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21211 92ND PL W.PDF111111111111 9025 21211 92ND PL W '7 1W (Y 9 0 . 1 9 9 - . City of Edmonds ' RIGHT-OF-WAY CONSTRUCTION PERMIT PermitNumber: 2;?.,33 9 EET FILE Issue Date: _/0 - 3 0 - ?42z— A. Address or Vicinity of Construction: - 21211 92 Place West B. Type of Work (be specific): Install New Service C. Contractor: Washington Natural Gas Compa y Contact: Frank Swan Mailing Address: 815 Mercer Street, Phone: 224-2278 State License #: Seattle, WA 98111 Liability Insurance: Bond:$ D. Building Permit # (if applicable): Side Sewer Permit # (if applicable): E. Commercial Subdivision R City Project %I Utility (PUD, GTE, WNG, CABLE, WATER) Multi -Family SingleFamily R Other INSPECTOR: INSPECTOR: WiAITC—ol T F. Pavement or Concrete Cut : El Yes 55Vo G. Size of Cut: — x H. Charge$ I, — APPLICANT TO READ AND ' N INDEMNITY. Applicant understands and by his signature to this application, agrees to the City of Edmonds harml4o)4glieR, �mages, or 'ins, , ( claims of any jUnd or description whatsoever, foreseen or unforeen, that may be made against t e City of Edmonds, or any of its departments or employ- ees, including or not limited to the defense of any legal proceedings including defense costs, and attorneyfees by reason of granting this permit. 0 THE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP A AD MA 7ERIALS FORA PERIOD OF ONE YEAR FOLLOWING 7HE FINAL INSPEC77ON , --, -f) AND ACCEPTANCE OF THE WORK ES77MA7ED RESTORA77ON FEES WILL BE HELD UA77LITHE-FINAL S7REET PAhTrH 19 �OAPLEYED BY C17-Y FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED 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 Department- 771-3202. Work 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 reg'u'lations as required 4 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 the permit requirements and the pink copy of the permit will be available on site at all timesfior i mpection pur poses. October�,22, 1992 Signature: Date: (Contractor or Agent) CALL DIAL -A -DIG PRIOR TO BEGINNING WORK A' ... .. . ... PERMIT FE .... . ..... .. . . . . .. ..... ........... .... ... . . . ............... ....... ... .. .. . . . . ...... .. TOTALFEI ..................... ..... ........... .......... . . ...................... . ... ....... ... . .. COMMENTS RECEIff N .. .......... DATE:- ISS UED BY Q 11 � ...4 - ........... ................... . ......... A2 W Engrg. Div. 1991 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: — FINAL APPROVAL BY: Date: Date: Eng. Div. July 1985 2-1211 '_`/ 27� Pz_ . L& t - _10NDS '1, 7 N ST. NIA WNG to window water main depth gas main Addendum to City of Edmonds Right of Way Permit Application Submitted by: 9jcvAAFo tjiLi-A�Q0 Engineering Aide Washington Natural Gas 622-6767 x2761 pager q(.9 - 1(.05G Wo cul-,<s 13 !M— -w- warcer -g- gas -ss- sewer -e- water hydrant 0 water valve 815 Maca St. (P.O. Box 1869), Seatt , WA 98111 (206) 622-6767 APPLICATION TM HEET FILE for The City of Edmonds SIDE SEWER F RMT EASEMENT No . .......................................... NEW CONSTRU( REPAIRS . .... .. .. --------------------------------- CONTRACTOR,/Z ----- PERMIT OWNER eeeo; ........ ADDRESS .,X.IA.I.Z ...... .............. LEGAL DESCRIPTION: LOT No".4- ............ BLOCK No . ............................................ E NAMEOF ADDITION ......................................................................................................................................... Ap r x.. ....... ................................. ........ By .................................................... 7c/ o P o 91� S Ly Date: . JulX 21, 1971 1; Memo to: Ron Whaley From: Leif R. Larson City Engineer Subject; Sewer Connection Charges Legal Description: See attached Commonly known as: 21211 92nd Place Owner; Stanley A. Olson Z.F.F. Calculation: z.r.r. x $ 300.00 Connection Fe Unit x ($ 25.00) $ 25.00 Trunk Charge $ 10.00 Permit 3�� 6 �I-Z3-7 t� $ 33A-00 TOTAL R.ECEIVED JIUIL 21 1971 32-4,s 3 e 0 f3, r do� I le. zst� 3 9,! 1 41 , 1�1 : 10. 1 APPLICATION for The City of Edmonds SIDE SEWER PERMT EASEMENT No . ........................... NEW CONSTRUCTION [:] REPAIRS OWNER .............. . ..................................... CONTRACTOP,,"/ .... PERMIT No . ......... ....... ADDRESS ...... ................. LEGAL DESCRIPTION: LOT Now ............ BLOCK No . ............................................ NAMEOF ADDITION .................................................................................................................................... 0 0 DAI // 1. 7-r ....................... BY<... 4a-de) 41 f ........... A. ER, -7. 'NIRS S111W E, W PERM T+-`�' .1-WATER,�9ENV,,ER-�:-DEPANRT-MENT,�:: A006- PER _41call',716-1-10T. for,.side sewer inspections BEFORE� covering" Y., portion, -of the construction. �Inspecfion, will be provIded, withih; 24: -hourkafter No,��'§at., Sun.,: or,hoIiday, inspections.) -,request. ADDRkS& L"6c, kno&�t)F�,;CONS.T.R�UcTiloN.....; ........ ...................... ............ ; ............................................................... t :VROPERTYLEG �DESCRIFTION ...... ..................... .................................................. ....... .............................................................................. .................. ........................................................ ............................................................................................................ ............. ....................... ............ ........ ......................................................... L ...... OWNER AND/OR-,BUILDVR ............... . .. . ............... .............................. ............................................ CONTIVACTOWSNAME &I ADDRESS ..... 'Al G­i.j n .......... ................ ....... ........................................ ........... .. . ... ........................................ ...... 7i PenYdSSi9nAs,grantZ-d . .......................... ........... * ...... ............... 19 ........ tor, i6pair and/or, connection of a. side,sewer to� the city sanitary sewer systefir In, accordance-With,City of Edmon& ordinances. ATTENTION I& CALLED'TO� THE FOLLOWING: ­TE'No� I—Th owners of th& property may. obtain a, permit to construct sewer imlde�property line. A licensed Side Sewer Contractor must be employed to construct sM sewer In, street area. Do.not cover any por�lon­of :sewer before -it has, been. 1nspected. N�_'�E No. 2—Aill work:performed ini-61ty right -of -*way reguire&�an- Invaslont of' Right -of -Way Permi ' t.obtalryable irom the City Engincer's. office. NOTM No;. 3—Obtal , n 461P Informat . ton regarding, Ordinance 1-1-.16.030? and, Re I gulations governing side , 'sewers,. when you, get permit. NOTE, No. 4­2T,6p,,61! side�,sewer mus&�bave at least 30 inches.' coverage :at property. ii'ne'- a�nd', 12.-ifiches-. lnside�.property fine;. minimum :grade' of' 2 No �b sharper than 'A wlll�.b.e permitt6d. ends: in grade N0TE,No.!Z--Trenches,Ih street must -be water settled and, surface of street restored'. to -origln�l�!'bnditior. Contractor's shall be responsible for Uilure due� . -to):improper work,whichr may develop within one year of completion., NOTH No; &�—It is.,unlawfuli,t o alter -or Ao, any other work tha'n'is' pr6vided' for In th I e;perrhit, :o . r,tb.;do� any, lv�ork on the maj�.sc�ver or its� appurtenances,,except to in- sert the�,pipe into� the �wye. ....... ................... DISAPPROVED) E3! ......... ....... ....... ......... BYL ........... L'. D B Date, .... . ......... ........ . .............. .. By ................. I Z �' Z ... ............ ............................................... APPROVD .............. V J Remarks: .................... ......................................................................... ....... ......... ...................................................................................... ............. -------------- ....................................................... .......................................... ....................... ................................................................................................................... a - BOTH Permit`- o�p/iejs.:M, ST'Be Signed By, Owner of �Fi= Performing �Construction, PRIOR To. Request For Inspection. ? I ........ . . .. ............. ... .................................. 6.1... hereby, pertif y -that,'-the:zide,sewer. installation, constructed; under, this�'permit (Ow�cr of Contracting Firm PerfGrming Construction)' led in accord ce, wit alf-governing ordihances of, the, City of -Edmonds. - was instal h Dated Z' .'.4,y, of.-- . ...... this .... ...... .......... Check BEFOREyou dig for:, Waterf]j �:Gas 7E], Telephone cr;ffl Sewer. PO" Other 'STRE8T FILE Memo to: Ron Whaley From: Leif R. Larson City Engineer Subject: Sewer Connection Charges Legal Description: See attached Commonly known as: 21 " Place Date: July 21, 1971 I Owner: Stanley A. Olson z.r.r. Calculation: Z.F.r., x $ 300.00 Unit x ($ 25.00) $ 25.00 $ 10.00 Connection Fee Trunk Charge Permit $ 335.00 TOTAL UJ cv-y- i4% jo fs 'ILA' A111. I w-- A �6' #W I., V kl, Ok 4t Vr 411' j - \In I PA iw" -7 S C AV mv , q�l , r,4 OA APPLICATION for The City of Edmonds SIDE SEWER PERNUT NEW CONSTRUCTION El REPAIRS 0 EASEMENT No . .......................................... 111-05550 OWNER........... St.an ... O.l.s.e.n ......................................................................... CONTRACTOR ............................................................. — .... ..... ---------------------------------- PERMIT No . ...................... ADDRESS ...... 2.12.11 ... :n ... 92n.d .. P] ...... 'I I . ................................................. LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................ NAME OF ADDITION 0 0 Dye Tested On Sewer 1972 Approved: DATE................................................ By