21505 92ND AVE W.PDF8914
21505 92ND AVE W
APPLICATION
for
The City of Edmonds
SIEDE SEWER PERIVHT
NEW CONSTRUCTION [] REPAIRS 0 EASEMENT No . ..........................................
110-09600
owNm ............. �jjqri.dan._[l6larqar CONTRACTOR .................................................................................................. PERMIT No . ......................
.. ........ .........................................................................
ADDRESS ......... 21.5.05 ... !n ... 92ad..Ave.-Al .................................... --------- LEGAL DESCRIPTION: LOT No - ---------- ................................... BLOCK No . ............................................
NAME OF ADDITION
0
Dye Tested On Sewer 1972
Approved:
DATE................................................ By— ...................................................................
9 0 C)
City of Edmonds
R1 kWNSTRUCTION
EPermit Number.
9421036
Wue Date:- 6 -,-2 7 -24
A. Address or Vicinity of Construction: 21505 92 Ave W
B. Type of Work (be specific): Install new Service
C. Contractor: Washington natural gas Company
MailingAddress: 815 mercer Street,Seattle_
State License #: WA 9811.1
Contact: Frank Swan
Phone: 224-2278
Liability Insurance: Bond: $
D. Buildingyermit # (if applicable): Side Sewer Permit # (if applicable):
E. E] Commercial Subdivision 0 City Project ff] Utility (PUD, GTE, WNG, CABLE, WATER)
Multi -Family Single Family Other
INSPECTOR: INSPECTOR:
F. Pavement or Concrete Cut 0 Yes ONo G. Size of Cut: x H. Chargq_$
APPLICANT TO READ AND SIGN,
ages, or
INDEMNITY. Applicant understands and by his signature to this application, agrees to hold t q t o Edmonds harmles ju, -,-A.
g �UC,
t City of Edmonds, or an3 bfles de a Intents or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be ma e a , ir�V t >01i
employees, including or not limited to the defense of any legal proceedings including deensee sis, and attorney fees,by reason ofgranting this permit.
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 FINALS TREET PA TCH
IS COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBITOR CREDIT WIIL BEPROCESSED FOR ISSUANCE TO THE APPLICANT.
Consduction. dr-'a'wing 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.
Restordtion 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 re4iiired 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.
Ihave read the above's tatemen ts and understand thepermit requirements and thepink copy of thepermit will be
available on site at a es f in e tion purposes.
Signature: Date: ,june "; 21- 1994
(Contractor or Agent�
CALL DIAL-A-DrM JPkkO'R TO f BEGINNING WORK
I �1- -
FOR CITY USE ONLY,,
APPROVED BY: RIGH T OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER DAYS DISRUPTION FEE/FUND Ill:
SPECIAL CONDITIONS: RESTORATION FEE:
COMMENTS:
PERMIT FEE: — 34J - L)L)
TOTAL FEE:
RECEIPT FEE:
DATE: ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE Engrg. I)iv. 1991
FIELD INSPECTION NOTES - . (Fund 111 - Route copy to Street Dept.)
Comments:
Diagram:
CONTRACTOR CALLED FOR INSPECTION 0 YES El NO
Partial Work Inspection by P.W.:
Work Disapproved By: Date:
FINAL APPROVAL BY: Date:
Addendum to t City of FAmonds
Right or way
Permit Applicafich
-Pubmitted by 2 ItI
YCHELL S.-LANKFOPD.
C4=' Engineering, Aide
Washington Natural cas;
#.'-521-'5246
11
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W� n depth
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121- 01 gas 3nain
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Key:
'-w-
water
_g-
gas
-ss-
sewer
-e-
watex hydrant
0 .
watu-.- valve
?IS ',Icrccr St. (1 0. )::" 18"9), Sc"-. WA S 1111 (206) 622.'767
NOTICE*
W"a r.r a n ty ... 0'. ur.
-N'o... acc
The information 'shown on the attached
piled for use by the City Of
MaP(S) was com
Edmonds, its Employees and Consultants.
Th,..e City of �Edrn.onds does. not . wa rra nt. the
set forth on these
accuracy of anything
map(s). An . y person or entity -requesting a
copy should conductanindependent
orm . ation shown- or
inquiry regarding the inf'
t Fi�� -rn a p (s), including, but not limited to,
-c ion of any sewer stub shown. Sud
the lo' at"
sewer stubs may or may not e.xist and may
or may not exist at the location shown.
o n,..
Neitheir t1he city of Erim ' ris nor its
em pl-o-yee-s o-r off ice-rs -shal] be a-f1j-4-e for -41-he
I n on this map(5), nor for
information give ' .
'ded based
e representation provi
any on
upon'said map(s).
The City of Eclm SVMET FILE
APPLICATION
for
SIDE SEWER PEPlam
NEW CONSTRUCTION REPAIRS 0
EASEMENT J.�& ......
,2 L0/13110 2 2
OVVNER ..........
0 Zn2,7 �' 6
........... ........ 4.-,gv -------------- ................. ... CONTRACTOR ..Z41 ..................... PERMaT No . ...... .. .... ....
ADDRESS ... W - C�7
..........
LEGAL DESCRIPTION: LOT No . .............. ............................... BLOCK No . ............................................
d, / 67""
a 4s— Ate NAME OF ADDITION ...... L-I.J.e ... 270 .. &6 ... .....................
77�?
Approved:
7o lfw /s i"",96)e- DATE . .......... B;Y
"T
�1�1�_-�"CITY OF EDMONDS Call pRospect 6-11 07 when work
CIVIC CENTER— WATER -SEWER DEPARTMENT is ready for inspection. (No, Inspec- NO 2840
tions Saturday, Sunday or holldays.)
r
SIDE SEWER PERMIT
nu
ADDRESS .... ----------__-
------ Weqtem--Sewer ........................................
CONTRACTOR
OWNER ...... S ...... L_ ... KcRamar
wer
March 21
Perinission is -granted ............................................. for ........................ days to REPAIR or CONNECT a side se
kvith City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING: wer inside property line. A licensed Side Sewer Contractor must
NOTE No. I —The owners of the property may obtain a permit to construct Be
be employed to construct side sewer in street area. Do not cover any portion of sewer before it has been inspected.
NOTE No. 2—Obtain full information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
NOTE No. 3—Top of side sewer must have at least 30 Inches coverage at property line and 12 inches Inside property line; minimum grade of 2%.
No bends in grade sharper than % will be permitted.
NOTE No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
NOTE No. 5--It is unlawful to alter or do any other work than is provided for in the permit, or to do any work on the main sewer or its appur-
tenances except to insert the pipe into the wye.