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19006 80TH AVE W
C I T Y 0 F * E D Mill 1 -0, Na-WIS
FILE
PUBLIC WORKS D15P PRFTIM- I N T
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SUSPENSE DATE:
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Investigate
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letter/memo
for my signature
For Information
Previously R-ef'd
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Return to:
OFFICE ADMINISTRATOR
BUILDINGS & GROUNDS DIV. SUPERVISOR
EQUIPMENT RENTAL DIV. SUPERVISOR
STREET DIVISION SUPERVISOR
WATER/SEWER DIVISION SUPERVISOR
TREATMENT PLANT DIV. SUPERVISOR
COMMENTS:
FROM:
DATE:
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CITY OF EDMONDS Permit No. A - -N In
PUBLIC WORKS DEPARTMENT 2 rp=. Issue Date
RIQT1HT - OF - WAY CONSTRUCTION.PERMIT
Dir. 0
A. *Address or vicinity of Construction 0 Permit Issu . ed To: OA)6
19006 80 AV W Plat 161-069,11 �
e Owner: Washington Natural Gas Co
Name
805 156 AV NE
Mailing Address
Bellevue, Wa 98007
City, S ta te, Zip Code
0 Contractor: Same As Above
Name
9 Type of Work to be Done:
Install New Service
0 Work in Connection With -
El Sub or Plat [��- ringle Family
El Comml. / Ind. 0 Apt. Condo.
0 Pavement Cut: 0 Yes El No
Mailing Address State License Number
City, State, Zip Code Telephone Number
* * 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.
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.
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. pern,4,," Vst e availmbft-la—t—ttie job4oe
I Jor inspection purposes at all times.
Signature:— Pjoi� 14440�� Date Nov 22, 1982
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: Vold after %310 days
Special Conditions:
Ammendments:
Permit Fee: -4,30-o
Security Deposit:
Receipt No.:
Fund 111 Fee:
Street Cut Dimensions
- - - X
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
Eng. Div. December 1978
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CI'IY,OF EDMONDS
PUBL
,)�C-WORKS DEPARTMENT
RIGHT - OF - WAY CONSTRUCTION PERATRET F11.
A. *Address or vicinity of Construction
V80 0 6 80 AV W Plat 161-069.1.1
0 Owner: Washington Natural Gas Co
Name
805 156 AV NE
Mailing Address
Bellevue, Wa 98007
City, S ta te, Zip Code
Contractor: Sarnwz Aq. Above
Name
Mailing Address
Permit No.
Issue Date
0 Permit Issued To: 1; 120,11,
e Type of Work to be Done:
Install New Service
e Work in Connection With:
1-1 Sub or Plat 0,15i�ngle Family
El Comml. / Ind. 0 Apt. Condo.
e Pavement Cut: 11 Yes El No
iate� L'i'cens e'&�mb�i
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t� City, State, Zip Code Telephone Number
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0. NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
B. APPLICANT TO READ AND SIGN
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fZ INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
t� 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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V4 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 2�0.
I understand that this permit must be
Signature:
ble at the job site for inspection purposes at all times.
*.,THIS PERMIT MUST A POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authorized: Void after k" n days
Special Conditions:
Ammendments:
Permit Fee: -4 n (n
Security Deposit:
Receipt No.:
Fund I I I Fee:
Street Cut Dimensions
X
NO WORK TO BEGIN PRIOR. -10..' PERMIT ISSUANCE
Eng. Div. December 1978
FIELD INSPECTION NOTES (Fund 111 - Route conv to Street Dept.
Comments:
Diagram:
Contractor called for inspection Yes NO
work Disa.r.3proved By: By: Date:
Work Approved BY: Date: '7-
Inspector:
Ena. Div. December 1978
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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 offiCer's -shall be liable for +Lhe
i nformation given on this map(s), nor for
any one representation provided based
upon said map(s).
APPLICATION UNly PLAtir-
for
The City of Edmonds S11DE SEWER PERN"
mot ——REPAIR8 0 EASEMENT No - ------------------------------------------
CONSTRUCTION 0
4
OWNER ... ------- .4--s . ...............
ADDRESS ZVFAVA� ------------------ ------------------------- .. .......
APF
MAY I u 1,4
CONTRACTOR......................... ..................................................... .................. PERNaT N=
LEGAL DESCRIPTION: LOT No . ...... / --------------------------------- 13LOCK No . ....... 4�� .............................
0111L -
NAME OF ADDMON .... .... ... ....................................
8
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Approved:
DATE .... 33Y
CITY- OF EbMONbS
CIVIC;,_CENTER — WATER -SEWER DEPARTMENT
SIDE -SEWER PERMIT
Cail P Rospect—��6:1i6L,` Nih
wer
Is ready f6r,inspeetion. ',(No IrIsPec`7
tions Satuid�;Y,-Sttndiiy"6r,liolidays.)
ADDREQQ ------- 19.006 ----- ---- 8.0-t.h .... Avenue ... W.e.s.t ............................................................................................................... ....................
.... .. .... ...............
G.D. Jackson Edinonds Underjzr6und
.............. CONTRACTOR ......... ................................ ....................................
OWNER ................................... ............................................
Perinission is grante I d ................. .... M �Ly ......... 10 jq..�8 ......... : ........ days to REPAIR or CONNECT a side sewer
.... ... I for ......
with City Sewers in accordance with application on file and governing ordinahces�
ATTEN TION -IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer Inside -property line. A .1tcensed,.Side, Sewer Contractor must
'be employed to construct side sewer in street axea. Do not cover any portion of sewer before it has been Inipected.
NOTE No. 2—Obtain full information regarding Ordinance 1IJ6.030 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 shaxper 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.
NL_,�No. 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-
tenances except to Insert the pipe Into the wye.