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19332 81 ST PL W
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City of Edmonds
9 C)
RIGHT-OF-WAY CONSTRUCTION
STPermit Number. Z3 .2,
REET FILE PERm'T
Issue Date:
A. Address or Vicinity of Construction: - 19332 81 P1. W. (9316389)
B. Type of Work (be specific): Install Ne4 Setvice
C. Contractor: Washington Nat'l. Gas Co.
Mailing Address: 815 Mercer St.Seattle,Wg.
State License #: 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. E] Commercial E] Subdivision El City Project ]Q>Utility (PUD, GTE, WNG, CABLE, WATER)
F1 Multi-Faniily [-] Single Family F1 Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: Yes 26&o G. Size of Cut: x H. Chargq,-$
APPLICANT TO READ AND,81GN
INDEMNITY. Applicant understands and by his signature to this application, agrees to I the City ofEdmonds harml =magek or
'01 t cur I,-gilj.t
'4 �"+
ar
claims of any kind or description whatsoever, foreseen or unforeseen, that may be ma e ainst the City of Edmonds, or. any of it artments or -
I : I A.* . . 14*'. 4, , h J_'r_ r I at r ceedi sinclud;-- ef-.'; C*osts! and attorne fees reas� n- 'ntl' _ihis ermit
emp oyees, u ng or no e a e nseo any-, po
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. ESTIMATED RESTORATIOYFEE,�_WILL BE HELD UNTIL THE F1.1V�AL-ST-WEET PATCH
IS COMPLETED BY CITYFORCES, AT WHICH TIMEA DEBIT OR C - DIT WILL BE, PhOCESPED FOR [SSUANCE;W;[kA4ACANT.
Construction drawing,of Oxoposed 64-�e Z
qxiired�jvlth, 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 Safdy shall be in accordance with Citylegulations as required by the City Engineer.
All street cut ditches shall-lbb'patched with asphalt or City approved material prior to the end of th� working day;
,NO EXCEPTIONS.
Ihave read the above statements and understand thepermit requirements and thepine�opy of thepermit will be
available on site at all times for inspection pj�rpo-s*s�.__
Signature: Date: May 20, 1993
(Contractor or,A 0
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
.J!
FOR CITY USE ONLY
APPROVED BY: VJ(' �'A
TIME AUTHORIZED . : VOID AFTER aA ""-- DAYS
SPECIAL CONDITIONS:
COMMENTS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
PERMIT FEE:
R
TOTAL FEE: 13o_.1�0_",6,�
RECEIPT FEE:
0
4
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
El NO
Addendum to City of Edmonds
Right of Way .
Permit Application
Submitted by: Guyla Connors
Engineering Aide
Washington Hatural Gas
521-5248
Iq55a jOIPLb�.D
lj-)A 6— 4F 6) 1:2� 1
ff
MEMM i
U/A WNG to window �
,j1A Water main depth
UM3CXMM~
gas main'
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VC
Key:
-w-
water
-g-
gas -
-ss-
sewer
-e-
water hydrant
C)
water valve
915 M=er St. (P.O. Box 1869). Scank, WA 98111 (206) 622-6767
The City of Edmdn'dT' R E wt'i 1p FILE
is 0 0
OWNER .... 4�"
HOUSE No..1.1-7—? ...... --------------------------
... _zz ........ -S.- -/. I W,
Ap
JA
Date
BACKFILL WORK ORDER ISSUED .....................
-------AEWER WORK ORDER.ISSUED ---------------------------
APPLICATION
for
SIDE SEWER PERNaT
OUTSIDE [] INSIDE [-] REPAIRS
CARDNo
- --------------------------------------
ILI!
EASEMENT No.
.—Z ---- a ................
4- / 4�'? A -� 50,
....................... CONTRACTOR ----- �O:— 7 ........................................... PERMIT No.
STREET
....................... AVENUE LOT No. -��h ..................... . BLOCK No . ........................
............
NAME ADD. ......... .......... ------------------------------
.......... DEPOSIT, $ .........................................
.......... DATE ................................................ B ................... ..........
.... ---------- - -----------------------
NOTICE:
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(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information sho.wn on
-map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may* no t exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
ernptoyee-s or officers -sh.a.111 be 1-.`1a.b-I..e for +Lhe
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS
Call PRospect 0-1107 when work
CIVIC CENTER — WATER -SEWER DEPARTMENT Is ready for inspection. (No Inspec"
SIDESEWER PERMIT tio" Saturfty, Sunday or holl"".) N2 1536
ADDRESS ..................... .... 19.3.3.2 --- 81s.t...Flace ... Ve.s:t
OWNER ......... .-Ormond E. Reed
......................... .......... ................................ I ............ CONTRACTOR ..... R@Aford & Son
...............................................................
Pertnission is granted ... j4A144rY --- Zk ................ 19fil, for ...................... days, to REPAIR or CONNECT A side sower
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOVVING:
NOTE No. I —The owners of the property may obtain a permit to construct sewer inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do not cover any portion of sewer before It ha.9 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.
I 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.
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 ap-
purtenances except to Insert the pipe into the wye.