717 DALEY ST.PDF11111111111111
10757
717 DALEY ST
CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT e 0 5844
!Call 775-2525 for side sewer inspections BEFORE covering any portion of the construction.
1
\Inspection will be provided within 24 hours after requst. NO sat., Sun., or holiday inspections./
ADDRESS LOCATION OF CONSTRUCTION...........!- ......... _..QCF! �...........................................__
PROPERTY LEGAL DESCRIPTION ..................•._.....:..� s 9.�,................�ti'"7 �!--... .»..... ...t............_........._...._...._...........................
..........................................................................._.......__.......------------...._..---...._........................._.................. _.................................. _..................................................
.................................................... ,:........... OWNER AND/OR BUILDER ............... ....... �. �._.......................................................
ACTOR'S NAME & ADDRESS.__._.......1G '.a-�''- ................ 1.+,... ........................ _....
...................................................
Ion is granted ........ :_-_ SILb�4..._.?'= ........:............ 197-11 for repair and/or connection of a side sewer to the city sanitary sewer
system in accordance with City of Edmonds ordinances.
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-way requires an Invasion of Right -of -Way Permit obtainable/from the City Engineer's office. -
NOTE No. 3—Obtain full information 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%,. 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_..._. ... By......_..... Date ............... _................... By_.....::.,.::..:.
APPROVED Da By.... _ ............................... . .. ....
Remarks: ...................... ................... ........ ........... .. •--........... _..----.................. _.... _. _..................
I,
was
in
...-.........................•............................_._._.........._............_....._...............................---_......_.............._._................................
C Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection —
__._ hereby certify that the side sewer i lation constructed under this permit
erforming Construction)
governing ordinances of the City of Edmonds.
Dated this ... ...................day o .._..................----.........................::...... 19.7,7
Check BEFORE you dig for: Water ❑, Gas 0, Telephone ❑,
Other ❑ V ,/ .
I
TAX ACCOUNT/PARCEL NUMBER: t7D",+zes3D3qb0
BUILDING PERMIT (NEW STRUCTURE): M -7-7O 15q
COVENANTS (RECORDED)
CRITICAL AREAS f� DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER): (%
PLANNING DATA CHECKLIST DATED: 3I 11-7
SCALED PLOT PLAN DATED:
SEWER LID FEE $: LID #:
SHORT PLAT FILE: r7 I l LOT: 34--, O BLOCK: g'J
SIDE SEWER AS BUILT DATED: I l I
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE / ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED: `J 9 )7 7
OTHER: — d'1 t fxd)
q 1`� �j 0 t V► b I I�e,.vL� e�
L\TEMP\DSTs\Forms\Street File Checklist.doc
BUILDING 'DEPARTMENT I Applicant Fill
VSE C PERMIT 770!5;
ZONE NVMBAlly ER t` 77
PERMIT APPLICATION Inside Heavy Lines
_
J08
' NAME (OR NAME BUSINESS)
��))
ADDRESS /
VARIANCE OR COND. USE NO.
D�tBO�. HEIGHT
E
MAILING
ADDRESS
Z
Q
j�
\V I 2'
YARDS LOT COVERAGE
02
�
'
CITY
ELEPHONE NUMBER
moo/ FRONT SIDE REAR r 0
d
�t%C7
170 O
SIGN AREA
NVIRONMENTAL REVIEW V
Z
v'Yf
/ ✓
ALLOW EO P
❑ COMPLETE EXEMPT Z
I
U
NAME
_
REMARKS Z
W
ADDRESS
a
P NI(l(.�)�D EI`T. OVA DATE
j
77
J/
C
CITY TELEPHONE NUMBER
{ (/•
(
LEGAL LOT
T AREA
SUBDIVISION NO.
❑YES ❑NO
'
NAME
-
STREET R/W
'
V�
EXISTING STREET R/W P)/1 FT. DEFICIENCY THIS PROPERTY
0
I-
ADDRESS
COMP. PLAN ST• R/W 6V FT. D FT.
i
I
V
R-•�E^MARKS
._
=I(
CITY
TELEPHONE NUMBER
yVl ���� I✓� a�
- O
-SyT�ATE LI TENSE NUMBER
ZZ_ 1
CITY LICENSE NUMBER
CHEGKE D
Z
ze 61> D
W
Legal Description of Property (Show Below or Attach Four Copies)
STREET AND/OR UTILITY WORK
R/W PERMIT REQUIRED W
'
•
REO-D. ❑YES ❑NO
❑YES ONO
V
_ t
6
Z }
VNDERGROUND
W 1
` Z
WIRING REQ'D.
