17606 72ND AVE W.PDFiiiiiiiiiiii
5640
17606 72ND AVE W
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number-
e%or
'EET HLE'
a M -!2?3
Issue Date:
A. Address or Vicinity of Construction: 1.7606 72 Av W (9401509)
�1� 8 9 0 1 9 C� B. Type of Work (be specific): Install New Service
C. Contractor: 'Washington Natiiral Gas Company
MailingAddress: 8j5 Mercer St, Heat I TTA
State License #: 9811FOO
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. F-1 Commercial F] Subdivision El City Project 1) "Utility (PUD, GTE, WNG, CABLE, WATER)
F] Multi -Family [:1 Single Family El Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut Yes @No ' G. Size of Cut: x H. Chargq�_$
APPLICANT TO READ A GN
INDEMNITY. Applicant understands and by his signature to this application, agrees =told h�e City of Edmonds harm?lYkroA i damages,
or
claims of any kind or description whatsoever, foreseen or unforeseen, that maybe gains t the City of Edmo , r ;?ft� of zt��artments or
employees, including or not limited to the defense ofany legal proceedings including defense costs, and attorney fees by reason ofgraniing this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA TERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INS PE C TI 0 N A ND A C CE P TA NCE 0 F THE WO RK. E S TIMA TED R ES TO RA TI ON FE E SF IvIL L, BE HEL D UN TH, THE FINA L S TREE T PA TC H
IS COMPLETED B Y CITY FORCES, A T WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required Vith permit application.
A 24 i��ur 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 copy of thepermitivillbe
available on site a�>�es for i . nspecti . on purpo ses.
Signature: — -007""."W &4qt&4 Date: NoypmhAr 1. 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: 11A lklcAdt
TIME AUTHORIZED': VOID AFTER DAYS
SPECIAL CONDITIONS: in a -
COMMENTS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND Ill:
RESTORATION FEE:
PEiRMITFEE: 4,36--Aa 'A'a
TOTAL FEE:
RECEIPT FEE:
DATE:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
En&7g. Nv. 1991
FIELD INSPECTION NOTES (Fund 111 Route copy to Street DepgY�
Comments.'
Diagram:
CONTRACTOR CALLED. FOR INSPECTION 0 YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
11/01/93 12:53 N.O.B. WASH. NAT. GAS. 003
x
In-
ddendum to City of Edmonds
Right of Way
Permit Applicaiion
Suboitti6d by: Guyla Conuore
Engineering Aide
Washington Natural Gas
521-5248
JC6 115n C)
7?, Av vi.
IVAWNG to window
Water main depth
unknown
2;::." gas zain
4
d-
-w-
WD6W&
wq�
gas -
-as-
s6wer
-&-
water hydrant
0
water valve
IM Mmer St. MO. SoX 1869), S=Mk, WA "S I I (X*) M-4?07
APPLICATION
Thfi City of Edmonds for
SIDE SEWER PERMIT EASEMENT NO . .........................................
NEW CONSTRUCTION REPAIRS LID NO. -A��A .... ASMX. NO.
V-4 1 L--- \ L"' CD r--1 .4
OWNER......... ................................................... CONTRACTOR .................................................................................... PERMIT No . ..... ..............
JOB ---- \4�-j ----------- I ............
ADDRESS A'7-'fc>-'P-5:FD ....... ----------- -- LEGAL DESCRIPTION: LOT NO. -------------- BLOCK NO . ....................................
..................................................................................................................................................................
T-- �� �7- �D '�, I --
NAME OF ADDITION --- ........ .... - — --- — --------- S( ...... U .....
Approved:
DATE..... //,, W- ... .. ------- By /.2d -0 ------- G ........... ..................
APPUCA710N
%e City of Umoncls for
SIDE SEWER PERMIT EASEMENT NO - -------------- ----------------------------
NEW CONSTRUCnON E] REPAIRS E] LID NO. .-/(4-.4-----ASMT. NO.
OWNER OV% --------- ------------------ CONTRA OR
CT
-------------------------- PERMIT NO. -443
JOB ADDRESS
... ... ---------------------------------- LEGAL DESCRIPTION: LOT NO. -------------------- ---------- BLOCK NO . ......... ------------
--------------
---------- --------- ...... ------------------------------------------
NAME OF ADDITION ---------------
RMOVE0
r7
jot 1974
Approved:
DATE-------------------------------------------- By -------------------
EWkkAjEPAM'T-A/
P)
7IRMIT ".7,
VE _3
"411 `4
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7'�: 2 1
oN��rlrig� 4'ny, portion,' of, the consi rue on. t;
C 117115"259. f3ir&4�Sid6`*;V er,' pectl I'll. itF. C' L , t,
-Inspection wlll� b; ,q.st. 'NO-, Sat., Sun-.-,,6r: holiday-, inspectionii)
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UCTIQM�-_'.." M& nn'16 V'
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........................... ....................
