18816 80TH AVE W.PDF111111111111
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18816 80TH AVE W
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number- ?3
I Issue Date:
A. Address or Viciiiity of Construction: 18816 80 Av W 4(9402227)
STREET FILE
--nomm— C) C3 B. Type of Work (be specific): Install New Service
9 0
C. Contractor: Washington Natural Gas Comppny Contact: Frank Swan
Mailing Address: 815 Mercer Sti;eBeattle, WA Phone: 224-2278
State License #: Liability Insurance: _ Bond: $
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. [] Commercial 0 Subdivision F1 City Project E) Utility (PUD, GTE, WNG, CABLE, WATER)
F] Multi -Family 0 Single Family F] Other
INSPECTOR: INSPECTOR: —V4-Li-Lk
F. Pavement or Concrete Cut: Yes []No G. Size of Cut: 1 (2 x 4) H. Chargq�_$
@ Water in W*a
APPLICANT TO READ ANI S '- N
INDEMNITY. Applicant understands and by his signature to this application, agrees to ho d t e City of Edmonds harmJ4",Qn-,%i . 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 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-FEF-S.,WILL BE HELD UNTIL THEPNAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A 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.
Traffic Control and Public Safety shall be in accordance with City'r'egufations as required by the 6ity' Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the.end of the working day;
NO EXCEPTIONS.
Ihaue read the aboue statements andu nderstand.thepermit requirements and thepink copyof thepermit willbe
auailable on si>ea-1--&it times o inspection purposes.
"ka Date: November 15, 1993
Signature:0:74=:21
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS DISRUPTION FEE/FUND 11 1:
SPECIAL CONDITIONS: RESTORATION FEE:
PERMIT, FEE:
TOTAL FEE:
COMMENTS: RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK.-�. 'SHALL BEGIN PRIOR TO PERMIT IAUANCE
Engrg. I)iv. 1991
FIELD INSPECTION NOTES (Fund 111 Route copy to Street Dept.)
Comments:
I Diagram,:
CONTRACTOR CALLED FOR INSPECTION El YES E] NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
ASS-
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Uddendum, to City of Edmonds
Right of Way
Permit Application
Submitted by: Guyla Connors
Engineering Aide
Washington Natural Gas
1-5248
JC6*-(��4COZZ7 00
I to
�101
WNG to wi ndow
'Water imain depth
anwn, -E!)C-=-) I I clle�
2- 11 gas main._
F > L
Key:
-w- water
-g- gas -
-ss- sewer
-e- water hydrant
C) water valve
815 M=cr St. (P.O. BOX 1969). Sc4ttle, WA 98111 (206) 622-6767
Seat STATEMENT
622-2500
Renton
255-0404
Bellevue KENNELL'S ROTO-ROOTER
454-6655 3534 BAGLEY AVE, NO. - SEATTLE, WASHINGTON 98103
Everett
353-9124
P, 7 1972
H.H. Homes
P.O. Box 644
Lynnwood , Washington 98036
36735
. . . . . . . . . . .. . . . DETACH AND RETURN TOP HALF WITH PAYMENT
PLEASE DISREGARD STATEMENT IF PAYMENT HAS BEEN MAILED.
DATE INVOICE # AMOUNTIDUE
11-4-72 36735 $20.21
Job Location: David Ross
18816 8oth West
FOR INFORMATION REGARDING YOURS I LLING —CALL ME 3.5506
/'-7.9W9 AND DRAIN CLEANING S'Ell�� 6 7 3 5
rV
e MAin 2-2500 SEATTLE,� HlNu.ON 98103
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L ADDRESS ZT
T CITY
ZIRCODE
0 7L"��.
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0 ADDRESS-u&�--'/x
-77
A PHONE- -
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PU RCHASE ORDER NO._
CUSTOME R SE R V I CES
OTHER
STATE SALES TAX
CASH:
CHECK:
OTHER
CONTACT
TOTAL
OPE
AMOUNT
I
Z22j:
mIll
THE SERVICE IS ACCEPTABLE, AND WILL BE PAID IN FULL AS SPECIFIED ABOVE. I I F NOT
THE PURCHASER AGREES TO PAY ALL COSTS INCURRED TO FACILITATE COLLECTION,
PLEASE PAY ON THIS INVOICE
CUSTOMER'S SIGNATURE
CUSTOMPR'� (-r�Pvl
e%A
-STREETFILE" 4P C E
D E [J" 1 1972
CLAIM FOR DAMAGES
CITY OF EDm6NDS
NOTICE
C1rV CLERK
Claim MUST be presented to the City Counci-1 and filed with the City Clerk within 120 days
from the date of Accident or Accrual of Damages.
