21419 95TH PL W.PDFiiiiiiiiiiii
9311
21419 95TH PL W
E
S TREET FILE -City of Edmonds
6? 9 0 - 1 9 4 -
RIGHT-OF-WAY CONSTRUCTION
1\ &P PERMIT Permit Number: %J 7IC2 37
/A
Issue Daote:
A. Address or Vicinity of Construction: - 21419 95 PlaCe Wast
B. Type of Work (be specific): Tristgil New qpryi,,p
C. Contractor: - Wash. Nat I I . Gas Company
MailingAddress: 815 Mercer St.Seattle,Wn
State License #: 98111
D. Building Permit # (if applicable):
Contact: Framh Swan
Phone: 224-2278
Liability Insurance: Bdhd: $
Side Sewer Permit # (if applicable):
E. _E] Commercial
0 Subdivision
El City Project
XX Utility (PUD, GTE, WNG, CABLE, WATER)
F-1 Multi -Family
F] Single Family
Other
INSPECTOR:
INSPECTOR:
F. Pavement or Concrete Cut: )U&es LJNo (2) G. Size of Cut: 2__ x 4 H. Charge$
@ATaltar-)& Gas
APPLICANT TO READ ANDSI N
I ti o the City of Edmo i nes, am
/a rsor
INDEMNITY. Applicant understands and by his signature to this app ica on, agre rids harrnl'11�24-�_V"" ae
claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the City of Edmonds, or any of Us departmehts or employ-
ees, including or not limited to the defense of any legal proceedings including defense c�sis, and attorney fees by reason of grantin thispermit.
.9 %,
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MA7ED RESTORA77ON FEES WILL BE-REL-DXN77L THE FINAL STREET PATCH IS COMPLETED BY
CITY FORCES, A T WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUA)a 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. I
Street shall be kept clean at all times.
Traffic Control and Public Safety shall be in accordance with'cify'iejulaiions as required by 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 timesfor inspection purposes.
Signature:
Date: July 19, 1992
(Contractor or Agent)
CAU DIAL -A -DIG PRIOR TO BEGINNING WORK
. ..... .. ....
FOR CITY USE ONLY-.,- ......
. ... .. .. ...
.. . ..... .. .... .. .. . .........
APPROVED:BY. RIGHT,:OF:WAY.DEPOSIT-..,
......... .... ... .......... .......... . .. ......... ..... ..... .. . ......... ..... . .......
. ......... ............................ ........ ... I........
. ............ ........ . ........... ......... ..... ....
................ .... . .... .
.............. . . . . .........
.. .........
. ... ........... ... ..... .... ...
. ...... ...... ......
TIM13,AUTHORIZE
DAYS. DISRUPTIONTEE/FUND. I.I.I. ..... ...
.............. ...... ....... ....
SPECIAL. -CONDITIONS:: �':RESTORATION FEE.
.. . ..... ........
............
. ....... ..
. .... ......... ............ .......
.. ................ .......... . ... .. ... ........
0, TER.MIT:FEE:
.................. . .. ............ ...... . ................ .....................
...........
TOTAL.FEE..
..... . ........................ - 11 11 ...... - 11 1 11 ........ 11 1
��.,,,DATF::::�,:.::,.::ISS.UED:BY:
NO WORK SHALL BEGIN PRIOR TO
Engrg. Div. 1991
FIELD INSPECTION NOTES
(Fund I I I - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P. W.:
Work Disapproved By:
FINAL APPROVAL BY:
0 YES
Date:
Date:
0 NO
Eng. Div. July 1985
-144musew-
8 9 0 - 1 9 9;
'City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number:
Issue Date:
A. Address or Vicinity of Construction: 21419 95 Place West
B. Type of Work (be specific): Install New Service
C. Contractor: -Washington NAtural Gas Company
Mailing Address: 815 Mercer Street,
StateLicense#: Seattle, WA 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance:
Bond: $
Side Sewer Permit # (if applicable):
E. M Commercial E] Subdivision F� City Project :g Utility (PUD, GTE, WNG, CABLE, WATER)
E] Multi -Family Single Family El Other
INSPECTOR:
INSPECTOR:
F. Pavement or Concrete Cut 93 Yes E]No(l) G. SizeofCut: 2 x 4 H. Charge$
APPLICANT TO READ AKD SIGN
INDEMNITY. Applicant understands and by his signature to this application
, agrees ,, hi the CYry of Edmonds harmlessfto-'m' injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeen, that may be made against the 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 auorneyfees by reason of granting this permit.
