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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 wordata4ate6final • Incorporated August 11, 1890 • Sister Cities International — Hekinan, Japan n COPY 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 �o 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 e Incorporated August 11, 1890 • Sister Cities International — Hekinan, Japan N � _ _. _ >Y - If✓#T \ __-r- `� .�r�y� - _. 4A' - � L A'+�IT�I'� 2P' f4`i+Y" A - _. t 1✓ r , -'. J . .�: .�i %Br'��9" RC ",.iz�'1"�°'�`��. ,Y v���.f'�j^I +�7�'.�I�r"'i+��tL'ry�.�3� :�..'b".-'TY�yV.:'i•.._,Y'�i �`-Y.f'.•�Ya.. . i;�a.,�, � i., ;F 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 AV*"Von&*WC*TpWV Addendum to': City of Edmonds Right of Way Permit Application Submitted by: Guyla Connors Engineering Aide Washington Natural Gas 521-5248 `7l 2v 1 Co S N WNG to window N Water main depth unknown l " gas main r- I C� Imo(_._. S� Q . Key: -w- water -g- gas -ss- sewer $ water hydrant O water valve 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-------------------------------------------------------- -- %UI I L • 1 �'CE4P I FL . s. w 1�-1 WC�•Z• 3'G�P ��oroor 3� 4" PUS lea 1 O sL.. 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. ------------------------------------ 0 a ----------- ------ --------------------- -------------- ................. 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 ❑ + L, FIL 301-0 41666— 77 '-------------- a- Strcct ||iCht-of'Y.'n>' Existing Acccss Easements Existi Utility Fascuiont Yxisting REM) �-�� Lot Per Subdivision Plat |hduqgrnmu] �irinC !k*d, 1,cc�lxOLq�fLnyxi |�cvcx h� ' U i," ` ' } | -------------------- �--- _-� � ozsu//: `xrcy �nin � ' `:ucr uo � c U |�J�v't �i�c [�i�t�/`� ���- 1 Pe�ccLnr Oock ��tcr Ro�o�ro� ~` /-__ on 1h�P(�.C�ib« |�jrc '--- - U . .9izc / �/to 5 / � -_-_'_-_'_-__-___--__ Septic To± Permit PomdrcJ �rrni� �\`. __--___----- Sonit:r!' �n`:or 8nzilo|,ili "rc!i. , || � -__-_- | /7/ Side 3o'cr Arxilohi]it- 3aidtzry )mar Dxxuctioo �c, Pc(j11irc �a / i------------------------ ! Keni ' � c: � - . 'hto _ | (�m` / ! | 0Ircrc |�,pircd ~_----- Sto: .� | U [xcd Pxri jrrd Indicate oil �,'f-o ?I ' | ^~ p , ) [L/n n r� -----{ / `k�m� nxm��� lm5��mS��P� | ' '----' --'----- - Soil Conditions FI C.nmmd Kutcr |:iclJ '---------------------'--------' ' ^ | | |<cviry hy. i BUILDING DEPARTMENT Fill PERMIT Nw NUMBER ZONE 9 PERMIT APPLICATION IApplicant nside Heavy Lines _ I�SE A JOB ADDRESS /^O NAME )OR NAME OF BUSINESS") 26� M��ep ek VARIANCE OR COND. USE NO. NO. HEIGHT C JADB W 3 0 MAILING ADDRESS 7.5-o �„[/)'/(%/� J d CIT/Y� { /� /�(jJCDC (/1/ �/ TELEPHONE NUM BER f�'/IM O�/I / 77���y�G}/ L-f/ uJ / / i`RAPA9D9•Y ARDS ),eFRONT / 'SIDE REAR LOT COVERAGE SIGN AREA ALLOWED PROPOSED ENVIRONMENTAL REVIEW ❑ COMPLETE ❑ EXEMPT Z Z F- U NAME �C J7•-`1//T,t / REMARKS ZQ -IS LL W ADDRES A N/l,y/ /J� n �Y �TEyLLEPH/ONE PLANNING DEPT, APPROVAL DATE QCITY /C4'rT�� NUMBER i �J (�. `D��� LEGAL LOT LOT AREA S BDI VISION NO. WOOS` 7 ,�Y ES ❑ NO rL, jqE E NAME///��) /� !�% irvl / /J/J�� O /'f�(� �V ,I' STREET R/W EXISTING STREET R/W 5�Q FT. DEFICIENCY THIS PROPERTY COMP, PLAN ST, R/W 570 FT. FT. Q U ADDRESS / 15; O E o CITY L�.LfMGit/rff' TELEPHONE NUMBER REMARKS Driveway slope not to exceed those indicated on Standard Drawinja #103. U STATE LICENSE NUMBER CITY LICENSE NUMBER - CHECKED B (9 Z W 7 Legal Description of Property (Show Below or Attach Four Copies) a/c STREET AND/OR UTILITY WORK REO'D. ❑VES UNO R/W PERMIT REQUIRED El YES 460 2 Z W �•4'. � .Zap✓ lir/C ,�> UNDERGROUND WIRING REQ'D, YES ❑NO IL !Y U to W 0 J Q U W J @3 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 // W f Q 3 �� 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 Z O J a m 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 ,�� /l�'.P"�'"_ /1 / NO. PLAN CHECK VALUATION FEE pF, U N W 0 PLOT PLAN INDICATE BUILDING SETBACKS, ABUTTING STREETS) BUILDING PLUMBING - m Q HEAT & GAS LINE FENCE SIGN RETAINING WALL SWIMMING POOL '