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1109 3RD AVE S (2).PDF1109 3RD AVE S 0 46 ADDRESS: Mq TAX ACCOUNT/PARCEL #: 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 #'s): PLANNING DATA CHECKLIST DATED: SCALED PLOT PLAN DATED: SEWER LID FEE $: LID #: SHORT PLAT FILE: LOT: BLOCK: SIDE SEWER AS BUILT DATED: o�ZY 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 V A JDS VNIAY Side Sewer Drawing TRUNNK LINE The City of Edmonds EASEMENT NO . ............. NEW CONSTRUCTION ❑ REPAIRS ■ LID NO. ..r. 47 -..ASMT. NO ................... OWNER ..... `::rl�--------- QS---•------------------------2......... CONTRACTOR - a4r j. .... 1 � SS�C PERMIT NO. 397 Q ; JOB ADDRESS ( �J---�-�--- �- -- ----- 5 --._,� ------ LEGAL DESCRIPTION: LOT NO. ---• BLOCK NO. ..-•----..... 0 n---rL ---------------------------------------- 1 NAME OF ADDITION ------ S O V� a_r----------� 4-Ll On CD M M M e- Fry U Approved: VIA EDV/1CNl.S WAY �-p i y TRUNK LINE � = .....;�^1-11/75 (REV.11l78) � DATE .-..- • --..•.._...----------- BY 1._" . CITY OF EDMONDS _ PUBLIC WORKS DEPAFPT FOR INSFECTION CAL permit h0 �� SIDE SEWER PERMIT 775-2525 Ext.' 220 Issue Date 9 /11/79 PERMIT MUST BE POSTED ON JOB SITE * 1. Address- of' Construction *Vi ,; , 2. Property Legal Description (include all easements) 3. Single Family Residence )? Multi. -Family No. of Units Commercial 4. Owner and/or Builder�G 5. Contractor & License No. raA --4 -A� ��, � 0 C 6. Invasion into City Right-of-Wa : No Yes (If Yes fight -of - way Construction Permit Required - Call Dial Dig (342-5344) before excavation). 7. Cross other private property: Yes No JC 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 side 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.esta f a six inch (6") side sewer line. d. Side sewers may n ns 1 E Z55 h a n thirty inches (30") ``to' any structure. . �' 48 ""s e. Side sewer line s 1 id ailEFQMim m g ade of 2% (1.150) and maximum grade of 10 %.( YOU DIG f. No turn in side s e r than /8 end) is allowed between cleanout. All t b c structed of a 450 (1/•8 bend) and wye with remo g. No down spouts, �raMQWM1JHo6QU1tV i s can be connected to side sewer system. 9TIUTTC00RDINAT1N6C01NM 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 noticed required. DATE:- / 4 - r' Z(:�+ Ei: ornotQb; ` 'Rukjk. L ►Ns IVicerti y that I hWe F-e ad ,and shall comply WlYth the above PERMIT FEE:© �JJ�'""'-" F�2�°'-'7RvnA D SAPPROVED BY: Date: ; Date: CONNECTION FEE: REQ0 igCD APPROVED By: Date: PERMIT MUST BE POSTED ON JOB 6 TE = STREET FILE HARVE H. HARRISON MAYOR 200DAYTON ST.•EDMONDS. WASHINGTON98020•(206) 775-2525 DEPARTMENT OF PUBLIC WORKS August 15, 1979 Pro.per_ty Owner 04 '9 TR% AvenuW Edmonds, Washington 98020 -Dear Property Owner: SUBJECT: LID NO. 204 - SANITARY SEWER CONNECTION You were notified on March 13, 1979, that you should make arrangements to connect to the new sanitary sewer within sixty (60) days. Your bi-monthly sewer charge has been raised effective May 12, 1979. Please make arrangements to make the required connection or notify me in writing by August 31, 1979. Permits may be obtained at the Public Works Department, 200 Dayton Street. Please contact Jim Roberts of the Engineering Division at 775-2525, extension 220, for any information or assis- tance