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HomeMy WebLinkAboutWTR2702153 W-2153 Safeway Store 1 F 1 BEGINNING OF FILE 1 FILE TITLE �3 fr! t N9 r'N crmRDFD RENRN 7R 7AN t Of:.a—:@e City Clcik rF Rent,,M nidpMBWiaMa 1998twoawalwss BILL OF SALE �NiVDER KNOW ALL MEN BY THESE PRESENTS ,a That Safeway Inc., a Delaware 6 corporation, 1000 124th Ave., NE. Suite 0202,a,tou of ling, State of Washington, M the partv(yftes)of the first part,for an in consideration of the sum of$1.00 Dollars lawful money of the United States of America, to Safeway, Inc., in hand paid by the City of Renton, Washington, the party(y/ies) of the second part, the receipt whereof is hereby € u+ acknowledged, do(es) by these presents grant, bargain, sell and deliver unto the said 3M art /ies of the second art, the following described "p Y(y ) p g personal property now located at 4300 NE 4th Street in the City of Renton, County of King and State of Washington, to wit. See Attached Exhibit"A" TO HAVE AND TO HOLD the same to the said party(yftes) of the second part, g (their/his/her) heirs, executors, administrators and assigns forever. And said party,v/ies) of the first part, for (theirthi0er) heirs, executors, administrators, covenan(s) and a j agree(s) to and with the said p.rty(y/ies) of the second pan, (their/Itis(her) executors, a" administrators and assigns, that said party(ylies) of the first part (is/are)the owner(s) of the said property, goods and chattels and has(ve)good right and full authority to sell the same, and that Safeway Inc., will warrant and defend the sale hereby made unto the said party(y/;es) of the second part, (their/his/her) executors, administrators and assigns, against all and every person or persons, whomsoever, lawfully claiming or to claim the same. rl awl O IN WITNESS WHEREOF, the said party(ylies)of the first pal: has(ve)hereunto CD set(their/hWher)hand and seal this 14th day of December 1995, O 4 SA.MAY INC., a Delawam Corp io _ By: Its 'st it i Pre d — By: Aaagant Secretary k r (r L.� I ACKNOWLEDGMENT STATE OF CALIFORNIA ) ss COUNTY OF ALAMEDA ) On December 14, 1995 before me, B. 1 Mazurie, Notary Public, personally appeared Sharman Bra'and Jerome P. Harrison, personally known to me to be persons whose f. names are subscribed to the within instrument and acknowledged to me that they executed the same in their authorized capacities, and that by their signatures on the instrument,the -1 persons or the entity upon behalf of which the persons acted,executed the instrument. WITNESS my hand and official seal. s Signature ,L,i &J. (Seal) W12U I t� O N V4 O cc OI - # 6- 000a f I u ^b` �I r' WTR 2153 WWP 2153 EXHIBIT TED ZM 'q• WY.@terma'n Improvements 95 lineal feet of 8• Ductile Iron watermain 1,140 lineal feet of 12• Ductile Iron watermain 7 each 12" gate valves 1 each 8" gate valve 7 Standard Fire Hydrant Assemblies Sanitary Sewer Imnrovement 924 lineal feet of 9" sanitary sewer main _ 5 each 48 inch manholes Road Improvements 55 lineal feet curb, gutter, sidewalk d' N W4 O .xC I f i `7b 000 y. 9 7 1� i e, G•A. 1 y, PROJECT CLOSING A6 rinaitcostrixtA FINAL COST DATA AND INVENTORY and Inveniory r� SUBJECT cITYPROJF•CTNuMnrits. STTH 27-2153 wvP. 35-2153 Safeway R1468 SWM1 -- Name of Protect TRO' 1 IED- MfJ-20 TI TO cay o(Renton f•ROM Absher Construction Company 3.. Man RcVicW SWiOn 8121 Shaw Roa Sout east mannmiVBuilding/PldllkWmas P.o. Box 280 (98371) 2W Mill Avenue South puyalluD. Washinaton 98372 `s), Rcnion,WA 99055 DATE. na_nmher 19. 1995 Per the request of the City of Renton,the following information is furnished concerning final costs for f improvements installed for the above referenced project. MIATIR SYSYaM coNsm cram OCR. .. 1<nelh Sim Type L.R.of wA7ERMAIN _95 L.P.of WA7ERMAIN .e. 1140 L.P of 110" WATERMAIN L.P.of wATERMAIN 7 FACII of 1 ON - ' CATE VALVr% t UCI'I of at, CAST:VALVES ) ' EACH of GATE VALVF_i 7 EACH of FIRE.IIYDRANT ASSEMEUI•b f I -Q70-00 (C."of Rrt I Intranta nnnl Ix IiMcd squntch0 f (Include Engmecnnif and Saks Tax if appi¢.hk f .. 1.OUL(X70 FORWAII!RSYTITM .� - SANITARY SEWER SYSTEM' q ORM DRAINAGE S=MIA. Icnifth Star TTP( IcnRlh Sipe Type SIl)RM UN[ 924 LFM @w 11'.w'rR MAIN LP.d L.F ROAM _— L.P f TORMLINC LP of MoUtMAIN LP Of 1 ORM UNC LA of it DIAMLITR MANIIOU S -- I:A Of �"1'OMI IN1.t1-(ul� s F TA of IMARMITRMANIIMFS IA Of STORM UrCnR.PIa (WhaiaR FN,.mnngaml Saka Tax rA of _ ' STORM U I CI WASH 1 daPplkabk) 1 (hwhxhng u FnROmennR aml 01ra 1'aa — 't MTALCOST tun SANI1'ARYSEWF.R SYSII M 1 141 171[-fIQ ......4t.W, I IOIAI CMI FOR%T RM I)RAINAOr SYRICAI 1 STREET IMPROVEMENTS' (Inrhdmµ tAnh.IAnICr,1alcw:K.A%ph.dt PawjitGtn and SHcet laghwitt) 1 each drive way per city standard $1 500.00 _ SIGNAULAnON (ImI do.µ Unit UTMgn 0141.(n)Ibm01 Pcra.WA N raks 1'ax) NIA _ _ GvatWk _ STREET UCHTING (Inel(ding Eng Ihalgn t tno I'av ibtmu PTeI WA M Saks Tax) 3tc1owok C.Te.0 _ -- fob 845-gS�lLi _ Pnnt atgnaalry nan(c A plat plaauT'a • t '. fW;NAi11RP7 IlRwwl uH 11.11 IR A'I'h lSsinauO utN Ic aWlptnacd al, f i M�IIIaIMaRaaaalw�r.tom+-rt,.+.w�..w.�.