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20907 WOODLAKE
DR
8 9 0 - 1 9 9 -
City,of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number.
Issue Date:
A. Address or Vicinity of Construction: 20907 VoodLske Dr A950639216
B. Type of Work (be specific): Insta.11 New Service
C. Contractor: - Washingtou Natural Gas Qgmpagy Contact: Frank Swan
Mailing Address: 1122 75 St SW Everett Phone: 447-3284
State License #: 98203 Liability Insurance: Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable):
E. F] Commercial []Subdivision El City Project [N Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family E] Single Family E] Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut KI Yes []No G. Size of Cut: x H. Chargq_$
2- cuts
APPLICANT TO READ ANDSIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City ofEdmondsharmles8frominjuri", damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made again8f the City of Edmonds, or any of its departments or
employees, including or not limited to the defense ofany legalproceedings including defense c6sr's, and attorney fees by reason ofgrw*tting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS(FON 4,PqRIOD OF ONE YEAR,'POLLOWINR THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STRkET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THEAPPLICANT.
Construction drawing of proposed'W'Ork 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�ti�. 'or inspection purposes.
Date: 19-15-94
Signature: 4wm-dt Azzl�
�06"n't'PactLMotVA44,6a
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USk ONLY
APPROVED BY: 'r Co'�^ RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER 30 DAYS DISRUPTION FEE/FUND Ill:
SPECIAL CONDITIONS: A RESTORATION FEE:
COMMENTS:
PERMITFEE:
TOTAL FEE: 0, OC)
RECEIPT FEE:
DATE:
ISSUED BY -
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Eng. Div. 1994
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:
Naftff fA GM
AVVWwigtonEnergvCDnpcYw
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596
I
WNG to window Key:
-W- Water
Watermain depth 1%" -G- Gas
Unknown -SS- Sewer
Water hydrant
gas main 0 Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331
IMF
wv�=VYMMI
Naturil GmA�
AV,b1vVtonEnergVC6mparr-/
WNG to window
Watermain depth IS"
Unknown
-!!/±- gas main
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596
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e> C1,5 OCO -:�)q
Zoqo-7
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Key:
-W-
Water
-G-
Gas
-SS-
Sewer
-&
Water hydrant
0
Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331
UP 1 9 - -
WVC�MVV5%nI
NaturNGasw`
AV40iington EnerWComparvy
WNG to window
Watermain depth IS"
Unknown
gas main
Addendum to: City of Edmonds
Right of Way
Permit Application
Submitted by: Mariamne Kingsbury
Engineering Aide
Washington Natural Gas
1356-7500 X7596
"0
-��E!> C1.5
2-0q()-7 T>F—
Key:
-W-
Water
-G-
Gas.
-SS-
Sewer
-&
Water hydrant
0
Water valve
Washington Natural Gas Company
1122 75th Street S.W., Everett, Washington 98203, (206) 355-3331
APPLICATION
for
The City of Edmonds SEI)E SEWER PERYaT EASEMENT No . ..........................................
NEW CONSTRUCTION E REPAIRS 0
OWNER M - = r . ..................... CONTRACTOR.Boa ..... NKL-.'.N ..... . ...... PERMIT No.... 4 S-5",.?
.... .. ..... . ...... .... ................. ...... ........... ..... . ....... ..................
'9409D,07 WOOML-We%p- E)Rlya 14
ADDRESS.......................................................................................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NN00A:)L-b"--V-%F—
NAMEOF ADDITION .........................................................................................................................................
.pproved:
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