0 ---------------- ------ BLOCK NO - ---------------------------------
.................................................................................................................................... -----------------------------
NAME OF ADDITION ---- W.P.-P ... .5 -------- // �2-
RECEP.Irn
14AY 2f 1976
Pubk WOrks'l-r-
Approved:
DATE-------------------------------------------- By --------------------------------------------------- ri7YF