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18308 84TH PL W
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NOTICE:
U..1 Y
-N'o ... wa r-r a n'CY ... 0 1 -d- ached
The information'shown on the att
map(s) was compiled for use by the City of
Edmondsl its Employees and Consultants.
Th,e City ofEdm.onds does not - wa rra nt ti
accuracy of anything set for.th on t * hese
Map(�-). Any person- or entity -requesting a
copy should conduct an independent
0 'ation shown on
inquiry regarding the infi rm
t-He -map(s), including� but not limited to, -h
th . e iociation of any sewer stub shown. Suc
exist and may
sewer stubs may or may I
or may not exist at the location shown.
Neither the City of Edmonds nor its
emp-to-yee-s o-r office-rs -sh-a-11.1 be 1--lia-b-11--e for the
information given on this rnap(s'), nor for
tation provided based
any one represen
upon said map(s).
APPLICATION
for
The City 'of Edmondstavoll' SIODE SEWER PERMIT
Fig.& NEW CONSTRUCTION REPAIRS E]
BASEMENT No.
Z/ ,
�NER ...... ............ ........
OV ---------
ADDRESS ...... Zk*-,�..!�� .... .......... ....... z .......... . ............
-21 �7,
CONTRACTOR Z� ... ....... PERMIT N .2
LEGAL DESCRIPTION: LOT No . .......... ........ ............... ...... BLOCK No . ......... ..................................
NAMEOF ADDITION ......... . .....................................................................
I
.A. P--ROVED
FEB- 1., 8 -M$
Approved:
...................................... I .........
DATE -1 —49 1 V- �;?
14
APPLICATION
for
The City of Edmonds SIDE SEWER PERlVHT
NEW CONSTRUCTION RE -PAIRS El EASEMENT No . ..........................................
0 VNER ......
V ............. ........ CONTRACTOR No.
ADDRESS ...... ...... ..... ........................... LEGAL DESCRIPTION: LOT No . .......... .............................. BLOCK No . .......... .................................
.............
NAME OF ADDITION ......... 1.7i.
.............. .......................................................................... . ...........................
Approved:
DATE................................... ............. By ..............................................
/11
CITY OF EDMONDS
CIVIC CENTER — WATER -SEWER DEPARTMENT Caj] )FRospect 6-1107 when work
is ready for inspection. (No inspec-
SIDE SEWER PERMIT tim's Saturday, Sunday Or holidays.) N? 3 F9.027
ADDRESS ...... IB.3.0_8 ... an ... 8_4"
tli_.Place ... Wes.t ---------
OWNER --------- C.-A ...... !!qQ6nAa.ch;Lq ...............
....................... CONTRACTOR_ ........ N
Permission is granted ----- Februar I _Or_t.b .. End --- aepti-C ... Tank ------------
.y..1.8_ 1Lq_6.9_' 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:
NOTE No. I —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 regarding 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; MiTUmum grade of 2%.
No bends in grade sharper than % 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. S—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.
C.
City -of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. -3 7�1
Issue Do, /,,�Q
A. Address or Vicinity of Construction: 18308 84th PI ace W
GTE to place, operate, and maintain a bueied service
90 199 y 0 MR %'V�ak� ') - — Tr m ex st ng Pedestal (V 6162 located al;
l8r08 84th Place W then*north tooa residence at 18308 84th Place W. to plow
60 feet p&sh driveways, and push zero road. R.O.W. 10 feet. Please qAA attadhed.
Mary A. Elower, Permft . orginator
Contractor: GTE Northwest Incorporated Contact: Dennis Alexander 771-9036 mobile 388-1358
2312-e,w. edzitno Rd
Mailing Address: Everett, Wa 98204-1440 Phone: Mary 206AW-1628 or-710-4130
State License #: Liability Insurance: Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. E] Commercial * E] Subdivision [I City Project [n Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family E) Single Family n Other 2100-9P001DI3 242310
INSPECTOR: 114SPECTOR: \JnAc_)rA
F. Pavement or Conc G. Size of Cut: X H. Chargcs '-F
retPlC%tse: seeflyffeascheAleotch
APPLICANT TO READ AND SIC.N
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 departyrients or
employees, 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, 77i-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 regulation&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 abovestatements and understand the permit requirements and thepink copyof thepermit willbe
available on site %kAll tim orl pection purposes.
e) talz!�L ___1 . . t
. '. d John H. Stewart November 27, 1996
Signature: _ti Se . Mgr. -Access -W09n
(Qatrawar Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: yj�.Al)rx
TIME AUTHORIZED: VOID AFTER —1 JEAL DAYS..
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/iFUND 111:
SPECIAL CONDITIONS: RESTORATION FEE:
PERMIT FEE:
COMMENTS:
I RYIN I DA
TOTAL FEE:
RECEIPT FEE:
ISSUED BY, -'—
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund 111 - Route copy to Street Dept.)
El YES
Date:
Date:
E] NO
f-ew I - LEGEND I .
PERMIT SUBMITTED BY
GTE
Wa 1-0 f
-----------------------
wda mail pl. vi
----------------------
'4�
rHE FOLLOWING INFO TO BE PROVIDED
RIGHT OF WAY LINES.EOP ORFACE OF CUMEXISTING SIDEWALK. POLES. ROAD
PECS 0
POLES 0
ROAD BORES
OVERHEAD LINES—
LNUTILITY POTHOLE 1=1
UG TRENCHING ---uGT—
RsOeWa
EOP
114 I No
0 %N
CUTS AND THE UTILITY UNDER. ROAD CUTS.
ABOVE GROUND FACILITIES.(Ie;) PEDS.BOXES.CABINETS. ETC..UNDERCROUND TRENCHING AND OvERHEAD LINES.
FOOTAGE OF WORK IN R.O.W.
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