6628 170TH PL SW.PDFI 1111111111
966
6628 170TH PL. SW
APPLICATION
for
The City of Edmonds SEDE SEWER PERNaT EASEMENT No . ..........................................
STREU RUX NSTRUCTION REPAIRS 0
LID Jql 9-7)
EN PERMIT No. 44.a.4�,
OWNER-------------------------------------------------------------------------------------------------------------- CONTRACTOR ............. ........... ..... ....
7 T"
74::� PPL—
ADDRESS.............. I .................................................................. LEGAL DESCRIPTION: LOT No . ................ ................ ...... BLOCK No . ............................................
NAME OF ADDITION ....... 44::)L� ............................................................
0
V w
The City of Edmonds
APPLICATION
for
SEDE SEWER PERNaT
EASEMENT No . ..........................................
NEW CONSTRUCTION 5jr REPAIRS [:]
OWNER.......... P.�nA .. 1 - K ------- ------------------------------
ADDRESS ..... 6-6-64.-F .......... 1.70-E"A' S. . ..........
---------------------------
10
I
CONTRACTOR ...... �--& .......... PERMIT No.
C
LEGAI, DESCRIPTION: LOT No . ............. / ........................... BDOCK No . ............................................
NAME OF ADDITION ...... i4K ........
I
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
4466
PERMIT
Call 7,76-1107 for side sewer inspections BEFORE covering any Portion of the construction.N
(Inspection will be provided within 24 hours after request. No Set., Sun., or holiday inspections.J
6628 - 170th P1. S-W . ............................................. . .......................................................
ADDRESS LOCATION OF CONSTRUCTION...... --------------------------------------------------------- ddition 3, Lot 9 ........................................
PROPERTY LEGAL DESCRIPT91ON -----
.................................... ............. . ................................................................................................ . ............... ................................... ........................ .......................
ick............... - -------------------------------------------------------
OWNER AND/OR BUILDER ------- ...... . ...................
CONTRACTOR'S NAME & ADDRESS ..... --- 4.01.3 ... Sh-elby .�q�d.,...Lyn.nwo.od .........
... . ........ .... ............
Permission is granted ..... ...... . ............ 191�, for repair and/or connection of, a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
A' /--,\ TION IS CALLED TO THE FOLLOWING. mit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
N,, _,�O- J.—The owners of the property may obtain a per rtion of sewer before it has been inspected.
side sewer in street area. Do not cover any po f Right-of-W&Y Permit obtain -able from the City Engineer's office.
NOTE No. 2—All work performed in city right-of-way requires an Invasion o ou get permit.
NOTE No. 3--Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when y o bends in grade
ra roperty line and 12 inches inside property line; minimum grade of 2-/,. N
NOTE: No. 4—Top of side sewer must have at least 30 inches cove ge at p
sharper than % will be permitted. estored to original condition. Contractors shall be responsible for failure due to improper
NOTE No. 5—Trenches in street must be water settled and surface of street r
work which may develop within one year of completion. rk on the main sewer or its appurtenances except to in -
NOTE No. rIt is unlawful to alter or do any other work than is provided for in the permit, or to do any wo
sert the pipe into the wye.
- --------------- - ------------------- 'BY ................
................ By ---------------- Date ............ ------------
DISAPPROVED E] Date --- - ---- ... �ate
, 1 .7 - ...............................................................
APPROVED Date ------- ...... BY --- - ----
Remarks: ..................................................... ............................... .............
..................................................................... . ........................................................................................ . .................................. . .......................................................
B02TKPe C ies Signe By owner of Firm Performing Construction PRIOR To Request For Inspection
B
tructed under this permit
..... .......... .... hereby certify that the side sewer installation coes
e of nt g Firm Perfc;rming Construction)
--Nst d in accordance with all governing ordinances of the City of Edmonds. Iw7
4,,- f ........ .................................... ..
Dated this ----- /,.2 .......... day o
,j -� Check.BEFORE you dig for: Water E], Gas 0, Telephone F1, Power El, Sewer [], Other C] -4 4