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21116 82ND PL W
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C,4TY OF.EDMONDS Permit No.
C4 I
COMMUNITY SERVICES DEPARTMENT
: 7RlGH.TL-OF-WA'YC'bNSTRUCTION PERMIT IssueDate (0
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A. * Owner: t-- hA M��iS2t�' \,- B. 9 Contractor: \/�*C- %I:-kC- \I,--
Name,.2 bLame,
VC) CE
Mailing Addres Mailing Address
NJ \0 �� " W(_� '.. 0-- 0 VL_'ba6l \ - W '-_\ , 9 �' 0-1
City State Zip City State Zip
1_0�x C__�' C- \r_� 4--'t 0 <=— q g S - �L st"
. State License Number Telephone Number
C. * Address or Vicinity c
Type of Work to be
El Single Family El City Projects
F/I
D. 0 Work in Connection With:
_NZYmercial 11 Multifamily tility
E. 0 Pavement Cut: 0 Y El N F. 0 Size of Cut: — X
APPLICANT TO READ AND SIGN
INDEMNITY: 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, forseen or unforseen, 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, court costs, and attorney fees by reason of granting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR FOLLOWING THE FINAL INSPECTION ANDACCEPTANCE OF THE WORK.
Estimated restoration fees will be held until the,
'/ 11 �- _ final street patch is completed by City forces, at which time a debit or credit will be
processedfor issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with ' City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS. /1"
I understand t e above and that this permit must be avapable at the job site for inspection purposes at all times.
Signature- Date:
Owner o Contractor
T is Permit Must be Posted at the J o*b Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
61 //) .1; 1
APPROVED BY: 'n / r ri AxAx,,1 i
Time Authorized: Void after 30 'days
Special Conditions:
PERMIT FEE: 4-
Restoration Fee:
Receipt No.: -
Fund I I I Fee:
Street Cut Dimensions: — - — = S
RELEASED BY:'�_ Date INSPECTED BY Date
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. March 1989
FIELD INSPECTION NOTES (Fund I I I - Route copy to Street Dept!)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July M5
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APPLICATION
44
is
The City of Edmonds for EASEMENT NO . ............................................
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS F-1 LID NO - ------------------ ASMT. NO - ------------------
OWNER .... ------- 7 ------ c- CONTRACTOR --- --------- . . ..... NO.
= kCE:)
JOB ADDRESS LEGAL DESCRIPTION: LOT NO - -------- ----------------------------- BLOCK NO . ....................................
..................................................................................................................................................................
NAME OF ADDITION ...... Y.-,F .. ....... f � -� c:: � � �-. --------------------------------------------
Approved:
DATE...... . loy-e& .................... ------------------------- ------- ---
77 YUY!Y
The City of Edmonds
APPLICATION
for
SIDE SEWER PERMIT
EASEMENT NO . ...........................................
NEW CONSTRUCTION REPAIRS LID NO . .................. . ASMT. NO . ..................
OWNER ------- _2--164-k
17 1 -------------- CONTRACTOR ----------- ------------ PERMIT NO.
JOB�J'� ........... .. .
ADDRESS -Z:� --------------- --------- z ------------------ LEGAL DESCRIPTION: LOT NO.
-------------------------------------- BLOCK NO - ---------
E
--------- -- --------------------------------------------------
---------------- ------------------------------------------------
NAME OF ADDITION
Approved:
DATE............................................ By ---------------------------------------------------
NOTICE:
N'o ... warranty of a:ccuracy.
The -information'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of �Edm.onds does not * warrant the
accuracy of anything set forth on these
map(§-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
Fe -m a p (s) . including, but not limited to,
th-e 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
e rn p-'I- o-y e e-s o -r o ff i *c e,r s -s h. a. 'I I b e 1`1 a. b..11..e f o r -,I h e
information given on this map(s), nor for
ion pr *ded based
any one representat' ovi
upon . said map(s).
SIDE SEWER PERMIT '�4
CITY OF EDMONDS
WATER -SEWER DiPARTMENT
PERMIT
Call 715-2525 for side sewer inspections BEFOJ�E covering any portion of the construetton-N
ter requst. NO SaA., Sun., or holiday inspections.]
