7001 MEADOWDALE BEACH RD.PDF11111111111111
12300
7001 MEADOWDALE
BEACH RD
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT NO - ----------------------------------------------
NEW CONSTRUCTION REPAIRS LID NO - ------------------ IASMT. NO - ------------------
OWNER —H -------- Kt-4v—`F"PE-7� ................................................... CONTRACTOR --- RL-1565? ........ _kZZ)Ht4_5�t ......... ........ --------- PERMIT NO.
JOB ADDRESS KA-Eatbz, 1� �.A — ------------------ BLOCK NO - ------------------------------------
Q -C>4h ---- --- --- --- RC> LEGAL DESCRIPTION: LOT NO - -----------------
..................................................................................................................................................................
NAME OF ADDITION ------- 1-::) .............................. .......................................
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The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION P,-' REPAIRS E]
OWNER --- // ...... IL.zz
JOB ADDRESS ...... 1 -.7 Vc6()0jW-
------------ /--& --� ----------------------------------
onrc H RO
EASEMENT NO - ------------------------- ------------------
LID NO - ------------------ ASMT. NO - ------------------
CONTRACTOR
---- /- - ----- : .5 ----------------
LEGAL DESCRIPTION: LOT NO - ---------------------------------- .-.. BLOCK NO - ------------------------- ----------
----------------------------------------------------------------------------------------------------------------------------
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NAME OF ADDITION --------- �9-/ -/'.. --------------
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i , C OF EDMONDS
IT`j - SIDE
WATER -SEWER DEPARTM fiWER PERMIT
ENT
PERMIT No.
Call 775-2525 for side sewer Inspections BEFORE covering any Portion of the construction.)
Inspection will be provided within 24 hours after requat. NO Sat., Sun., or holiday Inspection
5653
ADDRESS LOCATION OF CONSTRUCTION .... IOCA
PROPERTY LEGAL DESCRIPTIoN ...........
...................................................................................................................
...................... . ............................ . ....................... .................................................................................... * ----- ---------------------------
----- - ------------------------------------------------------- 014WERAND/OR BUILDER ...... : .............................
. . ....... . .......................................................
COXTRACTOR'S NAME & ADDRESS .............
... ...............
.. ....................... . .......................................................
Permisslonts granted -1
........... . .... — ..... . ........... 119.6 ... LXr-for repair and/or connection of a side Sewer to the city sanitary. Se
'�tezn in accordance with City of Edmonds ordinances.
wer
ATTENTION 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-wav requires an Invasion of I;Ught-Of-WaY Perrait obtain ble fri m. the City Engineer's offl
NOTE No. 3—obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when You get permit.
�40TE a 0 le
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 respo
work which may develop within one year Of completion. risible for failure due to improper
NOTE NO. 6--It is unlawful 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 -
DISAPPROVED0 Date --- - ------------------------------------ By ---------------- Date ............... . ................... BY ----------------- Date ............... . ................... By ......
APPROVED 9( Date.—AQ--c; ..... /4 .. 7C ....................... BY --- - ---- .... ..........
I---------------------------------------------------------------------------
Remarks: ........ ...... . .......................... . .. . .......................................................... . .....................................................................................................
......................................... ...................... . ................................................................................... ......
.......................................... ..................................................
was
tie Signe d By Owner of Firm Performing Construction PRIOR To R TFor �In,�pe;,ti..
rform ....... ** ---------- * ..... .... hereby certify that the side sewer installation constructed under this permit
'ing Construction)
governing ordinances of the City of Edmonds.
Dated this ............... . ........... day of ...... .....
I.,neaft BEFORE you dig for: Water --------- —.1 . . .........
El, Gas 0, Telephone t], Power C], S
ewer[], Other[j
I �
61 ' TY OF
ENGINEERING
S4!�E, E T
APPLICATION' FOR -RLGHT�-bF-14;�kY CQNSTRUCTION PERMIT
(At)rZs'c---nt to, ��.-.-jtete A & cnd submit in raz)Zicate)
-.-.PermiE to,be issued to:
EDMONDS
DEPARTMENT6.6
For work at: (address or vicinity) -70 1-
Type of work to be done: Al
(Attach Drawing When Applicable)
Time Required -- Etart:
Owner: 14 1 91, V:L�1'
Name V
7 oc) / &-�
Mailing Address
City State
Contractor: V tz
'4
Name V V
Mailing Address
City State
Finish:
M
Telephone Number
State License Number
Telephone Number
FIL E
IN`DE'.1!',11ITY: 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, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including but not limited to the defense of any legal proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the co�tractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Department.
Vork subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by the Engineering Department.
Call 775-2525.
e) Signatur
Owner or Agent Date - Signed
DO NOT WRITE BELOW THIS LINE (To be conTleted by Issuing Agency)
A 4
Permit Issued (Date)A--Nq 12 7 Permit Number
Fee:-. N (r). Bond:
Time Authorized:
INEER
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