7120 165TH PL SW.PDF925
7120 165TH PL SW
STREET' ADDRESS FILE
CITY OF EDMONDS
7110-210TH ST.S.W. - EDMONDS, WA 98026 - (206) 771-0235 - FAX (206) 744-6057
COMMUNITY SERVICES DEPARTMENT - PUBLIC WORKS DIVISION
July 22,1997
CERTIFIED FINAL NOTICE
JOHN CARMODY
7120 165th PL.W.
Edmonds, WA 98026
BARBARA FAHEY
MAYOR
Subject: Backflow Prevention Assembly Testing - Account #305375
On June 2, 1997, you were notified by letter that your backflow prevention
assembly was due for annual testing.
On July 1, 1997, the second notice was sent which stated that you had 15 days to
take care of this matter. Failure to comply, according to the City of Edmonds
Ordinance Chapter 7.20 and Washington State codes WAC 246-290-490, water
service to your premises will be discontinued if test results are not sent to me
within 20 days from the date of this letter.
Should you have any questions or concerns, please contact me at 771-0235,
extension 644.
Sincerely,
,:: r,_ ���`- 7!;
- ,
Linda McMurphy
Water Quality Control
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• Incorporated August 11, 1890 •
Sister Cities International — Hekinan, Japan
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CITY OF EDMONDS BARBARA FAHEY
MAYOR
7110-210TH ST.S.W. • EDMONDS, WA 98026 • (206) 771-0235 • FAX (206) 744-6057
COMMUNITY SERVICES DEPARTMENT - PUBLIC WORKS DIVISION
/Ist. 189v
June 2, 1997
John Carmody
7120 165th PI. W.
Edmonds, WA 98026
Account #305375
SUBJECT: BACKFLOW PREVENTION ASSEMBLY TESTING
Our records show the backflow prevention assembly(s) in your water supply system is due
for annual testing as required by state code WAC 246-290-490. Please have the testing
performed by a person holding a certificate of competency as a Backflow Assembly Tester,
issued by the state department of social and health services (telephone 1-800-525-2536).
If your assembly(s) fails its test, please have the necessary repairs made. Upon completion
of a satisfactory test, have the certified tester fill out the enclosed test and maintenance
report (see attached form) and return it to this office within thirty days from receipt of this
letter.
Additional information relative to this matter may be obtained by contacting me at 771-
0235, extension 644 between 7:30 AM and 4:30 PM Monday thru Friday.
Sincerely,
Linda McMurphy
Water Quality Control Specialist
Enclosures
BKFLIST.WPS
• Incorporated August 11, 1890 •
Sister Cities International — Hekinan, Japan
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CITY Y OF EDMONDS BARBARA FAHEY
MAYOR
7110-210TH ST.S.W. • EDMONDS, WA 98026 • (206) 771-0235 • FAX (206) 744-6057
COMMUNITY SERVICES DEPARTMENT - PUBLIC WORKS DIVISION
CSt. 189v
July 1, 1997
John Carmody
7120 165th PI. W.
Edmonds, WA 98026
Account #305375
SECOND NOTICES
A previous letter was mailed to you requiring testing of existing backflow prevention
assembly(s) installed in your water system.
Our records show that to date, the necessary inspection test report has not been received. In
order that such assemblies continue to operate properly in protecting water quality, they must
be tested and serviced when required. Accordingly, you are required to have your assembly(s)
tested within 30 days from the date of the first letter. The tester must complete the enclosed
inspection test report(s) and return them to our office.
If the required test report(s) are not received within 15 days of this letter, water service to the
premises may be discontinued as provided in the city of Edmonds ordinance chapter 7.20 and
WAC 246-290-490.
Additional information relative to this matter may be obtained by contacting me at 771-0235,
extension 644. Please disregard this notice if you have already submitted your test result
form(s).