WILLIAM"MAES
............................................... .... ........................... .......................................................
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4A,
CTORIM,NAM, DDRESS.� ......................................................................
CONTRA E'll,
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7 -7
jPe-nIssIOn),1s�grant6&_.: :1.., , - -4-., -1.9 'J�,.�epa -alidV6
...... ..................... Ir r,
ji*,4n''azeor an'c'e t-h nd 7
d y
A� 'NTIONAS!,&ALI�ED7TO, THEt FOLLOWING':`."
toi:c6nstru`6,�sewenl' insIde..pr'o'pc�,fj11*�e.. �`�Iicen.ed','SidwSewer Conti�et6r":mu���,�eiem�l�yed)' Icons6tict'
v
deLIiewer�in�fk'reet'diea% er�a��,'.,Poiti6n.'*of,,Isewer,,before;it has, beew lnspected�.'
-NOTE; No.�'21—A-M.work perform edfA n .:c it y� '-way,requfres,�an Ii
right -of iv6si'on"-�f.-�Jght'-of'-�ray:Permi't'�obtainable-from,,the City, Engi n�eer!i of f Ice;
IN OTE No� -3-6�t�in- 611tlnf��matlon*, 're[Q�
'governing, slde'�-'seweris, when:..You:get, permit.
1 .1 . " . '; �: ' f , y. ..... .
E N iv�r; r�ust,"ha4.zit "le * t A�c s �minlmu'm gradg,'oi.'26/�.�- 'iNo,��enj�fjliIi'-,��q4e
IiqbT 6!. 4TGp`.of. stde�4se as 30 he :coverali� al:-prop6rty. 11neand. 1 2'4n�hes,�Jnsic]6`.property� line;'
r s
hatpir,than, 'A, W 11, be� j5ermitted. I
NQT)g No., f&�Trenches -in, street rn�Btlb'e_ wate ''.settled" and- stirfice of I`it�ek '�restore'd to�orljfr�aal�coridftion.-. �C6nfractors shall!llie�-iespor�sl6l�.,'.f6'r.'-f�llure,.dtie",i-ol�-I
,mp�op�r
*,ork which., may viievelo�, ;�,Ithi �,ron e, of,co�TipIetIbn:.'
o for -An' anceB e�c�pt�tol)�
-NOTE) N ri�_it is uilawf ulto 'Blte�_�or,.do'any, othef w6r �..the.permjt, or�, twido:jan�,e w�qr� _o�,the,"main �sewer o�: Ifs appurfein'
"!Bert the pipe into,the v�,e. in7-
............... ......
Dal ......
.............. .. .. .... ........ y ................
11)19A-_PP'.RO.VE:D1 !'nl ,Dat'
AIPPR0 BO:
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............ 7.
—,BOTH-,Pe it, Co
ies,�.MUST
her eW&rAhAahailon
j�y ,certlfy*'*th�t,theside4§ rnlit, -
g forming;�Constructiow) -
vn oft fCont 1 4, r i.i, ":q
W `�nstalfled imac ordan
. ........
I ......... Of..'
eephon Seiyle�' er
-4t�'
M
SENDER.`Ae sure tG,fOI16%��i��tructions�:on�,,6thoir
side�
LEASE �URNISh,,§E�VI*C'E*(S)'-INDICATED"�13Y'CHEC'k�D,:BLCid
j S 1-1
OW address, 'Deliver -,.ONLY
where delivd�6'
itb�addr6sed',,�.'':*.
ECE10T.
ReceN-e',Ahe numbered'dificle
REGISFERM-NO.
GNATURE �71 1E OFAUDRESSEE-Must
_Nj �k
E
TirlE I'JO.'
Ti
-SIGNATURE F D S
4 SEE
A' D E
q�NT,� IF ANY
to
..........
AT,E; DELIVERED_,; DEL,
�SIIIOW -WHERE., IVE fjC,6d
e
3
'7
9 . 6
REGARDING: 17606— 72nd Avenue West 3 - C) C/o 0 0
(address)
R E C 0 R D 0 F C 0 N T A C T S
XTAMP 'PPnKM XTO F_
DATE .9 .1 COMMENTS
ADDRESS of CALLER
5/l/74 William Masson Certified Letter No. 406216 sent
requiring hook-up within 60 days.
6/7/74 Came into office and obtained
permit #4843.
6/17/74 Connection completed.
9,
ACTION TAKEN
Letter received.
INITIALS
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