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1034 C AVE
CITY OF EDMONDS — SIDE SEWER PERMIT
WATENEWER DEPARTMENT
_ PERMIT°
d�o
Call 775-2525 for side sewer inspections BEFORE, covering any portion of the construction.)
Inspection will be provided within 24 hours after requat. NO Sat., Sun., or holiday inspections./
5744 .
11 �i
ADDRESS LOCATION OF CONSTRUCTION......t f"1 � ...................A...� r'..........................................
PROPERTY LEGAL DESCRIPTTON ............. ..................................
OWNER AND/OR BUILDER ......f.'�.............�^�-� ............'' ...::A �r :'r'.._.....................................
.,
CONTRACTOR'S NAME ADDRESS .................. ^ n
jigrinission is granted -.--.fit'-r".? ....s:?.......:`_--: -...... 19:' _7 for repair and/or connection of a side sewer to the city sanitary sewer
In accordance with City of Edmonds ordinances.
ELATION IS CALLED TO THE FOLLOWING:
NOTE No..1—The owners of the property may obtaln 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 1t 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 3¢ 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 the permit, or to do any work on the main sewer or its appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED❑ Date .... .......... P ....................... By ................ Date ...................... By ................ Date ............... _................... By ................
�°.? ` f _-
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
(Owner of Contracting Firm Performing Construction)
It installed in accordance with all governing ordinances of the City of Edmonds.
Dated this ............................ day of .......................... ................. 19.........
1.
V V Check BEFORXt you dig for: Water ❑, Gas ❑, Telephone ❑, Power ❑, Sewer ❑, _ Other 0
•
ADDRESS: Ai r/,re—
TAX ACCOUNT/PARCEL NUMBER: Do- `q L[t 2 b O �
BUILDING PERMIT (NEW STRUCTURE): q -71 Q Q7—c1 9
COVENANTS (RECORDED)
CRITICAL AREAS: DETERMINATION: E] Conditional Waiver ❑ Study Required ❑ Waiver
DISCRETIONARY PERMIT
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED
PERMITS
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DA
SEWER LID FEE $:
SHORT PLAT FILE:
SIDE SEWER AS BUILT DATED: �I//?�I 7
SIDE SEWER PERMIT(S) #: 'J `'I 4
GEOTECH REPORT DA
STREET USE / ENCROACHMENT PERMIT #:
WATER METER TAP CARD DATED:
LID #:
LOT: 3 BLOCK:
L:\TEMP\DST's\Forms\Street File Checklist.doc
1
• . r^•• PER-- 770029
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BUILDING DEPARTMENT Applicant FiL'
inside Heavy Lines
PERMIT APPLICATION JOB
RE55 `
NAME (OR NAME OF BUSINESSI ADD NO.
VARIANCE OR COND. USE NO. ,
C 1 S LOT COVE Q•I
ly MAILING ADORES$ PR OPfiSEO YARD$�r' c/�� t� /1 O �•yt I r
I{ 7 ''jlQr �T '/ {GJ SIDE I ✓ "f REAR 6,( -
l. 3 �� �^ /T ONT ( 1
ELEPHONE NU:.rBER ENVIRONMENTAL REVIEW Z
0 CITY it SIGN AREA - Q
ZO �ALLOWED •PROPOSED ❑ COMPLETE EXEMP'r Z -
AMC REMARKS
1 `
F, DATE �
V PPROV AL
W ADDRESS pLANNI�+ $ W - A t 'I
_ $U BDIVISION NO. 'I I
U TELEPHONE NL'M CER LOT /•REA
CITY LEGAL LOT (�
YES ONO
0Ot/ �; 1
NAME STRECT R/W % FT. DEFICIENCY THIS PROPERTY
EXISTING STREET RIW L/CC�J�`� FT.
i Q / r /�� �J ✓I L PLAN
5T. R/W KJ� FT.
