19824 MAPLEWOOD DR.PDFIIIIIIIIIIIIII
12201
19824 MAPLEWOOD
DR
'..-The City of Edmonds
OWNER .... HA.�q ... ...........
ADDRESS .... ... a.q ........
N .
APPRovED
APR 22 1970
APPLICATION
for '.
SII)E SIEWER PERrMT
NEW CONSTRUCTION REPAIRS 0 EASEMENT No . .................................
. I,^ /.) / c,/
................................................... CONTRACTOR .... L Kh)C�.1.4j. 9� 5�'. ��:n
................................... PERMIT No..
-rION: LOT
........................... ..... LEGAL DEScRn EL40CK No . ............................................
NAME OF ADDITION .................... .............. /.
Approved:
r
J
DATE ..... :? ....... .............. ........... . By
:i7�
CITY "OVEDMON DS
CENT
ER *A
TER,-�SEWER DEPARTMENT Call PROspect 6-1107 when work
is ready for ection. (No.
tions Saturd hl�pec_ 3677
'SIDE 'SEWER PERMIT ay, Sunday or holidays.)
Ss .......... ............ 19824 Dri�,e
- ---------- I -------------------- I ---------------------- --- - -----
0" ER..-'7 -------- ........... .. . ........ ------------------------_--
e-rg -------------------- ---------
.................. CONTRACTOR... nnwo d Sewer
... . ...... . ...........................................
-Peripjs�jon is ted.
gran ------- px!i
---- -- 22
with� City glew�rs in . ....................... for --------------- - ------- days.* to REPAIR or. C
accordance with application on file and governing 6rd... QNNECT a side sewer
Inances.
ATTiNTIoN.IS CALLED TOTHE FOLLOWING:
NOTE No. I —The owners . o .
be f the property May obtain a Permit to construct sewer inside Property line.
employed to construct side sewer in street area. Do not cover any porti A Hcensed,.Side Sewer Contractor must
N-OTE NO.: 2" O*btain' full information regarding I On Of sewer before it has been inspected.
NOTE. No. Ordinance 11.16.030
3—Top of side Sciwer, must have at 1,at 30 inches and Regulations governing side sewers when you get permit.
No bends in grade sha * coverage at property line and 12 inches in de
rper than % will be permitted. .5i . Property line; minimum grade of 2%.
NOTE No. 4---.�Trencbes in street must ble wate settled and surface Of street restored
. . falluie'due to Improper work whrich to Original conditiom
NO- - 5--It is uhla may develop within one year of completion. Contractors shall be responsible for
wful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or 16
-tenances except to insert the Pipe into the wye.
aPpur-
City 0 ,,Edmonds
RIGHT-OF-WAY4CONSTRUCTION.
PERMIT
Permit Number.
Wu e Date:
A. Address or Vicinity of Construction: 19824 Replewood'Dr
8 9
B. Type of Work (be sp&-ific): Install 2131 "1— /4' IRA 1P from, 21 ITI
0 19c)
to 220'9 C/L Naplevood Dr on 199 St SU
C. Contractor: _H2sbJ2gt:o1m
oatuiEnl Gna Contact: Hariame Kinasba ry
Mailing Address: j122
75 St SW gVerptit Phone: 356-7500 X7596
State License #:
93203
Liability Insurance: Bond: $
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. 0 Commercial E)
Subdivision
El City Project fo Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family [I
Single Family
El Other
INSPECTOR:
INSPECTOR: V,�
F. Pavement or Concrete Cut ID Yes []No 2 G. Size of Cut: 4 x H. C
APPLICANT TO READ AND Sel
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless from injuries, damages, or
claims of any kind or description
whatsoever, foreseen or unforeseen, that may be made against the City of Edrnonds, or any of its departments or
employees, including or not limited to the defense of any legalproceedings including defense costs, and attorney fees by reason of granting thispermit.
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 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.
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.
Ihave read the above statements and understand thepermit requirements and thepink copy of thepermit will be*
available on -site at a timesforins ion purposes.
Signature: xs Date: 10-31-96
ntra&or or Ag�nt)
6)"0
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR, CITY USE ..6NLY
APPROVED BY: I RIGHT OF WAY DEPOSIT
TIME A . UTHORIZED: VOID AFTER* DAYS DISRUPTION FEE/FUND III:
SPECIAL CONDITIONS: MAkVTA(k) 6 Ily f ep RESTORATION FEE:'
FQA 211 T I S 6`51 64 PERMITFEE:
TOTAL FEE:
COMMENTS:
RECEIPT FEE:
DATE:
ISSUED BY -
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION. El YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
El NO
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Notes: The City of Edmonds
1 ) Field locate all utilities.
Call 1-800-424-5555
24 hours before digging.
2) Survey is not required
3) Maintain a minimum of 5'
horizontal and 3' vertical
clearance from all city
utilities and appurtenances.
4) Cuts in paving are shown as 0
5) __Z_ cuts in paving anticipated.
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Notes: The City of Edmonds
1) Field locate all utilities.
Call 1-800-424-5555
24 hours before digging.
2) Survey is not required
3) Maintain a minimum of 5'
hodzontal and 3' vertical
clearance from all city
utilities and appurtenances.
4) Cuts in paving are shown as 0
5) __Z_ cuts in paving anticipated.
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