(Inspection will be provided within 24 hours af
.................. .............. ................ . ........... ...........................................
ADDRESS LOCATION OF CONSTRUCTION ------- ......
.57-1, /::� ......... �Zlz ---------------------------------------------------------------------
PROPERTY LEGAL DESCRIPTION .............. 4�� ............... . ..................................................
...................... . .......................... . .......... . .. ....... . .......................................................
......................................
OWNER AND/OR BUILDER --------------
........................... ... 7 ----------------------------------------- I ----------
CONTRACTOWS NA1VIE & ADDRESS ------- - sanitary sewer
Permission Is granted ....... ................... . ....... ig.70, for repair and/or . connection of a side sewer to the City
system in accordance with City�f Edmonds ordinances-
ATTENTION,js CALLED TO THE FOLLOWING: to construct sewer inside property line. A licensed Side Sewer Contractor must be employed to construct
NOTE No. 1—The owners of the property may obtain a permi it has been inspected.
- side sewer In street area. Do not cover any portion of sewer before t obtainable from the city Engineer's office.
NOTE No. 2—All work performed in city right-of-way requires an Invasion of Right-of-way Permi a when you get permit.
Ing Ordinance 11.16.030 and Regulations governing side sewer rty line; minimum grade of 2%. NO, bends in grade
NOTE No. 3—Obtain full information regard es coverage at property line and 12 inches inside prope
NOTE No. 4—Top of side sewer must have at least 30 inch nsible for failure due to improper
I shaxper than % will be permitted. are of street restored to original condition. Contractors shall be respo
NOTE No. 5—Trenches in street must be water settled and surf
work which may develop within one year of completion. the permit, or to do any work on the main sewer or its appurtenances except to in
NOTE No. 6--It is unlawful to alter or do any other work than is provided for in
sert the pipe Into the wye.
By---------------- Date ............... - ----- ............ By ................ Date --------------- - ------------------- - By ----------------
DISAPPROVEDDate --- - ----------------------------------- -------- - ----------- * ............................................
APPROVED a t e... �; A/% ....................... BY ... . ....... ....................... .........................................
/. ..................................... ........................... .......... . .............. . ..........
Remarks: -------- ------ --------- -------------------------------------------
........................................ * ................. ........................................................................ . .............. . .................................. . ... ...................................................
A— gned Owner of Firm Performing Construction PRIOR To Request For Inspection
B PermitjUopie ST
hereby certdy that the side sewer installation constructed under this permit
- - - -------- ------
.......... . e . r ..... .. - in " Fj' 7n -'Per " ming --- constru ' ction
nt Wit
was installed c dan h all governing ordin - antes�o I f the City of Edmonds.
...... 119 .....
Datedthis ............................ day of ..........................................................
Telephone E], Power E], sewer 0, Other
Check BEFORE YOU dig for: Water F1, Gas
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BUILDING DEPARTMENT Ap$44161 &
PERMIT APPLICATION Inside Heavy Lin
NAME (OR NAME OF BUSINESS)
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0 CITY ELEPHONE NUMBER
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NAME
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NAME
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U -TATE LICENSE NUMBER CITY LICENSE NUMBER
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Legal Description of Property (Show Below or Attach Four Copies)
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WSE , I PERMIT
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ADDRESS
SUBDIVISION NO. I PLAT NAME I ASSESSOR MAP NO.
PUBLIC RIGHT OF WAY PER ORDINANCE NO.
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EXISTING RIGHT OF WAY
15(o
PROPOSED RIGHT OF WAY
DEFICIENCY OF RIGHT OF WAY
40
STREET/UTILITY WORK REQUIRED
OYES
NNO
PERMIT FOR WORK IN PU13LIC R/W
OYES
NINO
UNDERGROUND WIRING REQUIRED
IN YES
ONO
CONNECTION TO SANITARY SEWER
nyES
ONO
SEPTIC TANK PERMIT REQUIRED
OYES
ANO
SEPTIC TANK PERMIT NO.
