19407 81ST PL W.PDF7451
19407 81 ST PL W
890 - 199 -
City of 'Edm'onds
RIGHT-OF-WAY CONSTRUCT�ION
\' A
FILERECEPMMIT 'k \! N \-' \� Permit Number:
dpe
DEC 91991 Issue Date:
A. Address0u- JKW&Qruction: 19407 81 Place West
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Natural Gas Company
MailingAddress: 815 Mercer Street,
State License #: Seattle, WA 98111
Contact: Gary Swanson
Phone: 224-2080
Liability Insurance: Bond: $
D. Building Permit # (if applicable): SideZ$ew6r Permit #(if applicable):
E. E] Commercial E] Subdivision [I C' �!, Pp9ject Rj Utility (PUD, GTE, WNG, CABLE, WATER)
F1 Multi -Family El Single Family D Oth)�r
INSPECTOR: INSPEdrOR'.
P, V'/
F. Pavement or Concrete Cut [K] Yes ONo (1) G. Size of Cut: 2 x 5 H. Charge$
@ Gas
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harridessfrom injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, tharmay,be made,against.the City of Edmonds, or any of its departments or employ-
ees, including or not limited to the defense of any legal proceedings includi' -' e/eTe jrs,�Weo ey fees by reason of granting this permit.
1g, 1cos, I
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MIA7�PJI�S FOR A PERIOD OF ONE YEAR FOLLOWING THE FIN4L INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MA7FD RESTORA77ON FEES WILL BE HELD UN77L THE FINAL STREET PATCH IS COMPLE7ED BY
C17Y FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE, TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Department- 771-32U.
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 regulA ' tions 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 in�pectton
Signature: M Date: November 19 -1991
9
(Contractor p
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
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FOR CITY USE ONLY
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:RIGHT:OFW :DE SIT,
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TIME AUTHORIZED: VOID AFTER ..DAYS,
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DISRUPTION. FEE/FUND, 111:
,SPECIAL.-CONDrrIONS:,, ... .. ..—.RESTORATION:FEE:::.
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TOTkLTEE: ....... . —4,
.::...COMMENTS,:.
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RECEIPT.NO:.. .....
DATE:
ISSUED BY:
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NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES
(Fund III - Route copy to StreeLDept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P. W.:
Work Disapproved By:
0 YES
Date:
Date:
0 NO
FINAL APPROVAL BY:
Eng. Div. July 1985
Washington
NaturalGas'
AWIY.�&-WG-paw
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: Kerry Walsh
Engineering Aide
Washington Natural Gas
622-6767 x2761
i c14M s� P L- vQ pager 969-1686
40
I M oni ilm I
11 5
I LVEN
WNG to window
� C.ZXC5) (g- C--A�5
q/N- Water main depth IV 11 Key: _w- water
unknown -g- gas
�k -1 :.-. -, .-ss- sewer
411 gas mai7,--! water hydrant
815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767
77777-l'
CARD No - --------------------------------------
APPLICATION
for 'LAV
SIDE SF.WXR FERN" _MENT No - --------------------------------------
REET FILE EASE
d"' 6cls
r
INSIDE REPAIRS
OUTSIDE E]
......................... CONTRACTOR
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---------- PERMIT No.
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BLOCK No - -----------------------------------------------
STREL
-------- AVENUE LOT
No. . ........... -------------------------------------
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ADD. -----------
NAME
N
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v
APPI -oved:
DEPOSIT$ ---------------------------------------------
DATE
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 forth on these
map(�_). Any person or entity'requesting a
copy should conduct an independent
inquiry regarding the information shown on
tKe -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
ernp[o-yee-s o-r office-rs.sha-ll be 1--'-1a.b-1`e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS
DEPAUnMT '0." PpOsp'ft 6-1107 ,he.
'C"V"C CENTER — WATER-SEVMP
Is reaidy for Inspec
.Mon. (No , work
S-tarday, S.W,, Uspec-
SIDE SEWER PERMIT Or hollda".)
ADDRESS ..... 40 - N2 1535
-9..., .... 7 ...... _8.1st
OWNER.. ... !��At
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Pernilssiol! ............................... CONTRACTOR ....... ............................................. ............ ...........
Is Kranted _F
.y
With City sewer, 1, ... 25
accordance With ------------------ 119-67., for . ................................
ATTENTION application on file and ....... ------------ days, to REPAIR
NOTE No. 18 CALLED To THE VOLLoWING: governing ordinances. Or CONNECT a side sewer
I —The Owners Of the
NOTE No' 2--Obtain PT sewer in street Permit to construct sewer Inside Property line A 11
be employed to constgeot Ido may obtain a
NOTE No full Information regardin &rea- Do not cover an Portion Of sewer b * it censed Side
3--T.p Of aide sewer must hav 9 Ordinance 11-16.0.30 a -ad Regulatl Y efore has been Sewer Contractor must
e at least 30 inch Ons governing .
No bends in gPade sharper than ya Ide sewers when you ge Inspected.
be water settled and surface of air rid 12 Inches Inside Property line; Permit.
failure due to IrnproPertwork 0 ge at Property line a
NO, 4 Trenches In street mus % will be Zrsn�ttvd t
which may develop within on eet restored t rig, minimum grad.
No' 5—PlutrItserunlawful to alter or do an Of 2
Pt to e Year P, tlon. na
Ces exce Y other of COM Oeo I condition. Contractors SWI be
Insert the Pipe intwork than Is Provided for I responsible for
0 the wYe. n the Permit, Or to do an v work On the main sewer or Its ap.