6615 172ND ST SW.PDF1111111111
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6615 172ND ST SW
PUBLIC VORKS. DERUITM CHECKLIST
ERMSTRM
, I f
BUILDING P FILE I r:>,- I 17,m 0 �Sr.S W
(address) (date)
Street Right -of -Way Exist' 0
in��M��J�&
0' QD
Z
I .
Access Easements Existing.
D
�A
g
Utility Easement Existing
D
W
Lot Per Subdivision Plat
Assessor Map
Site Plan Checked for Accuracy
Z
Underground Wiring Reqd.
F4
0
Check Accuracy of Legal Description
-76
Z
Review by A:A �Date
-146
Existing Water Main Size
Wa in Required -
Service uired
Hydrant Size Existi
Hydrant Reqd Per Fire Code*.
Size
Detector Check Meter Reqd.
Cross Connection Inspecti
Fire Department CO s
W �a
�tter Charge Reqd.
.,�'keview
by.
Date
Septic Tank Design Approved
Date
S e Tank t R'
P
S ic Tank Permit Reqd.
e
Permit No. Z-11"
ni' r A
y lqd lit
Sanit ewer Availability
Sa t ew 7 i abl
Pro'.
Dibrawing No.
File No.
1
Side Sewer Availab * ty
S S it S w r Co c
anitary Sewer Connectio ee Reqd.
:3:
Review by
Pff<
Open Ditch Existing
Reqd.
Culvert Reqd._
ze
P4
Catch Basin Reqd.
Indicat Site Plan
0
Shoulder drainage tain collection an swale open rnu3noff
Manhole d. Indicate on Site Plan
L
�Oil dit-inns and Ground Water Field Checked
tio
gioew
w y
by.
Date
TGvised: MO-1977
Page 2
Revised: iv 10-1977
F-I
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).
e .
T
The City of
APPLICATION
for
SEDE SEWER PERMIT
NEW CONSTRUCTION M REPAIRS -
EASEMENT No . .....................................
OWNE. f;?-Nh-A-PV-A W. Jbe-Ksc:t4 RMIT No . ......................
R.............................................................................................................. CONTRACTOR U."A ........ . ............
6-r-
ADDRESS Sn..7.177Z 2� . .3m E—� .- \,4 .. ........................... LEGAL DESCRIPTION: LOT No . ............. JL ............................. BLOCK No . ............................................
. ....... Yk ----------- , .......... .
0
0
q' - - 7140N
NAME OF ADDITION ...... V-4.0-42E . ...... Pt44*DMIl ..................... ...............................................
Approved:
By
............
DATE .... ... ........ ..
'Oe000$214 -41 C-J
1j; IT Y 01FEDMONIDS, ww��.R,�,`PERMVIV
DiPA
WAT-16 SEWER, 1RTMkNT
V M TIT 0,47
;E M,,
.76-1,1" for- side, s6,A�er Inspections. BEFORE' covering,',(any"portion, 4f the construction.
((,Cnas' I t 7
pection'will"be �pr v Sum��,orljhollday
ovidedl wlthlh� 2�,hours, after. request.. Nd,'Sit. inspections;
F CONSTRU, CTI GO 17?
ADDRESS'LOCATION 0 ON ........................................... ...................................................................... ......................................................
PPERTY LEGAL,IDESCRIPTION ............................................................. ! ...... ............................................. .................. .................... 7 ................. . ..........
RO 1, Hovdc- Ad"),
........................................................................... ............................................ : ....................................... ................................. ...................................................
D/OR BU
........................ . .......... OIVNIER AN ILDEW ....... ............. w*� ........... t� ................................... I ............. .
.................... ................... ............... * ........
Swr ccms t . 2 1 Sol -`nd Ave S 1.
CONTRACTOWSNAME & ADDRESS� ................................................................................ 1 ............................................................... ...................... I ...........
Permission Is granted ............. t
............................................... for repair and/orconnecti6n, of a side.sewer-,to the, city/ sanitary' �sewer
system in accordance wlth� -City of Edmonds- ordinances.
AT, ION IS' CA-LLED�'TO THE'FOLLOWING:
NO`1,,__.& 1—The owners, of the.property may obtain a, permit to,tcorfsiruct sewer, inside property,line. A.Ilcedsed Side Sewer Contrace6r must lbe,,employed to,construct
side sewer in street area. 'Do not cover -any portion of sewer before -it has! been ftispected�
NOTE No. 2—All work performed, in city right- of -way yequires,an� Invasion. of Mghfwof-Way Permit:,obt aina ble, from Ithe. C . Ity. Erigine6i-'s,Wfice.
NOTE No� 3—Obtaln full Inforrnation, regarding Ordinance 11.16.030, aj4,keguiations' governing,,side; sewers, whew,you-.get permit.
NOTE No. 4—Top I of side:sewer must have "'at least,30 incheis;,'coverage.�& I t.property .11ne-'and 12�,dn6�e , 9, lnsidc,�property�l . Inel;: mjnImum,.`grade'iof' 2 No.,bends; ini, -grade
sharper than 'A, will be- permitted.
NOTE No* 5—Trenches In street must be water settled and' surface of'street restored taoriginal: 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'. athe permit,, or, to, do, any. work on; the main sewer or�,its appurtenances.,exceptU in-
.sert the, pipe into ithe wye.,
a e� ...... .......................
DISAPPROVED E] Date ... . .............. .......... ......... D' t ...........
...................... By ......... ....... Date; .......... By
.... ......
. ........... By
........... ......... .................
APPROVED Date..... ..... .......... 15.
..........
Remarks: ........................
............................................................................... ...................................... ..............
....................... ......... .............
.......................................................................................................... .......... : ............................... ........... ................... .........
_BOT#Permlt C,opies:MU�STBe.Sig-nedBy-.Owner,of Fi�m,,,Performing.,"Q6n�trudtion: PRIOR, Toi Request'V�ot,,'Inspqction�,,�.,.
hereby.Lcertify that. ihe, sidb:'sewer installatibn co I nstructed, under this, permit
n e-r �__
8� rm Performing Cons ru i?'-,)
r
r
wn"e ..... ... C"'o'n'trac ri 1!uZt1.nl,
i nidst*.",
V.Lstal�ledtin, a rdance with,alr -govern ng ordinancest,oi the, City of vE#n. b
Dated' this ........
49..: ... *...day. of ..... . ... ... ..........................
Check BEFORE you dik for: Water- E],,; Gas �E],,, 'Telephone, Power� E],, 'Sewer,,[-],. Other iE],
The Cy�of Edmonds
M
APPLICATION
for
SME SEWMR PERaM
NEW CONSTRUCTION REPAIRS 0 EJkSEMENT No . .....................................
---------------- CONTRACTOR V ------- .................... ....... . ......... ........ ...... .... PEl;tlkM No.
............... LEGAL DESCRIPTION: LOT No.../ ........................................ BLOCK No . ............................................
t9
NAME OF ADDITION 0.te& .... IMP
....................................... ...........................................................
NoA
36
A
Approved:
DATE ......
---------- BY ------------------------ ---------