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212 1 OTH PL N
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1yo Edihohd's'
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�v PERMIT
Penuit Number:
A,
Issue Date: lr_� - 1,;11
ry
12
A. Address. or Vicinity of Construction: M 211 10 Place. North
Q) B. Type of Work (be specific): . Ins tall 2" PE IP Main in 10 Place North f rom
'C�
�th ceRterline
14' South centerline of Edmonds -Street to 214' Sou,
of Edmonds Street. Per Attache�d Drawing: 920-0.94' IR 6M-3) (J'
C., Contractor: Wa'shington Natural Gas Company Contact: Gary Swanson
M` iling:,�ddress: 815 Mercer Street, Phone: 224-2080
Seattle, WA 98111
State
License Liability Insurance:, Bond:$
D. 'Building Permit # (if applicable): Side Sewer Permit # (if applicable): DEC.,.:3
E. -.,Commercial Ej Subdivision El City.Project' N, V ili ty,'(PUD, GTE, W`NG, CABLE , ,
WAT9A
Multi -Family, E] Single Family 'Other
F
INSPECTOR:
INSPECTOR: gC>y vv �_I: -r c. tj -r T
F. 'Pavement or Concrete Cut,: [3 Yes DNo(3) G.., Size of Cut:,. 2 x 4 H. Charge
2 Dftues
@ Main I -Ro'&d
APPLICANT TO READ AND SIGN,
EMNIYT: Applicant understands and by his sighdiure to this application,.o
-IND ,grees to hold the Cf ofEdinohds hatinlessftoin
ry
claitn�-qfany)dndlor description whatsoever,joresein or unforeen, that thay be;�Jaae against the, City-ofl Edmonds, or any of its d -Injents or employ-
ep
at
ee inse ofany legalprocee ingsMinc i
R91 e ei an. p ?i
s, includit.4 or norlinjited to, the def d* I id _dfi ise costs d u by reason ofgranting'lhis per7hit.
T CO* ERr ZRZ(b 1 0
HE NTRACTOR.IS RESPONSIBLE FOR WORKMANSHIP AND MAT A SFORAP I D A`� YEAR FOLLOWING THE FINAL INSPEC77ON
ACCEPTANCE OF TH&WORK. ES77MATED RESTORA77ONFEES WILL BE HELD UN77L THE FIAAL�STPEET PATCH IS COMPLETED Bi
CITYFOR'CES A T WHfCH'7TME,A'DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Consfrilcti(iii.-drawing.of-o_ropos�d w.ork reiluired with permit application.
A-24,hour notice is re
quired for inspection; Please call the Engineering, Department- 771-3202.
.:Womrk islo-he inspected during progress and at completion.
Restoration is to be in'accordance with City Codes.
Street shall, be kept clean at all times.
TraffitCoiltrol and Public Safety,shall be in accordancemith City regulations as requiredby the City Engineer.
All streefcut ditc'hes.shall be patched, with asphalt or City approved mdterial. prior to the endof the workin day;.
-NO EX C EPTIONS.
d
I have reael'the above statements and:understan the permit requirement's and the pink copy ofthe'permit will be available
on Site at �all times for ihsPection purposes..
ature:
Sign Date.:' December 14, 1991
(�6ntractor or Agent)
7
CALL DIAIA-DIG PRIOR TO BEGENNING WORk
FOR CITY USE ONLY
APPROVED BY: P)(A/
TIME AUTHORIZED: VOID AFrER �?b DAYS
A14-
.....SPECIAL CONDITIONS:
COM?AENTS:
RIC14T OF WAY DEPOSIT:
DISRUPTION FEE/FUND I 11:
RESTORATION FEE:..
PERMIT FEE:
TOTAL FEE:
RECEIPT NO:
DATE: ISSUED BY:
...-?ERMI-T,jSSUA-NCE
'-NO.i-W.ORK:SlfALL.BEGIN�.j?P�,IOR�TO,
Engrg. Div. 1991"',
SD APHIDS ':'S�IID:E,f�-SEWE,R..''P�E,R), "MIT
JCITY .0F,
.7
WATEW,SEWZR .!DEPANRTMENT
PERM
3,916 9
C a -Jin forr'slde�'s Nv' linsp'cu6n�'ill-,yolti�'.cov ring. -of., the, cons'tfuctl
ll� 776 1 e er e e. . any.�p6rtlonsl on!
