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k. Cityof Edmonds STA
EETFILE
RIGHT-OF-WAY CONSTRUCTION
PERMIT -
Permit Number.
Issue Date 4
A. Address or Vicinity of Construction: 1250 — 6h PLACE SOUTH
18 () 0 B. Type of Work (be specific): PALACE 120—FT OF BURIED SERVICt WIRE
90 19 -
C. Contractor: GTE NORTHWEST INCORPORATED Contact: BARBARA TOLLEFSON
Mailing Address: 22118 20TH AVE. SE SUITE 19lfbne: BARB 488-1642
State License #: BOTHELL, WA 98021 Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
PERMIT COORDINATOR
E. ❑ Commercial ❑ Subdivision ❑ City Project KI Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other WHO. # 2100-9POOIDB 242310
INSPECTOR: INSPECTOR: w L i:''�
F. Pavement or Concrete Cut: ❑ Yes @No G. Size of Cut: x H. Charge $
APPLICANT TO READ A . SIGN
INDEMNITY: Applicant understands and by his signature to this application, afire t Id the City of Edmonds haws %raft i� n s, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may m against the City of Edmo 5 tepartments 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 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 WILIdIRrt� `ESSED FOR ISSUANCE 7 0. T fI f AFP � CANT.
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 site at all times for inspection purposes.
Signature: - Date: 9-10-93
(Contractor or A e'nt)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: 1A4 t��'� RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER&DAYS DISRUPTION'FEE/FUND:111
SPECIAL CONDITIONS: RESTORATION. FEE:
PERMIT FEET r
TOTAL YEE:
COMMENTS: _ RECEIPT_ FEE:,,_
DATE: ISSUED BY: _
NO WORK SHALL BEGIN PRIOR TO PERMIT IS UANCE
Engrg. Div. 1991
i °2
_ 6
FIELD INSPECTION NOTES
Comments
::iikl
Diagram
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 Route copy to Street Dept.)
❑ YES
Date:
Date:
❑ NO
l
09—U-93 07:59 AM FROM Hallslake Const.Yrd,
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APPLICATION
The City of Edmonds� SIDE SEWER PERMIT
OUTSIDE ❑ INSIDE ❑ REPAIRS ❑
OWNER ....... \...__C. � ............
HOUSE No ................. \
CARDNo . ................... ................... v
EASEMENT No . ......................................
� :. .----�� ..............•--. PERMIT No.
CONTRACTOR Q Ql �. T
Ek�-c/ ::lj� STREET l
•--------------•-------------............----_..._ AVENUE LOT No. ......... ..1..1...................................................... BLOCK No. ...............................................
NAME ADD. - a �•a-� \ !� ,a-- L li A
1
------•----•--•--------------------------------•-• •-----..............................--
�a
APPROVED
APR
............................
Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .............................................
SEWER WORK ORDER ISSUED ... DATE I ......... ..'............... BY .�...--- ----.........._............
C I T Y 0 F E D M 0 N D S
-.,PUBLIC_WORKS._ENGINEERING
ACTION REPORT
N9 1466
SUSPENSE DATE:
Date: Time: 01-2"��O File #
REQUESTOR: NAME: I
ADDRESS:
PHONE:
REQUEST RECEIVED BY:
TELEPHONE
CONTACT IN OFFICE
OTHER:-
RECEIVED BY: CMI.g!�V62,�_)
-ROUTE TO:
# OPR NAME INIT DATE
INIT. NAME
/07tt,
2
3
4
5
All Concerned Notified
Action Completed/File
CITY OF EDM ONDS
- CIVIC '.6EkTER*_ WATER -SEWER, DEPARTMENT
SIDE SEWER PERMIT
Call PRospect 6-1107 when work
19'ready,_fqr Inspectloh.. -.7(No.-Inspee-
tions'§dtuirday, Sunday, or.holldays.) NO. 1393
ADDRESS ...................... 1.2.5.0 .... S. i.x t.h .... Av.enue...S.o.q.t.h ....................................... ...........................................................................
. .. .... .. .... ..........
.0 WNER ............... FrY.d.e ... ROMe.5 ............ ....................................... . CONTRACTOR ........... Qg4At .. Cpnjqmt!a ...............................
Permission Is granted ... 4ril .............. 19A.6.'. for ...................... days, to REPAIR or CONNECT a side sewer
With City Sewers in accordance with application on file and governing. ordinances.
ATTENTION IS CALLED TO THE .FOLLOWING:
NOTE No. 1—The . owners 'of Ahe - property may obtain a permit to -construct sewer ineide'property line. A licensed,81de Sewer Contractor must
be'employed to construct side sewer in street area. Do not cover any portion 6f.sewer before It has been inspected.
NOTE No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing. side,sewers when you :get permit.
NOTE No. 3—Top of side sewer must have at least 30 inches coverage at property line and 12 Inches inside property line; minimum grade of 2%.
No bends in grade sharper than 'A will be permitted.
NOTE No. 4—Trenches In street must be water settled and surface of street restored to original condition. Contractors shall be responsible for'
failure due to Improper work which may develop within one year of completion.
i%NOTE No. 5—Itfis unlawful to alter or do any other work than is provided for in the permit, or to do any work on the ma4nsewer or its apm-
,
purtenances except to Insert the pipe into the.wye.