21522 84TH AVE W.PDF111111111111
7917
21522 84TH AVE W
City of Edmonds
RIGHT-OF-WAY CONSTRUCTION
PERMIT
Permit Number.
STREET FILE
Wue Date:
A. Address or Vicinity of Construction: 21522 84 Av. W. (92217'93)
-ftwomm— C) B. Type of Work (be specific):
9 0 - 1 9
C. Contractor: Washington Nat'l. Gas Q.
MailingAddress: 815 Mercer st,seattle. Wn,
State License #: 98111
D. Building Permit # (if applicable):
Install New Service
Contact: — Frank Swan
Phone: 224-2278
Liability Insurance: _ Bond: $
Side Sewer Permit # (if applicable):
41-1
E. n Commercial
E] Subdivision
El City Project
gy Utility (PUD, GTE, WNG, CABLE, WATER)
F] Multi -Family
E] Single Family
EJ Other
INSPECTOR:
INSPECTOR:
tN LN
F. Pavement or Concrete Cut 0 Yes QNo G. Size of Cut: x H. Chargq�,$
APPLICANT TO READ ANDi SIGN
4) INDEMNITY. Applicant understands and by his signature to this application, agrees to ho6d'K City of Edm nds harm ess from injuries, damages, or
claims of any kind or description whatsoever, foreseen or unforeseen, that may be made<aeqi, t the C*1y of Edmonds, or any of its departments or
employees, including or not limited to the defense of any legalproceedings including defeni� 0 8 g5anp
,q., and attorney fees , ngthispermit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIAL9.PdR "PERIOD OF ONE YEAR.FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK. FSTIMA TED RESTORA TIO1Y FE q WILL BE HELD UNTIL THE Fi�A-f, ffl-liEET PA TCH
' &E,4SEDFOR ISSUANCE �VTHEAPP.ICANT.
t IS COMPLETED BY CITY FORCES, AT WHICH TIME A DEBfT OR CREDIT WILL kF t�
Construction drawing of proposed work required with permit applicationj
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.
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.
Ihaue read the above statements and understand thepermit requirements and thepink copy of thepermit will be
available on site at all times for inspection purposgs. 4
July 29, 1993
Signature: -Date:
(Contractor or Agen(f
CALL DIAL -A -DIG PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
APPROVED BY: L, 14 RIGHT OF WAY DEPOSIT
TIME AUTHORIZED: VOID AFTER 4 ITLA A— DAYS
SPECIAL CONDITIONS: )IJ /*--
COMMENTS:
DISRUPTION FEE/FUND III:
RESTORATION FEE:
PERMIT FEE. -
TO T AL FEE: 0 1�n—
RECEIPT FEE:
40
DATE:
A ISSUED BY:
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE
En&rrg. Div. 1991
0.
FIELD INSPECTION NOTES
Comments:
Diagram.:
CONTRACTOR CALLED FOR INSPECTION
Partial Work Inspection by P.W.:
Work Disapproved By:
FINAL APPROVAL BY:
(Fund,111 Route copy to Street Dept.),-
0
El YES
Date:
Date:
i
Addendum to City of Edmonds
Right of Way
Permit Application
Submitted by: Guyla Connors
Engineering Ai'de
Washington Natural Gas
521-5248
I Ltq ALV
W�,j c? --ft q 3z I -� 9
f
M,
QD CLYT*S
I
U,\
0�
WNG to window
-
Water main depth
unknown
ZJ-11
gas main
-w-
water
-9-
gas -
-ss-
sewer
-E)--
water hydrant
0
water valve
815 M=cr St. (P.O. Box 1869). ScAnk. WA 99111 (206) 622-6767
NOTICE:
-Nb---w'a rran- ty- OT -a-U(-,U1 �:d �_:Y
The inform ation'shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
Th,�e City of �Edm.onds does not warrant the
accuracy of anything set for.th on t hese
rnap(�_)- Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the inform . ation shown on
I ted to
tFe -map(s), including, but not I'mi
b shown. Such
the lociation of any sewer stu
sewer stubs may or may, not exist and may
or may not exist at the location sh ' own.
Neither the �lty of Edmo-nds nor its
. h. a- I. I b e 11 a. b.-Ife f o r t h e
e m p 11, o'y e e's o'r o ff i c e,r s "S i
information given' on this map(s), nor for
any one representation provided based
upon said map(s).
ANUICATION
The City of Edmonds STREET fLE for EASEMENT NO - --------------
SIDE SEWER PERMff ----- -------------
NEW CONSTRUCTION REPAIRS n LID NO.--.
------------- �:-ASMT.-NG-1
. .... ... .................................. --------- ------ ............... ..... CONTRACTOR - ----------------------------------
ft
0 R O\Nl�
.... . .......... ... ..... 1_'_I_.'_.l ....... PERMIT NO---: --------------------
JOB "DRESS ------------------------
--------------------------------- ------------ -DESC, RIPTIONT-LOT-
N� : --------------------- BLOCK
NAME OF ADDITION
__11111_1 By --- !�� ---- 6 -- ------ A
N_
7
1,1. j".t "W
P
4
7
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1 �A
OVID'A
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t;, y. �.` '�'' �; 110,Et4� N WV E R, P
MNIDS
A ERM
'WATER-SE.WiERDEPA\RTM,EN.T�',- -
4.