XY ES ONO
�
0
I
- FAVP
-
TYPE COW NECTION YES VERIFIED
a
SANITARY SEWER ❑ NO
N
/�
--��=i=
_
1
SEPTIC 5YSTEM PERMIT
❑ VES
NUMBER
' W
APPVD BY CITY EN-
O
(
REMARKS �. - _ ^ b-4'•'is"�D •';t+V T
Y"� ,�.
CHEGKE
METE SIZE SERVICE,SIZE CLEARANCE,
BY'
W
)
R KS
NEW
.RESIDENTIAL
GAS
[] LINE
FIRE TYPE107 V ION CO�
-
/\
f(J
'
ADD
NON-RESIDENTIAL
SIGN
V ,.
,(/JY-
RETAINING
G,DP.MOLISH ❑
SPECI IR INS^ECTOR AREA,
REQUIRED
OCCUPANCY
GROUP -
OCC VPANT
LOAD
~�6
••,•
WALL
❑ YES N0
Q
G �Q(J
1, .-
',
❑ ALTER E%CAV ATE FENCE
COR FILL ❑ (_ X_FTl
C7
P1,AN CHECKED BY
THIS SITE
,-%`tf�.
I� LOCATED IN THE
CITY
PRE•MO'JE swlM
El
OF EDMONDS.LOCAL' SALES TAX o
1
.
REPAIR
INSP, P0OL
SHOULD BE CODED Rt 06 0
KS
=
NUMBER OF S'rOR1E5
NVMBER OF
D I
I
•
DWELLING
_•
-
NATURE OF WORK TO BE DONEE-
UNITS
�
O
✓'
49
.•
'
+
VALUATION
FEE
—
Z
PROPOSED USE -
PLAN CHECK
I
•
1, O
� Gd42.c, N G.
NO.
Q
- y
PLOT PLAN INDICATE BUILD-NG SETBACKS,
.3 .
ABUTTING STREETS)
BUILDING
,
W
�✓. ! �/r N�
PLUMBING
- ....
D
el
HEATS GAS LINE
FENCE
—
SIGN
'
RETAINING WALL
SWIMMING POOL
O
1 hereby acknowledge that I have read this application; that the in-
TOTAL AMOUNT DUE
I ;
formation given is correct; and that 1 am the owner, or the duly author-
.
ized agent of the owner. I agree to comply with city and state laws regu-
lating construction; and in doing the work authorized thereby, no person
APPLICATION APPROVAL
will be employed in violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance.
AUTHORIZES
T'nls application is not a permit until
NOTE: Permit Limit One YBQr(Except DEMOLITIONS and PILL
ONLY THE
signed by the Building Official or his Dep-
PERMITS without conditional use permit, which shall be completed in 90
.WORK NOTED
uty; and fees are paid, and receipt is ac-
day ; VED-IN BUll.P4 S shall be completed in six months.)
INSPECTION
knowledged In apace provided.
'
y TYRE IOWNOR A TI
DATE IGNED
yy
DEPARTMENT
y----
D R" R'S I TURF / A
I
;
C
401
CITY OF
EnMON05
I
"
NOTE: Applicant Subject to Plan G7ieck Fee
775-2525
UATG
—
l
j
This Permit Covers work to be done on private property ONLY.
0
Any construction on the public domain (curbs, sidewalks, driveways,
ORIGINAL - File YELLOW - Inspector
i
marquees; etc.) will require separate permission,
COLD - Assessor PINK - Cwner
APPLICATION
The City of Edmonds for EASEMENT NO - ----------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS E] LID NO . .................. . ASMT. NO ...........
OWNER ------ ------------------------------ CONTRACTOR ---- ....................... PERMIT NO.
JOB ADDRESS .... �_ A 73- - --- -C:D --e -------- ----T�,
0
I
0
LEGAL DESCRIPTION: LOT NO- -------------------------------------- BLOCK NO. ----------- ------------
y--- - --<=V--
......... L-c�-I ..... .... <nF
... . -r- V�-
NAMEOF ADDITION -----------------------------------------------------------------------------------------------------------------------
Approved- I
TJw City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION B--- REPAIRS ❑
J.Ff Af ....................
�10
OWNER - ------ 4 - --------
JOB ADDRESS ----- 7-/-7 -------- -------------------------
e "
CONTRACTOR - -7/PZ�-.f -----
EASEMENTNO- --------------------------------------------
LID NO- ------------------ - ASMT. No - ------------------
��1701- - PERMIT NO. 'A
LEGAL 11WRIPTION: LOkNO- ----- ................................ BLOCK NO_ ............... w
we
lee
......................... .... ...............
