17121 TALBOT RD.PDF11111111111111
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17121 TALBOT RD
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APPLICATION
Th—e City of Edmonds for
SIDE SEWER PERMIT
EASEMENT No . ......
NEW CONSTRUCTION 0 REPAIRS 0
...... Y..� ........ / ...... PERMIT
OWNER . ................... CONTRACTOR ... ........
ADDRESS .... ............. cZ../Z.a.-r ............. /? ............... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAMEOF ADDITION' .................................................................................................................
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167,72-
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APPRnvrn .0 e Ap t4-, 7. 7
JUN 10 1970
Approved:
DATE .... 70
............................................ By .. . ......... . .....................................
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CITY- OF EDMONDS
Call PRospect 6-1107 when work
CIVIC CENTER � WATER -SEWER DEPARTMENT
Is ready for Inspection. (No Inspec.
-744
tions Saturday, Sunday or hoildays.) N2 09 13
SIDE SEWER - PERMIT
ADDRESS ...................................... 17.12.k.-Talbot Road
.. ..................................................................... . ................................................. : ..........................
Monroe N� Dennis
OWNER .................................... : ......................................................... CONTRACTOR ...... 4Y Inc.
�t and Son's, ...............................
..............................
Permission is granted......" J ' une * ... 1 ' 0 .............. 19J9, for ............ *'*'* ........ days to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION. IS'CALJED TO THE FOLLOWING:
NO.'I'—The owners of the property may obtain a permit to construct sewer inside Property line. A licensed Side Sewer Contractor must
. be employed to construct side sewer in street area. Do not cover any portion of 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 �� 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.
NOTE No. 6—It is unlawful to alter or do any other work than Is provided for in the permit, or to do any work on the main sewer or its appur-
tenances except to Insert the pipe into the wye.
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(M) MEASURED
(D) DESCRIPTION
FILE NO. 3870
F. B. 278/40
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number- z
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Usue Date:
A.
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Address or Vicinity of Construction:
-712KI
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Type of Work (be specific):,iRLt.3cA
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Contractor:
CbUWV-, P.Q\'3 Contact: .,
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Mailing Address� 4"'k\01N�n
IAO-� Ci Phone:
State License #: C -bmol�
<�� . Lj N Liability Insurance: Bond: $
Building*Permit # (if applicable):
Side Sewer Permit # (if applicakle):
E. F1 Commercial El Subdivision I El CitvProiect Utility (PUD, GTE, WNG, CABLE, WATER)
(] Multi -Family P- Single Family
INSPECTOR:
INSPECTOR:
F. Pavement or Concrete Cut 0 Yes ONO G. Size of Cut: x H. Chargq�,$
APPLICANT TO READ AND SI
D S
X
I
INDEMNITY. Applicant understands and by his signature to this application, agrees to ho e t ofEdmonds harmles&n?mj f4elq�amages, or
of
ns C.t
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made'a�gatns the City of Edmonds, or any of its'dej;artments or
t t
employees, including or not limited to the defense ofany legalproceedings including defen.e'cos-t and attorney fees by reas6n ofgranting this permit.
F1 0 0
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOI�A P R
R--, IOD OF ONE YEAR FQLLO!VING,.WE FINAL
�R
W1 I
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES Wjj'� PkE HELD UNTIL THE)UNAL ST.4-4'ET PA TCH
0 IS
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCE ED FOR ISSUANCE TO THE APPLICANT.
Construction drawing'of proposed work required'wfth permit dpplicati n.
A 24 hour notice is redu - iied 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 in1tccordance with City Codes.
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with City regul%ions as required by th?�,g
ilgineer.
All street cut ditches shall be patched with asphalt or City approved matefia:Yprior to the end of th& orkirig day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copy of theperm it will be
a *1 bl t� r insp ti purposes.
vai a e o��e a� tim, 1 6
,Signature: k Date:
(Co'ontractor or B11-ent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
I" e I FOR CITY USE ONLY I
APPROVED:BY:
TIM EA UTHORIZED VOID AFTE R 4) DAYS
SPECIAL CONDITIONS:
COMMENTS:
LIKIII 93,
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND III:
RESTORATION FEE:
PERMIT FEE:
TOTAL F
. 14 6
RECEIPT FEE:
ISSUED BY-'
[:1 Other 9-
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund 111 Route copy to Street Dept.)
Comments:
I Diagram;
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL. BY: Date:
Fc-: Q-1 1476
PUBLIC UTILITY DISTRICT NO.1 OF SNOHOMISH COUNTY REV. 7/87
AREA
LOCATION
POLE NO. 1 / 4 S -7 T -)Q R '-4 - D A TE 'Z-Z> W. 0. NO.
-0 (F
REASON FOR WORK ENGINEER D WG. N 0.
DR�FTER U. G. NO.
SCALE
DATE WORK COMPLETED APPROVED - DATE PRINTED
r u m L rA A 14 LNVlt-�UNIVILN IIAL AI\J/ALTZ>IZ)
0 EXEMPT 0 NOT EXEMPT SUBSTATION
FEES REQ'D YES 0 NO PARA. 18 ITEM C
PRIMARY OVERHEAD O.H. U.G. COND. KV CIRCUIT NO.
0 RESIDENTIAL ADD CKT FT PH
PHASE
0 COMMERCIAL
REM
CKT.
FT. PH
LEO#
/ /
NET
CKT.
FT.
SECONDARY OVERHEAD
O.H. U.G. COND.
KV
BASIC FEE
ADD
CKT.
FT. PH
os S
REM
CKT.
FT. PH
METER/CONV. POLE S-
NET
CKT. FT.
-7
PERMITS
(DATE GRANTED)
PRIMARY UNDERGROUND
0 TREE TRIM
• RESIDENTIAL
0 STATE
• COMMERCIAL
0 COUNTY
BASIC FEE
LEU #
y CITY
0
SECONDARY UNDERGROUND
EASEMENTS
0 REQUIRED A NOT REQUIRED
BASIC FEE
/ a$ /=$-
UNDERGROUND PLAT
DATE RELEASED
BASIC FEE
FOREIGN CONTACTS
(t FT. 0 $_ / =
0 GTNW JPN#
STREET LIGHTING
0 CATV JPN#
-t FT. 0 S
0 JOINT TRENCH GTNW & CATV
WORK IN RIGHT OF WAY
0 JOINT BORE GTNW & CATV
0 PRIMARY
0
XSECONADARY
POLE STENCILING
t FT. 0 3
FROM TO
MISCELLANEOUS FEES
TAKE OFF POLE
VAULT
PRE-CONSTR- REQUIREMENTS
PERMIT S -0C)
0 TREE TRIM 0 PUD LOCATOR
BACKHOE 0 FLAGGING
0 ONE CALL DATE
TOTAL DUE
INDEX
POLES
[PLAT
DATE PAID LOGS U-MAP
RECEIPT# _ XFMR I C-MAP
NEW SVCE APPLICATION# LOCATION MAP PAGE
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