17627 69TH PL W.PDFiiiiii iiiiii
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17627 69TH PL W
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RECF-IVED
JUN 1 6 1992
PERMIT COUNTER
FILE
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City of Edmonds Perlinit No:Jff_,)e-1- 015
RIGHT-OF-WAY 00�4STRUCrf',ION PERMIT Issue Date:
A. Address or Vicinity of Construction: CP
L
B: Type of Work (be -specific): -1. C%, �k
n� n IS Z Q�' 011L
10 1?
_74P ST �.s (4)
1\,� 4- cA�Al 00 C, kk--
-7 0 zo�z_ 9 A, N (0 v*c,,
C. Contractor.
Contact:&U_�16 Ifatt-1 �Af_ss
M 9
ailin' Address:
L
Phone: 64A -4/ 6-vi , .9 0 C, s?/7& V,9 3 7
State License #-_1T)1 L 0 4CZ /w"'M H
Liability Insurance: Bond: $
D. Building Permit (if applicable):
Side Sewer Permit (if applicable):
E. Commercial El SubdiVisi.on
City Project EJ EUC (PUD, VERIZON, PSE, AT& T, OVWD)
Multi-Farnily Single.Family
Other
F. PAVEMENT CUT-1 YES NO
G. SIZE OF CUT 9,- x JV1
CONCRETE CUT-' LJ YES E] No
�nr,64erstands by his/her signature to this application I helshe holds the City of Edmonds harmless from
1NDEmNITY.-Alice
injuries, dam�zg-es litlaims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City -of
r
Edmonds or an_�.�V�ff'its departments or employees, including but not limited to the defense of any legal proceedings including defense
costs and'attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP A AD MATERIALS FOR A PERIOD OF ONE YEAR FOLL097NG THE FINA L
INSPECTION AND, ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES HILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BYCITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLI.CANT,
+ Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of'the
required trainingin their possession.
+ Restoration is -to be in accordance with City.codes. All street -cut trench work -shall be patched with asphalt or City -
approved material prior to the end of the workday - NO EXCEPTIONS.
+ Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING 'WORK
HA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS.AND ACKNOWLEDGE
THA TIMUSTMAKE THE PINK COPY OF THEPERMITA VAILABLE ONSITEATALL TIMES FOR INSPECTIONS
Signature: J" Date:
(Coni-r'agtor or'Agent)
PA
FOR CITY USE ONLY
04
Approved by:. kight-of-way Fee: qdo -,: t �Sp—
Time Authorized: Void After r, to / 4.04 Disruption Fe6/Fund. I'll:
Soecial,Conditions:. MWhO V 11007MCJL�4*ZOM Restoration Fee:
Total Fee:
10044 &KW !;fftWDffJX M40, Receipt NO:
(AWMAVIL -ro U14, orjpj_f�AWOM,00- Issued'b�:..,LY�A&,d4_
UPON COMPLETION OF P ' ERMITTED WORK9 AN ENGINEERING FINAL
INSPECTION IS REQUI RED' PER CHAPTETZ 18.00 OF THE EDMONDS-
COMMUNITY DEVELOPMENT C05E f,ho 425.-77.1-0220, Ext. 1326),
FINAL APPROVAL OF PERMITTED WORK7 DATE: 17`�a,7-o
Inspector's Signature,
For inspection requirements see Engineering In.sp,ec.i,tion Information handout.
DAMy Documents\Forms\Engnmg\ROWperinit—.doc
Notes:
1. All signs and spacing to conform
to the MUTCD and City of Edmonds
Traffic Control specs.
2. Channelizing devices are 28"
traffic cones.
3. All signs are 48" x 48" B/O unless
otherwise specified.
4. Alert affected residents and businesses.
6. 1 Flagger will control alternating one
lane traffic.
7. Work area will be 15' E of C/L of 69 131
& 9'S of C/L of 176 St SW.
176th ST SW.