P*roN;ided:'withln'- 21,hours--affcr :reil 6 .)) � N,
-will bei�. t-. NO. Sat.,�,:.Sun.,' or.�holiday,inspec on�. %
7'.
An -1-2, 101h:-Place N qrtb'�
'0 C 6Y,OF C0NSTRUXT10N..::-:L ........... .... ......... .......................... _S
..AMDRESS,!1L .........................................................................................
............. ..
-it ,�F P j. t V.'_,r1f- RA nr d-q. A 1 �13 JINT I CA N 213, -,'�O ';M-A - t he
- -JPROr-ERT-YI-�L,']kGAM,,DESCRI'P,-'nON'. ...... ........................... M ... ......... ................. ............................ .. ... .... ..........
_01- r.f'- Ivn* 4
.................................................................. ............................................................... ..................................................... ................ .......... ............... ......
................ 'OWN ......................................... .......................... ...... ............ .. ....................
'r.TjPF0Rn- ('01 Y
-E
............
Pi r," itt 1 .1 T T I A i-I n4",li r.ys- h - I
T -ORISW 111�r� 5ipp
:s&ADDRESS ................................... ............. ................... ................ ................ ...... ..............................................
..... . .... . ..................... 1.19: ....... �,-Ior. -repair, jand/or connection of- a -side-...sdvyer Ao,1he,,city sanitarty�i'sewer_,,
'A' _IP
W-TTENTION, 4
Ir �CkL ibT& THF FOLLOWING:
t . . A _,L, ". —.:
c�.:�l�29�he-ow�E�rs��f't�e,-,p-ro'p"e'r�ty_�may.2obtain,;al,,permit�,to,,co'n.tru'6t..-sewer�'�-in- �velr�Co�nrr&sitbi.�r;ust lbeWergplciy�d�tto._,consfrlict
sid'e;property line., A licensed,Sidc,iSti
side-iseweriiiI 'street area: ,Domot-c&ver.any.portibri '6f-sew*sii -before,it -,has.,bccn ifispectcd-.�`
o 08t�in-ible*4ronv% the City E n 9 On"e"e-r' f f6c
KOTEj,No�.42L ANk, ori��p�rfor'med!�i*n-�6i'ty,-:right-of-'wELy.r6quires',anIriVas'lon'�' f RJghi'-1bf!Way' �Perryilt,,*
btAitirfullMn formationJregaxdIn g. Ord Inance, 1-11. 16:030:,O:�ndiReguidtions�.',gofcenI ng -side-, �bwers. when, you,,get -permit'. `
NOTEPNo. :3-0
�NOT-L�'�iqo..*,,4'---�l�'(>�'.�,of�;iide' sewer)must shave iat least -301,Anches`coverage ;at,',pro erty'. dincland,.12,, Inches, inside property �line;,�iminimuin�,,graderof,��2%-.-''iN6,,,b6nd.*,�i'�'�-� d
th- . - � 1) , I . I . . - I
harper � an,.A. %vill bc:permitted.'
NOTR-NoL .45_�Trenehes; I ri�,street :must !be,-iwater settled and- �s6 rface -of st�eeCxqstored-yto, lorigin aJ,Cond ition.z r -Ampeopbh,i�,
..,,Contra�ctors-ihEL11"�be,,I esponsiblei;for hift e'., "' - '"" - '
work mhiichQmrty1deviilop %vithin' on�e,year,of,.complWon'
ork than ls_.prov�j q6d Jor -:In Alie' j)crn V,,or, to.,do any wor h _'t
_-:WO.T134.No., (.64. Itj Aw-aPy. qther* w' k on it e�)mELin,�sewer.,,�or,.',Its�ELppurtenadce e p o* in,
,,,--.-:Ipe�rt.�the,pipe�..Into *th'e-wye..