A
T,
0.
Call, .7.15-2525'�' for side sewfE,ins`pections 1IFFORE. co��eiint any-,, portion'.. of', "the,:constr I
r
�ectlon�will.' be pro'v'id�d,,withi�,i2i,-fio�'r.�,�.fterrequ'st.,�;'�N6,isai�.",f. or holida�' Inspeptioris
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Av nue, e t
-91522`--_84th'
ATION 1OPiCONSTRUTTION A ........................
............... ........ I ...................................
.................... ............................................... .
WA 00'._-of V4, L q'i, 4-1 ,B ek, 4
S 75", 6fthe,.
............................ ............... ........ ........ ... t..J.lp ............
7 ... ..... . ..........................................
M. iMah6r -N6
6C -9 P
......................................................................................... ....................... ...... .............................. .................................................. I .....................................
-T., 0 Y::�
_OW�NER AND/OX',1BUILDEWt ..... ......
........................................................ .. . ..................... .......................
:� ......... .........
.A�CONTRACTORIS�,,NAMEW ADDRE ............................ ............. .............. ......
ss.: .... ORMERf ......... ............. ............. ; ............................. .......................
74-
............. ................. ........ 7.,A9!.! .... .i�for-repa�r-,aridZor.leonnectlon,of,,a.sde. sewer to,Ah6��C�ty sanitar sewer,
r n'
C*.. . -1, . I %
6fEdM6nds o ini% c�s,.�
7 NTION,,I&,CA1LLED TOzTHE FOLLOWING
uA�,,prdlierty'may� obtain.,. a'perinIt',.to,'consi i6ct'-sewer 'Insldd7lprolpe��'Itne.. liceris4 Sld'� se�r�i�,c.o'niracto'rir�us't'�b��ieir��loyed,,�t.o,,c6nstrti6t
N't si 0
IiCstreef �,Doi not, Icover)any-*,Port to n-,lof ls�bwer,be fore � It MsObeeii'Tfii0i�ct d
WdTv-No�, rfor d in , bity.,eiiht-of-wayrequire's-�Ein.In* asion,,of.,Pj�ht-of-
�t�-A,ji,rqrk p�e me v Wa:y"PermlVobtalnable� -from thei� City: Englfteer�s: office;
O�taink ifllNnforr� smtlor�, regar,di.ng,iord . inance'jlJ6.*030,`j'and,' 'Regu'lations.
NOTE'No%:�3— I-
I I R at properfy,,l d n
,�NOTE,Ji6.1 ii?��6FI-side sewer'must. have'at least 30 4n�he�,,co�e'.�4' i-g-ovIz Tnc`6s;Tiai'de: �ropert�� ilne:�,-,�niln6uriii,rade �beri* s'J, "grade
sharperAhan. 'A, will be permitted.
to, original -c6ndItiori,.iv,Contract`6rs. &Ili be resl>onsibleIlfor� fail
OTE_ No. S'LLTrench�W,in street'rnust'bel*iLter settled*and`s�irface - 'of." stre6t *xestored' e,Id.ue, to Impr6per
'work,whIch may'�diivelop. within, one. year'of complet16h�.
hy- woric on,. th ifialrisZwerjor its-ap u to in-
N -�ItAs.'.Ul�wful 1o,��Iter..'or do, any-'qther.worli:�, th�n,is provided for', in,.,:th�'p�imlt�*. or' to,d6-a 0 il�en.�u� e�,eptl'
s�r0thii-pi P e,into, thb'wye.',
IT
Date , .
P O_ ........ ID' 't ...........
DISIA -PR VED a e
y
W.
.......... ................. ... ...............................................
,AIPPRPV,ED.
-4
'PlIeM k
ar S:� ........ .1'
�7 ............................................................................................................ . . ..... . ....................
........................... ........ ...................... ...................................................... ............................ ..............
......... ..... :A-.-.,-------,-,-� ................
Zonstruction iom.,7
BOTH e, rm., t. C o' p, i e's, MU S T 'Be 'Sigifed :By' Owri'e,�-�
df.,,Firm 1�ekoiIfi�i� i4idWT 'Requ' e�s't .,Foi'1Jhsp ded
:Z"
h
sh
e
........ . . .
(Owner o Firm' Performing' Consti�uctii3A-)
f:Contractin
n 'a:ccicirdance '�go'v'ernin'*g*'�'prdiiia'iic'��lof:"��'��� it� 'ofT V A,
W stoled"Jin h all ltdriionds"
D
Z:;
ated!,this.;.�
oweri.
-.-Chec IU1,g for:� A�Vateli
-1 T� E], T61efih6ne�';E]
u
T "IT,
0--
APPLICATION
for
The City of Edmonds SWE SEVVER PERMT
NEW CONSTRUCTION El REPAIRS C] EASEMENT No . ..........................
L )n )q2---(
O'W"I*TM ........................................ .................
ADDRESS............................................. ........
141,
.................. CONTRACTOR .. ------------ - ............................................................... ------------------ PERMIT No. -J22 .....
.................. LEGAL DESCRIPTION: LOT No . ...................... ----------------------- BLOCK No.. ...........................................
NAMEOF ADDITION ........ ............................................................
/,z 0 ,
its
4.
Approved:
DATE .........
----------- By
RECEiVED
WAY 7 1974