0 0 0 9 0 0 9
100, 100, 100, 1
LEGEND
28" TRAFFIC CONE
WORK AREA
TRAFFIC FLOW
CL
.0
4-
DEAD END ST
LOW TRAFFIC VOLUME
MM21
I-+-
bj2
*=XX
4 t I
WORK AREA IN
ROAD
Pilchuck Contractors, Inc
Job # 107020295
June 14, 2004
lisgSheet 1 of 1 Rob Ing
0%
%0 10 . 0 t�i 0 0y, "10 0,
1+ 1* 111,
WORK AREA IN
GRASS SHOULDER
t
b
Lo
N E LAN
ONE LAN
ROAD
ROAD
AHEAD
D
b
L0
ROAD
WORK
AHELAD
0
CHANNELIZATION DEVICE SPACING
MPH
TAPER
TANGENT
50/70
40
80
35/45
30
60
25/30
20
25'
15'
co
17 6Ar
Iff
ST SW
60'RIW
CPAVEL.
GRA VEL 40 RIW
...........
. ......
-:`v'20' PA
............................
PE 9
X. Z_
X. Z_ TW IP 91S
.
GRAVEL 8C 421
. . . . . . . . .
2" BRANCH SADDLE
151, 9'S C L
co
PROP. 2" MPE IP MAIN
I 5'E CIL
t,969
END OF MAIN
(2 It MPE CAP)
129'S, WE CIL
I
C L
40' 1W
PLOT PLAN
SCALE: 1 "=50'
STANDARD GAS CONSTRUCTION NOTES:
1.
FIELD LOCATE ALL UNDERGROUND UTILITIES. CALL "ONE -CALL* TWO WORKING DAYS PRIOR TO CONSTRUCTION, IN
WESTERN WASHINGTON CALL' 1-800-424-5555. IN KITTITAS COUNTY CALL- 1-800-553-4344
2.
ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS AND GAS FIELD PROCEDURES.
3.
EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE 0150.3200 TECHNIQUES FOR TEMPORARY
EROSION AND SEDIMENT CONTROL AND ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.
4.
N01IFY PROPERTY OWNERS ADJACENT TO PROPOSED CONSTRUCTION ACTIVITIES A MINIMUM OF TWO WORKING DAYS
PRIOR TO BEGINNING CONSTRUCTION. USE ISI TO DISTRIBUTE FLYERS IF JOB IS LARGE, OTHERWISE HAND
DELIVER FLYERS BE SURE TO INCLUDE THE LIST OF FREQUENTLY ASKED QUESTIONS AND INFORMATION ABOUT
THE OPPORTUNITY TO PURCHASE AN EXCESS FLOW VALVE WHEN THEIR SERVICE IS INSTALLED OR REPLACED
PER GAS OPERATING STANDARD 2550.1600. ALLOW ADEQUATE TIME FOR CUSTOMER DECISION AND RESPONSE.
5.
ANY CHANGE IN ROUTE, TIE-IN METHOD OR ADD11IONAL MAIN FOOTAGE MUST BE APPROVED BY PSE GAS ENGINEERING
SERVICES.
8.
COMPLETE "PIPE CONDITION REPORT' ON ALL EXPOSED EXISTING PSE FACILITIES. CHECK BOX ON REPORT FOR WIRE
BOX (TEST LEAD) INSTALLATION.
7.
ACTIVE SERVICES DENOTED BY. FXXXX
8.
PIPELINE MARKERS AND WARNING SIGNS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS
OPERATING STANDARD 2525.2500.
9.
VALVE MARKERS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS OPERATING STANDARD
2525.2600 FOR ALL HP VALVES IF THE LOCATION IS NOT REDILY ACCESSIBLE, AND FOR ALL VALVES WHERE
PERSISTANT SNOWFALL MAY OBSCURE THE VALVE BOX .
10.
TO PREVENT ACCIDENTAL OVERPRESSURE OF ADJOINING SYSTEMS, NO TWO MAINS SHALL BE CONNECTED EXCEPT AS
SHOWN ON THIS DESIGN UNLESS APPROVED BY PSE GAS ENGINEERING SERVICES.
11.
SYSTEM MAOP DENOTED BY. ISYSTEM MAOP - �45 PSIG
12.