NAME OF ADDITION ......�wff-3 -------P14 - �-- ---- --------
c�'4kLTw-� fl,
�I
Approved:
DATE-------------------- - ---------------------- BY --------------------------------------------------- fiwi-
a
Z
O
w
E-
U
a
O
w
CITr% OF EDMONDS, RECEIVED Permit No.
COMMUNITY SERVICES DEPARTMENT RIGHT -OF =WAY CONSTRUCTION PERMIT JUN 2 1 1991 Issue Date
A. • Owner: Washington Natural Gas Company B. • Coractor:
NgmE V Name
Mercer Street_
Nl�a.dMdress WA 98111
City State Zip
CA Mailing Address
�' -
a`
5,6 "v City State Zip
State License Number Telephone Number
C. • Address or Vicinity of Construction: 717 Daley Street
Type of Work to be Done: Install New Service
D. • Work in Connection With: Q Sub or Plat ❑ Single Family ❑ City Projects .
❑ Commercial ` ❑ Multifamily Utility
E. • Pavement Cut: ® Y ❑ N F. • Size of Cut: 2 X —4 (1) @ Gas
APPLICANT TO READ AND SIGN
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 ale a 7nZa�t
Mry
ees,. including or not limited to the defense
of any legal proceedings including defense costs, cqus sees 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 inspection; Please call Engineering: 771-3202 STREET FI.
• Work is to be inspected during progress and at completion. FILE
• 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.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature: M� Date: June 4, 1991
Owner or Contractor
This Permit. Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: IRS%
Time Authorized: Void after AV(216_days.
Special Conditions: N 1N
PERMIT FEE:
Restoration Fee:
Receipt No.:
Fund I II Fee:
Street Cut Dimensions: x = $
RELEASED BY� . =�" Date I _ INSPECTED BY Date
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. "o7
FIELD INSPECTION NOTES
(Fun 111 -Route copy to Street DEpt.)
Comments:
Diagram:
i
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved By: - Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
0 Addendum to:
C]
D/Ii'4�Y 5-r
'Na TO
W IWCON
City of Edmonds
Permit Application
Engineering Aide : Kerry Walsh
Washington Natural Gas
622-6767 x 2588
a CAS AnAd
KEY:
-ss- sanitary sewer
-s- storms
-w- water
Owater valve
r
5
��
CITY OF EDMONDO"D
ENGINEERING DEPARTMENT
505 BELL STREET
EDMONDS, WASHINGTON 98020
APPLICATION FOR INVASION OF RIGHT-OF-WAY
(Submit In Duplicate)
Permit to be issued to:
For work at: (address (
Type of work to be done: LAZ�' S ,
(Attach Drawing %%hen Applicable)
Owner:
-0. E�. 2�Q
Stalling Address f_
City ,State Telephe e.Nurnber
21
Contractor
Name
Dialling Address
City State Telephone Number
/ Signature: i _ (O / G(o
w or ent Date Signed '
)0 NOT WRITE BELOW THIS .LINE (•ro be completed by Issuing Agency)
'omit Issued (dace) e
' ® ® STREr.FLE
:cmarks:
I.
the hi tie• E: _. ?ecrin< Dept.
r-�
~F10lT(` 7`7�)Q�X lI:Pl'. (IT7I 1-J57
0�DD]� }J]��T 07YIT�/
u
1-1
�
�
�
o
V;
3��
l
77
--���_��'------ ---' —�7e,—�
Street Egli t-of-14"ay Existin
Access Easements Existing
«—
�
Lot Pcrq,6divisi Plat —'-- ���oxso�/�n ~-----
'_--__
Site Plxn Oiockcd for Acouru — )
|
|Jjid roun0Pend,
Rcvial by
�!,-dn S
�
am 'onozo,/ 1-,v4
|
|kJno t 5i�x [ii
11rOroot )'cqvirod C"'L' 3j ze
. 1"ctcctor (Imck �'Otcr Required A114|
�
i-jre }'epor�z�ut
Er
Sanitary Sci,or
ROUT I'NG
NE'w,
SERVICE' INSTALLATION. 1
ADDRESS: •
DATE`
DIAL A DId# /14"4(
P.U.D.
_
TELEPHONE
CABLE T.V.
GAS STREET FILE
FOREMAN
STORM :SEWER
OTHER
FUTURE SERVICE INSTL: YES CRD
BORE:. CUT).
SURCHARGE: YES 0
OCK 'cTa rR `Cc' fif
CREW
DATE:-6-2INITIAL•'
DATE: INITIAL:'
":METER
ACCOUNT NUMBER: 2- /s__o
SHOP
SUPPLIER:
CIVIL ENGR.
