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CITY OF EDMONDS 5,]AffT F1L&rca:,,:,,
COMMUNITY SERVICES. DE.
RIGHT-OF-WAY CONSTRUCTIO N PERMIT AW 2
A. 0 Owner: Washington NAtural Gas Company B.
Name
815 Mercer Street
1,1,aili ddre,,
e e
ale WA 98111
City State Zip
Permit No. !?/-c2 9),/
Issu e Date ?--c23- 2/
Name
Mailing Address
City State Zip
State License Number Telephone Number
C. * Address or Vicinity of Construction: . 19915 81 Place West
Type of Work to be Done: Install New Service
D. 0 Work in Connection With: 0 Sub or Plat 0 Single Family 11 City Projects
0 Commercial 0 Multifamily IR Utility
E. 0 Pavement Cut: D Y 0 N F. 0 Size of Cut: — X
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signaturi��to this application-, igrees to hold the City of Edmonds
harmless from any injuries, damages, or clai S Of ankkK"nd or description wfiatsoever, forseen . or unforseeft, that may
be m ijolees including or not limited to the defense
s P
ade against the City of Edmonds, or an7yof it partme - s m
Ir ft
of any legal proceedings including defense costs, cou sts, Id 9ne) Xes'by reason of granting this permit.
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 time a debit or credit will be
processed for issuance to the applicant. A
0 A 24 hour notice is required for inspection; Please call Engineering: 771-3202
9 Work is to be inspected during progress and at completion.
6 Restoration to be in accordance with City Code.
0 Street to be kept clean at all times.
* Traffic Control to be in accordance with City regulations.
0 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.
Signature:
M�� MI'd Z
Owner or Contractor
Date: August 20, 1991
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior.to Beginning Work
APPROVED BY: RW
Time Authorized: Void after N EAM— days.
Special Conditions: 14 0 C---,-rS
RELEASED BY: _1
PERMIT FEE:
Restoration Fee:
Receipt No.: —
Fund I I I Fee: —
Street Cut Dimensions
Date INSPECTED BY
NQ WORK TO BEGIN PRIOR TO PERMIT IS.SUANCE
x V =$
Date
Eng. Div. March 1989
FIELD INSPECTION NOTES
Comments:
Diagram:
(Fund I I I - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July 1985
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Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: Kerry Walsh
Engineering Aide
Washington Natural Gas
622-6767 x2761
pager 995-6914
�'Io cu-Ts -
-w- WCLL.=L
-g- gas
-ss- sewer
-e- water hydrant
0 water valve
815 Mercer St. (P.O. Box 1869), Seattle, WA 98111 (206) 622-6767
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
rnap(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
�___tFe -map(s), including, but not limited to,
th . e loc'ation 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
ernp]-oyee-s o-r offiCle-r-'s -shall be Hla-b.11-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
The City of Edmonds
PPLICATION
for
STREET FIL� SEVVER PERAM
OUTSIDE E] INSIDE E] REPAIRS
LYNR PLANT CARD No . ......................................
ASEMENT No . .....
/—/p
.......................... CONTRACTOR .......... xy 4.101 .....
OV*rNER ........... 11 ......... .................. * -------- ------ -------- PERMIT
;�4 ........... ------- V, r
STREET
. ..........
HOUSE No . ..... ---------- . ....................................... ............ AVENUE 140T No . ........ ............................................ BLOCK N;.
--- ---- ------
PWVED
B 6 1967
tLi
Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ ............................................. ;
t& 7.
...........
SEWER WORK ORDER ISSUED .......................................... DAT] . . ............... �/ .............. 7 .....
-
By ... .....................
F
CITY.! -OF EDMONDS.
Call PRoipeet 64107 vAel!" Nv6rk
CIVI[C CENTER—WATERrSEWER DEPARTMENT is'ready for inspection (No insPec- '575
tions Saturday, ISun-day or holiddis.) N -0
� 4DE --SEWER PERMIT
, So.
ADDRESS ............... 1.991.5 --- ----- 8.1s.t ... Pla!zq ... V .............. .........................
............................................................................
................................................................. CONTRACTOR ..... MCW.q_Jn.cA ...................................................
P . eriiiissi . on. Is a sebruary for ..................... . days toREPAIR or CONNECT a side sewer
gi nted ................... ................
w1iWCity S(46is. In accordance with application on file and governing ordinances.,
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1�fhe* owners of the property may obtain a permit to construct sewe ' r 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 11.16.030 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, f2- inches Inside property line; minimum grade of 2%.
No bends.,in-.grade sharper than % will be permitted. -
NOT E. 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. 1
NOTE No. 5--It Is un lawful to alter or do any other work than is' provided for in the permit, or to do any work on the main Bower or its ap-
purtenances except to -insert the pipe into the wye.