19111 92ND AVE W.PDF1)
111111111 1111111111 111111 .
8874
19111 92ND AVE W
I I he City of Edmonds
OWNER ...... ....... .....................
ADDRESS ........ ...................................... ....................
5THEff RLE APPLICATION
for 21.
SIDE SEWER, PERMIT I ..
EASEMENT No - ------------------------------------------
NEW CONSTRUCTION Cj REPAIRS 0
CONTRACTOR -----------
................. .................................................................. PERMIT No.
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . .....................
NAME OF ADDITION .......................................
..........................................................
Approved:
DATE .... BY ------- ................................................
.......................................
CITY OF EDMONDS
Call PROSPeCt - '6-1107 when work
C]rVIC CENTER — WATER -SEWER DEPARTMENT Is ready for Inspection. (No inspec-
SIDESEWER PERMIT tions Saturday, Sunday or holidnys.) N -0 2895
ADDRESS ..................... 19111 92nd Ave. W.
.................... I ........................................................................................................ I ................................... ...............
OWNER ........................ P!?49� ... M4;jjg�y ................................ CONTRACTOR ..... 5A!f
Permission is granted ...... APril ... lks ............... 19.5.�_ for ........................ days to REPAIR or CONNECT a side sewer
ith City Sewers in accordance with application on file and governing ordinances.
wl
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a per It to c . onstruct sewer Inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street amrea. 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 .
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 whJch may develop within one year of completion.
NOTE 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-
ten&nces except to Insert the pipe into the wye.
according, -to -the. plat
That i.ty—riine -(2 IWMON'D,9 SEA V�L,'W�. TRACT:3
A
thereof I-ecordc-.)d :bi Voluillo, 3 0-f Plats on page 76, ra q co`lrds of omi-ty, Washington,
described as kollows; Beginnil'i.-g at the Northwest corner of said Trzact 29- -thence South
j 4) 89*4971311 Bast along, the North line of said Tract 29, a distance o*'f 123.25 feet to the.'
true point of begixming; thence South for 110 feet 'to intersect a lil-ie that is parallel
with and 110 feet South'of the North line of said tract; . then6e Soiith- 89*49113"' East para*llc-
to -the North line of said Lot 29 for 123-40 feet, more or less to -the West line of the
East 250 feet'of said Lot 29; thence North parallel 'to -the East lirie of said Tract 29
for 110 fact to -the North line of said lot; 'thence North 891h.qtlyl West to -bile point
beginning, TOG-rET111M Vd-ITH an easenlent for ingress and egrieus over the North 20 feet of the
"following (leocril)o(i trltct�. Beginning at the Northwest corner of na.id, 'J.'riact 29; thence
9
South 89,49111311 ...Ni'It ".0-ong NortAl liae of rittid 'tract for 123.25 ft;,lo-t.; fhencQ 3outh 1.10 foot
to intor.6ect a J., a is pt.-Lrallel with and 110 feet South of Wie North line of said'
Tract- -thence N(
co N( 't, 1 89'49".1311 Weat along said parallel line 123.22 feet -to -the West line
of said 'Tract; t i ce North 0*191 711 East 110 feo.. to -the true point of beginning; situate
in the.County of Sr Ho r ��?ee, 'Of -Washington- PP
n
3i �31 P
SUL ---------
:VECT TO.-
OFFIG
City of Edmonds Permit No: 99-.Zl 1
RIGHT-OF-WAY CONSTRUCTION PERMIT IssueDate:
'A.' Address or Vicinity of Construction: 19111 92 AVE W 1107007"S
'B-. Type of Work (be specific): PERMIT REDUMT TO INSTALL A 111/41' PL&%= PIPE— GAS NUN IN
92 AVE W. TIE UM EXISTING MAIN AT 1XV c/1 OF 92 AVE W.. EXTEW MAIN 2951E TO SERVE
TARGET,._ ,#UO 007045
fA,
ENEFM Contact: DOUG USITAL0
C. ontractor: ffJM SOUND
PI
dress: 1122...75th ST SW Phone: (425) 356-7520
State License #: 1I (1� Liability Insurance:— Bon&, $ Il �!31—
D. Building Permit # (if applicable): Side Sewer Permit # (if applicabl
E. F� Commercial E] Subdivision E] City Project [—] EUC (PUD, GTE, P�SE, CHAMBERS, OVWD)
Multi -Family Single Family. F� Other"
INSPECTOR- LJ
F.,. -PAVEMENT: YES F� NO G. SIZE OF CUT 2 4 H. Charge:
CONCRETE CUT: YES F� NO
APPLICANT TO READ AND SIGN
IDEMNITY. Appl icant 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 rqason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORK111ANSHIP 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 PA TCH IS
COMPLETED BY CITYFORCES, AT WHICH TIOEA DEBITOR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEA PPLICANT.
Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer, Every
flagger must - be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end of the workday — NO EXCEPTIONS.
Three sets of construction drawings of proposed work are required with the permit application.
IRA-VE READ�iHE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature: FEL14A H LOPEZ- F=M Date: 8/1141999
(Contractor or Agent)
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
R CIT)
Approved..'NyY V
T m V id, A*i-!!jg12f *1 o I I
ii e Authbiized.'j.:,V
.Specllial,Qonditibns�.:
JSE ONLY
Right-of-way Fee:
Disruption Fee/Fund Ill:
Restoration Fee:
Total Fee: 60
.,Receipt No:
Issue&by:
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMITTED WORK:
INSPECTOR,S SIGNATURE DATE:
For inspection requirements see Engineering Information Handout.
.L �'j
SCALE: 1"- 50'
N
C;
co
r4
C�?
a
1916T
ram
5/ 6' 1 16' 6
0
1993
PK I VATf, 1PK I Vf� (20')
I N 125' 6) 13'W Ct,
(2 X 1-1/4" TAP TEE)
5/6* 166' N
1966
Cil
I
192NO 6-r. 6-W.
0
P0 IF" MAIN-t
125' 6 1�
6NO MAI N t 125' 6) t 262' 6 ry,
19109
NOTES
-5555
h CALL 2 DAYS BEFORE YOU DIG 1-800-424
1
CITY OF EDMONDS:
Maintain a minimum of 5'ho,rizontal
and 3' vertical clearance from all
city utilities and appurtenances.
Cuts in paving are shown as —
1 cuts in paving anticipated.
Notify Engineering Division 24 hrs
prior to construction - 425-771-0220
PROJECT MANAGER: DOUG USITALO - 425-356-7520
PREL11MINARY ONLY
Not for Construction
'GAS MAIN INSTALLATIONRETIREMENT
-- I I—S
R
E
T E-N G-T-
T'P
MANUF—ACTURER
1
2
MPE
1i
295
MP
MPE
CALL 1-800-424-5555
2 BUSINESS DAYS BEFORE YOU DIG
--n. nr rArii ITIFe
5
REAL ESTATE/EASEMENT
PERMIT
EDMONDS
4
3
FUNCTION
NAME
PHONE
NO
DATE
2
PROJECT MGR:
USITALO
74725356-752C
8/
61TO
I
-ENGINEER:
REV*t
DATE
BY
DESCRIPTION
DRAWN BY:
COUNTY
MER SEC
I
Work Center
NSNHG
CHECKED BY:
APPROVED BY:
114 SEC
SW— 18-27-04
OP MAP
160.68
PLAT MAP
161.68
U-MAP*t (POWER)
CIR MAP#
CIRCUIT$1
,MAPPING:
JOINT FACILITIES ARRANGEMENTS
PHONE#
*1-1/4" PE IP MAIN EXTENSION
PIUC,ET To SERVE:
52—UND
FNF.RM 1911.1.,t W
9109 92ND AVE
INCIDENT.
DRAWINGI*
10700704�7'07007045
SUPERIOR IRDERU
�%CAtr! 1 " - 50' 11 / 1