SEE MEMO DATED
REMARKS
1,114-
CHECKED BY I
% L tj Ar 1 1 111pri 1
METEZ,SIZE , f [WUILDING SUPPLY SIZE
REMOR14S
SIGN AREA : I COMPSNV. REVIEW PT ADD NO.
ALLOWED I PROPOSED LETE I EXEM I
REMARKS
VARIANCE OR CU
NE
FSW
RE GAS
SIDENTIAL LINE
NON-RESIDENTIAL SIGN
I JE1
YARDS
FRONT
FIRE ZONE
7
F] ADD
ALTER
DEMOLISH
EXCAVATE
OR FILL
RETAINING
WALL
FENCE
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FT)
El
SPECIAL INSPECTOR
REQUIRED
0 YES 0 N 0
PLAN CHECKED BY
El REPAIR
PRE -MOVE
1:1 INSP.
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POOL
NUMBER OF STORIES
NUMBER OF
REMARKS
DWELLING
UNITS
NATURE OF WORK TO BE DONE
Me.
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F -
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5T—PLAN (I&DICATE DUILDIISG SETBACKS,
ABUTTING STREETS)
c, e- c
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
FENCE
SIGN
RETAINING WALL
PLANNING REVIEW BY I OAT
if OT COVERAGE
71k SIDE 16 REARI
OF CONSTRUCTION I CODE 1HEIGH7
'k OCCUPANCY OCCUPA
GROUP LOAD
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THIS SITE IS LOCATED IN THE CITV
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
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SW!MMING POOL
FILE
ST�EET
DATE.
MEMO TO: Building Division
Community Development Department
FROM: Engineering Division
Public Works Department
SUBJECT: 2pioitiv*� 2nou ct 6A MIFF
After review of'the subject building permit application, we have
the following comments:
(1) Coordination of the location of any structure with respect to
utilities, streets, propeHFy lines and driveway grades is the
responsibility of the contractor.
(2) The contractor, is required to keep the abutting streets clean-
ed of dirt and debris caused by the construction.
(3) A "Right-of-Wav Construction Permit" is required, from the
Engineering Division of Public Works, for any work within
the Public Riglit-of-11,lay or public easement.
(4) Driveway.slope not to exceed 14%.
(85 _2 Co N N WM M To SAN I TArrLY GE)N= I?f*() I WO
(G) Art _L W I Mcs 132 P--& riva� WO 0-
PW 5/77
%
PUBLICUORKS DEPARTMENT CHECKLIST
BUI1DING PERMIT REVIEW e2NOPI, W
(adEess) (date)
0
Street Right -of -Way Existing_ -57n/f5 n
Z
Access Easements Existing___U D&)JE�_r
_jEQD
REQD
p4
Utility Easement Existing&�'�—!>���J
�O�J��REQD
Lot Per Subdivision Plat
Assessor Map___=
Site Plan Checked for Accuracy,
Z
Underground Wiring Reqd.
0
Check Accuracy of Legal Description
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Review by Uinl map
Date 411
Existing Water Main Size
Water Main Required /,JO
Service Line Required S141
Hydrant Size Existing
P4
Hydrant Reqd Per Fire Code
Size
Detector Check Meter Reqd.A,)D
Cross Connection Inspection 41D
Fire Department Comments
Water Meter C'h'a'rge Reqd.
Review by. Q fig -
Date
Septic Tank Design Approved
Date
Septic Tank Permit Reqd._
Permit No.
Sanitary Sewer Availability
Proj.
Drawing No.
-----,--File No.
C4
Side Sewer Availability ;�:O
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Sanitary Sewer Connection Fee Reqd.
�3:
Review by W/S
Date
J(A.K.
.1
Open Ditch Existing
Reqd.
Culvert Reqd.
Size
P�
Catch Basin Reqd.
Indicate on Site Plan
0
Shoulder drainage mainLin' collection
on swale open runoff
Manhole reqd.
Indicate on Site Plan
v
Soil Conditions and �round Water Field Checked
Review by
Date
Revised: lvlO-1977
Page 2
Street Paving Reqd. I&Aff--
Curb-and Gutter Reqd.
Sidewalk,�Reqd.
