17500 69TH PL W.PDF111111111111
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17500 69TH PL W
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION*
PERMIT Permit Number:
REET FILE Issue Date:
A. Address or Vicinity of Construction:- 17500 69 Rl--W (9404112)
B. Type of Work (be specific): Install New Service
C. Contractor: -Washington Natural Gas Compa Contact: Frank Swan
Mailing Address: R19 Mearer. qt, Sq1ttle.-WA Phone: 294-997R
State License #: 99111 Liability Insurance: Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. El Commercial b Subdivision El City Project @ Utility (PU15, GTE, WNG, CABLE, WATER)
F1 Multi -Family E] Single Family Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: Yes []No G. Size of Cut: x 4) H. Chargq�_$
in -paving at. 2Q of tie-in of -Svc to main
0
APPLICANT TO READ AN41?D- GN
INDEMNITY. Applicant understands and by his signature to this application, agrees to h e City of Edmonds harmlc�s-f.JW�;-4fL�amage., or
a
claims of any kind or description whatsoever, foreseen or unforeseen, that may b (a. ai;nst the City of Edmor a of ifs dFoartments or
employees, including or not limited to the defense of any legalproceedings including aclense cb t 1nd attorney fees by rfason ofgrantin
gthispermit.
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 TIMEA DEBIT OR CREDIT WILZ—BF PhOCEqSED FOR ISSUANC� TO THE APPLICANT.
- ?( . I
Construction,,drawing of proposed work required with permit application.
A 24 hqu"i"rotice 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.Appro-�6d material prior to the erd of the working day;
NO EXCEPTIONS. 9 1.
Ihave read the abouestatements and understand 'the permit requirements and thepink copyof thepermit will be
available on site a�tall �time r inspection purposes.
Signature: Date: janil-gry 6, 1994
�(6��t �A'c to r _0 r Ve �77 4
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVE D BY:
.1 RIGHT OF. WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER �a VL I VDAYS DISRUPTION FEE/FUND 111:�,
SPECIAL CONDITIONS: RESTORATION FEE:
PERMIT FEE:
TOTAL FEE: 6 4
COMMENTS: _RECEIPT, FEE:
DATE: ISSUED BY: "J§41 J :'
Ctf= , , :0t0==!!7Jq . 1 1, 1 1
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
El YES El NO
Date:
Date:
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Addendum to C t
_Efi
-.K_of Edmonds
R 'a t of Z:�
9 t of way
Perm 4 4- 1 j
AIRF ca ion
_pubmitted by: PTTCHELL S.-LANKFORD
Engineering Aide
Washington Natural'Gas
# -'-521-�5'246
Key:
gas main
2, >:�4 Ij
-n L= -
CX� <UL T-r)
-w- water
-9- gas
-ss- sewer.
9- water hydrant
0 -water valve
815 )-f=CtSI- kPI-). BOX 1869J. tc&tt&._. WA 98-11(206) 622-67r7
APPICATION
The City of Edmonds., for
SIDE SEWER PERMT EASEMENT No . ..........................................
NEW CONSTRUCTION E) REPAIRS
OWNER ... ...... . ........... TF ......... No . ........... ..........
. ........................ ................................ CONTRACTOR A=k�H ........ A S F— R <: ... CON
ADDRESS 47F�� LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ...... .....................................
----------- * ---------- ------------------ * -------------
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NAMEOF ADDITION .........................................................................................................................................
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DATE-/// flPy ... ............ By
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'�'�OF,"IE:DIM'�,O�'N;DS"-' 'i.-SI'DE,,'�'S!EWER,-�PER),M'�ITI
-:C7UTYf
MEgr
y
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k C�11', '3,75�Z!525� for' Asidei 'se��r, 'insp ns ISEFORE! covering, -any)
portioni lof 't h*�� -construction
I�sl>ection��will!,bel�providedt,wii�i�'� 24"ihoursilaffere-requ.4t.. NO(]Sat_: un.',I(or:iholid'ay,�ir��pectio
ns
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�T OPERTY�E EGA%- iDESCR1PT1ON-- LA i8rry Crest
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XX XAG TIORIS�IMMEWAWDRES& .............. 7: ............. r7 ........................................