� C �•/ L� CO.A P.�
I-6 U /" J �__ Rt M.IR Ks'-1b- I
Tp LEPH ONE NUMBER ++��
LC CITY �D n sv- V_ /� O
77 / -15 CHECKED BY_ Z
0 LI l
Z vylonr�5 _ �.'•
�O ITY LICENSE NUMBER I
U STATE LICENSE NUM DER 'ti W
1 W r t
R/W PERMIT REQUIRED Z
STREET AND/OR UTILITY WORK .SYES ONO � rlv' I t
1. Legal
//YY REO'D. EYES ❑ NO Z ` i
' Legal Oes�cr'ipiion of property lShoW Aelov: or A%t�tajch/��"F Four OCo'PLs� W i
$Q'u(�1 a r—r G j�—r �U �• .� a�••+� R�.11 UNDERGROUND ONO
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µ''RING REO'D.VES
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1 0 c j / ( �,�5 r, /.}.dti ��`�f� TYPE CONNECTION YES VERI IE`� I
f! ' J ❑ N O
�` (J SANITARY SEWER PERMIT NUMBER
" U, C� /L 1 Re- `/1 /1� T SEPTIC SYSTEM ❑ YES
III
APPVD BY CITY ENG. S NO i
W O REMARKS
C /J
QI ��S PdC G V "EC •+ YJd l..-C I .
0 L
O ERVI E SIZE CLEARANCE CHECKED BY G' 4W METE SIZE S W I,
f J r' <
i
RE ARKS V - ^�O 1 akTjO I
❑ GAS NSTRVCTION CODE ;
FI R E TYPE OF tU j
NEW +� r RESIDE�-LLINE ^ l '
L(_] SIG
OCCUPANT
�, ❑ N."
C N-R REA OCCUPANCY LOAD - {
"PECIAL INSPECTOR GROUP - 1
❑.ADD ❑RETAINING gE0U1RED - 1•. S
i •j." DEMOLISH *ALL p S
! FENCE C YES 0 �(
i ❑ ALTER' EXCAVATE (--X�FT) PLAN CHECKED BY THIS SITE IS LOCATE IN THE CITY 1
' a OR FILL OF EDMONDS. LOCAL'SALES TAX D.
SHpULp 8�s9� z '
PRE•MOVE EOO
REPAIR IIJSp ❑POOL qEM AH KS �nJ� J '
(t - NUMBER OP�'utom ] .�
" NUMBER
OF STORIES DWELLING
p2 I/�GC:iPi UNITS C'!j
3—SrOP_Y ^ NSA �ultOh►
NATV rtE C:_,7•'-;ORK TO or DONE -� I
• - .7 "'l: VALUATION FEE
J
I
PLAN CHECK
o
PROPOSED USE Np
-
z U
' C pLpr PLAN Not
AS BUILDING SETBACKS. BUILDING Q 10
ABUTTING STREETS) 0 __ +
iPLUMBING
J N-
` - D NEAT & GAS LINE -----_
l - p _
' D — —
FENCC _
SIGN
jI RETAINING WALL
' SV,IMMING POOL
f
. —�-- TOTAL ANJOUNT DUE
I hereby .acknowledge that 1 have cad this application; that the in-
thor
formation given is cOrrcct: and that 1 an: the h c (y Or
tsta ehe ulawsly 'regu- gTTENTION AMiCATION APPROVAL
izcd agent of the owner. (agree to comply 1enUon is not n permit until
lacing construction; and in doing the '.cork authorized thereby, no personTHIS PC. This nppi .,
will be employed in violation of the Labor Code of the State of 1Vashington AUTHORIZE$ eigned by the Building Officlai or his Dep-
reinting to \Vorkmen's Compensation Insurance. ONLY THE and receipt is ac• I
wor+K NOTED uty; Bnd fees ore paid,
NOTE. Pcrmit Limit one Year(Esccpt DE, tOLIT10Ns and FILL kttowledged in space provided.
PERMITS without conditional use permit, which shall he completed in SO INSPECTION
•' �f days; i\tO�EJ-1N DINGS shall 17C complete ATE SIGNED n six t+tt, DEPARTMENT DIRECTOR' ION T RFA
.4'r $IGN ATV RE (OW NF_R OR AGENT) 1
/
CITY OF � ��-7 EDMONDS - -
(DATE °�
NOTE: APPIrcc,,, StIoject to Plan Check Fee 775-2525 c¢ _ � — --'�
ONLY. ORIGINAL - FJc YELLOW/ - is+zvectoc I .
