1620 9TH AVE N.PDFIIIIIIIIIIII
9869
1620 9TH AVE N
APPLICATION
for
The City of Ede 6 d
EASEMENT NO. ?&-0
SIDE SEWER PERMIT
4= NEW CONSTRUCTION 0 REPAIRS E] LID NO. ..... . ASMT. NO_ __________________
OWNER -------------------------- ------------------- CONTRACTOR ------- tsk-E�-1=7rlC — ------- PERMIT NO.
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= 1�-
TOB, ADDRESS LA.--- ----- 4 --------- LEGAL DESCRIPTION: LOT NO_ ------------ 9 ---------------------- BLOCK NO. ------------------------------------
DATE ........... By,.r -----
The City of Edmonds
APPLICATION
for EASEMENT NO.74-O31.70114
SIDE SEWER PERMIT
NEW CONSTRUCTION [] REPAIRS 0 LID NO.-------- - ASMT. NO- ------------------
r.
OWNER
�7-- --- ------- ----- ---
- - r-- _., ---------------------------
R
JOB ADDRESS ---------- . ..... ----- e-� ------------------
CONTRACTOR PERMIT NO.
LEGAL DESCRIPTION: LOT NO. ------ - ------------------------- BLOCK NO. ------------------------------------
--------------------- ------------------------------------------------------- -------------------------------- a�i ------------------------------------------
NAME OF ADDITION -------
MEMO --------
OR 151976
Pubk Works DePL
Approved:
DATE. ............................................ By ---------------------------------------------------
- 41 CITY OF EDMONDS
'
� �EPPUB 'GOOKS DEPARTMENT; ENGINEER NEERODIVIS-ION
J��-I
APPLICAT-I-ON .FOR RIGHT -OF .-IJAY CQNdJRUCTION PERMIT FEB 2 7
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTIONP'W0Pf 'L-8`-
Applicant to Complete Parts A and B
A, Permit to be issued to:
For Work at.:(address or vic
Type of Work to be done:i4(J�
(attach drawing when applicable)
Time Required -- Start: Finish:
Owner:
Name
0 g r�
Mai n Address
iho�.®S Johl 20
City State Zip
Contractor: U A,,2&Z —
Name
.7 Z72 o2
Mailing Address
77'Z- 1 l —
City State Zip
Telephone Number
/(a332- S — 620-0
State License Number
Telephone Number
B, 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, foreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including or not limited to the defense of any legal proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship -and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and restoration in accordance with City Code. A
24-hour notice is required for inspection by Engineering. Call 775-2525, ext. 220.
I understand that this permit must be available at the job site for inspection
purposes at all times.
Signature: C% Date: a2 -.a 7 - iR
Agent
TO BE COMPLETED BY ISSUING AGENCY:
Date Issued: Permit No.: ,�.s/ Fee:IleS`�
Security Bond:
Time Authorized: ,I�'D tV: ,V_y
APPROVED BY,/
10-771v (Revised)
Date:
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V) OV
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14
�-�.�Xii.;:•f7`v i:PssnN""i5 'Fati:ia' 'R .. TZ.,
"�''"ar'"• � � � rA:..a :� `jn'�'� �'u::?:��.iC�: ,,,vvsri-V.x�4.a,fn,--. , ��+.'> , �,trFS
City of Edmonds
EET T-OF-WAY CONSTRUCTION
PERMIT Permit Number. _
e Issue Date: _ -
A. Address or Vicinity of Construction: 1620 9 AV, N, (9326719)
B. Type of Work (be specific): Install New Service
C. Contractor:Wash. Nat' 1 o Gas Co.
Mailing Address: 815 Mercer St.Seattle Wn
State License #: 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance:
Bond: $
Side Sewer Permit # (if applicable):
E. ❑ Commercial ❑ Subdivision ❑ City Project Xa Utility (PUD, GTE, WNG, CABLE, WATER)
❑ Multi -Family ❑ Single Family ❑ Other
INSPECTOR: INSPECTOR: i,, N-4e-u+
F. Pavement or Concrete Cut: Mes ❑No G. Size of Cut:(232 x 4Cuts H. Charge $
_X1)@ Water.(2)@ Gas
APPLICANT TO READ A IGN
INDEMNITY: Applicant understands and by his signature to this application, agrees t d the City of Edmonds harm! s® 0ves, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be ins a against the City of Edmonds, or any of A departments or
employees, including or not limited to the defense of any legal proceedings includin- defense costa, 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 RF,STORATION.REES,WILL RF, HELD UNTIL T�IF, FIJVA� STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCFS -ED FOR ISSUANCF. TO THF. 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.
Ihave read the above statements and understand thepermit requirements and thepink copyof thepermit will be
available on site at all times for inspectiion oses.
Signature: Cr5w Date: Sept. f 0, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: 1-AJ 66 T le .+-1- RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DEC, I DAYS DISRUPTION FEE/FUND<L1l.,
SPECIAL CONDITIONS: -NIA RESTORATION FEE:
PERMIT FEE:
TOTAL,FEE:.,
COMMENTS: RECEIPT FEE:. //�
DATE: ISSUED BY:' 4� � Ag aC7 � • ,
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
F.nKrK. 1)iv. 1991
FIELD INSPECTION NOTES
Comments
Diagram
9
(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:
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: Guyla Connors _
Engineering Aide
Washington Natural Gas
521-524A
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2(zx4)cL."I-rs
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WIA WNG to window
Water main de;
1-7"a
2-- to
gas main
Key:
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water
-g-
gas
-ss-
sewer
$
water hydrant
O
water valve
815 Macs St. (P.O. Box 1869). Seattle, WA 98111 (206) 622_6767