20520 79TH AVE W.PDF6820
20520 79TH AVE W
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City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number. 1-7
Ttft Issue Date:
J, 3mawan �� '-/
2:L: 1A . FAILEr Vicinity of Construction: - 20520 79 Av W (9426931)
B. Type of Work (be specific): Install New Service
C. Contractor: Washington Natural Gas Company.
Mailing Address: 815 Mercer St, Ssattle,WA
State License #: ly5iil
D. Building Permit # (if applicable):
Contact: Frank Swart
Phone: 224-22789
Liability Insurance: _ Bond: $
Side Sewer Permit # (if applicable):
E. Commercial [-] Subdivision El City Project [3 Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family E] Single Family n Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut: 0 Yes §§No G. Size of Cut: — x — H. Chargq�_$
APPLICANT TO READ ANI?'91GN
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold the City ofEdmonds harmlesi fr'om injuriel, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made agbinst the City of Edmonds, or any of its departments or
employees, including or not limited to the defense ofany legal proceedings including defense costs,,�nd attorney fees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS'POn A'PERIOD OF ONE YEAR POL�()WIN THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATIONPEE� WILL 13E HELD UNTIL Ti 14JEET PA TCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BEPROCESSED 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.
I have read the above statements and understand thepermit requirements and the pink copy of thepermitwillbe
available on site at all�ti��or inspection purposes.
Signature: 7ff�&�. Date: August 26, 1994
On'tr'actor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: wkh'i-f- RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS
SPECIAL CONDITIONS: AIA
COMMENTS:
DATE:
DISRUPTION FEE/FUND 111:
RESTORATION FEE:
i-) J j
PERMIT FEE: - ,
TOTAL FEE:
RECEIPT FEE:
ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Eng�g. Div. 1991
FIELD INSPECTION NOTES
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by
Work Disapproved By:
FINAL APPROVAL BY:
P.W.:
(Fund 111 - Route copy to Street Dept.)
El YES
Date:
Date:
0 NO
to window
VA&4r—zmin depth
�wn �
gas main
Key:
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water
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gas -
-ss-
sewer
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Watex hyclrant
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watL,-.- VbLlve
?13 "Ac:rccr St. (1 0. SC&W.:, �VA S 11111206) 622.-767
The City al Edmonds
OWNER ..!�jgC.4kl CS ---------
........ C
.. ............
ADDRESS
................
2
4- if:.Jj-11 S/-Ope' 1�r
APPLICATION
for
SIDE SEV*r]M PERN"
CONSTRUCTION a--' REpAIRs 0
C'LYIV?4 PLAN
EASEMENT I -Jo . ....................
'61k,te OF
CONTRACTOR --- ------ jo;( .... ---------------------- � PERM 01
[T N
53 /-roex
LEGAL DESCRIPTION: LOT N . . .......... ........... ................... BLOCK No. .......
NAME OF ADDITION .........
Appriwed-
KOROVED
M
Al
A4,114
DATE
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 for ' th on these
map(s). Any person or entity-reque sting a
copy should conduct an independent
inquiry regardi ng the information shown on
the -map(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
emp-l-o-yee-s o-r officers s-hall be 1-ia.b.-le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS
CIVIC WATER-SUVMR DEPARTMENT Can rRospect 6-110,
Is ready for inspection when work
tio * ( sper
ns Saturday, Sun No in
SIDE SEWER PERMIT day Or bofld.X�.) -N2 2200
ADDRESS ......... Robe - r ' t '' T1 '- ' Walker
-----------
OWNER ----------- 205'2-0-----:! ---- 7-9th plac e ---" ' t ------------------------------------------------- . ...................................
. ................. .............................
Per'niss'.. is granted ---- N., CONTRACTOR ........
With City Sewers in -�Y ... 5 ................ 011mex .......
accordance '. ........... 196 7 for .... ............................
"th aWicatf -1 ........... . ....... ....................
on on file and governing Ordinances
-NTIOI'q 18 CLLED To days to REPAIR or CONNECT
4TTF
NOTE; No- I�The ow TFIE POLLOWING: side sewer
be en] nerB Of The Property zna, obtain
NOTE No. 2--Obtal PlOYed to construct side sewer 1. trepermit to construct sewer Inside Property line, A licensed Side Sewer Contractor inust
NOTE n full Information re et area. Do not cover any portion
gardlng Ordinance 11-16.030 and Of sewer before it baB been inspected.
'VO* 3--Top Of side sewer Must have at least 30 Inches Regulmtlo' governing side sewers when you get PerzMt.
NOTE NO bends In grade sharper than % will be pe,cove
NO- 4—Trenches in rage
failure due tstreet rnust be water settled and Itted. at property line and 12 Inches Inside property
XL No., ' a I-ProPer work which surface Of street line; grade Of 2%.
O—It "I Unlawful May develop with,, restored
tenances exc to alter or do any , One Year of couploetlon.
ept tO Insert the pi Other work th original c-ndit,.,, Contractors &hall be responsible for
Pe Into the wye. a" is provided for 1- the errit, Or to do any work on the Main sewer or its appur_