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1041 9TH AVE S
The 6y, of Edmonds
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for
SIDE SEWER PERMIT
OUTSIDE 0 INSIDE 0 REPAIRS 0
OWNER ................................... e................:.. . x�.�' 'i .................. CONTRACTOR ...................... .......
................. ....I.....,....
�� �,,� _J- STREET
HOUSENo............................................................................................................................. AVENUE LOT No...............................
NAMEADD ............................................
1
Date Lam'
r'
BACKFILL WORK ORDER ISSUED ........... ................................ DEPOSIT, $...........
_`vER WORK ORDER ISSUED ................................................
CARDNo......... :......... :.......................
EASEMENT No . ...............:.:..........................
..................................................... PERMIT No...%.Ir'J��.......
.................. I ........... . BLOCK No.............................................................
...........................................................................................................................
Approved:
........................................
DATE............ BY . ...
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j
'The itity of Edmonds
APPLICATION
for
SIDE $Zvi= PFJZBM
OUTSIDE [] INSIDE El REPAIRS Cl
....
OWNER ...... S. .............. .......................................... ...... CONTRACTOR ............ �J. ALL ...
STREW
HOUSE No. ......... - - ---- - ----------- ;Z.Z,� ........... ...... ).a,;,a/ AVENUE LOT No . .................................................
NA -AM ADD . ....... . ...... . ............................ ................
Date
BACEXU,L WORK ORDER ISSUED
SEWER WORK ORDER ISSUED .....
DEPOSIT, $ .......... -...
Approved:
DATE .....
CARD NO. -.- ...........
EASEMENT No . .............. .......
.................. PERMIT No.
BLOCK No . ....................
BY
� EET FILE.�
INSPECTION RECORD
CITY OF EDMONDS, PUBLIC WORKS DEPARTMENT
DATE: PROJECT: V\ XCLL�cL �� U& A %
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BY:
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CITY OF E.DMONDS
ACTION REPORT
E L 1 ��
N? 1619
SUSPENSE DATE:
Date: Time: , File #
Attachments: =Yes
QNo
SUBJECT: ,(2,(j .�l���I , ,Q /�
REQUESTOR: .:
ADDRESS: Ci'7 I 0 /7`
PHONE: � �y OV-2�
REQUEST RECEIVED BY: Y�Q�Z1�►*y,3�1
TELEPHONE
CONTACT IN OFFICE
OTHER:
RECEIVED BY:
ROUTE TO:
ROOM
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IMMUMMMIMMEMEM
ACTION:
All Concerned Notified
Action Completed/File
PUBLIC WORKS DEPARR* CHECKLIST
, BUILDING PERMIT REVIEW
Street Right -of -Way Existing
(o
REQD
z
Access Easements Existing
LML 1�, '.
READ
H
Utility Easement Existing
w
Lot Per Subdivision
Plat — Assessor Map
w
Site Plan Checked for Accuracy
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1-7 8
z
Underground Wiring Regd.
H
0
Check Accuracy of Legal Description
3 j1 "7
z
Review.. by
Date Date
w
��.
Existing Water Main Size
Water 'Main Required
Service Lin` e�equired
Hydrant Size Existingg-,,_
rz
Hydrant Reqd Per Fire Code
Size
w
Detector Check Meter Reqd.
Cross Connection Inspection
H
Fire Department Comments
Water Meter Reqd.
Review b
Date
Septic Tank Design Approved
Date
Se is Tank Permit Reqd.
Permit No.
Sanitary ewer Availability
Proj.
Drawing No.
File No.
Side Sewer Availa 'lity
w
Sanitary Sewer Connect Fee Reqd.
3.
Review by
Da
w
Open Ditch Existing
Reqd.
Culvert Reqd.
Size
94
Catch Basin Reqd.
Indica
on Site Plan
Shoulder drainage maintain c
ection on swale open runo
H
Manhole reqd.
Indicate on Site Plan
Soil Conditions Ground Water Field Checked
,
Review by
Date
14
Revised: 1vl0- 7
Page 2
rM
Street g Regd.
H
Curb and Gutte d. ,
w Sidewalk Reqd.
w Curb�Cut for Driveway Reqd.
a 7Bmdjl�d.
t-of-Way ion .Permit Regd.
H for Public Improvements
Street Name Sign Reqd.
cn
Other Signing Reqd.
A.::e_Pernmit Site Inspection made onz
: S
H
U
w W WATER.
