17839 TALBOT RD.PDF11111111111111
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17839 TALBOT RD
YM%��
Cit�� of Edmonds
-OF-WAY CONSTRUCT ON
RIGHT
-RMIT
Permit Number -
PE
I! ue Date:
SS �2
A. Address or Vicinity of Construction: - 17839 Talbot Rd (9620085)
8 --Nmm-- C) B. Type of Work (be specific): Trintall Service
9 0 - 19
C. Contractor: Washington Natural Gas Contact: Mariamne Kingsbury.
,,Mailing Address: 112 2 75 St SW Everett Phone: 356-7500 ext 7596
-State License #: 98203 Liability Insurance: Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):'
E. 0 Commercial EJ Subdivision El City Project [0 Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family E] Single Family E) Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut 0 Yes AMNo G. Size of Cut: H. Chargq,,$
APPLICANT TO READ ANI GN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employee s, including or not limited to the defense ofany legalproceedings including defense Costs, and attorney fees by reason ofgranting thispermit.
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 WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and materikis 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 thepermit will be
available on site at all times for inspection purpos
Signature:
Date:
C ntractor or ft)
0
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER 4F-A rl- DAYS DISRUPT`IONFEE/FUND� I I I:
SPECIAL CONDITIONS: RESTORATION FEE:
PERMIT FEE-
n
TOTAL FEE:,
COMMENTS- RECEIPT FEE:
DATE: is
-A
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
-rM Gas
Addendum to: 'City of Edmonds
light of Way
Permit Application
Submitted by:
Engineering Aide
Washington Natural Gas
1356-7500 X7596
I \161 Sw
Vatermain dep5 0
V
9 gas main
\j6B
1 -7
8 3'� 7-0-1 4 9
e;d
M OnA
A)O
C U -r!5
-9-
vater
-G-
Gas ' I I
-SS-
sewer
-&
Vatet-bydrant
0
Vatex;. valve
Washington Natural Gas Company
1122 75th Street S.W., Everett. Washington 98203, (M6) 355-3331
AMC=
P&M
\Olq
Vatermain depth A
gas main
Addendum to: City of Edmonds
Right of Vay
Permit Application
-if 4 vt
Submitted by: "---'—Iry.
Engineering Aide
Vashington Natural Gas
1356-7500 X7596
. 1. :.:
B 9 ( P'Z C)O 057
8,301 T-sAo4- Rd
4 rn qnA
C, U -r5
-V-
Vater
-G-
Gas '
-SS-
sever
-&
Vater-hydrant
0
Vater. valve
Washington Natural Gas Company
If 22 75th Street S.W., Everett, Washington 98203, (2D6) 355-3331
0
CIT ' Y OFEDMONDS Permit No.
VCOMMUNITY SEkVICES DEPART RIF
R'1GHT_'OF-WAY CONST T142''IR'N Issue Date
L;�._T HLE
A. 9 Owner: C k1% kl� 4-1, CA B..'* Contractor: "�4 C_ N ;r I C'
N Name
Mai i g Address Mailing Address
k�� n (*' %'�)N �' L_ �S� . W N I ,
City 'State Zip City State Zip
State License Nurrkber ephohe Number
>4
.-J
Z
0
U
94
0
V.
C. 9 Address or Vicinity of Conkructd—mg-
Type of Work to be
D. 0 Work in Connection With:
E. 0 Pavement Cut: 0 Y El N
El'SUO br Plat
0 Commercial
F. 0 Size of Cut:
• Single Family
• Multifamily
X
El City Projects
�Iutility
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees t6 hold the City of Edmonds
harmless from any injuries, damages, or claims of any kind or description whatsoever, forseen or unforseen, that may
be made against the City of Edmonds, or any of its departments or employees, including or not limited to the defense
of any legal proceedings including defense costs, court costs, and attorney fees by reason of granting this permit.
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 time a debit or credit will be
processed for issuance to the applicant.
A 24 hour notice is required for inspection; Please call Engineering: 771-3202
Work'is to be inspected during progress and at completion. -
Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS:
I understand the above and that this permit must be availaWe at the job site for inspection purposes at all times.
Signature* 011 Date: :9
Owner or Contractor
ThWPer*niit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: PERMIT FEE:
Time Authorized: Void after 3() days. Restoration Fee:
Special Conditions:
RELEASED BY:
Receipt No.:
Fund I 11. Fee:
Street Cut Dimensions
Date INSPECTED BY
NO. WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
$
Date
Eng. Div. March 1989
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: —
FINAL APPROVAL BY:
Date:
Eng. Div. July 1985
qL 6 S�
G
cy
APPLICATION
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for
The City of Edmonds SEDE SEWER P MAY 3 - EA�S ............................
NEW CONSTRUCTION El REPAIRS []
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ONTRACTOR k'!.Il PERMITNo....
OWNER ... . .......... V ------- .......... C.44.5-7 ...................... c I.AlAl .. W.41..,l ......
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ADDRESS .. P7 .. .......... rA.L .... 13-o-7 ............ 9..D.t ------- LEGAL DESCRIPTION: LOT No - ------ 4/4 ............................... BLOCK No . ............................................
NAME OF ADDITION .... -.7-A-.Zn-&..7 ............ PAA --- Z�.( .............. .............. .............................
? �f 4-e."
Approved:
DATE .... &7��Z---2-2 . .......
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BY ------ .. .....
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."ERSE, N'AE;R:.,lFk* TF,_,*:. .
AGNIDS,*,`;` .'SID, R) MY) I
4,CETT--�l 07 P.-ID M.
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i4t::i6i WIN
P must�be,, employed0to
I �,�dnstru�t,�e%�ei� inside;�prb sdd� 'Side' , Sei�er,,Contracto �,ednstrucV
-portion of"deweribeforc.' It-' has�,beem7ln6ected�,-_
llo.�,2411h work Per�orm�&*l nr. ght - df_way,, reqiiiies-,anoInvasion. of�Rlgiit�-of-�V.a�,i�*�r�mit�;obtainablel;from.,the',Cityi,Engineer�siloffice'.:
9� st.. nitgr e
O"Ve'raga
]�_;�-Pjoi Jslde�'ss�i6rr,iiiusOhave. dtAeastl�30!,Jnehes� e j;aj,,.proper�i-Jiineij
peirnitfed'.
sharper, thaW, %�HV.be
"Trenche�)iin�;,st�ree't,�*�m'�us't,'I;�,,,,j.idr eet r�s or �it.�16* lnal-'i6ond*ttio*n'��"j�(j'ontractors-'shall,,;be�:,resp�nsit,iekifgr-i�,iluie�duc�,',to��lm�r�P6'r,'�
work Whibhrmay.-,'develop'_wlthinl one:y6ar of'compldtion,
-in---t�e',,peri�ii;,,,or,,.to4do�any�,work�on'.' thel�maint-sewer-,or�its;ijipi�.�ii4��ancesi�ex6e�f 4tol iii?`�
-plpe' to,,
in theiwye`,-
!eereAthe* %
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APPRO4
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C 's For I"
inu' SIMIJ ST Bei,�Signed!--.By,itOWnei-�� rhii onstruftioy� OR,A,
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t:
ify Ufa iI a stft"
t;,t eysi 6�sewe�,dnsfallatibn�cbn ucted
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