1027 ALDER ST.PDF111111111111.11
10032
1027 ALDER ST
---------------------------District
City of Edmonds ---Water Department
TAP CARD
Dat jj--j--4--0S.54'PAID..
MeterNo.------....--- -----. Ta Nd ........................................
Size...----- P ....... Size ....................... .............. _.
Mfgrs. N --------------- -- .. ---. --- Styl..............................................
For...... -----------------` . -- -- -----............................................
...................................................................................... _........... -------------------------------------
LotNo ........................................... Blk. No.----.................---....--------------------...
Add--------------------------------------------------------------- --------- ... .
spa ................................... ...........--.... Service Location .... .......
.......................................
Mzter Location
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MakeTap .......................................
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Pressure.............................. lbs. Test ..................................... %
SendBills to----------------------------------------------------------------------------------
---------------------------------------------------------------- --- /...:........... ........
--.._....
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Dateof Work -------------------! . ---- -----------------------------------
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Foreman
Guar. Voucher No ........................................... $..........................................
Remarks: ..................................................................................................................
OUTGOING Index .......... Reg ....... Route Bk--------- Stencil ...... Card ........
INCOMING Index .......... Reg ....... Route Bk......... Stencil ...... Card .......
ial Chargeable to
NO.
°
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� Screw ___'
____
.............. _........
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'--- .......... _ _-- .................................... .............. ------..........
--- ---- -- -------'--'-------- '---' ---'
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, ' �m / -___-_ ___�_-_ Taps Connected
NO. SIZE, DESCRIPTION
RATE
AMC NT
zq
N ft-
ADDRESS: 10 &&" [ JU-
TAX ACCOUNT/PARCEL NUMBER: 064�4203-703100
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED)
CRITICAL AREAS
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
DETERMINATION: ❑ Conditional Waiver ❑ Study Required ❑ Waiver
SEWER LID FEE $: LID
SHORT PLAT FILE: LOT:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S)
GEOTECH REPORT DA'
STREET USE / ENCROACHMENT PERMIT #:
no
WATER METER TAP CARD DATED:
OTHER:
BLOCK:
L:\TEMP\DS'Ps\Forms\Street File Checklist.doc
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06
CITY OF EDIT, . WASIiINGTOy — DEPARTM. �' /F 4E:i;�DiNG3
S11:FiLt+111ttan i batlMHtl '
Applicant hereby certifies that a plot, plan, drawings, and sui5dent details to indicate
the intenfzon to fulfill all requirement; of this code are attached lwreto.
Application is hereb le for p=iiL tto,,''do the following work:
(ids,. s�i'i'•:����
.� •j�.• .3 �_,� .fir
................._...._...._..••- ref - .........._._ _ . �.� _ _...._._......_._.. - -- - i�
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at ................ _._..........
.1...... �.._.W_rt+_.._._..._........__...-............__.___._.-. O _11 �+ (^y- '. ..1'•. .t.
(SitrQ r = rxt tt tK a_. . w± ^�� Y •_ >. ,.•.i •.5 U "-`! �',
1. Building dimensions are_........_
2. Int dcnens,ons are..�..X-.. ....1_..._x._..-...i - ._.... ....
_ C O.
3. Building will li—..CS/.. ... stones in bight raa a
4. Dumber of haaemrmts.-._� =2? %.- ;
5. Occupancy of building will be.. ...-_....-.. _ _ -- _._--------
6. Building willr�I*vn neargg
jgadymning lot line- {i}
7. Owner....._...........L.. -� Pu:mated met
8. Owners Address .............._. X.-._-._.....-----•--_._.-_...__..------------- -
9. Builder ........... ......... __../,/.."�7.:
Group ho._._...__
i
10. Builders Add;esa.... ................. _-. .... ..._..._..._._.__ ', - •
ll. Architect or enginer-r..... -..........
.-..
Applicant's sig atu,eti -P� �: _ - .... Plans Slad:
Permission 1s he reby granted to do the work described hereon, ae nrdmg to the a pproved plam aM a fiCition -eriining
subject to mmpli+nce with the or&:ances of the City of Echnonds. This ^py is your rca'ip- for the following%fm—
/, Go
1. Building permit (fie S
,
2. Sewer permit fee .... ................. ...- .... _.-_.._..... ___ 5....._..._..-._..__..__..._..
3, Inspection and supervisiod fix- ............. ..... .... —...._.. 5...__.._..._.._....-... _ ••y
a,.
4. Tot;( ...__—..__._._._.._. 3.___L__..__._.. _ •' ��'s`'
PERMIT lti : SQ-3 I
of Ildmfinda•' -
1. The buildina i—:, fee ebirh apptk— p4. wbm Prtnaia it ;—d tlal] be barod m atri.._,.a e«e of She Propwal swap.';, an tM,:-�j of a1A0
31e00.00 of eau. I( dye am el cum or the ataaure, wbe� aaaDY detrtmimd, acetda the e¢tmareG oitl by me-e thaw d1ir. apple;.; -pees w: or m f&M-1 ke�;^�,`•.
of $1 00 for nth t'000.00 of sum nrm mat. In a«S e-nt no ma Permit ;Sall be cooed oara nab-diaeaeranty tee•• i. ; Jd. r ::' - :; ,' yy . •'
mar aoa 1faa . wh,—, a emir; f« rmaruaion !a esaaaai f« ...y cape.__ -.h— a10M.04 f« wheb a :;...ad rtbsea aLnr Pal d 6r -
the BtWd;a Cale of rhr G' f P.hoocd,.,,I. applira:rn f- a b, _ - h".d.
a v a •era Pa+air a.n be .aomP,.t;ee y . Qof N tba rawer.; and ,
.;
• apeellreri •}.our-d,rh.�aa<e(.t'.TA
"�•, 3.'P11« m emplariaa mi Iaboi w'remmenilea •.ai., .dye, Indua}til•Lvaama DiaLloa a: +..r k `-.,, '• '!- �C<` -
�viNr Oegar*( o�T-eMr�.ad .s. 1 h'•ei
' Na P.yrdl wad mvke foab!r.repr.a of q.tone Rail-laatooiom rhaM be"iibr.in.d [too i?e scabs M d rbe DePa,rmmr;rl Lhar ,era ef'tte'
.t rat
'•
'•"L
final payment. the — aboe;d ob::ia a r,laasa fam the ae-1 O!Rnaoa vbu in [-n dMW obtain rdl from an aabslvnrrrn: 77ftiryeaaea'rLuoN,�ha, -
—ttd br On DAP -- a-f 1.1,61. ftA ieduaria 'Th. abo.e Procedery a.e rrQaitaaria o[ die State LA—W Lemra«e ha.
APPLICATION
The City of Edmonds . for
EASEMENT NO- ------- ------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION ❑ REPAIRS ❑ LID NO ................... .ASMT. NO. _-_.._..._.___-_._
103-04250
OWNER------------- Arn07,d-P`-•---JOy.G.c-----------------------------------------------
JOB ADDRESS --- 1027__ Aldiu- Stx.QQt------------------------------------------
CONTRACTOR __.._____ PERMIT NO. ....................
LEGAL. DESCRIPTION: LOT NO- -------------------------------------- BLOCK NO.-----------------------------------
------------------------------------------------------------------------------------------------------------------------- -------------•-••------_..
NAMEOF ADDITION----------------------------------------------------------------------------------------------------------------------
DYE TESTED ON SEWER - February 11, 1976
By Jim Jensen
Approved:
DATE-------------------------------------------- By---------------------------------------------------iii-s