21328 92ND PL W.PDFiiiiiiii iiiiii
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21328 92ND PL W
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dOY OF EDMONDS
COMMUNITY SERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION PERMIT
A. 0 Owner: Washington Natural Gas Comp ny
WR'Mercer Street
Vgg�fl,�ddress WA 98111
RAZC Permit No. �5-
ssue Date 4—IC—ql
]EAWiRMtor: —
G Name
b 0 C"M 3 Mailing Address
City State Zip City State Zip.
Orm-A
v , nEET FILE State License Number Telephone Number
C. * Address or Vicinity of Construction: 21328 92 Place West
Type of Work to be Done: Install New Service
D. 0 Work in Connection With: El Sub or Plat 0 Single Family El City Projects
El Commercial 0 Multifamily R] Utility
E. 0 Pavement Cut: 0 Y El N F. 9 Size of Cut: 9 X 4 (1) @ Gas
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
I I
of any legal proceedings including defense costs, court,costs, a9d attorney fees by reason of granting this permit.
4'.' tol,
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.
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
9 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.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature: A4&A4oL&ta,.4L-� Date: April 3, 1991
Owner or Contractor
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: e10V A/
Time Authorized: Void after JUIQF— / Z- days.
Special Conditions:
PERMIT FEE: 2-, CV IXXY' XR
Restoration FPO
Receipt No
Fund I I Fee:
Street Cut Dimensions:
RELEASED BOA Date 9 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 De5t.) ' .0
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By:
Date:
Date:
FINAL APPROVAL BY:
Eng. Div. July 1985
V&wh*m on
__ _ gt_
Natur5l GWME��
AVA%Nngtbn&-WC-TpwV
gas maLn
proposed
Addendum to:
City of Edmonds
Permit Application
Engineering Aide: Kerry Walsh
Washington Natural Gas
622-6767 x2761
4)e G
water main depth unknown
Key:
:s- squitary sewer
w- wauer
-g- gas
water valve
hydrant
815 Mcrcer St. (P.O. Box 1869), Seaule, WA 98111 (206) 622-6767
j
NOTI. E:
w.. a nly ... 0 r. a. c.-cura-cyy,
N'o a r.r
The inform ation'shown on the attached
-led for u-se by the City Of
map(s) was com - p]
Edmonds- its Employees and Consultants.
Th,..e City of:Edm.onds does ' not warrant the
these
accuracy of anything set for.th on
r ent'ty'requesting a
map(S"). Any person 0 in I dependent
copyshould conduct an
inquiry regarding the InfOrm'ation shown- o
I I
tF�e -M a P (5) 1 including, but not hrn'ted to,
the c ion of any sewer stub shown. SUC
lo' at'
-not exist and may
sewer stubs may or may
or may not exist at the location shown.
ri ts
r-ity of Edmonc-AIS1 nor i
Neitheir the k__I or -IhE
M p*,* 0,y e e*s o,r o ff i -c e -r s -s h. a I. I b e l.`I a. f
information given on this map(5), nor for
*ded based
any one representation provi
upon said map(s).
APPLICATION
for
i he City of Edmonds EASEMENT NO - --------------------------------------------
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS LID NO. 'w, NO - --------------
xtp-PA 1p-, pe6
OWNERM��.t ------------------------------------------------- -------------- ------------------- CONTRACTOR
............................................ PERMIT NO.
JOB ADDRESS ------ — ------ W.a��-F LEGAL DESCRIPTION: LOT NO. - --------- -- ---------------------- BLOCK NO. - ........ - ---------- -----------
Isq
0
---------------------------- .................................................................. ------------------------------ I ----------------------------- -....
�-A L�11D�Dl -T-1 CD t-�
NAMEOF ADDITION ----- .................................................... ............................................................
oproved:
kTE ..... By
4 ....
APPLICATION
'The City of Edmonds for EASEMENT NO . ............................................
SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS E] LID NO.
OWNER ......
.......... E� . ..... . .. ................... CONTRACTOR ...................................................................................... PERMIT NO.-
. . .. .............. BLOCK*
PL I N OT NO . ............. .,-
- -- - --------- — ------ W F---'S— F LEGAL DESCRIPT'O
JOB ADDRESS ------------ :L
'e
0 .
0
'S.1
NAME OF ADDITION .... H.t&l( .... A.4�,S_an ------- AA
oproved:
�TE
RECEIVED
AUG 2 7 1974
By...........................................................