H H STREET
ENGINEERING
Specidl Requirements listed in memo to Conmunity Development Department,
Building Division
BY At Date
o All items filled in on Building Permit Application
x BY M!:t I Date
a' Drawings Stied and Notations Made
a BY �� Date
Approved by Public Works Department
Revised: lv 10-1977
�"' .. 4^a�r, -' ;s�§n4 �,,7`}'�t'� ,kt.f,:NX tF, p �; .,,v?a:,.r ✓; Ty. � ,� ,rF:sd.n �;"!r#c,;jrti :r..•�;m;.'„
. CITY flF EDMONbs a
COMMUNITYSERVICES DEPARTMENT' AUG Q 7 Permit No.
RIGHT =OF -WAY CONSTRUCTION PERMIT Issue Date F7'
ENGINEERING .
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A. •Owner: Washington Natural Gas 8ompany.: B. • Contractor: 1
e Name
e.
gfiercer Street ,� 1
� le ddress WA 98111 la's i0) Mailing Address 1
ll�
Git}a: a State Zip, , City State ZipSM E 1
i'm
State License Number Telephone Number 1
C. • Address or. Vicinity 'of Construction: 1041 ' 9 Avenue South
Type of Work.to be Done- Install 2' PE IP Main from 52' North to 225' North of centerline
of Fir Street. Per Attached Drawing: 910-014 (IR 6043-3.) (1)
D. • Work in Connection With: ❑ Sub or Plat ❑ Single Family ❑ City Projects
❑ •Commercial ❑ Multifamily KI Utility
E. • Pavement Cut: ® Y . ❑ N F. • Size of Cut: 2 X 4 (1) Cut
APPLICANT TO READ AND SIGN
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
be made against the City of Edmonds, or any of its departments orf erriployees, including or not limited to the defense
of anylegal proceedings including defense costs, cpurtc osts, and a(torney-fees�y 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.
• A 24 hour notice is required for inspection; Please call, Engineering: 771-3202
• Work.is to be inspected during progress and at.completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
6 All street -cut ditches must be patched with asphalt or. City approved material prior.to end of working day;
NO EXCEPTIONS.
I understand the above and that'this permit ,must be available at the job. site for inspection purposes at all times.,
Signature:
Date: August 1, 1991
Owner or Contractor
This Permit Must be Posted at the Job; Site For Inspection Purposes
' Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY:
a
Z Time Authorized: Void after C)C;T 15 days.
O
W Special Conditions: NA
F-.
V RELEASED BY:S Date 0
a'
O
PERMIT FEE: 030' / Af /2,. l
Restoration Fee:
Receipt No.:
Fund 111 Fee:
Street Cut Dimensions: x $
INSPECTED BY Date
NO WORK TO BEGIN PRIOR'TO PERMIT. ISSUANCE
F.ng. Div. March 1989
FIELD INSPECTION NOTES (Fund III - Route copy to Street'bept.),,
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
%1 END 3' PA5T LAST 5ERV ICE
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E.O. M - Lcc.
FROP05ED 2 PE I P MAI
1'WOFG/W,28'W
SQUEF-� #, FU5E
52' N
••
Fl R ST
EX-2"PE IP M,AIN
0
ziao PINE ST
— 3?;l 0
3rcl 0
'SI`d O
(oO R/W
* NOTES
I. FIELD LOCATE ALL UTILITIES
CALL 1-800-424-5555
48 HOUR5 BEFORE DIGGING
2. LAY DETECT WARNING WIRE OVER
ALL PE DIRECT BURIAL PIPE.
3. IN57ALL ONE POUND ANODE FOR
EVERY I000' OF LOCATING WIRE.
4. SURVEY NOT REQUIRED.
5. MAINTAIN A 5' HORIZONTAL AN D
3 VE.RTICAL CLEARANCE FROM
ALL CITY UTI LI TI E5.
1
1
i
o � -
_ 1
I i 1R=49rro0475-3 -
I
f 2:' PE GAP 52-ro50
'- 1-+3'j 1014GAUGE DETECT WARNCNG WIRE $5-940
2" 5DR-11 PE PIPE 70-260
ITE.%! OUANT DESCRIPTION STOCK NO.
f BILL OF MATERIAL
PERMITS: EDMOND5 1 /4 SEC: NW 25-2-f-3
{ PLAT: 164.66
•• I
OP MAP: 164.rc2
1
,5,44,14 i AREA: 241
TAX CODE:
�S SEQ. NO:
aVWN-ungtonEnergy -Corn anv
I
2." 5DR- l-4. PER MAIN. "TEN510N
.. I TO:
1041-9AVS
D W N./tiK I T i 1 5 91 f I R ro043 -3 j RR
jO 9 0-014-
^dG DESCRIPTION DATE BY APP'D CH-K D
DRAWING
REVISIONS SCALE I"=50' APP 910 - O14 / I
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