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1033 GLEN ST
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'STbEET City of Edmonds
�T-OF-WAY CONSTRUCTION
PERMIT
• ' Permit Number.
p
Issue Date•.
A. Address or Vicinity of Construction: 1033 glen St. (9325155 )
18 9 O 1 9 B. Type of Work (be specific): Install NPrJ SPrvi rP
C. Contractor: Washington Nat'l. Gas Co. Contact: Frank Swan
Mailing Address: 815 Mercer St.Seattle, Wa. Phone: 224_22�8
State License #: 8111
Liability Insurance: Bond: $
D. 'Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project UXUtility (PUD, GTE, MING, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR: WLN , c,
F. Pavement or Concrete Cut : ❑ Yes Mo G. Size of Cut: x H. Charge $ .
APPLICANT TO READ AND SIGN
1'�
INDEMNITY: Applicant understands and by his signature to this application, agrees to It the • ity of Edmonds harml� ff� u j mages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be mad a 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.
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THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FO4 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 TIMEA DEBIT OR CREDIT W/GI BE PROCESSED FOR 1SSUANCF. TO THF. APPLICANT.
;-r., -) 1 -1 'J - rt 3
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220. 4
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 and understand the permit requirements and the pink copy of thepermit hill be
available on site at all times for inspection purpos'@s.
Signature: ✓- ` "x ?� 4Da.te: Sept - 21, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: t,e,AL1-i
TIME AUTHORIZED: VOID AFTER IrA Y'�"bAYS
SPECIAL CONDITIONS: &JA
COMMENTS:
DATE:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND 111;
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
RECEIPT FEE:
ISSUED BY: _42
t
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. 1)iv. 1991
'k;
FIELD INSPECTION NOTES
Comments
Diagram
(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:
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Av�iOUn bn'W CorrfbM
r
Addendum to iI C ty of Edmonds
ght of Way
!�—Permit Application
Submitted by: Guyla Connors
Engineering Aide
Washington Natural Gas
521-5248
103� C-7L&✓_ u -rs
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" gas main
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Key:
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water
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gas .
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sewer
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water hydrant
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water valve
815 M=cr St. (P.O. Box 1869). Seattle, WA 98111 (206) 622-6767
3
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No- ------------------------------------------
NEW CONSTRUCTION 0 REPAIRS p
118-05400
OWNER.......... Mrs-.-H....A....S.CChdlit------------------------------------------------------ CONTRACTOR....--------------------..--....--•-------••-•----••-----•-•----------------..-•------------------ PERMIT No.......................
ADDRESS ......1033... 18n-.-S..................................................... .............. LEGAL DESCRIPTION: LOT No. ---------------------------------------------- BLOCK No. ............................................
W
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U.
01
NAMEOF ADDITION.-•-•........................•-•---••-----.............................--•---..............................................
Dye Tested On Sewer 1972
Approved:
DATE.......................................... ..... BY----...-.....-..-..-..-.-.............-.------------..._-------------
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