19204 80TH PL W.PDF111111111111
7263
19204 80TH PL W
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 �Eclmoncls 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
-fh-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
emp-l-o-yees o-r officer,-) Sh-all be liabl-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
�i. ��
APPLICATION
4p% for
The City of Ediii6nds", 'L ET F & n r?- SIDE SEWER PERMIT
Om" u E XMI - T� EASEMENT No . ..........................................
RFW CONSTRUCTION REPAIRS I- UAL
-7
OWNER ................ ......... /f
ADDRESS
-Y ----------------- .......... 61 .... ......
CONTRACTOR ...... G..:!....
................. PERMIT N/o'
LEGAL DESCRIPTION: LOT No.,?t ... 1.a ........................... BLOCK No . .....
NAME OF ADDITION
........... ...........
IV
.... . ...... - ........... ......
Approved:
DATE ... -7 ....... BY ........... ...................
Y........ .... ... ...... . . ....................................
'CITY1. - VEDMOND I S'
0
cillvi& lbk]6�
WATER�S EW"ER bjEJ�ART.MEr_ !Pal' PR-PeCt 64107 whim w6A
6:,`re"�. f4; Lspectlon., -
No, I
% 'I
0'
490:3
1. 2o4 8o' Pld
ADDRESS .......... __9 th. C
.. .............. r.
.................................................
------------- ------- .......... ......................... .....................................
R.. W. R4Y
OWNER' --------- ...................................... I_ C E U Constr.
.......... ........................... -AACTOR ------------------
CONT.
Apr.
Pernussion is
days, to REPAM or CONNECT a side sewer
g '7 . ............ 1 ---------------- --- ........... 19 .......
wl h City Sewers in accordance with rning ordinances.
4P cation on file and. Ve
go,,
ATTENTib�i IS CALLED TO THE. MLLOWiN-6:
NOTE No,.'- .1�=. The, owners of the, Property rn�y.obtalu a permit to I construct sewer Inside property line. A licens d Side Sewer Contractor must
-be employed to construct side sewe I rLin s , treet area. Do'not cover.,iny Portion of sewer before it has been inspected.
NOTE tain 'full information regarding Ordinaric
e.11.16.GW and;: Regulations go
verning side sewers when you get permit.
NOTE No�'.3,—Top of side sewer must have at least'�30 inches overage at . property line and 12 in hes inside Property line; I minimum grade of 2% -
No ben6 in'grade sharper than % will :be permcitted.
?' No;t 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 ofi6. year of completion.
N(Yl:']`� No- ---it is �Wa-ful to alter, or do any other work than is I p . ro . ide : for in the p . ermit, or to do any work on the main sewer or Its ap-
Purtenances except,to insert the pipe into the wy Y d
e.
perrn!t appiicanon.
determine whether any. potential Critical . Areas -are, or.
may be, present on the subjectproperty. The i4bimiiion Please submit, a.,viqpty map, -_along with z thi signed copy
needed to complete the Checklist should be easily of this form to assist CiiY Staff in *findinganO jli��ating the
available from: observations of the site - oi data availdble! it specific � piece - of - property' describ�a on this; A form. In
City Hall (Critical areas inventories, mapsi or ,soiV7: addition,. the):applicant tshall include other pertinent
surveys). information (e.g. site plan, topography map, etc.) or
-ddi6s'ih conjunction witli this Checklist to assistant staff
ist I t
'ifi � completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its -heirs, and assigns -in-consideration on the processing of the
applicanon agrees
to release, indemnify, defend and hold-the'Cit
_,y of. Edmondsl,harmlegs: from any:and all damages, includih -reasonable
I _ , g
attorney's fees, arising from any action or infraction, based in whole or part upon, false, misleading. inaccurate - or
incomplete information furnished by the applidant,� his/hL+/its- agent or employees.
By my signature, I certify that the information and 6 xhibits -herewith submitted are true'a[nd corred to 'the Wst of my
knowledge and that I am authorized to file this -application.oethe b.ehalf of the owner as listed below.
