20504 86TH PL W.PDF111111111111
8226
20504 86TH PL W
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number.
/7
Lssue Date:
A. Address or Vicinity of Construction: �—Ln <-1 G
/17 B. Type of Work (be specific): A�"
C. Contractor: Contact:
Mailing Address: 61 61, Phone:
State License #: Liability Insurance: Bond:$
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable):
E. E] Commercial [_1 Subdivision
. E] Multi-Farnily E] SingleFamily
INSPECTOR:
F. Pavement or Concrete Cut : D Yes 0No
El City Project Tt:!;
Other (PUD, GTE, WNG, CABLE, WATER)
INSPECTOR: I
G. SizeofCut. X_ H. Chargq�_$
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application to hold the City of Edmonds harmlessfrom injuries, damages, or claims ofany
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 of any legal proceedings including defense costs and attorneyfees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC-
TION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREETPATCHIS COMPLETED
BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT
Two sets of construction drawings 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 trench work shall be patched with asphalt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I have read the above statements and understand the permit requirements and the pink copy of the permit will be'
available on site at all timesfor inspection purposes.
Signature:
(Contractor or Agent)
Date:
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY. RIGHT OF WAY FEE:
TIME AUTHORIZED: VOID AFTER 17 DAYS DISRUPTION FEEIFUND I 11:
SPECIAL CONDITIONS: RESTORATION
-T OTAL FEE: D . ......
0(
RECEIPT NO.:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div 1997
FIELD INSPECTION NOTES (Fund 111 - Route copy to Street Dept.)
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION NO
Partial Work Inspection -by P.W.:
Work Disapproved By: Date: .
FINAL APPROVAL BY: Date:
NOTICE:
Y".
No war -ran' y ... 0
on the attached
shown
The information
map(s) W3S cOmPiled for use by the City Of
Edmonds, its Employees and Consultants.
nds does not warrant the
The City of 'EdmP
t forth on these
cy of anything se
accura
entity -requesting a
map(�_). Any person or
copy should conduct an independent
iry regarding the information shown on
inqu'
ot J I mited to,
Including, but n
tT�e -rn a p (s)
-h
the lociation of any sew-er stub shown. Suc
exist and may
sewer stubs may or may
or may not exist at the location shown.
Neitheir the City of Edmo'nds nor its
empl-o-yee-s o-r office-rs -shal] be Viab-Fe for -41-he
information given' o.n this rnap(s), nor for
e representation provided based
any on
upon said map(s).
APPLICATION
SINEET FILE for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No.21/zI.T.7. ..............
NEW CONSTRUCTION E] REPAIRS
OWNER -k-E�SLL.Z: ......... ............................... CONTRACTOR .......... — -- — - ------------------------------------------- PERMIT No.
ADDRESS ....... .......................... LEGAL DESCR=ION: LOT No . ........... q ............................... BLOCK No. . .......
NAMEOF ADDITION ............................................................................................................ . ...........................
po��04 ycr, 7 >
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APPROVED
SEP 16
Approved:
........ By .... �
CITY OF EDMONDS
CIVIC CENTER — WATE'R-SEWER D . EPARTMENT Call PRospoct 6-1167 when work
Is ready for inspection. (No Inspec-
tions Saturday, Sundav or holidavp.) N2
SIDE SEWER PERMIT R) :14Z
ADDRESS ............... Za.5.0_4 ... . .... 8.61h.-..P.1a.c.e ... W.es.t
OWNER ................. ..Le.s.l.ie .... Kri.sPl.oZo ................................ CONTRACTOR ........ 0Yne.r ......................................... .... .. .
.... .. .. .... ....... .. .. ....... .. . . . .........
Perinission is granted ................. agk�-! ...... 19.�P_ 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. I —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 axea. Do not cover any portion of sewer before It has been inspected.
NOTE No. 2—Obtain full Information regaxding 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 'A will be permitted.
NOTE No. 4—Trenches in street must be water settled and surface of atreet 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.