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C11Y OF EDMONDS
COMMUNITY SERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION PERMIT
STREET FILIErnit. No' q I — \ k 9
. R�CEIVEL) Issue Date- '�J — I L - S I
A. e Owner: Washington Natural Gas Company
Name
815 Mercer Street
VeailWddress
a e WA 98111
City State Zip
R, bi
Eft&colgtor:
C-0
Name
Mailing Address
City State Zip
State License Number Telephone Number
C. Address or Vicinity of Construction: 19331 84 Avenue West
Type of Work to be Done: Install New Service at the Following:
D. 0 Work in Connection With: El Sub or Plat 0 Single Family 0 City Projects
0 Commercial 0 Multifamily J Utility
E. 0 Pavement CutA@ Y El N F. 0 Size of Cut: 2 X 4 (1) @ Gas
APPLICANT TO READ AND SIGN
INDEMNITY: 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, forseen or unforseen, that may
be made against the City of Edmonds, or'any of its qrp�i?ments or employees, including or not limited to the defense
of any legal proceedings including defense costs, couft,4;dsts, aaaqtole f es by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WdftMANSH& AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION AND-ACCEPTANg qF (THE WORK.
Estimated restoration fees will be held until the final street patch is completed by City forces, at which time a debit or credit will be
processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
I understand the above and- that,this-051flif *must be avai�al'b'ie At'the job site for inspection purposes at all times.
Signature: Date
Owner or Contractor
April 8, 1991
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: 1� V,/.
Time Authorized: Void after 2-3 dals
Special Conditions: A=k8t-%AL_*T e'_,_� tAu,.%T- P,.Fr-
MADr_ f3NL�Y %AjtT1!J11Q R A I I P-0 -!Sl pr— WA t—
x — = $
RELEASED BY: Date INSPECTED BY Date
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
PERMIT FEE: -I-,T)
Restoration Fee:
Receipt No.:
Fund I I I Fee:
Street Cut Dimensions
Fng. Div. March 19X9
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.�
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
Date:
Eng. Div. July 1985
Addendum to:
City of Edmonds
Permit Application
Engineering Aide : Kerry Walsh
Washington Natural Gas
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APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
STREETNEW CONSTRUCTION E] REPAIRS
OWNER ------- --- ....
.......... . ....................................
ADDRESS ........ .... . .....
.................... ............ ............
EASEMENT No . ..........
f /7� /--�3 9�
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CONTRACTOR ................ .................... ...... PERMIT N,,(
LEGAL DESCRIPTION: LOT No . ....... .................................. BLOCK No . ................
..................
NAME OF ADDITION ........ F(' A Acf
..... .......... )c ........................... ...........................................
A P PAUV E D
- JUN 12 w6l
Lj
Approved: 0PV7719L 1-0
DATEZt ...... By ............................. ......................................
CITY OF EDMONDS
CIVIC CENTER — WATER --SEWER DEPARTMENT Call FRospect 6-1107 when work
Is ready foi inspection. (No Inspec-
tions Saturday, Sunday or holidays.) N2 2340
SIDE"*SEWER PERMIT
ADDRESS ...................... Ja7mes Sinclair
--------------------------------------------------------------------------------------------------- . .......................................................................
OWNER ................................. ... 8.4-th-M& --------_---------- CONTRACTOR -------
"N ------ Sea -view --- Qomstr./ ------------_--_-------
Permission is granted --------- jUne....j_2._, ............... 19 .... 6.7 for .................. ..... days to REPAIR or CONNECT a side sewer
with City Sewers in accordance with aPplication on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer inside pr
Bide Sewer ConVac-tor must
Do not cover any portion of sewer before it has been Inspected.
be employed to construct side sewer in street area. opertY line. A licensed
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—TrencheB 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.
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-
tenances except to insert the pipe into the wye.
0
NOTICE:
r a
cz-ama-
-N'o wa rra nty0T -a..
The information'shown on the attached
map(s) was compiled for use by the City Of
Edmonds, its Employees and Consultants.
The City of �Edm.qnds does not. warrant the
accuracy of anything set for.th on t hese
rnap(�_). Any person or entity --requesting a
copy should conduct an independent
iry regarding the inform-ation shown on
inqu'
tFe -map(s), Including, but not limited to,
b shown. Such
the location of any sewer stu
sewer stubs may or may- not exist and may
or may not exist at the' location shown.
Neither the �ity of Edmonds nor its
h. a. I I b e 11 a- b-'Fe f o r 11 h e
e m p,'I* o,y e e, s o off ice-rs -s
information given on this map(s), nor for
ovided based
any one representation pr I
upon I said map(s).