�.,.. W11FN RECORDED RSNRN'^J: Ea ogee or me Ciy Cklt - Rc Munlclpl auadi, Utilities ►calm Faaa 2m MillA 9803 5wN Rm..WA 9ia5 EASEMENT Pad TaxA¢ �P�e yA7�13 0$90$ Gnaw()Nu �M(f1G{{Y RTsQ rG— 1; D THIS INSTRUMENT.made this lgtWay of December _1995 R byandbetween SAFEWAY INC. , a Delaware and ""e0^ ° corpora ion ab _ ! .. . . O O hereinafter called"Granmr(s),'and the CITY OF RENTON,a Municipal Corporaden of King County, e N� Washington,hereinafter called 'Grantee. V 0 That said Grantor(s),for and in consideration of mutual benefits,do by these presents,grant,bargain,sell, s W convey,and warrants unto the said Grantee,its successors and assigns,an easement for public utilities(including water,wastewater,and rarface water)with necessary appurtenances over,under, through,across and upon the following described property(the right-of-way)in King County,Washington,more particularly described as follows: ' RF�FiVED Sec attached EXRMrr A for legal description. JAN 0 91996 glhm JQUNTY RECORDER f EXCISE TAX NOT REQUIRED 11aN11WrrpMAFRO'/{RaY r11n11M}EIKTeIII fRY ATRMVIIYtVI.H.11p sl 1 Of 2 e�.MFarsWRVrY.aOl'N r �9G-ODO� Iasr�rrraNr. ` F 71 For the purpose of constructing, reconstructing.installing,repairing, replacing,enlarging,operating and maintaining utilities and utility pipelines,including,but not limited to,water,sewer and storm drainage lines, together with the right o;ingress and egress thereto without prior institution of any suit or proceedings of law and without incurring any legal obligation or liability therefor. Following the initial construction of its facilities, Grantee may from time to time construct such additional facilities as it may require. This easement is granted subject to the following terms and conditions: 1. The Grantee shall,upon completion of any work within the property covered by the easement,restore the surface of the easement,and any private improvements disturbed or dtstroyed during execution of the work,as r' nearly as practicable to the condition they were in immediately before commencement of the work or entry by the Grantee. 2. Grantor shall retain the right to use the surface of the easement as long as such use does not interfere with the easement rights granted to the Grantee. Grantor shall not,however,have the right to: a. Erect or maintain any buildings or structures within the easement;or b. Pint trees,shrubs or vegetation having deep root patterns which may cause damage to or interfere with the utilities to be placed within the easement by the Grantee;or c. Develop,landscape,or beautify the easement area in any way which would unreasonably increase the costs to the Grantee of restoring the easement area and any private improvements rhereln. f d. Dig,tunnel or perform other forms of construction activities on the property which would disturb the cempaction or unearth Grantee's facilities on the right-of-way,or endanger the lateral support facilities. e. Blast within Me=(15)feet of the dghthf-way. t This easement shall run with the land described herein,and shall be binding upon the parties,their heirs, successors in interest and assigns. Grantors covenant that they are the lawful owners of the above properties and that they have a good and lawful right to execute this agreement. CID O Signatures of Grantors: X) SAFEWAY INC. , a Delaware corporation and � - O (V and Its as start ce President and IiY.: and Q) Its P/sristafiV tecretaryPmurAmmPbaMnFACKNOw DGMENT STATE OFWASHINOTON ) Form approved Mf SS / I COUNTY OF ICING ) I 1 certify that I know or have satisfactory evidence t / signed this instrument. on oath anted that he/she/they was/wem au ute the instrument and acknowledged it as the I( of to be the free and voluntary act o[such parry/parties for the user and purposes me the instrument. I Dated Notary Public in and for the State of Washington residing at Notary(print): My appointment expires: urn'ua F. .' SM 2 W 2 Coryone F.. ..mews-rww�numeoe. �'6�� A r^ ix 1V .,F ACKNOWLEDGMENT 1 a STATE OF CALIFORNIA ) ss COUNTY OF ALAMEDA ) i On December 18, 1995 before me, B. J. Muurie, Notary Public, personally appeared Sharman Braff and Jerome P. Harrison, per onally known to me to be persons whose names are subscribed to the within instrument and acknowledged to me that they executed the same in their authorized capacities, and that by their signatures on the instrument, the persons or the entity upon behalf of which the persons acted,executed th^instrument. WITNESS my hand and official seal. f �Signature B.J.AU21Ni1E a r '"-�i/l (Sm:) comm,0103455 O coum.wu�� f CA !'1 c0 7� F BUSH, ROED h HITCHINCS,INC. f 1 MATERLINE EASEMENT DESCRIPTION THAT PORTION OF THE SOUTHWEST QUARTER OF SECTION 10, TOWNSHIP 23 NORTH, RANGE 5 EAST, W.M., IN KING COUNTY, WASHINGTON, LYING WITHIN STRIP E10 NTENEV ES OF SUCH ON EACH SIDE AN EASEMENT CENTERLINE DESCRIBED A FOLLOW ; COMMENCING AT THE SOUTHWEST CORNER OF SAID SUBDIVISION, THE14CE ' SOUTH 88°02158" EAST 396.46 FEET ALONG THE SOUTH LINE THEREOF TO THE WEST LINE OF THE EAST 250.00 FEET OF THE WEST HALF OF THE SOUTHWEST QUARTER OF SAID SOUTHWEST QUARTER OF SECTION 10 (AS MEASURED ALONG THE SOUTH LINE THEREOF) ; THENCE NORTH 00-16-39" WEST 369.91 FEET ALONG SAID WEST LINE TO THE TRUE POINT OF BEGINNING OF SAID EASEMENT CENTERLINE; THENCE SOUTH 89944'45" EAST 51.53 FEET TO A POINT HEREINAFTER REFERRED TO AS POINT "A"; THENCE CONTINUING SOUTH 89-44-45" EAST 237.13 FEET TO A POINT HEREINAFTER REFERRED TO AS POINT "B"; THENCE CONTINUING SOUTH 89-44145" EAST 181.68 FEET TO A POINT } HEREINAFTER REFERRED TO AS POINT "C"; pV THENCE CONTINUING SOUTH 89°44145" EAST 22.97 FEET; THENCE NORTH 00°11'S2" EAST 6.03 FEET TO A POINT HEREINAFTER REFERRED TO AS POINT "D"; ..,INT THENCE CONTINUING NORTH 00°11 52 EAST 7.50 FEET TO A HEREINAFTER REFERRED TO AS POINT "E"; THENCE CONTINUING NORTH 00-11-52" EAST 95.10 FEET TO A POINT HEREINAFTER REFERRED TO AS POINT "F"; (D THENCE CONTINUING NORTH 00°11'52" EAST 119.99 FEET; CD THENCE NORTH 44°24'27" WEST 36.37 FEET; m THENCE SOUTH 89057'33" WEST 160.81 FEET TO A POINT HEREINAFTER N REFERRED TO AS POINT "G"; 3.42 FEET; THENCE CONTINUING SOUTH 89-57-33" WEST 8 TO THE SOUTH LINE OF THE T4 THENCE NORTH 03'48'43" EAST 38.97 FEET OF SAID SOUTHWESTSOUTH 15.00 FEET THE NORTH QUARTER OF SECTION 44.00 FEET 10 OANDHA TERMINUS OF WEST QUARTER EASEMENT CENTERLINE; ALL, BEGINNING AT POINT "A" DESCRIBED ABOVE, THENCE SOUTH 00°15'15" WEST 24.55 FEET TO A TERMINUS OF SAID EASEMENT CENTERLINE; NCE SOUTH WEST 23.76 , BEGINNING FEET TOPAZNT "B" DESCRIBED ABOVE,TERMINUS OF SAID EASEMENT E 0°15'15" CENTERLINE; ALaQ, BEGINNING AT POINT "C" DESCRIBED ABOVE, THENCE SOUTH 00°35'15" EAST 27.40 FEET TO A POINT HEREINAFTER REFERRED TO AS POINT "H"; THENCE CONTINUING SOUTH 00°35'15" EAST 46.98 FEET TO A POINT HEREINAFTER REFERRED TO AS POINT "I"; THENCE CONTINUING SOUTH 00°35'15" EAST 94.46 FEET TO A POINT HEREINAFTER REFERRED TO AS POINT "J"; THENCE CONTINUING SOUTH 00-35115" EAST 10.14 FEET TO A TERMINUS OF SAID EASEMENT CENTERLINE; 1/2 1� y i BUSH, ROED& HITCHINGS, INC ALSO, BEGINNING AT POINT "E" DESCRIBED ABOVE, THENCE SOUTH 89°48'08" EAST 37.67 FEET TO A TERMINUS OF SAID EASEMENT CENTERLINE; ' ALS_Q, BEGINNING AT POINT "F" DESCRIBED ABOVE, THENCE SOUTH 89°48'08" EAST 38.67 FEET TO A TERMINUS OF SAID EASEMENT CENTERLINE; ALSQ, BEGINNING AT POINT "G" DESCRIBED ABOVE, THFNCE NORTH 00°02'27" WEST 13.80 FEET TO A TERMINUS OF SAID EASEMENT CENTERLINE; ALSO, BEGINNING AT POINT "I" DESCRIBED ABOVE, THENCE NORTH 88°12'57" EAST 102.50 FEET TO THE EAST LINE OF THE WEST HALF OF THE SOUTHEAST QUARTER OF THE SOUTHWEST QUARTER OF SAID SOUTHWEST QUARTER OF SECTION 10 AND A TERMINUS OF SAID EASEMENT CENTERLINE; ALSO, BEGINNING AT POINT "J" DESCRIBED ABOVE, THENCE NORTH 89°24'45" EAST 25.66 FEET TO A TERMINUS OF SAID EASEMENT CENTERLINE; THE SIDELINES OF THE STRIP DESCRIBED ABOVE SHAY BE SO SHORTENED OR LENGTHENED SO AS TO MEET AT ANGLE POINTS AND Tb-!INATE IN SAID WEST LINE OF THE EAST 250.00 FEET AND IN SAID EAST LINE OF THE WEST HALF; 1 TOGETHER WITH THAT PORTION OF SAID SUBDIVISION LYING SOUTHERLY AND EASTERLY OF THE STRIP DESCRIBED ABOVE AND LYING NORTHERLY AND _ WESTERLY OF A LINE DESCRIBED AS FOLLOWS: COMMENCING AT POINT "D" DESCRIBED ABOVE, THENCE SOUTH 89-48-08" EAST 22.58 FEET TO A POINT ON THE SOUTH LINE OF THE STRIP DESCRIBED ABOVE AND THE TRUE POINT OF BEGINNING OF SAID LINE DESCRIBED C HEREIN; THENCE SOUTH 32.78 !.;ET TO A POINT WHICH BEARS NORTH 89°24'45" EAST Cj FROM POINT "H" DESCRIBED ABOVE; (j THENCE SOUTH 89-24-45" WEST 37.79 FEET TO A POINT ON THE EAST LINE rl OF THE STRIP DESCRIBED ABOVE AND THE TERMINUS OF SAID LINE DESCRIBED HEREIN; 0 ALSO TOGETHER WITH THE SOUTH 15.00 FEET OF THE NORTH 644.00 FEET OF THE EAST 250.00 FEET OF THE WEST HALF OF THE SOUTHWEST QUARTER OF SAID SOUTHWEST QUARTER OF SECTION 10 (AS MEASURED ALONG THE SOUTH LINE THEREOF) ; AL❑ ALSO TOGETHER WITH THE SOUTH 29.42 FEET OF THE NORTH 673.42 FEET OF THE WEST 15.00 FEET OF THE EAST 250.00 FEET OF THE WEST 4 HALF OF THE. SOUTHWEST QUARTER OF SAID SOUTHWEST QUARTER OF SECTION 4! 10 (AS MEASURED ALONG THE SOUTH LINE THEREOF) ; FF SITUATE IN THE CITY OF RENTON, KING COUNTY, WASHINGTON. F ,�X As7r.¢0 SAFEWAY, INC. II �e k�Tt STORE NO. 553 WILLIAM A. HICKOX, P.L.S. BRH JOB NO. 93178.09 NOVEMBER 21, 1995 II-2145 0� 2/2 MAU yv, #96-000l .J Ia > ,9 �3 7 3 DUSH, ROED& HITCHINGS, INC. 1 SEWER EASEMENT DESCRIPTION THAT PORTION OF THE SOUTHWEST QUARTER OF SECTION 10, TOWNSHIP 23 NORTH, RANGE 5 EAST, W.M. , IN KING COUNTY, WASHINGTON, LYING WITHIN A STRIP OF LAND 15.00 FEET IN WIDTH, HAVING 7.50 FEET OF SUCH WIDTH ON EACH SIDE OF AN EASEMENT CENTERLINE DESCRIBED AS FOLLOWS: COMMENCING AT THE SOUTHWEST CORNER OF SAID SUBDIVISION, THENCE. SOUTH 88°02'58" EAST 646.46 FEET ALONG THE SOUTH LINE THEREOF TO THE WEST LINE OF THE EAST HALF OF THE SOUTHWEST QUARTER OF SAID SOUTHWEST QUARTER OF SECTION 10; THENCE NORTH 00°16'39" WEST 42.03 FEET ALONG SAID WEST LINE TO THE NORTH MARGIN OF NORTHEAST 4fH STREET; THENCE SOUTH 88°02'58" EAST 14.39 FEET ALONG SAID NORTH MARGIN TO THE TRUE POINT OF BEGINNING OF SAID EASEMENT CENTERLINE; THENCE NORTH 00°09'29" EAST 343.25 FEET; I THENCE NORTH 89°44'45" WEST 250.14 FEET; THENCE NORTH 00-14 -31" EAST 239.96 FEET; 1 THENCE NORTH 20-10-46" WEST 55.36 FEET TO THE WEST LINE OF THE EAST 250.00 FEET OF THE WEST HALF OF THE SOUTHWEST QUARTER OF SAID SOUTHWEST QUARTF.1: OF SECTION 10 (AS MEASURED ALONG THE SCVTH LINE. j THEREOF) AND THE TERMINUS OF SAID EASEMENT CENTERLINF. THE SIDELINES OF THIS EASEMENT SHALL BE SO SHORTENED OR LENGTH.?NED SO AS TO MEET AT ANGLE POINTS AND TERMINATE IN SAID NORTH MARGIN AND IN SAID WEST LINE OF THE EAST 250.00 FEET. SITUATE IN THE CITY OF RENTON, KING COUNTY, WASHINGTON. O O N SAFEWAY, INC. V4 ,tjA A.010, STORE NO. 553 � _w Ap WILLIAM A. HICKOX, P.L.S. �, �t JOB NO. 93178.09 NOVEMBER 20, 1995 f �TstEaF9! . LASO FVIMs will I eeGG .1 N, 1 e x a� e'•g bl q� yak � p L y,pp Try 4 V1bTY �'^T5r k.. 7 pp d'+rye. y.