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1506 10TH PL N
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
STREET FILE
A. Address or Vicinity of Construction:
Permit Number:
Issue Date: 4C2 '-�Sa — L/
1506 10 Place tiorth
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Natural Gas Company
Mailing Address: 815 Mercer Street,
State License #: Seattle, WA 98111
D. Building Permit # (if applicable):
.T EC
Contact: Gary Swanson pr
Phone: 224-2080
Liability Insurance: Bond: $ FE
Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project ® Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR: (_,JI-t 1TCUT-T
F. Pavement or Concrete Cut : ❑ Yes ®No G. Size of Cut: x H. Charge $
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City of Fdmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, 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.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPECTION
AND ACCEPTANCE OF THE WORK. ES77MA7ED RESTORA77ON FEES WILL BE HELD UN77L THE FINAL STREET PATCH IS COMPLETED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
11
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Department- 771-3202.
Work 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: December 24, 1991
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: K W ,�
TIME AUTHORIZED: VOID AFTER �--i� DAYS
SPECIAL CONDITIONS:
COMMENTS:
DATE: T
NO WORK SHALL BEGIN PR:
Engrg. Div. 1991
FIELD INSPECTION NOTES
(Fund III - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION ❑ YES ❑ NO
Partial Work Inspection by P. W.:
Work Disapproved By:
Date:
Date:
FINAL APPROVAL BY:
Eng. Div. July 1985
A
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Washington —
Natural Gas
A WW-gfon Energy Company
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: Kerry Walsh
Engineering Aide
Washington Natural Gas
R, 622-6767 x2761
pager 969-1686
WN
Water main aeptn
unknown
2" gas main
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-w- water
-g- gas
-ss- sewer
water hydrant
815 Mercer St. (P.O. Box 1869), Seattle, WA 98111(206) 622-6767
APPLICATION CARD No . .............
......... . ..
for
The City of Edmonds SIDE SEWER PERMIT ' 3 EASEMENT No. ........
RIP �% SIDE IV INSIDE P- REPAIRS ❑�//����3�,TREET
OWNER L'. /t/ ................%%
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CONTRACTOR _C...
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��. �.................................... PERMIT N . , 6 71
HOUSE No. 6
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STREET
AVENUE LOT No............
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BLOCK No. ....7.d
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NAME ADD ...At�7..............X.¢rI...�
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APPROVED
21 1963
Date Approved:
BACKFILL WORK ORDER ISSUED ................................ *........... 4EPOSIT,$......................................................
SEWER WORK ORDER ISSUED ............................................... ` DATE.... �� BY