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21420 96TH AVE W
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STREET FILE cityof Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT Permit Number:
co r"I to Issue Date:
A. Address or Vicinity of Construction: - 21420 96 A,;�enue West
B. Type of Work (be specific): Tn;%tq1 I Npw sprvice
C. Contractor: Waghingron Nnriirgil GAr, Company Contact: Frank Swan
Mailing Address: 815 Mercer Street, Phone: 224-2278
State License #: Seattle, WA 98111 Liability Insurance: Bond:$
D. Building Permit # (if applicable):
Side Sewer Permit # (if applicable): �'
E. - R Commercial El Subdivision El City Project [M Utility (PUD, GTE, "G, CABLE, WATER)
F1 Multi -Family E] Single Family F� Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut : El Yes []No G. Size of Cut: x — i H. Charge$
7
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signaitire to thi's application, agrees,to hold the City of Edmonds hamilessftorn iniiiiies, damages, or
claims of any kind or description whaisoever,,foreseen or unforeen, that may be made against the City of Edmonds, or any of its departments or employ-
ees, inchiding or not limited to the de/ehie of any legal proceedings including defense costs, and attomeyfeis by reason of granting this permit.
THE CONTRA CTOR IS RESPONSIBLETOR WORKMANSHIP A ND MA TERIALS FOR A PERIOD OF ONE YEAR FOLLO WING THE FINAL INSPEC17ON
AND ACCEPTANCE OF THE WORK ES77MAYED RESTOR,47TON FEES WILL BE HE& UN77L THE FINAL STREET PA TCH IS COMPLETED 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 Departm
Work is to be inspected during progress and at completion. gm_
Restoration is to be in accordance with City Codes. 771-0220
Street shall be kept clean at all tim-es'—
Traffic Control and Public Safety shall be in accordance with Cityfwuations as required by the"C' ity ngineer.
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: 14 4.6 Date:August 24, 1992
(96OMr or"AIVO?EZ6Z
W
DATE: ::� .. .. ISSUED BY
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
Engrg. Div. 1991
FIELD INSPECTION NOTES
Comments:
Diagram:
. .,t
(Fund I I I - Route copy to Street Dept.)
CONTRACTOR CALLED FOR INSPECTION 0 YES 0 NO
Partial Work Inspection by P. W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
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Eng. Div. July 1985
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Addendun to City of -Edmonds
Right of Way
'Permit Application
Submitted by:
g Aide
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Washington Natural Gas
622-6767 X2761
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KIM-TE '. WP-,T� AkA-(JQ LOCAMOt'3
UmKt,��Q t�3 04-'R-sw
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( LAUREL STC-
9 14 -P(- SW I
WNG 'to window
depth
gas Ma=
1 LO
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zmy;
-w- water
-g- gas
-ss- sewer
vaterhyft=t
M MM= SL (P.O. Bm IM). Snctle, WA 99111 =6) 6=4767,
MON "k
,Y :OVED ER,`,PtRM
EWER DEPARTMIE T�
W,,iTEWS'
M111
-PER T]N�
fi.'1`1
Call 7-76-1,10T for side sewer inspections BEFORE covering,�any Portion of the constructi
n I , rs, after request, on.y.
(Inspection will -be Provided' witbi 24 hou '
NO.,'Sat., ;Sun.,, -or holiday Inspections'.
'2 J. 42 C
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PROF�ER'TY'-.,�LEGA��Es,bRxp,T,ION..� ......... .........
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............................................................... O'KWER, AND/OR BUILDER
....... ....
............ .....................
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CoNTP-AICT,OR'S-NA,MIE-&A,DDRESS..�. I -.qC
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Perml'
ssion Is, granted_
.1 19;_ -for repair and/or connection,,of a side sewer to,
the cit
System in accordance with'City of Edmonds ordinances.* Y Sanitary sewer
j�TTENTIOM ISL.CALLED TO; T
HE'FOLLOWlNG.:
'E, No. 1—The owners �of' the Propert
side sewer In street area. Y may obtain a'permit to consiru t sewer inside Propertyline. A licImsed, Side Sewer Contractor must be.einployed, to co*nstruct
DO not cover any portion Of sewerebefore it has been inspected.
��E No- 2—All, work Performed In 'city right-of-way requires an I v
"I n aslon Of Rlght-of-Way'Permit,obtairiable: from the City Engineer's. office.
NOTE No� 3—'.Obtain fulL.-In formation regarding Ordinance 11, 16.030 and Regulations governing, side sewers when you get permit.
NOTE No. 4—�Top, of side sewer, must'have at least .30 inches;,coverage at property line an
sharper them %, will be Permitted. d 12 inches inside property line; minimum grade of 2%.. No bends, In grade
NOTE No. 5--Trenches,in street must be water,settled and surface of street restored to original condition. Contractors sbali be responsible�,for failu're due to Imprope . r
work which may, develop within one y!�ar of completlon�
NOTE No. 6—It is unlawful! to alter or do; any oth
er work t I han 18,Provided, for in the� permlt, or to doany work on the maim sewer or its' appurtenances, except to in-
sert the pipe into,tthe wye.
DISAPPROVED E]; Date .... .........
.......................... BY ................ Date .................................... BY ................ Dateo
................................... Ily� ...............
APPROVED Date! ....
By. ................
.... . ............................
................
Remarks:
...... ........ n: ... ... . . .... ....... ........ ......
.......... ................................ I ....................... ......... ..............
. ......................
.............................................. ........
................................... : .....................................
.......... .................
wner of
was installed in accord�
T X
,.6. Signed, By Owner of Firm Per—formin 'Construction
u �y 'j w 01 1' 9 PRIOR To Request For Inspect -ion
her
-ti-n-
2C;�__60n. �r u'
...... .........
reby certify t'hat the;,side sewer installation, constructed
.. .... ... .. , he
` -;r P r n ,
1 rm Performing Construction, under,this! permit
S. of I
all',governing ordinallces:Of - .,CitY of.Edrnionds;,
Dated this ............................ day of ......
.......................................... .................. IR ........
V V Ulleck BEFORE you,'dig for: Water Gas Q; Telephone
in, Power C], Sewer,E], Other E], V.Nt
..9it till I'I'd,if, 1`01 0 IU 1, V
V -1i 10
t,, t 11 e a S or i i iz.� r c) f f IS a c J 0 n 2 J: P
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0 qa
R 3 j thence North 292 feet -0 3575' the"ce We s t
Iht' of biegihffing; thence No..rth 116: f 30 f e lit, t�o;;:
eet; thence e t
`:�'-V6.u'th� 116 fe.et; thenoe. Eu.st' f ele t to 'ppint'l-of
S t, of Tract 2 accotding to the U n J, e c o'r'*d eid Plat, of Gnavu 'Par
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APPLICATION
for
The City of EdmondsS rR EE T FIL J� :- SIDE SEWER PERMIT
NEW CONSTRUCTION REPAIRS 0
IT r- lm 0 f 4
'REAlW'"HT A4T_j
-T
EASEMENT No . ..........................................
............ PERMIT Nor--�..Ts..,
OWNER — --------- 1? ...... CONTRACTOR ---- .......
7—
ADDREss,�/$-'.',16 ....... . 157LZ ........... I ............ LEGAL DESCRIPTION: LOT No . ................ .......................... BLOCK No... ........... .......................
NAME OF ADDITION ....................................................................................
Approved:
..................................... 77
DATE... 5 ........ By
...................