• UNION AVEN . EASEMFI- .. . 8.W. 1/4. arc. 10. - CITY of RL'NTON. mzl ,q 1' i, a�;S<MJ CONCRET); AIONUNENT IN SOUTH LINE M ME mmN CASE (1959). - 5t5.00 EEET d< iN[SWM— WST WRRTM W THE WITNREST WMTM SlE7t`J2'E�� .� 249.9!' - \ _ N � n ,s.00' i -----1-_ i sosozitoss I 1 1 I p Iw1�1 I d I RI n I I �REST'UNE OF THE EAST 250.00 FEET OF I;OI ME KST HALF OF THE SOUTNREST 1`•I I 10UMTER OF 1,11 MUTIMMT OUARTTR is=7104 10. lylt, 1 ' 1 I 1 �1WE ii11 , , ' I T1� ti: JE SAFE WAY EXHIHI r :3 N.. It 6 E.. W.M. :OWKTV. WASHSNOTON r:µa GRAPHIC SCALE ST EE.E O<THL LAST XAV (N MT) THE SOUTHWEST MAMTEM 1 kWhso R THE SOUTHWEST OUMTEM ,MN U W THE SOUTHEAST WAMTp Di ME SCST oumTT1 w /ME I 3lSOT16'E � GJTH'LSOUTHW.EST OIIMTW OF SECt M TO . 324,03, G` s o 2-lr E -- r `aw__ zx�--.---- p1 [� S�� LA1[WAT(1H) , 1 I1 I 1 W ; is 1 1 1 1 I 1. � W I bPb � 1 l � f- N0016'39'w 32.15 A. 1� N68'02'56'WWAI- i b "N�O I 75.06' o S 1 d e r g �. i+e�aree�w 174.94' 1 SEPT(1223) 1 y� G� 9 10 J9646' vl —•'�-- ' �L _- �—_ _ COINICiWO 616,M -�^�- � i .,. s N.�•,�. C ``fII N.E. ME y - _ 1 �T Mn lifs ' ' ! P1111' . Ix� mj :. 'yr 1 . R6 1 1 I 1 EAST lRS a ME 1 lyl NEST NNf o ME Z� S.E. 1/4 X ME 1 I 1 S.W. 1/.O ME Sw. 1/4 I . L r� 3 Sor R ! N W N (V oO 1 N y 06 F �I 2'58'W 1{O.q' N8802'58'w 182.87 _ i +I xses.es PRINTED UN N BRAa SSDisc : SEPT(1993) DEC 191995 STREET BUSH,RDW 6 Hi nnvua i BUSH, .RUED do HITCHINGS;`INC. ,. aML ENGINEERS i UlND SURVEYORS ioat rWw♦K.[f.5r �'.'>t�N1L'ab�cf BRM ao)oii u moomwks M UN:�ON AVENUE SAFEWAY EASEMENT EXHIBIT S.. T. as r.. n e L•.. w.«. CITY of 1CLM'Or. IRNo COVr'I'Y. w/.aMNOMr ORAPM fi�J�J�11SCME fenryT �. -------------------- • 1 •`� -' Y � I�e•IIT / %a,wi��wr o a<wa T r I 9080LTTC!86 I �•�,�• 1 � Irew� rrY i 1 I I r 1 I 1 11 pdy' 11 i 1 ! LIt�1 I 1 1 Ili 1 1 • •.° a. 1. r^ �.ili I I11 1 '� r r r , i.N' �/rye{�r1 L1� r• ' 1rY — �1 Wir w .. I ffI Y\V�IbN I i xr�l i 1 I ' V��w wqi� I xle,r,l-e I 1 I v ,A r11R'YMA_—IH.«' — — �, �I�yw,e IY..1• — I+ xeevrcev 4xu' ��� N4•' N 1'AMIEU e� Y« «•fe4 ' DEC 1fdS : N.E. 4TH STREET(SE 129M sma, riH KMK am a reCxix s. W. ON IOAnR Y I,M,4nµNN fffflf rwx m e_ ••��.. n. rrF.6T t OF `v 1. i , q CITY OF RENTON PLANNINGBUIf.DING/PUBLIC WORKS MEMORANDUM DATE January 15, 1996 TO: STORM WATER WASTEWATER �. FROM: Areas H.X6198 SUBJECT: SAFEWAY FINAL PROJECT CLOSEOUT WOO RSTW 2153 C940106 4300 NE 4TH ST s A The purpose of this memo is to inform you that this project is done. Please refer to: -3aw two sheets for projca infortnatm , cc: Neil W. uuw.trori J J PROJECT CHECKLIST Project No. R-2153 Project Name- SAFEWAY S-2153 W-2153 W.O.No. 37580 Address:4300 NE 4th St. Permit No. CM106 Date Issued: 914/94 Issued to.Safews Preconstruction Mahn Se t.13 1994 Develo 's Name Safewa Address utility Contractor's Nam: Abscher Construction Rich Tedd 945-9544 City Pro ect M er Arrteta HenninYer Ci Pro at Ins or Steve Pinkham Latter Special Billing Yes No May Can"ZZ:Original is attached to tht x Final Impaction Signoff Date 6/19/95 As-Built Plan Checkprint Date:Yes `-^ --• _ Received As-buillt Plan sent to Date:12/81 ins for 95 As-B,ilt Plans Molars Date:l/IS/ Received 96 Sent to Ca Easement yes No N/A rrie 12I29I95 x on Date Recordin No. Bill of Sale sent to Came Date 12129/95 Recordi No. Cost-Data sent to Carrie Date 12129/95 ik Backflow Test R ru Yes No N/A Date Received See Tom Fire S rudder DDCVA Domestic Water Meter Snub Service ent Yes No N/A Date Water Meters St inch S.O No. Dorastic Meter 2" Landsca Meter 2" Fire Protection Meter Matntcmmce Bad to Dee Yes No N/A Expiration Date x i ARi , k I i ro R it 1_ �r 1 e I CITY OF RENTON MEMORANDUM i DATE: December 30, 1994 TO: Lys H. Dave C. Bob M. '..i;is Ron S. ' L FROM: Arneta Plan Review X6198 SUBJECT: SAFEWAY NE 4TH 6 UNION RSW 2153 " For your files. El REQUEST FOR FILE AND NUMBER x } ea PRECON NOTICE 0 PRECON MINUTES 0 ATTENDEES AT PRECON 0 LETTER OF SPECIAL BILLING SIGNED 0 MEMO TO BECKY AND RAY STATING THAT LETTER OF SPECIAL BILLING WAS SIGNED 0 CONSTRUCTION PERMIT +r. -- '_ 0 RECEIPT FOR CONSTRUCTION PERMIT--SEE SIERRA SYSTEM UNOER PERMIT C940106 0 STORM DRAINAGE REPORT WAS TURNED OVER TO STORM AT THE BEGINNING OF THE PRJJECT PC: Meil V. 1' �ftn i ' rf ' M I _ f Ih y 1 ir ik i AUTHORIZATION OF SPECIAL BILLING DATE: JULY 27,1994 PROJECT NAME: SAFEWAY AT NE 4TH ST EAST OF UNION AVE NE PROJECT NUMBER: C940106 I` WORK ORDER No.: 87580 It is the intent of this letter to authorize the City of Renton to bill the undersigned for all costs incurred relative to the referenced project,by the City of Renton for the following work: TIME AND MATERIALS FURNISHED BY CITY OF RENTON WATER DEPARTMENT TO PERFORM CONNECTIONS TO EXISTING WATER MAINS,WATER PURITY SAMPLES,AND RELATED WORK. ' TIME AND MATERIALS FOR.ANY AND ALL ROAD CLEANUP EFFORTS { PERFORMED BY CITY FORCES OR