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CITY OF EDMONDS BARBARA FAHEY
MAYOR
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0220 - FAX (425) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works e Planning/Building - Parks and Recreation e Engineering Wastewater Treatment Plant
F File*
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PERMIT GOUN-Vhti
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FDATE OF (COMPLAINT:
OF COMPLAINT:
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SUBJECT
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VIOLATION ADDRESS / LOCATION:
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NAME:
PHONE:
IS ALLEGED VIOLATOR THE E3 OWNER OR El TENANT OF THE ABOVE PROPERTY?
DETAILS OF COMPLAINT:
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Under the provisions of the Public Disclosure Law, RCW 42.17.310 (1) (e), the complainant may indicate a
desire for disclosure or nondisclosure of their identity. If nondisclosure is chosen, the bottom portion of this
form will not be released to the public. Please note that if this case is filed in court, your name must be
WbUlUbCU 1JP YUU dIC; W �, a w Uivaa ni ui� —o—
The City of Edmonds investigates possible violations on a complaint basis only, therefore, the name of the
person filing the complaint must be provided.
Name (please Print):Man'A Phone: :7 2'-5� -ce q3t?
Address: -7-7Th -P
Plpse check one of the following boxes:
�I/You may disclose my identity if requested. U You may not disclose my identity without my permission.
Signature: 14U!' Date: 0�6/99
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
. 'W - -, '�
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Pemit Numbe
Lssue Date':
STREARzd,'T FJLE (DA�
ress or 'Cuuty of Construction: _ 19212, 198,08, 19807 and 1981 1 77 Place
ID C 1101- 1. We t
lype o MkLmspecitic): Install 1 1/4 FE IF Main 14J' North centerlit
9 0 - 1 9 199 Street Southwest to 298' North centerline 77 Place West.
Per Attached DrawingL 920-590 (IR 6943-3) (1)
C. Contractor: -Washington Natural Gas Company Contact: Frank Swan
MailingAddress: 815 Mercer Street,
State License #: Seattle, WA 98111
D. Building Permit # (if applicable):
Phone: 224-2278 -
Liability Insurance: __ Bond:$
Side Sewer Permit # (if applicable):
E. Commercial 0 Subdivision El City Project 0 Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family 0 Single Family E] Other
INSPECTOR: INSPECTOR: W
F. ravement or Concrete Cut 1.12 Yes UNO (4) G. Size of Cut: 2 x 4 H. Charge
@ Drives
APPLICANT TO READ AND SIGN
INDEMNITY.* Applicant understands and by his signature to this application, agrees'lo hold the City of Edmonds har"desifrom ityaries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the Cry of Edmonds, or any of its departments or employ-
ees, including or not Limited to the defense of any legal proceedings including defense costs, and atrorneyfees by reason of granting this pl�)F
INE 0ONTRA CTOR IS RESPONSIBLE FOR WORndANSHIP AND MA TERIALS FOR A PERIOD OF ONE YEAR FOLLOWNG THE FINAL IMPEC77ON
AND A CCEPTA NCE OF THE WORY_ ES77MA 7ED RESTORA 71ON FEES WILL BE HELD UN77L THEMNAL STREET FA TCH IS COMPLEYED BY
CnYFORCES, AT WHICH 77ME A DEBIT OR CREDIT W7LL BE PROCESSED FOR IS§&ANCE TO THE APPLICANT.
Construction drawing of p
roposed work required with permit application.
A 24 hour notice is required for inspection; 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 dean 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: I X At-1A ^ 3%, �'-! I- -
(t6tii-r�c to� o* r -Agent)
APPROVED BY:
Date: flay 12, 1992
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
R W
FOR CITY USE ONLY
TIME AUTHORIZED: VOID AFTER DAYS
SPECIALCONDrrIONS: WIQDCW 4"e-
CONIMENTS:
DATE: —
RIGHT OF WAY DEPOSIT:
DISRUPTION FEE/FUND I 11:
RESTORATION FEE:
PERM IT FEE:
TOTAL FEE:
RECEIPT NO:
ISSUED BY:
-4
NO WORK SHALL BEGIMPRIOR TO
It
Enere. Div. 1991
14J�. N 14'W
NOTat)
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C-6h, L- 1-500-42-4-555�
445 HOUR5 BeFORF- OIGStt4G
a. Ljwy osmej=i W.6RNING WIRSOVER
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3. (N5-rAL-L- ONa POUND b6t-400E. FIOR
F_\/aRy IC�00' OF LiOCA,-r(Hrm \NlRa.
4. 5URVF-Y NOT REJOUIRF-D
.5. MAINT,&It-4 L MINIMUM 5� HORIZOt-4TAL�
AND 3'VaR-r(C-6.L- CLZBARAt-4Ce�
F=RC)" &L.L-Cl-ry UTIL-ITle-S
OREEN CU-r'5 ZS,.RF- e)HOWN W5
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STREET FILE
CITY OF EDMONDS
250 - 5th AVE N. - EDMONDS. WA 98020 0 (206) 771-3202
COMMUNITY SERVICES:
9 9 C) PublicWorks 0 Planning a P arks and Recreation a Engineering
August 2, 1988
LARRY S. NALIGHTEN
MAYOR
PETER E. HAHN
DIRECTOR
Snohomish County P.U.D.
P.O.-Box 1107
Everett, WA 98206
Attention: Jon Haffenclen
Illumination Engineer
SUBJECT: 19907-77th-Pl._W,-6909-160tti_St._SW,_215-2nd Ave. N
Gent.lemen:
The - tity of Edmonds authorizes the installation of:
(1) 100-watt high pressure sodium street light on each of the existing
poles at.- 19807-77th Pl. SW, 6909-160th St. SW, and 215-2nd
Ave. N. Please refer to the attached maps.
If you should have any questions please contact me at 771-3202,
exte.nsion-315.
;SincAr ly,
OF I
I Stroud,
Street Supervisor
Attachments
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LIGHINST/TXTSTREE
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a Incorporated August 11, 1890 a
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APPLICATION
for
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The City' of E-knonds
- Z11 7 —.7-0
SME SEWER PERMIT
EASEMENT No . ..........................................
STREET FILEEW CONSTRUCTION 2,1� REPAIRS
�
13`7
O�VNER ----------
Ij .......... IV .. ( . .................
CONTRACTOR ------ ...... S,().kS ........... .- PERMIT No. ...............
ADDRESS ..... ............
: ...... ?- .2 P( ------ 4 ...........
LEGAL DESCRIPTION: LOT No . ....... 3 ..........................
BLOCK No . ...................... ...
NAME OF ADDITION
. .........................................
APPROVED
APR jo 1967.
.:2 7,e r-- -
Approved':
/ C, - C�7,
DATE................................................ By ....................................................... ............
CITY OF EDMONDS
11�1 .11
CIVIC CENTER — WATER -SEWER DEPARTMENT Call PROSPOct 6-1107 when work
Is ready for Inspection. (No inspec-
SIDESEWER PERMIT tions Saturday, Sunday or holidays.) N2 2058
19807 - 77th Place West
ADDRESS--------------------------- - -------------------------------------------------------------------------------------------- . .......................................................................
Allen D. Fielding Russell Johnson
OWNER..................... ........................................................................ CONTRACTOR
Permission is granted ------ April 20, 19 --- 6.7, 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 regaxdlng 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.
TOTE No. 4—Trenches in street must be water settled and surface of street restored to original conditio Contra ors shall be sp nsible for
failure due to Improper work which may develop within one year of completion. ct re o
NOTE 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.