18627 80TH AVE W.PDF111111111111
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18627 80TH AVE W
APPLICATION
EET FIL Awk, for
The City of Edmonds S111DE SEWER PERMIN EASEMENT No . ..........................................
NEW CONSTRUCTION &1' REPAIRS
-P 1-3
OWNER ..... Ir e ........ jf#�
CONTRACTOR PERMIT N4.
ADDRESS ............. .......... ......... LEGAL DESC�=ION: LOT No..... BLOCK No . ............................................
----------------------------
NAME OF ADDITION ..........
r
. is
Approved:
el� -2
DATE ... .. ....................
A P P
NOTICE-:
No warranty of accuracy.
The information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of'Edmonds does not warrant the
accuracy of anything set for ' th on these
map(s-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
th-e -map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may'not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
empl-oyees or officers shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS I
III IRo pect 6-1107 when work
6VIC CENTER — WATER -SEWER DEPARTMENT Is ready fl.1pr inspection. (No Insper-
SIDESEWER PERMIT tt— Saturday, Sunday or holiday..) N? 2529
ADDRESS ............. 18627 - 80th Avenue West
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
OWNER ................. qreg_ Be re YTOR
.... ...... rg!� -------------------------------------------------- CONTRAC -------- X orth"t s.t. - Sower ...............................
November
Permission is granted -----_---- ----------------------- 13 iq.67
------ ........ 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; minimum grade of 2%.
No bends In grade sharper than % will be permitted.
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.
o. 5—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-
NC tenances except to insert the pipe into the wye.
Pilchuck Contractors, Inc.
Job # 8877604
May 3, 2004
Sheet I of I
Rob Inglis
N
MHV
MHOM
I
LU
0
Go
LEGEND
0
28" TRAFFIC CONE
1)0(1
WORK AREA
TRAFFIC FLOW
BLACKTOP ASPHALT
CHANNEUZATION DEIACE SPACING
MPH
TAPER
TANGENT
50/70
40
80
35/45
30
20
I
0
0
0
Notes:
1. All signs and spacing to conform
to the MUTCD and City of Edmonds
In -Street Manual.
2. Channelizing devices are 28"
traffic cones.
4. All signs are 48" x 48" B/O unless
otherwise specified.
5. Alert affected residents.
6'GRAVEL
SHOULDER
TYPICAL
BOTH SIDES
APPROVED AS NOTED
BY ENGINEERING
Date: (j2//
GWM6^1r3'1N Acw P&Rmir
P," vich Lick Contractors Inc SAP / Permit / Work Order
uest
Foreman Name:
Address: I 84o;?--� 0 0 IGU
Cit'V: <:fgJ,,,�n -,
Zip Code:
SAP#: �0--700
Leak#: /,/ bel 090
Plat: 1(oOOG9
Thomas Guide: 5-
Locate #
No Parks Required? Na' Yes
Permit Required? No -Yee---�
City/Crity? --% --F
Fiaggers Needed7
How manyl
Job Start NotificAtion? No Yes
Traffic Plan?
Hoe?
4-Man?
SurfaceTVpe:.
HoleSize: —?— -2-1c -4
No
Yes
No
Y14-
No
I Yes
Install: ;-2 - -j;� d��-S_
. Size/typellength:
Retire:
Size/type/length:
Check One
Service Leak Repair
STW Main Repair
Cl Main Repair
Bare Stl Repair
Valve Repair
Service Valve Repair (HOS)
Date:
DescriDtion Diagram of Work:
0
One Call Inbtructions:
177AZJV 01 J
c,)
Circle One
Stub
Ext Compl
Main
Check One
Scattered Service Replacement Residential
Scattered Service Replacement Commercial
Cut & Cap
Short Main Rehabilitation Res (Few Feet)
Short Main Rehabilitation Com (Few Feet)
SAP# For Main Replacement (One Block)
Specific SAP# For Maintenance (Main or Service)
CP Work order
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City of Edmdnds Permit No: PON 0/
RIGHT-O&WAY CONSTRUCTION PERMIT, IssueDate: (0-4,zaot
0. yj 3) c)
A. Address, or Vicinity of Construction:
B. Type of Work,(be specific): —70. a ay)6"_% (D a (4
,-),4 01 tJ 0. 1L. ns;, W U, -) c:P x L) �q 0 C.
, 0 f 4 'A -5 -7 -7UO
C. Contractor: Pf � (?)A LA� d4\ Contact: �,Q�Ak 0 S 181 j1N
Mailing Address: 13333
0 k) Phone:
State License #: L,�\_ �) C_T_ 0 3, V111 A Liability Insurance: Bond:$
City Business License #:
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. F1 Commercial El 'Subdivision F-1 City Proj I ect.,E] ]�UC (PUD, VERIZON, PSE, COMCAST, OVWSD)
F-1 IMulti-Family 0a Si YYA(3,� �N4<> ic,%je
.�gle Family ,ER Qther
VZI�INSPECTCIR:
F. PAVEMENTCUT: [2YES F� NO G. SIZE OF CUT C;L x
CONCRETE CUT: El YES F� NO
G. Ej Mail Approved Permit F-1 Call for Pickup
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands by hislher signature to this application helshe holds the City of Edmonds 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 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 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, A T WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
* Traffic control and public s.afety'shall be. in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as' required by (WAC) 296-15�-305 and must have certification verifying completion of the
required training in their possession.
* Restoration is to be in accordance with Cit�'codes. All street -cut trench work shall be patcljed with asphalt or City -
approved material prior to the end of the workday - NO,,EXCEPTI6NS'
* Three sets
,,pf construction drawings of proposed Work are required with the permit application.
4)
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORIC'
IHAVEIREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA TI MUST MAKE THE PINK COPY OF THE PERMITA VAILABLEDN SITE A TALL TIMES FOR INSPECTIONS
Signature: Date:
(Contractor or Agent)
S
FORCITY USE:`ONL
Approved..by: ....... -o s4ay. ee� 6 0. (0
Time Authorized: Void After' 4- 'Disrup f
Special Conditions: 12rc�TC-lZr- g.Cjl� M� 4jA-,!F :.Ar�*1)zr_1.,, JqsOctipfifee: Z.6d -so-
P A
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Fi26AA Al t r-, ry cl: Tj,�,�':, A pl� Re' �N
ce Ot 0:
Ae�b '.1ssued"IP
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REQUIRED INSPECTIONS: (D 7"�tAFr-jc Cnlq -rec- L C&g:Ac,,Z_- QA4j_ rH.- 1VWA.CAroe
P - /'F71 N A I - o6c,c, 7-C /,Z A T'
w- I t_n W Iz- f-Az I N r" PX- C 7-1 a&)
Call 425- 771-0220, Ext. 1326for a 24-hour voice -recorded inspection request line.
FINAL APPROVAL OF PERMITTED WORK: DATE:ff_:]L�
Inspector's Signature
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
CADocurnents and SettingsTuilisNy Documents\Fonns\Engnrng\ROWpermit_.doc Revised 10101103
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