CITY CONTRACT. ALL OVERTIME FOR INSPECTION AND RELATED ACTIVITIES,BILLABLE 't AT A RATE OF FIFTY DOLLARS($50.00)AN HOUR i TIME AND MATERIAL FOR ANY WORK DONE BY CITY STAFF TO REPAIR DAMAGES. ,. BILLING TO BE SENT TO. Name. Richard C. Teddy Company: Abscher Construction Co. Address PO Box 280 ! Puyallup, WA 98371 S Phone 206-845-9544 4/Devel"oper or Authorized Agent Authorization is subject to 24 hours notice of deficient conditions and ample opportunity for Absher Construction Company to make necessary repairs with it's own recourses. This notice provision shell apply except in cases where emergency response is required for public safety. r X Y.i I . I iI CITY OF RENTON f PLANNINGBUILDINGIPUBLIC WORKS MEMORANDUM I DATE: Dec mber 29, 1995 TO: Carrie Davis f FROM: Arne[a Henninger X6198 SUBJECT: BILL OF SALE FOR SAFEWAY 4300 NE dTH SINE 3TH ST &UNION AVE NE)RSW 2153 WON 87580 C940106 Attached is the Bill of Sale, the Exhibit A showing the inventory quantities & items that gets recorded with the Bill of Sale and the Cost Data Inventory form that remains here in City files. ` No further action is required now except to record the Bill of Sale along with the Exhibit A and send everybody copies. Thank you very much. ec; Neil Wen. Deve Chnereneen be H.,.WV 1 s. J Y j �. tp V SSoi. CITY OF RENTON PLANNINGBUILDING/PUBLIC WORKS MEMORANDUM DATE: December 29, 1995 TO: Carrie Davis " FROM: Ameta Henninger X6198 y�y SUBJECT; EASEMENTS FOR WATERMAIN AND FOR WASTEWATER FOR SAFEWAY 4300 NE 4TH ST(NE 4TH ST&UNION AVE NE) SW 2153 C940106 WOI 61580 i Attached is the signed easement, legal description and exhibit for the watermain and the sanitary sewer. No further action is required now except to record it. Once the documents are recorded II please send a copy to water and sanitary. Thank you. The Grantee's return address is: SAFEWAY INC. I REAL ESTATE 4TH &JACKSON STREETS OAKLAND, CA 94660 cc: Net Wen Us•a cbnemon 1p Homcbv I 1.� J I Laucks Testing Laborabrbs,Inc. ^ NOS H., e, So.9W WA 981US WATER BACTERIOLOGICAL ANALYSIS 51111ECOEEECnOR:RIMELSIWI TMbIBAMOFG MMI)COPY s wrwee.n..n na roesWM.EssslF wr w Rtsrs. MU COLLECTED r G UEITED OMPOV / RMF o.r YPw �� Fr • pw _ IYp1Y{E�,;E.,O�F,STV M s PMC srums.OWLEM U uxvmwL r...W 1 ePriel NAME OF SYSTEM I 1 1 1ME IE I�C ! MY u& 2f3-c EVBENeI 1 _r SViP1.EO ar.peeM DYETHtdYIEaWiR.:MaePl E]ft lYP�YM a 'PY ❑ � UFe1ElD ❑8PM16 ❑RM<}M7®e ❑eOjMK," R ORT ttE.y FieM 6NlFr7 >�bN t Ul/>fiOJdILJI!' TYPEOFSAIIPEPR -*w% QMAWE ❑eota E CMeFww IMAW:.__ TaW RFP) t%wmeWATER p - IluMw.ww-��❑PaMw ❑McM1Me Oee— p REPFAi SM E Pevueati4m PYRP.'ai UaP OaF I I L [_3MWS0IIRCEYMTER Swap©m TYllc�le ELONSTRUCTI .MMM �FMOFaee R ISP.n REMANO: w ttt aaq oMaoq wsa tsnuLn ' � ❑1aMsnErcroRY,cawrtnF.e+ twaaeeFEePFr� _ MPFK ❑E.CaFpRr+ ❑E.Ca. r ❑PEd PMME ❑F ~ 1 MM CMWOIw novel E.= nOsM PWIftca XOIaF_IMEF1 PEAR fAIae_rt_. . Alig 11 SAME 1ii I P YYEEMOTWOMMEEMUSE: TESTU TA aECPLSE. r�-�1+aMIP�F Coal1 �j Co�.e vP.e LJ 1REianeF�er ❑WC (L¢''{J�`ernslrelPe ❑rwJEwn ❑Eaer aFert IMYFIH SCEMe11 COPY"E%DIANAnMOFRESUETS wlapamw un.rne rtcervEo irtcEnco R+ :1 T5 SMS o MIMe WRIER SUPDI NiR LOPY I Lsuaks Testing LaOoratOd" "c. MO HM.Y Se-fte W4"'1 AL NALYSIS ' sua MIEc��R cnOK30klMUaGWe"CM a MMMDMIDR.«..wwsw.a..wMwMr nM� OAR wuEc*Eo T utcTEo Eo1Mrn RMa: 4 T IM OM -_ TEMODWLM � IRwYRw�wMIRWI 1./..��� MEIF OF SYSTEM q/ R YE l _Z nr Q. 1 R 87ETT I ❑%RM�OE syiRnO OanMa OEM 0,� 110M •'E TW�EOaFpSMSTIaM�FE Taa��MMMaaldEaO �OMaMYaYMR11 []OMnYW PWM: W_FwM a11eFYrMME—��Paws IRyraeMoas ' O rFROEATSAI wrFr+E urE �T Or MW WLU E WARP —?&We®� ftw i wfARSiRJCTgRw REMIw9 R ISPdM w ua au1 TaMMMTs awaa TMMsn p veATWACm .Cw~"" TT LLJJ !�S HEOrtrFMs �ftw~ PEOUNMO PYWf� �woanoaratma.R TOTM.OmMOm E.cou YTeoE+ �,M w�Raourt.—R+ PECK OOI_=_,Mgn1ER SMwE TMOMad RsrMVEuraa.E aEcwTec S�F NOi TESTED aEOWSE'. ONYSPDRa �REnp.mm T" T� iw ft SEE pEYE0.9E gs%Of DPEEN DOPY POR FIINMMT1011 OE Pt SUITS W RD PPbrM OFiE.RlalalaRED PT4iWDF oPTFrsPan®- uaDRMa . wnrr w suw.•i n u r nor J 1 k Ud ?�53 City of Renton, Utility Dept. 1AI PRESSURE TEST FORM Water Project `I`+' 53 Name of ProjectRskhS'(J This test was taken by — on At a pressure of -;Vi Psi, for Z �iE' �S minutes. The test "Failed" on "Passed" /s�9� onyL.ef_ Comments: —A_nrT 7x.P/� 24622 / 7 C sh«t Ma. (surf a_ REQUEST FOR PROJECT u Prelim Mar (PPp _ To Tcclwwl Services Date ?Ii�✓'J u'— Woo� _g�— lircenp From Plan Revic .Trgecr Manager ,/2„04 (�'_{'eaeeG Cn�K-1-_ T—� t Project Nam Deserip0tia,of Project. Circle Sim of Waterline: 8" 10" 12' Circle One New or Extension Circle Sim of Sewedin / e / y 10" 12" Circle One New or Extension Circle Sim of Stormline 12" 15" 18" 24" Circle One Nei or Extension Address or Street Name(s) 430 y n E xl�d/1 Dvlpr/Cwttactor/Owrrer/Cnsit� _''yA lj Chock each discipline inwdvod in Project �I.trDrwg p of sheets per discipline 1 i Y7 LCIn rtA L� (goad+a>+Drairwae) s O Transportation (t�a.rs'a•rl.wawn.arubw t+dMW _ w,tv TS Use Iy _ p - 1 Approved by TSMI Dare _._— ZA11VANCE TESTING&SERVICE P.O.Box 1485 Evemu,Washington 98206 • F":337-0208 (206)337.4I75 Pager: 339-8998 BACKFLOW PREVENTION ASSEMBLY TEST REPORT PURVEYOR IDR ATS ID Is _ NAME OF PREMISE $a9FE.l�39;� SERVICE ADDRESS 4C?4"-N —CITY ZIP sp-p!