you may desire. Yours very truly, JA S . ADAMS , P . E . City Engineer JEA:rm 41 ROBERTS DT ADMIN DT DIR PW DT CITY OF EDMONDS PUBLIC WCIW - EMINEE iIM ACTION REPORT STREET FILE Nm 4228 SUSPENSE DATE: j Date: I 0?0 Sw Time: / File Attachments: SUBJECT: REQUESTOR: NAME: <''� • ��/ ADDRESS: /la9-,3A PHONE: REQUEST RECEIVED BY: TELEPHONE CONTACT IN OFFICE p OTHER: _. O RECEIVED BY: 5. DYes ® t� ACTION: Van MVNILl t S.S - All Concerned Notified` Action Completed/File tom, a'�,tsS� ,-"•;+:''^"7"SSr�V"1 r City.of Edmon RIGHT-OF-WAY CONSTRUCTION c PERMITrermit Number, Issue Date:-,::,.? - i5- 9 � A. Address or Vicinity of Construction: 1109 Third AV S GTE to place operate and maintain a buried service 18 q B. Type of Work (be specific):wire from existing ;Able # 708 located at 1109 3r AV S 9 0 1 9 then east to a residence at 110 3rdv b. UILo Plow luu fee , pus no0 roads and no driveways. R.O.W. footage 5 feet. Mary A Bower, Permit Coo rd. C. Contractor: GTE Northwest Incorporated Contact: Dennis Alexander 771-9036 or mobile 388-1358 Mailing Address: Bothell, WA 98021 u e Phone: Mary 206/488-1628 State License #: Liability Insurance: Bond: $ D. Building Permit ti (if applicable): Side Sewer Permit # (if applicable): E. ❑ Commercial ❑ Subdivision ❑ City Project )E] Utility (PUD GTE WNG, CABLE, WATER) ❑ Multi -Family ® Single Family ❑ Other 2100 -9P001 DB 242310 INSPECTOR: INSPECTOR:iJ�' F. Pavement or Concrete Cut : ❑ Yes JANo G. Size of Cut: x H. Charge $ Please see attached sketch. APPLICANT TO READ AND SIGN INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may 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, 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. ESTIMATED RESTORATION FEES WILL BE HELD UNTIL.THE;FINAL STREET PATCH IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT. Construction drawing of proposed work required with permit application. A 24 hour notice is required- for inspection; Please call the Engineering Division, 771-02 Work and material is to be inspected during progress and at completion. Restoration is to be in accordance with City Codes. Street shall be kept clean at all times. Traffic Control and Public Safety shall be in accordance with City regulations as required by the City Engineer. All street cut ditches shall be patched with asphalt or, City approved•material prior to the end of the working day; NO EXCEPTIONS. I have read the above statements an nderstand the permit requirements and the pink copy of the permit will be available on site at all s f ctl urposes. , `4 •-' (.'- _ r c_ Signature. John H. Stewart Date: :z 9 96 (Contractor or Agent) Oprns Supv-OSP Engrg. CALL DIAL -A -DIG PRIOR TO. BEGINNING WORK FOR CITY/USE' ONLY" APPROVED BY: TIME AUTHORIZED: VOID AFTER DAYS SPECIAL CONDITIONS: COMMENTS: RIGHT OF WAY DEPOSIT DISRUPTION FEE/FUND III-. RESTORATION FEE: PERMIT FEE: +30. 0 O TOTAL FEE: RECEIPT FEE: DATE: ISSUED BY: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994 LEGEND PERMIT SUBMITTED BY GTE PODLES 0 ROAD BORES -"'- OVERKEAD LINES--'--- I.D. UTILITY POTHOLE =1 UG TRENCHING -UGT 0 R.O.W. ------------------------------------------------------------------- EO P 3 R UE S� ---------------------------_ _--- .------------------------------ 4 z 0 CJTS. 0 W m .w .o..se�. ( J