Curb Cut for Driveway Reqd:
g4 Right -of -Way Construction Permit Reqd.
Bond Reqd. for tublic In-provenrnts
Street Nam SigrY,Reqd.. 4AL
Other Signing Reqd.
Pre Permit Site Inspection made on
0
F4 BY: SEWER
E-4
0
W WATER
P4
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F-4
ENGINEERING P--.-) K)
Special Requirements listed in nem to Com=ity DevelopTwnt Department,
Building Division
BY F'13 N Date
o All item filled in on Building PernrLt Application 4 124,1,7
P4 BY Date
Drawings Stanped and Notations -Made
P4 BY b NJ Date
Approved by Public Works Department
Fevised: 1v 10-1977
FILE
TREE
S
PUBLIC WORKS DEPARTMENT CHECKLIST
BUILDING PERMIT REVIEW e2m P1 W
(addres7s
41-24 11A_
(dat e-)
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Street Right-of-14ay Existin REQD_
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Access Easements Existing___Lj��...�REQD__LL&_
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Utility Easement Existing_A5?��
��JO��)��REQD
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Lot Per Subdivision Plat
Assessor
Site Plan Checked for Accuracy
Underground Wiring Reqd.
Check Accuracy of Lega Description
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Review by�
Date 411 IS
Existing Water Main Size -
Water Main Required /J 0
Service Line Required 13/1-/
Hydrant Size Existing
Hydrant Reqd Per Fire Code
Size
Detector Check Meter Reqd. A,)O
Cross Connection Inspection 41D
Fire Department ConTnents
'dater 1,16-ter Charge qd.
Review by--;�,,;-
Date 4112-1 Z?Y
1
Septic Tank Design Approved Date
Septic Tank Permit Reqd.-
Permit No.
Sanitary Sewer Availab' ty —14�1
Proi.
Drawing No.
File No.
Side Sewer Availability /-rZD
Sanitary Sewer Connection Fee Reqd.
:3:
Review by
Date
Open Ditch Existing
eq
_�Req
:V
Culvert Reqd.
Size
04
Catch Basin Reqd.
Indicate on Site Plan
0
Shoulder drainage maintain collection an swale open off
run
Manhole reqd.
Indicate on Site Plan
Soil Conditions :ind.Ground Water Field
Checked.
Review by
Date
Revised: IVIO-1977
W W
BUILDING DEPARTMENT Applicant Fill
USE PERMIT
ZONE NUMBER
PERMIT APPLICATION Inside Heavy Lines
d4
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ADDRESS V
NAME (OR NAME OF BUSINESS)
SUBDIVISION NO.
PLAT NAME
F14T
J�SSESSOR MAP NO.
w MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER ORDINANCE NO.
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CITY
T ELEPHONE NUMBER
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EXISTING RIGHT OF WAY
PROPOSED RIGHT OF WAY
NAME—
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DEFICIENCY OF RIGHT OF WAY
W ADDRESS
STREET/UTILITY WORK REQUIRED DYES a N 0
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PERMIT FOR WORK IN PU13LIC R/W El YES 1P NO
UNDERGROUND WIRING REQUIRED YES 0 NO
M CITY
TELEPHONE NUMBER
CONNECTION TO SANITARY SEWER EYES 0 r-jo
SEPTIC TANK PERMIT REQUIRED DYES 45NO
NAME
SEPTIC TANK PERMIT NO.
0 ADDRESS
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SEE MEMO DATED
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CITY
TELEPHONE NUMBER
REMARKS
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STATE LICENSE NUMBER
CITY LICENSE NUMBER
CHECKED BY
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JAVUQ
Legal Description of Property (Show Below Or Attach Four Copies)
,(FUILDING SUPPLY 777
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INIETEZSIZE
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SIGN AREA ENV. REVIEW ADB NO.