% f� CONTACT PERSON PHONE:( ) FAX: OWNER MAILING ADDRESS CITY ZIP CONTACT PERSON PHONE:( ) FAX: '"" LOCATION OF ASSEMBLY 4dk064 Id"" CONFINED SPACE: ❑YES ❑NO PERMIT 0 DOWNSTREAM PROCESS ASSEMBLY _ AWAWO Mmulacww mom Sin Social No. ❑ RPBA 0 DCVA ❑ PVBA P-CtDA DATE INSTALLED—1 NO OF ASSEMBLIES THIS LOCATION_ LINE PRESSURE AT TIME OF TEST 931 PSI PRESSURE DROP ACR(`SS 411 CHECK PSI METER NO. METER READING RaA,ced Pmasure Aseanafe, Pnasure Vacuum BreaMr 00"Check AsrmMin Air 1n Chack Vahe IR Chia and OP" R•k11VWa vNe, Cbiad DbaM Opend at Opened at ir•t DC Tfht vl-� Tight Its.Ld, ps.i.d. Psid. RP P.aiA Leaked 0 LW"❑ Oid Nei Open❑ Did Not Open❑ Le"d O 'c Craned❑ Cleated 0 Crwrd O Clwed 0 Chow O Replaced❑ A"Iscilded O Re Wiml 0 Rapaped O Anprped 0 pate T., DC-Tight 0 closed Opened• Opened as Ale, R,pw RP p.ai,d. Tight❑ Pal.d. P.ei.d. ps rd. AIR OAP INSPECTC)N AogWmd mbb Isopap aeprafen p ae ?Yea'.0 No:❑ REMARKS INITIALTEST BY CERT NO D9 DATE'. REPAIRED BY CFFIT.NO. DATE FINAL TEST BY CERT NO DATE' SEND REPORT TO: ._- I CERTIFY THE ABOVE TEST HAS BEEN PERF011AE0 Ievnc.,n•MM reunn. Fpt.ctr.aNea L.� r I i q/,'r`7ADVANCB ESTQVG&SERVICE P.O.Bar 1485 Swmff,Washington 93.M For:337.0208 • (E06)337 4175 Pager: 339-SM BACKFLOW PREVENTION ASSEMBLY TEST REPOP— PURVEYORIDB ATS IDd NAME OF PREMISE'�9 SERVICE ADDRESSTr CONTACT PERSON PHONE:( ) FAX: OWNER MAILING ADDRESS CITY ZIP CONTACT PERSON PHONE:( ) FAX:�7T— I"' LOCATION OF ASSEMBLY / J/�fFi G� %L1t'i.CDI�A]�7d J'71/ CONFINED SPACE: ❑YE' �NO PERMIT B DOWNSTREAM PROCESS ASSEMBLY /� _ Manutacsim "-del sin S-rid No / . 0 RPBA �S DCVA ❑ PVBA ❑ DCDA DATEINSTALLED r NO.OF ASSEMBLIES THIS LOCATION LINE PRESSURE AT TIME OF TEST psi PRESSURE DROP ACROSS 81 CHECK/ psi METERNO. V7GQTl-lf7 METER READING O401510Z 7' RtduaO PR"tn AssMrebss pressure vaauun BwMMe Odusb Credo Ass-mtAws ANbdet CAWty" 161ched, V4 ci Rabat Val" I s:IN pose / Cbaad O"wat Opm•da Tan DC•TV, l Tghl p.al d. Pale p.ald AP p.al.d Leshad O L44W O Did Not Open O Did NWO"-O Leaned 0 Cleared O Cleaad O CMared❑ CYanW❑ CIaMM O Raplasad O R"laaaa O RspYead 0 ROOMS O Rsplswd O Ma T-n DC-TIaH O Cleaed op«laa Opwmd0 I RMSY M p.ai.d. TpAt O p.ai.d. paid pate. A)ROAPBWPECTKJN:14pdn0 nahntpn it pi-"Mason F~Yq'O NO ❑ 1 REMRRKS: pNT1Al TEST BY CERT.NOkfZ O7 eaTF• REPAEIED BY: CERT.NO DATE' RNAL TEST BY: CERT NO DATE' SEND REPORT TO: I CERTIFY THE ABOVE TEST BBEN MMORMED' ---- INaK'tan t-tlaa AM.CUSNMLn nw J I TADv wcs 7NS77?vc•SXXVICs AlS P.O.Bm:485 Fume.W"hingtm 98" • Fw:337-0208 (Y06J 337d175 • Po{er: 3394M BACKFLOW PREVENTION ASSEMBLY TEST REPORT PURVEYOR IDS ATS ID B NAME OF PREMISE f�`*may SERVICE ADORPee: 'oG d.�6. 6l r� CITY Zip 9 CONTACT PERSON_ PHONE:( ) FAX: OWNER MAILING ADDRESS CITY _ZIP CONTACTPERSON PHONE:( ) _FAX: LOCATION OF ASSEMBLY E_ 6afQ OF.�.4A!'[iA4 L r Yt /J'1�lFei'�// CONFINED SPACE: ❑YES ETF!'O PERMIT 0 DOWNSTREAM PROCESS _ZMAOf710A ASSEMBLY 1. go0 �dfy Z •� _,�� !!mmlg._. ALodel sip sww me � . ❑ RPSA �DGVA 0 PVBA O DCDA DATE INSTALLED NO.Of ASSEMBLIES THIS LOCATION LINE PRESSURE AT TIME OF TEST psi PRESSURE DROP ACROSS 41 CHECK METER NO. METER READING RedwW Pm"AswmbRu PmWte Vastlem Bf"W Double Check Asssmbssa Air In4t CNsY V" 19 chea fid ctma PAW V InNel C .w Cbe.d Cpww0 Op III Ten DC.-Tpbt IAA 71BIN BY/ psi.a. ps.Ld. RP p.sAd. L"m 0 t a.bd D DId Ntltop"❑ Did NwOpee❑ LeslNd 0 Recess Ckslted D Ckened 0 calum D CkrNd 0 CksM O Rs' O Rpplwdstl❑ Rspasd 0 Repsua 0 Repltpsd 0 Me Tnt DC-rot ❑ CbsW OPrwda Oprted■ AIW Repep RP p"I.d. Igh,❑ p.s.Ld. Pa.Ld. pALd. AIR(LIP INSPECTION:ReRuim i minmr I w pep sspoBNe pmYedT Yx:o Ne: C RB/AAIM: INn%L TEST BY: Irk, _CEi1T.NO. ldefIY09 DATE' REPAIRED BY JrCERT.NO_ DATE: FINAL TEST BY: CEIM NO. DATE- SENO REPORT TO 7 FAX 1 CERT6Y THE ABOVE TEST HAS BEEN PERF0"D: r.e Y41RN•fpPYf 1eR.OIftpNfA 1 06-14-1995 06:.iAM FROM ASO TO 12062352541 P.02 /TMVANCE TBSTWG 6 SERVICE ALS P.O.Bm 148S Everett,WaxMrWm 98" • F=:337-0208 • (206)337-4175 Pager: 339-8 4Be 998 BACKFLOW PREVENTION ASSEMBLY TEST REPORT PURVEYORIDB ATS ID NAME OF PREMISE S�AF JA �/ P SERVICE ADDRESS ' 11—C yLS7' CITY. ZIP 9-PAJ-1 CONTACT PERSON PHONE:( 1 _FAX: OWNER MAILING ADDRESS nAIl1C _ CITY ZIP CONTACTPERSON PNK .e�r�yJONELE ( 1 FAX: LOCATION OF ASSEMBLY CONFINEDSPACE. OYES L PERMIT III, DOWNSTREAM PROCESS A/ 6s9 rn/jrr Up ASSEMBLY !w>Azy Qij9 L '• _1•j�j) MenNaeNw Meer Side Sww No fi'RPBA ❑ DCVA p❑ PVBA O DCDA DATE INSTALLED �`�f_ NO.OF ASSEMBLIES THIS LOCATION LINE PRESSURE AT TIME OF TEST psi PRESSURE DROP ACROSS B1 CHECK METER NO. METER READING Al,&.d Reaw.AnaMha PNewle Vewun Bre.br DawM Chock Neemkeae A4 kdM Chock%*" 1r CMek 2M Chad ReW Yew Cloud OC-TION 0 / ��� C�� e -0�jGen� CPeMea TIONI .a� ��p.aiQ Pei e. pxitl. RP 9"..f pxie. - Leaked D Leaked O Did Na Open O Did NetOW O Leaked O R'P*s Ckeand O CMened O Cleaned o craea o Cl..ed❑ Pan.. Replaced 0 Rkploomod O Repkaee O Replaad 0 pyq o Dc-Tkjmtaye 0 Closed Opened Opened Raw a p.ete. rphe❑ ps.te. AIR OAP INSPECTION.P,,A dinMmuin rrM eepaatlm Dee.ad f,Yea: : O REMARKS: INITIAL TEST M: oswT O. DATE: REPMMM BV: 100r COAT NO. DATE FINAL TEST BV; COAT NO SEND REPORT TO: DATE. AX: I CERTIFY THE ABOVE TEST BEEN PERFOANED: F 06-14-1995 06:50A1 FROM A50 TU 12062352541 P.03 VANCE