21227 96TH AVE W.PDF111111111
9406
21227 96TH AVE W
9 0
. ............. ...
Cit
,y, of Edmonds
RIGHT-OF-WAY �z CONSTRUCTION
PERMIT, Permit Number -
Issue Date:
A. Address or Vicinity of Construction: .21227 96 AV W (9703905)
B. Type of Work (be specific): Install 45' 2" MPE IP Main @ 141S C/L
Spruce Wy from 13'W to 321W C/L 96 Av W
C. Contractor: Washington Natural Gas
Mailing Address: 1122 75 St SW Everett
State License #: 98203
D. Building Permit # (if applicable):
Contact: Mariamne KIngsbury
Phone: 35607500 X7596
Liability Insurance: Bond:$
Side Sewer Permit # (if applicable):
E. Commercial F] Subdivision El City Project a] Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family EJ Single Family n Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut [N Yes ONo. G. Size of Cut: 2 ..x-, 4 H. Chajge�
y (e
APPL - ICA . N - T . TO - READ AND SI[fN
INDEMNITY. Applicant understands and by his signature to this applicatior4 agrees to hold the City ofEdmondo harmless from 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 its departments or
employees, including or not limited to the defense ofany legal proceedings including defense costs, and attorney fees by reason ofgranting thispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH
IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
Construction drawftig of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Division, 771-0220.
Work and material 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 regulations as required by the City Engineer.
All street cut ditches shall be patched with as�halt or City approved material prior to the end of the working day;
NO EXCEPTIONS.
I ha ve read the above statements and understand the permit requirements and thepink copy of thepermit will be
available on site at all times for inspection purposes.
Signature: ()a,�'lv
(Codtractorlo��e'nt) ( I
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR,'CITY USE ONLY
APPROVED BY: RIGHT.OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER, MAAtC-VA -!'2—DAYS DISRU I PTION FEE/FUND'1 11:
SPECIAL CONDITIONS: NA RESTORATION FEE:
PERMIT FEE:.'
TOTAL FEE:
-00
COMMENTS: RECEIPT FEE
DATE: ISSUED BY:
4i
NO WORK SHALL BEGIN PRIOR TO PERMITISSUANCE
Eng. Div. 1994
FIELD INSPECTION NOTES
Comments:
Diagram.:
(Fund 111 - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION El YES 1:1 NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
1�yw,
RR L-1 cr-_=
co--r
LL
d.
>
U1
PR Li C
- 4cq
\� qk
Pf P lvw- M PC-- IP-
. IV
Notes: IU City of Edmonds
1)
Reid locate all uiftes.
Call 1-800-424-5555
24 hours before digging.
2)
Survey Is not required
3)
Maintal a minimurn of 5'
horlzonl and 3' vertical
clearance from all city
utilities and appurtenances.
4)
Cuts In paving we shown as Eg
5)
'15 cuts In paving anticipated.
3r,
2
le� PR LICE
15e=), ;Z"/w
NO. DESCRIPTION
REVISIONS
Notes: Tin City of Edmonds
1)
Field locate all uiliftlea.
Call 1-800-424-5555
24 hours before diggling.
2)
Survey Is not required
3)
Maintain a minimurn of 51
horizontal and 3' vertical
clearance from all city
utilities and appurtenances.
4)
Cuts In paving we shown as E2
5)
-:�) cuts In paving anticipated.
10
9
7
6
5
4
3
2
1
ITEM QUANT DESCRIPTION STOCK NO.
BILL OF MATERIAL
PERMITS: f---1:;'tA0t-40S 1/4SEC: WE--- 2JZ-)-Z-;-5
PLAT:
OP MAP: I c2,4 G-2-
AREA:
TAX CODE:
SEQ. NO:
Natm -0 Gas
AVA5hngb:)n ErergY COffPW?Y D.G.R:
P/4" mPF-- IP MAI�,l
T'C) epF_=VjVF_=' L_&UFUM C_-R%4;r=.7r
2-12.27 C-)GI AV W
DWN_,A4,e) I-Z/ 1-3 1'!5C. IR RR
DATE BY APP-D CHK'D_--,&!:� 1211 JOB
1 3, / �� DRAWING
-SCALE: 0=40' APP: - C_� -+ (2) -3 e) 0 5 q
/,,I
APPLICATION
for
The City of Edmonc!44;� NUE SEDE SEWER PERNaT
NEW CONSTRUCTION 0 REPAIRS 0 EASEMENT No . ..........................................
110-00250
OWNER............ Rober.t...U.-Coadorl ....................................................... CONTRACTOR -------------------------------------------------------------------------------------------------- PERMIT No . ......................
ADDRESS-------- 21227 --- — --- 96t-h ... Ave, ... W -4i ---------------------------------------------
0
0
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................ ...............
NAME OF ADDITION
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................
NOTICE:
a.-c-c-cv
r-r a n
N attached
The information shown on the
piled for use by the QtY 01
map(s) was com '
Edmonds/ its Empl.oyees and Consultants.
Th,.e CitY ofEdm.onds does ' not. warrant the
these
accuracy of anything set for.th on
M a P (s). A n . V person or entity -requesting a
copy should conduct an.independent
inquiry regarding the infoirmation shown"c
imIted to,
-m a P (S) / including, but not J
t
-er stub shown. Su(
the location of any sew
sewer stubs may or may' not e.xist and ma�,
or may not exist at the location shown
Neit-heir the j t y o f E cd rn On H-A S nor its
i -c e -r s 's h- a I- I b e 11 a. H.- e. f 0 r t1h.
emptoyee's O*r Off.
I n' on this map(s)) nor for
information g ve
any one represe.ntation provided based
upon'said map(S).