21001 83RD AVE W11111111111111
15371
21001 83RD AVE W
APPLICATION
for
�e City -of Edmonds SIDE SEWER PERMT
NEW CONSTRUCTION 0 REPAIRS EASEMENT No . ..........................................
OWNER .... ....... 1'� .......
.............. .............................................. CONTRACTOR --- ........... 4 -1
. ........ ....... PERMIT No....,.-.. ..............
ADDRESS ...... .......... -------- ............. LEGAL DESCRIPTION: LOT No . ........ ............................. ....... BLOCK No . ............................................
NAME OF ADDITION ........................ ...............................................................
Z:_
RECF-IVED
JUL 1 8 1974
r)
Approved:
DATE................................................ By ................................................... ..................
U6tity -of , A.2
7
5 4
APPLICATION
for
SIDE SEWER PERMIT
EASEMENT NO.
NEW CONSTRUCTION REPAIRS Fj LID NO. ...A!��?!___ASMT. NO. _<C:)A..:R)
OWNER ---------------- 7 ----------- CONTRACTOR ------ NO. -4. ':
JOB ADDRESS --- 2-1 --- — --- - ------------ LNF_�_ -
----------------------------- LEGAL DESCRIPTION: LOT F!E�UBLOCK NO - ------------------------------------
..........................
Approved:
x"
71ZI�
DATE --- --- ---- --- By ........ ...... G_
1 'M
116 11LE
REGARDING: 21001 - 83rd Avenue West (-)C,
(address)
I
R E C 0 R D 0 F C 0 N T A C T S
DATE NAM1E, PHONE NO., & COMMENTS
ADDRESS of CALLER
5/l/74 Edward Hunt Certified Letter No. 406403 sent
requiring hook-up within 60 days.
7/18/74 Water Specialists obtained permit #4981.
7/19/74 Connection c2Mleted.
ACTION TAKEN
Letter received'.
INITIALS
TE
TE
TE
NOTICE:
No warra --Y.77 of -a cc-u--r-a--c--y-..
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The city of �Edm.qnds does not . warrant the
accuracy of anything set forth on these
rnap(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
-tFe -map(s), including, but not limited to,
th-e lociation 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
emp-to-yee-s o-r office-rs -sh-a-11.1 be llab'Fe for the
information given+ on this map(s), nor for
ion provided based
any one representat'
upon I said map(s).
7
A
v
-:0Ft:1 7�
110E`SIEWIEV-� PIE RlM,,IT
M�, C TY
-EN
DEPAATM T
E.
TEIRM T
V�
ton.) '
--covering '.anyi p6rtirA; of onstruc I
'for side -sewer Arspecti��n4 BEFO�IF
-5 ections-
V Cali* 775 -5 uno� holldaY A�sP
d' w'*hin �i4 liutl e uqt t... S
rs after q
;be provi it �P� Sa
(Insl3eqUon will
.................... ................ .............
.. ........ ............................. ........
-AD . DR I ESSk LDCMn . 0 N,:OF CONSTR U CT1014..;.?.
P 0j ..... .
*i, d ne;,q t rac i
M as U t.C..... a I ...
T-10
PROPERTY.. L E
................... ........
h................ .......
.............. ......
MA*linvi. N
. , : . I I ;. ...........
EDWARD,-M .. . ...................... ....................
R '111PILDW ................... ...... it ............
MWER ANIDAO
... .... ....
mLi ...
...............
0.,.01 ........... . ........... ......
'NAME ADDRESS. - tL ...
......... iiar'y v
;QQN-TRACTOWS
san
and
r. conTi6eltion. of- a Idde seNver to.the*C1ty,-
f6r reii r
e
-rafited .............. .......
apc rd 6o-.%v1tWP1ty-q �]�Omonaslor -,? .'-.
dinances.'
S 'teTn 9 an, f,
V
d- 'construct
ractor mu�e be.emplo��
TO THE FOLLOWING: licensed. Side.Sewer �Cont,
ert'tm�'� obtatn1,a.".perriiit to% construct,,sewer lnslde�.prop�ky,jlri�._�A
'rs� cjf,7the�p
r Y.
140 .6 -1�Th owne op 1. � �any. portion. of. s�wer before 41. ',has.,been inspected.,,
iDo not cover n, dffl6c.
-an rnvas ity,.Engi eees
side se'wer�in�strce� area. -way Pe�mw!obtainable from the C
rk.peiforined'in cil.Y,Hght-of-way'�requjreg 1'96. of Rightz:of
ll�gulations -ioveriiing side, sewers when..y6u. get: permit.