GAUGE AND MONITOR USE OF ALL STOPPERS TO ENSURE ADEQUATE FEED.
13.
RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION.
14.
GAUGE AND MONITOR USE OF ALL STOPPERS AND SQUEEZES TO ENSURE ADEQUATE FEED. (USE MANOMETER FOR
LP SYSTEMS)
15.
RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION.
16.
PURGE POINTS AND PRESSURE TAPS TO BE INSTALLED PER PSE GAS OPERATING STANDARDS 2525.3400, A D 252 . 0
F117ER (CHECK BOX IF COMPLETF)
Work area left in Clean & Safe cond"tion.
Complete all Pipe Tables and Gas Pressure Stamp.
Field changes Red -Lined on as -built.
Material verified and Changes noted on paperwork.
All Valve & Tie-in Locations noted on cis -built.
Note beginning of Main, EOM & Line of Main locations.
Show Rope Locations-& Cul-de-sac Radius.
Foreman's Signature
Company DATE
El
1:1
GAS MAIN INSTALLATIONIRETIREMENT
Type/Work
Pipe Size
Type
Estimated
Length
Actual
Length
Manufacturer
rNSTALL
2"
NPR
120'
GAS MAIN PRESSURE& TESTING
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
DATE OFF
TIME OFF
TYPE TEST
PRESSURE
TESTED BY
DATE ON
ITIME ON
I
DATE OFF
ITIME OFF
Design Press 60
1 SYS MACIP 45 PSIG
I
PROJECT PHASE
NOTIF#
ORDER#
U)
SAP Superior
Service/Meter
Service/Meter
Service/Meter
Service/Meter
Ind. Service
Ind. MSA
Dis. Reg. / FT
HP Svc/MSA
Relocate
Retirement
X759249757
f07020295
X600919337
106f3ff73
I Contractor: CONSTRUCTION COST CODES:
104 111— 103— 11 - I I
Project Manager Contact Information:
PATTI NESS
425-327-2783 CELL PHONE
pcLtKnese0psexam
REV# DATE BY DESCRIPTION
3
2
1
COUNTY EIMER SECT
SNOHOMISH 4
114 SEC OP MAP
SW 08-27-04 156.068
UTILITIES
CONTACT
PHONE#
Vicinity Map
Owner / Developer Contact Info
THOMAS HUGHES
17627 69TH PL W
EDMOND, WA 98026
ATTN: THOMAS HUGHES
office: 425-379-6084
CALL (800) 424-5555
2 BUSINESS DAYS BEFORE YOU DIG
THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATION OF FACILITIES
REAL ESTATE/EASEMENT PERMIT
NIA EDMONDS
FUNCTION
CONTACT
PHONE
DATE
PROJECT IVIGR
P. NESS
206-418-4237
ENGR-GAS
DRAWNBY
MLOCK
206-418-42f7
06-04-0
CHECKEDBY
I P. NESS
1206-418-4237
lb'9'0'
I P. NESS
1208-4 t8-4237
16 -e -0
GAS WK CTR APPROVED BY
MCNSEG CP TECH.
PLAT MAP
159.070 MAPPING
JOINT FACILITIES ARRANGEMENTS
PUGET THOMAS HUGHES
SOUND 2 " MPE IP MAIN EXT.
ENERGY 17627 69TH PL W
EDMONDS, WA 98026
DESIGNED BY PILCHUCK CONTRACTORS INC.