ALLOWED I PROPOSED I COMPLETE I EXEMPT I
REMARKS
VARIANCE OR CU IPLANNING REVIEW BY I DATE
NEW
GAS
RESIDENTIAL LINE
IEJ
YARDS
FRONT
FIRE ZONE
TV
:] NON-RESIDENTIAL
SIGN
ADD
ALTER
El DEMOLISH
EXCAVATE
OR FILL
RETAINING
DWALL
FENCE
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PECIAL INSPECTOR
REQUIRED
0 YES El No
PLAN CHECKED BY
0 REPAIR
El PRE -MOVE
INSP.
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NUMBER OF STORIES
NUMBER OF
I REMARKS
DWELLING
UNITS
NATURE OF WORK TO BE DONE
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PLAN CHECK FEE
PROPOSED USE
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PLOT PLAN (INDICATE BUILDIOIG SETBACKS,
it
ABUTTING STREETS)
BUILDING
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PLUMBING
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MECHANICAL
FENCE
SIGN
RETAINING WALL
SWIMMING POOL
LOT COVERAGE
SIDE /5'.REARI
INISTRUCTION I CODE 1HEIGHT
AREA OCCUPANCY OCCUPANT
I GROUP I LOAD
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31.04.
VALUATION I FEE
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Notes:
1. All signs and spacing to conform
to the MUTCD and City of Edmonds specs
2. Channelizing devices are 28" traffic cones.
3. Alert affected residents.
4. All signs are 48" x 48" B10 unless
stated otherwise.
5. Work area is 103's/o 6/1211 PL SW
OV314V
avo-d
Pilchuck Contractors, Inc.
Job #107017217
26 July 03
Sheet 1 / 1
J. Buss
National Barricade Co.
(P
N
P
211 PL SW
CHANNELIZING DEVICE SPACING (FEET)
TAPER IT
20
V 0
z
N TO
SCALE
I LEGEND I
WORK AREA
281. TRAFFIC CONE
EXISTING TRAFFIC FLOVY
'3Z SIGN LOCATION
PROTECTIVE VEHICLE
MD OR WORK VEHICLE
Permit N
City of Edm6nds, o:
/1 8 —.'� 0 —0
RIGHT-OF-WAY CONSTRUCTIONFERMIT issue Date:
A. Address or Vicinity of Construction: G. ?z
Z
B. T e of Work (be SDOCifiO.-To I y\3�-C%'\' DORE-Ti M Cx% n (3 n
p 11
to -,�Pom )Oto3' ±p CIL 04 C:�I' I
QL 3W
C. Contractor: PnE 1 0, 64 Contact:,SIAQ &1(�A PQfi Uif S-S
MailingAddress: )3'__�N_) 'i Phone: C90(y - L) Fr 62n(o
State License fl(!� Liability Insurance: Bond: $
D. Building Permit# (if applicable):. Side Sewer Permit # (if applicable):
"7
E. El Commercial El Subdivision E] City Project EJ EUC (PU�P,-VERIZONj PSE, AT& T, OVWD)
EJ Multi -Family Single Family, Other
INSPECTOR:
F. PAVEMENT CUT: 52 YES El NO G. SIZE OF CUT X
CONCRETE CUT: YES NO
AN'LICANTTO IZEAI) ANI) SIGN
INDEMNITY. Applicant understands by his/her signature to this application helshe holds the City of Edmonds harmless ftom
i ' nj . uries, damages oe, claims of any kind or description -whatsoever, foreseen or unforeseen, that may be made against the City Of
Edmonds or any 6�its departments or employees, including,but not limited to the defense of any legal proceedings including defense
costs and attorneyfees by reason ofgrqnting this permit
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLL097NG THE FINAL. -
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES KILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BYCITYFORCES, AT WHICH TIMEA DEBITOR CREDIT KILL BEPROCESSED FOR ISSUANCE TO THEAPPLIC4NT.
* Traffic control and public safety shall be in accordance.with City regulations as required by the City Engineer. Ever
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training'in their possession.
* Restoration is to be in accordance with City codes. All street�cut trench work shall be patched with.asphalt or City -
approved, material prior to the end of the workday — NO EXCEPTIONS.
Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ THE ABO VE STA TEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND A CKNO WLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Signature: IC�� Date: 3-,
(Contractor or Agent)
FOR CITY USE ONLY
Approved, by:, McCall �'-
Right-of-1way fee: +
Time Authorized: Void'After 1:24 Disruption Fee/Fund -111:
Special Conditions:. IAWIWi�W 6' ff:99 01M4 Restoration Fee:
Tlotaffee:
Receipt No-.'
Issued by: J
01-CW G-fftWDftM-X' 4 "WW�� 1_0
A Vv�U -PON-'COM-Ph4E"TIO'N'-�-'O#'�j?ttMlw�T�tkii'WbRK, AN ENGINEERINljF'INAL
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE'EDMONDS
COMMUNITY DEVELOPMENT CODE (Phone 425-771-0220, Ext. 1326)
FINAL APPROVAL OF PERMITTED WORK.- DATE:
Inspect,or's.Signature
For inspection requirements see Engineering InspectionInformation handout.
t
NO WOIZK SHALL 131',GIN NZ101Z TO 1'E1ZMrr ISSUANCE
DAMy Documents\Forms\Engnmg\ROWpermit_.doc
1998 OJ'S
PROPOSED 1 1/4" MPE—IP MAIN
OR
E.O.M.
1 1/4- MPE CAP
136-S, -W CA
.1
STANDARD GAS CONSTRUCTION NOTES,
I . FIELD LOCATE ALL UNDERGROUND UTILITIES. CALL "ONE —CALL" TWO WORKING DAYS PRIOR TO CONSTRUCTION. IN
WESTERN WASHINGTON CALL: 1-800-424-5555. IN KITTITAS COUNTY CALL: 1-800-553-4344
2. ALL CONSTRUCTION IS TO CONFORM TO PSE GAS OPERATING STANDARDS AND GAS FIELD PROCEDURES.
3. EROSION AND SEDIMENT CONTROL SHALL BE PER PSE STANDARD PRACTICE 0150-3200 TECHNIQUES FOR TEMPORARY
EROSION AND SEDIMENT CONTROL AND ANY ADDITIONAL LOCAL JURISDICTION REQUIREMENTS.
4. NOTIFY PROPERTY OWNERS ADJACENT TO PROPOSED CONSTRUCTION ACTIVITIES A MINIMUM OF TWO WORKING DAYS
PRIOR TO BEGINNING CONSTRUCTION. USE IST TO DISTRIBUTE FLYERS IF JOB IS LARGE. OTHERWISE HAND
DELIVER FLYERS BE SURE TO INCLUDE THE LIST OF FREQUENTLY ASKED QUESTIONS AND INFORMATION ABOUT
THE OPPORTUNITY TO PURCHASE AN EXCESS FLOW VALVE WHEN THEIR SERVICE IS ISNTALLED OR REPLACED
PER GAS OPERATING STANDARD 2550.1600. ALLOW ADEQUATE TIME FOR CUSTOMER DECISION AND RESPONSE.
5. ANY CHANGE IN ROUTE, TIE—IN METHOD OR ADDITIONAL MAIN FOOTAGE MUST BE APPROVED BY PSE GAS ENGINEERING
SERVICES.'
6. COMPLETE "PIPE CONDITION REPORT" ON ALL EXPOSED EXISTING PSE FACILITIES. CHECK BOX ON REPORT FOR WIRE
BOX (TEST LEAD) INSTALLATION.
7. ACTIVE SERVICES DENOTED BY:
8. PIPELINE MARKERS AND WARNING SIGNS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS
OPERATING STANDARD 2525.2500.
9. VALVE MARKERS SHALL BE INSTALLED AND RECORDED BY THE CONTRACTOR PER PSE GAS OPERATING STANDARD
2525-2600 FOR ALL HP VALVES IF THE LOCATION IS NOT REDILY ACCESSIBLE, AND FOR ALL VALVES WHERE
PERSISTANT SNOWFALL MAY OBSCURE THE VALVE BOX
10. TO PREVENT ACCIDENTAL OVERPRESSURE 'OF ADJOINING SYSTEMS, NO TWO MAINS SHALL BE CONNECTED EXCEPT AS
SHOWN ON THIS DESIGN UNLESS APPROVED BY PSE GAS ENGINEERING SERVICES.
