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RIGHT-OF-WAY ONSTRUCTION
PERMIT Permit Numbe'.
Lssue Date: 06
A. Address or Vicinity of Construction: 19827 78 P1 V (9725764)
B. Type of Work (be specific): Install Service
C. Contractor: PUGET SOUND ENERGY
Mailing Address: 1122 75 St SW Everett
State License #: 98203
D. Building Permit # (if applicable):
Contact: Hariamne KIngsbuzy
Phone: 356-7506 X7596
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. F1 Commercial E] Subdivision [I City Project K] Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family E] Single Family E] Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut Yes 0 G. Size of Cut: H.�"Cha
_—R), 0
/� N6 ('V T�
APPLICANT TO READ AND SIGN
INDEMNITY. Applicant understands and by his signature to this application to hold the City of Edmonds harmiessftom injuries, damages, or claim;of�ny
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 of any legal proceedings including defense costs and attorney.fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP ANDMATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
I
TIONAND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings 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 trench work 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 times for inspection pyrpo e
Signature: L'o�& Date: 10-6-97
;/7" (Oont(,�cior or Alent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: 901( 1 Q
TIME AUTHORIZED: VOID AFTER pet. ;; 0 DAYS
CONDITIONS:
OAQ P�VE IAE�h.. WA 5.
-2 7
R IG14T OF WAY FEE: 1 30
DISRUPTION FEEIFUND I 11:
RECEIPT
ISSUED BY:
.4
NO WORK SHALL BEGIN PRIOR TO
T ISSUANCE Eng. Div 1997
FIELD INSPECTION NOTES
. Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR FOR INSPECTION El YES NO
Partial Work Inspqc�ion by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
PUG ET Xdaendum To: City of Edmonds
SOUND Right of Way
ENERGY Permit Application
Submitted by: Mariamne Kingsbury
New Customer Construction
Puget Sound Energy
# 356-7500 EXT. 7596
30E-s (3-3-2
-+S PU\N
Key:
Gas Main -W- Water
-G- Gas
-S9_, S�w`er
-SD- Storm Drain
FlugntSoundEnergy 0 1122 - 751h Street S.W. 0 Evorelf,WA98203
APPLICATION
for
The City of Edmonds KEET FILE SIDE SEWER PERMIT
1411-01600 NEW CONSTRUCTION [:] REPAIRS
OWNER ... . ........ — .......... .........
ADDRESS ... . .. ...... ..........................
I.MiOVED
LYNN PLANT
EASEMENT No . ..........................................
/1)
CONTRACTOR .................................... 6W41E e— (2-_ �
-_7
............................................................. PERMIT No.
LEGAL DESCRIPTION: LOT No . .............. k .......................... BLOCK No . ............................................
NAME OF ADDITION .... ............... ....... LL, ...... :�� ........... .................................................
Approved:
DATE. ..... . ?.—.;2.2.-.A0 ......... By ....................................................................
M
-- PI-0 F. t�:- x T Go. � I (- C- 677le-
0827
A- ui.
No.
NOTICE:
No warranty of accuracy.
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 for ' th on these
map(s). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may'not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employee-s or officers Sihall be I -Jab -le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS
Call PRospect 6-1107 when work
CIVIC CENTER — WATER -SEWER DEPARTMENT Is ready for Inspection. (No Inspeo-
SIDESEWER PERMIT tions Saturday, Sunday or holidays.) N2 1793
ADDRESS........................... .............. 1.9.82.7 ... ..... 7-8t.h --- Place ... We.st ................................................. ........... ...................................
OWNER ........... -Rob.ert --- W...._.Mi.1.1eir ........... Ovaier
....... ....... --- - ---- -- ---- -- ............................ CONTRACTOR .................................................. . ..........................
Perudssion is granted ___!�grhh 16
. ........................ ...... 4�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 —The 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.GW 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.
OE 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. 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 ap-
purtenances except to insert the pipe into the wye.