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-OF-WAY CONSTRUCTION
RIGHT
STREET FILE PERMIT Permit Number:
Issue Date:
A. Address or Vicinity of Construction: 19333 81 Place West
B. Type of Work (be s ecific): Install New Service
1990 lo �p
C. Contractor: -Washington Natural Gas Company Contact: Frank Swan
224-2278
MailingAddress: 815 Mercer Street, Phone:
State License #: Seattle, WA 98111 Liability Insurance: Bond:$
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. F-1 . Commercial"� El Subdivision City Project Yk Utility (PUD, GTE, WNG, CABLE, WATER)
F1 Multi -Family" EJ Single Family Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut : [M Yes E]No (2) G. Size of Cut� x 4 H. Charge$
,-Vmp 15—Zo—.7 �_ . .., -,
No CL)T5 APPLICANT TO REAP, rlp SIGN
INDEMNITY. Applieantunderstands and by his signature to this application, agreeYwhold the City of Edmonds harwdess4rn(nj�ijs,�Mres, or
claims of any jUnd or description whatsoever, foreseen or unforeen, that may be made �jainst the City of Edmonds, or any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings including defense costs, a)i� attorneyfees by reason'of granting this permit.
THE CON7RA CTOR IS RESPONSIBLE FOR WORKMANSHIP AAD MA TERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC77ON
AADACCEPTAI�,CEOfTHE WORK. ES77MATED RESTORA 77ON FEES WILL BE HELD UN77L THE FINAL S7REET PATCH IS COMPLETED BY
C17Y FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawing'6f -proposed work required with permit application.
A 24 hour notite is requirea-fiv ii!�pection; Please call the Engineering Department- 771-3202.
Work 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.
I have read the above statements and understand, the permit requirements and the pink copy of the permit will be available
on site at all timesfor inspection purposes.
Signature: IV6MA4441 Date April 7, 1992
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
::,C0M..MENTS.::., ..... .. �_::_::JREMPT.
...DATE: ISSUED BY...
.............. ....... . .. . - ...... - 1 ... ... -
kul
Engrg. Div. 1991
FIELD INSPECTION NOTES (Fund I 11. - Route copy to Stre% Pept.,).,
Comments:
I Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. viv. July
Washington
Natural Gas'
AV.t�&ergyC-rffTy
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WNG
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Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: Kerry Walsh
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager 995-6914
2��4) 0 Ofs
r
815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767
j
NOTICE:
----------N--o--w-a-rra-n-ty--�o-f-a-ccu-,ra-cy.----
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 forth on these
map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shoWn on
-map(s), including, but not limited to,
th I e 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
ernpl-o-yee-s o-r officers shall be 1.iab-11--e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
�-'CITY OF EDMONDS
CIVIC CENTER — WATER -SEWER DEPARTMENT
SIDE SEWER PERMIT
Call PROSPOet 6-1107 when work
Is ready for Inspection. (No inspee-
tlons saturfty, Sunday or holidays.) N2 2017
ADDRESS ............. 19333 81st Place West
OWNER------------- ...................... ..................................................
............................. C-IJUX Qr-d --- 1)�, ---- B_r_e_Cht CONTRACTOR -------- awn.er
Permission is granted ...... April 13, 67
With CRY Sewers in acco --------------------------------------- 19 ......... for ........................ days to REpAjm or C01VNEM a side sewer
rdance With aMicatiOn on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—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 nut cover any portion of sewer before been inspected.
NOTE No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers 'wttiheansyou get permit.
NOTE No. 3—Top of side sewer mu t have at least 30 inches coverage ai: Property line and 12 inches inside Property line; minimum grade of 2%.
No bends in grade sharper than % will be Permitted.
No. 4—Trenches In street must be water settled and surface of street restored to original condition. Contractors shall be responsible f r
N' failure due to improper work which may develop within one year Of completion. 0
'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.