627 GILTNER LNIIIIIIIIIIIIII
14001
627 GILTNER LN
CITY OF EDMONDS -2-""SIDE SEWER PERMIT
WATEWSEWM 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 CONSTRUCTION ...... .71 ...... U ... XT �1,1 5,- e I _Jt_zltskv� ................................
.......... . ..............
15;;: ---r . ..............................................................................................
- PROPERTY LEGAL DESCRIPTION .............. --f ..... ........... t* ........ Ir ..... ..... * ---
.................................................. . ................................................................................................. ............... . ................................... ..................................................
................................................................ OMWERANDJOR BUILDER .......... ..............................................................................
CONTRACTOR'S NAME & ADDRESS ........... 25��. .. ....................................... .............................. ........ ...................................................
Permission Is g"ated ...... V�� J ... 2A ............................ 19-7.C-pfor repair and/or connection of a side sewer to the city sanitary sewer
SW In accordance with City oi 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—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 1/s will be permitted.
NOTE No. 5—Trenches in.street must be water settled and surface of street restored to original condition. Coritraptors 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 E] Date... By ................ Date ....... ------- ......... Date ............... . ................... By ................
APPROVED Date... .. ..... -----------------------------------------------------------------------------
B
Remarks: ....... . .................................................................... ............................................................................ ....................................................
..................................................................... . .................................................................................................... ................................................................................
BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection
..................................................................... ................. ... I hereby certify that the side sewer installation constructed under this permit
(Own r of Contracting Firm Performing Construction)
�kstalled in aecleordance with all governing ordinances of the City of Edmonds.
Datedthis ............................ day of .................................................................. 19 .........
Check BEFORE you dig for: Water F], Gas E], Telephone E], Power E], Sewer Ej, Other E] -� V
AV
U Date— May 21, 1976.
emo to: Director of Maintenance & Operation
Public Works
.From: City Engineer
Subject: Sewer Connection Charges
Legal Description: See attached
Commonly known as: 627 Giltner Lane
Z.F.F. Calculation:.
Z.F.F. x
'Lateral X
Unit x $25
* Plat installed 200 feet of sewer main
CC:
61
F
STREET' .--
owner: Al Toccoli
$ 0 Connect , ion Fee
0 Lateral Char ge
$ 25.00 Trunk.Charge
$ 10.00 Permit
$ 35.00 TOTAL
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PIT
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500.
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number.
I Issue Date: 7
A. Address or Vicinity of Construction: 627 Giltner., Lane (9419793)
8 9 0 1 9 C� B. Type of Work (be specific): Install New Service
C. Contractor: Washington Natural Gag Company- Contact: Frank Swan.
MailingAddress: 815 Mercer St , §gj�tlemWA Phone: 224-2278
State License #: Liability Insurance: Bond:$
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. F1 Commercial 0 Subdivision El 'City Project E) Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family E] Single Family F1 Other
INSPECTdR: INSPECTOR:
F. Pavement or Concrete Cut Yes []No G. Size of Cut: 1 (2 x 4) H. Chargq�,$
In Asp4al -)over water
t
APPLICANT TO READ4N,b SIGN
VIN
INDEMNITY. Applicant understands and by his signature to this application, agrees (o Vd the City of Edmonds ha'. %yRn td-mages, or
f4
ty of E tdObif' t d rtments or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be AffAagainst the Ci o
8 attorney ees reason of grantin
e
.employees, including or not limited to the defense of any legal proceedings including defense 2�0�1 _gthispermit.
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.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required 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.
Traffic Control and Public Safety shall be in accordance with City regulations as required by the'Gity Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the abovestatements and understand thepermit requirements and thepink copyof thepermit willbe
available on site at all t' ror inspectL'on purposes.
Signature: Date: July 18, 1994
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVEDBY: WkJC.-,H RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS: AM --
COMMENTS:
DISRUPTION FEE/FUND Ill:
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Nv. 1991
FIELD INSPECTION NOTES
Comments:
Diagram;
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
El YES
Date: —
Date: —
13 NO
Addendum to, C1 d
ty of FAmon B':r
-w9rht
Pe=1t On
-��-Aubmitted bys X�TC�ELL S. -LANKF'
Engineering'Aid
Wa'shin4ton 'a
'-521-'5246
wo
Apply,
'7771
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4-
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Wx-
I ING to window
Water 3sain depth
114- 01 gas 3main
k-�D I
r C'.
-7
Key:
--w-
water
g-
gas
-As-
sewer
-E)--
water hydrant
0 .
watL,-.- valve
?IS JAcrccr St. (1 0. V,;,, 18'19). SC&W-. WA S q) H %1206) 6-12-.-767
1-1-76
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Instruction: 11-� (-.A L�� N , VV f-j L.
