21016 78TH AVE W.PDF6651
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CITY OF EDMONDS Permit No.
PUBLIC WORKS DEPARTMENT 00 17REET FILE Issue Date
RIGHT - OF - WAY CONSTRUCTION PERMIT
A. *Address or vicinity of Construction
21016 78 AV West
9 Owner: Waslliingten 'Nlaturaxl- Gas!, Co
Name
805 156 AV NE
Mailing Address
Bellevue, Washington 9800
City, S ta te, Zip Code
* Permit Issued To:
0 Type of Work to be Dbne: Install New Service
• Work in Connection With:
El Sub or Plat 5V Single Family
El Comml. / Ind. 0 Apt. Condo.
• Pavement Cut: El Yes 0 No
9 Contractor: Ta a g gTmeypc)w hlArPT13RAT, f--7\C COMPANY
Name
805 156 AV NE
Mailing Address iA State License Number
- Ballevu6, Washin�rton 98007 747-0650 ex 244
City, State, Zip Code Telephone Number
* * NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE * *
B. APPLICANT TO READ AND SIGN
INDEMITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds harmless
from any injuries, damages, or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made
against the City of Edmonds, or any of it's departments or employees, including or not limited to the defense of any legal
proceedings including defense, costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and materials for a period of one year
following the final inspection and acceptance of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until the final street patch is completed, at
which time a debit or credit will be processed for issuance to the applicant.
Work is to be inspected. Restoration to be in accordance with City Code. Traffic Control to be in accordance with Traffic
Section of City Code. Street to be kept clean at all times. A 24 - hour notice is required for inspection by Engineering. Call
775-2525, extension 220.
I understand that this
I
Signature:-
, , Owner or
e
t be availab V t
site for inspection purposes at all times.
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THIS PERMIT MUST BE POSTED AT THE JOB SIT FOR INSPECTION PURPOSES
CALL DIAL - DIG PRIOR TO BEGINNING WORK
C. Issued By:
Time Authoriz4/ oid after days
Special Conditions:
Ammendments:
Permit Fee:
Security Deposit:
Receipt No.:
Fund ill Fee:
Street Cut Dimensions
X
* * ��NO-
11 \W�ORK TO BEGIN PRIOR TO PERM ITJ SSQ-�6NCE.
Eng. Div. December 1978
FIELD INSPECTION NOTES
(Fund 111 - Route conv to Street Dent.
Comments:
Diagram:
Contractor called for inspection., Yes
I Bv: Date:
Nork DisaPproved By: Date:
Work Approved By: Date:
Inspector:
Eng. Div. December 1978
0
OW
APPLICATION CARD No.
for
The City of Edmonds 'R PERM[IT
TSIDE E] INSIDE ;�K REPAIRS E] EASEMENT No.
STREET FILE s"DE sEwF
/) — ?---, e 7)
...............................
OWNER ............ ;lD ................ ...................... ... CONTRACTOR .......... 7.Q.-C-X9�-r ......... ................... -------------- PERMIT No.
-5r STREET
HOUSE No. ............................................ ....... ............... ................... AVENUE LOT 'No . ................... 9
................................................... BLOCK No . ....................
17 IJ NAME ADD . ....... 4�,e..Y --- K-.#? ............ ........ .........................................
5
.2,(
,,2 3,-1 1
Date Approved:
BACKFILL WORK ORDER ISSUED .......... ........................ DEPOSIT, $ ............................................. .)�j-
------ /
SEWER WORK ORDER ISSUED ..................................... .... DATE ' / --------------
APPROVED
F EB.
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 reque sting a
copy should conduct an independent
inquiry regarding 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
employees or officers shall be liab-le for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
Call PRospect 6-1107 24 hours (Plus
N9 928
CITY OF EDMONDS Saturday, Sunday and Holidays) be -
CITY HALL — WATER -SEWER DEPARTMENT fore work is ready for Inspection.
SIDE SEWER PERMIT
IADDRESS ....... 340-212nd .. S4� .. ....................................................................................................................................................................................
................ CONTRACTOR .....
It OWNER ........ DL,11--ght ... Thanas ......................................... Wi6k6ti ... Gthdt ....... .......
III Permission is granted ........ ............ 9 19. ............ days, to REJVtr!j�jYCT a side sewer
#, for ............
with City Sewers in accorilni.?'��P' ... P't"ic"a e and governing ordinances.
0.00,
ic nSE
FE1' �
I ATTENTION IS CALLED TO THE FOLLOWING B Sewer Contraotor
h f it to cola struct sewer inside property line.
NOTE No. 1—T e owners 10 the property may obtain a perm any portion of sewer before it has been inspected.
must be emp oyed to construct side sewer in street area. Do not tover
NOTE No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side 9�VLOrADWIMhYalk54 permit.
NOTE No. 3—Top of side sower must have at least 30 inches coverage at property line and 12 inchesR%.W-X=erty 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 a original eondition, Contractors shall be responsible for
failure due to improper work which may develop within one year of compi tion.
royided for in the permit, or to do ally work on the main sewer or its ap-
NOTE No. 6—It is unlawful to alter or do any other work than is P
purtenances except to insert the pipe into the wye.