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r4�p�ir.�a'hdViDr-*,�'conn'ec'ti'oji;'.(of:a: sidb,s6wer,toIt: fie4,1tpj3afi a�y
,4erni&,Si fftrafitei_ ............. r
�i s; ordin
gs' a4ecorditii�e!,%�fth,).Cf�y.�oV'Edmorid ance
TIONr-IS)ICA�LILE6)-TOilTH-Ei,-FOLLIOW,I,NG*!
AT;
"Th' y 'to t . r , u
o;, 1-�- e,'Iownersitok,!;t6?;Propeft may obtain w*,perm t c9n'i ct Isewer A�sidevropertyllne. A, -;bej(emp]oy6dl,,t6�",ctons iuct'
I , ' . 11densed!!Stde'Sewer; Contractor:must
0 -noV - Jon oftsewe r-,be fore. tit 'has:ibeew
isidelisewerdniatreet aiea.: Do'. -cover. any por, -finspe6tedl.'
NOTEI l�-%�ork"'pei�or�ied;�i�;(City,��i*ghtzof-way�.requiresN-ani.*-Ih�aston,�',of * -.'.RJgh�-o'f..Way/,Peimit',obt�n.'61e',ii7o':m',�he,City Engineer.'sooffice!
:..-NOTEI.-N�*,:3�—,ObtELiiik,fullt,inform�ti6nt,rdgELr�ing�tOrdl�anc6 1-11.4 6:030�:,an&Regu la t tons. :goverhi ng,1 side, !�IeYe I rsl'w hepilyou-%et -permit;
NOTE! tha�e,,at� leaz� 30 inches.,coverage.�&C, proiert' 11n'e,,andI:12Anche s* inside �pro' eft' 'ade of,,2�%., No)�6nds;lnc,gradei�'
y p y, llne;�,,,minlmumI,�kr
h
.1 NOTE114ol, ',&:LL!Teenches�in�tit're6t,iri�st',�be,',-v�Ater.,,settledl,a�hdl"surfac�,of;;streit, restored, originall conditiont;* cContractors foi�.jafturie�'i��e; iio).4
work,�whichi,may�develo�i-,within (one�-year of.compliitlom;.- roproper,
uniawfdP ttb)alterqor� dbI, �any�,other-,'work,.',tfi&n�:fsI -Prwov,ld4lo�', in. Itha-, t'Atopin-
)perralt,,,or�',to,,*'dc;,(any�,worli,,ore,the� maiw'seN�er�,6r,,iti appurte cisl."e, p
sert�xfthe,)plpe-Apto � he,.,*ke�,' 8) nan xce
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Hv rm' i cl� f"Bi tr.ucfiorrPRIOR�'TO),,Re�qp6st:.,For,,�1.4specti rr
t'Xbpl S1 MUST, -Be- Signe B�;f ner, o irm Perforthing, lCong 0
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dre ',then '.ei1' dIdtibirt, c xu�ted(mndler isi er-mi
. L`e'117 nsta onst
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�,,�C rti�,y�thdf siil&dsew.
�(,O�vher-(o'f,,Contra�ftfig:Fizry�, rfor I g;,Const ct
-gp er
\W, idi��inla'cooid4iice�,��;tt�fiilli,.gp,�.er ink,'brdina e itY.,of'Edmoiit&,.
�b�:fedtlhls*;'..'., ............ ........... ....................................
(CheekjBEFORE; youldig,jor:! Water-:E]1,, -Gas):[DI, 'Wephonej;[3i, -Powei,,E]', Sew6r,'01, Other i0l
4.
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The City of Edmonds
APPLICATION
for
SIDDE SEWER PERMT
EASEMENT No . ........... ..............................
NEW CONSTRUCTION 0 REPAIRS E]
OWNER
... T ------ V ........ 5 .. aw ------------------ ........... * --------- CONTRACTOR PERMIT No. -4 .............
ADDRESS ... ............ .. .... 40.f-4: ....... ........... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No .. ..................................
NAME OF ADDITION ..... . ..... !�? ... .... ....... 4
a .................................................................
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tu Usk -
,46 of G 11:
M; th�4 raw k,.-
but lwa
Pralidedbasoupal
Approved:
MAY 1 1974
DATE................................................ By ......