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18717 92ND AVE W
Cit�,,of Edmonds
RIGHT-OF-WAY CONSTRUCTION
j?ERMIT
-Permit NuiaWr.
. 14,
Wue Date:
A. Address or Vicinity of Construction: - 18717 92 AV W (9616700)
Co B. Type of Work (be specific): Tnat
9 9 C� -nj I saryllce
C. Contracthr: Vashington Naturill "s
MailingAddress: ISZ27792SkySW"�1 Everett
State License #: . 98203
D. Building Permit # (if applicable):
Contact: —Mariamne Kingsbury
Phone: 356-7500 X7596
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. F] Commercial 0 Subdivision El City Proj4Tct [11 Utility (PUD, GTE, WNG, CABLE, WATER)
Ej Multi -Family El Single Family n Other `;' 1,
INSPECTOR: I INSPECTOR: Wri—Ax
F. Pavement or Concrete Cut k] Yes E]No G. Size of Cu x HrpafEo�$9�(
APPLICANT TO READAND SIGN
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
employees, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS WSPONSIBLE 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 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.
'17raffic 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 abovestatements and understand the permit requirements andthepink copyof thepermit will be
available on 7s 11 * es for inspection oses.
t a t P#rp
—5-96
7
Signature: Date:
Y�Itracior �(r Arent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR'CITY USE'ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER 6EeF3QDAYS DISRUPTION FEE/FUND.111*:
SPECIAL CONDITIONS: N/A RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
COMMENTS: RECEIPT' FEE:
DATE: ISSUED,
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSP ECTION NOTES
I Comments:
D iagram
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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Addendum to: WOODW*Y-fARK
"Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596
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Key:
-W- Water
-G- Gas
-SS- Sewer
-& Water hydrant
0 Water valve
Washington Natural Gas Company
1122 75th Street S.W., Evere'tt, WashingtonNA203, (206) 355-3331
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Addendum to:
R
igbt Of way
Permit Application
Submitted.by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
ST- Is N&/ 1356-7500 X7596
fit.-
Key:
-V- Water
-G- Gas
-SS- Sewer
-& Water hydrant
0 Water valve
Washington Natural Gas Company
(206) 355-3331
1122 75(h Street SX. Evere"tt, Washington"99203,
I
i"N 0 T I C E:
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Nowar-ranty--OT
The information on the attached
map(s) was compiled for use by the City Of
Edmonds/ its Empl-oyees and Consultants.
Th,..e City of EcIrn.onds does. not. warrant the
accuracy of anything set for.th on these
Map(s�. An . y person or entity -requesting a
copy should c:onduct an independent
inquiry regarding th*e inform-ation shown or
-.--t-Fe -map(S)i including, but not limited to,
-er stub shown. Suc
the lotation of any sew
sewer stubs may or may- not e.xist and may
or may not exist at the location shown
Neither the City of Edmonds nor its
=mpj*0*yee,s o,r office-rs -sh-a-1-1 be 11a-b-'Fe for the
information given on this map(5), nor for
ovided based
any one representa I tion pr
upon said map(s).
The City of Edmon V'REU NEW
OWNER Aj� ,c ............. ............
ADDRESS --- 1.t�
APPLICATION
for
SIDE SEWER PERMT
STRUCMON 0 REPAIRS 0
CONTRACTOR --- z /
EUMEMAENT No . ................
PERMT No.
LEGAL DESCPJPTION: LOT No . ......
................ BLOCK No . ............................................
NA3m OF ADDmoN .....
....... e ... f ffz..k .........
"2 C�-5- 7-1 � /YCT3
ApProved:
DATE .........
.... ... By
CITY OF EDMONDS
C1VJ1C CENTER—WATER-sEWER DEPARTMENT
SIDE SEWER PERMIT
Cajl PRospect 6-1107 when work
Is r"dy for Inspection. (No Inspec-
"O",S Saturday, Sunday or holIdays.) NO 2681
ADDRESS ....... 1�?IT .. ..... 9.2n.d. Avenue West
.....................
OWNER........... A .......................
tt ....................... I .......... CONTRACTOR ..... QAjt� p:�i
Permission is granted ......
...... 0�4;w4rY ........... 16 .... 19. t. ............
"'it]' CitY Sewers in accordance wi -�8 for ........................ days to REPAIR or CONNECT a side Sewer
th aPPfication "I file and governing ordinances.
ATTENTION is CALLED TO THE POLLOWING:
NOTE No. I—Tbe 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—Obtaln 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
No bends In grade sharper than % will be Permitted. Property line and 12 Inches Inside Property line; minimum grade of 2%.
NOTE NO. 4—Trenchesuintstreet must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure d e 0 Improper work which may develop within one Year Of Completion.
NOTE No. ti—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.