11. SYSTEM MAOP DENOTED BY:JSYSTEM MA5P = 45 PSIG
112. GAUGE AND MONITOR USE OF ALL STOPPERS TO ENSURE ADEQUATE FEED.
13. RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION.
14. GAUGE AND MONITOR USE OF ALL STOPPERS AND SQUEEZES TO ENSURE ADEQUATE FEED.. (USE MANOMETER FOR
LP SYSTEMS)
15- RESTORE ALL DRIVEWAYS SUBJECT TO OPEN CUT TO ORIGINAL OR BETTER CONDITION-
i
16. PURGE POINTS AND PRESSURE TAPS TO BE INSTALLED PER P,SE GAS OPERATING STANDARDS 2525.3400, AND 2525.1200.
FITTER (Check Box if Complete)
• WORK AREA LEFT IN CLEANISAFE CONDITION. El
• COMPLETE ALL PIPE TABLES AND GAS PRESSURE STAMP, El
• FIELD CHANGES RED —LINED ON AS—BUILTS. El
o MATERIAL VERIFIED AND CHANGES NOTED ON PAPERWORK. 1:1
• ALL VALVE AND TIE—IN LOCATIONS NOTED ON AS —BUILT. El
• NOTE BEGINNING OF MAIN, EOM,& LINE OF MAIN LOCATIONS. El
Is SHOW ROPE LOCATIONS & CUL—DE—SAC RADIUS Cl
Fitter's Signature
Company Employee ID#
GAS MAIN INSTALLATION/RETIREMENT
Type/Work
Pipe
size
Type
Estimated
Length
Actual
Length
Manufacturer
INSTALL
11/4"
MPE
30'
GAS
MAIN PRESSURE
& TESTING -----
TYPE TEST
PRESSURE
TESTED BY
DATE ON
TIME ON
DATE OFF
TIME OFF
TYPE TEST
PRESSURE
TESTED BY_
DATE ON
TIME ON
DATE OFF
TIME OFF
IDesign Press 60
SYS MAOP 45
PROJECT PHASE
NOTIF#
ORDER#
I
SAP Superior
Service/Meter
Service/Meter
Service/Meter
Service/Meter
Ind. Service
Ind. MSA
Dis. Reg./FT
HP Svc/MSA
Relocate
lRetirement
X457709626
107017217
X295370342
106111291
contractor. CONSTRUCTION COST CODES:
031-103-1
Project Manager Contact Information:
PATTINESS
CELL: 425-327-2783
Vicinity Map WORK
ITE
5 14
Ilk,
C)
2121TH ST SW ; 4
0
Ld
21,
Owner / Developer Contact Info
THONG TRA
21116 82 PL W
EDMOND, WA 98026
ATTN: THONG TRA offloe
9b
CALL (800) 424-5555
2 BUSINESS DAYS BEFORE YOU DIG N
THIS SKETCH NOT TO BE RELIED UPON FOR EXACT LOCATION OF FACILI TIES I t-
REAL ESTATE/EASEMENT PERMIT
N/A EDMONDS
REV# DATE BY DESCRIPTION FUNCTION __�_ �GUNTACT PHONE DATE
3 PROJECT MGR1 PAT-rI NESS 206-418-4237
2 ENGR — GAS
1 DRAWN BY
'OUNTY
SNOHOMISH
1 /4 SEC
SE-19-27-04
AER SECT
4
P MAP
160-068
CHECKED BY
GAS WK CTR APPROVED BY
MCNSEG FITTER #1
PLAT MAP 163-069 IFITTER #2
IMAPPING
JOINT FACILITIES ARRANGEMENTS
PHUONG DAO
PATTI NESS
PATTINESS
UTILITIES
CONTACT
PHONE#
PUGET 1 1/4" MPE-IP MAIN EXT.
SOUND
ENERGY 21116 82 PL W, EDMONDS, WA 98026
(THONG TRA)
DESIGNED BY PILCHUCK CONTRACTORS INC.
2064118-42118 7/19/03
206418-4237
2064IB4237
1 07017217
SCALE: AGE:
III = 50, r /I
I