. Check Accuracy of Le(ial Pescription
. Check Anainst Assessor's Map for Lenal Subdivision
. Does it conform to City Approved Subdivision?
Reviewer's
Initials
PEPMIT ADDRESS
i (Q
LECAL DESCRIP ------------
NEERING DEPARTMENT C11FCK LIST
1. This lot includedainl:,Z�division Plat No.
A
2. Site Inspection m de on:
3. Ilhat are around water and soil conditions?
k--le - %,
STREET FILE
4. Site Drainage Checked ? 4`11
5. Storm Sewer Availability: � �.SR
Roadside Ditch ProJect
6. Arading A Final Contours:_9
7. Septic Tank System Desinn Approved:
Ilk-
8. Sanitary Sevier Availability t. -,N of rhlq-. No. --XpoJect
Side sewer avai laD111TY:
9. Sanitary Sewer Connection Fees?
10. Uater Mains A Fire ff ' �ldrants (Indicate Size Main)
Check Fire Dept.'s Comments- %-.- --
11. Sidewalks: (Siteiwection shows conditions of sidewalks as follows)
1k
12.
Curbs: JINal F�, � i'—;- --
Curb Cuts/Driveways
(Check driveways for safety, lncation,
grade and width):
13..
Under(iround 1-tiring:
Street Lights:
14.
Street Right-of-way Bldg. setbacV-;-.f`A1V1---;Z�
Sht.
of r)fficial Street Map.
15.
Existing Utility Easements?
16.
Access Easements-
17.
Site Plan checked for accuracy?
18.
Special Requirements listed in Hemo to Bldg. Dept.
,4
19.
;Commercial & Apt. Reouirements form completed?
20.
Drawings stamped & notations made?
21.
All Items filled in on Bldg. Permit Application?
ez
e2 -Z
22.
Bonds posted for site work?
23.
Right-of-way Invasion Permit required?
COMMrNTS: -Mr. VhWfA1P&,rrion rnatoje-%UNAP-v4� kkm i ikii=w-
"A Good Customer Is Wortky of Every Consideration'.'�:��,
-P
1"j
.;WESTERN OfILITIES SUPPLY', c0i
Waterworks & Sewerage Su pp ies�
P.O. BOX 3524� 5499 OHIO A E. SO
SEATTLE .4 A SH--.,98 U4 76*2-7025 SE*A:TTLE"WASVH. 981*34
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IS(c 1,
19
4
lhe City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS M
-"- it�hl - I
OWNER----------- ------------------------------------------------------------------------------
JOB ADDRESS ------ c�:AL_-T"rMVNL. I t�&-,A= — --------
--------- _ --------------- -----------------------------
ul
uj
EASEMENTNO - --------------------------------------------
LID Ncj. ./'
NO -----------
CONTRACTOR -PERMIT NO!E�___
-- ---------------------------------------------------- 7 ---------- I -------- ------
LEGAL DESCRIPTION: LOT NO - ---------------- __ ---------------_- BLOCK NO - -----------------------------------
---------------------------- ............... I -------- ------------------------ -----------------------------------------------------------------------------------
NAMEOF ADDITION --------- ------------------------------------------------------
Approved:
DATE. ....... By ----------------
------------------------------- By aw
Ar�
APPLICATION
The City of Edmonds for EASEMENT NO - ------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS LID NO - --------------- - ASMT. NO -----------
OWNER --- 42 . ............ ------- ------------------------ CONTRACTOR ------ ......... C_,n
-------------------- PERMIT NO.
JOB ADDRESS -------
----------- - ----- - � --------------------- LEGAL DESCRIPTION: LOT NO - ---------------------------------- --- BLOCK NO - ------------------------------------
....... ---------------------------------------------- --- ATTACKE-b ----------------------------------------------
NAME OF ADDITION ........ 45%'L.-j- >
-----------
Approved:
DATE-------------------------------------------- BY --------------------------------------------- --- i . i7!Y!K
Memo to: Director of Maintenance & Operation
Public Works
From: City Engineer
Subject: Sewer Connection Charges
Legal Description: See attached
Commonly known as:-627 Giltner Lane
Z.F.F. Calculation:
Z.F.F. x
Lateral X
Unit x $25
* Plat installed 200 feet of sewer main
CC:
Date May 21, 1976
Al Toccol i
$ 0 Connection Fee
$ 0 Lateral Charge
$ 25.00 Trunk Charge
$ 10.00 Permit
$ 35.00 TOTAL
2108
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