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21222 82ND PL W
ADDRESS:
TAX ACCOUNT/PARCEL #:
BUILDING PERMIT (NEW STRUCTURE) #:
COVENANTS (RECORDED) FOR:
CRITICAL AREAS #: DETERMINATION: E] Conditional Waiver E] Study Required E] Waiver
CRITICAL AREAS #: DETERMINATION: Conditional Waiver Study Required Waiv er
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DATED:
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORD FOR:
PERMITS (OTHER — list permit #'s):
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:
SEWER LID FEE $:
LID #:
SHORT PLAT FILE:
LOT:
BLOCK:
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERMIT(S) #:
GEOTECH REPORT DATED:
STREET USE/ENCROACHMENT PERMIT #:
FOR:
WATER METER TAP CARD DATED:
OTHER:
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CITY OF EDMONDS %j I HEET FILE
COMMUNITY SERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. 0 Owner: Washington Natural Gas Co B. 0 Contractor:
Name
805 156 AV NE
Mailin& Address
-Bellevue,_WA 98007
City State Zip
Permit No. ?9 - q6 /_/
Issue Date /62 - -2 / j!FY
S ame
Name
Mailing Address
City State Zip
447-0700
'S" State License Number Telephone Number
e Address or Vicinity of a�structiow',\212.2.2 82 PL W
Type of Work to be Done:� Jhstall a new gas service /1g
Work in Connection With: 0 Sub or Plat 0 Single Family 0 City Projects
0 Commercial 0 Multifamily IR Utility
Pavement Cut: 0 Y 0 N
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
W be made against the City of Edmonds, or any of its departments or employees, including or not limited to the defense
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of any legal proceedings including defense costs, court'costs, and attorney fees by reason of granting this permit.
.4 THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE
YEAR'FOLLOWING THE�FINAL- INSPE0TION-�'AND=ACC
�E-P�TYANC-E�Of—.T-HE�W-ORK.,�
0
U Funds held from the Security Deposit (esti ' mated restoration fee) will be held until the final street patch is complete'd
by City forces, at which time a debit oi-credit.'will'be processed for issuance to the applicant.
0
• A 24 hour notice is require,4-"fbr inspection; Please call Public Works: 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.
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I understand the above and tha hiUse . musi be available at the job site for inspection purposes at all times.
Signature: T&vq I Date: 12/19/88
/ Owner or Contractor
This Permit Must Be Posted at the Job Site For Inspection Purposes
Call DIAL -DIG Prior To Beginning Work
ISSUED BY: / I - (
Time Authorized: Void after (�30 days.
Special Conditions:
Amendments:
-7
PERMIT FEE: Q
Security Deposit:
Receipt No.:
Fund I I I Fee:
Street Cut Dimensions:
X
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. July 1985
FIELD INSPECTION NOTES
(Fund 111 - 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 1985
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R-�� APPLICATION
'E for
The City of Edm$TsF' 5 SEDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS EASEMENT No . ..........................................
owNER=-M. N4 &T'Tl� F W LUT -4.E� ................... PERMIT No . ......................
��CJV�c ....... .... - ---------- .... .... . t:A CONTRACTOR --RW ................................................................
ADDRESS ..... f 5(2-6= .... P L I - � � � ............... LEGAL DESCRIPTION: LOT No . .............................................. BL4DCK No . ............................................
40
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By
APPLICATION
for
The City of Edmonds SIDE SEWER PERMIT EASEMENT No . ..........................................
NEW CONSTRUCTION REPAIRS 431-'
-F - - ... - .... . PERMIT No....
OWNER �� ..... .. C/f/t) CONTRACTOR-...'-/ .........
- Ac
ADDRESS O�IA 2 . . ........... e 4z4_lrl_"_
........ . . .......................................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . .......... ---------------------------------
NAMEOF ADDITION .................................................................................................... . ...................................
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Approved: F
DATE................................................ By ......................................................................
19
NOTICE:
Nb ... Warranty of a--cwracy-
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.qnds 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
_tFe -map(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
ernp-l-o-yee-s o-r office-rs -sh-a-1.1 be l--'-1a-b--lFe for the
information given on this map(s), nor for
ion provided based
any one representat"
upon . said map(s).