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20412 80TH AVE W.PDF111111111111 7123 20412 80TH AVE W U0, APPLICATION for The City of Edmoncli-ol SEDE SEWER PERMIT EASEMENT No . .......................................... NEW CONSTRUCTION REPAIRS 0 OV*rNER .... ............ A::�:,47 .................................................................................. ............ CONTRACTOR — ------ ....... . . ...................................... PERMIT No . ...................... C::> ADDRESS ........................................................ LEGAL DESCRIPTION: LOT No - ----- ................... BDOCK No . ....... .................................... ',N C) C-) CD-4 �-�CDP�-V-" NAMEOF ADDITION ......................................................................................................................................... Approved: DATE ... . . ... ............... .. .... .......... By ----- .......................... 16. APPLICATION The City of Edmonds for SIEDE SEWER PMN" NEW CONSTRUCT -ION REPAIRS EASEMENT No. PERMIT No. .4.6.47... OWWER ------ A .............. ... CONTRACTOR ............... ............................ ......... . 0 c q----- I -(. A ..... ....... T .... 0 .... I --.- A -- -- ----- --------------------------- SS .... to, -a ............. .... ... X ?A ADDRE LEGAL DESCRIPTION: LOT ............ BLOCK No . ............................................ ... odl .1 .............. .... ......... NAME OF ADDITION ... �j .... a�. / .................. RECEIVED MAY 2 1974 Approved: DATE ...... ......... BY ------- u 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 forth on these map(s'). Any person or entity -requesting a copy should conduct an independent inquiry regarding the information shown on ____ th-e rnap(s), including, but not limited to, the 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 employee-s or officers Shall be lialu-Ile for the information given on this map(s), nor for any one representation provided based upon said map(s). CITY OF EDMONDS - SIDE SEWER PERMIT WATER -SEWER DEPARTMENT PERMIT Call 77 -2525 for side sewer inspections BEFORE covering any portion of the construction.) Inspecti5on will be provided within 24 hours after requst. NO Sat., Sun., or holiday inspections. ADDRESS LOCATION OF CONSTRUCTION ....... 204.12...-_80.th .... AvAn.ue ... We.s.t ....................................... ....................................................... ....... . .. .. ..... .... .... .. .. .... ..... .. .. PROPERTY LEGAL DESCRIPTION ----------- LAt ... 1.0 ...... Vfno.d.va_1_.P.J4Art.h ................................................... . .......... . .......... . ........................................................................ ............... . ...................................................................................... ........ ....................................................... OWNER AND/OR BUILDER ...... 1AUCKA40rX ........ . .................................. . ....................................................... C,,�RACTOWS NAME & ADDRESS --- 3802 S ..... IA4th Washlnn-�nn ...... ............. . ....... .......... ... �..Piival 16n . ...... 4 ................. ...... ........... Z; ...................................... Permission Is granted ----------- - _A..a. ... v ..... 2 --- ............................. 19.14, for repair and/or connection of a side sewer to the city sanitary sewer systeorn in accordance with City of Edmonds ordinances. ArrENTION IS CALLED TO THE FOLLOWING: r \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. NO,i-jg No. 2—All work performed in city right-of-way requires an Invasion of Right -of -Way Permit obtainable from the City Engineer's office. NOTE No. 3—Obtalri full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit. NOTE No. 4—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. 5--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,lmay develop within one year of completion. NOTE No. 6—It is unlawf�i 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 appurtenances except to in- sert the pipe into the wye. DISAPPROVED E] Date--- By ................ Date. By ............. Date ................ ................... 'BY ---------------- B: Y:� APPROVED Date... * ..... 2..:12 77Z/ ................. ..................... . ....................................................... V A ----------------- * ------ Remarks: ....... . ....... .......................... . .. . ................................................................................................................... ................................................... ,7- V* ----------- ------ 11 ------- I ---------- - ---------------------------------------------------------------------------------------- . .................................. . ............................................. ......... BTt7n_Permit Copies Si -ed By Owner of Firm Performing Construction PRIOR To Request For Inspection _vt , I M S:: ........... .._ ........... .... hereby certify that the side sewer installation constructed under this permit (Owner of Contracting Firm Performing Construction) was installed in accordance with all governing ordinances of the City of Edmonds. ,�) V-� Dated this ..... 4C . .................. day of ...... ..................................... I 19)w. V V Check BEFORE you dig for: Water C], Gas Ej, Telephone 0, Power E], Sewer [-], Other E] -� V r --ammm— C) 9 0 _. 1 9 Cit Qr Ednibnds, Y' RIGHT-OF-WAY CONSTRUCTION., . PERMIT Permit Number. Issue Date: /- A. Address or Vicinity of Construction: - . 20412 80 AV W (9605846) B. Type of Work (be -specific): Install Service C. Contractor: Washington fttural Gas Mailing Address: 1199 75 St SW Euaxatt State License #: Contact: Mariamne Kingsbury Phone: 356-7500 X7596 Liability I=rance: _ Bond: $ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. E) Commercial F] Subdivision El City. Project Utility (PUD, GTE, WNG, CABLE, WATER) n Multi -Family E] Single Family El Other INSPECTOR: INSPECTOR: 16ILke_�k F. Pavement or Concrete Cut Mes ONo G. Size of Cut: x H. Charg4�_$ APPLICANT TO READ A IGN INDEMNITY. Applicant understands and by his signature to this qpplicati n, a �ewto hold the City ofEdmonds harmlesyrom injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, t against the City ofEd 6Zany of its dei-mrtments or employees, including or not limited to the defense ofany legalproceedings including defense costs, and attorney fees by reason ofgranting thi8permit. THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YWAR FOLLOWIVG 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 drawi�g"' 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 sh�ll 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 for inspection purposes. Signature: '24% /Ad Z 4� Y�7,1111 Z I ale: 1-5-96 aUontr`actor`-o_r)Wn-'1) CALL DJAL-A-DIG PRIOR TO BEGINNING WORK FOR CITY USE ONLY * APPROVED BY: 14 �4 'J�+ TIME A . UTHORIZED: VOID AFTER i-PbAYS SPECIAL CONDITIONS: A, COMMENTS: RIGHT OF WAY. DEPOSIT DISRUPTION FEE/FUND 111: RESTORATION FEE: PERMIT FEE: TOTAL FEE: RECEIPT FEE: DATE:. ISSUED BY: NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994 FIELD INSPECTION NOTES Comments: - Diagram.: (Fund I I I - Route copy to Street Dept.) CONTRACTOR CALLED FOR INSPECTION E] YES Partial Work Inspection by P.W.: Work Disapproved By: Date: FINAL APPROVAL BY: Date: 9 1:1 NO AV&#*VIonEr*wGmv" &T Addendum to::� City of Edmonds Right of Way Permit Application Submitted by: Mariamne Kingsbury Engineering Aide Washington Natural Gas 0356-7500 X7596 CVOO5B4( Jim% s 04�1 2, e 0 A--Y Key. .-W- Water Watermain depth Mo o-aoi c,%-rL40-0 -G- Gas -SS- Sever Water hydrant gas main .0 Water valve Washington Naitiral Gas Company 1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331