107020295
Drawina Number:
SCALE:
1 60, 1PA1
I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
— Gf, C) r,�, 9- bbr\ck KLA-1—
MAILING ADOR S
Z
4 ? P",
o j -7 6 -,;7
CITY TELEPHONE NUMBER
'"OJ j (V,4 -7412� -&87�_
NAME
P>4 P't - -es,
A---- T__
DDRESS
a Av� L-A)
L)
X,
< CITY CAXAA ZIPq E NUMBER
I TELEPHON
0
NAME
(1&-kALIC4 (01\J1I`"C�(4't,._
ADDRESS
U 15(4 2, S-
2 CITY ZIP TELEPHONE NUMBER
I-
0 %6*61 77(/ _q23 9
Z
U .4LICENSE NUMBER EXPIRATION DA7-
6gjF /00 T / .9?-,
gwc *1()IRN
Legal Descri tion of Propert� - include all llsements
Z
1% +-1- IS4 'rlr-Ljr
u v%%A,_,0_.jAa ?--,L -t,-,LA A, el�,�
Lu
a vak r", -13 S�rIvr(o,j
_j V\
< O� ?OXILA 'A S&& 0- P 14 V%—
C)
UJI Property
Tlix Account
Parcel No.- :5-13 000- 1.5-Y ZU
0 NEW RESIDENTIAL PLUMBING
ADDITION COMMERCIAL MECHANICAL
REMODEL APT_ BLDG. El SIGN
GRADING FENCE
REPAIR — CYDS. I X_ FT)
WOODSTOVE SWIMPOOL
DEMOLISH INSERT HOT TUB/SPA
GARAGE
RETAINING WALL/
CARPORT 11 ROCKERY El RENEWAL
0
=1 (TYPE QK USE, BUSINESS OR ACTIVITY) EXPLAIN:
UO NUMBER OF STORIES NUMBEROF
DWELLING
A 7WO 1UNITS We,
DESCRIBE WORK TO BE ONE (ATTA H PL
7& -el
EILE 0
USE -
ZONE PERMIT
NUMBER A-3, S
JOB ITE/A
su
ADDRESS 17W
/4� ,/
LEGAL DESCRIPTION C
ON NO.
LID NO,
2 —1 ? 'a.,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved 0
RW Peimit Required 0
EXISTING — REQUIRED DEDICATION —
Street Use Permit Req'd 0
PROPOSED
Inspection Required 0
Sidewalk Required 0
REMARKS
R
ING MEMO DATED REVIEW BY
SIZE ]BUILDING SUPPLY SIZE I NO. OF FIX
SIGN AREA SEPA REVIEW AD8 NO.
ALLOWED I PROPOSED I COMPLETE IE�EMPT I —
I I EXP It \
VARIANCE OR CU NNING REVIEW BY DATE
SETBACKS - FEET HEIGHT LOT COVERAGE
I FRONT :� '7 'SIDE I/j #REAP/S I I Z.1 02 L3 4
CHECKED BY YPE OF CONSTRUCTION CODE HEIGHT
/V
SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP V9 Z LOAD
0 YES /lA, S,�
MARKS
PROGRESS INSPECTIONS PER LIBC 305
MAL
FINAL INSPECTION REOUIRED
VALUATION
V V U
PLAN CHECK FEE
BUILDING
12 6bi
/30
HEAT SOURCE,
GLAZING
h, C 4 1 It,
—7 o
qd /o
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
I
drivpways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Permh'App'katlon: 180 Days
I
Permit Limit: I Year - Provided Work Is Started Within 160 Days
STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
Uwj harmless the City of Edmonds, Washington, its officials,
2 employees, and agents from any and all claims for damages of
PLAN CHECK DEPOSIT
< whatever nature, arising directly or Indirectly from the Issuance
of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
0
x nor limit In any way the City's ability to enforce any ordinance
I
TOTAL AMOUNT DUE
I
provision." I
/I
I
I hereby acknowledge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
information given is correct; and that I am the owner, or th.e duly
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; and In doing the work authoriz-
THIS PERMIT
AUTHORIZES
T his application is not a permit until
ed thereby, no person will be employed In violation of the Labor
ONLY THE
.
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa-
WORK NOTED
Deputy: and fees are paid, and receipt is
tion Insuranc . - —
I NSPECTION
acknowledged in space provided.
