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19421 86TH AVE W
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RIGHT-OF-WAY CONSTRUCTION
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Permit Numben to
Issue Date: —,A - /9-,7"/,
A. Address or Vicinity of Construction: - .19421 86 Av V (9607507)
B. Type of Work (be specific): Iustall Service
C. Contractor: -Washingtou Natuaral Gas
MailingAddress: 1122 75 St Sw Overeft
State License #: 1 98203
D. Building Permit # (if applicable):
E. 0 Commercial 0 Subdivision
E] Multi -Family 0 Single Family
INSPECTOR:
F. Pavement or Concrete Cut,: 0 Yes [11No
Contact: Hariamne KLngsbuKy
Phone: 356-7500 ext 7596
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
El City Project IN Utility (PUD, GTE, WNG, CABLE, WATER)
F1 Other
INSPECTOR: �_,& ILI " �4
G. Size of Cut:
APPLICANT TO READ
A�' x H. Chargq_$.
SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees t6hold the City ofEdmondshai-mle88from'injuries,damage8, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be Y" against the City of Edm�"; or n -of its departments or
employees, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgranting thi8perntit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS I FOR A PERIOD OF ONE YEA�? ALL�VIRG THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITYFORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
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. -.2
Street shall be kept clean at all times.
T�-affic 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 copy of thepermit will be
available on site at all times or ins e ion purposes.
Signature: k�� 7,74.1z Date: 2-8--96
ntrc(cio�_�r -Agelnt)
C�o '
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: iAjLk RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS:
COMMENTS:
DISRUPTION FEE/FUND 111;
.RESTORATION.FEE:
'PERMIT FEE:
TOTAL.FEE:
RECEIPT FEE:
DAT9:, YSSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund I I I - Route copy to Street Dept.)
0 YES El NO
Date:
Date:
P
CGUJ
V)
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by:,Xariamne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596
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LA
I Oe�2-1 2)6 AV vv
COT,5
Key:
-w- Water
Watermain depth -G- Gais
-SS- Sever
gas main -& Waterhydrant
0 Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331
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STREET FILE
Th'e City of Edmonds
-I)
AP,PLIC47ION
SIDE,:SEWEk PERMIT
EASEMENT No . . .........................................
NEW CONSTRU TION--
C REPAIRS
#� . S) � --
V
�J ---
OWNER ..... /'�k ..... ----
/11 -------------------------------------------
ADDRESS .... 4 ... . 121 ....... . .. .......... I ............
CONTRACTOR . W&M.. ..... ..... ... ........ * ...... ERMIT No.-k
LEGAL DESCRIPTION: LOT No. .......................... BLOCK No..-;;2 . . ..............................
NAME OF ADDITION�.f.:77 .. ...... . ............ ............ ................
io / t2r- j
/0 �,s
QQT X-0
Approved
. ...........
v ....
DATE ... .......... ........... By
/I r, CITY OF EDMONDS Cali rRospect 6-1107 when work
CIVIC CENTER — WATER-SEVMR DEPARTMENT Is ready for Inspection. (No lusper-
0 SIDE SEWER PERMIT tions Saturday, Sunday or holidays.) N 0-: 2491
ADDRESS ........... 86th Avenue West
-------------------------------------------------------- ....................................................................................................................
OU7NER ............... ro ---- %4_10ibly ------------ ----------------------------------- CONTRACTOR -------- Nor-thwest-Se-wer..Const - -------------
Permission is granted __ October ------- 20.., 1967, 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—Tbe 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 has 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.
NOTE 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.
NOTE No. &--�-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.
00 STREET FILE 0
October 10, 1966
Dr. Frank J. Leibly
19421 - 86th Avenue West
Edmonds, Washington 98020
Dear Dr. Leibly:
Receipt of the data relative to your property at 19421 - 86th
Avenue West is hereby acknowledged.
The assessment rolls for local improvement districts are made
up on the basis of the ownerships and legal descriptions as furnished
by the Snohomish County Treasurer, Snohomish County Court House, Everett,
Washington. Accordingly, in order to change theassessment, the require-
ments are as follows:
A. The deed be filed with the Snohomish County Auditor,
B. A copy of the deed be shown to our Consulting Engineer,
Mr. C. Wayne Jones of Reid, Middleton & Associates.
324 Main Street, Edmonds, Washington.
Yours very truly,
CITY OF EDMONDS
LEIF R. LARSON
City Engineer
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NOTICE:
T\__ 1: rf_.P. n.
-ur..d �' y.
The inform ation shown on the attached
map(s) was compiled for use by the City of
Edmonds/ its Employees and Consultants.
The City of 'Edm.onds does not warrant the
accuracy of anything set for.th on t ' hese
Map(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform - ation shown on
-map(s)l including, but not limited to,
t er stub shown. Such
the lociation of any sew
sewer stubs may or may, not exist and may
or may not exist at the location shown.
city of Edmonds nor its
Neitheir the ,
ernpl-o-yee-s o-r office-rs -sh-a-11 be Via-b-Ife for the
information given on this map(s), nor for
e representation provided based
any on
upon . said map(s).