Sincerely,
C11-
Linda McMurphy
Water Quality Control specialist
Enclosures
BKFL2ND.WPS
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Sister Cities International — Hekinan, Japan
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City of Edmonds
�- RIGHT-OF-WAY CONSTRUCTION
RMITPermit Number. dV
STREET FILE
Issue Date: /0 ]c2c
w
A. Address or Vicinity of Construction: 1170 165 pT. SW (9127635)
18 9p 19 C B. Type of Work (be specific): Install New Service
C. Contractor: liashington Natural Gas 1.0- Contact: Frank Swan
Mailing Address: 815 nMercer Street Phone: 22462278
State License #: ea e, Liability Insurance: Bond: $
D. Building'" Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ® Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR: V%r ✓�
F. Pavement or Concrete Cut: Lid Yes UNo G. Size of Cut: 1 .2 x 4_ H. Charge $
at Gas 10' Sott -)of Centerline
APPLICANT TO READ AN s ,SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to o he City of Edmonds harm[ei�ii uris; t{amages, or
♦ ^ claims of any kind or description whatsoever, foreseen or unforeseen, that may be m 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, 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. F'k� FSTIMATF,D RF,STORATIO2SWLL BF. HFLD UNTIL TH�FINA STET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMER DEBIT OR CREDIT W1 E PROOF, S� D FOR ISSUANCE, T T.I ANT.
Construction .drawing of pyoposed work required with permit application.
A 24 hour notice is require$ for inspection; Please call the Engineering Division, 771-0220.
Work and material is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shall be kept clean at all times. f
Traffic Control and Public Safety shall be in accordance with City regulations as required by.. the Cityli rigineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the tnd o tl working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of theperm.it luill be
available on site at all for inspection purposes.
Signature: Date: Oetoher 1 1 , 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: l0 6 LAA RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER MCC— Z L DAYS DISRUPTION FEE/FUND III:
SPECIAL CONDITIONS: t"r Ar RESTORATION FEE:
_ 4 ' PERMIT FEE:
TOTAL FEE..
COMMENTS: RECEIPT FEE:
DATE: ISSUED BY: 5z- i2 ^�
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
FIELD INSPECTION NOTES
Comments
Diagram
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION ❑ YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
❑ NO
ason
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Addendum to': City of Edmonds
Right of Way
Permit Application
Submitted by: Guyla Connors
Engineering Aide
Washington Natural Gas
521-5248
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Key:
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815 M=cr St. (P.O. Box 1869). Seattle, WA 98111 (206) 622-6767
APPLICATION
The City of Edmonds for EASEMENT NO . ............................................
STREETFILEWREPAIRS SIDE SEWER PERMIT❑ CONSTRUCTION � LID NO ................... ASMT. NO. _--..............
OWNER---------I��-----ti------------------------•---•------- CONTRACTOR ._.� PERMIT
JOB ADDRESS --- 71_ZU--- ........... LEGAL DESCRIPTION: LOT NO. ---••------- ------------------------- BLOCK NO. .......... ._........................
----------------------------------------•-----------------------------•--•--•------.._.._....-- •-------.....................................................
NAME OF ADDITION ----- EW--------------------------------------------------------
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Approved:
DATE 1�---- BY
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT EASEMENT NO- --------------------------------------------
NEW CONSTRUCTION �/r REPAIRS E] LID NO- ------------------ - ASMT. NO. ----.-------------
OWNER ----- #L ...... te�e—1 C
----- - r- --- � -- C --------- CONTRACTOR -------
^ ------- ------------- -------- PERMIT NO.
JOB ADDRESS ----- ----- /-, -- --------------- ----------------------------------------------- LEGAL DESCRIPTION: LOT NO. -------- / ---------------- -------- . BLOCK NO. ------------------------------------
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----------- ------ --------------------- -------------- .................
NAME OF ADDITION ....... 6' e,/--Zn ............
Approved:
31
DATE
* -------- By ---------------- * ---------------------------------- Vi7fg
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
PERMIT
/Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.`
Inspection will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections.)
