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' City of Edmonds'
b'90 199-
RIGHT—OF—WAY CONSTRUCTION
PERMIT Permit Number: 9,�, ; y07
STREET FILE Issue Date:
A. Address or Vicinity of Construction: 1230 11 Place North
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Natural Gas Company Contact: Frank Swan "
Mailing Address: 815 Mercer Street, Phone: 224-2278
State License #: Seattle, WA 98111 Liability Insurance: Bond: $
D. Building Permit# (if applicable):
Side Sewer Permit # (if applicable):
E. ' ❑ Commercial ❑ Subdivision ❑ City Project ® Utility (PUD, 'GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑. Single Family ❑ Other
1 �1
INSPECTOR: INSPECCTOR:
F. Pavement or Concrete Cut : ❑ Yes [nNo G. Size of Cut: H. Charge $
APPLICANT TO READ AND_ =SIGN �r�
+�" > , . /
INDEMNITY: Applicant understands and by his signature to this application, agrees to QoW tha% City of Edmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unfgreen, that may be made against the City of Edmonds, or\any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings including defense costs, and attorney fees by reason of granting this permit.
THEF CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD d ONE YEAR FOLLPWi G THE FINAL INSPECTION
AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORA77ON FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED BY
CITY FORCES, AT WHICH 77ME 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 Department- 771-3202.1
Work is to be inspected during progress and at completion.
Restoration is to be in accordance with City Codes.
Street shaft 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 the permit will be available
on site at all times for ins ion pu os s.
Signature: Date: December 14, 1992
0`0'offrltctor or Agent)
CALL DIALrA-DIG PRIOR TO BEGINNING WORK
APPROVED BY: > 1 RIGHT OF WAY DEPOSIT:....'
TIME AUTHORIZED: VOID. AFTER '" y E� R. DAYS.. DISRUPTION.FEEIFUND 111
SPECIAL. CONDrrIONS:: N RESTORATION: FEE;::
Jvlrr: FEE:
.0
NO
Engrg. Div. 091
FIELD INSPECTION NOTES (Fund I II - Route copy to Street-Mept.)�
Comments:
Diagram:
P
CONTRACTOR CALLED. FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. urv. !u
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: RILNA2D HIL -kQD
Engineering Aide
12
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$ water hydrant
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815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767
APPLICATION
The City of Edmonds` — �
;r l� 4i KAI �� U SIDE SEWER PERNIIT EASEMENT No. ...................
.......................
NEW CONSTRUCTION ❑ REPAIRS ❑
119-01200
OWNER .......... •......................•--.....----........---......---.-...--••----..... CONTRACTOR-...---------------.............-............---.............
-•.................................. PERMIT No....... ..
ADDRESS...... ....................................................... LEGAL DESCRIPTION: LOT No............................................... BLOCK No.............................................
NAMEOF ADDITION...........................•----.......--•--.....---......................---....--......................................................
•
•
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................