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�QITY OF EDMONDS �Permit No.
COMMUNITY SERVICES DEPARTMENT DEX_ It 9� o.
RIGHT -OF . -WAY CONSTRUCTION PERMIT Issue Date
Washington Natural Gag Co
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A. Owner: Contractor: KMA-,w [AJ k#—
Name Nam6 G
815 Mercer Street FILE
N�ilin Mailing Address
tk�.ddress
ea le, WA 9811.1
City State Zip City State Zip
State License Number Telephohe Nui. - "ber
C. e Address or Vicinity of Construction: 19827 80 Place West
Type of Work to be Done: Install New Service
D. 0 Work in Connection With: 0 Sub or Plat 0 Single Family El City Projects
El Commercial El Multifamily J1 Utility
E. 0 Pavement Cut: Y El N F. 0 Size of Cut: 2' X---"l) @ H 0
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APPLICANT TOREAD AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
harmless from any-in6uries, damages, or claims of any ki ription 't k 7 e�r, ", t -
J , w7,�� pe bor unforseen, that may
s�' gfor6ger
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be made against the City of Edmonds, or any'..of its dep e I g
s. 6f not limited to the defense
of any legal proceedings including defense costs, court- co t Aind altolney f es by reson of granting this permit.
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THE CONTRACTOR IS RESPONSIBLE FOR WORKfM*NSHIP AND MATE'RIALQ 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 time a debit or credit will be
processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is. to be -inspected during progress and at completion.
• Re.storationto be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control td be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
MCMA� �''
Signature: Date: Novem ei'9' 1990
Owner or Contractor
This Permit Must be. Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: w
Time Authorized: Void after R7-9 1170 _-&ays.
Special Conditions:
RELEASED B
PERMIT FEE:. 0 �Q_
Restoration Fee:
Receipt No.:
Fund. I I I Fee:
Street Cut Dimensions:
INSPECTED BY
NO WORK TO BEGIN,PRIOR TO PERMIT ISSUANCE.
Date
rng. uiv. marcii iyoy
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept.1
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES El NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. Ju
Addendum to:
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City of Edmonds
Permit Application
Engineering Aide''i !Cerry Walsh'
Washington Natural Gas
622-6767 x 2588
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KEY:
-ss- sanitary sewer
-s- storms
-w- water
0 water valve
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CITY of EDMONDS BU S LICENSE APPLICATION D LICENSE NO.
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Civic Center Edmonds, Washington 98020
N AL FEES
, wle City Clerk Phone . 775-2525 STREET FILE,. OME OCCUPATION PENALTY AFTER FEB. 15
CLASS YEAR LIC. EFFEC. DATE REASG. LIC. NO. SPEC.
INSTRUCTIONS: $10.00 (A) ADDITIONAL $5.00 - 0
• All items must be completed 0 SMALL BUSINESS
or application will not be ac- RECEIPT NO. DATE PAID PRINT W $15.00 (B) ADDITIONAL $7.50 0
cepted. IN SPEC. BOX
4A, � r) 11-01 F R ISSUE OF 0 Business with 10 or
• Sign and return application L FEE PAID PENALTY PAID CORRECTED more employees ADDITIONAL $25.00 0
LICENSE WITH
with fee. Renewals received ej 4,1 1 1 1 'LC* ACTION. $50.00 (C)
after February 15 must pay 2:�-NEW APPLICATION (LA)
penalty in addition to fee; 0 RENEWAL (LB)
NEW BUSINESSES AFTER ID CHANGE (LC)
JULY 31, 1/2 FEE. . (PLEASE MAKE ANY NECESSARY CHANGES) EJ DELETE (LD)
NAME OF FIRM
-T� /V 4 oo
BUSINESS PHONE
NO, QF EMPLOYEES
I Z� Pw
MAIUNG ADDRE
5';7 7 �?V
NATURE OF BUSINESS
P 0,2 6)
B�S R� E S
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INDIVIDUAL PARTNERSHIP CORPORATION
(P) P
--OWN-ERS-NAM
HOME ADDRESS
=(Z; �579 W/& K, ),g s
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HOME PHONE
�> 2"LEZ/9"
DATE OF BIRTH
1 12
P AC� OF BIRTH
1
SOCIAL SECURITY NUMBE
Z211 5_�_
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.5- -!r 2 - 1<1 91 - '? ;;, J'7
tMtHLiI=NL;Y NL) I IHL;AIIUN: (1) NAME: & TELEPHONE ?^r1 a 21 / 4- 4- / 2 6 - 17 7 / 1E
(PLEASE LIST TWO) (2) NAME& TELEPHONE 2- �'7'1'7
WASHINGTON STATE TAX NO.
