19308 76TH AVE W.PDFiiiiiiiiiiii
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19308 76TH AVE W
CITY of EDMONDS S I D E SEW ER PERAIA7,)
For Inspection Call 771-3202
Address of Construction:
Property Legal Description (Include all easements):
Owner and/or Builder: -3 " ��_U<z CA
Contractor & License No: 1zV_'5,5F-
Singl:e Family Residence
Multi -Family
Commercial
0
(No. of Units
(No. of fixture Units
PERMIT N.6.. 079 15
r FI.LE
FYNNWOO
L
Invasion into City Right -of -Way: No X Yes (If Yes, Right -of -Way*
Construction Permit 'required. Call One -Call -Center (1-800-424-5555) before any
excavation.)
Cross other Private Property: No Yes 2C (If Yes, easement required,
attach legal description and county easement number.) zh�980601603ZI,5_
PLEASE READ THE ITEMS LISTED ON THE BACK
RECEVvED /0 — a - gl�
I'certify that , have read and shall comply -OCT 18 e
with the items. isted'on the back.
PUBLIC WOMS
Permit Fee;
32.0 o 0
k
Jssued By -
Trunk Charge:
7_57�0 0-
bate Issued:
Assessment Fee:
6-31.0D
Receipt No.:
Partial Inspection:
Comments
Date Initial
Final Inspection
Approved:
Date Initial
00
-
Rejected:
C)
Reason
—Na"te Initial
PERMIT
MUST BE POSTED ON JOB SITE
W
Wh.ite Copy File
Green Copy -'Inspector
Buff Copy Applicant
V �
The City of Edmonds Side Sewer Drawing EASEMENT NO - --------------------------------------------
NEW CONSTRUCTION e
OWNER S,
- ----- ---------------------- I --------------------------------------------------
JOB ADDRESS --- ------- -.7-t4P " 0
Aqp. --W ............
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3
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REPAIRS [:] LID NO . .................. . ASMT. NO - ------------------
CONTRACTOR -,S � ----------------------------------------------------------------- PERMIT NO.
LEGAL DESCRIPTION: LOT NO - -------------------------------------- BLOCK NO - --------------------------------
PNAME OF ADDITION -----------------------------------------------------------------------------------------------------------------------
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32
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LYNNWOOD -k
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Approved:
............................. ------------- ..........
PWW-0001-11/75 (REV.11/78) DATEI ......... 0164�
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
9 0 9
PERM-Ff 0/-/- �3 99
Issue Date:
A. Address or Vicinity of Constructiow. 19308 :76th Av W #9503237
B. Type of Work (be specific): Install New Service
C. Contractor: Rashington Natural Gas Co.
Mailing Address: 815 Mercer §t. 4Sfjjle, WA
State License #:
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable)-'
E. F1 Commercial E] Subdivision F-1 City Project [?9 Utility (PUD, GTE, WNG, CABLE;,'WATER)
F] Multi-Farnily Rg Single Family [J Other
INSPECTOR: I INSPECTOR: UIA � C',
F. Pavement or Concrete Cut: Q Yes 0No G. Size of Cut: H. Chargq�_$
APPLICANT TO READ AN IGN
r
INDEMNITY. Applicant understands and by his signature to this application, agrees to ho City ofEdmonds harmless from inju s!dtlmages, 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
) I
employees, including or not limited to the defense ofany legal proceedings including defenqe,costs,(and attorney fees by reason ofgrantingithis 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�&S-N&� grt
WE HELD UNTIL THE1l#NA4qT -TT PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUA NCF 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 regulations as required by the City Engineer.
All street cut ditches shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepink copyof thepermit ivillbe
tl &0�n urposes.
available on site at all ��A�07
Signature: Date: November 14, 1994
(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 FEK/FUND IlL
SPECIAL CONDITIONS: RESTORATION FEE:,"
PERMIT,FEE:. 3�1).
TOTAL,FEE:,
COMMENTS: RECEIP`1`, FEE:
DATE: ISSUED, BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT I
UANCE
Engrg. Nv. 1991
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
AV*rrgCMfn CCM,
Addendum to City Or Edmonds
— T- -;fVaj
Permit Applicaiion%
--Pubmitted by., lt�TCHELL S.-LANKFORD'.
"wineering Aide
Washington Natural Gas
# .' -521-�5'246
LAJ
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FAter-main depth
CurLknow:��
gas main
11
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Key:
_w- water
-9- gas
-ss- sewer
19- water hydrant
0 water valve
815McmerSt- MO. Box 1869). Seattle, WA 9SIll (206)622-6767
CITY OF EDMONDS
AS*TfMiFAFobHEET
le"NEW
1:1 ADDITION
El RETIREMENT
ASSET NO
ADDITION TO ASSET NO.
DESCRIPTION -
4
SERIAL NO.
LOCATION
DEPT. NO./
PURCHASE ORDER NO.
PURCHASE ORDER DATE
COST
0
PROJECT NUMBER klkJ��
PROJECT COMPLETION DATE
COST 4,:P-7 " 2?
B.A.R.S. ACCOUNT NO.
ESTIMATED LIFE
INITIATED BY DATE APPROVED BY
"SUBMIT ASSET INFORMATION SHEET WITH FINAL PAYMENT REQUEST
*SUBMIT ASSET INFORMATION SHEET UPON CLOSE OF PROJECT
ACCOUNTING ONLY
0""DEPRECIATE
MONTHLY DEPRECIATION AMOUNT
ANNUAL DEPRECIATION AMOUNT
G.L. ENTRY
REFERENCE
DATE
A:�cl
VERIFIED BY
PROCESSED
BATCH NO. -
ttnp
INITIA
DEPARTMENT FILE