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19804 81 ST PL W
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City'd tdmondss-
Rld"11"Ir OF —WAY CONSTRUCTION
PERMIT Permit Number.
Issue Date: &
A. Address or Vicinity of Construction: 19804 81 P1 V (9701984)
890 9 C) B. Type of Work (be specific): Install Service
C. Contractor: Washingtoa NaturalL Gas
Mailing Address: 1122 75 St SW . Everett
State License #: 98203
D. Building Permit # (if applicable):
Contact: Mariame Kingsbury
Phone: 356-7500 X7596
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. Commercial E] Subdivision F1 City Project [N Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family El Single Family E] Other
INSP-E&OR: INSPECTOR: 'P\ \,J
F. Pavement or Concrete Cut u Yes zANo L),. bize or t_-ut: x m. t.;narge��
APPLICANT TO READ AND GN
//_ � -
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of Edmonds, or any of its departments or
employees, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgranting th&Perntit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
Construction drawl'n4g 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.
Street shall be kept clean at all times.
'IYaffic 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 sitg)at all tiraft or i . nsDeCti . on p ses.
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V��e - —30-96
Signature: AJJyL& — Date: 10
Yi0tractor or Agent) -1
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APP ROVED BY -
TIME AUTHORIZED: VOI D AFTER DAYS
SPECIAL CONDITIONS:
COMMENTS:
-DATE:
RIGHT OF WAY'DEPOSIT
DISRUPTIONF`EE/FUND Ill:,
RESTORATION FEE:
PERMIT FEE:
TOTAL FEE:
RECEIPT FEE -
ISSUED 11Y:
40
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund Ill - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
0356-7500 X7596
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Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
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Key:
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0 Water valve
NOTICE:
N-o--warranty--of -accuracy.
The information 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(s). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
�.'.__tf�e -map(s), Including, but not limited to,
ch
the location of any sewer stub shown. Su
sewer stubs may or may* not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
emp-1-o-yee-s o-r offiCerS -sh-all be lia-b.-le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
.16 TION
The City of Edmonds STREET FlLCPP,',f',��,PERM11T
-//,/ NEW CONSTRUCTION E] REPAIRS El
OWNERAlAea ...... ................................................
ADDRESS ........ v All P/ w I
... ........... . .........................................................
0
[,pphOVED
JAN, 4', 1967
--------- ....
0
LYNN PLANT
RAIMMENT No . .................. -- ....................
CONTRACTOR .... ........................ ........................ PERMIT No.
LEGAL DFSCRIPTION: LOT No. ----------------------- BLOCK No . ........... ................................
NAME OF ADDITION ......... ..... . .................................................... ....................
Approved:
DATE .... 7. 6 - 7....
.4 ... ... ... By .... ... ....... ...........................
C_UTY-- OF EDMONDS
.-CIVIC CENTER — WATER SEWER DEPARTMENT
PERMIT
SIDE :SEWER
Val] PROspect (l!_11107 when work
is ready for Inspection. (No Insp-ce- 4 5
tio.ns Saturday, Sunda'y-or holidays.)., N 2 15
DRESS ............... ... .....
........... ............................................... ...............................................................
Paul Pet
OWNER .............................. .................................................. CONTRACTOR ........ C & U Construction
........................................... ...........................
Termission is granted ... slan.uary..2.7 ................ I I 9_63.. for ............ ......... days, to REPAIR or CONNECT a side sewer
with.City Sewers In accordance with application on file and governing ordinances.
ATTENTION IS CALLE6 TO THE FO*LLOWING:
NOTE No. I —The owners, of the property may obtaln a permit to construct sewer Inside.propertillne. 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—TrenchesAn street must be water settled and s urface of street restored Ao rIg*Inal condition. Contractors shall be responsible for
'failure due to improper work which may develop within one year of comple0o
ti n.
-NOTE No. 5---It Is unlawful to alter or do any other work than Is provided for In I the permit, or to' do any work on the main sewer or Its ap-
purtenanqes except to Insert the pipe Into the -wye.