TES7'INO!SERVICE P.O.B=le6S • Emmtt,Washington 99W • Fa::337.02W • (2%)537-076 Pager: 339-SM BACKFLOW PREVENTION ASSEMBLY TEST REPORT PURVEYOR IDS —7-117111 _ATS ID k NAME OF PREMISE SERVICE ADDRESS CITY ZIP Sp sG CONTACT PERSON PHONE:( ) FAX: OWNER MAILING ADDRESS L "opl A CITY ZIP_ CONTACT PERSON PHONE:( 7 _FAX: LOCATION^F ASSEMBLY '616beA CONFINED SPACE: O YES 01TO PERMIT S DOWNSTREAM PROCESS ASSEMBLY d&A&BOeZL_ !! Mwejt w Mo" Six Seta"NO. a PBA O DCVA O PVBA O DCDA ' / DATE INSTALLED ,/�� NO,OF ASSEMBLIES THIS LOCATION LINE PRESSURE AT TIME OF TEST— SO psi PRESSURE DROP ACROSS S1 CHECK PSI METER NO. METER READING Reduced Dte "AnoftiN Pmsv Vee Bmww DaAa C Assemblies AY l+Nt Cheek Val e tet CMCA 2w 0M iYeN Vtlw ww Closed C:bd / p'ff`401 ODcnfdw Tea DC•TVht Tiphl 4l' �..L Rp Lewd 0 Leeeed 0 Did Nmom O Did Not Open❑ Leebd 0 , cwre O Cw.d 0 Cleaned O caenM O amw 0 Replead 0 hpmdtd O A - O PADand O R"w=I D Tea DC--Nm ❑ Caeee Opw m opened AY Reeek Rp ps,ld I Tght O pelt p.eiA. p.Ai.d. AIROMINIO[CTION:RepilW minimen ebppsepn pgridedT Yes: Ne:O IRMAISO: i 4 WTIAL TEST SY: 14N,I DATE'. gEPASDiD Sr: CEttt.NO DATE. alp MW TEST BY CERTNO. DATE Mo NEP011T TQ I �1. 1 w's I DSATIpY THE ASOVE TEST RM SEEN PERr•ORAEO: iAl n" PIdNNINGBUBDING/PUBUC WORKS DEPARTMENT Water Utility Enginccriog 235-2631 Municipal Building 200 Mill Ave.S.Renton,WA 98055 BACKFLOW DEVICE TEST REPORT ot®tr RblaR Accni.t N.. oaoun Penn. Ca.aat rea.c G..Ice Add�e � laatboane.ItFt/ GN / */- ��•J�� /! mo" She w SerW No. 0� I aA16 W F. aTttmaTae Ne.w.mtw: Sv O m tffi aea o.tar De.lae pAe Ptaoalo.sy. 0 e w- ^ seer.pkre rpedry iJ6o R.AaN Pes�se A.C.Mu Ptse..e v�anakcr novels taeckMmWw Ah Laws [beck Whe I.Oetk am Oeek ReketvNse opeeeda -P" -P b IneW h. Dcdo.�.d+Wei... ao.a tym... opexd. W w ope. O 4+eaa O RR$Sp+d m<a 3�Hpsd teakcd O weave ' w t I raAe. Dedo.dus� 0 ao.aWm... 0 opened. opeed. -prd Reptl Rp_r v --Pnd ^�•pr4".IF r LN-ON F Air Gap Inspection: Required minimum air gap separation provided PIP Remarks: >�AttovR RFYORi n®rtatm ro ee Tatre Return Report t0 rVV OR PRI?4M NAIQ Pnanc NuodKr Tom Malphnu,Cross a - pa- Connection Control Speeialist wmAt tvsr sr r rt Na. Date i .n Planning/Budding/ public Works Department Rrr By GM No. o n Water Utility Division 200 Mill Avenue South issr a cet Na. one Renton,Washington 98055 aroRNsrtnsvent�trtowmn M S r•e 1 S +1k PIANNING/BUB.DING/PUBUC WORKS DEFARTMENT Water Utility Pngineering 235.2631 Municipal Building 200 Mill Ave.S.Renton,WA 99055 BACF. IOW DEVICE TEST REPORT DBun Bwft Accou«no, cm hymn t Y Pben< name dPr®l.n derOcc Af. Y300 '0'U �/A/ . .ra-•• In«Iwnorneaee _..lN /_�,sirSlay By !l'DOFS![ GdG)C fy� woufaawc� 71oatl me t. SaW Na � ;.X B[C G✓ O7 T r aT. Ream r«De.ee rum r wn im sycem O keo l O able it pores VCC* kcd, PtlPYC Atxmbllo P We vetN,m tYeabcr IIf D n Oeek Aa Mea A4 Udet CbMk Valle Ix check 3vd O, k aeuefvaec opraeda _pals _I'll'i lwBwl Tex IX.cdoacd Babe... Onaed Ugh,... opened a DM na open O Iaked 0 R _pxd Ieaked O _P� Leaked :'O I^s„ R"ie,and Macdab UeM Tex Mee oc< uyn....0 tJ«ed dgha... 0 opmcd x opened u _paid Relak RP-_pxd _PBd —Pald Air Gap Inspection: Required minimum air gap separation provided 0 m Ono Remelts: _— TIIE ABOVE REPORT n®lTn'6b M M TWJ& Renun Report to MM OR D SAME. %wne n Tom Malphrus,Cross kkft Connection Control Specialist nrrruu.tT1T BY. cm N. naa Plirimng/BuildirW Public Works Department REPAIRED BY cen N. Due Water Utility Division 200 Mill Avenue South Renton,Washington W55 I �FORMS/MISfJMCKFl.OwTh I M t d Y. r N AY y, Y PL1N.aNG/BUI DING/PUBUC WORKS DEPARTMENT Wata Utility Engineering 235-263 t Municipal Building 200 Mill Avc.S.Renton,WA 98055 RACBFLOW DEVICE TEST REPORT Uaaur Ssa Accwnt No. Caouct Pcnoe foeu Y PEouc N,mc atrurmim �ifi rt -J.t� A16S Su.,ee Adakm S'3cao N $ ya� �fj�/lS,./rv�.../� S rarakm ut De+lce A/4/ 7C7 Cn"KSn Q((� ( L; �.y -,j tt Sbe t� Suicl lb. .arr5 t�SaT Ibe Prtvus a[Tlae arTm ek.w.u.w.: >° ❑so Das ae.w.ro nc.DeT Due rexecum syu® ❑ kapuca ❑ okke vac,:,N�mecDh /ooNr s' YO�✓rP/NS.Y/T acAucea Poem As+uaektka Prtewe ve artaka Double Cud Aa. Ak IaM oat vY is a& lea neck adkfva op. a __P+e _P owl TM p�_U�b-d Ush.... Coca rykr... br u aoao ❑ teakca ❑ a 2 aZptle Daakea p+a Dsakea ❑ ma.*6 ace TM Aft. 1)1l dada....❑ rJoeea uskt... ❑ opeoean OptMaM —p"a Repak ar_pw —Pda _—pad Air Gap inspection: Required minimum air gap xpantion provided O m Remarks: =s AwvrR RTM®DT TOUTRUE 'w' I D'• Return Report to oR PRIMTD NAME: Plwee Number Tom Malphrus,Crossi�' Connection Control Specialist v+rnAtT an ten No. ore PlamtingBuilding/ Public Works Dcpwtment REPAIRED av: Cca No. Dam Water Utility Division 200 Mill Avenue South Tarr ar cae Nc' D Renton,Washington 98055 , mRM<rMl[r/RAf.IffI.OWRYb L I 1`SY PLkNNING/BURDING/PUBIIC WORKS DEPARTHM Water Utility Engineering 235-2631 Municipal Building 200 Mill Ave.S.Renton,WA 98055 RACKFLOW DEVICE TEST REPORT Uuhy BBwy Account No. Codutt Paaoa Coosa Puooe Name d Pnmba — se..tceAmta. y300 w `t_ /-�/ 1X1,..TPJ t= 14 Slao unctaa Modrk �i saW No. �va MZ14 B/s33 Jx.naee YTT«orTaa / rve. •_, -w•. tea o ao s LES Aa+n.ror De.lce Pntenba st O BMpUo^ 0 otter retha tdaae Wp * AedocM hewn ASYmuitn Ptmwrc Vataoam Btata Dooktc mtck Ass w Air Wa Deck Vahr to meek Zed Chek Aelk(vahe opened. Pod _PW b*w Tat DCrlarA Ugh.... (]oxd U&M. Otxad u ph oa opcv 0 i<akN 0 M—,dd faked 0 —pAd i toted 0 Aeptln and Itaalala UYd TM Ma Deelaed ugh....