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20124 83RD AVE W
t
City of Edmonds
FILE
RIGHT'OF WAY CON T
s
PERMIT 9-? 3 �"-3
Permit Number.
Issue Date:
— F A. Address or Vicinity of Construction: 20124 83 Av W (9402133)
11 89 0 9 C) B. Type of Work (be specific): Trintall NAw SAryie-A
p
C. Contractor: Washington Natural Gas Company Contact: Frank Swan
Mailifig Address: 815 Mercer St. Seattle, WA Phone: 224-2278
State License #: 96111 Liability Insurance: Bond:$
D. Building Permit # (if applicable): '
Side Sewer Permit # (if applicable):
E. E] Commercial [J Subdivision [I City Project M Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family [J Single Family E] Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: R1 Yes []No G. Size of Cut: 1 (2 x 4) H. Chargq�_$
In Asphalt w#14� @ Gas
APPLICANT TO READ A�ND81[GN
INDEMNITY. Applicant understands and by his signature to this application, agrees to the City of Edmonds ha
iaoplsl damages, or
rm
gi '-itadepartments or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be m against the City ofEd ndWrn7jf
employees, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR 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 THE APPLICANT.
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. W
Ihave read the above statements and understand thepermitrequirements and thepink copy of theperm it will be
available on;si�te �a�tlnzes fy"'rpection purposes.
Signature: Date: November 15, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY:
TIME AUTHORIZED VOID AFTER DAYS
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND Ill:
SPECIAL CONDITIONS: OVE—&—t RESTORATION FEE:
4;!s MAW PERMIT FEE:
TOTAL FEE: L
COMMENTS: RECEIPT FEE. -
DATE: ISSUED BY:
0
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. I)iv. 1991
FIELD INSPECTION NOTES
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by
Work Disapproved By:
FINAL APPROVAL BY:
L "I,
(Fund 111 - Route copy to Street Dept.)
El XES
Date:
Date:
E1,NO.,
Addendum to
4Rigb AofWaPy
Perm t Appli6ation
Submitted by: Guyka Connors
Engineering Aide
Washinqton Natural Gas
521-5248
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N14Water main depth
unknown
gas main -I -/I
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-ss- sewer
- water !iydrant
S15 Mcrcer St. (P.O. Box 1869). Sunk, WA 99111 (206) 622-6767
APPLICATION
STREET FILE for
The City of Edmonds SEDE SEWER PERMIT EASEMENT No . ........................ ..............
.... . .....
NEW CONSTRUCTION REPAIRS
4 /,0 w- 174
VNER ... )8�
OV Ai ........... ZIZ4 .. 1-..,4 ........................................... CONTRACTOR . ... ..... ... ... ... ......... ...... PERMIT N -io
- -Vj 17- - --� - - - - -
A D D R. E S S ..... /---Q ..... -,/ ....... . ......... ... LEGAL DESCRIPTIC" ....
T n— "o. .............................. .........................
............. ............ BLOCK No . ...................
NAME OF ADDITION ...... .....
Approved:
DATE.................... ............................ BY
0
NOTICE:
N'o ... W a rr a n ty —Of—a-c-c-- -u-r--a-cy.
The information *shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of �Edm.onds does not . warrant the
accuracy of anything set forth on these
map(�-)- Any person or entity'requesting a
copy should conduct an independent
inquiry regarding the Inform-ation shown on
tRe -map(s), including, but not limited to,
th'e 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
ernp-1-o-yee-s o-r office-rs -sh-a-11.1 be 11a.b.-IFe 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 inspee,
SIDESEWER PERMIT tions Saturday, Sunday or holidays.) N 4 7
ADDRESS----------_---- ZQ12.4 ... 7n ... Qard --- AwLaw�__Ngs.t ... ................................................................................................................
OVMER ..................... Ben --- Hal.1 ................... .......................... CONTRACTOR .... Hyatt ... & --- S.on.s ....... In.c ...............................
....... ........ .. ............. .. . .... .. .
Perinission is granted ----- Apr". -A_ ---------------- 19_7Q, 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. 1—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 11.16.030 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 1/s will be permitted.
NOTE 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. 6--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.