SIGNATURE (OWNER OR AGENT) DATE SIGNED
DEPARTMENT
15,
CITY OF
OF JA 'S SIGgTURE T�
W 1;
A N-Z_
EDMONDS
JFRELE
I
4�4j
\3
CALL FOR
812�/ /ATE
'/I
A4TNTION
INSPECTION
X
,1—)6 SI
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
771-0220
Z31�
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL — File YELLOV�— ir(/spectc
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
PINK — Owner GOLD — Assessor
4
M
W
10247
STREET FILE
890-191-
City of Edmonds
Critical Areas Checklist
The Critical Ann Checklist contained on
this forni'mi to be filled out by my person
preparing a Development Permit
Application for the City of Edmonds prior
to histher submittal of a developmentTem3it
to the City. . I
1he purpose of -the Checklist is to enable
City staff to ddermine whether any potential
Critical Areas am or may be present on the
subject propedy. Ike information needed to
complete,the Checidist should be easily
available ftom observations of the site or
data available at City Hall (Critical Areas
inventories, maps, or soil surveys). -
An applicant, or hisrher representative, must
fill out thechecidist, sign and date it, and ,
submit it to the City. ne City will review'
the choddist, make a pr=u-sory site visit,
and m a on of the subsequent
steps necessary to complete a development
permit application-
Mrith a signed copy of this form, the
applicant should also submit a vicinity map
of the parcel with enough, detail that City
staff can find and identify the-subjeet
parcel(s). In addition, the applicant is
encouraged to include any other pertinent
information or studies in conjunction with
this Ched1dist to mist staff in completing
their preliminary assessment of the site.
I have completed the attached Critical Area Checklistand attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate coluniii below).
Owner / Applicant:
Nafne
Title
Street Address
C#Y; State, ZIP Phone
Signature
Date
Applicant Representative!
Vr-
Narne
((�' (\ V 'r CA (_ �� Y-
Title
Street Address
w
-7-7 q—q2-3 �
City, State, ZIP Phone
ev —
Soiature Date
RECEIV,.ED
Critical Areas'Checklist
Site Information
J-U N 0 4 1992
PLANNING DEPT.'
Project Name: Permit Number. —
Site Location: 76 -2- 6 q E� Property Tax Account Number 13 0
Approximate Site Size (acres or square feet): g;�,
Have you filled out a Critical Areas Checklist for a project on this site before? Ajo
General Site Conditions
1. Has the site been cleared or logged?
Soils / Topography
�'e 5-
Date of most recent action:
2. In the Snohomish County Soil Survey, what is the mapped soil type(s)?
3. Describe the general site topography. Check all that apply.
co "'n , t�)r Z 40 Ir 'et
. / I
Flat less than 5 feet elevation change over entirie' site.
Rolling- slopes on site generally less, than 15% (a vertical rise of 10 feet over a
horizontal distance of 66 feet.)
-iffilly. slopes present on site of more fim 15% and less than 30%. a vertical rise
of. 10 feet of horizontal distance.)
—Steep: grades of greater than 30% present on site.
Comments YU V"4
Hydrology/Vegetation
4. Site contains areas of year-round standing water
5. Site contains areas of seasonal standing water: AJO —Approx. Depth:
6. Site is in the floodway floodplain of a water course.
7. Site contains a crcek or an area where water flows across the grounds surface? Al- flows
are year-round? Flows are seasonal?
8. Site is primarily: forested meadow ;shrubs >�� mixed
9. Obvious wetland is present on site: A(o
10. Wetland inventory or map indicates wetland present on site:
11. Critical Areas inventory or map indicates any Critical Area on site:
Fqr City. Use Only
2
0
LU
.j
LL
LU
LU
CD
HEIGHT
PROP05ED STRUCTURF- PERIMLTER\ EXISTING S . TRUCTURE PERIMETE
6'
68,_004 -
....... .....
".77
7
X.,
10'-2"
7' Z" SEP 2 61983, /0,- /0"
-PLOT - STRUCTURE PLAN
0Er
'
�Cl'y
BLD.G. DEPT.
CONDITIONAL PERMIT
WORK- RIT ^6
ADDRESS-/2(o_?,7
OWNER- ?1(.,IeqAJU
1 APPROVED DATE- io-G-5'3
13Y A, Qee'f'e5
BLDG. OFFICIAL
KEEP THESE STM."PED
PLANS Ctl 03SITE FOR
ALL 1.,�SPECTIONS
PEiz,,,!!T NO.