❑ Ooaed ttg4.. 0 o PeMd u Opeoed Y Pad r gepak AF_Pah _pod _fokd Air Gap Inspection: Required minimum air gap separation provided O to O Be Remarks: ,.j Ttm AaowA RT24mtT6LDT MA r Return Report to oa MUYr n NAME: plwoe rvu$txr; Tom Malphrus,Crows Z711 11%1.4 Connection Control Specialist wr L T BY: Cen No. D.n Planning/Budding/ .4 Public Works Department a MRM BY con No. Due Water Utility Division 200 Mill Avenue South rBv ar: _con No. Dn< Renton,Washington 98055 - c FOAMS/MISC/BACKn.OWAk . J PIANNING/BUBDBdG/PUBUC WORKS DEPARTMENT 7� Water Utility Engineering 235-2631 Municipal Building 200 Mill Ave,S.Renton,WA W55 BACKFLOW DMCF TEST REPORT umnr maim k w,x rvo. I cmun e<„oo C.ua e Nme dPtembn / Bmke A M es 2f 3 U C) f< </r� c.-✓tea `N'^u6ctyv N°Etl �` Bli uoc P,esamc u Time dTeat 1n�/S Ner ImuYYbs 0 m Ream(a Dcelce Fhe Ptotealoo Sl'Tp (3 O Othc YaWer,pkweapetlr/ Redaaad OvaUm AaaembBeA lreame Vacwtm B,akr a::.. ., ' Dmbk CbK As Ak loln CLe4 Vahe :ql. IMmeek ] Otto R.Bdv.[e ope K —Pd �y —P"d IW W Td DC<tc''d U�s'LL... 0.4 Ught... yr ox..'p Did as opm Icaked RP-'``u)it l tealmd C1 -%+�-PWd [mked C) RCPW. M M.M" Ilaad Teat ARer Dc lmea tlRhc...0 0—ddM--- O opmx at Dpm n —Pd Repo aF_Pwt —PW —P� , Air Gap Inspection: Acquired mWmum air gap separation provided rd O w Remarks: (- - 1 v � JUiI 1 S i59- rtm Asovk RProar is aRnP®ro er rat Return Report to OR rRIMTn,JN4Ante. tTooe Tom Malphms,Cross Connection Control Specialist DQTTI LTEST BY: cna No. ate PlanNng/Building! Public Works Department RFPADIED BY: Celt N. Date Water Utility Division 200 Mill Avenue South m+ BY-. _ cm No. osw - Renton,Washington 98055 I ,;.FnRMS/MISfJBACI(FU)v/M I I J `TY PLANNING/BUB.DING/PUBLIC WORKS DEPARTMENT Water Utility Engineering 2352631 �FN.L•O Municipal Building 200 Mill Ave.S.Renton,WA 98055 RACEFLOW DEVICE TEST REPORT UWiry BBtine Accowr No. Cmun boon Cantu Pkone Name d Prtmnea se"",1"'m yao^U N� �1pnr �/N /�I.v:r ff 6rT av J e""ry t"° TfS oo4Qr ilne Pamum ssThne orTm � New a�...o.w., p 0 m Im Reuooror Mlce owe Cnw.pme,pedh I ReMcea piowue Auameum Pmapuc V..faker DmWe atedcAs®Wlea Alr Iola mrck Vane 14� LACkark a dYale opeoedss _,W —pad lomDd Tex DCo�m U12". awes uot.., op�enep Me opt. O uakee O •.. Rrv�Ea pdd Ided f r , t� 0 Repwa aed ttxcNY Ilaed Tm A DGdoxtl twl ...0 Clawed uane.. 0 opened a opm w _pap Reptr RP_pOd --P� _Pala ? h Air Crap inspection: Required minimum air gsp sepanuon provided •O m'..; t - Remarks. Tra asove RvoaT n mtTtpo-v ro u twtre Return Report to OR PRDlIFD NAME: Pkm<Numpee Tom Malphrus,Cross __,• a a� � q., Connection Control Specialist wow.Tw EY. een No. Due Planning/Building, _ Public Works Department RE MRM BY: Ten N. DMe Water Utility Division 200 Mill Avenue South ER+ BY: cis.Na. Dm Renton,Washington 98055 1 i� J y' .r- + PLANNING/BUI DING/PUBUC WORKS DEPARTMENT Water Utility Engineering 235-263 t �E Municipal Building 200 Mill Ave.S.Rentor `W.9"5 BACKnOW DEVICE TEST REPORT E ❑Wiry BIRieR Accaua No. Codtact Ponao Cman PMec1 since ysZoo nib MadWamuc Matd � ReUJ t�. riA 2�at y 7s 3✓ Y ;,:.rvmc urine dTm Nc.IdoJWim >e Ow N Pam tdr Deelee Pla PrdeeUoe system In+eiWv O am it'b"'P67 aP�y RMrN Premise ke®Elw Preaite Vaevdm Brea^ Ddriek Otto ANCWb b Atr Isla ch I Va IR Oack idd OeeY acidvate ope . _pdd P-W IOYW Tat Xda Uehe... QaaeA ..peMd at DW din^pate O 1.4ited M_ptld Leath __Fdd , Laded O i Repo avd NumLa ` Uud t Tes Asa ucdm UyM1e...11 Oosd UREr-_ (] nPmeda opined" —Prd ,Aii Repvir RP_Md _Pdd _—Ptld 1 Air Crap Inspection: Requited minimum au gap separation provided 60 e Remarks TIR AROV!RQORT 6 t2RTirtm l'O RL TRUR Return Report to 00.PRDrMD NAME PAoee NR r. Tom Malphms,Cross y _ Connection Control Specialist Bvmu.=BT: erne Nd. Due Planning/Budding/ Public Works Department RPPA BY, cm m Dam Water Utility Division 200 n Avenue South Renton, pw Br�cm No are . Rentoon,,Washington 98055 -- rctwwAennv!RnfKFl➢o'TM1 J a ti`tY PP ANNING/BURDING/PUBUC WORKS DEPARTMENT p T, Water Utility Engineering 235.2631 �ypNy.O Municipal Building 200 Mill Ave.S.Renton,WA 98055 BACISFLOW DEVICE TEST REPORT UNMy daft Accoua No. ('soarer tenon (:tout Phone Nuee NPYmue MaeW ModN A JacPe.aeurLae aPTcn New imuWloe: ❑eo •,1 7 Les y rr�T Recoo re Lk.1ee Nc P�aa sra® �jLv��a ❑ own rows.a>bsV drt Redwrzd Pnaurt aQeaDLae Prc Va Beta I �, DaihLe anck AQemhlb Air Lela oat vw. in oak ]ad neck Rdkrvehc ope -Pw _pW v{. Wdd Tm DCtlo tithe... Dead UgM.. rf opineda ownaope ❑ Leaked ❑ R _Pad inked Ll -Veb nkd ❑ R,y cod Mnafak Uacd Tea Ma DCelmed URhe...❑ Clned UgW... ❑ opeed a opeed a _PwL Repur R _pud -ptld _Pad Air Gap Inspection: Required minimum air gap separation provided Oro 0. Remarks: r.� _ ttte aaove aproaT u mLrmm To LrnLtne - Return Report to OR Pa E nPha�e Tom Malphrus,Cross Connection Control Specialist IM.ULTPSTBY: cen No. Doe Planning/Building/ Public Works Department MMRFD RY. Cen No. Dam Water Utility Division 200 Mill Avenue South tTsr a tin No. nae Renton,Washington 98055 jG C H1RMLMLSC,a C 0V/Nh �. . -�.,,,,,�--. ... , ..ak»Y;,.;�.�yw► � Mom'_l