1239 8TH AVE S.PDFIIIIIIIIIIII
8691
1239 8TH AVE S
City .0 Edmonds
RIGHT-OF-WAV CONSTRUCTION
:..e: PERMIT Perm;t Numbet: �-
t " Issue Date: iM
A. Address or Vicinity of Construction: 1239 8 Ay S 49615843)
18 --ammm— C) C3 B. Type of Work (be specific): Install Service
9 p . 1 9
C. Contractor: Washington Natural —Gas
Mailing Address: 1122 75 St SH Eyp-ratt
State License #: 98203
D. Building Permit # (if applicable):
Contact: Mariamne Kingsbury
Phone:. 35fi-7500 R759fi
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable): _
E. ❑ Commercial ❑ Subdivision ❑ City Project [2 Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other `'
INSPECTOR: I1SPECTOR:
F. Pavement or Concrete Cut : Kl Yes UNo G. Size of Cut: *' x H. Charge $
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees io li6ki the City of Edmonds harmless (romp injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the defense of any legal proceedings including defense costa, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANS ,P AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMA ED';�S7'OR qiO qN-EgES�WIL�.BErHELDP UNTIL .THE;F,INAL ,STREET PATCH —"
IS COMPLETED BY CITY FORCES, AT WHICH TIME 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 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 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 sit at all ti es for inspection purposes.
Signature:'- Date: 6-19-96
ntraeto or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
°APPROVED BY: Iwl�t
TIME AUTHORIZED: VOID AFTER A* DAYS
SPECIAL CONDITIONS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND III -
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
COMMENTS: RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
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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2 gas main
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596
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-W- Water
-G- Gas
-SS- Sever
-& Water hydrant
Q Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 982b3; (206) `355-3331 `ty
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Watermain depth (�
2 gas main
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
0356-7500 X7596
-W- Water
-G- Gas .
-SS- lever
-& Water hydrant
p Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 982d3, (206)'355-3331 '�1'
APPLICATION
for
The City of Edmonds �' � � ' .�� t-�
SIDE SEWER PERMIT
EASEMENT No...........................................
NEW CONSTRUCTION ❑ REPAIRS ❑
OWNER ........... Paul ...Brittle
-----••---•----••-•----•..................................... CONTRACTOR.............-------------------•---.........................---.................................. PERMIT No.......................
ADDRESS .......1.2.3.9-..-... 8,t_h Ave._.-.S... LEGAL DESCRIPTION: LOT No ............................. ............ BLOCK No .............................................
•
•
NAMEOF ADDITION----------------••----...............---......---..............----....................--•---...................----•-...................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By................................-•---.................................
STREET FILE APPLICATIONfor
The City of Edmonds SIDE SEWER P=w"
ttU (- c'2- R�,,-D NEW CONSTRUCTION 0 REPAIRS (3
-c-a- 2 CL,CZII
OWNER................................................................. CONTRACTOR ................................................
b( --- c -----------
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ADDRESS ...... Z:2 ... 7 --- 5� ------------------ !;F ............ - ............................... LEGAL DESCRIPTION: LOT No . .............
NAME OF ADDITION .................................
EDMONDS
EATMENIT PLAW
EASEMENT No.....
..................... PERMIT NO. --�
. .................... BLOCK No . ..........................
Approved: J� - 1 0 , S- -
14
DATE..... --------- BY ---- �---67 ......... J, .., ....... ......................