TREATMENT PLANT SIDE -SEWER PERMI'
DRAFTSMAN
E ;B L T
SUPERINTENDENT
INITIAL: DATE:''.�:7% 7
TAP CARD IMETER SHEET APPLICATION
- -
City of Edmonds ---Water Department
TAP CARD
cnr> a
f Date. '. g pA a..- -~
Meter No 5.... 9 Tap
allo................. -----------------
P
Size---------------- Size ..----------------=...... ...--......
Mf rs. N �9,23� -------�Y.I S le..RW....-----------
For f=p -------------- i
3 z�
-----71---7-------- g-Y--------- --- .r................ _.._.._..............
LotNo .............................
Add.......... ....... ...............
Service Location --.
Meter Location
-------------------------
Make Tap
Blk. No ......... .................................. .... -
................................... -......... _............... .................. _.... _-_._............
._. _._...
Pressure---- Q5 ------------lbs. Test .................................... %
SendBills to -------- ----- ------------------- ----------------------------------- ----------- ------
---------------------------.......... -...... —............. _................... -....... _.._._.....__........ _..........
Date of Ww rk - '�-�.�.�� rT 7%--.... -....... _.......... -........ _.--.................
./ C' -_
------ -' _ - ................. Foreman
Guar. Voucher No .......................... —.............. $---------------------------------- -
Remarks: ---
Material iargeable to Installation Me' tens
NO.
SIZE
DESCRIPTION
RATE
AMOUNT
--------------
----------
Meter ----- ----- ----- ----- ----- - ------
--- ---------
----------
Meter Box ----------------- ----- ------
--- - ---
---- ---------
----------
Meter Plate ----------- ----- ----------
--------- ----
—---- ----
--------------
••--------
Check Valve ----- ----- ----- --------
--- - ---
--------- ---
---------
Pipe, Galv. Screw ------------------
--------------
-------------
---------
-------------
----------
Nipples ---------------------------------
-------------
------------
---------
----------
---------
Bushings -------------_--
---------------
----------
Plaid Ells ------------- -------- ---------
-------------
-------------
----------
------------
----------
St' Ells ------------- ------- ----- - -------
--------- ----
------------
------- --
---------- - ---
----------
Tees -----------------------------------------
-------------
... .....
.-.......
---------- ---
-
---------------
---------- ----
----------
---------
--------
------------------------------------------------------
----------------------------------------------------
------------------------------------------------------
-----------------------------------------------------
-------------
--------------
--------- ----
--------------
-
---- --------
---- - -------
---- - ---- -
--- -----
--- -----
----------
----------
Material Chargeable to Taps Connected
NO. , SIZE DESCRIPTION
SATE
AMOUNT
--- ----------
Pipe, Black Screw ------ -----------
--- ----- ---
----- -------
---- ---
-- --
- ----
Pipe, Galv. Screw ------------------
--------------
----- -------
------ --
--------------
--------
Lead Connections ----- ------------
-------------
---- ----
---- -
---------
----------
Curb Cocks ----------------------------
---•----------
---- - ---- -
._ - - -
--------------
-----------
Corp. Cocks ----------- ----- - -------
- --
-------------
____
-------- -----
----------
Unions --------------------------------
----------_
---------
•---------
--------------
-•-_
Saddles ----------------- -_--------- ---
--------------
----- ---........_
_
---- —
--------------
---------
Nipples------------------------------------
---------------
-----------
--------- - ---
---------
Bushings--------------------------------
--------------
-------
----- - ---
--------------
----------
Plain Ells ----- ----------- ----- -------
-----------
--------------
----
Street Ells ------------------------ --
-------------
-- - ------
----------
Tees
-
-------
---- ----- ----
----------
Curb Boxes ------------------------
------------
--------- `
------ -
------------
----------
S. O. Extensions ----- ----- --------
--- ----------
------- ----
---- - ----
--------- --
----- ----
Gates ----------------------------------------
---------- --
---------
----------
-------- ---
----------
Plugs ---------------------------------------
-----------
- -
-
--
Couplings ===-=----------
-------------
----------
----- ----
Gate Boxes ------------ ---- ----------
---------- ---
---------
-------
-------- ----
------ --
---------
-
------------------------------------
Hours Time —Day Men --------
----
-----------
------------
-
- --
--.-------
---------
Hours Time —Monthly Men__
-----------
-_--- ----
---------
--------------
------ ---
Hours Time —Auto ------------ ---
--------
- --
-- -