17514 TALBOT RD.PDF11111111111111
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17514 TALBOT RD
The City of Edmonds
APPLICATION
for
SEDE SEWER PERMIT
NEW CONSTRUCTION E] REPAIRS
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IMN PLANt
EASEMENT No . ..........................................
11b 16-111(g.
CONTRACTOR ----- .1-1 ......... 5-a..r-.0 ....... 57"""
.......................................... PERMIT N.o.
LEGAL DESCRIPTION: LOT No. ......................... BLOCK No . ........................ ..........
..........
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NAME OF ADDITION ................................................................ 36
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Approved:
CITY OF- EDMONDS
CIVIC CENTER — WATER -SEWER DEPARTMENT
SIDE S EWER PERMIT
Call FRospect 6-1107 when work
Is'ready for Inspection. (No Inspec.
tions Sat . urday, Sunday or holidays.) NO-1 ' 3605
ADDRESS ................... .......................................................
................ ........................ * ---------
John R. Steve Sani Safe Sewer
OWNER................. ..................................... *CONTRACTOR ....... .........................................................................
Pern-iission is granted .... Kancb I ................... 19 ..... 7Q 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:
-1)TE No. 1—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 regaxdIng 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 2/s 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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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT 0� � Permit'Number: 91-mo
Issue Date:
A. Address or Vicinity of Construction: - 17514 Talbot Road
B. Tvne of Work (be specific): Install 2" PE IP Main in Talbot Rpad from
CY9 0. 19 9- 454' West to 734' West centerline of Fredrick Place. Per Attached
Drawing: 910-451 (IR 6043-3) (2)
Contractor: Washington Natural Gas Company Contact: Gary Swanson
MailingAddress: 815 Mercer Street, Ph ' one: 224-2080
State License #: Seattle, WA 98111 Liability Insurance: B,ond:$
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. -F] Commercial E] Subdivision El CityProject n Util1tjt'V0D,UjT "Ih( EABLE, WATER)
F] Multi -Family E] Single Family Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut Yes []No (3) G. Size of. Cut: — 2 x 4= H. Charge$
.. I @ Gas and.2 @ Water
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the Chy of 6monds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen,jhat 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 d�fensel'co'sts,- atui aittor'n'iey' es by reason of granting this permit.
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7HE COATRA CTOR IS RESPONSIBLE FOR WORKMA NSHIP A AD ��4 TE�Ar4 FOR �A' �i)�'JD OF OAE YEA R FOLLO WING THE FINA L INSPE C77ON
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AND ACCEPTANCE OF THE WORK ES77MA7EDRESTOR,477bt FEESWILL. 'EHELD UN77L'THE j,�MfL SiREET PATCH ��,COMPLEMEDBY,
C17Y FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO 7HE APPLICANT.
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 timesfor insp ection purposes.
Signature: Date: October 15, 1991
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund III - Route copy to Street.Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 No
Partial Work Inspection by P. W.:
Work Disapproved B
Pole:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
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