THE CONTRA CTOR IS RESPONSIBLE FOR WOR13fA NSHIP A AD MA TERIALS FOR A PERIOD OF ONE YEAR FOLLO WING THE FINk'INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MATED RESTORA77ON FEES WLL BE HELD UN77L THE FINAL STREET PATCH IS COMPLETED BY
CITY FORCES, AT WHICH 77ME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO 77LE APPLICAAT.
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 regulations as required by 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 timesfor inspection ��u.
Date: June 24, 1992
Signature:
(Contractor ent)
CALL DIAL -A -DIG PRIOR TO BEGRiNING WORK
FOR CrFY USE ONLY
APPROVED BY:. _F% IA/ RIGHT OF WAY DEPOSrr:..
;7
J&
TIME AUTHORIZED: VOID AFTER AV6 3 0 DAYS DISRUVrION FEE/FUND I 11:
SPECIALCONDITIONS: oVCf1L-A*y ISSO RESTORATION FEE:
PrPurr rrt:.
....TOTAL
RECEIPT NO:
M11
I V
V�
W
Engrg. Div. 1991
C
,)5 PL, W
WNG to window
Waternaim depth
unknown
gas main
Addendum to
Right of Way
Permit Application
Submitted by: IMMAIZO WILA.Alzml
Engineering Aide
Washington Natural Gas
622-6767 X2761
pager JLpe;
-2 1 �z
j rr7
JL-
- S
Key: _w- water
-g- gas
-55- sewer
water byft-ant
815 Mace SL (P.O. Box 1969).-SnoWe. WA 99111 (M) 622-6767
STREET FILE'' City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
8 9 0 - I C) 9 -
PERMIT Permit Number: 9,;� 9
C6 M to Issue Date:,
A. Address or Vicinity of Construction: 21419 95 Place West
B. Type of Work (be specific): Install New Serv:Lce
C. Contractor: -Washington NAtural Gas Compan
MailingAddress: 815 Mercer Street,
State License #: Seattle, WA 98111
D. Building Permit # (if applicable):
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond: $
Side Sewer Permit # (if applicable):
E. n Commercial F1 Subdivision El City Project Ig Utility (PUD, GTE, MING, CABLE, WATER)
F] Multi-Fariffly El Single Family Fl. Other
INSPECTOR: INSPECTOR: F,
F. Pavement or Concrete Cut 91 Yes E]No(l) G. SizeofCut: 2-,-. x 4 H. Charge$
�N
APPLICANT TO READ A -Si
4 city
INDEMNITY. Applicant understands and by his signature to this application, agrees, h, he of Edmonds harmlessfrom injuries, d�mages, or
claims of anykind or description whatsoever, foreseen or unforeen, that may be made against the 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 atiorneyfees by reason of granting this permit.
r
THE CONTRA CTOR IS RESPONSIBLE FOR WORKMANSHIP AND MA7ERIALS FOR �'P_Ekiob_ bF ONE YEAR FOLLOWING THE iIAL INSPEC77ON
AND ACCEPTANCE OF THE WORK ES77MA7ED RESTORATION FEES WILL BE HELD UN77L THE FINAL SYREET PATCH IS COMPLE.7ED BY
CITY 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.
'A.
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 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 timesfor inspectioiLpurposes.
Signature: Date: June 24, 19912
(C o n t 'ra ct or 'or'A g e n't)
CALL DIAL-A-DIO ]PRIOR -TO BEGINNING WORK
91
NO WORK SHALL BEGIN PRIORTO PERMIT ISSUANCE
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: Date:
FINAL APPROVAL BY: Date:
Eng. Div. July IS
1.
C5C
, )5, FL-., W
WNG
Wataw ma Jm depth
unknown
—" gas main
Lddendum to City of Edmonds
Aignt. ox wa
Permit Application
Submitted by: ICICRA'ap
Engineering Aide
Washington Natural Gas
622-6767 X2761
pager IjCc,�- jtpe,�.;
1,3
Z%Cy ;
-w- water
-g- gas
-SS- sewer
'Itrart-W bjrd3:,a=
815 MM= -SL (P.O. BOX 1869).,SMMd9. WA 98111 (206) 622-676-1
APPLICATION
for
The City of Edmonds SIODE SEWER PERMT
NEW CONSTRUCTION E] REPAIRS n EASEMENT No . ........ .................................
110-n2fion
OWNER ------------ I.la.rv.i..n ... A.n d.e.rs-o-n .................................................... CONTRACTOR ................................. ............................
..... .... . .. .. .... .. .... .. .. .................................... PERMIT No . ......................
ADDRESS -------- Z-1.41.9 ... ... 9.51h ... P.L.Jl ................................................. LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
-0
40
NAME OF ADDITION
Dye Tested On Sevier 1972
Approved:
DATE................................................ By ......................................................................