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City of Edmonds
WF-WAY CONSTRUCTION
ROLM PERMIT
--*7
Permit Number.
Issue Date: (b
A. Address or Vicinity of Construction: - 20324 87 Ay W (9328140)
B. Type of Work (be specific): Tn8tall New Sezvice
C. Contractor: Vlastaington NLatural. Gas CompaW
MailingAddress: 816 Mercer St, Soattlo, IJA
State License #: 981il
D. Building Permit # (if applicable):
Contact: Yrank Swan
Phone: 224-3278
Liability In rance: _ Bond: $
Side Sewer Permit # (if applicable):
E. F1 Commercial E] Subdivision El City Project (2 Utility (PUD, GTE, WNG, CABLE, WATER)
F] Multi -Family E] Single Family E] Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: 0 Yes ONo G. Size of Cut: _3(2 x 4) _ H. Chargq-$
APPLICANT TO READ AND,�
INDEMNITY. Applicant understands and by his signature to this application, agrees to, 4 t e City ofEdmonds harmlWr-q4t$-ji�,.A-age., or
--'#tments or
'e?
di
claims of any kind or description whatsoever, foreseen or unforeseen, that may be m dkainst the City of Edmonds" or any at its depar
employees, including or not limited to the defense of any legal proceedings including defense costs, and attorney fees,by reason ofgranting thispermit.
THS 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 PROCfSSED 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.
Ihave read the above statements and understand thepermit requirements and thepink copyof thepermit will be
available on site at all time�sj�nspection purposes.
Signature:
97Af 1466,9- Date: 611-tcher 19, 1991
(C5Vtr'a7tZr or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVEDBY: �pjkii&A,14
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS: hi At
COMMENTS:
RIGHT OF WAY DEPOSIT
DISRUPTION FEE/FUND Ill:
RESTORATION FEE:
PERMIT FEE:
TOTALFEE:
RECEIPT FEE:
DATE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. Div. 1991
I
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
A"
Addendum to City of Edmonds
Right of Way .
Permit Application
_.Submitted by: Guyla Connors
Engineering Aide
Washington Natural Gas
ZO-504 07 AN. W( 521-5248
NO rn
WNG to window
Water main depth
gas main
I I ZL�)-z -:--s--F
-w- water
-9- gas -
-ss- sewer
-e- water hydrant
0 water valve
815 M=cr St. (P-0. Box 1869). Scattk, WA 98111 (206) 622-6767
The City of Edmonds .—.Nlw
4,416ort7 -1
APPLICATION
for
SME SEWM PERMT
NEW CONSTRUCTION [] REPAIRS []
OWNER ...... . WIF ...................... !!��ff.40
.. 0.1 ...........................................
ADDRESS....... .... L? ...... �71- -1�4 .................. ..................... ......
e)l
09
EASEMENT No . ..........................................
CONTRACTOR. ....... PERAuT No. �/ �C5
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAME OF ADDITION .... LFI.6.64.V ..........
.... ........................... ...............................
PPROVED
C T 2 1969
Approved:
DATEI.q. .7 ... G ... .......... B;y- M -e - �- ..... . ......
NOTICE:
-.ac--c--UFa-UY---
-Nb---w-a r-r- a n. Of
The inform ation'shown on the attached
map(s) was compiled for use by the City Of
Edmonds/ its Employees and Consultants.
Th.e 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-ati - onshownon
.---t-Fe -map(s)/ including, but not limited to, -h
th'e lociation of any sewer stub shown. Suc
-not ex st and may
sewer stubs may or may
or may not exist at the location shown.
Neither the City of Edmonds nor its
empl-o-yee's o'r offi-ce-rs -sh-a-11*1 be 11a-b-lfe for the
information given on this rnap(s), nor for
ovided based
any one representation pr
upon . said map(s).
CITY OF EDMONDS
Call PRospect 6-1107 when work
CnrJ1C CENTER — WATER —SEWER DEPARTMENT Is ready for inspection. (No Inspec-
SIDESEWER PERMIT lions Saturday, Sunday or holidays.) N2 3485
ADDRESS.............. 2Q324..-:n ... Blth__Amenue --- West .......................................... . ........................... .................................................
OWNER ------------------ Wes --- Sage ------------------------------------------------------ CONTRACTOR ........... E@11M
..an .........................
Permission is granted .................. Qc-t ...... 2 ----------- 19_69., 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 % 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. 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 appur-
tenances except to insert the pipe into the wye.