6706 172ND PL SW.PDFI iiiiiiiiii
988
I
6706 172ND PL SW
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).
APPUCATION
for
%9 city of Edmonds STREE I FlLt siDE SEWER PERIAff
NEW CONSTRUCTION 0 REPAIRS
EASEMENT NO - ------------------------------
'- oLID NO. ;-- ; 1).---j,-AASj4T. NO. ----
PERMIT NO - ---------------------
- --- -------------- ------------------------ --------- I -----------------------
OWNER ---- L—� --------- -------- ...... ------------- ------- ------------ ............. CONTRACTOR
0. ---- ----- BLOCK NO - ------------------------------------
..... LEGAL DESCRIPTION: LOT N ---- -----------
JOBADDRESS ----------------------------- ------------------- ----------------------
---------------------------------------- ------------------- -----------------------------------------------
NAME OF ADDITION .......... ................
Approved: /A
DATE ....... ----------- n3 - -- ill- ----------------- -
- ----------------
_,77" 77'.�.,
-S1 SEW
CE, '0 ik
TY-1- 1PE iT
F E DMW 11DE
.WAT�kP.;-S-EWiER:DEPAIRT.M�ENT::
PERMIT :,T4
-(,,jC.aII for side: sewer inspectionsc iIEF�IKE ccver ngll,any� portio.n.'.of Ahe construed
_a ection wilV'be provided' within :24� hours after, requst., NO,.Sat.,, Sun.,,. or holiday. 'inspedtio a.
'RU
.....................
ADDRESS'LOCATION, OFJOONST CTION .............................................................. . .............................................. .........................
"IDESCRIPTION ........ ..............................
PROPERTY'LEGAL- . . ............ .... ...... :11:.:::Q1 .............. ......... ..4 ... . ...... �L4�=
.............. ...................................................... ...................................................... ............................................... ..................................................
............... * ..........
. ........................... ........................
.............................................. ............ OMINER �AND/OR BUILDER ....... :=4 ....... I ........................................ ... VVN
CONTRACTOWS MK�&ADDRESS ...... 7�,
NA ....... ... .. .......
.................................................................... ..... .............. ............... ............................
Pprinission Is granted'. ...........
..................................... 19 ...... for repair and/or -connectlon; of a side sewei to the city, sanitary sewei
In accorftnce!,WitIf'Pfty ofiEdmonds -ordinances
ATTENTION MCALLEMTO THEFOLLOWING:.
NOTE No. 1—The owners,',of',th�.Pr6perty may'-obtaln. a permit to construct sewer. inside propertyllne. A licensed Side Sewer Contractor must be employed to construct
side sewer in,strect area. Do not cover any portion of sewer before it has been.Inspected.
NOTE No., 2—All' wp�k performe'd,,in city right-of-way requires an Invasion of RJght-of-Way Permit obtain -able, from the City Engineer's office.
-NOTE No. 3—Obtain Jull, information�� regaxding Ordinance 11.16.030 arfdl-Regulations, governing side sewers -,when you get permit.
inches coverage�at property -in Ifea Inside,� property- line;, �mlnimum.,,,grade, oV 2%., Nw bends, IK grade
'4- oil�sldw4e mus !
NOTE No.� -To line and 12� c
sharp ' �r;tfiin.%,willlbe %permitted�
NOT I E No. I 5—Trcnch�s must be' water' settled. and; surface of street restored. to original conditio n. Contractors shal I I b6* responsible for, failure due: I. . ojmproper
work'which'may'deyelop within:one year of completion.
NOTE No. 6--It Js' 'unfawiull,; to, alter or-do-kry, other work. than Is provided f or.in the permit, or todo any.,Work. on the main sewer or Its appurtenances exceptAo In-
sert -the pipe,into thb. wye. :. . 1 . 1� I -, 1 1 , .
Date..' .. ........
DISAPPROVED -E] Date ... ... .......... B ............ .... ... .. ... ................. By ................ Date ..................................... Ily .... ..
APPROVED 'Date., ........ 7 ........................... .....
e ... .. . ....... . .................... . ..................... .... ............. ...........
;0 7
----------
Remarks: ................ .......... ........................... .............. ....... ................. ............... ........................................
.................................... ................... ................... 7 ................................................................. .................................................................................................................
B H Permfj�� 'r of Fir . m
OT -Copies,'MUST -Be Signed By",Owne 'Performing Coris ruction- PRIOR To RequestFor Inspection
............ ....... ............... ................................ hereby certif y,. that'�the side- sewer -installation conkructed: under this pemit
(Owner,' of',contracting Firm Performing, Construction).
waslnstall'ed in,accoidanice *JMali; g, ordinances� of the City, of'EdmoridS.
governin
bfi ................. 4
Date& . ........ ................................. ................ 19 ......... '.i
V.-j Che6kBEFORI
r,'y4?u dig. T�elephone Po*.ei7- �E3! ,.Seiy�r 9ther.-E].. V,,V,
The City of Edmonds
OWNER . ...........