TO THE CITY COU14CIL OF THE CITY OF EMIXAO
PLEASE.TAKE NOTICE, THAT
(if married, give husband's name)
WHO NMI RESI DES AT �IE
(State present actual address by street, number and city)
AND WHO iFOR SIX MONTHS PRIOR TO DATE OF ACCIDDIT HAS RESIDED AT 1--il 4!F
(Give residence by street, number and city)
CLAIMS DAMAGE S OF AND FROM THE CITY OF EID14ONDS IN THE SUM OF $
arising out of thefollowing circumstances:
Describe Claim, giving al"
DATE and TI14E injury or
damage occurred, PLACE 7?-_e,� 6-7-PZ /A/
and full particulars.
Accurately locate and �P72_ 1-1,4-z9 �'Zz:,W,65C.
describe defects caus-
ing injury or damage �O"46 6V ".9-6y,�c -5- ef: 0," M
and all acts of negli-
gence claimed. 6,1x)o 7�q6 77"T --36=
-9-( 7�
a�14 7
'15
Accurately describe
injuries or damage
State items of damage
J
claimed. Itemize all R/& C_
expenses and losses.
(Claim must be sworn to by claimant)
tdre of 'Claimant)
Q�9�
�ST7 CCRI:- A 1 ID S.ORN TO
b -fore n
c ie this day of
Not,-.�ry Public in an S-,;" te of
d lor Ane a
'Jashington, residinG
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/1-2 t"Ol
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APPLICATION -- D—L I -N-1
LYNN"'VV0
for j
The City of Edmonds SIDE SEVVER PERMT EASEMENT No - ------------------------------------------
NEW CONSTRUCTION REPAIRS 0 att
kk�
ACTOR ... ....... . ?�A� . ...... -------
OWNER ------------ ......................... .................... CONTR PERMIT No7-�//A
T I'\ U) ..... 7-
ADDRESS ../lY..L6 ............. ................................. ................ LEGAL DESCRIPTION: LOT No . ........................ Z ................. BLOCK No.. ........ ...... .........
-c-,irmw ... %dwee Al
NAME OF ADDITION ....................... ......... 7 Zfe-T-S ........................
c
a
0
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
employees or officers Shdall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS SIDE SEWER PERMIT
WATER -SEWER DEPARTMENT
PERMIT
Call 7.76-1107 for side sewer inspections BEFORE covering any portion of the construction.
Inspection will be provided within 24 hours after request. NO Sat., Sun., or holiday inspections.)
ADDRESS LOCATION OF CONSTRUCTION
PROPERTY LEGAL DESCRIPTION ............................. ...............................................
..........................................................................................................
....................... ........................... . ................................................................................................................ . ......................................................................................
................................................................ 0'*v*WERAL1'4`D/OR BUILDER
CONTRACTOR'S NAME & ADDRESS ----------------------- .................................................................. - ---------------------------------------
,\,-Permission is granted ........... ................................. . ......... 19 ......... for repair and/or connection. of a side sewer to the city sanitary sewer
itern in accordance with City of Edmonds ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
__1TE 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.
,__jTE No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office.
NOTE No. 3—Obtain full information regaxding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 4—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 'A will be permitted.
NOTE No. 5--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. 6--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 appurtenances except to in-
sert the pipe into the wye.
DISAPPROVED E] Date ... . ................................... By --------- ...... D
1W ----_---- ]pate . ............ . ................... 'BY ----------------
--------- ------------
APPROVED B'y::-:-::;
e*11D
---- -------------------------
Remarks: ........................................... . ..................................
........................................................................ ...............................................................
..................................................................... . .......................................... ...........................................................................................................................................
BOTH Permit Copies MUST Be Signed By Owner of Firm PerforTning Construction PRIOR To Request For Inspection
. . ...... hereby certify that fhe side sewer installation constructed under this permit
(Owner of Contracting Firm Performing Constructi
was installed in accordance with all governing ordinances of the City of Edmonds.
Datedthis ............................ day of ................................................................. 19_ .......
V Check BEFORE you dig for: Water E], Gas E],
Telephone 0, Power 0, Sewer 0, Other 0 -V V