20209 87TH AVE W.PDFIIIIIIIIIIII
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20209 87TH AVE W
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City of Edmonds
RI WAY CONSTRUCTION
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wREET 17IMPERmIT Permit Number. t?r) _091,:�
Issue Date:__�"
A. Address or Vicinity of Construction: - 2ngnq gy Ay w 9515948
B. Type of Work (be specific): Install New Serv:Lce
C. Contractor: Wasqhingtnn Nat-ural GAn
Mailing Address: 1122 75 St SW -Everett
State License #: 98203
D. Building Permit # (if applicable):
Contact: Fra-rik Swart
Pho ne: 447-3284
Liability Insurance: _ Bond: $
Side Sewer Permit # (if applicable):
E. Commercial EJ Subdivision El City Project [I Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family [] Single Family F] Other
INSPECTOR: INSPECTOR: V\J
F. Pavement or Concrete Cut : 0 Yes [JNo G. Size of Cut: — x — H. Chargq,$
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmless from injuries, damages, or
claims of any 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 ofany legalproceedings including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE'YEAR F04LOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL SPREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BEPROCESSED 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 all times Or4rtgj5ection pupposes.
Signature: Date: 5-5-95
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: a V'J
TIME AUTHORIZED: VOID AFTER YS
SPECIAL CONDITIONS:
COMMENTS:
DATE:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
PERMIT FEE: 3 L) , OL)
TOTAL FEE:
RECEIPT FEE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diaaram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION 0 YES
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
E-] NO
Washington
INIatural Gas
A W,),Jv xjjrvi F n(4cry U , 4 � yr,/
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Watermain depth
gas main
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
'Engineering Aide
Washington Natural Gas
1356-7500 X7596
2-o2- ;Z->T- VQ
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Q0 C-OTS
19S I ee
Key:
-W-
Water
-G-
Gas
-SS-
Sewer
-&
Water hydrant
0
Water valve
Washington Naltiral Gas Conipan%,
1122 7501 Strect S.\V.. h-crett. Washington 98203. (206) 355-3331
NOTICE:
—ra currary.
-No'*War-rantro tached
The information'shown on the at
map(s) was compiled for use by the CitY Of
Edrnonds� its Employees and Consultants.
Th..e City of *Edm.onds does not. warrant the
accuracy of anything set forth on t * hese
rnap(�_). Any person or entity -requesting a
copy should conduct an independent
m-ation shown on
inquiry regarding the infor
ff�e -map(s), including, but not limited to,
th'e lociation of any sew-er stub shown, Such
sewer stubs may or may, not exist and may
or may not exist at the location shown.
.As nor its
Neither the city of Erlmond
empl-o-yee-s o-r office-rs -shal] be 11a-b-Fe for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
APPLICATION
The City of Edmonds
for
SlIDE SEWER PERMIT
1 5c, ,,!NEW CONSTRUCTION REPAIRS
EASEMENT No . ..........................................
OWNER..................
.............................................
CONTRACTOR ...................... .............................................................
PERMIT No.
91 . Is -7 -kA v e-
A.DDRESS .................................. .......................................................... A .......
LEGAL DESCRIPTION: LOT No. — ........................................... BLOCK No . .............................................
NAMEOF ADDITION ------------------------------------------
Le, -2
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------------- ............. - T --------------------------------------------
0
Approved:
DATE ....... ��-5 .......... B Y�- - �4 ------ 74�
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CITY OF EDMONDS
aj
— WATER -SEWER DEPARTMENT is ready for inspection. (No Inspec
CIVIC CENTER C I PRospect 6-1107 when work
SIDESEWER PERMIT Ilona Saturday, Sunday or holidays.) N2 -01334
AMPLE SS .................................................. 20209 - 87th Avenue West
......................................................................................................................................................
OWNER ........................ 13mokenshire ........................................ CONTRA OR ....... $. .�-Safe
CT 4P
Permission is granted ..... �bAIY ... Z? .................... 1 19 ... ��, for ........................ days to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing or'dinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. I —The owners of the property may obtain a permit to construct sew er 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 bonds in grade sharper than % will be permitted.
P' 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.
NUTE No. S—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.
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