JOB ADDRESS --- 7
--------------------- /
---------------
APPLICATION
for
SIDE SEWER PERM
NEW CONSTRUCTION REPAIRS E]
EASEMENT NO. -- ---------------
LID NO - ------------------ - ASMT. NO. -- --------------
CONTRACTOR ------ le,�
PERMIT NO.
LEGAL DESCRIPTION: LOT NO - --------- �7 ----------------------- BLOCK NO - ------------------------------------
................................................................. ------------------------------------------------------------------------------------------------
e -
NAME OF ADDITION --------------- ,-s
Approved:
DATE----------------------------- -------------- By
CITY OF EDMONDS STREET SECTION
STREET CUT REPAIR
UTILITY OR WQNS�- UORRERDER
ADDRESS OF PROPERTY
INVOLVED: K,70,1, 6 71Y; 70 3 DATE RECEIVED: BY
NAME: RECEIPT NO.:
MAILING ADDRESS:
BUILDING PERMIT NO.: R/W CONSTRUCTION PERMIT NO.: --3
SIDE SEWER PERMIT NO.: WATER METER PROJECT NO.:
STREET CUT DEPOSIT:
-----------------------------------------------------------------------------------
TYPE OF REPAIR: ASPHALT ROADWAY CONCRETE SIDEWALK CONCRETE CURB
WATER METER CUT UTILITIES CUT
----------------------------------- ---------------------------------------
TOTAL AREA REPAIRED FT. x FT., TOTAL SQUARE YDS./LN. T.
Sq. Yds./Ln. Ft. Minimum Charges @ $
Sq. Yds./Ln. Ft. Additional @ $ $
TOTAL COST ................ = $
FUND #620 DEPOSIT FEE ............................................ = $
TOTAL REIMBURSEMENT .............................................. = $
TOTAL ADDITIONAL EXPENSE TO BILL ................................. = $
STREET CUT REPAIR REQUIRED: YES NO
THE FINANCE DIVISION IS AUTHORIZED TO:
PREPARE A CHECK IN THE AMOUNT OF $ MADE PAYABLE TO THE ABOVE
BILL THE ABOVE MENTIONED COMPANY FOR $ , TO COVER ADDITIONAL
EXPEN5E--"\ IV-URRED BY T �EET PIV�SION ON THE ABOVE SUBJECT WORK
REQUESTED BY.0 M-W)APPROVED BY:
S'WET SUPERVISOR DXTE SUPT. P.W. DATE
VERIFIED BY:
WORK ORDER COORDINATOR DATE
R/W/FORMS
2/87 g:!)O AJ Z-
0
Z
U
14 7;
tI�Y OF EDMONDS Permit No.
COMMUNITY SERVICES DEPARTMENT
RIGHT-bF-WAY CONSTRUCTION PERMIT Issue Date
A. 9 Owner: C t� 6 26 B. 0 Contractor: ;7-1 C_
1�_a —Name
A, N� 0 ';'Dc�)(
Mailing Address Mailing Address
":) 1% 8 %Zc) Wri, 9U_7'L
City State Zip City State Zip
a C_ t C C t '�� (�� C3 — 3 & 3(
State License Number eI4hone Number
C. 9 Address or Vicinity of Construction: 0
Type of Work to be Done:L
D. 0 Work in Connection With
E. 0 Pavement Cut: 0 Y RN
';' Ir /
/"K) Sub or Plat
0 Commercial
APPLICANT TO READ AND SIGN
F. * Size of Cut:
El Single Family
0 Multifamily
— X
x0 ity Projects
utility
INDEMNITY: 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, forseen or unforseen, that may
be made against the City of Edmonds, or any of its departments or employees, including or not limited to the.defense
of any legal proceedings including defense costs, court costs, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
Estimated restoration fees will be held until the final street patch is completed by City forces, at which time a debit or credit will be
processed for issuance to the applicant.
• A 24 hour notice is required for mspe6ion, Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion--
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
ai ble
I understanct the above and that this permit must be av at the job site for inspection purposes at all times.
S Z o Date:
ignature-
Owner odContractor
Thi rPerimit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: -Y). -vo'xyh") PERMIT FEE: r30- 'tir /20
Time Authorized: Void after 3 0 —days. Restoration Fee:
Special Conditions
RELEASED BY:
Receipt No.: —
Fund I I I Fee:
Street Cut Dimensions:
Date] INSPECTED BY
Date
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. March 1989
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Deptj
Comments:
Diagram:
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
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