-_7
%
B
Date:__: ......... ............... 'By ........ �Date ........ L.: .... y ......... ........... ... .... .........
.........
..................... .......... .............
... ...................
..... ........ ..............
................. * ...........
................................................... ..................
.............. ..................................... ...... .................
.................
.. . .. ....................................... ............ ............... ......... ...........
............... ..............................................
7---7 - 7
'-hihg,-�Constr T
_0B - P* '*t Q ME 'T'B'e.,,'Sig-nedh,By,,OWnei,'�4of,�Firm,�1P, - �l: � - � "'t
0 z, eftori .1QRj ,o�l�!equ�est!.tFor,,,I.nspectibh;.--
It
on.
.. . ... ..
P_'i Q
. ..... ... ... . 0_1 .:-hereby certify. -thatthe� side;s6sver inital hition. -cons truceeWu nd erAhi s�;'� qrm
rning�.�.rd
on
Wner!sof ng.sConstr ti
was?-.1hstd1 c ithl-all -gove d
h,.a -�.w -.City 4,
-i cc da ce �ning.�6rdidan e TAhe�
bf-Edinon
day, I V.
T
13at6& tit
V.
you
t ter
IC 1fe6k-,BkFGJfE ;(digJor:�V atcr-1E]-,._, G-w�,E], "T.06 ife.',ot ower',E],
APPLICATION
for
The City of Edmonds STRIEE T F I SEDE SEWER PERMIT
UEW CONSTRUCTION RL��" REPAIRS E]
7
OWNER .... C.41-6'.O.P-A ............. GOO-/ -/. ............
..............
.... . ...... .4,1
ADDRESS
............
........ . ....
&-moms
EASEMENT No . ..........................................
CONTRACTOR ... �F.4��J�S ----------- ......... .. PERMIT (No.
LEGAL DESCRIPTION: LOT NoAle—ls ............ BLOCK No . ..... llilrn6? ..........................
. .............. I ................
- - 11 - -
NAME OF ADDITION .......
........... 45�42 --- Zo.7 .. �27 .......................... .....................
1,9
Approved:
RECEIVED.
AM 4
KZ5
DATE-62 .. . .... �..—..7/ .............. �Z;- 7
...................... *"* ..........
93.5
00%
0% co
. 6%
F-D-MONDS.
z
m
\d- ?-'N/ EDGE PAV
141
l 0 r4)
k.
I ss, 11
ex 2. 5714 (P WS
PU.4- :1(,00& 3'ci.,
N O'T E S
FULUC) L-OCATS AL-L-
CA,\.-L \- 600- 4?-dc- 5535
4.6 HOL)Rs 9F-V-op..F- O%GG%%G
LAIN Or-TF-CT \-4kRAA\tAc-j \Oqxvkf- OVER
iNSTALL ONFE POIL)ND ANODF- FOP, E.VF-Rl
I000, oF L-Ocp,-rIKG WLRF-
5URVE'-? NOT RF-GUIRSO
MAU-4-TAktA A 5' �AORVZON-Tkk- AMD A
3' VERTICAL- Ct-E.AAANCE PROK- A"
cl-r.( UTILITIF-15
I. R. ro043-3
IY4:* PE CAP
a 0
o :-sFi4- GAUGF- DE7SCT WARMING WIRE
zoo' SIDR-�\. PS PIPS -70- 170
Ps RF-DUCIER '72.- 400
-800
I :?-,,TpAr4q%-TxotA FlaIN6 78
I TE5T LEAD BOY, '50 -:50-7
10' 0 10 7EST LF-AD WIRE zs--- 9,30
t -ME �417501 '79 - 7 it
3ILL,3F MATERIAL
SEC: SF
(o'S. V7
,p MAP. 1 (00 - (0 Z
ARE.A:
S4-1
a
x
Gas
lirl; PS CAP
lY4- PE T MA\iN 'EXTENSION
S PASr SERVICE
Eom L-or- -rO 2-12- 0 PL N
10E3 C)?-o- oc)4
-3RAWING
REVISIONS
9 20-0 94-