1049 3RD AVE S.PDFiiiiiiiiiiii
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1049 3RD AVE S
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ADDRESS: C�?
TAX ACCOUNUPARCEL��:---
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 Vs):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
L:\TEMP\DST's\Forms\Jana's Street File Checklist 5-14-08.doc
H
Q0 TREET FILE Side Sewer Drawing
The City of Edmonds
EASEMENTNO - --------------------------------------------
NEW CONSTRUCTION REPAIRS [:1 LID NO_ ------------------ 'ASlyff. NO. -_--____________
OWNER C-4L-,.� ---- C �-'c ------- FI.. CONTRACTOR --- C - ----------- ------------------------------------------ PERMIT NO.
JOB ADDRESS ---- . . ................ LEGAL DESCRIPTION: LOT NO. -------------------------------------- BLOCK NO- ------------------------------------
...... ...................
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DATE ..... ............. By --- — ----- 377'-:� �. ...
PWW-OWl-1 1/75 (REV.1 1178)
1
1
, ITY
OF EDMONDS
I PUBLIC
WORKS DEP FOR
INSPECTION CA �' permit !��
SIDE
SEWER PERMIT -r 775-2525 Ext. 220 Issue Date
PERMIT MUST BE
POSTED ON JOB SITE
1.
Address of Construction
2.
Property Legal Description
(include all easements)
K 1 t f a�
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3.
Single Family Residence -,e_ Multi -Family No. of Units
Commercial
4. Owner and/or Builder
i
5. Contractor & License No.
6. Invasion into City Right -of -Way: No,..Yes (If Yes Right-of-
way Construction Permit Required - Call Dial Dig (342-5344) before
excavation).
7. Cross other private property: Yes No•�r Easement required -
attach legal description and county easement number.
READ THE FOLLOWING AND SIGN:
a. Property owners must obtain a permit to install side sewers on
their property. A licensed _aide sewer contractor must be employed to
construct side sewers in the public right-of-way.
b. The side sewer contractor assumes full reponsibility for each
installation for one year.
c. Commercial establishment requires a minimum of a six inch (6")
side sewer line.
d. Side sewers may not be installed closer than thirty inches (30")
to any structure.
e. Side sewer lines must be laid at a minimum grade of 2% (1.15°)
and maximum grade of 100% (450).
f. No turn in side sewer greater than 45° (1/8;bend) is allowed
between cleanout. All 90 turns must be constructed of a 45° (1/8
bend) and wye with removable cap.
g. No down spouts, footing drains or floor drains can be connected
to side sewer system.
h. Pea gravel is required for bedding when installing sewer lines
through other than granular soil.
i. Cleanouts are required at 30"-60" from each plumbing exit line
and at minimum intervals of 100' along sewer line run.
j. Trenches within City right-of-way must be restored to original
conditions. Contractors shall be responsible for right-of-way failure
due to poor compaction of fill.
k.. Side sewer must be left uncovered until inspected and approved
by the City.
1. Inspection during normal working hours only. Two (2) working
days notice required.
DATE:
I certifyLt a't-'I have read
and shall comply with the above
PERMIT FEE:
H ��„ �.�..�.�&� DISAPPROVED By: Date:
w By:_ Date:
o CONNECTION FEE: APPROVED By: �(�<+, r Date •
w* PERMIT MUST s1§E. POSTED ON JOB SITE
CiTY Of EDMONDS PermitNo.___�-
COMMUNITY SERVICES DEPARTMENT STREET FILE
Issue Date V&Y
RIGHT-OF-WAY CONSTRUCTION PERMIT '.
A. *Owner: Washington Natural Gas Co
ft 156 AV NE
MailingAddress e's Bellevue. WA 9.8007
City State Zip
9 Address or Vicinity of Con
Type of Work to be Done:
B. o Contractor:..,, Same
Name
Mailing Address
City
State License Number
ion: ,_�'-VY49 3 AV S
New qas service installation
State Zip
447-0700
Telephone Number
Work in Connection With: ff8'18 or Plat `'Sihkle'Faffifly El City Projects LL
____MC05rmerciar-=9u TamTy
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Pavement'Cut: 0 Y 0 N
APPLICANT TO REA&,AND SIGN
a4
< INDEMNITY: 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, forseen or unforseen, that may
M
• be made against the City of Edmonds, or any of its departments or employees, including or not limited to the defense
of any legal Proceedings including defense costs, court. costs, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL, INSPECTION AND ACCEPTANCE OF THE WORK.
0
U Funds held from the Security Deposit, (estimated restoration fee) will be held until the final street patch is completed
by City forces, at which time 4 debit/or' cre it will be processed for issuance, to --the applicant.
V,
0
0 A 24 hour notice is required for inspection; Please call Public Works: 771'-3202
0 Work is to be inspected during progress and at completion.
9 Restoration to be in accordance with City Code.
0 Street to be kept clean at all times.
0 Traffic Control to be in accordance with City regulations.
.9 All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
no exceptions.
'.---ItndergtAfid,-,the�ab,OV�C-an d•—thaVAIii; imes..
'as
Signature: Date: 11/21/88
Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
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P4
0
114
ISSUED BY:
Time Authorized: V id after 30 —days.
Special Conditions:
Amendments:
PERMIT, FEE:-9'J 0 /Uo A
Security Deposit:
Receipt No.:
Fund III Fee:
Street Cut Dimensions:
X
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTION NOTES.:. (Fun I11 - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY:- Date:
Eng. Div. July 1985
STREET FILE
Nam.h: As 1972
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NOTE
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'CALL
4* PE JP MAIN
END MAIN MIDDLE Y. OF LOT
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4 't"Is
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p.0 I X1 Isla
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