APPLICANT'S SIGNATURE -
DO NOT WRITE BELOW THIS LNt
STAFF REVIEW: FILL IN LAND USE CODE, LIFIR NUMBERS, ZONING, ETC. CHECK APPROVAL OR
DISAPPROVAL, DATE, AND SIGN. IF DISAPPROVAL,. PLEASE COMPLETE "COMMENT -
SECTION. ROUTE TO NEXT DEPARTMENTON LIST.
PLANNING DEPARTMENT DATE .3 LAND USE CODE ZONING CODE
2'—APPROVE 0 DISAPPROVE _Y1 _E1 . _T�
SIGNATURE F
CONDITIONAL USE PERMIT
COMMENTS
B�KLDING DEPARTMENT
l!) APPROVE 0 DISAPPROVE DATE
SIGNATURE
COMMENTS:
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CAPACITY: (NO. UNITS,.APTS., OFFICES, SEATS, BEDS, STUDENTS)
Buildigg
0
Hotel/Motel
(L)
Permit
I I
0
. 0
Apt * Bldg.
Office Bldg.
(A)
(0)
Occupancy
0
Restaurant
(R)
Groug
0
Hosp/Nurs Home
(H)
El
School
(S)
FWE DEPARTMENT DATE 7
APPROVE 0- DISAPPROVE SIGNATURE
LCO 11 12-1
COMMENTS:
ICE DEPARTMENT
PPROVE 0 DISAPPROVE DATE3 7� SIGNATURE
COMMENTS:
PUBLIC WORKS DEPARTMENT
g,��ROVE 0 DISAPPROVE DATE 3 SIGNATURE
Comm
nI r- #\ - r- r-) r.-Ti i f-1 I, i -rn e� i-rNt f- i r7 6 1.,
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT
FILE NEW CONSTRUCTION REPAIRS
,—��ASEMENT No.
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OWNER ---- �V; 1.4. ...... /F ..... / ...................................
CONTRAC R ....... . ......................
...... f
........ PERMIT
No.
.................. ........................................
ADDRESS .......
LEGAL DESCRIPTION: LOT No. ..........................
...... BLOCK No....
/
.................. ... ............
NAALk &F ADDITION ........... .......................
.... ....... ........................
......................
01
Approved:
DATE ... . ......... B 7 --------------------- .....................
Y
CITY OF EDMONDS Call pRospect 6-1107 when work
CIVIC CENTER — WATER -SEWER DEPARTMENT is ready for Inspection- (NO InsPeo-
tions Saturday, Sunday or holidays.) N2 1696
SIDE SEWER PERMIT
ADDRESS.................. 19jaZ7 --- ---- jaQth ... -------------------------------------------------------------------------------- I -------- - ------
lb ...... ... CP . ..........
-A.-Mr-G111 vmu ------- Alligd-59P ic -.a@x!y - - ------
OWNER ........... . . William ................... cojwrimu
Permission is granted ........ March --- I ................... 19.163-, for ---------------------- days, to REPAIR or CONNECT a side sower
with CRY Sewers In accordance with application on file and governing Ordinances*
ATTENTION IS CALLED TO THE FOLLOWING: inside property line. A licensed Side Sewer Contractor must
NOTE No. I —The owners of the property may obtaln a permit to construct se er I as n nspect
be employed to construct Side sewer in street a-rea. Do not cover any portion of sewer before t h bee I ed.
NOTE No. 2--Obtatn full information regarding ordinance 11.16.030 and Regulations governing side "ewers 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. shall be responsible for
NOTE No. 4—Trenches In street must be water settled and surface Of street restored to original condition. Contractors
failure due to improper work which may develop within one year of completion.
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.
a
NOTICE:
No 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 �Eclmoncls does not warrant the
accuracy of anything set forth"on these
map(�-). Any person or entity -req uesting a
copy should conduct an independent
inquiry regarding the information shown on
tKe -map(s), including, but not limited to,
the loc'ation of any sewer stub shown. Such
sewer stubs may or may, not ex ist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
ernp-l-oyee-s o-r offiCer-�) S)hall be Halote for the
information given on this map(s), nor for
any one representation provided based
upon said map(s)..