710 ELM PL WIiiiii Iiiiiiii
13942
710 ELM PL W
7
CITY OF EDMONDS - SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT 3
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 ...... ZIP w M Pl�.c�L" -"St ........................................................
PROTERTY LEGAL DESCRIPTION ..................... Lot- ,d 3 Elm View Division C
....................................................................................................
l
OWNER AND/OR BUILDER.-- BOB FiENN~SS......_.................................. _.......................................................
CMACTOR'S NAME & ADDRESSA... & --- M Qcnt. actor 'S
Permission is granted ................ une....2 ..................--....-, 19_ 7 S, for repair and/or connection of a side sewer to the city sanitary sewer
A
m in accordance with City. of Edmonds ordinances.
NTION 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 % 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 thepermit, 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 ................
t
APPROVEDA0 Date..._ ......: ..... ::........ ... ...... By..._.. _........._..._..._.......................................................................................
Remarks a�......._...........
........................ _.............................................................. _...................................... _....................................................... ----------
— BOTH Permit Copies MUST Be Signed By Owner of Firm Performing Construction PRIOR To Request For Inspection —
-------------------- - -------------------------- ---- hereby certify that the side sewer installation constructed under this permit
(Owner of Contracting Firm Performing Construction)
nstalled 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 ❑
ADDRESS: ace
TAX ACCOUNT/PARCEL #:
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
CRITICAL AREAS #: DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT: 1 %J
BLOCK:
SIDE SEWER AS BUILT DATED: CP �5
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED: 7-2-1 75
OTHER:
L:\TEMP\DST's\Forms\Dana's Street File Checklist 5-14-08.doc
1,� "'+k.U_
}City o f E^dmon"ds Wrater�De partment�`
i TAP CARD
Date'. R 1,175 .
4' ]IN s NoJla.7..�o.9dofl
Meter ra Tap t
IVifgrs No �� .Style
3For .11 ... ..
714.._
..//may/ 7. -'T//-Z7
-4 .. y ..K'�T ICL.
.............-.....-......E........
..............-....T.......................... ......
Lot No / o. f
Service ;Coca ion x
aIUI'eter Location s �t .tom= .=
�x
Make Tap .. ..
x a
Pressure: .:.lbs Test ..3
Send Bills to '
.:
Date of :Work J ".75=
.. .,/ Foreman
.T
Guar Voucher No: ` ..$
Remarks: c o..
.. .........
1 ) .................................. .
••....••..
77" .... . ....... �.
OUtTGOING IndexStenciL ...Card:.:.
INCOMING Index Reg;.. Route Bk Stenc�T Card
,.
CoT_—° mpvr09:- A1E30
WATER , SEWER CHECK LIST
CALL AND FIELD CHECK
BEFORE DIGGING
ADDRESS
NAME
DATE
DISPOSITION
11
�'
N�
Q
LU
Z
0
w
w �-
-3
H �
W �
V
t,
The City of Edmonds
I~ .
APPLICATION
for
SIDE SEWER PERMIT
NEW CONSTRUCTION 0 REPAIRS ❑
EASEMENT NO- -------------_ ---------------------------
LID VQ% ASMT. NO- ------------------
OWNER -:.g�P :-:_---:----,1 _l�1-MESS.-----------=----=------:-....... - CONTRACTOR S: ..M_:-GQNT'F?i�,CT'�Fz;S:,. = -PERMIT--NO:
JOB ADDRESS �-_0: __:--------M._:__PL -------------------------------------------- LEGAL DESCRIPTION-: LOT NO. _._::_:_::_:.:__ 1�-S:.::...::.:.:.: BLOCK NO. _.._________.:_:::_:.:_:___:___:::::
--------------------------------------------------------------------------------------------------------------------------------------------------------------- ---
NAME OF ADDITION=_:u\E=VAC: : _.o.1.V.ISt.�N.. :
-----------------------------------------------------
Approved: /
DATE �� BY
• APPLICATION
for
The City of Edmonds SIDE SIMMB PERMIT
NEW CONSTRUCTION El REPAIRS❑
EASEMENT No . ..........................................
OWNER ----------------------------------- CONTRACTOR
. . ..... �.. ----------------,a............ ......... ..... QiA/ ................. PERMIT No. �aig
ADDRE
ss .......... 714 ...... C ........ A/ ................ LEGAL DESCRIPTION: LOT No .............i ................................ BLOCK No . ...................................
NAME OF ADDITION .....
. ........................................................
Approved:
RECSIVgty
MA!
DATE
BY