SIGNATURE OF APPLIcANT/AGENT DATE
Property Owner"s Authorization
By my signature, I certify that I have authorized the above Applidant/Agent to apply for the �ubjecfland:uie, application,
and grant my permission for the public officials and the. staff of the City of E4.inYnds to entef the subject-roro for the
purposes of inspection an4osting atten*t tcQhis application.
Owner/Applicant:
Name
.1-92z) /,5�, A),
Street Address
city State zip
Telephone: 6 70 -,76 Z0
Email address!'(optional) . 't,6-rA
�Lo�_& Ve'-Z I ZVO, tier
Critical Areas Checklist.doe/3.19.2001
Narne
Street Addregs
State zip
Telephone:
Email Addrespl9pocipal):
/nc. . 1 1 sc)�)
..City of Edmonds
1_4
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number.
Lssue Date: - 09-- Z28
A. Address oi Vicinity' of Construction: 19204 80 P1 W (9805837)
B. Typeof Work (bespecific): Permission to install 451 of 2" NPE
Gas Main in 80 P1
C. Contractor: - 211get Sound Energy Contact: I)nllg lIgits,10
Mailing Address: 1199 7s qt qw Phone: (425) 356-7520
State License #: 982 3-,-'
Q., Liability ln�mrance: Bond: $
D. Building Permit#(if applicable)�',,.�."e;�'rl.'.,,,.-:�.,'i-�'4�' Side Sewer'Permit # (if applicable):
E. n Commercial 'S6d&i�ion.;,-�" El City Project ji U (PUD, GTE, WNG, CABLE, WATER)
n Multi -Family E] SinO y
Pe Famil El Other
INSPECTOR:
INSPECTOR:
re& f I -T
F. Pavement or Concrete Cut Yes @No ' G. Size of Cut- H. Charg.-
APPLICANT TO READ ANIV�IGN
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessftom injuries, damages, or claims ofany
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 of any legal proceedings including defense costs and attorneyfees by reason of granting this permit.
THE CONTRA CTOR IS RESPVNSIBLE. FORX!?RKM� NSHIP A ND MA TERIA LS FOR A PER IOD OF ONE YEA R FOLL 0 WING THE FINA L INSPEC-
TION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings 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.in'spected 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 regulations as required by the City Engineer.
All street cuttrench work shall be patched with asphalt or City . approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements 'and the 12.,ink copy 6f the permit will be
available on'site at all tipes for inspection purposes.
Siknature: /�Jzv7��/ Date:
"7 (Cbntra�7or_o_r Aj(_nt)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: UJ RIGHT OF WAY FEE:
TIME AUTHORIZED: VOI`D AFTER I DAYS DISRUMON FEUFUND I 11:
SPECIAL CONDITIONS: N x RESTORATION FEE:
T OTALFEE:
RECEIPT NO
9
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
FIELD INSPECTION. NOTES -(Fund 1 il - Route copy to -Street Dept.)
Comments:
CONTRACTOR CALLED FOR INSPECTION El YES, E1 NO
"Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
�/ v -7 1 - /-,
4--- d'- V41 /- v — , — r v �
R2
-1--A/07-,,C-L-
,z
NO.
DESCRIPTION
DATE
BY -
AP`PP0
REMISIONS
A3 BUILT INFORNIATION
FITTER OR CONTRACTOR:
COORDINATOR:
F
TE co#APLETEo.
PERCENT COMPLETE�_
I
TE3T
INSTALLATION / RETIREMENT
3UMMA"
E
cwTEsr
PRLWURE
L
ow.
TWE Ow.
D
cATE OFF:
TIME OFF:
TYPE OF PtPE-
PIPE MANUFACTURER.
IMTWGY-
PUGET
D
ENERGY
OP MAP- lk5��iO
PLAT MAP.
L14SEC:
WORKAREX-
PROPOSED
MAIN
FOOTAGE
EMERGENCY SEC. No.:
W&I Sms
MATVFAAL
TOTAL FOOTAIN
DESIGN PRESSURE. PSG
D
3YSTEM MAOP, pm
F psim
E
PERMITS:
s
I
G
IP IWA IIVig'X 7',EWSION
/47.zolv so ALI. w
RAVM
I
Joe fw
CKED:
1
fli'l
DS
DRAWING NO.
c780-5 7 F
PROVED-