This Permit covers Work to be done on private property GOLD - PINK - Owner
Any construction on the public domain (turns, sidewalks, driveways, '
marquees, etc.l Ivill require Se
oerate permission.
APPLICATION
The City of Edmonds for EASEMENT NO- --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS ❑ LID NO- ------------------ ASMT. NO. ------------------
OWNER g' .• G � S—\at� CONTRACTOR ...--�D+-�\�1 W
-•--•--•-------------------------------------------•---------------------------------------------•-------- PERMIT NO. --------------.----.
JOB ADDRESS ---- } —-------•-----•--------- LEGAL DESCRIPTION: LOT NO- ------------------•-------•-----.---- . BLOCK NO. •-------•-•-----•------------------
LL-
CD
S
..............•-•-•-•--•---•-----------•-----•----------•---..........--•---......_......----•-•--------• •------_----
...�
.pproved: /
SATE ..... BY ���' .............. /
11
APPLICATION
The City of Edmonds for E I ASEMENT NO_ ---------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION ❑ REPAIRS D LID NO_ ------------------ - ASMT. NO. ------------------
OWNER ----
..... ------ ........ CONTRACTOR
-------------------------- ------------ PERMIT NO. -57"'C-4
JOB ADDRESS --------- -- - ------ C ------- ............. LEGAL DESCRIPTION: LOT NO. .......... BLOCK NO_ ____________________________________
C, 577-t- 47 — ------------------------------------------------------------------------------------------------------------------------------------------------------------
NAME OF ADDITION -------
/0 3y
Approved:
DATE
BY---------------------------------------------------
m
ROUTING SLIP
NEW S-
ICE INSTALLATION
-
ADDRESS :
DATE:
/ Q�f
A DIG# /�a/
DIAL
`
%q P.U.D.
TELEPHONE
CABLE T.V.
GAS
FORE"'LAN
r`
STORM SEWER
OTHER
SERVICE INSTL: YES NO j
FUTREco
CUT*
BORE:.
YES NO
SURCHARGE:
y
OC / 7 -7 INITIAL :
CREW
DATE
UNLOCK INITIAL:
DATE* _
-�7J cQ
ACCOUNT NUMBER: O
-METER .SHOP
SUPPLIER: t5
TREATMENT PLANT. SIDE -SEWER PERMIT.
CIVIL ENGR.
. B L T .7 x�
DRAFTSMAN.
7 �
DATE:
SUPERINTENDENT .INITIAL: '
APPLICATION/'
TAP CARD METER SHEET
DISPATCH
UTILITY
;
BILLING
7 76,.
J
ray _ CITY DF EDMONDS AMN
ENGINEERING DEPARTMENT _
= TREET FILE
APPLICATION FOR RIGHT OF ,lAY CONSTRUCTION PEPS
(Aocltic^:t to Cc.-mZete A & ° and Subm-Lt in Duplicate)
A,
Permit to be issued to: -
For work at: (address or vicinity).
Type of work to be done: C v3'� //✓l �Y�rc /='/i//vG ��� %l' �A/- c:,••
(attach Dra,,ing 1,1;en Applicable)
OPT -/��n1�1��'��
Time Required -- Start: O ,a S %G Finish:
Name
?Mailing Address
_)
's- /j.J 1_
T -.
City State Telephone Number
Contractor: iS %�.f-�.i�i V- Wiz/
Name State License Number
;~failing Address
City State Telephone `Dumber
B,
INDEYNI Y: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages or claims of any
kind or description whatsoever, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including but not limited to the defense of any legal proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Department.
1:or:- subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by the Engineering Department.
Call 775-2525.
Signature:
Owner,-'-rr ilgent Date Signed
DO HOT ti'JR I TE BELOW THIS LINE (To be completed by Issuing Agency)
Permit Issued (Date) �l .J-7 Permit Number �� �l C�
Fee: -FS0 --- Bond:
Time Authorized:
Par
h:R' S APP• RO ' \L DE
'r-*-.