18928 84TH AVE W.PDF111111111111
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18928 84TH AVE W
CITY OF EDMONDS
PUBLIC WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTIOMIKET - FILE
A. *Address or vicinity of Construction
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0 Owner:----[-.!
ame
Mailing Address
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City, S ta te, Zip Code
e Contractor:
Name
Permit No.
Issue Date
0 Permit Issued To:
• Type of Work to be Done:
Ingtall. Soxvice
• Work in Connection With:
El Sub or Plat E!�'Slngle Family
0 Comml. Ind. El Apt. Condo.
• Pavement Cut: El Yes El No
Mailing Address State License Number
City, State, Zip Code Telephone Number
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NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any 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 it's 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.
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W4 Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
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Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this permi
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job sfj§�Jpr inspection purposes at all times.
Signature:— # ' I f' '- ' ' 0,
—Date " De C 3 , 1.9
Owner or Agent
THIS PERMIT MUST BE�, POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Vdld after days
Special Conditions:
Ammendments:
Permit Fee:
Security Deposit:
Receipt No.:
Fund Ill Fee:
Street Cut Dimensions
X —
NO WORK, TO BEGIN PRIQR TO PERMIT ISSUANCE
Eng. Div. December 1978
FIELD INSPECTION NOTES (Fund 111 - Route cony to Street Dept.
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Diagram:
Contractor called for inspection Yes No
work Disapproved By: Date: Bv: Date:
Work Approved Bv: Date:
Inspector:
Enct. Div. December 1978
APPLICATION
for
The City of Edmonds SEDE SEWER PERMIT
STMW NEW CONSTRUCTION REPAIRS n
; . .................................... -------------
OWNER ..........
ADDRESS........ ............ ...................................
LZ
F]
A�t
EASEMENT No . ............... ..........................
CONTRACTOR.: ........... .......... ......... I .......................... PERMIT No.
LEGAL DESCRIPTION: LOT No . ............................................. BLOCK No . ...................
.......................
NAMEOF ADDITION ...... . ..... . . ...........................................................................
Approved:
DATE L .. .... ............
.. . .............. ........ .................
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NOTICE:
Ko warranty OT aU(,U1`d`-:Y.--
The information . shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
Th.e City of Edmonds does not - warrant the
accuracy of anything set for.th on these
map(§-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform-ation shown on
I ed to
tHe -m a p (s) , Including, but not Hmit
er stub shown. Such
the lociation of any sew
sewer stubs may or may- not exist and may
or may not exist at the location shown.
Neitheir the City of Edmo'nds nor its
ernpto-yee-s o-r office-rs -sh-a-'I'l be Viab'Fe for -the
information given on this Map(s), nor for
tation provided based
any one represen
upon . said map(s).
CITY OF EDMONDS Caj, pRospect 6-1107 when work
R DEPARTMENT is ready for Inspection' (No inspec' NO: 2350
CIVI[C CENTER — WATER-SEWE tion, raturday, Sunday or holids".)
SIDE ."' SEWER PERMIT
................................... ------------
. .......................... ...................................................................
ADDRESS --------- ...............
likej , - �4 �- 4 /-1 � .. CONTRACTOR -------
ONVNER.................. -- ------- --- ----------
....... jq.(�Z, for --------------- I ........ day, to REPAIR or CONNECT a side sewer
Permission is granted .....
------------- I... governing ordinances.
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" ance with application on file and
with CitY Sewers In accl ce 'I,
ATTENTION IS CALLED TO THE FOLLOWING: truct sewer inside Property line A licensed Side sewer - contractor must
NOTE No. 1--The owners of the property may Obtain a. permit to cons cover any rtion of sewer beiore it has been inspected
be employed to construct side sewer in street area. Do not PO governing side sewers when You get permit.
NoIrE No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations f 2%.
must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade o
No. 3—Top of side sewer than % will be permitted.
No bends In grade sharper of street restored to Original condition. Contractors shall be responsible for
NOTE No. 4--Trenches In street must be water settled and surface pletion.
a failure due to improper work which may develop within one year Of corn in sewer or its aPPur-
NOTE No. 5--It is unlawful to alter or do any other work than is Provided for in the permit, or to do sny work on the ma
tenances except to insert the pipe into the wYe-