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1002 EUCLID AVE
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
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�i� 890-19C) Q5
PERMIT permit Number. 2..
e�6 STREET-FfL c�2
A. Address or Vicinity of Construction: 1007 Viie-1 i d Avenue (9320625 )
B. Type of Work (be specific): Install New Serviee
C. Contractor: Washington Nat'l. Gas Co. Contact: Frank Swan
Mailing Address: S15 Mprepr St,Seattle, VU Phone: 224-22#8
State License #: 98111 Liability Insurance: Bond: $
D. Building Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision
❑ Multi -Family ❑ Single Family
INSPECTOR:
Side Sewer Permit # (if applicable):
❑ City Project )o Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Other
INSPECTOR:
F. Pavement or Concrete Cut : XflYes ❑No G. Size of Cut: 4 .2 x 4 H. Charge $
Cut `@ Wateb
APPLICANT TO READ AeKb SIGN
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INDEMNITY: Applicant understands and by his signature to this application, agrees�o hold`lhe City of Edmonds harmles rodVluVe.,.damagea, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made agµinst 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-,4 PER/OD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATION lEEPW/1l J. BE HELD UNTIL TI P`11VAIll BEET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPI./CANT.
Construction drawing of proposed work required.swith permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
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 l y the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end o-f th� working day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copyof th.epermit luill be
available on site at all times for inspectio purposes.
Signature:Date: July 16, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: W% '1"�(' �•• RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER 9 - 21' 1) DAYS DISRUPTION FEE/FUND III:
SPECIAL CONDITIONS: RESTORATION FEE:
PERMIT FEE:
COMMENTS:
DATE:
TOTAL FEE:
RECEIPT FEE:
ISSUED BY:
10
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Nv. 1991
FIELD INSPECTION NOTES
Comments
Diagram
e
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: Guyla Connors
Engineering Aide
Washington Natural Ga
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water valve
815 Mercer St. (P.o. BOX 1869), Seattle, WA 98111 (200 622-67, 67
.10
APPLICATION
The City of Edmonds for
SEDE SEWER PERMIT
OUTSIDE E] INSIDE ❑ REPAIRS
CARD No. .........
EASEMENT No. ......................................
...................................... ........................... OWNER ..... ............... I-- CONTRACTOR ......................................................................... -------- ........ ........ PERMIT No. 4ZL—,
STREET
................ AVENUE LOT No. ...... BLOCK No. ..Jw. ...... ��.X/ .......
HOUSE No. ......... .................... ---------
NAME ADD. .... ....... ......... lly .... ................ ................ ........... .......................................
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Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .......... ........ .........................
13
SEWER WORK ORDER ISSUED ..................... ................ DATE ........... Byo
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APPROVED
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