K" 05) 3
0
(y)
PARCEL A RO.02'
PARrn A (i,
0
Permit No: qq-.Z-1 91.
City,d Edmonds
RIGHTe-OF-WAY CONSTRUCTION PERMIT Issue Date:
17627 - 69th Pl. West
A. Address or Vicinity of Construction:
B. Type of Work (be specific): GTE to place, operate & maintain A buried service wire, from
existing . pedestal #2836, located at 6916 176,St. S.W., then south to a residence at
17627 69 Pl. West. GTE to plow 275 feet, push 1 driveway 25 feet, and push no roads.
R.O.W. footage it 200 feet.
_ PLEASE SEE ATTACHED SKETCH.
ENGR: Gene Kazmierczak 425/771-86831'
C. Contractor: GTE NORTHWEST INCORPORATED Contact: Sherry Jones, Permit Coordi
4P.hone: 4
2312C W. Casino Rd. Rverett,WP 25/710-4133
Mailing Address:
98204-J. 40
State License #: Liability Insurance: Bond:$
D. Building Permit # (if applicable):. Side S6ver Permit # (if applicabfd)-: 2 q eljq
7
E. r-1 Commercial E] Subdivision City Project J[X EUC (PUD,(��PSE, CHAMBERS,,,.OVWD).
F_� Multi-Farnily Single Family --.0thl GTf W.O.# 2850-9P001DB .2423.10
INSPECTOR-
F. PAVEMENT: YES IZE 0 C T
, IJR NO G. IYT X H. Charge: S
CONCRETE CUT: YES �4NO
APP'LICANT TO REAP) AND SIGN
IDEMNITY, Applicant understands by hi er signature to this a li ti , helshe holds the City ofEdmonds harmlessfrom injuries,
21
damages or clai�s of any kind or descriptio whatsoever, foreseen , r un reseen, that may be made against the City of Edmonds or
i
t h fapa
is p 1' t1o"
oreseen r u7
t
any of its 4epartMents or employees, includin but not limited t t, e de nse of any legal proceedings including defense'coits and
g
attorneyfees by heasonco-fgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WOR!K]� SI11P AND MATERML FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WRW. , EST �TED RESTOR-ATIOAlt FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPI E TED B Y�CITY Fdj? CES, A T WH71C471t�E �A_ EBIT CREDIT WILL BE P� OCESSED FOR ISSUA NCE TO THE A PPLICA NT.
* T trol- a n1d, public safety shall Qh-accor ance witt City regulations as required by the City Engineer. Every
I ' - 9
flagger', must be trained as required by ��,O�\012 155-305 and must have certification verifying completion of the
required training in their possession.
-;;�4* Restoration/is to be in accordance with Cit S.--A'l treet-cut trench work shall be patched with asphalt or City-
0
approved,material prior to the end of the workqy%,-,N0 PTIONS.
I 1_*
* Three sets of construction drawings of oroposed worg-ar equired with the permit application.
I HA VE READ THE ABOVE STATEMENTS A ND TAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
. THAT I MUST MAKE THE PINK COPY OFJHE A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature: Pate: 8/11/99
DAVE HAWKINS$ (Contractor or Agent) SEC. MGR. -ACCESS DESIGN
C,ALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
Approved,by- Right�of-way Fee: -
Time Auth,6'rii�d_:,`N"bid Aftef -1 12-0 1 PAtS Disruption Fee/Fund 111:
Special Conditions,- Restoration Fee:
Total- Fee: r710, 06
Receipt No: A t__
Issued'�Y:
UPON COMPLETION OF PERMITTED WORK9AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER'18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.,
IFINAL APPROVAL OF PERMITTED WORK.
I INSPECTOR'S SIGNATURE DATE:'
For inspection requirements see Engineering information Handout.
V!
LEGEND
.0
PERMIT SUBMITTED BY
GTE -
c7v,
PEDS 0
POLES 0
ROAD BORES
OVERHEAD LINES---;—
I.D. UTILITY POTHOLE C:l
UG 7 RENCHING T—
R.o.w.
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r-7-
i r
- +fD
--------- --------------------
r-7-
i r