-NOTE: No. 2—,All'wO.
-bepds.'ln. g ad c
f tion, rega�dlrig Ordjjiahce. jj.j6.(j30.aV.0 r
NOTFNo:. 3-�20bjaln �full in orma insW� propeMy line;. minimum grade
;r ,must . have'ai lea,91AO inches �coverage dt,:prol;erty 'line: . and'. 1. 2 inches.: .
'NOTE. No. — op of,'side sewer �for.'failure'due. to lmpr->per,:
e rtispo sibl
-41 'I'sharpe'r1than 'Is. �v ill,. be 'permitted. n. 'C6'ntractors shall b e
ettled and suriace of,�street restored ;to,orlkinal conditilo
—Tr' "-t- must be water.s
5� enelneslin.s ree e.year.of completiq its, . a. p . prt�nances,�.exc��,t`:to in-%
�.VOTI� Nq. - s
'wrirk.-which',may."develop within on nilt, �or to* do; iny'work on: the maj'n'� �wer,or,
�tiian. i' provld�e ior'-in the��per
EYN o.: 6,-:-i i i"4�iaw f U, :t 0. �a Ite r br� do an y other - work a d
e,
ert, into' -the. wyi.
s
B
Date::
.......... .. Y:
Date....... .. ........ ..... ...
EU` lt ........
.................... Byl�`.
;Da e ........
OV
..........
................. .......... .....................
B
E D y
APPROV
77* Z.
............ ..
D
. ....... ......
......... . ..
mair s
.... .. . ...... .. . .............
.. ...... ..
ve
............ ........ ...... ....... ............. .7
. ......... .........
.......... . ...........
z t
Re' nspec ion,.
Wnel, �o Firirn-'PeAb�ilii' , " ;
onstriicti6l� VRICOR" To� qltiest For
'tOTW -P e r� i t C op i e MI) ST Be-Signed.iBy 0,
-.permi
'iris tal I at idni-pon st rudt e&tind er �thi.s,
d')
the si e;sewer.
Q! MS,� 1
t\W
alt�
......... .. �,e
_�6ertifY,:that,
struction).
fcrming* Con
ti�n�jTirm '-Per 'd
the Cit� of'.Edmon So kW
'th ng�otdinaiic6s',of
dAn,ac :01,governi:
i-d e
w �itol c.6i
.................
da f ............. .......... ...........
Datefi. thi ... ............ Y'10 I
'I V
r ,
TelephOIWD
Chvck--BEI�OHE!_�qu, d1k foi:i.3VAt,eE.
forl6winstruc Ic
D
:SENDER-, -to
S_ BY.dHtCKEO-�BLOCK(Si
LEAst' FUkNISH,..SERVI.CE(S)'.INDICA,rED,
P �dJ�r4lies6-serviccO.
e iver
ow ddress-
a �4 e
a liv d' :iid_dr�ss'
where'-de'live're
RECEIPT',
W;
e irjb6d b
:R
la 4ved4hd,*nu,mi"r.ed art-icle
RE WNAME-OF SS E (M�i;t aj�vayi i1be.,filled,1q),
,,SIGNATU
REGISTERED
-CERTIFIED NU.
:41FDANY—
IGNATURE-'O,
2
INSURED' 'NO -
.0,
q
-.�cstad, awd inchtdo Z1f`Goa6),.
SHOW �WHERE!L1LLIVLKLV;JV110,1J tl
9A E DELIVERED T
%
%
CERTIFIED MAIL-30� (plus postage)
RECEIPT FOR
QRTMARK
DATE
SENT TO
M7
STREFT AND NO.
CD 56th Avenue West L!!-
tcr.tl p.O., STATE AND zip CODE n t 3
Co Mountlake - Terrace, Washi
—OPTIONA—
'IL SERVffis FOR ABBITIONAL.FEES
w date delivered ...... ..... 15
Shows to wheat at sso 0111y _ .......... 65
ICT RETURN With delivery to addre, d . 35�
RECEIPT 2. Shows to whom, date and . where idelivere 854
SERVICES With delivery to addresseo 0111Y
5j—
LIVER T(j /�I�)RESSEC ONLY ... .... .... .. .......
--Wq—Z1 red) .. .....................
—DFLIVElly (..t,. fee ,
PS Form NO INSURANCE OVERAGE pROVIOEO— (Soo other side)
3800 NTERNATIONAL MAIL or-0; 1970 0-397.40G
Ap 1971 NOT FOR I