ADDRESS LOCATION OF CONSTRUCTIOON....._ ........ . .............. .. .... p .:_........... ....................................................... 3
PROPERTY LEGAL DESCRIPTION ......... !!.... �11 t V -*-� , q• .dl eR ......................
....••----•-----------------,'.......t ....................--.................................................
.................................................. _...................... -........................................................................ _............... .................................. _..................................................
----------------•--••----•••-•••--------------------,---........OWNER AND/OR BUILDER--...----•-...!t:�..•...........--I�i\._ �...e::^t":.6 --------- .............................................
CONTRACTOR'S NAME & ADDRESS.........---.tv..��. D-��-_.
t.—�--•------�•.e -= :.gin......... -
Permission is granted .......�.`_ - ^:..---.. �_...-----.--, 1917, for repair and/or connection of a side sewer to the city sanitary sewer
s, -" vn in accordance with City of Edmonds ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The own- f the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
side. se 4 �-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-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtaini,&ll•ihformation regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No:'•4—Tap of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2 0• 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 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 the permit, or to do any work on the main sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED❑ Date ... -.......... ---- - --- By---•-.......... Date------........ P4......... By ---------------- Date ............... -................... By .................
APPROVEDDate..-_.. �L�i� rS �.,77-------- By....... ................... ----_.._.............................. _.........................................................
Remarks: ....... _...... _.......................... _.............................................................. _...................................... _................... ...............................................
— BOTH Pe Cop" S gned By Owner of Firm Performing Construction PRIOR To Request For Inspection —
------ r--------- •------------------------------ ---- hereby certify that the side sewer installation constructed under this permit
(Owner of Contracting Firm Performin onstruction)
was installed in accordance with all governing ordinances of the City of Edmonds.
Datedthis ............................ day of ................................................................. 19.........
Check BEFORE you dig for: Water ❑, Gas ❑, Telephone ❑, Power ❑, Sewer ❑, Other ❑
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PERMIT
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ALLOWED PROPOSED
ENVIRONMENTAL REVIEW
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REMARKS
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COMP, PLAN ST, R/W 570 FT. FT.
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ADDRESS
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CITY
L�.LfMGit/rff'
TELEPHONE NUMBER
REMARKS Driveway slope not to exceed those
indicated on Standard Drawinja #103.
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
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CHECKED B
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Legal Description of Property (Show Below or Attach Four Copies)
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STREET AND/OR UTILITY WORK
REO'D. ❑VES UNO
R/W PERMIT REQUIRED
El YES 460
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UNDERGROUND
WIRING REQ'D, YES ❑NO
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TYPE CONNECTION NAY YES
SANITARY SEWER ❑ NO
VERIFIED BY
SEPTIC SYSTEM
APPVD BY CITY ENG, ❑ YE
R NO
PERMIT NUMBER
_.
REMARKS
METER SIZE
SERVICE SIZE
CLEARANCE
CHECKED BY
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1\/1 NEW ® RESIDENTIAL ❑GAS
VX^fl LINE
IE]
REMARKS
FIRE ZONE
TYPE OF CONSTRUCTION
CODE
NON-RESIDENTIAL ❑ SIGN
❑ ADD ❑ DEMOLISH RETAINING
❑ WALL
1-1ALTER ❑ EXCAVATE FENCE
OR FILL a ( X FT)
REPAIR PRE -MOVE SWIM
INSP. ❑ POOL
I:
W
SPECIAL INSPECTOR AREA
REQUIRED
❑ YES ❑ NO
OCCUPANCY OCCUPANT
GROUP LOAD
PLAN CHECKED BY THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31
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NUMBER OF STORIES
NUMBER OF /
DWELLING
UNITS
REMARKS
NATURE OF WORK TO BE DONE
CaN S -,e kf_Cy1j,6,_jC7 �
PROPOSED USE
USE',(J ,��
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NO. PLAN CHECK
VALUATION
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BUILDING
PLUMBING
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HEAT & GAS LINE
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
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