303 3RD AVE N (2)1111111111111114604
303 3RD AVE N
•
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
OUTSIDE E] INSIDE E] REPAIRS ❑
CARD No. .........
EASEMENT No. ......................................
On
OWNER...... 'OR ............ ................................. ..................... CONTRACT .............................. ..... ......... . ...................... PERMIT No.
V
STREET
HOUSE No..--j ...................... AVENUE 0 ------ --- - - -YELOC No . ............. ......................
..... 0 LOT No. A Al.-
.... ................. ......... ............... -- ---- ...........
7C 7 1"J3
NAMEADD. .......................................... .. .. ------------ ---------- ------------------------------- ..... .....................................
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BACKFILL WORK ORDER ISSUED
SEWER WORK ORDER ISSUED .....
Date
........................ DEPOSIT,
,STR)E)E-r FILE
Approved:
...........
DATE
ARIPIRIWPD
0 0; T 2 P rlll 1§64
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CITY OF EDMONDS
CIVIC CENTER — WATER -SEWER DEPARTMENT is r PRoor In ecti ov when work
Is ready for inspection. (No tnspeo- �T O 1179
Lions Saturday, Sunday or holidays.) jr
SIDE SEWER PERMIT
ADDRESS............. KI_..Third. .------•-•--------_-----•-•-----.--------.-----•-•-----•----------------------------------•----•-----.-------••---•-----•-----.--
OWNER--------J)Qn- Tripp---•---------------------------------------------------------- CONTRACTOR.......Lee WOOley--------------•-------•----------------------
Permission is granted .._October 23........ Ig 64 for ...................... days, to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing 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—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—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. 4—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. 5—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 ap-
purtenances except to insert the pipe into the wye.
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The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
EASEMENT No ...............................
NEW CONSTRUCTION 0 REPAIRS ❑
.I.W...... ........OWNER .........L o .....................
ADDRESS................................ I .................... a ................... ...................
CONTRACTOR ...............................................
LEGAL DESCRIPTION: LOT No ..............
NAME OF ADDITION .................................
.................................... PERMIT No. ly<-�/-/ . .........
.................. BLOCK No..............
..........................................................................................
�yo-
C>^,)
Approved:
DATE.... ....... By ...............................................
-- -- - CITY of EDMONDS BUSINESS LICENSE APPLICATION DATE LICENSE NO.
.= Civic Center - Edmonds, Washington 98020
City Clerk Phone 775-2525
INSTRUCTIONS: CLASS YEAR L
All items must be completed
or application will not be ac- RECEIPT NO.
cepted.
k Sign and return application FEE PAID
with fee. Renewals received
after February 15 must pay
penalty in addition to fee. ��
NEW BUSINESSES AFTER
JULY 31, 1/2 FEE. (PLEASE MA
ANNUAL FEES PENALTY AFTER FEB. 15
HOME OCCUPATION
E REASG. LIC. NO. SPEC. \ __$10.00 (A) ADDITIONAL $5.00 ❑
❑ SMALL t3 - SINE�SS
PRINT 'X'
MID $15.00 (B)` A DD ITIONAL $7.50 ❑
7 F SPEC.
Box ❑ Business WittY10 or
FOR ISSUE OF
PAID CORRECTED more mp'loyees ADDITIONAL,$25.00 ❑
I LICENSE WITH
I ( 'LC' ACTION. - -$ 0.00 C)
❑ NEW APPLICATION (LA)
❑ RENEWAL (LB)
ILE ❑ CHANGE (LC)
-N C10S$jA §Y t,HANGES) ❑ DELETE (LD)
NAME OF FIRM BUSINESS PHONE NO. OF EMPLOYEES
FCX 0Lij A PT, 77/ 79? y i
MAILING ADD ESS NATURE OF BUSINESS
P.O. 30x SS 3 Fd►ricnds,U-1k-9'h2z
BUSINESS ADDRESS301r303- 3�' A/, cP13- 0,44 Do INDIVIDUAL PARTNERSHIP CORPORATION
® (S) 0 (P) 0 (C)
OWNERS NAME HOME ADDRESS
Ce or i e Rowe- S T O A RT t_ FOX .33o Cd r-)c -n d s ST
HOME PHONE tATE OF BIRTH PLACE OF BIRTH SOCIAL SECURITY NUMBER
77-5-/377 1 3-2Z-2-4 5EAT-TLE WA. 1 S.3
EMERGENCY NOTIFICATION: (1) NAME & TELEPHONE J EA N Z R t PP -- 771-9`/15
(PLEASE LIST TWO) (2) NAME & TELEPHONE LD DILLS REALTY
WASHINGTON STATE TAX NO. N/8 APPLICANT'S SIGNATURE
DO NOT WRITE BELOW THIS LINE
STAFF REVIEW: FILL IN LAND USE CODE, UFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT"
�e. SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE J 7- LAND USE CODE ZONING CODE
V�_APPROVE ❑ DISAPPROVE
SIGNATURE , b
CONDITIONAL USE PERMIT
COMMENTS E=
BUILDING DEPARTMENT DATE S �5jiili Building ❑ Hotel/Motel L
C-r'APPROVE ❑ DISAPPROVE ..SIGNATURE V�5 Permit ( )
❑ Apt. Dldg. (A)
❑ Office Bldg.
(0)
COMMENTS:
CAPACITY: (NO. UNITS, APTS.,
OFFICES, SEATS, BEDS, STUDENTS)
Occupancy
Group '
❑ Restaurant
❑ Hosp/Nurs Home
❑ School
(R)
(H)
(S)
FIRE DEPARTMENT
DATE
U.F.I.R.
;APPROVE ❑ DISAPPROVE SIGNATURE
COMMENTS:
POL1.0 -E DEPARTMENT
APPROVE 0 DISAPPROVE
DATE �'f-� SIGNATURE
COMMENTS:
PUBLIC WORKS DEPARTMENT y�
❑ APPROVE ❑ DISAPPROVE DATE S /9- 1 SIGNATURE
COMMENTS: 0g1100
PLEASE RETURN TO CITY CLERK