21402 90TH AVE W.PDFlill iiiiii - 11
8762
21402 90TH AVE W
d,
.0 City' of Edmonds
XCT FILE
RIGHT-OF-WAY CONSTRUCTT
(Y 9 0 - I C) 4 .. -
-,,--f-q)PERM1T Permit Number: 3-!�2-gp
-5TA Issue Date: 2,9
A: Address or Vicinity of Construction: y. W. (9308268)
B. Type*of Work (be specific):, Install New Service
C. Contractor: Washington, Natural @as Co.
Mailing Address:1815 Mercer St.'Geattle, Wn
State License #: 98111
D. Building Permit # (if applicable):
Contact: Stank Swan
Phone: 224-2278
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. n Commercial E] Subdivision El City Project x§* Utility (PUD, GTE, WNG, CABLE, WATER)
n Multi -Family El Single Family Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete.Cut Yes ONo G. SizeofCut:(1)2 x 4@ gas H. Charge$
APPLICANT TO READ-AINDaRN
INDEMNITY. Applicant understands and by - his signature to this application, agrees to the City of Edmonds harml 4,7-4�ages, or
J, �v
is deparimenis r employ -
claims of any kind or description whatsoever, fo�eseen or unforeen, that may be made a he City o plzt&
fEdrnonds; or an�
ees, including or not limited to the defense of any legal proceedings including defense costs, and attornqfees by reason of granting this perrnit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PER'IOD-6-AONE YEAR FOLL9.W'NG THE FINAL--INSPEC77ON
AND ACCEPTANCE OF THE WORK. ES77MA TED RESTORA 77ON FEES WILL BE HFR-UN71L THE FINAL STREET PATCH IS COMPLeTED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISS`WNVB TO THE APPLICANT.
Construction drawing of proposed work required with permit application.
A 24 hour notice is required for inspection; Please call the Engineering Departtn�—
Work is to be inspected during progress and at completion.
Restoration is to be in accordance with City C'odes.
Street shall be kept clean at all times.
Traffic Control and Public -Safety.shall be in accordance with Giv,reitilations as requir d 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 statem'ents and understand -the pernyt requirements and the pink copy of the perthit will be available
on site at all timesfor inspection pu ses. 7-
T-9
Signature:
Date: - Feb. 11, 1993
(Contractor or Agent)
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
............. . . ....
:APPROVED BY:;::. ,..Ri.G.H,T.O.F.i.WAY,:DEP.O.,Srr::::.
-7
..TWE.AUTHORIZED: VOID AFrER U'. DAYS DISRUPTION FEE/FUND. 111:.
A
T
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUA
Engrg. Div. 1991
Eng. Div. July 1985
to
j- -n
Natw& Gm
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: C-Iu\,tL,�,
Engineering Aide
Washington Natural Gas
2,1,40z- 0�c) \t-J 15 Z I - c:-5 Z4 (S.
) 4 t.,j \�,-4 \/
WNG to window
Water main depth
unknown
L-11 gas main
I / ---I, -,/ A\ /— I I -T—
Key:
_w- water
-9- gas
-ss- sewer
-e- water hydrant
0 water valve
815 Mercer St. (P.O. Box 1869), Seattk, WA 98111 (206) 622-6767
APPLICATION
for
The City of Edmonds
SIDE SEWER PERMT
EASEMENT No... ................................
NEW CONSTRUCTION E] REPAIRS 0
111-04250
OWNER.......... ......................................................................... CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ...... ... . ... . ............................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
0
NAMEOF ADDITION .........................................................................................................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................